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PubMed1999

Self-envy and intrapsychic interpretation.

Self-envy is described as the consequence of an early split between different part objects which form the structure of the oedipus complex. This takes place between an excluded destructive child part and another part usually modeled on a harmonic parental couple or on a creative and successful adult. The former will attack, paralyze, or destroy the latter, out of envy within the self. There are three main advantages in using an intrapsychic interpretation: (a) avoiding possible transference collusion in paranoid or perverse borderline structures; (b) eliminating possible persecutory anxiety from superego part objects projected into the analyst; and (c) putting the conflict in the right place, inasmuch as transference is a projection of internal conflicts. Clinical material is presented.

Adult↗
PubMed1999

Some implications of the analyst feeling disturbed while working with disturbed patients.

The analyst's experience of patients' disturbances is explored as an aspect of analytic technique. A number of premises are examined. First, it is expected that the analyst is committed to tolerating and understanding disturbances evoked in him by his patients' personalities and their disturbances. Second, that he regards the disturbances evoked in him as a form of manifest content to be understood in the usual method of association. Third, countertransference attitudes may propel the analyst toward rapid formulaic conceptions of his patients' disturbances or to considerations of diagnostic designations carrying serious, if not pejorative implications, such as borderline, narcissistic, perverse, or sociopathic. Such attitudes may also underlie the urge to consider psychotropic medications in response to the patients' disturbances. A selected review of the literature as well as illustrative work with disturbing patients are presented in support of the paper's premises.

Adult↗
PubMed2004

Father hunger and narcissistic deformation.

The author advances the hypothesis that paternal availability and the relationship between the mother and father are crucial components of evolving character structure in children. He proposes that a kind of narcissistic pathology featuring perverse sexuality may eventuate in the absence of paternal availability and in the presence of a disordered relationship between the parents. He also suggests that the ways in which aggression is or is not modulated and organized are crucial components of this evolving disorder, and that boys are more susceptible to its full manifestation and expression than are girls.

Adolescent↗
PubMed2001

Safety assessment of gadobenate dimeglumine (MultiHance): extended clinical experience from phase I studies to post-marketing surveillance.

Clinical trials completed by September 2000 on gadobenate dimeglumine (Gd-BOPTA; MultiHance) included 2540 adult and pediatric subjects that were administered this agent. For adult patient volunteers, the overall incidence of adverse events (AEs) was 19.8%, although marked study- and indication-related differences were apparent. Events potentially related to Gd-BOPTA administration were reported for 15.1% of adult patients. The vast majority of AEs were non-serious, mild, transient, and self-resolving. Headache, injection site reaction, nausea, taste perversion, and vasodilation were the most common AEs, reported with a frequency of between 1.0% and 2.6%. Serious AEs potentially related to Gd-BOPTA were reported for five (0.2%) patients overall. Controlled studies revealed no differences between Gd-BOPTA and other gadolinium chelates or placebo in the incidence and type of AEs. Similarly, no differences with respect to adult patients and/or comparator were noted in studies on pediatric subjects and subjects with renal or liver insufficiency. Post-marketing surveillance of approximately 100000 doses revealed an overall AE incidence of < 0.03% with serious AEs reported for < 0.005% of patients.

Adolescent↗
PubMedDate not supplied

Safety of gadoteridol injection: U.S. clinical trial experience.

As part of the clinical evaluation of gadoteridol injection, intravenous doses ranging from 0.05 to 0.3 mmol/kg were administered to 1,709 patients and volunteers. Safety monitoring included pre- and postdose physical examinations, vital signs, and clinical laboratory values. Adverse event recording included occurrence, duration, severity, relationship to injection, and clinical importance. No clinically important changes in physical examination results, electrocardiograms, or vital signs were attributed to gadoteridol injection except for one case of hypotension. Four clinically important changes in laboratory values possibly or definitely related to the contrast agent were noted in two patients (0.1%). Adverse events were recorded in 118 subjects (6.9%), including nausea in 24 subjects (1.4%) and taste perversion in 22 subjects (1.3%). All other adverse events occurred with a frequency of less than 1%. Adverse events related to contrast agent administration occurred in 79 subjects (4.6%). Gadoteridol injection demonstrated excellent clinical safety and patient tolerance at various doses and injection rates.

Adult↗
PubMed2000

Effects of a monetary incentive on primary care prescribing in Ireland: changes in prescribing patterns in one health board 1990-1995.

BACKGROUND: In an attempt to curb the rapidly rising costs of primary care prescribing in Ireland, the government introduced a financial incentive scheme in 1993, to encourage general practitioners to restrain their prescribing. PURPOSE: To investigate the effects of a financial incentive scheme on GP prescribing in Ireland on prescribing costs and volume, and on some specific therapeutic areas. METHODS: Prescribing for 3 years before (1990-1992) and 3 years (1993-1995) after the introduction of incentives, based on a defined cohort of 233 general practitioners in the area of one health board. GPs were divided into tertiles based on their performance against their prescribing budgets into 'savers' (generally underspent and received incentive payments), modest overspenders and large overspenders. RESULTS: Savers were always lower cost prescribers than the other groups. They contained their rate and costs of prescribing in contrast to the other groups, e.g. percentage rise in prescribing costs in the year after the introduction of the scheme -7.9%, +1.2% and +7.3% respectively, (P < 0.05) for savers, modest overspenders and large overspenders respectively. This effect was short lived however and was gone by the third year of the study. CONCLUSIONS: The financial incentives had a marked effect on prescribing volume and cost on some practices who could achieve targets and hence incentive payments. The incentives had little effect on high spending practices. Such incentive schemes need careful evaluation if they are not to become perverse to the good health of patients.

Drug Utilization↗
PubMed1998

Microbial corruption of the chemokine system: an expanding paradigm.

The chemokine signaling system includes more than 40 secreted pro-inflammatory peptides and 12 G protein-coupled receptors that together orchestrate specific leukocyte trafficking in the mammalian immune system, ideally for anti- microbial defense and tissue repair processes. Paradoxically and perversely, some chemokines and chemokine receptors are also promicrobial factors and facilitate infectious disease, the result of either exploitation or subversion by specific microbes. Two modes of exploitation are known: usage of cellular chemokine receptors for cell entry by intracellular pathogens, including HIV, and usage of virally-encoded chemokine receptors for host cell proliferation. Likewise, two modes of subversion are known: virally-encoded chemokine antagonists and virally-encoded chemokine scavengers. Understanding how microbes turn the tables on the chemokine system may point to new methods to prevent or treat infection, or, more generally, to treat inappropriate chemokine-mediated inflammation.

Animals↗
PubMed1995

Immunosuppression by a noncytolytic virus via T cell mediated immunopathology. Implication for AIDS.

HIV is basically a non- or poorly cytocidal virus. Therefore, HIV infections in humans represent an apparent perversity in the balance between the host immune system and infectious agent: This noncytopathic virus infects macrophages, antigen presenting cells, helper T cells and other host cells which are then destroyed by the CD8+ T cell immune response. Thus, HIV infects some of the key cells involved in immune reactions and therefore induces the immune system to destroy itself and thereby enables the virus to persist. Accordingly, immunosuppression is not a cause of HIV cytopathogenicity but a consequence of conventional T cell mediated immunopathology that destroys macrophages antigen presenting cells, T helper cells and facilitates infection by trivial intracellular parasites which eventually cause fatal disease. This immunopathological view of AIDS is testable and, if correct, impinges on rationales for AIDS prevention and treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1975

[Medical opinions on fatal auto-erotic accidents for insurance purposes (author's transl)].

The problematic nature of medico-legal opinions on fatal auto-erotic accidents made for private accident insurance companies is outlined in a survey based on our own records. Taking the "General Insuranc Terms for Accident Insurance" (AUB) into consideration, guidelines for the forming of such opinions are given. One is warned not to form summary opinions. Decisive is the insured's state of conciousness when the accident was triggered. Only in exceptional cases can an insurance covered accident be rejected because of a body injury inflicted by the insured on himself (see article). These actions do not usually result in external injury to the body. Experience proves that "ideal conditions" for forming an opinion are rarely given. Also, the nature of the death situation is such that often the corpse is discovered only days after death. From the outset, forming a medical opinion is beset with varying degrees of difficulty depending upon which category of auto-erotic activities the accident falls into: 1. direct stimulation of the erotic regions, 2. stimulation of sexual centers in the central nervous system, 3. the creation of fear and anguish in the context of masochistic perversion. According the presently valid insurance terms (AUB), cases of auto-erotic electrocution are to be regarded as covered. A disturbance of consciousness--with the exception of such disturbances following the influence of alcohol, medicines or narcotics--cannot be assumed for the moment in which the accident was triggered. At this moment body "integrity" was also intact. Accidents through strangulation, respectively asphyxiation (plastic bags etc.), usually occur during a disturbance of consciousness of the victim. This disturbance is the result of cerebral hypoxia, that is a result of strangulation, respectively external respiratory obstruction. The forming of a medical opinion for insurance purposes on auto-erotic accidents with clearly recognizable masochistic tendency is particularly difficult. A medical decision is only possible when an exact examination and description of the scene of the accident are available. In these instances, mechanical devices rigged by the victim often do not permit with sufficient probability to exclude the possibility of an accident without disturbance of consciousness on the part of the insured.

Asphyxia↗
PubMed1992

Sexuality in traditional China: its relationship to child abuse.

The sexual and marital history of China for 3000 year is reviewed, indicating a general open humanistic attitude about sex, with little perversion, sado-masochism, or denigration of sexuality. Foot fetishism (particularly foot binding) has been extensive in the past, but less so since World War I. Respect for women and their sexual rights and importance has been related to the low rate of child abuse. Currently, restrictions on sexual freedom and psychological injury to children is increasing in the urban areas (20% of the population) with resultant increase in infanticide particularly of little girls.

Adolescent↗
PubMed1980

Prepubertal vaccination of mice against experimental infection of the genital tract with type 2 herpes simplex virus.

Pre-pubertal immunisation of mice with a formalin-inactivated type 1 and 2 herpes simplex virus vaccine conferred a level of life-long protection against primary type 2 genital infection. Protection levels were better with type 1 vaccine and strikingly influenced by vaccine dosage where a one-hundred-fold reduction from the standard vaccine dosage diminished protection to insignificant levels. Vaccine efficacy was not significantly affected by the method of virus inactivation, the number of immunisations or the age of the mouse at immunisation. Vaccination conferred better protection than previous type 2 genital infection; this may be a consequence of a higher antigenic dose, more acceptable antigenic presentation or to a perversion of the immune response in a latently infected animal to homologous virus challenge.

Animals↗
PubMed1976

Voyeurism: a review of literature.

The most striking thing about the literature on voyeurism is the relative lack of material in print. In the present work, the author was able to find only 15 articles and no books that deal specifically with voyeurism. Of the 57 references compiled for this review, not one involves an experimental manipulation of variables. An attempt is made to review as many aspects of voyeurism as possible, giving illustrative case material whenever available. The areas of troilism and coprophilia are covered in some detail to establish to what degree they belong to the deviation of voyeurism. Theory of perversion has centered around the psychoanalytic and behavioral schools because of the lack of material from other approaches. The voyeur is found to be a relatively young man of low socioeconomic status, who sociosexually is said to be "not retarded but a late bloomer." He is prone to minor crimes and not major offenses. It is suggested that moyeurism be considered a deviation from normal sexual behavior and that deviations are not in and of themselves criminal behavior. At present, punishment is genera-ly mild but highly variable and unpredictable. Treatment is usually analysis or group therapy, but other forms of therapy such as aversion and avoidance conditioning are being attempted with increasing success.

Behavior Therapy↗
PubMed1996

The role of socialization in male anorexia nervosa: two cases.

Social isolation, competitiveness and self-defeating masochism are the major themes in male and female Anorexia Nervosa. A relationship is seen between Anorexia Nervosa and Perversions, where there is a preconscious reenactment of traumatic situations. This dynamic of competition and masochism is described in two cases of male anorexia and seen as part of many other cases.

Adult↗
PubMedDate not supplied

Randomized comparison of once-daily ceftibuten and twice-daily clarithromycin in the treatment of acute exacerbation of chronic bronchitis.

In an evaluator-blind, parallel-group, multicenter study, the efficacy and tolerability of ceftibuten 400 mg capsules once daily were compared with clarithromycin 500 mg twice daily for 7-14 days in the treatment of 309 patients with acute exacerbation of chronic bronchitis (AECB). Clinical (n = 262) and microbiological (n = 71) assessments were conducted before treatment, during days 4-6 of treatment, and at 0-6 and 7-21 days after treatment. Clinical efficacy success rates (cure/improvement) at the end of treatment (0-6 days) were 91.0% for ceftibuten and 93.0% for clarithromycin. In the intent-to-treat population, the overall clinical assessment showed a success rate of 77.6% (121/156) in the ceftibuten group and 78.4% (120/153) in the clarithromycin group (95% confidence interval, -10.8 to +9.0%). One patient in each of the ceftibuten and clarithromycin groups had a microbiological relapse and became a treatment failure. The overall success rate was 84.3% for ceftibuten and 86.7% for clarithromycin (C.I. -11.7%, +6.9). Overall eradication of the target pathogens (Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae) was 84.8% for ceftibuten and 89.5% for clarithromycin. Eradication rates for ceftibuten at 0-6 days post treatment were 95.2% (H. influenzae), 87.5% (M. catarrhalis), and 100% (S. pneumoniae), compared with 85.7%, 100% and 100%, respectively, for clarithromycin. Significantly fewer patients in the ceftibuten group experienced treatment-related adverse events than in the clarithromycin group (5.3 vs 21.9%; p < 0.001). This difference was due to a large number of patients in the clarithromycin group reporting taste perversion (12.6%) or gastrointestinal adverse events (9.9%). Given its tolerability and efficacy profiles, and the advantage of once-daily administration, ceftibuten provides a rational alternative for the treatment of AECB.

Acute Disease↗
PubMed2001

Prevention: a psychoanalytic viewpoint.

Psychoanalysis teaches that a symptom should not be regarded as an accident occurring during the development of one individual or another, but basically the effect of his or her "predisposition" to a disorder before any interaction with the environment takes place. Prevention seems to assume the form of a scientific and technical expedient aimed at the optimisation of life and the repression of pain. If it is not possible to prevent dreams, slips of the tongue and other parapraxes, in the same way we cannot prevent the other inventions of the unconscious from which a psychic illness, such as anorexia, bulimia, distortion of or obsession with the body image etc., emerges. The ethics of the unconscious subject does not surrender to the perverse mirages of illness, nor, however, to the normalising appearances of health. It simply claims the right not to be distorted, to be understood, but not made uniform. What could be the form of prevention that those who have chosen to work with the psyche are destined for?

Adolescent↗
PubMed1997

Worldwide clinical safety assessment of gadoteridol injection: an update.

Gadoteridol injection is a low molecular weight chelate complex of gadolinium (III) which is useful as a contrast agent for magnetic resonance imaging. A total of 2481 adult and pediatric subjects were studied with gadoteridol at doses from 0.025 to 0.3 mmol/kg in phase I-IIIb clinical trials in Europe and the United States. The study population had a mean age of 49 years, and included 119 patients under 18 years of age and 747 patients over 60 years of age. After 2656 administered injections of gadoteridol a total of 233 adverse events were recorded in 176 exposures, an incidence rate of 6.6 % irrespective of relationship to drug administration. The most frequently reported adverse events were nausea (1.5 %), taste perversion (0.9 %), and headache (0.6 %). All other adverse events occurred with an incidence of 0.5 % or less. This report confirms the excellent safety profile of gadoteridol in healthy subjects and patients with a variety of known or suspected pathologies.

Adolescent↗
PubMed2000

[Risk analysis in surgery. A method of increasing effectiveness and efficiency: a neglected method].

UNLABELLED: The estimation of risk should be an essential prerequisite for the choice of the correct surgical therapy and also for assessment of the quality of surgical care. The fact is, that many people talk about "risk" but have the wrong idea about this remarkable concept. Too often minutely detailed enumeration of negative events (complications) is mistaken for risk. Risk is the probability that something negative will happen. It is also a fact that risk is always regarded as negative. Another fact is that risk in medicine mostly--or only--describes morbidity and mortality. Even though this is correct and important, it is not enough! Today, risk must include the probability of a therapy option not working, or even the risk of perversion of the therapy intention! Determination of a risk factor is time-consuming. It is a typical example for clinical research. Proceeding stepwise is may-be helpful. I propose seven steps: Step 1 demands that the circumstances, facts, variables like negative events, ability to cooperate, mortality, severeness of sickness, social circumstances, etc. be clarified. Step 2 means collecting and compiling these circumstances assumed to be clinically relevant All sources of information are good, but better is a prospective data collection. Step 3 defines the individual surgical situation, and from this the different circumstances, which could be risk factors. This is regarded as development of hypothesis. In step 4 the probability is determined with which a special condition or a group of circumstances could become a clinically relevant risk factor. This is done in the clinical experiment with the aid of the mathematical models known today, but also with the experience and intuition of the surgeon. In step 5 the individual clinical situation can be determined according to the significance of the risk factors (ranking). Step 6 is intended for handling the known risk factors. How to proceed with the risk factor within the decision finding process at the surgical intervention? Step 7 is the all decisive step. It should supply the unequivocal information as to whether risk analysis in toto will bring any benefit for surgery--even more importantly, for the individual patient at a certain time. There is evidence (external) that the correct handling of the risk analysis brings a significant effect or benefit in surgery, but it still has its limits. It is a fact that risk analysis with the methods used nowadays has an advantage for group analyses, but ist limits are tight for the individual patient. This is especially true for the scores established and used for this. With the risk analysis the decisive risk factors can be recognized and determined and put into order according to their different effect. Whether this fact has a benefit in surgery or even for the individual patient is still without unknown. There is evidence that comparing the quality of surgical treatments in individual clinics without risk analysis is almost naive! This is the case for which risk analysis has proved to be the best! Risk analysis is so far unable to predict the risk of a surgical therapy for an individual patient with sufficient certainty. With a value of 70% certainty, risk analysis is as good--or as bad--as the experienced surgeon for this decisive question. CONCLUSION: Risk analysis has not yet given enough proof of its effectiveness. The method is time consuming and up to now only successful for assessment of groups. Comparison of surgical quality in different clinics is naive without risk analysis. Here its importance has been proved. The risk analyses practised so far have no chance when dealing with the individual patient. It can be recognized that the surgeon is a risk factor. However, in the complex system of different circumstances and mechanisms of a surgical care, he is only one factor even though an important one. Risk analysis is an aspect of clinical research and demands more consideration.

Age Factors↗
PubMed1986

Safety of encainide for the treatment of ventricular arrhythmias.

A data base of 1,245 patients treated for ventricular arrhythmias, most of whom had serious cardiac disease, was reviewed. Only 2.9% of these patients had benign ventricular arrhythmias without structural heart disease. The overall incidence of proarrhythmia in this population was 9.2% (115/1,245), but was as frequent as 16% in patients with a history of cardiomyopathy. The proarrhythmic form was new sustained ventricular tachycardia in 22 patients (1.8%). Only 2 of 71 patients (2.8%) with primary arrhythmia had a proarrhythmic event. The incidence has decreased markedly over the past years as reduced doses and gradual titration have been used. There were 137 deaths in the data base of which 82 were sudden, all in patients with advanced (79) or moderately severe (3) cardiac disease. High initial doses, prior myocardial infarction and congestive heart failure (CHF) were positively associated with sudden cardiac death. There were no deaths among the 71 patients with benign arrhythmias. Death rates were related to the severity of the arrhythmia being treated. Comparisons with published survival curves indicated modest improvement; in no case was survival decreased. Invasive and noninvasive measures of left ventricular function indicated no adverse hemodynamic effects. There was only 1 case of new and 3 cases of worsened CHF probably related to encainide. Only 5 patients discontinued for CHF or related signs and symptoms. The most frequent drug-related noncardiac adverse reactions were dizziness (26%), abnormal or blurred vision (19%), QRS interval prolongation (5%), taste perversion (4%) and tremor (3%). In conclusion, the use of reduced doses and gradual titration of encainide has markedly decreased the incidence of proarrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗