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PubMed2002

Balint after Lacan ... and after.

This paper examines Balint and Lacan's views about regression and symbolism, language, and transference. The author points out their similarities, their differences, and then proposes a synthesis through his approach of history, genealogy, trauma, and crisis. Freud's notions of masochism, of fixation (innate or phylogenetic) may thus be renewed, leading to the analyst's capacity to cope with deep regression and borderline (Balint) psychosis and perversion (Lacan) or to psychosomatics, including epilepsy.

Epilepsy↗
PubMed2002

Betwixt and between: ritual and the management of an ultrasound waiting list.

Hospital waiting lists are a feature of publicly funded health services that results when demand appears to exceed supply. While much has been written about hospital waiting lists, little is known about the dynamics of diagnostic waiting lists, or more generally why hospital waiting lists behave in perverse and often counter-intuitive ways. This paper attempts to address this gap by applying a recent development in critical systems thinking called boundary critique to understand how a particular ultrasound waiting list was managed. A new waiting list metaphor based on waiting lists as ritual forms is proposed.

Family Practice↗
PubMed2004

Ego constriction.

The terms ego constriction, ego inhibition, and ego restriction have not been clearly differentiated in their usage in the literature. In this paper a rationale for "ego constriction" as an entity distinct from both ego inhibition and ego restriction is given, despite its clear similarities to each. In a person with an ego inhibition, the ego inhibits a part of its own functioning because a particular function is linked to an unacceptable impulse. It is an internalized conflict. The person with an ego restriction, in contrast, avoids psychological pain triggered from an area in the outside world by restricting activity in that area. Like each of these problems but different, a person with an ego constriction first externalizes an internalized conflict associated with important functions or activities. Then, only through a series of particular obligatory steps can the person "overcome" the ego constriction--albeit temporarily. It is noted in this paper that the function of the specified obligatory steps is structurally parallel to the rigid obligatory behavior necessary for genital gratification in the perversions. As the recognition of this distinction arose in the course of an analysis of a mental health professional, something of the necessarily shared nature of analytic work is noticeable, shining through as the background for the work of this paper.

Conflict, Psychological↗
PubMed2004

[Etiology, diagnostic and therapeutic management of taste disorders].

Taste disorders can be subdivided in ageusia, which is the inability to detect any qualitative gustatory sensation and hypogeusia, which is a decreased sensitivity to all tastants. Dysgeusia or pargeusia is a distortion or perversion in the perception of a tastant in contrast to phantosmia, which is a perception of taste that occurs in the absence of a tastant. The site of lesion can usually be determined by history and clinical examination. History taking should always include the assessment of current and former medication. Conditions that interfere with access of a tastant to the taste bud are differentiated from conditions that either injure the receptor cell or damage the gustatory afferent nerves and the central pathways. Psychophysical taste evaluation includes identification of quality using sprays or taste strips and testing of intensity perception measuring threshold using the 3-drop technique. Moreover, measurement of taste in localized areas can be performed either with conventional chemicals or using an electrogustometer. Gustatory evoked potentials are not yet routinely elicited. Therapy has to be planned according to the cause of the disorder.

Diagnosis, Differential↗
PubMed2001

The consequences of political dictatorship for Russian science.

The Soviet communist regime had devastating consequences on the state of Russian twentieth century science. Country Communist leaders promoted Trofim Lysenko--an agronomist and keen supporter of the inheritance of acquired characters--and the Soviet government imposed a complete ban on the practice and teaching of genetics, which it condemned as a "bourgeois perversion". Russian science, which had previously flourished, rapidly declined, and many valuable scientific discoveries made by leading Russian geneticists were forgotten.

Communism↗
PubMed2002

Crowns and other extra-coronal restorations: occlusal considerations and articulator selection.

For many dentists, occlusion carries an air of mystique. It even seems sometimes that a perverse pleasure is derived in making the whole subject more complicated than it really is. As a clinician, you need to be able to decide what you expect from your proposed restoration, and to identify situations where you may need to alter the existing occlusal scheme. At a fundamental level, you also need to provide the laboratory with appropriate clinical records to ensure that when you fit them, adjustments to the expensively prepared restorations are minimal. This requires a sound understanding of the basics.

Centric Relation↗
PubMed2003

The efficacy and safety of the timolol/dorzolamide fixed combination vs latanoprost in exfoliation glaucoma.

PURPOSE: To evaluate the safety and efficacy of the timolol/dorzolamide fixed combination vs latanoprost 0.005% in exfoliation glaucoma patients. METHODS: We randomized in an observer-masked fashion 65 newly diagnosed exfoliation glaucoma patients to either the timolol/dorzolamide twice daily or latanoprost daily treatment for 2 months and then crossed these over to the other treatment. RESULTS: A total of fifty-four patients completed the study. After 2 months of chronic dosing, the morning intraocular pressure (IOP) (10:00) was reduced from a baseline of 31.2+/-6.5 mmHg to 18.1+/-3.0 with the fixed combination and to 18.9+/-4.1 mmHg with latanoprost (P = 0.21). Six patients were discontinued early from both treatment periods owing to inadequate IOP control and two others were discontinued from latanoprost treatment only. The fixed combination showed a significantly greater incidence of taste perversion (P < 0.001) and stinging upon instillation (P = 0.036), while latanoprost showed a trend for increased conjunctival injection (P = 0.056). However, five patients demonstrated either bradycardia or asthmatic symptoms with initiation of the fixed combination therapy. One patient on latanoprost complained of dizziness. Patient preference was generally given to latanoprost (63 vs 20.3%) mainly because of its once daily dosing (P < 0001). CONCLUSIONS: This study suggests that both latanoprost and the timolol/dorzolamide fixed combination are efficacious in the treatment of newly diagnosed exfoliation glaucoma.

Adrenergic beta-Antagonists↗
PubMed2000

A pot-pourri of plasmid paradoxes: effects of a second copy.

Bacterial plasmids are exemplary subjects for study, being conveniently isolated, dissected, reassembled, and introduced into various hosts. Their versatility and power make them eminently worthy of our attention. In what follows I consider some consequences of simply doubling the dosage of particular plasmid genes or of forming a plasmid dimer. These consequences can be perverse, paradoxical, or informative. They bear on questions of cell viability, copy number limitation, clonal homogeneity, check-point control, and the recovery of mutants. They have relevance to biotechnology, evolution and medicine. In reviewing these effects, my motivation is largely to share my enthusiasm for certain kinds of biological narratives, the nature of which is best left for the reader to discern.

Bacteria↗
PubMed2003

Bronchopulmonary afferent nerves.

Vagal afferent nerves are the primary communication pathways between the bronchopulmonary system and the central nervous system. Input from airway afferent nerves to the CNS is integrated in the brainstem and ultimately leads to sensations and various reflex outputs. Afferent nerves innervating the airways can be classified into various distinct phenotypes. However, there is no single classification scheme that takes all features, including conduction velocity, cell body diameter, ganglionic origin, and stimuli to which they respond (modality) into account. At present, bronchopulmonary afferent nerves are typically considered to belong to one of three general categories, namely C-fibres, rapidly adapting stretch receptors (RARs), and slowly adapting stretch receptors (SARs). As our understanding of bronchopulmonary afferent nerves continues to deepen, we are likely to see more sophisticated classification schemes emerge. It is clear that the function of afferent fibres can be substantively influenced by airway inflammation and remodelling. The perturbations and perversions of afferent nerve function that occur during these states almost certainly contributes to many of the signs and symptoms of inflammatory airway disease. A more lucid characterization of bronchopulmonary afferent nerves, and a better understanding of the mechanisms by which these nerves influence pulmonary physiology during health and disease anticipates future research.

Afferent Pathways↗
PubMedDate not supplied

The drug budget silo mentality: the French case.

OBJECTIVES: The objectives of this study were to give a review of the complex system of budgetary constraints to which the French health-care system has been committed since 1996 and to evaluate the consequences on drug policy and on efficient use of pharmaceuticals. METHODS: Literature review, legal texts analysis, and interviews with policy makers and companies managers were performed. RESULTS: The budgeting process applies to health insurance expenditures as a whole, but also to each of its components, especially hospital expenditures and pharmaceutical expenditures. Because the targets are set by reference to the gross domestic product growth while health-care expenditure is driven by demographic factors, technology, and expectations, there is inevitably a gap between the top-down budget and the bottom-up cost pressures. The pharmaceutical budget is achieved by a payback system that "taxes" companies when the growth target for aggregated pharmaceutical expenditure is exceeded. The government is now seeking to set more realistic overall global budgets and for pharmaceuticals in particular. It is also encouraging generics, delisting from reimbursement drugs of limited therapeutic value, making a special budget for new drug purchases available to hospitals, and replacing price control for innovative products with a more selective process of intervention in the expectation that companies will seek to price at a European level. CONCLUSION: The budgetary system produces a perverse incentive for companies to heavily promote new products in the knowledge that the budget overruns will be spread across all companies, as well as lacking incentives for using pharmaceuticals efficiently. Although the new drug policy will increase the efficiency of pharmaceutical expenditure, it is not apparent that they change the poor incentives facing doctors, hospitals, and insurers to use pharmaceuticals cost-effectively to achieve the optimal gain in health care. They will not remove "silo budgeting" at the national level for pharmaceuticals, which inhibits the efficient substitution of drug therapy for hospital treatment.

Budgets↗
PubMed2002

Talking about money: how primary care physicians respond to a patient's question about financial incentives.

Patients sometimes express concern about the influence of "perverse" financial incentives on their care. We recruited a convenience sample of 101 primary care physicians and obtained information on their compensation. Then we audiotaped them as they role-played a response to a videotaped mock patient who asked them how they were paid and how their method of compensation affected clinical decisions. Overall, 36% of the physicians did not give enough information in their role-play response to allow an independent determination of how they were paid. Adopting a broad spectrum of attitudes and approaches, nearly every physician avoided discussing the role of incentives and stressed instead that he or she could be trusted under any circumstance.

Adult↗
PubMed2002

New glaucoma medications in the geriatric population: efficacy and safety.

Glaucoma can be considered a disease of the aging eye. Most medications used to treat glaucoma are in topical eyedrop form and may cause numerous untoward systemic effects in older persons. In recent years, several new ocular hypotensive medications have become available. These medications are being used more commonly because there is a growing trend by ophthalmologists to aggressively lower intraocular pressure. Therefore, geriatricians require a comprehensive knowledge of medications used to treat glaucoma, in addition to an understanding of their mechanism of action profiles of untoward effects and possible interactions with other diseases or medications. Therefore, we performed a review of the medications recently introduced into clinical practice. We selected drugs approved by the U.S. Food and Drug Administration between 1996 and September 2001. The safety profiles of these agents and their untoward side effects were reviewed by class: topical carbonic anhydrase inhibitors (brinzolamide: ocular tolerance, taste perversion), beta-adrenoceptor antagonists (timolol: bradycardia and bronchospasm), alpha-adrenergic agonists (brimonidine: oral dryness, headache, and fatigue), and prostaglandin analogs (latanoprost, bimatoprost, travoprost, and unoprostone isopropyl: ocular hyperemia, iris color changes). The function of this review is to make geriatricians more aware of the efficacy and untoward effects of medications recently introduced into clinical practice. We recommend that geriatricians perform a medication review on all medications their patients use, including eye drops.

Adrenergic Agonists↗
PubMed2005

[The Lyssenko affair: the eclipse of reason].

Trofim Lysenko was a Ukrainian peasant whose malign influence dominated biology in the Soviet Union and its imperium through most of Stalin's reign. Lysenko owed his ascendancy to repeated promises that he would rescue Soviet agriculture from the catastrophic state into which it had sunk, following Stalin's disastrous policy of collectivisation of the farms, and a succession of bad harvests. He claimed to have devised methods of imposing desirable hereditary characteristics on plants, and even of converting one species into another at will. He noisily denounced modern genetics as a bourgeois imposture, a view that resonated well with Marxist doctrine. As Lysenko's power grew he was able to smother scientific debate, and to crush all opposition through the arrest and often execution of many leading scientists. Lysenko's preposterous theories became the accepted orthodoxy in the academies and universities of Eastern Europe, and were greeted with enthusiasm by many Communist intellectuals in the West, not least in France. The Lysenko phenomenon is the most extreme, but by no means the only example of the perversion of science by ideology, often with the acquiescence of the scientific community. Nor can we be confident that nothing of the kind could happen today.

Biology↗
PubMed2001

The efficacy and safety of two oral moxifloxacin regimens compared to oral clarithromycin in the treatment of community-acquired pneumonia.

An international multi-centre, randomized, prospective, double-blind study compared oral moxifloxacin (200 mg or 400 mg once daily for 10 days) with oral clarithromycin (500 mg, twice daily for 10 days) in the treatment of community-acquired pneumonia (CAP). The clinical success rate in the evaluable population at the primary efficacy assessment, 3-5 days after the end of study treatment, was 93.9% in patients treated with 200 mg moxifloxacin; 94.4%, with 400 mg moxifloxacin; and 94.3%, with clarithromycin. Clinical success rates were maintained at follow-up, 21-28 days after the end of treatment: 90.7% (200 mg moxifloxacin), 92.8% (400 mg moxifloxacin) and 92.2% (clarithromycin). The 95% confidence intervals indicated that all three treatment regimens were equally effective in treating CAP. At follow-up, the 400 mg moxifloxacin dose had a slightly higher observed cure rate than the 200 mg moxifloxacin dose, but this was not statistically significant. The most frequently isolated pathogens were Streptococcus pneumoniae (42%), Haemophilus influenzae (19%), Haemophilus parainfluenzae (10%), Moraxella catarrhalis (6%), Klebsiella pneumoniae (5%) and Staphylococcus aureus (4%). The bacteriological success rate (eradication and presumed eradication) was 72.5% (29/40) for 200 mg moxifloxacin, 78.7% (37/47) for 400 mg moxifloxacin and 70.7% (29/41) for clarithromycin. The adverse event profile was comparable between the three treatment groups. Most adverse events, possibly or probably related to the study drug, were generally mild or moderate in severity and mostly related to the digestive system: diarrhoea, nausea and abdominal pain in 200 mg moxifloxacin patients; diarrhoea, liver function abnormalities and nausea in 400 mg moxifloxacin patients and liver function abnormalities, diarrhoea, nausea and taste perversion in clarithromycin patients. Study drugs were discontinued because of adverse events in 7/229 (3%) patients treated with 200 mg moxifloxacin, 11/224 (5%) with moxifloxacin 400 mg and 11/222 (5%) with clarithromycin. In all assessments, moxifloxacin was at least as effective clinically, and as well tolerated as clarithromycin in the treatment of CAP. Bacteriological success rates in moxifloxacin-treated patients were greater than those of clarithromycin. Moxifloxacin, given once daily, is free of many drug-drug interactions and requires no dosage adjustments in most renal hepatic deficient patients.

Administration, Oral↗
PubMed2002

[Psyche - soma - delinquency. Empirical and clinical datas of psychosomatic disturbed delinquents: discussion and survey].

Psychosomatic disorders of delinquents are current clinical phenomena, but they are rarely examined and discussed. The contribution presents empirical-statistical results of a field-study with n = 202 unselected forensic patients in disciplinary measures. Psychosomatic diseases have been diagnosed in n = 48 cases. The interpretation of multi- and bivariate statistics hints at an iatrogene influence on detainees: Their psychosomatic disorders can be described as forms of autoplastic defence which must be considered in the context of specific basic personality structures and corresponding disturbed ego functions (control of impulses and anxiety, competence of communication and sublimation). This psychosomatic structure can be differentiated from perverse structured personalities. Characterised as an autoplastic and auto-aggressive reaction, the psychosomatic symptom can be distinguished from alloplastic and hetero-aggressive acting. Nevertheless these psychodynamics seem to be forensic-psychological predicators for anticipated delinquent relapses.

Adolescent↗
PubMed1999

[Sexual homicide--a data collection from psychiatric records].

After an analysis of the concerning literature we conceptualized a questionnaire with 124 items, which describes the most common characteristics of sexual murderers. The relevance of these characteristics was examined on the basis of psychiatric records. The hypothesis was, that persons who murdered more than once show these characteristics more evidently than single murderers. We compared 20 psychiatric records about single sexual murderers with those about 10 repetitive sexual murderers. Planned offenses, chronic isolation, narcism and tendency to perversity were found more often in persons that murdered more than once. Especially the psychosocial factors were found less often than in the angloamerican literature. More pronounced were the differences between a group of sadistic murderers compared with nonsadistic murderers, using criteria for sadism extracted from Kafft-Ebings first description (1892), Schorsch and Becker (1977), MacCulloch et al. (1983) and Ressler et al. (1988). A case example illustrates the importance of an elaborated concept of sadism and its relation to personality disorder.

Adult↗
PubMed1992

[Cumulative trauma caused by continued sadistic child abuse in a patient with chronic artefact disease].

A 37-year old female with borderline personality disorder, who had experienced the cumulative trauma of a history of sadistic child abuse by her mother, developed the symptomatology of chronic factitious illness after an operation necessitated by an accident injury. Relationships between chronic factitious disease and obsession, addiction, perversion and suicidal behaviour are discussed against the background of a literature review.

Adult↗
PubMed1996

A randomized trial of clarithromycin as prophylaxis against disseminated Mycobacterium avium complex infection in patients with advanced acquired immunodeficiency syndrome.

BACKGROUND: Disseminated infection with Mycobacterium avium complex is the most common opportunistic infection in patients with advanced stages of the acquired immunodeficiency syndrome (AIDS). We studied the efficacy and safety of prophylactic treatment with clarithromycin, a macrolide antibiotic. METHODS: We conducted a randomized, placebo-controlled, double-blind study of clarithromycin in patients with AIDS in the United States and Europe. Entry criteria included blood cultures that were negative for M. avium complex, a Karnofsky performance score of 50 or higher, a CD4 cell count of 100 or less per cubic millimeter, and a life expectancy of at least six months. RESULTS: After the first interim analysis, the study was stopped. M. avium complex infection developed in 19 of the 333 patients (6 percent) assigned to clarithromycin and in 53 of the 334 (16 percent) assigned to placebo (adjusted hazard ratio, 0.31; 95 percent confidence interval, 0.18 to 0.53; P<0.001). During the follow-up period of about 10 months, 32 percent of the patients in the clarithromycin group died and 41 percent of those in the placebo group died (hazard ratio, 0.75; P=0.026). In the clarithromycin group, isolates from 11 of the 19 patients with M. avium complex infection were resistant to clarithromycin. Prophylaxis with clarithromycin was associated with an increased incidence of taste perversion (11 percent in the clarithromycin group vs. 2 percent in the placebo group, P<0.001) and rectal disorders (8 percent vs. 3 percent, P = 0.007); however, the frequency of more severe adverse events was similar in the two groups (7 percent and 6 percent, respectively). CONCLUSIONS: In patients with advanced AIDS, the prophylactic administration of clarithromycin is well tolerated, prevents M. avium complex infection, and reduces mortality.

AIDS-Related Opportunistic Infections↗