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Models of reflexive recognition. Wallon's Origines du caractère and Lacan's "Mirror stage".

Jacques Lacan drew on the empirical research of the psychologist Henri Wallon both in his 1938 theory of the mirror stage ("the intrusion complex") and in subsequent formulations. Yet, like Lacan's famous "return" to Freud, his recourse to Wallon is revisionary and, at times, antithetical. This essay examines the disparities between Wallon's and Lacan's work on the mirror experience, focusing especially on the status of the mirror and the identity of the reflected image. An analysis of these differences helps to clarify the meaning of the child's specular activity--"an ontological structure of the human world"--in Lacan's later view and the implications of reflexive recognition for his conception of parental agency.

Ego↗

[Mirror movement due to the medial frontal lobe lesion].

We reported a case with acquired mirror movement in upper limbs due to the lesion of right medial frontal lobe including supplementary motor area, and also discussed a possible mechanism underlying it. A 59-year-old right-handed woman developed left hemiparesis caused by cerebral hemorrhage in the right frontoparietal lobe, on April 5, 1981. She had right hemiparesis and right hemianopsia due to cerebral hemorrhage in the left parieto-occipital lobe, 13 days later. As the patient was recovering from paresis, mirror movement appeared on upper limbs. The features of the mirror movement of this case are summarized as follows: (1) it appeared when using both proximal and distal region of upper limbs; (2) it appeared on left upper limb when the patient intended to move right upper limb or on right upper limb when intended to move left upper limb, while it appeared predominantly in the former; and (3) it was more remarkably found in habitual movement using gesture and pantomimic movement for the use of objects, and it was found in lower degree when actual object was used or when the patient tried to imitate the gesture of the examiner. The lesions in MRI were found in medial region of right frontal lobe (supplementary motor area, medial region of motor area, and cingulate gyrus), right medial parietal lobe, posterior region of right occipital lobe, and medial regions of left parietal and occipital lobes. There was no apparent abnormality in corpus callosum.(ABSTRACT TRUNCATED AT 250 WORDS)

Arm↗

The endo-mirror, a new instrument for ophthalmic surgery requiring visualization of the ciliary sulcus.

Safely suturing a posterior chamber intraocular lens (PC-IOL) to the ciliary sulcus requires a means of visualizing the ciliary sulcus, since it cannot be viewed directly with the operating microscope. We, therefore, created several trial instruments consisting of a mirror with a built-in light source, which we call an endo-mirror, designed for observing the area behind the iris. Using these instruments, we were able satisfactorily to view the ciliary sulcus and suture a PC-IOL to it, first in a number of animal eyes, and then, using an endo-mirror incorporating the best features of the trial versions, in actual clinical cases.

Animals↗

High cervical split cord malformation and neurenteric cyst associated with congenital mirror movements: case report.

A 48-year-old woman with congenital mirror movements of the hands presented with a high cervical split spinal cord malformation and a ventrally located neurenteric cyst. The clinical, radiological, and surgical features are presented. A brief discussion of the literature and embryology pertaining to split cord malformations and mirror movements is included. To our knowledge, this is the first case of radiographically and surgically proven split cord malformation associated with either mirror movements or a neurenteric cyst presenting in an adult.

Dominance, Cerebral↗

Use of a mirror needle holder with transsclerally sutured posterior chamber intraocular lenses.

A mirror needle holder has been designed to facilitate the passage of a needle through the ciliary sulcus during transscleral fixation of posterior chamber (PC) intraocular lens (IOLs). Two human postmortem eyes were used to demonstrate the efficacy of this mirror used as the needle holder. This method was compared with the current method of passing sutures without view of the ciliary sulcus. The mirror needle holder demonstrated precise passage of the needle into the ciliary sulcus by direct visualization of the ciliary processes and sulcus. This method may avoid the complications associated with transsclerally sutured PC IOLs during penetrating keratoplasty and secondary IOL placement.

Ciliary Body↗

[Correction of left handedness worsened mirror writing in a girl with spastic diplegia].

We experienced a 4-year-11-month old girl with right side dominant spastic diplegia caused by preterm birth and neonatal asphyxia. She tended to use the left hand but showed mirror writing on both hands, which was aggravated by correction of handedness to the right. Magnetic resonance T2-weighted imaging revealed a localized high intensity lesion in the white matter of her left parietal lobe, caused by hypoxic insult and suggested a damage of spatial orientation center. Wechsler Preschool and Primary Scale of Intelligence showed a total IQ of 76, VIQ of 86 and PIQ of 74, revealing borderline intelligence with insufficient visual perception. Frostig visual perception test revealed lower scores of position in space. Spatial confusion caused by a lesion in the left parietal lobe might have induced the mirror writing of this case. Forced correction to use the right hand with damaged left parietal lobe may aggravate spatial confusion and consequently worsen mirror writing.

Cerebral Palsy↗

Double-mirror peripheral vitrectomy lens.

Many surgeons use prism lenses to see the periphery of the fundus during vitrectomy; however, chromatic aberrations in higher-power prismatic lenses cause blurring of the peripheral image. For better visualization of the periphery of the fundus, we developed a new contact lens, the double-mirror peripheral vitrectomy lens. The new lens is a quartz cylinder with two mirrors, and it provides a crisp, clear, upright image of much more of the peripheral fundus than is visible through conventional prism lenses. The new lens also provides a wider area of view than conventional prism lenses.

Eye Diseases↗

The double-mirror gonioscopic lens for surgery of the anterior chamber angle.

Intraoperative examination of the anterior chamber angle is necessary during several glaucoma procedures, including goniosynechialysis and goniotomy. Many of the available lenses for this purpose are difficult to use because they require oblique illumination and their size interferes with surgical manipulations at the limbus. We have developed a double-mirror gonioscopic lens that uses direct illumination; provides an upright image of angle structures; and has a small diameter, allowing simultaneous access to the entire limbal region. We compared our lens with the Posner goniomirror (Ocular Instruments, Bellvue, Wash) and found that it provides an equal view of angle structures. The double-mirror gonioscopic lens facilitates the intraoperative visualization of the anterior chamber angle and should allow surgeons who treat glaucoma to more accurately and safely perform angle-related procedures.

Animals↗

New magnifying laryngeal and nasopharyngeal mirrors.

Indirect laryngoscopy and nasopharyngoscopy have been a part of every routine examination by the otolaryngologist and others who choose to use this technique. However, some early lesions of the nasopharynx and laryngopharynx are not detected by the naked eye through the plain mirror. New magnifying laryngeal and nasopharyngeal mirrors are described, which help to visualize the small lesions of the larynx and nasopharynx more easily.

Humans↗

Mirror-symmetric duplicated chromosome 21q with minor proximal deletion, and with neocentromere in a child without the classical Down syndrome phenotype.

We report on a mentally retarded child with multiple minor anomalies and an unusually rearranged chromosome 21. This der(21) chromosome has a deletion of 21p and of proximal 21q, whereas the main portion of 21q is duplicated leading to a mirror-symmetric appearance with the mirror axis at the breakpoint. The centromere is only characterized by a secondary constriction (with a centromeric index of a G chromosome) at an unexpected distal position, but fluorescence in situ hybridization (FISH) with either chromosome specific or with all human centromeres alpha satellite DNA shows no cross hybridization. Thus, the marker chromosome represents a further example of an "analphoid marker with neocentromere." Molecular analysis using polymorphic markers on chromosome 21 verified a very small monosomic segment of the proximal long arm of chromosome 21, and additionally trisomy of the remaining distal segment. Although trisomic for almost the entire 21q arm, our patient shows no classical Down syndrome phenotype, but only a few minor anomalies found in trisomy 21 and in monosomy of proximal 21q, respectively.

Abnormalities, Multiple↗

Hand mirror cell leukemia--immunologic and ultrastructural studies.

Acute lymphoblastic leukemia (ALL) with hand mirror cell (HMC) variant was diagnosed in a 26-year-old black man in May 1978. Hemoglobin was 3.6 g/dl; the platelet count was 19.0 x 10(9)/l; leukocyte count was 8.4 x 10(9)/l with 40% blasts, 66% of which had HMC appearance. Cytochemical studies, terminal deoxynucleotidyl transferase level, and immunologic marker studies indicated a non-T/non-B lymphoblastic origin of the leukemic population. Electron microscopic studies confirmed the hand mirror appearance. Mitochondria were more numerous in these cells compared with other lymphoid cells. Cytogenetic studies showed a 46XY karyotype. Our studies confirmed the previous studies reported by Stass, et al of lymphoblastic origin of HMC leukemia. The patient responded to treatment with vincristine, prednisone and L-asparaginase and went into complete remission. It appears that this morphologic variant of ALL does exist and is not an artifact.

Adult↗

Hand mirror cell lymphoid leukemia in adults. A distinct clinicopathologic syndrome. Case report and literature review.

Hand mirror cell (HMC) lymphoid leukemia is an unusual variant of acute lymphocytic leukemia (ALL) in which the bone marrow lymphoblasts manifest distinctive hand mirror morphologic features. Reported here is a 66-year-old woman with HMC lymphoid leukemia whose clinical course was characterized by 12 months of initial disease stability while she was receiving no chemotherapy; a prompt response to cyclophosphamide, vincristine, and prednisone therapy once instituted; and a hyperleukocytic episode (leukocyte count 607,000/mm3), which resulted in her death after 22 months of disease. This patient and 13 other reported adults (15 years and older) with HMC lymphoid leukemia (greater than 40% bone marrow HMC) are reviewed. HMC lymphoid leukemia appears to differ from typical adult ALL in that it has a female predominance, a relatively indolent early clinical course that lasts 1 year or longer, and it manifests the possibility of survival for 1 or 2 years despite the failure to achieve a complete remission with chemotherapy. Phenotypically, the HMC leukemic cells from all adults evaluated were null cells, Ia-positive, TdT-positive, and stained positively with acid phosphates, which suggests that HMC lymphoid leukemia is a variant of non-T, non-B-ALL. HMC lymphoid leukemia in adults appears to be a distinctive clinicopathologic entity.

Aged↗

Immunoglobulin A against viral capsid antigen of Epstein-Barr virus and indirect mirror examination of the nasopharynx in the detection of asymptomatic nasopharyngeal carcinoma.

To evaluate the efficacy of population screening for early stage nasopharyngeal carcinoma (NPC) in southern China, the authors recruited 42,048 and 10,402 apparently healthy subjects residing in a high incidence and a low incidence area, respectively; all subjects were between the ages of 30 and 59 years. The subjects' serum specimens were tested for immunoglobulin (Ig) A antibody against viral capsid antigen (IgA/VCA) of Epstein-Barr virus (EBV). Of the subjects from the high incidence area, 2823 were found to be seropositive. In follow-up, they had yearly examinations of the nasopharynx by indirect mirror with or without biopsy; 41 were found to have histologically confirmed asymptomatic NPC during the first 2 years of follow-up. The tumors in most of these cases were localized and were at earlier stages than tumors of symptomatic cases of NPC seen in the same region before the screening. The yearly indirect mirror examination of the nasopharynx seems to have effectively identified most of the tumors at the stage of asymptomatic disease. The risk of harboring NPC was found to be different among the different sex and age subgroups of seropositive individuals. By limiting such screening to those who are at exceedingly high risk, the cost of the screening can be kept within the spending of the public health authority, and the effectiveness of the screening also is improved.

Adult↗

A defect in the formation of uropod-bearing lymphocytes (hand-mirror cells) in patients with the Wiskott-Aldrich syndrome.

The formation of a uropod by lymphocytes (hand-mirror cells) represents a morphologic stage of immune activation and motility in lymphocytes. Immune complexes have been previously shown to induce hand-mirror-cell (HMC) formation in human lymphocytes and have been associated with increased number of HMC in acute leukemia. We studied the ability of immune complexes to induce HMC in patients with Wiskott-Aldrich syndrome (WAS), a disease of cellular immune deficiency. Our findings indicate that lymphocytes from patients with WAS adhere to immune complexes but have a defect in their ability to form HMC when compared with normal human lymphocytes. These results support the concept that immune complexes induce HMC formation and that the HMC is related to the normal cellular immune response.

Antibodies, Viral↗

Morphologic observations of contact-induced lysis of EBV-infected B lymphocytes by autologous hand mirror T cells.

To study the possible immunologic role of hand mirror lymphocytes (HML) in the control of Epstein-Barr virus (EBV)-infected B lymphocytes in patients with infectious mononucleosis (IM), we studied the in vitro interactions of these cells by time-lapse video light microscopy. Peripheral blood T lymphocytes isolated from three patients in the early recovery phase of IM were mixed with their autologous EBV-infected B cells. Motile lymphocytes with their characteristic hand mirror shape were observed to attach by their uropods to the B cells. The HML remained attached for variable periods ranging from 45-75 min. Following detachment, B cells that were in contact with HML underwent lysis. Mixtures of T cells from healthy donors and EBV-infected cell lines exhibited only rare uropod formation with no attachment or lysis of B cells. The present experiment indicates that contact-induced lysis of EBV-infected B lymphocytes is operative in IM and that this process is mediated by the HML.

B-Lymphocytes↗

Two patients with monomelic ulnar duplication with mirror hand polydactyly: segmental Laurin-Sandrow syndrome.

We have studied two unrelated boys with isolated left mirror hand and ulnar duplication. Neither had facial anomalies and family histories were unremarkable. We suggest that these boys have segmental Laurin-Sandrow syndrome, or mirror-image duplication, due to somatic mutation involving precursor cells of the left upper limb and that the facial and digital abnormalities in Laurin-Sandrow syndrome are consistent with ectopic anterior hedgehog signaling in the developing limb bud and in the maxillary processes of the face, which closely resemble findings in the Doublefoot (Dbf) mouse mutant.

Abnormalities, Multiple↗

A twin study of dental dimension. I. Discordance, asymmetry, and mirror imagery.

Bilateral tooth measurements in twins are partitioned into three orthogonal contrasts, each associated with one degree of freedom, to estimate three parameters: discordance, asymmetry, and mirror imagery. The probability levels of the within-pair variance ratios were used to test for significance of these estimates. The results provided strong evidences for the existence of significant genetic determinants of almost all of the individual tooth dimensions, but little or no evidence for a genetic basis of asymmetry. The analysis gave no indication that monozygotic twinning was associated with an increased degree of either fluctuating asymmetry or mirror imagery, when compared to dizygotic twins. The data on monozygotic twins further suggested that for most variables examined, the increment of environmental discordance resulting from the twinning phenomena was greater than the developmental noise that caused asymmetry within individual cotwins.

Female↗