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PubMed1999

A unique cause of unconscious urinary incontinence.

The authors present a case of a healthy 55-year-old woman with a 1-year history of vaginal malodor and perineal dampness. A pyridium (phenazopyridine) pad test revealed a well-defined stain area no greater than 3 cm. Cystoscopic examination revealed multiple multilobulated polypoid neoplasms, which we feel probably represent pedunculated hemangiomas. Removal of the neoplasms cured the dampness, malodor and recurrent vaginal infections. We submit this case as a unique cause of extraurethral incontinence.

Female↗
PubMed1994

[Anesthesia with flunitrazepam/fentanyl and isoflurane/fentanyl. Unconscious perception and mid-latency auditory evoked potentials].

There is a high incidence of intraoperative awareness during cardiac surgery. Mid-latency auditory evoked potentials (MLAEP) reflect the primary cortical processing of auditory stimuli. In the present study, we investigated MLAEP and explicit and implicit memory for information presented during cardiac anaesthesia. PATIENTS AND METHODS. Institutional approval and informed consent was obtained in 30 patients scheduled for elective cardiac surgery. Anaesthesia was induced in group I (n = 10) with flunitrazepam/fentanyl (0.01 mg/kg) and maintained with flunitrazepam/fentanyl (1.2 mg/h). The patients in group II (n = 10) received etomidate (0.25 mg/kg) and fentanyl (0.005 mg/kg) for induction and isoflurane (0.6-1.2 vol%)/fentanyl (1.2 mg/h) for maintenance of general anaesthesia. Group III (n = 10) served as a control and patients were anaesthetized as in I or II. After sternotomy an audiotape that included an implicit memory task was presented to the patients in groups I and II. The story of Robinson Crusoe was told, and it was suggested to the patients that they remember Robinson Crusoe when asked what they associated with the word Friday 3-5 days postoperatively. Auditory evoked potentials were recorded awake and during general anaesthesia before and after the audiotape presentation on vertex (positive) and mastoids on both sides (negative). Auditory clicks were presented binaurally at 70 dBnHL at a rate of 9.3 Hz. Using the electrodiagnostic system Pathfinder I (Nicolet), 1000 successive stimulus responses were averaged over a 100 ms poststimulus interval and analyzed off-line. Latencies of the peak V, Na, Pa were measured. V belongs to the brainstem-generated potentials, which demonstrates that auditory stimuli were correctly transduced. Na, Pa are generated in the primary auditory cortex of the temporal lobe and are the electrophysiological correlate of the primary cortical processing of the auditory stimuli. RESULTS. None of the patients had an explicit memory of intraoperative events. Five patients in group I, one patient in group II, and no patients in group III showed implicit memory of the intraoperative tape message. They remembered Robinson Crusoe spontaneously when they were asked their associations with Friday. In the awake state AEP peak latencies were in the normal range. During general anaesthesia in group I, the peaks Na, Pa did not increase in latency or decrease in amplitude before and after the audiotape presentation. The primary cortical complex Na/Pa could be identified as in the awake state. In contrast, in group II Na, Pa showed a marked increase in latency and a decrease in amplitude or were completely suppressed. CONCLUSIONS. During general anaesthesia auditory information can be processed and remembered postoperatively by an implicit memory function, when the electrophysiological conditions of primary cortical stimuli processing is preserved. Implicit memory can be observed more often when high-dose opioid analgesia is combined with receptor-binding agents like the benzodiazepines than under non-specific anaesthetics like isoflurane. Non-specific anaesthetics seem to provide a more effective suppression of auditory stimuli processing than receptor-specific agents.

Adult↗
PubMed2005

Unconscious confusion--a literature search for definitions of syncope and related disorders.

BACKGROUND: Imprecise definitions of syncope and related conditions appear common in the medical literature. To investigate the scope of the problem we systematically searched for definitions in high-ranking medical journals. METHODS: Literature review of articles on 'syncope', 'neurocardiogenic syncope', 'neurally mediated syncope', 'orthostatic intolerance', and 'orthostatic hypotension' with these keywords in the title, mainly published in the ten journals with the highest impact in the fields of cardiology, internal medicine, and neurology. RESULTS: Syncope, neurocardiogenic syncope, neurally mediated syncope, orthostatic intolerance, and orthostatic hypotension were defined in only 41%, 34%, 26%, 38%, and 48% of papers respectively. Definitions, when given, differed considerably among papers. Orthostatic hypotension was most frequently defined, with an increase in number and consistency of definitions after publication of a consensus in 1996. CONCLUSIONS: Syncope and related conditions proved to be infrequently and inconsistently defined in current medical literature. The lack of consistent terminology is likely to harm medical education, research, and patient care. There is a strong need for a systematic terminology for syncope and related conditions.

Autonomic Nervous System↗
PubMed1991

Unconscious perception of "extinguished" visual stimuli: reassessing the evidence.

When parietal-damaged patients fail to report a contralesional stimulus because of extinction, is this because the stimulus is not perceived, or because it is perceived but cannot reach conscious awareness? VOLPE et al. [10] reported an intriguing study that seemed to locate the problem at least partly in the transfer of information to conscious awareness. They showed patients with extinction pairs of stimuli, one in each hemifield. Although patients were predictably poor at reporting the identity of the contralesional stimulus, they were able to make accurate same/different judgements comparing the two stimuli. This was interpreted as evidence that both stimuli were perceived. In the present paper, we point out that the dissociation between identification and same/different matching could also be due to the possibility that less visual information about the contralesional stimulus is necessary to make a same/different judgement than to identify the stimulus, and that chance performance is considerably higher in the first than in the second type of task. In Experiment 1, we verified this by degrading one side of a stimulus display and "replicating" the dissociation with normal subjects. We also equated the amount of visual information needed for the two tasks by yoking the stimulus pairs on "different" trials of the same/different matching task with the choice pairs on a forced choice identification task. Under these conditions, the dissociation vanished. In Experiment 2, we administered these tasks to three parietal-damaged patients with extinction. When the original method was used, same/different matching was better than identification of the contralesional stimulus. With the forced choice identification method, the dissociation again vanished.

Aged↗
PubMed1996

A case of simulated, psychogenic or focal pure retrograde amnesia: did an entire life become unconscious?

A case of pure retrograde amnesia following mild head injury is reported. Neuropsychological, psychodynamic and statistical approaches are employed in an attempt to disentangle the clinical picture presented by the patient. Focal retrograde amnesia, psychogenic retrograde amnesia and simulated amnesia are all taken into account. From a public events questionnaire and an inquiry about famous people, consistency analyses showed that the patient was able implicitly to use information she denied having, but at the same time, made us lower the probability of a simulated amnesia. Moreover, psychodynamic analysis showed that the patient's personality structure was compatible with hysterical patterns and we suggest that the patient's memory defect may be related to her personality. It seems less likely, though still possible, that the case may be explained in terms of deliberate simulation. In this case we conclude that the classification along the conscious/unconscious dimension seems more informative than the contrast between psychogenic and organic genesis.

Adult↗
PubMed2005

Unconscious processing of multiple nonadjacent letters in visually masked words.

The claim that visually masked, unidentifiable ("subliminal") words are analyzed at the level of whole word meaning has been challenged by recent findings indicating that instead, analysis occurs mainly at the subword level. The present experiments examined possible limits on subword analysis. Experiment 1 obtained semantic priming from pleasant- and unpleasant-meaning subliminal words in which no individual letter contained diagnostic information about a word's evaluative valence; thus analysis must operate on information more complex than that contained in individual letters. Experiments 2 and 3 showed that analysis must operate on information more complex than that represented by individual bigrams (adjacent letters) or trigrams (three consecutive letters). These findings suggest that while subliminal priming is driven by subword analysis, the effective units of analysis are distributed widely across at least short (four- and five-letter) words.

Consciousness↗
PubMed2003

Measuring unconscious actions in action-blindsight: exploring the kinematics of pointing movements to targets in the blind field of two patients with cortical hemianopia.

We tested two patients with posterior cerebral lesions on two pointing tasks. In the first task, the patients pointed to targets presented on a touch screen monitor and pointing accuracy was recorded. One patient (JR) demonstrated good localisation of targets presented to her blind field while the other patient (YP) did not. Movement kinematics were measured in the second task to compare the kinematics of movements made to sighted field targets with those made to blind field targets. For this version of the task both patients demonstrated above chance localisation of blind field targets although the slope of the relationship between the end of pointing movements and the target locations was significantly steeper for JR than for YP. Furthermore, JR showed a kinematic profile for movements made to blind field targets that mirrored the profile of kinematics to sighted field targets. That is, both peak velocity and time to peak velocity increased with increasing target eccentricity for movements made to blind and sighted field targets alike. Although patient YP now showed more reliable spatial localisation on this pointing task when compared with the touch screen task, his kinematics for movements made to targets in his blind field were quite different from those made to targets in his sighted field. Based on the patients' CT scans, we suggest that the superior performance of patient JR is a consequence of greater sparing of her parietal cortex in the damaged hemisphere.

Adult↗