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PubMed1996

The meaning of perineal activity to women: an inner sphinx.

This paper is an inquiry into the close association of anal and genital functions in women and the background and meaning of that association. Excerpts from the analyses of two women with sexual and intellectual inhibitions illustrate aspects of erotic life deriving from anal-phase development, and the unconscious fantasy of an inner, erotic, and powerful "organ." Along with the lifting of their inhibitions, both analysands achieved integration of anal-sadistic and incorporative wishes with vaginal receptivity. Female anatomy and physiology are so arranged that the action of perineal and sphincter musculature also stimulates the genital. This fosters overlapping mental representations of vagina and rectum which in turn affect body image and unconscious fantasy in women. The experience of perineal contraction acquires complex psychic meanings with both libidinal and aggressive charge. The libidinal aspect is the largely covert erotic sensation that informs the mental representation of the genital and is destined to be integrated into female sexuality. The aggressive component may present as an unconscious fantasy of possessing an inner, powerful, and dangerous organ--a focus for conflict between anal-sadistic wishes and early elements of the superego.

Adult↗
PubMed1997

Some roots of persistent homosexual fantasy and the quest for father's love: conflicted parental identifications in a male patient: fragment of an analysis.

This is a clinical paper, which includes material from sessions, presenting the process of the analysis of a young adult male whose narcissistic character patterns, related to and evolved from failed attempts to integrate conflicting parental identifications. These unintegrated mother and father identifications contributed to life-long latent homosexual fantasies. Rodney's analysis indicates that for a boy/man, even a mother who has the qualities of a good enough parent, is not good enough to enable him to reach a nonconflicted manhood. A mother cannot provide for the boy the male model he needs and is searching for, the male who would affirm him in his maleness. Rodney wanted a father on whose shoulders he could stand to become a man. Rodney's persistent homosexual fantasy life, his quest for father's love, and his search for a masculine object to identify with stem from a combination of several factors. Rodney's regression to the negative oedipal phase was probably stimulated when father left the family. Rodney was eleven at the time. He felt overwhelmed experiencing himself as the oedipal victor. Unconsciously, Rodney feared his exacerbated incestuous wishes. He projected them upon his mother and subsequently incorporated them in his fantasies. His regression to more infantile dependency feelings was defensive. Rodney's father was an unsuitable object for identification. He was disinterested in Rodney and emotionally unavailable. Rodney, however, sought his father, whose lack of loving acknowledgement resulted in a lack of affirmation of Rodney's masculinity. Mother provided for Rodney the loving acknowledgement he lacked in his relationship with father. She was emotionally sustaining, an energetic, vibrant personality, who was seen by Rodney as a "superior human being." Rodney consciously idealized his mother toward whom he unconsciously also had ambivalent feelings. Rodney's identification with mother was not counterbalanced by the presence of a strong, loving father figure whom he could have used as a suitable model. This led to the development in Rodney of a strong sense of effeminization. Rodney in his homosexual fantasies assumed the so-called "feminine victimized" role. The regression to the negative oedipal phase contributed to an exacerbation of erotic, father-directed feelings, intensified by the identification with mother. Rodney was fixated in his quest for father's love. In addition, Rodney's unconscious guilt related to father and mother directed incestuous impulses, and his intense aggressivesadistic feelings contributed to the masochistic cast of his masturbation fantasies. Rodney's narcissistic aims and the quality of his narcissism changed during the analysis. His grandiosity almost disappeared. Rodney's goals became realistic and he acquired the skills necessary to achieve them. Inhibitions related to the "fear of success" were worked through. This enabled Rodney to compete successfully. His healthy narcissism derives from the success of his many achievements. Though Rodney remained a basically narcissistic personality, he did derive great pleasure from being a giving person. This was one of the many ways in which he identified with his mother. At the present, Rodney's identifications are selective and do not evoke intrapsychic conflict.

Adult↗
PubMed2004

The analytic third: implications for psychoanalytic theory and technique.

The author views the analytic enterprise as centrally involving an effort on the part of the analyst to track the dialectical movement of individual subjectivity (of analyst and analysand) and intersubjectivity (the jointly created unconscious life of the analytic pair--the analytic third). In Part I of this paper, the author discusses clinical material in which he relies heavily on his reverie experiences to recognize and verbally symbolize what is occurring in the analytic relationship at an unconscious level. In Part II, the author conceives of projective identification as a form of the analytic third in which the individual subjectivities of analyst and analysand are subjugated to a co-created third subject of analysis. Successful analytic work involves a superseding of the subjugating third by means of mutual recognition of analyst and analysand as separate subjects and a reap-propriation of their (transformed) individual subjectivities.

Humans↗
PubMed1995

A rediscovery of Sigmund Freud.

As part of his rediscovery of consciousness, Searle has recently provided an interpretation of Freud's account of consciousness, including the relation of consciousness to nonconscious mental occurrences [i.e., preconscious mental occurrences and unconscious (repressed) mental occurrences]. Regrettably, Searle's interpretation is based on a single paragraph from The Unconscious and serves to eliminate Freud's general view on these matters as being "incoherent." In the present article, I rediscover Freud's account and show that Searle has deeply misunderstood him, thus converting Freud into a "mental-eye" theorist of consciousness when Freud is actually an "intrinsic" theorist. I point out that Freud's and Searle's views on consciousness are actually similar, though Searle denies the existence of nonconscious mental occurrences. My discussion of Freud's account of consciousness addresses as well (a) Freud's understanding of emotions and feelings, including what he calls "misconstrued" emotions, and repression that works to suppress the development of affect, and (b) why Freud held that emotions and feelings never occur except consciously. I hope that my present contribution will be part of an intensive discussion that will proceed among psychologists of consciousness in a conscious and deliberate joint effort to develop the theory of consciousness.

Consciousness↗
PubMed1981

Significance of hyperlactatemia in acute hypnotic drug poisoning.

Lactate concentration, fibrinogen and fibrin(ogen) -- degradation-products in central venous blood were analysed in 35 unconscious patient with acute hypnotic drug poisoning (HDP) and compared with the results in 13 healthy control persons undergoing the same degree of forced diuresis via central venous catheters. Blood samples were taken on admission and at 12 h intervals up to 36 h after admission. Patients with HDP were attributed to the categories of moderate intoxications (n = 17) and severe intoxications (n = 18) according to their clinical condition. On admission, blood lactate was significantly higher in severe intoxication (3.90 +/- 2.94 mmol/l) as compared to the control group (1.25 +/- 0.17 mmol/l). Blood lactate was less elevated in moderate poisoning (2.74 +/- 1.22 mmol/l). Thirty-six hours after admission blood lactate was completely normalised in patients with moderate intoxication (1.19 +/- 0.69 mmol/l) but still significantly elevated in severely poisoned patients (2.26 +/- 1.48 mmol/l). Lactate concentration was above normal in 15 out of 17 patients with moderate and in 17 out of 18 patients with severe poisoning. A statistically significant linear correlation existed between the duration of unconsciousness and the maximal lactate concentration within 12 hrs after admission. For fibrinogen concentrations statistically significant differences were observed neither between groups nor across time. Titers of FDP were elevated in 9 out of 11 patients with moderate and to a higher degree in all patients with severe poisoning, indicating low rate DIC. Hyperlactatemia is a frequent finding in acute hypnotic drug poisoning. Blood lactate estimations may improve the evaluation of the severity of poisoning and the efficacy of therapeutic interventions.

Adult↗
PubMed2005

Ruptured abdominal aortic aneurysms: factors influencing early survival.

In this study we aimed to define relevant prognostic predictors for the outcome of surgical treatment of ruptured abdominal aortic aneurysms. The study included 406 consecutive patients treated between January 1991 and December 2003. There were 337 (83%) male and 69 (17%) female patients aged 67 +/- 7.5 years. Fourteen (3.5%) patients had aortocaval fistula whereas 4 (0.98%) had primary aortorenteric fistula caused by aneurysm rupture into the inferior vena cava or duodenum. Reconstruction included interposition of a tube graft (215-53%), aortobiiliac bypass (134-33%), and aortobifemoral bypass (58-14.3%). Findings on admission that significantly correlated with both intraoperative (13.5%) and total operative mortality (48.3%) were systolic blood pressure <95 mmHg, low diuresis, unconsciousness, cardiac arrest, leukocytes >14 x 10(9)/L, hematocrit <0.29%, hemoglobin <100 g/L, urea> 11 mmol/L, and creatinine >180 micromol/L. Intraoperative determinants of increased mortality were aortic cross-clamping time >47 min, duration of surgery >200 min, intraoperative blood loss >3500 mL, diuresis <400 mL, arterial systolic pressure <97.5 mmHg, and the need for aortobifemoral bypass. Respiratory complications and multisystem organ failure were significantly associated with lethal outcome in the postoperative period. Surgical treatment of ruptured abdominal aortic aneurysm was life-saving in 51.7% of patients. Variables significantly associated with mortality were unconsciousness, low systolic blood pressure, cardiac arrest, low diuresis, high urea and creatinine levels, signs of blood loss, and the need for aortobifemoral reconstruction. Short aortic cross-clamping and the total operation time, low intraoperative blood loss, and well-controlled diuresis and arterial pressure during surgery have improved survival. Therapeutic efforts should concentrate on intraoperative factors that are possible to correct, leading to better survival of these patients.

Adult↗
PubMed1993

Insight in behavior therapy.

Behavior therapists make frequent use of insight, but avoid the term because dynamic therapists have formulated it in terms of the unconscious. Insight does not necessarily imply belief in the existence of the "unconscious mind." Behavioral insight consists of making the client aware of the antecedents and consequences of target behavior. Case studies are presented in which behavioral insight was involved in therapeutic change. Implications of behavioral insight for behavior therapy are discussed.

Adolescent↗
PubMed1988

Comparison of sufentanil-oxygen and fentanyl-oxygen anesthesia for mitral and aortic valvular surgery.

The cardiovascular responses, speed of anesthetic induction, incidence of chest wall rigidity, need for anesthetic supplements (phentolamine, N2O, and nitroprusside) to control intraoperative hypertension, and speed of postoperative recovery were measured and compared in 44 patients undergoing aortic and mitral valvular replacement with fentanyl-O2 or sufentanil-O2 anesthesia. After a lorazepamatropine premedication and pancuronium pretreatment, fentanyl was administered intravenously at a rate of 400 micrograms/min and sufentanil at 200 micrograms/min until patients were unconscious; at this time they were given succinylcholine and their tracheas were intubated. After intubation, an amount of fentanyl or sufentanil equal to the dose producing unconsciousness was infused over the next 30 minutes, at which time the operation began. Additional fentanyl or sufentanil was given whenever systolic arterial blood pressure (SBP) increased more than 15% over preanesthetic values. When three successive supplemental doses of the narcotic failed to effectively decrease SBP, phentolamine was used to control pressure before and during bypass; after bypass, N2O (25% to 50%) or, if N2O was ineffective, nitroprusside was used. Average time of induction was 3.4 +/- 0.3 for fentanyl and 1.0 +/- 0.2 min (mean +/- SD) for sufentanil. Chest wall rigidity occurred in 36% of patients in both groups. Total doses of fentanyl and sufentanil required for the entire operation were 113 +/- 11 and 9.0 +/- 0.4 micrograms/kg (mean +/- SD), respectively. Heart rate, cardiac output, and mean right atrial pressure remained unchanged throughout the study in both groups. Mean arterial blood pressure (MBP) and SBP were significantly decreased during induction and after intubation in patients receiving sufentanil, but not fentanyl.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Intravenous↗
PubMed2005

Cervical spine clearance: a review.

Ethical concerns have hindered any randomised control blinded studies on the imaging required to assess the cervical spine in an unconscious trauma patient. The issue has been contentious for many years and has resulted in burgeoning but inconclusive guidance. MRI and multislice CT technology have made rapid advances, but the literature is slower to catch up. Never the less there appears to be an emerging consensus for the multiply injured patient. The rapid primary clinical survey should be followed by lateral cervical spine, chest and pelvic radiographs. If a patient is unconscious then CT of the brain and at least down to C3 (and in the USA down to D1) has now become routine. The cranio-cervical scans should be a maximum of 2 mm thickness, and probably less, as undisplaced type II peg fractures, can be invisible even on 1 mm slices with reconstructions. If the lateral cervical radiograph and the CT scan are negative, then MRI is the investigation of choice to exclude instability. Patients with focal neurological signs, evidence of cord or disc injury, and patients whose surgery require pre-operative cord assessment should be imaged by MRI. It is also the investigation of choice for evaluating the complications and late sequela of trauma. If the patient is to have an MRI scan, the MR unit must be able to at least do a sagittal STIR sequence of the entire vertebral column to exclude non-contiguous injuries, which, since the advent of MRI, are now known to be relatively common. Any areas of oedema or collapse then require detailed CT evaluation. It is important that cases are handled by a suitably skilled multidisciplinary team, and avoid repeat imaging due to technical inadequacies. The aim of this review is to re-examine the role of cervical spine imaging in the context of new guidelines and technical advances in imaging techniques.

Cervical Vertebrae↗
PubMedDate not supplied

Modelling general anaesthesia as a first-order phase transition in the cortex.

Since 1997 we have been developing a theoretical foundation for general anaesthesia. We have been able to demonstrate that the abrupt change in brain state brought on by anaesthetic drugs can be characterized as a first-order phase transition in the population-average membrane voltage of the cortical neurons. The theory predicts that, as the critical point of phase change into unconsciousness is approached, the electrical fluctuations in cortical activity will grow strongly in amplitude while slowing in frequency, becoming more correlated both in time and in space. Thus the bio-electrical change of brain-state has deep similarities with thermodynamic phase changes of classical physics. The theory further predicts the existence of a second critical point, hysteretically separated from the first, corresponding to the return path from comatose unconsciousness back to normal responsiveness. There is a steadily accumulating body of clinical evidence in support of all of the phase-transition predictions: low-frequency power surge in EEG activity; increased correlation time and correlation length in EEG fluctuations; hysteresis separation, with respect to drug concentration, between the point of induction and the point of emergence.

Action Potentials↗
PubMed2004

S100B protein in carbon monoxide poisoning: a pilot study.

Carbon monoxide (CO) poisoning is the most common form of lethal poisoning. The aim of this prospective clinical study was to assess the possible role of S100B, the structural protein in the astroglia, as a biochemical marker of brain injury in carbon monoxide poisoning. Serum S100B determination was performed in 38 consecutive patients poisoned by carbon monoxide who were admitted to the Emergency Department (ED) in Ljubljana. All three unconscious patients had elevated S100B levels. The patient with the highest S100B died. S100B was elevated in two of the six patients with initial transitory unconsciousness at the scene. All 29 patients without loss of consciousness had normal S100B levels. Carbon monoxide poisoning appears to be associated with elevated S100B levels.

Adolescent↗
PubMed2006

Indicators of mortality in African adults with malaria.

Malaria is a major cause of morbidity and mortality amongst adults in sub-Saharan Africa, but descriptions of symptoms and mortality in this group have received little attention in the past. A retrospective study was performed on adults admitted to a tertiary hospital in Tanzania with a primary diagnosis of malaria. Frequency and mortality for the criteria in the WHO definition of severe malaria were recorded. Logistic regression analysis was then used to identify symptoms with the greatest prognostic value. Two hundred and sixty-nine adults (median age 28 years) with a primary diagnosis of malaria were studied, with an overall mortality rate of 15.2%. Logistic regression identified three key prognostic indicators: unconsciousness (odds ratio (OR) 44.44; 95% CI 4.05-488.24), renal failure (OR 7.37; 95% CI 1.70-31.96) and pulmonary oedema (OR 13.83; 95% CI 3.52-54.32). Whilst the WHO criteria predicted all of the 41 adults who died, 37 (90.2%) had at least one of the following symptoms: unconsciousness (n=39, fatality rate 74.4%), renal failure (n=26, fatality rate 66.7%) and pulmonary oedema (n=28, fatality rate 64.3%). These symptoms can therefore identify those at a high risk of death in African adults with malaria.

Adult↗
PubMed1994

Circadian variation of cardiopulmonary disease onset in the general population: an emergency care system perspective from Berlin.

STUDY HYPOTHESIS: The objective of the present study was to determine the circadian pattern of onset of acute pulmonary emergencies in the general population and to analyze the influence of age and sex on these patterns. METHODS: Analysis of all 47,082 emergency calls during the years 1987 and 1988 of the Berlin emergency medical system. Analysis of circadian variation in incidence of subgroups with the leading symptom of respiratory distress, chest pain, or sudden unconsciousness. All cases of nontraumatic sudden death were analyzed. All missions were evaluated with regard to sex and age dependence. RESULTS: There is a circadian variation in acute cardiopulmonary emergencies with the highest incidence between 6 AM and noon. This applies to subpopulations of chest pain (9,068), respiratory distress (13,732), sudden unconsciousness (7,829), resuscitation attempts (4,787), and persons found dead without resuscitation attempts (4,780). Cases of chest pain, respiratory distress, and resuscitations show a second evening peak. Patients 65 years old or less have the highest rates in the afternoon, whereas those aged over 65 show a single morning peak (P < .0001). These relations are independent of sex and presenting complaint. CONCLUSION: Unselected populations show circadian variations in the incidence of cardiopulmonary emergencies. Age-related differences suggest different pathophysiological age-dependent mechanisms, eg, hormonal factors or lifestyle-dependent trigger mechanisms. Emergency medical systems should adjust the availability of emergency services to the distinct circadian differences of life-threatening cardiovascular and pulmonary diseases.

Adult↗
PubMed2002

The position of the spine in the recovery position--an experimental comparison between the lateral recovery position and the modified HAINES position.

UNLABELLED: The lateral recovery position is widely used for the positioning of unconscious patients. Ideally, in the setting of trauma it is avoided because of concerns about spinal cord injury. However, unconscious individuals with unsuspected trauma or trauma victims attended by partially trained first-aiders may be placed in the recovery position, potentially endangering the cord. Excessive movement of the spine in the recovery position may increase the risk of spinal cord injury in these situations. A new recovery position, termed the modified HAINES position, is described and the position of the spine in this position is compared with the lateral recovery position. HYPOTHESIS: That the modified HAINES position results in less distortion of the position of the spine than the lateral recovery position. METHODS: Thirty-eight healthy volunteers were imaged in the two different positions. Measurements of rotation, flexion and lateral flexion of the cervical and thoraco-lumbar spine were made. Two tailed paired t-tests were employed to compare measurements of the two positions and a McNemar test was used to compare the subjects' subjective experiences. RESULTS: The modified HAINES position resulted in 13.0 degrees (99% CI: 7.5-18.5) less lateral flexion and 12.6 degrees (99% CI: 9.4-15.9) less extension of the cervical spine while the position of the thoraco-lumbar spine was similar in both positions. Nineteen of 28 subjects found the modified HAINES position more comfortable (not significant). CONCLUSION: The modified HAINES position results in a more neutral position of the spine making it preferable to the lateral recovery position in the management of patients when trauma may have occurred. Further research is required to ensure that the recovery positions in use today are the best possible.

Adolescent↗
PubMed1997

Experience of an emergency mobile asthma treatment programme.

In order to reduce mortality and the need for hospital care for patients suffering from acute asthma, an emergency programme was set up. An ambulance crew, trained in coronary-pulmonary resuscitation was instructed in dealing with acute asthma and delegated to give 24 h treatment with bronchodilators (inhaled salbutamol and ipratropium bromide). If there was no, or only slight, improvement with this therapy, nurses (daytime) were delegated to give injections with corticosteroids (terbutaline and theophylline). Over a period of 2 years, 240 patients, 115 women and 125 men, were treated on 367 occasions. In 127 patients (53%), two or more treatments were given. The number of times treatment was given, as well as the proportion of females to males, increased the younger the patients were. Out of all the cases, more than 70% improved after treatment. On arrival, 21 patients (6%) were unconscious. After therapy, 15/21 patients (71%) survived. This may correspond to a similar reduction in mortality (population about 350,000 inhabitants), as it is unlikely that unconscious patients can survive without intensive care.

Adolescent↗
PubMed2002

Two successful cases of bromide therapy for refractory symptomatic localization-related epilepsy.

Potassium bromide was tried for two children with daily convulsive focal motor seizures with unconsciousness and focal motor seizure status. The treatment resulted in complete cessation of the attacks. It has been reported that bromide is effective for generalized tonic-clonic seizures and not for complex partial seizures, such as convulsive focal motor seizures with unconsciousness. However, our experiences provide evidence that bromide is one of the useful therapeutic agents for intractable symptomatic localization-related epilepsy.

Bromides↗
PubMed2004

Post-traumatic syndrome after minor head injury cannot be predicted by neurological investigations.

The aim of this study is to investigate predictive factors of post-traumatic syndrome in children with minor head injury. Prospective neurological, electroencephalographic and psychological investigations were performed in 98 children aged 3-13 years within 24 h after the trauma and 4-6 weeks later. Inclusion criteria for mild head injury were unconsciousness <10 min or none at all, lack of overt neurological symptoms and other complications requiring intensive care. Twenty-six of the children had been unconscious for a short period. Ten had suffered a skull fracture. Within the first 24 h, nearly all children reported acute symptoms of concussion and 64 of 98 showed abnormal EEG findings. After 4-6 weeks, 23 of 98 still exhibited post-traumatic complaints with headache, fatigue, sleep disturbances, anxiety and affect instability. Such post-traumatic symptoms did not correlate with somatic, neurological or electroencephalographic findings observed immediately after the injury or at the follow-up investigation. As opposed to the situation in more severe head trauma, post-traumatic syndrome after minor head injury in children is apparently not due to central nervous injury detectable by neurological examination or electroencephalography. Irrespective of the necessity of neuroradiological investigations and repeated EEGs in more severe and complicated head trauma, we discourage the routine EEG examination in very slight head injury and instead rather recommend parent and patient counselling.

Adolescent↗
PubMed2002

Prime-sight and blindsight.

Listening to subject's commentaries can be a useful spur to novel scientific departures, as in studies of blindsight. Recently further testing (after a gap of 17 years) has been possible with subject DB, who was a blindsight patient (the first) tested intensively over a period of 10 years and who was the subject of the book, (Blindsight OUP, 1986, 2nd edition, 1998). Essentially his original capacity is the same or somewhat more sensitive. Some further types of discriminations have now been tested that were not possible in the original study. But a new feature was discovered, namely that he describes conscious after-images of a wide range of inducing stimuli of which he is unconscious. The properties of the after-images are briefly described, such as their occurrence following unseen colour patches, luminance changes, shape, spatial frequency, their long durations, showing inter-ocular transfer, as well as their conforming to Emmert's Law. Various approaches are discussed towards finding the source of their generation, such as the use of after-images of colour mixes of separate inputs to the two eyes ("cortical yellow"). They are also discussed in terms of after-images in normal subjects that are generated by imagination. The discovery offers a rare potential opportunity to compare the brain activity associated with both the conscious and unconscious attributes of the precisely the same stimuli in the same locus in the same subject.

Adult↗