Transience: its beauty and danger.

The author argues that what he terms transition and what he will call transience go together quite often, but that analysis usually discuss transition rather than transience. In the first half of this paper, he examines Ukiyo-e and Japanese myths and folk tales, so as to introduce the Japanese concept of transience and its pathological connotation. In the second half, he quotes two treatments of self-destructive patients to show the importance of understanding the negative and positive aspects of transience in psychoanalytical terms. He concludes that masochistic identification with the transitory figure(s) can take place along with limitless accumulation of debt, causing everything, including one's own self, to be felt as transient. He points out that a Japanese word 'Arigatou', which is almost equivalent to 'thank you' in English, literally means 'difficult to exist', and thus the importance in Japan of appreciating the transience of valuable things. He considers that while readers may be reminded of Winnicott's discussion of transitional objects, transition is a phenomenological description of movement, while transience is mainly an emotional state, or one of painful feeling. Transience, he believes, is not only a feature of Japanese clinical phenomena but also universal.

[Post-gastrectomy gallstone disease].

Biliary tree of gastrectomized patients was examined with ultrasonography to investigate the factors affecting post-gastrectomy gallstone formation. Only gallbladder stone was found in 57 (18.9%). In 11 (20.0%) of 55 patients, stones had developed within 2 years after surgery, but no difference in incidence were observed by sex and age. Sixty four gastrectomized gallstone patients were examined in respect to the kind of gallstone. Patients with cholesterol gallstones were 18 (28.1%), patients with black gallstones were 29 (45.3%) and patients with calcium bilirubinate gallstones were 17 (26.6%). The incidence rate of cholesterol gallstones was lower and the rate of black gallstones and calcium bilirubinate gallstones was higher than that of non-gastrectomized patients. In conclusion, the incidence of pigment gallstones is very high in gastrectomized patients.

Bilirubin conjugation and biliary bilirubin excretion after intravenous bilirubin injection in dogs.

This study was undertaken to investigate the bilirubin clearance, bilirubin conjugation and biliary bilirubin excretion after an intravenous single bilirubin injection (5 mg/kg or 10 mg/kg) in 10 mongrel dogs. Serum total bilirubin concentration increased after the bilirubin injection, and then it immediately decreased. Biliary excretion of loaded bilirubin induced a rapid increase of the bile total bilirubin concentration and bilirubin-monoconjugate. In the 10 mg/kg group, the increase was larger than in the 5 mg/kg group and remained high up to 4 hr after injection, whereas in the 5 mg/kg group these bile components tended to decrease and returned to the preinjection levels within 4 hr. The total bile acid concentration in the bile remained unchanged in both groups. The bile flow did not change in the 5 mg/kg group, but in the 10 mg/kg group it decreased after bilirubin loading. Significantly positive correlations were observed between total bilirubin and bilirubin monoconjugate concentrations in bile both before and 1 hr after injection, but the slopes of regression lines were markedly different from each other. These results suggest that a bilirubin load surpassing the conjugating capacity of the hepatocytes increases bile bilirubin monoconjugate and also enhances the conjugating activity in the liver.

[Pathogenesis of black gallstones associated with hemolytic disease].

In order to investigate the pathogenesis of black gallstones associated with hemolytic disorders, experimental and clinical studies were performed. Firstly, a one-shot injection of bilirubin and hemolyzed blood, and a continuous injection of bilirubin were performed in mongrel dogs with the aim to analyze the changes of hepatic and gallbladder bile composition. Secondly, gallbladder bile obtained intraoperatively from the patients with black gallstones associated with hemolytic disease, patients with black stones not associated with hemolytic disease and patients with gallbladder polyp were analyzed in order to compare the characteristics of hemolytic patients' bile with those of the model animals. High concentration of total bilirubin and increased proportion of bilirubin monoconjugate (BMC) fraction was observed in the bile of patients with black stone associated with hemolytic disease compared with the bile of the patients of other two groups. Bile pH, total calcium concentration and ionized calcium concentration were similar in all the groups. Total bile lipid concentration of hemolytic patients was decreased but the ratio of total bile acid to total lipid was increased. Both bolus injection of bilirubin and hemolyzed blood produced an increase of total bilirubin concentration and BMC in hepatic bile. Continuous bilirubin injection for 7 days induced an increase of total bilirubin and BMC in both hepatic and gallbladder bile. These results suggest that the conjugating capacity of the hepatocyte is surpassed by the excessive amount of bilirubin produced after hemolysis, producing therefore, an increased BMC and unconjugated bilirubin content in bile. This increased content can precipitate in bile as black gallstones.

Metaphorization--making terms.

The analysts's receptivity to ambiguity is generally thought to be an essential part of his psychoanalytical practice. The interpretation of its multiple meanings can effectively create a 'bridging function' between personally metaphorical meanings and shared literal meanings. This function of ambiguous metaphor appears to be impossible in the treatment of the schizophrenic, who experiences metaphor in literal terms. Some of them, however, can utilize metaphor, indicating positive signs such as a non-psychotic part, anal retentive tendency, creativity, ambiguity tolerance, etc. This paper, based on my clinical experience, puts forward a hypothesis concerning the transitional process from the schizophrenic patient's literal experience to metaphorical understanding. To facilitate the process, the therapist's role of metaphorizing the patient's expressions, which are experienced literally, into 'here and now' events, is essential. Among the relevant technical issues, the appearance and usage of the 'in-metaphor' and the compound metaphor, which interweave the words and meanings of the two people in therapy, may play an important role. Ambiguous metaphor, which de-materializes and deodourizes the indigestible into a word, evolves alongside the establishing of interpersonal ambiguous area. It is concluded that this 'bridging' process can be promoted by the playfully shared metaphorization.