Menstrual cycle dependent right-to-left shunting: a single-blinded transcranial Doppler sonography study.

BACKGROUND AND PURPOSE: Menstruation has been described as risk factor for neurological decompression sickness in divers. In considering this for paradoxical gas embolism, we hypothesized that there may be a link between cycle-dependent hormonal changes and the manifestation of a right-to-left shunt (RLS). METHODS: 40 women with a regular cycle of 28 days underwent transcranial Doppler sonography examinations (TCD) on day 1 and on day 15 of the menstrual cycle. Cerebral high intensity transient signs (HITS) proved a RLS. RESULTS: We found a 25% RLS incidence consistent with the literature. In 7 of 10 shunt-positive women it was detected mainly or exclusively on day 15. This difference in PFO detection rate is statistically significant (p = 0.031), indicating more RLS during the peri-ovulatory period. CONCLUSIONS: Our results do not support menstruation as a risk factor for neurological decompression sickness. The peri-ovulatory estrogen peak, which leads to systemic vasodilation, may explain our data. Factors that increase the risk for developing a RLS and thereby paradoxical embolism should be avoided, perhaps including diving during the peri-ovulatory period of the menstrual cycle. Furthermore, contrast PFO testing in fertile females may be most sensitive if conducted mid-cycle.

Autistic phenomena in neurotic patients.

I have described a group of patients who are seemingly successful in their professional and social lives, and who seek analysis ostensibly for professional reasons or for minor difficulties in their relationship. However, sooner or later they reveal phenomena which are strikingly similar to those observed in so-called autistic children. These autistic phenomena are characterized by an almost impenetrable encapsulation of part of the personality, mute and implacable resistance to change, and a lack of real emotional contact either with themselves or the analyst. Progress of the analysis reveals an underlying intense fear of pain, and of death, disintegration or breakdown. These anxieties occur as a reaction to real or feared separation, especially when commitment to analysis deepens. In the case I have described in detail the patient used various projective processes to deflect painful emotions either into other people, including the analyst, or into their own bodies. As a consequence the various objects or organs of the body swell up and became suffused with rage as a result of having to contain the unwanted feelings. This process leads in turn to intense persecutory fears and a heightened sensitivity to the analyst's tone of voice and facial expression. It would seem that the initial hypersensitivity of part of the personality is such as to lead it to anticipate danger to such an extent that it expels feelings even before they reach awareness. The sooner the analyst realizes the existence of this hidden part of the patient the less the danger of the analysis becoming an endless and meaningless intellectual dialogue and the greater the possibilities of the patient achieving a relatively stable equilibrium. Although the analyst has to live through a great deal of anxiety with the patient I feel that ultimately the results make it worth while.