ABSTRACT
A patient with a diagnosis of Ehlers-Danlos syndrome was scheduled to undergo elective caesarean section with a combined spinal-epidural anaesthetic technique. The epidural attempt resulted in an inadvertent dural puncture, and we decided subsequently to place an intrathecal catheter. She required high repeated doses of hyperbaric bupivacaine (32.5 mg over 1 h) through the catheter to establish adequate sensory blockade, together with supplemental analgesic techniques. Soon after the procedure, she recovered motor function rapidly and required further supplemental analgesia. We believe this is the first report of possible local anaesthetic resistance with an intrathecal catheter anaesthetic technique for a patient with Ehlers-Danlos syndrome. If there is resistance to the first dose of intrathecal local anaesthetic, a general anaesthetic may be the best option for such patients.
Subject(s)
Health Care Reform , Health Policy , Marketing of Health Services , Europe, Eastern , Health Services Research , HumansABSTRACT
The health care system in Poland is characterised by central planning, by lack of separation of the preventive function and by being financed by the state. The author proposes a new approach which is now feasible within the framework of a democratic, elected government. Certain factors are proposed which will create a different and more effective health care system responsive to local need. These factors include separation of preventive and therapeutic functions, the provision of both public and private health insurance and local determination of needs and services.
Subject(s)
Health Care Reform/organization & administration , Health Planning/organization & administration , Health Policy , Humans , Poland , Social ChangeABSTRACT
Competition is an important force behind evolution in present-day ecological conditions, its intensity varying according to the organisms' expectations vis-à-vis resources available. On the other hand, the role of mutation in the evolutionary process can hardly be underestimated: Leading to the change of the preconsciously functioning archetype, mutation makes it impossible for the ego to realize its image. This is a consequence of the clash between the mutated, preconsciously functioning archetype and the system of ethical and moral norms functioning in the collective superego of a given population group. The type of mutation that results from the accelerated pace of evolution can be viewed as a continuity in the development of an organism's behavior. The preconsciously functioning archetype, resulting from these mutations, contains impulses and predispositions that differ markedly from the impulses and predispositions functioning in the genetically determined "pattern of behavior." In a situation where anxiety results from the inhibition of impulses and dispositions, hostility reactions are likely to occur. In its turn, reactive hostility can induce anxiety, thus creating a reaction cycle. Underlying this mechanism is the mutated, preconsciously functioning archetype, which itself is a result of the development of civilization in our contemporary world.
Subject(s)
Adaptation, Psychological , Aggression/psychology , Anxiety/psychology , Hostility , Psychoanalytic Interpretation , Social Environment , HumansSubject(s)
Anxiety/psychology , Personality Development , Psychoanalytic Theory , Social Environment , Arousal , Conflict, Psychological , HumansABSTRACT
Clonidine (ip) and methoxamine (ivc) inhibit the catalepsy produced by haloperidol or fluphenazine. Naphazoline and xylometazoline antagonize the catalepsy produced by haloperidol, but do not affect significantly that produced by fluphenazine. Phenylephrine did not affect the catalepsy produced by either neuroleptic. The results indicate that drugs stimulating central noradrenergic receptors antagonize the action of compounds blocking the central dopaminergic receptors.
