The unbearable agony of being: interpreting tormented states of mind in the psychoanalysis of sexually traumatized patients.

This article focuses on the clinical importance of the disturbing transference-countertransference matrix in the psychoanalysis of patients whose ego development was decisively influenced by early, traumatic sexual abuse. Dissociative defensive operations and "automatic" identifications are emphasized in accounting for the sadomasochistic and other characteristic features of the "traumatic" transference-countertransference ambiance. Two clinical vignettes depict the analyst's need to take his or her own disturbing experience as an object of analytic examination, while illustrating how "here-and-now" transference cues are used to interpret the patient's efforts to cope with overwhelming, traumatized states of mind.

A comparison of direct and indirect (oscillometric) measurements of arterial blood pressure in anaesthetised dogs, using tail and limb cuffs.

Oscillometric measurements of arterial blood pressure were compared with direct measurements in anaesthetised dogs being monitored during routine surgery. Readings were obtained with tail cuffs and limb cuffs and the reproducibility (precision) of the readings from various cuff sites was also compared in conscious dogs. Tail cuffs gave the best precision in conscious dogs and the closest correlation with direct measurements in anaesthetised dogs, especially for systolic pressure. The proximal hindlimb site gave results with a slightly lower precision.

Radiofrequency thermal angioplasty maintains arterial duct patency. An experimental study.

BACKGROUND: Long-term maintenance of arterial duct patency by a catheter technique would be a valuable nonsurgical method of palliation for duct-dependent circulations. We used a new method: percutaneous radiofrequency thermal balloon angioplasty of neonatal lamb arterial ducts. METHODS AND RESULTS: Radiofrequency balloons 5 or 6 mm in diameter were introduced via the femoral vein of 32 neonatal lambs and inflated to 4 atm. In 28, a radiofrequency generator was used to heat the saline/contrast mixture in the balloon to 65 degrees C (n = 2), 75 degrees C (n = 2), 85 degrees C (n = 10), 100 degrees C (n = 8), and 120 degrees C (n = 6). In 4 lambs, angioplasty alone was performed. Lambs were recatheterized to assess patency at intervals up to 78 weeks. Immediate results showed the arterial duct to be patent in all cases, with a mean rise in systolic pulmonary artery pressure of 13 +/- 8 mm Hg and a mean rise in pulmonary artery oxygen saturation of 12 +/- 15%. With a mean follow-up of 45.7 +/- 28 weeks, 3 of the 4 (75%) angioplasty alone ducts closed, but only 5 of the 28 (18%) radiofrequency-treated ducts (P < .05). The mean rise in oxygen saturation between the superior vena cava and the pulmonary artery was 7.6 +/- 7% at last follow-up. Follow-up angiography of the arterial ducts showed the development of stenoses in all patent ducts. CONCLUSIONS: Radiofrequency thermal balloon angioplasty leads to long-term arterial duct patency in lambs in > 80% of the treated group and is significantly more effective than balloon angioplasty alone.

Clinical evaluation of romifidine/ketamine/halothane anaesthesia in horses.

Romifidine, 100 micrograms/kg administered by intravenous injection, was evaluated as a premedicant to ketamine/halothane anaesthesia in 60 horses. Sedation developed within one to two minutes. In three cases mild staggering occurred within two minutes. Anaesthesia was induced after five minutes by the intravenous administration of ketamine (2 to 2.2 mg/kg). A mean time of 79 seconds elapsed before lateral recumbency was adopted. Fifty-four of the horses sank smoothly to the floor, with occasional steps sideways. Jaw tone, limb rigidity and mild muscle tremors often persisted for short periods after induction. Complete relaxation was achieved on average two minutes after the administration of ketamine. The transition to oxygen/halothane anaesthesia was excellent or good in 53 cases. The mean duration of anaesthesia was 79 minutes. Forty-seven of the horses were able to stand after one or two attempts with little or no ataxia. After halothane administration ceased, the mean time to sternal recumbency was 25 minutes and the mean time to standing was 33 minutes. Most horses appeared to be sedated upon standing, but they were able to walk soon after regaining their feet. The characteristics of the induction of anaesthesia were similar to those seen when detomidine/ketamine or xylazine/ketamine are used. The maintenance of anaesthesia with halothane was similar to that following other induction protocols, and the recovery from anaesthesia was smooth and free from excitement.

Clinical evaluation of an infusion of xylazine, guaifenesin and ketamine for maintenance of anaesthesia in horses.

General anaesthesia was maintained in 40 horses by the continuous intravenous infusion of a mixture of 500 ml 10% guaifenesin solution, 1 g ketamine and 500 mg xylazine. The median duration of infusion was 65 mins (interquartile range 51-95 mins). Anaesthesia was characterised by active palpebral reflexes, variable degrees of nystagmus and occasional swallowing. Swallowing was considered to be undesirable in horses undergoing laryngeal surgery, but the infusion produced satisfactory conditions for all other surgical procedures performed. Arterial blood pressure was well maintained in all cases (median mean arterial blood pressure = 85 mmHg after 30 mins anaesthesia). Heart rate and PaCO2 were significantly lower, whilst PaO2 was significantly higher in the infusion group than in a group of paired control horses which were anaesthetised with halothane. Recovery from anaesthesia was good (Grades 1-2) in 33 horses. Median times to sternal recumbency and to standing were 24 and 38 mins respectively. The infusion caused a significant fall in packed cell volume, haemoglobin concentration and red blood cell count (P < 0.01) and a significant rise in plasma glucose concentration (P < 0.01). These variables returned to pre-infusion values within 24 h.

Becoming a father: a psychoanalytic perspective on the forgotten parent.

This article has presented a psychoanalytic perspective on the process of becoming a father. It began with a discussion of the neglect of the father during pregnancy and briefly considered evidence as to the unique contributions made by fathers of the newborn. Nine psychodynamically based wishes emerging throughout the developmental process were next proposed to embody the male's motivation to become a father. The final section examined seven specific phases of expectant fatherhood, from getting ready through parturition.

Mutagenicity tests of fabric-finishing agents in Salmonella typhimurium: fiber-reactive wool dyes and cotton flame retardants.

Thirty-nine fabric-finishing agents were tested for mutagenic activity in Salmonella typhimurium. Twenty-four fiber-reactive wool dyes and three acid dyes (not fiber-reactive) were screened by spot tests in strains TA100, TA98, TA1535, and TA1537. Among these dyes, seven bromoacrylamide dyes and one vinyl sulfone dye were mutagenic. Additionally, one of the three acid dyes was mutagenic in spot tests. The mutagenicity of the acid dye was due to an impurity or breakdown product rather than to the dye itself; the origin of the activities of the other dyes is unknown. No mutagenicity was observed among five chlorotriazine or four sulfonyl-ethane sulfonic acid dyes. Eight phosphorus-containing flame retardants (phosphonium, phosphine, phosphine oxide, and phosphonic acid derivatives) and methyl-N-methylolcarbamate, which is employed to obtain a flame-retardant finish on cotton, were tested for mutagenicity in strains TA100, TA98, TA1535, and TA1537, using quantitative incorporation assays. All were nonmutagenic. Two of three bromoalkyl-substituted triazine flame retardants were mutagenic in strains TA100 and TA1535. It is unknown whether this activity is due to impurities or to the parent compound. The flame retardants tested were either in actual commercial use or in experimental development for potential commercial processes. These results indicate the need for early testing of potential fabric-finishing agents and processes.

Reduction of postoperative vomiting by preoperative administration of oral metoclopramide.

Preoperative oral metoclopramide was evaluted as a postoperative antiemetic agent. Two series of approximately one hundred patients were investigated in this context. One series was carefully controlled with regard to anaesthetic agents and technique. The other series had only one criterion of admission--the exclusion of narcotics. All patients received metoclopramide 20 mg by mouth or a placebo two hours before anaesthesia in a randomized double-blind fashion. A significant reduction in postoperative symptoms of antiperistalsis was observed in the metoclopramide-treated patients. On closer scrutiny it became apparent that, under these circumstances, metoclopramide is significantly more effective in males.