Implicit memory during anaesthesia attempt at replication.

The present study investigated implicit memory during general anaesthesia in patients with elective surgery on the cervical or lumbar spine. A total of 37 patients were investigated, together with 59 healthy control subjects. The patients were divided into two groups. One group heard repeated presentations of common words (animals, flowers, countries) during anaesthesia. The other patient group heard only pink noise during anaesthesia. After surgery, all patients were asked spontaneously to name three countries, flowers, and animals. The healthy control subjects were simply asked "on the street" to spontaneously name three countries, flowers and animals. The results showed no statistically significant differences in frequency of hits for the three categories for the three groups. However, the highest hit rate was for the patient group who had heard the words during surgery (35% hits), with no difference between the other two groups (29% hits). The finding of no difference between the groups is discussed in the context of methodological issues when studying memory in anesthesia. It is, furthermore, argued that a healthy nonanesthesized control group is necessary when comparing hit rates between various anesthesized patient groups.

Surgery during inhalation with nitric oxide in a patient with severe adult respiratory distress syndrome (ARDS).

Nitric oxide (NO) is increasingly used in intensive care units (ICU) in order to treat serious hypoxaemia secondary to ARDS. Since interrupting NO delivery in such patients for more than a few minutes could lead to serious adverse events, moving the patient outside the ICU has been very difficult. Recently developed equipment (Noresc 1503) enabled us to deliver 10 or 20 ppm NO from a ventilatory bag with reservoir. This is used for ventilation under transport from the ICU to the operating theatre (OT) or radiology department. We present a patient with severe ARDS undergoing major surgery while being treated with NO. The patient could be moved to the OT and operated on during five hours without significant changes in vital functions.

The personal myth as a clinical concept.

The author argues that the concept of personal myth is taken to refer to a universal mythification process, and that such a broad definition is too imprecise for clinical purposes. Previous contributions to psychoanalytic understanding of myths are reviewed. The author concurs with Green's (1991) conception of the personal myth as a heroisation of the self, providing liberation from the mother. By means of a clinical vignette, it is argued that the myth may have additional functions. The myth is a multiply-determined psychological product, offering 'solutions' to insoluble human dilemmas, such as that of separation. Self-images embedded in myths may be organised as stable structures reflected in attitudes and personal styles. The author argues for the clinical usefulness of the concept of personal myth. The myth may act as a point of reference in the analytic process, and may serve as a reminder for the analyst to focus subtly embedded narcissistic aspects of character that may otherwise remain as an unanalysed resistance. It also has the property of evoking self states rooted in infantile modes of experience. It is argued that unveiling the myth is not contrary to safeguarding its creative side, but that the defensive, wish-fulfilling and illusory aspects of the myth should be uncovered.

Evaluation of therapeutic outcome: some reflections on methodology.

Problems connected with choice of outcome-criteria are discussed. Some results from an outcome study of student-conducted dynamic psychotherapies are presented. The discussion is focused on discrepancies between subjective data and more objective measures, as reflected in Rorschach test results. It is claimed that in order to give a meaningful interpretation of these discrepancies, a conception of hierarchically ordered structures of personality is needed. Such a conception also seems to represent a necessary supplement both to Malan's psychodynamic hypothesis and to outcome-research applying multidimensional outcome measures.

Epidural block in twin labour and delivery.

In a clinical study, 28 twin mothers were provided with epidural block during labour and delivery. This group was compared to 24 twin mothers who received conventional analgesics throughout labour. General anaesthesia was administered when operative delivery was indicated in the control group. In the epidural group, duration of labour was significantly prolonged. A delayed second stage of labour caused an increased number of operative vaginal deliveries. Intra-uterine asphyxia was not more frequent in the epidural group. Judged by the Apgar score and the neonatal course, there was no difference between the newborn in the two groups. Neither clinical evaluation, nor acid-base investigations showed any difference between the condition of Twin I and Twin II in the epidural group.