On the nature of dissociation.

Psychoanalysis cannot presently account for the paradoxical nature of dissociation--those states of simultaneous knowing and not knowing in which perceptions are accurate and fully conscious, yet have no credibility to the subject. This paper suggests that dissociation is actually a different way of knowing: the patient constructs self-knowledge only in interaction with another. The subject perceives sensations and states of mind, but relegates to another the job of interpreting this experience. The divided sense of self reflects a division of labor between the subject, who registers sensation, and the other, who names it. Consequently, what the dissociative patient recognizes as "me" is determined by another's interpretation, and the subject knows him- or herself only as he or she is known to another.

Subtrochanteric fracture after fixation of slipped capital femoral epiphysis: a complication of unused drill holes.

Subtrochanteric fracture of the femur has been infrequently reported after in situ fixation of slipped capital femoral epiphysis, and this occurred in only 1.4% of our patients over a 10-year period. As this technique is used more frequently, however, the incidence of this complication is likely to rise. All four subtrochanteric fractures occurred through unused drill holes, and avoiding extraneous screw holes seems to be the best way to prevent postoperative subtrochanteric fracture. Once subtrochanteric fracture occurs, immediate open reduction and internal fixation with a compression hip screw device is the recommended treatment.

Hanging head sign as a presenting feature of spinal cord neoplasms: a report of four cases.

A series of four patients presented with a common but unique finding: inability to hold the head in an upright position. Each complained of pain with attempts at passive extension of the neck. All subsequently were diagnosed with spinal cord neoplasms. The literature indicates that the more classic symptoms of spinal cord tumors are often slow to develop and exist for months before being accurately diagnosed. The "hanging head sign" may provide an earlier diagnosis of spinal cord lesions.

From hospitals to jails: the fate of California's deinstitutionalized mentally ill.

This paper describes a shift of mentally ill persons from custodial care in state institutions during the 1960s to prosecution in criminal courts during the 1970s. The shift is attributed to the unforeseen clinical needs of this new outpatient population, the inability of community mental health centers to meet these needs, and the changes in mental health laws, specifically their emphasis on the concept of dangerousness.

Pulmonary pathology in acute respiratory insufficiency: lung biopsy as a diagnostic tool.

Forty-two patients underwent open-lung biopsy during the early phase of acute respiratory insufficiency. Correlation between the gross appearance of the lung at operation and the microscopic findings was good. Although only fair correlation was found between lung and tracheal cultures, the findings of two positive cultures in the lung only was of utmost importance. Biopsying multiple areas from the same operation showed identical pathology in 86 per cent of cases. The mortality rate of open-lung biopsy was zero; the morbidity rate was 4 per cent. The over-all survival rate of acute respiratory insufficiency (ARI) due to trauma was 39 per cent; that of pneumonia, 11 per cent. In 17 (33 percent) patients specific diagnoses and/or specific therapies were employed as a direct result of the biopsy or the thoracotomy. The incidence and prognostic implications of fibrosis and microthromboembolism are presented and discussed. Open-lung biopsy has been extremely safe and valuable in characterizing and managing ARI.