Ego-structuring psychotherapy

Psychoanalysis regards psychosis as an early disturbance in the development of the personality, specifically, of the ego. The disturbance occurs during that period prior to the castration complex and thus before the phase when the ordering of relations becomes oedipal. Responsible for this disturbance is, according to Freud, foreclosure (verwerfung) of an important factor that normally accomplishes the primal repression (urverdr?ngung) and which renders repression proper (verdr?ngung) out of the question. According to Lacan this factor is the Name of the Father, which instigates the metaphorical dimension as such and, thereby, makes language come into action through a pact between the subject and the Other. In psychosis, Lacan postulates a foreclosure of the Name of the Father, which hinders the unconscious, structured as a language, from safeguarding the ego and the world, that is, the imaginary. Ego-structuring psychotherapy brings the Name of the Father into effect, enabling the psychotic person to become linguistically structured; consequently, a world view develops in the person and he or she becomes a historically determined person engaged in fulfilling a plan for life.     

Expressing effects of osteoporosis interventions in terms of postponing of fractures

OBJECTIVE: To estimate the effect from an osteoporosis intervention in terms of postponement of hip fractures. DESIGN: A Markov model using Nordic data on mortality and hip fracture incidence. PATIENTS: Women aged 50 years and older with increased risk of hip fracture. INTERVENTION: A hypothetical intervention that reduces the risk of hip fracture by 50%. MAIN OUTCOME MEASURES: Postponement of hip fractures--that is increase in expected fracture-free survival from osteoporosis interventions. RESULTS: A 1-year treatment would on average postpone hip fracture by 12 days if therapy were started at the age of 50 years and 23, 55, 90 or 74 days if the treatment were started at the ages of 60, 70, 80 or 90 years, respectively. For 10 years of treatment, the benefit was 146, 260, 369, 373 and 167 days, respectively. The younger the patient, the lower the risk of fracture and, consequently, the greater the benefit for those few who actually could benefit. CONCLUSIONS: The benefit in terms of average postponement of hip fractures from osteoporosis intervention was, other things being equal, greatest in women aged 70-90 years. Fracture postponement may represent an alternative to risk reductions in expressing the effect of osteoporosis interventions.     

Activation of KCNQ5 channels stably expressed in HEK293 cells by BMS-204352

The novel anti-ischemic compound, BMS-204352 ((3S)-(+)-(5-chloro-2-methoxyphenyl)-1,3-dihydro-3-fluoro-6-(trifluoromethyl)-2H-indol-2-one)), strongly activates the voltage-gated K+ channel KCNQ5 in a concentration-dependent manner with an EC50 of 2.4 microM. At 10 microM, BMS-204352 increased the steady state current at -30 mV by 12-fold, in contrast to the 2-fold increase observed for the other KCNQ channels [Schr?der et al., 2001]. Retigabine ((D-23129; N-(2-amino-4-(4-fluorobenzylamino)-phenyl) carbamic acid ethyl ester) induced a smaller, yet qualitatively similar effect on KCNQ5. Furthermore, BMS-204352 (10 microM) did not significantly shift the KCNQ5 activation curves (threshold and potential for half-activation, V1/2), as observed for the other KCNQ channels. In the presence of BMS-204352, the activation and deactivation kinetics of the KCNQ5 currents were slowed as the slow activation time constant increased up to 10-fold. The M-current blockers, linopirdine (DuP 996; 3,3-bis(4-pyridinylmethyl)-1-phenylindolin-2-one) and XE991 (10,10-bis(4-pyridinylmethyl)-9(10H)-anthracenone), inhibited the activation of the KCNQ5 channel induced by the BMS-204352. Thus, BMS-204352 appears to be an efficacious KCNQ channels activator, and the pharmacological properties of the compound on the KCNQ5 channel seems to be different from what has been obtained on the other KCNQ channels.     

Vasoactive intestinal polypeptide loses its ability to increase vaginal blood flow after menopause

The effect of vasoactive intestinal polypeptide on vaginal blood flow was investigated in postmenopausal women. In women who were receiving hormonal replacement therapy the vasodilatory response induced by vasoactive intestinal polypeptide was identical to that of young women, whereas in postmenopausal women who were receiving no replacement therapy, the response induced by vasoactive intestinal polypeptide was absent. Plasma levels of vasoactive intestinal polypeptide and systemic cardiovascular effects were identical in the two groups.     

Influence of endotoxin-induced sepsis on the requirements of propofol-fentanyl infusion rate in pigs

Endotoxin-induced sepsis in pigs is a recognized experimental model for the study of human septic shock. Generally, pigs are brought into general anaesthesia before sepsis is induced. It is our experience that drug dosages of propofol and fentanyl need to be reduced during endotoxin-induced sepsis, in order to prevent respiratory and cardiovascular depression, but the scientific evidence for this observation is lacking. Therefore, we measured the consumption of propofol and fentanyl at equal level of anaesthesia in pigs with (n = 5) and without (n = 5) endotoxin-induced sepsis, using the cerebral state index (CSI) as measure of anaesthetic depth. Infusion rates of propofol (P < 0.01) and fentanyl (P < 0.05) were significantly lower in septic pigs. Pigs with endotoxin-induced sepsis had an infusion rate of 2.2 mg/kg/hr (S.D. 0.5) for propofol and 12 microg/kg/hr (S.D. 2) for fentanyl, whereas healthy pigs had infusion rates of 3.5 mg/kg/hr (S.D. 0.6) and 17 microg/kg/hr (S.D. 4), respectively. CSI was equal in both groups throughout the experiment, and had a lowest average value of 47 (S.D. 10) at t = 30 in healthy pigs and reached a highest average value of 67 (S.D. 19) at t = 240 in pigs with endotoxin-induced sepsis. Anaesthetic depth was sufficient, assessed clinically, throughout the experiment in both groups. We concluded that the consumption of propofol and fentanyl was significantly reduced in pigs with endotoxin-induced sepsis. In the present study, we adjusted the level of anaesthesia according to clinical signs, and found good agreement with CSI.     

Short bowel syndrome and intestinal failure: consensus definitions and overview.

Short bowel syndrome (SBS)-associated intestinal failure is a highly disabling condition that impairs quality of life and social integration. Although the condition is not uniformly fatal, it might lead to serious, life-threatening complications. The basic goals of medical treatment are to maintain fluid, electrolyte, and nutrient balances and to make appropriate modifications in disease management to avoid side effects. Various definitions have been proposed for SBS and intestinal failure within the medical literature, but many focus on different aspects of the conditions, leading to confusion. In the past, identifying the cause of intestinal failure was of little consequence, because all patients were managed on total parenteral nutrition at home. However, with the recent development of medical therapies such as recombinant growth hormone, octreotide, and glucagon-like peptide-2 analogues and with improvements in small bowel transplantation, many patients can be made nutritionally autonomous. To evaluate the relative efficacy of these therapies, there is now a need to develop consensus definitions so that patients can be properly categorized before therapy. To this end, a group of experts on the subject was convened to develop the following new definitions: "Intestinal failure results from obstruction, dysmotility, surgical resection, congenital defect, or disease-associated loss of absorption and is characterized by the inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance." "Short-bowel syndrome results from surgical resection, congenital defect, or disease-associated loss of absorption and is characterized by the inability to maintain protein-energy, fluid, electrolyte, or micronutrient balances when on a conventionally accepted, normal diet."     

Annoyance and performance during the experimental chemical challenge of subjects with multiple chemical sensitivity

OBJECTIVES: This study explored the subjective reactions and psychological test performance of smell-intolerant subjects during consecutive challenges to chemicals with contrasting neurotoxic properties. METHODS: Women with symptoms compatible with multiple chemical sensitivity (N=10) and healthy referents (N=20) were individually challenged in an exposure chamber. All the subjects attended two separate 2-hour sessions of exposure to n-butyl acetate and toluene, in counterbalanced sequence. After an initial phase without exposure, air concentrations were increased in steps ranging from 3.6 to 57 mg/m3 for n-butyl acetate and from 11 to 180 mg/m3 for toluene. The response measures comprised ratings of annoyance and smell intensity and also neurobehavioral test performance. RESULTS: Both groups showed an increase in annoyance ratings and a decrease in test performance in the initial unexposed chamber phase and also in the first phase of the chemical exposure, these results indicating slight immediate expectancy or "suggestion" effects. During the six chamber phases, the ratings of mucous membrane irritation and fatigue showed a steeper increase in the group with multiple chemical sensitivity than among the referents, while the ratings of smell intensity and smell annoyance were similar in the two groups. A reduction in test performance was observed during the chamber phases, particularly in the group with multiple chemical sensitivity. No relation was found between the ratings or performance and chemical substance. CONCLUSIONS: Stronger immediate expectancy or "suggestion" reactions than normal did not characterize the group with multiple chemical sensitivity. This group showed a stronger than normal gradual build-up of fatigue, mucous membrane irritation, and reduced performance during chemical exposure. The results offer the most support to an irritative basis for multiple chemical sensitivity.     

Cost-effectiveness of alendronate in the prevention of osteoporotic fractures in Danish women

Pharmacological interventions for osteoporosis may reduce morbidity and mortality, but they incur additional health care costs. The aim was to quantify the additional costs and health benefits of prescribing alendronate 10 mg and calcium/vitamin D daily for 71-year-old women with a fracture risk twice that of the population average in stead of calcium/vitamin D alone. A state transition model based primarily on Scandinavian data was developed. Women were followed from age of 71 years until 100. Alendronate was assumed to reduce the fracture risk by 50%. Health benefits from the interventions were expressed in terms of life years, quality adjusted life years, and fractures avoided. Societal costs were estimated using literature estimates and Danish tariffs. All costs were measured in 2002 Danish Kroner (DKK). Future costs and benefits were discounted at 5% per year. The incremental cost per QALY gained was DKK125,000 while the cost per life year gained was DKK 374,000. The use of alendronate was cost-saving when 1) the treatment was extended to five years, 2) the risk of fracture was four times the population average, 3) the effect of alendronate was assumed to persist for three years after discontinuation of treatment, 4) a greater proportion had severe sequelae after a hip fracture, or 5) the start of therapy was delayed until age of 77 years. In conclusion, the use of alendronate compares well with other well established therapies in terms of cost-effectiveness in older women with high risk of fracture.     

Aero-medical evacuation with interventional lung assist in lung failure patients

OBJECTIVE: Acute respiratory failure can make long distance transport by air extremely difficult. Despite pressurised cabins, the pressure will fall to about three quarters of one atmosphere, and the oxygen partial pressure will fall proportionally. Interventional lung assist (iLA) is a well documented treatment in the critical care unit, but has not been evaluated scientifically in long range aero-medical evacuation. The present animal study was performed to test the feasibility of treating lung failure with iLA during intercontinental air evacuation in a military setting. METHODS: Eight adult female pigs were cannulated in the right axillary artery and the right jugular vein. An arterio-venous iLA device (Novalung) was connected. The ventilator was adjusted to below half of the needed minute volume before the use of iLA. The animals went through different modalities of transportation in ambulances, helicopters and aircraft. Two of the pigs were tested in a hypobaric chamber, and the remaining two animals underwent a 7.5 h intercontinental transportation from Denmark to Greenland in a Hercules C130J transport airplane. RESULTS: It was possible to maintain physiological PaCO(2) and PaO(2) in normal flight altitudes with iLA. Compared to pump-driven ECMO systems iLA is safer and more efficient. The current study demonstrates the feasibility of iLA during military aero-medical evacuation.