Anxiety, nostalgia and melancholy. A few remarks on psychoanalysis and tango

Our work is based on the application of psychoanalytic techniques, in order to unveil this cultural phenomenon called tango, related with sexuality and unconscious processes. As a way of introduction, it deals with a brief theory of the birth of tango, the possible terminological source of its name, its main creators and interpreters, as well as the chronological classification into the first wave tangos, Guardia Vieja, and the newer wave tangos, Guardia Nueva. The former ones were awash with festive themes of the centennial years, expressed in behaviors that denote sexuality and love, whereas the latter ones, expose the great bewilderment of the thirties' crisis, due to the imminent downfall of the country, the denunciation of materialism, the crumbling of ideas; which led up to feelings of utter pessimism, loneliness and abandonment. From this point onwards, through the use of techniques provided by psychoanalysis applied to tango lyrics, we are able to unravel the unconscious processes of the drama of its characters; the immigrant, hopeful and at same time nostalgic for the loss of his mother country; the porteno -urban man from Buenos Aires city- who, overwhelmed by immigrants, has to give way to the new compatriots; the inland inhabitant, who was dragged to the city because of the new conditions of rural work; and finally the conventillo, tenement house, as a melting pot that fulfilled the integration of these groups. Like in a painter's palette, which contains various colors and shades, the interpretations about nostalgia, grief and loneliness become apparent, along with the father-son rivalry, the conflict with the absent mother, the relationship between sexes, male chauvinism, infatuation, identity, the fear of death, the rebirth to a new life, the passage from gaucho to guapo, from a shrewd horseman to a daring, bullying braggart.     

Stimulation electromyography as a method of intraoperative localization and identification of the facial nerve during parotidectomy: review of 15 consecutive parotid surgeries

INTRODUCTION: It has been widely recognized that one of the major hazards during operation of the parotid gland, mainly in tumor resection, is the injury of the facial nerve. Facial nerve monitoring has achieved wide application in otologic and neurotologic procedures to help localization and protection of the facal nerve in the temporal bone. MATERIAL AND METHODS: The authors analyze localization and identification of 15 nerves in 15 patients who underwent parotid gland surgery in the Department of Ear Nose and Throat Diseases of the Medical University in Plovdiv from September 15, 2000 to December 15, 2000. Nerve integrity monitor Neurosign 100 and specially designed electromyographic electrodes were used. RESULTS: In all patients stimulation electromyography of the facial nerve was successfully used to locate, identify and evaluate the integrity of the facial nerve during and at the end of the operation. No postoperative facial nerve injury was detected clinically. In two patients with parotid gland cancer the inferior division of the facial nerve was found infiltrated by the cancer growth. CONCLUSION: The results indicate that identification of the facial nerve by electromyography is a safe, effective and simple method of electrophysiologic monitoring during parotid gland surgery. This method allows assessment of the nerve integrity at the end of the operation.     

Method of anaesthesia in thyroid surgery with intraoperative monitoring of the recurrent laryngeal nerves

INTRODUCTION: The incidence of injury of the recurrent laryngeal nerve (RLN) in various types of surgery is reported to be as high as 12%. By monitoring the recurrent laryngeal nerve intraoperatively we can identify it and preserve it even in atypical positions or in operations for processes involving the nerve. These types of surgery give rise to some specific problems facing the anaesthesiologist and the method of anaesthesia used. AIM: The aim of the study was to assess the efficacy and relevance of an anesthetic method in thyroid surgery with intraoperative monitoring of the RLN. Tasks: 1. To determine the level of myorelaxation in anaesthetic patients by intraoperative neurostimulation of the ulnar nerve. 2. By careful dosing of the non-depolarizing myorelaxants to create a "window" in the myorelaxation immediately before identification of the RLN that is detected by a neurostimulator. MATERIAL AND METHODS: Forty eight patients subjected to different types of thyroid surgery were given inhalational anaesthesia with supplementation of non-depolarizing myorelaxants. The level of relaxation was constantly monitored by neurostimulation of the left ulnar nerve. This peripheral stimulation allows creating a "window" in the myorelaxation just before the identification of the recurrent laryngeal nerve. RESULTS: There were no perioperative complications in all patients as to both surgery and anesthesia; postoperative comfort was achieved. The recurrent laryngeal nerve was readily identified and its function was preserved in the postoperative period. CONCLUSIONS: The authors consider as a method of choice the general inhalational anaesthesia supplemented with non-depolarizing myorelaxants and permanent intraoperative monitoring of the level of relaxation in surgery with intraoperative monitoring of the cranial nerve and recurrent laryngeal nerve.     

Intraoperative identification of recurrent laryngeal nerves in thyroid surgery by electrical stimulation

INTRODUCTION: Iatrogenic injury of the recurrent laryngeal nerve and its prevention is one of the controversial issues in thyroid surgery. The incidence of this operative complication ranges from 0.4% to 3.9%. PATIENTS AND METHODS: The authors analysed the results of the identification of 114 nerves in 60 patients who underwent thyroid surgery between July 9, 1999 and December 19, 2000 in the 3rd Surgical Clinic at the Department of Clinical Surgery and in the Department of Ear Nose and Throat Diseases of the Medical University in Plovdiv, Bulgaria. Nerve integrity monitor Neurosign 100 and specially designed EMG electrodes (Magstim Company Ltd., Wales, UK) were used. The patients were examined pre- and postoperatively for vocal cord paralysis by otolarygologist. RESULTS: In all patients electrical stimulation of the recurrent laryngeal nerve was successfully used for identification of the nerve and evaluation of its integrity during and at the end of the operation. No postoperative recurrent laryngeal nerve deficit was detected clinically. CONCLUSIONS: The results indicate that the identification of the recurrent laryngeal nerve by electromyography is a safe, effective and simple method for electrophysiologic monitoring during thyroid surgery. This method allows assessment of the neural integrity at the end of the procedure.     

Acute unilateral pulmonary nonventilation due to mucous plugs

Acute bronchial obstruction by mucous plugs may be manifested clinically by dyspnea, hypoxemia, and respiratory alkalosis mimicking pulmonary thromboembolism. In eight cases with complete interruption of ventilation to an entire lung, chest radiography failed to reveal the extent of the obstruction. Perfusion was substantially less affected than ventilation. Routine ventilation-perfusion scintigraphy with technetium-99m DTPA aerosol aids in the diagnosis of acute major bronchial obstruction in patients with suspected pulmonary thromboembolism.     

Severe malaria in children in Papua New Guinea

The clinical features of severe falciparum malaria and risk factors for mortality were studied in 489 children admitted with malaria to Madang Hospital, Papua New Guinea. The most common severe manifestations of malaria were severe anaemia (22%) and coma (16%). Children with severe anaemia were younger than those with coma (median age 2.2 vs. 3.7 years) and had been ill for longer before admission (median 7 vs. 4 days, respectively). Although the clinical features of coma in Madang children with malaria resembled closely those reported in African children, mortality was lower (8% vs. 17-25%, respectively). Overall, 17 (3.5%) children died, most within 12 h of admission. A high level of plasma lactate (> or = 5 mmol/l) was common (20%) and was the major predictor of death in multiple regression analysis. Raised plasma creatinine and decreased plasma bicarbonate were also independent predictors of mortality. Coma was not predictive of death, although a high proportion of children with profound coma died. Investigation of the causes of acidosis in children with malaria is a high research priority. In view of the short time interval between admission and death in many children, emphasis must be placed on the prevention or early recognition and treatment of acidosis in the district health clinic as well as the central hospital.      

Patterns of Depressive Symptoms in Children

PROBLEM: Depressive symptoms in children have been linked to recurrent problems with depression, school problems, and risky health behaviors. Adolescent girls report depressive symptoms three to four times more frequently than adolescent boys. Few studies, however, have examined gender-related depressive symptoms in younger, school-aged children. METHODS: In the present study, gender differences in depressive symptoms in children ages 10-12 years were explored using the Children's Depression Inventory (CDI) with a convenience sample of 122 suburban middle-class public school fifth and sixth graders. FINDINGS: A distinct pattern of depressive symptom expression was found with girls reporting more internalizing and more negative self-esteem, and boys reporting more externalizing and more school problems. CONCLUSION: These findings suggest that despite similarities on a total depressive symptom score, there are distinct gender differences in depressive symptom expression that are identifiable before adolescence and may be associated with normative development.     

Antihypertensive efficacy of metoprolol XL/Low dose chlorthalidone (6.25 mg) combination: a randomized,comparative study in Indian patients with mild-to-moderate essential hypertension

Objective

High blood pressure is one of the most important risk factors, directly responsible for increasing the cardiovascular morbidity and mortality. The primary objective was to evaluate the efficacy of metoprolol XL/chlorthalidone against metoprolol XL/hydrochlorothiazide with respect to mean fall in systolic and diastolic blood pressure. The secondary objective was to compare the response rates and to evaluate the tolerability of study medications in patients with mild-tomoderate essential hypertension.

Methods

Total 130 eligible patients (65: metoprolol XL 25 mg/chlorthalidone 6.25 mg; 65: metoprolol XL 25 mg/HCTZ 12.5 mg) were enrolled in this randomized, comparative, multicentric, 12-weeks study. Sixty-two patients from each group completed the study. After 4-weeks of treatment, non-responders from chlorthalidone 6.25 mg combination group were shifted to metoprolol XL 50 mg/chlorthalidone 12.5 mg and non-responders from HCTZ 12.5 mg combination group were escalated to metoprolol XL 50 mg/HCTZ 12.5 mg.

Results

The study treatment groups were comparable with respect to demography and baseline disease characteristics. Both the starting therapies were comparable with respect to mean fall in SBP (p = 0.788) and DBP (p = 0.939), and response rates (p = 1.0) after 4-weeks of therapy. Also both the step-up therapies showed similar mean fall in SBP (p = 0.277) and DBP (p = 0.507) at the end of 12-weeks. However, significantly more number of patients from chlorthalidone 12.5 mg/metoprolol XL 50 mg group responded to therapy as compared to that from HCTZ 12.5 mg/metoprolol XL 50 mg group (p = 0.045). All the reported adverse events were of mild-to-moderate intensity. There were no clinically significant trends in electrolytes (Na⁺, K⁺, Cl^-)and fasting blood sugar, evident across the treatment groups.

Conclusion

Chlorthalidone in combination with metoprolol XL is as effective and well tolerated as widely used combination of metoprolol XL/HCTZ, thus providing an alternative therapeutic option.