Vicissitudes of bisexuality. Crucial points and clinical implications

The author begins by noting that the heuristic value of the concept of bisexuality can be explored in two directions, involving respectively its role in psychopathology and in the development of creativity and thought. The author concentrates on the first of these aspects, which entails a reconsideration of the 'phallic question'. The status of femininity is investigated on the basis of Freud's and Winnicott's theories of bisexuality and the author here finds an explanation for the repudiation of femininity and for the 'phallic question' thereby implied, which represents the underlying bedrock resulting in interminable analyses. An important element in this rejection is stated to be the maternal aspect of femininity. Particular reference is made to the somatic roots of phallic defences and to their effects on thought and symbolisation. Some brief clinical examples are presented to suggest that the bedrock may be due to the distorted use of sensoriality and of the erotogenic zones. The author contends that the anal zone plays a crucial part in the manifestations of bisexuality and contrasts phallic logic with the logic of triangulation. Numerous literature references and clinical examples support and illustrate her arguments throughout. The author ends with a discussion of the implications of bisexuality for thought and knowledge.

Alternative technique for subclavian vein cannulation

BACKGROUND

Subclavian vein catheterism, a commonly used methodology in ICU, is not devoid of complications, even some serious ones (Pneumothorax 0.5%).

METHODS

The authors propose an alternative technique based on the use of an introducer needle bent on its own axis to form an arch with its concavity turned towards the Quincke point. On searching the blood vessel, once the subclavian plane has been reached, the needle advancement towards the jugular fosse happens by following the needle curvature. In this way the operator can keep the needle on a plane parallel to the cutaneous one, and all the complications due to involuntary exceeding of the costal plane are avoided. The response of this new technique in 110 patients (study group) is compared through a retrospective study, to 100 patients with whom the standard technique has been used (control group).

RESULTS

The study group has presented a significant reduction both of total complications (p<0.05) and of total failures (p< 0.01).

CONCLUSIONS

Such results, although pertinent to a still limited study, testify to an improvement in terms of security and efficacy, with the new alternative technique without an increase in costs.

Thromboembolism in pregnancy: a new temporary caval filter

BACKGROUND

Our aim was to check out the advantages of temporary caval filtration in pregnancy with a retrievable filter: Tempofilter (tCF).

METHODS

During a period of 2 years we implanted tCF in four patients at the third pregnancy trimester with serious acute deep venous thrombosis (DVT) of the lower limbs for prophylaxis of pulmonary thromboembolic disease (TED) in the pre-partum, during Caesarian section (CS), and in the post-partum period. tCF has been placed percutaneously in local anaesthesia using the Seldinger technique and under image intensifier control. All procedures were performed in a polyvalent ICU.

RESULTS

tCF positioning was always easy. No complications linked to the adopted technique occurred. No incidence of pulmonary embolism was reported (PE). The permanence period of tCF in situ was 14 to 29 days (mean+/-SD: 21+/-6). The CS always took place without complications either for the patient or for the foetus.

CONCLUSIONS

The combined use of tCF and an anti-coagulating therapy resulted in an effective prophylaxis of TED for the pregnant woman without any interferences with CS and with no consequence as for permanent endovascular prosthesis for the young patient herself.

Novel mutations and structural implications in R-type pyruvate kinase-deficient patients from Southern Italy

Deficiency of the R-type pyruvate kinase (R-PK) causes an autosomal recessive, hereditary, nonspherocytic hemolytic anemia (HNSHA). We screened seven unrelated patients from the south of Italy for the known mutations and found one patient homozygous for the 1529A (R510Q) mutation, two others bearing the 1456T (R486W) mutation, one homozygous and another heterozygous, and two heterozygotes for the 994A mutation (G332S). We also found three novel mutations at the heterozygote status: a G to C transversion in position 1010 (1010C; R337P) and a C to T transition in position 1492 (1492T; R498C), which are missense, and a T to G transversion in position 1523 (1523G; L508Z), which produces a stop codon with a subsequent loss of the C-terminal protein domain. The structural features of R-PK in the mutation-bearing regions were examined. In all cases the mutations altered the local conformation of the enzyme. Both G332S and R337P are in highly conserved sequence regions. In particular, the R337P mutation significantly affects the intersubunit interactions, because it is located in a region subjected to a large conformational change that occurs during the R-->T allosteric transition, which is essential for the enzyme activity. The R486W mutation affects an external pocketlike region, producing only a local conformational change; the R498C mutation changes the interactions among neighbouring residues; the R510Q mutation involves the loss of interdomain interactions that may reduce enzyme stability and activity. Our data also indicate that in patients from Southern Italy, pyruvate kinase deficiency is heterogeneous, the 1529A mutation, which is the most frequent mutation in the U.S. Caucasian population, having a lower frequency.

A genome-wide search for susceptibility loci to human essential hypertension

We undertook a systematic search of the entire human genome with the affected sibling-pair model to identify major susceptibility loci to essential hypertension. Affected nuclear families (n=263) were recruited and divided according to definite or probable genetic contribution to hypertension depending on number of hypertensive siblings. The largest nuclear families were first screened with a set of microsatellite markers. Regions on the genome with P<0.05 were tested against the second set of smaller families. An exclusion map was generated to identify regions in which hypertension-causing genes are unlikely to reside. Sibling-pair linkage analysis identified a single locus on chromosome 11q (P<0.004) in the first pass. A second pass with nuclear families that had only affected sibling pairs was, as expected, insufficient to support linkage to 11q. Multipoint exclusion-linkage analysis showed that 3 genetic loci are necessary to explain familial aggregation of essential hypertension. Our preliminary findings suggest that no single region within the human genome contains genes with a major contribution to essential hypertension. We show that the disease is indeed polygenic, with each gene providing a relatively small risk. Our exclusion map will help future investigators to concentrate on areas likely to contain these genes. The region on chromosome 11 is the first to point to a new candidate gene for hypertension that has arisen out of a genome search, but replication of these results at a higher significance is necessary before positional cloning can be justified.

Identification of monozygotic twins that are concordant for preeclampsia

Preeclampsia is thought to be discordant in monozygotic twins. While recruiting for a genetic study into preeclampsia, we identified 4 sets of twins and a triplet gestation; all were monozygous on deoxyribonucleic acid "fingerprinting." Two twins were concordant for preeclampsia, and 2 of the triplets had pregnancy-induced hypertension, although only 1 of them had proteinuria. Hence we confirm the existence of monozygotic twins that are concordant for preeclampsia.

Factor V Leiden and thermolabile methylenetetrahydrofolate reductase gene variants in an East Anglian preeclampsia cohort

Preeclampsia is a heritable condition that develops as a result of widespread vascular endothelial dysfunction. The thrombotic tendency in this condition has suggested a number of candidate genes, and there have been recent reports of positive association with the Leiden variant of factor V and the thermolabile variant of methylenetetrahydrofolate reductase. We attempted to reproduce these results in a large cohort of well-characterized women with preeclampsia, recruited prospectively within the East Anglian region of the United Kingdom. Women in the preeclampsia cohort (n=283) were genotyped for both the Leiden variant (G1691A) of factor V and the thermolabile variant (C677T) of methylenetetrahydrofolate reductase. Genotype and allele frequencies were compared with those of 2 control groups, one consisting of women recruited prospectively (n=100) from the same maternity hospital as the subjects and another consisting of normotensive women (n=100) from East Anglia. No significant differences were detected. Specifically, the carrier rate for the Leiden variant was 5.3% in the preeclampsia group and 5. 5% in the combined control group. T677 homozygotes for methylenetetrahydrofolate reductase were 11% and 11.5% in the 2 groups, respectively. We conclude that there is no evidence of association of preeclampsia with either of these 2 polymorphisms in our study population.

[Consequences of cocaine addiction during pregnancy on the development in the child]

Cocaine facilitates neurotransmitter release from the central nervous system, decreases their re-uptake at the synapse junction level and increases their blood level due to receptors blockade. During pregnancy cocaine inhibits uterine adrenergic beta receptors and easily crosses the placenta, the main obstetrical consequences of overstimulation of the noradrenergic system being miscarriage, retroplacental haematoma, ruptured uterus, short and premature labour. Fetal and neonatal consequences resulting from both a decreased uterine blood flow and a direct effect of cocaine on fetal development can be severe. Decreased uterine blood flow lowers oxygen and nutriment transport which in turn can induce intra-uterine growth retardation. The direct effect of cocaine on the fetus is responsible for an increased catecholamine plasma concentration leading to vasoconstriction episodes, increased heart rate and blood pressure, and subsequent oxygen requirement. Several malformations have been reported, sometimes severe (involving central nervous system, heart, digestive tract, urinary tract and bone) that are mainly due to fetal circulation failure. Cocaine can also directly alter brain development because of neuronal mistargeting within the cerebral cortex.

Molecular characterization of G6PD deficiency in Southern Italy: heterogeneity, correlation genotype-phenotype and description of a new variant (G6PD Neapolis)

We report on the molecular basis of glucose-6-phosphate dehydrogenase (G6PD) deficiency in Southern Italy (Campania region). Thirty-one unrelated G6PD-deficient males were analysed at DNA level for the presence of G6PD gene mutations. Nine different G6PD variants were identified, eight of which have already been described (Mediterranean, Seattle, two different A-, Santamaria, Cassano, Union and Cosenza). G6PD Mediterranean, Santamaria, A- and Union were associated with haemolytic episodes. G6PD Seattle, which is polymorphic in several populations, Cassano and Cosenza appeared to be asymptomatic. A new variant (G6PD Neapolis) is reported here. The 467(Pro-->Arg) substitution responsible for G6PD Neapolis is discussed in the light of the current 3D model of human G6PD and in comparison with other natural mutations which occur in the proximity of residue 467.

Advances in prevention of radiation damage to visceral and solid organs in patients requiring radiation therapy of the trunk

BACKGROUND

As a part of multimodality therapy, many patients with tumors of the trunk receive radiation therapy. The major morbidity of this therapy is often secondary to incidental radiation damage to tissues adjacent to treatment areas.

METHODS

We detail our use of saline breast implants placed in polyglycolic acid mesh sheets to displace visceral and solid organs away from the radiation field.

RESULTS

Analysis of CT scans and dose volume histograms reveal that this technique successfully displaces uninvolved organs away from the radiation fields, thereby minimizing the radiation dose to such organs and tissues.

CONCLUSION

We believe this is a safe and efficacious method to prevent radiation damage to visceral and solid organs adjacent to trunk tumor sites.

Termination as a psychoanalytic event

After noting that the debate on termination encompasses both the singularity of clinical practice and the generality of theory, the authors propose an approach that focuses on the actual event of termination, for which the termination process is seen as a preparation. They show that termination as a process has featured in psychoanalytic theory for many years and give examples of different conceptions of it from the literature of the last seventy years. However, in their view the event of termination, as an act of passage and an entity that can be consigned to memory, is of particular importance and comprises a complex configuration that has the three coordinates of direction, communication and temporality, which are discussed in turn. Dreams, parapraxes and acting out, as well as parting gifts from the analysand to the analyst, assume particular significance in the context of termination, which sometimes emerges only after the analysis has ended. The concept of termination as event, in the authors' view, offers a typological framework that accounts for the differences between successfully terminated analyses, analyses that are broken off unilaterally by the patient or the analyst, impasse situations and interminable analyses. The points raised are illustrated by clinical vignettes.

Ferromagnetic Mn(II).Cu(II) Exchange in the New Bimetallic Quasi-2-D Compound Cu(op)(2)MnCl(4) (op = 1,4-Diazacycloheptane)

The synthesis, crystal structure, and magnetic properties are reported for the new bimetallic compound Cu(op)(2)MnCl(4), where op = HN(CH(2))(5)NH. The compound, C(10)H(24)N(4)Cl(4)CuMn, crystallizes in the monoclinic space group P2(1)/n. Cell dimensions are as follows: a = 15.316(3) Å, b = 16.608(3) Å, c = 7.141(2) Å, beta = 100.01(5) degrees, Z = 4. The structure consists of well-separated and magnetically equivalent layers which are composed of chloride-bridged Cu(op)(2)MnCl(4) binuclear units connected by rather loose Cu-N-H.Cl-Mn contacts. The MnCl(4) fragment approximates tetrahedral symmetry. The Cu(II) geometry is (4 + 1) square-pyramidal with the apical position occupied by a bridging chloride ligand and the basal ones by the nitrogen atoms from the organic ligands. The shortest interlayer M.M separations, approximately 7 Å, are of the Mn.Cu type. Magnetic susceptibility and single-crystal EPR measurements for the compound have been carried out over the range 4-300 K. At room temperature the chiT product (per MnCu unit) has a value of 4.84 emu.mol(-)(1).K, close to that expected for uncoupled S = (5)/(2) and S = (1)/(2) spins. When the temperature is lowered, chiT remains almost constant until 80-90 K, slightly increases to reach a maximum at approximately 13 K (5.21 emu.mol(-)(1).K), and then rapidly decreases. Comparison between theory and experiment, made with use of both a mean field corrected dimer model and an approximate 2-D model, indicates that Mn(II).Cu(II) exchange is ferromagnetic within the dimers (J(1) approximately 2.6 cm(-)(1)) and antiferromagnetic among dimers, with J values between -0.07 and -0.03 cm(-)(1) (the interaction Hamiltonian is of the form H = -2JS(A).S(B)). Single-crystal EPR spectra recorded along the a, b, and c axes show a large temperature dependence of the g factors: at 4.2 K, g(a) = 2.10, g(b) = 1.96, and g(c) = 2.01. This pattern substantiates the presence of a 2-D magnetic structure with ferromagnetic intradimer exchange and interdimer antiferromagnetic exchange of weaker magnitude. The opposite signs of the interactions are ascribed to the local symmetries of the Cu(II) and Mn(II) ions.

[Use of a new ultrasonographic contrast medium (Echovist-200) in the study of the tubal factor of infertility]

OBJECTIVE. Use of a new sonographic contrast medium (Echoivist-200) for the evaluation of tubal patency and morphology.

DESIGN

Comparative study.

SETTING

Istituto di Ginecologia ed Ostetricia dell'Università di Genova.

PATIENTS

Thirty women with primitive or secondary infertility since al least two years.

INTERVENTIONS

Hysterosonosalpingography has been performed on patients using a new sonographic contrast medium.

MEASUREMENTS

Tubal patency and morphology have been evaluated.

RESULTS

This procedure allowed to obtain a correct diagnosis in 86% of cases. 83% of patients had light pelvic pain, 20% of them experienced nausea and vomiting in one case a lipothymia occurred.

CONCLUSIONS

Hysterosonosalpingography with a new sonographic contrast medium should become the first choice procedure in the evaluation of tubal patency, addressing to the radiological examination only the uncertain cases or cases in which, the presence of a proximal tubal obstruction could be treated by selective catheterization.

Gastric Peristalsis Control by Mono Situ Electrical Stimulation: a Preliminary Study

BACKGROUND: This study was initiated 3 years ago when antral gastric stimulation was first used successfully to reduce free feeding in swine. METHODS: Three swine weighing 45 kg each were implanted with one subserosal bipolar electrode, positioned in the antrum, close to the pylorus, at the anterior side of the lesser gastric curvature. RESULTS: During 4 hours of kethamine anesthesia we paced the stomach by various patterns of electrical stimulation and obtained both forward and backward peristalsis, as well as gastric peresis. CONCLUSION: Variations in antral electrical stimulation produce characteristic patterns of forward and reverse peristalsis.