Ideal Treatment (ideal + treatment)

Distribution by Scientific Domains

Selected Abstracts

Acute renal failure in patients with cirrhosis: Perspectives in the age of MELD

HEPATOLOGY, Issue 2 2003
Richard Moreau
In patients with cirrhosis, acute renal failure is mainly due to prerenal failure (caused by renal hypoperfusion) and tubular necrosis. The main causes of prerenal failure are "true hypovolemia" (induced by hemorrhage or gastrointestinal or renal fluid losses), sepsis, or type 1 hepatorenal syndrome (HRS). The frequency of prerenal failure due to the administration of nonsteroidal anti-inflammatory drugs or intravascular radiocontrast agents is unknown. Prerenal failure is rapidly reversible after restoration of renal blood flow. Treatment is directed to the cause of hypoperfusion, and fluid replacement is used to treat most cases of "non-HRS" prerenal failure. In patients with type 1 HRS with very low short-term survival rate, liver transplantation is the ideal treatment. Systemic vasoconstrictor therapy (with terlipressin, noradrenaline, or midodrine [combined with octreotide]) may improve renal function in patients with type 1 HRS waiting for liver transplantation. MARS (for molecular adsorbent recirculating system) and the transjugular intrahepatic portosystemic shunt may also improve renal function in these patients. In patients with cirrhosis, acute tubular necrosis is mainly due to an ischemic insult to the renal tubules. The most common condition leading to ischemic acute tubular necrosis is severe and sustained prerenal failure. Little is known about the natural course and treatment (i.e., renal replacement therapy) of cirrhosis-associated acute tubular necrosis. [source]

,The healing power of love': The literary/analytic bond of marriage in Freud's essay on Gradiva

Dorit Ashur
Freud,'s declared position regarding the management of ,transference love' advocated ,abstinence', objectivity and even ,emotional coldness in the analyst'. However, his essay on Jensen's Gradiva reveals an identification with an involved and responsive ,maternal' analytic position associated with theorists such as Ferenczi, Balint and Winnicott. These theorists attribute the origins of transference love to the pre-oedipal stage, shaping their analytic model on the basis of the early relationship with the mother. Freud generally had difficulty identifying with such a position, since it entailed addressing his own inner feminine aspects. Yet a literary analysis of his ,Gradiva' reveals this stance in his textual performance, i.e. in the ways in which he reads and retells Jensen's story. Freud,'s narration not only expresses identification with Zoe, the female protagonist, but also idealizes her ,therapeutic' conduct, which is closer in spirit to that of object-relations theorists. His subtext even implies, however unintended, that an ideal treatment of transference love culminates in a psychical ,marriage' bond between the analytic couple, a metaphor used by Winnicott to describe the essence of the mother,baby (analyst/patient) bond. Freud,'s reading process is itself analogous to Zoe's ,therapeutic' conduct, in that both perform a creative and involved interaction with the text/patient. [source]

Baroreflex Sensitivity of an Arterial Wall During Rotary Blood Pump Assistance

Tomoyuki Yambe
Abstract It is well known that the baroreflex system is one of the most important indicators of the pathophysiology in hypertensive patients. We can check the sensitivity of the baroreflex by observing heart rate (HR) responses; however, there is no simple diagnostic method to measure the arterial behavior in the baroreflex system. Presently, we report the development of a method and associated hardware that enables the diagnosis of baroreflex sensitivity by measuring the responses of both the heart and the artery. In this system, the measurements are obtained by monitoring an electrocardiogram and a pulse wave recorded from the radial artery or fingertip. The arterial responses were measured in terms of the pulse wave velocity (PWV) calculated from the pulse wave transmission time (PTT) from the heart to the artery. In this system, the HR change corresponding to the blood pressure change in time series sequence was observed. Slope of the changes in blood pressure and HR indicated the sensitivity of the baroreflex system of the heart. This system could also measure the sensitivity of the baroreflex system of an artery. Changes in the PWV in response to the blood pressure changes were observed. Significant correlation was observed in the time sequence between blood pressure change and PWV change after calculating the delay time by cross-correlation. The slope of these parameter changes was easily obtained and it demonstrated the sensitivity of the baroreflex system of an artery. We evaluated this method in animal experiments using rotary blood pump (RBP) with undulation pump ventricular assist device, and PTT elongation was observed in response to increased blood pressure with RBP assistance. Furthermore, when tested clinically, decreased sensitivity of the baroreflex system in hypertensive patients was observed. This system may be useful when we consider the ideal treatment and follow-up of patients with hypertension. [source]

Psychotherapy for PTSD in the community: reported prototypical treatments

Michele A. Schottenbauer
Therapists who identified themselves primarily with psychodynamic/psychoanalytic or cognitive,behavioral theoretical orientations were recruited through professional organization online listservs. They were randomly presented one of four brief case studies, describing variations on traumatic stress. Participants then completed a Psychotherapy Process Q-sort to describe quantitatively their ideal treatment of the given patient. Results indicated significant heterogeneity among clinicians. Among clinicians who indicated that their primary theoretical orientation was psychodynamic, three prototypical treatments were discovered, and among clinicians who indicated that their primary theoretical orientation was cognitive,behavioral, four prototypical treatments were found. Overall, the prototypes in the current study were correlated with, but not identical to, prototypes of psychodynamic, cognitive,behavioral or interpersonal therapy developed in previous studies based on experts' ratings. Our findings suggest that there may be much greater heterogeneity in treatment of trauma among clinicians in the community than might be assumed by the theoretical orientations they espouse.,Copyright 2006 John Wiley & Sons, Ltd. [source]