Managing anxiety in eating disorders with knitting.

OBJECTIVE: Recovery from anorexia nervosa (AN) is often confounded by intrusive, anxious preoccupations with control of eating, weight and shape. These are distressing and represent a potential barrier to psychological change. Theoretical and empirical evidence suggests that performing a concurrent visuospatial task reduces the emotional intensity of distressing images. We assessed whether the visuospatial task of knitting influences the anxious preoccupation experienced by inpatients with AN. METHOD: Prospective interventional cohort. SUBJECTS: Thirty-eight women with AN admitted to a specialized eating disorder unit. INTERVENTION: All subjects were given knitting lessons and free access to supplies. MEASURE: Subjects were asked to report the qualitative effects of knitting on their psychological state using a self-report questionnaire. RESULTS: Patients reported a subjective reduction in anxious preoccupation when knitting. In particular, 28/38 (74%) reported it lessened the intensity of their fears and thoughts and cleared their minds of eating disorder preoccupations, 28/38 (74%) reported it had a calming and therapeutic effect and 20/38 (53%) reported it provided satisfaction, pride and a sense of accomplishment. DISCUSSION: This preliminary data suggests that knitting may benefit inpatients with eating disorders by reducing their anxious preoccupations about eating, weight and shape control. The specificity of this effect is yet to be determined. This preliminary outcome requires further controlled study in AN subjects. From a clinical perspective, knitting is inexpensive, easily learned, can continue during social interaction, and can provide a sense of accomplishment. The theoretical and empirical rationale for this observation, and implications for deriving alternative strategies to augment treatment in AN, are discussed.

[Ambulatory anesthesia and induced abortion. Comparative study of propofol-alfentanyl and ketamine-midazolam combinations]. / Anesthésie ambulatoire et interruption volontaire de grossesse. Etude comparative des associations propofol-alfentanil et kétamine-midazolam.

The use of propofol alone or with alfentanil in the day-case anaesthesia for abortion was compared with that of ketamine with midazolam. Two hundred young women were assigned to two successive series of two groups each. The four groups were: group 1 (2 mg . kg-1 propofol only); group II (0.5 mg . kg-1 ketamine with 0.25 mg . kg-1 midazolam); group III (2 mg . kg-1 propofol with 4 micrograms . kg-1 alfentanil); group IV (1 mg . kg-1 ketamine with 0.1 mg . kg-1 midazolam). All the patients were premedicated one hour before anaesthesia with 0.25 mg . kg-1 midazolam orally. All the patients were asleep at the end of the propofol injection (60 s), and 10 to 15 s later for the ketamine-midazolam groups. The haemodynamic parameters did not vary much during induction with ketamine-midazolam. In the propofol groups, the heart rate remained steady, with an 8 to 12% fall in blood pressure. A fall of the mandible was seen in 40 and 84% of the patients in the propofol groups, with a short apnoea in 32 and 48% of these same patients. Clinical recovery was very quick, less than 12 min for all groups. The four psychomotor and sensory tests were carried out at the 30th min by 95% of the patients in the propofol groups, whereas only 50% of those in the ketamine-midazolam groups did so. Speed and quality were significantly better in the propofol groups. The most frequent adverse effect of propofol was pain during injection in 32 and 14% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pharmacokinetics of continuous infusion of etomidate in cirrhotic patients]. / Pharmacocinétique de l'étomidate en perfusion continue chez le patient cirrhotique.

The pharmacokinetics of etomidate were studied in 9 control subjects (with normal liver function) and in 5 patients with cirrhosis scheduled for gastro-intestinal surgery. Anaesthetic induction included an initial bolus of etomidate 0.3 mg.kg-1, together with fentanyl 2 micrograms.kg-1, and pancuronium 60 micrograms.kg-1. An etomidate infusion was then started according to one of two following schemes: a (0.03 mg.kg-1.min-1 for 10 min, and then 0.01 mg.kg-1.min-1), or B (0.1 mg.kg-1.min-1 for 10 min, followed by 0.02 mg.kg-1.min-1 for a further 110 min, and 0.01 mg.kg-1.min-1 thereafter). Plasma concentrations of etomidate were determined at regular intervals throughout anaesthesia, and up to four hours afterwards, using inverse phase high pressure liquid chromatography. The infusion was given for 273 +/- 87 min in controls, and for 259 +/- 56 min in the cirrhotic group. Scheme A, only used in 3 controls and 1 cirrhotic in a preliminary study, resulted in very low plasma concentrations: 0.2 to 0.4 micrograms.ml-1. Those measured during the apparent plateau phase (steady state) of infusion protocol B were close to predicted values (0.5 to 0.6 micrograms.ml-1) in controls, whereas higher concentrations (approximately 1.5 micrograms.ml-1) were reached in cirrhotic patients. For all the patients the time interval to spontaneous recovery was 41 +/- 27 min; plasma levels were then 0.199 +/- 0.092 micrograms.ml-1. There were significant alterations in pharmacokinetic parameters in the cirrhotic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Unusual isolated common bile duct injury after blunt trauma.

Isolated injury to the extrahepatic biliary tree after blunt trauma is rare. The authors describe the case of a 17-year-old boy who suffered such an injury after falling over the handlebar of his motorcycle. Ultrasonography, computed tomography and abdominal paracentesis were used to make the diagnosis. At laparotomy there was a partial tear of the common bile duct at its junction with the cystic duct. A cholecystectomy was performed and a T tube inserted. The patient recovered without complication. The authors emphasize that only awareness of the condition and diagnostic confirmation by computed tomography and abdominal paracentesis can expedite the diagnosis and treatment. The choice of surgical repair must be individualized according to the clinical findings and the nature of the injury.

[The effect of surgical incisions on ventilatory function]. / Retentissement des incisions chirurgicales sur la fonction ventilatoire.

Normal surveillance was extended to include respiratory function tests (Vital capacity, FEV1, Maximum Breathing Capacity) on 40 post-operative patients. The reduction relative to pre-operative values on the 1st day after operation was of the order of 60 p. 100 for high abdominal incisions, 35 p. 100 for low abdominal incisions and 15 p. 100 for non abdominal incisions. A return to preoperative values was obtained on the 15th, the 6th and the 4th post-operative days respectively. These changes are found to be well correlated to the limitation of diaphragmatic movement in high incisions. As a result, there is a hypoventilation of the lower lobes of the lungs and a shunt effect which lead to hypoxaemia. The reduction in respiratory function in those subjects without an abdominal incision demonstrated that other factors, particularly the influence of a general anaesthesia, need to be taken into account. Numerous clinical observations show that a reduction in respiratory volumes and capacities do not spare the young subjects and may be dramatic in certain cases. These indicate that a daily assessment of respiratory function at the bedside may provide a simple means for early recognition of intercurrent complications.