Sexual delusion in a case of vaginal aplasia after surgical operation for neovagina.

The Mayer-Rokitansky-Kuster-Hauser (MRKH) is a syndrome of unknown etiology characterized by congenital aplasia of the uterus and the upper part (2/3) of the vagina in women showing normal development of secondary sexual characteristics. We report the case of a patient with vaginal aplasia and schizophrenia presenting with sexual delusion. To the authors' knowledge this is the first case to provide evidence of coexistence between MRKH and sexual delusion in a schizophrenic patient. The core of the patient's delirium was that she was having sexual intercourse with an eminent person through the big toe of her right foot. We approached this case using a neurological and a psychodynamic hypothesis. The neurological hypothesis suggests that the "deactivation" of the patient's genitalia led to an expansion of the adjacent big toe cortical area. The psychodynamic hypothesis supports that the sexual function and pleasure was partially expelled from the body image and was stored in a non sexual part of the body (i.e., big toe). Clinicians should be aware of this association and offer patients with MRKH psychological or/and psychiatric evaluation.

Psychologically induced cooling of a specific body part caused by the illusory ownership of an artificial counterpart.

The sense of body ownership represents a fundamental aspect of our self-awareness, but is disrupted in many neurological, psychiatric, and psychological conditions that are also characterized by disruption of skin temperature regulation, sometimes in a single limb. We hypothesized that skin temperature in a specific limb could be disrupted by psychologically disrupting the sense of ownership of that limb. In six separate experiments, and by using an established protocol to induce the rubber hand illusion, we demonstrate that skin temperature of the real hand decreases when we take ownership of an artificial counterpart. The decrease in skin temperature is limb-specific: it does not occur in the unstimulated hand, nor in the ipsilateral foot. The effect is not evoked by tactile or visual input per se, nor by simultaneous tactile and visual input per se, nor by a shift in attention toward the experimental side or limb. In fact, taking ownership of an artificial hand slows tactile processing of information from the real hand, which is also observed in patients who demonstrate body disownership after stroke. These findings of psychologically induced limb-specific disruption of temperature regulation provide the first evidence that: taking ownership of an artificial body part has consequences for the real body part; that the awareness of our physical self and the physiological regulation of self are closely linked in a top-down manner; and that cognitive processes that disrupt the sense of body ownership may in turn disrupt temperature regulation in numerous states characterized by both.

On Replacement Body Parts.

Technological advances are making devices that functionally replace body parts-artificial organs and limbs-more widely used, and more capable of providing patients with lives that are close to "normal." Some of the ethical issues this is likely to raise relate to how such prostheses are conceptualized. Prostheses are ambiguous between being inanimate objects and sharing in the status of human bodies-which already have an ambiguous status, as both objects and subjects. At the same time, the possibility of replacing body parts with artificial objects puts pressure on the normative status typically accorded to human bodies, seemingly confirming that body parts are replaceable objects. The paper argues that bodies' normative status relies on the relation of a body to a person and shows that persons could have similar relations to prostheses. This suggests that in approaching ethical issues surrounding prostheses, it is appropriate to regard them as more like body parts than like objects.

Population-based study of surgical factors in relation to health-related quality of life after oesophageal cancer resection.

BACKGROUND: Oesophagectomy for cancer has a negative impact on health-related quality of life (HRQL), but factors influencing postoperative HRQL have been sparsely studied. This study explored how selected surgical factors affected HRQL 6 months after operation. METHODS: This population-based study was based on a Swedish network of physicians with almost complete nationwide coverage and data on oesophageal cancer surgery collected prospectively between 2001 and 2005. Patients completed validated HRQL questionnaires 6 months after operation. Mean scores with 95 per cent confidence intervals were calculated and clinically relevant differences between groups were analysed in a linear regression model, adjusted for potential confounders. RESULTS: Some 355 patients were included in the analysis (participation rate 79.6 per cent). Extensive surgery, as indicated by a transthoracic approach, more extensive lymphadenectomy, wider resection margins and a longer duration of operation, was not associated with worse HRQL measures than less extensive operations. Dysphagia was similar in patients who had handsewn and stapled anastomoses. Technical surgical complications had significant deleterious effects on several aspects of HRQL. CONCLUSION: This study provides no evidence to suggest that less extensive surgery for oesophageal cancer should be recommended from the perspective of HRQL. It is essential, however, that attention be paid to minimizing technical surgical complications.

Altruism and the volunteer: psychological benefits from participating as a research subject.

Psychiatric assessment of potential volunteers for hazardous biomedical experimentation should include an assessment of the motivations underlying the altruistic action of volunteering. Screening goals include evaluation of informed consent as well as screening out experimental subjects who would be likely to be psychologically harmed by participation. This discussion of psychological issues to be considered, beyond those of informed consent and screening for severe psychopathology, originated in the psychiatric screening of the small group of original volunteers for the "Dobelle eye" Artificial Vision Project. These individuals entered the project over 20 years ago at a time when they could expect no tangible benefit from participation. Superficially altruistic behavior, such as volunteering for this project, serves multiple psychological functions and in a given clinical case, the determinants are often complex. A spectrum of altruistic behavior is suggested, based on interviews with these original subjects as well as from extensive evaluation of patients studied in the setting of psychoanalytic treatment with one of the authors (B.J.S.). We suggest that adaptive altruism can explain the finding that some volunteers gained actual psychological benefit from their participation. This unanticipated finding, that participating in research as an experimental subject can result in lasting improvement in self-esteem, is discussed. Suggestions are made for increasing the likelihood of such benefit. Ethical ramifications are addressed.

[The white coat as a cape: doctors, superheroes and bionics]. / Een witte jas als cape: over dokters, superhelden en bionica.

OBJECTIVE: To study the relationship between doctors and comic books, cartoons, superheroes and bionic prosthetic organs. DESIGN: Descriptive survey. METHOD: For this study, 341 doctors and medical students filled in a digital survey in the autumn of 2013. The questionnaire contained questions about comic books and cartoons, their superheroes, prosthetic organs and about bionic and non-bionic super powers. RESULTS: As a child more than half of the participants read comic books regularly or often, and most watched cartoons regularly or often. Now their childhood interest in this subject has mostly been lost. In their youth, Suske & Wiske were the favourite, and now it is Donald Duck. The number of doctors with a favourite superhero decreased as aged increased from 52% to 37%. The care givers entertain lively fantasies about having bionic superpowers. According to the participants, the idea doctor would have ultrasonic eyes and all sorts of other super senses. Ninety-one per cent thought that 'the development of prosthetic organs is not a waste of money'. CONCLUSION: If Batman and Superman come to blows, Catwoman wins.