Clinical Factors Associated with Videofluoroscopic Swallowing Study Findings in Stroke Patients / 대한연하장애학회지

OBJECTIVE: To examine the clinical factors and brain lesion locations related to the patterns of dysphagia in stroke patients in a rehabilitation hospital. METHODS: The medical records of 116 stroke patients who underwent a videofluoroscopic swallowing study (VFSS) between January 2010 and January 2015 in a rehabilitation hospital were reviewed retrospectively. The swallowing-related parameters were assessed using a VFSS. The brain lesion locations were classified as the cortex, basal ganglia, thalamus, midbrain, pons, medulla, cerebellum, and others (subarachnoid or intraventricular hemorrhage). The ambulation ability was assessed using functional ambulation categories (FACs). The independence in the activities of daily living and the degree of cognitive impairment were assessed using the Korean versions of the modified Barthel index (K-MBI) and Mini-Mental State Examination (K-MMSE), respectively. After adjusting for the potential confounding factors in multivariate analysis, the odds ratios and confidence intervals of the stroke brain lesions were calculated and the clinical factors for predicting the VFSS findings were determined. RESULTS: Among the 116 patients, 35 (27%) had an impaired oral stage and 58 (50%) had aspiration. The impaired oral stage was associated significantly with the onset time, basal ganglia stroke, dietary and fluid intake methods at the time of the VFSS, symptoms of dysphagia, FACs, K-MBI, and K-MMSE. Aspiration was correlated with a pontine stroke, methods of dietary and fluid intakes at the time of the VFSS, symptoms of dysphagia, FACs, and K-MBI. Multivariate analysis showed that the pontine stroke and methods of dietary and fluid intake at the time of VFSS predicted aspiration after adjusting for the potential confounding factors. In subgroup analysis of the diet type, the liquid and semisolid aspirations were correlated with the dietary and fluid intake methods and pontine stroke, respectively. CONCLUSION: Patients with a pons lesion stroke, who are on a modified diet (fluid thickening and tube feeding), have higher risks of aspiration. This provides evidence for precise clinical reasoning in this specific patient group.

Miasmes et maladies infantiles: approche psychanalytique / Miasms and infantile diseases: approuche psychoanalytic

Les maladies infantiles, qui se repetent depuis de nombreuses generations, jouent un role dans la maturation de notre systeme immunitaire. L'auteur analyse cet impact a la lumiere des miasmes hahnemanniens et des decouverts freudiennes. (AU)

Dependency and eating disorders in female psychiatric inpatients.

Research indicates that oral dependent and eating-disordered individuals have similar personality traits, attitudes, and behaviors, suggesting that dependency may be a factor in the dynamics of anorexia and bulimia. To investigate this issue, we compared the proportions of dependent and food-related percepts in the Rorschach protocols of matched samples of eating-disordered (N = 16), obese (N = 18), and non-eating-disordered, normal-weight female psychiatric inpatients (N = 17). Eating-disordered patients reported significantly more dependent Rorschach imagery than did obese or normal-weight control patients, but no difference in the proportion of food-related imagery was found among the three groups. These results support the hypothesis that unresolved dependency issues underlie anorexia and bulimia.

Keats's oral imagination: "'Tis not through envy".

This study of four of Keats's greatest poems explores a dynamic pattern in the poet's imagination: a relationship between the oral/fusional imagery and the romantic/oedipal themes. The poet's imagination seems to have been propelled backward from oedipal conflict to earlier narcissistic/oral unrest and pleasure. There is a layering of special psychic capabilities evident in Keats's imagination: an element of oedipal romance which stabilizes the process of sublimation, a sense of magical play and danger in the maternal/oral imagery, and powerful narcissistic longins organized through the desire to communicate and the gift for expression.

Aspects of the analysis of an adult son of deaf-mute parents.

This case demonstrates unique features connected with the parental deafness: the patient's anger toward women, his splitting of objects into all-good and all-bad, ease of regression, yearning for the symbiotic mother particularly as it was related to space as a transitional phenomenon into which he brooked no intrusion, his unique interests and creativity, his method of teaching, the shaping of the Oedipus complex by preoedipal trauma, and his feeling of entitlement with need to be treated as an exception. I have attempted to demonstrate the relation of the preverbal and preoedipal traumata, stemming from the deaf-mutism of the parents of a hearing child, to the patient's pathology, the shaping of his oedipal constellation, and character traits. I have described the compensatory ego functions that resulted in the development of creative, professional ability. Also, I have tried to demonstrate the complicated multiple overdetermination of his symptoms and aspects of his character formation.