[Visual experiences during cataract surgery under topical anesthesia]. / Visuelle Erlebnisse unter Kataraktchirurgie in topischer Anästhesie.

BACKGROUND: Cataract patients observe structures, colors and movements during surgery. Is there any pattern to their visual experiences? METHODS: From 2005 to 2011 a total of 20,000 phacoemulsification procedures were performed using topical anesthesia. From these patients we received 45 pictures which had been painted to reflect intraoperative their visual impressions so that approximately 1 out of 500 of the patients painted a picture. A further 98 patients were questioned postoperatively about their intraoperative visual impressions and were shown the 45 pictures. They described their own visual experiences and any similarities with the 45 pictures were documented. RESULTS: All patients were awake and cooperative during surgery. Afterwards they described their visual experiences whereby 36 patients saw mainly blue, 32 red/pink and 27 saw yellow colors. Out of the 45 pictures 30 (67%) were identified as being similar to their own visual images and 10 patients could not describe any postoperative visual phenomena. CONCLUSION: Patients notice optical phenomena during cataract surgery under topical anesthesia with eye drops. Visual images are often similar among patients. The surgeon can use this knowledge to explain these experiences while talking to the patient intraoperatively. This may reassure patients during surgery.

Impaired visual hand recognition in preoperative patients during brachial plexus anesthesia: importance of peripheral neural input for mental representation of the hand.

BACKGROUND: Perceptual illusions described in healthy subjects undergoing regional anesthesia (RA) are probably related to short-term plastic brain changes. We addressed whether performance on an implicit mental rotation task reflects these RA-induced changes in body schema brain representations. Studying these changes in healthy volunteers may shed light on normal function and the central mechanisms of pain. METHODS: Performance pattern was studied in upper limb-anesthetized subjects on a left/right hand judgment task, which is known to involve motor imagery processes relating to hand posture. Three conditions were used: control (i.e., absence of deafferentation), RA (i.e., deafferentation), and vision (i.e., deafferentated limb exposed to view). To limit potential bias such as order effect, the control state was recorded in a randomized manner. RESULTS: All subjects described perceptual illusions of their anesthetized limb. They were slower and less accurate on the task during RA compared with control. Response patterns were similar in all conditions, suggesting sensitivity of performance to arm/hand biomechanical constraints. Vision was associated with an increase in the proportion of correct responses and a reduction of the response times in hand judgment and was accompanied by disappearance of the lateralization of the underlying mental representations, which was identified during RA. CONCLUSIONS: These results suggest the following: (1) the right/left judgment task involves mental simulation of hand movements, (2) underlying mental representations and their neural substrates are subject to acute alterations after RA, and (3) the proprioceptive deficit induced by RA is influenced by the subject's ability to see the anesthetized limb.

Tres historias clínicas, tres enseñanzas doctrinarias / Three clinical records, three doctrinal teaching

La descripción de tres historias clínicas homeopáticas, da base a corroboraciones doctrinarias, como modo de aunar la práctica a la teoría homeopática (AU)

Tres historias clínicas, tres enseñanzas doctrinarias / Three clinical records, three doctrinal teaching

La descripción de tres historias clínicas homeopáticas, da base a corroboraciones doctrinarias, como modo de aunar la práctica a la teoría homeopática

La obsesividad de Thuja / The Thujas obsession

Se destaca a la OBSESIVIDAD como síntoma determinante en la caracterología de Thuja y la importancia de conocer todos los aspectos y las formas que la misma puede adoptar. En esta intención y desde un punto didáctico he querido clasificar los grupos habituales de presentación de las conductas obsesivo-compulsivas de este medicamento considerado el principal homeosycósico de la materia médica. A tal efecto estudiamos su meticulosidad, los rituales, las ideas fijas con los trastornos ilusorios que las alimentan, el fanatismo y sus tendencias al ocultamiento (AU)

La obsesividad de Thuja / The Thuja's obsession

Se destaca a la OBSESIVIDAD como síntoma determinante en la caracterología de Thuja y la importancia de conocer todos los aspectos y las formas que la misma puede adoptar. En esta intención y desde un punto didáctico he querido clasificar los grupos habituales de presentación de las conductas obsesivo-compulsivas de este medicamento considerado el principal homeosycósico de la materia médica. A tal efecto estudiamos su meticulosidad, los rituales, las ideas fijas con los trastornos ilusorios que las alimentan, el fanatismo y sus tendencias al ocultamiento