Spectrum of complaints: practices of complaining in therapeutic conversations as a window to spouses' personalities and couples' relationships.

Introduction: Complaining is a frequent phenomenon in human interactions and it frequently happens during couple counseling. A conversation between a therapist and spouses that requires them to talk about problems inevitably leads to complaining (especially during the first meeting). The institutional context and the presence of an impartial therapist shape the complaining sequences. Method: We used conversation analysis to explore the interactional organization of complaining in the specific context, which is couples therapy. Our data involve video recordings of nine couple therapy first consultations. Results: In the results section of our paper, we describe in detail the composition and delivery of complaints in couple therapy setting. Our observations made it possible to propose a nuanced spectrum of ways of complaining that spans the considerateness dimension. Our data suggest that there may be a relationship between the manner of complaining and the presence and severity of maladaptive personality traits of complainers. Discussion: We argue that paying close attention to complaining practices that arise during couple therapy is an important aspect of clinical work with couples and can be informative regarding the nature of spouses' quarrels and their personality constitutions.

Practices of joint meaning creation. Dreams in psychoanalytic discussion.

Using conversation analysis of audio recorded psychoanalytic sessions, this article investigates dream interpretation as conversational practice. We focus on the ways in which the "real world" meanings of objects or events in the dream are collaboratively created. Three routes for the meaning creation were found. (1) In plain assertions, either the analyst or the patient asserts the meaning of a dream element, for example stating that the cow in the dream means women. (2) In meaning creation through redescription, the analyst describes anew events belonging to the real world or the dream, which have been referred to in the earlier conversation. This redescription makes possible the subsequent assertion of explicit linkages between the dream and the real world. (3) In the merging of referential worlds, the analyst extends the patient's real-world description with images that are recognisably from the dream: the world of the dream and the real world are thus momentarily merged. In discussion, we point out that in our audio recorded data, the dream interpretation does not primarily involve revealing repressed and unconscious ideas, but rather it involves reminding the patient of something that the patient already knows but is reluctant to think or talk about.

Practices of Claiming Control and Independence in Couple Therapy With Narcissism.

Four couple therapy first consultations involving clients with diagnosed narcissistic problems were examined. A sociologically enriched and broadened concept of narcissistic disorder was worked out based on Goffman's micro-sociology of the self. Conversation analytic methods were used to study in detail episodes in which clients resist to answer a therapist's question, block or dominate the development of the conversation's topic, or conspicuously display their interactional independence. These activities are interpreted as a pattern of controlling practices that were prompted by threats that the first couple therapy consultation imposes upon the clients' self-image. The results were discussed in the light of contemporary psychiatric discussions of narcissism; the authors suggest that beyond its conceptualization as a personality disorder, narcissism should be understood as a pattern of interactional practices.

Recurrent chemotherapy-induced tumor lysis syndrome (TLS) with renal failure in a patient with chronic lymphocytic leukemia - successful treatment and prevention of TLS with low-dose rasburicase.

INTRODUCTION: Rasburicase is a recombinant urate oxidase that is produced by a genetically modified Saccharomyces cerevisiae and has been approved for prophylaxis and treatment of tumor lysis syndrome in 2001. In several studies, rasburicase, given at a dose of 0.15-0.2 mg/kg for up to 7 d, proved to be highly effective in lowering urate levels. CASE REPORT: We report the case of a patient with chronic lymphatic leukemia (CLL) who experienced tumor lysis syndrome (TLS) with acute renal failure after fludarabine/cyclophosphamide chemotherapy and after bendamustine treatment. During the first episode of TLS, after fludarabine/cyclophosphamide (creatinine 3.3 mg/dL, urate 24.6 mg/dL), the patient received rasburicase 0.2 mg/kg for 3 d. Urate levels decreased below the lower limit of normal and renal function recovered. After bendamustine therapy, given for disease progression 8 months later, TLS with acute oliguric renal failure re-occurred (creatinine 3.1 mg/dL, urate 20.8 mg/dL). The patient was treated with hyperhydration and two doses of rasburicase (0.056 mg/kg), resulting in a prompt decrease of the urate level and recovery of renal function. Both episodes of TLS were successfully treated with rasburicase in a lower dose than recommended by the manufacturer. During a second bendamustine course, TLS was successfully treated by low doses of rasburicase (0.056 mg/kg for 2 d). CONCLUSION: This is the first report of TLS in CLL after bendamustine chemotherapy reported in the literature. Treatment and prevention of TLS by low doses of rasburicase is possible and cost-effective.

IgA nephropathy and hodgkin's disease: a rare coincidence. Case report and literature review.

In Hodgkin's disease, the most common paraneoplastic glomerular abnormality is minimal change nephropathy, although other glomerular diseases occasionally have been described. We report a case of extracapillary immunoglobulin A glomerulonephritis presenting as acute renal failure in a woman with newly diagnosed Hodgkin's disease. Treatment with the bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone regimen resulted in complete hematologic and renal remission for more than 1 year after diagnosis.