Pandemic psychoanalysis.

Our clinical practice is contextualized by a co-participant trauma constituted by a confluence of upheavals-pandemic, politics, an epistemological crisis, pervasive distrust of expertise and evidence. Psychoanalytic work, parallel to the external world, has become defamiliarized, if not, at sometimes unrecognizable. The affect on the frame and the boundaries of the therapeutic frame and of the psychoanalytic institution are explored with an awareness of the uncertainty of the future. The experience of the onset of the pandemic is discussed with awareness of an unknown future.

Postoperative Complications Following Repair of Acute Achilles Tendon Rupture.

BACKGROUND: Controversy remains regarding which patients with acute Achilles tendon rupture would best be treated nonoperatively and which might benefit from operative repair. The primary aim of this study was to characterize the overall incidence of-and specific risk factors associated with-postoperative complications that follow operative repair. We also evaluated the specific differences between complications after the use of an open or minimally invasive surgical (MIS) approach. METHODS: Retrospective chart review identified 615 adult patients who underwent operative repair for an acute Achilles tendon rupture between January 1, 2001, and May 1, 2016, at 3 level I trauma centers. Minimum follow-up was 3 months. Patient demographics, comorbidities, injury mechanism, procedural details, and surgeon subspecialty were collected. Assessed complications included wound healing issues, rerupture, hematoma, nerve injury, deep vein thrombosis, and pulmonary embolism. RESULTS: Seventy-two patients (11.7%) developed a postoperative complication. Risk factors included advancing patient age (odds ratio [OR], 1.04, P = .007), active tobacco use (OR, 3.20, P = .007), and specific subspecialty training (OR, 2.04, P = .046). No difference in overall complication rate was found between the open and MIS approaches (11.6% vs 13.2%, P = .658). A subgroup analysis among orthopedic subspecialties demonstrated that patients treated by trauma surgeons had increased rates of wound complication ( P = .043) and rerupture ( P = .025) compared with those treated by other subspecialties. Patients treated by trauma surgeons were also more likely to be younger or have a body mass index (BMI) > 30, although neither factor was found to be independently predictive for postoperative complications. CONCLUSION: Approximately 1 in 9 patients undergoing operative repair of an acute Achilles tendon rupture developed a postoperative complication. Advancing age and active tobacco use were independent risk factors for developing such complications. Differences in subspecialty training also appear to impact complication rates, but the potential reason for this discrepancy remains unclear. As controversy remains regarding which patients who sustain acute Achilles tendon rupture should be treated nonoperatively and which would benefit most from surgical repair, a better understanding of postoperative complication rates and associated risk factors may enhance the decision-making processes in treating these injuries. It is not clear whether MIS techniques are superior to traditional open repair in terms of postoperative complications. LEVEL OF EVIDENCE: Level III, retrospective comparative series.

Symptomatic venous thromboembolism after non-operatively treated foot or ankle injury.

The purpose was to assess the incidence and risk factors associated with symptomatic venous thromboembolism in patients undergoing below knee immobilization for non-operative foot or ankle injury. We included all foot and ankle patients between January 2005 and May 2016 who underwent non-operative management using below knee immobilization with cast, splint, brace, and/or boot. The primary outcome was the development of a venous thromboembolism within 90 days of immobilization initiation. Of 6,088 patients, twenty-three (0.38%) developed a venous thromboembolism. Risk factors for venous thromboembolism were age>50 years, unremovable immobilization, Achilles tendon rupture, Modified Charlson Comorbidity Index>2, patients on chemoprophylaxis, varicose veins, history of venous thromboembolism, known hypercoagulability disorder, and rheumatoid arthritis. Routine thromboprophylaxis after below-knee immobilization for non-operative foot or ankle injury may be beneficial in these specific subpopulations. These data can facilitate more substantive shared decision-making between providers and patients with respect to use of thromboprophylaxis. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

The lonely passion of the "people".

This paper explores the psychological sources of support for a leader, and unwavering belief in the illusions he promotes, which persists despite confrontation with reality. Lonely passion is an oxymoron. It is passion because of the intensity of the supporters' longing which is partially shaped by fear and loss. Their passion is lonely because they appear to be left empty with their love unrequited, having given their selves up and only having an illusion in return. It explores the effects of socio-economic disruption in creating or contributing to the development of a "social character" and threatening the integrity of the self. It explores the characteristics of the leader, including methods of manipulation, in eliciting passionate devotion. It uses Ferenczi's Confusion of Tongues situation as a model for understanding the relationship between leader and follower. The idealization of the leader as a power to be feared and a savior from the imagined threats he has created, and the dynamics of identification, masochism and victimization are invoked. The only remedy for the toxicity of the situation is empathy, which is understood in a historical as well as psychological context.

The Holocaust after 70 years: Holocaust survivors in the United States(.).

Over 70 years, there have been different narratives of the Holocaust survivors coming to the United States. Survivors' stories begin with an event of major historical significance. Difficulties in conceptualizing historical trauma, along with common distortions and myths about Holocaust survivors and their children are examined. This article proposes that it is impossible to discuss the consequences of extreme suffering without consideration of historical meaning and social context with which they are entwined. The evolution of the social representation of the Holocaust and the contradictions in clinical attributions to survivors and their children with consideration of the future is described. Attributions to survivors and their children with consideration of the future is described.