Millard Fillmore Suburban Hospital

Abend’s paper is a gift for any author wanting a summary of where conflict theory (sometimes called “classical theory” by those who don’t embrace it, much to the annoyance of those who do and hear, in the word classical, the innuendo of old and outdated) stood on the question of countertransference thirty years ago, to be used as a launching pad from which to discuss developments in how we have been writing about it since then. His writing is clear and unambiguous (or as unambiguous as one could hope for, in the face of continued confusion/debate about such fundamental topics as the therapeutic action of psychoanalysis or how the mind works—especially unconsciously). Since then, the literature on countertransference wrestled with the problem that, while having a certain feeling at a specific moment can be treated as a fact, analysts, as is also true for patients, must interpret that feeling; and then analysts must make clinical choices about how to use their interpretations of their countertransference emotional experiences, and must also make clinical choices about how to respond to analysands’ interpretative readings of their analysts.

BackgroundSentinel-node biopsy, a minimally invasive procedure for regional melanoma staging, was evaluated in a phase 3 trial.MethodsWe evaluated outcomes in 2001 patients with primary cutaneous melanomas randomly assigned to undergo wide excision and nodal observation, with lymphadenectomy for nodal relapse (observation group), or wide excision and sentinel-node biopsy, with immediate lymphadenectomy for nodal metastases detected on biopsy (biopsy group).ResultsNo significant treatment-related difference in the 10-year melanoma-specific survival rate was seen in the overall study population (20.8% with and 79.2% without nodal metastases). Mean (±SE) 10-year disease-free survival rates were significantly improved in the biopsy group, as compared with the observation group, among patients with intermediate-thickness melanomas, defined as 1.20 to 3.50 mm (71.3±1.8% vs. 64.7±2.3%; hazard ratio for recurrence or metastasis, 0.76; P=0.01), and those with thick melanomas, defined as >3.50 mm (50.7±4.0% vs. 40.5±4.7%; hazard ratio, 0.70; P=0.03). Among patients with intermediate-thickness melanomas, the 10-year melanoma-specific survival rate was 62.1±4.8% among those with metastasis versus 85.1±1.5% for those without metastasis (hazard ratio for death from melanoma, 3.09; P<0.001); among patients with thick melanomas, the respective rates were 48.0±7.0% and 64.6±4.9% (hazard ratio, 1.75; P=0.03). Biopsy-based management improved the 10-year rate of distant disease–free survival (hazard ratio for distant metastasis, 0.62; P=0.02) and the 10-year rate of melanoma-specific survival (hazard ratio for death from melanoma, 0.56; P=0.006) for patients with intermediate-thickness melanomas and nodal metastases. Accelerated-failure-time latent-subgroup analysis was performed to account for the fact that nodal status was initially known only in the biopsy group, and a significant treatment benefit persisted.ConclusionsBiopsy-based staging of intermediate-thickness or thick primary melanomas provides important prognostic information and identifies patients with nodal metastases who may benefit from immediate complete lymphadenectomy. Biopsy-based management prolongs disease-free survival for all patients and prolongs distant disease–free survival and melanoma-specific survival for patients with nodal metastases from intermediate-thickness melanomas. (Funded by the National Cancer Institute, National Institutes of Health, and the Australia and New Zealand Melanoma Trials Group; ClinicalTrials.gov number, NCT00275496.)

This study compares outcomes of basilic and cephalic vein fistulas for hemodialysis. A retrospective review of arteriovenous fistulas in a university hospital system was performed using charts and hemodialysis records. Patency and demographic data were assessed with life table analysis. One hundred fifty-six patients (88 males; 68 females) underwent creation of 172 autogenous fistulas (mean age 61 years; mean follow-up 78 weeks). There were 101 basilic vein transpositions and 71 cephalic vein fistulas. Primary patency did not differ significantly, while assisted primary patency was significantly better for basilic vein fistulas at one year (73% versus 53%: P = 0.024). Secondary patency was significantly better for basilic fistulas through three years (58% versus 52%; P = 0.027). Primary failure (thrombosis before access or failed maturation) was significantly higher for cephalic than basilic fistulas (28% versus 13%; P = 0.01). Maturation time, usage time and complications were not significantly significant. Thirty-three (33%) basilic vein-based fistulas and 12 (17%) cephalic vein fistulas required revision during follow-up. Basilic vein-based fistulas perform as well as or better than cephalic vein-based fistulas in terms of patency, maturation time, and usage time and complication rates, though requiring more re-interventions.

To report the improvement of diarrhea in a patient with cytomegalovirus (CMV) colitis who was treated with octreotide after failure of loperamide. An 84-year-old male presented with chronic diarrhea and CMV colitis; he had been experiencing protracted diarrhea since 2006. In October 2009 he failed a 21-day course of valgancyclovir 900 mg orally twice daily. Several months later, due to continuing diarrhea and progressive malnutrition, a colonoscopy and subsequent biopsy again showed CMV. In March 2010 he was started on a 28-day course of intravenous ganciclovir 130 mg daily. Three weeks into treatment he continued with copious amounts of diarrhea, with no relief from loperamide, which was titrated from 2 mg/day to 2 mg every 6 hours. On day 20 of ganciclovir treatment he was started on octreotide 50 μg subcutaneously every 8 hours; within a few days, the patient began to experience decreased stool frequency and consistency. He completed the full 28-day course of ganciclovir, with octreotide continuing unchanged, with much improvement in his diarrheal symptoms and improvement in appetite, nutritional status, and quality of life. Studies regarding the treatment of CMV colitis-associated diarrhea are scarce, and are typically limited to treating the underlying cause with antiviral medications and with the addition of antimotility agents. Three cases have been reported in the literature in which octreotide was used for the symptomatic treatment of diarrhea, none of which was refractory to loperamide. This is the first known case of a patient with chronic diarrhea due to CMV colitis that was unresponsive to loperamide, required protracted antiviral treatment (valgancyclovir and gancyclovir), and subsequently experienced relief by the use of octreotide 50 μg subcutaneously every 8 hours.

Catheterization and Cardiovascular InterventionsVolume 69, Issue 5 p. 764-765 Coronary Artery Disease Turf wars and silos—Joined at the hip: What can be done? L. Nelson Hopkins MD, L. Nelson Hopkins MD Department of Neurosurgery, Millard Fillmore Hospital, Buffalo, New YorkSearch for more papers by this authorDavid R. Holmes Jr. MD, Corresponding Author David R. Holmes Jr. MD holmes.david@mayo.edu Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MinnesotaDivision of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905Search for more papers by this authorStephen Ramee MD, Stephen Ramee MD Department of Cardiovascular Disease, Ochster Health System, New Orleans, LouisianaSearch for more papers by this author L. Nelson Hopkins MD, L. Nelson Hopkins MD Department of Neurosurgery, Millard Fillmore Hospital, Buffalo, New YorkSearch for more papers by this authorDavid R. Holmes Jr. MD, Corresponding Author David R. Holmes Jr. MD holmes.david@mayo.edu Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MinnesotaDivision of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905Search for more papers by this authorStephen Ramee MD, Stephen Ramee MD Department of Cardiovascular Disease, Ochster Health System, New Orleans, LouisianaSearch for more papers by this author First published: 08 February 2007 https://doi.org/10.1002/ccd.21015Citations: 10Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume69, Issue51 April 2007Pages 764-765 SCAI Member Sign in RelatedInformation

In 1998, the International Psychoanalytic Association enjoined all member institutes to establish and maintain ethics committees. Similarly, the American Psychoanalytic Association in 2001 required its member institutes to establish a mechanism to address accusations of professional misbehavior. If an analysand or another analyst brings a complaint to the psychoanalytic institute in which the analyst is a member, an ethics committee of the institute is now mandated to construct procedures and guidelines to help shape the institute’s response. Since all licensed mental health practitioners are subject to ethics codes of their respective professions, what is the significance of mandating that psychoanalysts govern ourselves? Since medieval times professional associations have assumed such responsibilities for their members. All licensed mental health professionals have ethical codes that specifically pertain to their professional roles. Analysts are subject to those rules and standardized requirements of their licensing boards. Will analytic institutes replicate the established boards, or are we going to consider psychoanalytic ethics as something with another aim and other parameters? Mandated the responsibility to acquire a new analytic function of governing one another, analysts must learn to apply