Intermittent right coronary artery obstruction.

Although prospectively electrocardiogram-triggered acquisition is frequently used for coronary CT angiography examinations in routine clinical practice to achieve low radiation dose, the use of retrospectively electrocardiogram-gated techniques may be useful for cases that potentially have a dynamic temporal element or involve the valves. In this case of a valvular fibroelastoma, CT could demonstrate dynamic obstruction of the right coronary ostium.

Demyelinating and gliotic cerebellar lesions in Langerhans cell histiocytosis.

Purpose: To describe the involvement of the cerebellum by a gliotic and demyelinating process in Langerhans cell histiocytosis.

Methods: A retrospective analysis of all (N = 30) cases of Langerhans cell histiocytosis followed at our institution since 1975 yielded four patients with CT and/or MR evidence of cerebellar abnormalities.

Results: Four patients manifested strikingly similar findings of symmetric nonenhancing hypodensities in the dentate nuclei region of the cerebellum, which were hypointense on short-repetition-time/short-echo-time MR and hyperintense on long-repetition-time/long-echo-time MR.

Inflammatory pseudotumor of the spleen: MR findings.

Inflammatory pseudotumor of the spleen is an unusual lesion often mistaken preoperatively for other masses. Isolated inflammatory pseudotumors of the spleen are rare. We report a proven case examined with ultrasound, CT, single photon emission CT, and MRI.

Lateral ventricular neoplasms of the brain: differential diagnosis based on clinical, CT, and MR findings.

The differential diagnosis of lateral ventricular tumors was explored by retrospective analysis of 47 pathologically proved cases identified by CT and/or MR imaging. Third ventricular tumors adjacent to the foramen of Monro (e.g.

Lateral ventricular neoplasms of the brain: differential diagnosis based on clinical, CT, and MR findings.

The differential diagnosis of lateral ventricular tumors was explored by retrospective analysis of 47 pathologically proved cases identified by CT and/or MR imaging. Third ventricular tumors adjacent to the foramen of Monro (e.g.

Neuropathology of AIDS.

Involvement of the central and peripheral nervous systems as a result of primary infection by the human immunodeficiency virus (HIV) or due to secondary opportunistic infections and neoplasms has been recognized as a major clinical problem in patients with the Acquired Immunodeficiency Syndrome (AIDS). Currently, of new AIDS cases, 30 to 40% will have clinical evidence of nervous system dysfunction. Neurologic dysfunction will be the presenting problem in 10% of patients.

A posttraumatic lumbar spinal synovial cyst. Case report.

A patient with posttraumatic lumbar radicular paresthesias is presented. The preoperative diagnosis of an epidural synovial cyst was considered. At surgery, an epidural synovial microcystic mass was found emanating from a distracted L4-5 facet joint and dissecting into the layers of the ligamentum flavum.

Identification and its vicissitudes.

The treatment of 'identification' in the American literature is conveniently divided into three eras: (1) The Pioneers (1915-1945). (2) The Synthesizers (1945-1975). (3) Current Commentators (1975-1985).

The inconstant "principle of constancy".

A review of the principle of constancy, as it appeared in Freud's writings, shows that it was inspired by his clinical observations, first with Breuer in the field of cathartic therapy and then through experiences in the early usage of psychoanalysis. The recognition that memories repressed in the unconscious created increasing tension, and that this was relieved with dischargelike phenomena when the unconscious was made conscious, was the basis for his claim to originality in this area. The two principles of "neuronic inertia" Freud expounded in the Project (1895), are found to offer the key to the ambiguous definition of the principle of constancy he was to offer in later years.

Freud, Theodor Lipps, and "scientific psychology".

Freud's "scientific psychology" is traced from 1888 to 1938 in the succession of mental apparatuses he proposed. The key proposition, for which he shared credit with Theodor Lipps after 1898, holds that consciousness is a sense organ for detecting and translating the unknown inner reality of the unconscious. The significance of this approach from the standpoint of the methodology, constructions, and metapsychology of psychoanalysis is considered and compared with other views of metapsychology now current.

Freud's "analytic pact": the standard therapeutic alliance.

Freud's "analytic pact," as the final therapeutic model he evolved (1937, 1940), places the fundamental rule in a two-person structural framework that operates in a continuum between the inner reality and outer reality of both patient and analyst as these come to center in the analytic situation. To Freund's basic definition of psychoanalysis as related to resistance and transference, a third component is added, the collaboration that has been a feature of the treatment since the beginning. The alliance postulated by the pact relates a helpful physician to a sufferer in a carefully regulated operational field and atmosphere suitable for a particular technique and therapeutic goal.

Visual communication in the psychoanalytic situation.

The relationship between verbal and visual aspects of the analytic proceedings shows them blended integrally in the experiences of both patient and analyst and in contributing to the insights derived during the treatment. Areas in which the admixture of the verbal and visual occur are delineated. Awareness of the visual aspects gives substance to the operations of empathy, intuition, acting out, working through, etc.

Oedipus: history, legends, plays, complexes.

A discussion of "Oedipus Was Not the Son of Laius and Jocasta" by Angel Garma, M.D. The thesis that Oedipus was not the son of the Theban royal pair but his Corinthian "foster parents" raises questions as to which Oedipus is under discussion--one of several different "historical" and legendary accounts, the hero of the plays of Sophocles, or the synthesized "Oedipuses" of millions of individual and ethnic fantasies.

The therapeutic and working alliances.

The concepts of the "therapeutic alliance" (Zetzel, 1956) and "working alliance" (Greeson, 1965) are traced in their antecedents to Freud and other analysts and compared especially with Freud's "analytic pact." Differences both in theory and practice are elucidated with the aid of case material. While the therapeutic and working alliances are often used interchangeably, they are found to take up their positions at diametrically opposite points along a continuum defined by the analytic pact and show a marked tendency to depart from the guidance offered the traditional analysis by the fundamental rule.