缓慢的力量——Ilizarov技术在中国微言

1950年前苏联骨科医师Ilizarov发现了牵张成骨技术,应用模仿自然的缓慢牵伸力能治愈复杂创伤骨折、骨与软组织的缺损、感染和肢体的严重畸形。这种治疗模式既不同于传统骨科手术技术,也不同于现代的创伤骨科的骨折内固定接骨（AO）技术或截骨矫形技术,这些技术的特征之一就是迅速进行骨的固定和矫正畸形。以每天1mm为特征的Ilizarov技术,不仅解决了缺损和畸形中的骨的问题,而且解决了包括血管、神经、肌肉和皮肤在内的其他软组织的生长问题,对骨科一些创伤和畸形的效果无以伦比。由于诸多原因,在我国的传播不够广泛,还需要各方努力,来一起推动该技术的发展和应用。     

Theory in practice

We are privileged to publish the last talk Fordham prepared before he died, which Fordham himself observed was ‘rather discursive’. As he comments, ‘theories are so ingrained in my work that I do not need to remember them’. ‘Theory in practice’ was part of a series of talks on theory by different speakers, given to the Society of Analytical Psychology monthly scientific meeting. It is not a polished nor a comprehensive essay, rather it is the musings of an 89-year-old analyst intended for a group who knew his work and achievements. He was too ill to deliver it himself.

In this informal communication the part theory plays in analytic practice is examined and examples of the different uses to which theory is put within analytic sessions are considered. The usefulness and value of theories are discussed with reference to Jung's theories and attitudes to them and to the theory of the primary self.     

Correspondence: Mental health care in South Africa

Shame has been an insufficiently studied emotion in psycho-analytic literature until recently, mainly because it tended to be ‘absorbed’ under the concept of guilt. Now it is recognized as a powerful affect of pregenital origin, linked with narcissism and the ego ideal. Shame can be a motivation for achievements and social adaptation, it can protect an individual's integrity and can be a modulator of interpersonal relatedness; it can also function as a defence or initiate psychopathological states, such as depression, self-alienation, identity confusion or acting out. In adolescence shame is a ubiquitous phenomenon, as this developmental stage consists of all the parameters that can trigger feelings of shame. The emotional regression connected with the emergence of primitive impulses, conflicts and defences; the grandiose phantasies and the increased narcissism; the preoccupation with bodily functions and body image; the tendency to idealization and the need for social acceptance constitute the matrix within which shame and shame-derived feelings can develop. Shame is discussed as it is experienced by young patients and often by the therapist. Shame in the countertransference and during supervision is also considered. Stress is put on the importance of taking shame into account as a fundamental factor in psychotherapy with adolescents, particularly in relation to the establishment of the therapeutic relationship, understanding and interpretations. The thesis is illustrated with clinical vignettes.     

Transverse shear surface wave in a functionally graded material infinite half space

The variable substitution and power-series techniques are used for the asymptotic analytical derivation of the governing equation of a transverse surface wave. The results reveal that the transverse wave can propagate along the surface of a functionally graded infinite half space in various modes, and that their dispersion relations are normal. For certain cases, energy is concentrated on the surface region to a depth of several wavelengths. A new theoretical foundation based on the transverse surface wave can be provided for graded-material characterization by experimental measurement. Some phenomena of seismic wave propagation may also be explained.     

Making use of the vignette technique to examine methods of bereavement counselling: An exploratory study

Aim: The principal objective of this small‐scale study was to examine methods of bereavement counselling because of their lack of clarity. Method: The study made use of the vignette technique along with six semi‐structured interviews analysed by means of thematic analysis. Findings: Results showed that bereavement counsellors are using a multitude of different and diverse methods of counselling, characteristic of postmodernism. Advantages of these postmodern methods are that bereavement counselling methods are rich, creative, supportive, pluralistic and attentive to otherness. However, disadvantages of these postmodern methods have led to a lack of consensus amongst experts, unclear methods and an anti‐methodological way of working by counsellors. Implications for practice: Postmodernism is inherent in bereavement counselling. As a result no two counsellors work in exactly the same way because of the difference in their background and experience similarly it can be said that no one counselling method has exclusivity due to the diverse nature of postmodernism.     

The state,the institution,and the patient: A three-way collison at the crossroads as a hospital fights closure

This paper recounts the story of a National Health Service hospital which was almost closed for financial reasons in 1990. After a political campaign carried out in the full glare of publicity, the Hospital was reprieved. The account is based on the author's conversations with members of staff. The story of the staff, the patients, the Hospital, and the political struggle are woven together by common themes which are highlighted by reference to the Oedipus myth.     

Factors influencing newborns' preference for faces with eye contact

We investigated newborns' sensitivity to the direction of gaze of another's face by using a preferential looking technique. This study extends earlier work on a preference for faces with direct gaze in newborns. In Experiment 1, we replicate the basic finding of Farroni and colleagues that newborns prefer to look at faces with direct gaze. In Experiments 2 and 3, we establish that a preference for faces with direct gaze in newborns is present only within the context of an upright face and a straight head, suggesting that relatively primitive configuration-sensitive mechanisms may be operating. Overall, these results further the view that relatively simple perceptual biases in newborns may be an essential foundation for later social-cognitive development.     

Cognitive capacities for behavioural flexibility in wild chimpanzees (Pan troglodytes): the effect of snare injury on complex manual food processing

In chimpanzees, it is only in the restricted context of tool use that manual and cognitive skills have been described, comparable to those that gorillas and orang-utans display in obtaining plant foods. We report the complex food preparation skills used to eat, without tools, the leaves of the tree Broussonettia papyrifera in the Sonso community of chimpanzees at Budongo Forest, Uganda. Able-bodied individuals used multi-stage techniques that required bimanual role differentiation at several stages, and were hierarchical in organisation. A total repertoire of 14 techniques was found, with strong preference in all individuals for either of two of these; 6 additional techniques were found when flowers and leaves were eaten together. However, in this community over 20% of individuals suffer from some form of upper- or lower-limb injury as a result of snares. We investigated the manner of compensation for upper-limb injury. Only the most severely injured showed reduced feeding efficiency. Injured individuals were found to use the same repertoire of techniques as able-bodied chimpanzees. We found no evidence to suggest that injured individuals were able to develop wholly novel techniques optimal for their specific injuries, although shifts in preference for particular techniques did occur. Rather, injured individuals used novel ways of achieving particular steps in the process; by "working around" their impairments; in this way, they managed to use the same techniques as the able-bodied. Since snare injuries generally befall young animals, these results suggest that chimpanzees learn techniques partly through observational learning (of, necessarily, able-bodied individuals). Accepted after revision: 8 February 2001 Electronic Publication     

A Mixed Bag: The Realities of Psychoanalytic Practice

For a variety of reasons, psychoanalytic training is done in somewhat of a vacuum. It teaches a theory and a way of practicing that does not always translate well to day-to-day private practice work. The clinical realities of psychoanalytic practice prove the psychoanalytic method to be one that provides help to a wider audience than classical psychoanalytic training programs might suggest. The psychoanalytic approach offers the analyst many special opportunities to work with and help a wide variety of patients. Analysts who accept both the limitations as well as the wide application and broad benefits of the psychoanalytic approach may have a more fulfilling experience than their training experiences might foster. At the same time, the analyst's level of therapeutic skill, the patient's diagnosis, and many multiple external factors create different limitations in the practice and outcome of psychoanalytic work. Extensive case material is used to show the broad range of patients who are helped by the psychoanalytic method. The clinical material also shows the less than perfect, but often good enough outcomes of these difficult cases with often severely disturbed patients.