Was It Just a Dream? Aging and Dreaming the Psychoanalytic Process

By revisiting the last years of a long psychoanalytic treatment of a female patient, a psychoanalyst reflects on her own development as a clinician and on the changes in her experience of psychoanalytic generativity. An increasing ability to understand patient's shifts between creativity and destructiveness brings about a different understanding of the process of mourning, while the shared aging of the analytic dyad highlights the difficulty of ending an analysis that has become a way of life.

#ReadyToplay: hamstring injuries in women's football - a two-season prospective cohort study in the Norwegian women's premier league

In this two-season prospective cohort study (2020-2021), we aimed to describe the characteristics, clinical findings and magnetic resonance imaging (MRI) findings of hamstring injuries in the Norwegian women's premier league. Hamstring injuries were examined by team physiotherapists using a standardised clinical examination and injury form. Injury location and severity (modified Peetrons classification) were graded based on MRI by two independent radiologists. Fifty-three hamstring injuries were clinically examined, 31 of these with MRI. Hamstring injuries caused 8 days (median) lost from football (interquartile range: 3-15 days, range: 0-188 days), most were non-contact and occurred during sprinting. Gradual-onset (53%) and sudden-onset injuries (47%) were evenly distributed. The injuries examined with MRI were classified as grade 0 (52%), grade 1 (16%) or grade 2 (29%). One proximal tendinopathy case was not graded. Grade 2 injuries caused more time loss than grade 0 (19 ± 8 vs. 7 ± 7 days, p = 0.002). Of injuries with MRI changes, 60% were in the m. biceps femoris, mainly the muscle-tendon junction, and 40% in the m. semimembranosus, most in the proximal tendon. Compared to previous findings from men's football, a higher proportion of hamstring injuries in women's football had a gradual onset and involved the m. semimembranosus, particularly its proximal tendon.

Ultrasonography in Undescended Testes

The position of an undescended testicle is of importance for choice of therapy. The aim of this study was to investigate whether the anatomic positions occupied by undescended testicles could be detected by an objective method. Real-time ultrasonography was performed in 83 patients with 123 undescended testicles. Patient compliance was 97 per cent. The testis was demonstrated as an echo-poor, oval structure in 113 of 119 examinations (95%). By determining the relation of the testis to definable anatomic landmarks in the inguinal region, all positions occupied by the testis could be characterized by ultrasound and the testicles classified accordingly. The relationship of the testis to the external ring was established in 112 cases (94%). Twentyseven per cent of retractile and 11 per cent of truly undescended testicles were demonstrated in more than one ascended position. Estimation of testicular volume by sonography was unsuccessful compared with intraoperative measurements.

[Mentalization--the ability to keep mind in mind]

Mentalization is the ability to keep mind in mind, both one's own and another person's mind. Without mentalization ability, man is unable to anticipate personal and other person's reactions in different situations and to control his/her own emotional states. Insufficient mentalization ability makes life erratic and uncontrollable. It is associated with emotionally unstable personality and other psychic and neuropsychiatric disorders. At least five evidence-based forms of psychotherapy have been developed for the treatment of emotionally unstable personality disorder, all promoting the patient's mentalization ability.

Prevalence and characteristics of asymptomatic tears of the rotator cuff

We undertook clinical and ultrasonographic examination of the shoulders of 420 asymptomatic volunteers aged between 50 and 79 years. MRI was performed in selected cases. Full-thickness tears of the rotator cuff were detected in 32 subjects (7.6%). The prevalence increased with age as follows: 50 to 59 years, 2.1%; 60 to 69 years, 5.7%; and 70 to 79 years, 15%. The mean size of the tear was less than 3 cm and tear localisation was limited to the supraspinatus tendon in most cases (78%). The strength of flexion was reduced significantly in the group with tears (p = 0.01).

Asymptomatic tears of the rotator cuff should be regarded as part of the normal ageing process in the elderly but may be less common than hitherto believed.

[Benign fibrous mesothelioma of the pleura]

Benign fibrous mesothelioma of the pleura is rare. The tumour may present in several ways, as shown in our two patients, one with an elevated diaphragm and the other with slowly growing intrathoracic tumour. The tumour may reach a considerable size, is localized, is normally benign, and is curable by surgical resection.

[Pleural exudate and intestinal obstruction. Late manifestation of traumatic diaphragmatic hernia]

The diagnosis of diaphragmatic rupture is most commonly made during surgical exploration following penetrating injuries, or in the presence of obvious herniation of viscera through the diaphragm. In the absence of acute herniation a diaphragmatic rupture frequently remains unrecognized and may cause herniation of intra-abdominal contents into the thorax after latency periods of up to several decades. Therefore diaphragmatic rupture is an important differential diagnosis in subjects with unclear abdominal conditions or unexplained pleural effusion in the presence of a history of previous thoracoabdominal trauma. A case is presented which highlights pitfalls and clinical findings.

[Ultrasonic diagnosis of undescended testes. Methods and possibilities]

83 boys with 123 empty hemiscroti were assessed by clinical examination and ultrasound. After repeated clinical examination with the patient in general anesthesia 60 undescended testes were operated. We present the technical aspects of examination of undescended testes by ultrasound. When testicular position as established by ultrasound was compared with intraoperative finding position, ultrasound had a very high sensitivity, specificity and accuracy for testes positioned distal to the internal ring. The anatomical position of the testis at sonography and the patient's age provide objective evidence to discern retractile and truly undescended testes.

Ultrasonography in undescended testes

The position of an undescended testicle is of importance for choice of therapy. The aim of this study was to investigate whether the anatomic positions occupied by undescended testicles could be detected by an objective method. Real-time ultrasonography was performed in 83 patients with 123 undescended testicles. Patient compliance was 97 per cent. The testis was demonstrated as an echo-poor, oval structure in 113 of 119 examinations (95%). By determining the relation of the testis to definable anatomic landmarks in the inguinal region, all positions occupied by the testis could be characterized by ultrasound and the testicles classified accordingly. The relationship of the testis to the external ring was established in 112 cases (94%). Twenty-seven per cent of retractile and 11 per cent of truly undescended testicles were demonstrated in more than one ascended position. Estimation of testicular volume by sonography was unsuccessful compared with intraoperative measurements.

Ultrasound in the evaluation of retractile and truly undescended testes

The aim of this study was to evaluate ultrasound and clinical examination in the assessment of the exact position of an undescended testicle, and to see whether ultrasound could help discern retractile and truly undescended testicles. One hundred and twenty-three undescended testicles were examined. Of 113 detectable testicles 47 were assessed retractile and 66 truly undescended of which 60 were operated. Ultrasound had a sensitivity, specificity and accuracy of 100% for testicles positioned distally to the internal ring. The results of clinical examination by a urologist was poor, especially for testicles located in the inguinal canal. Bilateral symptoms were most common in the retractile group. Retractile testicles dominated at the age group 6-8 years and were most commonly found in the intermediate and external ring positions. Truly undescended testicles preferred the inguinal canal and a subcutaneous everted position. Differences are statistically significant. A discrimination analysis between retractility and true maldescent was performed based on whether symptoms were uni- or bilateral, patient's age and the position of the testicle. The most dominant factor was whether symptoms were uni- or bilateral.