Agressologie: revue internationale de physio-biologie et de pharmacologie appliquees aux effets de l'agression最新文献

After the question of TC patient's survival in Intensive Care Units, many other questions, during-coma awakening phase, appear to family, care team, and the patient himself i.e. will the patient be handicapped or will he be as before? which after-effects of this passage? The vital functions and autonomy conquest goes with a permanent adjustment of psychical functions for keeping together an "exploded" subject. Each patient's singular history, its expression and meanings, are catched into initial trauma, coma, intensive care and awakening phase framework. Clinical observations leads to describe three evolutive periods, specific of awakening but also bound up with each other.

Two researches merge together in this article: the former originates in coma clinical practice and aims at reaching a more abstract formulation, while the latter originates in the theory of narrative and tries to find practical applications. The interest of this merger lies in opening up a new field of study, comatics, whose object is to conceive the best possible conditions for comatose people, for specific varieties of comatose people and even for this or that individual comatose person to fit back into social life, which involves grasping meaning and clues and signals and signs, and finding one's way about in the circuit of communication. Comatics, in short, is semiotics as applied to awakening from comatose states.

S. Freud in his "Metapsychological supplement to the theory of dreams" considers dreams and Meynert's "Amentia" as a "Hallucinatory-wishful psychosis". After investigation in resuscitation units and reading of the "Amentia", it seems that this designation by a respectful master of Freud refers to pathological states identical to the ones we observe nowadays with patients getting out of coma. Jensen's "Gradiva" describes a kind of benign madness, since it is an amorous folly. This again is a "Hallucinatory wishful psychosis". Freud tells us that the novel explain precisely how to cure this state. From Meynert's "Amentia" and from Jensen's "Gradiva" commented by Freud, the author goes on with remarks about the illusions of resuscitation and about the means of helping the patient to recover.

Clinical observations as well as words pronounced by brain injured patients in coma awaking phases attest the emergence of an unconscious psychic register, which arises at the time of coma and resuscitation, and takes an active part in their perspective background during the subsequent phases. Reported clinical fragments illustrate the interconnections between this unconscious register and the various physiological breakdowns suffered by patients as well as their attempts to recover this background.

Among comatose or awakening subjects, psychoanalysis is able to theorize and to interpret clinical practice. For all, it is not possible to refer, for such subjects, to psychoanalytical practice.

The interruption of human intercourse induced by extended coma is compounded by the deleterious effects of an artificially deprived or understandable anymore could be a traumatic experience in itself. As a result of the many years of work carried out in the Neuro-Surgical service, Orléans-La Source, it seems necessary, when speaking about "enriched surroundings" and "stimulations" for the comatose patient, to associate the notions of personalized care, reawakening of desire, and, by the early introduction of familiar landmarks, to gain access to emotional language. Among all possible means, human attendance seems the most pertinent and efficient route to generate this emotion, when it truly expresses the motives of the attendant. The latter, once his defensive reactions are surmounted, will find his reward in the always important call for global care, and his motivation may be renewed by what seems properly termed as a nascent human relation.

Neurogenic pain is by definition linked to a lesion of the pain pathways at any level. There are many causes for the neurological pain which can be present in sympathetic disorders, in peripheral neuropathies and central nervous disorders too. In despite of these multiple aetiologies, the neurological pain is characterised by: demyelinisation at the anatomic lesion; a spontaneous firing described by the authors as related to three mechanisms, sensitivation, deafferentation and lost of inhibition; a common and specific clinical semiology very different indeed from the peripheral pain described as a surafferentation.

When the inside pressure of mouldable mattress is lowered isotropic deformation can be harmful for spinal cord. The axial force is measured placing stress gauge in a metallic manikin and in corpse (T2-L1), then on the cephalic top of volunteers. When soles and head are included in an usual mattress, during the retraction stress values raise up to 484 N at 262 mbar for manikin, to 150 N at 315 mbar for corpse, to 102 N at 310 mbar for cephalic top of the volunteers. In comparison, a prototype was tested. Results were improved on metallic models but not on human corpses or volunteers. This test allowed us a better understanding of the mechanism of the stress. It is possible to propose precautionary measures during patient immobilization (to provide a space between soles, head and mattress) and to build a new stressless mattress.