The Nell Dialogues

Nell M. came to her therapist with an unusual problem: She was disappointed that her metastatic breast cancer, with the promise of ending her life, was not progressing on her hoped-for schedule. She had hoped her death would prevent her from witnessing her spouse’s mental deterioration from Alzheimer’s disease. This is how Nell’s story began and proceeded for a period of 40 weeks of counseling meetings, including 12 recorded sessions. This book consists of 12 illness narratives created in the presence of her therapist. These dialogues explore the challenges of managing the physical and emotional demands of cancer, relationship issues with family and healthcare professionals, and disturbing, anxiety-provoking thoughts and the mourning that accompanies the end of life. Nell’s vibrant voice is a beacon throughout the narratives, sometimes sad, yet always hopeful for a good death. Her ability to navigate the difficult territory of mortal time and dying informs readers about how they might approach their own ending with grace and dignity.

Intravesical repair of vesicovaginal fistula guided by cystoscopy

Background: Vesicovaginal fistulas (VVF) are an unusual problem that may significantly affect a patient’s quality of life. The main causes for this condition are labour complications (mostly in developing countries) and pelvic surgeries (in industrialised countries). Treatment may be conservative or surgical. Regarding surgical treatment, there is still debate about the best approach and surgical technique. Objective: To demonstrate a correction of a VVF guided by cystoscopy using intravesical laparoscopic instruments. Methods: Case report and surgical video of a recurrent VVF treated with a hybrid technique involving direct transvesical insertion of 3 mm laparoscopic trocars and instruments guided by cystoscopy. As far as we know, although there are some reported techniques that use a combination of transvesical laparoscopic instruments and cystoscopy, this is the least invasive and most ergonomic technique described. Results: Two years after surgery, the patient remains asymptomatic and with no fistula recurrence. Conclusion: The transvesical approach guided by cystoscopy seems to be an effective, safe and ergonomic minimally invasive procedure for VVF repair.

Inferior Oblique Entrapment After Orbital Fracture With Transection and Repair

Extraocular muscle (EOM) entrapment with resulting reduction in motility and diplopia is a known complication of orbital fractures. Less commonly, transection of the EOMs due to trauma, iatrogenic injury, or intentional myotomy may lead to persistent diplopia. The inferior oblique (IO) is often encountered during orbital surgery along the medial wall and floor, and may be disinserted to aid in visualization. The authors present a case of IO entrapment which occurred during zygomaticomaxillary fracture reduction. Intraoperatively, an IO transection was performed and the muscle was reattached within the orbit. Postoperatively, the patient did not develop diplopia or motility disruption. This technique may provide a useful solution to an unusual problem during orbital fracture repair.

Constructing tetrahedra with given face areas

We tackle an unusual problem that, as far as I know, is not in the standard literature. To state it concisely I use what I call ‘valid sets’. We know that in any three or more positive quantities, only the largest can be half or more of the total value; and is then obviously greater than the sum of all the others. But if the largest is less than half the total of the set, it must be less than the sum of the others; and this is true for every element in this set. I call such a set ‘valid’. For example, the sides of a triangle are valid, as are the face areas of a tetrahedron. Our problem relates to the converse for a tetrahedron: given any four valid quantities, is there always a tetrahedron with those face areas? In this article I answer this by showing that, for any valid set, we can always construct the net of a corresponding tetrahedron. In fact, for any given valid set there is always an infinity of non-congruent tetrahedra with the given face areas. Although in general there are no formulae that give the exact edge lengths of these solids, I show that there are always several distinct infinite subsets that are constructible and whose edge lengths can be determined exactly.

Hallucinogens: Magic Mushrooms, Ayahuasca, Mescal Buttons, and Dr. Hofmann’s Problem Child

There are about 400,000 species of plants in this world. Only a small fraction, perhaps 100 in number, contain hallucinogenic chemicals. Nearly a century ago, Lewis Lewin, professor of pharmacology at the University of Berlin, in speaking of drugs he called phantasticants, said “The passionate desire which . . . leads man to flee from the monotony of daily life . . . has made him discover strange substances (which) have been integral to human evolution both societal and cultural for thousands of years.” An unusual problem presents itself to me in writing about these drugs: They straddle the worlds of science and mysticism. The Encyclopedia Britannica defines mysticism as the practice of religious ecstasies (religious experiences during alternate states of consciousness), together with whatever ideologies, ethics, rites, myths, legends, and magic may be related to them. Science I am comfortable with; mysticism not so much. Yet in our exploration of the agents found in this chapter, we will encounter many persons speaking of drug-induced mystical experiences. I have attempted to get around my unease by first providing the history and the pharmacology of these agents and then touching only lightly on mysticism, allowing readers to draw their own conclusions. What shall we call these chemicals? Hallucinogen, a substance that induces perception of objects with no reality, is the term most commonly encountered and the one that I have settled on for the title of this chapter. However, it comes with a caveat. Albert Hofmann, the discoverer of LSD, our prototypic hallucinogen, has pointed out that a true hallucination has the force of reality, but the effects of LSD only rarely include this feature. Two additional terms that we will find useful are psychotomimetic and psychedelic. We have already considered the former, an ability to mimic psychosis, in our discussion of amphetamine-induced paranoid psychosis in chapter 4 and the effects of phencyclidine in chapter 6. A psychedelic was defined in 1957 by Humphrey Osmond, inventor of the word, as a drug like LSD “which enriches the mind and enlarges the vision.”

Spontaneous angina bullosa hemorrhagica of tongue: An unusual problem following prosthodontic procedure

Introduction: Angina Bullosa Hemorrhagica (ABH) is the term used to describe benign subepitilial oral mucosal blood filled blisters, which are not attributed to any systemic disorder. It is a very uncommon condition, mostly seen in elderly patients. The exact etiopathogenesis of the ABH is not known. Herewith, we present a case of 50-year-old male patient who developed ABH on right lateral border of the tongue, following prosthodontics impression making for completely edentulous mouth. Methods: The case management method was topical application of chlorhexidine gel (1%) and lignocaine gel (2%) with avoidance of hot and spicy food. Result and discussion: After one week in treating with topical therapy, the lesion became normal. The diagnosis of ABH is difficult in patients because of its asymptomatic nature. The early diagnosis of the lesion is very important as a rapidly expanding blood-filled bulla in the oropharynx can cause upper airway obstruction. Therefore, a high level of suspicion is warranted on part of dentists who may the first to encounter the lesion. Conclusion: Spontaneous Angina Bullosa Hemorrhagica of tongue was an unusual problem that can occur following prosthodontic procedure. The management of the lession were intended to reduce pain or discomfort and prevent secondary infections.