Accidental hepatic artery ligation in humans

Despite the vast amount of information from experimental animals, it has been difficult to obtain a clear-cut picture of the effects of ligation of the hepatic artery in humans with relatively normal livers. The last complete review of this subject in 1933 indicated that a mortality in excess of 50 per cent could be expected in non-cirrhotic patients with injury of the hepatic artery or its principal branches. Five cases of dearterialization of the normal human liver have been observed. These were due to accidental interruption of the right hepatic artery in four and the proper hepatic artery in one. The injured vessel was repaired in one case and ligated in the others. In four of the five patients the vascular disruption was the sole injury. In the other the common bile duct was also lacerated. There was no evidence of hepatic necrosis in any case although one patient died from complications of common duct repair. Transient changes in SGOT and temporary low grade bilirubinemia were commonly noted. In addition, all cases of ligation of the hepatic artery reported since 1933 have been compiled. On the basis of reviewed, as well as the presently reported cases, it is concluded that ligation of the hepatic artery or one of its branches in the patient with relatively normal hepatic function is not ordinarily fatal in the otherwise uncomplicated case. Adequate perfusion of the liver can usually be provided by the remaining portal venous flow and whatever arterial collaterals are present, unless additional factors further reduce the portal venous flow or increase hepatic oxygen need. These factors include fever, shock and anoxia. The key to therapy in unreconstructed injuries to the hepatic artery is avoidance of these secondary influences. © 1964

Infant observation and the Tavistock model of teaching and learning: Continuity and change

This paper reviews the changing context of infant observation from the teaching perspective. It considers the benefits of infant observation (Bick's method) as set out by Martha Harris in 1976, and the challenges and opportunities posed to infant observation seminar leaders. These include the widening cultural, educational and social background of observers, the choice of family and the broader definition of what constitutes an ordinary family. The clinical context of public sector psychotherapy and its increasing emphasis on evidence-based work is also considered as a factor bearing on the seminar leader's capacities

Vigilance and vigilantes: thinking psychoanalytically about anti-paedophile action

This paper applies a psychoanalytic approach to the protests of members of `Residents Against Paedophiles' on the Paulsgrove estate in Portsmouth, UK, in August 2000. It sets these in the context of the strains existing in the British government's policy on sexual offenders. It is argued that the protests demonstrate the existence of links between a vigilante state of mind and the `mind of state' that makes community members responsible for crime management. Evidence is provided by the protesters' fabrication of a `mental list' of convicted sex offenders that mimicked the official register. The paper concludes that access to information does not always have the effect of containing adults in such a way that enhances their capacity to act as `responsible' citizens