Biomedical subjects
Publications and source records attributed to R Dickey.
A patient with multiple paraphilias who had been treated for several years with sex drive reducing agents (cyproterone acetate and medroxyprogesterone acetate) with little effect on sexual activity or fantasy was offered treatment with long-acting leuprolide acetate, on LHRH agonist. This produced a marked decrease in all reported sexual thoughts and activities with no significant side-effects.
Five groups of males were compared on penile volume changes elicited from viewing short movie strips and slides of nude children and adults of both genders. Subject groups were sex offenders against adult females, volunteer controls who erotically preferred adult females, volunteer controls who erotically preferred adult males, heterosexual pedophiles, and homosexual pedophiles. Pedophiles differentiated erotically between females and males less than males who erotically preferred physically mature partners.
The treatment and clinical management of gender dysphoric heterosexual men often poses a challenge to the clinician. Gender dysphoric patients pursuing various lifestyle options may seek psychotherapy to deal with some of their conflicts. This paper describes one form of counseling--group therapy--which has been helpful to gender dysphoric heterosexual men and outlines the group psychotherapy program at the Gender Clinic of the Clarke Institute of Psychiatry.
The reliability of the notion that pedophilia is caused by sexual abuse in childhood was explored by examining retrospective self-reports of 344 males. Included in the study were 77 heterosexual pedophiles, 54 homosexual pedophiles, 51 nonpedophilic sex offenders against children, 36 sex offenders against physically mature females, 75 heterosexual paid volunteers who erotically preferred mature females, and 51 homosexual clients who preferred mature males. For each sex offender the differential diagnosis of an erotic preference for minors vs. a preference for physically mature partners was made by means of the phallometric test of erotic gender and age preferences. The analysis of self-reports confirmed that the proportion of pedophiles who report having been sexually abused in childhood by mature persons is larger than that of men who were not charged for or accused of a sex offense against a child though the difference is relatively small (28.6 vs. 13.9 and 10.7% for the heterosexual pedophiles and the two groups of gynephiles, respectively, and 25.9 vs. 11.8% for the homosexual pedophiles and androphiles, respectively). Further analysis demonstrated, however, that pedophiles who admitted having an erotic interest in children significantly more often claimed that they had been sexually abused as children than pedophiles who did not admit having such feelings. This interdependence renders the reliability of these self-reports questionable.
This study investigated whether heterosexual males are more likely to regret sex reassignment surgery than homosexual males or females. Subjects were 111 postoperative transsexuals who had been surgically reassigned for at least one year, representing a follow-up rate of 84.1%. Subjects' feelings about surgery were assessed with self-administered questionnaires. None of the 61 homosexual females or 36 homosexual males consciously regretted surgery, compared to 4 of the 14 heterosexual males: a significant difference. This finding suggests that heterosexual applicants for sex reassignment should be evaluated with particular caution, although a heterosexual preference is not an absolute contraindication for surgery.
The behavior of sadists is bizarre and poorly understood. There are gross endocrine and brain abnormalities in a small number of these men. Approximately two-fifths show subtle temporal lobe brain abnormalities that are logically linked to sexual behavior and require further exploration. It would be interesting to explore the interface of the endocrine system and the brain--that is, to determine if there are interactive processes that may be related to the development of sexual anomalies, perhaps early in life as suggested by Kolarsky et al. Certainly, biological factors cannot determine whether an individual will act on his sexual impulses. Many psychological factors, such as family background and substance abuse, play a significant role in the dangerousness of the individual. However, it appears that biological factors are noteworthy in sexual sadism. Brain pathology, especially, shows some correlation with force used in offences and likelihood of recidivism, and for this reason alone it merits further study.
Over the last 5 years, technological advances have resulted in specialized technical aids, such as electronic communication devices, computer input devices, and environmental control systems, which have made it possible for many persons who are severely physically disabled to enjoy greater functional independence within the home, school, workplace, and the community. This paper focuses on environmental control systems and discusses how occupational therapists match environmental control systems with clients' needs.
Explore the source record for details and available documents.
Fifty-seven patients had sixty-three total hip replacements, performed using a femoral stem with a soft, low-modulus porous coating of Proplast and a conventional acrylic-cemented acetabular component. Forty-seven of the hips were followed for an average of thirty-seven months. Seventeen (36 per cent) of the forty-seven hips were judged to be clinical failures, and five of the failures were revised by inserting a new femoral component and fixing it with acrylic cement. The prostheses were thought to have failed because they had inadequate support, due to deficiencies in the design of the stem and in the fit of the implant in the femur. The five retrieved prostheses were found to have fibrous-tissue ingrowth into the coating, which had failed by shear within its substance. Therefore, we concluded that the coating had insufficient strength to withstand normal weight-bearing loads. To improve performance, a more stable prosthesis with a stronger porous coating is needed. In addition, a posterior surgical approach through a transtrochanteric osteotomy may give better exposure of the femoral canal and facilitate the use of longer-stem (140 to 153-millimeter) designs, which are less likely to be inserted in a varus position.
Explore the source record for details and available documents.
Propranolol has been utilized safely and successfully in the preparation for thyroidectomy in four pregnant patients with thyrotoxicosis. No ill effects were noted in mothers or infants. No change in fetal heart function was noted while two mothers were receiving propranolol. The major advantage of propranolol over the thiourea drugs is the rapidity with which the patient can be prepared for operation. Preparation with beta blockage can be accomplished in five to ten days. This limited experience suggests that propranolol is probably the drug of choice for preparation of the gravid thyrotoxic patient for whom thyroidectomy is planned.
Explore the source record for details and available documents.