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The authors discuss in the introduction hitherto reported data on the incidence and course of post-infarction ruptures of the interventricular septum and the results of conservative treatment. The high mortality rate after the conservative procedure led to attempts to resolve post-infarction ruptures of the interventricular septum surgically. The authors discuss in detail the indications for early and delayed operations has a decisive influence on the patients' survival. The authors had the opportunity to operate since 1978 till February 1986 five patients with post-infarction perforation of the interventricular septum. Four of the patients were women, one was a man. The mean age of the operated patients was 61 years, the oldest patient was a 75-year-old man and the youngest a 46-year-old woman. During the last check-up in 1994 it was revealed that of five operated patients three had died. One of them three years after operation and two after seven years. One female patient survives for 13 years and one for 11 years. Both are in a satisfactory conditions.

Five scenarios of child abuse were used to study the recognition and reporting of child abuse in a sample of 664 teachers, counselors, school psychologists, principals, and district superintendents. The following results emerged: (a) Reporting tendency varied by type of abuse described, forming a 3-level hierarchy; (b) reporting tendency and reporting rate were unrelated to the gender of the victim or respondent; (c) reporting tendency was unrelated to the profession of the educator (i.e., principal, counselor, etc.), though certain types of abuse were suspected and/or reported significantly less often by classroom teachers; (d) for each scenario a linear composite of decisional items discriminated Reporters from Nonreporters with 75% to 84% accuracy. Most salient in distinguishing Reporters from Nonreporters were issues involving quality of suspicion and the respondents belief that schools should be a first line of defense against abuse and neglect; (e) educators were uniform in their high level of awareness of mandatory reporting laws; (f) educators preparedness to detect child abuse differed by profession, but most desired additional training. The implications of these findings are reviewed and suggestions made for revisions to social service policies and training for educators.

Background: The authors deal with the problem of rare congenital and acquired aneurysm of the left atrium and auricular appendage. The authors attempted to compare findings on operation with results of preoperative examinations and evaluate the yield of echocardiographic and angiocardiographic examinations., Methods and Results: The authors had the opportunity to encounter this unusual finding of cardiac aneurysms in five patients operated in 1987-1990 on account of an advanced mitral defect associated in two patients with ischaemic heart disease. In all patients acquired aneurysms were involved. In two a large thrombus was found., Conclusions: In the diagnosis of aneurysms of the left atrium and auricular appendage transoesophageal echocardiography proved to be the most reliable method.

The authors present their initial experience with surgery of pulmonary affections in 32 patients where they used medial sternotomy as the route of approach. They provide evidence of the advantages of this approach, in particular in high-risk patients, and of the favourable effect of this approach on the postoperative course. Successful radical surgery under conditions of extracorporeal circulation, although a very advanced tumour was involved where posterolateral thoracotomy was unequivocally contraindicated, indicates that there is a possibility to extend indications of surgical therapy of otherwise inoperable pulmonary tumours.

Mandatory reporting laws have created a difficult dilemma for many mental health providers (MHPs). Professional ethics, confidentiality, and the best interests of the client are often seen as conflicting with the legal obligation to report child abuse. The receptivity of child protective service (CPS) agencies to three alternative MHP reporting strategies was assessed in a national survey. The results indicate strong support for the current model of reporting and marginal support for alternatives that supply the MHP and the family with more latitude in determining when to report and how reports are handled. The results are discussed in relation to what many MHPs see as the need for more integrated, flexible, and cooperative approaches to the protection of abused and neglected children.

A conception of the self and five motivational systems is applied to clinical psychoanalysis. Each motivational system develops in infancy from innate and learned patterns in response to a basic need, and each involves particular affects. Each motivational system contributes patterns from which important transferences evolve. At any given moment, motives derived from one or another system dominate a person's experience, motives from the other system being subsidiary or dormant. We describe the manner in which these concepts contribute to an explanation of foreground-background relations during analysis, and how analysts and analysands construct model scenes to give meaning to information acquired by empathic listening. We conclude with a clinical vignette illustrating the application of these concepts to the patient's transference and the analyst's response in the intersubjective realm of an analytic enactment and verbal exchange.

Freud's papers on technique were written at a time when he could express supreme confidence in the psychoanalytic process, based on his theory of libido. Freud was far less sanguine about the practices of many contemporary analysts; consequently the papers contain far more don't's than do's. From the vantage point of today, these papers portray a transitional stage in psychoanalysis, an age of innocence, in comparison to the complexities of our current view of the interaction between analyst and analysand.

The authors submit a review of the surgical treatment of ischaemic heart disease, and based on data from the literature and their own experience, they evaluate the asset of so-called indirect revascularization operations under conditions when an aortocoronary bypass is impossible or has only a short-term effect due to the diffuse sclerotic affection of the coronary circulation. Special attention is paid to attempts of retrograde revascularization of the heart muscle by bypasses into the coronary veins. Because at present the possibility of indirect revascularization of the myocardium by a retrograde approach via the cardiac veins still remains a by far not yet resolved problem, the authors recommend for situations where the aortocoronary bypass is out of question a procedure making use of the advantages of a direct aortocoronary bypass and Vineberg's operation performed so as to relieve the blood flow through the sclerotic coronary artery beneath the anastomosis. In special situations also a sequential bypass could be considered with a side-to-side anastomosis into the artery and end-to-side into the appropriate vein.

Application of the cardioplegic solution dramatically improved the results of the operations in ECC. Authors discussed the methods of application of the cardioplegic solution, mainly in the connection with its applications to the sinus coronarius. This is then discussed from another point of view of its use. In the field of the cardioplegy there is referred about new authors' method, and so on the possibility of its use, and the most propriete indications. Described method is available and its parameters, verified clinically and experimentally, are advantageous in the stated situations.

The authors evaluate the advantages and disadvantages of one-stage operations in concomitant cardiac and pulmonary diseases and define the optimal indications for this procedure. The justification of one-stage operations in selected patients is confirmed by the authors' own experience assembled in two patients. One suffered from lung cancer and ischaemic heart disease and the other one from a tuberculoma and ischaemic heart disease. The one-stage operation in both patients was without complications.

The concept of relational control was measured using the index of Topic Control to investigate Haley's assertion that successful therapy is characterized by the therapist controlling the definition of the therapeutic relationship and defining it as a complementary relationship in which the therapist is in a "one-up'' position. Following Haley's assertion, it was hypothesized that: (a) across a sample of successful therapeutic dyads, therapists exhibit a greater measure of Topic Control than clients; (b) across a sample of successful and unsuccessful therapists, successful therapists exhibit a greater measure of Topic Control than unsuccessful therapists; (c) across a sample of successful and unsuccessful clients, unsuccessful clients exhibit a greater measure of Topic Control than successful clients; and (d) across a sample of unsuccessful therapeutic dyads, clients exhibit a greater measure of Topic Control than therapists. Analysis of therapist-client transactions for Topic Control was conducted by trained raters across 18 full-case transcripts of actual therapy interviews. The same transcripts were also analyzed by trained raters with respect to clients' change over the course of treatment. The results did not support the notion that across successful dyads therapists exhibit a greater measure of Topic Control than clients; and they did not support the hypothesis that across successful and unsuccessful therapists, successful therapists exhibit a greater measure of Topic Control. Also, there was no support to show that across successful and unsuccessful clients, unsuccessful clients exhibit a greater measure of Topic Control. Finally, the results did not support that across unsuccessful dyads, clients exhibit greater Topic Control than therapists.

The authors present an uncommon finding of annular sclerosis of the mitral valve in four patients. On operation in three instances severe and in one instance a mild degree of annular sclerosis of the mitral valve was revealed. Two men were 55 and 67 years old and two women were 40 and 67 years old. In two instances the operation was indicated by a myxoma in the left atrium and in two instances by advanced insufficiency of the mitral valve.

Model scenes are constructed by analyst and patient to organize puzzling information, integrate previous understanding, and initiate further exploration of experience. They are derived from a variety of sources: literature (oedipal myth); transference; ordinary or traumatic childhood events that occupy a pivotal position. Model scenes may conceptualize experiences of any age and motivational system, and are contrasted with screen memories and "telescoping" of events. Two clinical examples are used to illustrate the relation between the model scene and the transference. Model scenes provide a valuable clinical tool for moving from general to specific experience. They afford empathic entry into the transference experience and the opportunity through which the experience of motivations representative of past and present can be conceptualized and integrated into a cohesive self organization.

Two-dimensional echocardiography is due to the detailed visualization of the right atrium and adjacent structures an indispensible non-invasive method for the detection pathological masses. In the differential diagnosis of these masses most frequently a mobile thrombus and myxoma are involved. The authors are presenting the case-history of a 71-year-old female patient where during hospitalization on account of a suspect non-Q-wave myocardial infarction in an anteroseptal position echocardiography revealed a pathological mass in the right atrium. From the case-history and results of examinations it was not possible to evaluate unequivocally the nature of the revealed mass. In view of the considerable risk of embolization into the pulmonary artery and coinciding ischaemic heart disease the patient was indicated for surgery and a mobile thrombus was removed. The described case draws attention to the differential diagnosis of right atrial masses and the optimal therapeutic approach.

The authors submit a report on a 47-year-old man with the syndrome of angina pectoris and history of myocardial infarction who died after a revascularization operation of the heart from left ventricular insufficiency. On necropsy extensive arteritis of the coronary vessels with aortitis was revealed and with arteritis of the small intramyocardial and lienal arteries and arteries in the renal pelvis. They describe in detail the histological finding on the blood vessels, and consistent with some data in the literature, they assume that this disease forms a separate unit. It must be considered in particular in middle-aged men who have signs of coronary ischaemia and risk factors suggesting atherosclerosis, not occur in the case-history.

The authors describe four cases of uncommon surgical findings in patients with the diagnosis of cardiac myxoma. In the first patient an encapsulated tumourous growth in the left atrium was present which was in the mural annulus of the mitral valve and in the adjacent parts of the atrial and ventricular wall and was evaluated from the histological aspect as annular sclerosis. In the second patient a tumour-like thrombus was detected in the right atrium which had the shape of a basket handle and was attached by two stalks to the atrial septum. The third patient had a myxoma of the left atrium covering a concurrent defect of the interatrial septum and the fourth patient had a large myxoma in the left atrium with three calcified small tumours in the area of the mural annulus of the mitral valve.

The authors submit an analysis of patients operated in 1972-1982 at the First Surgical Clinic, Faculty of General Medicine, Charles University Prague. The group of patients was divided into those under 65 years and those above this age. The effect of the patients' age on the postoperative course was investigated, the survival of the two groups was compared, the causes of early postoperative deaths, the extent of the disease and histological type of tumour were evaluated. In was revealed that the risk of early postoperative death within one month is greater in patients above 65 years where it is 19.6%, as compared with 11.3% in the younger group. The risk increases in particular in patients above 70 years where it is as high as 26%. There is no fundamental difference in the causes of death between the two groups. The highest percentage of operated patients dies from embolism (40% and 42% in the patients above 65 years), the second place is held by inflammatory pulmonary complications which are somewhat more frequent in patients of the younger age group (24% as compared with 15% in the older patients). The survival curves of patients who had a radical operation in stage I and II of the neoplastic disease are almost identical and there is no significant difference in the survival of the two groups. In the group under 65 years 30% survive five years, in the older group 25%. The ratio of differentiated types of lung cancer, i.e. adenocarcinoma and epidermoid carcinoma is equal in both groups, contrary to small-cell carcinoma which was recorded in 6% in the older patients, as compared with 15% in the younger ones.

Often nonprofessionals lack specific instruction in relevant counseling and problem-solving skills. The effects of training procedures on counseling and problem-solving behaviors were examined experimentally with university students. The procedures involved the use of behavioral specifications, rationales, situational examples, study guides, and practice plus feedback on performance. Following training, the average percentage of occurrence of counseling and problem-solving behaviors increased to 89%. Generalization data in sessions with actual clients and expert ratings of the overall quality of counseling provided evidence of generalization to other settings and other evaluative dimensions of counseling and problem-solving performance.

Unlabelled: Survival rates were determined for a group of 136 patients in whom left ventricular aneurysm was determined by angiography. They were treated medically (99 patients) or surgically (37 patients). Congestive heart failure was predominant in all patients. The two groups did not differ in regard to clinical and haemodynamic data except for a more extensive coronary artery disease in the surgical group. Survival rates at the 5, 7 and 9 years were 62.5%, 52.5% and 37.5% in the medicaly treated group and 50%, 40% and 32.5% in the surgical group. Functional improvement at least one Functional Class NYHA was present in 75% patients postoperatively, and in 27% of patients treated medically., Conclusion: In patients with left ventricular aneurysm with predominant congestive heart failure surgical treatment improved quality of life but did not increase long-term survival.