Journal articles on the topic 'Foetor ex ore'

Rund jede vierte Person hat Mundgeruch. Dabei muss zwischen Foetor ex ore (90%) und Halitosis (10%) unterschieden werden. Ersterer ist nur im Mundatem perzeptierbar und hat seine Ursache in der Mundhöhle. Halitosis ist im Mund- und/oder Nasenatem feststellbar und die Ursache liegt entweder nasal/pharyngeal (lokale Halitosis nur im Nasenatem), pulmonal oder selten gastrointestinal (systemische Halitosis im Mund- und Nasenatem). Eine entsprechende Differenzialdiagnose ist Voraussetzung für die Kausaltherapie. Verantwortlich für den Foetor ex ore sind flüchtige Schwefelverbindungen, welche durch proteolytische Mikroorganismen in der Mundhöhle produziert werden. Prophylaxe und Therapie basieren auf der mechanischen und chemischen Reduktion dieser Erreger. Mundgeruch kann ein nachhaltiges soziales Handikap sein, weshalb das Thema nicht tabuisiert werden darf.

SummaryJeder Mensch hat einen einzigartigen Körpergeruch. Doch nicht nur starkes Schwitzen, Zigaretten und der Verzehr von Knoblauch können diesen verändern oder zu Atemgeruch (Foetor ex ore) führen. Auch ernsthafte Erkrankungen können sich dahinter verbergen.

ZusammenfassungDas Krankheitsbild des Megaösophagus ist durch eine diffuse Dilatation und verminderte Peristaltik der Speiseröhre gekennzeichnet. Unterschieden wird eine kongenitale und eine erworbene Form. Die Letztgenannte tritt in Zusammenhang mit gastrointestinalen, endokrinen, immunvermittelten, neuromuskulären und paraneoplastischen Erkrankungen sowie toxischen Zuständen auf. Zu den häufigsten klinischen Symptomen zählen Regurgitieren, Gewichtsverlust, Husten und Foetor ex ore. In den meisten Fällen lässt sich die Diagnose durch röntgenologische Untersuchung des Thorax stellen. Die Diagnose der zugrunde liegenden Ursache erfordert jedoch neben einer ausführlichen Anamneseerhebung zusätzliche diagnostische Maßnahmen. Die Behandlung und die Prognose von Patienten mit Megaösophagus hängen in hohem Maße von der zugrunde liegenden Ursache der Erkrankung ab.

Halitosis is known as bad breath that emanates from the oral cavity either intra-oral and/or extra-oral origins with different nomenclature such as oral malodor, foetor ex ore, bad breath, foul smell or in Bengali durgondha. Fifty percent of people worldwide view themselves as having halitosis, with (85.0-90.0%) of the etiology being intra-oral. Oral causes include basically tongue coating and other various causes like tooth decay, periodontitis, chronic gingivitis, oral infections, pericoronitis, calculus deposition, oral mucosal ulceration (bacterial and/or fungal), impacted food particles, orthodontic problems and poor oral hygiene practice. These sorts of foul smell of the oral cavity most often results from the bacterial degradation of oral organic substrates as volatile sulfur compounds (VSC). The source of halitosis may be related both to oral and systemic condition, but majority of cases are commonly related to oral factors. So far knowledge goes there have been a few studies evaluating the prevalence of bad mouth breath (BMB) in general population. The aim of this reviews are the classification of halitosis, assessment, diagnosis, intra-oral and systemic contributing factors, treatment, management and clinical application.DOI: http://dx.doi.org/10.3329/jssmc.v5i2.20767J Shaheed Suhrawardy Med Coll 2013;5(2):106-110

Background: Persistent pulmonary hypertension (PPH) is one of the main causes of mortality and morbidity in infants affected by congenital diaphragmatic hernia (CDH). Since the structural changes that lead to PPH take place already in utero, a treatment starting in the prenatal phase may prevent the occurrence of this complication. Objective: To summarize the development process of antenatal sildenafil for CDH. Methods: The pharmacokinetics and efficacy of sildenafil have been assessed in the rat and the rabbit model. The transfer of the drug through the human placenta has been measured with the ex-vivo placenta perfusion model. Results from this experiment are being incorporated in a pregnancy-physiologically based pharmacokinetic (p- PBPK) model. A phase I-IIb placental transfer and safety study is ongoing. Results: Sildenafil administration to pregnant rats and rabbits led to therapeutic foetal drug levels without maternal and foetal toxicity, although it was associated with impaired vascular development in foetuses with nonhypoplastic lungs. Peak concentrations and 24-hour exposure were higher in pregnant rabbits compared to nonpregnant ones. In rat and rabbit foetuses with CDH, sildenafil rescued the lung vascular anomalies and partially improved parenchymal development. Sildenafil crossed the human placenta at a high rate ex-vivo, independently from the initial maternal concentration. Conclusion: There is preclinical evidence that maternally administered sildenafil prevents the vascular changes that lead to PPH in CDH newborns. The phase I/IIb clinical study together with the p-PBPK model will define the maternal dose needed for a therapeutic effect in the foetus. Foetal safety will be investigated both in the clinical study and in the sheep. The final step will be a multicentre, randomized, placebo-controlled trial.

Abstract Hereditary persistence of fetal haemoglobin (HPFH) and (δβ)0-thalassaemia are conditions caused by large deletions of δ- and β-globin genes and are characterized by high fetal haemoglobin (HbF) in heterozygotes of these mutations. Complete characterization of these deletions is important for understanding the transcriptional and epigenetic mechanisms involved in increase in HbF levels by these mutations. Previous studies demonstrated that these large deletions remove the regulatory sequences which suppress γ-globin gene expression and increase the interaction of enhancers with γ-globin promoter. However, the exact mechanism for elevated HbF in these conditions and differences in HbF levels and phenotypes between (δβ)0-thalassaemia and HPFH still remains unclear. We screened 90 individuals from 51 families by gap-PCR for previously reported common deletions and by MLPA and quantitative fluorescent multiplex -PCR (QFM-PCR) for new deletions in the β-globin cluster. After identification of the approximate locations of the deletions by MLPA and QFM-PCR, we developed PCR strategies to amplify across the breakpoints and the products were sequenced to characterize the breakpoints. We identified six different deletions in Indian population. The frequencies of the previously reported common mutations, Asian inversion deletion and HPFH-3, were 46.66% and 24.44%, respectively. The rare mutations which were not found earlier in Indian population include 49.3kb deletion (12.22%) and 32.6kb deletion (10%). We found 2 novel deletions, 49.98kb deletion and 86.7kb deletion, which accounted 5.55% and 1.11%, respectively. The breakpoints of the 49.98kb deletion were found to be very close to those of HPFH-3 and this mutation was found in compound heterozygous with β-thalassaemia in a 8 year old boy with thalassaemia intermedia (Hb=8.8g/dL). Four heterozygotes in the family had mean MCV = 79.7fL (range: 76-85.6), mean HbF%= 26.9% (range: 23.3-33.0) and pancellular distribution of HbF suggesting that this mutation causes HPFH. The 86.7kb region encompassing Aγ-, δ-and β- globin genes was found in heterozygous state in one individual and it also had haematological parameters of HPFH (MCV=80.8fL and HbF=32.2%). To develop an experimental model to study the molecular mechanisms for elevated HbF in these conditions we established ex-vivo erythropoiesis system with the peripheral blood mononuclear cells obtained from patients with Asian inversion deletion and HPFH-3. Quantitative real time PCR (qPCR) showed increased expression of γ-globin transcripts in the cultured erythroid cells and chromatin immunoprecipitation (ChIP) of RNA Polymerase II (RNAPII) also showed increased transcriptional activation of γ-globin gene in the erythroid cells obtained from the patients with these mutations. To understand the roles of non-coding transcripts at the 5’ and 3’ breakpoints of the deletions in the transcriptional activation of γ-globin, we performed qPCR with the cDNA obtained from cultured erythroid cells using the primers that bind upstream and downstream of these breakpoints. The results showed that the level of BGL3, the noncoding transcript present near the 5’breakpoint, is enhanced by these deletions. We found activation of a novel non-coding transcript at the 3’ breakpoints and they were absent in the erythroid cells of normal individuals. ChIP also showed significant binding of RNAPII at the genomic regions from where these non-coding transcripts are produced. The role of non-coding transcripts has not been reported earlier as a mechanism for increased γ-globin transcription in HPFH and (δβ)0-thalassaemia. It is possible that these deletions remove the genetic elements that cause transcription repression of γ-globin gene in normal adults and they also cause activation of non-coding transcripts which change the epigenetic status of γ-globin gene resulting in its active transcription. To conclude, using QFM-PCRs we could perform a comprehensive study of (δβ)0-thalassaemia and HPFH in Indian population and detected rare and novel deletions that cause these conditions. Using ex-vivo erythropoiesis system which mimicked the pattern of globin gene expression in normal individuals and patients with globin gene mutations, we could identify the role of noncoding transcripts in increased HbF expression in the patients with HPFH and (δβ)0-thalassaemia. Disclosures: No relevant conflicts of interest to declare.

The oldest remedies identified to mankind are herbal medicines. India is recognized worldwide for its Ayurvedic treatment. As only little studies are done on this plant, the purpose of current review is to make accessible up-to-date information on, botany, morphology, ecological biodiversity, medicinal uses, phytochemistry and pharmacological activities on diverse parts of Commiphora wightii (Arn.) Bhandari (C. wightii). This review was assembled using scientific literature from electronic search engine such as Springerlink, BioMed Central, PubMed, Scopus, ScienceDirect, Scielo, Medline and Science domain. Supplementary literatures were obtained from books, book chapters, dissertations, websites and other scientific publications. C. wightii (Syn. Commiphora mukul Hook. ex. Stocks) or Guggulu tree. C. wightii is a shrub or small tree belonging to Burseraceae family. C. wightii contains volatile oil, gum resin, gugulipids, guggulsterones, guggulsterols, mukolol and other steroids. Guggulu is very much used in Ayuvedic system of medicine as astringent, anti-septic, expectorant, aphrodisiac, carminative, anti-spasmodic, emmenagogue. In Ayurveda, it is the best among herbs that are used for Medoroga and Vata disorders. It is widely used for obesity and it is also known as fat burning agent all over the world. It helps to lower cholesterol and triglycerides level. It is very effective in rheumatoid arthritis, gout and sciatica. It is also one of the most important Rasayana of Ayurveda. In addition it treats sluggish liver, stimulates libido, nervous diseases, bronchial congestion, cardiac and circulatory problems, weak digestion, wounds, abscess, foetid ear, fractures, gynaecological problems and various skin diseases. C. wightii is a very important and trustworthy herb in Ayurvedic medicine. This alternative system of medicine is gaining increasing fame universal. There is a required to isolate active constituents, their biological test, molecular mechanisms, experimental defense and legalization of therapeutic uses of C. wightii. The collected information will be obliging to locate up study protocol for current drugs and Ayurvedic formulation extension in remedial and luxury a variety of ailments. 

Инфекције рана код паса и мачака са ентеробактеријама из рода Кlebsiella spp. су ријетке у клиничкој пракси. У Ветеринарску амбуланту „БЛ-вет“ Бања Лука доведена је женка бултеријера стара 8 мјесеци. Из анамнезе од власника сазнајемо да је куја оперисана у другој ветеринарској клиници неколико седмица прије него што су власници примијетили обилан исједак из носа. Клиничким прегледом је установљено да је опште стање пса неизмијењено. Из ноздрва је био примјетан обилан гнојни исцједак свијетло-зеленe боје са примјесама хране. Из усне шупљине, био је осјетан јак задах – foetor ex ore. Прегледом усне шупљине се уочава свјеже инфицирана рана на тврдом непцу. Зарастање ране је било очигледно отежано са присутном инфекцијом, тако да су рубови непца остали неприпојени. Тек након узимања бриса дна ране, могло се уочити да је ријеч о активном гнојном процесу. Klebsiella pneumoniae je изолована из ране непца код пса.

Infection of wounds in dogs and cats with enterobacteria from the genus Klebsiella spp. are rare in clinical practice. A female, Bull Terrier was brought to the veterinary clinic "BLvet" Banja Luka at the age of 8 months. Аccording to the owner, the dog was operated in another clinic and a several weeks later they noticed an abundant nasal discharge. Clinical examination revealed that the general condition of the dog was unchanged. There was a noticeable abundant purulent discharge, light-green in color with food remains from the nostrils. In the oral cavity, a foul breath - foetor ex ore was registered. By examining the oral cavity, a fresh-infected wound on the hard palate was visible. The wound healing was difficult due to the present infection, leaving the edges of the palate wound unattached. Only after taking a swab of the bottom of the wound, it could be noticed that this was an active suppurative process. Klebsiella pneumoniae was isolated from the wound of the dog's palate.

Progesterone promotes foetal growth in a restricted interspecies gestation (Ovis canadensis × Ovis aries). Veterinaria México OA. 2018;5(3).Gestations between bighorn (Ovis canadensis) and domestic sheep (O. aries) can be considered for ex situ conservation of bighorn. In the first experiment, domestic sheep were inseminated with bighorn or domestic semen. Bighorn inseminated sheep showed lower fertility than domestic inseminated sheep (40% vs. 65%, p = 0.11). Bighorn inseminated sheep had longer gestation periods (152.13 days vs. 146.54 days, p < 0.001) and lower progesterone levels during the last third. Hybrid lambs weighed less than domestic lambs (2.46 kg vs. 5.10 kg, p < 0.001). Their placentas were not as long (48.67 cm vs. 72.17 cm, p < 0.001), were less wide (17.83 cm vs. 23.83 cm, p < 0.001), and the weight of cotyledons was lower (1.50 g vs. 3.20 g, p < 0.001). In the second experiment, hybrid embryos (O. canadensis × O. aries) were transferred into domestic recipients, and pregnant ewes were divided into the treated group, which had a progesterone daily dose of 25 mg from weeks 7 to 20, and the non treated group. Gestation in domestic sheep that received one hybrid embryo and progesterone reached 152.60 days, which was similar to the 153.33 days (p = 0.51) in the non treated sheep. Hybrid offspring of the group treated with progesterone were heavier, 3.41 kg, than the control, 2.21 kg (p < 0.001), and their placentas were longer (71.20 vs. 50.83 cm, p = 0.002). Although progesterone levels were lower in domestic females inseminated with bighorn and in the recipients of hybrid embryos, it is possible to establish pregnancies between both species and the birth of viable offspring. The administration of progesterone during gestation increases the length of the placenta and promotes higher birth weights of hybrids.Figure 1. Progesterone (ng/mL) in interspecies gestations (O. c. mexicana × O. aries, n = 6) and intraspecies gestations (O. aries × O. aries, n = 6).*Statistically different values (p < 0.01).

I wake up early, questions buzzing through my mind. While I sip my morning cup of tea and read The Guardian online, the writer, restless because I’m ignoring her, walks around firing questions.“Expecting the patriarchy to want to share its enormous wealth and power with women is extremely naïve.”I nod. Outside the window pieces of sky are framed by trees, fluffy white clouds alternate with bright patches of blue. The sweet, heady first wafts of lavender and citrus drift in through the open window. Spring has come to Hvar. Time to get to work.The more I understand about narcissism, the more I understand the world. I didn’t understand before. In the 1990s.“No—you knew, but you didn’t know at the same time.”I kept telling everybody The River Ophelia wasn’t about sex, (or the sex wasn’t about sex), it was about power. Not many people listened or heard, though. Only some readers.I’ve come here to get away. To disappear. To write.I can’t find the essay I want for my article about the 1990s. I consider the novel I’m reading, I Love Dick by Chris Kraus and wonder whether I should write about it instead? It’s just been reprinted, twenty years after its initial release. The back cover boasts, “widely considered to be the most important feminist novel of the past two decades.” It was first published in the 1990s. So far it’s about a woman named Chris who’s addictively obsessed with an unavailable man, though I’m yet to unravel Kraus’s particular brand of feminism—abjection? Maybe, maybe … while I think, I click through my storage folder. Half way through, I find a piece I wrote about Kathy Acker in 1997, a tribute of sorts that was never published. The last I’d heard from Kathy before this had been that she was heading down to Mexico to try shark cartilage for her breast cancer. That was just before she died.When I was first introduced to the work of Foucault and Deleuze, it was very political; it was about what was happening to the economy and about changing the political system. By the time it was taken up by the American academy, the politics had gone to hell. (Acker qtd. in Friedman 20)Looking back, I’d have to say my friendship with Kathy Acker was intense and short-lived.In the original I’d written “was a little off and on.” But I prefer the new version. I first met Kathy in person in Sydney, in 1995. We were at a World Art launch at Ariel bookshop and I remember feeling distinctly nervous. As it turned out, I needn’t have been. Nervous, that is.Reading this now brings it all back: how Kathy and I lost touch in the intervening two years and the sudden fact of her death. I turn to the end and read, “She died tragically, not only because she was much too young, but because American literature seems rather frumpy without her, of cancer on the 30th November 1997, aged 53.”The same age as I am now. (While some believe Kathy was 50 when she died, Kathy told me she lied about her age even to the point of changing her passport. Women who lie about their age tend to want to be younger than they are, so I’m sticking with 53.) This coincidence spooks me a little.I make a cup of tea and eat some chocolate.“This could work …” the writer says. My reasons for feeling nervous were historical. I’d spoken to Kathy once previously (before the publication of The River Ophelia on the phone from Seattle to San Francisco in 1993) and the conversation had ended abruptly. I’d wanted to interview Kathy for my PhD on American fiction but Kathy wouldn’t commit. Now I was meeting her face to face and trying to push the past to the back of my mind.The evening turned out to be a memorable one. A whole bunch of us—a mixture of writers, publishers, academics and literati—went out to dinner and then carried on drinking well into the night. I made plans to see Kathy again. She struck me as a warm, generous, sincere and intensely engaging person. It seemed we might become friends. I hesitated: should I include the rest? Or was that too much?The first thing Kathy had said when we were introduced was, “I loved your book, The River Ophelia. I found it as soon as I arrived. I bought it from the bookshop at the airport. I saw your amazing cover and then I read on the back that it was influenced by the work of Kathy Acker. I was like, wow, no one in America has ever put that on the back cover of a novel. So I read it immediately and I couldn’t put it down. I love the way you’ve deconstructed the canon but still managed to put a compelling narrative to it. I never did that.”Why didn’t I include that? It had given me more satisfaction than anything anyone else had said.I remember how quickly I abandoned my bestselling life in Sydney, sexual harassment had all but ruined my career, and exchanged it for an uncertain future in London. My notoriety as an author was damaging my books and my relationship with my publisher had become toxic. The first thing I did in London was hire a lawyer, break my contract with Picador and take both novels out of print.Reality intrudes in the form of a phone call from my mother. Terminally ill with cancer, she informs me that she’s off her food. For a retired chef, the loss of appetite is not inconsiderable. Her dying is a dull ache, a constant tiredness and sadness in me. She’s just arrived in London. I will go there next week to meet her.(1)I first came across Kathy’s work in 1991. I’d just finished my MA thesis on postmodernism and parody and was rewarding myself with some real reading (i.e. not related to my thesis) when I came across the novel Don Quixote. This novel had a tremendous impact on me. Those familiar with DQ may recall that it begins with an abortion that transforms its female narrator into a knight.When she was finally crazy because she was about to have an abortion, she conceived of the most insane idea that any woman can think of. Which is to love. How can a woman love? By loving someone other than herself. (Acker Quixote 9)Kathy’s opening sentences produced a powerful emotional response in me and her bold confronting account of an abortion both put me in touch with feelings I was trying to avoid and connected these disturbing feelings with a broader political context. Kathy’s technique of linking the personal and emotional with the political changed the way I worked as a writer.I’d submitted the piece as an obituary for publication to an Australian journal; the editor had written suggestions in the margin in red. All about making the piece a more conventional academic essay. I hadn’t been sure that was what I wanted to do. Ambitious, creative, I was trying to put poststructuralist theory into practice, to write theoretical fiction. It’s true, I hadn’t been to the Sorbonne, but so what? What was the point of studying theory if one didn’t put it into practice? I was trying to write like French theorists, not to write about them. The editor’s remarks would have made a better academic essay, it’s just I’m not sure that’s where I wanted to go. I never rewrote it and it was never published.I first encountered I Love Dick (2017) during a film course at the AFTVRS when the lecturer presented a short clip of the adaptation for the class to analyse. When I later saw the novel in a bookshop I bought a copy. Given my discovery of the unpublished obituary it is also a bit spooky that I’m reading this book as both Chris Kraus and Kathy Acker had relationships with academic and Semiotext(e) publisher Sylvère Lotringer. Chris as his wife, Kathy as his lover. Kraus wrote a biography of Acker called After Kathy Acker: A Biography, which seems fairly unsympathetic according to the review I read in The Guardian. (Cooke 2017) Intrigued, I add Kraus’s biography to my growing pile of Acker related reading, the Acker/Wark letters I’m Very Into You and Olivia Laing’s novel, Crudo. While I’ve not read the letters yet, Crudo’s breathless yet rhythmic layering of images and it’s fragmented reflections upon war, women and politics reminded me less of Acker and more of Woolf; Mrs Dalloway, in fact.(2)What most inspired me, and what makes Kathy such a great writer, is her manner of writing politically. For the purposes of this piece, when I say Kathy writes politically, I’m referring to what happens when you read her books. That is, your mind—fuelled by powerful feelings—makes creative leaps that link everyday things and ideas with political discourses and debates (for Kathy, these were usually critiques of bourgeois society, of oedipal culture and of the patriarchy).In the first pages of Don Quixote, for example, an abortion becomes synonymous with the process of becoming a knight. The links Kathy makes between these two seemingly unrelated events yields a political message for the creative reader. There is more at stake than just gender-bending or metamorphoses here: a reversal of power seems to have taken place. A relatively powerless woman (a female victim except for the fact that in having an abortion she’s exerting some measure of control over her life), far from being destroyed by the experience of aborting her foetus, actually gains power—power to become a knight and go about the world fulfilling a quest. In writing about an abortion in this way, Kathy challenges our assumptions about this controversial topic: beyond the moral debate, there are other issues at stake, like identity and power. An abortion becomes a birth, rather than a banal tragedy.When I think about the 1990s, I automatically think of shoulder pads, cocktails and expense accounts (the consumption of the former, in my case, dependent on the latter). But on reflection, I think about the corporatisation of the publishing industry, the Backlash and films like Thelma and Louise, (1991) Basic Instinct (1992) and Single White Female (1992). It occurs to me that the Hollywood movie star glamorous #MeToo has its origin in the turbulent 1990s Backlash. When I first saw each of these films I thought they were exciting, controversial. I loved the provocative stance they took about women. But looking back I can’t help wondering: whose stories were they really, why were we hearing them and what was the political point?It was a confusing time in terms of debates about gender equality.Excluding the premise for Thelma and Louise, all three films present as narrative truth scenarios that ran in stark contrast to reality. When it came to violence and women, most domestic homicide and violence was perpetrated by men. And violence towards women, in the 1990s, was statistically on the rise and there’s little improvement in these statistics today.Utter chaos, having a British passport never feels quite so wonderful as it does in the arrivals hall at Heathrow.“Perhaps these films allow women to fantasise about killing the men who are violent towards them?”Nyah, BI is chick killing chick … and think about the moral to the story. Fantasy OK, concrete action painful, even deadly.“Different story today …”How so?“Violent female protagonists are all the rage and definitely profitable. Killing Eve (2018) and A Simple Favour (2018).”I don’t have an immediate answer here. Killing Eve is a TV series, I think aloud, A Simple Favour structurally similar to Single White Female … “Why don’t you try self-publishing? It’ll be 20 years since you took The River Ophelia out of print, bit of an anniversary, maybe it’s time?”Not a bad idea. I’m now on the tube to meet mum at her bed and breakfast but the writer is impatient to get back to work. Maybe I should just write the screenplay instead?“Try both. If you don’t believe in your writing, who else will?”She has a point. I’m not getting anywhere with my new novel.A message pips through on Facebook. Want to catch up?What? Talk about out of the blue. I haven’t heard from Sade in twenty years … and how on earth did he get through my privacy settings?After meeting mum, the next thing I do is go to the doctor. My old doctor from West Kensington, she asks me how I’m going and I say I’m fine except that mum’s dying and this awful narcissistic ex-partner of mine has contacted me on Facebook. She recommends I read the following article, “The Highly Sensitive Person and the Narcissist” (Psychology Today).“Sometimes being a kind caring person makes you vulnerable to abusers.”After the appointment I can’t get her words out of my head.I dash into a Starbucks, I’m in Notting Hill just near the tube station, and read the article on my laptop on wifi. I highlight various sections. Narcissists “have a complete lack of empathy for others including their own family and friends, so that they will take advantage of people to get their own needs and desires met, even if it hurts someone.” That sounds about right, Sade could always find some way of masking his real motives in charm, or twisting reality around to make it look like things weren’t his fault, they were mine. How cleverly he’d lied! Narcissists, I read, are attracted to kind, compassionate people who they then use and lie to without remorse.But the bit that really makes me sit up is towards the end of the article. “For someone on the outside looking at a relationship between a highly sensitive person and a narcissist, it’s all too easy to blame the HSP. How and why would anyone want to stay in such a relationship?” Narcissists are incredibly good at making you doubt yourself, especially the part of you that says: this has happened before, it’ll happen again. You need to leave.The opening paragraph of the psychology textbook I read next uses Donald Trump as an example. Trump is also Patrick Bateman’s hero, the misogynistic serial killer protagonist of Bret Easton Ellis’s notorious American Psycho. Despite an earlier version that broadly focused on New York fiction of the 1990s, Ellis’s novel and the feminist outcry it provoked became the central topic of my PhD.“Are you alright mum?”I’ve just picked Mum up and I’m driving her to Paris for a night and then on to Switzerland where she’s going to have voluntary euthanasia. Despite the London drizzle and the horrific traffic the whole thing has a Thelma and Louise feel about it. I tell mum and she laughs.“We should watch it again. Have you seen it since it first came out?”“Sounds like a good idea.”Mum, tiny, pointy-kneed and wearing an out-of-character fluoro green beanie given to her at the oncology clinic in Sydney, is being very stoic but I can tell from the way she constantly wrings her hands that she’s actually quite terrified.“OK Louise,” she says as I unfold her Zimmer frame later that evening.“OK Thelma,” I reply as she walks off towards the hotel.Paris is a treat. My brother is waiting inside and we’re hoping to enjoy one last meal together.Mum didn’t want to continue with chemo at 83, but she’s frightened of dying a horrific death. As we approach hotel reception Mum can’t help taking a detour to inspect the dinner menu at the hotel restaurant.“Oysters naturel. That sounds nice.”I smile, wait, and take her by the elbow.I’ve completely forgotten. The interview/review I wrote of Acker’s Pussy, King of the Pirates, in 1995 for Rolling Stone. Where is it? I open my laptop and quickly click through the endless publicity and reviews of The River Ophelia, the interview/review came out around the same time the novel was published, but I can’t find it. I know I had it out just a few months ago, when I was chasing up some freelance book reviews.I make a fresh pot of tea from the mini bar, green, and return to my Acker tribute. Should I try to get it published? Here, or back in Australia? Ever the émigré’s dilemma. I decide I like the Parisian sense of style in this room, especially the cotton-linen sheets.Finally, I find it, it’s in the wrong folder. Printing it out, I remember how Kathy had called her agent and publisher in New York, and her disbelief when I’d told her the book hadn’t been picked up overseas. Kathy’s call resulted in my first New York agent. I scrutinise its pages.Kathy smiles benign childlike creativity in the larger photo, and gestures in passionate exasperation in the smaller group, her baby face framed by countless metal ear piercings. The interview takes place—at Kathy’s insistence—on her futon in her hotel room. My memories clarify. It wasn’t that we drifted apart, or rather we did, but only after men had come between us first. Neither of us had much luck in that department.(4)Kathy’s writing is also political because her characters don’t act or speak the way you’d expect them to. They don’t seem to follow the rules or behave in the way your average fictional character tends to do. From sentence to sentence, Kathy’s characters either change into different people, or live revolutionary lives, or even more radical still, live impossible lives.When the narrator of DQ transforms herself into a knight (and lives an impossible life); she turns a situation in which she is passive and relatively powerless—she is about to be operated on and drugged—into an empowering experience (and lives a creative revolutionary life). Ironically, getting power means she turns herself into a male knight. But Kathy gets around the problem that power is male by not letting things rest there. The female, aborting Kathy isn’t actually replaced by a male knight, bits of him are just grafted onto her. Sure, she sets out on a quest, but the other aspects of her empowerment are pretty superficial: she does adopt a new name (which is more like a disguise), and identity (appearance); and picks up a bad habit or two—a tendency to talk in the language used by knights.“But who’s the father?” the writer wants to know. “I mean isn’t that the real question here?”No, that is exactly not the real question here and not the point. It is not about who the father is—it’s about what happens to a woman who has an unwanted unplanned pregnancy.The phone rings. It’s my brother. Mum’s waiting for me downstairs and the oysters are beckoning.(5)The idea that writing could be political was very appealing. The transformation between my first novel, Marilyn’s Almost Terminal New York Adventure and my second, The River Ophelia (Picador insisted on publishing them in reverse chronology) was partly a result of my discovery of Kathy’s work and the ideas it set off in me. Kathy wasn’t the first novelist to write politically, but she was the first female novelist to do so in a way that had an immediate impact on me at an emotional level. And it was this powerful emotional response that inspired me as a writer—I wanted to affect my readers in a similar way (because reading Kathy’s work, I felt less alone and that my darkest experiences, so long silenced by shame and skirted around in the interests of maintaining appearances, could be given a voice).We’re driving through Switzerland and I’m thinking about narcissism and the way the narcissists in my personal and professional life overshadowed everything else. But now it’s time to give the rest of the world some attention. It’s also one way of pulling back the power from the psychopaths who rule the world.As we approach Zurich, my mother asks to pull over so she can use the ladies. When she comes out I can see she’s been crying. Inside the car, she reaches for my hand and clasps it. “I don’t know if I’m strong enough to say goodbye.”“It’s alright Mum,” I say and hold her while we both cry.A police car drives by and my mother’s eyes snag. Harassed by the police in Australia and unable to obtain Nembutal in the UK, Mum has run out of options.To be a woman in this society is to find oneself living outside the law. Maybe this is what Acker meant when she wrote about becoming a pirate, or a knight?Textual deconstruction can be a risky business and writers like Acker walk a fine line when it comes to the law. Empire of the Senseless ran into a plagiarism suit in the UK and her publishers forced Acker to sign an apology to Harold Robbins (Acker Hannibal Lecter 13). My third novel Dependency similarly fell foul of the law when I discovered that in deconstructing gossip and myths about celebrities, drawing on their lives and then making stuff up, the result proved prophetic. When my publisher, Harper Collins, refused to indemnify me against potential unintended defamation I pulled the book from its contract on the advice of a lawyer. I was worth seven million pounds on paper at that point, the internet travel site my then husband and I had founded with Bob Geldof had taken off, and the novel was a radical hybrid text comprised of Rupert Murdoch’s biography, Shakespeare’s King Lear and Hello Magazine and I was worried that Murdoch might come after me personally. I’d fictionalised him as a King Lear type, writing his Cordelia out of his will and leaving everything to his Goneril and Reagan.Recent theoretical studies argue that Acker’s appropriation and deconstruction constitute a feminist politics as “fragmentation” (June 2) and as “agency” (Pitchford 22). As Acker puts it. “And then it’s like a kid: suddenly a toy shop opens up and the toy shop was called culture.” (Acker Hannibal Lecter 11).We don’t easily fit in a system that wasn’t ever designed to meet our needs.(6)By writing about the most private parts of women’s lives, I’ve tried to show how far there is to go before women and men are equal on a personal level. The River Ophelia is about a young woman whose public life might seem a success from the outside (she is a student doing an honours year at university in receipt of a scholarship), but whose private life is insufferable (she knows nothing about dealing with misogyny on an intimate level and she has no real relationship-survival skills, partly as a result of her family history, partly because the only survival skills she has have been inscribed by patriarchy and leave her vulnerable to more abuse). When Justine-the-character learns how to get around sexism of the personal variety (by re-inventing her life through parodies of classic texts about oedipal society) she not only changes her life, but she passes on her new-found survival skills to the reader.A disturbing tale about a young university student who loses herself in a destructive relationship, The River Ophelia is a postmodern novel about domestic violence and sexual harassment in the academy, contrary to its marketing campaign at the time. It’s protagonist, Justine, loves Sade but Sade is only interested in sex; indeed, he’s a brutish sex addict. Despite this, Justine can’t seem to leave: for all her education, she’s looking for love and commitment in all the wrong places. While the feminist lore of previous generations seems to work well in theory, Justine can’t seem to make it work in practise. Owning her power and experimenting with her own sexuality only leaves her feeling more despairing than before. Unconventional, compelling and controversial, The River Ophelia became an instant best-seller and is credited with beginning the Australian literary movement known as grunge/dirty realism.But there is always the possibility, given the rich intertextuality and self referentiality, that The River Ophelia is Justine’s honours thesis in creative writing. In this case, Sade, Juliette, Ophelia, Hamlet, Bataille, Simone, Marcelle and Leopold become hybrids made up from appropriated canonical characters, fragments of Justine’s turbulent student’s world and invented sections. But The River Ophelia is also a feminist novel that partly began as a dialogue with Ellis whose scandalous American Psycho it parodies even as it reinvents. This creative activity, which also involves the reader by inviting her to participate in the textual play, eventually empowers Justine over the canon and over her perpetrator, Sade.Another hotel room. This one, just out of Zürich, is tiny. I place my suitcase on the rack beneath the window overlooking the narrow street and start to unpack.“Hasn’t this all been said before, about The River Ophelia?” The writer says, trying out the bed. I’m in the middle of an email about self-publishing a new edition of TRO.Some of it. While the grunge label has been refuted, Acker’s influence has been underplayed.Acker often named her protagonists after herself, so losing the Acker part of my textual filiation plays into the whole grunge/dirty realism marketing campaign. I’ve talked about how I always name protagonists after famous women but not linked this to Acker. Bohemia Beach has a protagonist named after Cathy as in Wuthering Heights. Justine of The River Ophelia was doubly an Acker trait: firstly, she was named Justine after De Sade’s character and is a deconstruction of that character, and secondly she was named Justine self-reflexively after me, as a tribute to Kathy as in Kathy Goes to Haiti.The other context for The River Ophelia that has been lost is to do with the early work of Mary Gaitskill, and Catherine Texier. The narcissists were so destructive and so powerful they left no time for the relatively more subtle Gaitskill or Texier. Prototypes for Sex in the City, the 1990s was also a time when Downtown New York women writers explored the idea that gender equality meant women could do anything men did sexually, that they deserved the full gamut of libertine sexual freedoms. Twenty years on it should also be said that women who push the envelope by writing women protagonists who are every bit as sexually transgressive as men, every bit as addictively self-destructive as male protagonists deserve not to be shamed for that experimentation. They deserve to be celebrated and read.AfterwordI’d like to remember Kathy as I knew her briefly in Sydney. A bottle-blonde with a number two haircut, a leopard-skin bikini and a totally tattooed body, she swam a surprisingly genteel breast-stroke in the next lane in one of the world’s most macho lap-swimming pools.ReferencesA Simple Favour. Dir. Paul Feig. Lionsgate, 2018.Acker, Kathy. Don Quixote. London: Collins, 1986.———. Empire of the Senseless. New York: Grove, 1988.———. Hannibal Lecter, My Father. New York: Semiotext(e), 1991.———. Kathy Goes to Haiti. New York: Grove Press/Atlantic Monthly, 1994.——— and McKenzie Wark. I’m Very into You: Correspondence 1995-1996. New York: Semiotext(e), 2015.Basic Instinct. Dir. Paul Verhoeven. TriStar Pictures, 1992.Brontë, Emily. Wuthering Heights. New York: Norton and Co, 2003.Bushnell, Candace. Sex in the City. United States: Grand Central Publishing, 1996.Cooke, Rachel. “Review of After Kathy Acker: A Biography by Chris Kraus—Baffling Life Study.” The Guardian 4 Sep. 2017. 4 Dec. 2018 <https://www.theguardian.com/books/2017/sep/04/after-kathy-acker-a-biography-chris-kraus-review>.Deleuze, Gilles, and Felix Guattari. A Thousand Plateaus: Capitalism and Schizophrenia. Minneapolis: University of Minnesota Press, 1987.Ellis, Bret Easton. American Psycho. New York: Vintage, 1991.Ettler, Justine. Bohemia Beach. Melbourne: Transit Lounge. 2018.———. “Kathy Acker: King of the Pussies.” Review of Pussy, King of the Pirates, by Kathy Acker. Rolling Stone. Nov. 1995: 60-61.———. Marilyn’s Almost Terminal New York Adventure. Sydney: Picador, 1996.———. “La Trobe University Essay: Bret Easton Ellis’s Glamorama, and Catherine Texier’s Break Up.” Australian Book Review, 1995.———. The Best Ellis for Business: A Re-Examination of the Mass Media Feminist Critique of “American Psycho.” PhD. Sydney: University of Sydney, 2013.———. The River Ophelia. Sydney: Picador, 1995.Faludi, Susan. Backlash: The Undeclared War against American Women. New York: Crown, 1991.Friedman, Ellen G. “A Conversation with Kathy Acker.” The Review of Contemporary Fiction 9.3 (Fall 1989): 20-21.Gaitskill, Mary. Bad Behaviour. New York: Random House, 1988.I Love Dick. Dir. Jill Soloway. Amazon Video, 2017.June, Pamela B. The Fragmented Female Body and Identity: The Postmodern Feminist and Multiethnic Writings of Toni Morrison, Therese Huk, Kyung Cha, Phyllis Alesia Perry, Gayl Jones, Emma Perez, Paula Gunn Allen, and Kathy Acker. New York: Peter Lang Publishing, 2010.Killing Eve. Dir. Phoebe Waller-Bridge. BBC America, 2018.Kraus, Chris. After Kathy Acker: A Biography. London: Penguin, 2017.———. I Love Dick. London: Serpent’s Tail, 2016.Laing, Olivia. Crudo. London: Picador, 2018.Lee, Bandy. The Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President. New York: St Martin’s Press. 2017.Lombard, Nancy, and Lesley McMillan. “Introduction.” Violence against Women. Eds. Nancy Lombard and Lesley McMillan. London: Jessica Kingsley Publishers, 2013.Pitchford, Nicola. Tactical Readings: Feminist Postmodernism in the Novels of Kathy Acker and Angela Carter. London: Associated Uni Press, 2002.Schiffrin, André. The Business of Books: How International Conglomerates Took Over Publishing and Changed the Way We Read. London and New York: Verso, 2000.Shakespeare, William. King Lear. London: Penguin Classics, 2015.Siegle, Robert. Suburban Ambush: Downtown Writing and the Fiction of Insurgency. United States: John Hopkins Press, 1989.Single White Female. Dir. Barbet Schroeder. Columbia Pictures, 1992.Texier, Catherine. Panic Blood. London: Collins, 1991.Thelma and Louise. Dir. Ridley Scott. Metro-Goldwyn-Mayer, 1991.Ward, Deborah. “Sense and Sensitivity: The Highly Sensitive Person and the Narcissist.” Psychology Today (16 Jan. 2012). 4 Dec. 2018 <https://www.psychologytoday.com/us/blog/sense-and-sensitivity/201201/the-highly-sensitive-person-and-the-narcissist>.