Fatty Liver (part 2): Clinical Approach and Treatment

Patients with fatty liver are almost always asymptomatic; aminotransferases are usually elevated two to five times the expected value and are an important cause of initial consultation. All images can show fatty liver, and liver biopsy remains the gold standard for diagnosis. In any patient, non-invasive tests are an excellent alternative to biopsy to determine the degree of liver fibrosis and establish the stage of fibrogenesis. Weight loss and exercise are the fundamental pillars of the indicated treatment for all patients with overweight or obesity; a weight loss between 5% and 10% and a diet with caloric restriction of 500-1000 kcal/day, low in saturated fat and rich in Mediterranean diet products such as fruit, fish, vegetables, nuts, olive oil, among others, are recommended. There are other treatments, such as pharmacological measures and endoscopic and surgical procedures.

Los pacientes con hígado graso son casi siempre asintomáticos, las aminotransferasas usualmente están elevadas dos a cinco veces el valor normal y son una causa importante de consulta inicial. Todas las imágenes pueden evidenciar el hígado graso y la biopsia hepática sigue siendo la prueba de oro para su diagnóstico. En cualquier paciente las pruebas no invasivas son una excelente alternativa a la biopsia para determinar el grado de fibrosis hepática y establecer en qué etapa de la fibrogénesis se encuentra. La pérdida de peso y el ejercicio son los pilares fundamentales del tratamiento indicado para todos los pacientes con sobrepeso u obesidad; se recomienda una pérdida de peso entre 5% y 10% del peso corporal y una dieta con restricción calórica de 500-1000 kcal/día, baja en grasas saturadas y rica en productos de la dieta mediterránea como fruta, pescado, verduras, frutos secos, aceite de oliva, entre otros. Hay otros tratamientos como las medidas farmacológicas y los procedimientos endoscópicos y quirúrgicos.

Perpetual past: psychoanalytic effects on the temporal logic in a case of psychosis / Passado perpétuo: efeitos psicanalíticos da lógica temporal em um caso de psicose

ABSTRACT: In this paper, our aim is to study a specific clinical case taking the temporal dimension as the main angle of analysis. We explore the effects of psychoanalysis on time's representation of a patient showing psychotic symptoms. We analyze the different moments of the therapy that made possible an original integration of the temporal dimension by working on the local coordinates of the therapeutic setting. The "subjective effects" that guided the cure are stipulated and articulated to the different interventions to show the logical foundation of the psychoanalytic clinical practice in this case.

Resumo: Neste artigo, apresentamos um caso clínico especial considerando a dimensão temporal como perspectiva privilegiada. Examinamos os efeitos da psicanálise na representação do tempo de um paciente que apresenta uma sintomatologia psicótica. A partir de um trabalho centrado nas coordenadas locais do quadro terapêutico, analisamos os diferentes momentos da terapia ligados a uma nova integração da dimensão temporal. Consideramos os "efeitos subjetivos" específicos que orientam o tratamento como ligados às diversas intervenções, a fim de destacar os fundamentos lógicos da prática psicanalítica neste caso.

TCM network pharmacology: A new trend towards combining computational, experimental and clinical approaches / 中国天然药物

Traditional Chinese medicine (TCM) is a precious treasure of the Chinese nation and has unique advantages in the prevention and treatment of diseases. The holistic view of TCM coincides with the new generation of medical research paradigm characterized by network and system. TCM gave birth to a new method featuring holistic and systematic "network target", a core theory and method of network pharmacology. TCM is also an important research object of network pharmacology. TCM network pharmacology, which aims to understand the network-based biological basis of complex diseases, TCM syndromes and herb treatments, plays a critical role in the origin and development process of network pharmacology. This review introduces new progresses of TCM network pharmacology in recent years, including predicting herb targets, understanding biological foundation of diseases and syndromes, network regulation mechanisms of herbal formulae, and identifying disease and syndrome biomarkers based on biological network. These studies show a trend of combining computational, experimental and clinical approaches, which is a promising direction of TCM network pharmacology research in the future. Considering that TCM network pharmacology is still a young research field, it is necessary to further standardize the research process and evaluation indicators to promote its healthy development.

Análisis de los resultados de la evaluación multidisciplinaria de pacientes con cáncer pulmonar / Outcome Analysis of the Multidisciplinary Evaluation of Patients with Lung Cancer

RESUMEN Introducción: El cáncer de pulmón representa una gran carga de enfermedad a nivel global. La centralización de la atención de los pacientes para el diagnóstico y tratamiento añade un salto de calidad en la atención sanitaria. Objetivo: Evaluar los resultados de la consulta multidisciplinaria de cáncer pulmonar en la provincia de Camagüey. Métodos: Se realizó un estudio observacional analítico retrospectivo desde noviembre de 2015 hasta febrero de 2017. El universo quedó conformado por 182 pacientes evaluados en la consulta multidisciplinaria con cáncer pulmonar. La muestra, la cual fue de tipo probabilística, la constituyeron los 182 pacientes diagnosticados de cáncer pulmonar, coincidiendo con el universo. Se trabajó con una población objetiva conformada por todos los pacientes adultos que acudieron a la consulta antes mencionada y que fueron diagnosticados de cáncer pulmonar en la sistemática diagnóstica. Resultados: Prevaleció el sexo masculino y el grupo de edad entre 60 y 69 años. Todos los pacientes tenían relación con el hábito de fumar, y al menos, una radiografía de tórax al momento de la primera evaluación. El síntoma fundamental fue la tos. Más de la mitad de los pacientes acudieron antes de 60 días de comienzo de los síntomas, y recibieron el diagnóstico e iniciaron el tratamiento antes del mes. El adenocarcinoma fue el tipo histológico más frecuente, como la localización tumoral periférica, el estado funcional se deterioró en relación con la etapa clínica y el tratamiento quirúrgico fue el más indicado. Conclusiones: La atención multidisciplinaria en pacientes con cáncer pulmonar se ha convertido en el estándar de cuidado. La centralización de la atención, así como la aplicación de una vía clínica optimiza el uso de la tecnología disponible adecuada a cada caso en particular(AU)

ABSTRACT Introduction: Lung cancer represents a great burden of disease worldwide. Patient care centralization for diagnosis and treatment adds a leap in the quality of health care. Objective: To evaluate the results of the multidisciplinary consultation of lung cancer in the province of Camagüey. Methods: A retrospective, analytical, observational study was conducted from November 2015 to February 2017. The study population consisted of 182 patients with lung cancer who were evaluated in the multidisciplinary consultation. The sample, which was probabilistic, was made up of 182 patients diagnosed with lung cancer, coinciding with the population. We worked with an objective population made up of all the adult patients who attended the aforementioned consultation and who were diagnosed with lung cancer in the diagnostic systematics. Results: There was a predominance of the male sex and the age group between 60 and 69 years old. All the patients were associated with the smoking habit, and had at least one chest radiograph at the time of the first evaluation. The main symptom was coughing. More than half of the patients came before 60 days after the onset of symptoms, were diagnosed and started treatment before the month. The adenocarcinoma was the most frequent histological type, as the peripheral tumor location. The functional state was deteriorated in relation to the clinical stage and the surgical treatment was the most indicated. Conclusions: Multidisciplinary care in patients with lung cancer has become the standard of care. The centralization of care, as well as the application of a clinical approach, optimizes the use of available technology appropriate to each particular case(AU)

Consideraciones sobre las psicosis desde el "vértice" de la Escuela Inglesa de Psicoanálisis / Considerations about the psychoses from the 'vertex' of the English School of Psychoanalysis

Los autores de la Escuela Inglesa de Psicoanálisis abordan las psicosis. Llevan adelante curas de las que dan testimonio en sus escritos. Crean teorías o modelos y, en consecuencia, enfoques clínicos que, aunque diversos, coinciden en ir "más allá de las neurosis de transferencia". El esquema clásico del psicoanálisis no les resulta suficiente para producir cambios en el psiquismo de estos pacientes, dado que buscan generar modificaciones estructurales. En el presente trabajo se exponen las teorizaciones sobre las psicosis de tres destacados psicoanalistas: Klein, Bion y Winnicott. Se ubican puntos de encuentro y de divergencia en relación con este tópico. Se subraya el modo en que ellos presentan un importante volumen de material clínico a los lectores. Muestran, tanto el discurso de los pacientes adultos y el juego en niños, como así también sus intervenciones. De este modo, se ve facilitada la transmisión de sus particulares abordajes. Estos no solamente involucran aspectos conceptuales y clínicos, sino que reflejan, además, una postura ética.

The English School of Psychoanalysis authors approach the psychoses. They develop cures of psychotic patients and expose them in their writings. They create theories or models and therefore, clinical approaches which despite being diverse, coincide on going `beyond transference neurosis`. The classic scheme of psychoanalysis is not enough for them to produce changes on patient's psychism, given that they look for the generation of structural modifications. The theorizations about psychoses developed by three well-known psychoanalysts: Klein, Bion and Winnicott are exposed in this paper. Points of coincidence and divergence related to this topic are highlighted. The way they introduce an important volume of clinical material to their readers is underlined. They show not only the adult patients speech and children's play, but also their interventions. Consequently, the transmission of their particular focuses is eased. These approaches not only involve conceptual and clinical aspects, but also reflect an ethical posture.

Infecciones del tracto urinario en pediatría: enfoque clínico y seguimiento / Urinary Tract Infection in Pediatrics: Clinical Approach and Follow Up

Abstract Urinary tract infection (UTI) is a frequent pathology in the pediatric age, about 5-8% of children under 2 years of age with fever without defined focus have a UTI, it is a frequent infection, and although most cases have good prognoses, it will always be necessary to identify those patients at risk of permanent and progressive kidney damage. UTI has a high incidence during childhood, appearing in about 7% of febrile children under one year of age and is an indicator of anatomical and functional anomalies. Clinical suspicion will always be important to reach a rapid diagnosis, in order to perform timely treatments and thus reduce kidney damage and complications. In this article we make a particular emphasis on the clinical approach and the follow-up that should be done to a patient with this pathology.

Resumen La infección del tracto urinario urinario (ITU) es una patología frecuente en la edad pediátrica, alrededor del 5-8% de niños menores de 2 años con fiebre sin foco definido tienen una ITU, es una infección frecuente, y aunque la mayoría tienen un buen pronostico, siempre será necesario identificar aquellos pacientes con riesgo de daño renal permanente y progresivo. La ITU tiene una alta incidencia durante la infancia apareciendo en cerca de 7% de los niños febriles menores de un año y es un indicador de anomalías anatómicas y funcionales. Siempre será importante la sospecha clínica para llegar a un diagnostico rápido; con el fin de realizar tratamientos oportunos y de esta manera reducir el daño renal y las complicaciones. En este artículo hacemos un particular énfasis en el enfoque clínico y el seguimiento que se le debe realizar a un paciente con esta patología.

O professor do fim do Ensino Fundamental I perante alunos com dificuldades de aprendizagem: questões psí­quicas e mecanismos de defesa / The teacher at the end of elementary school towards students with learning difficulties: psychic questions and defense mechanisms / El maestro del quinto ciclo de la educación básica ante alumnos con dificultades de aprendizaje: cuestiones psí­quicas y mecanismos de defensa

Este artigo visa apresentar tensões e questões psíquicas ligadas à confrontação do professor do fim do Ensino Fundamental I com alunos com dificuldade de aprendizagem e com "necessidades educativas especiais", de acordo com as normas institucionais. Esse profissional realiza seu trabalho no colégio em um entre-deux. Foi escolhido um método de pesquisa clínico de orientação psicanalítica. Ele permite apreender os movimentos psíquicos conscientes e inconscientes mobilizados na "personalidade profissional" e a relação específica estabelecida entre o professor de 5º ano e tais alunos ditos com necessidades especiais. A análise de entrevistas clínicas de pesquisa conduzidas com professores na França e em países francófonos valoriza modos de defesa específicos.

This article aims to present tensions and psychic issues related to the confrontation of the teacher at the end of Elementary School with students with learning difficulties and "special educational needs", according to institutional norms. These professionals carry out their work in an entre-deux. A method of clinical research with a psychoanalytic orientation was chosen. It allows us to grasp the conscious and unconscious psychic movements mobilized in the "professional personality" and the specific relationship established between the 5th grade teacher and those students with special needs. The analysis of clinical research interviews conducted with teachers in France and in French-speaking countries values specific defense methods.

En este texto se pretende presentar las tensiones y cuestiones psíquicas en la relación del maestro del 5º ciclo de la educación básica y los alumnos con dificultades de aprendizaje y con "necesidades educativas especiales" según las normas institucionales. Este profesional trabaja en el colegio en un entre-deux. Se empleó el método de investigación psicoanalítico, el que permitió conocer los movimientos psíquicos conscientes e inconscientes que moviliza la "personalidad profesional" y la relación establecida entre el maestro del 5º ciclo y los alumnos con necesidades especiales. Desde el análisis, las entrevistas clínicas con los maestros en Francia y en países de habla francesa muestran modos de defensa específicos.

Síndrome de Rubinstein-Taybi, atención odontoestomatológica a pacientes especiales: reporte de caso clínico / Rubinstein-Taybi syndrome, medical and dental care for special needs patients: Clinical case report

Resumen: La atención odontoestomatológica a pacientes especiales, requiere en muchos casos un abordaje clínico rápido y efectivo con el propósito de mejorar su calidad de vida. El síndrome de Rubinstein-Taybi, es un trastorno poco común, donde se observan anomalías en los genes CREBBP y EP300, descrito en 1963 por dos médicos estadounidenses, entre las manifestaciones y características principales tenemos: retraso mental (moderado o severo), microcefalia, primer dedo de la mano o del pie engrosado, retraso del crecimiento, facies característica con maxilar hipoplásico, fisura palpebral inclinada de forma descendente, paladar ojival, dientes de implantación irregular apiñados, estrabismo, orejas mal formadas de implantación baja, nariz en forma de pico, cejas espesas, párpados largos. El concepto de adaptación del paciente a la consulta odontológica representa lograr y mantener su colaboración durante el tratamiento mediante un proceso de enseñanza-aprendizaje. Se realizó el modelamiento de conducta, exposición gradual, refuerzo positivo, restricción física activa con apoyo de la madre. Resultados: Se logró restablecer la salud bucal del paciente en forma satisfactoria.

Abstract: Medical and dental care for special needs patients oftentimes require effective and rapid clinical approach so as to improve patients' quality of life. Rubinstein-Taybi syndrome is a rare disorder where anomalies in genes CREBBP and EP300 are observed. This syndrome was first described in 1963 by two North American physicians. Among the main characteristics and manifestations of this syndrome we can count mental retardation (moderate or severe) microcephaly, thickened first finger or toe, growth retardation, characteristic face with hypoplastic lower jaw, downward-sloping arched palate, palpebral fissure, irregularly implanted teeth, crowded teeth, strabismus, low-set, malformed ears, beak-shaped nose, bushy eyebrows and long eyelids. The concept of patient adaptation to the dental office entails achieving and preserving his collaboration during treatment by means of a show-and-tell process. Behavior was modeled with gradual exposition, positive reinforcement and active physical restraint with the mother's help. Results: The patient's oral health was satisfactorily reestablished.

O “aluno estranho”: entre reflexibilidade e atribuição / The strange student: between reflexibility and attribution / El “alumno raro”: entre la reflexión y asignación

Qualificamos como estranho aquele que nos surpreende, que nos remete à diferença, que nos toca. Os quatro autores deste artigo interrogam-se sobre a questão do aluno estranho, isto é, da relação emocionalmente carregada que o profissional da educação pode manter com ou vários alunos em um espaço educativo. Para isso, eles/elas põem em debate seus diferentes trabalhos cuja referência comum ao sentimento de estranho familiar mencionado por Freud constitui a base de troca. A partir das abordagens qualitativas (Hatchuel, Kerrien, Markakis adotam uma abordagem clínica com orientação psicanalítica, e Chauvier se refere à etnografia da comunicação), e eles/elas fazem a hipótese de que considerar o afeto subjacente pode favorecer no sujeito um movimento de aceitação da diferença contra o da rejeição e/ou o da estigmatização.

W e name as strange the one who surprises us, who refers us to the different, who moves us. The four authors of this article ask about the issue of the strange student, i.e. the relationship emotionally charged that the educational professional could maintain with one or more students in an educational space. For this purpose, they discuss their different researches of which the common reference to the feeling of the worrying strangeness raised by Freud provides them with the basis of exchange. Based on qualitative approaches (Hatchuel, Kerrien, Markakis adopt a clinical approach of psychoanalytic orientation, and Chauvier refers to the ethnography of communication), they theorize that, by taking into account the underlying affect, the subject could assist an internal movement to the acceptance of the difference against the rejection and/ or the stigmatization.

El extraño es lo que nos sorprende, nos remite a la diferencia, nos mueve. Los cuatro autores de este artículo plantean el tema del alumno raro, es decir, de la relación emocionalmente cargada que el profesional de la educación puede entablar con uno o varios alumnos en un marco educativo. Para hacerlo, debaten sus diferentes trabajos cuya referencia común al sentimiento de la inquietante extrañeza evocada por Freud constituye la base del intercambio. Desde enfoques cualitativos (Hatchuel, Kerrien, Markakis adoptan un enfoque clínico de orientación psicoanalítica, y Chauvier se refiere a la etnografía de la comunicación), formulan la hipótesis de que la tomada en consideración del afecto subyacente puede favorecer al sujeto un movimiento de aceptación de la diferencia contra el del rechazo y/o de la estigmatización.

La clínica y el laboratorio / Clinic and Laboratory

El progreso en la tecnología ha puesto a disposición del médico una gran cantidad de exámenes de laboratorio y estudios de imágenes que le permiten confirmar y ampliar su diagnóstico clínico con gran capacidad para beneficiar a los pacientes. Sin embargo, su uso inadecuado expone a los enfermos a riesgos e incomodidades y además aumenta los costos sin mejorar la atención médica. La vigencia de la aproximación clínica a los enfermos ofrece una solución a este dilema. Aquí examinamos el problema, enumeramos las causas del uso inadecuado del laboratorio y se proponen algunas soluciones(AU)

Progress in technology has made available to physicians a lot of laboratory tests and imaging studies, allowing them to confirm their clinical diagnosis and benefit patients. However, the inappropriate use of these resources, produces risks and anxiety to patients, and also it increases costs without improving medical care. The clinical approach to patients offers a solution to this dilemma. Here we analyze the problem; the causes of inappropriate use of the laboratory and some solutions are proposed(AU)

El psicoanálisis en dispositivos públicos de salud: nuevas preguntas para la ética en un nuevo contexto socio-histórico a partir de una lectura clínica / Psychoanalysis within public health services: new questions in a new context and from a clinical approach

El objetivo del presente trabajo es formalizar uno de los problemas de investigación que identificamos en el Plan de Trabajo Cuestiones éticas de la salud mental en dispositivos públicos: peculiaridades de la práctica psicoanalítica frente a discursos institucionales. Convergencias y divergencias entre el campo normativo y la dimensión clínica. Estudio exploratorio-descriptivo (Beca de Maestría UBACyT, Maestranda Giselle A. López, Cohorte 2013; Dir. Prof. Gabriela Z. Salomone), enmarcado en el proyecto de investigación Dilemas éticos en la práctica psicológica: el diálogo con otros discursos disciplinares en contextos institucionales diversos. Estudio exploratorio descriptivo en base a una investigación cuali-cuantitativa (Programación Científica UBACyT 2012-2015; Directora: Prof. Gabriela Z. Salomone). Nos proponemos indagar una de las problemáticas actuales acerca del psicoanálisis en los dispositivos públicos de salud, relativa a la articulación de su práctica con los discursos institucionales y los sistemas normativos que la atraviesan en el contexto socio-histórico actual. El foco de interés se sitúa en la dimensión ética de la cuestión, en tanto la pregunta que relevamos se dirige a determinar en qué medida tales discursos inciden en las decisiones y moldean la posición de aquél que pretende sostener una lectura clínica singular que define a la praxis psicoanalítica.

The aim of this article is to formalize one of the research problems that we have identified in the work plan Ethical issues in Mental Health public practice: the peculiarities of psychoanalytic practice facing institutional discourses. Convergences and differences between institutional rules and the clinical dimension. Descriptive exploratory study (UBACyT Magister Scholarship, Giselle A. López. 2013. Director: Prof. Gabriela Z. Salomone), which is part of the ongoing investigation Ethical dilemmas in psychological practice: the dialogue with other disciplinary discourses in varied institutional contexts. Descriptive exploratory study on the basis of a quali-quantitative investigation (UBACyT Scientific Program 2012-2015; Director: Prof. Gabriela Z. Salomone). We propose to interrogate one of the current problems about Psychoanalysis in the Public Health Services, which is related to the articulation of its practice with the institutional discourses and the regulatory systems that intersect the practice among the current social historical context. The focus of interest is located on the ethical dimension of this issue, as the analysis is aimed to determine to what extent those discourses influence the decisions as well as shape the position of the professional who claims to sustain a singular and clinical approach.

El abordaje clínico de la preocupación en el trastorno de ansiedad generalizada: resultados preliminares / Clinical approach to worry in generalized anxiety disorder: preliminary results

El objetivo del presente estudio fue caracterizar el abordaje clínico de la preocupación en el Trastorno de Ansiedad Generalizada (TAG), a partir de cómo psicoterapeutas de distinta orientación teórica la incluyeron en sus intervenciones. Se realizó un análisis secundario sobre entrevistas a 5 terapeutas cognitivos y 5 psicoanalíticos, originalmente entrevistados por Etchebarne, Juan, Gómez Penedo y Roussos (en evaluación). Los participantes escucharon un material estímulo cuasi-clínico, e intervinieron como si estuviesen con un paciente real. Las entrevistas fueron audiograbadas y transcriptas. Para el análisis de los datos, en el presente estudio se categorizaron las respuestas utilizando el método de Investigación Cualitativo Consensual. Asimismo, se analizó cuantitativamente la proporción de intervenciones enfocadas en la preocupación, utilizando la Clasificación Multidimensional de Intervenciones Psicoterapéuticas. Los resultados preliminares sugieren que la preocupación es un fenómeno relevante para todos los participantes; pero su abordaje muestra focos comunes y específicos de cada marco teórico.

The goal of the present study was to characterize the clinical approach to worry in Generalized Anxiety Disorder (GAD), based on how psychotherapists with differing theoretical orientations included it in their interventions. A secondary analysis was conducted with interviews of 5 cognitive and 5 psychoanalytic therapists, originally interviewed by Etchebarne, Juan, Gómez Penedo and Roussos (in evaluation). Participants were asked to listen to a quasi-clinical material, and to intervene as if they were with a real patient. Interviews were audio-recorded and transcribed. For the data analysis in the present study, responses were categorized using Consensual Qualitative Research methodology, and the proportion of interventions targeting worry was also analyzed using the Multidimensional Classification of Psychotherapeutic Interventions. Results suggest that worry is a relevant phenomenon for all participants. Nevertheless, its approach shows common and specific foci regarding each theoretical framework.

Approach to Polyarthritis.

A child with polyarthritis is always a diagnostic challenge for the treating physician. By definition, polyarthritis, taken in context as a subgroup of juvenile idiopathic arthritis, is defined as inflammation of more than 4 joints on physical examination. Though the exact incidence and prevalence of polyarthritis in childhood is not known, it is not uncommon in pediatric practice. Polyarthritis can be a clinical manifestation of diverse disease processes and the differential diagnosis is understandably very broad. It can be caused directly by an infectious agent or indirectly by immune mechanisms, may be a component of a systemic disease process or may be idiopathic. The presentation can be acute or chronic. It can represent a benign self limiting illness requiring no specific treatment or may be a severely disabling condition with significant morbidity and, in some cases, even mortality.While in some situations it may be possible to arrive at a provisional clinical diagnosis right at the outset, in others the diagnosis gradually evolves over a period of time. As in most other arthritides, the most important aspects of the diagnosis are a thorough history and a detailed clinical examination. Relevant laboratory investigations can help in facilitating the diagnosis but can often also mislead the treating physician. Hereby we present a clinical approach to a child with polyarthritis.

Clinical Approach of Common Foot and Ankle Disorders / 대한류마티스학회지

Among the many regions (joints) of the human extremities, the foot and ankle area has a variety of disorders, which seem difficult to diagnose mainly because the anatomy seems rather complex. There are two main regions i.e. ankle and foot where the foot is divided into forefoot, midfoot and hindfoot. Among the many disorders, some of the most common and important disorders such as hallux valgus, osteochondral lesion of talus and lateral ankle instability are summarized in the aspect of clinical manifestations, physical examination, differential diagnosis, radiographic findings, initial treatments and the criteria for the surgery. The recent trend of surgical treatment options have also been described with related references.

Como os adolescentes das periferias (se) falam? Jogos na forma de se endereçar aos pesquisadores / How do teenagers in the city outskirts tell (about)?: An addressing game to researchers / Como los adolescentes (se) hablan?: Juego de formas de hablar con los investigadores

Apresentamos os resultados de uma pesquisa no domínio de uma clínica do social, desenvolvida na França - Copsy-enfant, 2005 - sobre a construção identitária adolescente relativa às referências de gênero e intergeneracionais. Foram realizadas observações em sala de aula, bem como organizados sete "grupos de palavra" em dois colégios de bairros da periferia. Avaliamos os efeitos do discurso social sobre essa construção adolescente. A indagação clínica foi possibilitada pela acolhida da palavra adolescente nestes dispositivos grupais que, em sua função de elaboração, permitiu que esses jovens pudessem se confrontar com o seu próprio dizer.

We present results from a research work in the domain of the social clinic, developed in France - Copsy-enfant, 2005 - on the construction of gender and intergenerational identity among teenagers. We conducted classroom observations and organized seven "word groups" in two schools located in peripheral districts. We assessed the effects of the social discourse on this adolescent construction. The clinical exploration was made possible by a device of welcoming the adolescent word: the groups, on their function of elaboration, allowed these young people to confront their own saying.

Se trata de los resultados de una investigación clínica social desarrollada en Francia - Copsy-enfant, 2005 - sobre la construcción identitaria adolescente respecto a las referencias de género e intergeneracionales. Fueron realizadas observaciones en escuelas secundarias y organizados "grupos de palabra" (o grupos focales) en dos colegios de barrios pobres. Focalizamos los efectos del discurso social sobre esa construcción adolescente. La experiencia clínica fue posible gracias a la puesta en funcionamiento de grupos continentes donde cada uno pudo confrontarse con su propio decir.

Microcarcinoma da tireóide: experiência e conduta em clínica privada / Thyroid microcarcinoma: experience and management in private clinic

OBJETIVO: Estudar o microcarcinoma papilífero observado nas tireoidectomias realizadas em nossa clínica privada. MATERIAL E MÉTODOS: Revisamos clínica e histologicamente 1.930 pacientes submetidos a tireoidectomias no período de 2002 a 2006, tendo 606 carcinomas e, desses, 332 como microcarcinomas papilíferos. Avaliamos sexo, idade, tipo histológico, tamanho da neoplasia, multifocalidade, freqüência do esvaziamento cervical, resultados da PCI e tireoglobulina sérica. RESULTADOS: Dos 332 pacientes, 48 eram do sexo masculino e 146 tinham idade superior a 45 anos. Todos foram submetidos a tireoidectomia total, 19 concomitantemente a esvaziamento cervical de necessidade (5,72 por cento), e 313 a iodoterapia (94,27 por cento). Tivemos metástase a distância em 5 pacientes (1,5 por cento). Após 1 ano, de 170 pacientes submetidos à PCI, temos 141 considerados livres de doença, 21 com anti-tireoglobulina positivo, 6 com tireoglobulina superior a 2 ng/ml, sendo 1 com metástase pulmonar e outro com recidiva linfonodal (0,3 por cento). CONCLUSÃO: Recomendamos que seja realizada a tireoidectomia total, esvaziamento cervical de necessidade e iodoterapia ablativa na presença de fatores clínicos e anátomo-patológicos de risco.

OBJECTIVE: The study of papillary microcarcinoma observed during the thyroidectomies in our private clinic. MATERIAL AND METHODS: We reviewed clinical and histopathological results of 1,930 consecutive patients submitted for thyroidectomies in the period from 2002 to 2006, 606 had thyroid carcinomas but only 332 were papillary microcarcinoma. We studied gender, age, histologic type, size, multifocality, frequency of neck dissection, and results of Whole Body Scan and thyroglobulin. RESULTS: Overall, we found 48 males and 146 older than 45 years old. Therapy included total thyroidectomy for all, therapeutic neck dissection in 19 (5.72 percent), and radioiodine for 313 (94.27 percent). We found 5 patients with distant metastases (1.5 percent). After 1 year, from 170 submitted to WBS, we consider 141 free of disease, 21 have positive thyroglobulin antibody, 6 have thyroglobulin level above 2 ng/ml, being 1 with lung metastases and other with lymph node recurrence (0.3 percent). CONCLUSION: We recommend total thyroidectomy, therapeutic neck dissection and radioiodine ablation when present clinical and pathological risk factors.

A Clinical Approach for Patients with Dementia

This article provides clinical practice guidelines for primary care physicians in the assessment of dementia patients. Dementia is an acquired syndrome due to brain dysfunction, which is characterized by multiple cognitive deficits with consequent impairment in daily or occupational activities. Thus, the first and second steps in the clinical approach to dementia are the assessment of cognition and activities of daily living (ACL). The third step may be the evaluation of abnormal behaviors associated with dementia, since those symptoms are one of the main causes of caregivers' burden and can be controlled by drugs such as antipsychotics and antidepressants. Finally, as the fourth step of the evaluation, the underlying etiologies for dementia should be explored. This article describes the elemental methods of history taking and clinical examinations for dementia patients with emphasis on the assessment of 1) cognition, 2) ADL, 3) behaviors, and 4) differential diagnosis. The assessment will lead the clinician to accurate diagnosis and better management of dementia patients.