The International Classification of Headache Disorders from the point of view of Thomas Kuhn: a reflection / A Classificação Internacional das Cefaleias sob o ponto de vista de Thomas Kuhn: uma reflexão

Headaches are characterized by a sensation of discomfort or pain in the cephalic region. Due to the large number of types and subtypes of headaches, the standardization of their approach is necessary through the International Classification of Headache Disorders (ICHD), a document that is currently in its 3rd edition (ICHD-3). The evolution of the ICHD follows the hypothetical-deductive model of science based on Karl Popper's philosophy, which has a strong presence in the health sciences. The classification of headaches has evolved over time, incorporating and removing criteria, reflecting the need to adapt the classification to constantly evolving scientific and clinical demands. However, some changes can generate discrepancies between clinical practice and the elaborated diagnostic tools. In this context, this article reflects on whether it would be advantageous to return to old principles and foundations of obsolete classifications. The criterion of osmophobia, which is no longer in use in ICHD-3, is highlighted. This reflection can be developed following Thomas Kuhn's (1922-1996) view on science. In his main work, "The Structure of Scientific Revolutions" (1962), Kuhn proposes a three-stage model for science: the adoption of a paradigm, normal science, and a period of crisis. Kuhn also proposes the principle of incommensurability to understand the limitations and complexities of science. The application of this principle allows headache specialists to recognize that different approaches to headache classification have their own limitations and complexities, encouraging them to consider a variety of perspectives, paradigms, and theories in approaching clinical cases and conducting scientific studies. An integrative approach that combines Popper's hypothetical-deductive model with Kuhn's principle of incommensurability allows headache specialists to have a broader and more critical understanding of headache classifications

As dores de cabeça são caracterizadas por uma sensação de desconforto ou dor na região cefálica. Devido ao grande número de tipos e subtipos de cefaleias, é necessária a padronização da sua abordagem através da Classificação Internacional das Cefaleias (ICHD), documento que se encontra atualmente na sua 3ª edição (ICHD-3). A evolução da ICHD segue o modelo hipotético-dedutivo de ciência baseado na filosofia de Karl Popper, que tem forte presença nas ciências da saúde. A classificação das cefaleias evoluiu ao longo do tempo, incorporando e eliminando critérios, refletindo a necessidade de adaptar a classificação às exigências científicas e clínicas em constante evolução. Contudo, algumas mudanças podem gerar discrepâncias entre a prática clínica e os instrumentos diagnósticos elaborados. Neste contexto, este artigo reflete sobre se seria vantajoso regressar aos velhos princípios e fundamentos de classificações obsoletas. Destaca-se o critério de osmofobia, que não é mais utilizado na ICHD-3. Esta reflexão pode ser desenvolvida seguindo a visão de Thomas Kuhn (1922-1996) sobre a ciência. Em sua obra principal, "A Estrutura das Revoluções Científicas" (1962), Kuhn propõe um modelo de três estágios para a ciência: a adoção de um paradigma, a ciência normal e um período de crise. Kuhn também propõe o princípio da incomensurabilidade para compreender as limitações e complexidades da ciência. A aplicação deste princípio permite que os especialistas em cefaleias reconheçam que diferentes abordagens à classificação das cefaleias têm as suas próprias limitações e complexidades, encorajando-os a considerar uma variedade de perspectivas, paradigmas e teorias na abordagem de casos clínicos e na condução de estudos científicos. Uma abordagem integrativa que combina o modelo hipotético-dedutivo de Popper com o princípio da incomensurabilidade de Kuhn permite que os especialistas em cefaleia tenham uma compreensão mais ampla e crítica das classificações das cefaleias

A compreensão filosófica da psicanálise de Donald Winnicott na perspectiva de Zeljko Loparic: aspectos fundamentais / The philosophical understanding of Donald Winnicott's psychoanalysis in Zeljko Loparic's perspective: fundamental aspects

O objetivo do presente trabalho é efetuar uma resenha da compreensão filosófica do pensamento psicanalítico de Donald Winnicott proposta por Zeljko Loparic. Tomando como referência alguns dos seus principais estudos dedicados ao problema da fundamentação filosófica da psicanálise winnicottiana, far-se-á uma exposição detalhada da forma como Loparic analisa e interroga a novidade do contributo de Winnicott para a ciência psicanalítica. Com essa finalidade, destacar-se-ão os dois eixos em torno dos quais a abordagem de Loparic se encontra organizada: (1) o argumento segundo o qual Winnicott inaugura um novo paradigma em psicanálise, nos termos da epistemologia de Thomas Kuhn; (2) a ideia de que o pensamento psicanalítico de Winnicott mantém estreitas afinidades com a analítica existencial de Martin Heidegger, podendo, nessa qualidade, servir o projeto da constituição de uma antropologia, de uma patologia e de uma terapia de inspiração daseinsanalítica.

The aim of this paper is to accomplish a detailed analysis of the philosophical understanding of the psychoanalytical thinking of Donald Winnicott proposed by Zeljko Loparic. Having into account some of his main articles dedicated to the problem of the philosophical underpinnings of winnicottian psychoanalysis, a thorough description will be made regarding the ways in which Loparic views and questions the novelty of Winncott's contribution to psychoanalytical science. With that purpose in mind, the two axes around which Loparic's approach is organized will be emphasized: (1) the argument according to which Winnicott establishes a new paradigm in psychoanalysis, in the terms of Thomas Kuhn's epistemology; (2) the idea that Winnicott's psychoanalytical thinking maintains tight affinities with Martin Heidegger's existential analysis, being, by that reason, in a favorable position to sustain the project of establishing an anthropology, a pathology and a therapy inscribed in a daseinsanalytical frame.

Síndrome de Mounier-Kuhn / Mounier-Kuhn Syndrome

El síndrome de Mounier-Kuhn o traqueobroncomegalia constituye una rara entidad clínica y radiológica caracterizada por una dilatación de la tráquea y los bronquios principales. Puede asociarse con estructuras saculares en las membranas intercartilaginosas (diverticulosis traqueal), bronquiectasias e infecciones respiratorias a repetición. Las formas de presentación clínica son variables. Tiene una prevalencia entre el 1-4,5 por ciento de la población y se presenta, mayoritariamente, en hombres con un amplio rango etario que oscila entre los 20 y 50 años de edad. Se presenta el caso de un paciente masculino de 77 años con cuadros de infecciones respiratorias bajas a repetición desde la juventud. Luego de realizarle estudios de imagen y broncoscopia, se llegó al diagnóstico de síndrome de Mounier-Kunh. Recibió tratamiento antibiótico inmediatamente y su evolución fue de manera satisfactoria(AU)

Mounier-Kuhn syndrome or tracheobroncomegaly is a rare clinical and radiological entity characterized by dilatation of the trachea and the main bronchi. It can be associated with saccular structures in the intercartilaginous membranes (tracheal diverticulosis), bronchiectasis, and recurrent respiratory infections. The forms of clinical presentation vary. It has a prevalence between 1-4.5 percent of the population and it occurs mainly in men, widely ranging ages between 20 and 50 years of age. We report the case of a 77-year-old male patient with recurrent lower respiratory infections since his youth. After performing imaging studies and bronchoscopy, he could be diagnosed with Mounier-Kunh syndrome. He immediately underwent antibiotic treatment and his evolution was satisfactory(AU)

De saltos paradigmáticos a redes de cuidado: un extraño recorrido / From paradigmatic leaps to care networks: a strange journey

Este trabalho tem como objetivo mostrar quão forte é a influência do pensamento de Loparic em minhas reflexões e quantos dos problemas que trabalho são atravessados por sua filosofia. É impossível falar sobre os caminhos das idéias percorridos sem falar da forte presença de Zeljko Loparic neles. Meu objetivo aqui é mostrar como passei de agradáveis exercícios epistemológicos para ocupações éticas desconfortáveis. Começarei descrevendo os primeiros e depois analisando as preocupações que surgiram e que me levaram à ética do cuidado, indicando como as reflexões filosóficas de Loparic estavam acompanhando esses itinerários.

Este trabajo tiene por objetivo mostrar cuan fuerte es la influencia del pensamiento de Loparic en mis reflexiones y cómo muchas de las problemáticas que trabajo están atravesadas por su filosofía. Es imposible hablar del camino de ideas andado sin hablar de la fuerte presencia de Zeljko Loparic en estos trayectos. Mi propósito aquí es mostrar cómo pasé de placenteros ejercicios epistemológicas a incómodas ocupaciones éticas. Comenzaré describiendo los primeros para luego analizar las inquietudes que fueron surgiendo y que me llevaron a la ética del cuidado, indicando cómo las reflexiones filosóficas de Loparic fueron acompañando estos itinerarios.

Não há outra igual / There is no other like it

O presente artigo atende ao escopo de realizar uma homenagem justa ao filósofo Zeljko Loparic, tendo como meio relatar a influência que ele exerceu sobre meu próprio trabalho de reflexão sobre a psicanálise de Freud. Esta se deu pela adoção da noção de paradigma, que Loparic tomou de empréstimo de Thomas Kuhn ("A estrutura das revoluções científicas", 1962). O resultado disso foi que pude reconhecer diferentes psicanálises pós-freudianas dando nome próprio para cada uma, mas especialmente reconhecendo a obra de Freud como não havendo outra que lhe seja igual. Em outras palavras, me permitiu apurar minha compreensão acerca da condição especial e de sua distinção. Não tenho dúvidas de que se trata de uma reflexão pertinente em épocas em que o uso compartilhado de teorias e terapias psicanalíticas tem sido tão festejado.

This article aims to pay a fair tribute to philosopher Zeljko Loparic by reporting his influence on my own work of reflection on Freud's psychoanalysis. It was due to the adoption of the notion of paradigm, which Loparic borrowed from Thomas Kuhn ("The Structure of Scientific Revolutions", 1962). As a result, I was able to recognize different post-Freudian psychoanalysis giving a proper name to each one, but especially recognizing that there is no other work like Freud's. In other words, it allowed me to improve my understanding of the special condition and its distinction. I have no doubt that this is a pertinent reflection at times when the shared use of psychoanalytic theories and therapies has been so celebrated.

On "asking for a kind of revolution" in clinical psychoanalysis: Winnicott's concept of regression, care-cure, working within the realm of needs and creating new experiences / Sobre "pedir por um tipo de revolução" na Clínica psicanalítica: o conceito winnicottiano de refressão, cuidado-cura, trabalho no reino das necessidades e criação de novas experiências

Neste artigo, abordo o rompimento radical das ideias teórico-clínicas de Winnicott a partir do trabalho psicanalítico tradicional, introduzindo uma mudança revolucionária na psicanálise clínica - uma transição de "extensão" para "revolução científica" e "mudança de paradigma" (para a usar a terminologia de Thomas Kuhn em "A estrutura das revoluções científicas", 1962). Para mim, essas ideias revolucionárias de Winnicott são muito importantes, tanto prática quanto teoricamente, pois fornecem uma matriz formative e um modo de trabalho e transformação que a prática psicanalítica não oferece.

In this article, I will address the radical departure of Winnicott's theoretical-clinical ideas from traditional psychoanalytic work, introducing a revolutionary change in clinical psychoanalysis - a transition from "extension" to "scientific revolution" and "paradigm change or paradigm shift" (to use Thomas Kuhn's terminology of the "Structure of scientific revolution", 1962). For me, these revolutionary ideas of Winnicott are profoundly important, theoretically and practically, as they provide a formative matrix and a mode of work and transformation that conventional psychoanalytic work does not offer (Eshel, 2013a, 2016, 2017a, 2019a, 2019b).

Airway management of a patient incidentally diagnosed with Mounier-Kuhn syndrome during general anesthesia

Mounier-Kuhn syndrome (MKS) is a disease characterized by dilation of the trachea and mainstem bronchi. Due to the risk of airway leakage, pulmonary aspiration, and tracheal damage, MKS can be fatal in patients undergoing tracheal intubation. Moreover, MKS may not be diagnosed preoperatively due to its rarity. In this case, a patient undergoing neurosurgery was incidentally diagnosed with MKS during general anesthesia. During anesthesia induction, difficulties in airway management led the anesthesiologist to suspect MKS. Airway leakage was resolved in this case using oropharyngeal gauze packing. Anesthesiologists should be aware of the possibility of MKS and appropriate management of the airways.

Síndrome de Mounier Kuhn en una paciente de 78 años con fibrosis pulmonar / Mounier Kuhn syndrome in a 78-year-old patient with pulmonary fibrosis

Resumen Se presenta el caso de una mujer de 78 años de edad con fibrosis pulmonar idiopàtica, quien consultó por exacerbación de sus síntomas respiratorios, a quien se le realizan estudios radiológicos, donde se evidencia dilatación de la vía aérea, previamente no descrita, y se realiza diagnóstico de síndrome de Mounier Kuhn. Hasta donde el conocimiento alcanza, es el primer caso reportado en Colombia y la tercera persona de mayor edad reportada en el mundo. Este es un hallazgo incidental, dado que desde el punto de vista fisiopatológico no hay ninguna relación causal entre la fibrosis pulmonar idiopática y el síndrome de Mounier Kuhn. Sin embargo, su presencia puedo afectar aún más el compromiso funcional, dado el eventual colapso de la vía aérea, lo cual puede llevar a intervenciones terapéuticas adicionales, como colocación de stent. (Acta Med Colomb 2017: 42-198-201).

Abstract The case of a 78-year-old woman with idiopathic pulmonary fibrosis who consulted for exacerbation of her respiratory symptoms is presented. Radiologic studies showed dilation of the airway that was not previously described, and for this reason the diagnosis of Mounier Kuhn Syndrome was made. To our knowledge, this is the first case reported in Colombia and the third oldest person reported in the world. This is an incidental finding, since from the pathophysiological point of view there is no causal relationship between idiopathic pulmonary fibrosis and Mounier Kuhn's syndrome. However, its presence may further affect the functional compromise, given the eventual collapse of the airway, which may lead to additional therapeutic interventions, such as stent placement. (Acta Med Colomb 2017: 42-198-201).

Cancer research in need of a scientific revolution: Using ‘paradigm shift’ as a method of investigation.

Despite important human and financial resources and considerable accumulation of scientific publications, patents, and clinical trials, cancer research has been slow in achieving a therapeutic revolution similar to the one that occurred in the last century for infectious diseases. It has been proposed that science proceeds not only by accumulating data but also through paradigm shifts. Here, we propose to use the concept of ‘paradigm shift’ as a method of investigation when dominant paradigms fail to achieve their promises. The first step in using the ‘paradigm shift’ method in cancer research requires identifying its founding paradigms. In this review, two of these founding paradigms will be discussed: (i) the reification of cancer as a tumour mass and (ii) the translation of the concepts issued from infectious disease in cancer research. We show how these founding paradigms can generate biases that lead to over-diagnosis and over-treatment and also hamper the development of curative cancer therapies. We apply the ‘paradigm shift’ method to produce perspective reversals consistent with current experimental evidence. The ‘paradigm shift’ method enlightens the existence of a tumour physiologic–prophylactic–pathologic continuum. It integrates the target/antitarget concept and that cancer is also an extracellular disease. The ‘paradigm shift’ method has immediate implications for cancer prevention and therapy. It could be a general method of investigation for other diseases awaiting therapy.

Traqueobroncomegalia: a propósito de un caso clínico-radiológico / Tracheobronchomegaly: a case report

Tracheobronchomegaly corresponds to the anomalous diffuse dilatation of the trachea and main bronchi, usually accompanied by bronchiectasis, which predisposes to recurrent infections. The imaging study is essential to recognize this entity. A case of a 40-year-old woman, with suspicion of bronchial asthma is presented. Imaging study and bronchofiberscopy confirmed the diagnosis of tracheobronchomegaly in this patient.

La traqueobroncomegalia corresponde a la dilatación anómala y difusa de la tráquea y bronquios principales, acompañado habitualmente de bronquiectasias, lo que predispone a infecciones recurrentes. El estudio radiológico resulta fundamental para reconocer esta entidad. Se presenta un caso de una mujer de 40 años en estudio por sospecha de asma bronquial en que el estudio de imágenes (Rx y TAC) y lafibrobroncoscopia confirmó el diagnóstico de traqueobroncomegalia.

A 54-Year-Old Man with Tracheomegaly, Tracheal Diverticulas and Bronchiectasis — Mounier-Kuhn Syndrome.

Mounier-Kuhn syndrome is a rare idiopathic clinical, radiological and bronchoscopic disorder characterised by abnormal dilatation of the tracheo-bronchial tree. The usual presentation is with recurrent lower respiratory tract infections. Herein, we report the case of an adult male who was diagnosed to have Mounier-Kuhn syndrome based on radiographic finding of a tracheal diameter of 45.5 mm on computed tomography and dynamic complete collapse of the tracheo-bronchial tree on forced expiration, observed during ronchoscopy.

Mounier Kuhn syndrome in adult: a case report.

Mounier-Kuhn syndrome or tracheobronchomegaly is a rare congenital abnormality of the trachea and main bronchi characterized by marked cystic dilatation of the tracheobronchial tree, associated with tracheal diverticulosis, bronchiectasis and recurrent lower respiratory tract infections. We report a case of 22 years adult male with history of recurrent lower respiratory tract infection.

Infección respiratoria causada por Alcaligenes xylosoxidans en un paciente con síndrome de Mounier-Kuhn / Case report: respiratory infection due to Alcaligenes xylosoxidans in a patient with Mounier-Kuhn syndrome

Mounier-Kuhn syndrome is a rare entity characterized by abnormal dilatation of the trachea and main bronchi (tracheobronchomegaly). Alcaligenes xylosoxidans is a non fermenting gram-negative pathogen common in extra-and intra-hospital environment, which may be related to immunosuppression states. We describe the case of a 75 years old male, ex-smoker with moderate functional obstruction, chronic respiratory failure and chronic colonization by Pseudomonas aeuriginosa. He had an infectious exacerbation of his disease, reason that previously required several hospital admissions. The patient was treated with antibiotics and his evolution was favourable with negativization in cultures of the pathogen. This is the first description of the isolation of Alcaligenes xylosoxidans as a cause of respiratory infection in a patient with Mounier-Kuhn syndrome.

Síndrome de Mounier-Kuhn: achados radiológicos e apresentação clínica / Mounier-Kuhn syndrome: radiological findings and clinical presentation

A síndrome de Mounier-Kuhn é uma doença rara, caracterizada clinicamente por infecções respiratórias de repetição. Apresentamos um relato de caso desta doença com análise da radiografia e da tomografia computadorizada de alta resolução do tórax que mostram como principais alterações aumento do calibre da traqueia, brônquios principais e bronquiectasias centrais. Estas alterações, associadas às informações clínicas, sugerem o diagnóstico.

Mounier-Kuhn syndrome is a rare disease clinically characterized by recurrent respiratory infections. The present report describes a case of this disease with analysis of chest radiography and high resolution computed tomography showing increased caliber of the trachea, main bronchi and central bronchiectasis. Such changes, in association with clinical data, suggest the diagnosis.

Anesthetic management of a patient with Mounier-Kuhn syndrome undergoing off-pump coronary artery bypass graft surgery: A case report / 대한마취과학회지

Mounier-Kuhn-syndrome patients have markedly dilated trachea and main bronchi due to an atrophy or absence of elastic fibers and thinning of smooth muscle layers in the tracheobronchial tree. Although this syndrome is rare, airway management is challenging and general anesthesia may produce fatal results. However, only a few cases have been reported and this condition is not widely known among anesthesiologists. We present the case of a tracheobronchomegaly patient undergoing an emergency off-pump coronary artery bypass. Although the trachea was markedly dilated with numerous tracheal diverticuli, there was an undilated 2 cm portion below the vocal cords found on the preoperative CT. Under a preparation of extracorporeal membrane oxygenation, we intubated and placed the balloon of an endotracheal tube (I.D. 9 mm) at this portion, and maintained ventilation during the operation. This case showed that a precise preoperative evaluation and anesthetic plan is essential for successful anesthetic management.

Investigando o desconhecido: filosofia da ciência e investigação de fenômenos "anômalos" na psiquiatria / Remarks on the scientific exploration of anomalous psychiatric phenomena

CONTEXTO: A investigação de áreas controversas, como a das relações entre espiritualidade e saúde, levanta uma série de questões sobre a prática científica que, se ignoradas, podem comprometer o desenvolvimento adequado das pesquisas. OBJETIVOS: Apresentar brevemente alguns temas de filosofia da ciência que podem contribuir na investigação de aspectos pouco explorados da realidade. MÉTODOS: Com base na descrição simplificada dos conceitos de paradigma, ciência normal e revolução científica, descritos por Thomas Kuhn, são propostos alguns critérios de avaliação de hipóteses científicas e algumas diretrizes epistemológicas para a exploração científica de novas áreas. RESULTADOS: A investigação científica deve se basear em hipóteses falseáveis, abrangentes, simples, com adequação empírica, predições experimentais precisas, integração e hierarquização teórica, bem como capacidade de predição de fenômenos de tipos novos. Nessa exploração, deve-se manter uma abertura para a investigação de fenômenos anômalos, busca de um referencial teórico que oriente as pesquisas, cuidado com a rejeição dogmática ou a aceitação precipitada de hipóteses e, no julgamento de uma hipótese, não conferir valor excessivo ao contexto que a gerou ou à autoridade das pessoas que a professam ou rejeitam. CONCLUSÕES: Para que possa produzir avanços significativos, a investigação de áreas controversas e/ou pouco exploradas cientificamente requer habilidades e conhecimentos específicos sobre a natureza da atividade científica, especialmente quanto ao que Kuhn chamou de "ciência extraordinária" (em contraste com a "ciência normal").

BACKGROUND: Scientific research on controversial subjects, such as spirituality-and-health, raises several issues about scientific activity that should be properly clarified for an adequate conduction of the investigations. OBJECTIVES: To highlight some topics of philosophy of science that can be useful in the exploration of unknown, or poorly known, aspects of reality. METHODS: By reviewing briefly the concepts of paradigm, normal science and scientific revolution, introduced by Thomas Kuhn, we discuss a set of criteria for evaluating scientific hypotheses, and present some general epistemological guidelines for the scientific exploration of new fields. RESULTS: Scientific activity should be based on theories exhibiting empirical adequacy, falseability, predictive accuracy, broadness of scope, simplicity, theoretical integration, theoretical ordering, and capacity to predict new kinds of phenomena. The proposed guidelines are: to take experimental findings seriously, even when they do not fit into the current paradigm; to search for a theory capable of guiding investigation; to avoid both the dogmatic rejection and the hasty acceptance of new hypotheses; and, in theory evaluation, to take care in not attributing undue value to the context in which the theory was first conceived, or to the authority of the persons who profess or reject it. CONCLUSION: The scientific exploration of new areas is rendered more fruitful by a thorough understanding of the nature of scientific activity, specially of what Kuhn has called "extraordinary science" (in contrast with "normal science").

A Case of Tracheobronchomegaly with Pneumonia / 결핵및호흡기질환

A 66-years-old man was refered to our hospital because of cough, sputum, chill and fever. Enlargement of the trachea and main bronchi on radiography and bronchoscopy is compatible with Mounier-Kuhn syndrome. Mounier-Kuhn syndrome or tracheobronchomegaly is a rare disorder of uncertain etiology, characterized by marked dilatation of the trachea and major bronchi. This syndrome is associated with tracheal diverticulosis, bronchiectasis and recurrent respiratory tract infection. We report a rare case of Mounier-Kuhn syndrome with pneumonia and literature reviews.