Una visión de la gestante con preeclampsia desde la perspectiva de enfermería / A Vision about the Pregnant Woman with Preeclampsia from the Nursing Perspective

Introducción: En un proceso patológico como la preeclampsia durante el embarazo, la Enfermería deberá enfocar sus cuidados a la gestante y a la complicación que se presenta. Un adecuado abordaje desde la profesión requiere, en este contexto, de una visión desde la perspectiva enfermera. Objetivo: Sistematizar el término gestante con preeclampsia en el contexto de la Enfermería. Métodos: Se realizó una revisión integrativa para un análisis crítico reflexivo de contenidos de documentos publicados desde 2003 al 2020 con una clara metodología y referencial teórico, seleccionados desde agosto del 2020 hasta febrero del 2021. Se utilizaron las palabras clave identificadas en DeCS y operadores booleanos: "embarazo" AND "complicaciones del embarazo" OR "procesos patológicos" AND "enfermería" OR "cuidados de enfermería". La búsqueda fue realizada en las bases de datos Medigraphic, SciELO, Index. Se utilizó el diagrama de flujo (PRISMA) para contribuir a la formulación de la estrategia de búsqueda. Conclusiones: La sistematización realizada permite identificar las características definitorias que caracterizan a la preeclampsia y las respuestas humanas que en ella afloran, información de extraordinaria relevancia para brindar un cuidado con enfoque holístico y de respeto, lo que favorece la interacción a través de la comunicación para satisfacer la necesidad de información y de ayuda insatisfecha(AU)

Introduction: In a pathological process such as preeclampsia (during pregnancy), nursing should focus its care on the pregnant woman and the complication that occurs. An adequate approach from the profession itself requires, in this context, a vision from the nursing perspective. Objective: To systematize the term pregnant woman with preeclampsia in the nursing context. Methods: An integrative review was carried out for a reflexive critical analysis of contents within documents published from 2003 to 2020 with a clear methodology and theoretical referential, selected between August 2020 and February 2021. The keywords identified in DeCS and Boolean operators were used: embarazo [pregnancy] AND complicaciones del embarazo [pregnancy complications] OR procesos patológicos [pathological processes] AND enfermería [nursing] OR cuidados de enfermería [nursing care]. The search was performed in the Medigraphic, SciELO and Index databases. The PRISMA flowchart was used to contribute to formulating the search strategy. Conclusions: The conducted systematization allows to identify the characteristics that define preeclampsia and the human responses that appear during it, an information of extraordinary relevance to provide care with a holistic and respectful approach, which favors interaction through communication in view of satisfying the unmet need for information and help(AU)

Factores asociados a la mortalidad en pacientes con síndrome de disfunción multiorgánica

RESUMEN Introducción: El síndrome de disfunción multiorgánica se caracteriza por el desarrollo de disfunción fisiológica progresiva y potencialmente reversible en dos o más órganos inducido por una amplia variedad de agresiones. En su patogenia el sistema inmunológico-inflamatorio desempeña un papel indispensable. Objetivo: Determinar factores asociados a la mortalidad en pacientes con síndrome de disfunción multiorgánica. Método: Se desarrolló un estudio observacional analítico de cohorte retrospectivo en 68 pacientes con síndrome de disfunción multiorgánica atendidos en el servicio de Medicina Intensiva del Hospital General Docente "Abel Santamaría Cuadrado" de Pinar del Río, durante los años 2018 y 2019. Se midieron variables, como: edad, sexo, diagnóstico al ingreso, valoración nutricional, puntuación según Sequential Organ Failure Assessment (SOFA), complicaciones desarrolladas, sistemas en fallo y número de órganos en fallo. Resultados: Se encontró predominio de pacientes masculinos (60,3 %) y del grupo de edades entre 60 años y 79 años (47,06 %). Hubo asociación estadísticamente significativa (p<0,05) entre la puntuación SOFA y el número de órganos en fallo con el estado al egreso. Las complicaciones respiratorias se manifestaron tanto en el 36 % de los pacientes fallecidos como en el 38,89 % de los egresados vivos. Se encontró un mayor número de pacientes con fallo cardiovascular (77,94 %). El fallo respiratorio (p<0,001, OR:9 IC:2,52-32,08) y SOFA ≥ 16 (p<0,042, OR:8,76 IC:1,07-71,51) incrementaron el riesgo de egresar fallecido. Conclusiones: El sobrepeso y la obesidad, el choque al ingreso, altos valores SOFA, el fallo respiratorio y nervioso, así como un mayor número de órganos en fallo se asociaron con peores pronósticos y mayor probabilidad de fallecer.

ABSTRACT Introduction: Multiorgan dysfunction syndrome is characterized by the development of a progressive and potentially reversible physiological dysfunction in two or more organs induced by a wide variety of aggresive situations. The immune-inflammatory system plays an indispensable role in its pathogenesis. Objective: To identify the mortality-associated factors in patients with multiorgan dysfunction syndrome. Method: An analytical, observational, and retrospective cohort study was developed in 68 patients with multiorgan dysfunction syndrome attended in the Intensive Care Medicine Service at the Hospital General Docente "Abel Santamaría Cuadrado", Pinar del Río, between 2018 and 2019. Variables used: age, sex, diagnosis at admission, nutritional assessment, score accordind to Sequential Organ Failure Assessment (SOFA), complications arose, systems and number of organs in failing process. Results: Male patients (60.3%) and age group between 60 and 79 (47.06%) were predominant. There was statistically significant association (p<0.05) between SOFA score and the number of failing organs at discharge. Respiratory complications were reported in 36% of deceased patients and in 38.89% of those discharged alive. Patients with cardiovascular failure were the most common (77.94%). Respiratory failure (p<0.001, OR:9 CI:2.52-32.08) and SOFA≥16 (p<0.042, OR:8.76 CI:1.07-71.51) increased the risk of decease-related discharge. Conclusions: Excessive body mass index and obesity, admission shock, high score of SOFA, respiratory and nerveous failure, as well as the enormeus failure of organs were associated with the worsen prognoses and with the highest probability of decease.

RESUMO Introdução: A síndrome de disfunção multiorgânica é caracterizada pelo desenvolvimento de disfunção fisiológica progressiva e potencialmente reversível em dois ou mais órgãos induzida por uma ampla variedade de agressões. Objetivo: Determinar os fatores associados à mortalidade em pacientes com síndrome de disfunção multiorgânica. Método: Foi realizado um estudo observacional analítico de coorte retrospectivo em 68 pacientes atendidos no serviço de Medicina Intensiva do Hospital General Docente "Abel Santamaría Cuadrado", durante os anos de 2018 e 2019. Foram medidas variáveis, tais como como: idade, sexo, diagnóstico na admissão, avaliação nutricional, escore Sequential Organ Failure Assessment (SOFA), complicações desenvolvidas, sistemas em falha e número de órgãos em falha. Resultados: Encontrou-se predomínio de pacientes do sexo masculino (60,3%) e da faixa etária entre 60 anos e 79 anos (47,06%). Houve associação estatisticamente significativa (p <0,05) entre o escore SOFA e o número de órgãos em falha com o estado de alta. Complicações respiratórias foram manifestadas em 36% dos pacientes falecidos e em 38,89% das altas hospitalares. Foi encontrado um maior número de pacientes com insuficiência cardiovascular (77,94%). Insuficiência respiratória (p<0,001, OR:9 CI:2,52-32,08) e SOFA ≥16 (p <0,042, OR:8,76 CI:1,07-71,51) aumentaram o risco de falecimento de alta. Conclusões: Sobrepeso e obesidade, choque na admissão, valores elevados de SOFA, insuficiência respiratória e nervosa, assim como maior número de órgãos em falha estiveram associados a pior prognóstico e maior probabilidade de óbito.

Histopathological and clinical analysis of 204 patients with cutaneous horns / 中华皮肤科杂志

Objective:To analyze clinical and histopathological features of cutaneous horns, and to explore their relationship.Methods:A total of 204 patients with cutaneous horns confirmed by clinical and histopathological examinations were collected from Department of Pathology, Shanghai Skin Disease Hospital between January 2014 and May 2020, and their clinical and histopathological data were retrospectively analyzed.Results:Among 204 patients, there were 88 males and 116 females with the age being 70.47±14.76 years and median ( P25, P75) course being 6 (6, 24) months. Cutaneous horns were solitary in 201 cases, and multiple in 3. There were a total of 207 cutaneous horns, including 163 (78.74%) located on the head, face and neck, 18 (8.70%) on the trunk and 26 (12.56%) on the extremities. According to histopathological conditions at the base of the cutaneous horns, 154 (74.40%) cutaneous horns were considered to arise from benign lesions (named as benign horns) , including viral warts ( n=129) , seborrheic keratosis ( n=15) , inverted follicular keratosis ( n=3) , trichilemmomas ( n=5) , pyogenic granuloma ( n=1) and calcifying epithelioma ( n=1) ; 40 (19.32%) were considered to arise from premalignant lesions (actinic keratosis) and named as premalignant horns; 13 (6.28%) were considered to arise from malignant lesions (named as malignant horns) , including Bowen′s disease ( n=5) and squamous cell carcinoma ( n=8) . The average ages of patients with premalignant and malignant horns were significantly higher than those of patients with benign horns ( H=4.05, 3.16, respectively, both P < 0.01) . The base width of the malignant horns was significantly higher than that of the premalignant and benign horns ( H=2.74, 3.49, P < 0.05, 0.01, respectively) , and there was no significant difference between the premalignant and benign horns ( H=0.73, P > 0.05) . The height to base width ratio was significantly lower in the premalignant and malignant horns than in the benign horns ( H=4.06, 3.72, respectively, both P < 0.01) . The incidence rate of basal erythema was significantly higher in the premalignant and malignant horns than that in the benign horns ( χ2=29.57, 6.23, P < 0.01, 0.05, respectively) , and bleeding and crusting occurred more frequently in the malignant horns compared with the benign horns ( χ2=4.89, P < 0.05) . Conclusions:The base of most cutaneous horns is benign, which mainly includes viral warts, and premalignant and malignant horns account for about a quarter. Male, older age, wide base, low ratio of the height to base width, basal erythema, history of bleeding and crusting can serve as clues to early recognition of malignant lesions at the base of cutaneous horns.

Histopathological and clinical analysis of 150 cases of dermatofibroma / 中华皮肤科杂志

Objective To analyze histopathological and clinical features of dermatofibroma,and to explore the relationship between them.Methods Clinical and histopathological data were collected from 150 patients with histopathologically confirmed dermatofibroma in Department of Pathology,Shanghai Skin Disease Hospital from September 2017 to August 2018,and analyzed retrospectively.Results Among the 150 patients,65 were males,and 85 were females.Their age was 42 ± 13.8 years,and the course of disease ranged from 3 months to 30 years.Some of the patients had concomitant symptoms,mainly manifesting as itching,some had spontaneous pain and mild tenderness,and 18 patients had a history of injury,insect bite or infection at lesion sites.Skin lesions mainly occurred on the extremities (107 cases,71.3％),and most were solitary (105 cases,70％).Before pathological examinations,102 cases were clinically diagnosed as dermatofibroma,16 as epidermoid cyst,13 as pigmented nevus,3 as keloid,12 as skin mass,1 as malignant melanoma,1 as xanthogranuloma,1 as prurigo nodularis,and 1 as neurofibroma.Among 169 hematoxylin and eosin (HE)-stained sections,25 (14.8％) appeared to be consistent with aneurysmal dermatofibroma,66 (39.1％)with cellular dermatofibroma,36 (21.3％) with sclerosing dermatofibroma,and 22 (13.0％)with epithelioid dermatofibroma.Coexistence of two or more subtypes could be seen in 12 sections.There were also a few new variants,such as dermatofibroma with hyperplastic sweat duct (1 case),deep dermatofibroma (3 cases),dermatofibroma with epithelioid cells intermingled with hyperplastic collagen (1 case).The duration of aneurysmal dermatofibroma varied from 7 months to 30 years,and most manifested as skin masses on the lower extremities.A relatively short course of disease was observed in patients with cellular dermatofibroma,who often visited a hospital several months after the onset,and cellular dermatofibroma was commonly observed on the extremities and frequently accompanied with itching and pain.The duration of sclerosing or atrophic dermatofibroma was usually long for years or decades,and it commonly occurred on the upper limbs without concomitant symptoms.Epithelioid dermatofibroma of varied durations had various clinical manifestations,frequently occurred on the lower limbs without concomitant symptoms.Conclusions The clinical and pathological manifestations of dermatofibroma are diverse.Different dermatofibroma lesions can share similar typical histopathological manifestations,and atypical pathological features can interfere with the diagnosis of dermatofibroma.

Application value of dermoscopy in the diagnosis of condyloma acuminatum / 中华皮肤科杂志

Objective To evaluate the application value of dermoscopy in the diagnosis of genital condyloma acuminatum (CA) in men.Methods A total of 122 warts from 66 male patients with suspected genital CA were firstly diagnosed by experienced dermatologists according to macroscopic morphological characteristics of lesions and clinical history of patients.Afterwards,the warts were examined and diagnosed by dermoscopy,and the two diagnosis results were compared with histopathological findings.Results Of 122 suspected warts,100 were diagnosed as CA by naked-eye examination,112 as CA by dermoscopy and 114 as CA by pathological examination.When histopathological findings served as the gold standard,dermoscopy had a sensitivity of 97.4％ and a specificity of 87.5％,and naked-eye examination had a sensitivity of 87.7％ and a specificity of 100％.Under dermoscopy,most male genital warts were pink (98/114,86.0％) and papillary (98/114,86.0％),and had distinct vascular characteristics (107/114,95.5％),which mainly included pleomorphic vessels (102/114,89.5％) and punctate vessels (98/114,86.0％).Conclusion CA has characteristic structures under dermoscopy,so dermoscopy can be used for the diagnosis of genital CA in men.

Comparison of lung injuries in pathological features and time-course changes between exertional and classic heatstroke rats / 解放军医学杂志

Objective To compare the differences in time-course changes and pathological morphology of lung injury between exertional and nonexertional heatstroke (HS) rats. Methods The rats were randomly (random number table) assigned into exertional heatstroke (EHS) group, nonexertional heatstroke (classic heatstroke, CHS) group, and two control groups (S-EHS and S-CHS respectively). The rats in the control groups were placed in a temperature of 23ºC and humidity of (55 5)%, while the rats of EHS and CHS groups were exposed to ambient temperature of 39 ºC and humidity of 65%. During heat stress or sham heated, EHS and c-EHS rats underwent the exercise protocol which was performed by making rats running at a speed of 15m/min (without incline) for 8min, and then rest for 2min. Rectal temperature (Tr, HS), systolic blood pressure (SBP) and pulse rate (PR) were monitored to analyze the difference in heat stress response between EHS and CHS rats. The time point at which the SBP started drop down from the peak level was taken as a point of HS onset. At the onset of HS, heat exposure was terminated, and the rats were immediately removed from the chamber, and returned to room temperature. The rats were scarified at 0, 6, 24 and 72h after HS onset respectively, with 8 rats each time point. The lungs of all the animals were isolated for contrastive study on the differences of pathological changes of lung injury between EHS and CHS rats. Results In comparison with CHS rats, EHS rats had significantly shorten HS latency and smaller heat load to induce HS (P0.05). Pathological changes of acute lung injury could be observed in both CHS and EHS rats, which presented as progressive dilation and congestion of interstitial blood vessels, hemorrhage of alveolar space, abscission of alveolar epithelia cells and disappearance of alveolar tissue structure. Comparative study revealed that there was no significant difference in lung injury score between EHS and CHS rats at the onset of HS and 72h after HS onset, while lung injury score was significantly higher in EHS than in CHS rats (P<0.01). Conclusion Although no significant difference in the extent of lung injury between EHS and CHS rats was observed at the onset of HS, EHS rats had significantly faster progress in lung injury during HS recovery, which provides an experimental basis for further study of the mechanisms of relative high mortality of EHS.

A case of cutaneous metastasis of osteosarcoma / 中华皮肤科杂志

A 68?year?old female patient was admitted to the hospital for multiple masses in the mouth and lungs as well as on dorsal hands for more than 20 days without obvious subjective symptoms. No abnormalities were found by physical examination. Dermatological examination showed two bean?sized dark?red nodules on the upper jaw as well as one pigeon egg?sized dark?red nodule on the left dorsal hand, and all the nodules were hard with smooth surfaces and limited mobility. Positron emission tomography?computed tomography (PetCT) revealed multiple metastases to the brain, lymph nodes, lungs, gastrointestinal tract, both kidneys, multiple bones and intermuscular tissues. Pathology of nodules from the upper jaw showed lowly differentiated tumor cells with osteoid matrix, chondroid structures and tumor bone in local areas, and immunohistochemical examination of tumor cells found positive staining for S100(focally), vimentin, CD99, P63 and Ki?67(60%), but negative staining for keratin. A diagnosis of osteosarcoma of the right side of the upper jaw was considered. Pathology of nodules from the dorsal hand revealed no obvious abnormalities in the epidermis, while there was a diffuse infiltration of medium?to large?sized histiocyte?like cells in the whole dermis with cell atypia and irregularly red?stained bone matrix and tumor bone in some regions. Immunopathology showed positive staining for Ki67(60%), and negative staining for CD3, CD10, CD20, Bcl?2, and Bcl?6. A diagnosis of cutaneous metastasis of osteosarcoma was made. The patient refused further treatment and died 6 months after the onset of lesions.

A case of keratosis circumscripta / 中华皮肤科杂志

A 13-year-old girl suddenly developed hypertrophic rough-surfaced plaques on both elbows, knees and ankles without obvious precipitating factors at 3 years of age.Because there was no subjective symptom or other discomfort, no treatment was given.Thereafter, the lesions neither faded nor spread.Skin examination revealed lesions covered with 1-2 mm-sized keratotic papules on the elbows and knees, which were clustered together and confluent in some areas.Circular keratotic plaques were observed on the ankles.Histopathology showed epidermal hyperkeratosis with mild parakeratosis, follicular keratotic plugs, acanthosis, broadened dermal papillae, telangiectasis and perivascular mononuclear infiltration in dermal papillae, infiltration of a few nonspecific cells in the superficial dermis.According to the clinical manifestations and histopathological findings, the patient was diagnosed with keratosis circumscripta, and treated with oral vitamin A and topical halometasone cream and urea-vitanmin E cream.The degree of skin hypertrophy and roughness was decreased after 15 days of treatment, but increased 1 month after drug withdrawal.

Clinicopathologic analysis of five cases of cutaneous intravascular natural killer/T-cell lymphoma / 中华皮肤科杂志

Objective To improve the understanding of cutaneous intravascular natural killer/T-cell lymphoma (CIVNKTC). Methods Clinical data on five cases of CIVNKTC were collected. The histopathological feature, treatment and prognosis of CIVNKTC were retrospectively analyzed and discussed. Results Of the 5 patients, 1 was male and 4 were female. The age of onset ranged from 38 to 83 years (average, 56.2 years). All the patients presented with multiple plaques and nodules as the primary symptoms. Histopathological examination revealed vasodilatation in the dermis and subcutaneous tissue, as well as atypical lymphoid cells with large hyperchromatic nuclei containing 1-2 small nucleoli in dilated veins. Immunohistochemical studies of tumor cells showed positive staining for CD3ε, cytotoxic proteins (including T cell-restricted intracellular antigen-1, granzyme B and perforin)and Epstein-Barr virus(EBV)-encoded microRNA, but negative staining for cytokeratin, CD20, CD79a, CD4 and CD8. Furthermore, the tumor cells stained positive for CD56 in two patients. Among the 5 patients, only 2 received chemotherapy and the remaining received no treatment. During a 24-month follow-up, 4 patients died, and only 1 survived with the tumor. Conclusion CIVNKTC is a rare extranodal Hodgkin′s lymphoma with distinct histologic manifestations and immunophenotypes, rapid and aggressive clinical course, and poor prognosis.

The analysis of clinical features,differential diagnosis and prognosis of 9 cases with ovarian malignant mixed mesodermal tumor / 重庆医学

Objective To investigate the clinical pathologic features of ovarian malignant mesoderm mixed tumor (malignant mixed mesodermal tumor of uterus ,MMMT ) ,and its differential diagnosis ,clinical treatment and prognosis .Methods A retrospec‐tive analysis of the clinicopathological data of 9 patients with MMMT in our hospital from January 1985 to December 1985 was per‐formed ,and the clinicopathological data included routine paraffin section of HE staining and special staining and immunohistochemi‐cal study .Results Results showed that 8 cases were examined by ultrasound with side ovarian tumor ,1 case of patients with bilat‐eral ovarian tumors .Histological examination showed that there was 5 cases of endometrial carcinoma in epithelial components ,3 ca‐ses in clear cell carcinoma ,1 case in mucous adenocarcinoma .Composition of mesenchymal cells were fusiform or irregular shape , weaving or beam pattern ,or chaotic ,which 4 cases showed chondrosarcoma ,2 cases showed bone sarcoma component and glandular epithelial cell keratin and stromal elements vimentin (Cytokeratin ,CK) of 9 cases were + ,and estrogen receptor (estrogen recep‐tor ,ER) detection of 3 cases were + ,Progesterone receptor(PR) detection of 2 cases were + ,protein (desmin) of 2 cases were + ;highly glycosylation type I transmembrane glycoprotein (CD34) of 1 case was + .Conclusion Histological appearance is the main detection methods of ovarian malignant germ layer in the diagnosis of mixed tumor ,and B ultrasonic and CA125 inspection at the same time can effciently improve the accuracy of clinical diagnosis .

Diffuse hyperpigmentation with guttate depigmentation macules: clinical analysis of 10 cases / 中华皮肤科杂志

Objective To assess the clinical feature and diagnosis of diffuse hyperpigmentation with guttate depigmentation macules.Methods A retrospective study was carried out among 10 patients with diffuse hyperpigmentation with guttate depigmentation macules collected at the Institute of Dermatology,Chinese Academy of Medical Sciences and Peking Union Medical College from 2005 to 2012.The clinical manifestations,pathological findings and disease outcomes in these patients were analyzed.Results Of the 10 patients,6 were male,and 4 were female.The median age at onset was 7 years (range,4-25),and there were only 3 adult patients among these patients.None of the patients had a family history of pigmentary disturbance.Typical clinical manifestations included densely distributed,guttate hypopigmented macules arising on diffuse and uniform hyperpigmentation.Lesions could slowly spread over the body surface without the trend towards spontaneous regression.Pathologically,there was a slight increase in pigmentation of the epidermal basal layer,as well as melanins and melanophages scattered around blood vessels in the superficial dermis,with or without focal vacuolar degeneration of the basal cell layer.Conclusions Diffuse hyperpigmentation with guttate depigmentation macules,a rare pigmentary disturbance that clinically manifests as both hyperpigmentation and hypopigmentation and is pathologically characterized by postinflammatory hyperpigmentation,often affects children.Once the lesions occur,there is no trend towards regression.No effective treatment is available for this entity at present.

Correlation between urinary biomarkers and pathological lesions in drug-induced tubulointerstitial nephritis / 中华内科杂志

Objective To find some urinary biomarkers for differential diagnosis in drug-induced tubulointerstitial nephritis (DTIN) by accessing the relationship between their changes and the pathological processes of DTIN.Methods Forty patients biopsy-proven DTIN and 24 healthy controls were enrolled in this study.The urine samples of DTIN patients were collected on the day of biopsy and were measured for the following biomarkers: urinary TGF-β with enzyme-linked immunosorbent assay (ELISA);urinary IL-6 with radio-immunoassay;N-acetyl-β-D-glucosaminidase (NAG) with enzyme-substrate colorimetric assay;α1-microglobulin (α1-MG) with immune transmission turbidity method.Meanwhile, the pathological changes on renal biopsy were analyzed semi-quantitatively and scored.The relationship between these pathological changes and the urinary biomarkers were analyzed and receiver operating characteristic curve ( ROC curve) of those biomarkers in distinguishing different pathological lesions were constructed.Results Urinary α1- MG levels were positively correlated to interstitial edema, inflammatory cell infiltration and tubular atrophy, while urinary IL-6 were negatively correlated to the above parameters.Urinary NAG had positive relationship with inflammatory cell infiltration and tubular atrophy, while urinary TGF-β had positive relationship with tubular atrophy.ROC analysis results indicated that the area under curve (AUC) of α1-MG was larger than that of NAG (0.797 vs 0.734, P ＜ 0.05 ).Combined measurement of α1-MG and NAG could enhance the sensitivity of detecting interstitial inflammatory cell infiltration.For detecting interstitial edema and tubular atrophy, only α1-MG had statistical significance ( AUC = 0.723, P = 0.027;AUC = 0.774, P = 0.008,respectively).Conclusions Urinary α1-MG and NAG levels can reflect the severity of interstitial inflammatory infiltration, combined measurement of both can enhance sensitivity.Urinary α1-MG level can also reflect the degree of interstitial edema and tubular atrophy.

Kraepelin e a questão da manifestação clínica das doenças mentais / Kraepelin and the question of the clinical manifestation of mental diseases

No artigo de 1920 intitulado "Die Erscheinungsformen des Irreseins", publicado já na maturidade teórica de Kraepelin, o grande autor alemão propõe uma releitura de suas concepções sobre a psicopatologia, considerando que as manifestações clínicas das doenças mentais não são jamais expressão direta dos processos mórbidos subjacentes. Elas dependem de uma complexa interação com o sujeito e sua história, no qual tal alteração se instala e inscreve.

Dans l'article de 1920, intitule "Die Erscheinungsformen des Irreseins", publié à la maturité théorique de Kraepelin, le grand auteur allemand propose une relecture de ses propres conceptions sur la psychopathologie, selon laquelle il considère que les manifestations cliniques ne constituent jamais l'expression directe des processus morbides sous-jacents. Elles dépendend d'une intéraction complexe avec le sujet et son histoire, dans laquelle cette alteration s'installe et s'inscrit.

In an article of 1920 entitled "Die Erscheinungsformen des Irreseins," published in Kraepelin's phase of theoretical maturity, this great German scholar presented a re-reading of his thinking on psychopathology, considering that clinical manifestations of mental diseases are never direct expressions of underlying pathogenic processes. Manifestations depend on a complex interaction with the subject in his or her history during which changes have been installed and inscribed.