Do Congresso Psicanalítico da Banana à cisão de 1998: deslocamentos traumáticos no lacanismo brasileiro1 / From the Psychoanalytic Congress of the Banana to the split of 1998: traumatic displacements in Brazilian lacanism / Du Congrès Psychanalytique de la Banane à la scission de 1998: des déplacements traumatiques dans le lacanisme brésilien / Del Congreso Psicoanalítico de Banana al división de 1998: dislocamiento traumáticos en el lacanismo brasileño

O manuscrito tem como objetivo uma reflexão sobre as rupturas na história das instituições de psicanálise lacaniana brasileiras. Tomou-se como base o Congresso Psicanalítico da Banana e a cisão de 1998 da Escola Brasileira de Psicanálise, eventos precursores do lacanismo brasileiro, que ainda reverberam na relação entre analistas. Documentos institucionais e discursos dos analistas partícipes desses eventos foram analisados adotando a temporalidade como característica fulcral da historiografia. Procedeu-se a uma análise histórica em direção êmica a partir do conceito de trauma articulado com as suas formas clínicas de apresentação. Concluiu-se que, no campo psicanalítico, prevalece uma política de identidade com seus aspectos de subordinação e identificação a grupos visando a hegemonia no interior do campo.

The manuscript aims to reflect on the ruptures in the history of Brazilian Lacanian psychoanalysis institutions. The basis was the Psychoanalytic Congress of the Banana and the 1998 Division of the Brazilian School of Psychoanalysis; precursor events of Brazilian lacanism that still reverberate in the relationship between analysts. Institutional documents and discourses of analysts who participated in these events were analyzed, adopting temporality as a central characteristic of historiography. A historical analysis was carried out in an emic direction from the concept of trauma articulated with its clinical forms of presentation. It was concluded that in the psychoanalytic field a policy of identity prevails with its aspects of subordination and identification to groups aiming at hegemony within the field.

L'objectif de ce manuscrit concerne à réfléchir sur les ruptures dans l›histoire des institutions psychanalytiques lacaniennes brésiliennes. Il a été basé sur le Congrès Psychanalytique de la Banane et la scission de 1998 de l'École Brésilienne de Psychanalyse; des événements précurseurs du lacanisme brésilien qui résonnent encore dans la relation entre analystes. Des documents institutionnels et les discours des analystes qui ont participé à ces événements ont été analysés en adoptant la temporalité comme caractéristique principale de l'historiographie. Une analyse historique a été effectuée d'une façon émique à partir du concept de traumatisme articulé avec ses formes cliniques de présentation. On a conclu que dans le champ psychanalytique prévaut une politique identitaire avec ses aspects de subordination et d'identification à des groupes visant l'hégémonie au sein du champ.

El manuscrito tiene como objetivo una reflexión sobre las rupturas en la historia de las instituciones de psicoanálisis lacaniana brasileñas. Se tomó como base el Congreso Psicoanalítico de Banana y la División de 1998 de la Escuela Brasileña de Psicoanálisis; eventos precursores del lacanismo brasileño que todavía reverberan en la relación entre analistas. Documentos institucionales y discursos de los analistas partícipes de estos eventos fueron analizados adoptando la temporalidad como característica indispensable de la historiografía. Se procedió un análisis histórico en dirección émica a partir del concepto de trauma articulado con las sus formas clínicas de presentación. Se concluyó que en el campo psicoanalítico prevalece una política de identidad con sus aspectos de subordinación e identificación a grupos visando la hegemonía en el interior del campo.

A CASE OF ANTEPARTUM HEMORRHAGE DUE TO EXTRA PLACENTAL CAUSE –RUPTURED VAGINAL VARICES

Vaginal varix during pregnancy is a rare condition that may be a concern for hemorrhage risk during childbirth.A 32yr old female G3P2L2 with NVD at 30 weeks of gestational age presented to OBG Department (Labor Room)with massive vaginal bleeding without known history of trauma nor any evidence of Placenta previa. On examination: Vital status is unstable and upon pelvic inspection- A stream of blood through a ruptured vein in vagina(Vaginal varices). Immediately vein is clamped with artery forceps and patient is stabilized by crystalloids, Dopamine, Nor-adrenaline and 4 PRBC transfusion and under short general anesthesia (ketamine) transvaginal ligation of vaginal varices is done and pregnancy is prolonged in view of threatened preterm labor( by Isoxsuprine)and terminated by 37 weeks of gestational age by EL.LSCS., Spontaneous resolution of vaginal varices occurred.

Trabalhando o vínculo, trabalhando no vínculo: considerações sobre o papel da transferência no atendimento de crianças e jovens que sofreram rupturas familiares / Working the bond, working in the bond: considerations about the role of transfer in the care of children and young people who have suffered family breaks / Trabajar el vínculo, trabajar en el vínculo: consideraciones sobre el papel de la transferencia en el cuidado de los niños y jóvenes que han sufrido descansos familiares

O objetivo deste trabalho é refletir acerca de situações de rupturas familiares, que geram consequências importantes para a formação do self, e sobre a possibilidade de elaboração frente a esperança produzida pela construção de novos vínculos. Quais as reverberações dessas rupturas familiares no processo de constituição da identidade e no desenrolar da própria transferência num atendimento de orientação psicanalítica? Numa tentativa de responder a essa pergunta, será destacado aqui o vínculo transferencial como promotor de uma potencialidade terapêutica.

The main objective of the present paper is, based on the psychoanalytic theory (specially Winnicott's considerations), to reflect about situations regarding the rupture of family links, which cause relevant consequences to the construction of the self of a child, and about the possibility of elaboration with the development of new links. Considering those ruptures, what are the reverberations in the process of identity constitution and, considering the analysis environment, in the outcome of the transference itself? To answer this question, it will be highlighted in the present paper the bond between analyst and patient as a promoter of a therapeutic potentiality.

El objetivo desto trabajo es refletir acerca de situaciones de rupturas familiares y las consecuencias que estas tienen en la formación del self, y acerca de la posibilidad de elaboración frente a la esperanza producida por la construcción de novos vinculos. ¿Quales son las reverberaciones de esas rupturas familiares en los procesos de constitución de la identidad y en el desenvolvimiento de la propia transferencia en un atendimiento de orientación psicoanalítica? En una tentativa de responder a essa pregunta, será destacado aqui el vínculo transferencial como promotor de una potencialidad terapeutica.

A new 3D printed guide plate for minimally invasive treatment of Achilles tendon rupture / 中华创伤骨科杂志

Objective:To investigate the clinical efficacy of a new 3D printed guide plate in the minimally invasive treatment of fresh closed Achilles tendon rupture.Methods:From January 2019 to January 2020, 14 fresh closed Achilles tendon ruptures were treated by minimally invasive surgery at Department of Foot and Ankle Surgery, Xuzhou Renci Hospital. There were 13 males and one female, with an average age of 39.1 years (from 18 to 63 years). The rupture of the Achilles tendon body, 3 cm in length on average, was located 2 to 6 cm above the attachment of the calcaneal tuberosity. The ruptured Achilles tendon was repaired by suture with the aid of the new 3D printed guide plate. After operation, in cooperation of the Rehabilitation Department, we performed rehabilitation exercise under the guidance of the concept of Enhanced Recovery After Surgery (ERAS). The length of incision, operation time, intraoperative blood loss, ankle function at the last follow-up and follow-up complications were recorded.Results:In this cohort, incision length averaged 2.5 cm (from 2.0 to 3.5 cm), operation time 45 min (from 30 to 60 min), and intraoperative blood loss 15 mL (from 10 to 20 mL). The 14 patients were followed up for 13 to 16 months (average, 14 months) after operation. In one patient, the epidermis at the incision edge became black and necrotic, which was healed after dressing change. Follow-ups observed no such complications as suture rejection, sural nerve injury, or Achilles tendon re-rupture. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores at the last follow-up averaged 98 points (from 93 to 99 points), yielding 13 excellent cases and one good case; according to the Arner-Lindholm evaluation, the efficacy was excellent in 12 cases, good in one and poor in one.Conclusion:The minimally invasive treatment of fresh closed Achilles tendon rupture with our new 3D printed guide plate has exhibited advantages of minimally invasive incision, limited complications, simple manipulation, good functional recovery of the ankle joint and strong reproducibility of surgical operations.

Facial-affective communication and verbal relational offers during ruptures and resolution strategies: A systematic single case study / Comunicación facial-afectiva y ofertas relacionales verbales durante rupturas y estrategias de resolución: Un estudio sistemático de caso único

Resumen La investigación sobre la relación terapéutica ha subrayado su papel central en el proceso de cambio terapéutico, indicando la relevancia de determinar los elementos y mecanismos específicos que intervienen en su configuración (Knobloch-Fedders, Elkin, & Kiesler, 2014). La investigación sobre las rupturas de la relación terapéutica ha aportado a la comprensión del proceso de negociación interpersonal que interviene en la interacción paciente-terapeuta. Aunque estudios anteriores han contribuido a la caracterización objetiva y exhaustiva de las rupturas, se necesitan más investigaciones para especificar los marcadores que permiten comprender el modo como los patrones de regulación afectiva entre paciente y terapeuta están involucrados y contribuyen a la generación de estos eventos y a los intentos de reparación. El objetivo de este estudio es caracterizar el comportamiento facial-afectivo de paciente y terapeuta asociado a las ofertas relacionales (OR) verbales durante los eventos de ruptura (R) y de estrategia de resolución (ER) en una terapia psicodinámica breve. El comportamiento afectivo facial se determinó usando el Facial Action Coding System (FACS), las ORs se derivaron del análisis del contenido de las transcripciones de sesiones, y las R y ER se determinaron usando el 3RS. Se realizaron análisis anidados para establecer asociaciones entre las variables. Los resultados indican la presencia de pautas regulatorias faciales-verbales entre paciente y terapeuta características de las rupturas y estrategias de resolución; y señalan el valor de combinar múltiples enfoques para permitir el acceso a indicadores observables de los procesos regulatorios diádicos que contribuyen a comprender y atender las oscilaciones de la relación terapéutica.

Abstract Research on the therapeutic relationship has underscored its central role for the therapeutic change process, indicating the relevance of determining the specific elements and mechanisms involved in its configuration (Knobloch-Fedders, Elkin, & Kiesler, 2014). Research on ruptures of the therapeutic relationship has yielded particular contributions to better understanding the interpersonal negotiation process involved in the patient-therapist interaction. Although previous studies have contributed to the objective characterization and the exhaustive description of ruptures, more research is needed to further specify markers that allow a better understanding about how patterns of affective regulation between patient and therapist are involved and contribute to the emergence of these events and the attempts at reparation. The aim of this study is to characterize patient's and therapist's facial-affective behavior associated to verbal relational offers (RO) during rupture (R) and resolution strategy (RS) events in a brief psychodynamic therapy. Facial-affective behavior was determined using the Facial Action Coding System (FACS), ROs were derived from the content analysis of session transcripts, and R and RS were determined using the 3RS. Nested analyses were carried to establish associations between variables. Results indicate characteristic patientherapist facial-verbal regulatory patterns for both rupture and resolution strategy events. These findings underscore the value of combining multiple approaches to allow an access to observable indicators of dyadic affect regulatory processes that can contribute to better understand and be attentive to the oscillations of the therapeutic relationship.

Rupturas del tendón del supraespinoso: correlación entre RMN y hallazgos quirúrgicos / Supraspinatus tendon ruptures: correlation between MRI and surgical findings

Resumen: Introducción: En la ruptura del manguito de los rotadores, el tendón del supraespinoso ocupa el primer lugar en frecuencia. La resonancia magnética es el estudio de elección para el diagnóstico y planificación preoperatoria. El objetivo de este estudio fue evaluar la concordancia entre los hallazgos observados con la IRM y los hallazgos transoperatorios en pacientes con ruptura del tendón del supraespinoso. Material y métodos: Se realizó un análisis retrospectivo de Enero de 2014 a Enero de 2020. Se incluyeron pacientes mayores de 18 años, con IRM y reporte de ruptura del tendón del supraespinoso. Se realizó un análisis de χ2 para la sensibilidad, especificidad, valores predictivos y certeza diagnóstica utilizando los hallazgos quirúrgicos como referencia. Se utilizó el índice de Kappa para mostrar la concordancia entre IRM y hallazgos transoperatorios. Resultados: Un total de 79 pacientes se incluyeron en el estudio, 45 masculinos y 34 femeninos. La edad promedio fue de 52.14 años. La IRM diagnosticó correctamente 60.76% de las rupturas del supraespinoso, mostró una sensibilidad de 74% y especificidad de 96% para rupturas completas. Para rupturas parciales mostró una sensibilidad de 96% y una especificidad de 33%. El índice de Kappa mostró una concordancia de 0.90 para rupturas totales y de 0.53 para rupturas parciales. Conclusiones: La resonancia magnética demostró una buena sensibilidad y especificidad para el diagnóstico de rupturas completas, con una buena concordancia con los hallazgos quirúrgicos. La IRM demostró ser un estudio poco específico para la identificación de rupturas parciales, lo cual genera que estas lesiones estén sobrediagnosticadas.

Abstract: Introduction: In rotator cuff rupture, the supraspinatus tendon ranks first in frequency. MRI is the study of choice for preoperative diagnosis and planning. The objective of this study was to assess the concordance between findings observed with MRI and transoperative in patients with supraspinatus tendon rupture. Material and methods: A retrospective analysis was conducted from January 2014 to January 2020. Including patients over the age of 18, with MRI and supraspinatus tendon rupture report. A χ2 analysis was performed for sensitivity, specificity, predictive values and diagnostic certainty using surgical findings as a reference. The kappa index was used to show the concordance between MRI and transoperative findings. Results: A total of 79 patients were included in the study, 45 male and 34 female. The average age was 52.14 years. MRI correctly diagnosed 60.76% of supraspinatus ruptures, showing 74% sensitivity and 96% specificity for complete ruptures. For partial ruptures I show a sensitivity of 96%, a specificity of 33%. The kappa index showed a match of 0.90 for total ruptures and 0.53 for partial. Conclusions: MRI demonstrated good sensitivity and specificity for diagnosing complete ruptures, with good match to surgical findings. MRI proved to be a non-specific study for the identification of partial ruptures, which causes these lesions to be overdiagnosed.

Vínculos amorosos em jovens adultos: rompimentos e separações / Loving links in young adults: ruptures and separations / Vínculos amorosos em jóvenes adultos: rompimientos y separaciones

As relações amorosas e a busca por um(a) parceiro(a) permeiam a vida dos sujeitos, ao longo de toda sua vida, interferindo de maneira direta em sua subjetividade. Contudo, mudanças sociais e culturais contemporâneas afetaram essas escolhas, alterando as prioridades dos sujeitos e provocando inúmeros rompimentos amorosos. Por essa razão, a presente pesquisa procurou investigar as concepções de jovens adultos solteiros, estudantes de uma universidade pública no município de Assis, os quais já vivenciaram alguma ruptura amorosa, e buscou apurar o que gerou o rompimento e como lidaram com isso. A coleta de dados foi feita por meio de entrevistas semidirigidas - gravadas e, posteriormente, transcritas. Os dados foram analisados, levando-se em consideração as regularidades e peculiaridades dos discursos, e a discussão e a interpretação dos dados foram realizadas de acordo com a teoria psicanalítica. Dessa forma, foi possível observar a prevalência de relacionamentos amorosos com pouco investimento afetivo, diante de um investimento narcísico exacerbado. Para a maioria dos jovens, permitir-se amar o outro significa assumir um risco maior, partindo do pressuposto de que isso pode gerar frustração e fugir da ideia de satisfação plena.

Loving relationships and the search for a partner permeate people's lives troughout their journey, interfering directly in its subjectivity. However, cultural and social changes that were caused by the postmodern age have affected those choices, shifting people's priorities and causing several loving ruptures. For this reason, the current paper intends to investigate the notion of single young adults who are college students of a public university in Assis, that have already been through any loving rupture. This project also intends looking to understand what has generated the rupture and how these students experienced that. The data collection was done through semi-structured interviews which was recorded and subsequently, transcribed. The data was analyzed considering the regularities and singularities of the speeches, and the data discussion and interpretation was done according to the psychoanalytic theory. Therefore, it was possible to observe the predominance of love relationships with low affective investment, against an extremely big narcissistic investiment. For most of the young, to allow yourself to love other person means to take a bigger risk, assuming that this can generate frustration and lose the ideia of full satisfaction.

Las relaciones amorosas y la búsqueda por un(a) compañero(a) permean la vida de las personas a lo largo de toda la vida, interfiriendo de manera directa en su subjetividad. Sin embargo, los cambios sociales y culturales contemporáneos afectaron estas elecciones, alterando las prioridades de las personas y provocando innumerables rompimientos amorosos. Por esa razón, la presente pesquisa buscó investigar las concepciones de jóvenes adultos solteros, estudiantes de una universidad pública en el municipio de Assis - São Paulo, que ya vivenciaron alguna ruptura amorosa, y buscó averiguar el motivo generó el rompimiento y cómo lidiaron con eso. La recolección de datos fue hecha por medio de entrevistas semidirigidas - grabadas y posteriormente transcriptas. Los datos fueron analizados teniendo en cuenta las regularidades y peculiaridades de los discursos, y la discusión e interpretación de los datos se realizaron de acuerdo con la teoría psicoanalítica. De esta forma, fue posible observar la prevalencia de relaciones amorosas con poca investidura afectiva, ante una investidura narcisista exacerbada. Para la mayoría de los jóvenes, permitirse amar al otro significa asumir un riesgo mayor, partiendo del supuesto de que esto puede generar frustración y huir de la idea de satisfacción plena.

Aspectos qualitativos das rupturas e afinamentos da membrana de Descemet no exame histopatológico / Qualitative aspects of ruptures and thinnings of Descemet's membrane in histopathological examination

Resumo Objetivo: Descrever os diferentes tipos de rupturas e afinamentos da membrana de Descemet encontrados no exame histopatológico, questionando uma possível relação entre eles. Métodos: Estudo observacional, transversal, retrospectivo e descritivo de botões corneanos provenientes de ceratoplastia penetrante, durante o período escolhido de forma aleatória de quatro anos: 2006, 2010, 2014 e 2015. A coloração foi realizada com Hematoxilina-eosina (HE). Após o preparo, os tecidos foram examinados com microscópio óptico pelos autores. Selecionamos apenas os casos de rupturas ou afinamento da membrana de Descemet no exame histopatológico, e classificamos os diferentes tipos desses achados. Resultados: As rupturas encontradas foram classificadas em total ou comum, parcial, fratura e bisel. Os afinamentos foram divididos em generalizado, localizado e extensivo. Conclusão: Apresentamos várias nuances das rupturas e dos afinamentos da membrana de Descemet no exame histopatológico. Os achados sugerem, considerando apenas aspectos mecânicos, uma possível relação entre afinamento e ruptura como causa e efeito.

Abstract Objective: To describe the different types of ruptures and thinning of Descemet's membrane found in the histopathological examination, questioning a possible relationship between them. Methods: Observational, transversal, retrospective and descriptive study of corneal buttons from penetrating keratoplasty during the randomly chosen period of four years: 2006, 2010, 2014 and 2015. The staining was performed with hematoxylin-eosin (HE). After preparation, the authors examined the tissues with an optical microscope. We selected only the cases of rupture or thinning of Descemet's membrane in histopathological examination and classified the different types of these findings. Results: The ruptures found were classified as total or common, partial, fracture and bevel. The thinnings were divided into generalized, localized and extensive. Conclusion: We presented several nuances of Descemet's membrane ruptures and thinning in histopathological examination. Considering only mechanical aspects, the findings suggest a possible relationship between thinning and rupture as cause and effect.

Relación entre la inclinación posterior de la tibia proximal y la inclinación meniscal. Estudio anatómico en resonancia magnética / The correlation between posterior tibial slope and meniscal slope. Anatomical study and magnetic resonance imaging

INTRODUCCIÓN: La geometría articular y las estructuras óseas se han mencionado como factores de riesgo para ruptura del ligamento cruzado anterior (LCA). La inclinación posterior de la tibia proximal (IPTP) es uno de los factores anatómicos mencionados. No se han encontrado estudios que reporten el rol del menisco externo en la estabilidad de la rodilla. El objetivo del siguiente estudio es determinar la relación entre la IPTP y la inclinación meniscal (IM) medidas por resonancia magnética (RM). MATERIAL Y MÉTODO: Se estudiaron 87 RM en 82 pacientes. Fueron excluidos pacientes con alteraciones anatómicas en la tibia proximal. Se realizaron las mediciones de la IPTP y la IM según el método de Hudeck. Se realizaron estudios de correlación para determinar la relación entre ambas variables. RESULTADOS: La edad media de los pacientes fue de 35.9 años. En el compartimento lateral la diferencia entre IPTP y la IM fue de 7.3° en promedio. El coeficiente Spearman entre IPTP del platillo externo y la IM es de 0.45. En el compartimento medial la diferencia entre la IPTP y la IM fue de 3.6°. El coeficiente Spearman entre la IPTP y la IM es de 0.57. CONCLUSIÓN: La correlación observada en ambos compartimentos es de baja a moderada lo que significa que la IPTP tiene poca participación en al valor final de la IM. Estos datos destacan la importancia del menisco externo en la biomecánica de la rodilla. Tipo de estudio: Serie de casos. Nivel de evidencia: IV.

BACKGROUND: Articular geometry and bony structures have been described as a risk factors for ACL ruptures. Posterior tibial slope´s one of the reported factors. We didn´t find studies describing the influence of the lateral meniscus in knee stability. Our aim is to determine the correlation between PTS and the meniscal slope (MS) in magnetic resonance images (MRI). METHODS: We studied 87 MRIs in 82 patients. Patients with anatomical changes in the proximal tibia (eg.: high tibial osteotomy) were discharged. The PTS and the MS was measured with the method of Hudeck. We did correlation tests to find any correlation between variables. RESULTS: Mean age was 35.9. In the lateral compartment the difference between PTS and MS was 7.3° and the Spearman tests was 0.45. In the medial compartment the difference between PTS and MS was 3.6° and the Spearmen tests was 0.57. CONCLUSIÓN: The correlation between both measures was low or moderate. The influence of the PTS in the MS it´s relative and we must consider the lateral meniscus in knee biomechanics. Type study: Number of cases. Level of evidence: IV.

Roturas agudas del tendón de Aquiles tratadas con técnica mínimamente invasiva de Dresden / Acute Achilles tendon ruptures treated with minimally invasive Dresden technique

Introducción: Las roturas del tendón de Aquiles son lesiones traumáticas frecuentes. El tratamiento generalmente es quirúrgico. La cirugía puede ser abierta o percutánea. El objetivo de este estudio es evaluar los resultados clínico-funcionales en pacientes con roturas agudas del tendón de Aquiles tratados por técnica mínimamente invasiva de Dresden. Materiales y Métodos: Estudio prospectivo comparativo de 15 casos con roturas agudas del tendón de Aquiles. Se analizaron características del intraoperatorio, la hospitalización, los resultados funcionales y la evaluación de acuerdo con el puntaje de la AOFAS. El seguimiento promedio fue de 18 meses. Resultados: Se mencionan los resultados sobre la base del tiempo quirúrgico, la estadía hospitalaria, el tiempo hasta la cirugía, la carga del peso y el protocolo posoperatorio. El puntaje de la AOFAS a los 5 meses fue 94,66. El retorno a la actividad laboral fue, en promedio, a los 3.53 meses y el retorno a la actividad deportiva, a los 6.53 meses. Conclusiones: La técnica percutánea para la reparación de roturas agudas del tendón de Aquiles es una buena opción, los pacientes tienen una buena evolución y el índice de complicaciones es bajo. Nivel de Evidencia: IV

Introduction: The Achilles tendon ruptures are common traumatic injuries. Treatment is usually surgical. Surgery may be open or percutaneous. The aim of this study is to evaluate the clinical and functional outcomes in patients with acute Achilles ruptures treated by minimally invasive Dresden technique. Methods: Prospective study of 15 patients with acute Achilles tendon ruptures. Intraoperative characteristics, hospitalization, functional outcomes and evaluation according to AOFAS score were evaluated. The average follow-up was 18 months. Results: Results are listed based on the surgical time, hospital stay, time to surgery, weight load and postoperative protocol. The AOFAS score at five months was 94.66 points. Patients returned to work at 3.53 months on average and to their sport activities at 6.53 months Conclusions: The percutaneous technique for the repair of acute Achilles tendon rupture is a good choice. Patients have a good outcome and the rate of complications is low. Level of Evidence: IV

Aliança terapêutica: estabelecimento, manutenção e rupturas da relação / Therapeutic alliance: establishment, maintenance and disruption of relationship / Alianza terapéutica: establecimiento, mantenimiento y rupturas de la relación

A Aliança Terapêutica (AT) tem sido apontada como importante sinalizador de resultados em psicoterapia. Este artigo teórico apresenta dois temas de pesquisa relacionados à AT. São eles: características pessoais do paciente e do terapeuta associadas à manutenção da AT na terapia, segundo a obra de Corbella e Botella, e fatores associados ao abandono precoce do tratamento, servindo para identificar, evitar e restaurar a AT, através da contribuição de Safran e Muran. A compreensão do desenvolvimento da formação da AT, bem como os fatores que podem influenciá-la de forma positiva, permite que o terapeuta fortaleça o vínculo e estruture um trabalho voltado para a necessidade do paciente.

Therapeutic Alliance (TA) has been identified as an important indicator of results in psychotherapy. This theoretical article presents two important research's topics related to TA: patient's and therapist's personal characteristics, which are associated to establishment and maintenance of TA in therapy, according to Corbella's and Botella's studies, and factors associated with early abandonment of treatment, aiding to identify, prevent and restore AT through contributions of Safran and Muran. Understanding development of AT, as well as the factors that can influence in a positive way, it allows to strengthen therapeutic relationship and to structure a treatment directed to patient's needs.

La alianza terapéutica (AT) se ha identificada como un importante indicador de resultados en la psicoterapia. Este artículo teórico presenta dos importantes temas de investigación relacionados con la AT. Ellos son: características personales del paciente y del terapeuta asociados con el mantenimiento de la AT en la terapia, de acuerdo con el trabajo de Corbella y Botella, y los factores asociados con el abandono terapéutico temprano, que sirve para identificar, prevenir y restaurar la AT a través de la contribución de Safran y Muran. La comprensión del desarrollo de la formación de la AT, así como los factores que pueden influir de manera positiva, permite al terapeuta fortalecer el vínculo y estructurar el trabajo hacia la necesidad del paciente.

Rupturas parciales del espesor del manguito de los rotadores, diagnóstico y tratamiento artroscópico / Partial-thickness rotator cuff tear: diagnosis and arthroscopic treatment / Ruptures partielles de la coiffe des rotateurs, diagnostic et traitement sous arthroscopie

INTRODUCCIÓN: las rupturas parciales del espesor del manguito rotador (tendones del supraespinoso, infraespinoso) se consideran dos veces más frecuente que las rupturas completas del espesor. Los estudios utilizan la artroscopia como método de elección para su diagnóstico y la convierten en la regla de oro. Numerosos cirujanos consideran conservar intactas la parte sana de las fibras del tendón y reparar el área de ruptura; principio posible de cumplir con las técnicas de reparación artroscópicas. OBJETIVO: evaluar los resultados de la aplicación de la técnica artroscópica para el diagnóstico y la reparación de las rupturas parciales del espesor del manguito de los rotadores, conservando la parte sana del tendón. MÉTODOS: se repararon rupturas parciales del manguito rotador con técnica artroscópica de sutura y anclaje sin completar la ruptura del tendón del supraespinoso e infraespinoso desde enero 2008 hasta mayo de 2009. El estudio incluyó 47 hombros, 34 rupturas parciales de la superficie articular, 7 rupturas parciales de la superficie bursal y 6 rupturas parciales intratendinosas. Se realizó un seguimiento promedio de 14,5 meses (rango de 12 a 17 meses), la distribución según el sexo 34 masculinos (72,3 %) y 13 femeninos (27,7 %) y un promedio de edad de 47,5 años. El miembro dominante estuvo afectado en 38 pacientes (80,9 %). RESULTADOS: se obtuvo resultados excelentes y buenos en 91,5 % de los pacientes y 95,8 % resultados excelentes, buenos y regulares evaluados según la escala de Constant-Murley. CONCLUSIONES: la reparación artroscópica utilizando técnica de sutura y anclaje sin completar la ruptura ofrece ventajas. Se conserva la anatomía, preservando la parte sana del tendón y evitando la progresión a defectos completos del espesor.

INTRODUCTION: partial-thickness rotator cuff tears (supraspinatus tendon, infraspinatus) are considered twice as frequent as full thickness tears. Studies using arthroscopy as a method of choice for diagnosis and they turn it in the golden rule. Many surgeons consider fully maintain the healthy part of the tendon fibers and repair the rupture area; which is possible to comply with arthroscopic repair techniques. OBJECTIVE: evaluate the results of the application of arthroscopic technique for the diagnosis and repair of partial-thickness rotator cuff ruptures, preserving the healthy part of the tendon. METHODS: partial rotator cuff tears were repaired with arthroscopic suture anchor technique without completing thesupraspinatus and infraspinatus tendon rupture from January 2008 to May 2009. The study included 47shoulders, 34 partial tears of the joint surface, seven partial teras of bursal surface and 6 intratendinous partial tears. An average follow-up of 14.5 months (range 12-17 months) was conducted. Distribution by sex 34 male (72.3 %) and 13 female (27.7 %) and an average age of 47.5 years was performed. The dominant limb was affected in 38 patients (80.9 %). RESULTS: excellent results were obtained in 95.8% of patients and good results in 91.5 %. Results were assessed as excellent, good, regular according to the Constant-Murley scale results. CONCLUSIONS: arthroscopic repair using suture anchor technique without completing rupture offers advantages. Anatomy is conserved, while preserving the healthy part of the tendon and preventing progression to full thickness defects.

INTRODUCTION: les ruptures partielles de la coiffe de rotateurs (tendons du sus-épineux, du sous-épineux) sont considérées deux fois plus fréquentes que les ruptures complètes. Dans les études, l'arthroscopie est utilisée comme méthode de choix pour le diagnostic des ruptures de la coiffe des rotateurs, et dévient alors un gold standard. Plusieurs chirurgiens tendent à laisser intacte la partie saine des fibres tendineuses et à réparer seulement la zone de la rupture, ce qui est tout à fait possible grâce aux techniques de réparation sous arthroscopie. OBJECTIF: le but de cette étude est d'évaluer les résultats de la mise en application d'une technique de diagnostic et de réparation sous arthroscopie dans le traitement des ruptures partielles de la coiffe des rotateurs. MÉTHODES: depuis janvier 2008 jusqu'à mai 2009, on a éprouvé une technique de suture et d'ancrage sous arthroscopie pour la réparation des ruptures partielles de la coiffe des rotateurs. Cette étude a compris 47 épaules (34 ruptures partielles des capsules articulaires, 7 déchirures partielles de la bourse glénoïdale, et 6 ruptures partielles des tendons). On a réalisé un suivi de 14.5 mois en moyenne (12 à 17 mois), avec une distribution par sexes de 34 hommes (72.3 %) et 13 femmes (27.7 %), et une moyenne de 47.5 ans. Le membre supérieur dominant a été affecté chez 38 patients (80.9 %). RÉSULTATS: on a obtenu des résultats excellents et bons chez 91.5% des patients, et les résultats ont été évalués d'excellents, de bons et de moyens chez 95.8% des patients selon l'échelle de Constant-Murley. CONCLUSIONS: cette technique de suture et d'ancrage sous arthroscopie, sans compléter la rupture, montre des bénéfices; on protège l'anatomie en préservant la partie saine du tendon et en évitant l'évolution complète des anomalies au niveau de la coiffe.

Hernia diafragmática postraumática: caso clínico / Traumatic diaphragmatic hernia: case report

Introducción: las hernias diafragmáticas traumáticas se producen después de un traumatismo cerrado o penetrante. El caso que se reporta en el presente trabajo constituye un diagnóstico incidental e inusual en la clínica para especialistas y personal en formación. Caso clínico: se presenta una mujer con historia de trauma toraco-abdominal por accidente de tránsito hace 30 años, con imagen radiopaca en la radiografía de tórax en la base pulmonar derecha en ocasión de afección respiratoria. La persistencia de la imagen después de tratamiento y remisión del cuadro, hizo posible el diagnóstico incidental de hernia diafragmática por tomografía axial computarizada. Discusión: un alto índice de sospecha es esencial durante la evaluación inicial del paciente con trauma toraco-abdominal contuso o penetrante. Conclusiones: las hernias diafragmáticas postraumáticas representan un desafío clínico y quirúrgico para su diagnóstico.

Introduction. Traumatic diaphragmatic hernias occur after blunt or penetrating trauma. The case reported in this article is an incidental and unusual diagnosis in clinical practice. Case. We report a woman with a history of thoraco-abdominal trauma from a road accident that occurred 30 years ago. In the chest X-ray we found a radioopacity in the right lung base resulting from a respiratory infection. The image persisted in spite of effective treatment for the underlying respiratory condition, which made us suspect a diaphragmatic hernia corroborated by computed tomography. Discussion. A high level of suspicion is essential for the initial evaluation of patients with blunt or penetrating thoraco-abdominal trauma. Conclusions. Traumatic diaphragmatic hernias constitute a clinical challenge both for diagnosis and surgical treatment.

Rupturas na aliança terapêutica e expressão verbal de necessidades do cliente: um estudo de caso / Psychotherapeutic alliance ruptures and verbal expression of client's needs: a case study

Apresentamos um estudo de caso cujo objectivo foi explorar a associação entre as rupturas na aliança terapêutica e a expressão verbal de necessidades do cliente em psicoterapia. Foi analisado um caso de insucesso de um cliente diagnosticado com Transtorno de Pânico com Agorafobia, através do Rupture Resolution Rating System (3R's) e do Sistema de Observação de Responsividade Terapêutica Os dados resultantes da aplicação dos dois sistemas de observação foram analisados com o software de análise de séries temporais SMA. Os resultados indicam que um aumento da Expressão Verbal de Necessidades numa sessão está associada a uma diminuição dos marcadores de ruptura após três e quatro sessões e um aumento dos marcadores de rupturas numa sessão está associado a um aumento da EVN após quatro sessões. Esta associação foi mais evidente entre as rupturas de confronto, particularmente do marco de insatisfação com as actividades da terapia, e a expressão de necessidades directamente relacionadas com a terapia.

We present a case study whose main goal was to explore the relationship between therapeutic alliance's ruptures and the client's verbal expression of needs in psychotherapy. We intensively analyzed an unsuccessful case of a client with Panic Disorder with Agoraphobia. The sessions were analyzed using the Ruptures Resolution Rating System (3R's) and the Sistema de Observação de Responsividade Terapêutica . The results indicate that an increase in the Verbal Expression of Needs (EVN) is associated with a decrease of the ruptures three and four sessions later and that an increase in ruptures is associated with an increase of EVN four sessions later. There was a more clear association between the confrontation ruptures, particularly the expression of dissatisfaction about therapeutic activities, and a specific type of EVN:the client's expression of direct requests related to therapy.

Reparación quirúrgica en roturas agudas del tendón de Aquiles: técnica de doble lazada percutánea (DLP) / Surgical repair of acute ruptures of achilles tendon: double bow percutaneous technique

The surgical treatment of acute ruptures of Achilles Tendon presents in its main advantages the lesser percentage of rerupture in relation to the conservative management. On the other hand the surgical treatment has a high percentage of complications such as superficial and deep infections, fistulas, damage of sural nerve and adhesions scars. The incidence of these complications has decreased with the development of percutaneous suture techniques, which are done with instrumental specially designed instruments, available as very expensive commercial kits. We present the description of a surgical technique of percutaneous suture in acute ruptures of Achilles tendon that uses instruments developed from disused fixation elements available in any public traumatologic service. We present a preliminary report with the results of the first 8 patients operated with this technique.

El manejo quirúrgico de las roturas agudas del tendón de Aquiles presenta entre sus principales ventajas el menor porcentaje de reroturas en relación al manejo ortopédico. Como contra partida, al tratamiento quirúrgico se le atribuye un alto porcentaje de complicaciones derivadas de la herida operatoria tales como infecciones superficiales y profundas, fístulas, lesiones del nervio sural y cicatrices adherentes. La incidencia de estas complicaciones ha disminuido con el desarrollo de técnicas de sutura percutánea, habitualmente realizadas con instrumental diseñado para tal fin, disponibles en kits comerciales de alto costo. Se presenta la adaptación de una técnica quirúrgica de sutura percutánea en roturas agudas del tendón de Aquiles que utiliza instrumental desarrollado a partir de elementos de osteosíntesis en desuso y trócares de anestesia peridural, disponibles en cualquier servicio público de traumatología. Se presenta un informe preliminar con los resultados de los primeros 8 pacientes operados con esta técnica.

Investigation of Artery Rupture Related to Electrical Burns

PURPOSE: To investigate the arterial rupture, we evaluated the 15 victims of high tension injury. METHOD: The review included clinical course of injured limbs (entrance vs exit), site of spontaneous ruptures (subeschar: G1 vs zone of ischemia: G2), causes (spontaneous vs iatrogenic: G3, inflammatory vs associated thrombi), time and consequences of rupture (site of ligature, vascular manipulation). RESULT: 1) There were 18 spontaneous (G1, G2) and 4 iatrogenic ruptures (G3). 2) The G1 were 8 in 5 patients on the 19.6 +/- 8.1 (6-29)th post burn day: princeps pollicis/dorsalis indicis, dorsalis pollicis/superficial radial, radial, ulnar/radial and posterior tibial artery. The G2 were 10 in 8 patients on the 18.4 +/- 7.2 (9-31)th post burn day: brachial, ulnar, radial, ulnar/radial and branch/trunk of popliteal artery. 3) The G3 were superficial femoral/superficial femoral (at clamping site/anastomosis), subclavian (at clamping site) and princeps pollicis (at ligature) artery by inflammation 2-8 days after surgery. 4) The initial wound of limbs or fasciotomy cannot predict the possible ruptures. 5) The entrance had more ruptures than exit. 6) Five patients had multiple ruptures 1-13 days after first episode (3 at different, 2 at the same limb). 7) There was no difference of rupture time between G1 and G2. The G2 occurred at 2-7 cm apart from burn eschar. 8) Nine among 18 spontaneous ruptures were caused by inflammation. The rest 9 thrombotic ruptures occurred at the arterial wall over (2), at the margin (6) and 2 cm near (1) the thrombi. There was no time difference between inflammatory and thrombotic rupture [19.2 +/- 7.2 (9-31) vs 19.0 +/- 8.0 (6-29) days]. 9) There was no rupture after proximal 2-4 cm ligature at superficial arteries. The thrombi were formed finally in superficial femoral artery at 9 cm proximal to the rupture site. CONCLUSION: We recommend that timely decision to amputate must be made to reduce spontaneous ruptures. Also careful attention should be paid to select the safe distance, at least 10 cm in deep arterial injures, in vascular procedures.

A Clinical Study of 15 Cases: Muscle Ruptures / 대한정형외과학회잡지

Rupture of muscle, either complete or incomplete, is a fairly frequent occurence. It may be caused by direct or indirect violence, and occurs either in normal or diseased muscle. Undoubtedly if any of the aching and painful muscles resulting from trauma is examined, a considerable number of partial ruptures would be found which is often overlooked or wrongly diagnosed as a strain, hematoma, myositis and neuralgia etc. We had the opportunity to examine the 15 patients with ruptured muscles. Our survey is presented in this paper.

Rupture of The Adductor Longus Muscle of The Thigh: 5 Cases Report / 대한정형외과학회잡지

Rupture of the adductor longus muscle of the thigh is a rare injury. It is produced by several causes, but indirect force is much more frequent than other causes. Wide abduction of the legs may produce rupture of the adductor longus muscle. Palpable mass appears at the upper third of the thigh and become more prominent during contraction of the adductor muscles. We have had the opportunity to examine 5 patients with ruptured adductor longus muscles of the thigh and report them in this paper.