Fonction et champ de la lettre dans la clinique du trauma et du transfert / A função e o escopo da letra na clínica de trauma e transferência / Function and field of the letter in the clinic of trauma and transfer / La función y el alcance de la letra en la clínica del trauma y la transferencia

Le constat de la traversée analytique de la lettre, dont Lacan s'est saisi pour mettre en lumière les modalités de manifestation de l'inconscient, incite à nous pencher sur ses apports, plus spécifiquement dans le champ d'une clinique à l'épreuve du trauma et du transfert. C'est à partir de deux experiences cliniques, celle avec Fatah, enfant mutique, et M. U., souffrant d'une névrose dite "traumatique", que nous aborderons les modalités d'évolution d'une lettre qui, via le transfert, tente de retrouver son inscription symbolique. Nous verrons que de ces rencontres advient la possibilité d'une réarticulation de la lettre, cette dernière fonctionnant comme mise en bouche d'une parole à advenir, une trace qui engage la dimension du réel et du corps organique, dans leur dialogue impossible et à jamais inachevé avec le langage.

El reconocimiento del recorrido analítico de la carta que Lacan utilizó para poner de relieve las formas en que se manifiesta el inconsciente nos lleva a examinar sus aportes, más específicamente en el campo de una clínica que ponen a prueba la transferencia y el trauma. A partir de dos experiencias clínicas, la de Fatah, un niño mudo, y la de M.U., que padece de una neurosis llamada "traumática", se examinarán las formas de evolución de una carta que, mediante la transferencia, intenta recuperar su inscripción simbólica. Se observa que estos encuentros dan lugar a la posibilidad de una rearticulación de la carta, que funciona como portavoz de una palabra aún por venir, un trazo que compromete la dimensión de lo real y del cuerpo orgánico, en su diálogo imposible y para siempre inacabado con el lenguaje.

Resumos O reconhecimento, por Lacan, da travessia analítica da carta, que ele utilizou para destacar os modos pelos quais o inconsciente se manifesta, nos leva a examinar suas contribuições, mais especificamente, no campo de uma clínica posta à prova pela transferência e pelo trauma. Com base em duas experiências clínicas, a de Fatah, uma criança muda, e a de M.U., que sofre de uma neurose dita "traumática", examinaremos as formas de evolução de uma carta que, por meio da transferência, tenta recuperar sua inscrição simbólica. Veremos que esses encontros dão origem à possibilidade de uma rearticulação da carta, que funciona como porta-voz de uma palavra ainda por vir, um traço que envolve a dimensão do Real e do corpo orgânico, em seu diálogo impossível e para sempre inacabado com a linguagem.

The analytical traversal of the letter, used by Lacan to highlight the ways in which the unconscious manifests itself, leads us to consider its contributions, more specifically, in clinical contexts put to the test by transference and trauma. Based on two clinical experiences, that of Fatah, a mute child, and that of M. U., who suffers from a so-called "traumatic" neurosis, we will look at the ways in which a letter evolves as it attempts to rediscover its symbolic inscription via transference. We will see that these encounters allow the re-articulation of the letter, the latter functioning as a mouthpiece for a word yet to come, a trace that engages the dimension of the Real and the organic body in its impossible and forever unfinished dialogue with language.

Memória, desmentida e traumatismo social sob a ótica da Psicanálise das Configurações Vinculares / Memory, denial and social traumatism from a Psychoanalysis of Binding Configurations perspective / Memoria, desmentida y trauma social desde la perspectiva del Psicoanálisis de las Configuraciones Vinculares / Mémoire, négationnisme et traumatisme social dans la perspective de la Psychanalyse des Configurations de Liaison

O discurso negacionista e a minimização dos efeitos nefastos da ditadura civil-militar por figuras do alto escalão do governo são exemplos emblemáticos da desmentida de histórias de sofrimento social. Este estudo teórico aborda os processos psicológicos de apagamento de memórias sociais traumáticas e seus efeitos na transmissão psíquica, da perspectiva da Psicanálise das Configurações Vinculares, à luz de Puget e Berenstein. Mobilizando os conceitos de memória social, desmentida, trauma e traumatismo social, argumentamos que a denegação de fatos traumáticos gera uma dupla violência: por um lado, produz lacunas na história e um não-trabalho vincular que favorece transmissões psíquicas transgeracionais e, por outro, atenta contra o pertencimento social e a constituição narcísica dos sujeitos. À vista disso, concluímos pela necessidade de criar um dispositivo de escuta dos traumatismos sociais na contramão da desmentida, garantindo o direito assegurado pela Declaração Universal dos Direitos Humanos do acesso do povo à própria história

Denialist discourses and the downplayed harmful effects of the civil-military dictatorship by high-ranking Brazilian government officials are emblematic examples of negationist attitudes towards narratives of social suffering. This theoretical study addresses the psychological processes of erasing traumatic social memories and their effects on psychic transmission based on psychoanalysis of linking configurations according to Puget and Berenstein. By mobilizing the concepts of social memory, denial, trauma and social trauma, we argue that negating traumatic facts generates a double violence: on the one hand, it produces gaps in history and a non-work linking that favors transgenerational psychic transmissions; on the other, it attacks the individuals' social belonging and narcissistic constitution. We thus conclude by pointing out the need to create a listening device for social trauma that opposes denial, ensuring the right guaranteed by the Universal Declaration of Human Rights of people's access to their own history

El discurso negacionista y la minimización de los efectos nocivos de la dictadura civil-militar por parte de altas figuras gubernamentales son ejemplos emblemáticos de la desmentida de las historias de sufrimiento social. Este estudio teórico aborda los procesos psicológicos de borrado de las memorias sociales traumáticas y sus efectos en la transmisión psíquica, desde la perspectiva del Psicoanálisis de las Configuraciones Vinculares, a la luz de Puget y Berenstein. Movilizando los conceptos de memoria social, desmentida, trauma y trauma social, argumentamos que la negación de los hechos traumáticos genera una doble violencia: por un lado, produce vacíos en la historia y un no-trabajo vinculante que favorece las transmisiones psíquicas transgeneracionales y, por otro lado, ataca la pertenencia social y la constitución narcisista de los sujetos. En vista de ello, concluimos con la necesidad de crear un dispositivo de escucha de los traumas sociales en la dirección opuesta a la negación, garantizando el derecho garantizado por la Declaración Universal de los Derechos Humanos del acceso de los pueblos a su propia historia

Le discours négationniste et la minimisation des effets néfastes de la dictature civilo-militaire par des personnalités gouvernementales de haut rang sont des exemples emblématiques du déni des histoires de souffrance sociale. Cette étude théorique s'intéresse aux processus psychologiques d'effacement des souvenirs sociaux traumatisants et leurs effets sur la transmission psychique basée sur la perspective de la psychanalyse des liens proposée par Puget et Berenstein. En mobilisant les concepts de mémoire sociale, négationnisme, traumatisme et traumatisme social, nous soutenons que le déni des faits traumatiques engendre une double violence: d'une part, il produit des lacunes dans l'histoire et un non-travail contraignant qui favorise les transmissions psychiques transgénérationnelles ; d'autre part, il attaque l'appartenance sociale et la constitution narcissique des sujets. Nous concluons sur la nécessité de créer un dispositif d'écoute du traumatisme social opposé au négationnisme, en assurant le droit garanti par la Déclaration Universelle des Droits de l'Homme d'accès des peuples à leur propre histoire

Traumatismo e violência: a criança em meio à guerra urbana brasileira / Trauma y violencia: el niño en medio de la guerra urbana brasileña / Traumatism and violence: the child in the middle of the Brazilian urban combat / Traumatisme et violence: l'enfant dans milieu de la guerre urbaine brésilienne

O cotidiano de muitas crianças no Brasil tem sido atravessado por situações violentas extremas, evidenciando um estado de abandono social. Sendo assim, o presente artigo visa compreender, a partir da história de Sandro Barbosa do Nascimento e da psicanálise, a natureza do traumatismo e sua relação ao trauma na experiência da criança que vivencia cenas violentas em seu cotidiano. Compreendemos que o traumatismo se constitui na dimensão singular de cada criança, a partir do modo como lidam com o encontro com o trauma que as cenas violentas comportam, bem como com o gozo que irrompe da proximidade do Outro totalitário. Estes modos podem se constituir do recurso simbólico de cada sujeito, mas também da experiência com o não-sentido

La vida cotidiana de muchos niños en Brasil ha estado atravesada por situaciones de extrema violencia, evidenciando un estado de abandono social. Así, este artículo pretende comprender, a partir del relato de Sandro Barbosa do Nascimento y del psicoanálisis, la naturaleza del traumatismo y su relación con el trauma en la experiencia de los niños que viven escenas violentas en su vida cotidiana. Entendemos que el traumatismo se constituye en la dimensión singular de cada niño, a partir de la forma en que se enfrenta al encuentro con el trauma que suponen las escenas violentas, así como con el goce que brota de la proximidad del Otro totalitario. Estos modos pueden constituirse a partir del recurso simbólico de cada sujeto, pero también de la experiencia con el sinsentido

The daily life of many children in Brazil has been crossed by extreme violent situations, evidencing a state of social abandonment. Thus, this article aims to understand, from the story of Sandro Barbosa do Nascimento and of psychoanalysis, the nature of traumatism and its relation to trauma in the experience of children who experience violent scenes in their daily lives. We understand that traumatism is constituted in the singular dimension of each child, from the way they deal with the encounter with the trauma that can be found at violent scenes, as well as with the jouissance that erupts from the proximity of the totalitarian Other. These ways may be constituted from the symbolic resource of each subject, but also from the experience with non-sense

La vie quotidienne de nombreux enfants au Brésil est traversée par des situations de violence extrême, et témoigne d'un état d'abandon social. Cet article vise à comprendre, à partir de l'histoire de Sandro Barbosa do Nascimento et de la psychanalyse, la nature du traumatisme et sa relation au trauma dans l'expérience des enfants qui vivent des scènes de violence dans leur vie quotidienne. Nous comprenons que le traumatisme se constitue dans la dimension singulière de chaque enfant, à partir de la manière dont il gère la rencontre avec le trauma qu'impliquent les scènes de violence, ainsi qu'avec la jouissance qui jaillit de la proximité avec l'Autre totalitaire. Ces voies peuvent se constituer à partir de la ressource symbolique de chaque sujet, mais aussi à partir de l'expérience du non-sens

Conducta selectiva en trauma penetrante de cuello / Selective management in penetrating neck trauma

Objetivo: evaluar la incidencia de hallazgosquirúrgicos positivos en pacientes con diagnóstico de traumapenetrante de cuello de dos instituciones hospitalariascapitalinas, sometidos a exploración quirúrgica inmediatao conducta selectiva. Métodos: en un estudio descriptivo,cuantitativo y transversal, se evaluaron 22 heridos condiagnóstico de lesiones penetrantes de cuello entre años 2017y 2021. Se dividieron en dos grupos de acuerdo al tipo deconducta aplicada. Las distintas frecuencias fueron expresadas ennúmero y porcentaje. Resultados: Grupo A, ocho heridos (36,4%), siete ingresaron con signos duros sometidos a exploraciónquirúrgica inmediata, el 87,5 % presentó hallazgos positivos ala cervicotomía; dos fueron incluidos en un esquema de cirugíade control de daños. Grupo B, catorce lesionados con signosblandos admitidos para conducta selectiva mediante observaciónfrecuente y realización de diversos estudios paraclínicos (63,6%),tres requirieron intervención operatoria por la presencia deenfisema subcutáneo expansivo después de las primeras 48 horas;se identificó una lesión esofágica, que se reparó con cierreprimario y rotación de colgajo muscular. Conclusión: En elpresente estudio, la incorporación de la conducta selectiva enel manejo multidisciplinario del trauma penetrante de cuellopermitió incrementar el número de exploraciones positivas yreducir las negativas. Nuevas estrategias como la cirugía decontrol de daños y la zona cero han sido incluidas en algunasheridas vasculares o lesiones extensas(AU)

Objective: To evaluate the incidence of positiveexplorations in patients with penetrating neck trauma oftwo capitals hospitals underwent to immediate surgicalexploration or selective management. Method: Studydescriptive, quantitative and transversal of twenty-two patientswith penetrating neck trauma since years 2017 to 2021. Distribute in two groups in the basis of the management.Different frequency express in frequency and percentages.Results: Group A, eight injured, 36.4 %. Seven with hardsigns, underwent immediate surgical exploration of the neck.the 87.5 % had positive explorations. Two were included in ascheme of surgery damaged control. Evidenced injuries extentsand for high velocity projectile. Group B, fourteen wounded,63.6 %. three required surgical intervention for the presence ofpersistent emphysema. One occult esophagical injury, repairedwith suture and muscular rotation. Conclusion: In the present study the selective management of penetrating neck traumapermit increase the number of positive explorations and reducethe negatives. this alternative was viable and secures(AU)

Prevalence and characteristics of accidental perineal tears during childbirth in a communal medical center in Guinea-Conakry: a cross-sectional study

Background: Prevalence studies are still rare in sub-Saharan Africa on perineal tears. We conducted this cross-sectional study in a communal hospital in Guinea-Conakry, with the objective of this study was to determining the prevalence and characteristics of post-obstetric perineal lesions.Methods: All deliveries between March 1st and August 31st, 2014 were reviewed. We included in the analysis all the single deliveries with perineal tears. The Anglo-Saxon classification of perineal tears was used.Results: The prevalence of perineal tears was 5.7% with 5.4% benign lesions and 0.3% severe lesions. We did not register 4th degree lesions. The average age of parturient was 22 years. The majority (96.6%) of parturient had a history of genital mutilation and perineal scarring (60.3%).Conclusions: This prevalence appear low compared to those reported in other studies in Africa and point to the need for more sophisticated studies to have a better estimate of the prevalence of perineal tears in Guinea-Conakry.

Amputación traumática de miembros inferiores / Traumatic Amputation of Lower Limbs

RESUMEN La amputación traumática completa se define como la separación total de un segmento del miembro del resto del cuerpo. El segmento cercenado algunas veces se puede reconectar, siempre que ambas partes de la extremidad hayan sido correctamente tratadas y se cumplan determinadas condiciones. Se presentan dos casos de amputación traumática de ambos miembros inferiores: el primero, una paciente femenina de 49 años de edad, debido a un accidente de trabajo y, el segundo, un paciente masculino de 39 años, víctima de un accidente en las vías férreas. Se expone la sintomatología presentada por ambos pacientes, su tratamiento quirúrgico y evolución(AU)

ABSTRACT Complete traumatic amputation is defined as the total separation of a limb segment from the rest of the body. The severed segment can sometimes be reconnected, provided that both parts of the limb have been correctly treated and certain conditions are met. Two cases of traumatic amputation of both lower limbs are presented: the first, a female patient of 49 years of age, due to an accident at work; and the second, a male patient of 39 years, victim of a railroad accident. The symptoms presented by both patients, their surgical treatment and evolution are exposed(AU)

Analysis of recall bias of information on soccer injuries in adolescents

Abstract Aims: to analyze the recall bias of injury characteristics, anthropometric variables, and training variables in a morbidity survey in adolescent soccer players for a period of four months. Method: cohort study with 198 adolescent male soccer players, divided into two parts: a prospective study over four months, followed by a retrospective study. A morbidity survey containing personal and training data, in addition to information on injuries and their characteristics (anatomical site, mechanism, nature, moment, severity, return to activities and recurrence) was administered weekly for four months, after which the questionnaire was applied again questioning the same information retrospectively for the four-month prospective study period. The data were collected through interviews addressing the occurrence of injuries and respective characteristics. Results: there were weak correlations and concordances for the recall of the occurrence of injury and all related variables. However, regarding the information relating to personal and training data, moderate correlations were observed for the variables height, time of training, weekly hours, absences, and position, as well as excellent correlations for body mass. Conclusions: we observed recall bias in all information about the characteristics of the injuries reported by adolescent soccer players.

Patología traumática ocular / Eye traumatic pathology

Resumen:La intoxicación se considera como una manifestación patológica definida por los signos y síntomas que secundarios a la acción de una o varias dosis de un agente tóxico y su evolución puede llevar al sujeto a un estado irreversible e incluso a la muerte. Cada año mueren alrededor de un millón de personas a consecuencia de diversos envenenamientos. La intoxicación alcohólica es causada por alcoholes, compuestos orgánicos que se derivan de los hidrocarburos y están formados por grupos hidroxilos. El etanol es el alcohol que con más frecuencia produce intoxicaciones ya que es el más común y el que más al alcance de la población se encuentra, este produce múltiples alteraciones a nivel del sistema nervioso y de otros sistemas del organismo.

Abstract:Often the medical examiner has to assess possible eye injuries and sequelae of a patient who has been the victim of an assault or some kind of accident (traffic, work, sport), which may have civil responsibility by the aggressor. The ocular pathology occurs for most forensics, not specialists in it, a major problem in establishing the etiology of injuries and their subsequent monitoring, given their complexity and specificity. Therefore in this article we try to make a review of the generalities of the anatomy, physiology and the most important variants of eye injuries that can lead to a trauma so that the forensic can make the assessment of injury with ophthalmological condition and have the information necessary so that you can interpret the ophthalmic report to provide the specialist in ophthalmology,dist inguish the offending box and interpreta previous state, if applicable, the final consequences.

Evisceración ocular: diez años de estudio / Eye evisceration: ten years of research

Objetivos: determinar la frecuencia de evisceración según edad, sexo, ojo afectado, criterio quirúrgico y causa más frecuente. Métodos: se realizó un estudio descriptivo, longitudinal y retrospectivo a través de la revisión de las historias clínicas de 89 pacientes a quienes se les realizó la evisceración en el período de enero 2002 a diciembre 2011 en el Hospital Militar Central Dr. Luis Díaz Soto. Se aplicaron métodos de estadística descriptiva para el procesamiento de los datos. Resultados: predominó el grupo de edad de 31-40 años con frecuencia absoluta (20), que constituyó el 22,4 por ciento de la muestra; el sexo masculino representó el 67,4 por ciento; predominó el ojo izquierdo en los casos eviscerados con 53 por ciento y la forma electiva de tratamiento con 78,7 por ciento. La causa más frecuente fue la ptisis bulbi con 32,7 por ciento. Conclusiones: son eviscerados con mayor frecuencia los ojos izquierdos de adultos jóvenes del sexo masculino, con criterio electivo de tratamiento quirúrgico. La ptisis bulbi es la causa más frecuente de evisceración(AU)

Objectives: to determine the evisceration frequency according to age, sex, affected eye, surgical approach and more frequent cause. Methods: descriptive, longitudinal and retrospective study was done through the revision from the clinical histories of 89 patients to all of them were applied the evisceration in the period of January 2002 to December 2011 in the Central Military Hospital Dr. Luis Díaz Soto. Methods of descriptive statistic were applied for the prosecution of the data. Results: there was bigger incidence in the 31-40 year-old group representing 22,4 percent of the sample, the male sex represented 67,4 percent, the left eye prevailed with 53 percent in the cases evisceration and the elective way of treatment with 78,7 percent. The most frequent cause was the ptisis bulbi occupying 32,7 percent. Conclusions: evisceration was done frequently in left eyes of young men, with elective approach of surgical treatment. The ptisis bulbi was the most frequent cause in evisceration(AU)

O trauma em tempos de vítimas / Trauma victims times

Investiga-se o trauma a partir da figura da vítima, uma das marcas da cultura atual. O objetivo é examinar a mudança no tratamento dispensado aos sujeitos tidos como traumatizados na passagem da modernidade freudiana para a contemporaneidade a partir de narrativas que versam, nos dois momentos, sobre experiências consideradas traumáticas. Conclui-se que há uma sensível diferença entre a noção freudiana de trauma, que remete ao excesso, ao inesperado, e aquela de traumatismo, um evento socialmente legitimado como produtor de vítimas. Ainda, sustenta-se a atualidade da clínica psicanalítica na sua potência para ultrapassar a identidade vitimizada e valorar os destinos sempre singulares do trauma.

Trauma in the time of victims. This paper investigates trauma from the figure of the victim, one of the hallmarks of current culture. The aim is to examine the change of treatments offered to subjects who are considered traumatized in the passage from Freudian modernity to contemporary through narratives that deal, on both occasions, with experiences taken as traumatic. What follows is an appreciable difference between the Freudian notion of trauma, which refers to the excess and the unexpected, as well as the traumatism, an event socially legitimized as a producer of victims. In addition, it sustains the actuality of the psychoanalytic clinic as a power that reveals the overcome of the victimized identity to appraise the always unique destinations of trauma.

Características clinicoepidemiológicas del trauma maxilofacial por violencia física contra la mujer / Clinical and epidemiological characteristics of the maxillofacial trauma due to physical violence against the woman

Se realizó un estudio descriptivo y transversal de 576 mujeres con traumas bucofaciales por violencia física, atendidas en el Servicio de Urgencia de Cirugía Maxilofacial del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde enero de 2007 hasta diciembre de 2010, con vistas a caracterizarles según variables clínicas y epidemiológicas de interés para la investigación. En la serie predominó el grupo de 15-34 años, los celos y la embriaguez como móviles para el maltrato, así como el esposo y el exesposo como principales agresores; asimismo, los incidentes se desarrollaron mayoritariamente en el domicilio y en la vía pública, donde se empleó como mecanismo lesional primario el puñetazo y los golpes con objeto. Entre las lesiones bucofaciales de tejido blando sobresalieron las formas cerradas (hematomas y escoriaciones) y abiertas (laceraciones faciales no complejas); entre los patrones lesionales de tejido duro, las fracturas nasales y dentoalveolares.

A descriptive and cross sectional study of 576 women with orofacial traumas due to physical violence, assisted in the Emergencies Service of Maxillofacial Surgery from "Saturnino Lora Torres" Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba was carried out from January of 2007 to December, 2010, with the aim of characterizing them according to clinical and epidemiological variables of interest for the investigation. The 15-34 years group, the jealousies and the alcohol consumption as causes for the abuse, as well as the husband and the ex-husband as main aggressors prevailed in the series; also, the incidents took place mostly at home and in the street, where the punch and the blows with objects were used as primary mechanism for the injury. Among the orofacial lesions of the soft tissue, the closed forms (hematomas and abrasions) and the open ones (non-complex facial lacerations) were relevant; among the injury patterns of hard tissue, the nasal and dentoalveolar fractures.

Characteristics and associated factors with sports injuries among children and adolescents

BACKGROUND: The participation of children and adolescents in sports is becoming increasingly common, and this increased involvement raises concerns about the occurrence of sports injuries. OBJECTIVES: To characterize the sports injuries and verify the associated factors with injuries in children and adolescents. METHOD: Retrospective, epidemiological study. One thousand three hundred and eleven children and adolescents up to 18 years of age enrolled in a sports initiation school in the city of Presidente Prudente, State of São Paulo, Brazil. A reported condition inquiry in interview form was used to obtain personal data and information on training and sports injuries in the last 12 months. Injury was considered any physical complaint resulting from training and/or competition that limited the participation of the individual for at least one day, regardless of the need for medical care. RESULTS: The injury rate per 1000 hours of exposure was 1.20 among the children and 1.30 among the adolescents. Age, anthropometric data, and training characteristics only differed with regard to the presence or absence of injuries among the adolescents. The most commonly reported characteristics involving injuries in both the children and adolescents were the lower limbs, training, non-contact mechanism, mild injury, asymptomatic return to activities, and absence of recurrence. CONCLUSIONS: The injury rate per 1000 hours of exposure was similar among children and adolescents. Nevertheless, some peculiarities among adolescents were observed with greater values for weight, height, duration of training, and weekly hours of practice. .

Implicación del traumatismo en la fisiopatología del pie diabético / Effect of traumatismo on the physiopathology of the diabetic foot

El pie diabético es el resultado de la interacción de factores sistémicos o predisponentes (neuropatía, microangiopatía y macroangiopatía), sobre los que actúan factores desencadenantes y agravantes. Con el objetivo de evaluar la implicación del traumatismo en la fisiopatología del pie diabético, se realizó una búsqueda bibliográfica en bases de datos nacionales e internacionales, se revisaron los trabajos hasta el 2011; los términos utilizados fueron: definición, concepto, traumatismo y fisiopatología del pie diabético, en idioma español e inglés. Se constató que el traumatismo en términos generales, solo es tratado en esta enfermedad como parte de los factores desencadenantes extrínsecos que se clasifican en mecánicos, térmicos o químicos; lo cual es avalado por cinco definiciones referidas a esta enfermedad. Se concluye que la limitada interpretación de la implicación del traumatismo en la fisiopatología del pie diabético, unida a una pobre interpretación de este factor en los diferentes conceptos conocidos, favorece la elaboración de una nueva definición de esta enfermedad.

The diabetic foot is the result of the interaction of systemic or predisposing factors (Neuropathy, Microangiopathy and Macroangiopathy) upon which unleashing aggravating factors also act. With the objective of evaluating the implications of traumatism in the physiopathology of the diabetic foot, literature review was made in national and international databases to analyze the papers published until 2011. The terms were definition, concept, traumatism and physiopathology of the diabetic foot in Spanish and English. It was verified that traumatism is generally addressed in this disease as part of the extrinsic unleashing factors that are classified into mechanical, thermal or chemical, which is supported on five definitions of this disease, one of them put forward by a domestic author. It was concluded that the restricted interpretation of the implication of traumatism for the physiopathology of the diabetic foot together with poor interpretation of this factor in the various concepts already known makes it possible to prepare a new definition of this disease.

Prevalência das injúrias orofaciais e uso de protetores bucais em uma população de atletas que praticam futebol e jiu-jitsu / Prevalence of orofacial injury and use of mouthguard in soccer and jiu-jitsu athletes

Este estudo epidemiológico teve por objetivo investigar a prevalência de injúria orofacial em dois grupos de atletas. O primeiro grupo foi de atletas integrantes do Fluminense Futebol Clube, em Xerém, e o segundo de atletas praticantes do jiu-jitsu em diferentes academias ou que participaram do Campeonato Brasileiro em 2011, no Rio de Janeiro. Um examinador calibrado, auxiliado por um assistente, preencheu os questionários com todos os atletas, seguido do exame clínico de todos. Grupo I: 260 atletas do Fluminense Futebol Clube com idade média de 14,08 (DP ± 2,71) anos de idade, todos do gênero masculino. Grupo II: 315 atletas de diversas academias de jiu-jitsu com idade média de 26,86 (DP ± 8,99), dentre esses indivíduos, apenas 10 eram do gênero feminino. A prevalência de injúrias orofaciais encontrada para o Grupo I foi de 47% (n=122; IC 95% 40,94% a 52,99%) e no Grupo II de 74,6% (n=235; IC 95% 69,52% a 79,09%). Considerando-se a prevalência de trauma apenas no elemento dentário, a prevalência diminuiu de 147 injúrias para 57 traumas dentais no futebol e de 289 injúrias para 93 traumas dentais no jiu-jitsu. Foi observada uma menor prevalência de injúria orofacial nos goleiros quando comparados aos outros jogadores de futebol. A maior parte das injúrias ocorreu durante o período do treino (n=42; IC 95% 26,59% a 43,22%) e apenas 4 desses atletas usavam protetor bucal. Por outro lado, no jiu-jitsu, a prevalência de injúria variou de acordo com a cor da faixa do uniforme do atleta. Os atletas da faixa preta exibiram mais injúrias (n=83). Atletas que treinavam de 7 a 15 horas por semana, sofreram mais injúria (n=109). A maioria das injúrias ocorreu durante o treino. Somente 28,57% dos atletas (IC 95% 23,86% a 33,79%) usavam protetor bucal. Nos dois esportes, a maioria dos atletas sofreu apenas uma injúria, sendo o tipo mais frequente em tecido mole. O dente mais atingido foi o incisivo central superior. Estes dados ressaltam ...

This epidemiological study aimed to investigate the prevalence of orofacial injury of two groups of athletes. The first group included athletes who were part of the Fluminense Soccer Club in Xerém, and the second group included athletes from different brazilian jiu-jitsu academies or who participated in the Brazilian Championship in 2011, in Rio de Janeiro. One calibrated examiner, with the help of the assistant, completed the forms of all athletes followed by the clinical examination of them. Group I: 260 male athletes from the Fluminense Soccer Club, mean age of 14.08 (SD ± 2.71). Group II: 315 athletes from a variety of brazilian jiu-jitsu academies, mean age of 26.86 (SD ± 8.99), among these individuals, only 10 of them were female. The prevalence of orofacial injuries found for Group I was 47% (n=122; IC 95% 40,94%; 52,99%) and for Group II was 74,6% (n=235; IC 95% 69,52%, 79,09%). When the prevalence of trauma was evaluated individually per tooth, it decreased from 147 injuries to 57 dental traumas in soccer and from 289 injuries to 93 dental traumas in brazilian jiu-jitsu. A lower prevalence of orofacial injuries in goalkeepers was observed when compared to the others soccer players. Most injuries occurred during the training period (n=42; IC 95% 26,59%; 43,22) and only 4 athletes used to wear mouthguard. The prevalence of injury in brazilian jiu-jitsu varied according to their uniform belt colour. Black belt athletes suffered more injuries (n=83). Athletes who trained between 7 to 15 hours per week experienced more injury (n=109). Most injuries occurred during training. Only 28,57% of the athletes (IC 95% 23,86%; 33,79%) used to wear mouthguard. In both sports, most of the athletes have suffered only one injury, and the most frequent type was in soft tissue. The tooth that was injured the most was the maxillary central incisor. These data reveal the importance of encouraging the use of mouthguards ...

Fracturas mandibulares en el hospital universitario "General Calixto García" 2010-2011 / Mandibular fractures in university hospital "General Calixto García" 2010-2011

Introducción: la mandíbula sufre frecuentemente traumas y sus fracturas son unas de las más comunes en la región maxilofacial. Objetivo: describir las frecuencias de las fracturas mandibulares en el Servicio de Cirugía Maxilofacial del Hospital Universitario "General Calixto García". Material y métodos: se realizó un estudio prospectivo, descriptivo. La muestra estuvo constituida por 50 pacientes, seleccionados del total de pacientes con fracturas mandibulares, quienes acudieron al Servicio de Cirugía Maxilofacial del Hospital Universitario "General Calixto García" en el período noviembre 2010-octubre 2011. Los pacientes se sometieron a interrogatorio, examen clínico e imagenológico para su diagnóstico. Se utilizaron las variables edad, sexo, etiología, tipo de tratamiento y complicaciones postoperatorias. Resultados: pacientes con edades comprendidas entre 18 a 27 años (34%) fueron los más afectados; género masculino (80%) y la agresión física constituyó el principal factor etiológico (34%). Se encontró que el tratamiento quirúrgico fue el más empleado (58%) y la maloclusión resultó la complicación postoperatoria más corriente (57,1%). Conclusiones: las fracturas mandibulares se presentaron fundamentalmente en hombres, en edades intermedias y causadas por la agresión física. Se emplearon comúnmente el tratamiento quirúrgico y la maloclusión dentaria fue la complicación postoperatoria más frecuente.

Introduction: the jaw suffers frequently traumatic lesions and its fractures are some of the most common in the maxillofacial region. Objective: it came true this study with the objective of describing the frequent of the mandibles fractures in the Maxillofacial Surgery's service at the University Hospital General Calixto García. Material and methods: it came true a prospective study, descriptive. The sign was constituted for 50 patients, selected candidates of the total of patients with mandibles fractures that resorted to Maxillofacial Surgery's service. University Hospital General Calixto García. Period November 2010 - October 2011. The patients submitted to interrogation, clinical exam and imagenologic for theirs diagnosis. They appraised the variables age, sex, etiology, method of treatment and postoperative complications. Results: the patients with ages understood among 18 to 27 years ( 34 % ) were the more affected; masculine gender ( 80 % ) and physical aggression constituted the principal etiological factor ( 34 % ) .It found that the surgical treatment was the more employee ( 58 % ) and the malocclusion proved to be the postoperative complication plus ordinary ( 57.1 % ). Conclusions: the mandibles fractures show up fundamentally in men, in intermediates ages and caused for physical aggression. It used commonly the surgical treatment and the dental malocclusion was the postoperative complication more frequent.

Genu valgum postraumático: presentación de un caso / Postraumatic Genu valgum: presentation of a case

Se presentó un caso de deformidad valgo de la rodilla izquierda en un adolescente, masculino, de 15 años de edad, como complicación de un traumatismo aparentemente simple, sin lesión ósea evidente en el estudio radiológico inicial. Se exponen los datos clínicos y radiológicos presentes en la historia clínica del paciente, así como el tratamiento quirúrgico que se realizó. Se señaló la posibilidad de ocurrencia de deformidades angulares de la rodilla por daño traumático de las placas de crecimiento mucho tiempo después del trauma inicial, a pesar de lo infrecuente que esto resulta, destacando la importancia que reviste tener siempre presente la posibilidad de este tipo de complicación, aún ante traumatismos de aparente baja intensidad, así como la importancia de realizar el tratamiento quirúrgico, según las características de cada paciente.

We present the case of a 15-years-old, male adolescent with valgum deformity of the left knee as a complication of an apparently simple trauma without evident bone injury at the initial radiological study. The clinical and radiological data gathered in the patient record and also the applied surgical treatment, are exposed. We point out the possibility of the occurrence of the knee angular deformities due to traumatic injury of the epiphyseal growth plate long time after the initial trauma in spite of the infrequent that it can be, emphasizing how important is to take into account the possibility of this kind of complication, even in the case of a traumatism of apparent low intensity, and the importance of carrying out the surgical treatment according to the characteristics of each patient.

Dental trauma clinically mimicking single central incisor syndrome / Traumatismo dentário mimetizando clinicamente a síndrome do incisivo central único

PURPOSE: This paper presents a clinical case in which a patient was missing a median central incisor due to trauma but was referred for orthodontic treatment because of suspicions of solitary median maxillary central incisor (SMMCI) syndrome. CASE DESCRIPTION: A 12-year-old female patient visited the clinic with concerns about the appearance of her teeth. An oral examination revealed the presence of a single central incisor that was located on the midline and was adjacent to the maxillary lateral incisors. The patient reported two episodes of dental avulsion (of teeth 11 and 21) that had occurred approximately four years earlier. Tooth 11 was replanted; however, it was subsequently extracted due to pain. A panoramic radiograph and cephalometric analysis revealed a history of unsuccessful root canal treatment on tooth 21, a straight profile and symmetrical facial features. Tooth 21 was extracted, followed by the traction of the maxillary teeth in the mesial direction and the esthetic transformation of the lateral incisors into central incisors and the canines into lateral incisors. CONCLUSION: Dental trauma followed by tooth loss may mimic solitary median maxillary central incisor syndrome.

OBJETIVO: Apresentar um caso clínico de ausência de um incisivo central perdido por traumatismo e encaminhado ao ortodontista com suspeita de apresentar síndrome do incisivo central único (SMMCI). DESCRIÇÃO DO CASO: Paciente gênero feminino, 12 anos com queixa da aparência de seus dentes. Ao exame intrabucal observou-se a presença de um incisivo central único localizado na linha média sem espaçamentos em relação aos incisivos laterais superiores. A paciente relatou dois episódios de avulsão dos dentes 11 e 21, cerca de quatro anos antes. No entanto, devido a sintomas de dor após reimplante, o dente 11 foi extraído. A radiografia panorâmica e análise cefalométrica revelou a presença de tratamento insatisfatório do canal radicular do dente 21, um perfil reto e padrão de equilíbrio facial. Extração do dente 21 foi realizada, com tração posterior dos dentes superiores na direção mesial, seguido pela transformação estética dos incisivos laterais em incisivos centrais e dos caninos em incisivos laterais. CONCLUSÃO: O traumatismo seguido de perda dentária pode mimetizar um quadro de síndrome do incisivo central único.

Caracterización del traumatismo renal en pacientes del Hospital Militar Central Dr. Carlos J. Finlay / Characterization of the renal trauma in patients admitted in the Dr. Carlos J. Finlay Central Military Hospital

INTRODUCCIÓN: la mayor parte de los traumatismos renales se consideran menores y requieren tratamiento conservador; los demás, necesitan algún tipo de intervención quirúrgica y los criterios diagnósticos que la deciden constituyen frecuentemente un dilema. OBJETIVO: caracterizar el traumatismo renal en sus aspectos diagnósticos y terapéuticos. MÉTODOS: se realizó un estudio retrospectivo descriptivo mediante la revisión de las historias clínicas de los pacientes ingresados con traumatismos renales en el Hospital Militar Central Dr. Carlos J. Finlay durante 4 años (2004-2008), teniendo en cuenta: sexo, edad, agente causal, sintomatología, exámenes complementarios utilizados, tipo de lesión renal, tratamiento aplicado, lesiones asociadas, complicaciones y mortalidad. RESULTADOS: predominó el sexo masculino y el grupo de edad más afectado fue el de 18 a 29 años. Los accidentes automovilísticos y las caídas de altura se presentaron, por igual, como los agentes causales mayoritarios. El síntoma predominante fue lumbalgia en el 59,2 por ciento de los pacientes. El ultrasonido abdominal resultó el estudio diagnóstico más utilizado. Predominó la lesión renal tipo I y el tratamiento no quirúrgico. Las lesiones asociadas más frecuentes se encontraron en las extremidades y como complicación la sepsis de la herida quirúrgica. Hubo un 5,3 por ciento de mortalidad. CONCLUSIONES: la mayoría de los traumatismos renales fueron leves y conllevaron tratamiento no quirúrgico, lo que hizo factible su manejo al relacionar la sintomatología de cada paciente con los hallazgos del ultrasonido abdominal

INTRODUCTION: most of the renal traumata are considered as minor and require a conservative treatment, some type of surgical intervention and the diagnostic criteria related to this situation frequently are a dilemma. OBJECTIVE: to characterize the renal traumatism in its diagnostic and therapeutic features. METHODS: a descriptive and retrospective study was conducted through a review of medical records of patients admitted with renal traumata in the Dr. Carlos J. Finlay Central Military Hospital over four years (2004-2008), taking into account: sex, age, causal agent, symptoms, the complementary examinations used, type of renal lesion, treatment applied, associated lesions , complications and mortality. RESULTS: there was predominance of male sex and the more involved age group was that of 18 to 29 years. Road accidents and falls from heights were equally present as the majority causal agents. The predominant symptom was the lumbago in the 59.2 percent of patients. The abdominal ultrasound (US) was the more used diagnostic study. There was predominance of type I renal lesion and the non-surgical treatment. The more frequent associated lesions were present in the lower extremities and as a complication the surgical wound sepsis. The was a 5.3 percent of mortality. CONCLUSIONS: most of the renal traumata were slights and entailed non-surgical treatment being feasible for its management relating the symptoms of each patient to the abdominal ultrasound findings