Résumé
Este artigo faz parte de uma pesquisa que busca articular a clínica psicanalítica com sujeitos ditos autistas com o estudo das noções de voz, vazio, silêncio, música e topologia. Aqui partimos de uma leitura do uso feito por Lacan, em suas aulas sobre o saber do psicanalista, da noção de ressonância para, enfim, abordar a questão da voz e da fala e sua articulação com conceitos provenientes do campo da teoria musical. O trabalho constitui uma investigação teórico-clínica no campo da psicanálise, com referência à experiência de extensão numa universidade brasileira. Além da incursão teórica na psicanálise e na teoria musical, faz-se referência a casos clínicos clássicos já publicados na literatura psicanalítica, como o caso Dick, descrito por Melanie Klein, o caso Marie-Françoise, abordado por Rosine e Robert Lefort, os casos Joey e Frank, de Bettelheim, e vinhetas provenientes de nossa experiência de trabalho. Relacionando as noções de ruído, ritmo e melodia com os registros do real, do simbólico e do imaginário, o artigo conclui sobre a importância clínica da dimensão musical da linguagem na constituição subjetiva e no enquadramento da voz como medida protetiva contra a invasão que alguns sujeitos sentem como ameaça.
This paper is part of a research that relates the psychoanalytic clinic with subjects deemed autist to the study of the concepts of voice, emptiness, silence, music and topology. In this study we start with a reading of Lacan's use of the notion of resonance in his classes about the knowledge of the psychoanalyst and the concept of resonance, in order to address the theme of voice and speech and their articulation with concepts from the field of music theory. This article constitutes a theoretical-clinical investigation in psychoanalysis, with reference to the experience of an extension project in a Brazilian university. In addition to the theoretical incursion into psychoanalysis and musical theory, a reference is made to classic clinical cases published in psychoanalytic literature, such as Dick's case, described by Melanie Klein, Marie-Françoise's case, by Rosine and Robert Lefort, and the cases of Joey and Frank, by Bettelheim. We also make use vignettes from our own experience. By relating the concepts of noise, rhythm and melody to the aspects of real, symbolic, and imaginary, the paper concludes on the clinical importance of the musical dimension of language in the subjective constitution and in the framing of the voice as a protective measure against the invasion that some subjects feel threatening.
Este artículo es parte de una investigación que busca articular la clínica psicoanalítica con sujetos dichos autistas y el estudio de las nociones de la voz, lo vacío, lo silencio, la música y la topología. Aquí comenzamos con una lectura del uso de Lacan, en sus clases sobre el saber del psicoanalista, de la noción de resonancia, para abordar el tema de la voz y la palabra y su articulación con conceptos del campo de la teoría musical. El trabajo constituye una investigación teórico-clínica en el campo del psicoanálisis, con referencia a la experiencia de extensión en una universidad brasileña. Además de la incursión teórica en el psicoanálisis y la teoría musical, se hace referencia a casos clínicos clásicos ya publicados en la literatura psicoanalítica, como el caso Dick, descrito por Melanie Klein, el caso Marie-Françoise, por Rosine e Robert Lefort, y los casos de Joey y Frank, de Bettelheim. Se hace referencia también a viñetas de nuestra experiencia. Relacionando los conceptos de ruido, ritmo y melodía con los registros de lo real, lo simbólico y lo imaginario, el artículo concluye sobre la importancia clínica de la dimensión musical del lenguaje en la constitución subjetiva y en el encuadre de la voz como medida protectora contra la invasión que algunos sujetos sienten tan amenazante.
Résumé
Objective:To investigate the clinical value of gadolinium ethoxybenzyl diethy-lanetriaminepentaacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI) in the preoperative diagnosis of macrotrabecular-massive hepatocellular carcinoma (MTM-HCC).Methods:The diagnostic test was conducted. The clinicopathological data of 150 HCC patients who were admitted to the First Affiliated Hospital of Army Medical University from January 2019 to December 2020 were collected. There were 116 males and 34 females, aged (53±10)years. There were 38 MTM-HCC patients and 112 non-macrotrabecular-massive hepatocellular carcinoma (nMTM-HCC) patients. All patients received Gd-EOB-DTPA enhanced MRI examination. Observation indicators: (1) clinicopathological features of MTM-HCC and nMTM-HCC; (2) imaging features of MTM-HCC and nMTM-HCC; (3) imaging features for diagnosis of MTM-HCC. The normality test of continuous data was analyzed by the Kolmogorov-Smirnov test. Measurement data with normal distribution and homoscedasticity were represented as Mean± SD, and comparison between groups was analyzed using the independent sample t test. Measurement data with skewed distribution were represented as M( P25, P75), and comparison between groups was analyzed using Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Multivariate analysis was conducted using the Logistic regression model. The receiver operating characteristic (ROC) curve was used to evaluate diagnostic value of indicators, and Delong test was used for comparison. Results:(1) Clinicopathological features of MTM-HCC and nMTM-HCC: the alpha-fetoprotein and cases with microvascular invasion were 329 μg/L(20 μg/L,1 034 μg/L) and 24 for MTM-HCC patients, versus 25 μg/L(8 μg/L,200 μg/L) and 31 for nMTM-HCC patients, showing significant differences between the two groups ( Z=-3.306, χ2=15.380, P<0.05). (2) Imaging features of MTM-HCC and nMTM-HCC: cases with regular morphology of tumor, intra-tumoral fat, arterial phase peritumoral enhancement, complete capsule, intratumoral necrosis or ischemia, peritumoral hypointense at hepatobiliary phase (HBP) were 6, 4, 20, 5, 28, 17 for MTM-HCC patients, versus 44, 40, 21, 43, 26, 11 for nMTM-HCC patients, showing significant differences between the two groups ( χ2=7.049, 8.684, 16.399, 8.303, 31.368, 22.783, P<0.05). (3) Imaging features for diagnosis of MTM-HCC. ① Results of multivariate analysis showed that intratumoral fat, intratumoral necrosis or ischemia were independent predictors for MTM-HCC ( hazard ratio=4.033,0.215, 95% confidence interval as 1.196-13.603, 0.079-0.588, P<0.05). ② Diagnostic efficacy: the arear under ROC curve, sensitivity and specificity of intratumoral fat combined with intratumoral necrosis or ischemia for diagnosis of MTM-HCC were 0.799(95% confidence interval as 0.718-0.880, P<0.05), 73.7%, 76.8%. The above indicators of intratumoral fat for diagnosis of MTM-HCC were 0.626(95% confidence interval as 0.530-0.721, P<0.05), 89.5%, 35.7%. The above indicators of intratumoral necrosis or ischemia for diagnosis of MTM-HCC were 0.752(95% confidence interval as 0.659-0.845, P<0.05), 73.7%, 76.8%. There were significant differences in the diagnostic efficacy between the intratumoral fat combined with intratumoral necrosis or ischemia and single intratumoral fat, between the intratumoral fat combined with intratumoral necrosis or ischemia and single intratumoral necrosis or ischemia, respectively ( P<0.05). Conclusions:Intratumoral fat, intratumoral necrosis or ischemia on Gd-EOB-DTPA MRI are independent predictors for MTM-HCC. The two combined features has higher diagnostic efficacy. Gd-EOB-DTPA MRI can be used for pre-operative diagnosis of MTM-HCC.
Résumé
En el marco de nuestra investigación, dedicada a la relación entre el síntoma, el sentido y lo real en la última enseñanza de J. Lacan, en el presente trabajo abordamos dos referencias fundamentales con las que elabora su concepción de la interpretación psicoanalítica durante los años setenta: la réson del poeta Francis Ponge y el objeto ready-made del artista Marcel Duchamp.
As part of our investigation, which aims the relationship between the symptom, the sense and the real in the last teachings of J. Lacan, in the present essay we address two fundamental references with which he elaborates his idea of the psychoanalytic interpretation during the seventies: the réson from poet Francis Ponge and the ready-made object from artist Marcel Duchamp.
Sujets)
Interprétation psychanalytique , PoésieRésumé
Objective To study the diagnostic value of susceptibility weighted imaging (SWI) in diffuse axonal injury (DAI) and investigate the relationship between SWI and clinical prognosis. MethodsTwenty patients (15 males and 5 females) with DAI were included in this study. Routine sequences (T1WI, T2WI and FLAIR) and SWI were performed on a 3.0 T MRI scanner. There were 8 cases whose Glasgow score scale (GCS) ranged from 3.0 to 5.0, 4 cases from 6.0 to 8.0 and 8 from 9.0 to 12.0. The interval time between injury and examination were from 3 hours to 20 days. The number and volume of lesions observed on SWI and routine sequence were compared using Mann-Whitney U-test and paired t-test. Pearson correlation was used to analyze the relationship between the number and volume of all lesions and GCS. Results The lesions showed punctate, beaded, patchy and cord-like hypointense signal with various size on SWI (lesion diameter <2.0 cm). Distribution of lesions was multifocal with clear boundary. Routine MRI scan found a total of 78 lesions, while SWI sequence detected 424 lesions. The number of the lesions found on SWI was more than that on conventional MRI (U=-15.447,P＜0.01). The total volume of the lesions measured on routine MRI and SWI were 19 340 mm3 and 38 042 mm3, respectively. The total volume measured on SWI was more than that on routine MR (t=5.870,P＜0.01). The number and volume of all lesions were negatively correlated with GCS (r=-0.802, -0.767, P＜0.01). Conclusion SWI sequence could find more bleeding lesions than the routine MRI sequences. The number and the volume of the lesions were closely related to GCS. SWI showed high value in the diagnosis and prediction of the prognosis of DAI.