Construção simbólica frente à falha do recurso à droga na psicose / Construction symbolique face à l'échec de la consommation de drogue dans la psychose / Symbolic construction on the failure of drug use in psychosis

A inserção de psicanalistas em instituições da rede de saúde mental, em especial nos dispositivos de atenção a usuários de álcool e outras drogas, amplia a discussão sobre o diagnóstico estrutural frente ao uso de substâncias psicoativas. O recurso às drogas na psicose pode operar como uma tentativa de estabilização ao localizar no real da substância os efeitos da invasão do real dos sintomas psicóticos. O objetivo deste artigo é discutir, a partir de um caso clínico, a possibilidade de construção simbólica frente à falha deste recurso. O caso analisado pela teoria lacaniana demonstra que o uso de drogas pode ser capturado pelo processo de desorganização pulsional. Discute-se a função do sonho na psicose e sua relação com a construção delirante. O endereçamento transferencial ao analista, por outro lado, permite que o discurso sobre as drogas em sua dimensão significante opere como uma forma de construção simbólica para a amarração dos registros

L'insertion despsychanalystes dans les établissements du réseau d'assistance de la santé mentale, notamment dans les dispositifs de prise en charge des usagers d'alcool et d'autres drogues, élargit la réflexion sur le diagnostic structurel face à l'usage de substances psychoactives. L'usage de drogues dans la psychose peut opérer comme une tentative de stabilisation en situant dans le réel de la substance les effets de l'envahissement du réel des symptômes psychotiques. L'objectif de cet article est de discuter, a partir d'un cas clinique, de la possibilité d'une construction symbolique face à l'échec de cette ressource. Le cas, pour la théorie lacanienne, démontre que la consommation de drogues peut être capturée par le processus de désorganisation de la pulsion. Les rêves sont discutés a partir du délire et de sa fonction dans la psychose. L'adresse du transfert à l'analyste, au contraire, permet au discours sur la drogue dans sa dimension signifiante d'opérer comme une forme de construction symbolique pour nouer les registres.

The insertion of psychoanalysts in institutions of the mental health network, especially in spaces dedicated to the care of users of alcohol and other drugs, broadens the discussion on the structural diagnosis in the face of psychoactive substance use. The use of drugs in psychosis can operate as an attempt at stabbilization by locating in the real of the substance the effects of the invasion of the real of psychotic symptoms. The objective of this article is to discuss, based on a clinical case, the possibility of symbolic construction when facing the failure of this resource. The case demonstrates through lacan´s theory that drug use can be captured by the process of disorganization of the drive. The function of dream in psychosis is discussed through its relation to delusion. The transferential addre to the analyst, on the other hand, allows the discourse about drugs in its signifying dimension to operate as a form of symbolic construction for tying the registers

Clínica, psicopatologia e laço social hoje / Clinique, psychopathologie et lien social aujourd'hui / Clinic, psychopathology and social bond today

Procuramos debater algumas perspectivas da clínica contemporânea e do campo da psicopatologia no contexto do laço social hoje, tomando como base as mudanças conceituais em Jacques Lacan sobre o Nome-doPai e as incidências sobre a noção de suplência no seu último ensino. Entendemos que a renovação da clínica em Lacan revigora a psicopatologia na lógica borromeana e orienta a prática do psicanalista na clínica do Real.

Clinique, psychopathologie et lien social aujourd'hui: On cherche à débattre de certaines perspectives de la clinique contemporaine et du domaine de la psychopathologie dans le contexte du lien social aujourd'hui. On l'examine à partir des changements conceptuels de Jacques Lacan autour du Nom-du-Père et des incidences sur la notion de suppléance dans ses dernières études. On comprend que la rénovation de la clinique de Lacan revigore la psychopathologie dans la logique borroméenne et guide la pratique du psychanalyste dans la clinique du Réel.

Clinic, psychopathology and social bond today: In this study, we discussed some perspectives of contemporary clinic and psychopathology field in the current social bond context, based on Jacques Lacan's concept changes regarding the Name-of-The-Father and the incidences of s replacement notion in his last teaching. We understand that clinic reformulation in Lacan invigorates the field of psychopathology in Borromean logic and guides psychoanalysts' practices in the clinic of the real.

Invenção e estabilização: uma experiência com crianças autistas em dispositivos de Saúde Mental / Invention and stabilization: an experience with autistic children in Mental Health units / Invention et stabilisation: une expérience avec des enfants autistiques dans des dispositifs de Santé Mentale / Invención y estabilización: una experiencia con niños autistas en dispositivos de Salud Mental

O artigo aborda o valor do trabalho de invenção como forma de estabilização na clínica do autismo, a partir de um projeto de extensão universitária voltada a crianças em grave sofrimento psíquico, que tem a psicanálise como direção de trabalho e de tratamento. Durante esta vivência, podemos presenciar - a partir do acompanhamento do movimento dessas crianças - sujeitos que, por meio de suas manifestações particulares, buscavam produzir algo que estabilizasse sua desorganização psíquica. Assim, entende-se que o trabalho subjetivo implicado no ato da invenção - enquanto o ato que um sujeito realiza uma construção singular de elementos de sua história a partir de materiais já existentes - pode redundar numa estabilização e mediação com o campo do Outro por parte do sujeito, algo que foi possível observar nessa experiência clínica.

This article discusses the value of invention work as a form of stabilization in the clinic of autism. It is based on a university extension project aimed at children with severe psychic suffering in which psychoanalysis is used to guide work and treatment. Watching the movement of those children allowed us to single out subjects who, through their particular manifestations, sought to produce something that would stabilize their psychic disorganization. Therefore, we understand that the subjective work involved in the act of invention - as an act through which a subject performs a unique construction of elements of his history based on existing materials - may result in stabilization and mediation with the field of the Other by of the subject, which was observed in this clinical experience..

Cet article discute de la valeur du travail d'invention en tant que forme de stabilisation dans la clinique pour autistes, basé sur un projet d'extension universitaire destiné aux enfants souffrant de troubles psychiques sévères, dont la psychanalyse guide le travail et le traitement. Au cours de cette expérience, nous avons détecté - en suivant les mouvements de ces enfants - de sujets qui, par leurs manifestations particulières, cherchaient à produire quelque chose qui stabiliserait leur désorganisation psychique. Ainsi, il est entendu que le travail subjectif impliqué dans l'acte de l'invention - comme acte de construction unique d'éléments de l'histoire du sujet à partir de matériaux existants - peut aboutir à une stabilisation et à une médiation du champ de l'Autre de la part du sujet, ce qui a été observé dans cette expérience clinique..

El artículo discute el valor del trabajo de invención como forma de estabilización en la clínica del autismo, a partir de un proyecto de extensión universitaria dirigido a niños con graves trastornos psíquicos, que tiene al psicoanálisis como orientador del trabajo y del tratamiento. Durante esta experiencia, podemos presenciar - desde el seguimiento del movimiento de estos niños - sujetos que, a través de sus manifestaciones particulares, buscaron producir algo que estabilizara su desorganización psíquica. Por lo tanto, se entiende que el trabajo subjetivo involucrado en el acto de la invención - como el acto en el que un sujeto realiza una construcción única de elementos de su historia a partir de elementos existentes - puede resultar en una estabilización y mediación con el campo del Otro por parte del tema, algo que puede ser observado en esta experiencia clínica.

Minimally Invasive versus Conventional Open Surgery for Fixation of Spinal Fracture in Ankylosed Spine

@#Introduction: This was a retrospective study aimed to investigate the perioperative outcomes of long construct minimally invasive spinal stabilisation (MISt) using percutaneous pedicle screws (PPS) versus conventional open spinal surgery in the treatment of spinal fracture in ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH). Material and Methods: Twenty-one patients with AS and DISH who were surgically treated between 2009 and 2017 were recruited. Outcomes of interest included operative time, intra-operative blood loss, complications, duration of hospital stay and fracture union rate. Results: Mean age was 69.2 ± 9.9 years. Seven patients had AS and 14 patients had DISH. 17 patients sustained AO type B3 fracture and 4 patients had type B1 fracture. Spinal trauma among these patients mostly involved thoracic spine (61.9%), followed by lumbar (28.6%) and cervical spine (9.5%). MISt using PPS was performed in 14 patients (66.7%) whereas open surgery in 7 patients (33.3%). Mean number of instrumentation level was 7.9 ± 1.6. Mean operative time in MISt and open group was 179.3 ± 42.3 minutes and 253.6 ± 98.7 minutes, respectively (p=0.028). Mean intra-operative blood loss in MISt and open group was 185.7 ± 86.4ml and 885.7 ± 338.8ml, respectively (p<0.001). Complications and union rate were comparable between both groups. Conclusion: MISt using PPS lowers the operative time and reduces intra-operative blood loss in vertebral fractures in ankylosed disorders. However, it does not reduce the perioperative complication rate due to the premorbid status of the patients. There was no significant difference in the union rate between MISt and open surgery.

A elaboração conceitual da teoria freudiana do desencadeamento e estabilização / The conceptual elaboration of freud's theory of triggering and stabilization / La elaboración conceptual de la teoría freudiana del desencadenamiento y estabilización / L'élaboration conceptuelle de la théorie de freud sur le déclenchement et la stabilisation

O ponto de partida do artigo é mostrar a relevância e a atualidade da teoria freudiana da psicose. Nesse sentido, o objetivo é retomar a literatura visando a delimitar uma hipótese inaugural sobre o desencadeamento e a estabilização, em que a perturbação do funcionamento pulsional já se constituía como fator importante na etiologia psíquica de seu desencadeamento e o delírio, como um trabalho psíquico de reparação, de estabilização. Para isso, o artigo expõe um levantamento das referências freudianas a fim de mostrar o desenvolvimento epistemológico de uma pesquisa etiológica cuja especificidade reside em: 1. Considerar a etiologia da psicose à luz da invasão pulsional; 2. Isolar, por meio do conceito de rejeição, um processo psíquico específico de defesa contra a pulsão cujo resultado é a perda da realidade; 3. Definir a função do delírio como reparador, restituidor da realidade.

The starting point of the paper is to show the relevance and timeliness of Freud's theory of psychosis. In this sense, the objective is to retake the literature aiming to delimit an inaugural hypothesis about the triggering and the stabilization, in which the disturbance of the drive functioning was already constituted as an important factor in the psychic etiology of its triggering and the delirium, as a psychic work repair, stabilization. To this end, the article exposes a survey of Freudian references to show the epistemological development of the etiological research whose specificity lies in 1: Considering the etiology of psychosis in light of the drive invasion; 2: Isolate, through the concept of rejection, a specific psychic process of defense against the drive which results in the loss of reality; and 3: Define the function of delirium as restorative, a restorer of reality.

El punto de salida de este trabajo es enseñar la relevancia y la actualidad de la teoría freudiana de la psicosis. En este sentido, el objetivo es retomar la literatura para delimitar una hipótesis inaugural sobre el desencadenamiento y la estabilización, en que la perturbación del funcionamiento pulsional ya se constituía como factor importante en la etiología psíquica de su desencadenamiento y el delirio, como un trabajo psíquico de reparación, de estabilización. Para eso, el trabajo expone una búsqueda de las referencias freudianas con el fin de enseñar el desenvolvimiento epistemológico de una investigación etiológica cuya especificidad reside en: 1. Considerar la etiología de la psicosis a la luz de la invasión pulsional; 2. Aislar, por medio del concepto de rechazo, un proceso químico específico de defensa contra la pulsión cuyo resultado es la perdida de la realidad; 3. Definir la función del delirio como reparador, restituidor de la realidad.

Le point de départ de cet article est de montrer la pertinence et l'actualité de la théorie de Freud sur la psychose. En ce sens, l'objectif est de reprendre la littérature pour délimiter une hypothèse inaugurale sur le déclenchement et la stabilisation. Dans l'hypothèse, le dérangement du fonctionnement de la pulsion était déjà constitué comme un facteur important dans l'étiologie psychique de son déclenchement. Du délire, à son tour, comme un travail psychique de réparation et de stabilisation. Pour cela, l'article expose des références freudiennes afin de montrer le développement épistémologique d'une recherche étiologique dont la spécificité réside dans: 1. Considérer l'étiologie de la psychose à la lumière de désintrication pulsionnelle; 2 Isoler, à travers le concept de rejet, un processus psychique spécifique de défense contre la pulsion dont le résultat et la perte de la réalité; 3 Définir la fonction du délire en tant que réparateur, restaurateur de la réalité.

Neurofibroma of lumbosacral region: a case report

Neurofibromas are benign tumors of the peripheral nerve sheath. Spinal neurofibroma often asymptomatic. Symptoms may present include sensory changes. Neurofibroma mostly encountered cervical cord, difficult to distinguish from schwannomas. This slow growing tumor remodel the bone resulting pedicle thinning and posterior vertebral body scalloping. MRI shows hyperintense rim. Although this highly suggestive neurofibroma, occasionally also seen in schwannoma and malignant PNST. Treatment choice for symptomatic lesions is surgery. We are reporting a case of neurofibroma in the 5th lumbar and 1st sacral region.

Desenvolvimento do self e processos de hiperindividualização: interrogações à Psicologia Dialógica / The development of the self and the process of hiper-individualization: inquiries to the Dialogical Psychology / Le développement du soi et les processus de l'hiperindividualisation: interrogations pour la Psychologie Dialogique / Desarrollo del self y proceso de hiperindividualización: cuestiones a la Psicología Dialógica

Resumo: Em psicologia, à perspectiva dialógica estão associadas teorias do self, em especial a Teoria do Self Dialógico (TSD). Embora avanços consistentes venham sendo alcançados no que se refere à compreensão da organização dinâmica da estrutura do self no tempo microgenético, a teoria carece de estudos que se aprofundem na compreensão do desenvolvimento do self, tomando-se por base os distintos níveis temporais e suas relações. Este estudo propõe explorar essa lacuna, tomando por ponto de partida a tríade epistemológica da abordagem dialógica, a saber, suas bases semiótico-culturais, fenomenológicas e construcionistas. Em seguida, apresentará um estudo de caso em que serão analisadas as transições de desenvolvimento de um adolescente, considerando-se os complexos semióticos de gênero, raça e religião e seu papel nas transformações vividas em termos da organização temporal do self.

Abstract: In Psychology the dialogical perspective is associated with various theories of self, in special, the Dialogical Self Theory (DST). Although important theoretical and methodological advances have been achieved by DST concerning our comprehension of the dynamic organization of the structure of the self in micro-genetic (temporal) processes, this perspective is in need of theories that explore in depth the development of the self including multiple temporal levels of organization and their mutual relationships. This paper aims to explore the triadic epistemological basis of the dialogical perspective in psychology, i.e., the cultural-semiotic basis, the phenomenology, and constructionism. Then, a case study concerning developmental transitions of an adolescent will be presented. We will analyze the semiotic complexes of gender, race and religion, as well as their role in the personal changes lived by him, in terms of the temporal organization of the self.

Résumé: En psychologie, la perspective dialogique est associée à la théorie du soi (self) qui a été développée, en particulier, à travers les théories du soi dialogique (dialogic self theory; DST). Bien que des avancées théoriques et méthodologiques importantes aient été réalisées par les DST concernant notre compréhension de l'organisation dynamique des structures du soi chez les processus microgénétiques (temporels), ces théories requièrent des recherches qui explorent en profondeur le développement du soi, lesquels doivent porter sur les multiples niveaux temporels et leur rapport mutuel. Cet article propose d'explorer cette lacune à partir des approches dialogiques psychologiques, soit leurs bases sémiotique-culturelles, phénoménologiques et constructionnistes. Enfin, on analyse les complexes sémiotiques de genre, de race et de religion, ainsi que leur rôle sur le plan des changements de l'organisation temporelle du soi d'un adolescent.

Resumen: En psicología, a la mirada dialógica se la relacionan teorías del self, especialmente, la Teoría del Self Dialógico (TSD). Aunque haya avanzado significativamente en lo que atañe a la comprensión de la organización dinámica de la estructura del self en el tiempo microgenético, la perspectiva carece de estudios que profundicen la comprensión del desarrollo del self, tomando como base los distintos niveles temporales y sus relaciones. Este estudio se propone a explotar esta laguna a partir de la tríada epistemológica del abordaje dialógico, es decir, sus bases semiótico-culturales, fenomenológicas y construccionistas. Enseguida, presenta un estudio de caso en el que se analizarán transiciones de desarrollo de un adolescente, considerándose los complejos semióticos de género, raza y religión, y su papel en las transformaciones vividas en términos de organización temporal del self.

Habitar, construir, existir: algunas consideraciones sobre el cuerpo en las psicosis / Habitar, construir, existir: algumas considerações sobre o corpo nas psicoses / To inhabit, to build, to exist: considerations concerning the body in psychoses / Habiter, bâtir, exister: quelques considérations sur le corps dans les psychoses / Wohnen, bauen, existieren: einige Überlegungen zum Körper in Psychosen / 住留，构建，存在：对肉体与精神世界的关系的思考

Desde Freud, Lacan y de un importante texto de Heidegger, que se ocupa del tema del habitar, se destaca la cuestión de la inscripción del cuerpo — la primera morada — desde el encuentro con el Otro. La ausencia del significante de la falta impide el psicótico de, en ciertas situaciones, apropiarse del sentido desencadenando la psicosis. La invención del cuerpo propio es una vía de rescate de la ruptura de la realidad y de la estabilización en las psicosis.

A partir de Freud, de Lacan e de um importante ensaio de Heidegger, que trata do tema do habitar, destaca-se a questão da inscrição do corpo — primeira morada — a partir do encontro com o Outro. A ausência do significante da falta impede o psicótico de, em certas situações, se apropriar do sentido fato que produz o desencadeamento da psicose. A invenção do corpo próprio resgata o sujeito da errância produzida pelo rompimento da realidade e produz a estabilização na psicose.

Based on Freud, Lacan and on an important essay by Heidegger dealing with the topic of inhabiting, the question concerning the inscription of the body — the first home — is highlighted following an encounter with the Other. The absence of the meaning of lack prevents the psychotic person, in certain situations, from appropriating for himself the sense fact that leads to the onset of psychosis. The invention of the personal body saves the subject from the wanderings produced by the disruption of reality, and leads to stabilization of the psychosis.

Depuis Freud, Lacan et un important essai de Heidegger traitant du thème de l’habiter, on distingue la question de l'inscription du corps — la première demeure — à partir de la rencontre avec l'Autre. L'absence du signifiant du manque empêche le psychotique, dans certains cas, de s'approprier le sens, fait qui produit le déclenchement de la psychose. L'invention du corps lui-même délivre le sujet de l'errance produite par la rupture de la réalité et produit la stabilisation dans la psychose.

Freud, Lacan und ein wichtiger Aufsatz Heideggers, der sich mit dem Thema Wohnen beschäftigt, bilden die Grundlage unserer Analyse über die Inskription des Körpers — der erste Wohnort — ab der Begegnung mit dem Anderen. Die Abwesenheit des Signifikanten des Mangels hindert den Psychotischen daran, in bestimmten Situationen, sich den Sinn anzueignen, ein Umstand der den Ausbruch der Psychose erzeugt. Die Erfindung des eigenen Körpers rettet das Subjekt vom Umherirren, welches durch den Bruch mit der Realität erzeugt wurde und erzeugt eine Stabilisierung in der Psychose.

佛罗依德，拉孔，甚至海德格尔的一篇重要的文章，都探讨了关于精神在肉体的住留问题，特别是关于肉体和精神的相遇，肉体“注册”成为精神的第一栖息地。专家指出，精神和肉体的缺乏有意义的协调，在某些情况下，会阻碍精神驾驭感知，从而引发精神病。我们认为对肉体的干预是解决精神和肉体关系不协调的一种办法，一种稳定精神病症的办法。.

Functional outcome of minimally invasive posterior stabilisation in dorsal and lumbar spine fractures.

Minimally invasive spinal surgery will be a highlight of operative approaches in the twenty-first century and already has been popularized worldwide. This procedure will provide surgical options that address several pathological conditions in the spinal column without producing the types of morbidity commonly seen in open surgical procedures. The objective was to assess the outcomes of minimally invasive posterior stabilization of dorsal and lumbar spine fractures. Methods: This was a prospective study of twenty patients with dorsal or lumbar fractures who were admitted at Sri Ramachandra University. All patients having dorsal and lumbar spinal fractures with intact neurology were included in the study. All the patients underwent minimally invasive posterior stabilization by freehand technique. Functional outcomes were measured by VAS scale, ASIA scoring (neurology), and their ability to mobilize. Results: The average duration of surgery was 85.50 minutes. The average blood loss in our study group was 77 ml. The average operation to mobilization time was 2.2 days. The average post-operative Cobb’s angle was 0.6 degree of kyphosis. The average post-operative gain was 12 degree. Conclusion: Minimally invasive percutaneous stabilization of the spine helps to minimize approach related morbidity and secondary iatrogenic soft tissue trauma. It enables early mobilization, which contributes to improved outcome.

A suplência perversa em sujeitos psicóticos como uma possível chave de leitura da psicopatia / La suppléance perverse chez les patients psychotiques comme un possible axe delecture de la psychopathie / The perverse replacement in psychotic individuals as a possible key for understanding psycopathy

O artigo busca defender a hipótese de que muitos casos diagnosticados como psicopatias podem na verdade ser casos em que psicóticos fazem uso de arranjos estabilizadores com matizes perversos. Para tanto, recorre ao texto do psicanalista francês Jean-Claude Maleval, intitulado “Suplência perversa em um sujeito psicótico”. A partir do esmiuçamento desse trabalho e do caso clínico que ele apresenta, coleta subsídios teóricos que demonstram como em algumas psicoses pode-se observar certa conivência com atos sadomasoquistas extremos, o que, não raro, leva a diagnósticos equivocados, como o de psicopatia

L'article cherche à défendre l'hypothèse que de nombreux cas classés comme des psychopaties ne sont en fait que des arrangements stabilisants à nuances perverses faits par des individus psychotiques. Pour ce faire, le texte du psychanalyste français Jean-Claude Maleval intitulé "Suppléance perverse chez un sujet psychotique." De l’analyse de ce travail et du cas clinique qu'il présente, sont prélevés des éléments théoriques qui montrent comment dans certaines psychoses il est possible d’observer une certaine connivence avec des actes sadomasochistes extrêmes, ce qui conduit souvent à des erreurs de diagnostic, tels que la psychopathie

The article aims to defend the hypothesis that many cases with psychopathic diagnoses may in fact be cases in which psychotics use stabilizing arrangements with perverse nuances. In order to do so, we resorted to an article from the French psychoanalyst Jean Claude Maleval called “Perverted replacement in a psychotic individual”. From the study of that work and the clinical case that it presents, we have collected the theoretical elements that show how in some psychoses we observe a certain collusion with extreme sadomasochistic acts, which leads, frequently, to flawed diagnosis such as psychopathy

Desplazamiento forzado, niñez y adolescencia: escenarios en relación con su estabilización socioeconómica / Forced displacement, childhood and adolescence: scenarios regarding socioeconomic stability

Objetivo Describir y analizar escenarios de estabilización socioeconómica para población en situación de desplazamiento forzado, en los que se preste especial atención a la situación de niños, niñas y adolescentes. Métodos Se utiliza, a partir de talleres de expertos, el método Analytic Hierarchy Process (AHP), elaborado por el profesor Thomas Saaty con participación investigadores, ONG y de comunidades en situación de desplazamiento del Área Metropolitana de Bucaramanga. Resultados El resultado parcial de esta investigación muestra como algunos adultos mayores de comunidades en situación de desplazamiento forzado prefieren adaptarse a los centros urbanos, antes que retornar sus lugares de origen, en particular cuando se trata de la protección y el bienestar de sus hijos menores. El índice de consistencia y la relación de consistencia del método están dentro de los parámetros previstos. Conclusión Es necesario repensar los programas de estabilización socioeconómica promovidos por el gobierno en relación con la población en situación de desplazamiento forzado, en particular cuando se prevén situaciones que comprometen el bienestar de los niños, niñas y adolecentes.

Objective Describing and analysing socio-economic stabilisation scenarios for populations which have been forcibly displaced paying special attention to the situation of children and adolescents. Method The analytic hierarchy process (AHP) multi-criteria decision-making method developed by Professor Thomas Saaty was used through expert workshops, involving researchers, leaders of NGOs and displaced communities living in the city of Bucaramanga. Results The partial result of this research showed that some elderly adults from forcibly displaced communities preferred to adapt themselves to urban centres, rather than return to their places of origin, particularly when it came to protecting younger children and dealing with their welfare. The method's consistency index and consistency ratio came within the expected parameters. Conclusion Government-promoted social and economic stabilisation programmes must be rethought regarding forcibly displaced populations, particularly when situations are envisaged involving the welfare of children and adolescents.

Giant Cell Tumour of the Distal Ulna: A Rare Presentation

Giant-cell tumour (GCT) of bone, a primary yet locally aggressive benign tumour, commonly affects patients between the ages of 20 and 40 years, with the peak incidence occurring in the third decade. Women are affected slightly more than men. The distal end of the ulna is an extremely uncommon site for primary bone tumours in general and giant cell tumours in particular. Wide resection of the distal ulna is the recommended treatment for GCT in such locations. Radio-ulna convergence and dorsal displacement of the ulna stump are known complications following ulna resection proximal to the insertion of the pronator quadratus. This leads to reduction in grip power and forearm rotatory motion. Stabilization of the ulna stump with extensor carpi ulnaris (ECU) tendon after wide resection of the tumour has been described in the literature. We report a case of GCT of distal end of ulna treated with wide resection and stabilization with ECU tendon.

Abordajes toracolumbares anteriores en lesiones requimedulares: experiencia en 72 casos / Anterior thoraco lumbar approches for spino medular injuries. About 72 cases

Objetivo: revisar nuestra experiencia en dos centros de la provincia de Buenos Aires, en el manejo de 72 casos con lesiones vertebrales y/o vertebromedulares de diferentes etiologías y topografías, utilizando abordajes anteriores y anterolaterales al raquis dorsolumbar. Material y método: analizamos retrospectivamente las indicaciones, técnica quirúrgica, resultados y complicaciones en 72 pacientes que requirieron un abordaje torácico o toracolumbar, en el período que va de enero de 1996 a junio de 2009. La vía de abordaje fue determinada de acuerdo al nivel afectado y a la extensión de la lesión. Las lesiones entre T2 y T10 se abordaron mediante estereotomía o toracotomía derecha; con lesiones T11 a L1, preferimos una toracotomía con o sin manipulación del diafragma desde la izquierda. Para las lesiones L2- L3, se utilizó una lumbotomía izquierda. En la inmensa mayoría de los casos, la artrodesis se acompañó de una osteosíntesis segmentaria con distintos sistemas de fijación (placa atornillada, barras y placas atornilladas). En todas las intervenciones, contamos con la asistencia de un equipo de cirugía general, cardiovascular o urológica, tanto en peri como postoperatorio. Resultados: la mayoría de las lesiones (50,6% del total), se ubicaron en los segmentos T10 a L2. Catorce casos correspondieron a lesiones exclusivamente lumbares, en un paciente se requirió del equipo de cirugía cardiovascular (estereotomía para el abordaje T2-T3). La etiología más frecuente fue traumática, seguida por los tumores primitivos o secundarios, en tercer lugar se ubicaron las patologías degenerativas y en último término, las infecciones (5 casos). Un porcentaje similar de pacientes se presentó con y sin déficit neurológico asociado. Veintiún enfermos (casi 1 de cada 3 operados) requirieron de una doble vía de abordaje, en general diferida a la primera cirugía...

Objective To analyse retrospectively our experience in two surgical centers in Buenos Aires, managing 72 cases of spinal lesions of different ethiologies, using anterior surgical approaches to the thoracolumbar spine. Material and method. Indications, surgical techniques and results, as well as complications in 72 cases requiring a thorcolumbar anterior approach performed between 1996 and 2009 were analised. Surgical route was chosen according to the level and extension of the injuries. Those between T4 and T10 were approached using a right thoracotomy: for lesions between T11 and L1, we used a left thoracotomy, with or without diaphragmatic section. For levels L2 L3, a left lumbotomy was performed. In most cases, arthtodesis was followed by segemental stabilisation with different devices. In all cases, we were assisted intra and postoperatively by a surgical team (general surgeons, cardiovascular surgeons and urologic surgeons). Results. Almost 50% of the cases were located between T10 and L2. 14 cases were exclusively lumbar lesions: in one case, the cardiovascular surgical team was required (sternotomy to expose T2T3). Trauma was the most common ethiological agent, followed by tumors: degenerative and infectious causes were uncommon. 21 patients required a combined anterior and posterior approach. Morbidity related to surgery was of 14% in our series, superficial infections being the most frequent finding (6 cases). Mortality related to surgery reached 1.33% (1 case). Conclusions. In our experience (72 cases operated on during the last 13 years), and with an adequate patient selection, the anterior approach resulted safe and effective, with an acceptable morbidity grossly equal to that described in the literature.

From the classical AO compression plate to the new internal fixator principle / 中华创伤骨科杂志

The importance of the biology and the care for the soft tissues and bone during internal fixation of the fracture, as the fourth AO principle, had been stressed. A conventional AO compression plate pressed against the bone surface interferes with the cortical blood flow and induces structural changes underneath the plate. Low contact dynamic contact plate(LC- DCP) could reduce the area of contact between plate and bone undercuts. Locking head screws, the Point Contact Fixator (PC Fix), and the Less Invasive Stabilisation System (LISS) had the next evolution.The so- called internal fixator can be considered as an external fixator, which has been approximated very close to the bone, however, without actually touching or compressing bone. This feature prevents any additional damage to bone vascularity. The stability of the internal fixator depends on the angular stability of the screw- plate combination. The new LISS and Locking Compression Plate( LCP) offer new options and challenges in modern operative fracture care. These implants are ideal for the MIPO (minimally invasive (percutaneous) plate osteosynthesis) and appear to have a considerably better purchase in osteoporotic bone. Nevertheless, it must be stated that these new plates and screws do not solve all problems, either as they too demand a very careful planning of every procedure, which includes a re- thinking of the classical AO principles, especially when addressing meta- and diaphyseal fractures.

Stabilisation of some of the protein synthesis components in the thermophilic fungus, Humicola lanuginosa.

The thermal stabilities of tRNA from the thermophilic fungus, Humicola lanuginose were compared with that from the mesophilic yeast, Candida utilis, by measuring the increase in the optical density with temperature. tRNAs from both the species were stable in the presence of millimolar quantities of magnesium chloride upto 50°C, the optimum growth temperature of the fungus. Aminoacyl tRNA synthetases were maximally active at 40°C under the in vitro assay conditions. They were fractionated and one species of valine tRNA synthetase was purified to homogeneity. The purified enzyme was protected against inactivation to varying degrees when preincubated with the substrates valine, tRNA and ATP as well as spermine. Protein turnover studies showed that the rate of turnover was higher at higher temperatures. It was concluded from these results that the protein synthesizing machinery of this fungus has no intrinsic stability but it is stabilised by intracellular factors. Higher rate of protein turnover also plays a role for growth at higher temperature.