O modelo e o exemplo na nosologia psicanalítica / The model and example in psychoanalytic nosology / Le modèle et l'exemple en nosologie psychanalytique

Diversamente do modelo nosológico que opera com um saber sobre a patologia do indivíduo, o recurso ao exemplo nos auxilia a pensar a condução clínica como uma prática guiada pelo saber construído pelo próprio sujeito em sua experiência de vida. É por isso que no lugar da simplificação homogênea do modelo, valemo-nos do exemplo como chamado para fazer a mesma coisa de forma diferente, no sentido em que uma situação clínica pode ser tomada como paradigmática para se pensar o que cada caso comporta de absolutamente inédito

Unlike the nosological model that operates with a knowledge about the pathology of the individual, the use of example helps us to think about clinical conduction as a practice guided by the knowledge built by the subject himself in his life experience. That is why, instead of the homogeneous simplification of the model, we use the example as called to do something differently in the sense that a clinical situation can be taken as paradigmatic to think about what is absolutely unheard of in each case

Contrairement au modèle nosologique qui utilise une connaissance de la pathologie de l'individu, l'utilisation de l'exemple nous aide à réfléchir à la conduction clinique en tant que pratique guidée par la connaissance construite par le sujet lui-même dans son expérience de vie. C'est pourquoi, au lieu de la simplification homogène du modèle, nous utilisons l'exemple comme appel à faire la même chose différemment dans le sens où une situation clinique peut être considérée comme paradigmatique pour réfléchir à ce que chaque cas comporte d' absolument inédit

Clinical analysis of unclassifiable B-cell lymphoma intermediates between diffuse lage B-cell lymphoma and Burkitt lymphoma / 中国肿瘤临床

Objective:To analyze clinical characteristics, treatment, and prognosis of B-cell lymphoma, unclassifiable, with features in-termediate between diffuse large B-cell lymphoma and Burkitt lymphoma (DLBCL/BL). Methods:The clinical and pathological data of 13 DLBCL/BL patients, who were treated in the First Affiliated Hospital of Zhengzhou University between January 2013 and December 2014, were collected. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method. Through the log-rank test, survival curves were compared among groups classified by clinical stage, age, serum lactate dehydrogenase (LDH) lev-el, international prognostic index (IPI) score, or first chemotherapy regimen. Results:Among the 13 patients with DLBCL/BL, 12 pa-tients showed extra-nodal involvement. The median OS and PFS were only 10 and 6 months, respectively. Univariate analysis showed that the LDH levels and IPI scores exerted statistically significant effects on prognosis. Some borderline differences in survival were not-ed among the CHOP, CHOP-like, and intensive chemotherapy groups. Conclusion:DLBCL/BL is an aggressive B-cell lymphoma with a short survival time. The majority of patients presented extra-nodal involvement. DLBCL/BL did not respond well to CHOP or CHOP-like regimen, and more intensive chemotherapy may improve survival. Elevated LDH levels and high IPI scores were predictors of poor sur-vival.

Clinicopathologic and molecular genetics features of mature aggressive B-cell lymphomas in pediatrics / 白血病·淋巴瘤

Objective To investigate the immunophenotype and molecular genetics of mature aggressive B-cell lymphomas in Chinese pediatric patients and provide the criteris for the diagnosis of them.Methods We collected 97 paraffin-embeded tissue samples of pediatric cases of mature aggressive B-cell lymphomas including 81 Burkitt lymphoma (BL) cases, 8 diffuse large B cell lymphoma (DLBCL) cases and 8unclassifiable B cell lymphoma with featares intermediate between BL and DLBCL (BL/DLBCL) cases. The immunophenotype and genetic features of them were detected by immunohistochemistry and interphase FISH.Results The expression of bcl-2 [3 %(2/66) in BL, 50 % (4/8) in DLBCL, 50 % (4/8) in BL/DLBCL], MUM1 [17 % (12/71) in BL, 63 % (5/8) in DLBCL, 63 % (5/8) in BL/DLBCL] and mean Ki-67 proliferation index [(93±4.4)% in BL, (83±14.3)% in DLBCL, (80±11.5)% in BL/DLBCL] were significantly different between BL and DLBCL and between BL and BL/DLBCL. The frequency of c-myc rearrangement [98 % (79/81) in BL,38 % (3/8) in DLBCL, 50 % (4/8) in BL/DLBCL] and an extra copy of bcl-6 [0 % in BL, 38 % (3/8) in DLBCL, 25 % (2/8) in BL/DLBCL] were also significantly different between BL and DLBCL and between BL and BL/DLBCL. Conclusion Diagnosis of the mature aggressive B cell lymphomas in pediatrics should be based on the comprehensive review and integration of morphologic, immunohistochemical and molecular genetic features. BL/DLBCL is more likely a subgroup of the DLBCL in pediatric population. The expression of CD10 and bcl-6 but not bcl-2, a high Ki-67 PI (＞90 %) and a c-myc rearrangement but not bcl-2 or bcl-6rearrangement are the features of BL. Regardless of the expression of CD10 and bcl-6, positive staining for bcl2, Ki-67 PI below 90 % and an extra copy of the bcl-6 favor a diagnosis of DLBCL or BL/DLBCL.