O grupo como aparelho para pensar os pensamentos: ferramenta ou ferra-mente / The group like the psychic apparatus of theory of thinking: tool (ferramenta) or fits the mind (ferra-mente)

O presente trabalho tem como objetivo refletir sobre as reuniões do grupo de psicoterapeutas do Setor Clínico do CEAPIA (Centro de Estudos, Atendimento e Pesquisa da Infância e da Adolescência) como uma ferramenta para pensar os pensamentos. Buscamos inicialmente percorrer o aporte teórico de Bion sobre a construção do aparelho psíquico, conceituar a supervisão e os movimentos que ocorrem dentro deste espaço de trocas somado a nossa experiência enquanto grupo. Através da exploração de um ato falho na construção deste artigo, concluímos que o movimento grupal oscila entre momentos em que é ferramenta para pensar os pensamentos e momentos em que ferra a mente dos integrantes do grupo. Salientamos que o grupo prevalece como ferramenta, o que faz com que nos mantenhamos coesos, unidos, produtivos e criativos

This article presents a review of findings from meetings of a group of psychotherapists from the department of Corpo Clínico of CEAPIA (Centro de Estudos, Atendimento e Pesquisa da Infância e da Adolescência). The purpose of these meetings was to explore the tool known as "ferramenta". Ferramenta is a like tool, Bion's theory of thinking. First, we discussed the theoretical contribution of Wilfred Bion's construction of the psychic apparatus and its influence on the movement and collective supervision of the group adding to our experience. Throught the exploration of a failed act during the construction of this article, the group members concluded the discussions oscillated between moments of "ferramenta" and moments in it which fits the minds of the members of the group. We emphasize that the group prevails as a tool which makes us stay cohesive, productive and creative

Preenchendo vazios e questionando enigmas: reflexões sobre o gênero / Filling blanks and questioning enigmas: reflections on gender

Este trabalho partiu do interesse de um grupo de mulheres terapeutas em questionar a falta de estudos de gênero dentro das instituições de orientação psicanalítica. Apresentamos a diferença entre o conceito de gênero usado pela Medicina/Psicanálise e pelas Ciências Sociais, distinguindo conceitualmente sexo, gênero e sexualidade. Interrogamos a patologização das novas expressões de gênero e sexualidade e apontamos a necessidade de uma contextualização histórico-cultural para sua compreensão. Utilizamos vinhetas para mostrar as consequências que o desconhecimento desse conceito pode acarretar na clínica. Concluímos que a aceitação acrítica de posições teóricas que não dão conta da realidade atual, mantém a feminilidade num lugar de enigma. Propomos às mulheres terapeutas o desafio de repensar a teoria e preencher os vazios teóricos sobre o feminino

This article has been originated from the interest of a group of female therapists, in questioning the lack of gender studies within the psychoanalytic oriented institutions. We present the difference between the concept of gender used by Medicine/Psychoanalysis and by the Social Sciences, conceptually distinguishing sex, gender and sexuality. We question the pathologization of new expressions of gender and sexuality an point towards the need of a cultural and historical conceptualization for a better comprehension of these factors. We present examples of situations experienced in the practice of psychotherapy to point out the consequences of which the lack of knowledge about these key concepts may lead to. The conclusion is that the uncritical acceptance of theoretical positions that do not account the current reality, keeps femininity still in the place of an enigma. We propose to female therapists the challenge of rethinking the theory and filling in the theoretical gaps on femininity

Diagnostic Yield of Video Capsule Endoscopy for Small Bowel Bleeding: Eight Consecutive Years of Experience at the VA Caribbean Healthcare System.

OBJECTIVE: To evaluate the diagnostic yield of video capsule endoscopy (VCE) in patients with small bowel gastrointestinal bleeding and examine the impact of this diagnostic technology on the clinical management of this complaint. METHODS: This was a retrospective study in which all patients who underwent VCE (May 7, 2003 - December 31, 2011) were included. Records were reviewed for the type of bleeding (overt vs. occult; when present), demographic data, lab results, and capsule endoscopy findings. Information regarding medical treatment (i.e., endoscopic intervention, surgical therapy, or both) was also recorded. RESULTS: A total of 229 subjects were included in the study. Most were men; the mean age of all the subjects was 69.8 years. Of the 229 VCEs, 154 (67.3%) were done because of occult bleeding and 75 (32%) because of overt bleeding. VCEs were normal in 34 (14.9%) cases and non-diagnostic in 15 (6.6%). Angiodysplasia, erosions, and ulcers were the most common findings (48.5%, 24.5%, and 10.92% respectively). Active bleeding was reported in 7 cases (3%). Nearly 20% of the 229 cases required either endoscopic or surgical intervention. CONCLUSION: In our study, VCE achieved a diagnostic yield of 78.6%. In 1 of every 5 subjects, video capsule endoscopy led to the identification of small bowel lesions that required either endoscopic or surgical resection, rather than conservative treatment with iron replacement. VCE proved to be a very useful investigative tool, not only for establishing the source of bleeding but also, most importantly, for directing the appropriate therapy for lesions that would otherwise have been missed by conventional studies.

Laparoscopic interval isthmocervical cerclage with cardiac tape in a patient with previous cervical amputation.

STUDY OBJECTIVE: To show the technique of interval laparoscopic isthmocervical cerclage using cotton cardiac tape. DESIGN: Case report (Canadian Task Force Classification III). SETTING: A private practice hospital in Brasília, Brazil. PATIENT: A 36-year-old female patient with primary infertility for 2 years caused by previous amputation of the cervix because of intraepithelial neoplasia. There was no other suspected factor for infertility. Before undergoing in vitro fertilization, she was referred for interval cerclage because of anticipated cervical insufficiency during an eventual pregnancy. The patient's clinical history was unremarkable, except for the fact that she had developed secondary dysmenorrhea since the amputation, which prompted her to undergo cervical dilatation on 2 occasions. During the physical examination, we noted the absence of the exocervix, a mobile and normal-sized uterus and adnexa, and no pain. Informed consent was obtained from the patient for this case report. The local institutional review board considered this report exempt from approval. INTERVENTIONS: The procedure was performed according to the technique described by Pereira et al. We incised the visceral peritoneum in the anterior cul-de-sac and developed the vesicouterine space for complete exposure of the uterine isthmus. Then, we incised the posterior leaf of both broad ligaments superiorly to the uterosacral ligaments and medially to the ureter and uterine vessels. We aimed to identify the bifurcation of the uterine artery and to create a "window" between them and the isthmus to place the cerclage tape. For this purpose, we used a 5-mm 36-cm blunt tip retractor for gastric banding (ref 30623G; Karl Storz, Tuttlingen, Germany) to transfix the broad ligament, anteriorly to posteriorly, under direct vision. We tied 2-0 Vicryl (Ethicon, Sommerville, NJ) sutures to the tips of 0.3 × 80 cm cotton cardiac tape (reference FAB-46; Ethicon) and pulled both edges of the tape through the windows in the broad ligament. The final position of the tape was inferior and medial to the main ascending branch of the uterine artery, right over the isthmus, and without any vessels interposed between them. This is to avoid any possible compression and congestion with uterine progressive enlargement as pregnancy proceeds. We then made 6 square knots in the anterior cul-de-sac and adjusted the tension-free tape firmly enough to give the uterine corpus support during pregnancy evolution. Finally, we closed the visceral peritoneum with a 3-0 PDS running suture (Ethicon). MEASUREMENTS AND MAIN RESULTS: The surgery lasted 70 minutes, and bleeding was minimal. The patient was discharged the following day. She is currently undergoing her 18th week of pregnancy resulting from in vitro fertilization treatment, and we wait for her obstetric results. CONCLUSION: Cotton cardiac tape is feasible for laparoscopic cerclage and can be used as an alternative to the commonly used Mersilene tape (Ethicon). Laparoscopy safely allows tape placement medial to the uterine vessels. Additional cases are necessary to establish the obstetric effectiveness of cotton cardiac tape for laparoscopic cerclage.

Condição de saúde bucal de crianças internas em hospitais da cidade de Maceió-AL / The state of oral health of children admitted to hospitals in Maceió, Alagoas- Brazil

O objetivo deste estudo foi determinar a prevalência de cárie dental, o índice de placa e a presença/ausência de lesões de tecidos moles em crianças hospitalizadas. Durante um período de 6 meses, 78 crianças hospitalizadas foram examinadas. A idade das crianças foram, 24 entre 3-5 anos e 54 entre 6-12 anos. Após 3 dias de hospitalização, foram determinados em cada criança, o ceo-d e CPO-D, o índice de placa e a presença/ausência de lesões de tecido moles. Todas as crianças pertenciam a famílias com baixo poder aquisitivo e foram hospitalizadas principalmente devidos a doenças pulmonares e gastrointestinais. A média de ceo-d foi 3.91 e o CPO-D foi de 1.21. O índice de placa foi muito alto e aumentou com o tempo de hospitalização. As gengivites (42 por cento) e os abscessos dentais (5 por cento) foram as doenças de tecidos moles mais frequentes. O padrão de saúde bucal nesta amostra de crianças é muito baixo e um programa preventivo-odontopediátrico é necessário para melhorar a saúde bucal daquelas crianças durante a hospitalização.

Psoriasis and pentoxifylline: a clinical, histopathologic, and immunohistochemical evaluation.

OBJECTIVE: The aim of this study was to examine the clinical and histopathologic effects of pentoxifylline on psoriasis, compared with placebo. METHODS: Sixty-one outpatients with active psoriasis were randomly assigned to either of 2 groups: one was given pentoxifylline 400 mg tid PO, and the other, placebo. Fifty-six patients concluded the study. They were evaluated clinically and by laboratory parameters before and after 8 weeks of treatment. Pretreatment and posttreatment biopsies were taken. Initial sections were stained with hematoxylin-eosin. Further cuts were immunostained for cytokeratins 10, 14, and 16. RESULTS: Clinical and histologic improvement did not show statistically significant differences between the groups. No laboratory abnormalities or serious reactions related to the drug were observed. CONCLUSIONS: No statistical difference was seen when the treatment group was compared with the control group. Pentoxifylline is a well tolerated and safe drug, but its efficacy in psoriasis appears to be limited.

Case for diagnosis

Paciente com 33 anos, sexo feminino, branca, babá, natural e residente no Rio de Janeiro, refere há 30 dias o surgimento de lesões eritemato-papulosas na face, de crescimento centrífugo, assintomáticas. Nega aparecimento anterior de outras lesões dermatológicas, sintomas gerais e adenomegalias. Foram realizados exames laboratoriais: hemograma completo, dosagem do cálcio, FAN, anti-HIV, exame do líquor e micológico, raio X do tórax sem alterações. As hipóteses diagnosticasforam: sífilis secundo-terciária, sarcoidose, hanseníase tuberculóide, dermatofitose no rosto, lúpus eritematosos, lúpus vulgar. Diante das lesões cutâneas, do resultando sorológico para lues e histopatológico, o diagnóstico proposto foi sífilis terciária, paciente foi tratada com penicilina benzatina 2400.000 UI em três doses, evoluindo com regressão completa das lesões