De objeto da pulsão a objeto-fonte da pulsão: um imperativo epistemológico / From drive object to source of drives object: An epistemological imperative / D'objet de la pulsion à objet-source de la pulsion: un impératif épistémologique / Del objeto de la pulsión al objeto fuente de la pulsión: un imperativo epistemológico

A sexualidade humana, no que se refere à identidade sexual e à escolha de objeto, situa-se no campo do psíquico, ou seja, da pulsão, expressando-se pela fantasia. Sua instalação é precoce, ocorrida ao tempo da sedução da criança pelo adulto, num tempo complexo que conjuga fundação do inconsciente, nascimento da pulsão e instalação do objeto a partir de fora, na chamada situação antropológica fundamental. Como já demonstrado pelo fracasso nas tentativas científicas de encontro de determinantes genéticas para a identidade sexual, o discurso a incidir sobre a sexualidade humana sai definitivamente do campo do natural rumo ao campo do psíquico. Tal constatação implicou, a partir da psicanálise, um remanejamento na própria esfera da epistemologia, de modo análogo à revolução que a antropologia já havia operado ao definir objeto da cultura também fora do campo da natureza.

Human sexuality, with regards to sexual identity and object choice, is located in the psychic field, that is, the drive, expressing itself through fantasy. It starts early, when as a child, one is enchanted by an adult, a complex time that combines the foundation of the unconscious, the drive start and the installation of the object from the outside, in the so-called fundamental anthropological situation. As shown by the failure in scientific attempts to find genetic determinants for sexual identity, the discourse on human sexuality clearly leaves the realm of nature for the psychic. Such observation implied, in the field of psychoanalysis, a shift in epistemology similar to the revolution that anthropology had already operated by defining culture as object outside of nature.

La sexualité humaine, en ce qui concerne l'identité sexuelle et le choix d'objet, se situe dans le champ du psychique, c'est-à-dire de la pulsion, s'exprimant par le fantasme. Son installation est précoce, lorsque, enfant, on est enchanté par un adulte - une époque complexe qui conjugue la fondation de l'inconscient, la naissance de la pulsion et l'installation de l'objet à partir du dehors, dans ce que l'on appelle une situation anthropologique fondamentale. Comme l'a déjà démontré l'échec des tentatives scientifiques pour trouver des déterminants génétiques de l'identité sexuelle, le discours sur la sexualité humaine quitte définitivement le domaine de la nature pour celui du psychique. Cette conclusion impliquait, à partir de la psychanalyse, un remaniement dans la sphère même de l'épistémologie, de manière analogue à la révolution que l'anthropologie avait déjà opérée en définissant l'objet de la culture hors du champ de la nature.

La sexualidad humana, en lo que se refiere a la identidad sexual y a la elección del objeto, se sitúa en el campo psíquico, es decir, el de la pulsión, expresándose a través de la fantasía. Su instalación es precoz al ocurrir en el momento de la seducción del niño por el adulto, en un momento complejo que conjuga la fundación del inconsciente, el nacimiento de la pulsión y la instalación del objeto desde el exterior, en la llamada situación antropológica fundamental. Como ya lo ha demostrado el fracaso en los intentos científicos de encontrar determinantes genéticos para la identidad sexual, el discurso que incide sobre la sexualidad humana sale definitivamente del campo natural al campo de lo psíquico. Tal constatación implicó, a partir del psicoanálisis, una reformulación en la propia esfera de la epistemología, análoga a la revolución que la antropología ya había operado al definir el objeto de la cultura también fuera del campo de la naturaleza.

Accuracy of three-dimensional soft tissue profile prediction in orthognathic surgery.

PURPOSE: To evaluate the accuracy of three-dimensional (3D) soft tissue prediction in bimaxillary orthognathic surgery. METHODS: Cone-beam computed tomographs of 88 patients with class II (n = 46) and class III (n = 42) malocclusions, who underwent bimaxillary orthognathic surgery, were included in this retrospective study. 3D soft tissue prediction and postoperative outcome were compared by using ten landmarks of facial soft tissues. Patients' sex and age were also assessed. Results were analyzed using a mixed model methodology (p < 0.05). RESULTS: The success criterion adopted was a mean discrepancy of < 2 mm. Most mandibular landmarks indicated a tendency for underprediction with a downward direction in class II patients, with some values > 2 mm. In class III, there was overprediction with a downward direction for the mandibular landmarks, with values < 2 mm. More accurate results were found in female and older patients. CONCLUSIONS: 3D surgical planning showed clinically acceptable results for predicting soft tissues in patients undergoing bimaxillary orthognathic surgery, with more accurate results for class III patients. Although some differences were found when age and sex were interacted, a consistent association between these variables could not be stated. These results support the clinician, as accuracy can provide a strong guide to the surgeon when planning surgical orthodontic treatment.

A comparative study of the accuracy between two computer-aided surgical simulation methods in virtual surgical planning.

OBJECTIVE: The aim of this retrospective and observational study was to compare the accuracy of two different virtual surgical planning (VSP) protocols, namely, the CASS method and the modified CASS method. MATERIALS AND METHODS: The patients underwent bimaxillary orthognathic surgery, planned using either the CASS method or the modified CASS method. Linear and angular discrepancies between the VSP outcome and postoperative outcome for both groups were compared for maxilla, mandible, and chin segments. Aside from the comparison between both groups, additional criteria were used to determine the accuracy of the protocol based on a linear and angular difference between planned and actual outcomes of less than 2 mm and 4°, respectively. The intergroup comparisons were performed by one-way ANOVA, with the level of significance set at 5%. RESULTS: A total of 21 patients, of both genders, were assigned into group I (n = 11), planned with the CASS method, and group II (n = 10), planned with the modified CASS method. Both the CASS and modified CASS methods presented similar accuracy with regard to linear differences for the maxilla, mandible, and chin segments, except for ΔX for the mandibular segment, where the modified CASS method showed slightly better accuracy. However, there was a statistically significant difference with regard to angular differences in the chin segment, with the CASS method shown to be the more accurate. Aside from Δpitch for the chin segment, no linear or angular differences exceeded 2 mm or 4°. CONCLUSION: Although statistically significant differences were found with regard to angular measurements in the chin segment, the accuracy of the modified CASS method for virtual planning can be considered as clinically equivalent, with a performance comparable to that of the CASS method.

Accuracy of 3D virtual surgical planning for maxillary positioning and orientation in orthognathic surgery.

OBJECTIVE: This retrospective and observational study evaluated the accuracy of a 3D virtual surgical planning (VSP) for the maxillary positioning and orientation in patients undergoing bimaxillary orthognathic surgery, comparing the planned and postoperative outcomes. SETTING AND SAMPLE POPULATION: Seventy consecutive patients of both sexes, who were submitted to bimaxillary orthognathic surgery between 2015 and 2019 were included in our study. MATERIAL AND METHODS: The patients were evaluated by fusing preoperative planning and postoperative outcome using cone-beam computed tomography scan evaluation. Three-dimensional VSP and postoperative outcomes were compared by using three linear and three angular measurements. The main outcome interest was the difference between the VSP movement, and the surgical movement obtained. The success criterion adopted was a mean linear difference of <2 mm and a mean angular difference of <4°. RESULTS: Results were analysed using a linear mixed model with fixed and random effects, at α = .05. No significant statistical differences were found for linear and angular measurements between the planned and postsurgical outcomes (P > .05). All overlapping points presented values within the range considered clinically irrelevant (<2 mm; <1°). CONCLUSIONS: Three-dimensional VSP was executed with a high degree of accuracy. When comparing the planned and postsurgical outcomes, all overlapping points presented values within the range considered clinically irrelevant.

Strategy for Optimizing Airway Volume With Genioglossal Advancement Using Cutting Guide in the Treatment of Obstructive Sleep Apnea.

The genioglossus advancement muscle is a technique used to treat obstructive sleep apnea and depends on the precise location of the muscle insertion into the geniotubercle. The aim of this article was to present a case report about a 38-year-old male patient with obstructive sleep apnea even after undergoing uvulopalatopharyngoplasty and mentoplasty. A maxillo-mandibular advancement and genioglossus was proposed, for this a virtual planning of the surgical guide was done using a specialized software. The great advantage is to reduce the osteotomy by focusing precisely on the insertion of the muscle. The cutting guide facilitated the surgical procedure in all aspects and brought safety.

Dentofacial Deformities and Implications on Quality of Life: A Presurgical Multifactorial Analysis in Patients Seeking Orthognathic Surgical Treatment.

PURPOSE: The purpose was to perform a quality-of-life survey in patients with skeletal malocclusion before undergoing orthognathic surgery, as well as delineate the sociodemographic profile and detect factors that may alter the quality of life. PATIENTS AND METHODS: This cross-sectional study was carried out in patients who sought care at the Hospital das Clínicas of the University of São Paulo Medical School (N = 106; average age, 27.2 years). Participants answered the Oral Health Impact Profile 14 (OHIP-14) questionnaire and Orthognathic Quality of Life Questionnaire (OQLQ). The χ2 or Fisher test was used to verify the association between impact and sociodemographic variables. RESULTS: On the Oral Health Impact Profile 14 (OHIP-14) questionnaire, the "psychological incapacity" dimension (64.15%) presented a higher prevalence of impact. The marital status of the interviewees had a statistically significant effect on the impact of quality of life (P = .0119). On the Orthognathic Quality of Life Questionnaire (OQLQ), the "facial esthetics" dimension represented 81.13% in the prevalence of impact on quality of life. The "gender" variable had a statistically significant effect on the quality of life of the respondents (P = .0005), with women having an 11.78 times greater chance of having this impact. CONCLUSIONS: In this study, psychological factors and esthetics exerted a strong influence on the quality of life of patients with dentofacial deformities, overlapping with functional aspects.

Vertical bone augmentation of posterior mandibular region: a description of two surgical techniques / Aumento ósseo em altura da região mandibular posterior: descrição de duas técnicas cirúrgicas

ABSTRACT Correction of severe vertical bone deficiency in the posterior region of mandibular alveolar ridge requires surgical management if implants are scheduled and cannot have primary stability. The aim of the present study is to report two cases; one treated with alveolar osteogenesis distraction and the other with segmental osteotomy with autologous graft interposition, by describing the surgical steps as well as show the results and experiences acquired with these techniques. We opted for these methods to reconstruct the posterior mandibular region after remarkable vertical bone loss based mainly by the height and thickness of the remaining bone. Alveolar osteogenic distraction is highly advisable when vertical deficiency is severe, and if these cases are treated with the segmental osteotomy and autologous graft interposition, complications as graft failure, necrosis and resorption are more prone to occur due to insufficient vascularization. After bone maturation and bone neoformation secondary to alveolar osteogenic osteogenic distraction and segmental osteotomy with autologous graft interposition, respectively, the two presented case reports were able to securely receive dental implants. In cases of vertical bone loss of the posterior mandibular region, both surgeries currently represent the best choice for bone gain prior dental implants placement for oral rehabilitation, without technical challenges, although biological evidence to assure the superiority of one technique over the other must be further investigated.

RESUMO A correção de deficiência óssea severa em altura na região posterior do rebordo alveolar da mandíbula requer tratamento cirúrgico caso a inserção de implantes dentários seja necessária e não se pode ter uma estabilidade primária. O objetivo do presente estudo é relatar dois casos; um tratado com distração osteogênica alveolar e o outro com osteotomia segmentar associada à interposição de um enxerto autógeno, descrevendo a sequência cirúrgica, bem como mostrar os resultados e as experiências adquiridas com essas técnicas. Optamos por esses métodos para reconstruir a região mandibular posterior baseados principalmente na altura e espessura óssea remanescentes. A distração osteogênica alveolar é altamente recomendável quando essa deficiência é avançada e, se esses casos são tratados com a osteotomia segmentar e interposição de enxerto autógeno, complicações como falha do enxerto, necrose e reabsorção são mais prováveis de ocorrer devido à vascularização sua insuficiente. Após os períodos de reparação e neoformação óssea secundária à distração osteogênica alveolar e à osteotomia segmentar com interposição de enxerto autógeno, respectivamente, os dois casos relatados estavam aptos a receberem seguramente os implantes dentários. Nos casos de perda óssea em altura na região mandibular posterior, ambas as cirurgias representam, atualmente, a melhor escolha para o ganho de estrutura óssea antes da colocação dos implantes dentários e reabilitação oral, sem muita complexidade quanto à técnica cirúrgica, embora ainda sejam necessário estudos posteriores para assegurar a superioridade de uma técnica em relação a outra.

Reparação volêmica na criança queimada / Fluid resuscitation in burned child

A queimadura é dos acidentes mais frequentes em Pediatria, com altas taxas de mortalidade.As complicações mais frequentes são o choque hipovolêmico, a desnutrição progressiva e as infecções. Este artigo faz uma revisão sobre a abordagem do choque hipovolêmico na criança queimada em relação à sua fisiopatologia e as diversas modalidades de tratamento, discutindo as suas vantagens e desvantagens.

Burns are the most frequent accidents in Pediatrics, with high mortality rates. The most frequent complications are a hypovolemic shock, progressive malnutrition, and infections.This article is a review of the hypovolemic shock approach in the burned child in relation to his pathophysiology and the various treatment modalities, discussing their advantages and disadvantages.

Vida e morte da palavra / Life and deth of the world

O artigo parte de uma discussão sobre o significado possível da ideia de vida da palavra para, em seguida, tratar das condições de sua morte. Para tanto, faz um levantamento das situações que levam ao desinvestimento da simbolização no desenvolvimento ontológico, relacionadas às diversas categorias psicopatológicas e sua incidência sobre a linguagem. Acrescenta a isso as patologias decorrentes das situações traumáticas para além do período da infância. Conclui tratando da especificidade da clínica psicanalítica nos casos em que, para além da interpretação, a função expressiva tem de ser reanimada.

The essay begins with a discussion of the possible sense of "words life", to treat then the conditions of their death. To do so, it makes an inventory of the situations that lead to the divestment of symbolization in ontological development related to various psychopathological categories and their impact on language. Add to that the pathologies resulting from traumatic situations beyond the period of infancy. Concludes dealing with specific psychoanalytic clinical where, in addition to the interpretation, the expressive function has to be resuscitated.

Transmissão e formação: apontamentos sobre o tripé analítico / Transmission and training: notes on the analytical tripod / Transmisión y formación: notas sobre el trípode analítico

O trabalho parte da experiência da transmissão da psicanálise e da formação psicanalítica no Departamento de Psicanálise do Instituto Sedes Sapientiae para apresentar os fundamentos teóricos do chamado tripé analítico. Defende que um projeto institucional de formação deve se alicerçar em convicções epistemológicas acerca do objeto da psicanálise, do fazer analítico e das condições institucionais adequadas. Todos os elementos do tripé devem, de diferentes maneiras, produzir efeitos analíticos. Além disso, os dispositivos institucionais subjacentes à formação devem funcionar de forma solidária ao tripé, criando um ambiente que seja acolhedor, mas que não favoreça a alienação.(AU)

This paper stems from the psychoanalytical transmission experience and training in the Psychoanalysis Department of Sedes Sapientiae Institute, in order to present the theoretical grounds of the so-called analytical tripod. The paper claims that an institutional project on psychoanalytical training should be grounded on epistemological convictions about the object of psychoanalysis, the analytical practice and the appropriate institutional conditions. All the elements of the tripod should result in analytical effects. Moreover, the subjacent institutional devices should also work in agreement with the tripod, creating a friendly atmosphere, however not leading to alienation.(AU)

El trabajo toma como base la experiencia de transmisión del psicoanálisis y la formación psicoanalítica del Departamento de Psicoanálisis del Instituto Sedes Sapientiae, para presentar los fundamentos teóricos del llamado trípode analítico. Sostiene que un proyecto institucional de formación psicoanalítica debe basarse en convicciones epistemológicas sobre el objeto del psicoanálisis, del hacer analítico y de condiciones institucionales adecuadas. Todos los elementos del trípode deben, en diferentes formas, producir efectos analíticos. Además, los dispositivos institucionales subyacentes a la formación deben trabajar de manera solidaria con el trípode, creando un ambiente acogedor, pero que no favorezca la alienación.(AU)

Transmissão e formação: apontamentos sobre o tripé analítico / Transmission and training: notes on the analytical tripod / Transmisión y formación: notas sobre el trípode analítico

O trabalho parte da experiência da transmissão da psicanálise e da formação psicanalítica no Departamento de Psicanálise do Instituto Sedes Sapientiae para apresentar os fundamentos teóricos do chamado tripé analítico. Defende que um projeto institucional de formação deve se alicerçar em convicções epistemológicas acerca do objeto da psicanálise, do fazer analítico e das condições institucionais adequadas. Todos os elementos do tripé devem, de diferentes maneiras, produzir efeitos analíticos. Além disso, os dispositivos institucionais subjacentes à formação devem funcionar de forma solidária ao tripé, criando um ambiente que seja acolhedor, mas que não favoreça a alienação...

This paper stems from the psychoanalytical transmission experience and training in the Psychoanalysis Department of Sedes Sapientiae Institute, in order to present the theoretical grounds of the so-called analytical tripod. The paper claims that an institutional project on psychoanalytical training should be grounded on epistemological convictions about the object of psychoanalysis, the analytical practice and the appropriate institutional conditions. All the elements of the tripod should result in analytical effects. Moreover, the subjacent institutional devices should also work in agreement with the tripod, creating a friendly atmosphere, however not leading to alienation...

El trabajo toma como base la experiencia de transmisión del psicoanálisis y la formación psicoanalítica del Departamento de Psicoanálisis del Instituto Sedes Sapientiae, para presentar los fundamentos teóricos del llamado trípode analítico. Sostiene que un proyecto institucional de formación psicoanalítica debe basarse en convicciones epistemológicas sobre el objeto del psicoanálisis, del hacer analítico y de condiciones institucionales adecuadas. Todos los elementos del trípode deben, en diferentes formas, producir efectos analíticos. Además, los dispositivos institucionales subyacentes a la formación deben trabajar de manera solidaria con el trípode, creando un ambiente acogedor, pero que no favorezca la alienación...

Effectiveness of surgical decompression in the treatment of a calcifying cystic odontogenic tumor.

The calcifying odontogenic cystic tumor (CCOT) is a benign lesion of odontogenic origin characterized by an ameloblastoma-like epithelium with ghost cells that may calcify. Despite broadly considered as a cyst, some investigators prefer to classify it as a neoplasm. Clinically, it occurs predominantly during the third decade of life. No difference in gender prevalence has been observed nor predilection of the lesion between maxilla and mandible. The most affected region extends from the incisor tooth to bicuspids. The classic treatment of the lesion is full excision, although a different approach may be determined by the possible association with another odontogenic tumor. Depending on the tumor size and the vicinity with important structures, decompression may be undertaken before its complete removal. The present report describes a case of CCOT with large proportions, located at the right maxilla and extending to the maxillary sinus, nasal cavity, and orbital floor. The treatment option was surgical decompression as the initial procedure, with satisfactory outcome. After partial remission, the lesion was fully removed, and the post-operative follow-up was uneventful.

Nasotracheal tube wire support: a safety device in maxillofacial surgery technical note after five years of experience.

A well fixed endotracheal tube is essential for safety during general anesthesia. In maxillofacial surgeries, securely fixing a nasotracheal tube in place has always been problematic. The aim of this article is to describe a simple but effective technique to fasten the nasotracheal tube using a wire support that allows a full range of head movement without interference in the surgical field. During the last 5 years, this device was successfully used in almost two hundred patients with very few complications.

As entrevistas iniciais e a escolha da técnica / Preliminary interviews and the choice of technique / Las entrevistas preliminares y la elección de la técnica

As entrevistas iniciais em psicanálise têm uma finalidade diagnóstica ampla, que não se reduz à classificação do paciente dentro de quadros nosográficos da psicopatologia. Desde Freud, entretanto, a preocupação com a diferenciação entre o neurótico e o psicótico sempre teve uma ênfase mais forte. Autores de diversas escolas ampliaram e enriqueceram uma teoria da entrevista, colaborando com a passagem do procedimento empírico a uma investigação com base epistemológica. No presente artigo, defende-se o valor do conceito de singularidade idiopática, de Maurice Dayan, na avaliação do funcionamento psíquico nas entrevistas iniciais e na consequente escolha da técnica a ser empregada no trabalho da análise.

Preliminary interviews in psychoanalysis have a broad diagnostic purpose, which is not reduced to the classification of the patient within frames of nosographic psychopathology. Since Freud, however, the effort in differentiating neurotic from psychotic has always had a stronger emphasis. Authors from various schools expanded and enriched a theory of the interview, collaborating with the passage from an empirical procedure to an epistemological investigation. The present paper defends the value of Maurice Dayan's concept of idiopathic singularity for the evaluation of psychic functioning in the preliminary interviews and the consequent choice of the technique to be employed in the work of analysis.

Las entrevistas preliminares en el psicoanálisis tienen objetivos de diagnóstico amplios, que no se reducen a la clasificación del paciente dentro de los cuadros nosográficos de la psicopatología. Desde Freud, sin embargo, la preocupación por la diferenciación entre neuróticos y psicóticos siempre tuvo un énfasis más fuerte. Autores de diversas escuelas han ampliado y enriquecido la teoría de la entrevista, colaborando con el paso del procedimiento empírico a una investigación con base epistemológica. En el presente trabajo se defiende el valor del concepto de singularidad idiopática, de Maurice Dayan, en la evaluación del funcionamiento psíquico en las entrevistas preliminares y en la consecuente elección de la técnica a ser empleada en el trabajo de análisis.

Biological detoxification of different hemicellulosic hydrolysates using Issatchenkia occidentalis CCTCC M 206097 yeast.

This work had as its main objective to contribute to the development of a biological detoxification of hemicellulose hydrolysates obtained from different biomass plants using Issatchenkia occidentalis CCTCC M 206097 yeast. Tests with hemicellulosic hydrolysate of sugarcane bagasse in different concentrations were carried out to evaluate the influence of the hydrolysate concentration on the inhibitory compounds removal from the sugarcane bagasse hydrolysate, without reduction of sugar concentration. The highest reduction values of inhibitors concentration and less sugar losses were observed when the fivefold concentrated hydrolysate was treated by the evaluated yeast. In these experiments it was found that the high sugar concentrations favored lower sugar consumption by the yeast. The highest concentration reduction of syringaldehyde (66.67%), ferulic acid (73.33%), furfural (62%), and 5-HMF (85%) was observed when the concentrated hydrolysate was detoxified by using this yeast strain after 24 h of experimentation. The results obtained in this work showed the potential of the yeast Issatchenkia occidentalis CCTCC M 206097 as detoxification agent of hemicellulosic hydrolysate of different biomass plants.

A somatização no campo da psicopatologia não-neurótica / Psichosomatics in the field of non-neurotic psychopathology

O trabalho trata do estatuto do corpo em psicanálise, partindo do conceito de neurose atual, e procurando analisar as razões pelas quais Freud o foi deixando de lado. A seguir, partindo das idéias de autores pós-freudianos ligados à escola francesa de psicossomática, são propostas articulações entre as neuroses atuais e os conceitos freudianos de trauma e pulsão de morte. Por fim, examina-se o aproveitamento clínico desta empreitada. Grosso modo, defende-se a idéia de que o corpo, em psicanálise, trata-se essencialmente de um "resto", e que tal “resto” é simultaneamente resto da teoria - aquilo que foi, num determinado momento, abandonado como objeto psicanalítico - e “resto” do sujeito psíquico em sua ontogênese, ou seja, o seu patrimônio genético herdado, que fica aquém da formação de um sujeito psíquico fundado na linguagem (e, portanto, marcado pela simbolização), e cujo funcionamento obedece aos esquemas filogenéticos ainda não singularizados. Retoma-se, assim, a distinção entre corpo somático e corpo erógeno, marcada pela ação do apoio (Anlehnung), ou da subversão libidinal, conforme terminologia de C. Dejours.(AU)

The paper is about the status of the body in psychoanalysis, starting with the concept of actual neurosis and trying to assess the reasons as to why Freud ignored it. Next, based on the ideas of the post-Freudian authors connected to the French school of Psychosomatics, connections are proposed between actual neurosis and the Freudian concepts of trauma and Death Instinct. Lastly, the clinical progress of this undertaking is assessed. Simply put, the idea put forward is that in psychoanalysis the body is means essentially what is the “remainder” and that this “remainder” is at one and the same time the remainder of the theory - that which was abandoned, at a specific moment, as a psychoanalytic object - as well as the “remainder” of the psychic subject in his ontogenesis, in other words, his inherited genetic patrimony, which does not quite achieve the constitution of a psychic subject based on language (and therefore, characterized by symbolization) and which functions in accordance with the phylogenetic schemes that have not yet been categorized. This denotes a resumption of the distinction between somatic body and erogenous body characterized by the action of support (Anlehnung), or of libidinal subversion, as coined by C. Dejours.(AU)