Fragmentos de dois casos atendidos por Charcot: antecedentes ligados aos desejos de viajar e sintomas de esclerose múltipla / Fragments of two cases of patients treated by Charcot: background linked to desires to travel and multiple sclerosis symptoms

São apresentados dois fragmentos de casos inéditos atendidos por Jean-Martin Charcot (James Lévy e Sioen). Busca-se pensá-los a partir de considerações psicanalíticas acerca de flashes da história de dois jovens diagnosticados com esclerose múltipla, cujas experiências são marcadas pela fuga de onde estavam e pelos “desejos poderosos de viajar”. A trajetória das viagens, realizadas em momentos de mudanças que cada doente viveu, era marcada pelo surgimento de manifestações somáticas da esclerose múltipla. A discussão acerca do complexo de Édipo relaciona-se com uma espécie de manifestação comportamental, fortemente associada ao domínio de expressão do corpo doente.(AU)

Two fragments of unpublished cases attended by Jean-Martin Charcot (James Lévy and Sioen) are presented. We try to think of them from psychoanalytic considerations about flashes of the history of two young people diagnosed with multiple sclerosis, whose experiences are marked by the escape from where they were and the “powerful desires to travel”. The trajectory of travels, carried out at times of change experienced by each patient, was marked by the emergence of somatic manifestations of multiple sclerosis. The discussion about the Oedipus complex is related to a kind of behavioral manifestation, strongly associated with the sick body’s expression domain.(AU)

Caminhos de um caso acompanhado por Charcot: escrita, transferência e sexualidade no tratamento / Following on the trails of one of Charcot's patients: writing, transference and sexuality in clinical treatment / Caminos de un caso acompañado por Charcot: escrita, transferencia y sexualidad en el tratamiento / Chemins d'un cas accompagné par Charcot: écriture, transfert et sexualité dans le traitement

O descobrimento de manuscritos inéditos de Jean-Martin Charcot no Hospital da Pitié-Salpêtrière, em Paris, é apresentado a partir da pulsão episte-mofílica da pesquisadora e dos bibliotecários da Biblioteca Charcot, caraterística da sexualidade infantil, fundamental para a pesquisa. A transcrição, tradução e escrita do caso é analisada com base nos conceitos freudianos de transferência e sexualidade e na relação transferencial da pesquisadora com Freud e Charcot. O caminho investigativo feito por Charcot envolve a histeria e acontecimentos traumáticos como hipótese etiológica da esclerose múltipla. O caminho feito pela paciente acompanhada por Charcot, marcado pela escrita, também é atravessado pela transferência e pela sexualidade. Os sintomas no corpo de Joséphine Leruth, diagnosticada com esclerose múltipla, apresentam melhora em razão da relação transferencial que foi estabelecendo com Charcot.

Unpublished manuscripts by Jean-Martin Charcot have been discovered at the Hôpital Pitié-Salpêtrière in Paris. This was due to the epistemophilic drive of the researcher and librarians at the Bibliothèque Charcot, which is a characteristic of childhood sexuality and is essential in scientific research. The transcription, translation, and writing of the case study is analyzed, in this paper, based on the Freudian concepts of transference and sexuality, as well as on the transference relationship between the researcher who found the manuscripts and the father of psychoanalysis and, in turn, Freud's relationship to his master, Charcot, the father of neurology. The investigative trail that Charcot pursued proposes that hysteria, as well as traumatic events, makes up the etiological basis for multiple sclerosis. Charcot's patient's trajectory, which is marked by her writings, is also effected by the transference relations she established and by her sexuality. The symptoms on Joséphhine Leruth's body - she who was diagnosed with MS - present with signs of amelioration, as a function of the transference relationship she had established with Charcot.

El descubrimiento de manuscritos inéditos de Jean-Martin Charcot en el Hospital Pitié-Salpêtrière en París, que se presenta, tiene como base la pulsión epistemofílica de la investigadora y de los bibliotecarios de la Bibliothèque Charcot, característica de la sexualidad infantil, fundamental para la investigación. La transcripción, traducción y escritura del caso es analizada con base en los conceptos freudianos de transferencia y sexualidad y por la relación transferencial de la investigadora con el padre del psicoanálisis y con su maestro, Charcot, padre de la neurología. El camino investigativo seguido por Charcot involucra la histeria y acontecimientos traumáticos como hipótesis etiológicas de la esclerosis múltiple. El camino seguido por la paciente acompañada por Charcot, marcado por la escritura, también es atravesado por la transferencia y la sexualidad. Los síntomas en el cuerpo de Joséphhine Leruth, diagnosticada con EM presentan mejoras en función de la relación transferencial que se estableció con Charcot.

La découverte de manuscrits inédits de Jean-Martin Charcot dans l'Hôpital Pitié-Salpêtrière à Paris, présentée ici, s'est basée sur la pulsion épistémophilique, caractéristique de la sexualité infantile de la chercheuse et des bibliothécaires de la Bibliothèque Charcot, fondamentale pour la recherche. La transcription, la traduction et l'écriture du cas sont analysées à partir des concepts freudiens de transfert et de sexualité et de la relation transférentielle de la chercheuse avec le père de la psychanalyse et son maître, Charcot, père de la neurologie. La voie d'investigation de Charcot concerne l'hystérie et les événements traumatiques en tant qu'hypothèse étiologique de la sclérose en plaques. Le chemin emprunté par la patiente accompagnée par Charcot, marqué par l'écriture, est également traversé par le transfert et la sexualité. Les symptômes dans le corps de Joséphhine Leruth, diagnostiquée de la SP, montrent des améliorations en fonction de la relation de transfert qu'elle a peu à peu établie avec Charcot.

Enhanced inflammatory response following coronary stent implantation in stable angina patients.

BACKGROUND: Percutaneous coronary intervention (PCI) is associated with an increase in inflammatory activity. However, little is known about the association between the inflammatory response post-PCI and plaque morphology. The objective of this study was to characterize the inflammatory response following coronary stent implantation (CSI) of stable atherosclerotic plaques, according to plaque morphology. METHODS: The study population consisted of 62 patients with stable angina that had an elective indication of CSI. Immediately before CSI, the patients underwent intravascular ultrasound (IVUS) for determination of the predominant plaque morphology of the target lesion: calcified (C, n=15), fibrocalcified (FC, n=16), fibrolipidic (FL, n=16), or lipidic (L, n=15). Angiographic lesion types were also determined. Coronary sinus samples were collected at baseline (BL) and 15 min after CSI for measuring inflammatory mediators (IM): interleukin-6 (IL-6, in pg/ml), tumoral necrosis factor-alpha (TNF, in pg/ml), interferon-gamma (IFN, in IU/ml), and neopterin (N, in ng/ml). RESULTS: BL IL-6, TNF, IFN, and N were, respectively, for C plaques (mean+/-S.D.): 1.3+/-3.0, 8.0+/-3.5, 0.1+/-0.2, and 3.2+/-0.8; for FC plaques: 6.7+/-3.3, 1.9+/-2.0, 0.1+/-0.1, and 3.8+/-2.0; for FL plaques: 0.7+/-0.9, 8.7+/-4.3, 0.1+/-0.2, and 4.0+/-2.4; and, for L plaques: 1.9+/-2.8, 0.9+/-1.4, 0.0+/-0.1, and 5.2+/-3.3. After 15 min of CSI, percentual changes of IL-6, TNF, IFN, and N, respectively, were for C plaques: 43.8+/-19.6%, 7.7+/-5.5%, -7.5+/-5.3%, and -20.0+/-11.2%; for FC plaques: 7.7+/-5.5%, 168.4+/-56.9%, 311.1+/-159.9%, and 0%; for FL plaques: 147.5+/-16.1%*, 714.3+/-34.4%*, 116.1+/-9.9%*, and 3000.0+/-230.0%*; and, for L plaques: 147.7+/-14.4%*, 140.3+/-15.0%*, 131.6+/-11.9%*, and 2300.0+/-25.9%*. Moreover, B1 (n=28) and B2 (n=32) predominated and resulted in significant changes only for IL-6 and IFN, respectively. *P<0.05: 15 min vs BL. CONCLUSIONS: These data suggest that stable angina patients with predominant lipidic (L and FL) plaques present a greater inflammatory response after CSI in than those with predominant calcified (C and FC) plaques.

Gestão ambiental em organizações goianas: as representações dos trabalhadores / Environmental management in goianas organizations: the worker's representations

A presente pesquisa teve como objetivo levantar dados a respeito de organizações goianas que desenvolviam ações de Gestão Ambiental, enfocando a implantação dessas ações a partir das representações dos trabalhadores sobre os programas desenvolvidos pelas organizações onde atuavam. Para que o SGA (Sistema de Gestão Ambiental) seja efetivo, ele deve: estar integrado ao planejamento global da organização; ter envolvimento dos setores e pessoas responsáveis por sua implantação; refletir a política ambiental; e submeter-se a uma revisão periódica. Algumas organizações que implantam os SGA buscam apenas reconhecimento externo, e a questão ambiental assume papel secundário. Trata-se de um estudo de casos, de caráter descritivo e exploratório, realizado em parceria com a FIEG (Federação das Indústrias do Estado de Goiás) e a Agência Ambiental do Estado de Goiás. Foram coletados dados em 10 organizações goianas, e foram utilizadas a análise documental, a entrevista semi-estruturada e a análise gráfica do discurso. As representações dos trabalhadores indicaram motivos distintos para a implantação das ações e focalizaram as abordagens diferenciadas utilizadas para conscientizar ou sensibilizar os trabalhadores. Alguns afirmaram que conheciam o programa e que as atividades desenvolvidas eram adequadas; outros declararam que as ações priorizavam o cumprimento da legislação, com pouco investimento para a sensibilização ou para a implantação do programa, e que ele não gerou mudanças. Houve, ainda, declarações de desconhecimento do programa.

This research had as objectives obtain data concerning organizations which develop environmental management, focusing the implantation of the program and data concerning employees' perception about the environmental program. For the success of the program it is important that it is included into general planning of the organizations; and the worker's involvement in ali sectors of organization, and also developed a environmental policy to change behaviors and to be revised in some periods. Many organizations begin the implantation of environmental programs only looking for external benefits as develop a positive institutional image, and the environmental questions seems to take a secondary place. This research had been developed in 10 organizations, and used documental analysis and interview exploring five topics: involvement and policy; planning; implantation; evaluation and critical analysis and intervention. The discursive analysis had been used. Data indicates that some organizations had planned and invested in programs to implant and develop changes in process and workers involved, and others did not planned or developed actions to implant the programs, in these second ones, workers had declared that they did not know programs, actions or changes related to.

Evaluation of prognostic indexes in critical acute renal failure patients.

OBJECTIVE: To study different prognostic indexes in acute renal failure (ARF) patients admitted to an intensive care unit (ICU). DESIGN: Prospective, cohort study. Individual Severity Score-Acute Tubular Necrosis (ISS-ATN) obtained prospectively and retrospectively, Acute Physiologic and Chronic Health Evaluation (APACHE II) Score, APACHE II Risk, Lung Injury Score (LIS), and Number of Organ Failures (NOF) were calculated for each patient. The outcome analyzed was death in the ICU. Discrimination was evaluated by the area under the receiver operator characteristic curve (AUC). For calibration analysis, the chi-square goodness-of-fit test was used to compare predicted mortality, calculated by ISS-ATN (obtained prospectively or retrospectively) and APACHE II risk, with observed mortality. SETTING: ICU, São Rafael Hospital, Salvador-BA, Brazil. PATIENTS: Seventy-six ARF patients admitted to the ICU within 6 months. INTERVENTIONS: Surgical and medical procedures. MEASUREMENTS AND RESULTS: The observed AUC was 0.69 for LIS, 0.73 for prospective ISS-ATN, 0.75 for retrospective ISS-ATN, 0.76 for APACHE II Score, 0.78 for APACHE II Risk, and 0.88 for NOF. These areas were significantly different from 0.5 (p < .001). There was no difference between the observed and expected death rate calculated by ISS-ATN. However, APACHE II underestimated the observed mortality (p < .001). CONCLUSION: The prognostic indexes studied showed good discriminative power. However, APACHE II was not well calibrated in contrast to the good calibration of ISS-ATN.

Caracterização da resposta inflamatória após implante de stent em pacientes com angina estável: Papel do Ultrassom intracoronário / Characterization of the inflammatory response following coronary stent implantation in stable angina patients: role of intravascular ultrasound

Para avaliar a correlação entre a resposta inflamatória (RI) pós-implante de "stent" coronário (SC) e a composição de placa, 30 pacientes com angina estável (PAE) realizaram ultrassom intracoronário (UIC) antes do SC. As placas foram classificadas em calcificadas, fibrocalcificadas (FC), fibrolipídicas (FL) ou lipídicas. As lesões angiográficas também foram analisadas. Sangue do seio coronário foi coletado antes e 15 minutos depois do SC para a dosagem dos marcadores inflamatórios (MI): interleucina-6 (IL-6), fator de necrose tumoral-a, interferon-g (IFN) e neopterina. Todos os MI se modificaram significativamente apenas para as placas FC e FL. Apenas IL-6 e IFN aumentaram para as lesões B1 e B2. Assim, UIC foi capaz de identificar placas propensas a uma RI aguda de maior grau após SC em PAE.In order to access the correlation between the inflammatory response (IR) post-coronary stenting (CS) and plaque composition, 30 stable angina patients (SAP) underwent intravascular ultrasound (IVUS) before CS. Plaques were classified as calcified, fibrocalcified (FC), fibrolipidic (FL) or lipid. Angiographic lesion types were also analyzed. Coronary sinus blood was collected before and 15 minutes after CS for the measurement of inflammatory markers (IM): interleukin-6 (IL-6), tumoral necrosis factor-a, interferon-g (IFN) and neopterin. All IM changed markedly only for FC and FL plaques. Only lesions B1 and B2 resulted changes for IL-6 and IFN. Thus, IVUS is able to identify plaques prone to a greater acute IR following CS in SAP...

Implante de stens coronarianos em pacientes diabéticos versus näo diabéticos. Resultados imediatos e evoluçäo a longo prazo / Coronary stent implantation in diabetic versus nondiabetic patients. Early and late outcomes

OBJECTIVE: To assess whether coronary stenting in diabetic patients provides in-hospital results and clinical evolution similar to those in nondiabetic patients. METHODS: From July `97 to April '99 we performed coronary stent implantation in 386 patients with coronary heart disease, who were divided into two groups: diabetic patients and nondiabetic patients. The in-hospital results and the clinical evolution of each group were retrospectively analyzed. RESULTS: The nondiabetic group comprised 305 (79 percent) patients and the diabetic group 81 (21 percent) patients. Basic clinical and angiographic characteristics were similar. Angiographic success was in diabetics = 96.6 percent vs in nondiabetics = 97.9 percent (p=ns). Among the major complications in the in-hospital phase, the rate of myocardial infarction was higher in the diabetic group (7.4 percent vs 1.9 percent) (p=0.022). In the follow-up, a favorable and homogeneous evolution occurred in regard to asymptomatic patients, myocardial infarction, and death in the groups. A greater need for revascularization, however, existed in the diabetic patients (15 percent vs 2.4 percent, p<0.001). CONCLUSION: Coronary stenting in diabetic patients is an efficient procedure, with a high angiographic and clinical success rate similar to that in nondiabetic patients. Diabetic patients, however, had a higher incidence of in-hospital myocardial infarction and a greater need for additional myocardial revascularization