Os 100 anos de “Além do Princípio do Prazer” e as novas concepções sobre a pulsão de morte / 100th year of the text “Beyond the Pleasure Principle” and the new conceptions on death drive

O interesse teórico e clínico acerca dos desdobramentos da noção freudiana de pulsão de morte ressurge com intensidade em razão do advento dos 100 anos do texto Além do Princípio do Prazer, sobretudo para aqueles que se dedicam à escuta de sofrimentos relacionados ao vazio psíquico, ao tédio e à apatia. No presente artigo, a autora dedica-se a apreciar as construções metapsicológicas derivadas desse texto freudiano, dando ênfase ao pensamento de Sándor Ferenczi, Donald Winnicott, André Green e Michael Balint, assim como aos aspectos clínicos referentes à posição do analista na escuta de tais casos em que predomina a circulação do mortífero.(AU)

The theoretical and clinical interest regarding the development of the Freudian notion of death drive reappears with intensity due to the advent of the 100th year of the text Beyond the Pleasure Principle, especially for those who work in psychoanalytical clinic with patients suffering from boredom, apathy and psychic void. In this article, the author appreciates the metapsychological constructions derived from this Freudian text, emphasizing the theories of Sándor Ferenczi, Donald Winnicott, André Green and Michael Balint, as well as the clinical aspects regarding the analyst’s position in listening to such cases in which predominates the circulation of the death drive.(AU)

Sobre reveries, quimeras e pensamentos paradoxais: impasses no setting analítico e o trabalho criativo do analista / On reveries, chimeras and paradoxal thoughts: the deadlocks in the analytical setting and the analyst’s creative work

Neste artigo, busca a autora garimpar subsídios sobre o tema da reverie, a fim de aprofundar a compreensão sobre os elementos motivadores do surgimento de imagens estranhas na mente do analista no curso de processos de análise, como pictogramas afetivos (ROCHA BARROS, 2000), quimeras e pensamentos paradoxais (M’UZAN, 1976). Sustenta-se que tais imagens surgem para atender a uma demanda de trabalho criativo quando são vivenciadas ameaças aos processos de simbolização, assim como a esterilidade do campo analítico em razão de impasses decorrentes de traumas primitivos, desvitalizações ou movimentos resistenciais da dupla analítica. O processo analítico, nesses casos, assume a natureza de “incubadora de símbolos” (HARTKE, 2005).(AU)

In this article, the author seeks to find subsidies on the theme of reverie, in order to deepen the understanding of the motivating elements that result in the appearance of strange images in the analyst’s mind during analysis, such as affective pictograms (ROCHA BARROS, 2000), chimeras and paradoxical thoughts (M’UZAN, 1976). It is sustained that such images appear to meet a demand for creative work when threats to the symbolization processes are experienced, as well as the sterility of the analytical field due to impasses resulting from primitive traumas, devitalizations or resistive movements of the analytical duo. The analytical process, in these cases, assumes the nature of a “symbol incubator” (HARTKE, 2005).(AU)

Outcomes after stereotactic radiosurgery of brain metastases in patients with malignant melanoma and validation of the melanoma molGPA.

INTRODUCTION: Malignant melanoma is the third most common primary in the diagnosis of brain metastases. Stereotactic radiosurgery (SRS) is a well-established treatment option in limited brain disease. We analyzed outcomes of SRS with a particular focus on the graded prognostic assessment (GPA, melanoma molGPA), prognostic factors, and toxicity. METHODS: We evaluated 173 brain metastases in 83 patients with malignant melanoma. All were treated with SRS median dose of 20 Gy prescribed to the 80 or 100% isodose line between 2002 and 2019. All patients were followed-up regularly, including contrast-enhanced brain imaging as well as clinical examination, initially 6 weeks after treatment, then in quarterly follow-up. RESULTS: The median age was 61 years (range 27-80); 36 female and 47 male patients were treated. After a median follow-up of 5.7 months, median OS (overall survival) was 9.7 months 95%-KI 4.7-14.7). LC (local control) at 6 months, 12, 24 months was 89%, 86%, and 72%, respectively (median was not reached). Median DBC (distant brain control) was 8.2 months (95%-KI 4.7-11.7). For OS, a KPS ≥ 80%, a positive BRAF mutation status, a small PTV (planning target volume), the absence of extracranial metastases, as well as a GPA and melanoma molGPA > 2 were prognostic factors. In the MVA, a small PTV and a melanoma molGPA > 2 remained significant. CONCLUSION: The present survival outcomes support the use of the disease-specific melanoma molGPA as reliable prognostic score. Favorable outcomes for SRS compared to other studies were observed. In the treatment of brain metastases of malignant melanoma patients, a multidisciplinary approach consisting of surgery, SRS, chemotherapy, and immunotherapy should be considered.

A busca do entorpecimento e os sintomas de tédio e apatia na clínica psicanalítica / The search for numbness and the symptoms of boredom and apathy in the psychoanalytic clinic

Novos discursos na clínica psicanalítica, assim como manifestações não verbais apontam para a questão do entorpecimento e do empobrecimento da vida simbólica de analisandos. No presente artigo, a autora trata do tédio e da apatia e do uso de objetos, tais como seriados, filmes e games de caráter repetitivo, drogas e objetos de adicção que impedem o acesso à transicionalidade. Tais analisandos evitam o contato com a ausência, com o vazio e com a separação que permitiria que se constituíssem como ego unitário. Aborda-se, ainda, a ideia winnicottiana de reação à intrusão em razão da superoferta materna, discorrendo sobre o manejo de tais casos e a escuta própria a esses padecimentos.(AU)

New narratives in the psychoanalytical clinic as well as nonverbal manifestations point to the question of numbness and impoverishment of the symbolic life of analysands. In this article, the author approaches the theme of boredom and apathy and the use of objects such as TV series, films and repetitive games, drugs and other elements of addiction that prevent access to transitionality. Such analysands avoid awareness of absence, emptiness and separation necessary that would allow them to constitute themselves as a unitary ego. It addresses Winnicott’s idea of reaction to intrusion due to the excess of maternal attention and offer. It also deals with the handling of such cases and the proper listening to these ailments.(AU)

Novas construções em análise perante o vazio psíquico, o tédio e a apatia / New constructions in analysis in the face of psychic emptiness, boredom and apathy / Nuevas construcciones en análisis ante el vacío psíquico, o el tedio y la apatía / Nouvelles constructions en cours d'analyse face au vide psychique, à l'ennui et à l'apathie

RESUMO No texto "Construções em análise", Freud afirma que a tarefa do analista envolve uma atividade de construção, originária da complementação e da integração dos restos conservados da história do analisando. Neste artigo, sustenta-se que, além do modelo de 1937, existem outras formas de construção em análise, concebidas a partir da relação da dupla analista-analisando e decorrentes do vínculo transferencial. Essas construções repercutem na simbolização primária e na elaboração de novas narrativas sobre o vazio psíquico. Propõe-se que, nos casos de vazio psíquico, tédio e apatia, o analista há de se envolver em um trabalho de construção para revitalizar a cena analítica, propiciar uma rota de simbolização do material cindido do analisando e contribuir para que a análise funcione como um espaço potencial para esse fim. Exemplifica-se tal manejo com um caso clínico da chamada síndrome da resignação.

ABSTRACT In the text Constructions in Analysis, Freud (1937/2018) states that the task of the analyst involves a construction activity, originating from the "complementation" and "integration of surviving remains" of the analysand's history. The aim of this article is to argue that, besides this 1937 model, there are also other forms of constructions in analysis, conceived from the relationship between analyst-analysand and resulting from the transference-countertransference link - constructions that generate repercussions on primary symbolization and the elaboration of new narratives about the psychic void. It is proposed that, in cases of psychic emptiness, boredom and apathy, the analyst should engage in a constructive work to revitalize the analytic scene, providing a route of symbolization of the analysand's split material and contributing to the analysis functioning as a potential space for that purpose. Such management is exemplified with a clinical case of the so-called Resignation Syndrome.

RESUMEN En el texto "Construcciones en análisis", Freud afirma que la tarea del analista envuelve una actividad de construcción, que tiene origen en la complementación y la integración de los restos conservados de la historia del analizado. En este artículo, se sostiene que, además del modelo de 1937, existen otras formas de construcción en análisis, concebidas a partir de la relación entre el dúo analista-analizado y decurrentes del vínculo transferencial. Estas construcciones repercuten en el simbolismo primario y en la elaboración de nuevas narrativas sobre el vacío psíquico. Se propone que, en los casos de vacío psíquico, tedio y apatía, el analista se envolverá en un trabajo de construcción para revitalizar la escena analítica, propiciar una ruta de simbolismo del material escindido del analizado y contribuir para que el análisis funcione como un espacio potencial para esa finalidad. Se ejemplifica tal manejo con un caso clínico de la llamada síndrome de la resignación.

RÉSUMÉ Dans le texte Constructions en analyse, Freud (1937/2018) affirme que la tâche de l'analyste implique une activité de construction, qui découle de la «complémentation¼ et de « l'intégration de vestiges conservés ¼ de l'histoire de l'analysant. Dans cet article, on soutient que, outre ce modèle de 1937, il existe aussi d'autres formes de constructions en cours d'analyse, conçues à partir de la relation entre l'analyste et l'analysant et résultant du lien transfert / contre-transfert, constructions qui ont des répercussions sur la symbolisation primaire et l'élaboration de nouveaux récits concernant le vide psychique. Il est proposé que, dans les cas de vide psychique, d'ennui et d'apathie, l'analyste s'engage dans un travail de construction visant à revitaliser la scène analytique, à fournir une voie de symbolisation du matériel scindé de l'analysant et à contribuer au fonctionnement de l'analyse en tant qu'un espace potentiel à cet effet. Une telle gestion est illustrée par la mention d'un cas clinique du syndrome dit de résignation.

Tédio: três formas de manifestação na clínica psicanalítica / Boredom: three ways of manifestation in the psychoanalytic practice / El tedio: tres formas de manifestación en la clínica psicoanalítica / L'ennui: trois voies de manifestation dans la clinique psychanalytique

Neste artigo, defende-se que o tédio é uma entidade nosológica autônoma e que, apesar de existirem certas similaridades nas manifestações do tédio e da melancolia em alguns casos clínicos, há diferenças relevantes entre os dois. Sugere-se, ademais, que o tédio expressa-se sob diversas formas na clínica psicanalítica, propondo-se no artigo três modalidades de manifestação do tédio, que requerem diferentes manejos clínicos por parte do analista. Por fim, sustenta-se que estas modalidades de tédio fazem parte de um campo maior, sendo exteriorizações de adoecimentos psíquicos por passivação.

In this article, the authors advocate that boredom be considered an autonomous nosological entity. They suggest that there be relevant differences between the manifestations of boredom and melancholia, even though some similarities in their manifestations may be noticed in some clinical cases. The authors also suggest that boredom may be expressed in different ways in the psychoanalytic practice. They specifically study three ways of expressing boredom which require different techniques to be used by the psychoanalyst in his clinical practice. Finally, authors understand that these forms of boredom belong to a larger field, as they are externalizations of psychic illnesses by passivation.

En este artículo, se defiende que el aburrimiento es una entidad nosológica autónoma y que, a pesar de existir ciertas similitudes en las manifestaciones del aburrimiento y de la melancolía en algunos casos clínicos, hay diferencias relevantes entre los dos. Se sugiere, además, que el aburrimiento se manifiesta bajo diversas formas en la clínica psicoanalítica, proponiéndose en el artículo tres modalidades de manifestación del aburrimiento, que requieren diferentes manejos clínicos por parte del analista. Por último, se sostiene que estas modalidades de aburrimiento forman parte de un campo mayor, siendo exteriorizaciones de adicciones psíquicas por pasivación.

Dans cet article, on soutient que l'ennui est une entité autonome de la nosologie et que, bien qu'il existe des similitudes dans les manifestations de l'ennui et de la mélancolie dans certains cas cliniques, des différences notables sont constatées entre les deux. En outre, il est suggéré que l'ennui se présente dans la clinique psychanalytique sous différentes formes. L'article en propose donc trois modalités requérant manipulations différentes de la part de l'analyste. Enfin, on défend que ces modalités de l'ennui, extériorisations de maladies psychiques par passivation, appartiennent à un domaine plus large de l'étude psychanalytique.

XDS: a flexible beamline for X-ray diffraction and spectroscopy at the Brazilian synchrotron.

The majority of the beamlines at the Brazilian Synchrotron Light Source Laboratory (LNLS) use radiation produced in the storage-ring bending magnets and are therefore currently limited in the flux that can be used in the harder part of the X-ray spectrum (above ∼10 keV). A 4 T superconducting multipolar wiggler (SCW) was recently installed at LNLS in order to improve the photon flux above 10 keV and fulfill the demands set by the materials science community. A new multi-purpose beamline was then installed at the LNLS using the SCW as a photon source. The XDS is a flexible beamline operating in the energy range between 5 and 30 keV, designed to perform experiments using absorption, diffraction and scattering techniques. Most of the work performed at the XDS beamline concentrates on X-ray absorption spectroscopy at energies above 18 keV and high-resolution diffraction experiments. More recently, new setups and photon-hungry experiments such as total X-ray scattering, X-ray diffraction under high pressures, resonant X-ray emission spectroscopy, among others, have started to become routine at XDS. Here, the XDS beamline characteristics, performance and a few new experimental possibilities are described.

Na,K-ATPase: a molecular target for Leptospira interrogans endotoxin.

On the basis of our report that a glycolipoprotein fraction (GLP) extracted from Leptospira interrogans contains a potent inhibitor of renal Na,K-ATPase, we proposed that GLP-induced inhibition of Na,K-ATPase might be the primary cellular defect in the physiopathology of leptospirosis. The present study was designed to test this hypothesis by determining whether or not 1). GLP inhibits all the isoforms of Na,K-ATPase which are expressed in the tissues affected by leptospirosis, 2) Na,K-ATPase from leptospirosis-resistant species, such as the rat, is sensitive to GLP, 3) GLP inhibits Na,K-ATPase from intact cells, and 4) GLP inhibits ouabain-sensitive H,K-ATPase. The results indicate that in the rabbit, a leptospirosis-sensitive species, GLP inhibits with similar efficiency (apparent IC50: 120-220 micrograms protein GLP/ml) all isoforms of Na,K-ATPase known to be expressed in target tissues for the disease. Na,K-ATPase from rat kidney displays a sensitivity to GLP similar to that of the rabbit kidney enzyme (apparent IC50: 25-80 and 50-150 micrograms protein GLP/ml for rat and rabbit, respectively), indicating that resistance to the disease does not result from the resistance of Na,K-ATPase to GLP. GLP also reduces ouabain-sensitive rubidium uptake in rat thick ascending limbs (pmol mm-1 min-1 +/- SEM; control: 23.8 +/- 1.8; GLP, 88 micrograms protein/ml: 8.2 +/- 0.9), demonstrating that it is active in intact cells. Finally, GLP had no demonstrable effect on renal H,K-ATPase activity, even on the ouabain-sensitive form, indicating that the active principle of GLP is more specific for Na,K-ATPase than ouabain itself. Although the hypothesis remains to be demonstrated in vivo, the present findings are compatible with the putative role of GLP-induced inhibition of Na,K-ATPase as an initial mechanism in the physiopathology of leptospirosis.

Na, K-ATPase: a molecular target for Leptospira interrogans endotoxin

On the basis of our report that a glycolipoprotein fraction (GLP) extracted from Leptospira interrogans contains a potent inhibitor of renal Na,K-ATPase, we proposed that GLP-induced inhibition of Na,K-ATPase might be the primary cellular defect in the physiopathology of leptospirosis. The present study was designed to test this hypothesis by determining whether or not 1) GLP inhibits all the isoforms of Na,K-ATPase which are expressed in the tissues affected by leptospirosis, 2) Na,K-ATPase from leptospirosis-resistant species, such as the rat, is sensitive to GLP, 3) GLP inhibits Na,K-ATPase from intact cells, and 4) GLP inhibits ouabain-sensitive H,K-ATPase. The results indicate that in the rabbit, a leptospirosis-sensitive species, GLP inhibits with similar efficiency (apparent IC5O: 120-220 mug protein GLP/ml) all isoforms of Na,K-ATPase known to be expressed in target tissues for the disease. Na,K-ATPase from rat kidney displays a sensitivity to GLP similar to that of the rabbit kidney enzyme (apparent IC50: 25-80 and 50-150 mug protein GLP/ml for rat and rabbit, respectively), indicating that resistance to the disease does not result from the resistance of Na,K-ATPase to GLP. GLP also reduces ouabain-sensitive rubidium uptake in rat thick ascending limbs (pmol mm-1 min-1 ñ SEM; control: 23.8 ñ 1.8; GLP, 88 mug protein/ml: 8.2 ñ 0.9), demonstrating that it is active in intact cells. Finally, GLP had no demonstrable effect on renal H,K-ATPase activity, even on the ouabain-sensitive form, indicating that the active principle of GLP is more specific for Na,K-ATPase than ouabain itself. Although the hypothesis remains to be demonstrated in vivo, the present findings are compatible with the putative role of GLP-induced inhibition of Na,K-ATPase as an initial mechanism in the physiopathology of leptospirosis.

Perfuracao gastrintestinal no recem-nascido. Analise de 11 casos. / Gastrointestinal perforation in newborn infants. Study of 11 cases

Foi realizado um estudo de 11 recem-nascidos com diagnostico de perfuracao gastrointestinal internados de agosto de 1980 a abril de 1982 no Hospital Infantil Joana de Gusmao, Florianopolis - SC. A idade media dos pacientes foi de um dia de vida.A lesao ocorreu, principalmente, no sexo masculino e apenas na raca branca.Um grande numero deles experimentou algum tipo de stress perinatal (58,1%). Distensao abdominal ocorreu em todos os casos acompanhada de vomito e stress respiratorio. Atualmente, a teoria mais aceita para explicar a etiologia destas lesoes e aquela que propoe a isquemia circulatoria seletiva. O tratamento cirurgico foi realizado em todos os casos. Ocorreram quatro mortes (35, 4%)