A fuga de Indira: Uma triterapia breve institucional

O autor apresenta um capítulo inédito do livro que recentemente publicou sob O título Chapéu Reclame de Cigarros - Contribuição para uma psicoterapia institucional. Com o objectivo de evidenciar os principais aspectos da triterapia, uma forma de terapia institucional, o autor apresenta um caso clínico, tratado no Centro de Dia do Quai des Orpailleurs, em Genebra, que apresentava uma crise esquizofrénica maniforme. Salienta, no que respeita ao trabalho terapêutico institucional, a acção desempenhada pelos diferentes agentes terapêuticos que não se cingem apenas ao psiquiatra mas abarcam, activamente, outros técnicos de saúde mental (como o psicólogo ou o enfermeiro). Por outro lado, privilegia o papel desempenhado pelos próprios doentes que, ao nível dos grupos de discussão, podem actuar decisivamente para a prossecução do tratamento de um determinado doente. Aponta ainda como factor positivo, pelo menos em certos casos, a colaboração das pessoas que, no quotidiano. contactam directamente com o doente

Psicanálise e conflito de gerações

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Major Pulmonary Surgery in Patients with Compromised Lung Function

Introduction: The risk stratification of lung resection is fundamentally based on the results of pulmonary function tests. In patients considered to be at risk, major surgery is generally denied, opting for potentially less curative therapies. Objective: To evaluate the postoperative outcomes of major lung surgery in a group of patients deemed high risk. Methods: We performed a retrospective review of clinical records of all patients submitted to lobectomy, bilobectomy or pneumonectomy in a 3-year period in a reference Thoracic Surgery Unit. The patients were then divided in two groups: group A composed of patients with normal preoperative pulmonary function and group B which included patients with impaired lung function, defined as FEV1 and/or DLCO ≤60%. Results: A total of 234 patients were included, 181 (77.4%) in group A and 53 (22.6%) in group B. In group B, patients had more smoking habits, were more often associated with chronic obstructive pulmonary disease and were also more frequently submitted to thoracotomy. When surgery was motivated by primary lung cancer this group had a more advanced clinical stage of the disease. In the postoperative period, these patients had longer hospital stay, longer chest drainage time and greater need for oxygen therapy at home, however, no statistically significant difference was noted in morbidity or mortality. Conclusions: Major thoracic surgery can be safely performed in selected patients considered to be high risk for resection by pulmonary function tests. A potentially curative surgery should not be denied based on respiratory function tests alone.info:eu-repo/semantics/publishedVersio

Prescrição do sintoma no tratamento do síndromo de Gilles de laTourette

Os autores principiam por fazer uma breve revisão bibliográfica do síndromo de Gilles de la Tourette.Seria uma doença caracterizada fundamentalmente por múltiplos tiques motores e exclamações em voz alta, não provocadas, que poderiam evoluir para a coprolalia. O síndromo começa geralmente na infância, antes dos 11 anos, predominando no sexo masculino, tendo sido descrito em praticamente todas as zonas do Globo, com uma prevalência provável de cerca de 4/100000. Muitos factores têm sido apontados para o seu aparecimento mas, actualmente, há tendência para se admitir que existiria uma insuficiência neurofisiológica de base reactivada por factores psicológicos. Descrevem seguidamente o caso clínico de uma doente de 15 anos que, assim como seu pai, apresentava tendência para os tiques em situações ansiógenas. Teriam existido importantes factores de desequilíbrio familiar e situações ansiógenas desencadeantes da sintomatologia aguda. Esta teria sido por sua vez agravada pela agressividade dos familiares. Na fase aguda, apresentava tiques muito frequentes, mais ou menos generalizados (exclamações vocais lembrando o grasnar e o silvar, ecolalia, perturbações do comportamento e ideias obsessivas no que respeita à morte.Ccom vista a poder tratar a doente em hospital de dia pelo haloperidol em boas condições, procurando evitar as eventuais dificuldades relacionais do meio institucional, a doente foi inicialmente tratada pela prescrição do sintoma. Foi dada uma conotação positiva aos sintomas, que foram presentes dentro de um ritual, na presença da mãe. Os efeitos benéficos foram evidentes. Posteriormente, a quase totalidade dos sintomas residuais desapareceram com um tratamento de haloperidol em hospital de dia. No controlo do nono mês, a situação mantinha- se estacionária.------ABSTRACT------ The authors start by giving a brief bibliographical survey of Gílles de Ia Tourette syndrome. It could be basically characterized by multiple motor tics and unprovoked loud exclamations which may develop into obscene speech (coprolalia). The syndrome usually starts in infancy, before the age of 11, predominantly in males, having been described in practically all countries of the world, with a likely prevalence of about 4/100,000. Many factors have been indicated as responsible for its appearance but at present there is a tendency to accept that there might exist a basic neurophysiological insufficiency reactivated by psychoIogica1 factors. Next they describe the clinical case of a 15-year-old patient who, like her father, showed a tendency to tics in situations of anxiety. There existed important factors of family instability and anxiety provoking situations setting off acute symptoms. This in its turn being aggravated by agressiveness on the part of members of the family.in its acute phase she had very frequent and more or less general tics (vocal cries like croaks and whistles, echololia, perturbed behaviour and obsessive ideas about death). With a view to treating the patient in hospital during the day with haloperidol under good conditions, trying to avoid possible difficulties related to an institutional atmosphere, the patient was initially treated for the curbing of the symptoms. A positive connotation was given to the symptoms, which were present within a pattern, in the presence of her mother. The good effects were evident. Latterly almost at the residual symptoms disappeared with a treatment of haloperidol in day hospital. The nine-month exams showed no change

Acute Hemodynamic Responses to Repetitions to Failure Using Different Resistance Exercises and Protocols in Normotensive Men: A crossover study

The present crossover design study investigated acute hemodynamic responses to two sets of leg press (LP) and bench press (BeP) at 10 and 20 repetition maximum (RM) in ten normotensive young men. At the end of each set, an increase in systolic blood pressure (SBP), heart rate (HR), and rate pressure product (RPP) was observed (p < .01), with no differences between intensities, but SBP was greater during the LP exercise (p < .01). Lower resting values of diastolic blood pressure (DBP) were observed in the post-BeP exercise period (p < .05), suggesting that DBP post-exercise hypotension may be more evident after upper-limb exercise

Conflito adolescente-progenitores e autonomia : Abordagem psicológica

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Cold atmospheric plasma, a novel approach against bladder cancer, with higher sensitivity for the high-grade cell line

Antitumor therapies based on Cold Atmospheric Plasma (CAP) are an emerging medical field. In this work, we evaluated CAP effects on bladder cancer. Two bladder cancer cell lines were used, HT-1376 (stage III) and TCCSUP (stage IV). Cell proliferation assays were performed evaluating metabolic activity (MTT assay) and protein content (SRB assay). Cell viability, cell cycle, and mitochondrial membrane potential (Δψm) were assessed using flow cytometry. Reactive oxygen and nitrogen species (RONS) and reduced glutathione (GSH) were evaluated by fluorescence. The assays were carried out with different CAP exposure times. For both cell lines, we obtained a significant reduction in metabolic activity and protein content. There was a decrease in cell viability, as well as a cell cycle arrest in S phase. The Δψm was significantly reduced. There was an increase in superoxide and nitric oxide and a decrease in peroxide contents, while GSH content did not change. These results were dependent on the exposure time, with small differences for both cell lines, but overall, they were more pronounced in the TCCSUP cell line. CAP showed to have a promising antitumor effect on bladder cancer, with higher sensitivity for the high-grade cell line.info:eu-repo/semantics/publishedVersio

Atherosclerosis and Bone Loss in Humans–Results From Deceased Donors and From Patients Submitted to Carotid Endarterectomy

Funding: We wish to thank all the collaborators (administrative staff, nurses, etc.) of the surgery block, as well as the doctors of the vascular surgery and transplantation departments of the Hospital of Santa Maria for the availability and assistance in the collection of the samples. We also thank Sociedade Portuguesa de Reumatologia for funding with two fellowships: Fundo de Apoio à Investigação 2014 and SPR/MSD 2015. DC-F received funding from a PhD grant from Fundação para a Ciência e a Tecnologia (SFRH/BD/80940/2011).Background and Aims: Atherosclerosis and osteoporosis share common risk factors, as well as inflammatory mechanisms. Our aim was to understand how atherosclerotic lesions are related with disturbances in bone. Methods: Gene expression of pro-inflammatory and bone metabolism related proteins (IL-1β, IL-6, IL-17A, TNF, RANKL, OPG, COL1, CTSK, OCL, TRAP, CBFA1, DKK1, SOST, ADIPOQ, and ADIPOR1) were analyzed in arteries and bones from 45 deceased donors and adipose tissue was used as control. Additionally, in 139 patients with advanced atherosclerosis submitted to carotid endarterectomy we compared calcium content (Alizarin red) and plaque inflammatory scores (CD3+, CD68+, and adiponectin) of patients with normal bone mineral density (BMD) with those with low BMD and explored the associations between gene expression in atherosclerotic plaques and BMD. Serum levels of pro-inflammatory and bone related proteins were measured both in donors and patients. Associations were investigated by the Pearson or Spearman correlation tests, and multivariate regression analyzes were performed when justified. Results: Gene expression of bone remodeling and pro-inflammatory proteins correlated positively in bone and aorta, independently of age and sex of donors, but not in adipose tissue. The expression of bone formation genes was significantly higher in atheroma plaques from endarterectomized patients with normal vs. low BMD as well as inflammatory CD68+ scores, regardless of patients' age and sex, but not of body mass index. No relationship was observed between serum levels and gene expression levels of pro-inflammatory or bone remodeling proteins. Conclusions: Our results suggest that the relationship between bones and vessels in the context of atherosclerotic disease and osteoporosis may rely on the intrinsic connection between the tissues involved, independently of disease stage. Serum measurements of pro-inflammatory and bone-remodeling proteins do not accurately translate tissue pathologic processes.publishersversionpublishe