Competências de assertividade na relação íntima: proposta de uma abordagem eclética

A presente investigação pretende analisar a eficácia de um programa breve de promoção de competências de assertividade na relação conjugal. Fez-se uma revisão da literatura de conceitos ligados à conjugalidade sendo os mais pertinentes para este estudo a satisfação conjugal, a comunicação e a intimidade. Focou-se também o psicodrama moreniano e outras abordagens utilizadas no trabalho de educação e enriquecimento do casal. Na elaboração do programa, optou-se por uma abordagem eclética, conciliando o modelo cognitivo-comportamental com uma técnica do Psicodrama Moreniano. O estudo foi realizado com uma amostra (conveniência) composta por 2 casais heterossexuais que vivem em coabitação. A metodologia utilizada foi maioritariamente qualitativa e para a recolha de informação usou-se a entrevista semi-estruturada IRI - Intimate Relationship Interview (Lima, Soares, Vieira & Collins, 2005) e a técnica da escultura. Os resultados obtidos demonstraram que os casais têm uma perceção bastante satisfatória na maioria das áreas da intimidade conjugal; a comunicação aparenta ser a área que requer mais intervenção por parte dos casais. Os instrumentos de recolha de informação mostraram-se eficazes e complementares. O programa evidenciou resultados satisfatórios atendendo aos ganhos dos casais, contudo serviu mais para o levantamento das áreas de dificuldades na relação do que para a aquisição de competências assertivas.This research intends to analyze the effectiveness of a brief program for the promotion of assertiveness skills in the marital relationship. We did a literature review of concepts related to conjugal, being the most relevant for this study the marital satisfaction, communication and intimacy. It also focused on the Morenian Psychodrama and other approaches used in the work of education and enrichment of the couple. In the preparation of the program, we opted for an eclectic approach, combining cognitive-behavioral model with a psychodrama technique. The study sample (convenience) is composed of two heterosexual couples living in cohabitation. The methodology used was mainly qualitative and the data collection was used a semi-structured interview IRI - Intimate Relationship Interview (Lima, Soares Vieira & Collins, 2005) and the sculpture technique. The results showed that couples have a perception quite satisfactory in most areas of marital intimacy; the communication appears to be the area that requires further involvement of couples. The information collection tools were effective and complementary. The program showed satisfactory results given the earnings of couples, but served more to survey the areas of difficulty in the relationship than to acquire assertive skills

Acute poisoning with Copper Sulphate: a clinical case

A intoxicação aguda pelo sulfato de cobre é rara e frequente- mente acidental. Manifesta-se por náuseas, vómitos, diarreia, anemia hemolítica e, nos casos mais graves, insufi ciência renal, insufi ciência hepática e coma. Os autores descrevem um caso clínico de intoxicação voluntária por sulfato de cobre, cujas principais manifestações clínicas foram náuseas, vómitos esverdeados, diarreia, hipotensão, icterícia e desorientação temporo-espacial. Laboratorialmente traduziu-se por anemia hemolítica com necessidade de terapêutica transfu- sional, disfunção renal (elevação do azoto ureico e da creatinina, e hematúria), e elevação do cobre sérico e urinário, atingindo valores máximos de 2,6 mg/L (N: 0,7-1,4 mg/L) e 1,1 mg/24h, (N <0,1 mg/24h), respectivamente. Realizou terapêutica de suporte e específi ca, com D-penicilamina, com evolução favorável.Acute copper poisoning is rare and frequently accidental. Nau- seas, vomiting, diarrhoea and haemolytic anaemia are its usual manifestations, while severe poisoning results in renal and /or hepatic insuffi ciency and coma. The authors describe a clinical case of voluntary acute copper sulphate poisoning manifested by gastrointestinal symptoms (nauseas, vomiting of a green liquid and diarrhoea), hypotension, jaundice and mental dysfunction. The laboratory results revealed a transfusion dependent haemolytic anaemia, renal dysfunction (rise of blood urea nitrogen and creatinine, as well as haematuria) and elevated serum and urine copper levels, reaching 2.6 mg/L (0.7-1.4) and 1.1 mg/24h, (< 0.1 mg/24h). The patient was treated with D-penicillamine with a favourable outcome

Positron Emission Tomography in the diagnosis of an unknown primary tumour

Em Medicina Interna, somos muitas vezes confrontados com o diagnóstico de doença maligna avançada, em doentes que desconheciam sofrer de patologia tumoral. A localização do tumor primitivo é fundamental, pois dela depende o correcto tratamento do doente. Alguns casos, e apesar de uma investigação exaustiva, permanecem sem diagnóstico, mesmo quando já ocorreu metastização. A Tomografia de Emissão de Positrões (PET) utilizando 18Fluoro-D-Glicose (18FDG) é um exame não invasivo, de corpo inteiro e multi-órgão, utilizado com bons resultados para diagnóstico e estadiamento de inúmeros tumores e, também, do tumor oculto. Apresentam-se dois casos clínicos de doentes do sexo feminino com diagnóstico de neoplasia maligna avançada, em que a 18FDG-PET foi fundamental para o diagnóstico.In Internal Medicine we are frequently confronted with the diagnosis of advanced malignant disease, in patients without previous tumour diagnosis. The localization of the primary tumour is fundamental for the patient treatment. In some cases, although exhaustive investigation is carried out, the primary site remains obscure, even in the presence of metastasis. The Positron Emission Tomography (PET), using 18Fluoro-D-Glucose (18FDG) is a whole body, multi-organ, non invasive exam, used to diagnose and stage a large number of malignancies, including the occult tumour. We present two female patients with advanced malignant disease, in whom the 18FDG-PET was essential for the diagnosis

An Unusual Case of Tricuspid Stenosis

Tricuspid stenosis is an uncommon valvular abnormality commonly associated with other valvular lesions. Ebstein's anomaly is a rare congenital heart malformation characterized primarily by abnormalities of the tricuspid valve and right ventricle. Endomyocardial fibrosis is a restrictive cardiomyopathy observed in tropical and subtropical regions. It may cause right ventricular distortion with apparent apical displacement of the tricuspid valve, mimicking Ebstein’s anomaly. Eosinophilia is the most commonly cited aetiological link in endomyocardial fibrosis. Here we report the case of 42-year-old male patient who presented with heart failure and severe tricuspid stenosis where a diagnosis of hypereosinophilic syndrome was also established. This case represented a diagnostic challenge in the search for the definitive cause of the tricuspid stenosis

Enterococcus gallinarum Causing Native Valve Endocarditis

Endocarditis due to Enterococcus gallinarum is a rare condition, usually affecting older patients. The most frequent source of infection is the gastrointestinal or genitourinary tracts; it frequently involves the aortic valve and tends to produce heart failure. We present a case of Enterococcus gallinarum endocarditis developing on a normal native heart valve. Enterococcus gallinarum is intrinsically resistant to vancomycin. Antibiotic susceptibility patterns indicate that most isolates are penicillin and ampicillin-susceptible

A Case of Severe Cholestasis due to Hepatic AL Amyloidosis

Introduction: Immunoglobulin light chain-associated amyloidosis results from extracellular tissue deposition of fibril-forming monoclonal immunoglobulin light chains, secreted by a clone of plasma cells. Although the liver is often involved histologically, most cases are clinically asymptomatic, and severe intrahepatic cholestasis as the primary manifestation of the disease is rare. Clinical Case: We report an unusual case of primary amyloidosis in a 71-year-old man, presenting with rapidly progressive cholestasis, associated with hepatomegaly. There are a few reported cases in the literature of cholestasis and acute liver failure as the first manifestations of AL amyloidosis. Conclusion: Infiltrative diseases, such as amyloidosis, must be considered when a patient presents with cholestatic hepatitis. A liver biopsy is essential for the diagnosis of amyloidosis when liver test abnormalities dominate the initial clinical presentation. Liver involvement in patients with amyloidosis is often an indicator of poor prognosis

Castleman disease

Apresentam-se dois casos clínicos de doença de Castleman, situação rara e de difícil diagnóstico, um na forma multissistémica e outro na forma localizada, um na variante plasmocitária e outro na de tipo misto. Nos dois casos, o diagnóstico só foi possível por exame histológico. Salienta-se a grande variabilidade na sintomatologia e prognóstico, de acordo com a variante histológica e a forma de apresentação.We report two cases ofCastleman disease, a systemic and a localized formo Diagnosis was based on the histological findings. The great variability in symptoms and prognosis, according to the histological variant and presentation form is emphasized

Testing Scale Models of Hydro-Reactor Profiled Ducts That Create Notable Net Head to Promote Hydroelectric Power from Currents

In this article, experimental results from the testing of four representative scale models of hydro-reactor profiled channels, which create a net head to promote the extraction of hydroelectric power from currents, are presented. The tested scale models include a narrower intermediate channel section of 300 mm diameter. The different profile models studied include an inlet compression chamber and an outlet depression chamber. A net head is created by the difference in pressure, with the head being higher the narrower channel’s zone than in the kinetic head of the outside stream velocity. Because there were no laboratory premises to test the constructed duct model sizes and to easily change the imposed steady current velocity, the experimental tests were performed by dragging the immersed models, attached to a raft in motion, in a place of steady water (the bay of a port). With this methodology, the same effect was obtained, making it possible to perform the testing for several current velocities (velocity of the raft relative to the steady water). Tests on free-flow to compare the difference in kinetic heads were performed. Furthermore, three loads obstructing different percentages of the channel’s narrower section were inserted to analyze the duct channel obstruction limits. The experimental results are validated by numerical results from finite element analysis

Paraquat poisoning in amedical ward

Os autores apresentam uma análise retrospectiva dos casos de intoxicação por paraquat internados num serviço de Medicina Interna dum hospital central. O estudo engloba um período de 7,5 anos, incluindo 26 casos, 16 homens e 10 mulheres, com idades compreendidas entre os 16 e os 74 anos. O tempo médio decorrido entre a ingestão do tóxico e a prestação dos primeiros cuidados médicos foi, nos doentes que recorreram nas primeiras 24 horas, de 1,8 horas, havendo 3 que só mais tarde recorreram ao hospital. As quantidades de tóxico ingeridas foram calculadas segundo os dados fornecidos pelos doentes e mostraram uma grande dispersão, tendo, no entanto, a maior parte deles ingerido entre 20 e 100 ml. Durante o internamento, faleceram 13 doentes (50%), que tiveram uma sobrevivência média de 7 dias. Os restantes 13 doentes tiveram alta hospitalar, tendo uma sobrevivência média conhecida de 10 meses. Foram comparados entre si os grupos dos doentes falecidos e dos sobreviventes, concluindo-se que o factor decisivo para a mortalidade foi a quantidade de tóxico ingerida. O aparecimento de dispneia, oligúria ou icterícia foi indicador de mau prognóstico, enquanto os valores laboratoriais, à entrada no Serviço de Urgência, de LDH, TGO e pCO2 estavam significativamente mais alterados nos doentes que vieram a falecer. Quando a dose ingerida foi elevada, as medidas terapêuticas, mesmo as mais agressivas, não alteraram o curso da doença. Finalmente, os autores discutem os resultados encontrados, comparando-os com os de outros estudos.The authors present a retrospective study of paraquat poisoning cases admitted at an Internal Medicine department of a central hospitaL This analysis includes a 7.5 years period, involving 26 cases, with male sex predominance (16 patients) and ages between 16 and 74 years old. The mean time elapsed between the toxic ingestion andfirst health care was 1,8 hours ifthey were admiUed in the first 24 hours; three patients arrived later to the hospitaL The quantities of poison ingested were variable, but more frequently between 20 and 100 mL Thirteen in-patients were death while the other 13 were discharged from hospital with good health (known middle survivai time of 10 months). The 2 groups were compared and the single prognostic factor was the ingested quantity ofparaquat. Dyspnea, oliguria andjaundice were the clinical manifestations with prognostic value, while values of LDH, AST and p02 (at admission on Urgency Room) were also prognostic indicators. Any medical measure seemed to modify the disease course when a high dose was ingested