Habilitar-se em saúde mental: observações críticas ao conceito de reabilitação

In the landscape of contemporary Psychiatry, rehabilitation is a proposal that stands out for its reach and implies a question itself. This notion, borrowed from Medicine at large, is laden with negative aspects, due, among other causes, to the interpretive and evolutional incompatibility between the psychic and the bodily phenomena, and the separation between distinct therapeutic spheres. Instead, a different proposal is submitted here: an idea of habilitation according to which past condition is not seen as a stigma, and the experience of past malady is not rejected, but, on the contrary, becomes the starting point of a new process. By these means one values those rehabilitating practices that affirm the individual’s potentialities, and broaden the possibilities of his or her positive identity as well. The proper ground of habilitation is the ground of practices, and it involves differentials vis-à-vis the rehabilitation, in that it emphasizes the exercise of individual rights, the development of exchanges and cooperation. The habilitation affirms itself as a form of accomplished democracy, that arises from the subject’s very necessities.A reabilitação no panorama da psiquiatria atual é uma proposta destacada por sua abrangência e constitui sua própria questão. Esta noção, tomada de empréstimo da medicina geral, carrega aspectos pesadamente negativos, pela incompatibilidade interpretativa e evolutiva entre os fenômenos do psiquismo e do corpo, a separação dos âmbitos terapêuticos, entre outros. Propõe-se aqui, em seu lugar, a idéia de habilitação em que o passado não constitui estigma, em que a experiência da doença não seja rejeitada e sustente o começo de um novo processo. Com isso, valorizam-se práticas reabilitantes que afirmam as potencialidades dos sujeitos e alargam as possibilidades de sua identidade positiva. O terreno do habilitar é o das práticas e envolve diferenciais em relação à reabilitação, dando ênfase ao exercício dos direitos, ao desenvolvimento de trocas e à cooperação. A habilitação se afirma como uma forma de democracia acabada, constituída a partir das necessidades do sujeito

Habilitar-se em saúde mental: observações críticas ao conceito de reabilitação

In the landscape of contemporary Psychiatry, rehabilitation is a proposal that stands out for its reach and implies a question itself. This notion, borrowed from Medicine at large, is laden with negative aspects, due, among other causes, to the interpretive and evolutional incompatibility between the psychic and the bodily phenomena, and the separation between distinct therapeutic spheres. Instead, a different proposal is submitted here: an idea of habilitation according to which past condition is not seen as a stigma, and the experience of past malady is not rejected, but, on the contrary, becomes the starting point of a new process. By these means one values those rehabilitating practices that affirm the individual’s potentialities, and broaden the possibilities of his or her positive identity as well. The proper ground of habilitation is the ground of practices, and it involves differentials vis-à-vis the rehabilitation, in that it emphasizes the exercise of individual rights, the development of exchanges and cooperation. The habilitation affirms itself as a form of accomplished democracy, that arises from the subject’s very necessities

Ulipristal Acetate Before High Complexity Hysteroscopic Myomectomy: A Retrospective Comparative Study

Study Objective: To evaluate the efficacy of preoperative treatment with ulipristal acetate (UPA) in patients undergoing high complexity hysteroscopic myomectomy. Design: Retrospective analysis of a prospectively collected database (Canadian Task Force classification II-2). Setting: University teaching hospital. Patients: Patients of reproductive age requiring hysteroscopic myomectomy with STEPW (size, topography, extension, penetration, and wall) score 5 or 6. Interventions: Patients included in the study either underwent direct surgery (group S) or received a 3-month preoperative treatment with UPA (group UPA). Based on a power calculation, 25 patients were required in each study group. Measurements and Main Results: Myoma characteristics were similar in the 2 study groups. The 3-month UPA treatment caused a 21.9% (\ub110.3%) mean (\ub1SD) percentage decrease in myoma volume. The number of complete resections (primary outcome of the study) was higher in group UPA (92.0%) than in group S (68.0%; p =034). The operative time was lower in group UPA than in group S (p =048), whereas there was no significant difference in fluid balance between the 2 study groups (p =256). The incidence of complications was similar in the 2 groups (p =609). Patient satisfaction at 3 months from surgery was higher in group UPA than in group S (p =041). Conclusion: A 3-month preoperative treatment with UPA increases the possibility of complete resection in high complexity hysteroscopic myomectomy. It decreases the operative time and improves patient satisfaction at 3 months from surgery

Impact of large ovarian endometriomas on the response to superovulation for in vitro fertilization: A retrospective study

Objective To assess the response to superovulation for in vitro fertilization (IVF) in patients with unilateral endometriomas with diameter 655 cm and in the contralateral healthy ovary. Study design This retrospective analysis of a prospectively collected database included patients who underwent superovulation for IVF/ICSI cycles and had unoperated single unilateral endometrioma with diameter 655 cm and healthy contralateral ovary. The primary outcome of the study was to compare the number of oocyte retrieved in the ovary with the endometrioma and the contralateral healthy ovary. Results The total number of follicles was lower in ovaries with endometriomas (2.6 \ub1 1.3) than in healthy ovaries (4.8 \ub1 2.0; p < 0.001). The number of codominant follicles and the total number of oocytes retrieved were lower in ovaries with endometriomas (1.5 \ub1 0.9 and 2.0 \ub1 1.2) than in the contralateral ovaries (3.7 \ub1 1.5 and 4.2 \ub1 1.7; p < 0.001, respectively). The number of oocytes retrieved suitable for fertilization was lower in ovaries with endometriomas (1.5 \ub1 1.1) than in the healthy ovaries (3.3 \ub1 1.5; p < 0.001). The total number of oocytes retrieved and the number of oocytes retrieved suitable for fertilization were lower in ovaries with endometriomas respectively in 21 (80.8%) and in 20 (76.9%) cases. The decreased responsiveness to ovarian superovulation was confirmed considering women with ultrasonographic diagnosis of deep infiltrating endometriosis. 30.8% of patients had positive HCG; the pregnancy rate was 23.1%. Conclusion The presence of large endometriomas ( 655 cm) at time of IVF significantly decreases the number of oocyte retrieved compared with the contralateral healthy ovaries

Recurring and generalized visceroptosis in Ehlers-Danlos syndrome hypermobility type

8Visceroptosis is described in several heritable connective tissue disorders, including the hypermobility type of Ehlers-Danlos syndrome (hEDS), a.k.a. joint hypermobility syndrome (JHS). Clinical features of hEDS comprise joint hypermobility, mild skin hyperextensibility, joint instability complications, chronic joint/limb pain, and positive family history. Uterine and rectal prolapse has been reported in nulliparous women. We report on a family with two patients with hEDS. The proposita, a 38-year-old woman, present bilateral kidney prolapse requiring three nephropexies, gastric ptosis treated with gastropexy and Billroth I gastrectomy, and liver prolapse treated with a non-codified hepatopexy procedure. Radiological evaluation also showed ovarian and heart prolapse. To our knowledge this is the first case of multiple visceral ptoses in hEDS. Visceral prolapse may lead to severe morbidity, affecting quality of life and a high rate of relapses after surgical procedures. Further investigations are needed to understand the molecular basis of the disease and retrospective studies on surgical outcomes, presentation of case series can be effective in order to offer a better treatment and prevention for hEDS patients.reservedmixedDordoni C.; Ritelli M.; Venturini M.; Chiarelli N.; Pezzani L.; Vascellaro A.; Calzavara Pinton P.; Colombi M.Dordoni, Chiara; Ritelli, Marco Giuseppe; Venturini, Marina; Chiarelli, Nicola; Pezzani, Lidia; Vascellaro, Annalisa; CALZAVARA PINTON, Piergiacomo; Colombi, Marin

Pharmacokinetics, pharmacodynamics and clinical efficacy of ospemifene for the treatment of dyspareunia and genitourinary syndrome of menopause

none7noOspemifene is a selective estrogen receptor modulator recently approved by the FDA for the treatment postmenopausal women experiencing moderate-to-severe dyspareunia and by the EMA for the treatment of moderate-to-severe symptomatic genitourinary syndrome of menopause (GSM) in women who are not suitable candidates for local vaginal estrogen therapy.Bondi, Chiara; Ferrero, Simone; Scala, Carolina; Tafi, Emanuela; Racca, Annalisa; Venturini, Pier Luigi; Leone Roberti Maggiore, UmbertoBondi, Chiara; Ferrero, Simone; Scala, Carolina; Tafi, Emanuela; Racca, Annalisa; Venturini, PIER LUIGI; LEONE ROBERTI MAGGIORE, Umbert

Efficacy and acceptability of long-term norethindrone acetate for the treatment of rectovaginal endometriosis

none8noTo study the efficacy of long-term treatment with norethindrone acetate (NETA) in patients with rectovaginal endometriosis.mixedMorotti, Matteo; Venturini, Pier Luigi; Biscaldi, Ennio; Racca, Annalisa; Calanni, Luana; Vellone, Valerio Gaetano; Stabilini, Cesare; Ferrero, SimoneMorotti, Matteo; Venturini, PIER LUIGI; Biscaldi, Ennio; Racca, Annalisa; Calanni, Luana; Vellone, VALERIO GAETANO; Stabilini, Cesare; Ferrero, Simon