US as the Primary Imaging Modality in the Evaluation of Palpable Breast Masses in Breastfeeding Women, Including Those of Advanced Maternal Age.

Background Women are increasingly delaying childbearing, and thus lactation, into their 30s and 40s, when mammography would typically be the initial imaging modality to evaluate palpable masses in the general population. Current guidelines recommend US as the first-line imaging modality for palpable masses in pregnant and lactating women, but data regarding breastfeeding women age 30 years and older are near nonexistent. Purpose To evaluate the diagnostic performance of targeted US as the primary imaging modality for the evaluation of palpable masses in lactating women, including those of advanced maternal age. Materials and Methods Lactating women with palpable breast masses evaluated at targeted US over a 17-year period (January 2000 to July 2017) were retrospectively identified. All US evaluations were performed at diagnostic evaluation, and mammography was performed at the discretion of the interpreting radiologist. Breast Imaging Reporting and Data System assessments, imaging, and pathology results were collected. Descriptive statistics and 2 × 2 contingency tables were assessed at the patient level. Results There were 167 women (mean age, 35 years ± 5 [standard deviation]), 101 of whom (60%) were of advanced maternal age (≥35 years). All women underwent targeted US, and 98 (59%) underwent mammography in addition to US. The frequency of malignancy was five of 167 (3.0%). Targeted US demonstrated a sensitivity and specificity of five of five (100%; 95% confidence interval [CI]: 48%, 100%) and 114 of 162 (70%; 95% CI: 63%, 77%), respectively. Negative predictive value, positive predictive value of an abnormal examination, and positive predictive value of biopsy were 114 of 114 (100%; 95% CI: 97%, 100%), five of 53 (9.4%; 95% CI: 3%, 21%), and five of 50 (10%; 95% CI: 3%, 22%), respectively. In the subset of 98 women who underwent mammography in addition to US, mammography depicted seven incidental suspicious findings, which lowered the specificity from 62 of 93 (67%; 95% CI: 56%, 76%) to 57 of 93 (61%; 95% CI: 51%, 71%) (P = .02). Conclusion Targeted US depicted all malignancies in lactating women with palpable masses. Adding mammography increased false-positive findings without any additional cancer diagnoses. © RSNA, 2020 See also the editorial by Newell in this issue.

Imaging characteristics associated with clinical outcomes in posterior reversible encephalopathy syndrome.

PURPOSE: Posterior reversible encephalopathy syndrome (PRES) is a disorder of cerebrovascular autoregulation that can result in brain edema, hemorrhage, and infarction. We sought to investigate whether certain imaging characteristics in PRES are associated with clinically significant patient outcomes. METHODS: We retrospectively reviewed all cases of PRES occurring between 2008 and 2014 at two major academic medical centers. Demographic, clinical, and radiographic data were collected. We analyzed imaging studies for vasogenic edema, hemorrhage, and diffusion restriction. We performed univariate analysis and stepwise logistic regression to assess the association between our radiologic findings of interest and clinical outcomes as defined by hospital discharge disposition and modified Rankin scale (mRS) at time of discharge. RESULTS: We identified 99 cases of PRES in 96 patients. The median age was 55 years (IQR 30-65) and 74% were women. In 99 cases, 60% of patients had active cancer, 19% had history of bone marrow or organ transplantation, 14% had autoimmune disease, and 8% were peripartum. Imaging at clinical presentation showed extensive vasogenic edema in 39%, hemorrhage in 36%, hemorrhage with mass effect in 7%, and restricted diffusion in 16%. In our final logistic regression models, the presence of extensive vasogenic edema, hemorrhage with mass effect, or diffusion restriction was associated with worse clinical outcome as defined by both discharge disposition (OR = 4.3; 95% CI: 1.4-36.3; p = 0.047) and mRS (OR = 3.6; 95% CI: 1.2-10.7; p = 0.019). CONCLUSIONS: Extensive vasogenic edema, hemorrhage, and restricted diffusion on initial imaging in PRES are associated with worse clinical outcomes.

Corticosteroid therapy and severity of vasogenic edema in posterior reversible encephalopathy syndrome.

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a variable cerebrovascular syndrome associated with hypertension and autoregulatory failure. Steroids have been reported to both precipitate and treat PRES. We sought to determine the prevalence of steroid therapy at the time of PRES and to assess the relationship between steroid therapy and extent of vasogenic edema. METHODS: We performed a retrospective review of radiology reports between 2008 and 2014 from two academic medical centers to identify cases of PRES. Clinical and radiographic data were collected. Descriptive statistics were used to determine the prevalence of corticosteroid therapy at the time of PRES onset and the latency from steroid initiation to PRES onset. The association between steroid therapy and extent of vasogenic edema was assessed in multiple regression models. RESULTS: We identified 99 cases of PRES in 96 patients. The median age was 55years (IQR 30-65) and 74% were women. Steroid therapy at time of PRES onset was identified in 44 of 99 cases. Excluding patients on chronic therapy, the median duration of steroid exposure before PRES onset was 6 (IQR, 3-10) days. Steroid therapy was not associated with extent of vasogenic edema in unadjusted or linear and logistic regression models adjusted for age, sex, and maximum systolic blood pressure on day of onset. CONCLUSION: Corticosteroid therapy, often of brief duration, frequently preceded the onset of PRES and was not associated with severity of vasogenic edema.

Sociodrama: action mechanisms and directing strategies at two public events / Sociodrama: mecanismos de ação e estratégias de direção em dois eventos públicos / Sociodrama: mecanismos de acción y estrategias de dirección en dos eventos públicos

The author describes the origins of morenian Sociodrama, its action mechanisms, its practices and the Director’s action strategies. She defines group, points to the existence of different focuses for directing: protagonist, spontaneous and relational, comprehensively showing the workings of the sociometric-relational model, which works through the affective forces of approximation, distancing or indifference of each participant concerning the other ones. It also shows that mutual choices produce group cohesion and discordant choices produce conflicting dynamics. She indicates that this type of practice holds its pillars: modes of interaction, shared goals and roles, relational structures and functioning group dynamics. The author uses as examples two public interventions on which the sociometric criteria were applied.

A autora relata a origem do Sociodrama moreniano, seus mecanismos de ação, suas práticas e as estratégias de ação do diretor. Define grupo, aponta a existência de diferentes focos de direção: protagonico, espontâneo e relacional, mostrando pormenorizadamente como opera o modelo sociométrico, que trabalha com as forças afetivas de aproximação, afastamento ou indiferença de cada participante em relação aos demais. Mostra que as escolhas mútuas produzem coesão grupal e as discordantes dinâmicas conflituosas. Aponta que este tipo de prática tem como pilares: os modos de convivência, os objetivos e papéis comuns, as estruturas relacionais e as dinâmicas de funcionamento conjunto. Dá como exemplo duas intervenções públicas onde o referencial sociométrico foi aplicado.

La autora nos relata las raíces del Sociodrama moreniano, sus mecanismos de acción, sus procedimientos y las posibles estrategias del Conductor de grupos. Explica lo que es el grupo, muestra las variadas formas de dirección del Psicodrama: con el protagonista, con la espontaneidad y con las relaciones, señalando con detalles como actúa el modelo sociométrico a partir de las fuerzas de atracción, de rechazo o de indiferencia de cada uno con los otros. Aclara que las elecciones mutuas producen la cohesión grupal y las no recíprocas, dinámicas de conflicto. Destaca que ese foco tiene como base los modos personales de convivir, las metas colectivas, los roles comunes, las estructuras relacionales y las dinámicas de actuación conjunta. Ilustra la teoría con dos intervenciones públicas en las cuales ese modelo de acción fue aplicado.

Social Psychotherapy in Brazil.

This paper describes the practice of sociodrama, a method created by J. L. Moreno in the 1930s, and the Brazilian contemporary socio-psychodrama. In 1970, after the Fifth International Congress of Psychodrama was held in Brazil, group psychotherapy began to flourish both in private practice and hospital clinical settings. Twenty years later, the Brazilian health care system added group work as a reimbursable mental health procedure to improve social health policies. In this context, socio-psychodrama became a key resource for social health promotion within groups. Some specific conceptual contributions by Brazilians on sociodrama are also noteworthy.

Coinconsciente para além do tempo e do espaço / The state of co-unconsciousness beyond time and space / Coinconsciente mas allá del tiempo y del espacio

Este artigo discute como o coinconsciente de Moreno se constitui relacionalmente na primeira etapa da Matriz de Identidade a partir da dinâmica relacional entre o bebê e seus primeiros cuidadores. Essa dinâmica desenvolve esquemas mentais de compreensão das relações e dos modos de funcionamento dos papéis, que passarão a ser usados por toda a vida. Em situações de crise pessoal ou social, esses modelos substituem os relacionamentos télicos. Propõe também que o Sociodrama é um instrumento eficiente para a elaboração desses estados compartilhados.

This article discusses how Moreno's coinconcious state occurs relationally in children, from the first stage of the Identity Matrix deriving from the relational dynamic between a baby and its first caregivers. This dynamic develops mental schemes for understanding relationships and the way roles function that will be used for their entire lives. In situations of personal or social crisis, these models substitute telic relationships. It is also proposed that Sociodrama is an effective tool for the elaboration of these shared states.

Este artículo analiza cómo el coinconsciente de Moreno se estructura en la primera etapa de la Matriz de Identidad a partir de la dinámica relacional entre el niño y sus primeros cuidadores. Esta dinámica desarrolla esquemas mentales para entender las relaciones y modos de funcionamiento de los roles que se utilizarán por toda la vida. En situaciones de crisis personal osocial, estos modelos sustituyen a las relaciones télicas. El artículo propone también que elSociodrama es un instrumento eficiente para la elaboración de estos estados compartidos.

Matriz do Sonhar Social: uma proposta brasileira / The social dreaming matrix: a Brazilian proposal / Matriz del Soñar Social: una propuesta brasileña

A Matriz do Sonhar Social (Dreaming Matrix) é um método criado por W. Gordon Lawrence no Instituto Tavistock de Londres, em 1982, no qual os participantes contam espontaneamente seus sonhos uns para os outros, em um processo de livre associação, que produz uma Matriz coinconsciente. Este artigo relata como ele foi associado, por psicodramatistas brasileiros, ao Sociodrama de J. L. Moreno, usado como prática transicional entre o mundo onírico dos participantes e as cenas coconstruídas no Sociodrama, que permitem um entendimento mais amplo da realidade social do grupo. Apresenta também um exemplo de intervenção pública no Centro Cultural São Paulo (CCSP), em 2013.

The Social Dreaming Matrix (SDM) is a method created by W. Gordon Lawrence in 1982 at the Tavistock Institute (London), in which participants spontaneously share their dreams with each other in a process of free association that produces a counconscious Matrix. This article describes how this method was linked by Brazilian Psychodramatists to J.L. Moreno's Sociodrama, and used as a transitional practice between the dream-world of the participants and the sociodramatric scenes jointly constructed by them, which enable us to better understand the social reality of the group. As an example of this intervention, we describe a public event, which took place in 2013 at the São Paulo Cultural Centre (CCSP).

La Matriz del Soñador Social (Social Matrix Dreaming) es un método creado por Gordon Lawrence en el Instituto Tavistok de Londres en 1982, en el que los participantes cuentan espontáneamente sus sueños entre sí en un proceso de libre asociación que produce una Matrix coinconsciente. En este artículo se relata cómo el método fue asociado por psicodramatistas brasileñas al Sociodrama de J.L. Moreno, utilizado como práctica transcional entre el mundo onírico de los participantes y las escenas coconstruídas en el Sociodrama, que permiten una comprensión más amplia de la realidad social del grupo. También se presenta un ejemplo de una intervención pública en el Centro Cultural São Paulo (CCSP) en 2013.