Christian David.

This article reviews the essential themes of Christian David's work. The contribution of this French psychoanalyst is deeply rooted in anti-intellectualistic convictions and a definite opposition to Lacan. His contribution to psychoanalytical theory can be seen as a full recognition of the work of affect, even in terms of representation as well as a relative lessening of the role of language. It is original in the interpretation it proposes of psychosomatic disorders, due to the role his theory gives to affect in the sublimating intention of the drive. His fundamental convictions go hand in hand with a distrust of any position that would tend to privilege a systematic and ready-made description of the diversity of psychic life. For him dream is more a function than a content and the good assessment of 'psychic bisexuality' opposes destiny' while being the shibboleth of true sublimation.

Impact of gynecologic cancer on pelvic floor disorder symptoms and quality of life: an observational study.

The objective of our observational prospective study was to investigate the severity and prevalence of urinary and pelvic floor disorders in gynecologic cancer survivors. All patients surviving gynecological cancer in the region as well as women receiving invitations to attend breast-screening checkups as the control population were asked to fill-in questionnaires assessing pelvic prolapse symptoms (PFDI-20, Wexner) and associated quality of life (PFIQ-7). Eighty-nine women were included in the cancer survivor group and 1088 in the control group. Pelvic floor symptoms (PFDI-20 questionnaire) were significantly worse in cancer survivors than in control women (score: 33.3 [14.6-74.1] vs. 20 [4.2-50.0], p = 0.0003). Urge incontinence was significantly worse in cancer survivors in both univariable (ORb = 2.061 [95% CI = 1.284-3.309], p = 0.0027) and multivariable analyses (ORa = 1.672 [95% CI = 1.014-2.758], p = 0.0442), as was fecal incontinence in univariable (ORb = 3.836 [95% CI = 1.710-8.602], p = 0.0011) and in multivariable (ORa = 3.862 [95% CI = 1.657-9.001], p = 0.0018) analyses. Women with benign hysterectomies had poorer quality of life and increased pelvic floor disorders compared to women with no history of surgery. Survivors of gynecological cancer experience significantly more pelvic floor symptoms and an associated reduction in quality of life.

Persistent urinary retention after surgery for deep infiltrating endometriosis: a multi-center series of 16 cases.

PURPOSE: Persistent urinary retention (UR) is a complication of 3.5-14.3% of patients having undergone deep pelvic endometriosis (DPE) surgery of posterior compartment, and it is prone to persist. The purpose of this study is to identify surgical procedures and clinical circumstances associated with persistent UR, and consider its treatment. METHODS: We undertook a multi-center retrospective study studying medical records of patients who had surgery for DPE between January 2005 and December 2012. Patients who suffered from UR defined as a post-void residual (PVR) volume >100 mL needing intermittent self-catheterizations more than 30 days after surgery were included. Preoperative data (functional complaints, clinical examination, imaging, medical treatment) were recorded. Types of surgery and detailed postoperative urinary symptoms were noted. RESULTS: 881 patients had surgery for DPE and 16 patients were included (1.8%). In 93.8% of cases, a lesion of posterior compartment was clinically significant. Mean lesion size was 28.8 ± 7.3 mm. Colorectal resection and colpectomy were necessary in 93.8 and 87.5% of cases, respectively. Loss of bladder sensation and straining during urination were the two most common post-operative symptoms. 11 patients still required self-catheterization up to 1 year after the intervention. CONCLUSIONS: Patients with increased risks of UR present with a symptomatic and clinically palpable deep pelvic endometriotic lesion of the posterior compartment. Treatment implies surgery with colorectal resection. Bilateral resection of utero-sacral ligaments and posterior colpectomy tend to increase that risk. Complications due to PVR volume and straining during urination may be prevented by self-catheterization.

Analysis of the learning curve of bilateral anterior sacrospinous ligament suspension associated with anterior mesh repair.

OBJECTIVE: To analyze the learning curve of bilateral anterior sacrospinous ligament suspension associated with anterior mesh repair in a single center. STUDY DESIGN: The first 113 bilateral anterior sacrospinous ligament suspensions associated with anterior mesh repair performed by three surgeons trained together in a single center were analyzed retrospectively for pre-operative, operative and post-operative data. To discover a turning point, all major complications were reported and the study population was divided into five groups of approximatively 22 interventions each, classed chronologically. Statistical analysis was carried out by the Cochran-Armitage trend test and Cox proportional hazards models. Other descriptive statistics were computed with the use of standard methods for means and proportions. RESULTS: Of the 103 evaluable patients (91.2%), the success rate for both anterior and apical compartments was 87.4%. The rate of major post-operative complications was 7.2% (8/111). Statistical analysis showed that the risk of major complications was reduced by approximately 30% every ten procedures (HR=0.71, 95% CI: 0.53-0.95). Success rate, operative time and hospital stay remained unchanged throughout the series. Mesh exposure rate was 3.6%. CONCLUSION: Bilateral anterior sacrospinous ligament suspension associated with anterior mesh repair was associated with a learning curve to decrease the rate of major complications.

Pelviperitonitis by colorectal perforation in the third trimester of pregnancy after surgery for deep pelvic endometriosis.

OBJECTIVE: To report a severe complication after colorectal resection for rectovaginal endometriosis. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 37-year-old patient treated with colorectal resection 3 years ago for rectovaginal endometriosis was admitted with a rectal perforation at 37 weeks' gestation. INTERVENTION(S): Caesarean section and simple interrupted stitch of the perforation by absorbable Vicryl. MAIN OUTCOME MEASURE(S): Determination of the cause of the perforation in healthy rectal tissue above the anastomosis. RESULT(S): The most likely mechanism was secondary colonic hyperpressure owing to stenosis of the colorectal anastomosis. CONCLUSION(S): Young patients planning to conceive but scheduled to undergo colorectal resection should be made aware of the significant complication rate associated with this procedure and the promising results of nodule excisions. We recommend close monitoring of patients suffering from chronic constipation after resection for rectosigmoid endometriosis.

Bilateral anterior sacrospinous ligament suspension associated with a paravaginal repair with mesh: short-term clinical results of a pilot study.

INTRODUCTION AND HYPOTHESIS: This study aims to assess anatomical and functional results of bilateral anterior sacrospinous ligament suspension associated with paravaginal repair with mesh. METHODS: Forty-eight patients were operated between March 2007 and August 2008. Mean age was 67 years old. Nineteen patients (39.6%) had been previously operated for a genital prolapse. All patients had both anterior vaginal wall prolapse and a level 1 defect; stage 2 to 4 (POP-Q). RESULTS: Median follow-up is 8 months (range 1 to 18). Perioperative complications were: one bladder injury (2.1%), three haematomas (6.3%), two ureteral kinking (4.2%) and two sciatic pain (4.2%). Anatomical success was observed in 47/48 patients (97.9%) for uterine or vaginal vault prolapse and 46/48 patients (95.8%) for anterior vaginal wall prolapse. CONCLUSIONS: This procedure is a challenging surgical technique requiring a significant level of skill and training, which yields a very high success rate; however, it is not without potential ureteral and neurologic complications.

Neurobehavioral profile and brain imaging study of the 22q13.3 deletion syndrome in childhood.

OBJECTIVE: The 22q13.3 deletion syndrome (Online Mendelian Inheritance in Man No. 606232) is a neurodevelopmental disorder that includes hypotonia, severely impaired development of speech and language, autistic-like behavior, and minor dysmorphic features. Although the number of reported cases is increasing, the 22q13.3 deletion remains underdiagnosed because of failure in recognizing the clinical phenotype and detecting the 22qter deletion by routine chromosome analyses. Our goal is to contribute to the description of the neurobehavioral phenotype and brain abnormalities of this microdeletional syndrome. METHODS: We assessed neuromotor, sensory, language, communication, and social development and performed cerebral MRI and study of regional cerebral blood flow measured by positron emission tomography in 8 children carrying the 22q13.3 deletion. RESULTS: Despite variability in expression and severity, the children shared a common developmental profile characterized by hypotonia, sleep disorders, and poor response to their environment in early infancy; expressive language deficit contrasting with emergence of social reciprocity from ages approximately 3 to 5 years; sensory processing dysfunction; and neuromotor disorders. Brain MRI findings were normal or showed a thin or morphologically atypical corpus callosum. Positron emission tomography study detected a localized dysfunction of the left temporal polar lobe and amygdala hypoperfusion. CONCLUSIONS: The developmental course of the 22q13.3 deletion syndrome belongs to pervasive developmental disorders but is distinct from autism. An improved description of the natural history of this syndrome should help in recognizing this largely underdiagnosed condition.

A palavra no setting / The word in the setting

A análise nasce de um encontro regulado pelo dispositivo do setting e pelo da linguagem. Nesse espaço singular, a representação de palavra não impõe apenas sua continência e seus limites aos processos inconscientes que nele se desenrolam. Ela também assegura o mais amplo desenvolvimento desses processos. É acima de tudo condutora de energia, favorece a sintonização de dois inconscientes e sincroniza a pulsação das representações destes. Pois a palavra, inclusive em sua dimensão lexical, está ligada à sensação

Analysis is the result of a meeting regulated by the existence of the setting and the language. Inside this unique space, the word representation does not impose only continence and its limits to the unconscious processes that take place in this space. The representation of the word also assures the broadest development of these processes. The word is, above all, the energy conductor. It favors the tuning in of two unconscious and synchronizes the beating of their representations, since the word, even in its lexical dimension, is connected to the sensation

A palavra no setting / The word in the setting

A análise nasce de um encontro regulado pelo dispositivo do setting e pelo da linguagem. Nesse espaço singular, a representação de palavra não impõe apenas sua continência e seus limites aos processos inconscientes que nele se desenrolam. Ela também assegura o mais amplo desenvolvimento desses processos. É acima de tudo condutora de energia, favorece a sintonização de dois inconscientes e sincroniza a pulsação das representações destes. Pois a palavra, inclusive em sua dimensão lexical, está ligada à sensação(AU)

Analysis is the result of a meeting regulated by the existence of the setting and the language. Inside this unique space, the word representation does not impose only continence and its limits to the unconscious processes that take place in this space. The representation of the word also assures the broadest development of these processes. The word is, above all, the energy conductor. It favors the tuning in of two unconscious and synchronizes the beating of their representations, since the word, even in its lexical dimension, is connected to the sensation(AU)

A força da linguagem / The force of language

O objetivo deste trabalho é demonstrar que a linguagem da talking cure manifesta-se de duas maneiras distintas, por um lado, a do proferimento compulsivo, e de outro, a da escuta associativa do outro. Ao contrário, para o paciente, a fala compulsiva acarreta habitualmente um processo de repetição ao idêntico. Para derrotá-la, é preciso que a escuta do analista, apoiando-se na sensação convocada pela fala, no que ela tem de mais profundo, possa restituir o bem essencial de uma escuta afetiva. Esta restituição, todavia, pode acarretar uma dependência da escuta do outro. Esta, por sua vez, tem sua fonte numa nostalgia do objeto oceânico seguramente, mas também numa recusa de assumir a satisfação alucinatória a fim de não ter que fazer o luto da mesma.(AU)

The object of this paper is to show that the language involved in a talking cure takes on two distinctive forms: that of compulsive utterance on the one hand and that of associative listening on the other. Compulsive speech on the subject's part, however, generally implies a process of identical repetition. In order to undermine the latter, the analyst's activity of listening should thus aim to reinstate the essential object that is implied in an affective form of listening and that is based on the feeling aroused by speech at its very deepest level. This reinstallation can, on the other hand, create a dependency on the listening role of the other. Whilst this dependency is assuredly rooted in nostalgia for the oceanic object, it also no doubt springs from a refusal to experience hallucinatory satisfaction in order not to then be obliged to mo um the latter.(AU)