Cerebral Venous Thrombosis in Patients With Traumatic Brain Injury: Epidemiology and Outcome.

The natural history and epidemiological aspects of traumatic cerebral venous thrombosis (CVT) are not fully understood. Due to the concomitant occurrence with intracranial hemorrhages, guidelines for medical treatment have been highly controversial. In this study, our objective was to carry out an analysis description of the population and to conduct a literature review. A prospectively gathered radiology registry data of patients hospitalized at the tertiary hospital of Centro Hospitalar Universitário do São João, Porto, Portugal, between 2016 and 2021 was carried out. All patients with traumatic brain injury (TBI) and concomitant CVT were identified. CVT was confirmed by CT venogram. Demographic, clinical, and radiological data and their medical management were reported. In-hospital complications and treatment outcomes were compared between patients measured by the Glasgow Outcome Score Extended (GOSE) at discharge and GOSE at three months. There were 41 patients with traumatic CVT admitted to this study. The majority (45.2%) had a hyperdense signal near the lateral sinus at admission, and only 26.2% presented with skull fractures. Of this cohort, 95% had experienced lateral sinus thrombosis. Twenty-five patients (60%) had occlusive venous thrombosis. Venous infarct was the main complication following CVT. Thirty-two patients (78%) were anticoagulated after CVT and four developed complications. At the three-month follow-up after discharge, 28.2% had good recovery (GOSE > 6). This study revealed a higher incidence of CVT in severe TBI and a mild association with skull fractures. There is a higher incidence of CVT in the lateral sinus. Management was inconsistent, with no difference in outcome without or with anticoagulation. Larger, prospective cohort studies are required to better comprehend this condition and determine evidence-based guidelines.

From Pansinusitis to Cerebritis Due to Eikenella corrodens.

Meningitis is a rare but possible complication of sinusitis. We present a case of a 21-year-old woman with a history of fever, headache and nasal obstruction who presented at the emergency department with psychomotor agitation. Orotracheal intubation and invasive mechanical ventilation were given to protect airway. Blood analysis showed leukocytosis and elevated C-reactive protein. Cerebral and maxillofacial computed tomography (CT) demonstrated pansinusitis with gas foci more prominent in the left frontal sinus with an area of ​​bone rarefaction on the posterior wall with possible communication with the cranial cavity. Lumbar puncture was performed. Empirical antibiotic and corticosteroid therapy were started. Neurosurgery (NC) and Ear Nose and Throat (ENT) surgeons declined indication for urgent surgery and she was admitted at General ICU. On the fourth day of hospitalization, a brain magnetic resonance imaging (CE-MRI) was performed, revealing subdural empyema and cerebritis adjacent to the frontal sinus. She was transferred to the reference neurosurgical center for surgical interventions and was admitted post-operatively at the Neurocritical Care Unit (NCCU). Reevaluation MRI showed residual anterior frontal empyema and absence of focus control in peri-nasal sinusitis, requiring a new ENT surgery. A Streptococcus spp was isolated from the blood, Eikenella corrodens from the pus collected from the sinuses, and the CSF was sterile. The patient completed 21 days of antibiotic therapy. She was extubated on the 19th day, with Broca's aphasia and right hemiparesis, and on the 23rd day transferred to the ENT Service and later to the Rehabilitation Service. We present a case of atypical central nervous system (CNS) infection by a rare agent, highlighting the importance of vigilance, focus control, and neurocritical care. In a severe and complex manifestation like this, the management typically involves medical and surgical interventions. Subdural empyema should be treated as a neurosurgical emergency due to the potential rapid deterioration in patient's neurological condition, attributed to secondary damage. In this case, brain multimodal monitoring, was very helpful in acute phase management. Neurocritical care teams should be involved early in patients with this presentation of CNS infection to provide optimal management, reducing complications and secondary brain lesions therefore improving patient outcomes.

Neurocritical care management supported by multimodal brain monitoring after acute brain injury.

OBJECTIVE: To evaluate the association between different intensive care units and levels of brain monitoring with outcomes in acute brain injury. METHODS: Patients with traumatic brain injury and subarachnoid hemorrhage admitted to intensive care units were included. Neurocritical care unit management was compared to general intensive care unit management. Patients managed with multimodal brain monitoring and optimal cerebral perfusion pressure were compared with general management patients. A good outcome was defined as a Glasgow outcome scale score of 4 or 5. RESULTS: Among 389 patients, 237 were admitted to the neurocritical care unit, and 152 were admitted to the general intensive care unit. Neurocritical care unit management patients had a lower risk of poor outcome (OR = 0.228). A subgroup of 69 patients with multimodal brain monitoring (G1) was compared with the remaining patients (G2). In the G1 and G2 groups, 59% versus 23% of patients, respectively, had a good outcome at intensive care unit discharge; 64% versus 31% had a good outcome at 28 days; 76% versus 50% had a good outcome at 3 months (p < 0.001); and 77% versus 58% had a good outcome at 6 months (p = 0.005). When outcomes were adjusted by SAPS II severity score, using good outcome as the dependent variable, the results were as follows: for G1 compared to G2, the OR was 4.607 at intensive care unit discharge (p < 0.001), 4.22 at 28 days (p = 0.001), 3.250 at 3 months (p = 0.001) and 2.529 at 6 months (p = 0.006). Patients with optimal cerebral perfusion pressure management (n = 127) had a better outcome at all points of evaluation. Mortality for those patients was significantly lower at 28 days (p = 0.001), 3 months (p < 0.001) and 6 months (p = 0.001). CONCLUSION: Multimodal brain monitoring with autoregulation and neurocritical care unit management were associated with better outcomes and should be considered after severe acute brain injury.

Lung Injury Risk in Traumatic Brain Injury Managed With Optimal Cerebral Perfusion Pressure Guided-Therapy.

Introduction: Management of traumatic brain injury (TBI) has to counterbalance prevention of secondary brain injury without systemic complications, namely lung injury. The potential risk of developing acute respiratory distress syndrome (ARDS) leads to therapeutic decisions such as fluid balance restriction, high PEEP and other lung protective measures, that may conflict with neurologic outcome. In fact, low cerebral perfusion pressure (CPP) may induce secondary ischemic injury and mortality, but disproportionate high CPP may also increase morbidity and worse lung compliance and hypoxia with the risk of developing ARDS and fatal outcome. The evaluation of cerebral autoregulation at bedside and individualized (optimal CPP) CPPopt-guided therapy, may not only be a relevant measure to protect the brain, but also a safe measure to avoid systemic complications. Aim of the study: We aimed to study the safety of CPPopt-guided-therapy and the risk of secondary lung injury association with bad outcome. Methods and results: Single-center retrospective analysis of 92 severe TBI patients admitted to the Neurocritical Care Unit managed with CPPopt-guided-therapy by PRx (pressure reactivity index). During the first 10 days, we collected data from blood gas, ventilation and brain variables. Evolution along time was analyzed using linear mixed-effects regression models. 86% were male with mean age 53±21 years. 49% presented multiple trauma and 21% thoracic trauma. At hospital admission, median GCS was 7 and after 3-months GOS was 3. Monitoring data was CPP 86±7mmHg, CPP-CPPopt -2.8±10.2mmHg and PRx 0.03±0.19. The average PFratio (PaO2/FiO2) was 305±88 and driving pressure 15.9±3.5cmH2O. PFratio exhibited a significant quadratic dependence across time and PRx and driving pressure presented significant negative association with PFRatio. CPP and CPPopt did not present significant effect on PFratio (p=0.533; p=0.556). A significant positive association between outcome and the difference CPP-CPPopt was found. Conclusion: Management of TBI using CPPopt-guided-therapy was associated with better outcome and seems to be safe regarding the development of secondary lung injury.

Creatinine Clearance in Acute Brain Injury: A Comparison of Methods.

BACKGROUND: Currently, the measurement of glomerular filtration rate is very complex and costly, so its daily evaluation is performed using endogenous markers, of which creatinine is the most frequently used. It allows the estimation of glomerular filtration rate by means of its clearance or by formulas based on its serum and urine concentration. Augmented renal clearance (ARC) is frequent among critically ill patients and is defined as creatinine clearance (CrCl) > 130 ml/min/1.73 m2. The aim of this study was to compare measured CrCl (MCC) and estimated CrCl obtained with the Cockcroft-Gault formula (CG), the Modification of Diet in Renal Disease Study equation (MDRD), and the Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EPI) in patients with severe traumatic brain injury and nontraumatic subarachnoid hemorrhage. The second aim was to assess the incidence of ARC in this population of neurocritical patients. METHODS: This was a prospective, observational, single center study from a cohort of 74 patients admitted to the neurocritical intensive care unit due to traumatic brain injury or subarachnoid hemorrhage. Serum creatinine (at 7 a.m.) and a 6-h urine collection were analyzed, and CrCl was measured and estimated by using CG, MDRD, and CKD-EPI. The intraclass correlation coefficient (ICC) was evaluated for each pair, and Bland-Altman plots were used to assess clinical significance. RESULTS: Among 74 patients, the median age was 53 (interquartile range [IQR] 36-65), and the median Glasgow Coma Scale score at admission was 6. The median MCC at admission was 176 (IQR 135-214). The medians of CG, MDRD and CKD-EPI were, respectively, 129 ml/min/1.73 m2 (IQR 95-176), 158 (IQR 115-202), and 116 (97-132). An ICC was applied to evaluate the correlation between MCC and estimated methods and showed a weak correlation between MCC and estimated CrCl obtained with the three different methods. The strongest ICC statistical correlation was found between MCC and MDRD, and the weakest correlation was found between MCC and CKD-EPI. Bland-Altman plots showed that differences between each pair were not clinically acceptable. ARC was present in 78% of measurements, using MCC. A weak correlation was observed between MCC and calculated CrCl. CG, MDRD, and CKD-EPI overestimated MCC when MCC ≤ 130 ml/min/1.73 m2 and underestimated it when MCC > 130 ml/min/1.73 m2. CONCLUSIONS: In this population, there was a weak statistical correlation between measured and estimated methods. In patients with ARC, formulas underestimated MCC. MCC should probably be the preferred methodology for renal function assessment in the clinical setting to better adjust drug dosage and guarantee drug effectiveness.

Neurocritical care management supported by multimodal brain monitoring after acute brain injury / Abordagem de cuidados neurocríticos apoiada por monitorização cerebral multimodal após lesão cerebral aguda

ABSTRACT Objective: To evaluate the association between different intensive care units and levels of brain monitoring with outcomes in acute brain injury. Methods: Patients with traumatic brain injury and subarachnoid hemorrhage admitted to intensive care units were included. Neurocritical care unit management was compared to general intensive care unit management. Patients managed with multimodal brain monitoring and optimal cerebral perfusion pressure were compared with general management patients. A good outcome was defined as a Glasgow outcome scale score of 4 or 5. Results: Among 389 patients, 237 were admitted to the neurocritical care unit, and 152 were admitted to the general intensive care unit. Neurocritical care unit management patients had a lower risk of poor outcome (OR = 0.228). A subgroup of 69 patients with multimodal brain monitoring (G1) was compared with the remaining patients (G2). In the G1 and G2 groups, 59% versus 23% of patients, respectively, had a good outcome at intensive care unit discharge; 64% versus 31% had a good outcome at 28 days; 76% versus 50% had a good outcome at 3 months (p < 0.001); and 77% versus 58% had a good outcome at 6 months (p = 0.005). When outcomes were adjusted by SAPS II severity score, using good outcome as the dependent variable, the results were as follows: for G1 compared to G2, the OR was 4.607 at intensive care unit discharge (p < 0.001), 4.22 at 28 days (p = 0.001), 3.250 at 3 months (p = 0.001) and 2.529 at 6 months (p = 0.006). Patients with optimal cerebral perfusion pressure management (n = 127) had a better outcome at all points of evaluation. Mortality for those patients was significantly lower at 28 days (p = 0.001), 3 months (p < 0.001) and 6 months (p = 0.001). Conclusion: Multimodal brain monitoring with autoregulation and neurocritical care unit management were associated with better outcomes and should be considered after severe acute brain injury.

RESUMO Objetivo: Avaliar a associação entre diferentes tipos de unidades de cuidados intensivos e os níveis de monitorização cerebral com desfechos na lesão cerebral aguda. Métodos: Foram incluídos doentes com traumatismo craniencefálico e hemorragia subaracnoide internados em unidades de cuidados intensivos. A abordagem na unidade de cuidados neurocríticos foi comparada à abordagem na unidade de cuidados intensivos polivalente geral. Os doentes com monitorização cerebral multimodal e pressão de perfusão cerebral ótima foram comparados aos que passaram por tratamento geral. Um bom desfecho foi definido como pontuação de 4 ou 5 na Glasgow outcome scale. Resultados: Dos 389 doentes, 237 foram admitidos na unidade de cuidados neurocríticos e 152 na unidade de cuidados intensivos geral. Doentes com abordagem em unidades de cuidados neurocríticos apresentaram menor risco de um mau desfecho (Odds ratio = 0,228). Um subgrupo de 69 doentes com monitorização cerebral multimodal (G1) foi comparado aos demais doentes (G2). Em G1 e G2, respectivamente, 59% e 23% dos doentes apresentaram bom desfecho na alta da unidade de cuidados intensivos; 64% e 31% apresentaram bom desfecho aos 28 dias; 76% e 50% apresentaram bom desfecho aos 3 meses (p < 0,001); e 77% e 58% apresentaram bom desfecho aos 6 meses (p = 0,005). Quando os desfechos foram ajustados para o escore de gravidade do SAPS II, usando o bom desfecho como variável dependente, os resultados foram os seguintes: para o G1, em comparação ao G2, a odds ratio foi de 4,607 na alta da unidade de cuidados intensivos (p < 0,001), 4,22 aos 28 dias (p = 0,001), 3,250 aos 3 meses (p = 0,001) e 2,529 aos 6 meses (p = 0,006). Os doentes com abordagem da pressão de perfusão cerebral ótima (n = 127) apresentaram melhor desfecho em todos os momentos de avaliação. A mortalidade desses doentes foi significativamente menor aos 28 dias (p = 0,001), aos 3 meses (p < 0,001) e aos 6 meses (p = 0,001). Conclusão: A monitorização cerebral multimodal com autorregulação e abordagem na unidade de cuidados neurocríticos foi associado a melhores desfechos e deve ser levado em consideração após lesão cerebral aguda grave.

Brain Multimodal Monitoring in Severe Acute Brain Injury: Is It Relevant to Patient Outcome and Mortality?

INTRODUCTION: Advanced multimodal monitoring (MMM) of the brain is recommended as a tool to manage severe acute brain injury in intensive care units (ICUs) and prevent secondary lesions. The aim of this study was to determine if MMM has implications for patient outcome and mortality. METHODS: We analyzed data on 389 patients admitted with a subarachnoid hemorrhage (SAH) or traumatic brain injury (TBI) to two general ICUs and one neurocritical care ICU (NCCU) between March 2014 and October 2016, and their subsequent outcomes. RESULTS: The study population consisted of 259 males and 130 females. Group 1, which comprised 69 patients with MMM admitted to the NCCU, was compared with group 2, which comprised patients managed without MMM. With the exceptions of the Simplified Acute Physiology Score (SAPS II) and Glasgow Coma Scale (GCS) scores, there were no differences between the two groups. Group 1 had significantly better outcomes at ICU discharge, at 28 days, and at 3 months, and also had a lower mortality rate (P < 0.05). When outcomes were adjusted for SAPS II scores, patients who had MMM had better outcomes (odds ratios 0.215 at ICU discharge, 0.234 at 28 days, 0.338 at 3 months, and 0.474 at 6 months) but no difference in mortality. CONCLUSION: Use of MMM in patients with SAH or TBI is associated with better outcomes and should be considered in the management of these patients.

Do mal-estar ao educar: desdobramentos do diálogo entre psicanálise e educação / Del malestar al educar: desarrollos del diálogo entre psicoanálisis y educación / Regarding the malaise in the educating process: outspreads of the dialogue between psychoanalysis and education / Du mal-être lorsque l ́on éduque: progression du dialogue entre psychanalyse et éducation

O presente artigo se inclina sobre os efeitos do encontro da psicanálise com a educação, cuja origem se situa num período inicial dos escritos de Freud, quando ainda idealizava a profilaxia das neuroses por meio de uma reforma na educação e na cultura. Ideal que se revelou uma ilusão diante da teorização sobre a pulsão de morte e a compulsão à repetição. Fundamentada em importantes estudos no campo da conexão psicanálise-educação, propõe-se aqui uma análise do atual cenário dos ideais que rondam a Educação, especialmente, a aposta num pretenso domínio científico, visando formar alunos cognitivamente e emocionalmente ideais. Esse percurso permite apurar uma crise proporcional ao volume de teorias em educação, o que justifica situar a psicanálise como via privilegiada pela qual é possível redimensionar os ideais colocados nesse campo

El presente artículo se apoya sobre los efectos del encuentro del psicoanálisis con la educación, cuyo origen se sitúa en un período inicial de los escritos de Freud, cuando aún idealizaba la profilaxis de las neurosis por medio de una reforma en la educación y en la cultura. Ideal que se reveló una ilusión delante de la teorización sobre la pulsión de muerte y la compulsión a la repetición. Fundamentado en importantes estudios en el campo de la conexión psicoanálisis-educación, se propone aquí un análisis del actual escenario de los ideales que rondan la Educación, especialmente, la apuesta en un pretenso dominio científico, buscando formar alumnos cognitivamente y emocionalmente ideales. Ese recorrido permitió averiguar una crisis proporcional al volumen de teorías en educación, lo que justifica situar el psicoanálisis como vía privilegiada por la cual es posible redimensionar los ideales puestos en esa área

This research aims to discuss the effects of the encounter of psychoanalysis and education, which origin takes place in the beginning of Freud's essays, when he still dreamed of the prophylaxis of neuroses through a remodeling in education and in culture. This ideal revealed an illusion before the theorization of the death instinct and the repetition compulsion. Reasoned in major studies in the field of the psychoanalysis-education connection, this article offers an analysis of the current scenario of ideals surrounding Education, specially, the bet on an ambitious scientific domain, addressing the shaping of cognitively and emotionally ideal students. This route allows the measurement of a crisis as big as the amount of education theories, what justifies the placement of psychoanalysis as a privileged pathway, which enables the resizing of the ideals put in this field

Cet article se penche sur les effets de la rencontre entre la psychanalyse et l'éducation, dont l'origine est à situer dans une période initiale des écrits de Freud, lorsque celui-ci concevait encore la prophylaxie des névroses par le biais d'une réforme de l'éducation et de la culture. Au regard de la théorisation de la pulsion de mort et de la compulsion de répétition, cet idéal se révéla une illusion. Sur la base d'études importantes dans le champ de la connexion psychanalyse-éducation, on propose ici une analyse de l'actuel scénario des idéaux qui entourent l'éducation, et notamment le pari visant, dans un cadre prétendument scientifique, à former des élèves cognitivement et émotionnellement idéaux. Ce parcours nous permet d'identifier une crise proportionnelle au volume de théories de l'éducation, ce qui justifie alors qu'on situe la psychanalyse comme voie privilégiée par laquelle il est possible de redimensionner les idéaux qui se posent dans ce champ

Dance teaching in national programs in Brazil and Portugal / Ensino de dança em programas nacionais no Brasil e Portugal / Enseñanza de danza en programas nacionales en Brasil y Portugal

This study examines the fundamental principles of dance teaching (GEHRES, 2008) in national programs in Brazil and Portugal. In Brazil we selected the Curricular Orientations and Parameters in Physical Education and Art; in Portugal we focused on the Programs of Physical Education and the Alternative Proposal for Dance Education for the second part of Primary Education. Taking the aim of the investigation into consideration, we chose to conduct analytical philosophical research which, according to Thomas and Nelson (2002), aims at critical investigation, the study of facts and the synthesis of variables to analyze the existing material under a viable theoretical model. The investigation of the guideline documents of the two countries showed predominance of subjective proposals in both nations. However, Portugal and Brazil diverge in terms of their focuses; Portugal has an objective approach while Brazil focuses on interactionism(AU)

Este estudo teve como objetivo analisar os fundamentos do ensino da dança (GEHRES, 2008) nos programas nacionais do Brasil e de Portugal. No Brasil, selecionamos os Parâmetros e Orientações Curriculares em Educação Física e em Arte; em Portugal, os Programas de Educação Física e a Proposta alternativa para o ensino da dança no ensino fundamental II. Levando em conta o objetivo da pesquisa, optamos por realizar uma investigação filosófica do tipo analítica que, como nos diz Thomas e Nelson (2002), visa à investigação crítica, ao estudo dos fatos e à síntese das variáveis, procurando analisar o material existente a partir um modelo teórico viável. A investigação dos documentos orientadores dos dois países revelou a predominância em ambos os países de propostas subjetivistas. Contudo, foi observado que Portugal e Brasil divergiam no privilégio ao objetivismo em Portugal e ao interacionismo no Brasil(AU)

Este estudio tuvo como objetivo analizar los fundamentos de la enseñanza de danza (GEHRES, 2008) en los programas nacionales de Brasil y Portugal. En Brasil, seleccionamos los Parámetros y Directrices Curriculares en Educación Física y Arte; en Portugal, los Programas de Educación Física y la propuesta alternativa para la enseñanza de danza en la educación primaria II. Considerando el objetivo del estudio, optamos por realizar una investigación filosófica de tipo analítico que, como nos dice Thomas y Nelson (2002), tiene como objetivo la investigación crítica, el estudio de los hechos y la síntesis de las variables, tratando de analizar el material existente a partir de un modelo teórico viable. La investigación de los documentos de orientación de los dos países reveló el predominio, en ambos países, de propuestas subjetivistas. Sin embargo, se observó que Portugal y Brasil difieren en que en Portugal se privilegia el objetivismo y en Brasil el interaccionismo(AU)

Optimal Cerebral Perfusion Pressure Management at Bedside: A Single-Center Pilot Study.

BACKGROUND: Guidelines recommend cerebral perfusion pressure (CPP) values of 50-70 mmHg and intracranial pressure lower than 20 mmHg for the management of acute traumatic brain injury (TBI). However, adequate individual targets are still poorly addressed, since patients have different perfusion thresholds. Bedside assessment of cerebral autoregulation may help to optimize individual CPP-guided treatment. OBJECTIVE: To assess staff compliance and outcome impact of a new method of autoregulation-guided treatment (CPPopt) based on continuous evaluation of cerebrovascular reactivity (PRx). METHODS: Prospective pilot study of severe TBI adult patients managed with continuous multimodal brain monitoring in a single Neurocritical Care Unit (NCCU). Every minute CPPopt was automatically estimated, based on the previous 4-h window, as the CPP with the lowest PRx indicating the best cerebrovascular pressure reactivity. Patients were managed with CPPopt targets whenever possible and otherwise CPP was managed following general/international guidelines. In addition, other offline CPPopt estimates were calculated using cerebral oximetry (COx-CPPopt), brain tissue oxygenation (ORxs-CPPopt), and cerebral blood flow (CBFx-CPPopt). RESULTS: Eighteen patients with a total multimodal brain monitoring time of 5,520 h were enrolled. During the total monitoring period, 11 patients (61 %) had a CPPopt U-shaped curve, 5 patients (28 %) had either ascending or descending curves, and only 2 patients (11 %) had no fitted curve. Real CPP correlated significantly with calculated CPPopt (r = 0.83, p < 0.0001). Preserved autoregulation was associated with greater Glasgow coma score on admission (p = 0.01) and better outcome (p = 0.01). We demonstrated that patients with the larger discrepancy (>10 mm Hg) between real CPP and CPPopt more likely have had adverse outcome (p = 0.04). Comparison between CPPopt and the other estimates revealed similar limits of precision. The lowest bias (-0.1 mmHg) was obtained with COx-CPPopt (NIRS). CONCLUSION: Targeted individual CPP management at the bedside using cerebrovascular pressure reactivity seems feasible. Large deviation from CPPopt seems to be associated with adverse outcome. The COx-CPPopt methodology using non-invasive CO (NIRS) warrants further evaluation.

Kidney-brain link in traumatic brain injury patients? A preliminary report.

BACKGROUND: Kidney hyperfiltration with augmented renal clearance is frequently observed in patients with traumatic brain injury. The aim of this study is to report preliminary findings about the relationship between brain autoregulation impairment, estimated kidney glomerular filtration rate and outcome in critically ill patients after severe traumatic brain injury. METHODS: Data collected from a cohort of 18 consecutive patients with severe traumatic brain injury managed with ICP monitoring in a Neurocritical Care Unit, were retrospectively analyzed. Early morning blood tests were performed for routine chemistry assessments and we analyzed creatinine and estimated creatinine clearance, osmolarity, and sodium. Daily norepinephrine dose, protein intake, and water balance were documented. Time average of brain monitoring data (intracranial pressure, cerebral perfusion pressure, and cerebrovascular reactivity pressure index--PRx) were calculated for 6 h before blood sample tests. Patient outcome was evaluated using Glasgow outcome scale at 6-month follow-up, considering nonfatal outcome if GOS ≥ 3 and fatal outcome if GOS < 3. Multiple linear regression models were used to study the crude and adjusted effects of the above variables on PRx throughout time. RESULTS: A total of 199 complete daily observations from 18 adult consecutive multiple trauma patients with severe traumatic brain injury were analyzed. At hospital admission, the median post-resuscitation Glasgow coma score was 6 (range 3-12), mean SAPSII score was 44.65 with predicted mortality of 36 %. Hospital mortality rate was 27 % and median GOS at 6 month after discharge was 3. Creatinine clearance (CrCl) was found to have a negative correlation with PRx (Pearson correlation--0.82), with statistically significant crude (p < 0.001) and adjusted (p = 0.001) effects. For each increase of 10 ml/min in CrCl (estimated either by the Cockcroft-Gault or by Modification of Diet in Renal Disease Study equations) a mean decrease in PRx of approximately 0.01 was expected. Amongst possible confounders only norepinephrine was shown to have a significant effect. Mean PRx value for outcome fatal status was greater than mean PRx for nonfatal status (p < 0.05), regardless of the model used for the CrCl estimation. CONCLUSIONS: Better cerebral autoregulation evaluated with cerebrovascular PRx is significantly correlated with augmented renal clearance in TBI patients and associates with better outcome.

A transferência e a ação educativa / The transference and the educative action

Síntese de uma dissertação de mestrado apresentada à Faculdade de Educação da USP, este texto propõe uma reflexão sobre algo atualmente bastante valorizado pela pedagogia: a relação professor-aluno. Buscou-se compreender como a pedagogia pensa essa relação, em quais pressupostos ela se baseia. Desde o princípio, a psicanálise foi o suporte teórico que conduziu a análise dos textos selecionados. E, mais especificamente sobre a questão da pretendida relação professor-aluno, o conceito psicanalítico de transferência foi o eixo da reflexão. O presente trabalho abrange uma análise crítica sobre a concepção pedagógica de relação professor-aluno e uma leitura psicanalítica sobre esta pretensa relação.

A transferência e a ação educativa / The transference and the educative action

Síntese de uma dissertação de mestrado apresentada à Faculdade de Educação da USP, este texto propõe uma reflexão sobre algo atualmente bastante valorizado pela pedagogia: a relação professor-aluno. Buscou-se compreender como a pedagogia pensa essa relação, em quais pressupostos ela se baseia. Desde o princípio, a psicanálise foi o suporte teórico que conduziu a análise dos textos selecionados. E, mais especificamente sobre a questão da pretendida relação professor-aluno, o conceito psicanalítico de transferência foi o eixo da reflexão. O presente trabalho abrange uma análise crítica sobre a concepção pedagógica de relação professor-aluno e uma leitura psicanalítica sobre esta pretensa relação(AU)

A transferencia de Freud

A psicanalise desenvolveu-se gracas aos efeitos negativos da transferencia (a resistencia), o que nos permite dizer que a historia do conceito de transferencia e a propria historia da psicanalise. A teoria psicanalitica, por sua vez, e fruto do 'movimento' psiquico de Freud, portanto, de suas transferencias. Assim, compreender o conceito de transferencia significa uma incursao na vida afetiva de Freud, em suas relacoes com mestres, amigos e amigos-mestres.