Sonhos possíveis e a relação transferencial / Possible dreams and the transferential relationship / Les rêves possibles et la relation transférentielle

Ogden (2010a) apresenta-nos uma teoria da clínica em que o sonhar é tomado como função de elaboração inconsciente, sendo a incapacidade do sujeito de "sonhar sua experiência emocional" um indicador de sofrimento psíquico. Tendo essa ideia como referência, assim como a teorização de Bion sobre a função alfa e o pensamento-sonho, falaremos no presente trabalho sobre o comprometimento da capacidade de sonhar e seus ecos para o psiquismo do sujeito. Com a apresentação de um caso clínico traremos ainda uma discussão sobre o mecanismo da identificação projetiva e seu valor de comunicação em análise.

Ogden (2010a) presents us with a theory of the clinic in which dreaming is taken as a function of unconscious elaboration, being the subject's inability to "dream his emotional experience" an indicator of psychological suffering. Taking this idea as a reference, as well as Bion's theorization about the alpha function and dream thoughts, in this work we will approach the compromise of the ability to dream and its echoes to the subject's psyche. We will present a clinical case and we will also discuss the mechanism of projective identification and its value of communication in analytical treatment.

Ogden (2010a) nous présente une théorie de la clinique dans laquelle le rêve est pris en fonction de l'élaboration inconsciente, et l'incapacité du sujet à «rêver son expérience émotionnelle¼ étant un indicateur de la souffrance psychique. Prenant cette idée comme référence, ainsi que la théorisation de Bion sur la fonction alpha et la pensée du rêve, nous parlerons dans le présent travail de l'incapacité de rêver et de ses échos à la psyché du sujet. Avec la présentation d'un cas clinique, nous aborderons également le mécanisme d'identification projective et sa valeur de communication en cours d'analyse.

Comparison of Cervical Stabilization with Transpedicular Pins and Polymethylmethacrylate versus Transvertebral Body Polyaxial Screws with or without an Interbody Distractor in Dogs.

OBJECTIVE: The main aim of this study was to compare the biomechanical properties of caudal cervical vertebral stabilization using bicortical transpedicular pins with polymethylmethacrylate (PMMA) versus transvertebral body polyaxial screws and connecting rods with or without an interbody distractor. STUDY DESIGN: Ten canine cervical vertebral columns (C2-T3) were used. Four models (intact, transvertebral body polyaxial screw with interbody distractor [polyaxial + distractor], transvertebral body polyaxial screw without interbody distractor [polyaxial - distractor] and bicortical transpedicular pins/polymethylmethacrylate [pin-PMMA]) were applied to C6-7 sequentially on the same specimens. Angular range of motion (AROM) in the form of flexion and extension was measured at C4-5, C5-6 and C6-7 in all groups. RESULTS: Treated vertebral specimens had significantly less AROM than unaltered specimens. There was no significant difference in AROM between the experimental groups at C6 and C7. Angular range of motion ratio in flexion-extension was 80.8, 72.7 and 78.3% for polyaxial + distractor, polyaxial - distractor and pin-PMMA groups, respectively, which were less than the intact group. There was no significant increase in the range of motion of the adjacent vertebrae after stabilization. CONCLUSION: Stabilization obtained with transvertebral body polyaxial screws was comparable to that from the well-established bicortical pins/PMMA construct. Association of an intervertebral distractor did not change AROM of the polyaxial screw constructs.

O brincar negativo na teoria de André Green / Negative play in André Green’s theory

Tendo como referência a compreensão sobre o trabalho do negativo, buscamos, neste estudo, traçar algumas possibilidades de entendimento do conceito de brincar no quadro da teoria de André Green, assim como refletir sobre a proposição desse autor acerca de uma modalidade do brincar como um “brincar negativo”. A partir da apresentação de um caso clínico, procuramos entender ainda em que medida teorizar sobre um brincar negativo traria implicações clínicas no manejo com pacientes que apresentam problemáticas relacionadas aos limites.(AU)

Based on our understanding of the work of the negative, we seek in this study to outline some possibilities of understanding the concept of playing within the framework of André Green’s theory, as well as to reflect on the author’s proposition of a modality of playing as a “negative play”. From the presentation of a clinical case, we try to understand to what extent theorizing about a negative play would have clinical implications in the management of patients who present problems related to the limits.(AU)

Distinct Habitats Select Particular Bacterial Communities in Mangrove Sediments.

We investigated the relationship among environmental variables, composition, and structure of bacterial communities in different habitats in a mangrove located nearby to an oil exploitation area, aiming to retrieve the natural pattern of bacterial communities in this ecosystem. The T-RFLP analysis showed a high diversity of bacterial populations and an increase in the bacterial richness from habitats closer to the sea and without vegetation (S1) to habitats covered by Avicennia schaueriana (S2) and Rhizophora mangle (S3). Environmental variables in S1 and S2 were more similar than in S3; however, when comparing the bacterial compositions, S2 and S3 shared more OTUs between them, suggesting that the presence of vegetation is an important factor in shaping these bacterial communities. In silico analyses of the fragments revealed a high diversity of the class Gammaproteobacteria in the 3 sites, although in general they presented quite different bacterial composition, which is probably shaped by the specificities of each habitat. This study shows that microhabitats inside of a mangrove ecosystem harbor diverse and distinct microbiota, reinforcing the need to conserve these ecosystems as a whole.

Elucidating carbon uptake from vinyl chloride using stable isotope probing and Illumina sequencing.

Vinyl chloride (VC), a known human carcinogen, is a common and persistent groundwater pollutant at many chlorinated solvent contaminated sites. The remediation of such sites is challenging because of the lack of knowledge on the microorganisms responsible for in situ VC degradation. To address this, the microorganisms involved in carbon assimilation from VC were investigated in a culture enriched from contaminated site groundwater using stable isotope probing (SIP) and high-throughput sequencing. The mixed culture was added to aerobic media, and these were amended with labeled ((13)C-VC) or unlabeled VC ((12)C-VC). The cultures were sacrificed on days 15, 32, and 45 for DNA extraction. DNA extracts and SIP ultracentrifugation fractions were subject to sequencing as well as quantitative PCR (qPCR) for a functional gene linked to VC-assimilation (etnE). The gene etnE encodes for epoxyalkane coenzyme M transferase, a critical enzyme in the pathway for VC degradation. The relative abundance of phylotypes was compared across ultracentrifugation fractions obtained from the (13)C-VC- and (12)C-VC-amended cultures. Four phylotypes were more abundant in the heavy fractions (those of greater buoyant density) from the (13)C-VC-amended cultures compared to those from the (12)C-VC-amended cultures, including Nocardioides, Brevundimonas, Tissierella, and Rhodoferax. Therefore, both a previously identified VC-assimilating genus (Nocardioides) and novel microorganisms were responsible for carbon uptake. Enrichment of etnE with time was observed in the heavy fractions, and etnE sequences illustrated that VC-assimilators harbor similar Nocardioides-like etnE. This research provides novel data on the microorganisms able to assimilate carbon from VC.

Diversity of a chlorine-resistant Bacillus population isolated from a wastewater treatment station.

This paper describes the phenotypic and genotypic diversity of a Gram-positive, aerobic bacterial population isolated from the chlorine tank of a wastewater treatment plant. A total of 12 sporeforming, rod-shaped isolates were identified using 16S rRNA gene sequencing and biochemical tests. Pairwise genetic comparisons revealed the identity among sequences obtained from isolates varied from 92.6 to 100%. Similarity searches on GenBank showed that five strains were closely related (99 to 100% identity) to Bacillus subtilis and two were almost identical (99%) to B. megaterium and B. licheniformis. Because the five remaining strains were either closely related (97 to 99% identity) or identical to B. cereus, B. thuringiensis, and B. anthracis, they were classified as belonging to the B. cereus group. Apart from one strain, all clades in the phylogenetic tree were identical to clusters formed in the dendrogram based on biochemical tests results. According to the biochemical profiles, all isolates were characterized as different strains. In addition to chlorine resistance, all isolates were found to be resistant to at least one of five antibiotics tested. These results identify the potential risk of spreading antibiotic resistance genes in the environment by chlorine-resistant strains of Bacillus.

Está no sangue: transmissão e psicanálise / It’s in the blood: transmission and psychoanalysis / C´est dans le sang: transmission et psychanalyse

A partir de um caso clínico e também do romance de Gabriel Garcia Márquez, Cem Anos de Solidão, o artigo aborda o conceito de transmissão em psicanálise, e a repetição do trauma entre diferentes gerações de uma família, entendendo a genealogia do sujeito como ser de linguagem, como inserido no campo do Outro. O trabalho busca compreender em que condições o trabalho analítico possibilita a emergência do sujeito em sua singularidade já que a condição de alienação está implícita em sua constituição e ele se encontra submetido aos mandatos categóricos do supereu, que comandam a repetição mortífera(AU)

Motivated by a clinical case and also by the novel by Gabriel Garcia Márquez, One Hundred Years of Solitude, the article approaches the concept of transmission in psychoanalysis and the repetition of trauma among the different generations of a family, considering the genealogy of the subject a being of language, as inserted in the field of the Other. The question is in what conditions the analytic work makes possible the subject´s emergence, once he is inserted in the condition of alienation, implicit in his constitution, and subjected to the categorical imperatives of the superego - that command the mortal repetition(AU)

Motivé pour un cas clinique et aussi pour le roman de Gabriel Garcia Márquez, Cent Années de Solitude, l'article approche le concept de transmission dans la psychanalyse, et la répétition du trauma parmi différentes générations d'une famille, comprennant la généalogie du sujet, être de langage, comme inséré dans le champ de l'Autre. La question du travail est de comprendre comme le travail analytique fait possible l'emergence du sujet dans sa singularité, une fois que la condition de l'aliénation est implicite dans sa constitution et que il est soumis aux imperatives catégoriques du surmoi qui commande la répétition mortelle(AU)

Está no sangue: transmissão e psicanálise / It’s in the blood: transmission and psychoanalysis / C´est dans le sang: transmission et psychanalyse

A partir de um caso clínico e também do romance de Gabriel Garcia Márquez, Cem Anos de Solidão, o artigo aborda o conceito de transmissão em psicanálise, e a repetição do trauma entre diferentes gerações de uma família, entendendo a genealogia do sujeito como ser de linguagem, como inserido no campo do Outro. O trabalho busca compreender em que condições o trabalho analítico possibilita a emergência do sujeito em sua singularidade já que a condição de alienação está implícita em sua constituição e ele se encontra submetido aos mandatos categóricos do supereu, que comandam a repetição mortífera

Motivated by a clinical case and also by the novel by Gabriel Garcia Márquez, One Hundred Years of Solitude, the article approaches the concept of transmission in psychoanalysis and the repetition of trauma among the different generations of a family, considering the genealogy of the subject a being of language, as inserted in the field of the Other. The question is in what conditions the analytic work makes possible the subject´s emergence, once he is inserted in the condition of alienation, implicit in his constitution, and subjected to the categorical imperatives of the superego - that command the mortal repetition

Motivé pour un cas clinique et aussi pour le roman de Gabriel Garcia Márquez, Cent Années de Solitude, l'article approche le concept de transmission dans la psychanalyse, et la répétition du trauma parmi différentes générations d'une famille, comprennant la généalogie du sujet, être de langage, comme inséré dans le champ de l'Autre. La question du travail est de comprendre comme le travail analytique fait possible l'emergence du sujet dans sa singularité, une fois que la condition de l'aliénation est implicite dans sa constitution et que il est soumis aux imperatives catégoriques du surmoi qui commande la répétition mortelle

Carcinoma lobular invasivo de mama com pólipo endometrial metastático / Breast invasive lobular carcinoma with metastatic endometrial polyp

Tumores extragenitais com metástase para o útero são raros, e destes o mais comum é o da mama. O tamoxifeno é uma droga utilizada como terapia adjuvante em mulheres com câncer de mama. Trata-se de droga antiestrogênica; no entanto, no endométrio sua ação é agonista para receptores de estrogênio. Esta descrição de caso relata rara associação do uso do tamoxifeno em paciente com câncer de mama que apresentou metástase para pólipo endometrial. Trata-se de paciente de 70 anos, em hormonioterapia com tamoxifeno há 19 meses, com queixa de sangramento vaginal. Em histeroscopia, evidenciaram-se pólipo endometrial e sua exérese, com diagnóstico de adenocarcinoma metastático, com provável sítio primário em mama. A paciente havia sido submetida à mastectomia radical modificada há três anos, seguida de adjuvância. Pólipos endometriais são achados comuns em mulheres menopausadas e também são complicações da terapia com tamoxifeno. A metástase de carcinoma mamário em pólipo endometrial é rara. Na literatura, foram descritas as seguintes metástases em pólipos endometriais: cinco casos por carcinoma lobular invasivo, três casos por carcinoma ductal e um caso do carcinoma apócrino. Portanto, existe dificuldade em determinar o prognóstico para essas pacientes.

Extragenital tumors metastasizing to the uterine corpus is uncommon; out of those, the most common primary site is the breast. Tamoxifen is used as adjuvant treatment for breast carcinoma. It is an antiestrogenic drug; however has a partial agonist effect on estrogen receptor in the endometrium. This case report relates rare association between the use of tamoxifen in patient with breast cancer which presented metastasis to endometrial polyps. A 10 years old woman received tamoxifen for 19 months after surgery treatment and presented vaginal bleeding. She underwent hysteroscopy with biopsy, which showed endometrial polyp. The polyp was taken out and the pathological diagnosis was metastasis from breast adenocarcinoma. Endometrial polyps are found relatively common in postmenopausal women and they are also related complications to the tamoxifen therapy. Breast carcinoma metastasis to endometrial polyp is rare. There were some descriptions in the literature: five cases of invasive lobular carcinoma, three cases of ductal carcinoma and one case of the apocrine carcinoma. There are few cases shown in the literature and, therefore, there are difficulties in determining the prognosis of these patients.

[Knowledge of obstetricians about the vertical transmission of hepatitis B virus]. / Conhecimento dos obstetras sobre a transmissão vertical da hepatite B.

CONTEXT: Vertical transmission is responsible for 35%-40% of the new cases of hepatitis B worldwide and it is associated with an increased risk of chronic hepatitis B, cirrhosis and hepatocellular carcinoma. OBJECTIVE: To describe obstetricians' knowledge on the recommended measures to the diagnosis of the infection by the hepatitis virus B in pregnant women and to prevent the transmission of this infection to the babies of infected mothers. METHODS: Obstetricians registered at the 'Sociedade de Ginecologia e Obstetrícia da Bahia', Salvador, BA, Brazil were randomly selected and invited to answer a questionnaire with questions regarding their academic formation, workplace, contact with medical students and their practices about the hepatitis virus B. Individuals who were not currently working as obstetricians or were not living in the state of Bahia were excluded from the study. Data were analyzed with the EpiInfo software with a 95% confidence interval. RESULTS: Three hundred and one obstetricians answered the questionnaire: 90.3% of them recognized that the hepatitis virus B could be transmitted vertically and 81.7% routinely screened their patients for hepatitis virus B infection during prenatal consultations; 66.0% considered HBsAg the best serological marker to be employed on the screening. Only 13.0% systematically recommended the vaccination against hepatitis virus B and the administration of immunoglobulin to the newborns of infected mothers in the first 12 hours of life. The frequency of correct answers about the vertical transmission of hepatitis virus B, the best serological marker for screening and the management of infected mothers and their newborns was higher among professionals who had the 'Título de Especialista em Ginecologia e Obstetrícia (TEGO)' than among the remaining ones (P = 0.018, P = 0.001 and P = 0.002, respectively). CONCLUSION: We observed that the knowledge of the obstetricians about the diagnosis and management of hepatitis virus B infection during pregnancy is not adequate, reinforcing the need of continuous medical education programs on the infections that can be transmitted vertically.

Conhecimento dos obstetras sobre a transmissão vertical da hepatite B / Knowledge of obstetricians about the vertical transmission of hepatitis B virus

CONTEXTO: A transmissão vertical é responsável por 35 por cento a 40 por cento dos novos casos de hepatite B no mundo e a infecção precoce pelo vírus da hepatite B aumenta o risco de evolução para a hepatite crônica, cirrose e carcinoma hepatocelular. OBJETIVO: Determinar o conhecimento dos obstetras sobre as práticas para o diagnóstico da infecção pelo vírus da hepatite B em gestantes e as condutas para a prevenção desta infecção em recém-nascidos de mães infectadas. MÉTODOS: Foram sorteados aleatoriamente profissionais de saúde cadastrados na Sociedade de Obstetrícia e Ginecologia da Bahia, que foram convidados a responder um questionário anônimo com informações sobre sua formação acadêmica, o local de trabalho, o contato com estudantes e as suas práticas profissionais em relação ao vírus da hepatite B. Adotou-se como critério de exclusão o não exercício atual da obstetrícia e a não residência na Bahia. A análise dos dados foi feita através do programa estatístico Epiinfo e para análise das correlações foi adotado intervalo de confiança de 95 por cento. RESULTADOS: Foram entrevistados 301 obstetras, dos quais 90,3 por cento reconheciam a transmissibilidade vertical do vírus da hepatite B e 81,7 por cento solicitavam algum exame para detecção de hepatite B durante o pré-natal de suas pacientes. Sessenta e seis por cento dos médicos entrevistados referiram o AgHBs como o marcador sorológico mais adequado para avaliar a presença de infecção pelo VHB. Apenas 13,0 por cento destes profissionais indicavam de modo sistemático a vacina contra a hepatite B e a administração de imunoglobulina nas primeiras 12 horas de vida do recém-nascido de mães infectadas. O número de respostas corretas quanto à transmissibilidade vertical do VHB, ao marcador sorológico mais adequado e à conduta para o recém-nascido de mãe infectada foi maior entre os obstetras que possuíam o Título de Especialista em Ginecologia e Obstetrícia que entre os demais profissionais...

CONTEXT: Vertical transmission is responsible for 35 percent-40 percent of the new cases of hepatitis B worldwide and it is associated with an increased risk of chronic hepatitis B, cirrhosis and hepatocellular carcinoma. OBJECTIVE: To describe obstetricians' knowledge on the recommended measures to the diagnosis of the infection by the hepatitis virus B in pregnant women and to prevent the transmission of this infection to the babies of infected mothers. METHODS: Obstetricians registered at the "Sociedade de Ginecologia e Obstetrícia da Bahia", Salvador, BA, Brazil were randomly selected and invited to answer a questionnaire with questions regarding their academic formation, workplace, contact with medical students and their practices about the hepatitis virus B. Individuals who were not currently working as obstetricians or were not living in the state of Bahia were excluded from the study. Data were analyzed with the EpiInfo software with a 95 percent confidence interval. RESULTS: Three hundred and one obstetricians answered the questionnaire: 90.3 percent of them recognized that the hepatitis virus B could be transmitted vertically and 81.7 percent routinely screened their patients for hepatitis virus B infection during prenatal consultations; 66.0 percent considered HBsAg the best serological marker to be employed on the screening. Only 13.0 percent systematically recommended the vaccination against hepatitis virus B and the administration of immunoglobulin to the newborns of infected mothers in the first 12 hours of life. The frequency of correct answers about the vertical transmission of hepatitis virus B, the best serological marker for screening and the management of infected mothers and their newborns was higher among professionals who had the "Título de Especialista em Ginecologia e Obstetrícia (TEGO)" than among the remaining ones (P = 0.018, P = 0.001 and P = 0,002, respectively). CONCLUSION: We observed that the knowledge...

Angiossarcoma de mama após tratamento com cirugia conservadora e radioterapia / Breast angiossarcoma after conservative surgery and radiotherapy

Dois cirúrgico conservador para carcinoma ductal invasor seguido de radioterapia, vieram a desenvolver lesão violácea em mama operada e irradiada, cujo diagnóstico foi angiossarcoma, sendo uma bem diferenciada e outra pouco diferenciada. Trata-se de neoplasia rara de mama, cujo relatos de casos referentes a pacientes com média de idade de 81 anos, que, após tratamento tratamento tem base mais no procedimento cirúrgico, no qual a quimioterapia e a radioterapia não têm sua indicação bem estabelecida e clara. O prognóstico é desfavorável, com média de sobrevida de 15,5 meses.

This study features two case reports of patients with the average age of 81 years, that after conservative surgical therapy for invasive ductal carcinoma followed by radiotherapy developed purple nodule in the operated irradiated breast, whose diagnosis was angiosarcoma, being one well-differentiated and other little differentiated. It is a rare breast neoplasm, whose treatment relies more on surgery when chemotherapy and radiotherapy dont’t have well established and cleary indication. The prognostic is unfavorable, with survival prospect of 15,5 months.

Hiperfosfatasemia transitória benigna na infância / Benign transient hyperphosphatasemia in childhood

A hiperfosfatasemia transitória benigna na infância (HTBI) é uma condição pouco conhecida, que se traduz por um estado benigno e de bom prognóstico. A HTBI resulta do aumento súbito e transitório na concentração sérica da fosfatase alcalina (FA) em crianças sadias. A sua etiopatogenia é ainda incerta, porém a diminuição do clearance da enzima na circulação tem sido considerada o mecanismo mais provável. Para divulgar os conhecimentos atuais acerca do diagnóstico da HTBI, foram selecionados, no Medline, os artigos de periódicos médicos internacionais mais relevantes desde a descrição inicial desta condição, em 1954. Os critérios para diagnóstico de HTBI são: acometer crianças com idade inferior a cinco anos, ausência de sintomas ou presença de sintomas associados a doenças não relacionadas, sem evidência clínica ou laboratorial de doença óssea ou hepática. A elevação da fosfatase alcalina varia entre 3 e 50 vezes o limite superior do valor para a idade. A análise das isoenzimas mostra elevação das formas óssea e hepática. Os níveis séricos da fosfatase alcalina retornam ao normal em quatro meses. A elevação sérica da fosfatase alcalina foi relatada em patologias como hiperfosfatasemia familiar persistente assintomßtica e sintomática e hiperfosfatasemia persistente não-familiar. É indispensável que a HTBI seja considerada no diagnóstico diferencial de um aumento considerável dos níveis séricos de fosfatase alcalina em crianças, sem que seja detectada uma causa óbvia, o que evitará procedimentos desnecessários e dispendiosos durante a investigação diagnóstica.

Comparação do diagnóstico endoscópico com o histopatológico em crianças portadoras de esofagite / Endoscopic diagnosis versus histologic diagnosis in children with esophagitis

O refluxo gastroesofágico representa o fluxo retrógrado do conteúdo gástrico para o esôfago. A doença do refluxo gastroesofágico é a condição na qual estão presentes sintomas e/ou complicações digestivas, dentre elas a esofagite. O diagnóstico da esofagite é realizado através da endoscopia digestiva alta (EDA) e do exame histopatológico da mucosa esofágica. O presente estudo teve como objetivo comparar os achados endoscópicos e histopatológicos da região esofágica em crianças portadoras de esofagite. Foram revisados resultados de EDA e de biópsias de 125 crianças com idade entre 0 a 18 anos com esofagite, no período de 1997 a 2001. Destes pacientes, 69 (52,20 por cento) eram do sexo feminino. Nos resultados endoscópicos, 104 (83,20 por cento) pacientes tiveram o diagnóstico de esofagite edematosa; na histologia, 48 (33,40 por cento) das crianças apresentaram esofagite crônica, enquanto na de 29 (23,20 por cento) não ocorreram alterações. Quando correlacionados à histopatologia, os resultados da EDA não são fidedignos a ponto de justificar-se o uso isolado desta. É fundamental a realização da biópsia para esclarecimento diagnóstico desta patologia e para acompanhamento dos pacientes. Há ainda a necessidade de múltiplas biópsias para análise adequada do processo e para identificação precoce do esôfago de Barrett.