Robotic transversus abdominis release: A paradigm shift in complex abdominal wall surgery?

Abdominal wall reconstruction techniques have evolved significantly over the last fifty years and continue to do so at an increasing pace. Beginning with open incisional hernia repair with bilateral rectus myofascial release, multiple techniques to offset tension at the midline by exploring options of layered myofascial release have been described. This article reviews the history, technique, advancements, and future of myofascial release in abdominal wall reconstruction leading from the open Rives-Stoppa repair to the robotic-assisted iteration of the transversus abdominis release.

Recurrence after retromuscular repair or posterior components separation: How to address them. A retrospective multicentre cohort study.

Abdominal wall hernias are common entities that represent important issues. Retromuscular repair and component separation for complex abdominal wall defects are considered useful treatments according to both short and long-term outcomes. However, failure of surgical techniques may occur. The aim of this study is to analyze results of surgical treatment for hernia recurrence after prior retromuscular or posterior components separation. We have retrospectively reviewed patient charts from a prospectively maintained database. This study was conducted in three different hospitals of the Madrid region with surgical units dedicated to abdominal wall reconstruction. We have included in the database 520 patients between December 2014 and December 2021. Fifty-one patients complied with the criteria to be included in this study. We should consider offering surgical treatment for hernia recurrence after retromuscular repair or posterior components separation. However, the results might be associated to increased peri-operative complications.

Evaluación crítica de la literatura sobre la toma de decisiones de las metástasis vertebrales / Critical evaluation of the literature on decision-making in spinal metastases

La toma de decisiones en pacientes con metástasis vertebral es de gran complejidad. En ella intervienen distintos factores del paciente, de su enfermedad oncológica y de las opciones de tratamiento. Los esquemas y estrategias de tratamiento se han ido modificando con la propia evolución del conocimiento y tratamiento de la enfermedad oncológica diseminada. En este trabajo se analiza la bibliografía que se ha empleado para la toma de decisiones en las tres últimas décadas, así como la evolución a los esquemas que podríamos considerar contemporáneos.(AU)

Decision-making in patients with vertebral metastases is highly complex. Different factors of the patient, their cancer disease and treatment options are involved in it. Treatment schemes and strategies have been modified with the evolution of knowledge and treatment of disseminated oncological disease. This paper analyzes the bibliography that has been used for decision-making in the last three decades, as well as the evolution to the schemes that we could consider contemporary.(AU)

[Translated article] Critical evaluation of the literature on decision-making in spinal metastases / Evaluación crítica de la literatura sobre la toma de decisiones de las metástasis vertebrales

La toma de decisiones en pacientes con metástasis vertebral es de gran complejidad. En ella intervienen distintos factores del paciente, de su enfermedad oncológica y de las opciones de tratamiento. Los esquemas y estrategias de tratamiento se han ido modificando con la propia evolución del conocimiento y tratamiento de la enfermedad oncológica diseminada. En este trabajo se analiza la bibliografía que se ha empleado para la toma de decisiones en las tres últimas décadas, así como la evolución a los esquemas que podríamos considerar contemporáneos.(AU)

Decision-making in patients with vertebral metastases is highly complex. Different factors of the patient, their cancer disease and treatment options are involved in it. Treatment schemes and strategies have been modified with the evolution of knowledge and treatment of disseminated oncological disease. This paper analyzes the bibliography that has been used for decision-making in the last three decades, as well as the evolution to the schemes that we could consider contemporary.(AU)

Valoración e indicaciones quirúrgicas: cirugía separación / Preoperative assessment and surgical indications: Separation surgery

La compresión neurológica se presenta entre el 10-20% de los pacientes que desarrollan una metástasis vertebral. En la última década, la evolución de las técnicas diagnósticas y médicas oncológicas, el cambio de la radiación convencional externa a la radiocirugía y los nuevos instrumentales quirúrgicos, han hecho que el tratamiento de estos pacientes deba de ser indicado de forma personalizada y en consenso, de forma multidisciplinar, en comisiones específicas.Hoy, el estado biológico del paciente, la presencia de inestabilidad mecánica, la valoración neurológica y el grado de compresión epidural, así como la mejor categorización pronóstica del tumor, se establecen como los factores de decisión previa a la indicación del tratamiento quirúrgico, tratamiento que ha pasado de un concepto «citorreductor» al de «separador» o «preparador» de la médula para asegurar una radiocirugía segura.(AU)

Neurological compression occurs in 10%-20% of patients who develop spinal metastases. In the last decade, the evolution of oncological diagnostic and medical techniques, the change from conventional external radiation to radiosurgery and the new surgical instruments have meant that the treatment of these patients must be indicated in a personalized manner and by consensus, multidisciplinary way, in specific commissions.Today, the biological state of the patient, the presence of mechanical instability, the neurological assessment and degree of epidural compression, as well as the best prognostic categorization of the tumor, are established as decision factors prior to the indication of surgical treatment, treatment that has passed from a cytoreductive concept to that of a spinal cord release from tumor in order to ensure safe radiosurgery.(AU)

[Translated article] Preoperative assessment and surgical indications: Separation surgery / Valoración e indicaciones quirúrgicas: cirugía de separación

La compresión neurológica se presenta entre el 10-20% de los pacientes que desarrollan una metástasis vertebral. En la última década, la evolución de las técnicas diagnósticas y médicas oncológicas, el cambio de la radiación convencional externa a la radiocirugía y los nuevos instrumentales quirúrgicos, han hecho que el tratamiento de estos pacientes deba de ser indicado de forma personalizada y en consenso, de forma multidisciplinar, en comisiones específicas.Hoy, el estado biológico del paciente, la presencia de inestabilidad mecánica, la valoración neurológica y el grado de compresión epidural, así como la mejor categorización pronóstica del tumor, se establecen como los factores de decisión previa a la indicación del tratamiento quirúrgico, tratamiento que ha pasado de un concepto «citorreductor» al de «separador» o «preparador» de la médula para asegurar una radiocirugía segura.(AU)

Neurological compression occurs in 10%-20% of patients who develop spinal metastases. In the last decade, the evolution of oncological diagnostic and medical techniques, the change from conventional external radiation to radiosurgery and the new surgical instruments have meant that the treatment of these patients must be indicated in a personalized manner and by consensus, multidisciplinary way, in specific commissions.Today, the biological state of the patient, the presence of mechanical instability, the neurological assessment and degree of epidural compression, as well as the best prognostic categorization of the tumor, are established as decision factors prior to the indication of surgical treatment, treatment that has passed from a cytoreductive concept to that of a spinal cord release from tumor in order to ensure safe radiosurgery.(AU)

Open vs. minimally invasive sublay incisional hernia repair. Is there a risk of overtreatment? EVEREG registry analysis.

INTRODUCTION: Incisional hernia (IH) is a very common surgical procedure. Registries provide real world data. The objective is to analyze the open and minimally invasive (MIS) sublay technique (with or without associated components separation [CS]) in IH cases from the EVEREG registry and to evaluate the evolution over time of the techniques. METHODS: All patients in EVEREG from July 2012 to December 2021 were included. The characteristics of the patients, IH, surgical technique, complications and mortality in the first 30 days were collected. We analyzed Group 1 (open sublay vs MIS sublay, without CS), Group 2 (open sublay vs MIS sublay, with CS) and Group 3 where the evolution of open and MIS techniques was evaluated over time. RESULTS: 4867 IH were repaired using a sublay technique. Group 1: 3739 (77%) open surgery, mostly midline hernias combined (P = .016) and 55 (1%) MIS, mostly lateral hernias (LH) (P = .000). Group 2: 1049 (21.5%) open surgery and 24 (0.5%) MIS. A meaningful difference (P = .006) was observed in terms of transverse diameters (5.9 (SD 2.1) cm for the MIS technique and 10.11 (SD 4.8) for the open technique). The LH MIS associated more CS (P = .002). There was an increase in the use of the sublay technique over time (with or without CS). CONCLUSION: Increased use of the sublay technique (open and MIS) over time. For some type of hernia (LH) the MIS sublay technique with associated CS may have represented an overtreatment.

[Translated article] Critical evaluation of the literature on decision-making in spinal metastases.

Decision-making in patients with vertebral metastases is highly complex. Different factors of the patient, their cancer disease and treatment options are involved in it. Treatment schemes and strategies have been modified with the evolution of knowledge and treatment of disseminated oncological disease. This paper analyzes the bibliography that has been used for decision-making in the last three decades, as well as the evolution to the schemes that we could consider contemporary.

[Translated article] Preoperative assessment and surgical indications: Separation surgery.

Neurological compression occurs in 10%-20% of patients who develop spinal metastases. In the last decade, the evolution of oncological diagnostic and medical techniques, the change from conventional external radiation to radiosurgery and the new surgical instruments have meant that the treatment of these patients must be indicated in a personalized manner and by consensus, multidisciplinary way, in specific commissions. Today, the biological state of the patient, the presence of mechanical instability, the neurological assessment and degree of epidural compression, as well as the best prognostic categorization of the tumor, are established as decision factors prior to the indication of surgical treatment, treatment that has passed from a cytoreductive concept to that of a spinal cord release from tumor in order to ensure safe radiosurgery.

Preoperative assessment and surgical indications: Separation surgery. / Valoración e indicaciones quirúrgicas: cirugía separación.

Neurological compression occurs in 10%-20% of patients who develop spinal metastases. In the last decade, the evolution of oncological diagnostic and medical techniques, the change from conventional external radiation to radiosurgery and the new surgical instruments have meant that the treatment of these patients must be indicated in a personalized manner and by consensus, multidisciplinary way, in specific commissions. Today, the biological state of the patient, the presence of mechanical instability, the neurological assessment and degree of epidural compression, as well as the best prognostic categorization of the tumor, are established as decision factors prior to the indication of surgical treatment, treatment that has passed from a cytoreductive concept to that of a spinal cord release from tumor in order to ensure safe radiosurgery.

Critical evaluation of the literature on decision-making in spinal metastases. / Evaluación crítica de la literatura sobre la toma de decisiones de las metástasis vertebrales.

Decision-making in patients with vertebral metastases is highly complex. Different factors of the patient, their cancer disease and treatment options are involved in it. Treatment schemes and strategies have been modified with the evolution of knowledge and treatment of disseminated oncological disease. This paper analyzes the bibliography that has been used for decision-making in the last three decades, as well as the evolution to the schemes that we could consider contemporary.

Psychological repercussions on children and adolescents after paternal estrangement due to conjugal violence: maternal narratives / Repercusiones psicológicas en niños y adolescentes tras la separación paterna por violencia conyugal: narrativas maternas / Repercussões psicológicas em crianças e adolescentes após afastamento paterno por violência conjugal: narrativas maternas

ABSTRACT Objective: to unveil the psychological repercussions perceived by mothers on children and adolescents after paternal estrangement due to conjugal violence. Method: this is a descriptive-exploratory study with a qualitative approach developed with mothers in legal proceedings for conjugal violence at the 2nd Domestic and Family Violence Court of Salvador, Bahia, Brazil. Data collection took place between September and November 2021 through interviews carried out using a virtual meeting application, guided by a semi-structured form. Interviews were recorded with authorization, and later converted to a written version with the support of Microsoft Word. Data were organized through thematic content analysis proposed by Bardin. Results: this research was carried out with eight women/mothers aged 29 to 39 years, mostly self-declared black, evangelical, single and with complete high school. At the time of the interview, women had been separated from six months to a year and a half; lived with the father of children and children aged 7 to 15; and most of them had a single child, whose age ranged between 5 and 15 years. As results of the interviews, Emotional, Behavioral and Psychological categories emerged. Conclusion: the study reveals that, after paternal estrangement resulting from protective measures for mothers with a history of conjugal violence, children and adolescents experience emotional, behavioral and psychological repercussions. The study can contribute to strengthening the psychological care of children/adolescents who have experienced violence, providing professionals with support to outline preventive strategies.

RESUMEN Objetivo: revelar las repercusiones psicológicas percibidas por las madres en niños y adolescentes luego del alejamiento paterno por violencia conyugal. Método: estudio descriptivo-exploratorio con enfoque cualitativo desarrollado con madres en procesos judiciales por violencia conyugal en el 2º Juzgado de Violencia Doméstica y Familiar de Salvador, Bahía, Brasil. La recolección de datos se realizó entre septiembre y noviembre de 2021 a través de entrevistas realizadas mediante una aplicación de reuniones virtuales, guiadas por un formulario semiestructurado. Las entrevistas fueron grabadas, previa autorización, y posteriormente convertidas a versión escrita con soporte de Microsoft Word. Los datos fueron organizados a través del análisis de contenido temático, propuesto por Bardin. Resultados: esta investigación se realizó con ocho mujeres/madres de 29 a 39 años, en su mayoría autodeclaradas negras, evangélicas, solteras y con educación secundaria completa. En el momento de la entrevista, las mujeres llevaban separadas entre seis meses y un año y medio, y vivían con el padre de los niños y adolescentes de edades comprendidas entre 7 y 15 años y, la mayoría de ellos, tenían un solo hijo, cuya edad oscilaba entre 5 y 15 años. Como resultados de las entrevistas surgieron las categorías Emocional, Comportamental y Psíquica. Conclusión: el estudio revela que, después del alejamiento paterno resultante de medidas de protección a madres con antecedentes de violencia conyugal, niños y adolescentes experimentan repercusiones emocionales, conductuales y psicológicas. El estudio puede contribuir a fortalecer la atención psicológica de niños/adolescentes que han vivido violencia, brindando apoyo a los profesionales para trazar estrategias preventivas.

RESUMO Objetivo: Desvelar as repercussões psicológicas percebidas por mães em crianças e adolescentes após o afastamento paterno por violência conjugal. Método: Estudo de caráter descritivo-exploratório e abordagem qualitativa desenvolvido com as genitoras em processo judicial por violência conjugal junto à 2ª Vara de Violência Doméstica e Familiar de Salvador, Bahia, Brasil. A coleta de dados ocorreu entre setembro e novembro de 2021 através de entrevista realizada por aplicativo de reunião virtual, sendo guiada por formulário semiestruturado. As entrevistas foram gravadas, mediante autorização e, posteriormente, convertidas para a versão escrita com apoio do Microsoft Word. Os dados foram organizados por meio da análise de conteúdo temático, proposto por Bardin. Resultados: Esta pesquisa foi realizada com oito mulheres/mães na faixa etária de 29 a 39 anos majoritariamente autodeclaradas negras, evangélicas, solteiras e com ensino médio completo. No momento da entrevista, as mulheres tinham de seis meses a um ano e meio de separadas, tendo convivido com o pai das crianças e adolescentes de 7 a 15 anos e, na sua maioria, tinha um único filho, cuja idade variava entre 5 e 15 anos. Como resultados das entrevistas emergiram três categorias: Emocionais, Comportamentais e Psíquicas. Conclusão: O estudo revela que, após o afastamento paterno decorrente de medida protetiva às mães com história de violência conjugal, crianças e adolescentes apresentam repercussões de ordem emocional, comportamental e psíquica. O estudo pode contribuir no fortalecimento do cuidado psicológico de crianças/adolescentes que experienciaram a violência, munindo profissionais de subsídios para traçar estratégias preventivas.

"No me taladres la cabeza". Cómo tratar al adolescente que rechaza ser tratado / "No em foradis el cap". Com tractar l’adolescent que rebutja ser tractat / "Don't drive me crazy". Dealing with adolescents who refuse to get treatment

En la clínica encontramos adolescentes con síntomas serios, que no tienen consciencia de conflicto, y relaciones familiares que no les hanpermitido diferenciase de su familia. En estos casos, proponemos una intervención familiar con el objetivo de resolver las distorsiones patológicas que bloquean el desarrollo del adolescente. Presentamos un caso clínicoen el cual se pueden observar las vicisitudes de la intervención familiar y como ésta facilita la evolución de lapsicoterapia individual.(AU)

A la clínica, trobem adolescents ambsímptomes seriosos, que no tenen consciència de conflicte i relacions familiars que no li han permès diferen-ciar-se de la família. En aquests casos, proposem una intervenció familiar adreçada a resoldre les distorsions patològiques que bloquegen el desenvolupament de l'adolescent. Presentem un cas clínic en el qual es podenobservar les vicissituds de la intervenció familiar i com aquesta facilita l'evolució de la psicoteràpia individual.(AU)

In our clinical work, we find adolescents with severe symptoms, who are not aware of the conflict, and family relationships that have notallowed them to differentiate themselves from their family. In these cases, we propose a family interventionto resolve the pathological distortions that block the adolescent's development. We present a clinical case inwhich we can observe the vicissitudes of family intervention and how it facilitates the evolution of individualpsychotherapy.(AU)

Hernia incisional y pérdida de dominio con neumoperitoneo progresivo preoperatorio más separacion de componentes. Un reporte de caso / Progressive preoperative pneumoperitoneum and components separation in incisional hernia with loss of domain. A case study report

Introducción: Una hernia con pérdida de dominio tiene un contenido de saco herniario de 50% o más del contenido de la cavidad abdominal, que conlleva a efectos locales y sistémicos. Reporte de Caso: Presentamos el caso de una paciente con hernia incisional y pérdida de dominio de 30 años de evolución, quien fue sometida a neumoperitoneo preoperatorio y durante acto quirúrgico, para evitar el cierre del defecto herniario con tensión, se realizó separación de componentes. Conclusión: El neumoperitoneo progresivo preoperatorio es un método recomendable en el manejo de pacientes con hernias gigantes y pérdida de dominio, porque es de bajo costo, seguro, fácil de realizar y evita las posibles complicaciones a las que el cierre del defecto con tensión conlleva.

Background:Ahernia with loss of domain has a hernia sac content of 50% or more than the content of the abdominal cavity, which leads to local and systemic effects. The case of a patient with an incisional hernia Report case: with loss of domain and 30 years of evolution is presented, she underwent preoperative pneumoperitoneum and during surgery, anterior component separation was performed to avoid tension in the closure of the hernia defect. Conclusion:Preoperative progressive neumoperitoneum is a recommended method in the management of patients with giant hernias and loss of domain, because it is low cost, safe and easy to perform and avoids the possible complications that the closure of the defect with tension entails

Prior On-Off Relationship Instability and Distress in the Separation and Divorce Transition.

Divorce is considered distressing for many individuals (Sbarra et al., Current Directions in Psychological Science, 2015, 24, 109); however, individuals in poor-quality relationships may experience certain benefits of leaving an unstable union (Amato & Hohmann-Marriott, Journal of Marriage and Family, 2007, 69, 621). On-off relationship cycling, or the breakup and reconciliation of a relationship, is a salient indicator of poor relationship quality and a common form of relationship instability (Dailey et al., Personal Relationships, 2009, 16, 23) that is associated with distress (Monk et al., Family Relations, 2018, 67, 523). In line with divorce-stress-adjustment and relational turbulence theory perspectives, we hypothesized that those whose relationships were characterized by on-off instability would experience less distress during the separation and divorce process. Given gender inequality in marriage (e.g., Dempsey, Journal of Sociology, 2002, 38, 91; Monin & Clark, Sex Roles, 2011, 65, 320), we also hypothesized that this association would be more pronounced for women. Using data from 98 divorced or separating couples, we found that relationship cycling prior to the separation and divorce process was associated with fewer distress symptoms for women. Conversely, a history of relationship cycling was associated with more distress symptoms for men. Our study provides support and extends prior investigations illustrating that, for some, those in unions characterized by more turmoil, may experience relief following a termination.

El divorcio se considera angustiante para muchas personas (Sbarra et al., 2015); sin embargo, las personas que tienen relaciones de mala calidad pueden percibir ciertos beneficios al romper una unión inestable (Amato & Hohmann-Marriott, 2007). El ciclo intermitente de las relaciones, o la separación y la reconciliación de una relación, es un indicador prominente de la mala calidad de la relación y una forma común de inestabilidad relacional (Dailey et al., 2009) que está asociada con el distrés (Monk et al., 2018). En consonancia con las perspectivas de adaptación al estrés por el divorcio y de la teoría del estrés relacional, planteamos la hipótesis de que aquellas personas cuyas relaciones se caracterizaban por la inestabilidad intermitente sufrirían menos distrés durante la separación y el proceso de divorcio. Dada la desigualdad de género en el matrimonio (p. ej.: Dempsey, 2002; Monin & Clark, 2011) también planteamos la hipótesis de que esta asociación sería más marcada para las mujeres. Utilizando datos de 98 parejas divorciadas o que se estaban separando, descubrimos que el ciclo relacional anterior a la separación y al proceso de divorcio estuvo asociado con menos síntomas de distrés en las mujeres. Contrariamente, un historial de ciclo relacional se asoció con más síntomas de distrés en los hombres. Nuestro estudio ofrece respaldo y amplía investigaciones previas demostrando que algunas personas que están en uniones caracterizadas por más confusión pueden sentir alivio después de una separación.

Fim da conjugalidade na transição para a parentalidade: adaptação feminina ao novo arranjo familiar / End of conjugality in the transition to parenthood: female adaptation to the new family arrangement / Fin de la conyugalidad en la transición a la paternidad: adaptación femenina al nuevo arreglo familiar

Este estudo é parte de uma pesquisa mais ampla sobre separação na transição para a parentalidade. Diante do crescente índice de pedidos de separação conjugal por mulheres, objetivamos investigar repercussões da dissolução conjugal para as mulheres, na transição para a parentalidade, em sua perspectiva. Como referencial teórico, utilizamos estudos psicanalíticos, sistêmicos e psicossociais. Realizamos 12 entrevistas com mulheres das camadas médias cariocas, entre 30 e 40 anos de idade, que se separaram há, no mínimo, dois anos, no período de zero a dois anos de idade do primeiro filho. Para a análise dos dados utilizamos o método de análise de conteúdo, na vertente categorial. Emergiram das narrativas três categorias de análise: paternidade após a separação conjugal; adaptação ao novo arranjo familiar; e imaginário social sobre a mãe separada. Os resultados indicaram que as mulheres souberam separar questões relativas à conjugalidade daquelas relativas à parentalidade, contribuindo para boa convivência do casal parental após a separação. Mostraram também que o conservadorismo, os preconceitos e o machismo podem ter prejudicado o período pós-separação das participantes e que possivelmente contribuíram para resistências delas mesmas a estabelecerem novos relacionamentos.(AU)

This study is part of a broader research on separation in the transition to parenthood. According to the growing rate of requests for marital separation from women, we aim to investigate the repercussions of marital dissolution on women in the transition to parenthood, in their perspective. As a theoretical reference, we used psychoanalytical, systemic, and psychosocial studies. We conducted 12 interviews with women from the middle class of the municipality of Rio de Janeiro, aged between 30 and 40 years, who had separated from their partners at least two years before and during the period their first child was zero to two years old. For data analysis, we used the method of content analysis, in the categorial aspect. Three categories of analysis emerged from the narratives: paternity after marital separation; Adaptation to the new family arrangement; and social imaginary about the separate mother. The results pointed out that women were able to separate issues related to conjugality from those related to parenting, contributing to the good relation of the parental couple after the separation. They also showed that conservatism, prejudice, and sexism may have affected the post-separation period of the participants and may have contributed to their own resistance to establishing new relationships.(AU)

Este estudio parte de una investigación más amplia sobre la separación en la transición a la paternidad. En vista de la creciente tasa de solicitudes de separación matrimonial femenina, el objetivo de este artículo fue investigar las repercusiones de la disolución matrimonial para las mujeres en la transición a la paternidad, desde su perspectiva. Como referencia teórica, utilizamos estudios psicoanalíticos, sistémicos y psicosociales. Realizamos 12 entrevistas con mujeres de clase media de Río de Janeiro, de entre 30 y 40 años de edad que habían estado separadas durante al menos dos años, en el período de cero a dos años del primer hijo. Para el análisis de datos, utilizamos el método de análisis de contenido, en el aspecto categorial. De las narraciones surgieron tres categorías de análisis: paternidad después de la separación conyugal; adaptación al nuevo arreglo familiar; y el imaginario social sobre la madre separada. Los resultados indicaron que las mujeres lograron separar las cuestiones relacionadas con la conyugalidad de las relacionadas con la paternidad, contribuyendo a la buena convivencia de la pareja parental tras la separación. También mostraron que el conservadurismo, los prejuicios y el sexismo pueden haber afectado el período posterior a la separación de los participantes y haber contribuido a su propia resistencia a nuevas relaciones amorosas.(AU)

Implicações para homens do afastamento do(a) filho(a) devido medida protetiva de urgência / Impacto en los hombres del distanciamiento del(la) hijo(a) debido a medida protectora de urgencia / Implications for men of separation from their children due to emergency protective measure

Resumo Objetivo Desvelar as implicações para os homens do afastamento pai-filho(a) em decorrência de medida protetiva por violência conjugal. Métodos Estudo descritivo exploratório, abordagem qualitativa, desenvolvido com nove homens que respondiam a processo judicial por violência conjugal junto às 1ª e 2ª Varas de Justiça pela Paz em Casa de Salvador, Bahia, Brasil. A pesquisa ocorreu por meio da entrevista semiestruturada, tendo seu conteúdo gravado, transcrito e, em seguida, submetido à validação pelos homens. Os dados foram sistematizados com base nos passos preconizados pela análise de conteúdo temática categorial. Resultados O estudo revela que o afastamento pai-filho em decorrência da medida protetiva de urgência suscita no rompimento do vínculo paterno, fomentando o desenvolvimento de problemas psicoemocionais, como ansiedade, depressão e ideação suicida, muitas vezes somatizados e expressos desde cefaleia até condições que necessitam de cuidados hospitalares. Conclusão O comprometimento do exercício da paternidade viola também o direito de crianças e adolescentes ao convívio com a figura paterna. Deste modo, há grande necessidade de que a Política Nacional de Atenção Integral à Saúde dos Homens contemple uma gestão que priorize ações preventivas para a violência, assim como desempenhe acompanhamento psicossocial aos homens.

Resumen Objetivo Revelar el impacto en los hombres del distanciamiento padre-hijo(a) como consecuencia de medidas protectoras por violencia conyugal. Métodos Estudio descriptivo exploratorio, enfoque cualitativo, llevado a cabo con nueve hombres que respondían a juicio por violencia conyugal en el 1º y 2º Juzgado de Justicia por la Paz en Casa de Salvador, estado de Bahia, Brasil. La investigación se realizó a través de encuesta semiestructurada, con grabación y transcripción del contenido, y luego sometido a su validación por los hombres. Los datos fueron sistematizados con base en los pasos preconizados por el análisis de contenido temático de la categoría. Resultados El estudio revela que el distanciamiento padre-hijo como consecuencia de medidas protectoras de urgencia provoca la ruptura del vínculo paterno y fomenta el desarrollo de problemas psicoemocionales, como ansiedad, depresión e ideación suicida, muchas veces somatizados y expresados desde una cefalea hasta condiciones que necesitan cuidados hospitalarios. Conclusión El comprometimiento del ejercicio de la paternidad también viola el derecho de niños y adolescentes a convivir con la figura paterna. De este modo, hay una gran necesidad de que la Política Nacional de Atención Integral a la Salud de los Hombres contemple una gestión que establezca prioridades en acciones preventivas contra la violencia, así como también realice un seguimiento psicosocial de los hombres.

Abstract Objective To unveil the implications for men of father-son estrangement as a result of a protective measure for conjugal violence. Methods This is an exploratory descriptive study, with a qualitative approach, developed with nine men who were responding to a lawsuit for conjugal violence at the 1st and 2nd Courts of Justice of the Peace in Casa de Salvador, Bahia, Brazil. The research took place through a semi-structured interview, with its content recorded, transcribed and then submitted for validation by the men. Data were systematized based on the steps recommended by the categorical thematic content analysis. Results The study reveals that the father-son estrangement as a result of an emergency protective measure causes paternal bond rupture, promoting the development of psycho-emotional problems, such as anxiety, depression and suicidal ideation, often somatized and expressed from headache to conditions that require hospital care. Conclusion The commitment to the exercise of paternity also violates the right of children and adolescents to live with their father figure. Thus, there is a great need for the Brazilian National Policy for Comprehensive Care for Men's Health to include a management that prioritizes preventive actions against violence as well as providing psychosocial support to men.

Guarda compartilhada à luz da bioética e do biodireito / Joint custody in the light of bioethics and biolaw / Custodia compartida a la luz de la bioética y el bioderecho

Resumo A família é a base fundante da sociedade e o melhor local para a educação e o crescimento da criança. O divórcio é deletério à saúde das crianças, impactando sobretudo na saúde mental e no desempenho escolar, além ter reflexos na vida adulta. O convívio por período igualitário com pai e mãe após o divórcio - a guarda compartilhada - garante benefícios, empiricamente comprovados, ao bem-estar físico e psicológico das crianças. No entanto, muitas decisões judiciais decretam guarda compartilhada em menos de um terço das separações. Ao analisar controvérsias éticas e morais na inter-relação das ciências jurídicas com as ciências da saúde, o biodireito faz com que a bioética tenha eficácia. Por esse motivo, argumenta-se que ações judiciais de família devem seguir critérios multidisciplinares que considerem as crianças como sujeitos vulneráveis que precisam de proteção.

Abstract Family is the founding basis of society and the best place for the education and growth of children. Divorce is deleterious to children's health, mainly impacting their mental health and school performance, in addition to having impacts on adulthood. Living both with the father and the mother for an equal period of time after divorce - joint custody - guarantees empirically proven benefits to the physical and psychological well-being of children. However, judicial decisions decree joint custody in less than a third of separations. By analyzing ethical and moral controversies in the interrelation of legal sciences and health sciences, biolaw makes bioethics effective. Thus, it is discussed that family lawsuits should follow multidisciplinary criteria that consider children as vulnerable subjects who need protection.

Resumen La familia es la base de la sociedad y es el mejor lugar para la educación y el crecimiento del niño. El divorcio es perjudicial para la salud de los niños, especialmente afecta la salud mental y escolar, con repercusiones en la vida adulta. Vivir juntos por un período igual con el padre y la madre después del divorcio, la custodia compartida, es un elemento con una relación causal estadística para proteger la salud de los niños. Sin embargo, las decisiones judiciales han decretado la custodia compartida en menos de un tercio de las separaciones. Bioderecho es una forma de hacer que la bioética sea efectiva, mediante el análisis de controversias éticas y morales en la interrelación entre las ciencias jurídicas y las ciencias de la salud. Las acciones legales familiares deben llevarse a cabo de manera multidisciplinaria, considerando al niño como el sujeto más vulnerable a proteger.

Manejo actual de las metástasis vertebrales: un trabajo en equipo / Current management of vertebral metastases: teamwork

La enfermedad metastásica vertebral es frecuente en los pacientes con cáncer avanzado, y conlleva a complicaciones inherentes a su progresión, como lo son la fractura patológica vertebral y la compresión neural metastásica. Se realizó una revisión de los aspectos terapéuticos actuales del manejo de la progresión y de las complicaciones de la enfermedad metastásica vertebral, enfatizando su enfrentamiento sistémico y personalizado. Nuestro objetivo principal es proporcionar información sobre el tratamiento actual de esta afección y la utilidad del manejo sistémico y multidisciplinario.

Metastatic spinal disease is common in patients with advanced cancer, and leads to complications inherent in its progression, such as pathological vertebral fracture and metastatic neural compression. A review of the current therapeutic aspects regarding the progression and complications of metastatic spinal disease was performed, highlighting its systemic, personalized approach. Our aim is to provide information about the current treatment of this condition and the usefulness of its systemic and multidisciplinary management.

Experiencia de una niña de nueve años ante la separación parental / Effects of parental separation: listening to a nine-year-old girl / Efeitos da separação parental: ouvindo uma menina de nove anos

Resumen (analítico) En este estudio cualitativo se describen y analizan los efectos de la separación parental, a través de la mirada y voz de una niña de nueve años. Se empleó como instrumento una entrevista semiestructurada y un análisis de resultados de tipo categórico. Las repercusiones observadas se clasificaron en efectos individuales como el manejo de la información y la construcción de explicaciones, así como una mayor independencia y mejora en su autoconcepto; y efectos en su entorno familiar, tales como la modificación en los vínculos afectivos con sus padres, dinámicas familiares más consistentes y mayores momentos de bienestar. Concluyendo que los infantes son participantes activos en la construcción de sus significados y que la separación de los padres puede permitir la generación de experiencias de crecimiento.

Abstract (analytical) In this qualitative study, the effects of parental separation are described and analyzed through the voice and point of view of a nine-year-old girl. The authors used a semi-structured interview and categorical data analysis to identify these effects. The identified repercussions of the parental separation were classified into individual effects, such as information management and construction of explanations, as well as higher levels of independence and improvements in self-awareness. The authors also identified effects on the family environment such as modification of affective bonding with parents, more consistent family dynamics and increased moments of wellbeing. The study concludes that children perform an active role in the construction of their meaning and parental separation can facilitate the generation of self-growth experiences.

Resumo (analítico) Neste estudo qualitativo, são descritos e analisados os efeitos da separação parental através da visão e da voz de uma menina de nove anos. Utilizou-se como instrumento uma entrevista semiestruturada e uma análise dos resultados categóricos. As repercussões observadas foram classificadas em efeitos individuais, como gerenciamento de informações e construção de explicações, além de maior independência e melhoria de seu autoconceito; Os efeitos no ambiente familiar, como mudanças nos laços emocionais com os pais, dinâmicas familiares mais consistentes e mais momentos de bem-estar, concluindo que as crianças são participantes ativas na construção de seus significados. E, por último, que a separação dos pais pode gerar experiências de crescimento.