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In our consulting rooms we find, depending on the period, certain conditions that relate closely to current cultural prejudices. In our culture, divorce and the reconstituted family can bring both creativity but also emotional difficulty, often triggered by marital betrayal. This paper explores marital betrayal in relation to childhood experiences of fidelity, infidelity and the lack of love. It asks whether there is a cultural prejudice related to marital fidelity, and whether sexuality only belongs in a loving couple, whether this is a patriarchal contract, and what role the anima plays in a loving bond; this is related to 'altericide' and need for respect for the other, as the libido seeks 'living symbols'.

Suivant les périodes, nous retrouvons dans nos salles de consultation des situations qui ont beaucoup à voir avec les préjudices culturels en vigueur. Dans notre culture le divorce et la famille reconstituée peuvent apporter à la fois de la créativité et de la difficulté émotionnelle, souvent déclenchée par la trahison dans le couple. Cet article explore la trahison dans le couple en relation avec les expériences infantiles de fidélité, d'infidélité, et de manque d'amour. L'article s'interroge: y-a-t-il un préjudice culturel lié à la fidélité dans le couple? La sexualité appartient-elle seulement à un couple qui éprouve de l'amour? S'agit-il là d'un contrat patriarcal? Et quel rôle joue l'anima dans une relation aimante? Ceci est mis en lien avec « l'altéricide ¼ et le besoin de respect à l'égard de l'autre, alors que la libido recherche des « symboles vivants ¼.

Encontramos en nuestros consultorios, dependiendo del período, ciertas condiciones que se relacionan cercanamente con prejuicios culturales vigentes. En nuestra cultura, el divorcio y la familia reconstituida puede brindar tanto creatividad como dificultades emocionales, a menudo ambas activadas por la traición marital. El presente trabajo explora la traición marital con relación a experiencias infantiles de fidelidad, infidelidad, y de falta de amor. Pregunta si existe un prejuicio cultural respecto a la fidelidad marital, si la sexualidad solamente pertenece a la pareja amorosa, si ésta es un contrato patriarcal y que rol juega el ánima en un vínculo amoroso. Esto está relacionado al 'altericidio' y a la necesidad de respeto por el otro, a medida que la libido busca 'símbolos vivos'.

Em nossas salas de consultório encontramos, dependendo do período, certas condições que se relacionam intimamente com os preconceitos culturais atuais. Em nossa cultura, o divórcio e a família reconstituída podem trazer criatividade, mas também dificuldade emocional, muitas vezes desencadeada pela traição conjugal. Este artigo explora a traição conjugal em relação às experiências infantis de fidelidade, infidelidade e falta de amor. Pergunta se há um preconceito cultural relacionado à fidelidade conjugal e se a sexualidade pertence apenas a um casal amoroso, se este é um contrato patriarcal e qual papel a anima desempenha em um vínculo amoroso; isso está relacionado ao "altericídio" e à necessidade de respeito pelo outro, já que a libido busca "símbolos vivos".

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This paper contains reflections on the use of the imagination in technologically-mediated therapy and analysis. As part of the individuation process the psyche is seen as needing to adapt to new technological ways of communicating. The notion of a technologically-mediated self is posited describing a self which can only be apprehended through, and by, the use of telecommunications. This self is seen as identical to the in-person self, a subset, or superset of it. There is a revisioning of our notions of the container and the field in this work performed through technological-mediation. The need to engage the imagination in approaching this kind of work is emphasized in order to create an imaginal play-space in which the body will be deeply affected. Some thoughts on how the process of individuation might look through such analytic work is presented.

Cet article contient des réflexions sur l'utilisation de l'imagination dans la thérapie et l'analyse pratiquées par la médiation de la technologie. En tant que partie intégrante du processus d'individuation, la psyché est considérée comme devant s'adapter à de nouvelles façons de communiquer, basées sur la technologie. La notion d'un soi atteint par la médiation de la technologie est postulée, un soi qui ne peut être appréhendé que par le biais de l'utilisation des télécommunications. Ce soi est considéré comme étant identique au soi dans la personne; un sous-ensemble, ou un sur-ensemble. L'article présente une révision de nos notions de contenant et de champ quand on travaille avec la médiation de la technologie. Il souligne le besoin de mobiliser l'imagination quand on aborde ce genre de travail afin de créer un espace imaginal de jeu dans lequel le corps sera profondément affecté. Il propose quelques pensées sur comment le processus d'individuation pourrait se présenter au travers d'un tel travail analytique.

El presente trabajo contiene reflexiones sobre el uso de la imaginación en terapia y análisis mediado por la tecnología. Como parte del proceso de individuación, la psique necesita adaptarse a nuevos modos tecnológicos de comunicación. Se propone la noción de un self mediado-tecnológicamente, al describir a un self que solamente puede ser aprehendido a través y por el uso de las telecomunicaciones. Este self es considerado como idéntico al self presencial, una parte o una versión mayor del mismo. Se presenta una revisión de nuestras nociones acerca del campo y del espacio de contención en este trabajo realizado a través de la mediación tecnológica. Se enfatiza la necesidad de comprometer a la imaginación al abordar esta forma de trabajo, para crear un espacio de juego-imaginal, en el cual el cuerpo estará profundamente afectado. Se presentan algunas reflexiones acerca de cómo podría mirarse el proceso de individuación a través de dicho trabajo.

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INTRODUCTION AND OBJECTIVES: The concept subtle Lisfranc defines low energy lesions of the tarsometatarsal joint complex (TMC) that involve joint instability. Often unnoticed, with long-term sequelae. The objective is to evaluate the clinical-functional results of patients with MTC ligament damage grade II-III (Nunley and Vertullo classification) treated with percutaneous surgery. MATERIAL AND METHODS: Retrospective study of 16 patients who underwent percutaneous surgery for MLC ligament damage. Demographic data, days of delay in diagnosis, surgical technique, joint reduction in load (adequate if C1-M2 space is less than 2 mm) and Manchester-Oxford scale (MOXFQ) score were collected. The sample consisted of nine males and seven females, mean age 43.6 years (17-71) and mean follow-up of 22 months (12-28). RESULTS: Diagnosis was delayed for more than 24 hours in four patients (3-6 days). In 11 patients the treatment consisted of closed reduction and percutaneous synthesis with cannulated screws from M2 to C1 and from C1 to C2. In three patients it was supplemented with Kirschner wires in the lateral radii. Two patients were treated with only M2 to C1 screws. An anatomical reduction was not achieved in six patients, with a mean of 2.6 mm between C1-M2 (2.1-3 mm); the mean functional MOXFQ score of these patients was 41.1% (IC 95% 23.1-59.1%), worse results compared to the anatomical reduction: 17.2% (IC 95% 5.7-28.7); statistically significant difference (p < 0.01). CONCLUSION: Subtle injuries from MTC are rare and can go unnoticed. Surgical treatment with percutaneous synthesis offers good clinical-functional results in the medium term. The anatomical reduction is a determining factor for the good functional result of our patients.

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Aortic dissection (AD) is the most common acute condition of the aorta and has a high mortality. Therefore, it is a radiological emergency of vital importance. Currently, five subtypes are distinguished, among which AD class 3 -also known as limited or subtle AD- is the less recognised. This type of dissection is infrequent and needs to be acknowledged radiologically in order not to go unnoticed. Regarding its imaging features, this entity is characterized by a small focal bulging of the aortic wall outline and/or a limited round dilation at the region affected by the intimal tear. Recently, the low familiarity of the radiologist with this condition has been emphasized. With the aim of illustrating the main imaging findings of this entity and reviewing its most relevant aspects, we present four cases of AD class 3 diagnosed in our hospital.

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Abstract Introduction Medical residents (MR) are an important pillar for a future effective health system. As such, it is important to study all the factors throughout their training that may influence their professional development, like gender-based violence (GV). Objetive To design and evaluate the psychometric proprieties of subtle GV among medical residents' assessment scale (SGEVRA). Method The design was carried out in two phases: (1) in the qualitative phase, three focus groups were interviewed to obtain information about GV during medical training; and (2) in the quantitative phase, the information was incorporated into the instrument and the psychometric properties were tested. Results A total of 1,645 medical residents (MRs) completed the instrument. Exploratory factor analysis led to a final two factor model comprised of 31 items that explained 74.9% of the variance. The factors were labelled as gender discrimination (factor 1) and sexual violence (factor 2); both demonstrated high internal consistency using Cronbach's alpha (factor 1: .987; factor 2: .935). Discussion and conclusion The SGEVRA is a brief, valid, and reliable instrument for assessing subtle GV among MR.

Resumen Introducción Los residentes médicos (MR) son un pilar importante para un futuro sistema de salud efectivo. Por ello, es importante estudiar todos los factores a lo largo de su capacitación que puedan influir en su desarrollo profesional, como la violencia de género (GV). Objetivo Diseñar y evaluar las propiedades psicométricas de la Escala de Violencia Sutil de Género en médicos residentes (SGEVRA, por sus siglas en inglés). Método El diseño se realizó en dos fases: (1) cualitativa: se entrevistó a tres grupos focales para obtener información sobre la VG durante la capacitación médica; y (2) cuantitativa, donde la información se incorporó al instrumento y se evaluaron las propiedades psicométricas. Resultados 1,645 residentes médicos (MR) completaron el instrumento. El análisis factorial exploratorio condujo a un modelo final de dos factores compuesto por 31 reactivos que explicaron el 74.9% de la varianza. Los factores fueron etiquetados como discriminación de género (factor 1) y violencia sexual (factor 2); ambos demostraron una alta consistencia interna con el alfa de Cronbach (factor 1: .987; factor 2: .935). Discusión y conclusión SGEVRA es un instrumento breve, válido y confiable para evaluar GV en MR.

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El propósito del presente estudio es examinar la relación entre diversas variables como predictores del prejuicio racista (sutil y manifiesto) y proponer un modelo de ecuaciones estructurales que exprese adecuadamente su relación. Estas variables incluyen: el autoritarismo, la orientación a la dominancia social, el conservadurismo y el hetero-estereotipo. Se busca establecer si todas ellas presentan una relación directa, indirecta o nula con el prejuicio. Como resultado se constató el prejuicio racista, se proponen y presentan evaluación del ajuste, de dos modelos predictivos del prejuicio, a los datos obtenidos. El estudio propone un modelo unifactorial y otro bifactorial, ambos con buenos indicadores de bondad de ajuste. Esta investigación cobra relevancia, considerando la situación de ciudad fronteriza de Arica y el aumento de inmigrantes latinoamericanos en los últimos años, hacia Chile.

The purpose of this study is to examine the relationship between various variables as predictors of racist prejudice (subtle and manifest) and propose a model of structural equations that adequately expresses their relationship. These variables include: authoritarianism, orientation to social dominance, conservatism and hetero-stereotype. It seeks to establish whether all of them have a direct, indirect or null relationship with prejudice. As a result, the racist prejudice was verified, and the evaluation of the data obtained from two predictive models of prejudice is proposed and presented. The study proposes a unifactorial and a bifactorial model, both with good indicators of goodness of fit. This research becomes relevant, considering the situation of the border city of Arica and the increase of Latin American immigrants in recent years, towards Chile.

O objetivo deste estudo é examinar a relação entre várias variáveis como preditores de preconceito racista (sutil e manifesto) e propor um modelo de equações estruturais que expressem adequadamente sua relação. Essas variáveis incluem: autoritarismo, orientação ao domínio social, conservadorismo e heteroestereótipo. Ele procura estabelecer se todos eles têm uma relação direta, indireta ou nula com o preconceito. Como resultado, foi encontrado o preconceito racista, e dois modelos de avaliação do preconceito são propostos e apresentam ajuste aos dados obtidos. O estudo propõe um modelo unifatorial e um modelo bifatorial, ambos com bons indicadores de qualidade de ajuste. Esta pesquisa se torna relevante, considerando a situação da cidade fronteiriça de Arica e o aumento de imigrantes latino-americanos nos últimos anos, em direção ao Chile

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This paper considers the transfer of somatic effects from patient to analyst, which gives rise to embodied countertransference, functioning as an organ of primitive communication. By means of processes of projective identification, the analyst experiences somatic disturbances within himself or herself that are connected to the split-off complexes of the analysand. The analysty's own attempt at mind-body integration ushers the patient towards a progressive understanding and acceptance of his or her inner suffering. Such experiences of psychic contagion between patient and analyst are related to Jung's 'psychology of the transference' and the idea of the 'subtle body' as an unconscious shared area. The re-attribution of meaning to pre-verbal psychic experiences within the 'embodied reverie' of the analyst enables the analytic dyad to reach the archetypal energies and structuring power of the collective unconscious. A detailed case example is presented of how the emergence of the vitalizing connection between the psyche and the soma, severed through traumatic early relations with parents or carers, allows the instinctual impulse of the Self to manifest, thereby reactivating the process of individuation.

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INTRODUÇÃO: O estado de mal epiléptico (EME) é subdiagnosticado, especialmente as formas clínicas com sinais motores sutis ou apenas com alteração da consciência. É uma emergência neurológica que necessita diagnóstico imediato e a tratamento agressivo e para prevenir lesão neuronal. OBJETIVOS: Revisar, discutir e propor protocolo para o tratamento desta condição. METODOLOGIA: A literatura foi selecionada a partir de pesquisa nas bases de dados MEDLINE e PUBMED. RESULTADOS: Propomos um protocolo utilizando diazepam, fenitoína, fenobarbital, midazolam, thiopental e pentobarbital ainda nos casos refratários topiramato ou levetiracetam. CONCLUSÕES: Um protocolo estruturado para a investigação da etiologia e tratamento do EME é necessário e possibilita melhores chances de evolução dos casos.

INTRODUCTION: Status epilepticus (SE) is an under recognized medical emergency, especially subtle SE or clinical presentation mostly with conscience disturbance (nonconvulsive SE). It is a medical emergency that requires immediate and aggressive diagnoses and treatment. OBJECTIVES: Review, discuss and a protocol suggestion for treatment. METHODOLOGY: Literature publication was selected from MEDLINE and PUBMED. RESULTS: A protocol with diazepam, phenytoin, phenobarbital, midazolam, thiopental and pentobarbital, including topiramate and levetiracetam for refractory cases was proposed. CONCLUSIONS: A standardized protocol for SE work-up and treatment is useful and probably improves outcome.

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