RESUMEN
Abstract Background: Our objective was to compare the safety and efficacy of Target-Controlled Infusion (TCI) versus intermittent bolus of propofol for colonoscopy sedation. Methods: We conducted a randomized (1:1), single-blind, parallel-group superiority trial with fifty ASA I or II patients, both sexes, aged 18 to 65 years, Body Mass Index ≤ 30 kg.mr-2, undergoing colonoscopy, allocated to receive propofol by TCI (effect-site, 2 μg.mL-1 plus 0.5 μg.mL-1 until unconsciousness and as necessary for agitation) or intermittent bolus (1 mg.kg-1 plus 0.5 mg.kg-1 every 5 minutes or as above). The primary safety outcome was the need for airway maneuvers and the primary efficacy outcome was the need for interventions to adjust the level of sedation. Secondary outcomes included incidence of agitation, propofol dose, and time to recovery. Results: The median (IQR) number of airway maneuvers and interventions needed to adjust sedation was 0 (0-0) vs. 0 (0-0) (p = 0.239) and 1 (0-1) vs. 3 (1-4) (p < 0.001) in the TCI and control groups, respectively. Agitation was more common in the intermittent bolus group - 2 (0-2) vs. 1 (0-1), p < 0.001. The mean ± SD time to recovery was 4.9 ± 1.4 minutes in the TCI group vs. 2.3 ± 1.6 minutes in the control group (p < 0.001). The total propofol dose was higher in the TCI group (234 ± 46 μg.kg-1.min-1 vs. 195 ± 44 μg.kg-1.min-1 (p = 0.040)). Conclusions: During colonoscopy, TCI is as safe as intermittent bolus of propofol while reducing the incidence of agitation and the need for dose adjustments. However, intermittent bolus administration was associated with lower total propofol dose and earlier recovery.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Propofol , Inconsciencia , Método Simple Ciego , Colonoscopía , Anestésicos Intravenosos , Hipnóticos y SedantesRESUMEN
BACKGROUND: Our objective was to compare the safety and efficacy of Target-Controlled Infusion (TCI) versus intermittent bolus of propofol for colonoscopy sedation. METHODS: We conducted a randomized (1:1), single-blind, parallel-group superiority trial with fifty ASA I or II patients, both sexes, aged 18 to 65 years, Body Mass Index ≤ 30 kg.m-2, undergoing colonoscopy, allocated to receive propofol by TCI (effect-site, 2 µg.mL-1 plus 0.5 µg.mL-1 until unconsciousness and as necessary for agitation) or intermittent bolus (1 mg.kg-1 plus 0.5 mg.kg-1 every 5 minutes or as above). The primary safety outcome was the need for airway maneuvers and the primary efficacy outcome was the need for interventions to adjust the level of sedation. Secondary outcomes included incidence of agitation, propofol dose, and time to recovery. RESULTS: The median (IQR) number of airway maneuvers and interventions needed to adjust sedation was 0 (0â0) vs. 0 (0â0) (p = 0.239) and 1 (0â1) vs. 3 (1â4) (p < 0.001) in the TCI and control groups, respectively. Agitation was more common in the intermittent bolus group â 2 (0â2) vs. 1 (0â1), p < 0.001. The mean ± SD time to recovery was 4.9 ± 1.4 minutes in the TCI group vs. 2.3 ± 1.6 minutes in the control group (p < 0.001). The total propofol dose was higher in the TCI group (234 ± 46 µg.kg-1.min-1 vs. 195 ± 44 µg.kg-1.min-1 (p = 0.040)). CONCLUSIONS: During colonoscopy, TCI is as safe as intermittent bolus of propofol while reducing the incidence of agitation and the need for dose adjustments. However, intermittent bolus administration was associated with lower total propofol dose and earlier recovery.
Asunto(s)
Propofol , Femenino , Humanos , Masculino , Anestésicos Intravenosos , Colonoscopía , Hipnóticos y Sedantes , Método Simple Ciego , Inconsciencia , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , AncianoRESUMEN
RESUMO: Figura polissêmica e polimorfa, de expressiva abrangência, a ironia é objeto de sucessivas análises de múltiplas áreas de estudos, o que contrasta com a quantidade de estudos psicanalíticos dedicados a ela. Este trabalho busca circunscrever e discutir a ideia de uma ironia inerente ao inconsciente proposta por Assoun e mostrar que comentários temáticos e críticos de textos elementares podem fornecer subsídios para a abordagem da ironia pela psicanálise, mesmo se comportarem um viés retrospectivo e comparativo.
ABSTRACT: A polysemic and polymorphic figure, of expressive scope, irony is the subject of successive analyses of multiple study areas, which contrasts with the amount of psychoanalytical studies dedicated to it. This work seeks to circumscribe and discuss the idea of an irony inherent to the unconscious proposed by Assoun and to show that thematic and critical comments of elementary texts can provide subsidies to the approach of irony by psychoanalysis, even if they have a retrospective and comparative bias.
Asunto(s)
Psicoanálisis , Inconsciencia , Trastornos PsicóticosRESUMEN
RESUMO: A partir da constatação de contradições cotidianas e de sua recepção na lógica clássica, onde não são admitidas, este trabalho teórico interroga, junto a outros campos, fenômenos linguageiros considerados indesejáveis e, consequentemente, descartáveis em descrições e análises. A discussão reconhece na Lógica paraconsistente avanços importantes para a abordagem das contradições em sistemas lógicos. Na Clínica de Linguagem, tropeços e embaraços são tratados como dados de subjetividade relevantes para elaborações teórico-clínicas; ali encontramos contribuições para discutir a contradição na Psicanálise. Resta dizer que o interesse pela questão decorre da afirmação de Freud de que a vida psíquica é composta de contradições.
ABSTRACT: Based on the observation of everyday contradictions and their reception in classical logic, where they are not admitted, this theoretical work interrogates, together with other fields, linguistic phenomena considered undesirable and disposable in descriptions and analyses. The discussion recognizes in Paraconsistent Logic important advances for the approach of contradictions in logical systems. At the Language Clinic, stumbling blocks and embarrassments are treated as relevant subjectivity data for theoretical-clinical elaborations; there we find contributions to discuss the contradiction in Psychoanalysis. It remains to be said that the interest in the question stems from Freud's assertion that psychic life is made up of contradictions.
Asunto(s)
Psicoanálisis , Inconsciencia , LógicaRESUMEN
RESUMO. A intenção deste ensaio é circunscrever na tradição social brasileira recente a problemática do populismo de extrema direita, em uma retomada e repetição do que se passou nos tempos nefastos da ditadura militar. Para isso, vamos destacar a dívida estabelecida pela sociedade brasileira para com os mortos, na medida em que os crimes realizados pela ditadura não foram julgados. Além disso, tal dívida remete a outras dívidas existentes na sociedade brasileira, referentes à tradição escravocrata, assim como as relações patriarcais no registro do gênero.
RESUME: L'intention de cet essai est de circonscrire dans la récente tradition sociale brésilienne la problématique du populisme d'extrême droite, dans une reprise et une répétition de ce qui s'est passé dans les temps néfastes de la dictature militaire. Pour cela, nous soulignerons la dette établie par la société brésilienne envers les morts, dans la mesure où les crimes perpétrés par la dictature n'ont pas été jugés. En outre, cette dette fait référence à d'autres dettes existant dans la société brésilienne, se référant à la tradition esclavagiste, ainsi qu'aux relations patriarcales dans le registre des sexes.
ABSTRACT. This essay intends to circumscribe in the recent Brazilian social tradition the problem of far right-wing populism, in a resumption and repetition of what happened in the nefarious times of the military dictatorship. For this, we analyzed the debt established by Brazilian society towards the dead, insofar as the crimes committed by the dictatorship were not judged. In addition, this debt refers to other existing debts in Brazilian society, referring to the slavery tradition, as well as gender related patriarchal relations.
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Política , Psicoanálisis , InconscienciaRESUMEN
Introducción: La hernia diafragmática surge como resultado del movimiento de los órganos abdominales hacia el tórax a través de un defecto del diafragma resultante de varios tipos de lesiones, que a menudo representan un desafío diagnóstico y terapéutico. La hernia diafragmática traumática es una enfermedad infrecuente. El trauma diafragmático rara vez es aislado, la mayoría de las veces se acompaña de otras lesiones toracoabdominales, cerebrales o musculoesqueléticas, siendo estas comorbilidades más graves responsables del mal pronóstico y aumento de la mortalidad. Caso clínico: Anciana de 90 años de edad, hipertensa, quien inicia cuadro clínico 48 horas previas a su ingreso, cuando posterior a caída del plano de bipedestación presenta disminución del estado de consciencia, náuseas, vómitos y disnea en reposo. Rx de tórax evidencia asas intestinales en hemitórax derecho. Se realizó laparotomía exploradora. Conclusión: Las hernias diafragmáticas traumáticas son infrecuentes, con incidencia <3%, sintomatología inespecífica y relacionadas generalmente con lesiones asociadas al trauma. Siempre se debe sospechar de una HD ante un paciente con antecedente de trauma cerrado de alto impacto o penetrante, en función de la cinética y mecanismo de lesión. El diagnóstico supone un reto para el cirujano, debiendo apoyarse en una firme sospecha y estudios radiológicos. Su tratamiento es quirúrgico, debiendo ser individualizado, con abordajes torácicos o abdominales en función del caso. La técnica a emplear dependerá de las características del defecto, de la fase del diagnóstico y la experiencia del equipo quirúrgico(AU)
Introduction: Diaphragmatic hernia arises as a result of the movement of the abdominal organs towards the thorax through a defect in the diaphragm resulting from various types of injuries, which often represent a diagnostic and therapeutic challenge. Traumatic diaphragmatic hernia is a rare disease. Diaphragmatic trauma is rarely isolated, most of the time it is accompanied by other thoracoabdominal, brain or musculoskeletal injuries, these more serious comorbidities being responsible for the poor prognosis and increased mortality. Clinical case: A 90-year-old woman with hypertension , who began a clinical picture 48 hours prior to admission, when after falling from the standing plane he presented a decreased state of consciousness, nausea, vomiting, and dyspnea at rest. Chest x-ray shows intestinal loops in the right hemithorax. Exploratory laparotomy was performed. Conclusion: Traumatic diaphragmatic hernias are rare, with an incidence of <3%, non-specific symptoms, and generally related to injuries associated with trauma. HD should always be suspected in a patient with a history of high-impact or penetrating blunt trauma, depending on the kinetics and mechanism of injury. Diagnosis is a challenge for the surgeon, and must be based on a firm suspicion and radiological studies. Its treatment is surgical, and must be individualized, with thoracic or abdominal approaches depending on the case. The technique to be used will depend on the characteristics of the defect, the diagnostic phase and the experience of the surgical team(AU)
Asunto(s)
Humanos , Femenino , Anciano de 80 o más Años , Radiografía Torácica , Pacientes , Signos y Síntomas , Inconsciencia , Vómitos , Disnea , GeriatríaRESUMEN
Esta é uma pesquisa qualitativa, em formato de ensaio, que realiza o estudo comparado de duas obras literárias, de A. Von Chamisso e E. T. A. Hoffmann, e de uma anotação do diário deste último para problematizar a repercussão de algumas formas de desestabilizações do Eu na dinâmica psíquica da neurose. O foco dos textos referidos está no fenômeno do duplo na sua forma negativizada, isto é, como o desaparecimento da imagem exterior que dá suporte ao Eu. As ausências da sombra e do reflexo são entendidas como representações metafóricas de uma alteração do Eu que engendra repercussões importantes na homeostase psíquica, sobretudo nas relações sociais de troca. Explora-se daí a menção no diário de Hoffmann de instrumentos ópticos para interrogar o uso desses aparelhos como modelos metapsicológicos na psicanálise. Salienta-se, ainda, a participação de processos de natureza estética na dinâmica psíquica do infamiliar, tomando como referência a ligação entre o conto de Hoffmann e o relato de Stendhal sobre a sua estadia em Florença.(AU)
This is a qualitative research, in essay format, which performs the comparative study of two literary works, by A. Von Chamisso and E. T. A. Hoffmann, and an annotation in the latter's diary to problematize the repercussion of some forms of destabilization of the Ego's in the psychic dynamics of neurosis. The focus of the referred texts is on the phenomenon of the double in its negative form, that is, as the disappearance of the outer image that supports the Ego. The absences of the shadow and the reflection are understood as metaphorical representations of an alteration of the Ego that generates important repercussions on psychic homeostasis, above all in social relationships of exchange. Thus, we analyze the mention of optical instruments in Hoffmann's diary to question the use of these devices as metapsychological models in psychoanalysis. Note, also, the participation of processes of aesthetic nature in the psychic dynamics of the uncanny, taking as reference the connection between Hoffmann's short story and Stendhal's account of his stay in Florence.(AU)
Este ensayo cualitativo realiza un estudio comparativo de dos obras literarias de A. Von Chamisso y de E. T. A. Hoffmann, junto con una anotación en el diario de este último para problematizar la repercusión de algunas formas de desestabilizaciones de la función del Yo en la dinámica psíquica de la neurosis. Los textos se centran en el fenómeno del doble en su forma negativa, como la desaparición de la imagen exterior que sostiene el Yo. Se entienden las ausencias de la penumbra y el reflejo como una representación metafórica de una alteración de la función del Yo que genera importantes repercusiones en la regulación psíquica, sobre todo en las relaciones de intercambio social. Se analiza la presencia en el diario de Hoffmann de instrumentos ópticos para discutir el uso de estos dispositivos como modelos metapsicológicos en psicoanálisis. Se destaca la reverberación de procesos de naturaleza estética en la dinámica psíquica de lo ominoso, tomando como referencia la conexión entre el cuento de Hoffmann y el relato de Stendhal sobre su estancia en Florencia.(AU)
Asunto(s)
Humanos , Espacio Personal , Psicoanálisis , Literatura , Narcisismo , Psicología , Psicopatología , Medicina Psicosomática , Trastornos Psicóticos , Inconsciente en Psicología , Inconsciencia , Ciencias de la Conducta , Síntomas Conductuales , Despersonalización , Interacción de Doble Vínculo , Extraversión Psicológica , Metacognición , Regulación Emocional , Trastorno de Personalidad Narcisista , Inhibición PsicológicaRESUMEN
BACKGROUND: Recent estimates of hypertension in Panama remain unknown. We aim to describe the variation in prevalence and unawareness of hypertension in two Panamanian provinces using two different cross-sectional population-based studies and to investigate risk factors associated with hypertension unawareness. METHODS: Data were derived from a sub-national study conducted in the provinces of Panama and Colon (PREFREC-2010 [2,733 participants]) and from a nationally representative study (ENSPA-2019), in which we restricted our analyses to the same provinces (4,653 participants). Individuals aged 30-75 years who had (a) self-reported history of hypertension or (b) blood pressure (BP) ≥140/90mmHg or (c) a combination or both were classified as hypertensive. Participants with BP≥140/90mmHg who denied a history of hypertension were considered unaware of the condition. Multivariable logistic regression models were used to estimate the association between risk factors and unawareness, expressed as odds ratios (OR) and 95% confidence interval (CI). FINDINGS: In 2010, the prevalence and unawareness of hypertension in men were 51.6% (95% CI: 45.7-57.5) and 32.3% (25.4-40.1), respectively, and in women 46.0% (42.1-49.9) and 16.1% (12.6-20.4), respectively. In 2019, the prevalence and unawareness of hypertension in men were 46.5% (42.1-51.0) and 52.3% (45.9-58.6), and in women 42.1% (39.6-44.7) and 33.3% (29.8-37.0). Men (2010 and 2019), age <50 years (2010 and 2019), having no/primary education (2010), and living in a non-urban region (2019) were positively associated with hypertension unawareness, whereas obesity (2010), physical inactivity (2010), family history of hypertension (2019), and BP assessment in the year before study enrollment (2010 and 2019) were inversely associated with hypertension unawareness. INTERPRETATION: Benefits of a decrease in the prevalence of hypertension are being undermined by an increase in hypertension unawareness. Actions should be encouraged to strengthen the implementation of the existing healthcare program for cardiovascular risk factor control.
Asunto(s)
Hipertensión , Masculino , Femenino , Humanos , Prevalencia , Estudios Transversales , Hipertensión/epidemiología , Factores de Riesgo , Presión Sanguínea , InconscienciaRESUMEN
The dynamic core hypothesis posits that consciousness is correlated with simultaneously integrated and differentiated assemblies of transiently synchronized brain regions. We represented time-dependent functional interactions using dynamic brain networks and assessed the integrity of the dynamic core by means of the size and flexibility of the largest multilayer module. As a first step, we constrained parameter selection using a newly developed benchmark for module detection in heterogeneous temporal networks. Next, we applied a multilayer modularity maximization algorithm to dynamic brain networks computed from functional magnetic resonance imaging (fMRI) data acquired during deep sleep and under propofol anesthesia. We found that unconsciousness reconfigured network flexibility and reduced the size of the largest spatiotemporal module, which we identified with the dynamic core. Our results represent a first characterization of modular brain network dynamics during states of unconsciousness measured with fMRI, adding support to the dynamic core hypothesis of human consciousness.
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Propofol , Inconsciencia , Encéfalo/diagnóstico por imagen , Estado de Conciencia , Humanos , Imagen por Resonancia MagnéticaRESUMEN
Horner's syndrome is a rare side effect for patients receiving epidural anaesthesia. Studies described Horner's syndrome due to cephalic spread of injected anaesthetics, a high spinal anaesthesia, or a sign of an inadvertent subdural block. A 31-year-old woman (Gravida 1 Para 0) at 40 weeks and 2 days had a caesarean section secondary to second stage arrest. Fourteen minutes after she received the lidocaine bolus, she became unresponsive with nystagmus, unequal pupils and no pupillary reflex. Head CT and MRI showed no intracranial haemorrhage and 2 hours later, she had spontaneous resolution of neurological symptoms with no further sequelae. Although Horner's syndrome is a benign, transient process, clinicians should be mindful regarding epidural catheter placement causing subdural blocks resulting in spontaneous, reversible neurological deficits.
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Anestesia Epidural , Síndrome de Horner , Adulto , Anestesia Epidural/efectos adversos , Cesárea , Femenino , Síndrome de Horner/inducido químicamente , Síndrome de Horner/diagnóstico , Humanos , Lidocaína/efectos adversos , Embarazo , InconscienciaRESUMEN
The cognitive functions of human and nonhuman primates rely on the dynamic interplay of distributed neural assemblies. As such, it seems unlikely that cognition can be supported by macroscopic brain dynamics at the proximity of equilibrium. We confirmed this hypothesis by investigating electrocorticography data from nonhuman primates undergoing different states of unconsciousness (sleep, and anesthesia with propofol, ketamine, and ketamine plus medetomidine), and functional magnetic resonance imaging data from humans, both during deep sleep and under propofol anesthesia. Systematically, all states of reduced consciousness unfolded at higher proximity to equilibrium compared to conscious wakefulness, as demonstrated by the computation of entropy production and the curl of probability flux in phase space. Our results establish nonequilibrium macroscopic brain dynamics as a robust signature of consciousness, opening the way for the characterization of cognition and awareness using tools from statistical mechanics.
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Estado de Conciencia , Propofol , Animales , Encéfalo , Inconsciencia , VigiliaRESUMEN
Within the insensitization by electronarcosis and the bleeding processes performed at the pig's slaughterhouses, there are some factors that hinder the achievement of an adequate slaughter of these animals, being this a critical phase in which animal welfare must be guaranteed; the objective of this study was to evaluate and compare the efficiency of insensitization by electronarcosis and two types of bleeding direction (horizontal and vertical). Dependent variables were measured as indicators of animal welfare (absence of the corneal reflex, absence of reflex of sensitivity to painful stimuli, attempts to reinstatement or posture recovery and vocalization), after the stunning and bleeding process, in four slaughterhouses of national category in "Eje Cafetero", Colombia. The methodological approach included the binomial distribution, descriptive statistics, hypothesis testing and statistical significance. The results show that the efficiency of the insensitization procedures and type of bleeding direction depends on multiple aspects, including the tranquility of the animals during their handling, the correct position of the insensitization clamps, the amperage used and the time between insensitization and bleeding. In this way, the analysis of possible preventive and/or corrective measures includes: Continuous training and supervision of the personnel in charge of carrying out the procedures, the need to immobilize pigs prior to their insensitization process, the continuous monitoring of process variables and the appropriate vascular cutting that ensures animal's death prior to their entrance into the scalding machine.
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Mataderos , Bienestar del Animal/estadística & datos numéricos , Inconsciencia/veterinaria , Animales , Colombia , Estimulación Eléctrica/métodos , Hemorragia , Reflejo , Porcinos/fisiologíaRESUMEN
OBJECTIVE: Asylum seekers experience a high burden of physical and psychological trauma, yet there is a scarcity of literature regarding the epidemiology and sequelae of head injury (HI) in asylum seekers. We examined HI prevalence and association with neuropsychiatric comorbidities in asylum seekers. METHODS: A retrospective cross-sectional study was performed through review of 139 medical affidavits from an affidavit database. Affidavits written from 2010 to 2018 were included. Demographic and case-related data were collected and classified based on the presence of HI. For neuropsychiatric sequelae, the primary study outcome was headache and the secondary outcomes were depression, posttraumatic stress disorder, and anxiety. Multivariable logistic regression was performed to examine the association between HI and neuropsychiatric sequelae, adjusted for demographic and clinical characteristics. RESULTS: A total of 139 medical affidavits of asylum seekers were included. The mean age was 27.4 ± 12.1 years, 56.8% were female, and 38.8% were <19 years. Almost half (42.5%) explicitly self-reported history of HI. Compared to clients who did not report HI, clients with HI were older and more likely to report a history of headache, physical abuse, physical trauma, concussion, and loss of consciousness. After adjustment for demographic and clinical characteristics, clients with HI had greater odds for neuropsychological sequelae such as headache (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0-8.7) and depression (OR 2.5, 95% CI 1.1-5.7). CONCLUSIONS: We observed a high prevalence of HI in asylum seekers. Comprehensive screening for HI and neuropsychiatric comorbidities is encouraged when evaluating asylum seekers.
Asunto(s)
Ansiedad/epidemiología , Traumatismos Craneocerebrales/epidemiología , Depresión/epidemiología , Cefalea/epidemiología , Refugiados/estadística & datos numéricos , Trastornos por Estrés Postraumático/epidemiología , Violencia/estadística & datos numéricos , Adolescente , Adulto , Ansiedad/psicología , Conmoción Encefálica/epidemiología , Conmoción Encefálica/psicología , Traumatismos Craneocerebrales/psicología , Estudios Transversales , Depresión/psicología , El Salvador/etnología , Femenino , Guatemala/etnología , Haití/etnología , Cefalea/psicología , Honduras/etnología , Humanos , Masculino , Trastornos de la Memoria/epidemiología , Trastornos de la Memoria/psicología , México/etnología , Nicaragua/etnología , Oportunidad Relativa , Cuestionario de Salud del Paciente , Prevalencia , Trauma Psicológico/epidemiología , Trauma Psicológico/psicología , Refugiados/psicología , Estudios Retrospectivos , Distribución por Sexo , Delitos Sexuales/psicología , Delitos Sexuales/estadística & datos numéricos , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Trastornos por Estrés Postraumático/psicología , Inconsciencia/epidemiología , Inconsciencia/psicología , Estados Unidos/epidemiología , Heridas y Lesiones/epidemiología , Heridas y Lesiones/psicología , Adulto JovenRESUMEN
RESUMO: Este artigo versa sobre as relações entre o sistema de escrita chinês e a instância da letra no inconsciente. Para isso, revisamos teoricamente uma rede de conceitos imbricados que suportam essa questão na Linguística, com Saussure e Peirce, e na Psicanálise lacaniana: escrita, letra, signo e significante, lidos a partir da experiência de aprendizado do Mandarim e de recortes clínicos de situação de análise. Tal percurso nos apontou que, ao escutar um sujeito em análise, além da escuta de seus significantes, devemos nos atentar à dimensão do que é letra, inclusive na sua dimensão visual, para então, quiçá, transpor algo disso para o simbólico.
Abstract: This article discusses the relation between the Chinese writing system and the instance of the letter in the unconscious. We review theoretically a network of interwoven concepts that support this issue in Saussure and Lacan: writing, signifier and letter rethought from the learning experience of Mandarin and from clinical clippings of analysis situation. This way showed us that while listening to a subject in analysis, in addition to listening to its significant, we must be aware of the dimension of what the letter is, including its visual dimension, so then, perhaps, transpose something from it to the symbolic.
Asunto(s)
Psicoanálisis , Inconsciencia , Escritura ManualRESUMEN
RESUMO: O objetivo deste artigo é discutir os efeitos das alianças inconscientes na restrição à extensão da psicanálise no que se refere à construção do conhecimento psicanalítico sobre os grupos. Cinquenta e cinco textos publicados na Revista Brasileira de Psicanálise RBP, entre 1967 e 1976, foram analisados a partir do referencial teórico-metodológico proposto por René Kaës. Numa breve reconstrução histórica, operou-se com o conceito de alianças inconscientes com o propósito de investigar as bases narcísicas presentes desde as origens da psicanálise; que restringiram a capacidade de pensar o grupo no campo da psicanálise. Benefícios narcísicos foram extraídos destas resistências que ainda hoje dificultam a extensão da psicanálise no que diz respeito à inclusão do grupo como objeto teórico.
Abstract: Contributions of René Kaës to the epistemology of psychoanalysis. The objective of this article is to discuss the effects of the unconscious alliances on extension of psychoanalysis. 55 texts published in the Revista Brasileira de Psicanálise between 1967 and 1976 were analyzed under the theoretical framework of René Kaës. A brief historical reconstruction with the concept of unconscious alliances in order to investigate the narcissistic bases present since the origins of psychoanalysis; that restricted the capacity to think in the group in the field of psychoanalysis. Narcissistic benefits were extracted of this resistance, that still today difficult the extension of the psychoanalysis for the inclusion of the group as a theoretical object.
Asunto(s)
Psicoanálisis , Inconsciencia , ConocimientoAsunto(s)
Enfermedades Desmielinizantes , Imagen de Difusión por Resonancia Magnética/métodos , Disartria , Fluidoterapia , Hipernatremia , Puente/diagnóstico por imagen , Temblor , Inconsciencia , Equilibrio Hidroelectrolítico , Anciano , Tratamiento Conservador/métodos , Enfermedades Desmielinizantes/etiología , Enfermedades Desmielinizantes/fisiopatología , Enfermedades Desmielinizantes/terapia , Disartria/diagnóstico , Disartria/etiología , Fluidoterapia/efectos adversos , Fluidoterapia/métodos , Humanos , Hipernatremia/complicaciones , Hipernatremia/diagnóstico , Hipernatremia/terapia , Masculino , Desnutrición/complicaciones , Desnutrición/diagnóstico , Examen Neurológico , Presión Osmótica , Resultado del Tratamiento , Temblor/diagnóstico , Temblor/etiología , Inconsciencia/diagnóstico , Inconsciencia/etiologíaRESUMEN
Loss of consciousness during spinal anesthesia is a rare but scary complication. This complication is generally related to severe hypotension and bradycardia, but in this case, the loss of consciousness occurred in a hemodynamically stable parturient patient. We present a 31 years-old patient who underwent an emergency cesarean section. She lost consciousness and had apnea that started 10 minutes after successful spinal anesthesia and repeated three times for a total of 25 minutes, despite the stable hemodynamics of the patient. The case was considered a subdural block, and the patient was provided with respiratory support. The subdural block is expected to start slowly (approximately 15-20minutes), but in this case, after about 10 minutes of receiving anesthesia, the patient suddenly had a loss of consciousness. After the recovery of consciousness and return of spontaneous respiration, the level of a sensory block of the patient, who was cooperative and oriented, was T4. There were motor blocks in both lower extremities. Four hours after intrathecal injection, both the sensory and motor blocks ended, and she was discharged two days later with no complications. Hence, patients who receive spinal anesthesia should be closely observed for any such undesirable complications.
Asunto(s)
Anestesia Obstétrica/efectos adversos , Anestesia Raquidea/efectos adversos , Inconsciencia/etiología , Adulto , Anestesia Obstétrica/métodos , Anestesia Raquidea/métodos , Cesárea/métodos , Femenino , Hemodinámica/fisiología , Humanos , EmbarazoRESUMEN
RESUMEN Presentamos el caso de un varón de 25 años con antecedentes de consumo de marihuana y tabaco, que durante viaje en vuelo comercial a Cusco presentó disnea, pérdida de conciencia y estado epiléptico. Arribó a esta ciudad presentando hipotensión arterial, murmullo pulmonar abolido, sin recuperación de conciencia. La tomografía de tórax reveló bullas pulmonares y la tomografía mostró neumoencéfalo, diagnosticándose embolia gaseosa cerebral. La hipoxemia asociada a convulsiones y pérdida de conciencia en una persona joven durante el vuelo no es un evento común. La pérdida de la presión en la cabina durante el ascenso parece ser el evento desencadenante en pacientes con enfermedad pulmonar.
ABSTRACT We present the case of a 25-year old man with a history of marijuana and tobacco consumption who, during a commercial flight to Cusco, presented dyspnea, loss of consciousness, and epileptic condition. He arrived in this city presenting arterial hypotension, abolished pulmonary murmur, with no recovery of consciousness. The thorax tomography revealed lung bullae and the tomography showed pneumocephalus. He was diagnosed with cerebral gas embolism. Hypoxemia associated with seizures and loss of consciousness in a young person during a flight is not a common event. Loss of cabin pressure during climb appears to be the triggering event in patients with lung disease.