bluuebunny/crossref_metadata_2025 huggingface dataset:
Two port video-assisted gastrostomy and jejunostomy: technical simplification and clinical results
Authors: VOLPE Paula , DOMENE Carlos Eduardo , SANTO Marco Aurélio , CECCONELLO Ivan
Published: April 2015

BACKGROUND: Patients presenting upper gastrointestinal obstruction, difficulty or inability in swallowing, may need nutritional support which can be obtained through gastrostomy and jejunostomy. AIM: To describe the methods of gastrostomy and jejunostomy video-assisted, and to compare surgical approaches for video-assisted laparoscopy and laparotomy in patients with advanced cancer of the esophagus and stomach, to establish enteral nutritional access. METHODS: Were used the video-assisted laparoscopic techniques for jejunostomy and gastrostomy and the same procedures performed by laparotomies. Comparatively, were analyzed the distribution of patients according to demographics, diagnosis and type of procedure. RESULTS: There were 36 jejunostomies (18 by laparotomy and 17 laparoscopy) and 42 gastrostomies (21 on each side). In jejunostomy, relevant data were operating time of 132 min vs. 106 min (p=0.021); reintroduction of diet: 3.3 days vs 2.1 days (p=0.009); discharge: 5.8 days vs 4.3 days (p= 0.044). In gastrostomy, relevant data were operative time of 122.6 min vs 86.2 min (p= 0.012 and hospital discharge: 5.1 days vs 3.7 days (p=0.016). CONCLUSION: The comparative analysis of laparotomy and video-assisted access to jejunostomies and gastrostomies concluded that video-assisted approach is feasible method, safe, fast, simple and easy, requires shorter operative time compared to laparotomy, enables diet start soon in compared to laparotomy, and also enables lower length of stay compared to laparotomy.
Fasting abbreviation among patients submitted to oncologic surgery: systematic review
Authors: PINTO Andressa dos Santos , GRIGOLETTI Shana Souza , MARCADENTI Aline
Published: April 2015

INTRODUCTION: The abbreviation of perioperative fasting among candidates to elective surgery have been associated with shorter hospital stay and decreased postoperative complications. OBJECTIVE: To conduct a systematic review from randomized controlled trials to detect whether the abbreviation of fasting is beneficial to patients undergoing cancer surgery compared to traditional fasting protocols. METHOD: A literature search was performed in electronic databases: MEDLINE (PubMed), SciELO, EMBASE and Cochrane, without time restriction. Were used the descriptors: "preoperative fasting", "cancer", "diet restriction" and "perioperative period". Randomized trials were included in adults of both sexes, with diagnosis of cancer. Exclusion criteria were: use of parenteral nutrition and publications in duplicate. All analyzes, selections and data extraction were done blinded manner by independent evaluators. RESULTS: Four studies were included, with a total of 150 patients, 128 with colorectal cancer and 22 gastric cancer. The articles were published from 2006 to 2013. The main outcome measures were heterogeneous, which impaired the unification of the results by means of meta-analysis. Compared to traditional protocols, patients undergoing fasting abbreviation with the administration of fluids containing carbohydrates had improvements in glycemic parameters (fasting glucose and insulin resistance), inflammatory markers (interleukin 6 and 10) and indicators of malnutrition (grip strength hand and CRP/albumin ratio), and shorter hospital stay. The methodological quality of the reviewed articles, however, suggests that the results should be interpreted with caution. CONCLUSION: The abbreviation of perioperative fasting in patients with neoplasm appears to be beneficial.
O TRANSEXUALISMO COMO SUPLÊNCIA NA PSICOSE
Authors: Westphal Laure
Published: April 2015

Pretende-se demonstrar que o sujeito psicótico, persuadido a se transformar em mulher, pode fazer do transexualismo uma suplência, na medida em que pode resolver sua dissociação corporal e psíquica ao fazer-se existir enquanto mulher no campo social. Nosso método consiste em comparar a saída do empuxo-à-mulher no delírio de metamorfose paranoica com o arranjo que ele faz no transexualismo. Nossos resultados mostram que essas duas clínicas distintas estão fundadas em uma base comum, que é a de regular o excesso de gozo não regulado pela função fálica. A discussão mostra que o transexualismo se distingue do delírio, fazendo da exceção feminina aquilo que articula as dimensões imaginária e simbólica. Como conclusão, o transexualismo regula o empuxo-à-mulher e permite ao sujeito a constituição de uma nova identidade que une o gozo do corpo e dá a ele um nome.
O TRAUMA EM TEMPOS DE VÍTIMAS
Authors: Canavêz Fernanda
Published: April 2015

Investiga-se o trauma a partir da figura da vítima, uma das marcas da cultura atual. O objetivo é examinar a mudança no tratamento dispensado aos sujeitos tidos como traumatizados na passagem da modernidade freudiana para a contemporaneidade a partir de narrativas que versam, nos dois momentos, sobre experiências consideradas traumáticas. Conclui-se que há uma sensível diferença entre a noção freudiana de trauma, que remete ao excesso, ao inesperado, e aquela de traumatismo, um evento socialmente legitimado como produtor de vítimas. Ainda, sustenta-se a atualidade da clínica psicanalítica na sua potência para ultrapassar a identidade vitimizada e valorar os destinos sempre singulares do trauma.
DO NORMAL AO CONSUMIDOR: CONCEITO DE DOENÇA E MEDICAMENTO NA CONTEMPORANEIDADE
Authors: Vaz Paulo
Published: April 2015

A relação entre medicamento e doença cada vez mais se assemelha ao nexo entre uma mercadoria e seu mercado. Este artigo indica as transformações no conceito moderno de doença que tornaram possível "vender" determinada doença. Um elemento crucial da subjetividade contemporânea é o desejo de se conceber como doente a requerer um medicamento para ter uma vida longa e prazerosa. Assim, a determinação dessa mudança conceitual é um elemento adicional na avaliação das diferenças entre a subjetividade moderna e contemporânea.
METÁFORAS EM PSICOTERAPIA: EXPRESSÃO DO CONFLITO DA RELAÇÃO ENTRE MÃE E FILHO NA PSICOSE
Authors: Costa Beatriz Lopes Cançado , Brasil Katia Tarouquella Rodrigues , Zanello Valeska
Published: April 2015

O presente artigo aborda as metáforas presentes na fala de uma paciente, mãe de um adolescente psicótico, atendida no contexto de uma psicoterapia de base psicanalítica. Um dos conflitos da paciente era sua dificuldade de diferenciação com o filho. Pôde-se identificar como as metáforas foram se transformando ao longo do processo psicoterápico e como a relação entre mãe e filho recebeu os impactos dessa transformação. Essa situação contribuiu para uma nova disposição da economia psíquica da paciente, e até mesmo para um rompimento na dinâmica familiar rigidamente estabelecida.
Análise de tensões e deslocamentos em peças cilíndricas de madeira devido à retração
Authors: Mascia Nilson Tadeu
Published: April 2015

A retração na madeira pode ser analisada sob o ponto de vista de sua influência em tensões, deformações e deslocamentos, presentes nas estruturas. Essa retração pode ser computada como parcela nas relações tensão-deformação, considerando-se nessa análise uma peça de madeira em forma de tronco cilíndrico sem forças externas, num sistema de coordenadas cilíndricas. Devido à simetria radial o campo de deslocamentos é função do raio e o deslocamento na direção angular é nulo. Considerando-se também que a deformação longitudinal seja constante, as deformações são escritas em função dos coeficientes de deformação reduzida e de um coeficiente associado denominado de k, apresentados por Lekhnitskii, os quais dependem das propriedades de elasticidade do material. Com isso a equação diferencial que rege esse problema é função dos coeficientes de deformação e consequentemente da retração. Para exemplificar o uso da equação regente do problema e consequente determinação de tensões nas direções radial e tangencial e deslocamentos radiais foram utilizados os coeficientes de elasticidade da espécie de madeira Pinus caribaeaobtidos em procedimento experimental auxiliar. De um modo geral, os resultados mostraram a importância de se verificar a influência da retração no estado de tensão radial e tangencial e nos deslocamentos radiais em peças de madeira.
Avaliação da eficiência de sistemas de proteção de superfície para concreto: absorção de água, migração de cloretos e ângulo de contato
Authors: Medeiros Marcelo Henrique Farias de , Pereira Eduardo , Figura Andrielli Scardanzan , Tissot Felipe Maués , Artioli Karen Alves
Published: April 2015

A camada de cobrimento do concreto funciona como uma barreira natural ao ingresso de agentes agressivos para o interior do material, dificultando a penetração de íons cloretos, reduzindo a absorção de água e limitando o acesso de oxigênio. Para garantir a eficiência desta camada protetora o uso de tratamentos de superfície mostra-se como uma alternativa viável para prolongar o período de proteção proporcionado pelo cobrimento do concreto. O objetivo deste trabalho é estudar o efeito de proteção de quatro produtos disponíveis no mercado para ser aplicados na proteção de superfície de concretos (cimento quartzoso, epóxi, silicatos, silano/siloxano), bem como comparar os métodos usados para investigar a eficiência de sistemas de proteção. Para isto procedeu-se sobre corpos de prova de concreto, ensaios de absorção por sucção capilar, resistência à penetração de cloretos por migração de íons e medição do ângulo de contato com a água sobre a superfície de concreto protegida ou não. Os produtos estudados apresentaram a capacidade de modificar a interação entre a água e a superfície de contato do concreto. Dentre os produtos estudados, o epóxi é o que apresenta a maior resistência à penetração de cloretos, menor absorção de água por capilaridade e caráter hidrófugo. Com exceção dos silicatos, verificou-se ainda uma boa correlação entre os resultados de absorção de água por capilaridade e o ensaio de migração de íons cloretos. Os produtos Epóxi e a base de silicatos, que apresentaram os menores valores de sortividade, foram os que apresentaram os maiores valores de ângulo de contato, sendo classificados como os de menor afinidade com a água.
Mechanical, structural and tribological properties of superaustenitic stainless steel submitted at solution heat treatment
Authors: Borges Fabiana Cristina Nascimento , Oliveira Willian Rafael de , Kublitski Jonas
Published: April 2015

The superaustenitic stainless steel presents several technological applications, mainly in corrosive environments. The different phase precipitation might alter some of its mechanical properties. Such alterations affect several factors, including the working life of the material under adverse working conditions. In this study, Instrumented Indentation techniques, Tribology and X-ray diffraction (XRD) were used to evaluate alterations in regions close to the surface. The parameters analyzed were: hardness and elastic modulus (instrumented indentation), friction coefficient (tribology) and structural alterations of the unit cell of the identified phases (XRD - Rietveld Refinement). All properties analyzed were compared with those of common austenitic steel. The presence of σ-phase (space group P42mnm) and γ-austenite (space group Fm3m) were detected. Data analyzed indicated that the presence of σ-phase caused small alteration in properties such as hardness in regions close to the surface. In the regions farther from the surface (material bulk) data can be compared to that of conventional austenitic steel.
Desenvolvimento de um Software para cálculo da densidade de nódulos de grafita em ferro fundido nodular através de Processamento Digital de Imagens
Authors: Peixoto Filipe de Macêdo , Rebouças Elizângela de Souza , Xavier Francisco Geilson de Lima , Rebouças Filho Pedro Pedrosa
Published: April 2015

O presente trabalho tem como objetivo determinar o número de nódulos de grafita em amostra de ferro fundido nodular, de acordo com a norma NBR 6913, utilizando técnicas de processamento e análise de imagens digitais. Esta contagem determina propriedades mecânicas do ferro fundido nodular que são utilizados para projetos para aplicações na área. Deste modo, esta contagem é feita, tradicionalmente, de forma visual por um operador através do auxílio de um microscópio óptico. Com o objetivo de reduzir o tempo de contagem da quantidade de nódulos e eliminar o máximo possível de erros na contagem, foi desenvolvido um software, utilizando a Linguagem C e com auxílio da biblioteca OpenCV. Esta biblioteca é livre e agrupa técnicas otimizadas de Visão Computacional através de técnicas de Processamento Digital de Imagens. Foram utilizadas duas abordagens para contabilizar os nódulos, uma através do método Crescimento de Regiões e outra utilizando Watershed. Testes são realizados e comparados com o resultado obtido por seis especialistas utilizando a técnica visual tradicional visando avaliar os métodos propostos. Os resultados obtidos demonstram que os métodos podem ser incorporados a um sistema para cálculo do número de nódulos em ferro fundido nodular. Ao fim deste trabalho, é possível confirmar a praticidade e a confiabilidade na contagem de nódulos utilizando o software desenvolvido, em comparação ao método tradicional de contagem, demonstrando sua importância para auxílio nesta área do conhecimento.
Caracterização do material particulado suspenso no ar de Cuiabá-MT no período de queimadas
Authors: Santiago Aline , Prado Rogério Junqueira , Modesto Filho Paulo , Alonso Rafael Viana
Published: April 2015

A caracterização química e morfológica do material particulado suspenso no ar da cidade de Cuiabá - MT, no período de queimadas do ano de 2012, foi realizada utilizando-se as técnicas de Microscopia Eletrônica de Varredura acoplada a um sistema de Microanálise de Raios X (SEM/EDS) e Fluorescência de Raios X por Dispersão em Energia(EDXRF). Deve ser ressaltado que são poucos os estudos realizados sobre o tema, particularmente para a cidade de Cuiabá e região. Com o uso das técnicas de SEM/EDS foi possível classificar o material particulado em quatro diferentes grupos, definidos em função de suas semelhanças morfológicas e composição química: aglomerados, placas, fibrosas e arredondadas. Por EDXRF foram identificados e quantificados 10 elementos químicos (Al, S, Cl, K, Ca, Fe, Cu, Zn, Sr e Ba), predominando aqueles característicos de ressuspensão do solo e queimadas (Al, Fe, Ca, K e Cl), além dos vinculados às emissões veiculares e industriais (Zn, S, Cu). As concentrações de material particulado em suspensão obtidas no mês de setembro, após longo período de seca, atingiram 306 μg/m3 de ar, superando o limite primário estabelecido pelo Conselho Nacional do Meio Ambiente (CONAMA), evidenciando a má qualidade do ar no período. Além disso, as partículas fibrosas identificadas neste trabalho não haviam sido relatadas anteriormente, sendo aparentemente características da região, e apresentando composição química condizente com forte influência de queimadas em sua formação.
Arresting settlement of clay using low-pressure grouting
Authors: Chew Soon-Hoe , Bharati Sanjay Kumar
Published: April 2015

In Singapore, ground settlement is one of the major problems encountered in built-up areas such as housing and industrial estates. While structures themselves are not affected by settlement, as they are supported by piles, a large amount of ground settlement occurs due to the presence of a thick layer of soft clay beneath service roads and car-parking areas. In built-up areas it may not be appropriate to us the conventional high-pressure jet grouting method as it has a potential of causing soil and foundation movement. In the present study a modified version of the jet grouting method, called ‘low-pressure grouting’, was developed to arrest the settlement of a soft clay layer in a built-up area. A laboratory grouting model apparatus was developed to simulate in situ low-pressure grouting, and the performance of the grouting was evaluated. The experimental data obtained were used to develop a predictive model, and the model was used to evaluate a grouted column. It was found that the diameter of the grouted column during low-pressure grouting fell within the lower range of that seen when using conventional high-pressure jet grouting. It was concluded that the proposed low-pressure grouting method can be used to treat a soft clay layer in a built-up area.
Effect of Hierarchy Legitimacy on Low Status Group Members' Attributions for Ingroup and Outgroup Failures
Authors: Beatson Ruth M. , Halloran Michael J.
Published: April 2015

Previous research has shown that people have a tendency to explain successes and failures in ways that favor their ingroups relative to outgroups. However, there has been a dearth of research examining whether social-contextual factors such as group status and hierarchy legitimacy moderate such intergroup attributions. Participants in this study were assigned to a low status group, and perceived hierarchy legitimacy was then experimentally manipulated; the extent to which ingroup versus outgroup failures were attributed to several causes was measured. When low status was considered illegitimate, ingroup failure was attributed to external causes (task difficulty, bad luck) more so than outgroup failure. Implications and directions for future research examining consequences and mediating processes are discussed.
Influence of Physical Therapists' Kinesiophobic Beliefs on Lifting Capacity in Healthy Adults
Authors: Lakke Sandra E. , Soer Remko , Krijnen Wim P. , van der Schans Cees P. , Reneman Michiel F. , Geertzen Jan H.B.
Published: April 2015

Background

Physical therapists' recommendations to patients to avoid daily physical activity can be influenced by the therapists' kinesiophobic beliefs. Little is known about the amount of influence of a physical therapist's kinesiophobic beliefs on a patient's actual lifting capacity during a lifting test.

Objective

The objective of this study was to determine the influence of physical therapists' kinesiophobic beliefs on lifting capacity in healthy people.

Design

A blinded, cluster-randomized cross-sectional study was performed.

Methods

The participants (n=256; 105 male, 151 female) were physical therapist students who performed a lifting capacity test. Examiners (n=24) were selected from second-year physical therapist students. Participants in group A (n=124) were tested in the presence of an examiner with high scores on the Tampa Scale of Kinesiophobia for health care providers (TSK-HC), and those in group B (n=132) were tested in the presence of an examiner with low scores on the TSK-HC. Mixed-model analyses were performed on lifting capacity to test for possible (interacting) effects.

Results

Mean lifting capacity was 32.1 kg (SD=13.6) in group A and 39.6 kg (SD=16.4) in group B. Mixed-model analyses revealed that after controlling for sex, body weight, self-efficacy, and the interaction between the examiners' and participants' kinesiophobic beliefs, the influence of examiners' kinesiophobic beliefs significantly reduced lifting capacity by 14.4 kg in participants with kinesiophobic beliefs and 8.0 kg in those without kinesiophobic beliefs.

Limitations

Generalizability to physical therapists and patients with pain should be studied.

Conclusions

Physical therapists' kinesiophobic beliefs negatively influence lifting capacity of healthy adults. During everyday clinical practice, physical therapists should be aware of the influence of their kinesiophobic beliefs on patients' functional ability.
Impact of body mass index on cerebellar tonsil position in healthy subjects and patients with Chiari malformation
Authors: Smith Brandon W. , Strahle Jennifer , Kazarian Erick , Muraszko Karin M. , Garton Hugh J. L. , Maher Cormac O.
Published: April 2015

OBJECT

It is unclear if there is a relationship between Chiari malformation Type I (CM-I) and body mass index (BMI). The aim of this study was to identify the relationship between BMI and cerebellar tonsil position in a random sample of people.

METHODS

Cerebellar tonsil position in 2400 subjects from a cohort of patients undergoing MRI was measured. Three hundred patients were randomly selected from each of 8 age groups (from 0 to 80 years). A subject was then excluded if he or she had a posterior fossa mass or previous posterior fossa decompression or if height and weight information within 1 year of MRI was not recorded in the electronic medical record.

RESULTS

There were 1310 subjects (54.6%) with BMI records from within 1 year of the measured scan. Of these subjects, 534 (40.8%) were male and 776 (59.2%) were female. The average BMI of the group was 26.4 kg/m2, and the average tonsil position was 0.87 mm above the level of the foramen magnum. There were 46 subjects (3.5%) with a tonsil position ≥ 5 mm below the level of the foramen magnum. In the group as a whole, there was no correlation (R2 = 0.004) between BMI and cerebellar tonsil position.

CONCLUSIONS

In this examination of 1310 subjects undergoing MRI for any reason, there was no relationship between BMI and the level of the cerebellar tonsils or the diagnosis of CM-I on imaging.
Predictors of sinonasal quality of life and nasal morbidity after fully endoscopic transsphenoidal surgery
Authors: Little Andrew S. , Kelly Daniel , Milligan John , Griffiths Chester , Prevedello Daniel M. , Carrau Ricardo L. , Rosseau Gail , Barkhoudarian Garni , Otto Bradley A. , Jahnke Heidi , Chaloner Charlene , Jelinek Kathryn L. , Chapple Kristina , White William L.
Published: April 2015

OBJECT

Despite the increasing application of endoscopic transsphenoidal surgery for pituitary lesions, the prognostic factors that are associated with sinonasal quality of life (QOL) and nasal morbidity are not well understood. The authors examine the predictors of sinonasal QOL and nasal morbidity in patients undergoing fully endoscopic transsphenoidal surgery.

METHODS

An exploratory post hoc analysis was conducted of patients who underwent endoscopic pituitary surgery and were enrolled in a prospective multicenter QOL study. End points of the study included patient-reported sinonasal QOL and objective nasal endoscopy findings. Multivariate models were developed to determine the patient and surgical factors that correlated with QOL at 2 weeks through 6 months after surgery.

RESULTS

This study is a retrospective review of a subgroup of patients studied in the clinical trial “Rhinological Outcomes in Endonasal Pituitary Surgery” (clinical trial no. NCT01504399, clinicaltrials.gov). Data from 100 patients who underwent fully endoscopic transsphenoidal surgery were included. Predictors of a lower postoperative sinonasal QOL at 2 weeks were use of nasal splints (p = 0.039) and female sex at the trend level (p = 0.061); at 3 months, predictors of lower QOL were the presence of sinusitis (p = 0.025), advancing age (p = 0.044), and use of absorbable nasal packing (p = 0.014). Health status (multidimensional QOL) was also predictive at 2 weeks (p = 0.001) and 3 months (p < 0.001) and was the only significant predictor of sinonasal QOL at 6 months (p < 0.001). A Kaplan-Meier analysis was performed to study time to resolution of nasal crusting, mucopurulence, and synechia as observed during nasal endoscopy after surgery. The mean time (± SEM) to absence of nasal crusting was 16.3 ± 2.1 weeks, mucopurulence was 6.2 ± 1.1 weeks, and synechia was 4.4 ± 0.5 weeks. Use of absorbable nasal packing was associated with more severe mucopurulence.

CONCLUSIONS

Sinonasal QOL following endoscopic pituitary surgery reaches a nadir at 2 weeks and recovers by 3 months postoperatively. Use of absorbable packing and nasal splints, while used in a minority of patients, negatively correlates with early sinonasal QOL. Sinonasal QOL and overall health status are well correlated in the postoperative period, suggesting the important influence of sinonasal QOL on the patient experience.
Intranasal delivery of bone marrow stromal cells to spinal cord lesions
Authors: Ninomiya Koshi , Iwatsuki Koichi , Ohnishi Yu-ichiro , Ohkawa Toshika , Yoshimine Toshiki
Published: April 2015

OBJECT

The intranasal delivery of bone marrow stromal cells (BMSCs) or mesenchymal stem cells to the injured brains of rodents has been previously reported. In this study, the authors investigated whether BMSCs migrate to spinal cord lesions through an intranasal route and whether the administration affected functional recovery.

METHODS

Forty Sprague-Dawley rats that were subjected to spinal cord injuries at the T7–8 level were divided into 5 groups (injured + intranasal BMSC–treated group, injured + intrathecal BMSC–treated group, injured-only group, injured + intranasal vehicle–treated group, and injured + intrathecal vehicle–treated group). The Basso-Beattie-Bresnahan (BBB) scale was used to assess hind limb motor functional recovery for 2 or 4 weeks. Intralesionally migrated BMSCs were examined histologically and counted at 2 and 4 weeks. To evaluate the neuroprotective and trophic effects of BMSCs, the relative volume of the lesion cavity was measured at 4 weeks. In addition, nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) levels in the CSF were evaluated at 2 weeks.

RESULTS

Intranasally administered BMSCs were confirmed within spinal cord sections at both 2 and 4 weeks. The highest number, which was detected in the intrathecal BMSC–treated group at 2 weeks, was significantly higher than that in all the other groups. The BBB score of the intranasal BMSC–treated group showed statistically significant improvements by 1 week compared with the control group. However, in the final BBB scores, there was a statistically significant difference only between the intrathecal BMSC–treated group and the control group. The cavity ratios in the BMSC-treated groups were smaller than those of the control groups, but the authors did not find any significant differences in the NGF and BDNF levels in the CSF among the treatment and control groups.

CONCLUSIONS

BMSCs reached the injured spinal cord through the intranasal route and contributed to the recovery of hind limb motor function and lesion cavity reduction. However, the effects were not as significant as those seen in the intrathecal BMSC–treated group.
Sleep-disordered breathing in patients with myelomeningocele
Authors: Patel Daxa M. , Rocque Brandon G. , Hopson Betsy , Arynchyna Anastasia , Bishop E. Ralee’ , Lozano David , Blount Jeffrey P.
Published: April 2015

OBJECT

A paucity of literature examines sleep apnea in patients with myelomeningocele, Chiari malformation Type II (CM-II), and related hydrocephalus. Even less is known about the effect of hydrocephalus treatment or CM-II decompression on sleep hygiene. This study is an exploratory analysis of sleep-disordered breathing in patients with myelomeningocele and the effects of neurosurgical treatments, in particular CM-II decompression and hydrocephalus management, on sleep organization.

METHODS

The authors performed a retrospective review of all patients seen in their multidisciplinary spina bifida clinic (approximately 435 patients with myelomeningocele) to evaluate polysomnographs obtained between March 1999 and July 2013. They analyzed symptoms prompting evaluation, results, and recommended interventions by using descriptive statistics. They also conducted a subset analysis of 9 children who had undergone polysomnography both before and after neurosurgical intervention.

RESULTS

Fifty-two patients had polysomnographs available for review. Sleep apnea was diagnosed in 81% of these patients. The most common presenting symptom was “breathing difficulties” (18 cases [43%]). Mild sleep apnea was present in 26 cases (50%), moderate in 10 (19%), and severe in 6 (12%). Among the 42 patients with abnormal sleep architecture, 30 had predominantly obstructive apneas and 12 had predominantly central apneas. The most common pulmonology-recommended intervention was adjustment of peripheral oxygen supplementation (24 cases [57%]), followed by initiation of peripheral oxygen (10 cases [24%]).

In a subset analysis of 9 patients who had sleep studies before and after neurosurgical intervention, there was a trend toward a decrease in the mean number of respiratory events (from 34.8 to 15.9, p = 0.098), obstructive events (from 14.7 to 13.9, p = 0.85), and central events (from 20.1 to 2.25, p = 0.15) and in the apnea-hypopnea index (from 5.05 to 2.03, p = 0.038, not significant when corrected for multiple measures).

CONCLUSIONS

A large proportion of patients with myelomeningocele who had undergone polysomnography showed evidence of disordered sleep on an initial study. Furthermore, 31% of patients had moderate or severe obstructive sleep apnea. Myelomeningocele patients with an abnormal sleep structure who had undergone nonoperative treatment with peripheral oxygen supplementation showed improvement in the apnea-hypopnea index. Results in this study suggested that polysomnography in patients with myelomeningocele may present an opportunity to detect and classify sleep apnea, identify low-risk interventions, and prevent future implications of sleep-disordered breathing.
Down syndrome and moyamoya: clinical presentation and surgical management
Authors: See Alfred P. , Ropper Alexander E. , Underberg Daniel L. , Robertson Richard L. , Scott R. Michael , Smith Edward R.
Published: April 2015

OBJECT

Moyamoya can cause cerebral ischemia and stroke in Down syndrome (DS) patients. In this study, the authors defined a surgically treated population of patients with DS and moyamoya and compared their clinical presentation, response to surgical treatment, and long-term prognosis with those of the general population of patients with moyamoya but without DS.

METHODS

This study was a retrospective review of a consecutive operative series of moyamoya patients with DS treated at Boston Children’s Hospital from 1985 through 2012.

RESULTS

Thirty-two patients, average age 9.7 years (range 1.8–29.3 years), underwent surgery for moyamoya in association with DS. The majority presented with ischemic symptoms (87% stroke, 42% transient ischemic attacks). Twenty-four patients (75%) had congenital heart disease. Nineteen patients (59%) had bilateral moyamoya on presentation, and 13 presented with unilateral disease, of which 2 progressed to surgery on the opposite side at a later date. Patients were followed for a median of 7.5 years (1–20.2 years) after surgery, with no patients lost to follow-up. Follow-up arteriography demonstrated Matsushima Grade A collaterals in 29 of 39 (74%) hemispheres, Grade B in 5 (13%), and Grade C in 5 (13%).

Complications included postoperative strokes in 2 patients, which occurred within 48 hours of surgery in both; one of these patients had arm weakness and the other confusion (both had recovered completely at follow-up). Seizures occurred in 5 patients perioperatively, including one who had a new seizure disorder related to hypocalcemia.

CONCLUSIONS

Moyamoya disease is a cause of stroke in patients with DS. Both the incidence of preoperative stroke (87% vs 67%) and the average age at diagnosis for children under age 21 (8.4 vs 6.5 years) were greater in patients with DS and moyamoya than in the general moyamoya surgical population, suggesting a possible delay in reaching a correct diagnosis of the cause of cerebral ischemia in the DS patient population. Pial synangiosis provided long-term protection from stroke in all patients treated.
Sensory abnormalities and masticatory function after microvascular decompression or balloon compression for trigeminal neuralgia compared with carbamazepine and healthy controls
Authors: Ichida Michelle Cristina , de Almeida Antonio Nogueira , Nobrega Jose Claudio Marinho da , Teixeira Manoel Jacobsen , de Siqueira José Tadeu Tesseroli , de Siqueira Silvia R. D. T.
Published: April 2015

OBJECT

Idiopathic trigeminal neuralgia (iTN) is a neurological condition treated with pharmacotherapy or neurosurgery. There is a lack of comparative papers regarding the outcomes of neurosurgery in patients with iTN. The objective of this study was to investigate sensory thresholds and masticatory function in 78 patients with iTN who underwent microvascular decompression (MVD) or balloon compression (BC), and compare these treatments with carbamazepine and 30 untreated healthy controls.

METHODS

The authors conducted a case-controlled longitudinal study. Patients were referred to 1 of 3 groups: MVD, BC, or carbamazepine. All patients were evaluated before and after treatment with a systematic protocol composed of a clinical orofacial questionnaire, Research Diagnostic Criteria for temporomandibular disorders, Helkimo indices, and a quantitative sensory-testing protocol (gustative, olfactory, cold, warm, touch, vibration, superficial, and deep pain thresholds).

RESULTS

Both MVD and BC were effective at reducing pain intensity (p = 0.012) and carbamazepine doses (p < 0.001). Myofascial and articular complaints decreased in both groups (p < 0.001), but only the patients in the MVD group showed improvement in Helkimo indices (p < 0.003). Patients who underwent MVD also showed an increase in sweet (p = 0.014) and salty (p = 0.003) thresholds. The sour threshold decreased (p = 0.003) and cold and warm thresholds increased (p < 0.001) in patients after MVD and BC, but only the patients who underwent BC had an increase in touch threshold (p < 0.001).

CONCLUSIONS

Microvascular decompression and BC resulted in a reduction in myofascial and jaw articular complaints, and the impact on masticatory function according to Helkimo indices was greater after BC than MVD. MVD resulted in more gustative alterations, and both procedures caused impairment in thermal thresholds (warm and cold). However, only BC also affected touch perception. The sensorial and motor deficits after BC need to be included as targets directly associated with the success of the surgery and need to be assessed and relieved as goals in the treatment of iTN.
Medical treatment decision making after total avulsion brachial plexus injury: a qualitative study
Authors: Franzblau Lauren E. , Maynard Mallory , Chung Kevin C. , Yang Lynda J.-S.
Published: April 2015

OBJECT

Complete avulsion traumatic brachial plexus injuries (BPIs) can be treated using nerve and musculoskeletal reconstruction procedures. However, these interventions are most viable within certain timeframes, and even then they cannot restore all lost function. Little is known about how patients make decisions regarding surgical treatment or what impediments they face during the decision-making process. Using qualitative methodology, the authors aimed to describe how and why patients elect to pursue or forego surgical reconstruction, identify the barriers precluding adequate information transfer, and determine whether these patients are satisfied with their treatment choices over time.

METHODS

Twelve patients with total avulsion BPIs were interviewed according to a semi-structured guide. The interview transcripts were qualitatively analyzed using the systematic inductive techniques of grounded theory to identify key themes related to the decision-making process and long-term satisfaction with decisions.

RESULTS

Four decision factors emerged from our analysis: desire to restore function, perceived value of functional gains, weighing the risks and costs of surgery, and having concomitant injuries. Lack of insurance coverage (4 patients), delayed diagnosis (3 patients), and insufficient information regarding treatment (4 patients) prevented patients from making informed decisions and accessing care. Three individuals, all of whom had decided against reconstruction, had regrets about their treatment choices.

CONCLUSIONS

Patients with panplexus avulsion injuries are missing opportunities for reconstruction and often not considering the long-term outcomes of surgery. As more Americans gain health insurance coverage, it is very likely that the number of patients able to pursue reconstruction will increase. The authors recommend implementing clinical pathways to help patients meet critical points in care within the ideal timeframe and using a patient- and family-centered care approach combined with patient decision aids to foster shared decision making, increase access to information, and improve patient satisfaction with decisions. These measures could greatly benefit patients with BPI while reducing costs, improving efficiency, and generating better outcomes.
Quantitative analysis of the Kawase versus the modified Dolenc-Kawase approach for middle cranial fossa lesions with variable anteroposterior extension
Authors: Tripathi Manjul , Deo Rama Chandra , Suri Ashish , Srivastav Vinkle , Baby Britty , Kumar Subodh , Kalra Prem , Banerjee Subhashis , Prasad Sanjiva , Paul Kolin , Roy Tara Sankar , Lalwani Sanjeev
Published: April 2015

OBJECT

The surgical corridor to the upper third of the clivus and ventral brainstem is hindered by critical neurovascular structures, such as the cavernous sinus, petrous apex, and tentorium. The traditional Kawase approach provides a 10 × 5–mm fenestration at the petrous apex of the temporal bone between the 5th cranial nerve and internal auditory canal. Due to interindividual variability, sometimes this area proves to be insufficient as a corridor to the posterior cranial fossa. The authors describe a modification to the technique of the extradural anterior petrosectomy consisting of additional transcavernous exploration and medial mobilization of the cisternal component of the trigeminal nerve. This approach is termed the modified Dolenc-Kawase (MDK) approach.

METHODS

The authors describe a volumetric analysis of temporal bones with 3D laser scanning of dry and drilled bones for respective triangles and rhomboid areas, and they compare the difference of exposure with traditional versus modified approaches on cadaver dissection. Twelve dry temporal bones were laser scanned, and mesh-based volumetric analysis was done followed by drilling of the Kawase triangle and MDK rhomboid. Five cadaveric heads were drilled on alternate sides with both approaches for evaluation of the area exposed, surgical freedom, and angle of approach.

RESULTS

The MDK approach provides an approximately 1.5 times larger area and 2.0 times greater volume of bone at the anterior petrous apex compared with the Kawase’s approach. Cadaver dissection objectified the technical feasibility of the MDK approach, providing nearly 1.5–2 times larger fenestration with improved view and angulation to the posterior cranial fossa. Practical application in 6 patients with different lesions proves clinical applicability of the MDK approach.

CONCLUSIONS

The larger fenestration at the petrous apex achieved with the MDK approach provides greater surgical freedom at the Dorello canal, gasserian ganglion, and prepontine area and better anteroposterior angulation than the traditional Kawase approach. Additional anterior clinoidectomy and transcavernous exposure helps in dealing with basilar artery aneurysms.
Au sujet de la théorie
Authors: Nasielski Salomon
Published: April 2015

Constat : de nombreux écrits présentent des théories, des réflexions dites théoriques, ou se réfèrent à des théories ; or, bien souvent, il ne s’agit pas, à proprement parler, de théorie, mais d’autre chose. L’auteur prend le temps de détailler ces autres choses, puis de clarifier ce que l’on peut réellement retenir comme définition de la théorie y compris en analyse transactionnelle.
II. La pensée réfléchie en interaction avec l’expérience
Authors: Grégoire José
Published: April 2015

Ce deuxième article examine le contact de la pensée avec l’expérience. Il examine les points suivants : 1) comme ce contact n’est jamais parfait, la pensée n’atteint l’expérience que sous un angle particulier, 2) la pensée, en revanche, révèle dans l’expérience des relations et des possibilités qu’une immersion complète dans l’expérience ne permettrait pas de percevoir, 3) cette interaction réciproque implique la nécessité de la vigilance et de l’évaluation.
III. Pensée centrée, pensée intégrée et évolution professionnelle
Authors: Grégoire José
Published: April 2015

Le premier article a précisé ce que l’on entendait par « pensée réfléchie » et par « théorie » et le deuxième a traité de l’interaction jamais close entre pensée et expérience. Voyons à présent par quels processus mentaux la pensée théorique ou non accomplit sa tâche.
Les manques à l’intégrité scientifique et médicale
Authors: Sculier Jean-Paul
Published: April 2015

Les manquements à l’intégrité scientifique sont en pleine augmentation. Ils ont plusieurs formes : fraudes aux données (fabrication, falsification, vol, embellissement, rétention de données), plagiats, occultation de conflits d’intérêt, fraudes aux auteurs. L’ampleur du phénomène, ses origines, sa prévention et sa répression sont analysés en fonction de données de la littérature.
Une éthique de l’interprétation : comment est-il bon d’interpréter étant donné ce que nous sommes ?
Authors: Donnelly Anne
Published: April 2015

L’auteur, psychanalyste, pose dans ce texte la question de l’interprétation – un des outils essentiel de la cure analytique - sous l’angle de l’éthique : si l’analyste travaille avec « ce qu’il est » est-ce « bon » pour l’analysant ? Sa réponse est positive mais à condition qu’il respecte certaines règles : une formation et un contrôle personnel pendant plusieurs années. Pour l’auteur, l’interprétation est un bon exemple du travail de deux inconscients tout au long de la cure. Trois vignettes cliniques sont proposées. Elles mettent en évidence ce que le psychanalyste « est » avec son patient quand surgit une interprétation équivoque.
La maltraitance en gérontologie. Point de vue psycho-dynamique
Authors: Péruchon Marion
Published: April 2015

L’auteur appréhende la maltraitance en gérontologie au cœur de l’institution, dans les relations familiales, chez l’aidant et chez le vieillard. À l’appui de quelques vignettes cliniques, il tente d’analyser la dynamique pulsionnelle qui se joue entre les différents protagonistes en mettant l’accent sur la pulsion de destruction et sur le narcissisme, sans omettre les caractéristiques psychologiques singulières de cette population âgée – telles que la dégradation physique et mentale, la dépendance ainsi que la proximité traumatique de la mort – qui peuvent peser de tout leur poids dans la balance économique de la violence.
Entre normalité et autonomie, la place du projet thérapeutique de l’enfant : réflexions éthiques menées dans un centre psychothérapeutique de jour pour enfants
Authors: Frankard Anne-Christine , Schonne Isabelle
Published: April 2015

L’hospitalisation de jour de jeunes enfants présentant une problématique psychiatrique nécessite de maintenir perpétuellement en tension la place de l’autonomie du sujet en regard des normes sociales, éducatives, familiales, institutionnelles... Cette mise en tension confronte les soignants d’un Centre Psychothérapeutique de Jour pour enfant à des questions éthiques. Plusieurs niveaux d’analyse entrent en ligne de compte. Ceux-ci seront dépliés dans cette contribution. Les auteurs de l’article analysent les différentes attentes des partenaires concernés par l’hospitalisation en lien avec les modalités du cadre thérapeutique dans l’accompagnement du quotidien de l’enfant.
Le silence sur la mort de Paul dans les Actes des apôtres
Authors: Marguerat Daniel
Published: April 2015

Daniel Marguerat * explore le mystère de la fin du livre des Actes. Pourquoi Luc n’a-t-il pas raconté la mort de son héros, Paul, alors que des passages du récit laissent pressentir une fin dramatique ? L’enquête est à la fois historique, littéraire et théologique. Historique : il semble bien que Luc n’ait pas voulu rapporter les circonstances troubles du martyre de Paul. Littéraire : achever un récit en omettant de raconter ce qu’il annonce est une technique antique de suspension narrative. Théologique : l’auteur des Actes a choisi de terminer sur une scène qui organise adéquatement le transfert du monde du récit au monde du lecteur.
Kitsch religieux et dynamique de la foi
Authors: Mathot Benoit
Published: April 2015

Le kitsch a été défini par Milan Kundera comme un « accord catégorique avec l’être ». Dans cette contribution, Benoit Mathot * établit la généalogie de cette notion à partir des travaux d’Hermann Broch, essayiste et dramaturge autrichien, avant d’en préciser les implications philosophiques chez l’écrivain tchèque. Il y examine la façon dont le kitsch peut contribuer à un éclaircissement de la situation religieuse actuelle, qu’il caractérise à partir de l’analyse engagée par le philosophe Slavoj Žižek. C’est l’occasion pour l’auteur d’explorer de manière critique la notion de kitsch et de poser quelques jalons en vue d’une dynamique chrétienne de la foi.
Justes, justice, justification. Harmoniques pauliniennes dans l’Évangile de Luc
Authors: Singer Christophe
Published: April 2015

Les approches littéraires récentes des Actes comme réception particulière de l’héritage paulinien offrent une opportunité de rouvrir la question des rapports théologiques entre Luc et Paul. L’examen du déploiement narratif de la problématique de la justice dans le troisième Évangile montre qu’au-delà de la figure identitaire, l’Évangile paulinien de la justification inspire la rédaction lucanienne plus précisément que ne le concédait une bonne partie de l’exégèse historico-critique.
La proactivité de carrière : un processus d’anticipation ou de planification d’événements ?
Authors: Gatignon Turnau Anne-Laure , Ventolini Séverine , Fabre Catherine
Published: April 2015

L’étude de la « proactivité de carrière », en tant qu’objet de recherche, se heurte à la réalité du terrain, c’est à dire à la difficulté et à la réticence des individus à se projeter dans leur avenir professionnel. Le plan de carrière semble être un exercice obligé auquel les salariés se prêtent de manière plus ou moins consentante pour correspondre aux exigences managériales. Cette observation initiale nous a amené à proposer deux lectures différentes de la proactivité de carrière, non pas seulement dans son acception habituelle, comme un processus de planification d’objectifs de carrière mais aussi comme un processus d’anticipation d’évènements de carrière, rejoignant en cela les travaux récents sur les comportements proactifs (Grant et Ashford, 2008 ; Bindl et Parker, 2010 ; Fuller et al., 2012). À partir de ces deux approches conceptuelles et d’entretiens menés auprès d’un échantillon de vingt-cinq ingénieurs, cet article vise à mieux comprendre ce qu’est un comportement proactif de carrière. Cette étude qualitative, s’inspirant de la méthode des incidents critiques, nous a permis d’approfondir la connaissance du processus proactif d’anticipation et de montrer que cette démarche « anticipatrice » est sans doute plus réalisable par les salariés que l’approche planificatrice, dans un monde professionnel considéré comme instable et peu prévisible.
Les associations dans l’impasse humanitaire ?
Authors: Pette Mathilde
Published: April 2015

Les associations qui apportent aide et soutien aux personnes exilées dans le nord de la France ont été contraintes d’adapter leur action militante aux décisions politiques en matière d’immigration. Les pouvoirs publics ont ainsi amené les militant·e·s à remplir un rôle qui revient à l’État, celui de l’action humanitaire d’urgence.
Les jeunes Roumaines sont des garçons comme les autres
Authors: Vuattoux Arthur
Published: April 2015

Lors d’une enquête sociologique menée en Île-de-France afin d’éclairer qualitativement les biais de genre dans la chaîne judiciaire concernant les mineurs (justice civile et justice pénale), le cas des « jeunes filles roumaines » – repérées et nommées ainsi par les professionnels de la justice des mineurs – est apparu comme un cas limite. Échappant aux schémas genrés qui président habituellement à la justice des mineurs, ces jeunes filles sont largement pénalisées et connaissent fréquemment la prison pour de simples vols. On peut avancer qu’elles subissent un traitement judiciaire d’exception, révélateur des discriminations multiples vécues par les Roms sur le territoire français.