L'adolescence dans l'histoire de la psychanalyse

The concept of adolescence emerged progressively during the twentieth century. At the onset psychoanalysis focused on puberty as a second stage in the sexual maturity of Man, before it considered adolescence as an active process in the psychic life of the human being. The present article reexamines the development of this concept in the history of ideas in general in order to demonstrate its importance in the history of psychoanalysis. The themes that are sucessively covered include the precursors of the concept in the nineteenth century, the birth of its theorization, the Aichhorn years, and adolescence identified as a psychic process, which participates to a significant degree in subjectivization.     

自制“茎突分离保护器”及茎突过长症的治疗应用

本文介绍了自制“茎突分离保护器”的质地、规格、性能。茎突截短术应用代用器械手术18例,每侧截除长度平均为1.75cm;应用自制器械30例,每侧平均截除长度为2.52cm,且比代用器械每侧可缩短手术时间30～40分钟。文章还评价了包括颈外切开的6例,共54例手术的疗效。     

额叶脑回的横断层定位

目的:在横切面上利用髓突对成人端脑额叶脑回进行影像学定位.方法:取20例正常成人尸头标本,作层厚6mm之横切脑片,选取其中典型层面,观察分析额上、中、下回所对应髓突的方向、数目等特征形态.结果:各切面.各脑回所对应髓突为1～2支;时针12-12点半方向髓突所对应脑回是额上回;时针12点半-1点(左)及10点半-11点半(右)方向髓突所对应脑回是额中回;时针2-3点(左)及9-11点(右)方向髓突所对应脑回是额下回.结论:额上、中、下回与髓突之间有对应规律可寻,影像学上可以通过髓突定位额上、中、下回.     

改良全椎板切除术治疗腰椎管狭窄症的疗效评价

目的:探讨保留棘突的全椎板切除术治疗腰椎管狭窄症的临床疗效。方法:腰椎管减压手术,从椎板一侧入路,保留棘突及棘间、棘上韧带,将棘突从根部及侧面切断,将棘突及另一侧骶棘肌推向一边,再行全椎板减压。结果:45例患者术后症状完全消除占80%,明显改善占20%,术后下地时间平均3周,随访最长5年,未出现复发及加重情况。结论:保留棘突的全椎板手术能对腰椎管起到有效的减压作用,对术后的恢复及脊柱稳定性有积极的作用。     

Clinique des psychoses et théorisation du désarroi

The psychotic states occupy a particular position (?) within the psychoanalytical theorization. They set a major resistance against their treatment so clinical as theoretical arousing movements of profound disarray at the clinicians. The part counter-transference (?) of the process of theorization aroused by the psychotherapy of the psychotic states engenders a particular shape of elaboration, an conceptual higher bid which plays the role of “theoretical reprisals” in front of the narcissistic wound imposed by these problems. These “theoretical reprisals” represent an attempt of connection of the psychic processes in failure and fix the limits of the models of understanding. This necessary stage of the work of conceptualization can be exceeded by return on the clinical practices allowing the subjective appropriation of the theorized notions.     

Évaluation de la dynamique criminelle et des processus qui sous-tendent l’agir infractionnel dans un cadre expertal

Psychiatric and psychological examinations are increasingly sought in the criminal field since 12 December 2005 law on recidivism, laws of 10 August 2007 on the floor sentences and, above all, 25 February 2008 on the retention safety. This criminal judge sur-sollicitation is, more than ever, psychologists and psychiatrists experts training problem. Faced with the evolutions of the law and the recognition of the contribution of the psychological examination, there exists nowadays a strong demand for psychologists from the courts of appeal, which implies a development of the formations in this particular field as well as the tools for the analysis of the offence. In continuity of “consensus conference” about psychiatric expertise et in order to analyze and give a meaning to the offence in a psychocriminological's perspective, this article presents the axes of analysis to be developed and their implementation through the different aspects of a clinical interview. The investigated aspects are taken from a clinical research and have been experimented in different theoretical works as well in the expert's clinic in court.     

2D and 3D assessment of sustentaculum tali screw fixation with or without Screw Targeting Clamp

IntroductionPrecise placement of sustentaculum tali screw(s) is essential for restoring anatomy and biomechanical stability of the calcaneus. This can be challenging due to the small target area and presence of neurovascular structures on the medial side. The aim was to evaluate the precision of positioning of the subchondral posterior facet screw and processus anterior calcanei screw with or without a Screw Targeting Clamp. The secondary aim was to evaluate the added value of peroperative 3D imaging over 2D radiographs alone.MethodsTwenty Anubifix™ embalmed, human anatomic lower limb specimens were used. A subchondral posterior facet screw and a processus anterior calcanei screw were placed using an extended lateral approach. A senior orthopedic trauma surgeon experienced in calcaneal fracture surgery and a senior resident with limited experience in calcaneal surgery performed screw fixation in five specimens with and in five specimens without the clamp. 2D lateral and axial radiographs and a 3D recording were obtained postoperatively. Anatomical dissection was performed postoperatively as a diagnostic golden standard in order to obtain the factual screw positions. Blinded assessment of quality of fixation was performed by two surgeons.ResultsIn 2D, eight screws were considered malpositioned when placed with the targeting device versus nine placed freehand. In 3D recordings, two additional screws were malpositioned in each group as compared to the golden standard. As opposed to the senior surgeon, the senior resident seemed to get the best results using the Screw Targeting Clamp (number of malpositioned screws using freehand was eight, and using the targeting clamp five). In nine out of 20 specimens 3D images provided additional information concerning target area and intra-articular placement. Based on the 3D assessment, five additional screws would have required repositioning. Except for one, all screw positions were rated equally after dissection when compared with 3D examinations.ConclusionThis study does not show a substantial benefit between the Screw Targeting Clamp and the freehand technique as well between experienced and inexperienced surgeons. Data suggest that the clamp might help positioning sustentaculum tali screws, especially for inexperienced surgeons. Perioperative 3D recordings facilitate identification of malpositioned screws.     

Testicular descent

Sixty male rats were treated twice weekly from birth with either oestradiol benzoate (E₂B) or sesame oil (controls) to see if oestrogen caused cryptorchidism by inhibition of gubernacular migration between 3 and 10 days after birth. Dissection was carried out at 10, 15, or 28 days, the processus vaginalis measured using a probe, and the weight of the testis recorded. The length of the processus was used as a measure of the length of migration of the hollow gubernaculum. Although E₂B affected testicular weight significantly at 15 days, the length of the processus vaginalis was not significantly different from controls during the normal time of gubernacular migration (3–10 days of age). Histology confirmed this observation, with the gubernaculum within but slightly higher in the scrotum in E₂B-treated males than in 15-day controls. Similar findings were found in a second group of 10 rats subjected to orchidectomy at birth to remove the androgen source. By 28 days all E₂B-treated animals were found to be cryptorchid, although the gubernaculum had completed its migration to mid-scrotal level. It is proposed that pubertal testicular descent in the rodent is inhibited by E₂B by mechanisms other than inhibition of gubernacular migration between birth and 10 days of age, which may be preprogrammed before birth.