C Duhalde | PubMed Health

PubMed1999

Extensor supracondylar femoral osteotomy as treatment for flexed haemophilic knee.

The experience with extensor supracondylar femoral osteotomy as treatment for the flexed haemophilic knee is presented with the description of 19 patients treated during a 30-year period (1968-98). The average age of the patients was 16 (8-35 years), and the average age follow-up was 13 years (3-30 years). Six patients had flexion fixed deformity while the rest presented 40 degrees average range of motion (10-75 degrees). In 13 patients a single osteotomy without internal fixation was performed, in one an osteosynthesis with a condylar plate and in five stabilization was achieved by means of Blount staples. Previous surgery was performed in two patients with patello-femoral ankylosis. The osteotomy site was consolidated in every patient and the deformity was corrected. Two bleeding complications were observed: one haemarthrosis and one psoas haematoma. Flexion relapsed in one patient who underwent another procedure after 12 years. One patient presented with a peroneal nerve paralysis; another one a genu recurvartum; which required flexor osteotomy. The extensor supracondylar femoral osteotomy is a procedure that aligns the limb with scarce modification of articular mobility.

Adolescent↗

PubMed1998

Haemophilic synovitis: is rifampicin an alternative?

Rifampicin synoviorthesis has been empirically used for the treatment of haemophilic synovitis for some time. This paper reports on the experience of three Latin American centers with this treatment and compares it with radioactive synoviorthesis results. Chemical synoviorthesis with rifampicin is best indicated in younger patients (< 15 years) and small joint (ankles and elbows).

Hemophilia A↗

PubMedDate not supplied

[Clinical inferential process in psychoanalysis].

OBJECTIVE: Despite the highest importance of studying the inferential process in psychotherapy, few systematic studies deal with the ways in which psychotherapists work with the material offered by their patients and construct clinical hypotheses about it. The purpose of this study is to present empirical findings about similarities and differences in the way psychoanalysts from different theorethical orientations and level of clinical experience produce their clinical inferences. METHODOLOGY: The sample includes 20 psychoanalysts selected according to their theoretical orientation (Freudian and Lacanian psychoanalysts) and their level of clinical experience (less than ten years and more than twenty years of clinical practice). They listened to the same tape-recorded first session of psychotherapy and were asked to report their clinical hypotheses, clues, and hunches about the material. They also answered a questionnaire about their inferential work. RESULTS: Freudian psychoanalysts produced more single hypothesis and the same number of combined hypothesis than lacanian psychoanalysts. The level of experience was a factor when it came to producing combined hypothesis, no matter their theoretical framework. 90 per cent of the interviewed made their first clinical inference before the first 9 minutes of the session (regardless of their experience and framework), and agreed on the core themes of the clinical case. CONCLUSIONS: there are similarities and differences in the inferential work according to the theoretical orientation and clinical experience of the psychoanalysts. Their level of experience has a positive matching with their capacity to produce more combined inferences. Most of the clinical inferences are psychological and relational, and they are produced at the very beginning of the session.

Adult↗