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Background Both Psychodynamic Group Therapy (PGT) and clonazepam are used as treatment strategies in reducing symptoms of generalized social anxiety disorder (GSAD). However, many individuals remain symptomatic after treatment with PGT or clonazepam. Method Fifty-eight adult outpatients with a diagnosis of GSAD according to DSM-IV were randomized to 12 weeks PGT plus clonazepam or clonazepam. The Clinical Global Impression-Improvement (CGI-I) Scale was the primary efficacy measure. Secondary efficacy measures included the Liebowitz Social Anxiety Scale (LSAS) total score, the World Health Organization Instrument to Assess Quality of Life-Bref (WHOQOL-Bref) Scale and the Beck Depression Inventory (BDI). Results CGI-I data from 57 patients (intent-to-treat population) showed that patients who received PGT plus clonazepam presented significantly greater improvement than those who received clonazepam (p=0.033). There were no significant differences between the two groups in the secondary efficacy measures. Conclusion/Discussion Our study suggests that the combination of PGT with clonazepam may be a promising strategy for the treatment of GSAD, regarding gains in the global functioning. However the present study failed to detect more specific changes in social anxiety symptomatology between the two groups.

Resumo: Introdução: No cenário educacional, diversas metodologias de ensino-aprendizagem vêm sendo utilizadas como ferramentas instrucionais, com o objetivo de aumentar a motivação dos estudantes e favorecer a aprendizagem significativa. Por sua vez, instrumentos que avaliem a motivação, após exposição a diferentes estratégias e materiais de ensino, podem contribuir para análise e decisão sobre sua efetividade. Nesse sentido, o questionário Instructional Materials Motivation Survey (IMMS) avalia a motivação, após atividades instrucionais, por meio de quatro domínios: atenção, relevância, confiança e satisfação. Assim, esta pesquisa teve como objetivo realizar a tradução e adaptação transcultural do IMMS para o português brasileiro. Método: A tradução e adaptação transcultural foram realizadas em seis etapas: tradução do questionário original, síntese das traduções, retrotradução, revisão pelo comitê de especialistas, teste da versão pré-final, confecção da versão final e auditoria pelo comitê externo. As traduções foram realizadas por duas professoras de inglês, de língua nativa brasileira. As retrotraduções foram realizadas por dois professores de inglês, de língua nativa inglesa. O comitê de especialistas foi formado por um professor de medicina e educação médica, dois professores de medicina, uma pedagoga, um estatístico e um professor de inglês. A versão brasileira final do IMMS foi testada, após aula invertida, tendo como objetivo avaliar a consistência interna do instrumento. Considerou-se como aceitável valor de alfa de Cronbach ≥ 0,70. Resultados: No processo de tradução e adaptação transcultural, foram atingidas todas as equivalências: semântica, idiomática, cultural e conceitual. Na avaliação da consistência interna, dos 52 estudantes submetidos à aula invertida, 48 (92,3%) responderam à versão brasileira do IMMS. O instrumento apresentou consistência interna de 0,718, avaliada por meio do teste alfa de Cronbach. Conclusões: A versão final do instrumento IMMS, após processo de tradução e adaptação transcultural, manteve todas as suas 36 sentenças e as instruções do instrumento original, e apresenta boa consistência interna, de acordo com o teste alfa de Cronbach. A possibilidade de avaliação da motivação, no contexto educacional, por instrumento amplamente validado, traz consigo ganhos tanto no campo da prática quanto da pesquisa pedagógica. Seu emprego no Brasil possibilitará novas validações em cenários educacionais nacionais e contextos diversos.

The knowledge of the normal anatomy and variations regarding the management of tumors of the sellar region is paramount to perform safe surgical procedures. The sellar region is located in the center of the middle cranial fossa; it contains complex anatomical structures, and is the site of various pathological processes: tumor, vascular, developmental, and neuroendocrine. We review the microsurgical anatomy (microscopic and endoscopic) of this region and discuss the surgical nuances regarding this topic, based on anatomical concepts.

Cavernous hemangioma of the central nervous system is a vascular malformation which is a developmental hamartoma, also known as cavernoma or cavernous malformation or venous angioma 1 .Cavernomas may affect any segment of the neuraxis. Most of these malformations are intracranial: supratentorial compartment is a site usually affected 2,3 . Pure spinal epidural cavernomas represent approximately 12% of spinal cavernous anomalies 4 and the thoracic segment is the most frequently affected 5 . There are approximately 80 cases of epidural cavernous hemangioma published in the literature 4,5 .We report on a case of thoracic extradural cavernous hemangioma, with emphasis on the clinical aspects. CASEA 63-years-old female caucasian patient with a previous history of cryptogenic epilepsy was referred to our emergency department with complaints of a one year history of gait ataxia, numbness and dysesthesia in both lower limbs. In the last 2 months, she also noticed reduced strength in the lower limbs.Neurological examination showed reduced strength in the lower limbs, grade 4/5 in the right lower limb and grade 3/5 in the left one. There was reduced sensation for all sensory modalities below the T10-11 dermatomes. There was also lower limb hyperreflexia and hypertonia, with bilateral extensor plantar response.An MRI showed an epidural space-occupying lesion involving the T9-T10 spinal canal levels and extending to the T9 left foramen, with an intense and homogeneous contrast enhancement (Figure).The patient was submitted to a T9-T10 laminectomy, including a T9 left foraminectomy. A posterior soft and reddish epidural mass with a good cleavage plan was completely removed. The patient evolved with partial improvement of sensibility in both lower limbs and strength.Histological examination revealed thin-walled blood vessels lined with a single layer of endothelial cells, surrounded by connective tissue. The microscopic appearance was compatible with cavernous hemangioma.

Psychodynamic Group Therapy (PGT) and clonazepam are strategies to reduce symptoms of generalized social anxiety disorder (GSAD). The addition of PGT might lead to changes in defense styles. The objective of this study is to examine changes in defense styles when comparing clonazepam to psychodynamic group therapy plus clonazepam in GSAD during 12 weeks. Fifty-seven patients that met DSM-IV criteria for GSAD participated. social anxiety disorder symptoms were evaluated with the Liebowitz Social Anxiety Scale, and defense styles with the Defense Style Questionnaire. All defense styles changed overtime for both groups, especially mature defense style, which increased independently of the treatment allocation group. Regression analyses found that overtime there was a reduction in neurotic defenses in the combined group, whereas there was an increase in the clonazepam group. Neurotic defense style can change toward greater adaptiveness with the addition of PGT to clonazepam in GSAD, even in 12 weeks.

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