O objetivo deste estudo foi revisar a epidemiologia, a sintomatologia clínica e a classificação dos diversos subtipos de transtornos depressivos, conforme os modernos sistemas de diagnóstico e de pesquisa, e descrever, de forma crítica, sob à luz da Psicanálise, os principais aspectos psicodinâmicos subjacentes. Destacamos, particularmente, os quadros de depressão melancólica e atípica, enfatizando a necessidade do reconhecimento diagnóstico precoce e da compreensão psicanalítica como instrumentos importantes para a intervenção e para o tratamento.

INTRODUÇÃO: O DSM-IV é um sistema diagnóstico e estatístico de classificação dos transtornos mentais, segundo o modelo categorial, destinado à prática clínica e à pesquisa em psiquiatria. O objetivo do presente estudo foi apresentar as vantagens do uso deste instrumento e suas limitações. METODOLOGIA: Os autores realizaram uma ampla revisão bibliográfica e apresentaram a relevância do tema, como está no momento configurado. Foram apontadas algumas mudanças prováveis, que ocorrerão nas próximas edições, e a discussão entre os modelos diagnósticos - dimensional e categorial. O artigo inclui os seguintes tópicos: histórico, conceito, vantagens e desvantagens da utilização, discussão e conclusão. Apresenta, também, um projeto que será desenvolvido no Núcleo de Atendimento dos Transtornos de Ansiedade (NATA), do Departamento de Psiquiatria da FCM/UNICAMP, aplicando um novo instrumento diagnóstico para o espectro do pânico agorafóbico, segundo o modelo dimensional.

Background: To date, there are no studies evaluating the use of the titanium-nitride-oxide coated stent in patients with multivessel coronary artery disease. We have compared the performance of the Titan-2 ® stent to that of the second generation drug-eluting stents in this scenario. Methods: From 2011 to 2012, 284 patients were treated with the Titan-2 ® stent, of which 100 (35.2%) had multivessel coronary artery disease. This group was compared to 100 patients, of a group of 304 (38.9%) patients with multivessel coronary artery disease treated with second generation drug-eluting stents with durable or biodegradable polymers. The primary endpoint was the occurrence of major adverse cardiovascular events at 1 year. Results: Clinical, angiographic and procedure-related characteristics of the patients did not show differences between groups. Most patients in the Titan-2 ® group were male (70%), mean age was 68.4 ± 12.9 years and 25% were diabetic. Stable symptomatic patients were prevalent (68%), 51% had three-vessel disease and ventricular function was preserved (55.6 ± 12.7%). The incidence of major adverse cardiovascular events at 1 year in the Titan-2 ® group was 21% (vs. 17%; p = 0.59), death was observed in 3% (vs. 2%; p > 0.99) of the patients, acute myocardial infarction in 5% (vs. 4%; p > 0.99) and a new revascularization procedure in 13% (vs. 11%; p = 0.83). Definitive stent thrombosis was not observed in either group. Conclusions: The Titan-2 ® stent showed similar results to those of the second-generation drug-eluting stents, which makes it attractive for use in the complex scenario of patients with multivessel coronary artery disease.

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Introduction: Standard treatment for pediatric patients with localized osteosarcoma includes high-dose methotrexate (HDMTX), and cure rates greater than 60% are observed. However, in adult patients, the toxicity profile limits the use of HDMTX and the drug is usually excluded from chemotherapy protocols for this group. We aimed to evaluate the outcomes of adult patients with localized osteosarcoma treated with chemotherapy without methotrexate. Methods: In this retrospective cohort, we evaluated adult patients with high-grade osteosarcoma who received chemotherapy treatment without methotrexate in a reference cancer center from 2007 to 2018. Outcomes analyzed were recurrence-free survival (RFS), overall survival (OS), and prognostic factors associated with overall survival. Results: A total of 48 patients had localized disease and received treatment with chemotherapy without methotrexate. The majority of them received chemotherapy with a combination of cisplatin and doxorubicin (n=42, 87.5%). Median age was 27 years (range 16.8-66.7). With a median follow-up of 29.2 months, median RFS was 29.9 months. Median OS was not reached. 5-year RFS and OS rates were 35.1% (95% CI: 20.3-50.2%) and 71.6% (95% CI: 52.3-84.2%), respectively. Patients who received cumulative doses of doxorubicin ≥375mg/m2 had better OS than those who received lower doses (HR 0.26, 95% CI: 0.07-0.94, p=0.041). Similarly, patients who received ≥6 cycles of neoadjuvant/adjuvant cisplatin tended to have better OS than those who received <6 cycles (HR 0.30, 95% CI: 0.08-1.09, p=0.069). Nineteen patients received less than 6 cycles of cisplatin and doxorubicin mainly because of grade 3 or 4 toxicities (11), disease progression (6), patient refusal (1), and physician choice (1). Conclusion: In our study, adult patients with localized highgrade osteosarcoma treated with chemotherapy without methotrexate had unfavorable outcomes. The cumulative doxorubicin dose and the number of cisplatin/doxorubicin cycles were associated with improved OS. The investigation of additional treatment strategies is of utmost importance to improve adult patients' outcomes.

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