Complicaciones hemorrágicas y trombóticas del embarazo: diagnóstico, prevención y tratamiento

Las hemorragias y la enfermedad tromboembólica venosa (ETEV) figuran entre las cinco causas más frecuentes de morbilidad y mortalidad materna en el mundo. Revisamos la evaluación y el manejo actualizado de las causas obstétricas de la hemorragia posparto (HPP), así como el diagnóstico y manejo de condiciones hematológicas que pueden causar o agravar la HPP, por ejemplo: coagulación intravascular diseminada, enfermedad de von Willebrand, trombocitopenia autoinmune y las microangiopatías trombóticas. Revisamos el rol del síndrome antifosfolípido y las trombofilias hereditarias como factores predisponentes a pérdidas fetales recurrentes y la ETEV en el embarazo y las recomendaciones actuales para la prevención de ambas complicaciones. Asimismo, repasamos el abordaje diagnóstico y líneas de manejo de la ETEV. Un objetivo adicional fue enfatizar la importancia del trabajo colaborativo multidisciplinario para lograr el manejo exitoso de las gestantes con las complicaciones obstétricas y hematológicas descritas.

Bleeding and venous thromboembolism (VTE) are among the five most common causes of morbidity and mortality in pregnant women worldwide. This review describes the current evaluation and management of the obstetric causes of postpartum hemorrhage (PPH), as well as the diagnosis and management of hematologic conditions which can cause or worsen PPH, such as disseminated intravascular coagulation, von Willebrand disease, autoimmune thrombocytopenia and the thrombotic microangiopathies. It also describes the role of the antiphospholipid syndrome and inherited thrombophilia as predisposing factors for recurrent pregnancy loses and VTE, and the current recommendations for the prevention of both complications. As well, the current diagnostic approach and management of ETEV are described. An additional objective of this Review is to emphasize the importance of a collaborative multidisciplinary approach for the successful management of the obstetric and hematologic complications herein described.

Avances en el diagnóstico y tratamiento de deficiencia de hierro y anemia ferropenica / Advances in the diagnosis and treatment of iron deficiency and iron deficiency anemia

RESUMEN Deficiencia de hierro (DH) y anemia ferropénica (AF) continúan siendo problemas de salud de magnitud en el mundo y afectan especialmente a niños preescolares y mujeres embarazadas. Este artículo tiene como objetivos: a) Describir las pruebas de laboratorio diagnóstico de AF y los factores que influyen en los niveles de ferritina y otros biomarcadores del estado del hierro; b) Presentar avances en el metabolismo del hierro, i.e. el rol regulador esencial de la hepcidina en la absorción y utilización del hierro; c) Describir el impacto que estos avances han tenido en el diseño de investigaciones clínicas comparando la absorción del hierro asociada con esquemas de ingesta diaria versus días alternados; d) Describir las situaciones clínicas en las cuales hierro endovenoso está indicado como tratamiento secundario o de primera línea. Los conceptos y sugerencias expresados en este artículo están basados en literatura actualizada y la experiencia clínica de los autores.

ABSTRACT Iron deficiency (ID) and iron deficiency anemia (IDA) are still major health problems worldwide, affecting especially preschool children and pregnant women. The objectives of this article are: a) To describe the laboratory tests for diagnosing IDA and the factors that may influence results of the serum ferritin and the other iron biomarkers ; b) To present advances in iron metabolism, i.e. the critical regulatory role of hepcidin in the absorption and utilization of iron ; c) To describe the impact this new knowledge has had in the design of clinical investigations comparing the absorption of iron following oral supplementation given in consecutive days vs. alternate days schedules; and, d) To describe the clinical situations in which intravenous iron is indicated as secondary or first-line treatment. The concepts expressed and the suggestions made in this article are based on updated literature and the clinical experience of the authors.

"Never sacrifice anything to laboratory work": The "physiological psychology" of Charles Richet (1875-1905).

Whilst best known as a Nobel laureate physiologist, Charles Robert Richet (1850-1935) was also a pioneer of scientific psychology. Starting in 1875 Richet had a leading role in the habilitation of hypnosis, in the institutionalization of psychology in France, and in the introduction of methodological innovations. Authoring several psychology books, Richet's works contributed to the recognition of the scientific nature of the discipline. This role is often underplayed by some historians and psychology textbooks in favor of his later position as a proponent of the controversial discipline he christened metapsychics in 1905, which today lies within the province of parapsychology. In this article, we show how his psychological approach guided by physiology, or physiological psychology, facilitated the reception of psychology. We hypothesize a strong continuity between his physiological psychology and his metapsychics, as he himself considered metapsychics as an advanced branch of physiology, and thus also an outpost of psychology.

Camille Flammarion on the powers of the soul; with an introduction by Carlos S.

There is a long conceptual tradition that interprets phenomena such as clairvoyance and apparitions as evidence for a spiritual component in human beings. Examples of this appear in the literatures of mesmerism, Spiritualism and psychical research. The purpose of this Classic Text is to present excerpts from a book by French astronomer Camille Flammarion touching on this perspective. They are selected from the introduction and conclusion of Flammarion's L'Inconnu: The Unknown (1900), a translation of L'Inconnu et les problèmes psychiques (1900), in which he published and commented on cases of apparitions and other phenomena he collected. In his view, these phenomena showed the existence of the soul. Similar beliefs regarding ideas of the nonphysical nature of human beings and psychic phenomena have continued to the present.

Jules Bernard Luys on magnetic pathology.

In the mesmeric movement, one of the phenomena cited to defend the existence of magnetic and nervous forces was the visual perception of them in the form of luminous emanations from people, or effluvia. This Classic Text is an 1892 article by French neurologist, Jules Bernard Luys (1828-97), about the observation of such effluvia by hypnotized individuals. Interestingly, the luminous phenomena perceived from mentally diseased individuals and from healthy ones had particular properties. Luys's interest in this and other unorthodox phenomena were consistent with ideas of animal magnetism in the late neo-mesmeric movement, as well as with some physicalistic conceptions of hypnosis and the nervous system held at the time.

Final chapter, From India to the Planet Mars: A Study of a Case of Somnambulism with Glossolalia, by Théodore Flournoy (1900).

Among the many attempts to explain mediumship psychologically at the turn of the century were the efforts of Swiss psychologist Théodore Flournoy (1854-1920). In his well-known book Des Indes à la Planète Mars (1900), translated as From India to the Planet Mars (1900), Flournoy analysed the mediumistic productions of medium Hélène Smith (1861-1929), consisting of accounts of previous lives in France and in India, and material about planet Mars. Flournoy explained the phenomena as a function of cryptomnesia, suggestive influences, and subconscious creativity, analyses that influenced both psychology and psychical research. The purpose of this Classic Text is to reprint the conclusion of Flournoy's study, whose ideas were developed in the context of psychological attention to mediumship and secondary personalities.

Cesare Lombroso on mediumship and pathology.

During the nineteenth century and the first decade of the twentieth, students of pathology such as Cesare Lombroso (1835-1909), the author of the excerpt presented here, became involved in observing, investigating and theorizing about the phenomena of Spiritualism, and mediumship in particular. The Classic Text presented here consists of an excerpt from Lombroso's writings which focus on the Italian medium Eusapia Palladino (1854-1918), who greatly influenced Lombroso's beliefs. Lombroso illustrates neglected theoretical ideas combining the interaction of pathology and what seem to be real psychic phenomena that have not received much attention in historical studies.

Joseph Maxwell on mediumistic personifications.

The study of mediumship received much impetus from the work of psychical researchers. This included ideas about the phenomena of personation, or changes in attitudes, dispositions and behaviours shown by some mediums that supposedly indicated discarnate action. The aim of this Classic Text is to reprint passages about this topic from the writings of French psychical researcher Joseph Maxwell (1858-1938), which were part of the contributions of some psychical researchers to reconceptualize the manifestations in psychological terms. Maxwell suggested these changes in mediums were a production of their subconscious mind. His ideas are a reflection of previous theorization about secondary personalities and a particular example of the contributions of psychical researchers to understand the psychology of mediumship.

'Report of the Committee on Mediumistic Phenomena', by William James (1886): With an introduction by.

Mediumship was a topic of great interest to some nineteenth-century students of mental phenomena. Together with the phenomena of hypnosis and other manifestations, mediumship was seen by many as a dissociative phenomenon. The purpose of this Classic Text is to present an excerpt of an article about the topic that William James (1842-1910) published in 1886 in the Proceedings of the American Society for Psychical Research about American medium Leonora E. Piper (1857-1950). The article, an indication of late nineteenth-century interactions between dissociation studies and psychical research, was the first report of research with Mrs Piper, a widely investigated medium of great importance for the development of mediumship studies. In addition to studying the case as a dissociative experience, James explored the possibility that Piper's mentation contained verifiable information suggestive of 'supernormal' knowledge. Consequently, James provides an example of a topic neglected in historical studies, the ideas of those who combined conventional dissociation studies with psychical research.

'Visions of the Dying', by James H Hyslop (1907): With an introduction by.

Deathbed visions have been of interest to psychical researchers and others since the nineteenth century. This Classic Text presents a reprint of an article on 'Visions of the Dying' published in 1907 in the Journal of the American Society for Psychical Research by philosopher and psychical researcher James H. Hyslop (1854-1920). The article was Hyslop's attempt to define the topic as one belonging to the agenda of psychical research and to request additional cases for further study. An introduction to this Classic Text sets it in the context of previous writings on the subject, of Hyslop's psychical research work, and of his writings about deathbed visions after 1907.

Spiritist delusions and spiritism in the nosography of French psychiatry (1850-1950).

At the turn of the twentieth century there was a wave of delusions which had a direct link to spiritism in their form and content. These so-called spiritist or mediumistic delusions were the object of detailed study, and clinicians assigned them a place in nosography, especially in France. This work of classification was carried out as a function of the convictions and paradoxes that these delusions aroused; it also made it possible to question the relationship between pathology and belief. It is therefore important to emphasize certain ideological views of psychiatry on para-normality. We observed both a reductionist discourse concerning these domains, and at the same time their utilization in the construction of psychiatric knowledge.

Fenômenos psíquicos e o problema mente-corpo: notas históricas sobre uma tradição conceitual negligenciada / Psychic phenomena and the mind-body problem: historical notes on a neglected conceptual tradition

Embora exista uma longa tradição de discussões filosóficas e históricas sobre o problema mente-corpo, a maioria delas não menciona os fenômenos psíquicos como tendo implicações para esse tópico. Este artigo é uma revisão de escritos selecionados publicados na literatura dos séculos XIX e XX sobre o mesmerismo, o espiritualismo e a pesquisa psíquica cujos os autores discutiram sobre aparições, telepatia, clarividência, experiências fora do corpo e outros fenômenos parapsicológicos como evidência para a existência de um princípio separado do corpo e responsável pela consciência. Os autores discutidos são de diferentes períodos de tempo. Entre eles estão John Beloff, J. C. Colquhoun, Camille Flammarion, J. H. Jung-Stilling, Frederic W. H. Myers e J. B. Rhine. Mais do que defender a validade de sua posição, minha proposta é documentar a existência de uma tradição intelectual e conceitual que tem sido negligenciada por filósofos, entre outros, nas discussões sobre o problema mente-corpo e aspectos de sua história.

Although there is a long tradition of philosophical and historical discussions of the mind-body problem most of them make no mention of psychic phenomena as having implications for such an issue. This article is an overview of selected writings published in the XIX and XX centuries literatures of mesmerism, spiritualism, and psychical research whose authors have discussed apparitions, telepathy, clairvoyance, out-of-body experiences and other parapsychological phenomena as evidence for the existence of a principle separate from the body and responsible for consciousness. Some writers discussed here include individuals from different time periods. Among them are John Beloff, J. C. Colquhoun, Camille Flammarion, J. H. Jung-Stilling, Frederic W. H. Myers, and J. B. Rhine. Rather than defend the validity of their position, my purpose is to document the existence of an intellectual and conceptual tradition that has been neglected by philosophers and others in their discussions of the mind-body problem and aspects of its history.

Bexarotene is active against subcutaneous panniculitis-like T-cell lymphoma in adult and pediatric populations.

INTRODUCTION: Subcutaneous panniculitis-like T-cell lymphoma (SPTL-AB) and cutaneous gamma/delta T-cell lymphoma (CGD-TCL) are rare T-cell lymphomas with varying clinical courses. There is no standard treatment, although chemotherapy and hematopoietic stem cell transplantation are commonly used. We describe results using bexarotene for children and adults with these disorders. METHODS: We identified 15 patients (12 adults, 3 children) who were treated with bexarotene between 2000 and 2010 from the Memorial Sloan-Kettering Cancer Center lymphoma database, the Stanford Cancer Center Registry, and the National Cancer Institute (NCI) pediatric lymphoma database. There were 8 females and 7 males, with a median age of 45 years (range, 3 years to 85 years). All patients had stage IV disease. Two of 15 and 4 of 15 patients had documented CGD-TCL and SPTL-AB, respectively; others were presumed to have SPTL-AB. Bexarotene was administered at flat doses corresponding to 91 to 339 mg/m(2)/d. Two of 15 patients received concurrent denileukin diftitox. Two children received bexarotene as maintenance therapy and were not evaluable for response. RESULTS: Among those treated with bexarotene alone, the overall response rate (ORR) was 82% (6/11 complete response [CR], 3/11 partial response [PR]). One of the 2 patients treated with concomitant denileukin diftitox responded for an ORR of 10/13 (77%), including 54% CR and 23% PR. Median progression-free survival was 38.4 months; median duration of response was 26.3 months. Six patients developed hypothyroidism and 9 developed hyperlipidemia; one patient developed dose-limiting hypertriglyceridemia. One pediatric patient developed insulin-dependent diabetes mellitus. CONCLUSIONS: In this retrospective series, bexarotene showed a high response rate in SPTL-AB and CGD-TCL. It was generally well-tolerated with durable responses; therefore, bexarotene represents a promising therapy for children and adults with these disorders.

Expression and functional role of inhibitor-of-apoptosis protein livin (BIRC7) in neuroblastoma.

We evaluated the expression of the inhibitor-of-apoptosis protein (IAP)livin (BIRC7)in 59 cases ofneuroblastoma (NBL) by quantitative RT-PCR. We also examined the role of livin in protecting tumor cells from chemotherapy drugs. Livin expression varied significantly amongtumors. High levels of expression were observed in 17 of 39 patients with advanced stages (stages 3 and 4) and 6 of 20 patients with localized stages (stages 1 and 2). Livin-transfected, MYCN-amplified NBL cells showed increased resistance to doxorubicin and etoposide. Conversely, livin knockdown with siRNA enhanced spontaneous and drug-induced apoptosis in NBL cells. Multivariate analysis of prognostic factors showed that high livin expression worsened prognosis for patients with MYCN-amplified tumors. Our data suggest that (i) livin is frequently expressed in NBL and protects tumor cells with amplified MYCN oncogene from genotoxic agents; (ii) the antiapoptotic effect of livin in NBL is blocked by siRNA; (iii) in the sample studied, high livin expression enhanced the adverse prognostic impact of MYCN amplification. These findings suggest that livin may contribute to drug resistance in NBL.

Out-of-body experiences and physical body activity and posture: responses from a survey conducted in Scotland.

Although there have been studies of some factors related to the features of out-of-body experiences (OBEs), the effect of physical body posture and activity has not been systematically explored. Over the years research has suggested that OBEs are more frequent in states of low physical activity and when the body is supine, in agreement with other findings related to alterations in consciousness. Thus, we predicted that OBEs would be associated with lying down and little or no physical activity, and that these factors would show a higher number of OBE features than OBEs in which the person was physically active and/or standing. OBE cases were collected through appeals in published sources. Respondents provided a description of their only or most recent OBE and filled out a questionnaire about OBE features. The findings indicate that OBEs were associated with low physical activity and being in a supine position. Those who had experiences under these conditions also obtained a higher number of OBE features than those who were active and standing at the time of the OBE.

PHA665752, a small-molecule inhibitor of c-Met, inhibits hepatocyte growth factor-stimulated migration and proliferation of c-Met-positive neuroblastoma cells.

BACKGROUND: c-Met is a tyrosine kinase receptor for hepatocyte growth factor/scatter factor (HGF/SF), and both c-Met and its ligand are expressed in a variety of tissues. C-Met/HGF/SF signaling is essential for normal embryogenesis, organogenesis, and tissue regeneration. Abnormal c-Met/HGF/SF signaling has been demonstrated in different tumors and linked to aggressive and metastatic tumor phenotypes. In vitro and in vivo studies have demonstrated inhibition of c-Met/HGF/SF signaling by the small-molecule inhibitor PHA665752. This study investigated c-Met and HGF expression in two neuroblastoma (NBL) cell lines and tumor tissue from patients with NBL, as well as the effects of PHA665752 on growth and motility of NBL cell lines. The effect of the tumor suppressor protein PTEN on migration and proliferation of tumor cells treated with PHA665752 was also evaluated. METHODS: Expression of c-Met and HGF in NBL cell lines SH-EP and SH-SY5Y and primary tumor tissue was assessed by immunohistochemistry and quantitative RT-PCR. The effect of PHA665752 on c-Met/HGF signaling involved in NBL cell proliferation and migration was evaluated in c-Met-positive cells and c-Met-transfected cells. The transwell chemotaxis assay and the MTT assay were used to measure migration and proliferation/cell-survival of tumor cells, respectively. The PPAR-gamma agonist rosiglitazone was used to assess the effect of PTEN on PHA665752-induced inhibition of NBL cell proliferation/cell-survival and migration RESULTS: High c-Met expression was detected in SH-EP cells and primary tumors from patients with advanced-stage disease. C-Met/HGF signaling induced both migration and proliferation of SH-EP cells. Migration and proliferation/cell-survival were inhibited by PHA665752 in a dose-dependent manner. We also found that induced overexpression of PTEN following treatment with rosiglitazone significantly enhanced the inhibitory effect of PHA665752 on NBL-cell migration and proliferation. CONCLUSION: c-Met is highly expressed in most tumors from patients with advanced-stage, metastatic NBL. Furthermore, using the NBL cell line SH-EP as a model, PHA665752 was shown to inhibit cMet/HGF/SF signaling in vitro, suggesting c-Met inhibitors may have efficacy for blocking local progression and/or metastatic spread of c-Met-positive NBL in vivo. These are novel findings for this disease and suggest that further studies of agents targeting the c-Met/HGF axis in NBL are warranted.

Ambroise August Liébeault and psychic phenomena.

Some nineteenth-century hypnosis researchers did not limit their interest to the study of the conventional psychological and behavioral aspects of hypnosis, but also studied and wrote about psychic phenomena such as mental suggestion and clairvoyance. One example, and the topic of this paper, was French physician Ambroise August Liébeault (1823-1904), who influenced the Nancy school of hypnosis. Liébeault wrote about mental suggestion, clairvoyance, mediumship, and even so-called poltergeists. Some of his writings provide conventional explanations of the phenomena. Still of interest today, Liébeault's writings about psychic phenomena illustrate the overlap that existed during the nineteenth-century between hypnosis and psychic phenomena--an overlap related to the potentials of the mind and its subconscious activity.

Late 19th- and early 20th-century discussions of animal magnetism.

The mesmerists explained the phenomena of what was later called hypnosis as the effects of a force called animal magnetism. Both psychologists' and physicians' writings generally create the impression that the magnetic movement disappeared after the mid-19th century. While the concept of animal magnetism declined significantly by the end of the 19th century, it did not disappear completely. Some examples include the work of Hector Durville, Henri Durville, Emile Magnin, and Edmund Shaftesbury. Detailed accounts of the work of Edmund Gurney and Albert de Rochas are presented. Similar to its earlier counterpart, the late mesmeric movement was associated with what today is known as parapsychological phenomena. This association, and the belief that the demise of magnetic theory represents scientific progress, has led many to emphasize a history that is incomplete.

Anaplastic large cell neuroblastoma.

Anaplastic large cell neuroblastomas (ALCNB) are a subset of undifferentiated neuroblastomas with marked pleomorphic and anaplastic features that render them diagnostically challenging. We reviewed the records of all patients diagnosed with ALCNB at Children's Healthcare of Atlanta (Egleston Children's Hospital) for their clinical, biologic, and pathologic characteristics and their treatment outcomes. From 1998 to 2006, 7 patients were diagnosed with ALCNB. All patients presented with abdominal-pelvic masses, 3 of them of adrenal origin and 2 with thoracic extension, with clinical stages 3 or 4, and were considered to have high-risk disease. The N-MYC oncogene was amplified in 3 cases and catecholamines were elevated in 5 of 6 patients tested. All pretreatment tumors demonstrate pleomorphic, anaplastic morphology with bizarre mitoses admixed with undifferentiated but monomorphic cells with minimal if any neuropil or neuro-ganglionic differentiation. Immunohistochemical markers for neuron specific enolase (NSE) and synaptophysin were strongly positive in all specimens and chromogranin in 4 of 5. Interestingly, all tumors showed strong Fli-1 nuclear positivity despite a negative CD-99 stain. However, reverse transcription polymerase chain reaction or fluorescent in-situ hybridization testing for Ewing sarcoma transcripts was negative in 4 available specimens. This same Fli-1 antibody had tested negative on 30 conventional neuroblastomas, indicating a peculiar cross reactivity with this subset of ALCNB. Posttreatment biopsies showed maturation changes to more conventional neuroblastoma histology in 5 of the 7 cases. Follow-up ranged from 9 months to 4 years from diagnosis (median: 25 months). Five patients are still alive after treatment, 1 died 9 months after diagnosis, and another patient refused high-risk therapy and progressed and died 9 months from diagnosis. Anaplastic large cell neuroblastomas are a subset of undifferentiated neuroblastomas characterized by the absence or marked paucity of histologic clues for the diagnosis of neuroblastoma. Although all these tumors are strongly positive for NSE and synaptophysin, they also show Fli-1 positivity. However, they are negative by molecular testing for EWS transcripts, and they are immunohistochemically negative for CD99. The true neuroblastic nature of these tumors is supported by the N-MYC oncogene amplification in some of them, catecholamine production, immunohistological reactivity, and their posttherapy maturation to a more recognizable neuroblastic morphology. Although follow-up is still somewhat limited, the response and survival of the patients in our institution is better than a previous European study that indicated an aggressive clinical behavior of these tumors, although treatment modalities were not described in that report. Further study of this variant of neuroblastoma with more patients is required to determine optimal therapy, more accurately predict outcome, and to ascertain if ALCNB are a distinct biologic group of neuroblastomas.

Note on online books and articles about the history of dissociation.

Students of the history of dissociation will be interested in the materials on the subject available in the digital document database Google Book Search. This includes a variety of books and journals covering automatic writing, hypnosis, mediumship, multiple personality, trance, somnambulism, and other topics. Among the authors represented in the database are: Eugène Azam, Alfred Binet, James Braid, Jean-Martin Charcot, Pierre Janet, Frederic W.H. Myers, Morton Prince, and Boris Sidis, among others. The database includes examples of case reports, conceptual discussions, and psychiatric and psychological textbook literature.