Evaluación de la efectividad de la timectomía como tratamiento de la Miastenia Gravis

Objetivo: evaluar efectividad de timectomía como alternativa de tratamiento a la Miastenia Gravis (MG) en nuestro centro, entre 2007 y 2019, y cómo ha impactado en calidad de vida y manejo farmacológico. Material y Método: cohorte retrospectiva de pacientes sometidas a timectomía por equipo Cirugía Torácica del Hospital Gustavo Fricke (HGF) entre 2007 y 2019. Las variables fueron el tratamiento médico y dosis de anticolinesterásicos pre y post timectomía, y la calidad de vida medida a través de la encuesta MG-QOL15. Se utilizaron medidas de desviación estándar y comparaciones estadísticas para el análisis de estas variables, considerando estadísticamente significativo un p < 0,05. Resultados: total de 20 pacientes, mayoría mujeres jóvenes, timectomía vía transesternal. Dosis de anticolinesterásicos mostró disminución estadísticamente significativa de 5,05 a 3,06 pre y post timectomía respectivamente (p < 0,05). Encuesta MG-QOL15 media de 11,9 puntos. Discusión: Se ha demostrado que la timectomía cumple un rol importante en el manejo de la MG, otorgando una superioridad frente al tratamiento médico exclusivo. La Fundación Americana para Miastenia Gravis, recomienda el uso de la encuesta MG-QOL15 como herramienta para evaluar la calidad de vida. Existe poca literatura nacional en relación a este tema. Conclusión: La timectomía, es un procedimiento que mejora la calidad de vida de los pacientes con MG y permite reducir en forma significativa la dosis de fármacos utilizados.

Objective: To evaluate effectivity of thymectomy as an alternative treatment of MG in our center, between 2007 and 2019 and to know how it has impacted in life quality and pharmacological management. Material and Method: cohort study patients treated with thymectomy by Thoracic Surgical team from Gustavo Fricke Hospital between 2007 and 2019. The study variables were medical treatment and anticholinesterases doses before and after the thymectomy, and life quality measured through MG-QOL15 survey. Standard deviation measures and statistics comparisons were used for the analysis of these variables, considering statistically significant a p < 0.05. Results: total of 20 patients, mainly young women, thymectomy through a Trans-sternal approach. Anticholinesterase doses, showed a statistically significant decrease from 5.05 to 3.06 before and after thymectomy (p < 0.05). Discussion: It has been demonstrated that thymectomy plays an important role on the management of MG, giving a mastery against medical exclusive treatment, The American Foundation for Myasthenia Gravis recommends the use of MG-QOL15 survey as an important tool to evaluate life quality. There is a limited amount of national literature related to this topic. Conclusion: Thymectomy is a life quality changing procedure for MG patients and it helps to significantly reduce the drug doses used.

[Obstacles and enablers for the use of barrier methods to avoid HIV/AIDS transmission]. / Obstáculos y facilitadores para el uso de métodos de barrera para la transmisión de VIH/SIDA.

BACKGROUND: There is an increase in HIV/AIDS transmission rates world-wide Aim: To explore obstacles and facilitators in the use of barrier methods for the prevention of HIV/AIDS among Chilean young people between 20 and 29 years of age. MATERIAL AND METHODS: During the second semester of the year 2020, 134 young Chileans answered an online questionnaire with open-ended questions about barrier methods. A qualitative methodology that considered the main techniques of grounded theory for data analysis was used. RESULTS: There are individual, interpersonal, sociocultural, and structural factors that operate as obstacles and facilitators for the use of barrier methods to prevent the transmission of HIV/AIDS. CONCLUSIONS: There are culturally embedded beliefs among young people, such as, a perception of invulnerability caused by not being part of risk groups, among others, that affect self-care.

Obstáculos y facilitadores para el uso de métodos de barrera para la transmisión de VIH/SIDA / Obstacles and enablers for the use of barrier methods to avoid HIV/AIDS transmission

BACKGROUND: There is an increase in HIV/AIDS transmission rates world-wide Aim: To explore obstacles and facilitators in the use of barrier methods for the prevention of HIV/AIDS among Chilean young people between 20 and 29 years of age. MATERIAL AND METHODS: During the second semester of the year 2020, 134 young Chileans answered an online questionnaire with open-ended questions about barrier methods. A qualitative methodology that considered the main techniques of grounded theory for data analysis was used. Results: There are individual, interpersonal, sociocultural, and structural factors that operate as obstacles and facilitators for the use of barrier methods to prevent the transmission of HIV/AIDS. CONCLUSIONS: There are culturally embedded beliefs among young people, such as, a perception of invulnerability caused by not being part of risk groups, among others, that affect self-care.

Brain-Computer Interfaces for upper limb motor rehabilitation of stroke patients / Interfaces Cerebro-Computadora para la Rehabilitación Motora de Miembro Superior de Pacientes con Enfermedad Vascular Cerebral

Abstract Brain-Computer Interfaces (BCI) decode users' intentions from the central nervous system and could be applied for upper limb motor rehabilitation of patients that have suffered stroke, one of the main causes of disability worldwide. Despite that research groups have reported the efficacy of these systems, a consensus has not yet been reached regarding their true potential. For this reason, a review of up-to-date assessments of BCI for upper limb stroke rehabilitation is presented from the perspective of analyzing common and different design variables presented across studies. Clinical and pilot studies with a control group were included in the review. Most BCI interventions assessments were performed with robotic assistive devices as feedback, followed by neuromuscular electrical stimulation (NMES) and visual feedbacks. Compared to other experimental interventions, the effects of a BCI intervention have been reported in a low number of patients. In addition, high variability between studies' designs such as stroke etiology and interventions' duration, do not allow to assess the potential of BCI for stroke rehabilitation. However, a trend towards significant rehabilitation outcomes with BCI systems can be highlighted, encouraging research groups to better coordinate in order to make valuable contributions to the field.

Resumen Las interfaces cerebro-computadora (BCI) decodifican del sistema nervioso central las intenciones de los usuarios, y pueden ser aplicadas para la rehabilitación motora del miembro superior de pacientes con enfermedad vascular cerebral (EVC), una de las principales causas de discapacidad a nivel mundial. A pesar de que diversos grupos han reportado la eficacia de estos sistemas, no se ha logrado un consenso sobre su verdadero potencial. Por esta razón, una revisión de la evaluación reciente de las BCI para rehabilitación del miembro superior en la EVC es presentado desde la perspectiva de analizar diferencias y similitudes entre las variables reportadas en los estudios. En la esta revisión se incluyeron estudios clínicos y pilotos con un grupo control. La mayor parte de los estudios utilizaron sistemas robóticos como retroalimentación, seguido por estimulación eléctrica neuromuscular y retroalimentación visual. En comparación con otras terapias experimentales, los efectos de intervenciones con BCI se han reportado en pocos pacientes. Además, la alta variabilidad en el diseño de los estudios, como la etiología de la EVC y la duración de las intervenciones, no permiten comparar los efectos de las terapias BCI. Sin embargo, se puede resaltar una tendencia hacia recuperaciones motoras significativas con BCI, motivando a grupos de investigación a coordinarse de mejor forma para continuar realizando contribuciones al campo.

Motion deficit in nodal interphalangeal joint osteoarthritis by digital goniometer in housewives.

Range of motion (ROM) measured objectively in nodal hand osteoarthritis (NHOA) is missing. Evaluation of collateral ligaments by ultrasound (US) is unknown in NHOA also. To compare ROM in interphalangeal joints in housewives with nodal OA, with a control group by a digital system using angle to voltage (Multielgon). The second objective was to assess correlation between collateral radial and ulnar ligaments thickness and ROM. For this cross-sectional observational study, we assessed 60 hands with symptomatic NHOA and 30 hands of healthy housewives matched for age. We obtained clinical and demographic characteristics (a complete standardized physical examination of hand joints, DASH questionnaire, pain surveys, gross grasp hand goniometer, and ROM measurements by Multielgon. Presence of synovitis, power Doppler signal, osteophytes, and collateral ligaments thickness was evaluated by US. We used descriptive statistics, Spearman correlation, X2 test, t test and odds ratio. Significant less gross grasp and ROM in the right hand were observed in NHOA (p = 0.01 for both). Presence of OA, painful joints, disease duration, and score DASH were significant correlated with reduced ROM (OR 4.12, 4.12, 1.04 and 1.09, respectively). Reduced ROM was statistical significant in thumb MCP and IP joints, second and third DIP in dominant hand. There was no association between collateral radial and ulnar ligaments and reduced ROM. Synovitis and osteophytes were more prevalent in OA group. Multielgon demonstrated the pattern of reduced ROM in nodal OA of housewives particularly in MCP and IP thumb joints, second and third distal interphalangeal joints.

Sensor fault detection and isolation system for a condensation process.

This article presents the design of a sensor Fault Detection and Isolation (FDI) system for a condensation process based on a nonlinear model. The condenser is modeled by dynamic and thermodynamic equations. For this work, the dynamic equations are described by three pairs of differential equations which represent the energy balance between the fluids. The thermodynamic equations consist in algebraic heat transfer equations and empirical equations, that allow for the estimation of heat transfer coefficients. The FDI system consists of a bank of two nonlinear high-gain observers, in order to detect, estimate and to isolate the fault in any of both outlet temperature sensors. The main contributions of this work were the experimental validation of the condenser nonlinear model and the FDI system.

Ectopia testicular cruzada unilateral: presentación de un caso clínico y revisión bibliográfica / Unilateral crossed testicular ectopia: case report and literature review

INTRODUCCIÓN: Es una patología infrecuente del descenso testicular, a la fecha en la literatura sólo se han reportado aproximadamente 100 casos. Afecta por lo general a varones de 1-2 años de edad. El diagnóstico en adultos es sumamente raro. OBJETIVO: Describir las características clínicas de un caso de ectopia testicular cruzada unilateral. CASO CLÍNICO: Paciente varón de 35 años de edad, consulta por tumoración en región inguinal izquierda de un 1 año de evolución, que desaparece al decúbito dorsal y aumenta de tamaño con el esfuerzo (estornudo y defecación). Niega dolor, edema, detención de heces y gases. Al examen físico de la región inguinal de pie se aprecia una tumoración de forma ovoidea, asimétrica desde anillo superficial hasta las bolsas escrotales del mismo lado; en decúbito dorsal se aprecia una tumoración de forma ovoidea, blanda, renitente, reductible e incoercible, por arriba del ligamento de Poupart y desde el orificio inguinal profundo-externo, se palpa testículo y epidídimo de forma y tamaño normal, RHA (+), transiluminación (-). La impresión diagnóstica indica hernia inguinal indirecta. Durante la disección y reparo del cordón se constata la presencia del doble paquete vascular correspondiente a ambos testículos exteriorizados a través del orificio inguinal profundo izquierdo. DISCUSIÓN: Esta rara patología es diagnosticada de forma casual en la mayoría de los casos, como hallazgo operatorio en pacientes diagnosticados de hernia inguinal o criptorquidia.

INTRODUCTION: It is a rare pathology of testicular descent, to the date the literature has reported only a hundred cases. Usually it affects boys between 1-2 years old. The diagnosis in adults is extremely rare. OBJECTIVE: To describe the clinical features of a case of Crossed testicular ectopia. CASE REPORT: Male, 35 years old, consulted for a lump of one year of evolution in inguinal region, that supine disappears and increases in size with the effort (sneeze and defecation). He denies pain, edema, detention of feces and gases. Physical examination of the inguinal region stand a tumor seen ovoid, asymmetrical from superficial ring to the scrotal sacs on the same side; supine a tumor seen ovoid, soft, renitente, reducible and intractable, above the ligament of Poupart and from deep-external inguinal ring, testis and epididymis of normal shape and size, bowel sounds (+), transillumination(-). Indirect inguinal hernia was diagnosed. During dissection and repair of the cord the presence of the double vascular bundle corresponding to both externalized testicles through the left inguinal deep hole is found. DISCUSSION: This rare disease, in most cases the diagnosis is casual, as surgical finding in patients diagnosed with inguinal hernia or cryptorchidism

Better quality of mother-child interaction at 4 years of age decreases emotional overeating in IUGR girls.

BACKGROUND/OBJECTIVES: While most "fetal programming" area focused on metabolic disease, intrauterine growth restriction (IUGR) is also associated with a preference for less healthy food. Post-natal factors such as strained maternal-child interactions are equally related to obesogenic eating behaviors. We investigated if IUGR and the quality of the mother/child relationship affect emotional overeating in children. SUBJECTS/METHODS: Participants were 196 children from a prospective birth cohort (the MAVAN project). As part of the protocol at 4 years of age, mothers completed the Children Eating Behavior Questionnaire (CEBQ) and mother-child interactions were scored during a structured task. A GLM adjusted for BMI examined the interaction between the "Atmosphere" score (ATM) task, sex and IUGR on the emotional over-eating domain of the CEBQ. RESULTS: There was a significant interaction of BWR vs. sex vs. ATM (P = .02), with no effects of IUGR, sex or ATM. The model was significant for girls with low ATM scores (B = -2.035, P = .014), but not for girls with high (P = 0.94) or boys with high (P = .27) or low (P = .19) ATM scores. Only in IUGR girls, 48 months emotional over-eating correlated with BMI at that age (r = 0.560, P = 0.013) and predicted BMI in the subsequent years (r = 0.654, P = 0.006 at 60 months and r = 0.750, P = 0.005 at 72 months). CONCLUSIONS: IUGR and exposure to a negative emotional atmosphere during maternal-child interactions predicted emotional overeating in girls but not in boys. The quality of mother-infant interaction may be an important target for interventions to prevent emotional overeating and overweight in early development, particularly in girls with a history of IUGR.

Análisis del tipo de publicación y áreas del conocimiento de Enfermería en la evaluación interna de la Revista Enfermería Universitaria 2007-2011 / Publication type and nursing knowledge areas analysis as part of the internal assessment of Enfermería Universitaria Journal, 2007-2011

Introducción: Analizar las publicaciones de una disciplina determinada permite evaluar su avance o consolidación en la construcción del conocimiento, identificar las áreas de interés de los propios investigadores y aquellas que requieren de fomento. Objetivo: Analizar el tipo de artículo y áreas del conocimiento en los artículos publicados en la revista enfermería universitaria en el periodo 2007-2011. Material y métodos: el diseño metodológico fue de corte cuantitativo, transversal, descriptivo. Se evaluó el tipo de artículos publicados y las áreas del conocimiento de Enfermería. La muestra de estudio fue el total de artículos publicados durante los años 2007 a 2011. Resultados: Respecto al tipo de artículos producidos: el 45.9% fueron de investigación, 21.8% de innovación para la práctica, 8.3% de revisión y 7.5% de docencia. En cuanto a las áreas de conocimiento se publicaron en mayor medida artículos de aspectos metodológicos, relacionados con la enseñanza-aprendizaje y con la administración-gestión. Conclusiones: el predominio, en cuanto a tipo, de artículos de investigación pudiera considerarse un avance en esta área, aunque es preciso continuar mejorando este indicador. Además se requiere apoyar a profesionales de Enfermería del área clínico-asistencial para que incursionen en la investigación y publicación de aspectos vinculados a su práctica cotidiana.

Introduction: Analyzing a determined discipline's publications allows an assessment of its development or consolidation towards knowledge construction, and an identification of the researchers' areas of interest, as well as those which require further impulse. Objective: to analyze the study type and knowledge areas of the published articles of Enfermería Universitaria Journal during the period 2007-2011. Material and methods: the study was quantitative, transversal, and descriptive. The article type and nursing knowledge areas of the journal publications from 2007 to 2011 were assessed. Results: Regarding the study types, 45.9% were identified as research, 21.8% as practice innovation, 8.3% as revision, and 7.5% as academic. Regarding the areas of knowledge, most published articles were related to methodological, teaching-learning, and managerial aspects. Conclusions: An interesting finding was the proportion of research articles published. Moreover, supporting nursing professionals within the clinical-assistance areas to conduct and publish re-search studies related to their practices is also suggested.

Espondiloartropatía entérica: presentación de un caso / Enteric spondyloarthropathy: a case presentation

Seronegative arthropathies or spondyloarthropathy belong to a group of diseases that share clinical and genetic characteristics associated strongly with major histocompatibility complex class I HLA-B27. We report a case of a female patient of 39 years old with nightly back pain, morning stiffness and diffuse lumbar pain in the right buttock. In the immunological study observed negative rheumatoid factor and radiographic study observed right sacroiliitis. The final diagnosis is an enteric spondyloarthropathy...

Las artropatías seronegativas o espondiloartropatías corresponden a un grupo de enfermedades que comparten características clínicas y genéticas, asociadas fuertemente con el complejo mayor de histocompatibilidad clase I HLA-B27. Se presenta el caso de una paciente de 39 años con dolor lumbar nocturno, rigidez matutina lumbar y dolor difuso en la región glútea derecha.En el estudio inmunológico se observa factor reumatoídeo negativo, y al estudio radiológico se constata sacroileítis derecha. El diagnóstico final es una espondiloartropatía entérica...

Calidad de vida y orientación estratégica institucional. Una aproximación desde el modelo ¿Cómo está la vida? Para medir el bienestar y el progreso de la OCDE / Quality of life and institutional strategic orientation. An approach from the model "¿How's life?" To measure welfare and progress of the OECD / Qualidade de vida e estratégico corporativo. Uma abordagem do modelo de "¿Cómo é vida?" Medida de bem-estar e progresso da OECD

[{"text": "Los pueblos y sus gobiernos fortalecen gradualmente el consenso sobre la necesidad de construir socie\r\n-\r\ndades más justas y con mejores condiciones de bienestar y calidad de vida. Los planes de gobierno, antes \r\ncentrados fundamentalmente en estrategias de crecimiento económico, dan cada vez mayor relevancia al \r\navance en estos aspectos. Esta tendencia también permea hoy las dinámicas de los pequeños colectivos \r\n(organizaciones), las familias y los individuos. El interés antes central en la consolidación financiera de \r\nlas empresas, se acompaña hoy del compromiso con el fomento del bienestar y calidad de vida de sus \r\nmiembros. Como individuos, el interés por llevar vidas personales y familiares más balanceadas remplaza \r\npoco a poco el dominio del sueño de amasar grandes riquezas y patrimonios. Mayor bienestar y mejor \r\ncalidad de vida para todos son solo algunas de las formas en que expresamos ese objetivo que parece ser \r\ncada vez más compartido.\r\nFilósofos, sociólogos, economistas y pensadores de todas las ramas del saber han discutido activamente en \r\nlos últimos aÃ

Sensor fault detection and isolation via high-gain observers: application to a double-pipe heat exchanger.

This paper deals with fault detection and isolation (FDI) in sensors applied to a concentric-pipe counter-flow heat exchanger. The proposed FDI is based on the analytical redundancy implementing nonlinear high-gain observers which are used to generate residuals when a sensor fault is presented (as software sensors). By evaluating the generated residual, it is possible to switch between the sensor and the observer when a failure is detected. Experiments in a heat exchanger pilot validate the effectiveness of the approach. The FDI technique is easy to implement allowing the industries to have an excellent alternative tool to keep their heat transfer process under supervision. The main contribution of this work is based on a dynamic model with heat transfer coefficients which depend on temperature and flow used to estimate the output temperatures of a heat exchanger. This model provides a satisfactory approximation of the states of the heat exchanger in order to allow its implementation in a FDI system used to perform supervision tasks.

Conocimiento sobre enfermedad periodontal y práctica de hábitos de higiene oral de pacientes del Programa Nacional de Diabetes del Ministerio de Salud Pública y Bienestar Social - Año 2010 / Periodontal disease knowledge and practice of oral hygiene of patients in the Diabetes National Ministry of Health and Welfare - Year 2010

La diabetes es una enfermedad que afecta a millones de personas en el mundo, en Paraguay afecta al 6,5% de la población adulta dándose en estos la mayor susceptibilidad a infecciones. Su relación con la enfermedad periodontal ha sido ampliamente estudiada, se considera a la prevención como el mejor tratamiento y a la educación, como pilar de la misma. Con el objetivo de determinar el conocimiento sobre Enfermedad Periodontal de pacientes diabéticos que concurrieron al Programa Nacional de Diabetes del Ministerio de Salud Pública y Bienestar Social en el período comprendido entre los meses de setiembre a diciembre del 2010, se planteó la realización de un estudio observacional descriptivo de corte transversal, con componente analítico en 83 pacientes a los que se les aplicó un cuestionario autoadministrado, que además de los datos demográficos contenía preguntas sobre signos, síntomas de la enfermedad periodontal, y su relación con la diabetes, además de hábitos de higiene oral. Los datos fueron procesados y analizados utilizando estadística descriptiva mediante el programa informático Excel 2007. Para relacionar el conocimiento y práctica con sexo, edad y nivel educativo se utilizaron la prueba del Chi cuadrado y test exacto de Fischer. Se observó que la mayor parte de la población afectada era del sexo femenino; el 63 % de de los encuestados considera que existe relación entre la diabetes y la enfermedad periodontal, solo el 37% utiliza hilo dental como medio auxiliar de higiene y el 45% de los pacientes no acuden al odontólogo por alto costo del servicio. Se concluyó que el conocimiento y práctica de la población es insuficiente. Estos datos servirán de base para otros estudios y para la promoción de un programa de salud oral en estos pacientes .

Field Evaluations of Leaf Spot Resistance and Yield in Peanut Genotypes in the United States and Bolivia.

Field experiments were conducted in 2002 to 2006 to characterize yield potential and disease resistance in the Bolivian landrace peanut (Arachis hypogaea) cv. Bayo Grande, and breeding lines developed from crosses of Bayo Grande and U.S. cv. Florida MDR-98. Diseases of interest included early leaf spot, caused by the fungus Cercospora arachidicola, and late leaf spot, caused by the fungus Cercosporidium personatum. Bayo Grande, MDR-98, and three breeding lines, along with U.S. cvs. C-99R and Georgia Green, were included in split-plot field experiments in six locations across the United States and Bolivia. Whole-plot treatments consisted of two tebuconazole applications and a nontreated control. Genotypes were the subplot treatments. Area under the disease progress curve (AUDPC) for percent defoliation due to leaf spot was lower for Bayo Grande and all breeding lines than for Georgia Green at all U.S. locations across years. AUDPC for disease incidence from one U.S. location indicated similar results. Severity of leaf spot epidemics and relative effects of the genotypes were less consistent in the Bolivian experiments. In Bolivia, there were no indications of greater levels of disease resistance in any of the breeding lines than in Bayo Grande. In the United States, yields of Bayo Grande and the breeding lines were greater than those of the other genotypes in 1 of 2 years. In Bolivia, low disease intensity resulted in the highest yields in Georgia Green, while high disease intensity resulted in comparable yields among the breeding lines, MDR-98, and C-99R. Leaf spot suppression by tebuconazole was greater in Bolivia than in the United States. This result indicates a possible higher level of fungicide resistance in the U.S. population of leaf spot pathogens. Overall, data from this study suggest that Bayo Grande and the breeding lines may be desirable germplasm for U.S. and Bolivian breeding programs or production.

[Childhood epilepsy status in a university hospital: a descriptive study]. / Estado epiléptico infantil en unhospital universitario: estudio descriptivo.

INTRODUCTION: Epileptic status (ES) is a medical emergency with a high rate of morbidity and mortality. AIM. To produce a retrospective description of the ES that are seen in the paediatric population attended in our centre. PATIENTS AND METHODS: We surveyed the records of 41 patients who presented ES and were controlled in the child neurology department between December 1999 and June 2007. Depending on the type of seizures, the cases were classified as either convulsive ES (CES) or non-convulsive ES (NCES). They were divided into categories according their causation using the modified Hauser classification. Newborn infants were excluded. RESULTS: A total of 41 patients were analysed, 25 (60%) of whom were males. The mean age was 32 months. Fifty-one per cent of cases were CES and 49% were NCES. Acute symptomatic ES (ASES) was the most frequent, especially in those under 2 years of age. ES recurrence was found to be 42% and ASES stood out as the least recurrent. The mortality rate was 2%. CONCLUSIONS: There was no difference in the number of cases between CES and NCES, probably due to the use of continual electroencephalogram monitoring in hospitalised patients with impaired consciousness. Hypoxic-ischaemic events were the chief cause of ASES, and malformations of the central nervous system prevailed in those of a remote aetiology. The rate of recurrence was high and in such cases patients must be submitted to a strict follow-up, especially those with an underlying condition.

Priapismo: enfoque actual y manejo / Priapism: current approach and management

El priapismo es una erección anormal y persistente del pene, dolorosa e involuntaria, sin relación con estímulos sexuales y que no se alivia con la descarga de catecolaminas después del orgasmo. Según su mecanismo fisiopatológico se reconoce un priapismo isquémico o de bajo flujo y uno no isquémico o de alto flujo. Es muy importante diferenciarlos, ya que tienen causas y tratamientos distintos. El priapismo isquémico es una urgencia que debe ser resuelta a la brevedad. Su tratamiento debe ser secuencial, siguiendo un algoritmo y tratando de evitar acciones que aumenten el riesgo de una disfunción eréctil iatrogénica posterior. El priapismo de alto flujo no es una urgencia médica, por lo que su manejo inicial debe ser expectante. A pesar de ser poco frecuente, el priapismo debe ser conocido por el mÚdico general, quien debe ser capaz de diferenciar los casos isquémicos de los no isquémicos y de tratarlos de manera de evitar secuelas y disfunciones sexuales posteriores. Se propone un algoritmo de acuerdo a las recomendaciones de la Asociación Americana de Urología. En él se establecen las medidas a tomar en un orden secuencial que va aumentando en complejidad y el empleo de procedimientos invasivos.

Clinical and cerebral blood flow changes in catatonic patients treated with ECT.

OBJECTIVE: To determine changes in clinical manifestations and cerebral blood flow (CBF) before and after administration of ECT to patients with catatonia due to schizophrenia or mood disorders. METHODS: A sample of nine patients who met DSM-IV criteria for catatonia was studied. Patients received between 5 and 15 sessions (thrice per week) of ECT. Severity of catatonia was measured with the Modified Rogers Scale (MRS). Changes in CBF were measured with a brain single positron emission computer tomography (SPECT) that was performed 1 week before the first ECT and 1 week after the last ECT. RESULTS: Catatonia was due to schizophrenia in five patients and mood disorders in four patients. There were no significant clinical and brain SPECT differences between these two groups before treatment. Pre- vs. post-ECT comparisons showed significant reduction of catatonic symptoms in both groups. However, patients with mood disorders needed less ECT sessions and showed greater clinical improvement. Brain SPECT showed significant increase in CBF in parietal, temporal, and occipital regions in patients with mood disorder and no significant changes in patients with schizophrenia. CONCLUSIONS: These results support the efficacy of ECT for treatment of catatonic patients, especially secondary to mood disorders, which seem to be correlated with improvements in CBF.