Entrenamiento de funciones ejecutivas en el trastorno por déficit de atención/hiperactividad / Executive function training in attention deficit hyperactivity disorder

Introducción. Las propuestas de tratamiento del trastorno por déficit de atención/hiperactividad (TDAH) son variadas; sin embargo, existe poca cantidad de material publicado para mejorar el rendimiento de los mecanismos atencionales, de control inhibitorio, de flexibilidad cognitiva y de memoria de trabajo en estos niños. Consideramos que la consolidación de un modelo de trabajo eficaz en el tratamiento de personas con TDAH requiere una comprensión exhaustiva de los síndromes que están involucrados en este déficit. Desarrollo. El presente trabajo, además de revisar las propuestas más relevantes y actualizadas dirigidas a mejorar la comprensión cognitiva del trastorno, hace referencia a tres síndromes neurobiológicos reconocidos dentro del TDAH, como el síndrome medial del cíngulo, el síndrome dorsolateral y el síndrome orbitofrontal. Conclusiones. Los avances en investigación neurocientífica y el diseño de materiales computarizados de tratamiento aportan datos muy valiosos que, sin duda, contribuyen a mejorar los resultados de las intervenciones psicopedagógicas y neuropsicológicas en el TDAH, puesto que nos brindan información relacionada con la ecuación temporoespacial (AU)

Introduction. A number of different treatments have been proposed to treat attention deficit hyperactivity disorder (ADHD), yet little material has been published in the literature to improve the performance of the mechanisms behind attention, inhibitory control, cognitive flexibility and working memory in these children. We think that a working model that is effective in the treatment of persons with ADHD can only be consolidated by means of a thorough understanding of the syndromes involved in this deficit. Development. In addition to reviewing the latest and most significant proposals aimed at improving the cognitive understanding of the disorder, this work also refers to three neurobiological syndromes that are recognised as forming part of ADHD, i.e. medial cingulate syndrome, dorsolateral syndrome and orbitofrontal syndrome. Conclusions. Advances in neuroscientific research and the design of computerised treatment materials offer extremely valuable data that will undoubtedly help to improve the results of psychopedagogical and neuropsychological interventions in ADHD, since they provide information about the temporal and spatial equation (AU)

[Metabolic risks in surgical hysteroscopy]. / Le risque métabolique de la chirurgie hystéroscopique.

Operative hysteroscopy is often carried out using glycine as an irrigant. This solution has interesting properties but also metabolic effects that are very well known by urologists. This study is concerned with the biological changes that have occurred after one hundred surgical hysteroscopies of which twenty nine were carried out using glycine. In hysteroscopy the significant variations are concerned with blood levels of protein, the haematocrit, changes in sodium levels and glycaemia. 44.9% of patients had changes greater than 5% as compared with the pre-operative levels. These changes concerned the haematocrit readings and in 57.1% the changes in protein in the blood and in sodium in 12%. The haematocrit changes, the protein changes and to a lesser degree the sodium changes could be correlated with one another but not with changes in glycine levels in the blood. Whatever the pathology inside the uterus, glycine went through in equal quantities. It was particularly significant when there was perforation of the uterus. It is linked to the glycine balance and to the length of time the operation had taken. When a mean quantity of fluid of 2.6 litres was used to irrigate, levels after the operation as compared with before the operation had multiplied 4.5 times. This corresponds to the dosage of glycine used. In five patients out of twenty nine post-operative quantities were 10 times those before operation. The consequences of these changes in glycine levels are variable and seem to be more significant in women who have never been pregnant or who are very heavy. Using vasoconstrictor agents does not alter these metabolic changes.

[Fibrinolytic activity in patients undergoing hepatic transplantation]. / Activité fibrinolytique chez les patients opérés pour transplantation hépatique.

Bleeding complications during liver transplantation have been attributed to accelerated fibrinolysis. In order to determine its cause, 11 adults (mean age: 38.9 +/- 13.2 yr) undergoing liver transplantation were studied. There were three groups of patients: cirrhosis (n = 4), fulminating hepatitis (n = 4) and one group including a primary biliary cirrhosis, a hepatic metastasis and a hepatoma. The following factors were studied in the immediate preoperative period, at different surgical times throughout the procedure and 2-3 h after the end of the abdominal sutures: platelet count, prothrombin concentration, fibrinogen, activated kephalin time, factors II, V, VII + X and VIIIc, antithrombin III, protein C, D-dimers, fibrinogen and fibrin degradation products (PDF), plasma plasminogen, tissue plasminogen activator (tPA) and the fast tPA inhibitor (PAi). Preoperatively, only the two patients with hepatic cancer had a normal haemostatic profile. Throughout the procedure, all patients had only moderate changes in platelets, coagulation factors and their inhibitors, and plasminogen, because platelet concentrates and fresh frozen plasma were transfused. Levels of tPA rose, becoming very high during the anhepatic period and just after graft reperfusion. An abrupt fall occurred at the end of surgery. There were important individual differences in tPA activity. PAi activity was low during the preanhepatic and anhepatic stages, rising rapidly after revascularization.(ABSTRACT TRUNCATED AT 250 WORDS)