[The oncologic patient: nursing care based on physiopathologic knowledge]. / El paciente oncológico: atención de enfermería basada en los conocimientos fisiopatológicos.

The patient with cancer is affected both by the development of the neoplasia and by the toxic action of radiotherapy and chemotherapy, often used at aggressive therapeutic intervals to eradicate tumourous cells. The most serious physiological consequences are the occurrence of gaseous exchange within tissues, the risk of infection and haemorrhage, the change in levels of nutrition and evacuation, the deterioration in tissue structure and oral mucous and the change in sleeping patterns and sense of well-being. As far as psychological, social and emotional problems are concerned, the main difficulties which occur are a sense of anxiety and fear and a change in one's self-image. The present article explains what are the main factors involved in producing the changes in the situations mentioned above and the physiopathological mechanisms underlying them, an understanding of which is essential both to prevent them from occurring and to provide the proper nursing care. Finally, it explains what information should be given to a patient and/or his family in order to help him re-integrate back into his normal environment in periods of remission.

Role of sialic acid in acquired dysfibrinogenemia associated with liver cirrhosis.

The possible existence of acquired dysfibrinogenemia was investigated in blood samples from 30 patients with liver cirrhosis, 15 newborns and 30 healthy control subjects. Alterations of thrombin time were found in newborns and in 14 cirrhotic patients; glucide fraction levels were measured in these subjects and an increase in sialic acid content was observed. Its functional role was studied by comparing thrombin time and electrophoretic mobility of purified and desialylated forms of fibrinogen. We observed a thrombin time normalization, which was initially prolonged upon the removal of the sialic acid. The anodic electrophoretic mobility underwent changes due to the removal of sialic acid.

Fibrinogen Logroño. A new case of congenital dysfibrinogenemia.

An abnormal fibrinogen was discovered in a 9-year-old male subject without history of hemorrhagic diathesis. Coagulation time, prothrombin time and Reptilase time were prolonged. The thrombin time was corrected using increasing concentrations of normal plasma and bovine thrombin; there was a partial correction at pH 6.5 and ionic strength 0.05. A study of the family showed that the mother and a brother of the propositus presented the same abnormalities. Analysis of the purified fibrinogen showed normal fibrinopeptide release and normal levels of sialic acid and hexosamines. However, coagulation index, polymerization of fibrin monomers, isoelectric point and sedimentation coefficient were abnormal. In view of the abnormalities described and by comparison with the data reported in the literature, we believe that this should be considered a new variant of the fibrinogen molecule and we have designated it 'fibrinogen Logroño'.

[Hormonal contraceptive therapy and thromboembolic disease]. / Terapéutica anticonceptiva hormonal y enfermedad tromboembólica.

A group of 55 patients with rheumatoid arthritis (RA) and 25 healthy persons is studied. In peripheral blood, the number of E rosettes is similar in both groups but in patients with RA who are not on steroid therapy, these is a decreased number of the absolute value of T lymphocytes. There is a positive correlation between quantitative cellular immunity and different biologic and clinical parameters.

PIP: Through a careful review of the published literature this document presents the most recent knowledge on the action of estrogens on the mechanism of blood coagulation. It now seems clear that oral contraceptives (OCs) cause an increase in the activity of platelet factor 3, and also an increase in platelet aggregation; at the same time coagulation is activated through decreased levels of antighrombin 3, resulting in a concentration of soluble fibrin fragments. Alteration of fibrinolysis is very possible, although the literature is contradictory on this point. Estrogens can also cause thrombotic accidents by alteration of the vascular walls, and by alteration of the lipid metabolism. According to different authors, the risk of thrombotic accident in OC users is greater than in nonusers. The risk greatly increases in smokers. It is possible that thrombotic risk can be decreased with the use of OCs with a lower estrogen content.