[Eyelid approach and pediatric orbital tumors: indications and surgical technique. About three children]. / Voie trans-palpébrale et chirurgie des lésions intraorbitaires pédiatriques : indications et technique chirurgicale. À propos de trois enfants.

Interdisciplinary collaboration can offer unusual approaches for the treatment of orbital pathologies. The authors report their experience with the eyelid incision in treating three children with epidural orbitary hematoma, dermoid cyst of the upper outer quadrant and a dermoid cyst of the internal inferior quadrant. For all the children, removal was complete and cosmetic results satisfying. The authors discuss the indications and complications of this surgical approach.

[Communication skills and their influence on prevention strategies in workplace]. / Abilità comunicative e loro influenza sulle strategie di prevenzione nei luoghi di lavoro.

Communication is a process which enables groups and individuals to increase their control over determining health factors acting on people's lifestyles to promote health. Good communication is fundamental to the health sector in a globalized world, since it may influence national and local policies, health promotion campaigns and correct operational practices. Our study analyses four significant incidents related to instances of bad communication and covers questions which have produced rather incoherent results provoking unjustified alarm. It is therefore necessary to prescribe a way of approaching these issues which will firstly lead to a more careful analysis of the risk involved and therefore to make known correct public information. It is necessary to improve the skills of experts in prevention, to promote educational initiatives at school, universities and in workplaces always focussing more on interdisciplinarity and developing new ways of approaching problems concerning health and safety.

Estabilidad temporal de mepivacaína al 1.5% alcalinizada / Alkalinized 1.5% mepivacaine stability over time

Objetivos: Estudiar la estabilidad en el tiempo de la mepivacaína alcalinizada en cuanto a valores de pH y formación de precipitados, ya que apenas existe información en la literatura acerca de la estabilidad temporal de este anestésico, y la información disponible aconseja alcalinizarla justo antes de su empleo. Material y métodos: Fueron preparadas tres jeringas (A, B y C) de 20 mL conteniendo mepivacaína al 1.5%. La jeringa A fue utilizada como control de pH, y las jeringas B y C fueron alcalinizadas adicionando 2 mL de bicarbonato al 8.4%. Fue medido el pH y calculado el porcentaje de base libre asociado en cada jeringa previamente a la alcalinización y posteriormente cada 10 minutos hasta completar una hora, salvo para la jeringa C en los últimos 30 minutos, que permaneció cerrada como control de fuga de CO2. Las soluciones fueron inspeccionadas visualmente durante todo el procedimiento para identificar eventuales precipitados macroscópicos y, tras la hora de estudio, fueron filtradas para indagar sobre la formación de precipitados microscópicos. Tras el filtrado, el pH de cada solución anestésica fue medido de nuevo. Resultados: Tras la alcalinización de la mepivacaína al 1.5% se produjo un aumento inmediato y significativo de los valores de pH y del porcentaje calculado de base libre en las jeringas alcalinizadas B y C con respecto a la de control A, y en todas las jeringas el pH permaneció muy estable durante una hora. Además, a los 60 minutos apenas existieron diferencias entre los valores de pH de las jeringas B y C, lo que indica que no se produjo fuga significativa de CO2. En este tiempo no hubo sospecha de formación de precipitados por inspección visual, y las mínimas diferencias encontradas entre los pesos secos de los filtros indican que no hubo formación de precipitados significativa (…) (AU)

PurposeIt is recommended to alkalinize mepivacaine just before employing it. However, data regarding alkalinized mepivacain estability over time are very scarce. The aim of this work was to investigate for pH stability and precipitation of alkalinized mepivacaine. Materials and Methods: Three syringes (A, B, C) containing 20mL of 1.5% mepivacaine each one were prepared. Syringe A served as pH control, and syringes B and C were alkalinized by adding 2mL of8.4% sodium bicarbonate solution. pH was measured into each syringe before alkalinization and every ten minutes lasting for one hour after. Associated free base percentage was calculated, except for the last 30 minutes for syringe C, which remained closed to serve as CO2 leakage control. Solutions were examinated by naked eyes looking for macroscopic precipitates, filtered after the procedure and the filters were weighed in order to looking for microscopic precipitates. After filtration pH was again measured. Results: Alkalinization resulted in immediate and significant increases in pH values and associated free base percentage of syringes B and C compared to syringe A. After that and for one hour pH values remained very stable. Besides, pH values between syringes B and C were very similar at 60 minutes, indicating no-significative leakage of CO2. The procedure was completed without evidence of precipitation by visual inspection, and differences between dry filters weights were minimalindicating no significative formation of microprecipitates. Conclusions: 1.5% mepivacaine solutions can be alkalinized and stored at room temperature in closed syringes for at least one hour before administration. In our opinion previous alkalinizationis much more convenient to daily clinical practice that actual recommendation of alkalinization just before use (AU)

Topiramato y síndrome constitucional en pacientes oncológicos / Topiramate and constitutional syndrome in the oncological patients

IntroductionNeuropatic pain in cancer patients is a difficult problemwhich represents a difficult challenge, with good answer tothe antiepileptic drugs. Diverse studies exist that confirm thegood results associated to the use of topiramate in cancer patientswith neuropatic pain. The data demonstrate that antiepilepticdrugs can differ from substantially in their effects onweight. Approximately a fifth of patients treated with topiramateexperience anorexia and/or weight loss.Clinical casesThree oncologic patients in the reduction weight associatedto the topiramate use was lived like a physical and psychicnegative effect.ConclusionsTopiramate is an effective drug in the treatment of thepain neuropatic. The reduction in weight that is from its usecan be beneficial in patients with important overweight. Thiseffect could be a contraindication relative to its use in patientswith anorexic clinic, severe desnutrition and cancer patients.In these last ones, the appearance of this constitutionalsyndrome can entail an important increase of episodes of anxietyin the family and the own patient, as well as an excessof medical tests to discard a tumorlike progression(AU)

IntroducciónLos pacientes oncológicos pueden presentar dolor de tiponeuropático, el cual representa un reto difícil, con buenarespuesta a la medicación antiepiléptica. Existen diversos estudiosque confirman los buenos resultados asociados al usode topiramato en pacientes con cáncer y sintomatología neuropáticaacompañante. Las diferentes drogas antiepilépticasdifieren de forma sustancial en sus efectos sobre el peso corporal.El topiramato conlleva cuadros de anorexia y/o pérdidadel peso hasta en un 15% de los casos.Casos clínicosTres pacientes oncológicos en los que la pérdida de pesoasociada al empleo de topiramato fue vivida como un efectonegativo físico y psíquico, por temor a una posible recidivatumoral.ConclusionesTopiramato es un fármaco eficaz en el tratamiento del dolorde tipo neuropático. La pérdida de peso que resulta de suutilización puede ser beneficiosa en pacientes con sobrepesoimportante. Este efecto podría ser una contraindicación relativaa su uso en pacientes con clínica de anorexia, desnutriciónsevera y en pacientes oncológicos. En estos últimos, laaparición de este síndrome constitucional puede conllevar un importante aumento de episodios de ansiedad en la familia yel propio enfermo, así como un exceso de pruebas médicaspara descartar una progresión tumoral(AU)

Experiencia de siete años e indicadores de calidad en una unidad de cirugía mayor ambulatoria / Seven years experience and quality indicators in ambulatory surgery

La cirugía mayor ambulatoria ha experimentado un espectacular incremento en nuestro país en la última década. Su objetivo final es conseguir resultados equivalentes a la cirugía tradicional, con menores costes, y con un grado de satisfacción de los usuarios igual o mayor. MATERIAL Y METODOS: Estudio retrospectivo en una unidad de cirugía mayor ambulatoria tipo II. El período de estudio abarca a los años 1997-2003, recogiéndose los principales indicadores de calidad para este tipo de cirugía. El registro de la actividad quirúrgica se realiza de acuerdo al PLAN HP HISS integrado en la gestión de la lista de espera quirúrgica. RESULTADO: En el período de estudio se intervienen 50573 pacientes en la Unidad de cirugía. De ellos, de forma programada y con criterios de selección para cirugía mayor ambulatoria se realiza 27307 procedimientos. Los indicadores de calidad propuestos y sus resultados globales son: Índice de sustitución (53,99%), Índice de Ingresos (7,10%), Índice de Reingresos (0,86%), Consultas a Servicios de Urgencias sin ingreso (2,07%), Índice de Suspensión (8,01%). CONCLUSIONES: La implantación y asentamiento de nuestra unidad de cirugía ambulatoria ha sido progresiva. Actualmente más del 50% de las intervenciones programadas se realizan en régimen ambulatorio (índice de sustitución del 53,99%), sin embargo el índice de ingresos y suspensiones es demasiado elevado, debiendo dirigirse los planes de mejora de calidad de la unidad a estos índices (AU)

INTRODUCTION: Ambulatory surgery has experienced an enormous increase in Spain in the last decade. Its final goal is to achieve results equivalent to those obtained in traditional surgery, at lower costs and with the same or higher patients´level of satisfaction. MATERIAL AND METHODS: A retrospective study in ambulatory surgical type II Unit. The study period is from 1997 to 2003, when the main quality indicators for this kind of surgery were established. Surgical activity is registered according to HP HISS PLAN, which is included in the management of the surgical waiting list. RESULTS: During this period, a total of 50,573 patients were operated on in the Surgical Unit, 27,307 of which were schedule and operated on following the selection criteria for ambulatory surgery. These are the proposed quality indicators and the global results: substitution index (53.99%), admission index (7.10%), re-admission index (0.86%), Emergency Department consultations without hospital admission (2.07%); cancellation index (8.01%). CONCLUSIONS: The Ambulatory Surgical Unit has been progressively established. Currently more than 50% of the scheduled surgical operations are perfomed in an ambulatory regime (substitution index of 53,99%). However, admission index and cancellation index ae still too high, therefore quality improvement plant for this unit must contemplate these mentioned indexes as a main objective for improvement (AU)

[Clinical semiology associated with increased creatinine kinase in patients attending emergency department]. / Semiología clínica asociada al aumento de creatinquinasa en pacientes que acuden a servicios de urgencias.

INTRODUCTION: The prognosis of rhabdomyolysis is conditioned by the development of acute renal failure which depends of quick preventive measures. Rhabdomyolysis is diagnosed by measuring plasma creatinkinase and it is usually suspected by the presence of previous putative causal factors like traumatisms. Non traumatic rhabdomyolysis usually lacks of clinical relevant antecedents and the syndrome should be suspected by patient clinical symptomatology; unfortunately, this one has been scarcely studied. OBJECTIVES: To describe the semiology observed in patients experiencing non traumatic rhabdomyolysis and to identify which symptoms induced to the subject to go to the emergency room in order to facilitate the diagnostic procedure. PATIENTS AND METHODS: We studied the patients with non traumatic rhabdomyolysis (creatinkinase > 1,000 IU/l) which attended the emergency room in a one year period. We collected data regarding their clinical symptomatology as well as which of them was responsible of his/her coming to the emergency unit. Symptoms were classified in four groups: muscular, urinary, neurological and others. RESULTS: We evaluated 49 patients. The relative frequency of each kind of symptoms was the following: muscular 51%, urinary 18%, neurological 67%, and others 47%. The absolute frequency of the symptoms which caused the consultation were: muscular 16%, urinary 2%, neurological 48%, others 22%, muscular and neurological associated 6%, and neurological and other associated 6%. CONCLUSION: CK serum levels should be measured in all of the patients attending the emergency unit who exhibit some type of neurological manifestation.

Semiología clínica asociada al aumento de creatinquinasa en pacientes que acuden a servicios de urgencias / Clinical semiology associated with increased creatinkinase in patientts attending the emergency department

Introduction. The prognosis of rhabdomyolysis is conditioned by the development of acute renal failure which depends of quick preventive measures. Rhabdomyolysis is diagnosed by measuring plasma creatinkinase and it is usually suspected by the presence of previous putative causal factors like traumatisms. Non traumatic rhabdomyolysis usually lacks of clinical relevant antecedents and the syndrome should be suspected by patient clinical symptomatology; unfortunately, this one has been scarcely studied. Objectives. To describe the semiology observed in patients experiencing non traumatic rhabdomyolysis and to identify which symptoms induced to the subject to go to the emergency room in order to facilitate the diagnostic procedure. Patients and methods. We studied the patients with non traumatic rhabdomyolysis (creatinkinase >1,000 IU/l) which attended the emergency room in a one year period. We collected data regarding their clinical symptomatology as well as which of them was responsible of his/her coming to the emergency unit. Symptoms were classified in four groups: muscular, urinary, neurological and others. Results. We evaluated 49 patients. The relative frequency of each kind of symptoms was the following: muscular 51%, urinary 18%, neurological 67%, and others 47%. The absolute frequency of the symptoms which caused the consultation were: muscular 16%, urinary 2%, neurological 48%, others 22%, muscular and neurological associated 6%, and neurological and other associated 6%. Conclusion. CK serum levels should be measured in all of the patients attending the emergency unit who exhibit some type of neurological manifestation.(AU)

Introducción. El pronóstico de la rabdomiólisis depende del desarrollo de fracaso renal agudo, el cual depende a su vez de la rapidez en instaurar medidas preventivas. El diagnóstico de certeza de rabdomiólisis se basa en el hallazgo de cifras elevadas de creatinquinasa en plasma, y el de sospecha suele recaer en los antecedentes inmediatos, como traumatismos. Habitualmente las rabdomiólisis de origen no traumático carecen de un antecedente llamativo, y la sospecha debería recaer en la clínica que presenten los pacientes, pero ésta ha sido escasamente estudiada. Objetivos. Describir la semiología asociada a cuadros de rabdomiólisis no traumáticas e identificar los síntomas que motivaron a los enfermos a acudir a urgencias, para facilitar la sospecha diagnóstica. Pacientes y métodos. Pacientes diagnosticados de rabdomiólisis no traumática (creatinquinasa >1.000 UI/l) en un servicio de urgencias externas hospitalarias a lo largo de un año. Obtuvimos información acerca de los síntomas padecidos, y del síntoma en concreto que los motivó a acudir a urgencias. Los síntomas referidos fueron clasificados en cuatro grupos: musculares, urinarios, neurológicos y otros. Resultados. Entrevistamos a 49 pacientes. Los grupos de síntomas aparecieron en los enfermos con las siguientes frecuencias relativas: musculares 51%, urinarios 18%, neurológicos 67% y otros 47%. Representaron el motivo principal de consulta con las siguientes frecuencias absolutas: musculares 16%, urinarios 2%, neurológicos 48%, otros 22%, musculares y neurológicos asociados 6%, neurológicos y otros asociados 6%. Conclusión. Debería determinarse la CK en todos aquellos pacientes que acudan a urgencias afectos de algún trastorno neurológico (AU)

Successful treatment of herpes simplex virus (HSV) recurrent genital infection with recombinant human (rh) granulocyte-macrophage colony stimulating factor (GM-CSF): a case report.

In the present work, we describe the treatment with rhGM-CSF of a woman affected by HSV recurrent genital infection and not responsive to specific antiviral therapy. The therapeutic regimen consisted of a subcutaneous administration of 300 mg/day of rhGM-CSF for six days. Before treatment with rhGM-CSF, polymorphonuclear cell and monocyte functional capacities and the antibacterial activity exerted by T cells were profoundly depressed. After treatment, a normalization of immune functions and a progressive disappearance of clinical manifestations were observed.

In vitro effects of recombinant human granulocyte-macrophage colony-stimulating factor (RhGM-CSF) on polymorphonuclear cell (PMN) and monocyte (MO) functional capacities in ovarian cancer patients versus human volunteers.

Human polymorphonuclear cells (PMN) and monocytes (MO) from four ovarian cancer patients and seventeen normal donors were in vitro pretreated with different concentrations (25, 50 and 100 IU, respectively) of rhGM-CSF. Phagocytosis and killing of PMN and MO as well as PMN polarization were evaluated in cancer patients before treatment (T0) and at the end of each chemotherapeutic cycle (T1, T2, T3 and T4, respectively) in comparison with normal donors. RhGM-CSF did not affect phagocytosis and killing of PMN and MO. On the other hand, this cytokine was per se endowed with the capacity to enhance PMN polarization in both cancer patients (at T2 interval) and normal donors.

Supplementation of male inhibitory material to lipid A activated human mononuclear cell supernatants contributes to the suppression of polymorphonuclear cell phagocytosis.

Human normal peripheral blood mononuclear cells were stimulated with lipid A (LA), the biologically active moiety of bacterial lipopolysaccharides. LA-activated supernatants were able to suppress polymorphonuclear cell (PMN) phagocytosis of Candida albicans. This inhibitory activity was enhanced by the supplementation of male inhibitory material (MIM) to active supernatants. The addition of a recombinant human anti-interleukin-1 beta monoclonal antibody to activated supernatants in the absence or presence of MIM diminished or abrogated, respectively, the suppressive effect on PMN function. The mechanisms and the significance of MIM-mediated inhibition of phagocytosis under these circumstances are discussed.

Frecuencia y características de la masturbación en adolescentes femeninas / Frecuence and characteristics of masturbation in female adolescents

Con el objetivo de conocer las características y establecer la frecuencia de la masturbación en adolescentes femeninas de tres (3) Liceos públicos de la ciudad de Santo Domingo, realizamos un estudio prospectivo longitudinal con 601 estudiantes del sexo femenino de 13-19 años de edad. La frecuencia masturbatorio osciló en un 77.3 (por ciento), que excede de la relación genital heterosexual (26 por ciento) y homosexual (17.3 pro ciento) coincidiendo su mayor pico a los 16-17 años de edad. Se destacan los porcentajes de las que se masturban para liberal tensiones emocionales, las que no logran orgasmo y las que tienen sentimientos de culpa y verguenza

Hepatitis C en pacientes sometidos a hemodiálisis periódicas / Hepatitis C in patients under periodic hemodialysis

Con el objetivo de conocer la incidencia de la hepatitis C en pacientes sometidos a hemodialisis periodicas del Centro Médico Universidad Central del Este. Se realizó un estudio descriptivo prospectivo en el periodo enero-marzo 1991. Nuestro Universo estuvo constituido por 14 pacientes: 10 del sexo masculino (71.$ por ciento ) y 4 del sexo femenino (28.6 por ciento ). La edad estuvo comprendida entre 20-72 años siendo la media 46 años, observamos que de los 14 pacientes estudiado solo uno fue Seropositivo para la hepatitis C 7.14 por ciento ; el resto fue negativo 92.86 por ciento . Encontramos que el paciente mas transfundido fue el que resulto seropositivo para la hepatitis C. Los resultados permitieron confirmar que las medidas de higiene, asepsia y cuidado del personal de hemodialisis con suficientemente buena como para no infectarse con el virus del hepatitis C y para no transmitir este virus de un paciente a otro