[History of patients with pelvic floor dysfunction]. / Hechos históricos en pacientes con disfunción del piso pelviano.

OBJECTIVES: 1) To determine differences between sexes; 2) To determine differences by sex and age groups in symptom onset, time of evolution, clinical forms and probable associated causes. POPULATION AND SAMPLE: 83 consecutive patients with diagnosed PCP (X age = 50.9 SE 2.21). 25 males (30.1% x 51.2 years-old, SE 4.1) and 58 females (69.9%, X 50.8 years-old, SE 2.2). Patients with organic colon-rectum pathology (with the exception of hemorrhoidal pathology, proctologic surgery and active anus fissure) had been excluded. METHODS: Colonic Double-contrasted Rx, rectum-sigma endoscopy, and eventually a Colonofibroscopy Historic facts and syndromic protocol. Diagnosis criteria: 1) Perineal inspection: perineal contraction with pujo; 2) Rectal tact; 3) Ano-Rectum manometry with perfused system; 4) 150 ml Rectal balloon expulsion dynamic; 5) Utoreported signs and symptoms from a cuestionnaire ad hoc. Division into evolutive groups (continuous and intermittent). Division by age (< = 5, 5.1-25, > 25 years old). EXPERIMENT DESIGN: descriptive, comparative, correlation, prospective, simple blind. STATISTICS: Levene, descriptive, chi square, ANOVA, Kruskall-Wallis, Kendal tau b. RESULTS: 1) Difference in sex proportion was significative (p = 0.0001); 2) There were not differences between sexes in age media at the moment of the study (p = 0.92; 3) The continue evolutive form represented 77.1%, (p = 0.0001) but there weren't differences between sexes (p = 0.19) There weren't evolutive differences between age groups. (p = 0-78) 4) Age of onsec: x = 24.04 years-old, SE 2.02 (4-80 years-old), without differences between sexes (p = 0.16). 14.5% started before age of 5, 85% after that age, without differences between sexes (p = 0.07); 5) The time of evolution x = 26.7 years, SE 2.21, without differences between sexes (p = 0.25); 6) Potential causes were divides into tree categories: I "the patient doesn't remember associated facts" (30.1%, II: psychological or physical stress (39.8%), III: facts related to sexual trauma (30.1%). The differences (p = 0.0001); 7) Analyzed in general by sec, the most common cause was psychological-physical stress rather than sexual trauma in men, while among women sexual trauma was most common than psychological-physical stress (p = 0.03); 8) Analyzed by age groups: in the under 5 years-old group: main cause was "I don't remember". In 5.1-25-years-old group: sexual trauma; and psychological-physical stress was the main cause in > 25 years-old group (p 0.0001). CONCLUSIONS: 1) Women suffer from or consult much more frequently than man; 2) Once the disease is present, there would not be differences in age, age of onset, or time or evolution into proportions by sex; 3) The continue forms were the predominant ones; 4) The probable associated causes vary for each age group; 5) The sub-group "I don't remember" could represent in many cases a mismatch learning, but not constantly (there are cases of stress in familiar context); 6) In the subgroup "late childhood-adolescence" the predominant causes were traumatic experiences in erotic zones (rapping intent, sexual abuse, fantasies, elimination of parasites by the anus); 7) in the subgroup "older than 25 years-old" the predominant causes were physical stress, (violence, accidents, surgery) or emotional stress (familiar environment, social environment, affective losses). Some paradigmatic cases are presented. Anismus would be a complex situation involving an striated, voluntary, automatizated muscle (puborectalis) controlling independently genital-sexual, urinary and ano-rectal functions.

Hechos históricos en pacientes con disfunción del piso pelviano. / [History of patients with pelvic floor dysfunction]

OBJECTIVES: 1) To determine differences between sexes; 2) To determine differences by sex and age groups in symptom onset, time of evolution, clinical forms and probable associated causes. POPULATION AND SAMPLE: 83 consecutive patients with diagnosed PCP (X age = 50.9 SE 2.21). 25 males (30.1

x 51.2 years-old, SE 4.1) and 58 females (69.9

, X 50.8 years-old, SE 2.2). Patients with organic colon-rectum pathology (with the exception of hemorrhoidal pathology, proctologic surgery and active anus fissure) had been excluded. METHODS: Colonic Double-contrasted Rx, rectum-sigma endoscopy, and eventually a Colonofibroscopy Historic facts and syndromic protocol. Diagnosis criteria: 1) Perineal inspection: perineal contraction with pujo; 2) Rectal tact; 3) Ano-Rectum manometry with perfused system; 4) 150 ml Rectal balloon expulsion dynamic; 5) Utoreported signs and symptoms from a cuestionnaire ad hoc. Division into evolutive groups (continuous and intermittent). Division by age (< = 5, 5.1-25, > 25 years old). Experiment design: descriptive, comparative, correlation, prospective, simple blind. STATISTICS: Levene, descriptive, chi square, ANOVA, Kruskall-Wallis, Kendal tau b. RESULTS: 1) Difference in sex proportion was significative (p = 0.0001); 2) There were not differences between sexes in age media at the moment of the study (p = 0.92; 3) The continue evolutive form represented 77.1

, (p = 0.0001) but there werent differences between sexes (p = 0.19) There werent evolutive differences between age groups. (p = 0-78) 4) Age of onsec: x = 24.04 years-old, SE 2.02 (4-80 years-old), without differences between sexes (p = 0.16). 14.5

started before age of 5, 85

after that age, without differences between sexes (p = 0.07); 5) The time of evolution x = 26.7 years, SE 2.21, without differences between sexes (p = 0.25); 6) Potential causes were divides into tree categories: I [quot ]the patient doesnt remember associated facts[quot ] (30.1

, II: psychological or physical stress (39.8

), III: facts related to sexual trauma (30.1

). The differences (p = 0.0001); 7) Analyzed in general by sec, the most common cause was psychological-physical stress rather than sexual trauma in men, while among women sexual trauma was most common than psychological-physical stress (p = 0.03); 8) Analyzed by age groups: in the under 5 years-old group: main cause was [quot ]I dont remember[quot ]. In 5.1-25-years-old group: sexual trauma; and psychological-physical stress was the main cause in > 25 years-old group (p 0.0001). CONCLUSIONS: 1) Women suffer from or consult much more frequently than man; 2) Once the disease is present, there would not be differences in age, age of onset, or time or evolution into proportions by sex; 3) The continue forms were the predominant ones; 4) The probable associated causes vary for each age group; 5) The sub-group [quot ]I dont remember[quot ] could represent in many cases a mismatch learning, but not constantly (there are cases of stress in familiar context); 6) In the subgroup [quot ]late childhood-adolescence[quot ] the predominant causes were traumatic experiences in erotic zones (rapping intent, sexual abuse, fantasies, elimination of parasites by the anus); 7) in the subgroup [quot ]older than 25 years-old[quot ] the predominant causes were physical stress, (violence, accidents, surgery) or emotional stress (familiar environment, social environment, affective losses). Some paradigmatic cases are presented. Anismus would be a complex situation involving an striated, voluntary, automatizated muscle (puborectalis) controlling independently genital-sexual, urinary and ano-rectal functions.

[Cold and warm thermoregulation by oropharynx area and esophagus]. / Termoregulación al frío y al calor por la región Buco-Faringea y el Esófago.

UNLABELLED: After being ingested, food and liquids suffer a thermal regulation process, which adapts them immediately to the body temperature by means of the mucosa diffusion. We have not found bibliographical information about this matter yet. OBJECTIVES: 1) To describe the reaction of the oropharynx area and the esophagus by heat and coldness. 2) To compare both areas reaction. STUDY POPULATIONS: Six patients (three men, three women, Age: mean 42 years old, SD 11.8), healthy individuals without both gastrointestinal and systemic disease that could after microcirculation. MATERIALS & METHODS: Temperature measurement of liquid at mouth entrance and at 24 cm and 38 cm from dentary superior arcade using two thermocouples. Deglution of 40 ml of hot water (X 60 degrees C at entrance) or cold water (X 4 degrees C) in two draughts. Temperature measurement at both thermocouples at the end of deglution (time = 0 (zero)) and every 10 seconds. Random sequences every 30 minutes. RESULTS: Using water at 60 degrees C, the temperature descended to 42 degrees C in the distal end. The oropharynx region dissipated 45% of the initial temperature while the esophagus completed the other 55%. The esophagus itself dissipated 65.6% of the 12.2 degrees C in time = 0 (zero). After 40 seconds the temperature reached the normal body temperature. In the case of the iced water (4 degrees C), the total work consisted on increasing temperature 33.6 degrees C to the normal corporal temperature. The 68.45% of the difference between the initial and the final temperature was obtained by the oropharynx region and the rest by the esophagus. In time = 0 (zero) the temperature increased up to 30 degrees C and the esophagus only contributed with 28.3% of the total work. The normal corporal temperature was reached after 40 seconds. It was observed a significant difference in the heating capacity between the oropharynx region and esophagus (p > 0.001). There was also a significant difference in the oesophagus itself between heat and coldness in time = 0 (zero) ¿65.6% (heat) Vs. 28.3% (coldness), 0.02 > p > 0.01¿ and values between time = 0 (zero) and 10-40 seconds (p > 0.001). CONCLUSION: 1) The ability of cooling was similar in both regions. 2) In the oropharynx region the capacity of heating was higher (voluntary time of deglution) than in the esophagus region. 3) The esophagus initial response before coldness was slower than oropharynx region's one. The buccal retention was greater. 4) Before both stimulus, normal corporal temperature was reached after 40 seconds. COMMENTARY: The isothermation of coldness and heat would work through the same mechanism: the mucosa vasodilatation and the increase of blood flow. This hypothesis would be valid for all the mucosa of the digestive tract. This mechanism could be altered in inflammatory diseases. Iced water washings on bleeding wounds be counter-productive. The persistence of extreme temperatures in the environment modifies the structure of the esophagus mienteric plexus (Auerbach's plexus). Frequent ingestion of fluids above 60 degrees C would be a predisponent factor for esophagus cancer.

Termoregulación al frío y calor por la región buco-faringea y el esófago / Cold and warm thermoregulation by oropharynx area and esophagus

After being ingested, food and liquids suffer a thermal regulation process, which adapts them immediately to the body temperature by means of the mucosa diffusion. We have not found bibliographical information about this matter yet. OBJECTIVES: 1) To describe the reaction of the oropharynx area and the esophagus by heat and coldness. 2) To compare both areas reaction. STUDY POPULATIONS: Six patients (three men, three women, Age: mean 42 years old, SD 11.8), healthy individuals without both gastrointestinal and systemic disease that could after microcirculation. MATERIALS & METHODS: Temperature measurement of liquid at mouth entrance and at 24 cm and 38 cm from dentary superior arcade using two thermocouples. Deglution of 40 ml of hot water (X 60 degrees C at entrance) or cold water (X 4 degrees C) in two draughts. Temperature measurement at both thermocouples at the end of deglution (time = 0 (zero)) and every 10 seconds. Random sequences every 30 minutes. RESULTS: Using water at 60 degrees C, the temperature descended to 42 degrees C in the distal end. The oropharynx region dissipated 45 per cent of the initial temperature while the esophagus completed the other 55 per cent.The esophagus itself dissipated 65.6 per cent of the 12.2 degrees C in time = 0 (zero). After 40 seconds the temperature reached the normal body temperature. In the case of the iced water (4 degrees C), the total work consisted on increasing temperature 33.6 degrees C to the normal corporal temperature. The 68.45 per cent of the difference between the initial and the final temperature was obtained by the oropharynx region and the rest by the esophagus. In time = 0 (zero) the temperature increased up to 30 degrees C and the esophagus only contributed with 28.3 per cent of the total work. The normal corporal temperature was reached after 40 seconds. It was observed a significant difference in the heating capacity between the oropharynx region and esophagus (p > 0.001)...(Au)

Termoregulación al frío y calor por la región buco-faringea y el esófago / Cold and warm thermoregulation by oropharynx area and esophagus

After being ingested, food and liquids suffer a thermal regulation process, which adapts them immediately to the body temperature by means of the mucosa diffusion. We have not found bibliographical information about this matter yet. OBJECTIVES: 1) To describe the reaction of the oropharynx area and the esophagus by heat and coldness. 2) To compare both areas reaction. STUDY POPULATIONS: Six patients (three men, three women, Age: mean 42 years old, SD 11.8), healthy individuals without both gastrointestinal and systemic disease that could after microcirculation. MATERIALS & METHODS: Temperature measurement of liquid at mouth entrance and at 24 cm and 38 cm from dentary superior arcade using two thermocouples. Deglution of 40 ml of hot water (X 60 degrees C at entrance) or cold water (X 4 degrees C) in two draughts. Temperature measurement at both thermocouples at the end of deglution (time = 0 (zero)) and every 10 seconds. Random sequences every 30 minutes. RESULTS: Using water at 60 degrees C, the temperature descended to 42 degrees C in the distal end. The oropharynx region dissipated 45 per cent of the initial temperature while the esophagus completed the other 55 per cent.The esophagus itself dissipated 65.6 per cent of the 12.2 degrees C in time = 0 (zero). After 40 seconds the temperature reached the normal body temperature. In the case of the iced water (4 degrees C), the total work consisted on increasing temperature 33.6 degrees C to the normal corporal temperature. The 68.45 per cent of the difference between the initial and the final temperature was obtained by the oropharynx region and the rest by the esophagus. In time = 0 (zero) the temperature increased up to 30 degrees C and the esophagus only contributed with 28.3 per cent of the total work. The normal corporal temperature was reached after 40 seconds. It was observed a significant difference in the heating capacity between the oropharynx region and esophagus (p > 0.001)...

[The time and pH at the moment of disappearance of pyrosis induced by of esophagus acid perfusion is an indicator of hyperalgesia]. / El tiempo y el pH de desaparición de la pirosis provocada por la perfusión ácida de esófago sería un indicador de hiperalgesia.

OBJECTIVES: 1) Describe and compare evolutionary features of the pyrosis symptom with a positive acid perfusion test in the entire study population, and divided by sex. 2) Describe the results of different tests according to sex (standard acid clearance, number of reflux episodes in a short testing period, period of time until the appearance of pyrosis during acid perfusion, period of time until its disappearance, and esophagus pH at the time). 3) Compare differences between control and patient cases regarding standard clearance and reflux episodes. 4) Establish a multivariance correlation between the results of the tests according to sex and historical data, looking for one or more regulating factors. 5) Establish the same descriptive and comparative assessments in both subgroups, with and without hiatal hernia (HH). STUDY POPULATION: 15 healthy subjects, 9 men and 6 women (control), and 50 patients with pyrosis, 23 men and 27 women, over 18 years old, with or without HH, matched for age and sex (p = NS), and consecutive. MATERIAL AND METHODS: Clinical data records, esophagogastroendoscopy with at least three biopsy samples, number of reflux episodes within 30 minutes, standard acid clearance, measurement of perfusion time, time it takes pyrosis to disappear, and esophagus pH at the time. This is a prospective, descriptive, comparative, experimental, longitudinal, single-blind study with control subjects. RESULTS: Eighty-two percent (82%) of the study population had pyrosis II. Average age: 39.9 +/- 13.3 years, with no differences between sexes (p = 0.31). Development period at study time: 5.7 +/- 5.5 years (p = 0.33). Fifty-eight percent (58%) of patients showed endoscopic signs of esophagitis, and 52% had HH. The number of reflux episodes, and of deglutitions needed to reach a pH of up to 5 were statistically different between patients and control subjects (p = 0.0005). The time required by acid perfusion for pyrosis to recur was 3.67 +/- 3.26 minutes. The time until its disappearance was 2.2 +/- 1.78 minutes. pH at pyrosis spontaneous cessation was 2.10 +/- 0.83. There was a correlation between the age at the time the symptom appeared, and the time the induced pyrosis disappeared (p = 0.02), as well as between this point in time and its corresponding pH (p = 0.006, r = 0.45). The presence of HH was associated with the number of reflux episodes and the frequency of proven endoscopic injuries, but not with the other parameters. CONCLUSIONS: 1) Most patients complaining of pyrosis were middle-aged, but it might also appear in very old people. 2) An early history of pyrosis was slightly associated with a delay in suppression of induced pyrosis. 3) Longer duration of pyrosis at induced pyrosis test was associated with a higher pH pyrosis degree, a fact that points to an enhanced sensory perception. 4) An association was established between HH and abnormal findings in esophagoendoscopy/hystopathology, but not so with sensory parameters. Hyperalgesia and a low pH are not the only factors which determine pyrosis. The findings strongly support the hypothesis according to which pyrosis, gastroesophageal reflux, and endoscopically proven injuries are associated, but independent.

El tiempo y el pH de desaparición de la pirosis provocada por la perfusión ácida de esófago sería un indicador de hiperalgesia / Time and pH at the moment of disappearance of pyrosis induced by means of acid perfusion might indicate hyperalgesia

Objetivos: 1) Describir y comparar las características históricas del sintoma de pirosis con prueba de perfusión ácida positiva en el grupo total y según sexos; 2) describir los resultados de los estudios (clearance ácido estánder, número de episodios de reflujo en tiempos cortos de observación, tiempo de aparición de la pirosis durante la perfusión ácida, tiempo de desapacición del síntoma y pH del esófago en el momento de la desaparición); comparación por sexos; 3) comparar las diferencias de depuraniones estándar y de episodios de reflujo entre controles y pacientes; 4) correlacionar de factores condicionantes; 5) realizar las mismas evaluaciones descriptivas y comparativas en los subgrupos con hernia hiatal (H.H.) y sin ella. Trabajo prospectivo, descriptivo y comparativo, experimental, longitudinal, ciego simple, con muestra de control. Población y muestra: 15 pacientes de control (9 hombres, mujeres) y 50 pacientes con pirosis (23 hombres, 27 mujeres). Mayores de 18 años. Con H.H. o sin ella. Equiparables (diderencias en edad y sexo, p=NS). Consecutivos. Material y metodologia: Registro de datos históricos, endoscopia alta, 3 (tres) biopsias como mínimo, número de episodios de reflujo en 30 minutos de observación, clearance ácido estánder, medición de tiempo de perfusión, tiempo de desaparición del síntoma evocado y pH en que desaparece el síntoma...(AU)

El tiempo y el pH de desaparición de la pirosis provocada por la perfusión ácida de esófago sería un indicador de hiperalgesia / Time and pH at the moment of disappearance of pyrosis induced by means of acid perfusion might indicate hyperalgesia

Objetivos: 1) Describir y comparar las características históricas del sintoma de pirosis con prueba de perfusión ácida positiva en el grupo total y según sexos; 2) describir los resultados de los estudios (clearance ácido estánder, número de episodios de reflujo en tiempos cortos de observación, tiempo de aparición de la pirosis durante la perfusión ácida, tiempo de desapacición del síntoma y pH del esófago en el momento de la desaparición); comparación por sexos; 3) comparar las diferencias de depuraniones estándar y de episodios de reflujo entre controles y pacientes; 4) correlacionar de factores condicionantes; 5) realizar las mismas evaluaciones descriptivas y comparativas en los subgrupos con hernia hiatal (H.H.) y sin ella. Trabajo prospectivo, descriptivo y comparativo, experimental, longitudinal, ciego simple, con muestra de control. Población y muestra: 15 pacientes de control (9 hombres, mujeres) y 50 pacientes con pirosis (23 hombres, 27 mujeres). Mayores de 18 años. Con H.H. o sin ella. Equiparables (diderencias en edad y sexo, p=NS). Consecutivos. Material y metodologia: Registro de datos históricos, endoscopia alta, 3 (tres) biopsias como mínimo, número de episodios de reflujo en 30 minutos de observación, clearance ácido estánder, medición de tiempo de perfusión, tiempo de desaparición del síntoma evocado y pH en que desaparece el síntoma...

El tiempo y el pH de desaparición de la pirosis provocada por la perfusión ácida de esófago sería un indicador de hiperalgesia. / The time and pH at the moment of disappearance of pyrosis induced by of esophagus acid perfusion is an indicator of hyperalgesiaO.

OBJECTIVES: 1) Describe and compare evolutionary features of the pyrosis symptom with a positive acid perfusion test in the entire study population, and divided by sex. 2) Describe the results of different tests according to sex (standard acid clearance, number of reflux episodes in a short testing period, period of time until the appearance of pyrosis during acid perfusion, period of time until its disappearance, and esophagus pH at the time). 3) Compare differences between control and patient cases regarding standard clearance and reflux episodes. 4) Establish a multivariance correlation between the results of the tests according to sex and historical data, looking for one or more regulating factors. 5) Establish the same descriptive and comparative assessments in both subgroups, with and without hiatal hernia (HH). STUDY POPULATION: 15 healthy subjects, 9 men and 6 women (control), and 50 patients with pyrosis, 23 men and 27 women, over 18 years old, with or without HH, matched for age and sex (p = NS), and consecutive. MATERIAL AND METHODS: Clinical data records, esophagogastroendoscopy with at least three biopsy samples, number of reflux episodes within 30 minutes, standard acid clearance, measurement of perfusion time, time it takes pyrosis to disappear, and esophagus pH at the time. This is a prospective, descriptive, comparative, experimental, longitudinal, single-blind study with control subjects. RESULTS: Eighty-two percent (82

) of the study population had pyrosis II. Average age: 39.9 +/- 13.3 years, with no differences between sexes (p = 0.31). Development period at study time: 5.7 +/- 5.5 years (p = 0.33). Fifty-eight percent (58

) of patients showed endoscopic signs of esophagitis, and 52

had HH. The number of reflux episodes, and of deglutitions needed to reach a pH of up to 5 were statistically different between patients and control subjects (p = 0.0005). The time required by acid perfusion for pyrosis to recur was 3.67 +/- 3.26 minutes. The time until its disappearance was 2.2 +/- 1.78 minutes. pH at pyrosis spontaneous cessation was 2.10 +/- 0.83. There was a correlation between the age at the time the symptom appeared, and the time the induced pyrosis disappeared (p = 0.02), as well as between this point in time and its corresponding pH (p = 0.006, r = 0.45). The presence of HH was associated with the number of reflux episodes and the frequency of proven endoscopic injuries, but not with the other parameters. CONCLUSIONS: 1) Most patients complaining of pyrosis were middle-aged, but it might also appear in very old people. 2) An early history of pyrosis was slightly associated with a delay in suppression of induced pyrosis. 3) Longer duration of pyrosis at induced pyrosis test was associated with a higher pH pyrosis degree, a fact that points to an enhanced sensory perception. 4) An association was established between HH and abnormal findings in esophagoendoscopy/hystopathology, but not so with sensory parameters. Hyperalgesia and a low pH are not the only factors which determine pyrosis. The findings strongly support the hypothesis according to which pyrosis, gastroesophageal reflux, and endoscopically proven injuries are associated, but independent.

Termoregulación al frío y al calor por la región Buco-Faringea y el Esófago. / [Cold and warm thermoregulation by oropharynx area and esophagus]

After being ingested, food and liquids suffer a thermal regulation process, which adapts them immediately to the body temperature by means of the mucosa diffusion. We have not found bibliographical information about this matter yet. OBJECTIVES: 1) To describe the reaction of the oropharynx area and the esophagus by heat and coldness. 2) To compare both areas reaction. STUDY POPULATIONS: Six patients (three men, three women, Age: mean 42 years old, SD 11.8), healthy individuals without both gastrointestinal and systemic disease that could after microcirculation. MATERIALS & METHODS: Temperature measurement of liquid at mouth entrance and at 24 cm and 38 cm from dentary superior arcade using two thermocouples. Deglution of 40 ml of hot water (X 60 degrees C at entrance) or cold water (X 4 degrees C) in two draughts. Temperature measurement at both thermocouples at the end of deglution (time = 0 (zero)) and every 10 seconds. Random sequences every 30 minutes. RESULTS: Using water at 60 degrees C, the temperature descended to 42 degrees C in the distal end. The oropharynx region dissipated 45

of the initial temperature while the esophagus completed the other 55

. The esophagus itself dissipated 65.6

of the 12.2 degrees C in time = 0 (zero). After 40 seconds the temperature reached the normal body temperature. In the case of the iced water (4 degrees C), the total work consisted on increasing temperature 33.6 degrees C to the normal corporal temperature. The 68.45

of the difference between the initial and the final temperature was obtained by the oropharynx region and the rest by the esophagus. In time = 0 (zero) the temperature increased up to 30 degrees C and the esophagus only contributed with 28.3

of the total work. The normal corporal temperature was reached after 40 seconds. It was observed a significant difference in the heating capacity between the oropharynx region and esophagus (p > 0.001). There was also a significant difference in the oesophagus itself between heat and coldness in time = 0 (zero) 65.6

(heat) Vs. 28.3

(coldness), 0.02 > p > 0.01 and values between time = 0 (zero) and 10-40 seconds (p > 0.001). CONCLUSION: 1) The ability of cooling was similar in both regions. 2) In the oropharynx region the capacity of heating was higher (voluntary time of deglution) than in the esophagus region. 3) The esophagus initial response before coldness was slower than oropharynx regions one. The buccal retention was greater. 4) Before both stimulus, normal corporal temperature was reached after 40 seconds. COMMENTARY: The isothermation of coldness and heat would work through the same mechanism: the mucosa vasodilatation and the increase of blood flow. This hypothesis would be valid for all the mucosa of the digestive tract. This mechanism could be altered in inflammatory diseases. Iced water washings on bleeding wounds be counter-productive. The persistence of extreme temperatures in the environment modifies the structure of the esophagus mienteric plexus (Auerbachs plexus). Frequent ingestion of fluids above 60 degrees C would be a predisponent factor for esophagus cancer.

[The physician-patient relationship in post-modernism]. / La relación médico-paciente en el postmodernismo.

The doctor-patient relationship represents a particular link that goes beyond formality and it is projected in time, space and emotionalism. It takes place in the midst of a cultural, social, physiological, scientific and technical context which at the same time is conditioned by local, regional, national and foreign influences as a consequence of globalization. Different ethnical groups, social stratification, economic structures, philosophical concepts, religious beliefs and moral values play a pivotal role. The technological advances have shown an exponential increase during the last forty years. This phenomenon was accompanied by deep changes that varied from philosophical to strictly technical aspects which were significatively intensified during the post Second World War period. The consequences have been unfortunate for physicians and particularly for patients. Those consequences came out by philosophical reviews, the economical liberalism and neoliberalism development, a new concept for science, the priorization of technique development together with changes in both ethical value scales and economic & politic power hegemonies. The great reports of philosophy have tried to justify these social changes. The end of modern meta discourses such as Iluminism, Idealism, and Marxism, incited the liberal and neoliberal discourse. Knowledge has been affected not only in the research field but in the teaching field as well. Today, the discourse in vogue is the performance. The "organic conjugation" of technique and profit precedes its union with science. The State disengagement in managing the great social problems in many countries, the globalization and the concentration of the capital has redefined the power. Neither the patient nor the medicine escapes from this reality. The final results are generations of physicians quite right informed but unable to solve or even face the minimum problems of a patient, and what is worst, they run the risk of feeling frustrated and resentful. Everything is thought and done through technique, and there is a fact that appears to justify this action "The malpractice judgement industry". The economical monopoly of private or sindical Healthcare Providers and self-managed Hospitals projects are rapidly and notoriously modifying the medical labour market. There seems to exist only one element that the doctor and the patient have in common in this new culture: loneliness. There is also a human communication failure that separates them: the patient is in more need of human comprehension than ever before and the doctor has a cultural inability to offer it. To sum up, the relationship between the doctor and the patient is still a theme of deep preoccupation, even more nowadays when everything seems to indicate that this relationship has suffered a significant impairment.

La relación médico-paciente en el postmodernismo / The physician-patient relationship in post-modernism

La relación médico-paciente representa un vínculo particular que transciende lo formol y se proyecta en el tiempo, el espacio y la emocionalidad. Se produce en un contexto cultural, social, psicológico, científico y técnico, condicionado por variables locales, regionales, nacionales y supranacionales y en el que la entidad, la estraficación social, las creencias religiosas y los valores éticos y morales juegan un rol pivotal. Los avances en los últimos 40 años han mostrado una curva exponencial últimos 40 años han mostrado una curva exponencial de la mano de profundos cambios que abarcan desde lo filosófico hasta lo estrictamente técnico. Ello ha afectado profundamente la relación entre el médico y el paciente. Las consecuencias han sido desafortunadas tanto para el médico como, y en particular, para el paciente. Estos cambios aparecem o se intensifican significativamente en el período de postguerra de la Segunda Guerra Mundial, y la tecnificación es el aspecto más aparente. Se exteriorizan por replanteos a nivel filosófico, desarrollo del liberalismo y neo-liberalismo económicos, replanteo en el concepto de ciencia, priorización del desarrollo tecnológico, cambios en las escalas de valores ético-morales y cambios en las hegemonías del poder político y económico. Los grandes relato de la filosofía han justificado los cambios sociales. El fin de los metadiscursos modernos (iluminismo, idealismo y marxismo) ha dado lugar al discurso liberal y, finalmente, al neoliberalismo. El "saber" ha sido afectado tanto en la investigación como en la enseñanza, y el nuevo metadiscurso pasa ahora por la performance. La conjugación orgánica de la técnica con la ganancia precede a su unión con la ciencia. La retirada del Estado en muchos países de los grandes problemas sociales, la globalización y la concentración del capital han redefinido el poder. Ni el paciente ni la medicina escapan a esta nueva realidad. La resultante final son generaciones de médicos bastante bien informados pero incapaces de enfrentar y resolver las problemáticas mínimas de un paciente, con el agravante de sentirse frustrados y resentidos. Se piensa y actúa a través de la técnica...(AU)

La relación médico-paciente en el postmodernismo / The physician-patient relationship in post-modernism

La relación médico-paciente representa un vínculo particular que transciende lo formol y se proyecta en el tiempo, el espacio y la emocionalidad. Se produce en un contexto cultural, social, psicológico, científico y técnico, condicionado por variables locales, regionales, nacionales y supranacionales y en el que la entidad, la estraficación social, las creencias religiosas y los valores éticos y morales juegan un rol pivotal. Los avances en los últimos 40 años han mostrado una curva exponencial últimos 40 años han mostrado una curva exponencial de la mano de profundos cambios que abarcan desde lo filosófico hasta lo estrictamente técnico. Ello ha afectado profundamente la relación entre el médico y el paciente. Las consecuencias han sido desafortunadas tanto para el médico como, y en particular, para el paciente. Estos cambios aparecem o se intensifican significativamente en el período de postguerra de la Segunda Guerra Mundial, y la tecnificación es el aspecto más aparente. Se exteriorizan por replanteos a nivel filosófico, desarrollo del liberalismo y neo-liberalismo económicos, replanteo en el concepto de ciencia, priorización del desarrollo tecnológico, cambios en las escalas de valores ético-morales y cambios en las hegemonías del poder político y económico. Los grandes relato de la filosofía han justificado los cambios sociales. El fin de los metadiscursos modernos (iluminismo, idealismo y marxismo) ha dado lugar al discurso liberal y, finalmente, al neoliberalismo. El "saber" ha sido afectado tanto en la investigación como en la enseñanza, y el nuevo metadiscurso pasa ahora por la performance. La conjugación orgánica de la técnica con la ganancia precede a su unión con la ciencia. La retirada del Estado en muchos países de los grandes problemas sociales, la globalización y la concentración del capital han redefinido el poder. Ni el paciente ni la medicina escapan a esta nueva realidad. La resultante final son generaciones de médicos bastante bien informados pero incapaces de enfrentar y resolver las problemáticas mínimas de un paciente, con el agravante de sentirse frustrados y resentidos. Se piensa y actúa a través de la técnica...

[Comparison between gastric and esophageal mechano-sensitivity in patients with functional dyspepsia]. / Comparación de la mecanosensibilidad gástrica y esofágica en pacientes con dispepsia funcional (D.F.).

UNLABELLED: Patients with non ulcer dyspepsia (NUD) and lowered mechano sensitivity thresholds in stomach may have lowered mechano sensitivity thresholds in oesophagus also. The aim was to check this hypothesis. METHODS: 39 patients with NUD (11 men and 24 women, mean age 57 years, SEM 3.72, range 17-86) and 20 controls (10 men, 10 women, mean age 49.3 years, SEM 3.72, range 31-66) were studied. Organis diseases were discarded. Gastric mechano sensitivity was studied with a latex balloon of low compliance, 8 cm length, connected to a manometer. Balloon was inflated "in ramp" at 10 ml/sec, and "first sensation", discomfort", and "pain" were registered. At 900 ml inflation was stopped if pain was not evoked. Oesophageal mechano sensitivity was studied with another latex balloon of low compliance which, after inflated with 15 ml. of air, was 3.5 cm. in diameter. Esophageal balloon was inflated "in ramp" (1 ml/sec) up 15 ml. and deflated in 2 cm step from 36 to 22 cm from SDA. Inflation was stopped when symptoms (pain or discomfort were evoked. Oesophageal acid perfusion test was performed. RESULTS: 83.4% of controls completed up 700 ml. of gastric distension vs. 35.9% of patients with NUD (p > 0.001). No significative differences in intra-balloon pressure slope were observed between both groups. 79.2% of NUD patients had chest pain with oesophageal ballon distension = < 7 ml. vs. 5% in controls (p > 0.001). Mean volumes were 7.03 ml. (NUD) and 11.9% (controls) (p = 0.001), 63% of dyspeptic patients with lowered gastric sensitivity thresholds (< 700 ml) had oesophagic symptoms with inflation volumes = < 7 ml. There was a positive correlation in stomach and oesophageal mechano sensitivities variations (r = 0.75, +/- 0.58, p > 0.01). When analyzed with that results, oesophageal acid perfusion test showed 38.5% of "mixed sensitivities" (both mechano- and chemo-), 30.7% of "mechano sensorials" (negative acid test, positive balloon test), and 10.3% of :chemo sensorials" (positive acid test only). In 20.5% both tests were normal at the moment they were done. These results agreed with our previous experiences in oesophagus. CONCLUSIONS: It was concluded that a significative proportion of NUD patients had lowered thresholds for mechano stimulation of stomach and oesophagus at the time that both tests were done. Such alterations support the hypothesis that a more general mechano-sensitivity alteration is present in patients with NUD.

[Electrogastrography and gastric emptying in non organic dyspepsia]. / Electrogastrografía y vaciamiento gástrico en pacientes con dispepsia no orgánica.

UNLABELLED: Electrogastrography allows to determinate the dominant frequency of gastric E.C.A. (electrical control activity). The aim was to investigate the gastric E.C.A. in a population of patients suffering from non-organic dispepsia (N.O.D.). Eighteen controls (9 males, 9 females, mean age 46.4 years old, SEM 3.72, range 24-72) and 52 dyspeptic patients (18 males, 34 females, mean age 54.19 years old, SEM 2.38, range 17-86) were studied. Two skin surface electrodes Ag-2ClAg were placed on epigastric area following a probabilistic antral axe. Reference electrode was placed on the right quadrant skin. In 5 patients, recordings with needle and cutaneous electrode were compared. Analogic waves were filtered, digitalized and processed. Signals were analyzed using F.F.T. (Fast Fourier Transformated) Only the predominant frequency in each block was considered, and percentage of total abnormalities on total recording time lesser than 2 c.p.m. or more than 4 c.p.m. was accepted. Recording were taken in fast time during 30 minutes, and 30 minutes after a meal containing 230 Cal. Running spectral analysis with F.F.T. In 43 non-selected patients the gastric emptying time of a mixed meal marked with 99 Tc in the solid phase was studied. RESULTS: 60.45% showed delayed gastric emptying. Mean of fast E.C.A. was 2.99 c.p.m. in controls, Vs 3.34 c.p.m. in dispeptic patients (p > 0.001). In the post-prandial period, mean of E.C.A. was 3.53 c.p.m. in N.O.D., and these differences were not significatives ("t", NS). 22% of controls showed isolated periods of tachygastria, but never more than 8% of the total recording time. It was seen seven six and forty five percent of arrhythmias were observed (71.15% tachygastria, 4.76% bradygastria, and 19.23% mixed) during post prandial recording in N.O.D. 48% of tachygastrias were between the range 30-60% of the time recording. Ninety six and one percent of patients with abnormal gastric emptying had gastric arrhythmias (0.05 > p > 0.02) Vs 50% in patients with normal gastric emptying. Needle recording increased about 200-300% the signal power. It would be the better choice in cases of hairy abdominal skin. CONCLUSIONS: a) More than 76% of patients with N.O.D. had abnormal recording of E.C.A. beyond these observed in controls; b) tachygastria was the more frequent abnormality observed; c) the more severe clinical cases were associated with bradygastria; d) No association between symptoms and abnormal gastric emptying was found; e) E.G.G. abnormalities were seen in 96% of patients with abnormal gastric emptying, Vs 50% in normal gastric emptying; f) Needle electrodes let a better recording of E.G.G. signal; g) No association was found between abnormalities in gastric emptying and/or E.G.G., and clinical subtypes of Dyspepsia.

Comparación de la mecanosensibilidad gástrica en pacientes con dispepsia funcional (D.F.) / Comparison between gastric and esophageal mechano-sensitivity in patients with functional dyspepsia

Patients with non ulcer dyspepsia (NUD) and lowered mechano sensitivity tresholds in stomach may have lowered mechano sensitivity treholds in oesophagus also. The aim was to check this hypothesis. Methods: 39 patients with NUD (11 men and 24 women, mean age 57 years, SEM 3.72, range 17-86) and 20 controls (10 men, 10 women, mean age 49.3 years, SEM 3.72, range (31-66) were studied. Organis diseases were discarded. Gastric mechano sensitivity was studied with a latex ballon of low compliance, 8 cm lenght, conected to a manometer. Ballon was inflated "in ramp"at 10 ml/sec. and "first sensation", disconfort", and "pain" were registered. At 900 ml inflation was stopped if pain was not evoked. Oesophageal mechano sensitivity was studied with another latex ballon of low compliance which, after inflated with 15 ml. of air, was 3.5 cm. in diameter. Esophageal ballon was inflated "in ramp" (1 ml/sec) up 15 ml. and deflated in 2 cm step from 36 to 22 cm from SDA. Infaltion was stopped whrn symptoms (pain or disconfort were evoked. Oesophageal acid perfusion test was performed. Results: 83.4 per cent of controls completed up 700 ml. of gastric distension vs. 35.9 per cent of patients with NUD (p>0.001). No significatives differences in intra-ballon pressure slope were observed between both groups. 79.2 per cent of NUD patients had chest pain with oesophageal ballon distension =<7 ml. vs. 5 per cent in controls (p>0.001). Mean volumes were 7.03 ml. (NUD) and 11.9 per cent (controls) (p=0.001). 63 per cent of dyspeptic patients with lowered gastric sensitivity tresholds (< 700 ml) had oesophagic symptoms with inflation volumes =< 7 ml. There was a positive correlation is stomach and oesophageal mechano sensiticities variations (r= 0.75 +/-0.58, p>0.01). Whem analyzed with that results, oesophageal acid perfusion test showed 38.5 per cent of "mixed sensitivities" (both mechano-and chemo-), 30.7 per cent of "mechano sensorials" (negative acid test, positive ballon test), and 10.3 per cent of schemo sensorials" (positive acid test only). In 20.5 per cent both tests were normal at the moment they were done. These results agreed with our previous experiences in oesophagus. Conclusions: It was concluded that a significative proportion of NUD patients had lowered tresholds for mechano stimulation of stomach and oesophagus at the time that both tests were done. Such alterations support the hypothesis that a more general mechano-sensitivity alteration in present in patients with NUD. (AU)

Comparación de la mecanosensibilidad gástrica en pacientes con dispepsia funcional (D.F.) / Comparison between gastric and esophageal mechano-sensitivity in patients with functional dyspepsia

Patients with non ulcer dyspepsia (NUD) and lowered mechano sensitivity tresholds in stomach may have lowered mechano sensitivity treholds in oesophagus also. The aim was to check this hypothesis. Methods: 39 patients with NUD (11 men and 24 women, mean age 57 years, SEM 3.72, range 17-86) and 20 controls (10 men, 10 women, mean age 49.3 years, SEM 3.72, range (31-66) were studied. Organis diseases were discarded. Gastric mechano sensitivity was studied with a latex ballon of low compliance, 8 cm lenght, conected to a manometer. Ballon was inflated "in ramp"at 10 ml/sec. and "first sensation", disconfort", and "pain" were registered. At 900 ml inflation was stopped if pain was not evoked. Oesophageal mechano sensitivity was studied with another latex ballon of low compliance which, after inflated with 15 ml. of air, was 3.5 cm. in diameter. Esophageal ballon was inflated "in ramp" (1 ml/sec) up 15 ml. and deflated in 2 cm step from 36 to 22 cm from SDA. Infaltion was stopped whrn symptoms (pain or disconfort were evoked. Oesophageal acid perfusion test was performed. Results: 83.4 per cent of controls completed up 700 ml. of gastric distension vs. 35.9 per cent of patients with NUD (p>0.001). No significatives differences in intra-ballon pressure slope were observed between both groups. 79.2 per cent of NUD patients had chest pain with oesophageal ballon distension =<7 ml. vs. 5 per cent in controls (p>0.001). Mean volumes were 7.03 ml. (NUD) and 11.9 per cent (controls) (p=0.001). 63 per cent of dyspeptic patients with lowered gastric sensitivity tresholds (< 700 ml) had oesophagic symptoms with inflation volumes =< 7 ml. There was a positive correlation is stomach and oesophageal mechano sensiticities variations (r= 0.75 +/-0.58, p>0.01). Whem analyzed with that results, oesophageal acid perfusion test showed 38.5 per cent of "mixed sensitivities" (both mechano-and chemo-), 30.7 per cent of "mechano sensorials" (negative acid test, positive ballon test), and 10.3 per cent of schemo sensorials" (positive acid test only). In 20.5 per cent both tests were normal at the moment they were done. These results agreed with our previous experiences in oesophagus. Conclusions: It was concluded that a significative proportion of NUD patients had lowered tresholds for mechano stimulation of stomach and oesophagus at the time that both tests were done. Such alterations support the hypothesis that a more general mechano-sensitivity alteration in present in patients with NUD.

["Mechano-" and "chemo-sensitive" esophagus. Investigation of non-cardiac chest pain using intraesophageal balloon test and acid perfusion]. / Esófago "Mecano" y "Quimio Sensible". Investigación del dolor toracico no cardiogenico con el test de balón intraesofágico y la perfusión ácida.

UNLABELLED: Mechano--and chemo--sensitivity were studied in 20 normal control patients and 73 patients suffering from pirosis, chest pain or both symptoms. Upper endoscopy, balloon and acid perfussion tests were performed. Balloon was inflated up to 15 ml. and deflated, in 2 cm. steps from 38 to 22 cm. from S.D.A. The number of patients with response, volume of balloon distension that evoked symptoms, place and irradiation of pain or discomfort were registered and plotted on 13 frontal and 10 dorsal zones. The total number of areas involved in pain irradiation was considered as "number of responses". Nine levels were stimulated. Acid perfusion and clearance tests were performed at the same session. Test positivity was accepted when some test evoked spontaneous patient's symptoms. RESULTS: When 9 levels were stimulated, balloon reproduced symptoms in 77.5%. If only one level was considered, the maximal rate was 51%. There were "silent areas" interposed between "trigger zones". In 66.6%, responses with volumes of + < 7 ml. were obtained. In all patients with chest pain upper endoscopy was normal. In 70% of the total group and in 62.5% of patients with pirosis the acid perfusion test was "positive". Esophagitis increased the probability of a positive test. In sixty per cent, patients with combined pirosis and chest pain responded separately with each test. In 6% acid perfusion evoked pain. In 6.1% balloon evoked pirosis. CONCLUSION: 1) Balloon test could be considered the most useful test in mechano-sensitivity investigation. 2) acid perfussion was useful for chemo-sensitivity investigation. As esophagitis increases chemosensitivity, it could be a conditionant factor in some patients. 3) Patients with combined symptoms responded as a mixed sensorial dysfunction with each test. 4) sub-population of patients had atypical responses to the provocative tests.