Los servicios de bioanálisis como sistemas autopoiéticos: cambio y transformación / The services of bioanálisis like autopoiéticos systems:change and transformation

La autopoiesis como teoría de la autoorganización en los seres vivos de los investigadores Maturana y Varela (1971). De máquinas y seres vivos, autopoiesis: la organización de lo vivo; plantean una nueva lógica de comprender los sistemas abiertos a partir del cambio, para generar un sistema con capacidad de autodefinirse y tener una propia autonomía concretada en una unidad. Con esta teoría las organizaciones, como los servicios de salud con siderados como sistemas abiertos, pueden explicar, su capacidad de autoorganizarse antes los diferentes acontecimientos de cambios, de donde emerge una racionalidad basada en una lógicas biologícista, con capacidad de explorar las realidades de las organizaciones embebida en las relaciones e interrelaciones de sus procesos que continuamente se están produciendo, no importando las propiedades de sus componentes.

Autopoiesis as a theory of the autoorganización in living beings themselves, from Maturana and Varela (1971). From machines and living beings, autopoiesis: the organization of living. They raise a new way to understand open systems from the change, to create a system able to define itself and to have its own autonomy specific into a unit. With this theory the organizations, as long as health service considered open systems, can explain, their capacity to organize themselves with the different change events, where rationality come from based on the complete biologic phenomenology. Able to explore the reality of organizations absorbed into relations and interrelation of their processes that continuously are marking by their own, no matter their components properties.

La comunicación e información en los servicios de bioanálisis: una perspectiva desde los sistemas dinámicos / The communication and information in the services of bioanálisis: a perspective from the dynamic systems

El presente artículo intenta abordar ideas fundamentales en los procesos de comunicación e información en los servicios de salud visto desde las concepciones de una organización dinámica que responde a los criterios de un sis tema vivo; desarrollándose eventos de interdependencia, autoorganización y/o autopoiético como sistemas dinámicos alejados del equilibrio termodinámico, en donde los procesos de comunicación e información se gestionan co mo me mes o genes de replicación de forma tal que la comunicación e información sea confiable, completa y oportuna.

The present article tries to approach fundamental ideas in the processes of communication and information the services of health seen from the conceptions of an organization who responds to the criteria of an alive system; being developed events of interdependence, auto-organization or autopoético like moved away dynamic systems of the thermodynamic balance, in where the communication processes information I know manage like memes or replication genes so that the communication and information is reliable, complete and opportune.

Efectos cardiovasculares del acortamiento del intervalo AV mediante estimulación eléctrica del corazón en miocardiopatía dilatada / Cardiovascular effects of AV interval shortening with heart electric stimulation in dilated cardiomyopathy

Patients and methods: Nine patients with dilated cardiomyopathy were studied. Hemodynamic and tissular perfusion values, echocardiographic and radioisotopic ventricular function parameters were measured before and after six hours of AV interval shortening with electrical stimulation of the heart. Results: After electrical stimulation, cardiac output increased from 3.38 ñ 0.8 to 32.87 ñ 0.79 l/min (p < 0.05). Pulmonary capillary pressure decreased from 23.8 ñ 8.9 to 19.8 ñ 9.2 mm Hg (p = NS). There were no significant changes in ventricular function parameters or in systemic and pulmonary pressures. Conclusions: Electrical shortening of AV interval in patients with dilated cardiomyopathy increases cardiac output but does not change ventricular function parameters

Prueba de esfuerzo cardiopulmonar en pacientes con insuficiencia cardíaca crónica: comparación con sujetos normales y reproductibilidad de las mediciones / Cardiopulmonary exertion test in patients with chronic cardiac failure: comparison with normal people and reproducibility of measurements

The aim of this work was to measure oxygen consumption and carbon dioxide production during exercise in 21 subjects with cardiac failure and 13 normal subjects. During the resting period, subjects with cardiac failure had higher ventilatory frequency and respiratory quotient than normals. During maximal exercise, the former achieved higher ventilatory frequency and oxygen ventilatory equivalent than normals. In subjects with cardiac failure and normals, anerobic thresholds were 14,4ñ0,9 and 28,8ñ2,2 ml/kg/min respectively and peak oxygen consumptions 17,1ñ1 and 34,4ñ1,7 ml/kg/min respectively. There were less than 10 percent differences in parameters when tests were repeated in 10 subjects with cardiac failure. It is concluded that gas exchange testing may be a reliable and objective assessment method in patients with cardiac failure

Características clínicas y seguimiento alejado de pacientes con insuficiencia cardiaca durante infarto del miocardio: factores pronósticos de mortalidad / Clinical features and follow up of patients with heart failure during myocardial infarction: predictor factors of mortality

La insuficiencia cardiaca constituye unfactor de riesgo de mayormortalidad intrahospitalaria en pacientes con infarto agudo del miocardio (IAM). En el presente trabajo analizamos retrospectivamente las características clínicas y evolución alejada de pacientes que presentan congestión pulmonar durante la fase aguda del IAM y los comparamos con los que no presentaron esa complicación. Para ello utilizamos un abase de datos de 518 pacientes consecutivos con IAM, 309 de los cuales no presentaron congestión pulmonar (Grupo I, edad promedio 61 ñ 11 años) y 209 que deasrrollaron insuficiencia cardiaca Killip II oIII (Grupo II, edad promedio 63 ñ 11 años). Las siguientes características fueron significativamente diferentes entre ambos grupos (Grupo II vs Grupo I, p<0,01). Mortalidad a 30 días 17,4 vs 4,7 por ciento localización anterior del IAM 62 vs 52 por ciento , IAM transmural 83 vs 76 por ciento ; arritmias ventriculares 24,4 vs 12,5 por ciento . En la evolución alejada (promedio 44 meses) los pacienets del Grupo II tuvieron mayor mortalidad (25,9 vs 6,8 por ciento , p<0,01) al año post IAM y a los cinco años de seguimiento (34,9 vs 12,9 por ciento , p<0,01). Confirmamos así que los pacientes que presentan congestión pulmonar durante el curso de un IAM tienen una mayor morbimortalidad tanto precoz como tardía y ello se relaciona con mayor incidencia de IAM anterior y de tipo transmural

Trombólisis sistémica precoz en el infarto agudo del miocardio: resultados clínicos y angiográficos / Systemic early thrombolysis during myocardial infarction: clinical and angiographic results

Systemic thrombolysis is an effective therapy for acute myocardial infarction, since it restores coronary flow and contributes to preserve left ventricular function. We analyzeour experience with intravenous thrombolytic therapy in 45 cases with acute myocardialinfarction treated within 6 hours of onset of symptoms. 28 patients had anterior and 17 inferior myocardial infarction. We treated 38 patients with streptokinase 1 to 1,5 million units infused during a during a 30 to 60 minute period and 7 patients with tissue plasminogen activator factor, 100 mg infused during 2 hours. Regression of chest pain and ST segment elevation and early CPK peaking (< 4 hours) were utilized as criteria for reperfusion. Accordingly 20 patients (64%) met these criteria. Coronary angiogram ws performed within 7 days in 38 patients. It disclosed a patent coronary artery in the infarcted area in 28 cases (74%). Transient hypotension with thrombolytic therapy was observed in 17 patients (38%) and bleeding complications in 3 cases (7%). Two patients (4%) died early after therapeutic failure. In summary we have confirmed that intravenous thrombolytic therapy is safe and effective in the early period of myocardial infarction and that is associated with a high incidence of clinical and angiographic reperfusion