Efecto de la inmunidad celular en el tratamiento de las úlceras del pie diabético con Heberprot-P® / Effect of cellular immunity in the treatment of diabetic foot ulcers with Heberprot-P®

Introducción: Los diabéticos muestran una disminuida función del sistema inmune. Su complicación más temida es la aparición de las úlceras del pie. El Heberprot-P® tiene efectos beneficiosos en la curación de estas úlceras. Objetivo: Evaluar el efecto de la inmunidad celular en el tratamiento de las úlceras del pie diabético con Heberprot-P®. Métodos: Se realizó un estudio observacional, prospectivo, de serie de casos, en 30 pacientes con úlcera de pie diabético, ingresados en el Instituto Nacional de Angiología y Cirugía Vascular. Se administraron 75 µg de Heberprot-P®, tres veces por semana, a través de vías peri- e intralesional, durante ocho semanas. Se evaluaron las variables edad, sexo, glucemia en ayunas, creatinina, urea, ácido úrico, prueba de hipersensibilidad retardada, porcentaje de granulación, tiempo de cierre de la lesión y localización de la úlcera, antes de comenzar el tratamiento, a las 4 y 8 semanas. Resultados: Se precisó un predominio del 60 por ciento en el sexo femenino y del color de piel blanca. Los niveles de glucemia y creatinina se comportaron más elevados en los anérgicos; la urea fue similar tanto en anérgicos como en reactivos; y el ácido úrico resultó mayor en hombres reactivos y en mujeres anérgicas. Hubo mayor proporción de reactivos (63,6 por ciento), que en la cuarta semana presentaron un tejido de granulación igual o mayor al 50 por ciento; y a la octava, igual o mayor al 70 por ciento. Conclusiones: La condición en los pacientes diabéticos de ser reactivo a las pruebas de hipersensibilidad retardada con úlcera de pie diabético de tipo neuropática, tratados con Heberprot-P®, está asociada directamente con una mejor respuesta en la cicatrización de sus lesiones, mediante la formación del tejido de granulación, que favorece el cierre total o parcial de la lesión. Esto no ocurrió con los pacientes anérgicos a dicha prueba(AU)

Introduction: Diabetics show decreased immune system function. Its most feared complication is the appearance of foot ulcers. Heberprot-P® has beneficial effects in healing these ulcers. Objective: To assess the effect of cellular immunity in the treatment of diabetic foot ulcers with Heberprot-P®. Methods: An observational, prospective, case series study was conducted in 30 patients with diabetic foot ulcer admitted to the National Institute of Angiology and Vascular Surgery. 75 µg of Heberprot-P®, three times a week, were administered through peri- and intralesional routes, during eight weeks. The variables age, sex, fasting blood glucose, creatinine, urea, uric acid, delayed hypersensitivity test, percentage of granulation, time of closure of the lesion and location of the ulcer, before starting treatment, at 4 and 8 weeks were evaluated. Results: A predominance of 60 % in females and white skin color were specified. Blood glucose and creatinine levels behaved higher in the anergics; urea was similar in both anergics and reagents; and uric acid was higher in reactive men and anergic women. There was a higher proportion of reagents (63.6 por ciento), which in the fourth week presented a granulation tissue equal to or greater than 50 por ciento; and at the eighth week, it was equal to or greater than 70 por ciento. Conclusions: The condition of being reactive to delayed hypersensitivity tests in diabetic patients with diabetic foot ulcer of neuropathic type, treated with Heberprot-P® is directly associated with a better response in the healing of their lesions, through the formation of granulation tissue, which favors the total or partial closure of the lesion. This did not occur with patients who were anergic to this test(AU)

Validación de una escala rápida de satisfacción del paciente en urgencias / Validation of a fast scale patient´s satisfaction in emergencies

Introducción: la calidad de la atención puede medirse por la satisfacción del paciente por la atención recibida, por lo que es necesaria una escala rápida validada que la evalúe en los servicios de urgencias. Objetivo: crear y validar la Escala Rápida de Satisfacción del Paciente de Urgencias (ERSAPUR). Material y métodos: estudio de proceso, longitudinal, para evaluar la nueva escala de satisfacción en urgencias, en una unidad de segundo nivel de atención. Fase I: 10 expertos en calidad de atención y en urgencias elaboraron la ERSAPUR, que obtuvo acuerdo en redacción por 20 usuarios consecutivos. Fase II: con consentimiento informado, se aplicaron la ERSAPUR y la Encuesta de Satisfacción del Servicio de Urgencias del Hospital Universitari de Bellvitge de Barcelona en pacientes atendidos en urgencias, mayores de 18 años; se excluyeron los pacientes con enfermedad psiquiátrica, retraso mental, encefalopatía y no hispanohablantes. Se reaplicó la ERSAPUR telefónicamente 7 a 10 días después. Se utilizó para consistencia interna, alfa de Cronbach; para validez concurrente, rho de Spearman, y para prueba-reprueba el coeficiente de correlación intraclase (CCI), la p ≤ 0.05 se consideró significativa. Resultados: se encuestó a un total de 260 pacientes. La satisfacción mayor fue por la atención de médicos y enfermería, y la mayor insatisfacción por limpieza y tiempo de espera, alfa de Cronbach = 0.873, Spearman = 0.654, CCI = 0.75 (p ≤ 0.01). Conclusiones: la ERSAPUR es válida, consistente y útil para evaluar rápidamente la calidad de la atención en Urgencias.

Background: Quality of attention is assessed through patient´s satisfaction about attention received. A validated fast scale to asses it in emergency medical services is necessary. Aim: To design and validate the Patient Satisfaction at Emergency Services Scale (ERSAPUR). Methods: Longitudinal, process study to assess the new satisfaction scale at Emergency room in a second level attention unit. PHASE I: ERSAPUR was designed by 10 quality and emergencies attention experts; redaction was approved by 20 patients consecutively. PHASE II: After written consent, ERSAPUR and Encuesta de Satisfacción del Servicio de Urgencias del Hospital Universitari de Bellvitge de Barcelona scales were applied to patients attended at emergency room, more than18 years-old. Those patients with psychiatric disease, mental handicap or non-spanish parlor were excluded. ERSAPUR was reapplied by phone 7-10 days later. Cronbach´s alpha was used for internal fiability, Spearman´s rho for convergent validity, and Intraclass correlational coefficient (CCI) for test-retest; p ≤ 0.05 was considered significant Results: 260 patients answered both scales. Medical and nurses cares produced the highest satisfaction. Clean and waiting time produced the highest dissatisfaction. Cronbach´s Alpha = 0.873, Spearman´s rho = 0.654, CCI = 0.75 (p ≤ 0.01). Conclusion: ERSAPUR is a valid and fiable scale, and it´s a useful instrument to assess the quality of attention in Emergency room services.

El déficit de vitamina D en pacientes con espondiloartritis en un hospital de Castilla-La Mancha / Vitamin D deficiency in patients with spondylarthritis in a Spanish (Castilla-La Mancha) hospital

RESUMEN Introducción: Las espondiloartritis son un grupo de enfermedades inflamatorias crónicas con afectación principalmente del esqueleto axial y también de articulaciones periféricas. En cuanto al metabolismo óseo de estos pacientes, se ha observado en algunos estudios que existen niveles más bajos de vitamina D en pacientes con espondiloartritis. Objetivo: Estimar la prevalencia de déficit/insuficiencia de vitamina D, el metabolismo fosfocálcico y sus implicaciones en una cohorte de pacientes con espondiloartritis. Metodología: Estudio observacional, descriptivo y transversal. Se llevó a cabo una revisión retrospectiva de la base de datos de pacientes con espondiloartritis que fueron atendidos en las consultas externas del Servicio de Reumatología del Hospital General Universitario de Ciudad Real entre junio del 2018 y junio del 2019. Las variables se describieron usando medidas de frecuencia o medidas de tendencia central/dispersión según correspondiera. Resultados: Se analizaron 115 pacientes, de los cuales 64 fueron hombres y 51 mujeres, con una edad media de 45,97 años (± 13,41 DE). Del total de los pacientes, 59 presentaron espon dilitis anquilosante, 24 artropatía psoriásica, 9 artritis asociada a enfermedad inflamatoria intestinal, 12 espondiloartritis axial no radiográfica y 11 artritis reactiva. Los niveles de vitamina D fueron de 23,81 ng/ml (±10,5 DE), con un 77,4% de los pacientes con cifras de déficit/insuficiencia de vitamina D. Agrupados por el subtipo de espondiloartritis y según las cifras de déficit/insuficiencia de vitamina D, 45 pacientes tenían espondilitis anquilo sante, 19 artropatía psoriásica, 9 artritis asociada a enfermedad inflamatoria intestinal, 7 espondiloartritis axiales no radiográficas y 9 artritis reactivas. Además, el déficit de vita mina D (< 20 ng/ml) se presentaba la mayoría de las veces en las estaciones de primavera e invierno, con 31 y 26 pacientes respectivamente. Conclusiones: Una optimización de los niveles de vitamina D puede implicar una mejoría en la situación clínica del paciente, medida tanto por BASDAI y DAPSA como por PCR y VSG. En consecuencia, se recomienda la monitorización y suplementación de vitamina D en pacientes con hipovitaminosis D.

ABSTRACT Introduction: Spondyloarthritis is a group of chronic inflammatory diseases that mainly affect the axial skeleton, and also the peripheral joints. In bone metabolism studies on these patients, it has been observed that there are lower levels of vitamin D in patients with spondyloarthritis. Objective: To estimate the prevalence of vitamin D deficiency / insufficiency, as well as calcium/ phosphate metabolism and their implications in a cohort of patients with spondyloarthritis. Methodology: Observational, descriptive, and cross-sectional study. A retrospective review of the databases was carried out on patients with spondyloarthritis who were treated in the outpatient clinics of the Rheumatology Department of the General University Hospital of Ciudad Real between June 2018 and June 2019. Variables are described using frequency and central tendency / dispersion measurements as appropriate. Results: The study included 115 patients, of whom 64 were men and 51 women, with a mean age of 45.97 years (± 13.41 SD). They included 59 patients with ankylosing spondylitis, 24 with psoriatic arthropathy, 9 arthritis associated with inflammatory bowel disease, 12 non-radiographic axial spondylarthritis, and 11 reactive arthritis. Vitamin D levels were 23.81 ng/ml (± 10.5 SD), with 77.4% of patients with vitamin D deficiency / insufficiency levels. Grouped by the spondylarthritis subtype, and according to vitamin D deficiency / insufficiency, 45 patients had ankylosing spondylitis, 19 psoriatic arthropathy, 9 arthritis associated with inflammatory bowel disease, 7 non-radiographic axial spondyloarthritis, and 9 reactive arthritis. Furthermore, vitamin D deficiency (< 20 ng/ml) mainly occurred in the spring and winter seasons, with 31 and 26 patients, respectively. Conclusions: An optimization of vitamin D levels may lead to an improvement in the clinical situation of the patients, as measured by both BASDAI and DAPSA, as well as by PCR and ESR. Therefore, vitamin D monitoring and supplementation is recommended in patients with vitamin D deficiency.

Artritis reumatoide, una enfermedad sistémica con un riesgo cardiovascular subestimado / Rheumatoid arthritis; a systemic disease with an under-estimated cardiovascular risk

RESUMEN Objetivo: Determinar el riesgo cardiovascular y la prevalencia de factores de riesgo cardiovascular (RCV) en los pacientes con artritis reumatoide. Materiales y métodos: Estudio observacional, descriptivo y transversal, realizado en el Hospital General de Ciudad Real, entre junio de 2013 y mayo de 2014. Se realizó una analítica completa, se elaboró un perfil clínico, se calculó el SCOREm y se estratificó el RCV. Finalmente, se determinó la presencia de aterosclerosis subclínica mediante la realización de una ecografía carotídea. Resultados: 119 pacientes aceptaron participar en el estudio. Hubo una prevalencia del 73,1% de los factores de riesgo tradicionales, 6,72% había presentado un evento cardiovascular al momento del estudio, 22,68% poseía un infradiagnóstico de diabetes mellitus o nefropatía. La distribución final del RCV fue: riesgo bajo 46 (38,7%), riesgo intermedio 33 (27,7%), riesgo alto 2 (1,7%), riesgo muy alto 38 (31,9%). Conclusiones: Existe una alta prevalencia de factores de RCV y riesgo elevado infradiagnosticado en esta población. Por lo que si bien la artritis reumatoide se manifiesta de forma más aparente a nivel articular, ha de considerarse una enfermedad sistémica asociada a una mayor incidencia de eventos cardiovasculares.

ABSTRACT Objective: To determine the cardiovascular risk and the prevalence of cardiovascular risk (CVR) factors in patients with rheumatoid arthritis. Material and methods: Observational, descriptive and cross-sectional study performed in the General Hospital of Ciudad Real from June 2013 to May 2014. A complete laboratory analysis was performed, a clinical profile was prepared, the Systematic Coronary Risk Evaluation (SCOREm) was calculated, and the CVR was stratified. Finally, the presence of sub-clinical atherosclerosis was determined by performing a carotid ultrasound. Results: 119 patients accepted to participate in the study. There was a prevalence of 73.1% of traditional risk factors; 6.72% having had a cardiovascular event at the time of the study, and 22.68% had an underdiagnosis of diabetes mellitus and/or nephropathy. The final distribution of the CVR was: Low risk 46 (38.7%), intermediate risk 33 (27.7%), high risk 2 (1.7%), very high risk 38 (31.9%). Conclusions: There is a high prevalence of CVR factors and an elevated risk of underdiagnosis in the rheumatoid arthritis population. Therefore, although rheumatoid arthritis manifests itself more in the joints, it should be considered a systemic disease associated with a higher incidence of cardiovascular events.

Salvia divinorum: enigma psicofarmacológico y resquicio mente-cuerpo / Salvia divinorum: psychopharmacologicai enigma and the mind-body interstice

En el presente trabajo se considera la investigación multidisciplinaria sobre Salvia divinorum y sus principios químicos activos con el objeto de valorar si la etnobotánica, la fitoquímica, la psicofarmacología y la neurofarmacología de esta planta psicoactiva y su principal producto químico, la salvinorina A, clarifican sus efectos mentales y sus usos adivinatorios. Esta labor científica ha trascurrido desde el registro inicial de ceremonias y creencias, ha continuado con la identificación botánica, el aislamiento de los principios químicos, la caracterización de los efectos mentales y cerebrales, las posibles aplicaciones terapéuticas y ha llegado a incurrir en el problema mente-cuerpo. Dado que el punto de partida de esta investigación es la transdisciplina de la etnofarmacología, se retoman aquí las creencias tradicionales, los usos rituales y los efectos mentales de esta menta sagrada de los indios mazatecos tal y como fueron registrados durante un proyecto de campo y laboratorio llevado a cabo entre 1973 y 1983. Un brebaje acuoso de hojas maceradas produjo un breve periodo de ligereza cefálica, disforia, sensaciones táctiles y propioceptivas exacerbadas, un sentido de despersonalización, percepción amplificada de sonidos y un aumento de la imaginación visual y auditiva, pero no verdaderas alucinaciones. Posteriormente otros autores describieron efectos similares usando cuestionarios y eventualmente fueron imputados al diterpeno salvinorina-A, pero no es posible explicar los efectos mentales sólo por la potente actividad agonista del receptor kappa a los opioides encontrada para la salvinorina; de allí el enigma psicofarmacológico. Se proponen algunos requerimientos para una clasificación de drogas que alteran cualitativamente el estado de conciencia e incluyen la activación de redes neuronales que necesariamente comprenden diversos sistemas neuroquímicos y módulos nerviosos. Para caracterizar estas redes será necesario emprender un tipo de investigación top-down, es decir el análisis de imágenes cerebrales obtenidas durante la experiencia psicoactiva analizada mediante un método narrativo, lo cual eventualmente podría permitir la exploración de efectos étnicos diferenciales. Como sucede con otras preparaciones que alteran la conciencia, una investigación rigurosa de la psicofarmacología de esta planta y su principio psicoactivo será relevante a empresas académicas tan diversas como el problema mente-cuerpo, la mejor comprensión del éxtasis chamánico y la posible generación de fármacos analgésicos, antidepresivos y moderadores de la drogadicción.

In the present paper, the multidisciplinary research on Salvia divinorum and its chemical principles is analyzed regarding whether the ethnobotany, phytochemistry, psychopharmacology, and neuropharmacology of this sacred psychoactive plant and main principle clarify its experienced effects and divinatory uses. The scientific endeavor traverses from the recorded traditional ceremonies and beliefs, continues with the botanical identification, the isolation of active molecules, the characterization of mental and neural effects, the possible therapeutic applications, and impinges upon the mind-body problem. The departure point of this search is ethnopharmacology, and therefore the traditional beliefs, ritual uses, and mental effects of this Mazatec sacred mint recorded during a 1973-1983 field research project are described. A water potion of crushed leaves produced short-lasting light-headedness, dysphoria, tactile and proprioceptive sensations, a sense of depersonalization, amplified sound perception, and increased visual and auditory imagery, but no actual hallucinations. Similar effects were described using questionnaires and are attributable to the diteprene salvinorin A, but cannot be explained solely by its specific and potent brain kappa-opioid receptor agonist activity. Some requirements for a feasible classification and mechanism of action of consciousness-altering products are proposed and include the activation of neural networks comprising several neurochemical systems. Top-down analyses should be undertaken in order to characterize such neural networks and eventually allowing to explore the differential ethnic effects. As is the case for other consciousness-altering preparations, a careful and encompassing research on this plant and principle can be consequential to academic undertakings ranging from the mind-body problem and a better understanding of shamanic ecstasy, to the potential generation of analgesic, antidepressant, and drug-abuse attenuating products.

Síndrome posparo cardiaco / Post cardiac arrest syndrome

RESUMEN Antecedentes: La reanimación en el paro cardiaco con isquemia global logra restablecer la circulación espontánea en algunos pacientes; sin embargo, la sobrevida depende de muchos factores que explican el síndrome posparo cardiaco. El entendimiento y el control de estos factores durante la última década han logrado mejorar el pronóstico en un subgrupo de pacientes. Objetivo: Describir la fisiopatología y el manejo actual del síndrome posparo cardiaco. Metodología: Revisión narrativa de la literatura a través de las bases electrónicas de Medline vía PubMed y Ensayos Clínicos usando los términos MeSH Cardiac arrest -Cardiopulmonary Resuscitation y (el término no MeSH) Post cardiac arrest syndrome. Resultados: Los estudios clínicos han establecido una serie de protocolos y guías de manejo basadas en objetivos terapéuticos con tasas de sobrevida que superan el 50% de las víctimas de paro cardiaco. Conclusiones: Actualmente el manejo de este síndrome ha fortalecido el último eslabón de la cadena de supervivencia al estandarizar la evaluación y la selección de víctimas de paro cardiaco con un protocolo de hipotermia terapéutica e intervención coronaria percutánea precoz.

ABSTRACT Background: Resuscitation from cardiac arrest with global ischemia restores spontaneous circulation in some patients; however, survival depends on many factors associated with post cardiac arrest syndrome. During the last ten years, the understanding and control of these factors have improved the prognosis in a subgroup of patients. Objective: To describe the pathophysiology and current management of the post cardiac arrest syndrome (PCAS). Methodology: Narrative review of the literature using Medline via PubMed and Clinical Trials, using the terms MeSH cardiac arrest - Cardiopulmonary Resuscitation and (no term MeSH) Post cardiac arrest syndrome. Results: Clinical trials have established a set of management protocols and guidelines based on therapeutic objectives with survival rates exceeding 50% of the cardiac arrest victims. Conclusions: The management of this syndrome has actually strengthened the last link in the survival chain by standardizing the evaluation and selection of cardiac arrest victims via a therapeutic hypothermia protocol and early percutaneous coronary intervention.

Anestésicos locales: de los conceptos básicos a la práctica clínica / Local anesthetics: from basic concepts to clinical practice

Los anestésicos locales son ampliamente utilizados en la práctica clínica por médicos especialistas y no especialistas en diferentes escenarios clínicos, dentro y fuera de las salas de cirugía. Desde su introducción, han sido empleados fundamentalmente para bloquear la transmisión de los impulsos nerviosos en áreas específicas permitiendo la realización de procedimientos quirúrgicos y proporcionando analgesia. Los fármacos anestésicos locales disponibles hoy corresponden a dos categorías farmacológicas −aminoamidas y aminoésteres− y ejercen su efecto mediante la interacción con canales de sodio dependientes de voltaje, impidiendo la generación y propagación de potenciales de acción en los axones. Pese a la revolución lograda en la cirugía y anestesia y a la extensión de su empleo, es frecuente su uso inapropiado y pueden relacionarse con efectos adversos, toxicidad local, sistémica y reacciones alérgicas. Es fundamental el conocimiento de los aspectos farmacológicos más relevantes de los anestésicos locales con el objetivo de optimizar su empleo, mejorando la experiencia del paciente y minimizando las complicaciones relacionadas.

La respuesta emocional a la música: atribución de términos de la emoción a segmentos musicales / The emotional response to music: attribution of emotions words to musical segments

Even though music is usually considered a source of intense, diverse, and specific affective states, at the present time there is not a standardized scientific procedure that reveals with reliable confidence the emotional processes and events evoked by music. The progress in understanding musical emotion crucially depends in the development of reasonable secure methods to record and analyze such a peculiar and universally-sought affective process. In 1936 Kate Hevner published a pioneer study where she used a list of 66 adjectives commonly used to categorize musical compositions arranged in a circle of eight groups of similar emotions. The volunteers selected the terms that seemed appropriate to categorize their emotional experience while they listened to masterpieces by Debussy, Mendelssohn, Paganini, Tchaikovsky, and Wagner. The results were presented in histograms showing a different profile for each piece. Subsequent studies have advanced in the methods and techniques to assess the emotions produced by music but there are many still unresolved difficulties concerning the criteria to choose the musical pieces, the terms of emotion, the design of the experiment, the proper controls, and the relevant statistical tools to analyze the results. The present study was undertaken in order to test and advance an experimental technique designed to evaluate and study the human emotions evoked by music. Specifically, the study intends to prove if different musical excerpts evoke a significant agreement in the selection of previously organized emotion terms within a relatively homogeneous population of human subjects. Since music constitutes a form of acoustic language that has been selected and developed through millennia of human cultural evolution for the expression and communication of emotional states, it is supposed that there will be a significant agreement in the attribution of terms of emotion to musical segments among human evaluators belonging to a relatively homogeneous population. The attribution system allowed both to obtain objective responses derived from introspection and to analyze the data by means of an appropriate statistical processing of data obtained in groups of subjects submitted to carefully selected musical stimuli. Volunteer subjects were 108 college-level students of both sexes with a mean age of 22 years from schools and universities located in the central Mexico. The audition and attribution sessions lasted for 90 min and were conducted in a specially adapted classroom located in each institution. Four criteria were established for the selection of the musical excerpts: instrumental music, homogeneous melody and musical theme, clear and distinct affective tone, and samples of different cultures. The ten selected pieces were: 1. Mozart's piano concerto no. 1 7, K 453, third movement; 2. A sound of the magnetic spectra of an aurora borealis, a natural event; 3. Mussorgsky's Gnome, from Pictures at an Exhibition orchestrated by Ravel; 4. Andean folk music; 5. Tchaikovsky's Fifth Symphony, second movement; 6. << Through the Never>>, heavy metal music by Metallica; 7. Japanese Usagi folk music played with koto and shyakuhachi; 8. Mahler's Fifth Symphony, second movement; 9. Taqsim Sigah, Arab folk music played with kamandja, and 1 0. Bach's Inventions in three parts for piano, BMW 797. The selected fragments and their replicas were divided in two to five musically homogeneous segments (mean segment duration: 24 seconds) and were played in different order in each occasion. The segments were played twice during the test. During the first audition, the complete piece was played in order for the subjects to become familiar with the composition and freely express their reaction in writing. During the second hearing, the same piece was played in the separate selected segments and the volunteers were asked to choose those emotion-referring terms that more accurately identified their music-evoked feelings from an adjunct chart obtained and arranged from an original list of 328 Spanish words designing particular emotions. The terms had been previously arranged in 28 sets of semantically related terms located in 14 bipolar axes of opposing affective polarity in a circumflex model of the affective system. The recorded attributions from all the subjects were captured and transformed into ranks. The non-parametric Friedman test of rank bifactorial variance for k related samples was selected for the statistical analysis of agreement. All the data were gathered in the 28 categories or sets of emotion obtained in the previous taxonomy of emotion terms and the difference among the musical segments was tested. The difference was significant for 24 of the 28 emotional categories for α=0.05 and 33 degrees of freedom (Fr ≥43.88). In order to establish in which segments were the main significant differences, the extension of the Friedman test for comparison of groups to a control was undertaken. Thus, after applying the appropriate formula, a critical value of the difference - R1 - Ru - was established at ≥18.59. In this way it was possible to plot the significance level of all 28 emotion categories for each music segment and thereby to obtain the emotion profile of each selected music fragment. The differences obtained for the musical pieces were established both for the significant response of individual emotion, groups of emotions, and the global profile of the response. In all the pieces used, one or more terms showed significance. Sometimes as many as seven terms appear predominant (Mahler, Mozart). In contrast other segments produce only one or two responses (aurora borealis, Arab music). In most musical segments there were null responses implying that there was an agreement concerning not only the emotions that were present, but also those that did not occur. Concerning the global response, there were several profiles recognizable among different pieces. The histogram is slanted to the left when positive and vigorous emotions are reported (Tchaikovsky, Bach). The predominance of emotions in the center-right sector corresponds to negative and quiet emotions (Arab music) or in the fourth sector of negative and agitated emotions (Mahler). Sometimes a <> shaped profile was obtained when vigorous emotions predominated (Mahler, Metallica). A bell-shaped response was obtained when calm emotions were reported, both pleasant and unpleasant (Japanese music). There is also music that globally stimulates one of the four quadrants defined in the affective circle, such as pleasant (Mozart), unpleasant (Mussorgsky), exciting (Metallica) or relaxing emotions (Japanese music). The only segment that produced scattered responses in the four sectors of emotions was the aurora borealis. Very similar profiles were obtained with very different pieces, such as the identical responses to Mozart and Andean music. It is necessary to analyze the individual emotion terms to distinguish them. Several common characteristics can be detected in these two pieces, such as fast speed in tempo allegro, binary rhythm, counterpoint figures, and ascending melody, well known features in music composition. In contrast other segments evoked unpleasant responses (Mussorgsky), where fear, tension, doubt or pain was reported. The listener probably concedes a high value to a piece that evokes emotions that normally avoids in the context of a controlled artistic experience.

Neurobiología de las emociones morales

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Summary This work presents a critical review of the historical, theoretical, and neurobiological bases of the theory of moral emotions. Neuroimaging methods and protocols used to study the neural correlates of moral emotions and the analysis of the brain functions involved in their processing, permit the formulation of hypotheses that attempt to understand some emotional and cognitive processes related to moral emotions. One such hypothesis refers to a neuro-matrix involving sensory systems, brainstemmediated physiological reactions and frontal brain regions processing the interaction between moral and emotional stimuli. Cross-cultural research on human facial expression has identified universal patterns to express basic emotions such as fear, anger, or happiness. Nevertheless, the experience of some emotions and their facial expressions are regulated by social and cultural mechanisms. This type of regulation is observed in moral emotions since they are linked to the interests or welfare either of society as a whole, or of persons other than the judge or agent. Two typical features that identify moral emotions are their typical elicitors and tendencies towards specific actions. The release of a moral emotion is the perception of implicit and explicit violations of social norms and stereotypes included in personal codes, attitudes, and beliefs. In turn, the actions ensuing from moral emotions are communal or prosocial, because they promote a benefit in others and/or in the social order. Although there is not a definitive taxonomy of moral emotions, four families of prosocial feelings are suggested: a) other-condemning emotions (contempt, anger, disgust); b) self-conscious emotions (shame, embarrassment, guilt); c) other-suffering emotions (compassion); d) other-praising emotions (gratitude, awe, elevation). Such emotions are relevant to the concept of morality because this is a complex representation that includes models of prohibited actions, notions of good and bad, concepts of fairness, ideals of justice, or justifications of punitive actions. Moreover, the cognitive processes and behaviors involved in moral emotions are related to the theory of mind that refers the ability to represent the mental and emotional states of others, such as their thoughts, desires, beliefs, intentions, and knowledge. The neurobiological substrate of this capacity involves cerebral regions related to the experience of basic emotions, such as the amygdala and the cingulated cortex, and regions related to complex cognition and emotional-social contexts, such as the prefrontal cortex and the superior temporal sulcus. Neurobiological approaches to moral emotions have become relevant to study psychopathologies linked to antisocial behaviors, particularly the psychopathic or Antisocial Personality Disorder. Psychopaths show decreased emotional and physiological reactions to emotional stimuli and deficiencies to identify emotional expressions. However, they do not fail to represent or to infer others mental states or theory of mind. Therefore, the psychopathic disorder is not only linked to distortions in interpreting socially-learned moral values, but also to alterations of cognitive processes required to link the affective system to moral values. This assumption is supported by brain-imaging studies demonstrating the involvement of areas associated to the processing of complex social stimulus and language, such as prefrontal cortex, orbitofrontal cortex, polar frontal cortex, and anterior temporal lobe in psychopathic patients. The affected areas also include regions such as the amygdala, ventromedial hypothalamus, thalamus, and caudate nucleus involved in the experience or expression of emotions. Scientific publications directly referring to the neurobiological research of moral emotions and the evaluation of moral judgments occupy a period between 2001 and 2005. The neurobiology of moral emotions has evolved rapidly by the use neuro-imaging techniques such as Functional Magnetic Resonance Imaging (fMRI) and Positron Emission Tomography (PET). Brain images related to moral emotions are obtained by the use of moral stimuli in three types of situations: (a) while subjects resolve cognitive tasks, for example, reading moral emotional statements, (b) during passive or instructed viewing of affective pictures, or (c) during the resolution of moral dilemmas. The brain areas that become significantly active during these tasks provide a neurobiological interpretation of the mental operations involved in moral emotions. Thus, the medial frontal gyrus is activated during the elaborate personal and impersonal moral judgments produced by viewing moral pictures, attributing intentionality of movement, processing of facial expressions, and during the attribution of mental states (theory of mind). The posterior cingulated, restrosplenial, and precuneus cortex are associated with the elaboration of moral judgments elicited by viewing moral pictures and theory of mind. The superior temporal sulcus and the parietal lobe are related with moral judgments while viewing moral and emotional pictures and films, and attributing intentional movements. The superior temporal sulcus is also associated with the processing of social contexts. Orbitofronal and ventromedial frontal cortex is associated with the processing of simple moral judgments while viewing moral pictures, the evaluation of emotionally-charged social events, during empathy and attribution. The temporal pole is also associated with theory of mind, the elaboration of simple moral judgments and with the recalling of emotional situations. The amygdala is activated during the processing of moral pictures and social events based on facial expressions. Other empirical investigations involving a moral interpretation of data such as studies of general emotions, empathy, theory of mind, neurological disorders, and antisocial behavior, are also relevant to understand the brain activation patterns associated to cognitive and emotional social functions. Working models of psychopathologies that manifest antisocial behaviors are also required to interpret neuroimaging data. Meta-analyses of human behavior and proto-moral behavior in non-human species related to the elaboration of moral judgments and emotions are also relevant for the same purpose. Finally, moral emotion research requires the elaboration of accurate protocols based on psychological approaches directed to elicit particular moral emotions which enable the definition and neural substrates of its specific qualities.

La ordenación piramidal del cerebro y el enjambre de la conciencia. Segunda parte

resumen está disponible en el texto completo

Abstract: The present paper offers a particular emergence, dual aspect, and dynamic system theory of the neural correlate of consciousness. The theory is grounded on two successive hypotheses supported with empirical evidences and concepts from the neurosciences, approximations to the sciences of complexity, and philosophical arguments. The first hypothesis is that consciousness emerges along with the highest level of brain function, i.e., at the intermodular domain of the whole organ. This hypothesis is upheld by two necessary requisites; the first is the generalized impression in neuroscience of the brain as an information-handling device, and that this property enables every mental activity, including consciousness, to take place. This concept is verified on several empirical grounds. If we take the synapse as a binary code of information, the computation capacity of the brain is in the order of 100 million Megabits. Even such enormous figure is limited and misleading because the synapse manifests not only two, but three possible informational states (excitation, rest, and inhibition), because there are subliminal potentials, and also a compact intracellular information machinery. Moreover, the informational requirement of consciousness is accurately delivered by Kuffler and Nichols' five ruling principles of brain function: (1) The brain uses electrical signals to process information; (2) Such electrical signals are identical in all neurons; (3) The signals constitute codes of codification and representation; (4) The origin and destiny of the fibers determines the content of information; (5) The meaning of the signals lies in the interactions. Even though the reference to representation, content, and meaning implies higher cognitive properties, it seems necessary to add a sixth principle for a more judicious neural implication in regard to consciousness. This principle is that information is processed in the brain in six levels of complexity, undergoing a gradual gain in density, integration, congruity, and capacity in each consecutive stratum. The six levels are the following: (1) Organismic, the integration of the nervous system with the rest of the organism systems; (2) Organic, the integration of the different modules in the whole brain; (3) Modular, the set of brain modules and their interconnections; (4) Intercellular, the designs and functional bindings among neuron cells; (5) Cellular, the set of brain cells, particularly neurons; (6) Molecular, the chemical components that mediate the transmission of information. In this fashion, the second requisite to uphold the emergence of consciousness lies in establishing that the different levels of brain organization constitute a pyramidal arrangement. Certainly, the number of elements is greater in the lower levels, while the integration of information is progressively enhanced in the upper levels. Moreover, this neuropsychological pyramid insinuates both an ascending cascade whereby the lower orders stipulate and influence the upper ones, and a progressive and convergent functional enrichment ultimately resulting in the qualia, feeling, and awareness attributes of consciousness. Information flows horizontally in each level, but it also overflows vertically in both directions. This pyramidal scheme is applied to clarify two parti cular aspects of brain function that are closely linked to consciousness: the electrical activity and the engram of memory. Such inquiry makes clear that a qualitative jump manifested by the emergence of various and dissimilar novelties occur at each layer of brain operation based upon a mass coordination. It seems feasible to envision the engram, and conceivably every other mental representation, as a plastic pattern involving all levels and aspects of brain operation, including the pinnacle where consciousness consolidates as the subjective aspect of the uppermost brain function. As a result of the proposed stratified and pyramidal scheme of brain functions, the first hypotheses is strengthened and specified. Thus, presumably consciousness and the neural capacities correlated to it constitute two associated aspects emerging from such particular functional hierarchy at the organic level of the brain by the efficient connection of its modules. It would not be required that all the modules of the brain become interrelated during a conscious processing, but that they would be functionally available while some of them become progressively active by intermodular articulation thereby making possible the arising and unfolding of conscious mental operation streams. In order to reinforce this notion the visual system is invoked since the scene that is consciously perceived emerges from the coordination of some 40 modules that separately appear to operate unconsciously. At the moment that such high-hierarchy and complex function presumably appears, it would achieve a conscious correlate and become altogether able to exert a descending causality and supervene the operation of the lower orders, which, among other capacities, would permit voluntary action to take place. In order to specify the first hypothesis asserting that consciousness emerges at the organic level of the brain along with the proficient inter-modular connectivity, a second hypothesis is formulated and justified in neuroanatomical, neurophysiological, and complexity science terms. The supposition is that the specific neural correlate of consciousness may be a function similar to a bird flock or an insect swarm orderly binding the operations of different modules in a cinematic, hipercomplex, coherent, and synchronic stream. The human brain contains some 400 cortical and subcortical modules functioning as partially specialized stations that potentially interchange particularly codified information through some 2500 fibers or intermodular pathways. The hypothesis requires that information complexity undergoes a further and substantial gain of attributions through the concise and prolific connectivity of the different modules. In this regard, it is supposed that a stream of coherent activation is constituted in the conscious brain by the intermodular dynamics and that such dynamics may acquire global patterned properties in a simi lar way as bird flocks and so-called intelligent swarms achieve unanimously shifting dynamics. This particular idea is supported with complexity science models of the remarkable performances of large groups of birds and insects and with the known behavior of massive populations of neurons. In so far as this would be a complex function operating at the limits of equilibrium resulting from local dynamics of the brain subsystems, the self-organization of high level brain functions justifies the notion that a dynamic coupling among modules can and may result in complex cognitive properties and consciousness. Intermodular brain dynamics is conceived here as an emergent, unbound, synchronic, hypercomplex, highly coherent, and tetradimensional process capable to navigate, steer, swirl, split, and flow throughout the brain and thereby connect very diverse systems in a fast and efficient manner. In the same way, its putative subjective correlate, the conscious process, can be conceived as an emergent, voluntary, unified, qualitative, and narrative process capable to access, coordinate, and integrate multiple local information mechanisms. The hypothesis poses that the conscious transformation of information is correlated, moment to moment and point to point, with the intermodular processing that evolves in the manner of a bird flock or swarm dynamics. It is finally posed that brain intermodular dynamics correlated to consciousness consolidates by the convergence of an ascending bottom-up organization of the different ranks of brain operation, and by the descending top-down influx of the social, cultural, and environmental information where the individual is immersed.

La ordenación piramidal del cerebro y el enjambre de la conciencia. Primera parte

resumen está disponible en el texto completo

Abstract: The present paper offers a particular emergence, dual aspect, and dynamic system theory of the neural correlate of consciousness. The theory is grounded on two successive hypotheses supported by empirical evidences and concepts from the neurosciences, approximations to the sciences of complexity, and philosophical arguments. The first hypothesis is that consciousness emerges along with the highest level of brain function, i.e., at the intermodular domain of the whole organ. This hypothesis is upheld by two necessary requisites. The first is the generalized impression in neurosciences of the brain as an information-handling device, and that this property enables every mental activity, including consciousness. This concept is verified on several empirical grounds. If we take the synapse as a binary code of information, the computation capacity of the brain is in the order of the 100 million megabits. Even such an enormous figure is limited and misleading because the synapse manifests not only two, but three possible informational states (excitation, rest, and inhibition), because there are subliminal potentials, and also a compact intracellular information machinery. Moreover, the informational requirement of consciousness is accurately delivered by Kuffler and Nichols' five ruling principles of brain function: 1. The brain uses electrical signals to process information; 2. such electrical signals are identical in all neurons; 3. the signals constitute codes of codification and representation; 4. the origin and destiny of the fibers determines the content of information; 5. the meaning of the signals lies in the interactions. Even though the reference to representation, content, and meaning implies higher cognitive properties, it seems necessary to add a sixth principle for a more judicious neural implication in regard to consciousness. This principle is that information is processed in the brain in six levels of complexity, undergoing a gradual gain in density, integration, congruity, and capacity in each consecutive stratum. The six levels are the following: 1. organismic, the integration of the nervous system with the rest of the organism systems; 2. organic, the integration of the different modules in the whole brain; 3. modu lar, the set of brain modules and their interconnections; 4. intercellular, the designs and functional bindings among neuron cells; 5. cellular, the set of brain cells, particularly neurons; 6. molecular, the chemical components that mediate the transmission of information. In this fashion, the second requisite to uphold the emergence of consciousness lies in establishing that the different levels of brain organization constitute a pyramidal arrangement. Certainly, the number of elements is greater in the lower levels, while the integration of information is progressively enhanced in the upper levels. Moreover, this neuropychological pyramid insinuates both an ascending cascade whereby the lower orders stipulate and influence the upper ones, and a progressive and convergent functional enrichment ultimately resulting in the qualia, feeling, and awareness attributes of consciousness. Information flows horizontally in each level, but it also overflows vertically in both directions. This pyramidal scheme is applied to clarify two parti cular aspects of brain function that are closely linked to consciousness: the electrical activity and the engram of memory. Such inquiry makes clear that a qualitative jump manifested by the emergence of various and dissimilar novelties occur at each layer of brain operation based upon a mass coordination. It seems feasible to envision the engram, and conceivably every other mental representation, as a plastic pattern involving all levels and aspects of brain operation, including the pinnacle where consciousness consolidates as the subjective aspect of the uppermost brain function. As a result of the proposed stratified and pyramidal scheme of brain functions, the first hypotheses is strengthened and specified. Thus, presumably consciousness and the neural capacities correlated to it constitute two associated aspects emerging from such particular functional hierarchy at the organic level of the brain by the efficient connection of its modules. It would not be required that all the modules of the brain became interrelated during a conscious processing, but that they would be functionally available instead, while some of them become progressively active by intermodular articulation, thereby making possible the arising and unfolding of conscious mental operation streams. In order to reinforce this notion, the visual system is invoked since the consciously perceived scene emerges from the coordination of some 40 modules that separately appear to operate unconsciously. At the moment that such high-hierarchy and complex function presumably appears, it would achieve a conscious correlate and become altogether able to exert a descending causality and supervene the operation of the lower orders, which, among other capacities, would permit voluntary action to take place. In order to specify the first hypothesis, asserting that consciousness emerges at the organic level of the brain along with the proficient intermodular connectivity, a second hypothesis is formulated and justified in neuroanatomical, neurophysiological, and complex scientific terms. The supposition is that the specific neural correlate of consciousness may be a function similar to a bird flock or an insect swarm orderly binding the operations of different modules in a cinematic, hipercomplex, coherent, and synchronic stream. The human brain contains some 400 cortical and subcortical modules functioning as partially specialized stations that potentially interchange particularly codified information through some 2500 fibers or intermodular pathways. The hypothesis requires information complexity undergoing a further and substantial gain of attributions through the concise and prolific connectivity of the different modules. In this regard, it is supposed that a stream of coherent activation is constituted in the conscious brain by the intermodular dynamics and that such dynamics may acquire global patterned properties in a simi lar way as bird flocks and so-called intelligent swarms achieve unanimously shifting dynamics. This particular idea is supported with complex scientific models of the remarkable performances of large groups of birds and insects and with the known behavior of massive populations of neurons. In so far as this would be a complex function operating at the limits of equilibrium resulting from local dynamics of the brain subsystems, the self-organization of high level brain functions justifies the notion that a dynamic coupling among modules may result in complex cognitive properties and consciousness. Intermodular brain dynamics is conceived here as an emergent, unbound, synchronic, hypercomplex, highly coherent, and tetradimensional process capable to navigate, steer, swirl, split, and flow throughout the brain and thereby connect very diverse systems in a fast and efficient manner. In the same way, its putative subjective correlate -the conscious process- may be conceived as an emergent, voluntary, unified, qualitative, and narrative process capable to access, coordinate, and integrate multiple local information mechanisms. The hypothesis poses that the conscious transformation of information is correlated, moment to moment and point to point, with the intermodular processing that evolves in the manner of a bird flock or swarm dynamics. It is finally posed that brain intermodular dynamics correlated to consciousness consolidates by the convergence of an ascending bottom-up organization of the different ranks of brain operation, and by the descending top-down influx of the social, cultural, and environmental information where the individual is immersed.

La identidad del dolor; ¿lesión, congoja, lamento o neuromatríz?

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Abstract: This article formulates a perceptual and representational theory of pain that requires a second-person epistemology that is optimally compatible with a dual aspect theory of consciousness calling for progressive psychophysical correlations. The identity of pain, taken as a peculiar state of consciousness, is explored in physiological, phenomenological, epistemological, and ontological terms. At the same time, and following the leads of philosophers of mind, pain is used to stipulate and examine the main current mind-body theories. The current definitions are unsatisfactory because it is not possible to identify the nature of pain with words beyond asserting that it is an unpleasant sensation resulting from a body injury. The usual definitions of pain accept that it is a conscious phenomenon that has well-established physiological foundations, except for its precise brain representation. Indeed, the phenomenological physiology of pain is known from the nociceptive receptors, the peripheral pathways and their central relays up to the thalamus and cerebral cortex. The somatosensory cortex, parieto-limbic, and anterior cingular sections of the cortex are involved in the central neuromatrix of pain, a concept that entails a functional binding among different sensory, cognitive, affective and volitional areas necessarily involved in the central representation of pain. A purely sensorial conception of pain is incomplete because it usually constitutes a legitimate perception in the sense that pain is the conscious representation of a bodily lesion subjected to different degrees of appraisal, knowledge, and understanding. Furthermore, as it occurs with every perception, in the case of pain there are illusions (referred pain), hallucinations (phantom limb pain), cognitive influences (the analgesia of the athlete and soldier), semantic components and pathologies where stimulus and representation can be dissociated. Phantom limb pain suggests that receptors and peripheral signals do not only activate the neuromatrix, but that it activates itself generating a pain experience without external stimuli. Upon these physiological and cognitive bases it is proposed that pain is the subjective representation of a bodily injury. The representation is composed of six different aspects: the sensitive (quale of pain sensation), affective (aversive and disturbing emotion), cognitive (recognition of the lesion), volitional(intending the actions), behavioral (movement, gesture, exclamation), and cultural (modulation according to beliefs and social learning of rules). The different components are linked in different ways to construct a complex representation where each one appears as physical and mental, neurophysiological and conscious. Different combinations of the various elements are the bases to build a medical taxonomy in classes such as "angina," "migraine," "colic," "trigeminal neuralgia," "lumbago," or "radicular pain." The spatial location of pain is baffling because even though it is referred to the site of the lesion, the neuroscience concept is that it is not there, but in the brain, creating an incongruity between phenomenological experience and scientific evidence. The perceptual and representational theory of pain solves this discrepancy but also opens the possibility that consciousness may cover more bodily territory than a restricted neuromatrix. The phenomenology of pain is difficult to establish because painful qualia are ineffable. In order to explore the phenomenology of pain, the Diario del dolor (Journal of Pain) by Mexican writer María Luisa Puga is used in the present article. In this journal pain appears as a foreign and invasive factor producing fear and forcing consciousness to focus on the discomfort, incapable of habituation to the affliction. Multiple strategies to deal with pain are set in operation. Pain acquires a face, a body, and a personality. Accepting pain implies to conceptualize it as an enemy that can be understood and with whom is possible to confer. Self-consciousness deteriorates and the narrator dos not recognize herself in the mirror, she has lost past and future, there is only a present with pain. The existence has become insipid and it is necessary to deal with dejection, depression, and defeat. Finally pain is recognized as intrinsically human and Puga's Journal underlies that the private and lonely experience of pain that a person experiences using multiple coping strategies may result in considerable understanding and dignity. From such a first person perspective, pain is confirmed to be a very complex experience where consciousness kindles unusual faculties, demands extraordinary resources, and stages costly battles. The epistemology of pain can be tackled from first, second, and third person perspectives. Since the subjective nature of pain is insuperable, the essential core of pain is the private experience reclaimed and expressed as a symptom by a subject. Nevertheless, from such first person perspective it is possible to describe, analyze, and evaluate the experience with phenomenological tools. Third person perspective means to be objective about the subjective symptom and it takes recourse in semiology and pathological correlations in order to reach a diagnosis. Usually first and third person perspectives are taken to be unfitting. From a methodological point of view there is no contradiction between these two falsely separated perspectives since what normally occurs is a face to face interaction calling for a second person perspective. From this methodological position pain consciousness overflows towards another person and ceases to be a private phenomenon acquiring an expressive and communicative aspect between the patient and the analyst gathering information through dialog and anamnesis. The second person perspective is based on the solicitation of help, and relief in the part of the patient, and the provision of attention, care, compassion, and therapy in the part of the supporter. A second person perspective acquires meaning in the interview, consultation and face-to-face dialog so that an adequate understanding aims at the subjective well being even before the cure of the injury. The ontological identity of pain is analyzed in neurobiological terms and philosophical theories. Identity theory poses that pain is a specific physiological state, such as the activation of pain fibers, brain centers, or a neuromatrix that may be species-specific. Nevertheless the identity theory appears deficient since pain is general to many species with different nervous systems, and because there is an explanatory gap between phenomenological qualia and neurophysiological mechanism that remains obscure. The theory of emergence is also formulated and it becomes apparent that it is necessary to identify the nature of the emergent property in order to become testable. Finally dual-aspect theory is proposed as the most satisfactory to understand the nature of pain. This theory implies the emergence of a high level of nervous integration that, because of its inherent complexity acquires a subjective qualitative aspect. Even though the precise nature of the aspectual shape of pain also remains blurred, the theory heuristically calls for correlations and not a reduction between phenomenological and neurophysiological aspects of pain. Such correlations are open to continuous scientific exploration and they may constitute psychophysical laws. This formulation is compatible with the perceptual and representational theory of pain and it requires the methodological approach of the second person perspective.

Quiste pericárdico gigante en el adulto: reporte de 1 caso / Giant pericardial cyst in the adult: a case report

Se presenta una paciente de 62 años de edad con un quiste pericárdico celómico gigante sintomático. A pesar de tener 2 400 mL de líquido en su interior fue un diagnóstico fortuito en la radiografía de tórax. Se trató quirúrgicamente y tuvo una evolución satisfactoria(AU)

A 62 year-old-patient with a giant symptomatic pericardial coelomic cyst is presented. Despite having 2 400 mL of fluid in its interior, he had a fortuitous diagnosis in the chest X-rays. He was surgically treated and had a satisfactory evolution(AU)

La estructura de la emoción humana: un modelo cromático del sistema efectivo / The structure of human emotions: a chromatic model of the affective system

Hay dos aproximaciones y esquemas distintos para clasificar las emociones humanas. Uno de ellos es la identificación de las variables o dimensiones fundamentales del sistema afectivo y el otro es el reconocimiento de las emociones primarias mediante el análisis de los gestos faciales universales. Planteamos aquí un esquema que pretende conjuntar las dos aproximaciones y que se deriva de las técnicas usadas para clasificar los colores. El modelo topológico resultante se basa en un análisis metódico, constructivo y progresivamente empírico del vocabulario emocional. Se plantea que la identificación de las palabras que directamente denotan emociones específicas y de sus relaciones de significado detectadas por encuestas es una ruta válida de inquisición sobre la estructura del afecto.El ejercicio consta de seis estadios consecutivos: 1) La recopilación de un vocabulario de 328 términos en castellano que designan emociones particulares; 2) la agrupación de los términos en 28 conjuntos o "campos semánticos" de 6 a 17 palabras afines (media = 12); 3) la selección de un término representativo de cada conjunto; 4) la ordenación de los términos de cada conjunto según la intensidad de la emoción que designan; 5) la identificación de pares de conjuntos antónimos o de signo contrario (agradable-desagradable) y, con ello, el establecimiento de 14 ejes polares de la emoción humana (calma-tensión, certeza-duda, compasión-ira, diversión-aburrimiento, agrado-desagrado, alegría-tristeza, placer-dolor, satisfacción-frustración, deseo-aversión, amor-odio, valor-miedo, vigor-agotamiento, entusiasmo-apatía, altivez-humillación) y 6) la elaboración del modelo actual del sistema afectivo como un círculo o rueda con los 14 ejes ubicados como ejes de carreta que por afinidades se colocan en un sistema ortogonal de las dos coordenadas mejor establecidas del afecto: una vertical que especifica el tono agradable o desagradable y otra horizontal de relajación o excitación. De esta forma cada uno de los términos de la emoción queda ubicado en un espacio cartesiano.Aunque el modelo es preliminar y requiere de mayor validación empírica se presenta como lícito y verosímil en lo general, y en particular en lo que se refiere a la estrategia constructiva utilizada para obtenerlo. Este modelo sugiere la existencia de sistemas neurofisiológicos relativamente delimitados y mutuamente inhibitorios cuya actividad y equilibrio se correlacione con las emociones de un eje determinado.

Estrategia en el cáncer de esófago torácico y cardias irresecable / Strategy in the cancer of thoracic esophagus and cardias irresecable

Se presenta la estrategia ante el cáncer de esófago irresecable y se exponen los resultados en 24 enfermos con mal estado general, en los que se utilizó prótesis transtumorales, combinada en 8 casos previamente con infiltración de alcohol absoluto al tumor, sin presentar mortalidad quirúrgica y una supervivencia del 75 por ciento a los 6 meses y del 33,3 por ciento al año. Todos los enfermos tuvieron control endoscópico previo, utilizando el método de tracción en la colocación de la prótesis(AU)

The authors present the strategy used in the non-resectable esophagus cancer and show the results obtained in 24 patients with a poor general state, among whom transtumor prostheses were utilized. These prostheses were previously combined with infiltration of absolute alcohol to the tumor in 8 cases. There was no surgical mortality and it was attained a survival of 75 percent at 6 months and of 33.3 percent at a year. All patients had a previous endoscopic control. Prostheses were placed by using the traction method(AU)

Ligadura de las arterias hipogástricas de urgencia / Ligation of hypogastric arteries in emergency situations

Se reportan 13 enfermas con ligadura de arterias hipogástricas de urgencia durante 1996 y 1998. Las causas más frecuentemente diagnosticadas fueron el cáncer de cuello uterino sangrante y la sepsis puerperal, en este último complementado con histerectomía abdominal. No se presentaron complicaciones en el procedimiento quirúrgico. Se obtuvieron óptimos resultados al controlar el sangramiento presente o evitar que éste se produjera(AU)

Hypogastric artery ligation under emergency situations was applied in 13 female patients during 1996 and 1998. The most frequent causes were the bleeding cervix carcinoma and peripheral sepsis, the latter being combined with abdominal hysterectomy. No complications were found in the original procedure. Optimal results in controlling bleeding or preventing it were obtained(AU)

Empiema pleural: Resultados del tratamiento en el Hospital Clinicoquirúrgico Docente "Comandante Manuel Fajardo

Se realizó un estudio prospectivo de 15 pacientes con empiema pleural, ingresados en el Hospital Clinicoquirúrgico Docente "Comandante Manuel Fajardo", en el período de enero de 1995 a diciembre de 1997. La forma aguda se presentó en 5 enfermos, mientras que la crónica se presentó en 10. La neumopatía inflamatoria fue la causa más frecuente. La mayoría fue tratada con combinaciones de antibióticos betalactámicos y aminoglucósidos, complementada con terapéutica quirúrgica. En la forma aguda resultó útil el lavado pleural, mientras que en la crónica el proceder más utilizado fue la decorticación, seguido de la ventana torácica y la resección pulmonar. Sólo falleció un enfermo con un cáncer de pulmón avanzado.

A prospective study of 15 patients with pleural empyema admitted at the "Comandante Manuel Fajardo" Clinical and Surgical Teaching Hospital from January, 1995, to December, 1997, was conducted. The acute form was observed in 3 patients and the chronic form in 10. The inflammatory neumopathy was the most frequent cause. Most of the patients were treated with combinations of lactam and amynoglycoside antibiotics, complemented with surgical therapeutics. In the acute form pleural lavage proved to be useful, whereas in the chronic form the most used procedure was decortication, followed by thoracic window and pulmonary resection. Only one patient died with advanced lung cancer.

Organización y resultados de la cirugía torácica en el Hospital Clinicoquirúrgico Docente "Comandante Manuel Fajardo

Se realiza un estudio de 191 pacientes a los que se les realizó algún proceder quirúrgico por afecciones torácicas, en el Hospital Clinicoquirúrgico Docente "Comandante Manuel Fajardo" durante el período de enero de 1995 a diciembre de 1997, lo que representó el 3,2 % de las operaciones mayores. El 8,79 % de los enfermos correspondió al sexo masculino con una relación de 5:1 con el femenino. El neumotórax y los cáncer de pulmón, esófago y cardias y las supuraciones pleuropulmonares fueron las afecciones más frecuentes. Las enfermedades malignas estuvieron presentes en el 27,2 % de los operados con una mortalidad quirúrgica general de 3,6 %, y predominaron las complicaciones cardiovasculares como causa de muerte. Se comprobó un incremento del doble de las intervenciones quirúrgicas del tórax desde la organización del grupo multidisciplinario.

A study of 191 patients who underwent some surgical procedure due to thoracic affections at the "Comandante Manuel Fajardo" Clinical and Teaching Hospital from January, 1995. To December, 1997, was conducted. This accounted for 3.2 % of major operations. 8.79 % of the patients were males. There was a relation of 5:1 with females. The pneumothorax, lung and esophagus cancer, cardia and pleuropulmonary suppurations were the most frequent affections. Malignant diseases were present in 27.2 % of the patients that were operated on. There was a general surgical mortality of 3.6 %. The cardiovascular complications predominated as a cause of death. It was observed a twofold increase of surgical procedures of the thorax since the multidisciplinary group was organized.