De los hospitales u hospicios a los modernos institutos nacionales de salud / From the medieval hospitals hospices to modern National public Health Institutes

Resumen: Desde las épocas más antiguas la instalación de hospitales y progresos de la clínica avanzaron pari passu. Hallamos ejemplos de tal aserto tanto en regiones propiamente griegas como en ciudades griegas de ultramar. Así, pues, en el periodo renacentista convergieron en Italia grandes figuras de aquel tiempo: el genial Leonardo da Vinci (1452-1519) y León Battista Alberti (1404-1472), humanista e innovador de la arquitectura. Michelangelo Buonarroti (1475-1564) y los artistas, sus contemporáneos, efectuaron disecciones anatómicas para perfeccionar su arte con el estudio de las formas del cuerpo humano. Los estudios anatómicos florecieron en la Universidad de Padua, impulsados por el flamenco Andreas Wesel, quién enseñó ahí esta disciplina desde 1437 hasta 1543. Los grandes anatomistas italianos del siglo XVI fueron discípulos directos o indirectos del maestro flamenco. Preparados por el estudio riguroso del sustrato anatómico resplandecieron, en el siglo XVII, los estudios concernientes a la función de las estructuras orgánicas ya conocidas. Dicho siglo se inició con la revelación de la circulación sanguínea mayor, por el médico inglés William Harvey, egresado de la Universidad de Padua, y se continuaron con la descripción de la circulación menor o pulmonar por autores antiguos o contemporáneos y de las conexiones periféricas entre el sistema arterial y el venoso (Marcello Malpigni, 1661). Todos estos investigadores, y otros más, eran miembros de la universidad patavina, en donde persistía la influencia benéfica de las enseñanzas de Galileo. En los siglos siguientes, junto con la anatomía normal y la embriología, la anatomía patológica, sistematizada por G.B. Morgagni, se impuso como piedra de toque de la clínica. Y el modelo de los antiguos hospitales evolucionó hacia el de los Institutos nacionales de salud, auspiciados por el maestro Ignacio Chávez.

Abstract: Since the most ancient times, hospital constructions and progresses in the clinical practice advanced pari passu. We can find exampless of this statement in Greek regions as well as in Greek citie overseas. Thus, during the renaissance, great figures ot that time converged in Italy: The genius Leonardo da Vinci (1452-1519) and Leon Battista Alberti (1404-1472), a humanist and innovator of architecture. Michelangelo Buonarroti (1475-1564) and his contemporany artists performed anatomical dissection to perfect their art by studying the human body. Anatomical studies flourished at the University of Padua, driven by the Flemish Master. Based on the rigorous study of the anatomical substrate, the studies on the function of the already known organic structures excelled in the XVII century. That century started with the revelation of the major blood circulation by the British physician William Harvey, alumni of the University of Padua, and continued with the description of the minior or pulmonary circulation by ancient or contemporany authors and of the peripheral connections between the arterial and the venous system (Marcelo Malpighi, 1661). All these researchers, and others, were membres of the University of Padua, were the beneficial influence of the teachings of Galileo persisted. In the following centuries, together with the embryological and normal anatomy, the pathological anatomy, systematized by G.B. Morgani, became the cornerstone of the clinical practice. The model of the ancient hospitals evolved to ward the National Institutes of Health in Mexico fostered by Dr. Ignacio Chávez.

El tabaco a la luz de la historia y la medicina / The tobacco in the light of history and medicine

Resumen: Se relata la admirable trayectoria del tabaco desde su primer encuentro con el hombre europeo el 15 de octubre de 1492 hasta la época nuestra. Dicha planta se conoció en Europa gracias a publicaciones del médico sevillano Nicolás Monardes (1574), a las relaciones de fray Andrés Thevet (1575) y al célebre tratado botánico de Charles de l' Écluse (1605). El botánico sueco Karl von Linneo incluyó la planta del tabaco en la familia de las solanáceas y se eliminaron de este grupo otras plantas que quedaban entremezcladas con esta. Su nombre botánico (Nicotiana tabacum) deriva del apellido del embajador francés en Portugal, Jean Nicot de Villemain, quien en 1560 la hizo llegar a la reina madre de Francia Catalina de Médicis. El uso del tabaco se difundió rápidamente por toda Europa, en donde se volvió común en el siglo XVII. Hacia fines del siglo XVIII en la Nueva España, además de los puros, ya se confeccionaban los cigarrillos que se vendían en cajetillas de diferente contenido y precio. La confección de las variadas formas de presentación del tabaco, realizadas en las fábricas tabacaleras de la capital novohispana y de varias ciudades de provincia, originó en 1796 la creación de las primeras guarderías infantiles para los hijos de quienes trabajaban en ellas. Esto gracias a la feliz iniciativa del entonces virrey Marqués de Branciforte. Pero contrariamente a las previsiones del padre Clavijero S.J. y de la señora Calderón de la Barca, esposa del primer representante diplomático español ante el gobierno de la República Mexicana, el uso del tabaco, con el pasar del tiempo, lejos de menguar ha ido aumentando en todas las clase sociales. Y ahora, más que los hombres, fuman las mujeres.

Abstract: Super trajectory is reported of tobacco from his first meeting with the European man October 15, 1492. This plant was known in Europe by the publications of the Sevillan physician Nicolas Monardes (1574), the relations of friar Andrés Thevet (1575) and the famous botanical treatise of Charles de l'Écluse (1605). The Swedish botanist Karl Linnaeus inclused tobacco plant in the family Solanaceae and deleted from this group other plants that were intermixed with it. Its botanical name (Nicotiana tabacum) derived from the surname of the French ambassador to Portugal, Jean Nicot of Villemain, who in 1560 sent it to the Queen Mother of France Cathérine de Medicis. The use of snuff quickly spread throughout Europe, were it became common in the seventeenth century. By the late eighteenth century in New Spain, in addition to cigars, cigarettes and due in packs of different content the tobacco is concocted and price. The preparation of the different presentations of snuff, tobacco made in factories in the capital and several provincial cities, originated in 1796 the creation of the first kindergartens for the children of those working in them. This thanks to the successful initiative of then viceroy Marquis of Branciforte. But contrary to the forecasts of Father F. J. Clavijero and Mrs. F. Calderón de la Barca, wife of the first Spanish diplomatic representative to the government of Mexico, the use of tobacco, with the passage of time, far from waning has been increasing in every social class. And now, more than men, women are smokers.

En torno a la evolución del pensamiento científico / On the evolution of scientific thought

Resumen: Hasta mediados del siglo XVII se asentaron los fundamentos de la ciencia moderna, gracias a una revolución operada esencialmente por Galileo, Bacon y Descartes. En el siglo XVIII, paralelamente al desarrollo de la gran corriente del empirismo inglés, hubo también un movimiento de renovación científica en la Europa continental, en la senda de los físicos holandeses, y sobre todo, de Boerhaave. En el siglo XIX Claude Bernard dominó el campo de la medicina científica; sin embargo, su determinismo riguroso no le permitió tomar en cuenta el dominio inmenso e imprevisto de lo aleatorio. Hoy en día se abordan las ciencias naturales y la medicina a partir no de leyes generales, sino de grupos particulares de hechos; es decir, de las respuestas que da la naturaleza a preguntas específicas. Además, en la epistemología reciente se ha afianzado el concepto de que los datos experimentales no son hechos "puros" sino interpretados en el seno de un contexto hermenéutico. Se afirma también una tendencia común a recoger, en las interrogaciones científicas, las cuestiones filosóficas acerca de la comprensión de la existencia y la esencia. A la luz de la evolución del pensamiento médico, es posible comprender la posición de la medicina actual, y de la cardiología, en el movimiento de ideas dominantes en nuestra época.

Abstract: The Nominalists of the XIV century, precursors of modern science, thought that science's object was not the general, vague and indeterminate but the particular, which is real and can be known directly. About the middle of the XVII Century the bases of the modern science became established thanks to a revolution fomented essentially by Galileo, Bacon and Descartes. During the XVIII Century, parallel to the development of the great current of English Empiricism, a movement of scientific renewal also arose in continental Europe following the discipline of the Dutch Physicians and of Boerhaave. In the XIX Century, Claude Bernard dominated the scientific medicine but his rigorous determinism impeded him from taking into account the immense and unforeseeable field of the random. Nowadays, we approach natural science and medicine, from particular groups of facts; that is, from the responses of Nature to specific questions, but not from the general laws. Furthermore, in recent epistemology, the concept that experimental data are not pure facts, but rather, facts interpreted within a hermeneutical context has been established. Finally a general tendency to retrieve philosophical questions concerning the understanding of essence and existence can frequently be seen in scientific inquiry. In the light of the evolution of medical thought, it is possible to establish the position of scientific medicine within the movement of ideas dominating in our time.

Rehabilitación cardiaca en cardiopatías congénitas / Cardiac rehabilitation in congenital heart disease

La cardiología pediátrica es una subespecialidad que surgió de manera sistemática, al inicio del siglo XX. A lo largo del tiempo y a través de diversos métodos se han establecido diagnósticos, se ha ofrecido tratamiento farmacológico, intervencionista y quirúrgico y actualmente, se evalúan y analizan los resultados de dichos procedimientos. A través de los programas de rehabilitación cardiaca, se le enseña a conocer los límites seguros de su corazón en actividades de la vida diaria, brindando a los pequeños una mejor calidad de vida donde aprenderán a vivir con las limitaciones que la enfermedad trae consigo.

Pediatric Cardiology is a medical subspecialty that emerged in a systematic manner during the beginning of the 20th century. Throughout time, with the use of several methods we have been able to establish a series of diagnosis, offer surgical treatments and currently we evaluate and analyze the results of such proceedings. In the cardiac rehabilitation programs, children and adolescents are taught to identify the safety limits of their hearts, being able to relate them to their daily effort activities, providing them with a better quality of life and where they learn to live with the limitations that their illness implies.

Acerca de la denominación actual de infartos miocárdicos / On the actual nomenclature of myocardial infarcts

Se examinan algunos criterios acerca de los infartos definidos en la literatura actual como inferiores e inferolaterales. Con este fin, se describen los aspectos anatómicos del corazón aislado e in situ. Se analizan también las relaciones de este último con otros órganos torácicos circunvecinos. Se representa, de manera esquemática, el corazón como una pirámide con base triangular y sus lados y bordes en relación con las paredes de la caja torácica. Se resume, además, la orientación espacial de los principales vectores resultantes de los procesos de despolarización y repolarización ventriculares. Se subraya la utilidad del registro de las derivaciones unipolares torácicas posteriores V7, V8, V9 y del círculo torácico electrocardiográfico. Esto permite detectar la existencia de un infarto miocárdico agudo en regiones medias y básales de la pared inferolateral del corazón y su verdadera extensión. Con base en cotejos electroanatómicos previos, se concluye que las derivaciones V7 - V9 exploran los segmentos inferior e inferolateral en su tercio basal y medio, anteriormente denominados regiones cardiacas posterolaterales. Los registros electrocardiográficos proporcionan datos esencialmente funcionales y las imágenes obtenidas por resonancia magnética dan una información sobre todo estructural. Por lo tanto, ambos procedimientos de exploración cardiaca no deben contraponerse, sino integrarse.

Certain criteria are examined for infarctions currents defined as inferior or inferolateral. To do this, certain considerations on the anatomical aspects of isolated and in situ heart are laid out. The topographical relationship of the in situ heart with other adjacent thoracic organs is described. The heart is schematically represented as a pyramid with a triangular base and its walls and borders are related to walls of the thorax. The spatial orientation of the main resulting vectors from ventricular depolarization and repolarization are summarized also. Usefulness of registering the unipolar thoracic leads V7, V8, V9 or a complete electrocardiographic thoracic circle, is underlined. This method allows to detect for of the existence of an acute myocardial infarction in the inferior and inferolateral segments in as third basal and mid cardiac regions previously denominated posterolateral. On the base of previous electro-anatomical comparisons, it is concluded that the thoracic posterior leads V7 - V9, as well as the magnetic resonance images, explore the same heart regions. Therefore, these two methods: electrocardiography which is an essentially functional method and magnetic resonance that especially focus on structural changes are not contradictory but rather complementary tests.

De la herbolaria medicinal novohispana a los inicios de estudios botánico-farmacológicos sistematizados (bosquejo histórico) / On Mexican medicinal plants

During the XVIII century, two Spanish scientific expeditions arrived here led, respectively, by the naturalist Martín Sessé and by the Italian mariner Alessandro Malaspina di Mulazzo, dependent from the Spanish Government. The members collected a rich scientific material, which was carried to Madrid in 1820. At the end of XVIII century, the Franciscan friar Juan Navarro depicted and described several Mexican medicinal plants in the fifth volume of his "American Garden". In the last years of the Colonial period, fundamental works of Humboldt and Bonpland, on the geographic distribution of the American plants, were published. At the end of the XIX century, the first researches on the Mexican medicinal botany were performed at the laboratory of the "Instituto Médico Nacional" under the leadership of doctor Fernando Altamirano, starting pharmacological studies in our country. During the first half of the XX century, trials of cardiovascular pharmacology were performed in the small laboratories of the cardiological unit at the General Hospital of Mexico, due to doctor Ignacio Chávez, initiative. Mexican botanical-pharmacological tradition remains alive and vigorous in the modern scientific institutes of the country.

Bloqueos miocárdicos periféricos no complicados y complicados / Uncomplicated and complicated myocardial peripheral blocks

Septal necrosis + peripheral left blocks. Because of an extensive septal necrosis, the manifestation of the initial ventricular activation forces decreases in the precordial leads. With left bifascicular block (LASB + LPSB), the first ventricular activation forces become more evident and the electrical signs of septal necrosis can be concealed. In the presence of a trifascicular block, the manifestation of the first ventricular electromotive forces diminishes again and the electrical signs of septal necrosis become evident once more. Small Q waves are present in leads V1 to V4. Extensive anterior necrosis + left peripheral blocks. This necrosis is manifested by QS complexes from V2 to V6. An associated left bifascicular block reduces the electrical manifestation of dead tissue: QS complexes persist only in V3 and V4. In turn, a coexisting trifascicular block causes the presence of QS complexes from V2 to V5. Posteroinferior necrosis + left peripheral blocks. Electromotive forces of the ventricular activation shift upward, due to a posteroinferior necrosis, and QS or QR complexes are recorded in leads aVF, II and III. An associated left bifascicular block displaces the main electromotive forces downward, posteriorly and to the left, due to a delay of the posteroinferior activation fronts. The ventricular complexes become positive and wider in all leads, reflecting the potential variations of the inferior portions of the left ventricle: aVF, II, III, sometimes V5 and V6. Consequently, the electrical signs of necrosis are reduced or abolished. Right ventricular peripheral blocks do not conceal the electrocardiographic signs of univentricular and biventricular dead myocardium.

Antiarrhythmic and arrhythmogenic action of inosine in experimental ventricular tachyarrhythmias / Efectos antiarrítmicos y arritmogénicos de la inosina en taquiarritmias ventriculares experimentales

OBJECTIVE: To study the possible action of inosine on experimental ventricular tachyarrhythmias. MATERIAL AND METHODS: We used 92 mongrel dogs weighing 13 kg-17 kg, anesthetized with 30 mg/kg sodium pentobarbital applied intravenously. Myocardial lesions were induced by injecting 1 ml-1.5 ml of 70% phenol in the free wall of the left ventricle. In 36 dogs, the ventricular arrhythmia (VT) was induced 30 min later with aconitine crystals inserted into the periphery of the damaged area; in 16, VT was due only to myocardial damage and in the other 13 VT was spontaneously originated. Twenty-nine animals constituted the control group; no inosine was administered to them. The possible effects of inosine were studied in 63 animals. Leads II, aVR or aVL, right and Left unipolar intraventricular leads and that on the wall of the superior vena cava were recorded under control conditions, once the myocardial damage had been induced, during the ventricular tachycardia, and following the injection of inosine. Of the 63 inosine-treated animals; in 34, VT was due to aconitine; in 16, it was produced only by the myocardial damage and, in 13, VT was presented spontaneously. RESULTS: Sinus rhythm was not reestablished in the animals of the control group. Inosine reestablished the sinus rhythm in 26 of 34 dogs (76%) that received phenol and aconitine, in 13 of the 16 (81%) presenting only the myocardial damage, and in 6 of the 13 (46%) with spontaneous ventricular tachycardia. In some experiments, inosine induced supraventricular tachycardias, ventricular-atrial blocks, and ventricular pre-excitation phenomena. CONCLUSIONS: In this experimental series, inosine showed antiarrhythmic and arrhythmogenic effects, similar to those of adenosine from which it derives.

Tronco común: variantes anatómicas, tratamiento quirúrgico y evolución / Truncus arteriosus, anatomy, surgical treatment, follow up

OBJECTIVE: To evaluate through a retrospective cohort the anatomy and results of patients that were operated of truncus arteriosus. MATERIAL AND METHODS: Historic cohort. From January 2000 to December 2005 twenty eight patients with troncus arteriosus were operated. RESULTS: There were fifteen male (53.6%) and 13 female patients (46.4%). The median age, at the time of the surgery, was 10.5 months. The median weight, at the time of the surgery was 6 kg. All the patients were dominant aortic. A woven-dacron tube was used in 25 cases, Hanckock to 2 and Barbero Marcial procedure in one. The media diameter for the tube for the 27 patients (96.4%) was of 14 +/- 2 mm. Two patients required aortic valvular replacement at the same time of the surgery and two more during follow up, after the first surgery. Fifty per cent of the patients had pulmonary hypertension crisis after de surgery. There were three deaths: one patient had cardiogenic shock; another had pulmonary hypertension and one more had obstruction of the traqueostomy cannula. During study monitoring, 3 patients (10.7%) needed interventionist procedures. One case needed dilatation of the tube and two cases needed dilatation of the pulmonary branches to implant a stent device. There has been one tube change 4.2 years after the correction. Actuarial survival after 30 days was of 96.42%, and 88.9% after one and five years. CONCLUSIONS: The surgical correction of the truncus arteriosus has allowed changing the natural history of this disease. Mortality is low however our follow up is not very long yet.

Doença de Ebstein: ausência de bloqueio de ramo direito como preditor de via anômala manifestada / Ebstein disease: absence of right branch block as a predictor of manifested anomalous way

O desenvolvimento anormal da válvula tricúspide na doença de Ebstein resulta em uma série de anormalidades na ativação, que inclui condução intra-atrial demorada, bloqueio de ramo direito(BRG) e pré-excitação ventricular. O objetivo desse tabalho era definir as características do ECG antes e depois da ablação de uma via anômala atrioventricular. De 226 pacientes consecutivos com anomalia de Ebstein, 64 apresentavam taquicardia documentada...

Infarto posterolateral izquierdo extenso. Cotejo electro-anatómico / Left posterolateral extensive myocardial infarct. An electroanatomical comparison

A complete ECG thoracic circle allows exploring some heart structures not explored by the conventional electrocardiogram. It provides a direct indication on the location of the damaged myocardium. In fact, posterolateral infarctions can be limited to the inferior third of the left ventricle or can cover the entire free left ventricular wall from the base up to the heart apex and can be univentricular or biventricular. On the other side, the unipolar thoracic leads and the high abdominal leads MD, ME, MI show the evolution of the signs of injury, characteristic of the acute stage of infarction, toward necrosis. We present the example of a 61-year-old man, whose ECG shows signs of subepicardial or transmural injury and of necrosis in the low precordial leads V5 and V6, as well as in the high left posterior leads V8 and V9. This fact suggests the presence of an acute extensive myocardial infarction extending from the base to the heart apex. Moreover, the moderate elevation of the RS-T segment from to V9R to V7R indicates the presence of subepicardial injury in the high posterior regions of the right ventricular wall. These electrocardiographic data were confirmed by the radioactive isotope study and, definitively, by the anatomical findings.

Síndrome de la válvula pulmonar ausente. Evolución, tratamiento y factores asociados a muerte / Absent pulmonary valve syndrome. Evaluation, surgical treatment and risk factors

From 1991 to 2003 were studied 33 cases with absent pulmonary valve syndrome (AVPS): 66% were female, with a medium age of 1.5 years old and 11 kg of weight. Twenty seven cases (82%) were associated to Tetralogy of Fallot. Fourteen patients (5 younger than 1 year old) had corrective surgery. After the surgery, one patient required ballon pulmonary valvuloplasty for pulmonary stenosis; another one required surgery for changing the pulmonary prothesis one and five years after the first surgery. The rest of the patients did not present important problems. The five year survival was 95.4% in patients older than 6 months and 30.1% in younger patients (p = 0.000). As factors associated to mortality were the age younger than six months old (p = 0.003) and mechanical ventilation (p = 0.001) in our population. We suggest to delay the surgery in this group of patients because no survival were seen with or without the surgery. In older children with symptoms, the surgery also must be delayed in order to avoid more interventions for changing the pulmonary prothesis.

Sindrome de ventrículo izquierdo hipoplásico: reporte de una enferma en edad adulta / Hypoplastic left ventricle syndrome: report of a case in an adult woman

Patients with hypoplastic left heart syndrome without surgery dye during the first year of life. In the literature there is only one report from our institution of a patient who survived to the second decade of life without surgery. The purpose of this work is to describe a case of a 24 years old female with hypoplastic left heart syndrome, who has survived until now in functional class I of New York Heart Association without surgery. In our patient, the survival is probably related with the presence of a ductus arteriosus, an interatrial septal defect and the secondary pulmonary arterial hypertension.

Acerca del valor diagnóstico de los hallazgos ECG indirectos de infarto miocárdico posterolateral basal izquierdo / On the diagnostic value of indirect electrocadiographic signs of left posterolateral basal infarction

The left basal posterolateral infarct does not give pathological Q waves nor ventricular QS complexes in the low lateral leads V5 and V6. For that, the increased voltage of R waves in the lead V2 and or transitional leads V3 and V4, constitutes only an indirect sign of the presence of dead myocardium in the left posterolateral basal regions. Naturally, in these cases, a differential diagnosis with left ventricular or biventricular hypertrophy is mandatory. Therefore it is suitable to register left posterior thoracic leads V7-V9 or, preferably, a complete thoracic circle. We present here three examples: two experimental and another clinical, in which the electrocardiographic findings corresponded to anatomical data of a left posterolateral basal infarction. This fact speaks for a no absolute but relative diagnostic value of the indirect electrocardiographic signs of altered ventricular depolarization and repolarization in the left posterolateral basal regions of the left ventricle.

Solución de glucosa-insulina-potasio (GIK): efectos cardioprotectores de la insulina / Glucose-insulin-potassium (GIK) solution: cardioprotective effects of insulin

In the Anesthesiology Department of the Instituto Nacional de Cardiología The medical staff uses the glucose insulin potassium i.v. for myocardial protection. The energy is dereived from lipidic beta oxidation, glucose breakdown and amino acid catabolism in mitochondria. In myocardial ischemia, from de aortic cross clamping, the metabolic myocardial substrates diminished as well as the energy produced by adenosine (ATP). During myocardial ischemia, an increase in long chain lipids emhances mitochondrial permeability, promotes depletion of citochrome C and lost of the capability of transmembrane regulation. In the hipoperfused myocardium, by coronary vasoconstriction, short chain fatty acids oxidation predominates, if fatty metabolism during reperfusion is elevated. More of them will enter [IBM1] the Krebs cycle and, as a consequence, less energy will be produced. The glucose-insulin-potassium solution provides the glucose needed by the myocardium in reperfusion conditions and protects the cellular membrane's integrity as well as pumps and ionic channels, it allows maintaining the action potential probably because ATP-depended channels block and prevent potassium loss, it reduces the cytosol calcium overload and prevent cardiac arrhythmias, preserves the sodium ATPasa pump avoiding the rise in cytosolic sodium; glucose prevents the production of free oxygen radicals. Fatty acids, during ischemia, are responsible for the metabolism and elevation of enzymes, such as acilcarnitine and acylcoenzime-A, which promote intracellular calcium overload and arrhythmias. The insulin has anti-inflammatory effects and anti-apoptoic effects. When blood glucose is controlled during the perioperative period the mortality is reduced.