Gradiente de presión de pulso posterior y previo a la maniobra de Valsalva como marcador de disfunción sistólica del ventrículo izquierdo / Post- and pre-Valsalva pulse pressure gradient as a marker of left ventricle systolic dysfunction

Resumen: ANTECEDENTES: La insuficiencia cardiaca afecta a 26 millones de personas en todo el mundo. Al evaluar la variación de las cifras de presión arterial y frecuencia cardiaca tras la realización de la maniobra de Valsalva se ha encontrado correlación entre la función ventricular izquierda y el péptido auricular natriurético. OBJETIVO: Determinar si el gradiente de presión de pulso posterior y previo a la maniobra de Valsalva es útil como marcador de disfunción sistólica del ventrículo izquierdo. MATERIAL Y MÉTODO: Estudio de cohorte realizado del 1 de enero al 30 de junio de 2017, en el que se determinó la fracción de eyección del ventrículo izquierdo, propéptido natriurético cerebral, así como la sustracción de presión de pulso posterior y previo a la maniobra de Valsalva, esta variable se determinó como gradiente de presión de pulso pos y pre-Valsalva. RESULTADOS: Se incluyeron 32 pacientes. Una cifra de gradiente menor de 4.22 tuvo correlación negativa con la fracción de eyección del ventrículo izquierdo menor de 50%, con coeficiente de correlación de -0.562 y valor p de 0.001, además de tener un área bajo la curva de 0.71. CONCLUSIONES: El gradiente y la fracción de eyección tuvieron correlación negativa, ésta en el área indeterminada de la función sistólica. Una FEVI menor de 50% implica riesgo de descompensación y de FEVI deprimida.

Abstract: BACKGROUND: Heart failure affects to 26 million people worldwide. The variation of the blood pressure and heart rate values after performing the Valsalva maneuver has been evaluated, finding a correlation between left ventricular function and natriuretic atrial peptide. OBJECTIVE: To determine if post- and pre-Valsalva pulse pressure gradient is useful as marker of left ventricle systolic dysfunction. MATERIAL AND METHOD: A cohort study was done from January 1st to June 30, 2017, determining left ventricular ejection fraction, cerebral natriuretic peptide, as well as the subtraction of post-Valsalva and pre-Valsalva pulse pressure, this variable was determined as pulse pressure gradient. RESULTS: There were included 32 patients. A gradient figure of less than 4.22 had a negative correlation with a left ventricular ejection fraction lesser than 50%, with a correlation coefficient of -0.562 and a p value of 0.001, in addition to having an area under the curve of 0.71. CONCLUSIONS: The gradient and the ejection fraction had a negative correlation, this in the indeterminate area of the systolic function. An LVEF lesser than 50% implies risk of decompensation and a depressed LVEF.

Resultados del uso de la esplenectomía videolaparoscópica en el Hospital Docente Clínico Quirúrgico Hermanos Ameijeiras / Outcomes of videolaparascopic splenectomy at Hermanos Ameijeiras Clinical Surgical Hospital

Introducción: la esplenectomía laparoscópica apareció con el desarrollo de la cirugía de mínimo acceso, se conviertió en la técnica preferida para la exéresis del bazo actualmente. Objetivo: evaluar los resultados de la esplenectomía videolaparoscópica en el tratamiento de las enfermedades hematológicas funcionales benignas. Método: se realizó un estudio descriptivo, longitudinal y prospectivo en 86 pacientes con diagnóstico de enfermedades hematológicas funcionales benignas, atendidos en el Hospital Clínico Quirúrgico Hermanos Ameijeiras desde octubre de 1996 hasta diciembre de 2011. Resultados: en la serie predominó el sexo femenino con 70,9 por ciento y la edad media fue de 40 años (37,8 por ciento). Las enfermedades más frecuentes fueron la púrpura trombocitopénica inmunológica (68,6 por ciento), la anemia hemolítica autoinmune con 23,3 por ciento y la esferocitosis hereditaria con 5,8 por ciento. Requirieron preparación preoperatoria 59,3 por ciento de los pacientes con 50,9 por ciento de respuesta efectiva a esta. El tiempo quirúrgico promedio fue 129 minutos. Como accidentes transoperatorios prevalecieron: la ruptura de la bolsa extractora con 12,8 pr ciento y el sangrado del hilio esplénico con 5,8 por ciento. Esto motivó la conversión a cirugía convencional y la exclusión del seguimiento de 6 pacientes. La complicación posoperatoria más frecuente fue el vómito persistente. El seguimiento de los pacientes se realizó desde los 7 días hasta los 2 años en 78 por ciento de los casos, con un tiempo promedio de 518 días. Hubo remisión total de su enfermedad en 82,7 por ciento de los pacientes, remisión parcial en 15,4 por ciento y solamente 1,9 por ciento no presentó remisión. Conclusiones: la esplenectomía videolaparoscópica es una técnica segura y efectiva en el tratamiento de las enfermedades hematológicas autoinmunes en cirujanos con experiencia en Cirugía de Mínimo Acceso de Avanzada(AU)

Introduction: Laparoscopic splenectomy appeared with the development of minimal access surgery. At the moment, it has become the technique preferred for the spleen exeresis. Objective: To evaluate the outcomes of videolaparoscopic splenectomy in the treatment of benign functional hematological diseases. Method: A descriptive, longitudinal and prospective study was carried out with 86 patients diagnosed with benign functional hematological diseases, attended at Hermanos Ameijeiras Clinical Surgical Hospital, from October 1996 to December 2011. Results: In the series, the female sex predominated (70.9 percent) and the average age was 40 years (37.8 percent). The most frequent diseases were immunological thrombocytopenic purpura (68.6 PERCENT), autoimmune hemolytic anemia (23.3 percent), and hereditary spherocytosis (5.8 percent). 59.3 percent of patients required a preoperative preparation, with 50.9 percent of effective response to it. The average surgical time was 129 minutes. The prevailing transoperative accidents were: the rupture of the extractor bag (12.8 percent) and the bleeding of the splenic hilum (5.8 percent). This motivated the change to conventional surgery and the exclusion of the follow-up of 6 patients. The most frequent postoperative complication was persistent vomiting. The follow-up of the patients was carried out from 7 days to 2 years in 78 percent of the cases, with an average time of 518 days. There was total remission of their disease in 82.7 percent of the patients, partial remission in 15.4 percent, and only 1.9 percent did not present any remission. Conclusions: Videolaparoscopic splenectomy is a safe and effective technique in the treatment of autoimmune hematological diseases for surgeons with experience in advanced minimal access surgery(AU)

Resultados del uso de la esplenectomía videolaparoscópica en el Hospital Docente Clínico Quirúrgico "Hermanos Ameijeiras" / Outcomes of videolaparascopic splenectomy at Hermanos Ameijeiras Clinical Surgical Hospital

Introducción: la esplenectomía laparoscópica apareció con el desarrollo de la cirugía de mínimo acceso, se conviertió en la técnica preferida para la exéresis del bazo actualmente. Objetivo: evaluar los resultados de la esplenectomía videolaparoscópica en el tratamiento de las enfermedades hematológicas funcionales benignas. Método: se realizó un estudio descriptivo, longitudinal y prospectivo en 86 pacientes con diagnóstico de enfermedades hematológicas funcionales benignas, atendidos en el Hospital Clínico Quirúrgico Hermanos Ameijeiras desde octubre de 1996 hasta diciembre de 2011. Resultados: en la serie predominó el sexo femenino con 70,9 por ciento y la edad media fue de 40 años (37,8 por ciento). Las enfermedades más frecuentes fueron la púrpura trombocitopénica inmunológica (68,6 por ciento), la anemia hemolítica autoinmune con 23,3 por ciento y la esferocitosis hereditaria con 5,8 por ciento. Requirieron preparación preoperatoria 59,3 por ciento de los pacientes con 50,9 por ciento de respuesta efectiva a esta. El tiempo quirúrgico promedio fue 129 minutos. Como accidentes transoperatorios prevalecieron: la ruptura de la bolsa extractora con 12,8 pr ciento y el sangrado del hilio esplénico con 5,8 por ciento. Esto motivó la conversión a cirugía convencional y la exclusión del seguimiento de 6 pacientes. La complicación posoperatoria más frecuente fue el vómito persistente. El seguimiento de los pacientes se realizó desde los 7 días hasta los 2 años en 78 por ciento de los casos, con un tiempo promedio de 518 días. Hubo remisión total de su enfermedad en 82,7 por ciento de los pacientes, remisión parcial en 15,4 por ciento y solamente 1,9 por ciento no presentó remisión. Conclusiones: la esplenectomía videolaparoscópica es una técnica segura y efectiva en el tratamiento de las enfermedades hematológicas autoinmunes en cirujanos con experiencia en Cirugía de Mínimo Acceso de Avanzada(AU)

Introduction: Laparoscopic splenectomy appeared with the development of minimal access surgery. At the moment, it has become the technique preferred for the spleen exeresis. Objective: To evaluate the outcomes of videolaparoscopic splenectomy in the treatment of benign functional hematological diseases. Method: A descriptive, longitudinal and prospective study was carried out with 86 patients diagnosed with benign functional hematological diseases, attended at Hermanos Ameijeiras Clinical Surgical Hospital, from October 1996 to December 2011. Results: In the series, the female sex predominated (70.9 percent) and the average age was 40 years (37.8 percent). The most frequent diseases were immunological thrombocytopenic purpura (68.6 %), autoimmune hemolytic anemia (23.3 percent), and hereditary spherocytosis (5.8 percent). 59.3 percent of patients required a preoperative preparation, with 50.9 percent of effective response to it. The average surgical time was 129 minutes. The prevailing transoperative accidents were: the rupture of the extractor bag (12.8 percent) and the bleeding of the splenic hilum (5.8 percent). This motivated the change to conventional surgery and the exclusion of the follow-up of 6 patients. The most frequent postoperative complication was persistent vomiting. The follow-up of the patients was carried out from 7 days to 2 years in 78 percent of the cases, with an average time of 518 days. There was total remission of their disease in 82.7 percent of the patients, partial remission in 15.4 percent, and only 1.9 percent did not present any remission. Conclusions: Videolaparoscopic splenectomy is a safe and effective technique in the treatment of autoimmune hematological diseases for surgeons with experience in advanced minimal access surgery(AU)

As dores do eu na dor neuropática hansênica: uma leitura psicanalítica do fenômeno subjetivo / / The us pain in hansenic neuropathic pain: a psychoanalytic reading of the subjective phenomenon

O presente trabalho elucida o caso clínico de uma paciente em tratamento na Divisão de Reabilitação do Instituto “Lauro de Souza Lima” por consequência da dor neuropática hansênica em ambos os pés. Essa circunstância a remeteu a condições emocionais e psíquicas de difícil compreensão, a manifestação da dor no corpo passou a apresentar correspondências subjetivas e inconscientes, fazendo emergir com isso sofrimentos psíquicos frente á dor. Sendo assim, tivemos como objetivo geral investigar e compreender as manifestações emocionais presentes no seu discurso, e como específico analisar qual a relação estabelecida entre os processos subjetivos e a presença da dor neuropática. Nossa proposta foi embasada na metodologia de estudo de caso, apoiada no referencial teórico psicanalítico em que se evidenciou uma construção de elementos para uma investigação analítica. Concluímos nesse contexto que ocorreram rupturas nos investimentos narcísicos, no âmbito das relações afetivas, que intensificam a relação conflitiva entre o eu-corpo-dor. E quando esses conteúdos emergem à consciência, proporcionam elaboração psíquica e recursos para lidar com as dores do eu

The present study elucidates the clinical case of a patient undergoing treatment in the Rehabilitation Division of the "Lauro de Souza Lima" Institute due to leprosy neuropathic pain in both feet. This circumstance referred to emotional and psychic conditions of difficult comprehension, the manifestation of pain in the body began to present subjective and unconscious correspondences, thus causing psychic sufferings in the face of pain. Thus, we had as general objective to investigate and understand the emotional manifestations present in his discourse, and how specific to analyze the relationship established between the subjective processes and the presence of neuropathic pain. Our proposal was based on the methodology of a case study, based on the theoretical psychoanalytical framework in which a construction of elements for an analytical investigation was evidenced. We conclude in this context that there are ruptures in narcissistic investments, in the ambit of affective relations that intensify the conflicting relationship between the body-pain-self. And when these contents are presented to the conscious light, they provide psychic elaboration and resources to deal with the pains of the self

Problem gambling among ethnic minorities: results from an epidemiological study.

A few studies have examined gambling behavior and problem gambling among minorities and reported higher rates of both participation and gambling problems among particular minority groups in comparison to Whites who gamble. The present study utilized a representative, epidemiological sample of adults in New Jersey to explore gambling behavior, gambling problem severity, substance use, problem behavior, and mental health issues among minorities. Univariate analyses were conducted, comparing Whites (n = 1341) to respondents who identified as Hispanic (n = 394), Black (n = 261), or Asian/other (n = 177). Overall, the highest proportion of Hispanics were high-risk problem gamblers. Hispanic participants were also significantly more likely than other groups to use and abuse substances and to report mental health problems in the past month, behavioral addictions, and/or suicidal ideation in the past year. Primary predictors of White high risk problem gamblers were being young and male with friends or family who gambled, fair to poor health status, substance use, gambling once a week or more both online and in land-based venues, and engaging in a number of gambling activities. In contrast, gender was not a predictor of minority high risk problem gamblers, who were characterized primarily by having friends or family who gambled, gambling online only, having a behavioral addiction and playing instant scratch-offs and gaming machines. Implications for research and practice are discussed.

Unenhanced CT findings can predict the development of urinary calculi in stone-free patients.

OBJECTIVES: To determine if calcium deposits in the papillae can be identified by unenhanced computed tomography (uCT) even before renal stones develop. METHODS: A retrospective review of 413 patients with calculi identified 31 patients (stone-forming group) with a history of urinary tract calculi with a calculus demonstrated by uCT and a stone-free uCT before calculi had developed. The control group (n = 31) was composed of live kidney donors with no history of calculi and a stone-free uCT. CT attenuation was measured in all CTs using two regions of interest of 0.05 cm(2) and 0.1 cm(2) over the tip and the neighbouring area of the papillae. Student's and Wilcoxon t-tests were used for comparing results in the two groups. RESULTS: The attenuation of the tip of the papilla was higher in the stone-forming group when compared to the controls after (45.2 HU versus 32.1 HU, P = 0.001) and even before frank calculi had developed (44.2 HU versus 32.1 HU, P = 0.003). There was no significant difference in papillary attenuation in the stone group before and after calculi had developed (45.2 HU versus 44.2 HU, P = 0.82). CONCLUSION: Stone-forming patients exhibit higher papillary density even before calculi develop. This could define a population at risk of developing calculi.

Un Protocolo para Observar cómo los Profesores Ayudan a sus Alumnos cuando Leen Textos en el Aula / A Protocol for Observation of how Students are Helped by Teachers when Reading Texts in Class

En este trabajo se propone y se justifica un sistema para analizar cómo transcurren las lecturas colectivas en las que profesores y alumnos abordan la lectura y la interpretación de un texto. El sistema conlleva analizar seis tipos de elementos, dispuestos en sucesivas capas que conforman el contexto de la actividad: la función que cumplen las lecturas, cómo se organiza globalmente la actividad, cómo se organiza localmente, el tipo de planes que se proponen, las ayudas locales que se proporcionan, y la retórica del texto. Se asume que esas capas canalizan y conforman la actividad mental y social de los alumnos. De cada una de ellas se propone un esquema para el análisis con guías específicas para interpretar los datos. Todo ello se ejemplifica en un caso real del que se desprenden algunas consecuencias para la intervención educativa (AU)

In this paper, a system for analysis of whole-group reading lessons (activity in which the teacher and his/her whole class read and interpret a text) is proposed and discussed. The system focuses on six elements to be analyzed: the function (role) of whole group reading within a curricular unit, the way in which this activity is organized globally, the way in which the interaction (between teacher and pupils) is structured locally, the kind of planning which takes place, the local aids provided by the teacher, and the rhetorical characteristics of the texts. These different elements form the successive layers of the context of teacher-aided reading activities, and it is assumed that these layers channel and make up the pupils´ mental and social activity. A guide is suggested to analyze each of them (with specific guidelines to interpret data). Finally, all this is illustrated with a case study from which implications are drawn for educational intervention (AU)

Logros y retos de la colecistectomía laparoscópica en Cuba / Achievements and challenges of the laparoscopic cholecystectomy in Cuba

Objetivo: conocer los resultados de la generalización de la colecistectomía laparoscópica en Cuba. Métodos: se realizó un estudio retrospectivo y descriptivo a través de una encuesta completada por 16 grupos de cirugía de mínimo acceso de hospitales universitarios en 9 provincias del país para definir carácter, conversiones, conducta ante litiasis de la vía biliar, morbilidad y mortalidad perioperatoria. Resultados: se obtuvieron datos relacionados con 56 878 intervenciones realizadas, desde los inicios de la actividad en esos servicios, hasta noviembre de 2007, y se definió carácter, conversiones, conducta ante litiasis de la vía biliar, morbilidad y mortalidad perioperatoria. El acceso laparoscópico se usó en 80,7 por ciento de los casos, electivo en 97,1 por ciento, con índices de conversión de 1,4 por ciento, morbilidad de 0,58 por ciento y mortalidad de 0,10 por ciento. Predominó, ante el hallazgo de litiasis coledociana, el convertir y explorar de forma convencional. Conclusiones: los resultados de la generalización de la colecistectomía laparoscópica en Cuba son excelentes, pero es necesario extender su uso como arsenal en el tratamiento de las complicaciones de la litiasis biliar(AU)

Objective: to know the results from the standardization of the laparoscopic cholecystectomy in Cuba. Methods: a descriptive and retrospective study was conducted be means of a survey completed by 16 groups of minimal access surgery from university hospital in 9 provinces of our country to define the character, conversions, behavior in face of biliary tract lithiasis, perioperative morbidity and mortality. Results: it was possible to obtain data related to 56 878 surgical interventions performed from the onset of activity in these centers up to November, 2007 defining the character, conversions, behavior in face of a biliary tract lithiasis and perioperative morbidity and mortality. The laparoscopic approach was used in the 80,7 percent of cases, elective in the 97,1 percent, with conversion rates of 1,4 percent, morbidity of 0,58 percent and mortality of 0,10 percent. There was predominance of conversion and exploration of conventional for in face of the choledochal lithiasis finding. Conclusions: results of standardization of laparoscopic cholecystectomy in Cuba are excellent, but it is necessary to extend its use as a tool in the treatment of the biliary lithiasis complications(AU)

Logros y retos de la colecistectomía laparoscópica en Cuba / Achievements and challenges of the laparoscopic cholecystectomy in Cuba

Objetivo: conocer los resultados de la generalización de la colecistectomía laparoscópica en Cuba. Métodos: se realizó un estudio retrospectivo y descriptivo a través de una encuesta completada por 16 grupos de cirugía de mínimo acceso de hospitales universitarios en 9 provincias del país para definir carácter, conversiones, conducta ante litiasis de la vía biliar, morbilidad y mortalidad perioperatoria. Resultados: se obtuvieron datos relacionados con 56 878 intervenciones realizadas, desde los inicios de la actividad en esos servicios, hasta noviembre de 2007, y se definió carácter, conversiones, conducta ante litiasis de la vía biliar, morbilidad y mortalidad perioperatoria. El acceso laparoscópico se usó en 80,7 por ciento de los casos, electivo en 97,1 por ciento, con índices de conversión de 1,4 por ciento, morbilidad de 0,58 por ciento y mortalidad de 0,10 por ciento. Predominó, ante el hallazgo de litiasis coledociana, el convertir y explorar de forma convencional. Conclusiones: los resultados de la generalización de la colecistectomía laparoscópica en Cuba son excelentes, pero es necesario extender su uso como arsenal en el tratamiento de las complicaciones de la litiasis biliar(AU)

Objective: to know the results from the standardization of the laparoscopic cholecystectomy in Cuba. Methods: a descriptive and retrospective study was conducted be means of a survey completed by 16 groups of minimal access surgery from university hospital in 9 provinces of our country to define the character, conversions, behavior in face of biliary tract lithiasis, perioperative morbidity and mortality. Results: it was possible to obtain data related to 56 878 surgical interventions performed from the onset of activity in these centers up to November, 2007 defining the character, conversions, behavior in face of a biliary tract lithiasis and perioperative morbidity and mortality. The laparoscopic approach was used in the 80,7 percent of cases, elective in the 97,1 percent, with conversion rates of 1,4 percent, morbidity of 0,58 percent and mortality of 0,10 percent. There was predominance of conversion and exploration of conventional for in face of the choledochal lithiasis finding. Conclusions: results of standardization of laparoscopic cholecystectomy in Cuba are excellent, but it is necessary to extend its use as a tool in the treatment of the biliary lithiasis complications(AU)

Quando Narciso acha feio o que é espelho: o sofrimento do sujeito contemporâneo no adoecimento dermatológico / When Narcissus finds its ugly what he sees in the mirror: the suffering of contemporary subjects in dermatologic illness

Este trabalho versa sobre uma reflexão acerca de algumas questões atuais que envolvem o sujeito contemporâneo a partir de uma compreensão histórica e psicanalítica, enfatizando a experiência corpórea, de sua relação com a pele e com o adoecimento. Nosso propósito foi o de investigar as implicações contemporâneas na constituição da subjetividade diante do processo de adoecimento dermatológico. Utilizamos o método clínico-qualitativo de pesquisa apoiado na teoria psicanalítica para a análise dos dados. Foram analisados os discursos de 3 pacientes, em tratamento dermatológico ambulatorial de um hospital, em que utilizamos a entrevista semidirigida para a apreensão do discurso do paciente e, posteriormente, foram realizadas a análise do conteúdo temático e latente com o objetivo de compreender o significado simbólico apresentado sujeito doente diante do adoecimento. Chama-nos a atenção, em especial, a experiência cotidiana do sujeito na sua convivência com a doença. O narcisismo, enquanto conceito psicanalítico, apresentou um recurso fundamental para compreender o sofrimento do sujeito diante das demandas psíquicas versadas sob a perspectiva do ideal de eu. A pele, entendida enquanto limite e continência do eu, mostra uma importante interface entre o eu e o outro. Com a falência dos ideais sociais, passa a existir um primado dos ideais narcísicos e da corpolatria. Os modelos de beleza produzidos na cultura são tomados como ideais e determinam padrões estéticos que são incorporados pelo sujeito. Consequentemente, a doença e, em especial, no nosso estudo, a dermatose traz um sofrimento ampliado ao paciente (...)

... dermatológico por esse distar do ideal de beleza e sedução contemporâneo, fazendo com que ele passe a conviver com o sentimento de diferente e de excluído. O adoecimento, enquanto característica própria da condição humana, é vivido como interdição das demandas por satisfação, e se ocupa do papel de frustrar o sujeito no seu projeto de felicidade e busca da perfeição narcísica

This work is about reflections concerning some actual questions which are raised with contemporary subjects based on a comprehension of history and psychoanalytics, stress of the physical experience; and the relationship of skin and falling ill. It is proposed to investigate the contemporary implications in subjective organization prior to the suffering dermatologic. A qualitative-clinical method of inquiry using psychoanalytic theory as the foundation of analysis of data is utilized. By analysis of discourse of 3 ambulatory patients in hospital dermatologic treatment, and semi-directive interviews concerning the suffering reported by patients, and later, conducting a latent theme content analysis with the objective of understanding the symbolic significance as shown by subjects becoming ill. Special attention is called to the daily experience of subjects in relationship to their illness. Whereas the narcissistic concept psychoanalytically presents to be how the basic complaint is the daily experience of the subject, in relationship to illness; before the demand of psychic versions under the perspective of the ideal self. The skin is understood to limit the contingence of display, and is thus an important interface between the inner, and outer self. With failure of the social ideal, there is the existence of the primary ideal of narcissistic physical projection. Our models of beauty are produced by a culture which takes sound ideals and determines esthetic requirements that are embodied by subjects as to how skin should appear. Consequently, an illness, and especially in the study, (...)

a dermatologic condition, carries amplified suffering for dermatology patients for that difference between the ideal of contemporary beauty and seductiveness, and how one passes and lives with feelings of difference and exclusion. Whereas traits of suffering are properly a part of the human condition; lived as interdiction; and life, the how of the interdiction of the demands for satisfaction, and the frustration of subjects as they project happiness, and find perfection in narcissism, are subjects of the paper

Can differences in the ability to recognize words cease to have an effect under certain reading conditions?

In this study, we aimed to ascertain whether it is possible to create reading contexts that eliminate the impact of word recognition on reading comprehension and permit pupils with reading disabilities (RD) to attain a level of comprehension similar to that of their peers without RD. Specifically, the study compared a traditional reading situation with one of reading with aids (joint reading). In both situations, pupils' comprehension level was assessed by means of a summary and a series of inferential questions, and we controlled the effect on comprehension of word recognition, previous knowledge, rhetorical competence, and working memory. The results showed that the aids provided during reading do not eliminate the effect of word recognition, but they do permit readers with RD to attain a comprehension level similar to that of their peers.

Evaluación de la microdureza superficial de una resina composita fotopolimerizada por lámparas de luz halógena y led´s / Evaluation of the surface microhardness of a composite resin photopolymerized by halogen light lamps and LEDs

La presente investigación evaluó el grado de polimerización de una resina composita mediante el test de microdureza Vickers, el material restaurador empleado fue la resina Filtek™ Z350 (3M-ESPE) color A2 fotopolimerizada con tres lámparas: Elipar™ 2500 (3M-ESPE) halógena; Elipar™ Freelight™ 2 (3M-ESPE) de tecnología LED y Litex™ 695 (DENTAMERICA®) de tecnología LED. Se conformaron 6 grupos con 10 cuerpos de prueba cada uno, fotopolimerizados durante 20 segundos. Los grupos A, C y E se elaboraron con incrementos de 2mm y los grupos B, D y F con incrementos de 4mm. Los grupos A y B se polimerizaron con la lámpara Elipar™ 2500, los grupos C y D se polimerizaron con la Elipar™ FreeLigth™ 2 y los grupos E y F con la Litex™ 695. Las mediciones fueron efectuadas empleando el micro durómetro Micromet® 2001 (Buehler) se aplicó una carga de 200 gramos/fuerza durante 15 segundos tanto en la superficie tope como en la base de los cuerpos de prueba. En el análisis estadístico se realizaron dos pruebas: Análisis de Varianza (ANOVA) el cual mostró que existen diferencias estadísticas significativas en los cuerpos de prueba en la superficie Tope de 2mm; Tope de 4mm; Base de 4mm; Tope de 2 y 4mm; Además en el porcentaje de polimerización se encontró diferencia estadística significativa en los grupos de 4mm. Se realizó el test de Tukey, donde se registraron diferencias estadísticas significativas, siendo la tecnología LED´s superior a la halógena. Con los resultados obtenidos se concluyó que la tecnología LED´s mostró mejor desempeño en la polimerización de la resina composita. Siendo la lámpara Litex™ 695 la que mostró mejores resultados.

The present investigation evaluated the degree of polymerization of a composite resin through the Vickers microhardness test, the restorative material used was Filtek ™ Z350 (3M-ESPE) color A2 resin photopolymerized with three lamps: Elipar ™ 2500 (3M-ESPE) halogen ; Elipar ™ Freelight ™ 2 (3M-ESPE) with LED technology and Litex ™ 695 (DENTAMERICA®) with LED technology. 6 groups were formed with 10 test bodies each, light-cured for 20 seconds. Groups A, C and E were made with 2mm increments and groups B, D and F with 4mm increments. Groups A and B were cured with the Elipar ™ 2500 lamp, groups C and D were cured with Elipar ™ FreeLight ™ 2 and groups E and F with Litex ™ 695. Measurements were made using the Micromet® microdurometer. 2001 (Buehler) a load of 200 grams / force was applied for 15 seconds to both the butt surface and the base of the test bodies. In the statistical analysis, two tests were carried out: Analysis of Variance (ANOVA) which showed that there are significant statistical differences in the test bodies on the Top surface of 2mm; 4mm stop; 4mm base; 2 and 4mm stop; In addition, the percentage of polymerization was statistically significant difference in the 4mm groups. The Tukey test was performed, where significant statistical differences were recorded, with LED technology being superior to halogen. With the results obtained, it was concluded that the LED technology showed better performance in the polymerization of the composite resin. The Litex ™ 695 lamp being the one that showed the best results.

Lesiones de la vía biliar en cirugía laparoscópica: análisis de 10 años de trabajo / Injuries of the biliary tract in laparoscopic surgery: analysis of 10 years of work

Se realizaron análisis de 5 558 pacientes operados por cirugía mínimamente invasiva en el período comprendido entre noviembre de 1991 y marzo de 2001, en el Hospital Clinicoquirúrgico "Hermanos Ameijeiras", Según la clasificación topográfica de lesiones totales. En 4 pacientes no se realizó el diagnóstico transoperatorio, fallecieron 2 (18,2 (por ciento) de ellos por complicaciones secundarias a esta causa. El resto recibió el tratamiento definitivo en el propio acto quirúrgico. Como tratamiento se preconizó la técnica de Hepp para secciones totales del colédoco, y la colocación de sonda en T de Kehr para las lesiones parciales. La sutura primaria se podrá realizar solo de forma excepcional(AU)

Lesiones de la vía biliar en cirugía laparoscópica: análisis de 10 años de trabajo / Injuries of the biliary tract in laparoscopic surgery: analysis of 10 years of work

Se realizaron análisis de 5 558 pacientes operados por cirugía mínimamente invasiva en el período comprendido entre noviembre de 1991 y marzo de 2001, en el Hospital Clinicoquirúrgico "Hermanos Ameijeiras", Según la clasificación topográfica de lesiones totales. En 4 pacientes no se realizó el diagnóstico transoperatorio, fallecieron 2 (18,2 (por ciento) de ellos por complicaciones secundarias a esta causa. El resto recibió el tratamiento definitivo en el propio acto quirúrgico. Como tratamiento se preconizó la técnica de Hepp para secciones totales del colédoco, y la colocación de sonda en T de Kehr para las lesiones parciales. La sutura primaria se podrá realizar solo de forma excepcional(AU)

5 558 patients operated on by minimal invasive surgery at "Hermanos Ameijeiras" Clinical and Surgical Hospital were studied. The most frequent causes of lesion and the conduct to be followed in every type of lesion were determined. 11 patients with lesions of the main biliary tract (0.20 percent) were reported. According to Ballesta's topographic classification, there were 6 type I lesions, 3 type II lesions, and 2 type III lesions. There was no transoperative diagnosis in 4 patients and 2 of them (18,2 percent) died due to complications secondary to this cause. The rest received the definitive treatment in the own surgical act. Hepp´s technique was recommended to treat the total sections of the choleduchus, whereas the placement of Kehr´s T-tube was suggested to treat the partial injuries. The primary suture could only used exceptionally(AU)

Identidade e adoecimento: a representacao do processo saude-doenca em pacientes dermatologicos / Identity and illness: the representation of the health-disease process in dermatological patients

O objetivo deste trabalho foi o de investigar o processo de adoecimento e suas implicacoes na constituicao da identidade de pacientes com psoriase, assim como a compreencao da relacao entre o sujeito e sua doenca. Para isso foi realizada uma pesquisa qualitativa, utilizando-se entrevistas semi-estruturadas com pacientes psoriaticos adultos, em situacao de tratamento ambulatorial, cujo tempo de convivencia com a doenca fosse superior a 5 anos. Foi realizada um analise do discurso desses pacientes, com objetivo de compreender a relacao entre sua identidade e seu adoecimento. Dentre os varios aspectos evidenciados pudemos observar qua a psoriase, enquanto doenca cronica, toma grande importancia na vida de quem convive com ela. As dificuldades mais aparentes dizem respeito a convivencia com situacoes estressantes, com sentimentos de rejeicao e revolta, bem como com signifivativas restricoes nas atividades socializadoras. A presenca constante de situacoes conflitantes aparece como outro fato marcante na percepcao dos pacientes, pois, o estabelecimento de vinculos afetivos, com pessoas significativas, costuma se dar com elevado grau de tensao emocional e sofrimento psiquico. O aspecto fisico provocado pela psoriase tende a criar um sentimento de repulsa, levando a percepcao de uma auto-imagem significativamente desfavoravel. A vivencia dos conteudos psiquicos, pelos pacientes, na relacao com a doenca, os levaram a incorporar caracteristicas tipicas do adoecimento como sendo proprias de sua identidade. A pele serve, nesse contexto, como campo de expressao de sua "identidade de doente". No trabalho com pessoas que convivem com doencas cronicas, e de significativa importancia que se leve em consideracao sua historia e vida e a relacao entre a configuracao da identidade e o processo de adoecimento, e que se entenda que mesmo com possiveis modificacoes do quadro clinico da doenca, os processo caracteristicos da identidade podem manter a crenca do individuo de que esses ...

Entre a "loucura" e a hanseníase: interfaces históricas das práticas e políticas instituídas / Between madness and leprosy: historical interfaces of instituted pratices and policies

A loucura e a hanseníase, dois quadros patológicos muito diferentes, apresentam em suas histórias diversas semelhanças e complementaçöes no que diz respeito às práticas e políticas públicas de saúde. Foi a esta relaçäo que este estudo atentou-se, verificando através do resgate da literatura, as interfaces exitentes entre ambas, no que diz respeito aos seus aspectos históricos, sociais e culturais. Entre as principais semelhanças verificou-se todo um contexto de isolamento social, segregaçäo, estigma e, em muitos momentos, descaso com as políticas de Saúde Mental e de Dermatologia Sanitária. Desde a disseminaçäo dos antigos leprosários europeus na Idade Média, que posteriormente passaram a pertencer, por herança histórica, aos insanos, que a hanseníase e a loucura vivem na instituiçäo do asilamento. Nos dias atuais, em especial no contexto brasileiro, onde presenciamos ainda um considerável índice epidemiológico da hanseníase e há mais de uma década o movimento antinacional, que busca garantia de direitos básicos de cidadania às pessoas com transtorno mental, vemos que estas duas realidades mantêm traços de seus processos históricos...

Entre a "loucura" e a hanseníase: interfaces históricas das práticas e políticas instituídas / Between madness and leprosy: historical interfaces of pratices and policies

A loucura e a hanseníase, dois quadros patológicos muito diferentes, apresentam em suas histórias diversas semelhanças e complementaçöes no que diz respeito às práticas e políticas públicas de saúde. Foi a esta relaçäo que este estudo atentou-se, verificando através do resgate da literatura, as interfaces exitentes entre ambas, no que diz respeito aos seus aspectos históricos, sociais e culturais. Entre as principais semelhanças verificou-se todo um contexto de isolamento social, segregaçäo, estigma e, em muitos momentos, descaso com as políticas de Saúde Mental e de Dermatologia Sanitária. Desde a disseminaçäo dos antigos leprosários europeus na Idade Média, que posteriormente passaram a pertencer, por herança histórica, aos insanos, que a hanseníase e a loucura vivem na instituiçäo do asilamento. Nos dias atuais, em especial no contexto brasileiro, onde presenciamos ainda um considerável índice epidemiológico da hanseníase e há mais de uma década o movimento antinacional, que busca garantia de direitos básicos de cidadania às pessoas com transtorno mental, vemos que estas duas realidades mantêm traços de seus processos históricos...(AU)