Algoritmo terapéutico de la mediastinitis aguda en la cirugía cardiovascular / Therapeutic algorithm of acute mediastinitis in cardiovascular surgery

La mediastinitis aguda es una complicación de la cirugí­a cardí­aca, la cual muestra alta mortalidad y siempre requiere tratamiento quirúrgico, del que existen varias modalidades terapéuticas. Las decisiones resultan complejas, por esta razón es imprescindible el establecimiento de un algoritmo terapéutico, que permita reducir la mortalidad por esta complicación. La gran variabilidad de los resultados y el espectro de técnicas quirúrgicas descritas al efecto, han atentado contra la creación de guías prácticas basadas en la evidencia para la infección mediastínica posoperatoria, de manera tal que los pocos algoritmos que se han publicado son incompletos o muy especí­ficos. Se presenta un algoritmo terapéutico para la mediastinitis aguda elaborado en el Cardiocentro de Santiago de Cuba, de fácil aplicación, que logró disminuir la mortalidad y puede ser aplicado en el resto de los centros del país, que no posean una herramienta similar(AU)

Acute mediastinitis is a complication of the heart surgery, which shows high mortality and it always requires surgical treatment, of which several therapeutic modalities exist. Decisions are complicated, for this reason the establishment of a therapeutic algorithm that allows to reduce mortality due to this complication is necessary. The great variability of the results and the spectrum of surgical techniques described on this respect, have attempted against the creation of practical guides based on the evidence for the postoperative mediastinal infection, in such way that the few algorithms that have been published are incomplete or very specific. A therapeutic algorithm is presented for the acute mediastinitis, elaborated in the Cardiology Center from Santiago de Cuba, it is of easy application. It decreased mortality and can be applied in the rest of the centers from the country, which don't have a similar tool(AU)

Calidad del tratamiento aplicado a gestantes con hipertensión arterial en el Distrito de Salud 4 Abel Santamaria Cuadrado / Quality of treatment applied to pregnant women with hypertension at Abel Santamaría Cuadrado Health District 4

Se evaluó la calidad del tratamiento aplicado a 32 embarazadas con hipertensión arterial, pertenecientes al Distrito de Salud 4 Abel Santamaría Cuadrado de Santiago de Cuba. El estudio, efectuado desde octubre de 2009 hasta mayo de 2010, incluyó a dichas gestantes y 93 médicos de familia de la localidad. La evaluación, que contempló proceso (calidad cientificotécnica) y resultado (satisfacción), se basó en el análisis retrospectivo de las historias obstétricas, el examen de conocimiento y la información obtenida a través de las encuestas. Se concluyó, entre otros aspectos, que tanto los profesionales en cuestión como las gestantes se mostraron insatisfechos en sentido general, de donde se derivó que tampoco la terapéutica fue adecuada al comparar los indicadores de cada criterio con los estándares prefijados.

The quality of the treatment applied to 32 pregnant women with hypertension, belonging to Abel Santamaría Cuadrado Health District 4 in Santiago de Cuba was evaluated. The study carried out from October 2009 to May 2010 included these pregnant women and 93 family physicians of the locality. The evaluation, which looked at process (scientific and technical quality) and result (satisfaction), was based on retrospective analysis of the obstetric records, examination of knowledge and information obtained through surveys. It was concluded, among other issues, that both the professionals and pregnant women were generally dissatisfied, therefore the therapy was inappropriate when comparing the indicators of each criterion with the preset standards.

Calidad del tratamiento aplicado a gestantes con hipertensión arterial en el Distrito de Salud 4 Abel Santamaria Cuadrado / Quality of treatment applied to pregnant women with hypertension at Abel Santamaría Cuadrado Health District 4

Se evaluó la calidad del tratamiento aplicado a 32 embarazadas con hipertensión arterial, pertenecientes al Distrito de Salud 4 Abel Santamaría Cuadrado de Santiago de Cuba. El estudio, efectuado desde octubre de 2009 hasta mayo de 2010, incluyó a dichas gestantes y 93 médicos de familia de la localidad. La evaluación, que contempló proceso (calidad cientificotécnica) y resultado (satisfacción), se basó en el análisis retrospectivo de las historias obstétricas, el examen de conocimiento y la información obtenida a través de las encuestas. Se concluyó, entre otros aspectos, que tanto los profesionales en cuestión como las gestantes se mostraron insatisfechos en sentido general, de donde se derivó que tampoco la terapéutica fue adecuada al comparar los indicadores de cada criterio con los estándares prefijados(AU)

The quality of the treatment applied to 32 pregnant women with hypertension, belonging to Abel Santamaría Cuadrado Health District 4 in Santiago de Cuba was evaluated. The study carried out from October 2009 to May 2010 included these pregnant women and 93 family physicians of the locality. The evaluation, which looked at process (scientific and technical quality) and result (satisfaction), was based on retrospective analysis of the obstetric records, examination of knowledge and information obtained through surveys. It was concluded, among other issues, that both the professionals and pregnant women were generally dissatisfied, therefore the therapy was inappropriate when comparing the indicators of each criterion with the preset standards(AU)

Effects and distribution of intravitreally or subretinally injected silicone oil identified in rabbit retina using osmium tetroxide method.

Silicone oil was injected into the eyes of 28 rabbits. Utilizing the specific affinity of osmium tetroxide for lipids, the pathological features and histochemical localization of silicone oil within the retina were studied. This osmium tetroxide technique makes it possible to identify the presence of silicone oil particles in the ocular tissues. It was demonstrated that in eyes with silicone oil injected into the vitreous cavity or subretinal space, silicone oil was detected in the inner retinal layer and in phagocytes in the vitreous cavity but not in the outer retinal layer, retinal pigment epithelium and choroid. In addition, prominent subretinal and epiretinal proliferation with abundant phagocytes containing silicone oil particles were noted in the eyes with subretinal injection of silicone oil through an artificial retinal break. This study suggests that when injected subretinally silicone oil induces excessive subretinal and epiretinal proliferation.

[Attempt to the measurement of the tension of zonular fibers--influence to the lens suspensory apparatus when the lens was vertically displaced by pushing posteriorly].

A new fine pressure gauge was developed to quantitate zonular tension of the albino rabbit eye. This apparatus consists of a plastic rod to press the crystalline lens, transducer, amplifier, and recorder. The diameter of this plastic rod is 8 mm. The cornea and the iris of enucleated eyes were removed by excision in the limbus. Afterwards the lens were vertically pressed by the plastic rod of the fine pressure transducer. It was necessary to disrupt a part of zonules by approximately 106 g (2.11 g/mm2). This result was equivalent to 155 mmHg. The morphological changes of the anterior part of eye globe which consists of lens, zonules, and ciliary process were investigated using scanning electron microscopy. In the control eyes, the zonular fibers mostly originated from the superior or lateral ciliary processes and inserted straight into the equatorial region of the lens. In comparison with control eyes, the zonular fibers which were pressed by the plastic rod were almost absent within 1/6 of a circle. This disruption occurred at the region adjacent to the ciliary e process, while the region of the insertion to the lens demonstrated a normal appearance. In the unaffected area zonules were well-preserved morphologically, apart from splits of the bundles of zonules. The present study indicated that zonular fibers could resist a stretching press up to approximately 8 times normal intraocular pressure.

2',3'-cyclic nucleotide 3'-phosphohydrolase activity in rat visual pathways with experimental allergic encephalomyelitis.

The enzyme 2',3'-cyclic nucleotide 3'-phosphohydrolase (CNPase) is one of the important markers for myelin synthesis or demyelination. We measured the CNPase activities in the visual pathway tissues of Lewis strain rats with experimental allergic encephalomyelitis (EAE) induced by inoculation of myelin basic protein from the brain. The enzyme activities in the retina, optic nerve, optic chiasma and lateral geniculate body were reduced to about 50-80% of that of controls at 15 days after myelin basic protein inoculation when symptoms of EAE were most severe. However, the activities recovered at 19 days except in the retina when the symptoms of EAE disappeared. Furthermore, the activities of the optic nerve and chiasma increased to a level higher than that of the controls at this time. By histopathological study, infiltration of inflammatory cells and focal demyelination were found in the optic nerve and lumbar spinal cord at 15 days after myelin basic protein inoculation. It was considered that the reduction of CNPase activity and its recovery and increase reflect demyelination and activation of oligodendroglia for remyelination, respectively.

2',3'-Cyclic nucleotide 3'-phosphohydrolase in acrylamide-induced optic neuropathy in rabbit.

The in vivo effects of acrylamide on the nerve tissues of the rabbit optic pathway were examined. The optic nerve of acrylamide-treated rabbits showed inflammatory changes and degeneration. The decrease of myelin was observed with myelin stain. The activity of 2',3'-cyclic nucleotide 3'-phosphohydrolase (EC.3.1.4.37) which is firmly bound to myelin was markedly diminished by acrylamide intoxication.