Comparison of depth of necrosis achieved by CO2- and N2O-cryotherapy.

OBJECTIVE: To compare the depth of necrosis achieved using CO2- and N2O-cryotherapy. METHOD: We treated 20 women with CO2-cryotherapy and 20 with N2O-cryotherapy 24 h prior to undergoing total hysterectomy for reasons unrelated to cervical cancer. Depth of necrosis in the ectocervix was measured on surgically removed tissue. RESULTS: The mean depth of necrosis for the anterior lip achieved by N2O-cryotherapy was 5.3 mm compared with 3.4 mm by CO2-cryotherapy (P<0.001). We found similar results for the posterior lip (5.0 vs 3.1 mm; P<0.001). N2O-cryotherapy was more likely than CO2-cryotherapy to achieve a depth of necrosis of >or=4.8 mm for the anterior lip (75% vs 15%; P<0.001) and posterior lip (60% vs 5%; P<0.001). CONCLUSIONS: Our study showed that CO2-cryotherapy may not achieve the depth of necrosis necessary to completely destroy cervical precancer and therefore may be less robust than N2O-cryotherapy.

Un santo mulato en la Lima seiscentista / A mulatto saint in the XVI Century Lima

En el ámbito del Virreynato peruano, en tiempos de su máximo esplendor, a fines del seiscientos y comienzo del setecientos, pese a la clara delimitación de las clases sociales, se pasó por una etapa de acentuada religiosidad y misticismo que, al lado de la proliferación de iglesias, conventos y otros espacios de culto, generó una notable gravitación de lo crencial religioso en una sociedad cerrada pero con relación estrecha de sus estratos sociales. En este medio, en el nivel inferior y marginal de la sociedad limeña. En los extramuros de la Ciudad de Los Reyes, vivió un mulato, Martín de Porras, quien sufrió en su infancia y temprano adolescencia la pobreza y limitaciones propias de una colectividad de negros siervos en un extenso barrio de gente de color. Su ingénito afán de servicio lo hizo desde muy temprano formarse como auxiliar práctico, barbero y herbolista, para integrarse después, como donado, a un convento de Lima, Martín optó por un género de vida religioso caracterizado por el cumplimiento de las más humildes tareas monásticas, como un modo de superar su condición personal y hacer penitente y expiatoria su existencia. En su lugar de preferente actividad, la enfermería, cuidó de los pacientes pobres con una piedad y abnegación sin límites logrando curaciones y alivio de las enfermedades en las que se vio pronta huella de lo milagroso, difundiéndose su arte excepcional en toda la sociedad limeña, incluyendo la corte virreinal y el propio Virrey. Murió en el olor de santidad y su imagen fue recordadada desde entonces como la de un santo. Vivió en una Lima de excepción, en que coincidieron su vida y las de Santo Toribio de Mogrovejo, de Santa Rosa de Lima y del beato Juan Masías. Se comentan aspectos de su personalidad y la simbología de la escoba, instrumento de su humilde trabajo y después de la señal de generosa entrega al prójimo.

In times of maximum splendor of the Peruvian viceroyalty, at the end the 15 th century and beginning of the 16 th, it went through a stage of marked religiousness and mysticism. Also, there was a proliferation of churches, monasteries and other worship places. Both circumstances lead to a remarkable influence of those aspects related with the religious belief on a closed society which also had a tight relationship between its social layers. It was in this environment, in the lower and marginal levels of Lima society, in the surroundings of the city of the kings, where a mulato called Martin de Porras lived. He suffered since his childhood and early adolescence the poverty and limitations typical of a black servant community living in a wide black people getto. His annate keenness to service lead him to educate himself as assistant, barber herbalist and finally to join, as a lay brother, to a monastery in Lima. Martin opted for a sort of religious life defined by the compliance to the humblest monastic tasks, as a way of overcoming its own personal condition and giving a meaning of penitence and expiation to his life. In his most frequent place of activity, the infirmary, he took care of those patients coming from the poor people with no limit piety and abnegation. He obtained of his exceptional art spread all over the Lima society, including the viceroyal court and even the own viceroy. He was considered as a saint when he died and this was the image that everybody remembered from him since then. He lived during an exceptional part of the Lima history, plenty of mysticism, in which his life coincided with the lifes of other of other saints as St. Toribio of Mogrovejo, St. Rosa de Lima and the blessed Juan Masias. Some parts of his personality are specially commented, including the symbolism of his broom, an instrument of his humble work, which after him became a symbol of generous devoting to the fellow man.

Alprazolam compared to clobazam and placebo in anxious outpatients.

In this double-blind study we compared alprazolam, clobazam, and placebo for the treatment of outpatients suffering from generalized anxiety disorder. At the end of the treatment, the three groups were significantly improved without showing differences among them. However, both active-drug groups were much improved at the end of week 1 in contrast to the placebo group. We were unable to find any difference on efficacy evaluations between alprazolam and clobazam, but alprazolam reached a consistently better outcome on some ratings compared to placebo. Although benzodiazepines share many common properties, it is necessary to identify selected groups of patients that can be helped by specific compounds or even placebo.

[The concept of man and alcoholism in ancient Peru]. / Concepción del hombre y alcoholismo en el antiguo Perú.

In the ancient Peru, particularly in the Inca Empire, the review of alcohol use and abuse must be made according to the ethnohistorical and cultural context with special emphasis on ideological and customary aspects. The outstanding research sources of alcohol consume types and characteristics are: a) The examination of chronicles of the Spanish Conquest and related papers on a textual criticism; b) The study of language from its semantic scope; and c) The archaeological and ethnological testimony. The only alcoholic beverage existing in the Inca's times was "chicha", mainly that of corn fermentation which was used under the ceremonial, ritual and convivial modalities. The pathological drinking types are clearly defined in the lexicon of the Pre-Columbian Peru prevailing languages, mainly Quechua. The social control of drinking overindulgence was evident and the repressive and punitive measures were similar to those of the great ancient civilizations. The image conveyed by most of the chroniclers as to alcohol excessive drinking among Inca people belongs to the trauma of Conquest which suppressed the psychopolitical and sociocultural control that supported their universe of values generating all sort of misbehaviors and selfdestructive types of toxic consume.

Concepción del hombre y alcoholismo en el antiguo Perú. / [The concept of man and alcoholism in ancient Peru]

In the ancient Peru, particularly in the Inca Empire, the review of alcohol use and abuse must be made according to the ethnohistorical and cultural context with special emphasis on ideological and customary aspects. The outstanding research sources of alcohol consume types and characteristics are: a) The examination of chronicles of the Spanish Conquest and related papers on a textual criticism; b) The study of language from its semantic scope; and c) The archaeological and ethnological testimony. The only alcoholic beverage existing in the Incas times was [quot ]chicha[quot ], mainly that of corn fermentation which was used under the ceremonial, ritual and convivial modalities. The pathological drinking types are clearly defined in the lexicon of the Pre-Columbian Peru prevailing languages, mainly Quechua. The social control of drinking overindulgence was evident and the repressive and punitive measures were similar to those of the great ancient civilizations. The image conveyed by most of the chroniclers as to alcohol excessive drinking among Inca people belongs to the trauma of Conquest which suppressed the psychopolitical and sociocultural control that supported their universe of values generating all sort of misbehaviors and selfdestructive types of toxic consume.

Desordenes afectivos en la senescencia y en la senectud. / Affective disorders in senescence and senility

Se revisan algunos aspectos de los desordenes afectivos en la senescencia y en la senectud. El deslinde conceptual enfantiza la importancia del caso individual y la variacion de la cronologia estricta por el ambiente cultural en la delimitacion de esta etapa del ciclo vital, y se agregan algunos datos epidemiologicos sobre la frecuencia de trastornos afectivos en la edad tardia. Se describen los cuadros clinicos agrupados en desordenes afectivos primarios y secundarios. Entre los primarios se revisa la psicopatologia y la clinica de los cuadros unipolares y bipolares Dentro de lo secundarios, se destacan las perturbaciones afectivas que acompanham a las enfermedades somaticas y las producidas por los farmacos. Se examinan las depresiones enmascaradas, los cuadros pseudodemenciales, el suicidio y el esquema general del proceso diagnostico en la Psiquiatria de la edad avanzada. Una consideracion final se detiene en la importancia del estudio del modo de ser y del estilo de vivir para el reconocimiento y el tratamiento de los desordenes afectivos en el tramo final de la vida

Desordenes afectivos en la senescencia y en la senectud. / Affective disorders in senescence and senility

Se revisan algunos aspectos de los desordenes afectivos en la senescencia y en la senectud. El deslinde conceptual enfantiza la importancia del caso individual y la variacion de la cronologia estricta por el ambiente cultural en la delimitacion de esta etapa del ciclo vital, y se agregan algunos datos epidemiologicos sobre la frecuencia de trastornos afectivos en la edad tardia. Se describen los cuadros clinicos agrupados en desordenes afectivos primarios y secundarios. Entre los primarios se revisa la psicopatologia y la clinica de los cuadros unipolares y bipolares Dentro de lo secundarios, se destacan las perturbaciones afectivas que acompanham a las enfermedades somaticas y las producidas por los farmacos. Se examinan las depresiones enmascaradas, los cuadros pseudodemenciales, el suicidio y el esquema general del proceso diagnostico en la Psiquiatria de la edad avanzada. Una consideracion final se detiene en la importancia del estudio del modo de ser y del estilo de vivir para el reconocimiento y el tratamiento de los desordenes afectivos en el tramo final de la vida

[Hermilio Valdizán, comparative psychiatry and folk medicine]. / Hermilio Valdizán, la psiquiatría comparativa y la medicina folklórica.

This paper, a reminder of Hermilio Valdizan's death semicentennial, reviews an aspect of this renowned investigator's work, the formal founder of Psychiatry and the most representative figure of its initial development in Peru. Firstly, it examines the theoretical frame eclosing Valdizan's thought aimed at searching for the Peruvian roots of Medicine and Psychiatry remarking the influence of positivism and the culturalist gravitation. Afterwards, it lingers over a biographical sketch with emphasis laid upon those circumstances that explain the Master's vocational trends and his especial concern on the analysis of Peruvian reality. It reviews Valdizan's innovative contributions to Comparative Psychiatry revealing that his production is considered as the first systematic one in this field in Latin America. It inquires into the sense, orientation, and content of Valdizan's work on Peruvian Traditional Medicine research, the fullest intent on approaching the masses's "sanitarian consciousness" and their closeties with the oral tradition fostered by the conceptions and practice of the healing art in Ancient Peru. Finally, as a distinctive note of this original written production, its main concern on the search for the sense and identity of Peruvian nationality is pointed out. And, after establishing Valdizan's position as the founder of the Peruvian School of Folkloric Medicine, the post-Valdizannian contributions and an actual view of the investigation in this field are concisely and panoramically presented.

Hermilio Valdizán, la psiquiatría comparativa y la medicina folklórica / [Hermilio Valdizán, comparative psychiatry and folk medicine]

This paper, a reminder of Hermilio Valdizan’s death semicentennial, reviews an aspect of this renowned investigator’s work, the formal founder of Psychiatry and the most representative figure of its initial development in Peru. Firstly, it examines the theoretical frame eclosing Valdizan’s thought aimed at searching for the Peruvian roots of Medicine and Psychiatry remarking the influence of positivism and the culturalist gravitation. Afterwards, it lingers over a biographical sketch with emphasis laid upon those circumstances that explain the Master’s vocational trends and his especial concern on the analysis of Peruvian reality. It reviews Valdizan’s innovative contributions to Comparative Psychiatry revealing that his production is considered as the first systematic one in this field in Latin America. It inquires into the sense, orientation, and content of Valdizan’s work on Peruvian Traditional Medicine research, the fullest intent on approaching the masses’s [quot ]sanitarian consciousness[quot ] and their closeties with the oral tradition fostered by the conceptions and practice of the healing art in Ancient Peru. Finally, as a distinctive note of this original written production, its main concern on the search for the sense and identity of Peruvian nationality is pointed out. And, after establishing Valdizan’s position as the founder of the Peruvian School of Folkloric Medicine, the post-Valdizannian contributions and an actual view of the investigation in this field are concisely and panoramically presented.

Hermilio Valdizán, la psiquiatría comparativa y la medicina folklórica. / [Hermilio Valdizán, comparative psychiatry and folk medicine]

This paper, a reminder of Hermilio Valdizans death semicentennial, reviews an aspect of this renowned investigators work, the formal founder of Psychiatry and the most representative figure of its initial development in Peru. Firstly, it examines the theoretical frame eclosing Valdizans thought aimed at searching for the Peruvian roots of Medicine and Psychiatry remarking the influence of positivism and the culturalist gravitation. Afterwards, it lingers over a biographical sketch with emphasis laid upon those circumstances that explain the Masters vocational trends and his especial concern on the analysis of Peruvian reality. It reviews Valdizans innovative contributions to Comparative Psychiatry revealing that his production is considered as the first systematic one in this field in Latin America. It inquires into the sense, orientation, and content of Valdizans work on Peruvian Traditional Medicine research, the fullest intent on approaching the massess [quot ]sanitarian consciousness[quot ] and their closeties with the oral tradition fostered by the conceptions and practice of the healing art in Ancient Peru. Finally, as a distinctive note of this original written production, its main concern on the search for the sense and identity of Peruvian nationality is pointed out. And, after establishing Valdizans position as the founder of the Peruvian School of Folkloric Medicine, the post-Valdizannian contributions and an actual view of the investigation in this field are concisely and panoramically presented.

[The borderline syndrome: conceptual problem, theoretical models, nosographic location]. / El síndrome fronterizo: problema conceptual, modelos teóricos, ubicación nosográfica.

The historical vicissitudes of the term "borderline" in psychiatric literature as well as its actual conceptual dimension are reviewed. The latter is exposed organized in categories or theoretical models as follows: as a peculiar or attenuate presentation of a psychosis, a grave form of a neurosis, a passage syndrome between a neurosis and a psychosis, or an independent nosographic picture. In mentioning pathochronic and generic aspects, an intent of unitary conceptualization is outlined which comprises: I) the clinical picture which translates ego pathology into behavioral terms with a "longitudinal" symptomatological hierarchization of functional levels which interact simultaneously sometimes (dynamic psychopathological space-time) and pointing out its dependence on the environment; II) the structural analysis or the dynamic formulation. The actual nosographic position of the borderline syndrome as well as the one established in the proposed Third Review of the American Psychiatric Classification and its heuristic value are examined. Finally, the presence of this syndrome in relation to modern time society characteristics is commented.