[Physiopathological alterations secondary to extracorporeal circulation in cardiac surgery]. / Alteraciones fisiopatólogicas secundarias a circulación extracorpórea en cirugía cardíaca.

Cardiopulmonary bypass (CPB) is one of the methods used in myocardial revascularization and can be associated with adverse events that are uncommon, but CPB induces high morbidity and mortality. Cardiac surgery and CPB activate a systemic inflammatory response characterized by tissular lesions, cells movements and blood flow toward the interstice where the harmful stimulus has begun, under the influence of the mediators. The systemic inflammatory response may be initiated during cardiac surgery by a number of processes, including blood contact with the foreign surface of the CPB apparatus, development of ischemia and reperfusion injury, and presence of endotoxemia. In the course of cardiac surgery using CPB, all three processes are present and contribute concurrently to the systemic inflammatory response. The term "systemic inflammatory response syndrome" (SIRS) has been proposed to describe an entity that continually overlaps with normal postoperative physiology. A frequent complication of SIRS is the development of organ dysfunction, including acute lung injury, shock, renal failure, and multiple organ dysfunction syndrome. Finally, long-term survival in patients developing SIRS may also be adversely affected. The purpose of this review is to examine and understand the pathological mechanisms for inflammatory response that occur following cardiopulmonary bypass.

[Nuclear medicine residents' clinical aptitude for interpreting gammagraphic images]. / La aptitud para la interpretación de imágenes gamagráficas en residentes de medicina nuclear.

OBJECTIVE: The study deals theoretical aspects of evaluation and the importance of consider one as part of a research process. The diverse theoretical trends in the field of education are synthesized in two main tendencies: the participating and passive education perspectives. The influences of these two tendencies in selection the subjects for evaluation are also discussed in order to explore the gammagraphic interpretation aptitude in residents of nuclear medicine. MATERIAL AND METHODS: An evaluation instrument developed by us to explore aptitudes result of a long validation process. It consists of 90 questions was applied to the whole sample (19 residents in two IMSS courses) in one single session. We also applied other instrument of multiple choice (90 questions too) within the passive tendency of education (control instrument). RESULTS: Scores obtained by three groups of residents in nuclear medicine in the aptitudes instrument, showed difference in accordance with the respective time of experience: first year obtained the lowest scores (31.5) second year showed intermediate scores (36) 3rd the highest (43) (p = 0.03 between 1st and 3rd). The scores obtained by the control instrument, was not clear difference: the 2nd year of residents was found better (score of 56) than 3rd year residents (score 52.5) The aptitude instrument is better than the control instrument in order to explored, discriminated and estratificated by time of formative experience in medical courses. CONCLUSIONS: We believe that the aptitude instrument is capable of detecting learning dependent on the time of clinical experience. Some considerations on the advantages and scope of this instrument, as compared to other current instruments, which are also intended to measure clinical aptitudes, are done. The theoretical superiority of the clinical aptitudes instrument in relation the others are discussed.