Trastornos de comportamiento de los adolescentes. Observaciones desde una perspectiva sistémica-relacional / Adolescent’s behavior dissorders. Observations from a sistemic-relational perspective

En este trabajo, los autores plantean que los trastornos de conducta de los adolescentes pueden estar sustentados en fenómenos de la órbita familiar. A este respecto, señalan la importancia de los desacuerdos conyugales, de los conflictos y dificultades de los procesos de desvinculación de los padres con respecto a sus familias de origen y de cómo influyen sobre el chico a través de dos patrones relacionales, que tienen su origen en una identificación proyectiva. En su casuística, han encontrado relación entre el diagnóstico psiquiátrico de la conducta problema, el tipo de desacuerdo en la pareja de los padres (conyugal o sólo parental) y el patrón relacional de trasfondo proyectivo puesto en marcha por los padres sobre sus hijos. Por último, los autores contrastan sus resultados y sus ideas con estudios psicodinámicos y con otros vinculados a la teoría del apego y terminan proponiendo dos hipótesis sobre el posible origen relacional de los trastornos de conducta (AU)

[Rectal catheter decompression in colonic pseudoobstruction (Ogilvie syndrome). Report of a case and review of the literature]. / Descompresión con sonda rectal en la pseudoobstrucción colónica (síndrome de Ogilvie). Informe de un caso y revisión de la literatura.

The Ogilvie's Syndrome is a major surgical complication. It is defined as a severe dilatation of the colon, the cecum, ascendant and transverse, without the presence air at the distal colon following abdominal surgery. The causes are unknown. We described a clinical case of patient delivered by C-S who developed this syndrome and a review of the literature. We emphasized on the importance of the early diagnosis by the use of the traditional abdomen X-Rays and we described a relatively new approach for this patients through the decompression by colonoscopy using a Levin's catheter successfully. This is an alternative minimum-invasive treatment which could be of a great benefit for the patients with this disease.

[Postpartum superior longitudinal sinus venous thrombosis]. / Trombosis venosa del seno longitudinal superior postparto.

The pregnancy increases the risk of cardiovascular ischemic events, The longitudinal sinus thrombosis is very rare, but the incidence increases during pregnancy and puerperium. The mortality rates range from 25% to 50%. This report consists of a case which was studied and managed at the Military Central Hospital. It occurred on the 12th day post C-S. The diagnostic was confirmed by MRI. The treatment consisted of rest and heparin with a successful development. Our findings agreed with the studies reported at the literature that suggested a beneficial effect with the heparin's use, lowering drastically the mortality rates. Some still oppose to its use because of the risk of an intracranial hemorrhage.

[Aortic contraction in pregnancy: report of a case at the Central Military Hospital]. / Coartación de la aorta y embarazo: informe de un caso en el Hospital Central Militar.

The coarctation of the aorta is an uncommon pathology which has a high mortality rate during pregnancy; a very thorough antenatal control must be performed due to the serious complications that may cause death. It is important to eliminate any congenital malformations related to this pathology, such as aneurysms of the Willis polygon, Ductus Persistent or ventricular intercommunication; arterial pressure must be strictly controlled using antihypertensive drugs when needed with beta-blockers. The delivery route may be vaginal, C-section must be reserved only for obstetric reasons. We present a case studied in the Military Hospital, treated with antihypertensives, the fetus had intrauterine growth retardation and was delivered by C-section successfully.

[Short-term antibiotic therapy of post-cesarean-section endometritis]. / Esquema corto de antibióticos en el tratamiento de endometritis posterior a cesárea.

Post-cesarean-section endometritis therapy usually combines an intravenous administered antibiotic followed, once fever has remitted, by an oral or intramuscular course of 7-10 days of the same antibiotic. From November 1993 to May 1994 and trying to reduce the length of the treatment we conducted a randomized, comparative study between the conventional post-C-section endometritis treatment used at the Hospital Central Militar (long course) and a short parenteral treatment with the same antibiotics. Thirty one patients were randomized in the short course group and 32 in the long course group. Only in the long course group there was a patient with persistence of infection after ten days of antibiotic treatment (p > 0.05). The short course regimen brought additional advantages as reduction in treatment days as well as discomfort for the intramuscular administration of antibiotics. This observation suggests that a short course of antibiotics based on the patient's clinical response is a safe and less expensive alternative in the treatment of post-C-section endometritis.

[Normal distribution curve for umbilical arterial flow velocimetry (S/D relation) measured by Doppler ultrasonography]. / Curva de distribución normal de flujometría arterial umbilical (relación S/D) por ultrasonido Doppler.

The umbilical artery flow is an important parameter for the management of obstetrical patients, specially those with retardation in intrauterine growth. A prospective study was carried out in 123 normal, pregnant women, from 20 to 40 weeks of gestation, with a reliable last menstruation date, who came for prenatal control to the Gyn-Ob Department at Hospital Central Militar, from June, 1991 to May 31, 1992. Umbilical artery velocimetry measurements, were done periodically, with S/D ratio determination, avoiding fetal respiratory movements, and at the chord site closest to the placenta. The equipment used was Toshiba Sonolayer SSA-270-A Doppler Duplex of pulsated wave; frequency of transmission-reception 3.5 Mhz and transductor fo 12 mm. diameter. All 123 products had a complete clinical examination, and determination of gestational age by Capurro at the time of birth, in order to exactly identify the gestational age of each ultrasonographic examination. With the obtained results four curves were made. One with average and standard error (EE +/- 1); another of simple lineal regression, obtaining confidence intervals of 95% with a correlation coefficient of r = 0.89; another one based on percentile 10, 50 and 90; and finally, one curve based of the confidence interval of 95%. The results are similar to the ones obtained by other authors, diminishing S/D ratio since week 20 to 40.

Ogilvie's syndrome in the postcesarean section patient.

Two cases of colonic pseudo-obstruction (the so-called Ogilvie's syndrome) are reported. Both patients were in the immediate postcesarean section puerperium. The importance of early diagnosis in these cases is stressed, because this complication has a high mortality rate, frequently in relation to delayed diagnosis and treatment. One patient was successfully treated with conservative measures because diagnosis was made early. A plain X-ray abdominal film which shows cecum dilatation, with or without ascending and transverse colon dilatation, and no distal air, makes the diagnosis. A cecum diameter of 9 cm or more is a surgical indication, because the possibility of wall perforation is high. Surgical techniques are: puncture decompression or cecostomy. When cecum diameter is less than 9 cm, non-surgical measures (nasogastric suction, correction of any fluid and electrolytic imbalance, and maybe a flatus tube) are indicated. Observation through repeated X-ray abdominal films shows when the surgical indication appears: (1) failure of the conservative treatment (cecal distension continues or increases); or (2) cecal perforation is documented.