Administración de surfactante profiláctico por vía orofaríngea previo al pinzamiento de cordón umbilical en el recién nacido de muy bajo peso en la maternidad del Hospital Universitario / Prophylactic oropharyngeal surfactant administration before cord clamping in very low birth weight newborns at the University Children Hospital Maternity Department / Administração de surfactante profilático por via orofaríngea antes do clampeamento do cordão umbilical em recém-nascidos de baixo peso extremo na Maternidade do Hospital Pediátrico Universitário

Resumen: En la era de la búsqueda de estrategias ventilatorias mínimamente invasivas, la administración profiláctica de surfactante con técnicas sencillas, que no requieren elevada destreza y que pueden ser realizadas en ámbitos de baja complejidad, deben ser investigadas para potencialmente disminuir la morbilidad y mortalidad del pretérmino. Se reporta el uso de surfactante en la orofaringe de cuatro recién nacidos de muy bajo peso (promedio de peso de 1.236 g y 28 semanas de edad gestacional), y concomitante colocación de presión positiva continua por pieza nasal antes de la primera inspiración extrauterina manteniendo el cordón intacto. No se registraron efectos adversos y la aspiración gástrica posterior demostró que el surfactante fue inspirado a los pulmones del recién nacido. La administración de surfactante orofaríngeo es una técnica innovadora, segura, factible y reproducible. A la vez que minimizamos los riesgos de posible iatrogenia por la técnica utilizada, facilitamos una transición cardiovascular más estable, manteniendo la circulación fetoplacentaria.

Summary: In the era of minimally invasive ventilatory procedures, the prophylactic administration of surfactant using simple techniques that can be performed in low complexity settings, should be researched as a tool to potentially reduce preterm morbidity and mortality. We report the use of oropharyngeal surfactant in 4 very low birth weight newborns (average birth weight 1236g and 28 weeks of gestational age) and of continuous positive airway pressure before the first intrauterine inspiration and keeping an intact umbilical cord. No adverse effects happened, and the aspiration of gastric residual confirmed that surfactant had reached the lungs. The administration of oropharyngeal surfactant is an innovative, safe, feasible and reproducible technique. It minimizes the risks of possible iatrogenesis due to the technique used, and it also facilitates a more stable cardiovascular transition, maintaining the fetus' placental circulation.

Resumo: Na era da procura de técnicas ventilatórias minimamente invasivas, a administração profilática de surfactante utilizando técnicas simples, que não requerem muita destreza e que pode ser realizada em contextos de baixa complexidade, deve ser pesquisada para reduzir potencialmente a morbidade e mortalidade dos pré-termos. Reportamos o uso de surfactante na orofaringe em 4 recém-nascidos com baixo peso ao nascimento (peso médio de 1,236 g e 28 semanas de idade gestacional), e colocação concomitante de pressão positiva contínua por adaptador nasal, antes da primeira inspiração extrauterina e mantendo o cordão umbilical intacto. Não houve efeitos adversos e o aspirado gástrico subsequente mostrou que o surfactante foi inspirado e observado nos pulmões dos recém-nascidos. O surfactante de administração orofaríngea é uma técnica inovadora, segura, viável e reprodutível. Minimiza os riscos iatrogênicos eventuais devido à técnica utilizada, à vez que proporciona uma transição cardiovascular mais estável porque mantém a circulação da placenta fetal.

[The Epistolarum medicinalium libri XX by Giovanni Mainardi]. / Per lo studio degli Epistolarum medicinalium libri XX di Giovanni Mainardi.

The paper aims at highlighting some aspects of the Epistolarum medicinalium libri XX by Giovanni Mainardi. This work, that enjoyed an European repute and was reprinted many times, has to be set against the background of the early 16th century attempts at reforming medical education. Mainardi, a skilled humanist and the pupil of Nicolb Leoniceno and Pico della Mirandola, advocated a return to the original sources of Greek and Latin medical thought. The choice of Epistolae as a literary genre was in itself meaningful, in that it allowed Mainardi an unusual freedom of expression on the whole range of medical problems. Mainardi advocated the notion of medicine as ars - not scientia - and he believed in disengaging it from natural philosophy in the Aristotelian sense. At the same time, he believed in the possibility of introducing novelties in medicine, and of correcting ancient but incorrect textual traditions.

[Didactic strategies of Giovan Battista da Monte (1489-1551) for the reformation of medical studies at the Paduan Studium]. / Le strategie didattiche di Giovan Battista da Monter (1489-1551) e il tentativo di riforma del "Curriculum" Patavino.

Da Monte was a very important member of medical Humanism; his position within the medical cultural scene of his time was characterised by strong interests in the epistemological problems of medicine. He considered the whole medicine - not only theory - a practical science according to the Aristotelian concept of science. During his teaching years at the Paduan Studium he tried to overcome the division of medicine into medical theory and medical practice and he elaborated an unitary method of teaching, trying to follow the Galen's Methodus medendi, in order to give a true scientific foundation also to the medical practice.