Dolor y sueño: dos variables biológicas siempre presentes / Pain and sleep: two biological present conditions

El dolor constituye una entidad psicobiológica tan importante que se le conoce como el quinto signo vital. Junto al dolor, también se alteran otras entidades biológicas, denominadas "comorbilidades", una de ellas es el sueño. Al interactuar estas dos entidades, comprometen la capacidad biológica y conductual del individuo otorgándole una peor calidad de vida. Resulta indispensable reconocer y tratar las alteraciones del sueño que ocurren tanto en dolor agudo como crónico. Una de las formas de entender las alteraciones del sueño es mediante una polisomnografía. Este artículo de revisión pretende analizar la emergente literatura médica que reconoce y describe esta problemática relación sueño-dolor.

The pain is an important psychobiology condition, called the five vital sign. The sleep is other biology condition or "comorbilities". When these two vital condition, pain and sleep interact, the biological and behavioral capacity of the patient is compromised, given the worse live quality. An important consideration in understanding the sleep disturbances found in acute and chronic pain relates to their measurements. The polysomnography is the standard for defining sleep and its disturbances. This articles review the emergent medical literature about this complex pain-sleep nexus.

Evolution of daytime quiet sleep components in early treated phenylketonuric infants.

The maturational patterns of 'tracé alternant' (TA) and sleep spindles obtained from 16 early detected phenylketonuric (PKU) children during their first months of life were compared with others that were evaluated in recordings taken from 42 controls of the same age group. The TA maturation evolved significantly later in the PKU group than in the control group during the 5th-8th week (the TA score for the PKU group was 64% vs. 10% in the control group, P < 0.001). Afterwards, during the 9th-12th week the score for the PKU group was 27% vs. 0% in the controls (P < 0.002). The sleep spindle evolution score also matured significantly later in the PKU than the control group: the score was 31% in PKU children vs. 85% in controls for the 5th-8th week of age (P < 0.01), and it was 66% vs. 96% for the 9th-12th week (P < 0.02). After the 12th week, TA pattern could not be detected, and spindles reached complete maturation in the PKU children as well. Our results show a consistent delay in the maturation of TA and spindle scores in PKU children. This trend of delay is parallel to the plasma phenylalanine normalization, but not necessarily dependent only on it. In conclusion, we suggest that studies on the critical maturational periods of different sleep components (TA and sleep spindles) might provide a sensitive tool for early diagnosis of neurophysiological brain alterations during the first trimester of life in a population of children "at risk'.

Prevalencia del cáncer de vesícula biliar en colecistectomías / Biliary gallblader cancer prevalence in cholecystectomy

De 2.090 colecistectomías efectuadas en el Servicio de Cirugía del Hospital Valparaíso entre 1988 y 1990, el 2,9% presentó cáncer vesicular. El promedio de edad de los pacientes con cáncer fue de sólo 49 años, siendo la distribución por sexo similar. El cáncer estuvo asociado siempre a colecistitis crónica litiásica; se presentó avanzado (tipo III y IV de Nevin) y correspondió casi siempre a adenocarcinomas indiferenciados. La cirugía practicada fue la simple colecistectomía. La sobrevida de los 61 pacientes operados con cáncer de vesícula fue de 10,5% al año

Prescripción y venta de medicamentos importantes sin receta médica en algunas farmacias de la zona / Prescription and sale of important drugs without medical recipe in some drugstore at the zone

Durante Septiembre de 1991, se encuestó una muestra de 400 personas, elegidas aleatoriamente para sexo y edad, las cuales compraron algún medicamento en farmacias de la zona. De las personas encuestadas, sólo un 2 por ciento presentó su receta médica al momento de la compra. En caso de que el medicamento no fuera para el encuestado, los datos obtenidos corresponden al destinatario, como por ejemplo, en el grupo de menores de un año. La distribución de los destinatarios de los medicamentos, comprendió un 67 por ciento al sexo femenino y un 33 por ciento al masculino; en relación a la edad, predominó el grupo de 31-40 años y el de menores de un año, respectivamente. De los productos comprados, predominan los antiinflamatorios no esteroidales (AINE) 32 por ciento, como dipirona e ibuprofeno, seguido de los antibióticos 28 por ciento, como cotrimoxazol, penicilina y ampicilina. El rubro otros (aminofilina, clorpropamida, anovulatorios, etc.) ocupó un papel importante en la compra, con un 32 por ciento

Headache in association with sleep disorders in children: a psychodiagnostic evaluation and controlled clinical study--L-5-HTP versus placebo.

Forty-eight elementary and junior high school students presenting the association of recurring headache and sleep disorders were selected for this study on the basis of a questionnaire filled out by the entire school population. The selected students had normal intellectual capacity but often showed inadequate progress in school, attentive-mnemonic deficiencies, and psychopathological elements of a depressive nature. The clinical characteristics predicted that this group would be responsive to treatment with L-5-hydroxytryptophan. The results of a double-blind, cross-over trial with placebo confirmed these expectations for headache and some sleep disorders, in particular frequent awakenings and some parasomnias.

EEG as a possible prognostic tool in phenylketonuria.

Clinical EEG and biochemical data were recorded in 10 children with classical PKU and 5 with variant forms of hyperphenylalaninaemias during the first year of life. A semiquantitative evaluation of the EEG showed a high correlation between epileptiform abnormalities and phenylalanine blood levels in the first 90 days of life and therefore with the delay before dietary therapy in PKU children. Although performed on a limited population, such an approach may indicate an additional non-computerized EEG tool for the clinical management of hyperphenylalaninaemias, and suggest some criteria for neurophysiological risk evaluation during the first year of life.