Middle-age abolishes cardioprotection conferred by thioredoxin-1 in mice.

Thioredoxin-1 (Trx1) has cardioprotective effects on ischemia/reperfusion (I/R) injury, although its role in ischemic postconditioning (PostC) in middle-aged mice is not understood. This study aimed to evaluate if combining two cardioprotective strategies, such as Trx1 overexpression and PostC, could exert a synergistic effect in reducing infarct size in middle-aged mice. Young or middle-aged wild-type mice (Wt), transgenic mice overexpressing Trx1, and dominant negative (DN-Trx1) mutant of Trx1 mice were used. Mice hearts were subjected to I/R or PostC protocol. Infarct size, hydrogen peroxide (H2O2) production, protein nitration, Trx1 activity, mitochondrial function, and Trx1, pAkt and pGSK3ß expression were measured. PostC could not reduce infarct size even in the presence of Trx1 overexpression in middle-aged mice. This finding was accompanied by a lack of Akt and GSK3ß phosphorylation, and Trx1 expression (in Wt group). Trx1 activity was diminished and H2O2 production and protein nitration were increased in middle-age. The respiratory control rate dropped after I/R in Wt-Young and PostC restored this value, but not in middle-aged groups. Our results showed that Trx1 plays a key role in the PostC protection mechanism in young but not middle-aged mice, even in the presence of Trx1 overexpression.

Predictive and Comparative Study Between Clinic Consensus Document for Pancreas Acceptance and Predictive Value of Preprocurement Pancreas Allocation Suitability Score (P-PASS).

The strict selection of pancreas for transplant has forced the development of different documents to select the suitable organ in order to minimize the risks and complications of the transplant. In 2008, Eurotransplant published the Preprocurement Pancreas Allocation Suitability Score (P-PASS) for pretransplant selection. In 2001 the Hospital Clinic of Barcelona developed a Clinical Consensus Document (CCD). OBJECTIVES: We aimed to analyze the predictive decision of the pancreas acceptance to offers received in the hospital, according to the CCD criteria and compare it with the recommended value of suitability for accepting the pancreas according to the P-PASS value. MATERIAL AND METHODS: We performed a retrospective comparative study between the criteria of selection of the CCD for pancreas from 2016-2017 in comparison with the values obtained if the P-PASS had been used: ≤ 17, acceptance criteria and P-PASS; > 17, risk criteria. We defined the organ reported as rejected or accepted. The accepted organ could be procured and transplanted or discarded. RESULTS: With the CCD criteria, 7 more organs were transplanted than if we only applied the potential P-PASS criteria. In contrast, P-PASS would have ruled out an additional 9% of pancreases in relation to CCD criteria. CONCLUSIONS: According our experience, it is difficult to find an adequate prediction model to select pancreas for transplantation. The application of the DCC criteria increases the number of organs valid for transplantation. At present, new criteria should be re-evaluated within multicenter studies.

Relatives' Perception After Tissue Donation Experience: Results of a Postdonation Phone Survey.

INTRODUCTION: Postmortem tissue donation (TD) requires the establishment of strategies for family approach to clearly explain the characteristics of multi-tissue donation. In a tertiary university hospital with a long tradition of tissue generation, we designed a survey to be applied to tissue donor families to evaluate global hospital care, care from Transplant Coordinators (TC), quality and content of information given about TD, experience, and motivations after TD process. METHODOLOGY: A prospective phone survey of 10 multiple-choice items was conducted to all TD relatives that agreed to donate one or more tissues. RESULTS: From the 166 calls made to TD relatives, 75 (45%) were answered: 50 were cornea donors and 25 were multiple-tissues donors. None of the relatives denied participating, the rest were not found. No statistical differences in demographical variables were found between both types of TD. The hospital and TC care perception, the quality of the given information about the processes of TD, the postdonation experiences in terms of procedures, and the impression about body appearance for relatives regardless of the type of donation, corneas or multiple tissues, were evaluated as good or very good for most of the TD relatives. Our study showed that 83% of the family members would agree to donate again; 40% of the relatives were surprised to be offered the option to donate; 10% did not know if they would donate again. Solidarity was the leading reason for TD. CONCLUSION: The relatives' perception of care is a critical component of the quality evaluation of the TD process. The global evaluation results support our strategies for family approach.

Left ventricular hypertrophy does not prevent heart failure in experimental hypertension.

BACKGROUND: Left ventricular hypertrophy (LVH) secondary to hypertension has been accepted to prevent heart failure (HF) while paradoxically increasing cardiovascular morbi-mortality. OBJECTIVES: To evaluate whether antihypertensive treatment inhibits LVH, restores beta-adrenergic response and affects myocardial oxidative metabolism. METHODS: Ninety spontaneously hypertensive rats (SHR) were distributed into groups and treated (mg/kg, p.o.) with: losartan 30 (L), hydralazine 11 (H), rosuvastatin 10 (R), carvedilol 20 (C). Hypertension control group comprised 18 normotensive rats (Wistar-Kyoto, WKY). Following euthanasia at 16months, contractility was measured in 50% of rats (Langendorff system) before and after isoproterenol (Iso) 10-9M, 10-7M and 10-5M stimulation. Left ventricular weight (LVW) was measured in the remaining hearts, and normalized by BW. Expression of thioredoxin 1 (Trx-1), peroxyredoxin 2 (Prx-2), glutaredoxin 3 (Grx-3), caspase-3 and brain natriuretic peptide (BNP) was determined. RESULTS: Systolic blood pressure (mmHg): 154±3 (L), 137±1 (H), 190±3 (R)*, 206±3 (SHR)*, 183±1 (C)**, and 141±1 (WKY) (*p<0.05 vs. L, H, WKY, **p<0.05 vs. L, H, WKY, SHR). LVW/BW was higher in SHR and R (p<0.05). Groups SHR, R and C evidenced baseline contractile depression. Response to Iso 10-5M was similar in WKY and L. Expression of Trx-1, Prx-2 and Grx-3 increased in C, H, R and L (p<0.01). CONCLUSIONS: Present findings argue against the traditional idea and support that LVH might not be required to prevent HF. Increased expression of thioredoxins by antihypertensive treatment might be involved in protection from HF.

Relation between periodontal disease and arterial stiffness.

BACKGROUND AND OBJECTIVE: Periodontal disease has been described as playing a role in the atherosclerosis process, and its relation with intimal thickness and vascular endothelial function (EF) has been investigated. The present study sought to determine whether there are differences in parameters of arterial stiffness and EF between patients with and without severe periodontal disease (SPD). MATERIAL AND METHODS: Patients referred to the School of Dentistry University of Buenos Aires, were assessed. Demographic characteristics, atherogenic risk factors and concomitant pathologies were recorded. Patients with known cardiovascular pathology were excluded. Using carotid Doppler ultrasound an operator assessed arterial stiffness parameters: compliance, elastic modulus (EM), ß stiffness index (ßSI) and vascular EF by brachial artery flow-mediated dilatation. The patients were divided into two groups: with and without SPD. RESULTS: Forty patients were included; 60% were women; 15 were in the SPD group and 25 in the group without SPD. Respective results of the studied variables were: age 56.53 ± 17.58 vs. 51.12 ± 12.97 years (NS); probing depth 2.53 ± 1.30 (95% CI 1.81-3.25) vs. 1.25 ± 0.51 (95% CI 1.31-1.73) p = 0.02; clinical attachment level 4.80 ± 2.00 (95% CI 3.69-5.91) vs. 1.72 ± 0.93 (95% CI 1.33-2.11) p = 0.001; intimal thickness 0.10 ± 0.17 (95% CI 0.095-0.11) vs. 0.82 ± 0.18 (95% CI 0.074-0.98) (NS); EM 48.33 ± 12.53 vs. 38.86 ± 7.69 (p = 0.005); ßSI 4.21 ± 1.03 vs. 3.64 ± 1.02 (p = 0.004); EF 16.13 ± 5.02 vs. 22.76 ± 4.50 (p = 0.0003). Correlation between: EM and clinical attachment level r = 0.58 (p < 0.001), ßSI and clinical attachment level r = 0.66 (p < 0.001), EF and clinical attachment level 0.59 (p < 0.001). CONCLUSIONS: Parameters of arterial stiffness and EF were worse in patients with SPD and correlated moderately with clinical attachment level. Correlation with compliance and EF was negative.

Quality Assessment of Postmortem Tissue Donors in a University Hospital: Detection and Generation Tissue Indicators.

BACKGROUND: Defining quality assessment and measurement tools in the area of tissue donation should be considered to be one of the most important strategies for developing health centers. The aim of this project was to identify, define, and analyze a set of indicators to assess the most important steps in the tissue donor detection and generation processes. METHODS: A prospective, descriptive, and comparative study of all potential tissue donors (TDs) detected and generated in a university hospital was performed. All deceased patients after cardiocirculatory death were evaluated in 2015 by the transplant coordinators (TCs). We defined as detection indicators: total deaths, percentage of detection and evaluation, percentage of clinical contraindications, tissue donor potentiality (TDP; corneal or multitissue potentiality), and the functional detection time (FDT); and as generation indicators: generation rate (corneal or multitissue generation), family request time, number of interviewed relatives, and TC experience (y). RESULTS: The detection and evaluation rate was 100% (n = 1,235); tissue clinical contraindications were 57%, and TDP was 43% (n = 528; corneal, 80%; multitissue, 20%). The FDT was 24 ± 30 minutes. The generation rate was 53.4% (n = 282): corneal, 57% (n = 241); and multitissue, 40% (n = 41). Family request time was 10 ± 17 minutes, average number of interviewed relatives was 2.2 ± 1.6, and 35% of TCs had experience in the field for >5 years. CONCLUSIONS: Obtaining indicators for quality assessment in the area of tissue donation is useful in predicting the outcome of the TD process as well as promoting the approach of continuous improvement.

Lithotomy's prohibition and referral to experts in medical oaths of hippocratic stemma. / Prohibición de la litotomía y derivación a expertos en los juramentos médicos de la genealogía hipocrática.

OBJECTIVE: The aim is to analyse how the Hippocratic Oath's commitments of not cutting for stone and referral to experts was modified in medical oaths of Hippocratic stemma from different time periods. METHODS: Nineteen oaths of Hippocratic stemma were studied: 4 Medieval, 2 Modern, and 13 Contemporary. They were selected according to: name of the oath when it includes the word «Hippocratic¼ or because their authors recognized having based their oaths on the Hippocratic Oath. Their historical significance and representativity regarding time period, renowned medical schools, and importance and reliability of the sources was also taken into consideration. RESULTS: Four oaths prohibit cutting for stone (one Medieval, 2 Modern, one Contemporary); 4 oaths mention seeking consultation about patients (all Contemporary); 3 mention not performing criminal operations (all Contemporary); 8 do not mention these commitments (3 Medieval, 5 Contemporary). CONCLUSION: The commitment of the Hippocratic Oath of not cutting for stone and referral to experts has been modified mainly in Contemporary oaths. The original commitment seems to have been split into 2 tendencies: those that mention obtaining consultation, and those that refer to not performing criminal operations. Due to the bioethics movement in the second half of the 20th century, referring patients that exceed the physician's limitations to more skilled colleagues constitutes an ethical obligation. Thus, it should be a commitment present in every Contemporary oath.

Desensitization in ABO-Incompatible Kidney Transplantation With Low ABO Iso-Agglutinin Titers.

BACKGROUND: In ABO-incompatible (ABOi) kidney transplantation (KT) with low iso-agglutinin (IG) titers (IGT), standard pre-conditioning treatment might be excessive. To try to answer this question, we evaluated the pre-conditioning requirements of a group of ABOi KT with low ABO IGT in our center. Our main objective was to assess desensitization requirements for ABOi KT with low IGT (<16) at Hospital Clinic of Barcelona from 2006 to 2014. METHODS: A retrospective study of desensitization (rituximab and plasma exchange [PE]) requirements for ABOi KT with IGT <16 was conducted. RESULTS: One and 5 years after KT, patient survival was 100%. Renal graft survival was 90% at 1 and 5 years after KT. Mean PE performed before KT was 1.7 (standard deviation [SD], 1.703); 50% of the patients did not receive PE after transplantation, 30% received 2 sessions of PE, and 20% received only 1. The average is 0.8 (SD, 0.91).Follow-up IG determinations remained with low titers (≤8/8). No rebounds of titers were observed during the first 4 to 6 months after transplantation. CONCLUSIONS: Recipients with IGT ≤8 required none or only 1 PE session to reach acceptable titers (titers ≤4) to perform ABOi KT safely. This information is useful to assess the possibility of a minimized desensitization protocol in ABOi KT donors with low titers of IG to reduce adverse effects, reduce cost, and simplify pre-transplant logistics.

Sterile leukocyturia is associated with interstitial fibrosis and tubular atrophy in kidney allograft protocol biopsies.

Kidney allograft interstitial fibrosis and tubular atrophy (IF/TA) is associated with a poorer renal function and outcome. In the current clinical practice, an early diagnosis can only be provided by invasive tests. We aimed to investigate the association of sterile leukocyturia with Banff criteria histological findings in kidney allograft protocol biopsies. We studied 348 allograft biopsies from two different European countries performed at 8.5 + 3.5 months after transplantation. In these cases, the presence of sterile leukocyturia (Leuc+, n = 70) or no leukocyturia (Leuc-, n = 278) was analyzed and related to Banff elementary lesions. Only IF/TA was significantly different between Leuc+ and Leuc- groups. IF/TA was present in 85.7% of Leuc+ and 27.7% of Leuc- patients (p < 0.001). IF/TA patients had higher serum creatinine and presence of proteinuria (p < 0.05). Independent predictors of IF/TA were donor age, donor male sex, serum creatinine and Leuc+ (hazard ratio 18.2; 95% confidence interval, 8.1-40.7). The positive predictive value of leukocyturia for predicting IF/TA was 85.7% whereas the negative predictive value was 72.3%. These studies suggest that leukocyturia is a noninvasive and low-cost test to identify IF/TA. An early diagnosis may allow timely interventional measures directed to minimize its impact and improve graft outcome.

Impaired cardiac mitochondrial function and contractile reserve following an acute exposure to environmental particulate matter.

BACKGROUND: It has been suggested that mitochondrial function plays a central role in cardiovascular diseases associated with particulate matter inhalation. The aim of this study was to evaluate this hypothesis, with focus on cardiac O2 and energetic metabolism, and its impact over cardiac contractility. METHODS: Swiss mice were intranasally instilled with either residual oil fly ash (ROFA) (1.0 mg/kg body weight) or saline solution. After 1, 3 or 5 h of exposure, O2 consumption was evaluated in heart tissue samples. Mitochondrial respiration, respiratory chain complexes activity, membrane potential and ATP content and production rate were assessed in isolated mitochondria. Cardiac contractile reserve was evaluated according to the Langendorff technique. RESULTS: Three hours after ROFA exposure, tissue O2 consumption was significantly decreased by 35% (from 1180 +/- 70 to 760 +/- 60 ng-at O/min g tissue), as well as mitochondrial rest (state 4) and active (state 3) respiration, by 30 and 24%, respectively (control state 4: 88 +/- 5 ng-at O/min mg protein; state 3: 240 +/- 20 ng-at O/min mg protein). These findings were associated with decreased complex II activity, mitochondrial depolarization and deficient ATP production. Even though basal contractility was not modified (control: 75 +/- 5 mm Hg), isolated perfused hearts failed to properly respond to isoproterenol in ROFA-exposed mice. Tissue O2 consumption rates positively correlated with cardiac contractile state in controls (r2 = 0.8271), but not in treated mice (r2 = 0.1396). GENERAL SIGNIFICANCE: The present results show an impaired mitochondrial function associated with deficient cardiac contractility, which could represent an early cardiovascular alteration after the exposure to environmental particulate matter.

Doctor-patient sexual relationships in medical oaths.

BACKGROUND: Doctor-patient sexual relationship is considered to be unfair because the first party would be abusing the second party's vulnerability. The prohibition of this relationship is noted in the Hippocratic oath. Currently, a reprise of the use of oaths in medical schools can be observed. AIM: To determine whether the prohibition has been maintained and how its expression has varied in the oaths during different periods. METHODS: 50 oaths were studied: 13 ancient-medieval and 37 modern-contemporary. Of the 50 texts, 19 were versions of the original oaths. The oaths that pointed out the prohibited doctor-patient relationship referred to any sexual aspect or included paragraphs that began as the Hippocratic oath does were noted. RESULTS: Of the 24 (48%) texts that expressed the prohibition, 8 (62%) were ancient-medieval and 16 (43%) were modern-contemporary. Some expressly call it Hippocratic oath, many use general terminology (corruption or vice) and others describe it in association with other commitments (abortion and euthanasia). CONCLUSIONS: The clause on the prohibition of the doctor-patient sexual relationship in Hippocratic oath was included to be for legal, economic and social reasons at the time. That the clause is found mostly in the ancient-medieval oaths can be attributed to the influence of the original. This commitment is generalised and associated with others by contemporary formulas. Currently, sexual relationships are the subject of legal and ethical analysis and their inclusion in the oaths is being debated.

Discriminación en la atención médica: una mirada a través de los juramentos médicos / Discrimination in medical assistance: An overview based on medical oath

BACKGROUND: All humans have the right to receive a thorough medical attention, and should not be discriminated. AIMS: To determine if there is a significant relationship between Medical Oaths that commit to the principle of no discrimination in health care and the time, origin and source of the modifications to the Hippocratic Oath. To specify which are the conditions for no discrimination. MATERIALS AND METHODS: Fifty Oaths found in different articles and publications were analyzed and selected considering their historical context. RESULTS: Of the fifty Oaths that were analyzed, nineteen express a commitment towards no discrimination, whereas one of the texts is discriminatory. The only significant relationship found was the origin and source of the texts. The most frequently discriminating factors found are social class, religion, nationality and race. At present, other factors can be found such as ideology, moral, aptitude, sex and political and sexual preferences. CONCLUSIONS: The commitment towards no discrimination is not widely found in Medical Oaths of all times (30/50). According to the bioethics principle of justice, physicians should find the limit of their obligation as doctors in providing medical assistance to everyone alike, wealthy or poor; Christians, Hebrews or Muslims; men or women; children, adults or old; with or without infectious diseases. Non discrimination should be a vow that physicians must be willing to take despite any of the factors that could influence health care.

[The activation of A1 adenosine receptors attenuates myocardial stunning in the rabbit]. / La activación de los receptores A1 de adenosina atenúa el atontamiento de miocardio en el conejo.

Hearts exposed to a prolonged period of ischemia (> or = 30 minutes) present smaller infarct size when reperfused in the presence of adenosine. However, when the period of ischemia is shorter, the infarct areas are not very significant, but a postischemic ventricular dysfunction persists. The objective of this study was to determine the effect of adenosine, (administered only during reperfusion) on systolic and diastolic alterations present in postischemic ventricular dysfunction, as well as to determine whether A1 receptors participate in this effect. Isolated isovolumic rabbit hearts were subjected to 15 minutes of global ischemia followed by 30 minutes of reperfusion. Before ischemia and during reperfusion ventricular function was evaluated. In the control group, the left ventricular developed pressure (LVDP) reached 56 +/- 2% of recovery at 30 minutes of reperfusion. The administration of adenosine improved LVDP 75 +/- 3% (P < 0.05 vs. control). However, when adenosine was given in presence of an A1 receptor selective antagonist (DPCPX), LVDP reached 50 +/- 2% (P < 0.05 vs. control). In the control group, left ventricular end diastolic pressure (LVEDP) (diastolic stiffness), increased 293 +/- 4%, at 30 minutes of reperfusion. Only a 15 +/- 8% (P < 0.05 vs. control) increase in LVEDP was observed with adenosine. Reperfusion with adenosine plus DPCPX did not attenuate an increase of 493 +/- 9% (P < 0.05 vs. control) in diastolic stiffness. Adenosine administered from the beginning of reperfusion attenuated both systolic alterations and diastolic stiffness in postischemic dysfunction. This effect was abolished by DPCPX, suggesting an important role for the A1 receptors in adenosine protection.

[Time course of the myocardial infarction in the rabbit]. / Cronodinamia del infarto de miocardio en el conejo.

The histopathologic evolution of myocardial infarct and of areas distant from infarct in rabbit hearts was studied. The left coronary artery of 55 rabbits was ligated, and rabbits were sacrificed at 2, 4, 6, 8, 12, 14, 16, 18, 26, 35 and 56 days post-ligature (n = 5 per group). Two rabbits were used as control and two were sham operated. The hearts were excised, cut in slices and stained with hematoxilin-eosin, Masson's trichrome and picrosirius red. Histological evaluation was semi-quantitative (scale: 0 to +++). At day 2, presence of neutrophils was +++, disappearing completely at day 6. Fibroblast proliferation increased from day 4 to day 14 post-occlusion. Coagulation necrosis in medial myocardium during the first week was +++. Subendocardic myocytolysis was evident from day 2 up to day 56 post-infarction. During the second week, proliferation of lymphocytes and macrophages (+++), granulation tissue formation (+++), and incipient traces of fibrosis that peaked at day 35 were observed. Cicatrization was complete at day 56 (+++). In areas far from infarction (right ventricle and septum), proliferation of fibroblasts was observed at day 2, and perivascular, interstitial and endocardic fibrosis at day 16. In conclusion, myocardial infarction in rabbits, unlike myocardial infarction in human beings, is characterized by early presence of fibroblasts and subendocardic fibrosis, and quick increase and precocious disappearance of neutrophils. An interesting finding was the early proliferation of fibroblasts in normal areas far from infarct.

La activación de los receptores A1 de adenosina atenúa el atontamiento de miocardio en el conejo. / [The activation of A1 adenosine receptors attenuates myocardial stunning in the rabbit]

Hearts exposed to a prolonged period of ischemia (> or = 30 minutes) present smaller infarct size when reperfused in the presence of adenosine. However, when the period of ischemia is shorter, the infarct areas are not very significant, but a postischemic ventricular dysfunction persists. The objective of this study was to determine the effect of adenosine, (administered only during reperfusion) on systolic and diastolic alterations present in postischemic ventricular dysfunction, as well as to determine whether A1 receptors participate in this effect. Isolated isovolumic rabbit hearts were subjected to 15 minutes of global ischemia followed by 30 minutes of reperfusion. Before ischemia and during reperfusion ventricular function was evaluated. In the control group, the left ventricular developed pressure (LVDP) reached 56 +/- 2

of recovery at 30 minutes of reperfusion. The administration of adenosine improved LVDP 75 +/- 3

(P < 0.05 vs. control). However, when adenosine was given in presence of an A1 receptor selective antagonist (DPCPX), LVDP reached 50 +/- 2

(P < 0.05 vs. control). In the control group, left ventricular end diastolic pressure (LVEDP) (diastolic stiffness), increased 293 +/- 4

, at 30 minutes of reperfusion. Only a 15 +/- 8

(P < 0.05 vs. control) increase in LVEDP was observed with adenosine. Reperfusion with adenosine plus DPCPX did not attenuate an increase of 493 +/- 9

(P < 0.05 vs. control) in diastolic stiffness. Adenosine administered from the beginning of reperfusion attenuated both systolic alterations and diastolic stiffness in postischemic dysfunction. This effect was abolished by DPCPX, suggesting an important role for the A1 receptors in adenosine protection.

Cronodinamia del infarto de miocardio en el conejo. / [Time course of the myocardial infarction in the rabbit]

The histopathologic evolution of myocardial infarct and of areas distant from infarct in rabbit hearts was studied. The left coronary artery of 55 rabbits was ligated, and rabbits were sacrificed at 2, 4, 6, 8, 12, 14, 16, 18, 26, 35 and 56 days post-ligature (n = 5 per group). Two rabbits were used as control and two were sham operated. The hearts were excised, cut in slices and stained with hematoxilin-eosin, Massons trichrome and picrosirius red. Histological evaluation was semi-quantitative (scale: 0 to +++). At day 2, presence of neutrophils was +++, disappearing completely at day 6. Fibroblast proliferation increased from day 4 to day 14 post-occlusion. Coagulation necrosis in medial myocardium during the first week was +++. Subendocardic myocytolysis was evident from day 2 up to day 56 post-infarction. During the second week, proliferation of lymphocytes and macrophages (+++), granulation tissue formation (+++), and incipient traces of fibrosis that peaked at day 35 were observed. Cicatrization was complete at day 56 (+++). In areas far from infarction (right ventricle and septum), proliferation of fibroblasts was observed at day 2, and perivascular, interstitial and endocardic fibrosis at day 16. In conclusion, myocardial infarction in rabbits, unlike myocardial infarction in human beings, is characterized by early presence of fibroblasts and subendocardic fibrosis, and quick increase and precocious disappearance of neutrophils. An interesting finding was the early proliferation of fibroblasts in normal areas far from infarct.

[Confidentiality in medical oaths: (When the white crow becomes gray...)]. / Confidencialidad en los juramentos médicos (cuando el cuervo blanco se vuelve gris...).

Confidentiality, together with the ethical principles of beneficence and non-maleficence, is the most important rule in Medical Oaths at the present time. However, the scientific-technical advances in medicine have made this rule one of the most controversial ones because of its exceptions. In consequence, the aim of the present paper is to comparatively analyze the rule of confidentiality in Medical Oaths of different places, times, origins and in different versions of the Hippocratic Oath in order to determine what should be kept a secret and with what degree of commitment (absolute or "prima facie"). Of the thirty six analyzed Oaths, twenty-seven manifest this rule and nine do not. No relation was found between the manifestation of this rule and the place, time, origin and different versions of the Hippocratic Oath. Most pledges suggest not to reveal what has been seen or heard during the medical act, the same as in the Hippocratic Oath. Seven texts point out that confidentiality should be absolute and four give exceptions in connection with beneficence and justice principles and the moral duty of causing no damage to third parties. Two pledges specify protection of privacy. In conclusion, today confidentiality is considered to be a moral duty for the benefit of the patient and out of consideration for his autonomy; however, at the present time in medicine the duty of keeping absolute secrecy is being reconsidered.

Confidencialidad en los juramentos médicos (cuando el cuervo blanco se vuelve gris...). / [Confidentiality in medical oaths: (When the white crow becomes gray...)]

Confidentiality, together with the ethical principles of beneficence and non-maleficence, is the most important rule in Medical Oaths at the present time. However, the scientific-technical advances in medicine have made this rule one of the most controversial ones because of its exceptions. In consequence, the aim of the present paper is to comparatively analyze the rule of confidentiality in Medical Oaths of different places, times, origins and in different versions of the Hippocratic Oath in order to determine what should be kept a secret and with what degree of commitment (absolute or [quot ]prima facie[quot ]). Of the thirty six analyzed Oaths, twenty-seven manifest this rule and nine do not. No relation was found between the manifestation of this rule and the place, time, origin and different versions of the Hippocratic Oath. Most pledges suggest not to reveal what has been seen or heard during the medical act, the same as in the Hippocratic Oath. Seven texts point out that confidentiality should be absolute and four give exceptions in connection with beneficence and justice principles and the moral duty of causing no damage to third parties. Two pledges specify protection of privacy. In conclusion, today confidentiality is considered to be a moral duty for the benefit of the patient and out of consideration for his autonomy; however, at the present time in medicine the duty of keeping absolute secrecy is being reconsidered.

[Analysis of the ethical principles of beneficence and no harm in medical oaths in relation with the Hippocratic one]. / Análisis de los principios éticos de beneficencia y de no-maleficencia en los juramentos médicos, en relación con el hipocrático.

The principles of beneficence and no-maleficence, already set forth in the Hippocratic Oath, have been the foundation of medical ethics for the last twenty-five centuries. The principle of beneficence is currently maintained in most wordings of the pledges of medical schools of the United States, Canada and Argentina; it is not the same with the principle of non-maleficence. The aim of this paper is to determine whether these principles are described in medical oaths at different times. These principles did not remain in an oaths. Of twenty-nine analyzed texts, nine describe both principles simultaneously, eleven only mention beneficence; three only express non-maleficence, and six indicate neither of them. Most wordings that describe these principles are modifications of the Hippocratic Oath. Two contemporary wordings describe the achievement of the greatest benefit with minimum harm. Two current wording also subordinate the principle of beneficence to the principle of respect for the patient's autonomy, and eight wordings indicate not only patients' benefit in particular but that of society in general. It is not possible to ignore that it is no enough to fulfill only these two principles. Physicians should encourage the development of patients' responsibility in managing their own health and respect their autonomy.

[Exogenous adenosine and postischemic dysfunction in the isolated rabbit heart]. / Adenosina exógena y disfuncion postisquémica en el corazon aislado de conejo.

It is recognized that adenosine lessens the systolic alterations of the postischemic ventricular dysfunction ("stunned myocardium"), but little is known about the drug's effects on the diastolic phase of the cardiac cycle. The aim of this work was to determine the effect of adenosine when it was administered: a) before ischemia and during reperfusion, and b) from the early reperfusion period to the end of the experiment on the systolic and diastolic function of the "stunned myocardium". An additional objective was to determine whether adenosine modifies the release of creatine phosphokinase (CPK) and lactate dehydrogenase (LDH), in the "stunned myocardium". Rabbit isolated isovolumic hearts were perfused according to Langendorff's technique, and subjected to 15 minutes global ischemia and 30 minutes reperfusion. A small latex balloon was inserted into the left ventricle via the left atrium which allowed to measure the ventricular end-diastolic pressure (diastolic stiffness) and calculate the developed pressure, the maximal rate of pressure generation and maximal rate of pressure decay (+dP/dtmax and -dP/dtmax), the ratio between these two variables (+P/-P), and the time constant of isovolumic relaxation (tau, Tau). The adenosine administered both before the ischemia period, and at the beginning of reperfusion, attenuated the systolic and diastolic stiffness alterations without modifying the isovolumic relaxation. The administration of adenosine did not diminish the CPK and LDH release significantly when it was given before the ischemia period or the beginning of reperfusion.