La salud mental desde los textos de Florencia Nightingale / The mental health since Florence Nightgale’s writings

Con frecuencia cuando se habla de Florence Nightingale, se piensa en la visión romántica de su imagen en unescenario de guerra cuidando de los heridos y se asume su significado para la enfermería de todos los tiempos alestablecer medidas generales de lo que debe ser esta disciplina. Hoy por hoy sus textos son, o deberían ser, un referenteobligado y tan actual que resulta difícil pensar en iniciar una reflexión de la práctica de enfermería sin considerarsu obra. De este modo y en el intento de mostrar que sus escritos son tan vigentes como ayer, los autoreshacen una reflexión del tema de la salud mental desde la obra “Notas de enfermería. Qué es y qué no es”, escritoque después de más de un siglo, nos permite descubrir derroteros a seguir dentro de la enfermería hoy llamadacontemporánea. Es entonces el presente escrito un acercamiento a los cánones que plantea Nightingale sobre lasalud mental, aspecto de relevancia mundial.

When referring to Florence Nightingale, people frequently picture a romantic vision of her taking care of thewounded in a war scene, and this is taken in nursing of all times as generally established measures that this discipleshould represent. Nowadays, her writings are and should be an essential reference without which it woulddifficult to start a reflection on nursing practices. Likewise, in an attempt to show that her writings are as up-todateas they were before, the authors reflect on the topic of mental health in the piece “Notes on Nursing: What itis and what it is not.” After more than one century, this work, allows us to discover the course to follow in what isnow referred to as contemporary nursing. This writing indeed constitutes an approach to the standards proposedby Nightingale about mental health, which is of world relevance.

El lugar del equipo de salud familiar en una comunidad educativa del barrio Jose I. Diaz: algunas aproximaciones diagnosticas / The role of a family health team in the school comunity of the Jose Ignacio Diaz quarter: an approximative diagnosis

Por su inserción comunitaria los equipos de salud familiar(ESF) ocupan un lugar clave para trabajar conjuntamente con las escuelas en la promoción de la salud y prevención de la enfermedad. El objetivo general de este trabajo es conocer el lugar del equipo de salud familiar en una comunidad educativa de barrio José Ignacio Días de la ciudad de Córdoba. Lametodología consistió en un diagnostico institucional parala construcción de hipótesis diagnostica. Se utilizaron técnicas formales e informales y por saturación. Las principales conclusiones dan cuenta de la tarea de los equipos de salud familiar (ESF) es fortalecer a las instituciones,pero como paso previo es necesario que la comunidad reconozca a los profesionales que desarrollan tares de promoción, prevención y asistencia comunitaria. Nuestra tarea será el de aportar elementos para que la propiainstitución se transforme en el verdadero referente del barrio.

El lugar del equipo de salud familiar en una comunidad educativa del barrio Jose I. Diaz: algunas aproximaciones diagnosticas / The role of a family health team in the school comunity of the Jose Ignacio Diaz quarter: an approximative diagnosis

Por su inserción comunitaria los equipos de salud familiar(ESF) ocupan un lugar clave para trabajar conjuntamente con las escuelas en la promoción de la salud y prevención de la enfermedad. El objetivo general de este trabajo es conocer el lugar del equipo de salud familiar en una comunidad educativa de barrio José Ignacio Días de la ciudad de Córdoba. Lametodología consistió en un diagnostico institucional parala construcción de hipótesis diagnostica. Se utilizaron técnicas formales e informales y por saturación. Las principales conclusiones dan cuenta de la tarea de los equipos de salud familiar (ESF) es fortalecer a las instituciones,pero como paso previo es necesario que la comunidad reconozca a los profesionales que desarrollan tares de promoción, prevención y asistencia comunitaria. Nuestra tarea será el de aportar elementos para que la propiainstitución se transforme en el verdadero referente del barrio.(AU)

Gastrotomy with anvil "dunk": a novel technique for gastrojejunostomy in the patient undergoing laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Many techniques for performing the gastrojejunostomy required in the laparoscopic roux-en-Y gastric bypass (LRYGB) have been described. The current study presents the results of a previously unreported method. METHODS: A total of 21 patients (2 men and 19 women) with morbid obesity underwent LRYGB over a period of 5 months. The gastrojejunostomy was created by performing a gastric transection to form a 20- to 30-ml pouch using a linear stapler. This was followed by gastrotomy using an ultrasonic scalpel along the anterior surface of the pouch. A purse-string suture then was placed circumferentially using standard laparoscopic intracorporeal suturing with an Endo-stitch device. Finally, a 25-mm circular stapler anvil was placed within the abdomen via the 15-mm left lower quadrant port site. The shaft of the anvil was grasped; the head of the anvil was "dunked" into the gastrotomy; and the purse-string suture was tied intracorporeally. RESULTS: A total of 21 patients have undergone LRYGB at the authors' institution using this technique. The early results have been excellent in all cases, with no leaks, no strictures, and no obstructions. CONCLUSION: Gastrotomy with anvil dunk is a reproducible and safe method for constructing the gastrojejunostomy. It is an advanced laparoscopic technique that closely resembles open surgical techniques and provides a safe alternative to existing methods.

Proteína S libre en embarazadas normales: comparación entre dos métodos / Free protein S (PS) in normal pregnancy: A comparison between two analytical methods

Background: Pregnancy is a physiological hypercoagulable state with an increased incidence of thromboembolic phenomena. There is an increase in the concentrations of most clotting factors, a decrease in concentration of some of the natural anticoagulants and reduced fibrinolytic activity. Changes in PS levels have also been reported. Aim: To establish referral range values of functional PS and free PS antigen, during the second (2nd T) and third trimester (3rd T) of normal gestation. Patients and methods: Forty one normal pregnant women were included in our study, 20 during the 2nd T (22-24 weeks) and 21 during the 3rd T (29-38 weeks). Functional PS was measured by a clot based test and free PS antigen by ELISA. Results: Free PS Antigen was 65.8±18.3% during the 2nd T and 62.3±16.5% during the 3rd T. The figures for normal controls were 106±6.5%. Functional PS was 43.8±13.3 and 25.9±14.6% during the 2nd T and 3rd T, respectively. The figures for normal controls were 97±24% (p <0.001 compared with pregnant women). Free PS antigen did not change from the 2nd to the 3rd T (p=NS), however functional PS fell significantly from the 2nd to the 3rd T (p <0.001) and was significantly lower than free PS antigen in both trimesters (p <0.001). Conclusions: Pregnancy is associated to a decrease in PS. This abnormality is more pronounced for functional PS than free PS antigen and functional PS falls progressively during pregnancy. These assays should not be used to screen for PS deficiency during pregnancy because they could lead to a misdiagnosis.

A nuclear casein kinase 2 activity is involved in early events of transcriptional activation induced by salicylic acid in tobacco.

Salicylic acid (SA) activates immediate early transcription of genes controlled by a family of DNA promoter elements named as-1-like elements. These elements are functional in the promoter of glutathione S-transferase genes. We have previously shown that SA increases the binding of tobacco (Nicotiana tabacum cv Xanthi nc) nuclear factors to the as-1 sequence in a process mediated by protein phosphorylation. In this study we give evidence for the participation of a nuclear protein kinase CK2 (casein kinase 2) in the pathway activated by SA in tobacco. The first line of evidence comes from the evaluation of the CK2 activity in nuclear extracts prepared from tobacco plants treated with SA or water as a control. Results from these experiments indicate that SA increases the nuclear CK2 activity. The second line of evidence derives from the evaluation of the in vivo effect of 5,6-dichloro-1-(beta-D-ribofuranosyl) benzimidazole (DRB), a cell-permeable CK2 inhibitor, on the responsiveness of the as-1 sequence to SA. Results from these experiments indicate that DRB impairs the activating effect of SA on the transcription of both, the GUS reporter gene controlled by a tetramer of the as-1 element, and the endogenous gnt35 gene encoding a glutathione S-transferase, in transgenic tobacco plants. DRB also impaired the increasing effect of SA on the binding of nuclear factors to the as-1 element. Furthermore, transcription of the as-1/GUS reporter gene activated by the synthetic auxin 2,4-dichlorophenoxyacetic acid and by methyl jasmonate was also inhibited by DRB. To our knowledge, this is the first report in which activation of a CK2 enzyme by a plant hormone is reported.

[Efficacy and safety of fexofenadine and cetirizine in the treatment of allergic rhinitis]. / Eficacia y seguridad de la fexofenadina y la cetirizina en el tratamiento de la rinitis alérgica.

BACKGROUND: Allergic rhinitis affects 20 million of people in United States and a higher figure all around the world. OBJECTIVE: To evaluate the efficacy and safety of fexofenadine compared with certirizine in the treatment of allergic rhinitis. MATERIAL AND METHOD: It was carried out a prospective, double blind, comparative, randomized and multicentric study in patients with allergic rhinitis, with ages between 12 and 65 years. In the first phase, placebo was administered during three days to all the patients; and then, they were randomly allocated to receive fexofenadine 120 mg or cetirizine 10 mg in one dose a day during 14 days. Laboratory and cabinet tests at the beginning and at the end were performed to value security, as well as a global evaluation of the researcher to estimate effectiveness. RESULTS: 176 patients were included, 63.6% were women, average age was 27 years (+/- 12), 47.7% received fexofenadine and 52.2%, cetirizine. There was not significant difference in parameters of effectiveness nor of security in the studied group. CONCLUSION: The results of the present study confirm the efficacy and safety of the antihistaminic fexofenadine in the treatment of allergic rhinitis.

Sarcoidosis of the breast: implications for the general surgeon.

Sarcoidosis is a multisystemic disease that may involve the breast parenchyma and can be confused with benign or malignant tumors. A recent case of sarcoidosis of the breast treated in our institution prompted us to review the world literature on the topic. From 1921 to 1997, 45 cases relating to sarcoidosis of the breast were reported; 10 of these cases were excluded from our review because of the lack of histological proof of sarcoidosis. The data were organized according to clinical presentation, diagnostic studies, treatment plan, and follow-up care. The mean age at presentation was 47 years (range 20-72 years) and all patients were female. Seven patients (20%) had a breast mass as primary presentation of sarcoidosis without any clinical evidence of systemic sarcoidosis. Thirty-one patients (89%) presented with a self-detected mass and three patients (8%) demonstrated skin dimpling and peau d'orange appearance mimicking cancer. The size of the breast lesions ranged from 0.25 to 5 cm in diameter. One patient presented with bilateral breast lesions and one with more than one lesion in the same affected breast. A single breast mass was found in the rest of the patients. Of the seven patients evaluated by mammography, only one revealed changes suspicious for malignancy. Fine-needle aspiration was used only in four cases; the results of two were compatible with sarcoidosis and two required an excisional biopsy as a result of inconclusive results. Seventeen cases reported excisional biopsy as the diagnostic procedure. In 11 patients the type of biopsy was not stated. In two cases of radical mastectomies for breast adenocarcinoma, sarcoidosis was an incidental finding, either in the remaining breast tissue or in the axillary nodes. One patient underwent a partial mastectomy revealing sarcoidosis as the definitive diagnosis. Ultrasound was used in two cases; one revealed a suspicious lesion and one was inconclusive. Although sarcoidosis of the breast constitutes a rare entity it should be considered in the differential diagnosis of breast cancer even in patients without clinical evidence of systemic sarcoidosis. These patients should undergo a biopsy to rule out malignancy because clinical findings, mammography, and ultrasound results can be misleading or inconclusive.

Cryosurgery: adjuvant treatment at the time of resection of a pelvic recurrence in rectal cancer.

We report a case in which cryosurgical ablation was used to treat recurrent rectal cancer. Several years after low anterior resection for rectal cancer, the patient was found to have a large pelvic recurrence with involvement of the presacral space. After resection of the pelvic mass, cryosurgery was applied to the presacral space, extending to the lateral pelvic wall and up to the sacral promontory. After a 24-month follow-up, the patient remains disease-free with a Karnofsky performance status of 100 per cent. Cryosurgery can be used as an adjuvant therapy at the time of resection to successfully treat a pelvic recurrence.

Laparoscopic resection of a benign true cyst of the spleen with the harmonic scalpel producing high levels of CA 19-9 and carcinoembryonic antigen.

Primary true cysts of the spleen constitute 10 per cent of all nonparasitic cysts of the spleen. These cysts have been managed with total or partial splenectomy or marsupialization. Previous series reported elevated serum levels of CA 19-9 and carcinoembryonic antigen (CEA). A 16-year-old male presented with left upper quadrant pain and was found to have a mass on palpation. An ultrasound and a CT scan of the abdomen showed a 20-cm cystic lesion in the spleen. The CA 19-9 and CEA serum levels were 1264 units/ml (nl <33 units/ml) and 7.5 ng/ml (nl <3.1 ng/ml), respectively. Laparoscopic resection of the cyst using the harmonic scalpel was performed. The pathology showed a benign true epithelial cyst of the spleen, with strongly immunoperoxidase stains for keratin, CA 19-9, and CEA. Levels of CA 19-9 and CEA in the cystic fluid were 48,275 units/ml and 96.6 ng/ml, respectively. This is the first case reported in the literature of a true benign splenic cyst producing high levels of CEA and CA 19-9 in serum and cystic fluid. The patient was discharged home on the 1st postoperative day without problems and returned to his normal daily activities with the 1st week after surgery. The CA 19-9 and CEA serum levels returned to normal levels.

Localized malignant mesothelioma: a case report.

Localized malignant mesothelioma is an extremely rare form of presentation of malignant mesotheliomas. Only six cases have been reported. A 66-year-old male, former smoker, with occupational exposure to asbestos for 35 years, presented complaining of increasing fatigability, low-grade fever and anorexia for 4 weeks. The chest radiography showed a left lung mass. The computed tomography showed a 5-cm left posterior mass. The biopsy showed malignant cells. The patient underwent a surgical en bloc resection of the tumor. Pathology revealed a localized, poorly differentiated mesothelioma. Immunohistochemistry was positive for cytokeratin and vimentin while negative for carcinoembryonic antigen and Leu-M1. The final diagnosis was localized malignant mesothelioma. Aggressive resection of the tumor has shown to increase survival in previous reports, although the biological behavior of such tumors is still difficult to predict.

[Clinical polymorphism in Epstein-Barr virus infection]. / Polimorfismo clínico en infección por virus de Epstein Barr.

Several diseases was associated with Epstein Barr virus (EBV) infection. In the next three cases, the clinical course was unusual . Case I: Polyclonal hypergammaglobulinemia, female 47 years old, she had systemic lupus erythematosus and clinical data of infectious mononucleosis but she evolved to a polyclonal gammopathy with IgM predominantly against EBV. Case II: Demyelinating encephalitis, male, 32 years old with central neurological alterations, IgM antibodies against EBV and demyelinating lesion in magnetic resonance image in brain steam. Case III. Villous leukoplakia, male, 40 years old developed right tonsil tumor. He had IgM antibodies against EBV. The antiviral and immunomodulator treatment (specific for each case) done a satisfactory clinical response in the three patients.

[Evaluation of the Espinosa Flores' operation of isthmo-cervical insufficiency]. / Evaluación de la operación Espinosa Flores en la insuficiencia istmico cervical.

An analysis of the results obtained in 66 patients with Espinosa Flores' operation for isthmo-cervical insufficiency, operated upon at La Raza Hospital, IMSS, was carried out. The study period was from January 1st to December 31, 1988. Gestational age and pregnancy evaluation were studied. The operation was done at 15.8 weeks of gestation, in average; the cerclage procedure was used as a second choice in 12 patients (18.1%) by slipping the tape: in two patients it was repeated in three different moments, which represents 21% of failure. There were a total of 17 cases of premature rupture of membranes, which represents 21.7%. Pregnancy was solved by delivery in 33 patients (50%), and by cesarean section in 25 cases (37.8%). There were a total of 8 abortions, and the total amount of alive products being discharged from the hospital, was 48 (72.7%).