Tratamiento tópico sobre úlceras varicosas de evolución tórpida con ampollas monodosis estériles de ciprofloxacino.La efectividad frente a suero fisiológico / Effectiveness of topical treatment of chronic varicose ulcers with sterile single-dose ciprofloxacin ampoules versus physiologic serum

OBJETIVO: Determinar la efectividad de la aplicación de solución tópica estéril de ciprofloxacino y suero fisiológico como tratamiento local en úlceras de etiología venosa, frente al empleo de suero fisiológico exclusivamente. DISEÑO: Estudio seudoexperimental cruzado. MATERIAL Y MÉTODO: Estudio cruzado, en donde se incluyeron pacientes con lesiones varicosas de más de tres semanas de evolución (n = 63), con una media de edad de 76,3 ñ 16,8 años, 21 varones (33 por ciento; 69,9 ñ 19,9 años) y 42 mujeres (67 por ciento; 80,2 ñ 12,3 años). La misma muestra fue distribuida para el análisis en dos grupos de pacientes; grupo A (N = 63), en el que se realizó una cura semioclusiva húmeda con ciprofloxacino (solución de cloruro sódico al 0,9 por ciento aplicada a chorro con jeringuilla de 20 ml y aguja desechable) junto con gasas (3-4 por acto) de entramado con algodón, ampollas monodosis estériles desechables de ciprofloxacino (n = 63), y grupo B, en el que se aplicó suero fisiológico sin ampollas monodosis (n = 63), utilizado durante un máximo de 2 semanas. RESULTADOS: En el estudio cruzado la respuesta fue positiva en 29 pacientes pertenecientes al grupo B y en 41 del grupo A (el 65 frente al 46 por ciento; p = 0,000). La disminución porcentual de la superficie fue del 31,2 frente al 9,3 por ciento (1,46 frente a 0,47 cm2; p = 0,00) en los grupos A y B, respectivamente. Los resultados de los cultivos para el estudio cruzado fueron: 37,5 por ciento Pseudomonas, 17,6 por ciento informado como estéril, 17,1 por ciento con Streptococcus grupo D, 14,1 por ciento como flora saprofita. CONCLUSIONES: El tratamiento con ciprofloxacino tópico sobre las lesiones varicosas de larga evolución junto al suero fisiológico parece ofrecer mejores porcentajes de respuesta inicial respecto al uso de suero fisiológico exclusivamente. La presencia de fibrina previa al tratamiento con suero no parece modificar la respuesta posterior al mismo. Añadir ciprofloxacino tópico en lesiones sin fibrina favorece la mejoría de la respuesta frente al uso únicamente de suero fisiológico. (AU)

Heart rate changes in response to mild mechanical irritation of the high cervical spinal cord region in infants.

Alterations in the heart rate were monitored before, during and after the application of a unilateral mechanical impulse to the high cervical spinal cord region which was administered strictly in connection with the so called manual therapy (diagnosis= KISS). The investigation is based on a survey of 695 infants between the ages of 1 and 12 months. A notable change in the heart rate was evident in 47.2% of all examined infants (n= 695). In 40.1% of these infants, the change in heart rate was characterized by heart rate decrease of 15-83% compared to control conditions. Infants in their first 3 months of life responded more often with a severe bradycardia (50-83% decrease), older infants (7-12 months) more often with a mild bradycardia (15-49.9% decrease). This comparison revealed a significantly increased occurrence of severe bradycardia in the younger age group compared to the group of children >3 months (significance 0.0017). In 12.1% (n= 84) of the infants, the bradycardia was accompanied by an apnea. We discuss the hypothesis that mechanical irritation of the high-cervical region serves as a trigger that may be involved in sudden infant death (SID).

[ESES-syndrome in child- and adolescent psychiatry]. / Das ESES-Syndrom in der Kinder- und Jugendpsychiatrie.

OBJECTIVES: The article describes the theoretical background of the diagnosis and therapy of the ESES syndrome. METHODS: The assessment and treatment of children with ESES in a child-psychiatric setting is shown. The underlying data have been taken from 18 outpatients with or without epileptic seizures. RESULTS: The early diagnosis of non-specific symptoms and the anti-epileptic treatment probably play an important role in preventing the progression of ultrastructural brain damage. Sultiam is the drug of first preference.

Standard form contracts and contract schemas: a preliminary investigation of the effects of exculpatory clauses on consumers' propensity to sue.

This study investigated the extent to which exculpatory clauses deter consumers from pursuing their legal rights. Undergraduate participants (N = 101) were presented with two written vignettes and asked to imagine themselves as a consumer harmed by a contracted for service. Participants then read a contract and responded to questions assessing their likelihood of seeking compensation and their perceptions of the contract. The presence of exculpatory clauses, the severity of the harm, and the nature of the harm were varied. The data suggest that exculpatory clauses, if read, have a deterrent effect on propensity to seek compensation. Development of a psychological definition of contract schemas and implications for legal policy are discussed.

Professional responsibility in elder law: a synthesis of preventive law and therapeutic jurisprudence.

This article focuses on the professional responsibilities that a lawyer owes to older clients. Specifically, this article proposes that when working with older clients, lawyers have a responsibility to ensure that their clients have the capacity to manage their own affairs and to ensure their clients' legal, financial, and personal interests are protected in case of sudden future incapacity. Furthermore, a lawyer working with older clients has a responsibility to remain cognizant of the realities of ageing without giving in to the falsities of senior citizen stereotypes. Through an integration of Therapeutic Jurisprudence and Preventive Law, a proactive, client-centered, four-stage framework for advancing therapeutic goals through preventive lawyering is developed. The framework is then applied to a model lawyer/client interaction typical of elder practice. The advantages and limitations of the four-stage framework are discussed.

An improved method for the determination of creatine kinase activity in serum.

An improved method for the determination of creatine kinase activity (EC 2.7.3.2) is described. For the reactivation of creatine kinase serum is first preincubated in the test solution in the presence of dithioerythritol. Then the enzymatic reaction is started by adding creatine phosphate. By optimizing the concentrations in the test solution and by altering the measurement procedure using dithioerythritol as reactivator, the assay is made more sensitive, and a far higher enzyme activity in serum is measured in comparison with other recommended tests. The reaction rate is linear for ten minutes up to 700 U/l. An increase in activity by enzyme dilution was not observed. In this study a sensitivity of detection of 0.9 U/l was achieved. This would be especially advantageous in the detection of the isoenzymes of creatine kinase after chromatography. Within-run precision was 1.2% (CV), day-to-day precision was 2.0% (CV). The test solution is stable for at least 24 hours.