The Human Sexual System in the Context of the Health Sciences

Before the lack of systematic sexual formation in the medical curriculum, we propose a sexual model based on the theory of the systems of Bertanalaffy, originator of the organisation of the paradigm of the sciences in the 20th century. A proof of it is that of medicine, abandoning the term apparatus to utilise systems, a concept that implies interrelationship, equilibrium and biogenesis, articulating its knowledge in locomotive, respiratory, digestive, excretory, circulatory endocrine, nervous and reproductive systems etc, The absence of the Sexual System is responsible for the scarcity of economic and research investment in the biological dimension of sexuality. Indeed, it does not exist as material on the page of knowledge, Throughout the article we present the anatomical subsystems that comprise it, the laws of the system and its ends. Its incorporation as a system would make obligatory instruction in sexuality, contribute to the advance of biological research and to assistance. It would end with the concept of quality to be constitutive and determinant of the human.     

Vesical endometriosis: report of two cases

Endometriosis affecting the urinary tract is very rare and the most common site of involvement is urinary bladder. The clinical features are urgency and frequency, hipogastric pain and hematuria. Cistoscopic examination is the most valuable diagnostic test but definitive diagnosis requires histologic confirmation. We report 2 cases of endometriosis in 2 young women, one with previously cesarean section, in which surgical treatment was effective. After 1 and 3 years of follow-up respectively the patients remain assymptomatic.     

Impact of a clinical pathway for stroke patients

OBJECTIVE: To assess the impact of the implementation of a clinical pathway for stroke patients. METHODS: We performed a controlled intervention study without random allocation that compared two non-concomitant cohorts of stroke patients corresponding to the periods immediately before (control group) and after (intervention group) the implementation of a clinical pathway. The main outcome measures were: a) quality of care indicators; b) improvements in functional capacity (Barthel score) and neurological function (Canadian scale); c) nosocomial complications; d) satisfaction, and e) mean length of hospital stay. RESULTS: One hundred and thirty-nine patients were recruited. Sixty-nine corresponded to the period before implementation of the pathway and 70 corresponded to the period after implementation. There were no significant differences between the two groups on admission. A 36.5% reduction in the time from admission to mobilization was observed. No significant differences were observed between the groups for the other quality of care indicators, or in improvements in functional and neurological capacity. Nosocomial complications occurred in 44.5% of patients in the control group compared with 28.6% in the intervention group (p = .039). No significant differences were observed in the overall satisfaction assessment, but patients in the intervention group showed greater satisfaction in the dimensions of "information" and "trust and professionalism". The mean length of hospital stay was reduced from 11 to 10 days. CONCLUSIONS: The implementation of the stroke clinical pathway contributed to reducing the length of hospital stay and the number of inpatient complications, as well as to improving some quality of care indicators.     

Parvovirus B19 in the acute arthropathies and juvenile rheumatoid arthritis

OBJECTIVE: To evaluate the prevalence of recent parvovirus B19 infection in a cohort of children presenting with acute arthropathy and to determine the prevalence of a subsequent diagnosis of juvenile rheumatoid arthritis in this cohort. METHOD: In this prospective study, parvovirus B19 IgM antibody was investigated in 75 patients who were referred to our clinic with acute joint complaints and also in 75 healthy controls. One patient in each group was excluded due to neuroblastoma and acute lymphoblastic leukaemia. The characteristics of parvovirus B19 IgM positive patients who were accepted as parvovirus B19 arthropathy were further evaluated. All the patients were followed up for at least 6 weeks and the patients with chronic progression of joint complaints were followed for at least 6 months to determine their progress. The cases of juvenile rheumatoid arthritis in this chronic group were identified. RESULTS: Parvovirus B19 IgM was detected in 16 of 74 patients (21.6%) with acute arthropathy compared with 3 of 74 (4.1%) in the healthy control group (chi(2) = 8.67; P = 0.003). The parvovirus B19 positive patients with arthropathy were more likely to become chronic (P = 3.7 x 10(-7)) and to be diagnosed as juvenile rheumatoid arthritis (P = 0.03) than the parvovirus B19 IgM negative group with arthropathy. Additional joint destruction developed in one case who was parvovirus B19 IgM positive in whom juvenile rheumatoid arthritis was diagnosed during follow up. CONCLUSION: These data support the hypothesis that parvovirus B19 infection may be associated with the onset of juvenile rheumatoid arthritis in a proportion of patients.     

Frequency of Mycoplasma pneumoniae among atypical pneumonia of childhood

We aimed to investigate the frequency of Mycoplasma pneumoniae among atypical pneumonia of childhood that is acquired from the community and to determine a practical approach to the diagnosis of these patients. In this prospective study, 55 patients (31 male and 24 female) with atypical pneumonia were investigated with conventional laboratory and radiological methods as well as culture and polymerase chain reaction (PCR) on throat swab. In addition, serum of the patients was tested for M. pneumoniae specific IgM. The patients were reevaluated clinically at 3-5 days and 3-4 weeks and serologically at 3-4 weeks. The data on patients with M. pneumoniae pneumonia were compared with the other patients with atypical pneumonia and controls. All patients were treated with macrolide antibiotics. The mean age of the patients was 7.8+/-2.9 years. The frequency of M. pneumoniae by this method was 34.5%. Neither clinical, laboratory, or epidemiological data nor response to macrolide antibiotics was useful in detecting the etiology of atypical pneumonia. Diagnostic sensitivity and specificity of IgM+IgG antibodies plus PCR on throat swab were estimated as 100%. M. pneumoniae was an important microorganism in the etiology of atypical pneumonia of childhood in our community. In order to prevent loss of time with beta-lactamase antibiotics, which are usually started in severe pneumonia, serologic tests and PCR must be done during the initial evaluation of the patient for the reliable diagnosis of M. pneumoniae, which will increase the chance of early and appropriate therapy.     

Embarazo abdominal secundario tras una esterilización tubárica

The ectopic pregnancy appears in the 10-12% of cases after tubal sterilization and it is usually located in the tube. 1% of ectopic pregnancies are abdominal and the implantation in omentum is a rare condition with only 16 described cases. According to Studdiford, they can be classified as primary or secondary depending on whether they are originated or not in the peritoneal cavity. We present the case of a secondary abdominal pregnancy located in omentum, in a woman with previous tubal sterilization, which has not been described to date; one is an abdominal pregnancy with origin in a tubal abortion, since trofoblastic invasion does not exist in omentum and there are remains of the same tissue in the right tube.     

Effects of early enteral nutrition on intestinal permeability and the development of multiple organ failure after multiple injury

Objective: To determine how immediate enteral nutrition (EN) affects gut permeability and the development of multiple organ failure (MOF) in multiply injured patients. Design: Prospective, randomised clinical trial. Setting: 20-bed surgical intensive care unit (ICU), university hospital. Patients: 28 consecutive multiply injured patients, admitted in shock and stabilised in 6 h. Interventions: Patients were randomly assigned to EN started not later than 6 h after admission to the ICU (group A), and to EN started later than 24 h after admission (group B). Measurements and main results: The lactulose/mannitol (L/M) test was performed in patients on days 2 and 4 after trauma, and in 5 healthy volunteers. MOF scores were calculated daily. The mean MOF score from day 4 onwards was 1.84 in group A versus 2.81 in group B (p < 0.002), and was correlated with the time of initiation of EN after injury and the L/M ratio on day 2. The median L/M ratio on day 2 was 0.029 for group A and 0.045 for group B, while on day 4 it was 0.020 and 0.060, respectively. On day 2 after trauma, the L/M ratio was significantly higher in group B (p < 0.05) than in normal volunteers (median 0.014) and was positively correlated with the time of starting EN. Conclusions: In contrast with normal volunteers, the patients started on EN later than 24 h after admission to the ICU demonstrated increased intestinal permeability on the second day after sustaining multiple injury. Also, they had a more severe form of MOF than the group placed on EN immediately upon admission. However, early EN had no influence on the length of ICU stay or the time of mechanical ventilation. Received: 16 March 1998 Final revision received: 15 September 1998 Accepted: 18 September 1998     

Concentraciones de interleucina-18 en preeclámpticas y embarazadas normotensas sanas

Objective

To compare concentrations of interleukin-18 in pre-eclampsia patients and healthy normotensive pregnant women.

Method

A total of 100 patients were selected. Fifty pre-eclamptic patients were selected as cases (group A) and a control group selected by having the same age and body mass index to study group, consisting of 50 healthy normotensive pregnant women. Blood samples were collected in all patients before labour and immediately after diagnosis in group B to determine interleukin-18 concentrations.

Results

There were no significant differences in relation to maternal age, gestation age and body mass index at the time of taking the sample (P = ns). There was a statistically significant difference in interleukin-18 concentrations between patients in cases group (group A; 38.6 ± 6.5 pg/ml) and patients in control group (group B; 32.2 ± 8.5 pg/ml; P < .05). There was a moderate, positive and significant correlation with systolic blood pressure values (r = 0.341; P < .05) and with diastolic blood pressure values (r = 0.408; P < .05).

Conclusions

Pre-eclampsia patients had significantly higher concentrations of interleukin-18 when compared with healthy normotensive pregnant women.