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Sample records for epistaxis consideraciones sobre

  1. Algunas consideraciones sobre Neisseria gonorrhoeae

    OpenAIRE

    Pardi, Germán; Pérez, María Fernanda; Pacheco, Aura; Mata de Henning, Magdalena

    2004-01-01

    En el presente artículo, se describen los principales aspectos relacionados con Neisseria gonorrhoeae, microorganismo que se puede encontrar presente como parte de la microbiota transitoria o transeúnte de la cavidad bucal de algunos individuos, donde se destacan: Historia, taxonomía, características morfológicas, fisiológicas y de cultivo, ultraestructura, estructura antigénica, así como algunas consideraciones en referencia a la ecología y a los mecanismos de patogenicidad por parte de esta...

  2. Epistaxis

    DEFF Research Database (Denmark)

    Rasmussen, Eva Rye; Larsen, Per Leganger; Arndal, Helge

    2012-01-01

    Epistaxis is a common clinical condition that can be challenging. Anterior epistaxis is managed by compression, cauterization or diathermy. Merocel and Rapid Rhino nasal packs are often successfully used. Refractory posterior epistaxis should be handled by otorhinolaryngologists. If conservative...

  3. Consideraciones sobre el fracaso escolar

    Directory of Open Access Journals (Sweden)

    Dora Laino

    2012-10-01

    Full Text Available En lo que respecta al fracaso escolar, el texto formula algunas consideraciones desde una aproximación conceptual que procura dar cuenta de los rasgos distintivos del aprendizaje de cada sujeto humano, en especial desde una psicosociología de los procesos cognoscentes que sustente las prácticas profesionales de una clínica del aprender. El reconocimiento que hagan de una criatura sus familiares más cercanos, sus educadores, sus compañeros, condiciona la construcción de su éxito o fracaso escolar. A partir de la comunicación intersubjetiva entablada entre adultos significativos e infantes, púberes o adolescentes (ya sea entre padres e hijos como entre docentes y alumnos se producen inscripciones inconscientes estructurantes de la subjetividad como de los esquemas de acción intelectual y de los habitus sociales de los aprendientes. No es el niño quien define las relaciones educativas en las que se ve involucrado. Tampoco, y por razones análogas, es el único responsable de los esquemas y habitus que construye en su historia vital, ni mucho menos de la graduación de los contenidos que le proponen para realizar sus aprendizajes. El entendimiento que logre en cada situación dependerá de la inteligibilidad, de la subjetividad, de la sociabilidad y de la corporalidad disponibles, como rasgos distintivos de sus posibilidades para aprender, en ese momento de su trayectoria vital.

  4. Epistaxis

    OpenAIRE

    Stevens, Holly E.

    1990-01-01

    Good equipment, readily available, and organized management are essential for successful control of epistaxis without exacerbating the patient's trauma. Epistaxis most commonly results from localized causes but can reflect systemic disease. The author describes practical management of epistaxis, particularly for acute problems in the emergency room.

  5. Consideraciones preliminares sobre la credibilidad

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    Fernando Verdugo

    2004-01-01

    Full Text Available A modo de introducción al Seminario Interno de Profesores de la Facultad de Teología de la PUC, el autor recuerda, en primer lugar, lo que suele entenderse por "credibilidad" y, también, algunos de los criterios generales por los cuales algo o alguien adquiere la calidad de creíble (el que sea razonable, relevante o significativo, capaz de producir gozo estético, etc.. Luego, en la parte más extensa, el autor vuelve a llamar la atención sobre la necesidad de atender a los condicionamientos culturales de la fe cristiana. La fe, al igual que toda experiencia humana, está culturalmente mediada. Tomar conciencia de ese hecho y asumir las consecuencias metodológicas es indispensable para una teología que quiere poner atención a los desafíos actuales y contribuir así a la credibilidad del cristianismoThis article reprints the introductory session to the internal seminar of lecturers from the Faculty of Theology of the UC. In the first place, the author sums up what is usually understood by `credibility' and the general criteria through which something or someone gains credibility (being reasonable, relevant or significant, capable of producing aesthetic pleasure. Then the author deals at length with the need to take notice of the cultural conditionings of the Christian faith. The faith, the same as any other human experience, is culturally mediated. It is crucial for theology to become aware of this fact and come to terms with its methodological consequences, if it wants to face current challenges and so contribute to the credibility of Christianity

  6. CONSIDERACIONES SOBRE EDUCACION MEDICA y SALUD

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    Jaime Escobar Triana

    1984-11-01

    Full Text Available

    l. Los cambios, las corrientes migratorias internas, transformaron un país de población rural en urbana, al mismo tiempo con un epifenómeno de ruralización de la ciudad. De un 700/0 de población rural se pasó a un 700/0 o más y con tendencia a umentar la población urbana. Esto lleva a un replanteamiento en la atención de la salud. Además, se suma a lo anterior, la información masiva sobre la población que alienta la posibilidad de alcanzar
    tratamientos y drogas maravillosas o recursos extraordinarios como las unidades de cuidados intensivos o los transplantes, para dar dos ejemplos, que motivan al público a demandar dichos servicios. De otra parte, la misma información científica que alcanza
    apabullantes cantidades, solamente permite que el médico logre obtenerla y asimilarla en forma limitada y angustiante para su aplicación práctica.

    2. En la creación de nuevas Escuelas de Medicina deben considerarse entre otros los siguientes hechos o factores, favorables o desfavorables que no sólo afectan a Colombia sino que tienen características universales en algunos de sus aspectos:
    a La demanda de cupos en educación superior, entre ellos la medicina, nunca satisfecha.
    b Las presiones sociales que tienen el estudio como un método de ascenso por prestigio local o regional o político o todos juntos y no por la necesidad de formar más médicos.
    c La inconveniencia de la masificación de la educacación médica que demerita la calidad y por tanto es preferible el crear nuevas escuelas con número limitado de estudiantes que permitan una alta calidad de formación.
    d La dificultad de modificar los curricula tradicionales establecidos que impiden actualizar la docencia a las circunstancias que vive y requiere la salud del país.
    e La politización de las universidades públicas que demeritan la actividad docente al imponerse condiciones extrauniversitarias en la formación y realización de

  7. Algunas consideraciones teóricas sobre el liderazgo transformacional

    Directory of Open Access Journals (Sweden)

    Otilia Bracho Parra

    2013-05-01

    Full Text Available El artículo tuvo como objetivo, realizar algunas consideraciones teóricas sobre el liderazgo transformacional, tomando como referencia los planteamientos de Bass y Avolio (2006, Velásquez (2006, Lerma (2007, Leithwood, Mascall y Strauss (2009, entre otros. El proceso metodológico implico revisión bibliográfica, a través de la hermenéutica. Concluyendo que el liderazgo transformacional implica convertir a los colaboradores en personas creativas, motivadas al logro, comprometidas e identificadas con la organización, además de inspirar en sus seguidores la participación, pensar en colectivo, esforzándose en alcanzar metas significativas, en pro de la misión y visión de la empresa.

  8. El proceso reproductivo: Algunas consideraciones sobre el maternaje

    Directory of Open Access Journals (Sweden)

    Ignacio González Labrador

    2001-10-01

    Full Text Available Se realizaron una serie de consideraciones generales sobre el proceso reproductivo, y como una consecuencia de él se consolida un proceso llamado maternaje, conceptualizándose según criterio del autor, cómo puede influir en la vida sexual de la mujer. Se conceptualiza según las letras que componen la palabra que denomina dicho procesoA series of general considerations on the reproductive process as a result of which the so-called motherhood process is strengthened were presented in this paper. The author conceptualizes the influence of this process on the woman’s sexual life. The conceptualization is based on the letters of the word defining such a process

  9. Consideraciones sobre ética, derecho y ambiente

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    Pierre Foy Valencia

    2009-12-01

    Full Text Available El presente ensayo aborda la importancia que progresivamente está adquiriendo la ética ambiental en relación con las variadas formas del ejercicio contemporáneo del Derecho, así como de sus diversificadas áreas o especialidades y, por cierto, en particular respecto del Derecho Ambiental. Para ello, en primer lugar, identificaremos conceptualmente el escenario y el proceso de la ética ambiental como presupuesto condicionante que impacta en los múltiples mecanismos de actuación social —léase la política, la economía, la educación, los sistemas jurídicos, entre otros—.2 Luego, estableceremos algunas premisas sobre la responsabilidad profesional en particular del abogado y cómo estas deberían ser integradas en una perspectiva ético-ambiental o, si se quiere, basadas en una ética de la sostenibilidad. Finalmente, interpretaremos cómo tales consideraciones debieran articularse con el ejercicio de las disciplinas jurídicas, en especial con el Derecho Ambiental, enfatizando la cuestión de la corrupción con la preocupación ambiental.

  10. Consideraciones sobre la produccion de frutas en Venezuela

    Directory of Open Access Journals (Sweden)

    Jesús Aular

    2011-10-01

    Full Text Available En la presente revisión se presenta información sobre superficie, producción, y rendimiento de los frutales en Venezuela. Además se hacen consideraciones sobre los sistemas de producción, destacando limitaciones, avances y sugerencias. La fruticultura en Venezuela ocupa el 3er. lugar dentro del sector agrícola vegetal. Existen 167.691 Ha de frutales y una producción 2.232.088 TM por año. Se producen comercialmente una docena de rubros frutícolas, siendo los principales: plátano, banano, naranjo y piña. Las áreas de producción van desde zonas bajas y áridas, en donde se obtienen uvas y piñas; hasta zonas altas y húmedas donde se hallan duraznos y fresas. Ha habido reducción de la superficie plantada, con excepción de lechosa, piña y aguacate. El manejo hortícola de los huertos frutícolas es heterogéneo, ya que se observa desde bajo hasta alto nivel de tecnología. La incorrecta aplicación de las prácticas hortícolas origina baja productividad y calidad de fruta. La poscosecha podría mejorarse a través del desarrollo e implementación de normas de clasificación, empaque, embalaje, y cadena de frío. La exportación de frutas venezolanas se ha reducido en los últimos años y se concentra en mango, naranja y lima Tahití. Los principales destinos son Colombia, Europa, Norteamérica y las islas del Caribe. Sólo la naranja se procesa de manera importante en Venezuela. Las perspectivas para la fruticultura venezolana es continuar como una actividad dirigida al mercado interno, no se vislumbra una mayor participación del país en el mercado internacional.

  11. Algunas consideraciones sobre la estrategia de mercadotecnia en los negocios internacionales

    OpenAIRE

    Ernesto Raúl González Ramírez

    2016-01-01

    El presente artículo aborda algunas consideraciones sobre la estrategia de mercadotecnia en el contexto de los negocios internacionales. La primera parte está dirigida a describir las particularidades de las estrategias específicas de mercadotecnia (producto, precio, comunicación y distribución) en el área internacional. La segunda parte, trata sobre la importancia de tener presente el nivel de orientación al mercado o aplicación del concepto de mercadotecnia en este contexto.

  12. Algunas consideraciones sobre la estrategia de mercadotecnia en los negocios internacionales

    Directory of Open Access Journals (Sweden)

    Ernesto Raúl González Ramírez

    2016-01-01

    Full Text Available El presente artículo aborda algunas consideraciones sobre la estrategia de mercadotecnia en el contexto de los negocios internacionales. La primera parte está dirigida a describir las particularidades de las estrategias específicas de mercadotecnia (producto, precio, comunicación y distribución en el área internacional. La segunda parte, trata sobre la importancia de tener presente el nivel de orientación al mercado o aplicación del concepto de mercadotecnia en este contexto.

  13. Consideraciones del bioderecho sobre la eutanasia en Colombia

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    José Antonio García Pereáñez

    2017-01-01

    Full Text Available Este artículo aborda de manera reflexiva las incidencias del bioderecho sobre situaciones de eutanasia en Colombia, al interpretar conflictos morales y jurídicos suscitados por las sentencias de la Corte Constitucional C239 de 1997, T970 de 2014 y la Resolución del Ministerio de Salud y Protección Social 1216, de 2015. El propósito fundamental es el análisis de las decisiones judiciales sobre el final de la vida humana. Por lo tanto, se realiza una revisión de la construcción histórica y jurídica del concepto de eutanasia y se propone la discusión sobre su manejo jurídico y su influencia en el colectivo moral. Asimismo, se diserta sobre el concepto de dignidad humana y muerte digna, como precedentes para dirimir los conflictos éticos que la eutanasia suscita. Al final, se analiza el caso de don Ovidio González, quien se convirtió en 2015 en el primer colombiano en recibir la eutanasia de manera legal dentro del sistema de salud.

  14. Orden de no reanimar, consideraciones sobre este problema

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    Dr. G. Luis Cereceda

    2011-05-01

    Se analizan los principales problemas, comenzando por las dificultades según los diferentes escenarios (servicio de urgencia, pabellón de maternidad, sala de hospitalizados, unidad de intensivo, pabellones quirúrgicos; se analiza la incertidumbre sobre el pronóstico de cada pacientes y sobre quién(es deben tomar las decisiones sobre el fin de la vida. Idealmente debe ser el paciente autónomo quien tome la decisión, pero en otros casos se requieren alternativas, una de ellas es la Orden Unilateral. Otros problemas son la Validez de las órdenes de no-RCP en los diferentes tiempos evolutivos, el problema de la Futilidad y la Validez de las “Directivas Anticipadas”, en este grupo resalta el enfoque POLST (Physician’s Order for Life Sustaining Treatment como más comprehensivo; como complemento ha surgido también el concepto AND (Allow Natural Death, que podría estar destinado a remplazar la orden de no-RCP (DNR.

  15. Consideraciones sobre la valoración social del agua

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    Robert Hérin

    2003-01-01

    Full Text Available Las características del clima mediterráneo y el intenso aprovechamiento de los recursos hídricos en este ámbito, son los causantes de la excepcional importancia que se atribuye al agua en la cultura y la configuración de los paisajes. En este artículo se realiza un análisis de la evolución que ha seguido, sobre todo en los últimos siglos, el agro mediterráneo, desde las huertas tradicionales y los paisajes de secano a las nuevas formas de aprovechamiento agrícola, desde una perspectiva social.

  16. Consideraciones prácticas sobre la placa distalizadora Benac

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    Mariela González Fernández

    2003-12-01

    Full Text Available Existen muchas modalidades de tratamiento sin extracciones de la maloclusión de clase II. Una de ellas consiste en convertir la relación molar de clase II en una de clase I mediante el desplazamiento de los molares superiores hacia distal en las etapas iniciales del tratamiento. Este procedimiento resulta interesante y controvertido, ya que desplaza los dientes en contra de la tendencia normal de movimiento mesial que muestran durante toda la vida, y en la actualidad ha ganado interés. Prestigiosos investigadores han comenzado a profundizar en ella y han aparecido técnicas intraorales, en su mayoría fijas, muy novedosas, con materiales cada vez más efectivos. Todos estos aparatos son efectivos distalizadores, pero crean incomodidad al paciente, dificultan la higiene bucal y, lo más importante, son muy costosos. Por lo antes expuesto, se decidió realizar este trabajo, con el objetivo de ampliar los conocimientos que se tiene sobre la placa distalizadora Benac, un aparato intraoral removible, su modo de construcción y las ventajas de su uso. Se concluye que esta placa no solo resulta de muy bajo costo, sino que además permite una higiene bucal correcta, es más aceptada por el paciente y logra resultados similares a los alcanzados con técnicas más modernas.There are many variants of non-extraction treatment of class II malocclusion. One of these variants consists of turning class II into class I molar relation through the displacement of upper molar to distal position at the initial stages of the treatment. This procedure is interesting but controversial since it moves teeth contrary to the normal mesial movement that they show during the whole life. However, this method has aroused the interest of prestigious researchers who have begun to delve into its application, so novel and mostly fixed intraoral techniques that use increasingly effective materials have emerged. All these appliances are effective distalizers but bother the

  17. La Leche: consideraciones sobre la higiene y la alimentacion

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    Gonzalo Luque Forero

    1988-08-01

    Full Text Available

    I. De acuerdo con estudios realizados en las Universidades Nacional y de los Andes y la Secretaría de Salud, un alto porcentaje de las leches que se consumen en el Distrito Especial, presentaron adulteraciones y deficiente calidad fisicoquímica y microbiológica.

    Un bajo porcentaje cumplió con todas las normas del Ministerio de Salud y se trata de Plantas que reciben y procesan leches de hatos, en donde las instalaciones, la alimentación, la sanidad, la calidad genética y la producción
    están a la altura de los países industrializados.

    II. El consumo de leche en el país es bajo y no alcanza los niveles recomendados por los organismos de Salud.

    III. La leche es susceptible de contaminarse por la ignorancia, negligencia, prácticas fraudulentas o el empleo de técnicas inadecuadas en su procesamiento, transporte, conservación, comercialización e industrialización.

    IV. Se plantean interrogantes sobre la presencia en la leche, de residuos de antibióticos, pesticidas, hormonas, tranquilizantes, compuestos inorgánicos y la forma como puedan estar afectando la salud humana.

    V. La contaminación cada vez mayor del ambiente, el rápido transporte de los alimentos; sus técnicas de elaboración, los cambios en los hábitos alimentarios, han aumentado los peligros de enfermedades que se pueden trasmitir por los alimentos.

    VI. La Salud depende en buena parte de la alimentación y si los alimentos de origen animal son medios de propagación de agentes patógenos y tóxicos, la respuesta a este interrogante no es solamente cómo aumentar la producción, sino cómo alimentar una población afectada por pobreza y desnutrición con alimentos sanos.

  18. Algunas consideraciones sobre la ética en el mercado

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    Montserrat Díaz Méndez

    2007-12-01

    Full Text Available La desconfianza generalizada hacia los dirigentes empresariales refuerza la importancia de la ética en la empresa, tanto en el ámbito meramente teórico-académico cuanto en la aplicación práctica de determinados principios morales a las actividades mercantiles. La responsabilidad social corporativa o empresarial es una concreción de la ética consistente en la asunción voluntaria por parte de las empresas de determinados comportamientos que implican una serie de obligaciones en su ámbito interno y externo. Se discute la necesidad o no de establecer por ley el contenido de la responsabilidad social corporativa y, por tanto, exigir su cumplimiento.Mantener su carácter voluntario no significa que el Estado no pueda establecer unas directrices claras sobre la dimensión social de las empresas, así como su implicación en la sociedad en la que viven y las ventajas para aquellas empresas que lo respeten. Los códigos éticos son un intento normativizador de la ética, que suponen un beneficio para el estado, ya que no se ve obligado a tener que producir normas de derecho positivo y crear sus correspondientes mecanismos de control de conflictos. Por su importancia económica, una especial atención ha merecido la regulación ética de las sociedades cotizadas. En cualquier caso, hay que concienciar de la necesidad de un comportamiento ético basado en la bondad y la justicia, partiendo de que quien actúa éticamente lo hace por convencimiento.The general distrust towards top management decisions has reinforced/ stressed the importance of business ethics. Social Corporate Responsibility (SCR is an specific aspect of ethics. It implies the voluntary assumption of certain behaviours and values which may involve several obligations for the company that will affect it as a whole. Nowadays, there exists a discussion about the need of whether establishing or not a law on the content of fulfillment. In this sense, it is important to consider that

  19. Consideraciones sobre los conceptos de nación y colonia en la independencia de la India

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    Saurabh Dube

    2012-07-01

    Full Text Available Este artículo pone en perspectiva algunos enfoques novedosos para el estudio crítico de los conceptos de nación, imperio e historia. En primer lugar, se realiza una discusión alrededor de los conceptos clave para el estudio de la nación y el nacionalismo –por lo tanto, del Estado y la modernidad– surgidos de los estudios sobre la India. En segundo lugar, el artículo examina cómo dichos “desarrollos conceptuales” están vinculados, en las investigaciones académicas sobre la región, a consideraciones cruciales sobre el colonialismo y el imperio. En tercer lugar, se mira “hacia atrás” para enfocarse en los fascinantes atributos de las formaciones nacionalistas y explorar, con mayor detalle, los términos, texturas y transformaciones de los nacionalismos subalternos en el subcontinente. En cuarto lugar, el trabajo resalta las implicaciones más importantes de los enfoques antes revisados, para ofrecer una perspectiva novedosa en cuanto a la naturaleza de la escritura de la historia. Finalmente aparecen, en lugar de conclusiones, algunas consideraciones relacionadas a la manera en que se podría abordar, históricamente, la construcción de la descolonización y del nacionalismo, a futuro.

  20. Lethal Epistaxis.

    Science.gov (United States)

    Byard, Roger W

    2016-09-01

    Epistaxis or nosebleed refers to bleeding from the nostrils, nasal cavity, or nasopharynx. Occasional cases may present with torrential lethal hemorrhage. Three cases are reported to demonstrate particular features: Case 1: A 51-year-old woman with lethal epistaxis with no obvious bleeding source; Case 2: A 77-year-old man with treated nasopharyngeal carcinoma who died from epistaxis arising from a markedly neovascularized tumor bed; Case 3: A 2-year-old boy with hemophilia B who died from epistaxis with airway obstruction in addition to gastrointestinal bleeding. Epistaxis may be associated with trauma, tumors, vascular malformations, bleeding diatheses, infections, pregnancy, endometriosis, and a variety of different drugs. Careful dissection of the nasal cavity is required to locate the site of hemorrhage and to identify any predisposing conditions. This may be guided by postmortem computerized tomographic angiography (PCTA). Despite careful dissection, however, a source of bleeding may never be identified. © 2016 American Academy of Forensic Sciences.

  1. SOBRE LA PAZ Y LOS DIÁLOGOS. CONSIDERACIONES SOBRE EL PAPEL DE LA SOCIEDAD CIVIL

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    William Ortiz Jiménez

    2014-10-01

    Full Text Available El ensayo hace una reflexión en torno al proceso de paz que se llevó a cabo en el gobierno del presidente Andrés Pastrana, y la participación que tuvo la sociedad civil en este asunto. Pero, trasciende, además, a la situación actual del conflicto en Colombia. A partir de las formulaciones de varios teóricos, entre los que se destacan Daniel Pécaut, Cohen, y Arato., Margarita Bonamusa, María Teresa Uribe, Daniel García-Peña, Habermas, Rawls, entre otros, se fortalece un marco teórico y de referencia bastante sólido para mostrar cómo lo público es indispensable en las acotaciones que lleven a la solución de los conflictos. Sin el concurso de lo público, tampoco sería viable la participación de la sociedad civil. Los espacios de solución de conflictos, el ágora, en palabras de Hanna Arendt, es el lugar esencial para la discusión, el consenso y los acuerdos. En política, la esfera de lo público prima sobre lo privado, porque el reconocimiento de las libertades, manifestaciones y la plenitud de los derechos sólo se logra en lugares comunes.

  2. Algunas consideraciones sobre el uso de la prueba de Mc Nemar en las intervenciones educativas

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    Irlán Amaro Guerra

    2013-11-01

    Full Text Available En este artículo se exponen algunas consideraciones acerca del empleo de la prueba de Mc Nemar en las intervenciones educativas, así como de los elementos que se deben tener en cuenta para su cálculo y correcta aplicación, dado que el sesgo de confusión constituye uno de los errores que con mayor frecuencia se observan en las investigaciones biomédicas, específicamente en la presentación y el análisis de la información en el mencionado diseño de estudio.

  3. CONSIDERACIONES ACERCA DE LA DIRECTIVA 2004/35/CE SOBRE RESPONSABILIDAD MEDIOAMBIENTAL

    OpenAIRE

    Mariano H. Novelli

    2012-01-01

    RESUMOEl presente estudio analiza, desde una perspectiva integral, el sistema instituido por la Directiva 2004/35/CE sobre responsabilidad medioambiental. Se focaliza sobre el régimen para la prevención y reparación de daños medioambientales que establece dicha norma, a la cual concibe como un exponente de la renovación del Derecho de Daños, rama jurídica que en tiempo reciente ha ampliado sus funciones incorporando a la clásica finalidad resarcitoria una tutela que procura la actuación ex an...

  4. Consideraciones transnacionales sobre la gestión del Programa Bracero, 1946-1952

    OpenAIRE

    Vézina, Catherine

    2016-01-01

    Resumen: Los estudios realizados sobre los debates políticos y regionales sobre el tema de la migración laboral mexicana y que explican las razones del mantenimiento del programa bracero se enfocan mayoritariamente en la gestión estadounidense del flujo migratorio. Este artículo se interesa en la dinámica global de las negociaciones que tuvieron lugar entre 1947 y 1952 y ofrece una historia integrada del programa bracero. Reconstruye diversas narrativas y, de acuerdo con el enfoque propuesto ...

  5. Consideraciones sobre afectividad en las relaciones de enseñanza: las contribuciones de Vigotski

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    Raimundo Nonato de Oliveira Falabelo

    2015-10-01

    Full Text Available Este artigo tiene como objetivo presentar conclusiones de un estudio sobre la cuestión afectiva en una perspectiva inter-relacional con la cognición, como una misma unidad, que es la vida psíquica humana, lo que significa concebir que el afecto está presente y es constitutivo de toda y cualquier acción humana. Tiene como base teórica los estudios realizados por L. S. Vigotski. Echamos mano, aún, de las contribuciones de algunos de sus comentadores o interpretadores que tratan específicamente de este tema. El texto hace parte de los fundamentos teóricos de la Tesis de Doctorado sobre esta problemática, en contexto empírico, de clase, en un aula de educación de jóvenes y adultos.

  6. El porvenir de la universidad: consideraciones sobre el futuro en un contexto mundial

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    Alfredo Pena-Vega

    2009-01-01

    Full Text Available Este artículo de ninguna manera pretende proponer una teoría sobre la situación de crisis de la universidad. Esta reflexión nos permite, a través de un cierto conocimiento, establecer un diagnóstico de la universidad. Observamos de una manera general, que hay convergencias en la caracterización de la crisis; más allá de múltiples situaciones, las reivindicaciones que se manifiestan sobre el futuro de la universidad tienen una base común: expresan su rechazo al universo ideológico neoliberal. Asistimos a un desconcierto profundo que es la parte oscura, no formulada, difícil de interpretar, de la crisis actual del mundo de la universidad. ¿Qué va a pasar?

  7. Algunas consideraciones sobre el problema de la prostitución en Colombia

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    Víctor J. Piñeros Piñeros

    1935-01-01

    Full Text Available El problema de la prostitución es en todas partes y más entre nosotros, un problema muy complejo, que importa desentrañar y estudiar en sus principales aspectos: así, hay que considerar la prostitución en sí, y luégo en sus relaciones con la sociedad y sobre todo en su aspecto sanitario.

  8. Algunas consideraciones sobre el problema de la prostitución en colombia

    OpenAIRE

    Piñeros Piñeros, Víctor J.

    2011-01-01

    El problema de la prostitución es en todas partes y más entre nosotros, un problema muy complejo, que importa desentrañar y estudiar en sus principales aspectos: así, hay que considerar la prostitución en sí, y luégo en sus relaciones con la sociedad y sobre todo en su aspecto sanitario.

  9. Nuevas consideraciones sobre el significado del petroglifo de Laxe das Rodas (Muros, Galicia)

    OpenAIRE

    Fernando ALONSO ROMERO

    2009-01-01

    La primera exposición pública de mi interpretación del significado del petroglifo de Laxe das Rodas tuvo lugar en la 1.a Reunión Gallega de Estudios Clásicos, celebrada en Santiago de Compostela en julio de 1979- En este mismo Congreso, L. Monteagudo presentó también un detenido estudio sobre los orígenes y paralelos de dicho petroglifo en otras áreas culturales.

  10. Nuevas consideraciones sobre el significado del petroglifo de Laxe das Rodas (Muros, Galicia

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    Fernando ALONSO ROMERO

    2009-10-01

    Full Text Available La primera exposición pública de mi interpretación del significado del petroglifo de Laxe das Rodas tuvo lugar en la 1.a Reunión Gallega de Estudios Clásicos, celebrada en Santiago de Compostela en julio de 1979- En este mismo Congreso, L. Monteagudo presentó también un detenido estudio sobre los orígenes y paralelos de dicho petroglifo en otras áreas culturales.

  11. Consideraciones sobre planificación familiar: métodos anticonceptivos

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    Ignacio González Labrador

    2001-08-01

    Full Text Available Resumen Se realizó una revisión histórica sobre el desarrollo de cada uno de los métodos anticonceptivos que pueden ser usados como medios para evitar los embarazos no deseados y poder tener una adecuada planificación familiar. Se hace referencia a los efectos que los diferentes métodos anticoncepcionales pueden tener en la sexualidad humanaSummary A historical review on the development of each of the contraceptive methods that can be used to avoid unwanted pregnancies and to attain an adequate family planning was made. The effects that the different contraceptive methods may have on human sexuality were also approached.

  12. Consideraciones sobre el comercio de libros en Lima a principios del siglo XVII

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    González Sánchez, Carlos Alberto

    1997-12-01

    Full Text Available Not available.

    El estudio de la circulación libraria en la América colonial continúa siendo un tema poco explotado, contrastando con el auge de las investigaciones sobre bibliotecas particulares o de instituciones de enseñanza. Las razones, muy diversas, vienen determinadas por la escasez de fuentes, entre las que destacan los inventarios de mercaderes libreros, cuya información es indispensable para el conocimiento de las inquietudes lectoras y, en definitiva, de los esquemas mentales de la sociedad de la Edad Moderna. En esta ocasión, dos interesantes inventarios de mercancía libraria, negociada en Lima a principios del siglo XVII, nos ofrecerán algunos indicios de una faceta crucial de la vida humana: libros y lecturas.

  13. Consideraciones sobre granulometrías discontinuas de máxima compactación

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    Olaya, Manuel

    1978-06-01

    Full Text Available Los materiales conglomerados que se presentan en la naturaleza deben su génesis estructural a la acomodación geométrica de unos y otros componentes. Tras un proceso de "cimentación", este acomodo, según sea la disposición particular, conlleva por parte del material una respuesta resistente frente a las acciones exteriores impuestas. Sobre esta idea cabe suponer que los conglomerados más resistentes serán aquellos que tengan su estructura fundamentada en los interapoyos de los granos más duros y resistentes. ya que de por sí el material cementante proviene en la mayoría de los casos de otros previamente meteorizados a los que la evolución geológica ha colocado entre los primeros.

  14. Consideraciones sobre la prevención del cáncer de piel

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    Rubén José Larrondo Muguercia

    1996-06-01

    Full Text Available Se exponen las diferentes categorías de las lesiones precancerosas de la piel y se indican en cada caso los cánceres a que dan origen. Se analizan las acciones a nivel primario de atención médica para la prevención de los tumores malignos de la piel. Se preconiza sobre el concepto de autoexamen de piel.The different categories of skin precancerous lesions are exposed as well as the cancers they give rise to in every case. Measures to be taken at the primary health care level for preventing malignant skin tumours are analyzed. The skin self-examination concept is explained.

  15. CONSIDERACIONES SOBRE EL ESTADO DEL ARTE DEL DESARROLLO ECONÓMICO

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    Néstor Juan Sanabria

    2003-07-01

    Full Text Available Este artículo ofrece una síntesis del estado del arte sobre los temas del desarrollo y es parte integrante de la investigación sobre los pymes y el desarrollo económico. Desde los enfoques clásicos hasta los modelos contemporáneos se ha debatido ampliamente la relación entre crecimiento y desarrollo económico. Para muchos autores el desarrollo está vinculado a los problemas de distribución. Para otros el desarrollo es sinónimo de disminución y eliminación de la pobreza o se resuelve a través de aumentar la producción. Otros enfoques se centran en la importancia de minimizar los costos de transacción o en la generación de una mejor calidad de vida. Ahora bien, las teorías del desarrollo predominantes hasta la década de los ochenta, asumen que el proceso del desarrollo no es más que la ruta de homogenización de los mercados duales. Para otros autores el problema se explica por la diferencia de tecnologías, capital social, capital intelectual y humano. Esta síntesis revisa entre otros enfoques los modelos con los que se ha intentado explicar la peculiaridad del desarrollo en los países del tercer mundo, en las economías en proceso de industrialización y la complejidad del caso particular del desarrollo en Latinoamérica y su modelo de sustitución de importaciones.

  16. Algunas consideraciones sobre los trastornos temporomandibulares Some considerations on the temporomandibular disorders

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    Ileana Grau León

    2005-12-01

    Full Text Available Se realizó una revisión documental mediante revistas, libros, tesis y otros documentos en formato electrónico acerca de la epidemiología de los trastornos de la articulación temporomandibular, con el objetivo de actualizar el material existente y ampliar nuestros conocimientos sobre esta alteración. En nuestro país se han llevado a cabo en las 2 últimas décadas, varios estudios epidemiológicos sobre los trastornos temporomandibulares (TTM y se ha hecho un esfuerzo notable por esclarecer su causa. De forma general, se acepta la idea de que el origen de los disturbios funcionales del sistema estomatognático es multifactorial, pero a pesar de que tanto en niños como en adultos la prevalencia de los trastornos temporomandibulares (TTM ha sido alta, no se ha evidenciado un factor causal predominante. La literatura alude que estas disfunciones afectan a un porcentaje muy elevado de la población mundial (80 %, con una edad media de 34 años y una proporción de 3 mujeres por cada hombre. Este dato es muy interesante, porque los estudios precisan que las mujeres de edades comprendidas entre los 25 y los 35 años presentan trastornos temporomandibulares (TTM con más asiduidad.A documental review of different sources was carried out to study the disfunctions of temporal mandibular joint (TMJ with the objective of updating and enlarge our knowledge of this disorder. In or country in the last two decades several epidemiological studies about the temporal mandibular joint dysfunction were carried out. In a general wade the idea about of the origin of the functional problems of the stomatognatic system is multifactioral. But although, in children as well as in adults the prevalence of temporal mandibular dysfunction (DTM has been high, a casual predominant factor has not been evidenced. Literature states that this dysfunction affect a very high percentage of the world populations, 80 % , the mean age 34 years old and the proportion 3 woman for

  17. Consideraciones sobre la categoría epistemológica de modelo

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    Adriana Patricia Gallego Torres

    2012-04-01

    Full Text Available En este artículo la autora presenta las diversas concepciones acerca de la categoría epistemológica de modelo científico. Intenta demostrar que esta categoría sigue estando afincada en el estatuto científico de la física, por lo que emplear la de teoría científica o la de modelo sin unas especificaciones desde aproximaciones históricas no aporta un cambio significativo en la mirada habitual sobre el estatuto científico de las diferentes ciencias de la naturaleza, especialmente si las conceptualizaciones al respecto siguen teniendo como matriz la física. Tampoco contribuye a una didáctica de la modelización o modelación, esto es, la de la construcción de modelos científicos en el aula, como se demuestra en los párrafos de este artículo.

  18. Algunas consideraciones sobre normalización en la administración pública

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    Rolando Bolaños Garita

    2011-01-01

    Full Text Available La Normalización es un concepto al que no podemos considerar divorciado de la Administración Pública, o exclusivo de abordaje en el campo de la Administración de Negocios. Cada día se denota con mayor fuerza el empuje que instancias como la Contraloría General de la República brindan a la estandarización de acciones o servicios en razón no solo de unificar la gestión administrativa, sino de brindar servicios a los ciudadanos bajo criterios de calidad. El peligro que visualizamos cuando se abordan temas como el aquí propuesto, es que los funcionarios públicos, que procedan a concretar acciones de Normalización, lo hagan sin tener noción o consideración del entorno y particularidades de la Administración Pública costarricense y, por el contrario, extrapolen tendencias, estrategias o incluso textos de carácter internacional y, sobre todo, anglosajón, lo que consideramos que sí echaría por tierra cualquier esfuerzo bien intencionado de mejor gestión y(o modernización pública.

  19. Consideraciones sobre el Trabajo Comunitario desde la perspectiva de equipos estatales y ONG

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    Omar Barrault

    2015-12-01

    Full Text Available En este trabajo se compartirán reflexiones del Equipo de Investigación de la Cátedra Estrategias de Intervención Comunitaria de la Facultad de Psicología de la Universidad Nacional de Córdoba. Dicha producción se enmarca en el proyecto que indagó sobre las “Características del Trabajo Comunitario (TC en la ciudad de Córdoba” (2012-2013 desde el Estado y las ONG’s. Se compararán resultados con un estudio anterior (1998-1999 focalizando en: cómo definen el TC, cuál es su importancia y finalidad última, cuáles son los principales obstáculos y facilitadores para su desarrollo. Puede sostenerse, como aspecto común el reconocimiento de que es un trabajo compartido con la gente y con un colectivo. Esto permitirá tensionarlo con categorías centrales como participación y construido en común.

  20. Algunas consideraciones sobre la relación pensamiento – lenguaje

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    MSc. Rubén Congo Maldonado

    2018-01-01

    Full Text Available En la psicología moderna, pensamiento y lenguaje son categorías polémicas y objeto de análisis por autores de renombre a nivel mundial, entre ellos Jean Piaget, L. S. Vygotsky, J. S. Bruner y A. R. Luria, los cuales pese a las diferencias en sus concepciones se devela una estrecha relación entre ellas. En el presente trabajo se realiza un análisis desde los planteamientos teóricos de estos autores respecto a cómo se relacionan estas categorías y su influencia en el desarrollo del individuo. Se concluye que las categorías pensamiento – lenguaje, no es posible separarlas; su relación es geneticamente variable; su evolución no es ni paralela ni uniforme; ellas se juntan, se separan, se cruzan repetidamente, se alinean paralelamente, incluso llegan a fundirse e inmediatamente dividirse en algún momento. Se coincide en los planteamientos teóricos cuando se afirma que el niño en el proceso de adquisición del lenguaje requiere la interacción de bases cognitivas como la herencia, la maduración, la experiencia y sobre todo la interacción social, aspectos esenciales a trabajar para el desarrollo del individuo como ser social

  1. CONSIDERACIONES SOBRE LAS ALGAS DEL VALLE DE TEHUACÁN-CUICATLÁN

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    Eberto Novelo

    2012-01-01

    Full Text Available El Valle de Tehuacán-Cuicatlán es una zona semiárida que presenta una flora de algas rica en los cuerpos de agua temporales y permanentes, consta de 357 especies, muchas de ellas no registradas previamente en México: 183 especies de Bacillariophyta representan cerca del 50 % de la flora; 81 especies de Cyanoprokaryota constituyen el 22 % de la misma, 77 especies de Chlorophyta aportan el 20 % de la riqueza; complementan la flora 10 especies de Euglenophyta (2.8 %, 5 especies de Heterokontophyta (1.4 % y una especie de Rhodophyta (0.2 %. Las especies más frecuentes y más ampliamente distribuidas son en su mayoría alcalífilas y eurihalobias. Sin embargo, la mayoría de las especies se distribuyen principalmente en una o dos localidades y en dos tipos de ambientes (canales de riego y charcos. Se discute sobre la heterogeneidad de la composición tomando en cuenta la frecuencia de aparición en las muestras y en las cuatro zonas del Valle y el significado de esa distribución. El análisis de distribución y dominancia de las especies sugiere que las condiciones acuáticas del Valle son muy cambiantes y ello promueve la proliferación de especies de un espectro ecológico amplio, dentro de los límites generales de alcalinidad y salinidad moderadas.

  2. Consideraciones clínicas sobre el problema de la psicogénesis del hipertiroidismo

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    Ch. de Nogales Q.

    1949-07-01

    Full Text Available Comunicación presentada a las sesiones Científicas del Instituto de Patología Médica. Director Prof. Marañón. Madrid 17. Enero 1948. Profesor Marañón. Señores: Entre los trabajos que tenemos actualmente en curso de realización en Barcelona figura el estudio de centenar y medio de observaciones de enfermos hipertiroideos tratados en nuestro Dispensario. Ante estos enfermos y desde el principio de la anamnesis nuestro intento había sido comprenderlos. No queríamos "interpretarlos" ni tampoco "catalogarlos" inmovilizándolos por tanto nosológica y nosográficamente. El diagnóstico sólo nos servía para centrar nuestra atención sobre ulteriores investigaciones, pero nuestro propósito ante ellos era, más ambicioso, pues pretendía hasta donde dio fuera posible, hacerlos etiopatogénicamente comprensibles, fisiopatológicamente comprensibles y también porqué no decirlo, en la mayoría de los casos, psicológicamente comprensibles. Queríamos comprender su devenir patológico a partir del estilo reactivo que arrancaba de su constitución y, como a seres que viven en un medio con el cual forman sistema y se integran, queríamos comprenderlos en la contingencia temporal especial y social de su vida. Intentaremos por lo tanto despistar de donde arrancaba el error biológico que los precipitaba en la dismetría que es la enfermedad.

  3. Algunas consideraciones sobre las reacciones adversas por alimentos Some considerations on the adverse ractions to food

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    Mirta Álvarez Castelló

    2004-12-01

    Full Text Available Las reacciones adversas por alimentos son motivo de consulta frecuente en el servicio de alergia del Hospital "Calixto García". En ocasiones su diagnóstico es complejo, y pueden requerir estudios más específicos, sobre todo, cuando los síntomas son respiratorios, como es el caso de la rinitis y el asma, o cuando existe sensibilidad a más de un alimento. Muchas veces estas reacciones adversas, luego de la ingestión de un determinado alimento nada tienen que ver con la alergia y adonde acuden inicialmente es a los médicos de atención primaria, por lo que se revisa en este artículo determinados aspectos de interés en su diagnóstico y atención, con el objetivo de mejorar el tratamiento y control de todo paciente con estas características. Finalmente se hace énfasis en la importancia de un buen interrogatorio, en las pruebas de eliminación y provocación, así como en la aparición de tolerancia a muchos alimentos en la etapa de la infancia, en la que es frecuente este comportamiento. Con este estudio se pretende difundir asimismo, el trabajo y control que debe aplicarse con dichos pacientes, al tiempo que se fomentan mejores hábitos alimentarios en la población.The adverse reactions to food are a reason for the frequent visit to the allergy service at "Calixto García" Hospital. Sometimes, its diagnosis is complex and it may require more specific studies, mainly when the symptoms are respiratory, as in the case of rhinitis and asthma, or when there is sensitivity to more than one food. Many times, these adverse reactions after the ingestion of a certain food have nothing to do with allergy and the patients initially go to see doctors at the the primary health care level, so some aspects of interest in its diagnosis and care are reviewed aimed at improving the treatment and control of every patient with these characteristics. Finally, emphasis is made on the importance of a good interview, on the tests of elimination and provocation

  4. Consideraciones actuales sobre las infecciones posoperatorias Current considerations on the postoperative infections

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    Izvieta Despaigne Alba

    2013-04-01

    Full Text Available A pesar de los avances de las técnicas quirúrgicas, anestésicas, microbiológicas, así como de la ingeniería genética y la biotecnología, las infecciones constituyen el enemigo invisible del paciente operado. La aparición de infección nosocomial en el periodo posoperatorio constituye una complicación frecuente que, independientemente de todas las medidas de prevención y control, aumenta la morbilidad y mortalidad posquirúrgicas; pues, además de comprometer los resultados de las intervenciones, favorecen la aparición de otras complicaciones, en ocasiones fatales, con repercusiones socioeconómicas muy desfavorables para el enfermo y las instituciones sanitarias. Por esas razones, la revisión sobre este tema nunca pierde actualidad, dado su origen multifactorial, diversidad de localizaciones y variedad de gérmenes que las provocan. Así, este artículo pretende contribuir a su prevención, diagnóstico precoz, tratamiento oportuno y adecuado, según las buenas prácticas médicas y quirúrgicas.In spite of the advances of the surgical, anesthetic and microbiologic techniques, as well as of the genetic engineering and the biotechnology, infections constitute the invisible enemy of the operated patient. The occurrence of nosocomial infection in the postoperative period constitutes a frequent complication which, independently from all the prevention and control measures, increases the postsurgical morbidity and mortality, as besides compromising the results of the interventions, they favor the appearance of other complications, occasionally fatal, with very unfavorable socioeconomic repercussions for the sick person and the health institutions. For these reasons, the review on this topic never loses updating, given its multifactor origin, diversity of localizations and variety of germs provoking them. Thus, this work seeks to contribute to its prevention, early diagnosis, opportune and appropriate treatment, according to the good

  5. Algunas consideraciones sobre Romanos y Partos en la frontera del Éufrates

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    Félix J. RODRÍGUEZ SAN JUAN

    2010-02-01

    Full Text Available RESUMEN: Este artículo pretende iniciar una serie de investigaciones centradas en la frontera oriental y los procesos culturales que se van a producir en ella fruto de la interrelación entre partos y romanos. A través de tres ciudades, escogidas por sus específicas condiciones y por encontrarse con elementos de especial relevancia dentro de la investigación, se persigue profundizar en las nuevas concepciones que sobre la frontera han ido asentando los más modernos estudios, que buscan alejarla de su definición exclusivamente política o militar, para acercarla más al posible concepto que tras el término Limes debió entenderse en su momento, así como la compleja realidad cultural que escondía. El comercio y la difusión religiosa constituyeron sus elementos principales de contacto, pero también la intervención directa desde el estado romano supuso cambios importantes en la cultura de las ciudades fronterizas, en especial cuando se pretendió la conquista y se utilizaron los elementos de propaganda para intentar transformarlos y asimilarlos a su sociedad y cultura.ABSTRACT: This paper pretend to begin a series of investigation about the Oriental frontier and the cultural process that they are going to produce in it, product of the interrelationship between Parthians and Romans. Three cities are chose for it specific conditions and because they have elements of special relevancy in the investigation. It's searched to deepen in the new conceptions that about the frontier are going to affirm the most modern studies, that like to estrange of an exclusive or military definition, in order to approach to the most possible concept at the Limes term in the antiquity and to the complicated cultural reality that is behind. The commerce and the religious diffusion are the principal elements of contact, but the direct intervention from the Roman state denoted important changes in the culture of the frontier cities, specially when the conquest is

  6. Remarks on the biogeography of land invasions Consideraciones biogeográficas sobre las invasiones terrestres

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    EDUARDO H. RAPOPORT

    2000-06-01

    times, agricultural insects 26 times and phytopathogens 37 times more cosmopolitan than, say, common mammals, taken as an example for comparison. Finally, although animals (invertebrates plus vertebrates show a higher mean dispersal rate than plants (field observations plus ancient pollen registers, it seems that animals are better colonizers of pristine or scarcely disturbed communities, while plants are more successful in anthropic habitatsSe analiza el porcentaje de especies de plantas exóticas (PES a escala macrogeográfica en forma de mapas políticos (Texas y América del Norte y mapas de isolíneas (Gran Bretaña. En estos últimos se observa mayor concentración del PES en puertos y áreas urbanas e industriales más que en áreas agrícolas. En consecuencia, es predecible que la razón entre ruderales y arvenses siga aumentando en el futuro. Sobre la base de un censo de 200 floras del mundo se hace un análisis de regresión múltiple para determinar la importancia de factores que contribuyen a la variación en el PES (disturbios 55 %, riqueza de especies 14%, insularidad 9% y latitud 2%. Precipitación y temperatura media anual no contribuyen significativamente en la varianza. La predominancia de Europa como principal distribuidora mundial de malezas ha sido atribuida a su geopolítica imperialista y construcción de la primera flota marina internacional. A ello, sin embargo, debió contribuir también el tamaño de Eurasia. Ya que varios autores hallaron una débil correlación positiva entre la tasa de dispersión y el éxito invasor en plantas, se hizo una comparación entre taxones mediante 153 datos colectados. Las tasas lineales de dispersión, en km/año, fueron 64,2 en microorganismos, 48,5 en invertebrados, 17,2 en vertebrados, 6,9 en plantas y 0,19 en registros palinológicos. Otra manera de comparar la capacidad invasora, especialmente, en plagas agrícolas, es a través del índice de cosmopolitismo (C*, que resultó ser 0,642 para fitopat

  7. Consideraciones sobre la despenalización del aborto en Colombia Remarks on abortion decriminalization in Colombia

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    José Antonio García Pereáñez

    2010-08-01

    Full Text Available

    La Corte Constitucional de Colombia, con la Sentencia C-325 de 2006, proporciona una fuente de análisis e interpretación jurídica para la despenalización del aborto en Colombia. Esa es una tarea difícil, ya que, por un lado, la población colombiana en la actualidad manifiesta una gran polarización respecto al tema, y por otro, la despenalización del aborto es objeto no solo del derecho sino también de diversas disciplinas científicas y filosóficas y de sistemas normativos como la ética, la moral y la religión. En este artículo se analiza, en primer lugar, lo que llevó a la Corte  onstitucional a pronunciarse sobre la despenalización del aborto en Colombia. En segundo lugar, se tratan las consideraciones de la Corte y el debate jurídico-ideológico que tuvo que librar para llegar a su decisión. A renglón seguido, se hace un análisis desde la bioética del debate ético-moral que ha generado tal Sentencia; y por último, se infieren algunas implicaciones de esta norma dentro del complejo funcionamiento de la sociedad colombiana.

     

    Ruling C-325 by the Constitutional Court of the Republic of Colombia in 2006 constitutes a framework for the interpretation and analysis of restricted liberalization of abortion in Colombia. In the heated context of the Colombian idiosyncrasy, such decision by the Court was a complicated task, made even harder by the fact that the issue of abortion is discussed not only by the Law, but by other

  8. Epistaxis na een schedeltrauma

    NARCIS (Netherlands)

    Nooij, Roland P; van Dijk, J M C Marc; Groen, Rob J M; Uyttenboogaart, Maarten; Eshghi, Omid S; Korsten-Meijer, Astrid G W

    2015-01-01

    BACKGROUND: Epistaxis is a common problem, which is usually benign in nature. In some cases, however, epistaxis is a symptom of a severe underlying condition. CASE DESCRIPTION: A 20-year-old male was treated conservatively following head injury with craniofacial and base-of-skull fractures.

  9. Epistaxis in the Athlete.

    Science.gov (United States)

    Stevens, H; Taunton, J E

    1988-12-01

    In brief: Epistaxis is common among nonathletes as well as athletes, but because athletes may be more likely to sustain nasal/facial trauma, they probably are more at risk for epistaxis than nonathletes. An epistaxis tray containing the proper equipment should be kept readily available to be used to stop bleeding that does not stop spontaneously. Supplies should include cotton pledgets, antibiotic ointment, a nasal suction tip, a suction source, a topical anesthetic/vasoconstrictor, and more. In some cases reduction of an associated nasal fracture may be required before bleeding will stop. The author outlines the local and systemic causes of epistaxis, the field and hospital treatment for anterior and posterior epistaxis, and the possible complications.

  10. An update on epistaxis.

    Science.gov (United States)

    Yau, Stephanie

    2015-09-01

    Epistaxis is one of the most common ear, nose and throat (ENT) emergencies to present to general practitioners (GPs). The management of epistaxis has evolved significantly in recent years, including the use of nasal cautery and packs. Successful treatment requires knowledge of nasal anatomy, and potential risks and complications of treatment. Epistaxis is often a simple and readily treatable condition. However, given the potential consequences of a significant bleed, GPs should have an understanding of the causes, potential risks and emergency management. Epistaxis can be classified into anterior or posterior bleeds, the former being the most common. Anterior bleeds can often be treated with cauterisation with silver nitrate sticks, provided there is good preparation, correct equipment and assistance close at hand. If there is a lack in any of these aspects, prompt use of nasal packing and referral to an emergency department or a specialist ENT service is recommended.

  11. Immediate Management of Epistaxis.

    Science.gov (United States)

    Davidson, Terence M; Davidson, Daniel

    1996-08-01

    In brief Epistaxis typically originates from the nasal septum when the nasal mucosa overlying a dilated blood vessel is injured. Epistaxis may, however, signal an underlying condition such as a coagulation disorder, so the treating physician must be alert for signs of serious illness. Most nosebleeds stop spontaneously within 5 minutes with or without pressure to the forehead, nose, or upper lip. Some require anterior nasal packing. A few arise from posterior arteries and require anterior-posterior nasal packing and a referral.

  12. Consideraciones en torno a los trabajos e investigaciones sobre calidad en la formación turística

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    Eugeni Aguiló Pérez

    1999-01-01

    Full Text Available En este trabajo se realiza un repaso de la literatura sobre los temas de calidad en la formación turística. Se citan las causas del retraso en la investigación sobre formación turística sobre todo en Europa. Tras reseñar algunos aspectos relativos a las habilidades demandadas por el sector turístico a sus profesionales, se analizan aplicaciones de la Gestión de Calidad Total a la formación turística y el papel del profesorado como determinante de la calidad. Las bases formativas del nuevo profesorado que sigue la carrera académica en turismo han sido extremadamente débiles

  13. Consideraciones sobre la marginación, la marginalidad, marginalidad económica y exclusión social

    OpenAIRE

    Fernando Cortés

    2006-01-01

    En los estudios sobre exclusión social se encuentran menciones recurrentes a que el concepto es vago, es impreciso. Sobre la base de la teoría de la significación de Mario Bunge se indaga en las raíces metodológicas de la vaguedad. El análisis lleva a concluir que la referida imprecisión se erige a partir de la carencia de sentido ya que el concepto de exclusión social no suele estar inserto en una teoría. En concordancia con esta conclusión metodológica el interés se vuelca hacia el ca...

  14. ALGUNAS CONSIDERACIONES SOBRE LAS TITULACIONES DE LA FORMACIÓN BIBLIOTECOLÓGICA EN AMÉRICA LATINA

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    María Teresa Múnera-Torres

    2014-12-01

    Full Text Available A la luz de la investigación sobre “La Terminología de la Bibliotecología en América Latina: un estudio comparativo”, se aborda el panorama sobre las titulaciones que se otorgan en diferentes universidades de esta Región y se presentan las tendencias frente a las que manifiestan mayor uso, tanto en el ámbito educativo universitario general como en el bibliotecológico específicamente. Además se destacan las titulaciones de educación bibliotecológica más utilizadas en la muestra de programas y universidades definidos para dicha investigación.

  15. ¿Hay un mal en morir? Consideraciones éticas y jurídicas sobre la muerte inducida

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    ALEJANDRA ZÚÑIGA F.

    2011-01-01

    Full Text Available Se analizan los dilemas morales asociados a la muerte, para reflexionar sobre los interrogantes que surgen al calificarla como un hecho banal desde la perspectiva de quien muere. Se estudian, además, las consecuencias éticas y jurídicas de reconocer autonomía moral a quienes deciden, en circunstancias extremas, tomar por sí mismos la decisión de cuándo y cómo morir.

  16. Consideraciones en cuanto al uso medicinal y recreacional de la marihuana y sus efectos sobre el pulmón

    OpenAIRE

    ALVEAR T, GONZALO

    2015-01-01

    El consumo de marihuana ha aumentado en Chile en los últimos años, especialmente en jóvenes y adolescentes y pareciera existir una percepción general de que su uso no conlleva mayores riesgos. La discusión actual sobre la legalización de la marihuana debe hacer la distinción necesaria entre uso medicinal y uso recreacional de ella. Existen escasas indicaciones aprobadas por los organismos de salud internacionales para su uso medicinal, todas ellas con derivados sintéticos de administración or...

  17. Consideraciones sobre el acné conglobata a propósito de un caso: Hospital Vladimir Ilich Lenin 2009.

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    Raquel Rojas Bruzón

    2009-01-01

    Full Text Available Se presenta la evolución de un caso de acné conglobata tratado en el servicio de cirugía plástica del Hospital Vladimir Ilich Lenin, del que se logró una reversión del 90% de los síntomas generales y minimizar los signos locales disminuyendo el número de complicaciones. Se captó a través de él un número importante de enfermos y personas de riesgo haciendo factible el asesoramiento genético basado en la genética clínica y la educación sobre su enfermedad de todos los integrantes de la familia.

  18. Consideraciones sobre la evaluación psicológica de las comorbidades psiquiátricas en obesos

    OpenAIRE

    Costa, Fabiana Silva; Bandeira, Denise Ruschel; Trentini, Clarissa Marceli; Brilmann, Mirian; Friedman, Rogério; Nunes, Maria Angélica

    2009-01-01

    Pretende-se neste artigo apresentar uma revisão teórica sobre avaliação psicológica, obesidade e comorbidades psiquiátricas mais frequentes na população obesa. A obesidade é uma doença clínica de múltiplas causas, e atualmente é considerada uma epidemia; assim seu adequado entendimento deve envolver uma equipe composta por diversos profissionais de saúde, incluindo o psicólogo. Serão abordadas questões pertinentes ao tema de obesidade, como etiologia, incidência e a relação entre obesidade e ...

  19. Algunas consideraciones sobre el aborto: La educación sexual como una alternativa en su prevención

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    Ignacio González Labrador

    2001-06-01

    Full Text Available Se hacen algunas reflexiones muy generales sobre el aborto como situación problémica a través de la historia, así como aspectos jurídicos de su situación en Cuba. Se propone la educación sexual alternativa y participativa con sus características propias como una vía posible en su prevención.Some very general reflections on abortion as a problem through history as well as on its juridical aspects in Cuba are made. An alternative and participative sex education with its own characteristics is recommended as a possible way for its prevention.

  20. Consideraciones sobre los fundamentos psicopedagógicos de la educación para la salud en la adolescencia

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    Adriana Monserrath Monge Moreno

    2018-01-01

    Full Text Available La acción psicoeducativa dirigida a adolescentes en la prevención de conductas riesgosas debe lidiar con las barreras que impone la convulsa sociedad moderna. Las herramientas psicopedagógicas constituyen andamiajes o recursos mediadores de tipo psicológico y social que posibilitan a largo plazo la prevención y protección a la salud de los adolescentes y jóvenes en temáticas que son una preocupación para las instituciones de salud, para ello se utilizan diversos espacios que van desde los públicos, como la escuela o las universidades, y los grupales que llegan hasta las sesiones individuales de atención y seguimiento si fuera preciso. Este trabajo pretende reflexionar sobre los principales sustentos psicopedagógicos de la educación para la salud en la adolescencia.

  1. El contrato de Factoring y la nueva Factura Cambiaria. Consideraciones sobre el contrato y el título valor

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    El contrato de Factoring y la nueva Factura Cambiaria. Consideraciones sobre el contrato y el título valor

    2010-07-01

    Full Text Available El presente artículo aborda el análisis del contrato de factoring desde diferentes perspectivas, a saber: su definición, obligaciones, clases, interpretación, regulación de las compañías de factoring, y esquema de eficacia negocial. A partir de los anteriores puntos se analiza la incidencia de la nueva factura unificada sobre el negocio jurídico de factoring, y se demuestra como el deber de información puede conducir a prevenir las posibles falencias de la nueva factura unificada.Esperamos así entregar al lector un material de utilidad práctica, en el que además de abordar los aspectos legales y jurídicos del factoring y la factura unificada, se entreguen también suficientes elementos de juicio para la mejor comprensión de cada una de ellas.

  2. El contrato de Factoring y la nueva Factura Cambiaria. Consideraciones sobre el contrato y el título valor

    Directory of Open Access Journals (Sweden)

    Camilo Franco

    2010-06-01

    Full Text Available El presente artículo aborda el análisis del contrato de factoring desde diferentes perspectivas, a saber: su definición, obligaciones, clases, interpretación, regulación de las compañías de factoring, y esquema de eficacia negocial. A partir de los anteriores puntos se analiza la incidencia de la nueva factura unificada sobre el negocio jurídico de factoring, y se demuestra como el deber de información puede conducir a prevenir las posibles falencias de la nueva factura unificada. Esperamos así entregar al lector un material de utilidad práctica, en el que además de abordar los aspectos legales y jurídicos del factoring y la factura unificada, se entreguen también suficientes elementos de juicio para la mejor comprensión de cada una de ellas.

  3. Algunas consideraciones sobre la sustentabilidad en la agricultura argentina. Herramientas para el cumplimiento de la normativa ambiental

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    Clara María Minaverry

    2014-01-01

    Full Text Available Actualmente los países compradores de insumos y mercancías exigen calidad además de valor agregado, lo cual implica adecuar conocimientos y tecnología para obtener productos agrícolas que sean competitivos en el comercio internacional. Dentro de esta tendencia surgieron las Buenas Prácticas Agrícolas (BPA y las normas sobre Responsabilidad Social, que a través de los sistemas de certificación ayudan a demostrar formalmente el cumplimiento de este “buen hacer”. En el presente trabajo se pretende analizar y difundir que la implementación de Sistemas de Gestión de la Calidad (SGC, especialmente las Buenas Prácticas Agrícolas (BPA y las normas sobre Responsabilidad Social, son complementarias para cumplir con lo estipulado en el Derecho Ambiental aplicable al ámbito agrícola argentino. Su importancia radica en que la protección, preservación y la consagración del derecho al ambiente sano antes de la reforma de la Constitución Nacional de 1994 se interpretaba dentro de los derechos implícitos del artículo 33 de la misma. La reforma significó un hito histórico en lo relativo a la evolución del Derecho Ambiental, ya que se incorporó, dentro del capítulo segundo titulado “Nuevos derechos y garantías”, el artículo 41; en éste, se estableció el derecho a un ambiente sano, equilibrado, apto para el desarrollo humano y se relaciona de forma directa con otros derechos, como: gozar de calidad de vida, al desarrollo, a la salud, a la propiedad, e información, entre otros.

  4. Consideraciones sobre el hormigón impermeable y el aspecto de su garantía

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    Safránez, Carlos

    1971-09-01

    Full Text Available Conditions to be met by fresh concrete, including Its setting process, to obtain waterproof concrete, are set down. The proportioning method, in terms of the interaction of the various components, are defined in terms of the necessary mix water to obtain a given consistency, and in relation to the aggregate proportioning. The action of the plastifying, fluidifying air entraining and waterproofing additives is described. These additives constitute the fourth component of concrete. Their influence adds the above mentioned properties to concrete, and corrects certain deficiencies of this medium. The author also emphasizes the need to control carefully the placing of the concrete at the site, as well as the mixing process. Curing and handling of the concrete are equally important, and should be precisely supervised. Reference is also made to the question of guaranteeing the quality of the concrete, when treated with waterproofing additives. This involves certain difficulties, and the author indicates possible ways of over coming them.Se definen las condiciones que tienen que cumplir el hormigón fresco y el fraguado para obtener un hormigón impermeable. Se indica el procedimiento a seguir para determinar su dosificación de acuerdo con la interrelación que existe entre sus distintos componentes, partiendo de la cantidad necesaria de agua de amasado en relación con la consistencia requerida y la composición granulométrica de los áridos. Se aclara la acción de los aditivos plastifícantes-fluidificadores, aireantes e impermeabilizantes, que forman el cuarto componente del hormigón, debido a cuyos efectos se facilita el cumplimiento de las citadas condiciones y se corrigen ciertas deficiencias inevitables. Se insiste sobre la importancia de un control efectivo de la ejecución de la obra, sobre todo en lo referente a la preparación del hormigón, de su puesta en obra y curado. Finalmente se expone el aspecto de la garantía, problema de cierta

  5. Algunas consideraciones sobre la Arqueología de Epoca Germánica en Euskal Herria.

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    Agustín Azkárate Garai-Olaun

    1990-01-01

    Full Text Available Se realizan en este artículo algunas reflexiones sobre el método arqueológico aplicado a la tardoantigüedad, considerada comúnmente como uno de los períodos menos conocidos de la historia de Euskal Herria. Valorando, en su justa medida, los esfuerzos realizados desde la historiografía de base documental, se reivindica, sin embargo, el uso de la arqueología como medio insustituible para avanzar en el conocimiento de lo acontecido durante la Spätantike en nuestro territorio; una arqueología, no obstante, que, lejos de servirse a sí misma, sea generadora de problemas históricos y vehículo para el esclarecimiento de los mismos. Sin ánimo de exhaustividad se realiza, finalmente, un balance de lo conocido hasta el presente, aportando la novedad, a modo de primicia, de uno de los hallazgos de arqueología histórica más importantes realizados hasta el presente en el Páis Vasco.

  6. Impulso formal e impulso sensible, algunas consideraciones sobre la educación estética desde Friedrich Schiller

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    Jorge Gregorio Posada Ramírez

    2016-07-01

    Full Text Available Este texto es un artículo de reflexión. Argumenta que la educación estética es un promisorio camino para promover uno de los más importantes objetivos de la educación: la formación integral. A partir de las Cartas sobre la educación estética del hombre, del filósofo y poeta Friedrich Schiller, se muestra que dos son los rasgos que pueden definir la vocación intelectual del hombre: el impulso formal y el impulso sensible. El primero, recoge la necesidad humana de racionalidad, esto es, la vocación a encontrar y construir abstracciones y regularidades del mundo, de fundirse en lo universal; el segundo, la inclinación de las personas a buscar emociones que aviven su sensibilidad y pasiones, de mantenerse como seres singulares. Descrito el impulso formal y el impulso sensible como las dos cualidades que holísticamente configuran las potencialidades intelectuales humanas, se muestra que la apreciación de lo bello, en términos de Schiller: la Forma viva, en tanto cultiva equilibradamente ambos ímpetus humanos, fomenta la educación integral en las personas.

  7. Consideraciones teórico-prácticas Sobre un proyecto de aula: Un ejemplo desde el lenguaje

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    JOSELYN CORREDOR TAPIAS

    2007-01-01

    Full Text Available En Este artículo se presentan, en principio, algunos planteamientos conceptuales sobre el proyecto de aula – enmarcado en la denominada “pedagogía por proyectos. Posteriormente, se proponen “nuevas definiciones” del proyecto de aula, considerándolo como práctica educativa; enseguida, se dan a conocer y se explican en forma precisa y sucinta las funciones y los elementos básicos de este tipo de proyecto pedagógico; aquí, se hace énfasis en la etapa de la elección y delimitación del tema; la formulación problemática, uno de los momentos cumbres del proyecto de aula. Finalmente, estas urdimbres teóricas se materializan en un caso ejemplificador: un proyecto de aula en el marco del léxico infantil, en donde se puede observar como: Proyecto de aula –interés investigativo- ortografía y léxico infantil constituyen un colectivo dinámico, impulsor e inquietante para producir un breve -pero necesario e interesante intento de diccionario infantil de los niños de 5o. Grado.

  8. El futuro en los tiempos que corren… Consideraciones sobre la problemática ambiental en la era hipermoderna.

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    Joaquín Marqués

    2016-11-01

    Full Text Available En el momento actual, asistimos a una problemática medioambiental donde las actividades humanas están generando una pérdida de biodiversidad y un importante deterioro de los recursos naturales indispensables para la continuidad de la vida en la tierra. En el marco de una globalización impregnada por el neoliberalismo, la reducción de los estados nacionales y la relevancia de las empresas transnacionales, la ley del mercado orienta las acciones en los distintos ámbitos del quehacer humano, incluso en las formas de pensar, sentir y hacer. La cuestión del desarrollo sostenible se ha ido convirtiendo en el eje político sobre el cual los países, integrados a los organismos multilaterales como algunos de los espacios de relacionamiento internacional, intentan enfrentar a duras penas la cuestión de lo económico, lo social y lo ambiental. Frente a la perspectiva homogénea que propone el momento actual del capitalismo, surgen críticas y diversas perspectivas y visiones que consideran y proponen la necesidad de un cambio civilizatorio que incluya las dimensiones de lo político, lo económico, lo social, lo cultural y lo académico – científico.

  9. Endoscopic Management of Posterior Epistaxis

    OpenAIRE

    Paul, J.; Kanotra, Sohit Paul; Kanotra, Sonika

    2011-01-01

    The traditional method of management of posterior epistaxis has been with anteroposterior nasal packing. Apart from the high failure rate of 26–50% reported in various series, nasal packing is associated with marked discomfort and several complications. In order to avoid nasal packing, we started doing endoscopic cauterization in cases of posterior epistaxis. A total of 23 patients with posterior epistaxis were subjected to nasal endoscopy with the intent to stop bleeding by cauterization of ...

  10. Más allá del cuerpo significante. Algunas consideraciones sobre las condiciones subjetivas del sentido

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    Germán Rosso

    2015-03-01

    Full Text Available Se presentan a continuación algunas conclusiones alcanzadas durante el Seminario de Diseño Gráfico y Publicitario, de la cátedra dirigida por Carlos Savransky (UBA, y posteriormente profundizadas en el PRII R13-217 “Sobre la constitución de la subjetividad y el sentido: teoría de la práctica y reflexividad. Un abordaje a partir de Castoriadis y Bourdieu”. Se apunta a una articulación entre diferentes categorías propuestas por el psicoanálisis freudiano, la fenomenología merleau-pontiana y el pensamiento de Castoriadis, ante un artículo fundamental en la perspectiva sociosemiótica: “El cuerpo reencontrado”, de Eliseo Verón. A partir del recorrido ontogenético que desarrolla el autor retomando la segunda tricotomía peirciana, donde se muestra el modo en que el sujeto se estructura al interior de la red discursiva (1987, se buscarán posibles complementaciones entre los enfoques recién mencionados. El cruce de perspectivas resulta pertinente si recordamos que Verón presupone varias de las categorías que dan cuenta de las condiciones de posibilidad para el surgimiento/reasunción del sentido instituido en la dimensión histórico-social. Al mismo tiempo, se retomarán las conclusiones de Piera Aulagnier en La violencia de la interpretación para enriquecer el recorrido genético y dar cuenta de la dimensión afectiva que recorre la actividad de representación.

  11. Consideraciones prácticas sobre la hemorragia en el periparto Practical considerations on hemorrhage during peripartum

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    Danilo Nápoles Méndez

    2012-07-01

    Full Text Available La hemorragia de origen obstétrico constituye la primera causa de morbilidad y mortalidad maternas en la región de las Américas y el mundo, con el sangrado posparto como su forma de presentación más común. La presente revisión ha perseguido actualizar la información disponible sobre prevención, diagnóstico precoz e intervención temprana en lo que respecta al tratamiento médico o quirúrgico del riesgoso proceso, a fin de que apoye a la comunidad científica de esta disciplina en la toma de decisiones, contribuya a lograr un mejor control de esa contingencia negativa en las féminas y disminuya el número de madres fallecidas por complicaciones del embarazo, parto o puerperio, como la mencionada al inicio de esta síntesis.Hemorrhage of obstetric origin constitutes the first maternal morbidity and mortality cause in the region of the Americas and of the world, with the postpartum bleeding as its most common form of presentation. The present review has been aimed at updating the available information on prevention, early diagnosis and intervention concerning medical or surgical treatment of the risky event, so that it supports the scientific community of this discipline in the decision making process, contributes to achieve a better control of this negative disorder in the females and diminishes the number of dead mothers due to complications of pregnancy, delivery or puerperium, as the one mentioned at the beginning of this synthesis.

  12. Surgical Management of Severe Epistaxis.

    Science.gov (United States)

    Lin, Giant; Bleier, Benjamin

    2016-06-01

    Many patients with severe epistaxis benefit from endoscopic intervention for control of bleeding. Critical maneuvers to improve endoscopic visualization during surgery include head-of-bed elevation, application of topical vasoconstrictors, and local injection of vasonstrictors. Controlled, hypotensive anesthesia may also decrease intraoperative blood loss and improve visualization during surgery. Intractable posterior epistaxis can be controlled with high rates of success with endoscopic sphenopalatine artery ligation. Although less common, intractable anterior epistaxis may be controlled by anterior ethmoid artery ligation once this artery is identified as the primary source. Less common sources of severe epistaxis are also discussed in this article. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. The initial management of epistaxis.

    Science.gov (United States)

    Tanner, R; Harney, M S

    2015-04-01

    Epistaxis affects up to 60% of people. The basic first aid management of epistaxis is clearly stated in the literature and guidelines. Anecdotal evidence would suggest that these principles are not understood by patients and are not being conveyed to patients by their doctors. The aim was to assess current knowledge of epistaxis first aid management and identify the principle source of education in epistaxis control. This was a single centre cross-sectional study. The study population included those presenting to otolaryngology outpatients with epistaxis. 20 patients participated in this study over a 7 month period. Five (25%) patients did not use compression during an episode of epistaxis. Nine (60%) patients that used the compression technique failed to compress the lower one-third of the nose. Only two (10%) of patients identified their GP as having taught them first aid for epistaxis. Knowledge of epistaxis management is poor. Education regarding the basic principles of first aid for epistaxis may reduce morbidity and unnecessary consultations from health professionals.

  14. Algunas consideraciones sobre el efecto del espesor de llanta en la resistencia a la fractura de ruedas dentadas.

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    G. González Rey

    2009-01-01

    Full Text Available En transmisiones por engranajes, con ruedas de llantas delgadas trabajando en régimen de carga nominal y con suficiente resistencia a los esfuerzos de flexión en la raíz de los dientes, ha sido observado el surgimiento de grietas por debajo de los dientes que se propagan a través de la llanta con rotura por fractura de la rueda dentada [2]. Las actuales formulaciones de las Normas ISO y AGMA para valorar el esfuerzo máximo resultante en la base de los dientes de las ruedas de engranajes cilíndricos introducen factores modificadores de los esfuerzos (YB y KB para ruedas dentadas con llantas de pequeño espesor. Estudios realizados [3, 13, 14, 15, 16, 17] valoran de forma diferente el factor por adelgazamiento de llanta en dependencia de la geometría de las ruedas y la rigidez conjunta entre llanta y los nervios soporte del núcleo de la rueda dentada. En el presente artículo, se expone un breve resumen del estado del arte sobre el tema, son mostrados y confirma dos resultados derivados de un análisis de la interrelación entre el factor por adelgazamiento de llanta, la razón de espesor relativo de la llanta y la razón de espesor relativo de los nervios del soporte en ruedas dentadas cilíndricas, y otros asociados con la tendencia del límite inferior de la razón de espesor relativo de la llanta en dependencia del número de dientes de la rueda.In thin rimmed gears running with nominal load and sufficient bending stress resistance at the tooth-root, fatigue cracks with propagation through the rims, rather than at the tooth fillet, has been observed [2]. Both the ISO and AGMA standards introduce stress-modifying factors (denominated rim thickness factors YB and KB for the bending stress calculation where the rim thickness is not sufficient to provide full support of the tooth root. However, some different behavior of rim thickness factor depending on gear geometry and the stiffness of both rim and web thickness have been reported [3

  15. Algunas consideraciones sobre el origen de los términos hormigón y concreto

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    Solesio de la Presa, M. Teresa

    1984-03-01

    da el término "hormigar" y añadiendo el sufijo ON, propio del aumentativo, tenemos la palabra hormigón. Por otro lado, en este trabajo se estudia, asimismo, el término "CONCRETO", palabra cada vez más usada en países de habla hispana para designar el término hormigón, por influencia de los países de habla sajona. Nunca la palabra "concreto" ha servido para designar un material de construcción, y sólo es a partir del siglo XIX cuando, seguramente, se usa para este fin, con objeto de dar a este material un matiz más científico. Por este motivo, se pretende en este trabajo aclarar que, teniendo nuestro idioma una acepción como la palabra hormigón —referida a material de construcción— y que figura en nuestros Diccionarios desde 1516, no debemos aceptar la palabra "concreto" y, sobre todo, debemos intentar que su uso no se generalice en países de habla hispana.

  16. [Epistaxis: causes and management].

    Science.gov (United States)

    Siwiec, H; Szymański, M; Szymańska, A; Klatka, J

    2001-01-01

    Evaluation of 265 patients treated in hospital due to nasal bleeding revealed that almost half of them suffered from hypertension and in about 30% of cases it was impossible to establish the cause of epistaxis. The most frequent way to stop the bleeding was anterior nasal packing and in case of failure posterior nasal packing together with anterior one. Posterior nasal packing with Foley's catheter is relatively simple and effective procedure. Introduction of superselective embolization of maxillary artery and dermoplasty in Rendu-Osler disease was very helpful.

  17. Tatuajes y piercing: consideraciones sobre el alcance de una ordenanza municipal en la ciudad de Córdoba Tattoos and piercing: considerations about the scope of a municipal statue in Cordoba city

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    J M Verduzco

    2008-09-01

    Full Text Available Las ordenanzas municipales son herramientas legales, a través de las cuales los municipios o comunas ejercen un control sobre diversas actividades, algunas de las cuales como el caso de la práctica de tatuajes y piercing, pueden ser nocivas para la salud. La Municipalidad de Córdoba a través de la Ordenanza Nº 10962, sancionada el 6 de Octubre de 2005, intenta controlar esta ancestral práctica realizada sobre la piel humana. El presente trabajo tiene como finalidad analizar el articulado de esta Ordenanza y hacer algunas consideraciones sobre su utilidad en la prevención de enfermedades.Municipal statues are legal tools ratified by the municipal legislative power, stablishing rules in the corresponding scope. This rules have the aim of regulating different activities, over which the Municipality police power is excercised. Many of this activities are related to public health, because they can cause diseases in the population exposed to them. The practice of tattoing and piercing is one of this activities able to cause diseases. Due to this fact, the Municipality of Córdoba has sanctioned statue 10962 in order to control this ancestral practice.

  18. Reflections on qualitative research in business Consideraciones sobre investigación cualitativa en administración Considerações sobre pesquisa qualitativa em administração

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    Ana Akemi Ikeda

    2009-09-01

    características, usos y aplicaciones de la investigación cualitativa en la Administración en su contexto general, reuniendo y organizando temas relacionados. Para eso se presentan varios puntos de vista de los autores, cotejándolos y analizándolos. Inicialmente se hacen consideraciones sobre el propósito de la investigación y las diferencias entre la inducción y la deducción; explicación de los términos metodología, método, técnica y procedimientos; y la comparación entre la orientación positivista y interpretativista. A continuación, se centra en la discusión del paradigma cualitativo. Para tanto son presentadas las orígenes de la investigación cualitativa; el campo, la validez y la confiabilidad; y la triangulación. Al final se abordan algunas de las críticas habituales. Se concluye que la investigación cualitativa es un término amplio que abarca muchos conceptos, métodos, técnicas y procedimientos, lo que puede oscurecer su comprensión, pero ofrece nuevas caminos, creativos y eficaces para los estudios en AdministraciónA pesquisa qualitativa, apesar de bastante utilizada na prática executiva, é relativamente pouco discutida em textos acadêmicos em sua acepção geral, ainda que haja exceções como os estudos de Godoy (1995 a,b,c e Silva et al. (2006, entre outros. Frequentemente, os artigos e livros sobre o assunto focam a descrição dos métodos e técnicas específicos utilizados nas investigações, tais como entrevistas em profundidade, discussão em grupo, estudo de casos, etnografia, teoria fundamentada e outros. O objetivo deste ensaio é fazer algumas considerações sobre as características, os usos e as aplicações da pesquisa qualitativa na área de Administração em seu contexto geral, reunindo e organizando temas relacionados. Para isso, são analisados e cotejados diversos pontos de vista dos autores. Inicialmente, são feitas considerações sobre o propósito da pesquisa e as diferenças entre indução e dedu

  19. Endoscopic management of posterior epistaxis.

    Science.gov (United States)

    Paul, J; Kanotra, Sohit Paul; Kanotra, Sonika

    2011-04-01

    The traditional method of management of posterior epistaxis has been with anteroposterior nasal packing. Apart from the high failure rate of 26-50% reported in various series, nasal packing is associated with marked discomfort and several complications. In order to avoid nasal packing, we started doing endoscopic cauterization in cases of posterior epistaxis. A total of 23 patients with posterior epistaxis were subjected to nasal endoscopy with the intent to stop bleeding by cauterization of the bleeding vessel. Of these, in four cases unsuspected diagnosis was made. Of the remaining 19, in three patients, the bleeding point could not be localized accurately and these patients were managed by anteroposterior packing. The rest of the 16 patients were managed by endoscopic cauterization. In four patients, there was recurrence of bleeding within 24 h. In one of these, cauterization controlled the bleeding while in the rest nasal packing had to be resorted to. Thus, of the 23 patients of posterior epistaxis subjected to nasal endoscopy, we could avoid nasal packing in 17 (74%). To conclude, endoscopic nasal cauterization is recommended as the first line to treatment in all cases of posterior epistaxis. This will not only prevent the uncomfortable and potentially dangerous nasal packing but also help in finding the underlying pathology.

  20. Epistaxis: Prevailing Factors and Treatment

    Directory of Open Access Journals (Sweden)

    Secchi, Myrian Marajó Dal

    2009-12-01

    Full Text Available Introduction: The epistaxis is one the most frequent otorhinolaryngologic emergencies in the medical practice. It is a benign affection, but the refractory cases require hospital admission. Objective: To evaluate prevailing factors in patients with epistaxis and treatment. Form of study: Retrospective study. Method: 60 patients with diagnosis of epistaxis were evaluated and they needed hospital admission between 2005 and 2006. Results: The main prevailing factors were: Systemic arterial hypertension 36% (n= 22, trauma 16% (n=10 and coagulopathy 5% (n=3. The treatment was the use of nasal splint: anterior 58% (n=35 and antero-posterior 27% (n=16, the electrocauterization of the identified bloody point 7% (n=4, endoscopic arterial bandage 8% (n=5 in severe epistaxis. For the patients with antero-posterior splint with recurrence of bleeding in the first 24 hours (five patients, after clinical stabilization, an arterial bandage was indicated by endoscopic means; four patients had systemic arterial hypertension and in one patient no prevailing factor was identified. Conclusion: The main associated prevailing factors were systemic arterial hypertension, trauma and coagulopathy. The treatment depends on the type, severity and cause of bleeding, initially the anterior and antero-posterior splint for bleeding control. The early endoscopic arterial bandage is indicated in patients with severe epistaxis and prevailing factors, and prolonged admission and morbidities associated with nasal splint should be avoided.

  1. 21 CFR 874.4100 - Epistaxis balloon.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Epistaxis balloon. 874.4100 Section 874.4100 Food... DEVICES EAR, NOSE, AND THROAT DEVICES Surgical Devices § 874.4100 Epistaxis balloon. (a) Identification. An epistaxis balloon is a device consisting of an inflatable balloon intended to control internal...

  2. Management of intractable spontaneous epistaxis

    Science.gov (United States)

    Rudmik, Luke

    2012-01-01

    Background: Epistaxis is a common otolaryngology emergency and is often controlled with first-line interventions such as cautery, hemostatic agents, or anterior nasal packing. A subset of patients will continue to bleed and require more aggressive therapy. Methods: Intractable spontaneous epistaxis was traditionally managed with posterior nasal packing and prolonged hospital admission. In an effort to reduce patient morbidity and shorten hospital stay, surgical and endovascular techniques have gained popularity. A literature review was conducted. Results: Transnasal endoscopic sphenopalatine artery ligation and arterial embolization provide excellent control rates but the decision to choose one over the other can be challenging. The role of transnasal endoscopic anterior ethmoid artery ligation is unclear but may be considered in certain cases when bleeding localizes to the ethmoid region. Conclusion: This article will focus on the management of intractable spontaneous epistaxis and discuss the role of endoscopic arterial ligation and embolization as it pertains to this challenging clinical scenario. PMID:22391084

  3. Consideraciones sobre la administración de proyectos de desarrollo de software, con ciclo de vida ágil, en el contexto costarricense

    Directory of Open Access Journals (Sweden)

    Anayansie Fallas Badilla

    2011-10-01

    Full Text Available En Costa Rica, la adopción de metodologías ágiles para el desarrollo de software ha traído consigo nuevas interrogantes para los administradores de proyectos: ¿cómo planificar este tipo de proyectos?, ¿cómo darles control y seguimiento en su ejecución? ¿cuáles competencias son las deseables para quienes tengan que administrar este tipo de proyectos? Este artículo presenta un marco teórico al respecto, da un panorama general del desarrollo de software en Costa Rica y del profesional en tecnologías de la información con que cuenta el país, y a partir de lo anterior enumera una serie de consideraciones que puedan servir como guía para quien requiera administrar proyectos de desarrollo de software con este tipo de metodología en el contexto costarricense.

  4. Interventional management of traumatic epistaxis

    International Nuclear Information System (INIS)

    Li Qiang; Jiang Xu; Yang Jijin; Yang Caoai; Zhang Huojun; Wang Weixing

    2009-01-01

    Objective: To discuss the clinical application of transcatheter arterial embolization in the treatment of traumatic epistaxis. Methods: Transcatheter arterial embolization was performed in 15 patients with traumatic epistaxis, caused by injury or surgery, after they failed to respond to medication and nasal packing. Seldinger technique was adopted via the femoral access and the bleeding site was determined with carotid angiography, super-selective catheterization was then carried out to embolize the ruptured artery with gelfoam particles or polyvinyl alcohol (PVA) particles. The clinical data and the therapeutic results were analyzed. Results: Of 15 patients, the epistaxis was caused by injury in 9 and by surgery of nasal or paranasal sinus in 6. Gelfoam particle was used in 14 cases and PVA particle in one case. The procedure was accomplished in one manipulation in all patients. The nasal tampon was removed in 2-3 days after the treatment with no recurrence of bleeding. No serious complications occurred. Conclusions: Transcatheter arterial embolization is a safe and effective therapy for profuse epistaxis on which the conservative management exerts no effect, and the gelfoam particle is the embolization material of first choice. (authors)

  5. Artritis reumatoide: consideraciones psicobiológicas

    OpenAIRE

    Japcy Margarita Quiceno; Stefano Vinaccia

    2011-01-01

    En la literatura es bien conocido el peso de las emociones negativas en la fisiopatología de la artritis reumatoide, pero hay poca información empírica del impacto de variables psicosociales positivas sobre esta enfermedad. Por tanto, el propósito de este trabajo es hacer énfasis en los factores psicobiológicos relacionados con la artritis reumatoide. Se describen las consideraciones epidemiológicas, los síntomas físicos constitutivos, los factores psicosociales más relevantes, como el papel ...

  6. Efeito de lubrificantes sobre a integridade da sonda de Foley e implicações no tamponamento nasal para epistaxe Effect of lubricants on the integrity of the Foley catheter and their implications in nasal packing for epistaxis

    Directory of Open Access Journals (Sweden)

    Fernando P. Gaspar-Sobrinho

    2004-06-01

    Full Text Available O tamponamento nasal para epistaxe é comumente realizado com gaze lubrificada e sonda de Foley. O balonete de Foley, de látex, pode ser dissolvido pela vaselina ou parafina; entretanto, estes são excipientes de várias pomadas e cremes. OBJETIVO: Avaliar o efeito de potenciais lubrificantes sobre a integridade da sonda de Foley. FORMA DE ESTUDO: Experimental. MATERIAL E MÉTODO: Balonetes de 80 sondas foram eqüitativamente distribuídos e mantidos sob tração em contato com um dos seguintes produtos: duas pomadas, três cremes, um gel, vaselina e gaze seca, e inspecionados a cada 24 horas por cinco dias. Os lubrificantes foram testados quanto a hidrossolubilidade. RESULTADOS: Vinte balonetes romperam-se, dos grupos vaselina e uma pomada. Os produtos não associados à degeneração da sonda mostraram-se hidrossolúveis, a despeito da presença de petrolato. DISCUSSÃO: Conjectura-se que a gaze do tampão nasal anterior com lubrificante hidrofóbico contendo petrolato, justaposto ao balonete de Foley, pode lesá-lo. CONCLUSÕES: Considerando-se apenas a inocuidade à sonda de Foley, os cremes e a pomada Furacin® poderiam ser indicados para lubrificar a gaze do tampão nasal anterior associado ao balonete de Foley. Nossos resultados sugerem que cremes, pomadas e géis hidrossolúveis preservam a integridade da sonda de Foley, ainda que contenham derivados do petróleo.Nasal packing for epistaxis is usually carried out using lubricated gauze and a Foley catheter. Lubricants such as Vaseline or paraffin can dissolve the Foley balloon of latex; however, they are excipients of various ointments and creams. AIM: To evaluate the effect of potential lubricants on the Foley catheter. STUDY DESIGN: Experimental. MATERIAL AND METHOD: Balloons from eighty Foley catheters were distributed into groups of equal size and kept under traction in contact with one of eight different products: two ointments, three creams, one gel, Vaseline and dry gauze. The

  7. CONSIDERACIONES SOBRE EL IMPACTO AMBIENTAL DEL EMPRENDIMIENTO HIDROELÉCTRICO DE PIEDRA DEL AGUILA EN LA CUENCA DEL RÍO LIMAY.

    Directory of Open Access Journals (Sweden)

    Juan M. Mendia

    1992-12-01

    Full Text Available Por definición los conflictos entre las sociedades y el medio, denominados en forma envolvente como ambientales, se dan a partir de como dicha sociedad organiza el aprovechamiento de un conjunto determinado de recursos. Es decir que los problemas ambientales tienen sentido como consecuencia de las acciones del hombre sobre la naturaleza.

  8. Ideas previas sobre carga, fuerza y campo eléctrico en estudiantes universitarios. Consideraciones para su superación

    Directory of Open Access Journals (Sweden)

    Marianela Nava

    2008-05-01

    Full Text Available El presente trabajo trata sobre el valor didáctico de las ideas previas de los estudiantes para la construcción de nuevos saberes, que lo posibiliten para dar explicaciones acordes con el conocimiento científico. Luego del análisis de los datos, se plantea el diseño de situaciones didácticas, fundamentadas en Posner et al, Ausubel, Amestoy, Alonso et al, que permitan promover la construcción de conceptos, aplicable a diversos campos. El estudio se encuentra enmarcado en un paradigma cuali-cuantitativo, a nivel descriptivo. Una conclusión importante es que las nociones sobre campo eléctrico, resultaron más deficientes que las de carga, pero menos que las de fuerza eléctrica, siendo necesario fomentar la construcción de conceptos científicos en los estudiantes universitarios.

  9. Algunas consideraciones sobre el análisis input-output de descomposición estructural aplicado a los casos de Andalucía y Madrid

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    José Manuel Rueda Cantuche

    2000-01-01

    Full Text Available El proceso de comparación estructural de una economía a través de la cantidad absoluta de valor añadido y del empleo nos arroja una serie de interrogantes sobre las distintas fuentes de variaciones estructurales en los procesos productivos a nivel sectorial entre dos regiones distintas. El análisis input-output de descomposición estructural estudia dichas fuentes a partir de cuatro diferentes tipos de orígenes: la diferencia de procesos tecnológicos, la demanda final interior, el comercio exterior y la productividad del trabajo. En nuestro documento pretendemos arrojar cierta luz sobre las diferencias estructurales entre regiones caracterizadas por economías de aglomeración Madrid y regiones menos desarrolladas (Andalucía a la luz del análisis input-output.

  10. Algunas consideraciones sobre la sicopatía y el suicidio de Silva : obsesion de la locura y del suicidio; un caso complicado de sicopatologia

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    Benigno Acosta Polo

    1965-08-01

    Full Text Available Sin haber dejado sospechar lo mínimo respecto de su terrible decisión; sin haber escrito una sola línea sobre el particular ni haberse dejado traicionar por los nervios durante el día y la noche que antecedieron a la tragedia; sin haber dejado traslucir la más leve impaciencia ante los caballeros y las damas que hasta la media noche tertuliaron en su casa, José Asunción Silva preparó, serenamente, su viaje definitivo por el angosto túnel del cañón de una pistola.

  11. La gastroenterología en Venezuela durante el primer quinquenio del siglo XXI (I) causas hepato-biliares: Consideraciones sobre mortalidad

    OpenAIRE

    Lizarzabal de Belloso, Maribel

    2007-01-01

    Los perfiles de mortalidad orientan sobre las prioridades necesarias en la prevención de enfermedades. En Venezuela se publican Anuarios de Mortalidad oficiales basados en Certificados de Defunción (distribuidos por Direcciones Regionales de Epidemiología/DVE/DEAE/MSDS) que contienen causas de muerte codificadas, siguiendo lineamientos internacionales CIE-10 de la OMS. Aún cuando estas cifras están a disposición del público, consideramos importante en este trabajo descriptivo-retrospectivo ex...

  12. Consideraciones acerca de la opinión del profesor Ben Karpman sobre psicodiagnóstico y psicoterapia del criminal

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    Luis Jaime Sánchez

    1938-01-01

    Full Text Available Lanzado al público de las ciencias psíquicas por "The Mental Science Publishing", ha aparecido una trascendente monografía del doctor Ben Karpman, profesor de psiquiatría en la Universidad de Howard, sobre examen psicológico del criminal. Atiende al libro que mencionó un particular y básico interés profesional, y este motivo me lleva a examinar con alguna detención la idea conductiva del psiquiatra norteamericano.

  13. Consideraciones sobre la regulación jurídica ambiental de los servicios ecosistémicos en Argentina

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    Clara María Minaverry

    2016-01-01

    Full Text Available El objetivo del presente trabajo es realizar un análisis de los aspectos centrales de la normativa sobre servicios ambientales o ecosistémicos de Argentina, y una breve referencia a la de una selección de países de América Latina (Perú y Costa Rica. Se utilizaron los métodos de observación documental y el de comparación normativa. Uno de los resultados más destacados es que en el último año se han presentado proyectos de leyes ante el Congreso Nacional, cuyos lineamientos generales podrían servir como antecedentes. Sin embargo, en paralelo debería realizarse una evaluación integral respecto a si deben derogarse o modificarse ciertas normas ambientales vigentes, para que no generen nuevas contradicciones. Una de las limitaciones para el caso de Argentina, es que no se dictó una norma específica que regule a los servicios ambientales. Podemos concluir que en la normativa de los otros países de la región que cuentan con leyes sobre pago por servicios ecosistémicos, se pueden encontrar algunos aspectos de relevancia que podrían ser tenidos en cuenta para una futura norma jurídica y/o políticas públicas en Argentina.

  14. Economic Aspects of Radiation Treatment; Considerations Economiques sur le Traitement par Irradiation; Ehkonomicheskie aspekty obrabotki produktov metodom oblucheniya; Consideraciones Economicas Sobre el Tratamiento por Irradiacion

    Energy Technology Data Exchange (ETDEWEB)

    Leveque, P. [Centre d' Etudes Nucleaires de Saclay (France)

    1966-11-15

    In May 1963, at the Conference held by the International Atomic Energy Agency on the Industrial Uses of Large Radiation Sources, there was considerable discussion of costs. This general exchange of views led to a number of assessments of the cost of treatment by radioactive sources and machines. After three years it seems appropriate to review the basic hypotheses, and in particular to take account of the drop in price: of radioisotopes, especially {sup 137}Cs. This affects the cost both of the installed kW and of the KWh of energy produced. In the light of the experience gained in the past: three years it is possible to define the efficiencies and the load factors observed in plants at present in operation. It is true that in most cases these are treating medical equipment and supplies, but the problems are comparable. (author) [French] En mai 1963, lors de la Conference organisee par l'AIEA sur l'emploi des sources de rayonnements intenses dans l'industrie, un large debat s'etait engage sur les prix de revient. De cette confrontation generale, on a pu tirer quelques evaluations du cout de traitement par sources radioactives et machines. Il est bon, trois ans apres, de revoir les hypotheses de base et surtout de tenir compte de l'abaissement du prix des radioelements et tout specialement du {sup 137}Cs. Ceci influe a la fois sur le prix du kW installe et du kWh d'energie produit. A la lumiere de l'experience acquise pendant ces trois dernieres annees, il est possible de preciser les rendements et facteurs de charge observes dans des installations actuellement en fonctionnement. Il s'agit il est vrai, dans la majorite des cas, de traitements d'accessoires medicaux, mais les problemes sont comparables. (author) [Spanish] En la Conferencia sobre las aplicaciones industriales de las fuentes de radiacion de elevada intensidad, celebrada.en mayo de 1963 bajo los auspicios del OIEA, se inicio un amplio debate sobre los precios de costo. De esta confrontacion general se

  15. Consideraciones teóricas sobre el concepto de liderazgo y su aplicación en la investigación educativa

    Directory of Open Access Journals (Sweden)

    Claudia Navarro-Corona

    2016-01-01

    Full Text Available El liderazgo ha sido estudiado por décadas desde diversas posturas y áreas del conocimiento; sin embargo, la abundancia de enfoques y publicaciones, lejos de contribuir a la discusión, ha dificultado los consensos. En medio de su indefinición, el término sigue adquiriendo relevancia en el campo de la investigación educativa. A partir de la revisión de 40 publicaciones, incluyendo cinco meta-análisis, el presente trabajo busca dar respuestas a las preguntas: ¿cómo se define el liderazgo?, ¿cómo se ha desarrollado el concepto en el campo educativo y en otros campos de conocimiento?, ¿qué aportes hace la bibliografía sobre el liderazgo que resulten relevantes para la definición del trabajo de los directores y directoras escolares y su estudio? El artículo reafirma las líneas de investigación a partir de las cuales se ha abordado el concepto y aporta una postura integradora de los tres enfoques principales desde los que se ha abordado el fenómeno en diversos campos del conocimiento. Se expone el liderazgo como una forma de ordenamiento social emergente de la coincidencia entre las características del líder y las necesidades de un grupo en una circunstancia específica y no solo como la consideración de cualidades individuales y del carisma del líder. Se concluye que el liderazgo representa una estructura frágil, vulnerable y corruptible cuando se desea establecerlo como orden permanente de funcionamiento. Se plantea que, en la medida en que se tenga claridad sobre el origen del liderazgo como fenómeno, podrán delimitarse las expectativas que se tienen sobre el desempeño de quienes ejercen las direcciones escolares.

  16. Risk factors for recurrent spontaneous epistaxis.

    Science.gov (United States)

    Abrich, Victor; Brozek, Annabelle; Boyle, Timothy R; Chyou, Po-Huang; Yale, Steven H

    2014-12-01

    To identify risk factors associated with spontaneous recurrent epistaxis. This was a retrospective cohort study assessing patients in the Marshfield Clinic system diagnosed as having epistaxis between January 1, 1991, and January 1, 2011. There were 461 cases with at least 2 episodes of spontaneous epistaxis within 3 years and 912 controls with only 1 episode in the same time frame. More than 50 potential risk factors were investigated, including demographic features, substance use, nasal anatomical abnormalities, nasal infectious and inflammatory processes, medical comorbidities, medications, and laboratory values. A Cox proportional hazards regression modeling approach was used to calculate hazard ratios of epistaxis recurrence. Traditional risk factors for epistaxis, including nasal perforation, nasal septum deviation, rhinitis, sinusitis, and upper respiratory tract infection, did not increase the risk of recurrence. Significant risk factors for recurrent epistaxis included congestive heart failure, diabetes mellitus, hypertension, and a history of anemia. Warfarin use increased the risk of recurrence, independent of international normalized ratio. Aspirin and clopidogrel were not found to increase the risk of recurrence. Few major adverse cardiovascular events were observed within 30 days of the first epistaxis event. Congestive heart failure is an underappreciated risk factor for recurrent epistaxis. Hypertension and diabetes mellitus may induce atherosclerotic changes in the nasal vessels, making them friable and more at risk for bleeding. Patients with recurrent epistaxis may also be more susceptible to developing anemia. Physicians should promote antiplatelet and antithrombotic medication adherence despite an increased propensity for recurrent epistaxis to prevent major adverse cardiovascular events. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  17. Consideraciones teóricas sobre la expresión oral profesional pedagógica en inglés

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    Julio César Rodríguez Peña

    2010-01-01

    Full Text Available En el artículo se abordó uno de los problemas más importantes y actuales para el proceso de enseñanza - aprendizaje del inglés como lengua extranjera: la formación de la habilidad de expresión oral. Para ello, el autor realizó un análisis de las fuentes que han dado tratamiento al tema. El aporte fundamental consiste en brindarles a los profesores de Inglés fundamentosteórico-metodológicos sobre las principales categorías pedagógicas de la habilidad de expresión oral en inglés, con un enfoque sistémico-comunicativo y profesional pedagógico.

  18. La débil Europa: consideraciones críticas sobre la política exterior de la Unión

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    Víctor C. Pascual Planchuelo

    2009-07-01

    Full Text Available Este trabajo tiene como objetivo analizar la Política Exterior de la Unión Europea. Para ello se revisa la orientación general de todos los países miembros, sus agendas diplomáticas y posturas geoestratégicas. En un contexto global en el que la Unión Europea desempeña un rol de simple observador, sin posibilidad de ejercer un poder decisorio sobre los aspectos fundamentales de la política internacional, la única opción válida es la de reforzar la Política Exterior. La Unión Europea tiene la obligación de hablar ante el mundo con una sola voz, y no delegar los temas de defensa y seguridad al aliado de costumbre, los Estados Unidos.

  19. Consideraciones sobre educación matemática y educación indígena en Colombia

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    Aldo Iván Parra Sánchez

    2014-09-01

    Full Text Available Se relatan parte de los procesos educativos adelantados por pueblos indígenas colombianos, para contestar y ampliar problemáticas planteadas internacionalmente desde una perspectiva crítica en educación matemática. Mediante dos estudios de caso (departamentos de Cauca y Guainía se consiguen plantear diferentes cuestionamientos en torno a la relación de las propuestas educativas en matemáticas y el contexto sociopolítico de las comunidades indígenas, en particular se indagan las implicaciones de una educación no diferenciada que no tiene en cuenta los proyectos de resistencia cultural en medio de situaciones de conflicto armado. También se propone una reflexión sobre el papel del investigador dentro de los procesos comunitarios, que puede suscitar cambios en futuras experiencias del campo.

  20. Consideraciones sobre educación matemática y educación indígena en Colombia

    Directory of Open Access Journals (Sweden)

    Aldo Iván Parra Sánchez

    2014-01-01

    Full Text Available Se relatan parte de los procesos educativos adelantados por pueblos indígenas colombianos, para contestar y ampliar problemáticas planteadas internacionalmente desde una perspectiva crítica en educación matemática. Mediante dos estudios de caso (departamentos de Cauca y Guainía se consiguen plantear diferentes cuestionamientos en torno a la relación de las propuestas educativas en matemáticas y el contexto sociopolítico de las comunidades indígenas, en particular se indagan las implicaciones de una educación no diferenciada que no tiene en cuenta los proyectos de resistencia cultural en medio de situaciones de conflicto armado. También se propone una reflexión sobre el papel del investigador dentro de los procesos comunitarios, que puede suscitar cambios en futuras experiencias del campo.

  1. Algunas consideraciones generales sobre la cardiopatía pulmonar crónica Some general considerations on chronic pulmonary heart disease

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    Carlos Aquin Roll

    2009-10-01

    Full Text Available La cardiopatía pulmonar crónica constituye una complicación frecuente de las neumopatías crónicas, fundamentalmente como consecuencia de enfermedades respiratorias obstructivas crónicas relacionadas con el nocivo hábito de fumar y la polución ambiental. En Cuba se dispone de un sistema de salud bien estructurado, que permite diagnosticar precozmente este cuadro clínico, porque se actúa en todo momento sobre los factores de riesgo. El tratamiento está encaminado a disminuir la hipertensión pulmonar y la congestión pulmonar, así como a prevenir la frecuente ocurrencia de procesos embólicos en estos pacientes. Esta revisión de la bibliografía médica al respecto, persigue brindar mayor información a todos los facultativos sobre tan importante asunto en materia de salud.Chronic pulmonary heart disease constitutes a frequent complication of chronic neumopathies, fundamentally as a consequence of chronic obstructive respiratory disease related to the harmful smoking habit and the environmental pollution. In Cuba there is a well structured health system that allows the early detection of this clinical pinture, because risk factors are well controlled. The treatment is aimed at diminishing pulmonary hypertension and congestion, as well as at preventing the frequent occurrence of embolism processes in these patients. This review of the medical literature in this respect, is intended to offer wider information to all doctors on such an important matter concerning health.

  2. Algunas consideraciones sobre el concepto de trabajo en Karl Marx y el análisis crítico de Jürgen Habermas

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    Juan A. Fraiman

    2015-07-01

    Full Text Available En la literatura marxista, la categoría de “trabajo” es revalorizada con la publicación tardía de los denominados Manuscritos económico-filosóficos del joven Marx. Entre las diversas lecturas contemporáneas, Habermas efectuará una interpretación crítica de esos escritos de carácter más bien filosófico-antropológicos para reformular así su conceptualización del Trabajo. No obstante, Habermas no abandonará su interés por Marx y el trabajo; se aproximará al fenómeno de la “reificación”, aunque sólo tomando la posterior crítica que Marx desarrolla en El Capital, sobre todo en la exposición del fetichismo de la mercancía, con intenciones de retraducirlo en términos de una teoría de la comunicación.

  3. Seasonal variation and predictors of epistaxis.

    Science.gov (United States)

    Purkey, Matthew R; Seeskin, Zachary; Chandra, Rakesh

    2014-09-01

    To examine the incidence of epistaxis as a function of season and age and to determine predictors of episodes within the epistaxis patient population presenting to a tertiary hospital system. Retrospective cohort study. Electronic medical record charts of patients presenting to the Northwestern Emergency Department, admitted to an inpatient ward, or seen in an outpatient setting between 2008 and 2012 were reviewed and selected for an International Classifications of Disease-Ninth Revision epistaxis code of 784.7. Season of presentation, demographic factors (age, race, gender, insurance status), medication use (including anticoagulants and topical nasal steroid administration), and several comorbidities were analyzed as potential predictors of episodes. A total of 2,405 patients were identified with a total of 3,666 individual epistaxis episodes over 5 years. Multivariate analysis identified allergic rhinitis (AR), chronic sinusitis (CRS), coagulopathy, hereditary hemorrhagic telangiectasia (HHT), hematologic malignancy, and hypertension (HTN) as predictors of a higher number of cases. Epistaxis occurred more frequently during colder months and in older patients. Epistaxis occurs more commonly during the winter and in older patients. AR, CRS, coagulopathy, HHT, hematologic malignancy, and HTN are associated with increased epistaxis incidence. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  4. Sistema de aseguramiento de la calidad de la educación superior: consideraciones sobre la acreditación en Colombia.

    Directory of Open Access Journals (Sweden)

    Víctor Manuel Gómez Campos

    2009-07-01

    Full Text Available Un tema de creciente importancia social y económica es el referido a los criterios, indicadores e instrumentos de medición y evaluación de la calidad de la educación superior. ¿Se mide ésta por la calidad de los egresados?, ¿por la calidad de la relación pedagógica?, ¿por el grado de homogeneización de condiciones de funcionamiento de las instituciones, según los criterios de acreditación vigentes en Colombia?, ¿por la productividad de los docentes?, ¿por el lugar alcanzado en los ranking internacionales de las mejores universidades? Tales temas se analizan con base en un estudio realizado sobre los dos sistemas de aseguramiento de la calidad de la educación superior en Colombia: registro calificado y acreditación. Dicho estudio señala el alto grado de redundancia existente y la carencia de mediciones directas de la calidad de la educación. Los indicadores de calidad, en ambos sistemas, son “indirectos”, se fundamentan en indicadores que no miden la calidad del aprendizaje realizado por el estudiante. Son sistemas centrados en procesos e insumos y con un fuerte énfasis en la homogeneización y estandarización de estos, mediante el cumplimiento de determinadas condiciones y factores comunes a todos los programas e instituciones. Como alternativa a estos indicadores indirectos de calidad de la educación superior se presentan diversos criterios y estrategias de promoción y medición de los logros y competencias adquiridos por los estudiantes.

  5. Tranexamic acid in epistaxis: a systematic review.

    Science.gov (United States)

    Kamhieh, Y; Fox, H

    2016-12-01

    The role of tranexamic acid in the management of epistaxis remains unclear. There is uncertainty about its safety and about the contraindications for its use. We performed a systematic review of the use of systemic and topical tranexamic acid in epistaxis and a comparative review of its use in other specialties. This review assesses and summarises the existing evidence for the efficacy and safety of tranexamic acid in the management of epistaxis. Systematic review. MEDLINE and EMBASE were searched for 'epistaxis' and equivalent MESH terms, combined with the Boolean operator 'OR' and 'tranexamic acid'. The Cochrane library and society guidelines were reviewed for evidence regarding the use of tranexamic acid in other specialties. All five relevant RCTs were included in the review and were evaluated according to the recommendations of the Cochrane Handbook for Systematic Reviews. Three RCTS pertained to spontaneous epistaxis; of these, one trial found no benefit of oral tranexamic acid in acute epistaxis, one trial found no significant benefit of topical tranexamic acid, but the largest of the trials showed significant benefit of topical tranexamic acid in acute epistaxis management. Two RCTs examined oral tranexamic acid for prophylaxis of recurrent epistaxes in patients with hereditary haemorrhagic telangiectasia; both showed significant reduction in severity and frequency. Tranexamic acid, as a WHO 'essential medicine', is a powerful, readily available tool, the use of which in epistaxis has been limited by uncertainty over its efficacy and its safety profile. This systematic review summarises the existing evidence and extrapolates from the wealth of data for other specialties to address the clinical question - does TXA have a role in epistaxis management? © 2016 John Wiley & Sons Ltd.

  6. A possible cause of epistaxis: increased masked hypertension prevalence in patients with epistaxis.

    Science.gov (United States)

    Acar, Baran; Yavuz, Bunyamin; Yıldız, Erdem; Ozkan, Selcuk; Ayturk, Mehmet; Sen, Omer; Deveci, Onur Sinan

    Epistaxis and hypertension are frequent conditions in the adult population. Masked hypertension is defined as a clinical condition in which a patient's office blood pressure level is epistaxis. The prevalence of this condition in patients with epistaxis is not well defined. This study aimed to evaluate the prevalence of masked hypertension using the results of office blood pressure measurement compared with the results of ambulatory blood pressure monitoring. Sixty patients with epistaxis and 60 control subjects were enrolled in the study. All patients with epistaxis and controls without history of hypertension underwent physical examination, including office blood pressure measurement, ambulatory or home blood pressure, and measurement of anthropometric parameters. Mean age was similar between the epistaxis group and the controls - 21-68 years (mean 42.9) for the epistaxis group and 18-71 years (mean 42.2) for the control group. A total of 20 patients (33.3%) in the epistaxis group and 7 patients (11.7%) in the control group (p=0.004) had masked hypertension. Night-time systolic blood pressure was significantly higher in patients with epistaxis than in the control group (pepistaxis (p=0.517). This study demonstrates increased masked hypertension prevalence in patients with epistaxis. We suggest that all patients with epistaxis should undergo ambulatory or home blood pressure to detect masked hypertension, which could be a possible cause of epistaxis. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  7. Teodosio, paradigma de príncipe cristiano. Consideraciones de Amborosio, Rufino de Aquileya y Agustín sobre la imperial persona

    Directory of Open Access Journals (Sweden)

    Francisco Javier LOMAS SALMONTE

    2010-02-01

    Full Text Available RESUMEN: Tengo escrito en reciente estudio sobre el panegírico de Pacato a Teodosio que la cultura que rezuma su oración eulógica es la que imparten las universidades tan bien representadas por la de Burdeos en los días de Ausonio; una cultura pagana absolutamente des vitalizada en un ámbito palaciego, sin embargo cristiano de más en más. Una cultura que predica una serie de virtudes imperiales cabalmente acordes con realidades sociales de tiempos pasados o a punto de fenecer. Llegados al campo cristiano, los diversos escritores que trataron de la imperial persona de Teodosio tienden a marcar unas directrices, huelga decir que cristianas, a las cuales ha de acomodarse el comportamiento regio. Si nos es lícito afirmar que el corpus de panegíricos llegado hasta nuestros días tiene una indudable unidad que nos permite considerarlo, inter alia, como speculum principum, con idéntica razón, digo más, mayor razón nos asiste para considerar algunos escritos cristianos como «Espejos de príncipes cristianos». Piénsese, por ejemplo, en el capítulo 25 del libro V de La Ciudad de Dios que en su día encantó a Bossuet, él mismo preceptor de un príncipe cristiano. Mas con anterioridad a Agustín ya se manifestaron, a propósito de Teodosio, Ambrosio de Milán y Rufino de Aquileya, sin olvidar a Paulino de Ñola quien compuso un panegírico en su honor del que tenemos constancia gracias a Jerónimo, a Paulino en carta a Sulpicio Severo y a Genadio; poco más de lo que estas fuentes nos transmiten podemos decir de él. De unos y de otros resaltaremos el lado cristiano de su pensamiento pero sin olvidarnos del legado pagano que les vincula con la tradición romana y gracias al cual, en parte al menos, pueden escribir de Roma y, en este caso, del emperador Teodosio.

  8. Nuevas consideraciones fisiopatológicas sobre el síndrome de respuesta inflamatoria sistémica relacionada con la sepsis

    Directory of Open Access Journals (Sweden)

    Vivian R. Mena Miranda

    1996-04-01

    Full Text Available El shock séptico constituye una de las primeras causas de morbilidad y mortalidad en las unidades de cuidados intensivos y forma parte de los estadios evolutivos la respuesta inflamatoria sistémica (SRIS en relación con la infección, que fueron modificados por Jaffari para su aplicación en la edad pediátrica. Está relacionado con la exposición del organismo a agentes exógenos y/o mediadores endógenos, que producen una inadecuada perfusión hística con alteración en el consumo de oxígeno, en la permeabilidad vascular y la aparición de trastornos hemodinámicos que comprometen la vida del paciente. Se considera que el mediador central en el shock séptico es el factor de necrosis tumoral-a(FNT- a, aunque también responden de forma descontrolada otras citocinas, los polimorfonucleares, el sistema de contacto, el fibrinolítico, el de la coagulación, así como otras sustancias endógenas. El conocimiento de su fisiopatología hace posible el diagnóstico y tratamiento precoz, sobre todo en los grupos de riesgo, y la reducción de la mortalidad en las unidades de terapia intensiva por esta afección.The septic shock is one of the first causes of morbidity and mortality in intensive care units, and the systemic inflammatory response syndrome (SIRS is a part of the evolutive stages related to the infection, that were modified by Jaffari for its application in the pediatric age. Septic shock is related with the organism exposition to exogenous agents, and/or endogenous mediators that produce an inadequate histic perfusion with alteration in oxygen consumption, in vascular permeability, and the presentation of hemodynamic disorders that compromise the patient's life. It is considered that the main mediator in septic shock is the tumoral necrosis factor - (TBF- , although other cytosines also reply in an uncontrolled fashion, the polymorphonuclears, the contact system, the fibrinolytic, the coagulation one, as well as other endogenous

  9. Consideraciones sobre el diagnóstico por imágenes de las masas selares Reflection on imaging diagnosis of sellar masses

    Directory of Open Access Journals (Sweden)

    José Arturo Hernández Yero

    2005-12-01

    Full Text Available Con el propósito de hacer un llamado de atención sobre una temática de importancia y tomando en consideración que con los avances en la imagenología moderna se aportan elementos distintivos y de gran utilidad en el diagnóstico por imágenes de un grupo de masas en la región de la silla turca, se hacen determinadas valoraciones al respecto, con precisión de algunas de las características de las principales masas selares y su apariencia en la resonancia magnética nuclear. Se destacan detalles en cuanto a la intensidad de la señal en los adenomas pituitarios, craneofaringiomas, quistes de la bolsa de Rathke, hiperplasia hipofisaria y el denominado síndrome de la silla turca vacía, entre otras causas de cambios anatómicos en la región selar. Se concluye que la imagen por resonancia magnética nuclear sería el método idóneo para un mejor diagnóstico de las masas selares aunque, en ausencia de esta, la tomografía contrastada puede resultar de utilidad si se realiza con cortes menores de 2 mm. Se resalta la importancia de integrar un equipo multidisciplinario entre clínicos, endocrinólogos, imagenólogos, neurocirujanos y anatomopatólogos, para obtener diagnósticos más precisos y resultados terapéuticos adecuados.Some reflections were made on imaging diagnosis of sellar masses, specifying some characteristics of the main sellar masses and their appearance in magnetic resonance imaging. The purpose was to call the attention on this important issue on the basis that modern imaging advances offer very useful distinctive elements in the diagnosis of a group of masses located in the sella turcica region. The paper underlined details of signal intensity in pituitary adenomas, craniopharyngiomas, Rathke´s pouch cysts, hypophysial hyperplasia and the so-called empty sella syndrome, among other causes of anatomical changes in sellar region. It was concluded that magnetic resonance imaging would be the ideal method for a better

  10. Epistaxis in children: approach and management

    African Journals Online (AJOL)

    Chantel

    of epistaxis by the age of 5 years. In the age group 6 -. 10 years the incidence increases to. 56%. Although .... Digital (nose picking). Foreign body/ rhinolith .... Ointment. Advice. Refer to haematologist. Manage accordingly/. Refer to ENT surgeon.

  11. Epistaxis: The role of arterial embolization.

    Science.gov (United States)

    Reyre, A; Michel, J; Santini, L; Dessi, P; Vidal, V; Bartoli, J-M; Moulin, G; Varoquaux, A

    2015-01-01

    Epistaxis is defined as flow of blood from the nasal fossae and is a common and benign disorder in the great majority of cases which does not require medical care. It may however become a genuine medical or surgical emergency because of the amount, repeated episodes or patient's medical vulnerability (such as coronary artery disease patients). Epistaxis may be either primary or a symptom of an underlying disease. Four levels of problems need to be answered faced with epistaxis: recognizing it, and in particular not missing "epistaxis" due to swallowed blood or venous hemorrhage, which falls outside of the scope of interventional radiology; establishing the amount and its repercussions, particularly as a decompensating factor in another disease; investigating its cause and in particular never missing a tumor (male adolescents); obtaining hemostasis. Epistaxis varies not only in type and cause but must be considered in its clinical context. Arterial embolization is a treatment of choice for severe refractory epistaxis and some hemorrhages. When carried out by trained operators, it is an effective method with few risks of complications and is increasingly being used in reference centers (Brinjikji et al.). It remains, however, a method which is less widely used than surgery, particularly in the United States where in a series of 69,410 patients treated over the last 10 years for refractory epistaxis, 92.6% underwent surgical ligation, 6.4% embolization and 1% combined treatments (Brinjikji et al.). Epistaxis is occasionally catastrophic and requires extremely urgent management. In each case, close collaboration with the surgeon, the presence of an intensive care anesthetist and at least sedation are all factors which improve management and therefore the results of embolization. All patients and/or their friends/close family should have given "reliable, clear and appropriate" information. Copyright © 2015 Éditions françaises de radiologie. Published by Elsevier

  12. Emergency Department care of childhood epistaxis.

    Science.gov (United States)

    Béquignon, E; Teissier, N; Gauthier, A; Brugel, L; De Kermadec, H; Coste, A; Prulière-Escabasse, V

    2017-08-01

    The aim of this review is to determine an efficient and safe primary strategy care for paediatric epistaxis. We searched PubMed and Cochrane databases for studies referenced with key words 'epistaxis AND childhood'. This search yielded 32 research articles about primary care in childhood epistaxis (from 1989 to 2015). Bibliographic references found in these articles were also examined to identify pertinent literature. We compared our results to the specific management of adult epistaxis classically described in the literature. Epistaxis is one of the most common reasons for referral of children to a hospital ENT outpatient department. The bleeding usually originates from the anterior septum, as opposed to adults. Crusting, digital trauma, foreign bodies and nasal colonisation with Staphylococcus aureus have been suggested as specific nosebleed factors in children. Rare aetiologies as juvenile nasopharyngeal angiofibroma appear later during adolescence. There are different modes of management of mild epistaxis, which begin with clearing out blood clots and bidigital compression. An intranasal topical local anaesthetic and decongestant can be used over 6 years of age. In case of active bleeding , chemical cauterisation is preferred to anterior packing and electric cauterisation but is only feasible if the bleeding site is clearly visible. In case of non-active bleeding in children, and in those with recurrent idiopathic epistaxis, antiseptic cream is easy to apply and can avoid 'acrobatic' cauterisation liable to cause further nasal cavity trauma. Aetiologies and treatment vary with patient age and the existence or not of active bleeding at the time of the examination. Local treatments are usually easy to perform, but physicians have to ponder their indications depending on the possible complications in order to inform parents and to know paediatric epistaxis specificities. Published by the BMJ Publishing Group Limited. For permission to use (where not already

  13. Changing Trends in the Management of Epistaxis

    Science.gov (United States)

    Alam, Elie; Hadi, Usamah

    2015-01-01

    Epistaxis is a very common complaint seen by many types of physicians including otolaryngologists, family physicians, and others. Management of epistaxis is often challenging and requires many types of intervention. The following review describes the different types of past and current treatment modalities including cautery, nasal packing, maxillary artery ligation, anterior artery ligation, and sphenopalatine artery ligation. The paper also proposes an algorithm for managing such cases. PMID:26351457

  14. Traumatic Anterior Cerebral Artery Pseudoaneurysmal Epistaxis.

    Science.gov (United States)

    Liu, Qing Lin; Xue, Hao; Qi, Chang Jing; Zhao, Peng; Wang, Dong Hai; Li, Gang

    2017-04-01

    Pseudoaneurysmal epistaxis is a rare but emergent condition. We report a case of traumatic anterior cerebral artery pseudoaneurysmal epistaxis and review the published literature. A 49-year-old man sustained severe head trauma. He was diagnosed with multiple skull bone fractures, left subdural hematoma, subarachnoid hemorrhage, pneumocephalus, and right frontal hematoma. Subdural hematoma evacuation was done at a local hospital. In the following months, he experienced repeated epistaxis that required nasal packing to stop the bleeding. Digital subtraction angiography showed an anterior cerebral artery pseudoaneurysm protruding into the posterior ethmoid sinus. Embolization of the aneurysm was performed with microcoils, and the parent artery was occluded by thrombosis. The patient presented 1 month later with another epistaxis episode. Digital subtraction angiography showed recanalization of the parent artery and recurrence of the aneurysm. The parent artery was occluded for the second time with coils and Onyx embolic agent. Pseudoaneurysmal epistaxis is rare, and this is the first report of an anterior cerebral artery pseudoaneurysm that manifested with epistaxis. Endovascular intervention has become the first choice of treatment for this disease. The high recurrence rate is the main disadvantage of endovascular intervention. Aneurysm trapping with bypass surgery is another treatment option. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Epidemiological characteristics of pediatric epistaxis presenting to the emergency department.

    Science.gov (United States)

    Shay, Sophie; Shapiro, Nina L; Bhattacharyya, Neil

    2017-12-01

    Investigate the epidemiological characteristics of pediatric epistaxis in the emergency department setting. Cross-sectional study using national databases. Children (age epistaxis were extracted from the State Emergency Department Databases for New York, Florida, Iowa, and California for the calendar year 2010. Associated diagnoses, procedures, encounter characteristics, and demographic data were examined. There were 18,745 cases of pediatric epistaxis (mean age 7.54 years, 57.4% male). Overall, 6.9% of patients underwent procedures to control epistaxis, of which 93.5% had simple anterior epistaxis control. The distribution of pediatric epistaxis was highest in spring and summer months (p epistaxis presentations (38.8%, p epistaxis control procedure performed (p epistaxis control procedure (p epistaxis control procedure compared to those of minority backgrounds (p epistaxis are uninvolved cases that do not require procedural intervention. The overrepresentation of low socioeconomic status patients may suggest an overutilization of emergency services for minor cases of epistaxis, and perhaps a lack of access to primary care providers. This is the first study to evaluate racial and socioeconomic factors in relationship to pediatric epistaxis. Further investigation is needed to better elucidate these potential disparities. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Consideraciones sobre el hidrocefalo de baja presion

    Directory of Open Access Journals (Sweden)

    E. Herskovits

    1976-12-01

    Full Text Available Se analizan las condiciones fisiopatológicas del sindrome de hidrocéfalo de presión normal. De un grupo de 21 pacientes con sintomatologia clínica correspondiente a esta entidad, se seleccionan 10 que presentan un diagnóstico clínico, radiológico y cisternográfico indudable de la entidad en estudio. Se observó que, a pesar de esta selección solamente un 50% de ellos se vió beneficiado con la colocación de una válvula de baja presión. Surge entonces la hipotésis de que este cuadro es un sindrome multicausal; que por un proceso fisiopatogenico común produce un cuadro clínico, radiológico y cisternográfico similar y que serían beneficiados únicamente aquellos enfermos en los que se soluciona el problema mecánico.

  17. Consideraciones sobre aislamientos térmicos

    Directory of Open Access Journals (Sweden)

    García Arroyo, A.

    1966-06-01

    Full Text Available The yearly change in ambient temperature, and also the daily variations, become notably evident inside buildings. In extreme cases they cause considerable discomfort. This can be avoided by two means: insulation and heating or air conditioning. As each of these factors covers a wide range of possibilities, a detailed study of the physical factors, such as location, cost, climate, etc., makes it possible to find the most suitable materials, with the best overall thermal transmission factor (Ue, and the cheapest thickness (te of the insulating material.La variación anual de la temperatura externa, así como la diaria, se manifiesta de una manera notable en el interior de los edificios creando, en condiciones extremas, un inconfort evitable mediante la combinación apropiada de dos elementos: aislamientos y sistemas de calefacción o aire acondicionado. Dada la extensa gama de variación de cada uno de estos factores, haciendo un estudio detallado de sus propiedades físicas, situación, costes y clima de la región, encontramos el material más idóneo a emplear, coeficiente global de transmisión térmica (Ue del aislamiento y espesor (te más económico del material aislante.

  18. Algunas consideraciones sobre la calidad de vida

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    Miguel Lugones Botell

    2002-08-01

    Full Text Available Se expone qué recoge el concepto calidad de vida en el contexto médico, aunque está sujeto a diversas interpretaciones según el círculo social en que se mueva el que lo esgrime. Pertenece al ámbito de la subjetividad, pero tiene mucho que ver también con la objetividad que envuelve a la persona.This paper presents what is contained in the quality of life concept in the medical environment, although it is subject to a number of interpretations according to the social circle of the individual that puts forward such concept. It belongs to the field of subjectivity but it has a lot to do with the objectivity surrounding the individual.

  19. The selective external carotid arterial embolization treatment of uncontrollable epistaxis

    International Nuclear Information System (INIS)

    Yao Qunli; Liu Yizhi; Ni Caifang

    2004-01-01

    Objective: To evaluate the selective external carotid arterial embolization of uncontrollable epistaxis. Methods: 27 procedures of super-selective external carotid arterial embolization were performed with absorbable gelfoam by using Seldinger's method in 26 cases with uncontrollable epistaxis. Results: 27 procedures of super-selective intra-arterial embolization of uncontrollable epistaxis were all successful without any serious complication. Conclusions: Selective external carotid arterial embolization is safe, effective and successful in the treatment of severe epistaxis. (authors)

  20. Epistaxis management: current understanding amongst junior doctors.

    Science.gov (United States)

    Fox, R; Nash, R; Liu, Z-W; Singh, A

    2016-03-01

    Epistaxis is a common and potentially life-threatening emergency. This survey assesses understanding and confidence in epistaxis management amongst current junior doctors. A cross-sectional study was conducted of foundation year one and two doctors based at three National Health Service trusts within a single region of the UK, assessing basic understanding and procedural confidence. A total of 111 foundation doctors completed this survey. The average duration of undergraduate exposure to otolaryngology was 8.1 days. Forty-one per cent of respondents stated that they would apply pressure to the nasal bones to control epistaxis. Seventy-five per cent lacked confidence in their ability to manage epistaxis. Those with two weeks or more of undergraduate exposure to otolaryngology were more confident than those with one week or less of exposure (p epistaxis management, with patient safety implications. Confidence is associated with the duration of undergraduate exposure to otolaryngology. A minimum emergency safe competency should be a priority during foundation training if not achieved in UK medical schools.

  1. Study of hemostasis procedures for posterior epistaxis.

    Science.gov (United States)

    Iimura, Jiro; Hatano, Atsushi; Ando, Yuji; Arai, Chiaki; Arai, Satoshi; Shigeta, Yasushi; Kojima, Hiromi; Otori, Nobuyoshi; Wada, Kota

    2016-06-01

    Hemostasis is difficult in patients with bleeding emanating from the deep regions in the nasal cavity; however, there is no standard treatment method. We studied hemostasis procedures in patients who visited our outpatient department and presented with idiopathic epistaxis extending from the posterior nasal cavity to Kiesselbach's area. The subjects were patients with epistaxis who visited our hospital between June 2008 and May 2010. We asked specific questions at the time of the hospital visit and examined patients using a nasal speculum, a flexible endoscope, and a rigid endoscope (0 or 70 degree) to identify bleeding sites. Hemostasis using electrocoagulation was selected as the first-line therapy for patients in whom a bleeding point had been identified, whereas hemostasis using a gauze tampon was performed in patients in whom the bleeding point was unknown. The subjects were analyzed by multivariate logistic regression analysis. The bleeding point was unknown in most cases of recurrent posterior epistaxis. Electrocoagulation was the best hemostasis procedure. Identifying the bleeding points as much as possible and performing electrocoagulation at these sites was the preferred procedures. We propose the treatment procedure for refractory epistaxis. When it is difficult to identify a bleeding point in a patient with refractory epistaxis due to a deviated nasal septum, a bleeding point should be identified after septoplasty; for bleeding from the sphenopalatine artery region, electrocoagulation or endoscopic cauterization of the sphenopalatine artery should be performed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. La victoria de Décimo Junio Bruto sobre los galaicos y la retirada de Emilio Lépido de Pallantia: algunas consideraciones sobre su cronología

    OpenAIRE

    San Vicente González de Aspuru, José Ignacio

    2013-01-01

    El trabajo propone una revisión cronológica de una serle de hechos relacionados con la campaña de Lépido contra Pallantia: la victoria de Décimo Bruto sobre los galaicos; el sitio de Pallantia por Lépido y Bruto; la entrega de Mancino a los numantinos y el abandono del cerco, que Adolf Schulten fechó el 1 de abril del año 136 a. C.El articulo adelanta la cronología tradicional en un año y, siguiendo la teoría de Schulten de que los pallantinos se retiraron por un eclipse lunar, plantea que el...

  3. Consideraciones éticas sobre el uso de metotrexate en el embarazo tubario (ET Consideraciones éticas sobre o uso de metotrexate na gravidez tubária (GT Ethical considerations about the use of metotrexate in ectopic pregnancy (TP

    Directory of Open Access Journals (Sweden)

    María de la Luz Casas M.

    Full Text Available El embarazo tubario (ET es la implantación de un óvulo fertilizado en la trompa uterina. El hecho es que el ET seguirá presentándose muchas veces al médico en forma de un isodio clínico urgente de hemorragia intraabdominal. El médico puede dar entonces por segura la muerte del embrión e intervendrá para extirpar los restos embrionarios y la trompa perforada y sangrante. Conseguirá así revertir la grave amenaza inmediata a la vida de la madre. El tratamiento médico con metotrexate (MTX es un procedimiento seguro y efectivo en el tratamiento del embarazo ectópico, sin los riesgos potenciales de la cirugía. La acción del médico no será atentar directamente sobre el embrión, sino sobre la causa de la patología, que quizás provoque la muerte del embrión. La intervención medicamentosa en estos casos ha sido considerada por algunos como una forma de aborto indirecto y, por tanto, en apreciación de la invulnerabilidad de la vida humana, un acto antiético. Pero la argumentación ética sobre el objetivo de esta intervención puede ser postulada bajo el principio del doble efecto.A gravidez tubária (GT é a implantação de um óvulo fertilizado na trompa uterina. O fato é que a GT seguirá apresentando-se muitas vezes ao médico em forma de um episódio clínico urgente de hemorragia intra-abdominal. O médico pode dar então por seguro a morte do embrião e intervirá para extirpar os restos embrionários e a trompa perfurada e sangrante. Conseguirá assim reverter a grave ameaça imediata à vida da mãe. O tratamento médico com metotrexate (MTX é um procedimento seguro e efetivo no tratamento da gravidez ectópica, sem os riscos potenciais da cirurgia. A ação do médico não será nunca atentar diretamente contra o embrião, senão sobre a causa da patologia, que quiçá provoque a morte do embrião. A intervenção medicamentosa nestes casos tem sido considerada por alguns como uma forma de aborto indireto e, portanto

  4. An update on management of pediatric epistaxis.

    Science.gov (United States)

    Patel, Neel; Maddalozzo, John; Billings, Kathleen R

    2014-08-01

    To evaluate the work-up and treatment of pediatric epistaxis in an outpatient clinical setting, with a focus on the diagnostic utility and associated costs of nasal endoscopy and adjunctive laboratory data. Retrospective, case series. Children under 18 years of age seen in an outpatient clinical setting at a tertiary care hospital between 2004 and 2012 for the primary diagnosis of epistaxis were identified. Patient characteristics were analyzed from a statistical and cost perspective. A total of 175 patients with epistaxis were included. One hundred twenty-two (69.7%) were male, with a mean overall age of 9.1 years (range 5 months to 17.9 years). The duration of bleeding ranged from 0.25 to 84 months (mean 11.5 months). Nasal endoscopy was performed in 123 (70.2%) patients. Three (2.4%) had nasal polyps, and 1 (0.8%) a juvenile nasopharyngeal angiofibroma. The average age of patients with nasal masses was significantly older (16.2 years versus 10.4 years, p=0.008). Of 131 patients with available blood work, laboratory values demonstrated anemia in 27 (20.6%) patients, elevated partial thromboplastin time in 5 (3.8%), and an abnormal platelet function analysis in 1 (0.8%) patient. Those with anemia were statistically younger (p=0.001), than those with either normal labs or abnormal coagulation studies. Epistaxis resolved in 88/135 (65.2%) who had follow-up visits. The majority of pediatric epistaxis cases resolved with nasal mucosa hydration. Nasal endoscopy can be reserved for teenaged patients with epistaxis, and routine laboratory screening may be useful in select cases based on the clinical judgment. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Recurrent epistaxis following nasotracheal intubation--a case report.

    Science.gov (United States)

    Chen, Y H; Chen, J Y; Hsu, C S; Huang, C T; So, E

    1996-06-01

    Epistaxis is one of the common complications of nasotracheal intubation. Clinical patterns of all nasal bleeding are mild and may stop spontaneously in most patients. Serious nasal bleeding requiring hospitalization are rare. Nasal bleeding occurs more frequently in children than in adults. Among adults, men have a higher incidence than women. Although numerous publications have reported the cases of initial epistaxis caused by nasotracheal intubation, recurrent epistaxis was reported rarely. We experienced a case of recurrent epistaxis occurring in the 6th, 8th, 15th and 18th day after nasotracheal intubation. Herein, we describe the clinical events and discuss the causes of epistaxis.

  6. An epistaxis severity score for hereditary hemorrhagic telangiectasia.

    Science.gov (United States)

    Hoag, Jeffrey B; Terry, Peter; Mitchell, Sally; Reh, Douglas; Merlo, Christian A

    2010-04-01

    Hereditary hemorrhagic telangiectasia (HHT)-related epistaxis leads to alterations in social functioning and quality of life. Although more than 95% experience epistaxis, there is considerable variability of severity. Because no standardized method exists to measure epistaxis severity, the purpose of this study was to determine factors associated with patient-reported severity to develop a severity score. Prospective, survey-based study. HHT care providers and a focus group of patients were interviewed to determine epistaxis-associated factors. From this, an electronic survey was developed and administered to patients with HHT. Descriptive analyses were performed with calculations of means and medians for continuous and proportions for categorical variables. Multiple ordinal logistic and linear regression models were developed to determine risk factors for epistaxis severity. Nine hundred respondents from 21 countries were included. Eight hundred fifty-five (95%) subjects reported epistaxis. The mean (standard deviation) age was 52.1 (13.9) years, and 61.4% were female. Independently associated risk factors for self-reported epistaxis severity included epistaxis frequency (odds ratio [OR] 1.57), duration (OR 2.17), intensity (OR 2.45), need for transfusion (OR 2.74), anemia (OR 1.44), and aggressiveness of treatment required (OR 1.53, P epistaxis severity in patients with HHT include frequency, duration, and intensity of episodes; invasiveness of prior therapy required to stop epistaxis; anemia; and the need for blood transfusion. From these factors, an epistaxis severity score will be presented.

  7. Consideraciones sobre los posibles mecanismos de corrosión de las estructuras de hormigón armado y sobre los factores que controlan su cinética

    Directory of Open Access Journals (Sweden)

    González, J. A.

    2004-04-01

    armaduras, d que el recubrimiento de hormigón tiene "siempre" un efecto protector sobre las armaduras, e que no importa el grado de corrosión inicial de las armaduras, porque la gran alcalinidad del hormigón garantiza su pasivación. En el trabajo presente se aportan resultados que demuestran que la respuesta de las EHA a las cuestiones anteriores es variada, a veces contradictoria, dependiendo del conjunto de condiciones experimentales.

  8. Radiological Diagnosis and Management of Epistaxis

    Energy Technology Data Exchange (ETDEWEB)

    Krajina, Antonín, E-mail: antonin.krajina@fnhk.cz [University Hospital Hradec Kralove and Medical Faculty of Charles University, Department of Radiology (Czech Republic); Chrobok, Viktor, E-mail: viktor.chrobok@fnhk.cz [University Hospital Hradec Kralove and Medical Faculty of Charles University, Department of Otorhinolaryngology and Head and Neck Surgery (Czech Republic)

    2013-11-15

    The majority of episodes of spontaneous posterior epistaxis treated with embolisation are idiopathic in nature. The angiographic findings are typically normal. Specific angiographic signs are rare and may include the following: a tumour blush, telangiectasia, aneurysm, and/or extravasation. Selective internal carotid artery (ICA) angiography may show rare causes of epistaxis, such as traumatic or mycotic aneurysms, which require different treatment approaches. Complete bilateral selective external and internal carotid angiograms are essential to evaluation. The images should be analysed for detection of central retinal blush in the external carotid artery (ECA) and anastomoses between the branches of the ECA and ICA. Monocular blindness and stroke are two of the most severe complications. Embolisation aims to decrease flow to the bleeding nasal mucosa while avoiding necrosis of the nasal skin and palate mucosa. Embolisation is routinely performed with a microcatheter positioned in the internal maxillary artery distal to the origin of the meningeal arteries. A guiding catheter should be placed in the proximal portion of the ECA to avoid vasospasm. Embolisation with microparticles is halted when the peripheral branches of the sphenopalatine artery are occluded. The use of coils is not recommended because recurrent epistaxis may occur due to proximal embolization; moreover, the option of repeat distal embolisation is lost. The success rate of embolisation therapy (accounting for late recurrence of bleeding) varies between 71 and 94 %. Results from endoscopic surgery are quite comparable. When epistaxis is refractory to nasal packing or endoscopic surgery, embolisation is the treatment of choice in some centres.

  9. Complications of balloon packing in epistaxis

    NARCIS (Netherlands)

    Vermeeren, Lenka; Derks, Wynia; Fokkens, Wytske; Menger, Dirk Jan

    2015-01-01

    Although balloon packing appears to be efficient to control epistaxis, severe local complications can occur. We describe four patients with local lesions after balloon packing. Prolonged balloon packing can cause damage to nasal mucosa, septum and alar skin (nasal mucosa, the cartilaginous skeleton

  10. Transcatheter Embolization in the Management of Epistaxis

    Science.gov (United States)

    Dubel, Gregory J.; Ahn, Sun Ho; Soares, Gregory M.

    2013-01-01

    A majority of the population will experience epistaxis at some time in their life. Most cases will be from an anterior source and can be treated with pressure, anterior nasal packing, or cautery. Intractable epistaxis is generally posterior in origin and may require endoscopic cautery, posterior packing, surgical ligation, or embolization. Embolization has been used to treat epistaxis for more than 30 years and success can be achieved in approximately 90% of patients, with major complications occurring in approximately 2%. These excellent results require thorough knowledge of the regional anatomy, familiarity with the equipment and various agents used to achieve this type of embolization, as well as attention to detail and meticulous technique. There remains debate on several aspects of embolization, including the agent of choice, preferred size of the embolic, and the number of vessels to embolize. Advances in endoscopic surgery have evolved to the point that similar success rates for embolization and modern surgical techniques in treating epistaxis may be expected. This detailed review of pertinent vascular anatomy, embolization technique, and surgical alternatives should allow practitioners to formulate treatment algorithms that result in optimal outcomes at their institutions. PMID:24436547

  11. Radiological Diagnosis and Management of Epistaxis

    International Nuclear Information System (INIS)

    Krajina, Antonín; Chrobok, Viktor

    2014-01-01

    The majority of episodes of spontaneous posterior epistaxis treated with embolisation are idiopathic in nature. The angiographic findings are typically normal. Specific angiographic signs are rare and may include the following: a tumour blush, telangiectasia, aneurysm, and/or extravasation. Selective internal carotid artery (ICA) angiography may show rare causes of epistaxis, such as traumatic or mycotic aneurysms, which require different treatment approaches. Complete bilateral selective external and internal carotid angiograms are essential to evaluation. The images should be analysed for detection of central retinal blush in the external carotid artery (ECA) and anastomoses between the branches of the ECA and ICA. Monocular blindness and stroke are two of the most severe complications. Embolisation aims to decrease flow to the bleeding nasal mucosa while avoiding necrosis of the nasal skin and palate mucosa. Embolisation is routinely performed with a microcatheter positioned in the internal maxillary artery distal to the origin of the meningeal arteries. A guiding catheter should be placed in the proximal portion of the ECA to avoid vasospasm. Embolisation with microparticles is halted when the peripheral branches of the sphenopalatine artery are occluded. The use of coils is not recommended because recurrent epistaxis may occur due to proximal embolization; moreover, the option of repeat distal embolisation is lost. The success rate of embolisation therapy (accounting for late recurrence of bleeding) varies between 71 and 94 %. Results from endoscopic surgery are quite comparable. When epistaxis is refractory to nasal packing or endoscopic surgery, embolisation is the treatment of choice in some centres

  12. 8. Prevalence of Epistaxis among Patients Receiving ...

    African Journals Online (AJOL)

    user

    The aim of this study was thus to determine the prevalence, aetiology and treatment modalities of epistaxis among patients receiving otorhinolaryngology services at MNH and MOI. Materials and Methods: A cross-sectional, hospital based study was done to 427 patients at Muhimbili. National Hospital (MNH) and Muhimbili.

  13. Epistaxis: an experience with over 100 cases

    International Nuclear Information System (INIS)

    Arshad, M.; Ahmed, Z.; Ali, L.

    2007-01-01

    To review and analyze the incidence, causes, management and results of treatment in patients who were treated for nasal bleeding. This retrospective descriptive study was conducted on patients of epistaxis, admitted to Combined Military Hospital Multan during a two years period from January 2005 to December 2006. Incidence, sex, age, cause of bleeding, associated clinical features, treatment and results were noted. During the study period, 1366 patients were admitted to hospital with various ENT diseases. Out of these, 109 (7.98%) had epistaxis as one of presenting complaints. Incidence was more in winter and spring months. Out of 109 patients, 76 were males (69.72 %) and 33 females (30.28%). The mean age was 35.06+19 years (range =3-83 years). Mean hospital stay was 4.98+4 days (1-27 days). The most common causes of epistaxis were idiopathic (31.19%), trauma (15.6%), infections (14.68%), hypertension (12.84%), bleeding disorders and blood dyscasias (11.01%). Sixty-six patients (60.55%) had anterior and 25 (22.93%) had posterior bleeding, while in remaining bleeding site could not be determined. Eighty-nine (81.66%) patients responded to conservative treatment and in 20 (18.35%) patients some surgical procedures had to be performed. The common causes of epistaxis were idiopathic, trauma, infections, hypertension and bleeding disorders. Most of the cases responded to conservative measures but in some cases surgical treatment had to be done. Further research is required to know about the underlying causes and optimal management of epistaxis. (author)

  14. Artritis reumatoide: consideraciones psicobiológicas

    Directory of Open Access Journals (Sweden)

    Japcy Margarita Quiceno

    2011-01-01

    Full Text Available En la literatura es bien conocido el peso de las emociones negativas en la fisiopatología de la artritis reumatoide, pero hay poca información empírica del impacto de variables psicosociales positivas sobre esta enfermedad. Por tanto, el propósito de este trabajo es hacer énfasis en los factores psicobiológicos relacionados con la artritis reumatoide. Se describen las consideraciones epidemiológicas, los síntomas físicos constitutivos, los factores psicosociales más relevantes, como el papel que juegan las emociones positivas y negativas, el apoyo social, la resiliencia, la autotrascendencia y la percepción de enfermedad en la evolución y pronóstico de esta patología reumática. Conclusión: variables psicosociales positivas pueden promover la salud mental y física y aminorar el afecto negativo en pacientes con artritis reumatoide.

  15. ADHD presenting as recurrent epistaxis: a case report

    Directory of Open Access Journals (Sweden)

    Wani Zaid A

    2011-04-01

    Full Text Available Abstract Epistaxis is an important otorhinolaryngological emergency, which usually has an apparent etiology, frequently local trauma in children. Here we present a case report wherein the epistaxis was recalcitrant, and proved to have a psychiatric disorder as an underlying basis. The child was diagnosed with Attention Deficit/Hyperactivity Disorder, hyperactive type, which led to trauma to nasal mucosa due to frequent and uncontrolled nose picking. Treatment with atomoxetine controlled the patient's symptoms and led to a remission of epistaxis.

  16. Recurrent Massive Epistaxis from an Anomalous Posterior Ethmoid Artery

    OpenAIRE

    Greco, Marco Giuseppe; Mattioli, Francesco; Alberici, Maria Paola; Presutti, Livio

    2016-01-01

    A 50-year-old man, with no previous history of epistaxis, was hospitalized at our facility for left recurrent posterior epistaxis. The patient underwent surgical treatment three times and only the operator’s experience and radiological support (cranial angiography) allowed us to control the epistaxis and stop the bleeding. The difficult bleeding management and control was attributed to an abnormal course of the left posterior ethmoidal artery. When bleeding seems to come from the roof of the ...

  17. Treatment of Hereditary Hemorrhagic Telangiectasia-Related Epistaxis.

    Science.gov (United States)

    Sautter, Nathan B; Smith, Timothy L

    2016-06-01

    Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease with an incidence of 1:5000. Recurrent, spontaneous epistaxis is the most common presenting symptom. Severity of epistaxis varies widely, from mild, self-limited nosebleeds to severe, life-threatening nasal hemorrhage. Treatment of HHT-related epistaxis presents a challenge to the otolaryngologist due to the recurrent, persistent nature of epistaxis often requiring multiple treatments. Treatment modalities range from conservative topical therapies to more aggressive surgical treatments. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Idiopathic epistaxis and meteorological factors: case-control study.

    Science.gov (United States)

    Jelavic, B; Majstorovic, Z; Kordić, M; Leventić, M; Grgić, M V; Baudoin, T

    2015-01-01

    The aim of this study was to determine the relationship between the occurrence of idiopathic epistaxis and daily values of air pressure, temperature, and humidity. We also investigated whether biometeorological forecasts should be addressed to persons with a history of nosebleed diathesis. We analyzed consecutive idiopathic epistaxis events over a 3-year period. Patients were included if they had been in the municipality of Mostar, Bosnia and Herzegovina at least 24 hours before the epistaxis occurrence. The monthly variation in epistaxis events was determined. Epistaxis days (Days "0", 0 = day with epistaxis occurrence) and selected nonepistaxis days (Days "-1", -1 = each first single day without epistaxis prior to Day 0) were compared according to daily values of mean, minimum, and maximum temperature; diurnal temperature range; minimum and maximum atmospheric pressure; diurnal pressure range; and mean relative humidity. The greatest and smallest percentage of epistaxis events occurred in the months of March and August, respectively. There were no significant differences between Days 0 and Days -1 with respect to the examined meteorological factors. In this region with a Mediterranean climate, we found a seasonal variation with an incidence peak during the spring transition months, but we did not identify any meteorological trigger factors for epistaxis. Thus, there is no need for biometeorological forecasts to be addressed to persons with a history of nosebleed diathesis.

  19. Considerações sobre violência doméstica, gênero e o trabalho das equipes de saúde da família Consideraciones sobre la violencia doméstica, género y el trabajo de los equipos de salud de la familia Considerations on domestic violence, gender and the activities of family health teams

    Directory of Open Access Journals (Sweden)

    Clara de Jesus Marques Andrade

    2008-09-01

    Full Text Available Este trabalho apresenta considerações sobre a violência doméstica contra as mulheres. Partindo do pressuposto que o fenômeno é baseado nas relações sociais de gênero, enfatiza a categoria analítica gênero como apropriada para uma abordagem aprofundada e consistente da questão. Considerando a promoção da saúde e a integralidade como eixos norteadores das ações, pretende fazer uma reflexão sobre a possibilidade do enfrentamento da violência doméstica a partir do trabalho das equipes do Programa de Saúde da Família. Aponta elementos que dificultam a abordagem da violência doméstica contra as mulheres, evidenciando a necessidade de reorganizar as práticas assistenciais, de capacitação dos profissionais de saúde e da realização de parcerias com instituições públicas e privadas, grupos de mulheres e famílias.Este trabajo presenta consideraciones acerca de la violencia doméstica contra las mujeres. Partiendo del presupuesto que el fenómeno se basa en las relaciones de género, enfatiza la categoría analítica de género como apropiada para un abordaje profundo y consistente de este tema. Considerando la promoción de la salud y la integralidad como ejes guías de las accionnes, pretende hacer una reflexión respecto a la posibilidad del enfrentamiento de la violencia doméstica a partir del trabajo de los equipos del Programa de Salud de la Familia. Señala elementos que dificultan el estudio de la violencia doméstica contra las mujeres, evidenciando la necesidad de reoganización de las prácticas asistenciales, de capacitación de los profesionales de salud y de la realización de un trabajo conjunto de instituiciones públicas y privadas, grupos de mujeres y familias.This work presents considerations on domestic violence against women. Based on the assumption that this kind of violence is based on gender-based social relations, it emphasizes the analytical category of gender as appropriate for a consistent

  20. Treatment of heavy epistaxis by intraarterial embolisation

    Energy Technology Data Exchange (ETDEWEB)

    Bohutova, J.; Kolar, J.; Olejnicek, A.

    1981-02-01

    Therapeutic intraarterial embolisation is a modern and effective approach in the therapy of otherwise untreatable heavy epistaxis. The most important indications for it were in the clinical survey reported here, bleedings after trauma and in arterial hypertension and/or generalised atherosclerosis. Several examples are documented. Therapeutic embolisation in this area necessitates a precise technique because in even small faults serious, mainly neurological complications may arise. For these reasons, this intervention is suitable for specialised laboratories only.

  1. Treatment of heavy epistaxis by intraarterial embolisation

    International Nuclear Information System (INIS)

    Bohutova, J.; Kolar, J.; Olejnicek, A.

    1981-01-01

    Therapeutic intraarterial embolisation is a modern and effective approach in the therapy of otherwise untreatable heavy epistaxis. The most important indications for it were in the clinical survey reported here, bleedings after trauma and in arterial hypertension and/or generalised atherosclerosis. Several examples are documented. Therapeutic embolisation in this area necessitates a precise technique because in even small faults serious, mainly neurological complications may arise. For these reasons, this intervention is suitable for specialised laboratories only. (orig.) [de

  2. Epistaxis in Sagamu | Sogebi | Nigerian Journal of Clinical Practice

    African Journals Online (AJOL)

    The aimof this studywas to analyze the causes,management and outcome of epistaxis in Sagamu This is an analysis of the patients who had epistaxis and were managed in the Ear, Nose and Throat department of Olabisi Onabanjo University Teaching Hospital in Sagamu, Ogun state between July 2003 and June 2007.

  3. Relationship Between Epistaxis And Hypertension: A Study Of ...

    African Journals Online (AJOL)

    Both epistaxis and hypertension are common in the general population. This study aimed at determining the prevalence of hypertension among epistaxics, and the relationship between epistaxis and hypertension. Retrospective analysis of 62 adults comprising 31 each of males and females with a mean age of 41.4 ± 16.6 ...

  4. A Retrospective Analysis of Aetiology and Management of Epistaxis ...

    African Journals Online (AJOL)

    BACKGROUND: Epistaxis is a common otolaryngological emergency and is often due to lesions within or around the nose and systemic conditions. Controlling epistaxis presents a challenge in the underdeveloped, resource-poor centres where there are limited facilities. OBJECTIVE: To describe the aetiopatogenesis of ...

  5. Evaluation of vitamin D levels in children with primary epistaxis.

    Science.gov (United States)

    Almis, Habip; Bucak, Ibrahim Hakan; Caliskan, Muhammed Nebi; Turgut, Mehmet

    2016-10-01

    This study aimed to investigate whether there is a relationship between 25-hydroxy vitamin D [25(OH)D 3] values and incidences of primary epistaxis among children. A total of 42 cases and 55 matched controls were included in our study. The study group and control group were well matched for age and gender. Age, gender, activated partial thromboplastin time (APTT) with reference to the international normalized ratio (INR), prothrombin time (PT), and 25(OH)D 3, parathormone (PTH), alkaline phosphatase (ALP), calcium (Ca), magnesium (Mg), and phosphorus (P) values were recorded for each participant. Serum 25(OH) D values were found to be statistically significantly (P = 0.03) lower in children with primary epistaxis than in the healthy control group. Our study also revealed that 25(OH) D values were considerably (P epistaxis and upper respiratory tract infections (RTI) than in the group with primary epistaxis without upper RTI. Univariate logistic regression analyses demonstrated that 25(OH)D 3 epistaxis. Furthermore, multivariate logistic regression analyses revealed that 25(OH)D 3 epistaxis. Many studies have revealed that vitamin D is a preventive and therapeutic agent for inflammation and infection, thereby providing benefits for children with primary epistaxis. In line with this, our study suggested that a patient's vitamin D status could also be important for the prevention of childhood primary epistaxis, although further studies are required to validate our findings. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Epistaxis management: evaluation of old tricks and new treatment options

    NARCIS (Netherlands)

    Fokkens, W. J.

    2011-01-01

    Although epistaxis is a very common and usually mild problem that is experienced by the majority of the population somewhere in life, it can be a very serious and life threatening event. Fighting with a patient with epistaxis usually in the middle of the night with not enough help around is an

  7. Epistaxis in Kaduna, Nigeria: a review of 101 cases | Kodiya ...

    African Journals Online (AJOL)

    Background: Epistaxis is defined as a hemorrhage from the nostril, nasal cavity, or nasopharynx. Sufferers and clinicians may develop significant anxiety despite the fact that majority of patients are treated successfully by the first attending physician. Objective: To review aetiology and management outcomes of epistaxis in a ...

  8. Epidemiologie et etiologies des epistaxis dans notre pratique: A ...

    African Journals Online (AJOL)

    Introduction: A frequent ailment in ENT, the epistaxis is an emergency that can put the vital prognosis at stake. An adequate follow up care deserves some knowledge of etiology. Objectives: Study the epidemiological and etiological aspects of the epistaxis. Methodology: A retrospective and descriptive study conducted on ...

  9. Nasal bacterial colonization in cases of idiopathic epistaxis in children.

    Science.gov (United States)

    Kamble, Payal; Saxena, Sonal; Kumar, Sunil

    2015-11-01

    To evaluate the role of nasal bacterial colonization in cases of idiopathic epistaxis in children. A descriptive, hospital based, observational study in our hospital was conducted on total 112 pediatric patients in the age group 4-16 years. Group A (control): 56 patients with no epistaxis; Group B (epistaxis): 56 patients with idiopathic epistaxis. A swab for microbiological evaluation was taken from the anterior nasal cavity of each child. A highly significant association between nasal colonization with pathological Staphylococcus aureus and idiopathic epistaxis was found. The presence of pathological S. aureus colonization in the anterior nasal cavity was also associated with statistically significant number of crusting and presence of dilated blood vessels on the anterior nasal septum of children in epistaxis group. Nasal bacterial colonization with S. aureus leads to a sequence of pathological events i.e. low grade inflammation, crusting and new vessel formation. This leads to irritation in nasal cavity resulting in digital trauma and subsequently epistaxis and thus it plays an important role in causing idiopathic epistaxis in children. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Torrential epistaxis in the third trimester: a management conundrum

    Science.gov (United States)

    Crunkhorn, Rosa Elizabeth Mary; Mitchell-Innes, Alistair; Muzaffar, Jameel

    2014-01-01

    Although epistaxis is common during pregnancy, large volume epistaxis is rare. Many standard epistaxis management options are limited in pregnancy due to absolute or relative contraindications. Ear, nose and throat surgeons need to be aware of what options can be used safely and effectively. We present a case of a 32-year-old woman, 32 weeks pregnant, who was admitted with heavy epistaxis refractive to conservative management. Several potential interventions including bismuth iodoform paraffin paste (BIPP) and Floseal were contraindicated or involved additional risk in pregnancy necessitating unorthodox management. This challenging case highlights suitable alternatives for managing large volume epistaxis during pregnancy, as well as discussing the differential diagnosis and relevant investigations. PMID:25301417

  11. Unilateral Anterior Epistaxis Electrocautery versus Chemical Cautery

    International Nuclear Information System (INIS)

    Umar, A. S.; Rahat, Z. M.; Hussain, S. S.; Khan, M. Z.; Fareed, G.

    2013-01-01

    Objective: To evaluate and compare the two methods, electrocautery versus chemical cautery, for controlling unilateral anterior epistaxis and to identify the complications. Design: Randomized control trial. Place and Duration: This study was conducted in ENT Department PNS Shifa Hospital Karachi from August 2009 to June 2011. Patients and Methods: Ninety two cases with unilateral anterior epistaxis were divided using random number trials into two groups i.e. group A and group B containing 46 cases each. In group A electrocautery and in group B chemical cautery with 50% silver nitrate was done and the results were compared. Results: In this study 92 cases were divided randomly into two groups i.e. group A and group B containing 46 cases in each group. In group A 44 (95.6%) out of 46 cases were treated successfully with a single visit as an outpatient by electrocautery, the patients were called for follow up on the fifth day and then fortnightly for three months after the procedure, only 2 (4.3%) cases reported in first five days with mild recurrence of bleeding. In group B 42 (91.3%) cases out of 46 cases were treated successfully in a single visit and recurrence of bleeding occured in 4 (8.7%) cases who required a second visit during the first five days. There were no major complications found in either group except few complaints of post cauterization pain and mucosal inflammation observed slightly more in group B patients. Conclusion: Electrocautery and chemical cautery with 50% silver nitrate both are equally effective procedures to control anterior epistaxis if the bleeding point is visible and small. Both procedures are reliable and there are no major complications. Occasionally if the bleeding point in the anterior nasal septum is large then electrocautery may be a preferred option. (author)

  12. Epistaxis 2016: national audit of management.

    Science.gov (United States)

    2017-12-01

    Epistaxis is a common condition that can be associated with significant morbidity, and it places a considerable burden on our healthcare system. This national audit of management sought to assess current practice against newly created consensus recommendations and to expand our current evidence base. The management of epistaxis patients who met the inclusion criteria, at 113 registered sites across the UK, was compared with audit standards during a 30-day window. Data were further utilised for explorative analysis. Data for 1826 cases were uploaded to the database, representing 94 per cent of all cases that met the inclusion criteria at participating sites. Sixty-two per cent of patients were successfully treated by ENT clinicians within 24 hours. The 30-day recurrent presentation rate across the dataset was 13.9 per cent. Significant event analysis revealed an all-cause 30-day mortality rate of 3.4 per cent. Audit findings demonstrate a varying alignment with consensus guidance, with explorative analysis countering some previously well-established tenets of management.

  13. Evaluation of a novel high-fidelity epistaxis task trainer.

    Science.gov (United States)

    Scott, Grace M; Roth, Kathryn; Rotenberg, Brian; Sommer, Doron D; Sowerby, Leigh; Fung, Kevin

    2016-07-01

    To assess the efficacy of a novel high-fidelity epistaxis simulator in teaching epistaxis management to junior otolaryngology head and neck surgery residents. Prospective cohort study. A novel high-fidelity epistaxis task trainer was developed using a cadaver head, intravenous tubing, and a food coloring-filled saline bag to emulate blood. Learners were instructed on two techniques of nasal packing (formal nasal pack and nasal tampon) for the management of epistaxis using the task trainer. Learners were videotaped attempting to pack the nose of the task trainer pre- and postintervention (verbal instruction, and practice time with task trainer). Five board-certified otolaryngologists (blinded to pre- and postintervention status) evaluated the packing technique using standardized subjective outcome measures. There were 13 junior otolaryngology residents enrolled in the study. This cohort showed a statistically significant increase in global rating scores (P epistaxis simulator has been successful in teaching and the practical application of various skills in epistaxis management. This task trainer appears to confer an educational benefit in technical skills acquisition in novice learners. Further studies are needed to determine long-term skill retention. Simulation is a promising educational adjunct that effectively enhances epistaxis management skills acquisition while maximizing patient safety. NA. Laryngoscope, 126:1501-1503, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Considerations over the effects caused by a heat recovery system for exhaust gases, adapted to gas turbines originally designed for the operation in a simple cycle; Consideraciones sobre los efectos causados por un sistema de recuperacion de calor de gases de escape, adaptado a turbinas de gas disenadas originalmente para operar bajo un ciclo simple

    Energy Technology Data Exchange (ETDEWEB)

    Cuesta Escobar, Cesar A [Instituto Mexicano del Petroleo, Mexico, D. F. (Mexico)

    1994-12-31

    This article sets out the considerations on what a heat recovery system from exhaust gases, to already installed and in operation gas turbines, and that were not originally designed to operate with this system, can cause. The potential effects are set forth on the control systems, on the combustion chambers, and in the gas turbine blades, utilized for natural gas pumping or power generation in land installations or in offshore platforms in trying to adapt to them a regenerative cycle or a heating system. Observed effects, fundamentally in the flame stability loop, flow velocity, thermal intensity coefficient, air/fuel relationships and mass flow. Also are presented the consequences that primary production system would suffer, mainly due to the natural gas pumping reduction, the space availability, the fuel consumption, and the maximum amount of heat susceptible to be recovered, comparing the requirements of this in the system. [Espanol] En este articulo se plantean las consideraciones sobre lo que puede provocar un sistema de recuperacion de calor de gases de escape adaptado a turbinas de gas ya instaladas, operando y que no fueron disenadas originalmente para operar con este sistema. Se plantean los probables efectos en los sistemas de control, en las camaras de combustion y en los empaletados de las turbinas de gas usadas para bombeo de gas natural o generacion electrica en instalaciones de tierra o plataformas marinas, al tratar de adaptarseles un ciclo regenerativo o un sistema para calentamiento. Efectos observados, fundamentalmente, en el LOOP de estabilidad de flama, velocidad del flujo, coeficiente de intensidad termica, relaciones aire-combustible y flujo masico. Tambien se presentan las consecuencias que sufriria el sistema primario de produccion debido, principalmente, a la reduccion del bombeo de gas natural, a la disponibilidad de espacio, al consumo de combustible y a la cantidad maxima de calor susceptible de recuperarse, comparada con los

  15. Application of transcatheter arterial embolization in the intractable epistaxis

    International Nuclear Information System (INIS)

    Huang Zhaodong; Li Mingjun; Zhang Chuanwen

    2005-01-01

    Objective: To evaluate the value of transcatheter arterial embolization (TAE) in the treatment of intractable epistaxis. Methods: TAE using gel form or polyvinyl alcohol (PVA) particles of forty-one patients with intractable epistaxis were undertaken by the femoral artery approach, through selective catheterization of involved maxillary artery or the bleeding arteries for the stoppage of bleeding. Results: Of the forty-one patient, 39 cases were cured by once TAE and the other 2 with recurrent bleeding on the next day after the TAE, to whom a second interventional treatment full filled the requirement. Conclusions: Transcatheter arterial embolization is a simple, safe and effective treatment for the intractable epistaxis. (authors)

  16. Recurrent Massive Epistaxis from an Anomalous Posterior Ethmoid Artery.

    Science.gov (United States)

    Greco, Marco Giuseppe; Mattioli, Francesco; Alberici, Maria Paola; Presutti, Livio

    2016-01-01

    A 50-year-old man, with no previous history of epistaxis, was hospitalized at our facility for left recurrent posterior epistaxis. The patient underwent surgical treatment three times and only the operator's experience and radiological support (cranial angiography) allowed us to control the epistaxis and stop the bleeding. The difficult bleeding management and control was attributed to an abnormal course of the left posterior ethmoidal artery. When bleeding seems to come from the roof of the nasal cavity, it is important to identify the ethmoid arteries always bearing in mind the possible existence of anomalous courses.

  17. Recurrent Massive Epistaxis from an Anomalous Posterior Ethmoid Artery

    Directory of Open Access Journals (Sweden)

    Marco Giuseppe Greco

    2016-01-01

    Full Text Available A 50-year-old man, with no previous history of epistaxis, was hospitalized at our facility for left recurrent posterior epistaxis. The patient underwent surgical treatment three times and only the operator’s experience and radiological support (cranial angiography allowed us to control the epistaxis and stop the bleeding. The difficult bleeding management and control was attributed to an abnormal course of the left posterior ethmoidal artery. When bleeding seems to come from the roof of the nasal cavity, it is important to identify the ethmoid arteries always bearing in mind the possible existence of anomalous courses.

  18. CONSIDERACIONES DIDÁCTICAS SOBRE EL USO DE LA MULTIMEDIA PARA LA ASIGNATURA ANATOMÍA Y FISIOLOGÍA HUMANA DEL INSTITUTO SUPERIOR DE CIENCIAS DE LA EDUCACIÓN DE HUAMBO

    Directory of Open Access Journals (Sweden)

    Cristiano Lucas Jamba Jamba

    2017-01-01

    Full Text Available 800x600 A partir de entrevistas y encuestas realizadas en 2010 a estudiantes y profesores de la carrera de Biología del Instituto Superior de Ciencias de Educación (ISCED de Huambo, se concluyó en que el uso de las TIC era prácticamente nulo. Se procedió a realizar una multimedia de Anatomía y Fisiología Humana teniendo en cuenta una metodología sustentada desde los puntos de vista didácticos y psicopedagógico. La misma fue construida usando fundamentalmente Microsoft Power Point y pretende ser útil para estudiantes y profesores, estimular el uso de las TIC y mostrar que es posible incrementar el uso de las computadoras como medio de enseñanza-aprendizaje sin grandes conocimientos informáticos. Por estas razones fue puesta al servicio de alumnos y profesores y evaluada satisfactoriamente por éstos. En el desarrollo de este trabajo se realiza la búsqueda de los fundamentos teóricos necesarios para concebir una multimedia didáctica y para su posterior elaboración con el objetivo de aportar en el proceso de enseñanza-aprendizaje de Anatomía y Fisiología Humanas en la carrera de Biología del ISCED-Huambo. El medio consiste en un material multimedia con contenidos de los sistemas anatómicos humanos, que incluyen además de los aspectos estructurales, aspectos funcionales, con ilustraciones, animaciones, cuadros resúmenes, con el uso de algunos modelos y simulaciones y que permite interacción entre estudiante y computadora durante el estudio independiente.PALABRAS CLAVE: Consideraciones didácticas; uso de multimídia; Anatomia; Fisiología Humana.DIDACTICS CONSIDERATIONS ABOUT USING MULTIMEDIA TO ANATOMY AND HUMAN FISIOLOGY SIGNATURE AT THE HIGHER EDUCATION SCIENCE INSTITUTE OF HUAMBOABSTRACTFrom interviews and questionnaires made in 2010 to students and teachers of the Higher Education Science Institute-ISCED/Huambo, of the Biology career, concluded that the use of the TIC was practically null. It proceeded to make a

  19. Microcatheter Embolization of Intractable Idiopathic Epistaxis

    International Nuclear Information System (INIS)

    Leppaenen, Martti; Seppaenen, Seppo; Laranne, Jussi; Kuoppala, Katriina

    1999-01-01

    Purpose: To assess the efficacy and safety of microcatheter embolization in the treatment of intractable idiopathic epistaxis. Methods: Thirty-seven patients underwent microcatheter embolization in 1991-1998. We evaluated retrospectively the technical and clinical outcome, the number of complications, the duration of embolization in each case, and the number of blood transfusions needed. All embolizations were done with biplane digital subtraction angiography (DSA) equipment. The procedure was carried out under local anesthesia using transfemoral catheterization, except in one case where the translumbar route was used. Tracker 18 or 10 microcatheters were advanced as far as possible to the distal branches of the sphenopalatine artery. Polyvinyl alcohol (PVA) particles were used for embolization in most cases, while platinum coils or a combination of these two materials were occasionally used. The primary outcome was always assessed immediately by angiography. Follow-up data were obtained from patient records, by interviewing patients on the telephone or by postal questionnaires when necessary. The mean follow-up time was 21 months. Results: The embolization was technically successful in all 37 cases. A curative outcome was achieved in 33 cases (89%). The mean duration of the procedure was 110 min. Four patients (8%) had mild transient complications, but no severe or persistent complications were encountered. Twenty-three patients needed a blood transfusion. Slight rebleeding occurred in three patients during the follow-up; all responded to conservative treatment. One patient suffered two episodes of rebleeding within 2 months after primary embolization. Re-embolizations successfully stopped the bleeding. Conclusion: Embolization is the primary invasive modality for treating intractable idiopathic epistaxis. It proved both safe and effective over a relatively long follow-up

  20. Endoscopic Management of Epistaxis in Lumbini Medical College

    Directory of Open Access Journals (Sweden)

    Anup Acharya

    2015-12-01

    Full Text Available Introduction: Epistaxis is one of the commonest Ear Nose Throat (ENT emergency. Proper guidelines for its management are lacking; on the other hand, the management is mostly done by the junior health service providers which has invited non-standardized practice of epistaxis management. Thereby this study was much inclined towards assessment of the effectiveness of endoscopic management of epistaxis.   Methods: This prospective study included patients above 16 years who were diagnosed with idiopathic epistaxis visiting Out Patient of ENT Department or in the Emergency Department of Lumbini Medical College from 1st of July 2014 to 30th of June 2015. ENT examination was done to find the cause and site of bleeding. Thereafter different epistaxis management interventions were done depending on the bleeding condition. The data were collected, entered and then analyzed using SPSS version 21. The descriptive statistics were applied.   Results: Of the total 116 patients, 53 (45.69% were male and 63 (54.31% were female showing no gender preponderance with epistaxis in our study. Majority (49% of the patients were managed with cauterization with silver nitrate or electrocautery in out-patient clinic. Second most common (18% procedure was endoscopic sphenopalatine artery cauterization. Nasal packing was done only in three cases with zero posterior pack.   Conclusion: Endoscopic intervention of epistaxis seems to be safe, simple, fast, and effective for the management of epistaxis with low rates of morbidity and complications. Thereby it can be preferred over the conservative nasal packing and considered as immediate second-line management.

  1. Immediate management of epistaxis: bloody nuisance or ominous sign?

    Science.gov (United States)

    Davidson, T M; Davidson, D

    1996-08-01

    Epistaxis typically originates from the nasal septum when the nasal mucosa overlying a dilated blood vessel is injured. Epistaxis may, however, signal an underlying condition such as a coagulation disorder, so the treating physician must be alert for signs of serious illness. Most nosebleeds stop spontaneously within 5 minutes with or without pressure to the forehead, nose, or upper lip. Some require anterior nasal packing. A few arise from posterior arteries and require anterior-posterior nasal packing and a referral.

  2. CONSIDERACIONES SOBRE EL PAPEL DE LA METACOGNICIÓN EN EL TRATAMIENTO A LAS HABILIDADES GENERALES Y ESPECÍFICAS DE LA PROFESIÓN COMO CONTENIDO DE LA SUPERACIÓN DE LOS DOCENTES

    Directory of Open Access Journals (Sweden)

    Hernán Feria Ávila

    2010-07-01

    Full Text Available La obra que en Psicología Educativa nos legara Lev Semiónovich Vigotsky está presente en todo el sustento de la pedagogía revolucionaria cubana. En este trabajo, sus autores propician un acercamiento al valor de esta obra como sustento de los estudios que sobre metacognición iniciara J. H. Flavell, en 1970. A partir de esta relación, se argumenta el papel de los procesos metacognitivos en el tratamiento a las habilidades generales y específicas de la profesión como contenido de la superación de los docentes.

  3. Evidence-based management of epistaxis in hereditary haemorrhagic telangiectasia.

    Science.gov (United States)

    Syed, I; Sunkaraneni, V S

    2015-05-01

    There are currently no guidelines in the UK for the specific management of hereditary haemorrhagic telangiectasia related epistaxis. The authors aimed to review the literature and provide an algorithm for the management of hereditary haemorrhagic telangiectasia related epistaxis. The Medline and Embase databases were interrogated on 15 November 2013 using the search items 'hereditary haemorrhagic telangiectasia' (title), 'epistaxis' (title) and 'treatment' (title and abstract), and limiting the search to articles published in English. A total of 46 publications were identified, comprising 1 systematic review, 2 randomised, controlled trials, 27 case series, 9 case reports, 4 questionnaire studies and 3 in vitro studies. There is a lack of high-level evidence for the use of many of the available treatments for the specific management of epistaxis in hereditary haemorrhagic telangiectasia. Current management should be based on a multidisciplinary team approach involving both a hereditary haemorrhagic telangiectasia physician and an ENT surgeon, especially when systemic therapy is being considered. The suggested treatment algorithm considers that the severity of epistaxis merits intervention at different levels of the treatment ladder. The patient should be assessed using a reproducible validated assessment tool, for example an epistaxis severity score, to guide treatment. More research is required, particularly in the investigation of topical agents targeting the development and fragility of telangiectasiae in hereditary haemorrhagic telangiectasia.

  4. A Rare But Important Entity: Epistaxis in Infants.

    Science.gov (United States)

    DeLaroche, Amy M; Tigchelaar, Helene; Kannikeswaran, Nirupama

    2017-01-01

    Epistaxis is a common emergency department (ED) complaint; however, this entity is rare among children younger than 2 years of age. In this age group, epistaxis may be a presenting sign of a bleeding disorder or nonaccidental trauma. We present a case of a 2-month-old infant who was evaluated in the pediatric ED for epistaxis and discharged home. The infant returned 2 days later with facial swelling and irritability, and was found to have significant head trauma. In this article we review the epidemiology and differential diagnoses for epistaxis among infants, as well as the initial approach to the evaluation of this uncommon clinical entity in this age group. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Potential etiologies for epistaxis among infants and young children include severe systemic disease and nonaccidental trauma. Given its rarity and possible clinical significance, the approach to epistaxis differs in this age group. Emergency physicians should screen for and exclude a bleeding disorder while also having a very low threshold for a nonaccidental trauma evaluation. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Heritability of epistaxis in the Australian Thoroughbred racehorse population.

    Science.gov (United States)

    Velie, B D; Raadsma, H W; Wade, C M; Knight, P K; Hamilton, N A

    2014-11-01

    Post exercise epistaxis, the manifestation of a severe form of exercise-induced pulmonary haemorrhage (EIPH), has been observed in many equine racing populations. Although multiple analyses have suggested that non-genetic factors may lead to the development of this condition, relatively little consensus has been reached regarding its genetic aetiology. The objective of this study was to provide insight into both genetic and non-genetic factors that may contribute to the expression of epistaxis in the Australian Thoroughbred racing population. Racing records and reported epistaxis occurrences were acquired for 117,088 horses entered in races and official barrier trials from 1 August 2000 until 22 February 2011. Heritability was estimated using two different logistic generalised linear mixed models (lifetime epistaxis risk h(2) = 0.27 and individual race epistaxis risk h(2) = 0.50). Sex, age, and year of birth were shown to be significant; however, trainer, jockey, race distance, condition of the track (i.e. 'going'), racecourse, track surface, number of race starters, year and month of race were not significant. Evidence suggests genetic and non-genetic links to EIPH expressed as epistaxis. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Consideraciones sobre el efecto de los armónicos de tiempo en motores trifásicos asincrónicos; Considerations about the Effect of Time Harmonics on Three Phase Induction Motor

    Directory of Open Access Journals (Sweden)

    Persy R Viego Felipe

    2011-02-01

    Full Text Available Se analiza el origen de los armónicos de tiempo en los sistemas eléctricos, tanto de los múltiplos integralescomo de los no integrales de la fundamental (interarmónicos y subarmónicos. Se consideran las causas y losefectos fundamentales de los mismos sobre las pérdidas en los motores asincrónicos. A partir de un estudio decaso, se evalúa el comportamiento de un motor en presencia de los principales armónicos y a partir del espectroarmónico de un circuito del CAI Ciudad Caracas, se ponen en evidencia los efectos negativos que sobre unmotor conectado en el mismo tendría esa distorsión armónica. Se establece, que para evaluar estos efectos,resulta conveniente emplear métodos de inteligencia artificial. The source of time harmonics in electric systems, no only integral multiples, but also non multiples of thefundamental (inter and subharmonics, are analyzed. The main causes and effects on induction motor losses areconsidered. On the base of a case study, the operation of an induction motor considering the most importantharmonics is evaluated. From a harmonic spectrum, the negative effects that would have a motor connected toa circuit of the sugar factory "Ciudad Caracas" are shown. The convenience of using tolls based on artificialintelligence for evaluating these effects is remarked 

  7. Consideraciones metodológicas sobre el estudio de los núcleos urbanos en la Castilla bajomedieval : notas para un modelo teórico de análisis

    Directory of Open Access Journals (Sweden)

    Manuel Fernando Ladero Quesada

    1991-01-01

    Full Text Available Esta ponencia es fruto de las reflexiones surgidas en la elaboración de nuestra propia investigación sobre la ciudad de Zamora (ver nota 2 y de la lectura de numerosos trabajos sobre la problemática urbana y concejil que no es posible reseñar aquí. (Para una información bibliográfica reciente, véanse los excelentes trabajos y reflexiones reunidos en las Actas del II Congreso de Estudios Medievales organizado por la Fundación Sánchez Albornoz en León en septiembre de 1989 (Madrid 1990: Concejos y ciudades en la Edad Media Hispánica. Como señalaba antes, este ponencia se ciñe fundamentalmente al ámbito castellano-leonés, es por ello que parezca obligado citar algunas obras consultadas con mayor asiduidad para la elaboración de la misma.

  8. Consideraciones sobre un nuevo y notable puñal calcolítico atribuible al grupo Treilles del Museu d´Arqueología de Catalunya en Barcelona

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    Rovira i Port, Jordi

    2004-12-01

    Full Text Available Althrough we were unaware of its concret origin, the Museu d´Arqueologia of Barcelona preserves in his collections a magnificent example of copper dagger assimilable to the series of daggers so-called «à encoche bilatérale » and «à soie courte crantée». These are pieces assimilated principally to the metallurgy of the pre-bell beakers of the Treilles Group, althrough certain pieces appear also in the prehistoric cultural groupes of Fontbuisse and Véraza. We present suggestions about its typology, filiation and the chronology of this dagger, as well as about its likely metallic composition.

    Aunque ignoramos su procedencia concreta, el Museu d´Arqueologia de Barcelona conserva en sus colecciones un magnífico ejemplar de puñal de cobre tipológicamente atribuible a las series de puñales denominados genéricamente como «à encoche bilatérale» y «à soie courte crantée». Se trata de piezas asimilables mayoritariamente a la metalúrgia precampaniforme del Grupo «des Treilles», aunque ciertos ejemplares aparecen también en los grupos culturales prehistóricos franceses de Fontbuisse y Véraza. En el artículo se efectúan apreciaciones sobre su tipologia, la filiación y la datación del puñal, así como sobre su probable composición metalográfica.

  9. Influence of air temperature variations on incidence of epistaxis.

    Science.gov (United States)

    Comelli, Ivan; Vincenti, Vincenzo; Benatti, Mario; Macri, Gian Franco; Comelli, Denis; Lippi, Giuseppe; Cervellin, Gianfranco

    2015-01-01

    Epistaxis is the most common ear, nose, and throat emergency observed in the emergency department (ED). An increased frequency of this condition has been observed during cooler months, but the results of available studies are controversial. The aim of this study was to investigate the seasonality and association of epistaxis presentations to a large urban ED with variations of air temperature and humidity. This study was a retrospective case series. Information on all the patients who presented for epistaxis in the ED of the Academic Hospital of Parma during the years 2003-2012 and ages ≥ 14 years were retrieved from the hospital data base, excluding those attributable to trauma. The chronologic data of all visits were associated with climate data (air temperature and humidity) by univariate linear regression analysis. Among the 819,596 ED patients seen throughout the observational period, 5404 were admitted for epistaxis. Of these, 5220 were discharged from the ED, whereas 184 (3.4%) needed hospital admission. A strong seasonality of epistaxis was observed, with a peak during winter. A strong negative correlation was also found between the daily number of epistaxes and the mean daily temperature in the whole population as well as in patient subgroups (those undergoing anticoagulant or antiplatelet therapy, or those with hypertension, inherited bleeding disorders, liver cirrhosis, or advanced malignancy). A weaker correlation was also found between air humidity and epistaxis but only in certain subgroups. The results of this study provided a contribution to improve our understanding of the epidemiology of epistaxis and for specific health policies that should also be planned by considering the seasonality of nosebleed.

  10. Severity and Features of Epistaxis in Children with a Mucocutaneous Bleeding Disorder

    NARCIS (Netherlands)

    Stokhuijzen, Eva; Segbefia, Catherine I.; Biss, Tina T.; Clark, Dewi S.; James, Paula D.; Riddel, Jim; Blanchette, Victor S.; Rand, Margaret L.

    2018-01-01

    Objective To use standardized bleeding questionnaires to compare the severity and patterns of epistaxis in children with a mucocutaneous bleeding disorder and control children. Study design The epistaxis sections of the Pediatric Bleeding Questionnaire (PBQ) administered to pediatric patients with

  11. Incidencia de los trastornos mentales en los profesionales de la aeronáutica civil y militar (1983-2014: un estudio descriptivo y consideraciones preventivas sobre la seguridad aérea

    Directory of Open Access Journals (Sweden)

    Jesús Medialdea Cruz

    Full Text Available Introducción: En el presente estudio se muestran los resultados obtenidos de la incidencia de trastornos psiquiátricos registrados en el Centro de Instrucción de Medicina Aeroespacial (Madrid en los últimos 30 años. Material y métodos: Se procedió a la revisión de toda la documentación contenida en las historias clínicas archivadas, con posterior codificación de los datos y de los trastornos según criterios de la Clasificación Internacional de Enfermedades Mentales (CIE-10, OMS. Resultados: Los resultados muestran la importante incidencia de respuestas de estrés y de trastornos neuróticos y secundarios a situaciones estresantes, sobre todo los trastornos adaptativos y los trastornos fóbicos, así como la incidencia de otros trastornos psiquiátricos. Conclusiones: Por último, se obtienen las principales conclusiones basadas en la elevada frecuencia de estos trastornos, en el pronóstico de los más frecuentes y su repercusión en la Seguridad Aérea, y que aconsejen los futuros métodos, procedimientos e intervenciones que la mejoren.

  12. Consideraciones sobre la sexualidad en estudiantes del programa de formación del nuevo médico latinoamericano Considerations on sexuality in students from the training program of the new Latin American physician

    Directory of Open Access Journals (Sweden)

    Camilo González Pérez

    2010-03-01

    Full Text Available Objetivos: explorar comportamientos y actitudes de los estudiantes del programa de formación del nuevo médico latinoamericano en algunos aspectos relacionados con la sexualidad. Métodos: se realizó un estudio descriptivo de corte transversal en 235 estudiantes del citado programa, entre los meses de octubre a diciembre del año 2008. La información se recogió mediante la aplicación de un cuestionario estructurado que examina variables del comportamiento sexual: relaciones sexuales, edad de inicio, antecedentes de infecciones de transmisión sexual, métodos de protección y necesidades de información. Resultados: en la mayoría de los estudiantes la conducta sexual no se correspondió con el nivel de conocimientos que tienen sobre temas relacionados con la sexualidad. El 25,9 % mantuvo relaciones sexuales sin protección, el 1,3 % tenía varias parejas sexuales, el 51,9 % refirió que ocasionalmente tenía sus relaciones sexuales sin protección mientras el 44,8 % dijo que siempre se protegían para mantener estas relaciones. Conclusiones: los estudiantes inician las relaciones sexuales en edades precoces con tendencia a que los varones comiencen primero, la mayoría sin protección en la primera relación sexual. Aunque conocen las ventajas del uso del condón para evitar una infección de transmisión sexual, un grupo considerable no lo utiliza. Los estudiantes refieren la necesidad de información sobre temas relacionados con la sexualidad, siendo los más solicitados los que tienen que ver con estas infecciones y la sexualidad con enfoque de género.Objectives: to explore the behaviors and attitudes of students from the Program of the New Latin American Physician in some features related to sexuality. Methods: a descriptive and cross-sectional study was conducted in 235 students of above mentioned program from October to December, 2008. Information was obtained by application of a structured questionnaire examining the following

  13. El proyecto Epicardian: un estudio de cohortes sobre enfermedades y factores de riesgo cardiovasculares en ancianos españoles: consideraciones metodológicas y principales hallazgos demográficos

    Directory of Open Access Journals (Sweden)

    Rafael Gabriel Sánchez

    2004-01-01

    Full Text Available Fundamentos: A pesar de que la incidencia de cardiopatía isquémica es más alta en sujetos mayores de 65 años, la mayor parte de la investigación cardiovascular se ha centrado en la población adulta de mediana edad, careciendo en España hasta la fecha de un estudio de cohortes en este grupo de población. El objetivo de este trabajo es revisar el papel y la metodología de los estudios de cohortes como herramienta epidemiológica imprescindible para la investigación de la prevalencia e incidencia de angina, IAM, ictus, y sus principales factores de riesgo cardiovascular. Métodos: Estudio de cohortes en tres zonas de España: Madrid (barrio de Lista, Arévalo (Avila y Begonte (Lugo. Muestra aleatoria estratificada por edad y sexo a partir de los padrones municipales de cada zona y municipio (n=5,079. Evaluación basal de la cohorte en dos fases: domiciliaria mediante encuesta estructurada para cribado de enfermedad isquémica cardiaca y factores de riesgo clásicos (hipertensión, dislipemia, diabetes y tabaquismo y clínica para confirmación de casos. En la fase de seguimiento se utilizó el «método de búsqueda en frío» del proyecto MONICA modificado para la búsqueda e indagación de casos incidentes usando todos los informes clínicos hospitalarios y de atención primaria para la confirmación del evento cardiovascular. Adicionalmente se solicitó al INE información sobre causa y fecha de la muerte de los individuos de la cohorte fallecidos...

  14. Consideraciones sobre algunas metodologías habituales para el análisis de tablas de movilidad social. Ventajas y limitaciones de una alternativa basada en cadenas de Markov

    Directory of Open Access Journals (Sweden)

    Germán Rosati

    2011-01-01

    Full Text Available El problema de la «movilidad social» constituye un tópico clásico en la ciencia social y ha tenido diversos abordajes. En este trabajo se presentan algunas herramientas metodológicas para el análisis de la movilidad social en matrices de transición. Se discutirán los alcances y limitaciones de algunas metodologías clásicas de análisis: análisis de «entradas» y «salidas; el índice de movilidad/ estabilidad social; el índice basado en el coeficiente Q de Joule desarrollado por Andrea Tyree y los modelos log-lineales. Estas herramientas funcionan bajo el supuesto de «independencia estadística» entre los momentos de la matriz de transición. Se intentará mostrar la utilidad que las cadenas de Markov poseen, en tanto permiten «flexibilizar» (al menos en teoría estos supuestos, al trabajar sobre distribuciones probabilísticas de movilidad (llamadas matrices de transición. Por ello se propondrán algunos elementos para la construcción de un índice basado en estas distribuciones probabilísticas y se compararán sus resultados con las metodologías anteriores. Se ilustrarán algunos de los resultados con datos secundarios provenientes de otros trabajos de investigación.

  15. Algunas consideraciones sobre la alimentación del lactante para la conservación de su salud bucal Some considerations on infant feeding for the preservation of oral health

    Directory of Open Access Journals (Sweden)

    Yanelis Urgellés Pérez

    2012-04-01

    Full Text Available La salud bucodental constituye un componente de la salud general de los seres humanos, vital para el adecuado crecimiento y desarrollo de niños y adolescentes, asociado a diferentes factores, tales como: nutrición, comunicación, fonación, estética y autoestima. La mejor manera de lograrlo, es con un correcto cepillado y la prevención de hábitos nocivos, entre los cuales figuran: uso de biberón, consumo de alimentos molidos, chupeteo de dedos y tetes, así como respiración bucal. A partir de esta reflexión se revisó la bibliografía biomédica disponible sobre algunos aspectos elementales de la alimentación en el primer año de vida, entre los que se encuentran: tipos de lactancia y ablactación, todo ello desde un enfoque estomatológico para acentuar la importancia de alimentar correctamente al lactante, con vistas a mantener su salud bucal.Oral dental health constitutes a component of the overall health of humans, vital for proper growth and development of children and adolescents, associated with different factors such as nutrition, communication, speech, appearance and self-esteem. The best way of achieving this is with correct brushing and prevention of harmful habits, including baby's bottle use, ground food consumption, sucking fingers and tetes, and mouth breathing. From this reflection available biomedical literature on some basic aspects of food in the first year of life was reviewed, including types of breastfeeding and ablactation, all from the stomatological approach to emphasize the importance of properly feeding the infants in order to maintain their oral health.

  16. Selective embolisation of posttraumatic intractable epistaxis

    International Nuclear Information System (INIS)

    Nickel, J.; Andresen, R.; Sachs, W.

    2003-01-01

    We report on a patient who developed hemodynamically relevant epistaxis due to splanchnocranial injuries after falling from his bicycle. Spiral-CT showed a fracture of the posterior nasal septum and of the inferior nasal concha. Despite anterior and posterior nasal tamponade, anemia occurred requiring transfusion and resulting in the interdisciplinary decision to perform transcatheter embolization. Via a trans femoral incision, a 5 F Vitek catheter was introduced into the maxillary artery, and a tracker system was then advanced through the catheter supraselectively and placed in the peripheral branches of the vascular system of the sphenopalatine artery. Selective DSA clearly showed the source of bleeding to be the area supplying the sphenopalatine artery. Following documentation of the localization of bleeding, a total of six (3/30 mm) complex heliacal mini-coils were inserted. After intravascular occlusion of the sphenopalatine artery, bleeding completely stopped within a few minutes. This shows that supraselective embolization is an easily conducted, effective and low-complication method for the definitive treatment of severe posttraumatic nose-bleeds, even in emergency situations. (orig.) [de

  17. A systematic review of anti-thrombotic therapy in epistaxis.

    Science.gov (United States)

    Musgrave, K M; Powell, J

    2016-12-01

    There is limited guidance available to clinicians regarding the management of antithrombotic therapy during epistaxis, whilst there has been an increase in the use of anticoagulation and antiplatelet therapy. In addition, the introduction of direct oral anticoagulants (DOACs), such as dabigatran and rivaroxaban, over the last decade has significantly increased the complexity of managing the anticoagulated epistaxis patient. We undertook a systemic literature review investigating potential management strategies for each class of anti-thrombotic therapy during epistaxis. A PubMED and Cochrane Library search was performed on 10/03/16 using, but not limited to, the search terms epistaxis, nosebleed, nose bleeding, nasal haemorrhage, nasal bleeding AND each of the following search terms: antithrombotic, anticoagulant, antiplatelet, aspirin, clopidogrel, warfarin, dabigatran, rivaroxaban, apixaban and tranexamic acid. This yielded 3815 results, of which 29 were considered relevant. Other sources such as national and international guidelines related to the management of anti-thrombotics were also utilised. We present the findings related to the management of each class of anti-thrombotic therapy during epistaxis. Overall we found a lack of evidence regarding this topic and further high quality research is needed. This is an area growing in complexity and the support of colleagues in Haematology and Cardiology is increasingly important.

  18. Diode laser coagulation for the treatment of epistaxis in a Scottish fold cat

    Science.gov (United States)

    Aoki, Takuma; Madarame, Hiroo; Sugimoto, Keisuke; Sunahara, Hiroshi; Fujii, Yoko; Kanai, Eiichi; Ito, Tetsuro

    2015-01-01

    We report the case of a 4-year-old, castrated 4.2-kg Scottish fold cat with recurrent epistaxis that was unresponsive to medical therapy. Diathermocoagulation of the nasal mucosa with a diode laser controlled the epistaxis and there was no significant recurrence of epistaxis during 1 year of follow-up. PMID:26130838

  19. El Libro di ricercate a qvattro voci (1575 de Rocco Rodio y algunas consideraciones sobre relaciones entre Nápoles y España en el siglo XVI

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    Tasini, Francesco

    2014-12-01

    ón en partitura, forma que será muy usada en Nápoles a finales del siglo XVI e inicios del XVII. Experimentará este fenómeno editorial una importante expansión a nivel nacional y europeo durante todo el siglo XVII, y aún durante el siglo XVIII se encuentran ejemplos. El análisis formal y estilístico de las composiciones publicadas en esta obra (cinco Ricercate, cuatro Fantasie sobre Canti Fermi y sobre La mi re fa mi re muestra la “modernidad” y el progresismo del autor: las Ricercate del cual son una elaboración de la práctica coeva de la improvisación y la diminución que se aplicaba en los motetes polifónicos vocales y en los madrigales con affetti; las Fantasie representan un soberbio ejemplo de invención y maestría que se inscribe no sólo en el campo de la composición «osservata» para tecla, sino que representa un modelo ejemplar en el ambiente más amplio de la ferviente producción vocal, didáctica y experimental de la escuela polifónicoinstrumental entre Nápoles, Roma y España. [it] Il Libro di ricercate a qvattro voci (1575 di Rocco Rodio e alcuni rilievi sui rapporti tra Napoli e la Spagna nel XVI secolo. Il saggio, dopo una sintetica messa a punto sugli studi musicologici relativi ai rapporti intercorsi tra Napoli e la Spagna in particolare nel campo della produzione tastieristica dei secoli XVI-XVII, si occupa in maniera pressoché esclusiva – sotto il profi lo analitico e stilistico – del LIBRO DI RICERCATE A QVATTRO VOCI DI ROCCO RODIO CON ALCVNE FANTASIE SOPRA VARII CANTI FERMI, pubblicato a Napoli da Gioseppe Cacchio dall’Aquila nel 1575. Il libro di Rocco Rodio («Rocchus Rodius Civitatis Barensis»; Bari, 1530ca-Napoli, 1615ca costituisce la prima stampa in assoluto apparsa in partitura, un sistema particolarmente seguìto a Napoli tra la fine del XVI secolo e l’inizio del XVII e che troverà un significativo impiego a livello nazionale ed europeo lungo tutto il corso del Seicento, con esempi anche nel Settecento. L

  20. Haematological factors in the management of adult epistaxis: systematic review.

    Science.gov (United States)

    Williams, A; Biffen, A; Pilkington, N; Arrick, L; Williams, R J; Smith, M E; Smith, M; Birchall, J

    2017-12-01

    The management of epistaxis requires an understanding of haematological factors that may complicate its treatment. This systematic review includes six distinct reviews examining the evidence supporting epistaxis-specific management strategies relating to warfarin, direct oral anticoagulants, heparin, antiplatelet agents, tranexamic acid and transfusion. A systematic review of the literature was performed using a standardised methodology and search strategy. Limited numbers of articles were identified in each systematic review, with level 1 evidence only regarding the use of tranexamic acid. No studies met the inclusion criteria within the heparin, direct oral anticoagulants or transfusion systematic reviews. Many studies were limited by small sample sizes and significant risk of bias. The management of major bleeding and transfusion practice is well documented in national guidance from multiple sources. The guidelines include advice on anticoagulants, antiplatelet agents and tranexamic acid. In the absence of more specific evidence, these guidelines should be applied in the management of epistaxis.

  1. Endovascular Treatment of Incoercible Epistaxis and Epidural Cerebral Hematoma

    Science.gov (United States)

    Bortoluzzi, M.; Pavia, M.

    2006-01-01

    Summary A young patient with a facial trauma after a road accident was admitted to our department with incoercible epistaxis. A CT scan showed a right pterional acute epidural hematoma (EDH). Angiography demonstrated multiple sources of bleeding of the right sphenopalatine arteries, cause of the epistaxis, and an intracranial leakage of the right middle meningeal artery, responsible for the EDH. The patient immediately underwent embolization of the right internal maxillary artery and right middle meningeal artery. The procedure stopped the epistaxis and no further enlargement of the EDH was observed, avoiding its surgical treatment. Endovascular surgery may be an effective procedure to stop the arterial meningeal bleeding sustaining acute EDH and may be a useful tool in the management of special cases of post traumatic EDH. PMID:20569576

  2. Algunas consideraciones sobre el efecto del espesor de llanta en la resistencia a la fractura de ruedas dentadas // Some considerations about the effect of the rim thickness on gear fracture resistance.

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    G. González-Rey

    2009-01-01

    Full Text Available En transmisiones por engranajes, con ruedas de llantas delgadas trabajando en régimen de carganominal y con suficiente resistencia a los esfuerzos de flexión en la raíz de los dientes, ha sidoobservado el surgimiento de grietas por debajo de los dientes que se propagan a través de la llantacon rotura por fractura de la rueda dentada. Las actuales formulaciones de las Normas ISO y AGMApara valorar el esfuerzo máximo resultante en la base de los dientes de las ruedas de engranajescilíndricos introducen factores modificadores de los esfuerzos (YB y KB para ruedas dentadas conllantas de pequeño espesor. Estudios realizados valoran de forma diferente el factor poradelgazamiento de llanta en dependencia de la geometría de las ruedas y la rigidez conjunta entrellanta y los nervios soporte del núcleo de la rueda dentada. En el presente artículo, se expone unbreve resumen del estado del arte sobre el tema, son mostrados y confirma dos resultadosderivados de un análisis de la interrelación entre el factor por adelgazamiento de llanta, la razón deespesor relativo de la llanta y la razón de espesor relativo de los nervios del soporte en ruedasdentadas cilíndricas, y otros asociados con la tendencia del límite inferior de la razón de espesorrelativo de la llanta en dependencia del número de dientes de la rueda.Palabras claves: rueda de llanta fina, engranaje, espesor de llanta, fractura, factor modificador deesfuerzo.____________________________________________________________________________AbstractIn thin rimmed gears running with nominal load and sufficient bending stress resistance at thetooth-root, fatigue cracks with propagation through the rims, rather than at the tooth fillet, hasbeen observed. Both the ISO and AGMA standards introduce stress-modifying factors(denominated rim thickness factors YB and KB for the bending stress calculation where the rimthickness is not sufficient to provide full support of the tooth root. However

  3. Consideraciones psicológicas en la valoración educativa de la discapacidad intelectual

    OpenAIRE

    Luque Parra, Diego Jesús

    2011-01-01

    En este artículo se trata de hacer una revisión sobre la evaluación psicológica de la discapacidad intelectual, como discapacidad caracterizada por limitaciones en el funcionamiento intelectual y en la conducta adaptativa, que se manifiesta en habilidades adaptativas conceptuales, sociales y prácticas. Se hace un acercamiento a su valoración interdisciplinar en un ámbito educativo, tratándose la evaluación de esas capacidades, concluyendo en consideraciones generales para la intervención psic...

  4. Capital social: consideraciones metódicas-conceptuales del rol de las comunidades locales

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    Comparato, Gabriel Joaquín

    2012-01-01

    En un contexto de debate en torno a liberalización de los servicios en términos multilaterales, al papel de de la globalización y su efecto en el desarrollo local, al respeto y cuidado medioambiental e incluso en la redefinición de lo que hoy concebimos por desarrollo, el presente trabajo buscará formular unas consideraciones de tipo metodológicas y conceptuales a la hora de abordar el capital social en torno a la actividad turística. Todo ello, con el objeto de analizar y profundizar sobre e...

  5. Algunas consideraciones generales acerca de la etiología del autismo: factores innatos y ambientales

    OpenAIRE

    Abal, Mauricio

    2015-01-01

    El presente trabajo se enmarca en el proyecto de investigación denominado “Las variedades del autismo: Sistematización y Evaluación de la Demanda Asistencial. Segunda Etapa” (2015-2017), acreditado y subsidiado por el Programa de Incentivos a la Investigación, UNLP, Dir. Lic. María Cristina Piro. En líneas generales pretende repasar algunas (y sólo algunas) de las consideraciones más sobresalientes sobre el autismo, las hipótesis etiológicas y sus implicancias a la hora de un abordaje tera...

  6. THREAT helps to identify epistaxis patients requiring blood transfusions

    Science.gov (United States)

    2013-01-01

    Objective To analyze the characteristics of patients who needed a blood transfusion due to epistaxis-caused anemia and to define potential risk factors. Design Retrospective cohort study. Setting A total cohort of 591 epistaxis patients, prospectively included between March 2007 and April 2008 at the ENT department of the University Hospital of Zurich, was evaluated concerning the need for blood transfusions. Methods The clinical charts and medical histories of these patients were evaluated. Main outcome measures Common parameters that increase the risk for severe anemia due to epistaxis. Results Twenty-two patients required blood transfusions due to their medical condition. 22.7% suffered from traumatic nosebleeds. Another 27.3% had a known medical condition with an increased bleeding tendency. These proportions were significantly higher than in the group of patients without need of blood transfusion. The odds ratio for receiving a blood transfusion was 14.0 in patients with hematologic disorders, 4.3 in traumatic epistaxis and 7.7 in posterior bleeders. The transfusion-dependent epistaxis patients suffered significantly more often from severe posterior nosebleeds with the need for a surgical therapeutic approach. Conclusions Patients with severe nosebleeds either from the posterior part of the nose or with known hematologic disorders or traumatic epistaxis should be closely monitored by blood parameter analyses to evaluate the indication for hemotransfusion. The acronym THREAT (Trauma, Hematologic disorder, and REAr origin of bleeding → Transfusion) helps to remember and identify the factors associated with an increased risk of receiving blood transfusion. PMID:23663751

  7. Endovascular Treatment of Epistaxis: Indications, Management, and Outcome

    International Nuclear Information System (INIS)

    Strach, Katharina; Schröck, Andreas; Wilhelm, Kai; Greschus, Susanne; Tschampa, Henriette; Möhlenbruch, Markus; Naehle, Claas P.; Jakob, Mark; Gerstner, Andreas O. H.; Bootz, Friedrich; Schild, Hans H.; Urbach, Horst

    2011-01-01

    Objective: Epistaxis is a common clinical problem, and the majority of bleedings can be managed conservatively. However, due to extensive and sometimes life-threatening bleeding, further treatment, such as superselective embolization, may be required. We report our experience with endovascular treatment of life-threatening epistaxis. Methods: All patients presenting with excessive epistaxis, which received endovascular treatment at a German tertiary care facility between January 2001 and December 2009, were retrospectively identified. Demographic data, etiology, origin and clinical relevance of bleeding, interventional approach, therapy-associated complications, and outcome were assessed. Results: A total of 48 patients required 53 embolizations. Depending on the etiology of bleeding, patients were assigned to three groups: 1) idiopathic epistaxis (31/48), 2) traumatic or iatrogenic epistaxis (12/48), and 3) hereditary hemorrhagic telangiectasia (HHT) (5/48). Eleven of 48 patients required blood transfusions, and 9 of these 11 patients (82%) were termed clinically unstable. The sphenopalatine artery was embolized unilaterally in 10 of 53 (18.9%) and bilaterally in 41 of 53 (77.4%) procedures. During the same procedure, additional vessels were embolized in three patients (3/53; 5.7%). In 2 of 53(3.8%) cases, the internal carotid artery (ICA) was occluded. Long-term success rates of embolization were 29 of 31 (93.5%) for group 1 and 11 of 12 (91.7%) for group 2 patients. Embolization of patients with HHT offered at least a temporary relief in three of five (60%) cases. Two major complications (necrosis of nasal tip and transient hemiparesis) occurred after embolization. Conclusions: Endovascular treatment proves to be effective for prolonged and life-threatening epistaxis. It is easily repeatable if the first procedure is not successful and offers a good risk–benefit profile.

  8. Algunas Consideraciones Dialécticas y Hermeneutizantes sobre la Epistemología y la Importancia de la Tradición em el Pensamiento Turístico

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    Napoleon Conde Gaxiola

    2010-07-01

    -para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

     

    Resumen

    El tema es una reflexión sobre la epistemología y la tradición de los saberes turísticos y ociológicos desde la perspectiva de la hermenéutica dialéctica. Su objetivo consiste en aproximarnos a la configuración de un pensamiento latinoamericanista de estirpe analógica, orientada a esquivar las limitaciones objetivistas típicas del univocismo turisticológico y de las deficiencias subjetivistas propias de los estudios de la posmodernidad del tiempo libre. La metodología está basada en la perspectiva de la contradicción y el enfoque hermenéutico. El trabajo es una reflexión crítica sobre el estatuto específico del pensamiento turístico de la modernidad tardía, señalando de manera sucinta sus fortalezas y debilidades. Los principales hallazgos en la investigación son: la necesidad de un horizonte dialéctico, analógico e interpretacional del turismo, priorizando la dimensión epistémica y la relevancia de la tradiciónDoce magnos oradores: Breves consideraciones biográficas e intento de acercamiento a uno de sus discursos

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    JOSELYN CORREDOR TAPIAS

    2012-01-01

    Este artículo ofrece una visión general sobre la vida de doce grandes oradores. En primera instancia, se presentan unas consideraciones teóricas sobre su biografía; posteriormente, se da a conocer uno de los discursos más famosos de algunos de los oradores escogidos. En el caso de otros, solo se presenta un fragmento; luego, se exponen algunas de sus frases célebres. Respecto de dos oradores, infortunadamente, no se presenta el texto del discurso debido a que no se halló –al menos hasta el mo...

  9. Duration of Nasal Packs in the Management of Epistaxis

    International Nuclear Information System (INIS)

    Kundi, N. A.; Raza, M.

    2015-01-01

    Objective:To compare the efficacy of nasal packs for 12 and 24 hours in the management of epistaxis. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital, Nowshera and Heavy Industries Taxilla Hospital, from October 2012 to April 2013. Methodology: A total of 60 patients presenting with epistaxis were selected and were divided into two groups of 30 patients each. Patients in both the groups were managed by nasal packs. In group-A packs were removed after 12 hours while in group-B after 24 hours. Symptoms of headache, lacrimation and recurrence of bleeding were recorded. SPSS 20 was used for data analysis and p-value less than 0.01 was considered significant. Results: There was significant difference for headache between removal of nasal packs after 12 hours and 24 hours (p < 0.001). There was significant difference for excessive lacrimation at 12 and 24 hours (p = 0.001). No significant difference was observed for recurrence of bleed when nasal packs were removed at 12 and 24 hours (p = 0.317). Conclusion: Duration in removal of nasal packs after 12 or 24 hours made a difference in the management of epistaxis. Symptoms of headache and excessive lacrimation were significantly higher when nasal packs were removed after 24 hours. It is recommended that patient could be managed with lesser duration of packs after episode of epistaxis to avoid inconvenience. (author)

  10. Bevacizumab: an option for refractory epistaxis in hereditary haemorrhagic telangiectasia.

    Science.gov (United States)

    Amann, Arno; Steiner, Normann; Gunsilius, Eberhard

    2015-08-01

    Recurrent epistaxis in hereditary haemorrhagic telangiectasia (HHT) patients significantly decreases their quality of life. Treatment in therapy refractory patients is limited although various options have been tested so far. Herein, one patient is described that was treated for HHT for over 20 years with only intermediate benefits. As epistaxis duration and frequency increased continuously, bevacizumab 5 mg/kg was administered every 2 weeks. During the time of treatment (six doses) and up to 3 month afterwards clinical symptoms, blood pressure, cardiac output, pulmonary arterial hypertension (PAH), bleeding duration and frequency were assessed as criteria for treatment benefit. Duration and frequency of epistaxis decreased immediately after the first application resulting in reduced need of blood transfusions. After completion of six cycles, a further decrease in frequency and duration of bleeding was noted. Cardiac output and PAH decreased or remained stable, respectively, during time and after treatment. No increase in blood pressure could be found but a significant increase in heart rate was experienced after completion of all six applications. Unfortunately, the patient died due to a cerebral abscess. Bevacizumab led to an improvement of HHT related epistaxis, refractory to other treatments.

  11. An Epistaxis Emergency Associated with Multiple Pollutants in Elementary Students.

    Science.gov (United States)

    Yuan, Wei Ming; Lu, Yuan Qiang; Wei, Zheng; Chen, Ming; He, Sheng Liang; Mai, Wen Yuan; Zhang, Mei Bian

    2016-12-01

    Emergencies of epistaxis in students caused by environmental pollution have rarely been reported to date. This study aimed to explore the cause of an emergency of epistaxis in elementary students by using a field epidemiological investigation. Twenty-two epistaxis cases from a single school with differences in gender, age, and classroom, were diagnosed within a period of 7 days. The air concentration of chromic acid mist (Cr6+) in the electroplating factory area, new campus, and residential area exceeded the limit of uncontrolled emissions. The emission of HCL and H2SO4 was also observed. Formaldehyde levels in the classrooms exceeded the limits of indoor air quality. Abnormal nasal mucosa was significantly more frequent in the case group (93.3%) and control group 1 (of the same school) (66.7%) than in control group 2 (from a mountainous area with no industrial zone) (34.8%; P epistaxis. Several lessons regarding factory site selection, eradication of chemical emissions, and indoor air quality in newly decorated classrooms, should be learned from this emergency. Copyright © 2016 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

  12. Bibliofilia. De las notas sobre El Quijote y otras consideraciones

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    Nelson Nicholls Santacoloma

    1966-03-01

    Full Text Available Después de considerar cuan grande es el número de tomos incompletos que se encuentran por ahí, a cada uno de los cuales cabe muy bien la denominación de libro expósito según lo dicho a nosotros por don Luis Villagómez en pasada oportunidad, no hemos resistido la tentación de averiguar con el devoto bibliófilo por la existencia de otros medios más, de aquellos que él propone para eliminar tan grave calamidad como es la de no poder reunir una obra completa especialmente cuando se trata de alguna vieja e inhallable edición.

  13. Consideraciones sobre elaislamiento en exudados vaginales de Streptococcus morbillorum

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    J.M. F. Egido

    1995-06-01

    Full Text Available De el estúdio de 195 exudados vaginales enviados por el Servicio de Ginecologia de este hospital, durante el período 1988-1990, hemos seleccionado aquellos en los que el cultivo fue positivo para estreptococos, 58 (30% de los cuales 26 (44.8% correspondia a Streptococcus morbillorum, 9 (15.5% a Gardnerella vaginalis, 5 (8.6% a Enterococcus faecalis-durans, y a Streptococcus agalactiae, 3 (5.1% a Streptococcus mitis y Streptococcus mitis, 2 (3-4% a Streptococcus bovis y Streptococcus cremoris y 1 (1.7% a Streptococcus salivarius, Streptococcus equinus y Strptococcus sanguis II respectivamente. En todos los casos se observo antecedentes de actuacción medico- quirurjica en el tracto genital, y en el 52.8% de los casos fuô concomitante con el diagnostico clinico-micologico de candidiasis vaginal. La ideittificaccion bacteriologica se realizo mediante el sistema API 20 STREP (sistema api bioMêríeux GmbH, Nütingen, Alemania dando un patron tipico ("excelente identificacción" para el Streptococcus morbillorum.We have tested 195 vaginal secretions sent by Gynecology Service of this hospital between the years 1988 - 1990. We achieved positive culture for streptococci in 58 (30% of these cultures, 26 (44.8% corresponding to Streptococcus morbillorum 9 (15.5%, to Gardnerella vaginalis 5 (8.6%, to Enterococcus faecalis-durans and to Streptococcus agalactiae, 3 (5.1 % to Streptococcus mitis and milleri 2 (3-4%, to Streptococcus bovis and cremoris, and 1 (1.7% to Streptococcus salivarius, equinus and sanguis II respectively. We previously found that 52.8% of these patients were positive for vaginal candidiasis. The bacteriological identification done by the API 20 STREP System (bioMerieux GmbH, Nútingen, Germanyprovides a typical pattern ("good identification" for the Streptococcus morbillorum.

  14. Algunas consideraciones sobre la economía textual

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    Lic. Carlos Lázaro Nodals García

    2016-03-01

    Full Text Available l artículo aborda el fenómeno de la proliferación de nuevos textos en las redes sociales, otras plataformas interactivas y equipos donde se aplican las tecnologías de la información y la comunicación. Se hace un análisis de sus características, contextos en que se producen y la escritura con economía textual, como centro de un debate entre las posiciones que la rechazan o exponen los problemas que puede originar en el ámbito del respeto a la lengua materna, los que ven en los mismos un fenómeno objetivo, que es necesario asimilar además de contextualizar, entre los que se encuentran los autores del trabajo, que incluso aprecian su dominio, como parte de las competencias culturales y comunicativas del profesional proactivo del siglo XXI.

  15. Algunas consideraciones sobre el intento de suicidio y su enfrentamiento

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    M. Tomas Baader

    2011-05-01

    Finalmente, debemos tener presente que el eje central del enfrentamiento de un paciente evaluado por intento de suicidio es la intervención en crisis, la cual debe ser realizada por el primer médico que tenga contacto con el paciente.

  16. Consideraciones Generales sobre el Cultivo del Arroz en Colombia

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    López Ramírez Gabriel

    1941-04-01

    Full Text Available La industria arrocera ha tenido un aumento progresivo en superficie, pero su producción por unidad apenas se ha sostenido ya que ésta limitada por varios factores de distinto orden que aún no han sido analizados con el fin de buscar un mejoramiento global que asegure al agricultor una mayor utilidad económica con un menor costo de producción, que es el punto básico de toda empresa. Teniendo el país un elevado standard de vida y una gran escasez de mano de obra, es necesario acudir a la técnica agrícola para así rebajar favorablemente el costo de las cosechas.

  17. Consideraciones sobre elaislamiento en exudados vaginales de Streptococcus morbillorum

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    J.M. F. Egido

    1995-06-01

    Full Text Available De el estúdio de 195 exudados vaginales enviados por el Servicio de Ginecologia de este hospital, durante el período 1988-1990, hemos seleccionado aquellos en los que el cultivo fue positivo para estreptococos, 58 (30% de los cuales 26 (44.8% correspondia a Streptococcus morbillorum, 9 (15.5% a Gardnerella vaginalis, 5 (8.6% a Enterococcus faecalis-durans, y a Streptococcus agalactiae, 3 (5.1% a Streptococcus mitis y Streptococcus mitis, 2 (3-4% a Streptococcus bovis y Streptococcus cremoris y 1 (1.7% a Streptococcus salivarius, Streptococcus equinus y Strptococcus sanguis II respectivamente. En todos los casos se observo antecedentes de actuacción medico- quirurjica en el tracto genital, y en el 52.8% de los casos fuô concomitante con el diagnostico clinico-micologico de candidiasis vaginal. La ideittificaccion bacteriologica se realizo mediante el sistema API 20 STREP (sistema api bioMêríeux GmbH, Nütingen, Alemania dando un patron tipico ("excelente identificacción" para el Streptococcus morbillorum.

  18. Consideraciones sobre Infortunios de Alonso Ramírez

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    Leonor Taiano

    2010-12-01

    Full Text Available This article attempts to provide new perspectives for approaching the study of Infortunios de Alonso Ramírez. Several researches about the text have given to Sigüenza y Góngora a character of strangeness to it, which would reduce him to the role of mere amanuensis, indicating that the discursive elaboration belongs to Ramirez. In view of that, I have performed a textual analysis, supported on the book's title and the final passage of the account, that I consider important elements that can offer a new perception on this issue. I base my research, additionally, on the study of its context of publication under the patronage of the New Spain viceroy, as well as the similarities of Infortunios de Alonso Ramírez with other contemporary texts.

  19. BREVES CONSIDERACIONES SOBRE EL BOXEO Y EL DERECHO

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    Luis Ariel Salanueva Brito

    2016-07-01

    Full Text Available A través de una reflexión, el autor determina analogías entre el Derecho y el boxeo, donde da fe de las coincidencias que en cuestión de habilidades se presentan en ambas tareas, en ambos compromisos; haciendo de la abogacía, una profesión naturalmente relacionada con el pugilismo.

  1. BREVES CONSIDERACIONES SOBRE EL BOXEO Y EL DERECHO

    OpenAIRE

    Brito, Luis Ariel Salanueva; Escuela Libre de Derecho (ELD)

    2016-01-01

    A través de una reflexión, el autor determina analogías entre el Derecho y el boxeo, donde da fe de las coincidencias que en cuestión de habilidades se presentan en ambas tareas, en ambos compromisos; haciendo de la abogacía, una profesión naturalmente relacionada con el pugilismo.

  2. Estado epiléptico, consideraciones sobre manejo y tratamiento

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    Solari B. Francesca, Dra.

    2013-11-01

    Full Text Available El estado epiléptico es una emergencia médica. Existen diversas definiciones de estado epiléptico y clasificaciones según etiología, tipo de crisis y respuesta a terapia. En esta revisión, se adopta la variable tiempo como fundamental en el manejo del paciente. Otro concepto que se resalta, es la sospecha frente a pacientes graves o con ciertas patologías, la posibilidad de presentar estado epiléptico no convulsivo, ya que la identificación de este, podría mejorar el manejo del paciente grave. Las benzodiacepinas siguen siendo la terapia de primera línea, con una muy buena tasa de respuesta, cuanto más precoz se adopte la terapia. Se discuten diferentes terapias de segunda línea (fenitoína, fenobarbital, valproato, levetiracetam y midazolam y se mencionan aquellas de tercera línea, tanto farmacológicas como otras (dieta cetogénica, inmunosupresores, corticoides y cirugía.

  3. ALGUNAS CONSIDERACIONES SOBRE EL PROBLEMA DE LA "MUERTE CEREBRAL"

    Directory of Open Access Journals (Sweden)

    Juan Mendoza Vega

    1978-10-01

    Full Text Available

    La muerte, ese momento final y hasta ahora inevitable que señala el término de la existencia terrestre de los seres, ha causado al hombre desde la más remota antigüedad una explicable angustia. No solo como protagonista -jamás mejor aplicado el término- sino en cuanto espectador conmovido por la desaparición de seres que le son queridos.

    Tal angustia ha movido los esfuerzos, cada vez más exitosos y complejos, para luchar contra las causas de la muerte; y ha desembocado, al acercarse el fin de otro milenio, en una situación, que parece absurdamente paradójica: la de una humanidad que, teniendo cada vez más y mejores medios para sostener las funciones corporales que aún persistimos en llamar "vitales" (reemplazando o estimulando una y otra vez en su función a los órganos que la han perdido empieza a preguntarse si es lícito y hasta cuándo el usar de tales medios, en presencia de un ser que ya no tiene las funciones superiores de su sistema nervioso ni la posibilidad razonable de recuperarlos.

    Este trabajo pretende dar una visión sintética del problema, con especial interés por la realidad colombiana y terminando con algunas propuestas acordes con esa realidad.


    Aspecto fisiológico de la muerte.
    Se aceptó durante siglos como definición de "muerte" la que vincula este fenómeno a la cesación de los ritmos respiratorios y cardíaco. Pero la aparición y perfeccionamiento de los aparatos y técnicas de respiración asistida o controlada, los desfibriladores cardíacos, las drogas capaces de modificar el ritmo del corazón, la presión arterial y otros parámetros, la creación de las "Unidades de Cuidados Intensivos", han forzado a poner en discusión tal concepto y buscar en cambio definiciones más acordes con el estado actual de nuestra ciencia y arte...

  4. CONSIDERACIONES SOBRE EL PENSAMIENTO ADMINISTRATIVO DE PORTER Y DE SENGE

    Directory of Open Access Journals (Sweden)

    Julio Enrique Lora Suárez

    2004-07-01

    Full Text Available En este artículo se reseñan los aportes conceptuales de dos de los más importantes analistas de la teoría administrativa: Michael Porter y Peter Senge. Ventajas competitivas, cadenas de valor y estrategias de valor son algunos de los principales desarrollos de la reflexión de Porter en torno a la administración de las organizaciones contemporáneas; en cuanto a la obra de Senge, se reseñan en este artículo los temas de aprendizaje en la organización y pensamiento sistémico.

  5. Relation between epistaxis, external nasal deformity, and septal deviation following nasal trauma

    Science.gov (United States)

    Daniel, M; Raghavan, U

    2005-01-01

    Objectives: To find if the presence of epistaxis after nasal trauma can be used to predict post-traumatic external nasal deformity or a symptomatic deviated nasal septum. Methods: Retrospective analysis of all patients seen in the fractured nose clinic by the first author between 17 October 2003 and 27 February 2004. Presence of epistaxis, newly developed external nasal deformity, and the presence of a deviated nasal septum with new symptoms of nasal obstruction were noted. Results: A total of 139 patients were included in the study. Epistaxis following injury was noted in 106 (76%). Newly developed external nasal deformity was noted in 71 (51%), and 33 (24%) had a deviated nasal septum with new symptoms of nasal obstruction. Of the 106 patients with post-trauma epistaxis, 50 (67%) had newly developed external nasal deformity and of the 33 patients without post-traumatic epistaxis, 11 (33%) had nasal deformity (pepistaxis was not associated with the presence of a newly symptomatic deviated septum (25% in patients with epistaxis after injury versus 18% if there was no epistaxis). Conclusions: Presence of epistaxis after nasal trauma is associated with a statistically significant increase in external nasal deformity. However, one third of patients without epistaxis following nasal trauma also had external nasal deformity and hence all patients with a swollen nose after injury, irrespective of post-trauma epistaxis, still need to be referred to the fractured nose clinic. PMID:16244333

  6. A Systematic Review of the Probability of Asphyxia in Children Aged Epistaxis.

    Science.gov (United States)

    Rees, Philippa; Kemp, Alison; Carter, Ben; Maguire, Sabine

    2016-01-01

    To determine the proportion of children aged epistaxis in the absence of trauma or medical explanation and to identify the characteristics of the clinical presentation indicative of asphyxiation. An all-language systematic review was conducted by searching 10 databases from 1900 to 2015 and gray literature to identify high-quality studies that included children with epistaxis aged epistaxis were excluded. For each comparative study, the proportion of children presenting with epistaxis that were asphyxiated is reported with 95% CI. Of 2706 studies identified, 100 underwent full review, resulting in 6 included studies representing 30 children with asphyxiation-related epistaxis and 74 children with non-asphyxiation-related epistaxis. The proportion of children presenting with epistaxis that had been asphyxiated, reported by 3 studies, was between 7% and 24%. Features associated with asphyxiation in live children included malaise, altered skin color, respiratory difficulty, and chest radiograph abnormalities. There were no explicit associated features described among those children who were dead on arrival. There is an association between epistaxis and asphyxiation in young children; however, epistaxis does not constitute a diagnosis of asphyxia in itself. In any infant presenting with unexplained epistaxis, a thorough investigation of etiology is always warranted, which must include active exploration of asphyxia as a possible explanation. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  7. Selective embolisation of posttraumatic intractable epistaxis; Selektive Embolisation bei posttraumatisch unstillbarer Epistaxis

    Energy Technology Data Exchange (ETDEWEB)

    Nickel, J.; Andresen, R. [Abt. fuer Diagnostische Bildgebung und Interventionelle Radiologie, Guestrower Krankenhaus (Germany); Sachs, W. [Klinik fuer Hals-Nasen-Ohrenerkrankungen, Guestrower Krankenhaus (Germany)

    2003-07-01

    We report on a patient who developed hemodynamically relevant epistaxis due to splanchnocranial injuries after falling from his bicycle. Spiral-CT showed a fracture of the posterior nasal septum and of the inferior nasal concha. Despite anterior and posterior nasal tamponade, anemia occurred requiring transfusion and resulting in the interdisciplinary decision to perform transcatheter embolization. Via a trans femoral incision, a 5 F Vitek catheter was introduced into the maxillary artery, and a tracker system was then advanced through the catheter supraselectively and placed in the peripheral branches of the vascular system of the sphenopalatine artery. Selective DSA clearly showed the source of bleeding to be the area supplying the sphenopalatine artery. Following documentation of the localization of bleeding, a total of six (3/30 mm) complex heliacal mini-coils were inserted. After intravascular occlusion of the sphenopalatine artery, bleeding completely stopped within a few minutes. This shows that supraselective embolization is an easily conducted, effective and low-complication method for the definitive treatment of severe posttraumatic nose-bleeds, even in emergency situations. (orig.) [German] Wir berichten ueber einen Patienten, welcher mit Eingeweideschaedelverletzungen nach Fahrradsturz eine haemodynamisch relevante Epistaxis entwickelte. In der durchgefuehrten Spiral-CT zeigte sich eine Fraktur des hinteren Nasenseptums und der Concha nasalis inferior. Trotz vorderer und hinterer Nasentamponade kam es zu einer transfusionsbeduerftigen Anaemie, so dass interdisziplinaer die Entscheidung zur Transkatheterembolisation getroffen wurde. Ueber einen transfemoralen Zugang erfolgte mit einem 5 F Vitek-Katheter der Eingang bis in die A. maxillaris, ueber den liegenden Katheter wurde dann supraselektiv ein Trackersystem bis in die peripheren Aeste des Stromgebietes der A. sphenopalatina platziert. Mittels selektiver DSA liess sich die Blutungsquelle eindeutig dem

  8. Intranasal topical estrogen in the management of epistaxis in hereditary hemorrhagic telangiectasia.

    Science.gov (United States)

    Minami, Kazuhiko; Haji, Tomoyuki

    2016-01-01

    Application of topical estriol ointment is an effective treatment for hereditary hemorrhagic telangiectasia (HHT) epistaxis. HHT is an autosomal-dominant disease characterized by epistaxis in more than 96% of patients. Management of this major symptom, epistaxis, has not been standardized. This study reports experience with topical application of estriol in patients with HHT. Five patients with a confirmed diagnosis of HHT who first visited the hospital between 2012 and 2013 received 0.1% estriol ointment and were guided to apply the ointment twice daily to the anterior part of both nasal cavities. Severity of epistaxis was valued using epistaxis severity score (ESS) before and 3 months after initiating therapy. Five patients (three males, two females) received treatment. After the initiation of treatment, intensity and frequency of epistaxis became moderate in all patients. ESS decreased significantly from pre- to post-treatment (p = 0.043). No adverse events were recorded during follow-up.

  9. Traumatic intracranial internal carotid artery pseudoaneurysm presenting as epistaxis treated by endovascular coiling

    Science.gov (United States)

    Al-Jehani, Hosam M.; Alwadaani, Hassan A.; Almolani, Fadhel M.

    2016-01-01

    Traumatic intracranial pseudoaneurysm is a rare complication of blunt trauma. It is even more rare when it presents as epistaxis. Massive epistaxis of a ruptured intracranial internal carotid artery pseudoaneurysm is a major cause of mortality, which requires emergency intervention. We report a case of traumatic intracranial internal carotid artery pseudoaneurysm secondary to skull base fracture, which presented with delayed onset of epistaxis. This was successfully treated by primary endovascular coil embolization. We discuss endovascular treatment options and review the literature. PMID:26818170

  10. Posterior epistaxis: Common bleeding sites and prophylactic electrocoagulation.

    Science.gov (United States)

    Liu, Juan; Sun, Xicai; Guo, Limin; Wang, Dehui

    2016-01-01

    Posterior epistaxis is a frequent emergency, and the key to efficient management is identification of the bleeding point. We performed a retrospective study of 318 patients with posterior epistaxis treated with endoscopic bipolar electrocautery during a 4-year period. Distribution of the bleeding sites was recorded. Patients with no definite bleeding sites in the first operation were assigned to Group A (n = 39) and Group B (n = 34). Patients in Group A were only observed in the ward. Patients in Group B were given prophylactic electrocoagulation at the common bleeding points. Of the 318 patients, bleeding sites were successfully identified and coagulated in 263 patients. All of them were located posteriorly, with 166 on the lateral nasal wall, 86 on the septum, and 11 on the anterior face of the sphenoid sinus. The rebleeding rate of Group B (8.8%) was lower than that of Group A (38.5%) (p < 0.01).

  11. Is antibiotic prophylaxis in nasal packing for anterior epistaxis needed?

    Directory of Open Access Journals (Sweden)

    Francisco Pérez

    2016-03-01

    Full Text Available La epistaxis es un problema extremadamente común que en ocasiones requiere de taponamiento anterior. Usualmente se indican antibióticos de forma concomitante para la prevención de complicaciones infecciosas, aunque el rol de esta medida es controvertido. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos una revisión sistemática que incluye tres estudios primarios, ninguno de ellos controlado y aleatorizado. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que no está claro si los antibióticos profilácticos disminuyen las complicaciones infecciosas en pacientes con taponamiento nasal por epistaxis anterior porque la certeza de la evidencia es muy baja.

  12. Initial assessment in the management of adult epistaxis: systematic review.

    Science.gov (United States)

    Khan, M; Conroy, K; Ubayasiri, K; Constable, J; Smith, M E; Williams, R J; Kuhn, I; Smith, M; Philpott, C

    2017-12-01

    The initial assessment of epistaxis patients commonly includes: first aid measures, observations, focused history taking, and clinical examinations and investigations. This systematic review aimed to identify evidence that informs how the initial assessment of these patients should be conducted. A systematic review of the literature was performed using a standardised methodology and search strategy. Seventeen articles were included. Factors identified were: co-morbidity, intrinsic patient factors, coagulation screening and ice pack use. Hypertension and anticoagulant use were demonstrated to adversely affect outcomes. Coagulation screening is useful in patients on anticoagulant medication. Four studies could not be accessed. Retrospective methodology and insufficient statistical analysis limit several studies. Sustained ambulatory hypertension, anticoagulant therapy and posterior bleeding may be associated with recurrent epistaxis, and should be recorded. Oral ice pack use may decrease severity and can be considered as first aid. Coagulation studies are appropriate for patients with a history of anticoagulant use or bleeding diatheses.

  13. The therapeutic efficacy of propranolol in children with recurrent primary epistaxis

    Science.gov (United States)

    Bjelakovic, Bojko; Bojanovic, Mila; Lukic, Stevo; Saranac, Ljiljana; Vukomanovic, Vladislav; Prijic, Sergej; Zivkovic, Nikola; Randjelovic, Dusica

    2013-01-01

    We hypothesized that some characteristics of beta-blockers, including negative inotropic, peripheral vasoconstrictor, and antiangiogenic effects, might be potentially useful in treating children with epistaxis. From June 2010 to March 2012, a total of seven children with recurrent primary epistaxis resistant to conventional management were observed at our institution. An overall effectiveness of propranolol was noted in all seven children when given a dose of 1.5–2 mg/kg/day (divided into three doses) as a second line therapy for terminating epistaxis. Based on our first experience, we believe that propranolol could be a favorable treatment option for patients with primary epistaxis. PMID:23467483

  14. Hemorrhagic Lacrimation and Epistaxis in Acute Hemorrhagic Edema of Infancy

    Directory of Open Access Journals (Sweden)

    Shireen Mreish

    2016-01-01

    Full Text Available Acute hemorrhagic edema of infancy is an uncommon benign cutaneous vasculitis. Despite its worrisome presentation, it carries good prognosis with rarely reported systemic involvement. Management of these cases has been an area of debate with majority of physicians adopting conservative modalities. We report a case that presented with classic triad of rash, low grade fever, and peripheral edema along with two rarely reported manifestations in literature: hemorrhagic lacrimation and epistaxis.

  15. The role of surgical neuroangiography in the treatment of epistaxis

    International Nuclear Information System (INIS)

    Miller, M.H.; Terbrugge, K.; Chiu, F.; Lasjaunias, P.

    1986-01-01

    The potential benefit of embolization procedures has not been fully recognized by North American otolaryngologists, who often choose surgical ligation over embolization. Complications associated with improper endovascular treatment further interfere with the demand for this treatment modality. The authors suggest that embolization for epistaxis is safe and reliable if performed by well-trained teams. A thorough understanding of vascular anatomy, anatomic variations, and the dangerous anastomosis is mandatory. They have performed (combined experience) surgical neuroangiography in more than 70 patients with persistent and recurrent epistaxis. The underlying pathology in the patients treated by embolization was quite varied. The nasal packings could always be removed in the angiography room immediately after the embolization procedure. A protocol approach to angiography as proposed by one of the authors (P. L.) is strongly recommended. Superselective catheterization allows the safe deposition of embolic material. Proper embolization will lead to early mobilization of the patient. The vascular supply to the nasal fossa and the pitfalls associated with embolization of this area are discussed in detail, as are the goals and results that can be expected with proper embolization of the various disease processes associated with epistaxis

  16. Surgical and interventional radiological management of adult epistaxis: systematic review.

    Science.gov (United States)

    Swords, C; Patel, A; Smith, M E; Williams, R J; Kuhn, I; Hopkins, C

    2017-12-01

    There is variation regarding the use of surgery and interventional radiological techniques in the management of epistaxis. This review evaluates the effectiveness of surgical artery ligation compared to direct treatments (nasal packing, cautery), and that of embolisation compared to direct treatments and surgery. A systematic review of the literature was performed using a standardised published methodology and custom database search strategy. Thirty-seven studies were identified relating to surgery, and 34 articles relating to interventional radiology. For patients with refractory epistaxis, endoscopic sphenopalatine artery ligation had the most favourable adverse effect profile and success rate compared to other forms of surgical artery ligation. Endoscopic sphenopalatine artery ligation and embolisation had similar success rates (73-100 per cent and 75-92 per cent, respectively), although embolisation was associated with more serious adverse effects (risk of stroke, 1.1-1.5 per cent). No articles directly compared the two techniques. Trials comparing endoscopic sphenopalatine artery ligation to embolisation are required to better evaluate the clinical and economic effects of intervention in epistaxis.

  17. Embolization of carotid artery branch in intractable epistaxis

    International Nuclear Information System (INIS)

    Kordecki, K.; Janica, J.; Lewszuk, A.; Lebkowska, U.; Ustymowicz, A.

    2008-01-01

    Long-term intractable epistaxis results in a series of complications including demise. Unprofessional therapy may account for severe topical and systemic complications. The authors assessed the efficacy and safety of embolization treatment of intractable epistaxis with the use of available embolizing materials. Embolization was performed in 58 patients (39 males aged 24-48 and 19 females aged 26-44) admitted to the ENT Department, Medical University of Bialystok in years 2000 -2005. 65 embolization procedures, including reembolizations, were performed. In 41 procedures (63%) a sponge was used, in 14 (21.6%) PVA, in 10 (15.4%) PVA and coils. In 9 patients, bleeding of a lesser intensity recurred within early hours following the procedure - 84.5% embolization success. On longer follow-up, embolization success was assessed to be 100%. Embolization with the use of proper embolisation materials is an efficient method of arresting spontaneous and posttraumatic epistaxis and may be a safe treatment procedure when performed by experienced medical personnel. (author)

  18. Acute Toxicity from Topical Cocaine for Epistaxis: Treatment with Labetalol.

    Science.gov (United States)

    Richards, John R; Laurin, Erik G; Tabish, Nabil; Lange, Richard A

    2017-03-01

    Topical cocaine is sometimes used for the treatment of epistaxis, as it has both potent anesthetic and vasoconstrictive properties. Cocaine has unpredictable cardiovascular effects, such as sudden hypertension, tachycardia, coronary arterial vasoconstriction, and dysrhythmia. We report a case of acute iatrogenic cardiovascular toxicity from the use of topical cocaine in a 56-year-old man presenting to the Emergency Department with profound epistaxis. To prepare for cauterization and nasal packing, the patient received 4% topical cocaine-soaked nasal pledgets. He became hypertensive, tachypneic, tachycardic, and dysphoric immediately after administration. To directly counter these adverse hyperadrenergic effects, the patient was given 10 mg intravenous labetalol, a mixed β- and α-blocker. This instantly normalized his vital signs and adverse subjective effects. His epistaxis was successfully treated, and he was discharged 1 h later. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We believe that emergency physicians should be aware of the unpredictable acute cardiovascular toxicity of topical cocaine. Labetalol represents an effective first-line treatment, which, unlike benzodiazepines, directly counters the pharmacologic effects of cocaine and has no respiratory or sedative side effects. Labetalol, with its mixed β/α-blocking properties, also mitigates the potential for "unopposed α-stimulation." Copyright © 2016 Elsevier Inc. All rights reserved.

  19. [Management of intractable epistaxis and bleeding points localization].

    Science.gov (United States)

    Yang, Da-Zhang; Cheng, Jing-Ning; Han, Jun; Shu, Ping; Zhang, Hua

    2005-05-01

    To investigate the common nasal bleeding points and the management of intractable epistaxis. The bleeding points and its correlation with age distribution, surgical techniques as well as its effects were studied retrospectively in 92 patients, in whom the bleeding points were not found by routine nasal endoscopy and the hemorrhage was not controlled with standard nasal packing. The bleeding points were found in the following different sites: superior wall of inferior nasal meatus (56.5%, 52/92), olfactory cleft of nasal septum (27.2%, 25/92), posterosuperior wall of middle nasal meatus (8.7%, 8/92) and uncertain (7.6%, 7/92). The results showed that the bleeding points had correlation with age. Epistaxis was well controlled by electrocoagulation in 83 cases, gelfoam packing in 8 cases, and transcatheter maxillary artery embolization in 1 case. There were no complications during a followed-up for 1 - 3 months after management. Among the 92 cases, the numbers of treatment needed to stop bleeding were 82 cases (89.1%) after 1 time of treatment, 9 cases (9.8%) after 2 times and in one case (1.1%) after 4 times. Endoscopy combined with displacement of the middle and inferior turbinate gives good visualization and direct management of the deeply-sited bleeding points, which were difficult in localization. The combined method provides an effective and safe way to control intractable epistaxis.

  20. Endoscopic Cauterization of the Sphenopalatine Artery to Control Severe and Recurrent Posterior Epistaxis

    Directory of Open Access Journals (Sweden)

    Behrooz Gandomi

    2013-06-01

    Full Text Available Introduction: Epistaxis is one of the most common medical emergencies, making the management of posterior epistaxis a challenging problem for the ear, nose, and throat (ENT surgeon. In the cases of conservative management failure, ligation of the major arteries or percutaneous embolization of the maxillary artery is performed routinely in most units, but rates of failure and complications are high.The objective of this study was to assess the effectiveness of endoscopic sphenopalatine artery (SPA cauterization in patients with refractory posterior epistaxis.   Materials and Methods: Between April 2011 and January 2012, 27 patients (15 males and 12 females with refractory posterior epistaxis underwent endoscopic SPA cauterization in two tertiary referral hospitals in Shiraz. Three patients underwent bilateral cauterization.   Results: Four patients (from 30 arteries had new epistaxis after surgery, three experienced subsequent epistaxis requiring medical treatment, and one patient had a minor epistaxis not needing treatment.   Conclusion:  The SPA electrocoagulation technique seems to be safe, simple, fast, and effective with low rates of morbidity and complications for the management of refractory posterior epistaxis. Endoscopic SPA cauterization should be considered as an immediate second-line management when conservative treatment as first-line management fails. 

  1. National long-lasting effect of endonasal endoscopic sphenopalatine artery clipping for epistaxis

    DEFF Research Database (Denmark)

    Ludvigsen Gede, Lisbeth; Aanaes, Kasper; Collatz, Helle

    2013-01-01

    We consider sphenopalatine artery ligation to be a safe and effective treatment of posterior epistaxis as the long-term need for revision surgery and the complication rates are low. Surgery should be considered earlier in the treatment of posterior epistaxis....

  2. Risk factors for epistaxis in patients followed in general practices in Germany.

    Science.gov (United States)

    Seidel, D U; Jacob, L; Kostev, K; Sesterhenn, A M

    2017-12-01

    The goal of the present study was to analyze the risk factors for epistaxis in patients followed in general practices in Germany. The current study sample included patients aged 18 years or older who received a first epistaxis diagnosis between January 2012 and December 2016 (index date). Epistaxis patients and controls without epistaxis were matched (1:1) on the basis of age, gender, insurance status and physician. A total of 16,801 patients with epistaxis and 16,801 control subjects were included in this study. Of the subjects, 53.2% were men, and the mean age was 59.6 years (SD=21.2 years). Epistaxis was found to be positively associated with hypertension, obesity, chronic sinusitis, other disorders of the nose and nasal sinuses, anxiety disorder, and adjustment disorder (ORs ranging from 1.13 to 1.44). Epistaxis was also associated with the prescription of vitamin K antagonists, preparations from the heparin group, platelet aggregation inhibitors excluding heparin, direct thrombin inhibitors, direct factor Xa inhibitors, other antithrombotic agents, selective serotonin reuptake inhibitors and nasal steroids (ORs ranging from 1.15 to 3.55). Overall, epistaxis risk is increased by multiple medical and psychiatric disorders. Several antithrombotic and nasal steroid therapies are also associated with this risk.

  3. The utility of FloSeal haemostatic agent in the management of epistaxis.

    Science.gov (United States)

    Khan, M K; Reda El Badawey, M; Powell, J; Idris, M

    2015-04-01

    FloSeal, a locally applied haemostatic agent, has been shown to be effective in a variety of clinical situations. This study investigated its potential benefits in the management of epistaxis. The outcomes of a series of patients with epistaxis presenting to one ENT unit, over a two-month period, were compared. Patients were either treated with FloSeal or traditional epistaxis management techniques. Success of FloSeal was classed as complete haemostasis after its application, without the need for further interventions and no readmission with epistaxis within 7 days. Our study comprised 101 adults, with a mean age of 70 years (range, 22-98 years). The overall success rate for FloSeal was 14 per cent (5 out of 36 cases). It was successful in 66 per cent of anterior epistaxis cases (2 out of 3) and in only 9 per cent of posterior epistaxis cases (3 out of 33). There was a significantly higher failure rate of FloSeal compared with nasal packing in posterior epistaxis (p epistaxis.

  4. Intranasal bevacizumab in the treatment of HHT -related epistaxis: a systematic review.

    Science.gov (United States)

    Stokes, P; Rimmer, J

    2018-03-01

    Hereditary haemorrhagic telangiectasia (HHT) remains a difficult disease for the ENT specialist to manage. Affected patients often report recurrent epistaxis as the most debilitating symptom. The pathogenesis of the disease is due to genetic mutations affecting angiogenesis. For this reason, the anti-angiogenic therapy bevacizumab has gained popularity in the local treatment of epistaxis in patients with HHT. A systematic review of the efficacy of bevacizumab in local treatment of epistaxis in patients with HHT based on epistaxis duration, frequency, severity and impact on quality of life. A systematic search was performed using the PubMed, MEDLINE and EMBASE databases. The Preferred Items for Systematic Reviews and Meta-Analyses guidelines were followed. Studies that measured the efficacy of intranasal bevacizumab treatment of epistaxis in patients with HHT were included for qualitative analysis. Thirteen studies (four randomised controlled trials, three prospective studies, three retrospective studies, one case series and two case reports) with a total of 357 patients were included. Local administration (either by submucosal injection or topically) did not have a significant impact on epistaxis duration, frequency, severity or quality of life compared to placebo or other local treatments. The available evidence suggests that intranasal bevacizumab treatment does not have a significant effect on epistaxis in patients with HHT. There are several limitations that require further investigation to confidently rule out local bevacizumab as an effective therapy in HHT related epistaxis.

  5. Impact of liver disease on outcomes of patients hospitalized for epistaxis.

    Science.gov (United States)

    Mohamed, Omar M; Govindan, Aparna; Filimonov, Andrey; Sylvester, Michael J; Zaki, Michael; Baredes, Soly; Eloy, Jean Anderson

    2017-12-01

    Liver disease (LD) often results in coagulation abnormalities that may predispose to more severe epistaxis. The purpose of this analysis was to examine characteristics of patients hospitalized for epistaxis with LD and explore the impact of LD on patient outcomes. The 2002 to 2013 National Inpatient Sample was queried for cases with a primary diagnosis of epistaxis. Cases with additional codes meeting the Agency for Healthcare Research and Quality's definition of LD were identified and compared to the non-LD cohort. Out of 39,879 cases meeting inclusion criteria, 3.6% had LD. LD was associated with younger age (55.7 years vs. 67.5 years; P epistaxis, LD resulted in greater morbidity and mortality. Clinicians should be aware of the particular risk that LD bears on the hospitalized epistaxis patient. 2C. Laryngoscope, 127:2691-2697, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  6. Risk factors for epistaxis in jump racing in Great Britain (2001-2009).

    Science.gov (United States)

    Reardon, Richard J M; Boden, Lisa A; Mellor, Dominic J; Love, Sandy; Newton, Richard J; Stirk, Anthony J; Parkin, Timothy D

    2015-07-01

    The aim of this study was to evaluate risk factors associated with developing epistaxis in jump racing in Great Britain (GB). A retrospective analysis of records from horses running in all hurdle and steeplechase races in GB between 2001 and 2009 identified diagnoses of epistaxis whilst still at the racecourse. Data were used from 603 starts resulting in epistaxis (event) and 169,065 starts resulting in no epistaxis (non-event) in hurdle racing, and from 550 event starts and 102,344 non-event starts in steeplechase racing. Two multivariable logistic regression models to evaluate risk factors associated with epistaxis were produced. The potential effect of clustering of data (within horse, horse dam, horse sire, trainer, jockey, course, race and race meet) on the associations between risk factors and epistaxis was examined using mixed-effects models. Multiple factors associated with increased risk of epistaxis were identified. Those identified in both types of jump racing included running on firmer ground; horses with >75% of career starts in flat racing and a previous episode of epistaxis recorded during racing. Risk factors identified only in hurdle racing included racing in the spring and increased age at first race; and those identified only in steeplechase racing included running in a claiming race and more starts in the previous 3-6 months. The risk factors identified provide important information about the risk of developing epistaxis. Multiple avenues for further investigation are highlighted, including unmeasured variables at the level of the racecourse. The results of this study can be used to guide the development of interventions to minimise the risk of epistaxis in jump racing. Copyright © 2015. Published by Elsevier Ltd.

  7. Demographic, Seasonal, and Geographic Differences in Emergency Department Visits for Epistaxis.

    Science.gov (United States)

    Chaaban, Mohamad R; Zhang, Dong; Resto, Vicente; Goodwin, James S

    2017-01-01

    Objective To determine the demographics and seasonal and geographic variation of epistaxis in the United States. Study Design Retrospective cohort analysis based on data from Medicare claims. Setting Emergency department visits. Subjects and Methods We used a 5% sample of Medicare data from January 2012 to December 2012. Our cohort included patients with an incident diagnosis of epistaxis during a visit to the emergency department, excluding those with a diagnosis in the prior 12 months. Demographics included age, sex, race, and ethnicity. We compared the rate of emergency department visits for epistaxis by geographic division and individual states. Results In the 5% sample of Medicare data, 4120 emergency department visits for incident epistaxis were identified in 2012. Our results showed an increase in the emergency department visits for epistaxis with age. Compared with patients 85 years old were 1.36 (95% confidence interval [95% CI], 1.23-1.50), 2.37 (95% CI, 2.14-2.62), and 3.24 (95% CI, 2.91-3.62) more likely to present with epistaxis, respectively. Men were 1.24 (95% CI, 1.17-1.32) times more likely to present with epistaxis than women. Blacks were 1.23 (95% CI, 1.10-1.36) times more likely to present with epistaxis when compared with non-Hispanic whites. Epistaxis emergency department visits were 40% lower in the summer months versus winter. The seasonal variation was more pronounced in the northern versus southern United States. Conclusion Emergency department visits for epistaxis increase with age and appear to be seasonal, with a more pronounced variation in the northern versus southern United States.

  8. Arterial ligation versus embolization in epistaxis management: Counterintuitive national trends.

    Science.gov (United States)

    Sylvester, Michael J; Chung, Sei Y; Guinand, Luis A; Govindan, Aparna; Baredes, Soly; Eloy, Jean Anderson

    2017-05-01

    Arterial ligation and embolization are treatment modalities indicated in severe and refractory epistaxis. The purpose of this study was to examine temporal trends and compare outcomes in treatment of hospitalized epistaxis patients with ligation or embolization. This retrospective cohort analysis utilized the 2008 to 2013 National Inpatient Sample to identify patients admitted with a primary diagnosis of epistaxis, and an associated procedure code for ligation or embolization. A total of 1,813 cases met the inclusion criteria, with 57.1% undergoing ligation. During the study period, treatment with ligation has trended downward, whereas treatment with embolization has remained constant. Overall, ligated patients were older (64.1 vs. 62.4 years; P = 0.027) and had higher rates of congestive heart failure (15.1% vs. 9.8%; P = 0.001). No significant differences in rates of chronic pulmonary disease, coagulopathy, liver disease, or hereditary hemorrhagic telangiectasia were observed between cohorts. No differences were observed in rates of blood transfusion, stroke, blindness, or in-hospital mortality; however, ligated patients had lower rates of intubation/tracheostomy (2.8% vs. 5.3%; P = 0.009). Ligated patients also experienced shorter hospital stays (3.6 vs. 4.0 days; P = 0.014) and incurred lower hospital charges ($33,029 vs. $69,304; P < 0.001). Compared to embolization, ligation is associated with significantly decreased hospital charges and shorter hospital stay, without an increase in complication rates. Counterintuitively, ligation appears to be trending downward nationally in its use relative to embolization. 2C Laryngoscope, 127:1017-1020, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  9. Uncontrolled Epistaxis Secondary to Traumatic Pseudoaneurysm of the Maxillary Artery

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    Eelam Adil

    2011-01-01

    Full Text Available We describe a rare case of traumatic pseudoaneurysm of the maxillary artery following a fall. The patient presented with epistaxis that could not be controlled with anterior and posterior nasal packing. She was urgently taken to the angiography suite for evaluation and ultimately underwent embolization of a left maxillary artery pseudoaneurysm with 500–700 micron Contour PVA followed by coiling with two 3 mm Tornado coils. Bleeding subsided after embolization, and the patient suffered no neurologic sequelae.

  10. Consideraciones Legales Relativas a la Privacidad en Proyectos de Cloud Computing en el Exterior de Argentina

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    Juan Cruz González Allonca

    2014-02-01

    Full Text Available El modelo de prestación de servicios de cómputo en la nube (cloud computing ofrece múltiples ventajas tanto técnicas como económicas para las empresas y organismos que deciden implementarla. Este modelo, sin embargo, requiere tener consideraciones de carácter legal y de cumplimiento normativo desde el inicio del proyecto. Este estudio se propone recorrer la normativa argentina relativa a la protección de datos personales bajo esta plataforma, brindándole al lector un panorama sobre el cuerpo normativo vigente que debe ser aplicado a servicios de cloud computing en el exterior del país. A su vez identifica los riesgos asociados a estos servicios que deben ser contemplados con el fin de evitar responsabilidades.

  11. The effects of epistaxis on health-related quality of life in patients with hereditary hemorrhagic telangiectasia.

    Science.gov (United States)

    Merlo, Christian A; Yin, Linda X; Hoag, Jeffrey B; Mitchell, Sally E; Reh, Douglas D

    2014-11-01

    Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease mainly characterized by epistaxis in more than 96% of patients. Recently, a validated questionnaire known as the HHT Epistaxis Severity Score (ESS) was developed. However, little is known about the relationship between epistaxis and quality of life. We hypothesize that epistaxis severity is a major factor predicting health-related quality of life (HR-QoL) in HHT patients. This is a cross-sectional study. The ESS questionnaire and Medical Outcomes Study 36-item short form (SF-36) were administered to subjects through an Internet survey. All participants had a definitive diagnosis of HHT through Curaçao criteria or genetic testing. Demographic information, genetics, and extensive histories were also collected. Descriptive analyses were performed with calculations of means and standard deviations (SDs) for continuous variables and proportions for categorical variables. Linear regressions were then performed to assess the association between HR-QoL and ESS. A total of 604 subjects participated between April and August 2008. All patients reported epistaxis, 285 (47.2%) had telangiectasias, and 545 (90.2%) had a family history of HHT; 167 (27.6%) patients had mild epistaxis (ESS epistaxis (≥4 ESS epistaxis (ESS ≥7). Patients with severe epistaxis had lower scores for both the Physical Component Summary (PCS) and the Mental Component Summary (MCS) of HR-QoL when compared to those with mild epistaxis (p epistaxis. © 2014 ARS-AAOA, LLC.

  12. CONSIDERACIONES RELACIONADAS CON LAS INSPECCIONES DE SOFTWARE

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    Bexy Alfonso Espinosa

    2006-04-01

    Full Text Available

     

     

    Las consideraciones que en el presente trabajo se reflejan están enfocadas a enfatizar la importancia y necesidad de la aplicación de técnicas de verificación como las inspecciones de software, en la industria de software. Especialmente si de pequeñas y medianas empresas se trata pues en ellas recae la responsabilidad de lograr una industria de software de excelencia y con la calidad requerida en países en vías de desarrollo. Se analizan además, una serie de autores y las investigaciones que han realizado relativas a la concepción del proceso de inspección de software y los recursos y personal que deben tenerse en cuenta para ello.

  13. A blind area of origins of epistaxis: technical or cognitive?

    Science.gov (United States)

    Wei, Wei; Lai, Yuting; Zang, Chaoping; Luo, Jiqin; Zhu, Bijun; Liu, Quan; Liu, Ying

    2018-04-24

    To investigate common origins and features of anterior epistaxis. Patients (168) with anterior nose bleed were studied from May to October 2013. Endoscopic examination with angled endoscope and then subsequent management (radiofrequency, selective packing,) was performed. Under thorough nasal endoscopy, anterior nasal bleeding origin was ranked in turn as follows: the anterior nasal septum (NS 83.3%), the small area of anterior lateral wall of nasal cavity corresponding to the nasal back (NB 7.1%), the anterior end of the inferior turbinate (IT 5.4%), and the nasal part of the nasal cavity roof (NR 4.2%). Arterial lesion and hypertension led to large instant quantity of bleeding; hypertension and negligible bleeding origin prolonged bleeding duration. Bleeding was successfully controlled with nasal endoscopy and radiofrequency or selective packing. The arterial bleeding small area of anterior lateral wall of nasal cavity corresponding to the nasal back and the nasal part of the nasal cavity roof accounted for more than 10% of anterior epistaxis and a thorough endoscopic examination should include these area with angled endoscope. Then radiofrequency and selective packing will sharply reduce the bleeding duration.

  14. Endovascular Treatment of Traumatic Pseudoaneurysm Presenting as Intractable Epistaxis

    International Nuclear Information System (INIS)

    Zhang, Chang wei; Xie, Xiao dong; You, Chao; Mao, Bo yong; Wang, Chao hua; He, Min; Sun, Hong

    2010-01-01

    To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudo aneurysms presenting as intractable epistaxis. For 14 consecutive patients with traumatic pseudo aneurysm presenting as refractory epistaxis, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudo aneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (Inca); out of which, two were managed with detachable balloons, two with covered s tents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from Inca pseudo aneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. In patients presenting with a history of cranio cerebral trauma, traumatic pseudo aneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudo aneurysms

  15. Endovascular Treatment of Traumatic Pseudoaneurysm Presenting as Intractable Epistaxis

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Chang wei; Xie, Xiao dong; You, Chao; Mao, Bo yong; Wang, Chao hua; He, Min; Sun, Hong [Sichuan University West China Hospital, Chengdu (China)

    2010-12-15

    To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudo aneurysms presenting as intractable epistaxis. For 14 consecutive patients with traumatic pseudo aneurysm presenting as refractory epistaxis, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudo aneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (Inca); out of which, two were managed with detachable balloons, two with covered s tents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from Inca pseudo aneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. In patients presenting with a history of cranio cerebral trauma, traumatic pseudo aneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudo aneurysms

  16. Intractable epistaxis: which arteries are responsible? An angiographic study.

    Science.gov (United States)

    de Bonnecaze, Guillaume; Gallois, Y; Chaynes, P; Bonneville, F; Dupret-Bories, A; Chantalat, E; Serrano, E

    2017-11-01

    Epistaxis constitutes a significant proportion of the Otolaryngologist's emergency workload. Optimal management differs in relation to the anatomic origin of the bleeding. The outcome of our study was to determine which artery(ies) could be considered as the cause of severe bleeding in the context of severe epistaxis. Fifty-five procedures of embolization preceded by angiography were reviewed. Medical records of interventionally treated patients were analysed for demographics, medical history, risk factors and clinical data. Angiographic findings were also assessed for active contrast extravasation (blush), vascular abnormality and embolised artery. Previous angiography showed an active contrast extravasation in only 20 procedures. The most common bleeding source was the sphenopalatine artery (SPA) followed by anterior ethmoïdal artery (AEA) and facial artery. Majority of multiple or bilateral extravasations occured in patients with systemic factors. A better understanding of the potential bleeding source might help and limit the risk of treatment failures. Our study confirms that the SPA is the most common cause of severe bleeding. We also emphasise the role of the AEA not only in traumatic context. Others arteries are rarely involved except in patients with comorbidities or frequent recurrences.

  17. Association between Hypertension and Epistaxis: Systematic Review and Meta-analysis.

    Science.gov (United States)

    Min, Hyun Jin; Kang, Hyun; Choi, Geun Joo; Kim, Kyung Soo

    2017-12-01

    Objective Whether there is an association or a cause-and-effect relationship between epistaxis and hypertension is a subject of longstanding controversy. The objective of this systematic review and meta-analysis was to determine the association between epistaxis and hypertension and to verify whether hypertension is an independent risk factor of epistaxis. Data Sources A comprehensive search was performed using the MEDLINE, EMBASE, and Cochrane Library databases. Review Methods The review was performed according to the Meta-analysis of Observational Studies in Epidemiology guidelines and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Results We screened 2768 unique studies and selected 10 for this meta-analysis. Overall, the risk of epistaxis was significantly increased for patients with hypertension (odds ratio, 1.532 [95% confidence interval (CI), 1.181-1.986]; number needed to treat, 14.9 [95% CI, 12.3-19.0]). Results of the Q test and I 2 statistics suggested considerable heterogeneity ([Formula: see text] = 0.038, I 2 = 49.3%). The sensitivity analysis was performed by excluding 1 study at a time, and it revealed no change in statistical significance. Conclusion Although this meta-analysis had some limitations, our study demonstrated that hypertension was significantly associated with the risk of epistaxis. However, since this association does not support a causal relationship between hypertension and epistaxis, further clinical trials with large patient populations will be required to determine the impact of hypertension on epistaxis.

  18. Epistaxis grading in Osler's disease: comparison of comprehensive scores with detailed bleeding diaries.

    Science.gov (United States)

    Parzefall, Thomas; Wolf, Axel; Frei, Klemens; Kaider, Alexandra; Riss, Dominik

    2017-03-01

    Use of reliable grading scores to measure epistaxis severity in hereditary hemorrhagic telangiectasia (HHT) is essential in clinical routine and for scientific purposes. For practical reasons, visual analog scale (VAS) scoring and the Epistaxis Severity Score (ESS) are widely used. VAS scores are purely subjective, and a potential shortcoming of the ESS is that it is based on self-reported anamnestic bleeding data. The aim of this study was to validate the level of correlation between VAS scores, the ESS, and actual bleeding events, based on detailed epistaxis diaries of patients. Records from daily epistaxis diaries maintained by 16 HHT patients over 112 consecutive days were compared with the monthly ESS and daily VAS scores in the corresponding time period. The Spearman rank correlation coefficient, analysis of variance models, and multiple R 2 measures were used for statistical analysis. Although the ESS and VAS scores generally showed a high degree of correlation with actual bleeding events, mild events were underrepresented in both scores. Our results highlight the usefulness of the ESS as a standard epistaxis score in cohorts with moderate to severe degrees of epistaxis. The use of detailed epistaxis diaries should be considered when monitoring patients and cohorts with mild forms of HHT. © 2016 ARS-AAOA, LLC.

  19. Nasal Bacterial Colonization in Pediatric Epistaxis: The Role of Topical Antibacterial Treatment

    Directory of Open Access Journals (Sweden)

    Mukaddder Korkmaz

    2016-04-01

    Full Text Available Background: Epistaxis is a common problem in childhood. It has been shown that children with recurrent epistaxis are more likely to have nasal colonization with Staphylococcus aureus. It has been suggested that low-grade inflammation, crusting and increased vascularity due to bacterial colonization contributes to the development of epistaxis in children. Aims: This study aimed to investigate the nasal colonization and treatment outcome in pediatric epistaxis patients. Study Design: Retrospective cross-sectional study. Methods: Charts of the pediatric patients referred to our university hospital otolaryngology outpatient clinics for the evaluation of epistaxis were reviewed. The patients whose nasal cultures had been taken at the first clinical visit comprised the study group. Results: Staphylococcus aureus was the most common bacteria grown. The presence of crusting and hypervascularity was not dependent on the type of bacterial growth and there was no relation between hypervascularity and crusting of the nasal mucosa. Thirty-six patients were evaluated for the outcome analysis. Resolution of bleeding was not dependent on nasal colonization; in patients with colonization, there was no difference between topical antibacterial and non-antibacterial treatments. Conclusion: Despite the high colonization rates, topical antibacterial treatment was not found superior to non-antibacterial treatment. Our study does not support the belief that bacterial colonization results in hypervascularity of the septal mucosa causing epistaxis since no relation was found between nasal colonization, hypervascularity and crusting. The role of bacterial colonization in pediatric epistaxis need to be further investigated and treatment protocols must be determined accordingly.

  20. Assessment of red blood cell distribution width and mean platelet volume in children with epistaxis.

    Science.gov (United States)

    Üstün Bezgin, Selin; Çakabay, Taliye; Odaman Al, Işık

    2017-04-01

    This study aimed to investigate whether there is a relationship between red blood cell distribution width, mean platelet volume and epistaxis in children. Between January 2015 and July 2016, 105 children who were referred to our clinic with epistaxis and 100 sex- and age-matched controls were retrospectively analyzed. Red blood cell distribution width (RDW) and mean platelet volume (MPV) values were determined in both groups. RDW values were found significantly (P epistaxis than in the control group (11.95 ± 1.31 vs. 12.74 ± 1.21). MPV was 7.49 ± 1.33 in the group with epistaxis and 7.23 ± 1.06 in the control group, and there was no significant difference between the groups (p > 0.05). We found no difference between MPV values of both groups and significantly lower RDW values in children with epistaxis. Decreased RDW values were considered as an accompanying marker rather than a result of epistaxis. In addition, it may be thought that low RDW values may increase the bleeding tendency by disrupting the thrombotic activities. Further studies are needed to validate the relation of these parameters with epistaxis and its mechanisms. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Internal Carotid Artery Aneurysms Presenting with Epistaxis - Our Experience and Review of Literature.

    Science.gov (United States)

    Garg, Kanwaljeet; Gurjar, Hitesh Kumar; Singh, Pankaj Kumar; Singh, Manmohan; Chandra, P Sarat; Sharma, Bhawani Shankar

    Intracranial internal carotid artery aneurysms are an extremely rare cause of spontaneous epistaxis, with a few documented cases. The management of such cases is challenging due to the relative anatomical inaccessibility of the bleeding point. The aim of the present study was to acquaint the readers with this rare type of aneurysm presenting with epistaxis and to report our experience of treating cases of severe epistaxis due to internal carotid artery (ICA) aneurysms. Data of 4 patients with İCA aneurysms presenting with epistaxis from June 2011 to July 2013 was retrospectively reviewed. The age of patients ranged from 16 to 62 years. Duration of epistaxis ranged from 3 months to 3 years. Two patients had severe epistaxis following transnasal biopsy. Two patients had a history of trauma. Two patients developed hemodynamically instability. All the patients were managed with trapping of the aneurysm. Complete exclusion of aneurysm from circulation was achieved in all the patients. ICA aneurysms can rarely present as life-endangering epistaxis. In patients presenting with a history of craniocerebral trauma, traumatic pseudoaneurysm must be considered as a differential diagnosis. Trapping of the aneurysm is a good option if there is good cross circulation.

  2. Notas sobre Matisia longiflora Gleas. (Bombacaceae Notas sobre Matisia longiflora Gleas. (Bombacaceae

    Directory of Open Access Journals (Sweden)

    Fernández Alonso José Luis

    1992-09-01

    Full Text Available Dentro del grupo de géneros de bombacáceas de hojas simples que componen la tribu Quararibeae (= Matisieae Hutchinson, es Matisia Humb. & Bonpl. el que cuenta con mayor número de especies en Colombia. Al respecto se presentaron recientemente algunas consideraciones preliminares sobre la diversidad de especies en este grupo en Colombia (Fernández Alonso, 1991.

  3. ESTADO DEL ARTE DE IPTV Y CONSIDERACIONES TÉCNICAS PARA SU MIGRACIÓN A IPV6 EN COLOMBIA

    Directory of Open Access Journals (Sweden)

    Danilo Alfonso López Sarmiento

    2011-08-01

    Full Text Available El artículo tiene como objetivos centrales hacer una revisión del estado del arte de IPTV (Televisión a través de IP y una propuesta para la implementación de esta tecnología en Colombia sobre una red IPv6. La convergencia de las teleco-municaciones ha dado origen a aplicaciones IP que permiten acceso a contenidos audiovisuales digitalizados a través de re-des que hacen uso de dicho protocolo. Se abordanestudios ac-tuales que tratan características fundamentales de televisión sobre la red de datos,  como el funcionamiento, la arquitectura, los estándares en los que se basa, propuestas para evaluar las políticas de calidad de servicio y por ultimo consideraciones técnicas para su implementación en una red IPv6.

  4. Spontaneous sphenopalatine pseudoaneurysm: recurrent epistaxis in a patient with cryptogenic vasculopathy

    Science.gov (United States)

    Goh, Samantha; Ritchie, Louisa; Joseph, Theo; Brookes, Jocelyn

    2015-01-01

    We present a unique case of recurrent epistaxis secondary to a spontaneous sphenopalatine artery aneursym in a young woman. This was investigated with an external carotid artery angiogram and subsequently treated successfully with endovascular embolisation of the aneurysm. PMID:26113592

  5. The frequency and severity of epistaxis in children with sickle cell anaemia in eastern Uganda

    DEFF Research Database (Denmark)

    Nardo-Marina, Amina Nielsen; Williams, Thomas N; Olupot-Olupot, Peter

    2017-01-01

    BACKGROUND: There are a paucity of data on epistaxis as it pertains to sickle cell anaemia. Some case studies suggest epistaxis to be a significant complication in patients with sickle cell anaemia in sub-Saharan Africa; however, no robust studies have sought to establish the epidemiology...... or pathophysiology of this phenomenon. METHODS: We conducted a case-control study with the aim of investigating the importance of epistaxis among children presenting with sickle cell anaemia at the Mbale Regional Referral Hospital in eastern Uganda. Cases were children aged 2-15 years with an existing diagnosis...... of laboratory confirmed sickle cell anaemia, while controls were children without sickle cell anaemia who were frequency matched to cases on the basis of age group and gender. The frequency and severity of epistaxis was assessed using a structured questionnaire developed specifically for this study. Odds ratios...

  6. Acute epistaxis. How to spot the source and stop the flow.

    Science.gov (United States)

    Alvi, A; Joyner-Triplett, N

    1996-05-01

    The goals of epistaxis treatment are control of hemorrhage, prevention of cardiovascular and airway compromise, and determination of the cause and the source of bleeding. Distinguishing anterior from posterior epistaxis is important because therapeutic approaches differ. Epistaxis can usually be managed nonsurgically, but a surgical procedure is sometimes necessary. Cauterization, nasal packing, and use of an intranasal tampon or balloon catheter are effective nonsurgical interventions, but they may cause sinusitis, middle ear effusion, patient discomfort, and hypoxia. Surgical interventions include arterial ligation, endoscopic cauterization, and angiographic embolization. These highly effective methods incur the risks of general anesthesia and require technical expertise. A thorough and methodical approach to epistaxis is necessary, with otolaryngologic consultation when appropriate.

  7. Sub-labial packing: a novel method of stopping epistaxis from Little's area.

    Science.gov (United States)

    Venettacci, O; Nettlefold, C; Chan, L; Daniel, M; Curotta, J

    2013-08-01

    Epistaxis is frequently managed both by patients in the community and by health professionals. Many methods have been described in the literature about how to manage this condition. Epistaxis is usually due to anterior circulation bleeding at an area known as Kiesselbach's plexus (Little's area). Five vessels supply Little's area; one of these, the septal branch of the superior labial artery, can be compressed via an easy and novel technique, sub-labial packing. Sub-labial packing is a technique proposed as an adjunct to the standard 15 min ala nasi compression as a simple yet effective technique to stop epistaxis. We hereby report two cases of managing epistaxis from Little's area using sub-labial packing. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Selective embolization in the treatment of intractable epistaxis

    DEFF Research Database (Denmark)

    Andersen, Pia Juul; Kjeldsen, Anette Drøhse; Nepper-Rasmussen, Jørgen

    2005-01-01

    : This was a retrospective review. Post-treatment effects and complications were evaluated by means of a questionnaire and a telephone interview. Owing to the different treatment strategies used, the results were evaluated for 2 groups of patients: Group A, 9 patients with HHT; and Group B, 13 patients with causes...... the bleeding may present difficulties. Several methods are used to control posterior epistaxis, one of the latest treatment strategies being selective embolization of the nasal arteries. The aim of this study was to describe the effect of selective embolization in 22 patients treated with a total of 30...... procedures at the ENT Department of Odense University Hospital between January 1995 and March 2004. To our knowledge this is the first Nordic work in which selective embolization has been used as a treatment strategy for patients with hereditary hemorrhagic telangiectasia (HHT). MATERIAL AND METHODS...

  9. Endovascular Treatment of Incoercible Epistaxis and Epidural Cerebral Hematoma: A Case Report

    OpenAIRE

    Bortoluzzi, M.; Pavia, M.

    2006-01-01

    A young patient with a facial trauma after a road accident was admitted to our department with incoercible epistaxis. A CT scan showed a right pterional acute epidural hematoma (EDH). Angiography demonstrated multiple sources of bleeding of the right sphenopalatine arteries, cause of the epistaxis, and an intracranial leakage of the right middle meningeal artery, responsible for the EDH. The patient immediately underwent embolization of the right internal maxillary artery and right middle men...

  10. Incidence, risk factors and management of severe post-transsphenoidal epistaxis.

    Science.gov (United States)

    De Los Reyes, Kenneth M; Gross, Bradley A; Frerichs, Kai U; Dunn, Ian F; Lin, Ning; Rincon-Torroella, Jordina; Annino, Donald J; Laws, Edward R

    2015-01-01

    Among the major complications of transsphenoidal surgery, less attention has been given to severe postoperative epistaxis, which can lead to devastating consequences. In this study, we reviewed 551 consecutive patients treated over a 4 year period by the senior author to evaluate the incidence, risk factors, etiology and management of immediate and delayed post-transsphenoidal epistaxis. Eighteen patients (3.3%) developed significant postoperative epistaxis - six immediately and 12 delayed (mean postoperative day 10.8). Fourteen patients harbored macroadenomas (78%) and 11 of 18 (61.1%) had complex nasal/sphenoid anatomy. In the immediate epistaxis group, 33% had acute postoperative hypertension. In the delayed group, one had an anterior ethmoidal pseudoaneurysm, and one had restarted anticoagulation on postoperative day 3. We treated the immediate epistaxis group with bedside nasal packing followed by operative re-exploration if conservative measures were unsuccessful. The delayed group underwent bedside nasal hemostasis; if unsuccessful, angiographic embolization was performed. After definitive treatment, no patients had recurrent epistaxis. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. N-Butyl Cyanoacrylate Proved Beneficial to Avoid a Nontarget Embolization of the Ophthalmic Artery in Endovascular Management of Epistaxis

    Science.gov (United States)

    Shuster, A.; Gunnarsson, T.; Klurfan, P.; Larrazabal, R.

    2011-01-01

    Summary Epistaxis is a common disorder affecting equally both genders. Posterior origin of epistaxis in some instances requires endovascular treatment. Anastomoses between external carotid artery and internal carotid or ophthalmic arteries heighten the risk of stroke or blindness, if particles of polyvinyl alcohol are used for embolization. We report a case of 90-year-old man for whom successful embolization with N-Butyl Cyanoacrylate glue was performed as an alternative treatment for recurrent epistaxis. PMID:21561554

  12. Influencia del índice de masa corporal y de otros factores de interés metabólico en los niveles de proteína C reactiva: Consideraciones sobre su posible valoración como marcador de comorbilidad y aspectos psiquiátricos Influence of the body mass index and other metabolic factors on the C-reactive protein: Considerations as a possible biomarker of comorbidity and psychiatric aspects

    Directory of Open Access Journals (Sweden)

    Jesús Medialdea Cruz

    2012-09-01

    Full Text Available Objetivos: El sobrepeso y la obesidad, por su frecuencia y la importancia médica de las complicaciones que conllevan, se han estudiado bajo muchos aspectos por su complejidad y heterogeneidad. El presente trabajo trata de estudiar en una muestra de 123 sujetos pertenecientes al sector aéreo (pilotos, controladores y tripulantes aéreos los siguientes aspectos: 1 Influencia del índice de masa corporal (IMC en los niveles de proteína C reactiva (PCR; 2 Frecuencia del Síndrome Metabólico (SM en la muestra seleccionada; 3 Relación entre la presencia de SM y los niveles de PCR; 4 valoración del nivel de PCR en función del número de criterios de SM; 5 Por último, algunas consideraciones bajo el punto de vista psiquiátrico de los resultados, según la literatura consultada. Material y métodos: A la muestra aleatoria seleccionada de 123 sujetos se les valoró los datos antropométricos (peso, talla, circunferencia de cintura, IMC y tensión arterial sistólica y diastólica, y se les determinó en suero el nivel de colesterol total, lipoproteínas de alta densidad (HDL, glucosa y triglicéridos, así como la PCR por métodos ultrasensibles. Resultados: Los resultados reflejaron una frecuencia de 36,5 % de individuos que cumplían los criterios de SM. Así mismo, se observó un incremento significativo de los niveles de PCR, que estaba relacionado con el número de criterios utilizados en el diagnóstico del mismo, así como un incremento de la PCR en aquellos sujetos con sobrepeso u obesidad con respecto a los sujetos con peso normal. Conclusiones: La PCR, como respuesta a un status inflamatorio, puede ayudarnos como marcador de comorbilidad de SM y de sujetos con sobrepeso y/o obesidad, y sugerirnos la existencia de una base inflamatoria que pueda tener influencia en el desarrollo de enfermedades cardiovasculares, metabólicas o en la aparición de trastornos psiquiátricos (sobre todo de tipo depresivo y su posible aplicación terap

  13. Consideraciones esenciales para un modelo estratégico de negocio del diseño en Cuba

    Directory of Open Access Journals (Sweden)

    Miguel Ángel Rubio Toledo

    2017-06-01

    Full Text Available Las recientes modificaciones políticas y económicas en Cuba, han generado la posibilidad de desarrollar potencialmente negocios de diversa índole, donde la gestión estratégica del diseño puede ser un factor de crecimiento sostenido tanto para los negocios en un sentido amplio, como específicos de diseño. Así, el objetivo de este trabajo es analizar algunos argumentos básicos desde diversos autores especializados, con el fin de establecer algunas consideraciones esenciales para la creación de un modelo estratégico de negocio de diseño para Cuba. Metodológicamente, parte de los antecedentes y contexto general, para determinar el problema a través de un diagnóstico en cuanto a las oportunidades actuales sobre negocios de diseño en Cuba, y se problematiza con algunos argumentos teóricos. Luego, se discuten algunas reflexiones y pautas que permiten moldear estas consideraciones esenciales o primarias. Finalmente, en las conclusiones se ejemplifica el resultado del análisis con fines sumarios.

  14. Successful Implementation of a Clinical Care Pathway for Management of Epistaxis at a Tertiary Care Center.

    Science.gov (United States)

    Vosler, Peter S; Kass, Jason I; Wang, Eric W; Snyderman, Carl H

    2016-11-01

    We compare the management of patients with severe epistaxis before and after the implementation a clinical care pathway (CCP) to standardize care, minimize hospital stay, and decrease cost. Single prospective analysis with historical control. Tertiary academic hospital. Patients treated for epistaxis between October 2012 to December 2013 were compared with a prospective analysis of patients treated for severe epistaxis after implementation of a CCP from June 2014 to February 2015. Severe epistaxis was defined as nasal bleeding not able to be controlled with local pressure, topical vasoconstrictors, or simple anterior packing. Severe epistaxis was similar in the pre- and post-CCP cohorts: 24.7% (n = 42) vs 18.9% (n = 22), respectively. Implementation of early sphenopalatine artery ligation resulted in decreased number of days packed (3.2 ± 1.6 to 1.4 ± 1.6; P = .001), decreased hospital stay (5.2 ± 3.9 to 2.1 ± 1.3 days; P vs 54.5%; P = .035), admission to an appropriate hospital location with access to key resources (41.7% vs 83.3%; P = .007), and decreased overall cost of hospitalization by 66% ($9435 saved). No patients received embolization after the CCP was implemented. Implementation of a CCP decreased hospital stay and days of packing, facilitated definitive care in patients with severe epistaxis, improved patient safety, and decreased cost. The results of this study can serve as a model for the management of severe epistaxis and for future quality improvement measures. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  15. An outcomes analysis of anterior epistaxis management in the emergency department.

    Science.gov (United States)

    Newton, E; Lasso, A; Petrcich, W; Kilty, S J

    2016-04-11

    Many treatment options exist for the management of anterior epistaxis. However, little is known about treatment outcomes. The objective was to identify the currently utilised methods of management and outcomes for patients with anterior epistaxis presenting to the emergency department (ED) at a Canadian tertiary care center. A retrospective review of ED visits from January 2012-May 2014 for adult patients with a diagnosis of anterior epistaxis was performed. Patient demographic data, comorbidities, and treatment methods were documented. The effectiveness of different treatment modalities was determined. Three hundred fifty-three primary anterior epistaxis cases were included. Mean patient age was 70 years and 49% of patients were female. Comorbidities included hypertension (56%), diabetes (19%), CAD (28%), and atrial fibrillation (27%). A large proportion of the cohort (61%) was on at least one anticoagulant or antiplatelet therapy. The most common utilised treatment modalities were silver nitrate cauterization, Merocel®, petroleum gauze packing, nasal clip and 15% were simply observed. Initial treatment success was achieved in 74% of cases. Of patients receiving specific treatment modalities, silver nitrate cauterization had the highest success rate at 80%. 26% of patients returned to the ED for recurrence of epistaxis with highest rates occurring in the nasal clip (59%), Merocel® (26%), and petroleum gauze packing (42%) groups. The differences in recurrence rate among the different treatment modalities observed may be due to true differences in effectiveness or differences in treatment selection by the ED physicians based on severity of epistaxis. Cauterization with silver nitrate, however, offers the added benefit of no need for follow up. Further study is needed to elucidate the most efficacious treatment modality based on epistaxis severity.

  16. Is chronic obstructive pulmonary disease a risk factor for epistaxis after coronary artery bypass graft surgery?

    Science.gov (United States)

    Cingoz, Faruk; Oz, Bilgehan Savas; Arslan, Gokhan; Guler, Adem; Sahin, Mehmet Ali; Gunay, Celalettin; Arslan, Mehmet

    2014-01-01

    Chronic obstructive pulmonary disease (COPD) has customarily been associated with increased surgical morbidity and mortality rates after coronary artery bypass graft surgery (CABG). The aim of this study was to determine whether there is a relationship between epistaxis and COPD after CABG surgery. There were 3 443 patients who consecutively underwent isolated CABG from January 2002 to March 2012. We retrospectively analysed the data of 27 patients (0.8%) with newly developed and serious spontaneous epistaxis, which required consultation with the Ear Nose and Throat (ENT) Department. The patients were divided into three groups according to severity of nasal bleeding. Twenty-one (77.7%) patients in the three groups had COPD. There were 19 males (70%) and eight females (30%). Their ages ranged between 52 and 72 years (mean 61 ± 5). Fifty-five per cent of the patients had hypertension and 78% had COPD. The overall duration of hospital stay was six to 11 days (mean 7.9 ± 1.1). Epistaxis was seen particularly on the fourth and seventh days postoperatively and 17 patients (63%) were treated with anterior, posterior, or anterior and posterior nasal packing (group 1). Nasal bleeding was controlled with electrocautery in six patients (22%) (group 2), and four (15%) were treated with surgical excision and blood transfusions (group 3). All patients (100%) had a good recovery with no mortality. The high coincidence between epistaxis and COPD made us wonder whether COPD may be a risk factor for epistaxis after CABG surgery. However, we could not find any direct causative link between COPD and epistaxis in patients who had undergone CABG. Epistaxis was more common in patients with COPD and it was more serious clinically in patients who had both COPD and hypertension.

  17. The long-term fate of epistaxis patients with exposure to antithrombotic medication.

    Science.gov (United States)

    Stadler, Rafael R; Kindler, Rahel; Holzmann, David; Soyka, Michael B

    2016-09-01

    The goal of this study was to evaluate independent risk factors for long-term epistaxis recurrences and their severity. Individual retrospective cohort study-2b level of evidence. The medical information of 603 emergency epistaxis patients was acquired during a former study. This cohort has been contacted 6 years later by conventional mail and asked to answer a specific paper questionnaire. The following parameters were evaluated: recurrent epistaxis episodes, need for a surgical intervention to stop the recurrent bleeding, patient's history for hypertension and diabetes, intake of hemostasis impairing medication now and in the past. One hundred and six (106) patients were included in the study (35.8 % response rate). The mean observation period was 76.58 months. Almost half of the patients (41.5 % = 44/106) reported at least one recurrent epistaxis episode. Patients with exposure to VKA (vitamin K antagonists) showed significantly more frequently a recurrent epistaxis episode. The binary logistic regression confirmed the intake of VKA as an independent and significant risk factor with an odds ratio of 11.6. Every single patient who had to undergo a surgical intervention to stop a recurrent bleeding stated ASA (Acetylsalicylic Acid) intake. We provide evidence that the intake of a vitamin K antagonist is an independent long-term risk factor for recurrent epistaxis episodes. The intake of ASA is a risk factor for the severity of recurrent epistaxis with the increased need for a surgical intervention not only in a short- but also in a long-term perspective. This prognostic investigation, designed as a combined prospective and retrospective cohort study, reaches level 2b level of evidence as it includes retrospective aspects.

  18. Breaking paradigms in severe epistaxis: the importance of looking for the S-point.

    Science.gov (United States)

    Kosugi, Eduardo Macoto; Balsalobre, Leonardo; Mangussi-Gomes, João; Tepedino, Miguel Soares; San-da-Silva, Daniel Marcus; Cabernite, Erika Mucciolo; Hermann, Diego; Stamm, Aldo Cassol

    Since the introduction of nasal endoscopy into the field of Otorhinolaryngology, the treatment paradigm for cases of severe epistaxis has shifted toward early and precise identification of the bleeding site. Although severe epistaxis is usually considered to arise from posterior bleeding, an arterial vascular pedicle in the superior portion of the nasal septum, around the axilla projection of the middle turbinate, posterior to the septal body, frequently has been observed. That vascular pedicle was named the Stamm's S-point. The aim of this study was to describe the S-point and report cases of severe epistaxis originating from it. A retrospective case series study was conducted. Nine patients with spontaneous severe epistaxis, where the S-point was identified as the source of bleeding, were treated between March 2016 and March 2017. Male predominance (77.8%) with age average of 59.3 years old were reported. Most cases presented comorbidities (88.9%) and were not taking acetylsalicylic acid (66.7%). A predominance of left sided involvement (55.6%) and anteroposterior bleeding being the principal initial presentation (77.8%) was seen. Six patients (66.7%) presented with hemoglobin levels below 10g/dL, and four (44.4%) required blood transfusion. Cauterization of S-point was performed in all patients, with complete resolution of bleeding. No patient experienced recurrence of severe epistaxis. The Stamm's S-point, a novel source of spontaneous severe epistaxis, is reported, and its cauterization was effective and safe. Otolaryngologists must actively seek this site of bleeding in cases of severe epistaxis. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  19. La Enseñanza de la Historia Consideraciones Generales.

    OpenAIRE

    Lombardi, Angel

    2003-01-01

    INDICE Presentación La Enseñanza de la Historia Consideraciones Generales Angel Lombardi "Tras su manto de neblina,..." Las Islas Malvinas como creación escolar Marí, Cristina; Saab, Jorge; Suárez, Carlos, Giufra, Lidia; Gerszenszteig, Marina; Stülgemayer, Sabrina; Avila, Andrea; Osuna Gutiérrez, Patricia; Suárez, Lourdes La...

  20. Endovascular Treatment of Traumatic Pseudoaneurysm Presenting as Intractable Epistaxis

    Science.gov (United States)

    Zhang, Chang wei; You, Chao; Mao, Bo yong; Wang, Chao hua; He, Min; Sun, Hong

    2010-01-01

    Objective To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudoaneurysms presenting as intractable epistaxis. Materials and Methods For 14 consecutive patients with traumatic pseudoaneurysm presenting as refractory epistaxes, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudoaneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (ICA); out of which, two were managed with detachable balloons, two with covered stents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. Results Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from ICA pseudoaneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. Conclusion In patients presenting with a history of craniocerebral trauma, traumatic pseudoaneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudoaneurysms. PMID:21076585

  1. Traumatic epistaxis: Skull base defects, intracranial complications and neurosurgical considerations.

    Science.gov (United States)

    Veeravagu, Anand; Joseph, Richard; Jiang, Bowen; Lober, Robert M; Ludwig, Cassie; Torres, Roland; Singh, Harminder

    2013-01-01

    Endonasal procedures may be necessary during management of craniofacial trauma. When a skull base fracture is present, these procedures carry a high risk of violating the cranial vault and causing brain injury or central nervous system infection. A 52-year-old bicyclist was hit by an automobile at high speed. He sustained extensive maxillofacial fractures, including frontal and sphenoid sinus fractures (Fig. 1). He presented to the emergency room with brisk nasopharyngeal hemorrhage, and was intubated for airway protection. He underwent emergent stabilization of his nasal epistaxis by placement of a Foley catheter in his left nare and tamponade with the Foley balloon. A six-vessel angiogram showed no evidence of arterial dissection or laceration. Imaging revealed inadvertent insertion of the Foley catheter and deployment of the balloon in the frontal lobe (Fig. 2). The balloon was subsequently deflated and the Foley catheter removed. The patient underwent bifrontal craniotomy for dural repair of CSF leak. He also had placement of a ventriculoperitoneal shunt for development of post-traumatic hydrocephalus. Although the hospital course was a prolonged one, he did make a good neurological recovery. The authors review the literature involving violation of the intracranial compartment with medical devices in the settings of craniofacial trauma. Caution should be exercised while performing any endonasal procedure in the settings of trauma where disruption of the anterior cranial base is possible. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  2. Prospective randomized trial of sclerotherapy vs standard treatment for epistaxis due to hereditary hemorrhagic telangiectasia.

    Science.gov (United States)

    Boyer, Holly; Fernandes, Patricia; Le, Chap; Yueh, Bevan

    2015-05-01

    Our previous studies have demonstrated the tolerability and low side-effect profile of office-based sclerotherapy with sodium tetradecyl sulfate (STS) for treating recurrent epistaxis due to hereditary hemorrhagic telangiectasia (HHT). The objective of this study was to use a prospective randomized trial to determine the effectiveness of sclerotherapy with STS vs standard treatment. This prospective randomized trial (conducted from November 1, 2011, through January 31, 2014) involved 17 patients with recurrent epistaxis due to HHT. We defined standard treatment as continuation of any treatment that the patient had previously undergone, such as moisturization, packing, and cautery. We used a crossover design, so study participants were randomized to either sclerotherapy or standard treatment during the first time period, and then to the other during the second period. The primary outcome measure was frequency and severity of epistaxis, as measured by the epistaxis severity score (ESS). The ESS is a 10-point scale, with higher scores corresponding to more bleeding. After controlling for treatment order, bleeding was substantially better controlled after sclerotherapy; the ESS after sclerotherapy was nearly one point lower than after standard treatment (-0.95, 1-sided p = 0.027). Treatment order, baseline ESS, the number of lesions, moisturization practices, and a history of previous blood transfusions did not significantly affect the results. This trial demonstrated that sclerotherapy with STS (vs standard treatment) significantly reduced epistaxis due to HHT. © 2015 ARS-AAOA, LLC.

  3. Thalidomide for Epistaxis in Patients with Hereditary Hemorrhagic Telangiectasia: A Preliminary Study.

    Science.gov (United States)

    Fang, Jia; Chen, Xiaomeng; Zhu, Bijun; Ye, Haibo; Zhang, Weitian; Guan, Jian; Su, Kaiming

    2017-08-01

    To evaluate the effectiveness of thalidomide for epistaxis in hereditary hemorrhagic telangiectasia (HHT), 7 HHT patients with recurrent epistaxis were treated with thalidomide at an initial dose of 50 mg/d, gradually increasing to 100 mg/d if needed. The Epistaxis Severity Score (ESS) was used to evaluate the treatment effects. Patients reported that epistaxis improved 1 to 3 weeks after starting thalidomide. The mean ESS before treatment, at the end of treatment, and 3 months after stopping treatment was 5.03 ± 2.05, 0.90 ± 0.84 ( P = .003), and 1.98 ± 1.33 ( P = .006), respectively. Four patients reported mild to moderate side effects, including drowsiness, dizziness, constipation, nausea, and peripheral neuropathy. Two patients stopped the treatment because of adverse effects. Those results showed that thalidomide may be a treatment choice for recurrent epistaxis in HHT patients, although the side effects should be considered. Further study should focus on guidelines for dosing and course and investigate how to reduce the adverse effects.

  4. Recurrent epistaxis caused by an intranasal supernumerary tooth in a young adult.

    Science.gov (United States)

    Al Dhafeeri, Hamed O; Kavarodi, Abdulmajid; Al Shaikh, Khalil; Bukhari, Ahmed; Al Hussain, Omair; El Baramawy, Ahmed

    2014-01-01

    Male, 27. Recurrent epistaxis. Nasal bleeding. -. -. Pediatrics and Neonatology. Congenital defects/diseases. Recurrent epistaxis is a common disorder among children and young adults. We report an unusual cause, intranasal supernumerary tooth causing friction with Little's area of the nasal septum. A 22-year-old male presented with recurrent, mild, unilateral left-sided epistaxis once to twice per month for 3 years. This usually occurred after minor nasal trauma or rubbing his nose. The patient also suffered from recurrent tonsillitis. There was neither history of blood transfusion or nasal packing, nor a history suggestive of bleeding diathesis. Anterior rhinoscopy revealed ivory white nasal mass antero-inferiorly in the left nasal cavity touching Little's area. There was no bleeding. Nasal endoscopy showed a white cylindrical bony mass 1 cm long arising from the floor of the nose, with no attachment to the nasal septum or the lateral wall of the nose. Examination of the right nasal cavity was unremarkable. Nasal teeth result from the ectopic eruption of supernumerary teeth and may cause a variety of symptoms including recurrent epistaxis. Their clinical and radiologic presentation is so characteristic that their diagnosis is not difficult. CT scan is helpful in planning management. Early extraction prevents further complications and prevents further attacks of epistaxis.

  5. Transarterial embolization in the management of intractable epistaxis: the angiographic findings and results based on etiologies.

    Science.gov (United States)

    Wang, Bin; Zu, Qing-Quan; Liu, Xing-Long; Zhou, Chun-Gao; Xia, Jin-Guo; Zhao, Lin-Bo; Shi, Hai-Bin; Liu, Sheng

    2016-08-01

    Transarterial embolization (TAE) appears to be a safe and effective treatment for patients with intractable epistaxis, despite different etiologies or angiography findings. Idiopathic epistaxis is prone to present with negative angiographic findings. To retrospectively evaluate the safety and effectiveness of TAE for intractable epistaxis, and focus on the factors of etiology and angiographic findings. From March 2008 to December 2014, the data of 43 patients with intractable bleeding undergoing TAE were reviewed. The outcomes of interventional therapy were assessed according to different etiology (malignant or benign disease) and angiographic finding (positive or negative angiogram). Positive angiographic findings were found in 11 of 12 cases with malignant diseases and 22 of 31 cases with benign diseases, respectively (p = 0.237). Among the 10 cases with negative angiographic findings, the negative angiography rate of idiopathic epistaxis was higher than that of epistaxis with definite etiology (p = 0.003). Bleeding was controlled successfully in all of the 43 patients after embolization. During the mean follow-up period of 24.0 ± 16.7 months, five patients relapsed. No significant difference was found in recurrence rates between malignant and benign diseases or between positive and negative angiography (p = 0.241, p = 0.704, respectively).

  6. Outcomes of recalcitrant idiopathic epistaxis in children: Septoplasty as a surgical treatment.

    Science.gov (United States)

    Levi, Jessica M; McKee-Cole, Katherine M; Barth, Patrick C; Brody, Robert M; Reilly, James S

    2016-12-01

    Our objective was to measure short- and long-term outcomes of children presenting with recalcitrant idiopathic epistaxis. The study was an 11-year (2000-2011) retrospective chart review of children evaluated and treated for epistaxis. A retrospective review of patients with diagnostic International Classification of Diseases, Ninth Revision code 784.7 (epistaxis) and 21.5/21.88 (septoplasty) was completed reviewing age at presentation, type of surgery, and number of bleeding events prior to and after surgery. In our cohort, almost 100% of children with idiopathic recurrent epistaxis responded to topical treatments. About 0.2% were refractory (20/9239), and 90% of those (18/20) resolved with either a traditional septoplasty (14/20) or modified septoplasty (6/20) without cartilage excision, with a mean follow-up of 35 months. One of the patients who did not show resolution was found to have Von Willebrand disease, which likely contributed to this outcome. Septoplasty surgery, with or without cartilage removal, appears beneficial for refractory idiopathic epistaxis in children. 4 Laryngoscope, 126:2833-2837, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  7. Epistaxis in end stage liver disease masquerading as severe upper gastrointestinal hemorrhage.

    Science.gov (United States)

    Camus, Marine; Jensen, Dennis M; Matthews, Jason D; Ohning, Gordon V; Kovacs, Thomas O; Jutabha, Rome; Ghassemi, Kevin A; Machicado, Gustavo A; Dulai, Gareth S

    2014-10-14

    To describe the prevalence, diagnosis, treatment, and outcomes of end stage liver disease (ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage (UGIH). This observational single center study included all consecutive patients with ESLD and epistaxis identified from consecutive subjects hospitalized with suspected UGIH and prospectively enrolled in our databases of severe UGIH between 1998 and 2011. A total of 1249 patients were registered for severe UGIH in the data basis, 461 (36.9%) were cirrhotics. Epistaxis rather than UGIH was the bleeding source in 20 patients. All patients had severe coagulopathy. Epistaxis was initially controlled in all cases. Fifteen (75%) subjects required posterior nasal packing and 2 (10%) embolization in addition to correction of coagulopathy. Five (25%) patients died in the hospital, 12 (60%) received orthotopic liver transplantation (OLT), and 3 (15%) were discharged without OLT. The mortality rate was 63% in patients without OLT. Severe epistaxis in patients with ESLD is (1) a diagnosis of exclusion that requires upper endoscopy to exclude severe UGIH; and (2) associated with a high mortality rate in patients not receiving OLT.

  8. An evaluation of the severity and progression of epistaxis in hereditary hemorrhagic telangiectasia (HHT) 1 vs. HHT 2

    Science.gov (United States)

    Hunter, Benjamin N.; Timmins, Benjamin H.; McDonald, Jamie; Whitehead, Kevin J.; Ward, P. Daniel; Wilson, Kevin F.

    2015-01-01

    Objective Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular dysplasia whose hallmark symptom is spontaneous recurrent epistaxis. Two major genetic sub-types of this syndrome are HHT1 and HHT2. Severity of epistaxis ranges from occasional low-volume bleeding to frequent large-volume hemorrhage. This study evaluated the severity and progression of epistaxis in HHT1 vs. HHT2. Study Design Retrospective cohort study Methods Retrospective chart review was performed for 183 genotyped HHT patients seen at our Center from 2010-2013. Data collected included epistaxis severity score (ESS), age of epistaxis onset, number and type of treatments, age at which treatments were sought, complete blood count values, ferritin, number of telangiectases, blood transfusions, iron therapy history, and patient demographics. Results 115 subjects with HHT2 were compared to 68 with HHT1. Subjects with HHT2 had a higher ESS compared to HHT1 (p=0.043) and a later age of onset of epistaxis (p=0.005). HHT2 subjects were more likely to use oral iron (p=0.032) and were more likely to seek interventions to control their epistaxis (p= 0.029). Conclusion HHT2 is associated with more severe epistaxis and a subsequent higher rate of interventions, requiring more aggressive therapy as compared to HHT1. PMID:26372311

  9. Patterns of hospital admission with epistaxis for 26,725 patients over an 18-year period in Wales, UK

    Science.gov (United States)

    Fishpool, SJC; Tomkinson, A

    2012-01-01

    INTRODUCTION Epistaxis is the one of the most common otorhinolaryngology emergencies. This study examined the age and sex distribution of all patients admitted with epistaxis to National Health Service (NHS) hospitals in Wales, UK, over a period of 18 years and 9 months. METHODS The Patient Episode Database for Wales was examined for all patient admissions with a diagnosis of epistaxis between April 1991 and December 2009. The age and sex of these patients was recorded and the proportion of the underlying population affected was calculated by comparing admission rates to the population data derived from the 1991 and 2001 national population censuses for Wales. RESULTS A total of 26,725 patients were admitted to NHS hospitals in Wales with epistaxis over the period studied. The proportion of the population admitted with epistaxis increased from the age of 40 onwards. For all ages except patients in the 10–14 years group, a higher proportion of the male population was admitted with epistaxis than the comparable female population. This discrepancy was most pronounced between the ages of 15 and 49 years, with the female-to-male ratio of hospital admissions with epistaxis being 0.55. These ages (15 and 49 years) approximate the average age of menarche and menopause respectively in the UK. CONCLUSIONS Women of menstrual age have fewer hospital admissions with epistaxis. This may be due to oestrogens providing protection to the nasal vasculature (as they do to other areas of the vascular tree). PMID:23131225

  10. An evaluation of the severity and progression of epistaxis in hereditary hemorrhagic telangiectasia 1 versus hereditary hemorrhagic telangiectasia 2.

    Science.gov (United States)

    Hunter, Benjamin N; Timmins, Benjamin H; McDonald, Jamie; Whitehead, Kevin J; Ward, P Daniel; Wilson, Kevin F

    2016-04-01

    Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular dysplasia whose hallmark symptom is spontaneous recurrent epistaxis. Two major genetic subtypes of this syndrome are HHT1 and HHT2. Severity of epistaxis ranges from occasional low-volume bleeding to frequent large-volume hemorrhage. This study evaluated the severity and progression of epistaxis in HHT1 versus HHT2. Retrospective cohort study. A retrospective chart review was performed for 183 genotyped HHT patients seen at our center from 2010 to 2013. Data collected included epistaxis severity score (ESS), age of epistaxis onset, number and type of treatments, age at which treatments were sought, complete blood count values, ferritin, number of telangiectases, blood transfusions, iron therapy history, and patient demographics. 115 subjects with HHT2 were compared to 68 with HHT1. Subjects with HHT2 had a higher ESS compared to HHT1 (P = .043) and a later age of onset of epistaxis (P = .005). HHT2 subjects were more likely to use oral iron (P = .032) and were more likely to seek interventions to control their epistaxis (P = .029). HHT2 is associated with more severe epistaxis and a subsequent higher rate of interventions, requiring more aggressive therapy as compared to HHT1. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  11. Evaluation of Etiology and Treatment Methods for Epistaxis: A Review at a Tertiary Care Hospital in Central Nepal

    OpenAIRE

    Parajuli, Ramesh

    2015-01-01

    Introduction. Epistaxis is one of the most common emergencies in Otorhinolaryngology. It is usually managed with simple conservative measures but occasionally it is a life threatening condition. Identification of the cause is important, as it reflects the management plan being followed. Aims and Objectives. To analyze the etiology and treatment methods for patients with epistaxis. Methods. A retrospective study was done in a te...

  12. Effect of Topical Intranasal Therapy on Epistaxis Frequency in Patients With Hereditary Hemorrhagic Telangiectasia: A Randomized Clinical Trial.

    Science.gov (United States)

    Whitehead, Kevin J; Sautter, Nathan B; McWilliams, Justin P; Chakinala, Murali M; Merlo, Christian A; Johnson, Maribeth H; James, Melissa; Everett, Eric M; Clancy, Marianne S; Faughnan, Marie E; Oh, S Paul; Olitsky, Scott E; Pyeritz, Reed E; Gossage, James R

    2016-09-06

    Epistaxis is a major factor negatively affecting quality of life in patients with hereditary hemorrhagic telangiectasia (HHT; also known as Osler-Weber-Rendu disease). Optimal treatment for HHT-related epistaxis is uncertain. To determine whether topical therapy with any of 3 drugs with differing mechanisms of action is effective in reducing HHT-related epistaxis. The North American Study of Epistaxis in HHT was a double-blind, placebo-controlled randomized clinical trial performed at 6 HHT centers of excellence. From August 2011 through March 2014, there were 121 adult patients who met the clinical criteria for HHT and had experienced HHT-related epistaxis with an Epistaxis Severity Score of at least 3.0. Follow-up was completed in September 2014. Patients received twice-daily nose sprays for 12 weeks with either bevacizumab 1% (4 mg/d), estriol 0.1% (0.4 mg/d), tranexamic acid 10% (40 mg/d), or placebo (0.9% saline). The primary outcome was median weekly epistaxis frequency during weeks 5 through 12. Secondary outcomes included median duration of epistaxis during weeks 5 through 12, Epistaxis Severity Score, level of hemoglobin, level of ferritin, need for transfusion, emergency department visits, and treatment failure. Among the 121 patients who were randomized (mean age, 52.8 years [SD, 12.9 years]; 44% women with a median of 7.0 weekly episodes of epistaxis [interquartile range {IQR}, 3.0-14.0]), 106 patients completed the study duration for the primary outcome measure (43 were women [41%]). Drug therapy did not significantly reduce epistaxis frequency (P = .97). After 12 weeks of treatment, the median weekly number of bleeding episodes was 7.0 (IQR, 4.5-10.5) for patients in the bevacizumab group, 8.0 (IQR, 4.0-12.0) for the estriol group, 7.5 (IQR, 3.0-11.0) for the tranexamic acid group, and 8.0 (IQR, 3.0-14.0) for the placebo group. No drug treatment was significantly different from placebo for epistaxis duration. All groups had a significant

  13. Severe epistaxis due to aberrant vasculature in a patient with STAT-1 mutation.

    Science.gov (United States)

    Chang, Michael T; Schwam, Zachary G; Hajek, Michael A; Paskhover, Boris; Judson, Benjamin L

    2016-03-01

    Signal transducer and activator 1 (STAT-1) mutations are rare and have been implicated in combined immunodeficiency, enhanced tumorigenesis, and vascular defects. A 60-year-old woman with a novel STAT-1 mutation and resulting immunodeficiency, squamous cell carcinoma, and vascular disease presented with profuse epistaxis secondary to rupture of an aberrant artery that she developed in part because of this mutation. After unsuccessful posterior packing, embolization was initiated but subsequently aborted because of a bovine origin carotid artery and a history of multiple carotid dissections. After repeat posterior packing, hemostasis was achieved. No additional episodes of epistaxis occurred in the subsequent 13 months. Vascular anomalies can present challenges in epistaxis management. In patients with conditions known to cause vascular anomalies, it is critical to obtain vascular imaging before intervention. © 2015 Wiley Periodicals, Inc.

  14. Treatment and experience of traumatic carotid artery injury with massive epistaxis

    Directory of Open Access Journals (Sweden)

    RAO Hai-cheng

    2013-09-01

    Full Text Available A retrospective analysis was made on 5 cases who had the traumatic carotid artery injury with massive epistaxis (from September 2007 to June 2011. All of them were finally diagnosed by digital substraction angiography (DSA. Among them, 2 cases of traumatic pesudoaneurysm from internal maxillary artery were embolized with polyvinyl alcohol particles and gelatin sponge. One case was carotid-cavernous fistula (CCF with traumatic pesudoaneurysm located in the sphenoid sinus. This patient's internal carotid artery (ICA and fistula was blocked with balloon, and then ICA was clipped proximal to the posterior communicating artery. One case with injuried ICA was treated with blocking by balloon. The pesudoaneurysm located in ICA cavernous segment of one case was embolized with coil and liquid glue. No recurrence was found after successful surgeries. Patients with massive epistaxis or recurrent epistaxis after craniofacial trauma should undergo CT angiography (CTA or DSA examination so as to get proper diagnosis and treatment as early as possible.

  15. The selective angiographic diagnosis and endovascular embolization treatment of severe epistaxis

    International Nuclear Information System (INIS)

    Zhang Xiquan; Lu Yonghong; Sun Jinghua; Guo Deqiang; Li Yuzhen; Wei Aihua

    2002-01-01

    Objective: To evaluate selective angiographic diagnosis and embolization of severe epistaxis in 57 cases. Methods: 41 cases with spontaneous haemorrhage, 11 cases with traumatic haemorrhage, 3 cases with haemorrhage of nasopharyngeal fibroangioma, and 2 case with haemorrhage of nasopharyngeal carcinoma were included in the study. Selective angiographic diagnosis and embolization of epistaxis were performed with absorbable gelatin sponge or balloon or spring coil by using Seldinger's method. Results: 59 procedure of angiographic diagnosis and embolization were performed in 57 cases. Both maxillaris internal artery embolization was performed in 6 cases. After embolization, satisfactory results were achieved immediately in 55 cases. After 6 months to 2 years' follow-up, no haemorrhage recurred. In 4 cases with traumatic haemorrhage in the face, simple maxillaris internal artery embolization was performed in 2 cases. Conclusion: Selective angiographic diagnosis and embolization are safe, effective, and successful method of choices in the treatment of severe epistaxis

  16. Endovascular treatment of incoercible epistaxis and epidural cerebral hematoma. A case report.

    Science.gov (United States)

    Bortoluzzi, M; Pavia, M

    2006-09-15

    A young patient with a facial trauma after a road accident was admitted to our department with incoercible epistaxis. A CT scan showed a right pterional acute epidural hematoma (EDH). Angiography demonstrated multiple sources of bleeding of the right sphenopalatine arteries, cause of the epistaxis, and an intracranial leakage of the right middle meningeal artery, responsible for the EDH. The patient immediately underwent embolization of the right internal maxillary artery and right middle meningeal artery. The procedure stopped the epistaxis and no further enlargement of the EDH was observed, avoiding its surgical treatment. Endovascular surgery may be an effective procedure to stop the arterial meningeal bleeding sustaining acute EDH and may be a useful tool in the management of special cases of post traumatic EDH.

  17. Traumatic pseudoaneurysm of the intracavernous ICA presenting with massive epistaxis: imaging diagnosis and endovascular treatment.

    Science.gov (United States)

    Han, M H; Sung, M W; Chang, K H; Min, Y G; Han, D H; Han, M C

    1994-03-01

    Traumatic pseudoaneurysm of the intracavernous internal carotid artery (ICA) is a very rare cause of epistaxis but is a life-threatening clinical situation when left untreated. The authors have experienced four cases of traumatic pseudoaneurysm involving the intracavernous ICA. Delayed massive epistaxes developed 1 to 8 months after trauma and initial transient epistaxis in all four patients. Three of the cases were successfully managed by the detachable balloon occlusion (DBO) of the ICA along with the aneurysm openings. In one case, a large pseudoaneurysm destroying a large area of the central skull base with peripheral blood clot was demonstrated on computed tomography, magnetic resonance imaging, and angiography; this patient died due to massive epistaxis before the trial of DBO. Imaging findings of pseudoaneurysms involving the intracavernous ICA in the four cases are described, and the role of endovascular treatment is discussed.

  18. Comparison of electro and chemical cautery in the treatment of anterior epistaxis.

    Science.gov (United States)

    Toner, J G; Walby, A P

    1990-08-01

    In the ENT Department of the Royal Victoria Hospital, Belfast, the impression (supported only by anecdotes) was that electro-cautery was superior to chemical cautery in the treatment of simple anterior epistaxis. Since no evaluation of the relative merits of electro and chemical cautery has been reported, a prospective randomized study was conducted to assess the effectiveness of electro-cautery and cautery with silver nitrate. The results of the study showed that there was no statistically significant difference between the two methods in either controlling the epistaxis or in the incidence of complications. It is concluded that since cautery with a silver nitrate tipped applicator is simpler, and of equal effectiveness, it would appear to be the treatment of choice for simple anterior epistaxis.

  19. Recurrent epistaxis: predicting risk of 30-day readmission, derivation and validation of RHINO-ooze score.

    Science.gov (United States)

    Addison, A; Paul, C; Kuo, R; Lamyman, A; Martinez-Devesa, P; Hettige, R

    2017-06-01

    To derive and validate a predictive scoring tool (RHINO-ooze score) with good sensitivity and specificity in identifying patients with epistaxis at high risk of 30 day readmission and to enable risk stratification for possible definitive intervention. Using medical databases, we searched for factors influencing recurrent epistaxis. The information ascertained together with our analysis of retrospective data on patients admitted with epistaxis between October 2013 and September 2014, was used as the derivation cohort to develop the predictive scoring model (RHINO-ooze score). The tool was validated by performing statistical analysis on the validation cohort of patients admitted with epistaxis between October 2014 and October 2015. Multiple linear regressions with backwards elimination was used to derive the predictive model. The area under the curve (AUC), sensitivity and specificity were calculated. 834 admissions were encountered within the study period. Using the derivative cohort (n= 302) the RHINO-ooze score with a maximum score of 8 from five variables (Recent admission, Haemorrhage point unidentified, Increasing age over 70, posterior Nasal packing, Oral anticoagulant) was developed. The RHINO-ooze score had a chi-square value of 99.72 with a significance level of smaller than 0.0001 and hence an overall good model fit. Comparison between the derivative and validation groups revealed similar rates of 30-day readmission between the cohorts. The sensitivity and specificity of predicting 30-day readmission in high risk patients with recurrent epistaxis (RHINO-ooze score equal/larger than 6) was 81% and 84%, respectively. The RHINO-ooze scoring tool demonstrates good specificity and sensitivity in predicting the risk of 30 day readmission in patients with epistaxis and can be used as an adjunct to clinical decision making with regards to timing of operative intervention in order to reduce readmission rates.

  20. Role of season, temperature and humidity on the incidence of epistaxis in Alberta, Canada

    Science.gov (United States)

    2014-01-01

    Background Classical dogma holds that epistaxis is more common in winter months but there is significant variability reported in the literature. No study has yet examined the effect of season, humidity and temperature on epistaxis in a location with as severe weather extremes as seen in Alberta, Canada. The objective of the study is to evaluate for an effect of these meteorological factors on the incidence of epistaxis in Alberta. Method A retrospective review of consecutive adult patients presenting to the Emergency room (ER) in Edmonton and Calgary, Alberta over a three-year period was performed. Daily temperature and humidity data was recorded from the respective airports. Statistical analysis with Pearson’s correlation coefficient was performed. Results 4315 patients presented during the study period. Mean daily temperatures ranged from a low of -40°C to a high of +23°C. A significant negative correlation was found for mean monthly temperature with epistaxis (Pearson’s r = -0.835, p = 0.001). A significant correlation was also present for daily temperature and epistaxis presentation (Pearson’s r = -0.55, p = 0.018, range 1.8 to 2.2 events/day). No correlation was identified with humidity and no significant seasonal variation was present. Conclusions A negative correlation was found to exist for both daily and mean monthly temperature with rates of epistaxis. A seasonal variation was seen in Edmonton but not in Calgary. No correlation was found for humidity when compared to both presentation rates and admissions. PMID:24755112

  1. A Comparison of Bipolar Electrocautery and Chemical Cautery for Control of Pediatric Recurrent Anterior Epistaxis.

    Science.gov (United States)

    Johnson, Nathan; Faria, John; Behar, Philomena

    2015-11-01

    To compare the outcome of children with anterior epistaxis treated intraoperatively with either bipolar electrocautery or silver nitrate chemical cautery. Case series with chart review. Tertiary-care pediatric otolaryngology practice. Children aged 2 to 18 years treated with either intraoperative bipolar electrocautery or silver nitrate chemical cautery of the anterior nasal septum for recurrent anterior epistaxis. Any reported bleeding event after surgery was recorded. The mean time from surgery to recurrent epistaxis was compared between groups. Fifty patients underwent bipolar electrocautery, while 60 patients underwent silver nitrate chemical cautery. Within 2 years, 1 (2%) patient in the bipolar electrocautery group and 13 (22%) patients in the silver nitrate chemical cautery group had recurrent epistaxis (P = .003). Two years after treatment, there was no difference between treatment groups. Overall, 4 patients (8%) had recurrent epistaxis postoperatively in the bipolar electrocautery group at a mean of 4.34 years after treatment, while 17 (28.3%) patients recurred after a mean of 1.53 years of treatment in the silver nitrate chemical cautery group (P = .01). Compared to those treated with chemical cautery, those treated with bipolar electrocautery had a longer nosebleed-free period and a lower incidence of recurrent epistaxis within 2 years of treatment. Beyond 2 years, the treatment methods are equivocal. Bipolar electrocautery may be a superior treatment in children who will not tolerate in-office chemical cautery, in those with a risk of severe bleeding, or when it can be combined with other operative procedures. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  2. A comparative study of propranolol versus silver nitrate cautery in the treatment of recurrent primary epistaxis in children

    Science.gov (United States)

    Ahmed, Ahmed E; Abo El-Magd, Essam A; Hasan, Gamal M; El-Asheer, Osama M

    2015-01-01

    Background Epistaxis is a common medical problem in pediatric population. Although in most cases it is mild and self-limiting, a proportion of childhood epistaxis is massive, recurrent, or resistant to conventional management. Objective To compare effectiveness of propranolol as a treatment option for childhood epistaxis versus conventional silver nitrate cautery. Study design and methodology This is a prospective interventional comparative study that was carried out during a period of 1 year (January 1, 2013 to December 31, 2013) at Qena University Hospital and Assiut University Children’s Hospital. One hundred children aged 6–12 years who presented with epistaxis to Qena University Hospital and Assiut University Children’s Hospital during the study period and fulfilling the inclusion criteria were included in the study. They were randomly assigned into one of two interventional groups, where 50 children were treated with oral propranolol (propranolol treatment group) and another 50 children were treated with conventional silver nitrate cautery (cauterization treatment group) for their epistaxis. Propranolol was given at a dose of 1.5–2 mg/kg/day (divided into three doses). Patients were followed for 6 months after their discharge for recurrence of epistaxis. Results Both groups of patients showed minimal recurrent epistaxis with rates of 14% for propranolol treated group and 12% for cauterization group, with no statistically significant difference between both groups. Local pain was found to be more in patients treated with silver nitrate cauterization. Conclusion Treatment of primary epistaxis with propranolol or silver nitrate cautery showed equal rates of recurrence, and local nasal pain was slightly more among silver nitrate cauterization treated group. Propranolol could be a favorable treatment option for patients with primary epistaxis. Further studies that include multiple centers and larger number of patients are recommended for more clarification

  3. Tranexamic acid for epistaxis in hereditary hemorrhagic telangiectasia patients: a European cross-over controlled trial in a rare disease.

    Science.gov (United States)

    Gaillard, S; Dupuis-Girod, S; Boutitie, F; Rivière, S; Morinière, S; Hatron, P-Y; Manfredi, G; Kaminsky, P; Capitaine, A-L; Roy, P; Gueyffier, F; Plauchu, H

    2014-09-01

    Hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder associated with abnormal angiogenesis and disabling epistaxis. Tranexamic acid (TA) has been widely used in the treatment of these severe bleeds but with no properly designed trial. To demonstrate the efficacy of TA in epistaxis in HHT patients and to explore its safety of use. A randomized, placebo-controlled, double-blind, cross-over trial was conducted. Participants were randomized to receive TA (3 g a day) then placebo or the opposite sequence. The main analysis compared intra-individual mean duration of epistaxis under TA vs. placebo on a log scale. The primary outcome was the mean duration of epistaxis per month, assessed with specific grids to be completed by participants. The number of epistaxis episodes was recorded as a secondary outcome. A total of 118 randomized patients contributed to the statistical analysis. The mean duration of epistaxis per month was significantly shorter with TA than placebo (0.19 on the log scale; SD = 0.07; P = 0.005), corresponding to a decrease of 17.3% (15.7 min) in the duration of epistaxis per month (CI 95%, 5.5-27.6). The median number of epistaxis episodes per month was 22.1 episodes in the placebo arm vs. 23.3 episodes in the TA arm. No thrombophlebitis was observed. In the ATERO study, we demonstrated a significant decrease in the duration of epistaxis in HHT patients taking TA. No safety issues were recorded in our cohort of patients. © 2014 International Society on Thrombosis and Haemostasis.

  4. Is the occurrence of spontaneous epistaxis related to climatic variables? A retrospective clinical, epidemiological and meteorological study.

    Science.gov (United States)

    Mangussi-Gomes, João; Enout, Mariana Junqueira Reis; Castro, Thaiana Carneiro de; de Andrade, José Santos Cruz; Penido, Norma de Oliveira; Kosugi, Eduardo Macoto

    2016-11-01

    Epistaxis has a bimodal age distribution. Anterior epistaxis of mild severity is more common in children; severe epistaxis occurs more often in adults and elderly patients. The occurrence of spontaneous epistaxis was shown to be weakly-to-moderately and inversely correlated to the mean monthly temperature, relative humidity and total rainfall. To describe the clinical and epidemiological profiles of patients diagnosed with spontaneous epistaxis; to correlate its monthly occurrence with meteorological variables. A retrospective cross-sectional study was performed in a referral ENT service in São Paulo, Brazil. The study assessed the clinical and epidemiological features of 508 patients with spontaneous epistaxis treated between February 2010 and January 2011. The occurrence of epistaxis was associated with weather variables for the same study period. Spontaneous epistaxis presented two age peaks of higher incidence (11-20 and 51-70 years). Children more frequently had localized bleeding (p = 0.003), in the anterior region of the nasal cavity (p = 0.0001), of absent-mild severity (p = 0.0082). Diffuse bleeding (p = 0.005), of moderate-severe intensity (p = 0.003), was more common in adults and elderly patients. The total number of visits because of epistaxis was inversely correlated to mean temperature (R = -0.489; p = 0.011), mean relative humidity (R = -0.364; p = 0.038), and total rainfall (R = -0.512; p = 0.009) during each month of the analyzed period.

  5. Management of patients with epistaxis by general practitioners: impact of otolaryngology experience on their practice

    NARCIS (Netherlands)

    Tassone, Peter; Georgalas, Christos; Appleby, Esther; Kotecha, Bhik

    2006-01-01

    This study aims to assess the management of patients with epistaxis by general practitioners (GPs) and to show whether previous experience as a junior doctor in ear, nose and throat (ENT) surgery influences their practice. A questionnaire was sent together with self-addressed reply envelopes to a

  6. pattern of epistaxis in sokoto,nigeria:a review of 72 cases

    African Journals Online (AJOL)

    Emmanuel Ameh

    otolaryngology. Lippincott-Raven,. Philadelphia.1998; 513-529. 2. Varshney S, Saxena RK. Epistaxis: a retrospective clinical study. Indian Journal of Otolaryngology,. Head Neck Surgery. 2005; 57:125-129. 3. Maran AGD, Lund VJ. Clinical rhinology. Thieme. Medical Publishers, New York. 1990; 101-103. 4. Watkinson JC.

  7. Relation of mean platelet volume and red blood cell distribution width with epistaxis.

    Science.gov (United States)

    Kemal, Ozgur; Müderris, Togay; Sevil, Ergün; Kutlar, Gökhan

    2015-04-01

    Mean platelet volume is the measurement of the average size of platelets in the blood, and red blood cell distribution width is the variability of the size of red blood cells in circulation. This study aimed to investigate if there was any relationship between mean platelet volume, red blood cell distribution, and epistaxis. Prospective controlled trial. The study included 90 patients admitted to Ankara Atatürk Hospital and Samsun Medicana Hospital with complaints of recurrent epistaxis, and a control group of 90 healthy subjects. Blood samples were taken from all patients and control group subjects. Mean platelet volume and red blood cell distribution parameters were examined and compared between the two groups. The mean platelet volume levels were determined as 8.86 ± 0.1 in the control group and 8.36 ± 0.1 in the patient group. The difference between the two groups with respect to mean platelet volume was statistically significant (P epistaxis. These findings could be beneficial in new investigations into epistaxis mechanisms. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  8. Should prophylactic antibiotics be used routinely in epistaxis patients with nasal packs?

    Science.gov (United States)

    Nightingale, K; Patel, NN; Salib, RJ

    2013-01-01

    Introduction The current mainstream practice in otolaryngology departments relating to the use of prophylactic antibiotics in epistaxis patients requiring nasal packing is highly variable. This is due primarily to the lack of any validated guidelines. As such, we introduced a new treatment algorithm resulting in significant reduction of use in the systemic antibiotics, with emphasis instead on the use of topical antibiotics. The results were validated through a complete audit cycle. Methods A total of 57 patients undergoing nasal packing for spontaneous epistaxis were studied. Reaudit occurred after the implementation of new guidelines. Telephone surveys were conducted six weeks after hospital discharge, assessing infective nasal symptoms as well as rebleeding and readmission rates. Results Systemic antibiotic prescribing in anterior nasal packing fell by 58.2% between audit cycles with no statistically significant associated increase in infective nasal symptoms, rebleeding or readmission rates six weeks following hospital discharge. Conclusions Systemic prophylactic antibiotics are unnecessary in the majority of epistaxis patients with nasal packs. The use of topical antibiotics such as Naseptin® may be more appropriate, cheaper and as effective. Implementation of this treatment algorithm will help standardise systemic antibiotic usage in epistaxis patients with nasal packing and should reduce costs associated with unnecessary use of such medication. PMID:23317726

  9. Endovascular management of a carotid aneurysm into the sphenoid sinus presenting with epistaxis.

    Science.gov (United States)

    Akkari, Mohamed; Gascou, Grégory; Trévillot, Vincent; Bonafé, Alain; Crampette, Louis; Machi, Paolo

    2015-12-01

    Non-traumatic cavernous internal carotid artery (ICA) aneurysms are rare, and favour the occurrence of massive recurrent epistaxis, which is associated with a high mortality rate. We report the case of a 67-year-old woman presenting a ruptured ICA aneurysm extending into the sphenoid sinus, revealed by epistaxis. Selective coil embolization of the aneurysm was performed. Flow-diverter stents were deployed in order to utterly exclude the aneurysm and prevent revascularization. Anti-platelet treatment was provided to lower the risk of in-stent thrombosis. A left frontal hematoma associated with a subarachnoid haemorrhage occurred at day 2. Outcome was favourable with no neurological sequelae, and no clinical recurrence of epistaxis occurred. A 4 months follow-up digital subtraction angiography showed a complete exclusion of the aneurysm. In addition, a magnetic resonance cerebral angiography at 16 months showed stable results. Thus, this two-stage endovascular procedure has proven its effectiveness in preventing epistaxis recurrence while preserving the ICA patency. © The Author(s) 2015.

  10. Endovascular treatment of intractable epistaxis — results of a 4-year ...

    African Journals Online (AJOL)

    Objective. Transcatheter embolisation is an accepted and effective treatment for intractable epistaxis. We analysed our success and complication rates and compared these with results from other published series. Design. Retrospective review. Setting. Unitas Interventional Unit, Centurion. Methods. Case record review (57 ...

  11. Early and Late Recurrent Epistaxis Admissions: Patterns of Incidence and Risk Factors.

    Science.gov (United States)

    Cohen, Oded; Shoffel-Havakuk, Hagit; Warman, Meir; Tzelnick, Sharon; Haimovich, Yaara; Kohlberg, Gavriel D; Halperin, Doron; Lahav, Yonatan

    2017-09-01

    Objective Epistaxis is a common complaint, yet few studies have focused on the incidence and risk factors of recurrent epistaxis. Our objective was to determine the patterns of incidence and risk factors for recurrent epistaxis admission (REA). Study Design Case series with chart review. Settings Single academic center. Subjects and Methods The medical records of patients admitted for epistaxis between 1999 and 2015 were reviewed. The follow-up period was defined as 3 years following initial admission. REAs were categorized as early (30 days) and late (31 days to 3 years) following initial admission. Logistic regression was used to identify potential predictors of REAs. Results A total of 653 patients were included. Eighty-six patients (14%) had REAs: 48 (7.5%) early and 38 (6.5%) late. Nonlinear incidence curve was demonstrated for both early and late REAs. Based on logistic regression, prior nasal surgery and anemia were independent risk factors for early REAs. According to multivariate analysis, thrombocytopenia was significantly associated with late REAs. Conclusion Early and late REAs demonstrate different risk predictors. Knowledge of such risk factors may help in risk stratification for this selected group of patients. All patients at risk should be advised on possible preventive measures. Patients at risk for early REA may benefit from a more proactive approach.

  12. The effect of bevacizumab (Avastin) treatment on epistaxis in hereditary hemorrhagic telangiectasia.

    Science.gov (United States)

    Simonds, Jana; Miller, Frank; Mandel, Jess; Davidson, Terence M

    2009-05-01

    Determine the effectiveness of treating epistaxis in hereditary hemorrhagic telangiectasia (HHT) with potassium titanyl phosphate (KTP) laser cautery combined with submucosal injection of 100 mg of bevacizumab. Retrospective pilot study. Bevacizumab was injected throughout the nasal cavity following KTP laser treatment in 10 patients (bevacizumab/KTP group) and compared to nine patients previously treated with KTP laser alone (KTP group). Epistaxis frequency and severity, blood transfusion requirement, intravenous iron supplementation, emergency department visit frequency, and quality of life within 1 month and 1 year pre- and postsurgery were analyzed. Benefit was defined as less than three nosebleeds per week, with less than 10 minutes to stop each nosebleed, and no blood transfusions. The pre- and postsurgery data were analyzed within and between the two groups. The groups were comparable in age and gender. Significant benefit was found in frequency of epistaxis (P epistaxis is superior to KTP laser treatment alone. It significantly decreases frequency and severity of nosebleeds and blood transfusion requirements, and significantly improves work ability and quality of life.

  13. A genetic analysis of epistaxis as associated with EIPH in the ...

    African Journals Online (AJOL)

    Pedigree and race run data from Thoroughbreds racing in Southern Africa, covering the period 1986-2002 (63 146 horses in pedigree data-set and 778 532 race runs), were analysed in order to study genetic and environmental factors affecting the incidence of epistaxis as associated with \\"exercise-induced pulmonary ...

  14. Considerações acerca da avaliação psicológica das comorbidades psiquiátricas em obesos Consideraciones sobre la evaluación psicológica de las comorbidades psiquiátricas en obesos Consideration about psychological assessment of psychiatric co morbidity in obese

    OpenAIRE

    Fabiana Silva Costa; Denise Ruschel Bandeira; Clarissa Trentini; Mirian Brilmann; Rogério Friedman; Maria Angélica Nunes

    2009-01-01

    Pretende-se neste artigo apresentar uma revisão teórica sobre avaliação psicológica, obesidade e comorbidades psiquiátricas mais frequentes na população obesa. A obesidade é uma doença clínica de múltiplas causas, e atualmente é considerada uma epidemia; assim seu adequado entendimento deve envolver uma equipe composta por diversos profissionais de saúde, incluindo o psicólogo. Serão abordadas questões pertinentes ao tema de obesidade, como etiologia, incidência e a relação entre obesidade e ...

  15. Massive epistaxis due to pseudoaneurysm of the sphenopalatine artery: a rare post-operative complication of orthognathic surgery.

    Science.gov (United States)

    Kim, Y-W; Baek, M-J; Kim, H-D; Cho, K-S

    2013-06-01

    To introduce pseudoaneurysm of the sphenopalatine artery as the possible aetiology of acute massive epistaxis in patients with a history of orthognathic surgery accompanied by Le Fort I osteotomy. Case report and literature review. This paper reports a case of acute life-threatening epistaxis following Le Fort I osteotomy. Computed tomography and angiography showed a pseudoaneurysm of the sphenopalatine artery, which was successfully treated by endovascular embolisation. Although a pseudoaneurysm of the sphenopalatine artery following Le Fort I osteotomy is extremely rare, it should be considered as the possible aetiology of acute massive epistaxis in patients with a history of orthognathic surgery accompanied by Le Fort I osteotomy.

  16. Embolization for the treatment of intractable epistaxis: 12 month outcomes in a two centre case series.

    Science.gov (United States)

    Robinson, Anthony E; McAuliffe, William; Phillips, Timothy J; Phatouros, Constantine C; Singh, Tejinder P

    2017-12-01

    Embolization is a treatment option for intractable epistaxis; however, concerns regarding tissue necrosis, stroke and blindness persist in the literature. A retrospective review of patients from September 2010 to January 2016 treated with embolization for epistaxis was performed. No patient was excluded. Follow-up was 12 months and no patient was lost. 62 embolizations on 59 patients occurred. 21 cases were taking anticoagulants, P2Y12 inhibiting agents or had a systemic coagulopathy. Embolized territories typically involved bilateral distal internal maxillary arteries with unilateral or bilateral facial arteries with polyvinyl alcohol particles. 60 cases had procedural general anaesthesia. There were no major complications. Six died of unrelated causes. Of the surviving 53 patients, excluding the 3 patients with hereditary haemorrhagic telangiectasia, 5 had recurrent epistaxis post-embolization. Four were taking P2Y12 inhibiting and/or anticoagulants, none of which required surgery, prolonged packing or repeat embolization. This group had a propensity to recur compared with cases taking aspirin only or no antiplatelet/anticoagulant (77.8 vs 97.1%, p = 0.04). The fifth underwent repeat embolization after previously only having ipsilateral distal internal maxillary and facial arteries treated. Embolization for epistaxis is safe and effective. Of those who had recurrent epistaxis post embolization, most were taking P2Y12 inhibition and/or anticoagulation. We prefer bilateral distal internal maxillary artery and unilateral facial artery embolization under general anaesthesia for optimal safety and efficacy. Advances in knowledge: Embolization with this technique seems to facilitate superior outcomes without complications despite the large proportion of patients taking anticoagulating or P2Y12 inhibiting agents.

  17. Epistaxis and pituitary apoplexy due to ruptured internal carotid artery aneurysm embedded within pituitary adenoma.

    Science.gov (United States)

    Peng, Zesheng; Tian, Daofeng; Wang, Hongliu; Kong, Derek Kai; Zhang, Shenqi; Liu, Baohui; Deng, Gang; Xu, Zhou; Wu, Liquan; Ji, Baowei; Wang, Long; Cai, Qiang; Li, Mingchang; Wang, Junmin; Zhang, Aimin; Chen, Qianxue

    2015-01-01

    Epistaxis due to ruptured internal carotid artery (ICA) aneurysm embedded within a pituitary adenoma (PA) has seldom been reported in the literature. Here we want to elaborate the incidence, mechanisms, clinical manifestations, and treatment strategy for this condition. The first survived case of a patient with epistaxis and pituitary apoplexy due to ruptured aneurysm embedded within PA was reported and the literature was reviewed. A 53-year-old male patient presented to our institution with sudden onset epistaxis and progressive vision loss. Neurological examination revealed bilateral ptosis and dilated unresponsive pupils. A CT scan showed a large mass in the pituitary fossa with bony erosion. MRI revealed a large pituitary tumor and abnormal signal intensity in the tumor. No aneurysm was noted during the pre-operative MR angiography. Abundant arterial bleeding suddenly occurred during urgent transsphenoidal surgery. Digital subtraction angiography confirmed the presence of a 14 mm unexpected saccular aneurysm of right ICA in the cavernous sinus with the dome protruding into the sella turcica. Balloon test occlusion of the right ICA was undertaken and permanent occlusion was performed. The patient recovered well and received bromocriptine and thyroid hormone replacement therapy during the follow-up period. At 14-month followup, the patient had no neurological deficits, no features of ischaemia relating to the right ICA therapeutic occlusion. Our case indicated that epistaxis and pituitary apoplexy could be due to the rupture of an ICA aneurysm embedded in a PA. Clinical suspicion should remain high when evaluating any case of epistaxis and pituitary apoplexy. Optimal treatment should take into consideration individual features of the tumor, aneurysm, and patient. Making the correct diagnosis as well as identifying an appropriate management strategy is critical in the care of such patients.

  18. Considerações acerca da avaliação psicológica das comorbidades psiquiátricas em obesos Consideraciones sobre la evaluación psicológica de las comorbidades psiquiátricas en obesos Consideration about psychological assessment of psychiatric co morbidity in obese

    Directory of Open Access Journals (Sweden)

    Fabiana Silva Costa

    2009-06-01

    Full Text Available Pretende-se neste artigo apresentar uma revisão teórica sobre avaliação psicológica, obesidade e comorbidades psiquiátricas mais frequentes na população obesa. A obesidade é uma doença clínica de múltiplas causas, e atualmente é considerada uma epidemia; assim seu adequado entendimento deve envolver uma equipe composta por diversos profissionais de saúde, incluindo o psicólogo. Serão abordadas questões pertinentes ao tema de obesidade, como etiologia, incidência e a relação entre obesidade e transtornos psiquiátricos. Serão propostos alguns instrumentos com o objetivo de estruturar informações necessárias ao tratamento e à demanda do paciente obeso, e reflexões referentes à avaliação psicológica em obesos e a prática do profissional de psicologia.Se pretiende en ese artículo presentar una revisión teórica sobre la evaluación psicológica, obesidad y comorbidades psiquiátricas más frecuentes en esa población. La obesidad es una enfermedad clínica con diversas causas y actualmente es considerada una epidemia, así el adecuado entendimiento de la obesidad debe involucrar un equipo compuesto por diversos profesionales de salud, incluso el psicólogo. En ese artículo serán abordadas cuestiones pertinentes a la temática de la obesidad, como etiología, prevalencia y la relación entre obesidad y los trastornos psiquiátricos. Serán propuestos algunos instrumentos* con el objetivo de estructurar informaciones necesarias al tratamiento y a la demanda del paciente obeso, reflexiones referentes a la evaluación psicológica en obesos y la práctica del profesional de PsicologíaWe intend in this article to present a theoretical review about psychological assessment, obesity and psychiatric co morbidity. Obesity is a clinical illness, it has multi factorial causes, and nowadays it is considered an epidemic, so the right knowledge must involve all health professional, include the psychologist. In this article we

  19. Accessory Meningeal Arterial Supply to the Posterior Nasal Cavity: Another Reason for Failed Endovascular Treatment of Epistaxis

    International Nuclear Information System (INIS)

    Duncan, I.C.; Santos, C. Dos

    2003-01-01

    A patient with intractable posterior epistaxis was treated with embolization of the ipsilateral sphenopalatine and facial arteries and contralateral sphenopalatine artery. She continued to bleed despite a seemingly adequate embolization procedure. A second angiogram revealed a significant collateral blood supply to the posterior nasal cavity from the accessory meningeal artery not identified during the first procedure. This was then embolized with no further epistaxis encountered. This case demonstrates yet another collateral arterial pathway that might account for a failed embolization

  20. The use of FloSeal haemostatic sealant in the management of epistaxis: a prospective clinical study and literature review.

    Science.gov (United States)

    Wakelam, O C; Dimitriadis, P A; Stephens, J

    2017-01-01

    INTRODUCTION It is standard practice in the UK that if conservative measures or chemical cautery fail to control epistaxis, patients receive nasal packing which is often uncomfortable, requires admission and has well documented associated morbidity. Our study aims to evaluate the use of FloSeal haemostatic sealant in managing patients with epistaxis. MATERIALS AND METHODS Patients were identified from those referred with active epistaxis. A successful outcome was defined as complete haemostasis with FloSeal alone, with no further significant bleeding requiring admission or further interventions in the subsequent 7 days. Patients reported satisfaction using a ten-point visual analogue scale. Ear, nose and throat doctors recorded patient demographics, time to prepare FloSeal, length of stay, need for further treatment and adverse events on an electronic database. RESULTS 30 patients were enrolled in the study. The mean time to prepare FloSeal was 5 minutes. The success rate of FloSeal was 90%. The mean length of stay was 2.75 hours. The mean patient satisfaction with FloSeal was 8.4/10. No adverse events occurred. DISCUSSION FloSeal was found to be effective in controlling anterior epistaxis. There was a single case of posterior epistaxis which required operative management. The literature largely supports FloSeal in anterior epistaxis, but indicates sphenopalatine artery ligation as the definitive management of posterior epistaxis. CONCLUSIONS Our data support the use of FloSeal in patients with anterior epistaxis not controlled with conservative measures or chemical cautery. It was found to be easy to use, is well tolerated by patients and is efficient in financial terms.

  1. Algunas consideraciones teóricas acerca del uso de las tecnologías de la información y las comunicaciones en la enseñanza superior.

    Directory of Open Access Journals (Sweden)

    Yamilet Trelles Mutis

    2007-03-01

    Full Text Available El trabajo, que a continuación se expone se titula Algunas consideraciones teóricas acerca del uso de las tecnologías de la información y las comunicaciones en la enseñanza superior, en el mismo se presentan algunas consideraciones teóricas acerca del uso de las tecnologías de la información y las comunicaciones. Se ofrecen consideraciones sobre la necesidad de implementar un Sitio Web en la biblioteca universitaria, donde los usuarios de esta institución tendrán la posibilidad de acceder y evaluar los recursos digitales en la gestión de la información desde cualquier punto de la red necesarios para la docencia y la investigación. En la búsqueda del conocimiento se utilizan métodos y técnicas con sus diferentes instrumentos de la investigación educacional. Se expone la metodología para el diseño del sistema.

  2. Use of potassium titanyl phosphate (KTP) laser Dermastat in the treatment of recurrent anterior epistaxis - a new technique.

    Science.gov (United States)

    Jain, A; Frampton, S J; Sachidananda, R; Jain, P K

    2016-09-01

    To evaluate the short- to medium-term effectiveness of potassium titanyl phosphate (KTP) laser Dermastat in patients with recurrent anterior epistaxis. Fifty-eight patients presenting with recurrent anterior epistaxis were treated using potassium titanyl phosphate laser Dermastat. Those with recurrent epistaxis arising from prominent vessels in Little's area, and/or those for whom treatment with silver nitrate cautery failed, were included. The main outcome measure was resolution of epistaxis at two months. Fifty-eight patients were treated; 27 were under 18 years old. Thirty patients had prominent vessels. Thirty-one patients had undergone previous cautery treatment. Thirty-eight patients had treatment to the left side, 19 to the right and 1 to both. At two months, 74 per cent reported resolution of epistaxis with no complications. This increased to 78 per cent at further follow up. Our technique is a successful, safe treatment for recurrent anterior epistaxis in an otherwise treatment-resistant group. A single procedure is effective. The handpiece and tip are reusable and sterilisable, resulting in cost-effectiveness.

  3. REDUCCION DEL OXIGENO SOBRE CALCOSITA, PIRITA Y GALENA EN MEDIO ALCALINO

    OpenAIRE

    ORTIZ, JUAN; BARBATO, SALVADOR; GAUTIER, JUAN LUIS

    2000-01-01

    La electroreducción del oxígeno fue investigada a pH = 14 sobre electrodos de calcosita, pirita y galena mediante voltamperometría cíclica y por voltamperometría estacionaria usando una celda electroquímica de flujo de doble canal (CEFDC). La superficie de los electrodos fue caracterizada mediante consideraciones termodinámicas y cinéticas. En todos lo casos la reducción del O2 ocurre con formación de iones HO2-. Sobre calcosita la reacción de reducción del O2 (RRO) ocurre sobre una superfici...

  4. Delayed massive epistaxis from traumatic cavernous carotid false aneurysms: A report of two unusual cases.

    Science.gov (United States)

    Mankahla, Ncedile; LeFeuvre, David; Taylor, Allan

    2017-08-01

    Introduction Blunt head trauma can injure the cavernous segment of the internal carotid artery (ICA). This may result in a carotid cavernous fistula (CCF). Rarely, a traumatic aneurysm may bleed medially causing massive epistaxis. Case presentation We present two cases of traumatic intracavernous carotid pseudoaneurysms with delayed massive epistaxis. The patients were managed with endovascular treatment involving coil embolization with parent vessel sparing and detachable balloon occlusion with carotid sacrifice. Early clinical outcome was good in both patients. Wherever possible, the CARE 1 guidelines were followed in the reporting. Conclusion These cases illustrate the delayed nature of traumatic aneurysms and the need for a high index of suspicion in the presence of skull base fractures. The use of endovascular detachable balloon occlusion and coil embolization treatment with parent vessel preservation is shown.

  5. Management of recurrent epistaxis in an anticoagulated patient by temporarily closing the nares with sutures.

    Science.gov (United States)

    Eng, Chee-Yean; Yew, Teck-Aun; Ng, Wai-Siene; El-Hawrani, Amged S

    2008-04-01

    We describe an unusual case of recurrent, refractory anterior epistaxis in an 86-year-old man with two mechanical heart valves who was on permanent warfarin therapy. His numerous episodes of epistaxis were incited by chronic nose-picking and strong nose-blowing, practices that he continued to engage in despite repeated medical advice to stop. Stopping his anticoagulation therapy was not considered as a management option because of an unacceptably high risk that this would lead to a thromboembolic event. Eventually, we temporarily sutured his nares closed, and his nosebleeds ceased. The suturing was performed in the ward with local anesthesia. This procedure was simple to perform,fairly well tolerated, easily reversible, and highly effective.

  6. O ensino do esporte para crianças e jovens: considerações sobre uma fase do processo de desenvolvimento motor esquecida La enseñanza del deporte para niños y jóvenes: consideraciones sobre una etapa olvidada del desarrollo motor The teaching of sport to chidren and youth: considerations about a forgotten phase of motor development

    Directory of Open Access Journals (Sweden)

    Go Tani

    2012-06-01

    Full Text Available O processo ensino-aprendizagem pode ser visto como um sistema constituído pela interação de três componentes - professor, aluno e matéria - que tem por meta promover mudanças efetivas nos comportamentos, capacidades e competências do aluno. Como numa visão sistêmica do processo ensino-aprendizagem, a função de um determinado componente implica sempre o estabelecimento de relação entre os dois componentes que restam, o papel principal do professor é estabelecer relação entre o aluno e a matéria. Neste contexto, a questão central é saber em que se basear para estabelecer essa relação. O presente ensaio parte da assunção de que o conhecimento sobre o desenvolvimento motor constitui um elemento fundamental quando a matéria de ensino é o esporte, discute uma fase desse processo que tem sido sistematicamente esquecida procurando identificar as suas possíveis causas e consequências e apresenta algumas sugestões para trabalhar com essa fase.The teaching-learning process can be viewed as a system constituted by the interaction of three components - teacher, learner and subject matter - whose goal is to promote the effective changes in the learner´s behaviors, capacities and competences. In a systemic view of the teaching-learning process the role played by a given component always implies the establishment of relations between the two remaining components. Thus, the role of the teacher is to establish relations between learner and subject matter. The main question to the teacher is on what to rely upon to establish these relations. The present essay departs from the assumption that knowledge about motor development constitutes a fundamental element when sport is the subject matter. It discusses a phase of that process that has been systematically forgotten in the teaching of sports trying to identify possible causes and consequences, and presents some suggestions of procedures to work with that phase.

  7. Comparison of Local Sclerotherapy With Lauromacrogol Versus Nasal Packing in the Treatment of Anterior Epistaxis.

    Science.gov (United States)

    Farneti, Paolo; Pasquini, Ernesto; Sciarretta, Vittorio; Macrì, Giovanni; Gramellini, Giulia; Pirodda, Antonio

    2016-06-01

    Epistaxis is one of the most common otorhinolaryngologic emergencies representing more than 12% of conditions managed at the Ear, Nose and Throat (ENT) Emergency Consulting Room of our Otorhinolaryngologic Unit each year. The elevated frequency of this pathology makes it necessary to adopt the most effective and least expensive therapeutic strategy available. The aim of this study was to compare the efficacy, costs and morbidity of nasal packing (NP), which is the mainstay of treatment for anterior epistaxis in our ENT Emergency Consulting Room versus submucosal infiltrations of lauromacrogol (LA). A retrospective study was designed from August 2012 to April 2013 involving 53 patients suffering from anterior epistaxis. Anterior NP was used in 27 patients versus 26 patients undergoing 27 procedures performed with submucosal infiltrations of LA (or polidocanol). Outcomes for each treatment were evaluated. Patients in group 1 were treated with LA 400 injection next to the bleeding point: 0.5- to 1-mL single or multiple infiltrations with a 27-gauge needle. The whitening of the nasal mucosa around the bleeding point during infiltration was considered a marker of correct procedure in order to achieve the best results. Bilateral treatment was also performed at the same time. Patients in group 2 were treated with standard NP. Bleeding recurrence was higher in the NP group even if it was not statistically significant (P=0.2935). However, the LA infiltrations were better tolerated with lower morbidity and costs as compared to NP. No complications were observed in either group. LA infiltrations were shown to be a viable alternative in anterior epistaxis treatment. They are safe, easy to use with good efficacy and have a low cost.

  8. Sphenopalatine Artery Ligation for Epistaxis: Factors Influencing Outcome and Impact of Timing of Surgery.

    Science.gov (United States)

    McDermott, Ailbhe M; O'Cathain, Eadaoin; Carey, Brian William; O'Sullivan, Peter; Sheahan, Patrick

    2016-03-01

    Sphenopalatine artery ligation is a commonly employed surgical intervention for control of posterior epistaxis unresponsive to nasal packing. The objective of the present study was to evaluate the outcome of sphenopalatine artery ligation for control of epistaxis at our institution and the impact of timing and other factors on outcome. Case series with chart review. Academic tertiary referral center. Case notes were reviewed for 45 consecutive patients undergoing sphenopalatine artery ligation for control of epistaxis between October 2008 and October 2014. Forty-one patients had nasal packing prior to sphenopalatine artery ligation, with 33 undergoing ≥2 packings. Postoperatively, 6 patients had rebleeding, which was treated with repacking (n = 4) and return to the operating room (n = 2). The overall success rate of sphenopalatine artery ligation was 87% (39 of 45). Rebleeding rate was not affected by concomitant septoplasty, anterior ethmoidal artery ligation, or postoperative nasal packing. Patients undergoing SPA ligation within the first 24 hours of admission had a significantly shorter hospital length of stay (3 vs 6 days, P = .02) and treatment cost (€5905 vs €10,001, P = .03). Length of stay was not influenced by sphenopalatine artery ligation after ≤1 nasal pack versus ≥2 packs. Timing of sphenopalatine artery ligation did not affect blood transfusion requirement (P = .84). Sphenopalatine artery ligation is an effective management strategy for surgical control of refractory epistaxis. Early timing of sphenopalatine artery ligation may lead to reductions in length of stay. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  9. Sinonasal quality of life outcomes following laser treatment of epistaxis related to hereditary hemorrhagic telangiectasia.

    Science.gov (United States)

    Kuan, Edward C; Peng, Kevin A; Thompson, Christopher F; Suh, Jeffrey D; Wang, Marilene B

    2017-04-01

    Hereditary hemorrhagic telangiectasia (HHT) is an inherited vascular disorder which manifests as recurrent, episodic, and potentially debilitating epistaxis. In this study, we aim to (1) characterize baseline sinonasal symptoms for HHT patients and to (2) analyze changes in sinonasal symptoms before and after laser surgical treatment for HHT. We performed a retrospective chart review of sinonasal outcome test-22 (SNOT-22) scores before and after one or more laser surgical treatments for HHT-related epistaxis between January 1, 2010 and December 1, 2015 at a tertiary academic medical center with an HHT Foundation-approved Center of Excellence. Preoperative and all subsequent postoperative SNOT-22 scores (short-term, epistaxis. Mean preoperative, short-term postoperative, and long-term postoperative SNOT-22 scores were 34.6 ± 5.4, 33.9 ± 5.5, and 18.8 ± 4.6, respectively. When analyzing subcategory scores, there was a significant improvement in the rhinologic domain from short-term to long-term postoperatively (13.5 vs. 7.3; p = 0.004), in the non-rhinologic otolaryngic domain from short-term to long-term postoperatively (2.8 vs. 1.7; p = 0.014), and in the psychological domain from preoperative and short-term postoperative to long-term postoperatively (12.2 and 10.0 vs. 6.0; p = 0.015 and 0.01, respectively). Following laser surgery for HHT-related epistaxis, patients' rhinologic symptoms worsened on the short run postoperatively but improved over time. The main benefit of laser treatment appears to be long-term improvement in psychological factors. This study once again underscores the important role of the otolaryngologist in managing sinonasal manifestations of HHT.

  10. Petrous internal carotid aneurysm causing epistaxis: Balloon embolization with preservation of the parent vessel

    Energy Technology Data Exchange (ETDEWEB)

    Willinsky, R.; Lasjaunias, P.; Pruvost, P.; Boucherat, M.

    1987-11-01

    A patient with severe, recurrent posterior epistaxis was shown at angiography to have an aneurysm of the petrous portion of the internal carotid artery (ICA). Since childhood, she had had pain related to eustachian tube blockage by the aneurysm. An endovascular balloon embolization of the aneurysm was successful with preservation of the parent artery. The treatment resulted in resolution of the symptoms. The report confirms the usefulness of an angiographic protocol in evaluating vascular problems.

  11. Inspection of the nasopharynx prior to fiberoptic-guided nasotracheal intubation reduces the risk epistaxis.

    Science.gov (United States)

    Kwon, Min A; Song, Jaegyok; Kim, Seokkon; Ji, Seong-Mi; Bae, Jeongho

    2016-08-01

    Various complications may occur during nasotracheal intubation. This may include epistaxis and damage to the nasopharyngeal airway. We tested the hypothesis that the use of fiberoptic bronchoscopy (FOB)-guided intubation is superior to endotracheal tube (ETT) obturated with an inflated esophageal stethoscope. Patients were randomly assigned to 1 of 2 groups (n=22 each): either an FOB-guided intubation group or ETT obturated with an inflated esophageal stethoscope group. After the induction of general anesthesia, patients in the FOB group received an FOB inspection through the nostril without advancement of ETT. Then, after confirming the placement of the bronchoscope tip in the trachea, the lubricated ETT was advanced via the nostril to the trachea along the bronchoscope. In the obturated ETT insertion group, the proximal opening of the ETT was blunted with an inflated esophageal stethoscope. The ETT was inserted into the selected nostril and advanced blindly into the posterior oropharynx. Then, the esophageal stethoscope was removed and tracheal intubation was performed with the bronchoscope. The number of attempts for successful tracheal intubation, the degree of difficulty during insertion, and bleeding during bronchoscopy were recorded. Another anesthesiologist, blinded to the intubation method, estimated the severity of epistaxis 5minutes after the intubation and postoperative complications. The FOB group had significantly less epistaxis during bronchoscopy, better navigability, and fewer intubation attempts and redirections. Fiberoptic-guided nasotracheal intubation was associated with less epistaxis. It also showed better navigability and less redirection rate. Therefore, FOB as an intubation guide is superior to ETT with an inflated esophageal stethoscope when intubating a patient via the nasotracheal route. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Petrous internal carotid aneurysm causing epistaxis: Balloon embolization with preservation of the parent vessel

    International Nuclear Information System (INIS)

    Willinsky, R.; Lasjaunias, P.; Pruvost, P.

    1987-01-01

    A patient with severe, recurrent posterior epistaxis was shown at angiography to have an aneurysm of the petrous portion of the internal carotid artery (ICA). Since childhood, she had had pain related to eustachian tube blockage by the aneurysm. An endovascular balloon embolization of the aneurysm was successful with preservation of the parent artery. The treatment resulted in resolution of the symptoms. The report confirms the usefulness of an angiographic protocol in evaluating vascular problems. (orig.)

  13. Cost of management in epistaxis admission: Impact of patient and hospital characteristics.

    Science.gov (United States)

    Goljo, Erden; Dang, Rajan; Iloreta, Alfred M; Govindaraj, Satish

    2015-12-01

    To investigate patient and hospital characteristics associated with increased cost and length of stay in the inpatient management of epistaxis. Retrospective cross-sectional study of the 2008 to 2012 National (Nationwide) Inpatient Sample. Patient and hospital characteristics of epistaxis admissions were analyzed. Multiple linear regression analysis was used to ascertain variables associated with increased cost and length of hospital stay. Variables significantly associated with high cost were further analyzed to determine the contribution of operative intervention and total procedures to cost. A total of 16,828 patients with an admitting diagnosis of epistaxis were identified. The average age was 67.5; 52.3% of the patients were male; 73.3% of the patients were Caucasian; and 70.7% of the hospital stays were government funded. The average length of stay was 3.24 days, and average hospitalization cost was $6,925. Longer length of stay was associated with black race, alcohol abuse, sinonasal disease, renal disease, Medicaid, and care at a northeastern U.S. hospital. Increased hospitalization costs of > $1,000 were associated with Asian/Pacific Islander race; sinonasal disease; renal disease; top income quartile; and care at urban teaching, northeastern, and western hospitals in the United States. High costs were predicted by procedural intervention in patients with comorbid alcohol abuse, sinonasal disease, renal disease, patients with private insurance, and patients managed at large hospitals. Although hospitalization costs are complex and multifactorial, we were able to identify patient and hospital characteristics associated with high costs in the management of epistaxis. Early identification and intervention, combined with implementation of targeted hospital management protocols, may improve outcomes and reduce financial burden. 2C. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Post-traumatic pseudoaneurysm of internal carotid artery: a cause of intractable epistaxis

    OpenAIRE

    Adeel, Mohammad; Ikram, Mubasher

    2012-01-01

    In this case report, the authors are presenting a case of a 35-year-old lady who presented to our clinic with recurrent episodes of massive epistaxis and loss of right eye vision for last 6 months following road traffic accident. There was no other significant medical and surgical history. Bleeding episodes were sometimes very severe with loss up to 400–500 cc and would stop spontaneously. She was given multiple blood transfusions after these episodes. A complete otorhinolaryngological examin...

  15. [Clinical analyses of patients with intractable epistaxis originated from deep-seated nasal cavity].

    Science.gov (United States)

    Xu, Tong; Li, Na; Jiang, Yan; Yu, Hailing; Yu, Longgang; Jiang, Ye

    2015-07-01

    To investigate the clinical features and management of intractable deep-seated epistaxis. Clinical data were analyzed retrospectively in 195 patients with intractable deep-seated epistaxis treated in Affiliated Hospital of Qingdao College between June 2008 and June 2014. The analyses included common risk factors, bleeding sites, treatments and therapeutic effects. SPSS 17.0 software was used to analyze the data. There were 162 males and 33 females, aged from 15 to 88 years old (mean 52 ± 16 years). One hundred and eighty-seven cases (95.9%) were unilateral and 8 cases (4.1%) were bilateral. One hundred and twenty-six cases (64.6%) had the history of hypertension or blood pressure higher than normal on admission. Eight patients were cured by nasal packing and appropriate drugs, and 187 patients were treated by endoscopy and electrocoagulation. The numbers of treatment needed to stop bleeding were 1 time in 184 cases (98.4%), 2 times in 3 cases (1.6%). Thirteen cases did not have certain bleeding point, while the other 174 had certain one or more bleeding sites. The rewarded bleeding sites were 222, which were found in the following different sites: posterior inferior nasal meatus (33.3%, 74 /222), olfactory cleft of nasal septum (26.6%, 59/222), the root of the middle turbinate (14.0%, 31/222), and so on. Hypertension and diabetes were risk factors (OR value was 3.411, 7.142, both P epistaxis are mainly found in males and are almost unilatera1. Hypertension and diabetes are the common risk factor. The most effective and safe treatment for intractable deep-seated epistaxis is electrocoagulation under nasal endoscopy.

  16. Guidelines of the French Society of Otorhinolaryngology (SFORL). Epistaxis and high blood pressure.

    Science.gov (United States)

    Michel, J; Prulière Escabasse, V; Bequignon, E; Vérillaud, B; Robard, L; Crampette, L; Malard, O

    2017-02-01

    The authors present the guidelines of the French Oto-Rhino-Laryngology - Head and Neck Surgery Society (Société Française d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou: SFORL) on epistaxis in high blood pressure. A multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work group. The final version was established in a coordination meeting. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. It is recommended to measure the blood pressure of patients in acute-phase epistaxis (Grade A); to control high blood pressure medically in the acute phase of bleeding, to reduce its duration; to monitor blood pressure at the waning of nosebleed; and to control high blood pressure medically in the waning phase to reduce the risk of recurrence. In case of persistent high blood pressure on waning of severe epistaxis, it is recommended to prescribe cardiovascular evaluation to screen for underlying hypertensive disease (Grade B). Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. Urgent embolization for the treatment of serious epistaxis in nasopharyngeal carcinoma after radiotherapy

    International Nuclear Information System (INIS)

    Zhu Jun; Ni Caifang; Liu Yizhi; Jing Yonghai; Zhu Xiaoli; Zou Jianwei

    2009-01-01

    Objective: To discuss the clinical effect and safety of urgent embolization with arterial catheterization in the treatment of serious epistaxis in patients with nasopharyngeal carcinoma after radiotherapy. Methods: Fifteen patients with nasopharyngeal carcinoma occurred serious epistaxis after radiotherapy. Because of failure to respond to the treatment of nasal packing and medication, embolization of the bleeding arteries with gelfoam or steel coils was carried out within 1-4 hours after the bleeding. The target arteries were judged by the internal and external carotid angiographic findings. Results: The embolization procedure was successfully completed, in all of 15 patients within 1.5 hours with the technical successful rate of 100%. The bleeding ceased in all 15 patients with the effective rate of 100%. Mild facial palsy occurred in 2 cases, and facial pain of the affected side in one case. All above symptoms were relived and disappeared in about one week after the procedure, leaving no serious complications. Conclusion: Urgent arterial embolization is an effective, safe and simple method for controlling the serious epistaxis in nasopharyngeal carcinoma after radiotherapy. (authors)

  18. Nasal closure for the treatment of epistaxis secondary to hereditary hemorrhagic telangiectasia.

    Science.gov (United States)

    Sena Esteves, Sara; Cardoso, Carla; Silva, Ana; Abrunhosa, José; Almeida E Sousa, Cecília

    Hereditary hemorrhagic telangiectasia (HHT), also known by the eponym Osler-Weber-Rendu syndrome, is an autosomal dominant disorder characterised by the presence of multiple arteriovenous malformations (AVMs) affecting multiple organs. Many procedures have been used for epistaxis control in patients with this disorder. The objective of this study was to report the treatment of severe HHT-related epistaxiswith the modified Young's procedure. We describe the treatment of 4 patients with severe blood-transfusion-dependent epistaxis who underwent a modified Young's procedure in a tertiary hospital. The nasal closure was bilateral and complete in all cases. All patients were followed for 12 months or longer. The procedure was well tolerated and complete cessation of bleeding was achieved in all the patients. Young's technique is a safe surgical procedure, well tolerated by patients with severe epistaxis and HHT. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  19. Emergency embolization in the treatment of intractable epistaxis resulted from carotid arterial disease

    International Nuclear Information System (INIS)

    Sun Zengtao; Liu Yanjun; Chao Baoting; Tang Jun; Liu Zuoqin; Chen Jie; Shang Jianqiang; Zhang Lei; Li Jijun

    2012-01-01

    Objective: To evaluate the clinical value of internal carotid artery occlusion in treatment of intractable epistaxis caused by carotid artery siphon traumatic lesions. Methods: A total of 37 patients with intractable epistaxis caused by traumatic carotid artery siphon pseudoaneurysm or carotid cavernous fistula were retrospectively analyzed. All the patients underwent embolization from October 1998 to June 2010, including 34 men and 3 women with the age ranged from 25 to 65 years and a average of 40 years. Only lesions were occluded in 12 cases without involving the internal carotid artery, while occlusions of internal carotid artery were performed in the rest 25 cases. Results: Thirty-six patients were cured without recurrent hemorrhage after embolization. Only 1 patient with carotid artery occlusion died 48 hours after operation. Conclusion: For patients with carotid arterial intractable epistaxis, if the elimination of the lesions is not applicable and the collateral circulation of Willis ring has a good compensation, the use of detachable balloon or coil occlusion of ipsilateral internal carotid artery is a quick and easy method to save patients' lives. (authors)

  20. Are patients with severe epistaxis caused by hereditary hemorrhagic telangiectasia satisfied with nostril closure surgery?

    Science.gov (United States)

    Ichimura, Keiichi; Kikuchi, Hisashi; Imayoshi, Shoichiro; Yamauchi, Tomohiko; Ishikawa, Kotaro

    2012-02-01

    Recurrent epistaxis as a manifestation of hereditary hemorrhagic telangiectasia (HHT) is usually difficult to control. Although no treatment is regarded to be completely efficacious, nostril closure is considered a modality of choice for the most severe cases. The cessation of airflow resulting from this procedure can stop bleeding by minimizing risk factors. However, loss of nasal functions is a disadvantage of nostril closure. We conducted a questionnaire survey of patients who underwent nostril closure surgery, regarding the effects and disadvantages of the operation. Seven patients were asked questions on issues including frequency and severity of epistaxis pre- and post-operatively, satisfaction of treatment, and impairment in daily living activities. Most patients reported complete cessation of bleeding. Some still had bleeding, but the frequency and severity were far lower. No transfusions were required in any of the cases. Patients reported some disadvantages, for example, respiratory, olfactory, and phonatory issues. Six out of seven patients were very satisfied with the outcome of surgery. Nostril closure surgery can remarkably reduce frequency and volume of epistaxis. Our survey indicated that satisfactory results were achieved. However, difficulties caused by complete nasal obstruction varied. Thus, individualized coping strategies are required. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  1. Comparison of 4% and 6% topical cocaine solutions for reduction of epistaxis induced by nasotracheal intubation.

    Science.gov (United States)

    Lu, I-Cheng; Hsieh, Yu-Hui; Hsu, Hung-Te; Chen, Chung-Ho; Hsu, Ching-Wei; Tseng, Kuang-Yi; Cheng, Kuang-I

    2014-03-01

    Nasotracheal intubation (NTI) provides a good field for surgeons in patients undergoing oromaxillofacial surgery; however, NTI is often complicated by epistaxis. The aim of this study was to compare the efficacy of 4% and 6% topical cocaine solutions in reducing epistaxis during NTI. A total of 79 patients (16-65 years old) undergoing oromaxillofacial surgery were randomly assigned to two groups treated with either 4% cocaine (n = 39) or 6% cocaine (n = 40). Topical cocaine (1 mL) was sprayed onto the selected nasal cavity prior to NTI. All intubations were performed by an expert anesthesiologist using a GlideScope. The incidence and severity of epistaxis was examined along the nasal cavity up to the nasopharynx using a fiber optic bronchoscope. The hemodynamic responses to stimuli during the peri-NTI period were also recorded. The incidence of epistaxis was 43.59% (17/39) in the 4% cocaine group and 50% (20/40) in the 6% cocaine group (p = 0.57). The severity of epistaxis did not differ between the two groups (p = 0.46). High resistance during NTI and epistaxis were closely correlated and the major bleeding sites were located at the nasopharynx. Compared with the 4% cocaine group, treatment with 6% cocaine resulted in a higher heart rate and mean arterial pressure (both p epistaxis. However, 6% cocaine may increase the hemodynamic responses while being sprayed. Therefore spraying with 4% topical cocaine had advantages with respect to 6% cocaine and is recommended for use prior to NTI. Copyright © 2014. Published by Elsevier B.V.

  2. Effect of Bevacizumab Nasal Spray on Epistaxis Duration in Hereditary Hemorrhagic Telangectasia: A Randomized Clinical Trial.

    Science.gov (United States)

    Dupuis-Girod, Sophie; Ambrun, Alexis; Decullier, Evelyne; Fargeton, Anne-Emmanuelle; Roux, Adeline; Bréant, Valentine; Colombet, Bettina; Rivière, Sophie; Cartier, César; Lacombe, Pascal; Chinet, Thierry; Blivet, Sandra; Blondel, Jean-Hugues; Gilbert-Dussardier, Brigitte; Dufour, Xavier; Michel, Justin; Harle, Jean-Robert; Dessi, Patrick; Faure, Frédéric

    2016-09-06

    Epistaxis is the most frequent and disabling manifestation of hereditary hemorrhagic telangiectasia (HHT). The efficacy of intravenous bevacizumab (an anti-vascular endothelial growth factor monoclonal antibody) for epistaxis has been shown. However, the efficacy of intranasal bevacizumab has yet to be evaluated. To evaluate the efficacy of 3 different doses of bevacizumab administered as a nasal spray in a repeated manner for the duration of nosebleeds in patients with HHT. Randomized, multicenter, placebo-controlled, phase 2/3 clinical trial with dose selection at an intermediate analysis and prespecified stopping rules (nonbinding stopping for futility). Patients aged 18 years or older with a diagnosis of HHT were recruited from 5 French centers from April 2014 to January 2015 with a 6-month follow-up after the end of treatment. Participants had a history of self-reported nosebleeds with a monthly duration of more than 20 minutes in at least the 3 months prior to inclusion corroborated by epistaxis grids completed during the same preinclusion period. Eighty consecutive HHT patients were randomized and treated in the phase 2 study, with 4 parallel groups in a 1:1:1:1 ratio. One group received placebo (n = 21); the other 3 received bevacizumab nasal spray. Each bevacizumab group received a different dose of the drug (25 mg [n = 20], 50 mg [n = 20], or 75 mg [n = 19] per treatment) in 3 doses 14 days apart for a total treatment duration of 4 weeks, resulting in a total dose of 75 mg, 150 mg, and 225 mg in each treatment group. Mean monthly epistaxis duration for 3 consecutive months immediately after the end of the treatment. Of the 80 patients who were randomized (mean age, 60.47 [SD, 10.61] years; 37 women [46.25%]), 75 completed the study. Mean monthly epistaxis duration measured at 3 months was not significantly different in the 59 patients receiving bevacizumab in comparison with the placebo group (P = .57) or between the bevacizumab groups

  3. Epistaxis and its Management in a Tertiary Health Facility in Nigeria:A need for thorough Evaluation.

    Science.gov (United States)

    Adedeji, T O; Bande, S A

    2014-01-01

    Epistaxis is one of the most common acute otorhinolaryngologic emergency disorders To review the aetiological profile, management and outcome of epistaxis in a resource challenged environment in Nigeria Methods: A retrospective review of patients that were managed for epistaxis over a five year period A total of 88 patients with an incidence of 18/1000 consisting of 53 males M:F ratio 1.5:1. The age ranged from 2- 68 years and age group 0-10 years was the most affected 29 (33%). Majority 73.9% presented during hot, dry season. Larger proportion (60.2%) was due to Idiopathic cause followed by trauma (11.4%). Over 47% has systemic illnesses that were incidentally discovered. Anterior nasal packing was the most common treatment modality in 46 (52.3%) patients. Thirty three (37.5%) patients were admitted either due to severe anaemia necessitating blood transfusion or due to underline medical condition. Eight (9.1%) patients had blood transfusion. Epistaxis is a common otorhinolaryngologic emergency among the children and the young adult in Africa with highest prevalence during the dry season. A deliberate effort to find the cause of epistaxis is hereby advocated as poverty and ignorance usually prevent most of our patients with underlying medical condition to present until they are in critical emergency situation.

  4. Epistaxis as a Common Presenting Symptom of Glanzmann’s Thrombasthenia, a Rare Qualitative Platelet Disorder: Illustrative Case Examples

    Directory of Open Access Journals (Sweden)

    Michael Recht

    2017-01-01

    Full Text Available Children often present to emergency departments (EDs with uncontrollable nose bleeding. Although usually due to benign etiologies, epistaxis may be the presenting symptom of an inherited bleeding disorder. Whereas most bleeding disorders are detected through standard hematologic assessments, diagnosing rare platelet function disorders may be challenging. Here we present two case reports and review diagnostic and management challenges of platelet function disorders with a focus on Glanzmann’s thrombasthenia (GT. Patient 1 was a 4-year-old boy with uncontrolled epistaxis. His medical history included frequent and easy bruising. Previous laboratory evaluation revealed only mild microcytic anemia. An otolaryngologist stopped the bleeding, and referral to a pediatric hematologist led to the definitive diagnosis of GT. Patient 2 was a 2.5-year-old girl with severe epistaxis and a history of milder recurrent epistaxis. She had a bruise on her abdomen with a palpable hematoma and many scattered petechiae. Previous assessments revealed no demonstrable hemostatic anomalies. Platelet aggregation studies were performed following referral to a pediatric hematologist, leading to the diagnosis of GT. As evidenced by these cases, the ED physician may often be the first to evaluate severe or recurrent epistaxis and should recognize indications for coagulation testing and hematology consultation/referral for advanced hematologic assessments.

  5. Complications from office sclerotherapy for epistaxis due to hereditary hemorrhagic telangiectasia (HHT or Osler-Weber-Rendu).

    Science.gov (United States)

    Hanks, John E; Hunter, David; Goding, George S; Boyer, Holly C

    2014-05-01

    The aim of this study was to identify and evaluate adverse clinical outcomes following office-based sclerotherapy using sodium tetradecyl sulfate (STS) for epistaxis due to hereditary hemorrhagic telangiectasias (HHT or Osler-Weber-Rendu). A retrospective chart review of 36 adult patients treated with STS sclerotherapy for severe and/or recurrent epistaxis due to HHT was performed. A total of 153 separate treatment sessions were analyzed. Each patient underwent an average of 4.3 sessions with an average of 7 intralesional injections per session. Bleeding during the procedure was experienced by 8 patients with a maximum reported blood loss of 200 mL in 1 patient, but less than 50 mL in all others. Seven patients reported some postinjection pain, which included nasal, cheek, and eye pain. Nasal congestion, sneezing, and vasovagal responses were each noted to occur 2 times. No complications of postprocedural visual loss, deep venous thrombosis/pulmonary embolus, transient ischemic attack (TIA)/stroke, or anaphylaxis were encountered. Conventional therapies used in the management of HHT-related epistaxis, such as laser coagulation, septodermoplasty, selective arterial embolization, and Young's occlusion each have specific associated complications, including worsened epistaxis, septal perforation, foul odor, nasal crusting, and compromised nasal breathing. STS is a safe office-based treatment option for HHT-mediated epistaxis that is associated with exceedingly few of the aforementioned serious sequelae. © 2014 ARS-AAOA, LLC.

  6. Role of topical tranexamic acid in the management of idiopathic anterior epistaxis in adult patients in the emergency department.

    Science.gov (United States)

    Logan, Jill K; Pantle, Hardin

    2016-11-01

    The role of topical tranexamic acid in the management of anterior epistaxis in adult patients in the emergency department (ED) is examined. The use of alternative agents for the treatment of epistaxis before the use of nasal packing may be reasonable due to patient discomfort, potential complications, and the need for follow-up with a healthcare provider for packing removal. One such agent is tranexamic acid. Two published studies evaluated the off-label use of topical tranexamic acid for the treatment of epistaxis. The first trial compared the efficacy of a topical gel containing 10% tranexamic acid with a placebo gel containing glycerin for the treatment of epistaxis. The percentage of patients whose bleeding ceased within 30 minutes of the intervention did not significantly differ between the tranexamic acid and placebo groups (p = 0.16). The second trial compared the efficacy of cotton pledgets soaked in the i.v. formulation of tranexamic acid inserted into the bleeding naris with standard nasal packing therapy. Bleeding cessation occurred within 10 minutes in 71% of the tranexamic acid group versus 31.2% of the standard treatment group (odds ratio, 2.28; 95% confidence interval, 1.68-3.09; p epistaxis in select ED patients, though additional studies are needed to confirm its role in treatment algorithms. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  7. Frequency of and risk factors for epistaxis associated with exercise-induced pulmonary hemorrhage in horses: 251,609 race starts (1992-1997).

    Science.gov (United States)

    Takahashi, T; Hiraga, A; Ohmura, H; Kai, M; Jones, J H

    2001-05-01

    To determine the frequency of epistaxis during or after racing among racehorses and identify factors associated with development of epistaxis. Retrospective study. 247,564 Thoroughbred and 4,045 Anglo-Arab race starts. Race start information (breed, age, sex, racing distance, and race type) was obtained for Thoroughbred and Anglo-Arab horses racing in Japan Racing Association-sanctioned races between 1992 and 1997. All horses that raced were examined by a veterinarian within 30 minutes of the conclusion of the race; any horse that had blood at the nostrils was examined with an endoscope. If blood was observed in the trachea, epistaxis related to exercise-induced pulmonary hemorrhage (EIPH) was diagnosed. Epistaxis related to EIPH was identified following 369 race starts (0.15%). Frequency of EIPH-related epistaxis was significantly associated with race type, age, distance, and sex. Epistaxis was more common following steeplechase races than following flat races, in older horses than in horses that were 2 years old, following races horses that had an episode of epistaxis, the recurrence rate was 4.64%. Results suggested that frequency of EIPH-related epistaxis in racehorses is associated with the horse's age and sex, the type of race, and the distance raced. The higher frequency in shorter races suggests that higher intensity exercise of shorter duration may increase the probability of EIPH.

  8. Consideraciones sobre el desarrollo de la literatura pesimista egipcia en el Reino Medio

    Directory of Open Access Journals (Sweden)

    Pablo Martín Rosell

    2010-04-01

    Full Text Available Durante el Reino Medio egipcio asistiremos al desarrollo de la denominada literatura pesimista, única por su contenido y sus mensajes, que se caracterizó por mostrar un mundo en caos, donde los ideales, los valores y las representaciones del orden en la tierra se encontraban alterados. Fueron los primeros textos que plantearon una visión alterada del orden, con el objetivo de mostrar cómo sería la vida sin un Estado fuerte que ordene y organice a la sociedad. Se analizarán obras las Admoniciones de Ipuwer, la Disputa de un hombre con su ba, la Profecía de Neferty y las Lamentaciones de Khakheperrasnebu

  9. Pollution and restoration of soils; Consideraciones generales sobre la contaminacion y restauracion de suelos

    Energy Technology Data Exchange (ETDEWEB)

    Hernandez, D.; Plaza, C.; Polo, A.

    2002-07-01

    Soil contamination has received increasing attention because of its potential consequences for environmental and human health. Soil has a considerable storage and buffering capacity, which protects environment against pollutants. However, it can be exceeded so that remediation technologies are required. This paper approaches soil response to pollutants and available restoration techniques, as well as the legal regime of contaminated soils in Spain. (Author) 20 refs.

  10. Consideraciones sobre la Ansiedad en la Primera Infancia (Considerations Concerning Anxiety in Early Infancy).

    Science.gov (United States)

    Muller, Elsa

    The results of an experience obtained while working with children in the early stages of infancy are presented. They are basically observations taken of a child's reaction to sudden changes, particularly separation from its mother. Anxiety was observed in these infants in diverse circumstances; in some cases it was at a normal level and in others…

  11. Habitar, construir, existir: algunas consideraciones sobre el cuerpo en las psicosis

    Directory of Open Access Journals (Sweden)

    Sonia Leite

    Full Text Available Desde Freud, Lacan y de un importante texto de Heidegger, que se ocupa del tema del habitar, se destaca la cuestión de la inscripción del cuerpo — la primera morada — desde el encuentro con el Otro. La ausencia del significante de la falta impide el psicótico de, en ciertas situaciones, apropiarse del sentido desencadenando la psicosis. La invención del cuerpo propio es una vía de rescate de la ruptura de la realidad y de la estabilización en las psicosis.

  12. Algunas consideraciones sobre la pena de azotes durante los siglos XVI-XVIII

    Directory of Open Access Journals (Sweden)

    Pedro Ortego Gil

    2002-12-01

    Full Text Available Punishment by whipping, one of the corporal punishments with the longest history, was a singularly shameful fate for those who suffered it, as it was especially feared. A different form of this punishment was correction by lashing, the difference being essentially numerical. It cannot be considered an accessory to other punishments, being part of a combination of them. Also, it was not always imposed together with the punishment of being sent to the galleys, or of exile, in spite of the legal doctrine, since in practice, judicial discretion reduced its imposition. As a consequence of this, it represents a reduced percentage, at least, in the Real Audiencia de Galicia, of the total of imposed sanctions. The scope of the application of this punishment was very extensive, notably for theft and for those criminals that, in current terminology, would be called habitual. Its disappearance, from the end of the eighteenth century, was due as much to legal stipulations as to the disuse of its application.

  13. About the recycling of hospital wastes; Consideraciones sobre el reciclaje de residuos hospitalarios

    Energy Technology Data Exchange (ETDEWEB)

    Trescher, J

    1996-12-31

    Why is the hospital waste problem accurate for the last years?. Is it a fashion or the financial cost too high?. It is only definite answer. We can try to justify the interest to the problem by examining a few figures. Only in France, the hospital spending is annually about 240 billions francs. The spending for cross infection is about 5 billion francs. This cost due to the infection can result of a bad hygienic management, and for a part by neglect of production technic in collecting and treatment of hospital waste.

  14. Consideraciones sobre el derecho fundamental a la presunción de inocencia

    Directory of Open Access Journals (Sweden)

    Humberto Nogueira Alcalá

    2005-01-01

    Full Text Available El artículo aborda el alcance de la presunción de inocencia en el ordenamiento jurídico nacional, teniendo en consideración el derecho convencional internacional de los derechos humanos, el código procesal constitucional y la jurisprudencia emanada de nuestros tribunales superiores como de la Corte interamericana de Derechos Humanos.The present article analyzes the scope of the presumption of innocence in Chilean law, considering the law of the international treatises on human rights, the constitutional procedural code, and the case material from both Chilean higher courts and the Inter-American Human Rights Court.

  15. Consideraciones para la toma de impresión de prótesis sobre implantes

    OpenAIRE

    Pérez Pellin, Siulbel

    2008-01-01

    El diseño protésico depende de ciertas condiciones orales y hoy en día el tratamiento con implantes es un recurso terapéutico habitual en el reemplazo de dientes. Existen circunstancias que modifican el desarrollo del tratamiento implantológico y que deben ser evaluadas como son: el espacio entre las arcadas dentales, plano oclusal existente, relación y forma de las arcadas dentales, número y posición de los dientes, entre otras, que determinan la intervención interdisciplinaria del área prot...

  16. ALGUNAS CONSIDERACIONES SOBRE COMUNICACIÓN, GÉNERO Y PREVENCIÓN DEL EMBARAZO ADOLESCENTE

    OpenAIRE

    Barbón Pérez,Olga Gloria

    2011-01-01

    Los principales riesgos que se derivan del embarazo adolescente afectan al sexo femenino, creando desigualdades entre las y los adolescentes involucrados en un embarazo a esta temprana edad, evidenciando la necesidad de que la comunicación intervenga como mediadora desde la perspectiva del proceso de construcción social que diferencia a los hombres y las mujeres y dicta sus relaciones con el poder y los recursos. El presente artículo manifiesta la posición de la autora en cuanto a la tríada c...

  17. Algunas consideraciones patológicas sobre la llamada cirrosis cardiaca

    Directory of Open Access Journals (Sweden)

    Alfonso Uribe Uribe

    1939-10-01

    Full Text Available La enferma que presento es una mujer de edad aproximada a los 48 años. Casada y madre de un hijo, nacido a término y que siempre ha gozado de buena salud. El marido murió no sabe ella de que enfermedad. Siempre ha ejercido oficios domésticos. No recuerda como enfermedades anteriores otras que la fiebre tifoidea y un reumatismo acaecido en la época de la pubertad. Hasta hace dos años estuvo bien de salud. Fue entonces cuando comenzó a sentir disnea de esfuerzo y a observer cianosis, y edemas declives vesperales. Estas tres manifestaciones fueron las únicas de su enfermedad haste el dia en que sufrió una caida en la que se golpeó el vientre. Desde entonces notó que este aumentaba de volumen a la vez que los síntomas anteriores se intensificaban, haciéndose permanente el edema de los miembros inferiores. Observó entonces oliguria acompañada de poliakiuria, con orinas muy rojas y con sedimento rojo. El médico que la vío le aconsejó hospitalización.

  18. Algunas consideraciones sobre raza - política - inmigración en el siglo XIX.

    Directory of Open Access Journals (Sweden)

    Luís María Delio Machado

    2014-06-01

    Full Text Available Las líneas que siguen tienen el propósito de examinar la visualización de un "sujeto" particular, el inmigrante, desde distintos ángulos: económico, político-jurídico y antropológico. El sujeto en cuestión, -el inmigrante-, se nos presenta en la segunda mitad del siglo XIX, bajo diversos rostros: o como simple unidad poblacional que puede incrementar cuantitativamente la variable demográfica, concebida ésta como puramente económica, o como variable cualitativa que involucra aspectos de carácter político, jurídico, antropológico y cultural que implican valoraciones. Nuestro análisis, quedará restringido al estudio de un corpus de fuentes bien delimitado: las tesis que los estudiantes de la Facultad de Derecho próximos a egresar debían presentarobligatoriamente para obtener el grado de Doctor en Jurisprudencia.

  19. Consideraciones sobre el desarrollo moral en escolares con trastornos de conducta

    Directory of Open Access Journals (Sweden)

    Alejandro David González López

    2017-11-01

    Full Text Available La asunción de contenidos socialmente valorados es una condición necesaria para el desarrollo moral de la personalidad. Por tal motivo, cuando las normas y valores sociales no son aprehendidas por el escolar, su desarrollo moral se inmoviliza. Si esto sucede en las primeras edades, generalmente el niño comienza a presentar un trastorno de conducta. El propósito del presente artículo es describir algunas de las particularidades del desarrollo moral de los escolares con este trastorno.

  20. Consideraciones sobre el cultivo del aguacate Persea Americana Mill. en Atlixco, Puebla

    Directory of Open Access Journals (Sweden)

    Teresa Reyna Trujillo

    1983-01-01

    Full Text Available The production of avocado Persea americana Mill in our country has been intensified the last years, particularly in some states such as Michoacán, Puebla, Veracruz and others. Specifically in Puebla, there are some counties "municipios", Atlixco among others, where its exploitation represents an important economical fact. Because of this, it is being pretended to increase the surface occupied with that fruit tree. However, its growth and cultivation, has been exposed to a great number of problems, such as the ecologic ones (inadecuate soils, for example and fitopathologic ones mainly, reasons enough to consider the increase of its growth as inadecuate.

  1. Consideraciones genéticas sobre las dislipidemias y la aterosclerosis

    OpenAIRE

    Julio César Fernández Travieso

    2008-01-01

    La interacción entre factores genéticos y ambientales explican muchos aspectos de la aterosclerosis y las variaciones genéticas constituyen marcadores de riesgo de la enfermedad coronaria (EC), la cual ocupa el primer lugar entre las causas de morbilidad y mortalidad a nivel mundial. La predisposición familiar a padecer EC, junto al avance vertiginoso en técnicas de análisis de ADN y la disponibilidad de secuencias del genoma humano, han orientado la investigación de alteraciones genéticas re...

  2. Consideraciones sobre la adquisición del adjetivo y su semántica

    OpenAIRE

    Millán Garrido, Mª del Rosario

    1988-01-01

    Con este trabajo se intenta profundizar en el adjetivo con un criterio semántico pero al ser difícil deslindarlo de sus estudios léxico y sintáctico, no vamos a excluir de él estos aspectos que se expondrán de forma breve y que nos ayudarán a sacar conclusiones más completas. Aunque la semántica ha ocupado la parte central de la investigación, ha tenido como apoyo el análisis léxico, reflejado en las gráficas, y un estudio sintáctico** previo.

  3. Consideraciones sobre el hidrocefalo de baja presion Considerations on low pressure hydrocephalus

    Directory of Open Access Journals (Sweden)

    E. Herskovits

    1976-12-01

    Full Text Available Se analizan las condiciones fisiopatológicas del sindrome de hidrocéfalo de presión normal. De un grupo de 21 pacientes con sintomatologia clínica correspondiente a esta entidad, se seleccionan 10 que presentan un diagnóstico clínico, radiológico y cisternográfico indudable de la entidad en estudio. Se observó que, a pesar de esta selección solamente un 50% de ellos se vió beneficiado con la colocación de una válvula de baja presión. Surge entonces la hipotésis de que este cuadro es un sindrome multicausal; que por un proceso fisiopatogenico común produce un cuadro clínico, radiológico y cisternográfico similar y que serían beneficiados únicamente aquellos enfermos en los que se soluciona el problema mecánico.The physiopathological conditions of the normal pressure hydrocephalus syndrome are analysed. Within a group of 21 patients with clinical sinto- mathology pertaining this entity, only were 10 selected with a clinical, radiological and cisternografic indubitable diagnosis. It has been noticed that in spite of the stricked selection only a 50% of them have been beneficed by the application of a low pressure valve. Then, the hypothesis that the disease is a multicausal syndrome appears, which by an identical physiopathologic process produces or exhibits a similar clinical, radiological and cisternographic picture. Only those patients on whom the mechanical problem is solved would be beneficed by neurosurgery.

  4. Consideraciones sobre «Ferrando Spagnuolo» y otros maestros ibéricos

    Directory of Open Access Journals (Sweden)

    Condorelli, Adele

    1998-12-01

    Full Text Available The review of the two exhibitions on the Hernandos held at Valencia and, on a minor scale, in Florence, sheds a special light on the noteworthy contribution given by the two Spanish painters to the dissemination of the oil painting technique in Florentine circles at the end of the 15th Century; mention is made of how Yañez drew inspiration from a drawing by Pollaiolo in conceiving the scene of the Baptist's Decollation. As for the Florence exhibition, the review rejects the attribution to Yañez of a part of Pecori's Circumcision. The problem of the Master of Bolea, with regard to Atri's paintings, is raised once again with specific references to drawings of Perugino for the Nativity and of Pollaiolo for the Flagellation.No disponible

  5. Algunas consideraciones sobre la diabetes mellitus y su control en el nivel primario de salud

    Directory of Open Access Journals (Sweden)

    Arnoldo Pérez Rodríguez

    2015-03-01

    Full Text Available La diabetes mellitus, enfermedad crónica no transmisible, es considerada un grave problema de salud por resolver en todo el orbe. A tales efectos se realizó una revisión bibliográfica exhaustiva para exponer algunos aspectos relacionados con esta afección (definición, patogenia, factores de riesgo, aspectos vitales para el diagnóstico, clasificación, complicaciones y cuadro clínico, entre otros y se puntualizó tanto en el tratamiento de los afectados como en la conducta a seguir en la atención primaria de salud

  6. Consideraciones sociologicas sobre profesionalización docente Sociological reflections on teacher's professionalization

    Directory of Open Access Journals (Sweden)

    Emilio Tenti Fanfani

    2007-08-01

    Full Text Available Desde hace algún tiempo el tema de la "profesionalización de los docentes" tiende a ocupar un lugar destacado en la agenda del campo de la política educativa, no sólo en América Latina, sino en otras latitudes (Europa y los Estados Unidos, por ejemplo. Sin embargo, sería ingenuo pensar que la discusión acerca del sentido y contenido de la profesionalización tiene una solución técnica, puesto que lo que en este caso está en juego es la cuestión del control de la autonomía en el trabajo docente. De esta manera el sentido de la profesionalización es un objeto de lucha donde intervienen una pluralidad de actores colectivos y de intereses que es preciso identificar. Al mismo tiempo, no se puede comprender la emergencia de esta cuestión si no se tienen en cuenta algunas transformaciones en la sociedad y en el propio sistema educativo que ponen en crisis las identidades colectivas de los docentes, en especial aquellas que estructuraron su propia emergencia como categoría ocupacional en el momento constitutivo de los sistemas educativos de Estado.For some time now, the subject of "teacher's professionalization" has tended to occupy a leading place in the agenda of educational policies not only in Latin America, but in other latitudes (Europe and the United States, for example, as well. Nevertheless, it would be ingenuous to think that the discussion on the sense and content of professionalization holds the technical solution, since what is at stake here is the issue of controlling the autonomy in teacher's work. The sense of professionalization is thus an object of struggle that involves a multitude of interests and collective actors that need to be identified. At the same time, it is impossible to understand the appearance of this issue if one does not bear in mind some transformations in society and in the very educational system. These throw the collective identities of teachers in a crisis, more particularly those that structure their own appearance as an occupational category when the State educational systems formed.

  7. Algunas consideraciones generales sobre el maltrato de mujeres en la actualidad

    OpenAIRE

    Ferrer Pérez, Victòria A.; Bosch Fiol, Esperança

    2003-01-01

    This study analyses the violence inflicted on women by partners or expartners. A definition of this term and its components (mental, psychological and sexual violence) are presented and discussed. The statistics for domestic violence in our country are analysed, and its status as a "hidden crime" is stressed. Finally, two important questions are studied: what causes domesticviolence, and why some women remain in a violent relationship.

  8. Historia natural y temporalización: consideraciones sobre la Historia natural de Buffon

    OpenAIRE

    María Verónica Galfione

    2013-01-01

    Presenta una relectura de la Historia natural de Buffon a la luz de los conceptos de reversibilidad e irreversibilidad temporal. El objetivo es determinar hasta qué punto Buffon introduce en dicha obra una concepción transformista de las formas naturales. A tales efectos, se analizan los puntos principales de la historia natural clásica y de la doctrina de los gérmenes preformados. Posteriormente, se considera el uso de la variable temporal que realizaba Buffon. Se demuestra, a partir de este...

  9. Historia natural y temporalización: consideraciones sobre la Historia natural de Buffon

    OpenAIRE

    Galfione,María Verónica

    2013-01-01

    Presenta una relectura de la Historia natural de Buffon a la luz de los conceptos de reversibilidad e irreversibilidad temporal. El objetivo es determinar hasta qué punto Buffon introduce en dicha obra una concepción transformista de las formas naturales. A tales efectos, se analizan los puntos principales de la historia natural clásica y de la doctrina de los gérmenes preformados. Posteriormente, se considera el uso de la variable temporal que realizaba Buffon. Se demuest...

  10. Historia natural y temporalización: consideraciones sobre la Historia natural de Buffon

    Directory of Open Access Journals (Sweden)

    María Verónica Galfione

    2013-09-01

    Full Text Available Presenta una relectura de la Historia natural de Buffon a la luz de los conceptos de reversibilidad e irreversibilidad temporal. El objetivo es determinar hasta qué punto Buffon introduce en dicha obra una concepción transformista de las formas naturales. A tales efectos, se analizan los puntos principales de la historia natural clásica y de la doctrina de los gérmenes preformados. Posteriormente, se considera el uso de la variable temporal que realizaba Buffon. Se demuestra, a partir de este examen, que pese a su rechazo de la teoría preformista y del sistema escolar de clasificación, Buffon continúa utilizando categorías que remiten a una matriz temporal de carácter reversible.

  11. Hábitat franco : consideraciones sobre La problemática cultural de la vivienda

    OpenAIRE

    Villa Franco, Julián Fernando

    2013-01-01

    Hábitat Franco es la búsqueda de la evolución teórica del concepto desde una visión antropocéntrica y cultural, hacia el mejoramiento de la calidad del hábitat material e inmaterial, lo cual tiene una relación directa con el tiempo, pasado, presente y futuro; y con el espacio, ya que el hombre es por naturaleza un ser espacial y espaciante. Para esto, se desarrolla un estudio a través de las características generales que componen el hábitat, como son: la sacralización, la territoriali...

  12. Consideraciones sobre la religión en la fenomenología del joven Heidegger

    Directory of Open Access Journals (Sweden)

    CÉSAR LAMBERT

    2008-01-01

    Full Text Available El presente artículo se ocupa de la tematización que Heidegger hace de la religión en su época de docente en Friburgo. Heidegger se encuentra en búsqueda de la fenomenología como ciencia originaria, y en ese contexto destaca tres dimensiones humanas de peculiar importancia: autobiografía, arte y religión. En ese contexto se muestra que lo que aquí interesa es la manera en que la vida táctica se expresa a sí misma. En el caso concreto de la religión, la vida religiosa y su expresión no operan como contenido y continente ajenos el uno del otro. A su vez, la ocupación heideggeriana con la filosofía de la religión tiene, ante todo, que ver con una descripción de las tendencias filosóficas imperantes en su tiempo. El artículo concluye con una somera referencia biográfica a la crisis personal del filósofo que lo lleva a abandonar el catolicismo.The present article is concerned with the themes that Heidegger addresses regarding religión during his time as a teacher in Freiburg. Here Heidegger is found searching for phenomenology as an original science, and in this context he highlights three human dimensions of singular importance: autobiography, art and religión. In this setting, it is shown that what is of interest is the way in which real life expresses itself. As for the concrete case of religión, religious life and its expression do not opérate as contained and container, distant from each other. At the same time, the heideggerian concern with philosophy of religión has to do with a description of the philosophical tendencies dominating in his day, before all else. The article concludes with a brief biographical reference to the personal crisis of the philosopher which leads him to abandon catholicism.onar el catolicismo.

  13. Instituciones Evanescentes : consideraciones políticas sobre la arquitectura itinerante

    OpenAIRE

    Otero Verzier, Marina Teresa

    2017-01-01

    Built architecture is generally conceived to be either ephemeral or permanent. However, there are architectures that are temporal without being ephemeral and permanent without remaining in place. Street markets, circuses and traveling theaters, portable or mobile structures, Archigram’s Ideas Circus and Instant City, Renzo Piano’s IBM Traveling Pavilion, as well as the most recent examples of traveling architectures— including the Chanel Mobile Art by Zaha Hadid and the BMW Guggenheim Lab by ...

  14. Consideraciones sobre la exactitud de las redes de levantamiento topográfico

    Directory of Open Access Journals (Sweden)

    Yordanis Esteban Batista-Legrá

    2013-09-01

    Full Text Available Se evaluó la exactitud de las poligonales medidas en el yacimiento Camarioca Sur lo que permitió obtener nuevos parámetros técnicos para la red de densificación geodésica, teniendo en cuenta el empleo de estaciones totales. Se utilizaron como referencia las poligonales trazadas por los técnicos de GEOCUBA, validándolas con los softwares Topo6, Autocad Map y Autocad Civil 3D 2010. Se empleó el sistema de posicionamiento global (GPS Leica 1200 para el control de los trabajos, tomando como referencia los puntos de apoyo utilizados por GEOCUBA Oriente Norte. Se concluye que cuando se usan estaciones totales es posible fusionar las poligonales de primera y segunda categoría en un solo grupo en virtud de que la exactitud de las mediciones es mayor.

  15. Consideraciones etnobotánicas sobre el género Dioscorea (Dioscoreaceae) en Cuba

    OpenAIRE

    Pérez Camacho, Jacqueline de los Ángeles; Albert Puentes, Delhy Basilia; Rosete Blandariz, Sonia; Sotolongo Molina, Lázara Ofelia; Fernández Zequira, Maira; Delprete, Piero; Raz, Lauren

    2005-01-01

    Se analizan algunos aspectos etnobotánicos de las dioscoreas cubanas. Se realizaron entrevistas para determinar los usos y aplicaciones de estas especies en diferentes regiones del país. Los usos más frecuentes de las especies del género Dioscorea en Cuba son como suplemento dietético, en afecciones gástricas (gastritis) y en rituales de la religión Yoruba. Se determinó los valores de uso de las especies útiles del género. Some ethnobotanical aspects of the Cuban dioscoreas are an...

  16. Consideraciones sobre la gobernabilidad como determinante del comportamiento electoral en Colombia: elecciones presidenciales de 2010

    Directory of Open Access Journals (Sweden)

    Fredy A. Barrero

    2011-12-01

    Full Text Available This article makes a contribution in the literature on electoral behavior in Colombia. Previous explanations have employed theories that emphasize the explanatory power of income, psico-social considerations and retrospective evaluation in order to assess the impact of programmatic, clientelistic and personalistic party-voter linkages on vote-choice. There is a gap in the literature that we propose to fill through the inclusion of governability appeals as a criterion that electors use when defining their electoral preferences. The fact that certain candidates are perceived with better conditions (or not to overcome challenges to governability based on their links with powerful veto players is another factor that influences vote choice in addition to key variables (e.g. ideology. Original empirical information, based on the analysis of a national survey data, confirms the hypothesis proposed.

  17. Consideraciones sobre la filosofía de la educación

    Directory of Open Access Journals (Sweden)

    Andrea Díaz Genis

    2013-01-01

    Full Text Available Este artículo trata de desarrollar la idea de cómo debe entenderse la Filosofía de la Educación en el que se considera, abigarrado y confuso, panorama de las Ciencias de la Educación. Termina resaltando la función teórica y práctica de la filosofía como arte de existencia que “sirve” a una educación emancipadora y enriquecedora del ser humano.

  18. Consideraciones sobre el factor humano en dirección de la empresa colombiana

    Directory of Open Access Journals (Sweden)

    Enrique Rugeles Amaya

    1988-04-01

    Full Text Available RESUMEN El factor humano es importante para el éxito empresarial, ya que en general las universidades hacen énfasis en la planeación, organización, coordinación, dirección y control.

  19. Consideraciones jurídicas sobre los procedimientos experimentales de mejora (enhancement) en neurociências

    OpenAIRE

    Casabona, Carlos María Romeo

    2013-01-01

    La nueva generación de productos psicofarmacológicos ha demostrado su eficacia. Algunas enfermedades neurodegenerativas, como la enfermedad de Alzheimer y la enfermedad de Parkinson, podrían ser tratadas por medio de la terapia génica. Aunque la etiología de tales enfermedades aún no es completamente conocida, se ha demostrado que los pacientes carecen de algunas sustancias que podrían producirse por medio de la transferencia de genes in vivo o ex vivo que las codifican en los lugares apropia...

  20. Rutas y lugares de patrimonio industrial en Europa : consideraciones sobre su aprovechamiento turístico

    Directory of Open Access Journals (Sweden)

    Carlos J. Pardo Abad

    2002-01-01

    Full Text Available Muchas zonas de Europa se han caracterizado en los dos últimos siglos a través de la actividad industrial. Los edificios industriales son tanto el testimonio del desarrollo económico y social como la expresión de la identidad regional. Conservándolos y haciendo de ellos algo útil para la población se consigue mantener vivo un importante aspecto de la historia europea, creando una base potencial para un nuevo desarrollo económico y regional. El patrimonio industrial ofrece muchas oportunidades como recurso turístico y hay muchos ejemplos al respecto en Europa: museos, centros culturales y de interpretación se han abierto en viejas fábricas ya abandonadas.Many areas of Europe have been characterised in recent centuries by industrial activity. Industrial buildings are both the witness of economic and social development and the expression of regional identity. Preserving them and making them available to the population helps to keep this important aspect of European history alive, and creates a potential basis for new economic and regional development. Industrial heritage offers many opportunities as a tourist resource and there are numerous examples in Europe: museums, cultural and interpretation centres have been created in old abandoned faetones.

  1. Estrés Laboral, consideraciones sobre sus características y formas de afrontamiento

    Directory of Open Access Journals (Sweden)

    Roberto Rodríguez Gonzales

    2002-01-01

    Full Text Available El presente trabajo al abordar el estrés y en particular su vinculación con la problemática laboral, intenta además de presentar las experiencias y recopilaciones de información de los autores, brindar enfoque novedoso e integral de l mismo atendiendo a la presencia e importancia que gana en la modernidad. Se ofrecen además recomendaciones acerca de su enfrentamiento desde los planos personal y organizacional.

  2. Consideraciones sobre Botrytis cinerea pers., agente causal de la pudrición de las flores

    Directory of Open Access Journals (Sweden)

    Garcés de Granada Emira

    1992-12-01

    Full Text Available El "moho gris" de las flores, ocasionado por el hongo
    Botrytis cinerea Pers., es una enfermedad de la cual
    se desconocen muchos aspectos fundamentales. Sin embargo y a pesar de esta carencia de conocimientos, frecuentemente se aplican fungicidas que, muchas veces, no resultan efectivos para el control adecuado de la enfermedad e, incluso, se exagera en uso, lo cual significa un aumento de costos y un efecto en el ambiente. Esta enfermedad es muy común en muchas flores de exportación, como rosa, clavel, crisantemo, estatice y gypsophila. Staby y Naegele (1985 opinan que las plantas pueden ser atacadas en el campo, en el transporte o en el almacenamiento. La penetración del patógeno se realiza directamente a través de heridas causadas por insectos o por medios mecánicos. En condiciones muy favorables, el hongo puede penetrar
    directamente en sus hospedantes a través de la cutícula, mediante la producción de enzimas que degradan los componentes de ésta.

  3. Consideraciones sobre la protección legal de la mancha húmeda

    OpenAIRE

    Hera Portillo, África de la; González Monterrubio, José Manuel; Llamas, Manuel Ramón

    2002-01-01

    La protección legal de los humedales resulta posible teóricamente en casi todos los casos, pues existen abundantes vías para conseguir tal objetivo, consistentes en la aplicación de diversas leyes: Ley del Suelo, Ley del Agua, Ley de la Conservación de los Espacios Naturales y de la Flora y Fauna Silvestre (LCENFFS), etc. Sin embargo, esta protección legal resulta poco eficaz desde el punto de vista hidrológico. Hasta el momento, la mayor parte de los mecanismos de protección legal de estos e...

  4. Algunas consideraciones sobre saturnismo entre los trabajadores de una fundición

    Directory of Open Access Journals (Sweden)

    César E Carlín

    1956-07-01

    Full Text Available Este estudio fué realizado en los trabajadores de una fundición que estaban expuestos, entre otros contaminantes atmosféricos, principalmente a humos de plomo. Entre 1,468 trabajadores observados, se encontró 138 casos de plumbismo, 3 de los cuales tenían sólo 30 días de trabajo. Los resultados más importantes del estudio clínico y de laboratorio en los 138 casos de plumbismo fueron: dolor abdominal (61.6%, cefalea (42.0%, debilidad (33.3%, vómitos (18.8%, ribete de Burton (56.5%, ictericia (42.0%, palidez (41.3%, hiperreflexia (21.0%, disminución de la fuerza muscular (15.9% . Del estudio comparado con un grupo patrón de 100 trabajadores no expuestos a humos de plomo y sanos al examen médico, se ha encontrado disminución significante en la hemoglobina, hematocrito, y hematíes de los individuos con plumbismo. La media aritmética de plomo en sangre total fué de 0. 162 mgrs. por 100 grs. y de 0.507 mgrs. por litro de orina, en muestras de 100 cc. Existen trabajadores intoxicados por plomo, con incapacidad potencial, desempeñando sus ocupaciones.

  5. Consideraciones sobre el control de la escabiosis en la atención primaria

    Directory of Open Access Journals (Sweden)

    Rubén José Larrondo Muguercia

    1998-06-01

    Full Text Available Se analizan las diferentes causas del incremento de la incidencia de la escabiosis en los últimos tiempos. Se exponen las características clínicas y los métodos de diagnóstico. Se precisan las modalidades terapéuticas y las medidas de control de la escabiosis a nivel primario de atención médica: The different causes of the increase of the scabies incidence during the last times are analyzed. The clinical characteristics and the diagnostic methods are exposed. The therapeutic modalities and the measures to control scabies at the primary health care level ara also determined

  6. Delayed Presentation of an Extracranial Internal Carotid Artery Pseudoaneurysm and Massive Epistaxis Secondary to a Nasal Foreign Body: Case Report and Review of the Literature.

    Science.gov (United States)

    Katsevman, Gennadiy A; Braca, John A; Welch, Kevin C; Ashley, William W

    2016-08-01

    Epistaxis is a very common medical condition and can often be controlled with conservative measures. Rarely, uncontrolled and life-threatening epistaxis can occur. We present the case of a 58-year-old man who developed delayed, massive epistaxis caused by an extracranial left internal carotid artery pseudoaneurysm caused by an intranasal foreign object without apparent recent trauma. The patient was successfully treated with endovascular stenting of the affected vessel segment. Massive epistaxis is a potentially lethal condition. Although the source uncommonly originates from the internal carotid artery, pseudoaneurysm rupture needs to be considered on the differential diagnosis in selected patients. This case illustrates the need for vigilance for the presence of foreign objects and/or vessel injuries in the setting of acute, massive epistaxis. Additionally, we describe treatment options and review the literature. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Ligation of the internal maxillary artery for intractable epistaxis. 3D imaging of internal maxillary artery using helical CT scan

    International Nuclear Information System (INIS)

    Handa, Toru; Yazin, Koji; Hirakawa, Katsuhiro; Fukushima, Noriyuki; Takumida, Masaya; Hirata, Shitau; Iguchi, Tetsuhiko; Amano, Yoshiharu

    2001-01-01

    Sever posterior epistaxis is one of the serious clinical problems. Nasal bleeding usually occurs in the anterior septal region, where it can be seen easily and controlled with topical cautery or localized packing. When the bleeding occurs in the posterior nose, it becomes a more serious problem. Many methods have been used to control posterior epistaxis. Some of these are electrocautery, posterior nasal packing, vascular ligation and therapeutic percutaneous embolization. Between 1997 and 2000, nineteen patients were admitted to our hospital because of intractable epistaxis. There were 16 male and 3 female patients whose average age was 55 years. Ten of 19 patients were hypertensive, and none of these had undergoing treatment. Five of 19 patients received maxillary artery ligation. Clinical applications of 3D imaging of the internal maxillary artery using helical CT scan were done for 5 patients. These images were helpful for planning of ligation of the internal maxillary artery. (author)

  8. Ligation of the internal maxillary artery for intractable epistaxis. 3D imaging of internal maxillary artery using helical CT scan

    Energy Technology Data Exchange (ETDEWEB)

    Handa, Toru [Akitsu Prefectual Hospital, Hiroshima (Japan); Yazin, Koji; Hirakawa, Katsuhiro; Fukushima, Noriyuki; Takumida, Masaya; Hirata, Shitau; Iguchi, Tetsuhiko; Amano, Yoshiharu

    2001-03-01

    Sever posterior epistaxis is one of the serious clinical problems. Nasal bleeding usually occurs in the anterior septal region, where it can be seen easily and controlled with topical cautery or localized packing. When the bleeding occurs in the posterior nose, it becomes a more serious problem. Many methods have been used to control posterior epistaxis. Some of these are electrocautery, posterior nasal packing, vascular ligation and therapeutic percutaneous embolization. Between 1997 and 2000, nineteen patients were admitted to our hospital because of intractable epistaxis. There were 16 male and 3 female patients whose average age was 55 years. Ten of 19 patients were hypertensive, and none of these had undergoing treatment. Five of 19 patients received maxillary artery ligation. Clinical applications of 3D imaging of the internal maxillary artery using helical CT scan were done for 5 patients. These images were helpful for planning of ligation of the internal maxillary artery. (author)

  9. The minimal important difference of the epistaxis severity score in hereditary hemorrhagic telangiectasia.

    Science.gov (United States)

    Yin, Linda X; Reh, Douglas D; Hoag, Jeffrey B; Mitchell, Sally E; Mathai, Stephen C; Robinson, Gina M; Merlo, Christian A

    2016-05-01

    Hereditary hemorrhagic telangiectasia (HHT) is a disease of abnormal angiogenesis, causing epistaxis in over 96% of patients. The Epistaxis Severity Score (ESS) was developed as a standardized measurement of nasal symptoms among HHT patients. The minimal important difference (MID) of a disease index estimates the smallest change that a patient and clinician would identify as important. This study aims to establish the MID of the ESS in a diverse population of HHT patients. Retrospective cross-sectional study in patients with a diagnosis of HHT using Curacao criteria or genetic testing. The ESS questionnaire and Medical Outcomes Study 36-Item Short Form (SF-36) were administered to participants recruited through the HHT Foundation Web site. Demographics and relevant medical histories were collected from all participants. An anchor-based method using a change of 5 in the Physical Component Summary (PCS) of the SF-36 and a distributional method were used to estimate the MID. A total of 604 subjects were recruited between April and August 2008. All participants reported epistaxis. An increasing ESS in the study cohort showed a significant negative correlation to the PCS (r = -0.43, P < 0.001). The MID was determined to be 0.41 via the anchor-based approach and 1.01 via the distribution-based approach, giving a mean MID of 0.71. Using both the anchor-based and distribution-based approaches, the estimated MID for the ESS in HHT is 0.71. Further implications include key metrics to help guide treatment responses in clinical care and essential information to calculate power and sample size for future clinical trials. 4. Laryngoscope, 126:1029-1032, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  10. Comparison of microporous polysaccharide hemospheres and Ankaferd Blood Stopper in a rabbit epistaxis model.

    Science.gov (United States)

    Yurttas, Veysel; Sereflican, Murat; Terzi, Elçin Hakan; Ozyalvaçlı, Gulzade; Kazaz, Hasan

    2016-04-01

    The aim of this study was to evaluate the histopathological impact, effectiveness, and safety of two hemostatic agents, Ankaferd Blood Stopper (ABS) and microporous polysaccharide hemospheres (MPH), in an experimental rabbit epistaxis model. Rabbits were randomly assigned, using a computerized random number generator, to the following three groups of six animals: group 1 (control, irrigated with saline); group 2 (ABS-treated); and group 3 (MPH-treated). In all groups, a standardized rabbit epistaxis model was used. Hemostasis time and extent of nasal bleeding were measured to compare the hemostatic effect of ABS and MPH among groups. Septums were removed for histopathological analysis, 7 days after the procedure. ABS reduced hemostasis time to 104.2 s and amount of bleeding to 20.5 mg. MPH reduced hemostasis time to 71.7 s and amount of bleeding to 11.5 mg. Mean bleeding time in wounds administered ABS and MPH was significantly shorter compared with wounds administered isotonic saline solution (p = 0.004). ABS and MPH application decreased bleeding significantly compared with the control group (p = 0.004). Bleeding time and amount in the MPH group was significantly reduced compared with the ABS group (p = 0.013 and p = 0.004, respectively). There was no significant difference in the histopathological evaluation results between the ABS, MPH, and control groups. Our data indicate that both ABS and MPH represent safe, effective, and fast-acting hemostatic agents in the management of epistaxis. MPH was more effective than ABS in terms of hemostasis time and amount of bleeding.

  11. Economic evaluation of floseal compared to nasal packing for the management of anterior epistaxis.

    Science.gov (United States)

    Le, Andre; Thavorn, Kednapa; Lasso, Andrea; Kilty, Shaun J

    2018-01-04

    To evaluate the cost-effectiveness of Floseal, a topically applied hemostatic agent, and nasal packing for the management of epistaxis in Canada. Outcomes research, a cost-utility analysis. We developed a Markov model to compare the costs and health outcomes of Floseal with nasal packing over a lifetime horizon from the perspective of a publicly funded healthcare system. A cycle length of 1 year was used. Efficacy of Floseal and packing was sought from the published literature. Unit costs were gathered from a hospital case costing system, whereas physician fees were extracted from the Ontario Schedule of Benefits for Physician Services. Results were expressed as an incremental cost per quality-adjusted life year (QALY) gained. A series of one-way sensitivity and probabilistic sensitivity analyses were performed. From the perspective of a publicly funded health are system, the Floseal treatment strategy was associated with higher costs ($2,067) and greater QALYs (0.27) than nasal packing. Our findings were highly sensitive to discount rates, the cost of Floseal, and the cost of nasal packing. The probabilistic sensitivity analysis suggested that the probability that Floseal treatment is cost-effective reached 99% if the willingness-to-pay threshold was greater than $120,000 per QALY gained. Prior studies have demonstrated Floseal to be an effective treatment for anterior epistaxis. In the Canadian healthcare system, Floseal treatment appears to be a cost-effective treatment option compared to nasal packing for anterior epistaxis. 2c Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

  12. Challenges in the management of massive intraorbital and hemifacial arteriovenous malformation as causing life-threatening epistaxis

    Directory of Open Access Journals (Sweden)

    Anura Michelle Manuel

    2017-03-01

    Full Text Available Arteriovenous malformations are congenital lesions that may evolve with time and manifest in a plethora of presentations. They can occur as torrential epistaxis when it extensively involves the facial region. Multi-imaging modalities are available to assist in characterizing the structure of the lesion as well as its location and extent. This complex disease requires a multidisciplinary team approach with preoperative embolization and surgery. We present a rare cause of life-threatening epistaxis in a gentleman with a longstanding orbital and hemifacial arteriovenous malformation and discuss the complexities involved in its management.

  13. Challenges in the management of massive intraorbital and hemifacial arteriovenous malformation as causing life-threatening epistaxis.

    Science.gov (United States)

    Manuel, Anura Michelle; Kalimuthu, Santhi; Pathmanathan, Sitra Siri; Narayanan, Prepageran; Zainal Abidin, Zurina; Azmi, Khairul; Khalil, Alizan

    2017-04-01

    Arteriovenous malformations are congenital lesions that may evolve with time and manifest in a plethora of presentations. They can occur as torrential epistaxis when it extensively involves the facial region. Multi-imaging modalities are available to assist in characterizing the structure of the lesion as well as its location and extent. This complex disease requires a multidisciplinary team approach with preoperative embolization and surgery. We present a rare cause of life-threatening epistaxis in a gentleman with a longstanding orbital and hemifacial arteriovenous malformation and discuss the complexities involved in its management. Copyright © 2017. Published by Elsevier Taiwan.

  14. [Clinical study of treatment of epistaxis of little's area by microwave, anterior nasal packing and trichloroacetic acid cautery].

    Science.gov (United States)

    Zhi, T; Liu, Y; Liu, F

    1999-11-01

    To study the difference and quality of three different kind of treatment methods for epistaxis of Little's area, such as: microwave, anterior packing of nasal cavity and trichloroacetic acid cautery. The cases were divided into three group. The state of bleeding, reaction of after-treatment and recurrence were recorded and analysed. Comparing with the anterior nasal packing and trichloroacetic acid cautery, the microwave is characteristic by thorough stop-bleeding, light reaction, less recurrence. Microwave is an ideal way to treat epistaxis of Little's area. The patient's reaction is mild and less the clinical effects is obviously better than the anterior packing of nasal cavity and trichloroacetic acid cautery.

  15. A very rare case of bloody tears with enigmatic epistaxis and haematuria.

    Science.gov (United States)

    Ho, Jason Z S; de Silva, Julian; Olver, Jane

    2011-03-01

    Bloody tears are a rare symptom that can be caused by local or systemic pathology. We describe a very rare case of bloody tears that resulted from hyperthyroidism. A 15-year-old female patient presented with a 6-month history of bloody tears and epistaxis. Examination excluded local ocular and nasal pathology, including neoplasm and coagulopathy. Systemic investigations identified elevated thyroid function and following treatment her symptoms resolved. We discuss the mechanism by which hyperthyroidism may induce haemostatic dysfunction. We present the first case of bloody tears secondary to thyroid dysfunction.

  16. Consideraciones éticas ante el paciente con hemorragia digestiva alta Ethical considerations regarding the patient with upper digestive bleeding

    Directory of Open Access Journals (Sweden)

    Martha Esther Larrea Fabra

    2009-03-01

    Full Text Available Se hace un análisis de la actuación que debe tener el personal de la salud ante una enfermedad aguda, como es el caso de la hemorragia digestiva, y de la repercusión que ésta tiene en las esferas física y psíquica del paciente y de sus familiares, así como de las alteraciones que puede ocasionar en la relación del hombre con su comunidad. Las consideraciones éticas sustentadas en la medicina basada en evidencias son de suma importancia para lograr la recuperación de estos pacientes graves y la mejor opción para que el enfermo recupere su salud de forma integral. Se hacen reflexiones respecto a los conceptos que sobre la ética médica han sido considerados y respecto a aquellos sobre los que se basa nuestra sociedad actual.An analysis is made of the way the health personal should act in the presence of an acute disease, such as digestive hemorrhage, of its impact on the physical and psychical spheres of the patients and their relatives, as well as of the disorders it may cause in the man-community relationship. The ethical considerations sustained on evidence-based medicine are very important to attain the recovery of these severe patients and they are the best option for the comprehensive recuperation of the patient's health. Reflections are made on the concepts of medical ethics that have been considered so far and on those on which our current society is based.

  17. Management of Epistaxis – A Single Centre Experience and Economic Considerations

    LENUS (Irish Health Repository)

    Keane, E

    2016-06-01

    Epistaxis represents the most common ENT emergency and its management has been a focus of audit recently, with consideration given to the associated economic burden. The aim of our study is to evaluate the management of epistaxis in terms of treatments used, duration of stay, recurrence and cost. A retrospective review of hospital inpatient enquiry (HIPE) data from a single secondary referral centre was undertaken during a four year period. Four hundrefd and thirty-four patients were identified. The majority (n= 262, 60.3%) were male and the average age was 64.2 years. The vast majority (n=362, 83.4%) were managed non-operatively. Only 15 patients (3.4%) were managed surgically. The average length of stay was 2.5 days and did not vary greatly between the treatment groups. The recurrence rate was 8.2% (n=36). Approximate costs of packing vs EUA and cautery suggest that packing alone is more economical but more data is needed to fully compare the options.

  18. Isolation and molecular characterization of Mycobacterium bovis causing pulmonary tuberculosis and epistaxis in a Thoroughbred horse.

    Science.gov (United States)

    Hlokwe, Tiny Motlatso; Sutton, David; Page, Patrick; Michel, Anita Luise

    2016-09-02

    Tuberculosis caused by Mycobacterium bovis (M. bovis) is very uncommon in horses worldwide. In the current study, an eight-year-old male Thoroughbred in good body condition was admitted to the Equine Clinic at the Onderstepoort Veterinary Academic Hospital in 2005 due to bilateral epistaxis accompanied by coughing. Routine examinations were conducted to determine the cause of the condition. Endoscopic examination revealed the major source of the epistaxis as the trachea, whereas thoracic radiography indicated the presence of a primary pulmonary mass. M. bovis was isolated from a broncho-alveolar lavage (BAL) sample collected. The pulmonary mass reduced in size three months later following an oral administration of enrofloxacin (7.5 mg/kg PO SID). Genetic fingerprinting by spoligotyping identified the M. bovis isolate as spoligotype SB0868 strain. This M. bovis strain type was never described previously in South Africa (SA). This is the first case of M. bovis infection in a horse in SA which has been fully documented including clinical findings, isolation and genetic characterisation of the causative pathogen. This report indicates that horses may contract and harbour M. bovis despite their lower susceptibility compared to other domestic animals. It also suggests that the infection may be more easily contained and eliminated from the host.

  19. Long-term result of out-patient neodymium-doped yttrium aluminium garnet laser photocoagulation surgery for patients with epistaxis.

    Science.gov (United States)

    Zhang, J; Qiu, R; Wei, C

    2016-01-01

    To evaluate the long-term efficacy of out-patient neodymium-doped yttrium aluminium garnet laser photocoagulation surgery for patients with epistaxis. A retrospective clinical study was conducted. A total of 217 consecutive patients who presented with acute or recurrent epistaxis received neodymium-doped yttrium aluminium garnet laser photocoagulation treatment in an out-patient setting. At three years, 94 per cent of acute epistaxis patients versus 88 per cent of recurrent epistaxis patients reported no bleeding. The outcome scores at 12 weeks and 3 years after treatment showed no significant differences between the 2 groups (p = 0.207 and p = 0.186). However, there was a significant difference in outcome scores at four weeks after treatment (p = 0.034). The median (and mean ± standard deviation) pain levels experienced during the laser operation (performed in an office setting) were 4.0 (3.75 ± 2.09) in the acute epistaxis group and 4.0 (3.83 ± 2.01) in the recurrent epistaxis group. Neither group had any complications. Neodymium-doped yttrium aluminium garnet laser photocoagulation is desirable in the treatment of both acute and recurrent epistaxis, and has long-lasting efficacy.

  20. Influence of temporary nasal occlusion (tNO) on epistaxis frequency in patients with hereditary hemorrhagic telangiectasia (HHT).

    Science.gov (United States)

    Wirsching, Kornelia E C; Haubner, Frank; Kühnel, Thomas S

    2017-04-01

    The objective of the study was to evaluate the influence of temporary nasal occlusion (tNO) with hypoallergenic tape on the frequency and severity of epistaxis in patients with hereditary hemorrhagic telangiectasia (HHT). This prospective observational study included 20 HHT patients who were undergoing Nd:YAG laser therapy at regular intervals. Over a 3-month period, laser therapy was supplemented by tNO with hypoallergenic tape for 5 h/day on average. On a 0-10 numeric rating scale, the patients reported significantly greater satisfaction in epistaxis terms after tNO treatment, with mean scores of 5 before and 7 after 3-month tNO (p = 0.05). The Epistaxis Severity Score also fell significantly from a median of 3.59-2.43 after 3-month tNO compared with laser therapy alone (p = 0.01). The patients' hemoglobin levels remained stable during the study (median: 12.2 g/dL before tNO; median: 11.7 g/dL after tNO; p = 0.387). Overall, the present study confirms the positive influence of tNO on epistaxis in HHT patients and on subjective satisfaction. This simple and inexpensive strategy is therefore a helpful option, especially in addition to regular Nd:YAG laser therapy, and is recommended by the authors.

  1. Epistaxis and other haemorrhagic events associated with the smoking cessation medicine varenicline : a case series from two national pharmacovigilance centres

    NARCIS (Netherlands)

    Harrison-Woolrych, Mira; Harmark, Linda; Tan, Ming; Maggo, Simran; van Grootheest, Kees

    Purpose To present a case series of haemorrhagic events associated with varenicline identified from the New Zealand (NZ) and Netherlands national pharmacovigilance centres and propose a possible mechanism for these adverse events. Methods Reports of epistaxis and other haemorrhagic events (in all

  2. Evaluation of Etiology and Treatment Methods for Epistaxis: A Review at a Tertiary Care Hospital in Central Nepal

    Science.gov (United States)

    2015-01-01

    Introduction. Epistaxis is one of the most common emergencies in Otorhinolaryngology. It is usually managed with simple conservative measures but occasionally it is a life threatening condition. Identification of the cause is important, as it reflects the management plan being followed. Aims and Objectives. To analyze the etiology and treatment methods for patients with epistaxis. Methods. A retrospective study was done in a tertiary care hospital in central Nepal. The study period was from May 2014 to April 2015. Results. A total of 84 patients had epistaxis; 52 were males and 32 were females. The most common cause of epistaxis was idiopathic (38.09%) followed by hypertension (27.38%), trauma (15.47%), and coagulopathy (8.33%). Regarding treatment methods, most (52.38%) of our patients required anterior nasal packing. Chemical cautery was sufficient to stop bleeding in 14.28% of patients while electrocautery and posterior nasal packing were performed in 2.38% and 16.66% patients, respectively. Two (2.38%) patients required endoscopic sphenopalatine arterial ligation. Conclusion. Hypertension, trauma and coagulopathy were the most common etiological factors among the patients in whom etiology was found although in most of the patients etiology could not be found. Anterior nasal packing was the most common treatment method applied to these patients. PMID:26346242

  3. Evaluation of Etiology and Treatment Methods for Epistaxis: A Review at a Tertiary Care Hospital in Central Nepal.

    Science.gov (United States)

    Parajuli, Ramesh

    2015-01-01

    Introduction. Epistaxis is one of the most common emergencies in Otorhinolaryngology. It is usually managed with simple conservative measures but occasionally it is a life threatening condition. Identification of the cause is important, as it reflects the management plan being followed. Aims and Objectives. To analyze the etiology and treatment methods for patients with epistaxis. Methods. A retrospective study was done in a tertiary care hospital in central Nepal. The study period was from May 2014 to April 2015. Results. A total of 84 patients had epistaxis; 52 were males and 32 were females. The most common cause of epistaxis was idiopathic (38.09%) followed by hypertension (27.38%), trauma (15.47%), and coagulopathy (8.33%). Regarding treatment methods, most (52.38%) of our patients required anterior nasal packing. Chemical cautery was sufficient to stop bleeding in 14.28% of patients while electrocautery and posterior nasal packing were performed in 2.38% and 16.66% patients, respectively. Two (2.38%) patients required endoscopic sphenopalatine arterial ligation. Conclusion. Hypertension, trauma and coagulopathy were the most common etiological factors among the patients in whom etiology was found although in most of the patients etiology could not be found. Anterior nasal packing was the most common treatment method applied to these patients.

  4. Late-Onset Massive Epistaxis due to a Ruptured Traumatic Internal Carotid Artery Aneurysm: A Case Report.

    Science.gov (United States)

    Arai, Nobuhiko; Nakamura, Akiyoshi; Tabuse, Masanao; Miyazaki, Hiromichi

    2017-01-01

    A traumatic internal carotid artery (ICA) aneurysm is rare and difficult to treat. Trapping of ICA is commonly performed owing to the difficulty of directly approaching ICA aneurysms. Recently, coiling the aneurysm itself was recommended if possible. However, it is controversial which of methods are best to completely treat aneurysm. We present the case of a 74-year-old man, who had experienced a head injury 8 years previously, with recurrent severe epistaxis. An ICA aneurysm was detected on computed tomography. The trapping and bypass was planned. However, sudden epistaxis occurred, we performed trapping to stop the bleeding and save his life. After the operation, no right ICA or aneurysm was detected. However, severe epistaxis recurred two months after the operation. In the second operation, a ligation of the common -/- external carotid artery and a severance of an ICA portion between the ophthalmic artery and the aneurysm were insufficient to stop the bleeding. This case indicates ICA trapping, even if a trapping portion is below an ophthalmic artery, is insufficient to treat an ICA aneurysm. ICA aneurysms should be suspected when a patient present with recurrent -/- massive epistaxis, who has a head injury history, even if it is far past.

  5. Evaluation of Etiology and Treatment Methods for Epistaxis: A Review at a Tertiary Care Hospital in Central Nepal

    Directory of Open Access Journals (Sweden)

    Ramesh Parajuli

    2015-01-01

    Full Text Available Introduction. Epistaxis is one of the most common emergencies in Otorhinolaryngology. It is usually managed with simple conservative measures but occasionally it is a life threatening condition. Identification of the cause is important, as it reflects the management plan being followed. Aims and Objectives. To analyze the etiology and treatment methods for patients with epistaxis. Methods. A retrospective study was done in a tertiary care hospital in central Nepal. The study period was from May 2014 to April 2015. Results. A total of 84 patients had epistaxis; 52 were males and 32 were females. The most common cause of epistaxis was idiopathic (38.09% followed by hypertension (27.38%, trauma (15.47%, and coagulopathy (8.33%. Regarding treatment methods, most (52.38% of our patients required anterior nasal packing. Chemical cautery was sufficient to stop bleeding in 14.28% of patients while electrocautery and posterior nasal packing were performed in 2.38% and 16.66% patients, respectively. Two (2.38% patients required endoscopic sphenopalatine arterial ligation. Conclusion. Hypertension, trauma and coagulopathy were the most common etiological factors among the patients in whom etiology was found although in most of the patients etiology could not be found. Anterior nasal packing was the most common treatment method applied to these patients.

  6. Randomized controlled trial comparing Nd:YAG laser photocoagulation and bipolar electrocautery in the management of epistaxis.

    Science.gov (United States)

    Zhang, Jing; Cao, Luhong; Wei, Chunsheng

    2017-09-01

    The objective of this study is to evaluate the efficacy and degree of comfort of Nd:YAG laser photocoagulation compared to bipolar electrocautery in the management of epistaxis. Seventy-two consecutive patients with a history of epistaxis were randomly assigned to receive treatment in an outpatient setting consisting of either bipolar electrocautery (group 1) or Nd:YAG laser photocoagulation (group 2). The study was conducted in university-affiliated teaching hospital. Seventy-two consecutive patients who suffered from anterior epistaxis and presented to the Otolaryngology Department at the Eye, Ear, Nose and Throat Hospital, Fudan University, between June 2015 and August 2015. The following outcome measures were assessed: bleeding intensity, bleeding frequency 4 and 16 weeks after treatment (0 = no bleeding, 1 = reduced bleeding, 2 = the same, and 3 = worse), participant perception of discomfort during treatment (grade 0-10, where 10 is the worst pain), and therapy duration and complications. At 16 weeks, 91% of the laser patients versus 91% of the bipolar electrocautery patients had no reported bleeding. The outcome scores at 4 and 16 weeks after treatment showed no significant difference between the two groups (P = 0.5 and P = 0.98, respectively; P > 0.05). The median pain levels experienced during the office laser and bipolar electrocautery procedures were 3.0 and 4.0, respectively, and the median durations of the laser and electrocautery therapies were 3.0 and 4.0, respectively. Neither groups had complications. It can be concluded that Nd:YAG laser photocoagulation and bipolar electrocautery are both effective in the treatment of epistaxis. These two therapies are recommended. As a whole, these two therapies, performed in an office setting, are timely, efficacious, and well tolerated in the treatment of epistaxis.

  7. La biblioteca virtual especializada de los derivados de la caña de azúcar: consideraciones, experiencias y perspectivas

    Directory of Open Access Journals (Sweden)

    Hernández Curbelo, Maby

    2011-03-01

    Full Text Available In this paper, the results of a project for the design and implementation of a specialized virtual library for sugar cane by-products are presented, including initial considerations, an architecture for working in a web environment, and the basic characteristics of software for managing a digital collection. This library supports research into sugar cane by-products and also represents an initial step toward the creation of a specialized virtual centre of information and knowledge for the sugar industry.

    En este trabajo se describen los resultados del proyecto de diseño e implementación de la biblioteca virtual especializada sobre los derivados de la caña de azúcar. Se abordan consideraciones, arquitectura de trabajo en ambiente de Internet y características básicas del software para la administración de su colección digital. Esta biblioteca es soporte para la investigación sobre los derivados de la caña de azúcar y constituye el paso inicial hacia la creación de un centro virtual especializado de información y conocimiento para el sector azucarero.

  8. [Management of side effects of targeted therapies in renal cancer: stomatological side effects (mucositis, epistaxis)].

    Science.gov (United States)

    Agbo-Godeau, Scarlette; Nicolas-Virelizier, Emmanuelle; Scotté, Florian

    2011-01-01

    The advent of targeted therapies in the treatment of renal cancer has shown different types of lesions of the oral cavity, which appear to be specific to the drug classes used (mTOR inhibitors, anti-angiogenic agents and conventional cytotoxic drugs). Before starting treatment with targeted therapy, it is essential to have an oral and a dental examination. The treatment of mucositis induced by targeted therapies is based on bicarbonate-based mouthwash, with the optional addition of an antifungal or a local antiseptic. It is possible to use topical or systemic analgesics for the pain. Dietary advice for patients is also useful. Most cases of epistaxis caused by anti-angiogenics stop spontaneously and require no medical intervention. Regular application of an emollient can be used to prevent the formation of scabs. Copyright © 2011 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  9. Post-traumatic pseudoaneurysm of internal carotid artery: a cause of intractable epistaxis.

    Science.gov (United States)

    Adeel, Mohammad; Ikram, Mubasher

    2012-05-23

    In this case report, the authors are presenting a case of a 35-year-old lady who presented to our clinic with recurrent episodes of massive epistaxis and loss of right eye vision for last 6 months following road traffic accident. There was no other significant medical and surgical history. Bleeding episodes were sometimes very severe with loss up to 400-500 cc and would stop spontaneously. She was given multiple blood transfusions after these episodes. A complete otorhinolaryngological examination including rigid endoscopy and coagulation investigation did not reveal any abnormality. CT with contrast of paranasal region showed blood within the right sphenoid sinus with linear fracture of the lateral wall with post-traumatic cavernous pseudoaneurysm of internal carotid artery localised to right sphenoid sinus. That was managed successfully by embolisation using a detachable balloon and a coil. She was followed up in the clinic at 6 weeks and 6 months interval with no symptoms.

  10. Effects of a topical hemostatic agent on an epistaxis model in rabbits.

    Science.gov (United States)

    Kurtaran, Hanifi; Ark, Nebil; Serife Ugur, K; Sert, Huseyin; Ozboduroglu, Akin Altug; Kosar, Ali; Gunduz, Mehmet

    2010-04-01

    Ankaferd BloodStopper (ABS) is a standardized herbal compound consisting of 5 different plant extracts. ABS, as a topical medicinal product, has been approved by the Turkish Ministry of Health for the management of dermal, external postsurgical and postdental surgery bleedings. The aim of this study was to assess the hemostatic effect of ABS in an experimental epistaxis model. Adult female New Zealand rabbits were used in this study. Standardized full-thickness mucosal wounds were created to provide bleeding on the right and left side of the nasal septum of rabbits with a 3-mm surgical punch. To stop bleeding, the wounds were treated with topical ABS on one side and with topical isotonic saline solution as a control on the other side of the nasal septum. Investigators were blinded to treatment. The duration of bleeding was measured in order to compare the hemo-static effect with ABS or topical isotonic saline solution. The wounds were observed for the duration of bleeding in order to compare the hemostatic effect of ABS with isotonic saline solution and acute adverse effects (AEs) for 30 minutes by a researcher blinded to treatment groups. Six rabbits (mean weight, 2.6 kg [range, 2.3-3.1 kg]) were used in this study. Mean (SD) bleeding time in the wounds administered ABS (98 [17] sec) was significantly less than that of the controls (266 [36] sec; P = 0.004). No AEs were observed up to 30 minutes after study initiation. This study suggests that ABS may be more effective in reducing time to hemostasis when compared with isotonic saline solution in this epistaxis model in rabbits.

  11. Epistaxis after partial middle turbinectomy: the role of sphenopalatine artery ligation.

    Science.gov (United States)

    Cassano, Michele; Cassano, Pasquale

    2012-01-01

    Extensive nasal polyposis could involve the middle turbinate inducing the surgeon to partially remove it. We initiated this retrospective study to evaluate the effect of a partial middle turbinectomy (PMT) on postoperative epistaxis and if sphenopalatine artery ligation (SPAL) could reduce the risk of bleeding in patients without nasal packing. Twenty-seven patients with extended bilateral nasal polyposis and submitted to primary functional endoscopic sinus surgery (FESS) with PMT on 40 sides were retrospectively selected. Postoperative bleeding and other complications were evaluated and compared with those of a control group of 27 patients who underwent FESS with middle turbinate preservation on 40 sides. The study group was furthermore divided into 2 groups according to the execution of SPAL. The incidence of postoperative bleeding of both groups and of the 2 parts of the study group was compared using the Fisher exact test. A SPAL was necessary to stop intraoperative bleeding in 21 (52.5%) sides of the study group patients and in 7 (17.5%) of the control group patients. After surgery, epistaxis occurred in 8 cases (20%) in the PMT group (1 submitted to SPAL) and in 2 (5%) of the control group. The comparison with the Fisher exact test confirmed the major tendency of postoperative bleeding in the study group and in those not submitted to SPAL (P < .05). Partial middle turbinectomy causes a higher incidence of postoperative bleeding in patients who are not packed during the FESS operation. The execution of SPAL greatly reduces this risk. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Intensity-Modulated Radiotherapy for a Rendu-Osler-Weber Disease Patient with Recurrent Severe Epistaxis: A Case Report

    Directory of Open Access Journals (Sweden)

    Maximilian Niyazi

    2010-01-01

    Full Text Available We present a case of a Rendu-Osler-Weber disease patient with recurrent life threatening epistaxis demanding multiple blood transfusions despite of repetitive endoscopic laser and electrocoagulations, endovascular embolisation, septodermoplasty, and long-term intranasal dressings. As alternative treatment modalities repeatedly failed and the patient became almost permanently dependent on nasal dressing, we performed a highly conformal intensity-modulated radiotherapy of the nasal cavity; a total dose of 50 Gy in 2 Gy single fractions was applied. The therapy was very well tolerated, no acute toxicities occurred. Two weeks after the last radiation dose had been applied, the nasal dressing could be removed without problems. Endoscopical control revealed an almost avascular white mucosa without any trace of bleeding spots; previously existing hemangiomas and crusts had disappeared. After a 1-year-follow up, the patient had no significant recurrent epistaxis.

  13. Epistaxis as the First Manifestation of Silent Renal Cell Carcinoma: A Case Report with Relevant Literature Review

    International Nuclear Information System (INIS)

    Lee, Seung Min; Kim, You Me; Kim, Bong Man

    2016-01-01

    The paranasal sinuses are known to be a rare location for metastasis. Renal cell carcinoma (RCC) is the most frequent primary tumor to metastasize to the sinonasal region, followed by lung and breast cancer. In particular, clear cell type RCC, which represents approximately 85% of RCCs, is characterized by early metastasis, and it sometimes spreads to unusual sites (1, 2). Metastatic tumors in the paranasal sinuses are distributed in the maxillary, sphenoid, ethmoid, and frontal sinuses, in order of decreasing frequency. Symptoms are usually nonspecific, but epistaxis is the most common sign, due to the hypervascularity of the primary tumor. The prognosis is uncertain, but the 5-year survival rate fluctuates between 15% and 30%. The purpose of this case report is to document a rare case of silent RCC that first presented as epistaxis due to nasal cavity and ethmoid sinus metastasis

  14. Late-Onset Massive Epistaxis due to a Ruptured Traumatic Internal Carotid Artery Aneurysm: A Case Report

    OpenAIRE

    Arai, Nobuhiko; Nakamura, Akiyoshi; Tabuse, Masanao; Miyazaki, Hiromichi

    2016-01-01

    A traumatic internal carotid artery (ICA) aneurysm is rare and difficult to treat. Trapping of ICA is commonly performed owing to the difficulty of directly approaching ICA aneurysms. Recently, coiling the aneurysm itself was recommended if possible. However, it is controversial which of methods are best to completely treat aneurysm. We present the case of a 74-year-old man, who had experienced a head injury 8 years previously, with recurrent severe epistaxis. An ICA aneurysm was detected on ...

  15. Guidelines of the French Society of Otorhinolaryngology (SFORL) (short version). Specific treatment of epistaxis in Rendu-Osler-Weber disease.

    Science.gov (United States)

    Robard, L; Michel, J; Prulière Escabasse, V; Bequignon, E; Vérillaud, B; Malard, O; Crampette, L

    2017-02-01

    The authors present the guidelines of the French Oto-Rhino-Laryngology - Head and Neck Surgery Society (Société Française d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou: SFORL) concerning specific treatment of epistaxis in Rendu-Osler-Weber disease. A multidisciplinary work-group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work group. The final version was established in a coordination meeting. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. Rendu-Osler-Weber disease is diagnosed from the presence of at least three of Curaçao's four criteria. In acute epistaxis, bidigital compression is recommended. Embolization is reserved for resistant epistaxis. Non-resorbable nasal packing and cauterization are contraindicated. Patient education is essential. Telangiectasia of the nasal mucosa can be treated by various local means. In the event of insufficient control, systemic administration of tranexamic acid is recommended. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  16. Guidelines of the French Society of Otorhinolaryngology (SFORL). Managing epistaxis under coagulation disorder due to antithrombotic therapy.

    Science.gov (United States)

    Escabasse, V; Bequignon, E; Vérillaud, B; Robard, L; Michel, J; Malard, O; Crampette, L

    2017-05-01

    The authors present the guidelines of the French Society of Otorhinolaryngology concerning the management of epistaxis during antithrombotic therapy. A review of the literature was performed by a multidisciplinary work group. Guidelines were drafted, then re-edited by a reading group independent of the work group to produce the final text. The proposed recommendations were graded A, B, C or expert opinion, on decreasing levels of evidence. Before any decision to modify antithrombotic treatment, it is recommended to screen for overdose and assess the risk of thrombosis. In stented patients, dual antiplatelet therapy must be maintained during the month following stenting and, if possible, for 3 months. In epistaxis with antivitamin K (AVK) overdose controlled by packing, corrective measures are based on the International Normalized Ratio (INR). In uncontrolled epistaxis, it is recommended to stop AVK, administer antidotes and regularly monitor INR. In case of intravascular embolization, it is not recommended to alter anticoagulant treatment. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. Epistaxis during nasotracheal intubation: a randomized trial of the Parker Flex-Tip™ nasal endotracheal tube with a posterior facing bevel versus a standard nasal RAE endotracheal tube.

    Science.gov (United States)

    Earle, Rosie; Shanahan, Enda; Vaghadia, Himat; Sawka, Andrew; Tang, Raymond

    2017-04-01

    Nasotracheal intubation is a widely performed technique to facilitate anesthesia induction during oral, dental, and maxillofacial surgeries. The technique poses several risks not encountered with oropharyngeal intubation, most commonly epistaxis due to nasal mucosal abrasion. The purpose of this study was to test whether the use of the Parker Flex-Tip™ (PFT) nasal endotracheal tube (ETT) with a posterior facing bevel reduces epistaxis when compared with the standard nasal RAE ETT with a leftward facing bevel. Sixty American Society of Anesthesiologists physical status I and II patients undergoing oral or maxillofacial surgery with nasotracheal intubation were recruited. Patients were randomized to either a standard nasal RAE ETT or a PFT nasal ETT. The ETT was thermosoftened and lubricated for both study groups prior to insertion, and the size of the tube was chosen at the discretion of the attending anesthesiologist. The primary outcome was the incidence of epistaxis, with a secondary outcome of epistaxis severity (scored as none, mild, moderate, or severe). An investigator measured both outcomes five minutes after intubation was completed. Mild or moderate epistaxis was experienced by 22 of 30 (73%) patients in the PFT group compared with 21 of 30 (70%) patients in the standard nasal RAE ETT group (absolute risk reduction, 3%; 95% confidence interval, -19 to 25; P = 0.78). There were no occurrences of severe epistaxis in either group. There was no difference in the incidence or severity of epistaxis following nasal intubation using the Parker Flex-Tip nasal ETT when compared with a standard nasal RAE ETT. This trial was registered at ClinicalTrials.gov, identifier: NCT02315677.

  18. Angina crónica estable. Consideraciones actuales

    Directory of Open Access Journals (Sweden)

    Yanier Coll Muñoz

    2011-03-01

    Full Text Available La angina de pecho crónica estable es un síndrome clínico caracterizado por dolor o malestar precordial secundario a isquemia miocárdica y sin características clínicas de inestabilidad. El debate actual sobre esta entidad clínica incluye tres aspectos fundamentales: diagnóstico, prevalencia e impacto socioeconómico, y tratamiento médico frente a revascularización miocárdica. En los últimos cuatro años se han dado a conocer los resultados de varios estudios multicéntricos de gran importancia que compararon tratamiento médico con revascularización miocárdica y cirugía de revascularización frente a intervención coronaria percutánea; además, han mejorado las técnicas de revascularización y existe abundante información sobre la eficacia de nuevos fármacos antiisquémicos. El presente trabajo tiene como objetivo hacer una revisión de los aspectos actuales más importantes relacionados con la angina de pecho estable y su tratamiento, publicados en la literatura especializada.

  19. Fiberoptic bronchoscopic treatment of blood aspiration and use of sugammadex in a patient with epistaxis

    Science.gov (United States)

    Ryu, Taeha; Kim, Dong Hyuck; Byun, Sung Hye

    2018-01-01

    Abstract Rationale: In patients with oropharyngeal and nasopharyngeal bleeding, blood aspiration can make airway management difficult and lead to severe pulmonary complications. Patient concerns: A 44-year-old male patient with recurrent epistaxis underwent surgery for hemostasis. The patient aspirated blood through the endotracheal tube when he hiccupped during the surgery. Diagnosis: The patient was diagnosed with blood aspiration after intraoperative fiberoptic bronchoscopy revealed a blood clot and viscous mucus in the airways, but no sign of active bleeding. Interventions: Tracheobronchial suctioning and irrigation with normal saline was performed through the bronchoscope to remove the aspirated blood clot. Prior to emergence from anesthesia, sugammadex was administered to induce complete neuromuscular recovery and enable the patient to cough up any blood remaining in the airways. Outcomes: The patient was successfully extubated and fully recovered with no complications. Lessons: Blood aspiration due to oropharyngeal or nasopharyngeal bleeding can be diagnosed and treated by tracheobronchial suctioning via fiberoptic bronchoscopy. In addition, sugammadex can enable patients to recover spontaneous breathing, facilitate extubation, and enable patients to cough up any blood remaining in the airways. PMID:29642212

  20. Consideraciones epistemológicas en torno al carácter científico de la administración

    Directory of Open Access Journals (Sweden)

    Diego Armando Marín-Idárraga

    2012-12-01

    Full Text Available Partiendo de la presunción de que la administración enfrenta un vacío epistémico debido a las concepciones retóricas que se han elaborado sobre su objeto y método, el presente artículo establece algunas reflexiones acerca de su estatuto científico. Se intenta ubicar históricamente el afianzamiento de la ciencia en el ámbito de la modernidad, para retomar el debate contendiente entre ciencias naturales y ciencias sociales, como referente para auscultar una posibilidad taxonómica para la administración, que junto a las consideraciones acerca del objeto de estudio y el método para la validación del conocimiento, provean un marco de análisis para su concepción epistemológica. Los argumentos teóricos expuestos proponen que la administración bien puede enmarcarse en el campo de las ciencias sociales, pero frente a algunas deficiencias epistémicas en su método y objeto, aún es prematura su categorización científica, por lo que queda abierta su valoración como disciplina de índole científica y de carácter fáctico, que por su naturaleza se ocupa de comprender la acción colectiva empresarial.

  1. Sobre a produção de valor: a recente circulação do poema “Viva Vaia”, de Augusto de Campos

    Directory of Open Access Journals (Sweden)

    Luciana Salazar Salgado

    2016-01-01

    Full Text Available Este artículo propone algunas consideraciones sobre el estatuto del material literario en la contemporaneidad desde un estudio de caso: un poema utilizado como ilustración de material periodístico. Movilizando categorías discursivas, pretende: i contribuir para investigaciones sobre los flujos de texto en cibercultura, y se la entiende como una c ultura hegemónica en el período actual, en la que se complejifica la problemática de la autoría; ii contribuir para el enfoque de los materiales literarios en sus formas de inscripción actuales o actualizadas.

  2. Consideraciones básicas en la auditoría de estados financieros

    OpenAIRE

    Gil, Miriam

    2014-01-01

    El objetivo de este trabajo es presentar las consideraciones básicas que se deben cumplir en la realización de una auditoría de estados financieros. Se destacan las fases que enmarcan el trabajo del auditor, partiendo de la definición de auditoría, su objetivo y la aplicación de las Normas Internacionales de Auditoría (NIAs). En conclusión, todo contador público que se dedique al trabajo de auditoría, debe cumplir cada una de las fases, de manera que pueda emitir su dictamen, que pue...

  3. El Hotel Burj Al Arab. Consideraciones de su desempeño sostenible.

    OpenAIRE

    Avila Higuera, Luis Fernando; Caicedo Lemus, José Fabio; Reyes Gaona, Javier Andrés; Tibaquirá Quintero, Carlos Alberto; Villamizar Bermúdez, María Clara

    2013-01-01

    El Hotel Burj Al Arab, ubicado en Dubai, Emiratos Árabes Unidos fue concebi-do y construido debido a la necesidad económica de convertir al emirato en un destino turís-tico, considerando que la actividad petrolera predominante en la región, no perdurará. Con un clima bastante exigente (Tropical húmedo), el edificio ha debido ser diseñado teniendo en cuenta consideraciones bioclimáticas y sostenibles. El artículo presenta un análisis bioclimático y de automatización del edificio considera...

  4. Consideraciones éticas en la evaluación educativa

    OpenAIRE

    Moreno Olivos, Tiburcio

    2011-01-01

    En este artículo se abordan algunas consideraciones éticas respecto a las prácticas de evaluación educativa. Se analiza el papel de la ética en la conducta profesional evaluadora, así como algunos dilemas y controversias éticas que afrontan los evaluadores. Se recuperan aportes teóricos de especialistas del campo de la investigación y evaluación cualitativas, los cuales brindan un conjunto de orientaciones que se deben atender en el proceso de investigación educativa para asegurar que éste se...

  5. Simultaneous occurrence of subarachnoid hemorrhage and epistaxis due to ruptured petrous internal carotid artery aneurysm. Association with transsphenoidal surgery and radiation therapy. Case report

    International Nuclear Information System (INIS)

    Endo, Hidenori; Fujimura, Miki; Inoue, Takashi; Matsumoto, Yasushi; Ogawa, Yoshikazu; Kawagishi, Jun; Jokura, Hidefumi; Shimizu, Hiroaki; Tominaga, Teiji

    2011-01-01

    A 62-year-old woman presented with simultaneous subarachnoid hemorrhage (SAH) and massive epistaxis. The patient had been treated for pituitary prolactinoma by two transsphenoidal surgeries, gamma knife radiosurgery, and conventional radiation therapy since age 43 years. Cerebral angiography showed left petrous internal carotid artery (ICA) aneurysm with slight stenosis on the adjacent left petrous ICA. She underwent superficial temporal artery-middle cerebral artery (STA-MCA) double anastomosis with endovascular internal trapping without complication the day after onset. Postoperative course was uneventful; the patient did not develop symptomatic vasospasm, recurrent epistaxis, or cerebrospinal fluid rhinorrhea. Postoperative angiography demonstrated complete disappearance of the aneurysm with patent STA-MCA anastomosis. The patient was discharged 2 months after surgery without neurological deficit. The present case is extremely rare with simultaneous onset of SAH and epistaxis caused by ruptured petrous ICA aneurysm. The transsphenoidal surgeries and radiation therapies might have been critical in the formation of the petrous ICA aneurysm. (author)

  6. Consideraciones en torno a los llamados Bastones de Mando

    Directory of Open Access Journals (Sweden)

    Rafael MENÉNDEZ GARCÍA

    2009-12-01

    Full Text Available RESUMEN: Se examinan las características de los bastones prehistóricos, valorando las especulaciones previas sobre su utilidad. Se establece mediante demostración teórica y práctica su uso como elemento esencial de un arma de caza. Específicamente, el bastón se utilizaría como un director a través del cual pasaba la flecha que era impulsada por la lanzadera.ABSTRACT: The study examines the characteristics of prehistoric batons, evaluates some previous speculations on their use and establishes a clear, practical and demonstrable determination of their purpose as an essential element of a hunting weapon. Specifically, the baton was used as a director through which the spear was passed, consequently projected by what has already been established as a spear thrower.RÉSUMÉ: On examine les caractéristiques des batons préhistoriques en évaluant l'état actuel des connaissances sur son usage. On essaie de prouver par la practique et la théorie une nouvelle hypothèse, selon laquelle le baton serait la partie dormente d'une arme et son but celui de diriger la sagaie qui passe par le trou et qui est impulsée par le propulseur.

  7. Treatment of severe refractory epistaxis in hereditary hemorrhagic telangiectasia using a two-flap nasal closure method

    Science.gov (United States)

    Timmins, Benjamin H.; Hunter, Benjamin N.; Wilson, Kevin F.; Ward, P. Daniel

    2016-01-01

    Background Nasal closure has been shown to effectively manage severe epistaxis refractory to other treatments in patients with hereditary hemorrhagic telangiectasia (HHT). The nasal closure procedure may be underutilized due to its surgical complexity and flap breakdown. Methods Retrospective review of thirteen HHT patients treated for severe epistaxis with nasal closure between 2005 and 2013. Operating room (OR) time, need for revision surgery, pre- and post-procedure epistaxis severity score (ESS), complete blood count values, and Glasgow Benefit Inventory (GBI) questionnaire results were collected for each patient. The technique is described. We characterize a typical nasal closure patient and compare outcomes based on our experience with the traditional three-flap closure and a simplified two-flap nasal closure procedure. Results The average candidate for nasal closure in this series had an ESS of 7.88, Hgb of 8.3 g/dL, and received multiple transfusions, iron therapy, and cautery/coagulation procedures. Average ESS subsequent to nasal closure using the two flap method is 0.92 and mean GBI score is 56.3. Comparison of five patients who underwent the traditional three-flap nasal closure procedure and eight patients receiving the two flap nasal closure showed no significant difference in post-op ESS or GBI metrics. Mean operating room times of the traditional and simplified methods were 3.12 hours and 1.44 hours (p=0.0001). Mean time to first revision for eight nasal closure patients is 21.5 months. Conclusion In short-term follow-up, the two-flap procedure has shown comparable effectiveness with significantly reduced complexity and operative time compared to the traditional nasal closure method. PMID:26751606

  8. Evaluación de las políticas educativas desde la Informed-Policy: Consideraciones teórico-metodológicas y retos actuales

    Directory of Open Access Journals (Sweden)

    José Sánchez-Santamaría

    2015-07-01

    Full Text Available La evaluación de las políticas educativas es una prioridad política, científica y social. Ello se debe a la existencia de una preocupación política por avanzar en el diseño e implementación de políticas de impacto, unido al interés de la comunidad científica por conocer mejor su sentido y función en la mejora de la calidad de los sistemas educativos en sociedades democráticas. Por todo ello, en este artículo se realiza una revisión sobre el estado de la evaluación de las políticas educativas de modo que nos permita establecer las perspectivas teóricas con mayor tradición y las emergentes, las cuestiones metodológicas referidas al desarrollo de sistemas de indicadores e índices de evaluación y los retos actuales planteados desde el movimiento de la Informed-Policy. Se apuesta por una aproximación descriptivo-exploratoria tomando como referencia fuentes de información y de datos primarios. Se aprecia una tendencia a establecer vínculos entre evidencias y políticas educativas, así como una preocupación creciente a que las evaluaciones de las políticas educativas informen sobre sus contribuciones a la equidad educativa.Cómo referenciar este artículoSánchez-Santamaría, J., & Espinoza, O. (2015. Evaluación de las políticas educativas desde la Informed-Policy: Consideraciones teórico-metodológicas y retos actuales. Foro de Educación, 13(19, 381-405. doi: http://dx.doi.org/10.14516/fde.2015.013.019.017

  9. Epistaxis revealing the rupture of a carotid aneurysm of the cavernous sinus extending into the sphenoid: treatment using an uncovered stent and coils. Review of literature.

    Science.gov (United States)

    Lehmann, Pierre; Saliou, Guillaume; Page, Cyril; Balut, Antonia; Le Gars, Daniel; Vallée, Jean Noel

    2009-05-01

    True carotid aneurysms with sphenoid extension and revealed by epistaxis are rare. A review of the literature shows the mortality risk of this pathology and the different therapeutic options. A 41-year-old female presented with a cavernous carotid aneurysm with sphenoid extension revealed by massive epistaxis. We propose a combined treatment of the affected vessel using coils and an uncovered stent. The first stage to stop the hemorrhages and occlude the aneurysm using the coil and the second stage several days later after anticoagulation using the stent to prevent revascularization. This treatment has been shown to be effective in producing immediate hemostasis and stable long-term occlusion.

  10. Endovascular Treatment of Persistent Epistaxis due to Pseudoaneurysm Formation of the Ophthalmic Artery Secondary to Nasogastric Tube

    Energy Technology Data Exchange (ETDEWEB)

    Selcuk, Hakan, E-mail: hakanselcuk73@yahoo.com; Soylu, Nur; Albayram, Sait; Selcuk, Dogan; Ozer, Harun; Kocer, Naci; Islak, Civan [Cerrahpasa Medical School, Istanbul University, Department of Radiology, Division of Neuroradiology (Turkey)

    2005-04-15

    We present the case of a 60-year-old man with persistent epistaxis for 20 days that had started 2 weeks after removal of a nasogastric tube placed for an abdominal operation. There was no pathologic finding at selective facial and internal maxillary artery injections. An injury to the ethmoidal branches of the ophthalmic arteries or other arterial origins of bleeding was suspected. The internal carotid artery angiography revealed a pseudoaneurysm of an anterior ethmoidal branch of the left ophthalmic artery. The pseudoaneurysm was occluded with NBCA-histoacryl (25%) injection.

  11. Endovascular Treatment of Persistent Epistaxis due to Pseudoaneurysm Formation of the Ophthalmic Artery Secondary to Nasogastric Tube

    International Nuclear Information System (INIS)

    Selcuk, Hakan; Soylu, Nur; Albayram, Sait; Selcuk, Dogan; Ozer, Harun; Kocer, Naci; Islak, Civan

    2005-01-01

    We present the case of a 60-year-old man with persistent epistaxis for 20 days that had started 2 weeks after removal of a nasogastric tube placed for an abdominal operation. There was no pathologic finding at selective facial and internal maxillary artery injections. An injury to the ethmoidal branches of the ophthalmic arteries or other arterial origins of bleeding was suspected. The internal carotid artery angiography revealed a pseudoaneurysm of an anterior ethmoidal branch of the left ophthalmic artery. The pseudoaneurysm was occluded with NBCA-histoacryl (25%) injection

  12. Consideraciones didácticas para la aplicación de estrategias de lectura

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    Solé, Maira

    2007-12-01

    Full Text Available Resumen: El propósito de este escrito es el de establecer ciertas consideraciones didácticas para la correcta aplicación de las estrategias de lectura. La estrategia por sí sola no genera ningún producto, es necesario que la maestra o el maestro la domine íntegramente aplicando la técnica adecuada para la consecución de los objetivos propuestos en el contenido. Se expondrán tres bloques de consideraciones didácticas: las de índole contextual, las constructivas y las de orden operativo o de actividad. La finalidad es analizar cada una de ellas, conocer cómo influyen y por último efectuar su aplicación en el proceso de lectura.Abstract: The intention of this writing is to establish certain didactic considerations for the correct application of the reading strategies. The strategy by itself does not generate any product, is necessary that the teacher dominates it completely applying the technique adapted for the attainment of the objectives proposed in the content. Three blocks of didactic considerations will be exposed: those of contextual nature, the constructives and those of operative order or activity. The purpose is to analyze each one of them, to know how they influence and finally to carry out its application in the reading process.

  13. Removing Nasal Packing in Epistaxis: What to Do in the Case of an Undeflatable Foley Catheter Balloon

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    Gaspar-Sobrinho, Fernando Pena

    2014-01-01

    Full Text Available Introduction Undeflatable Foley catheter balloons adapted for use as nasal packing in epistaxis represent a possible complication. Case Reports We report on three cases in which Foley catheter balloons adapted for use as posterior nasal packing in epistaxis failed to deflate. In one patient, deflation was achieved by simply using the fingertips to massage the segment of the catheter collapsed by the fixation device. In the second case, the Foley balloon was removed by the oral route after sectioning the catheter. In the third patient, the Foley catheter was successfully deflated after sectioning. Discussion The probable causes of the undeflatable balloons in these cases were a blockage or lumen collapse of the balloon or a malfunction in the valve system. Although no definitive method has been established for dealing with this complication, the options proposed are the following: manipulation to restore the permeability of the segment of the catheter collapsed by the fixation device, if this is the case; sectioning the catheter or inserting a stiletto catheter; bursting the balloon; or removing it by the oral route. The latter option is apparently the most appropriate for the otolaryngologist in cases unrelated to simple collapse caused by the fixation device.

  14. Can a multisensory teaching approach impart the necessary knowledge, skills, and confidence in final year medical students to manage epistaxis?

    Science.gov (United States)

    2013-01-01

    Objective The purpose of this study is to evaluate the efficacy of a multisensory teaching approach in imparting the knowledge, skills, and confidence to manage epistaxis in a cohort of fourth year medical students. Methods One hundred and thirty four fourth year medical students were recruited into the study from Aug 2011 to February 2012 in four groups. Students listened to an audio presentation (PODcast) about epistaxis and viewed a video presentation on the technical skills (VODcast). Following this, students completed a 5-minute Individual Readiness Assessment Test (IRAT) to test knowledge accrued from the PODcast and VODcast. Next, students observed a 10-minute expert demonstration of the technical skills on a human cadaver and spent half an hour practicing these techniques on cadaver simulators with expert guidance. The students’ confidence was assessed with Confidence Level Questionnaires (CLQs) before and after their laboratory session. The skill level of a subset of students was also assessed with a pre- and post-laboratory Objective Structured Assessment of Technical Skills (OSATS). Results Eighty two percent of the participants achieved a score of at least 80% on the IRAT. The CLQ instrument was validated in the study. There was a statistically significant improvement between the pre- and post-laboratory CLQ scores (pepistaxis. PMID:24479815

  15. 'How to stop a nosebleed': an assessment of the quality of epistaxis treatment advice on YouTube.

    Science.gov (United States)

    Haymes, A T; Harries, V

    2016-08-01

    Video hosting websites are increasingly being used to disseminate health education messages. This study aimed to assess the quality of advice contained within YouTube videos on the conservative management of epistaxis. YouTube.com was searched using the phrase 'how to stop a nosebleed'. The first 50 videos were screened. Objective advice scores and subjective production quality scores were attributed by independent raters. Forty-five videos were analysed. The mean advice score was 2.0 out of 8 and the mean production quality score was 1.6 out of 3. There were no correlations between a video's advice score and its search results rank (ρ = -0.28, p = 0.068), its view count (ρ = 0.20, p = 0.19) or its number of 'likes' (ρ = 0.21, p = 0.18). The quality of information on conservative epistaxis management within YouTube videos is extremely variable. A high search rank is no indication of video quality. Many videos proffer inappropriate and dangerous 'alternative' advice. We do not recommend YouTube as a source for patient information.

  16. Intractable Posterior Epistaxis due to a Spontaneous Low-Flow Carotid-Cavernous Sinus Fistula: A Case Report and a Review of the Literature

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    A. Giotakis

    2015-01-01

    Full Text Available We report a case of a 90-year-old patient with intractable posterior epistaxis presenting as the only symptom of a nontraumatic low-flow carotid-cavernous sinus fistula. Purpose of this case report is to introduce low-flow carotid-cavernous sinus fistula in the differential diagnosis of intractable posterior epistaxis. We provide a literature review for the sequence of actions for the confrontation of posterior epistaxis. We also emphasize the significance of the radiological diagnostic and therapeutic procedures in the management of posterior epistaxis due to pathology of the cavernous sinus. The gold-standard diagnostic procedure of carotid-cavernous sinus fistula is digital subtraction angiography (DSA. DSA with coils is also the state-of-the-art therapy. By failure of DSA, neurosurgery or stereotactic radiosurgery (SRS may be used as alternatives. SRS may also be used as enhancement procedure of the DSA. Considering the prognosis of a successfully closed carotid-cavernous sinus fistula, recanalization occurs only in a minority of patients. Close follow-up is advised.

  17. Topical application of timolol decreases the severity and frequency of epistaxis in patients who have previously undergone nasal dermoplasty for hereditary hemorrhagic telangiectasia.

    Science.gov (United States)

    Ichimura, Keiichi; Kikuchi, Hisashi; Imayoshi, Shoichiro; Dias, Mari Shimada

    2016-08-01

    Hereditary hemorrhagic telangiectasia (HHT) is widely known to cause bleeding that is difficult to control because of the associated vascular wall fragility. Although nasal dermoplasty results in decreased severity and frequency of nasal bleeding in patients with HHT, it does not eradicate epistaxis because this procedure cannot cover the entire nasal cavity. Residual bleeding warrants additional effective therapy. Preliminary reports on the use of β-adrenergic blockers for treating epistaxis in patients with HHT encouraged us to examine their effects in HHT patients who had previously undergone nasal dermoplasty but still complained of epistaxis. We performed a prospective topical timolol, a nonselective beta blocker, application study involving 12 HHT patients who had undergone nasal dermoplasty. The observation period lasted for 3 months. There was one improperly enrolled case in which timolol administration was discontinued. The mean score of bleeding intensity and that of bleeding frequency were markedly reduced after treatment. Two patients who had required transfusions before treatment did not need them afterward, and patients were generally satisfied with the treatment. Topical timolol application was effective in decreasing epistaxis. Although no adverse effects were observed in the properly selected patients, there are contraindications to timolol application that should be kept in mind when applying this treatment. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. Treatment of epistaxis in hereditary hemorrhagic telangiectasia with tranexamic acid - a double-blind placebo-controlled cross-over phase IIIB study.

    Science.gov (United States)

    Geisthoff, Urban W; Seyfert, Ulrich T; Kübler, Marcus; Bieg, Birgitt; Plinkert, Peter K; König, Jochem

    2014-09-01

    Epistaxis is the most frequent manifestation in hereditary hemorrhagic telangiectasia, in which no optimal treatment exists. It can lead to severe anemia and reduced quality of life. Positive effects of tranexamic acid, an antifibrinolytic drug, have been reported on epistaxis related to this disorder. We sought to evaluate the efficacy of treating nosebleeds in hereditary hemorrhagic telangiectasia with tranexamic acid. In a randomized, double-blind, placebo controlled, cross-over phase IIIB study, 1 gram of tranexamic acid or placebo was given orally 3 times daily for 3 months for a total of 6 months. 22 patients were included in the intention-to-treat analysis. Hemoglobin levels, the primary outcome measure, did not change significantly (p=0.33). The secondary outcome measure was epistaxis score and patients reported a statistically significant reduction in nosebleeds, equaling a clinically relevant 54% diminution (p=0.0031), as compared to the placebo period. No severe side effects were observed. Tranexamic acid reduces epistaxis in patients with hereditary hemorrhagic telangiectasia. (Clinical trial registration numbers: BfArM 141 CHC 9008-001 and ClinicalTrials.gov NCT01031992). Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Hegel sobre Tácito y la libertad teutona

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    Valerio Rocco Lozano

    2015-09-01

    Full Text Available Una investigación sobre la presencia (así como sobre la ausencia de Tácito en Hegel es crucial para entender la posición política y filosófica de este pensador, especialmente en la época de Jena. Tras algunas consideraciones sobre el conocimiento hegeliano de la historia y la cultura romanas, se abordará un análisis de su noción de "libertad teutona": Hegel se opone tanto a la neo-romanidad de los revolucionarios franceses como al esencialismo teutómano de los conservadores alemanes (derivado fundamentalmente de un uso fuertemente ideológico de la "Germania" de Tácito, así como a las caducas instituciones imperiales. Esta doble oposición sitúa a Hegel en medio de dos corrientes políticas (e incluso de dos ejércitos en guerra y se lleva a cabo desde una actitud que puede denominarse como “mediación sin nostalgia”

  20. La mente desencarnada: consideraciones históricas y filosóficas sobre la psicología cognitiva

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    Jorge Emiro Restrepo

    2009-01-01

    Full Text Available Se plantea el origen de la psicología cognitiva como una reacción ante la infecundidad de los paradigmas y escuelas psicológicas de mediados del siglo XX. Se realiza un estudio histórico de los factores que contribuyeron al desarrollo y consolidación del cuerpo epistemológico del paradigma cognitivo: la Teoría de la Información, la Cibernética y la Psicolingüística. Para cada uno de estos factores se desarrolla un análisis de las contribuciones teóricas, conceptuales y filosóficas que nutrieron a la psicología cognitiva. Se estudian reflexivamente lospresupuestos ontológicos y conceptuales que subyacen a cada factor y se resalta la manera como éstos ingresan y toman lugar dentro del armazón epistemológico de la psicología cognitiva. Se plantea la discusión respecto a un retorno al paradigma cognitivo y no, como se piensa, un origen de éste. Se analiza la filosofía de la mente implícita en el paradigma cognitivo y se señalan y discuten algunas implicaciones. Por último, se discute la pretendida autonomía de la explicación cognitiva y la validez epistemológica de ésta.

  1. Consideraciones teóricas sobre aspectos culturales en la gestión de la calidad total

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    Juan Manuel López

    2015-05-01

    Full Text Available RESUMEN En este artículo el autor define CWQC  en un sentido amplio, se describe a la calidad de la administración, la calidad de desempeño humano, la calidad del trabajo que se realiza, la calidad el ambiente de trabajo, la calidad del producto y la calidad del servicio, en este orden. Teniendo siempre presente como meta de calidad de la sociedad e industrias, la calidad de la economía nacional y la calidad y enriquecimiento de la humanidad. En Occidente, se refiere generalmente a la calidad de productos y servicios.

  2. Consideraciones sobre la aplicación del principio iura novit curia en el arbitraje comercial internacional

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    Nigel Blackaby

    2013-01-01

    Full Text Available A pesar de su reconocimiento en diferentes jurisdicciones, la apli­cación del principio iura novit curia al arbitraje comercial internacional ha sido objeto de debate. Desde el punto de vista más liberal, el principio es absolutamente aplicable al arbitraje comercial internacional, tal y como sería aplicado por un juez al dictar sentencia conforme a su derecho nacional, mientras que desde la postura más estricta, cualquier manifestación de este principio que permita a los árbitros tomar la iniciativa de traer nuevas cues­tiones de derecho al proceso debe ser rechazada por completo. Partiendo de la premisa de que, por lo general, los miembros de un tribunal arbitral inter­nacional no conocen el derecho aplicable a las controversias que se someten a su conocimiento, ni tienen experiencia o manejo práctico respecto a dicho derecho, la aplicación del principio iura novit curia de forma pura y simple no resultaría adecuada en el contexto del arbitraje comercial internacional en razón de su naturaleza contractual y los intereses involucrados. Por otra parte, rechazar de plano la aplicabilidad del principio en el arbitraje comercial internacional implicaría atar de manos a los árbitros y crearía el riesgo de que se emitan laudos que ignoren o contradigan normas y principios del derecho aplicable, lo que podría afectar su validez y dar pie a que su validez y ejecución posterior se vean cuestionadas. En razón de lo anterior, para que el principio iura novit curia pueda ser aplicado en el contexto del arbitraje comercial inter­nacional, dicho principio debe ser abordado desde una postura intermedia y sufrir una importante adaptación de forma que ciertas manifestaciones del mismo puedan ser aceptadas en casos excepcionales como una herramienta para que los árbitros puedan cumplir cabalmente con los deberes inheren­tes a su función decisoria, incluyendo el deber de no exceder la jurisdicción que les ha sido conferida, de dictar laudos válidos, ejecutables y apegados al derecho aplicable, de actuar en forma imparcial y de garantizar a las partes en todo momento derechos fundamentales derivados del debido proceso, como lo son el derecho a ejercer su defensa en forma adecuada y oportuna, así como el derecho a ser tratadas con igualdad.

  3. Cuando la calle se transforma en casa: algunas consideraciones sobre habito et diligo en el medio urbano

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    Marco Antonio da Silva Mello

    2007-07-01

    Full Text Available Este artículo presenta, a partir de una etnografía realizada en 1979, un análisis de los barrios de Catumbi y Selva da Pedra , en Río de Janeiro, como casos ilustrativos de una polaridad característica de las ciudades brasileñas y en particular de las regiones metropolitanas. La tradición urbana ibérica, predominante y reproducida en la arquitectura y el urbanismo de los barrios y suburbios más antiguos, constituye uno de los extremos del espectro. En el otro se ubican los modelos del modernismo, que tratan de compensar su falta de inercia histórico-cultural con una extraordinaria agresividad ideológica asentada en el cientificismo progresista, legado más permanente de nuestro siglo XIX. Así, el foco de esta investigación es la apropiación del espacio, un proceso que forma parte de la dimensión de lo vivido, de la experiencia cotidiana.O presente artigo apresenta parte da etnografia, realizada em 1979, através da articulação de dois casos -bairros de Catumbí e da Selva da Pedra , no Rio de Janeiro- ilustrativos de uma polaridade característica das cidades brasileiras, em particular nas regiões metropolitanas. A tradição urbana ibérica, predominante e reproduzida na arquitetura e no urbanismo dos bairros e subúrbios mais antigos, constituía um dos extremos do espectro. No outro, os modelos do modernismo, que tratavam de compensar sua falta de inércia histórico-cultural com uma extraordinária agressividade ideológica, assentada no cientificismo progressista, legado mais duradouro do nosso século XIX. Assim, o foco da pesquisa foi a apropriação do espaço. Um processo que faz parte da dimensão do vivido, da experiência quotidiana.In this paper we present part of an ethnography, done in 1979, in which we analyze the articulation of two cases -the neighborhoods of Catumbi and Selva da Pedra , both in Rio de Janeiro- which are illustrative of a characteristic polarity of the brazilian cities, specially clear in metropolitan areas. One side of this polarity is constituted by the Iberian urban tradition that prevails in the architecture and urbanism of the oldest neighborhoods and suburbs. On the other side, we find the modernism models, those which tried to compensate their lack of historical cultural inertia with an extraordinary ideological aggressiveness deeply rooted in the progressive scientism -the most permanent legacy of our XIX century. Thus, the focus of our research was the appropriation of space, a process that takes part of the everyday experience.

  4. On the genesis of the uraniferous deposits I; Consideraciones sobre la genesis de los yacimientos uraniferos. I.

    Energy Technology Data Exchange (ETDEWEB)

    Mingarro, E

    1964-07-01

    The main problems of the genesis of uranium deposits as hydro thermals are objectively considered here under three aspects: uranium source transport and deposition. The transport of uranium can be effected under a tetravalent form, or as complex ions of hexavalent uranium: as uranyl ion (UO{sub 2}){sup 2}+ or under complex carbonic or sulfuric forms, such as UO{sub 2}(XO{sub n}){sub 2}{sup 2}- or UO{sub 2}(XO{sub n}){sub 3}{sup 4}-. These three ways of transport correspond to the three basic geochemical para genesis of uranium: uranium-titanium, uranium-cobalt, uranium. Deposition is currently made by reduction and in some way is no dependent of mineralogical association. (Author) 61 refs.

  5. Consideraciones sobre la tecnología apropiada y la construcción tradicional en Mallorca

    OpenAIRE

    Ramis, Miquel

    2011-01-01

    La construcción actual genera una huella ecológica insostenble. Hay que recuperar las tecnologías tradicionales que permiten una construcción de calidad, con materiales de bajo impacto y de proximidad y con una mano de obra cualificada. Peer Reviewed

  6. Algunas consideraciones sobre la redefinición del campo de la Antropología Rural

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    Alejandro Balazote

    2017-06-01

    Full Text Available En este trabajo analizamos la redefinición del campo de la Antropología Rural acaecida en los últimos años, a partir de la configuración de un escenario socioeconómico y cultural caracterizado por la emergencia de nuevos actores económicos, por la implementación de disímiles modalidades de explotación del trabajo rural, por la yuxtaposición de formatos productivos y estrategias de comercialización, por la incidencia de la estructura financiera nacional e internacional y fundamentalmente por la puesta en marcha de un novedoso sistema de apropiación de la renta agropecuaria. Abordaremos los tópicos señalados, planteando que su entidad interpela prácticas teórico-metodológicas de la Antropología Rural en Argentina.

  7. Consideraciones generales sobre población, desarrollo y medio ambiente, el caso de Tijuana, Baja California

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    Margarita Barajas Tinoco

    1992-09-01

    Full Text Available A partir de las relaciones que se pueden encontrar entre la sociedad y el medio ambiente natural, en este trabajo se destacan los elementos que dentro de la planeación general se orientan a la población y el desarrollo. El concepto de "calidad de vida", en sentido amplio, es tomado como indicador de desarrollo para problematizar contradicciones manifiestas entre un crecimiento urbano particular y su déficit de infraestructura social y problemas de medio ambiente. Como estudio de caso ilustrativo se toma a la ciudad de Tijuana, espacio territorial que enfrenta una problemática urbana, manifiesta entre otros escenarios, en su medio ambiente natural y social.

  8. Consideraciones actuales sobre el diagnóstico de la apendicitis aguda: Current criteria Diagnosis of acute appendicitis:

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    Zenén Rodríguez Fernández

    2009-09-01

    Full Text Available INTRODUCCIÓN. El objetivo de la presente investigación fue identificar algunos aspectos relacionados con el diagnóstico preoperatorio de la apendicitis aguda, según variables seleccionadas, así como establecer comparaciones con los hallazgos de otros autores. MÉTODOS. Se realizó un estudio observacional, descriptivo y prospectivo de 560 pacientes operados y dados de alta con el diagnóstico histopatológico de apendicitis aguda. Los pacientes fueron atendidos en el Servicio de Cirugía General del Hospital Provincial Docente «Saturnino Lora» de Santiago de Cuba, durante el 2006. RESULTADOS. Entre los resultados más importantes sobresalieron el predominio de los varones jóvenes con mediana de edad de 25,5 años y la preponderancia del diagnóstico clínico. La mediana del tiempo de evolución preoperatoria fue mayor en los hombres y predominaron las variedades gangrenosa y perforada, aunque la primacía correspondió a la apendicitis supurada. En los fallecidos se detectaron las formas histopatológicas más graves, y estos fueron ancianos con manifestaciones clínicas atípicas de la enfermedad. CONCLUSIONES. El método clínico continúa teniendo una importancia capital, pues a través de él se puede diagnosticar precozmente esta urgencia tan común y reducir el tiempo de evolución preoperatoria, cuya prolongación es causa de morbilidad y mortalidad innecesarias.INTRODUCTION: The aim of present paper was to identify some features related to preoperative diagnosis of acute appendicitis, according the selected variables, as well as to establish comparisons with findings from other authors. METHODS: We made a prospective, descriptive and observational study of 560 patients operated on and discharged with the histopathology diagnosis of acute appendicitis. Patients were seen in General Surgery Service of the "Saturnino Lora" Teaching Provincial Hospital of Santiago de Cuba during year 2006. RESULTS: Among the more significant results were the predominance of young males with a mean age of 25,2 years, and the preponderance of the clinical diagnosis. Mean time of preoperative course was greater in men, and there was a predominance of gangrenous and perforated varieties, although the primacy was for the suppurative appendicitis. In the deceased ones the more severe pathologic histology ways were detected, and these were elderlies presenting with atypical clinical manifestations of disease. CONCLUSIONS: Clinical method has nowadays is of capital significance, since thorough it is possible early to diagnose this so common urgency, and to reduce the preoperative course time, whose length is cause of a unnecessary morbidity and mortality.

  9. Consideraciones sobre el desarrollo de la conducta normal y anormal del niño en Bogotá

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    Santodomingo Guzmán

    1955-08-01

    Full Text Available Desde que Alfredo Binet hizo por vez primera tests de runos débiles mentales ha sido aspiración de las ciencias afines a la Psicología, la Neurología y la Neuro-Psicología probar que eran tan útiles a la vida práctica como la Física lo es para la técnica. La Psicología experimental abrió el camino a la investigación de los problemas de la conducta humana, precisando en algunos aspectos sus acciones y reacciones frente a determinados estímulos del medio ambiente y a la posición en que la colocan de hecho sus condiciones fisiológicas y estados constitucionales. Sin embargo, la actitud de la mayoría de los investigadores y de los profanos es escéptica. Casi todos han rechazado como inutilizables los descubrimientos de la psicología del niño y, como lo afirma Charlotte Bühler, han acudido exclusivamente a las enseñanzas del psico-análisis de Sigmund Freud y sus secuaces o de la psicología individual de Alfredo Adler.

  10. Las reproducciones o por qué con ellas no se acaba el aura : Consideraciones sobre Walter Benjamin

    OpenAIRE

    Cappannini, Cecilia Beatriz

    2011-01-01

    Una de las cosas que podemos buscar en un filósofo no es tanto si estamos de acuerdo con todo lo que dijo sino cuánto nos desafía a pensar incluso contra él mismo. Este desafío puede consistir en buscar aquellas imágenes, conceptos y preguntas que el autor utiliza, para elaborar comprensiones de nuestra realidad. Entonces podemos aceptarla tal cual es, rechazarla en su totalidad o cuestionarla en algunos de sus aspectos. Pero a su vez podemos construirla. Elaborar un modo de comprender lo rea...

  11. Some problems on the thermodynamic state of the metallogenetic systems; Consideraciones sobre la genesis de los yacimientos uraniferos

    Energy Technology Data Exchange (ETDEWEB)

    Mingarro, E.

    1965-07-01

    In order to get a classification of the uranium deposits, the geological processes have been ordered in thermodynamic systems according to the independent parameters that define their equilibrium state. Also, to apply the phase rule, we suppose that the ore forming elements are always ideally mobile components; that is, in the geological systems, these components are defined by their chemical potentials. In this paper, we show that in random conditions, i. e.; for any possible value of the factors of equilibrium or state the stable mineralizations are formed only in metasomatic regimes; so that the mineralogical sequence is a function both of the Helmholtz's free energy and the crystallisation pressure of the minerals. (Author) 7 refs.

  12. Consideraciones teóricas sobre aspectos culturales en la gestión de la calidad total

    OpenAIRE

    Juan Manuel López; Julia Gutiérrez de Piñeres; Nora Choperena

    2015-01-01

    RESUMEN En este artículo el autor define CWQC  en un sentido amplio, se describe a la calidad de la administración, la calidad de desempeño humano, la calidad del trabajo que se realiza, la calidad el ambiente de trabajo, la calidad del producto y la calidad del servicio, en este orden. Teniendo siempre presente como meta de calidad de la sociedad e industrias, la calidad de la economía nacional y la calidad y enriquecimiento de la humanidad. En Occidente, se refiere generalmente a la cal...

  13. Consideraciones sobre la teoría socio-crítica de la enseñanza

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    Severino FERNÁNDEZ NARES

    2009-11-01

    Full Text Available RESUMEN: El estudio de la diferentes perspectivas en los modelos de organización es el mayor interés para profundizar en el conocimiento de la evolución de la enseñanza y de la escuela. La teoría "socio-crítica" se encuadra entre los modelos "políticos". En estos modelos subyace el paradigma del conflicto, el cual se entiende como un proceso derivado del poder y de la interacción que se produce en el seno de las organizaciones. J. Habermas —representante de la Escuela de Francfort— y, en general, la llamada Nueva Sociología de la Educación, constituyen fuentes claves en su inspiración, que es de raíz marxista y psicoanalítica. El enfoque "socio-crítico" recibe la objeción de que no es conocimiento verdaderamente científico, sino una forma dialéctica de predicar el cambio y la alteración del orden social existente, en función de criterios de "emancipación" y concienciación. Otro problema que se le plantea es que no resuelve la cuestión del paso de las teorías que propugna a su realización práctica.ABSTRACT: The study of the different perspectives in the organization models is of great interest to go deeply into the knowledge of teaching and school education. The "Socio-Critical" theory fits into the "political" models. Int these models, the paradigm "conflict" is underlying. Conflict is to be understood as a process derived from the power and interaction produced within organizations. J. Habermas, —representative of the School of Fracfurt—, and, in general, the so called New Sociology of Education, constituye its key sources of inspiration, which is of a Marxsit and Psychoanalitic origin. It is objected that the "Socio-Critical" aproach is not a real scientific knowledge but a dialectical way of preaching the change and alteration of the existing social order in terms of 'emancipation and consciousness criteria. Another objection to this approach is the fact that it does not provide a soluction for and appropiate transition from theory to practice.RESUME: L'étude des différentes perspectives des modeles d'organization est du plus importan intérét pour approfondir dans la connaissance de l'evolution de l'enseignance et de l'école. La téorie "socio critique" s'encadre dans les modeles "politiques". Dans ees modeles, on retrouve le paradigme du "conflict", qui peut se compendre comme un processus derivé du pouvoir et de l'intéraction qui se produit au sein des organisations. J. Habermas, —représentant de l'Ecole de Frankfurt—, et, en general, la connue Nouvelle Sociologie de l'Education, sont les sources principales de son inspiration, qui se base sur le marxisme et la psicoanalitique. Le point de vue "socio critique" recoit l'objetion de ne pas étre tout á fait scientifique, mais plutót une facón dialectique d'aborder le changement et la peturbation de l'ordre social existant, en fonction des critéres d'émancipation et de prise de conscience. Un autre probléme qui se pose c'est que l'on ne resout pas le passage de téories a la mise en pratique.

  14. Consideraciones generales sobre población, desarrollo y medio ambiente, el caso de Tijuana, Baja California

    OpenAIRE

    Margarita Barajas Tinoco; Elizabeth Méndez Mungaray

    1992-01-01

    A partir de las relaciones que se pueden encontrar entre la sociedad y el medio ambiente natural, en este trabajo se destacan los elementos que dentro de la planeación general se orientan a la población y el desarrollo. El concepto de "calidad de vida", en sentido amplio, es tomado como indicador de desarrollo para problematizar contradicciones manifiestas entre un crecimiento urbano particular y su déficit de infraestructura social y problemas de medio ambiente. Como estudio de caso ilustrat...

  15. Algunas consideraciones sobre la localización de actividades no deseables:el caso de los residuos urbanos

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    María Victoria Azcárate Luxán

    2001-01-01

    Full Text Available La ubicación de vertederos, como instalaciones destinadas al reciclaje y reutilización de los residuos urbanos, de acuerdo a la nueva normativa europea, constituye, hoy en día, un problema de primera magnitud, que las diversas instancias del poder territorial están considerando a la hora de elaborar políticas respetuosas con la conservación medioambiental. Sin embargo, la falta de criterios (de carácter positivo y negativo para la selección de emplazamientos, así como de una metodología precisa en la definición de un modelo de actividades no deseables, está favoreciendo la localización descontrolada de los mismos dentro del territorio municipal.The location of rubbish dumps, as facilities destined to recycle and re-use urban waste in agreement with the new European regulations, is a probiem of the first magnitude nowadays which various responsible authorities give consideration to, when drawing up policies which respect environmental conservation. Nevertheless, the lack of criteria (both positive and negative for selecting locations, as well as the absence of a methodology needed to define a model of undesirable activities, is encouraging a losa of control their localisation in municipal territory.

  16. Técnica, arte y temas fundamentales de la existencia. Consideraciones sobre el discurso de Paulo Mendes da Rocha

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    Maria Isabel Villac

    2016-07-01

    Full Text Available El enfoque de este documento tiene como objetivo discutir la relevancia de la técnica y del arte en el discurso en la arquitectura de Paulo Mendes da Rocha. Examina los textos del arquitecto, comprometido con la praxis y discute la “técnica” a la luz de la importancia que asume en la configuración de la arquitectura y de su dependencia a un programa de vida inherente a la humanidad. La dimensión del “arte”, por su parte integrada a la vida, es observada como la que siempre garantiza la condición inaugural de la obra y la prolongación de las características inherentes a los procesos ordinarios de la vida cotidiana. El argumento del texto se hace a partir de las palabras del arquitecto, considerando las memorias del proyecto, las clases impartidas, los testimonios y las entrevistas publicadas. Defiende la posición de que las especulaciones y la ética que revela el discurso son miembros de un “cuerpo del conocimiento” inherente a el “modus operandi” del proyecto. Para aquellos que conocen o se acercan a la obra, el amparo de las palabras del arquitecto explica que el saber de la arquitectura está en la discusión de un horizonte que implica al sujeto, a la humanidad y al mundo que construye. Este arco intencional, que se revela en el trazado individual de la obra, se ampara en racionalidad y enseña que la espacialidad es una condición y un valor de la vida, un discurso y una acción histórica interdependientes a la sensibilidad artística de la naturaleza humana. Para la comprensión de la arquitectura de Paulo Mendes da Rocha, que aspira ser la expresión de la objetividad como designación “radical” de la técnica, es necesario retroceder a los textos del arquitecto comprometido con la praxis e involucrado directamente con la producción de los sentidos de la arquitectura. El discurso revela que: en la “naturalidad inclusiva” de la dimensión estética se establece la mediación entre el deseo y la experiencia y que son los impulsos y sentidos del ser humano que organizan el fundamento de racionalidad y conocimiento.

  17. Consideraciones geomorfológías sobre la Sierra Madre Occidental en el norte de Jalisco, México

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    Rosier Barrera R.

    2002-01-01

    Full Text Available This analysis of the geographical space focuses on Geomorphology, a science that deals with the genesis and evolution of landforms. This definition includes two basic elements: relief and form. The former results from geological processes, and the latter from morpho-clilmatic processes. This work derives from the need to communicate the features of landform structures located at the northern portion of the Jalisco state, the main attributes of which including block tectonics, arisen from an extensive area affected by volcanic activity during the Mild Cenozoic. Tectonics respond to core movements generated, according to the pilate tectonics theory, during the Upper Tertiary and Pleistocene, and which have affected this area as a result of the proximity of subduction zones. Lava deposit blocks along with ancient volcanoes have jointly formed wide plateaus denominated riolithic plateaux in the field of structural geomorphology. Landform structures provide the basic element upon which exogenous or morpho-climatic forces work, thus modeling the relief´s sculptural forms. Interfluvial and slope modeling are characterized by the specific dissection of tropical zones; separately, chemical processes originate ferruginous soils and water runoff travels down ravines seeking the water table at the bottom of deep canyons limiting plateaux. Henece edaphogenetic processes dominate at fiat interfluvial areas, whereas displacement of detritic materials prevail along slopes and fluvial terraces at the bottom of valleys.

  18. Some problems on the thermodynamic state of the metallogenetic systems; Consideraciones sobre la genesis de los yacimientos uraniferos

    Energy Technology Data Exchange (ETDEWEB)

    Mingarro, E

    1965-07-01

    In order to get a classification of the uranium deposits, the geological processes have been ordered in thermodynamic systems according to the independent parameters that define their equilibrium state. Also, to apply the phase rule, we suppose that the ore forming elements are always ideally mobile components; that is, in the geological systems, these components are defined by their chemical potentials. In this paper, we show that in random conditions, i. e.; for any possible value of the factors of equilibrium or state the stable mineralizations are formed only in metasomatic regimes; so that the mineralogical sequence is a function both of the Helmholtz's free energy and the crystallisation pressure of the minerals. (Author) 7 refs.

  19. Efficacy and safety of thalidomide for the treatment of severe recurrent epistaxis in hereditary hemorrhagic telangiectasia: results of a prospective phase II clinical trial

    Science.gov (United States)

    Invernizzi, Rosangela; Quaglia, Federica; Klersy, Caherine; Pagella, Fabio; Ornati, Federica; Chu, Francesco; Matti, Elina; Spinozzi, Giuseppe; Plumitallo, Sara; Grignani, Pierangela; Olivieri, Carla; Bastia, Raffaella; Bellistri, Francesca; Danesino, Cesare; Benazzo, Marco; Balduini, Carlo L

    2016-01-01

    Summary Background Hereditary hemorrhagic telangiectasia (HHT) is a genetic disease that leads to multiregional angiodysplasia. Severe recurrent epistaxis is the most common presentation, frequently leading to severe anemia. Multiple therapeutic approaches have been tried, but they are largely palliative with variable results.We aimed to assess the efficacy of thalidomide in reducing epistaxis in patients with HHT refractory to standard therapy. Methods HHT patients with severe recurrent epistaxis refractory to mini-invasive surgical procedures were included in an open label, phase II, prospective, non-randomized, single-centre study. Thalidomide was administered at a starting dose of 50 mg/day orally. In the event of no response, thalidomide dosage was increased by 50 mg/day every four weeks until response to a maximum dose of 200 mg/day. After response achievement, patients were treated for eight to16 additional weeks. Monthly follow-up was based on the epistaxis severity score and transfusion need, with adverse events being reported (ClinicalTrials.gov Identifier: NCT01485224). Findings Thirty-one patients, mean age 62∙6 (SD 11∙1) years, were enrolled (median follow-up 15∙9 months, 25th-75th 10∙1-22∙3). Treatment induced cessation of bleeding in three cases (9∙7%) and a significant decrease in all epistaxis parameters in 28 cases (90∙3%). Twenty-five patients (80∙7%) obtained remission with 50 mg/day of thalidomide, five (16∙1%) with 100 mg/day and one (3∙2%) with 150 mg/day. Treatment significantly increased hemoglobin levels (pepistaxis in HHT patients, allowing for a rapid, often durable clinical improvement. Funding Telethon Foundation PMID:26686256

  20. ELLIPSE Study: a Phase 1 study evaluating the tolerance of bevacizumab nasal spray in the treatment of epistaxis in hereditary hemorrhagic telangiectasia.

    Science.gov (United States)

    Dupuis-Girod, Sophie; Ambrun, Alexis; Decullier, Evelyne; Samson, Géraldine; Roux, Adeline; Fargeton, Anne-Emmanuelle; Rioufol, Catherine; Schwiertz, Verane; Disant, François; Chapuis, François; Donazzolo, Yves; Paintaud, Gilles; Edery, Patrick; Faure, Frederic

    2014-01-01

    Hereditary hemorrhagic telangiectasia (HHT) is a dominantly inherited genetic vascular disorder in which epistaxis is the most frequent manifestation, responsible for high morbidity. Management of this symptom has no standard, and local treatments are often aggressive. Their efficacy is variable and has not been proven. Anti-angiogenic drugs, such as bevacizumab, are a new treatment strategy. Its systemic administration in patients with HHT improves liver damage-related symptoms and epistaxis. To limit the systemic adverse effects of bevacizumab and to ease administration, a local administration seems suitable. To evaluate the tolerance of increasing doses of bevacizumab administered as a nasal spray in patients with HHT-related epistaxis. Secondary objectives were to study the bioavailability and efficacy of bevacizumab against epistaxis when given as a nasal spray. Phase 1, randomized, double-blind, placebo-controlled, monocentric study performed sequentially (dose escalation) on 5 groups of 8 patients. Each group was made up of 6 verum and 2 placebos. Five increasing doses of bevacizumab nasal spray (25 mg/mL) were evaluated: 12.5, 25, 50, 75 and 100 mg. A total of 40 patients were included between October 2011 and October 2012. Bevacizumab nasal spray was well tolerated in all patients and the drug was not detected in their serum. No dose limiting toxicity was observed. No efficacy was observed at any dose in this study. Based on these results, bevacizumab nasal spray is a safe treatment of epistaxis in HHT. However, a randomized Phase 2 study is needed to determine its efficacy. ClinicalTrials.gov Identifier #NCT01507480.

  1. Los mitos griegos y la Hispania antigua : consideraciones metodológicas

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    José Carlos Bermejo Barrera

    1991-01-01

    Full Text Available El estudio de la difusión de la mitología griega a lo largo de la historia de la Hispania antigua debe llevarse a cabo con suma precaución, puesto que es muy fácil caer en alguna de las múltiples trampas que un devenir histórico muy complejo suele ir poniendo continuamente a nuestro paso. El problema no se reduce solamente a la escasez de las fuentes, que no nos permiten seguir las cronologías y las trayectorias de la difusión de estos mitos, sino que también se debe a la confusión metodológica que a veces reina en la mente de algunos historiadores. Por ello, con el fin de evitar este tipo de confusión, será necesario establecer de forma preliminar algunas consideraciones de método.

  2. Cáncer de colon recurrente: consideraciones actuales Recurrent colon cancer: present considerations

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    Zenén Rodríguez Fernández

    2009-03-01

    Full Text Available El cáncer colorrectal se considera la neoplasia más frecuente de este siglo y su morbilidad y mortalidad llevan un ritmo ascendente. Se presenta una revisión de las consideraciones actuales más relevantes, referidas a los tipos histológicos, pronósticos, tratamiento quirúrgico convencional y videolaparoscópico, terapia génica, seguimiento posoperatorio, prevención y tratamiento de dichos tumores.Colorectal cancer is considered the most frequent neoplasia of this century and its morbidity and mortality show an ascending rhythm. A review of the most significant current considerations regarding the histological, prognostic, conventional and videolaparoscopic treatment, gene therapy, postoperative follow-up, prevention and treatment of such tumors is presented

  3. Algunas consideraciones teóricas y metodológicas para el desarrollo de un modelo de competencias críticas (MCC: un enfoque operante

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    Giovanni León-Sanabria

    2011-01-01

    Full Text Available El presente documento expone algunas consideraciones teóricas y metodológicas para el desarrollo de un modelo de competencias críticas (MCC.Este se define como un conjunto de habilidades y conocimientos funcionalmente organizados que permiten alcanzar resultados medibles con consecuencias positivas para los objetivos estratégicos del negocio. Para el desarrollo de la propuesta, se abordaron planteamientos teóricos sobre el modelo clásico de competencias laborales, el modelo contemporáneo de competencias laborales y el modelo de competencia humana. La implementación del modelo contempla cinco pasos: 1 realizar un análisis del puesto considerando cuáles son las dimensiones o facetas que serán susceptibles de revisión; 2 identificar a las personas con los desempeños opuestos (los de desempeño superior y los de desempeño inferior; 3 identificar los incidentes críticos más relevantes al puesto; 4 desarrollar escalas de valoración de anclajes (EVA y 5 validar las EVA obtenidas con expertos en el tema. Comoconsideración final, se determina que los modelos de competencias requieren enfoques de medición precisos, ya que el teoricismo excesivo puede provocarque el tema de las competencias se vuelva una moda comercial con bajo o mínimo impacto,lo que afecta su validez, veracidad e implantación en las organizaciones.

  4. A CHILD WITH EPISTAXIS, REDUCED HEARING AND CERVICAL LYMPHADENOPATHY: A RARE CASE OF NASOPHARYNGEAL CARCINOMA IN A CHILD

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    SUHAIMI Y

    2011-01-01

    Full Text Available Although nasopharyngeal carcinoma (NPC is common in this part of the world, the incidence among children is still very low worldwide. The diagnosis is sometimes delayed because of the late reporting of the symptom by the patient or parents, or difficulty in reaching the final diagnosis due to its hidden anatomical location. The challenges include the difficult endoscopy in children, inability to differentiate an adenoid from the tumour on radiograph and often the inconclusive fine needle aspiration findings. If the tumour mass at Fossa of Rosenmuller can be clearly appreciated and biopsied with undoubtedly proven histology of NPC, the diagnosis can be straight forward and treatment can be commenced as early as possible. We report a 10-year-old child presented with bilateral neck cervical lymphadenopathy and epistaxis with fine needle aspiration cytology(FNAC of the neck mass reported as lymphoma. Further work-up confirmed he was suffering from NPC.

  5. Efficacy and safety of thalidomide for the treatment of severe recurrent epistaxis in hereditary haemorrhagic telangiectasia: results of a non-randomised, single-centre, phase 2 study.

    Science.gov (United States)

    Invernizzi, Rosangela; Quaglia, Federica; Klersy, Catherine; Pagella, Fabio; Ornati, Federica; Chu, Francesco; Matti, Elina; Spinozzi, Giuseppe; Plumitallo, Sara; Grignani, Pierangela; Olivieri, Carla; Bastia, Raffaella; Bellistri, Francesca; Danesino, Cesare; Benazzo, Marco; Balduini, Carlo L

    2015-11-01

    Hereditary haemorrhagic telangiectasia is a genetic disease that leads to multiregional angiodysplasia. Severe recurrent epistaxis is the most common presentation, frequently leading to severe anaemia. Several therapeutic approaches have been investigated, but they are mostly palliative and have had variable results. We aimed to assess the efficacy of thalidomide for the reduction of epistaxis in patients with hereditary haemorrhagic telangiectasia that is refractory to standard therapy. We recruited patients aged 17 years or older with hereditary haemorrhagic telangiectasia who had severe recurrent epistaxis refractory to minimally invasive surgical procedures into an open-label, phase 2, non-randomised, single-centre study at IRCCS Policlinico San Matteo Foundation (Pavia, Italy). We gave patients thalidomide at a starting dose of 50 mg/day orally. If they had no response, we increased the thalidomide dose by 50 mg/day increments every 4 weeks, until a response was seen, up to a maximum dose of 200 mg/day. After patients had achieved a response, they continued treatment for 8-16 additional weeks. The primary endpoint was the efficacy of thalidomide measured as the percentage of patients who had reductions of at least one grade in the frequency, intensity, or duration of epistaxis. We followed up patients each month to assess epistaxis severity score and transfusion need, and any adverse events were reported. We included all patients who received any study drug and who participated in at least one post-baseline assessment in the primary efficacy population. The safety population consisted of all patients who received any dose of study treatment. This trial is registered with ClinicalTrials.gov, number NCT01485224. Between Dec 1, 2011, and May 12, 2014, we enrolled 31 patients. Median follow-up was 15·9 months (IQR 10·1-22·3). Three (10%, 95% CI 2-26) patients had a complete response, with bleeding stopped, 28 (90%, 95% CI 74-98) patients had partial responses

  6. El capital social y su tratamiento en las entidades en las entidades de ahorro y crédito popular sobre la base de la normativa contable internacional

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    Luis Carlos Gámez Adame

    2013-03-01

    Full Text Available Las Entidades de Ahorro y Crédito Popular (Cooperativas constituyen un segmento importante dentro de los servicios financieros que se prestan en diferentes países y que han tenido un desarrollo vertiginoso al satisfacer demandas y necesidades de numerosas masas poblacionales.Se presentan algunas consideraciones asociadas al tratamiento del capital social en estas entidades sobre la base de la normatividad contable internacional vigente y donde a criterio de los autores existen una serie de incongruencias a las que hay que darles solución.

  7. Long-term efficacy of Nd:YAG laser photocoagulation vs. liquid paraffin plus antiseptic cream in the treatment of recurrent epistaxis.

    Science.gov (United States)

    Zhang, Jing; Qiu, Rongxing; Wei, Chunsheng

    2015-12-01

    The objective of this study was to evaluate the long-term efficacy of Nd:YAG laser photocoagulation with that of liquid paraffin plus antiseptic cream in the management of recurrent epistaxis. Eighty consecutive patients who suffered from recurrent anterior epistaxis presented to the Otolaryngology Department at the Eye and ENT Hospital, Fudan University between February 2011 and June 2011. These patients with histories of recurrent epistaxis were randomly assigned to receive treatment in an outpatient setting consisting of either a combination of liquid paraffin plus antiseptic cream (Group 1) or Nd:YAG laser photocoagulation (Group 2). the following outcome measures were assessed: bleeding intensity; bleeding frequency 2 years after treatment (0 = no bleeding, 1 = reduced bleeding, 2 = the same, 3 = worse), participant's perception of discomfort during the management (grade 0-10, where 10 is the worst pain), and complications. Finally, 70 patients remain in our study. At 2 years, 86 % of laser patients versus 31 % of control patients had no reported bleeding. The outcome score at 2 years after treatment showed a significant difference between the two groups (P = 0.000, P < 0.01). The median and mean ± SD pain levels experienced were 5.0 and 5.2 ± 2.2. Both groups had no complications. It can be further concluded that Nd:YAG laser photocoagulation is a preferable therapy in the treatment of recurrent epistaxis in long-term efficacy. The level of pain associated with the procedure was well tolerated. It is a simple, easy, safe and rapid therapy, which can be performed in an office setting.

  8. Ligation of the ipsilateral common carotid artery and topical treatment for the prevention of epistaxis from guttural pouch mycosis in horses.

    Science.gov (United States)

    Cousty, M; Tricaud, C; De Beauregard, T; Picandet, V; Bizon-Mercier, C; Tessier, C

    2016-01-09

    The objective of the study was to evaluate the effect of ligation of the ipsilateral common carotid artery (CCA) combined with various antimycotic treatments for the prevention of epistaxis in horses with guttural pouch mycosis. For each case, ipsilateral ligation of the CCA was performed, followed by application of various topical medications under endoscopic guidance. Frequency and number of treatments, outcome and recurrence of haemorrhage were retrospectively recorded. Twenty-four horses were included. Topical medication was administered by detachment of the diphtheric membrane and spraying (n=16) or by intralesional injection directly in the plaques using a transendoscopic needle (n=8). Epistaxis recurred in five horses (20.8 per cent), causing death of four horses (16.6 per cent). The mean number of treatments was 6.3±4.0 (range 2-14) for all topical treatments. Ligation of the ipsilateral CCA and topical medication carries a fair prognosis for avoidance of recurrent episodes of epistaxis, but fatal haemorrhage can occur. Removal of the fungal plaque and topical treatment of the underlying lesion appeared to speed up resolution of the mycotic mucosal lesions. The described technique is a salvage procedure when financial or technical constraints prevent the use of transarterial catheter occlusion techniques. British Veterinary Association.

  9. A self-controlled comparative clinical trial to explore the effectiveness of three topical hemostatic agents for stopping severe epistaxis in pediatrics with inherited coagulopathies.

    Science.gov (United States)

    Eshghi, P; Jenabzade, A; Habibpanah, B

    2014-09-01

    The aim of this study was to assess the effectiveness of localized treatments to persistently stop epistaxis in patients with inherited bleeding disorders. In a self-controlled comparative clinical trial, to offer the best solution to stop epistaxis at home (within 10 minutes), patients with inherited bleeding disorders were treated using three different topical hemostatic agents, including Tranexamic acid impregnated tampon, EpiCell tampon prepared from oxidized regenerated cellulose pad, and ChitoHem tampon (reinforced with chitosan). The results of using these different products on three groups of randomly selected patients were ultimately compared using the χ(2) and Fisher's exact test statistics. A total of 31 patients, 5 females and 26 males with a mean age of 5.6 years, were included in the study. Twenty-three patients had Glanzmann disease, four had von-Willebrand disease, two had Bernard soulier syndrome, two had activated factor VII deficiency, and one patient had impaired secretion of adenosine deaminase. The study exhibited that statistically there was no significant difference between EpiCell tampon and Tranexamic acid impregnated tampon treatments with respect to the hemostasis duration. However, ChitoHem tampon was more efficient than Tranexamic acid impregnated tampon (P value stop epistaxis. We recommend further research on the use of other hemostatic agents for localized bleeding in patients with inherited bleeding disorders.

  10. Consideraciones en torno a la tecnología y su didáctica

    Directory of Open Access Journals (Sweden)

    Luis Guillermo Gómez Ortiz

    2013-12-01

    Full Text Available En este artículo se exponen algunos de los desarrollos conceptuales que sustentan el proyecto “Diseño de propuestas de aula para la formación de maestros en el área de tecnología”, DTE-209-10, los cuales están relacionados con la noción de tecnología, los propósitos formativos en el campo de la tecnología, así como consideraciones en torno a la didáctica de la tecnología (dominios de representación y estilos de enseñanza/aprendizaje y el papel que en ella cumplen la metacognición y la reflexión en la acción; finalmente, se presenta una propuesta didáctica que tiene como finalidad el desarrollo de habilidades para el diseño, simulación, medición, graficación y análisis de respuesta en frecuencia de un circuito de filtro, en el marco de un tercer curso de circuitos eléctricos.

  11. TRES HISTORIAS SOBRE EL ESPAÑOL DEL PERÚ: LA INDIA, LA BLANCA Y LA MESTIZA

    Directory of Open Access Journals (Sweden)

    Carlos Garatea G.

    2017-06-01

    Full Text Available Muchas veces los historiadores de la lengua olvidan la diversidad textual; en otras, la presión ideológica puede deformar el valor de los textos y adscribirlos a expresiones de distinto origen. En este trabajo se muestra cómo se complementan y varían los registros y los niveles, de acuerdo con los tipos de textos, con la función de cada uno de ellos y, sobre todo, con la voluntad expresiva y la creatividad de los autores. Si bien el centro es la historia del español en el Perú, los criterios expuestos trascienden cualquier delimitación espacial y remiten a consideraciones teóricas y metodológicas de importancia en la historia de las lenguas.

  12. Luz y gravedad (Reflexiones geométricas sobre cáusticas y lentes gravitacionales

    Directory of Open Access Journals (Sweden)

    Elena Ortiz García

    2011-04-01

    Full Text Available Cuando los rayos de luz iluminan una taza de café en una tardesoleada, podemos observar la curva que más brilla sobre la superficie del líquido. Quizá sea ésta una oportunidad para plantearse el siguiente experimento mental: ¿cómo juegan los rayos de luz al reflejarse en diferentes “tazas” geométricas? Esta comunicación pretende proseguir esta discusión con algunas consideraciones sencillas que nos sitúen ante el fenómeno de las lentes gravitacionales, allí donde los efectos de la gravedad afectan, incluso, a la manera de propagarse de la luz, mostrando un sistema dinámico idealizado que resulta, a la vez, sencilloy (matemáticamente caótico.

  13. Sobre Comercio electrónico en la WEB 2.0 y 3.0

    OpenAIRE

    Francisco A. Fernández Nodarse

    2013-01-01

    El modelo Web 2.0 es un fenómeno emergente que viene a situar a este usuario en el centro de cualquier modelo de negocio. El comercio electrónico en la Web 2.0, la evolución del escaparate virtual a los prosumidores, la reputación corporativa en línea, los patrones de diseño, modelos de negocios, la WEB 2.0 y su evolución hacia la WEB 3.0 y algunas consideraciones sobre la seguridad informática son analizados en este estudio. El análisis de la seguridad informática abordó sus principios básic...

  14. El desempleo estructural y la tasa natural de desempleo: algunas consideraciones teoricas y su estado actual en Colombia

    OpenAIRE

    Will Alexander Yarce Posada

    2000-01-01

    n la actualidad, el concepto teórico de la tasa natural de desempleo ha trascendido las cátedras universitarias para convertirse en una herramienta útil para analistas y responsables de la política económica. En este artículo, la tasa natural de desempleo es el eje central de análisis y en él se plantean, en la primera parte, algunas consideraciones teóricas asociadas al desempleo estructural y a la tasa natural de desempleo y sus determinantes. La segunda parte del artículo se refiere a las ...

  15. Postes prefabricados de fibra: Consideraciones para su uso clínico

    Directory of Open Access Journals (Sweden)

    Hugo Calabria Díaz

    Full Text Available En la década de los 90 los Postes Prefabricados de Fibra (PPF se introdujeron al mercado como alternativa a los sistemas metálicos o cerámicos. Hasta la fecha se mantienen en uso, modificando de manera constante sus presentaciones comerciales y estrategias de fijación. Sus cualidades mecánicas como su bajo Módulo Elástico (ME similar al dentinario, introducen un nuevo paradigma en la rehabilitación del Diente Endodonticamente Tratado (DET: .ldquo;el poste debe acompañar en forma solidaria la flexión de los tejidos dentarios frente a las cargas.rdquo;. Sus actuales cualidades estéticas, la fácil remoción y la posibilidad de su cementado adhesivo, los han convertido en una alternativa válida a las soluciones convencionales. Sin embargo, algunos resultados contradictorios junto con la importante dificultad de lograr hibridación en la dentina radicular, mantienen interrogantes a resolver en el futuro. Se indican en casos en donde se prevea retratamiento, en pacientes jóvenes, de alta exigencia estética y toda vez que se quiera y pueda eludir los costos de aleaciones nobles. En el presente artículo se analizan los fundamentos clínicos y experimentales de distintos autores, extrapolándose consideraciones prácticas para su uso. Los mismos se ilustran en un caso clínico para un paciente joven, con antecedente de traumatismo y con altas expectativas estéticas

  16. CONSIDERACIONES PARA LA PLANIFICACIÓN DE RECURSOS HUMANOS EN HOTELES DE LA PROVINCIA DE MANABÍ

    Directory of Open Access Journals (Sweden)

    Rodney Alfonso Alfonso

    2015-10-01

    Full Text Available El objetivo de esta investigación fue realizar consideraciones relacionadas con la actividad de planificación de recursos humanos para las entidades hoteleras de la provincia de Manabí. Se presentó la propuesta de una herramienta para el diagnóstico de la planificación de recursos humanos en entidades hoteleras, que tomó en cuenta la conformación de un equipo de trabajo especializado, una caracterización general del objeto de estudio y de manera específica o detallada del área de recursos humanos. Seguido a esto, se analiza la planificación de recursos humanos, tomando en cuenta factores internos y externos, basándose específicamente en un análisis DAFO ponderado con el criterio de expertos previamente seleccionados y la determinación del estado actual o nivel de desarrollo de la planificación de Recursos Humanos en los hoteles. Los resultados del presente trabajo han sido importantes para la planificación de recursos humanos de forma eficaz y operativa en los hoteles que integran el sistema turístico de Manabí. Además, las entidades hoteleras de la provincia demandan de una gestión de sus recursos humanos con enfoque integral y sistémico, donde es decisivo el papel que desempeña la Planificación de los recursos humanos, con una transformación tanto de métodos como de pensamiento, para emprender acciones en el logro de mejores resultados y no solo el empleo de la experiencia o intuición de los directivos.

  17. Periodismo y moral - Una aproximación al discurso de prensa sobre el narcotráfico en Colombia

    Directory of Open Access Journals (Sweden)

    Dra. Catalina González Quintero

    1998-01-01

    Full Text Available Colombia es un país violento: este estereotipo, generalizado tanto entre los colombianos como en otros países del mundo, encuentra parte de su razón de ser en el predominio de la temática violenta ligada al narcotráfico cuando se tratan noticias sobre Colombia en la prensa extranjera. Para adentramos al estudio de este estereotipo, tendremos en cuenta, primero, algunas consideraciones generales sobre la representación mediática de la violencia, y segundo, los resultados un análisis las noticias sobre Colombia aparecidas en el diario El País, de España. Este análisis hizo parte de la investigación -tendiente a tesis doctoral- que realicé recientemente sobre el cubrimiento de Colombia en la prensa extranjera. El periódico El País, de España, fue escogido para realizar el estudio, dada su importancia en el contexto europeo, pues se trata del diario de habla hispana más importante de dicho continente. La muestra observada corresponde a las noticias sobre Colombia aparecidas en El País durante 1988 y 1989, tiempo en el que se desarrolló en Colombia el 'narcoterrorismo', enfrentamiento entre el llamado cartel de Medellín y el gobierno Colombiano, que dejó muchas víctimas en la población civil.

  18. Algunas consideraciones acerca del retraso mental y su conceptualización. Retos para la prevención pedagógica y social

    Directory of Open Access Journals (Sweden)

    Martín Martín Cala

    2017-11-01

    Full Text Available Se ofrecen consideraciones críticas acerca del retraso mental y su conceptualización, refiriéndose los primeros estudios científicos realizados al respecto y a través de la historia.

  19. El nuevo Aerocafé : consideraciones técnico-económicas

    OpenAIRE

    Duque Escobar, Gonzalo

    2014-01-01

    Esta obra que ayer se proyectó sobre enormes terraplenes que incorporaban la incertidumbre propia de cualquier obra subterránea, ahora se ha proyectado sobre un viaducto de concreto y con una pista 8 mts. más baja que modifica su dirección, para reducir sustancialmente la magnitud de los llenos e incertidumbre natural del proyecto, pero a un costo superior.

  20. Efectos del Hatha-Yoga sobre la salud: Parte I

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    Vivian López González

    1998-08-01

    Full Text Available Se expone que el interés cada vez creciente en la promoción de la salud, ha incrementado la práctica de ejercicios provenientes de la medicina tradicional India. Por esta razón pretendemos en este artículo exponer algunas de las investigaciones científicas llevadas a cabo para demostrar los beneficios de los ejercicios del sistema Hatha-Yoga en el funcionamiento del organismo y por consiguiente su aplicación para el tratamiento de diversos padecimientos, para distintas edades. También se ofrecen algunas consideraciones sobre las principales limitaciones de dichas investigaciones: It is expressed that the ever increasing interest on the promotion of health has encouraged the practice of exervises based on Indian traditional medicine. For this reason, we intend to set forth some of the scientific research works carried out to prove the benefits of Hatha Yoga system exercises on the body functions and therefore, for its application in the treatment of several diseases at different ages. Likewise, some considerations on the main limitations of these research works are provided

  1. To compare efficacy & discomfort in posterior nasal packing with foley's catheters versus bipp gauze packing in cases of posterior epistaxis

    International Nuclear Information System (INIS)

    Khan, M.A.; Ahmed, A.

    2015-01-01

    To compare efficacy and discomfort in posterior nasal packing with Foley's catheters versus BIPP gauze packing in cases of posterior epistaxis. Study Design: Randomized controlled trial. Place and Duration of Study: Combined Military Hospital (CMH) Kharian from October 2011 to October 2013. Material and Methods: A total of 206 patients of posterior epistaxis were included in the study through non-probability convenience sampling and randomly divided in two groups of 103 each. In group A patients were treated by posterior nasal packing with Foley's catheter and in group B patients were treated by posterior nasal packing with BIPP gauze and results in terms of control of epistaxis and discomfort during pack insertion, while the packs were in situ and pack removal, based on VAS (Visual Analogue Scale) were observed. Results: Average age in group A was 52.64 years (SD=9.57) and in group B it was 50.27 years (SD ± 10.13). There were 71 (68.9%) males in group A while 67 (65%) males in group B. During posterior nasal pack insertion, the mean pain score in Group A was 6.21 (SD ± I.13) and in Group B was 7.43 (SD ± 1.19). The mean pain score with the pack in situ was 4.27 (SD ± 0.08) in Group A versus 4.76 (SD ± 0.09) Group B. Similarly pack removal was also more painful in group B than group A (6.14 ± 0.91 vs 6.89 ± 1.09) (p =0.000). In the group A, 31 (30.1%) patients had rebleeding after pack removal, out of which 9 (8.7%) had significant bleeding requiring repacking. In 22 (21.4%) cases there was mild bleeding which settled without repacking. In group B 22 (21.4%) patients had rebleeding after pack removal, out of which 5 (4.7%) had significant bleeding requiring repacking. Conclusion: It is concluded that posterior nasal packing with BIPP gauze pack is effective for controlling posterior epistaxis but causes more discomfort to the patients as compared to Foley's catheter packing. (author)

  2. Tratamento cirúrgico da epistaxe grave: experiência de 11 anos Surgical treatment of severe epistaxis: an eleven-year experience

    Directory of Open Access Journals (Sweden)

    Paulo Saraceni Neto

    2013-02-01

    Full Text Available A epistaxe é uma das urgências otorrinolaringológicas de maior prevalência, cujas alternativas de tratamento cirúrgico cada vez mais fazem parte do dia-a-dia dos serviços de pronto-atendimento, principalmente naqueles casos refratários às condutas clínicas. OBJETIVO: Analisar o perfil dos pacientes e os resultados deste serviço no tratamento cirúrgico da epistaxe durante 11 anos. MÉTODO: Foram analisados dados retrospectivos de 98 pacientes, submetidos a tratamento cirúrgico para epistaxe entre 2000 e 2011. RESULTADOS: A maior parte da amostra foi de homens, com média de idade em torno de 46 anos. A hipertensão arterial sistêmica foi identificada em 58% dos pacientes e a época do ano em que os eventos mais ocorreram foi durante o outono e o inverno. A taxa de ressangramento foi de 13,27%. CONCLUSÃO: O presente estudo pôde concluir que o tratamento cirúrgico das epistaxes, quando indicado, tem bom índice de sucesso, com baixa incidência de complicações, e continua sendo, para este serviço, o tratamento padrão-ouro para as hemorragias nasais refratárias às medidas iniciais de manejo.Epistaxis is one of the most prevalent emergencies in ENT practice, and its surgical treatment is part of the routine at services for emergency care, especially in cases refractory to clinical procedures. OBJECTIVE: To analyze the profile of patients and the results this service has had in the surgical treatment of epistaxis for the last 11 years. METHOD: Data from 98 patients submitted to surgery for epistaxis between 2000 and 2011 were analyzed retrospectively. RESULTS: Most in the sample were males, and mean age was around 46 years. Hypertension was identified in 58% of patients, and most events occurred during fall and winter. The re-bleeding rate was 13.27%. CONCLUSION: This study concluded that the surgical treatment for epistaxis, when indicated, had good success rates and low incidence of complications. In our service, it remains as

  3. Superselective microcoil embolization in severe intractable epistaxis: an analysis of 12 consecutive cases from an otorhinolaryngologic and an interventional neuroradiologic point of view.

    Science.gov (United States)

    Seidel, D U; Remmert, S; Brassel, F; Schlunz-Hendann, M; Meila, D

    2015-11-01

    From 2006 to 2013, 12 patients with severe epistaxis refractory to prior conservative and surgical therapy were treated by superselective embolization of nasal arteries. Supersoft platinum microcoils with smallest diameters were used as the sole embolic agent in all cases. Coils were applied far distally in a stretched position for obtaining ideal target vessel superselectivity. The objective of this study is to evaluate efficacy and complications of superselective coil embolization for treatment of severe intractable epistaxis and to discuss results from an otorhinolaryngologic and an interventional neuroradiologic point of view. Retrospectively, all epistaxis inpatients between 2006 and 2013 were identified and subdivided by form of treatment: conservative, surgical and interventional therapy. Medical records of interventionally treated patients were reviewed for demographics, medical history, risk factors, clinical data, complications and short-term success, and patients were followed up for long-term success. Mean follow-up was 37 months. In 12 patients, 14 embolizations were carried out, with short-term success in 9 patients (75%), while early post-interventional rebleeding occurred in 3 patients (25%). Of 9 patients with short-term success, 1 died during stay, 1 was lost to follow-up and 1 had minor re-bleeding after 30 months. Six patients had short-term and long-term success. Before the first embolization, 3 ± 1 conservative and/or surgical procedures had been undertaken. Length of stay was 12.8 ± 3.6 days. 8 patients (67%) received red cell concentrates. Most frequent complications were mucosal damage and nasal pain, but these were related to repeated packing and surgery. Typical embolic complications as neurological or visual impairment or soft tissue necrosis were not observed in any patient. From the otorhinolaryngologic point of view, surgery is the treatment of choice in severe refractory epistaxis, but in case of repeated failure, superselective

  4. Conocimiento del contenido sobre polígonos de estudiantes para profesor de matemáticas (Mathematical Content Knowledge on Polygons of Peruvian Prospective Teachers

    Directory of Open Access Journals (Sweden)

    Emma Carreño

    2010-09-01

    Full Text Available En este trabajo analizamos el conocimiento geométrico sobre polígonos de estudiantes para profesor peruano. Este conocimiento se describe en función de las capacidades que evidencian. Hemos determinado dichas capacidades con base en el modelo de razonamiento de Van Hiele y en consideraciones sobre el aprendizaje geométrico. Mostramos los resultados generales del grupo de alumnos, así como el estudio de dos casos. In this paper we analyze the geometrical content knowledge related to polygons of a group of Peruvian prospective teachers. This knowledge is described in terms of capacities that theses teachers demonstrate. We had access to these capacities considering the Van Hiele model of reasoning together with other considerations on geometric learning. The general results of the group of students are presented as well as the analysis of two cases.

  5. Grave complicação do tratamento de epistaxe: relato de caso Severe complication in the treatment of epistaxis: a case report

    Directory of Open Access Journals (Sweden)

    Carlos Z. Arbulú

    2004-01-01

    Full Text Available Epistaxe é uma afecção muito comum, sendo geralmente autolimitada ou tratada com medidas mais conservadoras como compressão local, compressas frias, controle da pressão arterial, cauterização sob anestesia local (química ou termo-elétrica ou tamponamento nasal anterior. Contudo, podem se apresentar como quadros graves e de difícil tratamento, sendo necessárias medidas mais agressivas como tamponamento nasal antero-posterior, ligadura arterial cirúrgica ou embolização. Apresentamos o caso de um paciente de 49 anos de idade que cursou com epistaxe de difícil controle e evoluiu com uma grave complicação relacionada ao tratamento realizado em outro serviço.Epistaxis is a very usual disorder, it is usually self-restricted or controlled with conservative measures as local compression, cold gauze, arterial pressure control, cauterization under local anesthesia (chemical or thermoelectric or anterior nasal packing. However, it could be presented as severe cases, and more aggressive measures could be necessary, like posterior nasal packing, arterial ligation or embolization. We present one case of a forty-nine-year-old patient with epistaxis who developed a severe treatment complication from another department.

  6. Digital signage sobre IP

    OpenAIRE

    Casademont Filella, Albert

    2012-01-01

    Projecte que versa sobre el disseny i la implementació d'un sistema de Digital Signage (Cartelleria Digital) sobre IP, creant un gestor que permeti controlar de forma remota tot un conjunt de petits dispositius connectats a pantalles que emeten continguts multimèdia com vídeos, imatges, feeds rss...

  7. Notas sobre fiebre amarilla en Colombia

    Directory of Open Access Journals (Sweden)

    Luis Patiño Camargo

    1937-09-01

    Full Text Available I-Introducción ll.-Datos clínicos anteriores al período de las investigaciones de laboratorio. Época colonial. III-Período de laboratorio anterior al descubrimiento de los animales receptivos. IV.-Período posterior al descubrimiento de los animales receptivos y a la prueba de protección. V.-Trabajos en Colombia durante el período de las investigaciones. VI. El servicio de fiebre amarilla cooperativo entre el Departamento Nacional de Higiene y la Fundación Rockejeller. VIl.-Consideraciones generales. VIlI.-Conclusiones. IX-Recomendaciones. X. Agradecimientos. XI.-Bibliografía. XIl.-Anexos. Legislación sobre viscerotomía. Es de fundamental interés para la vida de la República el estudio y solución de los problemas que se refieren a la salud de sus habitantes; y como el territorio colombiano es cálido en su mayoría, lógicamente se concluye que los asuntos de patología tropical han de ser los primeros en orden de importancia. La fiebre amarilla ha revestido graves caracteres epidémicos en repetidas épocas y por su condición endémica en anchas zonas del territorio colombiano, es una constante amenaza pública; un estudio para conocer su historia, la aparición de los brotes epidémicos, su distribución geográfica, la incidencia de morbosidad y Ietalidad, la localización precisa y la extensión de los territorios afectados, las fuentes del virus y los agentes transmisores, así como la preparación de planes y programas de lucha contra el flagelo, son cuestiones tan interesantes que basta anunciarlas para reconocer su trascendencia. En el deseo de contribuír modestamente al desarrollo de tal programa, he recogido los apuntes cuya exposición forma el presente trabajo.

  8. Heurística para el balance de líneas de ensamble con consideraciones ergonómicas

    OpenAIRE

    Emilsy Medina Chacón; Ruth Illada García

    2015-01-01

    El presente artículo expone el diseño de un método heurístico para el Balance de líneas de ensamble con consideraciones ergonómicas, el cual está basado en la combinación de las teorías de balance de líneas tradicionales y dos métodos de evaluación ergonómica, el Método REBA y la evaluación multitarea de carga física, lográndose que con una única herramienta, se alcance un equilibrio de las variables de tiempo y  biomecánicas. El valor agregado del planteamiento radica en el tratamiento simul...

  9. Heurística para el balance de líneas de ensamble con consideraciones ergonómicas

    OpenAIRE

    Emilsy Medina Chacón; Ruth Illada García

    2015-01-01

    El presente artículo expone el diseño de un método heurístico para el Balance de líneas de ensamble con consideraciones ergonómicas, el cual está basado en la combinación de las teorías de balance de líneas tradicionales y dos métodos de evaluación ergonómica, el Método REBA y la evaluación multitarea de carga física, lográndose que con una única herramienta, se alcance un equilibrio de las variables de tiempo y biomecánicas. El valor agregado del planteamiento radica en el tratamiento simul...

  10. Comparison of nasal tampons for the treatment of epistaxis in the emergency department: a randomized controlled trial.

    Science.gov (United States)

    Singer, Adam J; Blanda, Michelle; Cronin, Kerry; LoGiudice-Khwaja, Melina; Gulla, Janet; Bradshaw, Jill; Katz, Arnold

    2005-02-01

    Nasal tampons are commonly used to stop bleeding, yet their insertion is painful. We compare the pain of insertion and removal of 2 commonly used nasal tampons. This was a prospective randomized controlled trial in 1 urban and 1 suburban emergency department (ED). Subjects were a convenience sample of adult ED patients with active epistaxis requiring insertion of a nasal tampon, regardless of coagulation status. Pretreatment of the nasal mucosa was performed using an aerosolized lidocaine-Neo-Synephrine combination. Patients were randomized to tamponade with a single Rapid Rhino or Rhino Rocket nasal tampon. The pain and ease of insertion and success of tamponade were recorded. Tampon removal was performed after 1 to 3 days, and the pain and ease of removal, as well as the presence of any bleeding, were noted. Patients rated pain of insertion and removal on a previously validated 100-mm visual analogue pain scale (100=worst pain). Physician ease of insertion and removal was recorded on a 5-point Likert scale. Continuous data are presented as means and 95% confidence intervals (CIs). We evaluated 40 patients evenly distributed between study groups and sites. Median patient age was 61 years (interquartile range 48 to 79 years), and 33% were female patients. Coagulopathy was present in 10 (25%) patients. Baseline characteristics were similar in both treatment groups. The mean pain of insertion of the Rapid Rhino (30 mm, 95% CI 18 to 41 mm) was significantly less than with the Rhino Rocket (48 mm, 95% CI 34 to 61 mm; mean difference 18 mm, 95% CI 1 to 35 mm). The mean pain of removal of the Rapid Rhino (11 mm, 95% CI 1 to 21 mm) was also lower than with the Rhino Rocket (23 mm, 95% CI 13 to 33 mm; mean difference 12 mm, 95% CI -1 to 25 mm). The Rapid Rhino was also easier to insert and remove and had a lower incidence of recurrent bleeding after removal than the Rhino Rocket. Rates of successful tamponade were similar in the 2 groups. The Rapid Rhino nasal tampon is

  11. Apuntes sobre esporotricosis

    OpenAIRE

    Londoño, Fabio

    2011-01-01

    Se hace una breve reseña histórica de las primeras comunicaciones sobre esporotricosis. Se destaca la amplia difusión de la enfermedad en nuestro país. 3. Se hace notar la no existencia de datos bibliográficos sobre formas extracutáneas. 4. Se llama la atención sobre la eficaz ayuda de la intradermo-reacción con esporotriquina en el diagnóstico de la enfermedad. 5- Se comunica un caso de esporotricosis verrugosa tratado con anfotericin B, con excelentes resultados

  12. Apuntes sobre esporotricosis

    Directory of Open Access Journals (Sweden)

    Fabio Londoño

    1960-01-01

    Full Text Available Se hace una breve reseña histórica de las primeras comunicaciones sobre esporotricosis. Se destaca la amplia difusión de la enfermedad en nuestro país. 3. Se hace notar la no existencia de datos bibliográficos sobre formas extracutáneas. 4. Se llama la atención sobre la eficaz ayuda de la intradermo-reacción con esporotriquina en el diagnóstico de la enfermedad. 5- Se comunica un caso de esporotricosis verrugosa tratado con anfotericin B, con excelentes resultados

  13. CONSIDERACIONS PER A UN ESPAIAMENT DE LA POLÍTICA I DEL PENSAMENT

    Directory of Open Access Journals (Sweden)

    Guillem Martí Soler

    2013-12-01

    Full Text Available Prenent la crisi econòmica, política i social de rerefons, plantegem una interrogació sobre l‘espai de la política. Partint de la teoria d‘Agamben sobre l‘estat d‘excepció, ens desplacem cercant un marc amb el qual dur a terme un qüestionament de la política alhora que un qüestionament del pensament. El resultat: el pensament treballant la política, la política treballant el pensament; un moviment exigit per dues problemàtiques: el proïsme i la comunitat.

  14. Algunas consideraciones para la reconstrucción del concepto de contabilidad para el presente siglo

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    Claudia Lucía Niño Galeano

    2003-06-01

    Full Text Available En este artículo se hace una reflexión sobre la posición de la contabilidad en el contexto actual, rescatando de manera general su evolución como disciplina y su transformación permanente. A partir de diversas definiciones sobre contabilidad se intenta resaltar los elementos que la determinan como disciplina y sus contenidos, los cuales deben responder o vincularse aún más con la realidad económica actual, caracterizada por la globalización y el impacto de los mercados financieros internacionales. En este contexto, la contabilidad debe ser flexible, tener la capacidad para responder en forma rápida a los cambios del entorno económico y tener las cualidades necesarias para informar objetivamente a los interesados.

  15. Consideraciones sismicas en el diseño de cimentaciones de concreto armado en puentes

    OpenAIRE

    Rivera Reyes, Eduardo; Rivera Reyes, Eduardo

    2000-01-01

    El presente trabajo profesional de cimentaciones de puentes, no se trata de un resumen de todo lo que habría que saber sobre cimentaciones, sino la ambición es sensibilizar a los Ingenieros en general, que quisieran diseñar estructuras de puentes, con los diversos problemas que los puentes plantean, facilitándoles una visión en conjunto de los tipos de cimentaciones que encontraran, pero incidiendo en el análisis sísmico de las estructuras que no era considerado al detalle en cimentaciones de...

  16. Algunas consideraciones geomorfológicas de la cuenca del Río de la Magdalena

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    Jorge Cervantes Borja

    1969-06-01

    Full Text Available En este trabajo se intenta demostrar cómo el medio físico se mantiene en una dinámica continua, sujeta tanto a acciones física como biológicas; dichas acciones reflejan fenómenos y hechos nuevos sobre el paisaje, generando una labor mixta raramente apreciada y menos aún cuantificada. La geomorfología moderna afirma que las formas actuales son el resultado de acciones pasadas, y que los procesos actuales, darán formas futuras hasta cierto punto previsibles, aunque ciertamente difíciles de cuantificar, por la complejidad de los mecanismos que entran en juego. Sobre esta base, se describe el modelado y se establece una probable evolución del mismo a partir de hechos pasados que se indican en un intento cronológico. Al mismo tiempo se analizan los procesos dinámicos que son la causa de la morfogénesis actual y esto nos permite emitir algunas recomendaciones prácticas para corregir el desequilibrio ecológico que amenaza la modificación de la cuenca.

  17. Planificación y ordenamiento territorial. consideraciones a partir del caso peruano

    Directory of Open Access Journals (Sweden)

    José Americo Roberto Chiarella Quinhoes

    2016-07-01

    Full Text Available El presente texto busca aclarar, conceptualmente, algunas de las diferencias de enfoque y complementariedades entre la planificación del desarrollo del territorio y el ordenamiento territorial, a partir de las experiencias sobre el tema en el Perú. Partimos mostrando el marco contextual sobre la planificación del desarrollo y el ordenamiento territorial en el Perú, para llegar a establecer las vinculaciones entre planificación y ordenamiento territorial. El camino que une ambos puntos pasa por la definición de los conceptos de planificación territorial y de ordenamiento territorial, así como del estudio del contexto internacional más próximo. Para tanto, realizamos una breve historia y discutimos el lugar y el papel de ambas herramientas en el proceso de desarrollo. Nuestro objetivo consiste en identificar las diferencias y complementariedades entre estos conceptos, con la finalidad de otorgar coherencia al uso de las herramientas de planificación y de alinear los diferentes instrumentos vinculados a la planificación y gestión de los procesos de desarrollo del territorio.

  18. CONSIDERACIONES SOBRE LA NATURALEZA DEL CAPITAL SOCIAL EN LAS SOCIEDADES COOPERATIVAS DE TRABAJO ASOCIADO/REMARKS ABOUT THE NATURE OF SHAREHOLDERS EQUITY IN THE ASSOCIATED LABOUR COOPERATIVES

    OpenAIRE

    Javier ITURRIOZ DEL CAMPO; Sonia MARTÍN LÓPEZ; Gustavo LEJARRIAGA PÉREZ DE LAS VACAS

    2007-01-01

    Las Normas Internacionales de Contabilidad (NIC), actualmente denominadas Normas Internacionales de Información Financiera (NIIF), han clasificado al capital social de la sociedad cooperativa como recurso ajeno, al tratarse de un pasivo exigible por estar sujeto a “cancelación o devolución”, cuando el socio decida causar baja de la misma. Esto ha reabierto el debate en el mundo cooperativo entre los defensores y los opositores a dicha clasificación. El principal argumento en contra de esta co...

  19. Metáforas y simbolismos zoológicos : consideraciones sobre los sentimientos respecto a la naturaleza en Antioquia, en los siglos XVIII y XIX

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    Juan Carlos Jurado Jurado

    1997-09-01

    Full Text Available El tema de las relaciones humanas con los animales ha ocupado la atención de los etnólogos, porque permite explicar mejor las características de una sociedad determinada, conocer sus valores y sus formas de convivencia. Lévi-Strauss ha señalado cómo los mitos y las prohibiciones, en especial las alimentarias, que establecen los hombres con el mundo zoológico, están dirigidas a negarse ellos mismos una naturaleza animal real, asumiendo los caracteres simbólicos con que diferencian a los animales entre sí. En otras palabras, toda comparación -en su sentido más amplio- establecida por los hombres con los animales para adjudicarse entre sí los rasgos con que los caracterizan, les facilita tomar distancia de ellos para establecer su condición humana, diferenciadora del mundo natural.

  20. Consideraciones sobre la morfología, anatomía y posición sistemática de Vesicarex Steyermark (Cyperaceae

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    Luis Eduardo Mora-Osejo

    1982-01-01

    Full Text Available En los páramos ocurren con relativa frecuencia angiospermas de porte arrosetado cespitoso. Entre tales se cuenta la diminuta ciperácea Vesicarex collumanthus Steyerm, descrita por Julian Steyermark (1951,63 como especie típica y hasta la fecha única del genero Vesicarex, propuesto por este mismo autor. Recientemente V. collumanthus se ha registrado en varias localidades, colombianas: Sierra Nevada del Cocuy: Grubb, Curry & Fernandez-Paraz No. 339 (COL,US; Sierra Nevada de Santa Marta: Cuatrecasas & Romero-Castaileda No. 24571 (COL, US; Cleef No. 24.571 (COL, U; Sierra Nevada del Cocuy, Cleff Nos. 5611,8875 ICOL,U.

  1. Consideraciones iconográficas sobre las decoraciones fijas anteriores al siglo XVIII del Palacio Real de El Pardo : conservador de Pintura del Patrimonio Nacional

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    Juan Martínez Cuesta

    1995-01-01

    Full Text Available Parece ser que la idea de construir un auténtico palacio en el rico cazadero de El Pardo se la debemos al rey Felipe ii, que tras su vuelta de Inglaterra, siendo aún Príncipe de Asturias, encomendó al arquitecto Luis de Vega la realización de las trazas del nuevo edificio que debía emular a los vistos en el país vecino. Las obras se iniciaron en 1544 y se prolongaron hasta 1557 en que se empezó a retejar el edificio a la manera flamenca —es decir, utilizando pizarra— constituyendo esta nueva técnica una de las características más típicas de la arquitectura madrileña del periodo barroco. Al tiempo que marchaban las obras se iba confeccionando un rico programa decorativo plasmado en importantes programas iconográficos para sus techos, y adquisición de pinturas de caballete para las paredes. Pero un trágico incendio ocurrido el 13 de marzo de 1604 dio al traste con este ambicioso proyecto. El 10 de agosto de 1605, el arquitecto Francisco de Mora elevó un memorial rey Felipe III manifestando que «no quedó en toda la casa suelo que pudiese servir ni pared que no haya menester descostrarse y blanquearse si no son las de las torres».

  2. CONSIDERACIONES SOBRE LA NATURALEZA DEL CAPITAL SOCIAL EN LAS SOCIEDADES COOPERATIVAS DE TRABAJO ASOCIADO/REMARKS ABOUT THE NATURE OF SHAREHOLDERS EQUITY IN THE ASSOCIATED LABOUR COOPERATIVES

    Directory of Open Access Journals (Sweden)

    Javier ITURRIOZ DEL CAMPO

    2007-01-01

    Full Text Available Las Normas Internacionales de Contabilidad (NIC, actualmente denominadas Normas Internacionales de Información Financiera (NIIF, han clasificado al capital social de la sociedad cooperativa como recurso ajeno, al tratarse de un pasivo exigible por estar sujeto a “cancelación o devolución”, cuando el socio decida causar baja de la misma. Esto ha reabierto el debate en el mundo cooperativo entre los defensores y los opositores a dicha clasificación. El principal argumento en contra de esta consideración es que, se considera que se puede poner en peligro la subsistencia y viabilidad económica de la sociedad al presentar una imagen ante terceros que no ofrece garantías suficientes. No obstante, la CINIIF 2 deja una puerta abierta para considerar la totalidad del capital social, o una parte del mismo, como recurso propio siempre que la cooperativa posea el derecho incondicional o parcial a rechazar el rescate de las aportaciones realizadas por los socios. En este estudio se realiza un análisis del capital social en las sociedades cooperativas de trabajo asociado teniendo en cuenta las implicaciones de considerar al capita social como un recurso ajeno o como un recurso propio. En este último caso, tendría lugar una aproximación aún mayor entre la figura de la sociedad cooperativa de trabajo asociado y la sociedad laboral. /The International Accounting Standards (IAS, nowadays International Financial Reporting Standards (IFRS, have classified the shareholders’ equity of the cooperatives as a liability, for being subject to " cancellation or return ", when the partner decides to resign from the cooperative. This has reopened the debate in the cooperative world among the defenders and the opponents for the above mentioned consideration. The principal argument in opposition to this consideration is that it is possible to put in danger the subsistence and economic viability of the society, because its image does not offer enough guarantees. Nevertheless the CINIIF 2 explains that all of the shareholders’ equity, or a part, could be consider as an own resource providing that the cooperative should possess the unconditional or partial right to reject the rescue of the contributions realized by the partners. In this study, an analysis of the shareholders’ equity is realized in the associated labour cooperatives taking into account the implications of the different classifications. If the shareholders’ equity is an own resource then, a still major approximation would take place between the figure of the associated labour cooperative and the employee-owned company.

  3. Flujos informacionales en repositorios cooperativos: consideraciones sobre algunas experiencias en instituciones académicas de América Latina

    Directory of Open Access Journals (Sweden)

    María Cecilia Corda

    2015-01-01

    Full Text Available Este trabajo, de tipo descriptivo exploratorio, se propone efectuar un análisis de una serie de repositorios cooperativos pertenecientes a instituciones académicas de América Latina. Hace hincapié en la importancia de la cooperación como práctica de larga data en el ámbito de las bibliotecas, muchas de las cuales se han convertido en líderes o partícipes importantes tanto en la implementación como en el desarrollo de los repositorios en sus respectivas instituciones. Se toman en consideración los flujos informacionales que los atraviesan a fin de conocer cómo se delinean y desarrollan en el marco de instituciones académicas de cierta envergadura y complejidad, a través de un análisis de documentación. Se resaltan los modelos de flujos de información detectados en dichos repositorios cooperativos y cómo estos, desde su singularidad, favorecen la visibilidad y la difusión del conocimiento académico y científico existente en formato digital.

  4. Consideraciones sobre el empleo de antisueros somáticos en la clasificación por serotipos de cepas de Pseudomonas aeruginosa

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    Aniel Moya

    2007-07-01

    Full Text Available El lipopolisacárido (LPS de bacterias gramnegativas se emplea en el desarrollo de candidatos vacunales, como antígeno expuesto en la preparación o formando parte de esta para aumentar su poder inmunogénico. Sin embargo, esta estructura química de la membrana externa puede ser también utilizada para clasificar bacterias. Según el LPS, presente en la membrana externa bacteriana, Pseudomonas aeruginosa se puede clasificar en 20 tipos somáticos diferentes, clasificación muy útil para estudios epidemiológicos. P. aeruginosa expone sus LPS en la membrana de forma estable, pero ocurren cambios en el fenotipo del LPS bacteriano durante la infección, sucesos que dificultan su clasificación. En estos momentos, los estudios que se desarrollan en el Instituto Finlay necesitan del empleo de tecnologías modernas de clasificación y del diagnóstico molecular para poder establecer patrones más precisos de expresión de los LPS por métodos que junto a los ya existentes permitan diferenciar cepas bacterianas de la misma especie en cualquier tipo de infección.

  5. Anemia esplénica hemolítica de origen palúdico: Consideraciones sobre esplenomegalia e indicaciones de la esplenectomía

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    Pedro Jose Sarmiento

    1942-02-01

    Full Text Available Falta demostrar de una manera científica cuales son las causas que han producido las alteraciones de la función normal hemolítica del bazo. Hay algunos factores que permiten pensar en la hipótesis que tiene bastantes probabilidades en su favor de que sean las toxinas de los hematozoarios de Laveran las responsables. Así, se encuentra en todos estos enfermos las reinfecciones palúdicas, en su pasado patológico; se sabe que el órgano más afectado en esta enfermedad es el bazo, se sabe que existe cierta inmunidad para el paludismo en los nativos de las regiones en donde el paludismo es endémico.

  6. La privatización del acueducto de Bogotá: 1887 – 1914 consideraciones históricas sobre la gestión

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    Juan Camilo Rodríguez Gómez

    1996-05-01

    Full Text Available RESUMEN En este trabajo se describen los antecedentes del abastecimiento de agua para la ciudad de Bogotá a lo largo de los siglos XVI, XVII y XVIII para llegar, ya en la segunda mitad del siglo XXI, a la definición de sistemas más complejos de administración que condujeron finalmente a la privatización del servicio (1887. Se estudia  luego lo que fue la gestión privada de acuerdo a su fracaso,  después de cerca de tres décadas, que llevó de nuevo a la municipalización (1914. Posteriormente se hace una rápida evaluación de las labores durante los primeros diez años  de gestión municipal (1914 – 1924 que permite plantear algunos criterios para confrontar los dos sistemas de gestión, el privado y el público. El trabajo concluye exponiendo la crisis de la empresa, luego de 1916, que llegaría de 1926. Se cierra así un amplio ciclo analítico que permite elaborar valiosos criterios para el análisis  de la historia empresarial del país.

  7. Consideraciones sobre una cámara de combustión experimental de 400 kW // Considerations on a 400 kW experimental combustor.

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    J. A. Cabrera Rodríguez

    2000-03-01

    Full Text Available El trabajo aborda el diseño térmico y constructivo de la cámara de combustión de un combustor experimental para lasimulación de procesos reales de combustión. Se analizan distintas variantes constructivas y se valora su influencia en elcomportamiento del horno, su estabilidad térmica y los gastos energéticos incurridos durante su funcionamiento.Palabras claves: Cámara de combustión, diseño, combustor.________________________________________________________________________________AbstractThe work approaches the thermal and mechanical design of a combustion chamber of an experimental combustor for thesimulation of real combustion process. Different designs are analyzed and their influence is valued in the behavior of thefurnace, thermal stability and cost incurred during their operation.Key words: Combustor, furnace design, thermical design .

  8. Algunas consideraciones sobre la hipertensión arterial en la diabetes mellitus tipo 2 Some considerations related to arterial high blood pressure in Type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Miguel Ángel Yanes Quesada

    2009-09-01

    Full Text Available Se realizó una revisión del tema relacionado con la hipertensión arterial en el paciente diabético tipo 2, con el objetivo de actualizar algunos elementos particulares en este grupo de pacientes. Se plantea que su prevalencia es considerablemente más alta que en la población no diabética, donde la hiperinsulinemia y la disfunción endotelial cobran un papel protagónico en su etiopatogenia. La hipertensión arterial en estos pacientes clínicamente se manifiesta como un patrón non dipper, lo que incrementa la morbimortalidad por esta entidad. El tratamiento medicamentoso es habitualmente necesario, y se usan como drogas de primera línea los inhibidores de la enzima convertidora, los antagonistas de los receptores de angiotensina ll y los calcioantagonistas, aunque se pueden utilizar también los diuréticos tiacídicos a dosis bajas.Authors made a review of the topic related to arterial high blood pressure in the patient presenting with Type 2 diabetes mellitus to update some particular elements in this group of patients. We propose that its prevalence is higher than that present in non-diabetic population, where the hyperinsulinism and the endothelial dysfunction have a leading role in its ethiopathogenesis. The arterial high blood pressure in these patients clinically is manifested as a non-dipper pattern increasing the morbidity and mortality. Drug therapy is commonly necessary and as first line-drugs are used the converting-enzyme inhibitors, the agiotensin-II receptors antagonists, and the antagonists-calcium, although the low-dose thiacidic diuretics.

  9. Consideraciones sobre el empleo de antisueros somáticos en la clasificación por serotipos de cepas de Pseudomonas aeruginosa

    OpenAIRE

    Moya, Aniel; Callicó, Adriana; Cedré, Bárbara

    2007-01-01

    El lipopolisacárido (LPS) de bacterias gramnegativas se emplea en el desarrollo de candidatos vacunales, como antígeno expuesto en la preparación o formando parte de esta para aumentar su poder inmunogénico. Sin embargo, esta estructura química de la membrana externa puede ser también utilizada para clasificar bacterias. Según el LPS, presente en la membrana externa bacteriana, Pseudomonas aeruginosa se puede clasificar en 20 tipos somáticos diferentes, clasificación muy útil para estudios ep...

  10. Algunas Consideraciones sobre la Adopción del Modelo Médico en Psicología: el Caso de las Terapias Empíricamente Fundamentadas

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    PATRICIA LANDA DURÁN

    2011-01-01

    retoman los argumentos, todavía vigentes, planteados por la aproximación conductual a la conducta anormal, a favor de una estrategia de análisis funcional, piedra angular de la evaluación conductual. Se propone la desprofesionalización como una ideología alternativa para establecer criterios de aplicación del conocimiento psicológico.

  11. Consideraciones sobre la naturaleza de los núcleos sintácticos. Hacia una representación sintáctica de dependencias

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    Marina Lloberes

    2012-01-01

    Full Text Available En el análisis sintáctico automático, la definición de criterios lingüísticos para gramáticas basadas en conocimiento lingüístico permite de desarrollar recursos coherentes y consistentes. La construcción de EsTxala y CaTxala, dos gramáticas de dependencias del español y del catalán para FreeLing (un entorno de herramientas de Procesamiento del Lenguaje Natural, se ha llevado a cabo según el diseño previo de un repertorio de criterios ecléctico y crítico en relación con algunos de los formalismos lingüísticos implementados en el análisis automático del lenguaje, la Gramática de Dependencias y la Gramática Generativa. El objetivo de dicho repertorio es facilitar la coherencia y la consistencia de la representación sintáctica en el desarrollo de gramáticas para el análisis sintáctico automático.

  12. Methodological issues related to studies of lead mobilization during menopause Consideraciones metodológicas relacionadas con estudios sobre movilización de plomo durante la menopausia

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    Gertrud S. Berkowitz

    1999-11-01

    Full Text Available While there has been a substantial decline in lead exposure in the United States during the past two decades, mobilization of existing lead stored in bone potentially represents an important endogenous source of exposure for menopausal women. It has been hypothesized that lead may be mobilized from skeletal stores during conditions of high bone turnover, such as during menopause. However, such mobilization has not been documented in prospective studies. This discussion is focussed on some of the methodological difficulties to be anticipated in longitudinal studies of lead mobilization specific to menopause and the issues that need to be taken into account when evaluating the results of such studies. To evaluate whether lead mobilization occurs during menopause, a prospective repeated measures design is needed using X-ray fluorescence analysis of lead in bone and serial measurements of blood lead. Potential confounders and effect modifiers also need to be taken into account in the statistical analysis.Mientras que la exposición a plomo ha declinado sustancialmente en Estados Unidos durante las dos décadas pasadas, la mobilización del plomo almacenado en los huesos representa potencialmente una importante fuente de exposición endógena en mujeres menopáusicas. No obstante, tal movilización no ha sido documentada por estudios prospectivos. La presente discusión se enfoca en algunas de las dificultades metodológicas a se anticipadas en estudios longitudinales de mobilización de plomo específicamente en la menopausia, y los aspectos que necesitan ser considerados cuando se evalúan los resultados de tales estudios. Para evaluar si durante la menopausia el plomo es mobilizado, se requiere de un diseño prospectivo con mediciones repetidas utilizando análisis de fluorescencia de rayos-X para determinar el plomo en hueso y una serie de mediciones de plomo en sangre. Los potenciales confusores y modificadores del efecto también deben tomarse en cuenta en el análisis estadístico.

  13. Consideraciones sobre el valor límite del contenido de SO4= en los áridos y materias primas para el hormigón

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    Gomá, F.

    1983-03-01

    Full Text Available The present paper points out the importance of three main subjects concerning the presence of sulphur compounds in concrete: i the maximum sulphate content of concrete aggregates specified in the Spanish concrete standard; ii the standardized analytical method to determine sulphur compounds in aggregates for concrete; and iii the troubles caused by sulphides and sulphates in concrete. The author suggests the possibility to revise the present limit for the content of sulphur in any state of valence in aggregates and other concrete materials, as well as the convenience to distinguish sulphur as sulphide from sulphur as sulphate in the total sulphur content of the aggregates, taking into account the different detrimental effects of both forms of sulphur in concrete.En este trabajo se señala la importancia de tres aspectos principales relativos a la presencia de compuestos de azufre en el hormigón: i el contenido máximo de sulfatos en áridos, especificado en la norma española para hormigón; ii el método analítico normalizado hasta el presente en España para la determinación de compuestos de azufre en áridos para hormigón; y iii los problemas causados por la presencia de sulfuros y sulfatos en el hormigón. El autor sugiere la posibilidad de revisar el límite actual para el contenido de azufre en cualquier grado de valencia en los áridos y en otros componentes del hormigón, así como la de distinguir entre azufre en estado de sulfuro y en estado de sulfato en el contenido total de azufre en los áridos, teniendo en cuenta los distintos efectos nocivos de uno y otro estado del azufre de los áridos, en el hormigón.

  14. Consideraciones ecológicas sobre la dieta, la reproducción y el parasitismo de Pseudopaludicola boliviana (Anura, Leptodactylidae de Corrientes, Argentina

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    Arturo I. Kehr

    2004-12-01

    Full Text Available Ecological aspects of diet, reproduction, and parasitism of Pseudopaludicola boliviana (Anura, Leptodactylidae from Corrientes, Argentina.The main objectives of this paper were to update the distribution range of Pseudopaludicola boliviana in Argentina, to determine its diet composition and the feeding patterns, to analyze some reproductive variables as mature ova count and diameter in relation to female snoutvent length, to describe the advertisement call for Argentinean populations, and to identify and to localize its helminth parasites. Eleven prey types were identified; dipterans were more important both in number (23.53% and in volume (41.30%;other important preys were collembolans, arachnids and coleopterans. The trophic niche width was 7.15 and the standardized trophic niche value was 0.61. Ovarian complement (number of mature ova for female ranged from 50 to 319 (mean 175.3 ± 86.12, while ovum diameter ranged from 0.2 to 0.4 mm (mean 0.27 ± 0.062. The nuptial call is composed by five notes. The dominant frequency ranged from 3.488 to5.927 kHz; emphasized frequency fluctuated between 4.942 and 5.224 kHz. A total of 10 helminth species (larvae and adults were found in 54 (96% infected frogs. Helminths were represented by Trematoda (7 species, Cestoda (1, Nematoda (1, and Acanthocephala (1.

  15. Algunas consideraciones sobre la enfermedad renal crónica en el anciano desde la atención primaria de salud

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    Leonor Hernández Piñero

    2014-08-01

    Full Text Available Se realizó una revisión bibliográfica con el objetivo de exponer la situación actual del diagnóstico y manejo de la enfermedad renal crónica en el anciano, con la aplicación de las guías KDOQI (Guías Clínicas Prácticas, introducidas por la National Kidney Foundation (NKF y la Kidney Disease Improving Global Outcomes (KDIGO. Partiendo de los cambios producidos por el envejecimiento en el riñón, se valora la viabilidad de la aplicación de las mismas en los ancianos. Se comparan los métodos más utilizados para el cálculo del filtrado glomerular estimado: Cockcroft-Gault y más recientemente el Modification of Diet in Renal Disease (MDRD, resaltando la fiabilidad y rapidez del primero en el contexto cubano. Se describen las particularidades de la enfermedad renal crónica en el adulto mayor y el manejo de la misma con énfasis en la Atención Primaria de Salud. Se concluye que las guías KDOQI son una herramienta excepcional para la prevención, más que como un factor determinante para el diagnóstico de la enfermedad renal en el caso del paciente geriátrico

  16. Consideraciones sobre la investigacion hermeneutica en la educacion en lenguas y culturas extranjeras (Aspects of Applying a Hermeneutic Approach to Foreign Language and Culture Education).

    Science.gov (United States)

    Zoreda, Margaret Lee

    Drawing on writings by recent post-modernist thinkers and semioticians, this paper focuses on a combination of hermeneutic and semiotic viewpoints and applies them to defining the nature of interpretation in an educational setting (e.g., text interpretation), the interpreter, and the essence of the act of comprehension and interpretation. The main…

  17. Posibilidad de un individualismo holista. Consideraciones hermenéuticas sobre el individualismo moderno desde la filosofía de Charles Taylor

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    Gracia Calandín, Javier

    2010-06-01

    Full Text Available The aim of this essay is to argue against the atomistic conception of man that underlies much of modern philosophy and to support, in contrast, a hermeneutical approach that makes possible to defend a holistic individualism. For this, starting from the distinction of Charles Taylor between «ontological issues» and «advocacy issues», I am going to focus on the presuppositions of individualism. What does holistic individualism mean? Thus, I try to clarify whether it is possible to defend such holistic individualism, and what advantages in terms of irreducible social goods and significative freedom brings for the articulation and development of the individual and modern society.

    Mi propósito en este artículo es argumentar contra la concepción atomista del ser humano que subyace a buena parte de la filosofía moderna y defender, por el contrario, un enfoque hermenéutico que haga posible sostener un individualismo holista. Para ello partiendo de la distinción entre «ontological issues» y «advocacy issues» a los que apunta Charles Taylor, recalamos en los presupuestos del individualismo. ¿Qué sentido tiene hablar de un individualismo holista? De este modo trataré de esclarecer si es posible defender dicho individualismo holista; así como qué ganancias supone en términos de libertad significativa y bienes sociales irreductibles para la articulación y desarrollo del individuo y de la sociedad moderna.

  18. Consideraciones sobre la evolución de la respuesta inmunitaria Th2 y sus posibles relaciones con parasitosis y alergia

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    Luis Caraballo

    2012-03-01

    El desarrollo de este equilibrio debió incluir adaptaciones de ambos organismos y la supervivencia del parásito podría ser el resultado de la adquisición de mecanismos supresores de la respuesta defensiva, la selección de los huéspedes con menor intensidad de la respuesta de tipo 2, o ambas. Esto, a su vez, sugiere que aunque las infecciones helmínticas hayan influido en la conformación de la inmunidad de tipo 2, no han sido una fuerza selectiva importante en el caso particular de la respuesta alérgica que, a su vez, está más ligada a una exagerada respuesta Th2/IgE.   DOI: http://dx.doi.org/10.7705/biomedica.v32i1.419

  19. La independència com a procés constituent. Consideracions constitucionals sobre la creació d'un estat català

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    Jordi Jaria i Manzano

    2015-10-01

    Full Text Available This contribution focuses in defining the constitutional framing for fulfilling a possible will of the people of Catalonia in order to constitute a new and independent state. The paper starts from the relevance of current constitutional framework, the Spanish Constitution, and acknowledges the impossibility of channelling secession through this framework. The reason of this is because secession implies the emergency of a primary political subject, ignored by the current constitutional structure and addressing to exercise framing (constituent power. Therefore amending power is not of relevance here. Nevertheless, it should be made a distinction between the expression of this framing will, which can be accommodated to current constitutional framework, and its fulfilment, which is clearly beyond. However, the framing process of emergent community should be respectful with the pre-existent community, within a supraconstitutional framework built by both actors implied, and based on democratic principle and rule of law, conceived in a substantial sense.

  20. Consideraciones prácticas sobre la cirugía oftalmológica en el paciente cardiópata

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    Mayelín Navarro Scout

    2013-10-01

    Full Text Available La responsabilidad de la evaluación preoperatoria integral en las intervenciones oftalmológicas, con frecuencia recae en el cirujano, quien debe identificar a los afectados con riesgo cardiovascular incrementado y tomar a tiempo las medidas para evitar complicaciones de esta índole. El presente artículo se enfoca en tales aspectos, definiendo las acciones que corresponden directamente al oftalmólogo, aquellas en que funge como gestor, y las que rigurosamente no le competen. También se exponen las estrategias farmacológicas más modernas, con énfasis en el consumo de antiagregantes plaquetarios o anticoagulantes y en la necesidad de la profilaxis antimicrobiana; se refieren las entidades cardíacas inestables que, salvo escasas excepciones, exigen postergar la intervención, y los principios del tratamiento en las enfermedades cardiovasculares más comunes