Endoscopic Management of Posterior Epistaxis

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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 ...

An epistaxis severity score for hereditary hemorrhagic telangiectasia.

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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.

Artritis reumatoide: consideraciones psicobiológicas

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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 ...

Treatment of Hereditary Hemorrhagic Telangiectasia-Related Epistaxis.

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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.

Tranexamic acid in epistaxis: a systematic review.

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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.

Epidemiological characteristics of pediatric epistaxis presenting to the emergency department.

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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.

Traumatic Anterior Cerebral Artery Pseudoaneurysmal Epistaxis.

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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.

Idiopathic epistaxis and meteorological factors: case-control study.

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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.

Endoscopic management of posterior epistaxis.

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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.

Recurrent epistaxis following nasotracheal intubation--a case report.

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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.

Consideraciones sobre el fracaso escolar

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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.

Epistaxis: The role of arterial embolization.

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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

Emergency Department care of childhood epistaxis.

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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

Epistaxis: Prevailing Factors and Treatment

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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.

Epistaxis management: current understanding amongst junior doctors.

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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.

Immediate Management of Epistaxis.

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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.

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)

Endoscopic Management of Epistaxis in Lumbini Medical College

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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.

Nasal bacterial colonization in cases of idiopathic epistaxis in children.

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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.

Torrential epistaxis in the third trimester: a management conundrum

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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

A Rare But Important Entity: Epistaxis in Infants.

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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.

Evaluation of a novel high-fidelity epistaxis task trainer.

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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.

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)

Management of intractable spontaneous epistaxis

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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

ADHD presenting as recurrent epistaxis: a case report

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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.

Heritability of epistaxis in the Australian Thoroughbred racehorse population.

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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.

An update on management of pediatric epistaxis.

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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.

Evaluation of vitamin D levels in children with primary epistaxis.

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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.

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.

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.

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.

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.

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

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.

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 ...

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.

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.

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

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)

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.

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 ...

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.

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.

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

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.

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.

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.

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.

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

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 ...

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.

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.

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.

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.

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

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.

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

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

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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. 

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 ...

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)

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.

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.

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.

Doce 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...

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.

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.

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

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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.

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

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

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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.

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 ...

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.

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

OpenAIRE

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...

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

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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.

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...

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

Artritis reumatoide: consideraciones psicobiológicas

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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.

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

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.

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.

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)

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.

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.

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.

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

Directory of Open Access Journals (Sweden)

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.

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.

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.

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....

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

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.

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.

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.

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.

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

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...

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.

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

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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.

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.

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)

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

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

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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.

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.

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

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.

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.

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

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...

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.

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.

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.

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.

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.

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

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

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.

[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.

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.

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

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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.

[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.

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.

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...

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.

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

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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

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.

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.

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.

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

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

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.

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...

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.

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

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.

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.

Consideraciones preliminares sobre la credibilidad

Directory of Open Access Journals (Sweden)

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

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

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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.

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

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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.

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)

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

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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.

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

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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.

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

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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.

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

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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).

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

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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.

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

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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.

Posterior epistaxis: Common bleeding sites and prophylactic electrocoagulation.

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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).

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

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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.

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

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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.

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

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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.

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

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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...

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

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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

Is antibiotic prophylaxis in nasal packing for anterior epistaxis needed?

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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.

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

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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.

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

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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.

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)

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)

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

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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.

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”

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

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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

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

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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.

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.

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

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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.

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 ...

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.

[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.

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.

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.

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

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

Directory of Open Access Journals (Sweden)

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.

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.

Consideraciones sobre la valoración social del agua

Directory of Open Access Journals (Sweden)

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.

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.

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.

Randomized controlled trial comparing Nd:YAG laser photocoagulation and bipolar electrocautery in the management of epistaxis.

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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.

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

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.

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.

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 ...

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.

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...

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.

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

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.

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.

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.

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.

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

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.

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

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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.

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

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.

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.

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.

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

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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

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

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 ...

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

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

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.

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.

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.

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.

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.

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.

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.

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.

La biblioteca virtual especializada de los derivados de la caña de azúcar: consideraciones, experiencias y perspectivas

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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.

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...

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

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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

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?

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.

Sobre a produção de valor: a recente circulação do poema “Viva Vaia”, de Augusto de Campos

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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.

Hemorrhagic Lacrimation and Epistaxis in Acute Hemorrhagic Edema of Infancy

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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.

Algunas consideraciones sobre el problema de la prostitución en colombia

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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.

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.

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

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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.

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.

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)

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)

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.

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

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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.

[Clinical study of treatment of epistaxis of little's area by microwave, anterior nasal packing and trichloroacetic acid cautery].

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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.

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.

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

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.

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.

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.

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.

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.

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...

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.

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

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

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

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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.

Intensity-Modulated Radiotherapy for a Rendu-Osler-Weber Disease Patient with Recurrent Severe Epistaxis: A Case Report

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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.

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

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.

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.

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)

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

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.

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

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...

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

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...

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

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.

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...

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

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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.

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.

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.

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.

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.

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.

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...

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

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

Periodismo y moral - Una aproximación al discurso de prensa sobre el narcotráfico en Colombia

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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.

'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.

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.)

Consideraciones éticas ante el paciente con hemorragia digestiva alta Ethical considerations regarding the patient with upper digestive bleeding

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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.

Algunas cuestiones que plantea el reembargo

OpenAIRE

Vegas Torres, Jaime

2005-01-01

I. Consideraciones generales sobre el reembargo y su regulación en la LEC. II. El orden de preferencia entre embargos trabados sobre un mismo bien. III. La prohibición general de enajenación en virtud de segundos y ulteriores embargos: consideraciones críticas. IV. Inviabilidad de la realización de inmuebles con embargos anteriores por importe superior al valor previsible de realización. V. Problemas que plantea la rebaja del importe de los embargos anteriores para la determinación del valor ...

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

Tratamento cirúrgico da epistaxe grave: experiência de 11 anos Surgical treatment of severe epistaxis: an eleven-year experience

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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

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

Que hay en el horizonte sobre el virus del papiloma humano, vacunas y el control del cáncer

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Patricia J. García

2007-07-01

Full Text Available Esta revisión provee una visión general sobre las infecciones genitales producidas por el virus del papiloma humano (VPH y de las neoplasias relacionadas con éste y la información sobre las expectativas crecientes de la vacunación como medio de prevención. Se explora como se han desarrollado las vacunas contra el VPH y que aspectos hay que tener en cuenta para una posible implementación de un programa de vacunación para prevenir el cáncer cervical, como los costos, el público objetivo (varones, mujeres o ambos, grupos de riesgo, a que edad vacunarlos, consideraciones que debemos tener en cuenta en la promoción de la vacuna, que pasaría con los programas de detección precoz de cáncer cervical y cuales son los potenciales problemas que tendría en países en desarrollo.

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.

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.

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.

Conocimiento del contenido sobre polígonos de estudiantes para profesor de matemáticas (Mathematical Content Knowledge on Polygons of Peruvian Prospective Teachers

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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.

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.

Luz y gravedad (Reflexiones geométricas sobre cáusticas y lentes gravitacionales

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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.

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

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.

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.

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.

TRES HISTORIAS SOBRE EL ESPAÑOL DEL PERÚ: LA INDIA, LA BLANCA Y LA MESTIZA

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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.

A self-controlled comparative clinical trial to explore the effectiveness of three topical hemostatic agents for stopping severe epistaxis in pediatrics with inherited coagulopathies.

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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.

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.

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 ...

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)

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.

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.

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...

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

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

Consideraciones epistemológicas en torno al carácter científico de la administración

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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.

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...

CONSIDERACIONES RELACIONADAS CON LAS INSPECCIONES DE SOFTWARE

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Bexy Alfonso Espinosa

2006-04-01

Full Text Available

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

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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

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.

¿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.

Algunas consideraciones acerca del retraso mental y su conceptualización. Retos para la prevención pedagógica y social

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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.

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

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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.

Endovascular Treatment of Persistent Epistaxis due to Pseudoaneurysm Formation of the Ophthalmic Artery Secondary to Nasogastric Tube

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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.

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

Can a multisensory teaching approach impart the necessary knowledge, skills, and confidence in final year medical students to manage epistaxis?

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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

Consideraciones sobre aislamientos térmicos

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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.

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

Consideraciones sobre la evaluación psicológica de las comorbidades psiquiátricas en obesos

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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 ...

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

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

Evaluación de las políticas educativas desde la Informed-Policy: Consideraciones teórico-metodológicas y retos actuales

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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

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.

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

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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.

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

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.

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

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.

Evolución doctrinal y jurisprudencial de la teoría del dominio del hecho

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Jorge Alberto Hernández Esquivel

2008-12-01

Full Text Available Sumario: i. introducción. ii. Breve rastreo jurisprudencial y doctrinal sobre el dominio del hecho. iii. algunas consideraciones sobre la autoría mediata por “dominio de la voluntad en virtud de estructuras organizadas de poder” y la jurisprudencia colombiana. iV. Delito de infracción de deber y el denominado interviniente. Tratamiento jurisprudencial

Grave complicação do tratamento de epistaxe: relato de caso Severe complication in the treatment of epistaxis: a case report

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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.

La subjetividad en una perspectiva cultural-histórica: avanzando sobre un legado inconcluso

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Fernando González Rey

2013-06-01

Full Text Available En el presente artículo se pretende mostrar cómo las transformaciones del psiquismo humano, a partir del carácter cultural de las producciones y prácticas del hombre, permiten retomar el tema de la subjetividad como nivel cualitativo distintivo de la especie humana. La subjetividad, entendida en la perspectiva aquí defendida, es un proceso inherente al funcionamiento cultural del hombre y al mundo social generado por sus producciones culturales. Estas consideraciones pretenden responder a la exclusión de la subjetividad por el post-estructuralismo y el neo-pragmatismo, apoyada en la idea de que se trababa de una noción que cargaba con las limitaciones del pensamiento moderno. Frente a esta postura, se argumenta que ninguna de estas corrientes de pensamiento tuvo una conciencia teórica sobre la subjetividad, un concepto que, de hecho, va en dirección opuesta a los principios fundamentales que sustentaron la modernidad tardía, apoyada en la idea de ciencia objetiva y en una representación racional del hombre

La subjetividad en una perspectiva cultural-histórica: avanzando sobre un legado inconcluso

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Fernando Luis González Rey

2013-07-01

Full Text Available En el presente artículo se pretende mostrar cómo las transformaciones del psiquismo humano, a partir del carácter cultural de las producciones y prácticas del hombre, permiten retomar el tema de la subjetividad como nivel cualitativo distintivo de la especie humana. La subjetividad, entendida en la perspectiva aquí defendida, es un proceso inherente al funcionamiento cultural del hombre y al mundo social generado por sus producciones culturales. Estas consideraciones pretenden responder a la exclusión de la subjetividad por el post-estructuralismo y el neo-pragmatismo, apoyada en la idea de que se trababa de una noción que cargaba con las limitaciones del pensamiento moderno. Frente a esta postura, se argumenta que ninguna de estas corrientes de pensamiento tuvo una conciencia teórica sobre la subjetividad, un concepto que, de hecho, va en dirección opuesta a los principios fundamentales que sustentaron la modernidad tardía, apoyada en la idea de ciencia objetiva y en una representación racional del hombre.

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

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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.

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

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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.

Reflexiones para una elaboración conceptual del proceso de chantaje, a partir del problema de selección adversa

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Luz Alexandra Montoya Restrepo

2007-10-01

Full Text Available El presente documento relaciona algunos de los principales aspectos sobre los cuales el enfoque de economía de la información reflexiona frente al funcionamiento del mercado. Además ofrece una breve introducción sobre la señalización en el mercado de trabajo y el modelo de selección adversa. Posteriormente emplea este marco conceptual para ofrecer consideraciones sobre un modelo de chantaje y ofrece algunas conclusiones.

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.

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.

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.

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.

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.

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

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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...

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.

Consideraciones sobre educación matemática y educación indígena en Colombia

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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.

Consideraciones sobre el hidrocefalo de baja presion

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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.

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.

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.

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

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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...

El autoconcepto en niños con necesidades educativas especiales

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Noemí Sabeh, Eliana

2002-01-01

En el presente artículo se desarrollan consideraciones teóricas acerca del autoconcepto y se analiza el efecto que diversos factores vinculados al desarrollo de niños con necesidades especiales pueden tener sobre la imagen de sí. Nos centramos posteriormente en los resultados de investigaciones actuales sobre autoconcepto en niños con discapacidad, refiriéndonos principalmente a niños con dificultades de aprendizaje, dado que son el grupo sobre el que se han realizado mayoritariamente los est...

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

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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...

[Management of side effects of targeted therapies in renal cancer: stomatological side effects (mucositis, epistaxis)].

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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.

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.

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.

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

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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.

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.

El desempleo estructural y la tasa natural de desempleo: algunas consideraciones teoricas y su estado actual en Colombia

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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 ...

Homo modulans (III: de la naturaleza de la música

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Modesto García Jiménez

2013-01-01

Full Text Available Partiendo de lo que pudiéramos llamar extraña universalidad de la música, pueden esgrimirse una serie de consideraciones sobre si la música es un don inherente o por el contrario un lenguaje adquirido, una casualidad sonora externa absolutamente al alma.

Algunos aspectos del leasing inmobiliario: especialmente enfocados con relación al orden jurídico uruguayo, y particularmente a la Ley 16.072, de 9 de octubre de 1989, que reglamenta el contrato de crédito de uso, modificada por la Ley 16.205 de 6 de seti

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Carlos López Fernández; Teresita Mercader Pizzorno

2015-01-01

Contenido: Introducción. Concepto y modalidades del leasing. Naturaleza jurídica del leasing financiero. Consideraciones sobre la ley uruguaya de "leasing financiero". La naturaleza jurídica del leasing inmobiliario.  La inscripción del contrato de leasing

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.

Estratigrafía del Grupo Mina Verdun, Proterozoico de Minas, Uruguay

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Poiré, Daniel G.; González, Pablo D.; Canalicchio, José M.; García Repetto, Flavio

2005-01-01

El objetivo del presente trabajo es el de presentar un cuadro estratigráfico para las sedimentitas del área del Cerro Verdún, Minas, Uruguay. Asimismo presentar algunas consideraciones sobre sus características sedimentológicas y sus estromatolitos, a fin de discutir sus condiciones paleoambientales. En el mismo sentido, se realizan inferencias sobre la edad abarcada por estas rocas y sus potenciales correlaciones regionales. Esta sucesión ha permanecido indefinida en general, mientras que su...

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.

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.

La historia, la comida, la salud: Un vínculo siempre más estrecho entre alimentación y medicina The history, the food, the health: A bond always more tight between feeding and medicine

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Giovanna Motta

2010-01-01

En las sociedades del Antiguo Régimen la influencia del pensamiento científico racionalista puesta en acto en el Siglo de las Luces es básico para que se afirme una nueva cultura médico-científica en el contexto en que cambia también la relación con la comida. Alimentarse asume entonces un valor social e inspira consideraciones más profundas sobre la salud, atrayendo siempre más la atención de los médicos sobre la dieta, sobre las condiciones ambientales e higiénicas. Pero desde la edad media...

Heurística para el balance de líneas de ensamble con consideraciones ergonómicas

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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...

Heurística para el balance de líneas de ensamble con consideraciones ergonómicas

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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...

Algunos aspectos del leasing inmobiliario: especialmente enfocados con relación al orden jurídico uruguayo, y particularmente a la Ley 16.072, de 9 de octubre de 1989, que reglamenta el contrato de crédito de uso, modificada por la Ley 16.205 de 6 de seti

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Carlos López Fernández

2015-10-01

Full Text Available Contenido: Introducción. Concepto y modalidades del leasing. Naturaleza jurídica del leasing financiero. Consideraciones sobre la ley uruguaya de "leasing financiero". La naturaleza jurídica del leasing inmobiliario.  La inscripción del contrato de leasing

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

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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

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.

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.

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.

BREVES CONSIDERACIONES SOBRE EL BOXEO Y EL DERECHO

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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.

Valoració general de la Sentència - Valoración general de la Sentencia

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Joaquín Tornos Mas

2010-07-01

Full Text Available La Sentència 31/2010: valoració general del seu impacte sobre l’Estatut i l’estat de les autonomies (11-22 Enoch Albertí RoviraAlguna consideració sobre la Sentència 31/2010 i el rol atribuït al Tribunal Constitucional (23-28Miguel A. Aparicio PérezUna visió general (29-32Xavier Arbós MarínBreus consideracions sobre la Sentència 31/2010 (33-38Mercè Barceló SerramaleraUna visió global de la Sentència (39-44Joaquim Ferret JacasValoració general (45-48Joaquín Tornos MasValoració general de la Sentència 31/2010 (49-63Joan Vintró CastellsEls efectes jurídics de la Sentència sobre l’Estatut (64-68Carles Viver Pi-SunyerLa Sentencia 31/2010: valoración general de su impacto sobre el Estatuto y el estado de las autonomías (11-22Enoch Albertí RoviraAlguna consideración sobre la Sentencia 31/2010 y el rol atribuido al Tribunal Constitucional (23-28Miguel A. Aparicio PérezUna visión general (29-32Xavier Arbós MarínBreves consideraciones sobre la Sentencia 31/2010 (33-38Mercè Barceló SerramaleraUna visión global de la Sentencia (39-44Joaquim Ferret JacasValoración general (45-48Joaquín Tornos MasValoración general de la Sentencia 31/2010 (49-63Joan Vintró CastellsLos efectos jurídicos de la Sentencia sobre el Estatuto (64-68Carles Viver Pi-Sunyer

Fiberoptic bronchoscopic treatment of blood aspiration and use of sugammadex in a patient with epistaxis

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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

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.

FORMACION Y CONTRASTACION DE LAS TEORIAS CIENTIFICAS EN CONTABILIDAD

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MONTESINOS JULVE, VICENTE

2005-01-01

Los problemas de formacion y contrastacion  de las teorias cientifcas en contabilidad los abordaremos a continuacion separando los propios del conocimiento descriptivo de los de tipo normativo. posteriormente nos ocuparemos del enlace entre ambos tipos de teorias y concluiremos con algunas consideraciones sobre la naturaleza cientifica de nuestra disciplina,derivadas de los planteamientos contemplados.

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.

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

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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.

Innovaciones en el diseño del instrumental manual en endodoncia

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Roig Cayón, Miguel; Brau Aguadé, Esteban; Canalda Sahli, Carlos

1994-01-01

En este artículo de divulgación los autores hacen una serie de consideraciones sobre los nuevos instrumentos endodóncicos que están apareciendo en el mercado, con nuevos diseños y diferentes aleaciones, y tratando de enjuiciar su efecto en la preparación biomecánica de los conductos radiculares.

“Hablando se entiende la gente: La oralidad en la formación on-line de idiomas.”

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Haidl Dietlmeier, Anton

2008-01-01

El autor presenta varias consideraciones teóricas sobre las características de la lengua oral que a su modo de ver deberían tenerse en cuenta a la hora de diseñar un curso online de una lengua extranjera. Publicado online:http://minerva.uca.es/publicaciones/asp/docs/obrasDigitalizadas/plurilinguismo.pdf

Adenoma tiroidiano con sospecha de degeneración maligna

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Manuel José Luque

1944-11-01

III El autor describe la intervención quirúrgica y anota los hallazgos del acto operatorio. Se hizo una estirpación meticulosa de todas las formaciones ganglionares. IV Transcribe día a día el post operatorio y termina con unas breves consideraciones sobre la degeneración neoplásica del cuerpo tiroides.

Consideraciones de diseño para la eliminación biológica de fósforo empleando procesos biopelícula

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Castillo de Castro, Pedro; Tejero Monzón, Iñaki

1999-01-01

El siguiente artículo es un resumen del estado del arte de la Eliminación Biológica de Fósforo (EBF) empleando procesos de biopelícula. En él se describen minuciosamente los mecanismos que intervienen en la eliminación biológica de este elemento, así como las teorías actualmente aceptadas. Se presentan los procesos biopelícula actualmente desarrollados, así como los consideraciones de diseño para reactores biopelícula, y la forma de trabajo necesaria para conseguir la EBF.

Curriculum: debates actuales. Trazos desde América Latina

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Mario Díaz Villa

2014-11-01

Full Text Available Ubicado en los límites del pensamiento curricular y de su crítica, el autor hace algunas consideraciones generales sobre el currículo en la educación superior para luego derivar efectos sobre la formación universitaria cuyos derroteros contemporáneos pasan por los discursos de la flexibilidad y de las competencias. La exposición construye un diagnóstico que explica derivaciones críticas sobre lo que hoy constituye el conocimiento en la universidad, las prácticas profesionales, las sociedades de habilidades y las economías del conocimiento.

Consideraciones en torno a la tecnología y su didáctica

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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.

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.

Alguna precisión sobre las nuevas tecnologías y la democracia deliberativa y participativa

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José Luis Martí

2008-02-01

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Este artículo pone de manifiesto que la participación democrática es deseable con tal de que se pueda promover una participación de calidad, y esto implica un compromiso normativo importante con la idea de deliberación democrática. Por lo tanto, se defiende una visión de la democracia participativa vinculada al ideal de la democracia deliberativa que disfruta actualmente de una gran repercusión académica en todo el mundo. Todo esto se hace desde una perspectiva aplicada al campo de las tecnologías de la información y la comunicación (TIC. Como corolario de esta idea, se proporcionan algunas reflexiones generales que deberían guiar el diseño institucional de mecanismos de participación. El artículo acaba analizando el caso de la campaña del Ayuntamiento de Barcelona "¿Y tú que harías?", para fomentar la participación democrática sobre el contenido del próximo Plan de actuación municipal de la ciudad, concluyendo que se trata de una campaña muy mal diseñada que infringe buena parte de las consideraciones generales antes identificadas.

Alguna precisión sobre las nuevas tecnologías y la democracia deliberativa y participativa

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José Luis Martí

2008-02-01

Full Text Available Este artículo pone de manifiesto que la participación democrática es deseable con tal de que se pueda promover una participación de calidad, y esto implica un compromiso normativo importante con la idea de deliberación democrática. Por lo tanto, se defiende una visión de la democracia participativa vinculada al ideal de la democracia deliberativa que disfruta actualmente de una gran repercusión académica en todo el mundo. Todo esto se hace desde una perspectiva aplicada al campo de las tecnologías de la información y la comunicación (TIC. Como corolario de esta idea, se proporcionan algunas reflexiones generales que deberían guiar el diseño institucional de mecanismos de participación. El artículo acaba analizando el caso de la campaña del Ayuntamiento de Barcelona "¿Y tú que harías?", para fomentar la participación democrática sobre el contenido del próximo Plan de actuación municipal de la ciudad, concluyendo que se trata de una campaña muy mal diseñada que infringe buena parte de las consideraciones generales antes identificadas.

LECTURA, ENSEÑANZA DE LENGUA Y DESERCIÓN ESTUDIANTIL EN SORDOS Y UNIVERSITARIOS

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Larrinaga, Juan Andrés

2016-01-01

RESUMEN En este trabajo se analiza la relación de los estudiantes sordos y de los estudiantes universitarios ingresantes en lo concerniente a la lectura de textos académicos, se muestran los similares procesos de exclusión que ocurren sobre ambos grupos, se vinculan dichos procesos con la educación lingüística, básicamente en torno a las prácticas de lectura, y finalmente se reflexiona sobre las intervenciones del sistema educativo en la formación lingüística. Estos análisis y consideraciones...

La despenalización de la eutanasia en Colombia: contexto, bases y críticas.

OpenAIRE

Díaz Amado, Eduardo

2017-01-01

En el debate global sobre la eutanasia el caso de Colombia, que la despenalizó en 1997, no suele ser discutido en profundidad. En este artículo se examinan el contexto socio-político y jurídico que permitió que la Corte Constitucional en 1997 a despenalizar el homicidio por piedad, los retos que implicó para la sociedad colombiana y los requisitos establecidos por esta corte en 2014 para hacer efectivo el derecho a la eutanasia. Al final se ofrecen algunas consideraciones críticas sobr...

Análisis de los componentes del tiempo de reacción

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Malapeira Gas, Joan Ma. (Joan Maria), 1951-2015; Honrubia Serrano, Ma. Luisa; Viader Junyent, Manel; Cosculluela Mas, Antonio; Viadé Sanzano, Albert; Ferrer Puig, Ramon

1995-01-01

En el presente trabajo se hacen una serie de consideraciones sobre la utilización de la técnica de los tiempos de reacción en diferentes campos de investigación, ejemplijicándose con experimentos en el campo de la percepción auditiva, en el estudio de los anteperiodos y en el establecimiento de la relación entre diferencias individuales, inteligencia y personalidad, y tiempos de reacción. A lo largo del trabajo se realizan varios comentarios sobre la necesidad de utilizar la información compl...

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.

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.

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.

Breves consideraciones acerca de la importancia de los árboles de decisión en el análisis de carteras

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Julio César Riascos Hermoza; Jesús Enrique Molina Muñoz

2016-01-01

La cada vez más estrecha relación entre las ciencias y/o disciplinas no es ajena a la relación derivada en los últimos 50 años entre las nanzas, la Econometría, la modelación estadística y los procesos de simulación computacional. El propósito de este artículo introductorio reside en exponer algunas breves consideraciones con respecto al potencial manejo de los árboles de decisión en la teoría nanciera y particularmente como complemento al diseño de los tradicionales árboles de rentabilidad. ...

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

Notas sobre fiebre amarilla en Colombia

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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.

Angina crónica estable. Consideraciones actuales

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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.

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.

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.

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.

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.

ALGUNAS CONSIDERACIONES SOBRE EL PROBLEMA DE LA "MUERTE CEREBRAL"

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Juan Mendoza Vega

1978-10-01

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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...

El nuevo Aerocafé : consideraciones técnico-económicas

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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.

CRÉDITO AGROPECUARIO Y SOSTENIBILIDAD DE LA AGRICULTURA

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Carlos Francisco Carranza

2001-08-01

Full Text Available El objetivo de este artículo es proveer un marco teórico para la demanda crediticia y uso del crédito por agentes económicos bajo la denominación y conceptualización de hogares finca o productores agropecuarios.Un enfoque de demanda es seleccionado para identificar la función de demanda de crédito del agricultor, suponiendo un comportamiento de maximización de la utilidad, en lugar de un enfoque basado en consideraciones sobre el prestamista o de oferta de fondos, a saber, costos, riesgos y rendimientos. Estas consideraciones del prestamista obviamente deben ser incorporadas en el análisis, puesto que el acceso observado al crédito es el resultado tanto de consideraciones de demanda como de consideraciones de oferta.De varias formas, los tópicos cubiertos en este artículo emergen del modelo básico de dos períodos de Fisher,1 con sus bien conocidas relaciones entre precios y producción, acervos fijos de factores productivos, oportunidades de inversión, mercados eficientes de capital y tasas inter-temporales de preferencias. Este modelo explica satisfactoriamente el problema de toma de decisiones que enfrenta el agricultor, un agente económico que es al mismo tiempo productor y consumidor. El modelo aplica también a la toma de decisiones de otras unidades económicas como la pequeña y mediana empresa.

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

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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.

Reconstrucción, representación gráfica y análisis de las redes de poder en la alta edad media. Aproximación a las prácticas sociales de la aristocracia a partir del ejemplo de Odón de Cluny († 942)

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Isabelle Rosé

2011-01-01

Este texto pretende mostrar cómo la utilización de métodos, de conceptos y de análisis sobre las redes sociales pueden ser útiles en el estudio del principio de la Edad Media. Para reconstruir una « red personal » en este periodo, este artículo pone de manifiesto primero varias dificultades : la falta de fuentes, la selección y uso de documentos adecuados, la identifiacion clara de redes aristocráticas así como consideraciones sobre la construcción de redes que evolucionan en el tiempo. Se pr...

El crecimiento demográfico en Colombia y sus posibles medios de estabilización

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Fernando Serpa Flórez

1966-01-01

Full Text Available El aumento de la especie humana es un problema inquietante, cuyas repercusiones sobre el bienestar, la economía y la salud de las gentes son obvias. Es por ello que deseo hacer algunas consideraciones al respecto, convencido de que el estudio de este tema y los consejos que se formulen sobre la mejor manera de afrontarlo y dar a la situación una solución practicable y acorde con la índole cultural del pais, habrá de ser una contribución benéfica para el futuro de la patria.

El carácter enigmático de las Tesis sobre Feuerbach y su secreto

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Candioti, Miguel

2014-06-01

Full Text Available In 1845 Marx wrote the Theses on Feuerbach, where he explicitly emphasized the essential place of Praxis in his new world outlook; and during the same year, he started writing the part of The German Ideology which also criticizes Feuerbach. These are two texts of similar content; but because of their respective eventful history of publication they could not be compared to each other until the twenties of last century, when the second one was finally published. From this historical observation, this article aims to show the existence of an intellectualist reading of the ambiguous terms that Marx used in the Theses to define Praxis. Historical considerations will be complemented, then, with a thorough philological analysis of such misunderstandings, and with a reflection on their ethical-political consequences.En 1845 Marx escribió las Tesis sobre Feuerbach, donde subrayaba de manera explícita el lugar fundamental que ocupa la Praxis en su nueva concepción del mundo; y durante el mismo año comenzó la redacción de la parte de La ideología alemana donde también se critica a Feuerbach. Se trata de dos textos de contenido similar, pero que –por la azarosa historia de su respectiva publicación– no pudieron ser cotejados hasta los años veinte del siglo pasado, cuando finalmente vio la luz el segundo de ellos. A partir de esta constatación histórica, el presente artículo se propone mostrar la existencia de una lectura intelectualista de los ambiguos términos que Marx utilizó en las Tesis para definir la Praxis. Las consideraciones históricas serán complementadas, pues, con un exhaustivo análisis filológico de tales equívocos, y con una reflexión sobre sus consecuencias ético-políticas.

Mitos y tabúes en la sexualidad humana

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Ignacio González Labrador

2002-06-01

Full Text Available Se realizan consideraciones muy generales sobre el origen de los géneros y cómo esta formación favorece la presencia de mitos y tabúes en la expresión de la sexualidad de la pareja humana.Very general considerations are presented on the origin of genders and how this formation has favored myths and taboos in the expression of the human couple's sexuality.

EVALUACIÓN DE INTANGIBLES: GESTIÓN DE RECURSOS HUMANOS

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Armando Cuesta Santos

2004-01-01

Se realizan consideraciones teóricas y metodológicas sobre la evaluación de intangibles concernientes a la actual gestión de recursos humanos (GRH), cuyo objeto se ha ampliado con la gestión del conocimiento. Se ejemplifica acerca de las escalas ordinales y las correlaciones entre indicadores intangibles e indicadores tangibles.

Revista de revistas

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Facultad de Medicina Revista

1942-08-01

Full Text Available British Medical lnformation Service. 3, Hanover Street.-London, w. 1. Algunas consideraciones prácticas acerca del control del tifus transmitido por piojos en Gran Bretaña a la luz de la experiencia de Rusia, Polonia. Rumania y China. Nueva nota sobre un método para teñir parásitos palúdicos en frottis gruesos de sangre Shock en el recién nacido

Contenido

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Facultad de Medicina Revista

1938-01-01

Full Text Available I DERMATOSIS PIGMENTADA Y PÚRPURICA. Profesor Gonzalo Reyes García. Bogotá. II CONSIDERACIONES ACERCA DE LA OPINIÓN DEL PROFESOR BEN KARPMAN SOBRE PSICODIAGNOSTICO y PSICOTERAPIA DEL CRIMINAL. Alumno Luis Jaime Sánchez. Bogotá. III HOMENAJE AL PROFESOR LUIS ZEA URIBE. Profesor Roberto Franco y doctor Alfonso Castro. Bogotá. IV SECCIÓN OFICIAL V NOTICIAS MÉDICAS VI BOLETÍN BIBLIOGRÁFICO

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.

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.

Intellectual property in ethnomathematics

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Aldo Parra

2015-01-01

Full Text Available Partiendo de reflexiones sobre la metodología empleada en una experiencia con una comunidad indígena colombiana, este artículo propone posibilidades para la investigación en etnomatemática, que tienen implicaciones en aspectos como la propiedad intelectual y la pertinencia social, así como en el reconocimiento y legitimación de ámbitos alternativos de generación, difusión y transformación del conocimiento matemático. El texto tiene cinco secciones: a información sobre la comunidad indígena, b descripción del proceso investigativo (por su carácter colectivo y comunitario es narrado en primera persona del plural, y de la elaboración de sus productos bilingües, así como de la dinámica actual del grupo investigador, c consideraciones individuales del autor, discutiendo la consonancia de la metodología en investigaciones etnomatemáticas con los presupuestos teóricos, humanistas y políticos del campo disciplinar. d consideraciones finales, compartiendo elementos para un desarrollo posterior, e epílogo o lectura de la experiencia desde otra mirada, donde se discute el espíritu que anima los análisis hechos.

An up date on influenza Influenza: actualización de conceptos

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Helí Salgado Vélez

2002-04-01

Full Text Available A review is presented on present-day concepts on influenza with emphasis on vaccination; included are considerations about the etiologic agent, pathogenesis, clinical picture, laboratory diagnosis, epidemiology and vaccines; concerning the latter, the following aspects are included: administration, secondary reactions, indications and contraindications. Se presenta una actualización de conceptos sobre la influenza con énfasis en la vacuna; se incluyen consideraciones sobre el virus, la patogénesis, la clínica, el diagnóstico de laboratorio, la epidemiología y las vacunas; acerca de éstas se detallan sus características, esquemas de aplicación, reacciones secundarias, indicaciones y contraindicaciones.

Lengua escrita y rendimiento escolar

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Arboleda Toro Rubén

1991-06-01

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En estas páginas no haré consideraciones técnicas resultantes de un diseño experimental sobre la lectoescritura como factor de éxito o fracaso escolar. Aventuraré algunas opiniones sobre lo que  impulsa a nuestro país a preocuparse por este asunto y el estado en que se encuentra la reflexión; trataré de relativizar y problematizar la relación que se establece entre lectura y rendimiento escolar, no para generar pesimismo en relación con nuestra acción sino para contribuir a valorarla adecuadamente y a fijar sus metas.

Trabajo infantil, pobreza y desarrollo local en el municipio de Buenaventura. Un estudio de caso

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Oscar Jehiny Larrahondo Ramos

2010-01-01

Full Text Available El presente texto es el resultado del estudio denominado “Trabajo infantil y factores de vulnerabilidad en Buenaventura”, el cual describe y perfila algunas consideraciones sobre el trabajo infantil y su relación con la pobreza y el Desarrollo Local en el municipio de Buenaventura en el año 2010, a partir de cinco espacios de interrelación laboral en los que se presenta la problemática. Aquí, se muestran algunas definiciones conceptuales pertinentes sobre el Trabajo Infantil y la Pobreza, al igual que una serie de hallazgos, al mismo tiempo que un conjunto de recomendaciones o conclusiones al respecto.

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

Postes prefabricados de fibra: Consideraciones para su uso clínico

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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

Reflexões sobre a importância da investigação histórica para o ecoturismo e o turismo de base comunitária.

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Luciana Conceição de Almeida Martins

2013-01-01

Full Text Available El objetivo de este texto es resaltar la importancia de la investigación histórica para el ecoturismo y el turismo de base comunitaria, considerando sus aspectos sociales, culturales, ambientales, históricos, tecnológicos y económicos, por medio de contextos que releven procesos dialógicos e dialécticos de construcción del conocimiento. En ese sentido, sobresalen los estudios sobre la investigación histórica como foco en el ecoturismo e en el turismo de base comunitaria son innovadores, interdisciplinares y por tanto incipientes. De esa manera, se revelan elementos que constituyen fundamentación teórico metodológica de los referenciales que aquí son utilizados, incluyendo un análisis contextualizado de proyecto de extensión de la Universidad del Estado de Bahía (UNEB con foco en el turismo de base comunitaria, desarrollado en la localidad de Cabula y alrededores, en Salvador de Bahía. Consideraciones finales apuntan potencialidades en la pesquisa histórica asociada a los elementos constitutivos de las propias prácticas de los sujetos y de los temas abordados.

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

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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

Consideraciones en torno al status jurídico de los profesores de religión católica (comentario de la STC 38/2007

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Agustín Motilla

2011-03-01

Full Text Available La sentenza è riportata per esteso in calce al commento. SUMARIO: 1. Antecedentes: el largo y tortuoso camino hacia la delimitación del status profesional - 2. Planteamiento del recurso de inconstitucionalidad - 3. Algunas cuestiones previas a la resolución del fondo - 4. La compatibilidad del régimen del profesorado de religión católica con la aconfesionalidad del Estado. -5. La revisión judicial del procedimiento de designación de los profesores de religión católica - 6. Limitaciones al derecho de libertad religiosa de las personas que trabajan como profesores de religión - 7. Consideraciones finales.

Equipo docente: formación, cultura colaborativa e interdisciplinariedad

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Jesús Alberto Echeverri Sánchez

2014-09-01

Full Text Available DOI: http://dx.doi.org/10.17227/01212494.39pys11.20 El equipo docente es una estrategia de trabajo colaborativo que se propone como alternativa de construcción de prácticas pedagógicas en las Escuelas Normales Superiores. Este artículo presenta un recorrido por sus concepciones y propuestas, dando paso a algunas consideraciones sobre su implementación y funcionamiento

Sobre la fundamentación discontinua de la matemática

OpenAIRE

Duque Salas, Martha

2010-01-01

Mi propósito principal es mostrar, teniendo en cuenta las observaciones de Kuhn acerca de las revoluciones en la ciencia, algunas consideraciones que sugieren una concepción de la matemática como una actividad discontinua. Para tal efecto, tomaré tres grandes episodios de la historia de la matemática que comparten una característica esencial: el intento fallido por fundamentar, por encontrar bases sólidas para el desarrollo seguro de la ciencia matemática. Tales episodios, en los que, a mi pa...

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.

Efecto de los inotrópicos sobre la mortalidad en falla cardiaca aguda. Metaanálisis en red de ensayos clínicos

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Juan M. Sénior

2017-09-01

Discusión: no hay diferencias en el uso de inotrópicos como dobutamina, levosimendán o milrinone en términos del desenlace de mortalidad, así que su utilización dependerá de otras consideraciones.

Algunas consideraciones patológicas sobre la llamada cirrosis cardiaca

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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.

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.

Consideraciones genéticas sobre las dislipidemias y la aterosclerosis

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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...

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.

Instituciones Evanescentes : consideraciones políticas sobre la arquitectura itinerante

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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 ...

CONSIDERACIONES SOBRE EL PENSAMIENTO ADMINISTRATIVO DE PORTER Y DE SENGE

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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.

Patrones de citación en la investigación española sobre evaluación de programas educativos (1975-200

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Fernández Cano, Antonio

2001-09-01

Full Text Available This study is a scienciometric review whose aim is to synthesize, according to citation indicators, a series of the primary Spanish studies found dealing with program evaluation into the educational field during the period 1975-2000.
Considering an isomorphism between research and publication of the corresponding reports in the form of articles in specialised journals, we begin with a literature retrieval in the ISOC-CSIC data base and proceed with other cross–references retrieved. In this way, a review was made with 138 studies published as research papers in Spanish educational scientific journals. Several citation indicators were obtained which could help us to infer some considerations on the evaluation of educational programs in this field and period of time.

Este estudio es una revisión cienciométrica que trata de sintetizar, utilizando indicadores de citación, las realizaciones de la investigación educativa española sobre evaluación de programas educativos durante el periodo 1975-2000.
Tras asumir un isomorfismo entre investigación y publicación de su informe como artículo en revistas especializadas, se parte de una búsqueda de tales informes fundamentalmente en la base de datos del ISOC/CSIC (Instituto de Información y Documentación en Ciencias Sociales y Humanidades, complementada con búsquedas cruzadas manuales, para realizar la revisión de 138 estudios recuperados y publicados como artículos de investigación en revistas científicas españolas del campo de la Educación. Al efecto, se elaboran y examinan una serie de indicadores cientimétricos de citación, que permiten inferir ciertas consideraciones sobre la evaluación de programas educativos en este campo y periodo.

Jóvenes en partidos políticos de La Plata. Una mirada sobre los estudios de los jóvenes y la práctica política

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Marcos Mutuverria

2011-06-01

Full Text Available Normal 0 21 false false false MicrosoftInternetExplorer4 El presente informe manifiesta los recorridos teóricos iniciales de la tesis doctoral “Jóvenes en partidos políticos tradicionales en la región La Plata”, que se propone indagar cuál es la construcción de subjetividad, prácticas y trayectorias de los y las jóvenes pertenecientes a partidos políticos tradicionales argentinos en la ciudad de La Plata. En este sentido, el artículo refleja un mapeo en el campo de los estudios que relacionan a los jóvenes con la política (y el rol de los jóvenes en partidos políticos con las primeras consideraciones del tesista para avanzar con el análisis en sus lógicas de acción partidarias, como parte de grupalidades con disputas de poder, y en clave reflexiva sobre condiciones de género y clase en vínculo con lo etáreo al interior de los propios partidos políticos.

Attention deficit hyperactivity disorder and other disruptive behavior disorders are risk factors for recurrent epistaxis in children: A prospective case-controlled study.

Science.gov (United States)

Özgür, Erdoğan; Aksu, Hatice; Gürbüz-Özgür, Börte; Başak, Hatice Sema; Eskiizmir, Görkem

2016-01-01

The aim of this study was to investigate the frequency of attention deficit hyperactivity disorder (ADHD) and other disruptive behavior disorders in children with recurrent epistaxis (RE). Children aged between 6-11 years were enrolled according to presence (n=34) and absence (n=103) of RE. Turgay DSM-IV-Based Child and Adolescent Disruptive Behavior Disorders Screening and Rating Scale was applied to parents. Moreover, Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime Version was performed. Oppositional defiant disorder (ODD) and ADHD were determined in 17.6% and 32.4% of patients, respectively. When psychiatric diagnoses between both groups were compared, statistically significant differences were found in terms of ADHD and ODD (p=0.028 and p=0.003). In children with RE, the frequency of ADHD and ODD are higher than children without RE. A referral to a child psychiatrist should be considered, if a child with RE also has symptoms of increased activity, inattention and/or body-injurious behaviors.

La igualdad de oportunidades con equidad

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Pacheco Zerga, Luz

2013-01-01

La autora del presente informe desarrolla significativas consideraciones sobre la política del Estado referidas a la igualdad de género y no discriminación, acudiendo en determinados acápites a citas del Tribunal Constitucional para apoyar su postura. Asimismo, realiza un magnífico estudio histórico del movimiento feminista que ha contribuido a reconocer el valioso papel de la mujer en la vida social y, especialmente, en la actividad laboral.

la dimensión regional en la política para la economía campesina: el caso del occidente antioqueño

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Jorge Lotero

1990-07-01

Full Text Available Se presentan los principales planteamientos metodológicos necesarios para abordar la política para la economía campesina en una perspectiva regional. Después de algunas consideraciones sobre la dimensión espacial en el Programa de Desarrollo Rural Integrado -DRl-, se examina la región del occidente antioqueño, la mayoría de cuyos municipios hacen parte del nuevo Plan de Desarrollo Integral Campesino -PIC-.

Una lectura de las tecnologías desde los estudios feministas: el caso OLPC y Sugarlabs en Colombia

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Tania Pérez-Bustos

2012-04-01

Full Text Available El artículo presenta los aportes de las epistemologías feministas contemporáneas para una lectura situada de la sociedad de la información, a la luz de una investigación sobre el proyecto “Una laptop por niño” y su plataforma de software en Colombia, Sugar. Argumenta que estos abordajes contribuyen a pensar las condiciones de posibilidad y las posiciones invisibles que definen las TIC. Se cierra con algunas consideraciones sobre cómo esta reflexión puede fornecer herramientas para comprender dinámicas de diseño, implementación y gestión de tecnologías sociales.

UNA LECTURA DE LAS TECNOLOGÍAS DESDE LOS ESTUDIOS FEMINISTAS: EL CASO OLPC Y SUGARLABS EN COLOMBIA

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Tania Pérez-Bustos

2012-01-01

Full Text Available El artículo presenta los aportes de las epistemologías feministas contemporáneas para una lectura situada de la sociedad de la información, a la luz de una investigación sobre el proyecto "Una laptop por niño" y su plataforma de software en Colombia, Sugar. Argumenta que estos abordajes contribuyen a pensar las condiciones de posibilidad y las posiciones invisibles que definen las TIC. Se cierra con algunas consideraciones sobre cómo esta reflexión puede fornecer herramientas para comprender dinámicas de diseño, implementación y gestión de tecnologías sociales.

Amor y política.

OpenAIRE

Hernando Bernal.

1998-01-01

Este trabajo pretende hacer una serie de consideraciones que apuntan sobre todo a extraer una definición de lo que es «la política» para el psicoanálisis a partir de una observación que hace Jacques Alain Miller en su texto Lógicas de la vida amorosa sobre cómo Freud introduce una «teoría política» a partir de su texto Psicología de las masas y análisis del yo.En dicho texto Freud hace ver el poder ordenador y apaciguador del amor) significante amo) en la medida en que una masa no es más que ...

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

Reflexões sobre desenvolvimento humano e neuropsicologia na obra de Vigotski Reflexiones sobre el desarrollo humano y neuropsicología en Vygotsky Reflections on human development and neuropsychology in the Vygotsky' works

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Joana de Jesus de Andrade

2012-12-01

Full Text Available O presente texto configura-se como um ensaio teórico acerca do tema desenvolvimento humano na obra de Lev Vigotski, bem como das implicações desse tema para a Neuropsicologia na obra de Alexander Luria. O trabalho foi feito com base nas obras completas em espanhol de Vigotski e nas obras em português de Vigotski e de Luria. Foram eleitos como focos de investigação considerações acerca do funcionamento cerebral humano, do conceito de compensação, dos estudos sobre deficiência e do conceito de Sistema Funcional Complexo. Apesar de os inúmeros estudos e diferentes traduções da obra de Vigotski terem ampla divulgação e repercussão, principalmente nos campos da Psicologia e da Educação, questões concernentes à Neuropsicologia não têm tido igual relevância. Em vista disto este texto procura realçar as contribuições e a fecundidade da obra no que se refere à originalidade das ideias do autor acerca dos estudos da Neuropsicologia e do desenvolvimento humano.Este texto es un ensayo teórico sobre el desarrollo humano en la obra de Lev Vygotsky, así como las implicaciones de este problema para Neuropsicología en la obra de Alexander Luria. El trabajo se realizó sobre la base de las obras completas de Vygotsky y en español, en portugués en los trabajos de Vygotsky y Luria. Fueron elegidos como foco de las consideraciones de la investigación sobre el funcionamiento del cerebro humano, el concepto de compensación, los estudios sobre la discapacidad y el concepto de sistema complejo funcional. A pesar de numerosos estudios y traducciones diferentes de la obra de Vygotsky tienen un impacto considerable y la difusión, especialmente en los campos de la psicología y la educación, las cuestiones relativas a la neuropsicología no ha tenido la misma importancia. Con esta intención es que este trabajo pretende poner de relieve las contribuciones y la fecundidad de la obra con respecto a la originalidad de las ideas del autor en

El desempleo estructural y la tasa natural de desempleo: algunas consideraciones teóricas y su estado actual en Colombia

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Will Alexander Yarce

2000-07-01

Full Text Available 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 estimaciones de la tasa natural en Colombia, los cambios estructurales en años recientes y a los cálculos del autor de la tasa natural para el periodo 1984-1997. Por último, se plantean algunas conclusiones, a manera de reflexiones finales e implementaciones de política.

CONSIDERACIONS PER A UN ESPAIAMENT DE LA POLÍTICA I DEL PENSAMENT

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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.

Líderes, imagen pública y medios de comunicación social

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Dr. Iván Abreu Sojo

1998-01-01

Full Text Available El tema del liderazgo es uno del mayor interés para Venezuela, y estimamos que para la región y el mundo entero, en estos momentos. Los medios de comunicación en mi país han "puesto en agenda" el asunto, de acuerdo con la gran cantidad de artículos y reportajes que en los últimos años se han venido publicando. Ante la situación del país, caracterizada por una ya larga crisis, el factor liderazgo aparece como crítico a la hora de buscar explicaciones a nuestros males. En este resumen se pasa revista a un diagnóstico sobre el tema, se realizan algunas consideraciones sobre el fenómeno del liderazgo, se analizan los resultados de una investigación sobre el liderazgo carismático en Venezuela y se discute sobre el liderazgo y la imagen pública, concluyendo en el análisis del liderazgo necesario.

Successful flow reduction surgery for a ruptured true posterior communicating artery aneurysm caused by the common carotid artery ligation for epistaxis.

Science.gov (United States)

Yamao, Yukihiro; Takahashi, Jun C; Satow, Tetsu; Iihara, Koji; Miyamoto, Susumu

2014-01-01

Carotid artery occlusion can lead to the development of rare true posterior communicating artery (PCoA) aneurysms because of hemodynamic stress on the PCoA. Surgical treatment of these lesions is challenging. The authors report a case of a true PCoA aneurysm that developed and ruptured 37 years after ligation of the ipsilateral common carotid artery for epistaxis. The lesion was successfully treated with clipping of the distal M1 segment of the middle cerebral artery (MCA) after the occipital artery-radial artery free graft-MCA bypass, which led to extreme reduction in collateral flow through the PCoA. A cortical branch, located just proximal to the obliteration site, functioned as a sufficient flow outlet. The aneurysm shrank, and the patient has been doing well without any symptoms for 5 years after surgery. M1 obliteration combined with high-flow extra-intracranial bypass might be a promising option for a true PCoA aneurysm, and therapeutic design that leaves a sufficient flow outlet on the M1 is mandatory to avoid unexpected occlusion of the M1 and its perforators.

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

Apuntes sobre esporotricosis

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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

Cocaína: complicaciones obstétricas, médicas y perinatales. Características clínicas y tratamiento a estas pacientes Cocaine: obstetric, medical and perinatal complications. Clinical characteristics and treatment of these patients

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Miguel Lugones Botell

2005-08-01

Full Text Available Se realizó una revisión sobre los efectos generales de la cocaína, y en particular, sobre el embarazo y el recién nacido, en la que se enfatiza en los efectos deletéreos que tiene esta droga sobre la gestación, entre los que se destacan el bajo peso al nacer, el hematoma retroplacentario, la hipertensión arterial y la muerte fetal, entre otras complicaciones, así como también las consecuencias negativas que provoca sobre el producto de la concepción. Se hacen consideraciones acerca del manejo integral que hay que tener sobre estas pacientes.A review on the general effects of cocaine and, in particular, on its effects on pregnancy and the newborn infant, was made. Low birth weight, retroplacental hematoma, arterial hypertension and fetal death, are some of the deleterious effects of this drug on gestation that were emphazised, among other complications, as well as its negative consequences for the product of conception. Considerations are made on the comprehensive management of these patients.

Las cláusulas abusivas en la contratación bancaria

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López Jiménez, José María

2016-01-01

En la presente tesis doctoral se agrupan las contribuciones doctrinales del doctorando relacionadas con las cláusulas abusivas en la contratación financiera, en general, y bancaria, en particular. Cada uno de los apartados cuyo contenido se muestra, someramente, a continuación, se fundamenta en los diversos trabajos publicados en los últimos años. Tras la introducción y una serie de consideraciones generales, se trata, en primer lugar, sobre la transformación del sistema financiero mundial...

Electronic commerce of services

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Llorente Viejo, Silvia

2004-01-01

La tesis "Electronic Commerce of Services" presentada por Silvia Llorente Viejo realiza un estudio de los diferentes componentes presentes en el comercio electrónico de servicios. En esta tesis se presentan los diversos aspectos presentes en el comercio electrónico, tanto de productos como de servicios, especialmente las fases que lo forman y consideraciones sobre participantes que se pueden encontrar en cada uno. Para el caso de los e servicios, se realiza una descripción completa de sus car...

Epistaksis

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Munir, Delfitri; Haryono, Yuritna; Rambe, Andrina Y.M.

2010-01-01

Epistaxis is bleeding that comes out from nostril, nasal cavity and nasopharynx. Etiologies of epistaxis are local and systemic disorder. The most common sources of bleeding is Kiessel-bach’s plexus. Diagnostic is made by anamnesis, clinical examination, radiographs and laboratory. Management principles of epistaxis are stop bleeding, prevent complication and recurrent. Anterior epistaxis is stopped by cauterization and anterior packing while posterior epistaxis by posterior packing (Bel...

A DISPLACEMENT-BASED DESIGN METHOD FOR MEDIUM-RISE REINFORCED CONCRETE WALLS

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HECTOR URREGO

2010-01-01

Full Text Available En los métodos de diseño basado en desplazamientos normalmente se hacen consideraciones de demanda a partir del primer modo de vibrar, sin embargo algunos autores han llamado la atención sobre la importancia de considerar los modos superiores ya que estos influyen en la distribución y en la demanda tanto de momentos como de cortantes a lo largo de los elementos verticales con efectos importantes. En este trabajo, se presenta un método práctico que permite considerar el efecto de los modos superiores sobre la respuesta sísmica de una estructura. Para ello, se propone un modelo simplificado de tres grados de libertad, desarrollado a partir de la concentración de las masas en cuatro puntos igualmente espaciados en la altura del edificio. El método desarrollado corresponde a un proceso iterativo, en el cual los procedimientos de análisis y diseño se realizan de manera simultánea, evitando hacer consideraciones o supuestos sobre valores de resistencia y ductilidad. El método ha sido aplicado a un edificio de muros estructurales de 15 niveles. Los resultados obtenidos muestran la eficiencia del método en términos del cumplimiento de los objetivos propuestos y la rapidez con que converge el proceso iterativo involucrado. El efecto de los modos superiores es altamente notorio en la distribución de esfuerzos cortantes y el uso de un predimensionamiento inicial que involucra el refuerzo, permite una consistencia entre el análisis y el diseño estructural.

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

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

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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.

Palladio y Piranesi ante las ruinas

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Juan Calduch

1998-12-01

Full Text Available “Tanto Palladio como Piranesi se enfrentan con la herencia romana de las ruinas para extraer enseñanzas que afectan a la propia disciplina arquitectónica. Una disciplina que se revela autónoma e independiente de otras como la historia o la arqueología volcadas sobre el mismo objeto de estudio”. A partir de estas consideraciones y de un agudo análisis del diferente enfoque de estos arquitectos dibujando la misma arquitectura de las ruinas romanas, el autor extrae consecuencias sobre los intereses profesionales de los arquitectos cuando se enfrentan con la arquitectura monumental y la necesidad de recuperar un juicio crítico de las intervenciones actuales propio de la disciplina arquitectónica.

La teoría del todo (2014, una mirada hacia los efectos de la Esclerosis Lateral Amiotrófica en la vida de Stephen Hawking/ The theory of everything (2014, a closer to the effects of Amiotrophic Lateral Sclerosis in the life of Stephen Hawking

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Sofia Aguiñaga?Malanco et al.

2017-03-01

Full Text Available Stephen Hawking, autor de las teorías más fundamentales sobre el comportamiento de los agujeros negros, entreotras consideraciones sobre el tiempo y el espacio; padece de esclerosis lateral amiotrófica, la cual le fue diagnosticadadurante su último año en Oxford, tal y como se describe en la película La teoría del todo (2014 dirigida porJames Marsh y producida por Anthony McCarten. La esclerosis lateral amiotrófica (ELA o enfermedad de Lou Gehriges una alteración neurodegenerativa progresiva que ocasiona debilitamiento gradual de la musculatura voluntaria.Se caracteriza por una pérdida progresiva de la moto?neurona de la corteza motora, tronco del encéfalo y médulaespinal.

APOLOGÍA DE LA LITERATURA INMIGRANTE: ¿HACIA UNA HOSPITALIDAD PLANETARIA?

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Paula Meiss

2014-10-01

Full Text Available El presente artículo postula la posibilidad de utilizar el relato de viaje migratorio como objeto de estudio de una disciplina comparatista que tenga en cuenta, por una parte, las consideraciones de Armando Gnisci sobre la hospitalidad y, por otro lado, también las de Gayatri Spivak sobre la planetariedad de la literatura comparada. De esta forma, intenta postular una posible línea de investigación en literatura comparada que no requiera del concepto de ‘literatura nacional’ para poder llevarse a cabo. El análisis del relato de viaje migratorio, a través de una serie de variables reconocidas dentro de la tradición de viajes, permite en fondo y en forma un comparatismo del encuentro.

Psicología clínica infantil : Exigencias que plantea su ejercicio

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Paladino, Celia Elba

1983-01-01

Motiva el presente trabajo el deseo y la necesidad de transmitir algunas consideraciones sobre el ejercicio de la Psicología Clínica Infantil. Las mismas son realizadas desde el marco de mi experiencia en el ejercicio profesional de la especialidad, así como, desde mi labor como docente universitaria. Es mi intención, sumarme a aquellos colegas que se esfuerzan para efectuar aportes tendientes a resolver las incumbencias profesionales y científicas de la Psicología. (Párrafo extraí...

La diversificación del comercio: una estrategia de desarrollo económico para México

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Lourdes Margarita Arce Rodríguez

2016-02-01

Full Text Available Este artículo analiza la situación de diversificación del comercio en el contexto de una estrategia de desarrollo económico para México en el marco internacional. Se argumentan algunas consideraciones sobre la evaluación económica a partir de la quiebra del mercado de desarrollo sustitutivo de importaciones así como la crisis de deuda externa en 1982. Minalmente se propone algunas alternativas estratégicas para la diversificación del comercio.

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

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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.

Consideraciones sobre la filosofía de la educación

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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.

Consideraciones sobre el desarrollo moral en escolares con trastornos de conducta

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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.

Algunas consideraciones generales sobre el maltrato de mujeres en la actualidad

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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.

La posible creación de mercados de agua y la gobernabilidad de este recurso en Colombia. Comentarios sobre el proyecto de ley del agua

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Manuel Rodríguez Becerra

2005-11-01

Full Text Available En la actualidad se está tramitando un proyecto de Ley del Agua en el Congreso de la República, presentado a su consideración por el Gobierno Nacional, mediante el cual "se establecen medidas para orientar la planificación y administración del recurso hídrico en el territorio nacional." Se trata de la segunda reforma del gobierno del Presidente Alvaro Uribe relacionada con la gestión del agua en Colombia. En efecto, al principio de su gobierno se expidió la Ley de 2003 de creación del Ministerio del Ambiente, Vivienda y Desarrollo Territorial (MAVDT, a partir del anterior Ministerio del Medio Ambiente, al cual se le trasladaron las funciones de vivienda, agua potable, saneamiento básico y desarrollo territorial, antes en cabeza del Ministerio de Desarrollo que se clausuró. Este ensayo tiene como objetivo hacer un examen de algunos aspectos críticos del proyecto de ley, tal como fue aprobado en primer debate en al Comisión Quinta de la Cámara de Representantes, y también efectuar algunas consideraciones sobre la marcha del MAVDT como autoridad nacional del agua, debido a que ambas reformas están encaminadas a fortalecer la gobernabilidad de este recurso en Colombia.

Retos Sobre el Modelado del Transistor de Compuerta Flotante de Múltiples Entradas en Circuitos Integrados

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Agustín Santiago Medina Vázquez

2012-11-01

Full Text Available En este artículo se presentan las consideraciones que hay que adoptar para el uso del transistor de compuerta flotante de múltiples entradas para el diseño de circuitos integrados analógicos. Para ello se presentan las principales características de este transistor así como sus principales ventajas con respecto al transistor MOSFET convencional que este dispositivo ofrece. También, se exponen los principales problemas que han frenado el uso de este dispositivo en el ámbito comercial debido a la falta de modelos precisos.

Mutaciones de la subjetividad en la comunicación digital interactiva. Consideraciones en torno al acontecimiento en los nativos digitales

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Juan Carlos Amador

2010-01-01

Full Text Available El artículo explora algunas consideraciones teóricoconceptuales acerca de las mutaciones de la subjetividad en las infancias contemporáneas, comprendidas como el conjunto de tránsitos, continuidades e irrupciones en las formas de ser y estar en el mundo de estos sujetos, en particular, por medio de la producción de lenguajes, saberes y convergencias culturales que proceden de su vinculación a la comunicación digital interactiva. Para tal efecto, se desarrolla el concepto de comunicación digital interactiva, apoyado en investigadores como Scolari, Igarza, Rueda y Piscitelli; posteriormente, se aborda el núcleo de las mutaciones de la subjetividad y su relación con el advenimiento de sujetos comunicativos e hiperconectados; finalmente, se presentan algunas reflexiones en torno a la condición ontológica de las infancias contemporáneas y su relación con la desestabilización de la infancia moderna y la crisis de las instituciones que pretenden gobernarlas.

Evolución y actualidad de la literatura infantil y juvenil en lengua vasca

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Olaziregi, Mari Jose

2008-01-01

1. Algunas consideraciones en torno a la literatura infantil y juvenil Como es sabido, toda actividad literaria necesita de un discurso crítico-teórico que la legitime. El hecho de que desde la universidad o desde otros ámbitos organicemos cursos, seminarios o congresos sobre LIJ no deja de ser más que un intento más para que esa literatura que hasta incluso en época reciente ha sido cuestionada por algunos, sea homogeneizada a la literatura con mayúsculas, es decir, a la literatura de adulto...

Aspectos nutricionales de la dieta mediterránea

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Mariné Font, Abel; Vidal, M. Carmen

1999-01-01

Se realiza un anàlisis de los orígenes de la dieta mediterránea, los cuales se remontan a las grandes culturas clásicas de la Edad Antigua. Además, se describe lo que hoy en dia cabe entender como dieta mediterránea y se analiza el valor nutritivo de los alimentos que integran los diversos tipos de dietas mediterrdneas. Finalmente, se realizan algunas consideraciones sobre la bondad de la dieta mediterránea, que, sin ser una panacea, es lo suficientemente equilibrada y agradable para consider...

Gerardo Molina y el Estado providente

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Cataño, Gonzalo

2008-01-01

En este ensayo Gonzalo Cataño examina la visión del Estado del notable pensador y dirigente socialista colombiano, Gerardo Molina. Ofrece una breve información biográfica y comenta su enfoque sobre las funciones del aparato estatal. Aunque en la exposición predomina un tono crítico, muestra que las limitaciones de un analista inteligente de los asuntos públicos son más instructivas que las consideraciones correctas de un comentarista trivial de la política. En este trabajo se denomina por Est...

Análisis facial en ortodoncia

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Mendoza Corbetto, Marco

2004-01-01

Las consideraciones sobre estética facial han sido conceptos inseparables de los principios y de la práctica de la ortodoncia y hoy en día se hace necesario enfatizar la importancia del análisis facial como examen complementario indispensable para el diagnóstico y planeamiento ortodóntico, resaltando que la mejora de la morfología facial debe ser el objetivo del tratamiento de las maloclusion es. Según Baldwin 5 el paciente busca en un tratamiento ortodóntico la ...

Programas de Rehabilitación Psicosocial en la Atención Comunitaria a las Personas con Psicosis

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Juan González Cases

2010-01-01

Full Text Available Este artículo pretende presentar los principales programas de rehabilitación psicosocial enfocados hacia la mejora de la calidad de vida, autonomía, integración social y manejo de la enfermedad en personas que padecen un trastorno mental grave y duradero, en especial esquizofrenia. Además se señalarán algunas consideraciones metodológicas sobre la aplicación de dichos programas, sus elementos esenciales y la importancia de implementar programas e intervenciones que tengan cierto aval de eficacia y utilidad.

Un marco institucional para la gestión del medio ambiente y para la sostenibilidad agrícola.

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Bejarano, Jesús Antonio

2011-01-01

En la primera parte de este trabajo se analiza el significado que tiene la agricultura sostenible en la agenda del desarrollo, precisando que la creciente preocupación por las sostenibilidad de la agricultura deriva no sólo de la preocupación más general sobre la preservación de las condiciones ambientales y de cambios en las condiciones del Comercio Internacional que han venido incorporando tales consideraciones, sino también de /a naturaleza de la crisis agrícola por /a que atraviesa la may...

Revista de tesis

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Facultad de Medicina Revista

1945-10-01

Full Text Available Terapéutica de choque en psiquiatría. Tesis de grado aceptada con "Mención honorífica". 1945. - Presentada por Marco A. Castro Rey / Contribución al estudio de la viscosimetria sanguínea en la tuberculosis pulmonar. Tesis de grado "Meritoria". 1945. - Presentada por Martiniano Sierra Carmona / Contribución al estudio del paludismo en Cundinamarca. Tesis de grado. "Meritoria. 1945. - Presentada por Ramón Dávila / Algunas consideraciones sobre el pian. Tesis de grado 1945. - Presentada por J. Guillermo Toro Lopera.

Una lectura de Polanyi desde la economía social y solidaria en América Latina

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Coraggio, José Luis

2014-01-01

Se presentan elementos del pensamiento social y de conceptos desarrollados por Karl Polanyi, en confrontación con el liberalismo económico, haciendo un paralelo con la lucha actual contra el neoliberalismo. Se plantean diferencias que surgen al hacer una lectura desde América Latina: un sesgo que podría calificarse como eurocéntrico, que excluye consideraciones sobre la co-constitución de AMérica y Europa, la heterogeneidad estructural que nos hace economías de mercado incompleta. A la vez se...

La diversidad cultural educativa indígena venezolana en el contexto socio-jurídico

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Jacqueline Coromoto Guillén de Romero

2013-01-01

Desde el análisis metodológico jurídico-documental se realiza consideraciones sobre el tema de los pueblos indígenas, su reconocimiento y la educación intercultural bilingüe. Resaltando los postulados del Texto Constitucional de 1999, la Ley Orgánica de Pueblos y Comunidades Indígenas, los Convenios Internacionales conexos o relativos a la materia, suscritos por Venezuela y otras fuentes documentales. Se describe, el profundo cambio de perspectiva política, jurídica y cultural que reorienta l...

Conócete a ti mismo... o mejor no. La multidimensionalidad del poder y el seudorradicalismo docente e intelectual

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Mariano Fernández Enguita

2009-01-01

El poder es un fenómeno multidimensional; incluso restringiendo nuestras consideraciones a la esfera económica, es decir, mercados y organizaciones, debemos reconocer al menos tres fuentes de poder: posesiones, autoridad y calificación; esto es, poder sobre (o a través, o con base en) los medios de producción (la materia del sistema económico), trabajo (su energía) y el conocimiento (información); o digámoslo capital económico, social y cultural. Sin importar la justificación (o no) de cualqu...

RELIGIÓN E IMPERIALISMO: REPRESENTACIONES DEL MARXISMO EN LA REVISTA LIÇÕES BÍBLICAS DE LA IGLESIA ASAMBLEA DE DIOS DE BRASIL (1980-1990

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André Dioney Fonseca

2010-04-01

Full Text Available Pocos estudios en la historia han intentado analizar las consideraciones de los liderazgos pentecostales sobre las teorías marxistas, o el socialismo y el comunismo. Así, el objetivo de este artículo es analizar a través de la revista Lições Bíblicas la preocupación de la Asamblea de Dios Ministerio Misión de Belén con el marxismo, en un momento en el que muchos países aún estaban ligados al bloque comunista del Este Europeo

El papel de los ciclos biogeoquímicos en el estudio de los problemas ambientales en Educación Secundaria

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Esteve, Patricia; Jaén, Mercedes

2013-01-01

En el estudio de la dinámica de los ecosistemas tiene un papel predominante el conocimiento de los ciclos biogeoquímicos. En este trabajo se ha realizado un análisis de estos contenidos desde criterios disciplinares y didácticos, incluidos los libros de texto, que ha conducido a una serie de consideraciones para su enseñanza. Como síntesis de los aspectos anteriormente citados, se han identificado algunas cuestiones clave sobre los ciclos biogeoquímicos, que se deberían considerar al planific...

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

Consideraciones en torno a la estructura ontológica existencial de la muerte en Martin Heidegger

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Elsa González Moscoso

2012-06-01

Full Text Available [ES] La pretensión del presente texto es el de dar cuenta de la concepción heideggeriana de la muerte a partir de las consideraciones de El Ser y el Tiempo. Para tal propósito se describe y desarrolla brevemente algunos elementos centrales tales como la idea de la muerte como fenómeno de la vida y no su simple terminación; la explicación de la muerte como posibilidad o un “aún no”; la proyección existenciaria de la propia muerte; la libertad de la muerte como abrirse a ella y la existencia auténtica. Todos estos elementos gravitando alrededor del concepto ontológico-existenciario de la muerte. [EN] The aim of the present writing is to offer an account of the heideggerian conception of death from the considerations of Being and Time. For that purpose, this paper briefly describes and develops some central elements such as the idea of death as a phenomenon collateral to life and not its simple ending; the explanation of death as a possibility or a “not yet”; the existentialist projection of the own death; the freedom of death as an opening to it and to the true existence. All of these elements gravitating around the ontological-existential concept of death.

Diseño e implementación de cursos abiertos masivos en línea (MOOC: expectativas y consideraciones prácticas

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Carmen M. Méndez García

2013-01-01

Full Text Available La popularidad de los cursos abiertos masivos en línea (MOOC durante los dos últimos años ha llevado a muchos diseñadores, docentes e instituciones a interesarse por este nuevo modelo de docencia, que incluso ha llegado a postularse como solución a algunos problemas de la educación universitaria. En este artículo trataremos de analizar cuáles son sus ventajas y desventajas, y sus diferencias respecto a otros modelos de enseñanza (cursos tradicionales, LMS para evaluar su utilidad y viabilidad dentro de la educación superior. También estudiaremos varios cursos creados según este modelo MOOC (específicamente, xMOOC, atendiendo a aspectos de diseño y de expectativas por parte de los distintos agentes del proceso educativo, para sistematizar una serie de consideraciones prácticas que pueden ayudar a quien se acerque al diseño e implementación de MOOC por primera vez.

La teoría del todo (2014, una mirada hacia los efectos de la Esclerosis Lateral Amiotrófica en la vida de Stephen Hawking

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Sofía AGUIÑAGA MALANCO

2017-06-01

Full Text Available Stephen Hawking, autor de las teorías más fundamentales sobre el comportamiento de los agujeros negros, entreotras consideraciones sobre el tiempo y el espacio; padece de esclerosis lateral amiotrófica, la cual le fue diagnosticadadurante su último año en Oxford, tal y como se describe en la película La teoría del todo (2014 dirigida por James Marsh y producida por Anthony McCarten. La esclerosis lateral amiotrófica (ELA o enfermedad de Lou Gehrig es una alteración neurodegenerativa progresiva que ocasiona debilitamiento gradual de la musculatura voluntaria.Se caracteriza por una pérdida progresiva de la moto?neurona de la corteza motora, tronco del encéfalo y médulaespinal.

Epistaksis dan Hipertensi : Adakah Hubungannya?

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Bestari J. Budiman

2012-09-01

Full Text Available Abstrak Latar Belakang: Epistaksis merupakan suatu kondisi klinis yang sering ditemui dan dapat terjadi pada semua umur dengan banyak variasi penyebabnya. Salah satu faktor risiko yang diduga ikut berperan dalam terjadinya epistaksis adalah hipertensi. Tujuan: Menjelaskan hubungan antara epistaksis dengan hipertensi. Tinjauan Pustaka: Hipertensi diduga tidak menyebabkan epistaksis secara langsung, tapi memperberat episode epistaksis. Mengendalikan tekanan darah sebagai salah satu faktor risiko, akan menurunkan insiden terjadinya epistaksis. Di ruang gawat darurat, pemberian obat anti hipertensi diberikan sebelum atau bersamaan dengan manajemen epistaksis itu sendiri. Kesimpulan: Terdapat hubungan antara epistaksis dengan hipertensi yang berlangsung lama dan adanya hipertrofi ventrikel kiri. Kata kunci : Hipertensi, kegawatdaruratan, penatalaksanaan epistaksis. Abstract Background: Epistaxis is a common clinical problem in all age groups with varied etiological factors. Hypertension has been suggested as a risk factor in epistaxis case. Purpose: To explain relationship between epistaxis and hypertension. Review: It has been suggested that hypertension does not cause epistaxis directly, but hypertension prolongs the episode of epistaxis when it does occur. The controlling for blood pressure as a risk factor will be decreased the incidencies of epistaxis. In emergency rooms, high blood pressure is usually treated before or in parallel with the management of epistaxis. Conclusion: There was an association between epistaxis and long duration of hypertension in adult and left ventricle hypertrophy. Key words : Hypertension, emergency case, management of epistaxis.

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.

Digital signage sobre IP

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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...

Sobre la enseñanza propia comunitaria. El caso de Aragón

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Eloy FERNÁNDEZ CLEMENTE

2010-02-01

Full Text Available RESUMEN: Al reflexionar, desde su propia experiencia de historiador y profesor de Historia Económica, sobre las circunstancias que rodean la tan discutida enseñanza de la Historia propia («nacional» o «regional», de cada Comunidad Autónoma española y, en concreto la suya, de Aragón, el autor se propone contribuir al debate sobre su obligatoriedad, sentido, finalidad, razonabilidad. Quiere ser una propuesta abierta y poco dogmática, un ensayo con diversas consideraciones que van desde la política y la ideología a la didáctica, y que aporta la experiencia concreta del Instituto de Ciencias de la Educación de la Universidad de Zaragoza, que lleva realizando una preparación muy sólida con vistas a las próximas transferencias de las enseñanzas primaria y media, que de seguro contemplarán la de la Historia de Aragón como un pilar de formación de esos estudiantes. Palabras clave: Historia nacional. Historia regional, Historiografía, Identidad colectiva. Didáctica de la historia. ABSTRACT: Upon reflecting, from his own experience as a historian and professor of Economic History, on the circumstances surrounding the much-debated teaching of the particular History ('national' or 'regional' of each Autonomous Community of Spain, and specifically of Aragón, the author aims to contribute to this debate on its necessity, sense, purpose and reasonableness. It aspires to be a proposal that is open and not very dogmatic, an essay with various considerations that go from politics and ideology to didactics, and which contributes the particular experience of the Institute of Educational Sciences (Instituto de Ciencias de la Educación oí the University of Zaragoza, which has been Ediciones Universidad de Salamanca Stud, hist., H.^ cont., 13-14, pp. 29-37 carrying out solid preparation with a view to the forthcoming transfer of primary and middle education, which will surely contemplate that of the History of Aragón as a mainstay of the

Una vez más sobre el proceso salud enfermedad. Hacia el pensamiento de la complejidad Going over the health-disease process once again towards the thought of complexity

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Rosa Aguirre del Busto

2002-04-01

Full Text Available Se reflexiona cómo el pensamiento de la complejidad puede constituirse una herramienta metodológica en la comprensión del proceso salud- enfermedad, valorándose las distintas interpretaciones sobre el mismo y sus paradigmas explicativos.Se evalúan desde el punto de vista histórico, las diversas aproximaciones que la ciencia epidemiológica aporta a este análisis: el desarrollo de la concepción lineal del proceso salud enfermedad; algunas consideraciones sobre el modelo ecológico multicausal y la interpretación de que este proceso refleja un fenómeno colectivo, histórico y complejo que se encuentra determinado en última instancia por cada sistema social. Se significa la necesidad de una reforma de pensamiento dentro de las ciencias médicas cubanas, que permitan abrir nuevas perspectivas sobre las dimensiones conocidas que actúan en dicho proceso, para demostrar por una parte, la importancia que tiene el análisis del contexto socio-cultural en las realidades de la enfemedad, la curación, el tratamiento y la rehabilitación y por otra, las transformaciones epistemológicas que exigen este reconocimientoIt is considered the way in which the thought of complexity can constitute a methodological tool in the understanding of the health - illness process, being valued the different interpretations of it and its explanatory paradigms.The diverse approaches that epidemics as a science offer to this analysis are assessed from the historical point of view: the development of the lineal conception of the health-illness process; some considerations on the multicausal ecological pattern and the interpretation that this process reflects a collective, historical and complex phenomenon that is determined ultimately by each social system. The necessity of reforms in people's way of thinking, that allow to open new perspectives on the well-known dimensions that act in this process in Cuban medical sciences is pointed out, to demonstrate on one hand

Inferencias sobre Grafos

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Sira M. Allende; Carlos N. Bouza

2002-01-01

El estudio de un juego puede ser modelado asumiendo que solo algunas partidas son observadas. Entonces el árbol del juego debe ser estimado utilizando información muestral. Similarmente ocurre al obtener información sobre el comportamiento de las decisiones tomadas por individuos muestreados sobre un árbol de decisión teórico. Al considerar una medida de probabilidad que caracterice el comportamiento de redes aleatorias se puede obtener un estimado del árbol asociado. Este problema es el anal...

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

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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.

Algunas consideraciones teóricas acerca del tráfico de mujeres en el contexto de la globalización

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Arun Kumar Acharya

2008-01-01

Full Text Available El objetivo del artículo es presentar algunas consideraciones teóricas relacionadas con los conceptos de migración, tráfico y contrabando de personas, particularmente de las mujeres. Se pretenden explicar las conexiones y desconexiones entre estos fenómenos sociales. Tanto el tráfico como el contrabando forman parte de los procesos de migración, los cuales pueden ocurrir con o sin el consentimiento de las personas. Cuando ocurren sin la anuencia de la persona o mediante medios coercitivos, puede hablarse de tráfico de migrantes; en contraste, cuando el traslado ocurre con el total consentimiento de un individuo para ingresar ilegalmente a un país, se habla de contrabando de personas. Así pues, el propósito principal que se encuentra detrás de ambas actividades es el mismo: el comercio de trabajadoras sexuales, la explotación de personas que son sometidas a realizar labores en condiciones de esclavitud, entre otras actividades, situación que hasta cierto punto es igual para el caso del fenómeno de la migración cuando ocurre con o sin el consentimiento de las personas.

Sobre software libre

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Matellán Olivera, Vicente; González Barahona, Jesús; Heras Quirós, Pedro de las; Robles Martínez, Gregorio

2004-01-01

220 p. "Sobre software libre" reune casi una treintena de ensayos sobre temas de candente actualidad relacionados con el software libre (del cual Linux es su ex- ponente más conocido). Los ensayos que el lector encontrará están divididos en bloques temáticos que van desde la propiedad intelectual o las cuestiones económicas y sociales de este modelo hasta su uso en la educación y las administraciones publicas, pasando por alguno que repasa la historia del software libre en l...

Revista de tesis de la Facultad de Medicina de Bogotá

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Facultad de Medicina Revista

1943-09-01

Full Text Available Tratamiento de las sinusitis crónicas por inyección intrasinusal del sulfatiazol. Tesis de grado, declarada meritoria. 1943. - Por Salvador Molina Quevedo / La cistometria y sus aplicaciones clínicas. Tesis de grado, declarada meritoria. 1943. Por Jesús Molina Quevedo / La glutationhemia en condiciones quirúrgicas. Tesis de grado, declarada meritoria. 1943. Por Gerardo Holguín Vélez. Hernia inguinal / Nuevo concepto sobre su tratamiento quirúrgico. Tesis de grado. 1943. Por Mario Negret López / Revaluación de conceptos sobre el funcionalismo renal en nuestro medio. Tesis de grado. 1943. Por Miguel Malagón S. Consideraciones médico-sociales en relación con las incapacidades permanentes en los problemas de trabajo. Tesis de grado. 1943. Por Justiniano Ramírez Meléndez.

El papel de las variables ambientales en la nueva geografía económica

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Diego Azqueta Oyarzun

2004-01-01

Full Text Available Este trabajo analiza algunas repercusiones que el incremento en la demanda social por una mayor calidad ambiental puede tener sobre los patrones de especialización espacial, con independencia de la escala de análisis. Se observa cómo, junto a las posibilidades que para las regiones menos desarrolladas puede suponer este desplazamiento de la demanda, podrían generarse, al mismo tiempo, soluciones subóptimas desde un punto de vista social. En esta misma línea, se plantea la posibilidad de que una asignación eficiente de recursos (incorporando consideraciones ambientales, pueda resultar incompatible con la liberalización del comercio internacional y, en concreto, con el desmantelamiento del proteccionismo agrícola en los países desarrollados. Se hace referencia, específicamente, al impacto sobre la diversidad biológica.

REPENSANDO AS RELAÇÕES INTRAFAMILIARES SOB UM OLHAR FOUCAULTIANO

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Adriane Maria Netto de Oliveira

2009-01-01

Full Text Available El actual estudio tiene como objetivo reflexionar sobre las relaciones entre la familia, bajo el punto vista de las ideas de Foucault. Al pensar en estas relaciones es importante tener en cuenta las potencialidades y las limitaciones de sus miembros, para proponer las intervenciones que puedan promover la salud familiar. Trae consideraciones sobre el vínculo afectivo conyugal, las relaciones de poder presentes en el contexto familiar y las relaciones entre la familia como posibilidad de “SER”. Se llega a la conclusión que una de las funciones de los profesionales de la salud es alentar a los sujetos a verbalizar sus dificultades, sus emociones, sus necesidades y descubrir sus potencialidades, con el fin de construir relaciones más armoniosas y tener una convivencia familiar más sana.

Tributos sobre a folha ou sobre o faturamento? Efeitos quantitativos para o Brasil

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Tiago V Cavalcanti

2008-09-01

Full Text Available Este artigo estuda os impactos alocativos e de bem-estar de uma reforma tributária que substitui os impostos sobre a folha de salários por outro que incide sobre a receita. Para isso, desenvolve-se um modelo neoclássico de crescimento econômico com impostos sobre a receita e sobre a folha de salários. As simulações com parâmetros da economia brasileira mostram que tal reforma tributária tem um efeito negativo no bem-estar, no estoque de capital de longo prazo e consequentemente no produto per capita de longo prazo. Contudo, o emprego aumenta.This paper studies the impacts of a tax reform which substitutes taxes on labor income by taxes on total revenue. In order to accomplish that, we construct and solve a general equilibrium neoclassical growth model with taxes on labor income and total revenue. The numerical simulations with Brazilian parameters show that such tax reforms would negatively affect welfare, the capital stock, and consequently per capita output. However, employment would increase. Such effects are quantitatively important.

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

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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 

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

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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.

Consideraciones sobre el derecho fundamental a la presunción de inocencia

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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.

Consideraciones sobre «Ferrando Spagnuolo» y otros maestros ibéricos

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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

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

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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.

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

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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.