Hipertensión pulmonar crónica tromboembólica tromboendarterectomía pulmonar / Chronic thromboembolic pulmonary hypertension

A nivel mundial, la tercera causa de muerte por causa cardiovascular es el Tromboembolismo Pulmonar (TEP), después del Infarto agudo de Miocardio y el Accidente cerebrovascular, con una incidencia anual estimada de 40 casos por cada 100.000 habitantes. Se comunica el caso clínico de un paciente de 44 años con diagnóstico de TEP recurrente con Hipertensión pulmonar tromboembólica crónica (CTPH) que fue sometido a tromboendarterectomía pulmonar bilateral (PTE) bajo paro circulatorio con hipotermia profunda. Se informa de los resultados de los medios de diagnóstico y del tratamiento quirúrgico mediante la tromboendarterectomía. Se discute el tema en el contexto de la experiencia internacional y nacional.

Pericarditis Constrictiva, variedad fibroelástica. Nuevas técnicas diagnósticas por imágenes / Constrictive Fibrous Pericarditis. Novel Diagnostic Imaging Techniques

Abstract Constrictive Pericarditis is a disease characterized by fibrous thickening of the pericardium that generates a failure in cardiac function. The case of a 54-year-old man, marathon runner with progressive symptoms of congestive heart failure and significantly reduction of Functional Class II-III (NYHA) lasting seven months is presented. Clinical findings are described and the diagnostic value of several imaging techniques - echocardiography, multi-slice computerized tomography and cardiac magnetic resonance - is emphasized. Constrictive fibrous pericarditis was confirmed at pericardiectomy.

Síndrome de tako-tsubo, caracterización clínica y evolución a un año plazo / Tako-tsubo syndrome: analysis of 37 cases

Background: Tako-tsubo Syndrome (TTS) is characterized by transient regional systolic dysfunction of the left ventricle (LV), mimicking myocardial infarction. It accounts for 0.9-1.2% of all acute coronary syndromes (ACS). Aim: To describe the incidence and characteristics of TTS within our population. Material and Methods: All patients diagnosed with ACS and TTS were selected from a clinical registry of all the coronary angiographies done in our hospital. Clinical features during initial presentation, hospital evolution and one year follow-up were analyzed. Results: The first case diagnosed in our hospital occurred in 2001. Since then, 4,433 coronary angiographies were done to patients with ACS until 2014 and 37 corresponded to TTS (0.83% incidence). The mean age of patients was 64 years, 73% were female, and 62% had hypertension. All patients had an identifiable trigger factor, abnormal EKG and elevated troponin. The coronary angiography did not show lesions in 97%. However, all had the characteristic extensive segmental-motility alteration with a mean ejection fraction of 44%. All patients were treated initially as an ACS. Seven patients had complications, namely acute cardiac failure in six and stroke in one. No patient died. At one year of follow-up, 100% showed normal segmental motility and ejection fraction, no patient had a new episode of TTS and all were alive. Conclusions: TTS is rare and the incidence found in this study is slightly lower than that reported elsewhere. TTS mimics ACS and it should be suspected by its clinical, electrocardiographic and enzymatic particularities. Coronary angiography helps to rule out other diagnosis. All patients normalize motility and ventricular function, which is the definitive differential feature respect to ACS.

Where is Darwin 200 years later?

The theory of evolution is perceived by many people, particularly but not only in the United States, as a controversial theory not yet fully demonstrated. Yet, that living organisms, including humans, have evolved from ancestors who were very different from them is beyond reasonable doubt, confirmed by at least as much evidence as any other widely accepted scientific theory. I argue that Darwin's contribution to science goes much beyond the theory of evolution in itself. The theory of natural selection explains the adaptations of organisms, their 'design'. The 'Copernican Revolution' brought the phenomena of the physical universe into the realm of science: explanations by natural causes that can be tested by observation and experiment. However, the scientific revolution that occurred in the 16th and 17th centuries had left the living world out of scientific explanations, because organisms seemingly show that they are 'designed,' and thus call for an intentional designer. It was Darwin's greatest contribution to science, to demonstrate that the adaptations of organisms, their apparent 'design', can be explained by natural processes governed by natural laws. At that point, science came into maturity, because all natural phenomena in the universe, living as well as nonliving, could be investigated scientifically, and explained as matter in motion governed by natural laws.

Nucleotide variation at the dopa decarboxylase (Ddc) gene in natural populations of Drosophila melanogaster.

We studied nucleotide sequence variation at the gene coding for dopa decarboxylase (Ddc) in seven populations of Drosophila melanogaster. Strength and pattern of linkage disequilibrium are somewhat distinct in the extensively sampled Spanish and Raleigh populations. In the Spanish population, a few sites are in strong positive association, whereas a large number of sites in the Raleigh population are associated nonrandomly but the association is not strong. Linkage disequilibrium analysis shows presence of two groups of haplotypes in the populations, each of which is fairly diverged, suggesting epistasis or inversion polymorphism. There is evidence of two forms of natural selection acting on Ddc. The McDonald-Kreitman test indicates a deficit of fixed amino acid differences between D. melanogaster and D. simulans, which may be due to negative selection. An excess of derived alleles at high frequency, significant according to the H-test, is consistent with the effect of hitchhiking. The hitchhiking may have been caused by directional selection downstream of the locus studied, as suggested by a gradual decrease of the polymorphism-to-divergence ratio. Altogether, the Ddc locus exhibits a complicated pattern of variation apparently due to several evolutionary forces. Such a complex pattern may be a result of an unusually high density of functionally important genes.

Angiografía coronaria: indicación, resultados y complicaciones en 5.000 pacientes consecutivos / Coronary angiography: indications, results and complications in 5.000 consecutive patients

Background: There are guidelines about equipment, premises, personnel, indications and complications rates for coronary angiography, that every center performing this procedure should adhere. Aim: To report the experience with 5.000 coronary angiographies and to assess the compliance of the center with the current guidelines. Material and methods: Prospective registry of 5.000 patients aged 60±11 years (3.475 males) subjected to coronary angiography since 1992, assessing all aspects of the procedure with special emphasis on complications. Results: The indications for 80 percent of procedures was suspected coronary atherosclerosis. The main risk factors were hypertension and smoking. Coronary atherosclerosis was demonstrated in 62 percent, mainly one vessel disease. These were two deaths due to the procedure (0.04 percent), three patients (0.06 percent) had an acute myocardial infarction or a stroke. These figures are lower than referential values. Conclusions: In this center, coronary angiography is a safe procedure, with complications rates that are even lower than referential values.

Molecular population genetics of the beta-esterase gene cluster of Drosophila melanogaster.

We have investigated nucleotide polymorphism at the beta-esterase gene cluster including the Est-6 gene and psiEst-6 putative pseudogene in four samples of Drosophila melanogaster derived from natural populations of southern Africa (Zimbabwe), Europe (Spain), North America (USA: California), and South America (Venezuela). A complex haplotype structure is revealed in both Est-6 and psiEst-6. Total nucleotide diversity is twice in psiEst-6 as in Est-6; diversity is higher in the African sample than in the non-African ones. Strong linkage disequilibrium occurs within the beta-esterase gene cluster in non-African samples, but not in the African one. Intragenic gene conversion events are detected within Est-6 and, to a much greater extent, within psiEst-6; intergenic gene conversion events are rare. Tests of neutrality with recombination are significant for the beta-esterase gene cluster in the non-African samples but not significant in the African one. We suggest that the demographic history (bottleneck and admixture of genetically differentiated populations) is the major factor shaping the pattern of nucleotide polymorphism in the beta-esterase gene cluster. However there are some 'footprints' of directional and balancing selection shaping specific distribution of nucleotide polymorphism within the cluster. Intergenic epistatic selection between Est-6 and psiEst-6 may play an important role in the evolution of the beta-esterase gene cluster preserving the putative pseudogene from degenerative destruction and reflecting possible functional interaction between the functional gene and the putative pseudogene. Est-6 and psiEst-6 may represent an indivisible intergenic complex ('intergene') in which each single component (Est-6 or psiEst-6) cannot separately carry out the full functional role.

Feto papiráceo: presentación de un caso / Papyracedus fetus: report of a case

Se trata de una paciente de 33 años de edad, IVG-III P, quien ingresa con el diagnóstico de embarazo de 37 semanas de edad menstrual en trabajo de parto, embarazo gemelar con feto papiráceo. El examen de anatomía patológica mostró una placenta monocorial biamniótica, con una zona en forma de semiluna, la cual correspondió al feto momificado, unido a través de un cordon umbilical de inserción excéntrica. En el examen microscópico de la placenta donde se encontraba el feto momificado se observó hialinización y calcificación focal más congestión vascular acentuada

Trypanosoma and Leishmania have clonal population structures of epidemiological significance

This paper presents three results concerning the population structure of Trypanosoma cruzi, the agent of Chagas disease: (1) The mode of propagation of T. cruzi in nature is clonal; sexual reproduction is either totally absent or so rare that it leaves no traces in the population structure of the parasite. (2) The genetic diversity of the clonal lineages is large: extant T. cruzi represent lineages of descent that have evolved independently for long time spans (up to 40 million years). (3) Some genetically identical clonal lineages (®clonets®) are geographically widespread (®ubiquitous®). However, most clonets are endemic, restricted in geographic distribution. These results have each in turn consequences of epidemiological significance: (1) In a sexually-reproducing organism the individual genotype is ephemeral; the entity that persists and evolves is the species (®gene pool®), and a few individuals contain most of the genetic variability of the species. In a clonally-propagating organism, the entity that persists and evolves is the clonal lineage; the genetic diversity of the species can only be captured by extensive sampling of distinct lineages. (2) The extensive genetic divergence among clonal lineages implies proportionally diverse biological characteristics, which are likely to include pathological effects, host propensity, vulnerability to drugs and vaccines, and other medically significant attributes. The extant T. cruzi lineages diverged much before human origins; hence, specific adaptation to human hosts, to whichever extent it exists, has evolved independently in separate lineages, and may not have evolved at all in some T. cruzi. (3) Epidemiological surveys and medical characterization, including search for specific vaccines and drugs, should not proceed randomly; rather, preliminary surveys must identify those clonets that are ubiquitous and target them for investigation. Review of published literature shows that Leishmania (and other parasitic protozoa) also has a clonal population structure. We advance a taxonomic and nomenclatural proposal that is appropriate for clonal organisms, yet simple

Hallazgos angiográficos post-trombolisis precoz con estreptokinasa endovenosa / Coronary angiography after early intravenous streptokinase in patients with acute myocardial infarction

Con el objeto de evaluar la magnitud de la lesión residual post-trombolisis se analizan los hallazgos angiográficos de 35 pacientes, 5,5 ñ 2,8 días después de haber recibido 1.500.000 U. de estreptokinasa endovenosa antes de las 6 horas de evolución de un infarto de miocardio. El tiempo entre el inicio del dolor y la administración de la droga fue de 2,9 ñ 1,2 horas. Seis pacientes (17%) permanecían con la arteria "culpable" ocluída, nueve (26%) con una lesión inferior al 70%, nueve (26%) entre 70-90% y once (31%) mayor de 90%. Siete pacientes (24%) mostraban trombos intraluminales y sólo 4 (14%) una placa ulcerada. Diecinueve pacientes (56%) presentaban enfermedad de uno, 11 (32%) de dos y 5 (14%) de tres vasos coronarios. El índice de sinergia global (1.68 ñ 0.67), de los pacientes sin reperfusión, es significativamente menor (p < 0.25) que el de los pacientes con lesión residual inferior al 70% (2.64 ñ 70). Se concluye que el tratamiento precoz con estreptokinasa EV se asocia a una alta incidencia de apertura de la arteria "culpable" y a la preservación de la función contractil cuando no queda una lesión crítica

Infarto agudo de miocardio tipo Q con recuperación funcional del área de necrosis: implicancias fisiopatológicas y terapeúticas / Q Wave acute myocardial infarction with funcional recovery of necrotic area: physiopathologic and therapeutic implications: case report

Se presenta el caso de una paciente que desarrolla un cuadro clínico de Infarto agudo de miocardio con evidencias de necrosis miocárdica según criterio eco, electro y ventriculográficos en la pared anterior del ventrículo izquierdo. La angiografía coronaria muestra una lesión de 95% en el tercio proximal de arteria descendente anterior. A los 90 días de evolución vuelve a tener episodios de angina de pecho encontrándose que han desaparecido los signos de necrosis en eco y electrocardiograma habiéndose normalizado, además el patrón de contracción segmentario del ventrículo izquierdo. Se discuten la relatividad de los criterios diagnósticos para establecer necrosis miocárdica

Estudio del acetato de flecainide en la supresión de arritmias ventriculares / Flecainide acetate in the suppression of ventricular arrythmias

El acetato de Flecainide (F), nuevo agente antiarrítmico del grupo I (Vaughan Williams), ha sido señalado de utilidad para el tratamiento de arritmias ventriculares tanto por vía oral como intravenosa. Los efectos de su administración oral se estudiaron en 21 pacientes, 16 hombres y 5 mujeres (x edades 51.7 años) que presentaban sobre 600 latidos ectópicos ventriculares (LEV) en 24 horas, en sus formas simples o complejas, y no habían respondido previamente a otros fármacos convencionales. Se determinó las variaciones de frecuencia cardíaca, de los intervalos PR, QRS, QTc y del número de LEV después del uso de la droga en comparación a las mediciones basales, sin droga. En el 67% de los pacientes tratados disminuyó el número de LEV en forma significativa, con desaparición de las formas complejas. El promedio de LEV disminuyó significativamente durante el tratamiento (p = 0.0021), independiente del número de LEV presente antes del uso de la droga. No se encontró significancia estadística para variaciones de frecuencia, intervalos PR y QRS, al revés de lo descrito en estudios electrofisiológicos. El incremento QTc fue, para el promedio de la serie, de un 7.1% (p = 0.0183) en relación a la prolongación del QRS. La tolerancia a la droga fue satisfactoria. Se concluye que F constituye una alternativa efectiva para el tratamiento ambulatorio de las arritmias ventriculares resistentes y que no produce efectos secundarios en el plazo comprendido en el protocolo de estudio