ABSTRACT
Se discuten los mecanismos moleculares que llevan a la formación de las lesiones más características de la Endocarditis Infecciosa, en especial, la formación de vegetaciones y los diferentes mediadores involucrados provenientes de los gérmenes causales.
Subject(s)
Humans , Endocarditis, Bacterial/microbiology , Enterococcus/pathogenicity , Staphylococcus/pathogenicity , Streptococcus/pathogenicity , Bacterial Adhesion , Complement Membrane Attack Complex , Drug Resistance, Microbial , Endocarditis, Bacterial/immunology , Endothelium/injuries , Heart Injuries/complications , Heart Valves/microbiologyABSTRACT
La Endocarditis Infecciosa sobre prótesis valvulares (EIPV) es una enfermedad con elevada morbimortalidad, en especial durante la fase activa y con un riesgo importante de graves complicaciones durante su evolución que obligan con frecuencia a una nueva cirugía para hacer un recambio valvular, erradicar los tejidos infectados y reconstruir la anatomía. Se discuten aspectos de su etiopatogenia, infección por gérmenes y esquemas de terapia antibiótica, aspectos clínicos, métodos diagnósticos y terapéuticos, en especial el manejo quirúrgico.
Subject(s)
Humans , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/therapy , Prosthesis-Related Infections , Heart Valve Prosthesis/microbiology , Anti-Bacterial Agents/therapeutic use , Gram-Negative Bacteria/pathogenicity , Gram-Positive Bacteria/pathogenicity , Early Diagnosis , Echocardiography/methods , Endocarditis, Bacterial/surgery , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial , FungiABSTRACT
Se revisan los fundamentos de la experiencia mundial de más de dos décadas sobre el aporte de la ecocardiografía de estrés al diagnóstico y manejo de la cardiopatía coronaria. Se señalan los aportes a la calidad de imagen que hace el contraste ultrasónico. Un importante desarrollo en la aplicación clínica de estas técnicas permitirá un mejor manejo técnico y costo-efectivo de los pacientes coronarios.
Subject(s)
Humans , Contrast Media , Coronary Disease , Echocardiography, Stress , Atropine , Diagnostic Imaging/trends , Dobutamine , Exercise TestABSTRACT
We studied left ventricular perfusion and motility in 37 patients with coronary artery disease and disturbances of parietal motility, aged 57 ñ 9 years old, before and after revascularization. Perfusion was assessed with dipyridamole-Tc99m SPECT and motility was assessed with 2 dimentional echocardiography with amrinone. Myocardial segments were defined as normal, viable or necrotic in both studies. Eighteen subjects were subjected to angioplasty and 19 to coronary bypass surgery. Submitted SPECT and echography were repeated 64 ñ 15 and 69 ñ 23 days after revascularization respectively. The concordance between SPECT and echocardiographic prerevascularization diagnosis was 60.1 percent. Eighty one percent of segment considered viable with SPECT and 71 percent thus considered with echocardiography improved after revascularization. Likewise, 50 percent of segments considered necrotic with SPECT and 68 percent of segment thus considered with echocardiography did not improve. It is concluded that althought there is a good concordance between both methods, they have limitations on the study of myocardial viability and should be considered as second choice