Sin elevación, también puede haber oclusión / Without elevation, there may also be occlusion

Resumen Ante un dolor torácico agudo y evidencia de elevación del segmento ST, se debe instaurar un tratamiento de reperfusión urgente, con el objetivo de abrir la arteria ocluida y minimizar el daño miocárdico y, así, mejorar el pronóstico del paciente. Por ello, es necesario conocer aquellos patrones eléctricos de alto riesgo equivalentes a una elevación del segmento ST e indicativos de una oclusión coronaria aguda, para evitar que se produzca una demora inadmisible en los tiempos de actuación, tal y como ocurrió en el caso que se presenta.

Abstract In light of an acute chest pain and evidence of ST-segment elevation, an emergent reperfusion treatment should be started with the objective of opening the occluded artery and reducing myocardial damage, thus, improving the patients´s prognosis. Therefore, it is mandatory to keep in mind those high-risk electrical patterns equivalent to a ST-segment elevation and indicative of an acute coronary occlusion to avoid an unacceptable delay in the times of action, such was the case that is reported.

Clinical features of patients with acute myocardial infarction presenting de Winter pattern on electrocardiogram / 中华全科医师杂志

Objective:To analysis the clinical features of patients with acute myocardial infarction (AMI) presenting de Winter pattern on electrocardiogram.Methods:A total of 1 287 patients with AMI admitted to Beijing Luhe Hospital between June 2017 and January 2019 were enrolled in the study. Electrocardiogram and clinical features of 13 patients with AMI presenting de Winter pattern on electrocardiogram were analyzed and compared with anterior wall ST-segment elevation myocardial infarction(STEMI, n=206). Results:Among the 13 patients, 12 were males, aged (52.23±12.55) years old. Compared to patients with anterior wall STEMI, the age in the de Winter group was younger [(52.23±12.55)years vs. (59.79±12.46)years; t=-2.12, P=0.03], and the time from onset to appearing a typical ECG was shorter [109.0 (71.5, 152.0)min vs. 200.5 (120.0, 397.5)min; Z=-3.38, P<0.01]. Three cases showed a shifting between de Winter pattern and typical STEMI ECG: the de Winter ECG pattern progressed to STEMI in 2 cases, 1 case changed from STEMI to de Winter,then converted to STEMI again. The emergency angiography was performed in all 13 patients, angiography showed that proximal left anterior descending branch (LAD) was involved in 11 cases, mid LAD was involved in 1 case, and diffuse spasm occurred in all vessels in 1 case. The de Winter ECG pattern vanished in all patients after primary percutaneous coronary intervention or emergency angiography. Conclusions:The de Winter ECG pattern suggests an acute proximal or mid LAD artery occlusion, and the de Winter ECG pattern can be alternated with STEMI. The de Winter pattern should be recognized and revascularization should be given early.

A Case of De Winter Syndrome with Dynamic ST Segment Evolution / 中国医学科学院学报

De Winter syndrome,a special electrocardiogram of acute total occlusion or subtotal occlusion of left anterior descending coronary artery,is not common in clinical practice.It has been generally considered static,whereas the electrocardiogram changes dynamically in this case.We propose that de Winter pattern may indicate a thrombotic disease and can be roughly divided into two types according to whether the electrocardiogram changes dynamically.

Cognition and progress of de Winter electrocardiogram pattern / 中南大学学报(医学版)

The de Winter electrocardiogram pattern is an acute ST-segment elevation myocardial infarction equivalent, however this specific electrocardiogram change is easily ignored by clinicians. The de Winter electrocardiogram pattern in patients with acute chest pain mostly indicates sub-complete or complete occlusion of the left anterior descending or the diagonal branch. Patients with acute chest pain and such electrocardiographic finding should undergo emergency coronary angiography immediately to determine the coronary condition, and reperfusion therapy should be performed as soon as possible to reduce the incidence of adverse cardiovascular events.

Análisis de concordancia de tres clasificaciones de terceros molares mandibulares retenidos / Agreement analysis of three mandibular third molar retention classifications

Resumen Introducción: Las clasificaciones de Pell y Gregory y de Winter son básicas en la categorización de terceros molares; la clasificación de Sánchez Torres es usada en México, pero no había sido evaluada previamente. Objetivo: Evaluar el grado de acuerdo en la valoración radiográfica de terceros molares mandibulares impactados, con el empleo de tres clasificaciones: Pell y Gregory, Winter y Sánchez Torres. Método: Estudio observacional, descriptivo, de concordancia interobservador, que incluyó a 10 cirujanos orales y maxilofaciales y 10 residentes en formación, quienes registraron la categorización radiográfica de terceros molares mandibulares (izquierdos y derechos) de acuerdo con las clasificaciones de Pell y Gregory, Sánchez Torres y Winter. Se evaluó el grado de acuerdo entre observadores mediante la prueba de kappa de Fleiss. Resultados: La clasificación de Pell y Gregory obtuvo el menor grado de acuerdo (kappa = 0.05 y 0.185), seguida de la clasificación de Sánchez Torres (kappa = 0.125 y 0.326); el mejor valor lo obtuvo la clasificación de Winter, con kappa = 0.28 y 0.636 para cirujanos orales y maxilofaciales y residentes en formación, respectivamente. Conclusión: La clasificación de Winter mostró un grado de acuerdo aceptable (moderado) para categorizar terceros molares mandibulares en los residentes en formación.

Abstract Introduction: Pell & Gregory and Winter classifications are basic in third molar categorization; Sánchez-Torres classification is used in Mexico, but it has not been previously evaluated. Objective: To assess the degree of agreement in the radiographic evaluation of impacted mandibular third molar with the use of three classifications: Pell & Gregory, Winter and Sánchez-Torres. Method: Observational, descriptive, inter-observer degree of agreement study that included 10 oral and maxillofacial surgeons and 10 training residents, who recorded the radiographic categorization of third mandibular molars (left and right) according to Pell and Gregory, Sánchez-Torres and Winter classifications. Inter-observer degree of agreement was assessed with Fleiss' kappa test. Results: Pell and Gregory classification obtained the lowest degree of agreement (kappa = 0.05 and 0.185), followed by Sánchez-Torres classification (kappa = 0.125 and 0.326); Winter had the best agreement, with kappa = 0.28 and 0.636 for oral and maxillofacial surgeons and training residents, respectively. Conclusion: The Winter classification showed an acceptable (moderate) degree of agreement to classify mandibular third molars by training residents.

de Winter syndrome, an easily ignored but life-threatening disease: a case report / 南方医科大学学报

de Winter syndrome is a special equivalent of anterior ST-segment elevation myocardial infarction (STEMI) characterized by the absence of overt ST-elevation with upsloping ST-segment depression followed by tall symmetrical T-waves in the precordial leads, often associated with total occlusion of the proximal left anterior descending coronary artery. Herein we present a case of de Winter syndrome in a 63-year-old man, whose initial ECG showed no ST-segment elevation, but subsequent coronary angiography confirmed total occlusion of the proximal LAD coronary artery. The patient was successfully treated via mechanical reperfusion therapy and stenting through percutaneous coronary intervention (PCI). de Winter syndrome is associated with a high mortality often due to insufficient awareness of this condition by clinicians. Immediate reperfusion therapy by PCI is the life-saving treatment for the patients diagnosed with this syndrome, and prompt recognition of the ECG pattern is critical to ensure the timely administration of the therapy.

Clinical characteristics of patients with the de Winter electrocardiogram pattern / 中南大学学报(医学版)

OBJECTIVES@#To explore the electrocardiogram manifestations and clinical characteristics of patients with the de Winter electrocardiogram pattern.@*METHODS@#This retrospective study was performed on acute coronary syndrome (ACS), patients with culprit lesion in left anterior descending branch (LAD), who admitted to Yongchuan Hospital of Chongqing Medical University from August 2017 to October 2018. Patients were categorized into those with or without the de Winter electrocardiogram pattern. The characteristics of de Winter electrocardiogram were analyzed by the clinical data of the patients.@*RESULTS@#Among 230 patients with left anterior descending branch lesion, 14 (6%) had the de Winter electrocardiogram pattern. Compared with the control group, patients with de Winter electrocardiogram pattern were younger [(53.86±10.26) years old vs (67.20± 11.60) years old @*CONCLUSIONS@#The de Winter electrocardiogram pattern syndrome in patients with acute chest pain mostly indicates that the left anterior descending or the diagonal branch is subtotal or completely occluded, which is a special ST-segment elevation myocardial infarction equivalent and should attract the clinicians' extensive attention.

Evolución electrocardiográfica infrecuente de la oclusión total de la arteria descendente anterior: Patrón de «de Winter¼ a propósito de un caso / Infrequent electrocardiographic pattern of complete left anterior descending artery occlusion: The "de Winter" pattern apropos of a case

RESUMEN El diagnóstico acertado a través del electrocardiograma es invaluable a la hora de establecer la conducta ante un síndrome coronario agudo. Se hace una breve revisión de la literatura, a propósito de un caso con patrón de «de Winter¼, el cual constituye un patrón electrocardiográfico infrecuente de oclusión total de la arteria descendente anterior y que provoca, al desconocerlo, una demora en la realización del procedimiento necesario en cada caso. Se presenta su evolución electrocardiográfica y el seguimiento posterior, con el objeto de no obviar la importante herramienta que continua siendo el electrocardiograma en la cardiología moderna.

ABSTRACT Accurate diagnosis through the electrocardiogram (ECG) is crucial when it comes to establishing certain behavior in the presence of an acute coronary syndrome. A brief review of the literature was carried out apropos of a case of de Winter ECG pattern which is an infrequent electrocardiographic pattern of complete left anterior descending artery occlusion that, if overlooked, causes the procedures required in each case to be unnecessarily delayed. Its electrocardiographic course and subsequent follow-up are presented so as not to forget that the electrocardiogram continues to be an invaluable and powerful tool in modern cardiology.

Patrón de «de Winter¼ en paciente con síndrome coronario agudo sin elevación del segmento ST / "De Winter" pattern in patients with non-ST-segment elevation acute coronary syndrome

RESUMEN El patrón de «de Winter¼ fue descrito por Robbert J. de Winter en 2008. Es un signo electrocardiográfico caracterizado por infradesnivel del segmento ST de 1-3 mm, en derivaciones precordiales (V1-V4), con una onda T alta y simétrica en las mismas derivaciones, asociado con supradesnivel del segmento ST en aVR, lo que se corresponde con una lesión grave de la arteria descendente anterior de localización proximal. Se presenta el caso clínico de un hombre de 22 años de edad que acudió a urgencias con las alteraciones electrocardiográficas descritas, y en la coronariografia se corroboró la presencia de una lesión grave, oclusiva (100%), de localización ostial, en la arteria descendente anterior, sobre la que se realizó angioplastia coronaria transluminal percutánea satisfactoriamente.

ABSTRACT "De Winter" pattern was first described by Robbert J. de Winter in 2008. It is an electrocardiographic sign characterized by ST-segment depression of 1-3 mm, in precordial leads (V1-V4), with a high and symmetrical T wave in the same leads, associated with ST-segment elevation in aVR, which represents a severe lesion of the proximal left anterior descending artery. The case report presented corresponds to 22-year-old man who came to the emergency department with the mentioned electrocardiographic changes; in the coronary angiography is confirmed the presence of a severe, occlusive lesion (100%), of ostial location, in the left anterior descending artery, on which a percutaneous transluminal coronary angioplasty was successfully performed.

Dental caries on distal surface of mandibular second molar / A cárie dentária na superfície distal do segundo molar inferior

O objetivo do estudo foi avaliar a frequência de cárie distal no segundo molar inferior influenciada pela angulação do terceiro molar inferior adjacente em radiografias panorâmicas em uma clínica de radiologia odontológica. Material e Métodos: Foi realizado um estudo descritivo e quantitativo que analisou 750 radiografias panorâmicas, deste total, 120 estavam de acordo com o critério de inclusão da pesquisa. Resultados: De 157 segundos e terceiros molares analisados, a prevalência de cárie na distal do segundo molar foi de 25,5%. A posição mais prevalente da angulação do terceiro molar foi a vertical com 57,3%, porém, a posição com maior porcentagem do segundo molar cariado na distal foi a mesioangular com 50% dos casos. Dos elementos coletados, o gênero masculino obteve 40% de segundo molar cariado na distal contra 17% para o gênero feminino. A faixa etária de 35 anos ou mais obteve a maior incidência com 50% de cárie distal, enquanto as demais faixas obtiveram 16,21% no grupo de 18 a 24 anos e de 23,52% no de 25 a 34 anos. Conclusão: Os resultados possibilitaram estabelecer uma escala decrescente da indicação para remoção profilática do terceiro molar inferior de acordo com a angulação de Winter: horizontal, mesioangular, vertical e distoangular. Percebe-se também uma maior relevância para a indicação de remoção profilática de indivíduos do gênero masculino e com idade acima de 35 anos...

The aim of this study was to evaluate the frequency of carious lesions on the distal surface of mandibular second molars influenced by the angulation of the adjacent mandibular third molar. Material and Methods: This is a descriptive and quantitative study that analyzed 750 panoramic radiographs from a clinic providing dental radiology services. Of these, 120 radiographs met inclusion criteria of the study. Results: Of the 157 second and third molars analyzed, the presence of caries lesions on the distal of the second molar was 25.5%. The most prevalent position of the third molar angulation was vertical with 57.3%; however, the position with the highest percentage of the second molar caries on the distal area of the crown was the mesio-angular with 50% of cases. Of the collected teeth, males presented 40% of second molar caries on distal surface, while females showed 17%. The age group of ≥35 years exhibited the highest incidence with 50% of carious lesions on the distal surface, while other groups obtained 16.21% in the group 18-24 years and of 23.52% in the group 25 to 34 years. Conclusion: It was possible to establish a decreasing scale of indication for prophylactic removal of mandibular third molar according to the Winter’s lines: horizontal, mesio-angular, vertical, and distoangular. It was also noticed a greater relevance for the prophylactic removal indication of males aged over 35 years...

Erupción y retención del tercer molar en jóvenes entre 17 y 20 años: Antofagasta, Chile / Eruption and retention of third molars in young people between 17 and 20 years of age: Antofagasta, Chile

La retención intraósea y la erupción en malposición de 3Ms han sido muy estudiadas. Son causadas, probablemente, por disminución del tamaño de maxilares por cambios de hábitos alimentarios, reduciendo el espacio retromolar, lo que dificulta la erupción normal entre 15 y 25 años de edad, y produce patologías o molestias por comprometer estructuras orofaciales próximas. Lo anterior, ha promovido la exodoncia profiláctica u ortodóncica, incluso del germen dentario, con altos costos clínicos, hospitalarios, laborales, comprometiendo parte de los recursos destinados a financiar otros procedimientos quirúrgicos orales, además de riesgos durante cirugía, postoperatorio y lesiones iatrogénicas temporales o permanentes. La muestra consistió en 100 jóvenes de 17 a 20 años de edad (50 mujeres y 50 hombres) de la ciudad de Antofagasta, sanos, sin malformaciones general y maxilofacial, sin haber presentado enfermedades infecciosas que alteraran odontogénesis y períodos eruptivos, sin exodoncias de 3M ni tratamientos ortodóncicos previos al examen de la radiografía panorámica y clasificando erupción de 3Ms según tablas de Pell-Gregory y Winter. Se determina 49,1 por ciento de 3Ms retenidos con p<0,05 significativo respecto dientes erupcionados, predominando retención maxilar, especialmente en mujeres. En todos los casos y en mandíbula predominan 3Ms con impactación mesioangulada (p<0,05 significativa) y en maxilares la retención vertical (p<0,05 de significancia). Prevalecen 3Ms distoangulados en maxilares, posición que predispone a complicaciones operatorias y postoperatorias en exodoncias. La retención horizontal se aprecia en mandibula, siendo el segundo tipo de retención (21,5 por ciento en toda la muestra y 30 por ciento en hombres). Sin una decisión clínica que indique la cirugía, se sugiere postegar la exodoncia profiláctica de 3Ms, esperando posible erupción tardía (Hattab, 1997; Ventã et al. 1999, 2004 y Kruger et al.). Meta-análisis demuestra: mínima morbilidad...

Intraoseous retention and anomalous eruption position of 3Ms had been widely studied. They are probably produced by reducing the size of jaws by changes in eating habits, reducing the retro molar space, making it difficult normal eruption between 15 and 25 years old, producing pathologies or discomfort by compromising nearly orofacial structures. The above, has promoted the extraction or prophylactic orthodontic, even from the dental germ, with expensives clinical cost, hospital surgery, compromising part of the resources to finance other surgical oral procedures, in addition to risks during surgery, postoperative and iatrogenic injuries temporary or permanent. The sample consisted in 100 young people aged 17 to 20 years of age (50 women and 50 men) of the city of Antofagasta, healthy, without general and maxillofacial malformation, without having submitted infectious diseases that distort odontogenesis and periods of eruption, without extractions of 3M nor orthodontic treatments prior to the examination of the x-ray overview and classifying eruption of 3Ms as tables of Pell-Gregory and Winter. It was determined that 49.1 percent of 3Ms were retained, with p<0.05 significant with regard to erupted teeth, predominate maxillary retention, especially in women. In all cases and in maxilla predominate 3Ms with mesiangular position (p<0.05 of significance) and in maxillary vertical retention (p<0.05 of significance). Prevailing 3Ms maxilla with distoangular position, a position that predisposes surgical complications and postoperative extractions. The horizontal retention is apparent only in mandible, being the second type of retention (21.5 percent in all cases and 30 percent in men). Without a clinic decision to indicate surgery, we suggest to postpone the prophylactic extraction of 3Ms, awaiting possible late eruption (Hattab, 1997; Ventã et al., 1999, 2004; Kruger et al., 2001). Meta-analyzes show minimum morbidity in 3Ms extractions in...