Hidatidosis cardiaca: caso clínico / Cardiac hydatidosis: Report of one case

Background: Hydatidosis is an endemic zoonosis in Chile. We report a 48-year-old former slaughterman, with a previous history of pulmonary hydatidosis, who presented a stroke without associated cardiovascular symptoms. An echocardiogram revealed a tumor mass with cystic features in the left ventricle. The patient was operated and the cyst was successfully excised. During the follow up, the patient remains asymptomatic.

Infarto agudo al miocardio secundario al uso de cocaina. Caso clínico y revisión del tema / Acute myocardial infarction secondary to use of cocaine. Case report and subject revision

There is same evidence to suggest that the use of cocaine has increased in our country in recent years. The negative actions of the drug can be observed in different organs; the cardiovascular system is particularly vulnerable. We present the clinical case of a young man who, as a consequence of occasional inhalation of cocaine presents an acute myocardial infarction. The reperfusion of the coronary artery was obtained with a Coronary angioplasty very close to the beginning of the occlusion. We discuss the pathophysiology of this particular form of myocardial infarction and emphasis the different therapeutic options in this arena and in particular, our preferred way of treatment.

Evaluación de la distribución de dosis producida por la radiación en el laboratorio de hemodinamia del Hospital Clínico de la Universidad de Chile / Evaluation of dose distribution produced by radiation in the laboratory of hemodynamics of the Clinical Hospital of the University of Chile

Los objetivos generales fueron determinar las curvas de isodosis dentro del Laboratorio de Hemodinamia, mediante la evaluación del KERMA (Kinetic Energy Release in Matter) en aire y relacionar las zonas analizadas con la distribución que adopta el personal ocupacionalmente expuesto (POE) durante la realización de estos procedimientos. Los objetivos específicos fueron medir la tasa de exposición con cámara de ionización para las distintas proyecciones utilizadas, calcular la tasa de dosis equivalente en mSv/h a la cual está expuesto el POE dentro del laboratorio en los distintos puntos utilizados para efectuar las mediciones e identificar los puntos con los mayores niveles de KERMA en aire dentro del laboratorio. Las mediciones fueron realizadas según proyección y espesor de fantoma con una misma cámara de ionización Radcal de 1800 cc ubicada en puntos definidos de antemano dentro del laboratorio de hemodinámica. Se confeccionaron gráficos y mapas con curvas de distribución de dosis superpuestas al plano arquitectónico del laboratorio de hemodinámica, delimitando en los mapas los niveles de distribución de dosis asociados a determinados sectores. Se identificó un punto de ubicación del POE en el cual la tasa de exposición y su equivalente tasa de dosis presentó los niveles más altos y peligrosos para las proyecciones y espesores de fantoma utilizados en este trabajo y que simularon condiciones laborales cotidianas. Se concluye que las curvas de isodosis obtenidas se modifican según la incidencia del haz de Rayos X o según las proyecciones utilizadas durante los procedimientos angiográficos, esto se desprende de la simple observación de los gráficos y mapas con las curvas de distribución de dosis.

The general objectives were to determine isodose's curves whithin Hemodinamia's Laboratory, by means of the evaluation of the KERMA (Kinetic Energy Release in Matter) in air and to relate the zones examined with the distribution that the staff occupationally exposed (POE) during the realization of these procedures embraces. The specific objetives were to measure the rate of exposition with ionization chamber for the different utilized projections, estimating the rate of exposition with ionization chamber for the different utilized projections, estimating the rate of equivalent dose around mSv/h witch the POE within the Laboratory in the several utilized points to make measurements and to identify the points with KERMA's bigger levels in air within the laboratory is on view to. Measurements were accomplished according to projection and fantoma's thickness with a same ionization chamber Radcal of 1800 cc located in points circumscribed in advance within Hemodinamia's Laboratory. They manufactured graphics and maps with curves of distribution of dose.

Resultados clínicos inmediatos y alejados del implante de stents metálicos no recubiertos: ¿Se justifica un reemplazo total por los stents liberadores de drogas? / Acute and long-term clinical results of bare metal coronary stenting

Background: Since the introduction of stents in 1994, improved clinical results have boosted the development of coronary angioplasty in Chile. Drug eluting stents, that have a reduced rate of restenosis, are being increasingly used. Aim: To assess the acute and long-term results of bare metal stent implantation. Patients and Methods: Acute and long-term clinical, procedural and angiographic results were assessed in non acute myocardial infarction patients undergoing coronary stent implantation between August 1996 and December 2003. Results: During the study period, 932 patients aged 30 to 87 years (194 women) had at íeast one stent implanted. Twenty two percent were diabetic, 33 percent had recent myocardial infarction, 53 percent unstable angina and 22 percent stable angina. Angiographic and clinical success were 99.6 percent and 98.2 percent, respectively. In hospital death was 0.5 percent. During a mean follow-up of 19.1 months, all cause mortality was 3.9 percent, cardiac death 1.9 percent and survival free of major cardiac ischemic events was 85.3 percent. Only 6.4 percent of lesions underwent target vessel revascularization (TVR). Independent predictors of TVR were previous surgery, íeft anterior descending artery, small post stent minimum luminal diameter. Ostial location, in-stent restenosis, and younger age were non significant predictors. Conclusions: Acute and long-term results of bare metal stents in this population were excellent. An intriguingly low rate of TVR was seen. Selective bare metal stenting should continue in lesions and patients with a low risk of clinical restenosis.

Resultados tardíos del tratamiento percutáneo de la reestenosis intrastent con el uso de stents con drogas: un estudio colaborativo / Percutaneous treatment of intra stent restenosis using drug eluting stents: late results in a multicenter study

Introducción. La proliferación neointimal es la causa de la reestenosis coronaria intra stent (RIS). Recientemente, el implante de stents liberadores de drogas (DES) ha emergido como una alternativa efectiva de tratamiento endovascular. Material y método. Seleccionamos pacientes con RIS de stents no recubiertos tratados con DES en forma consecutiva en 3 centros chilenos. Luego del alta los pacientes fueron seguidos por al menos 12 meses. Resultados. De 21 pacientes (19 por ciento mujeres) entre 47 y 91 años tratados por al menos una lesión coronaria con RIS, 33,3 por ciento eran diabéticos y 14,3 por ciento tenían cirugía coronaria previa. Se presentaron de preferencia con síndromes coronarios agudos y la mayoría tenía enfermedad de 1 vaso (71,4 por ciento). Se trató sólo 1 lesión con RIS, implantándose en 15 pacientes DES recubierto con Sirolimus y en 6 con Paclitaxel. El largo promedio de stent implantado fue de27,7 mm (13-51 mm). Se obtuvo éxito en todos los casos y no hubo complicaciones isquémicas intrahospitalarias. Durante el seguimiento, sólo 2 pacientes presentaron reestenosis intrastent y uno de ellos, un anciano, falleció en forma súbita en el seguimiento. El 90 por ciento se mantuvo libre de eventos isquémicos en el seguimiento. Conclusión. El implante de DES aparece como una alternativa efectiva en el tratamiento de la RIS.

Background. Neointimal proliferation causes coronary intrastent restenosis (ISR). Recently, drug eluting stents(DES) have emerged as an effective therapeutic approach to treat ISRMethods. Consecutive patients from 3 centers with in stent restenosis after bare metal stent implantation were treated with DES. Patients were followed for 12 months after discharge.Results. Of 21 patients (19 percent females), 47 to 91 years old, with one or more intrastent restenosis, diabetes was present in 33 percent and previous coronary artery surgery in 14 percent. Most patients presented with acute coronary syndromes and 71 percent had single vessel disease. Only one lesion in each patient was treated with DES implantation, 15 with paclitaxel and 6 with sirolimus stents. Mean stent length was 27.7 mm (13-51). The procedure was successful in all patients and no ischemic complications were observed prior to discharge. During follow up 2 patients developed new intra stent restenosis and one of them died suddenly. 90 percent of patients were free from ischemic events at the end of follow up. Conclusion. DES appears to be an effective therapy to treat intra stent restenosis.

Consideraciones sobre el uso de rayos X en la práctica médica convencional para la necesaria aplicación de normas básicas de seguridad / Considerations about the use of X-rays in the conventional medical practice for necesary aplication of basic security rules

The application maintained and increasing of the explorations with X-rays, consequence of significant development of the engineering together with evolved computacionals methodologies has allowed to reach to the great anatomical majority of locus where it seats the disease. The consequence immediate has been the increase of the exhibition of the patients to ionizing radiations. Different organizations, worried about the health publish, including with it to important societies of Radiology and also to tie international organizations directly related to the governments like the WHO and the OPS. They have emphasized the necessity to generateregulatory conducts destined to introduce the basic rules of the good medical practice. In our country a situation of smaller development in this particular area still persists. Contingencies experienced by general doctors in his professional practice in small town are described. Some situations derived from the use of conventional radiological procedures like mammography and axial computed tomography are presented commenting aspects that do necessary to prevent the doses that receive the patients in order to avoid the expression of stochasticor deterministic effects with high doses of radiation applied with medical intentions. General aspects of radiological procedures related to practices in pediatric patient emphasizing the conditions of increased risk for iatrogenic effects of radiation, particularly in those premature or new borns.

Evaluación de revascularización coronaria: comparación entre perfusión con Tc99m sestamibi-dipiridamol gatillado y ecografía-amrinona como predictores de viabilidad / Assessment of coronary revascularization: comparison between perfussion with Tc99m sestamibi-dipyridamol spect and echography-amrinone as predictors of viability

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

Estudio comparativo de perfusión miocárdica planar con talio 201 y mibi-Tc99m: correlación angiográfica / Comparative study of planar myocardial perfusion with thallium 201 and mibi-Tc99m: angiographic correlations

El presente trabajo tuvo como propósito comparar el estudio de perfusión miocárdica planar efectuado con talio-201 con el de mibi-tecnecio-99m (Tc99m) y correlacionarlos con coronariografía contrastada en pacientes coronarios. Se estudiaron 120 pacientes, en estrés y en reposo, 60 con talio-201 y los otros 60 con mibi-Tc99m. Se obtuvieron imágenes con gammacámara y computador en 3 proyecciones en ambas condiciones, y se efectuó análisis cuantitativo de la información por pacientes, por segmentos miocárdicos y por vaso coronario. Por pacientes, la sensibilidad del test de talio-201 fue de 88 por ciento y la del mibi-Tc99m de 90 por ciento (p= no significativo), considerando el esfuerzo y el dipiridamol en forma global, y la especificidad fue de 40 por ciento para el talio-201 y de 91 por ciento para el mibi-Tc99m (p<0,001). Por segmentos, la sensibilidad del talio-201 fue de 54 por ciento y la del mibi-Tc99m fue de 53 por ciento (p= no significativo) y la especificidad del talio-201 fue de 78 por ciento y la del mibi-Tc99m fue de 87 por ciento (p<0,0002). Por vaso coronario, sólo resultó significativamente más específico el mibi-Tc99m (86 por ciento) que el talio-201 (76 por ciento) para la arteria descendente anterior (p<0,02). Se concluye que el mibi-Tc99m es significativamente más específico que el talio-201

Tromboembolismo pulmonar masivo tratado con infusión selectiva de estreptoquinasa: comunicación de 2 casos / Massive pulmonary thromboembolism treated with selective infusion of streptokinase: report of 2 cases

We report 2 patients who developed massive pulmonary embolism with > 50% occludion of the pulmonary arterial circulation. Hypotension, syncope and right sided failure were the clinical manifestations. Immediately after diagnostic pulmonary arteriography, 20,000 U of streptokonase (SK) were delivered in the pulmonary artery nest to the thrombotic mass. A continous infusion of SK, 10,000 U/h was maintained for 24h in one patient and 72h in the other. Rapid clincial improvement was observed in the following 24h. Control angiography showed lysis of the embolus with residual obstructions of segmentary branches. The clinical value of this form of treatment for pulmonary embolism is discussed