Cirugía coronaria: veinte años de seguimiento / Results of coronary surgery: a 20 years experience

Background: Since the first surgical coronary revascularization done in Chile in 1971, 5000 such procedures bave been performed. Aim: To assess the long term results of coronary revascularization surgery in our institution and to identify prognostic factors. Patients and methods: Five groups of 100 patients each, composed by the first consecutive patients subjected exclusively to coronary bypass surgery in the years 1975, 1980, 1985, 1990 and 1995 were retrospectively studied. Results: Mean age of Patients increased from a median of 52 years old in 1975 to 62 yean old in 1995. No changes in the frequency of diabetes, hypertension, high serum cholesterol or prvious mycardial infarction were observed. There was an increase in the Proportion of patients with a recent (< 30 days) infarction that were operated along time. Seventy percent of patients had triple vessel disease or LMT and this proportion did not change. The number of grafts per patients increased form 1.9 to 3.4 and the use of arterial conduits from 0.18 to 0.81. Perioperative mortality remained constant and was 1.6 percent. Follow up information was obtained for 93 percent of 492 survivors. Actuarial survival at 5, 10, 15 and 20 years was 93ñ1, 82ñ2, 62ñ3 and 41ñ4 percent respectively. Ninety eight ñO.7, 89ñ2, 73ñ4 and 65ñ5 percent of patients remained free of a new myocardial infarction in the same lapses, respectively. Ninety seven ñl, 94ñ2, 76ñ4 and 47ñ7 percent of patients remained free of a new operation. Stepwise logistical regression analysis identified as bad Prognostic factors, in decreasing order: cardiac failure, diabetes, smoking, hypercholesterolemia and age at the moment of operation. Conclusions: Coronary artery bypass surgery provides good and long lasting clinical improvement. The prognosis of patients is influenced by the presence of cardiac failure, some well known coronary risk factors and age at the moment of operation

Entrenamiento físico: terapia alternativa para pacientes con enfermedad oclusiva arterial periférica de extremidades inferiores / Physical training: alternative therapy for patients with peripheral arterial oclussive disease of legs

La enfermedad oclusiva arterial periférica es causa frecuente de discapacidad en la población adulta mayor. El tratamiento conservador consiste en la eliminación de los factores de riesgo y medición activa. Una terapia alternativa la constituye el entrenamiento físico, el cual desde hace mucho tiempo ha sido descrito en la literatura como un método para el tratamiento de estas afecciones. Todos los estudios han manifestado un aumento en la capacidad de ejercicio ejecutable, una disminución del dolor experimentado y un mejoramiento del paciente en lo personal, social y cultural. Este trabajo pretende definir la eficacia de dichos sistemas de entrenamientos en los pacientes claudicantes y proponer un protocolo de entrenamiento físico

Perfusión cerebral retrógrada durante paro circulatorio con hipotermia profunda: nueva técnica para la protección encefálica en cirugía de aorta ascendente y arco aórtico / Retrograde cerebral perfusion during circulatory arrest with deep hypothermia: new technique for encephal protection in aortic arch and ascendent aorta surgery

Between may 1993 and august 1994, 15 patients (10 men) with type A aortic dissection (9 acute) had a replacement of the ascending aorta and/or aortic arch with circulatory arrest with profound hypothermia and retrograde cerebral perfusion. Mean circulatory arrest time was 47.5 min (range 23 to 68 min). Three patients (20 percent) died in relation to postoperative bleeding. No patient had a new neurologic damage related to surgery. Ten patients were awake and oriented before 24 hours of the operation and another one before 48 hours; 4 patients required more than 48 hours to be completely awake and oriented. Two patients were operated on with a recent stroke. One of them recovered without sequelae before hospital discharge and the other one had a major regression of his brain damage. Two other patients had emergency surgery because of cardiac tamponade and cardiogenic shock. Both of them had a satisfactory recovery. Six patients presented azotemia but only 2 of them needed dyalisis. There was no case of Q wave infarction nor congestive heart failure in the perioperative period. Follow-up was 100 percent completed (12 patients) with a mean of 9.8 months (range 5 to 18 months). One patient died on the 10th postoperative month because of a late infectious process. Eight patients are in functional class I and 3 in II. Ten of them are back to their usual activities. Although retrograde cerebral perfusion is a new surgical technique, it seems to be a very valuable complement for brain protection in ascending aorta and/or aortic arch surgery with circulatory arrest with profound hypothermia

Bezoares: análisis de 7 casos / Bezoars: analysis of 7 cases

Se revisan 7 casos de bezoares, que se presentaron en un período de 12 años en nuestro Servicio, 5 de sexo femenino y 2 de sexo masculino. De estos, 5 correspondían a fitobezoares y 2 tricobezoares. La edad promedio de los pacientes fue de 46 años y 3 de ellos tenían antecedentes de intervenciones quirúrgicas previas sobre el tubo digestivo. Cinco pacientes presentaron un cuadro de tipo obstructivo y dos fueron intervenidos en forma electiva. El método principal de diagnóstico fue la endoscopía digestiva. la complicación fue infecciosa en dos pacientes