Reporte de dos casos de miocardiopatía periparto en la Unidad de Terapia Intensiva Obstétrica / Report of two cases of peripartum cardiomyopathy in the Intensive Care Unit Obstetric

La miocardiopatía periparto es una enfermedad poco frecuente de causa desconocida, que se caracteriza por la aparición de insuficiencia cardíaca aguda en embarazadas que cursan el último mes de gestación y en el puerperio. En las poblaciones estudiadas, la frecuencia más alta se observa en Haití, donde se estima 1 caso cada 299 nacidos vivos; Sudáfrica 1 caso cada 1000 nacidos vivos. Las frecuencias más bajas corresponden a los Estados Unidos (1 caso cada 4000 nacidos vivos) y Europa. La tasa de mortalidad hospitalaria estimada es del 1,36% y la tasa global de mortalidad, del 2,05%. Se desconoce su verdadera prevalencia e incidencia en la Argentina, probablemente como consecuencia de subregistros. En nuestra Unidad de Terapia Intensiva Obsté- trica, ingresaron dos casos de miocardiopatía periparto, en un período de dos años, que fueron abordados por el equipo multidisciplinario compuesto por intensivistas, cardiólogos, nefrólogos y obstetras.(AU)

Peripartum cardiomyopathy is an unusual condition of unknown origin that is characterized by an acute heart failure during the last months of pregnancy and the puerperium. Most case studies show that Haiti has the highest rate of peripartum cardiomyopathy, 1 in 299 live births, followed by South Africa with 1 in 1,000 and the lowest rate is observed in United States (1 in 4,000 live births) and Europe. Hospital case mortality rate is 1.36% with a global mortality rate of 2.05%. Its prevalence and incidence in Argentina are unknown, perhaps as a result of underreporting cases. Two cases of peripartum cardiomyopathy were treated in our Obstetric Intensive Care Unit within a period of two years by a multidisciplinary team of intensivists, cardiologists, nephrologists and obstetricians.(AU)

Results and impact of eus guided biopsy: results of 10 years experience on more than 1500 patients

Endosonography is an established method for staging gastrointestinal malignancies. As an extension of imaging, several case series have described employing endosonography in conjunction with needle aspiration biopsy to sample lesions within and adjacent to the gastrointestinal tract. This added ability to perform endosonography guided fine needle aspiration biopsy may overcome some of the specificity problems associated with EUS in distinguishing benign from malignant lesions (e.g. lymph nodes, pancreatic masses, and gastric ulcers). To date, a large prospective evaluation has not been reported describing the accuracy of EUS-FNA or the safety of the technique. From November, 1991 till September, 2002: 1544 patients (904 males, 640 female) of average age (67,2 years extreme 17-88 years) had one or several EUS-FNA. Biopsies are performed at the end of ultrasound endoscopy examinations, the patient lying down on their left side. Neuroleptanaesthaesia is generally necessary. The biopsy technique is quite simple, and takes place in the following sequence: a) the lesion is positioned on the needle's exit path, b) the stylet is withdrawn, then the needle is inserted into the tumour. The operator can visualise the tip of the needle by ultraound enabling its correct position in the lesion to be verified, c) aspiration is performed with the aid of a 20 ml syringe as the needle makes to-and-fro movements within the tumour. One to three passages are usually necessary in order to obtain a micro-biopsy. As regards the 1544 patients having had an EUS-FNA, the result of the biopsy was confirmed either by surgical investigation or coelioscopy, or by the evolution and the follow-up of the patients. A complication occurred in 15 patien's (0,97 percent) it was about 9 feverish episodes, about 5 acute pancreatitis and of 1 bleeding. As regards result, for the diagnosis of malignancy, sensibility, specificity, predictive positive value, predictive negative value and the accuracy of EUS-FNA were respectively 84,6 percent-98,4 percent-99,6 percent-54,7 percent and 86,9 percent fot the 1544 patients. For the solid tumors of the pancreas, concerning the diagnosis of malignancy, sensibility, specificity, accuracy of EUS-FNA were respectively 89,8 percent and 90,1 percent