Dolor torácico no cardigénico / Non-cardiac chest pain

El dolor torácico no cardiogénico se define como episodios recurrentes de dolor subesternal en pacientes que no poseen una causa cardiológica luego de un estudio acabado. Representa un dilema clínico dado que el dolor frecuentemente es indistinguible de un dolor de origen coronario llevando a extensas y costosas evaluaciones. Diversos mecanismos han sido implicados en su origen, entre ellos el reflujo gastroesofágico, alteraciones de la motilidad, hipersensibilidad visceral y comorbilidad psicológica. Junto a ello, diversos test diagnósticos están disponibles en la práctica clínica para identificar el origen del dolor, incluyendo la pH metría de 24 horas, estudios de motilidad esofágica, endoscopía digestiva alta, test de probación y tratamientos de prueba. Su tratamiento idealmente debiera estar enfocado a corregir el mecanismo subyacente y aliviar los síntomas. Inhibidores de la bomba de protones, antidepresivos, relajantes de la musculatura lisa y terapia cognitiva conductual aparecen como medidas terapéuticas de utilidad.

Noncardiac chest pain is defined by recurrent episodes of subesternal chest pain in patients lacking a cardiac cause after a comprehensive evaluation. It is a diagnostic dilemma, chest pain is often indistinguishable from cardiac cause leading to extensive and expensive evaluations. Pathophysiologically, gastroesophageal reflux disease, esophageal dismotility, esophageal hypersensitivity, and psychological comorbidities have been implicated. A variety of diagnostic tests are available in the clinical practice to identify the origin of pain, including ambulatory pH testing, esophageal motility, upper endoscopy, provocative testing and even therapeutic trails. Ideally treatment should be aimed at correcting the underlying mechanism and relieving symptoms. Proton pumps inhibitors, antidepressants, smooth muscle relaxants and cognitive behavorial therapy appear to be useful for the treatment of these patients.

Surfactant Protein A Expression in Chronic Rhinosinusitis and Atrophic Rhinitis

Introduction Surfactant protein A (SP-A) exhibits antimicrobial properties and interacts with a variety of respiratory tract pathogens. Objective The objective of this study was to detect the presence of SP-A and measure its alterations in chronic rhinosinusitis (CRS) and primary atrophic rhinitis (PAR) versus healthy controls. Methods Inferior turbinate and sinus mucosal biopsies were taken from 30 patients with CRS, 30 patients with PAR, and 20 healthy controls. Immunohistochemical staining for SP-A and polymerase chain reaction (PCR) amplification of SP-A messenger RNA were performed on nasal tissue samples. Results Immunostaining localized SP-A to the mucosa and submucosal glands in CRS specimens but failed to localize it in PAR specimens. Quantitative PCR showed a high, statistically significant increase in the SP-A levels of patients with CRS when compared with controls (p < 0.0001) and also demonstrated a significant reduction of SP-A in patients with PAR compared with controls (p < 0.005). Conclusion SP-A is significantly increased in CRS and decreased significantly in PAR and appears to be expressed by respiratory epithelial cells and submucosal glandular elements of the sinonasal mucosa. The potential therapeutic applications of surfactant in the enhancement of mucociliary clearance need to be studied. .

Tratamento endovascular da Sindrome de Quebra-nozes (Nutcracker) / Endovascular treatment of Nutcracker syndrome

A Síndrome do Quebra-nozes se refere a um conjunto de sinais secundários à compressão da veia renal esquerda, mais comumente entre a artéria mesentérica superior e a aorta, levando ao comprometimento do fluxo para a veia cava. O diagnóstico desta síndrome frequentemente é difícil e, por esta razão, o diagnóstico é demorado, em muitos casos. É relatado, nesta publicação, o caso de uma mulher de 51 anos, tratada com sucesso pela embolização da veia ovariana associada ao implante de stent autoexpansível na veia renal esquerda. São discutidos os aspectos técnicos e as dificuldades do procedimento.

Nutcracker syndrome refers to signs and symptoms secondary to compression of the left renal vein, most commonly between the superior mesenteric artery and the aorta, leading to impaired outflow to the vena cava. Diagnosis of this syndrome is often difficult and as result is late in most cases. We report on the case of a 51-year-old woman successfully treated with embolization of the ovarian vein and insertion of a self expandable stent in the left renal vein. Technical details and pitfalls are discussed.

Alternativas a la cirugía: sonda nasoyeyunal y sonda nasogástrica / Alternatives to surgery: probe nasoyeyunal and nasogastric tube

The central nervous system damage is associated with a major dysfunction of gastrointestinal tract, whose magnitude is variable. The rehabilitation of disabled children should be confronted by a multi-professional team and beginning the most early as possible, with the aim of impacting so positive on morbidity and mortality associated with their condition. Enteral nutrition is a valuable tool when the indication is right, the first approach is to establish the form of food safer and less expensive according to the clinical circumstances of each case. When the nutritional rehabilitation can be achieved in the short term, the nutrition through probes both gastric as post-pyloric, are alternative for quick and easy access, often in stages prior to establish definitive food routes.

El daño del sistema nervioso central se asocia a una disfunción importante del tracto gastrointestinal, cuya magnitudes variable. La rehabilitación del niño discapacitado debe ser enfrentada por un equipo multiprofesional e iniciada lo más precozmente posible, con el objetivo de impactar de manera positiva en la morbimortalidad asociada a su condición. La nutrición enteral es una herramienta valiosa cuando la indicación es la adecuada, la primera aproximación es establecer la forma de alimentación más segura y menos costosa de acuerdo a las condiciones clínicas de cada caso. Cuando la rehabilitación nutricional se puede alcanzar en un corto plazo, la nutrición a través de sondas tanto gástricas como post pilóricas, son alternativas de fácil y rápido acceso, en muchas ocasiones en etapas previas a establecer rutas de alimentación definitivas.