Anesthetic management of pulmonary artery banding in adult patient with single ventricle and uncorrected transposition of the great arteries.

Pulmonary artery banding (PAB) is a procedure mainly performed during the neonatal period as an initial stage to definitive palliative reconstruction, a scenario in which the criteria for banding adjustment are well defined. However, the indication for BAP in the adult is extraordinarily rare, even more in patients with single ventricle and unrepaired transposition of the great arteries (TGA), and there are no established criteria for banding adjustment. Due to the small number of these procedures, there is limited experience in their anesthetic management and complications. We describe a case of a 29-year-old patient diagnosed with a cyanotic congenital heart disease of double-inlet left ventricle with TGA and unrepaired mitral stenosis, who underwent to a hybrid procedure of PAB and enlargement of the communication between the two atria.

Small-vessel vasculitis with prominent IgG4 positive plasma cell infiltrates as potential part of the spectrum of IgG4-related disease: a case report.

IgG4-related disease (IgG4-RD) is a systemic entity characterised by multiorgan inflammatory lesions with abundant IgG4+ plasma cells, obliterative phlebitis, and storiform fibrosis. Involvement of several organs such as the pancreas, gastrointestinal tract, salivary glands, periorbital tissue and lymph nodes has been described. Up to now, vascular involvement by IgG4-RD has been thought to be essentially confined to large vessels. We present a patient with small-vessel systemic vasculitis involving muscle, peripheral nerve and kidney (glomerulonephritis) in the context of IgG4-RD diagnosed on the basis of elevated serum IgG4+ concentrations and histologically consistent signs in all biopsied tissues. Thoracic and abdominal aortic aneurysms in addition to aortitis, suggestive of large-vessel involvement, were also present. This observation expands the spectrum of vascular involvement in the context of IgG4-RD and supports the inclusion of IgG4-RD in the category of vasculitis associated with systemic disorder.

Seven clinical conundrums in the treatment of ANCA-associated vasculitis.

Granulomatosis with polyangiitis and microscopic polyangiitis are two autoimmune diseases characterised by necrotising small-vessel vasculitis and presence of antineutrophil cytoplasm autoantibodies (ANCA). Current immunosuppressive regimes that combine cyclophosphamide and glucocorticoids have dramatically improved the outcome for these patients. However, these treatments are associated with toxic effects and do not lead to permanent remission in the majority of cases. Newer approaches have been sought during the last 15 years, with improvement in medication protocols and inclusion of novel therapies. This review develops on seven clinical conundrums of evidence-based therapeutic strategies for ANCA-vasculitis, posed as questions on aspects such as the role of established drugs in both remission induction and maintenance: glucocorticoids (and its duration), oral cyclophosphamide, methotrexate, TNF-α blockers, plasma exchange, mycophenolate mofetil, plus one related to newer developments in treatment with agents blocking the complement system and the possible role of sequential or combined therapies, mainly directed against B cells.

Hernia pulmonar intercostal espontánea secundaria a cuadro de tos / Spontaneous intercostal lung hernia secondary to coughing spell

Las hernias pulmonares son entidades infrecuentes y se relacionan sobre todo con traumatismos torácicos o cirugías previas. Las hernias pulmonares espontáneas son todavía más infrecuentes. Se describen dos casos de hernia pulmonar intercostal espontánea, su evaluación y tratamiento en todas sus modalidades, desde el manejo conservador en hernias de pequeño tamaño sin gran repercusión clínica hasta la corrección quirúrgica, bien con cierre primario de la pared torácica o uso de mallas sintéticas, en hernias de mayor tamaño o que presentaron signos de posible complicación (AU)

Lung hernias are rare entities and are primarily related to chest trauma or previous surgery. Spontaneous lung hernias are even more uncommon. We describe three cases of pontaneous intercostal pulmonary hernia, its evaluation and treatment in all its forms, from the conservative management in small hernias without significant clinical impact, to surgical treatment, either with primary closure of the chest wall or using synthetic mesh in larger hernias or in presence of signs of possible complications (AU)

[Gastric metastasis of breast carcinoma]. / Metástasis gástrica de carcinoma de mama.

Although distal dissemination from breast cancer is commonly found in bones, lungs, liver and brain, others less common sites have been occasionally reported. A 60 year-old woman with long standing disseminated breast cancer disease was admitted to our hospital with upper gastrointestinal bleeding. At endoscopy, an abnormal area was seen in the lesser curvature of the stomach. Invasion of the gastric wall by metastases from carcinoma of the breast was diagnosed in the biopsy. No further treatment was warranted and the patient died soon thereafter. Gastric metastases are primarily located in the submucosa and muscular layers of the stomach. Lack of mucosal involvement suggests a blood-borne spread. Although our patient had no progesterone receptors in the primary breast tumor, previous studies have suggested that the presence of receptors may facilitate gastrointestinal spread. Gastric metastases from extraintestinal cancers may be asymptomatic, and are usually late events in the progression of the disease.

[Evaluation of quality at the first health care level]. / Valoración de la calidad en el primer escalón sanitario.

A study of the quality of the health care process was carried out in three types of general practices: outpatients clinics, rural clinics and health centers. Data were collected from 6,163 protocols collected from the patients during the medical visit, and positive and negative parameters were elaborated from them. The highest quality was found in the health centers; there was a marked difference between them favoring the second one, in which the results were: 75.6% of medical acts, a mean time of 9 minutes 23 seconds for medical act; 65.5% of physical examinations; 15.6% of systematic medical examinations and 4.3% of questionably needed drug therapies. The satisfaction of the user was also evaluated by means of 421 questionnaires administered to the general population. Satisfaction was greatest in the health centers for the accessibility and service character, in the outpatients clinics for the perception of one's own health status, and there were no differences between the three types of centers for helpfulness and professional skill.

Mutagenicity of products generated by the reaction between several antiparasitic drugs and nitrite.

Drugs containing secondary aliphatic amines, heterocyclic nitrogen, or secondary aliphatic amido groups (chloroquine, dehydroemetine, mebendazole, and piperazine) and pyrimidine derivatives such as pyrantel pamoate were reacted in vitro with sodium nitrite at pH 3.7 and became mutagenic for Salmonella typhimurium strain TA1535. The products derived from the nitrosation of chloroquine and dehydroemetine required metabolic activation by mammalian hepatic S9 to be mutagenic. The N-nitroso derivatives of mebendazole, piperazine, and pyrantel pamoate were mutagenic with and without S9, although more activity was noted in the presence of S9 with the nitrosated compounds formed from mebendazole and piperazine. Under identical conditions, no mutagenic products were detected from quaternary ammonium salts such as bephenium hydroxynaphthoate or drugs containing tertiary heterocyclic amino groups, such as iodochlorhydroxyquin.