Valor del índice de predicción de la hipotensión y el dP/dtmax para predecir y tratar la hipotensión en un paciente con miocardiopatía dilatada / The value of hypotensive prediction index and dP/dtmax to predict and treat hypotension in a patient with a dilated cardiomyopathy

El índice de predicción de la hipotensión (iPH) es un nuevo parámetro diseñado para predecir el riesgo de aparición de un evento hipotensor, definido como una caída de la presión arterial media por debajo de 65mmHg. El valor numérico del iPH se muestra en un monitor como un dígito que va de 1 a 100, donde la primera alarma de aparición de la hipotensión ocurre cuando dicho valor excede de 85. Una pantalla secundaria muestra el volumen de variación sistólica, el dP/dtmax y la elastancia dinámica arterial. Describimos el caso de un paciente con una miocardiopatía dilatada moderada que presentó varios episodios de hipotensión tras la inducción anestésica, y cómo, usando la tecnología iPH, estos fueron resueltos. Recomendamos usar el valor de iPH>85 como alarma de intervención y utilizar la pantalla secundaria para determinar su causa y adecuar su tratamiento. Creemos que la tecnología iPH puede ser una alternativa válida en el manejo anestésico de los pacientes con miocardiopatía dilatada

The Hypotension Prediction Index (HPi) is a new parameter, recently developed to predict the risk of a patient developing a hypotensive event, defined as a fall in mean arterial pressure below 65 mmHg. The calculated HPi value is displayed on a monitor as a number ranging from 1 to 100; where the first warning for the appearance of such event occurs when HPi values exceed 85. A secondary screen shows the stroke volume variation value; the dP/dt max; and the dynamic arterial elastance. We described a patient with a mild to moderately dilated cardiomyopathy that presented several episodes of hypotension after induction of anaesthesia and how by using HPi technology, these were successfully solved. We recommend the use of a HPi value >85 as a warning of intervention, and to use the secondary screen to determine the cause and the treatment. We consider that HPi technology may be a valid alternative for the anaesthetic management of patients with a dilated cardiomyopathy

The value of hypotensive prediction index and dP/dtmax to predict and treat hypotension in a patient with a dilated cardiomyopathy. / Valor del índice de predicción de la hipotensión y el dP/dtmax para predecir y tratar la hipotensión en un paciente con miocardiopatía dilatada.

The Hypotension Prediction Index (HPi) is a new parameter, recently developed to predict the risk of a patient developing a hypotensive event, defined as a fall in mean arterial pressure below 65 mmHg. The calculated HPi value is displayed on a monitor as a number ranging from 1 to 100; where the first warning for the appearance of such event occurs when HPi values exceed 85. A secondary screen shows the stroke volume variation value; the dP/dt max; and the dynamic arterial elastance. We described a patient with a mild to moderately dilated cardiomyopathy that presented several episodes of hypotension after induction of anaesthesia and how by using HPi technology, these were successfully solved. We recommend the use of a HPi value >85 as a warning of intervention, and to use the secondary screen to determine the cause and the treatment. We consider that HPi technology may be a valid alternative for the anaesthetic management of patients with a dilated cardiomyopathy.

Apoptosis induction in nonirradiated human HL-60 and murine NSO/2 tumor cells by photoproducts of indole-3-acetic acid and riboflavin.

The effect of the photoproducts of indole-3-acetic acid sensitized by riboflavin on nonirradiated human HL-60 and murine NSO/2 tumor cells was studied. Severe damage with a dose-response effect was observed on both cell types. The effect was greater than that previously described for the tryptophan riboflavin photoproducts. Electron microscopy studies and flow cytometry analysis of DNA fragmentation allowed us to conclude that the photoproducts studied in this work induce cell death by an apoptotic mechanism.

Reclassification after delivery of diabetes in pregnancy.

Gestational diabetes mellitus (GDM) constitutes a risk factor for the development of non insulin-dependent diabetes mellitus (NIDDM). The search for parameters to provide discrimination between a high risk and a low risk for future development of NIDDM is today the aim of many investigations. The absence or presence of several factors such as glycemia during pregnancy and post partum, the need for insulin treatment, disorders of the pancreatic insulin secretion, the number of pregnancies, maternal obesity, the early diagnosis of GDM, the family history of diabetes mellitus, the race and immune disorders give rise to a very high relative risk (RR) of developing NIDDM. To know the degree of risk will allow a future appropriate clinical intervention to reduce the incidence of NIDDM and its economic cost.

Hepatic disease in the Spanish toxic oil syndrome. A thirty months follow-up study.

Clinical and biological evidence of liver disease was found in 99 out of 242 (40%) patients hospitalized with acute manifestations of the Spanish toxic oil syndrome. No patient was alcoholic. According to the severity of liver involvement, patients were classified in 3 groups and followed up for at least 30 months. Group I included 65 patients with a transient increase of serum aminotransferase activity as the only evidence of liver disease. This abnormality disappeared within 2 months in all these patients. Group II included 18 patients with raised aminotransferases and alkaline phosphatase. At the end of follow-up, liver tests remained slightly abnormal in 4 patients of this group (22%) and a liver biopsy revealed minor changes in 3 of them. Group III included 16 patients with raised aminotransferases, alkaline phosphatase and bilirubin. Thirty months after the acute episode, liver function tests remained abnormal in 8 patients (50%); a liver biopsy, performed in 5 cases, showed changes suggesting chronic biliary disease in 2, and fibrosteatosis, chronic hepatitis and minimal changes in each of the remaining 3. Pulmonary, cutaneous, vascular, neuromuscular and other extra-hepatic disturbances were noted in a large number of patients but no relationship was observed between the degree of hepatic disfunction and the presence and severity of systemic manifestations of the toxic oil syndrome.

Routine accurate determination of silica in silicate materials by atomic-absorption spectrophotometry and subsequent computation.

An accurate method for routine determination of silica in silicate materials is proposed. It is based on the decomposition of the silicate materials with LiCO(3)/H(3)BO(3) flux, stabilization of the silica with fluoride, and the use of a suitable calibration, measurement and computation pattern.

Optimization of silicate rock decomposition for determination of major elements by atomic-absorption spectrophotometry.

A rapid method for sample decomposition of silicate rocks and further accurate determination of major elements by atomic-absorption spectrometry is described. The solutions obtained were stabilized so that the measurements were comparable with those made on standard rocks solutions. Interferences were avoided. The most important methods of silicate rock decomposition were applied, and the useful characteristics from each were combined, and in some cases improved, to obtain the final procedure.