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1.
Arch. cardiol. Méx ; 88(4): 287-297, oct.-dic. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-1124150

ABSTRACT

Resumen Introducción: Se revisará la evolución del tratamiento farmacológico de la insuficiencia cardiaca (IC) en los últimos 25 an˜os, desde el concepto de tratamiento con vasodilatadores, pasando por el bloqueo o inhibición del sistema renina-angiotensina-aldosterona y la inhibición betaadrenérgica y su importante contribución en la disminución de la morbimortalidad por IC, el papel de los péptidos natriuréticos y, finalmente, se conocerá uno de los estudios más importantes en el área cardiológica y específicamente en el manejo de la IC, en el cual se demuestra un enfoque modulador de los sistemas neuro humorales que se activan en estos pacientes. Objetivos: La IC constituye la etapa final de la mayoría de las enfermedades cardiovasculares, con una alta tasa de hospitalización y de morbimortalidad cardiovascular, siendo, por lo tanto, de interés constante la necesidad de encontrar un agente terapéutico innovador que disminuya significativamente estas complicaciones y también que mejore la calidad de vida de los que la presentan. Metodología: Se realizará una descripción del PARADIGM-HF Clinical Trial, que utilizó un compuesto sacubitrilo/valsartán para el manejo de la IC con un mecanismo modulador diferente del concepto de bloqueador de sistemas deletéreos que se activan cuando un paciente presenta síntomas y signos de IC. Conclusiones: La muerte por causas cardiovasculares u hospitalización por IC (el punto final primario) se produjo en 914 pacientes (21.8%) en el grupo sacubitrilo/valsartán y 1,117 pacientes (26.5%) en el grupo de enalapril (razón de riesgo en el grupo sacubitrilo/valsartán, 0.80; intervalo de confianza (IC) del 95%: 0.73 a 0.87; p < 0.001 (exacta p = 4.0 × 10 - 7)). De los pacientes que recibieron sacubitrilo/valsartán, 537 (12.8%) fueron hospitalizados por IC, en comparación con los 658 pacientes (15.6%) que recibieron enalapril (razón de riesgo, 0.79; IC del 95%, 0.71 a 0.89; p < 0.001). Un total de 711 pacientes (17.0%) en el grupo sacubitrilo/valsartán y 835 pacientes (19.8%) en el grupo de enalapril murió (razón de riesgo de muerte por cualquier causa, 0.84; IC del 95%, 0.76 a la 0.93; p < 0.001).


Abstract Introduction: A review is presented on the evolution of the pharmacological treatment of heart failure (HF) in the last 25 years, from the concept of treatment with vasodilators to the blocking or inhibition of the renin angiotensin aldosterone system. Beta-adrenergic inhibition and its important contribution in the reduction of morbidity and mortality due to HF will be discussed along with the role of the natriuretic peptides. One of the most important studies in the cardiology area, and specifically in the management of HF, is presented, in which an approach is demonstrated of the modulator of the neurohumoral systems that are activated in these patients. Objectives: HF is the final stage of most cardiovascular diseases, and has a high rate of hospital admission, as well as cardiovascular morbidity and mortality. Therefore, there is constant interest in the need to find an innovative therapeutic agent that significantly reduces these complications and that improves the quality of life of those who suffer from it. Methods: A description will be presented of the PARADIGM-HF Clinical Trial using a sacubitril/valsartán compound for the management of HF with a modulating mechanism different from the concept of a deleterious system blocker that is activated when a patient has symptoms and signs of heart failure. Conclusions: Death due to cardiovascular causes, or hospital admission due to heart failure (the primary endpoint) occurred in 914 patients (21.8%) in the Sacubitril / valsartán group, and 1117 patients (26.5%) in the enalapril group (risk ratio in the sacubitril / valsartán group, 0.80, with a 95% confidence interval [CI]: 0.73 to 0.87, P<0.001 ;exact P= 4.0 × 10 --7;). Of the patients receiving sacubitril / valsartán, 537 (12.8%) were hospitalised due to heart failure, compared with 658 patients (15.6%) receiving enalapril (hazard ratio 0.79, 95% CI: 0.71 to 0.89, P<.001). A total of 711 patients (17.0%) in the sacubitril / valsartán group, and 835 patients (19.8%) in the enalapril group, died (all-cause death rate, 0.84, 95% CI: 0.76 to 0.93, P<.001)


Subject(s)
Humans , Tetrazoles/therapeutic use , Enalapril/therapeutic use , Aminobutyrates/therapeutic use , Heart Failure/drug therapy , Quality of Life , Systole , Tetrazoles/pharmacology , Biphenyl Compounds , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Enalapril/pharmacology , Drug Combinations , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin Receptor Antagonists/pharmacology , Valsartan , Aminobutyrates/pharmacology , Heart Failure/physiopathology , Hospitalization/statistics & numerical data
2.
Arch Cardiol Mex ; 88(4): 287-297, 2018.
Article in Spanish | MEDLINE | ID: mdl-29501368

ABSTRACT

INTRODUCTION: A review is presented on the evolution of the pharmacological treatment of heart failure (HF) in the last 25 years, from the concept of treatment with vasodilators to the blocking or inhibition of the renin angiotensin aldosterone system. Beta-adrenergic inhibition and its important contribution in the reduction of morbidity and mortality due to HF will be discussed along with the role of the natriuretic peptides. One of the most important studies in the cardiology area, and specifically in the management of HF, is presented, in which an approach is demonstrated of the modulator of the neurohumoral systems that are activated in these patients. OBJECTIVES: HF is the final stage of most cardiovascular diseases, and has a high rate of hospital admission, as well as cardiovascular morbidity and mortality. Therefore, there is constant interest in the need to find an innovative therapeutic agent that significantly reduces these complications and that improves the quality of life of those who suffer from it. METHODS: A description will be presented of the PARADIGM-HF Clinical Trial using a sacubitril/valsartán compound for the management of HF with a modulating mechanism different from the concept of a deleterious system blocker that is activated when a patient has symptoms and signs of heart failure. CONCLUSIONS: Death due to cardiovascular causes, or hospital admission due to heart failure (the primary endpoint) occurred in 914 patients (21.8%) in the Sacubitril / valsartán group, and 1117 patients (26.5%) in the enalapril group (risk ratio in the sacubitril / valsartán group, 0.80, with a 95% confidence interval [CI]: 0.73 to 0.87, P<0.001 [exact P= 4.0 × 10 - 7]). Of the patients receiving sacubitril / valsartán, 537 (12.8%) were hospitalised due to heart failure, compared with 658 patients (15.6%) receiving enalapril (hazard ratio 0.79, 95% CI: 0.71 to 0.89, P<.001). A total of 711 patients (17.0%) in the sacubitril / valsartán group, and 835 patients (19.8%) in the enalapril group, died (all-cause death rate, 0.84, 95% CI: 0.76 to 0.93, P<.001).


Subject(s)
Aminobutyrates/therapeutic use , Enalapril/therapeutic use , Heart Failure/drug therapy , Tetrazoles/therapeutic use , Aminobutyrates/pharmacology , Angiotensin Receptor Antagonists/pharmacology , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Biphenyl Compounds , Drug Combinations , Enalapril/pharmacology , Heart Failure/mortality , Heart Failure/physiopathology , Hospitalization/statistics & numerical data , Humans , Quality of Life , Systole , Tetrazoles/pharmacology , Valsartan
5.
Prog Lipid Res ; 52(4): 354-73, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23624223

ABSTRACT

On a nutritional standpoint, lipids are now being studied beyond their energy content and fatty acid (FA) profiles. Dietary FA are building blocks of a huge diversity of more complex molecules such as triacylglycerols (TAG) and phospholipids (PL), themselves organised in supramolecular structures presenting different thermal behaviours. They are generally embedded in complex food matrixes. Recent reports have revealed that molecular and supramolecular structures of lipids and their liquid or solid state at the body temperature influence both the digestibility and metabolism of dietary FA. The aim of the present review is to highlight recent knowledge on the impact on FA digestion, absorption and metabolism of: (i) the intramolecular structure of TAG; (ii) the nature of the lipid molecules carrying FA; (iii) the supramolecular organization and physical state of lipids in native and formulated food products and (iv) the food matrix. Further work should be accomplished now to obtain a more reliable body of evidence and integrate these data in future dietary recommendations. Additionally, innovative lipid formulations in which the health beneficial effects of either native or recomposed structures of lipids will be taken into account can be foreseen.


Subject(s)
Fatty Acids/metabolism , Lipid Metabolism/physiology , Lipids/chemistry , Animals , Biological Availability , Dietary Fats/metabolism , Humans , Triglycerides/chemical synthesis , Triglycerides/chemistry , Triglycerides/metabolism
9.
J Radiol ; 90(9 Pt 2): 1172-5, 2009 Sep.
Article in French | MEDLINE | ID: mdl-19752827

ABSTRACT

The recent and future advancements that are known in the field of cardiac imaging imply an optimal training of the operators. This training concerns medical specialists whether originating from radiology or cardiology. The training of the medical specialists in cardiac imaging entitles 3 main essential steps: The basic training taking place within each specialty, allowing the fellow to get acquainted with the clinical and technical basics. The specialized training, delivered principally in post-residency. This training must include an upgrading of each specialty in the domain that does not concern it (a technical base for the cardiologist, a physio-pathological and clinical base for the radiologist). It must include a specific theoretical training covering all aspects of cardiac imaging as well as practical training in a certified training centre. The continuous medical training and maintenance of skills that allow a sustained activity in the field and the obligation to regularly participate in the actions of specific validated training. The different aspects of these rules are exposed in this chapter.


Subject(s)
Heart Diseases/diagnosis , Radiology/education , Diagnostic Imaging , Guidelines as Topic , Humans
10.
J Radiol ; 89(11 Pt 2): 1855-70, 2008 Nov.
Article in French | MEDLINE | ID: mdl-19106843

ABSTRACT

Multidetector CT is very useful in the evaluation of polytrauma patients. MDCT is valuable for the detection and treatment planning of vascular injuries, but it may not be available to hemodynamically unstable patients. Embolization of visceral and parietal branches of the aorta benefits from advances in catheter technology: hydrophilic catheters and microcatheters are very helpful in this context. Resorbable particles (such as gelatin) and coils are the most useful occlusive agents. Endovascular stenting of aortic rupture is nowadays considered in many centers as the best therapeutic option and can be proposed as an alternative to surgery.


Subject(s)
Abdominal Injuries/diagnostic imaging , Abdominal Injuries/therapy , Radiography, Interventional , Thoracic Injuries/diagnostic imaging , Thoracic Injuries/therapy , Embolization, Therapeutic , Humans , Male , Middle Aged
11.
J Radiol ; 89(12): 1930-4, 2008 Dec.
Article in French | MEDLINE | ID: mdl-19106851

ABSTRACT

PURPOSE: Age determination based on bone maturate evaluation is routinely used in forensic science and anthropology. The aim of this study was to purpose a quantitative method of age determination on the second metacarpal in a population of children and adolescents by measurements of the epiphyso-metaphysal ratio (REM) (epiphysal diameter divided by metaphysal diameter) and the cortical index (IC). MATERIAL: and methods. We evaluated the REM and the IC on 417 hand radiographs of 2 from aged 20-year-old children. RESULTS: The correlation between REM and age for males (R2=0.62; p<0.001) and females (R2=0.68; p<0.001) was a good and significant. The correlation between IC and age for males (R2=0.34; p<0.001) and females (R2=0.30; p<0.001) was also significant but poor. CONCLUSION: Measurement of IC should not be used for age assessment. Measurement of REM is simple, reproducible and poor X-ray exposing technique. It should be very useful for age determination.


Subject(s)
Age Determination by Skeleton/methods , Metacarpal Bones/diagnostic imaging , Adolescent , Child , Child, Preschool , Female , Humans , Male , Retrospective Studies , Young Adult
12.
Prog Urol ; 18(6): 372-8, 2008 Jun.
Article in French | MEDLINE | ID: mdl-18558327

ABSTRACT

OBJECTIVE: To study the results of balloon nephrostomy urine drainage in the treatment of lower urinary tract fistula. MATERIAL AND METHODS: A series of 10 patients with lower urinary tract fistula was treated by balloon nephrostomy for tumour in eight cases and trauma in two cases with a palliative indication in two patients. RESULTS: The duration of diversion ranged from seven to 210 days (mean: 55 days). The only incidents observed were three cases of urinary sepsis and four cases of nephrostomy tube or balloon migration. On removal of the nephrostomy, there were no signs of stenosis or other ureteric lesion. Balloon nephrostomy drainage achieved cure of the fistula in four cases, and allowed successful surgical repair in the other cases. CONCLUSION: Balloon nephrostomy placement appears to constitute an alternative to surgical repair for lower urinary tract fistula. In the case of failure, it appears to allow surgical repair to be performed under better conditions than in the case of immediate surgery. However, these preliminary results need to be confirmed on larger series.


Subject(s)
Catheterization , Nephrostomy, Percutaneous/methods , Ureteral Obstruction/therapy , Urinary Fistula/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Nephrostomy, Percutaneous/adverse effects , Palliative Care , Time Factors , Treatment Failure , Ureteral Obstruction/etiology , Ureteral Obstruction/surgery , Urinary Bladder Fistula/etiology , Urinary Bladder Fistula/surgery , Urinary Bladder Fistula/therapy , Urinary Fistula/etiology
14.
J Radiol ; 88(9 Pt 2): 1261-3, 2007 Sep.
Article in French | MEDLINE | ID: mdl-17878872

ABSTRACT

The daily practice of radiologists has evolved and radiologists are increasingly being directly involved with patient care and treatment. Consequently, radiologists have become a part of the therapeutic team available to patients. This active role, in hospital based or out-patient practices, does not only have an impact on the radiologist's professional activities. New liabilities related to interventional procedures or treatments are now added to already existing professional liability from diagnostic activities. Therefore, musculoskeletal radiologists performing interventional procedures must be aware and familiar with their obligations towards patients, including the requirement to provide adequate information to patients and documenting that informed consent was obtained.


Subject(s)
Bone Diseases/therapy , Disclosure/legislation & jurisprudence , Informed Consent/legislation & jurisprudence , Liability, Legal , Muscular Diseases/therapy , Radiology, Interventional/legislation & jurisprudence , Ambulatory Care/legislation & jurisprudence , Consent Forms/legislation & jurisprudence , France , Humans , Medical Staff, Hospital/legislation & jurisprudence , Patient Care Team/legislation & jurisprudence
15.
J Radiol ; 88(2): 217, 2007 Feb.
Article in French | MEDLINE | ID: mdl-17372548
16.
Eur Radiol ; 17(6): 1452-63, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17115159

ABSTRACT

The purpose of this study was to assess the ability of 16-slice computed tomography (CT) to detect in-stent restenosis of proximal coronary arteries. From November 2002 to April 2004, 134 consecutive patients with proximal stents (3.25 +/- 0.47 mm) were prospectively studied. Multidetector CT (MDCT) was performed 24 h (baseline) and 6 months after angioplasty and analysed by two radiologists blinded to the results of the coronary angiography. Sensitivity, specificity, positive and negative predictive values for in-stent restenosis were compared with conventional quantitative coronary angiography (QCA). Stenosis with a diameter >or=50% was considered diagnostic of in-stent restenosis. The CT analysis was performed in 131 and 114 patients at baseline and 6 months, respectively. The in-stent lumen was evaluable in 111 (121 stents) and 99 patients (108 stents) at baseline and 6 months, respectively. The prevalence of in-stent restenosis was 22.5%. Restenoses were correctly identified in 91.7 and 87.5% by the two radiologists. The sensitivity, specificity, positive and negative predictive values for the assessment of significant in-stent restenosis were 92, 67, 43, 97% and 87, 66, 41, 95% for the radiologists, respectively. MDCT is a potential non-invasive technique for the screening of in-stent restenosis of proximal coronary arteries that needs further improvements.


Subject(s)
Coronary Restenosis/diagnostic imaging , Stents , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/therapy , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity
17.
Semin Intervent Radiol ; 24(2): 167-79, 2007 Jun.
Article in English | MEDLINE | ID: mdl-21326794

ABSTRACT

Type A aortic dissection remains fatal if untreated. Although classical medical therapy for type B dissection is considered the therapy of choice in uncomplicated cases, the paradigm is changing as greater experience is accrued with endovascular treatments and technical advances improve the long-term outlook. Diagnosis is also becoming more sophisticated, allowing greater appreciation of the anatomy of dissections and improving the knowledge base as their natural history is assessed.

18.
J Radiol ; 87(6 Pt 1): 619-38, 2006 Jun.
Article in French | MEDLINE | ID: mdl-16788536

ABSTRACT

The development of new imaging modalities such as computed tomography and magnetic resonance imaging is a new phenomenon in thanatology. The growing accessibility to these technologies allows, under some conditions, the acquisition of cross-sectional images on cadavers. The authors present a practical pictorial review of post-mortem changes and deadly injuries, illustrating the contributions of modern cross-sectional imaging techniques in thanatology.


Subject(s)
Magnetic Resonance Imaging , Postmortem Changes , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Aged, 80 and over , Cause of Death , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged
19.
Rev Pneumol Clin ; 62(2): 135-6, 2006 Apr.
Article in French | MEDLINE | ID: mdl-16670668

ABSTRACT

Interventional radiography performed for diagnostic and therapeutic purposes enables specific orientation of the diagnostic and/or therapeutic interention under radiographic guidance. This minimally invasive approach reduces intervention related morbidity. Mortality remains exceptional. Pleural biopsies and pleural drainage are two interventional procedures performed as routine practices in many centers.


Subject(s)
Drainage/methods , Pleura/pathology , Radiography, Interventional , Biopsy , Humans , Pleural Neoplasms/diagnosis
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