ABSTRACT
Although many experts position statements on autologous stem cell mobilization have been published, there are some aspects that are still under discussion. A Spanish Hematologist expert group was summoned to settle on agreements and uncertainties on PBSCs mobilization, including factors not always considered; as apheresis and cytometry key factors that determine a successful PBSC collection. This document reviews critical factors that define poor mobilizer patients and the tools to better collect the desired stem cells for a successful autologous haematopoietic stem cell transplant.
Subject(s)
Blood Component Removal , Peripheral Blood Stem Cells , Consensus , Hematopoietic Stem Cell Mobilization , Humans , Transplantation, AutologousABSTRACT
La personalidad nace con la persona, se modela y supone un conjunto de rasgos flexibles (dimensión perdurable o persistente), que caracterizan a un individuo, explican su conducta y lo hacen distinto de los demás. Los trastornos de personalidad son patrones estables, permanentes e inflexibles de conductas mal adaptadas a las expectativas o esquemas establecidos. Los rasgos pueden tornarse anómalos y constituir trastornos de la personalidad cuando son inflexibles, desadaptativos y causan un deterioro funcional y un malestar subjetivo en el sujeto y en los demás. La persona del caso estudiado viene marcada por una personalidad con discrepancias con su entorno desde la infancia. Ha vivido con un sentimiento de abandono y un victimismo que la han llevado a la búsqueda constante de afectos y llamadas de atención, que han determinado sus acciones judicializadas. Se caracteriza por rasgos de personalidad histriónica, paranoide y esquizoide
The personality is born with the person, it is shaped and assumes a set of flexible traits (lasting or persistent dimension), that characterize an individual, explain their behavior and make it different from others. The personality disorders are stables, permanents and inflexible patterns of not well adapted behaviors to established expectations or patterns. Traits can become anomalous and constitute personality disorders when they are inflexible, maladaptive and cause functional worsening and subjective discomfort in the subject and in others. The individual analysed has a personality with discrepancies with her environment since the childhood. She has lived with a neglect feeling and claiming she was being victimized. These feelings have made her to look constantly for affection and to attract the attention, determining her judicial actions. She is characterized by a histrionic, paranoid and schizoid personality
Subject(s)
Humans , Male , Female , Adult , Personality Disorders/psychology , Intimate Partner Violence/psychology , Crime Victims/psychology , Paranoid Disorders/diagnosis , Paranoid Disorders/psychologyABSTRACT
En la presente investigación, llevada a cabo por la Unidad de Valoración Integral de Violencia de Género de Sevilla (UVIVG), a lo largo de los años 2013 y 2014, se han incluido aquellos casos en los que se ha explorado la existencia de situaciones de violencia en la pareja, llegando a elaborar 562 informes. Dichos informes dan respuesta a las periciales solicitadas por jueces y magistrados, y en ellos se han valorado diferentes variables (edad, sexo, estudios, situación sociolaboral, raza, etc.) que tienen influencia en los comportamientos y respuestas dados por denunciantes y denunciados. Los resultados más elocuentes del estudio han sido el alto porcentaje de casos valorados como conflictividad de pareja, muy por encima de los casos valorados como violencia de género y maltrato, así como el alto porcentaje de las personas españolas y en trámites de separación, por encima de los extranjeros y parejas que mantienen sus relaciones en el momento de la denuncia. De las patologías emocionales más frecuentes que se observan en las mujeres afectas de las situaciones estudiadas tenemos la sintomatología ansiosa y depresiva, y han sido escasos los casos en que se ha valorado la existencia de secuelas psicológicas que impidan la realización de su vida cotidiana. La violencia de género, o cualquier tipo de maltrato en sus formas posibles, no elude a ninguna condición social, económica, cultural, etc. Sí se relacionan ciertas situaciones de trastorno metal y consumos de sustancias con conductas de marcada conflictividad (AU)
This study has been developed by UVIVG Seville, over the years 2013 and 2014. It includes those cases where the professionals of UVIVG have explored the existence of violence situations inside the couple. These professionals have elaborated 562 reports. The reports content the results of the expert investigations asked by the judges. The professionals have dealt different variables in the reports, as age, gender, socio-labour situation, race, etc., which influence over the behavior of the plaintiff and the defendant, and their given answers. The main results of this study have been the highest percentage of cases valuated as couple conflict, comparing with the cases considered as gender violence and maltreatment. Moreover, the study shows that the gender violence occurs more often in Spanish people than in foreigners, and during the process separation than in the stable couple situations. The most frequent emotional pathologies observed in women, who have been affected by the analyzed situations, are the anxiety and depressive symptoms. The existence of psychological aftermath, that impede their normal daily life, were analyzed in few cases. The gender violence or any other possible type of violence took place in every group, without differences between social, economic and social conditions, among others. However, certain mental derangements and narcotic consumption are closely related to conflictual behaviour (AU)
Subject(s)
Humans , Male , Female , Violence Against Women , Forensic Toxicology/methods , Psychology, Clinical/methods , Psychology, Clinical/standards , Substance-Related Disorders/diagnosis , Personality Disorders/psychology , Forensic Toxicology/classification , Forensic Toxicology/standards , Psychology, Clinical/classification , Spain/ethnology , Substance-Related Disorders/psychology , Personality Disorders/pathology , Intellectual Disability/complicationsABSTRACT
Se ha estudiado la posible relación entre el consumo de alcohol y la violencia ejercida por el hombre hacia la mujer con la que mantiene o ha mantenido relación sentimental, en una muestra de 50 parejas analizadas en la Unidad de Valoración Integral de Violencia de Género (UVIVG) de Sevilla, a lo largo de los años 2013 y 2014. Para ello se ha empleado una entrevista estructurada creada ad hoc, así como los cuestionarios MINI, MALT y CAGE. De las 50 parejas, en 25, las mujeres que denunciaron afirmaban que sus parejas eran consumidoras de alcohol y en ocasiones de otras sustancias de adicción, diagnosticándose tal consumo únicamente en 16 de estos hombres; la otra mitad de la muestra negaba el consumo de sustancias de adicción en sus parejas. Los resultados obtenidos muestran que los hombres que consumen alcohol ejercen violencia hacia su pareja en mayor proporción en estado sobrio que en estado ebrio. No obstante, el consumo de alcohol supone un incremento añadido en la frecuencia de la violencia ejercida. Igualmente, los resultados del estudio ponen de manifiesto que los hombres que no consumen alcohol ejercen violencia en menor porcentaje que los que sí lo hacen (AU)
This article examines the possible relation between alcohol consumption and violence of men towards women with whom they share or have shared a relationship. Our sample is composed of 50 couples analyzed under the Comprehensive Assessment of Gender Violence Unit (UVIVG) of Seville (Spain), during 2013 and 2014. It has been used an structured interview which has been created ad hoc, as well as the MINI, MALT and CAGE questionnaires. In 25 of the 50 analyzed couples, the woman, who had denounced, declared that her partner consumed alcohol and that he often consumed other substances of abuse. Nevertheless, this consumption was only diagnosed in 16 of those men. The women of the other half of the sample denied any consumption of substances of abuse by their partners. The results obtained from the analyzed sample shows that men who consume alcohol are more violent towards their partners when they are sober, than when they are drunk. However, the alcohol consumption increases the frequency of violent actions. Moreover, the results of the analysis reveal that men who do not consume alcohol resort to violence in a lower percentage than those who consume alcohol (AU)
Subject(s)
Adult , Female , Humans , Male , Alcoholism/psychology , Alcoholism/diagnosis , Violence Against Women , Spouse Abuse , Epidemiological Monitoring/trends , Violence , Substance-Related Disorders/psychology , Alcohol Drinking , Family Conflict , Child Abuse , Battered Women , Adult Survivors of Child Abuse , Family Relations , Risk Factors , Spain/epidemiologyABSTRACT
OBJECTIVE: To evaluate effectiveness of treatment with plerixafor in patients undergoing posterior mobilization for hematopoietic transplant at our hospital. METHODS: Retrospective study of all patients who until September 2012, received plerixafor in their scheme of mobilization into peripheral blood hematopoietic progenitors. We reviewed the medical records and records of drug dispensing outpatient consultation. Effectiveness variables used were: CD34/kg in apheresis product obtained, and day dose received colony stimulating factor (G-CSF) and Plerixafor. Each patient was compared to the effectiveness of the drug results with those obtained earlier mobilization schemes where Plerixafor not used, if present. Data were analyzed using IBM SPSS v19. RESULTS: A total of 24 patients received plerixafor in our hospital. Diagnoses were distributed: 15 NHL, 6 patients with multiple myeloma, 2 Hodgkin's disease, and one metastatic choriocarcinoma. The effectiveness outcomes were no plerixafor mobilization (n = 18): 5 patients were mobilized with G-CSGF only, 13 with G-CSF and chemotherapy. The G-CSF dose / day was mcg 931.1 (± 179.5) for 9.5 days (± 4.7). The average product obtained CD34/kg in cells was 0.2 (± 0.5). No patient received sufficient product (≥ 2 x 106 cells/kg) for subsequent autologous transplantation. 100% of the demonstrations failed. Mobilization with plerixafor (n = 24): 13 patients were mobilized with GCSGF only, 11 with G-CSF and chemotherapy. The G-CSF dose/ day and averaged Plerixafor mcg 885.1 (± 240.1) and 19.8 (± 4.4), respectively, administered for 8.9 (± 5.1) and 1 , 5 (± 0.6) days, respectively. The average product obtained in CD34/kg was 2.3 x 106 cells (± 1.7) (p = 0.014 in relation to the demonstrations without Plerixafor). Only 12.5% (n = 3) patients were unable to undergo autologous transplant. CONCLUSIONS: In our patients, plerixafor has proven effective in mobilizing hematopoietic progenitors for autologous back.
Objetivo: Evaluar efectividad del tratamiento con plerixafor en pacientes sometidos a movilización para posterior autotrasplante de progenitores hematopoyéticos en nuestro hospital. Métodos: Estudio retrospectivo de todos los pacientes que hasta septiembre 2012, recibieron plerixafor en su esquema de movilización de progenitores hematopoyéticos a sangre periférica. Se revisaron las historias clínicas y los registros de dispensación de medicamentos de la consulta de pacientes externos. Las variables de efectividad utilizadas fueron: CD34/kg en producto de aféresis obtenidas, dosis y días recibidos de factor estimulante de colonias (G-CSF) y de plerixafor. Para cada paciente se comparó los resultados de efectividad del fármaco con los obtenidos para anteriores esquemas de movilización en los que no se utilizó plerixafor, en caso de tenerlos. Los datos se analizaron mediante IBM spss v19. Resultados: Un total de 24 pacientes recibieron plerixafor en nuestro hospital. Los diagnósticos se distribuyeron: 15 linfoma no Hodgkin , 6 pacientes con mieloma múltiple, 2 enfermedad de Hodgkin, y 1 coriocarcinoma diseminado. Los resultados de efectividad fueron: Movilización sin plerixafor (n = 18): 5 pacientes se movilizaron sólo con G-CSGF, 13 con G-CSF y quimioterapia. La dosis de G-CSF /día fue de 931,1 mcg (± 179,5), durante 9,5 días (± 4,7). El promedio de CD34/kg en producto obtenido fue de 0,2 células (± 0,5). Ningún paciente obtuvo producto suficiente (≥?2 x 106 células/kg) para el posterior autotrasplante. El 100 % de las movilizaciones fracasaron. Movilización con plerixafor (n = 24): 13 pacientes se movilizaron sólo con G-CSGF, 11 con G-CSF y quimioterapia. La dosis de G-CSF /día y de plerixafor promedio fue de 885,1 mcg (± 240,1) y 19,8 (± 4,4), respectivamente, administrados durante 8,9 (± 5,1) y 1,5 (± 0,6) días, respectivamente. El promedio de CD34/kg en producto obtenido fue de 2,3x106 células (±1,7) (p = 0,014, en relación a las movilizaciones sin plerixafor). Sólo el 12,5% (n = 3) pacientes no pudieron someterse a autotrasplante. Conclusiones: En nuestros pacientes, plerixafor ha demostrado ser efectivo en la movilización de progenitores hematopoyéticos para posterior autotrasplante.
Subject(s)
Granulocyte Colony-Stimulating Factor/pharmacology , Hematopoietic Stem Cell Mobilization/methods , Heterocyclic Compounds/pharmacology , Peripheral Blood Stem Cell Transplantation , Adult , Antigens, CD34/analysis , Antineoplastic Combined Chemotherapy Protocols/pharmacology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Benzylamines , Blood Cell Count , Blood Component Removal , Choriocarcinoma/blood , Choriocarcinoma/drug therapy , Choriocarcinoma/secondary , Choriocarcinoma/surgery , Combined Modality Therapy , Cyclams , Drug Evaluation , Drug Synergism , Female , Hematologic Neoplasms/blood , Hematologic Neoplasms/drug therapy , Hematologic Neoplasms/surgery , Humans , Male , Middle Aged , Pregnancy , Retrospective Studies , Transplantation, Autologous , Uterine Neoplasms/blood , Uterine Neoplasms/drug therapyABSTRACT
OBJETIVO: Evaluar efectividad del tratamiento con plerixafor en pacientes sometidos a movilización para posterior autotrasplante de progenitores hematopoyéticos en nuestro hospital. MÉTODOS: Estudio retrospectivo de todos los pacientes que hasta septiembre 2012, recibieron plerixafor en su esquema de movilización de progenitores hematopoyéticos a sangre periférica. Se revisaron las historias clínicas y los registros de dispensación de medicamentos de la consulta de pacientes externos. Las variables de efectividad utilizadas fueron: CD34/kg en producto de aféresis obtenidas, dosis y días recibidos de factor estimulante de colonias (G-CSF) y de plerixafor. Para cada paciente se comparó los resultados de efectividad del fármaco con los obtenidos para anteriores esquemas de movilización en los que no se utilizó plerixafor, en caso de tenerlos. Los datos se analizaron mediante IBM spss v19. RESULTADOS: Un total de 24 pacientes recibieron plerixafor en nuestro hospital. Los diagnósticos se distribuyeron: 15 linfoma no Hodgkin , 6 pacientes con mieloma múltiple, 2 enfermedad de Hodgkin, y 1 coriocarcinoma diseminado. Los resultados de efectividad fueron: Movilización sin plerixafor (n = 18): 5 pacientes se movilizaron sólo con G-CSGF, 13 con G-CSF y quimioterapia. La dosis de G-CSF /día fue de 931,1 mcg (± 179,5), durante 9,5 días (± 4,7). El promedio de CD34/kg en producto obtenido fue de 0,2 células (± 0,5). Ningún paciente obtuvo producto suficiente (> 2 X 106 células/kg) para el posterior autotrasplante. El 100 % de las movilizaciones fracasaron. Movilización con plerixafor (n = 24): 13 pacientes se movilizaron sólo con G-CSGF, 11 con G-CSF y quimioterapia. La dosis de G-CSF /día y de plerixafor promedio fue de 885,1 mcg (± 240,1) y 19,8 (± 4,4), respectivamente, administrados durante 8,9 (± 5,1) y 1,5 (± 0,6) días, respectivamente. El promedio de CD34/kg en producto obtenido fue de 2,3x106 células (±1,7) (p = 0,014, en relación a las movilizaciones sin plerixafor). Sólo el 12,5% (n = 3) pacientes no pudieron someterse a autotrasplante. CONCLUSIONES: En nuestros pacientes, plerixafor ha demostrado ser efectivo en la movilización de progenitores hematopoyéticos para posterior autotrasplante
OBJECTIVE: To evaluate effectiveness of treatment with plerixafor in patients undergoing posterior mobilization for hematopoietic transplant at our hospital. METHODS: Retrospective study of all patients who until September 2012, received plerixafor in their scheme of mobilization into peripheral blood hematopoietic progenitors. We reviewed the medical records and records of drug dispensing outpatient consultation. Effectiveness variables used were: CD34/kg in apheresis product obtained, and day dose received colony stimulating factor (G-CSF) and Plerixafor. Each patient was compared to the effectiveness of the drug results with those obtained earlier mobilization schemes where Plerixafor not used, if present. Data were analyzed using IBM SPSS v19. RESULTS: A total of 24 patients received plerixafor in our hospital. Diagnoses were distributed: 15 NHL, 6 patients with multiple myeloma, 2 Hodgkin's disease, and one metastatic choriocarcinoma. The effectiveness outcomes were no plerixafor mobilization (n = 18): 5 patients were mobilized with G-CSGF only, 13 with G-CSF and chemotherapy. The G-CSF dose / day was mcg 931.1 (± 179.5) for 9.5 days (± 4.7). The average product obtained CD34/kg in cells was 0.2 (± 0.5). No patient received sufficient product (> 2 X 106 cells/kg) for subsequent autologous transplantation. 100% of the demonstrations failed. Mobilization with plerixafor (n = 24): 13 patients were mobilized with G-CSGF only, 11 with G-CSF and chemotherapy. The G-CSF dose/ day and averaged Plerixafor mcg 885.1 (± 240.1) and 19.8 (± 4.4), respectively, administered for 8.9 (± 5.1) and 1 , 5 (± 0.6) days, respectively. The average product obtained in CD34/kg was 2.3 X 106 cells (± 1.7) (p = 0.014 in relation to the demonstrations without Plerixafor). Only 12.5% (n = 3) patients were unable to undergo autologous transplant. CONCLUSIONS: In our patients, plerixafor has proven effective in mobilizing hematopoietic progenitors for autologous back
Subject(s)
Humans , Adjuvants, Immunologic/pharmacokinetics , Transplantation, Autologous , Hematopoietic Stem Cell Mobilization/methods , Hematopoietic Stem Cell Transplantation/methodsABSTRACT
Antecedentes. La yoduria es un buen marcador de la ingesta de yodo.En los países desarrollados existe una yodoprofilaxis silente, como consecuencia de un creciente contacto con sustancias y alimentos yodados. Objetivos. Conocer los determinantes ambientales de la yoduria en el curso de un estudio poblacional sobre deficiencia de yodo y bocio endémico. Material y métodos. A 756 niños de la población escolar de la Axarquía aleatoriamente seleccionados se les realiza una exploración clínica y medición de yodo en orina y hormonas tiroideas en sangre. A 548 niños se les realizó una encuesta alimentaria y de otros factores ambientales que pudieran condicionar el aporte de yodo. Resultados. La prevalencia de bocio ha sido del 37 por ciento y la mediana de yoduria, de 120 µg/l. Las siguientes variables han condicionado la yoduria de los niños: función tiroidea, procedencia geográfica, procedencia del agua de bebida, desinfección local de heridas recientes y muy especialmente la cantidad de leche ingerida. Conclusiones. La ingestión de leche ha sido la fuente más estable y consistente de yodo. El estudio demuestra que en ausencia de una yodoprofilaxis sistemática una mediana de yoduria de 120 µg/l es conseguida predominantemente a partir de fuentes (alimentarias y no alimentarias) que están sometidas a una gran variabilidad y discrecionalidad tanto en su composición de yodo como en su consumo, sobre todo si tenemos en cuenta el bajo consumo de sal yodada de la población. Ante la dificultad para conseguir una política institucional de yodoprofilaxis parece necesario aumentar la ingestión de lácteos en la población escolar, una recomendación, por otro lado, necesaria también para conseguir otros objetivos de salud (AU)
Subject(s)
Female , Male , Child , Humans , Iodine Deficiency , Iodine/urine , Thyroid Hormones/blood , Goiter, Endemic/epidemiology , Feeding Behavior , Breast-Milk SubstitutesABSTRACT
The aim of this study was to determine the relationship between auditory capacity and urinary iodine, taking into account thyroid volume and function, in a population of school-age children. Audiometry was carried out in 150 children (ages 6-14 years), together with measurements of thyroid volume, thyrotropin (TSH), free T3, free T4, thyroglobulin, antiperoxidase and anti-TSH receptor antibodies, as well as iodine in a casual urine sample. Children with a TSH >5 microU/mL were excluded from the study. In the children with palpable goiter, there was an inverse relation between the auditory threshold at all frequencies and ioduria. Children with thyroglobulin values >10 ng/mL had a higher auditory threshold at all frequencies. In the children with palpable goiter and ioduria <100 microg/L, the levels of thyroglobulin and ioduria and the age accounted for 75% of the decibel (dB) variance at 2000 (Hertz), with similar results at other frequencies. The children with a thyroid sized at the >95th percentile had an odds ratio of 3.86 (95% confidence interval: 2.59-5.10) of having a threshold >20 dB. The results warn that iodine prophylaxis is needed to prevent not only goiter but also other iodine-deficiency disorders, such as involvement of the auditory threshold in school-age children.
Subject(s)
Auditory Threshold/physiology , Goiter/drug therapy , Goiter/physiopathology , Iodine/administration & dosage , Thyroid Gland/physiology , Adolescent , Bone Conduction/physiology , Child , Child, Preschool , Deafness/etiology , Deafness/physiopathology , Female , Goiter/complications , Hearing Tests , Humans , Iodine/urine , MaleABSTRACT
Objetivos. a) Evaluar la prevalencia de bocio y de deficiencia de yodo (DDY) en la comarca de la Axarquía (Málaga) (el último estudio data de 1980), y b) comparar los diferentes criterios (bocio, yoduria, concentraciones de TSH neonatal, tiroglobulina y volumen tiroideo) propuestos para identificar los DDY. Material y método. Población de referencia: población escolar de la comarca de la Axarquía (sureste de la provincia de Málaga). Muestra: 756 niños. Error muestral del 3,4 por ciento (intervalo de confianza del 95 por ciento; 3,3-3,5 por ciento). Procedimientos: se calcula la prevalencia de bocio y DDY a partir de: a) palpación de tiroides y yoduria (criterios de las agencias internacionales); b) concentraciones de tiroglobulina > 10 ng/ml; c) valores de TSH de cribado de hipotiroidismo congénito (TSH > 5 µU/ml), y d) volumen tiroideo (ecografía) > percentil 97 (Delange, OMS). Resultados. La prevalencia de bocio por palpación ha sido del 37 por ciento. El 20,8 por ciento presentó un bocio grado Ia y el 16,3 por ciento, grado Ib. El bocio ha sido más frecuente en los pueblos del interior especialmente en la zona de la sierra de Almijara (59,7 por ciento). La yoduria media fue de 121,5 µg/l y la mediana de 120 µg/l. El 48,5 por ciento de los niños excretaron menos de 100 µg/l. La variable que más ha contribuido al riesgo de tener bocio ha sido la zona en la que se vive dentro de la comarca (odds ratio [OR] = 2,06). La tiroglobulina fue más alta en el grupo de niños con yodurias menores de 50 µg/dl. El 34,1 por ciento de los niños tuvieron la tiroglobulina entre 10 y 19,9 ng/ml y el 7 por ciento por encima de 20 ng/ml. La mediana de la tiroglobulina para toda la muestra ha sido de 8,9 ng/ml. La prevalencia de niños con TSH > 5 µU/ml en el programa de detección precoz de hipotiroidismos congénitos ha sido del 9,3 por ciento, en la Axarquía y 9,8 por ciento, en la comarca limítrofe de Antequera, frente al 6,6 y al 7,4 por ciento de dos distritos de Málaga capital. La prevalencia de bocio a partir del P-97 del volumen tiroideo por ecografía siguiendo los criterios propuestos por Delange fue del 3,2-3,8 por ciento. Discusión. En la comarca de la Axarquía (Málaga) persiste, en 1999, una endemia bociosa de grado I, a pesar de presentar una mediana de yoduria de 120 µg/l. De haber utilizado la tiroglobulina y los puntos de corte de volumen tiroideo grande propuestos por Delange como indicadores de DDY, se habría desestimado la existencia de esta endemia (AU)
Subject(s)
Female , Male , Child , Humans , Goiter, Endemic/epidemiology , Mass Screening/methods , Iodine/urine , Palpation/methods , Goiter, Endemic/diagnosis , Thyroglobulin/bloodABSTRACT
Acinetobacter sp. are gram-negative bacteria and usually resistant to multiple antibiotics. They are a customary cause of nosocomial infections, but are uncommon etiologic agents of endocarditis. We present a case of endocarditis caused by Acinetobacter iwoffi in a composite aortic graft with a St. Jude prosthetic valve, using the Bono and Bentall procedure, complicated with multiple graft dehiscenses causing first a peritube pseudoaneurysm and finally severe paraprosthetic valve regurgitation to the left ventricle which required emergency surgery.
Subject(s)
Acinetobacter Infections , Endocarditis, Bacterial/microbiology , Heart Valve Prosthesis , Surgical Wound Dehiscence/microbiology , Aneurysm, False/etiology , Aortic Aneurysm, Thoracic/etiology , Aortic Valve , Humans , Male , Middle AgedABSTRACT
After coronary bypass surgery in the left internal mammary artery, occlusive atherosclerosis in the proximal subclavian artery can produce reverse flow in the mammary artery and myocardial ischemia (coronary-subclavian steal syndrome). This is a rare cause of recurrent myocardial ischemia. We present two patients with postoperative complete obstruction in the proximal subclavian artery and inverse flow in the mammary artery producing severe ischemia in the left anterior descending artery territory. Both patients were treated with subclavian-subclavian bypass, which in one patient was ineffective in producing an adequate anterograde flow in the left internal mammary artery. We review clinical management, diagnostic methods and therapeutic options used in the coronary-subclavian steal syndrome.
Subject(s)
Angina Pectoris/etiology , Internal Mammary-Coronary Artery Anastomosis/adverse effects , Myocardial Ischemia/etiology , Aged , Angina Pectoris/surgery , Humans , Male , Middle Aged , Myocardial Ischemia/surgery , Reoperation , SyndromeABSTRACT
OBJECTIVES: To find the evolution of consumption of self-analysis material used to control Diabetes (reactive strips of glucose) and the costs involved, in the metropolitan area of Málaga from July 1994 to the first quarter of 1996. DESIGN: Descriptive retrospective study. SETTING: Metropolitan area of Málaga (580, 586 inhabitants), which is divided in two HEALTH DISTRICTS: Málaga East and West. PATIENTS: All diabetics using reactive strips in the metropolitan area of Málaga which are charged to the National Health system. MEASUREMENTS AND MAIN RESULTS: The data base of the health districts of the metropolitan area of Málaga was used for the review of public prescriptions of reactive strips. Consumption in relation to the total population was analysed and the average consumption per diabetic was calculated. The total number of patients for whom reactive strips were prescribed increased considerably over the three years studied. CONCLUSIONS: A considerable increase in consumption of glucose reactive strips was observed in recent years in the metropolitan area of Málaga, mainly because of its generalised use among elderly patients. Consumption of urine strips was small and tended to fall.
Subject(s)
Blood Glucose Self-Monitoring , Diabetes Mellitus/blood , Reagent Strips , Adult , Aged , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 2/blood , Humans , Middle Aged , Retrospective Studies , SpainABSTRACT
Catecholamine-induced cardiomyopathy is a rare complication of pheochromocytoma. We present a case of pheochromocytoma that developed preoperative heart failure. Left ventricular dilation and severe hypokinesia were demonstrated by echocardiography. Heart failure was successfully treated with digitalis, diuretics and captopril. There were no surgical complications and the follow up showed and improvement on the systolic function evaluated by echocardiography and isotope ventriculography, 3 and 6 months after surgery. We review the pathophysiology and evolution of catecholamine induced cardiomyopathy. Preload reserve can be one of the adaptive mechanisms of the ventricle in catecholamine-induced cardiomyopathy. Conventional therapy of hypertension and heart failure can be effective to correct the symptoms of cardiac dysfunction.
Subject(s)
Adrenal Gland Neoplasms/complications , Cardiomyopathies/etiology , Pheochromocytoma/complications , Adrenal Gland Neoplasms/blood , Adrenal Gland Neoplasms/surgery , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Captopril/therapeutic use , Cardiomyopathies/diagnosis , Catecholamines/blood , Digitalis , Diuretics/therapeutic use , Echocardiography , Follow-Up Studies , Furosemide/therapeutic use , Heart Failure/diagnosis , Heart Failure/drug therapy , Heart Failure/etiology , Humans , Male , Middle Aged , Pheochromocytoma/blood , Pheochromocytoma/surgery , Plants, Medicinal , Plants, Toxic , Time FactorsSubject(s)
Adenoma/diagnosis , Adrenal Cortex Neoplasms/diagnosis , Cushing Syndrome/complications , Hypertension/etiology , Adenoma/pathology , Adenoma/surgery , Adrenal Cortex/pathology , Adrenal Cortex Neoplasms/pathology , Adrenal Cortex Neoplasms/surgery , Female , Humans , Middle Aged , Tomography, X-Ray ComputedSubject(s)
Aorta, Abdominal/pathology , Paraganglioma, Extra-Adrenal/surgery , Ureter/pathology , Adult , Aorta, Abdominal/surgery , Biomarkers , Blood Vessel Prosthesis , Female , Follow-Up Studies , Goiter, Nodular/complications , Humans , Hypertension/etiology , Neoplasm Invasiveness , Nephrectomy , Paraganglioma, Extra-Adrenal/complications , Paraganglioma, Extra-Adrenal/diagnosis , Paraganglioma, Extra-Adrenal/pathology , Renal Artery/surgery , Renal Veins/surgery , Ureter/surgeryABSTRACT
BACKGROUND: The nutritional state reportedly influences the age of menarche. In this work we investigated the potential relationship between the intake of various types of foods and the age of menarche, irrespective of body weight. METHODS: An overall 777 schoolgirls of ages between 8 and 16 years from Benalmádena (Málaga, Spain) were subjected to a cross-sectional study involving: the age of menarche as the dependent variable; and the weight, body mass index, skinfold thickness, food intake (estimated from weekly food frequency questionnaires), and age of menarche in the proband's mother and sisters as independent variables. Several models were developed in order to calculate the strength of association between the dependent variable (the presence or absence of menarche) and the independent variables. RESULTS: The average age of menarche was 12.4 years. The intake of the various types of foods was not consistent between the different age groups. In girls of 12 or younger, the age of menarche was found to be related to weight: Odds ratio (OR) = 7.06; (Confidence intervals (CI) = 2.80-17.6). On inclusion of various foods groups, the OR rose to 49.89 (CI = 40.85-60.84). In girls over 12, the age of menarche was essentially related to the intake of nuts and seeds (OR = 0.71, CI = 0.40-0.98). Inclusion of other foods groups decreased the OR (OR = 0.34, CI = 0.14-0.39). CONCLUSIONS: Significant statistical relationship between intake of nuts and seeds and the age of menarche was found.