Efecto de un equipo multidisciplinar (código TEP) en el pronóstico de los pacientes con tromboembolia de pulmón aguda sintomática / Impact of a pulmonary embolism response team (PERT) in the prognosis of patients with acute symptomatic pulmonary embolism

Antecedentes No se han aclarado suficientemente los beneficios del manejo multidisciplinar (código TEP) de los pacientes con tromboembolia de pulmón (TEP) aguda sintomática. El objetivo de este estudio fue evaluar el efecto sobre la mortalidad a corto plazo del código TEP comparado con la atención habitual. Métodos Realizamos un estudio retrospectivo que incluyó a todos los pacientes con diagnóstico de TEP aguda sintomática ingresados en un hospital terciario universitario entre los años 2007 y 2022. Mediante un análisis de emparejamiento exacto 1:1, los pacientes atendidos por un equipo multidisciplinar para el manejo de la TEP (código TEP) fueron emparejados con otros que recibieron la atención habitual (es decir, no multidisciplinar) para la TEP. El evento primario de eficacia fue la mortalidad por cualquier causa durante los 30 primeros días después del diagnóstico. El evento secundario de eficacia fue la mortalidad por la propia TEP durante el mismo período de tiempo. Resultados De los 2.902 pacientes con diagnóstico de TEP aguda sintomática incluidos en este estudio, 223 (7,7%; intervalo de confianza [IC] del 95%: 6,7-8,7%) fueron manejados por el código TEP. Se emparejaron 207 pacientes manejados por el código TEP con 207 pacientes manejados de forma habitual. En la cohorte emparejada, la atención multidisciplinar a los pacientes con TEP aguda sintomática no se asoció a una reducción significativa de la mortalidad por cualquier causa (odds ratio [OR]: 1,09; IC del 95%: 0,63-1,89) o por la propia TEP (OR: 1,30; IC del 95%: 0,47-3,62) en el mes posterior al diagnóstico de la TEP. Conclusiones La atención multidisciplinar a los pacientes con TEP aguda sintomática no se asoció a una reducción significativa de la mortalidad precoz. (AU)

Background The effect of a pulmonary embolism response team (PERT) in the short-term prognosis of patients with acute symptomatic pulmonary embolism (PE) lacks clarity. We therefore aimed at evaluating the effect of a PERT team on short-term mortality among patients with acute PE. Methods We retrospectively reviewed consecutive patients with acute symptomatic PE enrolled in a single-center registry between 2007 and 2022. We used propensity score matching to compare treatment effects for patients with similar predicted probabilities of receiving management by the PERT team. The primary outcome was all-cause mortality within 30 days following the diagnosis of PE. The secondary outcome was 30-day PE-related mortality. Results Of the 2,902 eligible patients who had acute symptomatic PE, 223 (7.7%; 95% confidence interval [CI], 6.7%-8.7%) were managed by the PERT team. Two hundred and seven patients who were treated by the PERT were matched with 207 patients who were not. Matched pairs did not show a statistically significant lower all-cause (odds ratio [OR], 1.09; 95% CI, 0.63-1.89) or PE-related death (OR, 1.30; 95% CI, 0.47-3.62) for PERT management compared with no PERT management through 30 days after diagnosis of PE. Conclusions Our results suggest that multidisciplinary care of patients with acute symptomatic PE by a PERT team is not associated with a significant reduction in short-term all-cause or PE-related mortality. (AU)

Impact of a pulmonary embolism response team (PERT) in the prognosis of patients with acute symptomatic pulmonary embolism.

BACKGROUND: The effect of a pulmonary embolism response team (PERT) in the short-term prognosis of patients with acute symptomatic pulmonary embolism (PE) lacks clarity. We therefore aimed at evaluating the effect of a PERT team on short-term mortality among patients with acute PE. METHODS: We retrospectively reviewed consecutive patients with acute symptomatic PE enrolled in a single-center registry between 2007 and 2022. We used propensity score matching to compare treatment effects for patients with similar predicted probabilities of receiving management by the PERT team. The primary outcome was all-cause mortality within 30 days following the diagnosis of PE. The secondary outcome was 30-day PE-related mortality. RESULTS: Of the 2,902 eligible patients who had acute symptomatic PE, 223 (7.7%; 95% confidence interval [CI], 6.7%-8.7%) were managed by the PERT team. Two hundred and seven patients who were treated by the PERT were matched with 207 patients who were not. Matched pairs did not show a statistically significant lower all-cause (odds ratio [OR], 1.09; 95% CI, 0.63-1.89) or PE-related death (OR, 1.30; 95% CI, 0.47-3.62) for PERT management compared with no PERT management through 30 days after diagnosis of PE. CONCLUSIONS: Our results suggest that multidisciplinary care of patients with acute symptomatic PE by a PERT team is not associated with a significant reduction in short-term all-cause or PE-related mortality.

Are liver contour and bone fusion comparable to fiducials for IGRT in liver SBRT?

Introduction: Liver stereotactic body radiotherapy (SBRT) is increasingly being used to treat tumours. The purpose of this study was to compare the differences in patient positioning when using implanted fiducials as surrogates compared to alternative methods based on liver contour or bone registration. Material and methods: Eighteen patients treated with SBRT who underwent a fiducial placement procedure were included. Fiducial guidance was our gold standard to guide treatment in this study. After recording the displacements, when fusing the planning CT and CBCT performed in the treatment unit using fiducials, liver contour and bone reference, the differences between fiducials and liver contour and bone reference were calculated. Data from 88 CBCT were analyzed. The correlation between the displacements found with fiducials and those performed based on the liver contour and the nearest bone structure as references was determined. The mean, median, variance, range and standard deviation of the displacements with each of the fusion methods were obtained. µ, Æ©, and σ values and margins were obtained. Results: Lateral displacements of less than 3 mm with respect to the gold standard in 92% vs. 62.5% of cases using liver contour and bone references, respectively, with 93.2% vs. 65.9% in the AP axis and SI movement in 69.3% vs. 51.1%. The errors µ, σ and Æ© of the fusions with hepatic contour and bone reference in SI were 0.26 mm, 4 mm and 3 mm, and 0.8 mm, 5 mm and 3 mm respectively. Conclusion: Our study showed that displacements were smaller with the use of hepatic contour compared to bone reference and comparable to those obtained with the use of fiducials in the lateral, AP and SI motion axes. This would justify that hepatic contouring can be a guide in the treatment of patients in the absence of fiducials.

Influence of different drilling protocols and bone density on the insertion torque of dental implants.

BACKGROUND: The insertion torque of dental implants will depend on a combination of different factors such as bone density, the design of the implant and the drilling protocol used. However, it is not clear how the interaction of these factors affects the final insertion torque and which drilling protocol should be used in each clinical situation. The aim of this work is to analyse the influence of bone density, implant diameter and implant length on the insertion torque using different drilling protocols. MATERIAL AND METHODS: An experimental study was carried out in which the maximum insertion torque was measured, in standardised polyurethane blocks (Sawbones Europe AB) of four densities, for M12 Oxtein dental implants (Oxtein, Spain) with diameters of 3.5, 4.0, 4.5 and 5mm, and lengths of 8.5mm, 11.5mm and 14.5mm. All these measurements were carried out following four drilling protocols, a standard protocol, adding a bone tap, cortical drill or conical drill. In this way, a total of 576 samples were obtained. For the statistical analysis, the table of confidence intervals, mean, standard deviation and covariance was carried out, in total and grouped by the parameters used. RESULTS: The insertion torque for D1 bone obtained very high levels, reaching 77 6.95 N/cm, these values improved with the use of conical drills. In D2 bone, the mean torque obtained was 37.89± 13.70N/cm, with values within the standard. In D3 and D4 bone significantly low torques were obtained with values of 14.97± 4.40N/cm and 9.88± 4.16N/cm (p>0.001) respectively. CONCLUSIONS: In D1 bone, conical drills must be incorporated in drilling to avoid excessive torque, while in D3 and D4 bone, these would be contraindicated, as they drastically decrease the insertion torque, which may compromise the treatment.

Improvement in fetal pulmonary hypertension and maturity after reversal of ductal constriction: prospective cohort study.

OBJECTIVES: To test the hypotheses that estimated mean pulmonary arterial pressure (MPAP) decreases and pulmonary vascular maturation, assessed by the ratio of pulmonary arterial flow acceleration time to ejection time (AT/ET ratio), increases after reversal of fetal ductus arteriosus constriction by reducing maternal intake of the causal agent (prostaglandin inhibitors, such as polyphenol-rich foods or non-steroidal anti-inflammatory drugs), and that these effects are independent of gestational age, which are inferences not yet demonstrated in the clinical setting. METHODS: This was a prospective cohort study comparing Doppler echocardiographic ductal flow dynamics, MPAP and pulmonary arterial flow AT/ET ratio in third-trimester fetuses (≥ 28 weeks' gestation) with ductus arteriosus constriction, at the time of diagnosis and after 2 weeks of reduced maternal intake of prostaglandin inhibitors either by suspending the use of pharmacological agents with potential for prostaglandin inhibition or by restricting the consumption of polyphenol-rich foods. MPAP was estimated using the Dabestani equation (MPAP = 90 - (0.62 × AT)), and pulmonary vascular maturity was assessed using the AT/ET ratio, according to reported validation studies. Student's t-test was used for comparison of variables at diagnosis with those after reversal of ductal constriction. Change in MPAP and pulmonary AT/ET ratio between the two assessments was compared with the expected change in the same gestational period in normal fetuses based on reference curves of MPAP and pulmonary AT/ET ratio constructed in normal fetuses from healthy pregnant women at 19-37 weeks' gestation, encompassing the same gestational age range as the study group (28-37 weeks). RESULTS: Seventy pregnancies with fetal ductus arteriosus constriction were included in the study. After 2 weeks of reduced maternal intake of prostaglandin inhibitors, normalization of mean systolic (change from 1.86 ± 0.34 m/s at diagnosis to 1.38 ± 0.41 m/s; P < 0.001) and diastolic (change from 0.41 ± 0.11 m/s to 0.21 ± 0.065 m/s; P < 0.001) ductal velocities and of mean pulsatility index (change from 1.99 ± 0.20 to 2.55 ± 0.42; P < 0.001) was demonstrated. MPAP decreased between the assessments (change from 66.7 ± 6.90 mmHg at diagnosis to 54.5 ± 6.70 mmHg after 2 weeks; P < 0.001) and mean pulmonary AT/ET ratio increased (change from 0.20 ± 0.06 to 0.33 ± 0.07; P < 0.001). Change in MPAP between diagnosis and after 2 weeks of reduced maternal intake of prostaglandin inhibitors was -12.2 ± 0.30 mmHg, which was 5.3-times higher than that in 305 normal fetuses over 2 weeks during the same gestational period (-2.3 ± 0.19 mmHg) (P < 0.001), and change in pulmonary AT/ET ratio between the two assessments was 0.13 ± 0.08, which was 8.7-times higher than that in normal fetuses in the same gestational period (0.015 ± 0.08) (P < 0.001). CONCLUSIONS: Resolution of fetal ductal constriction is followed by a fall in MPAP and by an increase in pulmonary vascular maturity, to a significantly greater degree than is observed in normal fetuses in the same gestational-age period. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Advantages of surgical simulation in the surgical reconstruction of oncological patients.

BACKGROUND: Stereolithography, which consists of computer-aided designed/computer-aided manufactured (CAD-CAM) and computer simulations, is a manufacturing technologies used for the production of definitive models and prototypes printed in three dimensions, and is widely used in Oral and Maxillofacial Surgery. Surgical procedures using models made by these technologies offer several advantages. MATERIALS AND METHODS: This article describes three clinical cases of our experiences with patients diagnosed with squamous cell carcinoma and mandibular osteosarcoma, who underwent surgical removal of the lesions and subsequent mandibular reconstruction with a free fibula graft using surgical guides. RESULTS: In all three clinical cases, surgical guides were used for the mandibular osteotomy, fibula osteotomy, and graft placement in the recipient area. DISCUSSION: Surgical guidelines are useful for improving the accuracy of surgical interventions and are appropriate for many types of resection and mandibular reconstruction.

Influence of dental treatment in place on quality of life in oral cancer patients undergoing chemoradiotherapy.

BACKGROUND: This study aims to assess, in the population of patients with oral cancer treatment, the influence on the quality of life of two protocols of dental treatment: not ruled hospital treatment versus ruled hospital treatment. Matrial and Methods: A quasi-experimental approach justified on ethical grounds was used. A total of 41 patients were included in the control group (not ruled treatment outpatient health center) and 40 in the experimental group (ruled hospital treatment). A total of 14 questions to both groups were conducted in three stages: before starting cancer treatment, during treatment and after treatment. the proportions of positive responses in groups and different times were compared using the chi-square test. RESULTS: Based on similar situations during cancer treatment were identified as six issues favorable to the experimental group difference. This number rose to nine after finishing oncological treatment. CONCLUSIONS: From our data we can confirm that planned dental treatment performed during the oral cancer treatment produces an improvement in the quality of life in patients with oral cancer.

Reduction rate by decompression as a treatment of odontogenic cysts.

BACKGROUND: Odontogenic cysts are defined as those cysts that arise from odontogenic epithelium and occur in the tooth-bearing regions of the jaws. Cystectomy, marsupialization or decompression of odontogenic cyst are treatment approach to this pathology. The aim of this study was to evaluate the effectiveness of the decompression as the primary treatment of the cystic lesions of the jaws and them reduction rates involving different factors. MATERIAL AND METHODS: 23 patients with odontogenic cysts of the jaws, previously diagnosed by anatomical histopathology (follicular cysts (7) and radicular cysts (16)) underwent decompression as an initial treatment. Clinical examination and pre and post panoramic radiograph were measured and analyzed. In addition, data as gender, age, time reduction and location of the lesion were collected. RESULTS: Significant results were obtained in relation to the location of lesions and the reduction rate (p<0.01). In a higher initial lesion, a greater reduction rate was observed (p<0.05). CONCLUSIONS: Decompression as an initial treatment of cystic lesions of the jaws was effective; it reduces the size of the lesions avoiding a possible damage to adjacent structures. Cystic lesions in the mandible, regardless of the area where they occur will have a higher reduction rate if it is compared with the maxilla. Similar behavior was identified in large lesions compared to smaller.

A Prospective, Double-Blind, Randomized, Controlled Clinical Trial in the Gingivitis Prevention with an Oligomeric Proanthocyanidin Nutritional Supplement.

AIM: To evaluate the effectiveness on tissue response of the new nutritional supplement made of oligomeric proanthocyanidins in induced gingivitis after 21 days of use. MATERIAL AND METHODS: A prospective, double-blind, randomized, controlled clinical trial was carried out on 20 patients; it is divided into an experimental group and a control group after fulfilling the selection criteria. Patients had to come 4 times during the study to register the Silness and Löe index, the gingival bleeding index, the plaque index, the inflammatory crevicular fluid study (IL6), and the changes in the brightness of the gingiva. No complementary hygiene methods were allowed during the 21 days. RESULTS: The Silness and Löe index was higher in the control group than in the experimental group, reaching a twofold difference between the groups (p < 0.0001). The gingival bleeding index also supports this fact, since the bleeding was lower in the experimental group (p < 0.005). However, the dental plaque on the tooth surface according to the plaque index was 33% higher in the experimental group (p < 0.006). Some differences in the IL-6 were found in the crevicular fluid (p < 0.0001). CONCLUSION: Oligomeric proanthocyanidins have an effect on the periodontal tissue's health. No effects on the accumulation of plaque on the tooth surface were found, so further studies are needed to determine the nature of the plaque.

ESTES guidelines: acute mesenteric ischaemia.

PURPOSE: Acute mesenteric ischaemia (AMI) accounts for about 1:1000 acute hospital admissions. Untreated, AMI will cause mesenteric infarction, intestinal necrosis, an overwhelming inflammatory response and death. Early intervention can halt and reverse this process leading to a full recovery, but the diagnosis of AMI is difficult and failure to recognize AMI before intestinal necrosis has developed is responsible for the high mortality of the disease. Early diagnosis and prompt treatment are the goals of modern therapy, but there are no randomized controlled trials to guide treatment and the published literature contains a high ratio of reviews to original data. Much of that data comes from case reports and often small, retrospective series with no clearly defined treatment criteria. METHODS: A study group of the European Society for Trauma and Emergency Surgery (ESTES) was formed in 2013 with the aim of developing guidelines for the management of AMI. A comprehensive literature search was performed using the Medical Subject Heading (MeSH) thesaurus keywords "mesenteric ischaemia", "bowel ischaemia" and "bowel infarction". The bibliographies of relevant articles were screened for additional publications. After an initial systematic review of the literature by the whole group, a steering group formulated questions using a modified Delphi process. The evidence was then reviewed to answer these questions, and recommendations formulated and agreed by the whole group. RESULTS: The resultant recommendations are presented in this paper. CONCLUSIONS: The aim of these guidelines is to provide recommendations for practice that will lead to improved outcomes for patients.

Case Series: Fetal Pulmonary Vein A-Wave Reversal: An Early Marker of Left-Sided Cardiac Anomalies?

Background Improvements in congenital heart disease (CHD) screening are needed based on the lack of sensitivity of current screening methods and the understanding that the early detection of certain CHDs may improve outcomes. Fetal venous circulation has caught medical attention, and two studies demonstrated that it is feasible to register pulmonary vein flow velocity waveforms (FVWs) during early gestation. Meanwhile, the latter study proposed pulmonary vein A-wave reversal as a marker of cardiac anomaly. Methods We report a series of six consecutive fetuses with confirmed cardiac anomalies that underwent first-trimester screening, including pulmonary vein FVWs, at our center during 2013. CHD was confirmed by late pregnancy echocardiography, and in three cases fetal autopsies were performed. Result/Discussion The ductus venosus (DV) and nuchal translucency (NT) predicted 50% of CHD cases, whereas the combination of markers identified 66.6% of CHD cases. When adding pulmonary vein assessment, the rate of detection rose to 83.3%. Total five of six cases of CHD had reversal of pulmonary vein A-wave during early pregnancy. The sixth case with CHD and nonreversal of A-wave was described as right ventricle hypoplasia with type 1 tricuspid atresia and persistent ductus arteriosus. Conclusion This is the first series reporting pulmonary vein end-diastolic reversal as a CHD screening add-on during early pregnancy. The addition of pulmonary vein FVW assessment to the current CHD screening bundle could increase the rate detection of cardiac anomalies. This pilot study suggests that pulmonary vein end-diastolic flow reversal favors detection of left-sided CHD over the right-sided ones.

Profiling left and right ventricular proportional output during fetal life with a novel systolic index in the aortic isthmus.

OBJECTIVE: Left ventricular ejection causes forward flow in the fetal aortic isthmus while the right ventricle has a retrograde influence. The aim of this study was to create reference values for an isthmic systolic index (ISI) reflecting the changing influence of right and left ventricular performance on Doppler flow velocity waveforms of the aortic isthmus throughout normal pregnancy. METHODS: Doppler recordings of 260 normal fetuses with a gestational age of 18-37 weeks were reviewed. Peak systolic velocity (PSV) and end-systolic velocity (or systolic nadir; Ns) were measured on all aortic isthmus waveforms. An ISI was derived from the ratio Ns/PSV. Left and right ventricular outputs were also calculated. RESULTS: Up to 22-23 weeks' gestation, the mean ISI is stable at around 0.2. At about 28 weeks, a brief end-systolic deceleration wave is observed on the aortic isthmus waveforms, progressing steadily with gestation and causing a fall of ISI towards a mean value of zero between 30 and 31 weeks. This trend continues thereafter and a mean value of -0.4 was observed at the end of pregnancy. An inverse correlation was found between right ventricular output and Ns (r = -0.334, P = 0.001). Simultaneous recordings of the isthmus and the ductus arteriosus Doppler waveforms demonstrated that the primary cause of the end-systolic deceleration and ultimate reversal of flow at the isthmus is the increasingly dominant flow from the right ventricle. CONCLUSION: The transitional changes of the respective right and left ventricular outputs throughout pregnancy are well profiled by the ISI. This index highlights the physiological increase in fetal right ventricle flow preponderance as pregnancy progresses. Alteration of the ISI profile could be expected in clinical conditions associated with unbalanced alteration of the fetal ventricular outputs.

Assessment of pericallosal arteries by color Doppler ultrasonography at 11-14 weeks: an early marker of fetal corpus callosum development in normal fetuses and agenesis in cases with chromosomal anomalies.

OBJECTIVE: The aims of this study were to determine (a) whether the normal pericallosal vascular map can be visualized using color Doppler ultrasonography in normal fetuses in the first trimester of pregnancy and (b) whether an abnormal pericallosal artery (PA) vascular map can be observed in fetuses with corpus callosum agenesis early in pregnancy. METHODS: In 150 consecutive women undergoing a routine ultrasound examination at 11-14 weeks of gestation in our high-risk pregnancy unit as part of screening for chromosomal abnormalities, a mid-sagittal view of the fetal head was obtained to measure nuchal translucency thickness, assess nasal bones in their corresponding two oblique planes and intracranial translucency. In this view and with color Doppler ultrasonography, we evaluated the vascular map of the PA. RESULTS: The vascular map of the PA was observed in 97.02% of cases at the 11- to 14-week evaluation (144/150 fetuses). Two cases with an abnormal PA were identified and confirmed as corpus callosum agenesis in the second trimester, 1 due to trisomy 13 and the other due to triploidy. CONCLUSIONS: The PA can routinely be observed at the first-trimester evaluation with color Doppler ultrasonography using the mid-sagittal view of the fetal head. The presence of an abnormal vascular map of the PA by Doppler ultrasonography at 11-14 weeks raises the suspicion of corpus callosum agenesis.

Membranoproliferative glomerulonephritis possibly associated with over-vaccination in a cocker spaniel.

Membranoproliferative glomerulonephritis was observed in a seven-month-old male cocker spaniel dog. The clinical, microbiological, biochemical, radiographic and ultrasonographic examinations ruled out neoplasia, congenital disease and infectious disease. The anamnesis revealed that the owner had vaccinated the dog seven times, one vaccination per month, without veterinarian supervision. In both kidneys, severe thickening of the glomerular capillary walls was observed. Electron microscope examination revealed a large number of electron-dense deposits that were primarily in the glomerular subendothelial spaces and the basal membrane, which is compatible with antigen-antibody complexes. The immunohistochemical examination revealed that the antigen present in the glomeruli corresponded with the antigen present in the vaccine. We report a type III hypersensitivity nephropathy in a young dog, which was possibly caused by over-vaccination.

"Signo del cometa": primer indicio ecográfico del embarazo eutópico / "Comet sing": first echographic evidence of eutopic pregnancy

Objetivo. Demostrar mediante ultrasonografía la presencia de flujo vascular en el área de implantación («signo del cometa») previa a la observación del saco gestacional. Material y método. Se realizó un estudio observacional en ocho pacientes con mala historia reproductiva que acudieron a consulta por amenorrea conocida. Se les sometió a ecografía endovaginal con estudio Power Doppler y determinaciones seriadas de la subunidad B de gonadotropina coriónica (hCG-B) sérica. Resultados. En las ocho pacientes se identificaron el/los vaso(s) en el lugar de implantación utilizando el Power Doppler antes de la visualización del saco gestacional. Los valores de la hCG-B en dicho momento fluctuaron entre 375 UI y 730 UI, siendo la mediana 515 UI. Conclusión. El primer signo ecográfico de embarazo eutópico serían los vasos deciduales en el área de implantación demostrados con el Power Doppler

Objective. To demonstrate by using ultrasound the presence of vascular flow in the area of implantation («comet sign») before the observation of the gestational sac. Material and method. An observational study was made in eight patients with bad reproductive history, who came to consult because of known amenorrhea. Endovaginal ultrasound with Power Doppler and human chorionic gonadotrophin B (hCG-B) subunit in serum were taken. Results. In the eight patients were identified the vessels at the site of implantation using the Power Doppler, before visualization of the gestational sac. Values of hCG-B at those moments fluctuated between 375 UI and 730 UI, median 515 UI. Conclusion. The first echographic sign of eutopic pregnancy would be the decidual vessels at the site of implantation, demonstrated using the Power Doppler

Ondas de flujo doppler en las venas cavas superior e inferior en fetos normales y con crecimiento restringido / Dopppler flow velocity patterns of the superior and inferior venae cavae in normal fetuses and fetal growth retardation

Objetivo. Evaluar el comportamiento de las velocidades de las ondas de flujo de las venas cavas superior e inferior en gestaciones no complicadas y de fetos afectados por crecimiento restringido y someter a comprobación la hipótesis de que en fetos normales las velocidades en la vena cava inferior son más elevadas que las de la vena cava superior, y cuando existen condiciones de hipoperfusión placentofetal con redistribución de flujo sanguíneo dicha condición se invierte.Material y métodos. Estudio de carácter analítico, prospectivo mixto, longitudinal y de sección transversal en el que mediante flujometría doppler se evalúan 250 fetos normales entre las 12 y 41 semanas y 23 fetos con crecimiento restringido con elevada impedancia o ausencia de velocidades diastólicas en la arteria umbilical. Los parámetros evaluados fueron: durante la sístole ventricular el pico de velocidad sistólica máxima (Smáx) y la velocidad al final de la sístole (Smín). Durante la diástole se midieron los picos de velocidades de las ondas E y A. Se aplicaron técnicas estadísticas descriptivas e inferenciales de acuerdo al tipo de diseño.Resultados. Las velocidades de las ondas de flujo de las venas cavas aumentaron conforme progresó el embarazo; para ambos vasos las velocidades mostraron una tendencia ascendente a medida que avanzó la edad gestacional, siendo variable el grado de correlación entre ambas variables.De la comparación entre las velocidades de las venas cavas superior e inferior en el grupo normal podemos inferir que todas ellas difieren de manera estadísticamente significativa, siendo mayores en la vena cava inferior. Las velocidades de ambos vasos fueron significativamente mayores en el grupo comprendido entre 27 y 41 semanas que las observadas entre las 12 y 26 semanas. En los casos de crecimiento fetal restringido las velocidades de las ondas de flujo de la vena cava superior (Smáx, Smín y E) fueron significativamente mayores y las de la onda A significativamente menores que las de la vena cava inferior. Al comparar los valores entre ambos grupos se pudo comprobar que en el de crecimiento fetal restringido las velocidades en la vena cava superior fueron superiores a las del grupo control en sus componentes Smín, E y A, mientras que no existieron diferencias significativas para las Smáx. En la vena cava inferior fueron significativamente menores la Smáx, Smín, la onda A fue significativamente mayor y las velocidades de E no difirieron de manera significativa.Conclusiones. Los resultados obtenidos ponen en evidencia un aumento progresivo de las velocidades de flujo de las venas cava superior e inferior a lo largo de la gestación, que en fetos normales las velocidades de la vena cava inferior son más elevadas que las de la vena cava superior y que ante situaciones de hipoperfusión placentofetal que activen el circuito de redistribución de flujos las velocidades de la vena cava superior son significativamente mayores que las de la vena cava inferior (AU)

Evaluación mediante flujometría Doppler del dueto arterioso, arteria pulmonar y venas pulmonares en gestaciones de segundo y tercer trimestre / Doppler velocimetry assessment of the ductus arteriosus, pulmonary artery and pulmonary veins during the second and third trimester of pregnancy

Introducción. Se obtienen los valores de referencia de las ondas de velocidad de flujo de la arteria pulmonar (AP), dueto arterioso (DA) y de las venas pulmonares, y se somete a comprobación la hipótesis de una redistribución del flujo sanguíneo entre estos sectores vasculares mediante índices de impedancia. Métodos. Estudio de carácter prospectivo y de sección transversal en el que mediante flujometría Doppler se evalúan 400 fetos normales con edades comprendidas entre las 20 y 40 semanas. Los parámetros evaluados fueron: picos de velocidades sistólicos, diastólicas, tiempos de aceleración (TA) y de eyección (TE), los índices de impedancia (TA/TE) de cada arteria y el índice relativo de impedancia entre el DA y la AP (IRIDAP TA/TE).Resultados. Los valores de la impedancia para el DA disminuyeron con el avance de la edad gestacional; evento contrario fue registrado en la AP, cuyos índices de impedancia aumentaron a medida que el embarazo evolucionó. El IRIDAP TA/TE descendió a medida que el embarazo se acercó al término. Durante los movimientos respiratorios fetales se observó que durante la inspiración los picos sistólicos del DA aumentaron, mientras que los picos sistólicos de la AP disminuyeron. Todas las velocidades de las OVF de venas pulmonares aumentaron conforme avanzó el embarazo. Conclusiones. Los resultados obtenidos ponen en evidencia una redistribución de flujo desde el DA hacia el lecho pulmonar a medida que aquél avanza. Los cambios observa dos en los picos de velocidad de flujo en la AP y en el DA durante los movimientos respiratorios fetales revelan un efecto modulador de éstos sobre las OVF. Los datos presentados pueden resultar de valor en la evaluación del desarrollo del lecho vascular pulmonar y de la eficiencia del ventrículo izquierdo (AU)

[Symptomatic ischemia in a patient with a single right coronary artery without lesions]. / Isquemia sintomática en un paciente con coronaria derecha única sin lesiones.

Coronary artery anomalies are not a frequent finding, and a single right coronary artery is extremely rare. This anomaly has been included among the potentially serious ones because its association with infarction and sudden death has been reported. We present the case of a female patient who complained of chest pain, showed a positive exercise treadmill test and had a single right coronary artery in the angiography with no stenotic lesions. The pathophysiology and the clinical implications are discussed.