Extended Poststroke Rehabilitation Combined with Cerebrolysin Promotes Upper Limb Motor Recovery in Early Subacute Phase of Rehabilitation: A Randomized Clinical Study.

Background and Objectives: The recovery of stroke patients with severe impairment is usually poor and limited and, unfortunately, under-investigated in clinical studies. In order to support neuroplasticity and modulate motor recovery, Cerebrolysin combined with rehabilitation treatment has proven effective in the acute stroke phase in moderate to severe motor impairment. The aim of this study was to determine the efficacy of extended poststroke rehabilitation combined with Cerebrolysin on upper limb motor recovery in subacute stroke patients with severe upper limb motor impairment. Materials and Methods: A randomized, double-blind, placebo-controlled study was conducted. Sixty patients at the early stage of severe sub-acute stroke who fulfilled all eligibility criteria were randomly assigned to the Cerebrolysin group or placebo group (𝑛 = 30 each). Both groups, after conducting three weeks of conventional rehabilitation treatment five days per week, continued to perform conventional rehabilitation treatment three times per week until 90 days of rehabilitation treatment. The primary outcome measure was the Action Research Arm Test (ARAT), and the secondary outcomes were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) motor score, Barthel index (BI), and the National Institutes of Health Stroke Scale (NIHSS). The outcome data were evaluated before, after three weeks of treatment, and on the 90th day of rehabilitation treatment, and compared within groups and between the two groups. There were no adverse events. Results: Both groups showed a significant improvement (p < 0.001) over time in BI, FMA-UE, ARAT, and NIHSS scores. Patients receiving Cerebrolysin showed more significant improvement in post-stroke upper limb motor impairment and functioning compared to the placebo group after only three weeks, and the trend was maintained after 90 days of follow up. Conclusion: Cerebrolysin delivered in the early subacute post-stroke phase added to extended conventional rehabilitation treatment is beneficial and improves motor functional recovery in patients with severe motor impairment, especially on the paretic upper extremity.

Perspective of health personnel on end-of-life care in Intensive Care Units. / Perspectiva de los profesionales de la salud sobre cuidados al final de la vida en unidades de cuidados intensivos.

OBJECTIVE: To understand for what care of the patient at the end of life and their relatives means to ICU health professionals. METHODS: Qualitative study with a Research-Action (AI) design, in two intensive care units of the city of Bogotá. Groups were formed in each unit and each group included at least six health professionals, the data collection techniques were: 4 participative assemblies and 6 clinical narratives, the data analysis was done through the preparation of the data, discovery of topics, coding and interpretation of data, relativisation and rigour of the data. RESULTS: 20 ICU workers participated, the analysis of the data revealed four thematic categories: Multidisciplinary team of the ICU facing the end-of-life process, Management of critical patients and their families at the end of life in the ICU, Communication process between the patient, family and multidisciplinary team at the end of life, Ethical aspects at the end of life in the ICU CONCLUSIONS: The professionals consider preserving quality of life during the patient's stay in the ICU a therapeutic objective. The development of evidence-based guidelines that facilitate multidisciplinary management at the end of life, customisation of care, effective communication, fulfilling the physical, emotional and spiritual needs of the person and their family and favouring the patient's right of autonomy in decision making.

Difference between subjects in early chronic phase of low back pain with and without neuropathic component: observational cross-sectional study.

BACKGROUND: Neuropathic pain in early chronic low back pain is insufficiently recognized and treated. AIM: The aim of this study was to establish if there is a difference among chronic low back pain subjects with and without neuropathic pain and healthy subjects, in clinical characteristic and the level of trunk muscle activation. DESIGN: Cross sectional observational study. SETTING: Rehabilitation clinic, inpatient and outpatient. POPULATION: Thirty-three subjects in early chronic phase of low back pain and 26 healthy subjects were included in this research. METHODS: Clinical characteristics and relative thickness change of lumbar multifidus and transversal abdominal muscle, measured by ultrasound, in neuropathic, non-neuropathic chronic low back pain and healthy subjects were analyzed. RESULTS: Chronic low back pain subjects with neuropathic pain reported higher level of pain on Visual Analog Scale (VAS) (back pain P=0.016, leg pain P=0.006), had higher Oswestry Disability Score (P=0.029), had lower motor (P=0.001) and sensory leg scores (P=0.000), and decreased level of activation of transversal abdominal muscle (P=0.000) comparing to chronic low back pain group without neuropathic pain. Low back pain subjects with leg pain ≥5 on VAS were 11.2 times more prone to develop neuropathic pain. Motor leg score ≤47 increases this chance 35 times. Sensory leg score ≤25 increases this chance 14 times. Reduced activation of transversal abdominal muscle for 40-50% increases this chance 7-24 times. CONCLUSIONS: Chronic low back pain subjects with neuropathic pain were more painful and disabled, had lower motor and sensory scores, and lower relative thickness change of transversal abdominal muscle comparing to the low back pain group without neuropathic pain. Self -reported leg pain intensity of 5 or more on VAS, motor score of 47 and less, sensory scores of 25 and less and diminished activation of transversal abdominal muscle significantly increase the chance that chronic low back pain subject has neuropathic component of pain. CLINICAL REHABILITATION IMPACT: Neuropathic pain in early chronic low back pain subjects might be more readily recognized if patients with radiculopathy and diminished activation of transversal abdominal muscle were regularly screened for neuropathic pain.

Cambios en el pH sanguíneo en los pacientes críticos durante la hospitalización en Cuidados Intensivos / Changes in blood pH in critical patients during Hospitalization in Care Intensive

Objetivo: Determinar los cambios que se desarrollan en el pH sanguíneo de pacientes críticos en Cuidados Intensivos, según el tipo de trastorno. Diseño: Estudio cuantitativo, de observación, analítico, de tipo cohorte retrospectivo. Ámbito: Unidad de Cuidados Intensivos polivalente. Participantes, intervenciones y variables: 753 pacientes con pH normal, después de excluir a aquellos con registros insuficientes o antecedente de acidosis tubular renal. Se analizó la información de la base de datos clínica durante 21 meses. Mediante un análisis de supervivencia, se observó el cambio del pH, estratificando grupos de acuerdo con la alteración primaria y, luego, por morbilidad de ingreso. Se estimó la diferencia entre los grupos mediante la prueba del rango logarítmico. Los factores determinantes de acidemia metabólica se evaluaron mediante regresión de Cox. Resultados: Se evaluó a 753 pacientes (mediana de la edad 60 años [RIQ: 40- 71]). La mediana de estancia fue de 8 días (RIQ: 6-13). El 42% tenía alteración del pH. Predominó la acidemia, con más frecuencia en pacientes sépticos. La causa principal de acidemia parece ser la hipoperfusión. El desenlace es similar en pacientes alcalémicos. Conclusiones: Durante la estancia en la UCI, es frecuente el cambio del pH con igual proporción de acidemia y alcalemia. La mortalidad fue similar en pacientes con ambos trastornos. En pacientes acidémicos, la hipoperfusión parece ser el factor desencadenante más importante.(AU)

Abstract Objective: To determine which changes are seen in serum pH in critical care patients, during their stay in the Intensive Care Unit, stratifying findings according to the main disorder. Design: Quantitative, observational, analytical study of a retrospective cohort. Setting: Polyvalent Intensive Care Unit. Patients, interventions, variables: 753 patients with normal pH after excluding those with insufficient records and history of tubular acidosis. Data was gathered from the clinical database during a 21-month interval. Using a survival analysis, serum pH changes were stratified in their relation to the basic alteration and morbidity. Difference between groups was estimated using the log-rank test. In patients with metabolic acidosis Cox regression was used to search for determining factors. Results: A total of 753 patients were evaluated (median age: 60 years [IQR: 40-71]). The median length of stay was 8 days (IQR: 6-13). pH was abnormal in 42% of the population. Metabolic acidosis was the predominant finding being more frequent in septic patients. The main cause of acidosis seems to be hypoperfusion; outcomes were similar in alkalotic patients. Conclusions: Changes in pH are frequent in patients admitted to intensive care unit, with an equal proportion of acidosis and alkalosis. Mortality was similar in both disorders. pH can be related with a negative outcome in both alkalosis and acidosis. In the latter group hypoperfusion seems to be the major trigger.(AU)

A genetic linkage study in Brazil identifies a new locus for persistent developmental stuttering on chromosome 10.

Although twin, adoption, and family studies demonstrate that genetic factors are involved in the origins of stuttering, the mode of transmission of the disorder in families is not well defined and stuttering is considered a genetically complex trait. We performed a genome-wide linkage scan in a group of 43 Brazilian families, each containing multiple cases of persistent developmental stuttering. Linkage analysis under a dominant model of inheritance generated significant evidence of linkage in two Brazilian families, with a combined maximum single-point LOD score of 4.02 and a multipoint LOD score of 4.28 on chromosome 10q21. This demonstrated the presence of a novel variant gene at this locus that predisposes individuals to stuttering, which provides an opportunity to identify novel genetic mechanisms that underlie this disorder.

Desarrollo de barras de cereales nutritivas y efecto del procesado en la calidad proteica / Development of nutritive cereal bars and effect of processing on the protein quality

Commercial cereal bars (CB) have low and poor nutritional quality of protein and fats and are included in school snacks. A nutritional CB was developed with increased protein and fat content and quality, with a balanced energy distribution. The infIuence of processing on protein quality was studied. The process was divided into two stages: controlled formulation dry premix (DP) and further agglutination before consumption. In DP textured grains were used (rice, whole corn and semolina, wheat germ, oats), egg albumin and milk powder. Honey, egg white, soybean oil and sucrose were used as binding syrup. The processing was carried out in a pilot plant with drying at 105°C, per 30 minutes. Percentage and protein quality (NPU) were determined at each stage: DP, CB before and after drying (HCB and DCB). In DCB fatty acids (FA) were determined by gas chromatography and shelf-life through sensorial evaluation by a trained panel. The DP protein content reached was 21.6 % with NPU 70 % and 91 % of D. For HCB and DCB the results were: protein 14.7 % and 15.7%, NPU 73 % and 51 %, D 86 % and 81 % respectively. In DCB fat was 12.6 %% (16% saturated FA, 34 %% monounsaturated, 48 % polyunsaturated). The energy distribution was balanced. Sensory evaluation showed stable products for 7 days. It would be possible to develop CB in bakeries with short life where a unit of 25 g would cover 7 % of the protein requirement of a 30 kg child.

Las barras de cereales (BC) comerciales presentan bajo contenido y pobre calidad nutricional de proteínas y grasas, siendo actualmente incluidas en colaciones escolares. Se desarrollaron BC nutritivas con aumento del contenido y calidad de proteínas y grasas, distribución energética equilibrada y se estudió la influencia del procesado en la calidad proteica. El proceso se dividió en dos etapas: una premezcla seca (PS) de formulación controlada y posterior aglutinación previo al consumo. En PS se utilizaron cereales texturizados (arroz, maíz entero y sémola, germen de trigo, avena), ovoalbúmina y leche ambas deshidratadas. Para la aglutinación se utilizó miel, clara de huevo, aceite de soja y sacarosa. La elaboración se realizó en planta piloto con secado a 105°C, por 30 minutos. Se determinó el porcentaje y la calidad proteica (UPN) en cada etapa: PS, barra de cereal húmeda (BCH) y seca (BCS). En la BCS se determinaron los ácidos grasos (AG) por cromatografía gaseosa y la estabilidad mediante análisis sensorial por panel entrenado. En PS se alcanzó 21,6% de proteínas con UPN 70% y D 91%. Para BCH y BCS los resultados fueron: proteínas 14,7% y 15,7%, UPN 73% y 51%, D 86% y 81%, respectivamente. En BCS el contenido graso fue 12,6% (16% AG saturados, 34% monoinsaturados, 48% poliinsaturados). La distribución energética de macronutrientes fue equilibrada y la evaluación sensorial arrojó productos estables durante 7 días. Sería posible elaborar en panaderías BC de corta vida útil, donde una unidad de 25 g cubriría 7% del requerimiento proteico de un niño de 30 kg.

Mobilization with movement and kinesiotaping compared with a supervised exercise program for painful shoulder: results of a clinical trial.

OBJECTIVE: The purpose of this study was to compare the efficacy of Mobilization with Movement (MWM) and kinesiotaping (KT) techniques with a supervised exercise program in participants with patients with shoulder pain. METHODS: Twenty subjects with shoulder pain were included if subjects were diagnosed by the referring physician with either rotator cuff lesion with impingement syndrome or impingement shoulder syndrome. Participants were randomly assigned to 1 of 2 groups after clinical and radiologic assessment: group 1 was treated with MWM and KT techniques, whereas group 2 was treated with a supervised exercise program. The main outcome measures were active pain-free shoulder abduction and flexion tested on days 0, 5, and 10. RESULTS: Improvement in active pain-free shoulder range of motion was significantly higher in the group treated with MWM and KT. Repeated-measures analysis of variance indicated significant effects of treatment, time, and treatment×time interaction. CONCLUSION: This study suggests that MWM and KT may be an effective and useful treatment in range of motion augmentation of subjects with rotator cuff lesion and impingement syndrome or impingement shoulder syndrome.

Estudio ECAIS: eventos cardiovasculares adversos inadvertidos en sepsis / Ecais study: inadvertent cardiovascular adverse events in sepsis

Objetivo: Describir la incidencia de eventos cardiovasculares adversos en pacientes con diagnóstico de sepsis en sus diferentes estadios. Diseño: Estudio observacional, descriptivo, longitudinal. Ámbito: Unidades de cuidados intensivos de tipo mixto de dos hospitales universitarios en la ciudad de Bogotá. Participantes: Se incluyeron una serie de pacientes mayores de edad, que ingresan a UCI con diagnostico de sepsis, sin evidencia de lesión miocárdica isquémica previa. Intervenciones: Registros electrocardiográficos continuos de 12 derivaciones durante 48 horas con monitoría Holter Variables de interés: Isquemia, arritmia cardiaca, variabilidad de la frecuencia cardiaca. Resultados: Se analizaron 100 pacientes, 62% de los cuales se estadificó como choque séptico. El 3% presentó evento cardiovascular adverso de tipo isquémico detectado por Holter y desapercibido por monitoreo convencional. El 46% presentaron un evento de tipo arrítmico por Holter, comparado con solo un 6% detectado por monitoreo convencional. La mortalidad cruda fue de 40%. El 100% presentó pérdida de la variabilidad de la frecuencia cardiaca. Conclusión: La sepsis en esta experiencia mostró una baja incidencia de eventos cardiovasculares isquémicos. Los eventos arrítmicos, sin embargo, mostraron una incidencia alta. El monitoreo convencional falló en detectar la totalidad de los eventos isquémicos y en mayor proporción los eventos arrítmicos. En esta serie, los eventos cardiovasculares generados por descarga adrenérgica no impactan en la mortalidad (AU)

Objective: To describe the incidence of cardiovascular adverse events in patients with sepsis in its various stages. Design: A longitudinal, descriptive, observational study was carried out. Setting: Intensive care units of two university hospitals in Bogotá (Colombia). Patients: A number of patients consecutively admitted to the adult ICU with a diagnosis of sepsis, and no evidence of previous ischemic myocardial injury. Interventions: Forty-eight hours of electrocardiographic record using Holter technology. Main variables: Ischemia, cardiac arrhythmia, heart rate variability. Results: A total of 100 patients were analyzed, 62% being staged as presenting septic shock. Three percent suffered ischemic events detected by Holter and unnoticed through conventional monitoring. Forty-six percent suffered an arrhythmic event detected by Holter, compared with only 6% as detected by conventional monitoring. Mortality was 40%. All patients showed loss of heart rate variability. Conclusion: In this study patients with sepsis showed a low incidence of cardiovascular ischemic events. In contrast, arrhythmic events showed a high incidence. Conventional monitoring failed to detect any of the ischemic events and most arrhythmic events. In this study, cardiovascular events generated by adrenergic discharge had no impact upon mortality (AU)

[ECAIS study: inadvertent cardiovascular adverse events in sepsis]. / Estudio ECAIS: eventos cardiovasculares adversos inadvertidos en sepsis.

OBJECTIVE: To describe the incidence of cardiovascular adverse events in patients with sepsis in its various stages. DESIGN: A longitudinal, descriptive, observational study was carried out. SETTING: Intensive care units of two university hospitals in Bogotá (Colombia). PATIENTS: A number of patients consecutively admitted to the adult ICU with a diagnosis of sepsis, and no evidence of previous ischemic myocardial injury. INTERVENTIONS: Forty-eight hours of electrocardiographic record using Holter technology. MAIN VARIABLES: Ischemia, cardiac arrhythmia, heart rate variability. RESULTS: A total of 100 patients were analyzed, 62% being staged as presenting septic shock. Three percent suffered ischemic events detected by Holter and unnoticed through conventional monitoring. Forty-six percent suffered an arrhythmic event detected by Holter, compared with only 6% as detected by conventional monitoring. Mortality was 40%. All patients showed loss of heart rate variability. CONCLUSION: In this study patients with sepsis showed a low incidence of cardiovascular ischemic events. In contrast, arrhythmic events showed a high incidence. Conventional monitoring failed to detect any of the ischemic events and most arrhythmic events. In this study, cardiovascular events generated by adrenergic discharge had no impact upon mortality.

Colesterol-IDL y parámetros lipídicos en diabéticos tipo 2 / IDL-cholesterol and lipidic parameters in diabetic patients type 2

La diabetes mellitus ocupa el sexto lugar de las defunciones por causas definidas en la provincia de Misiones. Nos propusimos establecer si existen diferencias significativas para Colesterol Total (CT), Triglicéridos (TG), Colesterol-HDL(CHDL), Colesterol-LDL(CLDL), Colesterol-IDL(CIDL), Colesterol no-HDL y los índices CT/CHDL y TG/CHDL entre diabéticos tipo 2 y un grupo control y comparar los valores de CIDL entre ambos grupos según fenotipo de dislipidemia. Se estudiaron 70 diabéticos tipo 2 (DM 2) y 57 controles. CT, TG, CHDL y CLDL se determinaron por métodos enzimáticos colorimétricos y CIDL por método de Wikinski. Los resultados obtenidos en DM 2 vs. controles fueron: CT 214±49 vs. 205±34 mg/dl (p=0.488); TG 194±119 vs. 128±65 mg/dl (p<0.001); CHDL 43±11 vs. 50±13 mg/dl (p=0.001); CLDL 135±43 vs. 132±32 mg/dl (p=0.934); CIDL 13.8±8.7 vs. 7.2±3.5 mg/dl (p<0.001); CT/CHDL 5.26±1.54 vs. 4.40±1.33 (p=0.001); TG/CHDL 5.01±3.95 vs. 2.97±2.24 (p<0.001) y Col no-HDL 172±48 vs. 155±35 mg/dl (p=0.07); a igual patrón electroforético tanto normolipémico (p=0.043), fenotipo II (p=0.006) o fenotipo IV (p=0.001) el CIDL fue más elevado en el primer grupo. La cuantificación del CIDL mejora la valoración del riesgo aterogénico en DM 2 principalmente en los normolipémicos.

Diabetes Mellitus is in the sixth death cause in the province of Misiones. Majority of patients die in relation with atherosclerosis, being dislipidemias one of the mechanism that explain this increased risk. We aimed to establish if there are significant differences for total cholesterol (TC), triglyceride (TG), HDL-cholesterol (HDLC), LDL-Cholesterol (LDLC), IDL-Cholesterol (IDLC), no-HDL Cholesterol and the index TC/HDLC and TG/HDLC between diabetic patients type 2 and a control group, as well as comparing the IDLC amount between both groups according to the dislipidemia phenotype. We studied 70 diabetic patients type 2 and 57 controls, with similar distribution in age, sex and body mass index. TC, TG, HDLC and LDLC were tested by enzymatic colorimetric methods with internal and external quality controls and the IDLC by Wikinski method. The results obtained in diabetic patients vs controls were (table N°1): TC 214 ±49 vs 205± 34 mg/dl (p=0.488); TG 194±119 vs 128±65 mg/dl (p<0.001); HDLC 43±11 vs 50±13 mg/dl(p=0.001); LDLC 135±43 vs 132± 32 mg/dl (p=0.934); IDLC 13.8± 8.7 vs 7.2±3.5 mg/dl (p<0.001) (figure N°1); TC/HDLC 5.26 ±1.54 vs 4.40± 1.33 (p=0.001); TG/HDLC 5.01±3.95 vs 2.97±2.24 (p<0.001) y no-HDL cholesterol 172±48 vs 155±35 mg/dl (p=0.07); at a same electrophoretic pattern ( normolipemic (p=0.043), phenotype II (p=0.006) or phenotype IV (p=0.001)),the IDLC was higher in the first group (figure N°2). The diabetic patients show a more atherogenic lipoprotein profile than the control group. The quantification of IDLC improvement the assessment of atherogenic risk in type 2 diabetic patients, specially normolipemics.

Open-ring imaging sign: highly specific for atypical brain demyelination.

OBJECTIVE: To test the specificity for demyelination of a new neuroimaging sign: contrast enhancement shaped as an open ring or a crescent circumscribed to the white matter. BACKGROUND: Brain demyelination can cause ring enhancement mimicking neoplasm or infection on CT or MRI. METHODS: A MEDLINE search of pathology-proved demyelination yielded 32 illustrated cases of ring-enhancing lesions published between 1981 and 1995. Controls consisted of the same number of published images of neoplasms and infections, pathology proved, and matched by year of publication, and age and gender of the patient. Two neuroradiologists read the images twice independently 1 year apart. RESULTS: Interrater agreement was good (kappa = 0.64 and 0.66 for either reading). Test-retest reliability was high (kappa = 0.75 and 0.74 for either rater). The open-ring sign clearly distinguished demyelinating lesions from neoplasms and infections. For demyelination versus neoplasm or infection, the specificity of the reading by the first neuroradiologist was 93.8 (95% CI, 86 to 98), and that of the second was 84.4 (95% CI, 74 to 92). The likelihood ratio of demyelination versus neoplasm averaged 5.2, and versus infection, 17.2. That is, if the lesions had the same incidence in the population, in the presence of an open-ring sign demyelination would be five times more likely than neoplasm and 17 times more likely than infection. However, given the much higher incidence of neoplasms and infections, these lesions are still frequently responsible for open-ring enhancement. CONCLUSIONS: The open-ring sign is often present in large, contrast-enhancing demyelinating lesions and helps to differentiate them from neoplasms and infections.

Autoantibodies directed against the ribosomal P proteins are not only directed against a common epitope of the P0, P1 and P2 proteins.

The autoantibodies (aAbs) directed against the ribosomal P proteins (RPP aAbs) are known to react mainly against epitopes localized within the common C-terminal sequence of the three acidic ribosomal P proteins, P0, P1 and P2. In order to investigate the opportunity to select short recombinant peptides of this common C-terminal sequence to detect the RPP-aAbs, the location of the epitopes recognized by ribosomal proteins (RP) aAb(+)sera of systemic lupus erythematosus patients (SLE) was investigated. Immunoblotting and ELISA techniques using extracted or recombinant, entire or cleaved RPP showed that 55% of the RP aAbs were directed against the three ribosomal P0, P1, and P2 proteins. The epitopes recognized by the RPP aAbs are located not only within the C-terminal sequence common to the three proteins but also within the N-terminal sequence of the P2 or P1 protein. The other RP aAbs sera (45%) did not react with all three proteins but with some of them, and showed the following pattern: P0(+)P1(+); P1(+); P2(+); P0(+)and P1(+). They recognized epitopes located in the region of the C-terminal sequence of the protein but not common to the three proteins. In addition two out of the six monoclonal Abs produced by immunization of mice using the P1 protein did not react with the peptide N-65 or N-71 of the P2 protein or with the C-terminal sequence of the three proteins. In conclusion, this study showed that the RPP aAb in SLE patients are not only directed against epitopes within the C-terminal sequence shared by the three acidic ribosomal P proteins. In view of these data it seems necessary to be cautious in using only a C-terminal peptide of ribosomal P proteins in tests performed to detect RPP aAb in human sera.

[Respiratory tract obstruction caused by ballooning of an intubation tube cuff during nitrous oxide inhalation]. / Obstruction des voies aériennes par hernie du ballonnet de la sonde d'intubation au cours d'inhalation de protoxyde d'azote.

A typical case of upper airway obstruction due to deformation of a low pressure tracheal tube cuff is reported. It would seem that this herniation may have been due to nitrous oxide diffusing with in the air-filled cuff, thereby causing it to overdistend. This increase in pressure occurred after 3 hours of inhalation of a mixture of oxygen and nitrous oxide. The deformed cuff may either block the lumen at the end of the tube, or push the tube against the tracheal wall. The result is, in either case, a mechanical obstruction of the airway, with hypoxia, and then anoxia. In the reported case, it was the decrease of SpO2 which alerted the anaesthetist. Pulse oximetry was helpful for an early diagnosis. To avoid such accidents, it is suggested either to inflate the cuff with the gas mixture with which the patient is ventilated, or to deflate it every 30 min.

Angiographic follow-up after balloon angioplasty for coarctation of the aorta.

Balloon angioplasty for coarctation of the aorta was performed in 45 patients; 17 (Group 1) were infants (mean age 34 +/- 43 days). This study focuses on the remaining 28 patients (Group 2), children and adults ranging in age from 2 to 31 years (mean 13 +/- 8). Two patients had had previous surgery for coarctation; in the remaining 26 the coarctation had not been surgically treated. Twenty patients (71%) had a discrete type of coarctation; the remaining eight had a diffuse or eccentric stenosis. Angiographic studies of the aorta were performed before and immediately after angioplasty in all 28 patients; 16 (57%) of them also underwent angiographic reevaluation 10 +/- 2 months later. The pressure gradient decreased immediately after angioplasty and was unchanged at follow-up. Residual gradient at follow-up ranged from 0 to 40 mm Hg (mean 11 +/- 13). Patients with a discrete type of coarctation had a lesser residual gradient than did patients with other anatomic types of coarctation. Angiographically, the stenosis also decreased after angioplasty (68 +/- 10% versus 24 +/- 17%; p less than 0.01); a new small, but significant decrease was observed at follow-up (9 +/- 18%; p less than 0.05). A quantitative analysis of the aorta at different levels revealed no significant changes proximal and distal to the coarctation segment; however, at the level of coarctation, a significant (p less than 0.01) and homogeneous increment was observed after dilation that was unchanged at follow-up. One (6%) of 16 reevaluated patients had a clear aneurysm at the site of dilation.(ABSTRACT TRUNCATED AT 250 WORDS)