Importance of ventricular function in the election of electro heart mode.

The integration of the ventricular function is essential when making decisions over a patient subjected to cardiac electrostimulation in order to understand the structure followed in the new cardiac stimulation and resynchronising therapy guides. To support the importance of ventricular function in cardiac electrostimulation it is important to know: (i)the deleterious effect of stimulation on the right ventricle apex; (ii)the effect over the left ventricular function produced by complete blockage of the left branch, and (iii)left ventricular disfunction as arrythmogenic substrate. When it comes to decide what type of cardiac electrostimualtion to apply we will know: the percentage of ventricular stimulation needed and its ventricular function. A normal ventricular function will enable electrostimulation from the right ventricle apex or alternative site. On the contrary, if this value is lower than 50% the most recommended electrostimulation is cardiac resynchronisation (CRT-P), which will be accompanied by defibrillation (CRT-D) if FEVI is lower than 35%.

Duodenal compression caused by superior mesenteric artery: study of 10 patients.

BACKGROUND: the compression of the third portion of the duodenum by the superior mesenteric artery (aorto-mesenteric clamp) is a rare cause of abdominal pain. Its clinical appearance may range between an asymptomatic and accidental radiological finding and an acute duodenal ileus (superior mesenteric artery syndrome), which requires urgent surgical intervention. METHODS: we revised all of the reports of upper gastrointestinal tract contrast-medium study (which included the duodenum) made in our hospital between May 1999 and April 2002. We analysed the case history of those patients with a radiological image compatible with aorto-mesenteric clamp. RESULTS: of the 1280 studies analysed, 10 of them (0,78%) were compatible with an aorto-mesenteric clamp. The 10 patients were females whose mean age was 25,7 years (range 9-77) that consulted for different abdominal discomfort. The symptoms of the 9 youngest patients were not typical of duodenal obstruction and their evolution was favourable. In the eldest patient, the clinical data were compatible with a mesenteric superior artery syndrome, although a subsequent study showed the presence of a colon adenocarcinoma. CONCLUSIONS: the aorto-mesenteric clamp is a rare radiological finding (<1 %) which does not always justify the supported clinical data. In our series, 9 cases were considered non-obstructive aorto-mesenteric clamps, although some of them showed pathogenical factors (scoliosis and thinness). The superior mesenteric artery syndrome should be considered as a diagnosis of exclusion after performing an adequate clinical study when the situation of the patient requires it.

[Resident physician training in the digestive system. The point of view of the residents]. / Formación MIR en aparato digestivo. El punto de vista de los residentes.

AIM: To evaluate various aspects of current training of Spanish residents in gastroenterology. METHOD: An anonymous postal questionnaire was sent to fourth-year resident physicians in Spanish hospitals with accredited gastroenterology residency programs. RESULTS: Forty residents in the fourth year (53% offered positions), four from the second year and one from the first year (20 men, 25 women) answered the survey. Mean age was 29.7 years (26-42 years). Fifty-one percent of the departments did not have ultrasonography facilities apart from those in the radiology department. Endoscopic retrograde cholangiopancreatography (ERCP) was available in all the departments but in 55% of these, residents did not receive training in this technique. Forty-one percent of residents did not know the objectives of the various training periods. Eighty-four percent evaluated the pressure of clinical work as "intense" or "very intense" with 67% reporting that it disturbed their training "seriously" or "very seriously" and 71% that it disturbed their personal lives. Supervision in ultrasonography, endoscopy and clinical work were mainly evaluated as "good" or "very good". Supervision was rated lower in outpatient departments and while on duty. Forty-two percent of residents rated the supervision of the personal tutor as "average". Seventy-six percent were "fairly" or "very interested" in the introduction of "areas of specific training". CONCLUSIONS: The quality of residents' training in general and of gastroenterology training in particular is high. There are, however, several aspects which could be improved.