Fiebre sin foco en paciente con dolor crónico / Fever without center in patient with chronic pain

No disponible

No disponible

[Post-infarction left ventricular free wall rupture]. / Rotura post-infarto de la pared libre del ventrículo izquierdo.

We report four cases of subacute left ventricular free wall rupture after myocardial infarction successfully treated with emergency surgery. Some aspects dealing with clinical presentation, diagnosis and treatment are discussed.

Practical experience with a high Dk lotrafilcon A fluorosilicone hydrogel extended wear contact lens in Spain.

PURPOSE: Several research studies on high Dk soft contact lens materials have been published, but little has been reported from practical clinical experience with these new materials. This study reports in-practice clinical experience with the lotrafilcon A fluorosilicone hydrogel material from a 6-month study in Spain. METHODS: Eighty-five patients were dispensed lotrafilcon A lenses (Focuse NIGHT & DAY [CIBA Vision Corporation]) for monthly replacement by 13 investigators from eight practices. The recommended wear schedule was daily wear for the first week and then up to 6-night extended wear through the first month and up to 30-night extended wear through 6 months. Follow-up visits were at 1 week, 1 month, 3 months, and 6 months. Clinical and patient subjective data were collected at each visit. RESULTS: Among patients who continued in the study at each visit, Snellen visual acuity (VA) of 20/25 or better was achieved by at least 96% of all eyes at all visits; lens surfaces assessments for front surface deposits, front surface wetting, and back surface debris averaged less than grade 1 (0-4 scale) for all lenses at all visits; biomicroscopy grades averaged well below grade 1 (0-4 scale) for all eyes at all visits; acceptable or optimal fit was assessed for 97% or more of all lenses at all visits. These patients rated the average overall comfort, vision, and handling above 9 (0-10 scale) at 6 months and 98% reported satisfaction with the lenses at 6 months. Eighty-two percent of patients dispensed completed the study. Seven patients were discontinued because of fit, and seven were discontinued because of positive biomicroscopy signs. CONCLUSIONS: The lotrafilcon A lens performed well clinically and it was accepted well by patients, with most practitioners recommending and most patients wearing it for up to 30 nights extended wear. Practitioners should be attentive to fit and discomfort complaints at dispensing and follow-up and may want to recommend lubricating or rewetting drops for those patients with dryness symptoms.

Experimental and clinical evaluation of formalin containing pericardial bioprostheses for replacement of infected valves.

In 1988 we quantified the adherence of two Staphylococcus epidermidis strains to glutaraldehyde-fixed bovine pericardium and teflon. The pericardium was used with and without prior rinsing to remove the preservative formaldehyde. Bacterial adherence was not detected on non-rinsed pericardium, and it was significantly less on rinsed pericardium than on teflon (p < 0.001). In view of these results, we have since then implanted 31 pericardial bioprostheses without rinsing them in 29 patients with active bacterial endocarditis. Valve infection reoccurred in two patients (6.7%) and two patients developed early periprosthetic leaks in the absence of re-infection. No adverse clinical or biochemical findings attributable to residual aldehydes have been observed.

[Thromboembolism with the Ionescu-Shiley bovine pericardial bioprosthesis. Long-term results (11 years)]. / Tromboembolismo con la bioprótesis de pericardio bovino Ionescu-Shiley. Resultados a largo plazo (11 años).

With the aim to asses the thrombogenicity of "treated" bovine pericardial tissue, the incidence of thromboembolism with Ionescu-Shiley pericardial bioprostheses was analyzed in 349 operative survivors since January 1977. A total of 376 valves were available for the study. Mean age was 59 years. Preoperatively atrial fibrillation was present in 68.2% (91.7% of the mitral replacement group) and 62% were in NYHA functional class III-IV; in 10.6% previous embolism had been documented. Early anticoagulation (8-12 weeks) was administered in the first 232 patients (113 mitral replacements, 98 aortic replacements and 21 multiple replacements) and the rest of the patient population had no anticoagulation at all. Thromboembolic events were documented in 13 patients (3.72%) or 0.84% per patient/annum (1.49% per patient/annum for mitral and multiple replacements and 0.13% per patient/annum for aortic replacements). Early thromboembolism was detected in 6 patients (3 months after surgery), all in anticoagulated patients, three being in sinus rhythm. No valve thrombosis was detected in this series. Three patients with late thromboembolism were in NYHA functional class III-IV. Ten thromboembolic events were central (1 died and three had permanent neuro-residua). In two the location was peripheral and another one in the kidney. The Ionescu-Shiley pericardial bioprosthesis after 11 years has demonstrated a low thrombogenicity in the absence of chronic anticoagulation. Early anticoagulation does not influence the rate of thromboembolism during this period and therefore we believe that this therapeutic approach is not justified despite the presence of risk factors.

Duplication of the right atrioventricular orifice in a patient with common atrium and mitral cleft.

The following case involved duplication of the right atrioventricular valve in a patient with a common atrium. The accessory orifice, formed by two fine leaflets, connected the right atrium with the right ventricular outflow tract and had no subvalvular apparatus. Successful surgical correction was accomplished under standard cardiopulmonary bypass.