Urinary tract infection's etiopathogenic role in nephrolithiasis formation.

Urolithiasis has a high prevalence and recurrence rate, especially in developed countries, and is a major public health issue with a high socioeconomic cost. There are multiple causes of urolithiasis, including urinary tract infection (UTI). Infection stones (mainly composed of struvite) are associated with renal infections by urease-producing bacteria. However, there is limited knowledge about the role of UTIs in the formation of stones that are apparently not related with infection. We hypothesize that UTIs promote the formation of certain urolithiasis that appear to be non-infection stones. Some recent studies have reported the presence of bacterial growth in cultures of stones removed by endourological procedures. These findings have led to the hypothesis that UTIs have a role in the formation of stones that are apparently non-infection stones. It is unknown whether these UTIs promoted stone formation, or if the stones became infected after formation. Several in vitro studies and ultrastructural microscopic analyses of urolithiasis are consistent with our hypothesis. If our hypothesis is correct, it could have a great impact on the treatment of urolithiasis. Especially, early identification and treatment of renal infections could help to prevent septic events, which are frequently life-threatening. It could also help to reduce the recurrence of urolithiasis, and thereby reduce health care costs. In conclusion, some evidence suggests that UTIs have a role in the formation of some apparently non-infection urolithiasis. If this is so, it could have a great impact on the treatment and prevention of this disease.

Washing machine associated 50 Hz detected as ventricular fibrillation by an implanted cardioverter defibrillator.

This case report describes a patient with an automatic ICD who suffered a defibrillation shock without warning symptoms. An electrical interference can be observed in the stored EGM of the episode. The patient explained that the moment he felt the shock he was touching a washing machine. After correct grounding of this machine the patient did not suffer more inappropriate shocks.

Complete heart block in an adult with systemic lupus erythematosus and recent onset of hydroxychloroquine therapy.

Complete heart block (CHB) is a rare complication of systemic lupus erythematosus (SLE), mainly seen during an acute flare-up of the disease or after high-dose long-term treatment with antimalarial drugs, although anti-Ro and anti-RNP antibodies have also been implied by some authors. A 40-y-old woman developed CHB in the context of an acute flare-up of SLE, first diagnosed three years ago, having recently commenced hydroxychloroquine (HCQ) treatment. Anti-Ro and anti-RNP antibodies were also positive. No features of myocarditis were found. A temporary pacemaker was required and complete resolution was achieved on steroid therapy with withdrawal of antimalarial therapy. The characteristics of previous cases are well publicised and discussion focuses on the possible aetiology and pathogenesis of the present case.

[Severe digoxin poisoning. The successful use of the classic treatment]. / Intoxicación grave por digoxina. Utilización exitosa del tratamiento clásico.

In our environment, the use of Fab antibodies for digoxin intoxication is often difficult due to the low availability of this drug in most centers. We present a case of massive digoxin intoxication that was successfully managed with the classic treatment. Later, we discuss the need to individualize the management of this kind of intoxications in order to reduce, when possible, sanitary costs.

[A complete atrioventricular block and polymorphic ventricular tachycardia as the initial manifestation of secondary amyloidosis]. / Bloqueo auriculoventricular completo y taquicardia ventricular polimorfa como manifestación inicial de amiloidosis secundaria.

Cardiac injury is a frequent characteristic in primary, senile and myeloma related amyloidosis, but it is unusual in secondary amyloidosis. We report a patient with complete atrioventricular block and polymorphic ventricular tachycardia as the initial manifestation of secondary amyloidosis. Necropsy demonstrated amyloidosis deposits in the specific conduction system.

Cyclic changes in pulmonary wedge v waves in dilated cardiomyopathy.

Right and left cardiac catheterization was performed in a 29-year-old male with dilated cardiomyopathy. During the procedure, prominent v waves appeared spontaneously in the pulmonary capillary wedge pressure recording with a simultaneous decrease in left ventricular systolic pressure. Left ventricular angiography showed moderate to severe mitral regurgitation and an ejection fraction of 22%. The right ventricular endomyocardial biopsy revealed histological findings consistent with dilated cardiomyopathy. Cardiac catheterization was repeated 9 months later, after a period of clinical improvement and a reduction in the right and left ventricular filling pressures was documented. The cyclic swings in the pulmonary capillary wedge pressure and in the left ventricular systolic pressure were not observed. Left ventriculography showed mild mitral regurgitation with an ejection fraction of 37%. Right ventricular endomyocardial biopsy documented a reduction in myofibrillar and nuclear hypertrophy. Thus, cyclic changes in pulmonary wedge v waves may be observed in dilated cardiomyopathy. This finding is consistent with cyclic variations in the degree of mitral regurgitation. Disappearance of this factor seems to be related to improvement in left ventricular contractility.

Risk of thrombosis during coronary angioplasty with low osmolality contrast media.

Studies in vitro have suggested that nonionic low osmolar contrast agents produce an increase in thrombogenicity. To determine the incidence of thrombi related to the use of nonionic low osmolar contrast media during coronary angioplasty, a double-blind randomized study was performed in 100 patients. Medication before angioplasty included oral aspirin (250 mg/day) in all cases. At the beginning of the procedure, aspirin (250 mg) and heparin (10,000 U) were intravenously administered. During the procedure patients were randomly assigned to receive either an ionic low osmolar contrast agent ioxaglate (n = 50), or a nonionic low osmolar contrast media iohexol (n = 50). The presence of thrombus was evaluated on the angiogram and on the guidewire immediately after its retrieval from the patients. Clinical, angiographic and procedural variables were similar in the 2 randomized groups. Angiographic evidence of thrombus was observed in 1 patient (2%) assigned to ioxaglate and in 11 patients (22%) assigned to iohexol (p less than 0.005). One patient (2%) from the ioxaglate group and 6 patients (12%) from the iohexol group showed thrombotic residues on the guidewire (p = not significant). Three patients had acute myocardial infarction, 1 patient (2%) receiving ioxaglate and 2 patients (4%) iohexol (p = not significant). There were no deaths. Thus, compared with an ionic low osmolar contrast media ioxaglate, the nonionic low osmolar contrast agent iohexol increases the incidence of thrombus during coronary angioplasty.

False coronary dissection with the new Monorail angioplasty balloon catheter.

During percutaneous transluminal coronary angioplasty, the appearance of persistent staining in the vessel by contrast media suggests coronary dissection. We report seven patients in whom a false image of severe coronary dissection was observed during angioplasty performed with the new Monorail balloon catheter. This image emerges at the moment of balloon inflation, is distally located to the balloon, and disappears with balloon catheter deflation. No complications were associated with the appearance of this image.

[Coronary angiography and hemodynamic parameters in patients recovered from a myocardial infarction]. / Coronariografía y parámetros hemodinámicos en pacientes recuperados de un unfarto de miocardio.

The hemodynamic findings of a group of 112 patients with a prior history of myocardial infarction have been reviewed. The patients have been classified in three subgroups: anterior (48 cases), posterior (43 cases), and biventricular electrical infarction (21 cases). There was only one female in the 112 cases. There was a good correlation between the electrical region of infarction and ventricular asynergy localized to the same territory (76.65, and 90 %, respectively), as well as significant involvement of the corresponding coronary artery (89.88 and 100 %, respectively). A high percentage of patients with significant lesions of the coronary artery opposite the infarction was found (48 % in anterior necrosis, and 76 % in posterior lesions). In five cases the coronary vessels had no abnormalities. Ejection fraction and postangiography end diastolic pressure were the parameters of ventricular function most constantly altered. From this study it appears particularly relevant that there is a low incidence of women: there exists a good correlation between the infarct, the zone of asynergy, and the affected coronary; the number of affected coronaries increases with age; there are significant lesions in the opposite coronary, and there is a greater alteration of ventricular function in patients with biventricular infarction, followed by patients with anterior infarction.