[Physiopathological alterations secondary to extracorporeal circulation in cardiac surgery]. / Alteraciones fisiopatólogicas secundarias a circulación extracorpórea en cirugía cardíaca.

Cardiopulmonary bypass (CPB) is one of the methods used in myocardial revascularization and can be associated with adverse events that are uncommon, but CPB induces high morbidity and mortality. Cardiac surgery and CPB activate a systemic inflammatory response characterized by tissular lesions, cells movements and blood flow toward the interstice where the harmful stimulus has begun, under the influence of the mediators. The systemic inflammatory response may be initiated during cardiac surgery by a number of processes, including blood contact with the foreign surface of the CPB apparatus, development of ischemia and reperfusion injury, and presence of endotoxemia. In the course of cardiac surgery using CPB, all three processes are present and contribute concurrently to the systemic inflammatory response. The term "systemic inflammatory response syndrome" (SIRS) has been proposed to describe an entity that continually overlaps with normal postoperative physiology. A frequent complication of SIRS is the development of organ dysfunction, including acute lung injury, shock, renal failure, and multiple organ dysfunction syndrome. Finally, long-term survival in patients developing SIRS may also be adversely affected. The purpose of this review is to examine and understand the pathological mechanisms for inflammatory response that occur following cardiopulmonary bypass.

[Lymphatic mapping and sentinel lymph node biopsies in order to avoid axilar dissection in early breast cancer]. / Mapeo linfático y linfadenectomía del ganglio centinela para evitar la disección axilar en mujeres con cáncer temprano de mama.

OBJECTIVE: To present the characteristics of women with early breast cancer and clinically negative ganglia who were submitted to LM and SLNB in order to select the positive cases for axilar dissection and to identify the negative cases. MATERIAL AND METHODS: Cases included patients who attended the Breast Tumor Service of the Oncology Hospital of the National Medical Center of the Mexican Social Security Institute from March 1, 2002, to April 30, 2004. Women with early breast cancer and clinically negative ganglia (N0) were included, with out previous treatment and without previous biopsies. All cases were submitted to LM and SLNB with patent blue or double-blue technique and gamma probe. The lymph nodes were evaluated histopathologically and negative or positive results were considered, in order to determine whether or not to undertake the axilar dissection. No cases were excluded. RESULTS: Sixty cases were reviewed with an average age of 51 years. The average size of the ganglia was 1.9 cm, with stages EC-0: 9%, EC-I: 33%, EC-IIA: 58%. Sentinel lymph nodes were found in 100% and 95 ganglions were dissected, for an average of 1.6 per procedure. The histopathology was definitive in 19 women with metastasis (32%) and in 41 women with negative ganglia (68%). The results of transoperative histopathology were correlated with the histopathology report (one false positive and six false negative cases), sensitivity of 68.4%, specificity of 97.5%, positive predictive value 92.8% and negative predictive value 86.9%. CONCLUSIONS: LM and SLNB avoided radical axilar dissection in 68% of the cases and reduced the cost in 10% of the cases.

[Left atrial dissection. Review]. / Disección de aurícula izquierda. Revisión de la literatura.

The left atrial dissection is a rare complication occurring mainly after mitral surgery, thoracic trauma, myocardial infarction and infectious endocarditis. The clinical diagnosis can be confused with isolated prosthetic dysfunction, myocardial infarction. Its onset and, its form of presentation vary widely, concerning to the intensity and to the moment in which the symptoms appear. The most important data for its diagnostic are the antecedents and a new systolic murmur, although this last one can be absent. The transesophageal echocardiogram is the first choice for diagnosis since, the dissection can be missed by transthoracic echocardiogram. The treatment is surgical, two different types of surgical approaches have been reported. The prognosis depends on the extension of the dissection, tissue quality and associated complications.

[Mitral valve prolapse. A review]. / Prolapso valvular mitral. Revisión de la literatura.

Primary mitral valve prolapse (MVP) or the disease known as MVP, consists of mixomatous degeneration of the mitral valve with systolic displacement of a portion or all of one or both mitral leaflets beyond mitral annulus into left atrium during systole, associated or not with mitral insufficiency. Prevalence in Mexican population is <2%. MVP behavior is benign unless associated with mitral insufficiency (MI, moderate-to-severe) or complications, or is associated with other syndromes. The major clinical feature of mitral valve prolapse syndrome is mid-to-late systolic clicks identified with auscultation of mitral valve. Echocardiography is usually employed for diagnosis and management. Two-dimensional echocardiography displays one or both leaflets prolapsing behind mitral annulus and into left atrium in systole. In the majority of cases, MVP is harmless and does not cause symptoms nor does it need to be treated. In a small number of cases, it can cause severe mitral regurgitation and needs surgical treatment. Complications derived from MVP must be treated independently. Secondary MVP also consist of displacement of one or both valves toward atrium, but this is due to pathologies such as rheumatic heart disease, ischemic heart disease, or others. In these situations, treatment will be that of the underlying diseases.

[Nosocomial infection surveillance: experience at a cardiology hospital in Mexico]. / Vigilancia de infecciones nosocomiales: experiencia de un hospital de cardiología en México.

OBJECTIVE: To describe the results of the Nosocomial Infection surveillance program at the Cardiology Hospital in Centro Médico Nacional Siglo XXI of the Mexican Social Security Institute. METHODOLOGY: To inform of the epidemiologic follow-up results from January 2000 to July 2003. Global frequency, infection rates by infection site, hospital services, and frequency of most common microorganisms were estimated. RESULTS: During this period, global incidence showed that in every 100 discharges, there were 4.3 infections (4.3/100). Frequency of infection was slightly higher in the surgical intensive care unit. Average infection rate in lower respiratory tract infections was 27/1,000; in surgical-site infections: 8/1,000 (mediastinitis 0.8/1,000); it was found that in urinary tract infection, rate was 6.6/1,000. Most commonly isolated microorganisms were: coagulase-negative Staphylococcus (25%), Enterobacter sp. (17%), Candida albicans (13%), S. aureus (9%), P. aeruginosa (9%) and K. pneumoniae (6%). CONCLUSION: This study describes the epidemiology of nosocomial infections in a Cardiology Hospital. The information is obtained through epidemiologic follow-up programs. This information is very important to develop specific strategies for control of infections.

[Simultaneous evaluation of the myocardial perfusion and contraction for cardiac scintigraphy synchronized to the electrocardiogram for the differential diagnosis of dilated cardiomyopathy and the ischemic ventricular damage]. / Evaluación simultánea de la perfusión y contracción miocárdica por gammagrafía cardiaca para el diagnóstico diferencial de la miocardiopatía dilatada y el daño ventricular isquémico.

OBJECTIVE: We evaluated the precision of the perfusion and ventricular function through cardiac scintigraphy 99mTc-MIBI SPECT synchronized to the electrocardiogram to differentiate the ventricular damage of ischemic origin from the dilated cardiomyopathy. METHODS: Thirty patients with myocardial damage with ejection fraction =30% were included. We analyzed the prognostic value of clinical, angiographic, and 99mTc-MIBI SPECT variables. RESULTS: We studied 30 patients with myocardial damage, 26 men (86.7%) and 4 women (13.3%), with an average age of 45.7 +/- 9.3 years. The diagnosis established by cardiac catheterization was dilated cardiomyopathy in 17 patients (56.6%) and 13 with ischemic cardiomyopathy (43.4%). The study by cardiac scintigraphy 99mTc-MIBI SPECT synchronized to the electrocardiogram established the diagnosis of dilated cardiomyopathy in 18 patients, with a sensitivity of 100% and specificity of 92%. The predictive positive value was 100% and the predictive negative value 94.4%. CONCLUSIONS: Cardiac scintigraphy 99mTc-MIBI SPECT synchronized to the electrocardiogram differs in the etiology of the myocardial damage produced by dilated cardiomyopathy from that of ischemic origin in a noninvasive way and with high sensitivity and specificity.