[Conjunctival squamous cell carcinoma: paradoxical response to interferon eyedrops]. / Carcinoma epidermoide conjuntival: respuesta paradójica al colirio interferón.

CASE REPORT: A 67 year-old male seen for a longstanding corneal-conjunctival tumor. TREATMENT: topical interferon α2b (IFN-α2b) 10 U/ml. A significant increase in lesion size was observed after 8 weeks. A surgical excision with cryotherapy was then performed. Pathological examination confirmed the diagnosis of squamous cell carcinoma. At this time the patient was found to have a positive HIV serology. DISCUSSION: Conjunctival intraepithelial neoplasia (CIN) is a pre-cancerous lesion of the ocular surface. Medical treatment of CIN is essentially with IFN-α2b due to its antiviral/antitumor properties. In patients with HIV, treatment response could be paradoxical. We recommend serology for HIV before treatment with topical IFN-α2b.

[Risk factor control in the hypertensive patients with chronic ischemic heart disease attended in cardiologic outpatient clinics. The CINHTIA study]. / Control de los factores de riesgo en los pacientes hipertensos con cardiopatía isquémica crónica atendidos en las consultas de cardiología. Estudio CINHTIA.

OBJECTIVE: The CINHTIA study is a cross-sectional and multicentre survey designed to assess the clinical management of the hypertensive outpatients with chronic ischemic heart disease attended by cardiologists. PATIENTS AND METHODS: Patients > or = 18 years, with a diagnosis of hypertension and chronic ischemic heart disease, were included in the study. Patients with an acute coronary syndrome within the three months prior to the inclusion were excluded. Good blood pressure (BP) control was considered < 140/90 mmHg, < 130/80 mmHg for diabetics (ESH-ESC 2003). LDL cholesterol (LDL-c) < 100 mg/dl (NCEP-ATP III) and fasting glucose between 90 and 130 mg/dl (ADA 2005) were considered as good control rates. RESULTS: A total of 2,024 patients (66.8+/-10.1 years; 31.7% women) were included in the study. Systolic BP was 142.7 +/- 17.9 mmHg and diastolic BP 81.8 +/- 11.3 mmHg. 78.4% of the patients had dyslipidemia and 32.3% diabetes. Almost all the patients (99.7%) were taking at least one antihypertensive drug, beta blockers being the most frequent (67.1%). A total of 74.9% of the patients were taking lipid lowering drugs and 27.9% antidiabetics. BP was controlled in 40.5% of the patients, LDL-c in 30.6% of the dyslipidemic subgroup and fasting glucose in 26.6% of the diabetics. CONCLUSIONS: In this high-risk population, the control rates of risk factors continues to remain low even though the majority of patients were taking several drugs.

[Utility of myocardial perfusion SPECT for evaluation of patients from Chest Pain Unit]. / Análisis y utilidad de la tomografía de emisión de fotón único de perfusión miocárdica en la evaluación de pacientes de la Unidad de dolor torácico.

UNLABELLED: The Chest Pain Units (CPU) are currently the best solution to improve management of patients with acute chest pain in the Emergency Room thanks to the use of reliable ischemia diagnostic detection tests and early treatment. OBJECTIVE: To assess the value of myocardial perfusion SPECT (MPS) in the CPU in order to treat acute coronary syndromes (ACS) early and discharge patients with low risk of coronary artery disease (CAD) who can be treated as outpatients. MATERIAL AND METHODS: We studied 629 patients from January 2003 to September 2005 with acute chest pain suggestive of angina, normal cardiac enzymes and normal or non-diagnostic ECG who had been referred to Nuclear Medicine for evaluation with a stress test for ischemia: 32 p treadmill stress testing and 597 p MPS (525 p exercise-rest and 72 p pharmacologic stress test). We compared the results with catheterization and clinical follow up for a 6-months period, evaluating new coronary events. RESULTS: 76 % of MPS were normal and 24 % pathological. Only 1.5 % of the patients with normal MPS had CAD or coronary events in the follow-up, increasing to 35.2 % in patients with ischemia. A total of 45 catheterizations were performed, showing CAD 27 (24 with pathological MPS). A total of 2.6 % of the patients had coronary events during follow-up, 75 % of whom had pathological MPS. CONCLUSION: The MPS improves diagnosis of ACS in the CPU, with a very low number of new coronary events at 6 months of the follow-up and permits safe discharge of these patients.

Control de los factores de riesgo en pacientes diabéticos en prevención secundaria. Estudio MIRVAS / Control of risk factor in diabetic patients in secondary prevention. MIRVAS Study

Introducción. El control de los factores de riesgo cardiovascular (FRCV) en prevención secundaria adquiere gran importancia en los diabéticos, aunque suele ser aún más difícil de alcanzar que en los no diabéticos. En este artículo se compara el grado de control de los FRCV y los tratamientos pautados en los pacientes diabéticos frente a los no diabéticos del estudio MIRVAS, así como la influencia de una intervención intensiva y multifactorial sobre ambas variables en esta población. Material y métodos. Se comparan los subgrupos de diabéticos (71: 38 del grupo intervención y 33 del grupo control) entre sí y con el de no diabéticos (176: 83 y 93 respectivamente) del estudio MIRVAS. Los objetivos de control de los FRCV y los tratamientos a pautar son los recomendados en las guías internacionales. Resultados. En los diabéticos la prevalencia basal de la hipertensión arterial (HTA) y de la dislipemia es superior (70,4% frente al 54% y 73,2% frente al 50,6%, respectivamente). Al año, la presión arterial (PA) y el colesterol HDL son significativamente peores en los pacientes diabéticos (45,9% con una PA controlada en los diabéticos frente a un 81,9% en los no diabéticos; 49,43 mg/dl en diabéticos frente a 53,82 mg/dl en no diabéticos). Los diabéticos del grupo intervención presentan al año mejores cifras de HbA1c (5,52% frente a 6,59%), colesterol HDL (52,81 mg/dl frente a 45,24 mg/dl) y PA sistólica (123,03 mmHg frente a 136,50 mmHg) y de prescripción de estatinas (96,77% frente a 76,67%). Discusión. Aunque la presencia de diabetes dificulta el logro de los objetivos de control en prevención secundaria, una intervención intensiva y multifactorial como la realizada en el estudio MIRVAS puede obtener mejores resultados (AU)

Background. Control of cardiovascular risk factors (CVRF) in secondary prevention becomes very important in diabetic patients, although this can be even more difficult to achieve than in non-diabetic patients. This article compares the degree of control of CVRF and drugs prescribed to diabetics versus non-diabetics in the MIRVAS study. It also evaluates the results of an intensive and multifactorial intervention regarding both subjects in this population. Material and methods. The subgroups of diabetic patients are compared (71 patients: 38 in the intervention group and 33 in the control group) within groups and with the non-diabetics (176 patients: 83 and 93, respectively), all of them included in the MIRVAS study. The targets of CVRF control and drugs to be prescribed are those recommended in the international guidelines. Results. The baseline prevalence of high blood pressure and dyslipidemia is higher in diabetic patients (70.4% vs. 54% and 73.2% vs. 50.6%, respectively). At one year after the cardiovascular event, blood pressure (BP) and HDL-cholesterol control are significantly worse in diabetics (45.9% of diabetic patients vs. 81.9% of non-diabetics with BP under control; 49.43 mg/dl in diabetics vs 53.82 mg/dl in non-diabetics). Diabetics from the intervention group have better HbA1c (5.52% vs. 6.59%), HDL-cholesterol (52.81 mg/dl vs. 45.24 mg/dl), systolic BP (123.03 mmHg vs. 136.50 mmHg) and statins prescription (96.77% vs. 76.67%). Conclusions. Diabetes mellitus makes it more difficult to achieve the objectives of control in secondary prevention. An intensive and multifactorial intervention such as that one done in MIRVAS study can attain better results (AU)

[Control of risk factor in diabetic patients in secondary prevention. MIRVAS Study]. / Control de los factores de riesgo en pacientes diabéticos en prevención secundaria. Estudio MIRVAS.

BACKGROUND: Control of cardiovascular risk factors (CVRF) in secondary prevention becomes very important in diabetic patients, although this can be even more difficult to achieve than in non-diabetic patients. This article compares the degree of control of CVRF and drugs prescribed to diabetics versus non-diabetics in the MIRVAS study. It also evaluates the results of an intensive and multifactorial intervention regarding both subjects in this population. MATERIAL AND METHODS: The subgroups of diabetic patients are compared (71 patients: 38 in the intervention group and 33 in the control group) within groups and with the non-diabetics (176 patients: 83 and 93, respectively), all of them included in the MIRVAS study. The targets of CVRF control and drugs to be prescribed are those recommended in the international guidelines. RESULTS: The baseline prevalence of high blood pressure and dyslipidemia is higher in diabetic patients (70.4% vs. 54% and 73.2% vs. 50.6%, respectively). At one year after the cardiovascular event, blood pressure (BP) and HDL-cholesterol control are significantly worse in diabetics (45.9% of diabetic patients vs. 81.9% of non-diabetics with BP under control; 49.43 mg/dl in diabetics vs 53.82 mg/dl in non-diabetics). Diabetics from the intervention group have better HbA1c (5.52% vs. 6.59%), HDL-cholesterol (52.81 mg/dl vs. 45.24 mg/dl), systolic BP (123.03 mmHg vs. 136.50 mmHg) and statins prescription (96.77% vs. 76.67%). CONCLUSIONS: Diabetes mellitus makes it more difficult to achieve the objectives of control in secondary prevention. An intensive and multifactorial intervention such as that one done in MIRVAS study can attain better results.

¿Qué factores influyen en la concesión de una incapacidad permanente? / No disponible

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[Short-term evaluation of risk factor control and therapeutic prescription in secondary prevention of cardiovascular diseases]. / Evaluación a corto plazo del control de los factores de riesgo y de la prescripción terapéutica en prevención secundaria de enfermedad cardiovascular.

INTRODUCTION: Quantify risk factor control and compliance of present therapeutic recommendations in the two months following an acute myocardial infarction (AMI) or ischemic stroke. MATERIAL AND METHODS: Cross-sectional, descriptive study of risk factors and treatments prescribed on discharge after AMI or stroke. RESULTS: A total of 68% of 122 patients (65.6% AMI; 22.1% women; mean age: 64.9), had controlled BP; 70.1% BMI < 30 kg/m2; 54.1% LDL-cholesterol < 100 mg/dl. Controlled BP (78.7% versus 50%) and adequate LDL-cholesterol (62.3% versus 20.5%) were greater after AMI than after stroke (p < 0.001). ACEI/ARA II prescribed after AMI: 30% (p < 0.001). After AMI, 26.2% without beta blocker (only 8.8% contraindicated). HbA1c < 7% in 55.5% of diabetics; BP control inferior to non-diabetics (p < 0.001). DISCUSSION: Short term control of the risk factors after cardiovascular episode and prescription on hospital discharge are improvable, above all after a stroke.

Evaluación a corto plazo del control de los factores de riesgo y de la prescripción terapéutica en prevención secundaria de enfermedad cardiovascular / Short-term evaluation of risk factor control and therapeutic prescription in secondary prevention of cardiovascular diseases

Introducción. El objetivo de este estudio es cuantificar el control de los factores de riesgo y el cumplimiento de las recomendaciones terapéuticas actuales en los dos meses posteriores a un infarto agudo de miocardio (IAM) o un ictus isquémico. Material y métodos. Estudio transversal descriptivo de factores de riesgo y tratamientos prescritos al alta tras IAM o ictus. Resultados. De 122 pacientes (65,6% IAM; 22,1% mujeres; edad media: 64,9), 68% tenían presión arterial (PA) controlada, 70,1% índice de masa corporal (IMC) < 30 kg/m2, 54,1% colesterol LDL (ligado a lipoproteínas de baja densidad) < 100 mg/dl. PA controlada (78,7% frente a 50%) y colesterol LDL adecuado (62,3% frente a 20,5%) fueron mejores tras IAM que tras ictus (p < 0,001). Inhibidores de la enzima de conversión de la angiotensina (IECA)/antagonistas de los receptores de la angiotensina II (ARA II) pautado tras IAM: 80%; tras ictus: 30% (p < 0,001). Tras IAM, 26,2% sin bloqueador beta (contraindicados sólo 8,8%). HbA1c < 7% en 55,5% de diabéticos; control de PA inferior a no diabéticos (p < 0,001). Discusión. El control a corto plazo de los factores de riesgo tras un episodio cardiovascular y la prescripción al alta hospitalaria son mejorables, sobre todo tras un ictus (AU)

Introduction. Quantify risk factor control and compliance of present therapeutic recommendations in the two months following an acute myocardial infarction (AMI) or ischemic stroke. Material and methods. Cross-sectional, descriptive study of risk factors and treatments prescribed on discharge after AMI or stroke. Results. A total of 68% of 122 patients (65.6% AMI; 22.1% women; mean age: 64.9), had controlled BP; 70.1% BMI < 30 kg/m2; 54.1% LDL-cholesterol < 100 mg/dl. Controlled BP (78.7% versus 50%) and adequate LDL-cholesterol (62.3% versus 20.5%) were greater after AMI than after stroke (p < 0.001). ACEI/ARA II prescribed after AMI: 30% (p < 0.001). After AMI, 26.2% without beta blocker (only 8.8% contraindicated). HbA1c < 7% in 55.5% of diabetics; BP control inferior to non-diabetics (p < 0.001). Discussion. Short term control of the risk factors after cardiovascular episode and prescription on hospital discharge are improvable, above all after a stroke (AU)

Hiperoxaluria primaria / Primary hyperoxaluria

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[Yield of transthoracic echocardiography with high frequency transducer in the study of the anterior descending coronary artery]. / Rendimiento de la ecocardiografía transtorácica con sonda de alta frecuencia en el estudio de la descendente anterior.

INTRODUCTION AND OBJECTIVES: This study was performed to evaluate the feasibility and utility of a transthoracic high frequency transducer to detect and measure the left anterior descending coronary artery flow in patients with lesions in this artery or anterior myocardial infarction. MATERIALS AND METHODS: We studied 11 subjects with lesions greater than 75% and another 10 with anterior myocardial infarction. We compared the results with a control group of 18 subjects. An ATL HDI 5000 ultrasound unit with a 5-8 MHz transducer was used to identify the left anterior descending in the anterior interventricular sulcus from an apical four chamber window. We considered that left anterior descending was detected when a diastolic predominant flow pattern was obtained with pulse Doppler. RESULTS: Left anterior descending was detected in 37/39 of cases (94.4%). Patients with coronary lesions showed a decrease in the limit of significance in the diastolic/systolic peak velocity ratios: 2.5 (SD 0.7) vs 1.8 (SD 0.3) with a p = 0.024. Patients with anterior myocardial infarction obtained lower diastolic/systolic peak velocity ratios than controls: 2.5 (SD 0.7) vs 1.4 (SD 0.3) with a p = 0.001. CONCLUSIONS: Left anterior descending coronary artery flow can be assessed by transthoracic high frequency echocardiography in greater than 90% of the cases. Patients with coronary lesions and those with anterior myocardial infarction have a decreased diastolic/systolic peak velocity ratio.

[Left ventricular pseudoaneurysm with a fistula to right ventricle following previous repair of septal defect after acute myocardial infarction]. / Seudoaneurisma de ventrículo izquierdo con fístula a ventrículo derecho tras la corrección de una comunicación interventricular postinfarto.

A case of left ventricular pseudoaneurysm with a fistula to right ventricle is presented. It appeared following the repair of a ventricular septal defect after acute myocardial infarction. The left ventricular pseudoaneurysm is associated, in most cases, with acute myocardial infarction. However, we should not forget surgery as aetiology of this pathology. The most frequent post-surgery pseudoaneurysms appear after aneurysmectomy and after mitral valve replacement. They tend to develop fistulas which differ from post acute myocardial infarction pseudoaneurysms. Few cases have been described following the repair of septal defect and none of them complicated with a fistula to right ventricle, as in our case.

Cardiac fulguration, a new alternative therapy for atrioventricular nodal reentrant tachycardia.

Ten patients underwent endocardial catheter ablation of the atrioventricular junction for atrioventricular nodal reentrant tachycardias. Unipolar cathodic discharges at the distal electrode were administered against an external plate. Bipolar His and atrial deflections showed a mean of 0.15 mv and 0.5 mv respectively. Mean total energy used per patient was 195 J (range: 50-750), with a mean number of ablating discharges of 2.0 per patient, (range: 1-5). Complete atrioventricular block was achieved, but conduction reappeared in all except one patient, after a mean interval of 19.9 min. Electrophysiological evaluation was assessed 3-8 days after ablation. Sustained atrioventricular nodal reentrant tachycardias were no longer inducible in any patient. Retrograde conduction was abolished in six, and was slow and decremental in four. First-degree atrioventricular block, with intranodal delay was diagnosed in six, with an AH interval that ranged from 240 to 130 ms. Mean cycle length for appearance of Wenckebach atrioventricular block was 390 ms after ablation. One patient developed complete atrioventricular block after two discharges of 50 J, another required a repeat ablation for recurrence of intranodal tachycardia and also developed complete anterograde block in a new session of ablation with a 150 J discharge. In these two patients permanent pacing was needed. Eight patients were cured after a mean follow-up of 20 months. Less energy and fewer discharges should be administered to abolish functional dissociation of the atrioventricular node, without complete interruption of anterograde conduction.

[A sinus of Valsalva aneurysm ruptured into the right atrium secondary to aortic endocarditis. The usefulness of transthoracic and transesophageal echocardiography]. / Aneurisma de seno de Valsalva roto en aurícula derecha secundario a endocarditis aórtica. Utilidad de la ecocardiografía transtorácica y transesofágica.

We present a case of a sinus of Valsalva aneurysm ruptured into right atrium secondary to aortic endocarditis. Early surgical procedure was indicated bases on transthoracic echocardiography. This technique demonstrated a abscess image enlarged into the right atrium and color Doppler showed a turbulent flow from aortic valve to right atrium. Cardiac surgery was performed with transesophageal echocardiography monitoring. This technique allowed anatomical and functional aortic valve evaluation and the abscess location and extension. This case shows the value of transthoracic and transesophageal color Doppler echocardiography in the diagnosis and management of patients with complications secondary to infective endocarditis.

Traumatic rupture of aorta. Diagnosis by Doppler echocardiography.

Traumatic rupture of aorta is a serious complication in accidents, mainly road accidents, with a high mortality unless an immediate diagnosis and surgical correction is made. A case of traumatic rupture of the aorta shown in the acute phase by Doppler-echocardiography is reported. This technique can be of great value in the study of patients with thoracic trauma who do not show clear signs of aortic rupture which require urgent aortography.

[Prognostic significance of silent ischemia in the exercise test in patients with coronary disease]. / Significado pronóstico de la isquemia silente durante la prueba de esfuerzo en pacientes con enfermedad coronaria.

To evaluate the prognostic significance of silent ischemia during exercise testing, 152 consecutive patients (143 males, 9 females) with a mean SD of 55 +/- 7 years (age range 32-73) who underwent exercise testing and coronary arteriography within 3 months were studied. All patients had the following characteristics: 1) a positive electrocardiographic exercise test response; 2) significant coronary artery disease on the arteriography; 3) uninterrupted clinical follow-up for a minimum of 6 months. The 152 patients were divided in 2 groups: group I: 56 patients (37%) with ischemic ST-segment depression during exercise testing without angina (silent ischemia); group II: 96 patients (63%) with ischemic ST-segment depression and angina (symptomatic ischemia). Patients in group I and group II showed similar time to ST-segment depression (3.6 +/- 1.5 min vs 3.2 +/- 1.4 min; p = NS), maximal ST-segment depression and peak heart rate-systolic pressure product (21,151 +/- 7,124 vs 20,456 +/- 6,024; p = NS). Exercise duration was longer in group I than in group II (5.6 +/- 2.1 min vs 4.8 +/- 1.5 min; p less than 0.001). The extent of coronary artery disease defined by the number of significant narrowed coronary vessels, left ventricular end diastolic pressure and ejection fraction were similar in the 2 groups. Sixty six patients who underwent coronary bypass surgery were not included in the analysis. The remaining 86 patients (40 in group I and 46 in group II) were medically treated. The mean follow-up period was 43,5 +/- 25 months (range 6-101).2+ myocardial ischemia during exercise testing.

Ecological structures recognized by means of entropy analysis: assessment of differences between entropy values.

A procedure is outlined for the assessment of differences between entropy values obtained from a data set. The problem posed is that of identifying the data matrix representing least uncertainty in the disposition of its elements from two or more given matrices. Monte Carlo simulations were used, through which the maximum and minimum entropy values that could be obtained from each data set were estimated. Such values could be obtained by randomly interchanging the elements of each matrix and may serve as references in estimating the degree of order or randomness that an original matrix possesses.