RESUMEN
During the third trimester of her pregnancy, a 25-year-old carrier of Duchenne's muscular dystrophy developed severe cardiac failure and required mechanical circulatory support and transplantation. Her cardiac function improved during 311 days of circulatory support. However this improvement was not sufficient to allow removal of her left ventricular assist device before transplantation.
Asunto(s)
Cardiomiopatía Hipertrófica/diagnóstico , Distrofia Muscular de Duchenne/genética , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Adulto , Cardiomiopatía Hipertrófica/etiología , Cardiomiopatía Hipertrófica/terapia , Distrofina/análisis , Femenino , Trasplante de Corazón , Ventrículos Cardíacos/patología , Corazón Auxiliar , Heterocigoto , Humanos , Miocardio/patología , Embarazo , Complicaciones Cardiovasculares del Embarazo/etiología , Complicaciones Cardiovasculares del Embarazo/terapia , Tercer Trimestre del EmbarazoRESUMEN
Neuropsychological performance was examined among a group of patients with end-stage heart disease undergoing routine evaluation for transplantation using a matched case-control design. Heart transplant candidates and controls were matched case by case for gender, race, education and age range. In order to match all 44 controls, a clinical series of 303 heart transplant candidates evaluated between October 1995 through March 1998 were considered. Although not specifically matched on variables of estimated IQ and socioeconomic status, statistical analysis showed no group differences on these variables. A separate analysis of variance on each neuropsychological test indicated that the heart transplant candidates performed significantly worse than controls on tasks of fine motor speed and dexterity (i.e., Grooved Peg Board), psychomotor speed and mental flexibility (i.e., Trail Making Test, Part B), and abstract reasoning and problem solving ability (i.e., Shipley Institute of Living Scale-Abstraction subtest). Implications of the results and future directions are discussed.
Asunto(s)
Daño Encefálico Crónico/diagnóstico , Insuficiencia Cardíaca/psicología , Trasplante de Corazón/psicología , Pruebas Neuropsicológicas , Complicaciones Posoperatorias/diagnóstico , Adulto , Daño Encefálico Crónico/psicología , Estudios de Casos y Controles , Femenino , Insuficiencia Cardíaca/cirugía , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas/estadística & datos numéricos , Complicaciones Posoperatorias/psicología , Solución de Problemas , Psicometría , Desempeño Psicomotor , Tiempo de Reacción , Valores de ReferenciaRESUMEN
Our patient developed a wound infection that involved an implanted left ventricular assist device. At surgery, the pump was washed with a detergent-containing bacteriocidal solution, then antibiotic-impregnated polymethylmethacrylate beads were placed around the pump. The wound was revised using rectus muscle to cover the pump. The incisions have healed and the patient is now at home. She is on no systemic antibiotics and has no evidence of infection 11 months postoperatively.
Asunto(s)
Corazón Auxiliar , Infección de la Herida Quirúrgica/cirugía , Toracotomía , Adulto , Femenino , Humanos , ReoperaciónRESUMEN
A number of psychosocial measures were tested as correlates of coronary artery disease (CAD) in 122 males with positive coronary angiograms and 56 males with no manifest history of atherosclerotic disease who were selected to approximate the patients' age and socio economic status. Only denial of depression as indexed by spouse/friend-minus-self scores on the Ketterer Stress Symptom Frequency Checklist and number of unprovoked nocturnal awakenings were independently and positively related to CAD severity in multivariate regression analyses which controlled for jointly associated cardiac risk factors and commonly used cardiovascular medications. Denial of depression and unprovoked nocturnal awakening appear to be independent correlates of coronary artery disease.
