Migración de stent implantado en la arteria pulmonar en un paciente con tetralogía de Fallot / Migration of a stent implanted in the pulmonary artery of a patient with tetralogy of Fallot

La tetralogía de Fallot es una cardiopatía congénita que representa el 11-13% de estas. La estenosis e hipoplasia de las arterias pulmonares aparecen en un alto porcentaje, debido a que esta enfermedad cursa con una estenosis nativa de la rama pulmonar y a que la cirugía previa la puede estenosar. Los stents intravasculares expandibles mediante balón son una técnica alternativa a la reintervención en pacientes con cardiopatías congénitas. Sin embargo, a pesar del progresivo incremento de su utilización, el limitado número de procedimientos asociado a la amplia variedad anatómica y diferentes características de estos pacientes hace que aun en manos expertas, la implantación de stents en estos pacientes asocie una incidencia no despreciable de complicaciones, las cuales no son siempre inocuas y obligan en ocasiones a realizar tratamientos quirúrgicos en enfermos ya multiintervenidos, lo que aumenta la complejidad y el riesgo (AU)

Tetralogy of Fallot is a congenital heart disease that accounts for 11-13% of the congenital cardiomyopathies. Stenosis and hyperplasia of the pulmonary arteries occur in a high proportion of them as this disease causes a native stenosis of the pulmonary branch, which can be surgically repaired with a stent. The use of balloon expandable intravascular stents is an alternative technique to further surgery in patients with congenital heart diseases. However, despite the gradual increase in their use, the limited number of procedures, combined with the wide anatomical variability and different characteristics of these patients, even in expert hands, stent implants are associated with a not inconsiderable incidence of complications. These are not always obvious and often require performing surgery in patients who have already had multiple interventions, thus increasing the complexity and the risk (AU)

[Migration of a stent implanted in the pulmonary artery of a patient with tetralogy of Fallot]. / Migración de stent implantado en la arteria pulmonar en un paciente con tetralogía de Fallot.

Tetralogy of Fallot is a congenital heart disease that accounts for 11-13% of the congenital cardiomyopathies. Stenosis and hyperplasia of the pulmonary arteries occur in a high proportion of them as this disease causes a native stenosis of the pulmonary branch, which can be surgically repaired with a stent. The use of balloon expandable intravascular stents is an alternative technique to further surgery in patients with congenital heart diseases. However, despite the gradual increase in their use, the limited number of procedures, combined with the wide anatomical variability and different characteristics of these patients, even in expert hands, stent implants are associated with a not inconsiderable incidence of complications. These are not always obvious and often require performing surgery in patients who have already had multiple interventions, thus increasing the complexity and the risk.

Progresión de la obesidad infantil en Tenerife / Children obesity progression in Tenerife Island

Introducción: En nuestra práctica asistencial hemos observado recientemente un aumento de la obesidad en la población infantil y un adelanto en su edad de aparición. Nuestro objetivo es comprobar estos fenómenos, identificando la edad de mayor riesgo de inicio de obesidad infantil y estudiar su asociación a otros factores, como el sexo y el peso al nacimiento. Material, pacientes y métodos: Se analizan las historias clínicas de todos los niños (n= 660), pertenecientes a tres cohortes, según el año de nacimiento (1989, 1997 y 2000), en tres centros de salud del área de Tenerife. El peso al nacimiento se expresó como z-score, se calculó el índice de masa corporal(IMC) anualmente a partir del año de edad y hasta los 8 años. La progresión del IMC se representa gráficamente con su valor medio anual, por sexos y cohortes. Las diferencias de evolución del IMC por sexos, intra/intercohortes, se obtienen mediante un modelo lineal general multivariante para medidas repetidas, usándose modelos ANOVA para diferenciar la edad a laque se separan las diferentes cohortes en relación con el IMC. El poder predictivo independiente del año de nacimiento, elz-score del peso al nacer y el sexo del recién nacido sobre el IMC a los 8 años de edad se valora con modelos de regresión lineal múltiple. El riesgo de estos tres factores en relación con la aparición de la obesidad a los 8 años de edad se evalúa mediante modelos de regresión logística binaria multivariable. Resultados: El año de nacimiento, el z-score del peso al nacer y el sexo muestran un poder predictivo sobre el IMC a los 8 años de edad, y el primero es el factor de mayor significación y el que supone un riesgo significativo para presentar obesidad a esta edad. La edad más probable de inicio de obesidad infantiles a los 4 años. Conclusiones: a) la edad de inicio de la obesidad se ha adelantado en nuestra población infantil; b) la obesidad se inicia, como promedio, a la edad de 4 años, aunque es mayor en los varones, y c) al menos hasta los 8 años de edad, un mayor peso al nacer se asocia a un aumento del IMC (AU)

Introduction and aim: We have perceived an increased frequency and earlier onset of child overweight and obesity. Our objetive is to prove this hypothesis by identifying the age of higher risk of child obesity onset and by studying its association to gender and birth weight. Material and methods: Birth weight was expressed as zscore and yearly Body Mass Index (BMI) from the first year to the age of eight were collected from all clinical records of 660children of three Primary Health Centers of Tenerife. Data were classified into three cohorts by their birth year (1989, 1997 and 2000). BMI progression plots were done by gender and cohort.BMI evolution by gender, so intra as among cohorts, has been tested using a multivariate generalized linear model for iterated measurements. ANOVA test was used to estimate at which age the cohorts show a different BMI. The independent predictive power of birth year, birth weight z-score and gender on BMI at the age of eight was evaluated using multiple linear regression models, whereas the influence of these variables on the risk of obesity at eight years old was evaluated using binary multivariable logistic regression models. Results: Birth year, birth weight z-score and gender show predictive power on BMI at eight years of age, being the former which implies as significant risk of obesity at that age. Obesity onset is more frequent at the age of four years. Conclusions: a) obesity onset occur at earlier age in our children; b) obesity begins at four years of age in average and is more frequent in boys, and c) a higher birth weight is associated with an increased BMI, at least until the age of eight(AU)

[Practice Guidelines of the Spanish Society of Cardiology in the postoperative course of congenital heart diseases]. / Guías de práctica clínica de la Sociedad Española de Cardiología en el postoperado de cardiopatía congénita.

Improvements in myocardial protection, surgical techniques, and perioperative care have made it possible to achieve better prognosis in most congenital heart defects. This requires a coordinated, multidisciplinary approach to patient care, based on the preservation of adequate oxygen delivery to vital organs. It is important to have an understanding of normal postoperative status after cardiac surgery so that abnormal postoperative convalescence can be identified and treated.The causes of abnormal convalescence may be grouped into three categories: a) the pathophysiology of the defect before surgery and the acute changes in physiology that result from surgery; b) the effects of hypothermic cardiopulmonary bypass and deep hypothermic circulatory arrest on organ function, and c) the presence of residual anatomic defects. These conditions may result in prolonged convalescence as well as increased morbidity and mortality. Three primary hemodynamic pathophysiologic disturbances may occur during the postoperative period and lead to abnormal convalescence: left ventricular dysfunction, right ventricular dysfunction and pulmonary hypertension. Though sometimes not directly related to either the cardiac defect or surgery, specific problems involving different organs may alter the normal postoperative period. Neurologic, pneumologic, renal, gastrointestinal and infective complications are discussed separately.

[Practical usefulness of genogram in the handicapped patient care]. / Utilidad práctica del genograma en la atención al paciente inmovilizado.

OBJECTIVE: To know the practical use of genogram in the handicapped patient care, describing their characteristics and those of their families and to obtain the prevalence of bad care immobilized patients belonging to the health centre. DESIGN: Descriptive observational. SETTING: Urban health centre. PARTICIPANTS: People of both sexes registered at the health centre, immobilized in their houses, with a disability score of three or more in the physical disability scale of the Red Cross. MEASUREMENTS AND RESULTS: The most important features of our immobilized people, obtained from the genogram, are: women (63.5%), with mean age of 78.8 +/- 13.2 years old (CI, 76.5-81.17), with disability score of 3 (46.8%), immersed in a nuclear family (34.9%), in phase VI of dissolution of the vital cycle (45.2%), with very closed relations (45.2%), with arthrosis (23.8%) as the most frequent immobilized cause, and with one unique home career only (72%). The prevalence of bad care immobilized patients was 25.4%. CONCLUSIONS: The genogram is an excellent tool for describing immobilized people and their family nucleus, allowing the definition of an immobilized profile. If the patient is bad cared, he will need an special consideration. The immobilized score and the family relations ship may complicate their care, conditioning a worse prognosis. We wish to emphasize the importance of carrying out the genogram in the initial moment of the immobilization, because it establishes a dialogue route between the families and the sanitary professionals to improve the attention of these patients.

Utilidad práctica del genograma en la atención al paciente inmovilizado / Practical use of genogram in the handicapped patient care

Objetivo. Conocer la utilidad práctica del genograma en la atención al paciente inmovilizado, describiendo las características de éstos y de sus familias, y obtener la prevalencia de inmovilizados mal cuidados pertenecientes al centro de salud. Diseño. Observacional, descriptivo. Emplazamiento. Centro de salud urbano. Participantes. Personas de ambos sexos adscritas al centro de salud, inmovilizadas en sus domicilios, con un grado de incapacidad igual o superior a 3 en la escala de incapacidad física de la Cruz Roja. Mediciones y resultados. Las principales características de nuestros inmovilizados, obtenidas a partir de los genogramas, son: mujeres (63,5 por ciento), con edad media de 78,8 ñ 13,2 (IC, 76,5-81,17) años, con grado 3 de incapacidad (46,8 por ciento), inmersos en una familia nuclear (34,9 por ciento), en fase VI de disolución del ciclo vital (45,2 por ciento), con relaciones muy unidas o fusionadas (45,2 por ciento), con artrosis (23,8 por ciento) como causa más frecuente de inmovilización y con un solo cuidador (72 por ciento). La prevalencia de inmovilizados mal cuidados fue del 25,4 por ciento. Conclusiones. El genograma es una excelente herramienta para describir a los pacientes inmovilizados y su entorno familiar, permitiendo definir un perfil de inmovilizado. Si el paciente está mal cuidado, precisará una especial consideración; el grado de inmovilización y tipo de relaciones familiares pueden dificultar los cuidados, propiciando un peor pronóstico. Destacamos la importancia de la realización del genograma de forma rutinaria al inicio de la inmovilización, porque establece una vía de dialogo entre familia y profesionales sanitariosque redunda en una mejor atención a estos pacientes (AU)

[Isolated mitral valve substitution with Beall prosthesis. Long term results]. / Sustitución valvular mitral aislada con la prótesis de Beall. Resultados a largo plazo.

During a three-year period (1970 to 1973) the Beall mitral prosthesis (103, 104 & 105 series) was used in 97 patients for isolated mitral valve replacement. The early surgical mortality rate within the first 30 days of operation was 11.34%. Among the 86 survivors, 7 developed thromboembolic complications (8.14 per cent), and there were 20 late deaths. Incidence of other complications such as prosthetic malfunction and significant intravascular hemolysis are commented. The 92.42 per cent of the late survivors are in Class I or II of the N.Y.H.A. functional classification.