Optimismo de los pacientes cardiológicos respecto a la reanimación cardiopulmonar. Posibles causas y consecuencias / Optimism regarding cardiopulmonary resuscitation among patients with heart disease. Possible causes and consequences

OBJETIVO: El pronóstico predicho por los cardiópatas españoles respecto a la reanimación cardiopulmonar se aleja significativamente de la realidad. Buscamos determinar si existen diferencias de percepción con respecto a otros pacientes y elaborar hipótesis que puedan justificarlo. MÉTODO: Estudio descriptivo mediante encuesta a una serie consecutiva de pacientes cardiológicos, no cardiológicos y a estudiantes de medicina. RESULTADOS: Tras una parada cardiorrespiratoria intrahospitalaria los pacientes cardiológicos refirieron una supervivencia media al alta total (76 vs.62%; p < 0,01) y libre de deterioro cognitivo (65 vs.55%; p = 0,02) significativamente superior a la de los pacientes no cardiológicos, a pesar de tener una edad media superior y haber presenciado en más ocasiones maniobras de reanimación. Los estudiantes de medicina refieren supervivencias (62 y 48% respectivamente) que también se encuentran muy alejadas de la realidad. Aunque ambos grupos de pacientes referían que el médico era su principal fuente de información sobre la salud (91 y 90%), el contacto principal con la reanimación había sido a través de series o películas de televisión. Ningún paciente rechazó la participación en el estudio. CONCLUSIONES: El paciente cardiológico tiene una visión de los resultados de la reanimación cardiopulmonar más optimista que el resto. Este hecho debe tenerse en cuenta, puesto que podría comprometer el desarrollo de las conversaciones sobre sus cuidados al final de la vida

OBJECTIVE: The outcomes regarding cardiopulmonary resuscitation predicted by Spanish cardiac patients are far from the reality. We sought to determine differences of perception with respect to other patients and develop hypotheses that might justify them. Method: Descriptive study using an interview-guided survey with a consecutive series of cardiac patients, non-cardiac patients, and medical students. RESULTS: Following in-hospital cardiac arrest, cardiac patients reported a significantly higher mean survival to discharge (76 vs.62%, p < 0.01) and free from neurological disability (65 vs.55%, p = 0.02) than non-cardiac patients, despite being older and having more frequently undergone resuscitation manoeuvres. Medical students also reported survivals (62 and 48%, respectively) that are also far from the reality. Although both groups of patients reported that physicians were their main source of health information (91 and 90%), their main contact with resuscitation had been through TV series and/or movies. No patient declined to participate in the study. CONCLUSIONS: Cardiac patients have a more optimistic vision of the results of cardiopulmonary resuscitation. This fact should be taken into account in planning conversations about end-of-life care

Soria Cardioprotegida. Primer programa español de prevención y tratamiento integral de la muerte súbita cardiaca / Soria Cardioprotegida. The first Spanish program for the prevention and integral treatment of sudden cardiac death

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Las órdenes de no reanimar: ¿siempre consensuadas?. Respuesta / Do-notresuscitate orders: always with consensus?. Reply

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Edad y deseos de reanimación cardiopulmonar en pacientes cardiológicos / Age and cardiopulmonary resuscitation wishes of patients with heart disease

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Las órdenes de no reanimar. Historia y situación actual / Do-not-resuscitate orders. History and current status

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Diagnosis of Active Infective Endocarditis from Examination of the Toes and Soles.

A 72-year-old woman was admitted to our hospital with fever >38°C of unknown origin. Blood cultures were positive in two sets for Staphylococcus aureus. In the third day of admission, her husband drew attention to the presence of some small punctures in her right foot. Several small and non-tender, erythematous and hemorrhagic macular lesions were found on her sole (Janeway lesions). Besides, we detected some painful and palpable, erythematous nodules involving the pads of her toes (Osler nodes). At this point, according to the modified Duke criteria, the clinical diagnosis of definite infective endocarditis might be established. Additionally, the transesophageal echocardiogram just confirmed the presence of a large vegetation attached to the posterior leaflet of the mitral valve.

Expectativas de supervivencia tras la reanimación cardiopulmonar. Predicciones y deseos de los cardiópatas / Expectations of survival following cardiopulmonary resuscitation. Predictions and wishes of patients with heart disease

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Vitreoretinal presentation of secondary large B-cell lymphoma in patients with systemic lymphoma.

IMPORTANCE: Intraocular lymphomas represent a diverse group of hematologic malignant neoplasms involving different tissues within the eye. Predominant involvement of the retina and vitreous without uveal infiltration in systemic lymphoma, mimicking a primary vitreoretinal lymphoma, is extremely rare. Our study emphasizes the importance of systemic evaluation in addition to central nervous system evaluation in all patients with newly diagnosed vitreoretinal lymphoma. OBJECTIVE: To determine the incidence of secondary intraocular lymphoma presenting as vitreoretinal infiltrates without central nervous system involvement, mimicking primary vitreoretinal lymphoma in patients with systemic lymphoma. DESIGN Retrospective review of all vitreous aspiration biopsy samples acquired because malignant neoplasm was suspected clinically that were obtained at our institution from January 1, 2000, through December 31, 2010. Review included patient clinical history, radiographic study findings, cytologic and/or histologic preparations, immunophenotypic study findings, treatment, and outcomes. SETTING Mayo Clinic pathology database. PARTICIPANTS: Fifty-five patients with vitreous specimens available for review. EXPOSURES: Vitreous aspiration biopsy. MAIN OUTCOME AND MEASURE: Confirmation of the diagnosis of diffuse large B-cell lymphoma (DLBCL). RESULTS: Of the 55 patients with vitreous specimens available for review, 3 (5%) had a DLBCL infiltration in the vitreous without any central nervous system involvement as a manifestation of systemic lymphoma. All 3 patients were men, aged 54, 66, and 73 years, and had blurred vision and floaters for several weeks before undergoing diagnostic vitrectomy. Ophthalmic examinations revealed clumps of vitreous cells but no choroidal involvement. One patient had no history of lymphoma; the diagnosis of vitreoretinal lymphoma was followed by DLBCL after a lymph node biopsy. The other 2 patients had low-grade B-cell lymphoma and chronic lymphocytic leukemia for 29 and 7 months before large-cell transformation in the eye. Patients were treated with systemic chemotherapy plus intraocular injections of rituximab or methotrexate sodium. CONCLUSIONS AND RELEVANCE: Vitreoretinal symptoms of DLBCL in patients with systemic lymphoma may be more frequent than previously thought (5% in our study). Not all lymphomas with vitreoretinal involvement represent primary intraocular lymphomas; thorough ophthalmologic evaluation in patients with visual symptoms and complete staging in patients with documented ocular lymphoma are of utmost importance.

Clinical and histopathologic findings after photodynamic therapy of choroidal melanoma.

BACKGROUND: Photodynamic therapy (PDT) has been used occasionally as an alternative treatment for uveal melanomas. The present study describes the clinical and histopathologic features of five choroidal melanomas after PDT. METHODS: Three patients with pigmented choroidal melanomas were treated with PDT and intravitreal bevacizumab 1 week before undergoing biopsy and brachytherapy to minimize the risks of bleeding during the biopsy. Another two patients received PDT as a primary treatment for peripapillary amelanotic melanomas, one of them also in combination with bevacizumab. RESULTS: The tumors treated with PDT and bevacizumab showed a marked reduction in tumor vascularity assessed by indocyanine angiography, and the biopsies were conducted without recognizable bleeding, showing viable tumor cells. The tumors receiving PDT as a primary treatment were followed by progressive tumor growth that led to enucleation years after. The histopathology revealed overlying fibrosis with invasion of sclera and optic nerve. CONCLUSION: Photodynamic therapy and bevacizumab can induce closure of the superficial vasculature of a pigmented choroidal melanoma, but in none of our cases, there was evidence of tumor destruction from this treatment. Preoperative PDT may be useful to reduce the potential of bleeding at the time of tumor biopsy. Our cases do not support the use of a single session of PDT as a primary treatment for pigmented small choroidal melanomas.

Microcephaly-lymphedema-chorioretinal dysplasia associated with pachymicrogyria and atrophy of the cerebellar vermis: an integration of brain-ocular migration disorders.

BACKGROUND: Microcephaly-lymphedema-chorioretinal dysplasia (OMIM 152950) is a rare malformative inherited disorder that can be associated with other systemic features. Other ocular and brain anomalies rather than microcephaly and chorioretinal dysplasia have been inconstantly reported in this syndrome. METHODS: We present a case of microcephaly-lymphedema-chorioretinal dysplasia with a dysmorphic facies, hypertonicity in the extremities and neuropsychomotor delay. Ophthalmological examination revealed bilateral nystagmus, microphthalmia, posterior subcapsular cataratacts, extensive chorioretinal dysplasia, optic nerve aplasia, persistent fetal vasculature, and absent retinal vessels. RESULTS: Magnetic resonance revealed pachymicrogyria and discrete atrophy of vermis cerebelosum and confirmed optic nerve hypoplasia. CONCLUSIONS: The developmental alterations observed in the retina of this patient could be analogous to central nervous system anomalies, reflecting a reduction in neural population. Ophthalmic examination of children with microcephaly is warranted.