The Effects of Exercise on Cardiogenic Shock with an Intra-Aortic Balloon Pump: A Case Report. / Efeitos do Exercício em Choque Cardiogênico e Balão Intra-Aórtico: Um Relato de Caso.

This case report describes the exercise program on a hospitalized 54-year-old male patient with cardiogenic shock waiting for a heart transplant assisted by an intra-aortic balloon pump, a temporary mechanical circulatory support device. The temporary mechanical circulatory support device, an intra-aortic balloon pump, was placed in the left subclavian artery, enabling the exercise protocol. Measurements and values from Swan-Ganz catheter, blood sample, brain natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hs-CRP), as well as the six-minute walk test (6MWT) and venous oxygen saturation (SvO2) were obtained before and after an exercise protocol. The exercise training protocol involved the use of an unloaded bed cycle ergometer once a day, for a maximum of 30 minutes, to the tolerance limit. No adverse events or events related to the dislocation of the intra-aortic balloon pump were observed during the exercise protocol. The exercise program resulted in higher SvO2 levels, with an increased 6MWT with lower Borg dyspnea scores (312 meters vs. 488 meters and five points vs. three points, respectively). After completing the ten-day exercise protocol, the patient underwent a non-complicated heart transplant surgery and a full recovery in the ICU. This study showed that exercise is a feasible option for patients with cardiogenic shock who are using an intra-aortic balloon pump and that it is well-tolerated with no reported adverse events.

O presente relato de caso descreve o programa de exercícios aplicado a um paciente do sexo masculino, de 54 anos, internado com choque cardiogênico, aguardando transplante cardíaco e assistido por balão intra-aórtico, um dispositivo de suporte circulatório mecânico temporário. O dispositivo de suporte circulatório mecânico temporário, um balão intra-aórtico, foi colocado na artéria subclávia esquerda, possibilitando o protocolo de exercícios. Antes e após um protocolo de exercícios, foram obtidos dados a partir de cateter de Swan-Ganz, amostra de sangue, peptídeo natriurético cerebral (NT-proBNP), proteína C reativa de alta sensibilidade (PCR-as), teste de caminhada de seis minutos (TC6min) e medição da saturação venosa de oxigênio (SvO2). O protocolo de treinamento físico envolveu a utilização de um cicloergômetro adaptado ao leito, sem carga, uma vez ao dia, por no máximo 30 minutos, até o limite da tolerância. Não foram observados eventos adversos tampouco relacionados ao deslocamento do balão intra-aórtico durante o protocolo de exercícios. O programa de exercícios resultou em maior SvO2 com aumento do TC6min e menores escores de dispneia de Borg (312 metros vs. 488 metros e cinco pontos vs. três pontos, respectivamente). Após completar o protocolo de exercícios de dez dias, o paciente foi submetido a uma cirurgia de transplante cardíaco sem complicações e recuperação total na UTI. O presente estudo demonstrou que o exercício é uma opção viável para pacientes com choque cardiogênico em uso de balão intra-aórtico e que é bem tolerado, além de não haver relatos de eventos adversos.

Efeitos do exercício em choque cardiogênico e balão intra-aórtico: um relato de caso / The Effects of Exercise on Cardiogenic Shock with an Intra-Aortic Balloon Pump: A Case Report

O presente relato de caso descreve o programa de exercícios aplicado a um paciente do sexo masculino, de 54 anos, internado com choque cardiogênico, aguardando transplante cardíaco e assistido por balão intra-aórtico, um dispositivo de suporte circulatório mecânico temporário. O dispositivo de suporte circulatório mecânico temporário, um balão intra-aórtico, foi colocado na artéria subclávia esquerda, possibilitando o protocolo de exercícios. Antes e após um protocolo de exercícios, foram obtidos dados a partir de cateter de Swan-Ganz, amostra de sangue, peptídeo natriurético cerebral (NT-proBNP), proteína C reativa de alta sensibilidade (PCR-as), teste de caminhada de seis minutos (TC6min) e medição da saturação venosa de oxigênio (SvO2). O protocolo de treinamento físico envolveu a utilização de um cicloergômetro adaptado ao leito, sem carga, uma vez ao dia, por no máximo 30 minutos, até o limite da tolerância. Não foram observados eventos adversos tampouco relacionados ao deslocamento do balão intra-aórtico durante o protocolo de exercícios. O programa de exercícios resultou em maior SvO2 com aumento do TC6min e menores escores de dispneia de Borg (312 metros vs. 488 metros e cinco pontos vs. três pontos, respectivamente). Após completar o protocolo de exercícios de dez dias, o paciente foi submetido a uma cirurgia de transplante cardíaco sem complicações e recuperação total na UTI. O presente estudo demonstrou que o exercício é uma opção viável para pacientes com choque cardiogênico em uso de balão intra-aórtico e que é bem tolerado, além de não haver relatos de eventos adversos.

Donor hypernatremia and smoking addiction contribute to primary graft failure in heart transplantation

INTRODUCTION: Primary graft failure (PGF) is an important contributor to early mortality, accounting for 41% of deaths within the first 30 days after heart transplantation (HT). Donor hypernatremia has been associated with PGF development. However, controversial data exist regarding the impact of sodium deregulation in patient survival after HT. This study aimed to assess the influence of donor hypernatremia on PGF development and to determine the serum sodium level threshold to assist in decision-making for organ procurement. METHODS: The medical record from 200 HT patients and organ donors were retrospectively assessed and categorized by PGF occurrence. Donor sodium leve were compared and cut-off points obtained by receiver operating characteristic (ROC) curve. A multiple logistic regression model was applied to assess the effects of factors and covariates that influence PGF development. RESULTS: Sodium levels of donors were significantly higher in recipients who developed PGF than those who did not develop PGF (162 vs. 153 mmol/L, p = 0.001). The sodium cut-off value determined by the ROC curve was 159 mmol/L. The group who received organs from donors with a serum sodium concentration >/=159 mmol/L had a higher incidence of PGF (63.3% vs 32.4%, p < 0.001). Furthermore, donor sodium levels >/=159 mmol/L increased the likelihood of recipients developing PGF by 3.4 times. It is also observed that the incidence of donor smoking addiction was significantly higher in the PGF group (28.6% vs. 11.5%, p = 0.004) and donor smoking addiction increased the risk of developing PGF by 2.8 times. CONCLUSION: Smoking addiction and the application of suboptimal organs from donors with hypernatremia contribute to primary graft failure in heart transplantation. (AU)

Donor hypernatremia and smoking addiction contribute to primary graft failure in heart transplantation.

INTRODUCTION: Primary graft failure (PGF) is an important contributor to early mortality, accounting for 41% of deaths within the first 30 days after heart transplantation (HT). Donor hypernatremia has been associated with PGF development. However, controversial data exist regarding the impact of sodium deregulation in patient survival after HT. This study aimed to assess the influence of donor hypernatremia on PGF development and to determine the serum sodium level threshold to assist in decision-making for organ procurement. METHODS: The medical record from 200 HT patients and organ donors were retrospectively assessed and categorized by PGF occurrence. Donor sodium levels were compared and cut-off points obtained by receiver operating characteristic (ROC) curve. A multiple logistic regression model was applied to assess the effects of factors and covariates that influence PGF development. RESULTS: Sodium levels of donors were significantly higher in recipients who developed PGF than those who did not develop PGF (162 vs. 153 mmol/L, P = .001). The sodium cut-off value determined by the ROC curve was 159 mmol/L. The group who received organs from donors with a serum sodium concentration ≥159 mmol/L had a higher incidence of PGF (63.3% vs 32.4%, P < .001). Furthermore, donor sodium levels ≥159 mmol/L increased the likelihood of recipients developing PGF by 3.4 times. It is also observed that the incidence of donor smoking addiction was significantly higher in the PGF group (28.6% vs. 11.5%, P = .004) and donor smoking addiction increased the risk of developing PGF by 2.8 times. CONCLUSION: Smoking addiction and the application of suboptimal organs from donors with hypernatremia contribute to primary graft failure in heart transplantation.

Left Ventricular Reconstruction Surgery in Candidates for Heart Transplantation.

OBJECTIVE: To report our center's experience in the surgical treatment of ventricular reconstruction, an effective and efficient technique that allows patients with end-stage heart failure of ischemic etiology to have clinical improvement and increased survival. METHODS: Observational, clinical-surgical, sequential, retrospective study. Patients with ischemic cardiomyopathy and left ventricular aneurysm were attended at the Heart Failure, Ventricular Dysfunction and Cardiac Transplant outpatient clinic of the Dante Pazzanese Cardiology Institute, from January 2010 to December 2016. Data from 34 patients were collected, including systemic arterial hypertension, ejection fraction, New York Heart Association (NYHA) functional classification (FC), European System for Cardiac Operative Risk Evaluation (EuroSCORE) II value, Society of Thoracic Surgeons (STS) score, ventricular reconstruction technique, and survival. RESULTS: Overall mortality of 14.7%, with hospital admission being 8.82% and late death being 5.88%. Total survival rate at five years of 85.3%. In the preoperative phase, NYHA FC was Class I in five patients, II in 18, III in eight, and IV in three vs. NYHA FC Class I in 17 patients, II in eight, III in six, and IV in three, in the postoperative period. EuroSCORE II mean value was 6.29, P≤0.01; hazard ratio (HR) 1.16 (95% confidence interval [CI] 1.02-1.31). STS mortality/morbidity score mean value was 18.14, P≤0.004; HR 1.19 (95% CI 1.05-1.33). Surgical techniques showed no difference in survival among Dor 81% vs. Jatene 91.7%. CONCLUSION: Surgical treatment of left ventricular reconstruction in candidates for heart transplantation is effective, efficient, and safe, providing adequate survival.

Left ventricular reconstruction surgery in candidates for heart transplantation

OBJECTIVE: To report our center's experience in the surgical treatment of ventricular reconstruction, an effective and efficient technique that allows patients with end-stage heart failure of ischemic etiology to have clinical improvement and increased survival. METHODS: Observational, clinical-surgical, sequential, retrospective study. Patients with ischemic cardiomyopathy and left ventricular aneurysm were attended at the Heart Failure, Ventricular Dysfunction and Cardiac Transplant outpatient clinic of the Dante Pazzanese Cardiology Institute, from January 2010 to December 2016. Data from 34 patients were collected, including systemic arterial hypertension, ejection fraction, New York Heart Association (NYHA) functional classification (FC), European System for Cardiac Operative Risk Evaluation (EuroSCORE) II value, Society of Thoracic Surgeons (STS) score, ventricular reconstruction technique, and survival. RESULTS: Overall mortality of 14.7%, with hospital admission being 8.82% and late death being 5.88%. Total survival rate at five years of 85.3%. In the preoperative phase, NYHA FC was Class I in five patients, II in 18, III in eight, and IV in three vs. NYHA FC Class I in 17 patients, II in eight, III in six, and IV in three, in the postoperative period. EuroSCORE II mean value was 6.29, P

Cirurgia de reconstrução do ventrículo esquerdo em pacientes candidatos à transplante de coração / Left ventricular reconstruction surgery in heart transplant candidates

INTRODUÇÃO: O tratamento cirúrgico de reconstrução ventricular em pacientes candidatos à transplante de coração, é considerada como uma das técnicas, permitindo aos pacientes portadores de insuficiência cardíaca terminal de etiologia isquêmica ter melhora clínica e aumento da sobrevivência. Reportamos assim a experiência do nosso centro. OBJETIVO: Descrever o resultado da cirurgia de reconstrução do ventrículo esquerdo em pacientes candidatos à transplante de coração. MÉTODOS: Estudo analítico, clínico-cirúrgico, sequencial, retrospectivo. Pacientes portadores de miocardiopatia isquêmica com aneurisma do ventrículo esquerdo, acompanhados no ambulatório de insuficiência cardíaca, disfunção ventricular e transplante cardíaco do Instituto Dante Pazzanese de Cardiologia desde Janeiro de 2010 até Dezembro de 2016. Dados de 34 pacientes foram coletados entre eles HAS, Fração de Ejeção (F), Classe Funcional da NYHA (CF), EuroSCORE II, STS Score, técnica de reconstrução ventricular e sobrevivência. RESULTADOS: Mortalidade geral de 14,7 %, sendo a hospitalar de 8,82 % e a tardia de 5,88 %. Sobrevivência total aos 5 anos de 85,3%. Na CF Pré I: 5, II: 18, III: 8, IV: 3 vs. CF Pós I: 17, II: 8, III: 6, IV: 3. EuroSCORE II valor médio de 6,29 P≤ 0,01,HR 1,16 (IC 95 % 1,02 - 1,31) e STS escore mortalidade/morbidade valor médio de 18,14, P≤ 0,004; HR 1,19( IC 95% 1,05 - 1,33). Técnicas cirúrgicas não mostraram diferencia de sobrevida entre elas Dor 81% vs. Jatene 91.7 %. CONCLUSÃO: Tratamento cirúrgico de reconstrução do ventrículo esquerdo em pacientes candidatos a transplante de coração é efetivo, eficaz e seguro em relação proporcionando sobrevivência e mortalidade adequadas. (AU)

Retardo del crecimiento en pacientes pediátricos con diagnóstico de insuficiencia renal crónica. Instituto Nacional de Salud del Niño. Servicio de Nefrología. Periodo 2007-2010 / Delay of the growth in paediatric patients with diagnosis of renal chronic insufficiency. National institute of Health of the Child. Nefrología's service. Period 2007-2010

El presente trabajo tuvo por objetivo principal identificar el retardo de crecimiento en pacientes pediátricos con diagnóstico de IRC. El estudio fue de tipo descriptivo, retrospectivo, con una muestra de 20 pacientes pediátricos con diagnóstico del IRC que tuvieron seguimiento de 3 años en el Servicio de Nefrología en el Instituto Nacional de Salud del Niño (INSN) durante el periodo 2007-2010. Los datos se recolectaron con el formulario de recoleccion y se obtuvieron de las historias clínicas, se identifico la edad, sexo, talla y etiología de la IRC, datos que luego fueron procesados para hallar el estadio del IRC y las curvas de crecimiento...

The present work aimed to indentify the growth retardation in pediatric patients with the diagnosis of chonic renal failure (CRF). The study developed a descriptive, retrospective study, with a population sample of 20 pediatric patients diagnosed with CRF who were followed by 3 years at nephrology Service in the National Institute of Child Health (NICH) during the period 2007-2010. The information was recollected by the recollection form and was obtained from the medical, it was identified the age, sex, height and the CFR etiology, these information the was processed to find the CRF stage and the growth charts...

Pediatric gastric teratoma.

Neoplasms from germ cell origin are a heterogeneous group of tumors rarely seen in the pediatric population, teratoma is the most frequent among them. They can occur in either gonadal or extragonadal locations. Extragonadal teratoma arising from abdominal viscera is very unusual. There are less than a hundred reported cases of gastric teratoma in the worldwide literature. Since the occurrence of this pathology in the pediatric age group is quite rare, we describe a case of a teratoma located in the lesser curvature of the stomach in an infant with an emphasis in radiologic-pathologic correlation.

Tratamiento de las fracturas por estrés de la tibia en deportistas de alto rendimiento mediante litotripcia extracorpórea con ondas de choque / Treatment of stress fractures of the tibia in high performance athletes by litotripcia extracorporeal shock wave

Para determinar si la Terapia con Ondas de Choque Extracorpórea mejora la remodelación ósea y disminuye el tiempo de recuperación en fracturas por estrés de la tibia, se realizó un estudio experimental ciego auto-controlado en cinco cadetes navales con fracturas bilaterales. Se aplicaron dos ciclos de dos mil choques sónicos de 0.7 mili-Julios a la tibia más sintomática con un intervalo de 7 días. Se realizó un seguimiento clínico con intervalos de tres, seis, siete, nueve y doce semanas, cuatro y seis meses y un año. Se realizaron controles gamagráficos y radiográficos antes y al tercer mes del inicio del tratamiento. Todas las tibias tratadas se volvieron asintomáticas entre dos y tres meses antes que las no tratadas (P<0.05; β<0.1). No hubo cambios radiológicos ni gamagráficos en ambos grupos (P<0.05; ?<0.1). Estos resultados sugieren que la litotripcia extracorpórea con ondas de choque puede ser utilizada con seguridad en atletas de alto rendimiento para disminuir su tiempo de recuperación.

Litotripcia extracorpórea con ondas de choque para el aflojamiento de la interfaz cemento-hueso, cemento-prótesis: un modelo experimental en cadáver / Litotripcia extracorporeal shock waves to the loosening of the cement-bone interface, cement-prosthesis: an experimental model in body

Un artroplastias de revisión de cadera la extracción del cemento es difícil. Para determinar si la litotripcia extracorpórea con ondas de choque promueve el aflojamiento de la interfaz cemento-hueso y cemento-prótesis en cadera, se examinaron 20 fémures proximales frescos pareados de cadáver. Se comenta cada par, con prótesis pareadas y el mismo cemento-óseo. Se aplicaron 3.000 ciclos de ondas de 0.5 mf/mm2 a los 10 femures del grupo de estudio. Todos los especímenes fueron probados realizando una prueba biomecánica de falla en tensión. Se utilizó un sistema de acoplamiento estandarizado para cada prueba. Todos los especímenes fallaron inicialmente en la interfaz cemento-prótesis entre 4.700-4.900 Newtons, sin diferencias estadísticamente significativas (p=0.05, b=0.1). No se presentaron fallas en la interfaz cemento-hueso de ninguno de los especímenes. Estos resultados sugieren que la litotripcia extracorpórea con ondas de choque no tienen ningún efecto sobre la interfaz cemento-hueso y cemento-prótesis en el modelo cadavérico.