Consideraciones sobre el parto en una paciente con miocardiopatía hipertrófica y desfibrilador automático implantable / Considerations on delivery in a patient with hypertrophic myocardiopathy and an implantable cardioverter-defibrillator

La miocardiopatía hipertrófica es una enfermedad hereditaria autosómica dominante, que puede ser diagnosticada durante el embarazo. Teniendo en cuenta que la cardiopatía en el embarazo es la primera causa de morbimortalidad materna de causa no obstétrica, presentamos un caso de una gestante de 26 años con miocardiopatía hipertrófica, y portadora de desfibrilador automático implantable, discutiendo los aspectos más importantes en cuanto al manejo de este tipo de pacientes durante el parto, el preparto y el posparto inmediato (AU)

Hypertrophic cardiomyopathy is inherited as an autosomal dominant trait and can be diagnosed during pregnancy. Cardiomyopathy is the leading cause of nonobstetric maternal morbidity and mortality. We present the case of a 26-year-old pregnant woman with hypertrophic cardiomyopathy and an automatic implantable cardioverter defibrillator and we discuss the most important therapeutic considerations in the management of these patients before and during delivery and in the immediate postpartum period (AU)

Effect of an enteral diet enriched with eicosapentaenoic acid, gamma-linolenic acid and anti-oxidants on the outcome of mechanically ventilated, critically ill, septic patients.

BACKGROUND & AIMS: To assess the effect of an enteral diet enriched with eicosapentaenoic acid (EPA), gamma-linolenic acid (GLA), and anti-oxidants on the incidence of organ dysfunction and nosocomial infections in septic patients with acute lung injury or acute respiratory distress syndrome (ARDS) compared with a standard enteral diet. METHODS: This prospective, randomized, open-label study was performed in 11 Spanish intensive care units (ICU). Adult patients with sepsis and acute lung injury or ARDS were randomly allocated to receive either an EPA-GLA diet or a control diet. RESULTS: Of the 198 patients that were eligible, 160 were randomized and 132 were studied. Patient demographics, APACHE II and SOFA scores, and nutritional variables on admission were similar between the EPA-GLA diet and control diet groups. The EPA-GLA diet group showed a trend toward a decreased SOFA score, but it was not significant. No differences were observed in the PaO(2)/FiO(2) ratio or the days on mechanical ventilation between the groups. Incidence of infections was similar in the groups. The control group stayed longer in the ICU than the EPA-GLA diet group (16 vs. 18; p = 0.02). CONCLUSIONS: A diet enriched with EPA, GLA, and anti-oxidants does not improve gas exchange or decrease the incidence of novel organ failures in critically ill septic patients with acute lung injury or ARDS. Patients treated with the EPA-GLA diet stayed in the ICU for less time, but we did not find any differences in infectious complications.

Pulmonary venous obstruction after lung transplantation. Diagnostic advantages of transesophageal echocardiography.

Pulmonary venous vascular complications after lung transplantation are rare and a major cause of morbidity and mortality unless diagnosed and treated early. The epidemiological, diagnostic, and management characteristics of 33 patients (two of them in our hospital) with post-transplant pulmonary vein obstruction published in the literature were reviewed. We consider of utmost importance to differentiate stenosis from thrombosis as the cause of the obstruction. The angiography, considered the gold standard for diagnosis, was replaced by transesophageal echocardiography (TEE) in 79% of the cases, but no echocardiographic diagnostic criteria were defined. A diameter of the pulmonary veins, with 2D/color TEE, <0.5 cm, peak systolic flow velocity (PSFV) >1 m/s, pulmonary vein-left atrial pressure gradient (PVLAG) >/=10-12 mmHg, non-permeable flow through the stenosis and the presence of thrombus at that level, must lead us to suspect this complication. Higher mortality rates were found in unilateral procedures and in women. We consider that TEE must be carried out as part of the intraoperative routine or within the first 24 h of the post-operative period.

Síndrome mortal de embolia grasa, adquirido a través del donante, que conduce a insuficiencia multiorgánica en un receptor de trasplante de pulmón / Fatal Donor-Acquired Fat Embolism Syndrome Leading to Multiple Organ Failure in a Lung Transplant Recipient

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Intento autolítico por abuso de carbimida y alcohol con resultado fatal / Autolitic carbimide-alcohol reaction with fatal outcome

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Shock hipovolémico de repetición comoforma de presentación del síndrome deWünderlich / Recurrent hypovolemic shock as an onset form of Wünderlich syndrome

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[Electrocardiographic prediction of the site of lesion in the anterior descending artery in acute myocardial infarction]. / Predicción electrocardiográfica de la localización de la lesión en la arteria descendente anterior en el infarto agudo de miocardio.

INTRODUCTION AND OBJECTIVES: The goal of this study was to analyze the value of electrocardiography in predicting the site of the lesion in the left anterior descending coronary artery, in relation to the first septal and the first diagonal branches, in patients with acute anterior myocardial infarction. METHOD: Ninety consecutive patients who were admitted to the coronary unit with acute anterior myocardial infarction from July 1998 to May 2000 were studied retrospectively. The electrocardiographic changes were analyzed and correlated with the site of the lesion in the anterior descending artery, as determined by coronary angiography. RESULTS: The most useful parameters in predicting the site of the lesion in the left anterior descending coronary artery in acute anterior myocardial infarction are: 1) For lesions proximal to the first septal branch, ST-segment elevation in aVR (p < 0.001) and the absence of Q wave in V4-V6 (p = 0.01). 2) For lesions proximal to the first diagonal branch, abnormal Q wave in aVL (p = 0.01) and ST depression in III (p = 0.05). 3) For lesions proximal to both the first septal and first diagonal branches, ST elevation in aVR (p < 0.001), abnormal Q wave in aVL (p = 0.02), and absence of Q wave in V4-V6 (p = 0.01). 4) For lesions distal to both the first septal and first diagonal branches, abnormal Q wave in V4-V6 (p = 0.001) and absence of ST depression in III (p < 0.001). CONCLUSIONS: In acute anterior myocardial infarction, electrocardiography is useful for predicting the site of the lesion in the left anterior descending coronary artery in relation to the first septal and the first diagonal branches.

Predicción electrocardiográfica de la localización de la lesión en la arteria descendente anterior en el infarto agudo de miocardio / Electrocardiographic prediction of the site of lesion in the anterior descending artery in acute myocardial infarction

Introducción y objetivos. El objetivo de este estudio es analizar el valor del electrocardiograma (ECG) en la predicción del lugar de la lesión en la arteria descendente anterior, en relación a sus ramas primera septal y primera diagonal, en pacientes con infarto agudo de miocardio anterior. Método. Se analiza de forma retrospectiva a 90 pacientes con infarto agudo de miocardio anterior ingresados consecutivamente en la Unidad Coronaria, desde julio de 1998 a mayo de 2000. Se estudian los cambios electrocardiográficos y se correlacionan con el lugar de la lesión de la arteria descendente anterior determinada por angiografía coronaria. Resultados. Los parámetros más útiles para predecir el lugar de la lesión de la arteria descendente anterior en el infarto agudo de miocardio anterior son: a) para la lesión proximal a la primera septal: la elevación del segmento ST en aVR (p < 0,001), y la ausencia de onda Q en V4-V6 (p = 0,01); b) para la lesión proximal a la primera diagonal: la presencia de ondas Q anormales en aVL (p = 0,01) y el descenso del ST en III (p = 0,05); c) para la lesión proximal a ambas ramas, primera septal y primera diagonal: la elevación del ST en aVR (p < 0,001), onda Q anormal en aVL (p = 0,02) y ausencia de Q en V4-V6 (p = 0,01), y d) para la lesión distal a ambas ramas: la presencia de onda Q en V4-V6 (p = 0,001) y ausencia de descenso del ST en III (p < 0,001). Conclusiones. En el infarto agudo de miocardio anterior, el ECG es útil para predecir el lugar de la lesión de la arteria descendente anterior en relación con sus ramas primera septal y primera diagonal (AU)