[Complete vascular rings]. / Anillos vasculares completos.

The complete vascular rings, embryological anomalies of the aortic arch and great vessels, are frequently incidental findings, although patients with significant anomalies can present with upper airway and oesophagus compression, resulting in non-cardiac morbidity. The diagnostic needs high clinical suspicion. We describe six cases, with a mean age of two and a half months at diagnosis. The objective of our review is to describe the type of complete vascular ring (double aortic arch, right circumflex aortic arch and right aortic arch with aberrant left subclavian artery and left ligamentum arteriosus), the most common symptoms (respiratory symptoms including constant high-pitched, aggravated crying) and invasive and non-invasive diagnostic procedures (esophagograms, CT, MRI).

Anillos vasculares completos / Complete vascular rings

Los anillos vasculares completos, anomalías en el desarrollo embrionario del arco aórtico y grandes vasos, son frecuentemente hallazgos casuales; sin embargo, pacientes con anomalías importantes pueden presentar compresión de la vía respiratoria alta y esófago, con la consiguiente morbilidad no cardíaca que esta patología conlleva. Dado que para su diagnóstico se requiere un alto índice de sospecha clínica, el objetivo de la descripción de estos seis casos con una edad media en el momento del diagnóstico de 2,5 meses, es revisar el tipo de anillo vascular completo (doble arco aórtico, arco aórtico derecho circunflejo y arco aórtico derecho con arteria subclavia izquierda aberrante y ligamento arterioso izquierdo), las manifestaciones clínicas más frecuentes (síntomas respiratorios incluyendo el estridor constante, exacerbado con el llanto), y los métodos diagnósticos invasivos y no invasivos utilizados (esofagograma, tomografía computarizada, resonancia magnética) (AU)

The complete vascular rings, embryological anomalies of the aortic arch and great vessels, are frequently incidental findings, although patients with significant anomalies can present with upper airway and oesophagus compression, resulting in non-cardiac morbidity. The diagnostic needs high clinical suspicion. We describe six cases, with a mean age of two and a half months at diagnosis. The objective of our review is to describe the type of complete vascular ring (double aortic arch, right circumflex aortic arch and right aortic arch with aberrant left subclavian artery and left ligamentum arteriosus), the most common symptoms (respiratory symptoms including constant high-pitched, aggravated crying) and invasive and non-invasive diagnostic procedures (esophagograms, CT, MRI) (AU)

Valoración a largo plazo con resonancia magnética en pacientes corregidos de coartación de aorta / Magnetic resonance imaging in long-term assessment after surgery for aortic coarctation

Objetivos La resonancia con spin-eco o ecogradiente da una información suficiente que puede completarse con la angiorresonancia tridimensional para decidir una reintervención, controlar un seguimiento o dar el alta. Pacientes y métodos Durante el período 1990-2003 evaluamos 101 pacientes intervenidos inicialmente a los 3,1 ± 3 años, con estudio posterior al año y a los 12,4 ± 4,2 años de su intervención. No presentaron mortalidad en el seguimiento. Un total de 32 (31,6 %) fueron corregidos antes del mes de vida. Todos se estudiaron con spin-eco y ecogradiente y 34 con angiorresonancia. Los pacientes se dividieron en dos grupos: grupo A, con 68 pacientes, sin complicaciones (11 menores de un mes) con cirugía término-terminal 55, Álvarez 5, Waldhausen 6 y conducto en 2 casos; grupo B, con 33 pacientes complicados con recoartación precoz (21 corregidos antes de un mes), cirugía término-terminal 29, Álvarez 2 y parche en 2 casos. Durante el tiempo de seguimiento se realizaron 43 reintervenciones. Se midieron índices diámetro istmo/diámetro aorta descendente a la altura del diafragma e índice diámetro zona intervenida/diámetro aorta descendente en el diafragma. Resultados En el grupo A, el índice istmo/aorta descendente a la altura del diafragma era 0,92 ± 0,08 y el índice zona intervenida/aorta descendente en el diafragma, 0,9 ± 0,05. Un total de 23 fueron revisados con angiografía tridimensional. Se vieron dos estenosis tardías en un paciente de 10 años operado de término-terminal y en otro paciente de 18 años, un conducto con obstrucción distal y proximal. En el grupo B: el índice istmo/aorta descendente era 0,84 ± 0,1 y el índice zona intervenida/aorta descendente, 0,82 ± 0,11. De estos pacientes, 11 fueron revisados con angiorresonancia, 5 con reestenosis índice (0,53-0,73) intervenidos antes de los 2 meses, 4 con técnica inicial término-terminal y otro con parche. Conclusiones Nuestros resultados apoyan la influencia de la edad precoz, la técnica término-terminal y el parche en la recoartación y su influencia tardía en la rerrecoartaciones. Los pacientes del grupo A pueden ser dados de alta en edad juvenil-adulta, tras seguimientos periódicos cada cinco años con resonancia magnética durante 18 años si los resultados están dentro de la normalidad, mientras que los del grupo B necesitan controles más prolongados

Objectives Spin echo or gradient echo magnetic resonance imaging provides enough information to plan patient management and can be completed with the use of three-dimensional magnetic resonance angiography to evaluate the need for reintervention, assess follow-up, or discharge the patient. Patients and methods From 1990-2003, we evaluated 101 patients after initial corrective surgery for aortic coarctation at the age of 3.1 ± 3 years, with subsequent postoperative assessment at 1 year and again 12.4 ± 4.2 years later. No mortality was registered during the follow-up. Corrective surgery was performed in 32 patients (31.6 %) before the first month of life. All the patients were evaluated with spin-echo and echo gradient and 34 were evaluated with magnetic resonance angiography. The patients were classified into two groups: group A consisted of 68 patients (11 < 1 month old) with no complications. End-to-end anastomosis was performed in 55, the Alvarez technique in five, the Waldhausen technique in six, and conduit in two. Group B consisted of 33 patients complicated with early aortic recoarctation (21 corrected before the age of 1 month). End-to-end anastomosis was performed in 29, the Alvarez technique in two, and grafting in two. During the follow-up, 43 reinterventions were performed. Isthmus diameter/descending aorta diameter at the diaphragmatic level and repaired site diameter/descending aorta diameter at the diaphragmatic level were measured. Results Group A: the isthmus diameter/descending aorta diameter at the diaphragmatic level index was 0.92 ± 0.08 and the repaired site diameter/ descending aorta diameter at diaphragmatic level index was 0.90 ± 0.05. Twenty-three patients were assessed by means of three-dimensional magnetic resonance angiography, which revealed two late stenosis (one in a 10-year-old patient with an end-to-end anastomosis performed previously, and another in an 18-year-old patient with a proximal and distal obstructed conduit). Group B: the isthmus diameter/descending aorta diameter index was 0.84 ± 0.1 and the repaired site diameter/ descending aorta diameter index was 0.82 ± 0.11. Eleven patients were assessed by means of three-dimensional magnetic resonance angiography, which revealed five stenosis indexes (0.53-0.73) surgically corrected before the age of 2 months, four with an initial technique based on end-to-end anastomosis and one with a graft. Conclusions Our results support the influence of young age, the use of end-to-end anastomosis and grafts in recoarctation and their late influence on recurrent recoarctation. The patients in group A were discharged in childhood or adulthood after periodic follow-up every 5 years with magnetic resonance angiography for 18 years with results within the normal range, while patients in group B required longer follow-up

Simultaneous monitoring of nitric oxide, oxyhemoglobin and deoxyhemoglobin from small areas of the rat brain by in vivo visible spectroscopy and a least-square approach.

Nitric oxide (NO) is a versatile molecule involved in a wide range of biological processes. Under physiological conditions, NO reacts with oxyhemoglobin (OxyHb) to form methemoglobin (MetHb) at a very high rate. Previous works have shown that MetHb is proportional to NO and that MetHb absorption contributes to the in vivo absorption spectrum recorded with visible spectroscopy using optical fibers. However, in vivo spectrophotometric monitoring of a single molecule has long been a problem because the overlapping of OxyHb, deoxyhemoglobin (DeoxyHb), MetHb, cytochromes and other chromophores absorption spectra make in vivo quantitative spectroscopy difficult. The aim of this work was to evaluate the possibility of obtaining the contribution of each main endogenous chromophore, especially OxyHb, DeoxyHb and MetHb, to the in vivo visible absorption spectrum recorded from rat cortex, hippocampus and striatum. A least-square approach with a fitting equation containing the in vitro spectrum of the main endogenenous chromophores was used. The validity of this approach was studied by increasing the endogenous MetHb level with NO infusion and by biliverdin perfusion. Data indicate that in vivo visible spectroscopy in combination with the least-square fitting method may be a useful tool for gaining insight into the roles of NO, hemoglobins and the interaction between them even from small cerebral areas.

Criss-cross con discordanciaauriculoventricular, acabalgamiento de la válvula auriculoventricular derecha, doble salida del ventrículo derecho y preexcitación / Criss-cross heart with atrioventricular discordance, straddling A-V valve, double outlet right ventricle and preexcitation

Se presenta un recién nacido con cianosis, disnea y taquicardia supraventricular por reentrada con buena respuesta al tratamiento. El diagnóstico de la cardiopatía se realizó por ecocardiografía. El paciente falleció súbitamente a los 6 días. El estudio anatómico confirmó la anomalía: corazón en criss-cross con discordancia auriculoventricular (AV), válvula derecha acabalgante, válvula AV izquierda estenótica en conexión con el ventrículo trabeculado anterior del que emergían los dos vasos, aorta y pulmonar. La rotación precoz cuando la septación no ha concluido favorece las anomalías de las válvulas AV y las alteraciones del ritmo (AU)

Lactante con tetralogía de Fallot y estenosis grave del ostium de la coronaria izquierda / Tetralogy of Fallot and severe coronary ostium stenoses in an infant

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[Diagnostic value of reactive C protein in suspected acute appendicitis in children]. / Valor diagnóstico de la proteína C reactiva en las sospechas de apendicitis aguda en la infancia.

OBJECTIVE: The aim of this study was to evaluate the accuracy of C-reactive protein (CRP) measurements in the diagnosis of suspected acute appendicitis (AA) during childhood. PATIENTS AND METHODS: A prospective study of 195 consecutive children, aged between 2 and 14 years and suspected of having AA, that attended a pediatric emergency room was carried out. We obtained a careful patient history, physical signs, blood test results, final diagnosis and the histological findings in the cases who underwent appendectomy (classified as normal appendix, simple appendicitis (SA) or gangrenous appendicitis (GA). RESULTS: The final diagnoses and their frequencies were: AA (94), non-specific abdominal pain (80), mesenteric lymphadenitis (6) and others (15). Appendectomies were performed in 103 cases with 94 cases being AA (91.3%) and of these 51 SA and 43 GA. The average values of CRP (mg/l) were: AA: 30, SA: 16, GA: 67, non-specific abdominal pain: 15, and mesenteric lymphadenitis: 44 (p < 0.01). The values of AG were statistically higher than those of SA (p = 0.0000). The ROC curve of these data determined the best cut-off levels for AA to be 30 (sensitivity: 0.43, specificity: 0.92, predictive value of a positive result: 0.87 and predictive value of a negative result: 0.58). CONCLUSIONS: 1) The value of CRP in AA is higher than in other abdominal pain etiologies. Nevertheless, this value should not be used to deny surgery since it is often normal in SA. 2) When a CRP value > 40 mg/L is found in a suspected AA, one should think about GA and therefore, initiate prophylactic antibiotics and perform surgery immediately.