Effect of a Multicomponent Exercise Program (VIVIFRAIL) on Functional Capacity in Elderly Ambulatory: A Non-Randomized Clinical Trial in Mexican Women with Dynapenia.

BACKGROUND: During aging, loss of muscle strength (dynapenia) combined with unhealthy lifestyles and sedentarism can lead to functional limitations and dependency; currently there is still limited evidence about multicomponent training as a treatment for dynapenia and dependence in ambulatory older women. OBJECTIVE: To evaluate the effect of a multicomponent physical exercise program (VIVIFRAIL) on physical functionality in elderly ambulatory women with dynapenia. DESIGN, SETTING AND PARTICIPANTS: A non-randomized clinical trial was realized in 61 ambulatory older women (65-80 years old) with dynapenia that belonged from two Integral Gerontological Centers (IGC) of Hidalgo, Mexico, from June to December 2019. INTERVENTION: The control group (CG) received the physical daily training applied in the IGC (yoga, cardio-dance or tai chi) and the intervention group (IG) participated in a multicomponent program training (resistance, flexibility, balance and gait) called "VIVIFRAIL" for 12 weeks, minimum 3 weekly sessions of 45-60 minutes. MEASURES: All participants were evaluated at baseline (0 weeks), intermediate (6 weeks) and final (12 weeks), evaluations included glucose, blood pressure (SBP and DBP), anthropometric test, body composition evaluation and functional performance test with Short Physical Performance Battery (SPPB), Timed Up and Go Test (TUGT), muscle strength and a falls risk short test. RESULTS: 52 older women completed the study, mean age was 71.9 ± 4.46. According to SPPB passport classification was 1 Type A, 1 Type B+, 9 Type C, 7 Type C+ and 9 Type D. After 12 weeks of intervention, statistical analysis showed that multicomponent exercise significantly improved strength (p=<0.001), gait speed (p<0.001), standing from a chair (p<0.001) and TUGT (p<0.001). About falls risk, intervention group went from 70% to 12.5% while control group went from 52.4% to 63.6% (p<0.05). CONCLUSION: Older women who completed the 12 weeks multicomponent exercise program significantly improved their functionality in muscle strength, gait speed (3mt and 6mt), standing from a chair and TUGT tests. Also, it showed a significantly decrease in falls risk, therefore, this type of intervention can reduce the risk of frailty in the elderly.

Locura familiar: revisión clínica y a propósito de un caso / Folie a famille: clinical review and a case report

Introduction: Shared paranoia disorder, also known as folie à deux, is a fairly uncommon disturbance characterized by the presence of similar psychotic symptoms in two or more individuals. Most often the symptoms are delusional. The 'primary' case, the individual who first develops psychotic symptoms, can be distinguished from one or more 'secondary' cases, in whom the symptoms are induced. Usually two people are involved, although full family case reports are described. These cases are even more uncommon and more difficult to treat. Case report: We describe a case of folie a famille, this condition being a type of shared paranoia disorder. The case involves a father and his three sons and clinical picture appears after fourth son 's suicide The dead son is the primary' case, whilst his three brothers and his father are 'secondary' cases. The father was admitted to psychiatric unit for in-patient treatment. Conclusions: Treatment success was modérate in terms of improving the features of folie a famille in the four individuals involved. The first step for a right treatment is a right diagnosis. Social features and family relationships need to be consider.

Introducción: El trastorno psicótico compartido, también conocido como folie à deux, es un cuadro muy poco frecuente caracterizado por la presencia de síntomas psicóticos similares en dos o más individuos. Principalmente los síntomas son delirantes. El caso primario, el individuo que primero desarrolla los síntomas psicóticos se puede diferenciar de uno o más casos secundarios en los que los síntomas son inducidos. Lo más habitual es que participen dos individuos, aunque se han descrito casos que afectan a familias enteras, siendo estos cuadros muy poco frecuentes y con un abordaje más complicado. Caso clínico: Presentamos el caso de una locura familiar, un subtipo de trastorno psicótico compartido. El cuadro abarca a un padre y sus tres hijos y se desarrolla a partir del suicidio del cuarto hijo. El hijo fallecido constituye el caso primario mientras que sus tres hermanos y el padre son los casos secundarios. El padre es ingresado en la planta de psiquiatría. Conclusiones: El éxito del tratamiento fue moderado en el sentido de mejorar las características de la folie a famille en los cuatro sujetos implicados. El primer requisito para un tratamiento correcto es un diagnóstico correcto que tenga en cuenta aspectos sociales y la dinámica familiar.

Prognostic value of (13)C-phenylalanine breath test on predicting survival in patients with chronic liver failure.

AIM: To evaluate the prognostic value of percentage of (13)C-phenylalanine oxidation ((13)C-PheOx) obtained by (13)C-phenylalanine breath test ((13)C-PheBT) on the survival of patients with chronic liver failure. METHODS: The hepatic function was determined by standard liver blood tests and the percentage of (13)C-PheOx in 118 chronic liver failure patients. The follow-up period was of 64 mo. Survival analysis was performed by the Kaplan-Meier method and variables that were significant (P < 0.10) in univariate analysis and subsequently introduced in a multivariate analysis according to the hazard model proposed by Cox. RESULTS: Forty-one patients died due to progressive liver failure during the follow-up period. The probability of survival at 12, 24, 36, 48 and 64 mo was 0.88, 0.78, 0.66, 0.57 and 0.19, respectively. Multivariate analysis demonstrated that Child-Pugh classes, age, creatinine and the percentage of (13)C-PheOx (HR 0.338, 95% CI: 0.150-0.762, P = 0.009) were independent predictors of survival. When Child-Pugh classes were replaced by all the parameters of the score, only albumin, bilirubin, creatinine, age and the percentage of (13)C-PheOx (HR 0.449, 95% CI: 0.206-0.979, P = 0.034) were found to be independent predictors of survival. CONCLUSION: Percentage of (13)C-PheOx obtained by (13)C-PheBT is a strong predictor of survival in patients with chronic liver disease.

Tratamiento endovascular del aneurisma de aorta torácica descendente / Endovascular treatment of descending thoracic aorta aneurysm

BACKGROUND: The natural history of aneurysms ends in rupture and death. In 1990 the first endovascular exclusion of an aneurysm, using an endoluminal graft implanted through the femoral arteries was performed. More recently, the same procedure has been used for aneurysms of the thoracic aorta. AIM: To report our experience with endovascular treatment of thoracic aorta aneurysms. MATERIAL AND METHODS: Analysis of 14 patients (nine male), aged 30 to 79 years, treated between May 2001 and August 2002. RESULTS: The mean diameter of the aneurysms was 6.9 cm. The etiology was atherosclerotic in nine patients. The Excluder device (Gore) was preferentially used. There was no operative mortality or paraplegia. One patient had a transient leg monoparesis that reverted completely. No patient had type I endoleaks. Two patients had type II endoleaks on discharge, that sealed spontaneously. In a follow up, ranging from 2 to 17 months, one patient died of a bronchopneumonia and no aneurysm rupture has been detected. CONCLUSIONS: The short term results of endoluminal treatment of thoracic aorta aneurysms are excellent. This treatment is less invasive and has less complications than conventional surgery.

Predictors of radial artery patency for coronary bypass operations.

BACKGROUND: Few data exist regarding angiographic predictors of radial artery patency for coronary bypass grafting, and the benefit of calcium antagonists is not clear. METHODS: One hundred fifteen patients were studied who had myocardial revascularization with the radial artery plus internal mammary and vein grafts with 3.5 +/- 1.1 grafts per patient. Sixty-three patients received diltiazem and 52 patients did not. Base line and follow-up angiographies were analyzed 1 year postoperatively in 50 of these patients with a quantitative computerized method. RESULTS: One hundred fourteen patients survived and were followed for 30.1 +/- 12.6 months. Patency for mammary grafts was 100%, for radial grafts it was 80%, and for saphenous vein grafts it was 68%. Patent radial artery grafts had significantly greater degree of stenosis in the native vessels than occluded grafts (73% +/- 14% vs 40% +/- 24%), (p = 0.0007; confidence interval = 95%). Radial artery patency increased to 92% when arteries with 70% or more stenosis were considered. No differences were observed for clinical and angiographic end points in the patients that received diltiazem compared with the rest who had not. CONCLUSIONS: The degree of stenosis in the native coronary artery significantly influences the patency rate of radial artery grafts, independent of diltiazem.

[Treatment of advanced heart failure by heart transplantation]. / Tratamiento de la insuficiencia cardíaca avanzada mediante transplante de corazón.

BACKGROUND: Heart transplantation currently provides the most effective treatment for advanced heart failure. However, medical therapy for this condition has also improved, heart donors are scarce and the cost of the procedure is high. Therefore the indications and management of these patients need reevaluation. AIM: To analyze the results of 24 patients submitted to heart transplantation for end-stage heart failure needing repeated hospitalizations and i.v. inotropes for compensation. PATIENTS AND METHODS: The group was comprised by 21 men and 3 women with a mean age of 36.8 years, mean left ventricular ejection fraction 19 +/- 4.5%, mean systolic pulmonary artery pressure 48 +/- 13 mmHg (24-70) and mean pulmonary vascular resistance 2.6 Wood Units (1-5). Fourteen patients (58%) had a previous median sternotomy. Immunosuppression did not include induction therapy and steroids were discontinued early. RESULTS: Operative mortality was 4% at 30 days. Actuarial survival at one year was 90% and at 5 years 72%. Freedom from rejection at one year was 76% and at 5 years 50%. Freedom from infection was 70% at one year and 56.5% at five years. All patients with more than 3 months of follow-up were in functional class I. CONCLUSIONS: These results justify the proposed modifications for transplantation protocols.

[Coronary reoperation: a 16 years retrospective analysis]. / Reoperaciones coronarias: análisis retrospectivo de 16 años de experiencia.

BACKGROUND: Coronary artery bypass grafting (CABG) reoperation is being performed with increasing frequency. AIM: To assess the early and long term results of coronary reoperations in our institution and to identify prognostic factors. PATIENTS AND METHODS: 214 patients subjected to coronary reoperations between 1983 and 1999 were retrospectively studied. RESULTS: Mean age was 64.2 years (range 42-79 years), 202 (94.4%) were male and 12 (5.6%) female. The mean interval between the operations was 125.7 months (range 6-252 months). 10 (4.6%) were emergency surgeries. Overall operative mortality was 5.6% (11 deaths) and in 5 patients (3.4%) a perioperative myocardial infarction was noted. Univariate analysis identified moderate or severe left ventricular failure (p = 0.048) as predictor of increased operative mortality, meanwhile age over 75 years (p = 0.02) and moderate or severe left ventricular failure (p = 0.01) were identified as predictors of increased in hospital mortality in the multivariate analysis. Follow up of in hospital survivors (mean interval 65 months, range 4 to 190 months) documented a 5 years survival rate of 82.9%, a 10 years survival rate of 73.1% and a 15 years survival rate of 53.4%. Moderate or severe left ventricular failure (p < 0.0001) and emergency surgeries (p = 0.007) were identified as factors influencing the late survival in the stepwise logistical regression analysis. Multivariate analysis identified left ventricular failure (p = 0.01) and peripheral vascular disease (p = 0.01) as predictors of decreased late survival. CONCLUSIONS: Coronary reoperation has a low mortality in patients with a normal ventricular function and also has an excellent overall and disease free survival in the first 10 years of follow up. Left ventricular function is an independent risk factor increasing in hospital and late mortality.

[Neuropeptide Y contribution and the physiology of human sympathetic co-transmission. Studies in saphenous vein biopsies]. / Contribución del neuropéptido y a la fisiología de la co-transmisión simpática humana. Estudios en biopsias de vena safena.

BACKGROUND: It is known that the sympathetic varicosities co-store and co-release norepinephrine (NE) together with adenosine S-triphosphate (ATP) and neuropeptide Y (NPY). AIM: To describe the chemical characterization of stored and released NPY from the varicosities of sympathetic nerve terminals surrounding segments of the human saphenous vein, and the vasomotor activity of rings electrically depolarized or contracted by the exogenous application of the co-transmitters. MATERIAL AND METHODS: Saphenous vein tissues were obtained from patients undergoing elective cardiac revascularization surgery. RESULTS: The chromatographic profile of NPY extracted from biopsies is identical to a chemical standard of human NPY. Upon electrical depolarisation of the perivascular sympathetic nerve terminals, we demonstrated the release of NPY to the superfusion media, which did not exceed a 1% of its stored content. The release of the peptide is sensitive to guanethidine, and to extracellular calcium, suggesting that the mechanism of its release is exocytotic in nature. The electrically evoked release of NPY is dependent on the frequency and duration of the electrical pulses. Phenoxybenzamine reduces the electrically evoked release of NPY. Exogenous application of NE and ATP contract saphenous vein rings; the simultaneous application of NE plus ATP causes a synergic response, effect which is further potentiated by the joint co-application of 10 nM NPY. CONCLUSIONS: Present results highlight the role of NPY as a sympathetic co-transmitter in the regulation of human vascular tone.

[Humoral rejection in heart transplantation. Report of 2 cases]. / Rechazo humoral en trasplante cardíaco. Comunicación de dos casos.

Heart transplantation is a therapeutic alternative for selected patients with refractory heart failure. Acute allograft rejection is one of the main causes of early death after transplantation. The cellular rejection is characterized by cellular infiltrates with or without myocyte necrosis. However, some patients develop left ventricular dysfunction due to rejection without evidence of cellular infiltration. In these patients, the rejection is mediated by antibodies and complement. Humoral rejection is a relative rare but potentially fatal form of acute allograft rejection. We report two patients with left ventricular dysfunction secondary to humoral rejection, shortly after cardiac transplantation. Both patients were treated with methylprednisolone, and azathioprine was substituted by cyclophosphamide. One patient underwent plasmapheresis. The clinical outcome was satisfactory and the left ventricular function returned to normal in both cases. The diagnostic and therapeutic strategies for the management of humoral rejection are reviewed.

[Obituary: Dr René Favaloro (1923-2000)]. / Obituario. Dr René Favaloro (1923-2000).

René Favaloro MD, was born in La Plata, Argentina, in July 1923. He studied medicine in La Plata and made his cardiology residence in the Cleveland Clinic, where he developed coronary bypass surgery for the treatment of ischemic heart disease. At the present time, this surgical procedure is a well recognized therapy for coronary artery disease that has benefited millions of patients. Back in Argentina, he founded in 1992 the Institute of Cardiology and Cardiovascular Surgery that had an important research and teaching activity. Dr Favaloro wanted to be remembered as a teacher rather than as a surgeon, but he really was a great Master of Surgery in the Americas.

[Minimally invasive coronary artery surgery]. / Cirugía coronaria mínimamente invasiva.

BACKGROUND: There is a growing interest to perform a left internal mammary artery (LIMA) graft to the left anterior descending coronary artery (LAD) on a beating heart through a minimally invasive access to the chest cavity. AIM: To report the experience with minimally invasive coronary artery surgery. PATIENTS AND METHODS: Analysis of 11 patients aged 48 to 79 years old with single vessel disease that, between 1996 and 1997, had a LIMA graft to the LAD performed through a minimally invasive left anterior mediastinotomy, without cardiopulmonary bypass. A 6 to 10 cm left parasternal incision was done. The LIMA to the LAD anastomosis was done after pharmacological heart rate and blood pressure control and a period of ischemic pre conditioning. Graft patency was confirmed intraoperatively by standard Doppler techniques. Patients were followed for a mean of 11.6 months (7-15 months). RESULTS: All patients were extubated in the operating room and transferred out of the intensive care unit on the next morning. Seven patients were discharged on the third postoperative day. Duplex scanning confirmed graft patency in all patients before discharge; in two patients, it was confirmed additionally by arteriography. There was no hospital mortality, no perioperative myocardial infarction and no bleeding problems. After follow up, ten patients were free of angina, in functional class I and pleased with the surgical and cosmetic results. One patient developed atypical angina on the seventh postoperative month and a selective arteriography confirmed stenosis of the anastomosis. A successful angioplasty of the original LAD lesion was carried out. CONCLUSIONS: A minimally invasive left anterior mediastinotomy is a good surgical access to perform a successful LIMA to LAD graft without cardiopulmonary bypass, allowing a shorter hospital stay and earlier postoperative recovery. However, a larger experience and a longer follow up is required to define its role in the treatment of coronary artery disease.

Inverse association between plasma cholesterol and gallstone disease.

BACKGROUND: The association between gallstone disease (gallstones or cholecystectomy) and plasma lipids was evaluated in 2,089 subjects who attended a private health care facility in Mexico City from August 1991 to August 1992. METHODS: All participants provided data on their sociodemographic status, non-insulin-dependent diabetes mellitus diagnoses, alcohol consumption, and smoking habits; women also gave data regarding their obstetric-gynecologic histories. Ultrasounds of the liver and biliary tract were performed. Cholesterol levels, high-density lipoproteins cholesterol, and triglyceride plasma concentration were determined. RESULTS: This study shows a strong inverse association between gallstone disease and plasma cholesterol concentration, with OR = 0.61 (95% CI = 0.42-0.89) in the category of 181-239 mg/dL, and OR = 0.49 (95% CI = 0.32-0.77) in the group of 240 mg/dL or more, when compared to 180 mg/dL or less, after adjusting for the following risk factors: gender, age, and body mass index. CONCLUSIONS: These results suggest an increment in the catabolic pool of cholesterol, reflected in lower levels of plasma cholesterol in subjects with gallstone disease.

Aspectos morfo-funcionales de arterias y venas mamarias usadas en revascularización cardíaca / Morphologic and functional aspects of mammary arteries and veins used for myocardial revascularization surgery

Los vasos sanguíneos están inervados por el sistema nervioso simpático autonómico. La fisiología y neuroquímica de los nervios perivasculares humanos ha sido poco estudiada. Con el propósito de contribuir a las investigaciones sobre la fisiología de la co-transmisión simpática humana, esta investigación se concentró en: i) estudiar el contenido de los neurotransmisores simpáticos, noradrenalina (NA) y neuropéptido y (NPY) en vasos de arteria y vena mamaria interna humana; ii) detectar mediante técnicas inmunohistoquímicas la presencia de los nervios simpáticos perivasculares de estos vasos; iii) caracterizar la reactividad vascular de la arteria mamaria interna, como un modelo usado en implantes de revascularización cardíaca. Se estudió además, la vena mamaria derivada de la misma biopsia. La arteria y vena mamaria contienen 50 veces más NA que NPY, el contenido de NA y NPY en la arteria y en la vena es muy similar. La detección inmunohistoquímica de los nervios simpáticos demuestra que éstos se localizan entre las capas musculares de los vasos. La estimulación de los filetes nerviosos perivasculares produce respuestas vasomotoras sensibles a tetrodotoxina y guanetidina, lo que es consistente con la naturaleza simpática de la respuesta, confirmando que parte de los nervios perivasculares son simpáticos. Los músculos lisos se estimulan por NA y por ATP, que sólo no contrae, facilita las respuestas vasomotoras de la NA. Estos resultados permiten concluir que en la arteria y la vena mamaria interna humana NA, ATP y NPY cooperan en la respuesta vasomotora, evidenciando la co-transmisión simpática en humanos

[Long-term results of reconstructive surgery for mitral insufficiency]. / Resultados alejados de la cirugía reconstructora de la insuficiencia mitral.

BACKGROUND: Surgical repair is the procedure of choice for mitral insufficiency since it preserves better left ventricular structure and function. AIM: To assess the long term clinical and echocardiographic results of mitral valve reconstructive surgery. MATERIAL AND METHODS: A review of clinical and echocardiographic data of 68 patients (34 male, age range 17 to 82 years), subjected to surgical mitral valve repair between December 1991 and March 1998. Preoperative functional capacity of these patients was 2.96 +/- 0.7. Surgical repair was assessed using transesophagic echocardiography in all subjects. RESULTS: The etiology of mitral insufficiency was degenerative in 43 patients, rheumatic in 10, infectious in 6, ischemic in 5 and miscellaneous in 4. The most frequent pathological findings were dilatation of the mitral ring in 42% of patients, chordae tendinae rupture in 32% and enlargement in 24%. A mitral anuloplasty was done in 90% of patients, a cuadrilateral resection of posterior leaflet in 52% and chordae tendinae transference in 12%. An additional surgical procedure was done in 34% of subjects. Three patients died during hospitalization (4.4%). During the follow up of 36.5 +/- 22.3 months, five patients died and one required a mitral valve replacement. The actuarial survival probability was 95.3 +/- 2.6% at one year and 83.5 +/- 6.5% at five years. The reoperation free survival was 100% at one year and 97.4 +/- 2.5% at five years. At the end of follow up the functional capacity improved to 1.25 +/- 0.4. Echocardiography showed absence of mitral insufficiency in 48.4% of patients, minimal, mild and moderate insufficiency in 35.5, 14.5 and 1.6% of patients respectively. CONCLUSIONS: Surgical valve reconstruction in mitral insufficiency has satisfactory long term results and should be the procedure of choice for eligible patients.

Beneficial effect of carbohydrate maldigestion induced by a disaccharidase inhibitor (AO-128) in the treatment of chronic portal-systemic encephalopathy. A double-blind, randomized, controlled trial.

BACKGROUND: The most widely used treatment of portal-systemic encephalopathy (PSE) is the administration of oral, non-absorbable disaccharides. Theoretically, the inhibition of intestinal disaccharidases should induce malabsorption of disaccharides and increase delivery of undigested carbohydrates to the colon, thus stimulating the effects of lactulose and other non-absorbable disaccharides (that is, lactitol and lactose). AO-128 is an N-substituted derivative of valeolamine, an aminocyclitol that selectively inhibits intestinal disaccharidases. This study was performed to investigate whether AO-128 could be used as adjuvant therapy for the treatment of mild PSE in cirrhotic patients. METHODS: A double-blind, randomized, controlled trial was performed in 35 cirrhotic patients with PSE. Patients were given a 2-week treatment consisting of AO-128 (2 mg three times daily) or an identical placebo. The following features of PSE syndrome were assessed in a semiquantitative fashion before and after I and 2 weeks of therapy: mental state, asterixis, number connection test (NCT), venous blood ammonia concentration, electroencephalogram (EEG), and overall PSE index (PSEI). More patients receiving AO-128 than patients receiving placebo showed >40% improvement in the PSEI (83% versus 35%; P < 0.05). The mean stool pH decreased from 5.8+/-0.3 to 5.5+/-0.3 (P < 0.004) after AO-128 treatment, whereas no changes were observed in the placebo group. The EEG and nitrogen balance did not show significant changes in any of the two groups. A significant improvement was seen in the NCT performance after AO-128 (from grade 2.0+/-1.04 to grade 1.25+/-0.87; P < 0.05). Seven patients treated with AO-128 developed diarrhea, as compared with none in the placebo group (P < 0.05). CONCLUSION: These results suggest that AO-128 may be useful in the treatment of PSE, although further studies are required to establish the benefit of AO-128 and determine adequate individual doses.

[Coronary surgery. 20 years of follow-up]. / Cirugía coronaria. Veinte años de seguimiento.

BACKGROUND: Since the first surgical coronary revascularization done in Chile in 1971, 5000 such procedures have been performed. AIM: To assess the long term results of coronary revascularization surgery in our institution and to identify prognostic factors. PATIENTS AND METHODS: Five groups of 100 patients each, composed by the first consecutive patients subjected exclusively to coronary bypass surgery in the years 1975, 1980, 1985, 1990 and 1995 were retrospectively studied. RESULTS: Mean age of patients increased from a median of 52 years old in 1975 to 62 years old in 1995. No changes in the frequency of diabetes, hypertension, high serum cholesterol or previous myocardial infarction were observed. There was an increase in the proportion of patients with a recent (< 30 days) infarction that were operated along time. Seventy percent of patients had triple vessel disease or LMT and this proportion did not change. The number of grafts per patients increased form 1.9 to 3.4 and the use of arterial conduits from 0.18 to 0.81. Perioperative mortality remained constant and was 1.6%. Follow up information was obtained for 93% of 492 survivors. Actuarial survival at 5, 10, 15 and 20 years was 93 +/- 1, 82 +/- 2, 62 +/- 3 and 41 +/- 4% respectively. Ninety eight +/- 0.7, 89 +/- 2, 73 +/- 4 and 65 +/- 5% of patients remained free of a new myocardial infarction in the same lapses, respectively. Ninety seven +/- 1, 94 +/- 2, 76 +/- 4 and 47 +/- 7% of patients remained free of a new operation. Stepwise logistical regression analysis identified as bad prognostic factors, in decreasing order: cardiac failure, diabetes, smoking, hypercholesterolemia and age at the moment of operation. CONCLUSIONS: Coronary artery bypass surgery provides good and long lasting clinical improvement. The prognosis of patients is influenced by the presence of cardiac failure, some well known coronary risk factors and age at the moment of operation.

Arterial pressure-flow relationship in patients undergoing cardiopulmonary bypass.

We determined the arterial pressure-flow relationship experimentally by means of step changes of blood flow in 30 adult patients undergoing cardiopulmonary bypass (CPB). Anesthesia technique was uniform. CPB was nonpulsatile; hypothermia to 25-28 degrees C, and hemodilution to 18%-25% hematocrit were used. During stable bypass, mean arterial pressure was recorded first with blood flow 2.2 L.min-1.m-2. Flow was then increased to 2.9 L.min-1.m-2 for 10 s and reverted to baseline for 1 min. Then it was decreased to 1.45 L.min-1.m-2 for 10 s, and reverted to baseline for 1 min. Subsequently, it was decreased to 0.73 L.min-1.m-2 for 10 s and then reverted to baseline. Similar sets of measurements were repeated after 0.25 mg of phenylephrine and once the patient was rewarmed. The pressure-flow function was individually determined by regression, and the critical pressure estimated by extrapolation to zero flow. All patients had zero-flow critical pressure during hypothermia, with a mean value of 21.8 +/- 6.4 mm Hg (range 8.8-38.9). It increased after 0.25 mg phenylephrine to 25.4 +/- 7.2 mm Hg (range 12.2-43.9, P < 0.001). During normothermia, critical pressure was 21.2 +/- 5 mm Hg (range 13.4-30.9), not significantly different from hypothermia. During hypothermia, the slope of the pressure-flow function (i.e., resistance) was 14.9 +/- 3.5 mm Hg.L-1.min-1.m-2 (range 7.6-22.1). It increased significantly (P < 0.001) after phenylephrine, to 19.7 +/- 6.2 mm Hg.L-1.min-1.m-2 (range 11.4-40.5), and returned to 15.4 +/- 3.4 mm Hg.L-1.min-1.m-2 (range 10.1-24.2) during normothermic bypass. Systemic vascular resistance appeared to vary reciprocally with blood flow, although this finding may represent a mathematical artifact, which can be avoided by using zero-flow critical pressure in the vascular resistance equation.

[Myocardial revascularization with one and two mammary arteries: clinical results and long-term follow-up]. / Revascularización miocárdica con una y dos arterias mamarias: resultados clínicos y seguimiento alejado.

BACKGROUND: Coronary bypass grafts made with internal mammary artery have better long-term results than those made with saphenous vein. It is possible that the use of both mammary arteries would lead to even better results. AIM: To compare the long-term survival and the incidence of new coronary events of patients, in whom one or two mammary arteries were used as coronary bypass grafts. PATIENTS AND METHODS: One hundred and eight randomly selected patients who received one mammary artery for myocardial revascularization and 108 patients, matched for prognostic factors, who received two mammary arteries were studied. These patients were followed for a mean of 4 years (range 1 to 12 years). Operative complications, hospital mortality and long-term probability of being free of disease were compared in both groups. RESULTS: Operative mortality was similar in both groups (0.9%). Patients that received two mammary arteries had a higher frequency of operative wound complications. Long-term survival was 84% in patients who received one and 83% in patients who received two mammary arteries. The probabilities of being free of myocardial infarction (92 and 82% respectively) and angina (94 and 86% respectively) were lower in the later group. CONCLUSIONS: Patients who received two mammary arteries had a higher probability of a long term disease free survival than patients who received one mammary artery.

[Effects of fiber administration in the prevention of gallstones in obese patients on a reducing diet. A clinical trial]. / Efecto de la administración de fibra en la prevención de litiasis vesicular en obesos sometidos a dieta de reducción. Ensayo.

Nearly 30% of the obese patients treated with hypoenergetic diets for weight reduction develop gallstone disease (GD). Until the present time, the use of ursodeoxycholic acid (UDA) is the only available therapeutic measure to avoid the development of GD. Dietary fiber induce a bile acid synthesis. A double-blind clinical trial was conducted to compare the effect of rational diet plus UDA vs a rational diet supplemented with Psyllium plantago (Pp) for the prevention of GD in obese subjects undergoing a weight-reduction diet. Patients with a body mass index (BMI = weight in Kg/square height in m) of 30 Kg/m2 or more and with normal gallbladder and biliary tree ultrasound (GBUS) were included. Weight-reduction diets were individually calculated for each patient according to their energy expenditure (EE). Patients were randomly and blindly assigned either to group I (diet + 750 mg UDA + fiber placebo) or group II (diet + 15 g Pp+ UDA placebo). An anthropometric evaluation was performed to each patient before and after the two-month treatment, as well as resting EE by indirect calorimetry, GBUS and endoscopy for the determination of cholesterol crystals in duodenal bile. Weight reduction was similar in both groups (group I = 6 +/- 2 Kg vs group II = 6 +/- 3 Kg). GD development was observed in one patient of group I (5.5%) and two patients of group II (p > 0.05). All patients with GD lost a minimum of 4 Kg during the study period. GD development did not correlate with the presence of crystals in the duodenal bile at the beginning of the study. Our results suggest a beneficial effect of a rational diet with fiber supplementation to prevent GD development in obese patients included in a weight reduction program.