Insuficiencia cardiaca aguda en paciente con mixoma auricular simulando estenosis mitral severa / Acute heart failure in a patient with atrial myxoma mimicking severe mitral valve stenosis

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Respuesta a «Bloqueo completo auriculoventricular secundario a radioterapia: papel de las vías accesorias» / Response to «Complete atrioventricular block secondary to radiotherapy: Role of accessory

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Sistema Informático Perinatal (SIP): programas utilitarios y diagrama de redes: instrucciones de configuración del sistema

Las nuevas versiones de los programas del Sistema Informático Perinatal han sido preparadas para funcionar conformando una red hospitalaria, regional o nacional según diferentes modelos de complejidad. Esta nueva posibilidad facilita el flujo de información entre niveles para la major atención de la gestante y recién nacido, así como también para la gestión del sector, permitiendo centralizar bases de datos con información actualizada para evaluación y toma de decisiones de manera oportuna...

Taquicardia ventricular en paciente joven / Ventricular tachycardia in a young patient

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Surgical treatment of aortic dissections: initial experience with the adventitial inversion technique.

BACKGROUND: The adventitial inversion technique obliterates the false lumen and converts a dissected aorta into a conduit with tough adventitia on the inside and outside. Dacron grafts can be anastomosed to the aorta with fine sutures, which hold without tears. METHODS: From August 1995 to March 1997, we treated 6 patients with acute dissecting aneurysms. Three aneurysms were type I (A) involving the entire aorta, two type II (A) involving the ascending aorta, and one type III (B) involving the thoracoabdominal aorta. Circulatory arrest was used in 3 patients, 1 with type I aneurysm (A), 1 type II (A), and 1 type III (B). RESULTS: All Dacron-aorta anastomoses held sutures well and did not bleed intraoperatively or postoperatively. One patient (type II [A]) died of intraoperative low cardiac output. In patients with type I (A) aneurysms, the false lumen was obliterated, but 1 patient required resection of a 6-cm abdominal aortic aneurysm. CONCLUSIONS: The adventitial inversion technique is a safe technique for the treatment of acute dissecting aneurysms, which facilitates operation and solves the problem of intraoperative or postoperative bleeding due to tissue friability.

Pheocromocytoma and gastrointestinal bleeding.

A 46-year-old patient who presented with an abdominal mass and gastrointestinal bleeding associated with an extra-adrenal pheochromocytoma is discussed. He had no history of hypertension. An ill-defined mass was felt at the upper abdomen. CT and arteriography confirmed the presence of a large mass with calcifications in the right paravertebral region. Upper endoscopy revealed multiple varices at the third portion of the duodenum. Abdominal exploration revealed a huge tumor at the root of the small bowel mesentery with multiple arterial and venous vessels entering the third portions of the duodenum. The tumor was unresectable. Biopsy demonstrated a pheochromocytoma. The patient developed pulmonary edema in the immediate postoperative course. He recovered and was discharged home on Dibenzyline. He has been readmitted on various occasions with gastrointestinal bleeding and congestive heart failure. Presently he is working and feels relatively well 5 years after the operation. A review of the literature for gastrointestinal complications of pheochromocytomas was done. There is a scarcity of reports of gastrointestinal bleeding associated with pheochromocytomas.

Regulation of rabbit erythrocyte Ca(2+)-pump sensitivity to calmodulin in experimental hyperlipidemia.

Intracellular free calcium activity is in part determined by a calmodulin-regulated plasma membrane Ca(2+)-pump. Since changes in Ca2+ permeability have been implicated in atherosclerotic plaque formation, we initiated a lipid hyperalimentation protocol during which we measured various erythrocyte calcium flux parameters and early atheroma development. Adolescent New Zealand White rabbits were fed a diet with 0.5% cholesterol and 2.5% lard over a 3-month period. Plasma cholesterol and triacylglycerols increased on average 18.7- and 13.9-fold respectively, while erythrocyte membrane cholesterol content decreased 18% and total phospholipids by 54%. After 3 months of lipid hyperalimentation, 22% of the aortic arch was covered with large, early-stage, raised atheroma. Basal and calmodulin-activated (Ca2+ + Mg2+)-ATPase activities in erythrocyte membranes increased by 31% and 123%, respectively at 2 months, with a concomitant increase in calmodulin affinity (Km) from 15.6 to 4.2 nM. These differences were transient on account of changes in the control animals which exhibited a slowly developing sensitivity to calmodulin during maturation. Basal Ca2+ transport and passive Ca2+ permeability increased about 7-fold during the hyperlipidemic phase. This suggests that overt hyperlipidemia, leading to atherosclerotic plaque development, alters plasma membrane Ca2+ regulatory mechanisms including passive Ca2+ permeability. The changes in enzymatic function, membrane composition, and Ca2+ permeability seen in this red cell model system may be a reflection of early changes in cells that are directly involved in the development of atherosclerotic plaques.

Right coronary artery with anomalous origin and slit ostium.

Right coronary arteries that arise from the left sinus or ectopically from the right sinus with a slit ostium can cause myocardial ischemia, myocardial infarction, or sudden death. The surgical repair of these anomalies has evolved toward a simpler operation that widens the orifice of origin and reduces the compression of the intramural segment. We have repaired these anomalies without mortality in 8 patients. We summarize our experience and the evolution of this procedure.

[Radiodiagnosis of ureteral and bladder hernia. A further case contribution]. / Radiodiagnostica delle ernie ureterali e vescicali. Ulteriore contributo casistico.

The radiologic features of ureteral and bladder hernias are poorly known. These hernias can be located in 5 compartments, being extremely rare in 2 of them--the chest and lumbar sectors, where only 2 cases are reported in literature. In the other 3 compartments--i.e., ischiatic, crural and inguinal sectors--bladder and ureteral hernias are less uncommon findings. Over a relatively short period of time, 5 bladder hernias were observed--3 ischiatic, 1 inguino-scrotal and 1 crural cases--and 1 double ureteral hernia, which was inguinal on the right-hand side and ischiatic on the left-hand side. Thus, we reviewed the main urographic and cystographic signs on the basis of a previous report by one of us. In discussing the new cases, we emphasize the importance of a few typical diagnostic signs, which follow: asymmetry and anomalous location of herniated organs, ureter protrusion beyond the pelvic bones outline, the presence of ureteral spiral ("curlicue sign"), and bladder walls indentation.

Cardiac surgery on Jehova's Witnesses at Instituto Cardiovascular-Hospital Pavia.

Jehovah's Witnesses (J.W.) can undergo successful cardiac operations. We have operated five J.W. patients. Of these patients, two had coronary artery bypass surgery and three had correction of congenital anomalies. These included an atrial septal defect with infundibular pulmonic stenosis, a tetralogy of Fallot and a patient with a ventricular septal defect. Our treatment protocol includes a meticulous surgery, the use of early heparinization to collect all shed blood into the pump oxygenator, observation in the operating room for early exploration if the patient bleeds and administration of iron preparations. Recombinant human erythropoietin, although available and in our treatment protocol, has not been used yet. All patients survived the operation and left the hospital with an excellent hemoglobin and hematocrit. The length of stay varied from 7 to 15 days.

[Comparison of iopamidol 150 and 370 with the same iodine dosage (37 g) in urography]. / Confronto tra iopamidolo 150 e 370 alla stessa dose di iodio (37 g) nell'urografia.

Two different volumes of iopamidol (250 and 100 ml, respectively) containing 37.5 and 37 g of iodine in different concentrations (150 mgI/ml and 370 mgI/ml) were injected in the same time (10 minutes) with varying injection rates, to compare diagnostic effectiveness, image quality, distension of the collecting system, and influence of the better iodine concentration. Sixty patients of both sexes were randomly subdivided into two groups. Their renal function, blood pressure and pulse rate were normal. Their weight ranged 55-85 kg, not to change the distribution volume of the contrast medium. None of them had been given iodine compounds recently. Radiographs were taken 2, 5, 15, 25, and 30 minutes after the end of the injection. The image quality of nephrograms, pyelograms, bladder views and the degree of collecting system filling were evaluated by a blind study, using grading scores (0 to 3). In both groups image quality and degree of filling were satisfying; the volume of injected iopamidol had poor significance. The clinical findings confirm that, with a nonionic contrast medium, iodine concentration in the collecting system is the most important factor for image quality.

[Use of ultrasonography in the diagnosis of acute appendicitis]. / Impiego dell'ecotomografia nella diagnosi di appendicite acuta.

To date, the diagnosis of acute appendicitis (AA) has been made primarily on clinical grounds and imaging techniques have been considered less useful. This paper is aimed at evaluating US utility in the diagnosis of AA. US scans of the appendix, after Puylaert, were obtained in 30 healthy subjects (group A), in 49 patients with recurrent pain in the iliac fossa (group B), and in 28 patients with clinical signs highly suggestive of AA (group C). In none of the subjects in group A was the appendix seen. Neither was it demonstrated in the patients in group B, all of whom underwent surgery and never presented with suppurating, phlegmonous, gangrenous, perforating AA and/or abscess. In the patients in group C, 20 of whom had a positive histology for AA, US demonstrated 17 true positive, 8 true negatives and 3 false negatives. We consider as useful in the diagnosis of AA the following US signs: 1) the appendix cannot be demonstrated, in which case AA is to be excluded; 2) the appendix can be seen and is still, non-compressible and exhibits thickened walls; 3) the appendix contains fecaliths. The latter 2 findings are suggestive of AA. Thus, US of the appendix is useful (100% specificity in group B) in excluding AA when clinical diagnosis is questionable, but the method proves less reliable (85% sensitivity in group C) when clinical presentation is more definite.

[Arthrography of the ankle joint]. / Die Arthrographie des oberen Sprunggelenks.

Arthrography of the ankle joint was first carried out by Johnson and Palmer at the Military Hospital in Stockholm in 1940. Arthrography can be used for judging the integrity of the articular cartilage, of osteochondritis dissecans, arthritis or adhesive capsulitis. The literature shows, however, that more than 95% of the patients on whom this examination has been performed had suffered from acute trauma.