Assessment of knowledge and skills in using an Automated External Defibrillator (AED) by university students. A quasi-experimental study. / Evaluación del conocimiento y de las habilidades para el uso de un Desfibrilador Externo Automatizado (DEA) por estudiantes universitarios. Un diseño cuasiexperimental.

AIM: To evaluate layperson (university student) ability to use an automated external defibrillator (AED). DESIGN: A repeated measures quasi-experimental study with non-probabilistic sampling and a control group was carried out. SCOPE: Teacher training degree students at the University of Santiago de Compostela (Spain). PARTICIPANTS: The sample consisted of 129 subjects (69% women and 31% men), between 19-47 years of age (mean 23.2±4.7 years). As inclusion criterion, the subjects were required to have no previous knowledge of AED. INTERVENTIONS: Times to apply defibrillation with an AED to a mannequin were recorded untrained (T0), after a theoretical and practice explanation lasting less than one minute (T1), and 6 months after the training process (T2). MAIN VARIABLES OF INTEREST: The primary endpoint was the time taken to deliver a defibrillation discharge. The "improvement effect" variable was defined by the absolute time difference between T1 and T0, while the "degree of forgetfulness effect" variable was defined as the absolute difference between T1 and T2. RESULTS: The mean times were T0=67.7s; T1=44.2s; T2=45.9s. The time to apply defibrillation was reduced after explanation training (T1

[Repair of congenital heart disease in an adult with septal defects and pulmonary stenosis: anesthetic management]. / Cardiopatía congénita con estenosis pulmonar y comunicaciones intracardiacas asociadas en adulto: tratamiento anestésico.

A 66-year-old man with complex congenital heart defects (atrial septal defects, with incomplete cor triatriatum, an aneurysmal sac in the membranous septum, ventricular communication and pulmonary valve stenosis) was scheduled for surgery for progressive dyspnea even at rest. During anesthetic induction, effort was made to avoid increased shunting. Surgery consisted of resection of the cor triatriatum membrane, closure of communications with pericardial patches, pulmonary valve replacement, replacement of the root with a porcine root, and pulmonary artery aneurysmorrhaphy. Severely decreased contractility developed while the patient was still in the operating room; inotropic support with adrenaline and dobutamine was required. Extubation was completed in the postoperative recovery unit with no further complications. Echocardiography showed a left-ventricular ejection fraction of 45%. We found few published reports of cases of complex congenital heart disease treated surgically in adulthood. In such cases, cardiac pathophysiology must be carefully considered, and maneuvers that increase systemic resistance or right-ventricular ejection fraction should be avoided. Postoperative pulmonary vascular resistance should be kept as low as possible.

Cardiopatía congénita con estenosis pulmonar y comunicaciones intracardiacas asociadas en adulto: tratamiento anestésico / Repair of congenital heart disease in an adult with septal defects and pulmonary stenosis: anesthetic management

Paciente varón de 66 años con malformaciones cardiacas congénitas complejas consistentes esquemáticamente en comunicación interacuricular con tabicación incompleta tipo cor triatriatum, aneurisma de septo membranoso con comunicación interventricular y estenosis de válvula pulmonar. Se indicó cirugía por disnea progresiva hasta hacerse de reposo. Se procede a inducción de la anestesia intentando no aumentar el cortocircuito. El procedimiento quirúrgico consistió en resecar la membrana de cor triatiatum, cerrar las comunicaciones con parches de pericardio, sustituir la válvula pulmonar y raíz por una raíz porcina y aneurismorrafía de la arteria pulmonar. Presentó depresión severa de la contractilidad en quirófano que precisó apoyo inotrópico con adrenalina y dobutamina. Posteriormente se extubó en reanimación sin más incidencias. Una ecografía de control cuantificó la fracción de eyección del ventrículo izquierdo en 45%. En la bibliografía hallamos pocos casos de pacientes con cardiopatías congénitas complejas no intervenidos hasta la edad adulta. En ellos hay que considerar la fisiopatología cardiaca e intentar evitar elevaciones de las resistencias sistémicas, al igual que las maniobras que aumenten la resistencia a la eyección del ventrículo derecho. Tras la cirugía hay que intentar minimizar las resistencias vasculares pulmonares(AU)

A 66-year-old man with complex congenital heart defects (atrial septal defects, with incomplete cor triatriatum, an aneurysmal sac in the membranous septum, ventricular communication and pulmonary valve stenosis) was scheduled for surgery for progressive dyspnea even at rest. During anesthetic induction, effort was made to avoid increased shunting. Surgery consisted of resection of the cor triatriatum membrane, closure of communications with pericardial patches, pulmonary valve replacement, replacement of the root with a porcine root, and pulmonary artery aneurysmorrhaphy. Severely decreased contractility developed while the patient was still in the operating room; inotropic support with adrenaline and dobutamine was required. Extubation was completed in the postoperative recovery unit with no further complications. Echocardiography showed a left-ventricular ejection fraction of 45%. We found few published reports of cases of complex congenital heart disease treated surgically in adulthood. In such cases, cardiac pathophysiology must be carefully considered, and maneuvers that increase systemic resistance or right-ventricular ejection fraction should be avoided. Postoperative pulmonary vascular resistance should be kept as low as possible(AU)

Inhibitory effect of cysteine and methionine on free radicals induced by mercury in red blood cells of patients undergoing haemodialysis.

The inhibitory effects of cysteine and methionine on mercury-induced free radicals were studied in the red blood cells (RBC) of haemodialysed (HD) patients, using polyacrylonitrile membranes. RBC were taken from a control group of 10 healthy subjects and a group of 30 HD patients. The following were determined before and after HD: malonyldialdehyde (MDA), total glutathione (GST), reduced (GSH) and oxidized (GSSG) glutathione, and percentage haemolysis (before HD). RBC were incubated for 6 hr with mercury (Hg(2+); 10(-5)m), mercury and cysteine (0.001 m) and mercury and methionine (0.005 m). The percentage of mercury induced haemolysis differed between the control group and HD patients. The addition of cysteine and methionine to RBC has a markedly inhibitory effect on the mercury-induced haemolysis (a reduction from about 80 to 5% for cysteine and to 15% for methionine). MDA was increased in HD patients and increased further after HD. GST, GSH and GSSG were lower than normal in HD patients, both before and after HD. There was very little change in MDA concentration when the RBC were incubated with mercury for 6 hr.