[Peripheral cholesterol embolism in a percutaneous coronary angioplasty procedure. A case report]. / Embolismo periférico de colesterol en un procedimiento de angioplastia coronaria percutánea. Presentación de un caso.

Cholesterol embolism is a rare but potentially serious complication of cardiac catheterization. We report the case of a patient who presented a cholesterol embolism in the lower extremities after percutaneous angioplasty and the elective implantation of a stent. Clinical evolution was favourable. The appearance of cholesterol embolism could have been precipitated, in this case, by anticoagulation treatment with heparin and intense antiaggregation.

Acute and chronic changes in atrial natriuretic factor induced by ventricular pacing: a self controlled clinical trial.

A self controlled clinical trial was carried out to study the acute and chronic effects of ventricular pacing (VVI) on the atrial natriuretic factor (ANF). Eleven people were selected from a pool of 20 DDD paced patients. Pacemakers were programmed to the VVI mode for 1 month and their effectiveness tested by ECG at rest and after an effort test. AnF was measured by radioimmunoassay at baseline, after 15 minutes, and again 1 month after programming. The reliability of the radioimmunoassay was confirmed using the coefficients of variation between (12.5%) and within assay (9.7%). Data analysis was done using Wilcoxon's test. Our results showed that the onset of VVI pacing led to a sudden sharp rise in ANF in all patients (P < 0.0001). During VVI pacing, three patients were dropped from the study (2 were withdrawn because of symptoms and 1 voluntarily withdrew). After 1 month of VVI pacing, a significant increase of ANF above the baseline was observed (P < 0.05). The results showed that ventricular pacing led to an immediate rise in ANF and, that with long-term VVI pacing, there was an increase in ANF levels as well. The role of these findings in the pathophysiology of the pacemaker syndrome calls for further research.

[Chylopericardium after acute pericarditis]. / Quilopericardio tras pericarditis aguda.

We present an 18 year-old man with chylopericardium after acute pericarditis with severe pericardial effusion and cardiac tamponade secondary to Mycoplasma pneumoniae infection. We review the etiology, diagnostic procedures and therapeutic possibilities for chylopericardium.

A telemedicine system for remote cooperative medical imaging diagnosis.

Telemedicine is changing the classical form of health care delivery, by providing efficient solutions to an increasing number of new situations: here we consider those which require some type of computer-supported cooperative work (CSCW) between health care professionals located in different clinical sites. This paper presents the design and development of a telemedicine system for remote computer-supported cooperative medical imaging diagnosis. The main and novel component of our system is a new CSCW distributed architecture, comprised by a collaborative toolkit to add audioconferencing, telepointing, window sharing, user's coordination and application synchronization facilities, either to existing or new medical imaging diagnosis applications. In comparison with existing CSCW products, mainly based on centralized architectures, our distributed toolkit is specially designed for telemedicine applications: to allow different levels of sharing between participants, to improve user feedback in highly interactive user interfaces, and to optimize the required communication bandwidth in order to implement a telemedicine CSCW application on almost any telecommunication network. This telemedicine CSCW system has been applied to build a cooperative medical imaging diagnosis application, in which two doctors, located in different hospitals, need to achieve a cooperative diagnosis on haemodynamic studies using cardiac angiography images. The design of the graphical user interface for this kind of telemedicine CSCW systems, a critical component which conforms any telemedicine application, is also addressed with a new methodological approach, to assure the system usability and final user acceptance. The telemedicine cardiac angiography pilot has been implemented, tested and evaluated within the Research Project 'FEST-Framework for European Services in Telemedicine' funded by EU AIM Programme.

A telemedicine distributed system for cooperative medical diagnosis.

Telemedicine is changing the classical form of health care delivery, dramatically increasing the number of new applications in which some type of distributed synchronous cooperation between health care professionals is required. This paper presents the design and development of a telemedicine distributed system for cooperative medical diagnosis based on two new approaches: 1) a distributed layered architecture specially designed to add synchronous computer supported cooperative work features either to new or existing medical applications; 2) the definition of a methodological procedure to design graphical user interfaces for telemedicine cooperative working scenarios. The cooperative work is supported by a collaborative toolkit that provides telepointing, window sharing, coordination and synchronization. Finally, we have implemented and installed the telemedicine system in clinical practice between two hospitals, providing teleconferencing facilities for cooperative decision support in haemodynamics studies. This specific implementation and a preliminary evaluation were accomplished under the Research Project FEST "Framework for European Services in Telemedicine" funded by the EU AIM Programme.

Organization of auditory callosal connections in hypothyroid adult rats.

Callosal connections were studied with tracers (horseradish peroxidase (HRP) and wheat germ agglutinin-horseradish peroxidase (WGA-HRP)) in normal rats and rats deprived of thyroid hormones with methimazole (Sigma) since embryonic day 14 and thyroidectomized at postnatal day 6. In hypothyroid rats, the auditory areas, in particular the primary auditory area, showed cytoarchitectonic changes including blurred lamination and decrease in the size of layer V pyramidal neurons. In control rats, callosally-projecting neurons were found between layers II and VI with a peak in layer III and upper layer IV. In hypothyroid rats, labelled neurons were found between layers IV and VI with two peaks corresponding to layer IV and upper layer V, and in upper layer VI. Quantitative analysis of radial distribution of callosally-projecting neurons confirmed their shift to infragranular layers in hypothyroid rats. Three-dimensional reconstructions showed a more continuous tangential distribution of callosally-projecting neurons in hypothyroid rats which may be due to the maintenance of a juvenile 'exuberant' pattern of projections. These changes in cortical connectivity may be relevant for understanding epilepsy and mental retardation associated with early hypothyroidism in humans and to clarify basic mechanisms of cortical development.