Diagnostico cualitativo sobre perspectivas de usuarias, comunidad y proveedores de salud sobre salud sexual y reproductiva: Informe final / sss

El objetivo del presente documento es el de mejorar la calidad de atención en los servicios de anticoncepción del programa salud reproductiva desarrollado en áreas periurbanas de las ciudades de La Paz y Santa Cruz, permitiendonos conocer la situación en la que se encuentran ofertando los servicios de salud sexual y salud reproductiva en los centros de salud

[Impact of secondary irradiation on operators during coronary arteriography]. / Impacto de la radiación secundaria en el operador durante la arteriografía coronaria selectiva.

BACKGROUND: The activity over cellular genetic pattern of ionizing radiation can produce stochastic and unspecific damages. Interventional cardiology operators have increasing exposure times to ionizing radiation and there is no information about the real protection conferred by simple radiological protection devices. AIM: To assess the magnitude of secondary ionizing radiation exposure of operators during conventional coronary arteriography, evaluating the radiation exposure during different beam projections and the usefulness of leaded aprons. MATERIAL AND METHODS: Ionizing radiation received by operators during coronary arteriography was measured using a Geiger-Müller Victoreen model 490 counter. The device was placed in the ventral region, covered by the leaded apron and in the unprotected dorsal region. Radiation was measured in right and left projections during fluoroscopy and shooting. RESULTS: In right projection, the intensity of ionizing radiation in ventral and dorsal regions was 1.24 +/- 1.1 and 2.9 +/- 4 mR/h respectively (p = 0.08). In left projection, the figures were 2.95 +/- 3 and 7.86 +/- 7.2 mR/h respectively (p = 0.001). During shooting in left projection the radiation exposure in ventral and dorsal regions was 9.66 +/- 6.7 and 32.8 +/- 27 mR/h respectively (p < 0.001). During shooting in right projection that figures were 10.1 +/- 16 and 20.7 +/- 39.8 mR/h respectively (p = 0.09). No correlation between radiation exposure and patients surface area was observed. CONCLUSIONS: Secondary radiation received by operators is higher during shooting and in left projections. Leaded apron confers a partial protection for ventral region, and great fluctuations in the magnitude of radiation exposure were recorded. Unprotected dorsal region receives a greater amount of radiation in left projections.

[Mechanical reperfusion in acute myocardial infarction after failure of thrombolysis with intravenous streptokinase]. / Reperfusion mecanica en infarto agudo de miocardio por fracaso de trombolisis con estreptoquinasa endovenosa.

AIM: to report the clinical evolution of four patients with acute myocardial infarction that were subjected to immediate coronary angioplasty due to the failure of reperfusion with streptokinase. BACKGROUND: the limitations for the use of thrombolytic agents, an accepted treatment of acute myocardial infarction, or their uncertain results in selected groups of patients has prompted the search for mechanical revascularization infarction subjected to thrombolytic therapy with streptokinase (1.500.000 U i.v.) after administration of hydrocortisone (100 mg i.v.) and acetyl salicylic acid (500 mg od). After 60 min thrombolytic therapy and due to hemodynamic depression with requirement of inotropic agents or the absence of clinical signs of reperfusion, the patients were subjected to coronary angiography. In view of a total occlusion or severe stenosis of the artery responsible for the infarction, an immediate transluminal angiography was performed to improve coronary flow. RESULTS: transluminal coronary angioplasty revascularized arteries with total occlusion or increased the lumen of those with severe residual stenosis. This was accompanied by reduction in pain and hemodynamic improvement. In one patient with complete AV block, conduction was improved and sinus rhythm was recovered. Echocardiographic controls showed preservation of ventricular function with persistence of segmental motility alterations. CONCLUSIONS: transluminal coronary angioplasty can be a revascularization alternative in patients with acute myocardial infarction and failure of reperfusion with systemic streptokinase.

[Percutaneous transluminal angioplasty in stenosis of Blalock-Taussig pulmonary systemic shunt in an adult patient]. / Angioplastía percutánea transluminal en estenosis de la derivación sistémico pulmonar de Blalock-Taussig en paciente adulto.

AIM: The report of a female patient with tricuspid atresia and severe stenosis of the pulmonary artery, stenosis of the left pulmonary-systemic shunt and occlusion of the right systemic-pulmonary shunt. BACKGROUND: The use of transluminal angioplasty has been extended to the treatment of several congenital cardiopathies and, in some of them, it is the therapeutic procedure of choice. METHODS: Dilatation of the distal stenosis of the pulmonary-systemic shunt with a coaxial system composed initially by an 8 French right Judkins carrier catheter with a soft tip through which a 0.014" (0.036 cm) coronary angioplasty guidewire and 3 and 4 mm balloon catheters were advanced successively. Subsequently a 0.028" interchange Rosen guide was advanced, gradually introducing balloon catheters up to 8 mm of diameter. RESULTS: The dilatation with balloon catheter systems of increasing diameter allowed to amplify the stenosis zone, improving arterial oxygen partial pressure and saturation without evidences of left lung hyperflux. Considering the anatomic characteristics of the pulmonary systemic shunt, the use of carrier catheters facilitates the penetration of balloon catheters to the stenosis zone. CONCLUSION: Percutaneous transluminal angioplasty may be used with success in patients with stenosis of Blalock-Taussig shunts, independent of the anastomosis curvature and even if the magnitude of the stenosis is significant.

[Angiographic findings in non-Q wave infarction and their relation to ST-T changes]. / Hallazgos angiográficos del infarto no Q y su relación con las alteraciones del ST-T.

Non q wave myocardial infarction has been attributed to occlusion of a vessel with no ECG representation, early reperfusion of the occluded artery or occlusion of a vessel with generous collateral flow. The coronary arteriography of 84 patients with non Q wave myocardial infarction performed at 16 + 17 (SD) days after infarction was analyzed. Main left lesion was found in 6 (17%), single vessel disease in 30 (36%), two vessel disease in 18 (24%) and 3 vessel disease in 16 (19%). The "culprit" vessel had a critical residual lesion in 38 patients (45%): 22 affected the left anterior descending artery, 10 the circumflex, and 5 the right coronary artery. No residual lesion was found in 10 patients (12%). An occluded artery was found in 32 patients (38%): circumflex in 20, right coronary artery in 9 and left anterior descending in 3 (p < 0.01). Significant collateral flow to the occluded vessel was present in 41% of cases. The ST segment was analyzed in 82 patients. Depression of ST was found in 29 (35%), elevation in 22 (27%), negative T waves in 17 (21%) and minimal alterations in 17%. There was no correlation between ST levels and coronary occlusion of the culprit artery. Depression of ST was more commonly (p < 0.01) associated with severe coronary artery disease (main left or 3 vessel disease), which may be related to the poorer prognosis in these cases.