High-Bandpass Filters in Electrocardiography: Source of Error in the Interpretation of the ST Segment.

Introduction. Artifactual variations in the ST segment may lead to confusion with acute coronary syndromes. Objective. To evaluate how the technical characteristics of the recording mode may distort the ST segment. Material and Method. We made a series of electrocardiograms using different filter configurations in 45 asymptomatic patients. A spectral analysis of the electrocardiograms was made by discrete Fourier transforms, and an accurate recomposition of the ECG signal was obtained from the addition of successive harmonics. Digital high-pass filters of 0.05 and 0.5 Hz were used, and the resulting shapes were compared with the originals. Results. In 42 patients (93%) clinically significant alterations in ST segment level were detected. These changes were only seen in "real time mode" with high-pass filter of 0.5 Hz. Conclusions. Interpretation of the ST segment in "real time mode" should only be carried out using high-pass filters of 0.05 Hz.

Mechanical comparison of median sternotomy closure in dogs using polydioxanone and wire sutures.

OBJECTIVES: To compare the mechanical properties of two different materials for canine median sternotomy closure. STUDY DESIGN: In vitro biomechanical study. SAMPLE POPULATION: Twelve canine cadaveric entire sternum and portion of associated ribs and musculature. METHODS: Median sternotomy leaving the manubrium intact was closed using polydioxanone and stainless steel wire in a figure of eight pattern. Constructs were loaded in a servohydraulic material testing system and displacement was compared at loads of 125, 150, 200, 250, 300, 350 and 400 N, and at failure. RESULTS: Displacement at loads up to 400 N and failure did not show any statistical difference between the polydioxanone and the stainless steel wire. However, the loading forces to create failure of the construct were superior for the stainless steel. Polydioxanone and stainless steel wire had the same response to distractive forces for loads applied up to 400 N. CLINICAL SIGNIFICANCE: This study cannot recommend the use of polydioxanone over wires but suggests that polydioxanone can potentially be an alternative for primary median sternotomy closure in selected patients.

Effect of circulatory assistance on premature death and long-term prognosis.

BACKGROUND: Patients undergoing urgent heart transplantation (HT) have a poorer prognosis and more long-term complications. The objective of this study was to compare the preoperative course in patients undergoing urgent HT according to the need for preoperative intra-aortic balloon counterpulsation (IABP). MATERIALS AND METHODS: We studied 102 consecutive patients including 23 patients with IABP who underwent urgent HT between January 2000 and September 2006. We excluded patients who received combination transplants, those who underwent repeat HT, and pediatric patients who underwent HT. The statistical methods used were the t test for quantitative variables and the chi(2) test for qualitative variables. A logistic regression model was constructed to assess the possible relationship between IABP and other variables on premature death within 30 days after HT. RESULTS: Mean (SD) patient-age was 50 (10) years. No significant differences were observed in baseline characteristics between the IABP and the non-IAPB groups. The IABP patient group had higher rates of acute graft failure (45.5% vs 35.4%; P = .46) and premature death (18.8% vs 14.8%; P = .67) and shorter long-term survival (40.6 [34.9] vs 54.5 [43.7] mo; P = .30). Multivariate analysis demonstrated no association between the need for IABP and increased frequency of premature death. CONCLUSIONS: Use of IABP is not associated with premature or late death. We recommend use of IABP in patients with acute decompensated heart failure to stabilize them before HT.

Influence of HLA matching on survival in heart transplantation.

BACKGROUND: In renal transplantation, the degree of HLA matching has been reported to be negatively correlated with graft loss, with the number of rejections with complications. This association is less clear in heart transplantation, where there are contradictory studies, although most are consistent with those in renal transplantation. The objective of this study was to analyze differences in the probability of survival and the incidence of complications during follow-up according to the degree of HLA-A, -B, and -DR matching. MATERIALS AND METHODS: Two hundred forty-three consecutive patients transplanted over a 13-year period were analyzed for age, gender, pretransplant factors associated with mortality, number of rejections and infections, incidence of acute graft failure, arterial hypertension, diabetes, and survival time with cause of death with reference to the number of HLA matches (zero to six). Exclusion criteria included retransplants, heart-lung transplants, pediatric transplants, and perioperative mortality. Groups were compared using the chi(2) and ANOVA (Bonferroni posthoc test) tests. Kaplan-Meier survival curves were compared using the log rank test. The significance level was set at P < .05. RESULTS: The overall probability of survival of our series at 1, 5, and 10 years was 85%, 77%, and 60%, respectively. HLA-A, -B, and -DR compatibility: No significant differences were found when the curves were compared (log-rank: .005). The best survival rates were obtained with lower degrees of matching. No significant differences were found in the number of rejections or infections, although survival rates (P = .007) were higher among those with the lower degrees of matching. CONCLUSIONS: A higher degree of HLA-A, -B, and -DR matching did not have a positive effect on heart transplant patient survival, rejection episodes or infections.

[Clinical diagnosis of autism]. / Diagnóstico clínico del autismo.

INTRODUCTION: The disorders of the autistic spectrum form a collection of symptoms due to dysfunction of the central nervous system with great variations in the degree of severity. Autism is considered to be a generalized disorder of development (DSM-IV). Autism is not defined as a specific disease, since it does not have a specific aetiology. DEVELOPMENT: There are many syndromes related to autism, but most of these disorders are not selective and show a combination of autistic symptoms together with symptoms of neurological dysfunction. There is no specific aetiology, although in recent years genetics have been shown to be important. The prevalence varies between 1 and 1.2/1,000. Boys are more often affected than girls, in a proportion of 3-4 to 1. Diagnosis is clinical and is based on alterations of social interaction, problems of communication and also a restricted range of activities and interests (DSM-IV). There are anomalies associated with behaviour problems, such as delay in speaking, mental retardation, sensorial defects and motor difficulties. CONCLUSIONS: Over 75% of autistic children have mental retardation, and this proportion is higher in severe cases, especially when the children have attention deficit with hyperactivity. These children have many of the typical signs of autism: stereotyped movements, inappropriate language, obsessive behaviour with little mental flexibility, naivety and little skill in social interaction. In these cases it is difficult to draw the line between mental retardation and autism.

[Utility of pravastin in cardiac transplant dyslipidemia]. / Utilidad de la pravastina en la dislipidemia del trasplante cardíaco.

Patients undergoing cardiac transplantation are at increased risk of dyslipidemia (60% to 80%). Lipid-lowering treatment in these patients should be aggressive given the known role of dyslipidemia in chronic transplant rejection. The objective of this study was to evaluate the efficacy and safety of pravastatina therapy and its effect upon cyclosporine levels in a population of dyslipidemic cardiac transplant patients.A total of 20 cardiac transplant patients were enrolled in this 39-week length prospective observational study. Patients had serum cholesterol levels exceeding 200 mg/dl, and received pravastatin therapy at the adequate dose to obtain an optimal lipid profile without significant adverse effects. Pravastatin, at a mean dose of 50 18 mg/day, produced a significant reduction in total cholesterol levels (from 291 32 to 203 25 mg/dl, p < 0.05), LDL cholesterol (from 187 34 to 102 15 mg/dl, p < 0.05) and an increase in HDL-cholesterol levels (from 48 16 to 55 14, p < 0.05). A slight asymptomatic increase in CPK levels was observed but no differences in cyclosporine levels. Pravastatin has shown to be an effective and safe therapy in dyslipidemic cardiac transplant patients.

Utilidad de la pravastina en la dislipidemia del trasplante cardíaco / Utility of pravastin in cardiac transplant dyslipidemia

Los pacientes sometidos a trasplante cardíaco tienen un mayor riesgo de dislipidemia (60 por ciento-80 por ciento).Debido al conocido papel de la dislipidemia en el desarrollo de enfermedad vascular del injerto, el tratamiento hipolipidemiante debería ser especialmente agresivo en estos pacientes. El objetivo de este estudio ha sido evaluar la eficacia y seguridad del tratamiento con pravastatina y su efecto sobre los niveles de ciclosporina sobre una población de pacientes trasplantados dislipidémicos.Incluimos, en este estudio prospectivo observacional de 39 semanas de duración, a 20 pacientes trasplantados cardíacos con cifras de colesterol basales por encima de 200 mg/dl, que recibieron tratamiento con pravastatina a la dosis necesaria para alcanzar un óptimo perfil lipídico o aparición de efectos adversos significativos. Pravastatina, a una dosis media de 50 ñ 18 mg/día, produjo una reducción significativa de los niveles de colesterol (de 291 ñ 32 a 203 ñ 25 mg/dl, p < 0,05), colesterol LDL (de 187 ñ 34 a 102 ñ 15 mg/dl, p < 0,05) e incrementó el colesterol HDL (de 48 ñ 16 a 55 ñ 14, p < 0,05).Observamos un ligero incremento de las cifras de creatinfosfocinasa (CPK) asintomático y sin mayor relevancia clínica, y los niveles de ciclosporina no experimentaron diferencias significativas.La pravastatina se ha mostrado en nuestro estudio como un tratamiento seguro y eficaz en pacientes trasplantados cardíacos con dislipidemia (AU)

Diagnóstico clínico del autismo / Clinical diagnosis of autism

Introducción. Los trastornos del espectro autista lo forman una constelación de síntomas derivados de una disfunción del sistema nervioso central, con grandes variaciones en el grado de intensidad. El autismo está considerado como un trastorno generalizado del desarrollo (DSM-IV); no se expresa como una enfermedad específica, ya que no tiene una etiología determinada. Desarrollo. Hay muchos síndromes relacionados con el autismo, pero la mayoría de estos trastornos no son selectivos, y existe una combinación de síntomas autistas con otros de disfunción neurológica. No hay una etiología específica, pero en los últimos años se ha demostrado que la genética ocupa un lugar importante. La prevalencia varía entre el 1 y el 1,2/1.000. Afecta más a niños que a niñas, en una proporción de 3-4 a 1. El diagnóstico es clínico y se basa en las alteraciones de la interacción social, problemas de la comunicación, y por presentar un repertorio restringido de las actividades e intereses (DSM-IV). Existen anomalías asociadas a los problemas conductuales, tales como retraso del lenguaje, retraso mental, déficit sensoriales y problemas motores. Conclusiones. Más del 75 por ciento de los niños autistas padecen retraso mental, proporción que aumenta en los casos graves, sobre todo si los pacientes presentan déficit de atención con hiperactividad. Estos niños tienen muchos signos típicos del autismo: estereotipias motoras, lenguaje inapropiado, conductas obsesivas con escasa flexibilidad mental, ingenuidad y poca habilidad para la interacción social. En estos casos es difícil delimitar la barrera entre el retraso mental y el autismo (AU)

[Photosensitive epilepsies of children]. / Epilepsias fotosensibles del niño.

INTRODUCTION: Reflex epileptic seizures are caused by a specific sensorial stimulus which determines their classification. Photosensitive epilepsies are the commonest forms and are included with the idiopathic generalized epilepsies. DEVELOPMENT AND CONCLUSIONS: We analyze the different responses to intermittent light stimulation, in both normal and epileptic persons, and study the various epileptic syndromes in which photosensitivity is seen. The purely photosensitive (photogenic) epilepsies are characterized by seizures caused only by light as compared with the epilepsies with photosensitivity which also present spontaneous seizures. Special mention is made of seizures induced by the television screen, computer screen and video-games. The palpebral myoclonias with absences may be considered to be reflex seizures, since they are induced by eyelid closure, and include the vary rare self-induced epileptic seizures. Finally we study the epileptic seizures induced by pattern and exclusively due to intermittent light stimulation.

¿Posee el fosinopril efecto reductor de los lípidos en los pacientes hipertensos? / Does fosinopril have the lipid lowering effect among hypertensive patients?

Objetivo. El propósito de este estudio fue analizar el efecto del fosinopril sobre la presión arterial, perfil lipídico, función renal, hepática y masa ventricular en pacientes con hipertensión ligera o moderada. Material y método. Se incluyeron 24 pacientes de 66ñ8 años, 14 mujeres y 10 varones, 16 con hipertensión arterial aislada y 8 asociada a cardiopatía isquémica. Medicación concomitante: aspirina 9; nitratos 8; bloqueadores beta 5; antidiabéticos orales 4; hipolipidemiantes 4; calcioantagonistas 3; diuréticos 3 y ranitidina 2 pacientes. Esta medicación no se modificó a lo largo del estudio. Se incluyeron pacientes consecutivos y estables diagnosticados de hipertensión arterial esencial. Se realizaron controles a la semana de retirar la medicación antihipertensiva (revisión 1), semanas 4 (revisión 2), 12 (revisión 3) y tras 7 días de retirar el fosinopril (revisión 4).Resultados. Hubo diferencias significativas (p<0,05) en la presión arterial sistólica y diastólica al comparar el valor basal (PAS: 159ñ11 mmHg; PAD: 99ñ8 mmHg) y a las 4 (PAS: 137ñ10 mmHg; PAD: 82ñ7 mmHg) y 12 semanas (PAS: 136ñ12; PAD: 85ñ8, incluso tras retirar el fármaco (PAS: 151ñ12 mmHg; PAD: 96ñ10 mmHg). No hubo cambios en los triglicéridos, colesterol total ni colesterol HDL. Tampoco en los parámetros de función hepática y renal. Se encontró un descenso significativo en el colesterol LDL a las 12 semanas (132ñ9 frente a 141ñ12) y tras la suspensión del fármaco (133ñ12 frente a 141ñ12). La Lp(a) mostró cambios significativos, con respecto al basal, en todas las revisiones (revisión 2: 5ñ22 frente a 8ñ23; revisión 3: 4ñ22 frente a 8ñ23) aunque experimentó un efecto rebote al retirar el fosinopril (10ñ21 frente a 8ñ23). No se apreciaron cambios en los parámetros de función diastólica ni en la fracción de eyección; no obstante, la masa ventricular sí experimentó un descenso significativo 253ñ58 frente a 276ñ59). Conclusiones. Según estos resultados, creemos que el fosinopril debe ser considerado un fármaco de primera línea en el tratamiento de la hipertensión arterial. Es capaz, por un lado, de reducir la masa ventricular y, por otro, de mejorar de forma significativa el perfil lipídico del paciente sin producir alteraciones en la función hepática o renal (AU)

Right ventricular infarction mimicking anterior infarction: a case report.

Right ventricular infarction usually occurs in association with inferior infarction, with no remarkable electrocardiographic signs in conventional leads. This report describes a patient with a previous inferior acute myocardial infarction who developed right ventricular infarction with significant anterior lead ST segment elevation (V1-V4) caused by the loss of two large right ventricular branches during a coronary angioplasty of the right coronary artery. The case is discussed and the literature is reviewed.

[Myocardial bridging as a cause of acute ischemia. Description of a case and review of the literature]. / Puente miocárdico como causa de isquemia aguda. Descripción del caso y revisión de la bibliografía.

Myocardial bridges consist of muscle fiber bundles lining an epicardial coronary artery for a variable distance. They are a relatively common finding, with incidence changing on the basis of the study method used (angiographic/necropsy). Although myocardial bridges are usually associated with a benign prognosis, being in many cases asymptomatic and only found by chance, their presence has also been considered a cause of angina, malignant arrhythmia, myocardial infarction and sudden death. They are diagnosed in vivo by angiography when a systolic compression of a coronary artery which disappears during diastole is evidenced. We report the case of a patient with electrocardiographic signs of severe ischemia in the territory of the anterior descending artery, which was initially assessed as myocardial infarction and treated as such. Eventually, the ECG returned to normal, and no new Q waves of necrosis occurred. An angiohemodynamic study confirmed the existence of an isolated muscular bridge over the middle third of the anterior descending artery, with no other associated coronary lesions.

Erythrocyte hemolysis and shape changes induced by new lysine-derivate surfactants.

The effects of new synthetic lysine-derived anionic surfactants on human and rat erythrocytes were studied. The surfactants were salts of Nalpha,Nepsilon-dioctanoyl lysine with different counterions: lysine (77KK), tris (trishydroxymethyl amminomethane) (77KT), sodium (77KS), and lithium (77KL). 77KK and 77KT showed a biphasic hemolytic behavior in the erythrocytes. The surfactants 77KS and 77KL showed concentration-dependent hemolysis with a CH50 of about 3.4 and 2.6 mmol/l, respectively. 77KK and 77KT induced protection against hypotonic hemolysis in rat erythrocytes at the concentration which showed the least hemolytic activity under isotonic conditions. With human erythrocytes, 77KT did not show biphasic behavior in isotonic medium, but under hypotonic conditions biphasic behavior was present. Changes in shape of the erythrocyte, from discocytic to stomatocytic were observed after incubation with the anionic surfactants studied. Such shape changes occurred progressively over time, with total alteration in shape occuring after about 20 min of incubation.

Left ventricular end-diastolic extrasystole with pseudonormalization of a left bundle branch block unmasking inferior ischemia.

An electrocardiogram tracing of a patient in conducted sinus rhythm with left bundle branch block is shown, in which occasional pseudonormalization of intraventricular conduction is seen. This event is attributed to ventricular fusions with end-diastolic extrasystoles of the left His-Purkinje system distal to the block site. This type of extrasystole is discussed. In this case, normalization of ventricular activation allowed for diagnosis of inferior subepicardial ischemia.

[Diagnostic focus on the child with epilepsy and neuropsychological deterioration]. / Enfoque diagnóstico del niño con epilepsia y deterioro neuropsicológico.

Symptomatic epilepsy secondary to hereditary metabolic or degenerative disorders, is usually associated to neurological deterioration. Though epilepsy by itself does not induce neurological deterioration, we should remind that some epileptics encephalopathies, such as the West or Lennox-Gastaut syndromes, do actually induce limited neurological deterioration. Furthermore, in some forms of complex partial epilepsy, motor problems and behavior disorders can be observed, specially in adolescents with temporary lobe epilepsy. Other forms of epilepsy, such as the atypical benign partial epilepsy or the Landau-Kleffner syndrome, can present a certain degree of cognitive deterioration in the evolution, although they can recover later lost functions, totally or partially. The evolution of some refractory epilepsy, as patients are submitted to a multiple treatments, can make us suspect a degenerative disease. In some cases, the diagnosis of the hereditary metabolic and heredodegeneratives diseases can be made by the characteristics of the seizures but in most cases the diagnosis will be established by the symptoms of the basic disease and the lab data.

[Emergency implantation of intracoronary stent after acute occlusion of the common trunk of the left coronary artery]. / Implantación emergente de stent intracoronario tras oclusión aguda del tronco común de la coronaria izquierda.

Nowadays, the implantation of coronary endoprosthesis within the left main coronary artery is not considered as an absolute contraindication. Here, we show a case of acute occlusion within the left main coronary artery. This was resolved by implanting a stent during a programmed cardiac catheterization. It should be stressed that this problem was occurred without manipulating the left coronary tree. In addition, the patient was in cardiac arrest when the stent was implanted. Cardiopulmonary resuscitation was applied because of this condition.

[Non-hereditary +hyperekplexia. Study of a patient with unusual ictal EEG features and review of the literature]. / Hiperecplexia no hereditaria. Estudio de un paciente con características EEG ictales poco habituales y revisión de la bibliografía.

INTRODUCTION AND CLINICAL CASE: We present a male patient which presented distal muscular stiffness, from the first hours of the life. At this time, he also presented episodes of generalized muscular hypertonia with cyanosis and apnoea, started by somato-sensorial stimuli. Those episodes were terminated by passive flexion of the extremities and the head. Later, dream myoclonic jolts appeared. EEG tracings during hypertonic episodes showed an initial artefact potential followed by bursts of rhythmic and repetitive acute potentials in the bilateral fronto-central regions, at a 20-22 Hz frequency, similar to an epileptiform spike-wave burst. The EMG showed a continuous muscular activity, suppressed by rest and the administration of diazepam. Treatment with oral diazepam has been very effective. Now, the patient is four years old, is asymptomatic and continues treatment with oral diazepam. If the dose is decreased, the child starts unstable march, startle response on somatosensory stimuli with falls, and above all nocturnal myoclonia. The patient does not have familiar antecedents of hyperekplexia, even in its minor form. CONCLUSION: Clinical picture suggests us a not familiar form of hyperekplexia.