Analgesia y sedación en la pancreatitis aguda / Analgesia an sedation in acute pancreatitis

Las publicaciones acerca del tratamiento analgésico y sedante en la pancreatitis aguda son escasas y en general bastante antiguas. Se describen las vías por las que circula la información de la sensibilidad dolorosa del páncreas, los distintos fármacos según el punto de estas vías en que ejercen su acción, sus características favorables e indeseables, y los métodos de administración más adecuados en este entorno clínico. Se revisa particularmente, a la luz de las mejores evidencias disponibles, la polémica acción de los opiáceos sobre la presión en el interior de las vías biliares (AU)

[Value of transesophageal echocardiography in the diagnosis of acute aortic dissection]. / Valor da ecocardiografia transesofágica no diagnóstico da dissecção aguda da aorta.

We describe our experience of six patients with clinical suspicion of acute aortic dissection (AAD) who were studied consecutively by transesophageal echocardiography (TEE) from April to July of 1991. All of them were previously submitted to transthoracic echocardiogram. The diagnosis was correctly established by TEE in five cases, confirmed by aortography and/or surgery (four cases), or by autopsy (one case). In one patient the diagnosis of AAD was excluded by TEE, and posteriorly by nuclear magnetic resonance. Four patients had a Stanford type A, and one patient a type B dissection. The site of entry was identified in three cases; the intimal entry tear of the type B dissection, not observed by TEE, was localized in the aortic arch by aortography. In three of the four type A dissection cases, a thrombus in the false lumen and an aortic regurgitation were found. No other noninvasive methods were used after the diagnosis of AAD by TEE. The surgical repair was successful in three cases, one of which, without previous necessity of aortography. In our experience, TEE increased extraordinarily the diagnosis efficacy of AAD, making possible an earlier therapeutic approach, and probably contributing to the improvement of the prognosis of this pathology.

[Fistula of the right coronary artery near the right ventricle. An echocardiographic study]. / Fístula de la arteria coronaria derecha hacia el ventrículo derecho. Estudio ecocardiográfico.

A case of a 42-year-old woman with a right coronary artery fistula into the right ventricle is reported; she was asymptomatic and a continuous precordial murmur was found on physical examination. We discuss the usefulness and limitation of the Echo 2-D/Doppler findings, concerning this diagnosis, which was only definitively established by angiocardiography.