Biogeochemical responses to nutrient inputs in a Cuban coastal lagoon: runoff, anthropogenic, and groundwater sources.

Laguna Larga, a coastal lagoon in central Cuba, has been heavily altered by tourism infrastructure construction and sewage disposal. We hypothesize that this has decreased the circulation and caused eutrophication of the lagoon. To assess this, 12 bimonthly samplings were carried out in 2007-2008. Temperature, salinity, oxygen, nutrients and nitrogen, and phosphorous fractions (inorganic, organic, and total) were determined. Water and salt budgets, as well as biogeochemical fluxes of nitrogen and phosphorus were calculated using the LOICZ budget model for the three sections of the lagoon identified by morphological constrains and salinity patterns. Laguna Larga is a choked lagoon with restricted water circulation, low exchange, and high residence times that vary significantly along its sections. Residence time was estimated to be 0.1-0.7 years for the inner section and 1-9 days for the outer one. High levels of total nitrogen (annual means 126-137 µM, peaks up to 475 µM) and phosphorus (2.5-4.4 µM, peaks up to 14.5 µM) are evidence of eutrophication of Laguna Larga. During 2007, an average precipitation year, Laguna Larga exported water (703 m(3) d(-1)) and was a source of nitrogen (9.026 mmol m(-2) d(-1)) and phosphorus (0.112 mmol m(-2) d(-1)) to the adjacent sea. δ(15)N determinations in the seagrass Thalassia testudinum (-1.83 to +3.02 ‰) differed significantly between sites in the lagoon and offshore reference sites located W of the inlet, but were similar to those located E of the inlet. δ(15)N determinations in the seaweed Penicillus dumetosus (+1.02 to +4.2) did not show significant differences.

Muerte encefálica aparente tras sobredosis de baclofén / Apparent brain death after a baclophen overdose

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Hematoma subdural espontáneo asociado a púrpura fulminante en paciente esplenectomizada / No disponible

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Trombolisis precoz por tromboembolismo pulmonar tardío tras legrado. Monitorización mediante eco-doppler / Early thrombolytic treatment in late pulmonary thromboembolism after gynecological surgery. Continuous Echo-Doppler monitoring

Describimos el caso de una paciente joven que desarrolla un tromboembolismo pulmonar tardío a los 9 días de la realización de un legrado por aborto espontáneo dentro de los dos primeros meses de embarazo. El episodio tiene lugar tras el desarrollo de una trombosis venosa en el territorio popliteo-filio-femoral izquierdo a pesar de una profilaxis y tratamiento antitrombóticos correctos mediante heparina y deambulación precoz.El compromiso hemodinámico fue valorado mediante ecocardiografía-doppler transtorácica previamente y a las dos horas de terminar el protocolo de rt-PA constatándose mediante esta técnica la mejoría del cuadro hemodinámico inicial (AU)

[A hydatid cyst in the vena cava inferior and right atrium with venous flow obstruction and pulmonary dissemination]. / Quiste hidatídico en vena cava inferior y aurícula derecha con obstrucción del flujo venoso y diseminación pulmonar.

We report the case of a 62-year-old female patient operated for a hepatic hydatid cyst that years later was found to have a hydatid cyst in the inferior vena cava and right atrium that was the source of disseminated pulmonary spread of the disease and occlusion of the inferior vena cava blood flow. Cardiac hydatid disease is very uncommon and is frequently associated with a poor prognosis. The literature for hydatid disease of the heart is reviewed and the clinical and echocardiographic relevant findings of this patient are discussed.

[Characteristics and course of patients over 65 years of age with severe heart failure]. / Características y evolución de los pacientes mayores de 65 años con insuficiencia cardíaca severa.

INTRODUCTION AND OBJECTIVES: Although there have been many studies on the prognosis of congestive heart failure, most of them have not provided specific data about older patients. The aim of our study is to evaluate general characteristics and short and medium-term evolution of patients older than 65 years with severe heart failure. PATIENTS AND METHODS: We have carried out a prospective study of all patients older than 65 years admitted to our Department during 1993 due to severe heart failure (functional class III or IV of the NYHA classification), regardless of the etiology. In that year, 84 patients who fulfilled those criteria were admitted. RESULTS: The mean age was 72 +/- 6 years, 56% were male and 44% female. Age distribution was as follows: 36 patients were between 65 and 70 years, 27 between 70 and 75, 8 between 75 and 80, and 13 older than 80. The etiology of heart failure was: ischemic heart disease 44%, valvular heart disease 36%, idiopathic dilated cardiomyopathy 8%, systemic arterial hypertension 7% and other etiologies 5%. Significant systolic dysfunction (left ventricular ejection fraction < 0.45) was present in 36% of the patients. Ten percent of the patients suffered from severe ventricular arrhythmias (ventricular tachycardia or fibrillation). Regarding treatment, 24% underwent valvular surgery, 74% received only medical treatment and coronary angioplasty was performed in one patient. In hospital mortality was 9% (8 patients). After a mean follow-up of 8 +/- 4 months, the probability of survival was 78% at 1 month, 71% at 6 months and 63% at 1 year. The survival rate was better in patients with higher ejection fraction (53% for patients with ejection fractions of less than 0.45, 64% for those with ejection fractions between 0.45 and 0.60 and 79% for those with ejection fractions greater than 0.60). Considering etiology, the survival rate was worse for patients with acute myocardial infarction (30%) and aortic valve stenosis (58%). CONCLUSIONS: Patients older than 65 years admitted to the hospital for severe congestive heart failure represent a heterogeneous population in respect to etiology, systolic function and prognosis. Nevertheless, from this study it appears that a worse prognosis was associated with the lower left ventricular ejection fractions and with certain etiologies; such as acute myocardial infarction or aortic stenosis.