[Is closed mitral commissurotomy still indicated? Patient selection and postoperative problems. Analysis of 221 cases]. / Aún está indicada la comisurotomía mitral cerrada? Selección de pacientes y problemas transoperatorios. Análisis de 221 casos.

Indications, findings, complications, and immediate results in 221 patients in whom a closed mitral commissurotomy was practiced are presented. Emphasis is placed on the rigidity of the clinical criteria to select these patients with the object of diminishing to a minimum the accidents or problems and unexpected findings. The results are considered satisfactory and comparable to those reported in other great centers. Finally we considered that the results obtained with this criteria for selection were very satisfactory, with reduction of the immediate mortality to 0% in comparison with others reported, and maintaining an index of complications which we consider minimum in its clinical repercussion to the patient and less than in other series.

[Atherosclerotic ischemic cardiopathy in patients with dextrocardia in situs viscerum inversus]. / Cardiopatía isquémica aterosclerosa en pacientes con dextrocardia en situs viscerum inversus.

We describe the incidence, clinical, radiologic, electrocardiographic, echocardiographic and angiographic findings of two cases with dextrocardia in situ viscerum inversus with ischaemic heart disease. The first patient had coronary artery saphenous bypass graft and is currently asymptomatic with a negative maximal stress test. The other patient with diabetes mellitus and unfavorable coronary anatomy was not operated and is currently with stable angina on class II of the NYHA. The electrocardiographic, echocardiographic and angiographic strategies are commented.

[Medico-surgical experience in dysfunction of heart valve prostheses. Report of 55 cases]. / Experiencia médico-quirúrgica en la disfunción de prótesis valvulares cardíacas. Reporte de 55 casos.

The medical and surgical outcome of 55 patients with prosthetic valve disfunction are reported (39 bioprosthesis and 16 mechanical). Fifty patients were operated and five had medical treatment. The group of patients with mechanical prosthesis had a functional class of 2.4 +/- .74 vs patients with bioprosthesis who had a functional class of 2.8 +/- .71. Forty eight patients (87%) had congestive heart failure, four systemic emboli and three infective endocarditis. Three cases with mechanical prosthesis in tricuspid position were subjected to thrombolysis with streptokinase and experienced clinical and echocardiographical improvement. Time elapsed from original implantation and valve disfunction was 66 +/- 56 months for mechanical prosthesis vs 108 +/- 37 months in bioprosthesis (p less than 0.01), three patients died at surgery and two during the waiting period. All deaths resulted from cardiogenic shock. All of them were previously on functional class IV.

[Directional coronary atherectomy after unsuccessful angioplasty]. / Aterectomía coronaria direccional post-angioplastía no exitosa.

Directional coronary atherectomy (DCA) is a percutaneous revascularization procedure. The basic indications are complex lesions (excentricity, irregular borders with ulceration and in non-calcified lesions in large coronary vessels or in vein grafts). DCA in recent years has been a useful procedure in several circumstances, in which initial results with conventional coronary angioplasty had failed, specifically in those conditions like acute occlusions, threatened closure or "elastic recoil" phenomenal, focal dissection or residual stenosis > 50% due to hare atherosclerotic plaque. In this report two cases of "rescue" DCA due to residual stenosis > 50% because of "elastic recoil" are presented. One of them had a concentric lesion and the other a marked excentricity. Both cases had primary success. Atheroma was shown by histopathology. Rescue DCA is a useful feasible alternative procedure in selected cases, in which conventional coronary angioplasty had initially not been successful.

[Doppler echocardiography in endomyocardial fibrosis]. / Ecocardiografía Doppler en la fibrosis endomiocárdica.

Twelve patients with endomyocardial fibrosis with angiographic and/or histologic corroboration were studied with Doppler echocardiography with the purpose of describing the echocardiographic features and identify the affected sites. The average age was 41 years (range 16 to 59 years), 2 men and 10 women. Three patients (25%) had isolated right ventricular involvement, one patient (8%) left ventricular, 8 patients (66%) both ventricular. Our Doppler echocardiographic findings were: right atrium enlargement (91%), right ventricle outflow dilatation (83%), paradoxical septal motion (83%), left atrial enlargement (33%), mitral and tricuspid valve prolapse (50%), pericardial effusion (41%), mitral regurgitation (75%), tricuspid regurgitation (100%), apex obliteration (50%) and a restrictive type flow pattern (50%). Doppler echocardiography is a useful method for the diagnosis of endomyocardial fibrosis, the finding of normal or small ventricles associated with apex obliteration and enlarged atria, mitral or tricuspid regurgitation and a restrictive type flow pattern are characteristics of this disease. In our population, the isolated or predominantely right ventricular involvement is the most common finding as it represented 83% of the cases.

[Balloon valvuloplasty in stenotic bioprosthesis]. / Valvuloplastía con balón en bioprótesis estenóticas.

The results of balloon valvuloplasty performed on five patients with stenotic bioprosthesis treated in the Hospital de Cardiología Centro Médico Nacional Siglo XXI, are presented. All five bioprosthesis were right sided, two in tricuspid position, one in pulmonary valve position and two in valvulated conduits from right ventricle to pulmonary artery. In all cases a pressure gradient reduction was achieved, an improvement of clinical functional class and heart failure manifestations were obtained. Mansfields balloons were used. One in two patients, and two balloons in three. We had not complications with the procedure. We conclude that balloon valvuloplasty on bioprosthesis is a safe and dependable procedure to be used in right sided bioprosthesis.

Comparative in-vitro activity of levofloxacin against isolates of bacteria from adult patients with community-acquired lower respiratory tract infections.

This study was conducted to evaluate the activity of levofloxacin in comparison with a range of antibacterial agents against recent isolates obtained consecutively from patients with community-acquired pneumonia (CAP) or acute exacerbation of chronic bronchitis (AECB) during the period 1995 to 1996. Susceptibility testing was carried out by either microdilution or the Etest, and interpreted according to NCCLS breakpoints. The activity of levofloxacin was compared with that of amoxycillin, amoxycillin-clavulanate, cefuroxime, cefixime, erythromycin, roxithromycin, clarithromycin, azithromycin, ofloxacin and ciprofloxacin. Clinically significant numbers of bacteria were recovered from 31 CAP and 94 AECB specimens. The predominant bacterial species in the CAP specimens were Streptococcus pneumoniae (21 isolates) and Haemophilus influenzae (four isolates). The AECB isolates mainly consisted of S. pneumoniae (38%), Moraxella catarrhalis (26%), H. influenzae (19%) and Pseudomonas aeruginosa (10%). The overall percentage susceptible of the isolates for each antibiotic was: amoxycillin, 64%; amoxycillin-clavulanate, 89%; cefuroxime, 87%; cefixime, 78%; erythromycin, 85%; roxithromycin, 87%; clarithromycin, 87%; azithromycin, 85%; ofloxacin, 95%; ciprofloxacin, 95%; and levofloxacin, 97%. The activities of levofloxacin and the other agents were also compared against 40 S. pneumoniae isolates, of which 20 were penicillin-non-susceptible, recovered from CAP and AECB specimens during the period 1994 to 1996. These strains were all susceptible to levofloxacin, but only 50% were susceptible to ciprofloxacin and 80% to ofloxacin. Twenty M. catarrhalis, 20 H. influenzae and 20 methicillin-susceptible S. aureus isolates were also all susceptible to levofloxacin. Furthermore, 20 community-acquired P. aeruginosa isolates showed similar percentage susceptible rates to levofloxacin and ciprofloxacin. These in-vitro results suggest that levofloxacin may be useful in the treatment of community-acquired lower respiratory tract infections.

Perla de colesteatoma gigante / Giant cholesteatoma perl

Se presenta el caso de un paciente quien presento como complicación de una timpanoplastia, la formación de una gran perla de colesteatoma a nivel del neotimpano. Se revisa el caso, los estudios escanográficos, el tratamiento y la literatura pertinente

Policondritis recidivante / Relapsing polychondritis

La policondritis recidivante es una enfermedad sistemica, progresiva, recurrente y diseminada, caracterizada por una lesion inflamatoria potencialmente destructiva de las estructuras cartilaginosas. Se presenta el caso de un paciente relatando la evaluación clinica, los informes de los exámenes paraclinicos y tratamiento y se hace una revision de la literatura sobre la policondritis recidivante

Historia de la estimulación eléctrica coclear / History of cochlear electric stimulation

La estimulación electrica de la coclea es un gran adelanto tecnologico, que beneficia en gran medida a la población sorda bilateral que no es susceptible de mejorar con el tratamiento convencional de audifonos. Su historia se remonta al S. XVIII, cuando Volta estimulo electricamente los oidos mediante un alambre metalico. Pero no fue sino hasta en las tres ultimas decadas cuando el avance tecnologico, la miniaturización de los componentes, los estudios de biocompatibilidad y las experiencias obtenidas en los marcapasos cardiacos permitieron finalmente estimular en forma directa los restos neuronales auditivos de manera controlada, segura y eficaz

Quiste periapical con manifestaciones rinológicas / Periapical cyst with rhinologic manifestations

Los quistes odontogenicos se derivan del epitelio relacionado con la formación del aparato dental, variando el tipo de quiste segun el estado de odontogenesis. El quiste periapical pertenece a un grupo de quistes odontogenicos caracterizados por una lesion que afecta el ápice de un diente erupcionado relacionándose con los restos epiteliales de Malassez. El tratamiento es quirurgico. Se presenta el caso de una paciente con este tipo de lesion, que se manifiesta como una masa dolorosa en el piso de la fosa nasal izquierda, su diagnostico y tratamiento