[Pulsatile Fontan: transcatheter closure of patent pulmonary artery. Follow up mid-term]. / Fontan pulsátil: oclusión transcatéter de la arteria pulmonar permeable. Seguimiento a mediano plazo.

OBJECTIVE: We report the percutaneous closure of the pulmonary artery with residual shunt in patients with Fontan type circuit. METHOD: Patients aged 9 and 11 years, with SaO2 of 88 and 96%, respectively. One of them coursing with headaches and functional class II. Both patients with total cavopulmonary anastomosis and fenestrated extracardiac conduit and permeable pulmonary artery (pulsatile Fontan). An Amplatzer duct-occluder device was implanted in the pulmonary artery entering from the femoral vein. Follow-up by means of clinical examination, imaging, and catetherization was pursued. RESULTS: Case 1, patency fenestration, Qp/Qs: 0.7/1. Case 2, closed fenestration, Qp/Qs; 1.3/1. We obtained immediate occlusion with 6/4 and 8/6 devices, respectively; pressure recordings revealed modification of the arterial morphology to biphasic; pulmonary pressure dropped 2 mm Hg in the first patient, without alteration in the second case; no changes in SaO2 were registered. Time of fluoroscopy was 57 and 45 minutes, respectively. Follow-up was maintained for 2.8 and 2.3 years, respectively. In patient 1, headaches disappeared and the fenestration was occluded with an Amplatzer septal-occluder one year later, raising SaO2 to 96%; no complications occurred nor was recanalization of the pulmonary artery needed in either case. CONCLUSIONS: Percutaneous occlusion of patent pulmonary artery in patients with Fontan type circuit is a feasible and effective procedure, and avoids overload of the single ventricle.

Percutaneous closure of patent ductus arteriosus in adults using different devices.

Surgical closure of patent ductus arteriosus in adults involves a number of risks because there are associated anatomic and histologic alterations. Between October 1992 and August 2008, 23 patients were referred to our department with isolated patent ductus arteriosus. Their age ranged from 16-75 years (median 25.5 years) and their weight from 52-80 kg (median 57 kg). The pulmonary diameter ranged from 1.8-5.8 mm (mean 3.5 mm), and pulmonary artery pressure, from 9-72 mmHg (mean 15 mmHg). The rate of ductal occlusion achieved with the Rashkind patent ductus arteriosus occluder was 85.7%, and it was 100% with the Amplatzer duct occluder and the Nit-Occlud coil. The average hospitalization time and follow-up duration were 24 hours and 2 years, respectively. The only immediate complication was an inguinal hematoma, and there were no late complications. In adults, closure of patent ductus arteriosus using a number of different devices, especially the latest generation devices, was safe and effective, regardless of morphologic and histologic characteristics.

[Patent ductus arteriosus closure using a new device: the Nit-Occlud device]. / Cierre del ductus arterioso permeable con un nuevo tipo de dispositivo: Nit-Occlud.

Between May 2003 and July 2006, we carried out percutaneous patent ductus arteriosus closure using a Nit-Occlud device in 28 patients, who had a median age of 1.8 years (range 0.5-21 years) and a median weight of 10.9 kg (range 5.9-64 kg). The ductus arteriosus had several different morphologic forms, and there was one postsurgical recanalization of the ductus arteriosus. The median minimum ductal diameter was 1.8 mm and the median maximum aortic ampulla diameter was 6.5 mm. The occlusion rate immediately after intervention was 53.5%, which increased to 95.2% by 12 months and to 100% by 18 months. The median follow-up time was 20.5 months. The Nit-Occlud device provided an effective and safe means of patent ductus arteriosus closure, irrespective of ductus morphology.

Subsensado de fibrilación ventricular espontánea como causa de muerte súbita en un niño / Undersensing of Spontaneous Ventricular Fibrillation as a Cause of Sudden Death in a Child

Se han comunicado casos aislados de subsensado de fibrilación ventricular por el cardiodesfibrilador implantable. La mayoría de ellos ocurrieron durante la medición de umbrales desfibrilatorios. Se ha sugerido que este tipo de subsensado podría ser una causa potencial de muerte súbita. En esta presentación se describe a un paciente de 4 años con miocardiopatía hipertrófica que sufrió un episodio espontáneo de fibrilación ventricular, con una gran alternancia en la amplitud de los electrogramas ventriculares locales, que fue subsensado y no tratado por el dispositivo y provocó muerte súbita.

In few cases implantable cardiodefibrillators have been reported to undersense ventricular fibrillation, and most of them happened during the measurement of defibrillation thresholds. This type of undersensing has been suggested as a potential cause of sudden death. In this case report we describe a 4-year old boy with hypertrophic myocardiopathy who suffered a spontaneous episode of ventricular fibrillation with a great alternation in the amplitude of local ventricular electrograms. The episode was undersensed by the device and therefore it was not treated, causing the child's death.

Fontan pulsátil: oclusión transcatéter de la arteria pulmonar permeable. Seguimiento a mediano plazo / Pulsatile Fontan: transcatheter closure of patent pulmonary artery. Follow up mid-term

OBJECTIVE: We report the percutaneous closure of the pulmonary artery with residual shunt in patients with Fontan type circuit. METHOD: Patients aged 9 and 11 years, with SaO2 of 88 and 96%, respectively. One of them coursing with headaches and functional class II. Both patients with total cavopulmonary anastomosis and fenestrated extracardiac conduit and permeable pulmonary artery (pulsatile Fontan). An Amplatzer duct-occluder device was implanted in the pulmonary artery entering from the femoral vein. Follow-up by means of clinical examination, imaging, and catetherization was pursued. RESULTS: Case 1, patency fenestration, Qp/Qs: 0.7/1. Case 2, closed fenestration, Qp/Qs; 1.3/1. We obtained immediate occlusion with 6/4 and 8/6 devices, respectively; pressure recordings revealed modification of the arterial morphology to biphasic; pulmonary pressure dropped 2 mm Hg in the first patient, without alteration in the second case; no changes in SaO2 were registered. Time of fluoroscopy was 57 and 45 minutes, respectively. Follow-up was maintained for 2.8 and 2.3 years, respectively. In patient 1, headaches disappeared and the fenestration was occluded with an Amplatzer septal-occluder one year later, raising SaO2 to 96%; no complications occurred nor was recanalization of the pulmonary artery needed in either case. CONCLUSIONS: Percutaneous occlusion of patent pulmonary artery in patients with Fontan type circuit is a feasible and effective procedure, and avoids overload of the single ventricle.

Antihistamínico de nueva generación y descongestionantes nasales en rinitis alérgica / New generation antihistamines and nasal adescongestionants in allergic rhinitis

Con el propósito de evaluar la reacción clínica a las nuevas preparaciones de antihistamínico y pseudoefedrina se estudiaron 160 pacientes con rinopatía alérgica activa; se separaron al azar en cuatro grupos diferentes: 1) loratadina + pseudoefedrina; 3) terfenadina + pseudoefedrina; 4) placebo. A cada paciente se le entregó un cuestionario para autoevaluación y medición de la reacción clínica, tolerancia, inicio de acción y efectos colaterales. Se encontró mejoría importante en 87 por ciento de los pacientes del grupo 1, 85 por ciento en el grupo 2, 70 por ciento en el grupo 3 y 3 por ciento en el grupo 4. Se observaron efectos colaterales en 24 por ciento del grupo 1 y 48 por ciento en el grupo 2 y 47 por ciento en el grupo 3. El conocimiento de la reacción clínica a las diferentes combinaciones permite individualizar el tratamiento y ofrecer a los pacientes el mejor medicamento para su caso

Sistemas de evaluación, registros y protocolos para el tratamiento del dolor: Unidad Dolor. Hospital Naval Buenos Aires "Dr. Pedro Mallo" / Evaluation systems, files and protocols used in pain treatment: Unity Pain. Hospital Naval Buenos Aires \"Dr. Pedro Mallo\"

En el presente trabajo se presentan los protocolos y sistemas de registro utilizados en la evaluación, tratamiento y seguimiento, producidos en la Unidad Dolor del Hospital Naval Buenos Aires "Dr. Pedro Mallo". Asimismo se describe el proceso de resolución en la atención de pacientes, se discuten los resultados de los protocolos utilizados, se analizan los análisis de costos y la satisfacción de servicio en diferentes etapas del desarrollo de la Unidad como parte de los planes de calidad total a nivel institucional. Se demuestra la validez de los instrumentos utilizados, la eficacia de la sistematización en la recolección y procesamiento de la información y la eficiencia del tratamiento participativo de los pacientes con dolor.