[Integrated pharmaceutical care programme in patients with chronic diseases]. / Programa de atención farmacéutica integrada en pacientes con enfermedades crónicas.

OBJECTIVES: To assess whether an integrated pharmaceutical care programme (IPCP) improves clinical evolution, patient quality of life, and reduces health costs in chronic patients. MATERIAL AND METHODS: A parallel, open, and multi-centre clinical trial of an IPCP in patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD) in 8 different health areas in Cataluña. The intervened patient was monitored for pharmacotherapeutic evolution by hospital pharmacists, primary care physicians, and community pharmacists. Controls received normal follow-up. All patients were monitored for 12 months, with quality of life tests administered at the beginning and end of follow-up. RESULTS: We had the participation of 8 different hospitals, 8 primary care centres, and 109 community pharmacies. 238 patients completed the study, with 2.9% of participants lost during the study period. There were no significant differences in terms of readmissions, visits to the doctors, or to emergency services. We detected 50 different medication-related problems (MRP) in 37 patients, with a statistically significant difference in terms of MRP between the control and treatment groups of patients with HF, and almost significant differences in COPD patients. MRP were moderate-severe in 36% of cases. MRP were avoidable in 94% of cases, and the pharmacist resolved the issue in 90% of cases. There were no differences in terms of patient quality of life or health costs between the start and end of the study. CONCLUSIONS: Integrated pharmaceutical care programs facilitate an improvement in the quality of patient care, but electronic registries are necessary to promote communication between sections of the health care network.

[Tricuspid and pulmonary valve in a case of carcinoid syndrome]. / Afectación valvular tricuspídea y pulmonar en un caso de síndrome carcinoide.

The presence of liver methastasis and serotonin in plasma in the carcinoid tumor are responsible for the carcinoid syndrome. We present a case of tricuspid and pulmonary valvular disease secondary to this syndrome. The finding of liver hyperechogenic nodules added to the described valvular disease by subcostal echocardiogram oriented the diagnosis.

[Modified Takeuchi in adults]. / Takeuchi modificado en adultos.

Anomalous origin of left coronary artery from pulmonary artery is a rare congenital anomaly (0.25-0.46%). Mortality is high in the first months (65%). Paradoxically, some patients reach adulthood because of a net made of collaterals from the right coronary artery. Thus, we classify the entity in two ways of clinical onset: childhood and adulthood. Ideally, the best surgical approach is the arrangement of a double coronary system. The most well-known technique is the one described by Takeuchi, that links the aorta and the left coronary artery by a tunnel through the pulmonary artery, made from a pulmonary artery frontal wall flap (closing the defect with a pericardial patch). We present a case of anomalous origin of the left coronary artery in an adult, treated in our institution using a modified Takeuchi technique.

[Aortic subvalvular annular aneurysm after closed thoracic traumatism. Presentation of a case]. / Aneurisma anular subvalvular aórtico postraumatismo torácico cerrado. Presentación de un caso.

A case of a 29 year old man with congenital aortic stenosis who developed a subvalvular annular aneurysm of the left ventricle after being run by a car is presented. At surgery his aortic valve was replaced and the opening of the aneurysm was closed with a patch of Dacron. Due to the dense adhesions to the aorta and left atrium no attempts were made to excise the sac, that was not compromising the dynamics of any one of these structures.

Rat fat-cells have three types of adenosine receptors (Ra, Ri and P). Differential effects of pertussis toxin.

Activation of rat adipocyte R1 adenosine receptors by phenylisopropyladenosine (PIA) decreased cyclic AMP and lipolysis; this effect was blocked in cells from pertussis-toxin-treated rats. In contrast, the ability of 2',5'-dideoxyadenosine to decrease cyclic AMP was not affected by pertussis-toxin treatment. Addition of adenosine deaminase to the medium in which adipocytes from control animals were incubated resulted in activation of lipolysis. Interestingly, adipocytes from toxin-treated rats (which had an already increased basal lipolysis) responded in an opposite fashion to the addition of adenosine deaminase, i.e. the enzyme decreased lipolysis, which suggested that adenosine might be increasing lipolysis in these cells. Studies with the selective agonists N-ethylcarboxamidoadenosine (NECA) and PIA indicated that adenosine increases lipolysis and cyclic AMP accumulation in these cells and that these actions are mediated through Ra adenosine receptors. Adenosine-mediated accumulation of cyclic AMP was also observed in cells preincubated with pertussis toxin (2 micrograms/ml) for 3 h. In these studies NECA was also more effective than PIA. Our results indicate that there are three types of adenosine receptors in fat-cells, whose actions are affected differently by pertussis toxin, i.e. Ri-mediated actions are abolished, Ra-mediated actions are revealed and P-mediated actions are not affected.

Ebstein's anomaly: surgical treatment with tricuspid replacement without right ventricular plication.

Two patients with Ebstein's anomaly and severe cardiac impairment underwent surgical repair with tricuspid valve replacement and closure of associated congenital septal defects. No attempt was made to plicate the atrialized right ventricle. Good cardiac function was obtained at the end of the procedure, with uniform contractions of the whole right ventricle. Both patients are leading normal and active lives 38 and 32 months after operation. We believe that successful repair is achieved chiefly by placing a competent tricuspid valve on its true anatomical position, leaving the underlying atrialized portion of the ventricular wall undisturbed. That portion will contract and work synchronously with the rest of the right ventricle.