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Resumen: Introducción: el choque cardiogénico (CC) es un estado de hipoperfusión sistémica causado por disfunción cardíaca severa. La medición de la integral tiempo-velocidad del tracto de salida del ventrículo izquierdo (ITV-TSVI, por sus siglas en inglés) < 15 cm permite evaluar la presencia del choque. Objetivo: evaluar a la ITV-TSVI < 15 cm como predictor de choque cardiogénico en el paciente con infarto agudo de miocardio anterior con elevación del segmento ST (IAM-ST). Material y métodos: estudio observacional prospectivo realizado de mayo a octubre de 2019. Se incluyeron pacientes con IAM-ST anterior y revascularización mediante intervencionismo coronario percutáneo. Se midió mediante ecocardiografía transtorácica la ITV-TSVI, se registraron y compararon las variables demográficas y clínicas de los pacientes con ITV-TSVI < 15 cm versus aquéllos con ITV-TSVI ≥ 15 cm y se calculó la exactitud diagnóstica de la ITV-TSVI < 15 cm para predecir choque cardiogénico. Resultados: se analizaron los datos de 50 pacientes con media de edad: 63.5 ± 9.9 años, 70% fueron hombres, 54% tuvieron choque cardiogénico y la ITV-TSVI < 15 cm se presentó en 95.8% de los pacientes con choque cardiogénico. La exactitud diagnóstica del ITV-TSVI < 15 cm en choque cardiogénico en pacientes con IAM-ST anterior mostró sensibilidad de 85% y especificidad de 96%, con área bajo la curva: 0.90 (IC 95%: 0.81-0.99). Conclusión: el ITV-TSVI < 15 cm en pacientes con IAM-ST anterior tiene una exactitud diagnóstica muy buena para la predicción del choque cardiogénico.
Abstract: Introduction: cardiogenic shock (CC) is a state of systemic hypoperfusion caused by severe cardiac dysfunction. The measurement of the integral time-velocity of the left ventricular outflow tract (ITV-LVOT) < 15 cm allows to evaluate the presence of shock. Objective: to evaluate the ITV-TSVI < 15 cm as a predictor of cardiogenic shock in the patient with ST-segment elevation anterior acute myocardial infarction (ST-AMI). Material and methods: prospective observational study conducted from May to October 2019. Patients with previous ST-AMI and revascularization by percutaneous coronary intervention were included. TVI-LVOT was measured by transthoracic echocardiography, the demographic and clinical variables of patients with TVI-LVOT < 15 cm vs. those with TVI-LVOT ≥ 15 cm were recorded and compared, and the diagnostic accuracy of TVI-LVOT < 15 cm to predict cardiogenic shock was calculated. Results: data from 50 patients were analyzed with a mean age of 63.5 ± 9.9 years, 70% were men, 54% had cardiogenic shock, and TVI-LVOT < 15 cm occurred in 95.8% of those patients with shock. cardiogenic. The diagnostic accuracy of the TVI-LVOT < 15 cm for cardiogenic shock in patients with anterior ST-AMI showed sensitivity of 85% and specificity of 96%, with area under the curve: 0.90 (95% CI: 0.81-0.99). Conclusion: The TVI-LVOT < 15 cm in patients with anterior ST-AMI has a very good diagnostic accuracy for the prediction of cardiogenic shock.
Resumo: Introdução: o choque cardiogênico (CC) é um estado de hipoperfusão sistêmica causado por disfunções cardíacas severas. A medição da integral velocidade-tempo da vía de saída do ventrículo esquerdo (ITV-TSVI, por suas siglas em inglês) < 15 cm permite avaliar a presença do choque. Objetivo: avaliar a integral tempo-velocidade da via de saída do ventrículo esquerdo (ITV-TSVI) < 15 cm como preditor de choque cardiogênico em pacientes com infarto agudo do miocárdio anterior com supradesnivelamento do segmento ST (IAM-ST). Material e métodos: estudo observacional prospectivo realizado de maio a outubro de 2019. Incluíram-se pacientes com IAM-ST anterior e revascularização por intervenção coronária percutânea. Mediu-se por ecocardiografia transtorácica a ITV-TSVI, foram registradas e comparadas as variáveis demográficas e clínicas de pacientes com ITV-TSVI < 15 cm versus aqueles com ITV-TSVI ≥ 15 cm, e calculo-se a precisão diagnóstica de ITV-TSVI < 15 cm para prever o choque cardiogênico. Resultados: analizaram-se dados de 50 pacientes com idade média de 63.5 (± 9.9) anos, 70% eram homens, 54% apresentavam choque cardiogênico e ITV-TSVI < 15 cm apresentou-se em 95.8% dos pacientes com choque cardiogênico. A precisão diagnóstica do ITV-TSVI < 15 cm para choque cardiogênico em pacientes com IAM-ST anterior apresentou sensibilidade de 85% e especificidade de 96%, com área sob a curva: 0.90 (IC 95%: 0.81-0.99). Conclusão: ITV-TSVI < 15 cm em pacientes com IAM-ST anterior tem uma precisão diagnóstica muito boa para prever o choque cardiogênico.
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Resumen A 29 year old female with a past medical history of systemic lupus erythematosus, diagnosed 15 years earlier, presents with lupus nephritis, currently on peritoneal dialysis. She had myopericarditis in 2012 and is currently on immunosuppressants. The patient began with exertional dyspnea and angina 2 weeks before admission. An echocardiogram was performed, reporting severe mitral and tricuspid insufficiency. Afterwards, the patient presented with resting angina associated with an adrenergic and vagal response. Initially, rheumatology ruled out autoimmune activity caused by lupus. We performed a coronary angiogram based on clinical presentation, EKG changes and biomarkers, finding a trivascular coronary artery disease classified as a Markis I coronary artery ectasia and a coronary dissection of the ramus intermedius and the circumflex, posterior to the first obtuse marginal artery. Cardiothoracic surgery considered intervention with a coronary bridge posterior to the dissection of the intermedius ramus artery, marginal obtuse and posterolateral artery, as well as a mitral valve replacement and a tricuspid valve repair. Coronary dissection is more common in women (70%), clinical presentation varies from unstable angina to sudden death. In lupus nephritis, it is an uncommon form of extra renal vasculitis. Treatment depends on the number of arteries affected, as well as the haemodynamic state of the patient. It is imperative to individualize treatment options.
Abstract Se presenta el caso de una paciente de 29 años con antecedente de lupus eritematoso sistémico diagnosticado 15 años antes, que desarrolló nefropatía lúpica actualmente en diálisis peritoneal, cuadro de miopericarditis en 2012 y bajo tratamiento inmunosupresor. Inició con deterioro de su clase funcional por disnea y angina 2 semanas previas al ingreso. Se le realizó ecocardiograma, el cual reportó insuficiencias mitral y tricuspídea graves. Posteriormente presentó angina en reposo asociada a descarga adrenérgica y vagal. A su ingreso se descarta actividad lúpica por reumatología. Por presentación clínica, cambios en electrocardiograma y biomarcadores, se realizó cateterismo cardiaco, que reportó enfermedad coronaria trivascular con ectasia coronaria Markis I y disección coronaria de ramo intermedio y circunfleja posterior a la primera marginal obtusa. Se consideró por el servicio de cirugía cardiotorácica realizar intervención con puente coronario posterior a disección del ramo intermedio, marginal obtusa y posterolateral, así como cambio valvular mitral y plastia tricuspídea. La disección coronaria espontánea es más frecuente en las mujeres (70%); puede presentarse como angina inestable y hasta como muerte súbita. La asociación con lupus eritematoso sistémico es poco frecuente, con una incidencia del 0.42%. En la nefropatía lúpica es una manifestación poco frecuente de vasculitis extrarrenal. El tratamiento de elección depende del número de vasos afectados y del estado hemodinámico, por lo que es necesario individualizarlo para cada paciente.
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Humanos , Feminino , Adulto , Doenças Vasculares/congênito , Anomalias dos Vasos Coronários/etiologia , Lúpus Eritematoso Sistêmico/complicações , Doenças Vasculares/etiologiaRESUMO
Our society has become fully submersed in fourth generation (4G) technologies, setting constant connectivity as the norm. Together with self-driving cars, augmented reality, and upcoming technologies, the new generation of Internet of Things (IoT) devices is pushing the development of fifth generation (5G) communication systems. In 5G architecture, increased capacity, improved data rate, and decreased latency are the objectives. In this paper, a measurement campaign is proposed; we focused on studying the propagation properties of microwaves at a center frequency of 3.5 GHz, commonly used in 5G cellular networks. Wideband measurement data were gathered at various indoor environments with different dimensions and characteristics. A ray-tracing analysis showed that the power spectrum is dominated by the line of sight component together with reflections on two sidewalls, indicating the practical applicability of our results. Two wideband parameters, root mean square delay spread and coherence bandwidth, were estimated for the considered scenarios, and we found that they are highly dependent on the physical dimension of the environment rather than on furniture present in the room. The relationship between both parameters was also investigated to provide support to network planners when obtaining the bandwidth from the delay spread, easily computed by a ray-tracing tool.
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INTRODUCTION: The goal of conservative surgical treatment of laryngeal cancer is to obtain oncological control with preservation of laryngeal function. The concept of laryngeal function preservation should be understood as the preservation of the patient's ability to breathe normally with neither tracheostomy nor aspiration, and maintaining intelligible speech. This can be achieved by a balance between two fundamental aspects, proper patient selection (based on tumour extension and preoperative laryngeal function), and an adequate histopathological analysis of the surgical specimen. Supracricoid subtotal laryngectomy is the voice conservative surgical technique that offers the best possibility of control in patients with locally advanced laryngeal cancer. The proper histopathological analysis allows staging and selecting patients for adjuvant therapy, avoiding unnecessary ones as well as designing monitoring and surveillance programs based on risk factors. OBJECTIVE: To highlight key points in the histopathological evaluation of the surgical specimen of a subtotal laryngectomy. CONCLUSION: The proper communication between the surgeon and pathologist, offering complete information on preoperative clinical evaluation and the knowledge of the key points in the evaluation of the surgical specimen (sites of tumour leakage and surgical resection margins) are fundamental parameters to achieve a proper histopathological evaluation of the surgical specimen.
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Neoplasias Laríngeas/patologia , Laringectomia/métodos , Laringe/patologia , Patologia Clínica/métodos , Humanos , Comunicação Interdisciplinar , Neoplasias Laríngeas/cirurgia , Oncologia , Gradação de Tumores , Invasividade Neoplásica , Tratamentos com Preservação do Órgão , Otolaringologia , Equipe de Assistência ao Paciente , Seleção de Pacientes , Manejo de Espécimes , Prega VocalRESUMO
The purpose of conservative surgical treatment of laryngeal cancer is to obtain cancer control with preservation of laryngeal function, and in turn, the preservation of laryngeal function should be understood as the preservation of the patient's ability to ventilate in the normal way without tracheostomy and without aspiration and maintaining intelligible speech. This objective is achieved by maintaining a balance between two fundamental aspects: proper patient selection (based on tumor extension and preoperative laryngeal function) and an adequate histopathological analysis of the surgical specimen. Supracricoid subtotal laryngectomy (SCSL) is the voice conservative surgical technique which offers the best possibility of control in patients with locally advanced laryngeal cancer, and the proper histopathological analysis allows staging and selecting patients eligible for adjuvant therapy, avoiding unnecessary therapies, and allows design of a monitoring and surveillance program based on risk factors. The aim of this manuscript is to highlight key points in the histopathological evaluation of the surgical specimen of SCSL. The proper communication between the surgeon and pathologist, offering complete information on preoperative clinical evaluation and the knowledge of the key points in the evaluation of the surgical specimen (sites of tumor leakage and surgical resection margins) are fundamental parameters to achieve a proper histopathologic evaluation of the surgical specimen.