Utilidad de la histerosalpingografía como método diagnóstico en la infertilidad / Usefulness of hysterosalpingography in diagnosis in infertility

Objetivo: presentar una base a nuestra experiencia el estado actual de la histerosalpingografía (HSG) discutiendo las diferentes metodologías utilizadas y los hallazgos relacionados con anormalidades tanto a nivel uterino como de las trompas de Falopio. Material y Métodos: Estudiamos 256 pacientes consecutivas desde Julio de 2004 a Mayo de 2007 con edad media de 32.3 años en los días 7 a 10 del ciclo menstrual. Se colocó espéculo y luego de la higiene y antisepsia de la cavidad vaginal se utilizó pinza listerina para la fijación uterina y se administró material de contraste iodado a la cavidad uterina a través de cánula de Rubistein con oliva plástica bajo control radioscópico. Se obtuvieron incidencias radiográficas digitales en decúbito dorsal con relleno parcial, total y ambas oblicuas. Luego de las mismas se realizó la prueba de Cotte. Resultados: En 7 casos no se pudo realizar el estudio por incapacidad de canular el orificio cervical externo. En los demás estudios los resultados fueron clasificados en normales, defectos de relleno intrauterinos, adenomiosis, anomalías mûllerianas, hidrosálpinx, espasmos tubario, obstrucción tubaria, prueba de Cotte positiva o negativa uni o bilateral y sospecha de adherencias pelvianas o masas anexiales acorde a la distribución del material de contraste en la cavidad abdominal. Conclusión: La HSG sigue siendo e la actualidad el estudio de elección para la valoración de las trompas de Falopio y también de gran utilidad para la evaluación interna de la cavidad uterina. Hemos evidenciado un incremento paulatino de las pacientes que se someten a este tipo de estudio proporcional al desarrollo de nuevas metodologías terapéuticas médicas y quirúrgicas para el tratamiento de la infertilidad.

Purpose: To show our experience related to the actual state of the hysterosalpingography including techniques and findings that compromise the uterus and the Fallopian tubes. Material and Methods:We have studied 256 patients from July 2004 till May 2007 with a media of 32.3 years of age, between the days 7 and 10 of the menstrual cycle. We have used an speculum, cleaned the vaginal cavity and afteruterus fixation, the contrast material have been introduced through a Rubistein canula with a plastic olive. We have obtained radiographs in different positions such as partial and full filled endometrial cavity, both oblique incidences and post Cotte test. Results: In 7 cases we couldn´t perform the study because of tiny external cervical orifice. In the rest of the patients thefindings have been classified in normal, uterine filling defects, adenomyosis, müllerian anomalies, hydrosalpinx, tubalspasm, tubal obstruction, positive or uni o bilateral negative Cotte test, and peritoneal or anexial masses suspicion.Conclusion: The HSG is the elective study for the study of the Fallopian tube and have great utility to evaluate theendometrial cavity. We have observed an increase in the number of patients that go through this study related to thedevelopment of new therapeutical strategies (medical or surgical) for the treatment of infertility.

Colonic adenomas: prevalence and incidence rates, growth rates, and miss rates at colonoscopy.

Cost-effective use of colonic imaging studies can be achieved through an understanding of the prevalence, incidence, growth, and miss rates of colon adenomas. High adenoma prevalence rates are associated with increasing age, male gender, and a family history of colorectal cancer or multiple first-degree relatives with colorectal neoplasia or neoplasia diagnosed at a young age. The incidence rate of advanced adenomas is higher in patients with multiple adenomas and is likely also associated with a family history of colorectal cancer, increased age, and large adenoma size at the index examination. Direct observational data on growth rates suggests that adenomas <1 cm in size have a fairly stable size over a 3-year interval. Although colonoscopy is the most sensitive colonic imaging study, substantial miss rates for small adenomas are inherent to the procedure. Advancements in endoscopic technology should lead to reduced miss rates, allowing expansion of intervals between examinations while reducing negative outcomes of fatal interval cancers.

Induced nitric oxide inhibits IL-6-induced stat3 activation and type II acute phase mRNA expression.

Inducible nitric oxide synthase (iNOS) can be coexpressed with acute phase reactants in hepatocytes; however, it is unknown if NO can regulate the acute phase response. We tested the hypothesis that iNOS-derived nitric oxide (NO) attenuates the acute phase response by inhibiting IL-6-enhanced Stat3 DNA-binding activity and type II acute phase mRNA expression. iNOS was overexpressed in cultured rat hepatocytes via transduction with a replication defective adenovirus containing cDNA for human iNOS (AdiNOS), and Stat3 DNA-binding activity was determined by electrophoretic mobility shift assay (EMSA). EMSAs demonstrated that AdiNOS inhibits IL-6-induced Stat3 activation and that this inhibition is reversible in the presence of the NOS inhibitor N(G)-monomethyl-L-arginine (L-NMA). The induction of beta-fibrinogen mRNA by IL-6, a Stat3 dependent process, is attenuated in AdiNOS-transduced cells and partially reversed by L-NMA. Thus, iNOS overexpression suppresses IL-6-induced Stat3 activation and type II acute phase mRNA expression in cultured hepatocytes. This suppression may represent a mechanism by which NO down-regulates the acute phase response.

Outcome analysis of external coloanal anastomosis.

BACKGROUND: To evaluate the safety and efficacy of treating low-lying rectal lesions with resection and primary repair using a pull-through technique with rectal stump eversion and external coloanal anastomosis with immediate reintroduction into the pelvis. METHODS: All coloanal anastomoses with the above technique on the Gastrointestinal Surgery Service at the University of Pittsburgh from March 1990 to September 1995 were evaluated. RESULTS: Fifty-two patients underwent coloanal anastomoses with the above technique, and follow-up was available for 96% (50 of 52) of patients. Rectal lesions in the 50 patients included cancer (n = 34), rectal adenomas (n = 13), and other lesions (n = 3). Mean follow-up period was 29.6 +/- 21.8 months (28.5 months for patients with carcinoma). Fecal continence was normal or good in 88% (44 of 50) of patients. Moderate or complete incontinence was present in 12% (6 of 50) of patients. The local recurrence rate of rectal cancer was 0%. Morbidity occurred in 22% (11 of 50) of patients. Survival was 90% (45 of 50 patients). CONCLUSIONS: Coloanal anastomosis with this technique provides effective treatment for low-lying malignant or benign rectal lesions and has an acceptable complication rate.

Analysis of laparoscopy in trauma.

BACKGROUND: The optimum roles for laparoscopy in trauma have yet to be established. To date, reviews of laparoscopy in trauma have been primarily descriptive rather than analytic. This article analyzes the results of laparoscopy in trauma. STUDY DESIGN: Outcome analysis was done by reviewing 37 studies with more than 1,900 trauma patients, and laparoscopy was analyzed as a screening, diagnostic, or therapeutic tool. Laparoscopy was regarded as a screening tool if it was used to detect or exclude a positive finding (eg, hemoperitoneum, organ injury, gastrointestinal spillage, peritoneal penetration) that required operative exploration or repair. Laparoscopy was regarded as a diagnostic tool when it was used to identify all injuries, rather than as a screening tool to identify the first indication for a laparotomy. It was regarded as a diagnostic tool only in studies that mandated a laparotomy (gold standard) after laparoscopy to confirm the diagnostic accuracy of laparoscopic findings. Costs and charges for using laparoscopy in trauma were analyzed when feasible. RESULTS: As a screening tool, laparoscopy missed 1% of injuries and helped prevent 63% of patients from having a trauma laparotomy. When used as a diagnostic tool, laparoscopy had a 41% to 77% missed injury rate per patient. Overall, laparoscopy carried a 1% procedure-related complication rate. Cost-effectiveness has not been uniformly proved in studies comparing laparoscopy and laparotomy. CONCLUSIONS: Laparoscopy has been applied safely and effectively as a screening tool in stable patients with acute trauma. Because of the large number of missed injuries when used as a diagnostic tool, its value in this context is limited. Laparoscopy has been reported infrequently as a therapeutic tool in selected patients, and its use in this context requires further study.

Analysis of thoracoscopy in trauma.

BACKGROUND: The role of video-assisted thoracic surgery (VATS) in trauma has yet to be established. Up to the time of this writing, reviews of thoracoscopy in trauma have been primarily descriptive rather than analytic. This article analyzes the results of thoracoscopy (nonvideo and VATS) in trauma. METHODS: Analysis was done by reviewing 28 nonoverlapping studies since the introduction of thoracoscopy in 1910, with a combined total of more than 500 patients. RESULTS: Diagnostically, thoracoscopy has been used primarily to evaluate diaphragmatic injury, continued chest tube bleeding, and suspected cardiac injury. Thoracoscopy has a 98% (188/191 patients) accuracy rate in diagnosing diaphragmatic injuries. Therapeutically, thoracoscopy has been used primarily to control chest tube bleeding, evacuate retained hemothoraces, and evacuate empyemas. Thoracoscopy is 90% (89/99 patients) effective in evacuating retained hemothoraces, 86% (19/22 patients) effective in evacuating empyemas, and 82% (33/40 patients) effective in controlling chest tube bleeding. Thoracoscopy benefits include preventing 62% (323/514) of trauma patients from having a thoracotomy or laparotomy. Risks include a 2% (11/534 patients) procedure-related complication rate and a 0.8% (4/471 patients) missed injury rate. Technical failure rates are 10% (10/99 patients) and 4% (7/199 patients) in evacuation of retained hemothoraces and evaluation of diaphragmatic injuries, respectively. CONCLUSIONS: Analysis suggests that thoracoscopy (nonvideo and VATS) can be applied safely and effectively in the care of the injured patient.

Pulmonary tractotomy as an abbreviated thoracotomy technique.

BACKGROUND: Operative abbreviated thoracotomy techniques in thoracic trauma include emergency center thoracotomy, ligation of major arterial branches, packing the thoracic cavity for diffuse bleeding, towel clip or Bogota bag closure of the chest, and pulmonary tractotomy. Pulmonary tractotomy with selective vascular ligation was originally described for deep through-and-through lung injuries that did not involve hilar vessels or airways. Pulmonary tractotomy has evolved into use as an abbreviated thoracotomy technique in patients with severe thoracic or multivisceral trauma. As with any operative technique in high-risk patients, specific procedure-related complications may occur and are analyzed herein. The objective of this manuscript is to review the indications, techniques, and results for pulmonary tractotomy in trauma patients requiring abbreviated thoracotomy. METHODS: Medical records were retrospectively reviewed for 30 of 32 consecutive tractotomy patients treated at Ben Taub General Hospital, during a 3-year period. By using a model for logistic regression analysis, the characteristics of each patient and their clinical course were tested for impact on mortality. RESULTS: Seventy percent of patients had at least one intraoperative parameter indicative of acidosis (pH < 7.2), coagulopathy (prothrombin time > 13.8 or partial thromboplastin time > 38.0 seconds), or hypothermia (core temperature < 34 degrees C), and 50% of patients manifested two of these three parameters. The mortality rate among the 30 patients was 17%. Three of the five patients who died were noted to be acidotic, coagulopathic, and hypothermic. Twelve of 25 patients who survived more than 1 day had at least one thoracic complication. There were no late deaths. There was one failed tractotomy and one missed injury. A second thoracotomy was not required for control of a lung injury in any patient. Logistic regression analysis showed that intraoperative blood loss was the only predictive factor for mortality. CONCLUSION: Pulmonary tractotomy is a simple and effective technique in injured patients who require an abbreviated thoracotomy and has an acceptable mortality and complication rate. This follow-up report notes that as definitive therapy, tractotomy continues to allow for direct control of bleeding and air leak and obviates the need for formal resection.

[The no-reflow phenomenon: its incidence and clinical characteristics in a series of cases]. / Fenómeno de no-reflujo: incidencia y características clínicas en una serie de casos.

The no-reflow phenomenon refers to the inability to reperfuse myocardial tissue despite removal of an occlusion of a coronary artery. No reflow is a complication that may occur after revascularization of patients. This study examined the incidence and, clinical characteristics of no-reflow in a patient population treated with conventional percutaneous transluminal coronary angioplasty at the Instituto Nacional de Cardiología "Ignacio Chávez". We reviewed 204 elective angioplasties and 62 direct angioplasties; 14 patients were included (4 from the first group and 10 from the second group). No-reflow were more frequently in men, the mean age was 56 years and diabetes and smoking were the risk factors more frequently reported. No-reflow was found in left anterior descending coronary artery in 7 patients, the time of reperfusion, in direct angioplasty, was 10.6 hours (mean) and the strategy most frequently used to reestablish normal anterograde flow was intracoronary verapamil. The overall incidence of no-reflow for the two modalities was 5.2% (16.12% for direct angioplasty and 1.9% for elective angioplasty). The current study shows that the no-reflow phenomenon is not uncommon after angioplasty; no-reflow appears higher than the previous reports for both modalities of treatment.

[Late thrombolysis and electrical stability in acute myocardial infarction. Role of the collateral flow]. / Trombolisis tardía y estabilidad eléctrica en el infarto agudo del miocardio: importancia del flujo colateral.

We evaluated 249 patients (pts) with first acute myocardial infarction: 1. Pts without thrombolysis, n = 119, 2. Pts treated with thrombolysis within 6 hours following MI, n = 80 and 3. Pts treated with thrombolysis between 6-12 hours after MI. Arrhythmic events were evaluated during follow up. All underwent heart rate variability studies and coronary angiogram where anterograde flow (TIMI) and collateral flow (Rentrop scale 0-2 = poor collateral flow and 3 = good collateral flow) were determined. Pts in group 2 and 3 showed a better anterograde and collateral flow than group 1 (p < 0.001). A lower spectral power in the high frequency band and a higher ratio low/high frequency band were observed in group 1 (p < 0.05). Conjunctive consolidation analysis showed more malignant arrhythmias in TIMI 0-2 with poor collateral flow than TIMI 0-2 with good collateral flow (17/138-12.3% vs 0/14-0%). Kaplan Meier analysis was able to demonstrate more cardiac sudden death events in TIMI 0-2 with poor collateral flow than TIMI 0-2 with good collateral flow or TIMI 3 (x2 = 7.22, p = 0.028), independently of thrombolytic treatment.

Niveles lipídicos y calcificaciones coronarias detectadas por radioscopia con intensificador de imágenes TV en una población asintomática / Lipidic levels and fluoroscopyc detection of coronary artery calcification in asymptomatic subjects

Es sabido que la detección precoz de la arterosclerosis coronaria disminuye el riesgo de infarto. Con tal motivo se estudiaron 104 pacientes, de 52 años de edad promedio, mediante radioscopia TV. De acuerdo a los resultados de la calcificación coronaria CC y al número de territorios involucrados se clasificaron los pacientes en varios grupos, concluyendo que la radioscopia TV es un método de alta sensibilidad, bajo costo, rapidez y seguridad para la detección de CC

Urografía por RM: un método alternativo en la evaluación en pediatría del aparato urinario / MR urography: imaging alternative procedure of the urinary tract in childhood

Tomando como base las secuencias conocidas como RARE, las RM urográficas, se ha planteado como un método alternativo en la evaluación del aparato urinario. Se evaluaron 16 pacientes pediátricos, 11 niñas y 5 varones, con edades entre 4 meses y 14 años. Se investigaron: a) dilatación de la vía excretora, (6 pacientes); b) evaluación de estenosis pieloureterales, 2; c) evaluación postquirúrgica de estenosis pieloureterales, 1; d) riñón en herradura, 1; e) doble vía excretora, 3; f) en reemplazo de U.E., 2 y g) síndrome de regresión caudal, 1 paciente. Se evaluaron en forma adecuada las uropatías obstructivas, determinándose en forma exacta el punto de obstrucción, no así su causa; se logró con las imágenes obtenidas, adecuada discriminación anatómica córtico medular; también fueron satisfactorios los resultados en la evaluación de malformaciones del tipo riñón en herradura y síndrome de regresión caudal. Contrariamente no fueron buenos los resultados en la evaluación de la vía excretora. En conclusión, la RM urográfica actualmente puede ser considerada, un método válido para el estudio del tracto urinario, llegando a reemplazar al U.E. en situaciones específicas; las principales objeciones al método son su costo, las dificultades que presenta en la evaluación de vía excretora no dilatada y la necesidad de anestesiar a los menores de 5 años

Carcinoma hepatocelular: diagnóstico imagenológico y relación entre las características tumorales y parámetros clínicos de los pacientes / Hepatocellular carcinoma diagnostic imaging with clinical and pathologic correlation

La distribución geográfica del hepatocarcinoma (HCC) es bien conocida como así también su relación con la enfermedad cirrótica y sus causas (hepatitis viral B, C y hepatitis alcohólica). Existen muy pocos trabajos científicos en poblaciones no asiáticas y en especial de nuestro país. El objetivo de este trabajo es determinar las características imagenológicas del HCC en nuestra población (US, TC, RM), establecer si existe relación o no entre tamaño tumoral y cirrosis con el número y localización de las lesiones, edad y sexo de los pacientes, niveles de alfafetoproteína, la presencia de hepatopatía crónica, ascitis, e hipertensión portal. Se estudiaron 30.566 pacientes por trastornos abdominales a los cuales se realizaron 40.769 estudios por imágenes. Se detectaron 84 pacientes con HCC confirmados por anatomía patológica

The pathogenesis of Staphylococcus aureus in the trauma patient and potential future therapies.

BACKGROUND: Staphylococcus aureus is the most frequently isolated pathogen in the trauma patient and uses multiple virulent factors to cause infection. At the cellular level, infection begins with the prokaryotic bacterial cell manipulating the eukaryotic host cell through its virulent factors. Researching this cellular interaction by describing the mechanisms of actions of various virulent factors may lead to new preventive therapies which will make the trauma patient less susceptible to S aureus infections. METHODS: Surgical, medical, and microbial literature was reviewed to provide an update on S aureus pathogenesis. RESULTS: Novel future therapies, in addition to antibiotics, are being devised based on understanding the molecular nature of S aureus pathogenesis. CONCLUSION: The impact of S aureus on trauma will increase as S aureus develops more antibiotic resistance and as the trauma population becomes older and includes an increasing proportion of immunocompromised patients. To meet the challenge of increased virulence, trauma surgeons should be directly involved in the research of microbial pathogenesis.

Pancreatitis crónica cefálica / Cephalic chronic pancreatitis

La mayoría de las pancreatitis producen un agrandamiento glandular difuso, sin embargo la ecografía (ECO) y la tomografía axial computada (TC) pueden mostrar masas inflamatorias focales, indistinguibles del adenocarcinoma ductal. La colangiografía retrógrada endoscópica (CPER) puede poner en evidencia obstrucción completa del conducto de Wirsung y de la vía biliar haciendo el diagnóstico erróneo de carcinoma de páncreas. Se estudiaron 3 pacientes con sospecha de enfermedad pancreática que fueron examinados mediante ECO, TC y CPER. Dos de las pacientes fueron sometidas a cirugía mientras que a la paciente restante se le realizó una punción biopsia percutánea. Se concluye que las masas inflamatorias del páncreas no siempre pueden ser distinguidas de los carcinomas mediante los diferentes métodos por imágenes. La clínica del paciente puede ser la ayuda pero no siempre existen los antecedentes de alcoholismo. La punción biopsia dirigida por ECO o TC establece el diagnóstico

Angioma hepático: características ecográficas, tomográficas y por resonancia magnética / Hepatic angioma: US, CT and MR features

El hemangioma hepático es el tumor benigno más frecuente del hígado. El propósito de nuestro trabajo es presentar las características por Eco, TC y RM del angioma hepático en 791 pacientes, analizar las características imagenológicas de los angiomas gigantes y realizar un seguimiento de estas lesiones por Eco durante 6 a 48 meses. Los angiomas hepáticos presentaron un patrón ecográfico hiperecogénico en el 93,2 por ciento, tomográficamente el 100 por ciento de las lesiones fueron hipodensas sin contraste e hiperdensas en el 99,7 por ciento tras la administración de contraste, en RM el 92,5 por ciento de los tumores fue hipointensa en T1 y el 91,3 por ciento hiperintensa en T2. El éxito de la TC estuvo sujeto al tamaño de la lesión, la posibilidad de administrar contraste E.V., la colaboración del paciente y de la buena realización de la técnica de angioscan. Los angiomas gigantes presentaron características imagenológicas similares a las restantes lesiones. Los angiomas no sufren modificaciones en su tamaño y en sus características ecográficas en un período de tiempo determinado, por lo cual en un contexto clínico adecuado el seguimiento ecográfico periódico es innecesario

Linfangioma quístico del páncreas / Cystic lymphangioma of the pancreas: US, CT and MR findings

Los linfangiomas quísticos del páncreas (LQP) son considerados como lesiones malformativas clasificadas como alteraciones de tipo hamartomatoso. Muy pocos casos se han comunicado en la literatura. Presentamos dos pacientes con LQP confirmada mediante cirugía y una revisión de la literatura

Tumores quísticos del páncreas: diagnóstico y tratamiento a propósito de 24 casos: Tercer premio en el xiii Congreso Argentino de Radiología / Cystic tumors of the pancreas: Third price at the xiii th Argentine Congress of Radiology

Se evaluó el impacto de los nuevos métodos diagnósticos por imágenes y el resultado de las intervenciones quirúrgicas en los pacientes con tumores quísticos del páncreas. Se estudiaron 24 pacientes, 3 hombres y 21 mujeres, con una edad promedio de 45 años (rango 16-81), tratados desde 1980 a 1992. Dentro de los tumores quísticos se presentaron 16 cistadenomas mucinosos de los cuales 8 fueron benignos y 8 presentaron degeneración maligna; 5 cistoadenomas serosos, 2 neoplasias quísticas papilares y un cistoadenoma mucinoso ducto-ectático. Los 24 pacientes tuvieron cirugía y confirmación anatomopatológica. En un caso se realizó punción biopsia percutánea. A todos los pacientes se les realizó ecografía (US) y tomografía axial computada (TAC). A tres pacientes se les realizó estudios angiográficos, a uno colangipancreatografía retrógrada por vía endoscópica y a cuatro resonancia magnética por imágenes (RM). El estudio de CPER contribuyó en el diagnóstico de cistoadenoma ductoectático el cual comprometía la región del proceso uncinado del páncreas. todos los pacientes fueron sometidos a intervenciones quirúrgicas. Se realizó técnica de Whipple en 6 pacientes (3 con preservación pilórica). En 17 pacientes se efectuó pancreatectomía distal o izquierda y en un caso se realizó resección local. No hubo mortalidad postoperatoria. Nuestra experiencia sugiere que los métodos diagnósticos actuales, en particular la US,TC y la RM, ayudan a diferenciar las neoplasias quísticas de los tumores sólidos, pseudoquistes y quistes de retención. Además estos estudios muestran características que distinguen los tumores mucinosos de los serosos y ocasionalmente sugieren la presencia de malignidad. La aspiración citológica y la biopsia parcial de la pared no son suficientes para establecer el diagnóstico en los tumores mucinosos ya que la degeneración maligna puede ser pequeña y no detectable por los métodos de imágenes. La resección es la terapia de elección que puede realizarse con una morbi-mortalidad mínima y la mayor probabilidad de cura

Patrones radiológicos pronósticos del callo de elongación / Radiological patterns that forecast the bone elongation

Realizamos un estudio retrospectivo sobre 127 elongaciones óseas efectuadas en nuestro Depto de Diagnóstico por Imágenes y Ortopedia y Traumatología. El objetivo del trabajo fue poder establecer diferentes patrones radiológicos del foco de elongación, entre los 40 y 60 días de la misma y valorar su repercusión sobre la calidad final del hueso neoformado. La etiología más frecuente fue la acondroplasia, seguida en orden por el síndrome de Turner, postraumático, raquitismo hipofosfatérmico, displasias óseas, secuelas de polio, sepsis de cadera y la enfermedad de Ollier. Los patrones radiológicos se dividieron en dos grupos, metafisarios y diafisarios,según fuese el sitio de realizada la osteotomía percutánea. Dentro de los metafisarios encontramos cuatro patrones radiológicos: fusiforme, en bosque de abedules, excéntrico e hipotrófico. En los diafisarios observamos siete patrones: en bosque de abedules, fusiforme, fusiforme discontinuo, lacunar, en reloj de arena e hipotrófico. Concluimos que en aquellos casos en los cuales encontramos patrones radiológicos en bosque de abedules, fusiforme, fusiforme discontinuo o lacunar, se observó un mejor índice de elongación y una mejor calidad de hueso neoformado. El patrón excéntrico o en reloj de arena necesitó un tratamiento más prolongado (mayor índice de elongación). Ante un patrón hipotrófico se debió efectuar ejercicio del callo de elongación o el aporte de injerto óseo

[Coronary angioplasty in patients not accepted for surgical treatment. The initial experience of the Ignacio Chávez Instituto Nacional de Cardiología]. / Angioplastía coronaria en pacientes no aceptados para tratamiento quirurgico. Experiencia inicial del Instituto Nacional de Cardiología "Ignacio Chávez".

Coronary angioplasty has shown its efficacy in "high-risk" patients for surgical treatment (severe left ventricular failure, serious pulmonary or systemic disease). We studied a subgroup with multivessel coronary heart disease treated with coronary angioplasty because they were no candidates for surgery due to unsuitable coronary anatomy. Revascularization rate was determined in each patient as revascularization percentage obtained, compared with all the technically suitable lesions for coronary angioplasty. Ten patients (mean age 63 years) were studied, eight of them had unstable angina. Overall, 44 lesions were considered technically suitable for angioplasty and thirty-five could be dilated, technical success rate was 88% (31/35 lesions) and revascularization rate was 71% (31/44 lesions). Primary success rate was achieved in nine patients. Clinical follow-up varied from two to thirteen months (mean 7.8 months); eight patients have remained asymptomatic (class I of NYHA), another patient had stable angina and the other one had sudden death six months after the procedure. In conclusion, we demonstrated a high success rate in a short and long term with coronary angioplasty in a subgroup of patients with multivascular coronary heart disease that had been rejected for surgery due to unsuitable coronary anatomy.