Utilidad de la gasometría capilar para evaluar el intercambio gaseoso con FiO2 al 21% y al 100% en el sujeto con enfermedad cardiopulmonar estable a 2, 240 metros sobre el nivel del mar / Capillary blood gas test usefulness to evaluate gas exchange with 21% and 100% of oxygen inspired fractions in subjects with stable cardiopulmonary disease at 2, 240 meters above sea level

OBJECTIVE: Capillary blood gas test has had ample use in the infantile population. In the adult population, the information is limited and controversial. The agreement between capillary-arterial gases seems to parallel the pH and the carbon dioxide pressure in different studied populations. In order to know the degree of agreement between these gases, we evaluate them at breathing room air and at 100% of oxygen fractions at 2,240 meters above sea level. METHODS: We obtained capillary-arterial blood gases simultaneously from subjects with stable cardiopulmonary disease in both conditions of inspired oxygen. Demographic, hemodynamic, diagnostic, and laboratory variables were gathered. Statistical analysis: agreement was analyzed with the intraclass correlation coefficient and the Bland-Altman procedure. RESULTS: We studied 101 subjects, 48 men and 53 women, whose respective ages were 55 +/- 16 and 56 +/- 16. Mean systemic arterial pressure was 94.96 +/- 10.57 mmHg. Hemoglobin was 15.94 +/- 2.48 g/dl. The agreement between the variables with the inspired oxygen fractions, 21%, 100%, and the mean difference in parenthesis was respectively: potential hydrogen, 0.94 (0.0091), 0.94 (0.0039); oxygen pressure, 0.90 (2.94), 0.84 (74.99); carbon dioxide pressure, 0.97 (0.079), 0.97 (0.179); bicarbonate, 0.93 (-0.067), 0,96 (0.262); total dissolved carbon dioxide, 0.94 (-0.142), 0.93 (0.161); base excess: 0.94, (-0.125), 0.92 (0.235); oxygen saturation, 0.98 (0.764), 0.97(0.202). CONCLUSIONS: Capillary blood gas test could be a useful alternative to the arterial one, nevertheless, it is limited by its low agreement with the oxygen pressure in both oxygen inspired fractions.

Modificación de un dispositivo hidráulico para el bandaje controlado del tronco de la arteria pulmonar en caninos / Modification of a hydraulic device for controlled banding of the trunk of the pulmonary artery in dogs

Diversas enfermedades congénitas o adquiridas incrementan la presión sistólica del ventrículo derecho. Este incremento se ha realizado con el bandaje del tronco arterial pulmonar con cintas de lino o dispositivos hidráulicos. Presentamos un nuevo dispositivo hidráulico para ser usado en sujetos experimentales menores a 15 kilogramos. Material y métodos: Se realizó una fase experimental de laboratorio donde los dispositivos hidráulicos fueron probados contra presiones hasta de 80 mm Hg; posteriormente se colocaron en el tronco de la arteria pulmonar de perros donde se les determinó la presión sistólica del ventrículo derecho, la de la arteria pulmonar y el gradiente de ambos. Los valores se expresaron en medias ± desviación estándar. Resultados: El peso de los perros fue 12.6 ± 2.2 kilogramos. El diámetro del tronco de la arteria pulmonar encontrado en los perros fue de 12.4 ± 1.4 mm y 27.5 ± 1.6 mm de largo. Las presiones sistólicas ventriculares derechas en condición basal y de máxima elevación fueron: 25.5 ± 1.9 mm Hg vs 50.3 ± 6.9 mm Hg, p < 0.0001; las presiones sistólicas de la arteria pulmonar para estas mismas condiciones fueron: 24.7 ± 2 mm Hg vs 21.5 ± 6.9 mm Hg, p < 0.043; y el respectivo gradiente de ambas para estas presiones fueron: 0.8 ± 1.4 mm Hg vs 28.8 ± 4.2 mm Hg, p < 0.0001. Conclusiones: El DH permite el incremento agudo controlado de la presión sistólica del ventrículo derecho.

Different congenital or acquired diseases increase the right ventricular systolic pressure. The elevation is achieved by pulmonary artery banding with linen tape or hydraulic devices. We introduce a new hydraulic device to be used in experimental subjects of less than 15 kilograms. Methods: An experimental laboratory phase was conducted. In this phase, the hydraulic devices were tested against pressures as high as 80 mm Hg; later on the hydraulic devices were placed on the dogs' main pulmonary artery; the right ventricular systolic pressure, pulmonary artery pressure, and their differences were obtained. The values are expressed in average ± standard deviation. Results: The average weight of the dogs was 12.6 ± 2.2 kg. The average diameter found in the main pulmonary artery was 12.4 ± 1.4 mm and 27.5 ± 1.6 mm length. Right ventricular systolic pressure of basal condition to maximum pressure obtained was 25.5 ± 1.9 mm Hg vs 50.3 ± 6.9 mm Hg, p < 0.0001; pulmonary artery pressures under the same conditions were 24.7 ± 2 mm Hg vs 21.5 ± 6.9 mm Hg, p < 0.043; and the differences between them were 0.8 ± 1.4 mm Hg vs 28.8 ± 4.2 mm Hg, p < 0.0001, developed by the hydraulic device respectively. Conclusions: The hydraulic device allows attaining a controlled acute increase in right ventricular systolic pressure.

Hipertensión ventricular derecha severa secundaria a obstrucción metastásica por hepatocarcinoma / Severe right ventricular hypertension secondary to metastatic obstruction due to hepatocarcinoma

La hipertensión ventricular derecha es una entidad esperada en enfermedades cardiopulmonares. La obstrucción mecánica del tracto de salida del ventrículo derecho es una de ellas. Presentamos el caso clínico de un paciente masculino de 69 años de edad con historia de hepatocarcinoma previamente tratado, quien presentó hipertensión ventricular derecha por obstrucción metastásica única al ventrículo derecho. El comportamiento clínico es de un síndrome de hipertensión venosa sistémica. Los estudios no invasivos, como el ecocardiograma y la tomografía axial computarizada la delimitaron. No se demostró actividad neoplásica o metástasis en otros órganos. La neoformación intra-ventricular derecha fue corroborada mediante cardio-angiografía y la biopsia tumoral confirmó el diagnóstico.

Right ventricular hypertension (RVH) is an entity that could be expected in various cardiopulmonary diseases. Mechanical obstruction to the right ventricle outflow tract is a cause of RVH. We present the case of a 69 year-old male with a history of hepatocarcinoma previously treated. The developed RVH due to mechanical obstruction secondary to metastatic infiltration of the right ventricle. The clinical syndrome was characterized by systemic venous hypertension. Non-invasive studies, such as electrocardiogram and computed tomography scan limited the metastasis to the right ventricle; the diagnosis was confirmed by cardio-angiography and endocardial biopsy. The studies did not demonstrate neoplastic activity at any other level. (Arch Cardiol Mex 2005; 75: 170-177).

Síndrome de embllia grasa secundaria a inyección intramuscular de material oleoso

La embolia grasa describe la presencia de grasa en la circulación sanguínea, asociado o no al desarrollo de un síndrome clínico identificable por sus signos y síntomas. Puede ser secundaria a traumatismos, cirugía ortopédica, causas no traumáticas y al uso de sustancias y procedimientos con fines estéticos. Presentamos el caso clínico de una mujer que desarrolló el síndrome de embolia grasa después de la inyección de una sustancia oleosa en ambos glúteos, con fines estéticos. Hubo manifestaciones clínicas del aparato respiratorio, del sistema nervioso central y hematológicos. El diagnóstico fue establecido por los criterios clínicos de Gurd y Lindeque. La paciente presentó el síndrome de dificultad respiratoria del adulto por lo que requirió de ventilación mecánica. La evolución fue hacia la mejoría, y egresó del hospital con recuperación completa de sus funciones, que ha mantenido durante un año.

The term fat embolism refers to the presence of fat droplets in the circulation; patients can be asymptomatic or present with a full blown clinical syndrome. Fat embolism can develop after trauma, orthopedic surgery and cosmetic procedures. We present the case of a 15-year-old female that developed the fat embolism syndrome after a single intra-muscular injection in each buttock of an oily substance, for cosmetic reasons. The clinical picture was associated with respiratory failure, neurological impairment and blood abnormalities. The diagnosis was established according to the Gurd and Lindeque criteria. The patient developed the acute respiratory distress syndrome and required mechanical ventilation. The patient had a complete recovery and is without any sequelae after a one-year follow up.