Resección por videotoracoscopía de nódulos pulmonares marcados con lipiodol: experiencia en dos centros universitarios / Videotoracoscopy resection of pulmonary nodules marked with lipiodol: experience in two university centers

INTRODUCCIÓN: Para facilitar la localización intraoperatoria de los nódulos pulmonares existe la alternativa de marcarlos previamente con lipiodol. OBJETIVO: Describir los resultados quirúrgicos de los pacientes sometidos a resección por videotoracoscopía de nódulos pulmonares marcados previamente con lipiodol. MATERIAL Y MÉTODOS: Estudio descriptivo. Se incluyeron los pacientes que fueron sometidos a resección por videotoracoscopía de nódulos pulmonares marcados con lipiodol, en Clínica Las Condes e Instituto Nacional del Tórax, entre junio de 2012 y junio de 2019. Se consideraron variables demográficas, radiológicas, quirúrgicas e histológicas. RESULTADOS: Se estudió un total de 93 pacientes. La edad promedio fue 63,5 (± 11,9) años. El tamaño promedio de los nódulos fue de 10,7 (± 5,8) mm. Se identificó y extrajo el 100% de los nódulos marcados. Los días de hospitalización promedio fueron 4,7 (± 6,9). Solo se registró un fallecimiento de causa no quirúrgica. CONCLUSIONES: La resección videotoracoscópica de nódulos pulmonares marcados previamente con lipiodol, es una técnica segura y eficaz.

BACKGROUND: To facilitate the intraoperative location of lung nodules there is the alternative of pre-marking them with lipiodol. OBJECTIVE: To describe the surgical results of patients undergoing videotoracoscopy resection of pulmonary nodules previously marked with lipiodol. MATERIAL AND METHODS: Descriptive study. Patients who underwent videotorcoscopy resection of pulmonary nodules marked with lipiodol were included at Clínica Las Condes and Instituto Nacional del Tórax between June 2012 and June 2019. Demographic, radiological, surgical and histological variables were considered. RESULTS: A total of 93 patients were studied. The average age was 63,5 (± 11.9) years. The average size of the nodules was 10.7 (± 5.8) mm. 100% of the marked nodules were identified and extracted. The average hospitalization days were 4.7 (± 6.9). Only one death of non-surgical cause was recorded. CONCLUSIONS: Videotoracoscopic resection of pulmonary nodules previously marked with lipiodol is a safe and effective technique.

Implementation of the Integrated Care of Older People (ICOPE) App and ICOPE Monitor in Primary Care: A study protocol.

INTRODUCTION: The World Health Organization (WHO) has recently launched the term "intrinsic capacity", defined as "the composite of all the physical and mental capacities of an individual". Intrinsic capacity has a positive value towards healthy aging, and is constructed by five domains: cognition, vitality/nutrition, sensory, psychology, and mobility. ICOPE App and ICOPE Monitor are applications for the assessment (screening) of intrinsic capacity. HYPOTHESIS: Intrinsic capacity assessed by the ICOPE Apps at baseline could be associated with the incidence of frailty, functional decline, and health outcomes during 1-year follow-up. OBJECTIVES: To assess the association between intrinsic capacity measured by the ICOPE Apps at baseline and the incidence of frailty in community-dwelling older adults during 1-year follow-up. Secondarily, to assess the association of intrinsic capacity and functional decline, mortality, pre-frailty, falls, institutionalization, and quality of life. METHODS: Protocol for a cohort study of community-dwelling adults ≥65-year-old, with no other exclusion criteria than the inability to use the Apps or communicate by telephone/video-call for any reason (cognitive or limited access to telephone/video-call) OR being considered frail at baseline (defined as having a Rockwood's clinical frailty scale, CFS score ≥4). Intrinsic capacity measured by the ICOPE Apps and CFS will be assessed at baseline, 4-, 8- and 12-month follow-up by telephone/video-call. Assuming a prevalence of frailty of 10.7%, and incidence of 13% (alpha-risk=0.05), 400 participants at 12-month end-point (relative precision=0.10) and 600 participants at baseline will be required. RESULTS: Associations among the decrease in intrinsic capacity and higher risk of frailty, functional decline, and health adverse outcomes during 1-year follow-up are expected. CONCLUSIONS: ICOPE Apps might identify individuals at higher risk of frailty, functional decline, and health adverse outcomes. The implementation of the ICOPE Apps into clinical practice might help to deliver efficient person-centered care-plans, and benefit the healthcare systems.

Experiencia en trasplante pulmonar pediátrico en Chile / Experience with pediatric lung transplantation in Chile

El trasplante de pulmón (TP) es una opción para pacientes pediátricos con enfermedades pulmonares terminales. OBJETIVO: Evaluar resultados y sobrevida de pacientes pediátricos trasplantados de pulmón. MÉTODOS: Análisis retrospectivo de registros clínicos de pacientes TP ≤ 15 años de Clínica Las Condes. Se analizaron datos demográficos, tipo de trasplante, función pulmonar basal y post trasplante, complicaciones precoces y tardías y sobrevida. RESULTADOS: Nueve pacientes < 15 años de edad se han trasplantado. La edad promedio fue 12,7 años. La principal indicación fue fibrosis quística (7 pacientes). El IMC promedio fue de 17,6 y todos estaban con oxígeno domiciliario. El 77% utilizó soporte extracorpóreo intraoperatorio. Las principales complicaciones precoces fueron hemorragia y la disfunción primaria de injerto mientras que las tardías fueron principalmente las infecciones y la disfunción crónica de injerto. Cuatro pacientes han fallecido y la sobrevida a dos años fue de 85%. El trasplante les permitió una reinserción escolar y 3 lograron completar estudios universitarios. CONCLUSIÓN: El trasplante pulmonar es una alternativa para niños con enfermedades pulmonares avanzadas mejorando su sobrevida y calidad de vida.

Lung transplantation (TP) is a treatment option in children with terminal lung diseases. OBJECTIVE: To evaluate the results and survival of pediatrics lung transplant patients. METHODS: Retrospective analysis of clinical records of lung transplantation of patients ≤ 15 years from Clínica Las Condes, Santiago, Chile. Demographic data, type of transplant, baseline and post transplant lung function, early and late complications and survival rate were analyzed. RESULTS: Nine patients ≤ 15 years-old were transplanted. The average age at transplant was 12.7 years. The main indication was cystic fibrosis (7 patients). The average BMI was 17.6 and all the patients were with home oxygen therapy. 77% used extracorporeal intraoperative support. Average baseline FEV1 was 25.2% with progressive improvement in FEV1 of 77% in the first year. The main early complications were hemorrhage and primary graft dysfunction, while late complications were infections and chronic graft dysfunction. Four patients have died and the estimated 2 years survival was 85%. They achieved school reinsertion and three managed to complete university studies. CONCLUSION: Lung transplantation is an alternative for children with advanced lung diseases improving their survival and quality of life.

[Treatment of the pelvic floor in males with incomplete spinal cord injury: a systematic review].

Pelvic floor disorders are one of the most common complications in male patients with spinal cord injury. The aim of this review was to analyse the available evidence on the efficacy of different treatments used for pelvic floor dysfunctions in men with incomplete spinal cord injuries. The Scopus, Medline, PEDro, Web of Science, Dialnet, Pubmed and Cochrane databases were consulted for papers in Spanish and English published in the last twenty years. Fifteen articles were included, comprising a total of 706 male patients with incomplete spinal cord injury. In male patients with neurogenic bladder and erectile dysfunction, the best results were obtained with neuromodulation and combined treatments (electrotherapy or acupuncture / electroacupuncture with catheterization or bladder training).

Hypnosis for cingulate-mediated analgesia and disease treatment.

Hypnosis is a technique that induces changes in perceptual experience through response to specific suggestions. By means of functional neuroimaging, a large body of clinical and experimental studies has shown that hypnotic processes modify internal (self-awareness) as well as external (environmental awareness) brain networks. Objective quantifications of this kind permit the characterization of cerebral changes after hypnotic induction and its uses in the clinical setting. Hypnosedation is one such application, as it combines hypnosis with local anesthesia in patients undergoing surgery. The power of this technique lies in the avoidance of general anesthesia and its potential complications that emerge during and after surgery. Hypnosedation is associated with improved intraoperative comfort and reduced perioperative anxiety and pain. It ensures a faster recovery of the patient and diminishes the intraoperative requirements for sedative or analgesic drugs. Mechanisms underlying the modulation of pain perception under hypnotic conditions involve cortical and subcortical areas, mainly the anterior cingulate and prefrontal cortices as well as the basal ganglia and thalami. In that respect, hypnosis-induced analgesia is an effective and highly cost-effective alternative to sedation during surgery and symptom management.

Prevention of meconium obstruction in very low birth weight preterm infants. / Prevención de la obstrucción meconial en recién nacidos prematuros de muy bajo peso.

INTRODUCTION: Delayed meconium expulsion is a cause of bowel obstruction in the extremely premature newborn (<28 WGE) weighing less than 1500g at birth. OBJECTIVE: To evaluate the efficacy of conservative treatment in the prevention of meconium obstruction in very-low-birt- weight preterm infants. METHOD: Descriptive and retrospective study performed at the Neonatal Intensive Care Unit of a tertiary level hospital. All very-low-birth-weight preterm infants who were born during the study period, from August 2016 to January 2017, and who had meconium obstruction were included. RESULTS: A sample of 42 newborn infants was obtained. Regarding the expulsion of meconium, 57.1% of the sample spontaneously ejected meconium, while 42.9% received different treatments. Of these, 72.2% were treated with saline enemas, 16% with acetylcysteine enemas, 16% with Gastrografin® and none required surgical treatment. CONCLUSION: Conservative treatment seems to be an effective therapeutic measure for the prevention of meconium obstruction in very-low-birth-weight preterm infants since it achieved the expulsion of meconium without having to apply surgical treatment.

Marcación de nódulos pulmonares con lipiodol bajo tomografía computada: experiencia local y correlación anatomopatológica / Marking of pulmonary nodules with lipiodol by computerized tomography: local experience and anatomopathological correlation

El objetivo de este estudio es la descripción de la novedosa y poco invasiva técnica de marcación de pequeños nódulos pulmonares con lipiodol, guiado con TAC para su posterior resección por cirugía videotoracoscópica con apoyo radioscópico. Se trata de un estudio retrospectivo que incluye 51 pacientes consecutivos en un tiempo comprendido entre junio del 2012 a septiembre del 2017, obteniendo el diagnóstico final mediante la correlación anatomopatológica, representando los procesos malignos el 81% y los benignos el 19%. Mediante esta técnica se lograron identificar y extraer con éxito el 100% de los nódulos marcados, demostrándose la efectividad y seguridad del procedimiento por las mínimas complicaciones relacionadas.

The purpose of this study is describing a novel and minimally invasive technique of CT-guided marking of small pulmonary nodules with lipiodol prior to resection by videothoracoscopic surgery with radioscopic support. This is a retrospective study that includes 51 consecutive patients between June 2012 and September 2017, with the final diagnosis confirmed by pathology. Malignant nodules represented 81% of the cases with the remaining 19% being benign nodules. Through this technique, 100% of the marked nodules were successfully identified and extracted with few procedure related complications and no adverse clinical outcome, demonstrating the effectiveness and safety of the procedure.

Reference Intervals of Mineral Elements in Plasma of Anesthetized Free-Ranging Adult Females of South American Sea Lion, Otaria flavescens.

Levels of zinc (Zn), copper (Cu), potassium (K), calcium (Ca), magnesium (Mg), and phosphorus (P) in plasma of Otaria flavescens females (n = 29) were evaluated. Reference intervals were established for each element, being the first report for this species.

Comparison of pollen levels between 2 pollen traps in Salamanca, Spain

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Susceptibility of Tetranychus urticae Koch to an ethanol extract of Cnidoscolus aconitifolius leaves under laboratory conditions.

One of the main pests of commercial rose crops in Colombia is the phytophagous mite Tetranychus urticae Koch. To manage this pest, synthetic chemicals have traditionally been used, some of which are well known to be potentially toxic to the environment and humans. Therefore, alternative strategies for pest management in greenhouse crops have been developed in recent years, including biological control with natural enemies such as parasitoids, predators and entomopathogenic microorganisms as well as chemical control using plant extracts. Such extracts have shown toxicity to insects, which has positioned them as a common alternative in programs of integrated pest management. The objective of this study was to evaluate the effect of an unfractionated ethanolic extract of Cnidoscolus aconitifolius leaves on adult females of T. urticae under laboratory conditions. The extract was chemically characterized by recording its metabolic profile via liquid chromatography coupled to mass spectrometry, along with tentative metabolite identification. The immersion technique and direct application to rose leaves were used to evaluate the effects of seven doses (10-2,000 µg/mL) of the ethanol extract of C. aconitifolius leaves on T. urticae females under laboratory conditions. The mortality and oviposition of individuals were recorded at 24, 48 and 72 h. It was found that the C. aconitifolius leaf extract reduced fertility and increased mortality in a dose-dependent manner. The main metabolites identified included flavonoid- and sesquiterpene-type compounds, in addition to chromone- and xanthone-type compounds as minor constituents with potential acaricidal effects.

Hipertiroidismo no controlado inducido por amiodarona: implicaciones anestésicas / Uncontrolled hypertyroidism amiodarone-induced: anesthetic implications

La amiodarona es un fármaco antiarrítmico de clase III utilizado en el manejo urgente de la fibrilación auricular (FA) y taquicardia ventricular sostenida y en el tratamiento crónico de la FA y taquicardias paroxísticas supraventriculares. Por su alto contenido en iodo, puede ocasionar trastornos en la función tiroidea hasta en el 20 % de los pacientes que la toman, siendo la incidencia de hipertiroidismo inducido por amiodarona (HIA) del 2 al 10 %.El hipertiroidismo no controlado puede conllevar en los casos de crisis tirotóxica o tormenta tiroidea (TT) una mortalidad del 20 al 60 % según las series. La incidencia de TT intraoperatoria ha disminuido en los últimos tiempos gracias a la adopción de medidas de optimización preoperatoria encaminadas a disminuir los niveles de hormonas tiroideas circulantes. Presentamos el caso de una paciente con un hipertiroidismo no controlado secundario a amiodarona, propuesta para osteosíntesis tras fractura subtrocantérea femoral derecha. Repasamos las principales consideraciones anestésicas que requiere el manejo de un paciente con HIA, incidiendo en la importancia de una exhaustiva valoración preoperatoria y en los beneficios que aporta la elección de una adecuada técnica anestésica en el control intraoperatorio y postoperatorio inmediato de los episodios de crisis tirotóxica. Describimos el empleo de una técnica intradural complementada con un bloqueo nervioso periférico, como una alternativa válida a la anestesia general (AU)

Amiodarone is a class III antiarrhythmic agent used in the emergency management of atrial fibrillation (AF), sustained ventricular tachycardia and chronic treatment of AF and paroxysmal supraventricular tachycardia. Because of its high iodine content, it may cause disturbances in thyroid function in up to 20 % of patients who take it, with an incidence of amiodarone-induced hyperthyroidism (AIH) from 2 to 10 %.Uncontrolled hyperthyroidism can generate in cases of thyrotoxic crisis or thyroid storm a mortality of 20 to 60 % depending on the series. The incidence of intraoperative thyroid storm has decreased in recent years thanks to the adoption of measures which reduce the levels of circulating thyroid hormones. We report the case of a patient with uncontrolled hyperthyroidism secondary to amiodarone, given right femoral osteosynthesis surgery after subtrochanteric fracture. We review the main anesthetic considerations requiring the management of a patient with AIH, highlighting the importance of a thorough preoperative assessment and the benefits of choosing a suitable anesthetic technique on intraoperative and immediate postoperative episodes of thyroid storm. We describe the use of a spinal technique supplemented by a peripheral nerve block, as a valid alternative to general anesthesia (AU)

Effects and barriers to deployment of telehealth wellness programs for chronic patients across 3 European countries.

BACKGROUND: Benefits of cardiopulmonary rehabilitation (CPR) in patients with chronic obstructive pulmonary disease (COPD) are well established, but long-term sustainability of training-induced effects and its translation into healthy lifestyles are unsolved issues. It is hypothesized that Integrated Care Services supported by Information and Communication Technologies (ICS-ICT) can overcome such limitations. In the current study, we explored 3 ICS-ICT deployment experiences conducted in Barcelona, Trondheim and Athens. METHODS: In the 3 sites, a total of 154 patients completed an 8-week supervised CPR program. Thereafter, they were allocated either to an ICS-ICT group or to usual care (CPR + UC) during a follow-up period of at least 12 months with assessment of 6-min walking test (6MWT) as main outcome variable at all time points in the 3 sites. Because real deployment was prioritized, the interventions were adapted to site heterogeneities. RESULTS: In the ICS-ICT group from Barcelona (n = 77), the use of the personal health folder (PHF) was the cornerstone technological tool to empower COPD patients for self-management showing high applicability and user-acceptance. Long-term sustainability of training-induced increase in exercise capacity was observed in ICS-ICT compared to the control group (p = 0.01). Likewise, ICS-ICT enhanced the activities domain of the SGRQ (p < 0.01) and daily physical activity (p = 0.03), not seen in controls. No effects of ICS-ICT were observed in Trondheim (n = 37), nor in Athens (n = 40), due to technological and/or organizational limitations. CONCLUSIONS: The study results suggest the potential of the ICS-ICT Barcelona's approach to enhance COPD management. Moreover, it allowed identification of the factors limiting transferability to the other sites. The research prompts the need for large multicenter trials specifically designed to assess effectiveness, efficiencies and transferability of this type of intervention.

Aqueous root extracts from Mimosa albida Humb. & Bonpl. ex Willd display antinociceptive activity in mice.

ETHNOPHARMACOLOGICAL RELEVANCE: In this work, we study whether aqueous extracts from the roots of Mimosa albida Humb. & Bonpl. ex Willd, a plant known in the Highlands of Chiapas, Mexico as "Lotóm chíx" are endowed with both antinociceptive and anxiolytic effects. MATERIALS AND METHODS: ICR mice were systemically treated with aqueous extracts from Mimosa albida and the reference compounds (diazepam, dipyrone and/or fentanyl) and their behavior was evaluated in several behavioral tests. RESULTS: Administration of aqueous extracts from the roots of Mimosa albida resulted in a reduction of the nociception elicited in mice by both the hot plate (12.5, 25 and 50 mg/kg; i.p.) and the acetic acid-induced writhing (25 and 50 mg/kg; i.p.) tests. No effects were however observed both in the elevated plus-maze and hole board test (3.2, 12.5 and 25 mg/kg; i.p.). In contrast, both locomotion (open field test) and motor coordination (rotarod test) were affected at doses (50, 100 y 200 mg/kg; i.p.) higher than those having antinociceptive effects. CONCLUSION: These data suggest that in mice the systemic administration of low doses of aqueous extracts from the roots of Mimosa albida results in antinociceptive effects in several models of pain through mechanisms that do not involve the opioid system pathway. These results support the ethnopharmacological use of Mimosa albida in popular medicine.

Actualización en el síndrome del glúteo medio / Update on Gluteus Medius Syndrome

El dolor de espalda y/o región glútea es un motivo de consulta frecuente en atención primaria y en muchas ocasiones resulta difícil precisar su origen. Cuando un paciente consulta por este motivo solemos dirigir el foco de atención hacia el estudio de las estructuras óseas y nerviosas, sin tener en cuenta que en un gran número de casos está implicado el sistema miofascial. En un estudio realizado en 250 pacientes con el objetivo de determinar la prevalencia de tendinosis y roturas del glúteo medio o menor, se comprobó por medio de RM que el 14% de los pacientes que acudían al médico por dolor en la nalga, cadera o ingle presentaban este tipo de lesión en alguno de los músculos mencionados. En estos casos un diagnóstico y tratamiento precoz con infiltraciones es fundamental para evitar la progresión a un dolor persistente y disminución de la función muscular (AU)

Back pain and/or gluteal region pain is a frequent complaint in primary care and often is difficult to determine their origin. When a patient consults us for this reason we tend to direct the focus to the study of bone and nerve structures, without considering that in a large number of cases the myofascial system is involved. In a study with 250 patients in order to determine the prevalence of tendinosis and tear of the gluteus medius or minimus muscles, was found by MRI that 14% of patients who went to the doctor for pain in the buttock, hip or groin had this type of injury in any of the muscles mentioned (1). In these cases a diagnosis and early treatment with injections is essential to prevent progression to persistent pain and decreased muscle function (AU)

Biofeedback can reduce foot pressure to a safe level and without causing new at-risk zones in patients with diabetes and peripheral neuropathy.

BACKGROUND: Plantar pressure reduction is mandatory for diabetic foot ulcer healing. Our aim was to evaluate the impact of a new walking strategy learned by biofeedback on plantar pressure distribution under both feet in patients with diabetic peripheral neuropathy. METHODS: Terminally augmented biofeedback has been used for foot off-loading training in 21 patients with diabetic peripheral sensory neuropathy. The biofeedback technique was based on a subjective estimation of performance and objective visual feedback following walking sequences. The patient was considered to have learned a new walking strategy as soon as the peak plantar pressure (PPP) under the previously defined at-risk zone was within a range of 40-80% of baseline PPP in 70% of the totality of steps and during three consecutive walking sequences. The PPP was measured by a portable in-shoe foot pressure measurement system (PEDAR(®)) at baseline (T0), directly after learning (T1) and at 10-day retention test (T2). RESULTS: The PPP under at-risk zones decreased significantly at T1 (165 ± 9 kPa, p < 0.0001) and T2 (167 ± 11, p = 0.001), as compared with T0 (242 ± 12 kPa) without any increase of the PPP elsewhere. At the contralateral foot (not concerned by off-loading), the PPP was slightly higher under the lateral midfoot at T1 (68 ± 8 kPa, p = 0.01) and T2 (65 ± 8 kPa, p = 0.01), as compared with T0 (58 ± 6 kPa). CONCLUSIONS: The foot off-loading by biofeedback leads to a safe and regular plantar pressure distribution without inducing any new 'at-risk' area under both feet.

Sex differences in insulin resistance in GABAB1 knockout mice.

AIMS: We have previously demonstrated that the absence of functional GABA B receptors (GABABRs) disturbs glucose homeostasis in GABAB1KO mice. The aim of this work was to extend our studies of these alterations in GABAB1KO mice and investigate the sexual differences therein. MAIN METHODS: Male and female, GABAB1KO and WT mice were used. Glucose and insulin tolerance tests (GTT and ITT), and insulin and glucagon secretion tests (IST and GST) were performed. Blood glucose, serum insulin and hyperglycemic hormones were determined, and HOMA-IR calculated. Skeletal muscle insulin receptor ß subunit (IRß), insulin receptor substrates 1/2 (IRS1, IRS2) and hexokinase-II levels were determined by Western blot. Skeletal muscle insulin sensitivity was assessed by in vivo insulin-induced Akt phosphorylation (Western blot). Food intake and hypothalamic NPY mRNA expression (by qPCR) were also evaluated. KEY FINDINGS: Fasted insulin and HOMA-IR were augmented in GABAB1KO males, with no alterations in females. Areas under the curve (AUC) for GTT and ITT were increased in GABAB1KO mice of both genders, indicating compromised insulin sensitivity. No genotype differences were observed in IST, GST or in IRß, IRS1, IRS2 and hexokinase-II expression. Akt activation was severely impaired in GABAB1KO males while no alterations were observed in females. GABAB1KO mice showed increased food intake and NPY expression. SIGNIFICANCE: Glucose metabolism and energy balance disruptions were more pronounced in GABAB1KO males, which develop peripheral insulin resistance probably due to augmented insulin secretion. Metabolic alterations in females were milder and possibly due to previously described reproductive disorders, such as persistent estrus.

[Kounis syndrome secondary to an allergic reaction to metamizole]. / Síndrome de Kounis secundario a reacción alérgica a metamizol.

Severe cardiovascular events, such as coronary vasospasm or acute myocardial infarction can occur during anaphylactic reactions. Although rare, this cause of ischaemic heart disease is known. We present the case of a patient who suffered an angina episode after an anaphylactic reaction due tot administering metamizole, with no significant lesions observed in the coronary catheterisation.

Síndrome de Kounis secundario a reacción alérgica a metamizol / Kounis syndrome secondary to an allergic reaction to metamizole

Durante las reacciones anafilácticas pueden ocurrir eventos cardiovasculares graves como el vasoespasmo coronario o el infarto agudo de miocardio. Esta causa de cardiopatía isquémica es conocida aunque poco frecuente. Presentamos el caso de un paciente que sufrió un episodio anginoso tras una reacción anafiláctica por la administración de metamizol, objetivándose en la coronariografía ausencia de lesiones significativas(AU)

Severe cardiovascular events, such as coronary vasospasm or acute myocardial infarction can occur during anaphylactic reactions. Although rare, this cause of ischaemic heart disease is known. We present the case of a patient who suffered an angina episode after an anaphylactic reaction due tot administering metamizole, with no significant lesions observed in the coronary catheterisation(AU)