Fenómeno de Raynaud y el amamantamiento doloroso / Raynaud's phenomenon and pain during breastfeeding

El fenómeno de Raynaud es una patología provocada por la exposición al frío, que conduce al vasoespasmo intermitente de arteriolas, produciendo un cuadro clínico por la falta de aporte de oxígeno, consistente en palidez, parestesias y dolor de la zona afectada1. Es una causa tratable de amamantamiento doloroso que llega a afectar a 1 de cada 5 mujeres en edad fértil y que en ocasiones lleva al abandono de la lactancia si es erróneamente diagnosticado por su incomoda sintomatología (AU)

Raynaud's phenomenon of the nipple is a pathology precipitated by exposure to cold and leads to intermittent vasospasm of arterioles, producing clinical symptoms of pain, burning and paresthesias. This condition is a treatable cause of painful breastfeeding that can affect up to 1 in 5 women of childbearing age. If misdiagnosed, it can occasionally lead to cessation of breastfeeding due to its uncomfortable symptomatology (AU)

Multivessel coronary artery spasm refractory to intensive medical treatment.

This case report describes multivessel coronary artery spasm refractory to oral nifedipine, intravenous isosorbide dinitrate, diltiazem and nicorandil, and intracoronary nitroglycerin. Intracoronary administration of nicorandil only transiently relieved coronary artery spasm. Prednisolone was effective in preventing coronary artery spasm.

[Sudden cardiac death in non-professional athletes]. / Morte improvvisa cardiaca in atleti non professionisti.

Sudden death during sports activities in non-professional athletes is a rare occurrence, however it is of great interest in clinical pathology and forensic medicine. We performed chemico-toxicologic and histopathologic investigations in three cases of sudden cardiac death in non-professional athletes, focusing in particular on the cardiac conduction system. Examination of conduction tissue was performed on sections seriated every 150 microns, stained alternately with hematoxylin-eosin and Heidenhain's trichrome (azan). In all three cases diagnostic evidence showed hyperacute myocardial infarction, due to spasm of coronaries with mild atherosclerosis, and myocardial lesions due to reperfusive necrosis. The pathogenesis of sudden death in young athletes is not related only to ischemic-coronary damage that is not exclusively mechanical, but also a dynamic event (spasm and reperfusion), but also to fatal arrhythmias related to abnormal findings in the conduction system. Such findings can therefore be considered the morphologic substrate of sudden cardiac death.

Spasm of small coronary arteries and ischemic myocardial injury induced by hypothalamic stimulation in the rat.

Electrical stimulation of the lateral hypothalamus resulted in electrocardiographic evidence of acute myocardial ischemia in 35% of normal adult rats under anesthesia. Mean arterial blood pressure was also elevated. Study of vascular corrosion casts disclosed that spasm of smaller branches of the coronary circulation, rather than the major epicardial arteries, was the main cause of the ischemic response. The histologic changes of the same experimental treatment in a separate group of animals revealed multiple focal areas of tissue damage throughout the myocardium, which were quantitatively assessed. The results may be relevant for the clinical problem of various forms of ischemic heart disease in which little evidence is found for organic (atherosclerosis) or dynamic (spasm) stenosis involving the major coronary arteries.