[Superior vena cava syndrome as initial manifestation of acute aortic dissection: a case report and review of the literature]. / Síndrome de vena cava superior como primera manifestación de una disección aórtica aguda: presentación de un caso y revisión de la literatura.

Aortic dissection usually presents with chest pain, abnormal pulses and a widened mediastinum on chest radiograph. It is rarely associated with the superior vena cava syndrome as the first manifestation. This paper presents a patient who had a superior vena cava syndrome as a result of a painless aortic dissection and compared with other previously reported cases.

[Disease of the left coronary trunk. Our experience. An analysis of surgical morbimortality]. / Enfermedad del tronco de la coronaria izquierda. Nuestra experiencia. Análisis de la morbimortalidad operatoria.

INTRODUCTION AND OBJECTIVES: The superiority of surgical treatment over other procedures in the left main coronary artery stenosis is well known, being today the therapy of choice. The purpose of this work is to analyze the clinical characteristics and the immediate results of surgery in our patients. PATIENTS AND METHODS: In this paper we under-took a retrospective study of 147 consecutive patients, 129 men and 18 women with a 50% or more left main coronary artery stenosis without associated valvular disease, operated on at our institution during a period of 3.5 years, between January 1992 and May 1995. Thirty-one variables were analyzed under Chi-square, comparison of proportions and Student's t-tests. Then, it has been developed into a multivariant logistic regression of significant variables (p less than 0.05) of factors influencing mortality and rhythm disturbances which have been the most frequent postoperative complication. RESULTS: The mean age was 65 years. Sixty-two per cent had unstable angina and 51.7% had previous myocardial infarction. An average of 3.1 grafts were performed. Total mortality was 6.8%. The complications were 17% arrhythmias, 8% low cardiac output and 6% perioperative myocardial infarction. In the multivariate analysis, mortality has been strongly related to the presence of perioperative myocardial infarction and also with moderate to severe cardiomegaly and a high left ventricular end-diastolic pressure. Arrhythmias were related to an advanced age. CONCLUSIONS: 1) In hospital mortality remains within acceptable limits and is influenced by the presence of perioperative myocardial infarction, cardiomegaly and a high left ventricular end-diastolic pressure, and 2) elderly patients have more damaged vessels, more diseased coronary segments, and more complications, especially rhythm disturbances.

[Etiologic considerations regarding superior vena cava syndrome]. / Consideraciones etiológicas sobre el síndrome de vena cava superior.

Literature review indicates a change in the etiological trends of the Superior Cava Syndrome. While during the first half of the twentieth century, aortic aneurysms, malignant tumors and mediastinitis were its main causes, nowadays talking about obstruction of the superior cava is the same than talking about obstruction secondary to a malignant cause (85-90%). Benign affections account for 10-15% and, among them, intravenous iatrogenic foreign bodies constitute a new chapter as cause of thrombosis. Given that small cells simplex carcinoma is the most common cause of SCS and given that benign processes or other chemosensitive tumors can be present, it is currently necessary to secure the histologic diagnosis before starting the treatment.