[Consensus document on ultrasound training in Intensive Care Medicine. Care process, use of the technique and acquisition of professional skills]. / Documento de consenso para la formación en ecografía en Medicina Intensiva. Proceso asistencial, uso de la técnica y adquisición de competencias profesionales.

Ultrasound has become an essential tool in assisting critically ill patients. His knowledge, use and instruction requires a statement by scientific societies involved in its development and implementation. Our aim are to determine the use of the technique in intensive care medicine, clinical situations where its application is recommended, levels of knowledge, associated responsibility and learning process also implement the ultrasound technique as a common tool in all intensive care units, similar to the rest of european countries. The SEMICYUC's Working Group Cardiac Intensive Care and CPR establishes after literature review and scientific evidence, a consensus document which sets out the requirements for accreditation in ultrasound applied to the critically ill patient and how to acquire the necessary skills. Training and learning requires a structured process within the specialty. The SEMICYUC must agree to disclose this document, build relationships with other scientific societies and give legal cover through accreditation of the training units, training courses and different levels of training.

[Giant intracavitary thrombi secondary to a heparin-induced thrombocytopenia-thrombosis syndrome]. / Trombos gigantes intracavitarios secundarios a un "síndrome de trombocitopenia-trombosis inducido por heparina".

The secondary thrombocytopenia to heparin is not infrequently seen; nevertheless, the heparin-induced thrombocytopenia-thrombosis is much less frequent and associated to high mortality. We show one heparin induced thrombocytopenia-thrombosis syndrome with developed thrombi in the cardiac cavities. Its physiopathologic mechanism was reviewed, the importance of clinic suspicion in the presence of: thrombi in a rather unusual place, thrombi resistant to the common anticoagulant therapy, thrombosis repetition or thrombosis in a person with anticoagulant therapy by heparin. The complexity of its treatment, as well as the transesophageal echocardiography utility in diagnostics of thrombus on cardiac cavities, and its relationship with the reaction to the treatment, is discussed.

Hemodynamic activity of different doses of sulmazole by infusion.

By means of right heart catheterisation and thermodilution the hemodynamic response to two different doses of 2-[2-methoxy-4-(methylsulfinyl) phenyl]-1H-imidazo[4,5-b]pyridine (sulmazole, AR-L 115 BS, Vardax) (1.5 mg or 0.7 mg/min) was determined in 10 hospitalized patients with congestive cardiac insufficiency. It was found that sulmazole has a marked positive inotropic effect, increasing the cardiac output and stroke work index and decreasing the peripheral systemic and pulmonary vascular resistance, almost without altering the blood pressure values; furthermore, it reduces the right atrial pressure, the pulmonary capillary pressure and the pulmonary arterial pressure. Tolerance of sulmazole was excellent; no tachyphylaxis nor rebound reactions were observed during the 36-h period of medication.

[Solitary pulmonary nodule in a patient with treated carcinoma of the renal pelvis: metastatic disease?]. / Nódulo pulmonar solitario en paciente con carcinoma de pelvis renal tratado: enfermedad metastásica?

OBJECTIVE: To describe a case of a solitary pulmonary nodule in a patient that had been treated for carcinoma of the renal pelvis. METHODS: A solitary pulmonary nodule was detected on the chest film of a patient that had been treated for carcinoma of the renal pelvis. The characteristics of the nodule are described and its diagnosis, with special reference to metastasis and primary pulmonary carcinoma, is discussed. RESULTS: The anatomopathological study demonstrated a chondroid hamartoma. CONCLUSIONS: A metastatic or a primary tumor is suspected when a solitary pulmonary nodule is detected in a patient that has been previously treated for urothelial carcinoma. However, other types of lesions with a more favourable outcome cannot be discarded, such as chondroid hamartoma as in the case described herein.

Hipotermia terapéutica en el traumatismo craneoencefálico / No disponible

No disponible

Utilidad de los antagonistas de los receptores de la glucoproteína IIb/IIIa en pacientes ingresados por cardiopatía isquémica en la UCI de un hospital sin disponibilidad de cateterismo cardíaco / Use of glucoprotein IIb/IIIa in patients admitted in the intensive care unit of one hospital due to ischemic cardiopathy without disponibility of cardiac catterization

Fundamento. Se describe la utilización de antagonistas de la glucoproteína IIb/IIIa (AGIIb/IIIa) en una serie de casos, recogidos a partir de los pacientes con síndrome coronario agudo ingresados en la UCI de un hospital sin disponibilidad de cateterismo cardíaco, entre febrero de 1999 y diciembre de 2000.Método. Estudio descriptivo y retrospectivo sobre pacientes con síndrome coronario agudo tratados con AGIIb/IIIa. Se valoró la evolución inicial, a los 6 meses y los efectos secundarios.Resultados. Se estudió a 22 pacientes (20 varones) entre febrero de 1999 y diciembre de 2000. Once pacientes recibieron abciximab (cinco antes del cateterismo cardíaco por síndrome coronario agudo de alto riesgo y seis por isquemia refractaria) y 11 enfermos tirofibán (por isquemia refractaria). Inicialmente, 12 (70,6 por ciento) de los 17 pacientes con ángor refractario quedaron asintomáticos. Se realizó cateterismo cardíaco en otro hospital en todos los pacientes menos uno. En 18 enfermos se instauró tratamiento invasivo percutáneo, 2 pacientes requirieron cirugía cardíaca, un enfermo no presentó lesiones coronarias significativas y en otro enfermo éstas no fueron susceptibles de revascularización. A los 6 meses, 18 pacientes (81,8 por ciento) permanecían asintomáticos aunque cuatro (18,2 por ciento) habían precisado nueva revascularización percutánea. En ningún caso se constató muerte por cualquier causa o infarto de miocardio de nueva aparición.Respecto a efectos secundarios, un enfermo presentó hemorragia gastrointestinal y en otro paciente se evidenció trombocitopenia grave.Conclusión. Los AGIIb/IIIa son una opción terapéutica en los pacientes ingresados por angina inestable refractaria en hospitales sin disponibilidad de cateterismo cardíaco, ya que pueden estabilizar inicialmente el síndrome coronario agudo; no obstante, son fármacos que no están exentos de importantes efectos secundarios (AU)