Incremental value of live/real-time three-dimensional transthoracic echocardiography over the two-dimensional technique in the assessment of left ventricular endocardial rupture with myocardial dissection and contained apical epicardial rupture following myocardial infarction.

We report the incremental value of live/real-time three-dimensional transthoracic echocardiography (3DTTE) over two-dimensional transthoracic echocardiography (2DTTE) in making a definitive diagnosis of left ventricular endocardial rupture with myocardial dissection and contained apical epicardial rupture in an elderly male patient presenting with acute myocardial infarction. To the best of our knowledge, this has not been described previously.

Global longitudinal strain is superior to ejection fraction for detecting myocardial dysfunction in end-stage renal disease with hyperparathyroidism.

BACKGROUND: The estimation of left ventricular ejection fraction (LVEF) by 2D echocardiography (2D-ECHO) is the most used tool to assess LV systolic function (LVSF). Global longitudinal strain (GLS) has recently been suggested as a superior method for several evaluations. This study explored the association and prevalence of LV systolic dysfunction (LVSD) by using these methods in patients with end-stage renal disease (ESRD) and severe hyperparathyroidism (SHPTH); both associated with cardiovascular events (CEs). AIM: To evaluate the myocardial function in patients with ESRD and SHPTH by using the GLS and LVEF measured through conventional 2D-ECHO. METHODS: In 62 patients with ESRD and SHPTH, asymptomatic, and without a history of CEs, LVSF was evaluated by 2D-ECHO, obtaining the EF, by the Simpson biplane method, and GLS by speckle tracking. RESULTS: The total patients with ESRD had a preserved LVEF (> 50%) but abnormal GLS (< 13.55%). Additionally, multivariate analysis showed an independent association of GLS and serum parathyroid hormone (PTH), LV mass index, and hemoglobin. Also, PTH was independently associated with lateral e' wave and tricuspid regurgitation velocity. CONCLUSION: In patients with SHPTH linked to ESRD, the use of GLS by 2D-ECHO is a more sensitive tool than LVEF for detecting LVSD.

Incremental role of three-dimensional over two-dimensional ultrasound in the assessment of traumatic peripheral arteriovenous fistula.

We present a patient with an accidental self-inflicted stab wound to his right thigh in whom three-dimensional (3D) ultrasound was able to find two communications between the right femoral artery and the femoral vein, in contrast to two-dimensional (2D) peripheral ultrasound which could find only one communication between them, thereby showing an incremental value of 3D over 2D ultrasound.

Heritage, geographical scale and didactic potentiality: Students and teachers' perspectives.

Heritage and space establish reciprocal relations that have been studied for decades. On the one hand, heritage has been described as an inherently spatial phenomenon. On the other hand, places are defined according to the attributes that make up their identity, among which heritage is a fundamental instrument. On the basis of the idea that education plays an important role in the socialization process, transmitted by the inherited culture, to integrate each subject within the specific community, and the notion of scale as the closest to heritage, we defined as general objectives to determine the relationships between geographic scales, heritage perspective and the didactic potential granted to heritage, within the framework of the construction of collective identities, and to contrast the perspectives of students and teachers regarding the geographical scale, heritage and their didactic potential, deducing implications for educational practices. In order to answer to these objectives, we carried out a non-experimental quantitative research, with a relational-predictive objective. Specifically, we used a survey method, being the context the whole of the local scale (Fuente Álamo, Murcia, Spain) and acting as participants all students and teachers of Secondary Education (n = 459) linked to social sciences. They answered the Test on Didactic Potentiality of Heritage according to Scale (TDPHS), and its information was analysed through different procedures (Spearman's correlations, descriptive statistics, Mann-Whitney U…), using the statistical programs SPSS. The results show, on the one hand, that the scalar perspective scores are generally low, heritage perspective is consistent with the consideration of the scales, and the perceived didactic potential in relation to heritage is related to the importance given to each of the scales; and, on the other hand, the contrast in the perspectives of students and teachers regarding the geographical scale, heritage and their didactic potential is minimal.

[The echocardiography in cardiac remodeling after acute myocardial infarction]. / La ecocardiografía en la remodelación cardíaca después del infarto agudo de miocardio.

OBJECTIVES: The goal of this study was to assess the impact of left ventricular diastolic filling on remodeling and survival after acute myocardial infarction. METHODS: We studied 36 patients with first acute myocardial treated with thrombolytic agents. A Doppler echocardiography was performed at 24 hours, 30 and 90 days after infarction. It measured the relation between E and A waves peak velocities (E/A ratio) and of the E deceleration time (EDT, ms), as well as the flow propagation velocity using color mode M and the E'-wave by tissular Doppler at the lateral mitral ring. RESULTS: Patients were divided into three groups. Group I, restrctive filling (deceleration time < 140 ms, E/FPV > or = 2, E/A> 2 and E/E' > 15). Group II, elevated filling pressure (deceleration time > or = 140 ms, E/FVP > or = 2, E/A 1,2 and E/E' < or = 15). Group III, normal filling pressure (deceleration time > or = 140 ms, E/FVP < 2, E/A < 1 and E/E' < 15). The E/FPV showed a better correlation in the group with restrictive filling and left ventricular filling pressure was significantly greater than in the group with normal filling pressure at 90 days (2.18 +/- 0.90 vs. 1.5 +/- 0.35; r = 0.99; P = .0001). The end diastolic volume (EDV) was similar in the three groups 24 hours after infarction. EDV varied at 90 days after infarction in those patients that underwent successful coronary angioplasty. Group I, 142.48 +/- 32 vs. 112.48 +/- 32, r = 573; P < .0001). CONCLUSIONS: E/FVP, using color M-mode Doppler echocardiography, estimates left ventricular filling pressure and predicts left ventricular dilation after acute myocardial infarction.

[Correlation between left ventricular stroke work loss index and aortic valve area in patients with aortic stenosis]. / Correlación entre el índice de pérdida de trabajo-latido ventricular izquierdo y el área valvular aórtica en pacientes con estenosis aórtica.

UNLABELLED: In echocardiographic evaluation of patients with aortic stenosis (AS), prospective studies have demonstrated that left ventricular stoke work loss index (LVSWLI) provide a more clinical efficacy than calculate of aortic valve area (AVA) by continuity equation to estimate severity of stenosis. The aim of this study was assess in our population of patients with AS the correlation between LVSWLI and AVA in regard to severity. MATERIAL AND METHODS: Forty nine patients with moderate and severe AS were evaluated by transthoracic echocardiography. Grades of AS were assessed by transaortic flow velocity (Vmax) and mean aortic transvalvular gradient (deltaP). AVA and LVSWLI were calculated and Pearson's and Spearman's correlation coefficients between both methods were assessed. Significance level was set at <0.05. RESULTS: The age of the patients was 66 +/- 13 (31-84 years). Thirty four (69%) patients had severe AS and 15 (31%) moderate AS. The Pearson's correlation coefficient between LVSWLI and AVA was 0.79 (p<0.04) and between LVSWLI and deltaP was 0.90 (p<0.03). The Spearman's correlation coefficient between LVSWLI and symptomatic status was 0.70 (rho = 0.70, p < 0.003). CONCLUSIONS: In patients with moderate and severe AS, the correlation between LVSWLI and deltaP is higher than correlation between LVSWLI and AVA. Moreover LVSWLI has a higher correlation with presence of symptoms than AVA.

Evaluación de la función ventricular y auricular derecha con ecocardiografía 3D en tromboembolia pulmonar aguda / Assessment of right ventricular and atrial function with 3D echocardiography in acute pulmonary embolism

Introducción: La tromboembolia pulmonar aguda (TEP) es un padecimiento grave. La ecocardiografía tridimensional (ECO-3D) es un método accesible, novedoso y preciso para cuantificar la función ventricular y auricular derechas. A la fecha, no existen suficientes estudios que evalúen su papel en esta entidad. Objetivo: Determinar la utilidad del ECO-3D en la evaluación de la función ventricular y auricular derecha, y el riesgo de complicaciones cardiovasculares en pacientes con TEP aguda. Material y métodos: Se analizaron 35 pacientes, admitidos al HC CMN SXXI con TEP por angioTAC, mediante equipo Phillips IE 33, se midieron parámetros bidimensionales (2D) y 3D relacionados con función ventricular y auricular derecha (TomTec y qlab 10). Se evaluaron complicaciones cardiovasculares intrahospitalarias. Resultados: El riesgo relativo de eventos cardiovasculares mayores combinados (ECMC) intrahospitalarios por ECO-3D fue: índice de esfericidad de la aurícula derecha > 1.32; RR 20.3 IC 95% 2.9-13.8; p = 0.0001, FEVD RR 7.3 IC 95% 2.5-20.9; p = 0.0001, VDFVD > 77 mL RR de 7.3 IC 95% 2.56-20.9; p = 0.0001, VSFVD RR 5.5 IC 95% 2.26-13.3; p = 0.0001. El análisis multivariado mostró tres predictores de riesgo independiente: índice de esfericidad de la aurícula derecha > 1.32, TEP masiva y presión arterial media. Conclusiones: La evaluación combinada mediante ecocardiografía 3D de función ventricular y auricular derechas permiten una evaluación cuantitativa, predicción del riesgo para la presentación de complicaciones cardiovasculares y tiempo de estancia intrahospitalarios en pacientes con TEP aguda.

Introduction: Acute pulmonary embolism (PE) is a serious condition. Tridimensional Ecocardiography (3D ECHO) is an accessible, novel and accurate method for determination of right ventricular and atrial function. To date there are insufficient studies to assess their role in this entity. Objective: Determine the usefulness of ECO-3D in evaluating right atrial and ventricular function, and the risk of cardiovascular complications in patients with acute PE. Material and methods: 35 patients were admitted to the HC CMN SXXI with PE by CT angiogram, we analized 2D and 3D parameters by Philips iE33, right atrial and ventricular function (TomTec and QLAB 10). Hospital cardiovascular complications were evaluated. Results: The relative risk of major combined cardiovascular events for 3D ECHO was: right atrial sphericity index > 1.32; RR 20.3 95% CI 2.9-13.8; p = 0.0001, RVEF RR 7.3 95% CI 2.5-20.9; p = 0.0001, RVEDV> 77 mL RR 2.56 95% CI 7.3-20.9, p = 0.0001, RR 5.5 RVESV 95% CI 2.26-13.3; p = 0.0001. Multivariate analysis showed three independent risk predictors: right atrial sphericity index > 1.32, massive PE and mean arterial pressure. Conclusions: The combined assessment by 3D echocardiography right ventricular and atrial function allow a quantitative assessment, risk prediction for cardiovascular complications and presentation of time-hospital stay in patients with acute PE.

Correlación entre el índice de pérdida de trabajo-latido ventricular izquierdo y el área valvular aórtica en pacientes con estenosis aórtica / Correlation between left ventricular stroke work loss index and aortic valve area in patients with aortic stenosis

In echocardiographic evaluation of patients with aortic stenosis (AS), prospective studies have demonstrated that left ventricular stoke work loss index (LVSWLI) provide a more clinical efficacy than calculate of aortic valve area (AVA) by continuity equation to estimate severity of stenosis. The aim of this study was assess in our population of patients with AS the correlation between LVSWLI and AVA in regard to severity. MATERIAL AND METHODS: Forty nine patients with moderate and severe AS were evaluated by transthoracic echocardiography. Grades of AS were assessed by transaortic flow velocity (Vmax) and mean aortic transvalvular gradient (deltaP). AVA and LVSWLI were calculated and Pearson's and Spearman's correlation coefficients between both methods were assessed. Significance level was set at <0.05. RESULTS: The age of the patients was 66 +/- 13 (31-84 years). Thirty four (69%) patients had severe AS and 15 (31%) moderate AS. The Pearson's correlation coefficient between LVSWLI and AVA was 0.79 (p<0.04) and between LVSWLI and deltaP was 0.90 (p<0.03). The Spearman's correlation coefficient between LVSWLI and symptomatic status was 0.70 (rho = 0.70, p < 0.003). CONCLUSIONS: In patients with moderate and severe AS, the correlation between LVSWLI and deltaP is higher than correlation between LVSWLI and AVA. Moreover LVSWLI has a higher correlation with presence of symptoms than AVA.

La ecocardiografía en la remodelación cardíaca después del infarto agudo de miocardio / The echocardiography in cardiac remodeling after acute myocardial infarction

OBJECTIVES: The goal of this study was to assess the impact of left ventricular diastolic filling on remodeling and survival after acute myocardial infarction. METHODS: We studied 36 patients with first acute myocardial treated with thrombolytic agents. A Doppler echocardiography was performed at 24 hours, 30 and 90 days after infarction. It measured the relation between E and A waves peak velocities (E/A ratio) and of the E deceleration time (EDT, ms), as well as the flow propagation velocity using color mode M and the E'-wave by tissular Doppler at the lateral mitral ring. RESULTS: Patients were divided into three groups. Group I, restrctive filling (deceleration time < 140 ms, E/FPV > or = 2, E/A> 2 and E/E' > 15). Group II, elevated filling pressure (deceleration time > or = 140 ms, E/FVP > or = 2, E/A 1,2 and E/E' < or = 15). Group III, normal filling pressure (deceleration time > or = 140 ms, E/FVP < 2, E/A < 1 and E/E' < 15). The E/FPV showed a better correlation in the group with restrictive filling and left ventricular filling pressure was significantly greater than in the group with normal filling pressure at 90 days (2.18 +/- 0.90 vs. 1.5 +/- 0.35; r = 0.99; P = .0001). The end diastolic volume (EDV) was similar in the three groups 24 hours after infarction. EDV varied at 90 days after infarction in those patients that underwent successful coronary angioplasty. Group I, 142.48 +/- 32 vs. 112.48 +/- 32, r = 573; P < .0001). CONCLUSIONS: E/FVP, using color M-mode Doppler echocardiography, estimates left ventricular filling pressure and predicts left ventricular dilation after acute myocardial infarction.

Leucemias agudas en pacientes mayores de 60 años / Acute leukemias in over 60 years-old patients

Se realizó un estudio descriptivo en 50 pacientes con leucemia aguda y edad media al momento del diagnóstico, de 66 años. Se comprobó leucemia no linfoblástica aguda en el 80 por ciento de los casos y en el 22,5 por ciento, antecedentes de síndrome mielodisplástico u otro trastorno hematológico. Se presentó anemia en el 88 por ciento de los pacientes y niveles séricos elevados de deshidrogenasa láctica en el 60 por ciento. La visceromegalia fue más frecuente en la leucemia linfoblástica aguda. No se obtuvo remisión completa en pacientes con leucemia no linfoblástica aguda y la supervivencia media fue menor de 2 meses. En la leucemia linfoblástica aguda se obtuvo el 22,5 por ciento de remisión completa y una supervivencia media alrededor de 8 meses. Se confirmó el pronóstico desfavorable y la elevada mortalidad de los pacientes ancianos con esta enfermedad(AU)

Tratamiento quirúrgico de las lesiones de la columna vertebral en pacientes con mieloma múltiple / Surgical treatment of the vertebral column injuries in patients with multiple myeloma

Se estudiaron 20 pacientes con diagnóstico de mieloma múltiple, 8 hombres y 12 mujeres, edad promedio de 54 años, operados por lesiones de la columna vertebral para evaluar los resultados del tratamiento quirúrgico. Se comprobó que el mieloma G y el Bence Jones fueron los más frecuentes (9 y 6 pacientes), y la mayoría se hallaba en estadio III o II de Durie-Salmon (11 y 8, respectivamente); la localización más frecuente fue la dorsal (14 casos), en 12 eran de tipo osteolítica y 7 tenían destrucción extensa y fracturas. Se realizó recanalización intralesional con estabilización interna en 17; en otros 2, estabilización sin recanalización, y en 1, laminectomía solamente. Hubo complicaciones en 13 casos, y de los 18 procesos reportados, la sepsis local, la neuritis posoperatoria y los granulomas de la herida fueron los más frecuentes. En el momento de la intervención se reportó dolor, intenso o incapacitante en 13 pacientes y en 18 había manifestaciones de daño neurológico. La evaluación al año de la operación mostró que 12 (60 por ciento) pacientes no tenían dolor o era ligero, y 14 (70 por ciento), no presentaban manifestaciones neurológicas. Se halló que 5 enfermos fallecieron, en el primer año de la intervención, por complicaciones de la enfermedad mielomatosa, no relacionadas con la cirugía; uno de los fallecidos presentó recidiva de la lesión mielomatosa de la columna. Se concluyó que el tratamiento quirúrgico de las lesiones de la columna vertebral en los enfermos con mieloma múltiple y manifestaciones dolorosas y/o neurológicas puede ser una posibilidad terapéutica beneficiosa(AU)

Tratamiento quirúrgico de las lesiones de la columna vertebral en pacientes con mieloma múltiple / Surgical treatment of the vertebral column injuries in patients with multiple myeloma

Se estudiaron 20 pacientes con diagnóstico de mieloma múltiple, 8 hombres y 12 mujeres, edad promedio de 54 años, operados por lesiones de la columna vertebral para evaluar los resultados del tratamiento quirúrgico. Se comprobó que el mieloma G y el Bence Jones fueron los más frecuentes (9 y 6 pacientes), y la mayoría se hallaba en estadio III o II de Durie-Salmon (11 y 8, respectivamente); la localización más frecuente fue la dorsal (14 casos), en 12 eran de tipo osteolítica y 7 tenían destrucción extensa y fracturas. Se realizó recanalización intralesional con estabilización interna en 17; en otros 2, estabilización sin recanalización, y en 1, laminectomía solamente. Hubo complicaciones en 13 casos, y de los 18 procesos reportados, la sepsis local, la neuritis posoperatoria y los granulomas de la herida fueron los más frecuentes. En el momento de la intervención se reportó dolor, intenso o incapacitante en 13 pacientes y en 18 había manifestaciones de daño neurológico. La evaluación al año de la operación mostró que 12 (60 por ciento) pacientes no tenían dolor o era ligero, y 14 (70 por ciento), no presentaban manifestaciones neurológicas. Se halló que 5 enfermos fallecieron, en el primer año de la intervención, por complicaciones de la enfermedad mielomatosa, no relacionadas con la cirugía; uno de los fallecidos presentó recidiva de la lesión mielomatosa de la columna. Se concluyó que el tratamiento quirúrgico de las lesiones de la columna vertebral en los enfermos con mieloma múltiple y manifestaciones dolorosas y/o neurológicas puede ser una posibilidad terapéutica beneficiosa

Leucemias agudas en pacientes mayores de 60 años / Acute leukemias in over 60 years-old patients

Se realizó un estudio descriptivo en 50 pacientes con leucemia aguda y edad media al momento del diagnóstico, de 66 años. Se comprobó leucemia no linfoblástica aguda en el 80 por ciento de los casos y en el 22,5 por ciento, antecedentes de síndrome mielodisplástico u otro trastorno hematológico. Se presentó anemia en el 88 por ciento de los pacientes y niveles séricos elevados de deshidrogenasa láctica en el 60 por ciento. La visceromegalia fue más frecuente en la leucemia linfoblástica aguda. No se obtuvo remisión completa en pacientes con leucemia no linfoblástica aguda y la supervivencia media fue menor de 2 meses. En la leucemia linfoblástica aguda se obtuvo el 22,5 por ciento de remisión completa y una supervivencia media alrededor de 8 meses. Se confirmó el pronóstico desfavorable y la elevada mortalidad de los pacientes ancianos con esta enfermedad