Pandemia y atencion ambulatoria pediatrica de alta complejidad en un hospital publico. Experiencia de un modelo de atención con uso de telemedicina en niños/as con nutrición parenteral domiciliaria / Pandemic and highly complex pediatric outpatient care in a public hospital. Experience of a care model with the use of telemedicine in children with home parenteral nutrition

Introducción: Los pacientes que reciben nutrición parenteral domiciliaria (NPD) en seguimiento desde el Hospital requieren un monitoreo que debió modificarse por la pandemia por SARS-CoV-2. Objetivo: Valorar la utilización y el impacto en los resultados, de estrategias alternativas a la atención presencial de pacientes con NPD, empleando telemedicina, durante el inicio de la pandemia por SARS-CoV-2, comparándolas con las prácticas habituales previas. Materiales y métodos: Estudio analítico descriptivo retrospectivo que analizó el monitoreo, la evolución y las complicaciones de pacientes con NPD asistidos en el Hospital en el período previo a la pandemia (1/4/2019 y 31/3/2019) y durante su primer año (1/4/2020 a 31/3/2021), basado en la revisión de historias clínicas y bases de datos de complicaciones. Resultados: Las características demográficas, diagnósticos, procedencia y provisión de la NPD fueron similares en los dos períodos. Durante el período de la pandemia se redujeron en forma significativa el número de controles presenciales y aumentaron los realizados por telemedicina en forma sincrónica (con una modalidad pautada previamente), y los controles por profesionales locales. La participación de los cuidadores en los procedimientos de administración de la NPD aumentó en pandemia. Las tasas de complicaciones, re-internaciones, el número de inicios y suspensiones de tratamiento fueron similares en ambos períodos. Conclusiones: En pandemia fue posible implementar y monitorizar la NPD utilizando telemedicina sin observar afectación significativa de la evolución, las complicaciones de la enfermedad y del tratamiento. El seguimiento mediante telemedicina sincrónica resultó útil y se incorporará como una herramienta más al monitoreo habitual sin reemplazarlo

Introduction: Patients receiving home parenteral nutrition (HPN) under follow-up from the Hospital require monitoring that had to be modified due to the SARSCoV-2 pandemic. Objective: To assess the use and the impact on the results of other care strategies for patients with HPN, using telemedicine, during the beginning of the SARS CoV2 pandemic, compared with previous usual practices.Materials and methods: Retrospective descriptive analytical study that analyzed the monitoring, evolution and complications of patients with HPN assisted in the Hospital, in the period before pandemic ( 4/1/2019 to 3/31/2020) and during the first year of SARS CoV-2 pandemic (4/1/2020 to 3/31/2021), according to data obtained from medical records and databases. Results: demographic characteristics, diagnoses, place of residence and HPN provision were similar in both periods. During the pandemic period, the number of face-to-face controls were significantly reduced and those carried out by telemedicine synchronously, and by local professionals increased. The participation of caregivers in the administration procedures of the HPN increased in the pandemic period. The rates of complications, readmissions, number of initiations and suspensions of home treatment were similar in both periods. Conclusions: It was possible to implement and monitor HPN during pandemic. The evolution and complications of the disease and treatment were not significantly affected. Synchronous telemedicine follow-up was successfully useful and will be incorporated as another tool to regular monitoring

Short-lived corpora lutea syndrome in anoestrous ewes following 17ß-oestradiol or MAP treatments applied before an allogenic sexual stimulation with rams and oestrous ewes.

When induced to ovulate during anoestrus, ewes, does and cows frequently develop a short-lived corpora lutea (SLCL) syndrome associated to lack of previous progesterone. Exogenous progesterone precludes SLCL by blocking oxytocin endometrial receptors, thus inducing normal life-span CL (NLCL). Paradoxically, circa 50% of unprimed ewes do not develop SLCL. We report results from 3 trials assessing follicular, oestrous, ovulatory, and luteal end-points after 17ß-oestradiol or MAP treatments. Oestradiol benzoate (50µg) induced follicular turnover, provoked ovulation in 40% (24/60) of ewes treated (93% of which developed SLCL), but did not affect the incidence of SLCL (26/53) after an allogenic sexual stimulation (ASS) by rams and oestrous ewes. By the onset of the ASS, most NLCL ewes (26/27) had already experienced turnover of their largest follicle, had smaller largest and second largest follicles, and ovulated their largest follicle more frequently than SLCL ewes did. Most SLCL ewes (19/25) did not ovulate their largest follicles, ovulating instead smaller follicles of identical size to those of NLCL ewes. Priming (40mg of MAP for 12 days) was partially effective at preventing SLCL even when terminated 14 days in advance of an ASS, but failed at completely preventing SLCL when terminated 6 or more days in advance. The coupling of a timed acquisition of full steroidogenic capability before ovulation with a system of endometrial oestradiol-progesterone-oxytocin receptors linked in an unstable equilibrium controlling the amplification of the luteolytic feed-forward loop of oxytocin and prostaglandin F(2)α explains occurrence and relative incidences of both NLCL and SLCL, and links proximate and ultimate causes of the SLCL syndrome.

Linfoma no Hodgkin primario de vagina / Primary non Hodgkin's lymphoma of the vagina

La afectación primaria del tracto genital femenino de los linfomas no Hodgkin es poco frecuente (2 por ciento de los linfomas primarios extraganglionares). Los órganos más afectados son los ovarios seguidos del cérvix, siendo la localización endometrial y vaginal extremadamente rara. Presentamos el caso de una paciente de 44 años diagnosticada de linfoma primario de vagina, estadio IE A, con remisión completa tras tratamiento combinado quimioterápico y quirúrgico. Es importante tener presente estas raras aunque posibles localizaciones de linfomas para evitar que se puedan confundir con lesiones inflamatorias u otros tipos de tumores que nos lleven a un fracaso terapéutico.

Primary non-Hodgkin lymphomas rarely involve the female genital tract (2 percent of primary extranodal lym-phomas). The ovaries followed by the cervix are the most common affected sites while the involvement of the endometrium and vagina is extremely rare. We report the case of a 44 year old woman with a primary lymphoma of the vagina, stage IE A, with complete remission after combined chemotherapy and surgical treatment. These rare but possible locations must be kept in mind to avoid misdiagnosis with inflammatory lesions or other types of tumors which may lead us to a therapeutic failure.

Introduction of meat sheep breeds in extensive systems of Patagonia: lamb growth and survival.

Genotype effects on lamb growth, survival, and commercial finishing were estimated in a 5-yr study aimed at assessing potential benefits from introducing meat breeds into extensive sheep systems of northeastern Patagonia. Five ram [Corriedale: CO; Border Leicester: BL; Ile de France: IF; Texel: TX; and synthetic CRIII (25% Merino, 37.5% IF, 37.5% TX)] and 5 dam (CO; synthetic CRIII; BLCO: BL x CO; IFCO: IF x CO; and TXCO: TX x CO) genotypes were represented in the study. Data were collected from 1,426 born and 1,258 weaned lambs of 9 resulting genotypes (CO x CO, BL x CO, IF x CO, TX x CO, CRIII x CO, CRIII x BLCO, CRIII x IFCO, CRIII x TXCO, and CRIII x CRIII). Birth weight was recorded on all lambs; subsequently, BW and BCS (scale 1 to 5) were recorded at regular intervals until weaning. Body weights were adjusted to 60 and 90 (weaning) d of age, and ADG were calculated from the adjusted BW for the periods 0 to 60 d and 60 to 90 d; BCS was adjusted to 90 d. Survival to weaning and percentage of lambs reaching commercial finishing (BW >or= 23 kg and BCS >or= 2.5 points) were also recorded. Significant (P < 0.05) genotype x litter size interactions were detected for birth weight and ADG 60 to 90 d. With the exception of CRIII x CO, crossbred and synthetic genotypes presented greater (P < 0.05) ADG 0 to 60 d and BW at 60 and 90 d than CO x CO lambs. Second cross lambs reared as singles presented greater ADG 60 to 90 d (P < 0.05) than BL x CO, TX x CO, and CRIII x CO, but less (P < 0.05) ADG 60 to 90 d, and no differences were observed for twins. The IF x CO, CRIII x BLCO, CRIII x IFCO, and CRIII x CRIII genotypes showed greater BCS at 90 d (P < 0.05) than CO x CO. The probability of greater commercial finishing for crossbred and synthetic genotypes relative to CO x CO was at least 79%. Probabilities of greater survival to weaning in CO x CO and CRIII x BLCO lambs relative to IF x CO, TX x CO, CRIII x CO, and CRIII x CRIII lambs were greater than 81%. Results indicate significant improvements in lamb BW and saleable lambs from the introduction of meat genotypes. Among the terminal sire breeds evaluated, BL and IF would produce the greatest impact. Differential nutritional management of pregnant ewes carrying twins and of twin lambs beyond 60 d should be implemented to mitigate litter size x genotype interactions constraining growth potential benefits, which may be critical for northeastern Patagonia conditions.

Ram-induced oestrus and ovulation in lactating and weaned Corriedale ewes.

Two experiments were conducted in consecutive years in which recently (Experiment 1) or temporarily (Experiment 2) weaned ewes and matched post-partum non-lactating flockmates (DRY) were exposed to a stimulus group of rams and oestrous ewes (10 and 20 in Experiment 1, 20 and 20 in Experiment 2) for 28 days in spring. Lactating ewes (n = 130) in Experiment 1 were isolated from their lambs 4 (W-4), 2 (W-2), 1 (W-1) or 0 (W-0) days in advance and exposed along with a group of 32 DRY flockmates. Lactating ewes in Experiment 2 (n = 230) were allocated to an unreplicated factorial of two levels of temporary weaning before stimulation (B0: control; B24: lambs removed 24 h before stimulation) by four levels of ewe-lamb contact imposed at the start of the stimulation (A0: control; A12, A24 and A36: lamb-ewe separation during the initial 12, 24 or 36 h of exposure); DRY ewes (n = 54) acted as an augmented factorial control. Oestrus (rump marks) and ovulation (laparoscopy on day 5 and on day 28 (Experiment 1) or day 32 (Experiment 2)) were recorded. Ovulation and oestrous responses in Experiment 1 were similar for DRY (90.6% and 55.2%, respectively) and recently weaned ewes (83.8% and 53.7%, respectively). Amongst recently weaned ewes, the immediate ovulation response to the rams and the proportion of ewes still cycling by day 28 tended to be lower (P = 0.065 and P = 0.011) in ewes weaned on the day of ram exposure (71.9% and 54.8% v. 87.8% and 80.0%, respectively). Ovulation rate was lower (P < 0.003) in W-2 ewes (1.3 ± 0.10) than in the other recently weaned groups. In Experiment 2, ovulation (83.3%) and oestrous (68.9%) responses in DRY ewes were higher (P = 0.022 and P = 0.053, respectively) than in lactating ewes (66.2% and 51.0%, respectively). More ewes ovulated (P = 0.036) in B24 (70.5%) than in B0 (61.8%). Ewes having their lambs returned 12 h after the onset of stimulation (A12) had poorer ovulation responses (54.9%) than control ewes (A0, 72.9%, P < 0.05); this was probably associated to lamb restitution after the sunset. Main conclusions were that (i) the presence of the lambs is a depressing factor of both ovulation and oestrous responses to the ram effect in lactating ewes, (ii) the ovulation response of lactating ewes will probably benefit from removing lambs for a period of 24 h before the onset of stimulation, (iii) until additional information becomes available, temporary weaning protocols should be designed avoiding lamb restitution during the night.

Role of early experience in the development of preference for low-quality food in sheep.

Domestic ruminant selectivity induces floristic changes in pasturelands, risking sustainability and limiting the subsequent availability of susceptible plant species. Development of preferences for species of lower nutritional quality may help to overcome those problems. In this study, we tested the hypothesis that early experience of sheep with a low-quality food (LQF) in a nutritional enriched context increases preference for LQF in adulthood. We predicted a higher proportional consumption of LQF in experienced lambs (EL) than in inexperienced lambs (IL) in choice situations involving LQF and alternative foods. Additionally, we determined intake of LQF by EL and IL at different levels of high-quality food (HQF) availability. From 60 to 210 days of age, EL were fed in separated feed bunks mature oat hay (LQF) simultaneously with sunflower meal (SM) and corn grain (CG), whereas IL were fed alfalfa hay (HQF) simultaneously with SM and CG. After exposure, EL and IL were offered LQF in free choice situations involving alternative foods, and also at five levels of HQF availability (100%, 75%, 50%, 25% and 0% of ad libitum intake). Proportional consumption of LQF was lower or similar in EL than IL. Intake of LQF was also lower or similar in EL than IL at all levels of HQF availability, except when the LQF was the only food available. Our results did not support the hypothesis that early experience with a LQF in a nutritional enriched context increases preference for LQF in adulthood. On the contrary, experience with LQF diminished subsequent preference for LQF in adulthood. It is proposed that, in the conditions of our study, continuous comparison between the LQF and the high-quality supplements (CG and SM) during the early exposure period lead to devaluation of LQF by EL through a simultaneous negative contrast effect.

LH response of seasonally anovular Corriedale ewes acutely exposed to rams and estrous ewes.

Serial blood sampling before and after exposing four anovular Corriedale ewes to a group of rams and estrous ewes during the non-breeding season revealed a pattern of LH secretion similar to that previously observed in Merinos. Mean LH values doubled (P<0.001) from 0.24+/-0.06 microgL(-1) (mean+/-s.e.m.) before to 0.55+/-0.05 microgL(-1) after 2h of visual, auditory, and odor exposure to rams and estrous ewes in an indoor facility. A non-significant (P<0.17) increase of LH pulses per hour was also observed (0.7+/-0.3 pulses per hour before compared with 1.3+/-0.3 during stimulation). All four ewes had recently formed corpora lutea by five days after stimulation. Results are consistent with the pattern of sudden increase and sustained release of LH observed in other sheep breeds, particularly the Merino.

Cinco años de experiencia con malla suburetral retropubiana ubre de tensión en el manejo de la incontinencia urinaria de esfuerzo en el Hospital Regional de Valdivia / Five years experience with retropubic tension-free vaginal tape in patients with stress urinary incontinence treated at the Regional Hospital of Valdivia

Antecedentes: La incontinencia de orina de esfuerzo (IOE) es una patología ginecológica de consulta frecuente, por lo que es importante el enfrentamiento de esta para obtener resultados efectivos a corto y largo plazo. Objetivo: Presentar la experiencia de 5 años en la corrección de la IOE con la técnica quirúrgica de malla de prolene suburetral libre de tensión retropubiana en el servicio de Ginecología del Hospital Regional de Valdivia. Método: Se incluyen pacientes con IOE moderada y severa, primaria o recidivada, estudiadas con hidrodinamia. Se insertó malla suburetral, con revisión posterior de la vejiga por cistoscopia para descartar lesión vesical. La sonda Foley se mantuvo por 24 horas. Resultados: Se intervinieron 58 pacientes con edad promedio de 51 años (rango: 36-76 años), en 48 pacientes se asoció otra cirugía (histerectomía y plastia anterior y/o posterior). No hubo complicaciones en el intraoperatorio. Logramos un seguimiento en 55 pacientes (94,8 por ciento) y 3 (5,2 por ciento) se perdieron de control. Cincuenta pacientes se encuentran sin IOE (90,9 por ciento), con una media de seguimiento de 24 meses (rango: 4-50 meses). Cuarenta y dos pacientes se encuentran actualmente asintomáticas (85,5 por ciento) y 8 (14,5 por ciento) presentan vejiga hiperactiva en el seguimiento. Conclusión: La técnica de malla suburetral libre de tensión retropubiana es una alternativa eficaz a corto y a largo plazo en el enfrentamiento quirúrgico de la IOE, permitiendo realizar otra cirugía vaginal simultáneamente.

Reparación de polapso vaginal anterior con malla de prolene / Anterior vaginal prolapse repair with prolene mesh

ANTECEDENTES: La reparación del prolapso vaginal anterior presenta una alta tasa de recurrencia. La colporrafia anterior con malla de prolene es una buena alternativa quirúrgica que ha obtenido buenos resultados a largo plazo. OBJETIVO: Evaluar el resultado anatómico y la evolución de la colporrafia anterior con malla de prolene. MÉTODO: Estudio de cohorte prospectivo para evaluar el resultado quirúrgico. RESULTADOS: Ingresaron 35 pacientes con una edad promedio de 61,4 años; 85,7% de ellas estaba en postmenopausia y 3% utilizaba terapia hormonal de reemplazo. La principal patología asociada fue la incontinencia de orina de esfuerzo (54,3%). El estado del piso pelviano preoperatorio correspondió a 31,4% cistocele grado II, 48,6% cistocele grado III y 20% cistocele grado IV. Se asoció prolapso uterino en 88,6% de los casos y 74,3% con prolapso de la pared posterior. No hubo complicaciones intraoperatorias. Hubo complicaciones postoperatorias en 4 pacientes (11,4%). Una paciente presentó erosión de la malla (2,9%). El seguimiento fue de 1 a 11 meses. En la evaluación postoperatoria de las pacientes con cistocele grado II 80% corrigió a grado 0; para cistocele grado III 72% corrigió a grado 0. Un 11% llegó a grado I y 17% grado II. Para el grupo con cistocele grado IV, 71% resultó en grado 0 y 29% grado II. CONCLUSIÓN: La técnica presentada solucionó un severo problema de calidad de vida de las pacientes afectadas. Se requiere un mayor número de casos y tiempo de seguimiento para su recomendación definitiva.

BACKGROUND: Repair of anterior vaginal prolapse present a high rate of recurrence. Anterior colporrhaphy plus prolene mesh is a surgical option with optimal long term results. OBJECTIVE: To evaluate anatomical results and evolution of anterior colporrhaphy with prolene mesh. METHOD: A prospective cohort study was made to evaluate the surgical outcomes. RESULTS: 35 patients were recruited with a median age of 61.4 years. 85.7% of them were in postmenopausal status and 3% were using hormone replacement therapy. Stress urinary incontinence was associated in 54.3% of the cases. The pelvic floor stage at entry was 31.4% cysthocele stage II, 48.6% stage III and 20% cysthocele stage IV. Uterine prolapse was present in 88.6% of cases and the posterior wall was compromised in 74.3%. There were no intraoperatory complications. Postoperatory complications occurred in 4 patients (11.4%). Only in one case the mesh eroded (2.9%). The follow up was from 1 to 11 months. Of the patients with cysthocele stage II at the moment of evaluation, 80% were at stage 0. For cysthocele stage III 72% turned to stage 0. 11% turned to stage I and 17% to stage II. The cases that presented cysthocele stage IV 71% were at stage 0 and 29% at stage II. CONCLUSION: This technique solved an important quality of life problem of the affected patients. A higher number of cases and time of follow up is needed to recommend this technique definitely.

Histodytes microocellatus gen. et sp. nov. (Dracunculoidea: Guyanemidae), a parasite of Raja microocellata on the European Atlantic coast (north-western Spain).

We describe a new genus, Histodytes, within the family Guyanemidae (Nematoda: Spirurida: Camallanina: Dracunculoidea). The type species, Histodytes microocellatus n. sp., is found in the gill, heart, kidney, spleen and gonad tissues of Raja microocellata from the continental shelf off the estuary of Muros y Noia (north-western Iberian Peninsula). Histodytes differs morphologically from the three other genera described to date in this family ( Guyanema, Travassosnema, Pseudodelphys) because the vulva is situated a long way back from the oesophageal-intestinal union, and the anterior uterine branch almost reaches to the level of this union. In addition, it can be distinguished from Guyanema and Travassosnema by the absence of caudal alae in the male, and from Travassosnema by the much greater length of the glandular oesophagus and the lack of an oesophageal appendix. Histodytes is the only guyanemid genus described to date from an elasmobranch and the first one to be found on the European Atlantic coast.

[Cholesterolemia and arterial pressure levels. Relationship with different chronic stress configurations]. / Niveles de colesterolemia y de presión arterial. Su relación con diferentes configuraciones de estrés crónico.

Several experimental studies refer to the relationship between chronic stress, cholesterolaemia levels and variations in the arterial blood pressure. Our objective is to establish a significant statistical correlation between stress factors, hypertension and hypercholesterolaemia in the studied people. 146 agents were tested among teachers an others employees from the National University of Río Cuarto, who voluntarily went clinical control, reporting data such as arterial pressure, cholesterolaemia, patholgoic records; an standized survey was done considering potentially stress factors, grouped in four different types of stress: (1)-psychoalimentary, (2)-pure psychic, (3)-laboral, (4)-psychofamiliar, giving each of them a value whose addition gane a stress potential factor. The results show that 45.89% of the people studied have hypercholesterolaemia (higher 200 mg% with a mean 237.09 +/- 29.97) being significantly higher (P = 0.001) in the group of employees older than 40 years old., 7.53% of the people showed high arterial pressure, and the 90.90% of this people have hypercholesterolaemia. The hypercholesterolaemic group showed a marked incidence of stress rates higher, with respect to the total people in the four types of stress studied. Significative higher values were observed in the laboral and familiar stress types coinciding with the hypertense group of individuals. According to the collected data we conclude that the relationship between cholesterolaemia, arterial pressure and chronic stress varies with the different types of stress considered, and seem adequate index of stressors levels of studied people.

Embarazo cervical: un reto al gineco-obstetra / Cervical pregnancy

El embarazo cervical es una complicación obstétrica poco frecuente pero que representa un riesgo vital para las pacientes. Actualmente es posible efectual un diagnóstico precoz del embarazo cervical basado en el uso de la ultrasonografía transvaginal y en la medición de los niveles de ß-HCG. Su manejo terapéutico es controversial existiendo numerosas alternativas de tratamiento destinadas a disminuir la mortalidad y preservar la fertilidad de las pacientes. Nuestro objetivo es presentar un caso clínico de un embarazo cervical, estudiado y manejado en nuestro servicio, y discutir los elementos diagnósticos y terapéuticos actuales

Niveles de colesterolemia y de presión arterial. Su relación con diferentes configuraciones de estrés crónico. / [Cholesterolemia and arterial pressure levels. Relationship with different chronic stress configurations]

Several experimental studies refer to the relationship between chronic stress, cholesterolaemia levels and variations in the arterial blood pressure. Our objective is to establish a significant statistical correlation between stress factors, hypertension and hypercholesterolaemia in the studied people. 146 agents were tested among teachers an others employees from the National University of Río Cuarto, who voluntarily went clinical control, reporting data such as arterial pressure, cholesterolaemia, patholgoic records; an standized survey was done considering potentially stress factors, grouped in four different types of stress: (1)-psychoalimentary, (2)-pure psychic, (3)-laboral, (4)-psychofamiliar, giving each of them a value whose addition gane a stress potential factor. The results show that 45.89

of the people studied have hypercholesterolaemia (higher 200 mg

with a mean 237.09 +/- 29.97) being significantly higher (P = 0.001) in the group of employees older than 40 years old., 7.53

of the people showed high arterial pressure, and the 90.90

of this people have hypercholesterolaemia. The hypercholesterolaemic group showed a marked incidence of stress rates higher, with respect to the total people in the four types of stress studied. Significative higher values were observed in the laboral and familiar stress types coinciding with the hypertense group of individuals. According to the collected data we conclude that the relationship between cholesterolaemia, arterial pressure and chronic stress varies with the different types of stress considered, and seem adequate index of stressors levels of studied people.

Time to first shock in implantable cardioverter defibrillator (ICD) patients with Chagas cardiomyopathy.

UNLABELLED: The time to first ICD shock has been extensively studied in patients with coronary artery disease (CAD). However, there are no published data on ICD shocks in patients with Chagas cardiomyopathy (ChC). The occurrence of the first appropriate ICD shock during the first 6 months of follow-up in 20 patients with ChC (group 1) and 35 CAD patients (group 2) was analyzed retrospectively. All patients had received a third-generation pectoral ICD for ventricular tachycardia or fibrillation (VT/VF). Indications for ICD implantation were refractoriness to drug therapy or noninducibility of VT/VF at EPS in cardiac arrest survivors. RESULTS: The mean age, left ventricular ejection fraction (LVEF), and sex in groups I and II were 57.4 +/- 7 years versus 64 +/- 9 (P < 0.01), 30.9% +/- 10% versus 32.9% +/- 10% (P = NS), and 10 men versus 31 women (P < 0.005), respectively. Six months after ICD implantation, 85% (17/20) group I patients received appropriate ICD shocks versus 51% (18/35) in group 2, a statistically significant difference (P < 0.02, RR: 1.65, OR: 5.35). CONCLUSIONS: The incidence of appropriate ICD shocks within the first 6 months postimplantation was significantly higher in ChC patients than in CAD patients. ChC patients were younger and more often women than CAD patients.

Implantable cardioverter defibrillators in patients with Chagas' disease: are they different from patients with coronary disease?

Chagas' disease is a parasitic affliction, endemic to certain regions of South America, which may lead to a chronic dilated nonischemic cardiomyopathy. Ten Chagasic patients were compared to 18 coronary patients undergoing transvenous ICD implantation for ventricular tachycardia (VT), ventricular fibrillation (VF), or aborted cardiac arrest. Indications for ICD implantation were either drug intolerance or refractoriness, or no inducible tachyarrhythmia at EPS. There were no statistically significant differences between the Chagas and coronary artery disease groups with respect to age (60.2 vs 62.6 yrs), NYHA Class II (50% vs 62%), ejection fraction (31.1% vs 29.7%), and incidence of cardiac arrest (20% vs 33%), respectively. The following ICD implant and long-term follow-up variables were compared between the two groups: pacing threshold (0.94 V vs 0.95 V), defibrillation threshold (19.5 J vs 19.6 J), number of VT episodes (414 vs 435), number of spontaneous VT terminations (86 vs 187), percent efficacy of antitachycardia pacing (93.9% vs 92.1%), and total number of shocks (112 vs 145). These differences were not statistically significant. We conclude that patients with Chagas' disease, compared with coronary artery disease patients, have similar clinical characteristics leading to ICD implantation. Furthermore, no differences were found with respect to ICD and long-term follow-up characteristics between the two groups.

[Handling of Foley catheter regarding urinary retention syndrome following vaginal surgery]. / Manejo de la sonda Foley en relación al síndrome de retención urinaria posterior a cirugía vaginal.

The post surgical urinary retention syndrome is a frequent problem after vaginal surgery. In many medical centers it is used a transurethral vesical drainage for three to five days with or without vesical reeducation to prevent it. In order to determine the importance of the time of drainage and vesical reeducation in the presence of this syndrome 106 patients submitted to vaginal surgery were studied at random and prospectively, in our service. Patients were distributed in three groups: the first one, with 37 women in which the drainage was withdrawn at 24 hours; in the second group it was retired at 72 hours and in the third group the drainage was removed at 72 hours with previous vesical reeducation. The results show that those patients who were less time under vesical drainage presented a minor frequency of urinary retention after surgery (24.3% vs 30.7% and 43.7%).

Manejo de la sonda Foley en relación al síndrome de retención urinaria posterior a cirugía vaginal / Management of Foley catheter in relation to urinary retention after vaginal surgery

El síndrome de retención urinaria postoperatorio es una complicación frecuente en la cirugía vaginal y para obviarlo, en muchos centros se propicia el uso de drenaje vesical transuretral por tres a cinco dias, con o sin reeducación vesical. Con el fin de determinar si el tiempo de permanencia del drenaje y la reeducación vesical influyen sobre la ocurrencia de este síndrome, se estudiaron en forma prospectiva y randomizada 106 pacientes sometidas a cirugía vaginal en nuestro servicio, divididas en tres grupos: el primero constituído por 36 pacientes a las que se les retiró el drenaje vesical a las 24 horas; el segundo compuesto por 37 pacientes en las que el drenaje fue retirado a las 72 horas y el tercero que reunió a 33 pacientes en las que la sonda fue retirada a las 72 horas previa reeducación vesical. Nuestros resultados muestran que las pacientes que presentaron con menor frecuencia retención urinaria postoperatoria, fueron aquellas que tuvieron un menor tiempo de drenaje vesical (24,3 por ciento vs 30,7 por ciento y 43 por ciento) por lo que se concluye que el mantener la sonda Foley por más de 24 horas y realizar reeducación vesical, no disminuye la frecuencia del síndrome de retención urinaria y que sólo constituye un mayor riesgo de infección urinaria y de prolongación del tiempo de hospitalización