Claude bernard: médico, fisiólogo, biólogo y creador de la medicina experimental (parte i) / No disponible

Claude Bernard, médico, fisiólogo y biólogo francés, se le considera como el Fundador de la Medicina Experimental. Fue uno de los fundadores de la de la Sociedad Francesa de Biología, catedrático de Fisiología en la Sorbona y miembro de la Academia de las Ciencias. Realizó importantes aportaciones en el campo de la fisiología, de la clínica y sobre todo en la investigación médica, donde defendió que las hipótesis científicas deben ser verificadas a través de los experimentos. Sus conocimientos filosóficos tuvieron aplicación en el método experimental. Muchas de sus aportaciones tienen vigencia actual a pesar del paso del tiempo

Claude Bernard, a French physician, physiologist and biologist, is considered the Founder of Experimental Medicine. He was one of the founders of the French Society of Biology, Professor of Physiology at the Sorbonne and a member of the Academy of Sciences. He made important contributions in the field of physiology, clinic and especially in medical research, where he argued that scientific hypotheses should be verified through experiments. Many of their contributions are valid today despite the passage of time

Claude bernard: médico, fisiólogo, biólogo y creador de la medicina experimental (parte II) / No disponible

Claude Bernard habría realizado el sorprendente descubrimiento de que la "materia inerte" y los "cuerpos vivos" no son la misma cosa. En los seres vivos, ocurren reacciones orgánicas intrínsecas a las que Bernard llamó "medio interior", estas reacciones ocurren a nivel celular y están orientadas a la propia conservación de los seres vivos. Claude Bernard, dio a la biología carta de naturaleza como auténtica ciencia, sin embargo, le impuso unos límites claros, jamás podrá pronunciarse acerca de la esencia de la vida, si bien será capaz de elaborar leyes relativas a sus condiciones físico-químicas. Para Claude Bernard, las hipótesis constituirían la auténtica teoría científica. El pensamiento de Bernard y su filosofía de la experimentación queda reflejada en la Introducción al estudio de la medicina experimental

Claude Bernard would have made the surprising discovery that "inert matter" and "living bodies" are not the same thing. To the intrinsic organic reactions that occur in living beings, Bernard called "internal mediu", these reactions occur at the cellular level and are aimed at the conservation of living beings. Claude Bernard, gave biology a letter of nature as a true science, however, imposed some clear limits, he can never pronounce on the essence of life, although he will be able to develop laws related to their physical-chemical conditions. Claude Bernard, considered the hypotheses as the true scientific theory. Bernard’s thinking and his philosophy of experimentation is reflected in the Introduction to the study of experimental medicine

[Neurological complications in a series of 205 orthotopic heart transplant patients]. / Complicaciones neurológicas en una serie de 205 trasplantes cardíacos ortotópicos.

INTRODUCTION: A heart transplant is the only effective therapeutic option open to many patients with severe heart failure and performing such an intervention is not free of complications. Little is known about the risk factors for neurological complications after a heart transplant. AIMS: The aim of this study was to identify the risk factors for neurological complications following a heart transplant and, more especially, those associated with epileptic seizures, encephalopathy, cerebrovascular accidents (CVA) and headaches. PATIENTS AND METHODS: We conducted a retrospective review of the records of 205 orthotopic heart transplant patients and collected clinical, haemodynamic and laboratory data before, during and after the intervention, using a standardised protocol. RESULTS: 95 patients (48%) presented neurological complications. Their frequencies were as follows: encephalopathy (16.6%), epileptic seizures (13.6%), neuromuscular disorders (10.6%), headaches (10.6%), CVA (10.1%), psychiatric disorders (2.2%) and infection of the central nervous system (2.2%). The risk factors for encephalopathy were post-transplant renal failure (RR: 4.6; CI 95%: 1.4-15), post-transplant hepatic failure (RR: 5.6; CI 95%: 1.5-22) and pre-transplant haemodynamic instability (RR: 4.3; CI 95%: 1.3-14); for epileptic seizures they were a cardiac index of < or = 2 L/min/m2 (RR: 23.8; CI 95%: 2-247) and extracorporeal circulation time > or = 115 min (RR: 11.3; CI 95%: 1-79); and for CVA the risk factor was post-transplant hepatic failure (RR: 12.9; CI 95%: 2.5-66). CONCLUSIONS: Neurological complications often occur after a transplant and are transient. Perioperative haemodynamic instability giving rise to cerebral ischemia and the metabolic disorders secondary to multiple organ failure are determining factors of encephalopathy, epileptic seizures and CVA.

Complicaciones neurológicas en una serie de 205 trasplantes cardíacos ortotópicos / Neurological complications in a series of 205 orthotopic heart transplant patients

Introducción. El trasplante cardíaco es la única opción terapéutica efectiva para muchos pacientes con insuficiencia cardíaca grave, pero su realización no está exenta de complicaciones. Los factores de riesgo de complicaciones neurológicas después del trasplante cardíaco se conocen poco. Objetivos. Identificar los factores de riesgo de complicaciones neurológicas tras un trasplante cardíaco, especialmente los asociados con crisis epilépticas, encefalopatía, accidente cerebrovascular (ACV) y cefalea. Pacientes y métodos. Se revisaron de forma retrospectiva las historias clínicas de 205 pacientes con trasplantes cardíacos ortotópicos y se recogieron los datos clínicos, hemodinámicos y de laboratorio, antes, durante y después de la cirugía, según un protocolo estandarizado. Resultados. Hubo 95 pacientes (48 por ciento) que presentaron complicaciones neurológicas. Fueron encefalopatía (16,6 por ciento), crisis epilépticas (13,6 por ciento), alteración neuromuscular (10,6 por ciento), cefalea (10,6 por ciento), ACV (10,1 por ciento), trastornos psiquiátricos (2,2 por ciento) e infección del sistema nervioso central (2,2 por ciento). Los factores de riesgo para la encefalopatía fueron la insuficiencia renal postrasplante (RR: 4,6; IC 95 por ciento: 1,4-15), la insuficiencia hepática postrasplante (RR: 5,6; IC 95 por ciento: 1,5-22) y la inestabilidad hemodinámica pretrasplante (RR: 4,3; IC 95 por ciento: 1,3-14); para las crisis epilépticas fueron índice cardíaco = 115 min (RR: 11,3; IC 95 por ciento: 1-79), y para el ACV fue la insuficiencia hepática postrasplante (RR: 12,9; IC 95 por ciento: 2,5-66). Conclusiones. Las complicaciones neurológicas postrasplante son frecuentes y transitorias. La inestabilidad hemodinámica perioperatoria productora de isquemia cerebral y las alteraciones metabólicas secundarias a fallo multiorgánico son determinantes de encefalopatía, crisis epilépticas y ACV (AU)

Introduction. A heart transplant is the only effective therapeutic option open to many patients with severe heart failure and performing such an intervention is not free of complications. Little is known about the risk factors for neurological complications after a heart transplant. Aims. The aim of this study was to identify the risk factors for neurological complications following a heart transplant and, more especially, those associated with epileptic seizures, encephalopathy, cerebrovascular accidents (CVA) and headaches. Patients and methods. We conducted a retrospective review of the records of 205 orthotopic heart transplant patients and collected clinical, haemodynamic and laboratory data before, during and after the intervention, using a standardised protocol. Results. 95 patients (48%) presented neurological complications. Their frequencies were as follows: encephalopathy (16.6%), epileptic seizures (13.6%), neuromuscular disorders (10.6%), headaches (10.6%), CVA (10.1%), psychiatric disorders (2.2%) and infection of the central nervous system (2.2%). The risk factors for encephalopathy were post-transplant renal failure (RR: 4.6; CI 95%: 1.4-15), post-transplant hepatic failure (RR: 5.6; CI 95%: 1.5-22) and pre-transplant haemodynamic instability (RR: 4.3; CI 95%: 1.3-14); for epileptic seizures they were a cardiac index of ≤ 2 L/min/m2 (RR: 23.8; CI 95%: 2-247) and extracorporeal circulation time ≥ 115 min (RR: 11.3; CI 95%: 1-79); and for CVA the risk factor was post-transplant hepatic failure (RR: 12.9; CI 95%: 2.5-66). Conclusions. Neurological complications often occur after a transplant and are transient. Perioperative haemodynamic instability giving rise to cerebral ischemia and the metabolic disorders secondary to multiple organ failure are determining factors of encephalopathy, epileptic seizures and CVA (AU)

[Treatment of an infection from an intravenous cardiac stimulation lead with extracorporeal circulation]. / Tratamiento de la infección del cable de estimulación cardíaca intravenoso mediante circulación extracorpórea.

The infection of a transvenous lead implanted for cardiac stimulation is a rare but serious complication, because it can lead to the development of septicemia, tricuspid endocarditis, recurrent pulmonary emboli or thrombus formation in right cardiac chambers. The most efficient treatment is the removal of the entire pacing system (generator and lead). We describe our experience with the removal of infected leads with the aid of cardiopulmonary bypass. Indications of this technique and its advantages and disadvantages over the percutaneous extraction methods are discussed. A review of the literature is also presented.

[Valve repair in tricuspid endocarditis in the drug addict. Apropos a case]. / Reparación valvular en la endocarditis tricúspide del drogadicto. A propósito de un caso.

Valve replacement, valvulectomy and valve repair are the alternatives for the surgical treatment of intractable tricuspid valve endocarditis. We present the case of a 24-year-old, HIV-positive Caucasian female, intravenous drug addict, with intractable tricuspid valve endocarditis, that was successfully treated with tricuspid valve repair. Advantages and major drawbacks of the different techniques are discussed and the appropriate literature is reviewed.

[Biphasic graft preservation for lung transplantation]. / Preservación bifásica del injerto en el trasplante pulmonar.

The standard, most widely applied way of preserving a lung for transplantation is infusion through the pulmonary artery (PA) of a pulmonaryplegic solution. In this prospective study, we analyzed the initial function of the pulmonary and cardiac graft after biphasic infusion of a solution introduced retrograde through the left auricle and antegrade through the PA. Twenty-six heart and lung grafts (9 unilateral and 17 bilateral) were preserved by cardioplegia and pulmonaryplegia (biphasic) between January 1996 and March 1997. Indicators of graft viability recorded were the ratio of arterial oxygen pressure (PaO2) to inspired fraction (FiO2), mean systemic pressure (MSP), mean pulmonary artery pressure (MPAP) cardiac output, pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR). The variables were recorded upon arrival of the grafts in the intensive care unit and in the first 24 h. Morbidity and mortality after heart transplants were recorded throughout a follow-up period of one month. After transplantation, most patients had a oxygenation coefficient (PaO2/FiO2) greater than 252 mmHg in the first 48 h. Hemodynamic parameters were also kept within normal ranges immediately after surgery and 24 h later. Mean ischemic time was 245 min for unilateral transplants, 215 for the first lung in double lung transplants, and 300 min for the second lung. In the early postoperative period, 3 patients suffered lung graft dysfunction, which was treated satisfactorily with nitric oxide (NO). No heart transplant patient suffered primary heart failure or left ventricular dilatation. We conclude that biphasic pulmonary preservation achieves satisfactory initial functional viability of the graft. Heart grafts removed simultaneously functioned successfully in the transplanted patient without additional pharmacological or mechanical support.

[Surgical treatment of hypertrophic myocardiopathy using a video-assisted technique. Apropos of a case]. / Tratamiento quirúrgico de la miocardiopatía hipertrófica mediante técnica vídeo-asistida. A propósito de un caso.

The use of endoscopic technology is gaining more and more popularity within cardiac surgery. We present a case employing endoscopic instruments in the resection of the interventricular septum in a patient with hypertrophic cardiomyopathy unresponsive to medical treatment. Advantages of this technique are discussed.

[Revascularization surgery in the acute phase of myocardial infarct]. / Cirugía de revascularización en la fase aguda del infarto agudo de miocardio.

Hospital deaths from acute myocardial infarction are the consequence of cardiac arrhythmias and cardiac pump failure. However, for a limited period of time following the interruption of the coronary blood flow, a significant portion of the myocardium remains in a situation of "reversibility", which means that if the coronary flow is reestablished, the infarcted area is reduced. Pos-acute myocardial infarction reperfusion methods include thrombolytic therapy, percutaneous transluminal coronary angioplasty and surgical revascularization of the myocardium. The indications for the latter method, which is employed when procedures such as thrombolysis and percutaneous transluminal coronary angioplasty have failed, are analyzed and the results are discussed in terms of the time elapsed since the onset of acute myocardial infarction, ejection fraction, the number of vessels involved, the type of infarction and the concurrence of cardiogenic shock. The advisability of adopting different strategies and priorities for surgical revascularization in certain situations is indicated.

[Surgical treatment of atrial fibrillation]. / Tratamiento quirúrgico de la fibrilación auricular.

Atrial fibrillation is the most frequently found sustained arrhythmia. It increases the risk of thromboembolism and adversely affects cardiac performance because of loss of atrial kick. New surgical treatments of atrial fibrillation have been developed to ablate the origin of abnormal impulses on the atrium. The left atrial isolation and the corridor operation restores the regular rhythm, but do not reduce the risk of thromboembolism because the left atrium may continue to fibrillate. The maze operation has proven to be effective in both converting to sinus rhythm and regaining atrial contractility. However, this method is meticulous and time-consuming and takes more cardiac ischemic time, especially when other cardiac procedures are performed simultaneously.

[Multiple organ transplants]. / Trasplantes multiorgánicos.

The authors review the literature dealing with heart transplantation in combination with that of other extrathoracic solid organs. Heart-lung transplantation was not considered in this review as it is a well-defined procedure that does not strictly fit the concept of multiorgan transplantation. We present the experience of the first case of heart-liver transplantation involving organs from two different donors reported in the world medical literature. The recipient was a 9-year-old boy with type II homozygous familial hypercholesterolemia. Nine years later, the activity of the patient is normal, as are his liver and heart functions. Our series consists of fours cases of heart-kidney transplantation in patients who were undergoing periodic hemodialysis to treat glomeruloangiosclerosis and presented concomitant end-stage heart disease. On two occasions, both heart and kidney were transplanted during the same surgical procedure with organs from a single donor. The first to be performed was heart transplantation, and the kidney transplantation procedure was undertaken once hemodynamic stability was achieved. The remaining two patients had undergone kidney transplantation two and three years prior to heart transplantation. All the patients are alive, with NYHA class I, and present good ventricular and kidney function. The mean follow-up period is 5 years.

[Renovascular hypertension: results of surgical treatment with a three-year follow-up (author's transl)]. / Hipertensión arterial vasculorrenal: resultados del tratamiento quirúrgico con un seguimiento medio de tres años.

Between 1966 and December 1979, 58 patients with renovascular hypertension were surgically treated at our center. Follow-up was a minimum of one year in all patients and in all cases permeability of revascularization was assessed through angiography from one to six months after surgery. The mean follow-up was 39 months. Thirty-eight (65.5%) were male and 20 (34.6%) female. Age of onset was between 3 and 53 years (mean 36.3 years). Etiology was arteriosclerotic in 27 cases and fibrous dysplasia in all its manifestations in another 27, in 2 cases vascular compression due to retroperitoneal fibrosis and renal hypoplasia in the remaining two. In 4 cases lesions were bilateral. The cure rate was 37 patients (63.8%), Improvement in 16 (27.6%), while there was no improvement in 5 (8.6%). Surgical mortality rate was nil. The different techniques used, indications, long and short term complications and different results according to etiology are discussed.