Laparoscopy-assisted trans gastric wedge resection: A safe treatment for gastric pyloric liposarcoma: A case report and literature review.

Background: Gastric liposarcoma (GL) is extremely rare and radical surgery has been the conventional treatment, even in small tumors. Laparoscopic wedge resection has been reported worldwide for subepithelial tumors of the stomach. Case presentation: The patient was an asymptomatic 63-year-old man presenting with a subepithelial gastric tumor. The esophagogastroduodenoscopy showed a 3 cm ulcerated soft tumor located in the posterior wall of the antrum just above the pylorus. Two preoperative biopsies were performed with a negative result for malignant neoplasm. Dynamic computerized tomography revealed 35 × 35 mm well-defined pyloric mass with fat density. Despite the difficult location of the tumor, function-preserving surgery was performed. Surgery was initiated by a laparoscopic approach with four trocars. After the dissection of the greater omentum, the greater curvature and the posterior wall of the stomach were exposed. A gastrostomy was performed in the anterior wall of the antrum. Due to the difficulty in identifying the tumor location, a mini-laparotomy was conducted. After assessing the pylorus and section parameters, the tumor was extracted by gastrostomy and resected with a linear stapler. The patient was discharged after five days with no complications. The histological diagnosis was a well-differentiated liposarcoma. Resection margins were clear. The tumor cells tested negative for MDM2. No adjuvant therapy was indicated. The patient is alive without recurrence. Conclusions: Despite its rarity, gastric liposarcoma should be respected for differential diagnosis in submucosal tumors. The main diagnostic method is histological, and surgery is the conventional treatment without yet having a consensus. Minimally invasive wedge resection might be a suitable treatment even if the location is close to the pylorus. Multicenter studies are required to obtain better results in the management of this pathology.

Predictive factors of lymphatic metastasis and evaluation of the Japanese treatment guidelines for endoscopic resection of early gastric cancer in a high-volume center in Perú.

Purpose: This study aimed to identify the predictive factors of lymph node metastasis (LNM) in patients with early gastric cancer (EGC) and to evaluate the applicability of the Japanese treatment guidelines for endoscopic resection in the western population. Methods: Five hundred-one patients with pathological diagnoses of EGC were included. Univariate and multivariate analyses were conducted to identify the predictive factors of LNM. EGC patients were distributed according to the indications for endoscopic resection of the Eastern guidelines. The incidence of LNM was evaluated in each group. Results: From 501 patients with EGC, 96 (19.2%) presented LNM. In 279 patients with tumors with submucosal infiltration (T1b), 83 (30%) patients had LNM. Among 219 patients who presented tumors > 3 cm, 63 (29%) patients had LNM. Thirty-one percent of patients with ulcerated tumors presented LMN (33 out of 105). In 76 patients and 24 patients with lymphovascular and perineural invasion, the percentage of LMN was 84% and 87%, respectively. In the multivariate analysis, a tumor diameter >3 cm, submucosal invasion, lymphovascular, and perineural invasion were independent predictors of LMN in EGC. No patient with differentiated, non-ulcerated mucosal tumors presented LNM regardless of tumor size. Three of 17 patients (18%) with differentiated, ulcerated mucosal tumors and ≤ 3 cm presented LNM. No LNM was evidenced in patients with undifferentiated mucosal tumors and ≤ 2 cm. Conclusions: The presence of LNM in Western EGC patients was independently related to larger tumors (>3 cm), submucosal invasion, lymphovascular and perineural invasion. The Japanese absolute indications for EMR are safe in the Western population. Likewise, Western patients with differentiated, non-ulcerated mucosal tumors, and larger than 2 cm are susceptible to endoscopic resection. Patients with undifferentiated mucosal tumors smaller than 2 cm presented encouraging results and ESD could be recommended only for selected cases.

National Registry of Acute Coronary Syndrome in Paraguay (RENASCA-PY).

OBJECTIVE: To determine the initial management and in-hospital mortality of patients with acute coronary syndrome who attended referral hospitals in Paraguay. METHOD: Observational, multicenter study, in patients over 18 years with a confirmed diagnosis of acute coronary syndrome. RESULTS: 780 patients were included from May 2015 to February 2016; the mean age was 64.1 ± 12.3 years, 64.1% male. The clinical presentation was acute coronary syndrome with ST elevation in 40.1% and without elevation in 59.9%. In patients with ST elevation there is a high percentage of late attendance, more than 12 h of evolution in 49.8%; those with less than 12 h of evolution underwent reperfusion in 52.2% of the cases, received fibrinolytics in 36.3% of the cases, and primary percutaneous coronary intervention 15.9%. In-hospital mortality for acute coronary syndrome was 10.3%, with ST-segment elevation was 12.8%, and without ST-segment elevation was 8.6%. CONCLUSIONS: The management of acute coronary syndrome in Paraguay needs a comprehensive approach, which promotes earlier care, and increases the implementation of reperfusion therapies in the health services network, in order to improve the therapeutic response rates and decrease hospital mortality.

OBJETIVO: Determinar el tratamiento inicial y la mortalidad intrahospitalaria de pacientes con síndrome coronario agudo que acudieron a centros hospitalarios de referencia de Paraguay. MÉTODO: Estudio observacional y multicéntrico en pacientes mayores de 18 años con diagnóstico confirmado de síndrome coronario agudo. RESULTADOS: Se incluyó a 780 pacientes desde mayo de 2015 hasta febrero de 2016; la edad media fue de 64.1 ± 12.3 años y el género masculino representó el 64.1%. La presentación clínica fue la de síndrome coronario agudo con elevación del ST en 40.1% y sin elevación del ST en 59.9%. En pacientes con elevación del ST se observó un alto porcentaje de consultas tardías, mayor de 12 h de evolución en 49.8%; en aquéllos con menos de 12 h de evolución se indicó la reperfusión en 52.2%, el 36.3% recibió fibrinolíticos y 15.9% intervención coronaria percutánea primaria. La mortalidad hospitalaria del síndrome coronario agudo fue de 10.3%, con elevación del segmento ST en 12.8% y sin elevación del segmento ST en 8.6%. CONCLUSIONES: El tratamiento del síndrome coronario agudo en el Paraguay requiere un abordaje integral, que promueva consultas más tempranas y aumente la institución de tratamientos de reperfusión en la red de servicios de salud; el objetivo es mejorar los índices de respuesta terapéutica y disminuir la mortalidad hospitalaria.

Surgery of pancreas tumors in pediatric and adolescent patients: a single institution experience in South America.

PURPOSE: Pancreas tumors are extremely rare in pediatric and adolescent patients. Surgical resection is the mainstay of treatment; however, the data are limited with respect to morbidity and mortality. We aimed to evaluate short- and long-term outcomes of pediatric and adolescent patients who underwent surgical resection of pancreatic tumors. METHODS: Patients [Formula: see text] 18-year-olds who underwent resection of pancreas tumor at the National Institute of Neoplastic Diseases INEN during 2000-2020 were included. RESULTS: Thirty-four patients were diagnosed; 28 patients were female and 6 were male. The median age was 13.4-years-old. Histological diagnosis was solid pseudopapillary neoplasm (SPN) (n = 29, 85.3%), pancreatoblastoma (n = 3), neuroendocrine carcinoma (n = 1), and insulinoma (n = 1). No patient experienced postoperative mortality and 15 (44.1%) patients developed postoperative complications including pancreatic fistula as the most frequent. Under a median follow-up period of 33.8 (0.5-138) months, four (11.8%) patients died. Of the 29 patients with SPN, the 3- and-5-year OS rates were 100% and 83.1%, respectively. CONCLUSIONS: SPN was the most frequent cause of surgical treatment for pediatric and adolescent patients in the high-volume cancer center in Peru and was associated with favorable survival. Pancreaticoduodenectomy was safely performed in this patient group with acceptable morbidity and zero mortality.

Clinicopathological factors associated with recurrence in patients undergoing resection of pancreatic solid pseudopapillary neoplasm.

PURPOSE: Solid pseudopapillary neoplasm (SPN) is an uncommon pathology with a low-grade malignancy. Surgery is the milestone treatment. Nevertheless, despite appropriate management, some patients present recurrence. Risk factors associated with recurrence are unclear. The objective was to identify the clinicopathological factors associated with recurrence in patients with SPN treated with pancreatic resection. METHODS: Medical records of patients treated with pancreatic resection during 2006-2020 were evaluated. Patients with histological diagnosis of SPN were included. Survival analysis was performed to identify the clinicopathological factors related to recurrence. RESULTS: Seventy-four patients were diagnosed with SPN; 70 (94.6%) patients were female, and the median age was 20 years old. The median tumor diameter was 7.9 cm. Multivisceral resection was performed in 9 (12.2%) patients. Four (5.4%) patients presented lymph node metastasis.R0 resection was achieved in all cases. Six (8%) patients presented recurrence and the liver was the most frequent recurrence site (n = 5).After a median follow-up of 40.2 months, 9 (12%) patients died. Five (6.8%) patients died of disease progression. The 1-3- and 5-year overall survival (OS) was 97.1%, 90.2% and 79.9%, respectively. The 1-3-and-5-year recurrence-free survival (RFS) was 98.4%, 89.9% and 87%, respectively. In the univariate Cox-regression analysis, age ≥ 28 years(HR = 8.61, 95% CI 1.1-73.8),tumor diameter ≥ 10 cm(HR = 9.3, 95% CI 1.12-79.6),invasion of adjacent organs (HR = 7.45, 95% CI 1.5-36.9), lymph node metastasis (pN +) (HR = 16.8, 95% CI 2.96-94.9) and, AJCC Stage III (HR = 10.1, 95% CI 1.2-90.9) were identified as predictors for recurrence. CONCLUSIONS: SPN is more frequently diagnosed in young women with a good overall prognosis after an R0 surgical resection even with disease recurrence. Age ≥ 28 years, larger tumors ≥ 10 cm, invasion of adjacent organs, lymph node metastasis(pN +) and, AJCC Stage III were predictors factors of recurrence in resected SPN.

[Follow-up of primary care patients with a NANDA I nursing diagnosis of low self-esteem]. / Seguimiento a pacientes con diagnóstico enfermero NANDA: baja autoestima situacional, en la consulta de Atención Primaria.

OBJECTIVE: To describe the evolution and characteristics of the NANDA taxonomy I nursing diagnosis of «situational low self-esteem¼ (SLS) and its related factors in Primary Care patients from the towns of Fuenlabrada and Leganés in the Autonomous Community of Madrid, in the period 2003-2009. METHOD: An observational retrospective case series of patients diagnosed by their Primary Care nurse with SLS according to the NANDA I taxonomy. This case series was performed in the towns of Fuenlabrada and Leganes (Madrid). Descriptive analysis of the variables obtained from the database management software for electronic health records in Primary Care (OMI AP). Data observed in percentages. The main variable is 00120 NANDA I diagnosis: SLS. A total of 342 care plans with a SLS diagnosis having completed all the nursing process phases. The NANDA, NOC and NIC classifications were used for the diagnostic formulas, the performance criteria to measure the effectiveness and efficiency of care, and the interventions that were performed to achieve them. The assessment of the nursing process was made according to the Marjory Gordon Functional Health Patterns. RESULTS: The incidence between 2003 and 2009 increased 8-fold. The large majority (80%) were women, with 52.4% between 40 and 64 years. Eighteen percent of the cases were closed, with 88% positively resolved. The most frequent distinctive characteristic was «negative self-verbalization¼ (26.5%). The main related factors were «disturbed body image¼ (23.8%). The most established NOC was «to improve the self-esteem¼ (41.3%) and its evolution was positive in 61%. Just over half (53.2%) of the interventions were «to increase facing up to responsibilities¼ and «to boost self-esteem¼. More than half (55%) of the diagnoses were made due to psychological causes, with episodes of a feeling anxiety-nervousness-tension in 33%. CONCLUSIONS: Although the approach is still difficul, the resolution of psychosocial problems, particularly those of self-esteem, continue to improve. The diagnoses with follow-up show positive results. We must increase our knowledge of psychosocial problems and communication skills in order to respond to the current demands of the population.

Seguimiento a pacientes con diagnóstico enfermero NANDA: baja autoestima situacional, en la consulta de Atención Primaria / Follow-up of Primary Care patients with a NANDA I nursing diagnosis of low self-esteem

OBJETIVO: Describir la evolución y características del diagnóstico enfermero de la taxonomía NANDA I «baja autoestima situacional» (BAS) y sus factores relacionados, en pacientes de las ciudades de Fuenlabrada y Leganés de la Comunidad Autónoma de Madrid, en el ámbito de la Atención Primaria en el periodo de años 2003-2009. MÉTODO: Estudio observacional retrospectivo, tipo serie de casos, de pacientes que fueron etiquetados por su enfermera de Atención Primaria con el diagnóstico de Enfermería BAS, según la taxonomía NANDA I, en las ciudades madrileñas de Fuenlabrada y Leganés. Se realizó un análisis descriptivo de las variables obtenidas de la base de datos del programa informático de gestión de la historia clínica electrónica en Atención Primaria (OMI AP). Datos observados en porcentajes. La variable principal es el diagnóstico 00120 de NANDA I: BAS. Consistió en 342 planes de cuidados con diagnóstico de BAS que tienen cumplimentadas todas las etapas del proceso enfermero. Clasificaciones NANDA, NOC y NIC para la formulación de diagnósticos, la utilización de los criterios de resultados para medir la efectividad y la eficacia de los cuidados, y las intervenciones que se realizan para conseguirlos. La valoración durante el proceso enfermero se realiza según los Patrones Funcionales de Salud de Marjory Gordon. RESULTADOS: La incidencia entre el año 2003 y el año 2009 se multiplicó por 8. El 80% corresponde a mujeres, el 52,4% corresponde a edades entre 40 y 64 años. Se cierran el 18% de los casos. Resueltos positivamente el 88%. La característica definitoria más frecuente son las «verbalizaciones autonegativas», con un 26,5%. Los factores relacionados principales son «alteración de la imagen corporal», con un 23,8%. El NOC más planteado es «mejorar la autoestima», con un 41,3%, y su evolución es positiva en el 61%. El 53,2% de las intervenciones son «aumentar el afrontamiento» y «potenciar la autoestima». El 55% de los diagnósticos se formulan por causas de tipo psicológico, predominando los episodios de sensación de ansiedad-nerviosismo-tensión y alteraciones depresivas en el 33%. CONCLUSIONES: Se está consiguiendo una mayor resolución de problemas psicosociales, entre los cuales se están mejorando los problemas de autoestima de la población aunque el abordaje sigue siendo difícil. Los diagnósticos con seguimiento ofrecen resultados positivos. Debemos profundizar en conocimientos psicosociales y habilidades de comunicación para dar respuesta a las demandas actuales de la población

OBJECTIVE: To describe the evolution and characteristics of the NANDA taxonomy I nursing diagnosis of «situational low self-esteem» (SLS) and its related factors in Primary Care patients from the towns of Fuenlabrada and Leganés in the Autonomous Community of Madrid, in the period 2003-2009. METHOD: An observational retrospective case series of patients diagnosed by their Primary Care nurse with SLS according to the NANDA I taxonomy. This case series was performed in the towns of Fuenlabrada and Leganes (Madrid). Descriptive analysis of the variables obtained from the database management software for electronic health records in Primary Care (OMI AP). Data observed in percentages. The main variable is 00120 NANDA I diagnosis: SLS. A total of 342 care plans with a SLS diagnosis having completed all the nursing process phases. The NANDA, NOC and NIC classifications were used for the diagnostic formulas, the performance criteria to measure the effectiveness and efficiency of care, and the interventions that were performed to achieve them. The assessment of the nursing process was made according to the Marjory Gordon Functional Health Patterns. RESULTS: The incidence between 2003 and 2009 increased 8-fold. The large majority (80%) were women, with 52.4% between 40 and 64 years. Eighteen percent of the cases were closed, with 88% positively resolved. The most frequent distinctive characteristic was «negative self-verbalization» (26.5%). The main related factors were «disturbed body image» (23.8%). The most established NOC was «to improve the self-esteem» (41.3%) and its evolution was positive in 61%. Just over half (53.2%) of the interventions were «to increase facing up to responsibilities» and «to boost self-esteem». More than half (55%) of the diagnoses were made due to psychological causes, with episodes of a feeling anxiety-nervousness-tension in 33%. CONCLUSIONS: Although the approach is still difficul, the resolution of psychosocial problems, particularly those of self-esteem, continue to improve. The diagnoses with follow-up show positive results. We must increase our knowledge of psychosocial problems and communication skills in order to respond to the current demands of the population

Drenaje biliar percutáneo en pacientes con ictericia obstructiva neoplásica / Percutaneous biliary drainage in patients with obstructive jaundice neoplastic

Introducción: La aplicación de los procedimientos percutáneospara la descompresión de una vía biliar obstruida, resultadesde hace al menos una década, un avance en el manejo de enfermosgraves, a veces inoperables. El drenaje biliar – temporalo definitivo mediante técnicas mini-invasivas – constituye unlogro significativo de la ciencia médica.Objetivo: Revisar la experiencia de dichos procedimientosen un servicio de cirugía general, su frecuencia de aplicación,sus principales indicaciones y la modalidad en que fue realizada.Material y método: Estudio observacional descriptivo decorte transverso relacionado a pacientes tratados en la PrimeraCátedra de Clínica Quirúrgica del Hospital de Clínicas (FCMUNA)durante el período 2007-2010 y que fueran sometidos adrenaje biliar percutáneo en el manejo de la ictericia obstructivaneoplásica.Resultados: La frecuencia de aplicación del método percutáneoen la paliación de la ictericia obstructiva neoplásica fue de30%. El tumor de Klastkin ocupó el primer lugar como causaespecifica en la realización de este procedimiento (38%). Lamodalidad de drenaje que fue mayormente implementada fue eldrenaje externo realizado en el 77% de los casos.Conclusión: En un tercio de los pacientes de nuestra seriecon ictericia obstructiva neoplásica se ha utilizado el métodopercutáneo en la paliación de la obstrucción de las vías biliares,con resultados alentadores; teniendo al tumor de Klastkincomo la causa principal y siendo el drenaje externo la modalidadde derivación más utilizada.

Whole body bioimpedance monitoring for outpatient chronic heart failure follow up.

BACKGROUND: Although cardiac output index (CI), stroke volume index (SVI), and total systemic vascular resistance (TSVR) are important hemodynamic parameters for the prognosis of chronic heart failure (CHF), they are difficult to measure in an outpatient setting. Whole body bioimpedance monitoring using a Non-Invasive Cardiac System (NICaS) allows for easy, non-invasive estimation of these parameters. Here, whether NICaS-derived hemodynamic parameters are clinically significant was investigated by relating them to other conventional cardiovascular functional indices, and by evaluating their predictive accuracy for CHF readmission. METHODS AND RESULTS: Study subjects of 68 patients with CHF were enrolled in the study immediately upon discharge from the hospital. NICaS-derived CI, -SVI, and -TSVR values obtained at an outpatient clinic were significantly related with left ventricular ejection fraction (LVEF) measured by echocardiography, serum B-type natriuretic peptide (BNP), and exercise tolerance. During the 100 +/-98 days follow-up, 15 patients were readmitted to our hospital for CHF recurrence. Multivariate analysis indicated that LVEF, NICaS-derived CI, NICaS-derived SVI, and plasma BNP were significant indicators (receiver operating characteristic curve cut-off point, LVEF: 37%, NICaS-derived CI: 2.49L x min-1 x m(-2), NICaS-derived SVI: 27.2 ml/m(2), plasma BNP: 344 pg/ml) for readmission. CONCLUSIONS: Hemodynamic parameters derived by NICaS are applicable for the non-invasive assessment of cardiac function in outpatient CHF follow up.

Catheter-based transcoronary myocardial hypothermia attenuates arrhythmia and myocardial necrosis in pigs with acute myocardial infarction.

OBJECTIVES: This study evaluated the efficacy of catheter-based transcoronary myocardial hypothermia (CTMH) in pigs with acute myocardial ischemia. BACKGROUND: Although it has been suggested that hypothermia therapy can attenuate myocardial necrosis, few applications have been accepted for clinical use. METHODS: This study comprises 2 substudies. In both studies, pigs underwent 60 min of coronary occlusion and 180 min of reperfusion. In study 1, after 15 min of coronary occlusion with an over-the-wire-type balloon (OTWB), pigs in the hypothermia group (H) (n = 13) were directly infused with 4 degrees C saline into the coronary artery through the OTWB wire lumen (2.5 ml/min) for 60 min. Pigs in the normothermia group (N) (n = 15) received the same amount of 36.5 degrees C saline. In study 2, pigs in the hypothermia-reperfusion group (HR) (n = 5) were infused with 4 degrees C saline through the infusion catheter (8 ml/min) for 30 min with a later start (60 min after coronary occlusion), whereas simple reperfusion was used for the reperfusion group (R) (n = 6). RESULTS: Catheter-based transcoronary myocardial hypothermia was successful in both studies. In study 1, CTMH significantly decreased ventricular arrhythmia and the ratio of necrosis to ischemic risk area (H: 9 +/- 2%; N: 36 +/- 4%; p < 0.0001) with a significant reduction of enzyme leaks. In study 2, CTMH tended to reduce the ratio of necrosis (HR: 33 +/- 2%; R: 45 +/- 5%; p = 0.08). In both studies, CTMH significantly suppressed the increase of 8-iso-prostaglandin F(2alpha) while preserving the coronary flow reserve. CONCLUSIONS: Catheter-based transcoronary myocardial hypothermia reduced myocardial necrosis while preserving coronary flow reserve, due, in part, to attenuation of oxidative stress.

Neointimal coverage of sirolimus-eluting stents at 6-month follow-up: evaluated by optical coherence tomography.

AIMS: Since the intravascular ultrasound (IVUS) cannot detect neointimal layers in the majority of sirolimus-eluting stents (SES) at the chronic phase, it is still controversial to what extent SES remain uncovered. However, optical coherence tomography (OCT) with excellent resolution may be able to detect thinner neointima. METHODS AND RESULTS: A total of 34 patients (57 SES) underwent OCT and IVUS evaluations at 6-month follow-up. The thickness of neointima on each SES strut cross-section and strut apposition to the vessel wall was evaluated. By OCT evaluation, the median (25th, 75th percentiles) neointima thickness was 52.5 microm (28.0 microm, 147.6 microm) and the prevalence of struts covered by thin neointima undetectable by IVUS was 64%. The average rate of neointima-covered struts in an individual SES was 89%. Nine SES (16%) showed full coverage by neointima, whereas the remaining stents had partially uncovered strut lesions. Among the 6840 struts visualized by OCT in all of the SES, 79 struts showed malapposition without neointimal coverage, and were frequently observed in the areas of SES overlap. CONCLUSION: At 6 months, most of the SES were covered with thin neointima, but few showed full coverage.

Impedance cardiography for cardiac output estimation: reliability of wrist-to-ankle electrode configuration.

BACKGROUND: Non-invasive measurement of cardiac output (CO) may become an important modality for the treatment of heart failure. Among the several methods proposed, impedance cardiography (ICG) has gained particular attention. There are 2 basic technologies of ICG: thoracic and whole-body ICG whereby the electrodes are applied either to the chest or to the limbs. The present study is aimed to test the effectiveness of the Non-Invasive Cardiac System (NICaS), a new ICG device working with a wrist-to-ankle configuration. METHODS AND RESULTS: To evaluate the reliability of NICaS derived CO (NI-CO), 50 CO measurements were taken simultaneously with thermodilution (TD-CO) and modified Fick (Fick-CO) in 35 cardiac patients, with the TD-CO serving as the gold-standard for the evaluation. Overall, 2-tailed Pearson's correlation and Bland-Altman limits of agreement between NI-CO and TD-CO were r=0.91 and -1.06 and 0.68 L/min and between Fick-CO and TD-CO, r=0.80 and -1.52 and 0.88 L/min, respectively. Good correlation was observed in patients with loading conditions altered by nitroglycerin and also in patients with moderate valvular diseases. CONCLUSION: Agreement between NI-CO and TD-CO is within the boundaries of the FDA guidelines of bio-equivalence. NI-CO is applicable for non-invasive assessment of cardiac function.

Myocardial stiffness is an important determinant of the plasma brain natriuretic peptide concentration in patients with both diastolic and systolic heart failure.

AIMS: Plasma brain natriuretic peptide (BNP) concentration increases in proportion to heart failure (HF) severity. Although plasma BNP decreases to a certain level by optimal treatment, there is significant heterogeneity in the baseline value among individuals. The underlying mechanism of the steady-state plasma BNP levels remains still controversial. We investigated the hypothesis that myocardial stiffness (K(m)) is a major determinant of the plasma BNP level. METHODS AND RESULTS: In 19 patients with diastolic HF [DHF; left ventricular ejection fraction (LVEF) > or =4 5%], 18 with systolic HF (SHF; LVEF < 45%), and 12 controls, left ventricular (LV) performance variables and the results of the stress-strain analyses were obtained by the combined simultaneous measurement of echocardiographic and haemodynamic data, and compared with the plasma BNP level. In DHF, a significant correlation was observed between plasma BNP and fractional shortening (P = 0.010), pulmonary capillary wedge pressure (P = 0.030), end-diastolic pressure (P = 0.006), time constant of the LV isovolumic-pressure decline (P = 0.049), end-diastolic stress (P = 0.012), and K(m) (P = 0.004), respectively. In SHF, a significant correlation was observed between plasma BNP and end-diastolic stress (P = 0.036), chamber stiffness (P = 0.048), and K(m) (P = 0.003), respectively. CONCLUSION: In stable conditions, K(m) may be the most important determinant of the plasma BNP production in patients with both DHF and SHF.

Beneficial effects of human atrial natriuretic peptide on renal function in a patient with repeated coronary interventions: a case report.

Among percutaneous coronary intervention post procedural complications, renal acute dysfunction due to administration of contrast agent is commonly seen in patients with pre-existing renal impairment, especially with co-existent diabetes mellitus and/or congestive heart failure. Although several strategies have been proposed to ameliorate this condition, their effects are inconsistent. A 66-year-old diabetic man at high risk for this complication underwent three distinct percutaneous coronary intervention procedures. Different strategies were used during each intervention to prevent the development of contrast medium-induced nephropathy. Dramatic renal protection was observed with human atrial natriuretic peptide administration or hemofiltration, whereas saline hydration had no apparent effect.

Efecto de la aplicación de nitrógeno y potasio en el cultivo de Tembe (Bactris gasipaes H.B.K.), para producción de palmito en la región del trópico de cochabamba

Se estudio 4 niveles de N y 4 niveles de K para producción de palmito en el trópico de Cochabamba, Bolivia. Los mayores resultados se obtuvieron con 300 Kg/ha de Nitrógeno en las variables de estudio, el efecto simple del Potasio no fue signiticativo. Sin embargo la interacción Nitrógeno y Potasio incrementó el peso palmito neto para los niveles de 300 kg/ha de Nitrógeno y los niveles 0.75 y 150 kg/ha de Potasio. La mayor tasa de retorno marginal se obtuvo con el tratamiento 10, cuyos niveles son de 300 kg/ha de Nitrógeno y 75 kg/ha de Potasio.

Computer-assisted motivating rehabilitation (CAMR) for institutional, home, and educational late stroke programs.

Based on our results during the last 25 years, we are developing late stroke computer-assisted motivating rehabilitation (CAMR) for the upper extremity. Evidence has been accumulating that functional gains are possible even many years after the damage. However, postacute rehabilitation must be motivating and related to real-life functional activities, or it may fail to enlist active participation. With CAMR programs, such as briefly reported here, instead of exercise, the patient is engaged in a game (e.g., ping-pong); instead of concentrating on the specific movements, he/she is concentrating on the game and the movements become subconscious. Patients, even those who initially consider that they cannot accomplish the task, show interest and improvement, and functional recovery appears to be extended beyond the specific movements that are being practiced. CAMR is also suitable for late functional reorganization programs in an educational model.