Fluctuaciones del estado emocional en adolescentes embarazadas de zonas rurales en el norte de Colombia. Un estudio cualitativo / Emotional fluctuations in pregnant adolescents from rural areas in the north of Colombia

Esta investigación analiza las fluctuaciones del estado emocional en adolescentes embarazadas de zonas rurales del departamento de Sucre (Colombia). Se halló que la mayoría de las adolescentes ha experimentado cambios bruscos de humor, fluctuando de emociones positivas a negativas y de negativas a positivas, variaciones asociadas principalmente al apoyo sociofamiliar percibido, a la vivencia de acontecimientos vitales estresantes y, al parecer, a cambios hormo-nales. Es positivo para aquellas que consideran que el embarazo les ha dado un motivo para vivir y cambiar su vida. Es negativo para aquellas que tienen problemas en su proceso de gestación (patologías asociadas, problemas con la salud del bebé) o para aquellas cuya familia o esposo no apoyan la nueva situación de la adolescente (AU)

The current study analyses the fluctuations of the emotional state in pregnant adolescents from rural areas of the north of Colombia. Most adolescent girls have experienced sudden positive and / or negative mood swings. The mood fluctuations occurred from positive to negative emotions and from negative to positive, this fluctuation depended mainly on perceived social and family support, the experience of stressful life events and, apparently, hormonal changes. It was positive for those who considered that pregnancy has given them a reason to live and change their life. It was negative for those who have problems in their gestation process (associated pathologies, problems with the baby’s health, among others) or for those whose family or husband did not support the new situation of the adolescent (AU)

[Case report of serious cardiac insufficiency complicated by syncope]. / A propósito de um caso de insuficiência cardíaca grave complicada por síncope.

The authors describe a case of a patient with congestive heart failure complicated by syncope, hypotension and a transitory state of vigil coma. The transthoracic and transesophageal echocardiogram showed a huge mass that occupied almost totally the right ventricle causing sever obstruction. The patient was submitted to surgery and a resection of the mass with reconstruction of the free right ventricle wall was done. The histopathology revealed to be a leiomyosarcoma. There was a previous history of an uterine surgery.

[Treatment of malignant ventricular arrhythmia guided by electrophysiologic study]. / Tratamento de arritmias ventriculares malignas guiado por estudo electrofisiológico.

The purpose of this study was to assess the results of the treatment of malignant ventricular tachyarrhythmias guided by electrophysiologic studies. Thirty patients with ventricular arrhythmias, aged 56.6 +/- 14.1 years, were submitted to EP testing. The clinical presentation of arrhythmia was sustained monomorphic ventricular tachycardia in 24 (80%), non-sustained ventricular tachycardia in three and another three were survivors of sudden cardiac death. Twenty five patients (83%) had evidence of structural heart disease and left ventricular ejection fraction was less than 40% in 16 (53%). Antiarrhythmic drugs were considered effective when sustained monomorphic ventricular tachycardia was noninducible or significantly slowed in serial EP testing. Sustained monomorphic VT was induced in 19 patients (63%) and an effective drug therapy was found in 13 (68%). In the other 11 patients sustained arrhythmias were not induced, although in six of them the study was done already under antiarrhythmic drugs, that were continued in the follow-up. In the six patients in which an effective drug regimen could not be found and in two sudden death survivors with primary ventricular fibrillation and negative EP testing, an Implantable Cardioverter-Defibrillator was implanted. After 17.8 +/- 10.5 months, there was recurrence of the arrhythmia in 4 (18%) of the 22 patients on antiarrhythmic drugs and half of the patients with ICDs received appropriate therapy from the device. Three patients (10%) died in the follow-up, of which only one due to sudden death. We conclude that selection of optimal antiarrhythmic treatment based on the results of EP testing, is associated with decreased episode recurrence and sudden death.

[The catheter ablation of atrioventricular nodal reentry tachycardia: the results of a mixed electrophysiological/anatomical technic]. / Ablação por cateter de taquicardia de reentrada nodal aurículo-ventricular: resultados de técnica mista--electrofisiológica/anatómica.

OBJECTIVE: To describe the results of radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) by using a mixed electrophysiologic/anatomic mapping technique. DESIGN: Consecutive patients with AVNRT, submitted to AV node modification between November 1992 and March 1995. SETTING: Cardiology Department at an University Hospital. INTERVENTIONS: Twenty consecutive patients with AVNRT were submitted to AV node modification. The ablation technique included two sequential steps. Initially, a detailed electrophysiologic mapping was performed with the ablation catheter, positioned near the coronary sinus ostium, looking for a specific recording: fractionated atrial electrogram, suggestive "slow pathway" potential and a ratio of atrial: ventricular electrogram amplitude > 1. In case of failure, after 5 applications of radiofrequency energy, an anatomic technique was used. The fluoroscopic image, in left anterior oblique projection, was used to guide catheter progression, and the radiofrequency energy applied sequentially in the posterior (P), followed by medium (M) and anterior (A) septal areas if needed. Radiofrequency energy was applied a power of 16-36 watts for 30-60 sec. If a His bundle deflection > 0.0025 mV was recorded, energy was not applied. MEASUREMENTS AND RESULTS: Suppression of a AVNRT was initially obtained in 19 patients (95%). A mean of 8.3 +/- 6.1 energy application were required. Mean during of the entire procedure was 142 +/- 45 min and the fluoroscopy duration was 22 +/- 12 min. There were no complications. The location of successful ablation areas was: P in 15 patients, M in three and A in one. After a mean follow up of 10 +/- 6 months, two patients had recurrence of AVNRT. A second procedure was successful in the initially failed patient and in these two recurrences. CONCLUSIONS: A mixed electrophysiologic/anatomic mapping technique to perform radiofrequency catheter ablation of AVNRT was associated with high efficacy and no complications.

[The diagnosis and ablation of accessory atrioventricular pathways in the initial electrophysiological exam: a new therapeutic modality in pre-excitation syndromes]. / Diagnóstico e ablação de vias acessórias aurículo-ventriculares no exame electrofisiológico inicial: nova modalidade terapêutica dos síndromes de pré-excitação.

OBJECTIVE: To describe the experience and results in the diagnosis and catheter ablation of atrioventricular accessory (AP) pathways during the initial electrophysiologic study. DESIGN: We performed catheter ablation at the time of an initial electrophysiologic study in 22 consecutive patients (12 W and 10 M, mean age 42 +/- 15) with Wolff-Parkinson-White syndrome or supraventricular tachycardia. SETTING: Cardiology Department at University Hospital. INTERVENTIONS: The precise AP mapping was performed with the ablation catheter (4 mm distal electrode and deflectable tip) according to the earlier ventricular activation during sinus rhythm or the earlier atrial activation during ventricular pacing or orthodromic reentrant tachycardia. For left-sided pathways the ablation catheter was positioned on the mitral annulus retrogradely across the aortic valve, while for right-sided pathways it was positioned on the tricuspid annulus or near the coronary sinus os. Radiofrequency energy was applied for 20-60 segs with 55-65 Volts. MEASUREMENTS AND RESULTS: Seventeen AP were manifest and five were concealed. AP were left lateral in 11 patients (50%), left posterior in 5, and right postero-septal, right posterior or antero-septal in 2 patients each. The ablation was initially successful in 18/22 (82%), with 9 +/- 8 radiofrequency applications. Mean duration of the entire procedure was 145 +/- 59 min and the fluoroscopy duration was 39 +/- min. There were no major complications. During 2-9 months of follow-up AP conduction returned in two patients. CONCLUSIONS: Radiofrequency catheter ablation of AP is effective and safe and can be performed at the time of an initial electrophysiologic test, avoiding the need for long-term antiarrhythmic drug therapy or surgical ablation.