Effects of Sugar Beet Silage, High-Moisture Corn, and Corn Silage Feed Supplementation on the Performance of Dairy Cows with Restricted Daily Access to Pasture.

A study was undertaken to assess the effect of supplementation with sugar beet silage, corn silage, or high-moisture corn on dairy performance, rumen, and plasma metabolites in dairy cows under conditions of restricted grazing in spring. Eighteen multiparous Holstein Friesian cows, stratified for milk yield (39.4 kg/day ± 3.00), days of lactation (67.0 days ± 22.5), live weight (584 kg ± 38.0), and number of calves (5.0 ± 1.5), were allocated in a replicated 3 × 3 Latin square design. Treatments were as follows: SBS (10 kg DM of permanent pasture, 7 kg DM of sugar beet silage, 4 kg DM of concentrate, 0.3 kg DM of pasture silage, 0.21 kg of mineral supplement); corn silage (10 kg DM of permanent pasture, 7 kg DM of corn silage, 4 kg DM of concentrate, 0.3 kg DM of pasture silage, 0.21 kg of mineral supplement), and HMC (10 kg DM of permanent pasture, 5 kg DM of high-moisture corn, 4.5 kg DM of concentrate, 1.2 kg DM of pasture silage, 0.21 kg of mineral supplement). Pasture was offered rotationally from 9 a.m. to 4 p.m. Between afternoon and morning milking, the cows were housed receiving a partial mixed ration and water ad libitum. The effect of treatments on milk production, milk composition, body weight, rumen function, and blood parameters were analyzed using a linear−mixed model. Pasture dry matter intake (DMI) was lower in SBS than CS (p < 0.05) and similar to HMC, but total DMI was higher in HMC than SBS (p < 0.05) and similar to CS. Milk production for treatments (32.6, 31.7, and 33.4 kg/cow/day for SBS, CS, and HMC, respectively), live weight, and fat concentration were not modified by treatments, but milk protein concentration was lower for SBS compared with HMC (p < 0.05) and similar to CS. B-hydroxybutyrate, cholesterol, and albumin were not different among treatments (p > 0.05), while urea was higher in SBS, medium in CS silage, and lower in HMC (p < 0.001). Ruminal pH and the total VFA concentrations were not modified by treatments (p > 0.05), which averaged 6.45 and 102.03 mmol/L, respectively. However, an interaction was observed for total VFA concentration between treatment and sampling time (p < 0.05), showing that HMC produced more VFA at 10:00 p.m. compared with the other treatments. To conclude, the supplementation with sugar beet silage allowed a milk response and composition similar to corn silage and HMC, but with a lower concentration of milk protein than HMC. In addition, sugar beet silage can be used as an alternative supplement for high-producing dairy cows with restricted access to grazing during spring.

Impact of the COVID-19 Pandemic on Pediatric Surgical Volume in Four Low- and Middle-Income Country Hospitals: Insights from an Interrupted Time Series Analysis.

BACKGROUND: The impact of the COVID-19 pandemic on surgical care delivery in low- and middle-income countries (LMIC) has been challenging to assess due to a lack of data. This study examines the impact of COVID-19 on pediatric surgical volumes at four LMIC hospitals. METHODS: Retrospective and prospective pediatric surgical data collected at hospitals in Burkina Faso, Ecuador, Nigeria, and Zambia were reviewed from January 2019 to April 2021. Changes in surgical volume were assessed using interrupted time series analysis. RESULTS: 6078 total operations were assessed. Before the pandemic, overall surgical volume increased by 21 cases/month (95% CI 14 to 28, p < 0.001). From March to April 2020, the total surgical volume dropped by 32%, or 110 cases (95% CI - 196 to - 24, p = 0.014). Patients during the pandemic were younger (2.7 vs. 3.3 years, p < 0.001) and healthier (ASA I 69% vs. 66%, p = 0.003). Additionally, they experienced lower rates of post-operative sepsis (0.3% vs 1.5%, p < 0.001), surgical site infections (1.3% vs 5.8%, p < 0.001), and mortality (1.6% vs 3.1%, p < 0.001). CONCLUSIONS: During the COVID-19 pandemic, children's surgery in LMIC saw a sharp decline in total surgical volume by a third in the month following March 2020, followed by a slow recovery afterward. Patients were healthier with better post-operative outcomes during the pandemic, implying a widening disparity gap in surgical access and exacerbating challenges in addressing the large unmet burden of pediatric surgical disease in LMICs with a need for immediate mitigation strategies.

Rumen In Vitro Fermentation and In Situ Degradation Kinetics of Winter Forage Brassicas Crops.

The aim of the present study was to evaluate the nutritional value, the rumen in vitro fermentation, and the in situ degradation of Brassica oleracea (L.) ssp. acephala (kales) and Brassica napus (L.) ssp. napobrassica (swedes) for winter use. Five varieties of each brassica were used in three field replicates and were randomized in a complete block nested design. All forage varieties were harvested at 210 days post-sowing to analyze the chemical composition, in vitro gas production, volatile fatty acid (VFA) production and in situ dry matter (DM) and crude protein (CP) degradability. Kales presented higher DM and neutral detergent fiber (NDF) content (p < 0.01), whereas swedes showed higher CP, metabolizable energy (ME), glucose, fructose, total sugars, NFC, and nonstructural carbohydrate (NSC) content (p < 0.01). The kale and swede varieties differed in their CP and sugar concentrations, whereas the kale varieties differed in their DM and raffinose content. The rates of gas production were higher for swedes than for kales (p < 0.01). No differences between the brassica species (p > 0.05) were observed in the total VFA production, whereas kales had a higher proportion of acetate and swedes had higher proportions of butyrate (p < 0.05). Only the swede varieties showed differences in VFA production (p < 0.05). The soluble fraction "a", potential and effective in situ DM degradability were higher in swedes (p < 0.01), but kales presented greater DM and CP degradation rates. Differences were observed between brassica species in the chemical composition, degradation kinetics, and ruminal fermentation products, whereas differences among varieties within species were less frequent but need to be considered.

Diurnal Concentration of Urinary Nitrogen and Rumen Ammonia Are Modified by Timing and Mass of Herbage Allocation.

The objective of this work was to evaluate whether changes in time of herbage allocation and herbage mass (HM) (low (L) or medium (M)) modify the diurnal pattern of urinary nitrogen (N) concentration and ruminal ammonia (NH3) of lactating dairy cows. Four Holstein-Friesian cows fitted with rumen cannula were randomly allocated to one of four treatments: 1) low herbage mass in the morning (L-AM) (Access to new herbage allocation after morning milking with a herbage mass (HM) of 2000 kg DM/ha); 2) low herbage mass in the afternoon (L-PM) (Access to new herbage allocation after afternoon milking with a HM of 2000 kg DM/ha); 3) medium herbage mass in the morning (M-AM) (Access to new herbage allocation after morning milking with a HM of 3000 kg DM/ha); and 4) medium herbage mass in the afternoon (M-PM) (Access to new herbage allocation after afternoon milking with a HM of 3000 kg DM/ha). A four by four Latin Square design with four treatments, four cows, and four experimental periods was used to evaluate treatment effects. Rumen NH3 concentration was greater for L-AM compared to L-PM and M-PM at 13:00 and 16:00 h. Urine urea and N concentrations were lower for M-AM compared to L-AM. Urine N concentration was greater for L-AM than other treatments at 10:00 hours and greater for M-PM compared to M-AM at 16:00 hours. Results suggest that maintaining the cows in the holding pen at the milking parlor for two hours after morning grass silage supplementation for L-AM and for two hours after afternoon grass silage supplementation for M-PM, could allow collection of urine from cows at the holding pen and storage of urine in the slurry pit during the time of peak N concentration, returning cows to the pasture at a time of day when urinary N concentration is decreased.

Evolution of glomerulopathies associated with rheumatoid arthritis / Evolución de las glomerulopatías asociadas a la artritis reumatoidea

Abstract Introduction: Rheumatoid arthritis is one of the most common clinical syndromes within rheumatological conditions and its association with glomerular diseases is rare. Objective: To describe the histopathological findings in renal biopsies in patients with rheumatoid arthritis and to correlate them with the clinical and laboratory manifestations at the beginning, at 6 months and at one year of follow-up. Patients and Methods: This is a retrospective observational study conducted in the Hospital de Clinicas "Jose De San Martin" in Buenos Aires, Argentina; Where we included 41 patients diagnosed with RA (ACR 1987) in a period of 20 years. Histopathological diagnoses of membranous nephropathy (MN), minimal change disease (MCD), secondary amyloidosis (AA), focal and segmental glomerulosclerosis (FSGS); mesangial glomerulopathy (MGP) and glomerulonephritis with extracapillary proliferation (GNEC) were included. Histopathological description, different treatments, years of evolution of rheumatoid arthritis Clinical and laboratory characteristics were analyzed during the first 6 months and one year of follow-up in order to determine the progression of renal failure calculated through the formula of MDRD of 4 variables (Modification of diet in renal disease) and the increase of proteinuria. Results: The most frequent histological finding was amyloidosis with 34,1 % (n=14), followed by mesangial glomerulopathy 21,9 % (n=9), membranous nephropathy 19,5 % (n=8), glomerulonephritis with extracapillary proliferation 12,1 % (n=5), focal and segmental glomerulosclerosis 7,3 % (n=3) and minimal change disease 8,2 % (n=2). Nephrotic syndrome was the most frequent presentation in patients with amyloidosis in 85,7 %, microhematuria occurred in 100 % of patients with MPG and in 80 % of patients with GNEC. In patients with AA, moderate to severe interstitial fibrosis occurred in 85,7 %, followed by GNEC and NM with 80 % and 40 % respectively. The 24-hour proteinuria, creatinine and glomerular filtration rate estimated by MDRD at 6 months and 12 months were evaluated. Concluding, that patients with AA, FSGS and GNEC had greater progression of renal failure at 12 months; the opposite occurred in patients with minimal change disease (MCD) and mesangial glomerulopathy (MGP) who had a lower progression of renal failure at one year of follow-up; There was a correlation in the glomerulopathies that had greater deterioration of the renal function had greater interstitial tubule involvement as was the case of amyloidosis. The glomerulopathies that presented greater proteinuria at the beginning were membranous nephropathy, amyloidosis and minimal change disease. Both membranous nephropathy and minimal change disease had partial remission at one year, in contrast to amyloidosis, which showed progression of proteinuria at 12 months of follow-up. Conclusion: The glomerulopathies that presented greater progression of renal failure at 1 year based on the estimation by MDRD 4, had a higher renal tubular interstitial involvement in renal biopsy and these were amyloidosis (AA), segmental focal glomerulosclerosis (FSGS), glomerulonephritis with proliferation extracapillary On the other hand, those with the best evolution in relation to the degree of proteinuria and the glomerular filtration rate determined by the MDRD4 equation were mesangial glomerulopathy, minimal change disease, and membranous nephropathy.

Resumen Introducción: La artritis reumatoidea (AR) es uno de los síndromes clínicos con mayor frecuencia dentro de las afecciones reumatológicas y su asociación con las enfermedades glomerulares es poco frecuente. Objetivo: Describir los hallazgos histopatológicos en las biopsias renales en pacientes con artritis reumatoidea y correlacionarlos con las manifestaciones clínicas y de laboratorio al inicio, a los 6 meses y al año de seguimiento. Pacientes y métodos: Es un estudio observacional retrospectivo realizado en un hospital Universitario en Buenos Aires, Argentina. Se incluyeron 41 pacientes con diagnóstico de artritis reumatoidea de acuerdo a los criterios establecidos por el Colegio Americano de Reumatología publicados en 1987; en un período de 20 años. Se incluyeron diagnósticos histopatológicos de nefropatía membranosa (NM), enfermedad de cambios mínimos (ECM), amiloidosis secundaria (AA), gloméruloesclerosis focal y segmentaria (GEFS); glomerulopatía mesangial (GPM) y glomerulonefritis con proliferación extracapilar (GNEC). Las características clínicas, de laboratorios, la descripción histopatológica, los años de evolución de la artritis reumatoidea y los diferentes tratamientos fueron analizados durante los primeros 6 meses y al año del seguimiento. Con esto, se buscó determinar la progresión de la insuficiencia renal, calculada a través de la fórmula de MDRD (Modification of Diet in Renal Disease) de 4 variables y el aumento de la proteinuria. Resultados: El hallazgo histológico más frecuente fue la amiloidosis, con un 34.1 % (n=14), seguido de la glomerulopatía mesangial (21,9 %, n=9), la nefropatía membranosa (19,5 %, n=8), la glomerulonefritis con proliferación extracapilar (12,1 %, n=5), la glomeruloesclerosis focal y segmentaria (7,3 %, n=3) y enfermedad de cambios mínimos (8,2 %, n=2). El síndrome nefrótico fue la forma de presentación más frecuente en los pacientes con amiloidosis (en un 85,7 % de los casos), la microhematuria se presentó en el 100 % de los pacientes con GPM y en el 80 % de los pacientes con GNEC. En el 85,7 % de los pacientes con AA, se presentó fibrosis intersticial moderada a severa, mientras que en la GNEC y la NM la fibrosis se observó en un 80 % y 40 % respectivamente. Se evaluó la proteinuria de 24 horas, la creatinina y la filtración glomerular estimada por MDRD a los 6 y a los 12 meses. Se concluyó que los pacientes con AA, GEFS y GNEC presentaron mayor progresión de la insuficiencia renal a los 12 meses. Lo contrario sucedió en los pacientes con enfermedad de cambios mínimos (ECM) y glomerulopatía mesangial (GPM), los cuales tenían una menor progresión de la insuficiencia renal al año de seguimiento. Hubo una correlación entre las glomerulopatías que tenían mayor deterioro de la función renal en las cuales se observó a su vez, mayor compromiso tubulointersti-cial, (este fue el caso de la amiloidosis). Las glomerulopatías que presentaban mayor proteinuria al inicio eran la nefropatía membranosa, la amiloidosis y la enfermedad de cambios mínimos. Tanto la nefropatía membranosa como la enfermedad de cambios mínimos, tenía remisión parcial tras un año, a diferencia de la amiloidosis, la cual presentaba progresión de la proteinuria a los 12 meses de seguimiento. Conclusión: Las glomerulopatías que presentaron mayor progresión de la insuficiencia renal al año, con base en la estimación por MDRD4, tenían en la biopsia renal mayor compromiso tubulointersticial. Estas fueron la amiloidosis secundaria, la glomeruloesclerosis focal y segmentaria, y glomerulonefritis con proliferación extracapilar. Por el contrario, las de mejor evolución respecto al grado de proteinuria y tasa de filtrado glomerular determinado por MDRD4, fueron la glomerulopatía mesangial, la enfermedad de cambios mínimos y la nefropatía membranosa.

Rol de la hematuria dismórfica en las enfermedades gomerulares / Role of urinary dysmorphic red blood cells in glomerular disease

INTRODUCCIÓN: El sedimento de orina es una herramienta en la práctica clínica empleada desde hace muchos años para la evaluación de enfermedades renales. La detección de hematuria dismórfica es útil en el diagnóstico de enfermedades glomerulares. OBJETIVOS: Agrupar las hematurias dismórficas en los casos con presencia de acantocitos y los que no los presentan, y correlacionar estos dos grupos con los hallazgos histológicos de las biopsias renales. MATERIAL Y MÉTODOS: Estudio observacional, retrospectivo y analítico. Se incluyeron los sedimentos de orina de 276 pacientes. Se analizaron dos grupos de hematuria dismórfica: D1 (presencia de acantocitos) y D2 (sin acantocitos), y se correlacionó con los hallazgos histológicos de la biopsia renal (glomerulopatías proliferativas y no proliferativas). Se analizaron los diferentes elementos formes de la orina (cilindros hemáticos, leucocitarios, céreos, granulosos, grasos), la creatinina plasmática y la proteinuria de 24 hs en los dos grupos de glomerulopatías. Posteriormente se realizó una regresión logística para evaluar las variables independientes entre los hallazgos del sedimento de orina, con los correspondientes odds ratio (OR) e intervalos de confianza (IC 95%). RESULTADOS: Se contó con 172 muestras provenientes de mujeres (62.3%) y 104 de hombres (37,7%). La presencia de acantocitos (D1) en las enfermedades glomerulares proliferativas (GP) fue 17 veces más frecuente comparada con las no proliferativas (GNP) OR 17.7 IC 95% (9.6-32.5) p 0.001. La presencia de cilindros hemáticos es ocho veces más frecuente en las GP OR 8 IC 95% (3.1-20.9). Los pacientes con hematuria no acantocitica (D2) es 5 veces más frecuente en una GNP OR 5.2 IC (2.4-11.3) p 0,001. La presencia de cilindros grasos fue más frecuente en los pacientes con GNP a diferencia de los cilindros leucocitarios, cuya frecuencia fue mayor en la GP. CONCLUSIONES: La presencia de hematuria dismórfica no acantocitica (D2) se correlacionó en la histología renal con la presencia de glomerulopatías no proliferativas (GNP) en forma significativa, a diferencia de la hematuria acantocitica y cilindros hemáticos que se observaron en glomerulopatías proliferativas, por lo tanto se considera una herramienta útil para poder diferenciar clínicamente estos dos grupos, sin remplazar la biopsia renal para el diagnóstico preciso y el pronóstico

INTRODUCTION: The analysis of urine sediment is a tool that has been used for many years in clinical practice to evaluate kidney diseases. Detecting dysmorphic red blood cells (RBC's) in urine is useful for the diagnosis of glomerular diseases. OBJECTIVES: To divide the cases of glomerular hematuria into two groups, depending on the presence or absence of acanthocytes, and to compare this factor with the histological findings of renal biopsies. METHODS: In this observational, retrospective, analytical study, urine sediments of 276 patients were included. Two groups of subjects with glomerular hematuria were analyzed: D1 (presence of acanthocytes) and D2 (absence of acanthocytes). The results were compared with the renal biopsy histological findings, i.e. proliferative glomerulonephritis and non-proliferative glomerulonephritis, considered separately. The formed elements of the urine (red blood cell, white blood cell, waxy, granular and fatty casts), plasma creatinine concentration and 24-hour urinary protein were tested in the two groups. A logistic regression analysis was later performed to assess the independent variables among urine sediment findings, with the corresponding odds ratio (OR) and confidence intervals (CI 95%). RESULTS: The samples were collected from 172 women (62.3 %) and 104 men (37.7 %). The presence of acanthocytes (D1) was 17 times more frequent in proliferative glomerulonephritis (PGN) than in non-proliferative glomerulonephritis (NPGN) [OR 17.7, CI 95% (9.6-32.5), p 0.001]. The presence of red blood cell casts was 8 times more frequent in PGN [OR 8, CI 95% (3.1-20.9)]. Cases of hematuria with no acanthocytes (D2) were 5 times more frequent in NPGN [OR 5.2, CI (2.4-11.3), p 0.001]. Fatty casts appeared more frequently in patients with NPGN, whereas white blood cell casts were more common in PGN cases. CONCLUSIONS: Renal histological findings revealed a significant correlation between glomerular hematuria without acanthocytes (D2) and non-proliferative glomerulonephritis (NPGN), while the presence of acanthocytes and red blood cell casts was associated with proliferative glomerulonephritis (PGN). The existence of acanthocytes in urine constitutes a useful tool to make a clinical distinction between these two conditions, but it does not replace renal biopsy to establish an accurate diagnosis and prognosis

Maternal mortality due to pandemic influenza A H1N1 2009 virus in Colombia.

AIMS: The 2009 H1N1 pandemic illustrated the higher morbidity and mortality from viral infections in peripartum women. We describe clinical features of women who recently died of H1N1 in Colombia. METHODS: This is a case series study that was gathered through a retrospective record review of all maternal H1N1 deaths in the country. The national mortality database of confirmed mortality from H1N1 in pregnancy and up to 42 days after delivery was reviewed during the H1N1 season in 2009. Women with H1N1 infections were confirmed by the laboratory of virology. Demographic, clinical, and laboratory data were reviewed. Statistical analyses were performed and median values of non-parametric data were reported with inter-quartile range (IQR). RESULTS: A total of 23 H1N1 maternal deaths were identified. Eighty-three percent occurred in the third trimester. None of the mothers who died had received influenza vaccination. The median time from symptom onset to the initiation of antiviral treatment was 8.8 days (IQR 5.8-9.8). Five fatalities did not receive any anti-viral therapy. Median PaO2/FiO2 on day 1 was 80 (IQR, 60-98.5). All patients required inotropic support and mechanical ventilation with barotrauma-related complications of mechanical ventilation occurring in 35% of patients. CONCLUSION: In Colombia, none of the women suffering H1N1-related maternal deaths had received vaccination against the disease and most had delayed or had no anti-viral therapy. Given the lack of evidence-based clinical predictors to identify women who are prone to die from H1N1 in pregnancy, following international guidelines for vaccination and initiation of antiviral therapy in suspected cases would likely improve outcomes in developing countries.

Mediastinitis tras cirugía cardíaca: estudio de casos y controles para detectar áreas de mejora / Mediastinitis following cardiac surgery: case-control study to detect areas requiring improvement

Fundamento: La mediastinitis posquirúrgica es una de las complicaciones más graves de la cirugía cardíaca. Se han descrito diversos factores de riesgo y estrategias para disminuir su incidencia. El objetivo de este estudio es determinar la incidencia y los factores de riesgo de mediastinitis en enfermos sometidos a cirugía cardíaca en el Hospital Universitario La Paz y establecer propuestas de mejora del proceso asistencial. Material y métodos: Estudio de casos y controles, seleccionando 2 controles por cada caso de mediastinitis diagnosticado durante los años 2002 y 2003 y el primer cuatrimestre de 2004. Recogida de información mediante revisión de historias clínicas. Análisis estadístico: descriptivo (media, mediana, desviación típica y distribución de frecuencias) y analítico (*2 de Pearson y U de Mann-Whitney). Resultados: Incidencia, 3,5%. Principales factores identificados como susceptibles de mejora: control glucémico de los enfermos, identificación a priori de los enfermos con mayor riesgo de mediastinitis, para lo que se construyó un índice que evalúa 8 ítems, y actuación temprana ante la agrupación de 2 o más casos. Conclusiones: A partir de los resultados, se han propuesto cambios en el proceso asistencial que pueden contribuir a disminuir la incidencia de mediastinitis en enfermos intervenidos de cirugía cardíaca en el Hospital La Paz

Background: Postoperative mediastinitis is one of the most serious complications of cardiac surgery. Several risk factors and strategies to reduce the incidence of this complication have been described. The aim of this study was to determine the incidence of and risk factors for mediastinitis in patients undergoing cardiac surgery in the Hospital Universitario La Paz in Madrid (Spain) and to make recommendations for improving the healthcare process. Material and methods: We performed a case-control study, selecting two controls for each case of mediastinitis diagnosed in 2002, 2003, and the first four months of 2004. Information was gathered by reviewing medical records. Statistical analysis consisted of descriptive (mean, median, standard deviation and frequency distribution) and analytic techniques (Pearson's *2 test and the Mann-Whitney U test). Results: The incidence of mediastinitis was 3.5%. The main factors identified as requiring improvement were glycemic control, a priori identification of at-risk patients ­for which an index evaluating eight items was designed­ and early intervention when two or more patients were diagnosed in one month. Conclusions: Based on the results of this study, changes were proposed to the healthcare process that could help to reduce the incidence of mediastinitis in patients undergoing cardiac surgery in our hospital

T9 glioma cells expressing membrane-macrophage colony stimulating factor produce CD4+ T cell-associated protective immunity against T9 intracranial gliomas and systemic immunity against different syngeneic gliomas.

Cloned T9 glioma cells (T9-C2) expressing the membrane form of macrophage colony stimulating factor (mM-CSF) inoculated subcutaneously into rats do not grow and glioma-specific immunity is stimulated. Immunotherapy experiments showed that intracranial T9 tumors present for one to four days could be successfully eradicated by peripheral vaccination with T9-C2 cells. CD4+ and CD8+ T splenocytes from immunized rats, when restimulated in vitro with T9 cells, produced interleukin-2 and -4. Protective immunity against intracranial T9 gliomas could only be adoptively transferred into naive rats by the CD4+ splenocytes obtained from T9-C2 immunized rats. Rats immunized by the T9-C2 tumor cells also resisted two different syngeneic gliomas (RT2 and F98) but allowed a syngeneic NUTU-19 ovarian cancer to grow. Such cross-protective immunity against unrelated gliomas suggests that mM-CSF transfected tumor cells have immunotherapeutic potential for use as an allogeneic tumor vaccine.

[Multiplane transesophageal echocardiography in the preoperative evaluation of the sinus of Valsalva fistula to right chambers]. / Ecocardiografía transesofágica multiplana en la valoración preoperatoria de fístulas de senos de Valsalva en cavidades derechas.

INTRODUCTION AND OBJECTIVES: Ruptured sinus of Valsalva aneurysm to right cardiac chambers is an uncommon lesion in Western countries. The prognosis is usually serious unless the condition is promptly treated surgically. For this reason an accurate anatomical and functional evaluation is necessary. The main purpose of this report is to compare the usefulness of multiplane transesophageal echocardiography with transthoracic echocardiography and angiocardiography in the preoperative evaluation of ruptured sinus of Valsalva aneurysm to right chambers. PATIENTS AND METHOD: Since January 1990, 9 patients (mean age 36,3 18 yr, 6 males) with ruptured sinus of Valsalva aneurysm to right chambers were studied. The pathogenesis was congenital aneurysm in 6 patients, aortic prosthesis endocarditis in one and two cases of iatrogenia: during a percutaneous mitral valvuloplasty and after cardiac surgery. Transthoracic echocardiography was performed in all cases, transesophageal echocardiography in 7 and angiocardiography in 8. Two patients died before surgery, and 7 were successfully operated on. RESULTS: Transesophageal echocardiography was more useful when compared to transthoracic echocardiography and angiocardiography in detecting: a) the fistula; b) the sinus involved; c) the right chamber affected; d) congenital aneurysms morphology and size; e) aneurysm prolapse through a ventricular septal defect, y f) the identification of other cardiac congenital or acquired anomalies. CONCLUSIONS: Multiplane TEE is the most accurate tool in the preoperative evaluation of ruptured sinus of Valsalva aneurysm to right chambers.

Ecocardiografía transesofágica multiplana en la valoración preoperatoria de fístulas de senos de valsalva en cavidades derechas / Multiplane Transesophageal Echocardiography in the Preoperative Evaluation of the Sinus of Valsalva Fistula to Right Chambers

Introducción y objetivos. Las fístulas de senos de Valsalva a cámaras cardíacas derechas son una enfermedad infrecuente en el mundo occidental. El pronóstico suele ser grave y en la mayoría de los casos el tratamiento quirúrgico precoz es resolutivo. Es, por tanto, imprescindible una valoración preoperatoria anatómica y funcional precisa. El objetivo de este trabajo es comparar la utilidad de la ecocardiografía transesofágica multiplana con la ecocardiografía transtorácica y la angiocardiografía en la valoración preoperatoria de las fístulas de los senos de Valsalva a cámaras derechas. Pacientes y método. Desde 1990 se han estudiado 9 pacientes (edad media 36,3 ñ 18 años; 6 varones) con fístulas de senos de Valsalva a cámaras derechas. La etiología fue perforación de un aneurisma congénito en 6 casos, endocarditis protésica aórtica en uno y iatrogénica en dos: valvuloplastia mitral percutánea y secuela postquirúrgica. Se realizó ecocardiografía transtorácica en todos los casos, ecocardiografía transesofágica en siete y angiocardiografía en ocho. Dos pacientes fallecieron antes de la intervención y siete fueron operados con éxito. Resultados. El ecocardiograma transesofágico fue más útil que la ecocardiografía transtorácica y la angiocardiografía en: a) detección de la fístula; b) localización exacta del seno de Valsalva afectado; c) puerta de entrada de la fístula en cavidades derechas; d) tamaño y morfología de los aneurismas congénitos; e) prolapso del aneurisma a través de una comunicación interventricular, y f) identificación de otras anomalías cardíacas, congénitas o adquiridas asociadas. Conclusiones. La ETE multiplana es la técnica de imagen que mayor información aporta en la valoración preoperatoria de las fístulas de los senos de Valsalva en las cavidades derechas (AU)

Artroscopia de la articulación metatarsofalángica del dedo gordo / Hallus metatarsophalangeal joint arthroscopy

La artroscopia se ha convertido en una alternativa a la cirugía abierta en el tratamiento de ciertas patologías de la articulación metatarsofalángica del 1º dedo. Describimos en este artículo la técnica con las indicaciones comúnmente más aceptadas. Hemos recogido los casos intervenidos en nuestro centro, con un comentario de los mismos La artroscopia ha sido, para nosotros, útil en una serie de patologías. Creemos que es una técnica a indicar en algunos casos de difícil resolución con otro abordaje (AU)

Fibrilación ventricular secundaria a la aplicación de radiofrecuencia en la ablación de una taquicardia ventricular / Ventricular Fibrillation Secondary to Radiofrequency Application for Ventricular Tachycardia Ablation

La ablación con catéter mediante radiofrecuencia se ha establecido como un tratamiento de elección en diversos tipos de taquicardias por su elevada eficacia y bajo porcentaje de complicaciones. La aparición de complicaciones proarrítmicas por efecto directo de la radiofrecuencia es muy infrecuente. Describimos el caso de un paciente con infarto de miocardio antiguo y taquicardia ventricular monomórfica sostenida bien tolerada, sometido a ablación con catéter del sustrato de la misma, que durante dos de las aplicaciones de radiofrecuencia desarrolló fibrilación ventricular que requirió desfibrilación externa (AU)

Efecto proarrítmico tras la ablación con radiofrecuencia de una arritmia ventricular monomórfica repetitiva / Proarrhythmic effect following radiofrequency catheter ablation of repetitive monomorphic ventricular arrhythmia

La ablación con radiofrecuencia es un tratamiento de primera línea para una gran cantidad de taquiarritmias supraventriculares y algunas ventriculares, por su alta tasa de éxitos y baja probabilidad de complicaciones. Aunque la mayoría de éstas se relacionan con la técnica de cateterismo, algunas se deben al propio efecto de la radiofrecuencia. Presentamos el caso de un paciente con arritmia ventricular repetitiva no sostenida que tras la ablación eficaz con radiofrecuencia desarrolló una taquicardia ventricular monomórfica sostenida e incesante que requirió un nuevo procedimiento de ablación (AU)

Displasia congénita de la válvula tricúspide (Ebstein Like) en un varón de 73 años con insuficiencia tricuspídea severa / Congenital dysplasia of the tricuspid valve (Ebstein Like) in a 73 year-old male with severe tricuspid regurgitation

Se han descrito múltiples anormalidades congénitas en la estructura de la válvula tricúspide, que en la mayoría de los casos podrían considerarse variantes de la anomalía de Ebstein. El grado de disfunción valvular y el tamaño y función del ventrículo derecho determinan el inicio de los síntomas y la edad del diagnóstico. Éste varía desde el nacimiento hasta la edad adulta, pero es raro el retraso diagnóstico si la regurgitación es severa. Se presenta el caso de un varón de 73 años, en grado funcional I de la NYHA hasta 5 meses antes. Desde entonces refería hinchazón abdominal y edemas en los miembros inferiores de carácter progresivo. La exploración física sugería insuficiencia tricuspídea severa. Se practicó un estudio ecocardiográfico transtorácico y transesofágico que evidenciaron gran displasia en los velos tricuspídeos, con regurgitación severa por falta de coaptación, así como dilatación de ambas cámaras derechas y disfunción sistólica del ventrículo derecho (AU)