[Gastric cancer risk estimate in patients with chronic gastritis associated with Helicobacter pylori infection in a clinical setting]. / Estimación de riesgo de cáncer gástrico en pacientes con gastritis crónica asociada a la infección por Helicobacter pylori en un escenario clínico.

BACKGROUND/AIM: Severity of chronic gastritis associated with Helicobacter pylori infection (CGAHpI) could play a role in evaluating the potential risk to develop gastric cancer. Our aim was to estimate the risk for gastric cancer in a clinical setting, according to histopathologic criteria, by applying the gastric cancer risk index (GCRI) METHODS: Histopathologic study of the gastric biopsies (corpus-antrum) from consecutive adult patients that underwent gastroesophageal duodenoscopy was carried out, and the GCRI was applied in patients presenting with CGAHpI. RESULTS: One hundred eleven patients (77% female) with a mean age of 38.6±13.1 years were included. Active Helicobacter pylori infection (aHpi) was diagnosed in 77 cases (69.40%). In 45% of the cases with aHpi, pangastritis (23%) or corpus-predominant gastritis (22%) was diagnosed. Nine cases were diagnosed with intestinal metaplasia (8%), 7 of which (77.70%) were in the aHpi group. Twenty one percent of the patients with aHpi had a GCRI of 2 (18.10%) or 3 (2.50%) points (high risk index), while 79.10% accumulated a GCRI of 0 or 1 points (low risk index). Of the patients with no aHpi, none of them had 3 points (p=0.001). Of the 18 patients that accumulated 2 or 3 points, 6 (33.30%) presented with intestinal metaplasia (all with pangastritis and corpus-predominant gastritis), of which 4 cases (66.60%) had aHpi. CONCLUSIONS: The estimated gastric cancer risk in patients with CGAHpI in the clinical setting studied was relatively low and 5% of the patients had a histopathologic phenotype associated with an elevated risk for developing gastric cancer.

Bundle branch block after ablation for Wolff-Parkinson-White syndrome.

BACKGROUND: Bundle branch block (BBB) is a difficult diagnosis in the Wolff-Parkinson-White syndrome (WPW). We investigated the clinical implications of BBB that appears after performing an accessory pathway (AP) ablation. METHODS: We studied 199 patients with WPW who were submitted to AP ablation. Thirty (15%) exhibited BBB after the ablation. Twenty-two patients had right BBB and 8 had left BBB. Thirteen patients had right-sided AP and 17 had left-sided AP. They were compared with 82 similar patients without BBB after the AP ablation. RESULTS: Among the patients with BBB, 86.66% showed delays in the middle part of the QRS in the ECG recorded before ablation vs. 18.29% of the patients without BBB (p<0.05) (sensitivity 86%, specificity 81%, positive predictive value 67% and negative predictive value 93%). Forty-four percent of the patients with BBB had BBB morphology during orthodromic tachycardia vs. 10% of the patients without BBB (p<0.05) (sensitivity 44%, specificity 89%, positive predictive value 57% and negative predictive value 82%). No relationship was found between AP location and the site of the BBB. Ejection fraction was normal before (0.61 ± 0.03) and upon completion of follow-up (0.61 ± 0.07). BBB disappeared in 95.3% of the patients. CONCLUSIONS: Delays in the middle portion of the QRS may predict BBB after AP ablation. BBB after performing AP ablation is frequent, transient, benign, and not related to either the ablation lesion location or progression to structural heart disease. BBB after AP ablation may be related to cardiac memory.

Tratamiento no farmacológico de la fibrilación auricular / Non pharmacological treatment of atrial fibrillation

La fibrilación auricular es la arritmia que genera más hodpitalizaciones y gastos en atención de la salud. La prevalencia de la fibrilación auricular aumenta con la edad de la población y otros factores. Estimamos que en Venezuela puede haber unas 230.000 personas que sufren. El tratamiento farmacológico con los antiarrítmicos disponibles no ha producido una solución satisfactoria al problema. De hecho se estima que después de un año de seguimiento, los antiarrítmocos más eficaces sólo alcanzan a mantener en ritmo sinusal a menos del 30% los pacientes. Este fallo de los antirrítmicos ha estimulado la investigación para conseguir métodos no farmacológicos para el tratamiento de la fibrilación auricular. En 1982 se describión la ablación del nodo AV para el control de la respuesta ventricular y, después, la ablación quirúrgica y por catéter para restablecer el ritmo sinusal. Presentamos una revisión acerca del tratamiento no farmacológico de la fibrilación auricular, con particular énfacis en la ablación por catéter, y nuestros resultados en la serie inicial de pacientes que hemos tratado por este medio en mérida, Venezuela.

Atrial fibrillation (AF) is the arrhythmia that causes the highest number of hospital admissions and health expenses. The prevalence of AF increases with age and several other factors. We estimate that 230,000 persons suffer from AF in Venezuela. Antiarrhytmic drugs have not been found to be adequate for AF treatment. Indeed, at one-year follow-up, recent research has found that the most powerful antiarrhytmics drugs are able to maintain sinus rhythm in less than 30% of patients. This failure of pharmacotherapy stimulated researh to find non-pharmacological means to treat AF. AV nodal ablation was introduced in 1982 for ventricular rate response control and surgical and catheter ablation techniques were later designed to achieve sinus rhythm. In this article we review the non-pharmacological treatment of AF putting special emphasis on catheter ablation. We also present some preliminary results obtained from the theatment of patients in Mérida(Venezuela).

Nefrectomía radical abierta y laparoscópica: estudio comparativo de cuidados de enfermería y calidad de vida / No disponible

En la Fundación Puigvert se ha introducido la nefrectomía laparoscópica como innovación quirúrgica durante el año 2001. Desde enero de 2001 se emplean ambas técnicas quirúrgicas simultáneamente, disminuyendo progresivamente el número de nefrectomías abiertas en beneficio de la cirugía laparoscópica, lo cual nos exige no sólo conocer las diferencias clínicas existentes entre ambas, sino discernirlos cuidados de enfermería a proporcionar según la demanda asistencial. Como equipo de enfermería consideramos que es imprescindible poseer un cuerpo de conocimientos, habilidades y actitudes que se adapten a los cambios e innovaciones. De este modo podremos identificar necesidades de salud, planificar cuidados de enfermería adecuados, prevenir complicaciones y contribuir a la adaptación del paciente a la vida diaria fomentando la independencia en todas sus necesidades según el modelo conceptual de Virginia Henderson. El objetivo de este estudio es describir desde un punto de vista comparativo la evolución posquirúrgica de la nefrectomía radical abierta y laparoscópica durante la hospitalización y el alta domiciliaria, en función de los cuidados de enfermería requeridos según el modelo conceptual de Virginia Henderson (AU)

In the Puigvert Foundation the laparoscopic nephrectomy has been introduced as surgical innovation during 2001. From January 2001both surgical techniques are used simultaneously, decreasing progressively the number of open nephrectomies for the benefit of the laparoscopic surgery, which requires that us not only to know the existing clinical differences between both, but to discern the cares of nursing to provide according to the demand. We, as a nursing team, consider that it is essential to possess a corps of knowledge, skills and attitudes that could be adapted to changes and innovations. In this way, we will be able to identify health needs, plan adequate nursing cares, prevent complications, and contribute to the adaptation of the patient to daily life encouraging the independence in all their needs according to the conceptual model of Virginia Henderson. The goal of this study is to describe from a comparative point of view the post-surgical evolution of the open radical nephrectomy and laparoscopic during the hospitalization and the house discharge, according to the nursing cares required according to the conceptual model of Virginia Henderson (AU)

Efectos de la vitamina E sobre la toxicidad digitálica en un modelo experimental / Effects of the vitamin and on the digitalica toxicity in an experimental model

Introducción y objetivos: Los digitálicos tienen un margen terapéutico estrecho y con su uso se observan con frecuencia los cuadros de toxicidad que pueden manifestarse por arritmias mediadas por actividad disparada. La actividad disparada se produce pos oscilaciones iónicas a través de las membranas y la vitamina E, como agente estabilizador de membranas, podría contrarrestar este tipo de arritmias, efecto que, hasta el presente, no ha sido investigado. Métodos: Para investigar el efecto de la vitamina E sobre la toxicidad digitálica estudiamos 40 ratas Wistar, machos, adultos. Veinte ratas recibieron digoxina intraperitoneal (30 mg/Kg) y 20 recibieron placebo. A la mitad de cada grupo de 20 se le administró vitamina E endovenosa y a la otra mitad, placebo de vitamina E. Resultados: En los animales que recibieron digoxina se observó mayor mortalidad, bradicardia sinusual, bloqueo A-V, y arritmias supraventriculares y ventriculares. No encontramos diferencias significativas entre el grupo de animales que recibieron vitamina E y el de los que recibieron placebo de la vitamina E. conclusión: En este modelo experimental de intoxicación digitálica la vitamina E intravenosa no ofrece protección ni efecto terapéutico.

Utilidad de un esquema sencillo para el diagnóstico de arritmias cardíacas / Usefulness of simple scheme for the diagnosis of cardiac arrhythmias

Objetivo: Determinar si un algoritmo diseñado en nuestra Sección de Electrofisiología facilita el diagnóstico electrocardiográfico de las taquiarritmias. Métodos: Treinta y dos sujetos: médicos residentes del primer año de postgrado de cardiología, médico sinternos y estudiantes del último año de medicina recibieron un curso de electrocardiografía. Luego se les repartieron 100 ECG de pacientes con taquiarritmias y se dividieron al azar en dos grupos. El grupo A emitió su diagnóstico sin el uso del algoritmo, y el Grupo B analizó los ECG con auxilio del algoritmo. Los diagnósticos fueron comparados contra el emitido por un electrofisiólogo. Resultados: El diagnóstico del grupo A tuvo una concordancia de 41% con el diagnóstico formulado por electrofisiólogo. El grupo B tuvo una concordancia del 64% (p = 0.0000013). Entre los dos grupos no hubo diferencias en cuanto al tipo o número de ECG no respondidos. Conclusiones: Este árbol de decisiones incrementa la certeza del diagnóstico en manos menos experimentadas, lo cual, a su vez, podría redundar en una mejoría de las medidas terapéuticas aplicadas a las arritmias.

Objective: To determine whether an algorythm designed at our Electrophysiology Unit could facilitate the electrocardiographic diagnosis of tachyarrhythmias. Methods: Twenty two first-year cardiology residents, general practitioners and last-year medical students attended an electro-physiology course. One hundred ECG of tachyarrhythmic patients were distributed to the participants who were then randomly divided into 2 groups. Group A analyzed the ECG with the help of the algorythm, whereas Group B analyzed them without it. Results were compared to those obtained by an electrophysiologist. Results: Group A diagnosis coincided with that of the electrophysiologist in 41% of the cases. In Group B the concordance reached 64% (p = 0.0000013). There was no between-group difference regarding the type and number of uninterpreted ECG. Conclusions: The decision tree increases diagnostic accuracy in less expert hands. This could in turn entail an improvement in the therapeutic measures applied to the study of arrhythmias.

Relación entre el síndrome de Low-Ganong-Levine y la taquicardia por reentrada nodal / Relationship between the Low-Ganong-Levine syndrome and the taquicardia for penetrated nodal

Este estudio se emprendió para determinar si los pacientes que sufren taquicardia supraventricular y que en el electrocardiograma tienen un intervalo PR corto con QRS normal (síndrome de Lown-Ganong-Levine) tienen como sustrato fisiopatológico una doble vía nodal aurículo-ventricular (A-V). Estudiamos 87 pacientes (26 varones, de 30,9 ± 15,3 años), en quienes por estudio electrofisiológico se demostró la presencia de taquicardia supraventricular por doble vía nodal aurículo-ventricular (N = 52) o taquicardia supraventricular por fascículos accesorios ocultos (N = 35). Treinta y cuatro pacientes tenían un intervalo PR menor de 0,14 seg y en los demás estaba entre 0,14 y 0,20 seg. Para el diagnóstico de la presencia de doble vía nodal en pacientes con taquicardia supraventricular, el intervalo PR menor de 0,14 seg mostró una sensibilidad de 36 por ciento, especificidad de 58 por ciento, valor predictivo positivo de 55 por ciento y valor predictivo negativo de 38 por ciento. Concluimos que 1) El hallazgo de un intervalo PR corto o relativamente corto, en ausencia de ondas delta, en pacientes que han sufrido taquicardia supraventricular paroxística, no permite hacer el diagnóstico de taquicardia por re-entrada nodal. 2) La conducción nodal aurículo-ventricular supradivisional es similar en los pacientes con doble vía nodal aurículo-ventricular y en los que tienen fascículos accesorios ocultos. 3) El sustrato fisiopatológico del síndrome de Lown-Ganong-Levine puede corresponder por igual a la presencia de fascículos accesorios ocultos y a la de doble vía nodal

Bystander coronary sinus diverticulum and left anterolateral accessory pathway.

Left posteroseptal accessory pathways have been described inside coronary sinus diverticula. We here describe the case of a patient who was suffering from recurrent episodes of paroxysmal supraventricular tachycardia and had a concealed accessory pathway located in the left anterolateral margin of the mitral annulus and a left posterior coronary sinus diverticulum associated with an aneurysmal coronary sinus vein. In the electrophysiological study, an orthodromic supraventricular tachycardia was induced and reproduced. We performed a successful radiofrequency ablation of the pathway. Our case provides evidence of the coexistence of concealed accessory pathways capable of sustaining orthodromic tachycardia coexisting with a bystander posterior coronary sinus diverticulum and aneurysmal coronary sinus vein.

Detección de especies de aeromonas en heces de niños asintomáticos / Aeromanas species detection in feces of asymtomatic children

Las enfermedades diarreicas constituyen un problema de salud pública a nivel mundial, especialmente en los países en vías de desarrollo, como Venezuela donde representan unas causa importante de morbilidad y mortalidad infantil. Entre los principales agentes etiológicos bacterianos de esta entidad nosológica se encuentra el género aeromonas, sin embargo, el significado clínico de su aislamiento no se ha establecido definitivamente. El propósito de esta investigación es detectar fenoespecies bacterianas del género aeromonas en muestra de heces de niños aparentemente sanos, con la finalidad de esclarecer la existencia de portadores asintómaticos en nuestro medio y contribuir a dilucidar la importancia clínica de su aislamiento en pacientes con gastroenteritis. La investigación se llevó a cabo durante el período comprendido entre septiembre y diciembre de 1999; se colectaron y analizaron 122 muestras de heces de niños de ambos sexos, con edades comprendidas entre 3 y 6 años, registrados en 16 preescolares privados de la parroquia Chiquiquirá del Municipio Maracaibo. El análisis de las muestras para la detección de fenoespecies del género aeromonas se llevó a cabo empleando la metodología diagnóstica convencional, basada en pruebas bioquímicas. En las muestras analizadas se detectó 27,87 por ciento (34/122) de positividad a especies de aeromonas. Aeromonas caviae resultó la especie más prevalente (52,78 por ciento), seguida de A. jandaei (19,44 por ciento), A. veronii biovar sobria (13,89 por ciento), A. hydrophila (11,11 por ciento) y A. trota (2,78 por ciento). En la mayoría de los casos (94.1 por ciento) se aisló una sola especie por muestra. La distribución de los aislamientos por edad y sexo no resultó estadísticamente significativa (p>0.05). Los resultados obtenidos demuestran la existencia de un número considerable de portadores asintomáticos de aeromonas entre los niños estudiados, por lo que resulta imprescindible realizar mayores investigaciones que contribuyan a establecer el significado de su aislamiento en pacientes con diarrea

Left ventricular function and autonomic nervous system balance during two different stages of the menstrual cycle.

We studied the left ventricular function and cardiac autonomic nervous system balance variations during two different stages of the menstrual cycle. These two variables, as well as plasmatic estradiol and progesterone concentrations, were measured in a drug-free state in 20 women (29+/-6 year-old) with regular menstrual periods. A clinical evaluation, an echo-Doppler and a Valsalva manoeuvre were performed in all the patients on the third day of their menstrual cycle (follicular phase) and three days prior to their next menstrual cycle (luteinizing phase). When comparing the results obtained in these two phases, a statistically significant increase was put forward in plasmatic estradiol (50.6+/-24 vs. 127.3+/-52.8 pg/ml) and progesterone (0.37+/-0.42 vs. 11.92+/-10.8 ng/ml) concentrations, Valsalva index (1.55+/-0.22 vs. 1.67+/-0.33; P=0.044) and E/A mitral wave ratio (1.63+/-0.36 vs. 1.75+/-0.35, P=0.02). The right and left atrial volumes, left ventricular volumes and ejection fraction were similar in the two menstrual phases studied. We conclude that the autonomic nervous system balance and the left ventricular diastolic function suffer significant changes during the luteinizing phase of the menstrual cycle in normal women.

QT-interval dispersion in malnourished children.

BACKGROUND: Little is known about the electrocardiographic (ECG) QT interval and its variability in malnourished children. HYPOTHESIS: The study of the QT interval and its dispersion in malnourished children was undertaken to determine whether the QT interval and its variability are increased in these children. METHODS: In 40 children (20 malnourished and 20 controls) aged 12.2 +/- 14.4 months (23 male) a conventional ECG was performed for computing heart rate, heart rate variability, corrected QT interval, and QT-interval dispersion. A blood sample was obtained for measuring hemoglobin, hematocrit, plasma protein, and plasma electrolytic concentrations. RESULTS: Corrected heart rate, heart rate variability, and QT Interval were similar in both groups. When compared with the control group, the malnourished children had greater corrected QT-interval dispersion, and that dispersion was more accentuated in the precordial leads. They also had repolarization abnormalities (flattened or inverted T waves and U waves). Hemoglobin, hematocrit, plasma protein, and plasma electrolytic concentrations were lower in the malnourished children. However, the ECG findings showed no statistically significant relationship with either the blood parameters, the severity or type of malnutrition, and the size or the weight of the children. CONCLUSIONS: QT-interval dispersion is increased in malnourished children and the dispersion is more accentuated in the precordial leads.

PIP: This study aims to determine electrocardiogram (ECG) QT-interval dispersion and its variability in malnourished children of Venezuela. The sample population consisted of 40 children (20 malnourished and 20 well nourished). A conventional ECG was performed for computing the heart rate, heart rate variability, corrected QT-interval, and QT-interval dispersion. In addition, blood samples were obtained to measure hemoglobin, hematocrit, plasma protein, and plasma electrolyte concentrations. Findings showed that the corrected heart rate, heart rate variability, and QT-interval were similar in malnourished and well-nourished children. Moreover, malnourished children demonstrated a greater corrected QT-interval dispersion and that dispersion was more accentuated in the precordial leads. They also had repolarization abnormalities (flattened or inverted T waves and U waves). Hemoglobin, hematocrit, plasma protein, and plasma electrolyte concentrations were lower in malnourished children. However, the ECG findings showed no statistical significant relationship with either blood parameters, the severity or type of malnutrition, and the size or the weight of the children.

Cardiac arrhythmias during two different stages of the menstrual cycle.

We have frequently observed that female patients report an association between their arrhythmias and their menstrual period but little is known about such an association. We studied 25 female patients 25.9+/-7.3 year-old with regular menstrual periods. Thirteen patients were evaluated because they suffered from cardiac symptoms and complained of arrhythmia aggravation during their menstrual period. Twelve normal female patients formed the control group. The evaluation was performed in a drug-free state. All the patients had a 24-h Holter study performed during the 7th day of their menstrual cycle and 3 days before the following menstrual period. No patient had sustained arrhythmia during the monitoring periods. When comparing the two Holter recordings we did not find statistically significant differences with respect to either the total count of supraventricular and ventricular premature beats or the heart rate.

[Tachycardiomyopathy in patients with and without subacute cardiac pathology. Experiences at the Cardiovascular Center of Merida, Venezuela]. / Taquicardiomiopatía en pacientes con y sin patología cardiaca subyacente. Experiencia en el Centro Cardiovascular de Mérida-Venezuela.

We report our experiences with tachycardia-induced cardiomyopathy. Nine patients (3-56 years old) had incessant supraventricular tachycardia and congestive heart failure. The cardiac eco-Doppler evidenced a significant increase of cardiac volumes and mild tricuspid and mitral regurgitation. The ejection fraction (EF) was 0.31 +/- 0.12, the end diastolic volume was 162 +/- 48 cc and the end systolic volume, 116 +/- 54 cc. Four patients had accessory pathways, 3 atrial flutter, 1 A-V nodal reentrant tachycardia, and 1 ectopic atrial tachycardia. Two patients had Chagasic myocarditis. Only in one chagasic patient a decreased number of tachycardia episodes was achieved, this patient died. The autopsy revealed cerebellar and pulmonary emboli. In the other 8 patients the arrhythmia was well controlled. In these, the ventricular volumes decreased, the EF increased to 0.51 +/- 0.14 (p = 0.00006), and the congestive heart failure remitted. We conclude that incessant tachycardia produces a symptomatic dilated cardiomyopathy in patients with and without structural heart disease. The arrhythmia control is followed by an increase in cardiac function and a remission of heart failure symptoms.

Effects of electroconvulsive therapy on cardiac function in patients without heart disease.

In order to determine whether electroconvulsive therapy (ECT) alters left-ventricular function in patients without heart disease, we studied 11 patients who had a normal cardiovascular system and were submitted to ECT. Left-ventricular function was assessed by means of a clinical examination and an echocardiographic evaluation performed before the ECT and 20 min and 6 h after ECT. Twenty minutes after ECT, the patients' end-systolic volume was increased (p = 0.003), whereas the ejection fraction (p = 0.004) and E to A ratio were decreased (p = 0.004 and 0.028, respectively). These indexes returned to the normal control value 6 h later. None of our patients presented any clinical signs of heart failure. We conclude that in some patients, ECT produces a significant and transient decrease in left-ventricular systolic and diastolic function.

Cardiac arrest following holiday heart syndrome.

We describe the case of a patient who, after a binge, had an episode of ventricular fibrillation (holiday heart syndrome) and was successfully resuscitated. In the electrophysiological study, we found dual atrioventricular nodal pathways, an atrioventricular effective refractory period of 210 ms, and an inducible atrial fibrillation with a ventricular response of 210 bpm that produced hemodynamic collapse. Atrioventricular nodal modification by radiofrequency ablation was successfully performed. The patient stopped drinking alcohol and has remained completely asymptomatic. In this case, ventricular fibrillation was probably caused by the fibrillating atria combined with a fast AV node.

Results of electrophysiologic studies in patients with acute Chagasic myocarditis.

BACKGROUND: As the acute stage of Chagas' myocarditis is rarely detected, little is known about the electrophysiologic characteristics of that stage. HYPOTHESIS: This investigation was undertaken to conduct an electrophysiologic study of the properties of the heart during the acute phase of Chagasic myocarditis. METHODS: We studied eight patients who had positive xenodiagnosis, positive mice culture, and positive complement fixation test for Chagas' disease. RESULTS: Trypanosoma cruzi were identified in all of the patients' stained blood samples. Right ventricular endomyocardial biopsies were obtained, evidencing a distinct infiltrate of lymphocytes that confirmed the diagnosis of acute myocarditis. The cardiac dimensions and the ventricular systolic and diastolic function were preserved in all patients. The electrocardiogram evidenced conduction defects in two patients. The signal-averaged electrocardiogram displayed late potentials in three patients. In the electrophysiologic study, atrial fibrillation or flutter was induced in four patients. When compared with control patients, Chagasic patients were found to have greater values of atrial threshold, A-H interval, and atrioventricular (AV) nodal effective refractory period. The H-V interval was mildly prolonged in two patients, but the dynamic AV nodal conduction was preserved (1:1 conduction during right atrial stimulation at a cycle length of 400 ms) in all the Chagasic patients. The ventricular parameters were within normal limits, and no sustained ventricular arrhythmia could be induced. CONCLUSIONS: Patients with mild acute Chagasic myocarditis may suffer from electrical abnormalities and arrhythmias that are more evident at the supraventricular level and the AV junction.

[Relation of spondylarthropathies and HLA-B27 antigen in patients from the state of Zulia, Venezuela]. / Estudio de la relación existente entre las espondiloartropatías y el antígeno HLA-B27 en pacientes del estado Zulia de Venezuela.

HLA-B27 and associate antigens incidence were studied in 620 cases of seronegative spondiloarthropathies (SNS) and 262 controls of a Venezuelan mestizo population from Zulla state between 1985 and 1995. The incidence of HLA-B27 was 20.96% of all cases of SNS. It was increased in patients with ankilosing spondylitis (AS) 33.33% and Relter's syndrome (RS) 30%, but not in uveitis (Uv) 20% an psoriatic arthropathy (PsA) 0%. The incidence in the control group was 4.2%. This results are lower than the previous description in Venezuelan mestizo and caucasic population but are close to the incidence described in population of West Africa with important contribution to admixture of the occidental part of Venezuela.