Constrictive pericarditis after heart transplantation: report of two cases.

We report two cases of constrictive pericarditis after heart transplantation. It is noteworthy that constriction developed after a healed intrathoracic infection in the two patients. Unlike previous reported experiences, pericardiectomy was uneventful and successfully performed, although incomplete improvement was achieved in one case.

[The significance of cytomegalovirus infection in the period after a heart transplant]. / Trascendencia de la infección por citomegalovirus en el curso postrasplante cardíaco.

Cytomegalovirus (CMV) infection is a frequent source of morbidity after heart transplantation. Risk factors for the development of CMV infection include the use of antilymphocyte preparations in the postoperative phase or as antirejection therapy, and seronegative patients who receive a heart from a seropositive donor. Clinical spectrum varies from a mild illness with low-grade fever and leukopenia, to a severe disease with organ manifestations. CMV interferes in the immune system, and may trigger cellular rejection episodes, having a possible role accelerating graft coronary vasculopathy. Thus, an aggressive and early diagnostic approach to the infection is mandatory. Quantitative monitoring of antibody titers, cultures and CMV antigenemia may be helpful in the clinical diagnosis. Cytomegalovirus prophylaxis strategies in high-risk patients remain controversial. Currently, ganciclovir is the most safe and effective agent for the treatment of CMV infection. A better knowledge of the pathogenic mechanism of CMV infection will probably help the development of new diagnosis technology and more effective prophylactic and treatment strategies.

[Thrombosis and thrombocytopenia associated with the use of unfractionated heparin in a female patient with unstable angina]. / Trombosis y trombocitopenia asociadas al uso de heparina no fraccionada en una paciente con angina inestable.

A case of heparin-induced platelet activation with thrombocytopenia and several arterial emboli in a 60-year-old woman suffering unstable angina is presented. The early recognition of the syndrome, with cessation of heparin and the use of unfractionated heparin, led to an immediate remission of the thrombocytopenia and thromboembolic complications.

[Thyroid dysfunction induced by amiodarone in Catalonia. Prevalence and characteristics]. / Disfunción tiroidea inducida por amiodarona en Cataluña. Prevalencia y características.

The purpose of this study was to review the epidemiological aspects and the characteristics of the thyroid disfunction produced by amiodarone in Catalonia, an area with type I endemic goiter. For this purpose, three groups of patients have been studied: 1) 102 patients with prolonged amiodarone treatment, out of whom 6 (5.9%) presented hyperthyroidism, and 2 (1.9%) hypothyroidism. 2) 909 patients with hyperthyroidism of any origin out of which 42 (4.6%) were produced by amiodarone. 3) 203 patients presenting primary hypothyroidism of any origin out of which 11 (3.8%) were induced by amiodarone. Out of the 48 patients with amiodarone induced hyperthyroidism, 16 presented multinodular goiter, 2 toxic thyroid goiter and 7 Graves Basedow disease. Thyroid uptake of 131I was studied in 10 cases being normal or increased in six of them, all with a underlaying thyroid pathology. Out of the 13 patients with amiodarone induced hypothyroidism, 3 presented diffuse goiter; thyroid uptake of 131I was studied in 5 patients, being normal or increased in 4 cases, 2 of which with thyroid pathology. Amiodarone administration very often produces thyroid disfunction, specially hyperthyroidism. These patients with hyperfunctional thyroids usually present underlying thyroid pathologies in which thyroid uptake of 131I are frequently not suppressed as well as in those patients in whide amiodarone induced hypothyroidism.

[Pulmonary edema secondary to acute obstruction of the upper airways. Apropos of a case of immediate recovery]. / Edema pulmonar secundario a obstrucción aguda de las vías aéreas superiores. A propósito de un caso de instauración inmediata.

The AA. inform on the case of a girl, 13, carrying an aortic prosthesis who some hours after the removal of a laryngeal dilator had an asphyctic syndrome during a meal. The emergency being overcome an acute pulmonary edema could be diagnosed without either objective valvular or left ventricular dysfunctions. In spite of the prior heart pathology the reporters belief in the coincidence of the case displayed with a pulmonary edema following the acute obstruction of the upper respiratory tract. They review the proposed physiopathological hypothesis as well as the Spanish literature upon the subject.