Endocarditis sobre una válvula mitral nativa calcificada por irradiación / Endocarditis on a native mitral valve calcified by irradiation

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Friction force regimes and the conditions for endless penetration of an intruder into a granular medium.

An intruder penetrating into a granular column experiences a depth-dependent friction force F(z). Different regimes of F(z) have been measured depending on the experimental design: a nearly linear dependence for shallow penetrations, total saturation at large depths, and an exponential increase when the intruder approaches the bottom of the granular bed. We report here an experiment that allows us to measure the different regimes in a single run during the quasistatic descent of a sphere in a light granular medium. From the analysis of the resistance in the saturation zone, it was found that F(z) follows a cube-power-law dependence on the intruder diameter and an exponential increase with the packing fraction of the bed. Moreover, we determine the critical mass m_{c} required to observe infinite penetration and its dependence on the above parameters. Finally, we use our results to estimate the final penetration depth reached by intruders of masses m

[What to do when there is no evidence]. / Y cuando no hay evidencias, qué?

This article reflects the content presented by the authors in the framework of the VI National Symposium on Bed Sores and Chronic Wounds celebrated in Zaragoza from the 15th to 17th of November, 2005. It includes interesting commentaries about what is understood as evidence, what evidence exists and how evidence is used.

Y cuando no hay evidencias, ¿Qué? / What to do when there is no evidence

Este artículo refleja los contenidos expuestos por el autor en el marco del VI Simposio Nacional de Úlceras por Presión y Heridas Crónicas, celebrado en Zaragoza del 15 al 17 de noviembre de 2006. Interesantes reflexiones acerca de qué se entiende por evidencia, qué evidencia existe y cómo se utiliza

This article reflects the content presented by the authors in the framework of the VI NAtional Symposium on Bed Sores and Chronic Wounds celebrated in Zaragoza from the 15th to 17th of November, 2005. It includes interesting commentaries about what is understood as evidence, what evidence exists and how evidence is used

Manifestaciones neurológicas del paciente en estado crítico / Neurological manifestations in critically ill patients

Objetivo. Describir la fisiopatología, diagnóstico y manifestacionesclínicas de las complicaciones neurológicas que elpaciente en estado crítico suele desarrollar en las unidades de cuidadosintensivos, y aportar su tratamiento y pronóstico, acorde conla bibliografía contemporánea más relevante. Desarrollo. Los pacientesen estado crítico desarrollan sepsis como la más frecuentede sus complicaciones, asociada a una encefalopatía como manifestaciónprincipal, que guarda una estrecha relación con el pronósticodel paciente. La polineuropatía del paciente en estado críticose encuentra asociada a la sepsis como principal factor desencadenantey a la presencia de glucosa elevada, que es una limitaciónimportante para la retirada de la ventilación mecánica. Lamiopatía del paciente en estado crítico se relaciona con el uso deesteroides fluorados y bloqueadores neuromusculares, que se empleanfrecuentemente en estos pacientes. Todas estas entidades representanun reto diagnóstico significativo para el clínico y seacompañan de secuelas importantes que persisten tras el alta hospitalaria,además de miopatías y neuropatías asociadas al uso defármacos comúnmente empleados en el paciente en estado crítico,por lo que se debe conocer la fisiopatología del daño y los factoresasociados, para un abordaje diagnóstico oportuno. Conclusiones.La incidencia de estas patologías y sus complicaciones hace deellas entidades relevantes que necesitan un diagnóstico rápido yapropiado para su tratamiento temprano, así como el conocimientode su pronóstico

Aims. To describe the pathophysiology, diagnosis and clinical manifestations of the neurological complications thatcritically ill patients often develop in intensive care units, and to discuss their treatment and prognosis, in the light of the mostsignificant contemporary literature. Development. The most frequent complication suffered by critically ill patients is sepsis,with encephalopathy as the main manifestation, and this has a direct effect on their prognosis. Polyneuropathy of the criticallyill patient is linked to sepsis, as the main precipitating factor, as well as to the presence of high levels of glucose, which playsan important role in deciding whether mechanical ventilation can be withdrawn or not. Myopathy of the critically ill patient isrelated to the use of fluorinated steroids and neuromuscular blockers, which are frequently administered to these patients. Allthese entities represent a significant diagnostic challenge for the physician and are accompanied by important sequelae thatcontinue after the patient's discharge from hospital, as well as myopathies and neuropathies associated to the use of drugs thatare commonly administered to critically ill patients. It is therefore necessary to be familiar with the pathophysiology of thedamage and with the associated factors, if a suitable diagnostic approach is to be employed. Conclusions. The incidence ofthese pathologies and their complications makes them important conditions that require a swift, accurate diagnosis so thattreatment can be established early on and a prognosis can also be determined

[Neurological manifestations in critically ill patients]. / Manifestaciones neurologicas del paciente en estado critico.

AIMS: To describe the pathophysiology, diagnosis and clinical manifestations of the neurological complications that critically ill patients often develop in intensive care units, and to discuss their treatment and prognosis, in the light of the most significant contemporary literature. DEVELOPMENT: The most frequent complication suffered by critically ill patients is sepsis, with encephalopathy as the main manifestation, and this has a direct effect on their prognosis. Polyneuropathy of the critically ill patient is linked to sepsis, as the main precipitating factor, as well as to the presence of high levels of glucose, which plays an important role in deciding whether mechanical ventilation can be withdrawn or not. Myopathy of the critically ill patient is related to the use of fluorinated steroids and neuromuscular blockers, which are frequently administered to these patients. All these entities represent a significant diagnostic challenge for the physician and are accompanied by important sequelae that continue after the patient's discharge from hospital, as well as myopathies and neuropathies associated to the use of drugs that are commonly administered to critically ill patients. It is therefore necessary to be familiar with the pathophysiology of the damage and with the associated factors, if a suitable diagnostic approach is to be employed. CONCLUSIONS: The incidence of these pathologies and their complications makes them important conditions that require a swift, accurate diagnosis so that treatment can be established early on and a prognosis can also be determined.

Joint symbolic dynamic analysis of cardiorespiratory interactions in patients on weaning trials.

Assessing autonomic control provides information about patho-physiological imbalances. Measures of variability of the cardiac interbeat duration RR(n) and the variability of the breath duration TTot(n) are sensitive to those changes. The interactions between RR(n) and TTot(n) are complex and strongly non-linear. A study of joint symbolic dynamics is presented as a new short-term non-linear analysis method to investigate these interactions in patients on weaning trials. 78 patients from mechanical ventilation are studied: Group A (patients that failed to maintain spontaneous breathing and were reconnected) and Group B (patients with successful trials). Using the concept of joint symbolic dynamics, cardiac and respiratory changes were transformed into a word series, and the probability of occurrence of each word type was calculated and compared between both groups. Significant differences were found in 13 words, and the most significant pn(Wc010, r010): 0.0041 ± 0.0036 (group A) against 0.0012 ± 0.0024 (group B), p-value = 0.00001. The number of seldom occurring word types (forbidden words) also presents significant differences fwcr: 6.9 ± 6.6 against 13.5 ± 5.3, p-value = 0.00004. Joint symbolic dynamics provides an efficient non-linear representation of cardiorespiratory interactions that offers simple physiological interpretations.

Trombocitopenia inmune inducida por la heparina / Immune thrombocytopenia induced by heparin

Presentamos el caso de un paciente que precisó la administración de heparina no fraccionada para una terapia de reemplazo renal por una insuficiencia renal aguda anúrica, y se objetivó un descenso del recuento plaquetario mayor del 50 por ciento al séptimo día. La prueba de ELISA detectó los anticuerpos formados contra el complejo heparina/factor4 plaquetario y confirmó que se trataba de una trombocitopenia de origen inmune causada por la heparina. La actitud principal fue la supresión de cualquier exposición a la heparina y se inició un tratamiento con fármacos anticoagulantes alternativos para prevenir la elevada frecuencia de eventos trombóticos asociados a esta entidad clínica. El resultado fue una elevación progresiva del recuento plaquetario durante la semana siguiente a la suspensión de la heparina hasta su normalización y la ausencia de complicaciones tromboembólicas hasta el momento del alta hospitalaria (AU)

Study of the respiratory pattern variability in patients during weaning trials.

Mechanical ventilators are used to provide life support in patients with respiratory failure. One of the challenges in intensive care is the process of weaning from mechanical ventilation. We studied the differences in respiratory pattern variability between patients capable of maintaining spontaneous breathing during weaning trials and patients that fail to maintain spontaneous breathing. The respiratory pattern was characterized by the following time series: inspiratory time (T(I)), expiratory time (T(E)), breath duration (T(Tot)), tidal volume (V(T)), fractional inspiratory time (T(I)/T(Tot)), mean inspiratory flow (V(T)/T(I)), respiratory frequency (f), and rapid shallow breathing index (f/V(T)). The variational activity of breathing was partitioned into autoregressive, periodic and white noise fractions. Patients with unsuccessful trial presented a tendency to higher values of gross variability of V(T)/T(I) and f/V(T), and lower values of T(I). The autocorrelation coefficients tended to present higher values for T(I), T(I)/T(Tot) and V(T)/T(I). During both successful and unsuccessful T-tube test uncorrelated random behavior constituted > 75% of the variance of each time breath components and represented 50 to 70% in the breath component related to V(T). Correlated behavior represented 6 to 21% in time components and 28 to 50% in component related to V(T).

[Erythrocytosis and hydronephrosis in a horseshoe kidney]. / Poliglobulia e hidronefrosis, en riñón en herradura.

OBJECTIVE: To report a case of erythrocytosis in a patient with a hydronephrotic horseshoe kidney and normal erythropoietin values. METHODS/RESULTS: A hydronephrotic horseshoe kidney was discovered during evaluation to determine the etiology of the erythrocytosis in a 23-year-old male with normal erythropietin values. Blood parameters returned to normal following heminephrectomy. The hydronephrosis had been caused by stenois of the pyeloureteric junction. CONCLUSIONS: Although erythropoietin values may be normal, hydronephrosis can cause secondary erythrocytosis.

Hypomelanosis of Ito. Neurological complications in 34 cases.

We studied 34 Spanish children with hypomelanosis of Ito. This disease has an incidence of 1 per 1000 new patients consulting a paediatric neurological service, or 1 per 8000-10,000 unselected patients in a children's hospital. About 94% of our patients show noncutaneous abnormalities. Mental retardation (IQ below 70) was present in 64.7%; another 14.7% had an IQ between 70 and 90, usually associated with poor school performance. Four children exhibited autistic behaviour. Seizures of various types were present in 53% of cases. Other skin alterations in addition to the typical hypomelanosis were observed in 38% of our cases: café-au-lait spots, angiomatous nevi, nevus marmorata, nevus of Ota, Mongolian blue spot, heterochromia of the iris or hair, and other nonspecific pigmentations. Other associated disorders occur inconsistently and include macrocephaly, microcephaly, hémihypertrophy, kyphoscoliosis, coarse facial features, genital anomalies, inguinal hernia, congenital heart disease, hypertelorism, and abnormalities of the teeth, feet and eyes. Autosomal dominant inheritance is demonstrated in some but not all cases.

[Epidemiology of reno-ureteral lithiasis in the province of Toledo]. / Epidemiología de la litiasis renoureteral en la provincia de Toledo.

In this paper a review is made of a total of 384 patients suffering from lithiasic illness and the authors stress the high incidence of hyperuricuria in the province of Toledo, referring to the possible effect and cause link between this type of lithiasis and an unsuitable diet. On the other hand, they find no connection between this type of lithiasis and the chemical-mineral composition of the water as a possible contributory, lithogenetic factor.

[Triple tumor pathology of the left urinary tract]. / Triple patología tumoral de la vía excretora izquierda.

The authors present one case of three coexisting tumours in one excretory duct. The absence of clear haematuria at any time and the radiolucid urographic image, along with the clear picture of left, reno-ureteral colic, led to their considering the wrong diagnosis of left ureteral lithiasis. They discuss the rarity of the presence of three tumours, according to the world statistics, and the importance of the ascending pyelography and the exfoliative cytology for the diagnosis of suspicious radiotransparent images of the ureter.