[Pterigium colli: secondary surgical correction of one severe case]. / Pterygium colli: reprise d'une correction chirurgicale d'un cas sévère.

Congenital web neck is a deformity hardly ever reported in the English literature. It is usually associated to Ulrrich-Turner syndrome. There are several options to correct this deformity, but in severe cases complete correction of the web and the abnormal back hair is not always possible. We present our experience with a secondary case where previous butterfly method was employed, a combined procedure was used achieving a satisfactory result. We considered that this technique is useful and offers an important improvement of the contour.

Food odor, visual danger stimulus, and retrieval of an aversive memory trigger heat shock protein HSP70 expression in the olfactory lobe of the crab Chasmagnathus granulatus.

Although some of the neuronal substrates that support memory process have been shown in optic ganglia, the brain areas activated by memory process are still unknown in crustaceans. Heat shock proteins (HSPs) are synthesized in the CNS not only in response to traumas but also after changes in metabolic activity triggered by the processing of different types of sensory information. Indeed, the expression of citosolic/nuclear forms of HSP70 (HSC/HSP70) has been repeatedly used as a marker for increases in neural metabolic activity in several processes, including psychophysiological stress, fear conditioning, and spatial learning in vertebrates. Previously, we have shown that, in the crab Chasmagnathus, two different environmental challenges, water deprivation and heat shock, trigger a rise in the number of glomeruli of the olfactory lobes (OLs) expressing HSC/HSP70. In this study, we initially performed a morphometric analysis and identified a total of 154 glomeruli in each OL of Chasmagnathus. Here, we found that crabs exposed to food odor stimuli also showed a significant rise in the number of olfactory glomeruli expressing HSC/HSP70. In the crab Chasmagnathus, a powerful memory paradigm based on a change in its defensive strategy against a visual danger stimulus (VDS) has been extensively studied. Remarkably, the iterative presentation of a VDS caused an increase as well. This increase was triggered in animals visually stimulated using protocols that either build up a long-term memory or generate only short-term habituation. Besides, memory reactivation was sufficient to trigger the increase in HSC/HSP70 expression in the OL. Present and previous results strongly suggest that, directly or indirectly, an increase in arousal is a sufficient condition to bring about an increase in HSC/HSP70 expression in the OL of Chasmagnathus.

Thrombolysis and Q wave versus non-Q wave first acute myocardial infarction: a GUSTO-I substudy. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries Investigators.

OBJECTIVES: We assessed the outcomes of patients with a first myocardial infarction with ST segment elevation, with and without the development of abnormal Q waves after thrombolysis. BACKGROUND: Prethrombolytic era studies report conflicting short-versus long-term mortality in the overall non-Q wave population, probably related to its heterogeneity. METHODS: Patients with no electrocardiographic (ECG) confounding factors or evidence of previous infarction were included. Q wave infarction was defined as a Q wave duration > or = 30 ms in lead aVF; R wave > or = 40 ms in lead V1; any Q wave or R wave < or = 10 ms and < or = 0.1 mV in lead V2; or Q wave > or = 40 ms in at least two of the following leads: I, aVL, V4, V5 or V6. In-hospital clinical events and mortality at 30 days and 1 year were assessed. RESULTS: No Q waves developed in 4,601 (21.3%) of the 21,570 patients. This group comprised more women and had a lower Killip class, lower weight and less anterior baseline ST elevation. The non-Q wave group had less in-hospital cardiogenic shock (2.1% vs. 3.3%, p < 0.0001), less heart failure (8.5% vs. 13.9%, p < 0.0001) and a trend toward less stroke (0.7% vs. 1.0%, p = 0.07) but an increased use of angioplasty (28% vs. 24%, p = 0.0001). The unadjusted mortality rate in the non-Q wave group was lower at 30 days (0.9% vs. 1.8%, p = 0.0001) and 1 year (2.7% vs. 4.2%, p = 0.0001), as was the adjusted 30-day mortality rate (4.8% vs. 5.3%, p < 0.0001). CONCLUSIONS: Patients with no ECG confounding factors or evidence of previous infarction who do not develop Q waves after thrombolysis have a better 30-day and 1-year prognosis than patients with a Q wave infarction.

TIMI grade 3 flow and reocclusion after intravenous thrombolytic therapy: a pooled analysis.

Early and sustained flow of grade 3 according to Thrombolysis in Myocardial infarction (TIMI) criteria and reocclusion rates are the key measures that define the physiologic efficacy of thrombolytic agents in the treatment of acute myocardial infarction. We performed a systematic overview of angiographic studies after intravenous thrombolysis with accelerated and standard-dose tissue-plasminogen activator (TPA), anisoylated plasminogen streptokinase activator complex (APSAC), and streptokinase. There were 5475 angiographic observations from 15 studies for TIMI flow analysis and 3147 angiographic observations from 27 studies for reocclusion. At 60 and 90 minutes, the rates of TIMI grade 3 flow were 57.1% and 63.2%, respectively, with accelerated TPA, 39.5% and 50.2% with standard-dose TPA, 40.2% and 50.1% with APSAC, and 31.5% at 90 minutes with streptokinase. Overall reocclusion with standard-dose TPA was 11.8% versus 6.0% for accelerated TPA, 4.2% for streptokinase, and 3.0% for APSAC. Although the incidence of TIMI grade 3 flow increased over time with all thrombolytic regimens, decreased patency was observed at 180 minutes with accelerated TPA. Still, accelerated TPA is the most effective agent to establish early (90-minute) TIMI grade 3 flow.

Total myocardial revascularization with arterial conduits: radial artery combined with internal thoracic arteries.

OBJECTIVE: We prospectively tested the feasibility of achieving total arterial revascularization with the use of the radial artery to revascularize the circumflex, diagonal, and right coronary arteries combined with a left internal thoracic artery graft to the left anterior descending artery and, in some cases, a right internal thoracic artery graft to the right coronary artery. METHODS: In 164 patients, the radial artery was used as a free Y or T graft from the left internal thoracic artery. Of 568 grafts (3.5 +/- 1 [standard deviation] per patient), 296 (1.8 +/- 0.8 per patient) were constructed with the radial artery as single grafts or as double, triple, or quadruple sequential anastomoses to the circumflex, diagonal, and posterior descending arteries. Diltiazem was administered to prevent spasm. Forty-six patients underwent coronary angiography before discharge from the hospital. Follow-up time was 1 to 19 (9.5 +/- 6.1) months. RESULTS: Total arterial revascularization was achieved in 137 patients (83.5%). Three (1.8%) died postoperatively of sepsis, ventricular fibrillation, and heart failure, respectively. Three (1.8%) had postoperative myocardial infarction. No hand ischemia occurred. Angiography showed patency of all arterial conduits. Radial artery spasm appeared in 3 (6.5%) of 46 angiograms. Two patients (1.2%) died during the follow-up period of pneumonia and gastrointestinal tract bleeding, respectively. No other events or reoperations occurred, and 95.1% of the patients are free of symptoms. CONCLUSIONS: The radial artery, as a free Y or T graft from the left internal thoracic artery to the circumflex, diagonal, and right coronary arteries, permits total arterial revascularization with excellent patency rates, minimal morbidity and mortality, and no need for reoperation. Longer follow-up times are necessary to draw definitive conclusions.

[Hepatic artery aneurysm]. / Aneurisma de la arteria hepática.

We report the case of a 45-year old man who presented a common hepatic artery aneurysm. He had alcoholic habits and after an episode of upper gastrointestinal tract bleeding underwent an abdominal ultrasound study. This showed a large fluid-filled upper abdominal mass related to the pancreatic head. Both T scan and an angiogram showed an hepatic artery aneurysm. It was resected and the artery repaired interposing a saphenous vein graft. The patient was discharged a week after surgery. Most of the hepatic artery aneurysms are free of symptoms and difficult to palpate and only a few patients can be operated before the occurrence of aneurysmal fissure. Broad use of ultrasound and selective angiography has increased the number of cases diagnosed before complications, reducing the mortality rate, which, in the past, has been reported up to 59%.

[Elevation of ST segment and Bezold Jarisch reflex as evidence of early post-thrombolysis reperfusion]. / Supradesnivel del segmento ST y reflejo de Bezold Jarisch como evidencias de reperfusión precoz post-trombolisis.

The prognosis of patients with acute myocardial infarction (AMI) depends on the patency of the infarct-related coronary artery. This is the reason why the early recognition of the result of thrombolysis is very important in order to implement more aggressive studies and more complex treatments in case of failure. A clinical syndrome of "early coronary reperfusion" with an excellent correlation with angiographic data has been identified, characterized by: 1) pain decrease in more than 50%, 2) descent of ST segment elevation of more than 50%, 3) early elevation of creatinine phosphokinase (CPK) enzyme; other signs of reperfusión described are the Bezold Jarisch reflex (bradycardia and arterial hypotension) in patients with inferior AMI, an additional elevation of ST segment during thrombolytic infusion. These two signs of successful thrombolysis were seen early and together in our patient. He was a 41 year old male who had an anterior AMI 4 months before admission to our Coronary Care Unit with diagnosis of unstable angina (rest angina). After 10 hours he began with intensive precordial pain of 30 minutes with 2 mm of ST segment elevation in inferior leads. Streptokinase (STK) (1,500,000 units) by infusion was administered during 45 minutes; at 30 minutes of infusion the patient had an increase of ST segment elevation in the same leads which reached 3 mm and decreased to basal line after 2 hours. He also had bradycardia and hypotension which improved with atropine 1 mg IV. An episode of acute heart failure (confirmed by clinical, radiological and hemodynamic data) resolved just before the end of STK infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Supradesnivel del segmento ST y reflejo de Bezold Jarisch como evidencias de reperfusion precoz post-trombolisis / Elevation of ST segment and Bezold Jarisch reflex as evidence of early reperfusion post thrombolysis

El prognóstico de los pacientes con IAM depende en parte de la permeabilidad de la arteria "culpable". Es por lo tanto esencial reconocer precozmente el éxito de la terapia trombolítica. A los elementos clásicos de reperfusión, se han agregado otros indicios adicionales de éxito trombolítico como la activación del reflejo de Bezoid Jarisch (bradicardia e hipotensión arterial en pacientes con IAM inferior) y la sobreelevación adicional del segmento ST durante la infusión del trombolítico. Se describe el caso de un paciente de 41 años, que presentó IAM hiperagudo de cara inferior y que recibió precozmente tratamiento trombolítico. Durante la infusión de Estreptoquinasa (STK) se constataron estos indicios de reperfusión exitosa, además de los criterios tradicionales. La angiografía coronaria efectuada a los 6 días, corroboró la validez de estos hallazgos al encontrar la arteria responsable permeable. Se descartó isquemia por lo que se dio de alta al paciente, con tratamiento médico. La activación del reflejo de Bezold Jarisch en enfermos con IAM inferior repermeabilizados con trombolíticos y la elevación transitória adicional de segmento ST intrainfusión de STK son hallazgos precoces, que no han sido reportados en asociación o combinados con los demás elementos clásicos y pueden resultar de utilidad para predecir el éxito del tratamiento trombolítico en el IAM

Supradesnivel del segmento ST y reflejo de Bezold Jarisch como evidencias de reperfusión precoz post-trombolisis. / [Elevation of ST segment and Bezold Jarisch reflex as evidence of early post-thrombolysis reperfusion]

The prognosis of patients with acute myocardial infarction (AMI) depends on the patency of the infarct-related coronary artery. This is the reason why the early recognition of the result of thrombolysis is very important in order to implement more aggressive studies and more complex treatments in case of failure. A clinical syndrome of [quot ]early coronary reperfusion[quot ] with an excellent correlation with angiographic data has been identified, characterized by: 1) pain decrease in more than 50

, 2) descent of ST segment elevation of more than 50

, 3) early elevation of creatinine phosphokinase (CPK) enzyme; other signs of reperfusión described are the Bezold Jarisch reflex (bradycardia and arterial hypotension) in patients with inferior AMI, an additional elevation of ST segment during thrombolytic infusion. These two signs of successful thrombolysis were seen early and together in our patient. He was a 41 year old male who had an anterior AMI 4 months before admission to our Coronary Care Unit with diagnosis of unstable angina (rest angina). After 10 hours he began with intensive precordial pain of 30 minutes with 2 mm of ST segment elevation in inferior leads. Streptokinase (STK) (1,500,000 units) by infusion was administered during 45 minutes; at 30 minutes of infusion the patient had an increase of ST segment elevation in the same leads which reached 3 mm and decreased to basal line after 2 hours. He also had bradycardia and hypotension which improved with atropine 1 mg IV. An episode of acute heart failure (confirmed by clinical, radiological and hemodynamic data) resolved just before the end of STK infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Supradesnivel del segmento ST y reflejo de Bezold Jarisch como evidencias de reperfusión precoz post-trombolisis. / [Elevation of ST segment and Bezold Jarisch reflex as evidence of early post-thrombolysis reperfusion]

The prognosis of patients with acute myocardial infarction (AMI) depends on the patency of the infarct-related coronary artery. This is the reason why the early recognition of the result of thrombolysis is very important in order to implement more aggressive studies and more complex treatments in case of failure. A clinical syndrome of [quot ]early coronary reperfusion[quot ] with an excellent correlation with angiographic data has been identified, characterized by: 1) pain decrease in more than 50

, 2) descent of ST segment elevation of more than 50

, 3) early elevation of creatinine phosphokinase (CPK) enzyme; other signs of reperfusión described are the Bezold Jarisch reflex (bradycardia and arterial hypotension) in patients with inferior AMI, an additional elevation of ST segment during thrombolytic infusion. These two signs of successful thrombolysis were seen early and together in our patient. He was a 41 year old male who had an anterior AMI 4 months before admission to our Coronary Care Unit with diagnosis of unstable angina (rest angina). After 10 hours he began with intensive precordial pain of 30 minutes with 2 mm of ST segment elevation in inferior leads. Streptokinase (STK) (1,500,000 units) by infusion was administered during 45 minutes; at 30 minutes of infusion the patient had an increase of ST segment elevation in the same leads which reached 3 mm and decreased to basal line after 2 hours. He also had bradycardia and hypotension which improved with atropine 1 mg IV. An episode of acute heart failure (confirmed by clinical, radiological and hemodynamic data) resolved just before the end of STK infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Supradesnivel del segmento ST y reflejo de Bezold Jarisch como evidencias de reperfusion precoz post-trombolisis / Elevation of ST segment and Bezold Jarisch reflex as evidence of early reperfusion post thrombolysis

El prognóstico de los pacientes con IAM depende en parte de la permeabilidad de la arteria "culpable". Es por lo tanto esencial reconocer precozmente el éxito de la terapia trombolítica. A los elementos clásicos de reperfusión, se han agregado otros indicios adicionales de éxito trombolítico como la activación del reflejo de Bezoid Jarisch (bradicardia e hipotensión arterial en pacientes con IAM inferior) y la sobreelevación adicional del segmento ST durante la infusión del trombolítico. Se describe el caso de un paciente de 41 años, que presentó IAM hiperagudo de cara inferior y que recibió precozmente tratamiento trombolítico. Durante la infusión de Estreptoquinasa (STK) se constataron estos indicios de reperfusión exitosa, además de los criterios tradicionales. La angiografía coronaria efectuada a los 6 días, corroboró la validez de estos hallazgos al encontrar la arteria responsable permeable. Se descartó isquemia por lo que se dio de alta al paciente, con tratamiento médico. La activación del reflejo de Bezold Jarisch en enfermos con IAM inferior repermeabilizados con trombolíticos y la elevación transitória adicional de segmento ST intrainfusión de STK son hallazgos precoces, que no han sido reportados en asociación o combinados con los demás elementos clásicos y pueden resultar de utilidad para predecir el éxito del tratamiento trombolítico en el IAM (AU)

[Is there a clinical value of endomyocardial biopsy and immunosuppressive treatment in idiopathic dilated cardiomyopathy? Study by meta analysis]. / Tienen valor clínico la biopsia endomiocárdica y el tratamiento inmunosupresor en la miocardiopatía dilatada idiopática? Estudio por metanálisis.

This study was intended to answer two questions: 1) whether the prognosis of patients with dilated cardiomyopathy and myocardial inflammatory changes, and 2) whether immunosuppressive agents may modify survival. The meta-analysis technique was employed as a tool in order to homogenize the results of several reports that were not conclusive and often contradictory due to the small number of patients studied. Twenty one reports were included; in 12, there was a follow up study of patients with acute inflammatory changes. Four reports compared the follow up of groups showing acute inflammatory changes with controls with dilated cardiomyopathy lacking inflammatory phenomena in the biopsy, including a total of 272 patients; 47 (17.3%) disclosed inflammatory changes. Total mortality for this group was 25.6% while that for the control group was 28.4% (p = NS). Thirteen reports dealt with the effect of immunosuppressive treatment with myocarditis; 7 studies included an untreated control group, summing up 119 patients. Mortality did not differ between these groups: 31.3% and 30.9%, respectively (p = NS). It is concluded that 1) there are very few controlled and conclusive reports available on the prognostic value of endomyocardial biopsy and immunosuppressive treatment in idiopathic dilated cardiomyopathy; 2) the presence of inflammatory changes did not worsen the prognosis; and 3) immunosuppressive treatment did not improve survival.

¿Tienen valor clínico la biopsia endomiocárdica y el tratamiento inmunosupresor en la miocardiopatía dilatada idiopática? Estudio por metanálisis / Is there a clinical value of endomyocardial biopsy and immunosuppressive treatment in idiopathic dilated cardiomyopathy? Study by meta analysis

El objetivo de este estudio fue intentar responder los siguientes interrogantes: 1) si los pacientes (p) con miocardiopatía dilatada idiopática y cambios inflamatorios en la biopsia endomiocárdica tienen peor prognóstico que los que no muestran dichas alteraciones y 2) si en los p con cambios inflamatorios en la biopsia endomiocárdica, los inmunosupresores pueden modificar su evolución. Para resolver estas preguntas se utilizó el metanálisis como método estadístico para analizar los resultados de diversos trabajos de literatura que individualmente no fueron concluyentes o cuyos resultados fueron contradictorios. De 21 estudios com biopsia endomiocárdica, en 12 se presenta el seguimiento de los p con cambios inflamatorios agudos. En 4 de ellos se presenta, además, el seguimiento comparado entre los p con cambios inflamatorios y un grupo control sin ellos. Estos 4 estudios comprenden 272 p, de los cuales 47 (17,3) tenían actividad inflamatoria. La mortalidad global en este último subgrupo fue de 25,6% y la del grupo control 28,4% (p=NS). De 13 estudios en los que se emplearon los inmunosupresores para tratar p co signos de miocarditis ...

Tienen valor clínico la biopsia endomiocárdica y el tratamiento inmunosupresor en la miocardiopatía dilatada idiopática? Estudio por metanálisis. / [Is there a clinical value of endomyocardial biopsy and immunosuppressive treatment in idiopathic dilated cardiomyopathy? Study by meta analysis]

This study was intended to answer two questions: 1) whether the prognosis of patients with dilated cardiomyopathy and myocardial inflammatory changes, and 2) whether immunosuppressive agents may modify survival. The meta-analysis technique was employed as a tool in order to homogenize the results of several reports that were not conclusive and often contradictory due to the small number of patients studied. Twenty one reports were included; in 12, there was a follow up study of patients with acute inflammatory changes. Four reports compared the follow up of groups showing acute inflammatory changes with controls with dilated cardiomyopathy lacking inflammatory phenomena in the biopsy, including a total of 272 patients; 47 (17.3

) disclosed inflammatory changes. Total mortality for this group was 25.6

while that for the control group was 28.4

(p = NS). Thirteen reports dealt with the effect of immunosuppressive treatment with myocarditis; 7 studies included an untreated control group, summing up 119 patients. Mortality did not differ between these groups: 31.3

and 30.9

, respectively (p = NS). It is concluded that 1) there are very few controlled and conclusive reports available on the prognostic value of endomyocardial biopsy and immunosuppressive treatment in idiopathic dilated cardiomyopathy; 2) the presence of inflammatory changes did not worsen the prognosis; and 3) immunosuppressive treatment did not improve survival.

¿Tienen valor clínico la biopsia endomiocárdica y el tratamiento inmunosupresor en la miocardiopatía dilatada idiopática? Estudio por metanálisis / Is there a clinical value of endomyocardial biopsy and immunosuppressive treatment in idiopathic dilated cardiomyopathy? Study by meta analysis

El objetivo de este estudio fue intentar responder los siguientes interrogantes: 1) si los pacientes (p) con miocardiopatía dilatada idiopática y cambios inflamatorios en la biopsia endomiocárdica tienen peor prognóstico que los que no muestran dichas alteraciones y 2) si en los p con cambios inflamatorios en la biopsia endomiocárdica, los inmunosupresores pueden modificar su evolución. Para resolver estas preguntas se utilizó el metanálisis como método estadístico para analizar los resultados de diversos trabajos de literatura que individualmente no fueron concluyentes o cuyos resultados fueron contradictorios. De 21 estudios com biopsia endomiocárdica, en 12 se presenta el seguimiento de los p con cambios inflamatorios agudos. En 4 de ellos se presenta, además, el seguimiento comparado entre los p con cambios inflamatorios y un grupo control sin ellos. Estos 4 estudios comprenden 272 p, de los cuales 47 (17,3) tenían actividad inflamatoria. La mortalidad global en este último subgrupo fue de 25,6% y la del grupo control 28,4% (p=NS). De 13 estudios en los que se emplearon los inmunosupresores para tratar p co signos de miocarditis ... (AU)

[Thrombolytic therapy in a case of prosthetic aortic valve thrombosis]. / Trombolíticos en el tratamiento de un caso de trombosis valvular protésica en posición aórtica.

We present the case of a 40 year old woman, who had an aortic prosthetic valve, of the Björk Shiley type. Three months before admission she began with progressive dyspnea. She was admitted to the Cardiovascular Care Unit with a global cardiac failure. An aortic prosthetic valve thrombosis was diagnosed clinically (absence of the prosthetic click) and by radioscopy (a decrease in the movement of the valve disk, with an incomplete shunt). It was attributed to a secondary failure of the anticoagulant treatment. Despite the treatment she quickly developed a cardiogenic shock. A treatment with 750,000 UI of streptokinase in 30 min was started, followed by 100,000 UI during 12 hours, with total reversion of the hemodynamic features, as judged by clinical examination (recurrence of the prosthetic click), radioscopy (recurrence of the valve movement) and by Doppler echocardiography (reduction of the transvalvular gradient). No complications were observed, and in a follow up of 12 months she persisted asymptomatic. The prosthetic valve thrombosis is an infrequent and almost fatal complication. The classical therapy consists in surgery which is a procedure with a high mortality in patients with severe cardiac failure, and an emergency procedure, as it occurred in our patient. Despite the known success of the thrombolytic therapy in the prosthetic valve thrombosis of the right heart (tricuspid position) it was only in the last years that this treatment was reported in aortic or mitral position. Peripheric embolies were found in 13% of the cases, always with transitory symptoms. There are only 45 cases described in the world, and more experience is needed for definitive conclusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Tromboliticos en el tratamiento de un caso de trombosis valvular protesica en posicion aortica / Thrombolytic therapy in a case of prosthetic aortic valve thrombosis

Se presenta el caso de una paciente de sexo femenino, de 40 años de edad, portadora de una prótesis valvular tipo Björk Shiley en posición aórtica quien sufrió como complicación la trombosis de la misma, con progesivo deterioro hemodinámico, hasta llegar al schock cardidogénico. Se administró tratamiento trombolítico, con reversión total del cuadro. La conducta terapéutica tradicional es la quirúrgica, con elevado índice de mortalidad perioperatoria. Si bien el tratamiento trombolítico en trombosis de prótesis valvulares en posición tricuspídea fue sugerido desde 1971, hay pocos casos relatados de su aplicación a nivel de prótesis de cavidades izquierdas. Precisamente el motivo de este trabajo es la presentación de un caso, con la revisión de la literatura y el análisis de los beneficios potenciales de esta terapéutica