Quantification of mitral regurgitation by automated cardiac output measurement: experimental and clinical validation.

OBJECTIVES: To develop and validate an automated noninvasive method to quantify mitral regurgitation. BACKGROUND: Automated cardiac output measurement (ACM), which integrates digital color Doppler velocities in space and in time, has been validated for the left ventricular (LV) outflow tract but has not been tested for the LV inflow tract or to assess mitral regurgitation (MR). METHODS: First, to validate ACM against a gold standard (ultrasonic flow meter), 8 dogs were studied at 40 different stages of cardiac output (CO). Second, to compare ACM to the LV outflow (ACMa) and inflow (ACMm) tracts, 50 normal volunteers without MR or aortic regurgitation (44+/-5 years, 31 male) were studied. Third, to compare ACM with the standard pulsed Doppler-two-dimensional echocardiographic (PD-2D) method for quantification of MR, 51 patients (61+/-14 years, 30 male) with MR were studied. RESULTS: In the canine studies, CO by ACM (1.32+/-0.3 liter/min, y) and flow meter (1.35+/-0.3 liter/min, x) showed good correlation (r=0.95, y=0.89x+0.11) and agreement (deltaCO(y-x)=0.03+/-0.08 [mean+/-SD] liter/min). In the normal subjects, CO measured by ACMm agreed with CO by ACMa (r=0.90, p < 0.0001, deltaCO=-0.09+/-0.42 liter/min), PD (r=0.87, p < 0.0001, deltaCO=0.12+/-0.49 liter/min) and 2D (r=0.84, p < 0.0001, deltaCO=-0.16+/-0.48 liter/min). In the patients, mitral regurgitant volume (MRV) by ACMm-ACMa agreed with PD-2D (r= 0.88, y=0.88x+6.6, p < 0.0001, deltaMRV=2.68+/-9.7 ml). CONCLUSIONS: We determined that ACM is a feasible new method for quantifying LV outflow and inflow volume to measure MRV and that ACM automatically performs calculations that are equivalent to more time-consuming Doppler and 2D measurements. Additionally, ACM should improve MR quantification in routine clinical practice.

Utilidad de la heparina de bajo peso molecular en la sepsis abdominal / The usefulness of low molecular weight heparin in abdominal sepsis

Los fenómenos trombóticos secundarios a procesos sépticos abdominales son causa de una importante postoperatoria. Para su prevención, se ha empleado la heparina regular. Las fracciones de menor peso molecular tienen el mismo efecto, aunque menos efectos secundarios. En el presente trabajo se estudió la utilidad de la enoxaparina, una heparina de bajo peso molecular, para la prevención de los fenómenos trombóticos que ocurren después de un proceso séptico abdominal. Para tal efecto se estudiaron cinco grupos de 10 ratas cada uno. A todos los animales del estudio se les provocó peritonitis fecal. Durante el periodo posoperatorio, al grupo 1 se le administró heparina regular, al grupo 2 enoxaparina, al grupo 3 el antibiótico pefloxacina y a los grupos 4 y 5 la combinación de cada una de las heparinas con pefloxacina. Después de dar muerte a los animales, se realizó estudio de histopatología. Los resultados fueron evaluados con análisis estadístico no paramétrico de Kruskal-Wallis y Mann Whitney. En todas las ratas se produjo sepsis abdominal. El edema intraveolar fue mayor en el grupo de heparina regular comparado con el de enoxaparina con una p de 0.028; el resto de los grupos no tuvo diferencia estadística. Ninguna de las heparinas mostró efecto directo sobre el fenómeno séptico abdominal. En comparación con la heparina regular, la enoxaparina consiguió que las ratas con sepsis tuvieran menor edema intralveolar. No hubo diferencia en cuanto a la prevención de fenómenos trombóticos

[Spontaneous drainage of a pancreatic abscess into the digestive tract]. / Drenaje espontáneo hacia el tubo digestivo de un absceso pancreático.

Pancreatic abscess is a serious complication of acute pancreatitis and the best treatment is surgical drainage, even when morbidity and mortality are high. We present a patient with a pancreatic abscess after cholecystectomy and bile duct drainage because of cholelithiasis and pancreatitis. The abscess was manifested by a palpable painful mass in the epigastrium, fever, leukocytosis, and confirmed by ultrasound. Through a nasogastric tube we drained necrotic and purulent material with gradual and complete recovery. This is the first case in our hospital in which a pancreatic abscess drained spontaneously into the digestive tract without requiring external drainage.