Temporary work disability following trapezial resection and suspension arthroplasty for thumb carpometacarpal osteoarthritis. / Incapacidad laboral temporal tras cirugía de rizartrosis mediante trapecectomía y artroplastia de suspensión con sutura de alta resistencia.

PURPOSE: The aim of this study is to assess the time to return to work (TRW) in patients undergoing trapezial resection using the Mini TightRope® system at our center and to investigate factors that might delay return to work following this surgery. MATERIAL AND METHODS: A retrospective study was conducted on patients who underwent Trapezial resection and suspensionplasty using the Mini TightRope® system between 2015 and 2016, with a minimum one-year follow-up. Telephone interviews were conducted along with a review of medical records and radiology reports, as well as temporary work disability documents, collecting epidemiological and occupational data. Groups were compared based on age, gender, dominant hand, biomechanical occupational requirements of the patients, and whether they had experienced prior temporary work disability. RESULTS: A total of 36 patients (29 women and 7 men) with an average age of 55.7 years were included. The median time to return to work was 126 days. Self-employed workers re-entered the workforce 72 days earlier on average; workers who had experienced prior temporary work disability had a greater total temporary work disability duration and took 91 days longer to return to work compared to those who had not. CONCLUSIONS: Patients employed by others and those who had experienced prior temporary work disability before the surgery had longer temporary work disability periods. In our study, no differences were observed based on gender, dominant hand, or biomechanical work demands of the intervened patients.

Mental impact of Covid-19 among Spanish healthcare workers. A large longitudinal survey.

AIMS: Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors. METHODS: 8996 healthcare workers evaluated on 5 May-7 September 2020 (baseline) were invited to a second web-based survey (October-December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview. RESULTS: 4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar. CONCLUSIONS: Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565.

Four-month incidence of suicidal thoughts and behaviors among healthcare workers after the first wave of the Spain COVID-19 pandemic.

Healthcare workers (HCW) are at high risk for suicide, yet little is known about the onset of suicidal thoughts and behaviors (STB) in this important segment of the population in conjunction with the COVID-19 pandemic. We conducted a multicenter, prospective cohort study of Spanish HCW active during the COVID-9 pandemic. A total of n = 4809 HCW participated at baseline (May-September 2020; i.e., just after the first wave of the pandemic) and at a four-month follow-up assessment (October-December 2020) using web-based surveys. Logistic regression assessed the individual- and population-level associations of separate proximal (pandemic) risk factors with four-month STB incidence (i.e., 30-day STB among HCW negative for 30-day STB at baseline), each time adjusting for distal (pre-pandemic) factors. STB incidence was estimated at 4.2% (SE = 0.5; n = 1 suicide attempt). Adjusted for distal factors, proximal risk factors most strongly associated with STB incidence were various sources of interpersonal stress (scaled 0-4; odds ratio [OR] range = 1.23-1.57) followed by personal health-related stress and stress related to the health of loved ones (scaled 0-4; OR range 1.30-1.32), and the perceived lack of healthcare center preparedness (scaled 0-4; OR = 1.34). Population-attributable risk proportions for these proximal risk factors were in the range 45.3-57.6%. Other significant risk factors were financial stressors (OR range 1.26-1.81), isolation/quarantine due to COVID-19 (OR = 1.53) and having changed to a specific COVID-19 related work location (OR = 1.72). Among other interventions, our findings call for healthcare systems to implement adequate conflict communication and resolution strategies and to improve family-work balance embedded in organizational justice strategies.

Vertebroplastia percutánea guiada por tomografía para el manejo del dolor en pacientes con fractura del cuerpo vertebral / CT-guided Vertebroplasty for Painful Vertebral Fractures

Objetivo Describir la técnica y resultados en cuanto a la mejoría del dolor y complicaciones al realizar este procedimiento mediante guía por tomografía computada. Materiales y Métodos Estudio observacional descriptivo de una serie de 108 pacientes a quienes se les realizó vertebroplastia percutánea guiada por tomografía computada realizadas en dos hospitales universitarios, entre mayo 2007 y mayo 2017. Todos los procedimientos se realizaron de forma ambulatoria con anestesia local y se valoró el dolor mediante la escala visual análoga. Resultados Se realizaron 125 vertebroplastias, en el 87,9% de los pacientes (n = 95) se realizó el procedimiento en un cuerpo vertebral, en el 8,3% (n = 9) y 3,7% (n = 4) de los pacientes se cementaron 2 y 3 vertebras respectivamente. El rango de dolor según la escala visual análoga (EVA) previo al tratamiento varió entre 5 y 10, donde un 94% (n = 102) de los pacientes manifestaban una intensidad 10/10. En el postratamiento el rango de dolor varió entre 0a7dondeel 98% de la población reportó un valor menor o igual a 3. Se presentaron 3 complicaciones: tromboembolismo pulmonar por metil-metacrilato, extravasación al plexo de Batson y extravasación al espacio interdiscal, cada una en tres pacientes diferentes. Conclusión La vertebroplastia percutánea guiada por TC ofrece una indiscutible mejora inmediata del dolor en pacientes con fractura de uno o más cuerpos vertebrales, con una baja tasa de complicaciones.

Objetive Describe the technique, results in terms of pain improvement and complications to perform this procedure by computed tomography. Materials and Methods A descriptive observational study of a 108 cases series of percutaneous vertebroplasty guided by computed tomography performed in two university hospitals between May 2007 and May 2017. All procedures were performed with local anesthesia on an outpatient basis, pain was assessed by means of the Visual analogue scale (VAS). Results A total of 125vertebroplasties were performed. In 87.9% (n = 95) of the patients, the procedure was performed in one vertebral body, in 8.3% (n = 9) and 3.7% (n = 4) of the patientshad two or three vertebrae cemented respectively. The range of pain according to VAS prior to treatment varied between 5 and 10, where 94% (n = 102) of the patients manifested a 10/10 intensity; after treatment, the range of pain varied between 0 to 7 where 98% of the population reported a value less than or equal to 3. Three complications were reported, one pulmonary thromboembolism due to methylmethacrylate, one extravasation in to the Batson plexus and one extravasation of cement to the interdiscal space. Conclusion CT-guided percutaneous vertebroplasty offers an undeniable immediate improvement of pain in patients with fracture of one or more vertebral bodies, with a low rate of complications.

No nos olvidemos del bazo: el órgano huérfano / Do not forget the spleen: The orphan organ

Si bien cumple una función esencial en procesos como la filtración sanguínea y respuesta inmunitaria, el bazo es el órgano abdominal olvidado o huérfano, ya que ningún especialista (incluyendo a los radiólogos) le presta atención. No obstante, este puede verse afectado por una gran cantidad de patologías benignas y malignas, cuyas características en imágenes es importante conocer para lograr un correcto diagnóstico. En el presente artículo realizamos un ensayo iconográfico sobre las distintas entidades que pueden comprometerlo.

Even when the spleen plays a key role in processes such as blood filtration and immune response, it is the abdominal organ forgotten or orphan. The spleen can be affected by much benign and malignant disease, and is important to know the characteristics images of them to achieve a correct diagnosis. In this iconographic assay we show images of several of these diseases.

No nos olvidemos del bazo: el órgano huérfano

Si bien cumple una función esencial en procesos como la filtración sanguínea y respuesta inmunitaria, el bazo es el órgano abdominal olvidado o huérfano, ya que ningún especialista (incluyendo a los radiólogos) le presta atención. No obstante, este puede verse afectado por una gran cantidad de patologías benignas y malignas, cuyas características en imágenes es importante conocer para lograr un correcto diagnóstico. En el presente artículo realizamos un ensayo iconográfico sobre las distintas entidades que pueden comprometerlo.(AU)

Even when the spleen plays a key role in processes such as blood filtration and immune response, it is the abdominal organ forgotten or orphan. The spleen can be affected by much benign and malignant disease, and is important to know the characteristics images of them to achieve a correct diagnosis. In this iconographic assay we show images of several of these diseases.(AU)

Enfermedad de Sinding-Larsen-Johansson: análisis de factores asociados / Sinding-Larsen-Johansson disease: analysis of the associated factors

Objetivo. Analizar los factores clínicos, etiológicos biomecánicos asociados a la enfermedad de Sinding-Larsen-Johansson (SLJ). Material y método. Estudio de casos-control valorando los siguientes parámetros: edad, sexo, tiempo de evolución clínica, lateralidad, nivel de actividad deportiva, grado radiológico, existencia de patela alta, existencia de retracción de isquiotibiales y aumento de la caída posterior de la tibia. Resultados. Presentamos 15 rodillas en 14 pacientes (un caso de afectación bilateral). El porcentaje de varones es del 85,7% y la edad media de afectación es de 10,86 años (d.t. 1,61). Todos ellos presentaban un nivel de actividad física y deportiva elevado con una duración de los síntomas muy variable (1-36 meses). Sin tendencia clara en cuanto a la lateralidad, la mayoría se incluyen en un grado radiológico tipo ii (53,3%). El análisis de los datos no muestra diferencias significativas (p>0,05) entre los grupos respecto al índice de Caton ni de Insall modificado. En la medición del ángulo poplíteo en las rodillas lesionadas, sí encontramos diferencias significativas (media: 32,50 d.t.:8,90) con respecto al grupo control (17,67; 8,21). La diferencia en la medición del ángulo de caída posterior en las rodillas lesionadas también ha resultado estadísticamente significativo (10,47; 2,82) con respecto a las rodillas de los casos control (8,33; 1,40). Conclusiones. Los pacientes con la enfermedad tienen un aumento de la pendiente tibial y retracción de isquiotibiales respecto al grupo control y esta diferencia es estadísticamente significativa (AU)

Aim. To analyse the clinical symptoms, aetiology and biomechanical aspects related to Sinding-Larsen-Johansson (SLJ) disease. Material and method. A case control study was conducted, analysing the following variables: age, gender, clinical follow up, side of body with the symptoms, sporting activity, radiological stage, presence of patella alta, presence of short hamstring tendons, and increased posterior tibial slope. Results. A total of 15 knees in 14 patients were studied; one case with bilateral disease. The large majority of cases were 85.7% were male, and the mean age was 10.86 (standard deviation 1.61). All of them practised sport and physical activity at a high level with a variable duration of symptoms (1-36 months). There was predominance in side. The majority were radiological grade II (53.3). The data analysis did not show any significant difference (P>.05) between the study groups regarding the Caton and modified Insall indexes. There was a significant difference in the popliteal angle measured in the affected knees (mean: 32.50, SD: 8.9) compared with the control group (mean: 17.67, SD: 8.21). The difference in the posterior slope angle in the affected knees was also statistically significant (mean: 10.47, SD: 2.82) compared with the control (mean: 8.33, SD: 1.4). Conclusions. According to our data, patients have short hamstring tendons and increased posterior tibial slope compared to the control group, and this difference is statistically significant (AU)

[Sinding-Larsen-Johansson disease: analysis of the associated factors]. / Enfermedad de Sinding-Larsen-Johansson: análisis de factores asociados.

AIM: To analyse the clinical symptoms, aetiology and biomechanical aspects related to Sinding-Larsen-Johansson (SLJ) disease. MATERIAL AND METHOD: A case control study was conducted, analysing the following variables: age, gender, clinical follow up, side of body with the symptoms, sporting activity, radiological stage, presence of patella alta, presence of short hamstring tendons, and increased posterior tibial slope. RESULTS: A total of 15 knees in 14 patients were studied; one case with bilateral disease. The large majority of cases were 85.7% were male, and the mean age was 10.86 (standard deviation 1.61). All of them practised sport and physical activity at a high level with a variable duration of symptoms (1-36 months). There was predominance in side. The majority were radiological grade II (53.3). The data analysis did not show any significant difference (P>.05) between the study groups regarding the Caton and modified Insall indexes. There was a significant difference in the popliteal angle measured in the affected knees (mean: 32.50, SD: 8.9) compared with the control group (mean: 17.67, SD: 8.21). The difference in the posterior slope angle in the affected knees was also statistically significant (mean: 10.47, SD: 2.82) compared with the control (mean: 8.33, SD: 1.4). CONCLUSIONS: According to our data, patients have short hamstring tendons and increased posterior tibial slope compared to the control group, and this difference is statistically significant.

[Incidental diagnosis of an ostium-secundum-type interatrial communication during coronary surgery]. / Diagnóstico casual de una comunicación interauricular tipo ostium secundum durante cirugía coronaria.

Preoperative assessment of a 73-year-old woman scheduled for coronary revascularization revealed signs of severe disease in three coronary vessels, mild mitral valve insufficiency, moderate tricuspid insufficiency and moderate-to-severe pulmonary hypertension, with preserved left ventricular function. During surgery pulmonary artery catheter measurements confirmed pulmonary hypertension and the presence of very high cardiac output, leading to suspicion of atrial septal defect. Peripheral vein and right atrial blood samples revealed a sudden increase of 23 mm Hg in PO2 and of 22% in oxygen saturation. Finding the opening in the wall of the right atrium gave diagnostic confirmation of an ostium secundum defect 3 cm in diameter. The defect was closed and the coronary vessel bypasses were created. Upon weaning from extracorporeal circulation, the sudden oximetric increase was seen to have disappeared and pulmonary artery pressures had decreased. Postoperative course was satisfactory, with normal sinus rhythms alternating with episodes of atrial fibrillation. We stress the importance of invasive hemodynamic monitoring and transesophageal echography during heart surgery to confirm diagnoses that have not been established during preoperative assessment.

Diagnóstico casual de una comunicación interauricular tipo ostium ecundum durante cirugía coronaria / Ostium secundum atrial septal defect: fortuitous diagnosis during heart surgery

Una mujer de 73 años fue programada para cirugía de revascularización coronaria. En el estudio previo se evidenció afectación grave coronaria de tres vasos, insuficiencia mitral de grado leve, insuficiencia tricuspídea moderada e hipertensión pulmonar de grado moderadograve, con función ventricular izquierda conservada.Durante el periodo operatorio las medidas a través de un catéter de arteria pulmonar confirmaron la hipertensión pulmonar y la existencia de un gasto cardiaco muy elevado que hicieron sospechar la existencia de una comunicación interauricular. La extracción de muestras de sangre de vena periférica y de aurícula derecha mostró un salto oximétrico en la PO2 de 23 mm Hg y 22 por ciento en la saturación de oxígeno. La apertura de la aurícula derecha confirmó la existencia de un defecto tipo ostium secundum de 3 cm de diámetro. Se procedió al cierre del defecto y a la realización de los puentes coronarios, observándose a la salida de circulación extracorpórea la desaparición del salto oximétrico y el descenso de las presiones de la arteria pulmonar. La evolución postoperatoria fue satisfactoria, alternando el ritmo sinusal con episodios de fibrilación auricular. Destacamos la importancia de la monitorización hemodinámica invasiva y de la ecografia transesofágica durante la cirugía cardiaca para confirmar diagnósticos no establecidos en el examen preoperatorio (AU)

[Life events, quality of life and social support prior to acute cerebral vascular disease, as predictive factors of the quality of life and functional state following stroke]. / Acontecimientos vitales, calidad de vida y apoyo social previos a la enfermedad vascular cerebral aguda, como factores predictores de la calidad de vida y situación funcional posteriores al ictus.

INTRODUCTION: The repercussion of stroke on quality of life has been evaluated but not the possible relation between the quality of life before and months after an acute stroke. OBJECTIVE: To study the possible relation between quality of life, social support, stressful life events prior to the stroke and quality of life, social support and functional state months after. PATIENTS AND METHODS: A prospective study was made of 34 patients (71.7 +/- 8 years; 19 (56%) men; 15 (44%) women with stroke, by means of two evaluations: personal interview within the first 36 hours (quality of life--Nothingham health profile (NHP)-, perception of social support and stressful life events--Holmes and Rake inventory-) and an interview over the phone 16.5 +/- 5.3 months after the stroke (NHP, perception of social support and functional state--Rankin scale-). RESULTS: Following the stroke there was deterioration in perception of social support (19.8 +/- 3 vs 12.5 +/- 8; p = 0.000) and in the degree of social isolation of the NHP (9.4 +/- 20 vs 21.1 +/- 30; p = 0.03). The only relation found was between the following variables: pain at the first evaluation and pain (r = 0.45; p = 0.007) at the second evaluation; mobility at the first evaluation and emotional state (r = 0.39; p = 0.029) and social support (r = 0.37; p = 0.027) at the second evaluation; sleepiness at the first evaluation and energy (r = 0.55; p = 0.0006), pain (r = 0.39; p = 0.022), emotional state (r = 0.35; p = 0.038), mobility (r = 0.34, p = 0.048) and sleepiness (r = 0.51; p = 0.001) at the second evaluation. CONCLUSION: Our results indicate that there is little relationship between the previous state and that following stroke, and that the deterioration in perception of support and social isolation is due to the stroke itself.

Acontecimientos vitales, calidad de vida y apoyo social previos a la enfermedad vascular cerebral aguda, como factores predictores de la calidad de vida y situación funcional posteriores al ictus / Live events quality of life and social support prior to acute cerebral vascular disease, as predictive factors of the quality of life and functional state following stroke

Introducción. Se ha valorado la repercusión del ictus en la calidad de vida pero no la posible relación entre la calidad de vida previa y la que tienen los pacientes meses después del episodio agudo. Objetivo. Estudiar la posible relación entre calidad de vida, apoyo social y acontecimientos vitales estresantes previos al ictus y calidad de vida, apoyo social y situación funcional meses después del mismo. Pacientes y métodos. Estudio prospectivo de 34 pacientes (71,7 ± 8 años; 19 (56%) varones; 15 (44%) mujeres) con ictus mediante dos valoraciones: entrevista personal en las primeras 36 horas (calidad de vida –perfil de salud de Nottingham (PSN)–, percepción de apoyo social y acontecimientos vitales estresantes –inventario de Holmes y Rake–) y entrevista telefónica 16,5 ± 5,3 meses después del ictus (PSN, percepción de apoyo social y situación funcional –escala de Rankin–). Resultados. Después del ictus se produce un deterioro en la percepción del apoyo social (19,8 ± 3 frente a 12,5 ± 8; p= 0,000) y en la dimensión de aislamiento social del PSN (9,4 ± 20 frente a 21,1 ± 30; p= 0,03). Sólo se encontró relación entre las siguientes variables: dolor en la primera evaluación y dolor (r= 0,45; p= 0,007) en la segunda evaluación; movilidad en la primera evaluación y estado emocional (r= 0,39; p= 0,029) y apoyo social (r= 0,37; p= 0,027) en la segunda evaluación; sueño en la primera evaluación y energía (r= 0,55; p= 0,0006), dolor (r= 0,39; p= 0,022), estado emocional (r= 0,35; p= 0,038), movilidad (r= 0,34; p= 0,048) y sueño (r= 0,51; p= 0,001) en la segunda evaluación. Conclusión. Nuestros resultados sugieren que la relación existente entre la situación previa y la posterior al ictus es escasa, y que el deterioro en la percepción del apoyo y el aislamiento social se deben al ictus en sí mismo (AU)

Introduction. The repercussion of stroke on quality of life has been evaluated but not the possible relation between the quality of life before and months after an acute stroke. Objective. To study the possible relation between quality of life, social support, stressful life events prior to the stroke and quality of life, social support and functional state months after. Patients and methods. A prospective study was made of 34 patients (71.7 ± 8 years; 19 (56%) men; 15 (44%) women with stroke, by means of two evaluations: personal interview within the first 36 hours (quality of life –Nothingham health profile (NHP)–, perception of social support and stressful life events –Holmes and Rake inventory–) and an interview over the phone 16.5 ± 5.3 months after the stroke (NHP, perception of social support and functional state –Rankin scale–). Results. Following the stroke there was deterioration in perception of social support (19.8 ± 3 vs 12.5 ± 8; p= 0.000) and in the degree of social isolation of the NHP (9.4 ± 20 vs 21.1 ± 30; p= 0.03). The only relation found was between the following variables: pain at the first evaluation and pain (r= 0.45; p= 0.007) at the second evaluation; mobility at the first evaluation and emotional state (r= 0.39; p= 0.029) and social support (r= 0.37; p= 0.027) at the second evaluation; sleepiness at the first evaluation and energy (r= 0.55; p= 0.0006), pain (r= 0.39; p= 0.022), emotional state (r= 0.35; p= 0.038), mobility (r= 0.34, p= 0.048) and sleepiness (r= 0.51; p= 0.001) at the second evaluation. Conclusion. Our results indicate that there is little relationship between the previous state and that following stroke, and that the deterioration in perception of support and social isolation is due to the stroke itself (AU)

Diferencias de género en el contexto de salud mental / Gender differences in mental health

Las diferencias de género no sólo abarcan conductas, actitudes y sentimientos sino también las manifestaciones de la salud y del malestar. El presente trabajo analiza el recorrido que hace el paciente hasta ser atendido en un equipo de salud mental de distrito y describe las diferencias de género encontradas en una muestra de sujetos. Se trata de una reflexión sobre dichas diferencias que han de ser tenidas en cuenta en la práctica terapéutica (AU)

[Patent foramen ovale as a cause of recurrent cerebral embolism. Closure with minimally invasive surgery]. / Foramen oval permeable como causa de embolismo cerebral repetido. Cierre con cirugía mínimamente invasiva.

We report a clinical case of a 63-year-old patient, referred with a history of repeated strokes, whose only cause was a patent foramen ovale with shunt right to left diagnosed by transesophageal echocardiography. He underwent minimally invasive surgery, through right parasternal minithoracotomy, practising defect closure. We comment on the value of echocardiography for diagnosing this pathology and the utility of this surgical technique for repairing these defects.

[Occult rupture of the aortic arch caused by a traffic accident]. / Rotura oculta de cayado aórtico tras un accidente de tráfico.

A patient presented to our emergency department from another hospital diagnosed with pelvic fracture after a motor vehicle accident. In the ensuing 12 hours, chest pain developed, and a widened mediastinum on chest radiography was found. Posterior aortography showed aortic arch rupture. During surgery, we found a complete circumferential disruption of the arch between the brachiocephalic trunk and the carotid artery. Even though thoracic aortic injuries rarely occur in motor vehicle accidents, thoracic arch ruptures are extremely uncommon. This injury should be suspected after high-speed motor vehicle accidents, when accompanied with chest pain or widened mediastinum.

[Is crystalloid cardioplegia still a valid technique for myocardial myocardial protection?]. / Sigue siendo válida la cardioplejía cristaloide como técnica de protección miocárdica?

OBJECTIVES: The routine use of a cardioplegic solution for myocardial protection during the ischemic phase of cardiac surgery represents a great therapeutic advance. Two cardioplegic solutions are currently in use: crystalloid and blood solutions. As blood cardioplegia has been shown to offer superior myocardial protection, its use at present is widespread. We did a retrospective study to assess whether crystalloid cardioplegia might nevertheless continue to be useful. PATIENTS AND METHODS: Forty patients with heart disease underwent surgery between March 1994 and March 1995, with the use of crystalloid cardioplegia (group A). Blood cardioplegia was used in 72 patients during the same period (group B). RESULTS: There were no significant differences in clinical (age, arterial hypertension, diabetes, chronic bronchial disease, severity of angina, severity of heart disease) or surgical (emergency, percent use of the internal thoracic artery, duration of extracorporeal circulation) variables. The percentage of patients with low ejection fraction was higher in group B as a result of preoperative selection. The mean number of grafts was higher in group B than in group A (3.5% and 2.5, respectively) (p < 0.01). Postoperative results (use of inotropics, counterpulsation balloon, creatine phosphokinase, perioperative myocardial infarction or hospital mortality) were not significantly different. The percent of supraventricular arrhythmias after surgery was higher in group A than in group B (20% and 5%, respectively) (p < 0.05) and lactic dehydrogenase level was lower in group A than in group B (472 and 572 mu/l, respectively) (p < 0.05). CONCLUSIONS: We believe that crystalloid cardioplegia continues to be a valid and effective myocardial protection technique in heart patients with preserved left ventricular systolic function.

[Anomalous origin of the left coronary artery from the pulmonary artery in adults. Long-term follow up]. / Origen anómalo de la arteria coronaria izquierda desde la arteria pulmonar en adultos. Seguimiento a largo plazo.

Anomalous origin of the left coronary artery from the pulmonary artery is a serious pathology, that untreated supposes a high mortality. Usually it becomes symptomatic in early infancy, but some cases reach adult life with no symptoms. We report four cases diagnosed in teenagers and adults, three of them with the oldest ages known in worldwide literature and one of them the oldest reported until now. We have completed a long follow-up in the various surgical techniques, where we did not observe any differences in their prognosis, and we recommend an anti-arrhythmia treatment joined with surgical treatment in adult patients with this pathology.