Síndrome de tako-tsubo. Discinesia transitoria del ventrículo izquierdo. Presentación de nuestra casuística / Tako-tsubo syndrome. Transient left ventricular dyskinesia. Presentation of our casuistics

Este síndrome fue descrito en 1990, y se caracteriza por dolor torácico que simula un síndrome coronario agudo (SCA), alteraciones en el ECG y coronarias sin lesiones. Presentamos 16 pacientes ingresados en nuestra UCI, con criterios de síndrome de discinesia transitoria del ventrículo izquierdo (SDTVI). Todos nuestros pacientes menos uno eran mujeres con edad, en general, mayor de 55 años. Se detectó dolor torácico en el 75% de los pacientes. Un 43% tuvo como desencadenante una situación estresante emocional. Un 56% tuvo elevación del ST. La elevación de biomarcadores fue ligera-moderada, salvo en un paciente que fue especialmente elevado. A todos se les realizó coronariografía y ventriculografía, detectándose una discinesia septal o anterolateral, con fracción de eyección normal en el 75% de los casos. La discinesia desapareció entre los 4 días y las 6 semanas (AU)

This syndrome was described in 1990. It is characterized by chest pain that simulatesan acute coronary syndrome (ACS), with alterations in the ECG, but with normal coronaryarteries. We present 16 patients admitted in our ICU, who met the criteria of transient leftventricular dysfunction syndrome (TLVDS). All but 1 patient were women, with age in generalhigher than 55 years. Chest pain was detected in the 75% of them. A total of 43% had emotionalstress as 56% had an elevation of the ST segment, essentially anterolateral. The increase of thebiomarkers was slight-to-moderate, with the exception of one patient in whom it was especiallyhigh. All of them had undergone a coronary arteriogram and ventriculography, and either septalor anterolateral dyskinesia had been detected, with normal ejection fraction. In 75% of the casesthe dyskinesia had disappeared between 4 days to 6 weeks (AU)

Hemorragia cerebelosa secundaria a fuga de líquido cefalorraquídeo tras cirugía del canal lumbar / Cerebellar hemorrhage secondary to cerebrospinal fluid leak after lumbar canal surgery

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[Tako-tsubo syndrome. Transient left ventricular dyskinesia. Presentation of our casuistics]. / Síndrome de tako-tsubo. Discinesia transitoria del ventrículo izquierdo. Presentación de nuestra casuística.

This syndrome was described in 1990. It is characterized by chest pain that simulates an acute coronary syndrome (ACS), with alterations in the ECG, but with normal coronary arteries. We present 16 patients admitted in our ICU, who met the criteria of transient left ventricular dysfunction syndrome (TLVDS). All but 1 patient were women, with age in general higher than 55 years. Chest pain was detected in the 75% of them. A total of 43% had emotional stress as 56% had an elevation of the ST segment, essentially anterolateral. The increase of the biomarkers was slight-to-moderate, with the exception of one patient in whom it was especially high. All of them had undergone a coronary arteriogram and ventriculography, and either septal or anterolateral dyskinesia had been detected, with normal ejection fraction. In 75% of the cases the dyskinesia had disappeared between 4 days to 6 weeks.

Necrosis miocárdica y shock cardiogénico con coronarias normales: ¿cardiotoxicidad por 5-FU o miocardiopatía catecolamínica? / Myocardial necrosis and cardiogenic shock with normal coronaries: cardiotoxicity due to 5-FU or catecholamine cardiomyopathy?

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[Analysis of 73 cases of significant pericardiac effusion]. / Análisis de 73 casos de derrame pericárdico significativo.

Seventy-three patients with significant pericardiac effusion (SPE) are analyzed retrospectively. The results concerning etiology, clinical findings, evolution, echocardiography findings and pericardiac effusion (PE) findings are summarized. Conclusions drawn are: 1) the pericardiac effusion (PE) is a difficult diagnosis without the assistance of the echocardiogram; 2) the echocardiogram signs of hemodynamic alterations have prognostic value; 3) the most frequent causes of SPE are: tumors, idiopathic acute pericarditis, and iatrogenesis; 4) in an important percentage of DPS patients the cause is not identified; 5) the clinical presentation as pericardiac tamponade (PT) is most frequent in the tumors; 6) the analysis of the PE has a low yield, which means that diagnostic pericardicentesis is not justified in all patients with SPE; 7) the pericardiac biopsy hasa low diagnostic yield; 8) the predictive mortality factors are: presentation as PT and tumor etiology, and 9) because of the dynamic character of the SPE, it is important to carry out a progress follow-up of it.

[Non-glucose carbohydrates in the parenteral nutrition of patients with systemic inflammatory response syndrome]. / Hidratos de carbono no-glucosa en la nutrición parenteral de pacientes con síndrome de respuesta inflamatoria sistémica.

OBJECTIVE: To compare tolerance of two sources of isocaloric intake (fructose-glucose-xylitol mixture [FGX] versus glucose) in parenteral nutrition for patients with systemic inflammatory response syndrome (SIRS). DESIGN: Open, prospective, cohort and randomized study. SETTING: Intensive Care Unit. SUBJECTS AND METHODS: Two groups of patients admitted in ICU: acute pneumonia with sepsis, and necro-hemorrhagic pancreatitis. Criteria of exclusion were: diabetes, previous hypertriglyceridemia, renal failure with serum creatinine > 3 mg/dL on admission in ICU, or hyperbilirrubinemia > 2.5 mg/dL. Parenteral nutrition (TPN), consisting of 1.4 g AA + Lipids 1.3 g + carbohydrates 4 g/kg/d, (either glucose or FGX at random) was administered. Basal levels and days 1st, 4th and 10th plasma glucose, triglycerides, cholesterol, uric acid were determined, and blood venous gases as well. Capillary glycemia was measured every 6 hours and insulin given if glucose levels rose above 180 mg/dL. STATISTICS: Fisher's exact test; Student t-test; Mann-Whitney test. Data as mean and SD. RESULTS AND CONCLUSIONS: During 48 months, 119 patients admitted in the ICU (72 with pneumonia and 47 with pancreatitis) were included. In pneumonia, tolerance was similar with both intakes; glycemia was kept at the same level in both, but the amount of insulin given was significantly more in those patients fed on glucose (p < 0.05). Nevertheless, resting blood glucose and triglyceride levels were higher in pancreatitic patients, and more insulin was required. Those on FGX had lower triglyceride plasma levels (p < 0.05) and less insulin was given throughout the study. Glycemia was kept lower though no statistical significance was reached (p < 0.1). No hyperuricemia nor lactic acidosis was found.