Scimitar syndrome and left pulmonary vein stenosis: A serious and rare association.

Scimitar syndrome is a rare constellation of cardiovascular anomalies consisting of partial right anomalous pulmonary venous drainage to the inferior vena cava, hypoplasia of the right lung, cardiac dextroposition, and in many cases, one or more aortopulmonary collaterals from the descending aorta to the hypoplastic lung. The "infantile form" commonly presents with significant heart failure and pulmonary hypertension. Stenosis of the left pulmonary veins associated with scimitar syndrome is a rare but well-described combination, usually associated with a poor prognosis. We describe two patients with this association in whom the left pulmonary vein stenosis manifested months after the initial diagnosis as a progressive lesion that complicated the course of the disease due to severe pulmonary hypertension. Both patients were successfully treated with a combination of surgical, percutaneous, and hybrid treatment.

Increased collection efficiency of CD34+ cells after mobilization with preemptive use of plerixafor followed by leukocytapheresis on the same day.

BACKGROUND: Plerixafor should be administered 6 to 11 hours before starting leukocytapheresis. However, we have been using plerixafor followed by leukocytapheresis according to different time schedules since 2007. Our objective was to compare the CD34+ cell collection efficiency (CE1) of the first leukocytapheresis performed after using plerixafor at different time intervals. STUDY DESIGN AND METHODS: Same-day schedule refers to the administration of plerixafor at 10:00 AM and starting the leukocytapheresis on the same day at 4:00 PM (6 hours interval). Next-day schedule refers to the administration of plerixafor at 8:00 PM and starting the leukocytapheresis on the next day (10:00 AM or 4:00 PM; either a 14- or 20-hr interval). Variables that might influence the CE1 of CD34+ cells were analyzed by longitudinal linear regression with a random effects model derived by generalized estimating equations. RESULTS: The median CE1 of CD34+ cells was higher in the group of 30 patients who underwent leukocytapheresis on the same day when compared with the group of 62 patients who underwent leukocytapheresis on the next day (65.8% vs. 56.7%; p < 0.01). In the longitudinal linear regression analysis, only the time from plerixafor administration to leukocytapheresis start was associated with a statistically significant decrease in the CE1 of CD34+ cells (CE1 change -0.034%; p < 0.01). CONCLUSION: Higher CE1 of CD34+ cells was observed when patients underwent leukocytapheresis on the same day after receiving plerixafor in comparison with administering plerixafor and underwent leukocytapheresis on the next day. Larger studies are necessary to confirm present results.

Pulmonary vasodilator therapy and early postoperative outcome after modified Fontan operation.

Although mortality is low after the modified Fontan procedure, there is a significant percentage of patients with prolonged postoperative recovery. The objective of this study is to evaluate the usefulness of postoperative administration of oral sildenafil and inhaled nitric oxide on early postoperative outcome. A prospective interventional and comparison study with a historical cohort was conducted. Between January, 2010 and March, 2013, 16 patients received oral sildenafil during immediate modified Fontan postoperative period. Inhaled nitric oxide was also administered if the patient was kept intubated 12 hours after surgery. Early postoperative outcome was compared with a historical cohort of 32 patients on whom the modified Fontan procedure was performed between March, 2000 and December, 2009. Postoperative administration of sildenafil and nitric oxide had no influence on early postoperative outcome after the modified Fontan procedure in terms of duration of pleural effusions, mechanical ventilation time, length of stay in the ICU, and length of hospital stay.

Operación de Fontan. Estudio de los factores hemodinámicos asociados a la evolución postoperatoria / Fontan operation. Hemodynamic factors associated with postoperative outcomes

Introducción y objetivos. Los pacientes con corazón univentricular son sometidos a una serie de intervenciones paliativas que culminan en la operación de Fontan. El objetivo de este trabajo es revisar las características clínicas y hemodinámicas de un grupo de pacientes con fisiología univentricular paliados previamente con operación de Glenn bidireccional e identificar los factores de riesgo que influyen en la evolución postoperatoria de la cirugía de Fontan. Métodos. Estudio retrospectivo de 32 pacientes sometidos a cirugía de Fontan entre marzo de 2000 y diciembre de 2009. Se revisaron las características clínicas, los datos derivados del cateterismo, el tipo de cirugía y los tiempos quirúrgicos y se buscó su relación con la evolución postoperatoria. Resultados. La mortalidad hospitalaria fue del 3%. Tras una mediana [intervalo intercuartílico] de seguimiento de 44 meses [32-79], la supervivencia es del 90%. La presión media en arteria pulmonar medida en el cateterismo se relacionó con la mortalidad tardía. De las demás variables estudiadas, las que mejor se relacionaron con la evolución postoperatoria fueron los índices de Nakata y McGoon y el tiempo de circulación extracorpórea. En el 42% de los pacientes se realizó cateterismo intervencionista previo a la operación de Fontan. Conclusiones. Realizamos la operación de Fontan con muy baja mortalidad hospitalaria. El cateterismo previo a la operación de Fontan permite seleccionar a los pacientes de alto riesgo para la cirugía así como realizar procedimientos intervencionistas que podrían mejorar la evolución postoperatoria (AU)

Introduction and objectives. The Fontan operation is usually the final palliative procedure in patients with univentricular heart. The objectives of this study were, firstly, to describe the clinical and haemodynamic characteristics of a group of patients with univentricular physiology who had previously been palliated with a bidirectional Glenn procedure and, secondly, to identify risk factors that can influence postoperative outcomes after the Fontan operation. Methods. Retrospective study with 32 patients who underwent a Fontan operation between March 2000 and December 2009. Clinical characteristics, catheterization data, type and duration of surgery were revised and analyzed as predictors of postoperative outcome. Results. Hospital mortality was 3%. After a median follow-up of 44 months (interquartile range, 32-79), survival was 90%. Preoperative mean pulmonary arterial pressure (measured during catheterization) was correlated with late mortality. Of the remaining variables analyzed, the Nakata and McGoon indices, and duration of cardiopulmonary bypass showed the highest correlations with postoperative outcomes. Interventional catheterization before the Fontan operation was performed in 42% of patients. Conclusions. Hospital mortality after the Fontan operation was very low. The performance of a haemodynamic study before the Fontan operation made it possible to select high-risk patients for surgery as well as permitting the performance of interventional procedures that could improve postoperative outcome in these patients (AU)

Fontan operation. Hemodynamic factors associated with postoperative outcomes.

INTRODUCTION AND OBJECTIVES: The Fontan operation is usually the final palliative procedure in patients with univentricular heart. The objectives of this study were, firstly, to describe the clinical and haemodynamic characteristics of a group of patients with univentricular physiology who had previously been palliated with a bidirectional Glenn procedure and, secondly, to identify risk factors that can influence postoperative outcomes after the Fontan operation. METHODS: Retrospective study with 32 patients who underwent a Fontan operation between March 2000 and December 2009. Clinical characteristics, catheterization data, type and duration of surgery were revised and analyzed as predictors of postoperative outcome. RESULTS: Hospital mortality was 3%. After a median follow-up of 44 months (interquartile range, 32-79), survival was 90%. Preoperative mean pulmonary artery pressure (measured during catheterization) was correlated with late mortality. Of the remaining variables analyzed, the Nakata and McGoon indices, and duration of cardiopulmonary bypass showed the highest correlations with postoperative outcomes. Interventional catheterization before the Fontan operation was performed in 42% of patients. CONCLUSIONS: Hospital mortality after the Fontan operation was very low. The performance of a haemodynamic study before the Fontan operation made it possible to select high-risk patients for surgery as well as permitting the performance of interventional procedures that could improve postoperative outcome in these patients.

Current strategies in tetralogy of Fallot repair: pulmonary valve sparing and evolution of right ventricle/left ventricle pressures ratio.

OBJECTIVE: Chronic volume overload in repair of tetralogy of Fallot (TOF) with transannular patch leads to significant late morbidity and mortality. Preserving pulmonary valve integrity offers a better long-term prognosis, despite a risk of residual stenosis. In our study we analyzed the evolution of pressure gradients in patients operated with conservative approaches, with particular regard to those babies with an immediate postoperative Prv/Plv ratio >or=0.70. METHODS: Between January 2000 and June 2008, 24 patients with TOF underwent reparative surgery with a valve sparing procedure (median age 8.1 months, range 1.1-86.6). The intraoperative post-repair echocardiography showed a Prv/Plv ratio >or=0.70 in eight patients (33%, group A) and <0.70 in 16 patients (67%, group B). We realized a retrospective study of pre-, intra-, and postoperative data and of clinical and echocardiographic follow-up data. RESULTS: There was no early or late mortality, nor functional or rhythmic disturbances. One patient required re-operation for residual stenosis at annular level at one year. After a median follow-up of 32.8 months (range 0.6-73.1), the Prv/Plv ratio decreased by 16% (p=0.001) in all patients. In group A the reduction was 28% (p=0.018) and in group B it was 12% (p=0.14). CONCLUSIONS: After a valve sparing procedure there is a reduction of Prv/Plv ratio at medium-term follow-up; in our study this reduction was statistically significant in all patients and in the subgroup with higher postoperative ratios. A valve sparing strategy reduces pulmonary regurgitation, preserves RV function and decreases the incidence of late arrhythmias, which are the determinants of long-term outcome.

Bienestar espiritual en pacientes con cáncer de mama identificado a través de la relación enfermera-paciente / Spiritual well-being in patients with identified breast cancer through the relation nurse-patient

Introducción: El cáncer de mama es una experiencia devastadora, implica situaciones que provocan problemas fisiológicos, psicológicos, sociales y espirituales. La relación enfermera-paciente propuesta por Hildergard E. Peplau es esencialmente el marco en el que las creencias, valores, actitudes y conocimiento del paciente y de la enfermera pueden emplearse para explorar y comprender la dinámica de una existencia sana, en donde el bienestar espiritual juega un papel importante. Objetivo: Identificar el bienestar espiritual en pacientes con cáncer de mama, en la fase de orientación a través de la relación enfermera-paciente Metodología: Estudio descriptivo, transversal, con 25 pacientes, se utilizó cuestionario basado en Facit-SP-12, que forma parte de la evaluación funcional en terapia oncológica en relación con calidad de vida, con una confiabilidad de 0.8992. Resultados: El 88% de las pacientes presentó bienestar espiritual bueno y regular 12%. Discusión: El reconocimiento de implicaciones psicológicas y sociales de enfermedades crónicas ha dado lugar a que los profesionales establezcan objetivos de atención relacionado con comunicación efectiva entre cuidadores de la salud y el paciente. La mayoría de las personas presentaron bienestar espiritual bueno, y la relación interpersonal permitió explorar y comprender creencias valores y actitudes, con la finalidad de conducir a la salud, como cualidad dinámica que permite la experiencia potencial del bienestar físico y social, que confiere la oportunidad de vivir bien y en armonía.

Introduction: Breast cancer is a devastating experience which implies situations that provoke physiological, psychological, social, and spiritual problems. The relation nurse-patient proposed by Hildergard E. Peplau is essentially the frame in which the beliefs, values, attitudes and knowledge of the patient and nurse may be used to explore and understand the dynamics of a healthy existence, where the spiritual well-being plays an important role. Objective: To identify the spiritual well-being in breast cancer patients, in the phase of orientation through the relation nurse-patient. Methodology: Transversal, descriptive study done in 25 patients. A questionnaire based on Facit-Sp 12 that is part of the functional evaluation in oncology therapy related to the quality of life was utilized. The confidentiality was of 0.8992. Results: The good spiritual well-being was present in 88% of the patients and the regular spiritual well-being in 12% of them. Discussion: Acknowledgment of psychological and social implications due to chronic diseases, has lead the professionals to establish during their assistance objectives related to effective Communication between health caregivers, and the patient. The most of people showed up a good spiritual well-being, and the interpersonal relationship allowed exploring and understanding beliefs, values, and attitudes, with the objective of leading to health, as a dynamic trait that allows the potential experience of physical, and social well-being that confers the opportunity of living fine and in harmony.

Prevención de caídas en el adulto mayor: Intervenciones de enfermería / Prevention of falls in elderly population: Nursing interventions

En el adulto mayor se manifiestan los cambios fisiológicos propios del envejecimiento que modifican el proceso de vida/salud a nivel personal y de interacción. Se identifica a los accidentes como problema de salud derivado de la transición demográfica y entre ellos a las caídas como prioritarios. La OMS los define como "La consecuencia de cualquier acontecimiento que precipite a la persona al suelo contra su voluntad". En el anciano una caída tiene una afectación a su salud, directamente proporcional al nivel de riesgo en el cual califica a partir de edad, nivel de autosuficiencia, presencia de patologías crónicas y contar con cuidador primario. Las intervenciones de enfermería se fundamentan en la valoración de los factores de riesgo intrínsecos y extrínsecos con un enfoque hacia la prevención, acciones de promoción a la salud, atención al riesgo, limitación del daño y rehabilitación temprana tanto a nivel domiciliario como hospitalario.

In elderly people typical physiologic changes of aging are manifested that modify the process of life/health in a personal and interactive level. Accidents are identified as health problems derived from demographic transition and among them, falls are the priority. WHO defines them as "the consequence of any occurrence that plunges down a person to the floor against his will." In the elder, a fall has an effect to his health, directly proportional to the level of risk where is qualified on the base of age, level of self-sufficiency, presence of chronic disease, and having a primary caregiver. Nursing interventions are funded in valuation of intrinsic and extrinsic risk factors, with focus toward prevention, measurements of health promotion, awareness of risk, limitation of damage, and early rehabilitation, both in home as well as in hospital level.

Relación de ayuda: Intervención de enfermería para padres de recién nacidos hospitalizados en la UCIN / Help relation: Nursing intervention for parents with newborns in the Neonatal Intensive Care Unit (UCIN)

Introducción: Ante la necesidad de brindar apoyo emocional a padres de recién nacidos hospitalizados en la Unidad de Cuidados Intensivos Neonatales, se diseñó un estudio con el propósito de evaluar una estrategia educativa dirigida a enfermeras pediatras con enfoque en la relación de ayuda para disminuir la ansiedad en los padres de recién nacidos hospitalizados. Metodología: Se realizó un ensayo de campo. La estrategia educativa consistió en un taller durante cinco días con una hora de duración por día, se utilizó la técnica de discusión grupal, los componentes fueron discusión y revisión de bibliografía y asesoría en servicio: se realizaron 3 asesorías como mínimo por enfermera con una duración de media hora en el momento de la visita de los padres al recién nacido. Resultados: Al evaluar la relación de ayuda se encontraron diferencias significativas en la etapa postintervención (p <0.001) en aspectos de comunicación, empatía y simpatía. El nivel alto de ansiedad pre y postintervención fue de (30% vs 8%) respectivamente. Discusión: Las enfermeras establecieron una relación de ayuda con los padres de los niños hospitalizados y se logró disminuir la proporción de padres con alto grado de ansiedad. Conclusiones: Cuando la enfermera de UCIN adopta una actitud cálida, de respeto, comprensión y empatía (enfoque de relación de ayuda) brinda una atención integral y logra disminuir la ansiedad situacional de los padres de niños hospitalizados.

The purpose of this study was to evaluate the impact of an educational strategy for pediatrics nurses focused on the relationships of help in order to decrease anxiety in parents with new-borns in the NICU. Material and methods: The educational strategy consisted in a five days' workshop with one hour/day (for group discussion and bibliographical research). For consultant's office we did 3 advices at least for each nurse, with half-hour in the parents visit to the NICU. Results: The help and support given by the nurses to parents with hospitalized children in NICU before and after the operation was different in communication empathy and solidarity (p<0.001) the rate of anxious parents was lower after the operation directed to the nurses. The high level of anxiety before and after the operation was of 30% (before) and 8% (after). Conclusions: When the nurse adopts a warmth and respectful attitude and when she is compressive and emphatic, she gives a better care and she manages to decrease situational anxiety in parents with new-borns hospitalized in the NICU. Itis necessary to implement strategies directed to the health staff in order to give support with kids in a high risk.