Comprehensive analysis of right fascicular and right bundle branch blocks: A multi-center study.

Electrocardiographic patterns of right bundle branch and fascicular blocks were comprehensively analyzed in a two-phase study. The research aimed to address the scarcity of literature and the absence of standardized diagnostic criteria for these conditions. It revealed a weak correlation between the cardiac axis and age and highlighted the high misdiagnosis rate of these blocks. Furthermore, it discussed the challenges in fulfilling existing diagnostic criteria. The study emphasizes the need for a more precise understanding of right ventricular conduction disorders and the importance of developing robust diagnostic criteria.

Accuracy and reliability of bedside thoracic ultrasound in detecting pulmonary pathology in a heterogeneous pediatric intensive care unit population.

PURPOSE: This study was designed to access sensitivity and specificity of detection of lung abnormalities by the ultrasound (US) done by PICU providers of varying levels of experience compared to CXR and to assess the inter-rater reliability in the interpretation of the USG findings. METHODS: Up to three US examinations were performed on patients meeting eligibility criteria. US examinations were reported by the operator and remotely by an expert reader. Both operator and readers interpretation were correlated with CXR read by an independent pulmonologist. RESULTS: One hundred and thirty-five US examinations were performed on 91 patients over 9 months. Overall agreement between the operator and reader of the US was 0.53 (0.38-0.68). The agreement was highest with an expert-expert pair (0.75) and lowest with a novice-expert pair (0.27). Sensitivity and specificity of thoracic US to detect pulmonary abnormalities showed a high sensitivity by the operator (82.5%) compared to the reader (63.4%). Specificity was 25% and 42.8%, respectively. US was overall highly sensitive to detect pneumonia (96.4%) with a 100% PPV, but only modest for bronchiolitis. CONCLUSIONS: Lungs US is a rapid and sensitive bedside tool to assess lung consolidation in children in ICU. It, however, has low negative predictive values, and negative US examinations cannot rule out lung pathology.

Hernia umbilical eviscerada en pacientes cirróticos: reporte de un caso / Eviscerated umbilical hernia in cirrhotic patients: case report

La evisceración espontánea de las hernias umbilicales en pacientes con cirrosis hepática y ascitis es una complicación rara y potencialmente fatal que ocurre en menos de un 2% de los pacientes con esta patología. Se presenta un caso de un paciente masculino de 58 años de edad conocido con el diagnóstico de cirrosis hepática por alcohol, Child B, con síndrome de hipertensión portal, que consultó por dolor abdominal tipo cólico difuso y salida espontánea de líquido ascítico de color amarillo, no fétido, a través de hernia umbilical, de gran tamaño, con erosiones en su superficie. El citoquímico del líquido ascítico fue compatible con peritonitis bacteriana secundaria. Se manejó conjuntamente con cirugía, de forma conservadora con antibioticoterapia parenteral. Al cuarto día se apreció salida del epiplón a través del saco herniario. Se realizó herniorrafia umbilical sin complicaciones, evolucionando satisfactoriamente. Desde el primer caso reportado en 1901, son pocos los casos registrados en la literatura. Los factores precipitantes descritos son traumatismos y aumento de presión intra-abdominal. El manejo de la hernia umbilical en el paciente cirrótico es controversial, cuando se desarrollan complicaciones como la evisceración, la conducta quirúrgica es urgente

Spontaneous evisceration of umbilical hernias in patients with cirrhosis and ascites is a rare and potentially fatal complication that occurs in less than 2% of patients. We report a case of a 58-year old male patient with Child B alcoholic liver cirrhosis,with portal hypertension, who presented with diffuse crampy abdominal pain and spontaneous leaking of yellow not foul ascitic fluid through a large umbilical hernia with superficial tiny erosions. Cytochemical ascitic fluid analysis was consistent with secondary bacterial peritonitis. Patient was managed conservatively with parenteral antibiotics in conjunction with surgery. On fourth day, the omentum was seen through the hernia sac and surgical repair was performed without complications and the patient did well in the postoperative period. Since the first case reported in 1901, there had been few cases reported in the literature. Trauma and increased intra-abdominal pressure are among the precipitants reported. Management of umbilical hernia in cirrhotic patients is controversial, however when they develop complications, surgical treatment become urgent

Retención de cápsula endoscópica como complicación de enteritis actínica: reporte de un caso / Retention of capsule endoscopy as a complication of radiation enteritis: a case report

La cápsula endoscópica es un método, que ha modificado el enfoque diagnóstico de numerosos procesos patológicos en el intestino delgado, sin embargo presenta complicaciones como la retención de la misma. Se estima en la literatura mundial que esta suele ocurrir en menos del 2% de los casos. Femenino de 40 años de edad, con antecedente de cáncer de cuello uterino (2011) en tratamiento con quimioterapia, radioterapia convencional y braquiterapia, que presenta cuadro clínico caracterizado por dolor urente en mesogastrio, y emesis de aspecto biliosos. Ruidos hidroaéreos presentes, dolor a la palpación de mesogastrio sin irritación peritoneal. Radiografía de abdomen y ecosonograma abdominal normales. TAC abdomino pélvica con contraste oral con adecuada progresión de contraste hasta el recto. Se practica gastroscopia y colonoscopia sin evidencia de alteraciones. En vista de persistencia de sintomatología se indica realización de cápsula endoscópica observando en íleon distal, a los 246 minutos del paso duodenal, área muy congestiva, con una úlcera circunferencial friable, que no permite el avance de la misma. Se indica tratamiento médico con laxantes por 72 horas, el cual es infructuoso, por lo cual es llevada a mesa operatoria por presentar signos francos de obstrucción intestinal. Los hallazgos fueron: adherencias en flanco y fosa ilíaca derecha, las cuales fueron liberadas, y segmento de íleon a 10 cm de la válvula ileocecal con inflamación franca, practicándose resección y anastomosis termino-lateral. El estudio histopatológico reportó enteritis crónica activa exulcerada, necrosis fibrinoide de pequeños vasos, y fibrosis en la submucosa. Paciente con post-operatorio exitoso decidiéndose el egreso de la institución. Excelente correlación entre los hallazgos de la cápsula endoscópica y la intervención quirúrgica. Los hallazgos de la cirugía se encuentran relacionados al uso de radioterapia convencional, por lo cual recomendamos la realización de pexia...

Capsule endoscopy is a method that has changed the diagnostic approach to many pathological processes in the small intestine, but it has complications such as retention of the same, is estimated in the literature that this usually occurs in less than 2% cases. Women 40 years of age, with a history of cervical cancer (2011) undergoing chemotherapy, conventional radiation therapy, and brachytherapy, presenting clinical picture characterized by burning pain in midgut, and bilious emesis aspect. Present bowel sounds, tenderness of mesogastrium without peritoneal irritation. Abdominal radiography and abdominal ultrasonography normal. Pelvic CT with oral contrast Abdomino with progression adequate contrast to the rectum. Gastroscopy and colonoscopy was performed without evidence of tampering. In view of the persistence of symptoms embodiment shown in watching endoscopic capsule distal ileum, to 246 minutes of step duodenal study, very congestive area with a circumferential friable ulcer which does not allow the advance thereof. Indicated medical treatment with laxatives for 72 hours being fruitless, operating table being carried by presenting overt signs of intestinal obstruction. The findings were: adhesions flank and right lower quadrant, which were released and ileal segment 10 cm from the ileocecal valve with frank inflammation resection and end-side anastomosis. Histopathological study reported chronic active enteritis exulcerada, fibrinoid necrosis of small vessels, and fibrosis in the submucosa. Postoperative patient deciding successful graduation from the institution. Excellent correlation between the findings of capsule endoscopy and surgery. The findings at surgery are related to the use of conventional radiotherapy, so we recommend an pexia of the organs that are in the radiation field, prior to it, and intestinal transit before indicating capsule endoscopy

Aspectos clínicos y epidemiológicos de pacientes con carcinoma hepatocelular en dos centros de referencia de Venezuela / Clinical and epidemiological aspects of patients with hepatocellular carcinoma in two reference centers Venezuela

El carcinoma hepatocelular (CHC) es la neoplasia primaria del hígado más frecuente, constituyendo un problema mundial de salud pública por su alta prevalencia y tasa de mortalidad. Evaluar las características clínicas y epidemiológicas de los pacientes con carcinoma hepatocelular. Estudio de casos consecutivos con revisión retrospectiva de los registros médicos de pacientes con diagnóstico de CHC que acudieron a la consulta de hepatología de dos centros caraqueños entre 1997 y 2011. Se evaluaron características clínicas, epidemiológicas y de estadiaje según Barcelona Clinic Liver Cancer, BCLC. Se incluyó 116 pacientes con diagnóstico de CHC. La edad media fue 61,34 ± 12,02 años, 75% eran hombres y 89,7% de los pacientes tenían cirrosis hepática subyacente, siendo confirmada histológicamente en 33,7%. El 70,7% de los pacientes tenían alguna complicación asociada a hipertensión portal. El virus de la hepatitis C (VHC) constituyó la principal etiología de enfermedad hepática (31%), alcohol (21,6%), virus de la hepatitis B, VHB (14,7%) y enfermedad hepática grasa no alcohólica (14,7%). El hepatocarcinoma fue diagnosticado más frecuentemente en pacientes con cirrosis por HBV 15,56%. El 56% de los casos tenían niveles de alfafetoproteína mayores de 300 ng/ml. El lóbulo derecho fue la localización más frecuente (64,7%) y 79,3% de las lesiones mostraron patrón vascular típico en los estudios radiológicos. El estadio tumoral según los criterios de Barcelona Clinic Liver Cancer (BCLC) fueron estadio C (37,9%) D (25,9%), B (24,1%), A (7,8%) y 0 (2,6%). La infección por HCV es la etiología más frecuente de cirrosis hepática en pacientes con CHC, pero la infección por VHB tiene mayor impacto en términos relativos. El diagnóstico se hace en forma tardía (estadios intermedios o avanzados), siendo necesario intensificar medidas de pesquisa en estos pacientes

The hepatocellular carcinoma (HCC) is the main primary liver neoplasia and is a public health problem in the world due to high prevalence and mortality. Evaluate clinical and epidemiological characteristics in patients with Hepatocellular carcinoma. A retrospective analysis of a prospectively maintained database of 116 patients with diagnosis of HCC in two centers of Caracas between 1997 and 2011 was conducted. We evaluated epidemiological, clinical, biochemical and tumor aspects according to Barcelona Clínic Liver Cancer in patients with HCC. Mean age was 61.34 ± 12.02 years, 75% were male and 89.7% of patients had liver cirrhosis. Portal hypertension complications (ascites, hepatic encephalopathy, esophageal varices) were present in 70.7% of patients. Hepatitis C virus (HCV) was the main etiology of hepatic disease (31%) followed by alcohol (21.6%), hepatitis B virus (14.7%) and non alcoholic steatohepatitis (14.7%). HCC was more frequent in patients with cirrhosis associated to HBV infection. The 56% of patients had alpha-fetoprotein levels higher than 300 ng/ml. The 64.7% of tumors were localized in the right lobe of liver and 79.3% of tumor lesions demonstrated typical pattern in radiologic studies. The most patients had advanced disease according to Barcelona Clinic Liver Cancer (BCLC) staging classification (Stage C, 37.9%; stage D, 25.9%; stage B, 24.1%; stage A, 7.8% and stage 0, 2.6%). HCV infection was main cause of cirrhosis in patients with HCC, but HBV infection had higher impact in these patients. Our study showed that the diagnosis of these patients undergo late and is very important intensify screening measures in patients with liver cirrhosis

Site-dependent and subject-related variations in perioral thermal sensitivity.

The Marstock method of limits was used to obtain thresholds for detection of cooling, warming, cold pain and heat pain for 34 young adults, upon eight spatially matched sites on the left and right sides of the face, the right ventral forearm and the scalp. Male and female subjects were tested by both a male and a female experimenter. Neither the experimenter nor the gender of the subject individually influenced the thresholds. The thermal thresholds varied greatly across facial sites: sixfold and tenfold for cool and warmth, respectively, from the most sensitive sites on the vermilion to the least sensitive facial site, the preauricular skin. Warm thresholds were 68% higher than cool thresholds, on average, and 12% higher on the left compared to the right side of the face. The mean cold pain threshold increased from 21.0 degrees C on the hairy upper lip to 17.8 degrees C on the preauricular skin. Sites on the upper lip were also most sensitive to noxious heat with pain thresholds of 42-43 degrees C. The scalp was notably insensitive to innocuous and noxious changes in temperature. For the sensations of nonpainful cool and warmth, the more sensitive a site, the less the estimates of the thresholds differed between subjects. In contrast, for heat pain, the more sensitive a site, the more the estimates differed between subjects. Subjects who were relatively more sensitive to cool tended to be relatively more sensitive to warmth. Subjects' sensitivities to nonpainful cool and warmth were less predictive of their sensitivities to painful cold and heat, respectively. Short-term within-subject variability increased with the magnitude of the thresholds. The lower the threshold, the more similar were repeated measurements of it, within a 5-25 s period.