RESUMO
Advanced heart failure is a major health problem for which heart transplantation or left ventricular assist devices are the only effective treatments. Intra-aortic balloon pump inserted using femoral artery access as a bridge to heart transplantation is still frequently used, but has the disadvantage of limiting the patient's movements, hence exposing him or her to the hazards of immobility and threatening the success of the procedure or hindering recovery. Access through the subclavian artery has become an attractive alternative since it doesn't impair the patient's mobility, and there is increasing evidence supporting its use. We present the first case of subclavian counterpulsation balloon implantation in a cardiovascular care center in Colombia.
RESUMO
Coronary artery disease involving chronic occlusions and bifurcation lesions continues to be a challenge for the interventional cardiologist. The improvement in the techniques has allowed a higher success rate, however, the best intervention strategy is unknown in this subgroup of patients with chronic occlusions and associated bifurcation lesions. We present the case of a patient in whom, in an angiography for study of chest pain, a chronic total occlusion and a bifurcation lesion were evidenced and were successfully treated by coronary intervention.
RESUMO
Objetivo: describir las características clínico-epidemiológicas de las infecciones por Enterobacter. Metodología: se revisaron las historias clínicas de 54 pacientes hospitalizados durante agosto de 2004 a agosto de 2006, en la Clínica Cardiovascular de Medellín, con diagnóstico de infección por Enterobacter confirmado por Gram y cultivo. Resultados: 64.8 por ciento de los pacientes del estudio eran hombres con edad media de 48 años. Las especies que se aislaron con mayor frecuencia fueron E. cloacae (75 por ciento) y E. aerogenes (17 por ciento). El tiempo promedio de aislamiento fue de nueve días, luego del ingreso. Las muestras en que se que se aisló la bacteria fueron principalmente orina (42 por ciento) y hemocultivos (34 por ciento); la infección de tracto urinario y la de torrente circulatorio fueron las infecciones que más causó Enterobacter en los pacientes del estudio. La infección fue considerada nosocomial en el 75 por ciento de los casos. Los betalactámicos fueron los antibióticos que con más frecuencia se emplearon como terapia empírica, luego del diagnóstico de infección por Enterobacter y antes del antibiograma, cuyos resultados generaron un cambio en el tratamiento antibiótico en 78 por ciento de los casos. Conclusión: es importante que se tenga en cuenta un manejo empírico de acuerdo a los perfiles de resistencia que esta bacteria está mostrando en la institución.
Objective: to describe the clinical and epidemiological characteristics of infections by Enterobacter. Methods: clinical records of 54 patients who had been hospitalized and had received a confirmed diagnosis of Enterobacterinfection were reviewed. Results: 64.8% of patiens were male, with a mean age of 48. The species which were most commonly isolated included E. cloacae (75%) and E. aerogenes (17%). Mean time for isolation was 9 days after admission to the hospital ward. The samples from which the microorganisms were most commonly isolated were urine (42%) and blood (34%). Urinary tract and bloodstreaminfection were the most commonly caused by Enterobacter. The infection was considered to be hospital-acquired in 75% of cases. Betalactams antibiotics were the empirical choice at the time of treatment, after the infection diagnosis and before the results of antibiograms the treatment was adjusted in 78% of the patients.Conclusion: it is important to keep in mind the local resistance profiles when it comes to treatment of this infection in the institution.
