Angiographic patency study of an albumin-free recombinant streptokinase formulation in acute myocardial infarction.

PURPOSE: Fibrinolytic therapy restores coronary patency and reduces mortality in patients with acute myocardial infarction. Albumin is present in most of the streptokinase formulation as a stabilizer but it is not known whether it plays a role in the product's efficacy and safety profiles. The aim of this study was to assess 90 minutes-coronary patency of a new albumin-free recombinant streptokinase (rSK) formulation. METHODS . Patients with ischemic chest pain and ST-segment elevation, less than 12 hours after symptoms onset, without contraindications for fibrinolytic therapy, were included to receive 1.5 x 10(6) IU of rSK in a one-hour intravenous infusion. Angiography was performed 90 minutes after and coronary patency was classified according to the TIMI flow scales. RESULTS: The study enrolled 25 patients, 59.4 +/- 9.2 years-old, 88% men and 92% white. The mean time interval between the symptoms onset and rSK infusion was 3.0 +/- 2.0 hours. Patency rate (TIMI 2-3) of the infarct-related vessel was 72% (18/25). Partial or complete ST-segment resolution was achieved in 17 patients (68%). Hypotension and nauseas were the most frequent adverse events. Haemorrhage or in-hospital deaths were not reported. CONCLUSIONS: This study suggests that intravenous albumin-free rSK is a safe and appropriate therapy to get early (90-minute) coronary patency in patients with acute myocardial infarction.

Gated-SPECT myocardial perfusion imaging and coronary calcium score for evaluation of patients with acute chest pain and a normal or nondiagnostic electrocardiogram.

OBJECTIVE: To assess the ability of rest myocardial perfusion imaging (MPI) to rule out an acute coronary syndrome (ACS) in emergency department patients, as well as to investigate whether there exists a concordance between MPI and coronary calcium. MATERIALS AND METHODS: Fifty-five patients with chest pain and a normal or nondiagnostic ECG were included. Clinical follow-up was carried out within 1 year. RESULTS: Sixteen patients (29%) showed an abnormal rest MPI, and in 11 (20%) the MPI was equivocal. There was a weak concordance between MPI and coronary arteries calcium score (CACS) (κ: 0.25). Coronary angiogram driven by a positive MPI was performed in 12 patients (23%), resulting in percutaneous coronary intervention in nine cases (75%). A positive MPI (abnormal or equivocal results) was associated with the occurrence of events in the follow-up (χ(2)=19.961, P<0.0001). For a patient presenting to the emergency department with acute chest pain and a normal or nondiagnostic ECG, with a positive MPI, the relative risk of having events during the first year was 7.5 (95% confidence interval: 2.8-19.2), P<0.05, but with a positive CACS this was 1.77 (95% confidence interval: 0.69-4.56), P=NS. At 1 year 68.6% of patients were free of events. CONCLUSION: Patients presenting with acute chest pain and a low-to-intermediate likelihood of coronary artery disease with a normal rest MPI have a very low probability of cardiac events during the first year. Coronary calcium score was not helpful in risk-stratifying these patients.

Factores nutricionales y ambientales que influyen en el desarrollo del infarto del miocardio / No disponible

Introducción: Los radicales libres juegan un papel fundamental en la patología de diferentes enfermedades degenerativas, entre las que se encuentra el infarto del miocardio. Tanto la disponibilidad alimentaria como inadecuados hábitos dietéticos sobre el consumo de frutas y vegetales han provocado una ingestión limitada de diversos antioxidantes. Objetivo: Analizar indicadores nutricionales antropométricos y vitamínicos junto con factores ambientales de riesgo que pudieran estar asociados al Infarto del Miocardio. Métodos: Se seleccionó una muestra compuesta por 34 casos con un primer infarto del miocardio, los controles se tomaron al azar en el último mes de cada trimestre con un total de 61 personas. Se determinaron los niveles séricos de vitamina E, C y A y lipidograma, se realizó evaluación nutricional antropométrica por medición del IMC y pliegues cutáneos, se obtuvieron los datos de la dieta mediante encuesta de frecuencia semicuantitativa de alimentos y hábitos dietéticos. Resultados: Se encontró que el 73,5% de los casos pertenecían al sexo masculino con una edad promedio de 57 años. El 93,3% de los casos y el 59,3% de los controles fumaron alguna vez durante su vida. Predomina la hipertensión arterial en los casos (60%) en relación con los controles (15%). El 60% de los casos y el 55% de los controles realizaban actividad física ligera. Las variables que explican los resultados de alfa tocoferol fueron el índice cintura-cadera y las mayores concentraciones de colesterol total. De los factores estudiados que pudieran explicar el desarrollo del infarto sólo resultaron significativos el hábito de fumar, los antecedentes de hipertensión arterial y las concentraciones de vitamina C (AU)

Background: Free radicals play an important role in the development of degenerative diseases, among those yocardial infarction. Both food availability and inadequate dietary habits related to low consumption of fruit and vegetables have influenced a limited intake of several antioxidants. Objetive: To analyze anthropometical and vitamin nutritional status indicators along environmental risk factors which could be associated to myocardial infarction. Methods: A sample of 34 cases, patients diagnosed of a first myocardial infarction, and randomly selected control individuals were included in the sample. Control subjects were selected on the last month of each trimestre to complete 61 subjects. Seric levels of vitamin E, C and A as well as lipid profile were assessed. Anthropometrical appraisal was completed considering BMI and skinfolds. Dietary assessment was completed by means of a semiquantitative food frequency questionnaire and questions related to dietary practices. Results: 73,5% of the cases in the sample were males, with an average age of 57 years. 93,3% of the cases and 59,3% of controls had smoked sometime in their lives. 60% of the cases had high blood presión, while 15% in the control group. 60% of the cases and 55% of the control subjects practiced light physical activity. Variables explaining the results observed regarding TF were waist-hip ratio and higher levels of total cholesterol. Among the different factors which could explain the development of myocardial infarction analysed, only smoking, history of hypertension and serum levels of vitamin C were significant (AU)

Síndrome seudoulceroso poscoledocoduodenoanastomosis / Postcholedochoduodenal-anastomosis pseudoulcerous syndrome

Se efectúa un estudio de 40 pacientes, a quienes se les realizó una coledocoduodenoanastomosis, y se encontró que 15 de ellos presentaron síntomas de tipo ulceroso de intensidad variable. El hallazgo más interesante ha sido la permeabilidad de la neoboca, conjuntamente con la aparición de una gastroduodenitis moderada(AU)