Effect of the earthquake-tsunami (Chile, 2010) on toxic metal content in the Chilean abalone mollusc Concholepas concholepas.

Toxic metal content were measured in samples of mollusc Concholepas concholepas obtained from the Chilean coast. Samples were collected during two periods, one before and one after the earthquake-tsunami which occurred in the Maule Region, Chile, February 27th, 2010 as a result of an earthquake with a magnitude of 8.8. Quantification of toxic metals in samples of hepatopancreas and muscle tissue was performed using flame atomic absorption spectroscopy. The analytical methodology was validated with certified reference material. The content means measured in muscle tissue for January 2010 were Cu: 10.3; Cr: 0.7; Cd: < 0.1; Mn: 3.6 and Zn: 38.6 µg g-1 (dry weight). For October 2014, the means were Cu: 8; Cr: 2.4; Cd: < 0.1; Mn: 5.6 and Zn: 45.4 µg g-1 (dry weight). In hepatopancreas tissue, the content means were Cu: 14.8; Cr: 2.4; Cd: 246.2; Mn: 4.4 and Zn: 1552.9 µg g-1 (dry weight). For October 2014, the means were Cu: 53.7; Cr: 3.5; Cd: 118; Mn: 13.4 and Zn: 1352.3 µg g-1 (dry weight). Cd, Cr, Cu, Mn and Zn content in the samples of hepatopancreas were generally higher than those recorded in muscle tissue however they were not always statistically significant. Statistical analysis showed that Cu and Mn content in the post-tsunami period increased in the hepatopancreas tissue. The concentrations of Cd, Cr, Cu, Mn, and Zn measured in the muscular tissue (edible part) of the species Conchalepas concholepas, were lower than the maximum contents allowed by the current legislation (FAO/WHO, 2004; EU, 2001) and its consumption is not a risk to human health.

Evidence of activity-dependent withdrawal of corticospinal projections during human development.

OBJECTIVE: To characterize the development of ipsilateral corticospinal projections from birth and compare to 1) development of contralateral projections in the same subjects and 2) ipsilateral corticospinal projections in subjects with unilateral lesions of the corticospinal system acquired perinatally or in adulthood. METHOD: Transcranial magnetic stimulation excited the motor cortex, and responses were recorded bilaterally in pectoralis major, biceps brachii, and the first dorsal interosseus muscles. Subjects studied included 9 neonates recruited at birth, studied longitudinally for 2 years; 85 healthy subjects aged from birth to adulthood; 10 subjects with hemiplegic cerebral palsy; and 8 with hemiplegia after stroke. RESULTS: In neonates, ipsilateral responses had significantly shorter onsets than contralateral responses but similar thresholds and amplitudes. Thresholds within both pathways increased in the first 3 months. Differential development was present from 3 months so that by 18 months ipsilateral responses were significantly smaller and had significantly higher thresholds and longer onset latencies than contralateral responses. A similar pattern of smaller and later ipsilateral responses was observed after transcranial magnetic stimulation of the intact cortex in subjects with stroke. In contrast, subjects with hemiplegic cerebral palsy had ipsilateral responses with onsets, thresholds and amplitudes similar to those of contralateral responses. Significant branching of contralateral corticospinal axons from the intact motor cortex was excluded by cross-correlation analysis. CONCLUSIONS: These data, together with previously published anatomic and radiologic studies, are consistent with activity-dependent corticospinal axonal withdrawal during development and maintenance of increased corticomotoneuronal projections from the intact hemisphere after unilateral perinatal lesions.

Accuracy of reported family histories of essential tremor.

We studied the accuracy of reported family histories of essential tremor (ET) by questioning the patients in our clinic and subsequently by mail and phone. For individuals who continued to report a negative family history, we mailed a screening questionnaire to their first-degree relatives to further ascertain the presence of ET. On initial assessment, 67.7% of patients reported a positive family history of ET, but following all assessments, 96.0% of patients had a positive family history. We conclude that a negative family history of ET is often inaccurate, and that ET is primarily a hereditary disease.

Transposition of the great arteries with ventricular septal defects. Surgical considerations concerning the Rastelli operation.

We studied the anatomy of the ventricular septal defect in 20 heart specimens and eight operated patients with transposition of the great arteries regarding the feasibility of the Rastelli operation. They were divided into three groups. In Group I, comprising eight cases, creation of a left ventricle-aorta connection was not prevented by interposition of the atrioventricular valve tissue, and the ventricular septal defect was large or could be enlarged sufficiently. Thus, the Rastelli operation was feasible in all cases. In Group II, comprising 12 cases, interposition of the atrioventricular valves was not present, but the ventricular septal defect was inadequate in size for a good left ventricle-aorta connection. Small or even medium-sized ventricular septal defects were not enlargeable because of surrounding structures or inadequate septum for resection. In all cases, the ventricular septal defect was a tunnellike structure with two orifices; attempted enlargement would be more difficult at the left ventricular end (not obvious to the surgeon's view) than at the right one. The Rastelli operation was judged inadvisable in these cases. In Group III, comprising eight cases, the Rastelli operation was considered inadvisable because of interposition of atrioventricular valve tissue. The size of the ventricular septal defect and the presence of interposed atrioventricular valves can be diagnosed preoperatively. The presence of enough available space for resection, especially at the left ventricular end, should be determined preoperatively and/or intraoperatively in patients with medium-sized ventricular septal defects requiring enlargement. The anatomy of the ventricular septal defect may significantly alter the surgical approach for patients with transposition of the great arteries and ventricular septal defect.

Coarctation of the aorta and severe aortic insufficiency: What to repair first?

A new surgical approach is proposed for patients with coarctation of the aorta associated with severe aortic valvular insufficiency. The valvular lesion should be repaired first and the coarctation corrected during a second operation; both interventions should be done during the same hospital stay. We base our approach on the belief that improved coronary perfusion can be achieved when the aortic insufficiency is corrected first. The disadvantages of the opposite surgical approach, such as anticoagulation problems, renal underperfusion, and hypertensive complications are easily avoided.

Complete atrioventricular canal and tetralogy of Fallot: surgical management.

Between 1982 and 1989, nine patients with complete atrioventricular (AV) canal and tetralogy of Fallot underwent successful repair of both anomalies. Seven patients had Down's syndrome. One or more previous palliative shunts had been used in six patients. Associated cardiovascular lesions included persistent left superior vena cava (two patients), patent ductus arteriosus with marked stenosis of the left pulmonary artery (one patient). The diagnosis was confirmed by cardiac catheterization and cineangiography. Closure of the ventricular septal defect was performed through a combined right atrial and ventricular approach in each patient. The right ventricular outflow obstruction was relieved with the use of a transannular patch (4), right ventricular infundibular patch (4) or a valved external conduit (1). There were no hospital deaths. One patient died as a result of meningitis 2 years after repair. Progressive left AV valve incompetence developed in one patient requiring valve replacement. A single atrial approach may not provide the best exposure of the subaortic end of the defect. In this regard, we recommend an additional right ventriculotomy in order to ensure safe closure of the septal defect. Although an adequately shaped isolated patch could be sufficient to close the anterior VSD, we favour a separate patch to minimize the possibility of producing subaortic obstruction. A further method to avoid this subaortic stenosis consists of dividing the common anterior leaflet to the right towards the lateral extent of the infundibular septum.

Prosthetic valve endocarditis after heart catheterization.

It is accepted that patients with valvular disease or valvular prosthesis should be protected against endocarditis during procedures causing bacteriemia. On the other hand it has been shown that bacteriemia occurs during catheterization. Thus, protection against endocarditis for patients undergoing catheterization deserves more consideration, specially among patients with prosthetic valves. Moved by the fatal outcome of one of our patients with postcatheterization prosthetic valve endocarditis, the authors leave an open discussion about this subject.

Phrenic nerve paralysis following pediatric cardiac surgery. Role of diaphragmatic plication.

Eighteen children sustained unilateral phrenic nerve paralysis (PNP) after cardiac surgical procedures. Ten (Group I), under 7 months (mean: 2.9 +/- 2.2), required long-term ventilatory assistance (mean: 23.9 +/- 13.0 days); they failed to be weaned from the ventilator. All underwent diaphragmatic plication (DP). DP was performed late in 7 cases (Group Ia) with a mean time of 30.8 days between surgery and DP, and early in 3 others (Group Ib) with a mean time of 10.2 days. Eight children (Group II), older than 1 year, tolerated PNP better and could be extubated early without diaphragmatic plication. In Group Ia severe lung infections were recorded in 5 before or/and after DP, and two died at 3 and 30 days after plication. Five children from Group Ia and all 3 from Group Ib were late survivors. They could be weaned from ventilatory support in a mean time of 3 days after DP, although those with severe lung infection (Group Ia) took the longest time. All from Group II were late survivors. We conclude: PNP is well tolerated without plication in children older than 1 year. However early DP offers excellent and immediate results in infants with PNP. Early DP in these children avoids or reduces severe lung infections and death.

Isolated mitral valve replacement with the Björk-Shiley prosthesis in 100 consecutive patients. Short- and long-term results.

Single mitral valve replacement with the Björk-Shiley tilting disc prosthesis was performed in 100 consecutive patients between March 1971 and December 1973. The hospital mortality was 13% and the late mortality was 6%. 74 of the patients were followed for periods ranging between 12 and 46 months (mean follow-up: 24 months): clinical improvement was noted in 92%. The incidence of postoperative embolism, including 1 case of prosthesis thrombosis, was 6.7%, and all cases occurred within the first 9 months after surgery. 6 patients required reoperation because of prosthesis dysfunction due to thrombosis (1 patient), leakage (3), and late disc entrapment (2).

Rhabdomyoma of the heart: surgical treatment.

Rhabdomyoma of the heart may cause severe hemodynamic obstruction specially in infants. Medical treatment carries a 100% mortality, but there are no clear surgical indications for these patients. Accordingly we reviewed the world literature (30 operated patients) adding our own experience (1 successfully operated patient) Based on our data and that of other we conclude: (1) Severely ill patients with rhabdomyoma should be operated upon. Age or associated tuberous sclerosis are not surgical contraindications. (2) Removal of the hemodynamic obstruction should be the main surgical goal. Radical resection of the tumor is not necessary and may be dangerous. (3) Surgical mortality is acceptable and it is becoming lower with time. (4) Long-term outcome for successfully operated patients is unknown.

Aortopulmonary window with anomalous origin of the right coronary artery from the pulmonary trunk.

A case of aortopulmonary window associated with an anomalous origin of the right coronary artery from the pulmonary artery in a 3-month-old boy is reported. Angiographic diagnosis could be difficult because of the simultaneous filling of both great arteries that obscure the origin of the anomalous vessel; however, a careful evaluation of the angiogram may contribute to an accurate diagnosis. The surgical correction of this association of defects requires the connection of the aorta with the anomalous coronary ostium. An intrapulmonary tunneling procedure by means of a baffle is described.

[Cardiovascular surgery in Spain in 1991. Registry of operations of the Spanish Society of Cardiovascular Surgery (SECCV)]. / Cirugía cardiovascular en España en el año 1991. Registro de operaciones de la Sociedad Española de Cirugía Cardiovascular (SECCV).

The Spanish Society of Cardiovascular Surgery has sent a questionnaire to all 37 cardiovascular surgical groups to know the number and type of cardiovascular operations carried out in our country during 1991. The questionnaire was answered by 36 out of 37. In the year 1991, 21,771 cardiovascular patients have been operated upon and 10,913 interventions with extracorporeal circulation have been carried out: 42.4% in valvular disease, 37.2% in coronary and 11.2% in congenital. The number of operations was 5,415 for vascular disease, 4,627 for valvular, 3,168 for coronary, 1,896 for congenital and 3,741 for pacemaker implantation. The total number of operations in 1991 comparing to those performed during 1988 is similar; but the number of open heart operation and the number of these per cardiac unit and per million population during 1991 have increased 20.5, 13.9 and 24.3% respectively. Coronary and valvular operations have also increased 11 and 27% respectively, as well as the number of pacemaker implanted (30%). The number of congenital cases remains the same and the number of vascular operations has decreased by 7.9%.

[Cardiovascular surgery in Spain in 1992. The Registry of Operations of the Spanish Society of Cardiovascular Surgery (SECCV)]. / Cirugía cardiovascular en España en el año 1992. Registro de operaciones de la Sociedad Española de Cirugía Cardiovascular (SECCV).

The Spanish Society of Cardiovascular Surgery Registry of 1992 includes data from 41 centers. Within this year a total of 24,127 patients were operated on, with an average of 588 operations/center. Twelve thousand twenty-two of these were cardiac operations under extracorporeal circulation, with an average of 300 cases/hospital. The average of cardiac surgeons/hospital was 5.9 and the average of open heart operations/surgeon was 50. For the first time, the number of coronary bypass surgeries was superior to that of valvular procedures (5,049 vs 4,951). In the coronary bypass patients the average of grafts/patient was 2.43. The number of valvular prostheses implanted was 5,526 and 81% of these were mechanical. The number of patients operated on for congenital cardiac defects was 2,251 (1,278 open heart surgeries and 973 closed). The global mortality in the patients operated on under extracorporeal circulation was 7.6% (7.0% in valvular, 7.9% in congenital and 5.4% in coronary bypass). There were 6,054 patients subjected to surgery for peripheral vascular disease.

[The pulmonary artery closure may be a thromboembolic risk factor in patients with bidirectional cavo-pulmonary (Glenn) shunt]. / El cierre arterial pulmonar puede ser un factor de riesgo tromboembólico en pacientes con anastomosis cavopulmonar (Glenn) bidireccional.

Postoperative thrombosis after the Fontan procedure has been well noted in the literature, and its risk factors are also well known. In contrast, thrombosis after the bilateral cavo-pulmonary shunt (Glenn) has been rarely reported and almost always occurs around the anastomosis itself or near it, mainly causing pulmonary embolism. We present 2 cases with cerebral embolism 2-7 months after pulmonary artery closure and Glenn procedure, due to dislodgement of a thrombus in the proximal pulmonary artery stump. Based on these two cases and a few others reported in the literature, we want to call the attention to this new cause of thromboembolism after Glenn and stimulate discussion about its incidence, risk factors and preventive measures.

[The bidirectional cavopulmonary (Glenn) shunt without cardiopulmonary bypass: a safe and advisable technique]. / Derivación cavopulmonar (Glenn) bidireccional sin circulación extracorpórea: una técnica segura y recomendable.

The bidirectional cavopulmonary (Glenn) shunt is almost a routine first step procedure for total cavopulmonary connection in children with single-ventricle cardiac anomalies. It is usually performed with cardiopulmonary bypass, of which adverse effects can be especially deleterious in these cardiac conditions. To avoid these adverse effects, we performed the cavopulmonary shunt in 5 children through sternotomy without cardiopulmonary bypass. There was no mortality nor morbidity. We think that this technique is safe, reproducible, and even advisable in children with single-ventricle anomalies.

[Interrupted aortic arch with aortopulmonary window. Total primary correction without extracorporeal circulation in the newborn]. / Interrupción del arco aórtico con ventana aortopulmonar. Corrección total primaria sin circulación extracorpórea en el neonato.

This report describes the unusual association between the interruption of the aortic arch type B and aortopulmonary window type II in a neonate. When the patient was 20 days old, a one-stage surgical repair was done through left side thoracotomy without circulatory by-pass, making a left carotid artery to descending aorta anastomosis, closing the window with a hemaclip, respectively. A routine 2-D Doppler color echocardiography performed in the immediate postoperative period showed the absence of blood flow in the right pulmonary artery. The patient required a new intervention, changing the position of the clip in order to restore the normal pulmonary blood flow. Eight months after surgery, the "neoaortic arch" grows in harmony with the body surface area, without signs of cerebral circulatory deficiency or significant gradient at any level.

[Complete atrioventricular canal and tetralogy of Fallot: surgical considerations]. / Canal atrioventricular completo y tetralogía de Fallot: consideraciones quirúrgicas.

Nine patients with complete atrioventricular canal and tetralogy of Fallot underwent intracardiac repair of both anomalies between 1982 and 1989. The ages of the patients ranged from 6 months to 7 years. Six of the 9 had one or more previous systemic-pulmonary artery shunts. Two-dimensional echocardiography showed diagnostic characteristics of both malformations in all patients. The diagnosis was confirmed by cardiac catheterization and cineangiography. The ventricular septal defect was repaired by a combined right atrial and ventricular approach in every patient. Outflow tract reconstruction was performed with the use of a transannular patch (4), infundibular patch (4), and a valved conduit (1). There were no hospital deaths. Meningitis was responsible for the death of a patient 2 years after repair. We recommend early palliation, complete repair in those older than 4 or 5 years, surgical technique depending on the anatomical findings, combined atrial and ventricular approach, 2 separate patches to close the ventricular septal defect in required cases, adjusted correction of the right ventricular outflow tract, and careful postoperative care.

[The National Data Bank of the Spanish Society of Cardiovascular Surgery. The pilot experience]. / Banco Nacional de Datos de la Sociedad Española de Cirugía Cardiovascular. Experiencia piloto.

Since 1988, the Spanish Society of Cardiovascular Surgery has been enjoying through its National Intervention Registry a complete information about the number and type of cardiovascular surgical operations, yearly performed all over the country. However a computerized National Data Bank would probably offer a more specific, quick and complete information, although its organization is more complex. We want to demonstrate that the creation of a National Data Bank is possible in our country. The following condition has been essential to carry out this initial work on the National Data Bank: The previous existence of a National Intervention Registry, the edition of an universally accepted questionnaire of 33 questions with multiple answers for each question, which includes quantitative and qualitative aspects like mortality, the acquisition of the software Pats Programme by most cardiovascular centers, and finally the enthusiastic dedication of 6 surgical groups. The results of this work also shown in multiples figures, are the final product of the computerized fusion of 6 cardiovascular centers data on operations performed through the year 1991. The results clearly offer a more specific, detailed and extensive information about quantitative and qualitative aspects of the surgical data, than that obtained through the National Intervention Registry. These results should not be extrapolated at national level, as the surgical groups involved in this work are not homogeneous and its number is quite small. This initial study shows that the creation of the National Data Bank of the Spanish Society of Cardiovascular Surgery or other scientific society is possible in our country. Its usefulness is beyond any doubt.

[Surgery of congenital cardiopathies without previous catheterization. Preoperative evaluation and surgical indication using bidimensional echocardiography and Doppler]. / Cirugía de las cardiopatías congénitas sin cateterismo previo. Valoración preoperatoria e indicación quirúrgica por ecocardiografía bidimensional y Doppler.

With the non-invasive devices available nowadays, many congenital heart diseases may be diagnosed with a definition comparable and even perhaps superior to catheterization and angiography. According to this issue, from January 1983 to December 1987, 239 children underwent operations for palliation or correction of different cardiopathies based on an echo-Doppler assessment without prior catheterization. Preoperative echo-Doppler diagnoses had an adequate correlation with the surgical findings in 234 cases (97.9 percent), so there was no correlation in 5 cases. In general, we consider that echo-Doppler provides a complete and definitive diagnosis in most cases, thus eliminating the need for further invasive procedures, although we still have to rely on catheterization to obtain the necessary information or reassurance in some cases. Progressive increase of reliance in echo-Doppler techniques by the surgeon and self confidence of the cardiologist in his accurate state of the art will considerably increase the performance of cardiac operations without prior catheterization in the future. At present, this is our current policy, as day after day, we are increasing the diagnoses in which we consider unnecessary the catheterization to indicate surgery.

[Divided left atrium: operative results and follow-up in the cor triatriatum]. / Aurícula izquierda dividida: resultados quirúrgicos y seguimiento en el cor triatriatum.

INTRODUCTION AND OBJECTIVES: A divided left atrium because of cor triatriatum is a relatively rare cardiac anomaly requiring corrective surgery. We describe here our clinical and surgical experience with this congenital heart defect as well as the different medium and long term diagnostic, surgical and evolution aspects. PATIENTS AND METHODS: From 1981 to 1999, 15 children with cor triatriatum without complex associated cardiovascular defects underwent surgery at a mean age of 13 months (excision of the obstructive membrane). The surgical reports were reviewed and the clinical and echocardiographic data were analyzed before and after the intervention; six of these patients (40%) were referred to operating room only with the 2-D echo Doppler technique and color flow mapping information. The follow-up period ranged from 8 months to 19.3 years. RESULTS: Diagnosis was confirmed during the surgical procedure. One 9 month old patient died 60 days after a successful corrective surgery because of sepsis (7%). No late deaths or reoperations were found in the follow-up period. All 14 patients who survived the operation have a functional class I (NYHA), and they are asymptomatic in the follow-up. The overall survival rate was 93% (70% CI: 87-90). CONCLUSIONS: Corrective surgery with excision of the obstructive membrane dividing the left atrium restores normal anatomic, hemodynamic and clinical status in children with cor triatriatum without complex associated defects.