Hemodynamic evaluation and anti-hypertensive schemes used in puerperal women following pre-eclampsia.

Pre-eclampsia is still a very prevalent disease with critical hemodynamic changes. This study was evaluated the major anti-hypertensive schemes used at the Materno Perinatal Hospital "Monica Pretelini" (HMPMP) hospitalized at the Obstetric Intensive Care Unit (OICU) for at least seven days. In other group of patients we compared hemodynamic monitoring with Swan-Ganz catheter versus transthoracic electrical bioimpedance (TEB) and gasometric formulas. Statistical analysis was done using the Statistical Package for Social Science (SPSS) software, version 17. Amlodipine + temisartan + prazocin was the preferred anti-hypertensive drug combination used in our intensive care unit. Sodium nitroprusside is required in 25% of patients until reaching control. There was no statistically significant difference in cardiac output calculated with gasometric formulas compared to thermodilution with Swan-Ganz catheter. Calcium antagonists + angiotensin II receptor blocker (ARB) + α-blockers offer the best option to control hypertension in puerperal women that followed pre-eclampsia, but oral and IV drugs to control hypertension is required in 20% of cases, in a Mexican Intensive Care Unit specialized in obstetrical patients. Hemodynamic monitoring with gasometric formulas is still usefull in this set of patients, without discarding TEB with a correction factor due to the accumulated extravascular water in these patients.

Myocardial infarction in patients with systemic lupus erythematosus with normal findings from coronary arteriography and without coronary vasculitis--case reports.

The authors present the cases of two young patients, a man and a woman, who presented with myocardial infarction, in the absence of ischemic heart disease or stenosis of the coronary arteries. The woman was known to have systemic lupus erythematosus (SLE) for the past 3 years (the immunoglobulin M [IgM] anticardiolipins antibodies were positive), without a history of coronary risk factors. Suddenly she presented with acute chest pain on rest that lasted 4 hours and culminated in anterior wall myocardial infarction. She was admitted to the coronary care unit, where no thrombolysis was given. She did not have echocardiographic evidence of Libman-Sacks endocarditis, but myocardial infarction was evident at the electrocardiogram (ECG). The young man had SLE (the IgM anticardiolipins were absent, but he was positive for lupus anticoagulant antibodies), he was hyperlipidemic, was a moderate smoker and moderately obese, and had no history of ischemic heart disease. He suddenly presented with an acute myocardial infarction documented by ECG, enzymes, and gammagraphy. In both patients, coronary angiography findings were normal and myocardial biopsy did not show evidence of arteritis. The relevance of these cases is the rare association of ischemic heart disease in SLE, with normal coronary arteries and without evidence of arteritis or verrucous endocarditis.

A case of giant arteriovenous shunt in a renal carcinoma.

We present the case of a 51 year-old-white male with a giant right renal arteriovenous fistula secondary to a carcinoma. Neither the aorta nor the kidneys were visualized after the injection of 60 mL of contrast media into the abdominal aorta. Moreover, the right kidney could not be visualized after 30 mL of contrast media were injected selectively into the right renal artery. This was due to a great arteriovenous shunt through the right kidney. The right renal angiogram was obtained through digital imaging, after injecting contrast media into the right renal artery, previously occluded by a balloon-catheter. The image of an hypervascularized nephroma was obtained, depicting an important arteriovenous shunt of the contrast material toward the inferior vena cava from a fistula located in the right inferior renal pole. The occlusion of the right renal artery was partially achieved by injecting 40 mL of boiling contrast media, followed by small fragments of Gelfoam suspended in the contrast substance. The balloon-catheter remained inflated in the right renal artery until a nephrectomy was performed. As far as we know, a case in which the aorta and renal circulation are unable to be seen by means of conventional angiography, because of the presence of a renal arteriovenous shunt to the fistula, has not been described.

Unusual giant patent ductus arteriosus associated with ventricular septal defect and discrete aortic coarctation. A case report.

The authors present the case of a 26 years old female, 56 kg weight and 154 cm height, with a giant patent ductus arteriosus (2.4 cm of internal diameter), ventricular septal defect, discrete preductal narrowing of the aortic arch and pulmonary artery hypertension that did not diminished after 100% oxygen breathing. The authors speculate about the origin of the giant ductus here presented, based on hemodynamic and embryological data.

Endomyocardial fibrosis (Davies disease) coincidental with systemic lupus erythematosus.

This is the case of a 27 years-old woman with signs and symptoms of severe untreatable congestive heart failure, anemia, gingival mucosa ulcers, photosensitivity and alopecia. The electrocardiographic, echocardiographic, angiographic and hemodynamic data oriented the diagnosis of restrictive cardiomyopathy, mitral insufficiency secondary to mitral prolapse and bi-atrial dilation. The histologic study of the endomyocardial biopsy, performed during catheterization, showed signs of endomyocardial fibrosis, and immunological analysis was compatible with systemic lupus erythematosus. As far as we know, this is the first case of endomyocardial fibrosis (Davies disease) associated with systemic lupus erythematosus published in the medical literature. The etiology of Davies disease remains unrevealed and its association with systemic lupus erythematosus suggest a probable autoimmune origin.

[Asymptomatic ischemia in coronary arterial ectasia. Effects of anticoagulation]. / Isquemia asintomática en la ectasia arterial coronaria. Efecto de la anticoagulación.

We studied 23 patients (22 men and 1 woman), their ages ranged from 31 to 71 years (55.9 +/- 9.7 years), with isolated coronary arterial ectasia. Seventeen patients presented angina pectoris, 19 had myocardial infarction. An angiographic image of intracoronary thrombus was observed in 5 patients. Before the administration of anticoagulants (oral warfarin) 16 patients showed unstable angina, the exercise EKG was positive in 9 patients, and 16 patients presented silent ischemia (showed by EKG-Holter), whose duration was 35.21 +/- 29.27 min per day. After anticoagulants, only 5 patients showed unstable angina pectoris. Exercise EKG was positive in 7 patients and only 7 patients showed silent ischemia, whose duration decreased significantly (P < 0.001) to 12.47 +/- 22.5 min per day.

[Intestinal amebiasis]. / Amibiasis intestinal

Infection produced by Entamoeba histolytica constitutes a clinical problem of great importance due to its frequence and serious complications. Age, diagnosis and clinical manifestations, phisic exploration, lab. procedures, proctosigmoidoscopy, radiology, complications, pathologic anatomy, statistical reports from the Ministry of Health and Social Asistence in addition we emphasize on the importance of an accurate and precocious diagnosis. We expose an effective terapeutic regimen for the different amibiasis states.

Slender versus threatening angiodysplasias: observe, operate or obturate? A delusive decision.

Beside the immediate success of surgery and of embolization of angiodysplasias, certain number of patients return to medical consultation, because recanalization of the arteriovenous fistulae after their resection or obturation. From the presentation of two clinical cases of thoracic angiodysplasia: one of them slender, and threatening the other, the authors point out the complications and recurrence after surgical resection or arterial embolization. The recurrence takes place even when only one artery remains permeable after resection or embolization of the fistula. There are cases where the affected limb has to be amputated. However, angiodysplasia shows itself in the stump of the amputee limb. Uncontrolled angio-genesis is the natural history or postoperatory evolution of angiodysplasias, probably originated by an erroneous genetic program, which persist in spite of resection of the vascular malformation, causing a therapeutic failure.

Aortic origin of the right pulmonary artery associated with ductus arteriosus in an adult. A case report.

We describe the case of a 26-year-old female in functional class I (NYHA), with aortic origin of the right pulmonary artery associated with a persistent ductus arteriosus and severe pulmonary artery hypertension (101/40-70 mm Hg), which remained elevated (89/40-60 mm Hg) after the administration of 100% oxygen. Right pulmonary artery pressure (125/60-86 mm Hg) was higher than that of main pulmonary artery and similar to aorta pressure. The patient was successfully treated: surgical closure of the ductus arteriosus and end-to-end anastomosis between the pulmonary artery and right pulmonary artery were carried out. Systolic pulmonary arterial pressure, estimated by echocardiography Doppler, was 60 mm Hg six months after surgery. Cross-sectional echocardiogram showed the anastomosis of the right pulmonary artery with the main pulmonary artery. Pulmonary gammagraphy showed both lungs perfused through the main pulmonary artery; right lung perfusion was lesser than left lung perfusion, 30 vs. 70% respectively. Aortic origin of a right or left pulmonary artery is a heart disease seen in patients during the course of the first year of life. Its frequency is < 1% among all the congenital cardiopathies and the survival rate to adult life is very low. The originality of this paper is the presentation of a rare congenital cardiopathy treated surgically in an adult.

Hemicolectomía derecha: técnica mecánica semicerrada / Right hemicolectomy: mechanical sutures

Se presentan 45 pacientes, sometidos a hemicolectomía derecha con técnica de Barcelona, en el servicio de cirugía del Hospital Dipreca, entre abril de 1991 y julio de 1997. La edad promedio fue de 69 años. Se describe el procedimiento con una modificación diseñada por el autor. Se analizan los resultados comparándolos con otras series. En el 93 por ciento del grupo se realizó esta cirugía en patología oncológica, practicándose 41 intervenciones electivas. La morbilidad fue de 8,8 por ciento. La mortalidad fue 2,2 por ciento. Se concluye que es una técnica fácil de realizar, con baja tasa de infección y que permite una amplia boca anastomótica