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Resumen Durante mucho tiempo, los esfuerzos para disminuir el riesgo cardiovascular en los adultos se centraron en el intento de reducir tanto como fuese posible las concentraciones plasmáticas de colesterol 6, LDL (c-LDL). Hasta muy recientemente se concluyó que en los estudios clínicos de medicamentos con acción en los lípidos circulantes no existía evidencia directa que permitiera determinar cuál es la mejor meta de c-LDL para la disminución del riesgo cardiovascular y tampoco se concedió importancia suficiente a los eventos adversos de las diferentes combinaciones farmacológicas recomendadas para el logro de las concentraciones de c-LDL más bajas posibles. El análisis exhaustivo realizado para la actualización del Programa para el Control del Colesterol en el Adulto de Estados Unidos (NCEP-ATP-III), que comprendió una gran cantidad de estudios controlados con distribución al azar, permitió en 2013 la postulación de un nuevo paradigma de tratamiento que abandona el concepto de metas determinadas de c-LDL y que insiste en la importancia de las modificaciones favorables en el estilo de vida, además de que recomienda la administración preferencial de estatinas, en tipos y dosis fijas, debido a que un importante volumen de evidencia ha demostrado que estos agentes atenúan la progresión de la aterosclerosis coronaria y promueven la regresión de ésta, con lo que disminuyen significativamente la morbilidad y mortalidad cardiovasculares en la prevención primaria y en la secundaria. En este nuevo paradigma terapéutico fue posible también la identificación de los grupos de pacientes que pueden beneficiarse con la administración de estatinas. En consensos y guías más recientes, algunas asociaciones sostienen la necesidad de lograr ciertas metas de cLDL de acuerdo con el riesgo, pero mantienen a las estatinas como el pilar del tratamiento, solas o en combinación con ezetimiba o con antagonistas de la convertasa de proproteínas subtilisina/kexina de tipo 9 (PCSK9: proprotein convertase subtilisin/kexin type 9). En este artículo se revisa la evidencia clínica relativa a la administración de atorvastatina, que en gran medida permitió el desarrollo del nuevo paradigma de manejo del riesgo cardiovascular.

Abstract For a long time, efforts to reduce cardiovascular risk in adults focused on the attempt to reduce plasmatic LDL cholesterol (LDLc) levels as much as possible. Until very recently, it was concluded that in clinical studies of drugs with action on circulating lipids, there was no direct evidence to determine the best LDLc target for cardiovascular risk reduction, and that adverse events, or the almost absent demonstration of impact on hard outcomes of the different pharmacological combinations recommended for the achievement of the lowest possible LDLc concentrations, were not considered. The comprehensive analysis for the update of NCEP-ATP-III (National Cholesterol Education Program, Adult Treatment Panel III), which included a large number of controlled and randomized trials, allowed in 2013 the postulation of a new treatment paradigm, which leaves the concept of specific goals of LDLc and postulates the importance of favorable lifestyle modifications and which commends the pre-ferential use of statins, fixed doses and type, because a large volume of evidence has shown that these agents attenuate the progression of coronary atherosclerosis and promote the regression of this, which significantly decrease cardiovascular morbidity and mortality in both primary and secondary prevention. In this new therapeutic paradigm, it was also possible to identify the groups of patients that can benefit from the use of statins. In more recent consensuses and guidelines, some associations support the need to achieve risk-adjusted LDLc, but keep statins as the mainstay of treatment, alone or in combination with ezetimibe or proprotein convertase subtilisin/kexin type 9 (PCKS-9) antagonists. This article reviews the clinical evidence regarding the use of atorvastatin, which allowed the development of the new cardiovascular risk management paradigm.

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Resumen Este artículo aporta herramientas útiles para el diagnóstico y el diagnóstico diferencial de la hipertensión arterial resistente. En él, se refieren las recomendaciones de las principales guías internacionales de tratamiento respecto de las cifras meta de presión arterial, la incapacidad o falla del tratamiento triple en un amplio porcentaje de pacientes y los factores para la elección racional del cuarto agente para la institución de un tratamiento cuádruple. Esta elección se basa en la capacidad de la espironolactona -antagonista de los receptores de aldosterona- para inhibir los efectos nocivos de la aldosterona que dificultan el control de la presión arterial e incrementan el riesgo cardiovascular en un alto porcentaje de pacientes.

Abstract This article provides useful tools for the diagnosis and differential diagnosis of resistant hypertension. Here, we refer the recommendations of the main international guidelines of management respect to the target goals of the blood pressure, the failure of triple therapy in a large percentage of patients and the factors for the rational choice of the fourth agent for the institution of a quadruple therapy. This choice is based on the ability of spironolactone, antagonist of aldosterone receptors, to inhibit the deleterious effects of aldosterone that difficult the control of blood pressure and increase the cardiovascular risk in a high percentage of patients.

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Retrospectively, we studied 66 consecutive patients in whom we implanted an intravenous DDD pacemaker. The indications were: AV block in 52 patients (79%), sick sinus syndrome in 5 patients (7.5%), both AV block and sick sinus syndrome in 4 patients (6%), and other causes in 5 (7.5%). The venous access route was by subclavian punction in 38 cases (57.5%) and by cephalic vein dissection in 28 (42.5%). With a mean follow-up of 16 months, there were complications in 11 patients (17%), in 9 of them, it was necessary a change in pacing mode different to DDD, and was possible to maintain a DDD pacing mode in 2 patients with a minimal reprogramming. The complications were: A) lost of sense and/or atrial capture in 10 patients (3 of them, had also loss of ventricular capture, one had pacemaker-mediated tachycardia, other had diaphragmatic stimulation and other had a severe infection of the pocket), B) atrial fibrillation appeared in another patient. At the implantation time there were significant differences between patients with and without complications on follow-up, the P wave amplitude was 1.86 +/- 0.75 mV in the first group vs. 3.06 +/- 1.52 mV in the latter group, p < 0.005, and the atrial pacing threshold was 1.10 +/- 1.17 microJ in the first group vs. 0.65 +/- 0.66 microJ in the latter group, p < 0.005. We consider that dual chamber stimulation is a well established form of therapy, although, it requires a more laborious implantation and specialized personal for its follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

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Se estudio en forma prospectiva, randomizada y doble ciego una serie de 40 ratas Wistar, analizando el efecto de los glucocorticoides en anastomosis colonicas. Se observo una diferencia estadisticamente significativa, entre ambos grupos, visualizandose que las tratadas con dexametasona presentaban mayores complicaciones, especialmente dehiscencias parciales o totales de las anastomosis. Se describe el mecanismo de accion de los glucocorticoides y se discute su probable influencia en los resultados obtenidos

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Se estudio en forma prospectiva, randomizada y doble ciego una serie de 40 ratas Wistar, analizando el efecto de los glucocorticoides en anastomosis colonicas. Se observo una diferencia estadisticamente significativa, entre ambos grupos, visualizandose que las tratadas con dexametasona presentaban mayores complicaciones, especialmente dehiscencias parciales o totales de las anastomosis. Se describe el mecanismo de accion de los glucocorticoides y se discute su probable influencia en los resultados obtenidos

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We have developed an empirical mathematic formula which allows us to measure the muscular mass of the left ventricle. It expresses, in grams/square meter of corporal surface, the result of the correlation (r = 0.865) between the mass calculated by echocardiography and an index we call "Electric Mass of the Left Ventricle" (E.M.L.V.) and which equals the intrinsic deflection of V6 multiplied by R height in V6, cubed and divided by the corporal surface. The developing of a corrective factor (a factor of correction) allows us to express in grams/square meter the muscular mass measured by the electrocardiogram. The final formula is E.V. = Log. (1 + Nat. Log of the electric mass) + 56.66(3). The values obtained through this formula give us a correlation of r = 0.834.

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Anticoagulants are drugs capable to retard or even cancell the process of blood coagulation. They are many factors who influences the intensity and duration of oral anticoagulant acitivity, such as drugs, body constitution, physical agents, diseases, etc. The oral anticoagulants interacts with other drugs at differents levels: at the gut, at the plasma, modiffing the protein binding or the metabolism of such drugs, at the enzimatic induction or inhibition, or at unknown places with many other drugs. These paper deals with the description of such interactions.

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