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INTRODUCTION: Neuroinflammation is involved in the pathophysiology of various neurological disorders, in particular Alzheimer disease (AD) and Parkinson's disease (PD). Alterations in the blood-brain barrier may allow peripheral blood lymphocytes to enter the central nervous system; these may participate in disease pathogenesis. OBJECTIVE: To evaluate the peripheral blood lymphocyte profiles of patients with AD and PD and their association with the disease and its progression. METHODS: The study included 20 patients with AD, 20 with PD, and a group of healthy individuals. Ten of the patients with AD and 12 of those with PD were evaluated a second time 17 to 27 months after the start of the study. Lymphocyte subpopulations and their activation status were determined by flow cytometry. All patients underwent neurological examinations using internationally validated scales. RESULTS: Compared to healthy individuals, patients with AD and PD showed significantly higher levels of activated lymphocytes, lymphocytes susceptible to apoptosis, central memory T cells, and regulatory T and B cells. As the diseases progressed, there was a significant decrease in activated cells (CD4+ CD38+ and CD8+ CD38+ in PD and AD, CD4+ CD69+ and CD8+ CD69+ in PD), T cells susceptible to apoptosis, and some regulatory populations (CD19+ CD5+ IL10+ in PD and AD, CD19+ CD5+ IL10+ FoxP3+, CD4+ FoxP3+ CD25+ CD45RO+ in PD). In patients with AD, disease progression was associated with lower percentages of CD4+ CD38+ cells and higher percentages of effector CD4 cells at the beginning of the study. Significant differences were observed between both diseases. CONCLUSIONS: This study provides evidence of changes in peripheral blood lymphocyte phenotypes associated with AD and PD and their severity. Considering effective blood-brain communication, our results open new avenues of research into immunomodulation therapies to treat these diseases.

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OBJECTIVE: The pandemic disease by SARS-CoV-2 infection does not have an effective treatment. To prevent the disease, scientists developed vaccines that the clinicians use as an emergency licensed vaccine. The objective of this study was to determine the side effects in personnel vaccinated at the Military Central Hospital of Mexico with the BNT162b2 vaccine. PATIENTS AND METHODS: This study included the subjects who had received both doses of the BNT162b2 vaccine between December 2020 and February 2021. We asked about the side effects after the first and the second vaccine doses. One group had no history of COVID-19, and the second had a history of COVID-19. ANTI-SARS-CoV-2 antibodies were measured by the immunodetection technique in the second group only. RESULTS: We included 946 participants, 62% were women, and 80% were without comorbidities; 680 were included in the first group, and only 266 were in the second group. After the first dose, 77% of the first group and 86% of the second group presented some side effects. After the second dose, 84% of the first group and 89% of the second group showed some side effects. The main side effect was mild pain. All participants (126) were IgG positive, and only 26.9% were IgM positive at 17.5 days (12.8 days, 20.3 days) after the second dose. CONCLUSIONS: There is a positive correlation between side effects after the first dose in patients with a history of previous SARS-CoV-2 infection compared to those who did not. Nevertheless, this correlation is not present after the second dose. The low percentage of IgM could be related to the time interval between vaccination and sample measure.

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Intestinal failure is defined as the reduction of a functional gut mass below the minimal necessary for adequate digestion and absorption of nutrients and fluids. Intestinal failure is the final result of a number of different causes, being short bowel syndrome the most recognized. Its prevalence is low, but the impact in quality of life among patients and their families is critical. Furthermore, is associated with high economic costs, both for the patient and the health provider. Its main feature is the need for long-term parenteral nutritional support with high morbidity and mortality associated complications, such as line-derived bloodstream infections and liver disease. The management of these patients should be performed by a multidisciplinary team, and be aimed at promoting adaptation and recovery of bowel function to achieve intestinal autonomy.

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Portal vein thrombosis (PVT) is a serious complication of end-stage liver disease, representing a challenge for the liver transplantation (LT) team. The aim of this study was to analyze the results of LT in patients with PVT. Methods: All adult patients who underwent a LT from a cadaveric donor between March 1994 and March 2010 were included. PVT was categorized using the classification of Yerdel and McMaster. Results: A total of 109 LT were performed in 105 patients. PVT was found in 13 cases (12.4 percent). In 6 of them (46.2 percent), thrombosis was found preoperatively by transplant routine work up. Pre-transplant systemic anticoagulation was indicated in 3 cases. At the time of surgery, only 10 patients had persistent PVT. Grade I, II, III and IV PVT was found on 2, 3, 4 and 1 patient respectively. In the 3 cases treated with systemic anticoagulation preo-peratively, grade I (1 case) and grade II (2 cases) no thrombus was evident intraoperatively. Endovenectomy was performed in 7 cases; simple thrombectomy in one and a mesenteric vein graft was required in 2 cases. No thrombus recurrence was detected on postoperative follow-up. In-hospital mortality occurred in 2 cases with PTV grade III and IV due to medical complications. One-year patient and graft survival was 69 percent vs 79 percent in patients without PVT (p = 0,476). Conclusion: Liver transplant in patients with PVT thrombosis was not associated with a significant increased risk of mortality. Systemic anticoagulation seems to be warranted while waiting for liver transplantation.

La trombosis de la vena porta (TP) es una complicación grave de la enfermedad hepática crónica terminal. La factibilidad y pronóstico del trasplante hepático (TH) dependen de su extensión en el eje porto-mesentérico. Objetivo: Analizar los resultados del trasplante hepático en pacientes con TP. Material y Método: Estudio de cohorte no concurrente a partir de los registros clínicos de los pacientes adultos con TP sometidos a un TH entre marzo de 1994 y marzo de 2010. Las TP fueron clasificadas en cuatro grados según Yerdel y Mc Master. Resultados: De 109 TH en 105 pacientes, 13 (12,4 por ciento) tuvieron una TP; en 6 de ellos el diagnóstico fue preoperatorio (46,2 por ciento). En tres se indicó tratamiento anticoagulante vía sistêmica (TACO). En el intraoperatorio se encontró TP en 10 pacientes. La trombosis fue grado I, II, III y IV en 2, 3, 4 y 1 pacientes, respectivamente. Los 3 casos tratados con TACO tenían trombosis grado I y II; en ellos no se encontró trombosis durante el trasplante. Se realizó trombectomía simple en 1 paciente, trombectomía por eversión en 7 y un puente mesentérico-portal en 2 casos. No hubo re-trombosis. Dos pacientes (15,4 por ciento) fallecieron de complicaciones médicas con injerto funcionante. La sobrevida al año de seguimiento año fue de un 69 por ciento vs 79 por ciento en los sin TP (p = 0,476). Conclusiones: El TH en pacientes con TP no se asoció a mayor mortalidad en relación a los pacientes trasplantados sin TP. El tratamiento anticoagulante en pacientes con TP puede indicarse mientras se espera el trasplante.

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La epimastigogénesis de Trypanosoma cruzi ocurre naturalmente en el intestino del hospedador invertebrado. Se desconoce si los cambios morfológicos que ocurren durante la transformación de los tripomastigotas sanguíneos en epimastigotas son idénticos para diferentes aislados de T. cruzi. Aquí mostramos un método útil para estudiar los eventos que ocurren durante la epimastigogénesis, comparando parásitos de diferentes procedencias epidemiológicas. Se alimentaron artificialmente ninfas de V estadio de Rhodnius prolixus con una solución ad hoc conteniendo tripomastigotas tipo-sanguíneo y siguiendo los cambios morfológicos por 8 días. Los contenidos del intestino anterior de las ninfas se obtuvieron decapitando y comprimiendo el abdomen lo que permitió obtener rápidamente casi 100% del inóculo con cargas entre 1,9 y 8,9 × 106 tripomastigotas/ninfa. El número de parásitos por ninfa y los cambios morfológicos se determinaron por Microscopia de Contraste de Fases y coloración con Giemsa. Las ninfas ingirieron 7,4 veces su peso de solución infectante, con volúmenes entre 101 y 357 µL (229 ± 66 mg), 50% de esa ingesta se eliminó como orina durante las primeras 24 h. Los tripomastigotas se transformaron en formas redondeadas antes de evolucionar a epimastigotas, siguiendo cinéticas diferentes según el aislado. Proponemos esta metodología para estudiar rápida y cuantitativamente los eventos tempranos de la epimastigogénesis de T. cruzi in vivo.

Trypanosoma cruzi epimastigogenesis naturally occurs in the intestine of the invertebrate host. It is not known whether the morphological changes that occur during transformation of bloodstream trypomastigotes to epimastigotes are identical for different T. cruzi isolates. This research shows a useful method for studying the events that occur during epimastigogenesis, comparing parasites from epidemiological sources. Rhodnius prolixus V stage nymphs were fed artificially with an ad hoc solution containing blood-like trypomastigotes and the morphological changes were examined during eight days. Anterior intestinal contents were removed by decapitation and squeezing the abdomen of the nymphs, which permitted obtaining quickly almost 100% of the inoculate with loads between 1.9 and 8.9 × 106 trypomastigotes/nymph. The number of parasites per nymph and morphological changes were determined using phase microscopy with Giemsa staining. The nymphs ingested 7.4 times their weight of the infecting solution with volumes between 101 e 357 µL (229 ± 66 mg); 50% of the ingest was eliminated as urine during the first 24 hours. The trypomastigotes transformed to rounded forms before evolving into epimastigotes following different kinetics according to the isolate. This method is proposed for rapid, quantitative study of the early events of epimastigogenesis for T. cruzi in vivo.

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Osteoporosis is a common complication after liver transplantation. Aim: To assess bone mineral density of patients prior to liver transplantation. Material and Methods: Retrospective review of medical records of patients with liver cirrhosis, subjected to liver transplantation that had a measurement of bone mineral density prior to the operation. Results: Twenty nine of 112 transplanted patients complied with the inclusion criteria. Their mean age was 55 +/- 11 years, their body mass index was 26.9 +/- 3.2 k/m2, 73 percent were males and the period of clinical evolution prior to transplantation lasted 3.7 +/-2.9 years. Twenty four percent had an alcoholic liver disease, 21 percent C hepatitis and 14 percent non-alcoholic steatohepatitis. The main risk factors for osteoporosis were medication intake in 79 percent, alcohol in 52 percent, smoking in 41 percent and concomitant diseases in 31 percent. Bone mineral density was normal in 31 percent and showed osteopenia and osteoporosis in 48 and 21 percent of patients, respectively. Patients with a normal mineral density were younger than the rest of patients (46.9 +/- 13.4 and 58.5 +/- 7.4 years respectively p < 0.01). Conclusions: Patients subjected to liver transplantation had a high frequency of osteoporosis or osteopenia prior to the surgical procedure.

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Con el objetivo de evaluar los problemas disergonómicos asociados al mobiliario escolar, a las características dimensionales del aula, y el peso del morral en relación a las dimensiones antropométricas de los escolares, se realizaron mediciones antropométricos a 413 niños de tres planteles públicos y tres privados. Se consideraron las variables: edad, peso, estatura, altura poplítea y distancia sacro poplítea. Estas mediciones permitieron caracterizar a los niños de la muestra y realizar una comparación con los resultados de una investigación realizada durante la década de los años 80, encontrando que los niños de la presente investigación son más altos y con más peso hasta un 3,10% y un 23,3% respectivamente. También se encontró que los niños de los planteles privados presentaron mayor peso y talla que los niños de los planteles públicos. Se registró igualmente la información dimensional del mobiliario escolar para compararlo con los requisitos de las Normas Covenin 1650-89 y con los requerimientos antropométricos de los niños del estudio, encontrándose que los pupitres usados no cumplen con dichas normas Covenin ni son ergonómicamente confortables con los requerimientos dimensionales de los niños estudiados. Respecto al peso del morral, 67% de los niños cargan un peso superior al 10% de su peso corporal según lo sugerido por la Asociación Pediátrica Americana.

The investigation pursues the objective of evaluating the disergonomic problems associated to the school furniture, to the dimensional characteristics of the classroom, and the weight of the school bag in relation to the anthropometric dimensions of the students in public and private schools. For this purpose, anthropometric measurements were taken to 413 children from three public schools and three private schools. Among the variables taken, we can find the following ones: age, weight, height, popliteal height, popliteal sacrum distance, among others. These measurements allowed to characterize the children of the sample and to make a comparison with the results of other investigation during the decade of the eighties, finding that the children of the present investigation are higher and heavier to a 3,10% and a 23.3% respectively. It was also found that the children of the private schools had a higher weight and size than the children of the public schools. The dimensional information of the school furniture was also recorded to compare it with the requirements of the Covenin Norms 1650-89 and with the anthropometric requirements of the children of the study, finding that the used writing desks do not fulfil the requirements of the Covenin norms mentioned, nor are ergonomically comfortable with the dimensional requirements of the children of the sample. It was also found that 67% of the evaluated classrooms there are children who carry a weight higher than 10% of their corporal weight suggested by the American Pediatric Association.

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Biliary tract complications (BC) are cause of mortality after liver transplantation (LT). There are different treatment alternatives for this complication. Aim: to determ¨ªnate incidence, risk factors and treatment of biliary complications after LT. Materials and Methods: A retrospective descriptive cohort of patients undergoing LT between March 1994 and March 2009. Risk factors and incidence for BC were ex-plored. Also the BC impact on overall survival on LT patients was assessed. We used SPSS 15.0 for statistical analysis and considered a significant p value less than 0.05. Results: 107 LT were performed in 102 patients. In 30 (28 percent) there was some biliary complication. Ten (33.3 percent) were early complications (< 3 months) and 20 (66.7 percent) were late ( > 3 month). Anastomotic stricture was the more frequent BC. The gender male recipient, the cold ischemic time and biliary reconstruction technique without tutor were associated with an increased risk for BC. Endoscopic treatment of biliary stricture was successful in 91 percent of cases at one year follow up. Three (10 percent) patients died due to BC or their long-term treatment. Conclusions: Biliary Complications after Liver Transplantation are frequent and are cause of mortality. Decrease cold ischemic time and improve te-chniques for biliary reconstruction could reduce the high incidence of this complication.

Introducción: Las complicaciones biliares (CB) en el trasplante hepático (TH) son causa de mortalidad post-trasplante. Existen diferentes alternativas terapéuticas para su tratamiento. Objetivo: Determinar la incidencia, factores de riesgo y evaluar los resultados del tratamiento de las CB posterior al TH. Materiales y Método: Estudio retrospectivo, descriptivo de una cohorte de pacientes sometidos a un TH entre marzo-1994 y marzo-2009. Se analizó los factores de riesgo para CB, su incidencia en el tiempo, su tratamiento y se determinó su impacto en la sobrevida global de los pacientes. Se utilizó el programa SPSS 15.0 para cálculos estadísticos y se consideró significativo un p < 0,05. Resultados: Se realizaron 107 TH en 102 pacientes. En 30 (28 por ciento), se consignó una o más CB. En 10 (33,3 por ciento), la CB fue precoz y en 20 (66,7 por ciento) tardía. La estenosis de la anastomosis fue la CB más frecuente. El sexo masculino del receptor, el tiempo de isquemia fría y la técnica de reconstrucción biliar sin tutor, se asociaron significativamente a un mayor riesgo de CB. El tratamiento endoscópico de la estenosis biliar fue exitoso en el 91 por ciento de los casos a un año de seguimiento. Tres (10 por ciento) pacientes fallecieron por una CB o su tratamiento a largo plazo. Conclusiones: Las CB del TH son frecuentes y son causa de mortalidad. Disminuir el tiempo de isquemia fría y mejorar las técnicas de reconstrucción biliar podrían disminuir su incidencia.

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OBJECTIVE: To evaluate the progress achieved in the treatment of acute lymphoblastic leukemia (ALL) in our hospital. MATERIAL AND METHODS: A total of 235 patients diagnosed with ALL in the central region of Cuba from 1972 to 2000 were included. Four groups were considered according to the diagnostic period and treatment protocol. Group 1 was composed of 20 patients who did not receive a uniform treatment regimen. The remaining groups were treated with different protocols of the Latin American Group for Malignant Hemopathy Therapy (Glathem). Group 2 was treated with less aggressive classical regimens from the 1970s, and groups 3 and 4 received more aggressive regimens, type Berlin-Frankfurt-Munster (BFM). Intravenous high-dose methotrexate was used in group 4 but not in group 3. Classification by prognostic groups was based on age and leukocyte count. RESULTS: Of 215 patients included in the Glathem protocols, remission occurred in 197 (91.6%). Overall survival in the distinct treatment groups progressively increased during the study period, from a 5-year survival of 15% in group 1 to 72% in group 4. Event-free survival in patients included in the Glathem protocols increased from 42% in group 2 (classical protocols) to 68.7% in the BFM protocols (groups 3 and 4). Significant differences were found among the different treatment and prognostic groups considered. CONCLUSIONS: During the period analyzed, survival in children with ALL progressively increased in parallel with improved treatment regimens. These results demonstrate the importance of well-programmed polychemotherapy to achieve prolonged survival and a high percentage of cure in this disease.

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Objetivo Analizar los progresos obtenidos en el tratamiento de la leucemia linfoblástica aguda (LLA) en nuestro centro. Material y métodos Se incluyen en este estudio un total de 235 pacientes diagnosticados de LLA en la región central de Cuba de 1972 a 2000. Se consideraron 4 grupos según el período de diagnóstico y protocolo de tratamiento. El grupo 1 está constituido por 20 pacientes que no recibieron un esquema de tratamiento uniforme. Los restantes grupos fueron tratados con distintos protocolos del Grupo Latinoamericano de Tratamiento de Hemopatías Malignas (Glathem). El grupo 2 fue tratado con esquemas clásicos poco agresivos, de la década de 1970 y los grupos 3 y 4 recibieron esquemas más agresivos, tipo BFM. En el grupo 4 se utilizó metotrexato intravenoso en dosis elevadas, pero no en el grupo 3. La clasificación por grupos pronósticos se hizo según a la edad y la cifra de leucocitos. Resultados De 215 pacientes incluidos en los protocolos del Glathem hicieron remisión 197 (91,6 por ciento). El análisis de la supervivencia global en los distintos grupos de tratamiento muestra un incremento progresivo en el período analizado, desde el 15 por ciento de supervivencia a los 5 años en el grupo 1 hasta el 72 por ciento en el grupo 4. La supervivencia libre de eventos en los pacientes incluidos en los protocolos del Glathem se elevó de 42 por ciento en el grupo 2 (protocolos clásicos) al 68,7 por ciento en los protocolos BFM (grupos 3 y 4). Existen diferencias significativas entre los distintos grupos de tratamiento y los distintos grupos pronósticos considerados. Conclusiones Durante el período analizado se ha producido un incremento progresivo de la supervivencia de niños diagnosticados de LLA a medida que se han ido perfeccionando los esquemas terapéuticos. Esto demuestra la importancia de una poliquimioterapia bien programada para obtener supervivencias prolongadas y un elevado porcentaje de curación en esta enfermedad(AU)

OBJECTIVE: To evaluate the progress achieved in the treatment of acute lymphoblastic leukemia (ALL) in our hospital. MATERIAL AND METHODS: A total of 235 patients diagnosed with ALL in the central region of Cuba from 1972 to 2000 were included. Four groups were considered according to the diagnostic period and treatment protocol. Group 1 was composed of 20 patients who did not receive a uniform treatment regimen. The remaining groups were treated with different protocols of the Latin American Group for Malignant Hemopathy Therapy (Glathem). Group 2 was treated with less aggressive classical regimens from the 1970s, and groups 3 and 4 received more aggressive regimens, type Berlin-Frankfurt-Munster (BFM). Intravenous high-dose methotrexate was used in group 4 but not in group 3. Classification by prognostic groups was based on age and leukocyte count. RESULTS: Of 215 patients included in the Glathem protocols, remission occurred in 197 (91.6 percent). Overall survival in the distinct treatment groups progressively increased during the study period, from a 5-year survival of 15percent in group 1 to 72 percent in group 4. Event-free survival in patients included in the Glathem protocols increased from 42 percent in group 2 (classical protocols) to 68.7percent in the BFM protocols (groups 3 and 4). Significant differences were found among the different treatment and prognostic groups considered. CONCLUSIONS: During the period analyzed, survival in children with ALL progressively increased in parallel with improved treatment regimens. These results demonstrate the importance of well-programmed polychemotherapy to achieve prolonged survival and a high percentage of cure in this disease(AU)

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INTRODUCTION: Ischemic cerebrovascular disease includes a set of entities that are produced by disorders in components of the blood, the blood flow, the walls of blood vessels or the heart, and can be anatomical, functional or even mixed. CASE REPORT: We describe the case of an 18-month-old male patient with compensated celiac disease, with repeated ischemic strokes in different territories, including the right posterior cerebral artery and middle cerebral artery, in the course of a hypercoagulable state due to essential thrombocytosis. Computerised axial tomography scans, brain angioresonance, a complete blood chemistry analysis and bone marrow biopsy were all performed and confirmed the previous diagnosis. Exchange transfusion, antiplatelet drugs and a platelet production inhibitor (anagrelide) were begun as therapy. At present, the patient is 2 years old and still has a slight direct hemiparesis, which is complete and predominantly faciobrachial, with no alterations to language. CONCLUSIONS: Cerebral infarctions in infancy are infrequent, and their presentation obliges the attending clinician to seek causes that are not usual. In our patient the hypocoagulability came about due to essential thrombosis, which is rare in infancy. The cause behind the infarction determines the chances of its recurring. Acetylsalicylic acid did not prove to be effective for this purpose. We suggest using carbamazepine for the treatment of kinesigenic dystonias.

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Background: Induction of salivation is becoming increasingly popular in the assessment of salivary gland status. Various mechanical or pharmacological procedures are empirically used to produce salivation. Oral stimulation by citric acid (AC) is by far the most used sialagogue procedure. Aim: To characterize the salivary secretory response to AC solutions applied to the dorsolateral tongue surfaces. Subjects and methods: Young healthy women from the upper levels of a medical career (n=19) participated as volunteers. Salivary volume and UV-absorbing organic material in saliva from single subjects were measured after various protocols of topical stimulation by AC. Results: After a single stimulation by 1-8 percent AC the salivary flow rate peaked before 30 seconds and recovered the basal level earlier than 2 minutes. Repetitive stimulations at 30-sec intervals kept the flow rate at a maximum. After suspending these stimulations, basal flow rate was recovered before 2 minutes. Repetitive AC-stimulations at 8-min intervals produced a series of identical and independent secretory responses. The concentration of organic material in saliva remained unaltered after the various modes of stimulation. Thus, the profile of organic material secretion was always a direct expression of changes in salivary flow rate. In contrast to AC, the oral administration of the cholinergic agonist pilocarpine (PIL) produced a two-wave salivary response that as a whole lasted for about 30 minutes. In this case the volume and the amount of organic material were at least 10-fold the ones secreted in response to AC. Conclusions: AC provoked a rapid and short-lived salivary response that differs markedly from the one produced by other secretagogues, like pilocarpine

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Background: Collection of saliva produced by the major salivary glands may be accomplished either by cannulation of the glandular ducts or by the application of specific collecting devices to the emergence area of the glandular ducts. Those procedures are complex, slow, invasive and require skilled personnel. Aim: To report the design and application of a device to collect parotid saliva (snail collector) and another device to collect saliva from the submandibular/sublingual complex. Material and methods: The saliva collection devices were tested in 40 healthy volunteers (20 male) aged 18 to 22 years old. Saliva was collected using conventional conditions, during 5 to 15 min. Results: An average of 1 to 1.5 ml of saliva was collected in the 10-15 min period from both parotid and submandibular/sublingual glands. Flow rates from parotid glands were 80 µl/min and 180 µl/min from submandibular/sublingual glands. Parotid saliva had a protein and organic material concentration twice as high than saliva from submandibular/sublingual glands. The presence of human a-amylase duplet (Mr 55 kD and 58 kD) predominated in parotid saliva, whereas saliva from submandibular/sublingual glands had other molecular markers such as the lysozyme duplet (Mr 18.5 kD and 17 kD). Conclusions: The tested devices were easily applicable, comfortable and allowed the collection of both parotid saliva and submandibular/sublingual saliva from various subjects at once, under the supervision of a single professional

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The authors report the clinical history of a 15 years old young man with severe congenital pulmonary valvular stenosis who was treated, for the first time in Panama, with percutaneous balloon pulmonary valvuloplasty (PBPV). The patient presented with an episode of syncope at rest. The EKG showed right ventricular hypertrophy (RVH) and suggested the presence, with the echocardiogram, of pulmonary systolic pressures higher than the systolic systemic pressures. The diameter of the interior pulmonary ring was estimated to 20 mm. The chest X-ray suggested the presence of RVH. Multiple premature ventricular systoles were detected by the Holter monitoring. Cardiac catheterization showed pressures of 150/12 mm Hg in the right ventricle (RV) and 24/9 mm Hg in the pulmonary artery (PA) with a transvalvular gradient of 126 mm Hg. PBPV was successfully done on 19 june 1993. The pressures in the RV were then 38/5 mm Hg and in the PA 25/7 mm Hg with a residual gradient of 13 mm Hg. Twenty minutes after completion of the procedure the patient experienced a hypertensive crisis and pulmonary edema, a complication of PBPV not previously reported in the literature

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The authors report the clinical history of a 15 years old young man with severe congenital pulmonary valvular stenosis who was treated, for the first time in Panama, with percutaneous balloon pulmonary valvuloplasty (PBPV). The patient presented with an episode of syncope at rest. The EKG showed right ventricular hypertrophy (RVH) and suggested the presence, with the echocardiogram, of pulmonary systolic pressures higher than the systolic systemic pressures. The diameter of the interior pulmonary ring was estimated to 20 mm. The chest X-ray suggested the presence of RVH. Multiple premature ventricular systoles were detected by the Holter monitoring. Cardiac catheterization showed pressures of 150/12 mm Hg in the right ventricle (RV) and 24/9 mm Hg in the pulmonary artery (PA) with a transvalvular gradient of 126 mm Hg. PBPV was successfully done on 19 june 1993. The pressures in the RV were then 38/5 mm Hg and in the PA 25/7 mm Hg with a residual gradient of 13 mm Hg. Twenty minutes after completion of the procedure the patient experienced a hypertensive crisis and pulmonary edema, a complication of PBPV not previously reported in the literature.

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The authors report the results of therapy with amlodipine in 20 patients with mild or moderate hypertension (diastolic pressure between 95 and 115 mmHg). Amlodopine was administered in a dose of either 5 or 10 mg once a day for 12 weeks. None of the patients had a history of congestive heart failure. Eleven patients were men between 27 and 89 years of age (average age was 52.6 years). There was a significant decrease in systolic blood pressure (from 161 to 141 mm Hg or -12.4%) and in diastolic blood pressure (from 103 to 86 mm Hg or -16.5%). Heart rate remained between 78 and 77 beats per minute. Only one patient experienced palpitations and two complained of mild, transient giddiness while on this therapy.

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The authors report the results of therapy with amlodipine in 20 patients with mild or moderate hypertension (diastolic pressure between 95 and 115 mmHg). Amlodopine was administered in a dose of either 5 or 10 mg once a day for 12 weeks. None of the patients had a history of congestive heart failure. Eleven patients were men between 27 and 89 years of age (average age was 52.6 years). There was a significant decrease in systolic blood pressure (from 161 to 141 mm Hg or -12.4%) and in diastolic blood pressure (from 103 to 86 mm Hg or -16.5%). Heart rate remained between 78 and 77 beats per minute. Only one patient experienced palpitations and two complained of mild, transient giddiness while on this therapy

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The authors studied the clinical and angiographic findings in two patients who had a myocardial bridge (MB) in the right anterior descending coronary artery and did not have any arteriosclerotic lesions in the coronary arteries. The two patients were men, 57 and 58 years old. Both had a history of arterial hypertension (for 19 years and 6 months, respectively) and angina pectoris (for 7 years and 6 months, respectively). The resting EKG showed subepicardial ischemia in one and was normal in the other. The stress test was positive in both. Coronary artery angiography showed an MB in the right anterior descending coronary artery which caused a systolic constriction of 90% and 80%, 3 and 2 cm. long. Both patients had left ventricular hypertrophy. The authors conclude that MB is a frequent cause of coronary insufficiency and that the appearance of symptoms and their severity depends on the degree of systolic constriction, greater than 75%, and on the presence of left ventricular hypertrophy. The majority of patients are controlled with medical treatment and only a small number require surgical therapy.

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