Asunto(s)
Angina de Pecho/cirugía , Infecciones por Ascaridida/parasitología , Procedimientos Quirúrgicos Cardíacos/métodos , Complicaciones Posoperatorias , Anciano , Animales , Antinematodos/uso terapéutico , Infecciones por Ascaridida/diagnóstico , Infecciones por Ascaridida/tratamiento farmacológico , Ascaris lumbricoides , Electrocardiografía , Humanos , Masculino , Mebendazol/uso terapéutico , SíndromeRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano , Enfermedad Coronaria/diagnóstico , Ascaris lumbricoides/aislamiento & purificación , Ascariasis/complicaciones , Eosinofilia Pulmonar/diagnóstico , Reperfusión Miocárdica , Angiografía Coronaria , Mebendazol/uso terapéuticoRESUMEN
Se presenta el caso de una mujer de 74 años, portadora de una prótesis valvular mitral (CarboMedics de 27 mm), que ingresa en la Unidad de Cuidados Intensivos en situación de edema agudo de pulmón. Se comprueba disfunción de la prótesis compatible con trombosis, por ecocardiografía transesofágica (ETE), y considerando la situación general de la paciente, se plantea la opción del tratamiento con fibrinolíticos como alternativa a la cirugía. Tras dos dosis sucesivas de 100 unidades por kg de Tenecteplasa, se consigue apertura completa de la prótesis, confirmada por ETE, y una excelente evolución clínica posterior (AU)
Asunto(s)
Anciano , Femenino , Humanos , Fibrinolíticos/uso terapéutico , Trombosis de la Vena/tratamiento farmacológico , Prótesis Vascular , Estenosis de la Válvula Mitral/tratamiento farmacológico , Ecocardiografía Transesofágica/métodos , Válvula Mitral , Fibrinólisis , Trombosis de la Vena/diagnóstico , Estenosis de la Válvula Mitral/etiología , Estenosis de la Válvula MitralRESUMEN
No disponible
Asunto(s)
Humanos , Choque Cardiogénico/terapia , Contrapulsador Intraaórtico/métodos , Infarto del Miocardio/complicaciones , Choque Cardiogénico/etiología , Reperfusión Miocárdica/métodosRESUMEN
BACKGROUND: A study was designed to determine significant variables that could be used to predict survival in patients with ruptured abdominal aortic aneurysm. PATIENTS AND METHODS: Data of 106 unselected consecutive patients with ruptured abdominal aortic aneurysm undergoing operation between 1989 and 1998 were identified from a prospective hospital-based registry. A total of 32 variables were analyzed including demographic characteristics, vascular risk factors, coexisting conditions, preoperative findings, intraoperative variables, and postoperative complications. Preoperative and intraoperative variables related to vital status (alive, death) in the univariate analysis were subjected to stepwise linear regression analysis to determine whether a combination of variables would predict death. Of 99 evaluable patients, 48 died (mortality rate 48.5%). RESULTS: At univariate analysis, age, serum creatinine, hemoglobin, electrocardiographic ischemia, loss of consciousness on admission, preoperative shock, supra-renal rupture, and transfusion requirements were significantly associated with 30-day operative mortality. Postoperative complications except sepsis, mesenteric ischemia, and neurologic events were significantly associated with mortality. Electrocardiographic ischemia, shock, and supra-renal rupture appeared to be independent predictors of mortality in the multivariate analysis. The cumulative effect of 0, 1, and > or = 2 risk factors on mortality was 29%, 39%, and 90%, respectively. CONCLUSIONS: Electrocardiographic ischemia, preoperative shock, and supra-renal rupture were predictors of death in patients with ruptured abdominal aortic aneurysm.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/cirugía , Complicaciones Posoperatorias/mortalidad , Anciano , Aneurisma de la Aorta Abdominal/mortalidad , Rotura de la Aorta/mortalidad , Causas de Muerte , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Análisis de Regresión , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
We report two cardiac surgery patients on whom local hypothermia with slushed ice for myocardial protection was used. Bilateral diaphragm paralysis with respiratory failure occurred. In both cases, neurophysiologic studies have been used for the diagnosis. Prolonged ventilatory support was required for several weeks and they were totally recovered after months.
Asunto(s)
Puente de Arteria Coronaria/métodos , Hipotermia Inducida/efectos adversos , Parálisis Respiratoria/etiología , Anciano , Femenino , Paro Cardíaco Inducido/efectos adversos , Paro Cardíaco Inducido/métodos , Humanos , Hipotermia Inducida/métodos , Insuficiencia de la Válvula Mitral/cirugía , Infarto del Miocardio/cirugía , Falla de Prótesis , Reoperación , Respiración Artificial , Parálisis Respiratoria/terapiaRESUMEN
Se describe a 2 pacientes sometidos a cirugía cardíaca en los que se utilizó hipotermia local con hielo picado como método de protección miocárdica. En el postoperatorio presentaron una insuficiencia respiratoria grave secundaria a una parálisis diafragmática bilateral completa. El diagnóstico de esta complicación y su posterior seguimiento se realizaron, en ambos casos, mediante un estudio neurofisiológico. Los 2 enfermos precisaron ventilación mecánica durante algunas semanas y la parálisis revirtió de forma completa después de varios meses (AU)
Asunto(s)
Anciano , Femenino , Humanos , Insuficiencia de la Válvula Mitral , Infarto del Miocardio , Falla de Prótesis , Respiración Artificial , Reoperación , Parálisis Respiratoria , Puente de Arteria Coronaria , Hipotermia Inducida , Paro Cardíaco InducidoRESUMEN
The conceptual change and the dynamic care of patients observed in coronary care units, in recent years are reported. The coronary care unit is increasingly conceived as an intensive care unit for patients with acute or chronic cardiopathies with severe complications. Criteria for rational planification, functional and hierarchic organization and basic medical care arguments are established. The coronary care unit can not be considered as an isolated facility, but should rather be integrated in the cardiology department, under the direction of a cardiologist. The authors point out the basic, physical structure and characteristics of the equipment in the coronary care unit and the intermediate cardiac care unit, as well as the newly created chest pain units. Finally, we comment on the human resources (medical, nursing and administrative) and the criteria for admission and discharge in the coronary care unit.
Asunto(s)
Servicio de Cardiología en Hospital/normas , Enfermedad Coronaria/terapia , Equipos y Suministros de Hospitales/normas , Servicio de Cardiología en Hospital/organización & administración , EspañaRESUMEN
INTRODUCTION AND OBJECTIVES: The impact of acute myocardial infarction in labour activity changes from one country to another as well as patients' characteristics. Our purpose was aimed to learn the main demographic, professional, clinical and therapeutic variables which might affect the return to work after suffering a myocardial infarction in our environment. METHODS: 584 patients treated consecutively in our Coronary Unit for 4 years, aged under 65, were studied. The following aspects were analyzed: age, sex, previous ischaemic heart disease, previous working condition, professional level, economical area of labour activity, main therapeutic procedures and complications, number of days of sick leave, posterior labour status and date of invalidity or death, should it occur. The minimum follow up period was two years. RESULTS: 65.3% of patients were regularly working before suffering the myocardial infarction. Mean length of sick leave after myocardial infarction was 243.9 days although it changed according to age and economical areas. 56.6% of the patients returned to work according to age (odds ratio = 0.92), high professional status (odds ratio = 2.14), economical area of services (odds ratio = 2.03), and the presence of previous anginal attacks (odds ratio = 1.73). CONCLUSIONS: In our environment, patients less likely to resume their work after suffering a myocardial infarction are older, working in agricultural and industrial areas, with a lower professional level and without known ischemic heart disease antecedents.
Asunto(s)
Empleo , Infarto del Miocardio/psicología , Factores de Edad , Femenino , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Ausencia por Enfermedad , Factores Socioeconómicos , España/epidemiologíaRESUMEN
INTRODUCTION AND OBJECTIVES: The length of hospital stay for uncomplicated myocardial infarction is still a debatable issue. Our study tries to establish the rate of patients amenable early discharged and the safety of this practice. PATIENTS AND METHODS: We studied retrospectively the clinical features, in-hospital events and 30-day follow up of 238 patients discharged early (5 or 6 days) during the last three years. These patients were compared with the remaining group of 929 patients discharged after a conventional stay (mean 10.4 days) in the same time frame. RESULTS: The mean hospital stay in the early discharged group was 5.4 days. They had no ischemic, arrhythmic or haemodynamic complications in the acute phase. In the 30-day follow up there was only one death (at the 14 th post-myocardial infarction day) and 17 readmissions to the hospital, none with re-infarction. By contrast, there were 14 deaths and 43 readmissions among the patients with the standard stay at the hospital. CONCLUSIONS: At least 20% of patients with uncomplicated myocardial infarction can be discharged early. This practice seems to be safe in low risk groups, and is not associated with a higher rate of complications when compared with longer hospital stays.
Asunto(s)
Tiempo de Internación , Infarto del Miocardio/terapia , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Alta del Paciente , Readmisión del Paciente , Estudios Retrospectivos , Factores de TiempoRESUMEN
A case of thrombosis on an aortic bioprosthesis after the fourth month of implantation is presented. The patient had been well anticoagulated for the first three months after surgery. A suspicious diagnosis was made when the patient started with symptoms of cardiac failure and angina and an Echo-Doppler showed a significant transvalvular gradient. The definitive diagnosis will be determined with the removal of the valve at surgery. Although this is a rarity as an early complication, it should be kept in mind in such cases. Surgical intervention is mandatory and life-saving.
Asunto(s)
Bioprótesis/efectos adversos , Prótesis Valvulares Cardíacas/efectos adversos , Trombosis/etiología , Anciano , Humanos , Masculino , Factores de TiempoRESUMEN
During the VIII National Congress of the Spanish Society of Parenteral and Enteral Nutrition (SENPE) held in Santander on 5th, 6th and 7th of June last, a subject was raised among several others, which for us was of great current interest and not often found in scientific affairs, related to the organizational affairs of the discipline of Artificial Nutrition, namely the Nutritional Teams or Nutritional Support Units. The aim was to respond to the many problems raised by this discipline: What does it consist of? Is it necessary? What is its purpose? Who is involved in it? What qualifications must these people have? Does it enter into competition with Nutritional, Clinical and Dietetic Services? To reply to these and many other questions, we invited a number of professionals with wide experience in nutritional and other fields, in an attempt to form a group of experts in different specialties with interests in the subject. We were also lucky enough to be able to invite Doctor Rombeau, an internationally-recognized expert, in whose country there exists great experience in the organization of these units. This summary of our Round Table was prepared by the organizer, Doctor Ordóñez, and an attempt was made to respect the spirit of each author's contribution.