RESUMEN
Aortic dissection occurs when blood penetrates the aortic intima and forms an expanding hematoma within the vessel wall, separating the intima and media to create a so-called false lumen. Aortic dissection has been estimated to cause one of every 10,000 hospital admissions. The survival rate of untreated patients with aortic dissections is dismal, with a 2-day mortality of up to 50%. The medical conditions predisposing a patient to aortic dissection are hypertension, advanced age, sex, Marfan syndrome and some forms of congenital heart disease. Pregnancy and delivery are not considered major risk factors for the disease. We report here two consecutive cases of type A aortic dissection (Stanford classification) in young puerperal patients after elective caesarean section.
Asunto(s)
Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/cirugía , Cesárea , Complicaciones Posoperatorias/cirugía , Adulto , Aneurisma de la Aorta/diagnóstico por imagen , Ecocardiografía Transesofágica , Femenino , Humanos , Complicaciones Posoperatorias/diagnóstico por imagen , EmbarazoRESUMEN
OBJECTIVE: To identify the major determinants of survival and nonsurvival for patients in need of intra-aortic balloon pump (IABP) support after cardiac surgery and to define the role of ventilator-associated pneumonia. DESIGN: Retrospective study. SETTING: University and general hospital. PARTICIPANTS: A total of 105 consecutive patients undergoing cardiac surgery requiring IABP support and prolonged mechanical ventilation for >24 hours. INTERVENTION: All patients were assigned into 1 of 2 groups: survival (n = 69) and nonsurvival (n = 36). MEASUREMENTS AND MAIN RESULTS: Differences between the survival and nonsurvival groups were tested with the Student's t-test, chi-square test, and frequency analysis. The overall survival rate was 65.7%. Nonsurvivors (34.3%) had higher rates of acute myocardial infarction (27.7% v 4.3%; p < 0.002), Canadian Cardiovascular Society functional class III and IV (44.4% and 13.8%; p < 0.001), and depressed left ventricular ejection fraction (31.3 +/- 6.4% v 42.4 +/- 7.2%; p < 0.001). The nonsurvival group had longer duration of cardiopulmonary bypass (165 +/- 74.3 minutes v 135 +/- 36 minutes; p < 0.006) and aortic occlusion (81.8 +/- 9 minutes v 68.6 +/- 25.7 minutes; p < 0.004). In the nonsurvival group, 21 patients were not weaned from the IABP, and 15 patients were weaned from the IABP but died from renal failure (26.6%), multiorgan failure (13.3%), infection, and respiratory failure (66.6%). In the nonsurvival group, mechanical ventilation time was longer in patients weaned from the IABP. CONCLUSION: These data suggest that for patients not weaned from the IABP, the major determinants of death are low cardiac output (33.3%) and multiorgan failure (47.6%). Patients with a left ventricular ejection fraction of <30% have a poorer outcome. In patients weaned from the IABP, ventilator-associated pneumonia (66.6%) was the major cause of death.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Contrapulsador Intraaórtico , Anciano , Procedimientos Quirúrgicos Cardíacos/mortalidad , Femenino , Humanos , Contrapulsador Intraaórtico/efectos adversos , Contrapulsador Intraaórtico/mortalidad , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Complicaciones Posoperatorias/mortalidad , Cuidados Preoperatorios , Respiración Artificial/efectos adversos , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
[structure: see text] The total synthesis of the potent microtubule-stabilizing anticancer agent (-)-laulimalide has been achieved in 27 steps and 2.9% overall yield. Notable features are the use of Jacobsen HDA chemistry for the enantioselective construction of the side chain dihydropyran, a diastereoselective aldol coupling using chiral boron enolate methodology, a Mitsunobu macrolactonization, and a Sharpless AE to introduce the epoxide onto des-epoxy-laulimalide.
Asunto(s)
Antineoplásicos/síntesis química , Paclitaxel/análogos & derivados , Paclitaxel/síntesis química , Taxoides , Antineoplásicos/farmacología , Macrólidos , Microtúbulos/efectos de los fármacos , Paclitaxel/farmacología , EstereoisomerismoRESUMEN
[figure: see text] A stereoselective synthesis of 3, corresponding to the fully functionalized macrocyclic core of the novel microtubule-stabilizing agent, laulimalide, has been completed. Efficient macrolactonization was achieved by a Mitsunobu reaction, installing the sensitive (Z)-enoate, and macrocyclic stereocontrol was then exploited to introduce the methyl group and trans-epoxide.
Asunto(s)
Antineoplásicos/síntesis química , Paclitaxel/análogos & derivados , Paclitaxel/síntesis química , Taxoides , Antineoplásicos/química , Indicadores y Reactivos , Macrólidos , Modelos Moleculares , Conformación Molecular , Paclitaxel/química , EstereoisomerismoRESUMEN
C1 inhibitor (C1-INH) regulates, complement, contact system, coagulation and fibrinolysis. Bleeding complications during cardiopulmonary bypass (CPB) have been described in a deficient patient. We report a 72 year old man affected with acquired C1-INH deficiency who successfully underwent CPB.
Asunto(s)
Angioedema/complicaciones , Enfermedades Autoinmunes/complicaciones , Puente Cardiopulmonar , Proteínas Inactivadoras del Complemento 1/deficiencia , Anciano , Anabolizantes/administración & dosificación , Anabolizantes/uso terapéutico , Angioedema/sangre , Angioedema/tratamiento farmacológico , Antifibrinolíticos/administración & dosificación , Antifibrinolíticos/uso terapéutico , Aprotinina/uso terapéutico , Enfermedades Autoinmunes/sangre , Enfermedades Autoinmunes/tratamiento farmacológico , Bloqueadores de los Canales de Calcio/administración & dosificación , Bloqueadores de los Canales de Calcio/uso terapéutico , Activación de Complemento , Puente de Arteria Coronaria , Hemostáticos/uso terapéutico , Antagonistas de Heparina/administración & dosificación , Antagonistas de Heparina/uso terapéutico , Humanos , Edema Laríngeo/complicaciones , Edema Laríngeo/tratamiento farmacológico , Edema Laríngeo/etiología , Masculino , Infarto del Miocardio/complicaciones , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/cirugía , Complicaciones Posoperatorias/prevención & control , Protaminas/administración & dosificación , Protaminas/uso terapéutico , Recurrencia , Estanozolol/administración & dosificación , Estanozolol/uso terapéutico , Ácido Tranexámico/administración & dosificación , Ácido Tranexámico/uso terapéuticoRESUMEN
Insulin-like growth factors [IGF I and II or somatomedins (SMS)] are polypeptides chemically and biologically correlated with insulin. The main source of synthetic activity and secretion is the liver, although many other tissues have been demonstrated to synthesize SMS. In the circulation, they are not present in a free form, but are mostly bound to a specific carrier protein independently synthesized in the liver. Hepatic or extrahepatic storage organs have not been demonstrated; the half life of the SMS-binding protein complex is between 3 and 4. Synthesis of SMS is regulated by GH, insulin, thyroxine and nutrition (caloric and protein intake, and nitrogen balance). The role of corticosteroids is still a matter of debate: in patients treated with steroids SMS blood levels have been shown to be within normal limits, while biological activity has been demonstrated to be significantly reduced by SMS inhibitors, probably induced by corticosteroid therapy. The biological properties of SMS are related to their structural homology with insulin, and can be summarized as follows: A. Insulin-like activity (glucose oxidation, lipogenesis, glycogen synthesis, inhibition of lipolysis and glycogenolysis); B. Sulphation activity (incorporation of sulphate and leucine into glycosaminglycans of the cartilage); C. Stimulation of fibroblast multiplication; D. Amplification of other hormone activities (GH); E. Complementary anabolic activity with insulin. Low levels of SMS have been demonstrated in hypopituitarism (secondary) or in other diseases independent of GH reduced secretion (primary) such as malnutrition, malabsorption, acute or chronic liver failure and uraemia. Negative nitrogen balance, hypocaloric and/or low protein diets are usually correlated with low levels of SMS. Recently, Schalch et al. reported on the role of orthotopic liver transplantation (OLT) in normalizing SMS blood levels in a group of end-stage liver diseased patients. This preliminary paper deals with changes in IGF-I plasma levels (somatomedin C) in a group of patients affected by end-stage liver cirrhosis before and after OLT.