RESUMO

Bio-derived furan- and diacid-derived cyclic carbonates have been synthesized in high yields from terminal epoxides and CO2 . Furthermore, four highly substituted terpene-derived cyclic carbonates were isolated in good yields with excellent diastereoselectivity in some cases. Eleven new cyclic carbonates derived from 10-undecenoic acid under mild reaction conditions were prepared, providing the corresponding carbonate products in excellent yields. The catalyst system also performed the conversion of an epoxidized fatty acid n-pentyl ester into a cyclic carbonate under relatively mild reaction conditions (80 °C, 20 bar, 24 h). This bis(cyclic carbonate) was obtained in high yields and with different cis/trans ratios depending on the co-catalyst used. An allyl alcohol by-product was only observed as a minor product when bis(triphenylphosphine)iminium chloride was used as co-catalyst. Finally, two cyclic carbonates were used as building blocks for the preparation of non-isocyanate poly(hydroxy)urethanes by reaction with 1,4-diaminobutane.

RESUMO

A new coordination mode for the hybrid scorpionate/cyclopentadienyl ligand bpzcp, [bpzcp = 2,2-bis(3,5-dimethylpyrazol-1-yl)-1,1-diphenylethylcyclopentadienyl] is observed in iridium complexes. The reaction of the lithium precursor, [Li(bpzcp)(THF)], with a range of [IrCl(diene)]2 compounds leads to an unprecedented binding mode of the hybrid scorpionate/cyclopentadienyl ligand as η5-Cp-coordinated and the formation of Ir(I) derivatives [Ir(η5-Cp-bpzcp)(η4-cod)] (1), [Ir(η5-Cp-bpzcp){η4-CH2═C(Me)C(Me)═CH2}] (2), [Ir(η5-Cp-bpzcp)(η2-coe)2] (3), and [Ir(η5-Cp-bpzcp)(η2-CH2═CH2)2] (4). The Ir(I) complex 4 reacts with CO or bromine to afford the compound [Ir(η5-Cp-bpzcp)(CO)2] (5) and the 18e- Ir(III) complex [Ir(κ-N-η5-Cp-bpzcpBr2)Br2] (6), respectively. Reaction of the iridium compounds (2-4) with CuI or [PdCl2(CH3CN)2] yields the heterobimetallic iridium-copper or iridium-palladium complexes [Ir(η5-Cp-bpzcp){η4-CH2═C(Me)C(Me)═CH2}(µ-bpzcp){CuI(κ2-NN-bpzcp)}] (7), [Ir(η5-Cp-bpzcp)(η2-coe)2}(µ-bpzcp){CuI(κ2-NN-bpzcp)}] (8), [Ir(η5-Cp-bpzcp)(η2-CH2═CH2)2}(µ-bpzcp){CuI(κ2-NN-bpzcp)}] (9), [Ir(η5-Cp-bpzcp)(coe)2}(µ-bpzcp){PdCl2(κ2-NN-bpzcp)}] (10), and [Ir(η5-Cp-bpzcp)(η2-CH2═CH2)2(µ-bpzcp){PdCl2(κ2-NN-bpzcp)}] (11). All products were characterized by spectroscopic methods and the X-ray crystal structures of 1, 2, 3, 4, and 6 were also established.

RESUMO

El objetivo de este estudio consistió en caracterizar los principales fenómenos sintácticos presentes en textos científicos escritos por docentes del perfil de Higiene y Epidemiología de la Facultad de Tecnología de la Salud de Villa Clara. Se trabaja con una muestra intencional de ocho ponencias redactadas por los profesores de este perfil y presentadas en eventos provinciales, territoriales e internacionales durante 2010-2011. Los métodos y técnicas empleados posibilitaron sistematizar, analizar y percibir lo común de los datos registrados, y arribar a conclusiones confiables. Pudo constatarse que dichos profesionales conocen las generalidades del lenguaje científico; sin embargo, incurren inconscientemente en hechos sintácticos que afectan la claridad y calidad de sus textos. A partir del diagnóstico efectuado surge la necesidad de proyectar acciones de superación profesional y normativas relacionadas con esta labor.

The objective of this article is to characterize the process and outcomes of a research work, it was motivated by the occurrence of different syntactic problems found in the speech of professionals of Villa Clara Health Technology Faculty, which have an incidence in written scientific documents. The sample comprises eight scientific works that were written by professors of the Hygiene and Epidemiology career, which were presented in provincial, territorial and international events from 2010 to 2011. The methods and techniques applied made possible to systematize, analyze and perceive the registered common data, this allowed arriving at reliable conclusions. It could be stated that this professionals know the generalities of the scientific language; however, they unconsciously have syntactic problems which affect the clarity and quality of the scientific document. Consequently, Professional upgrading actions and norms related to the writing of scientific documents are proposed.

Assuntos

RESUMO

Posterior a la incorporación de la Facultad deTecnología de la Salud de la Universidad de Ciencias Médicas de Villa Clara a la educación superior, se pudo constatar la existencia de un pobre desarrollo de las habilidades investigativas del claustro, lo que incide en los resultados de rubros evaluables de los indicadores en la producción científica. Esta situación influye negativamente en los resultados de la investigación científico-estudiantil; de ahí que se decidiera desarrollar un estudio para analizar cómo contribuir a elevar su desarrollo en los docentes, y proponer una estrategia pedagógica que contribuyera al desarrollo de las mencionadas habilidades con carácter permanente. El método fundamental empleado fue la investigación acción, pues en la actualidad resulta muy útil para tratar los análisis de nuevos desarrollos curriculares y tendencias metodológicas en la investigación educativa.

After the incorporation of the Health technology Faculty to the Villa Clara University of Medical Sciences it was tested a poor development of researching abilities in the teaching staff, this aspect has an incidence in the scientific production indicator of the teacher´s evaluation. This situation has a negative influence in the results of the students scientific research works. That´s why it is decided to carry out a research work to analyze how to contribute to elevate the development of researching abilities in the teachers and to propose a pedagogical strategy which contribute to elevate the permanent development of researching abilities. The action investigation was the method used, because it´s very useful to analyze the new curricular development and methodological tendencies in the educative research works.

Assuntos

RESUMO

AREA DE ACCIÓN FARMACOLÓGICA: Mecanismo de acción: Natalizumab es un anticuerpo recombinante monoclonal humanizado inhibidor selectivo de las moléculas de adhesión, se une a la subunidad alfa cuatro de las integrinas humanas, profusamente expresada en la superficie de todos los leucocitos a excepción de los neutrófilos. En particular, se une a la integrina alfa 4-beta-1, bloqueando la interacción con su receptor análogo, la molécula de adhesión de células vasculares 1 (VCAM-1), y a los ligandos osteopontina y segmento de conexión 1 (CS-1), un dominio alternativamente dividido de la fibronectina. Natalizumab bloquea la interacción de la integrina alfa-4-beta-7 con la molécula de adhesión celular de adresina mucosa 1 (MadCAM-1). La alteración de estas interaciones moleculares evita la migración de los leucocitos mononucleares a través del endotelio hacia el tejido parenquimatoso inflamado. EVALUACIÓN DE LA EFICACIA: Resultados de los ensayos clínicos de mayor relevância: La eficacia en monoterapia ha sido evaluada en el estudio AFFIRM (natalizumab safety and efficacy in relapsing-remitting multiple sclerosis). Ensayo multicéntrico, aleatorizado, doble ciego controlado con placebo de 2 años de duración en pacientes con EM remitente recidivante EM RR que habían experimentado al menos 1 recidiva clínica durante el año anterior a su inclusión y tenían una puntuación entre 0 y 5 en la escala expandida del estado de discapacidad de Kurtzke (EDSS). La mediana de la edad de los pacientes fue de 37 años, y la de la duración de la enfermedad, de 5 años. Los pacientes (n= 942) fueron asignados aleatoriamente para recibir en una relación de 2 a 1, Natalizumab 300 mg (n = 627) o placebo (n = 315) cada 4 semanas, hasta un total de 30 perfusiones. Se realizaron evaluaciones neurológicas cada 12 semanas y en los momentos en los que se sospechaba recidivas. Se realizaron anualmente evaluaciones mediante resonancia magnética, utilizando imágenes T1 de lesiones realzadas con gadolinio (Gd) e imágenes T2 de lesiones hiperintensas. Los resultados mostraron una reducción de la tasa anual de recidivas (valor relativo) del 68% entre los pacientes tratados con natalizumab en relación al placebo durante los dos años. El porcentaje de pacientes que no habían progresado en la EDDS se redujo un 42% (valor relativo) en el grupo de natalizumab, (HR 0,58 (0,43-0,77), p<0,001). La robabilidad de progresión en la EDSS fue 17% para natalizumab vs 29% para placebo, diferencia en RAR 12%, NNT=8,3. El valor medio en la EDSS fue de 2,3 en ambos grupos, y la media de cambio en la escala evaluado a los 2 años fue de 0,4(±0,86) para natalizumab versus 0,41 para placebo p<0.0001. sin embargo es difícil interpretar la significación clínica de esta diferencia de 0,37 puntos en la escala EDSS. En el subgrupo de pacientes que cumplen criterios para el tratamiento de la EM remitente recidivante de evolución rápida (pacientes con 2 ó más recidivas y una o más lesiones de gadolinio) la tasa anual de recidiva fue de 0,28 en el grupo tratado con natalizumab (n=148) y de 1,45 en el grupo placebo (n=61) (p<0,001). El cociente de riesgo para la progresión de la discapacidad fue de 0,36 (IC 95%. 0,17-0,76) p=0,008. Estos resultados se obtuvieron en um análisis post hoc y deben interpretarse con cautela. Adicionalmente no se dispone de información de las recidivas antes de la inclusión de los pacientes en el estudio. EVALUACIÓN DE LA SEGURIDAD: En los ensayos controlados con placebo en 1617 pacientes con EM tratados con natalizumab durante un máximo de 2 años, se produjeron acontecimientos adversos que motivaron la retirada del tratamiento en el 5.8% de los pacientes tratados con natalizumab (placebo 4.8%). En este periodo el 43.5% de los pacientes tratados con natalizumab comunicó reacciones adversas graves (placebo 9.6%). Se han comunicado dos casos, uno mortal de leucoencefalopatía multifocal progresiva (LMP) en pacientes con EM que recibían interferon b-1a durante más de 2 años. Para algunos autores la relación entre el tratamiento con natalizumab y la ocurrencia de LMP es clara. Pero se desconoce la relación precisa entre el tratamiento con natalizumab y el desarrollo de LMP em términos de riesgo. CONDICIONES PARA APROBAR EL SUMINISTRO DEL FARMACO: -Debe firmarse un consentimiento informado informando a la paciente sobre los beneficios esperables para la droga y los posibles efectos adversos que eventualmente podrían surgir. Así como también poniéndola al tanto de que el suministro de la droga estará condicionado al grado de respuesta a la misma y a la aparición de efectos adversos graves. -Se aprueba el uso del fármaco en forma condicional por 6 meses a una evaluación global de la paciente y de las condiciones operativas que aseguren el suministro del fármaco. -La administración se hará en forma mensual por vía endovenosa en el Hospital Centenario bajo el control de médicos entrenados para atender eventuales efectos adversos durante la administración de la droga. -Debe haber un informe mensual o al menos bimensual del medico clínico a cargo en Hospital Centenario detallando: -Efectos adversos, -Numero de recaídas, -Actualización de déficit eurológico adquirido, -Dificultades con el suministro de la droga, -Otras dificultades operativas, -Control con especialista en neurología no menor a los 3 meses.

Assuntos

RESUMO

La información visual juega un papel extremadamente importante en el deportista porque alrededor del 85 por ciento de la información que requiere proviene del sistema visual; por eso el entrenamiento y desarrollo de las habilidades visuales se relacione con el rendimiento deportivo. Por ese motivo, nos propusimos como objetivos: determinar cómo influye el desarrollo de las habilidades visuales en el rendimiento deportivo de los jugadores de raquetball, evaluar el desarrollo de las habilidades visuales, definir cuáles son las más desarrolladas, compararlas por sexo, relacionarlas con el resultado deportivo y con patologías oculares o sistémicas. Se obtuvo como principal resultado que todos tenían desarrollada la binocularidad. Concluimos que hubo una mayor cantidad de atletas de raquetball con habilidades visuales desarrolladas; las más desarrolladas fueron: la binocularidad, la agudeza visual (estática y dinámica) y la visualización. En el sexo femenino las más desarrolladas fueron: la agudeza visual (estática y dinámica), la acomodación-convergencia, la binocularidad y la visualización mientras que en el masculino fueron: la binocularidad, la agudeza visual (estática y dinámica) y la visualización. En el caso del equipo femenino no hubo correspondencia entre la atleta con mayor desarrollo de las habilidades visuales y el mejor resultado deportivo; pero en el masculino sí se correspondió. No se encontraron patologías oculares o sistémicas asociadas a las habilidades visuales estudiadas. Recomendamos realizar este estudio a todos los atletas en su iniciación deportiva; y crear una consulta oftalmológica especializada dedicada al control de su visión, al entrenamiento visual para potenciar las habilidades visuales menos desarrolladas en los deportistas y examinarlos periódicamente.

Visual information plays a very important role in an athlete since roughly 85 percent of required information comes from the visual system; therefore training and development of visual skills are related to sport performance. The objectives of this paper were to determine how the development of visual skills affects the sports performance of racketball players, to evaluate the development of these skills, to define the most developed ones, to compare them by sex and associate them with the sports achievements and with ocular and/ or systemic pathologies. Binocularity was the most developed skill. It was concluded that there was a higher number of racketball athletes presenting with developed visual skills, particularly binocularity, visual acuity (statics and dynamics) and visualization. The most developed skills in females were visual acuity (statics and dynamics), accommodation-convergence, binocularity and visualization whereas males showed binocularity, visual acuity (statics and dynamics) and visualization. In the case of the female racketball team, the highest development of visual skills was not associated with the best sport achievements, but in the case of the male team, this association did exist. No ocular or systemic pathologies related to the studied visual skills were found. It was recommended to perform this study in all the athletes at the beginning of their sports life, and also to set up a specialized ophthalmologic service for vision control, visual training to potentate the less developed skills in athletes and for regular check-ups.

Assuntos

RESUMO

OBJECTIVE: To evaluate the rapid ventricular pacing in balloon aortic valvuloplasty to achieve balloon stability. MATERIAL AND METHODS: From September 2004 to July 2005, a prospective protocol was carried out: ten patients with aortic valve stenosis were treated with this method. Patient's age ranged from 3 to 16 years with mean age of 10.2+/-4.3 years. In all cases a bipolar pacing catheter was placed in the right ventricle. Rapid ventricular pacing was initiated at the rate of 150 per minute and was gradually increased to achieve a 50% drop in systemic pressure. The balloon was inflated only after the pacing rate was reached and the blood pressure dropped. Pacing was continued until the balloon was completely deflated. RESULTS: The systolic gradients across the aortic valve before balloon dilatation ranged from 40 to 110 mm Hg, mean 68.5+/-20 mm Hg. The pacing rate required to drop the pressure by 50% ranged from 170 to 250 per minute, mean 209+/-25. Balloon stability at time of inflation was achieved in all cases with no balloon movement. The post ballooning gradients ranged from 5 to 28 mm Hg, mean 19.7+/-8.3 mm Hg (p<0.001). In all cases there was no change in aortograms, performed before and after balloon dilatation in aorta, except in one patient who developed grade I aortic regurgitation. CONCLUSIONS: Rapid ventricular pacing appears to be an effective and a safe procedure to stabilize the balloon during balloon aortic valvuloplasty and is thought to decrease the incidence of aortic insufficiency.

Assuntos

RESUMO

El trauma ocular lo constituye cualquier lesión causada en el ojo por factores externos que no se relacionan con enfermedades del paciente. Las causas más frecuentes encontradas, son los accidentes domésticos, laborales y la práctica deportiva. En el caso específico del boxeo, existe una polémica en la que algunos afirman que con la medicina moderna, las nuevas reglas de arbitraje y las novedosas técnicas de entrenamiento, este deporte es casi inofensivo al que lo practique. Otros afirman que los traumatismos repetitivos provocan lesiones cerebrales responsables de la decadencia neuropsicológica de un gran número de pugilistas. Se revisaron 24 trabajos internacionales y un nacional (el único publicado hasta el momento). Se refieren estudios comparativos entre varios deportes 20 (80 porciento), entre los cuales se observa que 17 (85 porciento) son deportes donde se refieren una gran cantidad de severos traumatismos oculares (football, hockey y squash); y se mantiene el boxeo en un lugar de baja incidencia con respecto a estos y a otros deportes. A partir de los resultados hasta ahora obtenidos, concluimos que el boxeo tiene una baja incidencia en la ocurrencia de traumatismos oculares.

The ocular injure is any eye lesion caused by external factors that are not related to the patient`s disease. The most common causes are domestic, work accidents and sports practicing. In the particular case of boxing, there is a controversy in which some state that the modern medicine, the new refereeing rules and the novel training techniques, this sports is almost harmless to the individuals practicing it. Other people say that repeated traumas bring about brain injures responsible for neuropsychological decline of a great number of boxers. Twenty four international and one national (the only one so far published) papers were reviewed. Comparative studies among several sports 20 (80 percent) are mentioned; it was observed that 17 (85 percent) are sports where a great deal of severe ocular injures occur ( football, hockey and squash) ; however, boxing keeps low incidence if compared to these sports and others. According to the results achieved so gar, we may conclude that boxing has a low ocular injure incidence rate.

Assuntos

RESUMO

Objetivo: Evaluar la estimulación ventricular rápida en la Valvuloplastía Aórtica Percutánea como estrategia para obtener estabilidad del balón. Material y métodos: En septiembre de 2004 se inició un protocolo prospectivo. Tres enfermos masculinos consecutivos con estenosis valvular aórtica significativa fueron tratados con este método. Las edades fueron 13, 6 y 5 años. En todos se colocó un electrodo bipolar en el ventrículo derecho. Durante el procedimiento se registró la presión arterial sistémica con un catéter en la aorta descendente. La estimulación ventricular se inició a una frecuencia de 150 por minuto y se aumentó hasta obtener un descenso del 50% en la presión arterial sistémica y entonces el balón se infló para realizar la valvuloplastía aórtica. La estimulación se suspendió hasta que el balón fue completamente desinflado. Resultados: Los gradientes transvalvulares antes de la valvuloplastía fueron 90 y 110 mmHg. Las presiones en aorta fueron de 90, 110 y 55 mmHg. Se obtuvo una reducción del 50% de la presión sistémica con 170, 250 y 220 por minuto de estimulación. La duración de la estimulación rápida en los tres casos fue de 15 segundos. Se logró estabilización del balón sin movimientos en los dos casos. Los gradientes obtenidos después de la valvuloplastía fueron 23, 28 y 15 mmHg. No hubo modificación en el grado de insuficiencia aórtica después del procedimiento. En el primero se mantuvo grado I y en el segundo y tercer casos, no se observó regurgitación en el aortograma. Conclusiones: La estimulación cardíaca rápida estabiliza el balón durante la valvuloplastía, es segura, efectiva y puede disminuir la incidencia de insuficiencia aórtica.

Objective: To evaluate rapid ventricular pacing in balloon aortic valvuloplasty, an initial strategy to achieve balloon stability. Material and methods: From September to December 2004, a prospective protocol was started: three male consecutive patients with aortic valve stenosis were treated by this strategy. Age of the patients were 13, 6 and 5 years old. All had a bipoplar pacing catheter placed in the right ventricle. Invasive systemic pressures were documented with a catheter in the descending aorta. Rapid ventricular pacing was initiated at the rate of 150 per minute and increased to a rate required to achieve a drop in systemic pressure by 50%. The balloon was inflated only after the pacing rate was reached and the blood pressure dropped. Pacing was continued until the balloon was completely deflated. Results: The systolic gradients across the aortic valve before balloon dilatation were 90, 110 and 55 mmHg. The systolic pressures in aorta were 90 and 110 mmHg. The pacing rate to drop the pressure by 50% were 170, 250 and 220 per minute. The pacing time was 15 seconds in all patients. Balloon stability at time of inflation was achieved in all cases with no balloon movement. The post-ballooning gradients were 23, 28 and 15 mmHg. Angiogram performed post balloon dilatation showed no change compared with the pre-balloning angiogram in aorta: trivial aortic incompetence in the first case and none in the second and third cases. Conclusions: Rapid ventricular pacing to stabilise the balloon during balloon aortic valvuloplasty seems to be safe and effective and may decrease the incidence of aortic incompetence.

Assuntos

RESUMO

OBJECTIVE: To evaluate rapid ventricular pacing in balloon aortic valvuloplasty, an initial strategy to achieve balloon stability. MATERIAL AND METHODS: From September to December 2004, a prospective protocol was started: three male consecutive patients with aortic valve stenosis were treated by this strategy. Age of the patients were 13, 6 and 5 years old. All had a bipoplar pacing catheter placed in the right ventricle. Invasive systemic pressures were documented with a catheter in the descending aorta. Rapid ventricular pacing was initiated at the rate of 150 per minute and increased to a rate required to achieve a drop in systemic pressure by 50%. The balloon was inflated only after the pacing rate was reached and the blood pressure dropped. Pacing was continued until the balloon was completely deflated. RESULTS: The systolic gradients across the aortic valve before balloon dilatation were 90, 110 and 55 mmHg. The systolic pressures in aorta were 90 and 110 mmHg. The pacing rate to drop the pressure by 50% were 170, 250 and 220 per minute. The pacing time was 15 seconds in all patients. Balloon stability at time of inflation was achieved in all cases with no balloon movement. The post-ballooning gradients were 23, 28 and 15 mmHg. Angiogram performed post balloon dilatation showed no change compared with the pre-balloning angiogram in aorta: trivial aortic incompetence in the first case and none in the second and third cases. CONCLUSIONS: Rapid ventricular pacing to stabilise the balloon during balloon aortic valvuloplasty seems to be safe and effective and may decrease the incidence of aortic incompetence.

Assuntos

RESUMO

Se presenta el caso de un masculino de 15 meses de edad con síndrome de cimitarra y atresia pulmonar con comunicación interventricular. El diagnóstico se hizo mediante cateterismo cardíaco y angiocardiografía y confirmado por el estudio de autopsia. Se hacen las consideraciones clínicas y quirúrgicas de esta excepcional asociación que a la fecha es, hasta donde sabemos la primera reportada en la literatura.

We present the case of a 15 months-old male with Scimitar Syndrome associated with ventricular septal defect and pulmonary atresia. The diagnosis was made by cardiac catheterization and angiography and was confirmed by the necropsy. Clinical and surgical considerations of this exceptional association were made. To the best of our knowledge this is the first case reported in the relevant literature.

Assuntos

RESUMO

OBJECTIVE: To evaluate mid-term results with Percutaneous aortic valvuloplasty (PAV). MATERIAL AND METHODS: Records of 70 patients treated with percutaneous aortic valvuloplasty with at least 6 months follow-up were reviewed. RESULTS: The 70 patients with PAV aged 3 months to 36 years, mean 10.5 +/- 10.6 years, 40) 63%) were male and 26 (37%) female. Initial systolic peak gradient decreased from 84 +/-20 to 31 +/- 16 mmHg (p < 0.05), while the reduction percentage ranged from 25 to 100%, mean 60 +/- 22. Balloon/aortic annulus index was 0.9 +/- 0.17. Ten (14.1 %) patients developed aortic insufficiency after PAV. Follow-up ranged from 6 to 168 months, mean +/- 48 months. At end of follow-up, 21 patients (30%) were considered failed cases and 49 (70%) patients had a successful outcome. CONCLUSIONS: This study showed a series with the longest follow-up in Latin America with PAV. New prospective and multicentric studies are needed in this region.

Assuntos

RESUMO

Objetivo: evaluar los resultados a mediano plazo de la VAP. Material y métodos: se analizaron los enfermos con estenosis valvular aórtica congénita con VAP de 1988 al 2001 que tuvieran por lo menos seis meses de seguimiento. Resultados: fueron sometidos a VAP 70 enfermos. Cuarenta del sexo masculino (63%) y 26 del femenino (37%). Margen de edad de tres meses a 36 años, media de 10.5 ± 10.6 años. El gradiente sistólico pico-pico disminuyó de 84 ±20 a 31 ± 16 mmHg (P<0.01). El porcentaje de reducción varió de 25 a 100%, media 60 ± 22%. El índice balón/anillo aórtico fue de 0.9'±0.17. Después del procedimiento la insuficiencia aórtica grado III o IV se presentó en 10 (14.2%). El seguimiento varió de 6 a 168 meses, media 51 ± 48 meses. Al final del seguimiento hubo: fracasos 21 enfermos (30%) y éxitos 49 (70%) pacientes. Un enfermo murió tardíamente (1.4%). Conclusiones: este trabajo es la serie con seguimiento más largo después de VAP en latinoamérica. Se requieren nuevos estudios prospectivos y multicéntricos en la región.

Objective: To evaluate mid-term results with Percutaneous aortic valvulopasty (PAV). Material and Methods: Records of 70 patients treated with percutaneous aortic valvuloplasty with at least 6 months follow-up were reviewed. Results: The 70 patients with PA Vaged 3 months to 36years, mean 10.5 ± 10.6 years, 40) 63%) were male and 26 (37%) female. Initial systolic peak gradient decreased from 84 ± 20 to 31 ± 16 mmHg (p < 0.05), while the reduction percentage ranged from 25 to 100%, mean 60 ± 22. Balloon/aortic annulus index was 0.9 ±0.17. Ten (14.1 %) patients developed aortic insufficiency after PA V. Follow-up ranged from 6 to 168 months, mean ± 48 months. At end of follow-up, 21 patients (30%) were considered failed cases and 49 (70%) patients had a successful outcome. Conclusions: This study showed a series with the longest follow-up in latin America with PA V. New prospective and multicentric studies are needed in this region.

Assuntos

RESUMO

We present the case of a 15 months-old male with Scimitar Syndrome associated with ventricular septal defect and pulmonary atresia. The diagnosis was made by cardiac catheterization and angiography and was confirmed by the necropsy. Clinical and surgical considerations of this exceptional association were made. To the best of our knowledge this is the first case reported in the relevant literature.

Assuntos

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of transcatheter closure of secundum atrial septal defects and fenestrated Fontan with the Amplatzer septal occluder. METHODS: Fifteen consecutive patients, with a significant interatrial communications, were considered for the procedure; four patients with defects that were too large or with deficient margins were excluded after initial transesophageal echocardiography. RESULTS: Eleven procedures were performed in 11 patients (10 atrial septal defects and 1 fenestrated Fontan) aged 9 to 38 years, mean 17.7 +/- 9 years; body weight 30 to 87 kg, mean 51.4 +/- 16. The stretched balloon diameter of the defects ranged from 8 to 28 mm, mean 18.8 +/- 6.9; the diameter of the devices ranged from 10 to 30 mm, mean 20.8 +/- 6. Immediate total occlusion rate was 18.1%, rising to 63.6% after 24 hours. Total occlusion rate at one month reached 100%. Severe transient sinus bradycardia in one (9%) was the only complications. At follow-up (10 to 26 months, mean 13.2 +/- 5.0) all patients remain asymptomatic with no residual shunt. CONCLUSIONS: The Amplatzer septal occluder is very efficient and offered interventional interatrial communications closure in 100% of our group of consecutive patients with excellent intermediate results.

Assuntos

RESUMO

Objective: To evaluate the safety and efficacy of transcatheter closure of secundum atrial septal defects and fenestrated Fontan with the Amplatzer septal occluder. Methods: Fifteen consecutive patients, with a significant interatrial communications, were considered for the procedure; four patients with defects that were too large or with deficient margins were excluded after initial transesophageal echocardiography. Results: Eleven procedures were performed in 11 patients (10 atrial septal defects and 1 fenestrated Fontan) aged 9 to 38 years, mean 17.7 ± 9 years; body weight 30 to 87 kg, mean 51.4 ± 16. The stretched balloon diameter of the defects ranged from 8 to 28 mm, mean 18.8 ± 6.9; the diameter of the devices ranged from 10 to 30 mm, mean 20.8 ± 6. Immediate total occlusion rate was 18.1%, rising to 63.6% after 24 hours. Total occlusion rate at one month reached 100%. Severe transient sinus bradycardia in one (9%) was the only complications. At follow-up (10 to 26 months, mean 13.2 ± 5.0) all patients remain asymptomatic with no residual shunt. Conclusions: The Amplatzer septal occluder is very efficient and offered interventional interatrial communications closure in 100% of our group of consecutive patients with excellent intermediate results.

Objetivo: Evaluar la seguridad y eficacia del cierre transcateterismo de defectos septales atriales y Fontan fenestrado mediante el dispositivo de Amplatzer. Método: Quince enfermos consecutivos con comunicaciones interauriculares significativas fueron considerados inicialmente; se excluyeron 4 de ellos por defectos demasiado grandes o con bordes deficientes después de ecocardiografía transesofágica inicial. Resultados: Se realizaron 11 procedimientos en 11 enfermos (10 con defectos septales auriculares y uno con Fontan fenestrado), el rango de edad fue de 9 a 38 años, media 17.9 ± 9 años; peso de 30 a 87 kg, media 51.4 ± 16. El diámetro de balón ajustado al defecto varió de 8 a 28 mm, media 18.8 ± 6.9; el diámetro de los dispositivos varió de 10 a 30 mm, media 20.8 ± 6. La oclusión total inmediata ocurrió en el 18.1%, subiendo a 63.6% a las 24 horas. La oclusión total en el 100% de los enfermos se obtuvo al mes de seguimiento. Complicaciones: Se produjo severa bradicardia sinusal transitoria en un enfermo (9%). El seguimiento varió de 10 a 26 meses, media 13.2 ± 5.0. Todos los enfermos se encuentran asintomáticos sin corto circuito residual. Conclusiones: El oclu-sor Amplatzer es muy eficiente y ofrece el cierre de las comunicaciones interauriculares en el 100% de nuestro grupo de enfermos consecutivos con excelentes resultados a mediano plazo. (Arch Cardiol Mex 2003; 73:185-189).

Assuntos

RESUMO

Se realizó un estudio retrospectivo con una muestra de 71 boxeadores a los cuales se les examinaron las estructuras de referencia mediante oftalmoscopia directa y biomicroscopia ocular, antes de las 6 horas posteriores al término de sus peleas; donde se obtuvo como resultado que los anexos afectados fueron los párpados con 5 hematomas, 4 edemas y 1 excoriación; y la conjuntiva con 4 hiperemias y 8 hemorragias. En el segmento anterior del ojo sólo se afectó la córnea con 13 lesiones en total, divididas en 10 excoriaciones superficiales y 3 profundas. Las lesiones traumáticas predominantes en los anexos del ojo son las de los párpados y las de la conjuntiva y las del segmento anterior del ojo, las de la córnea. El ojo más afectado fue el izquierdo y las lesiones más frecuentes fueron en las categorías de 13 y 14, 17 y 18 y 19 y 34 años las corneales, las conjuntivales y la de los párpados, respectivamente

Assuntos

RESUMO

The case of a four-months old male with coexistent tricuspid atresia and common arterial trunk is presented. The diagnosis was made by cardiac catheterization and selective angiocardiography. Clinical considerations are discussed and the review of the available literature reveals this patient to be the tenth case reported of this very unusual association of cardiovascular defects, and the first with positive deletion of the 22q11 chromosome.

Assuntos

RESUMO

OBJECTIVE: To evaluate immediate and midterm results with percutaneous aortic valvoplasty. MATERIAL AND METHODS: We reviewed the records of 141 patients undergoing percutaneous aortic valvopasty over a period of 13 years. RESULTS: The patients were aged from 2 months to 40 years, with a mean of 10.9 +/- 9.9 years. Of the total, 90 (63+/%) were male. The initial systolic peak-to-peak gradient decreased from 163 +/- 52 mmHg to 32 +/- 18 mmHg (p < 0.01) after valvoplasty in all 141 patients, while the proportional reduction ranged from 0 to 100%, with a mean of 72 +/- 27%. The index of the size of the balloon to the diameter of the valvar orifice was 0.88 +/- 0.19 in 128 patients. The follow-up ranged from 6 to 168 months, with a mean 51 +/- 48 months in 70 patients. A significant difference was found in those failing after dilation when the initial evaluation was compared to the final evaluation of patients with follow-up. In those failing, the number of patients rose from 12 (17%) to 21 (30%) (p < 0.01). In contrast, in those in whom we achieved success, there was not such a great difference between the initial and final evaluation: 58 (83%) versus 49 (70%) (p < 0.1). The actuarial freedom curve of patients not needing new percutaneous aortic valvoplasty or surgery, by 182 months, was at 87% and 82% respectively. CONCLUSION: We have reviewed the largest series of patients in Latin-America reported thus far after undergoing percutaneous aortic valvoplasty, concentrating on mid term follow-up and limitations. New prospective and multicentric studies are needed from our region.

Assuntos

RESUMO

BACKGROUND: The double-chambered right ventricle (DCRV) is increasingly recognized as a distinct obstruction entity. The nature of the obstruction is not well defined. METHODS: Patients with DCRV were prospectively studied during the last 4 years according to the following criteria: 1) pressure gradient by echo Doppler and cardiac catheterization within the right ventricle; 2) angiographic demonstration, and 3) surgical confirmation. RESULTS: From March 1997 to March 2001, 10 new cases were included. Age ranged from 2 to 14 years (mean 9.5 +/- 4.4 years), weight ranged from 9.9 to 75 kg (mean 23 +/- 13.6 kg), and height from 0.85 to 1.48 m (mean 114 +/- 19 cm). Systolic gradient by echo Doppler ranged from 20 to 135 mmHg (mean 86 +/- 44 mmHg) and by cardiac catheterization, 18 to 130 mmHg (mean 78 +/- 35 mmHg). In terms of angiographic findings, in six patients the right ventriculogram showed an oblique and low obstruction; in four patients the obstruction was high and horizontal. With regard to surgical findings, angiographic findings were confirmed by the surgeon except in one patient, in whom both types of obstruction were present. No mortality was observed. With follow-up 4 to 40 months after surgery (mean 24 +/- 15 months), 8 of 10 patients were evaluated; all corresponded to class I NYHA. Systolic gradient by echo Doppler ranged from 0 to 11 mmHg (mean 4 +/- 6 mmHg). CONCLUSIONS: DCRV IS PRODUCED BY THE FOLLOWING THREE TYPES OF MUSCULAR OBSTRUCTIONS: low and oblique obstruction; high and horizontal obstruction, and mixed obstruction. Mid-term surgical results are satisfactory.

Assuntos