RESUMO
Resumen El implante percutáneo de un electrodo de estimulación ventricular izquierdo a través del seno coronario para resincronización cardiaca siempre ha implicado un reto y más aún en pacientes con anatomía venosa coronaria compleja. Este caso demuestra cómo una técnica de doble canulación del seno coronario con uso de catéter multi-snare permite la colocación exitosa de un electrodo de estimulación ventricular izquierdo mediante acceso retrógrado a una vena posterolateral estenótica.
Abstract The percutaneous implantation of a left ventricular pacing electrode through the coronary sinus for cardiac resynchronization has always been a challenge, especially in patients with a complex coronary venous anatomy. This case shows how double cannulation of the coronary sinus using a multisnare catheter allows a left ventricular pacing electrode to be placed through retrograde access to a stenotic posterolateral vein, with a good clinical outcome.
RESUMO
BACKGROUND: Post-surgical infections of the spine occur in from 0% to 18% of cases. Postoperative spine infections due to Clostridium Perfringens (CP) resulting in necrotizing fasciitis are extremely rare. However, since they may be fatal, early and definitive treatment is critical. CASE DESCRIPTION A: 62-year-old male with a T8-T9 Type C fracture, in ASIA Grade "E" (neurologically intact) underwent a posterior T6-T10 arthrodesis. However, 2 weeks postoperatively, he developed a postoperative thoracic wound infection; the cultures were positive for CP. As the patient developed necrotizing fasciitis, emergent debridement, negative pressure continued drainage, and initiation of appropriate antibiotic therapy were critical. CONCLUSION: Postoperative spinal infections due to CP with accompanying necrotizing fasciitis are extremely rare. As these infections may be fatal, they must be rapidly diagnosed and treated.
RESUMO
Resumen Paciente de 48 años con historia de fibrilación auricular paroxística, dislipidemia y antecedente de ablación de vía accesoria (2013). Anti coagulado con Rivaroxaban 20 mg PO. Paciente es llevado a aislamiento percutáneo de venas pulmonares (AVP) con sistema de navegación tridimensional Carto 3. 48 horas post AVP inicia con cuadro de distrés respiratorio agudo que requiere hospitalización en unidad de cuido intensivo, que resuelve con manejo diurético y antiinflamatorio. Describimos la importancia del manejo hídrico en relación al AVP.
Abstract 48 years old male, previous history of paroxysmal atrial fibrillation, hiperlipemia and previous accesory pathway ablation an 2013. Anticoagulated with Rivaroxaban 20mg PO. Patient underwent pulmonary vein insolation (PVI) with Carto 3 tridimensional navigation and mapping system. Discharged on day 1 after PVI, readmitted with acute respiratory distress that required intensive care unit admission that resolves with diuretics and anti-inflammatory management. We describe the role of hydric management related with PVI procedure.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Arritmias Cardíacas , Veias Pulmonares , Síndrome do Desconforto Respiratório , Fibrilação Atrial , Rivaroxabana/uso terapêutico , Insuficiência CardíacaRESUMO
INTRODUCTION: Spinal simple bone cysts, also known as solitary cysts, are extremely unusual benign primary bone tumors with few cases reported in the literature. CASE PRESENTATION: Incidental Magnetic Resonance Imaging (MRI) finding of a C2 Simple bone cyst in a 13-year-old female patient is reported. Complementary studies suggested the benign nature of the lesion. Patient underwent cervical curettage followed by tumor excision. A lateral submandibular approach to the upper cervical spine was used and careful bone resection was possible with a radiofrequency assisted burr and no instrumentation or fixation was required. The stability of the defect was ensured by filling it with bone allograft and by prescribing a postsurgical plastic cervical collar to maintain neck immobilization. Histological examination supported the diagnosis of simple bone cyst. At 6-12-month follow-up the patient presented no recurrence or symptomatology. CONCLUSIONS: Solitary bone cysts are infrequent entities in the cervical vertebrae and preservation of spine stability without instrumentation to avoid neurological complications is often challenging. In this case, the proximity of the cyst to the right vertebral artery and the risk of injury were high; however the surgical approach used was successful and no recurrence or instability was evidenced on postoperative MRI.
RESUMO
Resumen Introducción: El cuidado de los pacientes con infecciones asociadas al dispositivo sin endocarditis, incluye: la extracción completa y la realización de capsulectomía para evitar la reinfección. El uso de nuevos elementos como el sistema de la presión negativa es una terapia novedosa que ha demostrado disminuir: los tiempos de recuperación, el tiempo de estancia intrahospitalaria, la necesidad de nuevas intervenciones por sangrado o lavado y el tiempo de espera para un nuevo implante. Nuestro objetivo es describir la experiencia de un centro de cuarto nivel, en el manejo de las infecciones asociadas a los dispositivos sin endocarditis, con el uso de la terapia de presión negativa como parte del manejo. Metodología: Se realizó una descripción retrospectiva de la experiencia en el manejo de la terapia de presión negativa en pacientes con infecciones asociadas a dispositivo, en un centro de cuarto nivel. Se exponen cinco casos, a los que se les realizó: la extracción completa del dispositivo, la capsulectomía anterior y posterior, el lavado quirúrgico y el implante de la terapia con presión negativa. Conclusión: La experiencia presentada demuestra que el uso de la terapia de presión negativa es un protocolo de tratamiento novedoso, que en nuestros pacientes con infección asociada a dispositivo sin endocarditis, es segura y de fácil utilización.
Abstract Introduction: Care for patients with infections associated to the device without endocarditis include complete extraction and performing a capsulectomy to avoid reinfection. The use of new elements, such as the negative pressure system, is a new therapy that has shown to reduce recovery time, inpatient stay, need of new interventions due to bleeding or washing and waiting time for a new implant. The goal is to describe the experience of a fourth level centre for managing infections associated with devices without endocarditis using a negative pressure system as part of the therapy. Methods: Descriptive retrospective study of the experience of negative pressure therapy for managing patients with device-related infections at a fourth level centre. Five cases are exposed where complete removal of the device, anterior and posterior capsulectomy, surgical washing and negative pressure therapy were performed. Conclusion: Presented experience shows that the use of negative pressure therapy is a new therapy protocol that is safe and easy for managing our patients with an infection associated to the device without endocarditis.
Assuntos
Humanos , Masculino , Feminino , Adulto , Endocardite , Relógios Biológicos , Cápsula Articular , Equipamentos e ProvisõesRESUMO
BACKGROUND: Autonomic modulation is a valuable therapeutic option for the management of ventricular arrhythmias. Bilateral cardiac sympathetic denervation (BCSD) has shown promising results in the acute, intermediate, and long-term management of polymorphic and monomorphic ventricular tachycardia (VT) in patients with structural heart disease. Cardiomyopathy (CM) due to Chagas disease (CD), and associated VT, is thought to be in part due to autonomic neuronal destruction and dysfunction. OBJECTIVE: The purpose of this study was to assess whether BCSD is a safe and effective treatment modality in patients with CD and VT storm or refractory VT. METHODS: A retrospective analysis of data from patients with chagasic CM who underwent BCSD between 2009 and 2015 at 2 international centers was performed. RESULTS: Of 75 patients who underwent BCSD for VT storm or refractory VT in the setting of CM, 7 (9.3%) patients had CD as the etiology of CM. All patients had monomorphic VT. Median follow-up was 7 months (range 1-46 months). All patients either underwent previous unsuccessful catheter ablation or were not candidates for ablation. The median number of implantable cardioverter-defibrillator (ICD) shocks 1 month before BCSD was 4 (range 2-30) and decreased to 0 (range 0-2) during available follow-up after BCSD. When antitachycardia pacing therapies were included in the analysis, the median number of ICD therapies (shocks + antitachycardia pacing) still decreased to 1 (range 0-3). CONCLUSION: In patients with chagasic CM presenting with refractory monomorphic VT, early evidence suggests that BCSD reduces appropriate ICD therapy and may represent a valuable treatment option.
Assuntos
Cardiomiopatia Chagásica , Simpatectomia , Taquicardia Ventricular/prevenção & controle , California/epidemiologia , Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica/diagnóstico , Cardiomiopatia Chagásica/fisiopatologia , Colômbia/epidemiologia , Feminino , Seguimentos , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Simpatectomia/efeitos adversos , Simpatectomia/métodos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Resultado do TratamentoRESUMO
Objetivos: 1. Revisar las implicaciones dentro de la biomecánica de hombro, de la integridad y de la lesión del complejo capsuloligamentoso de la articulación acromio clavicular. 2. Elaborar un protocolo para el diagnóstico preciso, clínico y radiológico, y el seguimiento de pacientes con luxación acromioclavicular G III tratados quirúrgicamente. 3. Evaluar los resultados clínicos y radiológicos en pacientes con luxación acromio-clavicular G III tratados quirúrgicamente mediante reducción abierta, reparación de los ligamentos y cerclaje coracoclavicular con cinta de dacrón (Cervi-set ). Materiales y métodos: De 1985 a 1987, se operaron 23 paciente con luxación acromio clavicular, en el servicio de ortopedia y traumatología del Hospital Clínica San Rafael de Bogotá, de los cuales se lograron seguir 15. De los 23 pacientes, 21 son hombres y 2 mujeres, cuyas edades variaron entre los 23 y los 65 años con un promedio de 43 años, sin encontrar diferencia notable en cuanto al hombro comprometido. La mayoría de las lesiones se debieron a accidentes de tránsito y deportivos. Todos los pacientes ingresaron por el servicio de urgencias siendo avaluados según parámetros clínicos y radiológicos establecidos dentro del protocolo que se expone a continuación...
Assuntos
Articulação Acromioclavicular/cirurgia , Articulação Acromioclavicular/lesões , Luxação do OmbroRESUMO
Siendo testigos del aumento desproporcionado del numero de atentados terroristas mediante detonacion de explosivos en lugares publicos el ultimo ano, y del problema de tipo medico que ello conlleva, por la gran afluencia de politraumatizados remitidos a nuestros hospitales no siempre preparados para resolver tales situaciones hemos querido en este trabajo analizar la fisiopatologia de la lesion producida por explosion y la experiencia en tres de los hospitales universitarios de la capital (Hospital Militar Central, Hospital San Rafael, y Hospital de Kennedy) como muestra representativa se recolectaron 107 casos, victimas del atentado terrorista perpretado contra las instalaciones del DAS, el 6 de dicimebre de 1989, variedad de lesiones encontradas y de su magnitud, cuyos resultados se exponen en el presente estudio