Showing papers in "Revista Portuguesa De Pneumologia in 2001"

Doppler tissue imaging.

Abstract: This paper try to give a general overview of the main areas of DTI clinical application, its main technical limitations, new directions still under investigation and some potential future developments of this emerging imaging technique. In this review article we pretend to discuss the main aspects of the new DTI method, its present "state of the art" and future perspectives of scientific and technical development.

677T mutation of the MTHFR gene in adenomas and colorectal cancer in a population sample from the Northeastern Mexico. Preliminary results

Abstract: Introduction Adequate intake of folates has been associated to low prevalence of colon cancer. Methylenetetrahydrofolate reductase enzyme (MTHFR) plays an important role in folate metabolism. The role of the 677 mutation at the MTHFR gene in the risk for colorectal cancer remains controversial. A recent report established that this mutation has a high prevalence in the healthy Mexican population. Aims To analyze the prevalence of 677T MTHFR mutation in patients with colorectal cancer and controls without chronic gastrointestinal disorders. Methods Seventy-four colorectal cancer, 32 adenomas and 110 normal samples were analyzed. Patients and controls were matched for sex and age. For each sample, DNA isolation, PCR, and mutation detection by restriction enzyme digestion were performed to determine the allele at the 677 position in the MTHFR gene. Results Genotype 677C/677C was found in 18.7, 20.3, and 30.9% in adenomas, cancer lesions and controls, respectively. Frequencies of the 677C/677T genotype were 59.4, 56.7, and 47.3%, in adenomas, cancer lesions, and controls, respectively. Genotype 677T/677T was found in 21.9, 23.0, and 21.8% in adenomas, cancer lesions, and controls, respectively. The odds ratio between genotypes carrying the mutation (T/T and C/T) and normal genotype (CC) was 1.81 (IC 95% 0.97-3.3), chi 2 = 3.5, p = 0.06. Conclusion Our results showed that persons who carry the 677T mutation at MTHFR locus have a tendency for an increased risk for colorectal cancer. This study supports the basic concept that low levels of folic acid contribute with the colorectal cancer pathogenesis. Our lack of statistic significance may be due to reduced sample size.

Factores de riesgo para la hipertensión arterial

Abstract: Introducción os factores de riesgo son aquellas variables de origen Biológico, Físico, Químico, Psicológico, Social, Cultural, etc. Que influyen más frecuentemente en los futuros candidatos a presentar enfermedad. 1 La observación en los resultados de los estudios epidemiológicos permitió la identificación de los factores de riesgo. La posibilidad de que una persona desarrolle presión alta se le conoce como factor de riesgo y el conocimiento de éste o estos factores de riesgo son claves para prevención, manejo y control de la hipertensión arterial. La presente revisión se enfoca a los factores de riesgo tradicionales, modificables y no modificables a los que una persona está expuesta cotidianamente. 2

Cardiopatías congénitas en el adulto

Abstract: * Director General Instituto Nacional de Cardiología “Ignacio Chávez”. (INCICH. Juan Badiano No. 1, 14080 México, D.F.) os avances en el diagnóstico y en el tratamiento de las cardiopatías congénitas cambiaron en forma significativa el patrón de sobrevida de estos enfermos. Algunos pacientes llegan a la vida adulta sin tratamiento quirúrgico por no requerir operación en el momento del diagnóstico o a lo largo de la evolución, o bien no existía solución quirúrgica en el momento del diagnóstico. 1 Por otra parte, un número significativo de enfermos llegan a la edad adulta después del tratamiento quirúrgico favorable. Finalmente existen malformaciones en las que no se obtienen la cura completa y estos pacientes quedan con secuelas de su cardiopatía. Una revisión acerca de las malformaciones congénitas que con más frecuencia llegan a la vida adulta permite afirmar que las lesiones obstructivas como la estenosis aórtica por aorta bivalva, 2 l coartación aórtica y estenosis pulmonar; malformaciones con cortocircuito de izquierda a derecha como la comunicación interatrial y la persistencia del conducto arterioso; finalmente algunas cianóticas como la anomalía de Ebstein, la tetralogía de Fallot y enfermedad de Eisenmenger son anomalías observadas en la edad adulta. Es importante considerar, sin embargo, que existen cardiopatías congénitas poco frecuentes que por razones anatomofuncionales llegan a la edad adulta. Por tal razón consideraremos también este grupo (Tabla I).

Cardiac troponin I in systemic diseases. A possible role for myocardial strain.

Abstract: Cardiac troponin I levels are frequently above normal values in several disease states in which myocardial necrosis is not a prominent aspect, particularly in pulmonary embolism, heart failure, liver cirrhosis, septic shock, renal failure and arterial hypertension. Sub-clinical myocardial necrosis has been postulated to be the cause of the phenomenon. Studies performed so far have not included pathological data to confirm this hypothesis. Increased troponin I plasma levels may be the result of myocardial strain, especially the type of strain that accompanies some forms of cardiac dilatation or hypertrophy. Troponin I may act as a marker of myocardial strain, either acute (in pulmonary embolism, septic shock and acute heart failure) or chronic (in chronic cardiac, renal and hepatic failure, as well as in arterial hypertension). The apparent paradox of elevated levels of troponin I without elevated levels of creatine kinase in several disease states might be solved if troponin I could be released from myocardial cells without the disruption of myocardial cell plasma membranes. Precise pathological studies are needed to elucidate whether increased troponin I with normal CK is associated with myocyte death, and, if so, with necrosis or with apoptosis.

Cardiovascular manifestations in Marfan syndrome.

Abstract: Introduction Cardiovascular complications are the major cause of morbidity and mortality in Marfan syndrome (MS), a common connective tissue disorder. Currently it is considered that the prognosis and morphologic characteristics in infantile Marfan syndrome may be quite different from those reported in older patients. The objective of this study was to analyze the cardiovascular manifestations and evolution of the patients with Marfan syndrome followed at our pediatric cardiac unit. Methods The authors reviewed the clinical files of all the patients that fulfilled the diagnostic criteria for MS according to De Paepe et al. (1996). We analyzed the following parameters: gender, age at referral, race, family history, clinical examination, diagnostic exams, therapy and evolution. The patients were divided into two groups according to the age at diagnosis: infants (group 1) and older patients (group 2). Results Group 1 included 3 infants, two boys and one girl, sporadic cases, presenting congestive heart failure. The major cardiac diagnoses were aortic dilatation (1/3) and mitral valve prolapse with severe mitral regurgitation (2/3). Congenital heart disease was associated in two cases (patent ductus arteriosus and atrial septal defect). Two needed cardiac surgery at an early age and one was recently proposed for surgery. There were no deaths. Group 2 included 20 patients, 14 boys and 6 girls, first seen at a mean age of 8 years. Ten had a positive family history and none presented cardiac symptoms. The major cardiac manifestations were mitral valve prolapse (18/20) and aortic dilatation (17/20). There was no significant progression of the cardiac lesions, except for one case, during the 12 years of follow-up. Conclusion Infantile MS presented high morbidity; mitral regurgitation was severe in two cases. All patients presented heart failure, two needing early operations. In classic MS evolution was favorable, and the commonest cardiac lesions were mitral valve prolapse and aortic dilatation. We emphasize the need for beta-blockers to prevent progression of aortic dilatation. The decision for surgery rests upon the severity of valve regurgitation and the rate of progression of aortic dilatation. It is important to inform patients and family about physical exercise, prevention of endocarditis, risks associated with pregnancy and genetic counseling.

IgG subclass reactivity to Trypanosoma cruzi in chronic chagasic patients.

Abstract: La respuesta humoral anti-Trypanosoma cruzi y el isotipo de inmunoglobulina presente en individuos con enfermedad de Chagas se ha estudiado en relacion con las distintas manifestaciones clinicas. Se ha encontrado que titulos altos de IgR anti-T. cruzi especificos estan preferentemente presentes en pacientes con dano cardiaco, mientras que en la forma digestiva es la IgA anti-T. cruzi. En el presente trabajo se estudiaron 12 pacientes consecutivos con diagnostico de enfermedad de Chagas Todos ellos tenian una evaluacion clinica completa y estudios electrocardiografico, ecocardiografico, ventriculograma y coronariografia, ademas del estudio serologico de deteccion de anticuerpos IgR anti-T cruzi. En ellos se analizo el perfil de subclases de IgR anti-T cruzi. Todos los pacientes provenian de areas rurales de Mexico y algunos habian vivido alli siete o hasta 65 anos. En 7/12 (58%) de ellos presentaron dilatacion ventricular izquierda con una dimension final sistolica por arriba de 42 mm y con una fraccion de expulsion por abajo del 50% en 7/12 (58%). Los titulos de anticuerpos de IgR1 e IgR2 anti-T. cruzi fueron mas altos que los de IgR3, mientras que los niveles de IgR4 anti-T cruzi, si bien fueron positivos, resultaron ser consistetemente los mas bajos. La expresion de las cuatro subclases de IgR anti-T cruzi sugiere que se induce una respuesta mixta tipo Th1/Th2 en estos pacientes chagasicos cronicos. Aunque el tamano de muestra estudiado es pequeno, encontramos que los niveles altos de IgR2 anti-T. cruz presentaban una tendencia a asociarse con el grado de cardiomegalia

Daño miocárdico por reperfusión

Abstract: Rev Esp Cardiol 2004;57(Supl 1):9-21 9 El dano miocardico por reperfusion se define como el efecto adverso producido al restablecerse la circulacion y propiciar la llegada de sangre y nutrientes a las celulas previamente isquemicas. La restauracion del flujo sanguineo puede acompanarse de liberacion de radicales libres de oxigeno, acumulacion de calcio intracelular, alteracion en el metabolismo celular, etc., situaciones que pueden condicionar un dano miocardico funcional y estructural. Clinicamente, este dano puede manifestarse despues del restablecimiento de la circulacion coronaria previamente bloqueada, o despues del uso de la bomba extracorporea en cirugia cardiaca, manifestandose como miocardio aturdido o hibernante despues de un episodio de sindrome coronario agudo, como fenomeno de «no reflujo» (dano microvascular) despues de restablecer el flujo durante una angioplastia o de las denominadas arritmias por reperfusion y, sobre todo, despues de la revascularizacion quirurgica. El presente trabajo revisa las bases fisiopatologicas, las manifestaciones clinicas y las bases del tratamiento actual de cada una de estas entidades.

Heart surgery with cardiopulmonary bypass in pregnant women.

Abstract: Objective Definite data in heart surgery with extracorporeal circulation during pregnancy is limited. This report analyzes our experience in this area. Methods Fifteen women underwent open heart surgery under cardiopulmonary bypass during pregnancy at our institution between 1972 and 1998. Surgical procedures included valve replacement in 13 patients (12 mitral, 1 aortic), declotting of a tilting disk mitral prosthesis in one and closure, of an atrial septal defect in the remaining patient. Results Thirteen patients were in New York Heart Association functional class III to IV and were operated on urgently. Eight of these women had severe acute dysfunction of either a mechanical or a biological mitral prosthesis. There were 2 maternal operative deaths for a rate of 13.3%. Fetal losses resulted at the time of these maternal deaths. Fetal deaths occurred in 5 of the 13 pregnancies (38.5%) in women who survived the surgical procedure. Conclusions Because of the fetal risks, open heart surgery during pregnancy should be advised only in extreme emergencies. Although pregnancy per se does not increase the maternal risk, a high maternal mortality results from the emergency nature of the surgical intervention. Fetal mortality remains high.

Autonomic function in chronic liver disease assessed by Heart Rate Variability Study.

Abstract: BACKGROUND Chronic liver disease is associated with cardiovascular changes, including hyperdynamic circulation with increased blood volume and cardiac output, and with reduced peripheral vascular resistance. Autonomic dysfunction is a common finding in these patients, being involved in the pathogenesis of the hyperdynamic condition. The aim of our study was to evaluate autonomic function in cirrhotic patients by using the 24 hour Heart Rate Variability study. We also sought to relate the degree of autonomic dysfunction with the severity of the liver disease. MATERIAL AND METHODS We studied 22 cirrhotic patients, 50% of whom were male, mean age 44.14 +/- 11.32 years. The etiology was alcohol related in 12 (54.6%), virus hepatitis in 6 (27.2%), autoimmune related in two (9.1%) and other in the remaining two (9.1%). In terms of severity liver disease 6 patients were in Child-Pugh's class A (27.3%), 9 in Child-Pugh's class B (40.9%) and 7 in Child-Pugh's class C (31.8%). Thirteen patients (59%) had ascites. Both patients and 20 age-sex matched healthy volunteers underwent 24 hour ECG Holter study with assessment of Heart Rate Variability (time and frequency domains). RESULTS The cirrhotic patients showed severe decrease in Heart Rate Variability when compared to healthy volunteers: SDNN (84.14 +/- 35.78 ms vs 148.9 +/- 33.97 ms; p < 0.0001), pNN50 (3.54 +/- 4.61 vs 11.17 +/- 9.88; p = 0.004). The spectral analysis revealed markedly decrease of average total power, with reduction of all components (VLF, LF, HF), in the absence of significant difference in LF/HF ratio (2.52 +/- 1.40 vs 2.98 +/- 1.57; p = NS). Ascites had relationship with more pronounced autonomic impairment: SDNN (70.31 +/- 30.32 ms vs 104.11 +/- 34.97 ms; p = 0.03). On the other hand, alcohol related etiology did not influence Heart Rate Variability parameters. Moreover, we found significant positive correlations between SDNN (dependent variable) and Prothrombin activity (r = 0.64; p = 0.001), as well as with Serum Albumin (r = 0.40; p = 0.05), but not with Total Bilirubin (r = -0.14; p = 0.51). Prothrombin activity was the only independent predictor of autonomic dysfunction. CONCLUSION Chronic liver disease is accompanied by a significant Heart Rate Variability decrease. Alcohol related etiology does not indicate further autonomic dysfunction. The greater the hepatopathy severity, the greater the Heart Rate Variability impairment. Hepatocellular dysfunction indicators have more accuracy to demonstrate autonomic disturbances than cholestasis indicators.

Outcome of cardiac arrests in a Portuguese hospital--evaluation of a hospital cardiopulmonar resuscitation program at one year.

Abstract: OBJECTIVE Evaluation of a hospital-wide resuscitation program at one year. METHODS All records of cardiac arrest calls were collected, logged in a database by the same operator, and analyzed. The cardiac arrest teams consist of a physician and a nurse with ALS (Advanced Life Support) training. Each team has a radio that is activated by a single emergency number. Only cardiac arrest calls were analyzed. RESULTS Between March 1999 and March 2000 there were 173 emergency team calls. Of these, 120 were cardiac arrest calls (90 in-hospital and 30 from the emergency room--out-of-hospital cardiac arrests). Of the 90 in-hospital cardiac arrests, 61% were male, and median age was 73 years. In 90% of the calls, basic life support (BLS) was started before the arrival of the cardiac arrest team. The immediate cause was cardiac in 39% of the patients. Initial rhythm was ventricular fibrillation in 8%, asystole in 60% and other rhythms in 24% of the patients. Thirty percent presented return of spontaneous circulation (ROSC). There were no differences between those in whom BLS was started before the arrival of the cardiac arrest team and those in whom BLS had not been started. Ten patients (11%) were discharged from hospital. Of the 30 out-of-hospital cardiac arrests, 70% were male, and median age was 69 years. In 97% BLS was started before the arrival of the cardiac arrest team. The immediate cause was cardiac in 30% of patients. Initial rhythm was ventricular fibrillation in 10%, asystole in 73% and other rhythms in 17% of the patients. ROSC was achieved in 27% of the patients. Three patients (10%) were discharged from hospital. There were no differences either in ROSC or in survival to hospital discharge between in-hospital and out-of-hospital cardiac arrests. The state of health previous to cardiac arrest was significantly different between in- and out-of-hospital cardiac arrests: 3% versus 32% healthy, with no functional limitation. The authors conclude that: first, the current records do not enable all the desired goals of the "Utstein style" to be achieved and need to be reviewed; second, 90 to 97% of BLS previous to the arrival of the cardiac arrest team is a good indication of the efficiency of the hospital-wide program, which included training in BLS for all the hospital staff; third, the survival rate, although in accordance with much of the literature, could be improved.

Use of propranolol in heart failure patients: safety, tolerability, and effects on left ventricular function.

Abstract: Introduction and objectives Beta-blockers have been shown to improve prognosis in patients with heart failure (HF). Propranolol, which is a low-cost drug, has not been fully studied in this setting. We sought to determine the safety, tolerability and effects on left ventricular function observed with the use of propranolol in HF patients, in functional class II-IV of the New York Heart Association. Population and methods Prospective study in which 20 outpatients (10 male, mean age 56 +/- 12 years, ranging from 20 to 70) were included. Mean left ventricular ejection fraction (EF) was 28%. Safety, tolerability and effects on electrocardiographic and echocardiographic variables were analyzed. Patients were evaluated in three steps: a) Step I--optimization on conventional drugs and assessment of baseline parameters; b) Step II--start of propranolol (10-20 mg/day), increasing the dose weekly to achieve a heart rate of 60 bpm, or a maximum daily dose of 120 mg; c) Step III--reappraisal of the parameters analyzed in step I, after 3 months of propranolol treatment. Results On average, after treatment with propranolol, EF increased by 52% (p = 0.0003), E wave deceleration time was prolonged by 62% (p = 0.001) and effective ventricular filling time increased by 38.5% (p = 0.0005). Two patients developed mild congestion which was controlled by increasing diuretic doses, with no need to interrupt the protocol. Four patients had bradycardia-related symptoms, controlled by reducing digoxin doses. Nine subjects developed hyperkalemia, reversed by interrupting or reducing spironolactone. Conclusion Propranolol was safe and well tolerated, and had beneficial effects on ventricular function in HF patients. Its impact on mortality requires further study.

Transesophageal echocardiography in the assessment of patients presenting with ischemic cerebral events without previous evidence of a cardiac source of emboli.

Abstract: UNLABELLED Transesophageal echocardiography (TEE) is accepted as a valuable tool in the evaluation of ischemic stroke patients, particularly in the young and in cases of unknown cause. However, the real clinical impact of additional TEE data remains to be defined. PURPOSE The aim of this study was to present our experience with TEE in ischemic stroke patients without previous evidence of a cardiac source of emboli. METHODS From March 1991 to June 2000 we studied 172 patients (80 males, 92 females, mean age 43 +/- 12 years presenting with a transient ischemic attack or a recent cerebral infarction who had no previous evidence by clinical assessment, electrocardiogram and transthoracic echocardiography of a cardiac of emboli source. The population was divided into two groups: Group A--age 45 years, n = 71 (36 males, 35 females, mean age 54 +/- 7 years). Information was gathered from clinical records. In every case TEE included Doppler color flow imaging and multiple contrast injections (agitated saline) with and without Valsalva maneuver. RESULTS A potential cardiac of emboli source was found in 29% of the patients, with a higher prevalence in the older group (group A--25%, Group B--35%, ns). Atrial septal abnormalities accounted for most of the detected findings (23 patent foramen ovale, 17 atrial septal aneurysms and two atrial septal defects, representing altogether 71% of the findings). The other detected anomalies were distributed as follows: aortic plaques--six, mitral valve prolapse--five vegetations--four, thrombus in left atrial appendage--two. Only six patients (3.5%) had abnormalities which in themselves determined a specific approach, which were found mostly in the older group (Group A--two vegetations; Group B--two vegetations, two thrombi). CONCLUSIONS TEE identified additional findings with possible embolic potential in a considerable number of cases, the majority of which were of a debatable cause-effect relation. A higher diagnostic yield and clinical relevance was found in older patients, which argues against age being used as a selective criterion for it. Our experience suggests that routine TEE in this setting is of questionable value and has little impact on clinical management, for which reason TEE referral should be decided on an individual patient basis.

[Cardiac effects of acute poisoning with tricyclic antidepressants: systematic review of the literature -- Part IV].

Abstract: Tricyclic antidepressant overdose is a frequent diagnosis in the emergency room. It is responsible for a significant percentage of hospital admissions for observation and treatment. This is due to its cardiac (as well as neurologic) toxicity, and the difficulty in predicting its clinical gravity. The authors present this paper with two objectives in mind: 1) information about a common and significant cardiological emergency; 2) presentation of the methodology concerning systematic reviews of the literature. In this second (of four) articles, the clinical presentation and diagnosis of tricyclic antidepressant overdose are presented (in the first article--published in the previous issue of the Journal--we discussed the epidemiological aspects). In the remaining two papers we will present its management, prognosis and prevention. NOTE: This is the second of a series of four articles on the cardiac toxicity of tricyclic antidepressant overdose; the next two articles will be presented in the September and October issues of the Revista.

National survey of cardiac rehabilitation programs in Portugal--situation in 1999.

Abstract: In order to study the status of Cardiac Rehabilitation (CR) in Portugal in 1998 and 1999, a questionnaire was drafted and sent to all the heads of the CR centres in Portugal, with questions about their nature, location, staff, type of activity, movement, diagnosis leading to patient referral and funding. The rate of coronary patients admitted to the programs existing in the cities of Lisbon and Oporto was calculated. The total number of patients included in all the CR centres in both cities was subtracted from the total number of public hospital discharges of coronary patients in 1998, patients admitted due to acute ischaemic coronary syndrome or for revascularization in Portugal and in each of the two cities. We found that there were CR centres in only the two main cities (Lisbon and Oporto), with organization and types of activity in accordance with international guidelines and recommendations. The overall admission rate of coronary patients in Portugal in 1998 was 0.7%, with 0.9% and 1.9% in Lisbon and Oporto, respectively. These rates are well below the figures for countries of the European Union and for the USA. It is very important to increase the establishment and spread of CR centres throughout the country, creating the financial conditions and promoting a change in culture regarding physical activity and CR on the part of the Portuguese population, patients and health care providers responsible for the referral of cardiac patients to a therapeutic intervention that can increase quality of life and longevity. Doctors should be involved in programs that will train them to recognize the benefits of physical activity and secondary prevention.

Prevalence of adenomas and carcinomas of the colon. Results of the rectosigmoid exam

Abstract: UNLABELLED Colon adenomas are precursors for colon carcinoma. Their prevalence has been estimated at 20-30% in the general population and 40-60% in developed countries. They are classified as tubular, villous; or mixed, and as low- or high-risk lesions, which have any of the following characteristics: Being larger than 1 cm; having a villous component, or showing moderate to severe dysplasia. OBJECTIVE To analyze the results of a series of colonoscopies, carried out from 1993 to 1999 in a private hospital in Mexico City, with regard to the following: Prevalence of colon adenomas and carcinoma prevalence in different age groups, distribution by gender; frequency of single vs synchronous lesions; presence or absence of distal and/or proximal lesions as markers of neoplasia and finally, prevalence of proximal lesions in the absence of distal lesions. METHODS A retrospective analysis of a database of 701 colonoscopies, which the author carried out from January 1993 to December 1999. RESULTS The prevalence of colon adenoma was 14.69%. The prevalence of high-risk adenomas or carcinoma was 6.7%. In 29.72% of the cases, there were concurrent lesions. These were more common in male patients. The probability of finding a proximal lesion where there was a distal adenoma was greater (17.80%) than in the absence of the latter (6.05%), but the probability of a high-risk lesion was similar whether there was a distal lesion or not (2.73 vs 2.86%). Ninety percent of high-risk proximal lesions had no distal adenoma. CONCLUSION It was found that the prevalence of colon adenomas for the various age groups was lower than in the figures published for developed countries. Synchronic lesions were also less common. The results of this study support the use of colonoscopy as a screening test for adenomas and carcinoma of the colon, because the absence of distal lesions does not exclude the presence of high-risk neoplasia of the proximal colon.

Sudden death in intermittent Wolff Parkinson White syndrome

Abstract: Sudden death is a rare condition in asymptomatic patients with asymptomatic intermittent Wolff Parkinson syndrome (WPW); for this reason it is believed that these patients should not undergo to radiofrequency ablation. We report an asymptomatic 44 year old man who developed ventricular fibrillation with a pre-excited RR interval less than 200 msec during atrial fibrillation, as a first manifestation of WPW syndrome. The Holter monitoring showed intermittent pre-excitation at low heart rate (70 bpm). During the electrophysiological study a successfully radiofrequency catheter ablation of a right posteroseptal accessory pathway was performed. We concluded that intermittent pre-excitation may not be used to identify patients who are at risk of sudden death. Radiofrequency catheter ablation should be recommended in those patients with a very high success rate, and a low incidence of serious complications.

Prognosis in patients with heart failure and preserved left ventricular systolic function.

Abstract: BACKGROUND It is recognized that heart failure patients with preserved left ventricular systolic function have better prognosis; nevertheless, there are some studies with conflicting results. Also, there is a paucity of data concerning the prognostic factors in this group of patients. OBJECTIVES To determine possible variables with prognostic relevance in heart failure patients with preserved left ventricular systolic function (ejection fraction > 40%). METHODS 157 consecutive ambulatory patients with heart failure were assessed; those patients with ejection fraction > 40% were included in the study (n = 46). All patients were evaluated by clinical interview and physical examination, ECG, echocardiogram (M-mode, 2D and pulsed Doppler of mitral flow), biochemical study and determination of type B natriuretic peptide (BNP). The patients were grouped according to the rhythm presented on ECG: Group I--patients with atrial fibrillation; Group II--patients in sinus rhythm Group II was further subdivided in two groups according to the presence or absence of restrictive left ventricular filling pattern. All patients had a clinical follow-up, with recording of events (death or hospitalization from cardiac cause). The mean follow-up time was 682.2 +/- 55 days. RESULTS The mean age of the patients was 70.4 +/- 1.2 years; 54.3% were women; mean ejection fraction was 49.6 +/- 1%; mean BNP levels were 202.9 +/- 41.3 pg/ml. Mortality was 19.6% and the combined event death or hospitalization from cardiac cause) occurred in 26.1% of the patients. Among the clinical, demographic, biochemical, echocardiographic and neurohumoral parameters, only BNP levels had prognostic significance in the whole population. In Group II patients, BNP levels, heart rate and restrictive left ventricular filling pattern were identified as having prognostic significance. Kaplan-Meyer curve analysis showed that both BNP and restrictive left ventricular filling pattern seemed to be important prognostic markers. CONCLUSIONS This preliminary study suggests thar neurohumoral activity (determined by plasma BNP levels) and a restrictive ventricular filling pattern may be important factors in prognostic stratification of heart failure patients with preserved left ventricular systolic function.

Tratamiento quirúrgico del cáncer colorrectal. Experiencia de 10 años en el INCMNSZ

Abstract: Objective To analyze the short- and long-term outcomes of the surgical treatment for colorectal cancer at the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran (INCMNSZ) in Mexico City. Background Colorectal cancer is the second most frequent malignant tumor of the digestive tract in Mexico. Its incidence is rising, and its identification in early stages is important to offer a curative surgical treatment. Methods Retrospective, descriptive observational trial. We studied 165 patients who underwent colorectal surgery for treatment of cancer between 1985 and 1994 at the INCMNSZ. We compared the variables of patients and the surgical procedures and their relationship with morbidity and mortality with 5-year survival. Results Survival was greater in curative-attempting procedures of the colon than of the rectum (p 65 years of age had a higher mortality rate. Rectal surgery had higher morbidity than colonic surgery. Conclusions Detecting patients at earlier stages of the disease is required to offer them a curative-attempting surgery procedure. Stage at moment of diagnosis correlates with survival rates. Age was a risk factor for surgical mortality, and rectal surgery, a risk factor for morbidity.

Etiología de la oclusión intestinal

Abstract: SUMMARY Background: Intestinal obstruction is one of the leading causes of admission to emergency wards around the world, and its etiology has changed over the past century. Aim: The goal of this study was to ascertain the causes of intestinal obstruction at our Institution and compare the results with other reports of Mexican, U.S., and Canadian hospitals. Methods: Retrospective review of a cohort of patients with intestinal obstruction operated on between 1985 and 2000. Demographic data and operative findings were obtained. Results: Our cohort included 452 patients, 55.3% were women; mean age for the entire group was 54 years. The obstruction was located in the small bowel in 86.9% of cases and the leading causes were adhesions (58.6%), hernia (16.1%) and neoplasia (13.9%). Other etiologic factors had a low incidence that varied between 4.4 and 0.22%. Conclusions: The most common causes of intestinal obstruction are similar to those reported in the U.S., British and Canadian medical literature. Some tertiary-level Mexican institutions showed the same incidence of etiology, but some large general hospitals in Mexico City showed etiologic factors reported 100 years ago by the current so-called developed countries, i.e., that the same socioeconomic conditions existed in both population groups nearly a century apart.

Panorama epidemiológico de la hipertensión arterial en México

Abstract: * Subdireccion de Enfermeria. Instituto Nacional de Cardiologia “Ignacio Chavez”. (INCICH. Juan Badiano No. 1, 14080 Mexico, D.F.) Tel: 55732911 Ext. 1150 Introduccion a hipertension arterial esencial (HA) es la enfermedad cronica mas frecuente en nuestro medio, afecta a sujetos en las etapas mas productivas de la vida. La importancia del padecimiento radica en su repercusion sobre la esperanza y calidad de vida de quien tiene este padecimiento porque no se diagnostica oportunamente y cursa asintomatico hasta que aparecen una o varias complicaciones. Actualmente la etiologia de la HA es poco clara, sin embargo hay avances en el conocimiento de la participacion del endotelio vascular y sus productos, los nexos fisiopatologicos con otras entidades como la diabetes mellitus, la obesidad a traves de la resistencia a la insulina y el papel de los distintos cationes, en el desarrollo de la HAS. Tradicionalmente se consideraba a la HA como el proceso hemodinamico en el cual las resistencias al flujo sanguineo se encuentran elevadas, en la actualidad se define como la perdida del tono de vasodilatacion del sistema circulatorio. Las cifras de TA normal estan definidas por la Organizacion Mundial de la Salud (OMS), la Sociedad Internacional de Hipertension y el Comite para la Deteccion Evaluacion y Tratamiento de los Institutos de Salud de los Estados Unidos de Norteamerica (CDETH). Son: < 90 mmHg como diastolica y sistolica inferior a 140 mmHg, y constituye hipertension arterial, valores por arriba de los normales, registrados por lo menos en dos determinaciones en dias distintos. Tambien dichos organismos clasifican a la hipertension arterial (Tabla I ). Palabras clave: Hipertension arterial. Epidemiologia. Salud publica.