A left ventricular epicardial to right ventricular endocardial dominant frequency gradient exists in human ventricular fibrillation

Purpose  

We hypothesized that in patients with left ventricular dysfunction undergoing implant of a biventricular ICD, the local dominant frequency during early induced ventricular fibrillation would be higher at an epicardial left ventricular position compared to an endocardial right ventricular position.     

Documento de consenso sobre diagnóstico,tratamiento y prevención de la tuberculosis

Pulmonary TB should be suspected in patients with respiratory symptoms longer than 2–3 weeks. Immunosuppression may modify clinical and radiological presentation. Chest X-ray shows very suggestive, albeit sometimes atypical, signs of TB. Complex radiological tests (CT scan, MR) are more useful in extrapulmonary TB.     

Cirugía toracoscópica monoportal utilizando el instrumento SILS como un método novedoso en el tratamiento quirúrgico del neumotórax

Single Incision Laparoscopic Surgery (SILS) has recently been used by general surgeons to perform cholecystectomies and pre-peritoneal hernia repairs with mesh using minimally invasive surgery, thus decreasing post-operative pain and a more cosmetic result of the surgery being obtained. We describe the first cases of video-assisted thoracic surgery (VATS) in spontaneous pneumothorax using the SILS system. There are no previous reports on the use of the SILS system in VATS for spontaneous pneumothorax. This system also allows us to obtain a more cosmetic surgical result, as well as decreasing the mean post-operative hospital stay and the need for analgesics to improve the post-operative pain.     

Abordaje laparoscópico en el tratamiento de las tumoraciones adrenales malignas

BackgroundMalignant primary or secondary adrenal tumours are uncommon. For most of them early surgery with adrenalectomy is the only means of cure. Although controversy exists on this issue, the increasing experience in laparoscopic surgery extends the indication for laparoscopic adrenalectomy to potentially malignant and to metastatic adrenal tumours. Our aim was to evaluate the technical feasibility of laparoscopic adrenalectomy for malignant neoplasias, describing the results of our consecutive series of patients.Material and methodsWe retrospectively analysed 13 patients who underwent laparoscopic adrenalectomy for malignant neoplasia between March 1999 and June 2009, at the Hospital de Clínicas of the Universidad of Buenos Aires and at the Hospital Alemán of Buenos Aires. A transperitoneal laparoscopic approach was used in all patients. The mean follow up was 37.9 months (2–84).ResultsThirteen laparoscopic adrenalectomies were performed due to malignant neoplasia. Mean age was 55.2+12 years. The relationship between male and female was 10/3. Five patients had an adrenal carcinoma, 1 patient a malignant phaeochromocytoma, and 7 patients had metastatic tumours. Three patients required conversion to laparotomy. Average operation time was 146.4 min. There were two perioperative complications and no mortality. Average length of hospital stay was 4.6 days (1–35). The survival at 3 years was 46%. The cause of death was the underlying disease in all cases.ConclusionLaparoscopic adrenalectomy is a reasonable technique for malignant adrenal tumours, when the open oncological resection can be reproduced by the laparoscopic approach.     

Tratamiento del dolor anal por patología anorrectal aguda en urgencias: ¿baños de asiento con agua fría o caliente? resultados de un ensayo clínico aleatorizado

IntroductionThe popular belief advocates the use of sitz (sitting) baths with cold water for the treatment of acute anal pain, but clinical practice guides recommend the use of hot water for its known effect on the at-rest anal pressure.AimThe objective of the study was to examine the analgesic effect on the quality of life, manometer data and clinical progress, of the two temperatures in sitz baths in patients with anal pain.Material and methodsA randomised clinical trial on patients with acute anal pain due to haemorrhoids or anal fissures, divided into Group 1: Sitz baths with water at a temperature of less than 15 °C, and Group 2: Baths with a water temperature above 30 °C. The analgesia was the same in both groups. An analysis was made of the pain at 7 days (visual analogue scale), quality of life (SF-36), anal at-rest pressure and disease progress.ResultsOf the 27 eligible patients, 24 were randomised (Group 1: n=12 y Group 2: n=12). There were no statistical differences in pain, but it remained stable in Group 1, but gradually decreased in the patients of Group 2, the difference being in the pain scores on the first day compared to the seventh in Group 2 (p=0.244). The rest of the variables were similar.ConclusionThere were no statistically significant differences in pain control from day 1 to day 7 in the Group with sitz baths with hot water.(ISRCTN Number: 50105150).