Myocardial infarct and rupture of the left ventricular free wall. Some considerations on incidence, morphological characteristics and risk factors]

Rupture of the left ventricle free wall is a sudden and unexpected event in myocardial infarction. It is considered the third most common cause of death, following cardiogenic shock and arrhythmias. The frequency of rupture varies because many patients may survive the initial insult of myocardial infarction. Conflicting reports regarding risk factors have been published by several authors. With these considerations in mind, the present investigation was undertaken to evaluate ventricular rupture in an autopsy population from the Instituto Nacional de Cardiología. We analyzed the salient morphologic features and the risk factors. Our results indicated an incidence rate of 17.7% of cardiac rupture in patients who died of acute myocardial infarction and were autopsied. Ruptures are more common in elderly female patient during their first infarct, they were localized preferentially in the anterior wall and occurred within the first four days after infarction. Chance of rupture was greater in hypertensive patients, whereas a history of previous infarct protected against this contingency.     

Rehabilitation Course and Specification of Dysmetria of a Patient With Ataxia,Dysmetria, and Hemiparesis After a Stroke in the Corona Radiata: A Case Presentation

We present a case of a patient with ataxia, dysmetria, and hemiparesis after a stroke in the corona radiata. The patient had an excellent clinical course with near resolution of symptoms in 2 and a half weeks and returned back to work full duty and full time a couple of weeks later. We use videos of several neurologic tests to demonstrate and characterize the dysmetria. Interestingly, a key characteristic of the dysmetria appears to be different from that seen in patients with dysmetria arising from a cerebellar, thalamic, or pontine lesion. We propose a possible neurophysiologic mechanism—damage to and redundancy of part of the corticopontine portion of the cerebellar circuit located in the corona radiata—respectively responsible for this condition and recovery. We also discuss how a simple noninvasive study of patients with ataxia and dysmetria secondary to corona radiata, thalamic, pontine, and possibly other brain lesions may be helpful in elucidating the contribution of pontocerebellar fibers and other structures to motor control.

Use of contrast echocardiography to detect displacement of the needle during pericardiocentesis

Bedside pericardiocentesis is a safe and routinely practiced procedure. We report a case in which echocardiography-guided pericardiocentesis was performed urgently for cardiac tamponade. In this case, there was displacement of the periocardiocentesis needle that was only detected by change in the color of aspirated fluid and confirmed by the use of contrast echocardiography. We prescribe the use of routine echocardiographic monitoring during pericardiocentesis to avoid this type of complication.     

Blood glutamate scavenging as a novel neuroprotective treatment for paraoxon intoxication

Organophosphate-induced brain damage is an irreversible neuronal injury, likely because there is no pharmacological treatment to prevent or block secondary damage processes. The presence of free glutamate (Glu) in the brain has a substantial role in the propagation and maintenance of organophosphate-induced seizures, thus contributing to the secondary brain damage. This report describes for the first time the ability of blood glutamate scavengers (BGS) oxaloacetic acid in combination with glutamate oxaloacetate transaminase to reduce the neuronal damage in an animal model of paraoxon (PO) intoxication. Our method causes a rapid decrease of blood Glu levels and creates a gradient that leads to the efflux of the excess brain Glu into the blood, thus reducing neurotoxicity. We demonstrated that BGS treatment significantly prevented the peripheral benzodiazepine receptor (PBR) density elevation, after PO exposure. Furthermore, we showed that BGS was able to rescue neurons in the piriform cortex of the treated rats. In conclusion, these results suggest that treatment with BGS has a neuroprotective effect in the PO intoxication. This is the first time that this approach is used in PO intoxication and it may be of high clinical significance for the future treatment of the secondary neurologic damage post organophosphates exposure.     

Primary synovial sarcoma of the kidney: corroboration with in situ polymerase chain reaction

Synovial sarcoma is a tumor of the soft tissues with a unique chromosomal translocation t(X;18)(p 11.2;q11.2) that can be detected by polymerase chain reaction in tissue homogenates. The case of a 32-year-old woman with a primary synovial sarcoma of the kidney is described, the diagnosis was corroborated by the recently developed method of in situ polymerase chain reaction (IS-PCR). Synovial sarcoma of the kidney may be confused with other spindle cell tumors, for that reason IS-PCR may be useful to confirm the diagnosis in paraffin-embedded material.     

Breast cancer in Mexico: a growing challenge to health and the health system

Breast cancer is a major public health issue in low-income and middle-income countries. In Mexico, incidence and mortality of breast cancer have risen in the past few decades. Changes in health-care policies in Mexico have incorporated programmes for access to early diagnosis and treatment of this disease. This Review outlines the status of breast cancer in Mexico, regarding demographics, access to care, and strategies to improve clinical outcomes. We identify factors that contribute to the existing disease burden, such as low mammography coverage, poor quality control, limited access to diagnosis and treatment, and insufficient physical and human resources for clinical care.