Francisco Bosa Ojeda

Pericarditis meningocócica primaria por serogrupo C

We report the case of a 15-year-old female, with no previous medical history, who presented cardiac tamponade secondary to purulent pericarditis caused by Neisseria meningitidis serogroup C. This microorganism is the etiologic agent in 6-16% of the cases of purulent pericarditis, most in association with previous or concomitant central nervous system involvement (meningitis). Exceptionally, as in this case, the pericarditis is not accompanied by meningitis (Primary Meningococcal Pericarditis). The patient was treated with antibiotics, pericardiocentesis and steroids with excellent response. It is important to point out that meningococcal disease may present in unusual forms which may lead to diagnostic and therapeutics difficulties.

Endocarditis infecciosa sobre válvulas protésicas causada por Staphylococcus capitis: un nuevo caso

Se presenta el caso de un paciente varon, portador de protesis valvular aortica y mitral con endocarditis infecciosa por Staphylococcus capitis , bacteria recientemente descrita como agente productor de endocarditis, tanto sobre valvulas cardiacas nativas en pacientes con lesiones predisponentes como sobre valvulas protesicas. El curso evolutivo del paciente fue desfavorable, a pesar de tratamiento antibioterapico especifico, siendo necesaria la sustitucion valvular quirurgica, que consiguio la resolucion completa del cuadro clinico. Este caso pone en relevancia que, si bien es poco frecuente la presentacion de endocarditis infecciosa por Staphylococcus capitis , su patogenia es importante.

Procedural, Functional and Prognostic Outcomes Following Recanalization of Coronary Chronic Total Occlusions. Results of the Iberian Registry

INTRODUCTION AND OBJECTIVES There is current controversy regarding the benefits of percutaneous recanalization (PCI) of chronic total coronary occlusions (CTO). Our aim was to determine acute and follow-up outcomes in our setting. METHODS Two-year prospective registry of consecutive patients undergoing PCI of CTO in 24 centers. RESULTS A total of 1000 PCIs of CTO were performed in 952 patients. Most were symptomatic (81.5%), with chronic ischemic heart disease (59.2%). Previous recanalization attempts had been made in 15%. The mean SYNTAX score was 19.5 ± 10.6 and J-score was > 2 in 17.3%. A retrograde procedure was performed in 92 patients (9.2%). The success rate was 74.9% and was higher in patients without previous attempts (82.2% vs 75.2%; P = .001), those with a J-score ≤ 2 (80.5% vs 69.5%; P = .002), and in intravascular ultrasound-guided PCI (89.9% vs 76.2%, P = .001), which was an independent predictor of success. In contrast, severe calcification, length > 20mm, and blunt proximal cap were independent predictors of failed recanalization. The rate of procedural complications was 7.1%, including perforation (3%), myocardial infarction (1.3%), and death (0.5%). At 1-year of follow-up, 88.2% of successfully revascularized patients showed clinical improvement (vs 34.8%, P < .001), which was associated with lower mortality. At 1-year of follow-up, the mortality rate was 1.5%. CONCLUSIONS Compared with other national registries, patients in the Iberian registry undergoing PCI of a CTO showed similar complexity, success rate, and complications. Successful recanalization was strongly associated with functional improvement, which was related to lower mortality.

Zung scale factor invariance in male coronary patients and healthy people.

The objective of this study was, firstly, to determine the factor structure and factor invariance of the Zung Self-Rating Depression Scale (ZSDS) and, secondly, to justify its use in coronary patients (CPs) and healthy people (HP). Two comparable samples of males were studied: 217 CPs and 191 HP. Exploratory and confirmatory factor analyses (EFA and CFA) for ordinal data were carried out with Mplus. Two models obtained from all participants in this study and another two, the model of Shafer (2006) from a meta-analysis and that of Barefoot et al. (2000) with CPs, were analyzed in CFA. A two-factor structure was supported by EFA in both samples, but none of the models showed adequate goodness-of-fit for the CPs and the HP in CFA. Only the two and three-factor models obtained from the combined sample of CPs and HP showed adequate goodness-of-fit for HP. The ZSDS showed good reliability, replicated the prevalence of depressive symptoms found in other studies and was able to distinguish between CPs and HP. We conclude that the best fit is obtained from the two-factor solution in HP, that the factor structure of the ZSDS is not invariant and is linked to positively and negatively worded items.

Disección coronaria espontánea: papel del ultrasonido intravascular

which was normal. Elective minimally invasive valve replacement surgery was proposed, which the patient rejected. Angiodysplasia is a degenerative disease of the intestinal mucosa related to the aging process and one of the main causes of gastrointestinal bleeding in the elderly. Its association with aortic stenosis is well known.Manymechanisms have been considered to explain this syndrome; currently the most prominent is an acquired deficit of Type IIa vonWillebrand factor, characterized by a loss of the largest VWF multimers, although this causal relationship cannot always be demonstrated, as in this case. Von Willebrand factor is a high-molecular-weight multimeric protein secreted by endothelial cells that stimulates platelet adhesion and aggregation when there is vascular damage. These multimers are cleared by plasma proteases that are especially active in turbulent blood flow situations. In aortic stenosis, fragmentation of VWFmultimers is increased, which reduces their number and predisposes bleeding. Studies have reported that these coagulation anomalies are directly related to the severity of aortic stenosis and are reversible after valve replacement if successful, so that recurrence of bleeding could be an indication of persistent stenosis. Therefore, although in some cases of extensive bleeding, such as this one, intestinal resection is necessary, many authors have shown that gastrointestinal bleeding ceases after valve replacement, being even more likely to prevent recurrences than intestinal resection. Heyde’s Syndrome is an entity to be kept in mind, even more nowadays with an aging population, when assessing patients with a history of bleeding or anemia, especiallywhen the bleeding site is not found on initial examination. Based on these data, we propose the hypothesis that this association could be a new indication for valve replacement; however, gastrointestinal bleeding is not used as an indicator in current clinical practice guides.