A propósito de un caso de síndrome de Takotsubo atípico: revisión del tema

La miocardiopatía de Takotsubo es una alteración de la contractilidad o discinesia transitoria del ventrículo izquierdo en ausencia de lesiones coronarias significativas. Fue descrito por primera vez por Sato et al. en Japón en el año 1990. Afecta sobre todo a mujeres postmenopáusicas y se estima que tiene una incidencia del 1-2% de todos los casos con sospecha de síndrome coronario agudo. Característicamente, aparece tras un estrés emocional. Sin embargo, también puede aparecer tras un estrés físico como una enfermedad grave o incluso sin un desencadenante claro. La etiología y patofisiología del síndrome de Takotsubo es todavía desconocida. Existen varias teorías que hablan de las posibles causas del síndrome, entre las que destaca el papel de los niveles elevados de catecolaminas en sangre durante el evento. Se presenta clínicamente como dolor precordial con cortejo vegetativo y el electrocardiograma con elevación o descenso del segmento ST. Debido al parecido con el síndrome coronario agudo, tanto clínica como electrocardiográficamente, se debe plantear un diagnóstico diferencial donde será necesario demostrar la ausencia de lesiones coronarias significativas con una coronariografía y descartar, por tanto, la isquemia miocárdica. Otras pruebas complementarias como el ecocardiograma o la resonancia magnética nos ayudarán a orientar el diagnóstico. El pronóstico es en la mayoría de los casos (95.5%) muy bueno con recuperación completa de la función ventricular. La mortalidad global del síndrome de Takotsubo es del 4.5%. Caso clínico: Describimos un caso atípico de síndrome de Takotsubo porque se trata de una mujer joven que sufre una parada cardiorrespiratoria en su casa. Tras las exploraciones complementarias, se diagnostica como causa de la parada un síndrome de Takotsubo desencadenado por un estrés físico neurológico, que tendrá una evolución complicada.<br /

Pseudoaneurisma y fístula aortocavitaria como complicaciones de endocarditis protésica tardía

Infective endocarditis is a disease associated with high mortality and serious complications. The perivalvular extension of infective endocarditis is associated with a worse prognosis and more frequently affects prosthetic valves. Diagnostic imaging is essential to be able to identify these complications and establish the best therapeutic strategy, usually combining intravenous antibiotic treatment and surgery.La endocarditis infecciosa es una enfermedad asociada a una elevada mortalidad y complicaciones graves. La extensión perivalvular de la endocarditis infecciosa se asocia con peor pronóstico y afecta más frecuentemente a válvulas protésicas. El diagnóstico por imagen es fundamental para poder identificar estas complicaciones y establecer la mejor estrategia terapéutica, combinando, habitualmente, tratamiento antibiótico endovenoso y cirugía

Insuficiencia mitral severa secundaria a rotura del músculo papilar posteromedial

The prevalence of mechanical complications of infarction has decreased in recent years, however, mortality remains high. Echocardiography plays a fundamental role for early diagnosis and management of these complications.&nbsp; We present the case of a patient with ischemic rupture of the posteromedial papillary muscle and severe mitral regurgitation.La prevalencia de las complicaciones mecánicas del infarto se ha reducido en los últimos años, sin embargo, la mortalidad sigue siendo elevada. La ecocardiografía juega un papel fundamental para un diagnóstico y manejo precoz de estas complicaciones.&nbsp; Presentamos el caso de una paciente con rotura isquémica del músculo papilar posteromedial e insuficiencia mitral severa

Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.

Objective:To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL).Background:AL after RC resection often results in a permanent stoma.Methods:This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated.Results:This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76).Conclusions:The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies

Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients

Background: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. Methods: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2: 1). Results: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days). Conclusion: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding