Diagnosis of Active Infective Endocarditis from Examination of the Toes and Soles.

A 72-year-old woman was admitted to our hospital with fever >38 C of unknown origin. Blood cultures were positive in 2 sets for Staphylococcus aureus. In the third day of admission, her husband drew attention to the presence of some small punctures in her right foot (Figure 1). Several small and nontender, erythematous, and hemorrhagic macular lesions were found on her sole (Janeway lesions). Besides, we detected some painful and palpable, erythematous nodules involving the pads of her toes (Osler nodes). At this point, according to the modified Duke criteria, the clinical diagnosis of definite infective endocarditis might be established. In addition, the transesophageal echocardiogram just confirmed the presence of a large vegetation attached to the posterior leaflet of the mitral valve. Although the diagnosis of infective endocarditis may be challenged, sometimes there are simple clues: next time lift the bed sheets!pre-print380 K

Ritmo acelerado de la unión auriculoventricular.

post-print1913 K

Accordion music from the heart: dynamic coronary artery compression.

A 35-year-old woman was admitted to our hospital with unstable angina. During her last holidays, she had suffered an anterior myocardial infarction (MI). Her available medical records described a totally occluded mid left anterior descending (LAD) coronary artery treated with two overlapped stents. The new coronarography revealed a very tight systolic coronary stenosis at the proximal edge of the stents, secondary to severe dynamic shortening of the LAD in an accordion-like fashion.pre-print1757 K

Full wave modelling of hts dual mode patch filters and staggered coupled-line filters

In order to obtain high-power handling, dual-mode patch HTS filters have been analyzed through Green's function and desegmentation techniques. A precise circuit model has been obtained and applied to the filter design process, and useful design curves relating filter parameters and physical dimensions of the square patch have been plotted. Several designs have been made using them and then optimized with the Method of Moments in the Spectral Domain. For higher order circuits, staggered coupled-line HTS filters have been considered. The designs have been made using the method of moments to compute the coupling capacitances, and then optimized with the Method of Moments in the Spectral Domain. One dual-mode patch filter and one staggered coupled-line filter have been fabricated on a YBCO film. Measurements agree well with simulationsPeer Reviewe

Accuracy considerations in microstrip surface impedance measurements

An approach is proposed for the design, measurement and data extraction of superconducting microstrip resonators used in determination of surface resistance and penetration depth. Major sources of error are analyzed and procedures to minimize them are givenPeer Reviewe

Las órdenes de no reanimar. Historia y situación actual.

pre-print237 K

Problemática actual en la implementación de la orden de no reanimar en el paciente cardiológico.

Las enfermedades cardiovasculares continúan siendo la causa más frecuente de muerte y la insuficiencia cardíaca la causa más frecuente de ingreso hospitalario en pacientes mayores de 65 años. Pese a ello, la importancia otorgada por la Cardiología a los cuidados al final de la vida es escasa. Además, la percepción que tienen los pacientes cardiológicos del pronóstico de su enfermedad y del resultado de una reanimación cardiopulmonar dista mucho de la realidad. La orden de no reanimar permite al paciente expresar anticipadamente su rechazo a una reanimación cardiopulmonar, evitando así sus posibles consecuencias negativas. Sin embargo, estas órdenes continúan siendo infrautilizadas y malinterpretadas en los pacientes cardiológicos. La mayoría no suele tener la oportunidad de mantener las necesarias conversaciones con su médico responsable sobre sus preferencias de reanimación. En la presente revisión hemos realizado un análisis de las causas que podrían justificar esta situación.pre-print1329 K

Soria Cardioprotegida. Primer programa español de prevención y tratamiento integral de la muerte súbita cardiaca.

pre-print154 K

Full wave analysis of the image hybrid dielectric/HTS resonator

An analysis of the image hybrid dielectric / high-temperature superconductor (HTS) resonator is carried out. A full-wave radial mode-matching method is used to obtain the electromagnetic fields inside the resonator for single TE01 and dual HE11 modes. Measured resonant frequencies and quality factors of these modes are compared with numerical results of the analysis. The resonator power-handling capability is estimated from the field at the surface of the HTS film, assuming a certain value for the critical field of the HTS film.Peer Reviewe

Transcervical carotid stenting with internal carotid artery flow reversal: Feasibility and preliminary results

ObjectiveTransfemoral carotid artery stenting (CAS), with or without distal protection, is associated with risk for cerebral and peripheral embolism and access site complications. To establish cerebral protection before crossing the carotid lesion and to avert transfemoral access complications, the present study was undertaken to evaluate a transcervical approach for CAS with carotid flow reversal for cerebral protection.MethodsFifty patients underwent CAS through a transcervical approach. All patients with symptoms had greater than 60% internal carotid artery (ICA) stenosis, and all patients without symptoms had greater than 80% ICA stenosis. Twenty-one patients (42%) had symptomatic disease or ipsilateral stroke, and 8 patients (16%) had contralateral stroke. Four patients (8%) had recurrent stenosis, 7 patients (14%) had contralateral ICA occlusion, and 1 patient (2%) had undergone previous neck radiation. Twenty-seven procedures (54%) were performed with local anesthesia, and 23 (46%) with general anesthesia. Using a cervical cutdown, flow was reversed in the ICA by occluding the common carotid artery and establishing a carotid–jugular vein fistula. Pre-dilation was selective, and 8-mm to 10-mm self-expanding stents were deployed and post-dilated with 5-mm to 6-mm balloons in all cases.ResultsThe procedure was technically successful in all patients, without significant residual stenoses. No strokes or deaths occurred. There was 1 wound complication (2%). All patients were discharged within 2 days of surgery. Mean flow reversal time was 21.4 minutes (range, 9-50 minutes). Carotid flow reversal was not tolerated in 2 patients (4%). Early in the experience, carotid flow reversal was not possible in 1 patient, and there were 1 major and 3 minor common carotid artery dissections, which resolved after stent placement. One intraoperative transient ischemic attack (2%) occurred in 1 patient in whom carotid flow was not reversed, and 1 patient with a contralateral ICA occlusion had a contralateral transient ischemic attack. At 1 to 12 months of follow-up, all patients remained asymptomatic, and all but 1 stent remained patent.ConclusionTranscervical CAS with carotid flow reversal is feasible and safe. It can be done with the patient under local anesthesia, averts the complications of the transfemoral approach, and eliminates the increased complexity and cost of cerebral protection devices. Transcervical CAS is feasible when the transfemoral route is impossible or contraindicated, and may be the procedure of choice in a subset of patients in whom carotid stenting is indicated