Eficacia y seguridad de la infusión subcutánea de furosemida en domicilio para el manejo de la insuficiencia cardiaca

Heart failure is a very prevalent pathology, being one of the main causes of morbidity and mortality in developed countries. The treatment is based, among other drugs, on the administration of diuretics to improve the patient’s symptoms. However, in many cases, the lack of improvement with oral medication implies the need for hospital admission for intravenous administration.We present two cases of patients admitted to the Hospital at Home Unit who had refractory heart failure despite adequate diuretic treatment. Subcutaneous furosemide infusion was initiated in both. The first case presented symptom improvement with clinical resolution. The second was a terminally ill patient. Initially there was a clinical improvement but, due to the situation, the final decision was not to complete the treatment.La Insuficiencia cardiaca es una patología muy prevalente, siendo una de las principales causas de morbi-mortalidad en países desarrollados. Su tratamiento se basa, entre otros fármacos, en la administración de diuréticos para mejorar la sintomatología del paciente. Sin embargo, en muchas ocasiones, la falta de mejoría con el tratamiento oral supone la necesidad de ingreso hospitalario para la administración por vía intravenosa.Presentamos dos casos de pacientes ingresados a cargo de la Unidad de Hospitalización a Domicilio que presentaban insuficiencia cardiaca refractaria a pesar de tratamiento con diuréticos por vía oral. Se inició infusión de furosemida subcutánea en ambos. En el primer caso, presentó mejoría de la sintomatología con resolución del cuadro. En el segundo, al tratarse de un paciente en situación terminal, se produce una mejoría de la clínica pero, debido a su situación, se decidió no completar el tratamiento

Resumen de las actividades cientificas del 15. seminario internacional de cirugia general 'Cirugia de corta estancia y laparoscopica'

Centro de Informacion y Documentacion Cientifica (CINDOC). C/Joaquin Costa, 22. 28002 Madrid. SPAIN / CINDOC - Centro de Informaciòn y Documentaciòn CientìficaSIGLEESSpai

CAJA 238 - LEGAJO IX - SIGNATURA 01

Nota remitida por el Director del Banco de España, sucursal de Alicante, al Sr. D. Juan Besós, comunicando su deseo de ser socio corresponsal de la Económica valenciana.Banco de España. Alicante; Besós, J. (1886). Nota remitida por el Director del Banco de España, sucursal de Alicante, al Sr. D. Juan Besós, comunicando su deseo de ser socio corresponsal de la Económica valenciana. Real Sociedad Económica de Amigos del País de Valencia. http://hdl.handle.net/10251/25119Importación Masiv

Arte poética fácil : diálogos familiares en que se enseña la poesía a cualquiera de mediano talento de cualquier sexo y edad

Visitado el 19 de enero de 201

Memorial al Rey Nuestro Señor : Defensa Canonica, Historica-Politica, por la Santa Iglesia, y Ciudad de Orihuela coadiuvando su derecho ... en respvesta de otro qve se ha dado, por la Iglesia Colegiata de San Nicolas, y Ciudad de Alicante, en que pretenden, se les conceda Provisor, y Vicario General en su Partido , independente del que lo es para todo el Obispado ...

Copia digital. Madrid : Ministerio de Cultura. Subdirección General de Coordinación Bibliotecaria, 2008Palau 327559 lo supone impreso en Madrid en 1688En texto (r. de h. 22) consta la fecha de 1686: "hasta el año passado 1686"Sign.: [A]-Z\p2\s, 2A-2Z\p2\s, 3A-3Z\p2\s, 4A-4Z\p2\s, 5A-5Z\p2\s, 6A-6I\p2\sPort. con orla tip

Sensations evoked by selective mechanical, chemical, and thermal stimulation of the conjunctiva and

PURPOSE. To study the sensations evoked by selective mechanical, chemical, and thermal stimulation of the conjunctiva and compare them with those elicited by similar stimulation of the cornea. METHODS. Six young subjects participated in the study. Using a gas esthesiometer, selective mechanical (air puffs at flows from 0 to 264 ml/min), chemical (0 -80% CO 2 in air), and thermal (air at temperatures from Ϫ10°C to ϩ80°C) stimulation was performed on the center of the cornea and on the temporal conjunctiva. The intensity, degree of irritation, stinging and burning pain components, and thermal characteristics of the evoked sensation were evaluated after each stimulus in separate, 10-cm continuous visual analogue scales (VASs). The ability of the subjects to identify the quality of the stimulus applied to the cornea and the conjunctiva was also studied. RESULTS. The subjective intensity and thermal components (cooling or warming) of the sensation reported after mechanical, chemical, and heat stimulation were similar in the conjunctiva and cornea, although lower VAS scores were always reported in the conjunctiva for the irritation and the stinging and burning pain components. In the cornea, stimulation with low temperatures was perceived as a cooling sensation with an irritative component. In the conjunctiva, cooling was perceived as a purely cold sensation. Subjects showed similar discrimination capability in the cornea and the conjunctiva for the various types of stimuli. CONCLUSIONS. Sensations evoked in the cornea by selective mechanical, chemical, and heat and cold stimulation always presented an irritation component. In the conjunctiva, stimuli of the same intensity are always perceived as less irritating than in the cornea. Cold and other non-noxious subqualities of sensation can be evoked in the conjunctiva. (Invest Ophthalmol Vis Sci. 2001;42:2063-2067 T he quality of sensations arising from the application of different types of stimulating energy to the anterior surface of the eye has been a matter of discussion since von Frey's pioneering studies on ocular sensitivity. 3 However, in most of these studies the stimulation procedures precluded selective application of a given form of energy and a precise control of the stimulation parameters, thus making it difficult to define the site of origin of the sensation and its psychophysical characteristics. A more accurate procedure for stimulating the ocular surface was recently made available by the gas esthesiometer, 7 an instrument that allows the delivery of gas pulses of controlled mechanical force, temperature, and varying CO 2 concentration to the ocular surface. In humans, application with the gas esthesiometer of mechanical force, noxious heat, and low pH to the cornea evokes unpleasant sensations, with the degree of irritation, quality of pain, and thermal characteristics varying with the modality of stimulus. In contrast, moderate cold stimulation of the cornea elicits an innocuous sensation of cooling that becomes irritating when low temperatures are achieved. 9 MATERIALS AND METHODS Subjects Three women and three men were included in the study (mean age, 23.8 Ϯ 0.6 years). They received financial compensation for their participation. The research followed the tenets of the Declaration of Helsinki. The subjects signed an informed consent to a protocol approved by our institute and were free to interrupt the session at any time. None of them had a history of corneal or ocular disease. Three wore eyeglasses to correct myopia (less than Ϫ2 diopters [D]). Selective mechanical, chemical, and thermal stimulations of the cornea and the conjunctiva were performed in both eyes. The protocol was completed on four separate days. Esthesiometry A gas esthesiometer previously described 7 was used to apply to the corneal or conjunctival surface 3-sec gas jets of adjustable flow, composition, and temperature, separated by 2-minute pauses. Selective mechanical stimulation consisted of a series of nine pulses of air at variable flow (0 -264 ml/min) heated to 50°C at the tip of the probe to prevent changes in the temperature of the ocular surface during the air puff. A series of nine pulses of air and CO 2 mixture of different concentrations (0 -80% CO 2 ) at 50°C and with a flow 6.25 ml/min below mechanical threshold was used for chemical stimulation. Thermal (heat and cold) stimulation was performed by applying to the cornea and conjunctiva 10 pulses of air at different temperatures (Ϫ10°C to ϩ80°C), which produced variations of the basal corneal temperature (34.4°C) of Ϫ5°C to ϩ3°C (see Refs. 7 and 8) at a flow rate From th

Effects of oleoresin capsicum pepper spray on human corneal morphology and sensitivity. Invest Ophthalmol Visual Sci 2000; 42

PURPOSE. To examine the potential harmful effects on corneal structure, innervation, and sensitivity of a spray containing the neurotoxin capsaicin (oleoresin capsicum, OC). METHODS. Ten police officers who volunteered for the study were exposed to OC. Clinical signs were assessed. Corneal sensitivity was measured using a Cochet-Bonnet or a noncontact esthesiometer that provides separate measurements of mechanical, chemical, and thermal sensitivity. Tear fluid nerve growth factor (NGF) was measured. Corneal cell layers and subbasal nerves were examined by in vivo confocal microscopy. The subjects were examined before application and 30 minutes, 1 day, 1 week, and 1 month after OC exposure. RESULTS. OC spray produced occasional areas of focal epithelial cell damage that healed within 1 day. Each eye showed conjunctival hyperemia and in two subjects, mild chemosis. All except one eye had unchanged best corrected visual acuity (BCVA). A transient decrease (day 1) of mechanical sensitivity was observed with the Cochet-Bonnet esthesiometer. With the gas esthesiometer, mechanical sensitivity remained below normal values for 7 days. Chemical sensitivity to CO 2 was high for as much as 1 day and decreased below normal 1 week later, whereas sensitivity to cold was unaffected. Two subjects had measurable tear NGF that increased after exposure. Basal epithelial cell morphology suggested temporary corneal epithelial swelling, whereas keratocytes, endothelial cells, and subbasal nerves remained unchanged. CONCLUSIONS. Although OC causes immediate changes in mechanical and chemical sensitivity that may persist for a week, a single exposure to OC appears harmless to corneal tissues. The changes are possibly associated with damage of corneal nerve terminals of mainly unmyelinated polymodal nociceptor fibers. (Invest Ophthalmol Vis Sci. 2000;41:2138 -2147 T he cornea receives sensory innervation from primary sensory neurons located in the trigeminal ganglion 6 -9 Corneal nerve fibers exhibit immunoreactivity for a great variety of neuropeptides, including substance P and calcitonin gene-related peptide (CGRP), 10 -19 as well as classic neurotransmitters, presumably associated with autonomic nerve fibers. 9,20 -22 Functionally, corneal nerve fibers have been classified as mechanosensory units, activated only by mechanical stimulation, polymodal units, responding also to chemical substance and to heat, and cold-sensitive units, that are excited by low temperatures (see Reference 23 for review). Capsaicin (8-methyl-vanilyl-6-nonenamide), the pungent component of chili peppers, has been shown to induce intense pain in humans and pseudoaffective pain reactions in animals when applied to the skin and the front of the eye, as well as neurogenic inflammation due to the release of neuropeptides contained in nerve terminals. 24 -26 Capsaicin's effects are associated with acute stimulation of primary sensory nerve endings, 39 Capsaicin treatment in adult animals causes less prominent but still detectable alterations of sensory innervation. In vitro and in vivo studies show that nerve growth factor (NGF) reverses the decrease of transmitter content and restores the peripheral function of primary afferent neurons impaired by capsaicin treatment

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