COMPARACIÓN DE ESTRATEGIAS TERAPÉUTICAS PARA EL CONTROL DE LA TENSIÓN ARTERIAL Y LA ANGINA DE PECHO EN PACIENTES CON HIPERTENSIÓN ARTERIAL Y CARDIOPATÍA ISQUÉMICA CRÓNICA EN LA PROVINCIA DE VILLA CLARA. APÉNDICE DEL ESTUDIO INVEST / Comparison of therapeutic strategies for the control of blood pressure and angina in patients with hypertension and chronic ischemic heart disease in the province of Villa Clara. Appendix of INVEST study

Background and Objectives: The treatment of hypertension and its complications are a worldwide problem. In our country nearly 25 % of the population over 15 years old is hypertensive, and this figure nearly doubles in those over 60. This research aims to compare two treatment strategies for controlling hypertension in outpatients with chronic coronary ischemic syndrome. Method: A total of 150 patients was included, 73 were randomized to receive calcium antagonist and non-calcium antagonist respectively, as 4 patients were subsequently excluded. Each was asked to sign consent, underwent clinical examination and a 12-lead, conventional electrocardiogram. Blood pressure and episodes of angina were evaluated at 6 months and one year. All variables were entered into a database and statistical analysis was performed using Student's t and Chi square. Results: The mean age was 61,5 years. Women and white skin color were predominant. At 12 months of treatment, blood pressure normalized in more than 80 % of patients without significant differences between the two treatment strategies. Over 75 % of patients in both groups controlled the angina episodes and more than 85 % said the quality of life was good. Conclusions: Control of blood pressure and angina was achieved and there were no significant differences between the two treatment strategies

Utilidad diagnóstica de los anticuerpos antitransglutaminasa tisular en niños con síntomas digestivos crónicos y sospecha de celiaquía

Introduction: Celiac disease is the most common chronic enteropathy in the world, but its occurrence in children with chronic gastrointestinal symptoms in our environment is unknown. Objective: To evaluate the diagnostic utility of anti-tissue transglutaminase antibodies in children with chronic digestive symptoms. Methods: A prospective study was carried out from January 2008 to April 2011 at the José Luis Miranda Pediatric University Hospital in Santa Clara. It included 535 infants in which anti-tissue transglutaminase antibodies was screened. Duodenal transendoscopic biopsies were taken, which were interpreted according to the Marsh-Oberhuber classification and were related to the serological test. The diagnostic efficacy of the antibodies was assessed and the frequency of celiac disease was estimated. Results: Only 11 patients were positive for antibody determination (2.1%). The predominant type of anatomo-pathologic lesion in patients who were positive for antibodies was typical of celiac disease (9 boys, 75%). There was an agreement between the serological and histopathological diagnosis of the duodenum (K=0.78, p<0.001). The frequency of celiac disease in the series was 2.2% (12 patients). The sensitivity and specificity of the antibodies was 75% and 99% respectively. Conclusions: There was a low frequency of celiac disease in the series, and a good diagnostic accuracy of the serological tests in children suspected of suffering the disease was achieved.Introducción: la enfermedad celíaca es la enteropatía crónica más frecuente en el mundo, pero se desconoce su ocurrencia en niños con síntomas digestivos crónicos en nuestro medio. Objetivo: evaluar la utilidad diagnóstica de los anticuerpos antitransglutaminasa tisular en niños con síntomas digestivos crónicos. Métodos: investigación prospectiva entre enero de 2008 y abril de 2011 en el Hospital Pediátrico Universitario “José Luis Miranda” de Santa Clara que incluyó 535 infantes en los que se pesquisaron anticuerpos antitransglutaminasa tisular, se tomaron biopsias transendoscópicas del duodeno que se interpretaron según la clasificación de Marsh-Oberhuber y se relacionaron con la prueba serológica, se evaluó la eficacia diagnóstica de los anticuerpos y se estimó la frecuencia de celiaquía. Resultados: solo 11 pacientes resultaron positivos a la determinación de anticuerpos (2.1%), el tipo de lesión anatomopatológica predominante en los pacientes positivos para los anticuerpos fue característico de la enfermedad celíaca -nueve niños (75%)-, se comprobó la concordancia entre los diagnósticos serológicos e histopatológicos del duodeno (K=0.78; p<0.001), la frecuencia de enfermedad celíaca en la serie fue de 2.2% (12 pacientes) y la sensibilidad y la especificidad de los anticuerpos fue de 75% y 99% respectivamente. Conclusiones: se demostró baja frecuencia de celiaquía en la serie y se obtuvo una buena eficacia diagnóstica de la prueba serológica en niños con sospecha de esta enfermedad

DIAGNÓSTICO DE UN TROMBOEMBOLISMO PULMONAR AGUDO POR ANGIOTC / Diagnosis of acute pulmonary thomboembolism by CT angiography

ResumenEl tromboembolismo pulmonar agudo tiene mayor morbilidad y mortalidad en los ancianos, pero puede presentarse en adultos jóvenes; por eso el diagnóstico certero es muy importante en este grupo etario. En este artículo se presenta el caso de un hombre de 37 años de edad, que acude al cuerpo de guardia por dolor precordial, sin alteraciones electrocardiográficas y dilatación de las cavidades derechas en el ecocardiograma. Se realizó AngioTC y se observó una dilatación del tronco de la arteria pulmonar, donde había una imagen hipodensa que ocupaba su porción distal, en relación con tromboembolismo pulmonar agudo. El paciente evolucionó favorablemente con el tratamiento. Mediante este estudio, se evidencia la importancia del AngioTC con tomógrafo de doble fuente, para la evaluación del dolor torácico agudo, en el paciente que no tiene manifestaciones electrocardiográficas, ni enzimáticas de infarto agudo de miocardio. / AbstractAcute pulmonary thromboembolism have increased morbidity and mortality in the elderly, but it can also occur in young adults, which is why an accurate diagnosis is very important in this age group. This article presents the case of a 37-year-old man, who comes to the emergency room for chest pain without electrocardiographic abnormalities and dilatation of the right chambers on echocardiography. CT angiography was performed and it showed a dilated pulmonary trunk, where there was a hypodense image occupying its distal portion, in relation to acute pulmonary thromboembolism. The patient responded favorably to treatment. Through this study, the importance of CT angiography with dual-source CT scanner for evaluation of acute chest pain, in patients with no electrocardiographic manifestations or enzymatic myocardial infarction is demonstrated

CONCORDANCIA EN EL DIAGNÓSTICO CLÍNICO Y PATOLÓGICO DEL INFARTO AGUDO DE MIOCARDIO / Consistency in clinical and pathological diagnosis of acute myocardial infarction

ResumenIntroducción y objetivos: El infarto agudo de miocardio continúa siendo un grave problema de salud. Su diagnóstico certero puede mejorar el pronóstico. El objetivo de la investigación fue identificar la concordancia en el diagnóstico clínico−patológico en fallecidos por esta enfermedad. Método: Se realizó un estudio descriptivo, transversal, en fallecidos por infarto agudo de miocardio en el Hospital General "Camilo Cienfuegos" de Sancti Spíritus, desde enero 2009 hasta diciembre 2010 para determinar la eficacia diagnóstica. Se estudiaron todos los fallecidos con el mencionado diagnóstico y que se les había realizado la necropsia. Se emplearon los índices de eficacia diagnóstica sensibilidad, especificidad e índice Kappa. Resultados: Se constató una mayor concordancia clínico−patológica en el sexo masculino (sensibilidad de 78 % en el 2009 y de 81 % en el 2010), así como en los mayores de 65 años (sensibilidad de 82 % y 85 %), y cuando la estadía hospitalaria fue mayor de 24 horas (sensibilidad en 80 % y 83 %). Las salas con mejor concordancia clínico−patológica fueron las de Cardiología y la Unidad de Terapia Intensiva en los dos períodos estudiados. El índice Kappa mostró una eficacia en el diagnóstico clínico−patológico del infarto agudo de miocardio y mejoraron sus indicadores de un año al siguiente (0,85 en el 2009 y 0,87 en el 2010). Conclusiones: Existió una mayor concordancia clínico−patológica en los fallecidos del sexo masculino, en los menores de 65 años de edad y en los que tuvieron una estadía hospitalaria mayor de 24 horas. Los servicios con mejor concordancia fueron los de Cardiología y de Terapia Intensiva. Se puede afirmar que existe muy buena eficacia diagnóstica para el infarto agudo de miocardio en el Hospital "Camilo Cienfuegos" de Sancti Spíritus. / AbstractIntroduction and Objectives: Acute myocardial infarction remains a serious health problem. Its accurate diagnosis may improve prognosis. The objective of this research was to identify the consistency in clinical and pathological diagnosis in deaths from this disease. Method: A descriptive and cross−sectional study was performed in deaths from acute myocardial infarction at Camilo Cienfuegos General Hospital in Sancti Spiritus, from January 2009 to December 2010 to determine the diagnostic efficacy. All deaths with the above−mentioned diagnosis, which had undergone autopsy, were studied. Indexes of diagnostic efficacy such as sensitivity, specificity and Kappa index were used. Results: A higher clinical and pathological consistency was found in males (sensitivity of 78% in 2009 and 81% in 2010) and in those over 65 years (sensitivity of 82% and 85%) and when hospital stay was longer than 24 hours (sensitivity in 80% and 83%). The units with the best clinical and pathological consistency in the two periods studied were cardiology and the intensive care. Kappa index showed that there was efficacy in the clinical and pathological diagnosis of acute myocardial infarction and their indicators improved from one year to the next (0.85 in 2009 and 0.87 in 2010). Conclusions: There was an increased clinical and pathological consistency in male deaths, in those under 65 years of age and in those who had a hospital stay longer than 24 hours. The units with better consistency were Cardiology and Intensive Care. It can be said there is very good diagnostic accuracy for acute myocardial infarction at Camilo Cienfuegos Hospital in Sancti Spiritus

Aneurisma gigante del apéndice auricular izquierdo

Los aneurismas de la aurícula izquierda son raros y pueden ser congénitos o adquiridos. Los que interesan la pared libre o el apéndice auricular son entidades más raras aún, hasta 2002 sólo existían 49 casos reportados en la aurícula izquierda y 8 en la derecha. La manifestación clínica más frecuente es la aparición de arritmias auriculares incesantes o recurrentes y pueden presentarse embolias sistémicas que pueden dar al traste con la vida del paciente. Presentamos el caso de una paciente adolescente que presentó una embolia cerebral en el curso de una fibrilación auricularytenía un aneurisma gigante del apéndice auricular izquierdo que fue exitosamente extirpado. Se muestran las imágenes de la tomografía computada y el aneurisma durante la intervención quirúrgica

COMPLICACIONES GASTROINTESTINALES ENCONTRADAS EN FALLECIDOS DESPUÉS DE UNA CIRUGÍA CARDIOVASCULAR. EXPERIENCIA DE CINCO AÑOS / Gastrointestinal complications found in deceased patients after cardiovascular surgery. Five years of experience.

Background and Objectives: Gastrointestinal complicationsin heart surgery are low, between 0.4 to 2.9%;however, its diagnosis is of vital importance because itis associated with high mortality rates. An investigationwas conducted to determine the frequency of thesecomplications in those who died after cardiac surgery.Method: A retrospective study of 5 years (1999-2003)was performed in the Cardiovascular Surgery Department.Autopsy reports and medical records were analyzedto study gastrointestinal complications accordingto their frequency and their possible relationship tothe cause of death. Results: There were a total of 57deaths, 38.6% were valve replacements, 54.4% coronaryartery bypass grafting and 7.0% vascular prostheses.Multi-organ failure was predominant (38.6%),followed by stroke (26.3%) and shock (17.5%). 26complications were found, of which 15 (57.7%) indeaths from multiple organ failure, 6 (23.1%) in patientswith an infarct, 4 (15.4%) in the shock and 1 (3.8 %) ina dead from a pulmonary embolism. The acute hemorrhagic gastroenteropathy was the most frequent61.6%, acute cholecystitis and pancreatitis shared11.5%, just as mesenteric thrombosis and peptic ulcerdisease with 7.7% each. Conclusions: The acutehemorrhagic gastroenteropathy was the most frequentcomplication. Most complications appeared in thediseased from multi-organ failure and stroke. The identificationof risk factors, use of appropriate prophylaxisand the constant evaluation of these patients may helpwith early diagnosis and the establishment of the mostsuccessful therapy

Association between epicardial fat volume and coronary plaques diagnosed by multislice computed tomography

Introduction: Coronary atherosclerotic disease is a major cause of death in Cuba and elsewhere. The volume of epicardial fat is considered a new cardiovascular risk factor because of its association with coronary atherogenesis.Objective: To determine, by multislice computed tomography, the association between epicardial fat volume and the presence of coronary atherosclerotic plaques.Method: A descriptive study was conducted with a universe of 130 patients with chest pain suggestive of ischemic heart disease, of which 117 were selected by opinion sampling. These patients underwent a calcium score study, a coronary angiography and a measurement of the epicardial fat volume.Results: Male patients predominated (54.7%) and those aged 60-69 years (32.5%). A high volume of epicardial fat was found in 51.3% of patients, affecting 52.8% of women; 78.9% of patients with a calcium score between 100 and 399 UH had a high volume of epicardial fat, just as 71.2% of those with plaques and 100% of those with 4 or 5 plaques; 41% of patients had various types of plaque, which were mainly located in the anterior descending artery (88.1%).Conclusions: The measurement of the volume of epicardial fat is a useful tool to estimate the presence of coronary disease. When it was high, it was associated with older age, female gender and the presence of a higher calcium score, more plaques, more injuries and a greater involvement of the anterior descending artery

Asociación entre el volumen de grasa epicárdica y las placas coronarias diagnosticadas por tomografía multicorte/ Associationbetweenepicardialfatvolume and coronary plaques diagnosedbymultislicecomputedtomography

Introduction: Coronary atherosclerotic disease is a major cause of death in Cuba and elsewhere. The volume of epicardial fat is considered a new cardiovascular risk factor because of its association with coronary atherogenesis. Objective: To determine, by multislice computed tomography, the association between epicardial fat volume and the presence of coronary atherosclerotic plaques. Method: A descriptive study was conducted with a universe of 130 patients with chest pain suggestive of ischemic heart disease, of which 117 were selected by opinion sampling. These patients underwent a calcium score study, a coronary angiography and a measurement of the epicardial fat volume. Results: Male patients predominated (54.7%) and those aged 60-69 years (32.5%). A high volume of epicardial fat was found in 51.3% of patients, affecting 52.8% of women; 78.9% of patients with a calcium score between 100 and 399 UH had a high volume of epicardial fat, just as 71.2% of those with plaques and 100% of those with 4 or 5 plaques; 41% of patients had various types of plaque, which were mainly located in the anterior descending artery (88.1%). Conclusions: The measurement of the volume of epicardial fat is a useful tool to estimate the presence of coronary disease. When it was high, it was associated with older age, female gender and the presence of a higher calcium score, more plaques, more injuries and a greater involvement of the anterior descending artery