Marfan, embarazo y aneurisma aórtico / Marfan, pregnancy and aortic aneurism

Octubre 31, 2015. No. 2131Octubre, mes de lucha contra cáncer de mama.

Ver galeria View gallery El síndrome de Marfan es un trastorno multisistémico del tejido conectivo, con la participaciónprincipal de los sistemas cardiovascular, ocular y esquelético. El diagnóstico clínico del síndrome de Marfan se ha basado en los criterios de Ghent desde 1996. Entre sus muchas diferentesmanifestaciones clínicas cursa con afectación cardiovascular que merece una consideración especial, debido a su impacto en el pronóstico. Las mujeres embarazadas con síndrome de Marfancorren un riesgo particularmente alto de embarazo adverso y los eventos cardiovasculares pueden ser mortales.Se presenta un caso de una mujer con sindrome de Marfan y embarazo que falleció en postparto por un aneurisma aórtico toraco-abominal.   Marfan syndrome is a multisystem connective tissue disorder, with primary involvement of the cardiovascular, ocular, and skeletal systems. Clinical diagnosis of Marfan syndrome has been based on the Ghent criteria since 1996. Among its many different clinical manifestations, cardiovascular involvement deserves special consideration, owing to its impact on prognosis. Pregnant women with Marfan syndrome are at a particularly high risk of adverse pregnancy and cardiovascular events. We e-mail you images of a case of a woman with Marfan syndrome and pregnancy who died at the postpartum period due to an aortic thoracic-abdominal aneurysm.   Manifestaciones cardiovasculares deelsíndrome de Marfan y enfermedades relacionadas. Múltiples genes produciendo fenotipos similares Cardiovascular manifestations in Marfan syndrome and related diseases; multiple genes causing similar phenotypes. Cook JR, Carta L, Galatioto J, Ramirez F. Clin Genet. 2015;87(1):11-20. doi: 10.1111/cge.12436. Epub 2014 Jul 10. PDF Perspectivas sobre los criterios revisados de Ghent para diagnóstico de síndrome de Marfan Perspectives on the revised Ghent criteria for the diagnosis of Marfan syndrome. von Kodolitsch Y, De Backer J, Schüler H, Bannas P, Behzadi C, Bernhardt AM, Hillebrand M,Fuisting B, Sheikhzadeh S, Rybczynski M, Kölbel T, Püschel K, Blankenberg S, Robinson PN. Appl Clin Genet. 2015 Jun 16;8:137-55. doi: 10.2147/TACG.S60472. eCollection 2015. PDF Síndrome de Marfan: Una vision del síndrome. Marfan syndrome: An eyesight of syndrome. Kumar A, Agarwal S. Meta Gene. 2014 Jan 14;2:96-105. doi: 10.1016/j.mgene.2013.10.008. eCollection 2014. PDF Tratamiento médico de los aneurismas aórtivos en síndrome de Marfan y otras condiciones hereditarias Medical treatment of aortic aneurysms in Marfan syndrome and other heritable conditions. Attenhofer Jost CH, Greutmann M, Connolly HM, Weber R, Rohrbach M, Oxenius A, Kretschmar O,Luscher TF, Matyas G1. Curr Cardiol Rev. 2014 May;10(2):161-71. Abstract PDF Síndrome de Marfan y embarazo: Evolución materna y neonatal Marfan syndrome and pregnancy: maternal and neonatal outcomes. Curry RA1, Gelson E, Swan L, Dob D, Babu-Narayan SV, Gatzoulis MA, Steer PJ, Johnson MR. BJOG. 2014 Apr;121(5):610-7. doi: 10.1111/1471-0528.12515. Epub 2014 Jan 13. PDF Supervisión de salud para los niños con el síndrome de Marfan. Health supervision for children with Marfan syndrome. Tinkle BT, Saal HM; Committee on genetics. Pediatrics. 2013 Oct;132(4):e1059-72. doi: 10.1542/peds.2013-2063. Epub 2013 Sep 30. PDF  RNM cardiovascular en síndrome de Marfan Cardiovascular magnetic resonance in Marfan syndrome. Dormand H, Mohiaddin RH. J Cardiovasc Magn Reson. 2013 Apr 15;15:33. doi: 10.1186/1532-429X-15-33. PDF

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Marfan, embarazo, aneurisma y anestesia / Marfan, pregnancy, aneurisma and anesthesi

Noviembre 1, 2015. No. 2132

Disección aórtica en mujeres durante el embarazo o el puerperio. Informe de 11 casos en China Aortic dissection in women during the course of pregnancy or puerperium: a report of 11 cases in central south China. Yang G, Peng W, Zhao Q, Peng J, Xiang X, Chai X. Int J Clin Exp Med. 2015 Jul 15;8(7):11607-12. eCollection 2015. PDF El embarazo y el crecimiento de la raíz aórtica en el síndrome de Marfan: un estudio prospectivo Pregnancy and aortic root growth in the Marfan syndrome: a prospective study Lilian J. Meijboom, Frederiek E. Vos, Janneke Timmermans, Godfried H. Boers, Aeiko H. Zwinderman, Barbara J.M. Mulder European Heart Journal (2005) 26, 914-920 PDF  Disección aórtica aguda en embarazo con síndrome de Marfan Acute aortic dissection in pregnancy with the marfan syndrome. Kim SW, Kim D, Hong JM. Korean J Thorac Cardiovasc Surg. 2014 Jun;47(3):291-3. doi: 10.5090/kjtcs.2014.47.3.291. Epub 2014 Jun 5. PDF Disección aórtica postparto Postpartum aortic dissection. Yuan SM. Taiwan J Obstet Gynecol. 2013 Sep;52(3):318-22. doi: 10.1016/j.tjog.2013.06.003. PDF Síndrome de Marfan durante el embarazo. Manejo anestésico del parto en 16 casos Marfan's syndrome during pregnancy: anesthetic management of delivery in 16 consecutive patients. Allyn J, Guglielminotti J, Omnes S, Guezouli L, Egan M, Jondeau G, Longrois D, Montravers P. Anesth Analg. 2013 Feb;116(2):392-8. doi: 10.1213/ANE.0b013e3182768f78. Epub 2013 Jan 9. PDF Anestesia regional en síndrome de Marfan, no todas las ectasias durales son lo mismo. Informe de dos casos Regional anesthesia in Marfan syndrome, not all dural ectasias are the same: a report of two cases. Baghirzada L, Krings T, Carvalho JC. Can J Anaesth. 2012 Nov;59(11):1052-7. doi: 10.1007/s12630-012-9778-5. Epub 2012 Sep 14. PDF

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Óxido nitroso y depresión mayor / N2O and major depression

Noviembre 2, 2015. No. 2133

Combinación de óxido nitroso con isoflorano o escopolamina para depresión mayor resistente Combination of Nitrous Oxide with Isoflurane or Scopolamine for Treatment-resistant Major Depression. Yang C1, Hashimoto K. Clin Psychopharmacol Neurosci. 2015 Apr 30;13(1):118-20. doi: 10.9758/cpn.2015.13.1.118. PDF El óxido nitroso para tratamiento de la depresión mayor resistente: Un ensayo de prueba de concepto. Nitrous Oxide for Treatment-Resistant Major Depression: A Proof-of-Concept Trial. Nagele P, Duma A, Kopec M, Gebara MA, Parsoei A, Walker M, Janski A, Panagopoulos VN, Cristancho P, Miller JP, Zorumski CF, Conway CR. Biol Psychiatry. 2015 Jul 1;78(1):10-8. doi: 10.1016/j.biopsych.2014.11.016. Epub 2014 Dec 9. Abstract BACKGROUND: N-methyl-D-aspartate receptor antagonists, such as ketamine, have rapid antidepressant effects in patients with treatment-resistantdepression (TRD). We hypothesized that nitrous oxide, an inhalational general anesthetic and N-methyl-D-aspartate receptor antagonist, may also be a rapidly acting treatment for TRD. METHODS: In this blinded, placebo-controlled crossover trial, 20 patients with TRD were randomly assigned to 1-hour inhalation of 50% nitrous oxide/50% oxygen or 50% nitrogen/50% oxygen (placebo control). The primary endpoint was the change on the 21-item Hamilton Depression Rating Scale (HDRS-21) 24 hours after treatment. RESULTS: Mean duration of nitrous oxide treatment was 55.6 ± 2.5 (SD) min at a median inspiratory concentration of 44% (interquartile range, 37%-45%). In two patients, nitrous oxide treatment was briefly interrupted, and the treatment was discontinued in three patients. Depressivesymptoms improved significantly at 2 hours and 24 hours after receiving nitrous oxide compared with placebo (mean HDRS-21 difference at 2 hours, -4.8 points, 95% confidence interval [CI], -1.8 to -7.8 points, p = .002; at 24 hours, -5.5 points, 95% CI, -2.5 to -8.5 points, p < .001; comparison between nitrous oxide and placebo, p < .001). Four patients (20%) had treatment response (reduction ≥50% on HDRS-21) and three patients (15%) had a full remission (HDRS-21 ≤ 7 points) after nitrous oxide compared with one patient (5%) and none after placebo (odds ratio for response, 4.0, 95% CI, .45-35.79; OR for remission, 3.0, 95% CI, .31-28.8). No serious adverse events occurred; all adverse events were brief and of mild to moderate severity. CONCLUSIONS: This proof-of-concept trial demonstrated that nitrous oxide has rapid and marked antidepressant effects in patients with TRD. KEYWORDS: Major depression; Nitrous oxide; Treatment-resistant depression PDF

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