Surface ozone comparison conducted in two rural areas in central-southern Spain.

PURPOSE: The purpose of this work is to contribute to the understanding of the photochemical air pollution analysing the levels and temporal variations of surface ozone in two rural areas situated in central-southern Spain. METHOD: The study is based on ozone hourly data recorded during the overall period between January 2008 and November 2009. The seasonal and daily ozone cycles as well as the number of exceedances of the threshold established in the European Ozone Directive have been calculated and analysed. RESULTS: This study presents the first ozone data registered at these two rural sites in the Iberian Peninsula plateau. Ozone shows a clear seasonal variation with the lowest values in January and November. High ozone concentrations are interrelated with high radiation intensities, temperature and wind directions. The information threshold defined in the European Ozone Directives was exceeded six times, while the limit for protection of human health was exceeded more than 40 times. The limits to protect the vegetation were also exceeded. CONCLUSIONS: Porzuna (near Cabañeros National Park) presents higher ozone levels than Argamasilla during the night-time and during the daytime of the summer months. Ozone levels are lower in Argamasilla probably due to fresh emissions from the close industrial area of Puertollano. The ozone exceedances of the limits defined in the Ozone Directive point out an ozone problem in this rural region.

Agenesis of the inferior vena cava associated with lower extremities and pelvic venous thrombosis.

The absence of the inferior vena cava is an uncommon congenital anomaly and can be misdiagnosed. We report a 14-year-old boy initially admitted as a result of a painful abdominal mass; after admission, he experienced a deep venous thrombosis in his left leg. Subsequent evaluation revealed the congenital absence of the entire inferior vena cava, with a cluster of thrombosed collateral veins in his right pelvis, corresponding to the abdominal mass. The recognition of this anomaly may be helpful in the event of differential diagnosis in retroperitoneal masses. In young patients with idiopathic deep venous thrombosis, an inferior vena cava anomaly should be considered.

Síndrome de robo coronario-subclavio tratado mediante bypass carótido-subclavio / Treatment of coronary-subclavian steal syndrome by means of a carotid-subclavian bypass

Introducción. El síndrome de robo coronario-subclavio es una causa poco frecuente de angina recurrente que ocurre en pacientes intervenidos de bypass aortocoronario con injerto de arteria mamaria interna (AMI) izquierda. Una estenosis significativa u obstrucción en la arteria subclavia proximal al origen de la AMI puede limitar el flujo por el injerto, o incluso invertirlo, de manera que provoque una isquemia miocárdica. Caso clínico. Presentamos el caso de una paciente de 78 años de edad, intervenida de cirugía coronaria dos años y medio antes, con clínica de angina refractaria al tratamiento médico e isquemia electrocardiográfica en el territorio de la arteria descendente anterior. La arteriografía confirmó una obstrucción de la arteria subclavia izquierda proximal a la salida de la AMI; se intentó un tratamiento endovascular, que no fue efectivo, por lo que se realizó un bypass carótido-subclavio, junto con una endarterectomía carotídea derecha por una estenosis preoclusiva de ésta, con resultado satisfactorio. Conclusiones. Con el uso creciente de la AMI como injerto para revascularización coronaria y el aumento de la edad de los pacientes con patología vascular concomitante, cada vez es más frecuente el síndrome de robo coronario-subclavio. Una adecuada selección y seguimiento de los pacientes antes y después de la cirugía coronaria puede reducir su incidencia. La angioplastia percutánea y la colocación de stent ofrecen buenos resultados, pero pueden ocasionar complicaciones como embolización o disección local, por lo que una técnica alternativa segura es el bypass carótido-subclavio clásico, con baja morbimortalidad y alta permeabilidad a largo plazo

INTRODUCTION. Coronary-subclavian steal syndrome is a rare cause of recurring angina that occurs in patients who have undergone coronary artery bypass surgery involving a left internal mammary artery (IMA) graft. A significant amount of stenosis or obstruction in the subclavian artery proximal to the origin of the IMA can limit the flow through the graft, or even invert it, which then causes myocardial ischaemia. CASE REPORT. We report the case of a 78-year-old female who had undergone heart surgery two and a half years earlier and who had a history of angina that was resistant to medical treatment, as well as electrocardiographic ischaemia in the territory of the anterior descending artery. An arteriography study confirmed the existence of an obstruction in the left subclavian artery proximal to the exit of the IMA. Endovascular treatment was attempted, although it was not effective, and so a carotid-subclavian bypass was performed, together with an endarterectomy in the right carotid artery, due to its being affected by preocclusive stenosis; results were satisfactory in both cases. CONCLUSIONS. With the increasingly frequent use of IMA as a graft for coronary revascularisation and the rising age of patients with concomitant vascular disorders, coronary-subclavian steal syndrome is becoming more and more common. The incidence of this condition can be reduced by proper selection and follow-up of patients before and after heart surgery. Percutaneous angioplasty and stent placement offer good results, but can give rise to complications such as embolisation or local dissection, which makes the classical carotid-subclavian bypass a safe alternative technique, with low morbidity and mortality rates and a high degree of long-term patency