[Neuroendocrine expression markers in triple-negative, luminal-A, luminal-B and HER2neu breast cancer]. / Expresión de marcadores neuroendócrinos en cáncer de mama triple-negativo, luminal-A, luminal-B y HER2neu.

Background: Primary breast tumors with neuroendocrine (NE) differentiation are a heterogeneous tumor group with diversity of biological behavior, with poorly defined prevalence and prognosis. Objective: To evaluate the chromogranin, synaptophysin, CD56, INSM1 markers expression prevalence and the association between NE differentiation and tumor molecular type. Material and methods: Observational, cross-sectional study which included 110 breast tissue samples with primary invasive carcinoma. Immunohistochemistry was performed for chromogranin, synaptophysin, CD56 and INMS1 markers. NE differentiation was considered with 10-90% positive cells, and NE tumor with > 90% positive cells. Results: 26.3% showed neuroendocrine differentiation. Out of these, 48.2% were luminal-A type, 24.1% luminal-B, 11.5% HER2neu, 17.2% triple-negative; 1.8% were NE tumors. Tumors were marker positive, and out of these to chromogranin in 24.5%, synaptophysin in 28.2%, CD56 in 2.7%, INSM1 in 16.4%. Synaptophysin was expressed in 17.3% luminal-A type, 6.4% luminal-B, 0.9% HER2neu, 3.6% triple-negative. NE differentiation showed association with synaptophysin expression (r = 0.586, p = 0.0001). Conclusion: The NE differentiation prevalence was 26.3% in primary invasive breast cancers, with luminal-A molecular type predominance.

Introducción: los tumores primarios de mama con diferenciación neuroendócrina (NEBC por sus siglas en inglés) son un grupo heterogéneo de tumores con diversidad de comportamiento biológico, con prevalencia y pronóstico poco definido. Objetivo: evaluar la prevalencia de la expresión los marcadores cromogranina, sinaptofisina, CD56, INSM1 y la asociación entre la diferenciación neuroendócrina y el tipo molecular del tumor. Material y métodos: estudio observacional, transversal que incluyó 110 muestras de tejido mamario con carcinoma invasor primario. Se realizó inmunohistoquímica para los marcadores cromogranina, sinaptofisina, CD56 y INMS1. La presencia 10-90% de células positivas se consideró diferenciación neuroendócrina y tumor neuroendócrino con > 90% de células positivas. Resultados: el 26.3% mostró diferenciación neuroendócrina. De estos, 48.2% fueron tipo luminal-A, 24.1% luminal-B, 11.5% HER2neu y 17.2% triple-negativo; 1.8% resultaron tumores neuroendócrinos. Los tumores presentaron marcadores positivos y de estos, 24.5% fueron a cromogranina, 28.2% a sinaptofisina, 2.7% a CD56 y 16.4% a INSM1. La sinaptofisina se expresó en 17.3% del tipo luminal-A, 6.4% luminal-B, 0.9% HER2neu, 3.6% triple-negativo. La diferenciación neuroendócrina mostró asociación con la expresión de sinaptofisina (r = 0.586, p = 0.0001). Conclusión: la prevalencia de la diferenciación neuroendócrina fue del 26.3% en los cánceres invasores primarios de mama, con predominio en el tipo molecular luminal-A.

[Aggressive multifocal extensive cutaneous epithelioid haemagioendothelioma. A case report]. / Hemangioendotelioma epitelioide cutáneo extenso multifocal agresivo. Informe de un caso.

Epithelioid haemangioendothelioma is a rare vascular tumor, first described in 1975 by Dail and Liebow as a bronchioloalveolar carcinoma. Although it usually behaves like a low-grade neoplasm, cases have been reported in which the tumor shows a high grade of malignancy, spreading rapidly throughout the body. We present the case of a 41-year-old man with dermatosis in the left thigh with rapid extension to the abdomen; the initial differential diagnoses were metastatic carcinoma versus lymphoma. When the histopathology was re-examined, a diagnosis of skin epithelioid hemangioendothelioma was confirmed and treatment with radiotherapy was initiated. This tumour rarely affects the skin; there are only a few previously reported cases.

Relación neutrófilos, linfocitos y plaquetas como predictor de lesión renal aguda en sepsis por COVID-19 en la Unidad de Cuidados Intensivos / Neutrophiles, lymphocytes and platelets ratio as a predictor of acute kidney injury in sepsis by COVID-19 in the Intensive Care Unit / Relação de neutrófilos, linfócitos e plaquetas como preditor de lesão renal aguda na sepse por COVID-19 na Unidade de Terapia Intensiva

Resumen: Introducción: La lesión renal aguda se encuentra en 40% de los pacientes que presentan sepsis (S-LRA), ya que la inflamación es una de las causas fisiopatológicas de la lesión renal aguda. Durante la pandemia, la principal causa de sepsis en la unidad de cuidados intensivos (UCI) fue secundaria a enfermedad por coronavirus 2019 (COVID-19), en ésta se ha reportado incidencia de lesión renal de 36 a 75%. La fisiopatología de esta complicación aún no se conoce, pero se han demostrado mecanismos similares a la lesión renal séptica típica. La relación neutrófilos, linfocitos y plaquetas (RNLP) previamente se ha asociado con la presencia de lesión renal aguda en otros ámbitos (cirugía cardiaca y cirugía abdominal mayor), y en pacientes con sepsis secundaria a COVID-19 puede ser un marcador que identifique a los pacientes con riesgo de presentar esta complicación. Objetivo: Determinar si la relación neutrófilos, linfocitos y plaquetas es un predictor de lesión renal aguda en sepsis secundaria a COVID-19 en la UCI adultos. Material y métodos: Estudio de cohorte prospectiva, unicéntrico. En pacientes mayores de 18 años que ingresen a la UCI con diagnóstico de sepsis por COVID-19 se realizará el cálculo de la RNLP desde el día uno hasta el día siete. Se dividen en dos grupos: RNLP mayor de tres puntos y RNLP igual o menor de tres puntos, observando presencia o no de lesión renal aguda durante su estancia, y posterior al desenlace. Para el objetivo principal se hace prueba χ2, y se realiza prueba de regresión logística multivariable para valorar la asociación de las diferentes variables con el desenlace (OR IC95%). Resultados: Se estudió una población de 119 pacientes, se obtuvo una incidencia de lesión renal aguda inducida por sepsis (S-LRA) de 53.8% (IC95% 44-62%) en pacientes con sepsis secundaria a COVID-19, siendo la mayoría KDIGO I (53.2%). El grupo de RNLP mayor de tres tuvo una incidencia de 68.4% de S-LRA en comparación con el grupo de RNLP igual o menor de tres con 28% (p = 0.001, OR 4.255 IC95% 1.782-10.16), los pacientes con RNLP mayor de tres tuvieron estancia más prolongada en la UCI (12 versus 10 días, p = 0.018), y más tiempo de ventilación mecánica (11 versus ocho días, p = 0.003). Conclusión: El incremento de la relación neutrófilos, linfocitos y plaquetas es un factor de riesgo y puede ser pronóstico para la presencia de lesión renal aguda en sepsis por COVID-19 en la UCI.

Abstract: Introduction: Acute kidney injury is found in 40% of patients with sepsis (S-AKI), since inflammation is one of the pathophysiological causes of acute kidney injury. During the pandemic, the main cause of sepsis in the ICU was secondary to COVID-19, in which an incidence of kidney injury of 36 to 75% has been reported. The pathophysiology of this complication is not yet known, but mechanisms similar to typical septic kidney injury have been demonstrated. The neutrophil, lymphocyte and platelet ratio (RNLP) has previously been associated with the presence of acute kidney injury in other settings (cardiac surgery and major abdominal surgery) and in patients with sepsis secondary to COVID-19 it may be a marker that identifies the patients at risk of presenting this complication. Objective: To determine if the ratio of neutrophils, lymphocytes and platelets is a predictor of acute kidney injury in sepsis secondary to COVID-19 in the adult ICU. Material and methods: Prospective, single-center cohort study. In patients over 18 years of age who are admitted to the ICU with a diagnosis of sepsis due to COVID-19, the RNLP will be calculated from day 1 to day 7, it is divided into 2 groups: RNLP greater than 3 and RNLP equal or less than 3, observing the presence or not of acute kidney injury during their stay, and after the outcome, for the main objective a χ2 test is performed, and a multivariate logistic regression test is performed to assess the Association of the different variables with the outcome (OR with 95% CI). Results: A population of 119 patients was studied, there was an incidence of S-AKI of 53.8% (95% CI 44-62%) in patients with sepsis secondary to COIVD-19, the majority being KDIGO I (53.2%). In the RNLP group greater than 3 I had a 68.4% incidence of S-AKI compared to the RNLP group less than or equal to 3 with 28% (p = 0.001, OR 4.255 95% CI 1.72-10.16), the patients with RNLP greater than 3 had a longer stay in the ICU (12 vs 10 days, p = 0.018), and a longer time of mechanical ventilation (11 vs 8 days, p = 0.003). Conclusion: The increase in the neutrophil, lymphocyte and platelet ratio is a risk factor and can be a prognostic for the presence of acute kidney injury in sepsis due to COVID-19 in the ICU.

Resumo: Introdução: A lesão renal aguda é encontrada em 40% dos pacientes com sepse (S-LRA), uma vez que a inflamação é uma das causas fisiopatológicas da lesão renal aguda. Durante a pandemia, a principal causa de sepse na UTI foi secundária à COVID-19, na qual a incidência de lesão renal foi relatada de 36 a 75%. A fisiopatologia dessa complicação ainda não é conhecida, mas mecanismos semelhantes à lesão renal séptica típica foram demonstrados. A proporção de neutrófilos, linfócitos e plaquetas (RNLP) já foi associada à presença de lesão renal aguda em outros âmbitos (cirurgia cardíaca e cirurgia abdominal de grande porte) e em pacientes com sepse secundária à COVID-19 pode ser um marcador que identifica os pacientes em risco de apresentar esta complicação. Objetivo: Determinar se a proporção de neutrófilos, linfócitos e plaquetas é um preditor de lesão renal aguda na sepse secundária à COVID-19 na UTI adulto. Material e métodos: Estudo de coorte prospectivo, unicêntrico. Pacientes maiores de 18 anos admitidos na UTI com diagnóstico de sepse por COVID-19, o RNLP será calculado do dia 1 ao dia 7, dividido em 2 grupos: RNLP maior que 3 e RNLP igual ou inferior a 3, observando a presença ou não de lesão renal aguda durante sua internação, e posteriormente o desfecho, para o objetivo principal, é realizado um teste de χ2, e se realiza um teste de regressão logística multivariável para avaliar a associação das diferentes variáveis com o resultado (OR com 95% IC). Resultados: Estudou-se uma população de 119 pacientes, com incidência de S-LRA de 53.8% (IC 95% 44-62%) em pacientes com sepse secundária a COVID-19, sendo a maioria KDIGO I (53.2%). No grupo RNLP maior que 3, houve uma incidência de 68.4% de S-LRA comparado ao grupo RNLP menor ou igual a 3 com 28% (p = 0.001, OR 4.255, IC 95% 1.782-10.16), os pacientes com RNLP maior que 3 tiveram maior tempo de permanência na UTI (12 vs 10 dias, p = 0.018) e maior tempo em ventilação mecânica (11 vs 8 dias, p = 0.003). Conclusão: O aumento da proporção de neutrófilos, linfócitos e plaquetas é um fator de risco e pode ser prognóstico para a presença de lesão renal aguda na sepse por COVID-19 na UTI.

Terapia de electroestimulación para el tratamiento de la atrofia diafragmática inducida por ventilación mecánica / Electrostimulation therapy for the treatment of diaphragmatic atrophy induced by mechanical ventilation / Terapia de eletroestimulação para o tratamento da atrofia diafragmática induzida por ventilação mecânica

Resumen: Introducción: La atrofia y disfunción del músculo diafragmático es frecuente en pacientes sometidos a ventilación mecánica. La terapia de electroestimulación diafragmática transcutánea (TEDT) ha demostrado mejorar la fuerza en pacientes con debilidad muscular; sin embargo, no ha sido evaluada como tratamiento para la atrofia en la disfunción diafragmática inducida por ventilación mecánica (DDIVM). Objetivo: Determinar si la TEDT puede mejorar el grosor diafragmático de los pacientes que se encuentran bajo ventilación mecánica. Material y métodos: Se realizó un ensayo clínico aleatorizado en dos grupos independientes: un grupo intervención con 15 pacientes y un grupo control con 17 pacientes. El grupo de intervención recibió TEDT con sesiones de 20 minutos cada seis horas en las 72 horas subsecuentes a su inclusión al estudio. El grosor diafragmático basal fue medido mediante ecografía en ambos grupos, después de la TEDT para el grupo intervención y 72 horas después en el grupo control. Resultados: De los 32 pacientes evaluados se documentó una media de grosor diafragmático inicial para el grupo control de 2.04 ± 0.43 mm y de 1.9 ± 0.52 mm para el grupo intervención con un valor de p = 0.652. Posterior a la intervención, se registró una media de grosor diafragmático final de 1.7 ± 0.43 mm para el grupo control y 2.3 ± 0.55 mm para el grupo intervención con un valor de p = 0.002 al comparar ambos grupos. Conclusión: Se encontró diferencia estadísticamente significativa en ambos grupos al aplicar la TEDT, evidenciando un aumento del grosor diafragmático basal en el grupo intervención y disminución del mismo en el grupo control.

Abstract: Introduction: Muscle involvement in critically ill patients is present in the majority of those admitted to the intensive care unit, including alteration of the diaphragmatic muscle, especially during mechanical ventilation (MV). Transcutaneous diaphragmatic electrostimulation therapy (TEDT) has been shown to improve respiratory strength in patients with muscle weakness. However, it has not been evaluated as a treatment for atrophy in Ventilation-Induced Diaphragmatic Dysfunction (DDIVM). Objective: To determine if TEDT can improve diaphragmatic thickness in patients undergoing mechanical ventilation. Material and methods: A randomized clinical trial was carried out in two independent groups: an intervention group with 15 patients and a control group with 17 patients. The intervention group received TEDT with sessions of 20 minutes every 6 hours in the 72 hours after their inclusion in the study. Baseline diaphragm thickness was measured by ultrasound in both groups, after TEDT for the intervention group and 72 hours later in the control group. Results: Of the 32 patients evaluated, a mean initial diaphragmatic thickness was documented for the control group of 2.04 ± 0.43 mm and of 1.9 ± 0.52 mm for the intervention group with a p value of 0.652. After the intervention, a mean final diaphragmatic thickness of 1.7 ± 0.43 mm was recorded for the control group and 2.3 ± 0.55 mm for the intervention group with a p value of 0.002 when comparing both groups. Conclusion: A statistically significant difference was found in both groups when applying TEDT, showing an increase in baseline diaphragmatic thickness in the intervention group and a decrease in it in the control group.

Resumo: Introdução: Atrofia e disfunção do músculo diafragmático é comum em pacientes submetidos à ventilação mecânica. A terapia de estimulação elétrica diafragmática transcutânea (TEDT) demonstrou melhorar a força em pacientes com debilidade muscular, mas não foi avaliada como tratamento para atrofia na disfunção diafragmática induzida pela ventilação (DDIVM). Objetivo: Determinar se a TEDT pode melhorar a espessura diafragmática de pacientes com ventilação mecânica. Material e métodos: Realizou-se um ensaio clínico randomizado em 2 grupos independentes: um grupo intervenção com 15 pacientes e um grupo controle com 17 pacientes. O grupo intervenção recebeu TEDT com sessões de 20 minutos a cada 6 horas por 72 horas após a inclusão no estudo. A espessura diafragmática basal foi medida por ultra-som em ambos os grupos, após TEDT para o grupo de intervenção e 72 horas depois no grupo controle. Resultados: Dos 32 pacientes avaliados, (17 grupo controle, 15 grupo intervenção). Documentou-se uma média da espessura diafragmática basal para o grupo controle de 2.04 ± 0.43 mm e 1.9 ± 0.52 mm para o grupo intervenção com um valor de p = 0.652. Após a intervenção, foi registrada uma espessura média final do diafragma de 1.7 ± 0.43 mm para o grupo controle e 2.3 ± 0.55 mm para o grupo intervenção, com valor de p = 0.002 na comparação entre os dois grupos. Conclusão: Encontrou-se diferença estatisticamente significativa em ambos os grupos na aplicação do TEDT, mostrando aumento da espessura basal do diafragma no grupo intervenção e diminuição da mesma no grupo controle.

Determinación niveles de glucosa por medio de espectroscopía como método no invasivo / Determination of glucose levels by means of spectroscopy as a non-invasive method

Introducción: la diabetes mellitus es uno de los problemas más graves de salud pública que enfrenta México. El factor más preocupante es la falta de control de la misma, lo que incide de manera directa, causando daños severos a la salud y la calidad de vida del paciente y familiares, así como una carga económica al país. Por lo tanto, el desarrollo de un método no invasivo para la medición de la glucemia proporcionaría a los pacientes una forma sencilla e indolora de monitoreo y, en consecuencia, un mejor control de la diabetes. Objetivo: investigar, desarrollar y validar un sensor no invasivo por medio de la espectroscopía para la estimación del nivel de glucosa en sangre. Material y métodos: se realizó un análisis de estudio transversal analítico de correlación realizado en las instalaciones del laboratorio de la UMAE No 1, Bajío. Se incluyeron pacientes adultos voluntarios que acudieron al laboratorio de dicha unidad para la toma de niveles de glucosa sérica y de manera simultánea se realizó la medición a través de método no invasivo por espectroscopía y, posteriormente, se compararon ambos resultados para demostrar la validez del dispositivo. Resultados: mediante el análisis de la diferencia de medias de Bland-Altman, se identificó que solamente un paciente tuvo un valor extremo, y que el método para medir la glucosa de manera no invasiva sobreestima hasta un 10.2% del valor de glucosa central. Conclusión: comparando dichos resultados con las normas para glucómetros digitales se concluye que nuestro dispositivo es capaz de proporcionar niveles de glucosa certeros.

Background: Diabetes mellitus is one of the most serious public health problems in Mexico. The most worrying factor is the lack of control of it, which has a direct impact, causing severe damage to the health and quality of life of the patient and its family, as well as an economic burden to the health system. Therefore, the development of a non-invasive method for measuring blood glucose would provide to patients a simple and painless way of monitoring and consequently better control of diabetes. Objective: Research, development and validation of a non-invasive sensor by means of spectroscopy for the estimation of the blood glucose level. Material and methods: An analysis of a cross-sectional analytical correlation study was carried out in the facilities of the laboratory at the UMAE No. 1, Bajío. Voluntary adult patients who attended the laboratory of the UMAE to take serum glucose levels were included, and simultaneously the measurement was carried out through a non-invasive method by spectroscopy and, later, both results were compared to demonstrate the validity of the device. Results: By the Bland-Altman mean difference analysis, it was identified that only one patient had an extreme value, and that the method to measure glucose non-invasively overestimates up to 10.2% of the central glucose value. Conclusion: Comparing these results with the standards for digital glucometers, it is concluded that our device is capable of providing accurate glucose levels.

Comparación entre la técnica de malla cupular elíptica (MCE) con la técnica de Lichtenstein para disminuir el dolor postquirúrgico en plastía inguinal abierta: Resultados preliminares / Comparison of a dome-shaped elyptical mesh (DSEM) technique with the Lichtenstein technique to diminish post-surgical pain in open hernioplasty: Preliminary results

Objetivo: Comparar la técnica de Lichtenstein con la técnica de la malla cupular elíptica (MCE) en cuanto a dolor postoperatorio. Sede: Unidad Médica de Atención Ambulatoria número 55 del Instituto Mexicano del Seguro Social. León, Gto. Diseño: Ensayo clínico controlado, aleatorizado, doble ciego. Análisis estadístico: Chi cuadrada, prueba Logrank-KaplanMeier, análisis de varianza de medidas repetidas con factor agrupante, análisis de riesgo de Cox. Material y métodos: Aleatorizamos 90 pacientes con hernia inguinal en dos grupos: MCE y Lichtenstein. Seguimiento a la semana, uno, tres y seis meses. Variables estudiadas: intensidad del dolor por escala visual análoga, frecuencia de dolor, consumo de analgésicos, tipo de disestesias, complicaciones y recidiva a seis meses. Resultados: Grupos comparables en características generales. Encontramos proporción menor de pacientes con dolor en grupo MCE (X2 = 7.28, p = 0.007). MCE mostró menor intensidad del dolor con (F = 22.37, p = 0.000003). No hubo diferencias en tiempo quirúrgico, consumo de analgésicos o frecuencia de disestesias a excepción de la primera semana. La técnica quirúrgica demostró ser determinante para dolor en análisis de riesgo (p = 0.009). Se presentó una recidiva en grupo MCE. Conclusiones: MCE es una técnica quirúrgica, igual de efectiva y segura que la técnica Lichtenstein y produce menor dolor postoperatorio.

Iron overload as cardiovascular risk factor in children and adolescents with renal disease.

BACKGROUND: Iron overload can affect cardiac structure and function by the production of free radicals in addition to iron deposits in heart muscle. The purpose of this study was to compare traditional and non-traditional cardiovascular risk factors (CVRF) in children and adolescents on renal replacement with and without iron overload. Also, we evaluated the relationships between iron overload and left ventricular mass (LVM). METHODS: First, in a cross-sectional study, we evaluated traditional and non-traditional CVRF in 143 children and adolescents, 48 on peritoneal dialysis (PD), 53 on hemodialysis (HD) and 42 after renal transplantation according to iron overload. In a second phase with a case-control study, we measured LVM in 12 case patients and 12 matched controls. RESULTS: Iron overload was identified in 15 patients (10.5%), 11 in HD and 4 in PD (P = 0.002). The group with iron overload had lower body mass index (17 versus 19; P = 0.01), total cholesterol (132 versus 165 mg/dL; P = 0.03) and hemoglobin (8.5 versus 10.6 g/dL; P = 0.003) but higher interleukin (IL)-6 levels (4.8 versus 3.6 ng/L; P = 0.04) and hypertension diagnosis (79 versus 48%; P < 0.001) than those without iron overload. Ferritin showed a positive correlation with C-reactive protein (CRP) and IL-6 levels. In a subgroup of 24 patients (12 with and 12 without iron overload), LVM was not different. However, ferritin levels showed a borderline positive correlation (r = 0.44, P = 0.05) with LVM. CONCLUSION: Children and adolescents with iron overload show more CVRFs, especially if they received replacement therapy with HD. Ferritin is related to CRP and IL-6 levels.

Las cardiopatías congénitas asociadas a ductus persistente pueden tratarse con stent: presentación de tres casos y revisión de la literatura / Congenital heart defects associated with persistent ductus and stent treatment: case report and literature review

Presentación de tres casos de cardiopatías asociadas al ductus persistente, donde la colocación de stentfue una alternativa de tratamiento, como paso previo a la corrección quirúrgica.

[Coronary artery disease in Mexican women]. / Cardiopatía isquémica en mujeres mexicanas.

OBJECTIVE: To identify differences between both genders regarding coronary artery disease occurrence. PATIENTS AND METHODS: In referred patients for cardiac catheterization we investigated coronary risk factors, clinical diagnosis, associated diseases, left ventricle ejection fraction, and coronary lesions. Data were analyzed by X2 test, Student t test, odds ratio and confidence intervals, a p value < 0.05 was considered significant. RESULTS: We studied 586 patients, 409 were men. Women were older than men (59.43 +/- 9.93 vs 56.80 +/- 10.14 years old, p < 0.05). The frequency of coronary lesions in women was 56 vs 81% in men. The proportions of positive nuclear medicine studies (14 vs 16%) and exercise treadmill test (36 vs 28%) were similar. Acute myocardial infarction was the most frequent diagnosis in men (46%) whereas in women it was angor pectoris (57%). Smoking was observed more in men (72 vs 26%) and systemic arterial hypertension in women (65 vs 48%), There were no differences in diabetes mellitus and dyslipidemia frequencies. CONCLUSION: Systemic arterial hypertension was the risk factor more frequent in women, where as in men it was smoking. Ischemia induction tests are less specific to identify coronary atherosclerosis in women. In spite of the clinical data, image and laboratory results, we had a great proportion of women without coronary lesions.

Cardiopatía isquémica en mujeres mexicanas / Coronary artery disease in Mexican women

OBJECTIVE: To identify differences between both genders regarding coronary artery disease occurrence. PATIENTS AND METHODS: In referred patients for cardiac catheterization we investigated coronary risk factors, clinical diagnosis, associated diseases, left ventricle ejection fraction, and coronary lesions. Data were analyzed by X2 test, Student t test, odds ratio and confidence intervals, a p value < 0.05 was considered significant. RESULTS: We studied 586 patients, 409 were men. Women were older than men (59.43 +/- 9.93 vs 56.80 +/- 10.14 years old, p < 0.05). The frequency of coronary lesions in women was 56 vs 81% in men. The proportions of positive nuclear medicine studies (14 vs 16%) and exercise treadmill test (36 vs 28%) were similar. Acute myocardial infarction was the most frequent diagnosis in men (46%) whereas in women it was angor pectoris (57%). Smoking was observed more in men (72 vs 26%) and systemic arterial hypertension in women (65 vs 48%), There were no differences in diabetes mellitus and dyslipidemia frequencies. CONCLUSION: Systemic arterial hypertension was the risk factor more frequent in women, where as in men it was smoking. Ischemia induction tests are less specific to identify coronary atherosclerosis in women. In spite of the clinical data, image and laboratory results, we had a great proportion of women without coronary lesions.

Angiographic concurrence of coronary artery disease and aortoiliac lesions.

The importance of recognizing the association between aortoiliac disease and coronary artery disease includes the following: (1) Long-term morbidity is higher and survival ratio poorer in patients with coronary heart disease compared with isolated lower extremity revascularization surgery. (2) Coronary artery bypass grafting is a relatively high-risk procedure in patients with severe vascular disease. (3) There is the prospect that the patient will eventually face simultaneous coronary artery and vascular surgery, or coronary artery angioplasty previous to aortoiliac surgery. The aim of this investigation is to know the frequency of the association of coronary artery disease with aortoiliac lesions and to stratify the risk factors related to such an association. In total, 65 men and 19 women (30 to 76 years of age) with a history of coronary heart disease underwent abdominal aortography after selective coronary artery and left ventricle angiography. Aortoiliac lesions were identified at angiograms. Relevant coronary artery disease was diagnosed when at least 1 coronary artery was obstructed > 50%. The frequency of association between aortoiliac and coronary artery lesions was established, as well as the relationship of these lesions to the following clinical variables: age, weight, height, smoking habit, history of coronary heart disease, systemic arterial hypertension, diabetes mellitus, intermittent claudication, glycemia, uricemia, and triglyceridemia. There were 36 patients (42.9%) with aortoiliac lesions. In 34 patients (40.5%) coronary artery disease was associated with aortoiliac lesions. Abdominal aortic dilations were found in 10 instances, abdominal aortic stenosis in 13 patients, and stenosis of the iliac arteries or their branches on 28 occasions. The variables statistically related to the presence of aortoiliac lesions were smoking habit and a history of intermittent claudication. The number of affected coronary arteries was directly related to the frequency of aortoiliac lesions. In the entire sample, 11 patients (13%) had no coronary artery disease, and 15 (17.9%) had 1-vessel, 24 (28.6%) 2-vessel, and 34 (40.5%) 3-vessel disease. The extent of coronary disease was directly related to the frequency and extent of aortoiliac lesions. Frequencies of aortoiliac lesions were strongly related to a history of smoking habit and intermittent claudication and directly related to the extent of coronary artery disease.