Manejo del aneurisma de aorta abdominal sintomático no roto: últimos adelanto / Management of symptomatic unruptured abdominal aortic aneurysms: state of the art

RESUMEN El aneurisma de aorta abdominal (AAA) sintomático no roto es una patología que involucra a aquellos pacientes con AAA intacto, pero que presentan dolor abdominal y/o lumbar atribuido al aneurisma. Esta forma de presentación clínica es po tencialmente mortal dado que su etiopatogenia comprende cambios agudos en la pared aórtica, incluyendo inflamación, lo que incrementa la probabilidad de ruptura inminente. Está claro que estos pacientes deben ser derivados a reparación del AAA. Sin embargo, el momento de la intervención es controvertido. Por lo tanto, el objetivo del presente trabajo fue revisar la información actualizada sobre el abordaje diagnóstico-terapéutico del AAA sintomático no roto.

ABSTRACT Symptomatic unruptured abdominal aortic aneurysm (AAA) refers to a group of patients with intact AAA but who present abdominal and/or lumbar pain attributed to the aneurysm. This form of clinical presentation is potentially fatal since its etiopathogenesis, involving acute changes in the aortic wall, including inflammation, increases the probability of impending rupture. It is clear that these patients should be referred to AAA repair. However, the timing of the intervention is contro versial. Therefore, the aim of the present work was to review updated information on the diagnostic-therapeutic approach of symptomatic unruptured AAA.

Endoscopically Active Ulcerative Colitis Is Associated With Asymptomatic Atherosclerotic Vascular Disease: A Case-Control Study.

BACKGROUND: Chronic inflammation in immune-mediated conditions has been associated with an increased risk in atherosclerotic disease. There is paucity of evidence regarding the prevalence of asymptomatic atherosclerosis in patients with ulcerative colitis (UC) and its association with disease activity. We sought to compare the prevalence of asymptomatic atherosclerotic disease between young patients with UC with and without mucosal healing (MH) and healthy control individuals. METHODS: An observational study was conducted in 2 hospitals in Buenos Aires, Argentina. Patients with UC 18 to 50 years of age with at least 1 previous colonoscopy in the last year were enrolled, along with age- and sex-matched healthy control individuals. Carotid and femoral ultrasound assessments were performed to determine the prevalence of atherosclerotic lesions and abnormal intima-media thickness (IMT). We compared the prevalence of atherosclerotic disease and the prevalence of abnormally increased IMT in at least 1 vascular territory. RESULTS: Sixty patients with UC and 60 healthy control individuals were enrolled. Mean age was 38 years and 53.33% were men. Although the prevalence of atherosclerotic lesions was similar in patients with UC without MH when compared with both patients with UC with MH and control individuals (3.7% vs 0% vs 6.67%; P = .1), we found a significant increase in abnormal IMT in at least 1 vascular territory in UC patients without MH when compared with healthy control individuals (48.15% vs 26.67%; P = .05). CONCLUSIONS: Patients with UC with active mucosal inflammation showed a significantly increased odds of asymptomatic femoral or carotid vascular disease when compared with control individuals.

Young patients with endoscopically active ulcerative colitis showed a significantly higher prevalence of abnormal intima-media thickness when compared with control individuals. Among patients with ulcerative colitis, age, disease duration, and C-reactive protein were associated with increased odds of asymptomatic vascular lesions.

Angioplastia primaria en el infarto agudo de miocardio: predictores de eventos en el seguimiento a largo plazo / Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction: Long-Term Predictors of Adverse Events

Introducción: El infarto agudo de miocardio (IAM) es una de las principales causas de muerte cardiovascular. Los tratamientos de reperfusión, aplicados dentro de las primeras horas del evento, han contribuido a disminuir significativamente esa mortalidad. No existen en nuestro país registros con seguimiento a largo plazo de pacientes con IAM tratados con angioplastia transluminal coronaria primaria (ATCP). Objetivos: Evaluar los resultados intrahospitalarios y el pronóstico alejado de pacientes sometidos a ATCP por IAM con supra-desnivel del segmento ST (IAMCST) y su relación con las principales variables clínicas y terapéuticas aplicadas en diferentes décadas (1993-2002 vs. 2003-2012). Material y métodos: Estudio observacional y retrospectivo de todos los pacientes con diagnóstico de IAMCST a los que se les realizó una ATCP en dos hospitales de comunidad entre los años 1993 y 2012. Resultados: Se incluyeron 851 pacientes ingresados consecutivamente entre los años 1993 y 2012. La edad promedio fue de 61 ± 12 años y la mediana de seguimiento fue de 7,8 años en el 85% de la población. La mortalidad intrahospitalaria total fue del 6% y del 1,6% excluidos los pacientes con shock al ingreso; las variables independientes asociadas fueron la edad (OR 1,06, IC 1,03-1,09; p < 0,001), el sexo femenino (OR 3,1, IC 1,5-6,2; p < 0,002), la diabetes mellitus (OR 3,9, IC 1,86-8; p < 0,001) y la enfermedad de tres vasos coronarios (OR 4,3, IC 2,1-8,6; p < 0,001); el flujo final TIMI 3 fue una variable predictora de menor mortalidad intrahospitalaria (OR 0,28, IC 0,08-0,11; p < 0,008). La mortalidad global en el seguimiento fue del 14,3% y los predictores independientes fueron la edad (OR 3,1, IC 1,8-5,5; p < 0,001), la diabetes mellitus (OR 2,3, IC 1,25-4,3; p < 0,007) y la clase C o D de la clasificación de Killip y Kimball (KK) al ingreso (OR 4, IC 1,7-9; p < 0,001); la utilización de stent se asoció con menor mortalidad global alejada (OR 0,35, IC 0,21-0,6; p < 0,001). Conclusiones: En este grupo de pacientes con IAMCST, la ATCP aplicada adecuadamente y una elevada tasa de seguimiento alejado permitió obtener resultados intrahospitalarios favorables que se mantienen en el largo plazo. La edad avanzada al momento del IAMCST, la diabetes mellitus, el sexo femenino y la presencia de lesiones significativas en más de un vaso epicárdico mayor fueron los predictores de mortalidad intrahospitalaria, mientras que los dos primeros (edad y diabetes mellitus) y el KK C o D fueron predictores independientes de mortalidad en el seguimiento. Los pacientes asistidos durante la segunda década mostraron una tendencia no significativa a menor mortalidad intrahospitalaria en comparación con los de la primera década.

Introduction: Acute myocardial infarction (AMI) is one of the leading causes of cardiovascular death. Reperfusion treatments performed within the first hours have contributed to produce a significant reduction in mortality. In our country, there are no long-term follow-up registries of AMI patients treated with primary percutaneous coronary intervention (PCI). Objectives: The aim of this study is to evaluate the in-hospital results and long-term outcome of ST-segment elevation AMI (STEMI) patients undergoing primary PCI and their correlation with the main clinical and therapeutic variables applied in different decades (1993-2002 vs. 2003-2012). Methods: We performed an observational and retrospective study of all STEMI patients undergoing primary PCI in two community hospitals between 1993 and 2012. Results: The study included 851 patients consecutively admitted between 1993 and 2012. Mean age was 61 ± 12 years and median follow-up was 7.8 years in 85% of the population. In-hospital mortality was 6% and 1.6% when patients with shock at admission were excluded. It was independently associated with age (OR 1.06, CI 1.03-1.09; p < 0.001), female sex (OR 3.1, CI 1.5-6.2; p < 0.002), diabetes mellitus (OR 3.9, CI 1.86-8; p < 0.001) and three-vessel disease (OR 4.3, CI 2.1-8.6; p < 0.001). Conversely, final TIMI grade 3 flow predicted lower in-hospital mortality (OR 0.28, CI 0.08-0.11; p < 0.008). During follow-up, overall mortality was 14.3% and the independent predictors were age (OR 3.1, CI 1.8-5.5; p < 0.001), diabetes mellitus (OR 2.3, CI 1.25-4.3; p < 0.007) and Killip and Kimball (KK) class C or D at admission (OR 4, CI 1.7-9; p < 0.001); stent implant was associated with lower overall long-term mortality (OR 0.35, CI 0.21-0.6; p < 0.001). Conclusions: In this group of STEMI patients, the adequate use of primary PCI and the high rate of patients at long-term follow-up allowed the collection of favorable in-hospital and long-term results. Advanced age at the moment of STEMI, diabetes mellitus, female sex and multiple vessel disease were predictors of in-hospital mortality, while age, diabetes mellitus and KK class C or D were independent predictors of mortality during follow-up. Patients treated during the second decade showed a non-significant trend towards reduced in-hospital mortality compared with those of the first decade.

Bacteriemia en pacientes internados con celulitis / Bacteremia in patients hospitalized with cellulitis

La celulitis es una inflamación aguda de la dermis y tejido celular subcutáneo de causa bacteriana, que generalmente complica a heridas, úlceras y dermatosis, aunque de manera frecuente no existe sitio de entrada. Se recomienda la realización de cultivo de punción de piel y partes blandas (PPB). Los hemocultivos raramente dan resultados positivos. El objetivo de este trabajo fue determinar la prevalencia de bacteriemia en pacientes internados en nuestra institución con diagnóstico de celulitis. Se analizaron retrospectivamente los registros clínicos de los pacientes con este diagnóstico al ingreso entre junio de 2007 y marzo de 2010. Se evaluaron los datos poblacionales, presencia de comorbilidades, y resultados de los cultivos. En ese período, se internaron 140 pacientes con diagnóstico de celulitis y a todos ellos se les realizó hemocultivo y cultivos de PPB. Setenta y cuatro eran varones (52.8%). La edad promedio: 47.5 ± 19.7 años (rango 16-94). El 40% tuvo cultivos positivos de PPB, en los que el Staphylococcus aureus meticilino resistente (SAMR) fue el germen más frecuentemente aislado (35.7%); la prevalencia de bacteriemia fue del 8.6%, en donde el germen más frecuente fue Streptoccocus Beta hemolítico, grupo G (33% del total de hemocultivos positivos). La bacteriemia se asoció significativamente a mayor estadía hospitalaria (10.5 ± 8.9 vs. 4.9 ± 6, p = 0.004). Se asoció con mayor riesgo de hemocultivo positivo a ser diabético, tener cultivo de PPB positivo, consumo de alcohol y/o enfermedad pulmonar obstructiva crónica.

Cellulitis is an acute inflammation of dermis and subcutaneous tissue, usually complicating wounds, ulcers, or dermatosis. Even though in these cases it is recommended to perform culture from skin and soft tissue samples, the utility of blood cultures remains controversial due to the low frequency of positive results. Here we report the prevalence of bacteremia in patients with cellulitis admitted in our Hospital, and evaluate the presence of risk factors associated with the occurrence of this event. Clinical records of patients with diagnosis of cellulitis admitted between June 2007 and March 2010 were retrospectively reviewed. Patients without skin and soft tissue culture and/or blood cultures were excluded. Demographic data, presence of comorbidities, and culture results were analyzed. In this period, 140 patients were admitted with this diagnosis. Fifty six (40%) of them had positive skin and soft tissue cultures; where methicillin resistant Staphylococcus aureus (MRSA) was the most frequently isolated bacterium species (35.7%). Bacteremia was detected in 8.6% of these cases, where the most frequently isolated bacteria were Group G Beta haemolytic Streptococcus (33%). Bacteremia was significantly associated with longer hospital stay (10.5 ± 8.98 vs. 4.9 ± 6, p = 0.004). The following variables were significantly associated with the occurrence of positive blood cultures: diabetes (41.7% vs. 14.1%; p = 0.02; OR 4.4), positive skin and soft tissue culture (75% vs. 35.2%; p = 0.01; OR 5.5), alcoholism (16.7% vs. 3.9%; p = 0.01; OR 4.9), and chronic obstructive pulmonary disease (16.7% vs. 0.78%; p = 0.01; OR 25.4).