Terapia endovascular en trauma periférico: una alternativa a la cirugía abierta tradicional / Endovascular therapy in peripheral trauma: our experience

Resumen Introducción: La terapia endovascular ha demostrado ser una buena alternativa de tratamiento en las enfermedades arteriales y venosas. Asimismo, en trauma vascular periférico constituye una excelente opción, especialmente en sitios anatómicos difíciles de acceder y con lesiones complejas como seudoaneurismas, fístulas arteriovenosas (FAV) o la combinación de ambos, con numerosas ventajas. Objetivo: Evaluar los resultados del tratamiento endovascular en trauma vascular penetrante por agresiones y iatrogenias. Materiales y Método: Revisión retrospectiva de todos los pacientes con trauma vascular periférico sometidos a terapia endovascular. Resultados: Entre abril de 2011 y mayo de 2020 se trataron 30 pacientes, 28 hombres y 2 mujeres. Con edades fluctuantes entre 17 y 84 años. La causa del trauma fue 20 penetrantes y 10 iatrogenias. Los vasos afectados fueron arteria femoral superficial 6, femoral profunda 2, subclavia 9, axilar 1, poplítea 4, ilíacas 1, peronea 1, tibial anterior 5, tronco venoso braquiocefálico 1. Diecisiete pacientes fueron tratados con endoprótesis, 9 con embolización y 4 con cierre percutáneo en relación con catéteres arteriales en subclavia. No hubo mortalidad, pero dos pacientes requirieron reparación abierta: un seudoaneurisma poplíteo gigante y un seudoaneurisma de tibial anterior, en ambos se constató sección completa de ambas arterias. El seguimiento clínico ha sido entre 30 días y 3 años. Conclusiones: En esta serie de casos, la terapia endovascular en lesiones de trauma vascular periférico ofrece excelentes resultados con baja morbimortalidad y permeabilidad aceptable a corto y mediano plazo.

Introduction: Endovascular therapy has proven to be a good treatment alternative in arterial and venous diseases. Likewise, in peripheral vascular trauma it is an excellent option, especially in anatomical sites that are difficult to access and with complex lesions such as pseudoaneurysms, arteriovenous fistulas (AVFs) or the combination of both, with numerous advantages. Aim: To evaluate the results of endovascular treatment in trauma Penetrating vascular injury and iatrogenesis. Materials and Method: Retrospective review of all patients with peripheral vascular trauma undergoing endovascular therapy. Results: Between April 2011 and May 2020, 30 patients were treated, 28 men and 2 women. With fluctuating ages between 17 and 84 years. The cause of the trauma was 20 penetrating and 10 iatrogenic. The affected vessels were superficial femoral artery 6, deep femoral 2, subclavian 9, axillary 1, popliteal 4, iliac 1, peroneal 1, anterior tibial 5, brachiocephalic venous trunk 1. Seventeen patients were treated with endoprosthesis, 9 with embolization and 4 with percutaneous closure in relation to arterial catheters in the subclavian. There was no mortality but two patients required open repair: a giant popliteal pseudoaneurysm and an anterior tibial pseudoaneurysm in which both sections of both arteries were found to be complete. Clinical follow-up was between 30 days and 3 years. Conclusión: In this serie, endovascular therapy in peripheral vascular trauma lesions offers excellent results with low morbidity and mortality and acceptable patency in the short and medium term.

Self-assembly of iron oxide precursor micelles driven by magnetic stirring time in sol-gel coatings.

The purpose of this work is to fabricate self-assembled microstructures by the sol-gel method and study the morphological, structural and compositional dependence of ε-Fe2O3 nanoparticles embedded in silica when glycerol (GLY) and cetyl-trimethylammonium bromide (CTAB) are added as steric agents simultaneously. The combined action of a polyalcohol and a surfactant significantly modifies the morphology of the sample giving rise to a different microstructure in each of the studied cases (1, 3 and 7 days of magnetic stirring time). This is due to the fact that the addition of these two compounds leads to a considerable increase in gelation time as GLY can interact with the alkoxide group on the surface of the iron oxide precursor micelle and/or be incorporated into the hydrophilic chains of CTAB. This last effect causes the iron oxide precursor micelles to be interconnected forming aggregates whose size and structure depend on the magnetic stirring time of the sol-gel synthetic route. In this paper, crystalline structure, composition, purity and morphology of the sol-gel coatings densified at 960 °C are examined. Emphasis is placed on the nominal percentage of the different iron oxides found in the samples and on the morphological and structural differences. This work implies the possibility of patterning ε-Fe2O3 nanoparticles in coatings and controlling their purity by an easy one-pot sol-gel method.

Seis años de experiencia en cirugía digestiva asistida por robot / 6 years of experience with robotic assisted gastrointestinal surgery

Resumen Introducción Desde su aprobación, la cirugía robótica ha crecido como una técnica útil, prometedora y probablemente superior en muchas cirugías. El objetivo de este estudio es exponer y evaluar los resultados de 6 años de experiencia, en cirugía digestiva asistida por robot, utilizada en diferentes procedimientos gastrointestinales, a lo largo de estos años. Material y Método Realizamos una revisión retrospectiva de todos los pacientes consecutivos sometidos a cirugía asistida por robot, realizada por un cirujano digestivo del Departamento de Cirugía Bariátrica y Departamento de Cirugía Robótica de la Clínica Santa María, de Santiago de Chile, entre septiembre de 2011 y mayo de 2017. Resultados Un total de 290 pacientes fueron sometidos a cirugía digestiva asistida por robot durante 6 años. Todos los pacientes fueron operados por el mismo cirujano digestivo. Los procedimientos primarios realizados fueron bypass gástrico en Y-Roux con anastomosis manual, gastrectomía en manga, cirugía revisional bariátrica y no bariátrica, fundoplicatura de Nissen, colecistectomía con puerto único, miotomía de Heller con fundoplicatura de Dor, hernioplastías, y otros casos excepcionales. La mayoría de los procedimientos secundarios fueron colecistectomías, hernioplastías hiatales y adherenciolisis. La estadía hospitalaria promedio fue de 3 días. Se observaron complicaciones postoperatorias en 27 (9,3%) pacientes. De acuerdo a la clasificación de Clavien Dindo, 4 (1,4%) complicaciones fueron Clavien I, 5 (1,7%) Clavien II, 18 (6,2%) Clavien III, 0 Clavien IV, 0 Clavien V. No hubo mortalidad en este grupo. El tiempo total promedio de los procedimientos fue de 76 min. El tiempo quirúrgico promedio fue de 64 min. Conclusión La cirugía digestiva asistida por robot es una técnica confiable y segura, que se puede utilizar para muchas enfermedades.

Background Since its approval, robotic surgery has been growing as a useful, promising and probably superior technique for many surgeries. The aim of this study is to expose and evaluate the results of a 6-year experience, of a single surgeon, with robotic assisted surgery, used for different gastrointestinal procedures throughout this years. Study Design We conducted a retrospective revision of all consecutive robotic assisted gastrointestinal cases performed by a single gastrointestinal laparoscopic surgeon of the Bariatric Surgery Department and Robotics Surgery Department of Clínica Santa María of Santiago, Chile, between September 2011 and May 2017. Results A total of 290 patients underwent robotic gastrointestinal surgery during 6 years. All cases were performed by the same gastrointestinal surgeon. Primary procedures performed were totally hand sewn Roux-en-Y gastric bypass, sleeve gastrectomy, revisional bariatric and non-bariatric surgery, Nissen fundoplication, single port cholecystectomy, Heller myotomy with Dor fundoplication, hernia repairs, and other exceptional cases. A total of 512 procedures were performed in 290 patients. The majority of secondary procedures were cholecystectomies, hiatal hernia repairs and adhesiolysis. Average length of hospital stay was 3 days. Postoperative complications were observed in 27 (9.3%) patients. According to Clavien Dindo classification of surgical complications, 4 (1.4%) complications were Clavien I, 5 (1.7%) Clavien II, 18 (6.2%) Clavien III, 0 Clavien IV, 0 Clavien V. There were no deaths in this group. Mean operative time was 76 minutes. Mean surgical time was 64 minutes. Conclusion Robot assisted upper gastrointestinal surgery is a reliable and effective technique, that can be used in many diseases.

Experiencia inicial con cirugía revisional bariátrica asistida por robot / Initial experience with robotic assisted revisional bariatric surgery

Resumen Introducción La cirugía bariátrica robótica es una técnica novedosa y en desarrollo en Chile. Los procedimientos bariátricos revisionales han aumentado durante los últimos años. No existen publicaciones en nuestro país relacionadas con experiencias en cirugía bariátrica revisional robótica. El objetivo de este estudio es describir la experiencia inicial y los resultados a corto plazo con el uso de la cirugía robótica en estos procedimientos. Material y Métodos Realizamos una revisión retrospectiva de todos los pacientes sometidos a cirugía bariátrica revisional asistida por robot, en Clínica Santa María, de Santiago de Chile. Analizamos las características demográficas, resultados quirúrgicos, morbilidad, mortalidad y tiempo de estadía hospitalaria. Resultados Se realizaron un total de 59 cirugías bariátricas revisionales asistidas por robot, 11 remodelamientos de gastrectomía en manga, 34 bypass gástrico en Y-Roux, 1 remodelamiento del pouch gástrico en un bypass gástrico en Y-Roux, 3 extracciones de banda gástrica ajustable, 1 de ellas con gastrectomía en manga simultánea, 5 instalaciones de banda gástrica ajustable en pacientes con bypass gástrico en Y-Roux, 3 gastrectomías totales, 1 resección de fístula gastro-gástrica y una anastomosis gastroyeyunal. La edad promedio fue de 47,8 años. El Índice de Masa Corporal promedio preoperatorio fue de 33,86 kg/m2. El tiempo quirúrgico promedio fue de 101,63 min. Se observaron complicaciones postoperatorias en 3 pacientes (5,08%). En 2 (3,39%) de ellos, se requirió una reoperación. No hubo fallecidos. El tiempo promedio de estadía hospitalaria fue de 3,6 días. conclusión La cirugía bariátrica revisional asistida por robot es una técnica novedosa, que parece ser segura y efectiva.

Background Robotics in bariatric surgery is a novel development in medical institutions in Chile. Revisional bariatric procedures have increased during the last years. There are no publications in our country related to the initial experience and results in robotic revisional bariatric surgery. The aim of this study is to describe the initial experience and short term outcomes with robotic revisional bariatric surgery. Study Design We conducted a retrospective study of all consecutive robotic revisional bariatric surgeries performed by a single surgeon in Clínica Santa María in Santiago, Chile. We analyzed demographic characteristics and surgical outcomes, morbidity, mortality and length of hospital stay. Results 59 revisional bariatric surgeries were performed, 11 reshaping of sleeve gastrectomy, 34 Roux in Y gastric bypass, 1 pouch reshaping of Roux in Y gastric bypass, 3 extractions of laparoscopic adjustable gastric banding, 1 of them with simultaneous sleeve gastrectomy, 5 laparoscopic adjustable gastric banding to patients with previous Roux in Y gastric bypass, 3 total gastrectomy, 1 resection of gastro-gastric fistula and 1 gastro enteral anastomosis. Mean age was 47.8 years. Average preoperative body mass index was 33.86 kg/m2. Mean surgical time was 101.63 minutes. Postoperative complications were observed in 3 patients (5.08%). In 2 (3.39%) of this patient, reoperation was required. There were no deaths in this group. Average length of hospital stay was 3.6 days. Conclusion Robotic revisional bariatric surgery is a novel technique that appears to be safe and effective.

Chronic effects of simultaneous electromyostimulation and vibration on leg blood flow in spinal cord injury.

STUDY DESIGN: Randomized two-group parallel. OBJECTIVES: The objective of this study was to analyze the adaptations on the popliteal artery (mean blood velocity (MBV), peak blood velocity (PBV), arterial resting diameter (RD) and blood flow (BF)) induced by 12 weeks of simultaneous application of whole-body vibration and electromyostimulation (WBV+ES) in patients with spinal cord injury (SCI). Secondarily, the musculoskeletal effects of this therapy on the gastrocnemius muscle thickness (MT) and femoral neck bone mineral density (BMD) were analyzed. SETTING: Valladolid, Spain. METHODS: Seventeen SCI patients (American Spinal Injury Association (ASIA) A or B) were randomly assigned to the experimental group (EG=9) or the control group (CG=8). Each subject was assessed in four different occasions: at baseline, after 6 weeks (Post-6) and 12 weeks of the treatment (Post-12) and 8 weeks after the end of the treatment (Post-20). Subjects in the EG performed 30 10-min sessions of WBV+ES during 12 weeks. RESULTS: In the EG, RD increased compared with the baseline value at Post-6 (9.5%, P<0.01), Post-12 (19.0%, P<0.001) and Post-20 (16.7%, P<0.001). Similarly, in the EG, BF increased compared with the baseline value and with CG only at Post-12 ((33.9%, P<0.01) and (72.5%, P<0.05), respectively). Similarly, WBV+ES increased the MT of the gastrocnemius. BMD of both hips remained invariable during the study. CG showed no change at any point. CONCLUSIONS: WBV+ES improved popliteal artery BF, RD and MT after 12 weeks in SCI patients. This increase in RD remained above baseline after 8 weeks. The combination of WBV and ES could be considered a promising alternative to reverse the musculoskeletal atrophy and improve peripheral vascular properties in SCI patients.

Libyan Thymus capitatus essential oil: antioxidant, antimicrobial, cytotoxic and colon pathogen adhesion-inhibition properties.

AIMS: In the present work, the Libyan wild-growing Thymus capitatus essential oil (EO) was evaluated for its biological properties. METHODS AND RESULTS: Carvacrol (68.19%) and thymol (12.29%) were found to be the main compounds of the oil. Antioxidant properties, determined by 2,2-diphenylpicrylhydrazyl (DPPH) assay, revealed that IC50 values were 119, 403 and 105 µg ml(-1) for oil, thymol and carvacrol respectively. Microdilution method showed strong antibacterial and especially antifungal potential. Tetrazolium (MTT) colorimetric assay indicated moderate cytotoxicity towards human cell lines MRC-5, HCT 116 and HT-29 (IC50 = 30-150 µg ml(-1)). In adhesion-inhibition assay oil and main compounds reduced adhesion of Escherichia coli and Listeria monocytogenes on colon cells HT-29 (51 and 39% of inhibition against L. monocytogenes and E. coli respectively). CONCLUSIONS: Essential oil of Th. capitatus showed moderate cytotoxic activity, together with excellent antimicrobial effect, in particular against fungi, and significant potential to reduce pathogen colonization in colon. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first report that EO of Th. capitatus could protect against colonization of pathogens to colon epithelium. Thymus capitatus from Libya should be recognized as possible new source of natural antioxidants, antimicrobials as well as possible source of new chemotherapeutics.

Allogeneic hematopoietic SCT in multiple myeloma: long-term results from a single institution.

The role of allogeneic hematopoietic SCT (allo-HCT) in multiple myeloma (MM) remains controversial. A total of 58 patients received an allo-HCT (25 of them with myeloablative conditioning-allo-MAC-and 33 with reduced-intensity conditioning-allo-RIC) at our institution over a 28-year period. The CR rate for allo-MAC was 36%. The incidence of grade III-IV acute GVHD (aGVHD) and chronic GVHD (cGVHD) was 28% and 39%, respectively The TRM at any time was 60% and the main causes of death were aGVHD or infectious complications not directly related to GVHD. The estimated PFS and OS at 15 years were 8% and 15%, respectively. The CR rate with allo-RIC was 45%. The incidence of grade III-IV aGVHD and cGVHD were 24% and 41%, respectively. The TRM at any time was 33% and was mainly related to aGVHD. The estimated PFS and OS at 5 years were 22% and 38%, respectively. Despite its high TRM, a proportion of patients with high-risk myeloma (early relapse and newly diagnosed ultrahigh risk) may obtain long-term disease control with allo-HCT. New approaches aimed at decreasing the incidence of aGVHD, and consequently to decrease the TRM, are needed.

A new approach for diffusive sampling based on SPME for occupational exposure assessment.

Passive sampling is a well-established methodology for the evaluation of exposures to environmental volatile organic compounds (VOCs). The solid-phase microextraction (SPME) technique is a reliable means of sampling VOCs in air. SPME is also being applied as a passive sampler to determine time-weighted average exposure. The use of SPME as a diffusive sampler was evaluated. The passive sampler is based on the use of a cylindrical diffusion cell (porous hydrophobic polyethylene) with an 80 µm carboxen/polydimethylsiloxane fiber to obtain radial diffusion of the analytes to the sorbent. Standard atmospheres of organic vapors in air were used to determine the experimental uptake rates for toluene and chlorobenzene. Toluene concentrations between 2 and 38 mg/m(3) with sampling times between 15 and 60 min were evaluated, as well as chlorobenzene concentrations between 2 and 47 mg/m(3) with sampling times between 30 and 60 min. The mean diffusive uptake rate was 2.14 mL/min for toluene and 2.57 mL/min for chlorobenzene, and no statistical significant effects of concentration and sampling time were observed under the studied conditions for the two compounds. Relative standard deviation ranged from 2.6 to 6.5%. The performance of the sampler under varying concentrations of toluene was also tested, showing that the sampler reflects the average exposure concentration. Effects of temperature, relative humidity, velocity of the air, back diffusion, competitive adsorption, and the stability of chlorobenzene in the sampler were also studied. Sampler behavior was tested in gas stations, and the results were successfully compared with a 3M-3500 diffusive sampler. The results are promising for using this new SPME device for diffusive monitoring for occupational exposure assessment.

Plerixafor plus granulocyte CSF can mobilize hematopoietic stem cells from multiple myeloma and lymphoma patients failing previous mobilization attempts: EU compassionate use data.

Plerixafor was recently approved by the US Food and Drug Administration (FDA) and the European Medicines Evaluation Agency (EMEA) to enhance stem cell mobilization for autologous transplant in patients with lymphoma and multiple myeloma. In this study, we present the first European compassionate use experience in mobilization failures, patients who are hardest to remobilize but were not included in registration trials. A total of 56 consecutive patients from 15 centers in Spain and the United Kingdom were included: age 60 (33-69) years; 29 men (32 with myeloma and 24 with lymphoma); 2 lines of previous chemotherapy (1-10); 73 previously failed mobilization attempts with G-CSF (28), chemotherapy plus G-CSF (43) or G-CSF plus SCF(2). Overall, 71% of patients reached ≥ 10 CD34+ cells per µL with plerixafor on day 5 after a 7.6-fold expansion from day 4. A total of 42 patients (75%) collected ≥ 2 × 106, average 3.0 ± 1.7 (0.4-10.6) CD34+ cells per kg with plerixafor plus G-CSF. There were no severe drug-related adverse events. In all, 35 patients (63%) underwent transplant, receiving an average of 3.1±1.2 (1.9-7.7) × 106 CD34+ cells per kg. All patients engrafted neutrophils (day 12; 13.4 ± 0.8; 8-30) and platelets (day 15; 18.5 ± 2.4; 8-33). In our experience, plerixafor offers an effective alternative to collect sufficient CD34+ cells for autologous SCT from patients who fail conventional mobilization methods, with good tolerance and a high success rate.

Engraftment syndrome after auto-SCT: analysis of diagnostic criteria and risk factors in a large series from a single center.

Engraftment syndrome (ES) is increasingly observed in patients who receive auto-SCT. To investigate this fact, validate the clinical criteria for ES diagnosis and analyze the risk factors for this complication, we reviewed 328 consecutive peripheral blood auto-SCT performed during the past 7 years. A total of 43 patients presented with clinical or biological data suggestive of ES. Of the total, 41 (95%) and 22 (51%) could be diagnosed with ES using the Maiolino criteria (MC) and the Spitzer criteria (SC), respectively. The SC were less sensitive as they do not consider some relevant clinical data and limit the observation time after engraftment. All ES cases had high C-reactive protein (CRP) values not observed in the remaining patients at engraftment (median +/- s.d.: 17.5 +/- 7.3 vs 2.4 +/- 3.4 mg per 100 ml; P=0.0001). Multivariate analysis showed a higher risk of ES in SCT performed in recent years (relative risk (RR) 2.3, 95% confidence interval (CI 1.0-4.7), female patients (RR 2.5, 95% CI 1.2-5.2), and absence of intensive chemotherapy before SCT (RR 8.8, 95% CI 3.3-20.5). All patients except one improved after treatment with corticosteroids. The MC seem to be the best tool to establish a diagnosis of ES. In doubtful cases, the diagnosis could be confirmed by evaluating CRP. Auto-SCT in patients not receiving previous chemotherapy could explain the increasing incidence of ES in the past years.

Incidence of acute myocardial infarction in the Spanish epic cohort.

BACKGROUND: There is some evidence that Mediterranean diet reduces risk of ischemic heart disease, and this is to be investigated in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). In this paper we present the incidence of acute myocardial infarction (AMI) in four EPIC Spanish cohorts. METHOD: Incidence cases were ascertained in EPIC cohort during the follow up period (from recruitment to the end of 2004), by means of self-report questionnaires, hospital morbidity and mortality registries, and population AMI registries. Analysis was restricted to aged 45 to 74. The present study included data from 13,704 women and 19,410 men, after excluding a priori participants with prevalent AMI. Age standardized incidence rate for each cohort was estimated and compared with the available population rates. RESULTS: The Median duration of follow-up was 9.3 years, yielding a total of 297,704 person-years. 391 men and 99 women presented AMI in the four cohorts studied. Age standardized AMI rates in men of the EPIC cohorts go from the lowest 302 (CI: 268-335) per 100.000 person-year of Gipuzkoa to the highest 330 (CI: 293-367) of Navarra. Women in Navarra presented the lowest AMI incidence with 60 (CI: 43-77) per 100,000 and the highest was observed in Murcia (114, CI: 91-137). The AMI incidence in all EPIC centres are close to the population incidence rates and in any case these are within the EPIC 95% CI. CONCLUSIONS: The comparison of incidence in EPIC with population rates shows very good agreement for acute myocardial infarction.

Antifungal activity of the essential oil of Thymus vulgaris L. and thymol on experimentally induced dermatomycoses.

The in vivo evaluation of the toxicological and antifungal activity of the essential oil of Thymus vulgaris L. and its main component thymol was made on 2-month-old male Wistar rats. We examined the therapeutic potency against experimentally induced dermatomycoses in rats, using the most frequent dermatomycetes, Trichophyton mentagrophytes, T. rubrum, and T. tonsurans. The therapeutic efficacy of a 1% solution of the essential oil of Thymus vulgaris and thymol as well as the commercial preparation bifonazole was evaluated. During the 37-day observation period the oil-treated animals were cured.

Neuroimmune mechanisms in patients with atopic dermatitis during chronic stress.

OBJECTIVE: To identify pathoaetiological neuroimmune mechanisms in patients with atopic dermatitis (AD) and chronic stress, focusing at nerve density, sensory neuropeptides, and the serotonergic system. METHODS: Eleven patients with AD with histories of stress worsening were included. Biopsies from involved and non-involved skin were processed for immunohistochemistry. Salivary cortisol test was done as a marker for chronic stress. RESULTS: There were more acanthosis and fewer nerve fibres in epidermis and papillary dermis of involved compared with non-involved skin. Whereas there was no significant change in the number of substance P and calcitonin gene-related peptide-positive nerve fibres between the involved and non-involved skin, there was an increase in the epidermal fraction of 5-hydroxtrytamine 1A (5-HT1A) receptor and serotonin transporter protein (SERT) immunoreactivity in the involved skin. The number of 5-HT2AR, CD3-positive cells, and SERT-positive cells, most of them being CD3 positive, was increased in involved skin. There was an increase in mast cells in the involved skin, and these cells were often located close to the basement membrane. There was a strong tendency to a correlation between 5-HT2AR positive cells in the papillary dermis of involved skin and low cortisol ratios, being an indicator of chronic stress. CONCLUSION: A changed innervation and modulation of the serotonergic system are indicated in chronic atopic eczema also during chronic stress.

[Surgical treatment of chronic mesenteric ischemia: report of one case]. / Tratamiento quirúrgico de la isquemia mesentérica crónica: Caso clínico.

Although the classic therapy for chronic mesenteric ischemia is surgical revascularization, endovascular therapy is a new therapeutic option. We report a 55 year-old female, with a 2 years history of post prandial abdominal pain, diarrhoea, and weight loss, with occlusion of both mesenteric arteries and critical stenosis of the celiac artery. The initial treatment consisted in angioplasty and celiac artery stent placement in two occasions, with a brief symptomatic relief. Finally, a visceral artery bypass was performed, with good post operative outcome and complete symptomatic resolution at one year follow up. In our opinion endovascular therapy is a good therapeutic option for chronic mesenteric ischemia in high surgical risk patients, specially when dealing with stenotic injuries. It may also be a complement for patients who need to recover their nutritional status prior to revascularization surgery. On the other hand, due to the long term patency and symptomatic relief, surgical treatment is a good option in low risk patients.

Tratamiento quirúrgico de la isquemia mesentérica crónica: Caso clínico / Surgical treatment of chronic mesenteric ischemia: Report of one case

Although the classic therapy for chronic mesenteric ischemia is surgical revascularization, endovascular therapy is a new therapeutic option. We report a 55 year-old female, with a 2 years history of post prandial abdominal pain, diarrhoea, and weight loss, with occlusion of both mesenteric arteries and critical stenosis of the celiac artery. The initial treatment consisted in angioplasty and celiac artery stent placement in two occasions, with a brief symptomatic relief. Finally, a visceral artery bypass was performed, with good post operative outcome and complete symptomatic resolution at one year follow up. In our opinion endovascular therapy is a good therapeutic option for chronic mesenteric ischemia in high surgical risk patients, specially when dealing with stenotic injuries. It may also be a complement for patients who need to recover their nutritional status prior to revascularization surgery. On the other hand, due to the long term patency and symptomatic relief, surgical treatment is a good option in low risk patients.

G-CSF increases the number of peripheral blood dendritic cells CD16+ and modifies the expression of the costimulatory molecule CD86+.

Dendritic cells (DC) play a key role in initiating immune reactions after allogeneic stem cell transplantation. The two main peripheral blood DC populations are myeloid (DC1) and lymphoplasmacytoid (DC2). A new subset of myeloid DC, expressing CD16, has been identified. We analyzed the number and CD86 expression of DC subsets in peripheral blood of 18 healthy donors, before and after granulocyte colony-stimulating factor (G-CSF) and in the inoculum of allogeneic peripheral blood transplants (allo-PBT; n=100) and allogeneic bone marrow transplants (allo-BMT; n=22). Granulocyte colony-stimulating factor administration increased the median number of DC1 (P=0.0007), of DC2 (P<0.0001) and of DC CD16+ (P=0.0001). Granulocyte colony-stimulating factor administration was also associated with a significant decrease of CD86 expression on DC1 (P=0.0003) and with a trend for an increase on DC CD16+ (P=0.07). Recipients of allo-PBT received similar quantities of DC1 and higher doses of DC2 and DC CD16+ than recipients of allo-BMT (P=0.5; P=0.0001; P<0.0001, respectively). Granulocyte colony-stimulating factor modifies the number of DC in peripheral blood and the expression of the costimulatory molecule CD86. This resulted in a different composition of DC2 and especially of DC CD16+ in the harvests, which might explain some of the differences observed in allogeneic reactions after allo-PBT with respect to allo-BMT.