ABSTRACT
Ruptured abdominal aortic aneurysm (RAAA) is an arterial emergency with an overall mortality of 80%-90% secondary to massive hemorrhage. If a patient with RAAA presents in a primary hospital without resolution capacity, survival will depend on early transfer to a center with adequately trained specialists. This article reviews the evidence supporting the centralization of AAAR treatment in qualified centers, specifying the criteria used for the selection of referral centers and the role of a coordinating unit. Our current referral system, which is based primarily on costs, is also described. Patients with AAAR who consult in non-resolving centers should be rapidly transferred to a qualified referral center, following a transfer protocol, and guided by a coordinating unit acting according to technical and established criteria based on results, quality, and costs. Qualified referral centers should have an accredited vascular surgeon and a high institutional aortic surgery volume, adequate infrastructure, endovascular resolution capacity, support services (intensive care, hemodialysis, etc.) and specialized personnel permanently available.
Subject(s)
Humans , Aortic Rupture/surgery , Aortic Aneurysm, Abdominal/surgery , Endovascular Procedures/methods , Retrospective Studies , Risk Factors , Treatment Outcome , Hospital Mortality , HospitalsABSTRACT
Abstract Endovascular embolization of arteries feeding pulmonary sequestrations is a growing therapeutic option. A 51-year-old woman with chest pain and hemoptysis was admitted. During hospitalization she presented 150 mL hemoptysis, hypotension, and hematocrit fell to 23.3%. Contrast-enhanced computed tomography confirmed a pulmonary sequestration irrigated by an aneurysmal artery from the abdominal aorta. The patient underwent endovascular coil embolization of the artery feeding the aneurysm and an Amplatzer device was deployed in the proximal third of the sequestration artery. Subsequent contrast-enhanced computed tomography confirmed complete thrombosis of the aberrant artery feeding the aneurysm and absence of irrigation of the pulmonary sequestration. At 56 months follow-up the patient remains asymptomatic, tomography showed involution of the sequestration and complete thrombosis of the aberrant artery. The challenges presented by the different treatment alternatives are discussed.
Resumo A embolização endovascular das artérias que alimentam os sequestros pulmonares é uma opção terapêutica em crescimento. Uma mulher de 51 anos com dor torácica e hemoptise foi internada. Durante a internação, ela apresentou hemoptise de 150 mL, hipotensão e queda do hematócrito para 23,3%. A tomografia computadorizada com contraste confirmou um sequestro pulmonar irrigado por uma artéria aneurismática originária da aorta abdominal. A paciente foi submetida a embolização endovascular da artéria que alimentava o aneurisma com uso de coils e dispositivo Amplatzer no terço proximal da artéria sequestrante. A tomografia subsequente confirmou a trombose completa da artéria aberrante que alimentava o aneurisma e a ausência de irrigação dentro do sequestro pulmonar. No seguimento de 56 meses, a paciente permanecia assintomática, e a tomografia mostrou involução do sequestro e trombose completa da artéria aberrante. Os desafios apresentados pelas diferentes alternativas de tratamento são discutidos neste artigo.
Subject(s)
Humans , Female , Middle Aged , Aortic Aneurysm, Abdominal/therapy , Embolization, Therapeutic , Endovascular Procedures , Aorta, Abdominal , Tomography, X-Ray Computed , Bronchopulmonary Sequestration/diagnosisABSTRACT
Primary aortoenteric fistula is the spontaneous communication between the lumen of the aorta and a portion of the digestive tract. The most common cause is the erosion of an abdominal aortic aneurysm into the 3rd or 4th portion of the duodenum. It manifests clinically as gastrointestinal bleeding, with or without abdominal pain and a pulsatile abdominal mass on physical exam. Gastrointestinal bleeding is initially recurrent and self-limiting and progresses to fatal exsanguinating hemorrhage. Endoscopic examination diagnoses only 25% of aortoenteric fistulas because these are usually located in the distal duodenum. Contrast computed tomography of the abdomen and pelvis is diagnostic in only 60% of cases. We report three cases with this condition. A 67-year-old male presenting with an upper gastrointestinal bleeding. He was operated and a communication between an aortic aneurysm and the duodenum was found and surgically repaired. The patient is well. A 67-year-old male with an abdominal aortic aneurysm presenting with abdominal pain. He was operated and anticoagulated. In the postoperative period he had a massive gastrointestinal bleeding and a new CAT scan revealed an aorto enteric fistula that was surgically repaired. The patient is well. An 82-year-old male with an abdominal aortic aneurysm presenting with hematochezia. A CAT scan revealed a communication between the aneurysm and the third portion of the duodenum, that was surgically repaired. The patient died in the eighth postoperative day.
Subject(s)
Humans , Male , Aortic Diseases , Aortic Rupture , Vascular Fistula/surgery , Vascular Fistula/complications , Vascular Fistula/diagnostic imaging , Intestinal Fistula/complications , Intestinal Fistula/diagnostic imaging , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnostic imaging , Duodenal Diseases/surgery , Duodenal Diseases/complications , Duodenal Diseases/diagnostic imaging , Aorta, Abdominal , Duodenum , Gastrointestinal Hemorrhage/etiologyABSTRACT
Background: Chronic limb ischemia can lead to high rates of limb loss and mortality. Open surgery is the gold standard for treatment of distal disease. Endovascular surgery should have less complications with similar outcomes. Aim: To report a cohort of patients with distal arterial disease treated with endovascular surgery at our institution. Material and Methods: Review of angioplasty records of patients undergoing distal lower extremity endovascular procedures between 2016 and 2019. Demographics, comorbidities, form of presentation, type of intervention, perioperative complications, and length of stay were analyzed. The primary outcomes were wound healing, reinterventions and freedom from major amputation. Secondary outcomes were overall survival and amputation-free survival. Results: Forty-eight limbs of 41 patients with a mean age 75 years (78% males) were treated. Ninety-three percent had hypertension, 88% diabetes, 30% chronic kidney disease. 73% presented with major wounds. Plain balloon and drug coated balloon angioplasties were carried out in 65 and 31% of procedures respectively, with no difference in results. In 46% of the cases, only chronic total occlusions were treated. Wound healing was achieved in 85% of procedures and 90% of patients were free from amputation at one year of follow up. Complications were observed in 18% of procedures, perioperative mortality was 2% and one-year survival was 76%. Conclusions: Endovascular therapy achieves high rates of wound healing and freedom from amputation with low perioperative mortality and moderate complication rates.
Subject(s)
Aged , Female , Humans , Male , Peripheral Arterial Disease , Endovascular Procedures , Retrospective Studies , Risk Factors , Treatment Outcome , Critical Illness , Limb Salvage , Peripheral Arterial Disease/surgery , Endovascular Procedures/adverse effects , Ischemia/surgery , Amputation, SurgicalABSTRACT
Resumen Objetivo: Describir un caso de histocitosis de células de Langerhans en un paciente pediátrico. Método: Paciente de 4 años con proptosis, diplopía, fiebre y pérdida de agudeza visual, con imagen en tomografía computarizada evidente de masa orbitaria con erosión ósea. Se realizó biopsia excisional por craneotomía coronal, el resultado histopatológico fue histiocitosis de células de Langerhans. Resultados: El estudio anatomopatológico transoperatorio mostró una neoplasia de células pequeñas redondas y azules, compatible con rabdomiosarcoma. Las pruebas de inmunohistoquímica concluyeron el diagnóstico de histiocitosis de células de Langerhans. Conclusión: La histiocitosis de células de Langerhans es una enfermedad poco frecuente que requiere de una sospecha clínica y diagnóstico oportuno, adecuar el tratamiento y mejorar la sobrevida de los pacientes.
Abstract Objective: To describe a case of Langerhans cell histiocytosis in a pediatric patient. Method: A 4-year-old patient with proptosis, diplopia, fever and loss of visual acuity, with evident image in a computed tomography of orbital mass with bone erosion. An excisional biopsy was performed by coronal craniotomy. The histopathological result was Langerhans cell histiocytosis. Results: The anatomopathological study showed a neoplasm of small round and blue cells, compatible with Rhabdomyosarcoma. Immunohistochemical tests concluded the diagnosis of Langerhans cell histiocytosis. Conclusion: Langerhans cell histiocytosis is a rare disease that requires clinical suspicion and a timely diagnosis to adjust the treatment and improve the survival of patients.
ABSTRACT
Resumen: El compromiso simultáneo del arco aórtico y aorta descendente proximal, ya sea por disección o aterosclerosis, constituye uno de los mayores desafíos que puede enfrentar un cirujano cardiovascular. La prótesis híbrida Thoraflex, introducida en los últimos años, ha resultado ser una importante ayuda para el tratamiento quirúrgico de esta compleja y grave patología. Esta consiste en un tubo protésico de Dacron con 4 ramas, para el reemplazo del arco aórtico y sus troncos braquiocefálicos y perfusión corporal distal, y una endoprótesis que queda como "trompa de elefante suspendida" en la aorta descendente proximal. Presentamos en esta oportunidad nuestra experiencia inicial en 4 pacientes, 3 con disección aórtica crónica y una con un aneurisma aterosclerótico, usando la prótesis híbrida Thoraflex.
Abstract: Atherosclerotic aneurysm or dissection of the aortic arch and proximal descending thoracic aorta is one of the major challenges for a cardiovascular surgeon. The new hybrid prosthesis Thoraflex has become an important devise to simplify the surgical treatment of this very complex and technically demanding aortic pathology. This hybrid prosthesis consists of a 4-branched arch graft with a stent-graft at the distal end. The proximal part is a gelatin-coated woven polyester prosthesis. The stented section is a self-expanding endoprosthesis constructed of thin-walled polyester and nitinol ring stents that is left in the proximal descending aorta as a "frozen elephant trunk". We present our initial experience with the Thoraflex prosthesis in four patients, three of them with chronic aortic dissection and one with an atherosclerotic aneurysm.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/methods , Endovascular Procedures/methods , Aortic Dissection/surgery , Aorta, Thoracic/surgery , Aorta, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/diagnostic imaging , Computed Tomography Angiography , Aortic Dissection/diagnostic imagingABSTRACT
Background: Conventional treatment of deep vein thrombosis (DVT) is anticoagulation, bed rest and limb elevation. Proximal DVT patients with persisting edema, pain and cyanosis of extremities despite of conventional therapy may develop ischemia. Direct treatment of thrombosis becomes necessary. Aim: To report our experience with mechanical trombolysis of proximal lower extremity DVT. Material and Methods: Retrospective review of medical records of proximal DVT patients treated with thrombolysis between March 2012 and August 2015. Thirteen patients, 14 limbs, median age 34 years (22-85), 8 women, were admitted with pain and swelling of recent onset; one patient with venous gangrene. All patients initially received heparin in therapeutic doses without clinical improvement. Results: In all 13 cases, mechanical thrombolysis was performed using AngioJet®, and associated with single dose thrombolytic agent in 9. Additional angioplasty for residual stenosis was performed in 12 (7 stents) and IVCF were implanted in 8. All patients were subsequently anticoagulated. Early outcomes with disappearance of pain and decrease of edema, with no mortality or bleeding complications. The patient with foot gangrene required amputation. Conclusions: Mechanical thrombolysis with a single dose of a thrombolytic agent is safe and effective in patients with proximal DVT with an unfavorable evolution.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Venous Thrombosis/therapy , Mechanical Thrombolysis/methods , Fibrinolytic Agents/therapeutic use , Angiography , Heparin/therapeutic use , Stents , Retrospective Studies , Treatment OutcomeABSTRACT
La paniculitis mesentérica es un raro desorden inflamatorio de la grasa mesentérica, de la cual hay, hasta ahora, aproximadamente 200 casos reportados en la literatura. Se presenta en adultos a partir de la tercera década de la vida y su etiología es desconocida, pero es sabida su asociación con neoplasias gastrointestinales, genitourinarias y enfermedades reumatológicas. Entre sus manifestaciones clínicas están el dolor abdominal, las alteraciones del tránsito intestinal, la pérdida de peso, la fiebre y los vómitos. El diagnóstico definitivo es fundamentalmente histopatológico, también existen algunos estigmas tomográficos que podrían sugerir su presencia. Debe ser tratada a la mayor brevedad posible y los corticosteroides son los medicamentos a elegir. Se presentó un paciente con diagnóstico de paniculitis mesentérica idiopática, como resultado del estudio de una fiebre de origen desconocido, en el cual logramos además demostrar la asociación de la paniculitis con la enfermedad relacionada con IgG4, desorden recientemente descubierto, caracterizado por lesiones inflamatorias seudotumorales, que cursan con infiltración hística por células plasmáticas IgG4 positivas.
Mesenteric panniculitis is a rare inflammatory disorder of the mesenteric fat, of which there is, so far, about 200 cases reported in the literature. It occurs in elderly adults and its etiology is unknown but its association with gastrointestinal tumors, genitourinary and rheumatological diseases is known. Among its clinical manifestations are abdominal pain, altered bowel movements, weight loss, fever and vomiting. The definitive histopathological diagnosis is fundamentally, there is some tomographic stigma that might suggest its presence. It should be treated as soon as possible and corticosteroids are the drugs of choice. A patient diagnosed with idiopathic mesenteric panniculitis as a result of the evaluation of fever of unknown origin, which we further demonstrate the association of panniculitis with related disease IgG4, disorder recently discovered, characterized by lesions in flammatory pseudotumoral occurs, that occur with tissue infiltration IgG4 positive plasma cells.
Subject(s)
Humans , Male , Adult , Prednisone/therapeutic use , Panniculitis, Peritoneal , Panniculitis, Peritoneal/diagnosisABSTRACT
Background: symptoms predominate. Diagnosis is based on clinical findings and appropriate imaging. We report two females, aged 35 and 51 years. One of them presented with a pelvic mass and dyspnea, the other patient had severe cardiac failure on admission. Computed axial tomography scan allowed an accurate preoperative diagnosis on both patients. Successful one stage resection of the tumor was performed under cardiopulmonary bypass. Both patients are asymptomatic on follow up at 6 months and 25 years.
Subject(s)
Adult , Female , Humans , Middle Aged , Heart Neoplasms/diagnosis , Leiomyomatosis/diagnosis , Pelvic Neoplasms/diagnosis , Vascular Neoplasms/diagnosis , Diagnosis, Differential , Heart Neoplasms/pathology , Leiomyomatosis/pathology , Pelvic Neoplasms/pathology , Tomography, X-Ray Computed , Vascular Neoplasms/pathology , Vena Cava, Inferior/pathologyABSTRACT
Introducción: Con la intención de evaluar la influencia de la hiperglucemia en la evolución de pacientes con accidentes macrovasculares agudos se estudiaron 73 personas hospitalizadas con síndrome coronario agudo o accidente cerebrovascular, independientemente de su condición de padecer diabetes mellitus (21,9 por ciento) o no. Métodos: Se registraron complicaciones tempranas (vasculares, sépticas y muerte) y se determinó la glucemia al ingreso, de ayuno y posprandial, así como la hemoglobina glucosilada (HbA1c). Se calcularon las medias de cada determinación y se compararon los grupos de pacientes complicados con aquellos que evolucionaron satisfactoriamente. Resultados: Se halló que solo la glucemia de ayuno se asoció con un peor pronóstico (p=0,004), lo que no se confirmó con el resto del perfil glucémico ni con la HbA1c (p=0,25), aún cuando todos los promedios fueron superiores en el grupo de pacientes complicados. El perfil lipídico tampoco se asoció con las complicaciones posteriores a un proceso macrovascular. Conclusiones: La hiperglucemia de ayuno, en rango diabético, se asoció con una evolución desfavorable en el grupo de pacientes estudiados
Introduction: To assess the influence of hyperglycemia on the course of patients with acute macrovascular accidents, 73 patients admitted due to acute coronary syndrome or cerebrovascular accident were studied, independently of its diabetes mellitus (21,9 percent) or not. Methods: There were early complications (vascular, septic and death); authors determined the presence of glycemia at admission, fasting and postprandial, as well as the glycosylated hemoglobin (HbA1c). The means of each determination were estimated and the groups of patients complicated were compared with a satisfactory evolution. Results: There was found that fasting glycemia was associated with the worse prognosis (p = 0,004) even though all averages were higher in the complicated patients group. The lipid profile was not associated with complications after a macrovascular process. Conclusions: Fasting hypoglycemia, in diabetes rank was associated with a unfavourable course in the group of study patients
Subject(s)
Stroke/complications , Hyperglycemia/diagnosis , Acute Coronary Syndrome/complications , Longitudinal Studies/methods , Retrospective StudiesABSTRACT
Introducción: Las endoprótesis actuales para tratar aneurismas aórticos (AAA) requieren introductores de alto diámetro (18-25F) y se sustentan excluyendo el aneurisma, mediante la fuerza radial de stents metálicos. Objetivo: prótesis Ovation (TriVascular, EEUU) con aquellas disponibles en el mercado. Material y Método: Entre Noviembre 2009 y Agosto 2010 tratamos 47 AAA. En 10 pacientes usamos Ovation (Grupo 1). Grupo Control (2): diez pacientes tratados contemporáneamente con endoprótesis comerciales. Ovation es tri-modular, de PTFE y nitinol con un stent barbado para fijación supra-renal. Sella bajo las arterias renales mediante 2 anillos llenados con un polímero durante el implante. Usa introductor 13-15F. Usa-Philips-Allura (Best, Holanda). Comparamos: duración del procedimiento, hospitalización y complicaciones. Utilizamos test de Fisher exacto y t de student no pareado. Resultados: Éxito técnico 100 por ciento. Sin diferencia entre grupos (edad, sexo, tamaño AAA, riesgo ASA, laboratorio preoperatorio). Tiempo operatorio (hrs): 2,12 +/- 0,7 vs. 2,0 +/- 0,6 (NS). Estadía postoperatoria (hrs): 44,5 +/- 10,7 vs 49,5 +/- 32,0 (NS). El cuello del AAA y la permanencia en UTI fueron más cortos en grupo 1 (p= 0,035 y 0,0451). Seguimiento (4,5-12 meses) sin eventos adversos, endofugas tipo I ni III, ni re-intervenciones. Conclusiones: Los resultados con Ovation a corto plazo son comparables con los de otras endoprótesis, cumpliendo con estándares de eficacia y seguridad. Ovation navega por vasos pequeños, permite un despliegue preciso y sellado efectivo en cuellos > 7 mm, ampliando el tratamiento endovascular del AAA.
Background. Current endografts used in treatment of abdominal aortic aneurysm (AAA), use large (18-25F) delivery systems. Graft fixation and aneurysm sealing is obtained by a proximal stent, requiring an aortic neck >15 mm. Objective. To compare the efficacy and safety of Ovation endograft (TriVascular, USA) with standard endografts. Methods. Between November 2009 and August 2010 we treated 47 AAA. In 10 patients we used Ovation (Group 1). Ten patients treated during the same period with commercially available endografts were used as controls (Group (2). The Ovation endo-prosthesis is tri-modular, made of PTFE andnitinol with low profile (13-15F) and has a barbed suprarenal stent for fixation. Sealing is obtained independently through 2 inflatable rings filled with a biocompatible polymer during the procedure. Implantation followed the standard procedure through femoral exposure, using the Philips Allura imaging equipment (Best, Netherlands). Procedure duration, length of stay (LOS) and complications were compared between groups. Fisher exact test and unpaired Students t test were used for comparisons. Results. Results. Technical success was 100 percent. We observed no difference between groups (age, sex, AAA size, ASA risk, preoperative lab work). Procedure time (hrs) was 2,12 +/- 0,7 vs. 2,0 +/- 0,6 (NS), LOS (hrs) was 44,5 +/- 10,7 vs. 49,5 +/- 32,0 (NS) in Groups 1 and 2, respectively. Aneurysm neck length and ICU stay were shorter in Group 1 (p= 0,035 and 0,0451 respectively). During a 12 month follow up no adverse events, type I or III endoleak, or secondary interventions have occurred. Conclusion. Results with Ovation are comparable to other endografts currently available, achieving the same standards of efficacy and safety. Its highly flexible delivery system allows navigation through small vessels, easy deployment and effective sealing of AAA with necks > 7 mm, broadening the span of patients suitable for endovascular treatment.
Subject(s)
Humans , Male , Female , Middle Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/methods , Length of Stay , Pilot Projects , Postoperative ComplicationsABSTRACT
Se realizó un estudio que evaluó la utilidad de las técnicas de tomografía axial multicorte en la detección, en fase subclínica, del daño coronario en pacientes con diabetes mellitus (DM), con el objetivo de describir la frecuencia de afectación aterosclerótica asintomática y su probable asociación con la hiperglucemia de ayuno y posprandial. Se incluyeron 59 pacientes con diabetes tipo 2, en el estudio se compararon los resultados de la determinación de calcio coronario con los hallazgos de la angiografía por tomografía axial computarizada multicortes (TAC-M). Se registró concordancia de un 44,1 por ciento entre ambos estudios. Predominaron las placas blandas en el 55,9 por ciento de los pacientes. El 42,4 por ciento de los pacientes mostró estrechamiento de la luz arterial, lo que fue significativo en el 16,5 por ciento del total. Un mayor número de pacientes con hiperglucemia presentaron daño coronario al compararlos con los enfermos con buen control glucémico (p=0,024). Esta relación fue más evidente con la hiperglucemia posprandial (p=0,016). La hiperglucemia mostró una mayor probabilidad (5,99 veces) de detectar lesiones coronarias por TAC-M al compararla con otros factores de riesgo ateroscleróticos mayores, como la hipertensión arterial, el tabaquismo, las dislipidemias y la obesidad, lo que se expresó de manera significativa (p=0,045). Concluimos que las técnicas de angio TAC-M y de calcio score son útiles en detectar lesiones de las arterias coronarias, en pacientes con diabetes mellitus tipo 2 asintomáticos de isquemia miocárdica, lo que se asoció a la presencia de hiperglucemia, fundamentalmente posprandial
A study was conducted to assess the usefulness of multi-scan axial tomography techniques to detect, in a subclinical stage, the coronary damage in patients presenting with diabetes mellitus (DM) to describe the frequency of asymptomatic atherosclerotic affection and its potential association with the fasting and postprandial hyperglycemia. In study were included 59 patients with type 2 diabetes to compare the results of coronary calcium determination with the findings of angiography by multi-scan axial computed tomography (CAT-M). There was a concordance of a 44.1 percent between both studies, as well as a predominance of soft plaques in the 55.9 percent of patients. The 42.4 percent showed a narrowing of arterial lumen, which was significant in the 16.5 percent of total. A high figure of patients with hyperglycemia had coronary damage compared to those ills with a good glycemia control (p = 0.024). This relation was more evident with the postprandial hyperglycemia (= 0.016). Hyperglycemia had a high opportunity (5.99 times) to detect coronary lesions by TAC-C compared to other major atherosclerosis risk factors like the high blood pressure, smoking, dyslipemias expressed in a significant way (p = 0.045). We conclude that Angio TAC-C and Calcio Score techniques are useful to detect lesions of coronary arteries in patients with type 2 diabetes mellitus without symptoms of myocardial ischemia, which was associated to presence of a hyperglycemia, fundamentally postprandial
Subject(s)
Humans , Adult , Middle Aged , Coronary Angiography/methods , Coronary Artery Disease/diagnosis , Hyperglycemia/diagnosis , Tomography, X-Ray Computed/methods , Epidemiology, DescriptiveABSTRACT
Se presentó una paciente con antecedentes patológicos personales de asma bronquial leve persistente y de dermatitis atópica. Acudió por tener fiebre de 60 d de evolución, tos, disnea, anorexia y pérdida de peso, con empeoramiento progresivo. Se diagnosticó neumonitis por hipersensibilidad después de realizar estudios de imágenes e histológicos. Se describió la evolución clínica y radiológica.
Authors present the case of a woman with personal pathologic backgrounds of persistent light bronchial asthma and of an atopic dermatitis. She came to our service by fever of 60 days of evolution, cough, dyspnea, anorexia, and weight loss with a progressive worsening. A hypersensitivity pneumonitis was diagnosed after imaging and histological studies. Clinical and radiological course was described.
Subject(s)
Humans , Alveolitis, Extrinsic Allergic/classification , Alveolitis, Extrinsic Allergic/pathologyABSTRACT
Objetivo: La cirurgía endovascular se ha estabelecido como uma opción eficaz en el tratamiento de la enfermedad oclusiva aterosclerótica de las arterias iliacas. Sin embargo, el uso de estos procedimientos para tratar otro tipo de lesiones aún no ha sido bien estudiado. Nuestro objetivo es analizar indicaciones y resultados del uso de endoprótesis en lesiones ilicas no oclusivas. Material y métodos: Revisamos retrospectivamente los registros de 14 pacientes consecutivos, todos hombres, 61,6 años de edad en promedio (rango: 25-80) tratados por vía endovascular entre 2001 y 2006 por lesiones iliacas no oclusivas. El estudio pre y posoperatorio incluyó tomografía computada. El procedimiento se efectuó en quirófano, utilizando un angiógrafo digital. Se usó acceso femoral insertando endoprótesis tubulares. Resultados: En 11 pacientes se asoció embolazación de arteria hipogástrica ipsilateral. Las patologías tratadas fueron: ocho aneurismas ateroscleróticos, 3 disecciones, 2 lesiones traumáticas y un pseudoaneurisma anastomótico...
Subject(s)
Male , Adult , Humans , Aneurysm/surgery , Aneurysm/complications , Aneurysm/diagnosis , Iliac Artery/injuries , Iliac Artery/pathology , Tomography/methods , TomographyABSTRACT
El pseudoaneurisma de troncos supraórticos y la embolia arterial por proyectil son lesiones traumáticas infrecuentes con uma elevada morbimortalidad associada. El diagnóstico de estas lesiones requiere un alto índice de sospecha clínica, ya que con frecuencia pueden pasar inadvertidas en la evaluación inicial, presentando complicaciones o secuelas de solución compleja. El estudio de imágenes es fundamental para planificar la mejor estrategia terapéutica. La tomografia helicoidal multicorte permite obtener información con mínimo riesgo en apcientes hemodinámicamente estables.Se presenta un caso clínico de lesión torácica por bala que determinó un pseudoaneurisma del tronco braquiocefálico y una embolia axilar derecha por proyectil. Se revisa la literatura sobre estas patologias.
Subject(s)
Male , Female , Humans , Embolism/complications , Embolism/diagnosis , Aneurysm, False/complications , Aneurysm, False/diagnosis , Wounds, Gunshot/complicationsABSTRACT
Se presentó un estudio de casos y controles (60 y 120 respectivamente) en donantes de sangre del Banco Provincial de Cienfuegos. Los casos fueron aquellos que se identificaron como positivos en la prueba de detección de anticuerpos contra el virus C de la hepatitis (VHC) y los controles, los donantes seleccionados con prueba negativa (test de ELISA de tercera generación). Se trató de estimar la prevalencia de factores de riesgo para adquirir hepatitis C en donantes de sangre y medir la fuerza de asociación entre factores de riesgo y aparición de infección por VHC. Se comprobó que las variables de riesgo con valores más altos de los odds ratio (con significación estadística) fueron las transfusiones recibidas, tratamientos parenterales y antecedentes de enfermedad de transmisión sexual (ETS). Se halló alta prevalencia de asma entre los pacientes seropositivos al VHC (23 por ciento) lo que pudiera estar relacionado con la vía de transmisión percutánea por tratamientos parenterales repetidos
Subject(s)
Humans , Blood Donors , Hepatitis C , Risk Factors , Case-Control StudiesABSTRACT
Se estudió una serie de 60 sujetos donantes de sangre con presencia de anticuerpos contra el virus C de la hepatitis (Ac VHC). Se trató de identificar la expresión clínica de la enfermedad por VHC en donantes, de conocer los resultados laparoscópicos e histológicos y de evaluar la concordancia entre la visión endoscópica y los informes histológicos del hígado en los casos con biopsias. Se observó que la infección por VHC en donantes cursó de forma silente; sin embargo, el 62 porciento de ellos tenían alteraciones histológicas hepáticas las cuales probablemente estuvieron relacionadas con este agente viral. Se halló pobre concordancia entre diagnóstico laparoscópico y resultados histológicos. El análisis de la sensibilidad y la especificidad, así como el valor predictivo positivo y el negativo aplicados a la laparoscopia, demuestran las limitaciones de esta prueba para el diagnóstico de hepatitis crónica, el cual debe ser confirmado histológicamente
Subject(s)
Humans , Male , Adult , Female , Biopsy , Blood Donors , Hepatitis C , Hepatitis C Antibodies , Liver/pathology , Laparoscopy , Prospective StudiesABSTRACT
Se estudiaron 101 pacientes diabéticos: 42 tipo 1 y 59 tipo II en busca de cardiopatía isquémica y factores de riesgo coronario, y 100 pacientes no diabéticos que constituyeron el grupo control. Influyeron en forma individual en la aparición de cardiopatía isquémica, la hipercolesterolemia, la hipertension arterial, la edad y el hábito de fumar. No se demostró influencia de la diabetes mellitus como factor aislado en la aparición de la cardiopatía isquémica, se observó en los diabéticos una marcada susceptibilidad a la enfermedad coronaria cuando estuvieron presentes otros factores.
Subject(s)
Humans , Coronary Disease , Diabetes Mellitus, Type 1 , Diabetes Mellitus, Type 2 , Risk FactorsABSTRACT
El síndrome de Budd-Chiari es producido por una obstrucción parcial o total del drenaje venoso hepático. Dos mujeres portadoras de un síndrome de Budd-Chiari de diferente causa precipitante, son evaluadas y tratadas quirúrgicamente. Una de ellas, con oclusión completa de las venas suprahepáticas, recibe un shut mesoatrial, y la otra, es sometida a la resección de un angioleiomioma de la vena cava inferior con extensión intracardíaca. Ambas pacientes recuperan una adecuada función hepática en el período postoperatorio y en el seguimiento alejado de 24 y 40 meses gozan de una actividad normal y sin restricciones físicas ni dietéticas