Experiencia de trabajo en cirugía vascular en Ecuador / Experiences working in vascular surgeries in Ecuador

Introducción: Las enfermedades vasculares periféricas comprenden un variado número de entidades nosológicas que afectan a los sistema arterial (excluidos los vasos del corazón, e intracraneales) y venolinfáticos del organismo. Objetivo: Describir las características de los pacientes que necesitaron ser atendidos por un cirujano vascular por presentar algún tipo de enfermedad vascular periférica. Métodos: Estudio descriptivo realizado en el total de pacientes atendidos por consulta externa y hospitalizados en el Servicio de Cirugía Vascular del Instituto Ecuatoriano de Seguridad Social; Hospital Manuel Ignacio Montero Valdivieso. El período de estudio fue de dos años (septiembre de 2014 a octubre de 2016). Se tuvieron en cuenta las siguientes enfermedades vasculares periféricas: enfermedades vasculares periféricas, insuficiencia venosa crónica, pie diabético, trombosis venosa profunda y trombosis arterial aguda Los resultados se expresaron en trabajo con las frecuencias absolutas y relativas. Resultados: La insuficiencia venosa crónica fue la causa más frecuente de hospitalización y consulta externa. Se encontró un predominio del sexo femenino. La úlcera del pie diabético se ubicó en orden decreciente de frecuencia entre las enfermedades consideradas. El desbridamiento quirúrgico o limpieza quirúrgica fue el procedimiento más empleado. La amputación mayor se realizó en todos los pacientes que tuvieron una trombosis arterial aguda de extremidades inferiores. Conclusiones: Se describen las características de los pacientes atendidos por el cirujano vascular en Ecuador, así como las enfermedades vasculares periféricas más frecuentes atendidas que son motivo de consulta externa y de hospitalización(AU)

Introduction: Peripheral vascular diseases include a varied number of nosologic entities that affect the arterial (excluding heart and intracranial vessels) and venolymphatic systems of the organism. Objective: To characterize patients who needed to be treated by a vascular surgeon after presenting some type of peripheral vascular disease. Method: A descriptive and prospective study was carried out in all the patients treated by external consultation and to the patients hospitalized in the service of Vascular surgery of the Ecuadorian Institute of Social Security and Manuel Ignacio Montero Valdivieso Hospital. The study lasted two years ( from September 2014 to October 2016). The following peripheral vascular diseases were taken into account: peripheral vascular diseases, chronic venous insufficiency, diabetic foot, deep-vein thrombosis and acute arterial thrombosis. The results were expressed in this paper with absolute and relative frequencies. Results: Chronic venous failure was the most frequent cause of hospitalization and outpatient consultation. A prevalence of female sex was found. The diabetic foot ulcer was observed in a decreasing order of frequency. Surgical debridement and/or surgical cleaning were the most used procedures. Major amputations were performed in all patients who had an acute arterial thrombosis of the lower limbs. Conclusions: It was possible to characterize the patients treated by the vascular surgeon in Ecuador, as well as the most frequent peripheral vascular diseases attended that needed outpatient consultation and hospitalization(AU)

Significantly reduced function of T cells in patients with acute arterial thrombosis / 老年心脏病学杂志（英文版）

Objectives To explore the intrinsic factors related to the pathogenesis of acute arterial thrombosis (AAT) and to elucidate the patho-genesis of AAT on the basis of differentially expressed genes. Methods Patients with acute myocardial infarction (AMI), stable angina (SA) and healthy controls (n=20 per group) were recruited, and the whole human genome microarray analysis was performed to detect the dif-ferentially expressed genes among these subjects. Results Patients with AMI had disease-specific gene expression pattern. Biological func-tional analysis showed the function of T cells was significantly reduced, the mitochondrial metabolism significantly decreased, the ion me-tabolism was abnormal, the cell apoptosis and inflammatory reaction increased, the phagocytosis elevated, the neutrophil-mediated immunity increased and the post-traumatic repair of cells and tissues increased in AMI patients. The biological function in SA group and healthy con-trols remained stable and was comparable. Conclusions The reduced function of T cell gene models in AAT showed the dysfunction of the immune system. The pathogenesis of AAT may be related to the inflammatory reaction after arterial intima infection caused by potential pathogenic microorganisms.

A Case of Repeated Acute Limb Ischemia with Malignant Tumor / 日本心臓血管外科学会雑誌

A 72-year-old man had undergone aorto-bifemoral bypass for Leriche syndrome at age 67, but acute limb ischemia developed three times after the first operation, in January 2008, April 2008, and April 2009. There were no abnormal heart rhythms or thrombotic factors, and he had received anticoagulant therapy with warfarin (target prothrombin time-international normalized ratio : 1.7 to 3.0) since January 2008. Nevertheless, he came to our hospital because of sudden onset of severe pain in the right lower limb in April 2010. Since CT showed occlusions in the right leg involving the aortobifemoral bypass and femoropopliteal bypass graft, emergency thrombectomy and femoropopliteal bypass (below knee), was performed. CT on admission showed enlargement of lymph nodes around the stomach, and gastric cancer was diagnosed by esophagogastroduodenoscopy. Since we considered the hypercoagulability in this patient with cancer to have resulted in repeated acute arterial thrombosis, these episodes were broadly diagnosed as Trousseau's syndrome.

Acute Arterial Thrombosis in Leg Associated with Hyperhomocysteinemia

Herein, two cases of acute arterial thrombosis associated with hyperhomocysteinemia are reported. A 34-year old male patient without heart disease, was brought to hospital with an acute ischemic limb due to thromboses of both superficial femoral arteries, where no atherosclerotic lesions were found. Subsequent investigation revealed that the patient had hyperhomocysteinemia, with a low folic acid level. Catheter directed thrombolysis was attempted, but failed, so bypass surgery was performed. After revascularization, anticoagulation therapy and folate supplementation were initiated. His plasma homocysteine level returned to normal, and there has been no recurrence during the 48 month follow up periods. The other case was a 51-year man with an acute left ilio-femoro-popliteal artery occlusion, who had also shown hyperhomocysteinemia, with a low folic acid level. There was nothing abnormal from his medical records, and showed normal findings in his transesophageal echocardiogram. In a serologic hypercoagulability test, everything was normal, with the exception of an increased homocysteine level. After a successful thrombectomy with a Fogarty catheter, folate supplementation was administered until his homocysteine level returned to normal. In both patients, the heterozygous mutation of 5, 10-methylenetetrahydrofolate reductase (MTHFR), C677T (alanine to valine substitution), was detected.