Early results after synchronous carotid stent placement and coronary artery bypass graft in patients with asymptomatic carotid stenosis.

BACKGROUND: The optimal management of patients with combined carotid and coronary artery disease requiring cardiac surgery is still unknown. Staged carotid endarterectomy and carotid artery stenting (CAS), each followed by coronary artery bypass graft (CABG), are options frequently employed. However, for patients with severe carotid artery disease in urgent need of open cardiac revascularization, staged operations may not be the most appropriate alternative. The aim of this study was to describe our experience using a synchronous CAS-CABG method with minimal interprocedural time. We used this synchronous combination of procedures in patients with combined carotid and coronary artery disease admitted for urgent CABG. METHODS: Patients with concomitant severe carotid and coronary artery disease scheduled for synchronous CAS and urgent CABG between December 2006 and January 2010 were included in the study. All procedures were performed at a single center: the Cardiovascular Foundation of Colombia, in Floridablanca, Santander, Colombia. The study cohort was characterized according to demographic and clinical characteristics, which included degree of carotid stenosis, presence/absence of preoperative neurological symptoms, and cardiac operative risk profile. All patients underwent CAS under embolic protection devices and then CABG within the next 2 hours. Patients received aspirin pre- and postprocedure but were started on clopidogrel only after CABG. The primary end point of the study was the composite incidence rate of myocardial infarction, stroke, and death 30 days after CAS-CABG. RESULTS: Fifteen patients with concomitant severe carotid and coronary artery disease underwent synchronous CAS-CABG. Most patients (60%) were men, and mean (± standard deviation) age was 65.2 (± 8.4) years. Most patients (93%) were neurologically asymptomatic. The median (interquartile range) ejection fraction and logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) for the cohort were 55% (36%-62%) and 9.7% (4.6%-14.8%), respectively. There were no deaths, major strokes, minor strokes, or myocardial infarctions during the procedure or within 30 days of CAS-CABG. One patient experienced neurological symptoms likely as a result of transient ischemic attack ipsilateral to the CAS procedure. None of the patients required cardiac or carotid reinterventions, and there were no cases of postoperative bleeding requiring reoperation. CONCLUSIONS: Synchronous CAS-CABG, when CABG is performed within the 2 hours of the CAS procedure, may be a viable alternative to the more generally accepted staged combination, particularly among patients for whom CABG cannot be postponed. We hope that this strategy will be further evaluated in larger prospective studies and adequately powered randomized clinical trials.

Early evaluation of the metabolic syndrome in Bucaramanga, Colombia.

BACKGROUND: Metabolic syndrome (MS) is one of the conditions that increase the risk of developing cardiovascular diseases (CVD) and type-2 diabetes in the early future if it appears during childhood or adolescence. The purpose of the study to compare the MS prevalence of MS estimated in a representative sample of school-age population in Bucaramanga, Colombia, and the MS prevalence estimated in a subsample from the same population in the adolescent stage. METHODS: An analytical cross-sectional survey (in the adolescent stage) (n=494) was carried out, nested in a population-based cohort assembled when children were of school age (n=1,282). Selection employed a bi-stage randomized sampling per neighborhoods and houses across the city. Sociodemographic and anthropometric variables, as well as cardiometabolic factors were analyzed in accordance with their distribution, and statistical significance tests were applied according to each case. MS was determined using the Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria. RESULTS: Estimated MS prevalence in school age according to the ATP III criteria was 9.5% (95% CI: 8.0-11.3%) and according to the IDF criteria it was 8.0% (95% CI: 6.6-9.7%). At the time of follow up the prevalence of MS was 13.2% and 14.8% according to the ATP III and IDF criteria, respectively. CONCLUSIONS: MS prevalence of MS increased in 4% from the school age (9.5%) to the adolescence (13.1%).

Hematuria fatal por fístula ilíaco-vesical, reporte de caso / Lethal hematuria du to ilio-vesical fistula. Case report

Las fístulas ilíaco-vesicales son una rara complicación de los aneurismas de la aorta abdominal. Se presenta el caso de un paciente de 76 años con aneurisma roto de arteria ilíaca contenido en vejiga, que se manifestó por dolor abdominal y hematuria, y en quien se sospechó por tomografía una fístula ilíaco-vesical, la cual se confirmó durante la cirugía. El paciente falleció a los 20 días del procedimiento, por shock mixto séptico.

Iliocovesical fistulas are infrequent complications of abdominal aortic aneurysms (AAA). We report the case of a 76 year-old male with a contained ruptured aneurysm of the iliac to the urinary bladder. Complaints on presentation were abdominal pain and hematuria; suspected iliacovesical fistula was reported on a computed tomography (CT) scan, which was confirmed during laparotomy. The patient died 20 days after the procedure due to mixed distributive septic shock.

¿Reanimación agresiva o hipotensión permisiva? Rompiendo paradigmas en trauma / Aggressive Resuscitation or permisiva hypotension? Breaking paradigms in trauma

En el transcurrir de los años, todo paciente politraumatizado que se encuentre hipotenso ha sido sinónimo de reanimación agresiva con líquidos hasta alcanzar la normotensión antes de llegar a cirugía, esto ha hecho que la mortalidad preoperatoria en trauma no haya mejorado y que sea la anemia aguda por causa del sangrado la responsable de este fatal desenlace La respuesta fisiológica del organismo busca frenar la hemorragia y tratar de mantener el flujo sanguíneo a órganos vitales. La reanimación agresiva lleva a mayor sangrado por ruptura de la respuesta fisiológica que el organismo monta y del coágulo inmaduro formado y por ende a mayor mortalidad. Hoy la mayoría de los estudios en animales y los pocos en humanos han demostrado que la reanimación hipotensiva, que consiste en infundir liquidos solo hasta que el paciente tenga pulsos centrales (tensión arterial sistólica 60 y 70 mm Hg.), ha permitido que mayor numero de pacientes lleguen vivos al quirófano para realizar el control del sangrado y la corrección de las heridas, objetivo fundamental del paciente con trauma penetrante que se encuentra hipotenso...