Changes in tuberculosis in human immunodeficiency virus infected patients in a Spanish tertiary hospital (1995-2013).

OBJECTIVE: Although the incidence of human immunodeficiency virus (HIV)-associated tuberculosis (TB) has decreased, changes in other characteristics of the disease are largely unknown. To describe the trends in TB in patients infected with HIV from 1995 to 2013. METHODS: We review all cases of TB in a tertiary hospital in Madrid, Spain. RESULTS: Among 1,284 patients diagnosed of TB, 298 (23%) were coinfected with HIV. The prevalence of HIV infection during the period of study has decreased from 40% to 14% (p for the trend < 0.001). Clinical presentation has also changed. Although pulmonary and extrapulmonary TB has remained unchanged, miliary presentation has significantly decreased (from 36% to 22%, p = 0.005). The 4-drug regimen was the preferable scheme, with higher implementation at the end of the study period (82% from 1995-1999 to 95% in 2010-2013, p = 0.43). Factors such as treatment failure (OR: 11.7; CI 95%: 3.12-44.1) and miliary form (OR: 2.8; CI 95%; 1.09-7.3) were independently associated with TB related mortality, while the longer duration of treatment was as a protective factor (OR 0.7; CI 95%: 0.6-0.8). CONCLUSIONS: HIV has decreased very significantly as a risk factor for the development of TB. Despite improvement in the treatment of both TB and HIV, and in overall mortality, deaths attributable to the disease in this population remain high mostly in miliary and relapsing forms.

Manejo y cuidados de la úlcera diabética: Revisión y puesta al día / Prevention and management of the diabetic food ulcer: a review

El cuidado minucioso del pie diabético es vital para prevenir infecciones y complicaciones como amputaciones y sepsis. Ese cuidado debe empezar en la identificación y un correcto diagnóstico precoz, prevención y tratamiento de las úlceras diabéticas. Revisamos la epidemiología, características clínicas, diagnóstico, tratamiento y prevención de las úlceras diabéticas, fundamentalmente en sus fases iniciales no complicadas (AU)

The meticulous care of the diabetic foot is essential to prevent infections and complications such as amputation and sepsis. This care should begin in the detection, diagnosis and proper treatment and prevention of diabetic ulcers. We review the epidemiology, clinical features, diagnosis, treatment and prevention of diabetic ulcers, mostly in their early stages is not complicated.(AU)

Traumatismo de Aorta Torácica. Revisión y puesta al día / Traumatic throacic aortic transections. Systematic review

INTRODUCCIÓN. Los traumatismos de aorta torácica aunque son infrecuentes (5% de los traumatismos vasculares) conllevan una alta mortalidad. En los últimos años han aparecido gran número de artículos en la bibliografía analizando las distintas opciones terapéuticas de esta patología. MATERIAL Y MÉTODOS. Se realizó una búsqueda bibliográfica de la Nacional Library of Medicine (PubMed). Las palabras clave introducidas para realizar dicha búsqueda fueron: lesiones traumáticas aorta torácica, tratamiento abierto, tratamiento endovascular. Se incluyeron los trabajos publicados desde Enero de 2006 hasta Diciembre 2009, en inglés y español. RESULTADOS. Con los límites citados anteriormente se encontraron 102 artículos y 25 revisiones, de los cuales eran referentes al tema 15 de ellos. CONCLUSIONES. El tratamiento endovascular de las lesiones traumáticas de la aorta torácica se asocia a bajas tasas de mortalidad y de paraplejia respecto a la cirugía abierta convencional (AU)

INTRODUCTION. Injuries of the thoracic aorta are rare (5% of vascular injuries) carry a high mortality. In recent years, a large number of articles in the literature analyzing the different treatment options of this condition. MATERIAL AND METHODS. A bibliographical search has been done in the National Library of Medicine (PubMed). The key words introduced to realize the above mentioned search were traumatic injuries thoracic aorta, open repair, endovascular The included articles published from January 2006 until December of 2009, in English and Spanish. RESULTS. With the limits mentioned previously, we found 102 articles and 25 reviews, 15 of them were relating to the topic. CONCLUSION. Endovascular treatment of traumatic injuries of the thoracic aorta is associated with low rates of mortality and paraplegia respect to conventional open surgery (AU)

Patología Traumática de la aorta abdominal y arteria ilíaca: revisión y puesta al día / Traumatic pahtology of the abdominal aorta and iliac artery: review and update

Los traumatismos vasculares abdominales constituyen el 25% de los traumatismos vasculares en general y tienen una importante relevancia en la actualidad debido a su letalidad. Su correcto diagnóstico, manejo y tratamiento son fundamentales para disminuir la mortalidad. Revisamos en este trabajo las generalidades de los traumatismos vasculares abdominales (epidemiología, etiopatogenia, clínica, diagnóstico y tratamiento) así como las generalidades y el manejo terapéutico específico de los traumatismos de aorta abdominal y arteria ilíaca

Abdominal vascular injuries constitute 25% of vascular injuries in general and have an important relevance in today because of its lethality. Correct diagnosis, management and treatment are essential to decrease mortality. Reviewed in this paper the generalities of abdominal vascular injuries (epidemiology, etiology, clinical, diagnosis and treatment) as well as the general and specific therapeutic management of abdominal aortic injuries and iliac artery

Evidencia científica en la indicación de filtro de vena cava inferior: Revisión bibliográfica / Scientific evidence in inferior vena cava filter indication: Bibliographic review

En esta revisión bibliográfica se pretende aplicar la Medicina Basada en la Evidencia a las indicaciones de colocación de filtro de vena cava inferior, y establecer una comparación con las indicaciones clásicas. Asimismo se revisan las indicaciones de los filtros temporales de vena cava, así como sus características, ventajas e inconvenientes. Finalmente se hace una breve mención a la indicación de filtro de vena cava inferior en algunos casos especiales, como son los pacientes politraumatizados y oncológicos (AU)

In this review is intended to implement the Evidence-based indications of a placement of inferior vena cava filter, and a comparisonwith the classic signs. It also reviews the indications of temporary vena cava filters, as well as their characteristics, advantages and disadvantages. Finally a brief mention of the indication of inferior vena cava filter in some special cases, such as cancer patients and polytraumatized (AU)

Stent carotídeo. Revisión y puesta al día / Carotid stenting. Review of the evidence

INTRODUCCIÓN. En el momento actual no existe un total acuerdo sobre el tratamiento de elección en la estenosis carotidea, las dos opciones terapéuticas existentes son la tromboendarterectomia (TEA) carotidea y el stent carotideo. En esta revisión hemos querido analizar los resultados de los estudios publicados en los últimos años y la evidencia científica existente en la actualidad. MATERIAL Y MÉTODOS. Se realizó una búsqueda bibliográfica de la Nacional Library of Medicine (PubMed). Las palabras clave introducidas para realizar dicha búsqueda fueron carotid stenosis, stent, y thrombo endarterectomy. Se incluyeron los trabajos publicados desde 2006 hasta 2008, en inglés y español. RESULTADOS. Con los límites citados anteriormente se encontraron 225 artículos y 24 revisiones, de los cuales eran referentes al tema 14 de ellos. CONCLUSIONES. Los datos son difíciles de interpretar porque los ensayos son heterogéneos (diferentes pacientes, técnica y duración de seguimiento) y cinco ensayos se interrumpieron anticipadamente por el elevado índice de stroke/muerte del tratamiento endovascular. La evidencia científica sobre el tratamiento de la estenosis carotídea mediante angioplastia/stent, no apoya un cambio en la práctica clínica frente a la tromboendarterectomía carotídea, salvo en grupos seleccionados de pacientes (AU)

INTRODUCTION. In the current moment a total agreement does not exist on the treatment of choice in the carotid stenosis, both therapeutic existing options are carotid thromboendarterectomy and carotid stent. In this review we have wanted to analyze the results of the studies published in the last years and the scientific existing evidence at present. MATERIAL AND METHODS. There was realized a bibliographical search of Native Library of Medicine (PubMed). The key words introduced to realize the above mentioned search were carotid stenosis, stent, and thromboendarterectomy. The articles were included published from2006 until 2008, in English and Spanish. RESULTS. With the limits mentioned previously, we found 225 articles and 24reviews, 14 of them were relating to the topic. CONCLUSION. There are several controversies because the studies are heterogeneous(different patients, technicals and duration of follow-up) and five of them were interrupted early by the high index of stroke/death of the endovascular treatment. The scientific evidence on the treatment of the carotid stenosis by means of angioplasty/stent, does not support a change in the clinical practice opposite to carotid thromboendarterectomy , except in groups of selected patients (AU)

Isquema mesentérica. Revisión y puesta al día / Mesenteric ischemia. Review and update

A pesar de los recientes avances que han mejorado los resultados de la mayoría de las patologías quirúrgicas en las últimas décadas, la isquemia mesentérica continúa constituyendo una enfermedad con una elevada morbilidad. Una elevada sospecha clínica, así como el conocimiento de las diferentes posibilidades diagnósticas son esenciales para el correcto tratamiento de estos pacientes. El tipo de tratamiento depende en gran medida de la presentación clínica así como del tiempo de evolución puesto que representa el factor de mayor importancia para determinar la viabilidad intestinal. La angioplastia transluminaly el stent de las arteria viscerales son unas alternativas viables en el tratamiento de la isquemia mesentérica crónica. Revisamos la fisiopatología, la presentación clínica y el estado actual de las técnicas diagnósticas y terapéuticas (AU)

Although recent advances have improved outcomes in most surgical diseases over the last several decades, mesenteric ischemiaremains a highly morbid condition. High clinical suspicious and knowledge of the differential diagnostic possibilities inthis clinical setting are essential for the correct management of this patients. The type of the treatment depends largely on the clinical presentation, with time being the most important factor determining viability before irreversible damage occurs to the bowel. Transluminal angioplasty and stenting of the visceral arteries is a viable alternative for treatment of chronic mesentericischemia. We review the pathophysiology, the clinical presentation and the current state of the art in diagnosis and treatment (AU)

Actualización en diagnóstico y tratamiento de la isquemia aguda en extremidades / Updating diagnosis and treatment in acute limb ischemia

La isquemia aguda de la extremidad es definida como cualquier disminución brusca de la perfusión que cause una posibleamenaza a la viabilidad de la misma. La isquemia aguda de extremidad inferior continua asociada a una alta morbilidady mortalidad a pesar de los avances en los cuidados perioperatorios y en las técnicas de revascularización. En especial lospacientes de edad avanzada están expuestos a un alto riesgo de complicaciones graves tanto locales como sistémicas. Lacomorbilidad, los trastornos metabólicos asociados a la isquemia aguda y el síndrome de reperfusión están asociados a estepobre pronóstico. En este artículo nos proponemos una actualización en el manejo de este tipo de pacientes presentandonovedades en diagnóstico y tratamiento. Para ello hemos realizado una revisión de la literatura publicada en los últimos 5años centrándonos en los trabajos que aportan nuevas herramientas en diagnóstico y tratamiento para reducir la elevadamorbilidad y mortalidad que presentan este tipo de pacientes (AU)

A systematic review of the medical literature was performed for relevant studies. We searched a number of electronic databasesand hand-searched relevant journals since January 2002 until November 2007. We considered studies in which diagnosisand treatment were evaluated to diminish the morbimortality. Isquemia acute of the extremity is defined as any abruptdiminution of the perfusión that causes a possible threat to the viability of the same one. Isquemia acute of continuous inferiorextremity associated to a high morbidity and mortality in spite of the advances in the perioperatorios cares and the techniquesof revascularización. In special the age patients outpost they are exposed to a high risk of local serious complicationsas as much sistémicas. The comorbidity, the metabolic upheavals associated to isquemia acute and the syndrome of reperfusiónare associate to this poor prognosis. In this article we set out an update in the handling of this type of patients presenting/displaying new features in diagnosis and treatment. For it we have made a revision of Literature published in the last5 years having centered in the works that contribute to new tools in diagnosis and treatment to us to reduce the high morbidityand mortality who present/display this type of patients (AU)

Oclusión del bypass infrainguinal / Infrainguinal graft occlusion

La oclusión del bypass infrainguinal puede ocurrir en el periodo postoperatorio inmediato (oclusiones agudas) o años después (oclusiones tardías). La prevención de la oclusión incluye una correcta decisión de intervenir y una adecuada elección del flujo de entrada y salida, lugares de anastomosis proximal y distal y del conducto empleado. Además se encuentran la confirmación intraoperatoria del éxito técnico, la antiagregación postoperatoria, el seguimiento con dúplex, y el cese del hábito tabáquico o el control estricto de los niveles glucémicos. Las oclusiones agudas deben ser tratadas inmediatamente con una esperanza razonable de restaurar la permeabilidad. El pronóstico de los pacientes con oclusiones tardías es pobre, sin embargo, la reoperación electiva con un nuevo bypass de vena autóloga consigue unos porcentajes favorables de salvamiento de extremidad en pacientes con síntomas isquémicos. El propósito de nuestra revisión es aportar un acercamiento a la oclusión del bypass infrainguinal que logre una máxima permeabilidad a largo plazo, salvamiento de extremidad y supervivencia del paciente (AU)

Infrainguinal graft occlusions may occur in the immediate postoperative period (acute occlusions) or years later (late occlusions). Prevention of postoperative graft occlusions includes a correct decision to operate and adequacy inflow and outflow vessels, proximal and distal anastomoses, and conduit. Intraoperative confirmation of technical success, postoperative antiplatelet therapy, follow-up with duplex scanning and smoking cessation or close perioperative glycaemic control, were included in this composite endpoint. Acute occlusions should be treated immediately with a reasonable expectation that patency can be restore. The overall prognosis for patients with late failed infrainguinal grafts is poor however elective reoperation with a new autogenous vein graft achieves favourable limb salvage rates in patients with ischemic symptoms. Aim of our review is provided an approach to graft infrainguinal occlusions that results in maximal long-term graft patency, limb salvage and patient survival (AU)

Superficial femoral artery as a substitute for common carotid artery affected by malignant cervical tumors.

Tumoral disease of the arteries is uncommon. It is possible that, in tumoral reoperations affecting cervical structures, periarterial fibrosis due to radiotherapy and previous surgery and metastatic adherences to the arterial wall makes radical surgery difficult. We present a case where the surgical treatment of a regional relapse from laryngeal neoplasm needed the removal of the common carotid artery and its reconstruction with autologous patent superficial femoral artery. Surgical technique included a PTFE graft interposition in the leg.

Sartorius myoplasty for the treatment of infected groins with vascular grafts.

INTRODUCTION: Vascular graft infection is a rare (0.8-2.6%) but serious complication of reconstructive vascular surgery, that comprises limb-threatening when located in the groin. PURPOSE: Review our experience in the treatment of infected groin wounds after femoral surgery by using sartorius myoplasty. MATERIALS AND METHODS: Between January 1989 and October 1993, 13 patients with infected groin wounds involving vascular graft (Grade III of Szilagyi) were treated with local gently debridement, 10% povidone iodide lavage for 5 days, local and systemic antibodies for 14 days and in situ change of the infected graft followed by sartorius myoplasty, detaching its origin from superior anterior iliac spine and fixing it to inguinal ligament, except in one case where tissue cultures were negative and the graft was not changed. Follow-up was done using clinical and echographical criteria at 3, 6, 12 months after operation, and annually. RESULTS: Hospital mean stage was 10 days (8-13). The mean follow-up was 36 months (12-65). There was only one immediate complication from hemorrhage that needed surgery. The patient whose graft was not changed developed an abscess in the prosthetic bed 12 weeks after treatment. It was necessary to change it after debridement and antibiotics. No mortality was related to this technique. CONCLUSIONS: Sartorius myoplasty, with detaching and origin transposition, after in situ change of infected graft, is an excellent therapeutic option for reconstruction and treatment for infected groins with vascular grafts because it is easy to perform and offers very good results in long-term follow-up.