Caso 7. Degeneración quística adventicial de la arteria poplítea / Case 7. Degeneration of an adventitial cyst of the popliteal artery

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Solución del caso 7. Degeneración quística adventicial de la arteria poplítea / Solution to case 7. Degeneration of an adventitial cyst of the popliteal artery

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Utilidad de la gammagrafía de receptores de somatostatina en la detección de recurrencias y seguimiento de paragangliomas carotídeos / Usefulness of somatostatin receptor scintigraphy in the detection of recurrences and follow-up of carotid paragangliomas

Introducción: El octreótido es un análogo sintético activo de la somatostatina que marcado con indio-111 tiene la capacidad de unirse a sus receptores, especialmente presentes en células neuroendocrinas. El objetivo es evaluar la utilidad de la gammagrafía de receptores de somatostatina (GRS) para la detección de recurrencias o restos tumorales de paragangliomas carotídeos. Material y métodos: Fueron considerados para análisis 29 casos tratados en 26 pacientes entre enero de 1996 y diciembre de 2010. Los estudios de GRS fueron comparados con angio-TC, así como los hallazgos clínicos y patológicos. Se registraron las variables demográficas, técnicas terapéuticas y los datos de seguimiento. Resultados: Mediana de edad de 68 años (r-27-82), 76,9% mujeres, resección completa del tumor glómico con reconstrucción vascular en 2 casos, endarterectomía carotídea en 3 y embolización preoperatoria en 3 casos. No se registró mortalidad perioperatoria. Tras una mediana de seguimiento de 5,8 ± 3,9 años, la lesión neurológica fue la complicación más frecuente (un nervio hipogloso, disfonía en 2 casos y glosofaríngeo en otro). El estudio GRS fue posible en 17 pacientes (mortalidad 19,2% [5], pérdida de seguimiento 15,4% [4]). Uno de los pacientes mostró hallazgos anormales en el estudio que no fueron detectados con angio-TC, confirmándose quirúrgicamente una recidiva local. Conclusiones: La GRS es una técnica útil para la detección de tumores neuroendocrinos primarios y metastásicos. Esta técnica permite la distinción entre paragangliomas carotídeos y otros tumores de cabeza y cuello, siendo válida para el seguimiento postoperatorio y la detección de recurrencias (AU)

Introduction: Octreotide is an active synthetic analogue of Indium-111-labelled somatostatin. It has the ability to bind to their receptors, especially present in neuroendocrine cells. The objective is to evaluate the usefulness of somatostatin receptor scintigraphy (GRS) for the detection of recurrences or residual tumours of carotid paragangliomas. Material and methods: A total of 29 cases in 26 patients treated between January 1996 and December 2010 were considered for analysis. GRS studies were compared with CT angiography and the clinical and pathological findings. We recorded demographic, therapeutic techniques and monitoring data. Results: Mean age 68 years (r-27-82), 76.9% female, complete resection of glomus tumour with vascular reconstruction in 2 cases, CEA in 3 patients, and preoperative embolization in three cases. There was no perioperative mortality. After a mean of 5.8±3.9 years, neurological injury was the most common complication (hypoglossal nerve injury in one case, dysphonia in two cases, and glossopharyngeal injury in another). The GRS study was possible in 17 patients (19.2% mortality, 15.4% lost to follow-up). One of the patients showed abnormal findings in GRS study that were not detected in CT; confirmed surgically as a local recurrence. Conclusions: The GRS is a useful technique for the detection of primary and metastatic neuroendocrine tumours. This technique helps to distinguish between carotid paragangliomas and other head and neck tumours, and is valid for the monitoring and detection of postoperative recurrence (AU)

Tratamiento quirúrgico del síndrome de atrapamiento de arteria poplítea: nuestra experiencia / Surgical treatment of popliteal artery entrapment syndrome: our experience

Introducción: El síndrome de atrapamiento de la arteria poplítea (SAAP) es una entidad pocofrecuente cuya incidencia varía del 0,17 al 3,5 %.Objetivo: Revisamos a los pacientes tratados quirúrgicamente en nuestro servicio durante losúltimos 15 años.Material y métodos: Estudio retrospectivo entre 1995 y 2009, en que se registraron variablesdemográfi cas, comorbilidad, clínica, exploración física, pruebas complementarias, tratamientoquirúrgico realizado, así como evolución a los 15 años.Resultados: Se intervino quirúrgicamente a 8 pacientes (el 50 %, varones) por SAAP con una medianade edad de 41,5 (intervalo, 16-62) años; 2 pacientes (25 %) presentaron claudicación invalidante,5 (62,5 %), dolor de reposo y en 1 caso (12,5 %), lesiones trófi cas. La prueba de elecciónen todos ellos fue la arteriografía, aunque también en 2 casos se realizó TC y en 3, angio-RM. Eltratamiento quirúrgico fue miotomía con liberación de la arteria poplítea en 3 pacientes (37,5 %)(en uno de ellos se asoció injerto venoso), miotomía junto a trombectomía poplítea en 2 pacientes(25 %), bypass poplíteo-poplíteo con vena en otros 2 (25 %) y un caso de simpatectomía lumbar(12,5 %). La arteriografía intraoperatoria fue normal. Durante el seguimiento a 15 años (medianade seguimiento 7,5 ± 3,98 años) el 50 % de los pacientes estaba asintomático, el 25 %presentaba claudicación no invalidante y otro 25 % falleció como consecuencia de su afecciónconcomitante.Conclusiones: En nuestra experiencia, la liberación de la arteria poplítea mediante miotomíadel tendón de inserción anómalo, asociada o no a la realización de un bypass poplíteo-poplíteo,es el tratamiento quirúrgico de elección(AU)

Introduction: Popliteal artery entrapment syndrome (PAES) is a rare condition with an incidencethat varies from 0.17-3.5 %.Aim: We reviewed patients treated with surgery in our department over the past 15 years.Material and methods: A retrospective study between 1995-2009 recorded demographicvariables, comorbidity, physical examination, diagnostic tests, surgical treatment and outcomeat 15 years.Results: Eight patients (50 % male) were treated with surgery for PAES, with a mean age41.5 years (range, 16-62). Two patients (25 %) had disabling claudication, 5 (62.5 %) pain at rest,and in one case (12,5 %) trophic lesions. The test of choice in all of them was arteriography,although two patients also had a CT and three an angio-MR. Surgery was myotomy with releaseof the popliteal artery in three patients (37.5 %) (one of them involving vein graft), myotomywith popliteal thrombectomy in two patients (25 %), popliteal-popliteal bypass with vein inanother 2 (25 %), and one case of lumbar sympathectomy (12.5 %). Intraoperative arteriographywas normal in all cases. During follow-up to 15 years (mean 7.5 ± 3.98 years), 50 % of patientswere asymptomatic, 25 % had no disabling claudication, and another 25 % died as a result ofdisease.Conclusions: In our experience, the release of the popliteal artery by myotomy abnormal tendoninsertion, with or without conducting a popliteal-popliteal bypass, is the surgical treatment ofchoice(AU)

[Neck schwannomas]. / Schwannomas de cuello.

Given the rareness of cervical schwannomas, they are often mistaken for other kinds of lesions. We present 2 clinical cases, make comments on the clinical-pathological features involved and point out the essential elements that ensure the differential diagnosis of these tumours.

Lumbar sympathectomy as isolated technique for the treatment of lower limbs chronic ischemia.

BACKGROUND: Lumbar sympathectomy (LS) is often the only alternative treatment that can be considered as a means of improving the distal circulation to such extent that major amputation is prevented. To make a retrospective study in order to know the current value of LS as isolated technique for the treatment of severe ischemia of lower limbs in the absence of the possibility for vascular reconstruction. METHODS: Between 1987 and 1992, 100 LS were performed in 93 patients (82 males and 11 females) aged 64.5+/-11.1 yrs. 63% were older than 70 years. Indication was invalidant claudication/rest pain (grade II, 57%) or trophic lesion (grade III, 43%) in patients where previous reconstructive surgery failed (18%), was not possible to do (23%) or refused revascularization (20%), or with poor surgical risk (39%). Preoperative evaluation included Doppler measures, ankle/brachial index (ABI) and arteriography in every case. Surgical sympathectomy was performed in all patients. Success was considered if rest pain was absent or trophic lesions have healed at six months, comparing results in patients diabetics and non-diabetics with ABI higher or lower 0.3. RESULTS: Postoperative stage was 6.4+/-2.3 days. Morbidity was 4% and mortality was 7% in the 30-day postoperative period, related with patients older than 70 years. Long-term mortality was 9%, for a global nortality of 16%. 12 patients needed inflow surgery after LS. There was success in 58.5% of grade II and 61.7% of grade III patients at six months, with significative difference (p=0.049) if ABI was >0.3. In diabetics with ABI >0.3, trophic lesions have worse prognostic than ABI <0.3. Pre- and postoperative ABI were correlated (R2=0.65), and the increasing of 0.1 in preoperative ABI had a positive prognostic value over lesion healing. Patency of superficial femoral artery (SFA) has correlated significantly (p=0.000021) with successful outcome after LS. CONCLUSIONS: LS could be a technique that moderately improves the ischemic limb in patients who refuse major surgery or where arterial reconstruction is not indicated. Preoperative ABI has prognostic value in postoperative outcome, with clinical improvement if it is >0.3. Diabetes has not been a negative predictive factor in our series. Patency of superficial femoral artery is related to successful outcome of the patients.