Low-molecular-weight heparin for prevention of venous thromboembolism after varicose vein surgery in moderate-risk patients: a randomized, controlled trial.

BACKGROUND: Deep vein thrombosis (DVT) after varicose vein surgery (VVS) is not well recognized. Observational studies have yielded variable estimates of the risk, but evidence from randomized trials is lacking. Our aim was to compare the use of thromboprophylaxis with and without low-molecular-weight heparin (LMWH). METHODS: We prospectively randomized moderate-risk patients scheduled for VVS in two arms. The first group of patients received bemiparin for 10 days at a prophylactic dose, early ambulation, and compression therapy for 3 months; the second group received early ambulation and compression therapy alone. The primary efficacy outcome was the composite of DVT (symptomatic or asymptomatic detected by mandatory, bilateral duplex scan). Secondary efficacy and primary safety end points were superficial venous thrombosis, postoperative bleeding, and clinical pulmonary embolism (PE). We assessed transient and permanent risk factors for venous thromboembolism. RESULTS: Two-hundred sixty-two patients were eligible for evaluation. There were no cases of DVT. There were also no cases of clinical PE, death, or major bleeding. No significant differences were seen between groups in the rates of bleeding episodes. CONCLUSION: The data show no superiority of a short-term regimen of LMWH and early ambulation and compression therapy, as compared with early ambulation and compression therapy alone, in patients undergoing VVS in a moderate-risk population.

Shotgun wound and pellet embolism to the intracranial carotid artery.

Missile embolism into the cerebral circulation is a very unusual complication of shotgun wounds to the chest or neck. We report a case of an 11-year-old boy who sustained an air gunshot wound and pellet embolism to the intracranial carotid artery. The cerebral artery pellet embolus resulted in contralateral hemiplegia. The patient was successfully treated by emergency flow reversal and embolectomy. Because this injury is extremely rare, the literature is reviewed, and several principles are suggested to improve the management.

Calidad de la información disponible en internet sobre el aneurisma de aorta y su tratamiento endovascular / The quality of information available on the internet about aortic aneurysm and its endovascular treatment

Introducción y objetivos. Evaluar legibilidad, accesibilidad, utilidad y fiabilidad de la información existente en internet sobre el aneurisma de aorta y su tratamiento endovascular, para comprobar su función como vehículo de información comprensible que capacite al paciente para participar en decisiones respecto a su enfermedad. Métodos. En noviembre de 2010 se recopiló información en internet sobre los términos «aneurisma aorta» y «endoprótesis de aorta» empleando los buscadores más extendidos: Google, Yahoo y MSN/Bing. Se analizaron las primeras 30 páginas ofrecidas por cada uno. Para calcular la legibilidad de los textos, se empleó el programa informático Inflesz y el instrumento LIDA como método validado de evaluación de páginas web relacionadas con la salud sobre accesibilidad, utilidad y fiabilidad. Resultados. Los índices de correlación Word (48,3±11,42; 50,11±9,33; p=0,87), Flesch-Szigriszt (52,69±8,86; 49,31±7,24; p=0,87), Fernández-Huerta (58,05±8,5; 54,44±7,19; p=0,82) y Gunning-Fog (22,03±2,05; 23,86±1,59; p=0,83) y el grado de la escala Inflesz (2,39±0,7; 2,08±0,64; p=0,28) de las páginas web sobre «aneurisma de aorta» y «endoprótesis de aorta», respectivamente, reflejaron una legibilidad «algo difícil». Los valores de accesibilidad (82,28±14,14; 77,77±12,64; p=0,98), utilidad (72,28±16,67; 72,28±26,61; p=0,08), fiabilidad (46,17±28,69; 56,38±16,17; p=0,06) y valoración total LIDA (70,22±16,85; 72,15±14,93; p=0,52) resultaron «moderados». Conclusiones. La información disponible en internet sobre el aneurisma de aorta y su terapéutica mediante implantación de endoprótesis presenta deficiencias en cuanto a accesibilidad, utilidad y fiabilidad, con la dificultad añadida de una complicada legibilidad. Creemos que los índices de legibilidad deber ser utilizados en la elaboración o la mejora de las páginas web sobre conocimientos médicos cardiovasculares (AU)

Introduction and objectives. To evaluate the readability, accessibility, usability, and reliability of information available on the Internet in the Spanish language about aortic aneurysm and its endovascular treatment, and to determine whether this information source provides comprehensible material that will enable patients to participate in decisions regarding their condition. Methods. In November 2010, information from the Internet was compiled by entering the terms “aneurisma aorta” (aortic aneurysm) and “endoprótesis aorta” (aortic endoprosthesis) in the most widely used search engines: Google, Yahoo, and MSN/Bing. The first 30 pages provided by each search engine were analyzed. The Inflesz software was used to calculate the readability of the information retrieved and the LIDA instrument, a validated tool to evaluate the quality of health-related Web sites, was used to assess accessibility, usability, and reliability. Results. The results for Web pages containing the terms aneurisma aorta and endoprótesis aorta indicated that the readability of the material retrieved was “somewhat difficult” based on the Flesch index within Microsoft Word (48.3±11.42 and 50.11±9.33, respectively; P=.87), Flesch-Szigriszt index (52.69±8.86, 49.31±7.24; P=.87), Fernández-Huerta index (58.05±8.5, 54.44±7.19; P=.82), and Gunning-Fog index (22.03±2.05, 23.86±1.59; P=.83), as well as the Inflesz grading scale (2.39±0.7, 2.08±0.64; P=.28). The LIDA values for accessibility (82.28±14.14, 77.77±12.64; P=.98), usability (72.28±16.67, 72.28±26.61; P=.08), and reliability (46.17±28.69, 56.38±16.17; P=.06) and the total score (70.22±16.85, 72.15±14.93; P=.52), yielded an evaluation of “moderate”. Conclusions. The Internet information on aortic aneurysms and its endovascular treatment with aortic endoprostheses was deficient with regard to accessibility, usability, and reliability, and had the added difficultly of complicated readability. Our results suggest that readability indexes should be incorporated in the creation and improvement of Web sites providing medical information related to cardiovascular disease (AU)

Tratamiento endovascular de las arterias distales del miembro inferior / Endovascular treatment of distal lower limb arteries / Tratamento endovascular das artérias distais do membro inferior

La angioplastía es un procedimiento que se ha introducido en el tratamiento de las lesiones oclusivas de los miembros inferiores con resultados prometedores. No obstante, son importantes los nuevos aportes de datos sobre los resultados obtenidos, teniendo en cuenta la falta de homogeneidad de los pacientes tratados afectados por diferentes procesos obstructivos arteriales, tratados en diferentes situaciones clínicas y con una muy variada extensión de las lesiones. Se realiza un análisis de 239 casos incluidos en un estudio prospectivo con el objetivo de analizar los resultados en relación a los diversos factores que afectan a los pacientes. Se analizan los resultados y se valoran los mismos.

A angioplastia é um procedimento que foi introduzido no tratamento das lesões oclusivas dos membros inferiores com resultados prometedores. Entretanto, são importantes as novas contribuições de dados sobre os resultados obtidos, levando em consideração a falta de homogeneidade dos pacientes tratados afetados por diferentes processos obstrutivos arteriais, tratados em diferentes situações clínicas e com uma muito variada extensão das lesões. Realiza-se uma análise de 239 casos incluídos em um estudo prospectivo com o objetivo de analisar os resultados com relação aos diversos fatores que afetam os pacientes. Analisam-se os resultados e se valorizam os mesmos.

Angioplasty is a procedure that has been introduced with promising results in the treatment of occlusive lesions of the lower limbs. However, it is necessary further input of data on the results obtained taking into account the lack of homogeneity of patients suffering from obstructive arterial different processes, treated in different clinical situations and with a very wide extent of the injury. An analysis of 239 cases in a prospective study to analyze the results in relation to the various factors that affect patients. The results are analyzed and valued the same.

[The quality of information available on the internet about aortic aneurysm and its endovascular treatment]. / Calidad de la información disponible en internet sobre el aneurisma de aorta y su tratamiento endovascular.

INTRODUCTION AND OBJECTIVES: To evaluate the readability, accessibility, usability, and reliability of information available on the Internet in the Spanish language about aortic aneurysm and its endovascular treatment, and to determine whether this information source provides comprehensible material that will enable patients to participate in decisions regarding their condition. METHODS: In November 2010, information from the Internet was compiled by entering the terms "aneurisma aorta" (aortic aneurysm) and "endoprótesis aorta" (aortic endoprosthesis) in the most widely used search engines: Google, Yahoo, and MSN/Bing. The first 30 pages provided by each search engine were analyzed. The Inflesz software was used to calculate the readability of the information retrieved and the LIDA instrument, a validated tool to evaluate the quality of health-related Web sites, was used to assess accessibility, usability, and reliability. RESULTS: The results for Web pages containing the terms aneurisma aorta and endoprótesis aorta indicated that the readability of the material retrieved was "somewhat difficult" based on the Flesch index within Microsoft Word (48.3 ± 11.42 and 50.11 ± 9.33, respectively; P = .87), Flesch-Szigriszt index (52.69 ± 8.86, 49.31 ± 7.24; P = .87), Fernández-Huerta index (58.05 ± 8.5, 54.44 ± 7.19; P=.82), and Gunning-Fog index (22.03 ± 2.05, 23.86±1.59; P=.83), as well as the Inflesz grading scale (2.39 ± 0.7, 2.08 ± 0.64; P=.28). The LIDA values for accessibility (82.28 ± 14.14, 77.77 ± 12.64; P=.98), usability (72.28 ± 16.67, 72.28 ± 26.61; P=.08), and reliability (46.17 ± 28.69, 56.38 ± 16.17; P=.06) and the total score (70.22 ± 16.85, 72.15 ± 14.93; P=.52), yielded an evaluation of "moderate". CONCLUSIONS: The Internet information on aortic aneurysms and its endovascular treatment with aortic endoprostheses was deficient with regard to accessibility, usability, and reliability, and had the added difficultly of complicated readability. Our results suggest that readability indexes should be incorporated in the creation and improvement of Web sites providing medical information related to cardiovascular disease.