Embolisation of prostate arteries in benign prostatic hyperplasia in non-surgical patients. / Embolización de arterias prostáticas en la hiperplasia benigna de la próstata en pacientes no quirúrgicos.

OBJECTIVE: To present the results of a multidisciplinary study of two tertiary hospitals, together with urology services, on 102 consecutive patients not candidates for surgery treated for more than 6 years, in whom prostatic arteries were embolised for the treatment of benign hyperplasia. MATERIAL AND METHODS: From December 2012 to February 2019, 102 patients with symptoms of benign prostatic hyperplasia (BPH) not candidates for surgery or who explicitly rejected surgery, with an average age of 73.9 years (range 47.5-94.5), underwent prostatic artery embolisation. The patients were followed up by questionnaires on urinary symptoms, sexual function and impact on quality of life, as well as measurement of prostate volume, uroflowmetry and prostate specific antigen (PSA) at one, 3 and 6 months and one year following the procedure. RESULTS: The technique was successful in 96% of patients (76.2% bilateral and 19.8% unilateral). The mean duration of the procedure was 92minutes and of the radioscopy 35.2minutes. Statistically significant changes were demonstrated (p <.05) in PSA, peak urinary flow, QoL (quality of life) questionnaire and the International Index of Erectile Function (IPSS). PSA had reduced by 58% from baseline at 3 months. Similarly, the Qmax had increased significantly by 63% in the third month following embolisation. A significant improvement in the QoL and IPSS tests was achieved, with a reduction of 3.7 points and a mean 13.5 points, respectively, at one year's follow-up. Prostate volume showed a non-statistically significant decrease at follow-up of one year following treatment. A series of minor complications was collected, no case of which required hospital admission. CONCLUSIONS: Prostatic embolisation for the treatment of BPH proved an effective and safe technique in patients who were not candidates for surgery.

Revascularización carotídea con stent: implicaciones clínicas y para el procedimiento de la presencia de una lesión suboclusiva / Carotid artery stenting: clinical and procedural implications for near-occlusion stenosis

Introducción y objetivos: La conveniencia del implante de stent en lesiones carotídeas suboclusivas es un tema controvertido. Nuestro trabajo valoró las implicaciones clínicas y de procedimiento de la revascularización de lesiones carotídeas suboclusivas. Métodos: Se incluyó a 205 pacientes con enfermedad carotídea revascularizados con stent: los pacientes con lesiones suboclusivas (n = 54) fueron comparados con el resto de la población (n = 151). Resultados: No hubo diferencias entre grupos para la edad, el sexo y la tasa de pacientes sintomáticos (que constituían 3 cuartas partes de la población). El implante de stent en lesiones suboclusivas cursó con una alta tasa de éxito (96%), similar al resto de las lesiones (98%). La revascularización de las lesiones suboclusivas condicionó un mayor uso de protección proximal (54% vs. 20,5%, p < 0,001) y necesidad de predilatación (33% vs. 17%, p = 0,01). El abordaje de lesiones suboclusivas ocasionó un mayor desprendimiento de placa, manifestado por una mayor tasa de material embólico extraído (18,5% vs. 7%, p = 0,01) y de lesiones isquémicas cerebrales periprocedimiento (47% vs. 31%, p = 0,07). A los 30 días de la revascularización, la tasa de eventos neurológicos (muerte, ictus mayor, ictus menor) mostró tendencia a ser mayor para el grupo con lesiones suboclusivas (9,2% vs. 3,2%, p = 0,08). Conclusiones: La revascularización con stent de lesiones carotídeas suboclusivas presenta una alta tasa de éxito de procedimiento; sin embargo, su mayor carga de placa ocasiona un superior porcentaje de lesiones isquémicas cerebrales, y de eventos neurovasculares en el primer mes (AU)

Introduction and objectives: The advisability of implanting a stent in carotid near-occlusion stenosis is a controversial topic. We have assessed procedural and clinical implications of stent implantation for carotid artery disease with near occlusion. Methods: We included 205 patients who underwent carotid artery revascularisation with a stent. The group of patients with near-occlusion stenosis (n=54)was compared to the rest of the population (n=151). Results: No differences were found between groups for age, sex, and the percentage of symptomatic patients (three-quarters of the population). Carotid stent revascularisation for near-occlusion stenosis presented a high procedural success rate (96%) similar to that of revascularisation processes for other lesions (98%). Stenting in cases of near-occlusion stenosis required increased use of proximal protection (54% vs. 20.5%, P<.001) and predilation (33% vs. 17%, P=.01). The process to repair near-occlusion stenosis cause increased detachment of plaque, as shown by higher percentages of macroscopic plaque captured by protection devices (18.5% vs. 7%, P=.01) and of perioperative ischaemic brain lesions (47% vs 31%, P = .07). At 30 days of follow-up, the tendency toward adverse neurological events (death, major and minor stroke) was higher in the near-occlusion group (9.2% vs. 3.2%, P=.08). Conclusions: Stent revascularisation for near-occlusion carotid stenosis has a high procedural success rate; however, its higher plaque load was responsible for the increased rate of ischaemic brain lesions and adverse neurovascular events at 30 days post-procedure (AU)

Carotid artery stenting: clinical and procedural implications for near-occlusion stenosis.

INTRODUCTION AND OBJECTIVES: The advisability of implanting a stent in carotid near-occlusion stenosis is a controversial topic. We have assessed procedural and clinical implications of stent implantation for carotid artery disease with near occlusion. METHODS: We included 205 patients who underwent carotid artery revascularisation with a stent. The group of patients with near-occlusion stenosis (n=54)was compared to the rest of the population (n=151). RESULTS: No differences were found between groups for age, sex, and the percentage of symptomatic patients (three-quarters of the population). Carotid stent revascularisation for near-occlusion stenosis presented a high procedural success rate (96%) similar to that of revascularisation processes for other lesions (98%). Stenting in cases of near-occlusion stenosis required increased use of proximal protection (54% vs. 20.5%, P<.001) and predilation (33% vs. 17%, P=.01). The process to repair near-occlusion stenosis cause increased detachment of plaque, as shown by higher percentages of macroscopic plaque captured by protection devices (18.5% vs. 7%, P=.01) and of perioperative ischaemic brain lesions (47% vs 31%, P = .07). At 30 days of follow-up, the tendency toward adverse neurological events (death, major and minor stroke) was higher in the near-occlusion group (9.2% vs. 3.2%, P=.08). CONCLUSIONS: Stent revascularisation for near-occlusion carotid stenosis has a high procedural success rate; however, its higher plaque load was responsible for the increased rate of ischaemic brain lesions and adverse neurovascular events at 30 days post-procedure.

[The capacity of the rest-dobutamine gated SPECT protocol to predict contractile recovery after revascularization of myocardial dysinergic areas]. / Capacidad del protocolo de gated-SPECT reposo/dobutamina para predecir la recuperación contráctil posrevascularización de áreas miocárdicas disinérgicas.

INTRODUCTION AND AIM: Gated-SPECT is a promising method to analyze myocardial viability. We have assessed the accuracy of a new protocol of rest/Dobutamine gated-SPECT, based on the evaluation of contractile reserve induced by 10 microg/kg/min of Dobutamine, to predict contractile recovery after revascularization of dysinergic myocardial territories. PATIENTS AND METHODS: In a group of 36 patients submitted to percutaneous revascularization, we selected 40 vascular territories (21 left descending artery, 19 right coronary-circumflex) with severely depressed contractility (contrast ventriculography, center line method). Follow up evaluation at 6 months showed the absence of angiographic restenosis and control contrast ventriculography assessed the contractile changes of the selected territories, considering those with contractile restoration as viable. Before revascularization, rest/Dobutamine gated-SPECT study was applied and viability was defined as the presence of contractile reserve (positive or improvement [n = 21] and negative or impairment [n = 7]) with non viability being the absence of contractile reserve (n = 12). We analyzed the evolution of the ejection fraction in a group of 27 patients with impaired ventricular function and complete revascularization. RESULTS: Gated-SPECT showed a sensitivity of 0.96 (95% CI 0.78-0.99) and a specificity of 0.78 (95% CI 0.48-0.94) in the diagnosis of viability. The ejection fraction (median [interquartile range]) increased after revascularization: 0.42 (0.15) vs 0.55 (0.22), Z = -3.9; p < 0. 001. The diagnosis of viability by gated-SPECT (p < 0.001) and the extent of severely depressed myocardium (p = 0.04) independently predicted the increase of the ejection fraction after revascularization. CONCLUSIONS: The analysis of contractile reserve by rest/Dobutamine gated-SPECT is adequate to diagnose viability in territories with severely depressed contractility and independently predicts the increase of ejection fraction after revascularization.

[Identification of the ischemic origin of dilated myocardiopathy using positron emission tomography]. / Identificación del origen isquémico de la miocardiopatía dilatada mediante tomografía por emisión de positrones.

INTRODUCTION AND OBJECTIVES: The aim of this study was to differentiate ischemic from nonischemic dilated cardiomyopathy with positron emission tomography. This differentiation is necessary to establish an adequate treatment, and it is often difficult with non-invasive diagnostic procedures. METHODS: Ten patients with an echocardiographic diagnosis of dilated cardiomyopathy who had undergone coronary angiography were selected. The presence or absence of angiographic coronary lesions was used to define the ischemic (n = 6) and the nonischemic group (n = 4). The ejection fraction was depressed in both groups, with no significant differences found. A perfusion study with 13N-ammonium and a metabolic imaging with 18F-florodeoxyglucose were performed on each patient. The images were quantitatively and qualitatively analysed, defining three criteria: accumulation defect (areas with activity under 50% of the maximal radioactivity), degree of heterogeneity, and match of images with both tracers. To determinate the degree of heterogeneity, nine segments on the three standard tomographic planes were studied. Based on the following heterogeneity features: irregular borders, coexisting different degrees of accumulation, and patched accumulation, a score ranging from 0 to 3 points was assigned to these segments. To analyse the radioactivity defects and the matching of studies with both tracers, the accumulation defects or the accumulating surface were outlined on a midventricular level coronal plane. RESULTS: The ischemic group has contrary to the nonischemic one, wider perfusion (0.26 +/- 0.21 vs 0.00) and metabolism defects (0.38 +/- 0.30 vs 0.06 +/- 0.09; p < 0.05). The degree of heterogeneity is significantly higher in the nonischemic group, either in perfusion (14.5 +/- 8.38 vs 2.5 +/- 1.04; p < 0.05) or in metabolism studies (15.5 +/- 3.31 vs 2.33 +/- 1.50; p < 0.005). Assigning wide defects and homogeneous accumulation to ischemic cardiomyopathy, and absence of defects and heterogeneous accumulation to nonischemic cardiomyopathy, the aetiology of the disease was identified in 9 of the 10 cases in the perfusion study and 100% of them with the metabolism imaging. CONCLUSIONS: Positron emission tomography allows to identify the aetiology of dilated cardiomyopathy, either with coronary perfusion or with myocardial glucose metabolism studies. Thus, only one of both PET studies could be used. Ischemic cardiomyopathy is characterised by wide defects and homogeneous radioactivity, and the nonischemic one by the absence of defects and heterogeneous accumulation of the tracer.

[Immunoblastic lymphoma as expression of the final phase of IgA multiple myeloma]. / Linfoma inmunoblástico como expresión de la fase terminal de un mieloma múltiple IgA.

We present the case of a patient diagnosed of IgA multiple myeloma who, four months after being diagnosed and after four cycles with VCAP with good response, showed high fever and constitutional syndrome; multiple subcutaneous nodules appeared during his hospitalization. Biopsy of the bone marrow, and of one of the nodules showed an immunoblastic lymphoma. Even with treatment the patient died due to a pneumonia and a digestive hemorrhage.

[Dehydroepiandrosterone sulfate and lipids in acute myocardial infarct]. / Dehidroepiandrosterona-sulfato y lípidos en el infarto agudo de miocardio.

To establish the possible relationship between acute myocardial infarction (AMI) and dehydroepiandrosterone-sulfate (DHEA-S) in a group of 15 patients with AMI, blood levels of DHEA-S and certain lipids (total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides) were determined at admission in the hospital and after 10 days. As controls a group of healthy individuals or with minor diseases, and a group of 24 severely ill non-cardioischaemic patients have been studied. DHEA-S and HDL-cholesterol levels have been found significantly lowered both in patients with AMI (at 10th day) as well as in the severely ill non-cardioischaemic patients, in comparison with the healthy volunteers group. We conclude, then, than the lowering in DHEA-S and HDL-cholesterol seems not to be specifically relates with AMI but has a certain relationship with severe disorders in general.

[Dehydroepiandrosterone sulfate, cortisol and their precursors in severely ill (acute and chronic) patients]. / Dehidroepiandrosterona-sulfato, cortisol y sus precursores en enfermos graves (agudos y crónicos).

This study tries to evaluate the interrelationship amongst certain corticoadrenal hormones (Dehydroepiandrosterones-Sulphate (DHEA-S), progesterone, 17-OH progesterone and cortisol) in male patients with severe organic processes (24 chronic and 22 acutely ill) and comparing them with a control group of 15 healthy male subjects or suffering mild processes. Corticoadrenal hormone behaviour in the presence of a severe disease show marked differences between the androgenic and the glucocorticoid pathways. While DHE-S shows a significant decrease in severe disease, independently of the underlying disease (acute or chronic), the contrary occurs with the glucocorticoid pathway, in which cortisol and specially its precursors, progesterone and 17-OH-progesterone, predominantly present in the acute situation, normal or significantly increased levels. These differences between the two adrenal pathways suggest that apart from ACTH there must be another regulatory mechanism of the androgenic pathway which may facilitate the androgenic adaptation to the situation of severe disease.