Collateral Development in Thrombosis of the Hepatic Artery After Transplantation.

OBJECTIVES: The authors sought to identify strictures or hepatic artery obstruction with posterior collateral transformation in our series of liver transplantation, treatment, and evolution. The thrombosis or severe hepatic artery stenosis sometimes presents a compensation mechanism, the collateral transformation of the artery. MATERIAL AND METHODS: From April 2002 to December 2011 we collected 18 cases of collateral transformation. We analyzed data regarding the transplantation, diagnosis, treatment, clinical evolution, liver function, and Doppler-ultrasound. RESULTS: The main indication was alcoholic cirrhosis, followed by hepatocellular carcinoma - hepatitis C virus. The mean cold ischemia time was 292.2 minutes mean hot ischemia was 48.8. The anastomosis was performed on the gastroduodenal-splenic patch donor in 14 cases, the celiac trunk in 2 cases, and on grafts to the aorta in another 2. Doppler ultrasound showed 8 cases without complications, 8 with low flows, and 2 cases with alterations of the right hepatic artery. Computed tomographic (CT) angiography was performed in patients with impaired eco-Doppler and found 4 obstructions, 2 cases with kinking, 1 stenosis, and 3 normal cases. Three patients with low flows were re-operated and another re-transplanted. After diagnosis of collateral transformation, all were treated with antiplatelet agents. Two cases of angioplasty were associated. The collaterals were diagnosed 1 month to 44.8 months after transplantation. Five patients died. In the latest data, 10 patients do not have analytical alteration. The Doppler ultrasound shows 7 cases being normal and 6 with flow but low resistances. CONCLUSIONS: In our series, all patients with collateral transformation, except one who was transplanted, maintain good liver function with permeable vessels.

Aneurisma de la vena ácigos. A propósito de un caso / No disponible

No disponible

[Effectiveness of primary health care in the diagnosis and treatment of arterial hypertension]. / Efectividad de la atención primaria de salud en el diagnóstico y tratamiento de la hipertensión arterial.

Arterial hypertension (AHT) is a significant public health problem due to its high cardiovascular morbidity and mortality and its economic and social costs. Background. To identify the prevalence of AHT detected in primary care and its degree of control; to determine the types of treatment used and factors associated with its control. Patients and methods. Transversal comparative study of two years in the Villava Health Centre. The computerised clinical history data for the years 2003 and 2006 was analysed. The following variables were studied: age, gender, systolic and diastolic arterial pressure, total cholesterol, HDL, LDL, triglycerides, tobacco use, body mass index in both years. Hypotensor treatment in the year 2006. The variables for the year 2006 associated with good control were identified through logistic regression. Results. AHT prevalence detected in (3)18 year olds: 2003: 11.6% (CI:10.9-12.3); 2006: 16.6% (CI:15.8-17.4) (p<0.001). Control of hypertense persons with a register of arterial tension (AP:<140/90) in 2003: 45.1% (CI: 41.0-48.0) and in 2006: 40.4% (CI: 37.7-43.2) (p<0.05). Variables associated with good control: being male [OR 1.60 (IC: 1.26-2.03)] treatment with ARA II [OR 2.16 (CI: 1.50-3.09)] and being diabetic [OR 1.50 (CI: 1.10-2.03]. Associated with poor control: presenting cerebral vascular disease, peripheral vasculopathy and treatment with ACE inhibitors. Conclusions. A low prevalence of AHT was detected. The level of control was higher for the DAP than for the SAP. Treatment with AIIRA, being male and being diabetic were associated with a better control. Peripheral vasculopathy, ichaemic cardiopathy, cerebral vascular disease, ACE inhibitors use and age were associated with a poorer control.

Efectividad de la atención primaria de salud en el diagnóstico y tratamiento de la hipertensión arterial / Effectiveness of primary health care in the diagnosis and treatment of arterial hypertension

La hipertensión arterial (HTA) es un importante problema de salud pública, por su elevada morbimortalidad cardiovascular y sus costes económicos y sociales. Fundamento: Identificar la prevalencia de HTA detectada en atención primaria y su grado de control; conocerlos tipos de tratamientos utilizados y factores asociados a su control. Pacientes y métodos: Estudio transversal comparativo de dos años en el Centro de Salud de Villava. Se analizan los datos de la historia clínica informatizada en los años 2003 y 2006. Se estudian las variables: edad, género, pensión arterial sistólica y diastólica, colesterol total, HDL, LDL, triglicéridos, tabaquismo, índice de masa corporal en ambos años. Tratamiento hipotensor en el año 2006. Mediante regresión logística se identifican las variables del año 2006 asociadas a buen control. Resultados: Prevalencia detectada de HTA en ≥ 18 años: 2003: 11,6% (IC:10,9-12,3); 2006: 16,6% (IC:15,8-17,4)(p<0,001). En hipertensos con registro de presión arterial estaban controlados (PA:<140/90) en 2003: 45,1% (IC: 41,0-48,0) y en 2006: 40,4% (IC: 37,7-43,2) (p<0,05). Variables asociadas a buen control: ser varón [OR 1,60 (IC: 1,26-2,03)]tratamiento con ARA II [OR 2,16 (IC: 1,50-3,09)] y ser diabético[OR 1,50 (IC: 1,10-2,03]. Se asocian a mal control: presentar enfermedad vascular cerebral, vasculopatía periférica y el tratamiento con IECA. Conclusiones: La prevalencia de HTA detectada es baja. El nivel de control es superior para la PAD que para la PAS. El tratamiento con ARA II, ser varón o ser diabético se asocia a mejor control. La vasculopatía periférica, la cardiopatía isquémica, la enfermedad vascular cerebral, el tratamiento con IECA y edad se asocian a peor control (AU)

Arterial hypertension (AHT) is a significant public health problem due to its high cardiovascular morbidity and mortality and its economic and social costs. Background: To identify the prevalence of AHT detected in primary care and its degree of control; to determine the types of treatment used and factors associated with its control. Patients and methods: Transversal comparative study of two years in the Villava Health Centre. The computerised clinical history data for the years 2003 and 2006 was analysed. The following variables were studied: age, gender, systolic and diastolic arterial pressure, total cholesterol, HDL, LDL, triglycerides, tobacco use, body mass index in both years. Hypotensor treatment in the year 2006. The variables for the year 2006 associated with good control were identified through logistic regression. Results: AHT prevalence detected in ≥ 18 year olds: 2003: 11.6% (CI:10.9-12.3); 2006: 16.6% (CI:15.8-17.4) (p<0.001). Control of hypertense persons with a register of arterial tension (AP:<140/90) in 2003: 45.1% (CI: 41.0-48.0) and in 2006: 40.4% (CI: 37.7-43.2) (p<0.05). Variables associated with good control: being male [OR 1.60 (IC: 1.26-2.03)] treatment with ARA II [OR 2.16 (CI: 1.50-3.09)] and being diabetic [OR 1.50 (CI: 1.10-2.03]. Associated with poor control: presenting cerebral vascular disease, peripheral vasculopathy and treatment with ACE inhibitors. Conclusions: A low prevalence of AHT was detected. The level of control was higher for the DAP than for the SAP. Treatment with AIIRA, being male and being diabetic were associated with a better control. Peripheral vasculopathy, ichaemic cardiopathy, cerebral vascular disease, ACE inhibitors use and age were associated with a poorer control (AU)

[Impact of common reasons for consultation on the feeling of vitality and the physical performance of the over-65s]. / Impacto de los motivos comunes de consulta en el sentimiento de vitalidad y en el rendimiento físico de personas mayores de 65 años.

OBJECTIVES: To measure two functional dimensions (vitality and physical function) involved in the quality of life of the over-65s and to find what relationship they maintain with the commonest reasons for consultation. DESIGN: Cross-sectional, descriptive study. SETTING: Primary care. PARTICIPANTS: Randomised sample of 179 patients over 65 from 14 primary care clinics in Navarra. METHODS: SF-36 quality-of-life questionnaire and most common reasons for consultation. Personal and family details and ongoing drug prescription were also recorded. RESULTS: The most common reasons for consultation were insomnia (31.8%), arthrosis (48%), and urinary symptoms (16.2%). The greatest differences in the SF-36 scales occurred in patients with insomnia. In the multiple regression models, inverse associations were found for each of the reasons for consultation with the vitality and physical function dimensions. Vitality was associated with urinary symptoms, with an adjusted beta coefficient of -11.2 points (95% CI, -18.6 to -3.7). Insomnia was associated with significant decline in vitality and physical function, with beta of -7.7 points (95% CI, -13.9 to -1.5) and -10.3 points (95% CI, -19.1 to -1.6), respectively. Arthrosis symptoms behaved in a similar way. CONCLUSIONS: The most common pathologies or symptoms causing primary care consultations in the over-65s affect significantly the quality-of-life dimensions relating to the pursuit of normal daily life.

Impacto de los motivos comunes de consulta en el sentimiento de vitalidad y en el rendimiento físico de personas mayores de 65 años / Impact of common reason for consultation on the feeling of vitality and the physical performance of the over-65s

Objetivo. Medir 2 dimensiones funcionales (vitalidad y rol físico) implicadas en la calidad de vida de las personas > 65 años y conocer qué relación mantienen con los motivos de consulta más habituales. Diseño. Estudio descriptivo, transversal. Emplazamiento. Atención primaria. Participantes. Muestra aleatoria de 179 pacientes > 65 años procedentes de 14 consultas de atención primaria de Navarra. Métodos. Cuestionario de calidad de vida SF-36 y motivos de consulta más frecuentes. Se recogieron también datos demográficos, familiares y de prescripción continuada de fármacos. Resultados. Los motivos de consulta más frecuentes fueron: insomnio (31,8%), artrosis (48%) y síntomas miccionales (16,2%). Las mayores diferencias en las escalas del SF-36 se produjeron en los pacientes con insomnio. Se observaron asociaciones inversas de cada uno de los motivos de consulta indicados con las dimensiones vitalidad y rol físico en los modelos de regresión múltiple. La vitalidad se asoció con presencia de síntomas miccionales, con un coeficiente β ajustado de –11,2 puntos (intervalo de confianza [IC] del 95%, –18,6 a –3,7). El insomnio se asoció con descensos significativos de la vitalidad y el rol físico, con β de –7,7 puntos (IC del 95%, –13,9 a –1,5) y –10,3 puntos (IC del 95%, –19,1 a –1,6), respectivamente. Un comportamiento similar se obtuvo para los síntomas artrósicos. Conclusiones. Las enfermedades o los síntomas más frecuentes que motivan consultas de atención primaria en > 65 años afectan significativamente a las dimensiones de la calidad de vida relacionadas con el desarrollo de una actividad diaria normal

Objectives. To measure two functional dimensions (vitality and physical function) involved in the quality of life of the over-65s and to find what relationship they maintain with the commonest reasons for consultation. Design. Cross-sectional, descriptive study. Setting. Primary care. Participants. Randomised sample of 179 patients over 65 from 14 primary care clinics in Navarra. Methods. SF-36 quality-of-life questionnaire and most common reasons for consultation. Personal and family details and ongoing drug prescription were also recorded. Results. The most common reasons for consultation were insomnia (31.8%), arthrosis (48%), and urinary symptoms (16.2%). The greatest differences in the SF-36 scales occurred in patients with insomnia. In the multiple regression models, inverse associations were found for each of the reasons for consultation with the vitality and physical function dimensions. Vitality was associated with urinary symptoms, with an adjusted beta coefficient of –11.2 points (95% CI, –18.6 to –3.7). Insomnia was associated with significant decline in vitality and physical function, with beta of –7.7 points (95% CI, –13.9 to –1.5) and –10.3 points (95% CI, –19.1 to –1.6), respectively. Arthrosis symptoms behaved in a similar way. Conclusions. The most common pathologies or symptoms causing primary care consultations in the over-65s affect significantly the quality-of-life dimensions relating to the pursuit of normal daily life

[The Ottawa ankle guidelines: analysis of their validity as clinical decision guidelines in the indication of X-rays for ankle and/or middle-foot injuries]. / Reglas del tobillo de Ottawa: análisis de su validez como reglas de decisión clínica en la indicación de radiografías en los traumatismos de tobillo y/o medio pie.

OBJECTIVE: To analyse the validity of the Ottawa ankle guidelines (OAG) as clinical decision guidelines in the indications of X-rays for ankle and/or middle-foot traumas in primary care. DESIGN: Observational, with application of the OAG and prospective measurement of the results.Setting. Hospital casualty. PATIENTS: Adults who attended casualty for ankle or middle-foot traumas between 1st June 1999 and 31th March 2000. Criteria for exclusion were: under 18, pregnancy, grave sensory and/or awareness disturbances, multi-trauma or multi-contusion patients, traumas over a week old, skin lesions as side-effects of the trauma, X-ray in other department, high inflammation or oedema hindering palpation of bone protuberances. MEASUREMENTS: Application of the OAG and X-ray on all patients, regardless of the result of the OAG. Calculation of sensitivity, negative predictive value, specificity and positive predictive value. RESULTS: 56 of a sample of 494 patients had a fracture (11.34%), 34 in the malleolus area (6.9%) and 22 in the middle-foot area (4.44%). OAG sensitivity was 96.43% (95% CI, 94.8-98). Negative predictive value was 97.22% (95.77-98.67). Specificity was 15.98% (12.75-19.21), and positive predictive value was 12.8% (9.86-15.74). CONCLUSIONS: The OAG are valid in primary care as guidelines to decide whether to request X-rays for patients with ankle or middle-foot traumas.

Reglas del Tobillo de Ottawa: análisis de su validez como reglas de decisión clínica en la indicación de radiografías en los traumatismos de tobillo y/o medio pie / The Ottawa ankle guidelines: analysis of their validity as clinical decision guidelines in the indications of X-rays for ankle and/or middle-foot traumas

Objetivo. Analizar la validez de las reglas del tobillo de Ottawa (RTO) como reglas de decisión en la indicación de radiografías en los traumatismos de tobillo y/o medio pie (TTM) en nuestro medio. Diseño. Observacional, con aplicación de las RTO y medición prospectiva del resultado. Ámbito. Urgencias hospitalarias. Pacientes. Adultos que acudieron a urgencias por TTM desde el 1 de junio de 1999 al 31 de marzo de 2000. Fueron criterios de exclusión: edad menor de 18 años, embarazadas, graves alteraciones sensoriales y/o de la conciencia, politraumatizados y/o policontusionados, traumatismos de más de una semana de evolución, lesiones cutáneas secundarias al traumatismo, realización de radiografía en otro ámbito, gran inflamación o edema que impidiera la palpación de los relieves óseos. Mediciones. Aplicación de las RTO y realización de radiografía a todos los pacientes, con independencia del resultado de aquéllas. Cálculo de sensibilidad, valor predictivo negativo, especificidad y valor predictivo positivo. Resultados. Sobre una muestra de 494 pacientes, 56 presentaron fractura (11,34 por ciento), 34 de la zona maleolar (6,9 por ciento) y 22 de la zona del medio pie (4,44 por ciento). La sensibilidad de las RTO fue del 96,43 por ciento (IC del 95 por ciento, 94,8-98 por ciento). El valor predictivo negativo fue del 97,22 por ciento (IC del 95 por ciento, 95,77-98,67 por ciento). La especificidad fue del 15,98 por ciento (IC del 95 por ciento, 12,75-19,21 por ciento) y el valor predictivo positivo, del 12,8 por ciento (IC del 95 por ciento, 9,86-15,74 por ciento). Conclusiones. Las RTO son válidas en nuestro medio como reglas de decisión a la hora de solicitar radiografías en los pacientes con TTM (AU)

[The long-term efficacy of a recombinant hepatitis B vaccine in newborns]. / Eficacia a largo plazo de la vacuna recombinante de hepatitis B en recién nacidos.

A prospective evaluation of the immunogenicity, protective efficacy and safety of the recombinant hepatitis B vaccine associated to the immunoglobulin (IG) in newborns with high risk of infection by the hepatitis B virus was carried out. Two groups of newborns were used. The first group was formed by children with HBsAG carrier mothers (56 children) and the second group consisted of newborns of mothers negative for HBsAG, but having a high risk of infection (21 children). Within the first few hours of life, all of the newborns received a dose (20 mcg) or recombinant vaccine and 0.5 ml of IG. New doses of vaccine were administered at one and six months of life. At eight months of age, the anti-HBs seroconversion rate in children belonging to groups 1 and 2 was 100%, with an elevated anti-HBs titer and with no detected cases of positive HBsAG. On a long term basis (39 +/- 5 months), only 5.6% of the children present an anti-HBs titer < 10 mUI/ml. The recombinant hepatitis B vaccine associated to IG is immunogenic and provides efficient protection in newborns. Important side effects were not observed.

[High frequency ventilation in the newborn. Study of 27 cases]. / Ventilación de alta frecuencia en el recién nacido. Estudio de 27 casos.

The clinical histories of 27 neonates ventilated with high frequency respirators (Volumetric Diffusive Respirator VDR-2) have been analyzed in order to evaluate the efficiency of this type of ventilation in neonatal pathology. The average gestational age of these patients was 32 +/- 4 weeks. Most of them (70%) presented respiratory distress due to hyaline membrane disease. Of the remaining cases, three (11%) presented with congenital diaphragmatic hernia, two with pulmonary hypertension, two with meconium aspiration syndrome, one with Group B Streptococal sepsis/shock and one with case diaphragmatic agenesia. Between two and six hours after initiation of high frequency ventilation (HFV), pH, paCO2 and pO2 improved significantly in relationship to former values (p < 0.05- p < 0.001), reaching values in the normal range at 6.5 +/- 14 hours regarding pH, 30 +/- 50 hours regarding paCO2 and 6.5 +/- 10 hours regarding paO2. No hemodynamic modification could be attributed to this procedure. The principal complications were ectopic air (62%) and necrotizing tracheobronchitis (TBN) (25%). Bronchopulmonary dysplasia (BDP) was diagnosed in 20% of the cases, ductus (DAP) in 33% of the cases and intracraneal hemorrhage in 25% of the cases. Mortality was 70%. High frequency ventilation is an alternative procedure to conventional ventilation in this group of neonates. It produces an important number of favorable responses, but has complications that can not be overlooked.

PIP: Clinical records of 27 newborns treated with high frequency ventilation in a hospital neonatal service in Madrid were retrospectively studied. High frequency ventilation is a technique with specific indications that has recently been applied in some neonatal pathologies as an alternative to conventional ventilation. The respirators, model 2 Volumetric Diffusive Respirators, were used in 24 of the 27 cases because of failure of conventional ventilation. The 27 newborns weighed an average of 1850 +or- 944 g and ranged from 900 to 4000 g. Their average gestational age was 32 +or- 4 weeks, and the range was 26-42 weeks. 19 had respiratory difficulties stemming from hyaline membrane disease, 3 had congenital diaphragmatic hernias, 2 had pulmonary hypertension, and one each had meconium aspiration syndrome, septic shock from group B streptococcus, and diaphragmatic agenesia. 66% were delivered by cesarean. The pH, paCO2, and paO2 improved significantly between 2 and 6 hours after initiation of HFV treatment. Values in the normal range were reached at 6.5 +or- 14 hours for pH, 30 +or- 50 hours for paCO2, and 6.5 +or- 10 hours for paO2. No hemodynamic modifications were attributed to HFV. The most significant complications were ectopic air (62%) and necrotizing tracheobronchitis (25%). Broncopulmonary dysphasia was diagnosed in 20%, ductus in 33%, and intracraneal hemorrhage in 25%. The case fatality rate was 70%. Ten newborns improved definitively with HFV and proceeded to conventional ventilation. Two later succumbed to other causes. The study showed that HFV can lead to serious complications and should be applied with great prudence despite it great potential benefit.

[Asphyxiating thoracic dysplasia in 2 dizygotic twins]. / Displasia torácica asfixiante en dos gemelas dicigóticas.

Two cases of asphyxiating thoracic dysplasia in a pair of dizygous twin females are described. Both were diagnosed at birth and presented characteristic clinical, radiological and pathological features of this rare entity.

[Follow-up of children born to parents affected by the toxic oil syndrome]. / Seguimiento de hijos nacidos de padres afectados por el síndrome tóxico.

Conditions at birth and evolution during the first year of life of a group of infants whose parents were affected by the Spanish Toxic Syndrome are presented. They are distributed in three groups: first those infants of high risk whose father or mother (or both) have consumed toxic oil; second children whose parents had consumed non-brandname oil not demonstrated to have been toxic and without signs of disease; and a third control group of normal newborns without previous medical history. From the present study, authors cannot affirm whether ingestion of toxic oil by pregnant women had influenced intrauterine growth or first year growth. Nonetheless, new studies are needed which clarify evolutionary aspects of these children.