Protective T Cell and Antibody Immune Responses against Hepatitis C Virus Achieved Using a Biopolyester-Bead-Based Vaccine Delivery System.

Hepatitis C virus (HCV) infection is a major worldwide problem. Chronic hepatitis C is recognized as one of the major causes of cirrhosis, hepatocellular carcinoma, and liver failure. Although new, directly acting antiviral therapies are suggested to overcome the low efficacy and adverse effects observed for the current standard of treatment, an effective vaccine would be the only way to certainly eradicate HCV infection. Recently, polyhydroxybutyrate beads produced by engineered Escherichia coli showed efficacy as a vaccine delivery system. Here, an endotoxin-free E. coli strain (ClearColi) was engineered to produce polyhydroxybutyrate beads displaying the core antigen on their surface (Beads-Core) and their immunogenicity was evaluated in BALB/c mice. Immunization with Beads-Core induced gamma interferon (IFN-γ) secretion and a functional T cell immune response against the HCV Core protein. With the aim to target broad T and B cell determinants described for HCV, Beads-Core mixed with HCV E1, E2, and NS3 recombinant proteins was also evaluated in BALB/c mice. Remarkably, only three immunization with Beads-Core+CoE1E2NS3/Alum (a mixture of 0.1 µg Co.120, 16.7 µg E1.340, 16.7 µg E2.680, and 10 µg NS3 adjuvanted in aluminum hydroxide [Alum]) induced a potent antibody response against E1 and E2 and a broad IFN-γ secretion and T cell response against Core and all coadministered antigens. This immunological response mediated protective immunity to viremia as assessed in a viral surrogate challenge model. Overall, it was shown that engineered biopolyester beads displaying foreign antigens are immunogenic and might present a particulate delivery system suitable for vaccination against HCV.

Characterization of novel markers of senescence and their prognostic potential in cancer.

Cellular senescence is a terminal differentiation state that has been proposed to have a role in both tumour suppression and ageing. This view is supported by the fact that accumulation of senescent cells can be observed in response to oncogenic stress as well as a result of normal organismal ageing. Thus, identifying senescent cells in in vivo and in vitro has an important diagnostic and therapeutic potential. The molecular pathways involved in triggering and/or maintaining the senescent phenotype are not fully understood. As a consequence, the markers currently utilized to detect senescent cells are limited and lack specificity. In order to address this issue, we screened for plasma membrane-associated proteins that are preferentially expressed in senescent cells. We identified 107 proteins that could be potential markers of senescence and validated 10 of them (DEP1, NTAL, EBP50, STX4, VAMP3, ARMX3, B2MG, LANCL1, VPS26A and PLD3). We demonstrated that a combination of these proteins can be used to specifically recognize senescent cells in culture and in tissue samples and we developed a straightforward fluorescence-activated cell sorting-based detection approach using two of them (DEP1 and B2MG). Of note, we found that expression of several of these markers correlated with increased survival in different tumours, especially in breast cancer. Thus, our results could facilitate the study of senescence, define potential new effectors and modulators of this cellular mechanism and provide potential diagnostic and prognostic tools to be used clinically.

Epidermal growth factor receptor tyrosine-kinase inhibitor treatment resistance in nos-small cell lung cancer: biological basis and therapeutic strategies

Lung cancer remains the leading cause of cancer-related death. Non-small cell lung cancer (NSCLC) represents 85 % of all lung cancer cases and it is classified into three major subtypes: adenocarcinoma, squamous cell carcinoma and large-cell carcinoma. In the past years, molecular-targeted therapies have been developed in order to improve response, survival and quality of life in patients with advanced NSCLC. Lung cancers harboring mutations in the epidermal growth factor receptor (EGFR) respond to EGFR tyrosine-kinase inhibitors (TKIs). However, virtually all patients with initial response relapse due to acquired resistance. Better understanding the biology of these tumors and mechanisms of EGFR TKIs resistance could shed some light on research of new therapeutic options in this setting. This review aims to emphasize on EGFR involved lung cancer pathway, primary and acquired mechanisms of TKIs resistance, and discuss agents currently used in clinical development in this emerging scenario (AU)

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Epidermal growth factor receptor tyrosine-kinase inhibitor treatment resistance in non-small cell lung cancer: biological basis and therapeutic strategies.

Lung cancer remains the leading cause of cancer-related death. Non-small cell lung cancer (NSCLC) represents 85 % of all lung cancer cases and it is classified into three major subtypes: adenocarcinoma, squamous cell carcinoma and large-cell carcinoma. In the past years, molecular-targeted therapies have been developed in order to improve response, survival and quality of life in patients with advanced NSCLC. Lung cancers harboring mutations in the epidermal growth factor receptor (EGFR) respond to EGFR tyrosine-kinase inhibitors (TKIs). However, virtually all patients with initial response relapse due to acquired resistance. Better understanding the biology of these tumors and mechanisms of EGFR TKIs resistance could shed some light on research of new therapeutic options in this setting. This review aims to emphasize on EGFR involved lung cancer pathway, primary and acquired mechanisms of TKIs resistance, and discuss agents currently used in clinical development in this emerging scenario.

Stra6, a retinoic acid-responsive gene, participates in p53-induced apoptosis after DNA damage.

Stra6 is the retinoic acid (RA)-inducible gene encoding the cellular receptor for holo-retinol binding protein. This transmembrane protein mediates the internalization of retinol, which then upregulates RA-responsive genes in target cells. Here, we show that Stra6 can be upregulated by DNA damage in a p53-dependent manner, and it has an important role in cell death responses. Stra6 expression induced significant amounts of apoptosis in normal and cancer cells, and it was also able to influence p53-mediated cell fate decisions by turning an initial arrest response into cell death. Moreover, inhibition of Stra6 severely compromised p53-induced apoptosis. We also found that Stra6 induced mitochondria depolarization and accumulation of reactive oxygen species, and that it was present not only at the cellular membrane but also in the cytosol. Finally, we show that these novel functions of Stra6 did not require downstream activation of RA signalling. Our results present a previously unknown link between the RA and p53 pathways and provide a rationale to use retinoids to upregulate Stra6, and thus enhance the tumour suppressor functions of p53. This may have implications for the role of vitamin A metabolites in cancer prevention and treatment.

Ruptura esplénica posterior a colonoscopia: complicación infrecuente pero potencialmente letal / A ruptured spleen following colonoscopy is a rare, but potentially lethal complication

La colonoscopia es el método diagnóstico y terapéutico más importante en la detección de lesiones tumorales del colon. Sin embargo, la perforación y la hemorragia son las complicaciones más frecuentes aunque en un porcentaje bajo en los exámenes diagnósticos. Se han descrito complicaciones menos comunes como neumomediastino, neumorretroperitoneo y ruptura de bazo. Nosotros presentamos un caso de lesión esplénica posterior a la realización de colonoscopia en el servicio de Coloproctología del Hospital Militar Central, diagnosticado luego de 48 horas y con tratamiento conservador. Mediante revisión de la literatura se encuentra que la ruptura esplénica es causa infrecuente de dolor abdominal secundario a colonoscopia y que puede ser potencialmente letal, además de requerir un alto grado de sospecha para ser diagnosticada de manera temprana. La utilización de la tomografía axial computarizada (TAC) de abdomen es el elemento diagnóstico más importante, aunque no se ha empleado como decisión terapéutica en el tratamiento no quirúrgico o con esplenectomía. El manejo conservador con seguimiento intrahospitalario, reanimación y antibioticoterapia se considera como la opción terapéutica pese a que la esplenectomía fue el tratamiento más utilizado en los casos encontrados. La sospecha clínica y diagnóstico temprano de estas lesiones son los elementos más importantes que pueden disminuir el riesgo de morbilidad y mortalidad por estas complicaciones que son raras en la colonoscopia, pero que pueden ser letales.

Colonoscopy is the paramount diagnostic tool for polyps and lesions in the colon and rectum. Although, the most common cause of complications are bleeding and perforations, diagnostic colonoscopy generally has a low incidence of complications. Less common complications include pneumomediastinum, pneumoperitoneum and splenic injuries. We describe a clinical case of a spleen injury following colonoscopy in the colorectal surgery section of the Army Hospital and Nueva Granada University in Bogotá, Colombia. This splenic injury was discovered 48 hours after surgery. Splenic injury could be considered a very unusual cause of abdominal pain following colonoscopy but it could potentially be dangerous. A CT scan is a remarkable diagnostic tool but it is not considered to be useful for deciding on surgical treatment. Clinical observation with follow up, IV fluids, transfusions and antibiotics is one treatment option. Splenectomy is the most common option found in our review. Clinical suspicion and early diagnosis are the cornerstones for avoiding morbidity and mortality in this rare endoscopic complication.

Analysis of hepatitis C virus core encoding sequences in chronically infected patients reveals mutability, predominance, genetic history and potential impact on therapy of Cuban genotype 1b isolates.

BACKGROUND AND OBJECTIVES: Hepatitis C virus (HCV) genotypes are relevant to epidemiological questions, vaccine development, and clinical management of chronic HCV infection. In the present work, we aimed at investigating HCV genotype, variability and genetic history of HCV isolates in Cuba from a sample of chronically infected patients. MATERIAL AND METHODS: A prospective study, involving 73 Cuban anti-HCV positive patients, was carried out. RT-PCR and phylogenetic analysis was employed to determine HCV genotypes. Divergence dates and demographic parameters in a Bayesian coalescent framework were estimated, as implemented in BEAST v1.4.8. RESULTS: HCV RNA was undetectable in 15 patients that received antiviral therapy. All HCV RNA positive patients, 58, were infected with genotype 1, three of them with subtype 1a and 55 with subtype 1b. The analysis of the DNA sequence coding for a core fragment, spanning nt positions 435-816 (relative to strain H77), revealed high percent (96.7% +/- 0.8%) nucleotide identity within Cuban HCV subtype 1b sequences. However, 56.7% and 20% of 30 analyzed individuals had changes in the core region in a six-month interval, at the nucleotide and amino acid level, respectively. Mutations involving aa changes were mainly found in the region encompassed between aa 70 and 106 of the core protein, with only one isolate showing a point mutation at position 43. Interestingly, some of the observed changes seem to be reversions and might in fact contribute to reducing the variability of this region. The estimated date for the most recent common ancestor of HCV genotype 1b Cuban isolates is 1969 (CI, 1953 to 1977). DISCUSSION: Analysis of HCV core encoding sequences from chronic patients reveals mutability of genotype 1b isolates in Cuba, which seem to be predominant and rapidly multiplied during the eighty decade of last century, and might limit the benefits obtained from current antiviral therapy.

Angiomixoma agresivo en hombres: Reporte de caso clínico y revisión de la literatura / Aggressive angiomyxoma in men: Clinical case report and literature review

Se presenta el caso clínico de un angiomixoma agresivo, de presentación en un paciente de sexo masculino, con localización presacra, el cual fue diagnosticado e intervenido en el Hospital Militar Central de Bogotá. Se realizó un abordaje tipo Kraske con la escisión completa de la lesión y mínimo impacto funcional y estético para el paciente. Esta clase de tumores son extremadamente infrecuentes y predominan en mujeres, con una localización pélvica. La presentación en hombres es aún más exótica, con pocos casos reportados en la literatura. Su manejo obliga a la extirpación completa de la lesión y al seguimiento clínico e imagenológico periódico, dada su alta tasa de recidiva.

We report a case of a male patient with an aggressive angiomyxoma located in the presacral space which was diagnosed and clinically treated at the Hospital Militar Central in Bogotá, Colombia. Kraske’s posterior approach was used to completely excise the lesion with minimal functional and aesthetic impact on the patient. Aggressive angiomyxomas are extremely rare. They are most commonly found in pelvic locations in women. They are even more exotic in men, with very few cases reported in the literature. Management requires complete removal of the lesion and the clinical and imaging follow-up given their high rate of recurrence.

Tratamiento endovascular de la isquemia mesentérica. Revisión y puesta al día / Endovascular treatment of the mesenteric ischemia

La isquemia mesentérica continúa representando una enfermedad con elevada morbimortalidad a pesar de los recientes avances que han mejorado los resultados de la mayoría de las patologías quirúrgicas en las últimas décadas. La cirugía abierta ha sido considerada el tratamiento de elección durante las últimas décadas, pero el intenso desarrollo del tratamiento endovascular durante los últimos años ha facilitado su instauración en gran parte de los centros hospitalarios. Revisamos las generalidades, indicaciones y resultados de los procedimientos endovasculares en el tratamiento de la isquemia mesentérica aguda y crónica (AU)

Mesenteric ischemia continues to be a disease with high mortality despite recent advances that have improved the results of most surgical pathologies in recent decades. Open surgery has been considered the treatment of choice during the last decades, but the intense development of endovascular treatment in recent years has facilitated its establishment in most of the hospitals. We review the general indications and results of endovascular procedures in the treatment of acute and chronic mesenteric ischemia (AU)

Embolización de los Tumores del cuerpo carotídeo / Embolizariton of carotid body tumors

Los tumores del cuerpo carotídeo son altamente vascularizados y por lo general tienen un carácter benigno, considerándoseles derivados de tejido nervioso. La embolización endovascular preoperatoria se utiliza para facilitar la cirugía, pero a menudo no es completa, debido a arterias que alimentan pequeñas ramas no siendo factible la cateterización selectiva. Se analizan los beneficios de la embolización preoperatoria y las complicaciones postoperatorias, cuando se lleva a cabo la embolización preoperatoria (AU)

Carotid body tunors are highly vascularized usually benign neoplasms arising from nerve tissue. Endovascular preoperative embolization is used to facilitate surgery but is often not complete, due to tiny feeding arteries not feasible for selective catheterization. We analyzed the benefits of preoperative embolization and the postoperative complications when preoperative embolization was performed (AU)

Síndrome compartimental abodominal en cirugía vascular: manejo y revisión bibliográfica / Abdominal compartment syndrome in vascular surgery: management and bibliographic review

INTRODUCCIÓN. El síndrome compartimental abdominal (SCA) continúa siendo actualmente una complicación que asocia una importante morbi-mortalidad en el paciente vascular. El objetivo de nuestro trabajo es revisar la bibliografía científica para actualizar pautas de manejo del SCA y las consecuencias asociadas. MATERIAL Y MÉTODOS. Se realizó una revisión de la literatura científica de los últimos años que versa sobre el manejo diagnóstico y terapéutico del SCA además del abdomen abierto tras laparotomía descompresiva. Para ello se utilizó la base de datos de la Nacional Library of Medicine (PubMed). El estudio se limitó a trabajos publicados en los últimos 10 años en inglés y español que dispusieran de abstract on-line. Las palabras clave introducidas para la búsqueda fueron abdominal compartment symdrome, vascular surgery, ruptured aneurysm. RESULTADOS. Con dichos parámetros de búsqueda aparecen 84 trabajos de los cuales, 46 de ellos hacen referencia directa o indirecta mientras que los 38 trabajos restantes fueron desechados por no ajustarse a la finalidad de la búsqueda. De los trabajos recogidos se analizaron detenidamente 16 de ellos, a los cuales se hace referencia en el artículo de acuerdo al orden de aparición. CONCLUSIONES. El paciente sometido a cirugía vascular abdominal presenta alto riesgo para desarrollar el SCA por ello se debería monitorizar la presión intraabdominal en el ingreso en la unidad de cuidados intensivos tras la cirugía. La descompresión quirúrgica debería reservarse para aquellos pacientes con SCA refractario al tratamiento médico intensificado, utilizando un sistema de cierre asistido por vacío (VAC) como primera elección siempre que fuera posible (AU)

INTRODUCTION. The abdominal compartmental syndrome (SCA) is a complication that associates an important morbi-mortality in the vascular patient. The objective of our paper is to review the scientific bibliography in order to modernize rules of management of the SCA and the associated consequences. MATERIAL AND METHODS. We reviewed the scientific literature of the last years that deal with diagnosis and therapeutic of the SCA. We used the data base of the National Library of Medicine (PubMed). The study was limited to articles published in 10 last years, in English and Spanish language that they have an abstract on-line. The key words introduced for the search was abdominal compartment symdrome, vascular surgery, ruptured aneurysm. RESULTS. With these parameters we found 84 works, 46 of them makes direct reference to our aim while the 38 remaining works were discarded by not adjusting to the purpose of the search. 16 of them were analyzed. CONCLUSIONS. The vascular patient presents high risk in order to develop the SCA for it would be monitorized the intraabdominal pressure in the unit of intensive cares after the surgery. The surgical decompression should reserve for those patient with refractory SCA to the medical treatment, using a system of vacuum assisted closure (VAC) whenever it is possible (AU)

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

Tumor del cuerpo carotídeo en paciente joven / Carotid body tumour in young patient

Se presenta por los autores un caso de tumor carotídeo desarrollado en una joven. Se realiza una revisión sobre el manejo de este tipo de patología y se discute las características del caso con la información disponible en la bibliografía

The authors present a case of Carotid body tumor in a young women. A review of carotid body tumour management is made and have the discussion with the characteristics of the case in comparition of the information of the bibliography

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)

Immunogenicity of CIGB-230, a therapeutic DNA vaccine preparation, in HCV-chronically infected individuals in a Phase I clinical trial.

SUMMARY: Hepatitis C virus (HCV) is a worldwide health problem. No vaccine is available against this pathogen and therapeutic treatments currently in use are of limited efficacy. In the present study, the immunogenicity of the therapeutic vaccine candidate CIGB-230, based on the mixture of pIDKE2, a plasmid expressing HCV structural antigens, with a recombinant HCV core protein, Co.120, was evaluated. CIGB-230 was administered by intramuscular injection on weeks 0, 4, 8, 12, 16 and 20 to 15 HCV-chronically infected individuals, non-responders to previous treatment with interferon (IFN) plus ribavirin. Interestingly, following the final immunization, neutralizing antibody responses against heterologous viral pseudoparticles were modified in eight individuals, including six de novo responders. In addition, 73% of vaccinees exhibited specific T cell proliferative response and T cell IFN-gamma secretory response 24 weeks after primary immunization with CIGB-230. Furthermore, 33.3% of individuals developed de novo cellular immune response against HCV core and the number of patients (46.7% at the end of treatment) with cellular immune response against more than one HCV structural antigen increased during vaccination (P = 0.046). In addition, despite persistent detection of HCV RNA, more than 40% percent of vaccinated individuals improved or stabilized liver histology, particularly reducing fibrosis, which correlated with cellular immune response against more than one HCV antigen (P = 0.0053). In conclusion, CIGB-230 is a promising candidate for effective therapeutic interventions based on its ability for enhancing the immune response in HCV chronically infected individuals.

Tromboendarterectomía carotídea tras ictus o accidente isquémico transitorio: revisión bibliográfica / Carotid endarterectomy after cva or transient ischaemic accident: Bibliographic review

Introducción: Actualmente existe una gran controversia sobre la indicación en el tiempo de la realización de la cirugía sobre una carótida sintomática (ICTUS, TIA, INI). El objetivo de esta revisión es determinar ese momento óptimo de acuerdo la literatura científica más reciente. Material y métodos: En el presente trabajo se realizó una revisión de la literatura científica de los últimos años. Para ello se utilizó la base de datos de la Nacional Library of Medicine (PubMed). El estudio se limitó a trabajos publicados en los últimos 10 años en inglés y español que dispusieran de abstract on-line. Las palabras clave introducidas para la búsqueda fueron carotid stenosis, endovascular, stenting, thromboendarterectomy. Resultados: Con dichos parámetros de búsqueda aparecen 140 trabajos de los cuales, 77 de ellos hacen referencia directa o indirecta. De los trabajos recogidos se analizaron detenidamente 22 de ellos, a los cuales se hace referencia en el artículo de acuerdo al orden de aparición. Conclusiones: El beneficio potencial para el paciente aumenta cuanto mayor es el riesgo de ICTUS o de recurrencia. Por ello recomendamos la cirugía precoz en las dos primeras semanas (AU)

Background: Actually there is a great controversy on the indication in the time in order to carry out the surgery on a symptomatic carotid (CVA, TIA, INI). The aim of this revision is to determine that good moment of agreement the most recent scientific literature. Material and methods: This paper was carried out a revision of the scientific literature of the last years. We used the data base of the National Library Medicine (PubMed). The study was limited to papers published in English and Spanish with abstract on-line in the last 10 years. The key words introduced for the search was carotid stenosis, endovascular, stenting, thromboendarterectomy. Results: With these parameters of search appear 140 articles. 77 of them makes reference to the aim of the article. We reviewed 22 of them. Conclusions. The potential benefit for the patient increases in the high risk period. We recommend the early surgery in the first two weeks (AU)

Utilidad y pautas de seguimiento de la revacularización de miembros inferiores: Revisión bibliográfica / Utility and surveillance protocol of lower limbs revascularization: A bibliographic review

INTRODUCCIÓN. Actualmente no existe unanimidad sobre las pautas de seguimiento de la revascularización de miembros inferiores; ni siquiera si ésta resulta útil a medio y largo plazo. La finalidad del trabajo es revisar la bibliografía científica para establecer un protocolo de seguimiento actualizado según las últimas publicaciones. MATERIAL Y MÉTODOS. Se utilizó la base bibliográfica de la Nacional Library of Medicine (PubMed). El estudio se limitó a trabajos publicados en los últimos 10 años en inglés, español que dispusieran de abstract on-line. RESULTADOS. Con dichos parámetros de búsqueda aparecen 124 trabajos de los cuales, 22 de ellos hacen referencia directa o indirecta mientras que los 102 trabajos restantes fueron desechados por no ajustarse a la finalidad de la búsqueda. CONCLUSIONES. Aunque la tasa de amputaciones, permeabilidad y salvamentos a los 18 meses en los pacientes seguidos mediante eco-doppler no difiere significativamente de los pacientes que se incluyen dentro de programas de seguimiento clínico, un estudio ecográfico a las 6 semanas puede predecir la historia natural de un by-pass con vena y así establecer los pacientes que se beneficiarían del seguimiento ecográfico. De ésta forma se reducurían los costes asociados y la tasa de reintervenciones (AU)

INTRODUCTION. At the moment there is no unanimity on the rules of surveillance of the revascularization of lower limbs; not even if this is useful to half and long term. The purpose of the article is to revise the bibliography in order to establish a protocol of follow up modernized according to the last publications. METHODS. The bibliographical base of the National Library Medicine (PubMed) was used. The study was limited to papers published into 10 last years. RESULTS. With this parameters of search 124 entries appear of which, 22 of them makes direct or indirect reference to the purpose while the 102 remaining papers were discarded by not adjusting to the purpose of the search. CONCLUSIONS. Although the rate of amputations, patency and salvages at the 18 months in the followed patients by echo-doppler don't differ significantly of the patients that are included into programs of clinical follow up, a duplex scan sonography at the 6 weeks predicts the natural history of a vein graft and so establish the patients that would benefit from the surveillance by echo-doppler in order to decrease the associate costs and the rate of reinterventions (AU)