Quantitative sensory testing to evaluate and compare the results after epidural injection and simple discectomy, in patients with radiculopathy secondary to lumbar disc herniation.

The objective assessment of the radiculopathy secondary to lumbar disc herniation is essential to optimize treatment. The quantitative sensory test (QST) is a useful tool to evaluate somatosensory nerves. The aim of our study is quantifying by QST the alterations of patients treated by epidural injections (EI) or surgical lumbar decompression (LD). A prospective, cohort study has done in Hospital Universitario Rio Hortega, Valladolid, Spain, between January 2014 and December 2016.The study includes 74 patients (40 men) who underwent EI (50) or LD (24) with lumbar disc herniation and treated by EI or LD. Participants underwent a brief battery of QST at baseline and after 1, 3 and 6 months of follow-up. QST threshold were measured in three series of five warm and cold stimuli (cold detection threshold, warm detection threshold, cold pain threshold, heat pain threshold) bilateral. Additionally, pain assessment (Visual Analogue Scale) and neurological examination was performed. Thermal thresholds were analysed and compared. In the EI group, warm detection threshold (WDT) measurements were significantly lower after 3 and 6 months of follow-up (40.44 ± 3.42°C vs. 38.30 ± 3.73°C and 37.48 ± 4.58°C respectively, p = 0.031 and p = 0.043). LD group showed lower WDT measurements at 1, 3 and 6 months of follow up (40.20 ± 2.97°C vs., 37.98 ± 2.04°C, 37.43 ± 3.80°C and 36.55 ± 2.77°C respectively, p = 0.049, p = 0.032 and p = 0.024) and lower heat pain threshold (HPT) levels after 3 and 6 months of follow-up (48.75 ± 1.37°C vs. 43.26 ± 0.60°C and 42.06 ± 1.37°C respectively, p = 0.037 and p = 0.021). QST explorations were compared between both groups. At 1-month follow-up only the WDT parameter was different, higher in EI group (40.98 ± 4.04°C vs. 37.98 ± 2.04°C, p = 0.043). There were no differences in any parameter measured by QST after 3 and 6-months follow-up between both groups. Epidural injection should be considered the first-step of treatment.

Laparoscopic treatment of median arcuate ligament syndrome: a systematic review.

INTRODUCTION: Median arcuate ligament syndrome (MALS) is an uncommon condition caused by the extrinsic compression of the celiac trunk (CT) and celiac ganglion, secondary to an anatomical abnormality of the median arcuate ligament fibers. It is characterized by postprandial epigastric pain, chronic abdominal pain, weight loss, nausea and vomiting. MALS is typically diagnosed after the exclusion of other, more common conditions; however, a variety of imaging and diagnostic modalities, including Duplex ultrasonography, computed tomography angiography, magnetic resonance angiography, gastric tonometry and angiography can suggest findings consistent with MALS. EVIDENCE ACQUISITION: Laparoscopic approach has been proposed as the option of choice for the treatment of these patients. A systematic review of the international literature regarding this modality of treatment is presented here. EVIDENCE SYNTHESIS: The review included 504 cases, and several principles are suggested to improve the management. The advantages of this minimally invasive technique include short operative time (136.0 minutes, range 70-242), shorter hospital stay (3.8 days, range 0.5-7) and low rate of conversion to open surgery (4.2%). CONCLUSIONS: Various treatment modalities are available to decompress the celiac trunk. Although open surgery has been traditionally accepted as the gold standard, laparoscopic division of the MALS has proven equal results. Others have described different treatment modalities, including bypass surgery and endovascular procedures (angioplasty or stent placement). Laparoscopic approaches to correct MALS are feasible and safe. It may be the preferred modality of treatment in view of its lack of morbidity, shorter hospital stay and good results.

Endovascular Treatment of Popliteal Artery Occlusion Caused by a Ruptured Supera Interwoven Nitinol Stent.

The Supera peripheral stent system has a woven wire design that may confer a potential advantage and has higher resistive radial strength of traditional stents, which gives it the ability to avoid kinking. Because a stent is a permanent implant in the target vessels and they would be subjected to a wide variety of torsion, compression, and stress, a rupture is not surprising. Only three cases of ruptured Supera stents have been published in literature. We present a case of P2 popliteal segment thrombosis secondary to Supera stent fracture. A 51-year-old male patient presented with lifestyle-limiting intermittent claudication after 6 months of popliteal recanalization and Supera stent implantation. The computed tomography angiography demonstrated a popliteal artery occlusion secondary to stent fracture. The lesion was satisfactorily treated by endovascular recanalization and with a new Supera stent deployment. The duplex examination after 3 and 6 months demonstrated stent's permeability, and the plain anteroposterior and lateral radiographs did not reveal new stent fractures. Our data suggested that Supera stents are not free of fractures during follow-up and their treatment depends on the type of fracture, with the possibility for endovascular treatment in type III fractures.

Ocular Myasthenia Induced by Rivaroxaban in Patient with Deep Vein Thrombosis.

The non-vitamin K antagonist oral anticoagulant rivaroxaban is indicated in prevention and treatment of venous thromboembolism (VTE). A 60-year-old male patient complained of bilateral ptosis after administration of rivaroxaban for deep vein thrombosis (DVT). Myasthenia gravis (MG) was confirmed by positive serum antiacetylcholine receptor antibody test. No mediastinal thymoma was found. The ocular myasthenia reversed after discontinuing rivaroxaban treatment. Nevertheless, ptosis recurred and chronic oral pyridostigmine bromide treatment was necessary. The mechanism of MG development by rivaroxaban therapy is not completely understood. The development of rivaroxaban-induced autoimmune disease could be based on cross-reactivity between antibodies against rivaroxaban-derived antigens or by T-cell activation. To our knowledge, this report of ocular myasthenia by rivaroxaban administration is the first in the literature. Despite the benefits of rivaroxaban, it is important to recognize unexpected immune-related adverse events.

Nueva escala de predicción de mortalidad en los aneurismas de aorta abdominal rotos / New scale for predicting mortality in ruptured abdominal aortic aneurysms

INTRODUCCIÓN: Conocer la utilidad de las escalas de riesgo de mortalidad para el tratamiento endovascular de los pacientes con aneurisma de aorta abdominal roto. Diseñar una escala de riesgo específica. MÉTODOS: Estudio retrospectivo de 61 pacientes intervenidos mediante reparación endovascular de aneurisma de aorta abdominal roto entre 2009 y 2014. Se recogieron variables preoperatorias y de mortalidad intrahospitalaria, así como las escalas Hardman, GAS, Vancouver y ERAS. RESULTADOS: La mortalidad intrahospitalaria fue del 45,9%. El estudio univariante obtuvo como factores pronósticos la edad, el sexo varón, la hipertensión arterial, el hábito tabáquico, la enfermedad pulmonar obstructiva crónica, la tensión arterial sistólica < 90 mmHg, la frecuencia cardiaca y la pérdida de conciencia. Tras la realización del análisis multivariante, la variables significativas fueron la edad (p = 0,021), la presión arterial sistólica (p = 0,004) y la frecuencia cardiaca (p = 0,050). Las escalas GAS (76,79 ± 9,88 vs. 90,43 ± 14,76; p = 0,001), Vancouver (4,41 ± 0,62 vs. 4,83 ± 0,55; p = 0,007) y ERAS (0,06 ± 0,24 vs. 0,86 ± 0,76; p = 0,001) resultaron estadísticamente diferentes en los pacientes fallecidos. La escala resultante de la siguiente fórmula: 0,083 + 0,158 (si edad > 80 años) + 0,701 (si tensión arterial< 80 mmHg) + 0,598 (si frecuencia cardiaca< 70 lat/min) obtuvo un área bajo la curva de 0,95. CONCLUSIONES: Edad, presión sistólica y frecuencia cardiaca constituyen factores predictores de mortalidad intrahospitalaria de los pacientes con aneurisma de aorta abdominal roto tratados mediante exclusión endovascular. La aplicación de la escala propuesta en el presente estudio, en combinación con las escalas GAS, Vancouver y ERAS, permite conocer los pacientes que no se beneficiarían de tratamiento endovascular

INTRODUCTION: To determine the usefulness of mortality risk scores for the endovascular treatment of ruptured abdominal aortic aneurysms. METHODS: Retrospective study of 61 patients undergoing endovascular repair between 2009 and 2014. Preoperative variables and in-hospital mortality were collected. The Hardman, GAS, Vancouver and ERAS scales were calculated. RESULTS: In-hospital mortality was 45.9%. The univariate predictors obtained were age, male sex, hypertension, smoking, chronic obstructive pulmonary disease, systolic blood pressure < 90 mmHg, heart rate and loss of consciousness. After completing the multivariate analysis, significant variables were age (P=.021), systolic blood pressure < 90 mmHg (P = .004) and heart rate (P = .050). The GAS (76.79 ± 9.88 vs. 90.43 ± 14.76, P=.001), Vancouver (4.41 ± 0.62 vs. 4.83 ± 0.55, P =.007) and ERAS scales (0.06 ± 0.24 vs. 0.86 ± 0.76, P = .001) were statistically different between the groups. The scale resulting from the following formula: 0.083 + 0.158 (if age > 80 years) + 0.701 (if systolic blood pressure < 80 mmHg) + 0.598 (if heart rate < 70 beats/min); obtained an area under the curve of 0.95. CONCLUSIONS: Age, systolic pressure and heart rate, are predictors of hospital mortality of patients treated with endovascular repair of ruptured abdominal aortic aneurysms. Applying the scale proposed in this study, in combination with GAS, Vancouver and ERAS scales, allows the detection of patients who would not benefit from endovascular treatment

New scale for predicting mortality in ruptured abdominal aortic aneurysms. / Nueva escala de predicción de mortalidad en los aneurismas de aorta abdominal rotos.

INTRODUCTION: To determine the usefulness of mortality risk scores for the endovascular treatment of ruptured abdominal aortic aneurysms. METHODS: Retrospective study of 61 patients undergoing endovascular repair between 2009 and 2014. Preoperative variables and in-hospital mortality were collected. The Hardman, GAS, Vancouver and ERAS scales were calculated. RESULTS: In-hospital mortality was 45.9%. The univariate predictors obtained were age, male sex, hypertension, smoking, chronic obstructive pulmonary disease, systolic blood pressure <90mmHg, heart rate and loss of consciousness. After completing the multivariate analysis, significant variables were age (P=.021), systolic blood pressure <90mmHg (P=.004) and heart rate (P=.050). The GAS (76.79±9.88 vs. 90.43±14.76, P=.001), Vancouver (4.41±0.62 vs. 4.83±0.55, P=.007) and ERAS scales (0.06±0.24 vs. 0.86±0.76, P=.001) were statistically different between the groups. The scale resulting from the following formula: 0.083+0.158 (if age>80 years)+0.701 (if systolic blood pressure<80mmHg)+0.598 (if heart rate<70 beats/min); obtained an area under the curve of 0.95. CONCLUSIONS: Age, systolic pressure and heart rate, are predictors of hospital mortality of patients treated with endovascular repair of ruptured abdominal aortic aneurysms. Applying the scale proposed in this study, in combination with GAS, Vancouver and ERAS scales, allows the detection of patients who would not benefit from endovascular treatment.

Effects of rosuvastatin as an adjuvant treatment for deep vein thrombosis.

BACKGROUND: Statins have been reported to help prevent the development and the recurrence of deep vein thrombosis (DVT). We conducted a prospective randomized clinical trial to compare the effects of rosuvastatin plus a low-molecular-weight heparin (LMWH), bemiparin, with conventional LMWH therapy in the treatment of DVT. PATIENTS AND METHODS: In total, 234 patients were randomized into two groups, 116 in the LMWH group and 118 in the statin plus LMWH group. All patients underwent lower limb duplex ultrasound and analytic markers at diagnosis and three months of follow-up. The final analysis included 230 patients. RESULTS: No significant differences were observed in D-dimer levels after three months of follow-up between patients treated with LMWH+rosuvastatin compared to the LMWH group (802.51 + 1062.20 vs. 996.25 + 1843.37, p = 0.897). The group of patients treated with statins displayed lower levels of CRP (4.17 + 4.27 vs. 22.39 + 97.48, p = 0.018) after three months of follow-up. The Villalta scale demonstrated significant differences between groups (3.45 + 6.03 vs. 7.79 + 5.58, p = 0.035). There was a significant decrease in PTS incidence (Villalta score> 5) in the rosuvastatin group (38.3 % vs. 48.5%, p = 0.019). There were no differences in EuroQol score between groups. CONCLUSIONS: Adjuvant rosuvastatin treatment in patients diagnosed of DVT improve CRP levels and diminish PTS incidence.