Mesh excision secondary to spondylodiscitis after colposacropexy graft rejection: a step by step video.

INTRODUCTION: Spondylodiscitis secondary to colposacropexy is an extremely rare entity. Infection and mesh rejection are the main causes. Removal of the mesh is essential for patient's recovery and it can be a very challenging surgical procedure. CASE: A 72-year-old woman presented with severe low back pain in the context of a recent colposacropexy. Magnetic resonance imaging was performed and spondylodiscitis secondary to prolapse correction surgery with mesh was suspected. In order to ensure an adequate recovery, removal of the mesh was required. CONCLUSIONS: Spondylodiscitis secondary to colposacropexy should be suspected when the patient starts with moderate lumbar pain and is not correctly controlled with first-level analgesia. Infection or mesh rejection should be considered. Mesh rejection should be suspected when the patient does not improve after antibiotics. Complete removal of the mesh is needed in order to ensure the patient's recovery.

RENEB Inter-Laboratory Comparison 2021: The Dicentric Chromosome Assay.

After large-scale radiation accidents where many individuals are suspected to be exposed to ionizing radiation, biological and physical retrospective dosimetry assays are important tools to aid clinical decision making by categorizing individuals into unexposed/minimally, moderately or highly exposed groups. Quality-controlled inter-laboratory comparisons of simulated accident scenarios are regularly performed in the frame of the European legal association RENEB (Running the European Network of Biological and Physical retrospective Dosimetry) to optimize international networking and emergency readiness in case of large-scale radiation events. In total 33 laboratories from 22 countries around the world participated in the current RENEB inter-laboratory comparison 2021 for the dicentric chromosome assay. Blood was irradiated in vitro with X rays (240 kVp, 13 mA, ∼75 keV, 1 Gy/min) to simulate an acute, homogeneous whole-body exposure. Three blood samples (no. 1: 0 Gy, no. 2: 1.2 Gy, no. 3: 3.5 Gy) were sent to each participant and the task was to culture samples, to prepare slides and to assess radiation doses based on the observed dicentric yields from 50 manually or 150 semi-automatically scored metaphases (triage mode scoring). Approximately two-thirds of the participants applied calibration curves from irradiations with γ rays and about 1/3 from irradiations with X rays with varying energies. The categorization of the samples in clinically relevant groups corresponding to individuals that were unexposed/minimally (0-1 Gy), moderately (1-2 Gy) or highly exposed (>2 Gy) was successfully performed by all participants for sample no. 1 and no. 3 and by ≥74% for sample no. 2. However, while most participants estimated a dose of exactly 0 Gy for the sham-irradiated sample, the precise dose estimates of the samples irradiated with doses >0 Gy were systematically higher than the corresponding reference doses and showed a median deviation of 0.5 Gy (sample no. 2) and 0.95 Gy (sample no. 3) for manual scoring. By converting doses estimated based on γ-ray calibration curves to X-ray doses of a comparable mean photon energy as used in this exercise, the median deviation decreased to 0.27 Gy (sample no. 2) and 0.6 Gy (sample no. 3). The main aim of biological dosimetry in the case of a large-scale event is the categorization of individuals into clinically relevant groups, to aid clinical decision making. This task was successfully performed by all participants for the 0 Gy and 3.5 Gy samples and by 74% (manual scoring) and 80% (semiautomatic scoring) for the 1.2 Gy sample. Due to the accuracy of the dicentric chromosome assay and the high number of participating laboratories, a systematic shift of the dose estimates could be revealed. Differences in radiation quality (X ray vs. γ ray) between the test samples and the applied dose effect curves can partly explain the systematic shift. There might be several additional reasons for the observed bias (e.g., donor effects, transport, experimental conditions or the irradiation setup) and the analysis of these reasons provides great opportunities for future research. The participation of laboratories from countries around the world gave the opportunity to compare the results on an international level.

Evaluating the impact of the biocontrol agent Trichoderma harzianum ITEM 3636 on indigenous microbial communities from field soils.

AIM: To investigate the impact of inoculating peanut seeds with the biocontrol agent Trichoderma harzianum ITEM 3636 on the structure of bacterial and fungal communities from agricultural soils. METHODS AND RESULTS: Polymerase chain reaction (PCR)-denaturing gradient gel electrophoresis (PCR-DGGE) and next-generation sequencing (NGS) of amplicons (or marker gene amplification metagenomics) were performed to investigate potential changes in the structure of microbial communities from fields located in a peanut-producing area in the province of Córdoba, Argentina. Fields had history of peanut smut (caused by Thecaphora frezii) incidence. The Shannon indexes (H'), which estimate diversity, obtained from the PCR-DGGE assays did not show significant differences neither for bacterial nor for fungal communities between control and inoculation treatments. On the other hand, the number of operational taxonomic units obtained after NGS was similar between all the analysed samples. Moreover, results of alpha and beta diversity showed that there were no significant variations between the relative abundances of the most representative bacterial and fungal phyla and genera, in both fields. CONCLUSIONS: Trichoderma harzianum ITEM 3636 decreases the incidence and severity of agriculturally relevant diseases without causing significant changes in the microbial communities of agricultural soils. SIGNIFICANCE AND IMPACT OF THE STUDY: Our investigations provide information on the structure of bacterial and fungal communities in peanut-producing fields after inoculation of seeds with a biocontrol agent.

Rare earth activated yttrium aluminate phosphors with modulated luminescence.

Yttrium aluminate (Y3 A5 O12 ) was doped with different rare earth ions (i.e. Gd(3+) , Ce(3+) , Eu(3+) and/or Tb(3+) ) in order to obtain phosphors (YAG:RE) with general formula,Y3-x-a Gdx REa Al5 O12 (x = 0; 1.485; 2.97 and a = 0.03). The synthesis of the phosphor samples was done using the simultaneous addition of reagents technique. This study reveals new aspects regarding the influence of different activator ions on the morpho-structural and luminescent characteristics of garnet type phosphor. All YAG:RE phosphors are well crystallized powders containing a cubic-Y3 Al5 O12 phase as major component along with monoclinic-Y4 Al2 O9 and orthorhombic-YAlO3 phases as the impurity. The crystallites dimensions of YAG:RE phosphors vary between 38 nm and 88 nm, while the unit cell slowly increase as the ionic radius of the activator increases. Under UV excitation, YAG:Ce exhibits yellow emission due to electron transition in Ce(3+) from the 5d level to the ground state levels ((2) F5/2 , (2) F7/2 ). The emission intensity of Ce(3+) is enhanced in the presence of the Tb(3+) ions and is decreased in the presence of Eu(3+) ions due to some radiative or non-radiative processes that take place between activator ions. By varying the rare earth ions, the emission colour can be modulated from green to white and red. Copyright © 2015 John Wiley & Sons, Ltd.

Rotura de aneurisma venoso en la unión safeno femoral en contexto de recidiva varicosa / Venous aneurysm rupture in the saphenofemoral junction in the context of a varicose recurrence

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Coatings of nanostructured pristine graphene-IrOx hybrids for neural electrodes: Layered stacking and the role of non-oxygenated graphene.

The need to enhance charge capacity in neural stimulation-electrodes is promoting the formation of new materials and coatings. Among all the possible types of graphene, pristine graphene prepared by graphite electrochemical exfoliation, is used in this work to form a new nanostructured IrOx-graphene hybrid (IrOx-eG). Graphene is stabilized in suspension by IrOx nanoparticles without surfactants. Anodic electrodeposition results in coatings with much smaller roughness than IrOx-graphene oxide. Exfoliated pristine graphene (eG), does not electrodeposit in absence of iridium, but IrOx-nanoparticle adhesion on graphene flakes drives the process. IrOx-eG has a significantly different electronic state than graphene oxide, and different coordination for carbon. Electron diffraction shows the reflection features expected for graphene. IrOx 1-2 nm cluster/nanoparticles are oxohydroxo-species and adhere to 10nm graphene platelets. eG induces charge storage capacity values five times larger than in pure IrOx, and if calculated per carbon atom, this enhancement is one order magnitude larger than the induced by graphene oxide. IrOx-eG coatings show optimal in vitro neural cell viability and function as cell culture substrates. The fully straightforward electrochemical exfoliation and electrodeposition constitutes a step towards the application of graphene in biomedical systems, expanding the knowledge of pristine graphene vs. graphene oxide, in bioelectrodes.

Endarterectomía carotídea precoz versus diferida en estenosis carotídea sintomática / Early versus delayed carotid endarterectomy in symptomatic carotid stenosis

INTRODUCCIÓN: El momento óptimo para realizar la endarterectomía carotídea (EAC) tras un ictus es controvertido. Aunque estudios preliminares sugirieron que un período de 6 semanas tras el ictus era recomendable, el hallazgo en estudios recientes de un alto riesgo de recurrencia de ictus tras un primer episodio sustenta la EAC precoz. Revisamos nuestra experiencia para examinar los resultados perioperatorios según el momento quirúrgico de la EAC en pacientes sintomáticos. MATERIAL Y MÉTODOS: Revisión retrospectiva de una base de datos prospectiva con 349 EAC llevadas a cabo en nuestro servicio de Cirugía Vascular en el período 2002-2014, de las cuales 226 se realizaron en pacientes sintomáticos (64,7%). La EAC fue considerada «precoz» si se realizaba en los primeros 14 días tras el ictus, y «diferida» cuando se efectuaba después de 14 días. Revisamos nuestra experiencia para analizar resultados perioperatorios según el momento de la EAC. RESULTADOS: De 226 EAC, las indicaciones fueron: accidente isquémico transitorio en el 46% de los casos e ictus en el 45,1%. La tasa global de ictus-muerte perioperatoria es del 3,9%. La proporción de pacientes sometidos a EAC precoz (≤ 14 días) es del 34,1%, siendo los pacientes en los que se realiza EAC diferida (> 14 días) el 65,9%. Los factores demográficos y de comorbilidad son similares en ambos grupos. En el grupo EAC precoz fue más frecuente el «signo de la cuerda» que en aquellos intervenidos de forma diferida (5,2% vs. 0,7%; p < 0,05). Los resultados inmediatos (< 30 días) en la cohorte EAC precoz fueron: 0 (0%) complicaciones cardiológicas; 0 (0%) accidentes isquémicos transitorios; 2 (2,6%) ictus ipsilaterales; ningún ictus contralateral; y 2 casos de mortalidad (2,6%). En la cohorte tardía, 2 (1,3%) complicaciones cardiológicas; 2 (1,3%) accidentes isquémicos transitorios; 4 (2,7%) ictus ipsilaterales; ningún ictus contralateral; y 2 fallecimientos (1,3%); p > 0,05. CONCLUSIONES: Puesto que no hay diferencias estadísticamente significativas en los resultados perioperatorios entre ambos grupos consideramos que la EAC precoz dentro de los primeros 14 días tras el evento neurológico puede llevarse a cabo con seguridad

INTRODUCTION: The optimal timing of carotid endarterectomy (CEA) after ipsilateral hemispheric stroke is controversial. Although early studies suggested that an interval of about 6 weeks after a stroke was preferred, more recent data support early carotid endarterectomy. A review of our experience is presented in order to examine perioperative outcome as regards the timing of CEA in symptomatic patients. MATERIAL AND METHODS: A retrospective review of a prospective database of all CEAs performed in our Vascular Surgery Department from 2002 to 2014 showed that 349 CEAs were performed, of which 226 (64.7%) were on symptomatic patients. CEA was considered «early» if performed ≤ 14 days from symptom onset, and «delayed» if performed after > 14 days following the symptoms. RESULTS: Of 226 CEAs, 46% had a transient ischemic attack and 45.1% had stroke as indications for surgery. The 30-day death/stroke rate was 3.9%. Early CEA (≤ 14 days) was performed on 34.1% of patients, with delayed CEA (> 14 days) being performed on 65.9%. Demographics and comorbidity were similar between groups. Patients who underwent early CEA were significantly more likely to have the «string sign» than patients in the delayed group (5.2% vs 0.7%, P < .05). For 30-day outcomes, in the early CEA cohort: cardiological complications: 0 (0%); transient ischemic attack: 0 (0%); ipsilateral stroke: 2 (2.6%), contralateral stroke: 0%; deaths: 2 (2.6%), and in the delayed CEA cohort: cardiological complications: 2 (1.3%); transient ischemic attack: 2 (1.3%); ipsilateral stroke: 4 (2.7%), contralateral stroke: 0 (0%); deaths: 2 (1,3%), P > .05. CONCLUSIONS: There were no differences in 30-day adverse outcome rates between the early and delayed CEA cohorts. On the basis of these results it appears that early carotid endarterectomy (< 14 days) can be safely performed

Cuándo realizar la endarterectomía carotídea en pacientes sintomáticos / When to perform carotid endarterectomy in symptomatic patients

La endarterectomía carotídea (EAC) ha demostrado reducir el riesgo de ictus y muerte en pacientes sintomáticos con enfermedad carotídea extracraneal. Sin embargo, existe controversia con relación al momento de realizar la cirugía en pacientes con ictus previo. Históricamente, la literatura había sugerido que el momento óptimo era aproximadamente a las 6 semanas del ictus. A esta conclusión se llegó por la alta morbimortalidad si la EAC se realizaba demasiado pronto. Sin embargo, este abordaje ha sido puesto en duda, actualmente, por la indiscutible evidencia de que a) el riesgo precoz de ictus tras AIT/ictus minor es mayor de lo previamente enseñado y b) el beneficio a largo plazo de la cirugía cae rápidamente tras el evento. Este artículo discute la literatura de finales del siglo XX centrándose en la literatura más reciente del siglo XXI con relación al timing de la EAC tras un ictus

Carotid endarterectomy (CEA) has been shown to reduce the risk of stroke and death in symptomatic patients with carotid occlusive disease. However there is controversy on the timing of surgery in patients who suffer a stroke. Historically, in the literature it has suggested that the optimal timing to perform CEA was approximately 6 weeks after an acute stroke. This conclusion was reached due to the high perioperative morbidity and mortality if CEA was performed too early. Notwithstanding, this approach has now been called into question because of indisputable evidence that a) the early risk of stroke after a patient suffers a transient ischemic attack (TIA)/minor stroke is significantly higher than previously taught, and b) the long term benefit of surgey diminishes rapidly following onset of the index event. This article discusses 20th Century literature and focuses on more recent 21st Century literature as regards the timing of CEA after acute stroke

Tratamiento endovascular de dislocación aguda compleja de rama de endoprótesis aórtica / Endovascular treatment of an acute complex dislocation in aortic-stent branch

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Reparación endovascular de aneurismas iliacos aislados. Nuestra experiencia en los últimos 10 años / Endovascular repair of isolated iliac aneurysms. Our experience in the last 10 years

OBJETIVOS: Analizar los resultados del tratamiento endovascular de aneurismas iliacos aislados en los últimos 10 años. MATERIAL Y MÉTODO: Treinta y cinco aneurismas iliacos aislados en 28 pacientes con una edad media de 75,4 años (IC 95% 72,8-78) fueron intervenidos de forma programada entre el 1 de enero de 2002 y el 31 de diciembre de 2011. El 71% afectaban a la arteria iliaca común (AIC) y el 29% a la arteria iliaca interna (AII). Bilaterales eran 6 (5 de AIC y uno de AII). Un paciente presentaba aneurisma combinado de AIC y AII. El diámetro medio aneurismático fue de 45,21 mm (rango 30-80). El 85,7% eran asintomáticos, y sintomáticos, el 14,3%. La cardiopatía aparece como la enfermedad asociada más prevalente (57,1%), y la HTA es el principal factor de riesgo cardiovascular (53,6%). Todos los pacientes fueron clasificados de elevado riesgo anestésico según la clasificación ASA. El seguimiento clínico se efectuó a los 3, 6, 12, 18 meses y luego anualmente. RESULTADOS: El tratamiento endovascular se extendió entre AIC y AII en 19 aneurismas iliacos aislados unilaterales; solo se cubrió la AIC en un caso de forma aislada. Debido a la morfología anatómica, 5 casos precisaron de endoprótesis bifurcadas y 3 casos de endoprótesis aortomonoiliaca e injerto cruzado. Se embolizó la hipogástrica solo en un paciente. La estancia media posoperatoria fue de 5,7 días (rango 2-35). La mortalidad posoperatoria fue del 7%. El seguimiento medio fue de 30,2 meses (rango 2-102 meses), observando 3 endofugas (8,5%) −2 tipo II y una tipo III − y una trombosis de endoprótesis (2,8%). CONCLUSIONES: El tratamiento endovascular de los aneurismas iliacos aislados en pacientes de elevado riesgo quirúrgico es una técnica segura y eficaz con baja tasa de morbimortalidad

OBJECTIVES: To analyze the results of endovascular treatment of isolated iliac aneurysms in the last 10 years. MATERIAL AND METHOD: A total of 35 isolated iliac aneurysms in 28 patients with a mean age of 75.4 years (95% CI 72.8 to 78) were routinely operated on from January 1st 2002 to December 31st 2011. The common iliac artery (CIA) was most affected, with 71%, and 29% was in internal iliac artery (IIA). There were 6 bilateral cases (5 CIA and one IIA). One patient had combined CIA and IIA. The mean diameter of the aneurysms was 45.21 mm (range 30-80). There were no symptoms present in 85.7%. Heart disease arised as the most prevalent comorbidity (57.1%), and hypertension was the main cardiovascular risk factor (53.6%). All patients were considered as high risk according to the ASA anesthesia classification. Clinical follow-up was performed at 3, 6, 12, 18 months, and then annually. RESULTS: The endovascular treatment performed between AIC and IIA in 19 unilateral cases, covering only CIA in one single case. Due to the anatomical morphology, 5 cases needed bifurcated stent-grafts, and 3 cases with an aorto-mono-iliac stent-graft and a crossed graft. The internal iliac was embolized in only one patient. The mean hospital stay was 5.7 days (range 2-35). Postoperative mortality was 7%. Mean follow-up was 30.2 months (range 2-102 months), with 8.5% endoleak incidence (2 cases with type II endoleak and one case with type iii). Stent thrombosis in one case (2.8%) was treated with open surgery. CONCLUSIONS: Endovascular treatment of isolated iliac aneurysms in high surgical risk patients is a safe and an effective procedure

Nanocomposites of iridium oxide and conducting polymers as electroactive phases in biological media.

Much effort is currently devoted to implementing new materials in electrodes that will be used in the central nervous system, either for functional electrostimulation or for tests on nerve regeneration. Their main aim is to improve the charge capacity of the electrodes, while preventing damaging secondary reactions, such as peroxide formation, occurring while applying the electric field. Thus, hybrids may represent a new generation of materials. Two novel hybrid materials are synthesized using three known biocompatible materials tested in the neural system: polypyrrole (PPy), poly(3,4-ethylenedioxythiophene) (PEDOT) and iridium oxide (IrO2). In particular, PPy-IrO2 and PEDOT-IrO2 hybrid nanocomposite materials are prepared by chemical polymerization in hydrothermal conditions, using IrO2 as oxidizing agent. The reaction yields a significant ordered new hybrid where the conducting polymer is formed around the IrO2 nanoparticles, encapsulating them. Scanning electron microscopy and backscattering techniques show the extent of the encapsulation. Both X-ray photoelectron and Fourier transform infrared spectroscopies identify the components of the phases, as well as the absence of impurities. Electrochemical properties of the final phases in powder and pellet form are evaluated by cyclic voltammetry. Biocompatibility is tested with MTT toxicity tests using primary cultures of cortical neurons grown in vitro for 6 and 9days.

Tratamiento endovascular de rotura aórtica infecciosa / Endovascular treatment of an infectious aortic rupture

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¿Es necesaria la biopsia de la arteria temporal para el diagnóstico de arteritis de la temporal? / Is temporal artery biopsy necessary for the diagnosis of temporal arteritis?

El eco-Doppler color (ED) se ha empleado en el diagnóstico de la arteritis de la temporal (AT), describiendo un halo hipoecoico perivascular (HHP). El objetivo de este estudio es valorar la utilidad del ED en el diagnóstico de AT. Material y método: Estudio prospectivo en 32 pacientes con sospecha de AT. Se realizó ED evaluando la presencia de HHP. Posteriormente se practicó biopsia de arteria temporal, analizando la presencia de células gigantes multinucleadas. Se compararon los resultados obtenidos, valorando sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN).Resultados: La presentación clínica fue: 40,6% (13) cefalea, 12,5% (4) clínica visual, 21,9%(7) dolor de la arteria temporal, 9,4% (3) AIT, 15,6% (5) polimialgia, 9,4% (3) claudicación mandibular, y 87,5% (28) elevación de VSG. Se visualizó HHP en el ED en 6 casos (18,8%). El resultado anatomopatológico de AT fue positivo en 3 casos (9,4%). Al comparar los resultados se obtiene una sensibilidad, especificidad, VPP y VPN del 66, 86, 33 y 96%, respectivamente. Conclusión: El ED es una prueba útil en el diagnóstico de AT, dejando la biopsia de la arteria temporal para casos seleccionados (AU)

Duplex ultrasound (DU) has been used in the diagnosis of temporal arteritis (TA), showing a hypoechoic perivascular halo (HPH). The aim of this study is to assess the usefulness of DU in the diagnosis of TA. Materials and method: A prospective study was conducted on 32 patients with suspected TA. DU was performed to detect the presence of HPH. A temporal artery biopsy was subsequently to analyse the presence of multinucleated giant cells. The results were compared by evaluating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The clinical presentation was: 40.6% (13) headache, 12.5% (4) visual clinical signs,21.9% (7) temporal artery pain, 9.4% (3) TIA, 15.6% (5) polymyalgia, 9.4% (3) jaw claudication, and 87.5% (28) elevated ESR.HPH was visualized in the DU in 6 cases (18.8%). The pathology of TA was positive in 3 patients (9.4%). On analysing the results, the sensitivity, specificity, PPV and NPV was 66%, 86%, 33%, and 96%, respectively. Conclusion: DU is a useful screening test in diagnosis of TA, leaving temporal artery biopsy for selected cases (AU)

Rotura de arteria femoral superficial por infección arterial / Rupture of the superficial femoral artery due to an arterial infection

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Seudoaneurismas radiales: a proposito de 2 casos / Radial artery pseudoaneurysm: a report of 2 cases

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Tratamiento de la isquemia crítica de las extremidades inferiores. Cirugía distal y endovascular / Treatment of critical ischaemia of the lower limbs. Surgical or endovascular distal revascularization

Introducción: La isquemia crítica de los miembros inferiores (ICMI) es un proceso crónico con pronóstico muy desfavorable. Objetivo: Analizar la cirugía derivativa (CD) y endovascular (CE) de troncos distales en el tratamiento de la ICMI. Material y métodos: Estudio retrospectivo en el que se incluyeron 113 pacientes (89 hombres y 32 mujeres) intervenidos entre enero de 2006 y diciembre de 2010. Método de Kaplan-Meier para el análisis de resultados. Resultados: Edad media 74,5 años; diabéticos 62%; el 26,4% dolor de reposo; el 73,6% lesión distal. Se realizaron 121 procedimientos: 69 derivaciones, 52 angioplastias. CD: anastomosis proximal más frecuente en femoral común (60%) y la distal en peronea (41,4%). Se utilizó vena safena en el 74% de casos. CE: la arteria más tratada fue la tibial anterior (59,6%). En 19,2% de casos se trató más de un tronco distal y en 57,7% se trataron también lesiones proximales simultáneamente. Sin diferencias significativas en el análisis de permeabilidad, salvamento de extremidad y supervivencia en función del tipo de cirugía. Permeabilidad total: 69,2% al primer mes, 51,6% a los 6 meses y 48,2% al año. Tasa de salvamento de extremidad: 83,2% al primer mes, 71% a los 6 meses y del 65% al año. Supervivencia total: 92,5% al primer mes, 85,5% a los 6 meses y del 72,3% al año. Conclusiones: Ambas técnicas, CD y CE, son útiles para salvamento de extremidad frente a la alternativa de amputación mayor. No obstante, en ocasiones la amputación mayor de entrada es preferible a revascularizaciones límites que nos van a llevar a un fracaso precoz(AU)

Introduction: Critical ischemia of the lower limbs (CILL) is a chronic process with a poor prognosis. Objective: To analyse bypass surgery (BS) and endovascular surgery (ES) of distal branches in the treatment of CILL. Material and methods: A retrospective study was conducted on 113 patients (89 males, 32 females) who were treated between January 2006 and December 2010. The Kaplan Meier method used for analysing the results. Results: No major differences in patency, limb salvage, and survival as regards the type of surgery. Total patency: 69.2% in the first month, 51.6% after 6 months, and 48.2% after one year. Limb salvage rate: 83.2% on the first month, 71% after 6 months and 65% after one year. Overall survival: 92.5% in the first month, 85.5% after 6 months, and 72.3% after one year. The mean age was 74.5 years, with 62% diabetics, 26.4% with rest pain, and 73.6% with a distal lesion. Of the121 procedures, there were 69 bypasses and 52 angioplasties. BS: Common femoral was the most frequent anastomosis (60%) and distal peroneal (41.4%). Saphenous vein was used in 74% of the cases. (ES): The anterior tibial was the most treated artery (59.6%). In more than 19.2% of cases, more than one distal branch was treated, and 57.7% of cases also had proximal lesions treated simultaneously. Conclusions: Both techniques, BS and ES, are useful for limb salvage compared to the alternative of major amputation. However, major amputation as first option is sometimes preferable to extreme revascularisations that may lead to early failure(AU)

¿Es útil el eco-Doppler portátil en el diagnóstico de enfermedad arterial periférica? Estudio de validación / Usefulness of a portable duplex scanning device in the diagnosis of peripheral arterial disease. A validation study

Objetivos: Validar el eco-Doppler portátil (EDP) para el diagnóstico de enfermedad arterial periférica (EAP) y analizar la influencia del tipo de lesión arterial en el resultado. Material y método: Estudio prospectivo: 60 extremidades (45 pacientes), edad media 68 años, 33 hombres/12 mujeres, 30% diabéticos, 37% dislipémicos, 58% hipertensos, 27% cardiópatas. Realizamos un EDP siguiendo las guías de diagnóstico vascular no invasivo del sector femoropoplíteo (8 segmentos), comparándolo con la arteriografía. Clasificamos como estenosis < 50%, > 50% y trombosis. Calculamos sensibilidad (S), especificidad (E), VPP, VPN e índice de acuerdo kappa. Las lesiones arteriales se clasifican en únicas o múltiples y se comparan con el grado de acierto del EDP (test chi cuadrado). Resultados: En el sector supragenicular el índice de acuerdo es bueno para diagnóstico de trombosis (K=0,779, S=86%, E=95%, VPP=79%, VPN=96%) y de estenosis > 50% (K=0,651, S=82%, E=85%, VPP=70% y VPN=92%).En el sector infragenicular el grado de acuerdo es bueno para diagnóstico de trombosis (K=0,610, S=72%, E=87%, VPP=77%, VPN 84%), pero moderado en estenosis > 50% (K=0,472, S=68%, E=78%, VPP=70% y VPN=76%).El EDP identifica correctamente 94% de trombosis en lesiones únicas frente 85% en estenosis múltiples (p=0,008) y 86% de estenosis > 50% en lesiones únicas frente 79% en múltiples (p=0,070). Conclusiones: La sensibilidad, especificidad, VPP y VPN del EDP son buenos en diagnóstico de EAP siendo más sensible para diagnóstico de trombosis que estenosis.- El EDP ofrece mayor fiabilidad en diagnóstico de EAP en sector supragenicular frente al infragenicular.- Las lesiones arteriales múltiples disminuyen la fiabilidad del EDP en el diagnóstico de trombosis(AU)

Objectives: The aim of this study is investigate the agreement between a portable duplex scanner (PDS and angiography in the diagnosis of peripheral arterial disease (PAD) and analyse the influence of the type of lesion on the result. Material and methods: A prospective study was conducted on 60 limbs (45 patients) with a mean age of 68 years, 33 males/12 females, 30% diabetes mellitus, 37% dyslipidaemias, 58% arterial hypertension, and 27% heart diseases. A PDS was made following the guidelines for the non-invasive diagnosis of femoral-popliteal sector (8 segments) and comparing it with the angiography. The stenosis were classified as <50%, and thrombosis as >50%. The sensitivity (Se), specificity (Sp), Positive Predictive Value (PPV), Negative Predictive Value (NPV) and Kappa (K) index of agreement was calculated. The arterial lesions were classified in singles or multiples, and were compared with the level of accuracy of the PDS (chi-squared test). Results: In the above-knee segment, the level of agreement was good for the diagnosis of thrombosis (K=0.779, Sp=86%, Se=95%, PPV=79%, NPV=96%) and stenosis >50% (K=0.651, Se=82%, Se=85%, PPV=70% and NPV=92%).In the below-knee segment, the index of agreement was good for the diagnosis of thrombosis (K=0.610, Sp=72%, Se=87%, PPV=77%, PNV=84%), and moderate in stenosis >50% (K=0.472, Sp=68%, Se=78%, PPV=70% and NPV=76%).The PDS correctly identified 94% of thrombosis in single lesions compared to 85% in the multiple lesions (P=.008) and 86% in stenosis >50% in single lesions compared to 79% in multiple lesions (P=.070)(AU)

Conclusions: The sensitivity, specificity, PPV, NPV and Kappa index are good in the diagnosis of PAD, being more sensitive for the diagnosis of thrombosis than for the diagnosis of stenosis.- The was more reliable for the diagnosis of PAD in above-knee segments than below-knee segments.- Multiple arterial lesions decrease the reliability of PDS in the diagnosis of thrombosis(AU)

[Brachioradial pruritus as a symptom of cervical radiculopathy]. / Prurito braquiorradial como síntoma de radiculopatía cervical.

Brachioradial pruritus is characterized by the presence of pruritus on the lateral aspect of the arms. The etiology of this enigmatic entity is the subject of some debate some authors claim that brachioradial pruritus is a photodermatosis whereas others attribute it to the presence of underlying cervical radiculopathy. In these case reports, we present our experience with brachioradial pruritus and discuss the role of underlying neuropathy in its etiology and that of other types of localized pruritus such as notalgia paresthetica, anogenital pruritus, and burning mouth syndrome.

Prurito braquiorradial como síntoma de radiculopatía cervical / Brachioradial pruritus as a symptom of cervical radiculopathy

El prurito braquiorradial (PBR) se caracteriza por la presencia de prurito localizado en la cara lateralde los brazos. Se trata de una entidad enigmática con una etiología controvertida; mientras que algunos autoresconsideran el PBR como una fotodermatosis, otros atribuyen su aparición a la presencia de una radiculopatíacervical subyacente. En este artículo se presenta nuestra experiencia con esta entidad y se discute el papel de una neuropatía subyacente en la etiología de este y otros pruritos localizados como la notalgia parestésica, el prurito anogenital o el síndrome de la boca ardiente (AU)

Brachioradial pruritus is characterized by the presence of pruritus on the lateral aspect of the arms. The etiology of this enigmatic entity is the subject of some debate -some authors claim that brachioradial pruritus is a photodermatosis whereas others attribute it to the presence of underlying cervical radiculopathy. In these case reports, we present our experience with brachioradial pruritus and discuss the role of underlyingneuropathy in its etiology and that of other types of localized pruritus such as notalgia paresthetica, anogenital pruritus, and burning mouth syndrome (AU)