[Validation of a questionnaire for the analysis of digital competence in patients with type 1 diabetes mellitus]. / Validación de un cuestionario para analizar la capacidad digital de pacientes con diabetes mellitus tipo 1.

OBJECTIVE: Validation of a questionnaire designed to stratify the level of digital competence in chronic patients. METHOD: Cross-sectional study, carried out in the Endocrinology and Nutrition Section of the Complejo Asistencial Universitario de León (CAULE). We selected the digital competencies section of the Cambados questionnaire, designed for the identification of digital chronic patient, with a maximum score of 20 points. The questionnaire was completed for validation by patients for whom were prescribed a digital tool for glycemic control. Reliability was assessed by assessing the correct use of the prescribed tool and internal consistency. RESULTS: The questionnaire was completely filled in by 171 patients, with a mean age of 44.36 (SD 17.36). The mean score obtained in the questionnaire was 11.04 (SD 4.74) and a score over 12 was the most appropriate cut-off point to discriminate between patients according to their level of digital competence. 48.54% of the patients made adequate use of the tool. The scale showed good internal consistency with a Cronbach's alpha of 0.77. CONCLUSIONS: The results reached in the present study allow us to affirm that the responses obtained from the patients in the digital competency definition questionnaire are a good indicator of the use of digital tools.

Texture-Modified Diet for Improving the Management of Oropharyngeal Dysphagia in Nursing Home Residents: An Expert Review.

OBJECTIVES: This paper provides evidence-based and, when appropriate, expert reviewed recommendations for long-stay residents who are prescribed texture-modified diets (TMDs), with the consideration that these residents are at high risk of worsening oropharyngeal dysphagia (OD), malnutrition, dehydration, aspiration pneumonia, and OD-associated mortality, poorer quality of life and high costs. DESIGN: Nestlé Health Science funded an initial virtual meeting attended by all authors, in which the unmet needs and subsequent recommendations for OD management were discussed. The opinions, results, and recommendations detailed in this paper are those of the authors, and are independent of funding sources. SETTING: OD is common in nursing home (NH) residents, and is defined as the inability to initiate and perform safe swallowing. The long-stay NH resident population has specific characteristics marked by a shorter life expectancy relative to community-dwelling older adults, high prevalence of multimorbidity with a high rate of complications, dementia, frailty, disability, and often polypharmacy. As a result, OD is associated with malnutrition, dehydration, aspiration pneumonia, functional decline, and death. Complications of OD can potentially be prevented with the use of TMDs. RESULTS: This report presents expert opinion and evidence-informed recommendations for best practice on the nutritional management of OD. It aims to highlight the practice gaps between the evidence-based management of OD and real-world patterns, including inadequate dietary provision and insufficient staff training. In addition, the unmet need for OD screening and improvements in therapeutic diets are explored and discussed. CONCLUSION: There is currently limited empirical evidence to guide practice in OD management. Given the complex and heterogeneous population of long-stay NH residents, some 'best practice' approaches and interventions require extensive efficacy testing before further changes in policy can be implemented.

Role of Oral Nutritional Supplements Enriched with ß-Hydroxy-ß-Methylbutyrate in Maintaining Muscle Function and Improving Clinical Outcomes in Various Clinical Settings.

Aging and disease-related malnutrition are well associated with loss of muscle mass and function. Muscle mass loss may lead to increased health complications and associated increase in health care costs, especially in hospitalized individuals. High protein oral nutritional supplements enriched with ß-hydroxy-ß-methylbutyrate (HP-ONS+HMB) have been suggested to provide benefits such as improving body composition, maintaining muscle mass and function and even decreasing mortality rates. The present review aimed to examine current evidence on the effect of HP-ONS+HMB on muscle-related clinical outcomes both in community and peri-hospitalization patients. Overall, current evidence suggests that therapeutic nutrition such as HP-ONS+HMB seems to be a promising tool to mitigate the decline in muscle mass and preserve muscle function, especially during hospital rehabilitation and recovery.

Tratamiento endovascular de lesión iatrogénica en aorta torácica causada por tornillo de artrodesis / Endovascular treatment of iatrogenic injury in the thoracic aorta caused by an arthrodesis screw

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Disability and its influence in nutritional assessment tools in elderly people living in nursing homes / Discapacidad y su influencia en las herramientas de valoración nutricional en ancianos institucionalizados en residencias geriátricas

Introduction: Poor nutritional status is associated with increased morbidity and mortality, especially in older people. Objective: The aim of this study was to assess nutritional status in elderly nursing home residents with different nutritional test, and to determine which parameters used for nutritional assessment can be carried out in this population, which usually have a high prevalence of functionally dependent residents. Methods: A cross-sectional study was performed in 383 elderly. The nutritional assessment tools used were the Mini Nutritional Assessment (MNA), the new ESPEN consensus definition of malnutrition, and the tool for Controlling Nutritional Status (CONUT). Moreover, the ability to perform basic activities of daily living was assessed with the Barthel index (BI). Results: According to BI, 78.9% had a total dependence and only 20.9% could be weighed and heighed. The prevalence of malnutrition with MNA, ESPEN and CONUT was 21.3%, 17.6% and 20.7%, respectively. The agreement between MNA vs ESPEN criteria was moderate (κ = 0.483), but with CONUT was low. Conclusions: Nursing homes had a high percentage of totally dependent residents. This high degree of functional dependence made difficult to obtain some anthropometric parameters such as weight and height, which are essential to carry out most nutritional tests. MNA, CONUT and the new ESPEN criteria of malnutrition showed a high prevalence of malnutrition and risk of malnutrition in subjects in which they could be performed (AU)

Introducción: un estado nutricional deficiente está asociado con un incremento de la morbilidad y la mortalidad, especialmente en personas ancianas. Objetivo: el objetivo de este estudio fue evaluar el estado nutricional en ancianos institucionalizados en residencias geriátricas mediante diferentes test nutricionales, y determinar qué parámetros utilizados en la valoración nutricional pueden ser realizados en esta población. Métodos: se llevó a cabo un estudio transversal en 383 ancianos. Las herramientas de valoración nutricional empleadas fueron el Mini Nutritional Assessment (MNA), el nuevo consenso de definición de malnutrición, y el CONUT. Además, la capacidad de realizar las actividades básicas de la vida diaria fue evaluada con el índice de Barthel. Resultados: según el índice de Barthel, hasta un 78,9% de los residentes tenía una dependencia total, y en solo el 20,9% se pudo determinar el peso y la talla. La prevalencia de malnutrición con MNA, el consenso de ESPEN y CONUT fueron 21,3%, 17,2% y 20,7%, respectivamente. La concordancia (kappa) entre el MNA y el ESPEN fue moderada (κ = 0,483), pero con CONUT fue baja. Conclusiones: en las residencias geriátricas públicas existe un elevado porcentaje de ancianos totalmente dependientes. Este alto grado de dependencia funcional dificulta la obtención de algunos parámetros antropométricos como el peso y la talla, que son esenciales para llevar a cabo la mayoría de los test de valoración nutricional. El MNA, el CONUT y los nuevos criterios de desnutrición de la ESPEN mostraron una elevada prevalencia de desnutrición y de riesgo de desnutrición en esta población de ancianos institucionalizados, en aquellos en los que fue posible realizarlos (AU)

Aneurismas de arteria iliaca: Actualización y algoritmos de decisión / Iliac artery aneurysms: Update and decision-making algorithms

Los aneurismas de arteria iliaca aislados constituyen una entidad especial, no solo por su infrecuencia (0,4-1,9% de la patología aneurismática) sino también por la demostrada mayor complejidad de su reparación, respecto a los aneurismas de aorta abdominal, especialmente cuando aquellos se extienden a la arteria iliaca interna. La aparición de las técnicas endovasculares, con su menor morbimortalidad, ha supuesto un cambio en el paradigma de tratamiento de los aneurismas de arteria iliaca, desplazando en los últimos años a la cirugía abierta como principal forma de reparación. Además, la preservación de la arteria iliaca interna se ha convertido en un objetivo prioritario, añadiéndose nuevas estrategias endovasculares, como la técnica «bell-bottom», la técnica sándwich, el «iliac branch device»… El objetivo de este artículo es actualizar el manejo y tratamiento quirúrgico de los aneurismas de arteria iliaca y exponer con claridad, en forma de algoritmos, la multitud de opciones terapéuticas para su reparación mediante cirugía abierta o endovascular (AU)

Isolated iliac artery aneurysms constitute a special case, not only for being extremely rare, 0.4% to 1.9% of all aneurysmal diseases, but also as their repair is more challenging, compared to that of abdominal aortic aneurysm, especially if the internal iliac artery is involved. The onset of endovascular techniques, with decreased morbidity and mortality, has led to a paradigm shift, replacing open surgical repair as the primary means of treatment. Furthermore, preserving internal iliac artery has become a critical issue, leading to newer endovascular techniques being used, such as bell-bottom technique, sandwich technique, the use of iliac branch devices, etc. The aim of this article is to update the management and treatment of iliac artery aneurysms in order to clearly demonstrate, using algorithms, the variety of open and endovascular surgical options (AU)

Compresión de la vía aérea superior secundaria a un pseudoaneurisma carotídeo / Compression of the upper airway secondary to carotid pseudoaneurysm

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Aneurismas poplíteos pequeños. ¿Son todos benignos? / Small popliteal artery aneurysms. Are all of them benign?

INTRODUCCIÓN: Los aneurismas poplíteos (AP) son infrecuentes, sin embargo, sus complicaciones tromboembólicas son usuales y pueden conducir a la pérdida de la extremidad. El comportamiento de los AP pequeños (APP) es incierto. El objetivo de nuestro estudio es: 1) describir y analizar el comportamiento de los APP dentro de una extensa serie quirúrgica de AP; 2) realizar un estudio comparativo con aquellos AP>2cm. MATERIAL Y MÉTODOS: Entre el 31 de agosto de 1986 y el 31 de diciembre de 2013, 157 AP en 132 pacientes fueron intervenidos en nuestro Servicio de Cirugía Vascular. La información ha sido recogida en una base de datos retrospectiva. Se consideran APP aquellos con diámetro transversal ≤ 2 cm. Se establecen 2 grupos: 31 AP ≤ 2 cm (grupo 1) y 126 AP>2cm (grupo 2). RESULTADOS: En el grupo de APP (grupo 1) el 67,7% de los casos fueron sintomáticos y en el grupo 2, el 58,7%, sin diferencias estadísticamente significativas. Los APP se manifiestan con isquemia aguda en el 32,3% de los casos, claudicación en 9,7%, dolor de reposo en el 19,4% y lesiones tróficas en el 6,5%. En el grupo, 2 los casos de dolor de reposo y lesiones tróficas son 5,6 y 0,8%, respectivamente, p = 0,026. La trombosis aneurismática está presente como complicación principal en el 58,1% en el grupo 1 y en el 33,3% en el grupo 2, en tanto que la rotura es del 0% en el grupo 1 y del 6,3% en el grupo 2, p = 0,040. CONCLUSIONES: Los APP no son tan benignos como pudiera pensarse ya que pueden trombosarse y producir isquemia crítica de la extremidad. Puesto que el objetivo de la reparación quirúrgica de un AP es prevenir las complicaciones tromboembólicas, se ha de considerar la reparación de los APP≤2 cm (AU)

BACKGROUND: Popliteal artery aneurysms (PAAs) are uncommon; however thromboembolic complications are usual and may result in limb loss. The natural history of small PAA is unknown. The aim of our study is: 1) to describe and analyse the behaviour of small PAA through our wide experience, and 2) to compare small PAAs to those PAA > 2 c m. MATERIAL AND METHODS: A total of 157 PAAs were operated on in 132 patients were operated on in our vascular surgery department from 31 August 1986 to 31 December 2013. Data from all the patients were retrospectively collected int a database. A small PAA was defined as a popliteal artery with a diameter ≤ 2 cm. Two groups were formeded: 31 PAA ≤ 2 cm (group 1) and 126 PAA > 2 cm (group 2). RESULTS: In group 1, 67.7% PAAs were symptomatic and 58.7% in group 2. In group 1 acute limb ischaemia was observed in 32.3%, claudication in 9.7%, ischaemic rest pain in 19.4%, and tissue loss in 6.5%. There was rest pain in 5.6% and tissue loss in 0.8% of group 2: P=.026. Aneurysm thrombosis was present as a primary complication, in 58.1% of group 1, and in 33.3% of group 2, with aneurysm rotura in 0% of group 1 and in 6.3% of group 2; P=.040. CONCLUSION: A small PAA is not as benign as it might seem, since it may thrombose and can result in limb ischaemia and limb loss. As the objective of popliteal artery aneurysm repair is to prevent thromboembolism, a surgical approach must be considered in small PAAs before complications appear

Clinical and financial implications of disease-related malnutrition in a department of Internal Medicine: prospective cohort study. / Repercusiones clínicas y económicas de la desnutrición relacionada con la enfermedad en un servicio de Medicina Interna: estudio de cohortes prospectivas.

BACKGROUND: Disease-related malnutrition is a challenge for Spanish hospitals. Our objective was to assess the feasibility and importance of establishing a nutritional screening strategy in our community. PATIENTS AND METHODS: A prospective cohort study was conducted in a department of internal medicine for 3 months. The nutritional screening was conducted at admission and was repeated weekly using the Malnutrition Universal Screening Tool. We analysed the clinical data, mean stay and expenses. RESULTS: The study included 330 patients (53.9% men), with a mean age of 77.8 years. The mean stay was 7 days, and the Charlson comorbidity index was 5.4. At admission, the Malnutrition Universal Screening Tool detected 26.9% of patients with a risk of malnutrition. Eighteen percent of the patients with a good nutritional state developed malnutrition during the hospitalisation. The patients with initially severe malnutrition had a longer mean stay. The patients whose nutritional state worsened during the hospitalisation had a significantly longer stay (2.5 days) compared with those whose state did not worsen. These cases of malnutrition caused a cost overrun of €767 per hospitalisation (35% greater), which entailed a malnutrition-related excess expenditure of €646,419.93 annually in the studied department. The appropriate coding resulted in an increase in mean weight from 2.11 to 2.81, which represented €82,568.52 and has not been previously quantified. CONCLUSION: The high prevalence and clinical and financial implications of Disease-related malnutrition in patients hospitalised in internal medicine warrants establishing protocols for its early detection and treatment.

Osteoporosis Management in a Real Clinical Setting: Heterogeneity in Intervention Approach and Discrepancy in Treatment Rates when Compared with the NOGG and NOF Guidelines.

Objective: The National Osteoporosis Guideline Group (NOGG) proposes intervention thresholds that vary by age. Instead, the National Osteoporosis Foundation (NOF) proposes a fixed threshold for decision. The aim of the present study was to compare the actual therapeutic decisions taken in a routine clinical practice setting with those recommended by the NOF and NOGG guidelines. Material and methods: A cross-sectional study was conducted in individuals referred to a densitometric unit who were not receiving antiresorptive therapy. The absolute risk of major and hip fracture was calculated using the British formula provided by the FRAX® tool. NOGG and NOF guidelines' therapeutic intervention thresholds were used. Agreement was calculated using Cohen's kappa. Results: A total of 640 individuals were included, of which 95% were women, with a median age of 59.4 (IQR=14) years. 31.7% of subjects who were analyzed received treatment for osteoporosis. The type of treatment that was mainly prescribed (71.9%) consisted of bisphosphonates. When applying the NOGG criteria, treatment was recommended in 22.7% of cases; this percentage increased to 42.2% with the NOF guidelines. According to both guidelines, 20.4% of patients would not have received treatment. The concordance, expressed as the kappa index, was low; 0.25 (CI 95% 0.17-0.34) and 0.49 (CI 95% 0.42-0.55), with the NOGG and NOF, respectively. Conclusions: Important heterogeneity exists in the treatment of osteoporosis in real practice. The choice of guideline has a major impact on the proportion and selection of individuals recommended for treatment and, subsequently, on treatment-related expenditures.

Aneurismas poplíteos rotos: revisión a 28 años / Popliteal aneurysm rupture: A 28-year review

INTRODUCCIÓN: La rotura de un aneurisma poplíteo (AP) es una complicación insólita, que ocurre tan solo en un 0-7% en las series publicadas. OBJETIVOS: Describiremos los casos acontecidos durante 28 años en nuestro servicio: características clínicas, resultados y peculiaridades de una entidad tan infrecuente en nuestra práctica clínica habitual. MATERIAL Y MÉTODOS: Entre agosto de1986 y enero de 2014, se intervinieron 157 AP en 132 pacientes, de los cuales 8 (5,1%) se presentaron clínicamente con rotura aneurismática: 6 varones y 2 mujeres. Edad media: 80,6 ± 6,2 años. ANTECEDENTES: tabaco: 4, HTA: 8, EPOC: 4, dislipidemia: 2, cardiopatía: 2; DM: 1; isquemia cerebrovascular: 1. Aneurismas en otras localizaciones: bilateralidad: 5; aortoilíaco: 1. El 100% fueron sintomáticos con hematoma y edema de extremidad; isquemia aguda asociada: 2 casos; isquemia crónica asociada: 2. Método diagnóstico: eco: 6; eco + arteriografia: 3; TAC: 1. Tamaño > 3 cm, con trombo mural: 100%. Forma: fusiforme: 2; sacular: 6. Todos fueron cirugía urgente por abordaje medial. Técnica quirúrgica: ligadura sin revascularización: 2; ligadura + bypass PTFE: 2; ligadura + bypass de vena safena interna: 2; resección + PTFE: 2. RESULTADOS: Permeabilidad: 100%. Complicaciones postoperatorias: un seroma, un absceso. Tasa de amputación: 0%. Fallecimiento precoz: 0%. Alta: 6 casos asintomáticos; 2 con claudicación intermitente por arteriopatía distal previa. CONCLUSIÓN: La rotura de un AP sucede generalmente en varones añosos. Constituye una urgencia quirúrgica en la que es crucial un diagnóstico precoz y diferencial, ante la presencia de edema o hematoma con masa pulsátil en hueco poplíteo. La cirugía abierta sigue siendo el tratamiento de elección, reservándose la terapia endovascular para casos seleccionados

INTRODUCTION: Rupture of popliteal aneurysms (PA) is exceptional, only occurs in 0-7% in published series, and with few cases described in the literature. OBJECTIVES: A review of the cases recorded in a hospital unit over a 28-year period is presented, including their clinical features, the results, and other peculiarities obtained in such an uncommon occurrence in our daily clinical practice. MATERIAL AND METHODS: Between 1986 and 2014, there were 157 cases of AP involving 132 patients, of which 8 (5.1%), 6 males and 2 females, clinically presented with an aneurysm rupture. The mean age was 80.6 ± 6.2 years. Personal history: Tobacco: 4 patients, AHT: 8, COPD: 4, dyslipidemia: 2, heart: 2, DM: 1, cerebrovascular ischemia: 1. Aneurysms in other locations: bilateral: 5, and aorto-iliac: 1. All symptomatic hematoma and/or limb edema, acute ischemia associated: 2 cases, chronic ischemia associated: 2 cases. The diagnostic method used was ECO: 6, ECO + arteriography: 3, and CT: 1. Size > 3 cm with mural thrombus in 100% of cases. Form: fusiform: 2, saccular: 6. All emergency surgery for medial approach. Surgical technique: ligation without revascularization: 2 + ligation PTFE bypass: 2 + ligation bypass saphenous vein: 2; resection + PTFE: 2. RESULTS: Permeability: 100%. Postoperative complications: one seroma, one abscess. There was a 0% amputation rate. Early death 0%. There were 6 highly asymptomatic cases, and 2 with intermittent claudication due to previous distal artery disease. CONCLUSION: Rupture of an AP is an unusual event that usually occurs in very old males, and with large aneurysms. Saccular types seem to be associated with an increased in the risk of rupture. It is a surgical emergency, and although hemorrhagic shock is exceptional, early and differential diagnosis versus other pathologies is crucial when there is the presence of edema and/or hematoma in the limb with pulsatile mass in the popliteal fossa

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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Cirugía aórtica por laparoscopia: resultados a largo plazo / Laparoscopic aortic surgery: Long-term results

OBJETIVOS: Describimos los resultados a largo plazo de nuestra experiencia en cirugía aórtica por laparoscopia, total y asistida, en las lesiones arteriosclerosas oclusivas y en un aneurisma del sector aortoilíaco. MATERIAL Y MÉTODOS: Estudio prospectivo donde se analiza a los pacientes intervenidos de bypass del sector aortoiliacofemoral, desde noviembre de 2001 hasta octubre de 2003 y desde mayo de 2006 hasta septiembre de 2008, 7 y 14 pacientes respectivamente (21 en total), por lesiones de tipo D del Transatlantic Inter-Society Consensus (TASC) II y estadios II, III y IV de Fontaine y un aneurisma de aorta abdominal (AAA); 11 casos totalmente laparoscópicos y 10 asistidos. En la primera fase seguimos abordaje retroperitoneal y en la segunda,transperitoneal. RESULTADOS: Se estudió a un total de 21 pacientes, 20 hombres y una mujer, con una media de edad de 60 años (rango 41-76). Media de tiempo operatorio: 390 min (rango entre 220 y 570 min). Media de pinzamiento aórtico: 110 min. Mortalidad 0%. Complicaciones mayores postoperatorias: un infarto de miocardio (IAM) perioperatorio, una perforación duodenal, una hemorragia de sutura aórtica, una trombectomía de rama a las 12 h. Complicaciones en el seguimiento: una infección de prótesis, resuelta por ligadura aórtica y by-pass axilo-bifemoral. Reintervenciones: una trombosis de injerto por plicatura a los 5 meses y 2 trombectomías de rama y profundoplastia a los 7 meses, y 10 años respectivamente, un recambio de by-pass bifurcado a los 2 años, todos los pacientes seguían fumando. Hubo 5 fallecimientos a los 4, 5, 6, 7 y 10 años, solo uno relacionado con su enfermedad. En 2013 estaban vivos 16 pacientes, con permeabilidad del 100%. CONCLUSIONES: La dificultad de esta cirugía y la curva de aprendizaje propician mayores complicaciones en el postoperatorio inmediato; los resultados de permeabilidad asistida a largo plazo se equiparan a los excelentes resultados de la abierta

OBJECTIVES: To present the long-term results using total and assisted laparoscopic aortic surgery in arteriosclerotic occlusive lesions and an aneurysm in the aortic-iliac region. Material and methodmethods: A prospective study was conducted by analysing the data of 7 and 14 patients (a total of 21) operated on using aortoiliofemoral bypass from November 2001 to October 2003, and from May 2006 to September 2008, respectively. The lesions consisted of Transatlantic Inter-Society Consensus (TASC) II Type D lesions, and Fontaine stage II, III, and IV lesions, and one abdominal aortic (AAA) lesion, with 11 cases totally laparoscopic and 10 assisted. In the first period, a retroperitoneal approach was used, and in the second, transperitoneal. RESULTS: Of the 21 patients with a mean age of 60 years (range 41-76), 20 were males and one was female. The mean operating time was 390 min (range 222 to 570 min). The mean time using an aortic clamp was 110 min. There was no perioperative mortality, and the major complications were: one perioperative acute myocardial infarction (AMI), one duodenal perforation, one aortic stitch haemorrhage, and branch thrombectomy at 12 hours. The complications at follow-up included: one prosthesis infection (resolved by aortic ligature and axillo-bifemoral bypass. Further surgery was performed on one graft thrombosis due to plication at 5 months, 2 branch thrombectomies and a profundoplasty at 7 months and 10 years, respectively, and one bifurcated bypass replacement at 2 years, with all of them continuing to smoke. There were 5 deaths at 4, 5, 6, 7, and 10 years, with only one associated with its disease. In 2013, 16 patients are alive, with 100% patency. CONCLUSIONS: The difficulty of this surgery and the learning curve, can lead to major complications in the immediate post-operative period. The assisted patency results in the long-term are similar to the excellent results of open surgery

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

Modelos animales para el aprendizaje de la cirugía endovascular / Animal models for endovascular surgery training

La evolución y transformación de la especialidad de Angiología y Cirugía Vascular en los últimos 20 años hacia modos mínimamente invasivos, materializados en la cirugía endovascular, ha constituido un punto de inflexión en el aprendizaje de las técnicas y procedimientos quirúrgicos vasculares. El uso de modelos animales para la adquisición de las habilidades y destreza quirúrgica necesarias para la realización de cirugía endovascular representa la culminación en el aprendizaje de la misma como paso previo necesario y exigible para su ejecución en el humano. En este artículo se describe el contenido y evolución de los cursos de cirugía endovascular en modelos animales, como reflejo de la evolución de la especialidad a lo largo de los últimos 15 años

The evolution and transformation of the Angiology and Vascular Surgery specialty in the last 20 years to minimally invasive methods, materialised in endovascular surgery, has been a turning point in the training in vascular surgery techniques and procedures. The use of animal models to acquire the skills and dexterity needed to perform endovascular surgery is the highpoint in the learning of this technique as a necessary and mandatory prior step to practicing it on humans. The contents and progress of the endovascular surgery courses on animal models are presented in this article, as a reflection of the progress of this speciality over the last 15 years

Inflammatory status is different in relationship to insulin resistance in severely obese people and changes after bariatric surgery or diet-induced weight loss.

AIM: To assess if insulin resistance is related to a different inflammatory status (especially lymphocyte subpopulations) in severely obese people and to evaluate changes after weight loss either following a very-low calorie diet (VLCD) or bariatric surgery. RESEARCH METHODS & PROCEDURES: Severely obese patients were consecutively recruited in our Obesity Unit. Blood lymphocyte subpopulations and inflammatory parameters were measured baseline, after a VLCD during 6 weeks and one year after biliopancreatic diversion. Insulin resistance was evaluated by Homeostasis Model Assessment (HOMA) index. RESULTS: After excluding diabetic patients, 58 patients were studied. HOMA index classified 63.8% of them as insulin resistant (IR). Serum baseline levels of inflammatory cytokines were not significantly different between IR and insulinsensitive (IS) patients but, regarding lymphocyte subpopulations, Natural Killer (NK) cells were higher in IR patients [(305.0 (136.7) vs. 235.0 (80.7) cells/µL, p=0.047]. NK cells showed a significant positive correlation with HOMA index (r=0.484, p=0.000) and with the carbohydrate content of the diet (r=0.420, p=0.001). After VLCD, NK cells significantly decreased, but only in IR patients and in those losing more than 10% of their initial weight. After biliopancreatic diversion, total and CD8 T Lymphocytes, B lymphocytes and NK cells also decreased but only in IR individuals. CONCLUSION: NK cells are significantly increased in IR severely obese people in respect to IS, suggesting a slightly different immune status in these patients with a probable dietary relationship. Weight loss could reverse this increase either after VLCD or after bariatric surgery.

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