Impacto del control de la tensión arterial sobre la morbimortalidad en pacientes hipertensos mayores de 65 años en el ámbito comunitario / Impact of blood pressure control on morbidity and mortality in hypertensive patients aged 65 years and over in the community setting

Objetivo: evaluar el impacto del control de la tensión arterial (TA) sobre la morbimortalidad en > 65 años, sin patología cardiovascular previa, en el ámbito comunitario. Métodos: estudio de cohortes retrospectivas. Se incluyeron todos los pacientes (≥ 65 años) con diagnóstico de hipertensión arterial (HTA) (01/01/2007-31/12/2008), sin eventos cardiovasculares previos de los centros de salud de la Comunidad de Madrid, con al menos dos registros de TA el primer año de seguimiento (n = 17.150). Se evaluaron la aparición de eventos cardiovasculares (incluida mortalidad cardiovascular) y la mortalidad total, mediante regresión de Cox. Resultados: la mediana de seguimiento para mortalidad fue de 129,58 meses (rango intercuartil [RIC]: 120,41-136,94 meses). Se produjeron 8.641 eventos cardiovasculares y 4.073 muertes por cualquier causa. Ajustado por género, grado de hipertensión, tabaquismo, diabetes e hipercolesterolemia, el buen control (TA < 140/90 mmHg) no se asociaba con una disminución de eventos cardiovasculares, pero sí con una disminución de mortalidad del 14,41% (hazard ratio [HR] 0,8559; intervalo de confianza [IC] 95%: 0,7776-0,9421%) entre 75 y 84 años. Cuando se utilizan las cifras de 130/80 mmHg para definir el buen control, este se asociaba con un exceso de mortalidad del 43,58% (IC 95%: 19,60-72,36%) entre 65 y 74 años y del 61,22% (IC 95%: 22,99-111,35%) en sujetos de 85 y más años. Conclusión: el control de la TA en sujetos >65 años se asocia con una disminución ligera de la mortalidad entre 75 y 84 años. Cifras de control más estrictas se relacionan con mayor ocurrencia de evento cardiovascular y de mortalidad, especialmente en el grupo de mayor edad.(AU)

Objective: to assess the impact of blood pressure (BP) control on morbidity and mortality in over 65-year-olds, without previous cardiovascular pathology, in a community setting. Methods: retrospective cohort study. All patients (≥65 years) with a diagnosis of HT (01/01/2007-31/12/2008), without previous cardiovascular events (CVD), with at least two BP recordings in the first year of follow-up) from every health centres in the Community of Madrid were included (n = 17,150). The occurrence of CVD (including CV mortality) and total mortality were assessed using Cox regression. Results: the median follow-up for mortality was 129.58 months (IQR: 120.41-136.94 months). There were 8,641 CVDs and 4,073 deaths from any cause. Adjusted for gender, hypertension severity, smoking, diabetes, and hypercholesterolemia, good control (BP < 140/90 mmHg) was not associated with a decrease in CVD, but was associated with a 14.41% decrease in mortality (HR 0.8559, 95% CI: 0.7776- 0.9421) between 75 and 84 years. When threshold of 130/80 mmHg is used to define good control, this was associated with an excess mortality of 43.58% (95% CI 19.60-72.36%) between 65 and 74 years and 61.22% (95% CI 22.99-111.35%) in subjects aged 85 and over. Conclusion: BP control in people over 65 years of age is associated with a slight decrease in mortality between 75 and 84 years of age. Tighter control figures are associated with a higher incidence of CVD and mortality, especially in the older age group.(AU)

Anatomy variant symptomatic of the duplication of the common bile duct type IV.

INTRODUCTION: Duplicity of the common bile duct (BCBD) is an unusual congenital disorder. CASE REPORT: A 80-year-old woman with duplication of the common bile duct with retrograde endoscopic cholangiopancreatography (ERCP) who did not resolve the symptoms. DISCUSSION: Our case is a variant of type IV to the classification of DCBC. The MR cholangiography and presurgical ERCP allows assessment of the bile ducts, their caliber, and assessment of abnormalities. The treatment before DCBC will depend on the clinic and the type of opening of the CBCA. CONCLUSIONS: It is important to perform a pre-surgical study and during surgery with CIO.

INTRODUCCIÓN: La duplicidad del conducto biliar común (DCBC) es una alteración congénita insólita. CASO CLÍNICO: Mujer de 80 años con duplicación de la vía biliar común con colangiopancreatografía retrógrada endoscópica (CPRE) que no dilucida la clínica. DISCUSIÓN: Este caso es una variante del tipo IV de la clasificación de DCBC. La colangiorresonancia y la CPRE prequirúrgica permiten valorar las vías biliares, su calibre y las anormalidades. El tratamiento depende de la clínica y el tipo de apertura del conducto biliar común accesorio. CONCLUSIONES: Es importante realizar estudio prequirúrgico y durante la operación con colangiografía intraoperatoria.

Serum VEGF and VEGF-C values before surgery and after postoperative treatment in gastric cancer.

INTRODUCTION: Angiogenesis and lymphangiogenesis are essential processes for the formation of blood and lymphatic vessels that allow tumour growth and spread. The binding of VEGF and VEGF-C factors with their receptors (VEGFR2, VEGFR3) in endothelial cells triggers signals that regulate these processes. We compared preoperative serum VEGF and VEGF-C levels with samples obtained after completion of surgery and adjuvant treatment in patients with gastric cancer. In addition, we determined the prognostic value and relationship to survival of serum VEGF and VEGF-C levels. METHODS: We used a prospective cohort study of 59 gastric cancer patients who underwent surgery. Serum VEGF and VEGF-C were measured by enzyme-linked immunosorbent assay (ELISA) the day before surgery and 6 months later, after completion of adjuvant treatment. RESULTS: Serum VEGF values decreased after treatment in patients with resectable tumours (mean ± SD) (405.42 ± 298.38 vs. 306.38 ± 212.47 pg/ml; p < 0.01), poorly differentiated and undifferentiated tumours (G3, G4) (438 ± 339.71 vs. 322.47 ± 210.71 pg/ml; p = 0.01), locally advanced gastric tumours (T4 stage) (424.27 ± 323.08 vs. 333.62 ± 221.72 pg/ml; p = 0.03) and tumours with a greater number of involved regional lymph nodes (N3) (442.38 ± 311.52 vs. 337.4 ± 203.64 pg/ml; p = 0.04). Serum preoperative VEGF values over 761 pg/ml were associated with shorter patient survival. The mean overall survival time for patients with serum VEGF levels higher than 761 pg/ml was 7 ± 2.99 months (95 % CI 1.14-12.86) while for patients with serum VEGF levels of less than 761 pg/ml was 21.18 ± 2.88 (95 % CI 15.54-26.83) The mean disease-specific survival time for patients with serum VEGF levels higher than 761 pg/ml was 6.25 ± 2.53 months (95 % CI 1.29-11.21) while for patients with serum VEGF levels of less than 761 pg/ml was 27.57 ± 3.45 (95 % CI 20.80-34.35). Multivariate analysis identified preoperative serum VEGF levels as an independent prognostic factor (HR = 0.144; p = 0.03). CONCLUSIONS: Serum VEGF levels decreased after the completion of treatment in patients with resected tumours, suggesting VEGF tracking may be useful in monitoring progression. Preoperative measurement of serum VEGF may help us identify patients with a poor prognosis.