Enfermedad quística adventicial de la arteria poplítea, una causa rara de claudicación intermitente / Popliteal artery cystic adventitial disease, a rare cause of intermittent claudication

Introducción: la enfermedad quística adventicial es una patología inusual que afecta predominantemente la arteria poplítea. No hay un consenso respecto al diagnóstico y al tratamiento. Caso clínico: mujer de 67 años que presentó claudicación intermitente en el sóleo gemelar derecho con progresión a dolor de reposo, manteniendo pulsos distales. En la ecografía Doppler se observó un quiste adventicial en la arteria poplítea que ocasionaba una estenosis crítica, confirmada mediante angio TC. Se realizó adventicectomía con preservación de la pared arterial. La sintomatología cesó completamente, sin recidiva del quiste en el seguimiento. Discusión: la claudicación intermitente de inicio repentino con recuperación tardía en pacientes con riesgo ateroesclerótico bajo sugiere enfermedad quística adventicial. La ecografía Doppler es útil en el diagnóstico y en el seguimiento. El tratamiento quirúrgico puede eliminar la causa de la enfermedad y reducir la recidiva.(AU)

Hematoma intramural persistente secundario a la disección de la arteria carótida interna / Persistent intramural hematoma secondary to an internal carotid artery dissection

Introducción: la disección de la arteria carótida interna en pacientes con accidente cerebro vascular isquémico se diagnostica cada vez más. En adultos jóvenes representa un 20-25 %. Aún no se ha establecido un consenso respecto al diagnóstico y al tratamiento. Caso clínico: un hombre de 44 años presentó súbitamente cefalea junto a déficit motor y sensitivo en el miembro superior izquierdo después de realizar ejercicio físico. En la resonancia magnética se observó un infarto en el territorio de la arteria cerebral media derecha con transformación hemorrágica. En el angio TC de los troncos supraaórticos se observó un hematoma trombosado en la luz falsa de la disección de la carótida interna derecha. El paciente se recuperó espontáneamente. Al principio se mantuvo una actitud conservadora, pero al año de seguimiento hubo una progresión del hematoma que produjo una estenosis > 75 % de la arteria carótida interna derecha. Fue entonces cuando se optó por el implante de un stent no recubierto a este nivel. Discusión: el diagnóstico y el tratamiento temprano de la disección carotídea permiten evitar secuelas neurológicas incapacitantes. Para pacientes con disección carotídea se recomienda el seguimiento con ecografía Doppler semestral durante los primeros años.(AU)

Introduction: dissection of the internal carotid artery in patients who suff ered an ischemic stroke is increasingly being diagnosed. In young adults it represents 20-25 %. no consensus has been established regarding diagnosis and treatment. Case report: a 44-year-old man presented a sudden headache with motor and sensory defi cits in the left upper limb after doing physical exercise. on the MrI scan revealed an infarction in the right middle cerebral artery with a hemorrhagic transformation. CT angiography of the supra-aortic trunks showed a thrombosed hematoma in the false lumen of the right internal carotid dissection. The patient made a spontaneous recovery. at fi rst, we maintained a conservative attitude but after one year of monitoring, there was progression of the hematoma producing a steno- sis > 75 % of the right internal carotid artery. at this point it was decided to implant an uncovered stent at this level. Discussion: early diagnosis and treatment of carotid dissection makes possible preventing disabling neurological sequelae. In patients with carotid dissection it is recommended a biannual monitoring with a doppler ultrasound during the fi rst years.(AU)

Percutaneous Tibial Nerve Stimulation Therapy for Overactive Bladder Syndrome: Clinical Effectiveness, Urodynamic, and Durability Evaluation.

OBJECTIVE: To evaluate percutaneous tibial nerve stimulation (PTNS) effectiveness, durability, and impact on the pathophysiology of overactive bladder syndrome (OAB) in patients who have been previously treated with antimuscarinics without success. MATERIALS AND METHODS: A prospective study that included 200 women diagnosed with OAB between 2007 and 2015 at Virgen de la Victoria University Hospital (Málaga, Spain) was conducted. OAB patients were treated with PTNS therapy after antimuscarinic treatment failed. To evaluate OAB symptoms, clinical and urodynamic studies were performed before and after PTNS treatment. Treatment's success was defined as a reduction of clinical parameters by >50% and an improvement of at least 2 urodynamic parameters by >50%. The Kolmogorov-Smirnov test and Student's t test or Wilcoxon test were used based on the data. A linear correlation analysis and a multivariate linear regression analysis were performed to determine factors associated with the success of PTNS therapy. RESULTS: Of the patients, 94% experienced a positive response to PTNS considering clinical and urodynamic parameters. PTNS benefits were extended by 24 months. We identified daytime urinary frequency (r = -0.165; P = .024; 95% confidence interval, -0.248 to -0.018) and first sensation of bladder filling (r = 0.208; P = .030; 95% confidence interval, 0.001-0.028) as significant independent predictor factors for PTNS success. CONCLUSION: The current data confirmed a high effectiveness of PTNS improving OAB symptoms through 24 months. Furthermore, daytime urinary frequency and first sensation of bladder filling act as a significant independent predictor factors for PTNS success.

Guía de práctica clínica sobre terapia intravenosa con dispositivos no permanentes en adultos / Clinical practice guideline on intravenous therapy with temporary devices in adults

El objetivo principal de la guía es proporcionar a los profesionales sanitarios una herramienta que les permita tomar decisiones basadas en evidencia sobre aspectos de la atención al paciente adulto con indicación de terapia intravenosa con dispositivos no permanentes. Además, se señalan los objetivos secundarios siguientes: aumentar la calidad de las intervenciones, evitar complicaciones relacionadas con la terapia intravenosa y reducir la variabilidad existente entre los profesionales sanitarios.

The guideline includes recommendations for taking care of adult patients with intravenous therapy who are at primary care centres, hospitals and homes.

Targeted therapies in the treatment of germ cell tumors: the need for new approaches against "orphan" tumors.

Germ cell tumors (GCTs) are a heterogeneous group of tumors that are highly clinically relevant to oncologists. GCTs are generally highly sensitive to cisplatin-based chemotherapy and represent a model for curable neoplasms. Cisplatin-based combination therapy followed by surgical resection of the residual tumor is the cornerstone for GCTs treatment. Although the overall cure rate is high for patients with GCTs, patients with a poor prognosis according to International Consensus Criteria or with chemoresistant disease remain a major clinical challenge. Currently, between 15% and 20% of patients with metastatic disease still progress and will die as a consequence of the disease. Therefore, the discovery of new treatment strategies or new drugs based on translational oncology remains a priority for the treatment of patients with cisplatin-refractory disease and those with a poor prognosis. Clinical trials with new targeted therapies are ongoing for the treatment of GCTs. In this article, we review some of the new targeted biologic therapies that act on the most relevant oncogenesis pathways and are in clinical development for the treatment of GCTs.

Percutaneous tibial nerve stimulation in treatment of overactive bladder: when should retreatment be started?

OBJECTIVE: To study the response to posterior tibial nerve stimulation in patients with overactive bladder refractory to medical treatment. METHODS: A cohort of 53 patients were treated by posterior tibial nerve stimulation and followed up for a maximum of 24 months. All patients completed the International Consultation on Incontinence Modular Questionnaire-Short Form quality of life questionnaire and kept a urination diary to record the daytime urination frequency and night-time urination frequency. Urodynamic studies were also conducted. RESULTS: At 6 months of follow-up, a cure/improvement rate of 92.4% (49 of 53 cases) had been achieved. Ten patients were given additional treatment and were excluded from subsequent follow-up analysis. At 12 months of follow-up, a cure/improvement rate of 91.69% had been achieved (39 of 43). At 24 months of follow-up, of the 16 patients initially included during the first year, a cure/improvement rate of 62.5% had been achieved (10 of 16). The first sensation of bladder filling had increased by the end of treatment, with differences observed before and after posterior tibial nerve stimulation (P ≤ .001). The average post-treatment bladder capacity had increased by 72.7 mL compared with the initial value (P ≤ .001). At 24 months of follow-up, the group of 16 patients evaluated recorded a significant worsening of night-time urination frequency (P ≤ .05) and quality of life (P ≤ .01). CONCLUSION: Posterior tibial nerve stimulation is a good option for the treatment of overactive bladder. In our series, the optimal point to start retreatment would be at 24 months after therapy completion.