Dysautonomia and small fiber neuropathy in post-COVID condition and Chronic Fatigue Syndrome.

BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and post-COVID condition can present similarities such as fatigue, brain fog, autonomic and neuropathic symptoms. METHODS: The study included 87 patients with post-COVID condition, 50 patients with ME/CFS, and 50 healthy controls (HC). The hemodynamic autonomic function was evaluated using the deep breathing technique, Valsalva maneuver, and Tilt test. The presence of autonomic and sensory small fiber neuropathy (SFN) was assessed with the Sudoscan and with heat and cold evoked potentials, respectively. Finally, a complete neuropsychological evaluation was performed. The objective of this study was to analyze and compare the autonomic and neuropathic symptoms in post-COVID condition with ME/CFS, and HC, as well as, analyze the relationship of these symptoms with cognition and fatigue. RESULTS: Statistically significant differences were found between groups in heart rate using the Kruskal-Wallis test (H), with ME/CFS group presenting the highest (H = 18.3; p ≤ .001). The Postural Orthostatic Tachycardia Syndrome (POTS), and pathological values in palms on the Sudoscan were found in 31% and 34% of ME/CFS, and 13.8% and 19.5% of post-COVID patients, respectively. Concerning evoked potentials, statistically significant differences were found in response latency to heat stimuli between groups (H = 23.6; p ≤ .01). Latency was highest in ME/CFS, and lowest in HC. Regarding cognition, lower parasympathetic activation was associated with worse cognitive performance. CONCLUSIONS: Both syndromes were characterized by inappropriate tachycardia at rest, with a high percentage of patients with POTS. The prolonged latencies for heat stimuli suggested damage to unmyelinated fibers. The higher proportion of patients with pathological results for upper extremities on the Sudoscan suggested a non-length-dependent SFN.

Saturated and unsaturated fat diets impair hippocampal glutamatergic transmission in adolescent mice.

Consumption of high-fat diets (HFD) has been associated with neuronal plasticity deficits and cognitive disorders linked to the alteration of glutamatergic disorders in the hippocampus. As young individuals are especially vulnerable to the effects of nutrients and xenobiotics on cognition, we studied the effect of chronic consumption of saturated (SOLF) and unsaturated oil-enriched foods (UOLF) on: i) spatial memory; ii) hippocampal synaptic transmission and plasticity; and iii) gene expression of glutamatergic receptors and hormone receptors in the hippocampus of adolescent and adult mice. Our results show that both SOLF and UOLF impair spatial short-term memory. Accordingly, hippocampal synaptic plasticity mechanisms underlying memory, and gene expression of NMDA receptor subunits are modulated by both diets. On the other hand, PPARγ gene expression is specifically down-regulated in adolescent SOLF individuals and up-regulated in adult UOLF mice.

Paraganglionas del cuerpo carotídeo. Nuestra experiencia / Carotid body paraganglioma. Our experience

El paraganglioma carotídeo, es un tumor considerado benigno que se origina a partir de las células del corpúsculo carotideo. Suubicación es a nivel del cuello en la bifurcación carotídea entre las arterias carótida interna y externa. Se realiza en el trabajo, unanálisis descriptivo, retrospectivo de estos tumores tratados en un periodo de 40 años. Se analizan datos demográficos con respectoal sexo y edad de presentación y otros morfológicos de tamaño y extensión, adscribiéndoles en los diferentes tipos de acuerdo a laclasificación de Shamblin. Se valora el tipo de tratamiento quirúrgico practicado y los resultados obtenidos. (AU)

Paraganglioma is a benign tumor that originates from the cells of the carotid corpuscle. Its location is at the level of the neck at thecarotid bifurcation between the internal and external carotid arteries. A retrospective analysis of these tumors treated over a periodof 40 years is carried out at work. Demographic data with respect to sex and age of presentation and other morphological data ofsize and extension are analyzed, assigning them to the different types according to the Shamblin classification. The type of surgicaltreatment performed and the results obtained are assessed. (AU)

Searching for bodies: ERP evidence for independent somatosensory processing during visual search for body-related information.

Attention allows us to select relevant information by modulating neural activity within sensory brain areas processing that information. Previous research has shown that visual perception of body stimuli recruits visual cortices together with observer's body representation in somatosensory cortex, which is known for processing body-related information (e.g., haptics, kinematics). However, whether attentional selection of visual body stimuli involves just visual or additional somatosensory areas remains elusive. Here we elicited visual and somatosensory evoked activity during a visual search task, whereby participants searched for target hand images defined by either visual (colour) or bodily (posture) features. In line with previous studies, we found electrophysiological evidence for attentional selection over visual areas (i.e., N2pc) regardless of the feature type. Importantly, after dissociating somatosensory from visual evoked activity, we show that only attentional selection of hand posture - but not hand colour - elicits modulation of somatosensory evoked electrocortical activity over somatosensory cortex. This suggests that attention may not only modulate cortical activity associated with the input-sensory modality (in this case, visual), but, depending on the type of attended information, it may also modulate cortical activity associated with another task-relevant sensory modality (in this case, somatosensory). Overall, our results provide evidence for a flexible attention mechanism that operates according to specific behavioural goals and the information embedded in the percept.

Persistent recruitment of somatosensory cortex during active maintenance of hand images in working memory.

Working memory (WM) supports temporary maintenance of task-relevant information. This process is associated with persistent activity in the sensory cortex processing the information (e.g., visual stimuli activate visual cortex). However, we argue here that more multifaceted stimuli moderate this sensory-locked activity and recruit distinctive cortices. Specifically, perception of bodies recruits somatosensory cortex (SCx) beyond early visual areas (suggesting embodiment processes). Here we explore persistent activation in processing areas beyond the sensory cortex initially relevant to the modality of the stimuli. Using visual and somatosensory evoked-potentials in a visual WM task, we isolated different levels of visual and somatosensory involvement during encoding of body and non-body-related images. Persistent activity increased in SCx only when maintaining body images in WM, whereas visual/posterior regions' activity increased significantly when maintaining non-body images. Our results bridge WM and embodiment frameworks, supporting a dynamic WM process where the nature of the information summons specific processing resources.

Role of the clock gene Rev-erbα in metabolism and in the endocrine pancreas.

Several hormones are regulated by circadian rhythms to adjust the metabolism to the light/dark cycles and feeding/activity patterns throughout the day. Circadian rhythms are mainly governed by the central clock located in the suprachiasmatic nucleus but also by clocks present in peripheral organs, like the endocrine pancreas. Plasma glucose levels and the main pancreatic hormones insulin and glucagon also exhibit daily variations. Alterations in circadian rhythms are associated with metabolic disturbances and pathologies such as obesity and diabetes. The molecular components of central and peripheral clocks and their regulatory mechanisms are well established. Among the different clock genes, Rev-erbα is considered one of the key links between circadian rhythms and metabolism. Rev-erbα is a critical part of a negative feedback loop in the core circadian clock and modulates the clock oscillatory properties. In addition, Rev-erbα plays an important role in the regulation of lipid and glucose metabolism, thermogenesis, adipocyte and muscle differentiation as well as mitochondrial function. In the endocrine pancreas, Rev-erbα regulates insulin and glucagon secretion and pancreatic ß-cell proliferation. In the present review, we discuss all these subjects and, particularly, the role of the clock gene Rev-erbα in the endocrine pancreas.

Valor pronóstico de la anatomía EVAR en el tratamiento quirúrgico del aneurisma de aorta abdominal roto / Prognostic value of EVAR anatomy in the surgical treatment of a ruptured abdominal aortic aneurysm

INTRODUCCIÓN: Diversas series han indicado que el tratamiento endovascular (EVAR) del aneurisma de aorta roto (AAAr) podría disminuir la mortalidad respecto a la cirugía convencional abierta (OR). Sin embargo, un factor confusional en estos hallazgos puede ser la anatomía aortoilíaca del aneurisma. El EVAR solo es posible si los pacientes tienen una anatomía quirúrgica apropiada. OBJETIVO: El objetivo de este estudio ha sido analizar los resultados del tratamiento quirúrgico de los AAAr en presencia o no de una anatomía EVAR-favorable. MATERIAL Y MÉTODOS: Se diseñó un estudio retrospectivo de todos los AAAr atendidos en nuestro hospital entre junio de 2005 y junio de 2010. Los pacientes se agruparon de acuerdo con la idoneidad anatómica para EVAR basados en el análisis ciego de la angio-TAC preoperatoria. Se analizó la mortalidad perioperatoria y las complicaciones según la idoneidad anatómica de los pacientes intervenidos. RESULTADOS: De 71 pacientes atendidos, 50 disponían de angio-TAC. Solo se intervino a 41 (30-OR, 11-EVAR). De los 30-OR, 14 fueron EVAR-favorable y 16 no lo fueron. Ambos grupos fueron homogéneos con un Glasgow-aneurysm-score de 90 ± 13,8 y 92,1 ± 14,6, respectivamente. Se observó una reducción significativa en la mortalidad a 30 días en el grupo EVAR-favorable (21,4%) en comparación con el grupo EVAR-no favorable (56,3%) (p = 0,05), lo que se tradujo en una menor tasa de transfusiones, complicaciones sistémicas y estancia hospitalaria. CONCLUSIÓN: La idoneidad anatómica para EVAR mejora significativamente el pronóstico a corto plazo de los pacientes tratados de AAAr. Esto indica que la reducción de la mortalidad debida al EVAR probablemente esté sesgada por la selección de pacientes con mejor configuración anatómica

INTRODUCTION: Several comparative studies have suggested that endovascular treatment (EVAR) of ruptured abdominal aortic aneurysms (AAAr) could reduce mortality compared to conventional open repair (OR). A confounding factor in these findings could be the aorto-iliac anatomy. EVAR is suitable if patients have an appropriate surgical anatomy. OBJECTIVE: The purpose of this study was to analyze the results of surgical treatment of rAAA in the presence or not of an EVAR-friendly anatomy. MATERIAL AND METHODS: A retrospective study was designed and conducted on consecutive patients with rAAA treated in our hospital between June 2005 and June 2010. Patients were categorized according to the anatomical suitability for EVAR, based on a blinded analysis of preoperative CT-angiography. Perioperative mortality and complications were determined in each group. RESULTS: Of the 71 patients studied, 50 underwent preoperative CT. Of these, only 41 patients were operated on (30-OR, 11 EVAR). In the 30 patients who underwent OR, 14 were suitable for EVAR, and 16 showed a hostile anatomy. Both groups were homogeneous with a Glasgow-aneurysm-score of 90 ± 13.8 and 92.1 ± 14.6, respectively. A significant reduction in mortality at 30 days in the EVAR suitable group (21.4%) was observed in comparison to the EVAR unsuitable group (56.3%) (P=.05). A lower transfusion requirement, length of stay, and in hospital morbidity was shown in patients with a friendly anatomy. CONCLUSION: Anatomical suitability for EVAR significantly improves short-term prognosis of patients treated with rAAA. This suggests that the reduction in mortality from EVAR is probably biased by the selection of patients with a better anatomical configuration

Manejo endovascular de la disecciones Tipo A / Endovascular management of type a dissections

La Diseccion tipo A, es una patología con altísima morbi-mortalidad, sobre todo con puerta de entrada en aorta ascendente. El tratamiento convencional mediante parada cardiaca y by pass cardio-pulmonar presenta elevado riesgo quirúrgico, por lo que el tratamiento endovascular cada vez más proximal en aorta torácica, trata de brindar una solución menos invasiva para un grupo seleccionado de pacientes. El desarrollo de nuevos dispositivos mejor adaptados para aorta proximal, podrán brindar soluciones cada vez más satisfactorias, para éste tipo de patología aórtica compleja en un futuro (AU)

Type A aortic dissection is a disease with a high morbidity and mortality, especially in dissections with entrance in the ascending aorta. Conventional treatment with cardiac arrest and cardiopulmonary bypass has a high surgical risk. Endovascular treatment in the proximal thoracic aorta seeks to provide a less invasive solution for a selected group of patients. The development of new and better suited devices for the proximal aorta may provide satisfactory solutions for this type of complex aortic disease in the future (AU)

Procedimientos endovasculares infrapoplíteos: indicaciones clínicas y tipo de lesiones / Infrapopliteal endovascular procedures clinical indications and type of lessions

La ATP de las arterias infrapoplíteos es una técnica segura, con una morbimortalidad perioperatoria baja. La ATP puede ser considerada la terapia inicial para los pacientes con isquemia crítica de extremidades inferiores. En este sector, la clasificación ASC es útil como herramienta pronostica pero ha resultado inútil para decidir si el tratamiento más adecuado es endovascular o quirúrgico abierto. De tal forma, se ha llegado a recomendar que la indicación de cirugía abierta no se base en criterios angiográficos si no en criterios clínicos del paciente, reservándola para pacientes con bajo riesgo quirúrgico, un buen flujo de salida a nivel del pie y una adecuada vena safena interna. Las estrategias basadas en la arteria relacionada con la herida o la úlcera (angiosomas), se incrementan las posibilidades de cura de las lesiones isquémicas en tobillo y pie (AU)

PTA of infrapopliteal arteries is a safe technique, with low periprocedural morbimortality. PTA is the initial therapy in patients with critical ischemia of the limbs. In the infrapopliteal area, the TASC classification is an useful prognostic tool, but it results useless to decide between endovascular techniques or open surgical repair. The guidelines for revascularization should be based on clinical criteria, not on angiographic findings. Surgery could be indicated in patients with low surgical risk, good run-off in the foot, and good saphenous vein. The strategies based on wound or ulcer related artery (angiosomes) increase the health possibilities of the ischemic lesions in ankle and foot (AU)

Vertebro-Basilar occlusive disease

Vertebro-basilar occlusive disease is a condition that can cause symptomatology related to encephalic posterior circulation ischemia. Vertebro-basilar (VB) ischemia represents a 25% of all TIA’s and Strokes in North America (1). In a patient with a VB-TIA, if vertebro-basilar (VB) pathology is demonstrated, he or she will have a 30-35% risk of having a VB circulation stroke in the next 5 years (2); demonstrating that vertebro-basilar occlusive disease is a relevant condition regarding mortality, morbidity and health-related costs. Since Crawford and colleagues described the trans-subclavian vertebral artery endarterectomy by the end of the 50’s, vertebro- basilar occlusive disease has been studied rather little. We pretend to do a revision of this disease, and to discuss briefly the most up-to-date therapies described in current literature for this condition (AU)

No disponible

Neuroarquitectura de la emoción musical / Neuroarchitecture of musical emotions

La respuesta emocional ante la música, o emoción musical, es una respuesta universal que depende de diferentes procesos psicológicos y recluta una extensa red de estructuras neuronales. Mediante el empleo de técnicas como la electroencefalografía, la resonancia magnética funcional y los estudios con población clínica e individuos con formación musical previa, se ha empezado a dilucidar estos mecanismos cerebrales. El objetivo de este artículo es hacer una revisión de los trabajos más relevantes en los que se identifican los correlatos neuronales de la emoción musical, desde los procesos más automáticos hasta los más complejos, y comprender cómo interaccionan en el cerebro. En concreto, se describe cómo la presentación de música emocional está asociada a una respuesta rápida en estructuras talámicas y subtalámicas, acompañada por cambios electrodérmicos y endocrinos. También se explica que el procesamiento de la emoción musical implica la activación de la corteza auditiva y estructuras límbicas y paralímbicas, como la amígdala, la corteza cinguladaanterior o el hipocampo, lo que demuestra la contribución del sistema límbico a la emoción musical. Asimismo, se detalla cómo la emoción musical depende de los significados semántico y sintáctico de la música, procesados en áreas temporales y parietofrontales, respectivamente. Además, se mencionan trabajos recientes que han demostrado cómo los mecanismos de simulación emocional también contribuyen a la emoción musical. Por último, se hace un resumen de estos trabajos, comentando sus limitaciones y ofreciendo alternativas para seguir avanzando en el estudio de la neuroarquitectura de la emoción musical (AU)

The emotional response to music, or musical emotion, is a universal response that draws on diverse psychological processes implemented in a large array of neural structures and mechanisms. Studies using electroencephalography, functional magnetic resonance, lesions and individuals with extent musical training have begun to elucidate some of these mechanisms. The objective of this article is reviewing the most relevant studies that have tried to identify the neural correlates of musical emotion from the more automatic to the more complex processes, and to understand how these correlates interact in the brain. The article describes how the presentation of music perceived as emotional is associated with a rapid autonomic response in thalamic and subthalamic structures, accompanied by changes in the electrodermal and endocrine responses. It also explains how musical emotion processing activates auditory cortex, as well as a series of limbic and paralimbic structures, such as the amygdala, the anterior cingulate cortex or the hippocampus, demonstrating the relevant contribution of the limbic system to musical emotion. Further, it is detailed how musical emotion depends to a great extent on semantic and syntactic process carried out in temporal and parietofrontal areas, respectively. Some of the recent works demonstrating that musical emotion highly relies on emotional simulation are also mentioned. Finally, a summary of these studies, their limitations, and suggestions for further research on the neuroarchitecture of musical emotion are given (AU)

Manejo de arteria hipogástrica en el tratamiento endovascular de aneurismas aorto-ilíacos / Iliac artery management in endovascular treatment of aorto-iliac aneurysms

La patología aneurismática en arteria ilíaca representa un gran desafío para los tratamientos endovasculares, dado que dificulta el anclaje distal del dispositivo, comprometiendo el éxito técnico. El tratamiento clásico inicial ha sido la exclusión de la arteria hipogástrica mediante el avance del dispositivo hacia ilíaca externa, junto a la embolización de la misma con coils; aunque en los últimos años, numerosos artículos han descrito complicaciones por isquemia pélvica no despreciables. Las técnicas de preservación de flujo, han demostrado disminuir la tasa de dichas complicaciones. La técnica de bell bottom, que conserva la hipogástrica, es una opción terapéutica, aunque no está exenta de endofugas distales debido al crecimiento del saco. Las técnicas de revascularización mediante dispositivos con ramas y la técnica de sandwich, surgen como alternativa segura y efectiva, aunque harían falta mas tiempo de seguimiento y estudios multicéntricos, para definir mejor los requisitos anatómicos necesarios y de ésta forma mejorar la selección de pacientes (AU)

Iliac artery aneurysmal disease is a major challenge for endovascular treatments, as difficult distal device anchor compromises technical success. The initial standard treatment has been the exclusion of the hypogastric artery by advancing the device to the external iliac artery, with coils embolization of the artery; although in recent years, numerous articles have described that pelvic ischemic complications are not insignificant. Flow preservation techniques have been shown to decrease the rate of such complications. The bell bottom technique, which preserves the hypogastric artery, is a therapeutic option, although not without distal endoleak possibility due to the growth of the sac. Revascularization techniques using devices with branches and the sandwich technique emerge as safe and effective, though it would take longer follow-up and multicenter studies to better define the anatomical requirements necessary and thus improve patient selection (AU)

Nuevos avances en el tratamiento del pie diabético / Current progress on diabetic foot therapy

El cuidado minucioso del pie diabético es vital para prevenir infecciones y complicaciones como amputaciones y sepsis. Su manejo debe consistir en un abordaje multidisciplinar en el que el eje central sea la prevención así como la valoración y el tratamiento integral individualizado del paciente. En los últimos años, se ha evidenciado que terapias aplicadas hasta entonces a otros campos, podrían ser empleadas en el pie diabético, constituyendo un aumento del arsenal terapéutico que debe tener como finalidad combatir la infección y preservar la extremidad del paciente. Analizamos la eficacia, resultados clínicos y los costes de estas nuevas terapias, especialmente la terapia con presión negativa (TPN), la oxigenoterapia hiperbárica, el tratamiento con factores de crecimiento-terapia celular, apósito modulador de proteasas, la terapia eléctrica y los suplementos dietéticos (AU)

The meticulous care of the diabetic foot is vital to prevent infection and complications such as amputations and sepsis. Its management should be a multidisciplinary approach in which the central axis is the prevention and the assessment and individualized comprehensive treatment of the patient. In recent years, has shown that therapies applied previously to other fields, could be used in the diabetic foot, constituting an increase in the therapeutic arsenal should be designed to fight infection and preserve the patient's limb. We analyze the effectiveness, clinical outcomes and costs of these new therapies, especially negative pressure therapy (NPT), hyperbaric oxygen therapy, treatment with growth factors, cell therapy, protease modulating dressings, electrical therapy and the nutritional supplements (AU)

Aneurismas inflamatorios de la aorta abdominal / Inflammatory abdominal aortic aneurysms

Los aneurismas inflamatorios de la aorta abdominal constituyen una entidad diferenciada de etiología desconocida que se caracteriza por una gruesa pared, superficie nacarada y la presencia de tejido fibrótico perianeurismático que atrapa las estructuras vecinas, especialmente los uréteres. Característicamente, aparecen en varones, muy fumadores y con edad media de 65 años y son mucho más sintomáticos que los aneurismas no inflamatorios, siendo lo más frecuente la aparición de dolorabdominal, pérdida de peso y elevación de la VSG. La prueba de referencia para su diagnóstico es el TAC, con una imagen típica en cuatro capas (luz aórtica, trombo mural, pared engrosada y masa periaórtica retroperiteneal). Su tratamiento se basa en tres pilares: exclusión del aneurisma (cirugía abierta o endovascular), actuación frente la fibrosis (corticoides einmunosupresores) y manejo de las complicaciones por afectación de órganos adyacentes. La cirugía abierta presenta grandesdificultades técnicas con una alta morbimortalidad, en cambio, el tratamiento endovascular constituye una opción no sólo posible, sino efectiva y segura, con unos resultados similares al tratamiento de los aneurismas no inflamatorios. El pronóstico de estos pacientes depende de la evolución de la fibrosis retroperitoneal, la cual es muy variable tanto en la cirugíaabierta como endovascular. Las series de que disponemos son aún pequeñas y de cortos períodos de seguimiento, por lo que es necesario hacer un seguimiento a largo plazo de la evolución de la fibrosis post EVAR para llegar a conclusiones más definitivas (AU)

Inflammatory abdominal aortic aneurysms constitute a distinct entity of unknown etiology characterized by a thick wall, awhite glistening surface and the presence of inflammatory retroperitoneal scar tissue that traps neighbour structures, especially the ureters. Tipically appear in males and heavy smokers with a mean age of 65 years. They are much more symptomaticthan non-inflammatory aneurysms, especially with the presence of abdominal pain, weigth loss and elevated ESR. The gold standard for diagnosis is TAC, with a typical image in four layers (aortic lumen, intraluminal thrombus, calcified andthickened wall and periaortic retroperitoneal mass). Their treatment is based on three pillars: exclusion of the aneurysm (open surgery and EVAR), treatment of fibrosis (corticosteroids and immunosuppressors) and anagement of complicationsof the neighbour organs involvement. Open surgery presents major technical challenges with high morbidity and mortality.EVAR appears as an option not only feasible but safe and effective, with similar results to the treatment of non-inflammatory aneurysms with EVAR. The prognosis of these patients depends on the development of retroperitoneal fibrosis, which is highly variable in both open and endovascular surgery. The series we have are still small and short periods of follow up, so it is necessary to follow the long-term evolution of fibrosis post EVAR to reach more definitive conclusions (AU)

Comparative analysis of intraocular lens power calculation methods after excimer laser surgery.

Many methods have been used in an attempt to more accurate predict the intraocular lens (IOL) power in the eyes undergoing refractive surgery, but none has proved most accurate. The aim of this study was to evaluate the accuracy and predictability of different IOL power calculation methods in eyes after excimer laser surgery. The outcomes of phacoemulsification and IOL implantation in 18 eyes of 16 patients with prior excimer laser keratectomy were documented. The lowest error was achieved using history-derived method. The refractive results of IOL implantation using the same biometry data in eyes after excimer laser surgery can vary markedly. In the present study, the SRK-T formula resulted in highest accuracy.

Induction of thrombosis of the abdominal aneurysm sac through the application of radiofrequency. An experimental study.

UNLABELLED: This is an experimental study of endovascular aortic surgery for evaluation of the effect of thrombosis induced in the aneurysmal sac using a radiofrequency method. PURPOSE: To determine the efficacy of the induction of thrombosis of the abdominal aneurysm sac as a prevention of endoleaks after endovascular treatment. MATERIALS AND METHODS: Six dogs underwent radiofrequency blood clotting of the aneurysm sac and where afterwards treated with stent-grafting. A comparison with a historical group of 4 dogs with an abdominal aneurysm treated with stent-grafting was used. Radiofrequency was applied to each sac for 1 minute at 127 mA ± 33 (mean ± SD) (tip temperature, 92°C ± 2). IVUS ultrasonography and histology studies were used for the evaluation of the method. RESULTS: The results show the efficacy of the radiofrequency method and its possible future inclusion as a standard clinical application. DISCUSSION AND CONCLUSIONS: Endovascular repair of abdominal aortic aneurysms is dependent on the complete exclusion of the aneurysm from the arterial circulation. Later growth of the aneurysm is originated from retrograde flow into the sac. This study demonstrates how the use of radiofrequency induced thrombosis in a canine model of aneurysm sac. Ultrasound IVUS enabled further control for assessment of blood coagulation after radiofrequency treatment. This approach may be considered a tool for future prevention of endoleaks, in clinical practice.

Manejo de infecciones de las endoprótesis aórticas / Managemente of infections aortic stent-graft

En el siguiente trabajo se discuten los aspectos mas importantes de las infecciones post-EVAR: frecuencia, factores predisponentes, presentación clínica; Así también la conducta terapéutica planteada hasta el momento (AU)

In this paper we discuss the most important aspects of post-EVAR infections: frequency, predisposing factors, clinical presentation, so also the therapeutic raised so far (AU)

Angioplastia con balones liberadores de fármacos en arteias distales de extremidades inferiores. Revisión y puesta al día / No disponible

Los autores realizan una revisión sobre la acción de las drogas liberadas por balón sobre las oclusiones arteriales de los miembros inferiores. Se analiza la acción de los diferentes fármacos en especial el paclitaxel, aspectos técnicos del procedimiento utilizado en la aplicación de la droga en la pared de la arteria y los resultados, tanto preclínicos como clínicos obtenidos en laos diferentes estudios y registros realizados (AU)

The authors have a review of the action of drugs on the ball released by arterial occlusions of the lower limbs. We analyze the action of different drugs in particular paclitaxel, technical aspects of the procedure used in the application of the drug into the artery wall and results from both preclinical and clinical studies obtained in different studies and registries made (AU)

Actualización en el manejo terapéutico del fenómeno de Raynaud / Update on the therapeutic management of raynaud´s Phenomenon

El fenómeno de Raynaud es un proceso vasoespástico que afecta típicamente a las partes acras de las extremidades en respuesta al frío o a estímulos mecánicos o emocionales. Este fenómeno se clasifica como primario cuando no se evidencia una causa subyacente, y secundario cuando existe una entidad patológica asociada. Esta distinción es importante pues condiciona el pronóstico, la gravedad y el tratamiento. Fisiológicamente, el equilibrio vasomotor se mantiene por complejas interacciones entre el endotelio, músculo liso y el sistema nervio autónomo que inerva los vasos. En esta revisión se analizan los mecanismos implicados en su desregulación, así como las diversas aproximaciones terapéuticas de acuerdo con la evidencia médica más reciente (AU)

Raynaud´s phenomenon is a vasospactic process that typically affects the acral parts of the limbs in response to cold or emotional or mechanical stimuli. This phenomenon is classified as primary when no evidence of an underlying cause, and secondary when there is an associated pathological entity. This distinction is important because it determines the prognosis, severity and treatment. Physiologically, the vasomotor balance is maintained by complex interactions between endothelium, smooth muscle and autonomic nervous system innervates the vessels. This review discusses the mechanisms involved in deregulation, and the various therapeutic approaches according the latest medical evidence (AU)

Tratamiento endovascular de la isquemia mesentérica. Revisión y puesta al día / Endovascular treatment of the mesenteric ischemia

La isquemia mesentérica continúa representando una enfermedad con elevada morbimortalidad a pesar de los recientes avances que han mejorado los resultados de la mayoría de las patologías quirúrgicas en las últimas décadas. La cirugía abierta ha sido considerada el tratamiento de elección durante las últimas décadas, pero el intenso desarrollo del tratamiento endovascular durante los últimos años ha facilitado su instauración en gran parte de los centros hospitalarios. Revisamos las generalidades, indicaciones y resultados de los procedimientos endovasculares en el tratamiento de la isquemia mesentérica aguda y crónica (AU)

Mesenteric ischemia continues to be a disease with high mortality despite recent advances that have improved the results of most surgical pathologies in recent decades. Open surgery has been considered the treatment of choice during the last decades, but the intense development of endovascular treatment in recent years has facilitated its establishment in most of the hospitals. We review the general indications and results of endovascular procedures in the treatment of acute and chronic mesenteric ischemia (AU)