Fístula aorto-entérica secundaria a prótesis vascular como causa de hemorragia digestiva / Aortoenteric fistula due to a vascular prosthesis as the cause of gastrointestinal bleeding

La fístula aorto-entérica es una entidad muy infrecuente, pero dada la situación urgente y en algunas ocasiones vital que supone su diagnóstico, es importante recordar su existencia, sobre todo en aquellos pacientes que han sido sometidos a una cirugía vascular previa. Por tanto, la hemos de tener en cuenta a la hora de hacer un diagnóstico diferencial con otras causas de hemorragia digestiva. Presentamos el caso de un paciente que acude a urgencias por hematemesis y rectorragia, y analizamos su diagnóstico y tratamiento (AU)

Aortoenteric fistulas are very rare, but because of the urgent and sometimes life-threatening nature of this complication, its possibility should be taken into consideration, especially if patients have undergone vascular surgery. In such situations, aortoenteric fistula should be included in the differential diagnosis for gastrointestinal bleeding. We report the case of a man who came to the emergency department with hematemes is and rectal bleeding. Diagnosis and treatment are analyzed (AU)

[Intravenous thrombolytic treatment in acute ischemic stroke: initial results in the Complejo Hospitalario Universitario de Albacete]. / Administración de tratamiento trombolítico intravenosoen el ictus isquémico en fase aguda: resultados enel Complejo Hospitalario Universitario de Albacete.

AIM: To analyze the safety profile and clinical outcome of patients with acute cerebral ischemia who received open treatment with tissue plasminogen activator (rt-PA) in a hospital without previous experience. PATIENTS AND METHODS: This prospective and observational study were realized from January 2004 to January 2007. A total of 1,704 consecutive patients with ischemic stroke were attended. 72 of them (4.2%) were treated with rt-PA within 3 hours from the symptoms onset. We analyzed age, vascular risk factors, initial and 24 hours neurological state by the National Institute of Health Stroke Scale (NIHSS), incidence of intracerebral hemorrhage and mortality and independence at 90 days. Patients were treated by neurologist and stroke monitoring was performed in the emergency area. RESULTS: Baseline median NIHSS was 16. At 24 hours, 53% of patients had improved = or > 4 points in the NIHSS and 33% showed = or > 10 points improvement or total recovery. The median time from stroke onset to rt-PA treatment was 160 minutes. Symptomatic intracerebral hemorrhage occurred in two patients (2.7%). Overall mortality at 90 days was 9.7%, but was due to hemorrhagic brain complications only in one case. At three months, 51% of patients were independent according to the modified Rankin scale. CONCLUSIONS: Treatment of acute ischemic stroke within three hours with intravenous rt-PA is safe and is associated with favorable outcome when it is applied by neurologists following approved protocols even in hospitals without previous experience.

Administración de tratamiento trombolítico intravenoso en el ictus isquémico en fase aguda: resultados en el Complejo Hospitalario Universitario de Albacete / Intravenous thrombolytic treatment in acute ischemic stroke: inicial results in the Complejo Hospitalario Universitario de Albacete

Analizar los resultados obtenidos en administración de trombólisis intravenosa en el ictus isquémicoagudo en el Complejo Universitario Hospitalario de Albacete, un centro sin experiencia previa adquirida en ensayos clínicos en la administración de este tratamiento. Pacientes y métodos. Estudio observacional y prospectivo, realizado entre enero de2004 y enero de 2007. En este período se atendieron 1.704 ictus isquémicos, 343 de los cuales fueron remitidos como código ictus. Se trató a 72 pacientes (4,2%) con activador del plasminógeno tisular recombinante (rt-PA). Analizamos las variablesedad, factores de riesgo vascular, tiempos de latencia intra y extrahospitalaria, evolución clínica temprana, incidencia de hemorragias cerebrales, mortalidad y situación funcional tres meses después del ictus. Resultados. La edad media fue de 69 años, y la puntuación mediana de la escala de ictus del National Institute of Health (NIHSS) inicial, de 16 puntos. A las 24 horas del inicio, el 53% de los pacientes manifestó mejoría igual o superior a 4 puntos en la NIHSS. El 33% mejoró en 10 puntos o más o presentó una recuperación completa. El tiempo medio desde el inicio de los síntomas-administración rt-PA fue de 160 minutos. Dos casos (2,7%) presentaron hemorragia cerebral sintomática. A los tres meses, el 51% presentaba independencia para sus actividades (escala de Rankin modificada igual o inferior a 2) y la mortalidad era del 9,7%. Conclusiones. El establecimiento y aplicación estandarizada de protocolos extra e intrahospitalarios de atención urgente al ictus permite ofrecer tratamiento trombolítico intravenoso en el infarto cerebral de manera segura y eficaz desde el principio, aun en centros que, como éste, carecían de experiencia previa en este tipo de tratamiento

To analyze the safety profile and clinical outcome of patients with acute cerebral ischemia who received opentreatment with tissue plasminogen activator (rt-PA) in a hospital without previous experience. Patients and methods. This prospective and observational study were realized from January 2004 to January 2007. A total of 1,704 consecutive patients with ischemic stroke were attended. 72 of them (4.2%) were treated with rt-PA within 3 hours from the symptoms onset. Weanalyzed age, vascular risk factors, initial and 24 hours neurological state by the National Institute of Health Stroke Scale (NIHSS), incidence of intracerebral hemorrhage and mortality and independence at 90 days. Patients were treated by neurologist and stroke monitoring was performed in the emergency area. Results. Baseline median NIHSS was 16. At 24 hours,53% of patients had improved = or > 4 points in the NIHSS and 33% showed = or > 10 points improvement or total recovery. The median time from stroke onset to rt-PA treatment was 160 minutes. Symptomatic intracerebral hemorrhage occurred in two patients (2.7%). Overall mortality at 90 days was 9.7%, but was due to hemorrhagic brain complications only in one case. Atthree months, 51% of patients were independent according to the modified Rankin scale. Conclusions. Treatment of acute ischemic stroke within three hours with intravenous rt-PA is safe and is associated with favorable outcome when it is applied byneurologists following approved protocols even in hospitals without previous experience

[Pilot study of the evaluation of the nutritional status in a population sample in a health area]. / Estudio piloto de valoración del estado nutricional en una muestra de población de una zona de salud.

We report the evaluation of a pilot study for the nutritional state carried out at a Health Center in Murcia, using a qualitative foodstuff questionnaire related to the previous 24 hours and the evaluation of anthropometric and analytical data. The evaluated individuals were randomly selected between the persons who had previously consulted. The survey was carried out by an interviewer. An outstanding result was that 90% of the surveyed individuals had ingested, at least one foodstuff from each group. The fat compartment was measured through the tricipital and subscapular fold and Quetelet index, and the protein compartment was measured through the muscular area of the arm. As reference values, the NHANES (USA) and the Alastrue Vidal (Spain) tables were used. It was found that the tricipital fold of the investigated population was underrated in the american tables (p less than 0.01).