Association between maltreatment and polydrug use among adolescents.

Different studies have related sexual and physical abuse during childhood and adolescence to the development of substance abuse disorders. Nevertheless, we are not aware of the role that other more common maltreatment types, such as neglect, will play among the most risky pattern of consumption: the polydrug use. A clinical sample of 655 adolescents, divided into two groups: polydrug users and non-polydrug users, were assessed on their pattern of drug consumption, history of childhood maltreatment, current psychopathology and their family history of alcoholism. Polydrug users had a greater prevalence of all types of maltreatment, although the most associated to this group were sexual abuse and emotional neglect. Other relevant variables to adolescent consumption were: the diagnosis of depressive disorder, the presence of anxiety traits and the family history of alcohol dependence. Polydrug users have higher risks of having had problems during infancy and adolescence, such as maltreatment and other psychopathological conditions, with the addition of family history of alcoholism. Accordingly, practitioners should take into account that those variables may influence polydrug abuse because it is the most risky pattern for subsequent dependence of substances, and they should always be considered during treatment.

Ansiedad en drogodependientes. Diferencias existentes en función del programa de tratamiento / Anxiety in drug dependents: existing differences depending on the treatment program

La relación entre ansiedad y consumo de sustancias ha sido analizada en diversos estudios, tanto con muestra clínica como con muestra de población general, reflejando la existencia de datos que apoyan la hipótesis de una influencia recíproca entre ambas. En este artículo se presenta un estudio empírico en el que se contrastan las afirmaciones realizadas por otros autores, quienes declaran que el rasgo de ansiedad, los tres sistemas de respuesta y las áreas situacionales (medidos a través del Inventario de Situaciones y Respuestas de Ansiedad ) de los politoxicómanos se mantienen elevadas aún cuando dejan de consumir. La muestra se compone de tres grupos de politoxicómanos – en tratamiento y/o abstinentes – y un cuarto grupo perteneciente a la población general. El primero se encuentra realizando un Programa Libre de Drogas; el segundo está recientemente desintoxicado y a la espera de entrar en el Programa Libre de Drogas; y el tercero está en un Programa de Mantenimiento con Metadona. Estos grupos se comparan entre sí y a su vez con un grupo de población normal. Los resultados obtenidos apoyan parcialmente los resultados de otros estudios en el sentido de que, en general, únicamente el grupo del Programa de Mantenimiento con Metadona presenta niveles de ansiedad más elevados que el grupo de población general o grupo control

The relationship between anxiety and drug use has been analyzed in different studies, ioncluding clinical and non-clinical smaples; existing data support the hipothesis of a reciprocal influence among both. The aim of this empirical study is to confirm the affirmations of several authors who declare that even after poly drugs addicts stop consuming, their anxiety levels – trait anxiety, triple response system and situational areas – remain high (as measured by the Inventory of Situations and Responses of Anxiety). The sample is made up of three groups of polydrugs addicts (under treatment and/or abstinent) and a fourth group recruited from the general population. The first one is participating in a Drug-Free Program; the second is recently abstinent, waiting to be included in the Drug-Free-Program with Methadone. These groups are compared among each other as well as with the fourth group. The results obtained partially support those of other studies. In general terms, only the Maintenance Program with Methadone group shows higher levels of anxiety than the general population group

Postoperative morbidity of closely staged bilateral carotid endarterectomies: an intersurgical interval of 4 days or less.

The purpose of this study was to determine if there is increased morbidity and mortality with bilateral carotid endarterectomies (CEAs) done with an intersurgical period of less than 4 days compared to historical groups of unilateral CEAs, or those with a greater intersurgical delay. From January 1991 to July 1998, 1390 carotid endarterectomies were performed, of which 154 (11.1%) were closely staged bilateral CEAs. Seventy-seven patients (51 male, 26 female; mean age 72.5 years) underwent bilateral CEAs within 4 days or less. Immediate and 30-day postoperative morbidity, including neurologic deficits, cranial nerve deficits, and mortality, were documented. Although controversial, there is no increased morbidity or mortality with bilateral CEAs done with an intersurgical delay of less than 4 days, when compared to the unilateral CEA historical groups.

Endovascular repair of AAA rupture 20 months after endoluminal stent-grafting.

PURPOSE: To demonstrate the feasibility of endovascular repair of a ruptured abdominal aortic aneurysm (AAA) previously treated with an endoluminal stent-graft. CASE REPORT: An 84-year-old man with a 9.5-cm AAA underwent endoluminal repair with an Endologix stent-graft, but a type I endoleak was detected postprocedurally. The patient was discharged and lost to follow-up. Twenty months later, he suffered an aneurysm rupture, which was repaired using endovascular techniques. Although he had a postoperative course complicated by aspiration pneumonia and renal failure, he recovered fully and was discharged from the hospital with no evidence of endoleak on the postprocedural imaging studies. CONCLUSIONS: Late ruptures after endoluminal AAA stent-grafting can be successfully treated with endovascular techniques.

Xantoma plano difuso asociado a gammapatía monoclonal, crioglobulinemia e hipocomplementemia / Diffuse plane xanthoma associated with monoclonal gammapathy, cryoglobulinemia and hypocomplementemia

El xantoma plano difuso es una forma de presentación poco frecuente de xantomatosis en general normolipémica. Frecuentemente se ha visto su asociación con trastornos hematológicos. Describimos el caso de un varón de 62 años que presentaba lesiones cutáneas de xantoma plano difuso asociado a gammapatía monoclonal de significado incierto que había sido diagnosticado años antes. Posteriormente se detecta una crioglobulinemia tipo 1, hipocomplementaria y hepatopatía no obstructiva con anticuerpos anti-LKM positivos. Destacamos la necesidad del seguimiento estrecho de estos pacientes, ya que otros procesos se pueden ir sumando a la patología inicial a lo largo del tiempo (AU)

Long-term follow-up of endoluminal grafting for aneurysmal and occlusive disease in the superficial femoral artery.

PURPOSE: To examine the long-term outcome of patients treated with endoluminal grafts (ELGs) for aneurysmal and occlusive disease in the femoropopliteal (FP) segment. METHODS: ELGs of radially expandable polytetrafluoroethylene with terminal Palmaz stents were used to form intimal conduits to revascularize lengthy occlusive disease and exclude aneurysms in the FP segment. Patient records were reviewed retrospectively for outcome. RESULTS: Fifty-five (98%) of 56 ELGs were placed successfully in 51 patients treated from August 1993 to February 1996. Over a mean 36-month follow-up, 28 (50%) ELGs occluded. Half of these failures reflected early technical difficulties. There were 11 (20%) stent stenoses, 6 in the proximal stent and 5 in the distal device. The majority of the graft failures were treated with endovascular techniques; however, FP bypass was required in 7 (25%) patients, while 2 (7%) were not treated. Life-table analysis demonstrated 46% primary and 68% secondary patency rates at 24 months. Among demographic and procedural variables, only previous dilation or stent procedures in the target artery was associated with failure (p < 0.0001). CONCLUSIONS: The prototype ELG used in this series demonstrated durability similar to conventional surgical therapy utilizing synthetic material. Endoluminal grafting of FP lesions may be a more durable alternative to classical bypass once devices and techniques are refined.

Stenting for atherosclerotic occlusive disease of the subclavian artery.

The purpose of this study was to evaluate the results of stenting subclavian artery pathologic lesions. Between July 1991 and December 1995, 69 patients (36 males: mean age 67 years, range 34-87 years) underwent intraluminal balloon dilatations followed by stent implantations in 70 subclavian arteries to treat primary atherosclerotic stenoses > 70%. Twenty-three patients (34%) were treated for vertebrobasilar insufficiency (VBI), 25 patients (36%) were treated for upper limb ischemia (ULI), and 10 patients (15%) were treated for both VBI and ULI. Other indications included symptomatic subclavian steal phenomenon (SSS), protection of dialysis arteriovenous fistula, coronary steal syndrome, protection of axilloaxillary bypass, distal embolization, and protection of left internal mammary artery (LIMA)-coronary bypass. Fifty-three cases (78%) were treated for stenosis and 17 cases (22%) for total occlusion of the origin of the subclavian artery. The results of this series indicate that stenting of subclavian artery stenosis appears safe and feasible with good short and mid-term patency, improving at those intervals the initial disappointing reports of balloon angioplasty alone. However, its long-term durability is at present unknown.

Renal artery stenosis treated with stent deployment: indications, technique, and outcome for 108 patients.

From January 1993 to May 1996, 108 patients (64 men, 44 women; mean age, 72 years; age range, 37 to 87 years) underwent 125 percutaneous transluminal angioplasties and stent implantations primarily for atherosclerotic lesions of the renal artery. Sixty-four patients underwent treatment for renovascular hypertension (two antihypertensive medications or more), 32 patients underwent treatment for a combination of hypertension and renal failure (serum creatinine level >/=1.6 mg/dL), and a small group of six patients (5%) without hypertension or diminished renal function underwent treatment to prevent the progression to renal artery occlusion and kidney loss. Thirty-three patients (31%) had renovascular hypertension that was classified as severe on three or more medications, 31 patients (29%) had renovascular hypertension that was classified as moderate on two medications, and 38 patients (35%) had renovascular hypertension that was classified in the mild group on a single antihypertensive agent. Stenotic lesions were located at the ostium of the renal artery in 82 cases (65%) and were ostial-adjacent (<5 mm from renal ostium) in the other 43 cases (34%). A total of 125 stents were deployed in 125 arteries (procedural success 97.6%). Renovascular hypertension either was cured or was improved in 73 patients (68%), with 14 patients (13%) considered cured (normotensive on no medications). The conditions of 29 patients (27%) were unchanged, and 6 patients (5%) had worsening hypertension after surgery. We were unable to demonstrate a statistically significant improvement in serum creatinine levels after renal artery balloon angioplasty/stenting. Complications occurred in a total of nine cases (7.2%), six of which were related to technical problems. One patient had worsening renal insufficiency caused by contrast agent, and another patient had a perinephric hematoma develop that necessitated evacuation. There were four postoperative deaths (30-day mortality). Two of these deaths were caused by postoperative myocardial infarction. The other two patients had progressive renal failure develop that necessitated dialysis. These patients later died of the disease process despite supportive care. Follow-up renal artery duplex scan studies and angiograms were available on 96 patients (76%). The mean peak systolic renal/aortic ratio on duplex scanning was 2.2. Life-table analysis yielded a 74% primary patency rate and an 85% secondary patency rate at 36 months. This retrospective analysis showed the effectiveness of combining percutaneous transluminal angioplasty with stent deployment for significant renal artery stenosis to treat renovascular hypertension.

Intraluminal Palmaz stent implantation for treatment of recurrent carotid artery occlusive disease: a plan for the future.

While carotid endarterectomy (CEA) has been used commonly and with great effectiveness for de novo carotid occlusive lesions, its success in cases of recurrent disease has been attenuated by a higher incidence of complications and lower durability. Although interventional techniques have been introduced cautiously into the cerebrovascular system, balloon dilation for both primary and recurrent carotid atherosclerotic disease has been successful in establishing an adequate lumen without an increase in embolic complications over surgery. Because the likelihood exists that postdilation restenosis may be as common in the carotid arteries as it is in other vascular segments, the use of intraluminal stenting may mitigate this long-term complication, a benefit that has been demonstrated in other high flow vessels such as the aorta and iliac arteries. To begin an investigation of this hypothesis, we treated a 69-year-old symptomatic man who required a third intervention for recurrent carotid disease. A > 90% stenosis of the distal third of his right common carotid artery was successfully dilated, and a Palmaz stent was deployed without incident. The patient experienced no complications to the percutaneous procedure, and at 15 months posttreatment, he is well and asymptomatic. Although greater clinical experience must be accumulated with this new approach, intraluminal stenting following balloon dilation for recurrent carotid disease may surpass redo CEA in long-term patency and may entail fewer procedural complications.

[Congenital mesoblastic nephroma in an adult: immunohistochemical study]. / Nefroma mesoblástico congénito en el adulto: estudio inmunohistoquímico.

A case of congenital mesoblastic nephroma in a 60-year-old female patient is described. The clinical onset was gross hematuria of 48 hours evolution and pain in the right renal fossa which irradiated to the iliac fossa of the same side. A routine pathological analysis was carried out on the surgical specimen including an extensive immunohistochemical analysis which was highly positive for keratin in the epithelial lining of the tubular and cystic structures and for desmine and vimentin in the fusocellular stroma of the tumor. The different histogenetic hypotheses are discussed. The importance of a precise anatomopathological diagnosis in order to institute adequate treatment is underscored.

[Epidermoid carcinoma of the urinary tract. Immunohistochemical study]. / Carcinoma epidermoide de vías urinarias. Estudio inmunohistoquímico.

Six patients diagnosed as having urothelial carcinoma with varying degrees of squamous features are described. Four had pure squamous carcinoma. Two had transitional cell carcinoma (1 with squamous areas and the other had carcinoma in situ). The histological analyses of specimens were performed using immunohistochemical techniques to detect epithelial markers with low molecular weight monoclonal antibodies to cytokeratin. The tests were positive for pure squamous carcinoma and transitional cell carcinoma with squamous areas, and were negative for all areas of transitional cell carcinoma. We underscore the importance of the squamous component in the prognosis of urothelial carcinomas as well as the usefulness of this type of markers, particularly low molecular weight antibodies to cytokeratin, in differentiating squamous areas.