Las trombosis venosas profundas distales de los miembros inferiores: un problema controvertido / Distal deep vein thrombosis of the lower limbs: A controversial problem

La frecuencia de la trombosis venosa profunda distal oscila entre un 20 y un 50% de todas las trombosis profundas de los miembros inferiores y presenta los mismos factores de riesgo que las proximales y que el embolismo pulmonar, con un 50% menos de riesgo de recurrencia. Su historia natural, deficientemente conocida, explica el debate sobre su importancia. La complicación más frecuente es el síndrome postrombótico. El ecodoppler es el método diagnóstico más empleado. El dímero D solo no excluye la trombosis, no es útil como factor pronóstico de recurrencia ni se asocia con el síndrome postrombótico. La selectina P soluble combinada con el índice de Wells es una prueba diagnóstica excelente. La anticoagulación varía entre 3 meses e indefinidamente según la trombosis sea provocada o idiopática. En caso de cáncer se recomienda continuar el tratamiento hasta pasados 6 meses después de su curación o de su remisión completa

The frequency of the distal deep vein thrombosis is between 20 and 50% of all deep lower limb thrombosis, and has the same risk factors as proximal and pulmonary embolism, and with 50% lower risk of recurrence. Its natural history is not well-known, and may explain the debate about its importance. The most common complication is post-thrombotic syndrome. The echo-Doppler is the most used diagnostic method. D-dimer alone does not exclude thrombosis, is not useful predictors of recurrence, and is associated with post-thrombotic syndrome. Soluble P-selectin, combined with the Wells index is an excellent diagnostic test. Anticoagulation varies between 3 months and indefinitely depending on whether the thrombosis is provoked or idiopathic. If cancer, it is recommended to continue treatment until 6 months after cure or complete remission

La selectina P soluble, nuevo biomarcador para el diagnóstico de la enfermedad tromboembólica venosa / Soluble P-selectin: A new biomarker for the diagnosis of venous thromboembolic disease

No disponible

Tratamiento de la trombosis venosa profunda iliofemoral y del síndrome postrombótico / Treatment of iliofemoral deep vein thrombosis and post-thrombotic syndrome

Los pacientes con trombosis venosas profundas iliofemorales tienen mayor riesgo de sufrir un tromboembolismo venoso recurrente y un síndrome postrombótico que los que padecen trombosis venosas proximales menos extensas. Aunque las heparinas y el fondaparinux son utilizados como terapia inicial, es muy probable que los nuevos anticoagulantes orales los sustituyan en un futuro próximo. La trombólisis sistémica y la dirigida por catéter están siendo reemplazadas por la percutánea mecánica y farmacomecánica debido a sus menores tasas de hemorragias, de tiempo de perfusión y de consumo de recursos hospitalarios. La trombectomía quirúrgica venosa se reserva para pacientes con contraindicaciones o fracaso de estas últimas. Aunque el tratamiento quirúrgico está indicado en casos severos de síndrome postrombótico, carecemos de estudios metodológicamente consistentes sobre su efectividad y seguridad (AU)

Patients with iliofemoral deep vein thrombosis are at increased risk of recurrent venous thromboembolism and post-thrombotic syndrome than those with less extensive proximal venous thrombosis. Although heparins and fondaparinux are used as initial therapy, it is likely that new oral anticoagulants, mostly those replaced in the near future. Systemic thrombolysis and catheter-directed is being replaced by mechanical and pharmacomechanical percutaneous due to their lower rates of bleeding, infusion time and consumption of hospital resources. The venous thrombectomy should be reserved for patients with contraindications or failure of the latter. Although surgical treatment is this one indicated in severe cases of post-thrombotic syndrome, lack of methodologically robust studies on its effectiveness and safety (AU)

Medullary thyroid carcinoma and duodenal calcitonin-secreting neuroendocrine tumour: more than coincidence?

UNLABELLED: Neuroendocrine tumours (NETs) are a heterogeneous group of neoplasms whose management can be problematic. In many cases, multiple tumours may occur in the same patient or his or her family, and some of these have now been defined genetically, although in other cases the underlying gene or genes involved remain unclear. We describe a patient, a 63-year-old female, who was diagnosed with a medullary thyroid carcinoma (MTC), which was confirmed pathologically after thyroidectomy, but whose circulating calcitonin levels remained elevated after thyroidectomy with no evidence of metastatic disease. Subsequently, an entirely separate and discrete duodenal NET was identified; this was 2.8 cm in diameter and was removed at partial duodenectomy. The tumour stained immunohistochemically for calcitonin, and its removal led to persistent normalisation of the circulating calcitonin levels. There was no germline mutation of the RET oncogene. This is the first identification of a duodenal NET secreting calcitonin and also the first demonstration of a second tumour secreting calcitonin in a patient with MTC. We suggest that where calcitonin levels remain high after removal of a MTC a search for other NETs should be conducted. LEARNING POINTS: NETs are a complex and heterogeneous group of related neoplasms, and multiple tumours may occur in the same patient.Calcitonin can be produced ectopically by several tumours outside the thyroid.Persistently elevated calcitonin levels after removal of a MTC may not necessarily indicate persisting or metastatic disease from the tumour.The real prevalence of calcitonin-producing NETs may be underestimated, as serum determination is only recommended in the diagnosis of pancreatic NETs.

[Education on nutrition: from the university to specialized care]. / Formación en Nutrición: de la universidad a la especialidad.

The 7th Abbott-SENPE Forum is structured facing the new regulations of the European Space of High Education regarding the studies on Nutrition in the different degrees (Medicine, Pharmacology, Nutrition, Nursing) and post-doctoral education. A multi-professional and multidisciplinary discussion on the current situation of university education on nutrition, and its capabilities and limitations, is carried out. The value of the role of continuous medical education, the inhouse training programme, masters, and of scientific societies is also assessed. It is concluded that there is a need to urge academic authorities, the National Commission of Medical Specialties, the persons in charge of continuous medical education, and scientific societies of the importance of the studies relating to nutrition, feeding, and dietetics at both pre-graduate and post-graduate educational levels, and to implement and develop these studies in their areas of influence.

Formación en Nutrición: de la universidad a la especialidad / Education on Nutrition: Drom the university to specialized care

De cara a las nuevas normas del Espacio Europeo de Educación Superior en su relación con los estudios de nutrición tanto en los diferentes grados (medicina, farmacia, nutrición, enfermería) como en el postgrado, se estructura el VIIo FORO Abbott-SENPE. Se efectúa una reflexión multiprofesional y multidisciplinar sobre la actual situación de la formación universitaria en nutrición, sus posibilidades y límites. También se valora el papel de la formación continuada, del sistema de residencia, de los másteres y de las sociedades científicas. Se concluye en instar a las autoridades académicas, a la Comisión Nacional de Especialidades, a los responsables de formación continuada y a las sociedades científicas a reflexionar sobre la importancia de los estudios relacionados con la nutrición, alimentación y dietética tanto en el pregrado como en el postgrado y a implementarlos y desarrollarlos en sus áreas de influencia (AU)

The 7th Abbott-SENPE Forum is structured facing the new regulations of the European Space of High Education regarding the studies on Nutrition in the different degrees (Medicine, Pharmacology, Nutrition, Nursing) and post-doctoral education. A multi-professional and multidisciplinary discussion on the current situation of university education on nutrition, and its capabilities and limitations, is carried out. The value of the role of continuous medical education, the inhouse training programme, masters, and of scientific societies is also assessed. It is concluded that there is a need to urge academic authorities, the National Commission of Medical Specialties, the persons in charge of continuous medical education, and scientific societies of the importance of the studies relating to nutrition, feeding, and dietetics at both pre-graduate and post-graduate educational levels, and to implement and develop these studies in their areas of influence (AU)

Citometría de flujo de plaquetas en la diabetes mellitus y otras patologías metabólico-vasculares / Platelet flow cytometry in diabetes mellitus and in other metabolic-vascular pathologies

En los últimos años, la citometría de fl ujo ha experimentado un gran desarrolloque la confi rma como una importante herramienta de trabajocon gran potencial clínico y analítico. Sus principales ventajas derivan delhecho de utilizar directamente sangre entera –sin el riesgo de activaciónartefactual que frecuentemente se produce por la manipulación de lamuestra cuando se trabaja con plaquetas lavadas– y de poder detectarsimultáneamente diversos antígenos en distintas subpoblaciones celularesbien identifi cadas. Esta metodología permite estudiar plaquetas circulantesactivadas espontáneamente y valorar el efecto in vitro y ex vivode diversos fármacos sobre la función plaquetaria en numerosas patologías.A pesar de sus ventajas, actualmente la aplicación de la citometríade flujo en el estudio de la diabetes y otras patologías metabólicovascularesestá lejos de ser un hecho habitual(AU)

In recent years flow cytometry has experienced a great development,which confirms it as an important tool to work with a greatclinical and analytical potential. Its major advantages derive from thefact that we work directly with whole blood, without the risk of artefactualactivation that often occurs by the manipulation of the samplewhen working with washed platelets. In addition, flow cytometry isable to detect simultaneously different antigens on well-defined cellsubpopulations. This methodology permit the study of circulatingspontaneously activated platelets and evaluate the effect of severaldrugs, in vitro and ex vivo, on platelet function in numerous pathologies.Despite its advantages, flow cytometry is currently not usedusually in the study of diabetes and other metabolic-vascular pathologies(AU)

Myelolipomatous adrenal masses causing Cushing's syndrome.

Adrenal myelolipomas are uncommon benign tumors, composed of mature adipose tissue and haematopoietic elements in varying proportions. They are usually asymptomatic, non-functioning adrenal incidentalomas, but there have been a few reports of myelolipomatous masses associated with adrenocortical hypersecretion. We report two cases of large mixed adrenal tumors, with heterogeneous appearance and areas of fat density in imaging techniques, and with autonomous cortisol production leading to Cushing's syndrome. Both underwent adrenalectomy and the histological study showed an adrenocortical adenoma with widespread myelolipomatous metaplasia. Hypercortisolism resolved in the one patient that could be evaluated after surgery. We review all the previous reported cases of hypercortisolism associated with adrenal myelolipomas. We also discuss the recommended diagnostic approach and therapeutic management of adrenal masses of lipomatous appearance.

Utilidad de la citometría de flujo para valorar el efecto de la atorvastatina sobre la función plaquetaria y la movilización del Ca2+ en pacientes hiperlipémicos / Usefulness of flow cytometry in assessing the effect of atorvastatin on platelet function and Ca2+ in hyperlipemic patients

Introducción. En pacientes hiperlipémicos resultan frecuentes los procesos trombóticos, en los que las plaquetas desempeñan un papel decisivo. La presencia de plaquetas activadas circulantes, descrito en un trabajo anterior, constituye un importante factor de riesgo trombótico, por lo que resulta de gran interés disponer de un fármaco hipolipemiante que, además de normalizar los lípidos plasmáticos, también disminuya la activación de las plaquetas circulantes.Los principales objetivos del presente estudio son valorar si la mayor activación plaquetaria de los pacientes hipercolesterolémicos se acompaña de cambios en la movilización del calcio libre citoplasmático plaquetario y si dichas alteraciones se normalizan mediante la medicación con atorvastatina. Material y métodos. Para alcanzar éstos objetivos se estudian 30 pacientes hipercolesterolémicos y 40 controles normolipémicos. En sangre anticoagulada con citrato, se determina el porcentaje plaquetas CD62+, el número de microagregados plaquetarios formados espontáneamente (MAP/5.000 plaquetas) y la movilización del calcio libre citoplasmático. Para ello, se utiliza un citómetro EPICS-XL, y los anticuerpos y fluorocromos CD61.PE, CD62.FITC y FURA3-AM. Los pacientes se estudian antes y después de 2 meses de tratamiento con atorvastatina (20mg/día). Resultados. Los resultados obtenidos indican que el tratamiento con atorvastatina disminuye significativamente la concentración de colesterol total, colesterol unido a lipoproteínas de baja densidad (cLDL) y triglicéridos. En paralelo se observa una disminución del % plaquetas circulantes CD62+ (2,41±1,55% a 1,45±1,06%; p<0,05) y del número de MAP (390±43 a 322±48; p<0,05). Estos cambios se acompañan de la normalización de la movilización del Ca2+ libre citoplasmático plaquetario. Conclusiones. Como conclusión, se observa que la citometría de flujo de sangre entera constituye una técnica útil para abordar temas tales como los planteados en el presente trabajo. Los pacientes hipercolesterolémicos presentan mayor activación plaquetaria, que se acompaña de la formación de microagregados plaquetarios y de cambios en la movilización del Ca2+, que se normalizan mediante el tratamiento con atorvastatina, hecho que no se ha comunicado previamente en la bibliografía revisada (AU)

Introduction. Thrombotic events are common in hyperlipemic patients in which platelet activation play a decisive role. The presence of activated platelets, as described in a previous paper, is a major risk factor for thrombosis in patients with a high plasma cholesterol and it is therefore of great interest to have a lipid lowering drug that, in addition to normalising plasma lipids, also decreases this activation of circulating platelets. The main aims of this study are to assess whether the increased platelet activation in hypercholesterolemic patients is accompanied by changes in cytoplasmic free calcium mobilisation in platelets and the formation of platelet microaggregates, and whether these changes are normalised by treatment with atorvastatin. Material and methods. To achieve these aims 30 hypercholesterolemia patients and 40 normolipemic controls were recruited. The percentage of CD62 positive platelets, the number of spontaneously formed platelet microaggregates (MAP/5000 platelets) and the free calcium mobilization in platelets were evaluated in citrated blood . An EPICS-XL flow cytometer and the antibodies and fluorochromes CD61.PE, CD62.FITC and FLUO3-AM were used for this study. The patients were evaluated before and after two months of atorvastatin (20mg/day) treatment. Results. The results show that atorvastatin treatment significantly decreases the plasma concentration of total and LDL-Cholesterol and triglycerides. In parallel a decrease was noted in the percentage of activated circulating CD62 positive platelets (2.41±1.55% to 1.45±1.06%, P<0.05) and also in the number of spontaneously formed MAP (390±43 to 322±48, P<0.05). These changes were accompanied by the normalization in the free calcium mobilization in platelets. Conclusions. As a conclusion it is noted that the flow cytometry of whole blood is a useful technique for evaluating aspects such as those raised in this study. Hypercholesterolemia patients showed more spontaneous platelet activation, which was accompanied by the formation of platelet microaggregates and changes in the cytoplasmic free calcium mobilization, which were normalised by treatment with atorvastatin, which has not been previously reported in the literature (AU)

[Idiopathic pulmonary artery aneurysm: report of a case and review of the literature]. / Aneurisma idiopático de la arteria pulmonar. Presentación de un caso y revisión de la literatura.

Woman of 63 years old with essential arterial hypertensión, essential trembling and chronic venous insufficiency of inferior members; she came to the Internal Medicine outpatients department because of her chronic venous insufficiency, objectifying in the physical examination a systolic heart murmur II/VI in the left sternal border and many signs of chronic venous insufficiency in the inferior members. In the chest radiograph was found as an accidental finding, a properly delimited vascular image in the left upper mediastino, for this reason there were later realized diverse complementary examinations gradually more aggressive, that included a pulmonary angiography which revealed the presence of an aneurysmatic dilatation in the common and left pulmonary arteries. With these findings, the patient was undergoing a surgical operation, in which was realized a partial resection and folder to the common and left pulmonary arteries to reduce diameter to 2-3 centimetres, with a post-operative period without complications and staying without symptoms after the surgery.

Aneurisma idiopático de la arteria pulmonar. Presentación de un caso y revisión de la literatura / Idiopathic pulmonary artery aneurysm: report a case and review of the literature

Mujer de 63 años de edad con hipertensión arterial esencial, temblor esencial e insuficiencia venosa crónica en miembros inferiores; que acude a la Consulta Externa de Medicina Interna por su insuficiencia venosa crónica, objetivandose en la exploración física un soplo sistólico WVI en borde esternal izquierdo y signos de insuficiencia venosa crónica en miembros inferiores. En la radiografía de tórax se encontró como hallazgo casual, una imagen vascular bien delimitada a nivel del medias tino superior izquierdo, motivo por el que se realizaron posteriormente diversas exploraciones complementarias progresivamente más agresivas, que incluyeron una angiografía pulmonar, que reveló la presencia de una dilatación aneurismática de las arterias pulmonares común e izquierda. Con estos hallazgos, la paciente fue sometida a intervención quirúrgica, realizándose resección parcial y plicatura de las arterias pulmonares común e izquierda hasta reducir a un diámetro de 2-3 centímetros, con un postoperatorio sin complicaciones y permaneciendo asintomática tras la cirugía

Woman of 63 years old with essential arterial hypertensión, essential trembling and chronic venous insufficiency of inferior members; she carne to the Internal Medicine outpatients department because of her chronic venous insufficiency, objectifying in the physical examination a systolic heart murmur WVI in the left sternal border and many signs of chronic venous insufficiency in the inferior members. In the chest radiograph was found as an accidental finding, a properly delimited vascular image in the left upper mediastino, for this reason there were later realized diverse complementary examinations gradually more aggressive, that included a pulmonary angiography which revealed the presence of an aneurysmatic dilatation in the common and left pulmonary arteries. With these findings, the patient was undergoing a surgical operation, in which was realized a partial resection and folder to the common and left pulmonary arteries to reduce diameter to 2-3 centimetres, with a postoperative period without complications and staying without symptoms after the surgery

[New criteria for the diagnostic and treatment of the deep vein thrombosis of the lower limbs]. / Nuevos criterios para el diagnóstico y tratamiento de la trombosis venosa profunda de los miembros inferiores.

The diagnosis of the deep vein thrombosis (DVT) based exclusively on its symptomatology and on the examination clinic is of few usefulness due to its small sensibility and especificity. However, its adequate combination with the presence of risk factors for the thrombosis, and the existence or not of an alternative diagnosis, it can be employed it to classify to the patients according to the forecast model clinic of DVT of Wells in two categories: high or probability decrease of suffering it. Their utilization in urgencies together with the determination of the D dimer (DD) will indicate us the need or not of accomplishing an echo -- Doppler, currently the complementary election test. The phlebography is maintained as "the gold test", though is reservation for certain cases. Unless exceptions, the heparins of under molecular weight have displaced the heparins not fractioned in the treatment of the disease, due to the series of inconvenients that present: complications hemorrhagics, thrombocytopenia, need of hospitalization and of biological control. It is possible, that in a future most or less next new antithrombotics, as the fondaparinux or the ximelagatran change substantially the treatment of the DVT. The indication of the thrombolysis is little accepted, due to the fact that the relationship risk -- benefit is not satisfactory. Though they are not exempt of complications, exist clean-looking situations in those which is indicated the placement of a filter in the inferior vein cava. An exception, they would be the thrombosis massive veins with gangrene risk phlegmasia cerulea dolens, in patient with under risk hemorrhagic. Finally, in the cases that developed ischemia venous, that generally appear in the occlusions most proximals -- iliac and inferior vein cava --, an effective option to re-establish the venous permeability would be the thrombectomy venous.

Nuevos criterios para el diagnóstico y tratamiento de la trombosis venosa profunda de los miembros inferiores / New criteria for the diagnostic and treatment of the deep vein thrombosis of the lower limbs

El diagnóstico de la trombosis venosa profunda (TVP) basado exclusivamente en su sintomatología y en el examen clinico es de poca utilidad debido a su escasa sensibilidad y especificidad. Sin embargo, su adecuada combinación con la presencia de factores de riesgo, y la existencia o no de un diagnóstico alternativo, puede emplearse para clasificar a los pacientes según el modelo de predicción clínica de TVP de Wells en dos categorías: alta o baja probabilidad de padecerla. Su utilización en urgencias junto con la determinación del dímero-D (DD) nos indicará la necesidad o no de realizar un eco-Doppler, actualmente la prueba complementaria de elección. La flebografía se mantiene como "la prueba de oro", aunque se reserva para ciertos casos. Salvo excepciones, las heparinas de bajo peso molecular han desplazado a las no fraccionadas en el tratamiento de la enfermedad, debido a la serie de inconvenientes que presentan: complicaciones hemorrágicas, trombopenia, necesidad de hospitalización y control biológico. Es posible, que en un futuro más o menos próximo nuevos antitrombóticos, como el fondaparinux o el ximelagatrán cambien substancialmente el tratamiento de la TVP. Aunque no están exentos de complicaciones, existen situaciones en las que está indicada la colocación de un filtro en la vena cava inferior. La trombolisis es poco aceptada, debido a que la relación riesgo-beneficio no es satisfactoria. Una excepción, serían las trombosis venosas masivas con riesgo de gangrena (flegmasia cerúlea dolens), en pacientes con bajo riesgo hemorrágico. Finalmente, en los casos que cursan con isquemia venosa, que generalmente aparecen en las oclusiones más proximalesvena iliaca y cava inferior-, una opción eficaz para restablecer la permeabilidad venosa sería la trombectomía venosa (AU)

Detection of melon necrotic spot virus in water samples and melon plants by molecular methods.

Melon necrotic spot virus (MNSV) is a water and soil-borne pathogen affecting species of the Cucurbitaceae family both in hydroponic and soil crops. Molecular methods for detecting MNSV in water samples, nutrient solutions and melon plants were developed. For this purpose, water samples from a water source pool of a hydroponic culture or from the recirculating nutrient solution were concentrated by ultracentrifugation or PEG precipitation followed by RT-PCR analysis. Both concentration methods were suitable to allow the detection of MNSV and represent, as far as we know, the first time that this virus has been detected in water samples. A non-isotopic riboprobe specific for MNSV was obtained and used to detect the virus in plant tissue. Different parts of mechanically infected plants were examined including the roots, stems, inoculated cotyledons and young leaves. Excluding the inoculated cotyledons, the tissues showing the highest accumulation levels of the virus were the roots. The potential inclusion of such tools in management programs is discussed.

Nuevos avances en el conocimiento del síndrome postrombótico / New advances in the understanding of post-thrombotic syndrome

La verdadera incidencia del síndrome postrombótico (SPT) no se conoce con precisión, aunque de la mayor parte de los estudios disponibles, parece deducirse que puede establecerse un año después de la trombosis venosa profunda (TVP) aguda de los miembros inferiores en el 17 por ciento al 50 por ciento de los pacientes. Inseparablemente unido a la hipertensión venosa que sigue al desarrollo de la incompetencia valvular, se acompaña de una serie de reacciones inflamatorias que incluyen el aumento de la permeabilidad endotelial, la unión de los leucocitos circulantes al endotelio, la infiltración por monocitos, linfocitos y mastocitos del tejido conectivo, y el desarrollo de infiltrados tisulares fibróticos y distintos marcadores moleculares. Al contrario que en las TVP, sabemos muy poco acerca de los factores que incrementan el riesgo de padecer un SPT, ya que el único identificado hasta ahora es la TVP recurrente. Actualmente disponemos de distintas escalas estandarizadas para su diagnóstico clínico, aunque el eco-Doppler duplex color es, actualmente, la técnica no invasiva de elección para detectar, localizar y evaluar la incapacidad venosa valvular y la obstrucción venosa crónica. Las modernas técnicas de imagen: tomografia computarizada (TC), resonancia magnética (RM) e isotópicas tienen un futuro prometedor, si bien se encuentran en fase de validación. Los fármacos flebotrópicos son la estrategia terapéutica de elección para los pacientes con SPT en los que no está indicada la cirugía o en los que ésta es un coadyuvante del tratamiento médico. Finalmente, la cirugía venosa profunda debe reservarse para todos aquellos pacientes que sufren de insuficiencia venosa crónica grave, con reflujo venoso significativo e hipertensión venosa ambulatoria. (AU)

Reflexiones sobre la enfermedad tromboembólica venosa / Reflections on the thrombolic venous disease

No disponible

Retinol and alpha-tocopherol in serum of type 1 diabetic patients with intensive insulin therapy: a long term follow-up study.

OBJECTIVE: We evaluated the effect of intensive insulin therapy and glycemic control in patients with type 1 diabetes on biochemical markers of vitamin A and E. METHODS: Fifty-seven patients with type 1 diabetes were enrolled in a follow-up study for 3 to 33 mo. At entrance, all patients were on conventional insulin therapy or recently had been diagnosed with the disease. Intensive insulin therapy (multiple daily glycemia records and at least three insulin doses daily) was established, and every 3 to 6 mo patients were screened for clinical, biochemical, and hematologic indexes. Biochemical markers of vitamin A and E nutrition status were measured at each visit by a quality-controlled high-performance liquid chromatography. RESULTS: At entrance, serum retinol concentrations, but not the ratio of alpha-tocopherol to cholesterol, showed a negative correlation with increasing values of HbA1c and insulin dose, neither of which was significant in multiple regression models. With intensive insulin therapy, a trend to normalize parameters of glycemic control (HbA1c and fructosamine) was observed within subjects and on a group level. However, no significant changes were observed in serum retinol or alpha-tocopherol:cholesterol ratio according to the metabolic control of the disease. CONCLUSIONS: Patients with type 1 diabetes under intensive insulin therapy tend to normalize the clinical parameters of glycemic control, although this improvement does not significantly affect biochemical markers of vitamin A and E status.

[New advances in the knowledge on post-thrombotic syndrome]. / Nuevos avances en el conocimiento del síndrome postrombótico.

The real incidence of the post-thrombotic syndrome (PTS) is not known precisely, though of the most part of the variable studies, seems be deduced that it can be established a year after the deep venous thrombosis (DVT) acute of the inferior members in 17% to the 50% of the patients. Inseparably united to the venous hypertension that continues to the development of the incompetence valvular, is accompanied of a series of inflammatory reactions that include the increase in the permeability endothelial, the union of the circulating leukocytes at endothelium, the infiltration by monocytes, lymphocytes and mastocytes of the connective tissue, and the development of infiltrated tissular fibrotics and different molecular markers. To the contrary that in the DVT, we know very little about the factors that increase the risk of suffering a PTS, since the only one identified up until now it is the recurrent DVT. Currently we have different scales standardized for their your clinical diagnosis, though the Echo-Doppler is, currently, the technique not invasive of election to detect, locate and evaluate the venous disability valvular and the venous obstruction chronicle. The modern technical of image: computed tomography (CT), magnetic resonance (MR) and isotopics have a promising future, even though are found in validation phase. The phlebothropics drugs are the therapeutic election strategy for the patients with PTS in those which is not indicated the surgery or in those which this is a assisting of the medical treatment. Finally, the deep venous surgery must be reserved for all those patients that suffer from venous insufficiency serious chronicle, with meaningful venous reflux and ambulatory venous hypertension.

[Aortoenteric fistula secondary to aortobifemoral prosthesis infection]. / Fístula aortoentérica secundaria a infección de prótesis aortobifemoral.

We present the case of a 76 year-old man, intervened of an obstruction bilateral iliac by means of placement of a prosthesis aortobifemoral that presented pain in the grave left iliac and fever in needles of 39 degrees C to the five years of the intervention. In the physical exploration it highlighted a painful abdomen in the grave left iliac with signs of peritoneal irritation. In the laboratory tests a leukocytosis was detected with neutrophilia and negative culture. The computed thomography (CT) show the presence of gas bubbles around the prosthesis, as well as a liquid collection with areas necrotics in their interior that affected to the psoas and iliac muscles. In the same exploration the aspirative puncture with drainage of the absces demonstrated in the cultivations carried out in aerobic means the presence of Enterococcus faecalis and Enterobacter cloacae. When presenting a high gastrointestinal hemorrhage abruptly, he was practiced and gastroduodenal endoscope in which a aortoduodenal fistula was evidenced with having bled active. When a bypass extra-anatomic, the sick person will practice it died when presenting a shock abrupt hipovolemic that he didn't respond to the pertinent treatment. We analyze the approaches current diagnoses of infection of the vascular prosthesis and their more serious complication, the aortoenteric fistula (AEF) that either appears in the 0.3-5.9% of the patients who undergo prosthetic reconstruction of the abdominal aorta, for occlusive or aneurismal disease. We highlight the importance of carrying out a precocious diagnosis of the infection of the portion retroperitoneal of the vascular graft that, often, it is manifested with subtle and not specific clinical signs, with the techniques at the moment available as: the CT, fine needle aspiration guided by her, and to diminish the rates of mortality, from the current of 43%, until the most optimistic estimated in 19%.