International Union of Angiology consensus document on vascular compression syndromes.

Vascular compression syndromes (VCS) are rare diseases, but they may cause significant symptoms interfering with the quality of life (QoL) of patients who are often in their younger age. Given their infrequent occurrence, multiform clinical and anatomical presentation, and absence of dedicated guidelines from scientific societies, further knowledge of these conditions is required to investigate and treat them using modern imaging and surgical (open or endovascular) techniques. This consensus document will focus on known VCS, affecting the arterial and venous system. The position paper, written by members of International Union of Angiology (IUA) Youth Committee and senior experts, will show an overview of pathophysiology, diagnostic, and therapeutical approaches for patients with VCS. Furthermore, this document will provide also unresolved issues that require more research that need to be addressed in the future.

International Union of Angiology Position Statement on no-option chronic limb threatening ischemia.

This position paper, written by members of International Union of Angiology (IUA) Youth Committee and senior experts, shows an overview of therapeutical approaches for patients with chronic limb-threatening ischemia (CLTI) and absence of 'standard' solutions for revascularization. The aim was to demonstrate the accurate management of the 'no-option' CLTI patient including the wound treatment and the rehabilitation, considering always the goal of the increase of quality of life of the patients.

International Union of Angiology Position Statement on perioperative drug and hemostasis management in vascular surgery.

This position paper, written by members of International Union of Angiology (IUA) Youth Committee, shows an overview of coagulation system and laboratory tests, analysis of medical therapies (older and newer), medication discontinuation/restart recommendations, bridging therapy recommendations, and an overview of hemostatic agents used in the operating room.

Epidemiología y definiciones en infecciones quirúrgicas / Epidemiology and definitions in surgical infections

El presente trabajo forma parte de una serie de artículos de revisión cuyo objetivo es repasar conceptos fundamentales en el ejercicio quirúrgico a fin de estimular y reforzar el uso racional de los antibióticos, mediante la adquisición de herramientas relacionados con la importancia, prevención y el manejo de las infecciones quirúrgicas. En este artículo en particular se aborda la epidemiología local, regional y mundial de las infecciones quirúrgicas, su diagnóstico y su impacto social(AU)

This work is part of a series of review articles whose objective is to reassess fundamental concepts in surgical practice in order to stimulate and reinforce the rational use of antibiotics, through the acquisition of tools related to the importance, prevention and management of surgical infections. This particular article addresses the local, regional and global epidemiology of surgical infections, their diagnosis and their social impact(AU)

Comparison of Bypass with Endoscopically Harvested Internal Saphenous Vein versus Bypass with Surgically Harvested Internal Saphenous Vein for Lower Limb Arterial Disease.

BACKGROUND: Patients with lower limb arterial disease have a high risk for complications related with surgical wounds. The endoscopic extraction of the great saphenous vein (GSV) is a less invasive alternative to the conventional surgical extraction. METHODS: A clinical and ultrasonographic follow-up was carried out on the lower limb bypass with GSV performed in our institution between years 2007 and 2012. Patients were selected for open or endoscopic harvesting depending on the surgeon assigned (endoscopic or open surgeon). Follow-up was performed at 1, 3, 6, and 12 months after surgery and annually thereafter. All the GSV endoscopic harvestings (GSVEH) were performed by the same surgeon. Data for primary, assisted, and secondary patency and amputation-free survival were analyzed. Anatomopathalogic analysis were performed on pares of samples of the same vein dissected surgically and endoscopically from the same patient. RESULTS: Sixty bypass surgery has been performed on 60 patients (54 men and 6 women), 30 with GSVEH (50%), and 30 with GSV open harvesting (GSVOH). All patients were intervened for critical limb ischemia (Rutherford cathegory 4, 5, and 6). Significant differences were found between both groups for suture dehiscence (GSVEH 0%, GSVOH 20%, P = 0.01) and infection (GSVEH 3%, GSVOH 30% P, 0.006). No significant differences were found between both groups regarding to primary patency, assisted primary patency, or amputation-free survival. An anatomopathologic comparison of segments of veins extracted surgically and endoscopically of the same patients did not show any significant differences. CONCLUSIONS: Although no statistically significant differences were found between GSVOH and GSVEH bypass for lower limb revascularization, there is a trend toward poorer patency rates for the endoscopic technique. GSVEH lowers the risks for infection and dehiscence of surgical wounds.

Diagnosis and treatment of a symptomatic primary thoracic aortic tumor: endovascular exclusion to prevent recurrent embolization.

Intraluminal aortic malignant masses are extremely rare. Clinical symptoms of these tumors include locally occlusive aortic disease, peripheral emboli, or mesenteric emboli. Eventually, general symptoms, such as fatigue, weight loss, or fever, will occur. Nevertheless, the diagnosis is most often made after surgery or autopsy, when histologic data can be examined. Few cases of intraaortic masses treated endovascularly have been reported, most of them related to intraluminal blood clot formation. We present a case of intraaortic malignant tumor formation with distal embolization to the legs, in which the diagnosis of malignant disease was reached after analysis of the material obtained during embolectomy. Endovascular exclusion was performed as a transient treatment to avoid new embolic events.

Evolution in the management of acute myocardial infarction in the autonomous community of valencia (Spain): ten years of the primvac registry (1995-2004).

INTRODUCTION AND OBJECTIVES: Several registries of acute myocardial infarction (AMI) have been carried out in Spain, but few remain active. This work analyses the evolution of the characteristics and control of patients with AMI during the first 10 years of the PRIMVAC registry, initiated in 1995. METHODS: The demographical and clinical characteristics, therapeutic-diagnostic procedures and pharmacological treatment of patients admitted with AMI between January 1995 and December 2004, were analysed in 17 coronary centres in the Autonomous Community of Valencia (South eastern Spain). RESULTS: The mean age of the 19,719 patients recruited was of 65. The percentage of women, hypertension, hypercholestrolemia and diabetes increased during registry period. The median time of symptoms onset-hospital arrival was 151 minutes, without a decrease over the time, and the delay of thrombolysis fell from 200 to 154 minutes (p<0.01). Percentage of thrombolytic treatment oscillated between 39% and 48%. The mortality in the coronary units decreased (14.1% vs. 8.9%; p<0.001). The number of coronary angiography and percutaneous revascularisation performed increased up to 61% and 32%, respectively, of patients included. On discharge, the use of beta-blockers (29.3% vs. 66.7%), angiotensin-converting enzyme (ACE) inhibitors (41.7% vs. 57.9%) and statins (29.3% vs. 71%) went up. CONCLUSIONS: Overall mortality in the coronary unit decreased, without any variation in the incidence of serious complications. Time to thrombolysis was reduced over the time, with no significant increment in its use. The performance of coronary angiography and percutaneous revascularisation increased, with a low use of primary angioplasty. The use of beta-blockers, ACE inhibitors and statins increased at discharge.

Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in Spain.

INTRODUCTION: Patients with influenza A (H1N1)v infection have developed rapidly progressive lower respiratory tract disease resulting in respiratory failure. We describe the clinical and epidemiologic characteristics of the first 32 persons reported to be admitted to the intensive care unit (ICU) due to influenza A (H1N1)v infection in Spain. METHODS: We used medical chart reviews to collect data on ICU adult patients reported in a standardized form. Influenza A (H1N1)v infection was confirmed in specimens using real-time reverse transcriptase-polymerase-chain-reaction (RT PCR) assay. RESULTS: Illness onset of the 32 patients occurred between 23 June and 31 July, 2009. The median age was 36 years (IQR = 31 - 52). Ten (31.2%) were obese, 2 (6.3%) pregnant and 16 (50%) had pre-existing medical complications. Twenty-nine (90.6%) had primary viral pneumonitis, 2 (6.3%) exacerbation of structural respiratory disease and 1 (3.1%) secondary bacterial pneumonia. Twenty-four patients (75.0%) developed multiorgan dysfunction, 7 (21.9%) received renal replacement techniques and 24 (75.0%) required mechanical ventilation. Six patients died within 28 days, with two additional late deaths. Oseltamivir administration delay ranged from 2 to 8 days after illness onset, 31.2% received high-dose (300 mg/day), and treatment duration ranged from 5 to 10 days (mean 8.0 +/- 3.3). CONCLUSIONS: Over a 5-week period, influenza A (H1N1)v infection led to ICU admission in 32 adult patients, with frequently observed severe hypoxemia and a relatively high case-fatality rate. Clinicians should be aware of pulmonary complications of influenza A (H1N1)v infection, particularly in pregnant and young obese but previously healthy persons.

Clinical course of acute myocardial infarction in the hypertensive patient in Eastern Spain: the PRIMVAC registry.

OBJECTIVE: The study's objective was to analyze the acute complications and prognosis of acute myocardial infarction (AMI) in hypertensive patients in Spain. METHOD: Complications and early mortality were recorded among the patients with AMI admitted to the coronary care units of the 17 hospitals in the Valencia Community (Spain) between 1995 and 2000. RESULTS: A total of 12.071 patients were registered, of whom 46% were hypertensive (5.550 cases). Atrial fibrillation was more frequent in the hypertensive group, whereas ventricular fibrillation was more common among normotensive patients. We found higher mortality rates in the hypertensive group (14.4% vs 12.4%; P<.001). However, after multivariate adjustment, hypertension was not independently associated with mortality (odds ratio: .95; P=.46), and remained independently associated with a lower risk of primary ventricular fibrillation (odds ratio: .83; P<.05). CONCLUSION: Hypertensive patients do not present comparatively greater mortality during AMI, although primary ventricular fibrillation is less common in such subjects.

[Reinfarction as a complication of acute myocardial infarction. PRIMVAC Registry data]. / El reinfarto como complicación del infarto agudo de miocardio. Datos del registro PRIMVAC.

INTRODUCTION AND OBJECTIVES: The clinical profile of patients with acute myocardial infarction (AMI) who have reinfarction (REAMI) during their stay in the intensive cardiologic care unit (ICCU) is not well known. The aim of this study was to identify factors predictive of REAMI, as well as its global incidence and mortality. PATIENTS AND METHOD: All patients with AMI admitted to the ICCU of 17 hospitals in the Comunidad de Valencia (Spain) in the period 1995-2000 (PRIMVAC Registry) were included. Differential characteristics between patients with or without REAMI were determined, and odds ratios (OR) for possible predictive factors were estimated with their 95% confidence intervals by logistic regression. RESULTS: A total of 12,071 patients were included. Mean age of the patients was of 65.5 years, the percentage of women was 23.8%, and the incidence of REAMI was 2.8%. The REAMI group was significantly older than the non-REAMI group. Female sex was significantly more common in the REAMI group. More diagnostic and therapeutic procedures were carried out, more drugs were used and there were more complications in the REAMI group. Mortality was significantly higher in the REAMI group (37.8% vs 12.6%). Only age, diabetes mellitus, previous myocardial infarction and the appearance of Q waves in the electrocardiogram were independently associated with the presence of REAMI. CONCLUSIONS: REAMI in the ICCU was associated with high mortality. Some clinical factors present during the first few hours after AMI were associated independently with the appearance of REAMI.

El reinfarto como complicación del infarto agudo de miocardio. Datos del registro PRIMVAC / Reinfarction as a complication of acute myocardial infarction. PRIMVAC registry data

Introducción y objetivos. El perfil clínico de los pacientes con infarto agudo de miocardio (IAM) que presentan un reinfarto (REIAM) durante su estancia en la unidad de cuidados intensivos cardiológicos (UCIC) es poco conocido. El objetivo de este trabajo es determinar los factores predictores de REIAM, su incidencia global y su mortalidad. Pacientes y método. Se incluyó a todos los pacientes con IAM ingresados en las UCIC de 17 hospitales de la Comunidad Valenciana en el período 1995-2000. Se determinaron las características diferenciales de los pacientes con y sin REIAM, y se calcularon las odds ratio y sus intervalos de confianza del 95% mediante un análisis de regresión logística para los posibles factores predictores. Resultados. Se incluyó a 12.071 pacientes con IAM. La edad media fue de 65,5 años, la proporción de mujeres del 23,8% y la incidencia de REIAM del 2,8%. La edad fue significativamente mayor en el grupo con REIAM que en el grupo sin REIAM, al igual que el porcentaje de mujeres. Se realizaron más procedimientos, se utilizaron más fármacos y hubo más complicaciones en el grupo con REIAM. La mortalidad fue significativamente mayor en el grupo con REIAM (37,8 frente a 12,6%). La edad, la diabetes mellitus, el infarto de miocardio previo y el desarrollo de onda Q en el electrocardiograma se asociaron de forma independiente con la presencia de REIAM. Conclusiones. El REIAM en la UCIC conlleva una alta mortalidad. Algunos factores presentes en las primeras horas del IAM se asocian con la aparición de REIAM

Introduction and objectives. The clinical profile of patients with acute myocardial infarction (AMI) who have reinfarction (REAMI) during their stay in the intensive cardiologic care unit (ICCU) is not well known. The aim of this study was to identify factors predictive of REAMI, as well as its global incidence and mortality. Patients and method. All patients with AMI admitted to the ICCU of 17 hospitals in the Comunidad de Valencia (Spain) in the period 1995-2000 (PRIMVAC Registry) were included. Differential characteristics between patients with or without REAMI were determined, and odds ratios (OR) for possible predictive factors were estimated with their 95% confidence intervals by logistic regression. Results. A total of 12 071 patients were included. Mean age of the patients was of 65.5 years, the percentage of women was 23.8%, and the incidence of REAMI was 2.8%. The REAMI group was significantly older than the non-REAMI group. Female sex was significantly more common in the REAMI group. More diagnostic and therapeutic procedures were carried out, more drugs were used and there were more complications in the REAMI group. Mortality was significantly higher in the REAMI group (37.8% vs 12.6%). Only age, diabetes mellitus, previous myocardial infarction and the appearance of Q waves in the electrocardiogram were independently associated with the presence of REAMI. Conclusions. REAMI in the ICCU was associated with high mortality. Some clinical factors present during the first few hours after AMI were associated independently with the appearance of REAMI

[Mortality of myocardial infarction in the PRIMVAC registry. Prognostic factors]. / Mortalidad del infarto de miocardio en el registro PRIMVAC. Factores pronósticos.

BACKGROUND AND OBJECTIVE: The aim of this study was to determine the mortality due to acute myocardial infarction in the coronary units from Comunidad Valenciana (Spain) and the prognostic factors associated with a higher mortality. PATIENTS AND METHOD: Demographic characteristics, coronary risk factors, electrocardiographic ischemic signs, complications and mortality of patients with acute myocardial infarction admitted in the coronary units were collected. The study period comprised January 1995-December 1999. Death incidence was measured during coronary unit's stay. Factors associated with poor prognosis were analyzed. RESULTS: 10.213 patients entered into the study. Mean age at admission was 65 12 years. 23.8% were females (76.2% males). Global mortality in coronary units was 13.3%. Independent variables associated with higher mortality were (p < 0.05): advanced age (OR=1.06 [1.05-1.06]), female sex (OR=1.45 [1.26-1.66]), diabetes mellitus (OR=1.53 [1.35-1.74]), previous myocardial infarction (OR=1.46 [1.23-1.70]), previous angor pectoris (OR=1.29 [1.13-1.49]) and Q-wave infarction (OR=1.23 [1.03-1.43]). Factors associated with lower mortality were: hypercholesterolemia (OR=0.76 [0.66-0.78]), smoking (OR=0.65 [0.57-0.74]) and thrombolysis (OR=0.85 [0.78-0.92]). CONCLUSIONS: At present, in the reperfusion therapy era, acute myocardial infarction has a high mortality after coronary unit admission. Several clinical factors are associated with a worse prognosis.

[Acute myocardial infarction in patients under 45 years]. / Infarto agudo de miocardio en pacientes menores de 45 años.

INTRODUCTION AND OBJECTIVE: To evaluate the differential features of acute myocardial infarction in patients younger than 45 years old compared to older patients. PATIENTS AND METHODS: From 1995 to 1999, delays in the assistance, evaluation, and therapeutic strategies as well as complications in patients hospitalized with a diagnosis of acute myocardial infarction, have been registered in the intensive care units of the 17 hospitals participating in the PRIMVAC Register. RESULTS: During the study, 10,213 patients were registered, 6.8% younger than 45 years old (691 patients). Young patients show a greater prevalence of cigarette smoking (80.9 vs 34.1%; p < 0.0001) and hypercholesterolemia (39.9 vs 28.6%; p < 0.0001), whereas arterial hypertension, diabetes, and history of coronary disease were significantly more frequent in the older group. This subgroup reached the healthcare system at an earlier stage (120 vs 160 min; p < 0.0001). Thrombolysis was performed in 59.9% of patients younger than 45 years and in 45.9% of patients older than 45 years. Young patients were more frequently given aspirin (94.5%), heparin (70.6%), and beta-blocker drugs (38.4%), whereas patients older than 45 years were given a higher percentage of ACEI, digoxin, and inotropic drugs. Younger patients had a better prognosis and a lower mortality rate (3.5 vs 14%; p < 0.00001). CONCLUSIONS: Acute myocardial infarction in patients younger than 45 years had different clinical features and responded to different therapeutic and diagnostic approaches than acute myocardial infarction in patients over 45 years, as well as a better short-term prognosis.

Infarto agudo de miocardio en pacientes menores de 45 años / Acute Myocardial Infarction in Patients Under 45

Introducción y objetivo. Evaluar las características diferenciales del infarto agudo de miocardio en el paciente joven (menor de 45 años) en relación con el paciente de mayor edad.Pacientes y métodos. Se han recogido las características clínicas, retrasos en la asistencia, estrategias diagnósticas y terapéuticas y complicaciones de los pacientes ingresados con diagnóstico de infarto agudo de miocardio entre los años 1995 y 1999 en las unidades de cuidados intensivos de los 17 hospitales que participan en el registro PRIMVAC.Resultados. Se han registrado 10.213 pacientes, de los cuales el 6,8 por ciento tenía una edad menor de 45 años (691pacientes). Los pacientes jóvenes presentan una mayor prevalencia de tabaquismo (80,9 frente a 34,1 por ciento; p < 0,0001) e hipercolesterolemia (39,9 frente a 28,6 por ciento; p < 0,0001), mientras que la hipertensión arterial, la diabetes y los antecedentes de enfermedad coronaria son significativamente superiores en el grupo de mayor edad.Este subgrupo contacta antes con el sistema sanitario (120 frente a 160 min; p < 0,0001). La trombólisis se realizó en el 59,9 por ciento de los pacientes jóvenes en comparación con el 45,9 por ciento de los pacientes mayores de 45 años.Los pacientes jóvenes recibieron más frecuentemente aspirina (94,5 por ciento), heparina (70,6 por ciento) y bloqueadores beta (38,4 por ciento), mientras que la administración de IECA, digoxina e inotrópicos fue superior en los mayores de 45 años.Los pacientes jóvenes tuvieron un pronóstico mejor, con una menor mortalidad (3,5 frente a 14 por ciento; p < 0,00001).Conclusiones. El infarto agudo de miocardio en el paciente joven presenta unas características clínicas y un tratamiento diagnóstico y terapéutico diferentes respecto al grupo de mayor edad, así como un pronóstico a corto plazo más favorable (AU)

Sonografía del carcinoma colorectal: reporte de un caso / Sonography of colorectal carcinoma: report of a case

Se presenta el caso de un carcinoma colorectal en una mujer de 29 años de edad con dolor en hemiabdomen inferior, estreñimiento y evaluaciónes escasas con moco y sangre. La ecografia pélvicoabdominal con enema acuoso revela una imagen tubular parauterina izquierda, con centro ecogénico rodeado de dos bandas hipoecoicas que sugieren tumor de origen intestinal o tubárico. La ecografia, colon por enema, rectosigmoidoscopia y tomografia computada, permitieron obtener el diagnóstico preoperatorio de un adenocarcinoma de célilas en anillo de sello en la unión rectosigmoidea. Se discute abordaje diagnóstico y seguimiento de la paciente

Riesgo de SIDA en cirugía / Risks of AIDS on surgery

Aun cuando fue descrito en 1981, el SIDA sigue siendo una patología que angustia al personal de salud en general y más aún a los cirujanos por la exposición a sangre y superficies cruentas. Por lo tanto se revisan las estadísticas sobre el SIDA en personal de salud que haya sufrido accidentes de trabajo con material contaminado, además se hacen recomendaciones pertinentes

Duplicación intestinal en el adulto: a propósito de un caso / Intestinal duplication in adult: apropos of a case

Se presenta el caso de una mujer de 18 años de edad, que fue intervenida con el diagnóstico presuntivo de un tumor de ovario derecho, evidenciandose durante la intervención quirúrgica la presencia de un tumor pediculado unido al sigmoide, que logró ser resecado totalmente y cuyo reporte Anatomo-patológico fue el de una duplicación intestinal. Se trata de un caso de aparición de dicho cuadro en la edad adulta, la cual se comporto en todo momento como un proceso que simulaba una patología ginecológica. Se estudia el caso y se revisa la literatura

Obstrucción intestinal baja por tricobezoar / Intestinal obstruction due to trichobezoars

Los bezoares son formaciones de material extraño al organismo en el estómago o intestino del hombre o animales. Pueden estar formados por pelos (tricobezoar) o por frutos (fitobezoar), siendo los primeros los més comunes (55% de los casos). En la mayoría de los casos, los tricobezoares se encuentran confinados sólo al estómago, pero ocasionalmente, pueden presentar una cola que se extiende hasta el duodeno. También raramente pueden fragmentarse y ser causa de obstrucción intestinal. Presentamos a continuación la experiencia personal con dos casos de obstrucción intestinal debida a tricobezoar, el primero de los cuales es un caso hasta ahora no encontrado en la literatura