Recanalización espontánea tras la embolización de una arteria renal con un tapón vascular Amplatzer tipo 4 / Spontaneous recanalization after embolization of the renal artery with an Amplatzer vascular plug 4

El tapón vascular Amplatzer (Amplatzer vascular plug [AVP]) es un dispositivo oclusor utilizado para embolizaciones vasculares, que debido a su excelente maniobrabilidad y efectividad, está siendo utilizado cada vez con mayor frecuencia. Su última versión, el AVP 4, permite llevarlo a vasos más tortuosos y de menor calibre. Hasta la fecha, únicamente han sido publicados casos de repermeabilización espontánea con versiones anteriores de los AVP. Presentamos un caso de repermeabilización tras la embolización de una arteria renal con un AVP 4 (AU)

The Amplatzer vascular plug (AVP) is an occluding device used in vascular embolizations. Thanks to its excellent maneuverability and effectiveness, it is being used more and more often. The latest version, the AVP 4, enables access to smaller and more tortuous vessels. To date, the only cases of spontaneous recanalization published occurred with earlier versions of the AVP. We present a case of recanalization after renal artery embolization with an AVP 4 (AU)

Predictors of outcome and different management of aortobronchial and aortoesophageal fistulas.

OBJECTIVE: Aortoesophageal and aortobronchial fistulas are uncommon but life-threatening conditions. The present study aimed to identify potential differences in outcomes, depending on the etiology, type, and management of the fistulas, and to determine mortality predictors. METHODS: We retrospectively reviewed a series of 26 consecutive patients with thoracic aorta fistulas admitted to our institution from 1998 to 2013 (18 aortobronchial, 7 aortoesophageal, and 1 combined fistula). RESULTS: The mean age was 61.5 ± 13.4 years, with 22 men. Management was thoracic endovascular aortic repair (TEVAR) in 8, open repair in 7, and conservative in 11. The TEVAR and nonoperative patients were significantly older and presented with more comorbidities. Shock developed in 15 patients and sepsis in 9. The most common radiologic findings were intramural hematoma (65.4%), pseudoaneurysm (53.8%), and bronchial compression (46.20%). Active contrast extravasation (23.1%) and ectopic gas (19.2%) were associated with a worse prognosis. In-hospital mortality was 100% in the conservative group, 37.5% in the TEVAR group, and 14.3% in the open repair group (P = .04). Septic shock was the most common cause of death. The risk factors for in-hospital mortality were hemodynamic instability on admission (P = .02), sepsis (P = .04), and conservative management (P < .001). The overall long-term survival in surgical patients at 1 and 5 years was 66% and 58.7%, respectively. Infectious and malignant etiologies resulted in the worst prognosis. CONCLUSIONS: The outcomes are ultimately conditioned by the etiology of the fistula. Both open and endovascular management of aortic fistulas can prevent death by exsanguination; however, patients remain at high risk of infectious complications. Failure to treat the underlying cause will result in poor midterm outcomes.

Estimating the glomerular filtration rate in the Spanish working population: chronic kidney disease prevalence and its association with risk factors.

OBJECTIVE: This study aims to investigate the influence of estimated glomerular filtration rate (eGFR) with two equations (and by one or two separate measurements), on the prevalence of chronic kidney disease (CKD) and its association with blood pressure, and cardiovascular and metabolic risk factors. METHODS: Between January 2010 and October 2011, the Ibermutuamur CArdiovascular RIsk Assessment project included 128 588 workers (77.2% men, mean age 39.3 years, range 16-75), who underwent two consecutive yearly medical check-ups and had information for eGFR according to the MDRD-IDMS and CKD-EPI equations (serum creatinine was measured by a isotope-dilution mass spectrometry traceable method in a single central laboratory). CKD was defined by an eGFR less than 60 ml/min per 1.73 m. Subclinical (occult) renal disease was defined as an eGFR less than 60 ml/min per 1.73 m in patients with serum creatinine below 1.3 mg/dl and below 1.2 mg/dl in men and women, respectively. RESULTS: In this working population, prevalence of CKD was very low, but two to six times lower when two separate eGFRs below 60 ml/min per 1.73 m were used. The prevalence of CKD was significantly lower with the CKD-EPI compared to the MDRD-IDMS equation. The same applies to occult CKD. In male workers, occult CKD was practically nonexistent.Multivariate analyses show that blood pressure, total serum cholesterol, and serum glucose (positively), and high-density lipoprotein and low-density lipoprotein (negatively) were associated with CKD, with both equations. Another metabolic factor (waist circumference) was only associated (positively) with CKD defined by the CKD-EPI equation, which appears to be associated with most components of the metabolic syndrome. CONCLUSIONS: The CKD-EPI formula, calculated on the basis of two reported blood samples, may provide the most specific definition of CKD.

[Spontaneous recanalization after embolization of the renal artery with an Amplatzer vascular plug 4]. / Recanalización espontánea tras la embolización de una arteria renal con un tapón vascular Amplatzer tipo 4.

The Amplatzer vascular plug (AVP) is an occluding device used in vascular embolizations. Thanks to its excellent maneuverability and effectiveness, it is being used more and more often. The latest version, the AVP 4, enables access to smaller and more tortuous vessels. To date, the only cases of spontaneous recanalization published occurred with earlier versions of the AVP. We present a case of recanalization after renal artery embolization with an AVP 4.

Carcinoma epidermoide pancreático que inicia como conglomerado adenopático supraclavicular izquierdo / Virchow's node as the form of onset of squamous cell carcinoma of the pancreas

El carcinoma escamoso del páncreas es un tumor extraordinariamente infrecuente.Caso clínicoPaciente varón de 63 años que acude a la consulta del gastroenterólogo por un cuadro constitucional acompañado del hallazgo de una masa pétrea supraclavicular izquierda. El escáner demostró la existencia de una neoplasia de cuerpo pancreático que interesaba tronco celíaco. La histología de la adenopatía supraclavicular y del páncreas fue de carcinoma epidermoide queratinizante.ConclusionesEn el artículo se realiza una revisión sobre la incidencia, las características de este tumor tan infrecuente y las nuevas indicaciones de tratamiento (AU)

Squamous carcinoma of the pancreas is a highly uncommon tumor.Case reportA 63-year-old man was referred to the gastroenterology department because of hyporexia, cachexia and weight loss. A left supraclavicular node was noted. The computed tomography scan showed a tumor in the pancreatic body involving the celiac axis. Histological examination of the supraclavicular node and pancreatic mass revealed squamous cell carcinoma.ConclusionsThe incidence and characteristics of this highly infrequent tumor, as well as new treatment indications, are reviewed (AU)

[Virchow's node as the form of onset of squamous cell carcinoma of the pancreas]. / Carcinoma epidermoide pancreático que inicia como conglomerado adenopático supraclavicular izquierdo.

UNLABELLED: Squamous carcinoma of the pancreas is a highly uncommon tumor. CASE REPORT: A 63-year-old man was referred to the gastroenterology department because of hyporexia, cachexia and weight loss. A left supraclavicular node was noted. The computed tomography scan showed a tumor in the pancreatic body involving the celiac axis. Histological examination of the supraclavicular node and pancreatic mass revealed squamous cell carcinoma. CONCLUSIONS: The incidence and characteristics of this highly infrequent tumor, as well as new treatment indications, are reviewed.

Aspectos médicos de la catástrofe volcánica del Nevado del Ruiz

Este amplio trabajo quiere ser un registro histórico del desastre provocado por la erupción del Cráter Arenas del Volcán Nevado del Ruíz, la noche del 13 de noviembre de 1985 en Colombia. Su contenido se encuentra dividido en cinco partes. En la primera se analizan algunos aspectos geológicos de interés general, que permiten entender la conformación volcánica de la Cordillera Central y las características especiales del Nevado del Ruiz y de su lodo volcánico. En la segunda se incluye una recopilación de carácter periodístico con relatos y acontecimientos que vivieron y padecieron los pobladores de las zonas afectadas, así como las ponencias, análisis y actividades de algunos equipos de instituciones públicas y privadas que participaron en el rescate de víctimas. La parte tercera esta dedicada exclusivamente a la atención hospitalaria que se ofreció a las victimas en instituciones de tercer nivel. En la cuarta, diversos especialistas realizan una revisión lo más pormenorizada posible sobre las patologías especiales y por sistemas que afectarón a los heridos. En la quinta se analizan aspectos como el médico-legal que tuvo muchas deficiencias, los programas de rehabilitación, la atención sanitaria y las acciones y las acciones de salud emprendidas por Resurgir

Infeccion urinaria inespecifica / Unespecific urinary tract infection

La infeccion urinaria ocupa por su frecuencia en el organismo, el segundo lugar despues de las infecciones del aparato respiratorio. Su estudio reviste capital importancia por las alteraciones que produce, muchas de las cuales determinan la muerte del paciente. Se han dividido para su estudio en dos grandes grupos: las infecciones inenspecificas y las infecciones especificas.