Slow femoral venous flow and venous thromboembolism following inguinal hernioplasty in patients without or with low molecular weight heparin prophylaxis.

BACKGROUND: Prosthetic material (mesh) is commonly used to repair inguinal hernias. Its implantation close to the common femoral vein (CFV) can induce slow flow and favor the appearance of venous thromboembolism (VTE) events. AIM: To investigate the speed of flow, diameter and area of the CFV after inguinal hernioplasty. METHODS: Two hundred and fifty patients receiving open hernioplasty with a non-resorbable mesh for the repair of a unilateral, primary, simple inguinal hernia were prospectively investigated. Patients were stratified, by consensus, into a low or a moderate risk of VTE group. The moderate-risk group (n = 163) received low molecular weight heparin. On day 10 post-operation a blinded Echo-Doppler was carried out, and repeated 7 days later in patients with a venous flow of <15 cm/s. The speed of flow (cm/s), diameter (cm), and area (cm(2)) of the ipsilateral and contralateral CFV of the groin operated upon were measured. RESULTS: No event symptomatic of VTE was documented. One case of asymptomatic deep vein thrombosis (1/163, 0.6%) was found in the moderate-risk group. In 29 patients (2 and 27 in the low- and moderate-risk groups, respectively; p < 0.001) a maximum blood flow velocity of <15 cm/s was found in the ipsilateral CFV; these flows were close to normal in the second measurement. Taking the entire sample into account, the maximum venous blood flow found in the ipsilateral CFV of the operated groin was less than that measured in the contralateral CFV (20.88 vs. 24.01 cm/s; p < 0.001); this difference was significant in both VTE risk groups. The diameter and area of the CFV were both greater in the ipsilateral than the contralateral CFV (p < 0.01); this finding proved to be significant only in hernias of the left groin (p < 0.001). CONCLUSIONS: In the immediate postoperative period, inguinal hernioplasty with mesh induces a temporarily slow venous flow in the ipsilateral CFV. However, this does not lead to an increase in the incidence of VTE.

Relative value of the Ankle-Brachial Index of intermittent claudication.

INTRODUCTION: The Ankle-Brachial Index (ABI) makes it possible to identify patients with peripheral artery disease (PAD). Intermittent claudication (IC) is the first major symptom of PAD, although many patients with an ABI ≤ 0.9 do not exhibit IC, and the range of ABI among those who do have IC is very variable. This study evaluates the correlation between ABI and the perception (symptomatology) of claudicant patients. MATERIAL AND METHODS: An observational, cross-sectional and multicentre, study of 920 patients with IC. Clinical history, ABI, Walking Impairment Questionnaire (WIQ) and European Quality of Life Questionnaire (EQ-5D) were recorded. Associations were analysed using Spearman's correlation coefficient. RESULTS: The mean ABI of the series was 0.63 (SD = 0.19). The mean WIQ-distance was 34.07 (SD = 26.77), values being smaller for lower ABI values (r = 0.343, p < 0.001). The mean EQ-5D score of the series was 0.58 (SD = 0.21), also showing lower values as the ABI decreased (r = 0.278, p < 0.001). The correlations of WIQ and EQ-5D with ABI were statistically significant in both cases, but always less than 0.400 (between 0.278 and 0.343). CONCLUSIONS: The correlations of ABI with the questionnaires of walking capacity and quality of life are weak. For this reason, although in clinical practice the ABI of CI patients is commonly measured, decisions should not be taken during the development of IC exclusively on the basis of the ABI.

Eficacia y seguridad de un hemostático local de tercera generación y precursores en cirugía vascular. Revisión de la literatura / Efficacy and safety of a third generation local haemostatic and precursors in vascular surgery: A review of the literature

El control de la hemostasia y el sellado tisular son 2 aspectos cruciales en cualquier proceso quirúrgico. Los hemostáticos locales selladores de fibrina contribuyen a disminuir el riesgo de sangrado favoreciendo la coagulación y además, agentes como TachoSil® (TS), poseen propiedades sellantes que refuerzan las suturas quirúrgicas, especialmente las vasculares, cuando las técnicas estándar son insuficientes. El objetivo principal de este trabajo es recoger la evidencia científica actual sobre la utilización de TS en procesos quirúrgicos relacionados con la cirugía vascular. Para ello, se llevó a cabo una búsqueda en Medline hasta marzo de 2011. Tras las lecturas críticas, fueron incluidos 5 estudios preclínicos y 10 clínicos con diferentes grados de evidencia. El resultado de esta revisión demuestra que TS presenta propiedades hemostáticas y de refuerzo de suturas vasculares y es de utilidad su uso en cirugía con riesgo de hemorragia y que precise sellado de estructuras(AU)

The control of haemostasis and tissue sealing are two essential aspects in any surgical procedure. The local haemostatic fibrin sealants help to reduce the risk of bleeding by favouring coagulation. Furthermore, agents such as TachoSil® (TS) have sealant properties that strengthen surgical sutures, particularly vascular, when standard techniques are insufficient. The main objective of this work is to review current scientific evidence on the use of TS in surgical procedures related to vascular surgery. For this purpose, a literature search was conducted using Medline for articles published from January 1987 until March 2011. After methodological evaluation, five preclinical studies and ten clinical studies were included, according to scientific evidence levels. The result of this review shows that TS has haemostatic and vascular suture reinforcement properties. For these reasons, it is useful in surgical procedures with a risk of bleeding and which may require sealing structures(AU)

Estratificación del riesgo de enfermedad tromboembólica venosa y tromboprofilaxis con heparina de bajo peso molecular en pacientes sometidos a cirugía mayor ambulatoria. Estudio prospectivo observacional / Venous thromboembolism risk stratification and thromboprophylaxis with low molecular weight heparin in patients undergoing major ambulatory surgery: an observational prospective study

Introducción: el riesgo de enfermedad tromboembólica venosa (ETV) después de cirugía mayor ambulatoria (CMA), aunque supuestamente es bajo, continua siendo desconocido. Esta cirugía, que cada vez es más frecuente y extensiva a pacientes de mayor edad y comorbilidad, nos obliga a buscar pacientes de riesgo. El objetivo es validar de forma prospectiva una estratificación del riesgo de ETV, en pacientes de CMA, lo que determina el tipo de tromboprofilaxis a realizar. Pacientes y métodos: estudio prospectivo en 402 pacientes consecutivos (45,1 ± 16,0 años) sometidos a diversos procedimientos de CMA, fundamentalmente de pared abdominal (82%) y bajo anestesia regional (60,5%). Los pacientes son estratificados según un consenso español en: a) sin riesgo ETV (n = 141 pacientes); b) con riesgo moderado (n = 228), o c) alto (n = 33). Los grupos de riesgo moderado y alto recibieron heparina de bajo peso molecular (bemiparina 2500 o 3500 UI), comenzando 6 horas después de la operación durante siete días. Al décimo día del postoperatorio se realizo eco-doppler color (de forma ciega), el cual se repitió a la semana en caso necesario; a los 10 y 30 días se midieron diversos parámetros de eficacia y seguridad. Se realizo un estudio trombofílico preoperatoriamente a un tercio de la muestra con la intención de conocer cómo modificaría a posteriori la estratificación realizada. Resultados: completaron el estudio 357 pacientes (88,8%). No se observó ningún evento sintomático; en el grupo de riesgo moderado se detectó una (..) (AU)

Although supposedly low, the risk of venous thromboembolism (VTE) after major ambulatory surgery (MAS) remains to be established. We have carried out a prospective validation of the risk stratification of VTE in MAS patients. Methods: 402 consecutive patients were stratified according to a Spanish consensus as: a) no risk of VTE (n = 141), b) moderate risk (n = 228), and c) high risk (n = 33). The moderate and high risk groups received thromboprophylaxis with low molecular weight heparin. On post-operative day 10, a colour Echo-Doppler was obtained; on days 10 and 30 different parameters of efficacy and safety were measured. Results: 357 patients completed the study. No symptomatic events were observed; one case of asymptomatic deep vein thrombosis was observed. Overall, in 39 patients (three from the low risk group and 36 in the moderate and high risk groups; p<0.001) a decrease to 15 cm/s was observed in interior femoral blood flow. Haemorrhagic complications, all of them minor, in the surgical wound accounted for 2%. The study of thrombophilia revealed a high number of patients with hidden thrombophilia (28.1%). Conclusion: MAS patients are not free of VTE events and require risk stratification. Thromboprophylaxis with LMWH in moderate and high risk of VTE is safe and effective (..)(AU)

Construction and international validation of CIVIQ-14 (a short form of CIVIQ-20), a new questionnaire with a stable factorial structure.

BACKGROUND: The factorial instability of the CIVIQ-20 social dimension in different populations has necessitated the development of a new stable questionnaire to interpret results from international studies. OBJECTIVE: Construction of a stable and psychometrically validated questionnaire from CIVIQ-20. METHODS AND MAJOR FINDINGS: A prospective, international study was used to construct a stable CIVIQ scale and to validate its psychometric properties. An iterative process was implemented to eliminate the more unstable items (six), and the social and physical dimensions were combined. The resulting instrument comprised 14 items, split into three dimensions (pain, physical, and psychological), and was named CIVIQ-14. The stability of the CIVIQ-14 factorial structure was confirmed in Polish, Czech, Spanish, and French populations using principal component analysis and multitrait/multimethod analysis. Psychometric assessment demonstrated that CIVIQ-14 was reliable (intra-class coefficient >0.8; weighted kappa >0.8), valid (correlation coefficients between dimension scores and clinical severity scores between 0.3 and 0.6), and sensitive (effect sizes >0.6 for psychological dimension; >0.8 for the other dimensions). CONCLUSION: CIVIQ-14 is a reliable, valid, and sensitive instrument applicable to international studies of patients with chronic venous disease.

Análisis de los costes y la efectividad del uso de cilostazol frente a naftidrofurilo y pentoxifilina en el tratamiento de la claudicación intermitente en España / Cost-effectiveness analysis of cilostazol vs naftidrofuryl and pentoxifylline for the treatment of intermittent claudication in Spain

Introducción: El cilostazol es un inhibidor reversible de la fosfodiesterasa III que presenta actividad antiagregante plaquetaria y vasodilatadora. El objetivo de este estudio fue estimar las consecuencias clínicas y económicas del uso de cilostazol en comparación con naftidrofurilo y pentoxifilina en el tratamiento de la claudicación intermitente (CI) en España. Métodos: Se ha construido un modelo fármaco económico basado en la literatura para describir el manejo de la CI y sus consecuencias clínicas y económicas para cada opción terapéutica evaluada en pacientes con 40 o más años y una historia de CI sintomática, secundaria a enfermedad vascular periférica de las extremidades inferiores. Los resultados clínicos provienen de una revisión de los ensayos clínicos respectivos. Se utilizaron costes unitarios españoles para medir las consecuencias económicas asociadas al uso de recursos sanitarios a partir de un estudio similar realizado en el Reino Unido. Resultados: Iniciar el tratamiento con cilostazol en lugar de pentoxifilina aumentaría la distancia máxima recorrida en un 72%, reduciendo los costes en un 11,5%. En comparación con naftidrofurilo, cilostazol se asoció a un aumento de la efectividad del 34% y un aumento de los costes sanitarios del 11,2%. Estos resultados suponen que cilostazol, naftidrofurilo y pentoxifilina presentarían ratios de coste por punto porcentual de aumento de la distancia máxima recorrida de 7,8, 9,1 y 14,7 € respectivamente. Conclusiones: Los resultados de este estudio muestran que iniciar tratamiento con cilostazol presenta una relación de costes y efectividad más favorable respecto a otros tratamientos para la CI en España(AU)

Introduction: Cilostazol is a reversible selective inhibitor of phosphodiesterase III which has platelet antiaggregating and vasodilatory activity. The aim of this study was to estimate the clinical and economic consequences of the use of cilostazol compared with naftidrofuryl and pentoxifylline in the treatment of intermittent claudication (IC) in Spain. Methods: A pharmaco economic model was built based on the literature to describe the management of IC and its clinical and economic consequences for each treatment option evaluated in patients 40 years or older with a medical history of symptomatic IC secondary to peripheral vascular disease of the lower extremities. Clinical results were obtained from a review of clinical trials of the comparators. Spanish unit costs were used to measure the economic consequences associated with the use of healthcare resources based on a similar study performed in the UK. Results: Starting treatment with cilostazol instead of pentoxifylline would increase the maximum distance covered by 72%, reducing costs by 11.5%. Compared with naftidrofuryl, cilostazol was associated with an increase in effectiveness of 34% and an increase in healthcare costs of 11.2%. These results mean that cilostazol, naftidrofuryl and pentoxifylline would have a cost, per one percentage point increase of the maximum distance covered, of € 7.8, € 9.1 and € 14.7, respectively. Conclusions: The study results demonstrate that starting treatment with cilostazol has a more favourable cost-effectiveness ratio compared to other treatments for IC in Spain(AU)

Influencia de la mutación C677T del gen de la metilentetrahidrofolato reductasa en la enfermedad tromboembólica venosa / Influence of the C677T mutation in methylenetetrahydrofolate reductase gene in venous thromboembolic disease

La enfermedad tromboembólica venosa (ETV) es considerada como una enfermedad multifactorial. Es necesaria la presencia de factores genéticos, que predisponen al individuo a la trombosis, y factores ambientales, que desencadenan la trombosis (interacción gen-ambiente). En los últimos años se han descrito numerosos polimorfismos asociados con un mayor o menor riesgo a padecer una enfermedad trombótica en sus distintas variantes. Una de estas mutaciones de interés es la C677T del gen metilentetrahidrofolato reductasa (MTHFR), que consiste en la sustitución de una citosina por una timina en el nucleótido 677. Este cambio de aminoácido genera una variante de MTHFR termolábil con capacidad reducida para metabolizar la homocisteína, pudiendo aparecer una hiperhomocisteinemia leve-moderada, factor de riesgo conocido en la ETV. Por tanto, C677T MTHFR podría predisponer a la aparición y recurrencia de la ETV. Este artículo pretende analizar el papel concreto desempeñado por este polimorfismo en la ETV, así como su aplicabilidad clínica(AU)

Venous thromboembolism (VTE) is a multifactorial disease in which both environmental and genetic factors are involved. The presence of mutations in genes coding for haemostatic, fibrinolytic and, also, inflammatory proteins is associated with an increased risk of first episode and recurrence of venous thrombosis. So, in the last years, several polymorphisms associated with thrombosis have been reported. Recently, the 677C > T polymorphism in the methylenetetrahydrofolate reductase (MTHFR) gene (a C > T substitution at base pair 677 leading to the exchange of alanine to valine) has been proposed by some studies to be a thrombophilic risk factor. This mutation causes moderate hyper-Hcy, and Hyper-Hcy is well known to cause VTE. We analysed the role of C677T MTHFR in VTE, as well as its clinical applicability(AU)

Nuevos anticoagulantes orales / New oral anticoagulants

Después de realizar una perspectiva histórica de los anticoagulantes, se relatan los problemas ylas limitaciones de los actuales, para posteriormente hacer una clasifi cación de los nuevos.El presente artículo de revisión focaliza su atención en los nuevos anticoagulantes orales. Setrata de una apuesta importante de la industria farmacéutica por unos anticoagulantes de administraciónoral, inicio de actividad precoz y una diana específi ca y directa anti-Xa o anti-IIa.Los productos que poseen el desarrollo clínico más avanzado son dabigatran etexilato y rivaroxaban.Se concluye que aunque los nuevos anticoagulantes orales son muy atractivos por diversas razones,todavía no sabemos cuándo reemplazarán a los anticoagulantes convencionales. Cada potencialindicación específica requerirá de nuevas y numerosas investigaciones(AU)

After carrying out a historical review of anticoagulants, the problems and limitations of currentanticoagulants are discussed, and the new anticoagulants are subsequently classify.This review article focuses on new oral anticoagulants. This represents a major commitment bythe pharmaceutical industry with some oral, fast-acting, specifi c target and direct anti-Xa oranti-IIa anticoagulants. Products such as dabigatran etexilate and rivaroxaban are in moreclinically advanced stages of development.It concludes that, although the new oral anticoagulants are more attractive for various reasons,we still do not know when they will replace conventional anticoagulants. Each specifi c potentialindication will need to be defi ned along with many studies(AU)

Activity of Ertapenem and Ceftriaxonein the eradication of Salmonella ina model of experimental peritonitisin mice

Since the beginning of the 1990s, the prevalence ofisolates of non-typhoidal Salmonella species resistant toantimicrobial agents, including those commonly used forthe treatment of Salmonella infections such as fluoroquinolones,trimethoprim-sulfamethoxazole or β-lactams,has increased substantially. Infections caused by multidrugresistantstrains of non-typhoidal Salmonella are now frequentlyencountered.In order to consider an appropriate role of Ertapenemin Salmonella-due intraabdominal infections, in the presentstudy we compare the efficacy of Ertapenem versus that ofCeftriaxone in a mouse peritonitis model.Bacteriological eradication from blood, liver andmesenteric lymph nodes was observed after 5 and 7 days oftreatment in all infected mice receiving ceftriaxone.Although both antimicrobial agents —Ertapenem andCeftriaxone— were observed to be effective in reducingmortality in inoculated mice, our data suggests a reducedefficacy of Ertapenem in the bacteriological eradication ofSalmonella enterica serotype Typhimurium in a mouse peritonitismodel (AU)

Desde la década de 1990, la prevalencia de aislamientosde diferentes especies de Salmonella no-typhiresistentes a antimicrobianos, incluidos los utilizadosmás frecuentemente en el tratamiento de infecciones por Salmonella como fluorquinolonas, SXT o β-lactámicos,se ha incrementado notablemente. Las infecciones causadaspor cepas multirresistentes son en estos momentosfrecuentemente descritas.Con el fin de considerar el papel de ertapenem en eltratamiento de infecciones intraabdominales causadaspor Salmonella se diseña el presente estudio que comparala eficacia de ertapenem frente a ceftriaxona en unmodelo experimental de peritonitis en ratones.La erradicación bacteriológica en sangre, hígado yganglios mesentéricos fue observada a los 5 y 7 días detratamiento en todos los ratones infectados que recibieronceftriaxona.Aunque ambos antimicrobianos, ertapenem y ceftriaxona,demostraron ser eficaces reduciendo la mortalidadde los ratones inoculados, los datos obtenidos sugierenque ertapenem posee una eficacia reducida en laerradicación bacteriológica de Salmonella no-typhi eneste modelo experimental (AU)

[Activity of Ertapenem and Ceftriaxone in the eradication of Salmonella in a model of experimental peritonitis in mice].

Since the beginning of the 1990s, the prevalence of isolates of non-typhoidal Salmonella species resistant to antimicrobial agents, including those commonly used for the treatment of Salmonella infections such as fluoroquinolones, trimethoprim-sulfamethoxazole or beta-lactams, has increased substantially. Infections caused by multidrug-resistant strains of non-typhoidal Salmonella are now frequently encountered. In order to consider an appropriate role of Ertapenem in Salmonella-due intraabdominal infections, in the present study we compare the efficacy of Ertapenem versus that of Ceftriaxone in a mouse peritonitis model. Bacteriological eradication from blood, liver and mesenteric lymph nodes was observed after 5 and 7 days of treatment in all infected mice receiving ceftriaxone. Although both antimicrobial agents -Ertapenem and Ceftriaxone- were observed to be effective in reducing mortality in inoculated mice, our data suggests a reduced efficacy of Ertapenem in the bacteriological eradication of Salmonella enterica serotype Typhimurium in a mouse peritonitis model.

Occurrence and management of chronic venous disease in primary health care in Spain. A comparison of DETECT-2006 with DETECT-2000.

AIM: The aim of this study was to investigate the prevalence and initial treatment of chronic venous disease (CVD) in the Spanish primary health care system during 2006 and to compare the results with those obtained in 2000. METHODS: The survey involved 1 118 general practitioners co-ordinated by 37 specialists in angiology and vascular surgery, assessing 15 consecutive patients, each attending the clinics between 29 May and 2 June 2006. RESULTS: Of the16 186 patients reported, 82% had CVD risk factors. When asked about CVD signs or symptoms 11 277 patients (69.7%) mentioned some kind of clinical manifestation/sign compatible with the disease. Diagnosis was established in accordance with the clinical section of the CEAP classification, 38% of the total being classified as C2-C6. Sixty-two percent of the symptomatic patients had received prior treatment (vs 24.8% in year 2000), and following the survey 88% of the patients diagnosed with CVD were treated (vs 62% in 2000). CONCLUSIONS: The results for 2006 confirm the high prevalence of CVD in primary health care in Spain. In comparison with the results for 2000, an improvement in the patterns of medical advice use, treatment and prescriptions are observed. Despite these findings, specific training programs in primary health care regarding the diagnosis and treatment of CVD continue to be necessary.

The autologous superficial femoral artery as a substitute for the carotid axis in oncologic surgery. Three new cases and a review of the literature.

When neck cancer affects the carotid artery, the best therapeutic option is to remove the tumor en bloc, including the affected vessels. When the carotid artery is revascularized, the usual practice according to the literature is to replace the defective carotid artery with an autologous graft from the saphenous vein, although it is also possible to use an autologous superficial femoral artery (SFA). The use of the SFA in oncologic surgery does not seem to be widespread; in fact, we only found 7 references (67 cases). Here we report three cases in which the SFA was employed and offer a review of the literature. The SFA has advantages and disadvantages in comparison with the saphenous vein. The need for interdisciplinary collaboration (otorhinolaryngology/vascular surgery) is very important, especially in situations where the saphenous vein is not available.

Angiogénesis terapéutica en pacientes con isquemia crítica crónica de las extremidades inferiores. Estudio fase II mediante inyección de células AC133+ obtenidas de sangre periférica movilizadas con G-CSF. Seguimiento de tres primeros casos / Therapeutical angiogenesis in patients with critical leg ischemia. Phase II study with injection of AC133+ cells mobilized with G-CSF from peripheral blood. Follow-up of three first cases

Introducción: La insuficiencia arterial crónica de las extremidades inferiores es una enfermedad extremadamente incapacitante y que afecta un 3,5% de los varones mayores de 60 años. En el momento actual, la terapia celular es una alternativa de reciente aplicación que presenta grandes perspectivas en el tratamiento de las isquemias periféricas. El objetivo del presente estudio fue analizar la seguridad y eficacia de las células AC133+ autólogas en promover la revascularización de MMII en pacientes con isquemia crítica de las EEII. Material y Métodos: Se han incluido 3 pacientes con isquemia crítica de las extremidades inferiores que fueron sometidos a movilización de células hematopoyéticas desde la médula osea a la sangre periferica (SP) a través del G-CSF. Posteriormente, los progenitores endoteliales autólogos AC133+, extraídos y seleccionados desde SP mediante el sistema CliniMACS® (Miltenyi Biotec), fueron inyectados intramuscularmente. Se hizo un seguimiento de los pacientes durante 6 meses según el protocolo del estudio, valorándose variables clínicas, funcionales, hemodinámicas, anatómicas y de calidad de vida. Resultados: El proceso de movilización, recolección y infusión de los progenitores endoteliales fue bien tolerado. A lo largo del seguimiento no se ha producido ninguna amputación y hubo mejoría objetiva y subjetiva de algunas de las variables estudiadas. Conclusión: Hasta el momento y con tres enfermos incluidos en el estudio el proceso de administración de las células AC133+ se ha mostrado seguro y sin complicaciones, entretanto hemos de ser prudentes en correlacionar la terapia celular y mejoría clínica. Con la inclusión de nuevos pacientes y su seguimiento a medio plazo seguramente se nos aclarará el efecto clínico de las células AC133+

Introduction: Chronical arterial disease (CAD) is an extremely incapacitating illness which affects 3-5% of the male population above 60 years-old. Actually, cell therapy is an alternative that causes great expectation for the treatment of the peripheral ischemias. The aim of the present study was to analyze the efficiency and security of autologous AC133+ cells on promoting limb revascularization in patients with critical CAD. Material and Methods: Three patients with critical CAD were included and followed up to date. The patients were subjected to mobilization of hematopoietic precursors from the bone marrow to peripheral blood with G-CSF. Later, the autologous endothelial stem cells AC133+, extracted and selected from blood through the CliniMACS® (Miltenyi Biotec) system, were injected intramuscularly. The patients were followed for 6 months as the study’s protocol and clinical, functional, hemodynamic, anatomical and quality of life variables were evaluated. Results: The process of mobilization, collection and infusion of the endothelial stem cells was well tolerated. Through the follow-up there were no amputations and there was objective as well as subjective improvement of some studied variables. Conclusion: So far and with three included patients, the process of administration of the AC133+ cells has shown security and lack of complication, although we have to be cautious on correlating cell therapy with clinical improvement. With the inclusion of new patients and their mid term follow-up we shall clarify the clinical effect of the AC133+ cells

Nitric oxide prevents the bacterial translocation and inhibits the systemic inflammatory response produced by implantation of a vascular prosthesis followed by Zymosan A.

OBJECTIVE AND DESIGN: To evaluate the beneficial effects of exogenous NO and its levels of action in a model of SIRS/Bacterial Translocation (BT) induced by two sequential insults. MATERIAL OR SUBJECTS: Eighty-six Wistar rats were submitted to different treatments and their tissue and blood samples were accessed at the end of the experiment. TREATMENT: Nitric Oxide was compared to Gentamicin as the tested guideline for our study. METHODS: Dacron graft implantation (first insult) and subsequent administration of Zymosan A((R)) (second insult) were performed in Wistar rats. The animals were divided into 6 groups: I) No manipulation (BASAL: ); II) Laparotomy (L) + mineral oil (SHAM: ); III) L + Graft-Zymosan (GZ) (CONTROL: ); IV) L + GZ + Antibiotic (A) (ASSAY: I); V) L + GZ + NO (ASSAY: II) and VI) L + GZ + A + NO (ASSAY: III). Determinations: Survival, Bacterial Translocation, myeloperoxidase (MPO), Cytokines (TNF-alpha, IL-1beta, IFN-gamma), Oxygen Free Radical (OFR) SOA and detoxifying enzymes (SOD, Superoxide Dismutase, CAT, Catalase and GPX, Glutathione Peroxidase), Cell Adhesion Molecules, CAMs (ICAM-1, VCAM-1 and PECAM-1) and Nuclear Transcription Factor, NFkappaB. RESULTS: The model established induced a mortality rate of 20% and generated BT in all samples. It also significantly increased all variables, with P < 0.001 for MPO and all Cytokines; P < 0.01 for all OFR, and P < 0.05 for CAMs and for NFkappaB. Treatment with A reduced mortality to 0%, significantly decreased BT, MPO, Cytokines and OFR (P < 0.05), but did not reduce CAMs or NFkappaB. NO, either alone or associated, reduced mortality to 0% and abolished BT, significantly decreasing nearly all the variables studied (P < 0.001 for MPO and all Cytokines; P < 0.01 for OFR, and P < 0.05 for CAMs and for NFkappaB). CONCLUSIONS: The exogenous administration of NO before the two sequential insults prevented BT and controlled SIRS peripherally and at both cellular and transcriptional level in a lasting manner. In contrast, antibiotic treatment only exerted its action at peripheral level. The association of both treatments did not provide any important advantages.

Quality of life (Spain and France): validation of the chronic venous insufficiency questionnaire (CIVIQ).

A health-related quality of life (HRQOL) assessment is particularly necessary for patients with chronic venous insufficiency (CVI), as is an assessment of the objective signs (edema, dilated veins, ulceration and other lesions). A comprehensive 3-year research program was undertaken in France to construct and validate the Chronic Venous Insufficiency Questionnaire (CIVIQ), a questionnaire designed specifically to evaluate the quality of life for CVI sufferers. The next step was to implement a program of cross-cultural validation in several countries. Translation into Spanish was undertaken following international guidelines. Face validity was verified with a pilot test among 12 Spanish patients. Psychometric validation was performed in Spain (n = 476 patients with CVI). The Spanish CIVIQ demonstrated very good internal consistency, high reproducibility and responsiveness, as well as longitudinal clinical validity. It appears to be a valuable instrument for assessing improvement in patient quality of life in response to both therapy in clinical practice and clinical trials.