Caso 6. Aneurisma gigante de arteria hipogástrica en paciente con bifurcado / Case 6. Giant hypogastric artery aneurysm in a patient with a bifurcated gift

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Solución del caso 6. Aneurisma gigante de arteria hipogástrica en paciente con bifurcado / Solution to case 6. Giant hypogastric artery aneurysm in a patient with bifurcation

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Multifunctional targets of dietary polyphenols in disease: a case for the chemokine network and energy metabolism.

Chronic, non-acute inflammation is behind conditions that represent most of the disease burden in humans and is clearly linked to immune and metabolic mechanisms. The convergence of pathways involving the immune response, oxidative stress, increased circulating lipids and aberrant insulin signaling results in CCL2-associated macrophage recruitment and altered energy metabolism. The CCL2/CCR2 pathway and the energy sensor AMP-activated protein kinase (AMPK) are attractive therapeutic targets as a part of preventive management of disease. Several effects of polyphenols are useful in this scenario, including a reduction in the activities of cytokines and modulation of cellular metabolism through histone deacetylase inhibitors, AMPK activators, calorie-restriction mimetics or epigenetic regulators. Research is currently underway to develop orally active drugs with these effects, but it is convenient to examine more closely what we are eating. If a lack of relevance in terms of toxicity and substantial effectiveness are confirmed, plant-derived components may provide useful druggable components and dietary supplements. We consider therapeutic actions as a combination of synergistic and/or antagonistic interactions in a multi-target strategy. Hence, improvement in food through enrichment with polyphenols with demonstrated activity may represent a major advance in the design of diets with both industrial and sanitary value.

Los resultados de la cirugía convencional siguen siendo superiores a los de las técnicas endovasculares / No disponible

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The role of combined assessment of defense against oxidative stress and inflammation in the evaluation of peripheral arterial disease.

Atherosclerosis in symptomatic peripheral arterial disease affects wide portions of numerous arteries in lower extremities. The resulting active inflammation in a considerable amount of arterial tissue facilitates systemic detection via measurement of inflammation-related variables. We reasoned that the combined assessment of defense against oxidative stress, in the form of paraoxonase-1 (PON1), and monocyte migration measured as circulating (C-C motif) ligand 2 (CCL2), may play a role in the evaluation of these patients. Plasma CCL2 and serum PON1-related variables, assessed by their interaction with functional genetic variants, were measured in a cross-sectional study in patients with symptomatic PAD. We found that PON1 activity and concentration were significantly lower and CCL2 concentration higher in PAD patients compared to controls, that the combination of plasma CCL2 and PON1- related values, especially PON1 concentration differentiated, almost perfectly, controls from patients and that the expression of CCL2 and PON1 generally co-localized in the atherosclerotic lesion. Since no association with genetic variants was found, such a relationship is probably the result of the disease. Our data suggest a coordinated role between CCL2 and PON1 that may be detected in blood with simple measurements and may represent an indicator of the extent of atherosclerosis.

Fístula arteriovenosa carotidoyugular de origen congénito / Congenital carotid-jugular arteriovenous fistula

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Leucocitosis y abdominalgia en un paciente con masa abdominal pulsátil / No disponible

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Estenosis de arteriarenal segmentaria causante de hipertensión renovascular / No disponible

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Phlegmasia cerulea dolens of the lower extremities secondary to thrombosis of an inferior vena caval aneurysm.

We present the clinical case of a 34-year-old male with an aneurysm of the inferior vena cava in which thrombosis led to a picture of bilateral phlegmasia cerulean dolens of the lower extremities. A clear and precise diagnosis was achieved by angio CT which allowed initial conservative management with good immediate and short term outcome. To our knowledge only 23 cases of aneurysm of the inferior vena cava have been reported in the literature worldwide making it difficult to establish a diagnostic and therapeutic algorithm for these cases. Nine cases were presented with thrombosis and in the other 14 the diagnosis was incidental. They mimic a pararenal mass requiring differential diagnosis with retroperitoneal neoplasms.

Tratamiento médico de la isquemia aguda de miembros inferiores / Medical treatment of acute ischemia of lower limbs

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Dolor abdominal e impotencia funcional de la extremidad inferior como forma de presentación de un aneurisma de aorta abdominal con rotura crónica / Abdominal pain and functional impotence of the low limb as presentation form of an abdominal aorta aneurysm with chronic rupture

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Reingeniería de procesos como herramienta para la gestión de listas de espera de varices / Process re-engineering as a tool for managing waiting lists for treatment of varicose veins

Introducción. Las listas de espera de varices son un problema que afecta a la mayoría de los servicios de cirugía vascular. Existen diversos mecanismos para el abordaje de estas listas, entre ellos, las medidas de tipo organizativo encaminadas a mejorar la eficiencia mediante una gestión adecuada de éstas. Dentro de estas medidas, las técnicas de reingeniería de procesos son una herramienta a nuestro alcance que puede ayudarnos en la gestión apropiada de las listas de espera. Objetivo. Rediseñar el proceso variz para conseguir una reducción de la lista de espera de varices en un servicio de cirugía vascular. Materiales y métodos. La lista de espera pendiente de intervención por varices en nuestro hospital era de 305 pacientes. Para abordar esta larga lista de espera, se realizó un rediseño del proceso variz en tres fases: análisis del proceso variz y determinación de sus puntos críticos; implantación de estrategias para crear el nuevo proceso variz y evaluación del nuevo proceso variz en forma de eficacia (reducción de la lista de espera), eficiencia (test de calidad de vida) y calidad (complicaciones, reingresos y recidivas). Resultados. Eficacia: en un año, se realizaron un total de 335 intervenciones de varices en 323 pacientes con un índice de cumplimiento de quirófano del 95,7%; eficiencia: al año de seguimiento, hubo un aumento de 5 puntos en la calidad de vida global de los pacientes intervenidos; y calidad técnica: el total de complicaciones fue de nueve (2,6%). Hubo cinco reingresos (1,4%) y tres recidivas al año (0,9%). Conclusión. La aplicación de un programa de reingeniería nos ha permitido una reducción de nuestra lista de espera de varices de una manera efectiva

Introduction. Most vascular surgery services are affected by the problem of the length of the waiting lists for treatment of varicose veins. A number of approaches can be used to handle these lists, including organisational-type measures that are oriented towards enhancing efficiency by implementing a more suitable method of managing them. Process re-engineering techniques are one of these measures that can help us to establish a more adequate way of managing such waiting lists. Aim. To redesign the therapy process in order to reduce the waiting lists for treatment of varicose veins in a vascular surgery service. Materials and methods. The number of patients on the waiting list for surgery to correct varicose veins was 305. To deal with this waiting list, the process used in varicose vein therapy was redesigned in three phases: analysis of the varicose vein therapy process and determination of its critical points; implementation of strategies for the creation of the new varicose process and evaluation of the new process as regards its effectiveness (reduction in the length of the waiting list), efficiency (test for quality of life) and quality (complications, re-admissions and relapses). Results. Effectiveness: in one year a total of 335 operations were carried out to treat varicose veins in 323 patients, with a theatre compliance rate of 95.7%; efficiency: at one year follow-up, the overall quality of life of the patients who had undergone surgery had increased by 5 points; and technical quality: in all there were nine complications (2.6%). There were five readmissions (1.4%) and three relapses at one year (0.9%). Conclusions. Applying a re-engineering programme enabled us to reduce our waiting lists for treatment of varicose veins in an effective manner

Quiste adventicial de arteria poplítea y su relación con la articulación de la rodilla. Histología y resonancia magnética / Adventitial cyst of the popliteal artery and its relation to the knee joint. Histology and magnetic resonance imaging

Introducción. El quiste adventicial de arteria poplítea es una causa poco frecuente de síntomas isquémicos de extremidades inferiores. No obstante, es importante considerarlo en el diagnóstico diferencial de individuos jóvenes afectos de claudicación intermitente gemelar. Pese a que la etiología y patogenia de esta entidad permanece todavía incierta, un correcto diagnóstico permite al especialista restaurar el flujo sanguíneo normal de la extremidad. Caso clínico. Paciente de 57 años con claudicación intermitente y portador de un quiste adventicial de arteria poplítea, en el que su comunicación con la articulación de la rodilla puede demostrarse por resonancia magnética y confirmarse por cirugía. Conclusión. La resonancia magnética es una prueba diagnóstica que pudo mostrar claramente esta patología y reforzar la hipótesis sinovial

Introduction. Adventitial cysts of the popliteal artery are an infrequent cause of ischaemic symptoms in the lower extremities. It is, however, important to take them into account in the differential diagnosis in young individuals with intermittent claudication in the calf muscles. Although the causation and pathogenesis of this condition remain uncertain, a correct diagnosis allows the specialist to restore normal blood flow in the extremity. Case report.We studied the case of a 57-year-old patient with intermittent claudication and an adventitial cyst of the popliteal artery, which magnetic resonance imaging showed to be communicating with the knee joint, and this was later confirmed by surgery. Conclusions. Use of magnetic resonance imaging as a diagnostic test was able to clearly demonstrate the existence of this pathology and lend support to the synovial hypothesis

[Carotid stenosis in high risk patients. The SAPPHIRE study versus a decision analysis. Which is the best therapeutic option?]. / Estenosis carotídea en enfermos de alto riesgo. Estudio SAPPHIRE frente a un ánalisis de decisión. Cuál es la mejor opción terapéutica?

INTRODUCTION: In the results from the SAPPHIRE study on high surgical risk patients with carotid stenosis there are no differences between carotid stent-angioplasty (CSA) and carotid endarterectomy (CEA). AIMS: The aim of this study was to analyse the cost-effectiveness of these two interventions based on the data from the above-mentioned study and on our own experience in carotid surgery. PATIENTS AND METHODS: We evaluated 108 CSA carried out between 1999 and 2003. The morbidity and mortality rates in the subgroup of high risk patients, according to the criteria used in the SAPPHIRE study, were analysed according to whether they were symptomatic or asymptomatic. Data concerning endovascular treatment were taken from the literature. A cost-effectiveness study was conducted considering four possible perioperative events: absence of sequelae, AMI, established CVA and death. The computer software package DATAPro was used after fitting the decision to the theoretical quality of life for each of these groups. Cost-effectiveness was estimated based on the cost of each procedure. RESULTS: Of the 108 patients, 41 (37.96%) belonged to the high risk subgroup; 46.3% of them were asymptomatic and 53.7% were symptomatic. In the 30 days following the intervention, one CVA (5.2%) and one AMI (4.5%) were observed. No deaths occurred. The decision analysis for symptomatic patients showed CEA to be the most effective therapeutic option. Similar results were obtained for asymptomatic patients. The average cost for CEA was 3,963 euros and rose to 5,158 euros in the case of CSA. CONCLUSIONS: In our study, CEA is the preferred technique in high risk patients owing to its having a better cost-benefit ratio.

Estenosis carotídea en enfermos de alto riesgo. Estudio SAPPHIRE frente a un análisis de decisión. ¿Cuál es la mejor opción terapéutica? / Carotid stenosis in high risk patients. The SAPPHIRE study versus a decision analysis. Which is the best therapeutic option?

Introducción. En los resultados del estudio SAPPHIRE sobre pacientes con estenosis carotídea de alto riesgo quirúrgico, no se demuestran diferencias entre la angioplastia-endoprótesis carotídea (AEC) y la endarterectomía carotídea (EDA). Objetivo. Realizar un análisis coste-eficacia entre estas dos intervenciones a partir de los datos de dicho estudio y de nuestra experiencia en cirugía carotídea. Pacientes y métodos. Valoramos 108 EDA realizadas entre 1999 y 2003. Se analizó la morbimortalidad del subgrupo de pacientes de alto riesgo, según los criterios utilizados en el estudio SAPPHIRE, en función de si eran sintomáticos o asintomáticos. Los datos relativos al tratamiento endovascular se extrajeron de la literatura. Realizamos un estudio coste-eficacia en función de cuatro posibles eventos perioperatorios: ausencia de secuelas, IAM, AVC establecido y muerte. Se utilizó el paquete informático DATAPro ajustando la decisión a la calidad de vida teórica para cada uno de estos grupos. Se realizó una estimación coste-eficacia a partir del precio para cada procedimiento. Resultados. De 108 pacientes, 41 (37,96%) pertenecían al subgrupo de alto riesgo. Eran asintomáticos el 46,3%, y sintomáticos el 53,7%. En los 30 días posteriores al procedimiento se observó un AVC (5,2%) y un IAM (4,5%). No hubo ningún fallecimiento. El análisis de decisión para pacientes sintomáticos muestra como opción terapéutica más eficaz la EDA. Se obtienen resultados similares para los pacientes asintomáticos. El coste medio para la EDA fue de 3.963 € , y para la ASC, 5.158 € . Conclusiones. En nuestro estudio, la EDA es la técnica de elección en pacientes de alto riesgo al tener mejor relación coste-beneficio

Introduction. In the results from the SAPPHIRE study on high surgical risk patients with carotid stenosis there are no differences between carotid stent-angioplasty (CSA) and carotid endarterectomy (CEA). Aims. The aim of this study was to analyse the cost-effectiveness of these two interventions based on the data from the above-mentioned study and on our own experience in carotid surgery. Patients and methods. We evaluated 108 CSA carried out between 1999 and 2003. The morbidity and mortality rates in the subgroup of high risk patients, according to the criteria used in the SAPPHIRE study, were analysed according to whether they were symptomatic or asymptomatic. Data concerning endovascular treatment were taken from the literature. A cost-effectiveness study was conducted considering four possible perioperative events: absence of sequelae, AMI, established CVA and death. The computer software package DATAPro was used after fitting the decision to the theoretical quality of life for each of these groups. Cost-effectiveness was estimated based on the cost of each procedure. Results. Of the 108 patients, 41 (37.96%) belonged to the high risk subgroup; 46.3% of them were asymptomatic and 53.7% were symptomatic. In the 30 days following the intervention, one CVA (5.2%) and one AMI (4.5%) were observed. No deaths occurred. The decision analysis for symptomatic patients showed CEA to be the most effective therapeutic option. Similar results were obtained for asymptomatic patients. The average cost for CEA was 3,963 € and rose to 5,158 € in the case of CSA

Aneurismas de aorta abdominal. Influencia de la presión atmosférica y la estación anual en su rotura / Abdominal aortic aneurysms. The influence exerted by atmospheric pressure and the season of the year on their rupture

Introducción. Existen varios factores que se han relacionado con la rotura de los aneurismas de aorta abdominal. Uno de estos factores son las variaciones estacionales, y dentro de éstas, los cambios de las presiones barométricas. Objetivo. Analizar si existe relación entre la variación de la presión atmosférica o las estaciones anuales y la rotura de aneurismas de aorta abdominal. Pacientes y métodos. Estudio retrospectivo de pacientes intervenidos en nuestro servicio de aneurisma de aorta abdominal roto (AAAR) en los últimos cinco años. En cada paciente se determinó: presión atmosférica media (Pmed) del mes anterior, la semana anterior y el mismo mes en el que se produjo la rotura. Además, se determinó el número de aneurismas rotos según la estación. Se empleó la correlación de Pearson para relacionar la variación de la presión atmosférica y la estación anual con el número de AAAR. Resultados. Pacientes intervenidos: 51; edad media: 73 años (r = 51-87). Mes con mayor número de roturas: noviembre (8). Meses con menos roturas: febrero y marzo (1). Estaciones anuales con mayor número de roturas: primavera y otoño. Al analizar los resultados, únicamente se observa correlación entre el número de roturas y la disminución de la presión atmosférica la semana anterior a la rotura (p = 0,006; r = -0,744). No existe correlación con el resto de los parámetros analizados. Conclusiones. Existe una relación entre el aumento de la incidencia de AAAR y la disminución de la presión atmosférica la semana anterior a la rotura del aneurisma (AU)

Documento de Consenso sobre Tratamiento Extrahospitalario de la Trombosis Venosa / No disponible

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