[Vascular graft of aponeurosis with peritoneum in dogs]. / Injerto vascular de aponeurosis con peritoneo en perros.

BACKGROUND: Vascular autografts are commonly used to repair damage to blood vessels; however, they can be used only with small-caliber vessels. Although synthetic vascular grafts are good options, there may be a high likelihood of thrombus formation. METHODS: An experimental animal model was used in order to evaluate feasibility and viability of a vascular autograft. Under inhalatory anesthesia, seven mongrel dogs were operated on. A 4-cm vascular autograft was created with the posterior rectus aponeurosis with subjacent peritoneum, leaving the second one as the internal sheath. A 2-cm-long portion of the abdominal aorta was removed and the vascular autograft was inserted by end-end surgical anastomosis. Animals were observed for 7 weeks, evaluating clinical data of vascular insufficiency (intensity of pulse, temperature and trophic changes of the legs). At the end of the experiment, aortography under fluoroscopic visualization was performed. Dogs were sacrificed and autograft removed in order to evaluate permeability. RESULTS: All dogs survived until the end of the procedure. Vascular autograft was easy to create. During surgery, no evidence of bleeding of the anastomosis or the graft suture was noted. At the end of the procedure, no clinical signs of vascular insufficiency were noted; radiographic evaluation of the autograft showed no dye leakage at any level. Autografts were removed and no signs of thrombus formation were noticed. CONCLUSIONS: Feasibility of the vascular autograft was demonstrated with good permeability and no thrombogenicity.

Injerto vascular de aponeurosis con peritoneo en perros / Vascular graft of aponeurosis with peritoneum in dogs

BACKGROUND: Vascular autografts are commonly used to repair damage to blood vessels; however, they can be used only with small-caliber vessels. Although synthetic vascular grafts are good options, there may be a high likelihood of thrombus formation. METHODS: An experimental animal model was used in order to evaluate feasibility and viability of a vascular autograft. Under inhalatory anesthesia, seven mongrel dogs were operated on. A 4-cm vascular autograft was created with the posterior rectus aponeurosis with subjacent peritoneum, leaving the second one as the internal sheath. A 2-cm-long portion of the abdominal aorta was removed and the vascular autograft was inserted by end-end surgical anastomosis. Animals were observed for 7 weeks, evaluating clinical data of vascular insufficiency (intensity of pulse, temperature and trophic changes of the legs). At the end of the experiment, aortography under fluoroscopic visualization was performed. Dogs were sacrificed and autograft removed in order to evaluate permeability. RESULTS: All dogs survived until the end of the procedure. Vascular autograft was easy to create. During surgery, no evidence of bleeding of the anastomosis or the graft suture was noted. At the end of the procedure, no clinical signs of vascular insufficiency were noted; radiographic evaluation of the autograft showed no dye leakage at any level. Autografts were removed and no signs of thrombus formation were noticed. CONCLUSIONS: Feasibility of the vascular autograft was demonstrated with good permeability and no thrombogenicity.

[Construction of an ultrasound clinical scale for the diagnosis of choledocolithiasis]. / Construcción de una escala clínica-ultrasonográfica para el diagnóstico de coledocolitiasis.

OBJECTIVE: to describe the construction of a clinical ultrasonographic scale for diagnosing choledocholithiasis. MATERIAL AND METHODS: A retrospective study of diagnostic tests, done through files of patients older than 18 years old with diagnosis related to having jaundice, who received care at three hospital facilities in Culiacan, Sinaloa, Mexico from 1998 to 1999, was carried out. Clinical, lab and cabinet data were collected. Gold standards were considered endoscopic retrograde cholangio-pancreatography as well as exploratory laparotomy. A diagnostic scale for choledocholithiasis was constructed through logistic regression and multivariate analysis using principal components. Sensitivity, specificity, prediction values, negative and positive likelihood ratio (LR) and ROC curves were estimated. The threshold model was applied for medical decision making. RESULTS: For detecting choledocholithiasis the scale's sensitivity was 98%, specificity was 95%, positive and negative predictive values were 95% and 97%, respectively. The estimated positive LR was 19.6 and negative 0.02. CONCLUSIONS: In adult patients up to 70 years with acute jaundice evolution, the scale can diagnose securely choledocholithiasis. The pretest prevalence and/ or probability do not affect importantly its accuracy for medical decision making.