Hipertensión arterial refractaria en paciente joven secundaria a tumor del cuerpo carotídeo bilateral productor de catecolaminas / Refractory arterial hypertension in a young patient with a bilateral catecholamine-secreting carotid body tumour

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Explante quirúrgico de endoprotésis aórtica tras endofuga de tipo II persistente / Surgical removal of aortic stent grafts after persistent type II endoleak

No disponible

Seudoaneurisma gigante por perforación de rama de injerto aortobifemoral en cirugía de prótesis de cadera / Massive pseudoaneurysm secondary to perforation of a branch of an aortobifemoral Dacron(R) graft after total hip arthroplasty

No disponible

Compresión de la vía aérea superior secundaria a un pseudoaneurisma carotídeo / Compression of the upper airway secondary to carotid pseudoaneurysm

No disponible

Aneurismas poplíteos pequeños. ¿Son todos benignos? / Small popliteal artery aneurysms. Are all of them benign?

INTRODUCCIÓN: Los aneurismas poplíteos (AP) son infrecuentes, sin embargo, sus complicaciones tromboembólicas son usuales y pueden conducir a la pérdida de la extremidad. El comportamiento de los AP pequeños (APP) es incierto. El objetivo de nuestro estudio es: 1) describir y analizar el comportamiento de los APP dentro de una extensa serie quirúrgica de AP; 2) realizar un estudio comparativo con aquellos AP>2cm. MATERIAL Y MÉTODOS: Entre el 31 de agosto de 1986 y el 31 de diciembre de 2013, 157 AP en 132 pacientes fueron intervenidos en nuestro Servicio de Cirugía Vascular. La información ha sido recogida en una base de datos retrospectiva. Se consideran APP aquellos con diámetro transversal ≤ 2 cm. Se establecen 2 grupos: 31 AP ≤ 2 cm (grupo 1) y 126 AP>2cm (grupo 2). RESULTADOS: En el grupo de APP (grupo 1) el 67,7% de los casos fueron sintomáticos y en el grupo 2, el 58,7%, sin diferencias estadísticamente significativas. Los APP se manifiestan con isquemia aguda en el 32,3% de los casos, claudicación en 9,7%, dolor de reposo en el 19,4% y lesiones tróficas en el 6,5%. En el grupo, 2 los casos de dolor de reposo y lesiones tróficas son 5,6 y 0,8%, respectivamente, p = 0,026. La trombosis aneurismática está presente como complicación principal en el 58,1% en el grupo 1 y en el 33,3% en el grupo 2, en tanto que la rotura es del 0% en el grupo 1 y del 6,3% en el grupo 2, p = 0,040. CONCLUSIONES: Los APP no son tan benignos como pudiera pensarse ya que pueden trombosarse y producir isquemia crítica de la extremidad. Puesto que el objetivo de la reparación quirúrgica de un AP es prevenir las complicaciones tromboembólicas, se ha de considerar la reparación de los APP≤2 cm (AU)

BACKGROUND: Popliteal artery aneurysms (PAAs) are uncommon; however thromboembolic complications are usual and may result in limb loss. The natural history of small PAA is unknown. The aim of our study is: 1) to describe and analyse the behaviour of small PAA through our wide experience, and 2) to compare small PAAs to those PAA > 2 c m. MATERIAL AND METHODS: A total of 157 PAAs were operated on in 132 patients were operated on in our vascular surgery department from 31 August 1986 to 31 December 2013. Data from all the patients were retrospectively collected int a database. A small PAA was defined as a popliteal artery with a diameter ≤ 2 cm. Two groups were formeded: 31 PAA ≤ 2 cm (group 1) and 126 PAA > 2 cm (group 2). RESULTS: In group 1, 67.7% PAAs were symptomatic and 58.7% in group 2. In group 1 acute limb ischaemia was observed in 32.3%, claudication in 9.7%, ischaemic rest pain in 19.4%, and tissue loss in 6.5%. There was rest pain in 5.6% and tissue loss in 0.8% of group 2: P=.026. Aneurysm thrombosis was present as a primary complication, in 58.1% of group 1, and in 33.3% of group 2, with aneurysm rotura in 0% of group 1 and in 6.3% of group 2; P=.040. CONCLUSION: A small PAA is not as benign as it might seem, since it may thrombose and can result in limb ischaemia and limb loss. As the objective of popliteal artery aneurysm repair is to prevent thromboembolism, a surgical approach must be considered in small PAAs before complications appear

Valor pronóstico de un ingreso previo médico o quirúrgico en pacientes con embolia pulmonar sintomática ambulatoria / Prognostic value of a previous medical or surgical admission in outpatients with symptomatic pulmonary embolism

Objetivo. Determinar si el antecedente de un ingreso, médico (IM) o quirúrgico (IQ), en los 3 meses previos es un factor asociado a la mortalidad a los 30 días en pacientes con embolia pulmonar aguda sintomática ambulatoria. Método. Estudio observacional de cohortes retrospectivo que incluyó a pacientes adultos con el diagnóstico de embolia pulmonar aguda sintomática en un hospital terciario durante 6 años. Resultados. Se incluyeron 870 pacientes con una edad media de 72,7 años. Un 10,6% (92) tuvieron un IM previo y un 4,9% (43) un IQ. Ciento doce (12,9%) fallecieron en los primeros 30 días. En el grupo de IM se documentó mayor frecuencia de Pulmonary Embolism Severity Index (PESI) simplificada de alto riesgo (≥1) (IM 90,2% vs. IQ 65,1% vs. sin ingreso previo 67%; p<0,001) y de mortalidad a los 30 días (IM 20,7% vs. IQ 7% vs. sin ingreso previo 12,9%; p=0,038). Tras un análisis de regresión logística la PESI simplificada≥1 fue el único factor independiente de mortalidad a 30 días. Conclusiones. La gravedad del episodio agudo, valorada por la escala PESI simplificada, se asocia de forma independiente con la mortalidad a 30 días en los pacientes con embolia pulmonar aguda sintomática ambulatoria. El antecedente de un IM en los 3 meses previos suele conllevar mayor gravedad en el episodio agudo (AU)

Objective. To determine whether an earlier medical (MA) or surgical (SA) admission in the previous three months is a factor associated with mortality at 30 days in outpatients with acute symptomatic pulmonary embolism. Method. Observational, retrospective cohort study on adult patients diagnosed with acute symptomatic pulmonary embolism in a tertiary hospital over a period of 6 years. Results. The study included 870 patients with a mean age of 72.7 years: 10.6% (92) had a prior MA, 4.9% (43) had a SA and 12.9% (112) died within the first 30 days. The MA group showed a higher frequency of simplified Pulmonary Embolism Severity Index (PESI) of high risk (≥1) (MA 90.2% vs SA 65.1% vs no prior admission 67.0%; p<0.001) and mortality at 30 days (MA 20.7% vs SA 7.0% vs no prior admission 12.9%; p=0.038). The logistic regression analysis demonstrated that a simplified PESI≥1 was the only independent risk factor for mortality at 30 days. Conclusions. The severity of the acute episode, as assessed by the simplified PESI scale, is independently associated with mortality at 30 days in outpatients with acute symptomatic pulmonary embolism. An earlier MA in the previous 3 months usually involves greater severity in the acute episode (AU)

Prognostic value of a previous medical or surgical admission in outpatients with symptomatic pulmonary embolism.

OBJECTIVE: To determine whether an earlier medical (MA) or surgical (SA) admission in the previous three months is a factor associated with mortality at 30 days in outpatients with acute symptomatic pulmonary embolism. METHOD: Observational, retrospective cohort study on adult patients diagnosed with acute symptomatic pulmonary embolism in a tertiary hospital over a period of 6 years. RESULTS: The study included 870 patients with a mean age of 72.7 years: 10.6% (92) had a prior MA, 4.9% (43) had a SA and 12.9% (112) died within the first 30 days. The MA group showed a higher frequency of simplified Pulmonary Embolism Severity Index (PESI) of high risk (≥1) (MA 90.2% vs SA 65.1% vs no prior admission 67.0%; p<0.001) and mortality at 30 days (MA 20.7% vs SA 7.0% vs no prior admission 12.9%; p=0.038). The logistic regression analysis demonstrated that a simplified PESI≥1 was the only independent risk factor for mortality at 30 days. CONCLUSIONS: The severity of the acute episode, as assessed by the simplified PESI scale, is independently associated with mortality at 30 days in outpatients with acute symptomatic pulmonary embolism. An earlier MA in the previous 3 months usually involves greater severity in the acute episode.

Distrofia simpático refleja / Reflex sympathetic dystrophy

La Distrofia Simpático Refleja (DSR), o Distrofia de Südeck, es una entidad patológica poco estudiada, infradiagnosticada, con graves consecuencias y que altera la calidad de vida de los pacientes que la padecen. Ha recibido otras denominaciones históricas como Causalgia (mayor o menor), aunque en la actualidad se le denomina Síndrome de Dolor Regional Complejo (SDRC), también conocido como CRPS por sus siglas en inglés (Complex Regional Pain Syndrom). Este cuadro clínico se divide en dos tipos: 1/ SDRC tipo I o Distrofia Simpático Refleja, y 2/ SDRC tipo II o Causalgia. La diferencia entre ellos radica en la lesión del nervio, que es objetivable únicamente en el tipo II. El síntoma clave que define a esta enfermedad es la presencia de un intenso y persistente dolor, de causa inexplicable, junto con disestesias y alodinia térmica. Su diagnóstico es básicamente clínico, acompañado de sus antecedentes, generalmente traumáticos, así como algunos estudios radiológicos complementarios. En cuanto a la terapéutica de esta enfermedad, es necesario combinar tanto la fisioterapia como tratamientos farmacológicos y psicológicos (AU)

Reflex Sympathetic Dystrophy (RSD), or Südeck dystrophy is a pathological entity understudied, underdiagnosed, with serious consequences and impaired quality of life for patients who suffer. It has received other mainline denominations as causalgia (major o minor), but today is called Complex Regional Pain Syndrome, also known as CRPS for its acronym in English. This clinical disease is divided into two types: 1 / CRPS Type I or Reflex Sympathetic Dystrophy, and 2 / CRPS type II or causalgia. The difference between them is nerve damage, which is objective only in type II. The key symptom that defines this disease is the presence of an intense and persistent pain, unexplained, along with dysesthesia and thermal allodynia. Diagnosis is mainly clinical, accompanied by his background, usually traumatic, and additional radiologic studies. As for the treatment of this disease, it is necessary to combine both physiotherapy as pharmacological and psychological treatments (AU)

Factores epidemiológicos asociados a la hospitalización por descompensación de la insuficiencia cardiaca / Epidemiological events related to decompensated heart failure

Objetivo: El presente estudio pretende conocer el perfil del paciente que ingresa por descompensación de insuficiencia cardíaca en un hospital de tercer nivel asistencial. Métodos: Se diseña un estudio observacional y retrospectivo en el que se registra de forma aleatoria los ingresos por este proceso en nuestro centro durante el año 2005. Resultados: El tamaño muestral es de 209 pacientes (media de edad: 78,6 ± 9,1; 52,4% varones), con un índice de comorbilidades del 87,55%. Casi un tercio de los pacientes no disponen de valoración de la función sistólica y entre los restantes, la gran mayoría (72,4%) presentan función sistólica conservada. La gran mayoría de las descompensaciones surgen en el seno de infecciones respiratorias. La cardiopatía isquémico-hipertensiva es el origen más frecuente de la cardiopatía con disfunción sistólica. Se registró una estancia hospitalaria media de 12,9 días con un índice de mortalidad del 9,56% resultando sus principales factores de riesgo estadíos funcionales avanzados en las escalas de la NYHA o de la Cruz Roja así como la presencia de demencia o ictus. Conclusiones: El presente estudio muestra un perfil del paciente hospitalizado por descompensación de insuficiencia cardíaca que difiere notablemente de aquel incluído en los grandes ensayos clínicos, lo que sin duda dificulta la aplicación de estrategias terapéuticas que han demostrado ser útiles en aquellos casos

Objective: The present study aimed to evaluate the profile of patients with decompensated heart failure hospitalized in a tertiary hospital. Methods: It was designed an observational and retrospective study where data from clinical records of patients suffering from heart failure along 2005 were registered randomly. Results: 209 patients were collected (average age: 78.6 ± 9.1; male:52.4%) with a comorbidity rate of 87.55%. Almost one third of them have not stimation of systolic function and among the others 72.4% have it preserved. Most of decompensated were due to respiratory infections. Ischemic-hipertensive cardiopathy was the most frequent aetiology ofsystolic disfunction. Average stay was 12.9 days with a mortality rate of 9.56%. Its main risk factors were advanced stages in NYHA od Red Cross scales, as so as dementia or ictus. Conclusions: The present study shows a patient hospitalized for decompensated heart failure roughly different from that one reported at clinical trials. It makes difficult to apply therapeutical interventions, previously well documented to be useful

[Epidemiological events related to decompensated heart failure]. / Factores epidemiológicos asociados a la hospitalización por descompensación de la insuficiencia cardiaca.

OBJECTIVE: The present study aimed to evaluate the profile of patients with decompensated heart failure hospitalized in a tertiary hospital. METHODS: It was designed an observational and retrospective study where data from clinical records of patients suffering from heart failure along 2005 were registered randomly. RESULTS: 209 patients were collected (average age: 78.6 +/- 9.1; male: 52.4%) with a comorbidity rate of 87.55%. Almost one third of them have not stimation of systolic function and among the others 72.4% have it preserved. Most of decompensated were due to respiratory infections. Ischemic-hipertensive cardiopathy was the most frequent aetiology of systolic disfunction. Average stay was 12.9 days with a mortality rate of 9.56%. Its main risk factors were advanced stages in NYHA od Red Cross scales, as so as dementia or ictus. CONCLUSIONS: The present study shows a patient hospitalized for decompensated heart failure roughly different from that one reported at clinical trials. It makes difficult to apply therapeutical interventions, previously well documented to be useful.

[Drug interactions in the prescription of medical patients at hospital discharge]. / Interacciones entre medicamentos prescritos al alta en un Servicio de Medicina Interna.

OBJECTIVES: To detect and evaluate the clinical significance of drugs interactions in patients discharged from hospital. MATERIAL AND METHODS: We retrospectively screened the medication for potential drug interactions of 412 patients discharged. Interactions were catalogued according to clinical importance following the Hansten and Horn's classification. RESULTS: Three hundred twenty-nine potential interactions were detected. The 39.9% of the patients had at least one potentially interacting drug combination. The 52.6% of the interactions were catalogued as Class 3, bearing in mind minimizing the risk of the interaction. We did not find any Class 1 or 2 interactions, which have potentially major severity. Oral anticoagulants and digoxin were the most frequently implicated drugs. The patient monitoring was well done in the 100% of the interactions of Oral anticoagulants with other drug, but in the interactions of digoxin with another, this control was not done adequately. One patient was rehospitalised due to high levels of digoxin, he had been discharged with two potential interactions. CONCLUSIONS: The frequently of potential drug interactions in medical patients at hospital discharged was high, but the clinical significance appear to be low.

Interacciones entre medicamentos prescritos al alta en un Servicio de Medicina Interna / Drug interactions in the prescription of medical patients at hospital discharge

Objetivos: Estimar la frecuencia y valorar la relevancia teórica y repercusión clínica real de las interacciones medicamentosas en pacientes dados de alta desde un área médica. Material y métodos: Se revisan los tratamientos al alta de 412 pacientes de forma aleatoria. Se identifican las potenciales interacciones usando la Guía de Terapia Farmacológica Medimecum. Para la clasificaciónsegún su relevancia clínica teórica se usa la propuesta por Hansten y Horn. Resultados: Se encuentran 329 interacciones teóricas. El 39,9% de los pacientes presentaban al menos una interacción [IC 95%, 34,9%-44,9%]. El 52,6% de las interacciones eran clase 3 según Hansten, aquellas en las que ha de tomarse alguna medida para disminuir el riesgo de efectos indeseables. No se encontró ninguna interacción clase 1 ó 2 de Hansten, categorías de mayor gravedad. Las interacciones clase 3 más frecuentes implican a anticoagulantes orales y digoxina. Las medidas de control fueron realizadas en el 100% de los casos para las interacciones entre anticoagulantes orales y otros fármacos. En las interacciones de digoxina y otros fármacos las medidas de control recomendadas no fueron realizadas suficientemente. Un paciente reingresó con niveles porencima de rango de digoxina, habiendo sido dado de alta con dos potenciales interacciones. Conclusiones: La frecuencia de interacciones en pacientes dados dealta desde el área médica es alta. La relevancia teórica y la práctica parece ser baja

Objectives: To detect and evaluate the clinical significance of drugs interactions in patients discharged from hospital. Material and methods: We retrospectively screened the medication for potential drug interactions of 412 patients discharged. Interactions were catalogued according to clinical importance following the Hanstenand Horn’s classification. Results: Three hundred twenty-nine potential interactions were detected. The 39.9% of the patients had at least one potentially interactingdrug combination. The 52.6% of the interactions were catalogued as Class 3, bearing in mind minimizing the risk of the interaction. We did not find any Class 1 or 2 interactions, which have potentially major severity.Oral anticoagulants and digoxin were the most frequently implicated drugs. The patient monitoring was well done in the 100% of the interactions of Oral anticoagulants with other drug, but in the interactions of digoxin with another, this control was not done adequately. One patientwas re-hospitalised due to high levels of digoxin, he had been discharged with two potential interactions. Conclusions: The frequently of potential drug interactions in medical patients at hospital discharged was high, but the clinical significance appear to be low

Absceso primario de psoas / Primary psoas abscess

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[A rare presentation of tuberculosis. Miliary tuberculosis in a immunocompetent patient]. / Rara presentación de tuberculosis. Afectacón miliar en paciente inmunocompetente.

Currently, miliary TB has a higher incidence among the elderly and immunodepressed patients, and exceptionally in young adults. A case of miliary tuberculosis was diagnosed in a young immunocompetent patient without using invasive techniques. The clinical and diagnostic implications will be discussed.

Rara presentación de tuberculosis. Afectación miliar en paciente inmunocompetente / A rare presentation of tuberculosis. Miliary tb in an immunocompetent patient

En la actualidad, la TB miliar tiene una mayor incidencia en edades avanzadas y en pacientes inmunodeprimidos siendo excepcional en adultos jóvenes. Presentamos el caso de una tuberculosis miliar que fue diagnosticada, en una paciente joven inmunocompetente, sin necesidad de realizar pruebas invasivas. Comentamos las peculiaridades clínicas y diagnósticas de esta entidad (AU)

Anemia hemolítica autoimmune como forma de presentación de lupus eritematoso sistémico / Autoimmune hemolytic anemia as form of presentation to systemic lupus erythematosus

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[Endocarditis caused by Stenotrophomonas maltophilia: report of a case and review of literature]. / Endocarditis caused by stenotrophomonas maltophilia: report of a case and review of literature.

We report a case of a 65 year-old woman with late endocarditis of prosthetic aortic valve and paravalvular abscess by Stenotrophomonas maltophilia, which had an acute presentation for the memtionated abscess broken, with fever, bacteremia and congestive heart failure secondary to severity aortic regurgitation. Itacute;s a rare cause of endocarditis with only 22 cases descripted in medical literature, the most of them in parenteral drug addict and as complication of cardiac valve replacement. The literature is reviewed and relate the epidemiology, clinical and prognosis characteristics of this disease, the same as his treatment and prevention.