Reconstrucción vascular durante cirugía conservadora de la extremidad en el tratamiento de sarcomas del miembro inferior / Vascular reconstruction during limb preserving surgery in the treatment of lower limb sarcoma: A report on four cases

Objetivo: Exposición de la experiencia de este centro en reparación quirúrgica de vasos mayores durante la cirugía de resección de tumores en la extremidad inferior y la pelvis. Material y método: Se presentan 4 casos consecutivos de cirugías de resección tumoral del miembro inferior asociadas a reconstrucción vascular de vasos mayores en el mismo acto quirúrgico en tumores del aparato locomotor realizadas en el hospital entre 1990 y 2009. Se analizan el tipo tumoral, la reconstrucción vascular y las complicaciones inmediatas y a largo plazo que presentaron. Resultados: Se estudió un sarcoma de Ewing de pelvis, un condrosarcoma de pelvis, un sarcoma parostal de fémur distal y un schwannoma atípico de muslo. En 2 casos la reparación se realizó por lesión vascular intraoperatoria. En los otros 2 casos se realizó una resección vascular por no haber plano de disección entre el tumor y los vasos. Se logró conservar la extremidad en 3 de los 4 casos (AU)

Purpose: To report on the experience acquired by our center in the field of surgical repair of the great vessels during tumor resection surgery in the lower limb and the pelvis. Materials and Methods: We present 4 consecutive cases of lower limb musculoskeletal tumor resection surgery associated to great vessel reconstruction performed in the same surgical procedure. The procedures were performed in our hospital between 1990 and 2009. We analyzed tumor type, technique for vascular reconstruction and immediate and long-term complications. Results: We studied a Ewing sarcoma of the pelvis; a pelvic chondrosarcoma, a parosteal distal femur sarcoma and an atypical thigh schwannoma. In two cases, repair was achieved through an intraoperative vascular lesion. In the other two cases, a vascular resection was carried out owing to the inexistence of a dissection plane between the tumor and the vessels. Limb preservation was achieves in three of the four cases (AU)

[Guidelines of the Spanish Society of Cardiology for car driving, airplane flying,and underwater activities in subjects with heart disease]. / Guías de práctica clínica de la Sociedad Española de Cardiología sobre conducción de vehículos, pilotaje de aviones y actividades subacuáticas en cardiópatas.

Car driving, airplane piloting and underwater activities by subjects with heart disease may cause sudden incapacitation leading to the loss of the safety margins necessary to avoid accidents. In the case of car driving and airplane piloting the risk affects, not only the driver or pilot, but also passengers and/or bystanders within an accident zone. In the case of diving the risk resides basically in the loss of control of the vital support mechanisms necessary in a very hostile medium. This document reviews the possible causes of unexpected incapacitation, with or without loss of consciousness, in the light of the pathophysiologic consequences of fatigue, hypoxia, stress or barotrauma posed by each activity. Detailed recommendations are made for limiting driving, piloting and diving, based on official Spanish and European regulations and the addresses of specialized centers are provided for consultation. Moreover, recommendations for airplane travel for patients with heart disease are indicated.

[How and when to use cardioversion in atrial fibrillation at the beginning of the year 2000]. / Cuándo y cómo cardiovertir la fibrilación auricular al inicio del año 2000.

The high incidence and associated complications are causing atrial fibrillation to emerge as a disease of uncertain prognosis, rather than an acceptable alternative to sinus rhythm. There is accumulated evidence of an electrical and anatomical remodelling in atrial fibrillation that facilitates the onset and maintenance of this arrhythmia, and the capacity for these changes may be reversed if sinus rhythm is restored. The development of new drugs that decrease the incidence of recurrences and the advent of internal cardioversion, which has proven to be very effective when traditional methods have failed, have widened the indications and increased the number of patients who may benefit from this technique. These advances pave the way for the development of an implantable atrial cardioverter, which would allow an early treatment of atrial fibrillation and, therefore, lessen the deleterious effects brought on by this rhythm disorder.

[Prognostic implications of early discharge from the coronary unit in patients with acute myocardial infarction]. / Implicaciones pronósticas del alta precoz de la unidad coronaria en pacientes con infarto agudo de miocardio.

INTRODUCTION AND OBJECTIVES: The high demand for health care has obliged Coronary Units to hasten the discharge of patients in less serious condition and this might be an influence on their prognosis. Our objective have been: a) to analyse the characteristics and the evolution (death or readmission) during the first month of patients with myocardial infarction and very early discharge from the Coronary Unit (stay of 2 days or less), and b) to assess the profile of very low risk group patients for complications who could be discharged early from the Coronary Unit. PATIENTS AND METHODS: A study of 978 consecutive patients who had been admitted for acute myocardial, in faration were divided into two groups according to their length of stay in the Coronary Unit (A < or = 2 and B > 2 days). Their baseline characteristics, course of stay and vital status at month, were compared. A subgroup of patients at low risk was studied and complications that might have arisen from their early discharge from the Coronary Unit were assessed. RESULTS: Seventy-three patients (7.5%) died within the first two days. Of the remaining 905, the stay was 2 days or less for 336 patients (group A); and longer than 2 days for 569 (group B). Group A had a higher frequency of dyslipemia, Killip class I on admission, uncomplicated myocardial infarction in the Coronary Unit and the use of beta-blockers and had less frequency of diabetes, Q wave myocardial infarction, anterior infarction or the use of fibrinolytics. In the first month after discharge from the Coronary Unit, 10 patients from group A and 18 patients from group B died, the rate of death or readmission into the Coronary Unit within 30 days was similar between both groups (group A = 13% and group B = 13%). A multiple regression showed that Killip class on admission (p < 0.001) and an uncomplicated course (p < 0.001) were independently related with the length of stay in the coronary unit. A subset of 378 low risk patients (Killip I on admission, uncomplicated course in the ICU and age < 71 years) had no mortality at 30 days and their readmission rate in the first month was 4%. In this subgroup, those patients whose stay was equal to or less than two days were more frequently readmitted in the first week. (group A = 9/197 [5%] and group B = 1/181 ([0.5%]; p = 0.034). CONCLUSION: Selected patients with myocardial infarction can be discharged very early from the Coronary Unit with a low risk of death. A readmission rate following discharge of some 5% must be allowed for these patients.