Aneurisma aórtico abdominal en pacientes mayores de 80 años: tratamiento quirúrgico convencional en 80 casos consecutivos / Abdominal aortic aneurysms in patients over 80 years of age: conventional surgical treatment in 80 consecutive cases

BACKGROUND: Abdominal aortic aneurysms (AAA) may be lethal unless appropriately and timely treated. Since age is a surgical risk, octogenarians are usually not considered as candidates for surgical intervention. AIM: To asses surgical complications and mortality in octogenarians treated for AAA. SUBJECTS AND METHODS: Patients aged 80 years older, treated consecutively between 1984-2001 were retrospectively analyzed. RESULTS: Sixty one patients were male, and their age ranged from 80 to 95 years. All were treated with open surgery. The operation was elective in 58 and as an emergency in 22 patients (symptomatic or ruptured AAA). Aortic diameter was 6.8 +/- 1.4 cm in asymptomatic patients and 7.7 +/- 1.8 cm in emergency cases (p = 0.024). Thirty days postoperative mortality was 5.1% in elective surgery compared to 40.6% in emergency operations (p < 0.01). Five years survival rate was 44.7% in asymptomatic patients compared to 10.4% in the emergency cases (p < 0.023). CONCLUSIONS: Elective surgery for asymptomatic AAA can be performed with low operative mortality in octogenarians. However, surgery in emergency cases has an 8 fold increase in risk. Accordingly, octogenarian patients should be considered for elective AAA repair in a selective basis.

Determinacion de inmunoglobulinas M en 129 recien nacidos normales de Santiago. / Immunoglobulin M determination in 129 normal newborn infants of Santiago

En 129 muestras de sangre de cordon, correspondiente a recien nacidos aparentemente normales, se practico determinacion cuantitativa de IgM total, mediante tecnica de inmunodifusion radial. Los resultados obtenidos oscilaron entre 0 y 138 mg% y un analisis estadistico, que cubrio el 80% de las muestras, dio un P10 de 3 mg% un P90 de 36 mg%, con una media de 11 mg%. De acuerdo con estos resultados, en nuestro medio se recomienda considerar como IgM elevada, en sangre de cordon, todo valor que exceda los 30 mg%. La cuantificacion de IgM en sangre de cordon constituye un metodo util para la pesquisa de los recien nacidos con riesgo de infeccion congenita; sin embargo, en aquellos casos com IgM elevada deben aplicarse tecnicas adicionales, especificas, que permitan establecer el diagnostico definitivo