Telemedicina en cirugía vascular y endovascular: experiencia en un centro universitario

Background: Telemedicine became a relevant means to provide healthcare without face-to-face medical evaluation during the COVID-19 pandemic. Aim: To describe the effectiveness of telemedicine in vascular surgery. Materials and Methods: Review of medical records of all vascular surgery consultations carried out in a clinical hospital between April and October 2020. The main outcome measured was the resolution of the reason for consultation. Secondary outcomes were the need to request laboratory tests or imaging, the need to evaluate the patient in person, and the need for referral to hospitalization or emergency service. Results: One hundred-six new consultations and their follow-up (remotely or in person) were analyzed. A definitive diagnosis could be reached in 74% of consultations, treatment could be instituted or modified in 69% of them, and the reason for consultation could be resolved in 74% of cases. Laboratory and imaging tests were requested in 36 and 63% of consultations, respectively. Four percent of patients were referred to the emergency department or hospitalization. Conclusions: In the vast majority of consultations, it was possible to achieve a definitive diagnosis, prescribe a treatment and resolve the reason for consultation without the need for a face-to-face medical evaluation.

Cirugía convencional del aneurisma tóraco-abdominal

Background: Thoracoabdominal aortic aneurysm (TAAA) is an infrequent disease and demands a highly specialized and experienced management. Open repair (OR) is the gold standard but it is associated with significant morbidity and mortality. Paraplegia and renal failure are the most important complications. Aim: To report our results with OR treatment of TAAA. Material and Methods: Descriptive study including all patients with TAAA operated electively and consecutively by OR between 1983 and 2019. Main outcomes are operative mortality, renal and neurological morbidity, and long-term survival. Results: We report 45 operated patients aged 33 to 84 years, 74% males. Aneurysm extension according to Crawford classification was I in 18%, II in 18 %, III in 36% and IV in 29%. Operative mortality was 4%. The frequency of paraplegia or paraparesis at discharge was 9%. No patient was discharged on hemodialysis. Survival at 5 and 10 years were 60% and 40% respectively. Conclusions: OR of TAAA is a complex procedure. Our results show perioperative mortality rates comparable to highly experienced centers. Although being a major procedure, OR remains an alternative to treat this serious condition.

Isquemia de extremidades inferiores secundaria a arteritis de la arteria temporal

Giant cell arteritis is more common in women older than 60 years, is associated with systemic inflammation symptoms and mainly involves the aortic arch and cranial arteries, specially the temporal artery. Symptomatic lower extremity arterial stenosis or occlusion is uncommon and can lead to limb loss. We report a 73-year-old woman presenting with a one-month history of lower extremity intermittent claudication of sudden onset. She also complained of fever, malaise, headache and weight loss. A non-invasive vascular study showed moderate femoral popliteal occlusive disease, with and abnormal ankle-brachial index (0.68 and 0.83 on right and left sides, respectively). An angio-computed tomography showed thickening of the aortic wall and severe stenosis in both superficial femoral arteries. Steroidal treatment was started, and a temporal artery biopsy was performed confirming giant cell arteritis. Six weeks after steroid therapy the patient had a complete remission of symptoms. A serologic exacerbation was subsequently treated with a humanized monoclonal antibody against the interleukin-6 receptor Tocilizumab, obtaining long time remission.

Sobrevida del cáncer vesical infiltrante: experiencia Hospital Sótero del Río / Survival of muscle-invasive bladder carcinoma: experience of Hospital Sotero del Rio

Objetivo: Análisis de la sobrevida y de los factores que influyen en el pronóstico del cáncer vesical infiltrante. Material y métodos: Se realiza un estudio retrospectivo de pacientes con el diagnóstico de cáncer vesical infiltrante sometidos a cirugía entre los años 1996-2006. Se realiza un análisis de sobrevida mediante Método de Kaplan-Meier y se analizan las variables que influyen en el pronóstico. Resultados: La serie consta de 78 pacientes que ingresaron al Servicio de Urología y que presentaron cáncer vesical infiltrante. La edad promedio es de 69,11 años, siendo el 65,38 por ciento de los pacientes (51) de sexo masculino. El tipo histológico predominante fue Carcinoma de Células Transicionales (69,2 por ciento).De los 78 pacientes de la serie, el 52,5 por ciento (41) fue sometido a cistectomía radical. El resto sólo tuvo procedimientos de carácter paliativo para control local de la enfermedad. Respecto de la presentación según etapas (clasificación TNM-AJCC), el 40 por ciento de los pacientes se presentó en etapa II, 20 por ciento en etapa III y un 40 por ciento en etapa IV. El seguimiento promedio fue de 22,1 meses. La sobrevida cáncer específica estimada según Kaplan- Meier fue de 54,3 por ciento, 34,6 por ciento, 25,9 por ciento a 1, 3 y 5 años respectivamente. El factor más importante que se correlaciona con la sobrevida fue la etapa de presentación. Conclusión: En nuestra serie el cáncer vesical infiltrante se presenta en etapas avanzadas (etapa IIIy IV) lo que limita las posibilidades de ofrecer procedimientos efectivos con intención curativa asociándose a una baja sobrevida. Se hace necesario aumentar los esfuerzos para una pesquisa precoz y ofrecer un manejo terapéutico activo a estos pacientes.

Objective: Survival and prognostic factors analysis in Muscle-Invasive Bladder Cancer. Material and Methods: A retrospective analysis of patients with Muscle-Invasive Bladder Cancer between years 1996-2006. Survival analysis was made with Kaplan-Maier method and prognostic variables that affect the survival were analyzed. Results: Our study cohort included 78 patients who were hospitalized at the Urology Service with the diagnosis of Muscle-Invasive Bladder Cancer. The mean patient age was 69.11 years, being a 65.38 percent (51) men. Predominant histological type was Transitional Cell Carcinoma (69,2 percent). 52.5 percent (41/78 patients)under went Radical Cystectomy. The rest of the patients only received palliative procedures for the local control of the disease. According to staging (TNM-AJCC classification), 40 percent of the patients were diagnosed at stage II, 20 percent at stage III and 4 at stage IV. Mean follow up time was 22.1 months. Cancer specific survival estimated with Kaplan-Maier method was 54.3 percent, 34.6 percent, 25.9 percent for 1, 3 and 5 years respectively. Most important variable that correlates with survival was stage at diagnosis. Conclusion: In our series invasive bladder cancer is diagnosed at advanced stages (III and IV), which reduces the possibilities of getting effective procedures with curative intention, resulting in a low survival rates. It is mandatory improve the efforts in order to obtain a early diagnosis and to offer an active treatment to those patients.