Prehypertension is associated with peripheral arterial disease and low ankle-brachial index

Patients with prehypertension suffer endothelial dysfunction and are at increased cardiovascular risk. Ankle-brachial index (ABI) constitutes an efficient tool for diagnosing peripheral arterial disease; but also an ABI < 0.9 is an independent and positive predictor of endothelial dysfunction and is associated with increased cardiovascular risk and mortality. The aim of this study was testing whether ABI was decreased in prehypertensive patients when compared with normotensive subjects. Methods We included 70 prehypertensive patients older than 19 years, in whom the ABI was registered with a 5 megahertz Doppler (Summit Doppler L250, Life Dop., USA). The highest ankle systolic pressure was divided by the highest brachial systolic pressure. We also included 70 normotensive subjects in whom the ABI was registered in the same way. The measurements were performed by the same physician who was blinded about the study. Statistical analysis was performed with odds ratio and student t-test. Results The ABI values in normotensive subjects were 1.023 ± 0.21, whereas prehypertensive patients significantly had lower ABI (0.90 ± 0.14p = 0.00012). We found ABI <0.9 in 30 prehypertensive patients (42.85%) and 13 normotensive patients (18.5%). The odds ratio of ABI <0.90 in prehypertensive patients was 3.288 (IC95 1.5–7.0, p = 0.0023). A regression analysis failed to show any independent association between ABI values and any other clinical parameter. Conclusions Prehypertensive patients had lower ABI and higher prevalence of peripheral artery disease when compared with normotensive subjects; this fact increases their cardiovascular risk. ABI must be included in global evaluation of prehypertensive subjects.

Edema pulmonar no cardiogenico inducido por dextran 40 / Non cardiogenic pulmonary edema induced by dextran 40. case report

El dextran 40 debe ser considerado como otro factor etiológico del edema pulmonar no cardiogénico inducido por drogas. La reacción anafiláctica a los expansores del plasma como el dextran 40 es rara; no obstante, como es utilizado frecuentemente en la práctica clínica, se puede observar este efecto. Este trabajo reporta un caso de edema pulmonar no cardiogénico, inducido por drogas (dextran 40) al finalizar la anestesia general en un paciente masculino de 62 años de edad a quien se le realizó una exploración vascular con colocación de injerto bifemoral en pantalón y endarterectomia bilateral por trombosis de injerto aortobifemoral. El paciente evolucionó satisfactoriamente el tratamiento convencional antiedema pulmonar no cardiogénico, no así, del problema quirúrgico, por lo que fue reintervenido para revisión de puente femoropopiteo y aplicación de injerto, bajo BPD L3-L4 sin incidentes. Fue dado de alta a los 17 días de la segunda intervención