Distancia de claudicación e índice tobillo-brazo en pacientes con insuficiencia arterial tratados con células madre / Claudication distance and ankle-arm index in patients with arterial insufficiency treated with stem cells

Introducción: La enfermedad arterial periférica de miembros inferiores constituye un problema de salud por ser responsable de más del 40 % de las amputaciones no traumáticas en diabéticos y no diabético. Las células madre pudieran contribuir positivamente a su tratamiento, al participar en el proceso angiogénico. Objetivo: Describir la distancia de claudicación y el índice de presiones tobillo-brazo en pacientes con insuficiencia arterial tratados con células madre. Métodos: Se realizó un estudio cuasi experimental, prospectivo y analítico en 36 pacientes con el diagnóstico de insuficiencia arterial, atendidos en el servicio de Angiología del Hospital Militar Central "Dr. Carlos J. Finlay". Los pacientes fueron tratados con células mononucleares autólogas obtenidas de sangre periférica, aplicadas por vía intramuscular. Las variables estudiadas resultaron: edad, sexo, factores de riesgo, patrón oclusivo, distancia de claudicación e índice de presiones tobillo-brazo. Resultados: Predominaron el sexo masculino (63,9 por ciento), el grupo de edades de 65 y más años (44,4 percent), y el color de piel blanco (61,1 percent)). Los factores de riesgo más frecuentes fueron el tabaquismo (72,2 percent)) y la hipertensión arterial (69,4 percent)). En el 77,7 percent) desapareció el dolor a la marcha (p < 0,01). La distancia de claudicación aumentó (p < 0) al concluir el sexto mes (397,2 ± 118,8 metros: IC 95 percent): 357; 437,4). Hubo un incremento altamente significativo (p < 0) del índice de presiones tobillo-brazo de la arteria pedia. Conclusiones: Las células mononucleares autólogas resultan eficaces en el tratamiento de la insuficiencia arterial, por eliminar el dolor ante el ejercicio, aumentar la distancia a la marcha y elevar los índices de presiones tobillo-brazo(AU)

ABSTRACT Introduction: Lower limb´s peripheral artery disease is a health problem as being the cause of more than 40% of non-traumatic amputations in diabetic and non-diabetic patients. Stem cells could contribute positively to their treatment by participating in the angiogenic process. Objective: Describe claudication distance and ankle-arm´s pressure index in patients with arterial insufficiency treated with stem cells. Methods: A quasi-experimental, prospective and analytical study was carried out in 36 patients diagnosed with arterial insufficiency, attended in the Angiology service of "Dr. Carlos J. Finlay" Central Military Hospital. Patients were treated with autologous mononuclear cells obtained from peripheral blood, and they were used intramuscularly. The studied variables were: age, sex, risk factors, occlusive pattern, claudication distance and ankle-arm´s pressure index. Results: Male sex (63.9%), age group of 65 years and older (44.4%), and white skin (61.1%) predominated. The most common risk factors were: smoking habit (72.2%), and high blood pressure (69.4%). In 77.7% of the cases, the pain while walking disappeared (p < 0.01). The claudication distance increased (p< 0) at the end of the sixth month (397.2 ± 118.8 meters: IC 95 %: 357; 437.4). There was a highly significant increase (p< 0) of the ankle-arm´s pressure index of the dorsalis pedis artery. Conclusions: Autologous mononuclear cells are effective in treating arterial insufficiency as they eliminate pain during exercise, increase distance while walking, and increase ankle-arm´s pressure rates.

Insuficiencia arterial aguda severa vinculada a ergotismo / Severe acute arterial insufficiency linked to ergotism / Insuficiência arterial aguda severa vinculada a ergotismo

El ergotismo es un síndrome clínico poco frecuente pero potencialmente letal vinculado a la intoxicación aguda o crónica con el uso de alcaloides del ergot en el tratamiento de la migraña. Se caracteriza por un vasoespasmo severo generalizado que puede generar isquemia periférica o visceral y conducir a disfunción orgánica múltiple y muerte. Existen numerosos fármacos de metabolismo hepático que pueden alterar la metabolización de la ergotamina pudiendo alcanzar concentraciones tóxicas incluso a bajas dosis. Presentamos el caso de un paciente infectado con virus de la inmunodeficiencia humana bajo tratamiento antirretroviral que incluía inhibidores de la proteasa y que se había automedicado con ergotamina. El paciente presentó posteriormente sintomatología sensitivo motora deficitaria de miembros superiores e inferiores, acompañada de elementos de hipoperfusión distal severa. Se solicitó Doppler arterial que evidenció vasoespasmo de ejes arteriales de miembros. Se realizó diagnóstico de ergotismo secundario a la asociación de ergotamina - ritonavir, ingresando a cuidados intensivos. Se inició tratamiento en base a suspensión de ambos fármacos, vasodilatación arterial con nitroprusiato y antiagregación con ácido acetilsalicílico. En relación con este caso se presenta una revisión del mecanismo de toxicidad de la ergotamina, sus interacciones farmacológicas, así como diagnóstico y tratamiento disponibles para esta patología. (AU)

Ergotism is a rare but potentially lethal clinical syndrome linked to acute or chronic poisoning with the use of ergot alkaloids in the treatment of migraine. It is characterized by a severe generalized vasospasm that can generate peripheral or visceral ischemia and lead to multiple organ dysfunction and death. There are numerous drugs of hepatic metabolism that can alter the metabolism of ergotamine and can reach toxic concentrations even at low doses. We present the case of a patient infected with human immunodeficiency virus under antiretroviral treatment that included protease inhibitors and who had self-administered with ergotamine. The patient subsequently presented motor sensory deficit symptoms of upper and lower limbs, accompanied by elements of severe distal hypoperfusion. Arterial Doppler was requested, which showed vasospasm of the arterial axis of the limbs. A diagnosis of ergotism secondary to the ergotamine-ritonavir association was made, entering intensive care. Treatment was started based on suspension of both drugs, arterial vasodilatation with nitroprusside and antiaggregation with acetylsalicylic acid. In relation to this case, we present a review of the ergotamine toxicity mechanism, its pharmacological interactions, as well as the diagnosis and treatment available for this pathology. (AU)

O ergotismo é uma síndrome clínica pouco frequente, porém potencialmente letal vinculado à intoxicação aguda ou crônica pelo uso de alcalóides do Ergot no tratamento da enxaqueca. Caracteriza-se por um vaso espasmo severo generalizado que pode gerar isquemia periférica ou visceral e levar a disfunção orgânica múltipla e morte. Existem múltiplos fármacos de metabolismo hepático que podem alterar a metabolização da ergotamina podendo alcançar concentrações tóxicas inclusive em doses baixas. Apresentamos o caso de um paciente infectado com vírus da imunodeficiência humana recebendo tratamento antirretroviral que incluía inibidores da protease e que se automedicou com ergotamina. O paciente apresentou posteriormente sintomatologia sensitiva motora deficitária de membros superiores e inferiores, acompanhada de elementos de hipoperfusao distal severa. Solicitou-se Doppler arterial que mostrou vaso espasmo dos eixos arteriais de membros. Realizou-se diagnóstico de ergotismo secundário à associação ergotamina - ritonavir, e transferiu-se o paciente a cuidados intensivos. Iniciou-se tratamento com a suspensão de ambos os fármacos, vasodilatação arterial com nitroprussiato e antiagregaçao com ácido acetilsalicílico. Apresenta-se uma revisão do mecanismo de toxicidade da ergotamina, suas interações farmacológicas, seu diagnóstico e os tratamentos disponíveis para esta patologia. (AU)

Dual stent placements for occlusion/stenosis of subclavian artery associated with stenosis of adjacent vertebral artery initial site / 介入放射学杂志

Objective To evaluate the efficacy of dual stent placements for the treatment of occlusion/stenosis of subclavian artery associated with stenosis of adjacent vertebral artery initial site. Methods The clinical data of 9 patients with occlusion/stenosis of subclavian artery associated with stenosis of adjacent vertebral artery initial site were retrospectively analyzed. Stent implantations in the affected subclavian artery and vertebral artery were separately performed; the patients were followed up for 3-12 months after the treatment. The therapeutic efficacy was evaluated with the clinical symptoms and Doppler ultrasonic examination. Results Successful implantation of two stents was accomplished in all 9 patients, with the technical success rate of 100%. After the treatment, the blood flow in both the subclavian and vertebral arteries was unobstructed. Following-up examination showed that the subjective symptoms were obviously improved in all 9 patients, and no serious procedure-related complications occurred. Doppler ultrasound examination showed that no in-stent restenosis or stent displacement was observed. Conclusion For the treatment of occlusion/stenosis of subclavian artery associated with stenosis of adjacent vertebral artery initial site, dual stent placement technique is a safe and feasible means with satisfactory effect in improving vertebro-basilar arterial insufficiency.

Clinical Observation of Acupuncture at Eight Nape Points for Vertigo Due to Vertebrobasilar Arterial Insufficiency / 上海针灸杂志

Objective To observe the therapeutic efficacy of acupuncture at the eight nape points in treating vertigo due to vertebrobasilar arterial insufficiency. Method Totally 150 patients with vertigo caused by vertebrobasilar arterial insufficiency were randomized into acupuncture group 1, acupuncture group 2, and a medication group, 50 each. Acupuncture group 1 was intervened by acupuncture at the eight nape points, acupuncture group 2 was by acupuncture at Baihui (GV20), Fengchi (GB20), Tianzhu (BL 10), etc, and the medication group was by oral administration of Flunarizine. The symptoms and Transcranial Doppler (TCD) results were observed before and after intervention in the 3 groups. Result After treatment, the excellent rate was 82.0%in acupuncture group 1, versus 62.0%in acupuncture group 2 and 52.0%in the medication group, and the excellent rate of acupuncture group 1 was significantly different from that of the other two groups (P＜0.01). TCD showed that the systolic velocity, mean velocity, and pulsatility index of the bilateral vertebral arteries were markedly improved in acupuncture group 1, significantly better than that of the other two groups. Conclusion Acupuncture at the eight nape points can significant improve the vertebrobasilar arterial blood supply.

Asistencia primaria y especializada en pacientes con insuficiencia arterial aguda / Specialized and primary care in patients with acute arterial insufficiency

Se efectuó un estudio descriptivo y observacional de los pacientes con insuficiencia arterial aguda de las extremidades, ingresados en el Servicio de Angiología del Hospital Clinicoquirúrgico Docente "Dr. Ambrosio Grillo Portuondo" de Santiago de Cuba, desde enero del 2008 hasta abril del 2011, con vistas a observar la evolución de estos en cuanto a un diagnóstico precoz y tratamiento oportuno. Todos los integrantes de la serie presentaron los síntomas clásicos de la afección; sin embargo, a la mayoría no se le realizó el examen de los pulsos arteriales en la atención primaria de salud y a pesar de que más de 50 % de estos fue atendido en las 4 primeras horas de iniciado el cuadro clínico, el mayor número recibió asistencia especializada de 9 a 24 horas después de manifestarlo. De igual manera, primaron el grupo etario de 61 y más años, la procedencia urbana, la ateroesclerosis obliterante (sola o unida a otras enfermedades) como la entidad clínica más asociada y la cirugía revascularizadora como proceder inicial. Un importante porcentaje de aquellos que fueron intervenidos antes de las 8 horas salvó la extremidad, pero los que recibieron tratamiento quirúrgico pasadas las 24 horas del inicio agudo fueron amputados.

A descriptive and observational study was carried out in patients with acute arterial insufficiency of the limbs, admitted to the Angiology Department of "Dr. Ambrosio Grillo Portuondo" Clinical Surgical Teaching Hospital of Santiago de Cuba, from January 2008 to April 2011, with the purpose of monitoring their progress as for an early diagnosis and treatment. All the members of the series had the classic symptoms of the condition, but the majority did not undergo the examination of arterial pulses in the primary health care, and although more than 50% of them were treated at the first 4 hours after the onset of symptoms, most of them received specialized care between 9 and 24 hours of its manifestation. Similarly, age group of 61 years and over, urban origin, obliterating atherosclerosis (alone or combined with other diseases) prevailed as the clinical entity most associated and surgical revascularization as an initial procedure. A significant percentage of those who were operated before 8 hours saved the limb, but those that were operated after 24 hours of acute onset were amputees.

Isquemia arterial aguda en pacientes pediátricos por procedimiento cardiovascular percutáneo: Incidencia, causas y evolución / Acute arterial ischemia in pediatric patients due to percutaneous cardiovascular procedure: incidence, causes and evolution", "_i": "

Introducción: La isquemia arterial aguda periférica (IAAP) es lainterrupción brusca del aporte sanguíneo a una determinada partedel organismo mediante: la obstrucción, el debilitamiento de las paredesarteriales o daño de las válvulas de las venas, teniendo comoetiología las causas de tipo orgánica y funcional. Objetivo: Determinarla incidencia y describir las causas de la isquemia arterialaguda periférica en pacientes pediátricos como consecuencia de unprocedimiento cardiovascular percutáneo. Metodología: Se realizóun estudio transversal y retrospectivo de 17 pacientes sometidos aintervencionismo, de N = 621 pacientes atendidos en los Serviciosde Hemodinámica y Cardiopediatría del Instituto Nacional de CardiologíaIgnacio Chávez, del 1 de enero de 2008 al 31 de mayo de2009. Se incluyeron pacientes de 0 a 2 años a los que les realizócateterismo cardíaco diagnóstico y terapéutico, que presentaronisquemia arterial aguda periférica. El análisis de datos se realizómediante el programa estadístico SPSS v. 17, los resultados se expresaronmediante medidas de resumen; y se utilizó la correlaciónde Spearman para el número de punciones y causas de isquemiaarterial aguda. Resultados: La muestra (n = 17) representa unaincidencia de 2.73%, predominando el sexo masculino en un 53% yafectando a los pacientes de 0 a 4 meses de edad. Las causas encontradasson el traumatismo en el 35.29%, la trombosis en el 29.41%,la embolia en el 17.64%. Existe una correlación de Spearman positivaentre número de punciones y las causas de IAAP. Conclusión:Los factores relacionados a la IAA son en su mayoría prevenibles,por lo que es necesario una adecuada detección de factores de riesgopara prevenir complicaciones vasculares periféricas.

Introduction: Acute peripheral arterial ischemia (APAI) consistsof the sudden interruption of blood supply to certain part of thehuman body through: obstruction, artery-wall weakening or veinvalveharm, being the etiology produced by organic- or functionaltypecauses. Objective: To determine the incidence of acute peripheralarterial ischemia over pediatric patients as a consequence of apercutaneous cardiovascular procedure. Methodology: A transversaland retrospective study was carried out on seventeen patientssubjected to interventionism, from N = 621 patients attendedat the Hemodynamics and Cardiopediatrics Services in the «IgnacioChávez¼ National Institute of Cardiology, from January the 1st,2008, to may 31st, 2009. The study included patients ranging from0 to 2 years old, who were practiced diagnostic and therapeuticcardiac catheterization, and presented Acute Peripheral ArterialIschemia. The data analysis was performed through the SPSS v.17 statistical program, the results were expressed by means of summarymeasurements. Spearman’s Correlation was employed forpuncture number and causes of Acute Arterial Ischemia. Results:The sample (n = 17) represents an incidence of 2.73%, prevailingthe male sex in a 53%, and affecting pediatric patients from 0 to 4months old. It was found a positive Sperman’s Correlation betweennumber of punctures and APAI causes. Conclusion: The factors relatedto APAI are mostly preventable, so proper risk-factor detectionis necessary in order to prevent peripheral vascular complications.

Oclusão arterial aguda por derivados da ergotamina / Acute arterial occlusion caused by ergotamine derivatives

Os derivados da ergotamina compõem diversas drogas amplamente utilizadas no tratamento de ataques agudos de migrânea. A intoxicação por estas substâncias resulta geralmente de sua administração crônica, promovendo sintomas secundários ao espasmo arterial e à consequente isquemia distal. Neste artigo, é relatado o caso de uma paciente de 47 anos com diagnóstico de oclusão arterial aguda em membros inferiores secundária ao uso de derivados da ergotamina. Após a suspensão da droga e a prescrição de anticoagulantes, vasodilatadores e antiagregante plaquetário, a paciente evoluiu com melhora da dor, da parestesia e com o retorno da coloração normal e dos pulsos distais em membros inferiores.

Ergotamine derivatives include several drugs widely used in the treatment of acute migraine attacks. Intoxication by these substances generally results from chronic administration, promoting symptoms secondary to arterial spasm and the consequent distal ischemia. The authors report the case of a 47-year old patient with acute arterial occlusion in lower limbs secondary to the use of ergotamine derivatives. After drugs were suspended and anticoagulants, vasodilators and antiplatelet drugs were prescribed, the patient progressed with improvement of pain, paresthesia and return of normal skin color and distal pulses in lower limbs.

Neovascularization in Branch Retinal Vein Occlusion Combined with Arterial Insufficiency

The aim of this study is to elucidate the association of neovascularization in branch retinal vein occlusion (BRVO) combined with major arterial insufficiency (MAI), compared with BRVO alone. The authors retrospectively reviewed the charts, color photographs, and fluorescein angiograms of 304 patients (308 eyes) who had BRVO from 1990 to 2002 at Hanyang University hospital. Patients with BRVO combined with MAI and patients with BRVO alone were differentiated by angiographic appearance. Of the 308 eyes, 12 (3.9%) had neovascularization, all of which were in the 56 eyes of the MAI group for which the neovascularization rate was 21.4%. Neovascularization in BRVO was more strongly associated with the non-perfusion caused by MAI, rather than with the extent of the non-perfusion area that originated from retinal capillary obstruction. MAI is considered as a risk factor for neovascularization and hence could be a prognostic factor.

A Study about Reliability of Radioisotope in Diagnosing Varicocele / 대한비뇨기과학회지

In order to consider the usefulness of radioisotope in diagnosing varicocele, a study was performed on 124 cases. Among them, 74 cases were diagnosed as varicocele, which included 16 cases of subclinical varicocele. Among 74 varicocele patients, 62 cases ( 83.8%) were diagnosed by varicocele index and 59 cases (79.7% ) were diagnosed by static image. A combination of the above two methods allowed 67 cases (90.5 %) to be diagnosed. 21 patients who had a high ligation of internal spermatic vein showed 11 excellent results, 6 good results and 4 poor results. Out of 10 patients with subclinical varicocele, there were 6 excellent results, 3 good results and 1 poor result and 9 patients showed improvement on postoperative semen analysis. There was no significant statistical difference in frequency of the testicular arterial insufficiency between the small varicocele group and the large varicocele group. Also, through scrotogram, it became known that semen analysis proved little help in aiding the diagnose of subclinical varicocele. In conclusion, 'Scrotogram proved very helpful in diagnosis and judging the results of operations of varicocele including subclinical varicocele.