Utilidad del mapeo ecográfico preoperatorio para los accesos vasculares de hemodiálisis / Use of pre-operative ultrasound mapping for haemodialysis vascular access

OBJETIVOS: Valorar la utilidad clínica de la introducción rutinaria del mapeo ecográfico de extremidades superiores en el estudio preoperatorio de los pacientes candidatos a un acceso vascular (AV) para hemodiálisis. MATERIAL Y MÉTODOS: Estudio unicéntrico retrospectivo de 4 años de duración. Incluimos pacientes con enfermedad renal crónica terminal (ERCT) candidatos a un AV para hemodiálisis, excluyendo a aquellos con fístulas arteriovenosas (FAV) previas en la misma extremidad superior. Dos grupos de estudio: exploración física (EF: junio de 2011-febrero de 2014) y mapeo ecográfico (ECO: marzo de 2014-junio de 2015). Analizamos: variables demográficas, comorbilidad y tipo de AV. En el subgrupo FAV radiocefálicas, analizamos la tasa de permeabilidad inmediata (48 h), precoz (4 semanas), tardía (6 meses) y los procedimientos realizados. RESULTADOS: Estudiamos a 81 pacientes (EF: 42; ECO: 39), de los que el 63% eran hombres, con una edad media de 66,5±13,1 años. El 81% fueron izquierdos. No se evidenciaron diferencias significativas entre los grupos respecto a demografía, comorbilidad ni etiología de la ERCT. Tipo de AV (EF vs. ECO): FAVRC* (47,6 vs. 69,2%; *p < 0,05); húmero-cefálicas* (38,1 vs. 10,3%); húmero-basílicas (11,9 vs. 17.9%) y prótesis húmero-axilares (2,4 vs. 2,6%). Tasa de permeabilidad FAV radiocefálicas: inmediata (90 vs. 85,2%); precoz (75 vs. 100%*) y tardía (55 vs. 88,9%*), respectivamente. Solo observamos un mayor número de AV realizados en otros territorios (25 vs. 3,7%*) en el grupo EF de las FAV radiocefálicas. CONCLUSIONES: En nuestro centro, la introducción rutinaria del mapeo ecográfico de las extremidades superiores en el estudio preoperatorio de los pacientes candidatos a un AV permitió optimizar el territorio vascular distal y mejorar la permeabilidad precoz y tardía de las fístulas radiocefálica

OBJECTIVES: To assess the clinical usefulness of routine doppler ultrasound vascular mapping of upper extremities before creating a vascular access (VA) for haemodialysis. MATERIAL AND METHODS: A retrospective single-centre study conducted over a four-year period including end-stage renal disease (ESRD) patients referred to for VA creation for haemodialysis. Patients with previous VA in the same upper extremities were excluded. Two study groups were formed: Physical examination (PE: June 2011-February 2014) and ultrasound mapping (US: March 2014-June 2015). An analysis was performed on the demographic variables, comorbidities and AV location. The results of the patency rates of the radio-cephalic fistulae (RCF) subgroup were recorded, immediately (48 h), early (4 weeks), and late (6 months). RESULTS: The study included a total 81 patients (42 PE, 39 US), with 63% males. The mean age was 66.5±13.1 years, and 81% were affected on the left side. There were no significant differences between the groups as regards, demographics, comorbidities, or ESRD aetiology. The VA type (PE vs. US): 47.6 vs. 69.2% radio-cephalic fistula* (*P<.05), 38.1 vs. 10.3% brachial-cephalic fistula*, 11.9 vs. 17.9% brachiobasilic fistula, and 2.4 vs. 2.6% humeral-axillary grafts. RCF patency rates: Immediate 90 vs. 85.2%, early 75 vs. 100%*, and late 88.9 vs. 55%*; respectively. However, an increase in AV performed in other territories was observed in PE group (25 vs. 3.7%*) in RCF. CONCLUSIONS: Routine doppler ultrasound mapping of upper extremities before VA creation in our centre allowed the distal vascular territory to be optimised, and improved the primary patency rates of both early and late radio-cephalic fistulas

Importancia de la cirugía aorto-ilíaca previa o simultánea en la evolución del trasplante renal / Importance of prior or simultaneous aortoiliac surgery in the outcome of renal transplant

Introducción: La enfermedad renal crónica terminal se ha convertido en un problema de salud pública mundial relacionado con el envejecimiento de la población y la elevada prevalencia de diabetes e hipertensión arterial, siendo ambas patologías factores de riesgo de enfermedad arterial aorto-ilíaca. Objetivos: Comparar la evolución de función renal en pacientes trasplantados renales sometidos a cirugía arterial aorto-ilíaca previa o simultánea al trasplante, respecto a los pacientes que no presentaban patología aorto-ilíaca conocida, al momento del trasplante, en nuestro centro. Material y métodos: Se trata de un estudio observacional retrospectivo; desde enero de 1994 hasta junio de 2010 se reclutaron pacientes trasplantados renales y se asignaron a dos grupos, el grupo 1 formado por pacientes con algún tipo de cirugía aorto-ilíaca previa o realizada al momento del trasplante renal y el grupo 2 o control con pacientes trasplantados sin antecedentes de arteriopatía conocida. Se estudió la evolución del filtrado glomerular mediante fórmula MDRD-4 a los 30 días y al año del trasplante y se evaluó la mortalidad a un año. Resultados: Se incluyeron 17 pacientes en el grupo 1 y 43 pacientes en el grupo 2. La media de MDRD-4 a los 30 días en el grupo expuesto fue de 28,71 ml/min/1,73 m2, y en el grupo no expuesto 37,7 ml/min/1,73 m2. Mientras que la media del MDRD-4 al año en grupo expuesto fue de 36, 3 ml/min/1,73 m2 y en el grupo no expuesto fue de 46,1 ml/min/1,73 m2 sin hallarse diferencias estadísticamente significativas. Tampoco se obtuvieron diferencias respecto a la mortalidad. Conclusiones: La evolución del filtrado glomerular en los pacientes trasplantados renales en nuestro centro no fue afectada por la presencia de cirugía arterial aorto-ilíaca previa o simultánea al trasplante(AU)

Introduction: End-stage renal disease has become a worldwide public health problem related to the aging population, with the high prevalence of diabetes and hypertension, both conditions being risk factors for aortoiliac artery disease. Objectives: To compare the course of renal function in transplant patients undergoing aortoiliac artery surgery before or at the same time as the transplant compared to patients with no known pathology aorto-iliac disease at transplant in our centre. Material and methods: A retrospective observational study was conducted from January 1994 until June 2010, on kidney transplant patients recruited and assigned to two groups; group 1patients with any type of prior aorto-iliac surgery or performed at the time of renal transplant, and group 2 or control transplant patients with no known history of arterial disease. We studied the course of the glomerular filtration rate using the Modification of Diet in Renal Disease(MDRD-4) formula at 30 days, and at one year after transplant, and evaluated the mortality atone year. Results: A total of 17 patients were included in group 1, and 43 patients in group 2. The meanMDRD-4 at 30 days in group 1 was 28.7 ml/min/1.73m2, and in group 2 it was 37.7 ml/min/1.73 m3. The mean MDRD-4 a one year in group 1 was 36.3 mL/min/1.73 m2 and in group 2 it was46.1 mL/min/1.73 m2, with no statistically significant differences being found. There were no significant differences in mortality. Conclusions: The course of glomerular filtration rate in renal transplant patients, in our centre was not affected by the presence of prior aorto-iliac arterial surgery performed before or at the same time as kidney transplant(AU)

[Vesico-scrotal hernia with hypocontractile detrusor]. / Hernia vesico escrotal con detrusor hipocontráctil.

OBJECTIVE: To present a case of massive inguinoscrotal hernia associated with low detrusor contractility. METHODS/RESULTS: A 70-year-old male patient with a history of diabetes and a previous diagnosis of low contractile bladder presented with urinary retention. Acute renal failure secondary to ureteral obstruction and inguinal bladder herniation was diagnosed. The direct bilateral hernia was repaired. Postoperative urodynamic evaluation showed an acontractile bladder. Intermittent catheterization was started, with satisfactory functional result and improvement of renal function. CONCLUSIONS: Massive bladder hernia can present as acute renal failure without lower urinary tract obstruction. The underlying impaired detrusor contractility can be diagnosed by urodynamic evaluation. Surgical treatment, with self-catheterization if required, achieves good results with preservation of renal function.

Totally implanted device for long-term intravenous chemotherapy: experience in 123 adult patients with solid neoplasms.

Vascular access in patients receiving prolonged chemotherapy is a difficult problem. This led to the introduction of a totally implanted device. We intend to assess the efficacy of this device in a subset of oncologic patients. Between May 1989 and November 1992, 129 devices were placed in 123 adult patients with solid neoplasms. Most of the catheters were inserted by cut-down of the external jugular vein. Follow-up period ranged from 28 to 70 months. Early complications occurred in 4 of 129 implants, all in percutaneously inserted catheters. Infection was the most frequent late complication. By March 1995, 113 devices had been removed, 15 (13.3%) because of complications. Mean life of the explanted systems was 512 days. Totally implanted devices provide safe and efficient long-term venous access. Implantation should be performed by experienced surgeons, by cut-down whenever possible. Infection is the most serious complication and may be prevented by careful management.

[The efficacy of injectable flurbiprofen in the symptomatic treatment of biliary colic]. / Eficacia del flurbiprofeno inyectable en el tratamiento sintomático del cólico biliar.

BACKGROUND: To evaluate the efficacy of flurbiprofen (nonsteroidal anti-inflammatory drug) in the treatment of biliary colic pain as compared with the drugs commonly used (analgesics and/or spasmolytics). METHODS: Eighty-four patients aged between 21 and 86 affected by intense pain of simple hepatic colic participated in the study. Following a single intramuscular dose of 150 mg of flurbiprofen (FRI, n = 30), 20 mg of N-hyoscine butylbromide (HBB, n = 25) or 30 mg of pentazocine (PTZ, n = 29) the patients were observed during the 6 hours after administration. RESULTS: The evolution of the pain was significantly better in the patients treated with FRI with differences being detected between the three drugs after 30 minutes of administration. A greater number of adverse reactions were seen among the patients who received PTZ with the differences being statistically significant with the other 2 treatments (p less than 0.02). CONCLUSIONS: Intramuscular flurbiprofen was more effective and generally better tolerated than pentozocine and hyoscine butylbromide.