Prognostic Value of Serum Paraprotein Response Kinetics in Patients With Newly Diagnosed Multiple Myeloma.

INTRODUCTION: Response kinetics is a well-established prognostic marker in acute lymphoblastic leukemia. The situation is not clear in multiple myeloma (MM) despite having a biomarker for response monitoring (monoclonal component [MC]). MATERIALS AND METHODS: We developed a mathematical model to assess the prognostic value of serum MC response kinetics during 6 induction cycles, in 373 NDMM transplanted patients treated in the GEM2012Menos65 clinical trial. The model calculated a "resistance" parameter that reflects the stagnation in the response after an initial descent. RESULTS: Two patient subgroups were defined based on low and high resistance, that respectively captured sensitive and refractory kinetics, with progression-free survival (PFS) at 5 years of 72% and 59% (HR 0.64, 95% CI 0.44-0.93; P = .02). Resistance significantly correlated with depth of response measured after consolidation (80.9% CR and 68.4% minimal residual disease negativity in patients with sensitive vs. 31% and 20% in those with refractory kinetics). Furthermore, it modulated the impact of reaching CR after consolidation; thus, within CR patients those with refractory kinetics had significantly shorter PFS than those with sensitive kinetics (median 54 months vs. NR; P = .02). Minimal residual disease negativity abrogated this effect. Our study also questions the benefit of rapid responders compared to late responders (5-year PFS 59.7% vs. 76.5%, respectively [P < .002]). Of note, 85% of patients considered as late responders were classified as having sensitive kinetics. CONCLUSION: This semi-mechanistic modeling of M-component kinetics could be of great value to identify patients at risk of early treatment failure, who may benefit from early rescue intervention strategies.

Trombosis arterial subclavioaxilar y embolización distal tras luxación glenohumeral anterior traumática / Subclavian-axillary arterial thrombosis and distal embolisation after traumatic anterior glenohumeral dislocation

La lesión vascular arterial asociada a la luxación anterior de hombro es una complicación rara, pero potencialmente devastadora, a menudo en el contexto de traumatismos de alta energía o heridas penetrantes. Se trata de una urgencia médica que puede llegar a comprometer la viabilidad y funcionalidad del miembro, incluso la vida del paciente si no es identificada precozmente y tratada de forma adecuada. Sin embargo, su diagnóstico puede ser difícil, pues precisa un alto índice de sospecha. La presencia de una trombosis de la arteria axilar con una luxación de hombro por un mecanismo de baja energía es extraordinariamente poco frecuente, especialmente cuando se presenta de forma subaguda con embolismo en la arteria radial

Arterial vascular injury associated with anterior dislocation of the shoulder is a rare but potentially devastating complication, often seen in the context of high-energy trauma or penetrating injury. It is a medical emergency that can compromise both the viability and functionality of the limb, as well as the patient's life if it is not identified early and treated properly. However, its diagnosis can be difficult, since it requires a high index of suspicion. The presence of an axillary artery thrombosis after shoulder dislocation resulting from low-energy trauma is extremely rare, even more so with subacute clinical presentation associated with embolism to the radial artery

Subclavian-axillary arterial thrombosis and distal embolisation after traumatic anterior glenohumeral dislocation. / Trombosis arterial subclavioaxilar y embolización distal tras luxación glenohumeral anterior traumática.

Arterial vascular injury associated with anterior dislocation of the shoulder is a rare but potentially devastating complication, often seen in the context of high-energy trauma or penetrating injury. It is a medical emergency that can compromise both the viability and functionality of the limb, as well as the patient's life if it is not identified early and treated properly. However, its diagnosis can be difficult, since it requires a high index of suspicion. The presence of an axillary artery thrombosis after shoulder dislocation resulting from low-energy trauma is extremely rare, even more so with subacute clinical presentation associated with embolism to the radial artery.

Bortezomib, lenalidomide, and dexamethasone as induction therapy prior to autologous transplant in multiple myeloma.

Achieving and maintaining a high-quality response is the treatment goal for patients with newly diagnosed multiple myeloma (NDMM). The phase 3 PETHEMA/GEM2012 study, in 458 patients aged ≤65 years with NDMM, is evaluating bortezomib (subcutaneous) + lenalidomide + dexamethasone (VRD) for 6 cycles followed by autologous stem cell transplant (ASCT) conditioned with IV busulfan + melphalan vs melphalan and posttransplant consolidation with 2 cycles of VRD. We present grouped response analysis of induction, transplant, and consolidation. Responses deepened over time; in patients who initiated cycle 6 of induction (n = 426), the rates of a very good partial response or better were 55.6% by cycle 3, 63.8% by cycle 4, 68.3% by cycle 5, and 70.4% after induction. The complete response rate of 33.4% after induction in the intent-to-treat (ITT) population, which was similar in the 92 patients with high-risk cytogenetics (34.8%), also deepened with further treatment (44.1% after ASCT and 50.2% after consolidation). Rates of undetectable minimal residual disease (median 3 × 10-6 sensitivity) in the ITT population also increased from induction (28.8%) to transplant (42.1%) and consolidation (45.2%). The most common grade ≥3 treatment-emergent adverse events during induction were neutropenia (12.9%) and infection (9.2%). Grade ≥2 peripheral neuropathy (grouped term) during induction was 17.0%, with a low frequency of grade 3 (3.7%) and grade 4 (0.2%) events. VRD is an effective and well-tolerated regimen for induction in NDMM with deepening response throughout induction and over the course of treatment. This trial was registered at www.clinicaltrials.gov as #NCT01916252 and EudraCT as #2012-005683-10.

Factores de riesgo de la trombosis de rama en el tratamiento endovascular aórtico infrarrenal: nuestra experiencia / Experience of the risk factors of limb thrombosis in EVAR

Objetivo: Analizar la trombosis de rama en el tratamiento de aneurisma de aorta abdominal (EVAR) en nuestra serie y su relación con factores de riesgo predisponentes. Material y método: Se incluyeron todos los EVAR programados entre enero de 2007 y enero de 2103. Mediante angio-TC y seguimiento analizamos los factores de riesgo preoperatorios (calcificación, tortuosidad y angulación), tipo de material implantado, sobredimensión y arteria ilíaca de sellado; la incidencia y manejo de la trombosis. También analizamos las angio-TC de cada una de las trombosis. Con las variables estudiadas se realizó un análisis comparativo de casos (trombosis) y controles (libre de trombosis). Resultados: De los 151 pacientes tratados mediante EVAR, con un seguimiento medio de 41,7 meses, 11 pacientes (7,2%) presentaron oclusión de rama ilíaca. No se observaron diferencias entre los grupos. En el análisis por ilíacas, en el que se incluyeron 294 ilíacas tratadas (8 aortomonoilíacos) con 15 casos (5,1%) de oclusión ilíaca, se observó la asociación de la trombosis de rama con el sellado en ilíaca externa (p=0,001) y con la sobredimensión superior al 20% (p=0,003). Conclusión: El sellado distal en ilíaca externa y la sobredimensión ≥ 20% en el tratamiento del EVAR son factores de riesgo independientes asociados con la trombosis de rama en nuestra serie (AU)

Objective: To analyse the limb occlusion after endovascular aortic repair (EVAR) and its predisposing risk factors. Materials and methods: The study included all elective EVAR cases between January 2007 and January 2013. An assessment was made of predisposing risk factors using pre-surgical angioCT scan and follow-up. A pre-surgical analysis was performed on risk factors (calcification, tortuosity, and angulation), type of endograft implanted, oversizing, and the iliac artery landing zone used. A comparative analysis was performed of the cases (occlusion) and controls (occlusion free) to assess the variables. Results: The study included a total of 151 treated patients with follow-up time of 41.7 months, and 11 patients (7.2%) presented with limb occlusion. No differences were observed in the comparison between the patient groups. Of the 294 iliac arteries included in the study (with 8 aorto-uni-iliac endografts), there were 15 (5.1%) cases of limb occlusion. The analysis revealed an association between limb occlusion and using the external iliac artery as a landing zone vessel (P=.001). There was a statistically significant relationship between oversizing ≥ 20% and limb occlusion (P=.003). Conclusion: Using external iliac artery as a landing zone vessel and oversizing ≥ 20% during EVAR are independent risk factors for limb occlusion in our case series (AU)

Sellado distal en ilíaca externa: ramificación ilíaca frente a la exclusión de la arteria hipogástrica / Extern iliac as distal sealing: Iliac branch device versus hypogastric exclusion

Objetivo: Comparar los resultados del sellado distal del EVAR en ilíaca externa (IE) mediante ramificación ilíaca frente a la exclusión de la arteria hipogástrica. Pacientes: Incluimos a 67 pacientes desde 2007 hasta 2014, en los que incluimos 25 ilíacas con branched ilíaco (grupo I) y 77 con fijación en IE y exclusión hipogástrica (grupo II). Métodos: Mediante análisis retrospectivo valoramos factores sociodemográficos y comparamos parámetros intraoperatorios, estancia hospitalaria, complicaciones en la evolución como claudicación glútea ipsolateral, trombosis de rama, migración, reintervención y crecimiento de la ilíaca común (IC) mediante el seguimiento clínico y radiológico. Resultados: El seguimiento medio fue de 26,7 y 49,3 meses en el grupo I y II, respectivamente. Sin diferencias en estancia hospitalaria, el tiempo de escopia, la dosis de irradiación el tiempo quirúrgico y el contraste empleado fue mayor en el grupo I. En el 50,6% del grupo II se embolizó la hipogástrica. El éxito técnico del branched fue del 92%. La tasa de complicaciones entre grupo I y II: claudicación glútea del 4 y el 36% (p < 0,0001), la tasa de trombosis de rama a los 24 meses fue del 6 y el 10,4% (p < 0,2) y de reintervención del 6 y el 12% (p: 0,1) respectivamente. El grupo II presentó 4 casos de migración distal y 4 casos que precisaron extensión de rama. La disminución de la IC en el seguimiento fue de 3,4 cm y 2 cm, respectivamente (p: 0,09). Conclusión: En nuestra serie, la menor tasa de complicaciones del dispositivo ramificado en el sellado distal en IE, podría justificar su empleo en pacientes seleccionados (AU)

Objective: To compare the results of endovascular aneurysm repair (EVAR) in external iliac (EI) as distal sealing using an iliac branch device (IBD) versus the exclusion of the internal iliac artery. Patients: The study included 67 patients treated by EVAR between 2007 and 2014 that were divided into two groups. Group I included 25 iliac arteries receiving an iliac branch device, and group II with 77 iliac arteries in which their sealing was in EI with hypogastric exclusion. Methods: A retrospective study was conducted in an assessment and comparison was made using the characteristics, risk factors, intra-operative parameters, and days in hospital. Complications, such as ipsilateral buttock claudication, limb occlusion, device migration, re-interventions, and growth of common iliac (CI), were followed by physical and radiological examinations. Results: Mean follow-up was 26.7, and 49.3 months in the group I and II, respectively. There were no differences in days in hospital, but the fluoroscopy time, radiation dose, procedure time, and contrast was higher in group i. The hypogastric artery was embolised in 50.6% of group II, with 92% technical success with the IBD in group i. The complication rate between group I and II: buttock claudication was 4% and 36% (P < .0001), the limb occlusion rate at 24 months was 6% and 10.4% (P < .2), and re-intervention was 6% and 12% (P = .1), respectively. Group II had 4 cases of distal migration, and 4 cases requiring extension to EI. The CI diameter decreased by 3.4 cm and 2 cm, respectively (P = .09). Conclusion: In our series, the low rate of complications in distal sealing with iliac branch devices could justify their use in selected patients (AU)

Rapid Aneurysmal Sac Expansion Following Endovascular Repair of a Dissecting Thoracoabdominal Aneurysm.

Endovascular repair of dissecting thoracoabdominal aneurysms (TAAA) is challenging and often requires multiple procedures. A 61-year-old man with a dissecting type-II TAAA treated first by placement of a thoracic endograft, and subsequently implantation of a fenestrated endograft. Six months postoperatively, a 10-mm increase of the aorta was observed. A reentry tear in left external iliac artery (EIA) was perfusing the false lumen in a retrograde fashion connecting with the endoleak caused by the inferior mesenteric artery and lumbar arteries. False lumen embolization of the left EIA and outflow vessels was performed. Thrombosis and rapid decrease of false lumen diameter was then observed. This case illustrates the complexity of endovascular management of extensive chronic aortic dissections.

Resultados tras el cambio de estrategia en el sellado distal de endoprótesis aórticas infrarrenales / Results after a change in strategy in distal sealing zone of infrarenal aortic endoprostheses

INTRODUCCIÓN: Tras estudios propios referentes a la evolución del sellado distal modificamos la actitud en el sellado de las endoprótesis de aorta abdominal: sellando en iliacas primitivas (IP) si eran menores de 16mm de diámetro y en iliacas externas (IE) si eran mayores. El objetivo del trabajo es valorar los efectos del cambio de criterio en el sellado distal. PACIENTES Y MÉTODOS: Se incluyeron los aneurismas infrarrenales programados consecutivos tratados mediante endoprótesis, desde enero de 2008 a diciembre de 2012. Se evaluó el crecimiento iliaco medio y las tasas de incidencia de endofugas tipo I distales (Ib), reintervenciones iliacas, trombosis de rama, rotura aórtica, mortalidad global y mortalidad relacionada con el aneurisma. Se excluyeron los casos con un seguimiento radiológico menor a 12 meses, aunque sí que fueron incluidos para valorar la mortalidad. RESULTADOS: Se incluyeron un total de 81 pacientes y 126 iliacas. La fijación distal se realizó en 86 IP y 40 IE. El seguimiento medio fue de 30,6±14 meses. El crecimiento medio de las IP fue -0,17±3mm (+1mm si la fijación fue en IP y -2,6mm si la fijación fue en IE; p = 0,0001) y el de las IE fue de -0,10±1,4mm (-0,3mm si se fijó en IP y +0,4mm si se fijó en IE; p = 0,01). No se detectaron endofugas Ib ni rotura del aneurisma. La tasa de reintervenciones iliacas total fue del 3,2% (4 casos, 1,1% en IP y 7,5% en IE; p = 0,09). La tasa de trombosis de rama fue mayor en los pacientes con sellado en IE (10% frente a 0%; p = 0,009), al igual que una mayor incidencia de claudicación glútea (37,5% frente a 4,6%; p = 0,0001). La mortalidad postoperatoria fue del 2,5%. La mortalidad global y la relacionada con el aneurisma a los 3 años fue del 19,5% y 2,5% respectivamente (sin influir las reintervenciones en la mortalidad). CONCLUSIONES: Los resultados avalan el cambio de estrategia en el sellado distal eliminando el riesgo de fuga Ib y de rotura aórtica en nuestra experiencia. Sin embargo, el sellado distal en IE se asocia a mayor trombosis de rama (sin aumentar la mortalidad relacionada con el aneurisma) y de claudicación glútea

INTRODUCTION: After assessing the results our own studies regarding the outcomes of patients in relation to distal sealing strategy, we modified our previous sealing approach of abdominal aortic endografts. For this study, distal sealing on common iliac artery (CI) is proposed when its diameter was less than 16mm, and in external iliac artery (EI) for diameters greater than 16mm. The aim of this study is to assess the effects of the modification of fixation criteria during follow-up. PATIENTS AND METHODS: Patients consecutively treated for infrarenal aortic aneurysms by elective endovascular repair during the period between January 2008 and December 2012 were included. Average iliac growth, type I distal endoleak (Ib), limb thrombosis, re-interventions due to iliac related complications were assessed, as well as overall mortality and aneurysm related mortality. Patients with less than 12 months follow-up were excluded, although they were included in the analysis to assess mortality. RESULTS: A total of 81 patients accounting for 126 iliacs were included. Distal fixation was carried out at CI in 86 and EI in 40 cases, respectively. Mean follow-up was 30.6±14 months. Average CI growth rate was -0.17±3mm (+1mm when fixation was performed in CI and -2.6mm when for fixation in EI; P=.0001); and -0.10±1.4mm for EI (-0.3mm when fixation was performed in CI and +0.4mm for fixation in EI; P=.01). No type 1b endoleaks or aneurysm ruptures were detected during follow-up. Total iliac re-intervention rate was 3.2% (4 cases, 1.1% in CI vs 7.5% in EI; P=.09). Limb thrombosis rate was higher in patients with sealing in EI (10% Vs 0%; P=.009), as well as the incidence of buttock claudication (37.5% vs. 4.6%; P=.0001). Perioperative mortality rate was 2.5%. Overall and aneurysm-related mortality at 3 years was 19.5% and 2.5% respectively (re-interventions did not have any influence on mortality rates). CONCLUSIONS: The observed results support the strategy modification in distal sealing zone, eliminating the risk of Ib endoleaks and aneurysm rupture in our experience. However, distal sealing in EI was associated with a higher incidence of limb thrombosis (Without any increase in aneurysm-related mortality), and buttock claudication

Applicability of Zenith p-branch Standard Fenestrated Endograft in Our Series.

BACKGROUND: In the endovascular treatment of abdominal aortic aneurysm (AAA) with short or absent infrarenal neck, the delay in the availability of fenestrated device and its high cost, have led to the manufacture of standardized models. Another option is the endografts with stents in parallel; however, regulated criteria for their use and long-term studies are lacking. The aim of this study was to assessed whether the AAA treated with fenestrated device or stents in parallel in our department, complied with the characteristics for the placement of the new endograft p-branch(®). Furthermore, the differences between the p-branch and the implanted prosthesis were analyzed. METHODS: Single-center and descriptive study of 41 aneurysms treated consecutively from 2008 to 2015. The anatomic characteristics analyzed were: relative distances between the visceral arteries, time position, diameter in the sealing area and number of fenestrations, and its compatibility with the p-branch. RESULTS: The anatomic compatibility rate with the p-branch options was 73.2% (30 cases). Of the 11 incompatible cases, 6 were due to misalignment of the visceral branches, 2 due to the aortic neck diameter being greater, another because the femoral access was inappropriate, and 2 more due to the fenestration configuration. Of the 30 cases in which compatibility existed, in 12 (40%) the configuration used coincided with the p-branch. In 13 cases, the number of fenestrations was higher than those actually used, with 23 fenestrations carried out and 39 hypothetical fenestrations with the new endograft. In the 5 remaining cases, a fenestration for the celiac trunk was necessary to achieve an adequate seal. CONCLUSIONS: The p-branch could meet the needs of three-quarters of the aortic anatomies of our series, with favorable expectations on cost and waiting time. However, in most cases either a higher number of fenestrations are needed for visceral arteries or the proximal seal was shorter than would be ideal.

Aplicabilidad de la nueva endoprótesis fenestrada Zenith p-branch(R) / Aplicability of Zenith p-branch(R) standard fenestrated endograft

INTRODUCCIÓN: En el tratamiento endovascular de los AAA con cuello infrarrenal corto o ausente, el retraso en la disponibilidad de endoprótesis fenestradas y su elevado coste han llevado a fabricar modelos estandarizados con el objetivo de un uso protocolizado y sin demora. Otra opción de recurso empleada son las endoprótesis con stents en paralelo, que aún carecen de un criterio de uso regularizado y de estudios a largo plazo. OBJETIVO: Analizar los AAA tratados en nuestro servicio con endoprótesis fenestradas o stents en paralelo, para valorar si cumplían las características de la nueva endoprótesis p-branch(R) y sus diferencias. MATERIAL Y MÉTODOS: Estudio unicéntrico, descriptivo de 31 aneurismas tratados consecutivamente entre 2008-2013 en el que se analizaron características anatómicas: distancias relativas entre arterias viscerales, su posición horaria, el diámetro en la zona de sellado y el número de fenestraciones requeridas y su compatibilidad con la p-branch(R). RESULTADOS: La tasa de anatomías compatibles con una de las 2 opciones de p-branch(R) fue del 74,2% (23 casos). De los 8 casos incompatibles 5 fueron por inadecuada alineación de las ramas viscerales, uno por diámetro de cuello aórtico mayor al máximo disponible, otro por inadecuado acceso femoral y otro por la configuración de las fenestraciones. De los 23 casos compatibles, en 7 (30%) la configuración coincide con las 3 fenestraciones de la p-branch(R). En 13 el número de fenestraciones sería mayor con respecto al utilizado, con 23 fenestraciones realizadas y 39 hipotéticas con la nueva endoprótesis. En los 3 restantes ha sido necesaria la fenestración del TC para un sellado adecuado. CONCLUSIÓN: La endoprótesis p-branch(R) podría abarcar 3/4 partes de las anatomías aórticas de nuestra serie, con unas expectativas favorables en coste y tiempo de espera, aunque en la mayoría requiriendo mayor número de fenestraciones o un sellado proximal más corto al ideal

INTRODUCTION: In the endovascular treatment of abdominal aortic aneurysms (AAA) with short or absent infrarenal neck, the delay in the availability of a fenestrated device and its high cost, has led to the manufacture of standardised models. Although there are no regulated criteria for their use and long-term studies are lacking, another option is the endograft with stents in parallel. OBJECTIVE: The AAA treated with fenestrated device or stents in parallel in our department were assessed to see whether they complied with the characteristics for the placement of the new p-branch(R) endograft, and to analyse the differences between the p-branch(R) and the implanted prosthesis. MATERIAL AND METHODS: A descriptive study was performed on 31 aneurysms treated consecutively from 2008-2013. The anatomical characteristics analysed were: relative distances between the visceral arteries, "o'clock" position, diameter in the sealing area and number of fenestrations, and its compatibility with the p-branch(R). RESULTS: The anatomical compatibility rate with the p-branch(R) options was 74.2% (23 cases). Of the 8 incompatible cases, 5 were due to misalignment of the visceral branches, one to the aortic neck diameter being greater, another because the femoral access was inappropriate, and one more due to the fenestration configuration. Of the 23 cases where there was compatibility, in 7 (30%), the configuration used coincided with the p-branch(R). In 13 cases the number of fenestrations was higher than those currently used, with 23 fenestrations carried out and 39 hypothetical fenestrations with the new endograft. In the 3 remaining cases a fenestration for the coeliac artery was necessary to achieve an adequate seal. CONCLUSION: The p-branch(R) could meet the needs of three quarters of the aortic anatomies of our series, with favourable expectations on cost and waiting time. However, in most cases either a higher number of fenestrations are needed for visceral vessels or the proximal seal was shorter than would be ideal

Tratamiento de la coartación aórtica en el adulto con stentautoexpandible: presentación de un caso y revisión de la bibliografía / Treatment of coarctation of the aorta in the adult with a self-expanding stent: presentation of a case and a review of the literature

No disponible

Diferencias entre la planificación del tratamiento endovascular de aneurismas de aorta abdominal con reconstrucción tridimensional vs tomografía computarizada y angiografía, y su impacto clínico / Differences between endovascular abdominal aortic aneurysm repair planning using three-dimensional reconstruction versus computed tomography and angiography

OBJETIVO: El objetivo es comparar la planificación del tratamiento endovascular de aneurismas de aorta abdominal (endovascular aneurysm repair [EVAR]) realizada mediante estudio tridimensional con la basada en tomografía computarizada (TC) y aortografía centimetrada. Analizar el impacto de la variabilidad de las mediciones en los resultados. MATERIAL Y MÉTODOS: Análisis retrospectivo de 35 casos de EVAR tratados entre 2006-2008 con información completa disponible (mediciones realizadas con TC y aortografía centimetrada). Se comparan dichas mediciones con las realizadas mediante estudio tridimensional (estación de trabajo 3Mensio(R)), mediante 2 modalidades con interpretación diferente: línea luminal central pura (CLL) y CLL rectificada (estimando el trayecto de la endoprótesis en la aorta). Se analizó la variabilidad intra e interobservador, y la correlación entre los métodos de medición fue analizada utilizando el coeficiente de correlación intraclase (CCI). Se analizó la influencia de variables anatómicas y las relacionadas con el procedimiento, en la diferencias entre las diferentes técnicas, mediante χ2, test de Fischer y t de Student, considerando un valor de p < 0,05 estadísticamente significativo. RESULTADOS: Se obtuvo elevada correlación entre las diferentes técnicas de medición, cercana a 0,9 para diámetros, y con CCI de 0,83, 0,75 y 0,76 para L1, L2 y L3, respectivamente (L1: longitud en milímetros desde el cuello aórtico a la bifurcación ilíaca, L2 y L3: longitud en milímetros del cuello aórtico a la zona de sellado en iliaca derecha e izquierda). La correlación intra e interobservador fue superior a 0,8 en todas las mediciones. El diámetro del aneurisma, la tortuosidad de las iliacas y la angulación del cuello influyeron en una mayor variabilidad (p < 0,05). El implante varió respecto al planificado (15%) y se registró una mayor duración de la intervención y tiempo de fluoroscopia en el grupo con variabilidad en medidas L2 y L3 (p < 0,05). CONCLUSIONES: Aunque el método clásico se ha mostrado eficaz, y los resultados obtenidos con ambas técnicas de medida son comparables, en nuestra experiencia la reconstrucción tridimensional ofrece una mayor precisión en la planificación y aporta beneficios clínicos, sobre todo mediante el uso apropiado de las diferentes técnicas de medida en función de las características anatómicas del aneurisma

OBJECTIVES: The primary endpoint of this study is to compare endovascular aneurysm repair (EVAR) planning using a three-dimensional study with the one based on computed axial tomography and calibrated aortography. The impact of the variability in the measurements on the clinical and technical outcomes was also analyzed. MATERIAL AND METHODS: Retrospective and observational study of 35 EVAR procedures between the years 2006-2008. Measurements made with CT and calibrated aortography were collected and then compared with measurements made in a three-dimensional study. The CT studies were processed at a workstation using two techniques with two different interpretations: pure central lumen line (CLL) and rectified CLL (estimating the path of the graft in the aorta). The correlation between the lengths and diameters were assessed. Intra- and inter-observer agreement and variability between measurement methods were analyzed using the intraclass correlation coefficient (ICC). The anatomical and technical variables associated with differences were also analyzed. χ2, Fischer, and Student-t tests were used for statistical analysis, considering P < 0.05as statistically significant. RESULTS: The correlation between different measurement techniques was high, close to 0.9 ICC for diameters; and 0.83, 0.75 and 0.76 for L1, L2, and L3, respectively (L1: length in millimeters from the aortic neck to the iliac bifurcation; L2 and L3: length in millimeters from the aortic neck to the right and left iliac bifurcation). The intra- and inter-observer agreement was higher than 0.8 in all measurements. The aneurysm diameter, the tortuosity of the iliac vessels and aortic neck angulation, were associated with greater variability (P < .05). There was a longer surgery and fluoroscopy time, and a need for more limb extensions, and modifications of planned graft in the group with variability in length measurements. CONCLUSIONS: In our experience the classical method is effective, and the results obtained with both measurement techniques are comparable. Additionally, the three-dimensional study provides greater accuracy in planning, gives more knowledge of the anatomical characteristics of the aneurysm, and provides clinical and technical benefits

Tratamiento mediante «técnica de chimenea» en aneurisma de aorta yuxtarrenal sintomático: a propósito de un caso / The chimney technique in the repair of a symptomatic aortic juxtarenal aneurysm: presentation of a case

No disponible

Tratamiento endovascular como alternativa terapéutica en isquemia mesentérica aguda / Endovascular treatment as a therapeutic alternative in acute mesenteric ischemia

No disponible

Claudicación intermitente en mujer deportista de élite / Intermittent claudication in a professional female athlete

No disponible

Acquired hemophilia A: three different presentations of the same disease.

Acquired hemophilia A is a rare disorder characterized by the presence of an autoantibody (mainly immunoglobulin G) to the clotting factor VIII with a clinical resemblance to hemophilia A. This autoantibody may arise because of dysregulation of the immune system. It is associated with various autoimmune or dermatologic diseases, pregnancy, or drug ingestion, but in almost 50% patients, the cause is unknown. In the present study, we have reported three different clinical presentations of acquired hemophilia. In two cases, the underlying disorder was the probable respiratory chronic disease (asthma), and in the other, it was idiopathic. We reviewed the response to a given treatment. The severity of the clinical presentation was different in all the cases, and was taken into account when we decided on the best course of treatment. The present report presents two patients successfully treated with a tapering course of steroids, and one with the anti-CD20 monoclonal antibody not given as first line treatment.

Tandem transplants with different high-dose regimens improve the complete remission rates in multiple myeloma. Results of a Grupo Español de Síndromes Linfoproliferativos/Trasplante Autólogo de Médula Osea phase II trial.

Between 1994 and 1999, 88 multiple myeloma (MM) patients were included in a phase II study to evaluate a tandem autologous stem cell transplantation (ASCT) programme. The first was conditioned with melphalan 200 mg/m2 (MEL200-ASCT1), and the second with cyclophosphamide, etoposide and BCNU (CBV-ASCT2). All patients were in response after MEL200-ASCT1. A control group of MM patients with response to a single ASCT was selected to compare outcomes. After MEL200-ASCT1, 26 patients (30%) achieved complete remission (CR). Of the remaining 48 evaluable patients, 16 (33%) achieved CR with CBV-ASCT2. The final CR rate was 48%. The 5-year survival (OS) was 55%[95% confidence interval (CI) 43-67%] while the event-free survival (EFS) was 28% (95% CI 15-39%). CR status after CBV-ASCT2 was the most important prognostic factor for OS and EFS (P = 0.00001), although no differences in outcomes were detected when the patients in CR after MEL200-ASCT1 were compared with those who obtained CR after CBV-ASCT2. Univariate and multivariate analyses showed improved OS and EFS for the tandem series as compared with the control series treated with a single MEL200-ASCT. However, in a stratified comparison by response, there were no prognostic differences between tandem patients and control patients treated with a single ASCT. In summary, our study suggests that the benefit of a second high-dose therapy course depends on its capacity to result in CR for MM patients who have not attained CR after ASCT1.