Tratamiento endovascular de la patología de la aorta descendente: experiencia preliminar sobre cinco casos / Endovascular treatment of the descending thoracic aorta diseases: preliminary experience about five cases

Objetivo. Analizar nuestros resultados en el tratamiento endovascular de cinco casos con patología de la aorta torácica descendente. Pacientes y métodos. Hemos tratado mediante la colocación de endoprótesis recubierta a cinco pacientes varones, con una edad media de 63 años (54-72) y con diversa patología de la aorta torácica descendente. Las patologías fueron: dos aneurismas de aorta torácica descendente de 7 y 7,5 cm de diámetro, respectivamente, una fístula aortobronquial, una rotura traumática a nivel del itsmo y una disección aguda tipo B. Las endoprótesis implantadas fueron en cuatro tipo TalentÔ y una AneuRxÔ. Resultados. En todos los casos se consiguió el éxito técnico y clínico inmediato. Como complicación postoperatoria se presentó un caso de monoparesia radial no relacionada directamente con el procedimiento. La media de seguimiento ha sido de 11 meses (6-18). En todos los casos se realizó una TAC a los 3, 6 y 12 meses sin que se presentara ninguna complicación. Conclusión. La técnica endovascular ha resultado eficaz y segura para el tratamiento de las patologías de la aorta torácica descendente (AU)

Cocket syndrome: thrombotic-septic disease post-appendicectomy complication.

The incidence of complications following treatment of acute appendicitis in childhood is lower than 5%, while thromboembolic disease at that age is exceptional. The case of a 13-year-old male who was operated on in our pediatric surgery department for acute gangrenous appendicitis is presented. His condition improved until the sixth day after the operation when he suffered thrombosis in both the left iliac vein and the inferior cava. Ultrasonography, plethysmography and computer tomography (CT) studies were carried out and a diagnosis of venous thrombosis was made with an underlying congenital vascular malformation where the iliac vein was compressed by the overlying iliac artery; known as the Cocket syndrome. The etiology diagnosis and treatment of this rare disease in childhood is reviewed.

[Echo-Doppler duplex combined with intracavernous injection of prostaglandin E1 in the diagnosis of impotence]. / Eco-Doppler duplex asociado a inyección intracavernosa de prostaglandina E1 en el diagnóstico de la impotencia.

Sixty-two patients that had consulted for impotence were evaluated by intracavernal injection of prostaglandin E1 and duplex echo-Doppler. The internal diameter and the mean flow of the cavernosal arteries were determined by echo-Doppler in the flaccid state. Thereafter 20 micrograms of PGE 1 was injected intracavernously and the erectile response was evaluated clinically after 5 to 15 minutes. Another Doppler evaluation was performed during tumescence to study the changes of the internal diameter and the mean flow increase of the cavernal arteries. Twenty-nine patients (46.7%) achieved normal erection after intracavernal PGE 1 and the Doppler study was normal in all but 2 patients (3.2%). The remaining 33 patients (53.1%) failed to achieve normal erection following intracavernal injection of PGE 1. The Doppler study, however, was normal in 7 of these patients (11.2%), which indicates venous leak to be the underlying cause of impotence. There were minor complications (19.3%) presented a small hematoma at the site of injection and 12.9% referred moderate pain at the time of injection) and no patient has a sustained erection for more than 3 hours. The hemodynamic mechanisms and the current concepts relative to the neurologic aspects of erection are discussed. We believe duplex echo-Doppler combined with intracavernal PGE 1 to be a very reliable method in the diagnosis of impotence of a vascular origin. It can distinguish those patients that cannot achieve erection following intracavernal PGE 1 with a normal arterial tree whose impotence can be ascribed to venous leak.