Evolución en una década del riesgo quirúrgico en cirugía coronaria según el predictor euroscore logístico. Estudio monocéntrico / Evolution in a decade of surgical risk in coronary surgery according to the logistic euroscore predictor. Monocentric study

Introducción: Numerosos estudios avalan la modificación del perfil de riesgo de los pacientes sometidos a cirugía coronaria en los últimos años. Es trascendental investigar la evolución de dicho perfil de riesgo y sus factores condicionantes en Canarias. Objetivos: Comparar el riesgo estimado por EuroSCORE Logístico de los pacientes intervenidos en 2003 y 2012 (objetivo primario), así como los factores condicionantes del mismo (objetivo secundario). Material y métodos: 260 pacientes consecutivos intervenidos de cirugía coronaria, incluyendo procedimientos cardio-quirúrgicos asociados, en el Servicio de CCV del HUC (173 en 2003 y 87 en 2012). Los factores condicionantes del perfil de riesgo de cada paciente se obtuvieron del informe de alta que figura en el SAP, y se recogieron en Microsoft Office Excel 2007. Se calculó el riesgo teórico quirúrgico de cada paciente conforme al EuroSCORE Logístico. Se utilizó el paquete estadístico SPSS® v.12.0. Resultados: El riesgo estimado por el EuroSCORE no varió (p=0.243). Las medianas fueron 5.865 en 2003 y 5.330 en 2012. Los factores de riesgo tampoco variaron, exceptuando: creatinina (p<0.001), con una mediana de 0.9 mg/dl en 2003 y 0.8 mg/dl en 2012; angina inestable (p<0.001), 41% en 2003 y 17.2% en 2012; IAM (p<0.05), 22% en 2003 y 6.9% en 2012; cirugía distinta a coronaria aislada (p<0.001), 12.1% en 2003 y 31% en 2012; y cirugía sobre la aorta torácica (p<0.05), 0% en 2003 y 2.3% en 2012. Conclusión: El riesgo teórico estimado por el EuroSCORE Logístico en cirugía coronaria no varió. La mayoría de los factores de riesgo, como edad, sexo femenino, enfermedad pulmonar crónica, arteriopatía extracardiaca, disfunción neurológica o cirugía cardiaca previa, tampoco variaron. Sí cambiaron: disminuyeron los valores de creatinina y la prevalencia de angina inestable e IAM; y aumentaron las cirugías distintas a coronaria aislada

Introduction: Risk profile change of patients undergoing coronary artery bypass grafting (CABG) in recent years is supported by numerous studies. Studying the evolution of the risk profile and its conditioning factors on the Canary Islands is transcendental. Objectives: To compare the mortality predicted by Logistic EuroSCORE in patients undergoing CABG in 2003 and 2012 (primary objective), and also its risk factors (secondary objective). Methods: 260 patients who underwent CABG in the Cardiovascular Surgery Department of the University Hospital of the Canary Islands were selected (173 patients in 2003 - 87 patients in 2012), including those who underwent other major cardiac procedures than isolated CABG. Risk factors were obtained from the discharge summary contained in SAP, and were collected in Microsoft Office Excel 2007. The surgical theoretical risk of each patient in accordance with the logistic EuroSCORE was calculated. Statistical software package SPSS(R) v.18.0 was used to analyze the predicted mortality and its risk factors. Results. The mortality predicted by EuroSCORE has not changed (p=0.243). The medians were 5.865 in 2003 and 5.330 in 2012. Risk factors have not changed either, except: creatinine (p<0.001), whose median was 0.9 mg/dl in 2003 and 0.8 mg/dl in 2012; unstable angina (p<0.001), 41% in 2003 and 17.2% in 2012; myocardial infarction (p<0.05), 22% in 2003 and 6.9% in 2012; other major surgery than isolated CABG (p<0.001), 12.1% in 2003 and 31% in 2012; and surgery on thoracic aorta (p<0.05), 0% in 2003 and 2.3% in 2012. Conclusion: The mortality predicted by Logistic EuroSCORE in coronary surgery has not changed. Most of the risk factors, such as age, female sex, chronic pulmonary disease, extracardiac arteriopathy, neurological dysfunction or previous cardiac surgery, have not change either. Some risk factors have changed: creatinine values and prevalence of unstable angina and myocardial infarction decreased; and other major cardiac procedures than isolated CABG increased, including surgery on thoracic aorta

Estudio epidemiológico descriptivo de la cardiopatía isquémica en un servicio de urgencias / Epidemiologic descriptive study in ischemic cardiophaty at an urgency service

Las enfermedades cardiovasculares representan la primera causa de muerte en las provincias canarias. En el presente trabajo se estudió lo acontecido en el servicio de urgencias de un hospital de referencia respecto a la cardiopatía isquémica: la forma de acceso de los pacientes, el destino que tuvieron, el género y la edad de los mismos, si acudieron al servicio de urgencias en día festivo o laboral, el momento del día en que se presentan en urgencias, cual es la procedencia y si su edad es mayor de 71 años o menor de 70 años Cardiovascular disease are the main cause of death in Canary Islands. Some variables refering the myocardial ischemic syndromes reaching the emergency department of a referal hospital are reported: way the patients acceded to the hospital, final destination inside the hospital, gender and age of the patients, day of the week (holyday or not) they came, moment of the day they reached the emergency department, from where they came and stratification of ages over or below 70 years (AU)

[The blue tests. Current data concerning its indications and interpretation (author's transl)]. / L'épreuve au bleu. Données actuelles sur ses indications et son interprétation.

The blue test is designed to reveal oedema of total or partial lymphatic origin. It consists of the subcutaneous or intradermal injection in oedematous areas of a very small amount of violet patent blue and study of its resorption. The diagnosis is immediate and although reliability is not absolute it is nevertheless highly constant. Intolerance to the dye injected is rare, though sometimes severe, and users should be aware of the possibility. The Blue test remains of great interest in angeiology.

[Nosology of so-called capillaritis ulcers]. / Nosologie de l'ulcère dit capillaritique.

It was with ochre dermatitis that the clinical notion of "capillaritis" was first put forward, but in what sense is it still possible today to speak of "capillaritic ulcer"? Although some special characteristics have been ascribed to it, this ulcer is derived from a microvascular and tissue reaction to venous stasis, whether the latter is primary due to varicose veins or secondary due to "post-thrombotic syndrome" or obliterative arteriopathy of the supplying trunks and especially the nutritional branches of the dermohypodermic network. This type of ulcer involves the Circulatory Unit and is expressed by an imbalance in irrigation, the result of a whole sequence of capillary closures and anastomotic openings, of which the "mosaic" appearance on infra-red thermography is evidence. It is a stasis ulcer in which the mode of distribution of the capillaries is involved just as much as the thickness of the skin of the groove of Bisgaard, but it is the result of the majority of the angiopathic states of the lower limb.