Detection of valvular heart diseases combining orthogonal non-negative matrix factorization and convolutional neural networks in PCG signals.

BACKGROUND AND OBJECTIVE: Valvular heart disease (VHD) is associated with elevated mortality rates. Although transthoracic echocardiography (TTE) is the gold standard detection tool, phonocardiography (PCG) could be an alternative as it is a cost-effective and noninvasive method for cardiac auscultation. Many researchers have dedicated their efforts to improving the decision-making process and developing robust and precise approaches to assist physicians in providing reliable diagnoses of VHD. METHODS: This research proposes a novel approach for the detection of anomalous valvular heart sounds from PCG signals. The proposed approach combines orthogonal non-negative matrix factorization (ONMF) and convolutional neural network (CNN) architectures in a three-stage cascade. The aim of the proposal is to improve the learning process by identifying the optimal ONMF temporal or spectral patterns for accurate detection. In the first stage, the time-frequency representation of the input PCG signal is computed. Next, band-pass filtering is performed to locate the spectral range that is most relevant for the presence of such cardiac abnormalities. In the second stage, the temporal and spectral cardiac structures are extracted using the ONMF approach. These structures are utilized in the third stage and fed into the CNN architecture to detect abnormal heart sounds. RESULTS: Several state-of-the-art CNN architectures, such as LeNet5, AlexNet, ResNet50, VGG16 and GoogLeNet, have been evaluated to determine the effectiveness of using ONMF temporal features for VHD detection. The results reveal that the integration of ONMF temporal features with a CNN classifier significantly improve VHD detection. Specifically, the proposed approach achieves an accuracy improvement of approximately 45% when ONMF spectral features are used and 35% when time-frequency features from the short-time Fourier transform (STFT) spectrogram are used. Additionally, feeding ONMF temporal features into low-complexity CNN architectures yields competitive results comparable to those obtained with complex architectures. CONCLUSIONS: The temporal structure factorized by ONMF plays a critical role in distinguishing between normal heart sounds and abnormal heart sounds since the repeatability of normal heart cycles is disrupted by the presence of cardiac abnormalities. Consequently, the results highlight the importance of appropriate input data representation in the learning process of CNN models in the biomedical field of valvular heart sound detection.

Unsupervised detection and classification of heartbeats using the dissimilarity matrix in PCG signals.

BACKGROUND AND OBJECTIVE: Auscultation is the first technique applied to the early diagnose of any cardiovascular disease (CVD) in rural areas and poor-resources countries because of its low cost and non-invasiveness. However, it highly depends on the physician's expertise to recognize specific heart sounds heard through the stethoscope. The analysis of phonocardiogram (PCG) signals attempts to segment each cardiac cycle into the four cardiac states (S1, systole, S2 and diastole) in order to develop automatic systems applied to an efficient and reliable detection and classification of heartbeats. In this work, we propose an unsupervised approach, based on time-frequency characteristics shown by cardiac sounds, to detect and classify heartbeats S1 and S2. METHODS: The proposed system consists of a two-stage cascade. The first stage performs a rough heartbeat detection while the second stage refines the previous one, improving the temporal localization and also classifying the heartbeats into types S1 and S2. The first contribution is a novel approach that combines the dissimilarity matrix with the frame-level spectral divergence to locate heartbeats using the repetitiveness shown by the heart sounds and the temporal relationships between the intervals defined by the events S1/S2 and non-S1/S2 (systole and diastole). The second contribution is a verification-correction-classification process based on a sliding window that allows the preservation of the temporal structure of the cardiac cycle in order to be applied in the heart sound classification. The proposed method has been assessed using the open access databases PASCAL, CirCor DigiScope Phonocardiogram and an additional sound mixing procedure considering both Additive White Gaussian Noise (AWGN) and different kinds of clinical ambient noises from a commercial database. RESULTS: The proposed method outperforms the detection and classification performance of other recent state-of-the-art methods. Although our proposal achieves the best average accuracy for PCG signals without cardiac abnormalities, 99.4% in heartbeat detection and 97.2% in heartbeat classification, its worst average accuracy is always above 92% for PCG signals with cardiac abnormalities, signifying an improvement in heartbeat detection/classification above 10% compared to the other state-of-the-art methods evaluated. CONCLUSIONS: The proposed method provides the best detection/classification performance in realistic scenarios where the presence of cardiac anomalies as well as different types of clinical environmental noises are active in the PCG signal. Of note, the promising modelling of the temporal structures of the heart provided by the dissimilarity matrix together with the frame-level spectral divergence, as well as the removal of a significant number of spurious heart events and recovery of missing heart events, both corrected by the proposed verification-correction-classification algorithm, suggest that our proposal is a successful tool to be applied in heart segmentation.

Guía clínica española del acceso vascular para hemodiálisis / Spanish clinical guidelines on vascular access for haemodialysis

El acceso vascular para hemodiálisis es esencial para el enfermo renal tanto por su morbimortalidad asociada como por su repercusión en la calidad de vida. El proceso que va desde la creación y mantenimiento del acceso vascular hasta el tratamiento de sus complicaciones constituye un reto para la toma de decisiones debido a la complejidad de la patología existente y a la diversidad de especialidades involucradas. Con el fin de conseguir un abordaje consensuado, el Grupo Español Multidisciplinar del Acceso Vascular (GEMAV), que incluye expertos de las cinco sociedades científicas implicadas (nefrología [S.E.N.], cirugía vascular [SEACV], radiología vascular e intervencionista [SERAM-SERVEI], enfermedades infecciosas [SEIMC] y enfermería nefrológica [SEDEN]), con el soporte metodológico del Centro Cochrane Iberoamericano, ha realizado una actualización de la Guía del Acceso Vascular para Hemodiálisis publicada en 2005. Esta guía mantiene una estructura similar, revisando la evidencia sin renunciar a la vertiente docente, pero se aportan como novedades, por un lado, la metodología en su elaboración, siguiendo las directrices del sistema GRADE con el objetivo de traducir esta revisión sistemática de la evidencia en recomendaciones que faciliten la toma de decisiones en la práctica clínica habitual y, por otro, el establecimiento de indicadores de calidad que permitan monitorizar la calidad asistencial.

Vascular access for haemodialysis is key in renal patients both due to its associated morbidity and mortality and due to its impact on quality of life. The process, from the creation and maintenance of vascular access to the treatment of its complications, represents a challenge when it comes to decision-making, due to the complexity of the existing disease and the diversity of the specialities involved. With a view to finding a common approach, the Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology [S.E.N.], vascular surgery [SEACV], vascular and interventional radiology [SERAM-SERVEI], infectious diseases [SEIMC] and nephrology nursing [SEDEN]), along with the methodological support.

Análisis bibliométrico de la producción científica sobre el efecto del consumo de estatinas en las manifestaciones oftalmológicas de la miastenia gravis / Bibliometric analysis of the scientific production as regards statin use for ophthalmological symptoms of myasthenia gravis

Introducción: Los pacientes con miastenia gravis (MG) suelen empezar con afectación de la musculatura ocular. Es relevante que el oftalmólogo disponga de información actualizada del estado de la investigación respecto a la relación de esta enfermedad con el consumo de fármacos, como las estatinas. Material y métodos: Se realizó un análisis bibliométrico, utilizando la base de datos Scopus y aplicando una estrategia de búsqueda consistente en la selección de documentos que contuvieran los descriptores referidos a estatinas en el campo «Título» («TI») y los descriptores «ophthalm*», «myast*», «visual*» en cualquier otro campo del documento (de 1986 a 2015). Resultados: Los resultados confirman que, mientras el número de publicaciones científicas sobre efectos oftalmológicos de las estatinas ha crecido linealmente (n = 838; y = 2,267x-4507,1; r = 0,7221; tiempo de duplicación: 4,66 años y tasa de crecimiento anual: 50,06%), las publicaciones específicas sobre MG han experimentado un crecimiento exponencial (n = 38; y = 2E-262e0,3001x; r = 0,3892; tiempo de duplicación: 2,95 años y tasa de crecimiento anual: 46,25%), sin que se haya alcanzado la saturación postulada en la teoría de Price de la expansión de la literatura científica. La mayor parte de las publicaciones relativas a la MG son reportes de casos vinculados a un empeoramiento de la sintomatología de la MG, y los agentes que más publicaciones aportan son simvastatina y atorvastatina. Conclusiones: Estos resultados permitirán al oftalmólogo ampliar su conocimiento respecto a la evolución de la investigación sobre estatinas y MG y reflejan un interés creciente por la relación entre el consumo de ambas, señal de la relevancia de dicha relación causal (AU)

Introduction: The first symptoms of myasthenia gravis (MG) usually involve weakness of the ocular muscles, making it relevant that ophthalmologists have updated information on studies as regards its relationship with the consumption of drugs, such as statins. Materials and methods: A bibliometric analysis was performed using the Scopus database and by a search strategy in the selection of documents containing descriptors related to statins in the «Title» («TI») field and the descriptors «ophthalm *, «myast *, «visual * in other fields of the document (period 1986-2015). Results: The results showed that, while the number of scientific publications on ocular effects of statins has grown lineally (n = 838; y = 2.267x-4507.1; r = 0.7221; time of duplication: 4.66 years, and rate of annual growth: 50.06%), the specific publications about MG have experienced an exponential growth (n = 38; y = 2E-262e0.3001x; r = 0.3892; time of duplication: 2.95 years, and rate of annual growth: 46.25%) without reaching the saturation postulated in Price theory of the expansion of the scientific literature. The majority of publications relating to MG are reports of cases linked to a worsening of the MG symptoms, and simvastatin and atorvastatin are the agents mentioned in most of the publications. Conclusions: These results should enable ophthalmologists to expand their knowledge concerning the evolution of studies on statins and MG, pointing out the relevance of such causal relationships (AU)

Bibliometric analysis of the scientific production as regards statin use for ophthalmological symptoms of myasthenia gravis. / Análisis bibliométrico de la producción científica sobre el efecto del consumo de estatinas en las manifestaciones oftalmológicas de la miastenia gravis.

INTRODUCTION: The first symptoms of myasthenia gravis (MG) usually involve weakness of the ocular muscles, making it relevant that ophthalmologists have updated information on studies as regards its relationship with the consumption of drugs, such as statins. MATERIALS AND METHODS: A bibliometric analysis was performed using the Scopus database and by a search strategy in the selection of documents containing descriptors related to statins in the «Title¼ («TI¼) field and the descriptors «ophthalm *', «myast *', «visual *' in other fields of the document (period 1986-2015). RESULTS: The results showed that, while the number of scientific publications on ocular effects of statins has grown lineally (n=838; y=2.267x-4507.1; r=0.7221; time of duplication: 4.66 years, and rate of annual growth: 50.06%), the specific publications about MG have experienced an exponential growth (n=38; y=2E-262e0.3001x; r=0.3892; time of duplication: 2.95 years, and rate of annual growth: 46.25%) without reaching the saturation postulated in Price theory of the expansion of the scientific literature. The majority of publications relating to MG are reports of cases linked to a worsening of the MG symptoms, and simvastatin and atorvastatin are the agents mentioned in most of the publications. CONCLUSIONS: These results should enable ophthalmologists to expand their knowledge concerning the evolution of studies on statins and MG, pointing out the relevance of such causal relationships.

Registro de actividades de la Sociedad Española de Angiología y Cirugía Vascular, año 2014 / Activities register of the Spanish Society of Angiology and Vascular Surgery: 2014

OBJETIVO: Describir la actividad asistencial del año 2014 de los servicios/unidades de Angiología y Cirugía Vascular en España. PACIENTES Y MÉTODOS: Estudio transversal con encuesta a 107 centros sobre procedimientos quirúrgicos y exploraciones vasculares realizados en 2014. Análisis descriptivo de resultados y comparación de la ratio de actividad/100.000 habitantes con 2013. RESULTADOS: Respondieron 72 servicios (35 de ellos, docentes) correspondientes a 78 centros. En 2014 se produjeron 44.295 ingresos, 32,2% urgentes y 67,8% programados, con estancia media de 7,3 días. En lista de espera, a 31/12/2014, existía predominio de la patología venosa sobre la arterial (13.446 vs. 1.890). La actividad quirúrgica global en cirugía arterial en 2014 fue semejante a la de 2013 con variaciones en la ratio/100.000 habitantes según el sector: 9,4 vs. 10,3 en troncos supraaórticos; 1,2 vs. 1,5 en aorta torácica; 0,38 vs. 0,31 en aorta toracoabdominal; 1,3 vs. 1,4 en arterias viscerales; 9,6 vs. 9,4 en aorta abdominal; 11,2 vs. 11,4 en sector aortoilíaco; 22,0 vs. 21,4 en sector femoropoplíteo y 9,9 vs. 9,4 en sector distal. Prácticamente en todas ellas la ratio de procedimientos de cirugía convencional fue inferior, mientras que el de cirugía endovascular aumentó en algunos. En 2014 se realizaron similar número de accesos de hemodiálisis (20,6 vs. 19,9). La actividad en amputaciones mayores y menores fue semejante (7,4 vs. 7,6 y 10,8 vs. 11,3). La actividad global en 2014 sobre el sector venoso fue semejante a la de 2013 (65,4 vs. 67,4), si bien se realizaron más procedimientos con cirugía endovascular para tratamiento de varices. La ratio/100.000 habitantes de exploraciones vasculares fue parecido a 2013 (760,5 vs. 764,1). CONCLUSIÓN: Con relación a 2013: se mantiene la participación y la actividad quirúrgica arterial global, con incremento de procedimientos endovasculares en algunos territorios; la venosa global se ha mantenido, con gran aumento de procedimientos endovasculares para el tratamiento de varices; las exploraciones vasculares se han mantenido

OBJECTIVE: To describe the health-care activities carried out by Angiology and Vascular Surgery Departments/Units in Spain in 2014. PATIENTS AND METHODS: Cross-sectional study using a questionnaire sent to 107 centres on surgical procedures and vascular examinations performed in 2014. A descriptive analysis of results and comparison of the activity ratio/100,000 population with 2013 is also presented. RESULTS: Responses were received from 72 department (35 of them teaching), corresponding to 78 centres. In 2014 there were 44,295 admissions, of which 32.2% were emergency and 67.8% were elective, with a mean hospital stay of 7.3 days. The waiting list on December, 31st 2014 showed a predominance of venous rather than arterial disease (13,446 vs. 1,890). Arterial surgery in 2014 was similar to 2013, with some differences in the ratios/100,000 population: 9.4 vs. 10.3 in the supra-aortic trunk, 1.2 vs. 1.5 in the thoracic aorta, 0.38 vs. 0.31 in the thoracic-abdominal aorta, 1.3 vs. 1.4 in visceral arteries, 9.9 vs. 9.4 in the abdominal aorta, 11.2 vs. 11.4 in the aortic-iliac segment, 22.0 vs. 21.4 in the femoral-popliteal segment, and 9.0 vs. 9.4 in the distal segment. The ratio of conventional surgical procedures was lower for all of these, whereas that of endovascular surgery increased in some cases. Compared to 2013, there was similar number of haemodialysis access procedures performed in 2014 (20.6 vs. 19.9). Procedures involving major and minor amputations were similar (7.4 vs. 7.6, 10.8 vs. 11.3, respectively). The overall venous surgery activity in 2014 was similar to 2013 (65.4 vs. 67.4), although there were more procedures using endovascular surgery. The ratio/100,000 population of vascular examinations was similar to 2013 (760.5 vs. 764.1). CONCLUSION: The activity was stable in 2014 compared to 2013, in almost the whole area of arterial surgery, although endovascular procedures increased in some vascular areas. Venous surgery on the whole has remained, with similar number of procedures, despite that the varicose treatments significantly increased in endovascular procedures. Vascular examinations maintained a similar activity to 2013

Tratamiento de linfoceles y seromas periprotésicos mediante ecoescleroterapia con espuma / Lymphoceles Treatment of lymphoceles and periprosthetic seromas by foam ecosclerotherapy

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Flebología low cost + facultativos low profile = pacientes con low results / Low cost phlebology + low profile professionals = Patients with low results

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25 Años de comunicación y salud / No disponible

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Estenosis de vena cava inferior tratada con stent / Inferior vena cava stenosis treated with a stent

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Criterios de derivación entre niveles asistenciales de pacientes con patología vascular. Documento de consenso semFYC-SEACV / Criteria for between-care-level referrals of patients with vascular disease. semFYC-SEACV consensus document

La Sociedad Española de Medicina Familiar y Comunitaria (semFYC) y la Sociedad Española de Angiología y Cirugía Vascular (SEACV) han elaborado, mediante un grupo de trabajo conjunto, un documento de derivación entre niveles asistenciales de los pacientes con las principales patologías vasculares: enfermedad arterial periférica, insuficiencia venosa y pie diabético. Se han definido las responsabilidades y habilidades requeridas de cada nivel asistencial y también los criterios de derivación mutua, así como los de priorización. La elaboración de este documento consensuado pretende aportar una herramienta eficiente que asegure la continuidad en la asistencia sanitaria, respetando siempre las particularidades y necesidades específicas de cada zona sanitaria(AU)

The Spanish Society of Family and Community Medicine (semFYC) and the Spanish Society of Angiology and Vascular Surgery (SEACV), through a Joint Working Group, have prepared a document on between care-level referrals of patients with the main vascular diseases; peripheral arterial disease, venous insufficiency, and diabetic foot. The responsibilities and skills required at each care level have been defined, as well as the criteria for mutual referral and how to prioritise them. The preparation of this consensus document attempt to provide an efficient tool that may ensure the continuity of health care, always respecting the specific characteristics and needs of each health care area(AU)

Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program.

AIM: The Vein Consult Program is an international, observational, prospective survey aiming to collect global epidemiological data on chronic venous disorders (CVD) based on the CEAP classification, and to identify CVD management worldwide. The survey was organized within the framework of ordinary consultations, with general practitioners (GPs) properly trained on the use of the CEAP classification. METHODS: Screening for CVD was to be performed by enrolling in the survey all consecutive outpatients >18 years whatever the reason for consultation, to record patient's data and classify them according to the CEAP, from the stage C0s to C6. The program enrolled 6232 GPs 91545 subjects were analysed. Their mean age was 50.6±16.9 years, younger patients being in the Middle East and older ones in Europe, and the proportion of women was higher than that of men. RESULTS: The worldwide prevalence of CVD was 83.6%: 63.9% of the subjects ranging C1 to C6, and 19.7% being C0s subjects. C0s patients were more frequently men whatever the age and the geographical zone. C1-C3 appeared to be more frequent among women whatever the country but the rate of severe stages (C4-C6) did not differ between men and women. GPs consider CVD subjects as patients eligible to specialist referral beginning from C2 but some geographical disparities were observed. CONCLUSION: The VCP survey provides reliable results on CVD global epidemiology and shows that CVD affects a significant part of the populations worldwide, underlining the importance of adequate screening for CVD and training of both GPs and specialist physicians.

Multipactor radiation analysis within a waveguide region based on a frequency-domain representation of the dynamics of charged particles.

A technique for the accurate computation of the electromagnetic fields radiated by a charged particle moving within a parallel-plate waveguide is presented. Based on a transformation of the time-varying current density of the particle into a time-harmonic current density, this technique allows the evaluation of the radiated electromagnetic fields both in the frequency and time domains, as well as in the near- and far-field regions. For this purpose, several accelerated versions of the parallel-plate Green's function in the frequency domain have been considered. The theory has been successfully applied to the multipactor discharge occurring within a two metal-plates region. The proposed formulation has been tested with a particle-in-cell code based on the finite-difference time-domain method, obtaining good agreement.

Emerging roles of ADAM and ADAMTS metalloproteinases in cancer.

A disintegrin and metalloproteinases (ADAMs) are a recently discovered family of proteins that share the metalloproteinase domain with matrix metalloproteinases (MMPs). Among this family, structural features distinguish the membrane-anchored ADAMs and the secreted ADAMs with thrombospondin motifs referred to as ADAMTSs. By acting on a large panel of membrane-associated and extracellular substrates, they control several cell functions such as adhesion, fusion, migration and proliferation. The current review addresses the contribution of these proteinases in the positive and negative regulation of cancer progression as mainly mediated by the regulation of growth factor activities and integrin functions.

Anomalías congénitas del sistema venoso cavo superior. A propósito de dos casos / Congenital anomalies of the superior caval venous system. Two case reports

Introducción. La persistencia de la vena cava superior izquierda (VCSI) es la anomalía venosa torácica más frecuente, con una prevalencia de hasta el 2% en la población general. De curso asintomático, su detección suele corresponder a un hallazgo durante la cateterización de vías venosas centrales superiores. Reconocer alguna de sus variantes ante dificultades durante el cateterismo puede evitarnos iatrogenia o errores diagnósticos. Casos clínicos. Caso 1: mujer de 58 años, con insuficiencia renal terminal en hemodiálisis. Historia de múltiples accesos vasculares. Implantamos un nuevo catéter en la vía yugular izquierda. Técnica habitual sin anomalías. Comprobamos el buen funcionamiento de ambas luces y con radioscopia observamos su extremo en silueta cardíaca, con latido y un recorrido anómalo paravertebral izquierdo. La placa de control reveló un recorrido semejante al de una VCSI. La gasometría era venosa y se practicó angiorresonancia magnética y angiografía para diferenciar una VCSI de posibles malposiciones. El catéter fue útil en tres sesiones antes de su retirada. Caso 2: mujer de 32 años, con síndrome de Down y disfunción sinusal. Programada para implante de marcapasos DDDR (doble ‘sensado’, doble estímulo y doble respuesta). Se avanzaron los cables vía vena cefálica izquierda, dibujándose una silueta de VCSI, desconocida previamente. A través del seno coronario se implantaron en sus respectivos destinos. Chequeo normal. Conclusión. La VCSI y sus variantes congénitas son anomalías venosas no infrecuentes, cuya detección durante el cateterismo de vías centrales superiores es esencial para evitar iatrogenia grave (perforación venosa central) y falsos diagnósticos sobre malposiciones intraarteriales o extravasculares intratorácicas

Introduction. Persistent left superior vena cava (LSVC) is the most frequent thoracic venous anomaly, with a prevalence of up to 2% in the general population. As it is asymptomatic, it is usually only detected during catheterisation of the upper central veins. Recognising some of its variants when faced with difficulties during catheterisation can save us from iatrogenic effects or diagnostic errors. Case reports. Case 1: a 58-year-old female with terminal renal failure on haemodialysis. The patient had a history of multiple vascular accesses. We placed a new catheter in the left jugular line. This is a usual procedure with no anomalies. We checked both lumina were functioning properly and with radioscopy we observed its tip in the cardiac silhouette, with an anomalous left paravertebral route and beating. The control X-ray revealed a route that was similar to that of an LSVC. Blood gas analysis showed it to be venous and magnetic resonance angiography and angiography were performed to distinguish an LSVC from possible malpositioning. The catheter was used in three sessions before it was withdrawn. Case 2: a 32-year-old female with Down syndrome and sinus node dysfunction. The patient was programmed for a DDDR (dual sensor, dual stimulus and dual response) pacemaker implant. The wires were run along the left cephalic vein, which traced a previously unknown LSVC silhouette. They were implanted in their respective destinations through the coronary sinus. Check-up was normal. Conclusions. LSVC and its congenital variants are venous anomalies that are not infrequent; their detection during the catheterisation of upper central lines is essential in order to prevent serious iatrogenic effects (perforation of the central venous line) and false diagnoses involving intra-arterial intrathoracic or extravascular malpositioning

Arteritis de células gigantes y oclusión de la arteria central de la retina / Giant cell arteritis and retinal central artery oclussion

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Historia natural de la disección aórtica / Natural history of aortic dissections

Objetivo: Se analiza con detenimiento la historia natural de la disección tipo B y sus distintas formas evolutivas e igualmente se sigue por separado la historia natural del hematoma de pared y de la úlcera de pared de aorta. Desarrollo. Se propone abandonar la clasificación en aguda y crónica ya que es arbitraria y basada en días naturales que no siempre tienen que ver con la evolución y la situación clínica del caso; en su contra se propone dividir las disecciones tipo B en progresivas y estabilizadas y además en complicadas y no complicadas. Se presenta un resumen de una serie propia de 91 disecciones de aorta, 59 de las cuales pertenecen a una serie histórica tratada médicamente y 32 corresponden a una serie realizada de forma prospectiva con tratamiento endovascular, se comparan los resultados de ambas. Se justifica este tratamiento en vistas a los resultados del tratamiento médico que sigue presentando un 13% de mortalidad, un 10% de afectación medular, un 22% de insuficiencia renal, un 28% de isquemia intestinal y/o periférica y un 30% de redisecciones. Conclusión. Concluimos estableciendo que ante lo impredecible de la evolución de la disección tipo B, el tratamiento médico podría sustituirse por el quirúrgico cuando a las 48 horas de su inicio no ha sido capaz de hacer desaparecer el dolor y controlar la hipertensión arterial

Aims: We perform a detailed analysis of the natural history of type B dissections and their different forms of progression. At the same time we also carry out separate examinations of the natural history of aortic wall haematomas and wall ulcers. Development. We propose giving up the practice of classifying them as acute and chronic since this is decided at random and is based on the number of days, which does not always have a clear relation to the progression and clinical situation of the case. In contrast, however, we suggest dividing type B dissections into progressive and stabilised, as well as into complicated and non-complicated cases. We report on a series of our own consisting of 91 aortic dissections, 59 of which belonged to a historical series that was treated medically and 32 from a prospective series with endovascular treatment; results from the two series are compared. This treatment is justified by the outcomes obtained with medical treatment, which continues to offer a 13% mortality rate, a 10% rate of spinal cord involvement, 22% renal failure, 28% intestinal and/or peripheral ischaemia and a 30% rate of redissections. Conclusions. We conclude by stating that, given the unpredictability of the progression of type B dissections, medical treatment could be replaced by surgery when, 48 hours after starting therapy, it has been unable to make the pain disappear and to control the high blood pressure

Encuestas de actividades en Angiología y Cirugía Vascular / Surveys of activities in Angiology and Vascular Surgery

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[Intraocular phakic lens ZSAL-4 for high myopia correction]. / Lente ZSAL-4 para la corrección de la alta miopía.

PURPOSE: To evaluate the effectiveness, safety and predictability of the phakic intraocular lens (IOL) ZSAL-4 for correction of high myopia. METHODS: In this retrospective study 28 IOL in 19 patientes were implanted. The following data were recorded, preoperatively, one week, one month, 3, 6 and 12 months postoperatively: spherical equivalent (SE), astigmatism, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), endothelial cell density (CD), coefficient of variation (CV) and intraocular pressure (IOP). We performed LASIK in 3 eyes to correct a residual refractive defect. RESULTS: The mean age was 29.7 S.D. 5.77 years and the mean following 7.62 S.D. 7.29 months. Six months postoperatively, the preoperative SE of -14.91 S.D. 2.88 was reduced to -1.29 S.D. 0.53; the BCVA varied from 0.56 S.D. 0.16 to 0.58 S.D. 0.12; the CD changed from 2670 S.D. 252 cells/mm2 to 2344 S.D. 262. The CV showed stability. The UCVA six months postoperatively was 0.39 S.D. 0.15. No eyes lost any line of BCVA; during the first month 63% of the eyes won 2 or more lines. The efficacy index was 0.83 S.D. 0.24 one month postoperatively and 0.63 S.D. 0.32 one year postoperatively; the safety index was 1.44 D.S. 0.34 and 1.30 S.D. 0.35 respectively. One IOL was explanted the second day due to pupilary blockage; 7 eyes had transient high IOP; 2 eyes developed pupilary ovalization and in 4 cases the IOL suffered some degree of rotation. One eye presented a flat retinal detachment one year postoperatively but with no other complications. The 3 eyes submitted to LASIK presented 0.8 of BCVA the third month after LASIK. CONCLUSIONS: ZSAL-4 IOL implantation is an effective and safe procedure with an acceptable predictability which, in some cases, could be improved with LASIK.