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2.
Angiol. (Barcelona) ; 75(1): 25-42, ene.-feb. 2023. tab
Article in Spanish | IBECS | ID: ibc-215797

ABSTRACT

Las guías de práctica clínica se han posicionado como una herramienta extremadamente útil, accesible y necesaria para llevar a cabo de forma adecuada el trabajo diario. El Capítulo de Diagnóstico Vascular de la Sociedad Española de Angiología y Cirugía Vascular viene desarrollando este instrumento de difusión, consolidación y homogenización del saber en la vertiente del diagnóstico vascular, que es la que le incumbe. La insuficiencia venosa de las extremidades inferiores es uno de los campos de estudio y diagnóstico clásicos más ricos y defendidos desde el Capítulo de Diagnóstico Vascular. Esta entidad ya ha publicado dos excelentes guías sobre este tema. Aunque a un ritmo menor y con una filosofía diferente a otro tipo de guías clínicas, las guías de diagnóstico también deben actualizarse para incorporar nuevas áreas de saber, cambiar puntos de vista o, simplemente, explicar los mismos hechos desde otras perspectivas. Con este ánimo presentamos esta nueva actualización de la Guía de la exploración venosa de los miembros inferiores, teniendo muy claro que no tratamos, ni mucho menos, de sustituir las ya publicadas, sino de complementarlas y sumarles conocimientos. Desde esta perspectiva, hemos plasmado los hallazgos ecográficos que podemos constar en un estudio venoso, hemos incluido un capítulo sobre la anatomía ecográfica “normal” de las venas de las extremidades inferiores, actualizando su nomenclátor, hemos pormenorizado con todo lujo de detalles lo que sería una exploración ecográfica venosa de miembros inferiores, hemos reservado un espacio para recordar y actualizar protocolos de estudio ecográfico de la trombosis venosa y, finalmente, y como tema estrella, hemos desarrollado todo un capítulo innovador sobre el estudio de la insuficiencia venosa pélvica.(AU)


Clinical practice guidelines have positioned themselves as an extremely useful, accessible, and necessary tool to properly carry out daily work. The Capítulo de Diagnóstico Vascular of Sociedad Española de Angiología y Cirugía Vascular has been developing this instrument of dissemination, consolidation and homogenization of knowledge in the aspect of vascular diagnosis, which is the one that concerns it. Venous insufficiency of the lower limbs is one of the richest and most defended fields of study and diagnosis since the Chapter on Vascular Diagnosis. This entity has already published two excellent guides on this subject. Although at a lower rate and with a different philosophy than other kind of clinical guidelines, diagnostic guidelines must also be updated, incorporating new areas of knowledge, changing points of view, or simply, explaining the same facts from other perspectives. With this spirit we present this new update of the "Guide to the venous exploration of the lower limbs", being very clear that we are not trying, far from it, to replace those already published, but to complement them and add knowledge. From this perspective, we have captured the ultrasound findings that we can record in a venous study; we have included a chapter on the "normal" ultrasound anatomy of the veins of the lower extremities, updating its gazetteer; we have detailed in great detail what would be a venous ultrasound examination of the lower limbs; we have reserved a space to remember and update ultrasound study protocols of venous thrombosis; and, finally, and as a star theme, we have developed an innovative chapter on the study of pelvic venous insufficiency.(AU)


Subject(s)
Humans , Venous Insufficiency , Lower Extremity , Ultrasonography, Doppler , Thoracic Surgery , Cardiovascular System , Blood Vessels
3.
Rev Esp Enferm Dig ; 115(9): 533-535, 2023 09.
Article in English | MEDLINE | ID: mdl-36562523

ABSTRACT

Aortoenteric fistula (AEF) is a low-prevalence, life-threatening condition regardless of treatment, with a 30-50% postoperative (≤60 days) mortality. This study aimed to estimate our postoperative cumulative mortality incidence and assess the feasibility of the diagnostic-therapeutic algorithm used in our clinical practice. We performed a retrospective cohort study of patients treated for AEF at a fully-equipped tertiary healthcare center between January 2008 and December 2020.


Subject(s)
Aortic Diseases , Intestinal Fistula , Vascular Fistula , Humans , Retrospective Studies , Vascular Fistula/diagnostic imaging , Vascular Fistula/surgery , Aortic Diseases/diagnostic imaging , Aortic Diseases/surgery , Intestinal Fistula/surgery , Intestinal Fistula/etiology , Patient Care Team , Algorithms
4.
Cir Esp (Engl Ed) ; 100(7): 431-436, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35523416

ABSTRACT

INTRODUCTION: Retrograde access performed guided by fluoroscopy or ultrasound. We aimed to analyze the usefulness of ultrasound in retrograde access in patients with critical limb ischemia. METHODS: Observational analytical study. From December 2013 to June 2019. We included all retrograde accesses that were guided by ultrasound. Our register assesses demographic and clinical data, the vessel used as retrograde access, the procedure performed, the amount of contrast agent used and time of fluoroscopy, access failure, and local complications. RESULTS: On 715 procedures performed, was used ultrasound-guided retrograde access in 25 patients (64% men). The mean age was 74.8 years (45-90), with 92% of diabetics and 32% of chronic renal failure. Two patients with Rutherford stage 4 and 23 with stage 5-6. In 24 (96%) patients the ultrasound-guided puncture was successful, while in one (4%) of them, it was not possible to enter the target vessel. After the punch, was achieved the technical success of revascularization in 19 (79.2%) patients, with 5 (20.8%) in whom did not the arterial injury was not overcome. The arteries used as retrograde access were: anterior tibial 11, posterior tibial 10, and peroneal in 4. The mean of contrast used was 63 mL (9-100 mL) with an average time of 43 min (15-76 min). Complications related did not observe in retrograde access. CONCLUSIONS: Ultrasound-guided retrograde distal access is an effective method that may use as a bailout method in those endovascular procedures in which it is not possible to cross the lesion anterogradely.


Subject(s)
Peripheral Arterial Disease , Aged , Chronic Limb-Threatening Ischemia , Female , Humans , Ischemia/diagnostic imaging , Ischemia/surgery , Male , Treatment Outcome , Ultrasonography, Interventional , Vascular Patency
5.
Ann Vasc Surg ; 81: 225-231, 2022 Apr.
Article in English | MEDLINE | ID: mdl-34775010

ABSTRACT

BACKGROUND: Thoracic outlet syndrome (TOS) causes neurogenic symptoms in 95% of the cases due to neurovascular bundle compression. The treatment goal is the decompression of the neurovascular structures. In the last decade, non-surgical treatments have been evaluated as a treatment option for spastic syndromes and thoracic outlet syndrome. In this study we report the use of botulinum toxin (BTX-A) injection as a diagnostic tool to identify the pectoral minor syndrome, and as a less aggressive treatment-option. METHODS: An observational cohort study of patients with neurogenic thoracic outlet syndrome who underwent sonographically guided chemodenervation of pectoral minor muscle with botulinum toxin. Follow-up includes clinical evaluation at one month, 3 months and 6 months after the procedure. Clinical evaluation was made with clinical questionnaire. In case of patients with partial improvement of the symptoms, a second infiltration of BTX-A was performed. The categorical variables were shown as percentages, and the continuous variables as mean and standard deviation (SD). For the comparison of categorical variables, the Fisher's exact test was used. Statistical analysis was performed using the SPSS version 20.0 program. We consider P <0.05 to be statistically significant. RESULTS: A total of twenty-six patients were diagnosed with thoracic outlet syndrome in this period, and 20 accomplished the inclusion criteria. 7 patients were excluded (1 due to neoplasia, 2 did not sign the informed consent, 1 due to neoplasia, 2 did not sign the informed consent, 1 was lost during the follow-up and 3 due to anomalies of the first rib secondary to fractures and cervical rib and 1 was lost during the follow-up), therefore a sample of 13 patients aged between 24 and 55 years was obtained. The most common type of procedure performed was the single injection of 50 IU of botulinum toxin. 4 patients were infiltrated in 2 occasions due to partial improvement in symptoms at 1month follow-up. Clinical stability was found at three months and at 6 months follow-up. CONCLUSION: The ultrasound-guided botulinum injection of the pectoralis minor muscles provides symptoms relief in patients with pectoral minor syndrome, and could be considered a safe tool in the diagnosis of the pectoralis minor syndrome within the spectrum of thoracic operculum syndrome.


Subject(s)
Botulinum Toxins , Cervical Rib , Thoracic Outlet Syndrome , Adult , Botulinum Toxins/therapeutic use , Cervical Rib/surgery , Decompression, Surgical/adverse effects , Humans , Middle Aged , Pectoralis Muscles/diagnostic imaging , Pectoralis Muscles/surgery , Thoracic Outlet Syndrome/diagnostic imaging , Thoracic Outlet Syndrome/drug therapy , Treatment Outcome , Young Adult
6.
Cir Esp (Engl Ed) ; 2021 May 07.
Article in English, Spanish | MEDLINE | ID: mdl-33972063

ABSTRACT

INTRODUCTION: Retrograde access performed guided by fluoroscopy or ultrasound. We aimed to analyze the usefulness of ultrasound in retrograde access in patients with critical limb ischemia. METHODS: Observational analytical study. From December 2013 to June 2019. We included all retrograde accesses that were guided by ultrasound. Our register assesses demographic and clinical data, the vessel used as retrograde access, the procedure performed, the amount of contrast agent used and time of fluoroscopy, access failure, and local complications. RESULTS: On 715 procedures performed, was used ultrasound-guided retrograde access in 25 patients (64% men). The mean age was 74.8 years (45-90), with 92% of diabetics and 32% of chronic renal failure. Two patients with Rutherford stage 4 and 23 with stage 5-6. In 24 (96%) patients the ultrasound-guided puncture was successful, while in one (4%) of them, it was not possible to enter the target vessel. After the punch, was achieved the technical success of revascularization in 19 (79.2%) patients, with 5(20.8%) in whom did not the arterial injury was not overcome. The arteries used as retrograde access were: anterior tibial 11, posterior tibial 10, and peroneal in 4. The mean of contrast used was 63 mL (9-100 ml) with an average time of 43 minutes (15- 76 min). Complications related did not observe in retrograde access. CONCLUSIONS: Ultrasound- guided retrograde distal access is an effective method that may use as a bailout method in those endovascular procedures in which it is not possible to cross the lesion anterogradely.

7.
Angiol. (Barcelona) ; 72(4): 186-197, jul.-ago. 2020. tab
Article in Spanish | IBECS | ID: ibc-193581

ABSTRACT

Los pacientes infectados por el nuevo coronavirus COVID-19 presentan un riesgo incrementado de enfermedad tromboembólica venosa (ETEV). La presente guía de práctica clínica del Capítulo Español de Flebología y Linfología y la Sociedad Española de Angiología y Cirugía Vascular pretende dar una serie de recomendaciones sobre profilaxis y tratamiento de la ETEV en los pacientes infectados por COVID-19, tanto a nivel hospitalario como ambulatorio, y consejos sobre su seguimiento clínico y ecográfico. Se recomienda que todos los pacientes con infección por COVID-19 hospitalizados, tengan o no factores de riesgo protrombótico asociados, reciban profilaxis antitrombótica, si no existe contraindicación. En caso de pacientes ambulatorios, según perfil clínico e historial médico, se recomienda valorar tromboprofilaxis con heparina de bajo peso molecular (HBPM), en ausencia de contraindicación. Ante el diagnóstico de TVP en paciente con COVID-19, tanto hospitalizado o ambulatorio, debe iniciarse el tratamiento anticoagulante con HBPM a dosis terapéuticas. No existen interacciones farmacológicas descritas de las HPBM con los fármacos empleados contra el COVID-19. Los niveles elevados de dímero-D son un hallazgo común en pacientes con COVID-19, por lo que este parámetro, de forma aislada, no es indicativo para realizar una ecografía Doppler de rutina. Se aconseja la realización de ecografía Doppler a un paciente COVID-19 positivo (con las medidas de protección necesarias) para descartar TVP solo en pacientes con alta sospecha clínica de TVP y cuando se dé una de las dos situaciones clínicas: alto riesgo de sangrado, o que exista un incremento brusco e inesperado de los niveles de dímero-D


Patients infected with the new coronavirus COVID-19 have an increased risk of venous thromboembolic disease (VTEV). The present clinical practice guide of the Spanish Chapter of Phlebology and Lymphology and the Spanish Society of Angiology and Vascular Surgery, aims to give a series of recommendations on prophylaxis and treatment of VTE in patients infected with COVID-19, both at the hospital and outpatient, and advice on their clinical and ultrasound monitoring. It is recommended that all hospitalized patients with COVID-19 infection, whether or not they have associated prothrombotic risk factors, should receive antithrombotic prophylaxis, if there is no contraindication. In the case of outpatients, according to clinical profile and medical history, it is recommended to evaluate thromboprophylaxis with low molecular weight heparin (LMWH), in the absence of contraindication. Given the diagnosis of DVT in a patient with COVID19, both hospitalized and outpatient, anticoagulant treatment with LMWH should be started at therapeutic doses. There are no described pharmacological interactions of HPBMs with the drugs used against COVID19. High levels of D-dimer are a common finding in patients with COVID-19, so this parameter, in isolation, is not indicative for routine Doppler ultrasound. Doppler ultrasound is recommended for a COVID-19 positive patient (with the necessary protective measures), to rule out DVT, only in patients with high clinical suspicion of DVT, and when one of the two clinical situations occurs: high risk of bleeding, or a sudden and unexpected increase in D-dimer levels


Subject(s)
Humans , Anticoagulants/pharmacology , Betacoronavirus/isolation & purification , Coronavirus Infections/drug therapy , Fibrinolytic Agents/pharmacology , Pneumonia, Viral/drug therapy , Pulmonary Embolism/drug therapy , Societies, Medical/standards , Pandemics , Risk Factors , Heparin, Low-Molecular-Weight/therapeutic use , Ultrasonography , Coronavirus Infections/physiopathology , Home Care Services/standards
8.
J Vasc Surg Venous Lymphat Disord ; 8(5): 734-740, 2020 09.
Article in English | MEDLINE | ID: mdl-32063524

ABSTRACT

OBJECTIVE: Our goal was to analyze the utility of the age-adjusted D-dimer cutoff value in patients with clinically suspected deep venous thrombosis (DVT) in an ambulatory care setting, including distal DVTs. METHODS: This was an observational cohort study of 606 outpatients older than 18 years presenting with low or moderate clinical suspicion of lower limb DVT (measured by Wells scale). D-dimer levels were obtained, and duplex ultrasound was performed (including femoropopliteal and below-knee veins). We calculated sensitivity, specificity, and positive and negative predictive D-dimer values and when to apply the age-adjusted D-dimer cutoff value (D-dimer threshold = age × 10 µg/L). We split patients older than 50 years into 10-year age groups. We constructed receiver operating characteristic curves of the D-dimer test for each group to find the best threshold (defined as the value of D-dimer that gives more specificity, maintaining the maximum possible sensitivity). RESULTS: There were 249 men and 357 women with a mean age of 69.3 years; 41 patients were diagnosed with DVT. At a D-dimer threshold of 250 µg/L, sensitivity was 93%, specificity was 8%, positive predictive value was 7%, and negative predictive value was 94%. When the age-adjusted cutoff level was applied, global sensitivity was 76% and specificity 61%; positive predictive value was 12%, and negative predictive value was 97%. False-negative rate was 24%. We split patients older than 50 years into 10-year age groups: 50 to 60 years, 60 to 70 years, 70 to 80 years, and >80 years. The optimum thresholds were, respectively, 526 µg/L, 442.5 µg/L, 475 µg/L, and 549. µg/L. CONCLUSIONS: In our series, the age-adjusted D-dimer cutoff level is not useful in the diagnostic algorithm of DVT.


Subject(s)
Decision Support Techniques , Fibrin Fibrinogen Degradation Products/analysis , Outpatients , Venous Thrombosis/diagnosis , Age Factors , Aged , Algorithms , Biomarkers/blood , Female , Humans , Male , Predictive Value of Tests , Prospective Studies , Reproducibility of Results , Venous Thrombosis/blood
11.
Ann Vasc Surg ; 44: 277-281, 2017 Oct.
Article in English | MEDLINE | ID: mdl-28479456

ABSTRACT

INTRODUCTION: Contrast-induced nephropathy (CIN) is defined as an increase >25% of serum creatinine from baseline, occurring in 24-48 hours after exposure to contrast, while alternative explanations for renal impairment have been excluded. The volume administered directly relates to risk, increasing by 12% per 100 mL of contrast. According to the series, its incidence varies between 3.3% and 8% in patients without renal damage and 12-50% in patients with chronic kidney disease (CKD) and/or diabetes mellitus (DM). The purpose of this study is to determine the incidence of CIN in endovascular revascularization of lower limbs in our center, where we apply the ALARA concept (As Low As Reasonably Achievable) to the use of contrast. MATERIAL AND METHODS: 163 patients who underwent endovascular revascularization procedures in lower limbs were included in this prospective observational study between February 2013 and April 2015. They were classified according to clinical stage and presence of DM and/or CKD. Data included serum creatinine values preoperative and postoperative, type and volume of contrast used. Patients on hemodialysis and those without sufficient analytical data were excluded. Chi-squared test and Student t-test were used for data analysis. P < 0.05 was considered statistically significant. RESULTS: 109 patients were enrolled, with 67% of DM and 31.5% of CKD. CIN incidence was 3.7% in patients without DM neither CKD, in DM was 6.8% and 12.5% in CKD. Mean creatinine presurgery was 97.96 and postsurgery 97.07, finding no significant differences between them (P = 0.753). Medium-contrast volume was 37.43 mL ± 22.3. The worsening variable (creatinine postsurgery minus creatinine presurgery) was evaluated according to clinical stage, DM, or CKD, being not significant in either group. CONCLUSIONS: In our experience, the dose administered of contrast was not related to the existence of postprocedure CIN, due to the policy of optimizing the use of contrast.


Subject(s)
Angiography/adverse effects , Contrast Media/adverse effects , Endovascular Procedures/adverse effects , Kidney Diseases/chemically induced , Lower Extremity/blood supply , Peripheral Arterial Disease/therapy , Radiography, Interventional/adverse effects , Aged , Aged, 80 and over , Biomarkers/blood , Chi-Square Distribution , Creatinine/blood , Diabetes Mellitus/epidemiology , Female , Humans , Incidence , Kidney Diseases/blood , Kidney Diseases/diagnosis , Kidney Diseases/epidemiology , Linear Models , Male , Middle Aged , Peripheral Arterial Disease/diagnosis , Predictive Value of Tests , Prospective Studies , Renal Insufficiency, Chronic/epidemiology , Risk Factors , Spain/epidemiology , Time Factors , Treatment Outcome , Up-Regulation
13.
Med Clin (Barc) ; 144 Suppl 1: 16-20, 2015 Jan.
Article in Spanish | MEDLINE | ID: mdl-25771087

ABSTRACT

We performed a subanalysis of cancer patients enrolled in a clinical trial that compared long-term (6 months) treatment with a low-molecular-weight heparin (LMWH) administered subcutaneously or with acenocoumarol. The subanalysis assessed whether the characteristics of the tumor had an influence on the clinical response. A randomized open trial included 69 patients with cancer and symptomatic proximal deep vein thrombosis of the lower limbs. The tumor characteristics and treatment type were recorded. The main assessment criterion was the 12-month incidence of recurrent symptomatic venous thromboembolism (VTE). Sixty-one patients (88.4%) were analyzed. At the time of inclusion, the cancer characteristics and treatment were comparable between the 2 groups. Over the course of 12 months, the recurrent VTE was significantly greater in the elderly patients (71.5 ± 6.4 vs. 62.0 ± 15.1; p=.006). The logistic regression analysis showed no association between VTE recurrence and the location or extent of the tumor. However, the use of thrombogenic chemotherapy (p=.045) was independently associated with VTE recurrence, and longterm treatment with tinzaparin was almost a protective factor (p=.15). In this small sample, we observed an association between thrombogenic chemotherapy and recurrent VTE. The tendency towards a reduction in VTE recurrence at 12 months in patients with cancer in the LMWH group could be attributed to the effect of the full LMWH dosage.


Subject(s)
Acenocoumarol/therapeutic use , Anticoagulants/therapeutic use , Fibrinolytic Agents/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Neoplasms/complications , Venous Thrombosis/drug therapy , Adult , Aged , Drug Administration Schedule , Female , Humans , Logistic Models , Male , Middle Aged , Recurrence , Risk Factors , Treatment Outcome , Venous Thrombosis/etiology
15.
Med. clín (Ed. impr.) ; 144(supl.1): 16-20, ene. 2015. tab
Article in Spanish | IBECS | ID: ibc-136045

ABSTRACT

Realizamos un subanálisis de los pacientes con cáncer incluidos en un ensayo clínico en el que se comparaba el tratamiento a largo plazo (6 meses) con una heparina de bajo peso molecular (HBPM) subcutánea o con acenocumarol, para evaluar si las características del tumor tenían alguna influencia sobre la respuesta clínica. En un ensayo aleatorizado y abierto se incluyó a 69 pacientes con cáncer y trombosis venosa profunda proximal sintomática de miembros inferiores. Se registraron las características del tumor y el tipo de tratamiento. El criterio de valoración principal fue la incidencia a 12 meses de tromboembolia venosa (TEV) sintomática recurrente. Se analizó a 61 pacientes (88,4%). En el momento de la inclusión, las características y tratamiento del cáncer eran comparables entre ambos grupos. A lo largo del período de 12 meses, la TEV recurrente fue significativamente mayor en los pacientes ancianos (71,5 ± 6,4 frente a 62,0 ± 15,1; p = 0,006). En el análisis de regresión logística no se encontró ninguna asociación entre la recurrencia de TEV y la localización o la extensión del tumor. Sin embargo, el uso de quimioterapia trombogénica (p = 0,045) se asoció de forma independiente a la recurrencia de la TEV y el tratamiento a largo plazo con tinzaparina estuvo cerca de ser un factor de protección (p = 0,15). En esta pequeña muestra se observó una asociación entre la quimioterapia trombogénica y la TEV recurrente. La tendencia a una disminución de la recurrencia de la TEV a los 12 meses en pacientes con cáncer del grupo de la HBPM podría atribuirse al efecto de la dosis plena de HBPM (AU)


We performed a subanalysis of cancer patients enrolled in a clinical trial that compared long-term (6 months) treatment with a low-molecular-weight heparin (LMWH) administered subcutaneously or with acenocoumarol. The subanalysis assessed whether the characteristics of the tumor had an influence on the clinical response. A randomized open trial included 69 patients with cancer and symptomatic proximal deep vein thrombosis of the lower limbs. The tumor characteristics and treatment type were recorded. The main assessment criterion was the 12-month incidence of recurrent symptomatic venous thromboembolism (VTE). Sixty-one patients (88.4%) were analyzed. At the time of inclusion, the cancer characteristics and treatment were comparable between the 2 groups. Over the course of 12 months, the recurrent VTE was significantly greater in the elderly patients (71.5±6.4 vs. 62.0±15.1; p=.006). The logistic regression analysis showed no association between VTE recurrence and the location or extent of the tumor. However, the use of thrombogenic chemotherapy (p=.045) was independently associated with VTE recurrence, and longterm treatment with tinzaparin was almost a protective factor (p=.15). In this small sample, we observed an association between thrombogenic chemotherapy and recurrent VTE. The tendency towards a reduction in VTE recurrence at 12 months in patients with cancer in the LMWH group could be attributed to the effect of the full LMWH dosage (AU)


Subject(s)
Humans , Heparin, Low-Molecular-Weight/pharmacokinetics , Vitamin K/antagonists & inhibitors , Venous Thromboembolism/drug therapy , Neoplasms/complications , Acenocoumarol/pharmacokinetics , Time/statistics & numerical data , Injections, Subcutaneous , Treatment Outcome , Antineoplastic Agents
16.
Med. clín (Ed. impr.) ; 133(14): 529-532, oct. 2009. tab, graf
Article in Spanish | IBECS | ID: ibc-76086

ABSTRACT

Fundamento y objetivo: Existe una asociación bidireccional entre neoplasia y enfermedad tromboembólica venosa (ETV). Ahora bien, se desconoce si esta asociación sigue existiendo en la recidiva de una neoplasia. El objetivo del estudio es valorar la incidencia de recidiva neoplásica tras el diagnóstico de ETV y determinar si la ETV puede ser un marcador de recidiva de la neoplasia. Pacientes y método: Estudio observacional de cohortes retrospectivo. Las observaciones se realizaron en junio de 2008 y se incluyó a 132 pacientes que entre enero de 2002 y diciembre de 2005 presentaron una trombosis venosa profunda (TVP) y tenían una neoplasia sin actividad en los últimos 12 meses en su historial médico. Se observó si la neoplasia había recidivado, se dividió la muestra en función de la presencia o la ausencia de recidiva neoplásica y se compararon las variables recogidas en el estudio. Resultados: La incidencia de recidiva neoplásica en la muestra tras el diagnóstico de una TVP fue del 50,7%. En el 55,2% la recidiva tuvo lugar en los siguientes 4 meses y fue más frecuente y más temprana en los pacientes con neoplasias de la mama (p=0,0014), en pacientes con carcinomas (p=0,02), en pacientes que recibieron quimioterapia paliativa y en pacientes con metástasis previas (p=0,00). Conclusiones: En el 50,7% de los pacientes con una neoplasia sin actividad en el último año, la TVP fue el primer signo de recidiva tumoral. Remitir a estos pacientes a un servicio de Oncología preferentemente sería útil para detectar la recidiva lo antes posible (AU)


Background and objective: There is a bidirectional association between neoplasia and venous thromboembolism (VTE). However, whether this association has an impact in tumor recurrence is unknown. The aim of the study is to assess the incidence of cancer recurrence after diagnosis of VTE and determine if VTE could be a marker for cancer recurrence. Patients and method: This was a retrospective cohort observational study. The observations were made in June 2008. The study included 132 patients diagnosed with a deep vein thrombosis (DVT) between January 2002 and December 2005 and had a cancer without activity in the last 12 months in their medical history. The cancer recurrence was assessed. The sample was divided according to the presence or absence of cancer recurrence and study variables were compared. Results: The incidence of cancer recurrence after diagnosis with DVT was 50,7%. This recurrence occurred in the first 4 months in 55,2% and more frequent and earlier in patients with breast tumors (p:00014), with carcinoma (p:0,02), in patients under palliative chemotherapy and in patients with previous presence of metastasis. (p:0,00). Conclusions: In 50,7% of patients without neoplasic activity in the last year, DVT was the first sign of tumor recurrence. These patients should be referred to an oncology department as soon as possible in order to diagnose the tumor recurrence (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Venous Thrombosis/complications , Neoplasms/diagnosis , Neoplasm Metastasis/diagnosis , Venous Thrombosis/diagnosis , Carcinoma/diagnosis , Cohort Studies , Neoplasm Metastasis/drug therapy
17.
Med Clin (Barc) ; 133(14): 529-32, 2009 Oct 17.
Article in Spanish | MEDLINE | ID: mdl-19656530

ABSTRACT

BACKGROUND AND OBJECTIVE: There is a bidirectional association between neoplasia and venous thromboembolism (VTE). However, whether this association has an impact in tumor recurrence is unknown. The aim of the study is to assess the incidence of cancer recurrence after diagnosis of VTE and determine if VTE could be a marker for cancer recurrence. PATIENTS AND METHOD: This was a retrospective cohort observational study. The observations were made in June 2008. The study included 132 patients diagnosed with a deep vein thrombosis (DVT) between January 2002 and December 2005 and had a cancer without activity in the last 12 months in their medical history. The cancer recurrence was assessed. The sample was divided according to the presence or absence of cancer recurrence and study variables were compared. RESULTS: The incidence of cancer recurrence after diagnosis with DVT was 50,7%. This recurrence occurred in the first 4 months in 55,2% and more frequent and earlier in patients with breast tumors (p:00014), with carcinoma (p:0,02), in patients under palliative chemotherapy and in patients with previous presence of metastasis. (p:0,00). CONCLUSIONS: In 50,7% of patients without neoplasic activity in the last year, DVT was the first sign of tumor recurrence. These patients should be referred to an oncology department as soon as possible in order to diagnose the tumor recurrence.


Subject(s)
Neoplasm Recurrence, Local/complications , Venous Thrombosis/etiology , Adult , Aged , Cohort Studies , Humans , Middle Aged , Retrospective Studies , Young Adult
18.
Angiología ; 58(2): 127-135, mar.-abr. 2006. tab
Article in Es | IBECS | ID: ibc-045039

ABSTRACT

Objetivos. Principal: evaluar la influencia de la deambulación precoz en pacientes con trombosis venosa profunda (TVP) aguda sobre la incidencia de tromboembolismo pulmonar (TEP) sintomático; secundario: valorar si la localización del trombo y/o el tiempo de evolución influyen en la aparición del TEP sintomático. Pacientes y métodos. Ensayo clínico de observación realizado en dos centros, en el período 2002-2003, con asignación aleatoria 1:1 según sobres cerrados. Se diagnosticaron 650 pacientes con TVP, de los cuales sólo se incluyeron 146, 68 mujeres y 78 hombres (edad media: 60,7 años; rango: 18-83 años). Criterios de inclusión: TVP inferior a 15 días de evolución, consentimiento informado, esperanza de vida mayor de un año y condición clínica sin riesgo vital. Ambos grupos se trataron con heparinas de bajo peso molecular, seguido de anticoagulación oral según protocolo. Grupo A: 67 pacientes, cinco días de reposo. Grupo B: 79 casos, deambulación precoz con contención elástica. Se compararon ambos grupos según el tiempo de evolución y la localización de la trombosis. El análisis estadístico se realizó mediante un estudio descriptivo; se utilizó la prueba de chi al cuadrado o el estadístico exacto de Fisher y análisis multivariante. Resultados. Cuatro casos de TEP sintomático (2,7%), sin diferencias estadísticamente significativas entre los dos grupos (p = 0,33). Tampoco hubo diferencias en relación con el tiempo de evolución (p = 0,45) ni localización del trombo (p = 0,37). El análisis multivariante no detectó ninguna variable con significación estadística. Conclusión. Parece ser que la localización del trombo y el tiempo de evolución no influyen en la incidencia de TEP sintomático


AIM. To evaluate if early mobilization in patients with acute lower limbs deep vein thrombosis (DVT) increases the incidence of symptomatic pulmonary embolism (PE). To evaluate determining factors of PE, like location of the thrombus and /or time of clinical evolution. PATIENTS AND METHODS. Prospective randomised clinical trial. Carried on in two university hospitals, from January 2002 to December 2003. 146 patients with acute lower limbs DVT where included, 68 female and 78 male, with a mean age of 60.7 years. The inclusion criteria were: less that 15 days of initial symptoms, life expectancy greater than one year, no life threatening clinical condition, inform written consent. These patients were randomized into two groups. Group A: 67 patients (45.9%) hospital treatment with a 5 days bed rest. Group B: 79 patients (54.1%) home care with early walking and compressive bandage. Primary end point was the presence of symptomatic PE during the first ten days of treatment. The relationships between time of clinical evolution, location of thrombus and symptomatic PE were also analyzed. The statistical analysis was made using the chi-square o Fisher exact test, homogeneity basal and multivariate analysis. RESULTS. Four cases of symptomatic PE were detected (2.7%), two in each group. There was no significant difference concerning the occurrence of new PE between the two groups (p = 0.33). Also no difference was detected according to time of evolution (p = 0.45) and location of thrombus (p = 0.37). Multivariate analysis did not show any significant difference between groups. CONCLUSION. Seemingly location of thrombus and elapse time of symptoms did not increase the incidence of symptomatic PE


Subject(s)
Male , Female , Adult , Aged , Adolescent , Middle Aged , Aged, 80 and over , Humans , Venous Thrombosis/therapy , Pulmonary Embolism/etiology , Locomotion , Prospective Studies , Time Factors , Risk Assessment , Acute Disease
19.
Angiología ; 57(4): 335-343, jul.-ago. 2005. ilus, tab
Article in Es | IBECS | ID: ibc-039837

ABSTRACT

Objetivo. Dar a conocer los resultados preliminares de la aplicación de factores de crecimiento (FC) intraplaquetarios en la cura de las úlceras de causa vascular crónicas. Pacientes y métodos. Estudio descriptivo, sobre 14 pacientes (ocho hombres/seis mujeres) a los que se aplicó el protocolo de nuestro centro para la obtención y cura con FC intraplaquetarios de úlceras vasculares crónicas. Ocho de las lesiones eran de etiología venosa, cinco arterial y una mixta. En todos los casos se trató, en primer lugar, la patología de base cuando fue posible: en las lesiones arteriales no se consideró revascularizar por índices tobillo/brazo (> 0,5) en tres, en dos no fue posible hacerlo; en las venosas, dos se operaron, cuatro no por el estado basal del paciente, dos no se consideró por afectación del sistema profundo; la mixta no se revascularizó por índices, y no se planteó corrección venosa. Resultados. Curaron 12 de los 14 pacientes, en un tiempo medio de 2,93 meses (0,5-7 meses). En uno de los casos tuvo que suspenderse la aplicación de los factores debido a sobreinfección por Staphylococcus aureus resistentes a meticilina, y en otro caso se tuvo que proceder a la amputación del dedo que contenía la lesión por gangrena húmeda de éste. Conclusiones. No se pueden establecer conclusiones por los pocos casos y la escasa potencia del estudio, pero la impresión subjetiva es que la aplicación de FC para el tratamiento de las úlceras crónicas vasculares puede suponer una buena alternativa, siempre tratando primordialmente la etiología de las mismas


AIM. To show preliminary results in application of plaquetar derivated growth factors in treatment of chronic vascular ulcers. PATIENTS AND METHODS. Descriptive study with 14 patients (8 male/6 female) in whom we applied center’s method to obtain and apply plaquetar derivated growth factors in chronic vascular ulcers. Eight wound were venous ulcers, five had arterial cause, and one was a mixed ulcer. In all cases, first of all, was treated the etiology of wound when this was possible: in arterial wounds did not revascularize three cases in attention to ankle/brachial index (> 0.5), and in two because it was not possible; in venous ulcers, we repaired venous pathology in two cases, in four patients we did not consider surgery because of basal state of them, and in two other patients this was not possible because of alteration of deep venous system; in mixed ulcer we did not revascularize because of ankle/brachial index and did not establish repair on venous disease. RESULTS. We obtained the healing in 12 of 14 wounds, in mean-time of 2.93 months (0.5-7 months). In one case we had to stop the treatment because of infection with Staphylococcus aureus resistant to methyciline. In another patient we had to cut off the toe with the wound because it became gangrenous. CONCLUSIONS. We can not establish conclusions because of few cases and little power of this study, but it seems, subjectively, that application of growth factors in treatment of chronic vascular ulcers can suppose a good alternative in healing them, always keeping in mind the treatment of etiology of ulcers first of all


Subject(s)
Male , Female , Aged , Middle Aged , Humans , Growth Substances/therapeutic use , Skin Ulcer/drug therapy , Varicose Ulcer/drug therapy , Administration, Topical , Diabetic Foot/drug therapy , Wound Healing
20.
J Ultrasound Med ; 23(11): 1493-8, 2004 Nov.
Article in English | MEDLINE | ID: mdl-15498914

ABSTRACT

OBJECTIVE: To determine the clinical usefulness of color duplex sonography in the diagnosis of giant cell arteritis as an alternative to temporal artery biopsy. METHODS: From May 1998 to November 2002, 68 consecutive patients seen in our hospital with a clinical suggestion of active temporal arteritis were included. Forty-eight patients were female and 20 were male, with a mean age of 77 years. Color duplex sonography with a linear array transducer (5-10 MHz) was used to assess temporal artery morphologic characteristics before a biopsy was performed. The main sonographic criterion for a positive diagnosis was visualization of a hypoechoic halo around the temporal artery. These data were compared with pathologic findings. The kappa statistic was used to determine the level of agreement. Sensitivity, specificity, positive and negative predictive values, and accuracy of duplex sonography as a diagnostic test were assessed. RESULTS: The color duplex sonographic findings were positive in 25 of 68 patients with a clinical suggestion of giant cell arteritis. The diagnosis was confirmed by biopsy in 22 patients; there were 4 false-positive results and 1 false-negative result by duplex sonography. The kappa value was 0.84. Sensitivity, specificity, positive and negative predictive values, and accuracy for duplex sonography were 95.4%, 91.3%, 84%, 97.6%, and 92.6%, respectively. CONCLUSIONS: The use of high-resolution color duplex sonography may replace biopsy in the diagnosis of giant cell arteritis.


Subject(s)
Giant Cell Arteritis/diagnostic imaging , Ultrasonography, Doppler, Color , Ultrasonography, Doppler, Duplex , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Sensitivity and Specificity
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