Venous giant post-thrombotic chronic ulcer: successful treatment with Bosentan.

OBJECTIVE: To report a case of a refractory post-thrombotic chronic venous ulcer managed with an off-label treatment. METHOD: We present the case of an 82-year-old woman with a previous medical history of severe hypertension and a deep vein thrombosis three years before. A refractory giant chronic venous ulcer in her left leg was treated with Bosentan. RESULTS: The appearance of the ulcer improved in the first 45 days, worsened after an unintended stop of the treatment and was almost resolved after 90 days of treatment. Ulcer-associated pain improved very quickly and so, in only one week, opioid treatment was stopped. Bosentan treatment was well tolerated, with only mild and manageable side effects. CONCLUSION: Treatment with Bosentan has been successful in the treatment of this case of refractory chronic venous ulcer.

Iron deficiency in the acute-phase reaction after open aortic surgery.

The objective of this study was to quantify the magnitude of iron deficiency in the postoperative period after open aortic surgery. This was a prospective observational study in 55 consecutive patients. Blood samples were obtained on postoperative days 1, 2, 4, 30, and 45, and the parameters determined were the following: iron, transferrin, transferrin saturation index, transferrin-soluble receptor, ferritin, red cell count, hemoglobin, hematocrit, serum C-reactive protein, fibrinogen, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and number of blood units transfused. We performed statistical ANOVA test for repetitive measurements (lower bound) in regard to its basal level. Iron deficiency and its parameters reached the maximum at 48 hours postoperatively (iron: 18.92 g/dL and transferrin saturation index: 11.1%) (P <.05). There was not a complete recovery after 45 days (iron: 51.23 g/dL and transferrin saturation index: 18.0%) (P <.05). A similar evolution was observed in the other measured parameters (red cell count: 3.5 x 106/L.; hemoglobin: 10.4 g/dL; hematocrit: 30.7%) (P <.005), none affecting the values of concentration or volume (P <.05). Transferrin-soluble receptors, normal at first, were increased at postoperative days 30 and 45 (2.7 and 2.4 mg/dL respectively, P <.005). After open aortic surgery there is an important acute-phase reaction, a dramatic iron deficiency, and a lack of its transporters until the 45th analyzed day. The elevation of transferrin-soluble receptors in the 4th and 6th weeks denotes a necessity of iron supplementation for a correct development of the immature hematic cells since blood parameters do not reach normal levels in the 6th postoperative week.

Pseudoaneurisma de la arteria femoral infectado por clostridium septicum. Un caso clínico y revisión de la literatura / Femoral artery pseudoaneurysm infected by Clostridium septicum. A case report and review of the literature

Desde diciembre de 1995 a diciembre de 1996 se han revisado todas las complicaciones mayores tras punciones femorales diagnóstico-terapéuticas. Se realizaron 5.100 punciones femorales, de las que 3.500 correspondieron a cateterismos cardiacos (68,6 por ciento); I.200 a intervenciones radiológicas vasculares diagnósticas e intervencionistas (23,5 por ciento) y las 400 restantes a intervenciones neuroradiológicas (7,9 por ciento). Necesitaron intervención quirúrgica 10 pacientes: 8 pseudoaneurismas (0,16 por ciento); una fístula arterio-venosa (0,02 por ciento) y una infección (0,02 por ciento).Presentamos el caso de un pseudoaneurisma micótico por Clostridium septicum tras las realización de un cateterismo cardíaco que, al principio, evoluciona sin complicaciones. A los 3 meses acude al Servicio de Urgencias de nuestro hospital, presentando una tumoración ulcerada y maloliente en región femoral derecha. Pese al tratamiento antibiótico y la intervención quirúrgica, la paciente fallece por un cuadro séptico generalizado, comprobándose infección arterial por Clostridium septicum.Se revisan los 10 casos publicados, en la literatura de infección arterial por Clostridium septicum con una tasa de mortalidad superior al 70 por ciento y se analizan las pautas de diagnóstico y tratamiento (AU)

Pseudoaneurismas pedio tras resección de juanete / Dorsalis pedis pseudoaneurysms after bunion resection

El motivo de esta comunicación es presentar dos casos de pseudoaneurisma de la arteria pedia tras resección de juanete a los que les apareció a los 6 días y 3 meses respectivamente una masa pulsátil a nivel de la incisión dorsal de la intervención para extirpación de juanete por la técnica de McBride.En un caso se procedió a la ligadura de la arteria y en el otro caso tras irse a otro centro se le extirpó el aneurisma sin detalles de la técnica. La evolución en ambos casos fue buena con persistencia del dolor local en un paciente (AU)

Iliac arteriovenous fistula as a complication of lumbar disc surgery. Report of two cases and review of literature.

Vascular lesions following surgery of the lumbar disc are very infrequent, and exceptionally an arteriovenous fistula can developed. An important proportion of the reported cases were previously diagnosed as deep venous thrombosis, because this kind of pathology was not suspected. Postsurgical arteriovenous fistula produces severe haemodynamic disturbances, and congestive heart failure will develop if they are left to their natural course without intervention. Arteriovenous fistula should be suspected in the post-operative period of the lumbar disc surgery if congestive heart failure appears, accompanied by swelling of one or both lower limbs. Early surgery is the treatment of choice in order to prevent the congestive heart failure, and to preserve the normal function of the lower extremities. The technical choice seems to be the closure of the orifice of the fistula through the arterial lumen, together with appropriate arterial reconstruction.

Abdominal aortic aneurysms. Results of surgical treatment.

One hundred and twenty-one aneurysms of the abdominal aorta were operated on during a ten year period (1971-1981). Elective surgery was carried out in 89 patients (73.5%). Thirty-two patients were operated on for impending or frank rupture. Most of the patients treated electively had no symptoms on admission. The mortality of this group of patients was 6.7% (6 patients). All the patients treated as emergencies had acute abdominal or back pain. Six cases presented with shock and acute renal failure. The hospital mortality was high in this group of 11 patients (34.3%). Nine of them were operated on because of suspected rupture but this was not confirmed at operation. Only one patient in this group died after the operation (11.1%). The hospital mortality of the 23 patients with ruptured aneurysms was 43.4% (10 patients). Six of them died in the operating room. While elective surgery carries an acceptable mortality, the emergency procedure involves a high risk. All the aneurysms must be resected electively in spite of the absence of symptoms.