Identifying Improved and Non-improved Aspects of Health-related Quality of Life After Liver Transplantation Based on the Assessment of the Specific Questionnaire Liver Disease Quality of Life.

INTRODUCTION: The specific questionnaire Liver Disease Quality of Life (LDQOL) is a valid tool for measuring quality of life (QOL) and has been used to show that liver transplantation (LT), which is an effective treatment for end-stage liver disease, may improve QOL. OBJECTIVES: This study aims to identify aspects of QOL that improve after LT and those that do not. PATIENTS AND METHODS: Patients accepted for LT were invited to answer the LDQOL at baseline and after transplantation at 6 and 12 months. LDQOL contains the 36-item Short Form Health Survey (SF-36) and 12 specific dimensions. Responsiveness was assessed using the paired Student t test. RESULTS: The study included a cohort of 156 patients, 73% males, of an average age of 53 (26-67) years, with the following common indications: tumor (35%), hepatitis C (23%), and alcohol-related (21%) liver disease. Mean scores showed a statistically significant (P < .05) improvement after 1 year in 6 of 8 SF-36 dimensions, in the physical component summary score, and in 7 of 12 disease-specific dimensions. The two dimensions that showed no improvement in the SF-36 dimensions were "social functioning" and "vitality," whereas the specific dimensions to not improve were "sleep problems," "social interaction," "activities of daily living," and "concerns about the future." CONCLUSION: Findings suggest that perceived QOL after LT improves but could be further enhanced with the use of specific programs for amending sleep disorders and physical aspects.

Relación entre el valor del ratio elastográfico y la clasificación citológica de Bethesda en la patología tiroidea

Objetivo: Presentar nuestra experiencia en la categorización de la patología tiroidea, a través de la utilización de parámetros ecográficos de malignidad y elastografía con medición del ratio de la deformación tisular, y la correlación de los hallazgos obtenidos con la clasificación citológica de Bethesda. Materiales y métodos: Se llevó a cabo un estudio prospectivo y observacional, entre septiembre de 2012 y abril de 2013, que incluyó 137 nódulos tiroideos. Se excluyeron 10 casos Bethesda III-IV. Se realizó ecografía, power Doppler, visualización de micropartículas (Micropure) y elastografía con medición del ratio elastográfico, así como también punción aspirativa con aguja fina guiada por ecografía (con el citólogo presente), utilizando la clasificación Bethesda. Los estudios fueron hechos por el mismo operador con un ecógrafo Toshiba Aplio 400 y los datos estadísticos se evaluaron con el programa IBM SPSS Statistics 20. Resultados: Se estudiaron 127 nódulos en pacientes con una edad promedio de 59±16 anos. El 82% de los casos ocurrió en mujeres. Ciento veinte nódulos (94%) fueron clasificados como Bethesda II. La media elastográfica para Bethesda I-II fue de 1,94±2,12 vs. 7,07±5,46 para V-VI (p: 0,048). El punto de corte elastográfico ≤ 2 (87 de 127) presentó una sensibilidad del 85,7% y una especificidad del 81,7% para predecir Bethesda asociada a patología benigna, con un valor predictivo negativo (VPN) del 99% y un valor predictivo positivo del 15%. Conclusiones: El ratio elastográfico permitió descartar la patología tiroidea maligna con valores ≤ 2 y un VPN del 99%, mejorando la selección de los pacientes a punzar. El incremento del ratio elastográfico se asoció a una mayor probabilidad de patología maligna, aunque no se pudo establecer un valor de corte debido al bajo número de casos con Bethesda V-VI.(AU)

Objectives: We present our experience in the categorization of thyroid pathology using the sonographic parameters of malignancy and elastography with measurement elastography strain ratio, to evaluate the relationship between the results found and the Bethesda classification. Materials and methods: Prospective observational study, included 137 thyroid nodules studied between September 2012- April 2013. We excluded 10 cases with Bethesda categories III-IV. Ultrasonography, Doppler, Micropure, elastogrphy strain ratio between the lesion and the normal tissue, fine needle aspiration cytology (FNAC),were the diagnosis methods used. The pathologist was always present and the cytological classi fication of Bethesda was used. All study was made by the same physician used Toshiba Aplio 400 ultrasound unit. Results were analyzed with IBM SPSS Statistics 20. Results: We studied 127 nodules in patients 59±16 years old, 82% were female; 120 were Bethesda II (94%). The average strain ratio for nodules Bethesda I-II was 1.94±2.12 vs. 7.07±5.46 for those nodules Bethesda V-VI (p:0,048). This means that an elastography strain ratio ≤ 2 (87 of 127 nodules) has a sensibility of 85.7% and a specificity of 81.7% of predicting Bethesda associated with benign pathology with a negative predictive value (NPV) of 99% and a positive predictive value of 15%. Conclusion: The elastography strain ratio allowed to discard malignant nodules with strain ratio ≤ 2 with a NPV of 99% improves the selection of patients for FNAC. The increment in the elastography strain ratio was associated to a higher possibility of malignant thyroid pathology, being unable to determine a limit value due to the low amount of cases with nodules Bethesda V-VI.(AU)

Relación entre el valor del ratio elastográfico y la clasificación citológica de Bethesda en la patología tiroidea / Relationship between the value of elastography ratio and the cytological classification of Bethesda in thyroid pathology

Objetivo: Presentar nuestra experiencia en la categorización de la patología tiroidea, a través de la utilización de parámetros ecográficos de malignidad y elastografía con medición del ratio de la deformación tisular, y la correlación de los hallazgos obtenidos con la clasificación citológica de Bethesda. Materiales y métodos: Se llevó a cabo un estudio prospectivo y observacional, entre septiembre de 2012 y abril de 2013, que incluyó 137 nódulos tiroideos. Se excluyeron 10 casos Bethesda III-IV. Se realizó ecografía, power Doppler, visualización de micropartículas (Micropure) y elastografía con medición del ratio elastográfico, así como también punción aspirativa con aguja fina guiada por ecografía (con el citólogo presente), utilizando la clasificación Bethesda. Los estudios fueron hechos por el mismo operador con un ecógrafo Toshiba Aplio 400 y los datos estadísticos se evaluaron con el programa IBM SPSS Statistics 20. Resultados: Se estudiaron 127 nódulos en pacientes con una edad promedio de 59±16 anos. El 82% de los casos ocurrió en mujeres. Ciento veinte nódulos (94%) fueron clasificados como Bethesda II. La media elastográfica para Bethesda I-II fue de 1,94±2,12 vs. 7,07±5,46 para V-VI (p: 0,048). El punto de corte elastográfico ≤ 2 (87 de 127) presentó una sensibilidad del 85,7% y una especificidad del 81,7% para predecir Bethesda asociada a patología benigna, con un valor predictivo negativo (VPN) del 99% y un valor predictivo positivo del 15%. Conclusiones: El ratio elastográfico permitió descartar la patología tiroidea maligna con valores ≤ 2 y un VPN del 99%, mejorando la selección de los pacientes a punzar. El incremento del ratio elastográfico se asoció a una mayor probabilidad de patología maligna, aunque no se pudo establecer un valor de corte debido al bajo número de casos con Bethesda V-VI.

Objectives: We present our experience in the categorization of thyroid pathology using the sonographic parameters of malignancy and elastography with measurement elastography strain ratio, to evaluate the relationship between the results found and the Bethesda classification. Materials and methods: Prospective observational study, included 137 thyroid nodules studied between September 2012- April 2013. We excluded 10 cases with Bethesda categories III-IV. Ultrasonography, Doppler, Micropure, elastogrphy strain ratio between the lesion and the normal tissue, fine needle aspiration cytology (FNAC),were the diagnosis methods used. The pathologist was always present and the cytological classi fication of Bethesda was used. All study was made by the same physician used Toshiba Aplio 400 ultrasound unit. Results were analyzed with IBM SPSS Statistics 20. Results: We studied 127 nodules in patients 59±16 years old, 82% were female; 120 were Bethesda II (94%). The average strain ratio for nodules Bethesda I-II was 1.94±2.12 vs. 7.07±5.46 for those nodules Bethesda V-VI (p:0,048). This means that an elastography strain ratio ≤ 2 (87 of 127 nodules) has a sensibility of 85.7% and a specificity of 81.7% of predicting Bethesda associated with benign pathology with a negative predictive value (NPV) of 99% and a positive predictive value of 15%. Conclusion: The elastography strain ratio allowed to discard malignant nodules with strain ratio ≤ 2 with a NPV of 99% improves the selection of patients for FNAC. The increment in the elastography strain ratio was associated to a higher possibility of malignant thyroid pathology, being unable to determine a limit value due to the low amount of cases with nodules Bethesda V-VI.

Anatomical variations of the coronary arteries: I. The most frequent variations / Variaciones anatómicas de las arterias coronarias: I. Variaciones más frecuentes

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Actualmente, con el advenimiento de las nuevas técnicas de diagnóstico por la imagen y el desarrollo de tratamientos poco invasivos, es esencial conocer tanto la anatomía arterial coronaria normal así como sus variaciones Su desconocimiento, en algunos casos, puede llevar a una interpretación incorrecta o a la aparición de complicaciones desastrosas durante la cirugía cardiaca. En este artículo se describe la anatomía normal y las variaciones más frecuentes de las arterias coronarias, es decir, las que se observan con una frecuencia superior al 1 por ciento (AU)

[Recanalization of the peripheral arteries by laser thermal balloon angioplasty. 2 years of clinical experience]. / Recanalización de arterias periféricas mediante laser térmico asociado a balón de angioplastia. Dos años de experiencia clínica.

Laser angioplasty represents an attractive alternative to overcome the limitations of balloon angioplasty. We describe our results with laser thermal balloon angioplasty (LTBA) in the treatment of atherosclerosis obliterans in the lower limbs after two years clinical follow up. We also analyse the influence of lesion characteristics on immediate results. Thirty seven patients (34 men), whose mean age was 58 +/- 9 years, were included in this study. Occlusive arterial disease (Fontaine stage II-IV), with 39 significant haemodynamic arterial lesions were present in all of them. Ankle/brachial Doppler index was O,51 +/- 0,17. Eighteen lesions were located in the iliac area (13 stenoses 2,3 +/- 1 cm of length and 5 occlusions 4,2 +/- 3 cm) and 21 lesions in femoro-popliteal area (5 stenoses 2,6 +/- 2 cm and 16 occlusions 5,7 +/- 3 cm). A percutaneous procedure was used in 38 cases and only in one case a femoral dissection was necessary. The laser source was argon in 26 cases and Nd-YAG in 13. The overall immediate angiographic and clinical success was 85% (89% in iliac lesions and 81% in femoropopliteal lesions; 100% in stenoses and 70% in occlusions). The presence of occlusion (p less than 0,01) and/or calcium (p less than O,05) influenced negatively the immediate results. No major complications were observed. Seven (17%) minor complications occurred, but no emergency surgery was necessary. The ankle/brachial Doppler index after treatment was 0,82 +/- 0,21. Cumulative clinical patency was 91% for successfully treated patients after two years follow up. We conclude that LTBA represents an effective and less aggressive way to treat atherosclerosis obliterans.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary arterial anastomoses. Study of their distribution in adult hearts specially emphasizing the Crista supraventricularis.

After examining 100 hearts belonging to subjects who at the time of death had no record of coronariopathy, the presence of anastomoses between the 2 coronary systems was confirmed in 96% of the cases. Intramyocardial anastomoses located in the Crista supraventricularis accounted for 76% of the cases, 4 main types are described. The fact that crestal anastomoses always connect both coronary systems (even in cases of left dominance) is their most outstanding characteristic. The possible usefulness of this type of anastomoses was finally discussed. It was suggested that they might serve as a safety mechanism which would join areas severely affected by arteriosclerosis to others not so seriously damaged.

Coronary arterial anastomoses. Study of their distribution in adult hearts specially emphasizing the Crista supraventricularis area.

After examining 100 hearts belonging to subjects who at the time of death had no record of coronariopathy, the presence of anastomoses between the 2 coronary systems was confirmed in 96% of the cases. Intramyocardial anastomoses located in the Crista supraventricularis accounted for 76% of the cases, four main types are described. The fact that crestal anastomoses always connect both coronary systems (even in cases of left dominance) is their most outstanding characteristic. The possible usefulness of this type of anastomoses was finally discussed. It was suggested that they might serve as a safety mechanism which would join areas severely affected by arteriosclerosis to others not so seriously damaged.

[Branches of the coronary arteries supplying the supraventricular crest]. / Etude des branches des artères coronaires irriguant la crista supraventricularis.

The vascularization of the Crista Supraventricularis has not been investigated thoroughly by authors studying the morphology of the region. Among the scarce references which exist, great differences can be observed when evaluating the criteria on the source of arterial vascularization i.e. whether unicoronary or mixed. We therefore examined 54 human hearts which were submitted to corrosion and dissection and 46 hearts of various animal species. The vascularization patterns of the crista were determined and the intracrestal anastomoses described. We then proceeded to evaluate their role in cases of coronary occlusion.