Seguimiento de los pacientes con diabetes tipo 2 durante la pandemia por COVID-19: un estudio multicéntrico en Atención Primaria / Follow-up of patients with type 2 diabetes during the COVID-19 pandemic: A multicentre study in Primary Care

Antecedentes La pandemia de COVID-19 obligó a tomar medidas que implicaban la desatención a los pacientes con diabetes tipo 2 (DM2). Objetivos Explorar la repercusión de la discontinuidad asistencial sobre los pacientes con DM2. Diseño Estudio observacional retrospectivo multicéntrico. Emplazamiento Cinco centros de atención primaria (AP), que no tenían protocolo de actuación específica para ellos, durante 2020 y 2021. Participantes Pacientes con DM2 en Tenerife, Islas Canarias, España. Mediciones principales De las historias clínicas se extrajeron el sexo y la edad, las variables de seguimiento del programa de detección y control de la enfermedad vascular ateroesclerótica (pEVA), de cumplimiento de los objetivos de control y frecuentación al médico de familia y enfermera comunitaria. Resultados Se incluyó a 3.543 pacientes, 1.772 (50%) mujeres, de ellos 2.204 (62%) mayores de 65 años. La gran mayoría de actividades registradas y objetivos de control disminuyeron en 2020, recuperándose en 2021 sin alcanzar los niveles de 2019. En 2020 aumentaron las consultas telefónicas y disminuyeron las presenciales, tendencia mantenida en 2021 para las telefónicas. Las mujeres y los mayores de 65 años presentaron mayor frecuentación, más registros de actividades y logros de objetivos de control en la mayoría de los parámetros. Conclusiones La pandemia supuso una sobrecarga de la AP que ha afectado a la atención de los pacientes con DM2, que no ha logrado restablecerse a los niveles prepandémicos. Los hombres jóvenes conforman la diana de priorización de esta atención. Las medidas antipandémicas han aumentado la consulta telefónica, un recurso que debe potenciarse (AU)

Background The COVID-19 pandemic meant measures had to be taken that implied the neglect of patients with type 2 diabetes (T2D). Objectives to explore the impact of care discontinuity on patients with T2D in Primary Care (PC) centres, who did not have a specific action protocol for them, during 2020 and 2021. Design Multicenter retrospective observational study. Participants Patients with T2D in Tenerife, Canary Islands, Spain. Main Measurements Sex and age, follow-up variables of atherosclerotic vascular disease detection and control programme (pEVA), compliance with the control objectives and visits to the family practitioner and community nurse were extracted from their medical records. Results 3,543 participants took part in the study, 1,772 (50%) women, 2,204 (62%) of whom were older than 65 years of age. The vast majority of registered activities and control objectives decreased in 2020, recovering in 2021 without reaching 2019 levels. In 2020, telephone consultations increased and in-person consultations decreased, a trend that remained unchanged in 2021 for telephone consultations. Women and those over 65 years of age presented higher frequentation, more activity records and achievement of control objectives in most of the parameters. Conclusions The pandemic caused an overload in the PCs that affected the care of patients with T2D, which has not returned to pre-pandemic levels. Young men are the target for prioritization of this care. Anti-pandemic measures have led to an increase in telephone consultations, a resource that should be strengthened (AU)

[Follow-up of patients with type 2 diabetes during the COVID-19 pandemic: A multicentre study in Primary Care]. / Seguimiento de los pacientes con diabetes tipo 2 durante la pandemia por COVID-19: un estudio multicéntrico en Atención Primaria.

BACKGROUND: The COVID-19 pandemic meant measures had to be taken that implied the neglect of patients with type 2 diabetes (T2D). OBJECTIVES: to explore the impact of care discontinuity on patients with T2D in Primary Care (PC) centres, who did not have a specific action protocol for them, during 2020 and 2021. DESIGN: Multicenter retrospective observational study. PARTICIPANTS: Patients with T2D in Tenerife, Canary Islands, Spain. MAIN MEASUREMENTS: Sex and age, follow-up variables of atherosclerotic vascular disease detection and control programme (pEVA), compliance with the control objectives and visits to the family practitioner and community nurse were extracted from their medical records. RESULTS: 3,543 participants took part in the study, 1,772 (50%) women, 2,204 (62%) of whom were older than 65 years of age. The vast majority of registered activities and control objectives decreased in 2020, recovering in 2021 without reaching 2019 levels. In 2020, telephone consultations increased and in-person consultations decreased, a trend that remained unchanged in 2021 for telephone consultations. Women and those over 65 years of age presented higher frequentation, more activity records and achievement of control objectives in most of the parameters. CONCLUSIONS: The pandemic caused an overload in the PCs that affected the care of patients with T2D, which has not returned to pre-pandemic levels. Young men are the target for prioritization of this care. Anti-pandemic measures have led to an increase in telephone consultations, a resource that should be strengthened.

Self-expanding intestinal expansion sleeves (IES) for short gut syndrome.

PURPOSE: Many disease processes (necrotizing enterocolitis, caustic esophageal injury, malrotation with volvulus), can result in short-gut syndrome (SGS), where remnant intestinal segments may dilate axially, but rarely elongate longitudinally. Here we mechanically characterize a novel model of a self-expanding mesh prototype intestinal expanding sleeve (IES) for use in SGS. METHODS: Gut lengthening was achieved using a proprietary cylindrical layered polyethylene terephthalate IES device with helicoid trusses with isometric ends. The IES is pre-contracted by diametric expansion, deployed into the gut and anchored with bioabsorbable sutures. IES expansion to its equilibrium dimension maintained longitudinal gut tension, which may permit remodeling, increased absorptive surface area while preserving vascular and nervous supplies. We performed mechanical testing to obtain the effective force-displacement characterization achieved on these prototypes and evaluated minimal numbers of sutures needed for its anchoring. Furthermore, we deployed these devices in small and large intestines of New Zealand White rabbits, measured IES length-tension relationships and measured post-implant gut expansion ex vivo. Histology of the gut before and after implantation was also evaluated. RESULTS: Longitudinal tension using IES did not result in suture failure. Maximum IES suture mechanical loading was tested using 4-6 sutures; we found similar failure loads of 2.95 ± 0.64, 4 ± 1.9 and 3.16 ± 0.24 Newtons for 4, 6 and 8 sutures, respectively (n = 3, n.s). Pre-contracted IES tubes were deployed at 67 ± 4% of initial length (i.l.); in the large bowel these expanded significantly to 81.5 ± 3.7% of i.l. (p = 0.014, n = 4). In the small bowel, pre-contracted IES were 61 ± 3.8% of i.l.; these expanded significantly to 82.7 ± 7.4% of i.l. (p = 0.0009, n = 6). This resulted in an immediate 24 ± 7.8% and 36.2 ± 11% increase in gut length when deployed in large and small bowels, respectively, with maintained longitudinal tension. Maintained IES induced tension produced gut wall thinning; gut histopathological evaluation is currently under evaluation. CONCLUSION: IES is a versatile platform for gaining length in SGS, which may be simply deployed via feeding tubes. Our results need further validation for biocompatibility and mechanical characterization to optimize use in gut expansion.

Consensus and recommendations on vaginal-cuff Brachytherapy of the Spanish Brachytherapy Groups of SEOR and SEFM

Purpose/objective(s) On October 5, 2018, a meeting of the Spanish Society of Radiation Oncology (SEOR) Brachytherapy Group was held, in collaboration with the Spanish Society of Medical Physics (SEFM), with the aim of preparing a consensus document on postoperative vaginal-cuff brachytherapy (VCBT). Materials/methods A survey including 42 questions was sent to Spanish Radiation Oncology Centres before the meeting. The survey items included: experience in VCBT, technique indications, previous patient preparation, applicator type, implant procedure, computerized tomography (CT) simulation, definition of target volumes and organs at risk (OAR), dose prescription, fractionation, treatment planning, dosimetric parameters and constraints to OAR. Thirty-three centres answered the survey. Statistical analysis of the survey considered that there was consensus when there was ≥ 85% of agreement related to a survey item, otherwise an item with < 85% of agreement would be discussed during the meeting to reach consensus. Results The results of the survey are reported here. The mean number of patients treated per centre in 2017 was 52 ± 41 (range 7–175), and the mean number of procedures per centre was 175 ± 150 (range 24–701).There was consensus on: the indications, applicator type, the OAR to be considered, the prescription point, standardisation and dosimetric quality parameters. There was no consensus on: patient preparation for the implant, the need for performing CT simulation and the frequency, the length of the vagina to be treated, if CTV should be delimited, the definition of the clinical target volume, fractionation, overall EQD2, active source length, separation between dwelling stepping source positions, if considering the uniformity/maximum values for dwelling stepping sources, the optimization mode, and the limiting doses to the OAR (AU)

Consensus and recommendations on vaginal-cuff Brachytherapy of the Spanish Brachytherapy Groups of SEOR and SEFM.

PURPOSE/OBJECTIVE(S): On October 5, 2018, a meeting of the Spanish Society of Radiation Oncology (SEOR) Brachytherapy Group was held, in collaboration with the Spanish Society of Medical Physics (SEFM), with the aim of preparing a consensus document on postoperative vaginal-cuff brachytherapy (VCBT). MATERIALS/METHODS: A survey including 42 questions was sent to Spanish Radiation Oncology Centres before the meeting. The survey items included: experience in VCBT, technique indications, previous patient preparation, applicator type, implant procedure, computerized tomography (CT) simulation, definition of target volumes and organs at risk (OAR), dose prescription, fractionation, treatment planning, dosimetric parameters and constraints to OAR. Thirty-three centres answered the survey. Statistical analysis of the survey considered that there was consensus when there was ≥ 85% of agreement related to a survey item, otherwise an item with < 85% of agreement would be discussed during the meeting to reach consensus. RESULTS: The results of the survey are reported here. The mean number of patients treated per centre in 2017 was 52 ± 41 (range 7-175), and the mean number of procedures per centre was 175 ± 150 (range 24-701).There was consensus on: the indications, applicator type, the OAR to be considered, the prescription point, standardisation and dosimetric quality parameters. There was no consensus on: patient preparation for the implant, the need for performing CT simulation and the frequency, the length of the vagina to be treated, if CTV should be delimited, the definition of the clinical target volume, fractionation, overall EQD2, active source length, separation between dwelling stepping source positions, if considering the uniformity/maximum values for dwelling stepping sources, the optimization mode, and the limiting doses to the OAR. After presenting the results of the survey, the consensus meeting discussion focused on the issues for which there was no consensus. CONCLUSION: A consensus document on postoperative VCBT of the Spanish Brachytherapy Groups of SEOR-SEFM was elaborated.

Extra long Argentinian lockdown: Revising the energy regime.

With the first confirmed cases of COVID-19 in March 2020, a long and strict lockdown was implemented in Argentina, as a means of avoiding health services collapse. Measures were taken early in order to strengthen the health system before the potential spread of the virus. Mandatory isolation measures impacted on the energy system: they modified energy demand and production patterns, and caused reasons for uncertainty among investors and project stakeholders. Nevertheless, profound changes caused by the pandemic, pave the way for the adoption of sustainable solutions with the potential to improve people's quality of life. This paper aims to explore the effects of the COVID-19 lockdown on the Argentinian energy sector and on the course of the transition. By means of secondary sources, such as public reports and national statistics, and semi-structured interviews, changes in the energy sector are analysed as well as local-scale alternatives for the post-pandemic. Community-led energy initiatives and the possibility of implementing sustainable practices, could contribute to reducing uncertainty and valorizing local resources and capabilities.

Tratamiento endovascular con stent no cubierto en el trombo flotante intraaórtico / Endovascular treatment with a bare stent in floating intra-aortic thrombus

No disponible

Pseudoaneurismas arteriales secundarios a fractura de fémur: opciones terapéuticas / Arterial pseudoaneurysms secondary to femur fracture: treatment options

No disponible

Rb optical resonance inside a random porous medium.

We studied resonant laser interaction with Rb atoms confined to the interstitial cavities of a random porous glass. Due to diffusive light propagation, the effect of atomic absorption on the light scattered by the sample is almost entirely compensated by atomic fluorescence at low atomic densities. For higher densities, radiation trapping increases the probability of nonradiative decay via atom-wall collisions. A simple connection of the fluorescence/absorption yield to the sample porosity is given.

Perceived sources of stress amongst Chilean and Argentinean dental students.

INTRODUCTION: The prevalence of high levels of stress as well as its multilevel consequences is well documented amongst students in the health sciences, and particularly in dentistry. However, investigations of perceived stress amongst Spanish-speaking student groups are sparse. This study aimed to (i) describe the translation, adaptation and psychometric properties of a Spanish version of the Dental Environment Stressors questionnaire and (ii) to examine the perceived sources of stress and their associations with the students' study year and gender in two dental schools in Latin America. MATERIALS AND METHODS: All students officially registered in the dental schools of the University of San Sebastian (USS) in Chile and the Catholic University of Cordoba (CUC) in Argentina were invited to participate in the study. The DES30 questionnaire was adapted in Spanish using translation/back-translation, an expert bilingual committee, and consensus building. Cronbach's alpha was used to measure the instrument's internal consistency, and iterated principal factor analysis with promax rotation was employed to explore its underlying factor structure. Descriptive, bivariate and multivariate methods were used to examine the patterns of association between individual stressors, factor scores and students' characteristics. RESULTS: Three hundred and four students comprised the study's analytical sample, with two-thirds of those being female. The DES30-Sp demonstrated good internal consistency (Cronbach's α = 0.89). A four-factor solution emerged and included 'academic workload', 'clinical training', 'time constraints' and 'self-efficacy beliefs' factors. 'Fear of failing a course or a year', 'examinations and grades' and 'lack of time for relaxation' were amongst the top individual-item stressors reported by students in both schools. Amongst this group of undergraduate dental students, those in Argentina, in higher study year, and females reported higher perceived stress. CONCLUSIONS: Increased workload, time constraints and some aspects of clinical training were the top stressors of approximately 300 Chilean and Argentinean dental undergraduates. Some variations between schools, males and females and study years were noted. The Spanish version of the DES30 questionnaire performed well, but future studies should evaluate the instrument's properties in larger and more diverse dental student populations.

Reflux patterns and risk factors of primary varicose veins' clinical severity.

OBJECTIVES: Primarily, to determine the association between the clinical severity of primary varicose veins and different reflux patterns in an anatomic and haemodynamic clinical study using duplex ultrasonography (DU). Secondly, to analyse the association of clinical severity with other aspects, such as risk factors for chronic venous insufficiency (CVI) and other concurrent diseases. METHOD: A total of 2036 limbs were evaluated using DU. Clinical status was characterized by the CEAP (clinical, aetiological, anatomical and pathological elements) classification. The degree of clinical severity was grouped into two categories, mild to moderate CVI (C1­C3)and severe CVI, characterized by the presence of skin changes (C4­C6). We analysed the association of the different reflux patterns with CEAP status. RESULTS: Saphenofemoral junction (SFJ) reflux of the great saphenous vein (GSV) was associated with the most severe form of the disease (odds ratio [OR] » 2.96; confidence interval [CI] 95%: 2.2­3.8), whereas competent SFJ of the GSV with reflux from proximal veins (OR » 2; CI 95%: 1.4­2.7) and the pure non-saphenous reflux (OR » 4.1; CI 95%:1.8­9.0) were associated with mild to moderate CVI. Obesity increased the frequency of severe CVI 2.7 times (OR » 2.7; CI 95%: 1.6­4.6); being a woman also increased the frequency of more severe disease 1.3 times (OR » 1.3; CI 95%: 1.0­1.7). CONCLUSION: Anatomical and haemodynamic studies by DU are postulated as a useful diagnostic tool that allow, by identifying the pattern of venous reflux of varicose pathology, characterization of the probable association to CVI clinical severity.

Resultados del tratamiento endovascular de los aneurismas de arteria poplítea / Results of endovascular treatment of popliteal artery aneurysms

Objetivo: Evaluar los resultados a largo plazo del tratamiento endovascular de los aneurismas de arteria poplítea (AAP). Pacientes y métodos: Análisis retrospectivo de una serie de 27 AAP intervenidos en 24 pacientes entre enero de 2004 y diciembre de 2010. Parámetros a valorar: complicaciones, salvamento de extremidad y permeabilidad según el método de Kaplan-Meier. Resultados: La edad media fue de 69±12 años. El diámetro medio de los AAP era de 29,5±13mm, con salida por 3 troncos distales en la mitad. Seis casos eran sintomáticos. Se utilizó técnica híbrida en 25 casos, mediante abordaje de la arteria femoral superficial proximal, y percutánea en 2. Se emplearon endoprótesis Fluency en 21 casos y Viabahn/Hemobahn en 6. Promedio de endoprótesis por caso: 2. Éxito técnico inicial: 100%. Morbimortalidad postoperatoria nula. Estancia media: 2,6±2 días. Control periódico clínico y ecográfico en todos los casos. Con una media de seguimiento de 51±24 meses se produjeron 9 oclusiones, 7 el primer año. Otras complicaciones: 2 migraciones con endoleak tipo I, 2 fracturas y una rotura contenida. Hubo 6 conversiones a cirugía abierta, la mayoría por trombólisis fallida, estando todos los bypass funcionantes. Permeabilidad primaria y secundaria a 4 años: 66 y 72%, respectivamente. Salvamento de la extremidad: 100%. No hubo pérdidas de seguimiento, durante el cual se produjeron 2 exitus por neoplasia. Conclusiones: El tratamiento endovascular de los AAP presenta una baja morbimortalidad y puede ser una alternativa terapéutica a la cirugía convencional(AU)

Objective: To evaluate the long term results of the endovascular treatment of popliteal aneurysms. Patients and methods: A retrospective analysis of 27 popliteal aneurysms in 24 patients operated on between January 2004 and December 2010. Endpoints: Complications, limb salvage and patency using the Kaplan-Meier method. Results: The mean age of the patients was 69±12 years. The mean diameter of aneurysms: 29.5±13mm. There were three run-off vessels patency in 52%. Six aneurysms were symptomatic. The technique with dissection of the proximal superficial femoral artery was used in 25 cases, and percutaneous in two. Fluency endografts were used in 21 cases, and Viabahn/Hemobahn in 6. The average number of stent-grafts per case was two. Initial tecnical success was obtained in 100%. There was no postoperative morbidity or mortality. The average in-hospital stay was 2.6±2 days. Clinical and duplex follow-up was possible in all patients. Nine occlusions (seven during the first year) were documented, with an average follow-up of 51±24 months. Other complications: two migrations with endoleak type I, two fractures, and one contained rupture. There were six conversions to bypass surgery, most of them due to failed thrombolysis, all remaining patent. Primary and secondary patency at 4 years was 66 and 72%, and limb salvage was 100%. No patient was lost in the follow-up, and two died of neoplasia. Conclusions: Endovascular treatment of popliteal aneurysms is a feasible and safe therapeutic alternative to conventional bypass surgery, with low morbidity and mortality(AU)

Current opinion in cervix carcinoma

We review the current status of the conventional therapeutical approaches of cervix carcinoma. Radical hysterectomy remains as the main stone in early stages and play an important role in relapses. Radiotherapy plays an important role in early and advance disease. New techniques and image expand indications and treatment possibilities. Chemotherapy platinum based with radiation therapy goes on being the standard treatment in advanced tumours or non surgical candidates. New systemic strategies are being explored in clinical trials (AU)

Tratamiento endovascular de los aneurismas poplíteos / No disponible

No disponible

Reflux or not reflux? Reflexiones sobre la publicación anglosajona del término en las varices primarias de los miembros inferiores en relación con nuestro entorno / Reflux or not reflux? Reflections on the term used in English language publications in relation to primary varicose veins of the lower limbs compared to that in Spanish literature

El significado práctico del término "reflux" en el estudio hemodinámico de las varices primarias publicado en la literatura varía en función del marco conceptual que se tenga de las distintas alteraciones hemodinámicas del sistema venoso. En este trabajo se exponen los fundamentos hemodinámicos y las discrepancias más interesantes entre la literatura anglosajona y "nuestro entorno"(AU)

The meaning of "reflux" in the haemodynamic study of primary varicose veins varies in the literature, according to different concepts of haemodynamic disorders of venous system. In this paper we present the haemodynamic basis and the main differences between English and Spanish literature(AU)

Documento de voluntades anticipadas: opinión de los profesionales sanitarios de Atención Primaria / Advanced Directives Document: opinion of the primary health care professionals

Objetivo: Conocer la opinión de los profesionales sanitarios de la Atención Primaria (AP) sobre el Documento de Voluntades Anticipadas (DVA). Diseño. Estudio descriptivo transversal. Emplazamiento. Seis centros de salud de Tenerife. Sujetos. Médicos, enfermeros y residentes de medicina familiar y comunitaria. Método; Los participantes recibieron información escrita sobre el DVA junto con un cuestionario de seis preguntas cerradas diseñado específicamente. Resultados. Participaron un total de 113 profesionales (38,7% médicos; 22,6% residentes de Medicina Familiar y 38,7% enfermeros). El 60,6% fueron mujeres. La media de edad fue de 38,59 años (desviación típica [DT]: 9,4) y la media de experiencia laboral de 14,68 años (DT: 10,24). El 68,1% de los participantes conocía la posibilidad de realizar el DVA. El 70% respondió que el paciente debería tener la iniciativa de hablar sobre el DVA. Un 53,2% consideró la consulta de AP como el entorno adecuado, existiendo diferencias según la categoría profesional (residentes: 70,8%, enfermeros: 48,7% y médicos de AP 46,3%; p = 0,005) y según los años de experiencia laboral (menos de 15 años: 66,88%, más de 15 años: 36,84%; p = 0,05). Un 60,7% se sentiría cómodo abordando el tema. Las principales dificultades se encontraron al hablar de la muerte con el paciente (52,2%) o explicar trámites administrativos (45,1%). Conclusiones. El DVA es conocido por más de la mitad de los profesionales de AP, prefiriendo que sea el paciente el que tome la iniciativa. El considerar la consulta de AP el entorno adecuado para hablar del DVA es bien valorado, sobre todo por los profesionales con menos años de experiencia (AU)

Objective. To know primary care (PC) health professional´s opinion about advanced directives (AD). Design. Cross sectional, descriptive study. SETTING. Six health care centres in Tenerife. Participants. Primary care physicians, nurses and family medicine residents. Methods. Participants received written information on the AD along with a questionnaire that consisted of six closedended questions specially designed for this study. Results. 113 professionals participated (38,7% PC physicians, 22,6% family medicine residents and 38,7% nurses). 60,7% were women. The mean age was 38,59 years (SD: 9,4) and the average number of years of work experience was 14,68% (SD: 10,24). Over 68,1% knew the possibility of performing an AD. About 70% answered that patients take the initiative in discussing AD. Fifty-three percent considered a primary care visit as a suitable opportunity to discuss AD, but there were differences according to professional category (residents physicians: 70,8%, nurses: 48,7%, PC physicians: 46,3%, p = 0,005) and years of working experience (<15 years: 66,8%, >15 years: 36,84%, p = 0,05). Over 60,7% felt comfortable dealing with this subject. The main difficulties were found when talking about death with the patient (52,2%) or explaining administrative procedures (45,1%). Conclusions : More than a half of the primary care professionals knew AD, and they preferred patients to take the initiative regarding this subject. Considering primary care visit a suitable moment to discuss AD is well appreciated, especially by those professionals with less experience (AU)

[Positron emission tomography (PET) imaging in head and neck cancer]. / La Tomografía por Emisión de Positrones (PET) en la patología oncológica de cabeza y cuello.

Positron Emission Tomography (PET) with 18F-Fluordeoxyglucose is a diagnostic imaging technique very useful in the management of head and neck cancer, better than anatomic imaging in most cases. PET shows higher diagnostic accuracy in the detection of local and regional tumor recurrences. PET is also indicated for the identification of unknown primary tumors when regional nodal metastasis is the presenting feature. The improved planning of radiation therapy with hybrid cameras PET-CT, the earlier diagnosis of post-radiotherapy residual disease and the possibility of monitoring the effects of chemotherapy makes PET imaging an important tool in evaluating tumor response to treatment.

La Tomografía por Emisión de Positrones (PET) en la patología oncológica de cabeza y cuello / Positron Emission Tomography (PET) imaging in head and neck cancer

La Tomografía por Emisión de Positrones (PET) con 18 F-Fluorodesoxiglucosa es una prueba de imagen de gran utilidad en el manejo de pacientes con patología tumoral maligna de cabeza y cuello, superior en la mayoría de los casos a las técnicas de imagen anatómicas. La detección de la enfermedad recurrencial es la indicación donde muestra un mayor rendimiento diagnóstico. También es de gran utilidad en la localización de tumores primarios desconocidos que debutan con adenopatías metastásicas cervicales. La posibilidad de mejorar la planificación de los tratamientos mediante la imagen híbrida PET-TAC, la capacidad de detectar precozmente y de forma más exacta la enfermedad residual post-radioterapia y la valoración precoz de la respuesta a la quimioterapia, hacen de la PET una prueba fundamental en la monitorización terapéutica de estos pacientes (AU)

Positron Emission Tomography (PET) with 18F-Fluordeoxyglucose is a diagnostic imaging technique very useful in the management of head and neck cancer, better than anatomic imaging in most cases. PET shows higher diagnostic accuracy in the detection of local and regional tumor recurrences. PET is also indicated for the identification of unknown primary tumors when regional nodal metastasis is the presenting feature. The improved planning of radiation therapy with hybrid cameras PET-CT, the earlier diagnosis of post-radiotherapy residual disease and the possibility of monitoring the effects of chemotherapy makes PET imaging an important tool in evaluating tumor response to treatment (AU)

Cirugía de revascularización tras angioplastia-stent renal en la nefropatía isquémica: a propósito de un caso y revisión de la literatura / Revascularisation surgery following renal stent-angioplasty in ischemic nephropathy: a case report and review of the literature

Introducción. La angioplastia y/o stent o la cirugía de revascularización de la arteria renal puede disminuir la hipertensión arterial y la necesidad de fármacos antihipertensivos, pero esta circunstancia puede desempeñar, actualmente, un papel se cundario en la estrategia terapéutica de la nefropatía isquémica, comparado con la posible prevención del fracaso renal. Existe un cambio sustancial en el objetivo principal del tratamiento de las estenosis arterioscleróticas de las arterias renales que van encaminadas a la prevención del fracaso de la función renal. Caso clínico. Presentamos un caso de cirugía de revascularización renal por reestenosis tras angioplastia-stent renal en un riñón único normofuncionante y se revisa la literatura relacionada con la nefropatía isquémica así como los resultados de los distintos procedimientos terapéuticos. Conclusiones. La cirugía de revascularización renal se presenta como una buena opción, avalada por sus aceptables resultados de permeabilidad y supervivencia. Se necesita un estudio clínico aleatorizado y prospectivo que compare el tratamiento médico, la angioplastia con y sin stent, y la cirugía de la arteria renal para definir el método más óptimo de intervención de los pacientes con arteriosclerosis de la arteria renal (AU)

Aneurisma de carótida extracraneal con estenosis crítica contralateral / Extracranial carotid aneurysm with contralateral critical stenosis

Introducción. Los aneurismas de carótida extracraneal son una patología poco frecuente y de etiología variable, aunque con una gran relevancia clínica. Sus manifestaciones son principalmente neurológicas y de origen tromboembólico. El tratamiento de elección es quirúrgico en la mayoría de casos, mediante la resección y revascularización. Caso clínico. Presentamos el caso de un paciente con un aneurisma de bulbo carotídeo, y una estenosis crítica contralateral tratado en nuestro servicio. El diagnóstico se realizó mediante ecografía Doppler asociada a una tomografía axial computarizada y una angiografía. El tratamiento consistió en una endarterectomía carotídea contralateral, seguida ocho semanas después de la resección del aneurisma y la reconstrucción mediante un injerto de Dacron impregnado en rifampicina, y el reimplante de la carótida externa. La evolución posterior ha sido favorable, sin complicaciones neurológicas. Discusión. Los aneurismas de carótida extracraneal son raros, pero tienen una gran relevancia clínica debido al alto porcentaje de complicaciones neurológicas que presentan. Además, debe tenerse en cuenta su posible etiología infecciosa. El tratamiento conservador sólo se justifica en una minoría de los casos, ya que el resto requiere únicamente un tratamiento quirúrgico. Los resultados de la reconstrucción justifican esta actitud; la ligadura carotídea se reserva en escasas indicaciones. Existen pocas publicaciones sobre la terapéutica endoluminal aplicada a esta patología, por lo que aún no puede considerarse una clara alternativa (AU)