ABSTRACT
Introducción. Las fístulas aortoentéricas o las erosiones entericoprotésicas del territorio aórtico en los pacientes sépticos pueden ser difíciles de diagnosticar debido a su clínica, en ocasiones larvada e insidiosa, por lo que el diagnóstico temprano es una de las mejores garantías a la hora de establecer una terapia rápida y eficaz Varón de 66 años operado cinco años atrás de una derivación aortobifemoral por patología oclusiva aortoilíaca. Acude a nuestro centro por presentar un cuadro séptico con un gran absceso retroperitoneal detectado mediante una tomografía axial computarizada (TAC), que engloba la rama izquierda del injerto. Con la sospecha diagnóstica de fístula aortoentérica secundaria por decúbito del duodeno sobre el injerto, se realiza una exploración digestiva mediante el uso de una `cápsula endoscópica', que consiste en una cámara en color, encapsulada y desechable, que muestra imágenes compatibles con la visualización directa del injerto a través de la luz duodenal. El diagnóstico de una erosión entericoprotésica se confirma durante la cirugía, y se realiza una exéresis de la prótesis infectada con una ligadura del muñón aórtico, previa derivación extranatómica a xilobifemoral, con limpieza y drenaje del absceso retroperitoneal. Conclusión. Se considera el uso de la `cápsula endoscópica' como una opción válida y una posibilidad diagnóstica más en el manejo de fístulas aortoentéricas primarias y secundarias o de las erosiones entericoprotésicas, junto a la endoscopia clásica, cuando las lesiones asienten distalmente a la cuarta porción duodenal o cuando otras técnicas de imagen no sean concluyentes. (AU)
Subject(s)
Aged , Male , Humans , Arterio-Arterial Fistula/diagnosis , Endosonography/methods , Aortography/methods , Ultrasonography, Doppler/methods , Laparotomy/methods , Radionuclide Imaging , Tomography, Emission-Computed/methods , Escherichia coli/isolation & purification , Escherichia coli/pathogenicity , Arteriovenous Fistula/diagnosis , Arteriovenous Fistula/surgery , Fistula/surgery , Fistula/diagnosis , Fever/complications , Fever/etiology , Mesenteric Arteries/pathology , Aorta, Abdominal/pathologyABSTRACT
Objetivos. Uno de los argumentos esgrimidos para justificar la utilización de endoprótesis en pacientes con aneurismas de aorta es que obtengan una clasificación ASA IV en la valoración preoperatoria de riesgo anestésico. Para rechazar o defender este criterio hemos realizado un estudio retrospectivo de este tipo de pacientes intervenidos en el período 1991-1995 con el fin de conocer, de esta forma, su evolución. Pacientes y métodos. Se consideraron ASA IV 36 pacientes de un total de 126 intervenidos entre 1991 y 1995 de aneurisma de aorta infrarrenal. Se excluyeron los pacientes intervenidos urgentemente y los casos de pinzamiento suprarrenal. La edad media fue de 69,6 y sólo uno era del sexo femenino. Los factores de riesgo predominante fueron el tabaquismo y la hipertensión. La enfermedad asociada más frecuente fue la cardiopatía, sobre todo la isquémica, y la limitación crónica al flujo aéreo. Resultados. La mortalidad hospitalaria fue del 2,7 por ciento, la mortalidad al año fue del 8,3 por ciento, a los tres años del 36 por ciento, y a los cinco años, del 55,5 por ciento. La causa más frecuente fue el cáncer, seguido del infarto de miocardio. Conclusiones. La mortalidad operatoria de los ASA IV en nuestra serie es baja, aceptable y similar a la mortalidad global de los aneurismas, entre ellos los ASA III. La clasificación ASA presenta un bajo valor predictivo en cuanto a la mortalidad quirúrgica. Ambas conclusiones se deben a la sobrevaloración del riesgo en alguno de nuestros pacientes y, por lo tanto, la clasificación ASA no es el método adecuado de guía para la inclusión de pacientes en el tratamiento con endoprótesis aórtica; ésta debe basarse en criterios anatómicos y siempre dentro de un estudio controlado. (AU)
Subject(s)
Adult , Aged , Female , Male , Middle Aged , Humans , Risk Factors , Tobacco Use Disorder/physiopathology , Hypertension/complications , Diabetes Mellitus/complications , Diabetes Mellitus/diagnosis , Aneurysm/complications , Aneurysm/diagnosis , Aneurysm/mortality , Thrombosis/complications , Thrombosis/diagnosis , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Myocardial Revascularization/methods , Kidney/surgery , Kidney/pathology , Angiography/methods , Hyperlipidemias/complications , Hyperlipidemias/diagnosis , Heart Diseases/complications , Heart Diseases/diagnosis , Heart Diseases/epidemiology , Postoperative Complications , Angioplasty/methods , Aneurysm/classificationABSTRACT
The most recent Human Leucocyte Differentiation Antigen Workshop ("HLDA7") took place in 2000 in Harrogate, UK and the proceedings are about to be published (Leucocyte Typing VII). New Sections were introduced in this Workship (Dendritic cells, Stem/progenitor cells, Erythroid cells and Carbohydrate Structures) and monoclonal antibodies were selected for which at least some molecular data were already available (to avoid "blind" screening of reagents against known specificities). A total of more than 80 new CD specificities were established (previously the average was less than 30 new CD specificities per Workshop) and these are listed in this article. There is already evidence for the existence of many new leucocyte surface molecules for study at the next HLDA Workshop (in Adelaide in 2004), and we have listed in this article a number of such potential CD candidates (identified following the production of monoclonal antibodies or via gene cloning). There are also today an increasing number of lineage- and/or stage-restricted leucocyte-associated molecules localised within the cell cytoplasm (or nucleus): they will certainly prove of intense in the future for many laboratories studying human haematopoietic cells (regardless of whether a new "intracellular CD" categorisation scheme is devised for such molecules).
Subject(s)
Antigens, CD/genetics , Humans , Terminology as TopicSubject(s)
Aneurysm, Infected/microbiology , Brain Abscess/microbiology , Carotid Artery Diseases/microbiology , Intracranial Aneurysm/microbiology , Salmonella Infections , Salmonella enteritidis/isolation & purification , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/therapy , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/therapy , Carotid Artery, Common , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/therapy , Male , Middle Aged , Radiography , Salmonella Infections/diagnosis , Salmonella Infections/therapySubject(s)
Abdomen, Acute/etiology , Aorta, Abdominal/surgery , Blood Vessel Prosthesis , Chylous Ascites/etiology , Polyethylene Terephthalates , Postoperative Complications/etiology , Thrombosis/surgery , Abdomen, Acute/surgery , Aged , Chylous Ascites/surgery , Humans , Male , Multiple Organ Failure/etiology , Postoperative Complications/surgery , Reoperation , Shock, Septic/etiologyABSTRACT
During the last years diverse types of Dacron prosthesis without porosity (because to be impregnated by different materials) have appeared. In the presented study, outcomes from three different types of prosthesis (differentiated by the impregnated material) were evaluated and a comparison with classical prosthesis was made.
Subject(s)
Aorta, Abdominal , Blood Vessel Prosthesis , Femoral Artery , Follow-Up Studies , Humans , Intraoperative Complications , Male , Middle Aged , Polyethylene Terephthalates , Porosity , Postoperative Complications , ThrombosisABSTRACT
The authors present their experience with Morphologic Capillaroscopy, and analyze the diagnostic dates provided by this technique to the current Angiology and Vascular Surgery protocols. Morphologic anomalies founded during diverse systemic diseases as well as the changes on the capillary field produced in cases of chronic ischaemia and venous insufficiency were analysed. The study was made on the basis of 236 capillaroscopic images and it was completed by an extensive bibliographic review of the subject.
Subject(s)
Capillaries/pathology , Microscopy/instrumentation , Vascular Diseases/diagnosis , Humans , Vascular Diseases/physiopathologyABSTRACT
A case is presented of fistula formation between a primary hydatid cyst and the abdominal aorta which we believe is the first in the world literature. The patient underwent surgery with a diagnosis of aneurysm of the coeliac trunk. During the operation the presence was discovered of a hydatid cyst opening into the aorta. It was dealt with by partial resection and closing of the communication. Three months later the patient was readmitted with a new bleeding episode which resulted in a fatal outcome.
Subject(s)
Aortic Diseases/etiology , Echinococcosis/complications , Fistula/etiology , Aorta, Abdominal , Humans , Male , Middle Aged , Retroperitoneal SpaceABSTRACT
There is not an extensive literature about nutritional value in Vascular Surgery. In this study, efficacy and cost/benefit relation in the application of Peripheric Parenteral Nutrition (PPN) in postoperative of aortic surgery, are investigated through two randomized groups, in patients with aortoiliac obstructive arteriopathy and who needed an aortobifemoral bypass.
Subject(s)
Aorta/surgery , Parenteral Nutrition, Total , Postoperative Care/methods , Anastomosis, Surgical , Cost-Benefit Analysis , Evaluation Studies as Topic , Humans , Male , Postoperative Care/economics , Random AllocationABSTRACT
The experience about 18 patients subjected to aortoiliac surgery is exposed. The cardiac flow was bloodless monitorized by means of an apparatus, based in Doppler effect, which proved its accuracy and usefulness. Authors considers necessary to monitorize the cardiac flow in this sort of surgery, and this bloodless method has showed its validity and simplicity.
Subject(s)
Aorta, Abdominal/surgery , Cardiac Output , Echocardiography, Doppler , Iliac Artery/surgery , Aged , Humans , Intraoperative Period , Male , Middle Aged , Postoperative PeriodABSTRACT
Serum total thyroxine, triiodothyronine, and thyrotropin response to thyrotropin-releasing hormone (TRH-TSH test) were measured in 126 consecutive patients admitted with atrial fibrillation: 33 patients with an acute arterial limb embolism (Group I), 31 patients with an acute embolic stroke (Group II), and 62 patients without any arterial occlusion (Group III). A blunted TRH-TSH test, suggestive of thyrotoxicosis, was found in 5 patients in Group I, 8 patients in Group II, and 2 patients in Group III. The diagnosis of hyperthyroidism was confirmed in 8 patients (by repeated TRH-TSH test and scintigraphy): 4 patients in Group I (12.1%) and 4 patients in Group II (12.9%). All of them had a nonvalvular atrial fibrillation. Thyrotoxicosis should not be recognized in 6 of them if TRH-TSH test was not performed, because peripheral hormone levels were normal. Five of these 8 patients with thyrotoxicosis had reversion to sinus rhythm after treatment with carbimazole, either spontaneously or after cardioversion. This outcome prevented prolongation of anticoagulant therapy for an indefinite time.
