Reparación endovascular del aneurisma de aorta abdominal. Papel del deterioro postoperatorio de la función renal en la supervivencia / Endovascular aortic repair of abdominal aortic aneurysm: Role of post-surgical renal function decline in survival

Introducción: La reparación endovascular del aneurisma de aorta abdominal (EVAR) ha supuesto desde su llegada y desarrollo una disminución en la mortalidad precoz con respecto a la cirugía convencional. Como factores predictivos de mortalidad se han identificado el deterioro de función renal preoperatorio, la enfermedad pulmonar obstructiva crónica y la cardiopatía isquémica. Objetivo: Evaluar la influencia en la supervivencia a largo plazo de los factores de riesgo preoperatorios y del deterioro de función renal perioperatorio en los pacientes sometidos a EVAR en nuestro centro. Material y métodos: Se realizó un estudio observacional retrospectivo en pacientes sometidos a EVAR en nuestro centro entre los años 2008 y 2012. Se hizo un análisis de la supervivencia a medio y largo plazo, llevado a cabo mediante curvas de Kaplan-Meier. Se estudió la influencia de los factores de riesgo preoperatorios y del deterioro de función renal perioperatorio sobre la supervivencia empleando el modelo de regresión de Cox. Resultados: Se incluyeron 79 pacientes con una edad media de 75,2 años (57,6-85,9). La mediana del tiempo de seguimiento fue de 38 meses (0,4-83,4). Durante este periodo de tiempo se registraron 26 muertes (32,9%). La probabilidad de supervivencia al cabo de un año fue del 93,7%; a los 2 años del 82,3%; a los 4 años del 68,9%; y a los 6 años del 56,5%. Una mayor tasa de supervivencia se asoció con cifras analíticas de creatinina menores de 1,2 mg/dl a las 24 h y a los 7 días, y filtrado glomerular mayor de 60 ml/min a las 24 h y a los 7 días. El análisis multivariante evidenció una probabilidad de muerte 2,39 veces mayor en los pacientes que presentaron un valor analítico de creatinina a las 24 h mayor de 1,2 mg/dl con respecto a los que mostraron una cifra menor de 1,2 mg/dl (HR: 2,39; IC95%: 1,06-5,42); p = 0,037). Conclusión: El deterioro de función renal tras la EVAR es un factor independiente de mal pronóstico a largo plazo. Tanto en la preparación preoperatoria como durante el postoperatorio deben ponerse los medios necesarios encaminados a corregir las circunstancias que provoquen un deterioro de la función renal

Background: Since its introduction and development, endovascular aortic repair (EVAR) has shown an improvement in short-term mortality compared to conventional surgery. Pre-operative renal function impairment, chronic obstructive pulmonary disease, and ischaemic heart disease, have been identified as mortality predictors. Objective:To assess the influence on long-term survival of pre-operative risk factors and peri-operative renal function impairment in patients that underwent EVAR in our centre. Material and methods: A retrospective observational study was conducted on patients subjected to EVAR in our centre between the years 2008 and 2012. The Kaplan-Meier curve was used to analyse the long and medium-term survival. The influence of pre-operative risk factors and perioperative renal impairment on survival was analysed using the Cox regression model. Results: A total of 79 patients were finally included in the study. The mean age was 75.2 years (57.6-85.9). The mean follow-up period was 38 months (0.4-83.4). During this period 26 (32.9%) deaths were registered. Survival probabilities during the first, second, fourth, and sixth years were 93.7%, 82.3%, 68.9%, and 56.5%, respectively. A greater survival rate was associated with creatinine levels lower than 1.2mg/dL at 24hours and at 7 days, and a glomerular filtration rate higher than 60mL/min at 24hours and at 7 days. Multivariate analysis showed a HR 2.39 higher in patients with a creatinine level higher than 1.2mg/dL at 24hours compared to patients with a creatinine level lower than 1.2mg/dL (HR: 2.39, 95% CI: 1.06-5.42; P=.037). Conclusion: Renal function impairment after endovascular aortic repair of abdominal aortic aneurysm represents an independent long-term poor prognosis factor. During pre-operative preparation and post-operative care necessary steps should be taken aimed at correcting the circumstances that cause renal function impairment

Postmarketing study for assessment of tolerability of a grass allergen immunotherapy tablet (GRAZAX) in patients with rhinitis or rhinoconjunctivitis.

BACKGROUND AND OBJECTIVE: Many patients with grass pollen allergy in Spain have concomitant sensitization to other allergens such as profilin. Since this type of sensitization is more common in Mediterranean countries than in countries where most patients were enrolled in clinical trials on GRAZAX (Phleum pratense 75,000 SQ-T/2, 800 BAU, ALK), the aim of this study was to analyze tolerability to GRAZAX under clinical practice conditions in patients with grass pollen allergy. METHODS: A total of 155 patients were enrolled consecutively in a prospective, open-label, observational study. Adverse reactions were recorded during the first month of treatment at 3 different timepoints: after the first dose, when patients were kept under observation for 30 minutes, and on days 15 and 30 after starting treatment RESULTS: With the first dose, 117 adverse reactions were recorded in 63 patients (40.7%). The commonest reactions (>10% patients) were oral pruritus (25.2%) and throat irritation (24.5%). Ear pruritus was recorded in 7.7%. All reactions but 1 occurred within 30 minutes of administration and all were mild-to-moderate. At the end of treatment, the percentage of patients with adverse reactions had decreased significantly (21.3%). Most adverse reactions (95.2%) were mild-to-moderate and only 3 (1.4%) were severe. No serious adverse reactions were recorded. CONCLUSION: GRAZAX seems to be well tolerated, and most reactions were mild-to-moderate. Many of these reactions occur with the first dose. Therefore, according to the Summary of Product Characteristics, the first dose has to be administered under medical supervision.

Anaphylactic reaction to young garlic.

BACKGROUND: Garlic is well known to cause contact dermatitis and asthma. However, it is a very rare cause of food allergy. We present the case of a 23-year-old woman with previous history of allergy to pollen and dried fruit, and food-dependent, exercise-induced anaphylaxis for which no specific food could be identified as responsible, who experienced an anaphylactic reaction after eating young garlic. METHODS: Skin prick tests and specific IgE immunoassay with several pollens and foods were performed, as well as the prick-prick test with young garlic and SDS-PAGE followed by immunoblotting IgE to young garlic and other Liliaceae species, mustard, sesame, parsley, celery, hazelnut, almond, and pollen of birch and mugwort. RESULTS: Skin prick tests and specific IgE were mainly positive for grass, plane tree, and mugwort pollen; peanut; hazelnut; walnut; almond; and mustard. Prick-prick tests with young garlic and garlic were positive. Total IgE was 113 U/ml. SDS-PAGE immunoblotting showed IgE-binding bands at 12 kDa to young garlic, garlic, onion, and leek extracts. Similar bands could also be detected with mugwort pollen and hazelnut extract. CONCLUSIONS: We describe IgE-mediated reaction to young garlic in a patient sensitized to pollen and dried fruit.

Severe hypersensitivity reaction to minocycline.

Minocycline is a tetracycline derivative mainly used in the treatment of acne vulgaris in young persons. Adverse events have been reported with minocycline, although it can be considered a safe drug. We report a case of severe hypersensitivity reaction to minocycline in a young patient. Laboratory examinations, chest X-ray, skin test and skin biopsy were performed. Oral challenge test with minocycline was not carried out as it can be hazardous. A case of severe reaction to minocycline is described in this article. The clinical and laboratory findings may be helpful in diagnosing similar reactions for which the immunological mechanisms are unknown. Moreover, this type of reaction must be recognized early due to the potential fatal outcome.