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1.
Ann Vasc Surg ; 24(2): 287-94, 2010 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-20142004

RESUMEN

BACKGROUND: In some patients with critical limb ischemia (CLI) the possibility of revascularizing treatment does not exist. In this case therapeutic angiogenesis (TA) using autologous endothelial progenitor cell (EPC) transplantation could be an alternative. The objective of our study was to evaluate the safety and efficacy of TA using EPC. METHODS: Twenty-eight patients with CLI who were not candidates for surgical or endovascular revascularization were included in a prospective study. To mobilize EPCs from the bone marrow, granulocyte colony-stimulating growth factor was injected subcutaneously at doses of 5 microg/kg/day for 5 days. Apheresis was performed, obtaining 50 mL of blood with a high rate of EPCs (CD34(+) and CD133(+) cells were counted). EPCs were implanted in the ischemic limb by intramuscular injections. Primary end points were the safety and feasibility of the procedure and limb salvage rate for amputation at 12 months. Other variables studied were improvement in rest pain, healing of ulcers, ankle-brachial pressure index (ABI), and digital plethysmography. All procedures were done pretreatment and every 3 months for a year on average. Postransplantation arteriography was done in selected cases. RESULTS: No adverse effects were observed. Mean follow-up was 14 months. Before treatment, mean basal ABI was 0.35+/-0.2 and at 18 months postimplantation, 0.72+/-0.51 (p=0.009). There was a mean decrease of five points in pain scale: basal 8.7+/-1, after TA 3.8+/-2.9 (p=0.01). Seven patients required major amputation. Kaplan-Meier analysis revealed a limb salvage rate of 74.4% after 1 year. CONCLUSION: Implantation of EPCs in CLI is a safe alternative, improves tissue perfusion, and obtains high amputation-free rates. Nevertheless, this is a small cohort and results should be tested with long randomized trials.


Asunto(s)
Células Endoteliales/trasplante , Isquemia/terapia , Extremidad Inferior/irrigación sanguínea , Neovascularización Fisiológica , Trasplante de Células Madre , Adulto , Anciano , Amputación Quirúrgica , Índice Tobillo Braquial , Eliminación de Componentes Sanguíneos , Movimiento Celular/efectos de los fármacos , Enfermedad Crítica , Células Endoteliales/efectos de los fármacos , Femenino , Factor Estimulante de Colonias de Granulocitos/administración & dosificación , Humanos , Inyecciones Intramusculares , Inyecciones Subcutáneas , Isquemia/complicaciones , Isquemia/fisiopatología , Isquemia/cirugía , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Dolor/etiología , Dolor/prevención & control , Dimensión del Dolor , Fotopletismografía , Proyectos Piloto , Estudios Prospectivos , Trasplante de Células Madre/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler , Cicatrización de Heridas , Adulto Joven
3.
Eur J Vasc Endovasc Surg ; 35(1): 79-83, 2008 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-17919947

RESUMEN

OBJECTIVES: The aim of this study is to evaluate the functional recovery after Thoracic Outlet Syndrome (TOS) surgery, by the application of Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. MATERIAL AND METHODS: This was a prospective study of all patients operated on for TOS from January 1998 to December 2005. The DASH questionnaire was administered pre- and postoperatively. The scores were analysed according to TOS type, the associated comorbidity and the type of surgery performed. Results were assessed with Wilcoxon Test for continuous variables, and the Fisher Test for categories. RESULTS: Twenty-three consecutive patients were included in the study, the average age was 37 years (range: 22-54). Fourteen patients presented with venous TOS and 9 with neurogenic TOS. Patients with venous TOS had a preoperative score of 14.9 (SD 18.31) and a postoperative score of 14.8 (SD 15.6) (p>0.05). The preoperative score in patients with neurogenic TOS was 53.96 (SD 15.6) and the postoperative score was 17.8 (SD 15.3) (p=0.01). CONCLUSIONS: DASH questionnaire is a valid and objective test for evaluating the functional state after TOS surgery. Venous TOS is clinically less incapacitating than neurogenic. Surgically decompression of thoracic outlet leads to significant benefit in patients with neurogenic TOS.


Asunto(s)
Descompresión Quirúrgica , Evaluación de la Discapacidad , Enfermedades del Sistema Nervioso/complicaciones , Encuestas y Cuestionarios , Síndrome del Desfiladero Torácico/cirugía , Trombosis de la Vena/complicaciones , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/fisiopatología , Enfermedades del Sistema Nervioso/cirugía , Satisfacción del Paciente , Estudios Prospectivos , Recuperación de la Función , Reproducibilidad de los Resultados , Síndrome del Desfiladero Torácico/etiología , Síndrome del Desfiladero Torácico/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Trombosis de la Vena/fisiopatología , Trombosis de la Vena/cirugía
4.
Angiología ; 58(6): 501-504, nov.-dic. 2006. ilus
Artículo en Es | IBECS | ID: ibc-049300

RESUMEN

Introducción. El mecanismo patogénico más frecuente de la disfunción eréctil es el de origen vascular. Hasta la fecha, en el diagnóstico de la disfunción eréctil por fuga venosa, únicamente se disponía de pruebas diagnósticas invasivas, como la cavernosometría y la cavernosografía, con un riesgo potencial de yatrogenia para los pacientes. Caso clínico. Varón de 38 años de edad con disfunción eréctil de origen vascular por fuga venosa (disfunción del mecanismo corporovenooclusivo), diagnosticado únicamente mediante eco-Doppler e índice peneano en nuestro gabinete de diagnóstico vascular no invasivo. Conclusiones. La exploración hemodinámica mediante eco-Doppler de las arterias cavernosas, sobre todo desde la incorporación de la administración intracavernosa de fármacos vasoactivos, ha pasado a considerarse como la prueba de elección en el diagnóstico de disfunción eréctil en la fase arterial. De la misma forma, muchos autores también la consideran de elección en la valoración del mecanismo corporovenooclusivo (o fase venosa) y ha desplazado de forma paulatina a pruebas como la cavernosografía y la cavernosometría dinámicas


Introduction. The most common pathogenic mechanism causing erectile dysfunction has its origins in a vascular disorder. To date, in the diagnosis of erectile dysfunction due to venous leak, only invasive diagnostic tests, such as cavernosometry and cavernosography, have been available, and such methods naturally entail a potential iatrogenic risk for patients. Case report. A 38-year-old male with vascular erectile dysfunction due to venous leak (dysfunction of the corporal veno-occlusive mechanism), diagnosed using only Doppler ultrasonography and the penile index in our noninvasive vascular diagnosis clinic. Conclusions. Haemodynamic examination using Doppler ultrasound recording of the cavernous arteries has now become the preferred test for diagnosing erectile dysfunction in the arterial phase, and more so since the incorporation of intracavernous administration of vasoactive drugs. Likewise, many authors also consider it to be the preferred method for evaluating the corporal veno-occlusive mechanism (or venous phase) and it has gradually substituted dynamic tests such as cavernosography and cavernosometry


Asunto(s)
Masculino , Adulto , Humanos , Ecocardiografía Doppler/métodos , Disfunción Eréctil/diagnóstico , Disfunción Eréctil/cirugía , Vasodilatadores/efectos adversos , Diagnóstico Diferencial , Anamnesis/métodos , Enfermedad Iatrogénica/epidemiología , Erección Peniana , Erección Peniana/fisiología
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