In vitro activity of cefiderocol and other newly approved antimicrobials against multi-drug resistant Gram-negative pathogens recovered in intensive care units in Spain and Portugal.

OBJECTIVE: The antimicrobial resistance is a significant public health threat, particularly for healthcare-associated infections caused by carbapenem-resistant Gram-negative pathogens which are increasingly reported worldwide. The aim of this study was to provide data on the in vitro antimicrobial activity of cefiderocol and that of commercially available comparator antibiotics against a defined collection of recent clinical multi-drug resistant (MDR) microorganisms, including carbapenem resistant Gram-negative bacteria collected from different regions in Spain and Portugal. METHODS: A total of 477 clinical isolates of Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia were prospectively (n=265) and retrospectively (n=212) included (2016-2019). Susceptibility testing was performed using standard broad microdilution and results were interpreted using CLSI-2021 and EUCAST-2021 criteria. RESULTS: Overall, cefiderocol showed a good activity against Enterobacterales isolates, being 99.5% susceptible by CLSI and 94.5% by EUCAST criteria. It also demonstrated excellent activity against P. aeruginosa and S. maltophilia isolates, all being susceptible to this compound considering CLSI breakpoints. Regarding A. baumannii (n=64), only one isolate was resistant to cefiderocol. CONCLUSIONS: Our results are in agreement with other studies performed outside Spain and Portugal highlighting its excellent activity against MDR gram-negative bacteria. Cefiderocol is a therapeutic alternative to those available for the treatment of infections caused by these MDR bacteria.

Risk assessment of arterial allograft contamination from tissue donors colonized by Candida auris.

BACKGROUND: Microbiological contamination is one of the main risks that must be controlled in tissue banking practices. For this reason, strict donor selection criteria are applied, disinfection protocols are used, and microbiological monitoring is performed at various stages. AIM: To detect Candida auris in arterial allografts and assess its origin. METHODS: Data on two multi-tissue donations with positive microbiological cultures for C. auris were analysed. Risk factors for microbiological contamination were assessed at procurement, processing and post storage. FINDINGS: C. auris was only isolated in cultures from arteries, and was not detected in cultures from cornea, musculoskeletal tissue or skin (even in the axillary-rectal sample taken from one donor). CONCLUSION: The donor's own skin was identified as the most likely source to explain the contamination of arteries by C. auris. Due to the pathogenicity of this fungus and difficulties associated with its correct identification, the implementation of measures for its detection in tissue donations is recommended.

Detection of two simultaneous outbreaks of Klebsiella pneumoniae coproducing OXA-48 and NDM-1 carbapenemases in a tertiary-care hospital in Valencia, Spain.

Klebsiella pneumoniae is one of the most common hospital-acquired Gram-negative pathogens. During the last decade, the emergence of strains with reduced susceptibility or resistance to carbapenems is becoming a therapeutic challenge. This study takes place after the isolation of 14 strains of carbapenem-resistant K. pneumoniae with similar susceptibility patterns and carriage of OXA-48 and NDM-1 carbapenemases genes. Fourteen patients were found to be colonized (faecal carriage) and/or infected by two different clones of carbapenemase-coproducing K. pneumoniae during a 1-year period of time. Some of the patients had shared a hospital ward and continued to be colonized several months after the outbreak.

Herd-specific interventions to reduce antimicrobial usage in pig production without jeopardising technical and economic performance.

Pig farmers are strongly encouraged to reduce their antimicrobial usage in order to reduce the risk of antimicrobial resistance. Herd-level intervention is needed to achieve national and European reduction targets. Alternative, especially preventive measures, have to be implemented to reduce the need for antimicrobial treatments. However, little is known about the feasibility, effectiveness and return on investment of such measures. The objective of this study was to assess, across four countries, the technical and economic impact of herd-specific interventions aiming at reducing antimicrobial usage in pig production while implementing alternative measures. An intervention study was conducted between February 2014 and August 2015 in 70 farrow-to-finish pig farms located in Belgium, France, Germany and Sweden. Herd-specific interventions were defined together with the farmer and the herd veterinarian. Farms were followed over one year and their antimicrobial usage and technical performance were compared with values from the year before intervention. Compliance with the intervention plan was also monitored. Changes in margin over feed cost and net farm profit were estimated in a subset of 33 Belgian and French farms with sufficient data, using deterministic and stochastic modeling. Following interventions, a substantial reduction in antimicrobial use was achieved without negative impact the overall farm technical performance. A median reduction of 47.0% of antimicrobial usage was achieved across four countries when expressed in terms of treatment incidence from birth to slaughter, corresponding to a 30.5% median reduction of antimicrobial expenditures. Farm compliance with intervention plans was high (median: 93%; min-max: 20; 100) and farms with higher compliance tended to achieve bigger reduction (ρ=-0.18, p=0.162). No association was found between achieved reduction and type or number of alternative measures implemented. Mortality in suckling piglets, weaners and fatteners, daily weight gain and feed conversion ratio did not significantly change over the course of the study, while the number of weaned piglets per sow per year slightly increased. The median change in net farm profit among Belgian and French farms was estimated to be €4.46 (Q25-Q75:-32.54; 80.50) and €1.23 (Q25-Q75:-32.55; 74.45) per sow per year using the detererministic and stochastic models, respectively. It was more influenced by a change in feed conversion ratio and daily weight gain than by a change in antimicrobial expenditures or intervention direct net cost. Therefore, costs of alternative measures should not be perceived as a barrier, but rather as an opportunity to optimise production practices for sustained productivity and improved animal health.

[Evaluation of galactomannan antigen and Aspergillus real time PCR for diagnosis of invasive aspergillosis]. / Evaluación del antígeno galactomanano y la PCR en tiempo real de Aspergillus para el diagnóstico de aspergilosis invasiva.

INTRODUCTION: The aim of the study was to compare the galactomannan antigen (GA) and molecular biology (PCRrt) tests with the culture in the diagnosis of invasive aspergillosis (IA). MATERIAL AND METHODS: Four hundred and seventy two samples were analyzed: 388 respiratory and 84 serum samples from 271 patients. Culture and GA were evaluated in the respiratory samples and GA in the serum samples. PCR was used when discrepancies were observed among culture and GA tests. RESULTS: The detection of GA in serum was positive in 22 (of 84), 21 had the test positive respiratory sample. Of the 62 sera with negative GA, 45 were also negative respiratory specimens. The culture was positive in 37 of which were positive for GA. Comparing culture with AG, it showed PPV=23%, NPV=100%, S=100% and E=52%. The PCR showed respect to culture: PPV=69%, NPV=89%, S=64% and E=82%. In sera were found in 60% discrepancies between PCRrt and GA. CONCLUSIONS: We consider useful the GA detection in serum combined with culture and GA in respiratory samples, for diagnosis of AI. PCR requires further studies for standardization and set breakpoints.

Dolor abdominal súbito durante un viaje en avión: pienso en lo más frecuente, pero, ¿y si se trata de una entidad infrecuente? / Sudden abdominal pain during an airplane flight: what if the horse turns out to be a zebra?

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Viral infections of the central nervous system in Spain: a prospective study.

The aim of the study was to determine the incidence of viruses causing aseptic meningitis, meningoencephalitis, and encephalitis in Spain. This was a prospective study, in collaboration with 17 Spanish hospitals, including 581 cases (CSF from all and sera from 280): meningitis (340), meningoencephalitis (91), encephalitis (76), febrile syndrome (7), other neurological disorders (32), and 35 cases without clinical information. CSF were assayed by PCR for enterovirus (EV), herpesvirus (herpes simplex [HSV], varicella-zoster [VZV], cytomegalovirus [CMV], Epstein-Barr [EBV], and human herpes virus-6 [HHV-6]), mumps (MV), Toscana virus (TOSV), adenovirus (HAdV), lymphocytic choriomeningitis virus (LCMV), West Nile virus (WNV), and rabies. Serology was undertaken when methodology was available. Amongst meningitis cases, 57.1% were characterized; EV was the most frequent (76.8%), followed by VZV (10.3%) and HSV (3.1%; HSV-1: 1.6%; HSV-2: 1.0%, HSV non-typed: 0.5%). Cases due to CMV, EBV, HHV-6, MV, TOSV, HAdV, and LCMV were also detected. For meningoencephalitis, 40.7% of cases were diagnosed, HSV-1 (43.2%) and VZV (27.0%) being the most frequent agents, while cases associated with HSV-2, EV, CMV, MV, and LCMV were also detected. For encephalitis, 27.6% of cases were caused by HSV-1 (71.4%), VZV (19.1%), or EV (9.5%). Other positive neurological syndromes included cerebellitis (EV and HAdV), seizures (HSV), demyelinating disease (HSV-1 and HHV-6), myelopathy (VZV), and polyradiculoneuritis (HSV). No rabies or WNV cases were identified. EVs are the most frequent cause of meningitis, as is HSV for meningoencephalitis and encephalitis. A significant number of cases (42.9% meningitis, 59.3% meningoencephalitis, 72.4% encephalitis) still have no etiological diagnosis.

[Risk factors for postoperative complications in major head and neck surgery]. / Factores de riesgo para las complicaciones postoperatorias en cirugía mayor de cabeza y cuello.

BACKGROUND AND OBJECTIVE: Tumor extension is the factor that usually determines the choice of radiotherapy or surgery for head and neck cancers. The choice of surgery carries with it certain specific risks that must be assessed jointly by the maxillofacial surgeon and the anesthetist so that they can agree on the best course of action to choose. We aimed to identify risk factors for complications after major head and neck surgery. PATIENTS AND METHODS: Retrospective descriptive analysis of data for patients who underwent oncologic head and neck surgery with graft reconstruction. The main candidate predictors gathered from records were age, sex, ASA physical status classification, time under anesthesia, and intra- and postoperative events. The main dependent variables were records of early and delayed complications, time until extubation, and related mortality. RESULTS: We identified 61 interventions in 56 patients (mean duration of surgery, 9 hours). Early complications developed in 57.4% while they were in the critical care area. Age > or =60 years was associated with longer hospital stays. Short-term mortality was higher in current smokers (P= .01). Survival was significantly higher in patients classified ASA 1 or 2 in comparison with those classified as ASA 3 or 4, in whom long-term mortality was higher (P < .05). CONCLUSIONS: The incidence of postoperative complications was associated with comorbidity and risk behaviors found in this type of patient. We feel that a multidisciplinary medical team should assess the surgical and postoperative care of these patients.

Factores de riesgo para las complicaciones postoperatorias en cirugía mayor de cabeza y cuello / Risk factors for postoperative complications in major head and neck surgery

Objetivo: En los cánceres de cabeza y cuello la extensión del tumor es el parámetro que generalmente determina la elección de la radioterapia o la cirugía como alternativa terapéutica. Esta última opción conlleva unos riesgos específicos que deben ser evaluados conjuntamente por el cirujano maxilofacial y el anestesiólogo para optimizar dicha elección. El objetivo de esta trabajo fue identificar la existencia de factores de riesgo en las complicaciones postoperatorias en cirugía mayor de cabeza y cuello. Pacientes y métodos: Estudio observacional descriptivo retrospectivo en pacientes sometidos a cirugía oncológica maxilofacial más reconstrucción con injertos. Como variables principales predictoras se emplearon: edad, sexo, ASA, tiempo de anestesia e incidencias intra y postoperatorias y como variables principales dependientes: indicadores de complicaciones precoces, tardías y tiempo hasta extubación, así como la mortalidad asociada. Resultados: Sesenta y un intervenciones en 56 pacientes con un tiempo promedio de 9 horas de cirugía. Un 57,4% presentaron complicaciones precoces en la unidad de reanimación y 39% complicaciones tardías. Una edad >= 60 años se asoció a mayor duración de estancia hospitalaria. Los fumadores activos presentaron una mayor mortalidad a corto plazo (p = 0,01). Los pacientes con estado físico ASA I-II tuvieron una supervivencia significativamente mayor que los pacientes ASA III-IV, teniendo estos últimos una mayor mortalidad a largo plazo (p < 0,05). Conclusiones: La variabilidad en la incidencia de complicaciones postquirúrgicas asociadas a la comorbilidad y conductas de riesgo que presentan este tipo de pacientes, hace necesaria, a nuestro juicio, una evaluación por el equipo médico multidisciplinar involucrado en la cirugía y posteriores cuidados(AU)

Background and objective: Tumor extension is the factor that usually determines the choice of radiotherapy or surgery for head and neck cancers. The choice of surgery carries with it certain specific risks that must be assessed jointly by the maxillofacial surgeon and the anesthetist so that they can agree on the best course of action to choose. We aimed to identify risk factors for complications after major head and neck surgery. Patients and methods: Retrospective descriptive analysis of data for patients who underwent oncologic head and neck surgery with graft reconstruction. The main candidate predictors gathered from records were age, sex, ASA physical status classification, time under anesthesia, and intra- and postoperative events. The main dependent variables were records of early and delayed complications, time until extubation, and related mortality. Results: We identified 61 interventions in 56 patients (mean duration of surgery, 9 hours). Early complications developed in 57.4% while they were in the critical care area. Age >=60 years was associated with longer hospital stays. Short-term mortality was higher in current smokers (P = .01). Survival was significantly higher in patients classified ASA 1 or 2 in comparison with those classified as ASA 3 or 4, in whom long-term mortality was higher (P < .05). Conclusions: The incidence of postoperative complications was associated with comorbidity and risk behaviors found in this type of patient. We feel that a multidisciplinary medical team should assess the surgical and postoperative care of these patients(AU)

Detection of human papilloma virus in normal skin and in superficial and nodular basal cell carcinomas in immunocompetent subjects.

BACKGROUND: Human papilloma virus (HPV) is increasingly recognized as an important human carcinogen but its role in the aetiopathogenesis of basal cell carcinoma (BCC) in immunocompetent individuals is unclear. OBJECTIVE: A prospective case-control study was designed to compare the prevalence of HPV in BCC and normal skin samples from immunocompetent subjects and to assess the influence of different clinical features on the risk of cutaneous HPV. METHODS: A total of 142 samples from 70 BCC cases (superficial BCC 38 and nodular BCC 32) and 72 controls were analysed by a degenerated nested PCR technique. Clinical data were recorded and risk factors for HPV infection were assessed by multivariate analysis. RESULTS: There were 31 HPV DNA-positive samples. HPV was detected more frequently in cases (25.7%) than in controls (18.1%) and in nodular (31.3%) than in superficial (21.1%) BCC lesions but differences were not statistically significant. Older age (OR 1.5; 95% CI: 1.02-1.09) and actinic keratosis (OR 2.62; 95% CI 1.15-5.96) were the only significant factors associated to the presence of HPV. Risk of HPV positivity was also higher in blond-haired subjects, fair/pale skin colour, history of sunburn, solar lentigines and seborrheic keratosis but the differences were not significant. Both in cases and controls, ß -types were the most frequent. CONCLUSIONS: HPV does not seem to play a fundamental role in the aetiopathogenesis of either nodular or superficial BCC. The presence of HPV appears to be more related to actinic damage and possibly to an alteration of the barrier function associated with ageing.

[Comparative activity of doripenem, meropenem, and imipenem in recent clinical isolates obtained during the COMPACT-Spain epidemiological surveillance study]. / Actividad comparativa de doripenem, meropenem e imipenem en aislados recientes obtenidos durante el estudio de vigilancia epidemiológica COMPACT-España.

INTRODUCTION: Doripenem is a new carbapenem with broad spectrum antibacterial activity indicated for the treatment of nosocomial pneumonia and complicated urinary and intraabdominal infections. METHODS: Isolates of Pseudomonas aeruginosa, Acinetobacter and Enterobacteriaceae from patients with nosocomial pneumonia, bacteremia and complicated intraabdominal infections attended in 16 Spanish hospitals were included (October 2008-May 2009). Susceptibility to imipenem, meropenem and doripenem was studied with the Etest method, and the results were interpreted according to the EUCAST criteria. RESULTS: Considering all the isolates, doripenem (MIC(50) 0.12 mg/L) was 2- to 8-fold more active than meropenem (0.25 mg/L) and imipenem (1 mg/L). In relation to Enterobacteriaceae, the MIC(50) and MIC(90) values of doripenem and meropenem were similar (0.03 and 0.12 mg/L, respectively) and clearly superior to those of imipenem (0.25 and 1 mg/L). In the case of P. aeruginosa, MIC(50) and MIC(90) were more favorable to doripenem (0.25 and 16 mg/L) than to meropenem (0.5 and ≥64 mg/L) or imipenem (2 and ≥64 mg/L). In this species, the percentage of strains with lower MIC values for doripenem among those exhibiting intermediate susceptibility and resistance to meropenem was 63.0% (29/46) and 61.7% (63/102), respectively, versus only 4.3% (2/46) and 1.9% (2/102) with higher MIC values for doripenem. CONCLUSIONS: The results obtained in this study are similar to those reported in other countries, and reinforce the superior in vitro activity of doripenem versus the other carbapenems and its position in the treatment guidelines regarding the nosocomial infections for which it is indicated.

Actividad comparativa de doripenem, meropenem e imipenem en aislados recientes obtenidos durante el estudio de vigilancia epidemiológica COMPACT-España / Comparative activity of doripenem, meropenem and imipenem in recent clinical isolates obtained during the COMPACT-Spain epidemiological surveillance study

Introducción. Doripenem es un nuevo carbapenem con actividad antibacteriana de amplio espectro útil para el tratamiento de la neumonía nosocomial y las infecciones intraabdominales y urinarias complicadas. Métodos. Se incluyeron aislados de Pseudomonas aeruginosa, Acinetobacter y Enterobacteriaceae de pacientes con neumonía nosocomial, sepsis e infección intraabdominal complicada procedentes de 16 hospitales españoles (octubre de 2008 a mayo de 2009) pertenecientes al estudio COMPACT. Se estudió la sensibilidad a imipenem, meropenem y doripenem por el método de Etest y los resultados se interpretaron según criterios de EUCAST. Resultados. Considerando todos los aislados, doripenem (CMI50, 0,12 mg/L) fue de dos a ocho veces más activo que meropenem (0,25 mg/L) e imipenem (1 mg/L). En Enterobacteriaceae, los valores de CMI50 y CMI90 de doripenem y meropenem fueron similares (0,03 y 0,12 mg/L, respectivamente), y claramente superiores a los de imipenem (0,25 y 1 mg/L). En P. aeruginosa, las CMI50 y CMI90 fueron más favorables para doripenem (0,25 y 16 mg/L) que para meropenem (0,5 y ≥64 mg/L) o imipenem (2 y ≥64 mg/L). En esta especie, el porcentaje de cepas con menor CMI a doripenem entre las intermedias y resistentes a meropenem fue del 63,0% (29/46) y 61,7% (63/102), respectivamente, frente a sólo un 4,3% (2/46) y 1,9% (2/102) que tuvieron respectivamente CMI más altas al doripenem. Conclusiones. Los datos obtenidos son similares a los de otros países, ponen de manifiesto la mejor actividad in vitro de doripenem en comparación con la de los otros carbapenems y refuerzan la posición de doripenem en las guías de tratamiento de las infecciones nosocomiales para las que presenta indicación(AU)

Introduction. Doripenem is a new carbapenem with broadspectrum antibacterial activity indicated for the treatment of nosocomial pneumonia and complicated urinary and intraabdominal infections. Methods. Isolates of Pseudomonas aeruginosa, Acinetobacter and Enterobacteriaceae from patients with nosocomial pneumonia, bacteremia and complicated intraabdominal infections attended in 16 Spanish hospitals were included (October 2008 – May 2009). Susceptibility to imipenem, meropenem and doripenem was studied with the Etest method, and the results were interpreted according to the UCAST criteria. Results. Considering all the isolates, doripenem (MIC50 0.12 mg/L) was 2- to 8-fold more active than meropenem (0.25 mg/L) and imipenem (1 mg/L). In relation to Enterobacteriaceae, the MIC50 and MIC90 values of doripenem and meropenem were similar (0.03 and 0.12 mg/L, respectively) and clearly superior to those of imipenem (0.25 and 1 mg/L). In the case of P. aeruginosa, MIC50 and MIC90 were more favorable to doripenem (0.25 and 16 mg/L) than to meropenem (0.5 and ≥64 mg/L) or imipenem (2 and ≥64 mg/L). In this species, the percentage of strains with lower MIC values for doripenem among those exhibiting intermediate susceptibility and resistance to meropenem was 63.0% (29/46) and 61.7% (63/102), respectively, versus only 4.3% (2/46) and 1.9% (2/102) with higher MIC values for doripenem. Conclusions. The results obtained in this study are similar to those reported in other countries, and reinforce the superior in vitro activity of doripenem versus the other carbapenems and its position in the treatment guidelines regarding the nosocomial infections for which it is indicated(AU)

Lack of prompt expansion of cytomegalovirus pp65 and IE-1-specific IFNgamma CD8+ and CD4+ T cells is associated with rising levels of pp65 antigenemia and DNAemia during pre-emptive therapy in allogeneic hematopoietic stem cell transplant recipients.

Rising levels of cytomegalovirus (CMV) DNAemia and/or pp65 antigenemia have been observed during pre-emptive ganciclovir therapy in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-SCT). We assessed the incidence of this event in our series, and investigated whether its occurrence was associated with an impairment in the CMV-specific T-cell response. A total of 36 allo-SCT recipients experienced one or more episodes of active CMV infection (n=68) that were pre-emptively treated with val(ganciclovir). Rising levels of antigenemia and DNAemia, and an isolated increase in antigenemia, were observed in 39.7 and 2.9% of all episodes, respectively. Receipt of corticosteroids was associated with rising levels of antigenemia and DNAemia. Median increases of 12- and 6.8-fold of IFNgamma CD8(+) T and IFNgamma CD4(+) T cells, respectively, were observed at a median of 16.5 days after initiation of therapy in episodes with decreasing levels in antigenemia and DNAemia. In contrast, the numbers of both T-cell subsets at a median of 13.5 days after initiation of therapy did not differ significantly from those of pre-treatment samples in episodes with rising levels of antigenemia and DNAemia. Lack of prompt expansion of CMV pp65 and IE-1-specific IFNgamma CD8(+) and CD4(+) T cells is associated with rising levels in antigenemia and DNAemia during pre-emptive therapy.

Soil respiration at mean annual temperature predicts annual total across vegetation types and biomes.

Soil respiration (SR) constitutes the largest flux of CO(2) from terrestrial ecosystems to the atmosphere. However, there still exist considerable uncertainties as to its actual magnitude, as well as its spatial and interannual variability. Based on a reanalysis and synthesis of 80 site-years for 57 forests, plantations, savannas, shrublands and grasslands from boreal to tropical climates we present evidence that total annual SR is closely related to SR at mean annual soil temperature (SR(MAT)), irrespective of the type of ecosystem and biome. This is theoretically expected for non water-limited ecosystems within most of the globally occurring range of annual temperature variability and sensitivity (Q(10)). We further show that for seasonally dry sites where annual precipitation (P) is lower than potential evapotranspiration (PET), annual SR can be predicted from wet season SR(MAT) corrected for a factor related to P/PET. Our finding indicates that it can be sufficient to measure SR(MAT) for obtaining a well constrained estimate of its annual total. This should substantially increase our capacity for assessing the spatial distribution of soil CO(2) emissions across ecosystems, landscapes and regions, and thereby contribute to improving the spatial resolution of a major component of the global carbon cycle.

Rotura crónica de aneurisma de aorta abdominal y fístula arteriovenosa intrarrenal como complicación de la cirugía aórtica / Chronic rupture of an abdominal aortic aneurysm and an intrarenal arteriovenous fi stula as a complication of aortic surgery

Introducción. La rotura crónica es una complicación muy poco frecuente del aneurisma de aorta abdominal cursa con una clínica insidiosa y sin repercusión hemodinámica lo que permite planificar el tratamiento quirúrgico. Caso clínico. Varón de 73 años con lumbalgia crónica es diagnosticado de forma casual de aneurisma de aorta abdominal y hematoma retroperitoneal crónico que le había producido una osteólisis intensa de los cuerpos vertebrales L3-L5. Se programó el tratamiento quirúrgico, manifestándose en el postoperatorio una fístula intrarrenal sintomática que se resolvió con una embolización selectiva. Conclusión. La rotura contenida de aneurisma de aorta debe ser considerada como una causa rara en el diagnóstico diferencial del dolor lumbar crónico en los pacientes de edad avanzada(AU)

Introduction. Chronic rupture is a rare complication of AAA (abdominal aortic aneurysm). The clinical course is insidious and with no haemodynamic repercussions, which means it may be treated surgically. Clinical case. A 73 year-old male with chronic lumbar pain was diagnosed by chance with an AAA and a chronic retroperitoneal haematoma, which had caused severe osteolysis in the L3-L5 vertebral bodies. Surgical treatment was scheduled, with a symptomatic intrarenal fistula appearing in the post-operative period, which was resolved with selective embolisation. Conclusion. The contained aortic aneurysm rupture should be considered as a rare cause in the differential diagnosis of chronic lumbar pain in patients of advanced age(AU)

Tratamiento endovascular de un aneurisma micótico en aorta torácica por Salmonella / Endovasular treatment of a mycotic aneurysm in the thoracic aorta due to salmonella

Introducción. Los aneurismas micóticos continúan siendo una entidad clínica muy poco frecuente en el campode nuestra especialidad y un desafío en su tratamiento por la elevada morbimortalidad derivada de ellos y de las característicasdel propio paciente. Caso clínico. Varón de 65 años que fue remitido urgentemente a nuestro centro por hallazgode reciente aparición de un aneurisma de aorta torácica de morfología y localización atípica durante una tomografía axialcomputarizada (TAC). Entre sus antecedentes destacaba que era un paciente inmunosuprimido por diabetes mellitus y unlinfoma tratado hacía un año. Dos meses antes de realizarse la TAC para el control del linfoma, había presentado un cuadrode diarrea y bacteriemia por Salmonella que se trató con antibióticos, sin remisión clínica completa. Ante los antecedentesclínicos de inmunosupresión y bacteriemia por Salmonella y los hallazgos radiológicos, la alta sospecha diagnósticafue de aneurisma micótico en la aorta torácica y se decidió tratar al paciente mediante una endoprótesis aórtica y antibioterapiaprolongada. No hubo complicaciones durante el procedimiento ni en el postoperatorio. El paciente se encuentraasintomático y con excelente evolución clínica desde hace tres años. Conclusión. El tratamiento endovascular combinadocon una antibioterapia prolongada puede ser una alternativa al tratamiento quirúrgico convencional con toracotomíaen el manejo de los aneurismas micóticos en la aorta torácica descendente(AU)

Introduction. Mycotic aneurysms are still a very rare clinical condition within our speciality and theirtreatment poses a challenge due to the high rates of morbidity and mortality deriving from them and the characteristicsof the patients themselves. Case report. A 65-year-old male who was referred to our centre urgently after a recent aneurysmwith an abnormal morphology and location was discovered in the thoracic aorta during the course of a computerisedaxial tomography (CAT) scan. Relevant events in the patient’s history included his being immunosuppressed because ofdiabetes mellitus and a lymphoma that had been treated a year earlier. Two months before performing the CAT scan tomonitor the lymphoma, he had presented diarrhoea and bacteraemia due to Salmonella, which was treated withantibiotics, although without full remission of the clinical symptoms. In view of the clinical history of immunosuppressionand bacteraemia due to Salmonella and the findings in the imaging studies, the main diagnostic suspicionwas a mycotic aneurysm in the thoracic aorta and the decision was made to treat the patient by means of an aortic stentand prolonged antibiotic therapy. There were no complications during the operation or in the post-operative period. Thepatient has been asymptomatic and his clinical course has been excellent for the last three years. Conclusions. Endovasculartreatment combined with prolonged antibiotic therapy can be an alternative to conventional surgical treatmentinvolving a thoracotomy in the management of mycotic aneurysms in the descending thoracic aorta(AU)

Acute upper airway obstruction caused by massive oedema of the tongue: unusual complication of sialoendoscopy.

OBJECTIVE: To underline the importance of accurate clinical evaluation of major salivary gland obstructions, in order to choose the right surgical approach and to reduce the risk of complications. CASE REPORT: We report a case of an unusual, previously unreported upper airway obstruction caused by massive swelling of the tongue following a successful sialoendoscopy, performed for treatment of submandibular sialolithiasis under general anaesthesia. CONCLUSIONS: Sialoendoscopy has gained popularity and is an accepted method for diagnosis and treatment of most inflammatory conditions of the major salivary glands. It can be performed as an out-patient procedure under local anaesthesia, and is not usually associated with significant complications. However, in the presence of larger stones (>4 mm) of the submandibular gland, we suggest that interventional sialoendoscopy should be performed under general anaesthesia with optimal airway control, in order to manage the major risk of perforations and ductal lesions enabling spread of saline solution into the mouth tissues and causing life-threatening swelling of the floor of the mouth and tongue.

Cirugía convencional tras el fracaso del tratamiento endovascular en la isquemia mesentérica crónica / Conventional surgery following failure of endovascular treatment in chronic mesenteric ischarmia

Introducción. La angina mesentérica es un síntoma infrecuente de la ateroesclerosis. La clínica clásicamentedescrita es: dolor posprandial, pérdida de peso y miedo a la ingesta. El tratamiento estándar ha sido la revascularizaciónabierta de los vasos mesentéricos. Las técnicas endovasculares han abierto nuevas oportunidades de tratamiento, aunquecon resultados de permeabilidad menores. Presentamos el caso de una paciente con isquemia mesentérica crónica yfracaso a corto plazo del tratamiento endovascular. Caso clínico. Mujer de 77 años de edad, con múltiples factores deriesgo cardiovasculares y clínica de ángor abdominal clásico. En el año 2006 fue tratada mediante una angioplastia ystent de la arteria mesentérica superior (AMS) por lesión suboclusiva en su origen. Se produjo una recidiva clínica 10meses tras el tratamiento debido a una oclusión del stent y una progresión de la lesión ya existente en el origen del troncocelíaco. Mediante una arteriografía diagnóstico-terapéutica se trató una lesión > 70% del tronco celíaco con angioplastiay stent sin poder recanalizar el stent previo de la AMS. Los episodios de dolor reaparecieron a los ocho meses dela última intervención. Debido a la recidiva clínica por fracaso del tratamiento endovascular se decidió realizar unbypass aortomesentérico retrógrado a la AMS. Conclusión. El objetivo de la revascularización es aliviar los síntomas,evitar el infarto intestinal y mejorar el estado nutricional. La paciente que se presenta sufrió síntomas recurrentes abdominalestras el fracaso de las técnicas endovasculares. La cirugía convencional ha resultado satisfactoria clínicamente ycon una permeabilidad de 18 meses(AU)

Introduction. Mesenteric angina is an infrequent symptom of atherosclerosis. The classical signs and symptomshave been reported as: post-prandial pain, weight loss and fear of intake. Standard treatment has consisted in openrevascularisation of the mesenteric vessels. Endovascular techniques have opened up new opportunities for treatment,although with lower patency outcomes. We report the case of a female patient with chronic mesenteric ischaemia andshort-term failure of endovascular treatment. Case report. A 77-year-old woman with multiple cardiovascular risk factorsand signs and symptoms of a classic abdominal angina. In 2006 she underwent an operation involving an angioplastyand stent in the superior mesenteric artery (SMA) to treat a sub-occlusive lesion at its origin. Clinical recurrenceoccurred 10 months after the treatment due to occlusion of the stent and a progression of the existing lesion at the originof the celiac trunk. A diagnostic-therapeutic arteriography scan was used to treat a lesion > 70% of the celiac trunk withangioplasty and stent, although it was not possible to rechannel the previous stent in the SMA. The episodes of painreappeared eight months after the last intervention. The clinical recurrence caused by the endovascular treatment meantthat the decision was taken to perform a retrograde aortomesenteric bypass in the SMA. Conclusion. The aim ofrevascularisation is to relieve the symptoms, prevent intestinal infarction and improve the nutritional status. The patientthat we report here suffered from recurring abdominal pains following failure of the endovascular techniques. Conventionalsurgery has been clinically satisfactory and with 18 months’ patency(AU)