Revascularización de miembro inferior con infección de la Región inguinal utilizando un bypass obturador / Lower Limb revascularization with infection of the inguinal region using a bypass plug

Se presenta el caso de un paciente anciano, portadorde un bypass axilo-femoral izquierdo infectado. El mismodebió ser retirado con el consecuente peligro de isquemiay amputación del miembro afecto. Para revascularizareste y a fin de evitar la zona infectada, se procedió a realizarun bypass a través del agujero obturador de la pelvis.

Oral sodium phosphates solution versus polyethylene glycol for colon cleansing prior to radiological assessment.

A clean bowel environment is essential prior to radiological assessment of the colon. The objectives were to determine patient compliance and acceptability, physician satisfaction, overall clinical effectiveness and tolerability with the use of oral sodium phosphates (Fosfosoda) and polyethylene glycol solutions as bowel cleansing agents in a relatively large cohort of Spanish patients requiring radiologic examination of the colon. This was an observational survey involving 592 patients (> or =18 years and approximately 60% women) who received Fosfosoda or polyethylene glycol solutions according to data sheet instructions. Parameters measured included mucosal cleansing (presence of solid residues), patient acceptability (including any adverse effects to treatment) and compliance with the treatment regimen, and physician-rated satisfaction with the procedure. The date from the study demonstrated that Fosfosoda and polyethylene glycol solutions were found to be equally well tolerated in this study, although patients receiving Fosfosoda found it easier to complete the treatment regimen. Fosfosoda was significantly superior to polyethylene glycol solutions with regards to mucosal cleansing with 52% achieving an 'excellent' result compared with only 36% of the polyethylene glycol group (relative risk:1.43; 95% confidence interval: 1.12-1.82). Physician-rated assessment of the bowel cleansing procedure also significantly favored Fosfosoda (p = 0.014). In conclusion, while Fosfosoda and polyethylene glycol solutions were equally well tolerated when given to patients prior to radiologic examination of the colon, Fosfosoda was shown to be significantly more effective in terms of bowel cleansing. Based upon the available evidence this could provide significant cost benefit for Fosfosoda.

Tratamiento percutáneo de las complicaciones vasculares agudas en el síndrome de la abertura torácica superior / Percutaneous treatment of acute vascular complications in thoracic outlet syndrome

Objetivo: Presentar los resultados obtenidos en el tratamiento percutáneo de las complicaciones vasculares agudas del síndrome de la abertura torácica superior (SATS). Materiales y métodos: Dieciséis pacientes presentaron complicaciones vasculares agudas (12 casos de carácter venoso y cuatro de origen arterial) del SATS. En todos ellos se efectuaron radiografías simples de cuello y tórax para descartar anomalías óseas cérvico-torácicas, así como el estudio angiográfico correspondiente. En función de la clínica y de los hallazgos radiológicos, el tratamiento consistió en fibrinólisis, angioplastia transluminal (ATP) o cirugía. Resultados: Ninguno de los pacientes con complicaciones venosas presentaba anomalías cérvico-torácicas. De ellos, 10 fueron tratados con fibrinolíticos, obteniéndose repermeabilización venosa en todos los casos, con trombosis mural residual inferior al 50 por ciento de la luz en tres pacientes. La ATP se efectuó en cinco pacientes, con resolución completa de la estenosis en dos casos y parcial en los otros tres, produciéndose como complicación hematoma mural en un paciente. De los cuatro pacientes con complicaciones arteriales, tres presentaban costilla cervical. A uno de ellos se le administró urocinasa con buena respuesta clínico-radiológica. Todos los pacientes fueron intervenidos con resolución completa de su sintomatología. Conclusión: El tratamiento fibrinolítico presenta una gran efectividad en el manejo inicial de las complicaciones vasculares del SATS. (AU)

Magnetic resonance cholangiography versus ultrasound in the evaluation of the gallbladder.

Ultrasonography (US) is currently the reference technique for evaluating gallbladder pathology. The aim of this study was to prospectively determine the diagnostic efficacy of magnetic resonance cholangiography (MRCP) in evaluating the gallbladder, as compared with US. The study included 80 patients (mean age, 69.3 years; male-to-female ration, 1.3:1) who underwent prospective US and MRCP; 5 patients in whom MRCP was contraindicated were excluded. In all cases, US was performed before MRCP. Ultrasound was the reference technique for evaluating MRCP sensitivity and specificity. Magnetic resonance cholangiopancreatography provided good image quality in 65 patients (81.2%) and poor image quality in 15 (mostly because of poor patient cooperation). Artefacts did not influence visualization of the gallbladder or evaluation of the background pathology. The sensitivity of MRCP in diagnosing gallbladder stones (43 patients; 97.7%) was comparable to US (44 patients). In contrast, MRCP diagnosed biliary sludge or microlithiasis in 13 patients, versus 5 in the case of US. Magnetic resonance cholangiopancreatography is a good technique for diagnosing cholelithiasis and biliary sludge. However, its high cost, contraindications, and the need for patient cooperation limit the use of the technique in routine clinical gallbladder studies. Magnetic resonance cholangiopancreatography could contribute to the diagnosis of microlithiasis, provided that future studies confirm its greater sensitivity versus US.