[Hemodynamic depression in carotid artery stent without angioplasty]. / Incidencia de la depresion hemodinamica en el implante de endoprotesis en la arteria carotida sin dilatacion.

INTRODUCTION: Hemodynamic depression is a frequent complication related to carotid artery stenting with angioplasty. The aim of this study was to assess our results regarding hemodynamic depression, in patients who underwent carotid artery stenting without angioplasty. PATIENTS AND METHODS: Between October 2002 and April 2010, 261 carotid stenosis (in 242 patients) were treated with the use of self-expanding stents without angioplasty. Inclusion criteria were symptomatic carotid stenosis > 50%, asymptomatic carotid stenosis > 70%, and stenosis ranging between 50-70% with evidence of high risk plaque morphology or micro-embolism. Outcomes during hospitalization and 30 days after procedure were registered. Hemodynamic depression was defined as hypotension (systolic blood pressure < 90 mm Hg) or bradycardia (heart rate < 60 beats/min). RESULTS: During the procedure 7 (2.9%) patients presented bradycardia and 3 (1.2%) hypotension. No patient required vasopressor drugs or ICU for hemodynamic monitoring. No patient developed asystole or other types of arrhythmia. During hospitalization, hemodynamic depression was not observed in any patients. During the first 30 days post-procedure, there were 11 TIAs (4.5%), 1 disabling stroke (0.4%), 1 non disabling stroke (0.4%), and 1 death (0.4%) (1 stent thrombosis at 11 days). CONCLUSION: The incidence of hemodynamic depression is low when carotid stenting procedure is performed without balloon angioplasty. The incidence of neurological complications post procedure was also low. This report highlights the need for performing randomized trials comparing both techniques.

Incidencia de la depresión hemodinámica en el implante de endoprótesis en la arteria carótida sin dilatación / Hemodynamic depression in carotid artery stent without angioplasty

Introducción. La depresión hemodinámica es una complicación frecuente tras el implante de una endoprótesis carotídea con angioplastia. El objetivo del estudio es evaluar la incidencia de depresión hemodinámica en pacientes sometidos al implante de endoprótesis carotídea sin angioplastia. Pacientes y métodos. Entre octubre de 2002 y abril de 2010, se trataron 261 estenosis carotídeas (242 pacientes) con endoprótesis autoexpandibles sin angioplastia. Los criterios de inclusión fueron estenosis carotídea sintomática > 50%, estenosis carotídea asintomática > 70%, estenosis entre el 50-70% y evidencia de alto riesgo de microembolismo por la morfología de la placa de ateroma. Se evaluó a los pacientes al ingreso y 30 días después del procedimiento. La depresión hemodinámica se definió como hipotensión (presión arterial sistólica < 90 mmHg) o bradicardia (pulso < 60 lpm). Resultados. Durante el procedimiento, siete pacientes (2,9%) presentaron bradicardia y tres (1,2%), hipotensión. Ninguno de ellos necesitó medicación o monitorización. No se observó asistolia u otro tipo de arritmia en ningún paciente. Durante la hospitalización, no se observó depresión hemodinámica en ningún paciente. En los 30 primeros días después del procedimiento se produjeron 11 ataques isquémicos transitorios (4,5%), un ictus incapacitante (0,4%), un ictus no incapacitante (0,4%) y un fallecimiento (0,4%) (por trombosis de la endoprótesis a los 11 días). Conclusiones. La incidencia de depresión hemodinámica y de complicaciones neurológicas es baja en pacientes sometidos a implante de endoprótesis en la arteria carótida sin angioplastia con balón. Este estudio subraya la necesidad de realizar ensayos aleatorios que comparen ambas técnicas con y sin angioplastia(AU)

Introduction. Hemodynamic depression is a frequent complication related to carotid artery stenting with angioplasty. The aim of this study was to assess our results regarding hemodynamic depression, in patients who underwent carotid artery stenting without angioplasty. Patients and methods. Between October 2002 and April 2010, 261 carotid stenosis (in 242 patients) were treated with the use of self-expanding stents without angioplasty. Inclusion criteria were symptomatic carotid stenosis > 50%, asymptomatic carotid stenosis > 70%, and stenosis ranging between 50-70% with evidence of high risk plaque morphology or microembolism. Outcomes during hospitalization and 30 days after procedure were registered. Hemodynamic depression was defined as hypotension (systolic blood pressure < 90 mm Hg) or bradycardia (heart rate < 60 beats/min). Results. During the procedure 7 (2.9%) patients presented bradycardia and 3 (1.2%) hypotension. No patient required vasopressor drugs or ICU for hemodynamic monitoring. No patient developed asystole or other types of arrhythmia. During hospitalization, hemodynamic depression was not observed in any patients. During the first 30 days post-procedure, there were 11 TIAs (4.5%), 1 disabling stroke (0.4%), 1 non disabling stroke (0.4%), and 1 death (0.4%) (1 stent thrombosis at 11 days). Conclusion. The incidence of hemodynamic depression is low when carotid stenting procedure is performed without balloon angioplasty. The incidence of neurological complications post procedure was also low. This report highlights the need for performing randomized trials comparing both techniques(AU)

In-hospital complications and mortality following major lower extremity amputations in a series of predominantly diabetic patients.

The purpose of this study was to analyze the outcomes of major lower extremity amputations (MLEAs) in a series, including diabetic patients, with the aim to study whether diabetes mellitus is a risk factor of in-hospital mortality and perioperative complications. A retrospective analysis of 283 MLEAs (221 of these patients were diabetic and 62 were nondiabetic) performed between January 1, 1998, and December 31, 2008, at the General Surgery Department and Diabetic Foot Unit of La Paloma Hospital in Las Palmas de Gran Canaria (Canary Islands) was done. The significant risk factors of mortality were >" xbd="324" xhg="301" ybd="1481" yhg="1446"/>75 years of age (odds ratio [OR] = 4.1, 95% confidence interval [CI] = 1.4-11.7), postoperative cardiac complications (OR = 12.3, 95% CI = 3.7-40.2) and postoperative respiratory complications (OR = 3.8, 95% CI = 1.0-13.3). No statistically significant risk factors were found related to the presence of systemic and wound-related complications. In diabetic patients, the significant risk factors of mortality were postoperative cardiological complications (OR = 13.6, 95% CI = 3.1-59.6), postoperative respiratory complications (OR = 5.9, 95% CI = 1.0-35.5), and first episode of amputation (OR = 5.9, 95% CI = 1.4-24.3). There were no statistically significant differences in the outcome of major amputations between diabetic and nondiabetic patients. Hospital stay was significantly longer in diabetic patients (P < .01) though when the patients with diabetic foot infections were excluded, this difference was not found.

[Ultrasonographic histological study on the evolution of a canine model of hormone-induced benign prostatic hyperplasia]. / Estudio ultrasonográfico e histológico de la evolución de un modelo canino de hiperplasia benigna de próstata inducida por hormonas.

INTRODUCTION: Despite exhibiting histological differences from the human process, canine hormone-induced benign prostatic hyperplasia (BPH) is still the most widely used animal model for evaluating treatment strategies. OBJECTIVES: The aim of this study is to determine the optimal moment for starting a therapeutic trial in this animal model. MATERIAL AND METHODS: Six male beagle dogs over one year of age were used in this study. All animals received a combination of steroid hormones, namely 17beta-estradiol and 5alpha-androstene 3alpha 17beta-diol, every other day during three (Group 1, n=3) or five months (Group 2, n=3). Transrectal ultrasonographic examinations to measure prostate volume were performed monthly. Animals were euthanized after five months for histological study of their prostates. RESULTS: All animals developed BPH, with prostate volume increasing over time as hormones were administered (r=0,910). All ultrasonographic studies performed up to the third month evidenced a significant increase in prostate volume when compared to the prior ultrasound measurement. A significant decrease in prostate volume was seen in Group 1 once hormone administration was interrupted, whereas Group 2 animals showed a continuing increase in prostate size. Histological examination showed almost no evidence of BPH in Group 1 animals, while Group 2 animals clearly exhibited moderate epithelial hyperplasia. CONCLUSIONS: The administration of a combination of steroid hormones is effective in inducing benign prostatic hyperplasia in canines, but this hyperplasia disappears when hormone treatment is interrupted. In order to be useful for experimental studies, hormones should be administered for at least three months before commencing any treatment, and they should be continued throughout the length of the study..

Estudio ultrasonográfico e histológico de la evolución de un modelo canino de hiperplasia benigna de próstata inducida por hormonas / Ultrasonographic histological study on the evolution of a canine model of hormone-induced benign prostatic hyperplasia

Introducción: A pesar de exhibir diferencias histológicas con el proceso en humanos, la hiperplasia benigna de prostáta (HBP) inducida por hormonas en perros representa el modelo más utilizado actualmente para la evaluación de tratamientos. Objetivos: El objetivo del presente estudio es determinar el momento óptimo para la realización de un ensayo terapéutico en este modelo. Material y métodos: En el estudio se utilizaron 6 perros beagle, machos mayores de un año, a los que se administró una combinación de hormonas, 17b-estradiol y 5a-androsteno 3a17b-diol, en días alternos durante 3 (grupo 1, n = 3) o 5 meses (grupo 2, n = 3). Se realizaron seguimientos ultrasonográficos mensuales, con determinación del tamaño prostático. A los 5 meses se procedió al sacrificio de todos los animales y el estudio histológico de las glándulas prostáticas. Resultados: Todos los animales desarrollaron una HBP, con un volumen prostático que aumentaba con el tiempo de administración hormonal (r = 0,910), evidenciándose en todos los estudios ecográficos hasta el tercer mes un aumento significativo de tamaño frente al estudio anterior. El tamaño prostático disminuyó considerablemente en el grupo 1 al retirarla hormonoterapia, al tiempo que en el grupo 2 continuó aumentando. Los animales del grupo 1 apenas evidenciaron signos histológicos de HBP, frente a los del grupo 2, que presentaron una clara hiperplasia del epitelio glandular. Conclusiones: La administración de una combinación de hormonas esteroides es efectiva para inducir hiperplasia de próstata en perro, si bien ésta desaparece en el momento que se retira la hormonoterapia. Para utilizar este modelo en estudios experimentales, se deben administrar hormonas al menos durante 3 meses antes de la actuación terapéutica, y continuar durante todo el ensayo (AU)

Introduction: Despite exhibiting histological differences from the human process, canine hormone-induced benign prostatic hyperplasia (BPH) is still the most widely used animal model for evaluating treatment strategies. Objectives: The aim of this study is to determine the optimal moment for starting a therapeutic trial in this animal model. Material and methods: Six male beagle dogs over one year of age were used in this study. All animals received a combination of steroid hormones, namely 17b-estradiol and 5a-androstene 3a 17b-diol, every other day during three (Group 1, n=3) or five months (Group 2, n=3). Transrectal ultrasonographic examinations to measure prostate volume were performed monthly. Animals were euthanized after five months for histological study of their prostates. Results: All animals developed BPH, with prostate volume increasing over time as hormones were administered (r=0,910). All ultrasonographic studies performed up to the third month evidenced a significant increase in prostate volume when compared to the prior ultrasound measurement. A significant decrease in prostate volume was seen in Group 1 once hormone administration was interrupted, whereas Group 2 animals showed a continuing increase in prostate size. Histological examination showed almost no evidence of BPH in Group 1 animals, while Group 2 animals clearly exhibited moderate epithelial hyperplasia. Conclusions: The administration of a combination of steroid hormones is effective in inducing benign prostatic hyperplasia in canines, but this hyperplasia disappears when hormone treatment is interrupted. In order to be useful for experimental studies, hormones should be administered for at least three months before commencing any treatment, and they should be continued throughout the length of the study (AU)

Epidemiology of diabetes-related lower extremity amputations in Gran Canaria, Canary Islands (Spain).

We have studied the rate of lower extremity amputations (LEAs) in the south of Gran Canaria. The incidence rate was 319.7 per 100,000 (95% CI, 258.6-380.8) per year in the diabetic subjects. The incidence of both diabetic and non-diabetic LEAs is the highest reported in Spain.

Reparación endovascular de aneurismas de aorta abdominal (parte I). Epidemiología indicaciones y limitaciones / Endovascular repair of abdominal aortic aneurysms (Part I). Epidemiology, indications, and limitations

Los aneurismas de la aorta abdominal son una patología frecuente, con alta afinidad hacia la ruptura y muerte. La reparación endovascular es una alternativa al reparo convencional en pacientes de alto riesgo, y el desarrollo tecnológico y el perfeccionamiento de las endoprótesis va a permitir su aplicación en pacientes de buen riesgo para reparo convencional con cirugía abierta. En este artículo se dan las pautas básicas que deben conocer los especialistas en enfermedades cardiovasculares acerca de la epidemiología, indicaciones y limitaciones del reparo endoluminal de los aneurismas de la aorta abdominal.