Bypass carótido-subclavio por síndrome de robo coronario-subclavio / Carotid-subclavian bypass for coronary-subclavian steal syndrome

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Evolución del perfil de los pacientes sometidos a cirugía abierta de aneurisma de aorta abdominal en la era endovascular / Changes in the profile of patients subjected to open repair of abdominal aortic aneurysm in the endovascular era

INTRODUCCIÓN: El incremento del uso de la cirugía endovascular en el tratamiento del aneurisma de aorta abdominal (AAA) puede haber modificado el perfil de los pacientes que son tratados mediante cirugía abierta (CA) y sus resultados. OBJETIVO: Evaluar la evolución, las características clínicas y anatómicas de los pacientes tratados mediante CA electiva de AAA en los últimos años en nuestro servicio y su relación con los resultados postoperatorios. MATERIAL Y MÉTODOS: Realizamos un estudio retrospectivo de pacientes tratados mediante CA electiva de AAA entre 2008 y 2014 con TAC preoperatoria disponible. Registramos: datos demográficos (edad, sexo), comorbilidad (cardíaca, respiratoria, renal), medicación preoperatoria, características anatómicas (diámetro, longitud, calcificación, trombo y angulación del cuello aórtico proximal) y parámetros analíticos. Definimos cuello aórtico proximal hostil como: <10 mm de longitud o >50% de la circunferencia de trombo o >50% calcificación o angulación infrarrenal >60°. Registramos: mortalidad, complicaciones, reintervenciones y reingresos. Dividimos la muestra en 2 periodos: 1 (2008-2011) y 2 (2012-2014). RESULTADOS: Incluimos a 107 pacientes con edad media de 69,26 años (DE = 6,239). El tiempo medio de seguimiento fue 28,39 meses (DE = 23,13) con una supervivencia del 78,6% (n = 92) a los 64 meses. En el periodo 2 aumentó la incidencia de cuello hostil (45,2 vs. 64,6%; p < 0,05) y la calcificación >50% en el cuello aórtico (8,1 vs. 24,1%; p < 0,05). También en el periodo 2 se requirió un mayor número de transfusiones sanguíneas (26,2 vs. 56,9%; p < 0,05) pero se produjeron menos complicaciones cardiológicas en los 30 primeros días (16,7 vs. 4,6%; p < 0,05). Las tasas de mortalidad, reintervención y reingreso fueron similares en ambos periodos (p > 0,05). CONCLUSIÓN: En nuestra serie los pacientes tratados mediante CA de AAA presentan características anatómicas progresivamente menos favorables, sin que ello se acompañe de una mayor morbimortalidad postoperatoria

INTRODUCTION: The increasing use of endovascular repair in the treatment of abdominal aortic aneurysm (AAA) may have modified the profile of patients undergoing open repair (OR), as well as the results. OBJECTIVE: The aim is to evaluate the clinical and anatomical characteristics of patients with AAA undergoing elective OR in our department over the last few years, and their relationship with the post-operative results. METHODS: A retrospective study was conducted on patients undergoing elective AAA OR between 2008 and 2014 and who had a pre-operative computed tomography (CT) scan available. The following variables were recorded: Demographics (age, gender), comorbidities (cardiac, respiratory, renal), pre-operative medication, anatomical characteristics (proximal neck diameter, length, calcification, thrombus, and angulation), and blood test parameters. A hostile proximal infrarenal aortic neck was defined as: <10 mm length and/or >50% circumference thrombus and/or >50% calcification and/or >60° angulation. The mortality, complications, re-interventions and re-admissions were recorded. The sample was divided into 2 periods: 1 (2008-2011) and 2 (2012-2014). RESULTS: A total of 107 patients were included, with mean age of 69.26 years (SD = 6.239). Mean follow-up was 28.39 months (SD = 23.13), with a survival rate of 78.6% (n = 12) at 64 months. It was found that there was a greater incidence of hostile neck (45.2 vs. 64.6%; P<.05) and proximal neck calcification >50% (8.1 vs. 24.1%; P<.05) in the second period of time. During period 2 a greater number of blood transfusions were required (26.2 vs. 56.9%; P<.05), but fewer cardiac complications were recorded during the first 30 days post-surgery (16.7 vs. 4.6%; P<.05). The mortality, re-intervention, and re-admission rates were similar in both periods (P>.05). CONCLUSION: In our series, the patients with AAA who underwent elective OR showed increasingly less favourable anatomical characteristics, but this does not lead to increased postoperative morbidity and mortality

Rotura de aneurisma gigante de arteria esplénica / Giant splenic artery aneurysm rupture

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Endarterectomía por eversión y reimplante en una estenosis carotídea y un bucle distal / Eversion endarterectomy and re-implantation in carotid stenosis and distal kink

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Seudoaneurisma micótico de aorta abdominal a causa de una espondilodiscitis por Escherichia coli / Mycotic abdominal aortic pseudoaneurysm due to spondylodiscitis caused by Escherichia coli

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Situs inversus totalis and abdominal aortic aneurysm: Surgical repair of an extremely uncommon association.

INTRODUCTION: Situs inversus totalis (SIT) is an uncommon congenital syndrome, which refers to a reversal mirror-image of the normal thoracoabdominal organs position. The coexistence of SIT and abdominal aortic aneurysm has been seldom previously reported. PRESENTATION OF THE CASE: We report a case of a 69-year-old man with SIT and infrarenal abdominal aortic aneurysm (AAA) that underwent open repair with a straight graft through a minilaparatomy without evisceration. DISCUSSION: There is no consensus on which should be the optimum approach in cases of open surgical repair of AAA due to the limited number of cases described. The fact of intestinal scrolling to the left abdomen, unlike usual, is due to the anatomical arrangement of the root of the mesentery which is directed obliquely from duodenojejunal on the left side of the vertebra L2 to the ileocecal junction and right sacroiliac joint. CONCLUSION: A minilaparotomy without evisceration and with intestinal scrolling to left hemiabdomen, can be very useful and beneficial on those cases of congenital anatomical abnormalities that may add difficulty during the surgical procedure.

Esclerosis con polidocanol vía intravenosa de malformación arteriovenosa periférica digital / Sclerosis of peripheral vascular malformations with intravenous polidocanol

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Evaluation of the antimeningococcal immunoglobin activity against five strains of Neisseria meningitidis group B from Latin America using mice as model.

To know the activity of antimeningococcal immunoglobulin, Balb/c mice of 18-22 g of body weight were challenged with 5 serotype B strains of Neisseria meningitidis (Nm) isolated from patients of different Latin American countries. The specific antimeningococcal Ig was extracted from the serum of volunteers previously vaccinated with the antimeningococcal BC vaccine VA-MENGOC-BC (Finlay Institute, Havana, Cuba). The Ig was intraperitoneally (IP) administered in a unique dose of 10 mg/mouse. The strains A, B, C, CH and D were inoculated IP in the following charges: strain A, 20 LD50; B, 25 LD50; C, 44.5 LD50; CH, 36 LD50, and D, 200, 20 and 2 LD50. For each strain, a control group received living bacteria and virulent stimulating factor (VSF). The Ig was injected 30 min before or 30 min after the challenge dose had been given, except for strain D, which only received the Ig 30 min after the challenge. As VSF, 0.5 mg of iron in the form of iron dextran was used. The experiment was analyzed considering the survival time after the challenge for each strain compared to the corresponding control group (C). When the Ig was used 30 min before the challenge, the protection period for the A strain was (C:18.1h) more than 72h (P<0.001) and 100% survival; for the B strain, (C:29.5h) 42h (P<0.05) and almost 20% survival; for the C strain (C:16.5h) 35h (P<0.01) with a 40% survival, and the CH strain (C:18.1h) 26.5h (P<0.02), with a 20% survival. When the Ig was injected 30 min after the challenge, the average survival time and the survival for the A strain was 28h (P<0.05) with 62.5%; for the B strain it was 42 h (P<0.005) and 0.0%; for the C strain 27.3 h (P<0.05) and 30%; for the CH strain 25.8h (P<0.05) and 0.0%, and for the D strain 19.1h, 26h, and more than 72h with a 0.0%, 60% and 100%, depending on the challenging dose. In general, the specific Ig used showed a protective effect in mice against the different Latin American strains tested. Additionally, the experimental model proved to be useful for the study of the antimeningococcal human Ig.