[Aortoenteric fistulas: clinical presentation and helical computed tomography findings]. / Fístulas aortoentéricas: presentación clínica y hallazgos por tomografía computarizada helicoidal.

Aortoenteric fistula (AEF) is an uncommon complication of abdominal aorta aneurysms. They are divided into two types: primary AEF due to a spontaneous communication of the lumen of an aortic aneurysm and an intestinal loop, usually the duodenum, and secondary AEF, which are more common and occur in patients who have undergone surgical repair of aneurysms with prosthetic implants. The most frequent presenting sign of AEF is upper gastrointestinal bleeding. Clinical suspicion is essential in the diagnostic approach to AEF and the most commonly used techniques for its diagnosis are endoscopy and computed tomography (CT). However, it is not unusual for the results of these techniques to be negative and for the diagnosis to be made at surgery. We present three cases of AEF (one primary) with distinct patterns of upper gastrointestinal bleeding, in which preoperative diagnosis was allowed by clinical and helical CT findings. We discuss the role of this technique in the diagnosis of this entity and describe the findings that allow AEF to be suspected or confirmed.

Fístulas aortoentéricas: presentación clínica y hallazgos por tomografía computarizada helicoidal / Aortoenteric fistulas: clinical presentation and helical computed tomography findings

Las fístulas aortoentéricas son una complicación infrecuente de los aneurismas de aorta abdominal. Se dividen en 2 tipos: primarias, debidas a la comunicación espontánea de la luz de un aneurisma aórtico y un asa intestinal, principalmente el duodeno, y secundarias, más frecuentes que las anteriores, que ocurren en pacientes intervenidos de reparación quirúrgica de aneurismas con implantación de prótesis. El signo clínico de presentación más frecuente de las fístulas aortoentéricas es una hemorragia digestiva alta. La sospecha clínica supone un pilar fundamental en la aproximación diagnóstica de las fístulas aortoentéricas, y la endoscopia y la tomografía computarizada son las técnicas más usadas para su diagnóstico, aunque no es infrecuente que estas técnicas sean negativas y se realice el diagnóstico en la cirugía. Presentamos 3 casos de fístulas aortoentéricas (una de ellas primaria) con diferentes patrones de hemorragia digestiva alta, en los que el contexto clínico y los hallazgos de tomografía computarizada helicoidal permitieron su diagnóstico preoperatorio; discutimos el papel de esta técnica para el diagnóstico, y describimos los diferentes hallazgos que permiten sospechar o confirmar una fístula aortoentérica

Aortoenteric fistula (AEF) is an uncommon complication of abdominal aorta aneurysms. They are divided into two types: primary AEF due to a spontaneous communication of the lumen of an aortic aneurysm and an intestinal loop, usually the duodenum, and secondary AEF, which are more common and occur in patients who have undergone surgical repair of aneurysms with prosthetic implants. The most frequent presenting sign of AEF is upper gastrointestinal bleeding. Clinical suspicion is essential in the diagnostic approach to AEF and the most commonly used techniques for its diagnosis are endoscopy and computed tomography (CT). However, it is not unusual for the results of these techniques to be negative and for the diagnosis to be made at surgery. We present three cases of AEF (one primary) with distinct patterns of upper gastrointestinal bleeding, in which preoperative diagnosis was allowed by clinical and helical CT findings. We discuss the role of this technique in the diagnosis of this entity and describe the findings that allow AEF to be suspected or confirmed

[Levels of lipoprotein(a), other lipids and lipoproteins in adolescents from the health area of Alcoy]. / Niveles de lipoproteína (a), otros lípidos y lipoproteínas en adolescentes del área sanitaria de Alcoy.

Several epidemiological and necroscopic evidences suggest that, despite that the ischemic cardiopathy (IC) can be generally detected only since the fourth decade of life, it starts during the first years of life and adolescence. We have studied 278 teen-agers, with 13-14 years of age, attending the 8th school year (primary education) in five schools of Alcoy. 117 were males and 161 females. Levels of lipoprotein (a) (Lp[a]), total cholesterol (TC), cholesterol linked to high density lipoproteins (C-HDL) and its subfractions (C-HDL2 and C-HDL3), triglycerides (TG), apoproteins A-I and B (Apo A and Apo B) were determined. Cholesterol linked to low density lipoproteins (C-LDL) was calculated using the Friedewald-Fredrickson's equation. Mean values and standard deviation were: Lp(a) = 29.99 +/- 33.61 mg/dl., TC = 160.4 +/- 25.4 mg/dl., C-HDL = 54.0 +/- 12.3 mg/dl., C-HDL2 = 8.7 +/- 6.5 mg/dl., C-HDL3 = 46.2 +/- 18.6 mg/dl., TG = 72.6 +/- 26.8 mg/dl., C-LDL = 91.6 +/- 22.0 mg/dl., Apo A = 136.4 +/- 24.2 mg/dl., Apo B = 60.7 +/- 21.7 mg/dl. 38% teen-agers had Lp(a) levels higher than 30 mg/dl., 7.5% had levels of TC higher than 200 mg/dl., 12.8% had levels of C-HDL equal or higher than 40 mg/dl. and 4.7% had levels of C-LDL equal or higher than 130 mg/dl. From our study, we can conclude that, despite that the levels of TC, C-LDL and C-HDL in these teen-agers are within relatively normal limits, there is a high percentage with levels of Lp(a) actually considered as a risk factor.