Circulating carotenoids are associated with favorable lipid and fatty acid profiles in an older population at high cardiovascular risk.

Carotenoid intake has been reported to be associated with improved cardiovascular health, but there is little information on actual plasma concentrations of these compounds as biomarkers of cardiometabolic risk. The objective was to investigate the association between circulating plasma carotenoids and different cardiometabolic risk factors and the plasma fatty acid profile. This is a cross-sectional evaluation of baseline data conducted in a subcohort (106 women and 124 men) of an ongoing multi-factorial lifestyle trial for primary cardiovascular prevention. Plasma concentrations of carotenoids were quantified by liquid chromatography coupled to mass spectrometry. The associations between carotenoid concentrations and cardiometabolic risk factors were assessed using regression models adapted for interval-censored variables. Carotenoid concentrations were cross-sectionally inversely associated with serum triglyceride concentrations [-2.79 mg/dl (95% CI: -4.25, -1.34) and -5.15 mg/dl (95% CI: -7.38, -2.93), p-values = 0.0002 and <0.00001 in women and men, respectively], lower levels of plasma saturated fatty acids [-0.09% (95% CI: -0.14, -0.03) and -0.15 % (95% CI: -0.23, -0.08), p-values = 0.001 and 0.0001 in women and men, respectively], and higher levels of plasma polyunsaturated fatty acids [(0.12 % (95% CI: -0.01, 0.25) and 0.39 % (95% CI: 0.19, 0.59), p-values = 0.065 and 0.0001 in women and men, respectively] in the whole population. Plasma carotenoid concentrations were also associated with higher plasma HDL-cholesterol in women [0.47 mg/dl (95% CI: 0.23, 0.72), p-value: 0.0002], and lower fasting plasma glucose in men [-1.35 mg/dl (95% CI: -2.12, -0.59), p-value: 0.001].

Identificar el pie de riesgo en pacientes con diabetes. Un espacio de mejora en atención primaria / Identify the risk foot in patients with diabetes. A space for improvement in primary care

Objetivos: Identificar los factores condicionantes del pie de riesgo (PR) comparando 2 métodos de evaluación (cualitativo y cuantitativo) para neuropatía, arteriopatía y deformidades del pie. Concordancia entre alteraciones detectadas y registradas en el historial clínico (HC). Material y métodos: Estudio observacional. Ámbito: 2 centros de atención primaria del Instituto Catalán Salud. Población: Quinientos treinta y dos pacientes con diabetes, ambos sexos >18 años con registros del PR y consentimiento informado. Mediciones: Neuropatía: valoración síntomas (NSS) y signos discapacidad (NDS). Arteriopatía: índice tobillo brazo (ITB), cuestionario Edimburgo, pulsos pedios. Deformidades pie: pedigrafía. Valores de referencia cuantitativos: Neuropatía definida: NDS>6 puntos o 3-5 y NSS>5 puntos. ITB: valor normalidad (0,90-1,30). Resultados: Mujeres: 46,42%; edad media: 67,29 años (DE: 7,69). Ciento cincuenta y tres pacientes sin complicaciones neurovasculares. Cualitativo: Sin diferenciar manifestaciones clínicas: 252 pacientes presentaron neuropatía; 99 pacientes presentaron ITB alterado; 28 pacientes presentaron complicaciones y 101 pacientes cuestionario Edimburgo alterado. Cuantitativo: Diferenciando manifestaciones clínicas: del grupo neuropatía, 110 pacientes solo presentaron síntomas; 46 pacientes presentaron neuropatía definida y 96 pacientes puntuación NDS y NSS, sin criterios neuropatía definida. ITB alterado: 52, solo ITB>1,30; 47, solo ITB<0,90; 12, asociaron neuropatía e ITB>1,30 y 16 con ITB<0,90. Cuestionario Edimburgo: 47 pacientes presentaron clínica atípica y 54, típica. Concordancia entre alteraciones neurovasculares cuantitativas y registradas r=0,32 para neuropatía y r=0,21 en arteriopatía. El punto de presión sobre el 5.° metatarso se asoció a neuropatía cuantitativa: OR: 2,32 (1,188-4,546); p=0,01.Conclusión: La evaluación, identificando manifestaciones clínicas, mejora la identificación del PR aunque necesitamos más investigación (AU)

Goals: Identify conditioning factors of the foot risk (FR) by comparing two evaluation methods (qualitative and quantitative) for neuropathy, arteriopathy, foot deformities. Concordance between detected the alterations and registered in clinical history (CH). Material and methods: It is an observational study. Ambit: in two primary care centers of the Catalan Health Institute. Population: Five hundred thirty-two patients with diabetes, both >18 years with FR records and informed consent. Measurements: Neuropathy: symptom assessment (NSS) and signs of disability (NDS). Arteriopathy: Index ABI. Edinburgh Questionnaire, fart pulses. Foot deformities: Pedigraphy. Quantitative reference: Values Defined neuropathy: NDS>6 points or 3-5 and NSS>5 points. ITB: Normal value (.90-1.30). Results: Women, 46.42%. Middle ages, 67.29 years (SD 7.69). One hundred fifty-three patients did not present neurovascular alterations. Qualitative: Without differentiating clinical manifestations: 252, patients presented neuropathy; 99, altered ITB; 28, two complications and 101, Edinburgh Quiz: altered. Quantitative: Differentiating clinical manifestations: among the neuropathy group; 110, patients only presented symptoms; 46, definite neuropathy. In 96, NDS and NSS scores without defined neuropathy criteria. Altered ABI: 52, only ABI>1.30; 47, ABI<.90; 12, associated neuropathy and ABI>1.30 and 16, with ABI<.90. Edinburgh questionnaire: 47, presented atypical symptoms and 26, typical. Agreement, between quantitative and recorded neurovascular alterations r=.32 for neuropathy and r=.21 in arteriopathy. The pressure point on the 5th metatarsal, was associated with quantitative neuropathy: OR: 2.32 (1.188–4.546), P=.01. Conclusion: The evaluation, identifying clinical manifestations, improves the identification of FR, although we need more research (AU)

[Identify the risk foot in patients with diabetes. A space for improvement in primary care]. / Identificar el pie de riesgo en pacientes con diabetes. Un espacio de mejora en atención primaria.

GOALS: Identify conditioning factors of the foot risk (FR) by comparing two evaluation methods (qualitative and quantitative) for neuropathy, arteriopathy, foot deformities. Concordance between detected the alterations and registered in clinical history (CH). MATERIAL AND METHODS: It is an observational study. Ambit: in two primary care centers of the Catalan Health Institute. POPULATION: Five hundred thirty-two patients with diabetes, both >18 years with FR records and informed consent. MEASUREMENTS: Neuropathy: symptom assessment (NSS) and signs of disability (NDS). Arteriopathy: Index ABI. Edinburgh Questionnaire, fart pulses. Foot deformities: Pedigraphy. Quantitative reference: Values Defined neuropathy: NDS>6 points or 3-5 and NSS>5 points. ITB: Normal value (.90-1.30). RESULTS: Women, 46.42%. Middle ages, 67.29 years (SD 7.69). One hundred fifty-three patients did not present neurovascular alterations. QUALITATIVE: Without differentiating clinical manifestations: 252, patients presented neuropathy; 99, altered ITB; 28, two complications and 101, Edinburgh Quiz: altered. QUANTITATIVE: Differentiating clinical manifestations: among the neuropathy group; 110, patients only presented symptoms; 46, definite neuropathy. In 96, NDS and NSS scores without defined neuropathy criteria. ALTERED ABI: 52, only ABI>1.30; 47, ABI<.90; 12, associated neuropathy and ABI>1.30 and 16, with ABI<.90. Edinburgh questionnaire: 47, presented atypical symptoms and 26, typical. Agreement, between quantitative and recorded neurovascular alterations r=.32 for neuropathy and r=.21 in arteriopathy. The pressure point on the 5th metatarsal, was associated with quantitative neuropathy: OR: 2.32 (1.188-4.546), P=.01. CONCLUSION: The evaluation, identifying clinical manifestations, improves the identification of FR, although we need more research.

Validation of a score to identify inpatients at risk of a drug-related problem during a 4-year period.

OBJECTIVE: Drug-related problems (DRP) produce high morbidity and mortality. It is therefore essential to identify patients at higher risk of these events. This study aimed to validate a DRP risk score in a large number of inpatients. MATERIAL AND METHODS: Validation of a previously designed score to identify inpatients at risk of experiencing at least one DRP in a tertiary university hospital from 2010 to 2013. DRP were detected by a pharmacy warning system integrated in the electronic medical record. The score included the following variables associated with a higher risk of DRP: prescription of a higher number of drugs, greater comorbidity, advanced age, specific ATC groups and certain major diagnostic categories. RESULTS: The study included a total of 52,987 admissions; of these, at least one DRP occurred in 14.9%. After validation of the score (period range, 2010-2013: 0.746-0.764), the area under the curve (AUC) was 0.751 (95% CI: 0.745-0.756). CONCLUSIONS: This value is higher than those reported in other studies describing validation of risk scores. The score showed good capacity to identify those patients at higher risk of DRP in a much larger sample of inpatients than previously described in the literature. This tool allows optimization of drug therapy monitoring in admitted patients.

Computerized pharmacy surveillance and alert system for drug-related problems.

WHAT IS KNOWN AND OBJECTIVE: Because of the impact of drug-related problems (DRPs) on morbidity and mortality, there is a need for computerized strategies to increase drug safety. The detection and identification of the causes of potential DRPs can be facilitated by the incorporation of a pharmacy warning system (PWS) in the computerized prescriber order entry (CPOE) and its application in the routine validation of inpatient drug therapy. A limited number of studies have evaluated a clinical decision support system to monitor drug treatment. Most of these applications have utilized a small range of drugs with alerts and/or types of alert. The objective of this study was to describe the implementation of a PWS integrated in the electronic medical record (EMR). METHODS: The PWS was developed in 2003-2004. Pharmacological information to generate drug alerts was entered on demographic data, drug dosage, laboratory tests related to the prescribed drug and drug combinations (interactions, duplications and necessary combinations). The PWS was applied in the prescription reviews conducted in patients admitted to the hospital in 2012. RESULTS AND DISCUSSION: Information on 83% of the drugs included in the pharmacopeia was introduced into the PWS, allowing detection of 2808 potential DRPs, representing 79·1% of all potential DRPs detected during the study period. Twenty per cent of PWS DRPs were clinically relevant, requiring pharmacist intervention. WHAT IS NEW AND CONCLUSION: The PWS detected most potential DRPs, thus increasing inpatient safety. The detection ability of the PWS was higher than that reported for other tools described in the literature.

Tetania neonatal por hipocalcemia secundaria a hipovitaminosis D. Forma extrema de una enfermedad que resurge / Neonatal hypocalcemic tetany due to vitamin D deficiency. Extreme form of a re-emerging disease

Desde el inicio de la era industrial, el raquitismo ha sido una enfermedad endémica. Con el descubrimiento de la vitamina D y el aporte de suplementos, sobre todo en las fórmulas lácteas infantiles, prácticamente había desaparecido, pero durante los últimos años parece haberse convertido de nuevo en un problema de salud pública. La carencia de vitamina D se asocia no sólo a problemas óseos, sino también a un importante incremento del riesgo de enfermedades cardiovasculares, autoinmunes, infecciosas y tumorales. Comunicamos un caso de tetania neonatal por hipocalcemia secundaria a hipovitaminosis D en un neonato de menos de 2 días de vida. La precocidad de la aparición y la gravedad clínica son excepcionales. Además, advierte del problema emergente que constituye el déficit de vitamina D y de la necesidad de instaurar la suplementación con ésta vitamina, siguiendo las últimas recomendaciones de la Asociación Española de Pediatría (AU)

Since industrial revolution, rickets has been an endemic disease. Since the discovery of vitamin D and its supplements, above all in milk formulates, practically it was disappear, but in the last few years it seems to be again a public health problem. Vitamin D deficiency contributes, not only to bone problems, but also to an important increase in the risk of cardiovascular, autoimmune, infectious diseases and cancer. We communicate a case of neonatal hypocalcemic tetany secondary to a vitamin D deficiency that appeared in a neonate before the second day of life. The precocity of its appearance and its clinical severity are exceptional. It also warn of the emergent problem that it suppose the vitamin D deficiency and the necessity of set up the supplementation with this vitamin, following the last recommendations of the Spanish Paediatrics Association (AU)

Convulsión hiponatrémica con parada respiratoria de etiología poco común / Hyponatremic seizure with respiratory arrest uncommon etiology

Las crisis convulsivas pueden ser la primera manifestación de una patología insospechada. Junto con el tratamiento anticonvulsivo, es necesario un protocolo de actuación dirigido a descartar y tratar las posibles causas reversibles. Las convulsiones por hiponatremia son una manifestación de máxima gravedad con claro riesgo vital, por lo que es necesaria una rápida actuación que eleve la natremia y la osmolaridad a cifras de seguridad. Una causa infrecuente de hiponatremia en los lactantes es la pérdida renal de sodio, secundaria a una infección del tracto urinario. Su origen parece deberse a una resistencia a la acción de la aldosterona en los túbulos renales. Presentamos el caso clínico de un lactante de 49 días de vida, que presentó una crisis convulsiva y una parada respiratoria en el contexto de una hiponatremia grave (Na+: 110 mEq/L). El urocultivo confirmó una pielonefritis por Enterobacter aerogenes, y la ecografía una pielocaliectasia bilateral con cistografía normal, sin evidencia de reflujo vesiculoureteral(AU)

Seizures may be the first symptom of an unsuspected pathology. Anticonvulsant treatment also requires a protocol of action aimed at dismissing and treating any possible reversible causes. Seizures caused by hyponatremia are extreme severity life-threatening manifestations and urgent action is required in order to rise serum sodium and osmolarity to security levels. A rare cause of hyponatremia in infants is the sodium loss secondary to urinary tract infection. Its origin is due to a tubular renal resistance to the action of aldosterone in children with urinary infections. We would like to report the case of a 49-day infant presenting seizure and respiratory arrest in the context of severe hyponatremia. Enterobacter aerogenes growth in the urine culture confirmed pyelonephritis and the ultrasound scan showed a bilateral pyelocaliectasis with normal cystography, not showing vesicouretal reflux(AU)

El dolor en los pacientes hospitalizados: estudio transversal de la información, la evaluación y el tratamiento / Pain in hospitalized patients: cross-sectional study on information, evaluation and treatment

Objetivo: Para proponer e implementar acciones de mejora en el manejo del control del dolor en los centros hospitalarios del IMAS (Institut Municipal d’Assitència Sanitaria), la Comisión de Evaluación y Tratamiento del Dolor, elaboró un cuestionario dirigido a los pacientes ingresados en sus centros, que complementó un estudio previo destinado a conocer la opinión y la actitud de los profesionales hospitalarios. Material y métodos: Estudio transversal realizado mediante encuesta de opinión y revisión de historia clínica. Las preguntas se agruparon en 5 categorías: información recibida acerca de la importancia de manifestar y tratar su dolor; métodos utilizados en su evaluación; repercusión en las actividades de la vida diaria hospitalaria; tratamiento aplicado, y satisfacción con el proceso de la gestión del dolor. Se incluyeron 325 entrevistas realizadas a pacientes adultos con ingreso superior a 48 h, se excluyeron los que presentaban dificultad de comunicación y los ingresados en psiquiatría en los que su médico no consideró oportuna la entrevista. La selección de camas fue aleatoria y el cálculo de la muestra se realizó estratificado por centro y áreas (agudos médicos, agudos quirúrgicos, larga estancia y psiquiatría). Se realizó un análisis descriptivo. Resultados: Un 42,2% de los pacientes refirió no haber recibido ningún tipo de información acerca de la importancia de manifestar su dolor. A un 62,8% se le había preguntado sobre la intensidad de su dolor, siendo el método más utilizado una escala categórica (48,5%), seguido de la escala verbal numérica (35,8%). Un 76,9% de los pacientes había presentado algún tipo de dolor durante su ingreso, y de éstos un 22% no había solicitado atención por dicho motivo...(AU)

Objective: To propose and implement strategies to improve pain management in hospitals belonging to the Municipal Institute of Healthcare (Instituto Municipal de Asistencia Sanitaria, Barcelona, Spain), the Committee for Pain Evaluation and Treatment developed a questionnaire to be used in patients admitted to these centers to complement a previous survey of opinions and attitudes among hospital staff. Material and methods: We performed a cross-sectional opinion survey and review of medical records. The questions were grouped into five categories: information given to the patient on the importance of reporting and treating pain, the methods used to assess pain, the effect on activities of daily living during hospitalization, the treatment applied and satisfaction with pain management. A total of 325 adult patients hospitalized for more than 48 hours were surveyed. Patients with communication difficulties were excluded, as were psychiatric patients if the treating physician considered participation inappropriate. Patients were selected randomly. In the calculation of sample size, stratification was by hospital and patient type (acutely ill medical or surgical patients, long-stay patients and psychiatric patients). Descriptive statistics were compiled. Results: No information about the importance of reporting pain was received by 42.2% of the patients; 62.8% had been asked about pain intensity, the most frequent method used being a categorical scale (48.5%), followed by a verbal-numerical scale (35.8%). Most patients (76.9%) experienced some type of pain during admission; of these, 22% did not seek help for pain management. Overall, 85.8% of the patients felt that their pain had received sufficient attention, while 33.3% reported moderate or considerable limitation of daily activities due to pain while in hospital...(AU)

Effectiveness and safety of colistin for the treatment of multidrug-resistant Pseudomonas aeruginosa infections.

PURPOSE: To describe the clinical and microbiological outcomes of patients infected with multidrug-resistant Pseudomonas aeruginosa (MDRP) treated with colistin (colistimethate sodium) and the adverse events observed with this treatment. METHODS: Retrospective study of MDRP infections treated with colistin from 1997 to 2006. RESULTS: 121 episodes were identified. The median daily intravenous dose was 240 mg/day; 28.9% of patients received intravenous and nebulized colistin. Clinical outcome was favorable in ten cases of bacteremia (62.5%, n = 16), 43 cases of bronchial infection (72.9%, n = 59), 13 cases of pneumonia (65%, n = 20), 11 cases of urinary infection (84.6%, n = 13), eight cases of skin and soft tissues (72.7%, n = 11), and in the one case of arthritis and one case of otitis. Eradication was achieved in 31 (34.8%) of the 89 patients with available bacteriologic data. Factors associated with bacteriological failure were smoking, chronic obstructive pulmonary disease (COPD), and previous infection with P. aeruginosa. Nephrotoxicity occurred in ten cases (8.3%), with the associated factors being previous chronic renal insufficiency, diabetes mellitus, and aminoglycoside use. Crude mortality was 16.5%, and related MDRP was 12.4%, and was higher in patients with pneumonia or bacteremia (36.1%) than in other types of infections (8.2%). CONCLUSIONS: Colistin is a safe option for the treatment of MDRP infections, with acceptable clinical outcomes. However, bacteriological eradication is difficult to achieve, especially in COPD patients.

Fiebre y lesiones cutáneas en paciente en tratamiento con fenobarbital / No disponible

No disponible

Rotura tardía de un aneurisma de aorta abdominal infrarrenal por migración de la endoprótesis / Late rupture of an infrarenal abdominal aortic aneurysm due to migration of the stent

Introducción. Desde que Parodi colocó la primera endoprótesis (EP) en 1991, la terapéutica endovascular ha tenido una evolución creciente y su utilización forma parte de la práctica quirúrgica diaria. Con el paso del tiempo han surgido nuevas complicaciones cuya resolución no siempre está consensuada. Caso clínico. Varón de 74 años con alto riesgo quirúrgico que fue tratado con una EP de tipo Vanguard bifurcada por un aneurisma de aorta abdominal. El postoperatorio cursó sin complicaciones. En la radiografía de abdomen a los seis meses se observó una rotura de la sutura proximal; la tomografía computarizada (TC) no informó de complicaciones. A los dos años, la TC mostraba una fuga de contraste en las ramas, aunque se mantenía el diámetro del saco. Medio año después, el tamaño del aneurisma había crecido 1 cm. La angiografía por sustracción digital mostró una fuga de tipo II que requirió la embolización con coils. En los controles posteriores, la TC demostró la disminución del aneurisma y las radiografías evidenciaron una progresiva angulación y elongación de la EP. A los seis años y medio de la colocación de la EP, el paciente acudió a urgencias por un dolor lumbar e hipertensión. En la TC de urgencias se observaba una migración de la EP con extravasación de contraste en el saco sin sangrado retroperitoneal. El paciente fue intervenido y se encontró una extracción de la EP dificultosa. Finalmente falleció por shock hemorrágico

Introduction. Since the first stent was placed by Parodi in 1991, endovascular therapy has continued to develop and grow and it is now commonly used in daily surgical practice. As time goes by new complications have arisen and specialists do not always agree on how to resolve them. Case report. Our study involved the case of a 74-years-old male with a high surgical risk who was treated for an abdominal aortic aneurysm by means of a bifurcated Vanguard-type stent. No complications occurred during the post-operative period. An X-ray of the abdomen taken at six months revealed breakage of the proximal suture; a computerised tomography (CT) scan did not show any complications. At two years, the CT showed a contrast leak in the branches, although the diameter of the sac was preserved. Half a year later, the aneurysm had grown 1 cm. Digital subtraction angiography showed a type II leak that required coil embolisation. In later revisions, the CT scan showed that the aneurysm had got smaller and x-rays evidenced a progressive kinking and lengthening of the stent. Six and a half years after placement of the stent, the patient visited the emergency department because of lower back pain and high blood pressure. The emergency CT scan revealed migration of the stent with contrast extravasation in the sac and no retroperitoneal bleeding. The patient was submitted to a surgical intervention and extraction of the stent was found to be a complicated procedure. The patient finally died due to haemorrhagic shock

Feto acardio en aborto gemelar / Acardiac fetus in intrauterine fetal demise in a twin pregnancy

Se trata de una entidad poco frecuente que complica las gestaciones múltiples, en mayor medida las gemelares univitelinas, aunque puede afectar también a las monocoriales dicigóticas, las triples e incluso a embarazos únicos. La presencia del feto acardio supone una sobrecarga para el gemelo donante que tiene que mantener la perfusión propia y la del gemelo parásito. Se presenta el caso clínico de una paciente con gestación gemelar (no controlada) con diagnóstico de muerte fetal intraútero de ambos gemelos, uno de ellos un feto acárido (AU)

Acardiac fetus is a rare entity that complicates multiple pregnancies. Occurrence is more frequent in monozygotic twin pregnancies but monochorionic dizygotic, triple and even singleton pregnancies may also be affected. The acardiac fetus acts as a parasite on the pump twin, which must provide a blood supply for the perfused fetus. We present the case of a patient with a twin pregnancy (without prenatal monitoring) with a diagnosis of intrauterine fetal demise in both twins, one of which was an acardiac fetus (AU)

Comparative study of two chromatographic methods for quantifying 2,4,6-trichloranisole in wines.

Here we present the validation and the comparative study of two chromatographic methods for quantifying 2,4,6-trichloroanisole (TCA) in wines (red, rosé and white wines). The first method involves headspace solid-phase microextraction and gas chromatography with electron-capture detection (ECD). The evaluation of the performance parameters shows limit of detection of 0.3 ng l(-1), limit of quantification of 1.0 ng l(-1), recoveries around 100% and repeatability of 10%. The second one implies a headspace solid-phase microextraction and gas chromatography with mass spectrometric detection. The performance parameters of this second method are limit of detection of 0.2 ng l(-1), limit of quantification of 0.8 ng l(-1) and repeatability of 10.1%. From the comparative study we can state that both methods provide similar results and the differences between them are the better sensitivity of the GC-ECD method and the very shorter chromatogram running time of the GC-MS method. The two methods are able to quantify TCA below the sensorial threshold in red, rosé and white wines using just a calibration graph, thus they could be a very good tool for quality control in wineries.

Tratamiento endovascular de la patología aórtica excepcional / Endovascular treatment of exceptional aortic pathologies

Objetivo. Realizar una revisión de la literatura referente al tratamiento de la ruptura de la aorta torácica de etiología no traumática y la valoración de los resultados del tratamiento endovascular. Desarrollo. La ruptura de la aorta, independientemente de su localización, es una patología extremadamente grave. La ruptura aórtica se asocia con el hematoma mediastínico, el hemotórax y la fístula aortobronquial o aortoesofágica. La cirugía abierta continúa teniendo una mortalidad significativamente elevada y posiblemente no asumible, por lo que la conducta actual, cuando las condiciones anatómicas lo permiten, suele ser decantarse por el tratamiento endovascular; sin embargo, el beneficio de el tratamiento endovascular urgente permanece incierto. Las endoprótesis aórticas se han usado para tratar los aneurismas de aorta torácica en pacientes de alto riesgo, incluidos aquellos que presentaban una fístula aortobronquial o aortoesofágica. Conclusiones. Si no se trata, la ruptura de la aorta torácica es una situación mortal, los resultados de la cirugía abierta son desalentadores y la morbilidad de los supervivientes elevada. A pesar de que la terapia endovascular consigue una reducción significativa de la morbimortalidad, la información actual se basa en series cortas o casos aislados, por lo que es necesario completar los registros actuales para poder confirmar las expectativas generadas

Aim. To review the literature concerning the treatment of rupture of the thoracic aorta due to non-traumatic causes and to evaluate the outcomes of endovascular treatment. Development. Rupture of the aorta, regardless of where it happens, is an extremely severe condition. Aortic rupture is associated with mediastinal haematoma, haemothorax and aortobronchial or aortoesophageal fistula. Open surgery continues to have a significantly, and possibly unacceptably, high mortality rate and therefore the current behaviour (anatomical conditions allowing) is usually to opt for endovascular treatment. The benefits of urgent endovascular treatment, however, remain uncertain. Aortic stents have been used to treat thoracic aortic aneurysms in high risk patients, including those who have an aortobronchial or an aortoesophageal fistula. Conclusions. If left untreated, rupture of the thoracic aorta is a fatal situation, outcomes of open surgery are disappointing and morbidity among survivors is high. Despite the fact that endovascular therapy achieves a significant reduction in morbidity and mortality rates, the information currently available is based on short series or isolated cases, and therefore present records must be completed in order to confirm the expectations that have been generated

Quantification of chloroanisoles in cork using headspace solid-phase microextraction and gas chromatography with electron capture detection.

Chloroanisoles can migrate from the cork stopper in wine bottles to the wine and give it a musty taint so it is important to find a method by which they can be determined. The aim of this paper is to develop a method for quantifying 2,4-dichloroanisole, 2,6-dichloroanisole, 2,4,6-trichloroanisole, 2,3,4,6-tetrachloroanisole and 2,3,4,5,6-pentachloroanisole in cork using headspace solid-phase microextraction and gas chromatography with electron capture detection. After we had prepared the cork standards that were so essential to the work we optimised the parameters that most influence headspace solid-phase microextraction: fibre coating, vial volume, cork, kind and volume of solvent to help the extraction, extraction temperature and time, ionic strength and stirring. The method quantifies the total amount of chloroanisoles in cork stoppers (natural, agglomerated, agglomerated with disks and sparkling wine stoppers), at suitable concentrations so that the capacity of these compounds to give wine a musty taint can be evaluated. The quantification limits are: 2,6-dichloroanisole (8.6 ng/g), 2,4,6-trichloroanisole (0.8 ng/g), 2,4-dichloroanisole (3.5 ng/g), 2,3,4,6-tetrachloroanisole (0.6 ng/g), 2,3,4,5,6-pentachloroanisole (0.8 ng/g). The other quality parameters are: recoveries (90.3-105.8%), repeatability (4-13% (RSD expressed)) and intermediate precision (5-14% (RSD expressed)).

La elección del corticoide oral para la crisis del asma / Choice of oral corticosteroids for asthma exacerbations

No disponible