Diseño, aplicación clínica y utilidad de una nueva escala de riesgo en isquemia crítica de extremidades inferiores

La isquemia crítica es la manifestación clínica más grave de la enfermedad arterial periférica. Su pronóstico es muy malo, con un riesgo muy elevado de exitus y/o amputación mayor a corto plazo. El tratamiento de elección es la revascularización de la extremidad, pero conlleva un alto riesgo quirúrgico asociado. Es difícil establecer de forma objetiva que pacientes pueden beneficiarse de la intervención. Las escalas y los modelos predictivos de riesgo aportan información objetiva que ayuda en la toma de decisiones quirúrgicas; sin embargo, apenas hay escalas desarrolladas y suficientemente validadas en el campo de la revascularización por isquemia crítica. En este trabajo se desarrolla un nuevo modelo de riesgo y se realiza una validación interna del mismo, comparándolo con otras escalas de riesgo ya establecidas.Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapi

Hematological and ventilatory responses to a 3900 m altitude sojourn in an elite wheelchair-marathoner.

This case study aimed to report blood markers and resting respiratory rate (RR) oscillations at sea level, during a 5-wk 3900 m altitude sojourn, and after returning to sea level in a 36-year-old professional wheelchair marathoner. Outcome measures plasma erythropoietin (EPO) concentration, hemoglobin, reticulocytes count, erythrocytes and hematocrit as well as RR were measured upon wakening 7-weeks pre-altitude, 7-days pre-altitude, 35 hours after arrival to altitude, on days 8, 15, 21, 28 and 35 at altitude, 6 and 16 days after returning to sea level. EPO increased up to 259 % (31.6 U l-1) 35 hours upon arrival at altitude and decreased below pre-altitude level (12.2 U l-1) on the 21st day of the camp (8.7 U l-1), reaching the lowest values 16 days after returning from altitude (1.9 U l-1). All blood parameters, except for reticulocytes, increased (range: +17.9 to +23.8%) after 35 days of altitude exposure. Compared to pre-altitude, RR increased during the first week of exposure to hypoxic conditions and remained elevated throughout the camp until the fifth week (5.1±0.4 vs. 9.1±1.6 and 6.6±0.8 breaths min-1; Cohen´s d = +3.4 and +2.4, respectively). A 5-wk high-altitude sojourn triggered polycythemia and elevations in RR (as indicators of effective hypoxic acclimatization) in a professional wheelchair-marathoner

Influence of Training Load on Mood Disturbance at Sea Level and 3900 m Altitude: A Case Study of a Wheelchair Athlete

The purpose of this case study was to investigate the influence of a training load (TL), oxygen saturation (SO2) and blood pressure (BP) on mood states in a wheelchair marathoner during (7 weeks at sea level (SL), 5 weeks at 3860 m altitude, 1 week returning to SL). TL was obtained with Foster's equation while mood states were obtained with the Profile of Mood States Questionnaire (POMS). Furthermore, SO2 and BP were assessed upon wakening. SO2 (%) decreased at altitude, compared to SL (88.31 ± 2.46 vs. 98.52 ± 0.11) and increased until the last week at altitude (92.64 ± 1.12). Systolic pressure (SP) increased at altitude compared to pre-altitude (126.0 ± 5.1 vs. 107.6 ± 4.4 mmhg), and was not different from the last week at altitude. Controlling for SO2 and SP, differences were also observed in fatigue (97.66 ± 18.92 vs. 17.39 ± 13.71) and vigor (73.23 ± 8.62 vs. 26.48 ± 11.89) as a function of altitude. Upon return to SL, fatigue, vigor, SO2 and SP returned to pre values. This case study demonstrated the POMS was sensitive to worsening patterns in fatigue and vigor at altitude through a practical survey approach combined with daily physiological assessment

Historia de los hospitales de Valladolid

Se realizan en el trabajo un recordatorio de los hospitales que existieron y existen en la ciudad de Valladolid, a lo largo de su historia. Se analiza el origen de los mismos, su gestión, mantenimiento y las causas de desaparición de algunos de ellos. También se aportan datos sobre dedicación y prestaciones. Se aporta información de diferentes eventos que repercutieron sobre su situación e incluso en la supervivencia de los mismos.A reminder is made of the hospitals that existed and exist in the city of Valladolid, throughout its history. The origin of them, their management, maintenance and the causes of disappearance of some of them are analysed. They also provide data on dedication and benefits. Information are provided on different events that affected their situation and even their survival.Key words: Hospital, Story, Medicine, Valladoli

Combination of BeGraft and Solaris stent grafts for the covered endovascular reconstruction of aortic bifurcation—BS-CERAB technique

Producción CientíficaBackground: This study examines the impact of the use of the combination of BeGraft and Solaris stent grafts on the outcomes during the covered endovascular reconstruction of aortic bifurcation (BS-CERAB) technique and extension to the iliac arteries. Methods: Consecutive patients with aortoiliac occlusive disease who underwent endovascular treatment using BS-CERAB between January 2020 and December 2023 were included. Patient demographics, symptoms, lesion characteristics, and procedural and follow-up details were collected and analyzed. Perioperative complications and reinterventions were also identified. Results: A total of 42 patients met the inclusion criteria (32 men, 76.2%, median age 72 years, range 59–85). Indications for treatment were intermittent claudication (42.9%) and critical limb ischemia (57.1%). Procedure success was achieved in all cases. The median patient follow-up time was 14 months (1–36). One patient died at a 10-month follow-up due to lung cancer. The mean pre-operative ABI increased from 0.37 ± 0.19 before intervention to 0.71 ± 1.23 post-operatively at 12 months (p = 0.037). The estimated primary patency rates at 3, 6, and 12 months were 90.5%, 85.7%, and 81.0% and primary assisted patency rates were 90.5%, 90.5%, and 85.7%, respectively. Secondary patency was 95.2% at 3 and 6 months and 90.5% at a 12-month follow-up. Active cancer (p = 0.023, OR 2.12 95%CI 1.14–3.25) was a risk factor for restenosis. Conclusions: This mid-term experience shows that the CERAB technique using the combination of BeGraft and Solaris stents grafts, for the endovascular treatment of severe aortoiliac atherosclerotic disease, may allow an effective reconstruction of the aortic bifurcation and iliac arteries related to high-patency and lower-reintervention rates.Junta de Castilla y León, Fundación Instituto de Estudios de Ciencias de la Salud de Castilla y León (IESCYL) - (grant PIP0277) (project VA171P20

Apuntes de la historia del tratamiento de los aneurismas

Aneurysmal disease represents a whole disorders characterized by dilation of blood vessels and subsequent rupture as occlusion and thrombosis of the vascular conduit. The historical evolution of their treatment since ancient times has been a marked progressive advancement of successes and failures up to the current time with appropriate treatment options successfully. One historical journey referring to surgeons who have made contributions in various fields especially int he area diagnosed and treatment is done. Special reference to the most relevant aneurysms such as the aorta artery.La patología aneurismática, representa un conjunto afecciones caracterizadas por la dilatación de los vasos y las posteriores oclusiones centradas en la ruptura y la trombosis del conducto vascular. La evolución histórica de su tratamiento desde tiempos lejanos ha constituido un progresivo avance jalonado de éxitos y fracasos hasta llegar al tiempo actual con adecuadas opciones de tratamiento con éxito. Se realiza una recorrido histórico donde se hace referencia a cirujanos que han realizado aportaciones en los distintos campos en especial en al área diagnostica y del tratamiento. Se hace especial referencia a los aneurismas más relevantes como son los de la arteria aorta

Mortality in patients undergoing open aortoiliac surgery : prognostic value of troponin T in tehe inmediate postoperative period

Producción CientíficaBackground: Patients undergoing open aortoiliac surgery constitute a high-risk subgroup. The aim of this study was to evaluate the relationship between postoperative troponin T (TnT) elevation with the associated postoperative mortality, and mean hospital stay. Methods: This was a prospective observational study of consecutive patients who underwent open aortoiliac surgery during 2006. TnT levels in the first 72 hours after the operation, immediate mortality, postoperative care unit stay, and total postoperative hospital stay were recorded. Statistical analyses were performed with the program SPSS 14.0; the chi-square test (or the Fisher’s exact test) was used for qualitative variables and the ManneWhitney test for quantitative variables. Results: Of the 65 patients included in the study, postoperative TnT was elevated in 14 (21.5%) patients. No significant differences were found in age, sex, hypertension, dyslipidemia, smoking, diabetes mellitus, ischemic heart disease, heart failure, bronchopathy, or renal failure between groups. Mortality in patients with elevated TnT levels was significantly higher (42% compared with 3.92%; relative risk 10.93 ± 0.76; p ¼ 0.001). Likewise, their mean postoperative intensive care unit stay was significantly greater (23.21 ± 6.96 days compared to 2.86 ± 1.96; p < 0.001). This finding resulted in a significantly longer postoperative hospital stay (32.57 ± 25.38 days compared with 12.47 ± 2.21). Conclusion: TnT level in the immediate postoperative period is a highly relevant indicator of prognosis in patients undergoing major vascular surger

Actividad cardíaca vagal, volumen e intensidad de entrenamiento en una atleta de fondo keniata. [Cardiac vagal activity, training mileage, and intensity in a Kenyan female distance athlete].

El objetivo de este estudio fue analizar las oscilaciones de la actividad cardíaca parasimpática (ACP) en un mesociclo de una atleta keniata. La variabilidad de la frecuencia cardiaca (VFC) se midió durante tres semanas. En la primera semana (W1) el volumen de entrenamiento fue 120,55 km, en la segunda (W2) 96,71 km y en la tercera (W3) 79,45 km. Se analizó la media semanal de los intervalos (R-R), la expresión logarítmica (Ln) del cuadrado de la raíz media de la unión de los intervalos R-R adyacentes (LnrMSSD), la desviación estándar de los intervalos R-R (LnSDNN), la frecuencia cardíaca media (FC) de cada sesión y las fluctuaciones diarias de LnrMSSD (LnrMSSDCV). Se observaron incrementos signifcativos en LnrMSSD y LnSDNN de W1 a W3. El LnrMSSDCV fue mayor en W1 comparado a W2 y W3. Este estudio de caso demostró que tanto el volumen como la intensidad de entrenamiento afectaron la ACP de la atleta. Esta monitorización podría ser una valiosa herramienta para prevenir el sobreentrenamiento

Tratamiento quirúrgico de las varices

The goals of ablation therapy in patients with symptomatic venous disease are improvement in symptoms, appearance and prevention of complications. Superficial vein ablation produces beneficial effects by reducing venous volume in the limb and thereby the effects of venous hypertension upon the cutaneous tissues. Surgical methods of vein ablation have largely been supplanted by less invasive methods. More and more with the imposition of endovascular techniques the bound tend to be pushed further and further. The efficacy of the different techniques is not the question. all are effective if well done. The actual question is the cost and the short term results.Los objetivos de la terapia de extirpación varicosa en pacientes con enfermedad venosa sintomática son la mejoría en los síntomas, la apariencia y la prevención de complicaciones. El tratamiento quirúrgico de las venas superficiales varicosas produce efectos beneficiosos al reducir el volumen venoso en la extremidad y de ese modo los efectos nocivos de la hipertensión venosa sobre los tejidos cutáneos. Los métodos quirúrgicos de la ablación de la vena en gran parte han sido sustituidos por métodos cada vez menos invasivos. Poco a poco se ha ido imponiendo las técnicas endovasculares. La eficacia de las diferentes técnicas no es la cuestión puesto que todas son eficaces si están bien realizadas. La pregunta real es el costo y los resultados a corto plazo

La cirugía del Renacimiento: el tratamiento de las heridas de guerra

El periodo del Renacimiento se considera una de las etapas más revolucionarias en la historia de la humanidad y en especial en Europa. La cultura, las artes y las ciencias sufren cambios revolucionarios que también afectan al saber médico y por extensión la cirugía. El avance quirúrgico en parte se debe a las frecuentes y casi continuas guerras que afectan el componente europeo donde es necesario dar solución a las heridas que se producen por las armas empleadas en los conflictos, que por otra parte se utilizan nuevas tecnología y medios de destrucción que producen otro tipo de lesiones en especial ocasionadas por las armas de fuego y por el empleo de la pólvora que las hacen diferentes a las armas punzantes y cortantes utilizadas previamente. Conocer las características de las armas lleva también a hacerlo de las lesiones y comprender los tratamientos terapéuticos utilizados. Dos figuras destacan en esta época como son los cirujanos Ambrosio Paré y Dionisio Daza Chacón, militantes cada uno en cada bando enfrentado.The period of the Renaissance is considered one of the most revolutionary stages in the history of humanity and especially in Europe. Culture, arts and sciences undergo revolutionary changes that also affect medical knowledge and, by extension, surgery. The surgical advance partly is due to the frequent and almost continuous wars that affect the European component where it is necessary to solve the wounds that are produced by the weapons used in the conflicts, which on the other hand are used new technology and means of destruction They produce other types of injuries, especially caused by firearms and by the use of gunpowder that makes them different from the sharp and sharp weapons previously used.Knowing the characteristics of weapons also leads to doing so of injuries and understanding the therapeutic treatments used. Two figures stand out in this era as are the surgeons Ambrosio Paré and Dionisio Daza Chacón, militants each on each side facing each other