Influence of aspirin therapy in the ulcer associated with chronic venous insufficiency

Producción CientíficaBackground: To determine the effect of aspirin on ulcer healing rate in patients with chronic venous insufficiency, and to establish prognostic factors that influence ulcer evolution. Methods: Between 2001 and 2005, 78 patients with ulcerated lesions of diameter >2 cm and associated with chronic venous insufficiency were evaluated in our hospital. Of these, 51 patients (22 men, 29 women) with mean age of 60 years (range: 36e86) were included in a prospective randomized trial with a parallel control group. The treatment group received 300 mg of aspirin and the control group received no drug treatment; in both groups, healing was associated with standard compression therapy. During follow-up, held weekly in a blinded fashion, there was ulcer healing as well as cases of recurrence. Results were analyzed by intention-to-treat approach. Cure rate was estimated using KaplaneMeir survival analysis, and the influence of prognostic factors was analyzed by applying the Cox proportional hazards model. Results: In the presence of gradual compression therapy, healing occurred more rapidly in patients receiving aspirin versus the control subjects (12 weeks in the treated group vs. 22 weeks in the control group), with a 46% reduction in healing time. The main prognostic factor was estimated initial area of injury (P ¼ 0.032). Age, sex, systemic therapy, and infection showed little relevance to evolution. Conclusions: The administration of aspirin daily dose of 300 mg shortens the healing time of ulcerated lesions in the chronic venous insufficiency (CVI). The main prognostic factor for healing of venous ulcerated lesions is the initial surface area of the ulcer

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

Can the Cytokine Profile According to ABO Blood Groups Be Related to Worse Outcome in COVID-19 Patients? Yes, They Can

Producción CientíficaSevere status of coronavirus disease 2019 (COVID-19) is extremely associated to cytokine release. Moreover, it has been suggested that blood group is also associated with the prevalence and severity of this disease. However, the relationship between the cytokine profile and blood group remains unclear in COVID-19 patients. In this sense, we prospectively recruited 108 COVID-19 patients between March and April 2020 and divided according to ABO blood group. For the analysis of 45 cytokines, plasma samples were collected in the time of admission to hospital ward or intensive care unit and at the sixth day after hospital admission. The results show that there was a risk of more than two times lower of mechanical ventilation or death in patients with blood group O (log rank: p = 0.042). At first time, all statistically significant cytokine levels, except from hepatocyte growth factor, were higher in O blood group patients meanwhile the second time showed a significant drop, between 20% and 40%. In contrast, A/B/AB group presented a maintenance of cytokine levels during time. Hepatocyte growth factor showed a significant association with intubation or mortality risk in non-O blood group patients (OR: 4.229, 95% CI (2.064–8.665), p < 0.001) and also was the only one bad prognosis biomarker in O blood group patients (OR: 8.852, 95% CI (1.540–50.878), p = 0.015). Therefore, higher cytokine levels in O blood group are associated with a better outcome than A/B/AB group in COVID-19 patients.Instituto de Salud Carlos III (grant COV20/00491)Junta de Castilla y León (grant 18IGOF

José Goyanes Capdevila (1876-1964): pionero de la cirugía vascular española

Se puede considerar al Dr. José Goyanes Capdevila uno de los ciruanos pioneros a nivel mundial y también español de la cirugía vascular. Desarrolló técnicas de sutura vascular, angioplastia y fue el primero en realizar una sustitución venosa en el tratamiento de un aneurisma poplíteo, además de otras interesantes aportaciones.Sus publicaciones se realizaron en revistas de limitada difusión por lo que su obra no fue conocida de forma generalizada atribuyéndose aportaciones realizadas de forma pionera por Goyanes a otros autores. Se muestra en este trabajo su biografía y se hace una descripción de sus publicaciones tanto científicas como humanísticas.The surgeon José Goyanes Capdevila can be considered one of the pioneers worldwide and also Spanish of vascular surgery. Development of techniques of vascular suture, angioplasty and was the first to perform a venous substitution in the treatment of a popliteal aneurysm, in addition to other interesting contributions.His publications were made in magazines of limited diffusion reason why his work was not known of generalized form being attributed contributions made The surgeon José Goyanes Capdevila can be considered one of the pioneers worldwide and also Spanish of vascular surgery. Development of techniques of vascular suture, angioplasty and was the first to perform a venous substitution in the treatment of a popliteal aneurysm, in addition to other interesting contributions.His publications were made in magazines of limited diffusion reason why his work was not known of generalized form being attributed contributions made in a pioneering way by Goyanes to other authors. This work shows his biography and a description of his scientific and humanistic publications

Clinical and haemodynamic evolution of lesions treated by means of a therectomy with Silver Hawk in the femoropopliteal sector

Producción CientíficaThe objective of the work is to study the clinical and haemodynamic evolution, over 1 year, in patients with femoropopliteal arterial pathology treated by means of atherectomy with the SilverHawk device. Materials and methods: Nineteen (19) patients were treated between December 2008 and May 2009, collecting data on sex, age, comorbidity and clinical degree, with prospective monitoring over 12 months of clinical symptoms, physical examination and ecodoppler, obtaining results on diameter and peak systolic velocity at different arterial levels. Results: Of the 19 patients, 14 were men and 5 women, with a mean age of 70 years, hypertensive (73%), diabetic (63%) and smokers (63%). Six (6) presented disabling claudication and 13 critical ischemia with advanced distal trophic lesions in 5. A good arteriographic result was obtained in 12 cases, a stent was placed on the superficial femoral artery in 5 due to suboptimal outcome. Contrast extravasation was observed in 2, with femoropopliteal bypass performed and one exclusion with endoprosthesis for repair. In the ecodoppler after 1, 3, 6 and 12 months, a progressive reduction in lumen diameter and peak intraarterial systolic velocity was observed, particularly on the distal superficial femoral artery. After one year, 7 patients (36.8%) were symptom-free, 5 (26.3%) presented mild or moderate intermittent claudication and 1 patient (5.3%) presented localised distal trophic lesion. Four (4) major amputations were performed, in 2 the knee was preserved, there were 3 thromboses due to the procedure, a secondary endovascular procedure was performed in one case and a femoropopliteal bypass in another, and there were 2 non procedure-related deaths. Discussion: atherectomy with SilverHawk achieves an improvement in clinical degree, with a good rate of extremity salvage in patients with critical ischemia. In the first year, the ecodoppler shows evolution of the arteriopathy, without this necessarily meaning a clinical worsening