Peripheral arterial disease (PAD) is a growing and often underdiagnosed health problem that predicts cardiovascular events and mortality. Estimating its prevalence in the general population is a major issue for assessing health needs and planning health services. The aim of this study was to determine the prevalence of PAD and its risk factors in an urban Mexican population. A random sample of 400 adult subjects was selected from a Family Medical Unit of the Mexican Institute of the Social Security. Clinical examination was performed and a questionnaire was applied to all subjects. After an overnight fast, serum glucose, triglyceride, and cholesterol concentrations were measured. Blood pressure was taken and the ankle-brachial index (ABI) was calculated by Doppler examination in both sides. PAD was diagnosed if one of the ABIs was less than 0.90. Prevalence was estimated with 95% confidence intervals (CI95%), and odds ratios (OR) with CI95% were obtained to assess association with some atherogenic risk factors in a multiple logistic regression analysis. The prevalence of PAD was 10.0% (CI95%, 7.24%-13.37%), and it was higher in men. Most subjects with PAD had no signs or symptoms, although the presence of either signs or symptoms was more frequent in subjects with PAD. The main risk factors related to PAD were serum triglycerides > or = 150 mg/dL (OR 2.25; CI95% 1.0-5.1), heavy smoking (OR 2.5; CI95% 0.9-6.7) and a history of diabetes mellitus for longer than 7 years (OR 1.9; CI95% 0.6-5.8). The prevalence of PAD is high in this Mexican urban population. Asymptomatic PAD may be highly frequent, and low-cost, noninvasive Doppler ultrasonography should be considered as an adequate screening procedure in primary care to detect individuals at high risk for major cardiovascular events.
Combined injuries of the aorta and inferior vena cava are rare. Mortality is over 70%, primarily from exsanguinating hemorrhage. Post-traumatic aortocava fistula can develop in survivors, who present in the postoperative period with manifestations of high output heart failure. This is a retrospective review of five male patients, age from 9 to 39 years, with aortocava fistulas that were referred with congestive heart failure, 2 days to 6 months after abdominal penetrating injuries. They had undergone surgery at another hospital and several organ injuries were treated. Retroperitoneal hematomas were not seen or were seen and left undisturbed. Four patients received a gunshot injury, had the fistula at the infrarenal level, and survived surgical repair. In one of the survivors, a left popliteal artery bullet embolism also occurred and was treated. Another patient sustained a thoracoabdominal stab injury and an aortocava fistula developed at the suprarenal level; he was in severe congestive heart failure and died during surgery. There are very few reports on this sequelae of vascular injuries at the abdominal level. Patients with aortic and cava injuries have a high mortality rate and arteriovenous fistula may develop with communicating pseudoaneurysms. If high output heart failure develops in a patient with a history of abdominal penetrating injury, an arteriovenous fistula must be suspected and arteriography will disclose the location of the fistula. Surgical treatment is necessary to prevent further heart damage. In the future endovascular procedures may have a role in the management of these difficult conditions.
Introducción: Luego de revisar la literatura clínica disponible, no hay datos que indiquen la proporción de ACV infantil respecto a la población general, generando vacíos de conocimiento acerca del impacto de esta condición. Adicionalmente, teniendo en cuenta que más del 40% de los pacientes que sufren esta patología presentan un grado importante de discapacidad y una cuarta parta fallece secundariamente también. Asimismo, es una patología de gran importancia, pues hace parte de las diez principales causas de muerte en los niños. Objetivos: Describir las características demográficas clínicas, radiológicas, de tratamiento y de resultado de los casos de Ataque Cerebrovascular (ACV) de tipo hemorrágico en población pediátrica, en un hospital pediátrico de alta complejidad y centro de referencia a nivel nacional, entre los años 2012 y 2017 en la ciudad de Bogotá, Colombia. Métodos: Se revisarán de forma retrospectiva las historias clínicas de los pacientes que hayan ingresado por ACV hemorrágico en niños mayores de 1 mes y menores de 18 años durante el 2012 a 2017-I basados en un instrumento específico que permita recolectar las variables a estudio. Se realizó el análisis de las variables incluidas en el estudio obteniendo las frecuencias relativas de las características demográficas, clínicas, epidemiológicas y de resultado. Además, se realizó un análisis descriptivo de acuerdo a la naturaleza de la variable por medio de la herramienta EpiInfo 7 (CDC, 2008) y SPSS Statistics 22 para Windows. Resultados: Se revisaron 283 historias clínicas, de las cuales, después de aplicar los criterios de exclusión y revisión, se obtuvieron 55 pacientes como población del estudio. La mayor parte de los pacientes fueron adolescentes entre 9 y 14 años de edad. El hematoma intraparenquimatoso fue el hallazgo tomográfico más frecuentemente encontrado y las causas hematológicas como la leucemia, la hemofilia y otros trastornos hemorrágicos y de coagulación ocuparon cerca del 40% de la etiología de los eventos y en 25% de los casos no fue posible diagnosticar un proceso etiológico relacionado. En menos de la mitad de los casos, el manejo de la patología fue de carácter quirúrgico. La mortalidad de los pacientes fue del 38% de los casos y la discapacidad severa fue de alrededor del 12,8%, medida con la escala de Rankin de 3 a 5. Puede existir alguna relación estadísticamente significativa entre el estado neurológico, el volumen del hematoma y la escala modificada de Rankin. Conclusiones: Se corroboró el aumento del riesgo de ACV hemorrágico en población pediátrica en pacientes con neoplasias y discrasias sanguíneas; además, del gran impacto para la salud pública y los costos económicos, debido a su gran morbilidad y discapacidad. Este es uno de los primeros estudios descriptivos para esta enfermedad subestimada. Colombia no cuenta con estadísticas claras de este problema, por lo que se requieren más estudios que permitan ampliar las correlaciones y pronósticos de esta patología.
Objective: Present our experience as a tertiary referral center in the surgical management of the carotid paraganglioma.Introduction: Carotid paraganglioma is a slow-growing tumor, originated at the chemoreceptor cells of the carotid bulb and due to factors as chronic hypoxia, familiar history or female gender it can present hyperplasia. Most of these tumors are benign and asymptomatic which delays its diagnosis and treatment. Surgical excision is the gold standard treatment. Methods:We performed an ambispective study from 1987 to 2019 of the patients with the diagnosis of carotid paraganglioma that underwent surgical excision in our center, using the Shamblin classification system to describe them.Results: A total of 964 tumors were resected from patients of 21 to 82 years old, in 32 years, with an average of 30 procedures each year. 92% of the patients were female, Shamblin type I 7%, type II 47% and type III 46%; bleeding went from 50 to 10,000 ml, with previous embolization in 8 cases, usage of stent-graft in 10 patients, 6 with external carotid artery ligation and only 1 patient with bypass using PTFE (Polytetrafluoroethylene) graft. Morbidity and mortality: cerebral vascular event in 3%, bleeding >2000 ml in 11%, nerve injury in 23%, vascular injury in 25% and overall mortality 2%. Conclusion:In our center experience, surgical removal is the first treatment of choice; there is no benefit from using other therapies such as embolization, usage of stent-graft in the external carotid artery and only certain chosen patients could benefit from radiotherapy. Malignancy is less than 1%, severe neurological complications in about 3%. Genetic factor in our population, associated with the area height can be determinant.
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