Enrique San Norberto García

Femoral pseudoaneurysms post-cardiac catheterization surgically treated: evolution and prognosis

OBJECTIVES To analyze the postoperative complications of patients who have undergone surgical repair of femoral pseudoaneurysm after cardiac catheterization. DESIGN Prospective study. MATERIALS Cardiovascular risk factors, related to surgery and cardiac catheterization were collected prospectively in 79 patients from 2003 to 2006 in Valladolid University Hospital. The indications of surgery included necrosis of adjacent soft tissue, rapid growth, infection, bleeding, hemodynamic instability or failure of the percutaneous treatment (US-guided compression and US-guided percutaneous thrombin injection). METHODS Patient and management related predictors for 30-day outcome were analyzed. RESULTS Fifty-six patients (56/79, 71%) experienced some type of postoperative complication, the most frequent being the need for a transfusion. Infection (15/79, 19%) and dehiscence of the surgical wound (10/79, 12.7%) were the other two most common complications. The mortality related to the intervention was 3.8% (3/79). The mean hospital stay was 32.5 days (+/-28.4 days). Significant risk factors in logistic regression model were gender (P=0.023, OR=9.66), 70 years old (P=0.049, OR=0.15) and the concurrent use of anticoagulation or antiplatelet therapy after the cardiac catheterization (P=0.005, OR=0.03). CONCLUSION Patients who undergo surgical treatment of femoral pseudoaneurysm post-cardiac catheterization experience a high postoperative morbidity and hospital stay. Factors such as female gender, age over 70 years and treatment with anticoagulants or antiplatelets increase the postoperative morbidity. A seasonal influence was appreciated, with a higher frequency during the summer period.

A procedure for the determination of very low activity levels of tritium in water samples

We describe the procedure developed for the electrolytic concentration of3H in water, together with systematically applied checks to guarantee the reproducibility of the process and to minimize the variability between water samples concentrated simultaneously in the different electrolytic cells. Starting from initial volume of 250 ml water, we obtained enrichment parameters normally greater than 70%, with a dispersion always less than 5%. Measuring the concentrated and the unelectrolyzed samples under the same conditions, we found that the lowest detectable activities had been improved from around 1.5 to 0.3 Bq/l. This allowed us to quantify the3H activity levels of 100% of the rainwater samples collected in Cáceres from 1994 to 1996. The resulting average value for this period was (0.79±0.38) Bq/l.

Low-Molecular-Weight Heparin for Prevention of Venous Thromboembolism After Varicose Vein Surgery in Moderate-Risk Patients: A Randomized, Controlled Trial

BACKGROUND Deep vein thrombosis (DVT) after varicose vein surgery (VVS) is not well recognized. Observational studies have yielded variable estimates of the risk, but evidence from randomized trials is lacking. Our aim was to compare the use of thromboprophylaxis with and without low-molecular-weight heparin (LMWH). METHODS We prospectively randomized moderate-risk patients scheduled for VVS in two arms. The first group of patients received bemiparin for 10 days at a prophylactic dose, early ambulation, and compression therapy for 3 months; the second group received early ambulation and compression therapy alone. The primary efficacy outcome was the composite of DVT (symptomatic or asymptomatic detected by mandatory, bilateral duplex scan). Secondary efficacy and primary safety end points were superficial venous thrombosis, postoperative bleeding, and clinical pulmonary embolism (PE). We assessed transient and permanent risk factors for venous thromboembolism. RESULTS Two-hundred sixty-two patients were eligible for evaluation. There were no cases of DVT. There were also no cases of clinical PE, death, or major bleeding. No significant differences were seen between groups in the rates of bleeding episodes. CONCLUSION The data show no superiority of a short-term regimen of LMWH and early ambulation and compression therapy, as compared with early ambulation and compression therapy alone, in patients undergoing VVS in a moderate-risk population.

Study of the comparative dynamics of the incorporation of tissue free-water tritium (TFWT) in bulrushes (Typha latifolia) and carp (Cyprinus carpio) in the Almaraz nuclear power plant cooling reservoir.

The Almaraz nuclear power plant (Spain) uses the water of Arrocampo reservoir for cooling, and consequently raises the radioactive levels of the aquatic ecosystem of this reservoir. From July 2002 to June 2005, monthly samples of surface water, bulrushes (Typha latifolia) and carp (Cyprinus carpio) were collected from this reservoir. They were analyzed to determine the temporal evolution of the levels of (3)H in surface water and of its transfer from the surface water to free-water in the tissues (TFWT) of the aforementioned two organisms. The tritium levels in the surface water oscillate with a biannual period, with their values in the study period ranging between 53 and 433 Bq/L. The incorporation of tritium to bulrushes and carp was fairly similar, the respective mean concentration factors being 0.74 and 0.8 (unitless, as Bq/L tissue water per Bq/L reservoir water). The temporal evolution of the levels fairly closely followed that observed for the surface water tritium, although detailed analysis showed the dominant periodicity for the bulrushes to be annual. This difference reflects the influence on the incorporation of tritium to bulrushes of diverse environmental and metabolic factors, especially evapotranspiration and the seasonal growth of this plant.

Influence of interbasin transfers between the Alcántara and Guadiloba reservoirs on the radiological quality of the drinking water of the city of Cáceres (Spain)

From 1994 to 1996 we have studied a number of radioactive (total b and residual b-activity levels and 3H activity) and physico-chemical (pH, conductivity, and natural potassium content) parameters in the water of two Alcántara and Guadiloba reservoirs, which are artificially connected by interbasin transfers. The analysis of the results showed the existence of major correlations between the two systems for tritium activity, conductivity, and stable potassium content. A model based on the water balance in the Guadiloba reservoir was also elaborated which allowed us to forecast its effective surface area monthly, which varied extraordinarily between 0.405 and 135 km2.

Open Surgical Repair and Endovascular Treatment in Adult Coarctation of the Aorta

BACKGROUND The aim of this study was to compare the results of endovascular therapy (covered stenting) with surgical technique to repair aortic coarctation in adults. METHODS A prospective study of 11 patients who were treated during the past 10 years was carried out. Of these, five patients underwent endoprosthesis (group A) and six an open surgical repair (group B). Follow-up comprised monitoring of the blood pressure, echocardiography, and computed tomography and magnetic resonance angiographic studies. RESULTS The mean age of the patients was 46 years (range: 17-67 years) and the mean follow-up was 52.6 months (range: 1-117 months; 32.3 for group A vs. 69.7 for group B; p = 0.01). Two cases in group A were recoarctations after child angioplasty. The rate of postoperative complications was 27.7% (one hemothorax for group A vs. one pneumothorax and one hemothorax for group B); however, mortality did not occur. The success rate of the endovascular technique was 80%. The stay in the intensive care unit was 2.3 days with significant differences (one group A vs. three group B; p = 0.01), whereas length of hospital stay was 11 days (7.8 group A vs. 11.83 group B; p = 0.17). The pressure gradient across the stenosis decreased by 21.9 ± 3.7 mm Hg (24.5 ± 4.3 group A vs. 33 ± 3.2 group B). Six patients (54.5%) showed persistent hypertension (80% group A vs. 33% group B), with a mean residual pressure gradient of 23.4 ± 4.3 mm Hg (22.5 ± 5.4 group A vs. 22 ± 2.1 group B; p = 0.58). CONCLUSIONS Short- and medium-term results of the endovascular therapy are similar, with shorter stay in the intensive care unit and higher necessity of antihypertensive treatment. Echocardiography and Doppler aortic coarctation gradients slightly higher than 20 mm Hg are usual during follow-up.

Temporal evolution of the3H levels in the surface waters around the Almaraz Nuclear Power Plant

We have quantified the evolution during 1994 of the impact on the Tagus river of liquid releases of3H (51.3 TBq in the cited year), originating from the functioning of the Almaraz Nuclear Power Plant, and conditioned by the management of the cooling reservoir water. Taking into account, on the one hand, that tritiated water is hydrodynamically indistinguishable from untritiated water when both form part of the same mass of liquid, and, on the other, the practically null stratification and forced circulation of the water in the cited cooling reservoir, together with the hydrological fluxes interchanged between the said reservoir and the Tagus river (which is entirely regulated in the section under study and, because of prolonged drought, had a relatively small flow during the study period), we were able to model satisfactorily the temporal evolution of the3H activity in the cooling reservoir.