Search

Objective: Helicobacter pylori resistance to antimicrobial agents is on the rise and it is thus imperative to be aware of local resistance rates. The main objective of the present study was to describe the evolution of primary antimicrobial resistance in H. pylori, analysing its antibiotic susceptibility over a 13-year period in a region of northern Spain, as well as host-related factors., Patients and Methods: Between 2004 and 2016 a total of 3426 patients who met the H. pylori eradication criteria underwent gastroscopy. The gastric biopsies were processed and those testing positive for H. pylori were identified and tested for clarithromycin, metronidazole and levofloxacin susceptibility using E-test., Results: H. pylori was isolated in 1604 (47%) patients, ranging from 63% (133/212) in 2004 to 39% (137/347) in 2016. Primary resistances to clarithromycin, metronidazole and levofloxacin were on average 19% (278/1116), 40% (572/865) and 17% (137/669), respectively. Clarithromycin resistance was 24% (167/686) in females and 15% (11/753) in males (p=0.0002); metronidazole resistance was 29% (72/246) in patients over 70 years compared to 42% (499/1190) in younger patients (p=0.0396); levofloxacin resistance increased with age, being 13% (57/439) in patients ≤55 years, 19% (46/236) for those between 56 and 70, and 26% (34/130) in patients >70 years (p=0.0087)., Discussion: A decline in the prevalence of H. pylori infection was observed over the years, along with relatively high rates of primary resistance to clarithromycin, metronidazole and levofloxacin. Variations in resistance rates were found with sex and age., (Copyright © 2019 Elsevier España, S.L.U. All rights reserved.)

Percutaneous retrieval of intravascular foreign bodies has emerged as a standard method of treatment, which audits major surgery. This procedure was performed in a patient with a fragment of a broken introducer sheath located in the right ventricle with risk of arrhythmias. Extraction was difficult because the sheath was trapped in the tendinous cords. The foreign body was embolized to the pulmonary artery and extraction was performed. No clinically significant complications occurred.

Objective: Vascular malformations are uncommon pathologic entities in which surgery is usually not possible or is inefficient. Our experience with the percutaneous treatment of peripheral vascular malformations, by means of transarterial embolization or direct puncture is here reported., Material and Methods: During the 1993-1997 period a total of 35 patient, 20 females (57%) and 15 males (43%) aged 11 to 75 years, were treated at our Unit. Sixteen vascular malformations were hemodynamically active (45.7%) and 19 hemodynamically inactive (54.3%). A total of 126 embolizations (mean 3.6) were performed. Malformations were studied by means of doppler-echography, magnetic resonance, arteriography and direct puncture angiography. Considering location, size and hemodynamic characteristics a specific approach and therapy was performed in each case. In two cases (5.7%) a surgical exeresis after embolization was performed., Results: A technical success, defined as the possibility of embolizing the malformation, was achieved in 100% of cases. No technical complications during the procedure occurred. The mean follow-up time was 23 months (6-69). All patients but one improved both objectively and subjectively and all but one have recovered their daily activities in the following days. The exception was one patient who developed a severe complication--cutaneous necrosis--a few days after the procedure which required repairing surgery. All patient had edema, pain and increased functional impairment after the embolization which subsided with medical treatment., Conclusions: Percutaneous embolization of vascular malformations is an effective method associated with a low complication rate. Our results are encouraging although more extensive investigation are required to draw definite conclusions.

Objective: To obtain an initial assessment of the implantation technique of bifurcated vascular endoprothesis in the treatment of abdominal aorta aneurysms (AAA)., Methods: Eleven Vanguard type endoprostheses were implanted in eleven patients with infra-renal aortic aneurysm. The technique was performed with surgical approach in one femoral artery, and percutaneously in the other. The procedure was performed with epidural anesthesia., Results: A technical success--i.e., the exclusion of the aneurysm--was obtained in all cases. No technical complications occurred during the procedure. Three patients had low degree contrast leak in the angiographic control immediately after the procedure. Eight patients had low grade fever in the immediate follow-up which resolved with medical therapy, two patients had hematomas in the approach sites, one renal infarction, one ileus for two days, another one for five days, and three patients had lymphatic effusion. During follow-up the patients with leak had to undergo co-axial endoprosthesis implantation., Conclusions: It is our view that bifurcated vascular endoprostheses offer a valid alternative in the treatment of AAA. The procedure can be performed with epidural anesthesia and sedation, with a low rate of complications. The long term follow-up and the perfecting of the approach and resection systems will ultimately dictate their usefulness in this and other vascular conditions.

Objective: To report our experience with long term external catheters and implantable ports in the last 8 years., Material and Methods: From December 1987 to August 1995 a total of 617 central venous catheters were implanted in 541 patients in our Interventionist Vascular Radiology Unit, 265 men (49%) and 276 women (51%), with a mean age of 46 years. A total of 335 (54%) were partially implantable external catheters and 241 (39%) implantable ports in chest and 41 (7%) in the forearm., Results: A technical success--defined as the possibility of implanting the catheter--was achieved in 98% of cases. Immediate complications included 5 pneumothorax (0.8%), 11 accidental carotid artery puncture (2%) with no clinical relevance, 18 catheter misplacement (3%), and 8 vein spasm (1%). Fifty-two catheters (8%) were removed on account of infectious complications. Currently, 71 catheters are still in use (12%), 433 (70%) have been removed or the catheter was patent until patients's death., Conclusions: Partially implantable central venous catheters and totally implantable ports are a safe alternative in patients requiring a central venous access for prolonged treatments. The low number of immediate complications renders the Interventionist Vascular Radiology Unit the proper place where to perform these procedures.

Background: The purpose of this study was to evaluate the clinical results analyzing the cure, improvement and failure rates of percutaneous transluminal angioplasty (PTA) in patients with the diagnosis of renovascular hypertension with special reference to those with atherosclerotic vascular disease, according to their age, and their effect on blood pressure control and renal function., Patients and Methods: In 93 hypertensive patients with a mean age of 43.4 years 123 renal artery PTA were performed: Twenty-six patients older than 50 years and eleven with 50 years or less had atherosclerosis, 27 fibromuscular dysplasia and a mixed disease was found in one patient. Twenty-eight patients with renal transplant were diagnosed as having arterial graft stenosis., Results: After renal PTA, there was a significant decrease in blood pressure in all cases. Patients with atherosclerotic renal vascular disease showed a decrease in systolic pressure (SP) from 168 +/- 19 before PTA to 154 +/- 8 mmHg at 96 months (p < 0.001) and diastolic (DP) from 113 +/- 10 before PTA to 90 +/- 4 mmHg at 96 months (p < 0.001) respectively after the procedure. Significant differences were also observed in patients with fibromuscular dysplasia. Most patients with renal transplant arterial stenosis had less than five years of follow-up and SP and DP decreased from 162 +/- 18 and 109 +/- 8 mmHg before PTA, to 147 +/- 10 (p < 0.001) and 91 +/- 7 mmHg (p < 0.001) at 12 months after dilation respectively. Clinical improvement was achieved in 91% of patients with atherosclerosis at 96 months and fifty percent of the patients with fibromuscular dysplasia were cured after the same period from the time of PTA. Twelve months after the renal transplant artery dilation was achieved a clinical improvement in 81% and a cure rate in 6% of the patients. Ostial lesions comprised the majority of blood pressure benefit failures. There was no significant improvement in renal function immediately after renal artery dilation except in those patients with fibromuscular dysplasia. Residual stenosis greater than 75% was present in 15 patients after the first PTA. Complications were seen in 4.8% and were related to renal failure and vessel dissection., Conclusion: Angioplasty is effective in the long-term management of high arterial blood pressure and may preserve renal function according to renal artery disease.