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Background: Carotid paragangliomas are rare tumors. They are usually unique, non‐secreting, resectable, and benign. However, additional rare cases of complex tumors (bilateral, secretory, nonresectable, or malignant) complicate the management and final outcomes. Methods: Records of paragangliomas from our hospital are reviewed. Criteria defining complex paragangliomas have been previously defined. These are compared with those of the simple group. Results: Fifty patients, two groups: simple (n = 39) and complex (n = 11). The patients in the complex group were significantly younger (47.7 vs 63.8 years). Postoperative nerve complications (45.4% vs 6.3%) and mortality during follow‐up (27.3% vs 0%) were significantly more common in the complex group. Vascular complications (0% vs 3.1%) and early mortality (0%) were similarly in both groups. Conclusions: Patients with complex carotid paragangliomas are heterogeneous. The former are younger, exhibit a high degree of diagnostic and therapeutic complexity, and have poorer morbidity and mortality. Surgical experience and interdisciplinary collaboration are essential. [ABSTRACT FROM AUTHOR]

In this review, the role of the rivaroxaban-plus-aspirin approach (dual pathway inhibition – DPI) in patients with chronic coronary syndrome (CCS) and to perform practical recommendations about its use was updated. The contents of this review were proposed in an expert meeting. To identify relevant articles, a systematic search of Medline/Embase was performed (to July 2019), using the key words 'rivaroxaban', 'vascular dose', 'COMPASS' and 'coronary artery disease' in the search strategy. Despite current antithrombotic strategies (single/dual antiplatelet therapy) have decreased rates of recurrent cardiovascular events among patients with CCS, residual risk remains unacceptably high. The COMPASS trial showed in CCS patients that compared with aspirin 100 mg rivaroxaban 2.5 mg bid plus aspirin 100 mg reduced the risk of major cardiac events, cardiovascular hospitalization and mortality, without an increase of intracranial or fatal bleedings. Importantly, residual risk with the rivaroxaban plus aspirin approach was lower than with different dual antiplatelet therapy regimens. The rivaroxaban plus aspirin strategy is of particular benefit in patients with CCS and high-risk cardiovascular feature (i.e. ≥2 vascular beds, heart failure, renal insufficiency, peripheral artery disease, previous stroke or diabetes) and should be considered in these populations. [ABSTRACT FROM AUTHOR]

Cell therapy is a progressively growing field that is rapidly moving from preclinical model development to clinical application. Outcomes obtained from clinical trials reveal the therapeutic potential of stem cell-based therapy to deal with unmet medical treatment needs for several disorders with no therapeutic options. Among adult stem cells, mesenchymal stem cells (MSCs) are the leading cell type used in advanced therapies for the treatment of autoimmune, inflammatory and vascular diseases. To date, the safety and feasibility of autologous MSC-based therapy has been established; however, their indiscriminate use has resulted in mixed outcomes in preclinical and clinical studies. While MSCs derived from diverse tissues share common properties depending on the type of clinical application, they markedly differ within clinical trials in terms of efficacy, resulting in many unanswered questions regarding the application of MSCs. Additionally, our experience in clinical trials related to critical limb ischemia pathology (CLI) shows that the therapeutic efficacy of these cells in different animal models has only been partially reproduced in humans through clinical trials. Therefore, it is crucial to develop new research to identify pitfalls, to optimize procedures and to clarify the repair mechanisms used by these cells, as well as to be able to offer a next generation of stem cell that can be routinely used in a cost-effective and safe manner in stem cell-based therapies targeting CLI. [ABSTRACT FROM AUTHOR]

The article discusses that peripheral artery disease of the lower limbs is caused by a progressive decrease in blood supply, generally owing to arteriosclerosis; and mentions that pain control in critical lower-limb ischemia (CLI) is based on the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and oral or parenteral opioids, which require several doses throughout the day to ensure their effectiveness.

Background Pain control in critical limb ischemia ( CLI) varies considerably between individuals. Objective To evaluate pharmacogenetically the response to transdermal buprenorphine ( BUP- TTS) in patients with CLI who are awaiting revascularization. Methods One hundred and seven patients with CLI were treated with BUP- TTS. The following were analyzed: (1) pain perception (visual analog scale ( VAS) before and 4 days after treatment) and (2) genetics: glucuronosyltransferase ( UGT2B7), cytochrome ( CYP3A4), and μ-opioid receptor ( OPRM1) gene polymorphisms. Results Ninety-three patients completed the study. The VAS score by the fourth day of analgesia dropped from 6.82 to 3.38 ( P < 0.05). The analgesic response to BUP- TTS was greater in men than in women ( P = 0.019). Patients who were AA homozygotes for the CYP3A4 gene showed the best response to analgesic treatment ( P = 0.003). The combination of the CYP3A4 gene with UGT2B7 or OPRM1 was favorable to the effect of the CYP3A4 gene ( P = 0.045 and P = 0.026, respectively). The combination of UGT2B7 with OPRM1 was ineffective ( P = 0.648). The 3 polymorphisms together had no effect on response to treatment ( P = 0.461). Conclusions BUP- TTS is efficacious in the control of pain in patients with CLI. The homozygous AA carriers of the CYP3A4 gene respond better to treatment with BUP- TTS. [ABSTRACT FROM AUTHOR]

Background: Intermittent claudication (IC) and its consequences have customarily been underestimated in women. Our study aimed to determine the differences on functional and quality-of-life issues between women and men in a large group of claudicants. Methods: This study was an observational, cross-sectional, nonrandomized, multicenter study of 1,641 claudicants (406 women). Information was collected from patients' medical history, a physical examination, the ankle-brachial index (ABI), the Walking Impairment Questionnaire (WIQ), and the European Quality of Life Questionnaire (EQ-5D). Results: On average, women with IC were older than men with IC (70.0 vs. 67.8 years; p<0.001) and tended to have a different socio-occupational status. Women were more likely to be obese and less likely to smoke or have dyslipidemia ( p<0.001). Women were notable for their greater prevalence of cardiac insufficiency ( p=0.016) and arrhythmias ( p<0.001) and a lower prevalence of ischemic cardiopathy and acute myocardial infarction ( p<0.001). At the same time, there was a significantly higher level of osteoarticular diseases in women: arthrosis ( p<0.001), arthritis ( p<0.001), and lumbar pathology ( p=0.006). All the symptoms evaluated that were associated with IC were more frequent in women ( p<0.05). The mean ABI was similar in claudicant women and men. Conversely, the parameter estimates of the WIQ were significantly lower in women (by 4.3%, and 6.5%, respectively; p=0.003). Likewise, the EQ-5D score was 7% lower in women than in men (from 0.52 to 0.59; p<0.001). Conclusions: Women claudicants have higher risk factors and more frequent cardiovascular comorbidity than men do. Women have a lower capacity for exercise and a poorer quality of life than male claudicants, despite having a similar ABI. These poorer outcomes in women can be partially explained by the presence of greater osteoarticular comorbidity. [ABSTRACT FROM AUTHOR]

Introduction Diabetes mellitus (DM) and intermittent claudication (IC) are frequently associated health conditions. Our hypothesis is that the nature, severity and quality of life (QoL) of patients with IC and DM are worse than those of claudicant patients without diabetes. Material and methods An observational, cross-sectional and multicentre study of 920 patients with IC, divided into two groups: diabetic (n = 477) and non-diabetic (n = 443). For each group, we examined clinical and biological characteristics (including levels of glucose and lipids), the anklebrachial index (ABI), responses to the Walking Impairment Questionnaire (WIQ) and the European Quality of Life-5 Dimensions (EQ-5D) questionnaire. Results Compared with claudicant patients without diabetes, claudicants with diabetes were older (p < 0.001), more likely to be female (p = 0.006), with a higher BMI (p < 0.001), more likely to have a sedentary lifestyle (p < 0.001) and to be a non-smoker (p < 0.001). Claudicant patients with diabetes also had significantly more cardiovascular risk factors (p < 0.001), more frequent ischaemic cardiopathy (p = 0.023) and chronic renal failure (p = 0.002), and fewer prior ictus events (p = 0.003). No significant differences between groups were found with respect to blood pressure, levels of cholesterol or triglycerides. The mean ABI of diabetic-IC patients was slightly lower than IC patients without diabetes (p = 0.016). All WIQ subdomains scores were significantly lower (p < 0.001), indicating poorer walking ability, in claudicant and diabetic patients with compared with those without diabetes. The mean E5- QD global scores and the mean EQ-5D visual analogue scale in the whole series were 0.58 (SD = 0.21) and 55.04 (SD = 21.30), respectively. Both E5-QD scores were significantly lower, indicating poorer QoL, in claudicant patients with diabetes than claudicant patients without diabetes (p < 0.001). Conclusion Patients with IC and DM had more risk cardiovascular factors, cardiovascular conditions, disability and worse haemodynamic status and QoL than claudicant patients without diabetes. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Vagal paragangliomas (VPs) represent a rare pathology in which surgery is usually recommended, but where experience is crucial to reduce the number of post-operative complications. In this study, we present our experience and a review of the literature. Methods: Between 1991 and 2006 we have treated 42 patients with 50 paragangliomas of the head and neck (26 carotid, 18 jugular/tympanic and 6 vagal). Examination of the literature (Medline and non-indexed Spanish source) from the last 30 years has revealed 23 series that each reported more than three cases; reaching a total of 332 VPs. Results: VPs are infrequent among paragangliomas of the head and neck (6/50) presenting clinical peculiarities such as multiple tumours, and malignant evolution. Within this current series, surgery was possible in all cases. Post-operative dysfunction in cranial nerves was frequent (the cranial X nerve was systematically sacrificed). There were no bronco-aspirations or mortalities. The literature review reveals similar results. Conclusion: To obtain the best results, it is important that the candidates for surgery be selected by experts within multidisciplinary groups. [Copyright &y& Elsevier]

The article discusses case reports of primary aortoduodenal fistula (PADF), also called abdominal aortic aneurysm (AAA). A 72-year-old man who was diagnosed with AAA complicated by an aortoduodenal fistula underwent surgery and remains asymptomatic one year after the surgery. Another case involves a 63-year-old man who was being monitored for AAA and developed melena with no hemodynamic repercussions during his stay at the hospital.

Bacterial translocation is an important phenomenon in clinical medicine and leads to an increase in patient morbidity and mortality by multiple organ failure. The selectin family plays an important role in the pathogenesis of inflammation, causing an increase in leukocyte–endothelium interactions and inducing a greater leukocyte's migration. This study considered the effect of a sulfo derivative of Sialyl-Lewis X , GM 1998-016, that will block the P- and E-selectins interaction with a ligand, the Sialyl-Lewis X , valuing the modulation of the systemic inflammatory response and the induced translocation. Seventy-five Wistar male rats were injected intraperitoneally with Zymosan A and treated with different doses of GM 1998-016 according to study groups. Measurements of values of qualitative and quantitative microbiology, neutrophil infiltration (myeloperoxidase), oxygen free radicals (superoxide anion, superoxide dismutase, catalase, and gluthatione peroxidase), and cytokines (tumor necrosis factor-α and interleukin-1β) were taken at different times after Zymosan administration. A significant decrease of bacterial translocation, both local (MLN) and systemic ( p [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the efficacy, safety, and cost of Iow-molecularweight heparin compared to saphenofemoral disconnection for the treatment of internal saphenous proximal thrombophlebitis (SPT). Eighty-four consecutive patients diagnosed as presenting SPT alone (symptoms/echo-Doppler) were divided into 2 comparable groups treated with (1) saphenofemoral disconnection under local anesthesia with a short hospital stay (n=45) or (2) prospective enoxaparin on an outpatient basis for 4 weeks (n=39). Informed consent was obtained and inclusion, exclusion, and withdrawal criteria were established. Patients were followed up at 1, 3, and 6 months. Thirty patients per group completed the study requirements. In the disconnection group, 2 patients (6.7%) presented complications of the surgical wound, 1 (3.3%) had SPT recurrence (however, there was no deep venous thrombosis), and 2 (6.7%) had nonfatal pulmonary embolism confirmed by radionuclide scan. In the enoxaparin group, there were 2 cases (6.7%) of minor bleeding (epistaxis and rectal bleeding) and 3 (10%) recurrences of SPT. In the enoxaparin group there was no case of progression of the thrombosis to the deep venous system or pulmonary embolism. The study found no statistically significant differences between saphenofemoral disconnection and enoxaparin in the treatment of SPT, but the Iow-molecular-weight heparin group had socioeconomic advantages. [ABSTRACT FROM AUTHOR]