Resultados de la endarterectomía carotídea en pacientes ancianos

Introduction

Forty-five per cent of stoke patients have a surgically accessible stenosis. The objective of our study is to describe the response to carotid endarterectomy (EA) in patients of advanced age compared to younger ones.

Material and method

Retrospective evaluation of the clinical history of all patients who underwent an endarterectomy in a tertiary hospital between January 1995 and December 2006. The patients were grouped into those 75 years or older and those less than this age. The incidence of peri-operative complications in the first month after surgery, and the long-term mortality was evaluated using a survival analysis.

Results

Data were collected on 147 EA in 134 patients of 75 years or more, and on 201 EA in 177 patients less than 75 years-old. The incidence of peri-operative complications was similar in both groups, with a mortality of 2% in the older age group and a stroke incidence of 2.6% (half transient ischaemic accidents). The older patients had a mean follow-up of 4.1 years, with a survival of 86% at one year and 54% at 5 years and with the main cause of death being heart disease.

Conclusions

Carotid EA is a safe and effective technique for the treatment of extracranial carotid stenosis in the elderly, having the same peri-operative morbidity and mortality as younger ones. Age must not affect our therapeutic attitude, although an exhaustive cardiology study must be made in the elderly prior to the operation.     

Estudio de la sensibilidad especifica en residentes de un area endemica a la Paracoccidioidomicosis en Venezuela

Resumen Se presenta el estudio de la reacción a la Paracoccidioidina de los habitantes de un área de alta incidencia de Micosis de Lutz y Splendore, encontrándose positividad en el 52% de los residentes. Se hizo simultáneamente intradermo-reacciones al P.P.D., Histoplasmina y Esporotriquina, encontrándose cierta correlación de resultados sólo con la Histoplasmina. Con fines de comparación se hizo encuesta en pequeño grupo de habitantes de otra área del pais, encontrándose una diferencia estadisticamente significante con los resultados de la zona en estudio. Se hacen varios comentarios.

---

Cutaneous sensitivity to paracoccidiodin was tested in 686 persons of an endemic area of Paracoccidioidomicosis in Venezuela. The antigen was prepared in our laboratory according to the technique used byFava Netto (Brasil). Skin-testing such as histoplasmin, sporotrichin and P.P.D. also were performed. Due to the high percentage obtained in the reading of the paracoccidioidin (52%) an inquiry was made in a not endemic area obtaining a percentage of 6,1%; this difference is statistically significant. Significant results are also obtained for the two remaining antigens of mycotic origin.Emphasis is laid on the importance of working with the same antigen used in Brasil.Commentaries are made on the common reactions that occur between paracoccidioidin and histoplasmin, and on the possibility of interpreting them as crossed reactions or that the same person is sensitive to the two agents which are in the environment of the place where they live.No crossed reactions were found between sporotrichin and paracoccidioidin in a significant number of cases, nor between the latter and the P.P.D. and this is considered very important in connection with the active or residual possible pulmonary lesions that could be seen in the persons with negative P.P.D.The appearance of positive reactions to paracoccidioidin was observed by beginning at the age of 10 and becoming more intense at 20 and it is higher in males than in females.

---

---

Trabajo realizado con la ayuda económica de la FundaciónJose Maria Vargas.     

Role de la tension superficielle en biologie

Sans résumé     

Estudio de la patogenicidad de conidiobolus Coronatus en animales de experimentacion

Resumen A partir de una cepa de Conidiobolus coronatus aislada de Aenolamia postica, se inocularon 152 ratones, 42 cobayos y 47 hamsters por vías intraperitoneal (IP), subcutánea (SC), intratraqueal y por escarificación en la mucosa oral; cada animal se inoculó 3 veces a intervalos de una semana. Los animales se sacrificaron a los 1, 8, 15, 45 y 225 días de la primera inoculación, haciéndose estudios de alteraciones macroscópicas (nódulos, abscesos, adherencias), exámenes directos, cultivos e histopatología. Las alteraciones macroscópicas de los tejidos fueron las más frecuentes y todas evolucionaron a la curación espontánea. Los animales presentaron un mayor múmero de estudios positivos cuando se inocularon por vía IP y SC. Los estudios histopatológicos hechos al 1° y 8° día, demostraron un infiltrado inflamatorio agudo y filamentos fúngicos bien conservados; a los 15 días se observaron granulomas con células gigantes y filamentos fragmentados en desintegración; a los 45 y 225 días se observó una reacción de fibrosis sin filamentos fúngicos. Se consideró que en ningún caso se logró reproducir la rinoentomoftoromicosis y de acuerdo a éstos resultados se estima que esta cepa no tiene patogenicidad o bien ésta es muy baja.

---

The pathogenicity of a strain of Conidiobolus coronatus isolated from Aenolamia postica was investigated in 152 mice, 42 guinea pigs and 47 hamsters. Four routes of inoculation were used: intraperitoneal, subcutaneous, intratracheal and scarification in the oral mucosa. Each animal was inoculated 3 times at 3 week intervals. Animals were sacrificed at 1, 8, 15, 45 of 225 days after the first inoculation. Observations of macroscopic lesions (nodules, abscesses, adhesions, etc.) direct examinations, cultures and histopathological studies of different tissues were performed. The aforementioned lesions of tissue were the most frequently found and all of them were resolved by spontaneous cure. The animals inoculated intraperitoneally and subcutaneouslly presented the highest number of positive results. The histopathological features at the 1st and 8th days after inoculation showed an acute inflamatory infiltrate with well preserved fungus filaments; at the 15th day granulomas with giant cells were observed containing fragmented and disintegrated fungal hyphae; at the 45th and 225th days a fibrosis reaction was observed and no fungal filaments, could be found. In no animal was rhinoentomophthoromycosis never reproduced, and according to these results it is considered that either this strain is not a pathogen or its pathogenicity is very low.