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OBJETIVOS: Registrar la incidencia de reestenosis tras endarterectomía carotídea (EDAc), observar su evolución natural e identificar los factores de riesgo para su desarrollo. MATERIAL Y MÉTODOS: Estudio retrospectivo de una cohorte prospectiva de EDAc realizadas en 2006-2011. Registramos: datos clínicos, detalles quirúrgicos, desarrollo de reestenosis moderada (REM) (50-69%), reestenosis severa (RES) (≥ 70%) y oclusión. El seguimiento se realizó con ecodoppler carotídea en los 6, 12, 18 y 24 meses tras la intervención, y después anualmente en caso de REM/RES. Todas las RES se confirmaron con angio-RNM. Ninguna reestenosis se reintervino de forma abierta ni endovascular. Realizamos un análisis descriptivo y utilizamos chi-cuadrado/test de Fisher para la definición de factores de riesgo de RES. RESULTADOS: Incluimos 186 carótidas, 77 (41,4%) sintomáticas, y se utilizó parche (dacron) en 19 (10,2%) casos. El primer año detectamos 20 (10,8%) REM de las cuales 9 (45%) remitieron (a <50%) y una (5%) progresó a RES el 2.° año. Se observaron 12 (6,5%) RES el 1.er año, 4 (33,3%) remitieron (a 50-69%) durante el 2.° año y 3 (25%) más durante el 3.er año. Ninguna RES se ocluyó ni fue sintomática. Se ocluyeron 2 carótidas el primer año (una fue sintomática) y una el segundo año, sin reestenosis ≥ 50% previa. El uso de puntos de Kunlin aumentó el riesgo de desarrollar RES (OR 3,61; IC = 95%: 1,13-11,57; p = 0,023). CONCLUSIONES: La RES tras EDAc mayoritariamente con cierre directo es poco frecuente. La evolución natural de las RES durante el seguimiento es benigna. Los puntos de Kunlin se asocian con el desarrollo de RES

OBJECTIVES: To determine the incidence of restenosis after carotid endarterectomy (CEA), as well as to observe its natural history and identify the risk factors for its development. MATERIAL AND METHODS: Retrospective study of a prospective cohort of CEA performed in 2006-2011. The variables recorded were: clinical data, surgical details, incidence of moderate restenosis (MRE) (50-69%), severe restenosis (SRE) (≥ 70%), and occlusion. The patients were followed-up with carotid duplex-scan 6, 12, 18 and 24 months after the procedure, and annually thereafter if MRE/SRE was found. All SRE were confirmed with MRI. No restenosis was surgically or endovascularly repaired. A descriptive analysis was performed, and Chi-squared/Fisher's exact test was used for the definition of SRE risk factors. RESULTS: A total of 186 patients with carotid endarterectomy were included, 77 (41.4%) performed in symptomatic patients, and a patch (dacron) used in 19 (10.2%) cases. During the first year of follow-up 20 (10.8%) MRE were found, with 9 of them (45%) regressed (to <50%) and one (5%) progressed to SRE during the second year. SRE was observed in 12 (6.5%) patients during the first year of follow-up, and 4 (33.3%) regressed (to 50-69%) during the second year, and 3 (25%) more during the third year. No SRE were occluded or became symptomatic. Two carotid arteries became occluded during the first year (one caused a stroke), and one more during the second year, without previous ≥ 50% restenosis. The use of Kunlin stitches increased the risk of developing SRE (OR 3,61; 95%CI: 1.13-11.57; P=.023). CONCLUSIONS: SRE after CEA, mostly with direct suture, is infrequent. The natural history of SRE during follow-up is benign. Kunlin stitches are associated to the development of SRE

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OBJETIVO: Valorar la asociación entre las concentraciones plasmáticas de la proteína C reactiva (PCR) y la evolución de los aneurismas de aorta abdominal (AAA) infrarrenal, para verificar su validez como biomarcador de crecimiento aneurismático. MATERIAL Y MÉTODOS: Cohorte prospectiva de AAA asintomáticos seguidos en consultas externas desde 2008. Registramos: datos clínicos, mediciones seriadas del diámetro máximo de los AAA (mediante ecografía y angio-TAC) y determinaciones seriadas de PCR ultrasensible. El seguimiento fue anual para los AAA de 30-39 mm y semestral para aquellos ≥ 40 mm. Excluimos las determinaciones de PCR > 15 mg/L para evitar que posibles procesos agudos pudieran actuar como factor de confusión. Calculamos las tasas del crecimiento aórtico en cada periodo de seguimiento mediante la diferencia entre los diámetros aórticos en mediciones consecutivas y los clasificamos de forma dicotómica (progresión si el crecimiento fue > 2 mm, estabilidad si el crecimiento fue ≤ 2 mm). Empleamos para el análisis de datos la correlación de Pearson y los modelos mixtos lineales. RESULTADOS: Incluimos 218 AAA con un diámetro basal medio de 41,2 mm (desviación estándar [DE] 10,3 mm, intervalo 30-90 mm). El seguimiento medio fue 28,8 meses (DE 13,7; intervalo 4,8-62), y la concentración basal de PCR media fue 4,1 mg/L (DE 3,3; intervalo 0,5-15). Observamos una relación significativa entre los niveles basales de PCR y el diámetro basal (r = 0,23; p = 0,001), asociación que se mantuvo en las determinaciones seriadas a lo largo del seguimiento (p < 0,0001). No detectamos asociación significativa entre las concentraciones de PCR y las tasas de crecimiento aórtico medidas como variable continua (p = 0,10), pero concentraciones crecientes de PCR se asociaron a la progresión de los AAA, tomada la variable de forma dicotómica (OR = 1,008; IC 95%: 1,000-1,016; p = 0,04). CONCLUSIONES: Las concentraciones plasmáticas de PCR mantienen una asociación con el diámetro aneurismático a lo largo del seguimiento y se relacionan con la progresión de los AAA

OBJECTIVE: To assess the association between high sensitivity C-reactive protein (hs-CRP) plasma levels and the prospective progression of aortic abdominal aneurysm (AAA) in order to test its value as a biomarker. MATERIAL AND METHODS: Prospective cohort of asymptomatic AAA patients followed up in an outpatient clinic since 2008. Clinical data, serial maximum aneurysm diameter (ultrasound and CT) and hs-CRP plasma levels were recorded. Small AAA (30-39 mm) were followed up annually, and large AAA (≥ 40 mm) every 6 months. Hs-CRP levels > 15 mg/L were excluded from the study to avoid acute events acting as potential confounders. Aortic expansion rates were calculated in each follow up period, as well as the difference between aortic diameters in consecutive measurements. Aortic growth was also classified as a dichotomic variable (progression if the growth was > 2 mm, and stability if the growth was ≤ 2 mm). The Pearson correlation and mixed linear models were used for statistical analysis. RESULTS: The study included 218 AAA with a mean baseline diameter of 41.2 mm (SD 10.3 mm, range 30-90). The average follow up time was 28.8 months (SD 13.7, range 4.8-62) and the mean baseline hs-CRP level was 4.1 mg/dL (SD 3.3, range 0.5-15). A significant association was observed between hs-CRP levels and baseline AAA diameter (r = 0.23, P = .001), and this association was maintained over serial determinations throughout the follow-up (P < .0001). No statistically significant association was observed between hs-CRP concentrations and aortic growth rates, measured as a continuous variable (P = .10). However, increasing hs-CRP levels were associated with AAA progression [(OR = 1.008; 95% (1.000-1.016) P = .04)]. CONCLUSIONS: hs-CRP plasma levels are consistently associated with AAA diameter throughout the follow-up of the patients, and increased levels are associated with AAA progression

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The Drug Allergy Committee of the Spanish Society of Allergology and Clinical Immunology reviewed the allergenic potential of several substances of food origin that are found in the composition of some drugs. Despite recent legislation on labeling, many labels do not clearly state whether the drug contains raw material (active ingredients, excipient, or other manufacturing intermediate) with an origin in any of the substances in the list of the 14 groups of food allergens that are subject to mandatory declaration. The objective of legislation is that the drug package, the Summary of Product Characteristics, and the patient information leaflet clearly state the food content in order to improve the safety of allergic patients. Therefore, any food or allergen derivative that must be declared should be clearly stated on the drug label. Of all the evaluated products, egg and milk derivatives are the most frequently discussed in literature reviews. The natural or synthetic origin of potentially allergenic substances such as lysozyme, casein, lactose, albumin, phosphatide, and aromatic essences should be clearly stated. Providing this information has 2 clear advantages. First, allergic reactions to drugs in patients with food allergy could be avoided (if the substances have a natural origin). Second, prescription would improve by not restricting drugs containing synthetic substances (which do not usually induce allergic reactions).

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