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Protocolo terapéutico de las vasculitis con afectación visceral 内脏性血管炎的治疗方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.006
A. Movasat Hajkhan, J. Muñoz Serrano, E. Rico Sánchez-Mateos, C. Corral Cuadrado
{"title":"Protocolo terapéutico de las vasculitis con afectación visceral","authors":"A. Movasat Hajkhan,&nbsp;J. Muñoz Serrano,&nbsp;E. Rico Sánchez-Mateos,&nbsp;C. Corral Cuadrado","doi":"10.1016/j.med.2025.06.006","DOIUrl":"10.1016/j.med.2025.06.006","url":null,"abstract":"<div><div>Vasculitides with visceral involvement are severe and complex forms of vasculitis that entail target organ involvement. They are associated with a worse prognosis. Treatment should be early and individualized to attempt to achieve rapid remission and prevent irreversible organ damage. The mainstay of treatment is high-dose corticosteroids and various immunosuppressants. This protocol describes the treatment of severe forms with organ involvement of the major primary vasculitides, including giant cell arteritis, Takayasu's arteritis, anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides, central nervous system vasculitides, anti-glomerular basement membrane (GBM) disease, and IgA vasculitides. Its objective is to provide guidelines for the management of these diseases that will help clinicians in their routine clinical practice.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 34","pages":"Pages 2087-2092"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico y terapéutico de la patología linfática 淋巴病理诊断和治疗方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.025
F. Álvarez Herrero , A. Baturone Blanco , A. Bartolomé Sánchez , J. Reina Barrera , O. Uclés Cabeza , A. Martín-Conejero
{"title":"Protocolo diagnóstico y terapéutico de la patología linfática","authors":"F. Álvarez Herrero ,&nbsp;A. Baturone Blanco ,&nbsp;A. Bartolomé Sánchez ,&nbsp;J. Reina Barrera ,&nbsp;O. Uclés Cabeza ,&nbsp;A. Martín-Conejero","doi":"10.1016/j.med.2025.06.025","DOIUrl":"10.1016/j.med.2025.06.025","url":null,"abstract":"<div><div>Lymphangitis is an inflammatory disease of the lymphatic channels caused by infections or other diseases. Lymphedema is an accumulation of interstitial fluid and fibroadipose tissue due to an abnormality in the lymphatic system. The diagnosis of lymphangitis is based on the medical record, a physical examination, and laboratory and microbiological tests. Treatment depends on the cause and may include antibiotics, antifungals, or surgery. The diagnosis of lymphedema is based on the medical record, physical examination, and imaging tests such as Doppler ultrasound and isotopic lymphography. Treatment includes general measures such as physical exercise and limb elevation as well as specific treatments such as compression therapy and surgery. The clinical manifestations of both conditions as well as the different stages and degrees of lymphedema are described. This protocol provides a complete overview of lymphatic diseases, from diagnosis and classification to treatment. It highlights the importance of a multidisciplinary approach and comprehensive care to address these complex, prevalent conditions.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 36","pages":"Pages 2212-2215"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico y terapéutico de la isquemia arterial aguda de los miembros inferiores 急性下肢动脉缺血的诊断和治疗方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.024
A. Bartolomé Sánchez , O. Uclés Cabeza , A. Martín-Conejero , J. Reina Barrera , A. Baturone Blanco , F. Álvarez Herrero
{"title":"Protocolo diagnóstico y terapéutico de la isquemia arterial aguda de los miembros inferiores","authors":"A. Bartolomé Sánchez ,&nbsp;O. Uclés Cabeza ,&nbsp;A. Martín-Conejero ,&nbsp;J. Reina Barrera ,&nbsp;A. Baturone Blanco ,&nbsp;F. Álvarez Herrero","doi":"10.1016/j.med.2025.06.024","DOIUrl":"10.1016/j.med.2025.06.024","url":null,"abstract":"<div><div>Acute ischemia of the lower limb is a serious medical-surgical emergency characterized by the sudden interruption of blood flow to a limb with symptoms that have been ongoing for less than two weeks that rapidly compromise tissue viability and endanger the patient's life. Its diagnosis requires an early multidisciplinary approach that also includes studies such as Doppler ultrasound to classify severity, identify etiology, and guide treatment. The initial therapeutic intervention includes systemic heparinization to prevent secondary thrombosis followed by therapeutic options such as embolectomy, bypass, or catheter-directed fibrinolysis, depending on the cause. However, in extreme cases, amputation may be unavoidable.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 36","pages":"Pages 2208-2211"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Enfermedades de la aorta: síndrome aórtico y aneurismas de aorta 主动脉疾病：主动脉综合征和主动脉瘤
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.019
A. Martín-Conejero , A. Baturone , F. Álvarez Herrero , A. Bartolomé Sánchez , O. Uclés Cabeza , J. Reina Barrera
{"title":"Enfermedades de la aorta: síndrome aórtico y aneurismas de aorta","authors":"A. Martín-Conejero ,&nbsp;A. Baturone ,&nbsp;F. Álvarez Herrero ,&nbsp;A. Bartolomé Sánchez ,&nbsp;O. Uclés Cabeza ,&nbsp;J. Reina Barrera","doi":"10.1016/j.med.2025.06.019","DOIUrl":"10.1016/j.med.2025.06.019","url":null,"abstract":"<div><div>Acute aortic syndrome (AAS) is defined as a sudden injury to the aorta that imminently threatens the patient's life. The three main clinical entities that give rise to this syndrome are aortic dissection, intramural hematoma, and penetrating aortic ulcer. It is important to differentiate between type A and type B AAS, since they have a different prognosis and treatment; the former is usually surgical and the latter is usually medical or conservative.</div><div>Aortic aneurysms, on the other hand, are focal, permanent dilatations of all artery layers. They are classified as fusiform if they affect the entire arterial circumference and saccular if they consist of an eccentric dilatation of the arterial circumference. Aneurysms can occur in any location of the arterial tree, but are more frequent in the infrarenal aorta. The diameter of abdominal aortic aneurysms is the main risk factor for rupture and surgery is indicated for those greater than 5.5<!--> <!-->cm in men.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 36","pages":"Pages 2163-2174"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Actualización en cardiopatías congénitas 先天性心脏病的更新
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.031
E. Hernández Sánchez, M.A. Sanromán Guerrero, J.L. Zamorano Gómez
{"title":"Actualización en cardiopatías congénitas","authors":"E. Hernández Sánchez,&nbsp;M.A. Sanromán Guerrero,&nbsp;J.L. Zamorano Gómez","doi":"10.1016/j.med.2025.06.031","DOIUrl":"10.1016/j.med.2025.06.031","url":null,"abstract":"<div><div>Congenital heart diseases are anatomical lesions that affect one or more of the four heart chambers, the septa separating them, or the valves and outflow tracts present at birth. Their exact origin remains unknown, but it is believed to be associated with abnormalities in embryonic development. The global prevalence continues to rise and up to 90% of these patients reach adulthood thanks to advances in the diagnosis and treatment over the past decades. Since most surgical techniques are palliative rather than curative, these patients will face increased mortality, a high reintervention rate, and complications in adulthood. For this reason, patients should be evaluated at least once in their lifetime by a cardiologist who is an expert in adults with congenital heart diseases, who will coordinate further care based on the complexity and progression of each patient's heart disease. In addition to the common complications seen in all patients with congenital heart disease, each condition is characterized by a set of particular characteristics regarding its pathophysiology, clinical findings, and natural history, which will be addressed in the second half of this update.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 37","pages":"Pages 2246-2257"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Varón de 64 años con múltiples factores de riesgo cardiovascular con palpitaciones y disnea paroxística nocturna 患有多种心血管危险因素的64岁男性，伴有心悸和夜间发作性呼吸困难a
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.018
A. Leandro Barros , J. Serpa Morán , D. García Arribas , A. Ruiz-Saavedra , C. Tejada González , A. García Lledó
{"title":"Varón de 64 años con múltiples factores de riesgo cardiovascular con palpitaciones y disnea paroxística nocturna","authors":"A. Leandro Barros ,&nbsp;J. Serpa Morán ,&nbsp;D. García Arribas ,&nbsp;A. Ruiz-Saavedra ,&nbsp;C. Tejada González ,&nbsp;A. García Lledó","doi":"10.1016/j.med.2025.06.018","DOIUrl":"10.1016/j.med.2025.06.018","url":null,"abstract":"","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 35","pages":"Pages 2161.e1-2161.e4"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico y terapéutico de los aneurismas de la aorta infrarrenal 红外线主动脉动脉瘤的诊断和治疗方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-06-01 DOI: 10.1016/j.med.2025.06.027
A. Baturone Blanco , A. Bartolomé Sánchez , O. Uclés Cabeza , J. Reina Barrera , F. Álvarez Herrero , A. Martín-Conejero
{"title":"Protocolo diagnóstico y terapéutico de los aneurismas de la aorta infrarrenal","authors":"A. Baturone Blanco ,&nbsp;A. Bartolomé Sánchez ,&nbsp;O. Uclés Cabeza ,&nbsp;J. Reina Barrera ,&nbsp;F. Álvarez Herrero ,&nbsp;A. Martín-Conejero","doi":"10.1016/j.med.2025.06.027","DOIUrl":"10.1016/j.med.2025.06.027","url":null,"abstract":"<div><div>Abdominal aortic aneurysms (AAA) are a prevalent disease. Ultrasound is the technique of choice for screening and follow-up on asymptomatic AAAs, especially in at-risk groups such as men over 65 years of age or with a family history. The management of unruptured AAA includes controlling cardiovascular risk factors (especially smoking and hypertension). The diameter of the aneurysm is the main risk factor for rupture, so surgical repair is recommended in men with an AAA equal to or greater than 55<!--> <!-->mm and women with an AAA equal to or greater than 50<!--> <!-->mm or in cases of rapid growth. Open or endovascular surgical repair depends on the patient's comorbidity and aneurysm anatomy. In ruptured AAAs, the diagnosis is made by computed tomography angiography, since ultrasound is not sufficiently accurate to plan the intervention. Rupture entails a high mortality rate (86%–89%) and endovascular treatment is preferable when the anatomy allows it.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 36","pages":"Pages 2221-2224"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico y terapéutico de la anemia en pacientes con artritis reumatoide 类风湿关节炎患者贫血的诊断和治疗方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-05-01 DOI: 10.1016/j.med.2025.05.015
M. Ramírez Martín, E. Fernández Fernández, J. Muñoz Serrano, A. Abbasi Pérez
{"title":"Protocolo diagnóstico y terapéutico de la anemia en pacientes con artritis reumatoide","authors":"M. Ramírez Martín,&nbsp;E. Fernández Fernández,&nbsp;J. Muñoz Serrano,&nbsp;A. Abbasi Pérez","doi":"10.1016/j.med.2025.05.015","DOIUrl":"10.1016/j.med.2025.05.015","url":null,"abstract":"<div><div>Anemia is one of the most frequent extra-articular manifestations and the most common hematologic disorder in patients with rheumatoid arthritis. The most frequent are anemia of chronic disease (ACD), which is usually mild normocytic normochromic and asymptomatic, and iron-deficiency anemia. Macrocytic, hemolytic, and drug-induced anemia occur less frequently. Its prevalence in rheumatoid arthritis ranges from 30% to 70%, depending on the series studied. ACD is due to a combination of reduced iron availability in peripheral blood and decreased erythroid formation in the bone marrow. It is fundamental to identify the cause in order to establish treatment, as anemia in rheumatoid arthritis is often assumed to be due to chronic disorders and is sometimes inadequately treated by intensifying treatment with disease-modifying drugs.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 33","pages":"Pages 2021-2025"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Afectación de vías aéreas y pulmón en la artritis reumatoide, síndrome de Sjögren y espondilitis 风湿性关节炎、Sjogren综合征和脊柱炎引起的气道和肺部疾病
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-05-01 DOI: 10.1016/j.med.2025.05.013
E. Rabadán Rubio, C. Corral Cuadrado, M. Ramírez Martín, J. Muñoz Serrano, E. Fernández Fernández
{"title":"Afectación de vías aéreas y pulmón en la artritis reumatoide, síndrome de Sjögren y espondilitis","authors":"E. Rabadán Rubio,&nbsp;C. Corral Cuadrado,&nbsp;M. Ramírez Martín,&nbsp;J. Muñoz Serrano,&nbsp;E. Fernández Fernández","doi":"10.1016/j.med.2025.05.013","DOIUrl":"10.1016/j.med.2025.05.013","url":null,"abstract":"<div><div>Immune-mediated rheumatic diseases are a heterogeneous group of conditions which, in addition to joint involvement, are defined by their systemic nature, with the respiratory system being one of the most frequently affected systems. In rheumatoid arthritis (RA), lung injury affects 5% of patients and is a significant cause of mortality. Various structures may be involved, including pleura, lung parenchyma, airway, and vascular involvement. Diffuse interstitial lung disease (DIPD) is the most frequent pulmonary manifestation of RA. In regard to histology, the two predominant types are usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP). Respiratory symptoms such as cough or dyspnea are very frequent in Sjögren's syndrome. The frequency and compromise of pulmonary involvement can manifest in multiple ways involving the airways, lung parenchyma, and pleura. In addition, other forms of pulmonary involvement, including lymphoproliferative diseases such as follicular bronchiolitis and lymphoma, should also be considered in these patients. In spondylitis, it should be considered in cases of advanced disease. Restrictive ventilatory problems may occur when the rib cage joints are affected, resulting in ankylosis; bullous apical pulmonary fibrosis is a characteristic condition. Management of these manifestations requires a multidisciplinary approach to control both the underlying disease and pulmonary complications.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 33","pages":"Pages 2005-2015"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico y tratamiento del riesgo cardiovascular en las enfermedades sistémicas inmunomediadas 免疫介导的全身性疾病的心血管风险诊断和治疗规程
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2025-05-01 DOI: 10.1016/j.med.2025.05.017
E. Rico Sánchez-Mateos, E. Rabadán Rubio, J. Muñoz Serrano, J. Campos Esteban
{"title":"Protocolo diagnóstico y tratamiento del riesgo cardiovascular en las enfermedades sistémicas inmunomediadas","authors":"E. Rico Sánchez-Mateos,&nbsp;E. Rabadán Rubio,&nbsp;J. Muñoz Serrano,&nbsp;J. Campos Esteban","doi":"10.1016/j.med.2025.05.017","DOIUrl":"10.1016/j.med.2025.05.017","url":null,"abstract":"<div><div>This protocol provides guidelines for the assessment and management of cardiovascular risk (CVR) in patients with immune-mediated systemic diseases (IMSDs) such as systemic lupus erythematosus and rheumatoid arthritis, among others. Patients with IMSD have significantly higher cardiovascular risk compared to the general population due to the greater prevalence of traditional risk factors and the presence of chronic inflammation that can be aggravated by the prolonged use of some treatments such as glucocorticoids. Risk estimation should be based on cardiovascular risk calculators, the identification of comorbidities, and additional tools, such as carotid ultrasound, to better reflect true risk in IMSDs. Therapeutic management includes lifestyle modifications; strict control of hypertension, glycemia, and dyslipidemia; as well as the use of immunosuppressive agents. A multidisciplinary approach and regular follow-up are essential to reduce cardiovascular morbidity and mortality in this vulnerable population through interventions tailored to each patient's specific characteristics.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 33","pages":"Pages 2031-2034"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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