Reconstrucción con colgajo de músculo temporal en defecto del tercio medio de la región facial. Nuestra experiencia en un hospital de mediana complejidad / TEMPORALIS MUSCLE FLAP RECONSTRUCTION IN FACIAL REGION DEFECTS. OUR EXPERIENCE IN MEDIUM COMPLEXITY HOSPITAL

Introducción: El colgajo pediculado realizado con músculo temporal es una opción terapéutica válida para la reconstrucción de defectos de la región facial posterior a una resección quirúrgica, es una alternativa aceptable a los colgajos libres cuando estos no pueden ser utilizados ya sea por el performance status o patología de base de los pacientes a tratar o por no contar con cirujano microvascular. Objetivo: Describir nuestra experiencia en el uso de este colgajo para la reconstrucción de 7 pacientes con defectos de órbita, paladar y mucosa yugal tras la cirugía ablativa de diversas patologías. Materiales y métodos: Revisión retrospectiva de los pacientes del Servicio de Cirugía General del Hospital José Ramon Vidal, Corrientes-Argentina operados en el periodo comprendido desde enero del 2019 hasta enero del 2021.En este lapso, 7 pacientes fueron sometidos a cirugía reconstructiva inmediata con colgajo de músculo temporal en defectos del tercio medio de la región facial. Resultados: Un total de siete pacientes, (4 masculino- 3 femenino), sometidos a cirugía ablativa por presentar patología maligna (6) y patología benigna (1), con una edad media de 60 años. Dos colgajos se utilizaron para defectos de región orbitaria y partes blandas, seis para defectos en la cavidadoral­ en un paciente se emplearon los 2 músculos temporales-. El colgajo fue exitoso en todos los casos, se presentaron complicaciones menores como: dolor postoperatorio, hematoma, trismus, depresión de la zona dadora. Se obtuvo márgenes libres en el total de los procedimientos. Discusión: La cirugía reconstructiva con colgajo pediculado de musculo temporal es una excelente alternativa de colgajo regional con buenos resultados, posee alta tasa de éxito justificada por su buena vascularización. Además, la proximidad del músculo temporal con la región maxilofacial y su inserción contribuyen a obtener un arco de rotación hasta 180° sin comprometersu vitalidad. Es útil para la reconstrucción en un acto quirúrgico, acortando el tiempo intraoperatorio y sin cambios posicionales. Conclusiones: El colgajo de músculo temporal resulta una opción válida a los colgajos libres osteo-mio-cutáneos para defectos mixtos (óseos y de partes blandas) del tercio medio facial luego de la cirugía ablativa, cuando estos últimos no pueden ser implementados teniendo en cuenta varios aspectos como performance estatus de los pacientes, patología de base y necesidad de contar con un cirujano microvascular

Introduction: temporalis muscle vascularized flaps is a valid therapeutic option for reconstruction of defects in facial region after surgical resections. It is an acceptable alternative to free transfer flaps when these cannot be used because of the patient's performance state and base pathologies. Or because of the lack of a microvascular surgeon. Objectives: To describe on experience applying this kind of flaps for the reconstruction or 7 patients, with defects in palate orbit and yugal mucose after resective surgeries for various pathologies. Materials and methods: retrospective revision of patients in the general department, of Jose R Vidal Hospital (Corrientes - Argentina) into underwent surgery during the period between January 2019 ad January 2021. A total of 7 patients underwent immediate reconstructive surgery using a temporalis muscle flap. Results: 7 patients (4 males y 3 female) underwent resective surgery for different malignant (6) and benign (1) with a median age of 60. Two flaps were used for defects of the orbitary region and soft tissue, six for defects of the oral cavity (in one patient both temporalis muscle were used. Te procedure was successful in all cases, and minor complication were present, (post operatory pain, hematoma, trismus, excavation of the donor region) all procedures resulted un surgical margins of lesion of malignancy. Discussion: reconstructive surgery using a vascularized flap of temporalis muscle is an excellent alternative for regional flaps with good results and a high success justified because of its a good irrigation. Besides the proximity between temporalis muscle and the maxillofacial region, possibilities a flap rotation of up to 180 grades without compromising its vitality it is also useful for reconstruction in a single surgery shortening intra-operatory time while avoiding repositioning of the patients during the procedure. Conclusions: Temporalis muscle flaps are valid option to free osteo- mayo- cutaneal flaps for mixed defects (involving bone and soft tissue) of the medium third of facial region after resective surgeries when the latter cannot be carried and because of various aspects little performance status base pathologies and lack of microvascular margin.

Outcomes of percutaneous coronary intervention of coronary left main disease / Монголын Анагаах Ухаан

Introduction @#The left main (LM) bifurcational stenting is coronary high risk interventional procedure (CHIP) which associated with various post procedural outcome.@*Goal@#In this study, we aimed to describe current practice of coronary left main bifurcational stenting and patient’s outcome in Mongolia. @*Materials and Methods@#We selected 50 patients who gave informed consent and treated by left main bifurcational stent. All the patients gave informed consent form which was approved by ethical committee of Mongolian National University of Medical Sciences. Coronary stenosis was evaluated by Syntax score and Medina classification. The 1 year survival rate was estimated using Kaplan-Meier estimation. @*Results @#A total of 50 patients who received LM bifurcational stent were chosen (mean age 60±11, male gender 78%). Mean syntax I score was 26.1±8.6 and mean Syntax II score was 44.7±6.2. Medina 110 type lesion was 46% (n=23), medina 111 type lesion was 36% (n=18), medina 100 type lesion was 6% (n=3), medina 011 type lesion was 4% (n=2) and medina 010 type lesion was 8% (n=4). The median degree of stenosis was 50% (IQR 30%; 90%) for LM, 90% (IQR 80%; 99%) for LAD and 0% (IQR 0%; 80%) for LCx. The final procedural success with final TIMI 3 flow was achieved in 44 patients (88%). All-cause mortality was occurred 5 patients during follow-up and survival rate at the 1 year was 82% (95% CI 66; 97).@*Conclusion @#The bifurcational stenting is acceptable treatment choice which has good survival for high risk patients with LM bifurcational disease.

The Combined Use of Intraluminal and Intrasaccular Flow Diversion for the Treatment of Intracranial Aneurysms: Report of 25 Cases / 신경중재치료의학

PURPOSE: The Medina Embolic Device (MED) is a new intrasaccular device with promising early results. Previously we documented our initial experience of this device both alone and in combination with other devices including flow diverter stents (FDS). We sought to determine the effect of the MED + FDS strategy for the treatment of selected aneurysms. MATERIALS AND METHODS: We performed a retrospective analysis of prospectively collected data to identify all patients with aneurysms treated using both the MED and intraluminal FDS. We present our technical success rate, early and mid-term angiographic follow-up, and clinical outcome data. RESULTS: We identified 25 non-consecutive patients. The treatment was staged in 9 patients and in a single session 16 patients. The average age was 61±12.8 years (range 40–82). The average fundus height was 11±3.6 mm and average fundus width was 10.1±3.4 mm. In the staged cohort (n=9) at delayed angiography (mean 10 mths) 8 aneurysms (89%) showed complete exclusion (mRRC 1) and in one patient there was a parent vessel occlusion. In the simultaneous cohort delayed angiography (n=10, mean 8.1 months) demonstrated complete occlusion (mRRC 1) in 6 aneurysms (60%), 3 neck remnants (mRRC 2) (30%) and 1 patient (10%) showed persistent aneurysmal filling (mRRC 3a). There were 5 complications with permanent morbidity (mRS >2) in two patients. There were no mortalities. CONCLUSION: The MED can be successfully used in combination with intraluminal FDS and in selected aneurysms this may represent an alternative to FDS and adjunctive coiling.

A Educação Física cuida do corpo... E 'mente'": entre discursos e dispositivos / A Educação Física cuida do corpo... E 'mente'": between speeches and devices

A obra "A Educação Física cuida do corpo... e 'mente': bases para a renovação e transformação da educação física", escrita por João Paulo Subirá Medina, repercutiu entre os profissionais da Educação Física no Brasil na década de 1980 ao enfatizar as crises na área. Buscamos identificar autor e obra a partir do contexto de sua produção, das coerências e das descontinuidades com os debates contemporâneos de sua época. Para tanto, discutimos alguns preceitos: o motivo pelo qual tal livro não foi suplantado; os desdobramentos do debate, a partir dos novos capítulos acrescentados na recente reedição; as diferentes apropriações da obra; o contexto de produção do livro como macrounidade das diferentes correntes da Educação Física; o diálogo com o livro "O brasileiro e seu corpo"; os desdobramentos do ensaio de 1983 nas realizações do autor; a utilização da obra no meio universitário e no meio profissional; e o misticismo que permeia a obra, isto é, sua capacidade de, ao mesmo tempo, inquietar e alimentar a esperança. A obra ainda é válida para o momento, uma vez que é possível relacioná-la com o projeto que se seguiu (Universidade do Futebol) o qual, em linhas gerais, é coerente e interdependente no jogo discursivo e nas teias engendradas das relações de poder. A produção de Medina pode nos levar à conclusão de que o não-dito é mais relevante que o explícito, sendo que as práticas discursivas e as práticas não-discursivas contribuem para a construção de dispositivos...(AU)

The work "A Educação Física cuida do corpo... e 'mente': bases para a renovação e transformação da educação física", written by João Paulo Subirá Medina, repercuted among the professionals of Physical Education in Brazil in the 1980s by emphasizing the crises in the area. We try to identify the author and the work from the context of its production, from the coherency and from discontinuities with the contemporary debates of its time. To do so, we discuss some precepts: the reason why the book was not supplanted; the unfolding of the debate, from the new chapters added in the recent reissue; the different appropriations of the work; the context of production of the book as the macro-unit of the different currents of Physical Education; the dialogue with the book "O brasileiro e o seu corpo"; the unfolding of the essay of the year 1983 in the author's achievements; the use of the work in the university environment and in the professional environment; and the mysticism that permeates a work, this is, its ability to, at the same time, disturb and feed the hope. The work still is valid for this moment, since it is possible to connect it to the project that follows (Universidade do Futebol) which, in general, is coherent and interdependent in the discursive game and in the engendered webs of power relations. The Medina production can lead us to the conclusion that the unspoken is more relevant than the explicit, and discursive practices and non-discursive practices contribute to the construction of devices...(AU)