Programa de superación profesional para angiólogos sobre tratamiento de enfermedades vasculares periféricas con técnicas novedosas

Introducción: La superación profesional es un conjunto de acciones de carácter educativo vinculadas con la actualización de conocimientos y el desarrollo de habilidades y actitudes profesionales en correspondencia con la identificación de problemas profesionales. En Ciego de Ávila, Cuba, los especialistas de Angiología y Cirugía Vascular carecen de actividades de superación profesional de forma general, sistemática y de participación colectiva, dirigidas u orientadas desde la Universidad de Ciencias Médicas. Objetivo: Elaborar un programa de superación profesional del especialista en Angiología y Cirugía Vascular para el tratamiento de las enfermedades vasculares periféricas con técnicas novedosas, a partir de insuficiencias identificadas. Método: Se realizó una investigación cualitativa con un estudio descriptivo en especialistas de Angiología y Cirugía Vascular de la provincia de Ciego de Ávila, vinculada directamente con la atención a pacientes, en el año 2020. Se trabajó con toda la población compuesta por 19 especialistas. Fue aplicada una encuesta y se utilizó la estadística descriptiva para organizar y clasificar los indicadores cuantitativos obtenidos. Resultados: La preparación para la aplicación de tratamiento con técnicas novedosas en las enfermedades vasculares periféricas se encontró como insuficiencia en nivel de Poco adecuado y No adecuado en más del 90 % de los especialistas. Conclusiones: Se aporta un programa de superación profesional como sistema abierto, de carácter flexible, que facilita su rediseño constante para adaptarse a condiciones específicas de los contextos de aplicación.

Introduction: Professional development is a set of educational actions linked to update knowledge and professional skills and attitudes in correspondence with the professional problems met. In Ciego de Avila, Cuba, specialists in Angiology and Vascular Surgery lack professional improvement activities in general, systematic and collective participation way, straightly performed or oriented from the University of Medical Sciences. Objective: To design a professional development program for specialists in Angiology and Vascular Surgery on the treatment of peripheral vascular diseases with the use of novel techniques based on the professional problems met. Method: A qualitative research with descriptive study was carried out in Angiology and Vascular Surgery specialists linked directly to the patient care service in 2020. It worked with the whole population comprised of 19 specialists. A survey was applied and descriptive statistics were used to organize and classify the quantitative indicators obtained. Results: Knowledge on how to use the novel techniques in peripheral vascular diseases treatment proved to be inadequate at a pointed level of Less adequate and Inadequate in more than 90% of studied specialists. Conclusions: The professional development program is provided with characteristics of an open system and flexibility, which facilitates its constant redesign to adapt to the specific conditions of the contexts required.

Introdução: O aperfeiçoamento profissional é um conjunto de ações educativas vinculadas à atualização de conhecimentos e desenvolvimento de habilidades e atitudes profissionais em correspondência com a identificação de problemas profissionais. No Ciego de Ávila, Cuba, os especialistas em Angiologia e Cirurgia Vascular carecem de atividades de aperfeiçoamento profissional de forma geral, sistemática e de participação coletiva, dirigidas ou orientadas pela Universidade de Ciências Médicas. Objetivo: Desenvolver um programa de aperfeiçoamento profissional do especialista em Angiologia e Cirurgia Vascular para tratamento de doenças vasculares periféricas com técnicas inovadoras, a partir das insuficiências identificadas. Método: Foi realizada uma investigação qualitativa com estudo descritivo em especialistas de Angiologia e Cirurgia Vascular na província de Ciego de Ávila, diretamente vinculados ao atendimento ao paciente, no ano de 2020. Trabalhamos com toda a população composta por 19 especialistas. Aplicou-se um survey e utilizou-se estatística descritiva para organizar e classificar os indicadores quantitativos obtidos. Resultados: A preparação para a aplicação do tratamento com novas técnicas nas doenças vasculares periféricas revelou-se insuficiente ao nível de Pouco adequado e Pouco adequado em mais de 90% dos especialistas. Conclusões: Um programa de aperfeiçoamento profissional é fornecido como um sistema aberto, de natureza flexível, o que facilita seu redesenho constante para se adaptar às condições específicas dos contextos de aplicação.

Aneurisma venoso postraumático en extremidades superiores. Presentación de dos casos / Post-traumatic venous aneurysm in the upper limbs. Case report on two patients / Aneurisma venoso pós-traumático nos membros superiores. Apresentação de dois casos

RESUMEN Los aneurismas venosos, en especial de la extremidad superior, son malformaciones vasculares de baja frecuencia. Se presentó el manejo de dos pacientes del sexo femenino atendidas en el Servicio de Angiología y Cirugía Vascular del Hospital General Docente "Dr. Agostinho Neto" de la provincia Guantánamo, Cuba, a las que se les diagnosticaron aneurismas en diferentes segmentos del sistema venoso superficial de la extremidad superior, los que se resecaron quirúrgicamente y se les confirmó el diagnóstico mediante biopsia.

ABSTRACT Venous aneurysms, especially the ones located in the upper limbs, are vascular malformations with low incidence in the population. Two cases of venous aneurisms on female patients showed up at the Angiology and Vascular Surgery services at the General Teaching Hospital ¨Dr. Agostinho Neto¨ in Guantanamo, Cuba. Aneurism diagnosis was confirmed through biopsy. They were located in different segments of the superficial venous system of the upper limbs, and were surgically resected.

RESUMO Os aneurismas venosos, principalmente de membro superior, são malformações vasculares de baixa frequência. Foi apresentada a gestão de duas pacientes do sexo feminino atendidas no Serviço de Angiologia e Cirurgia Vascular do Hospital General Docente "Dr. Agostinho Neto" da província de Guantánamo, Cuba, que foram diagnosticados com aneurismas em diferentes segmentos do sistema venoso superficial do membro superior, os quais foram ressecados cirurgicamente e o diagnóstico foi confirmado por biópsia.

Características clinicoepidemiológicas de pacientes con trombosis venosa profunda en los miembros inferiores / Clinical and epidemiological characteristics of patients with deep venous thrombosis in lower limbs

Introducción: La trombosis venosa profunda consiste en la formación de un trombo en un trayecto de una vena profunda, lo que provoca la oclusión total o parcial de esta. Objetivo: Caracterizar una población de afectados por esta entidad clínica, según variables de interés. Métodos: Se efectuó un estudio observacional y descriptivo de serie de casos, de pacientes con presunto diagnóstico clínico de trombosis venosa de miembros inferiores, atendidos en el Servicio de Angiología y Cirugía Vascular del Hospital Provincial Clinicoquirúrgico Docente Saturnino Lora Torres de Santiago de Cuba desde enero de 2015 hasta junio de 2017, en quienes se realizó ecografía Doppler para confirmar la presencia de este episodio vascular. Resultados: La enfermedad primó en el grupo etario de 65 y más años (32,1 %) y en el sexo femenino (74,1 %). La inmovilidad de miembros inferiores constituyó el factor de riesgo predominante (27,0 %), en tanto el dolor, el edema y la taquicardia resultaron las manifestaciones clínicas más frecuentes (20,5 % en cada una), y el miembro inferior izquierdo fue el más afectado (69,0 %). Conclusiones: La trombosis venosa de los miembros inferiores se presentó como propia de las edades avanzadas de la vida, fundamentalmente en mujeres, con un cuadro clínico que indicaba claramente su existencia.

Introduction: The deep venous thrombosis consists on the formation of a clot in a deep vein way, what causes its total or partial occlusion. Objective: To characterize a population affected by this clinical entity, according to variables of interest. Methods: An observational and descriptive study of a serial cases, of patients with presumed clinical diagnosis of venous thrombosis of the lower limbs, assisted in the Angiology and Vascular Surgery Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba from January, 2015 to June, 2017, to whom a Doppler echography to confirm the presence of this vascular episode was carried out. Results: The disease prevailed in the 65 and more age group (32.1 %) and in the female sex (74.1 %). The immobility of lower limbs constituted the predominant risk factor (27.0 %), as long as pain, edema and tachycardia were the most frequent clinical manifestations (20.5 % in each one), and the left lower limb was the most affected (69.0 %). Conclusions: The venous thrombosis of lower limbs was presented as characteristic of the advanced ages of life, mainly in women, with a clinical pattern that indicated with high clarity its existence.

Atención primaria de salud en angiología y cirugía vascular en Cuba / Primary health care in Angiology and vascular surgery in Cuba

En la década del sesenta del siglo xx, la Revolución Cubana a través de su Ministerio de Salud Pública crea las áreas y los policlínicos integrales de salud. En 1964 la especialidad de angiología y cirugía vascular fue la primera en participar en acciones de promoción, prevención y atención médica especializada en los policlínicos y en la comunidad. El objetivo de esta breve comunicación es el de exhortar a nuestros especialistas y residentes en angiología y cirugía vascular de nuestro país, a mantener, incrementar y reforzar cuantitativa y cualitativamente, las consultas en los policlínicos integrales de salud de sus provincias, en la medida de sus posibilidades y continuar así el accionar histórico de esta especialidad(AU)

In the 1960´s decade, the Cuban Revolution through its Ministry of Public Health created the comprehensive health areas and Policlinics. In the year 1964, Angiology and Vascular Surgery specialty was the first in participating in promotion, prevention and specialized medical care actions in the policlinic and in the community. The objective of this brief communication is exhorting the specialists and residents in Angiology and Vascular Surgery of our country to maintain, increase and reinforce quantitative and qualitatively the consultations in the integral policlinics of health of their provinces continuing with the historical development of this specialty(AU)

Anatomy of the abdominal aorta in the hoary fox (Lycalopex vetulus,Lund, 1842) / Anatomia da aorta abdominal em raposa-do-campo (Lycalopex vetulus, Lund, 1842)

The hoary fox (Lycalopex vetulus,Lund, 1842) is the smallest Brazilian canid, whose weight varies between 2 and 4 kg, has a slender body, a small head, and a short and blackened snout. Despite being considered an endemic species, little is known about the hoary fox as it is one of the seven less studied canids in the world. Thus, this study aimed to describe the anatomy of the abdominal aorta artery of the hoary fox and to compare it with the pre-established literature data in domestic canids. For this purpose, we used two adult hoary foxes without definite age. We collected the corpses of these animals along roadsides of Catalão-GO, being later fixed and conserved in a 10% formalin solution. The results showed that the abdominal aorta in hoary fox is at the ventral face of the lumbar region vertebral bodies, being slightly displaced to the left of the median plane. The first branch is visceral, named celiac artery, followed by a paired parietal branch: the phrenic abdominal arteries. The third and fourth branches are the cranial mesenteric arteries and the right and left are the renal arteries, respectively. The posterior branches of the renal arteries are equally visceral, paired, being called testicular arteries. Distal to the latter, both the caudal mesenteric artery and deep circumflex iliac arteries originate. Finally, two large external iliac arteries and its terminal branches composed of internal iliac arteries and the median sacral artery originate. In addition, five pairs of lumbar arteries originate alongside the abdominal segment of the aorta. Considering these findings, it is possible to conclude that despite the hoary fox being a wild animal, the anatomy of its abdominal aorta is very similar to that of domestic canids.(AU)

A raposa-do-campo (Lycalopex vetulus,Lund, 1842) é o menor canídeo brasileiro, cujo peso varia entre 2 e 4 quilos, possui corpo esguio, a cabeça é pequena, focinho curto e enegrecido. Considerada uma espécie endêmica, pouco se sabe a seu respeito, e é um dos sete canídeos menos estudados no mundo. Assim, o presente estudo teve o objetivo de descrever a anatomia da parte abdominal da artéria aorta em raposa-do-campo e comparar com dados literários pré-estabelecidos de canídeos domésticos. Para a realização deste estudo foram utilizados dois exemplares de raposa-do-campo, adultos, sem idade definida. Os cadáveres dos animais foram recolhidos às margens de rodovias no entorno da Catalão-Goiás, fixados em solução aquosa de formol a 10% e conservados na mesma solução. Os resultados mostraram que a aorta abdominal da raposa-do-campo está localizada sobre a face ventral dos corpos vertebrais da região lombar, levemente deslocada para a esquerda do plano mediano. O primeiro ramo é visceral, denominado artéria celíaca, seguido por um ramo parietal, pareado, as artérias frênico-abdominais. O terceiro e quarto ramos são a artéria mesentérica caudal e as artérias renais direita e esquerda, respectivamente. Os ramos posteriores das artérias renais são igualmente viscerais, pareados, denominados artérias testiculares. Distal à essas últimas, originam-se a artéria mesentérica caudal e as artérias circunflexas ilíacas profundas. Finalmente surgem duas grandes artérias ilíacas externas e os ramos terminais compostos pelas artérias ilíacas internas e artéria sacral mediana. Ao longo do trajeto da aorta abdominal, cinco pares de artérias lombares se originam da face dorsal. Considerando esses achados, pode ser concluído que a anatomia da aorta abdominal da raposa-do-campo é muito similar àquela de canídeos domésticos, embora ela seja um animal silvestre. (AU)

Origin and distribution of the coronary arteries of boars / Origem e distribuição das artérias coronárias de javalis

The heart of a domestic swine is similar to that of a human regarding anatomy, blood perfusion, and distribution of nurturing arteries. In addition to the similarities, its low cost compared with other species is also one of the reasons these animals have been increasingly used in medical schools and in clinical, surgical, and pharmacological studies. Therefore, we aimed to identify the origin and distribution of the right and left coronary arteries of boars, emphasizing the configuration and macroscopic representativity of their branches while characterizing a possible dominance concerning the type of circulation and the potential use of this animal as an experimental model, hence boars are the ancestors of the domestic pigs. The left coronary artery has bifurcated into paraconal interventricular branch and circumflex branch; or it has trifurcated into paraconal interventricular branch, the oblique branch, and into the left circumflex branch. The right coronary artery has originated the marginal branches to the right ventricle and the right circumflex branch, which has branched out in the subsinuous interventricular branch. Anastomoses have stood out among the paraconal and subsinuous interventricular branches ­ where a right dominant coronary artery occurred ­ and between the right and left circumflex branches. We concluded that the morphology and the distribution of the coronary arteries of boars resemble those of a human and, thus, our results are useful for the conception of experimental hemodynamics and possible use as process models.(AU)

O coração dos suínos domésticos apresenta semelhanças ao dos humanos mediante a anatomia, perfusão sanguínea e configuração da distribuição de suas artérias nutridoras. Tendo um menor custo para sua aquisição quando comparado a outras espécies, e dada sua similaridade apresentada, o uso desses animais nas escolas de medicina, em estudos clínicos, cirúrgicos e farmacológicos tem aumentado. Portanto, objetivou-se identificar a origem e distribuição das artérias coronárias direita e esquerda de javalis com ênfase na configuração e representatividade macroscópica dos ramos derivados das mesmas, caracterizando uma possível dominância quanto ao tipo de circulação e o potencial uso deste suídeo como modelo experimental, visto que são considerados ancestrais dos suínos domésticos. A artéria coronária esquerda bifurcou-se e deu origem aos ramos interventricular paraconal e circunflexo esquerdo, ou trifurcou-se nos ramos interventricular paraconal, oblíquo e circunflexo esquerdo. Já a artéria coronária direita deu origem aos ramos marginal para o ventrículo direito e circunflexo direito que, por sua vez, ramificou-se no ramo interventricular subsinuoso. Foram evidenciadas anastomoses entre os ramos interventriculares paraconal e subsinuoso, e entre os ramos circunflexos direito e esquerdo e, conforme tal origem do ramo interventricular subsinuoso, a forma de dominância coronariana foi predominantemente direita. Conclui-se que a morfologia e distribuição das artérias coronárias de javalis se assemelham à do homem e, desse modo, nossos resultados são úteis para sua concepção da hemodinâmica experimental, e possível utilização como modelos processuais.(AU)

Ramos do arco aórtico e da aorta torácica em bicho-preguiça (Bradypus variegatus) / Branches of the aortic arch and thoracic aorta of the sloth (Bradypus variegatus)

As preguiças são mamíferos arborícolas, bem específicos quanto aos hábitos e à morfofisiologia. Essa condição faz delas ainda mais vulneráveis aos impactos ambientais. Com o objetivo de fornecer informações que auxiliem na clínica médico-cirúrgica desses Xenarthras, realizou-se um estudo do arco aórtico e da artéria aorta torácica, a fim de se identificarem seus principais ramos. Foram utilizados 10 animais da espécie Bradypus variegatus, sendo uma fêmea e três machos submetidos a dissecação, por meio da qual foram obtidas medidas de diâmetro e comprimento dos vasos, enquanto três fêmeas e três machos destinaram-se à técnica de radiografia digital com contraste. Constatou-se uma sintopia uniforme do arco, bem como da porção descendente da artéria aorta no tórax. No entanto, a topografia difere consideravelmente. Com base nos ramos, percebeu-se, independentemente do sexo, uma maior variação naqueles originados do arco e dos que emergem da artéria aorta torácica e irrigam estruturas medianas e do antímero direito do tórax. Foram obtidos valores maiores para o diâmetro das artérias na fêmea do que nos machos e, para o comprimento da artéria aorta torácica, foram encontrados valores correspondentes em ambos. Toda essa variação dos bradipodídeos apresenta diferenças em relação a outros mamíferos.(AU)

Sloths are arboreal mammals, very specific, regarding their habits and morphology. This condition makes them even more vulnerable to environmental impacts. In order to provide information to assist in the medical and surgical assistance to these Xenarthras, a study of the aortic arch and thoracic portion of the descending aorta was carried out with the purpose of identify its main branches. Ten animals of the Bradypus variegatus species were used. One female and three males were submitted to dissection, where measurements of vessel diameter and length were obtained, while three females and three males were submitted to the digital contrast x-ray technique. There was a uniform syntopy of the arch, as well as of the descending portion of the aorta in the thorax. However, the topography differs considerably. Based on the branches, regardless of gender, a greater variation was observed in those originating from the arch, and those that emerge from the thoracic aorta and irrigate medial structures and the right antimere of the thorax. Greater values were obtained for the diameter of the arteries in the female than in the males and corresponding values for the length of the thoracic aorta in both. All this variation is possibly related to the adaptive processes of Bradipodidae over time.(AU)

Pacientes con cardiopatía isquémica y enfermedad arterial periférica asintomática determinada mediante el índice tobillo-brazo / Patients with ischemic heart disease and asymptomatic peripheral vascular disease determined by means of the ankle-arm index

Se realizó un estudio descriptivo, de serie de casos, de 42 pacientes con afecciones cardiovasculares isquémicas y enfermedad arterial periférica asintomática ingresados en el Servicio de Cardiología Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero hasta diciembre de 2012, con vistas a determinar la frecuencia de dicha enfermedad mediante la estimación del índice tobillo-brazo. En la serie prevaleció el valor bajo de dicho índice (64,0 por ciento), seguido del normal (29,0 por ciento). Cabe destacar que solo 7,0 por ciento presentó calcificación arterial por encima de 1,3; datos reveladores del predominio de la enfermedad arterial periférica asintomática o subclínica

A serial cases descriptive study of 42 patients with ischemic cardiovascular disorders and asymptomatic peripheral vascular disease was carried out. They were admitted to the Cardiology Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba from January to December, 2012, aimed at determining the frequency of this disease by means of the ankle-arm index estimation. In the series the low value of this index prevailed (64.0 percent), followed by the normal index (29.0 percent). It is necessary to highlight that only 7.0 percent presented arterial calcification over 1.3; data revealing the prevalence of the asymptomatic or subclinic peripheral vascular disease

El consentimiento informado en las amputaciones mayores de miembros inferiores / Informed Consent in Major Lower Limb Amputations

Se realiza la investigación con el objetivo de perfeccionar la obtención del consentimiento informado en las amputaciones mayores de causa vascular en el Servicio de Angiología del Hospital Universitario Manuel Ascunce Domenech. Se constató debilidades en la institucionalización del consentimiento informado y específicamente en el caso de tales amputaciones. Se utilizaron métodos y técnicas del nivel empírico: encuestas a 30 pacientes con riesgo inminente de amputación. El 64% eran mayores de 65 años, 73 % femeninos, todos escolarizados y 73% residentes urbanos. Los resultados más relevantes fueron: que el 54% de los pacientes manifestaron debe existir consentimiento en la aceptación de la amputación, aunque un grupo no despreciable el 37% declinó este derecho a favor de sus familiares. A los médicos se les realizó una entrevista y aunque no hubo unanimidad de criterios, todos coincidieron en que debía legislarse este consentimiento, como parte del perfeccionamiento de los servicios de salud.

Research is conducted to improve the process of obtaining informed consent for major amputations due to vascular causes in the Angiology Service of the Manuel Ascunce Domenech Teaching Hospital. Deficiencies were identified in the institutionalization of informed consent protocols, most specifically as they relate to major lower limb amputations. Empirical methods and techniques were used. Thirty patients at imminent risk of amputation were surveyed by questionnaire methods; 64% of those surveyed were of 65 years of age, 73% were female, all of them had an average educational level, and 73% were urban residents. The results indicated that 54% of patients recognized the importance of informed consent in cases of amputation, although a rather considerable group (37%) declined this right for their families. Physicians were also interviewed and, although there was no unanimity of criteria, all of them considered that this consent should be legislated as part of the improvement of health services.

Similitudes em angiologia / Similarities in angiology

São descritos verbetes ou expressões populares usados para melhor explicar os fenômenos e as estruturas encontradas em Angiologia, de forma a trazer para a Medicina o usual da vida humana, para tornar fácil e prática a sua compreensão.

Popular terms and expressions used to explain phenomena and structures found in Angiology are described, bringing Medicine closer to everyday human life and making it easier to understand.

Caracterización clínica y quirúrgica de pacientes con enfermedad arterial periférica aortoilíaca / Clinical and surgical characterization of patients with aortoiliac peripheral artery disease

Se realizó un estudio observacional y descriptivo, de serie de casos, de 14 pacientes con enfermedad arterial periférica aortoilíaca, operados por procedimientos vasculares directos en el Servicio de Angiología y Cirugía Vascular del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, de enero del 2010 a octubre del 2012, con vistas a caracterizarles según algunos parámetros clínicos y quirúrgicos y así evaluar la efectividad del tratamiento quirúrgico. Entre los principales resultados se obtuvo que el total de la serie eran hombres de más de 50 años de edad, en quienes se efectuó la ecografía Doppler como técnica imagenológica de elección; todos los afectados con oclusiones eran fumadores y de ellos, 50 % recibió revascularización quirúrgica, mientras que la totalidad de pacientes con aneurismas padecía hipertensión arterial y en 62,5 % de estos se practicó la cirugía de sustitución vascular. Se concluyó que la enfermedad arterial periférica aortoilíaca oclusiva tiene una aparición cada vez más temprana, los aneurismas de la aorta abdominal no son diagnosticados precozmente, las angiografías y tomografías son estudios necesarios para decidir el tratamiento quirúrgico, y que los parámetros quirúrgicos, como el tiempo de pinzamiento de la aorta, la diuresis durante el pinzamiento, la diuresis total y el tiempo quirúrgico; no tuvieron graves repercusiones en el período posoperatorio, ni en la supervivencia de los pacientes.

An observational and descriptive study of case series was conducted in 14 patients with aortoiliac peripheral artery disease, operated through direct vascular procedures at the Department of Angiology and Vascular Surgery of "Saturnino Lora Torres" Provincial Teaching Clinical Surgical Hospital in Santiago de Cuba, from January 2010 to October 2012, to characterize them according to some clinical and surgical parameters and evaluate the effectiveness of the surgical treatment. Among the main results it was obtained that the total number were men over 50 years of age in whom the Doppler ultrasound was selected as imaging technique; all patients with occlusions were smokers and 50% of them underwent bypass surgery, whereas all patients with aneurysms had hypertension and 62.5% of them underwent vascular replacement surgery. It was concluded that occlusive aortoiliac peripheral artery disease has an increasingly early onset, abdominal aortic aneurysms are not diagnosed early, and angiography and CT studies are needed to decide the surgical treatment, and surgical parameters such as time of aortic clamping, diuresis during clamping, urine output and surgical time had no serious implications in the postoperative period or survival of patients.

Modelo de suprimento sanguíneo do intestino delgado e grosso da preguiça de coleira (Bradypus torquatus) / Blood supply model of the small and large intestine of the maned three-toed sloth (Bradypus torquatus)

O Bradypus torquatus, conhecido como preguiça de coleira, está classificado na lista vermelha da IUCN como vulnerável. Este animal é um folívoro estrito que se alimenta de um pequeno número de plantas. O suprimento sanguíneo do intestino delgado e grosso de oito Bradypus torquatus, pertencentes ao acervo da Anatomia dos Animais Domésticos e Sivestres da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, foi estudado. O método incluiu preparação de relatório macroscópico, perfusão do sistema arterial com água (40°C), injeção de látex corado (Neoprene® 650, Sulvinil® 2350-0003), fixação com formaldeído (10%), conservação em solução modificada de Laskowiski e dissecação por mesoscopia de luz (Lupa LTS® 3700). A irrigação dos intestinos delgado e grosso dependeu da aorta abdominal, cujo ramo visceral ventral identificado como artéria mesentérica comum distribuiu-se no mesentério e mesocólon. Uma sequência de 9 a 25 ramos colaterais primários craniais destinaram-se ao duodeno, jejuno, íleo e parte da bolsa cecal. Outra sequência de 4 a 11 ramos caudais destinaram-se à bolsa cecal e cólons. No animal adulto, o modelo de vascularização do intestino diferiu dos outros vertebrados recentes em razão de não ocorrer coalescência peritoneal ao longo do intestino delgado e grosso.

The Bradypus torquatus also known as maned three-toed sloth is listed as vulnerable in the IUCN red list. This species is strict folivorous that feeds on a relatively small number of food plants. The blood supply in the small and large intestines of eight Bradypus torquatus was studied. These animals are from the Anatomia dos Animais Domésticos e Silvestres collection of the Universidade de São Paulo . The method included preparation of the macroscopic collection report, perfusion of the arterial network with water (40°C), injection of colored latex (Neoprene 650®, 2350-0003 Suvinil® dye), fixation in formaldehyde (10%), preservation in modified Laskowski solution and dissection under mesoscopic light (Lupa LTS® 3700). The blood supply of small and large intestine depends on the abdominal aorta, whose ventral visceral branch identified as the common mesenteric artery was distributed in the mesentery and mesocolon. A sequence of 9 to 25 primary collateral branches cranial is allocated to the duodenum, jejunum, ileum and part of the cecum. Another sequence of 4 to 11 caudal branches are destined to the cecum and colon pouch. The vascular pattern of adult maned three-toed sloth intestine differs from those of other previously described vertebrates, because there is no occurrence of coalescence peritoneal through small and large intestine.

Aneurismas de aorta abdominal e ilíaca y síndrome de Loeys- Dietz / Abdominal aortic iliac aneurysms and Loeys-Dietz syndrome

Se presenta el caso clínico de una paciente de 29 años de edad, con antecedentes de ectasia aórtica, quien había sido estudiada a los 18 años mediante cineangiografía y se halló un aneurisma fusiforme de la aorta abdominal infrarrenal y de la arteria ilíaca primitiva izquierda, de causa no precisada, las cuales fueron sustituidas con derivación aortofemoral izquierda. Posteriormente, en el 2012, presentó dolor y aumento del volumen en la región inguinal izquierda, por lo que fue atendida en el Cuerpo de Guardia del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, y evaluada por especialistas del Servicio de Angiología y Cirugía Vascular, los cuales determinaron operarle de urgencia, al observar un aneurisma anastomótico de la arteria femoral izquierda, de causa micótica, y las características: craneosinostosis, úvula bífida y hendidura del paladar; propias del síndrome de Loeys-Dietz.

The case report of a 29 year-old patient, with a history of aortic ectasia who had been studied when she was 18 years through cineangiography is presented and a fusiform aneurysm of the infrarrenal abdominal aorta and of the left primitive iliac artery, of unspecific cause was found, which were substituted with left aortofemoral bypass. Later on, in 2012, she presented pain and increase of the volume in the left inguinal region, reason why she was assisted in the emergency room of "Saturnino Lora Torres" Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba, and evaluated by specialists of the Angiology and Vascular Surgery Service, which determined to treat her with an emergency surgery, when observing an anastomotic aneurysm of the left femoral artery of fungal cause, and the characteristics: craneosinostosis, bifid uvula and cleft palate; characteristic of Loeys Dietz syndrome.

Asistencia primaria y especializada en pacientes con insuficiencia arterial aguda / Specialized and primary care in patients with acute arterial insufficiency

Se efectuó un estudio descriptivo y observacional de los pacientes con insuficiencia arterial aguda de las extremidades, ingresados en el Servicio de Angiología del Hospital Clinicoquirúrgico Docente "Dr. Ambrosio Grillo Portuondo" de Santiago de Cuba, desde enero del 2008 hasta abril del 2011, con vistas a observar la evolución de estos en cuanto a un diagnóstico precoz y tratamiento oportuno. Todos los integrantes de la serie presentaron los síntomas clásicos de la afección; sin embargo, a la mayoría no se le realizó el examen de los pulsos arteriales en la atención primaria de salud y a pesar de que más de 50 % de estos fue atendido en las 4 primeras horas de iniciado el cuadro clínico, el mayor número recibió asistencia especializada de 9 a 24 horas después de manifestarlo. De igual manera, primaron el grupo etario de 61 y más años, la procedencia urbana, la ateroesclerosis obliterante (sola o unida a otras enfermedades) como la entidad clínica más asociada y la cirugía revascularizadora como proceder inicial. Un importante porcentaje de aquellos que fueron intervenidos antes de las 8 horas salvó la extremidad, pero los que recibieron tratamiento quirúrgico pasadas las 24 horas del inicio agudo fueron amputados.

A descriptive and observational study was carried out in patients with acute arterial insufficiency of the limbs, admitted to the Angiology Department of "Dr. Ambrosio Grillo Portuondo" Clinical Surgical Teaching Hospital of Santiago de Cuba, from January 2008 to April 2011, with the purpose of monitoring their progress as for an early diagnosis and treatment. All the members of the series had the classic symptoms of the condition, but the majority did not undergo the examination of arterial pulses in the primary health care, and although more than 50% of them were treated at the first 4 hours after the onset of symptoms, most of them received specialized care between 9 and 24 hours of its manifestation. Similarly, age group of 61 years and over, urban origin, obliterating atherosclerosis (alone or combined with other diseases) prevailed as the clinical entity most associated and surgical revascularization as an initial procedure. A significant percentage of those who were operated before 8 hours saved the limb, but those that were operated after 24 hours of acute onset were amputees.

Experiencia cubana con el uso terapéutico de células madre adultas / Cuban experience with the therapeutic use of adult stem cells

Las investigaciones básicas y clínicas realizadas en los últimos años sobre las células madre y sus posibilidades terapéuticas, son en la actualidad uno de los temas más excitantes de la medicina contemporánea. Ya se han obtenido importantes avances en el estudio y aplicación de las células madre adultas que muestran notables ventajas sobre las embrionarias, pues su manipulación resulta más simple, económica y se pueden obtener del propio individuo que va a ser tratado. Para la introducción en Cuba de la terapia celular regenerativa, en el Instituto de Hematología e Inmunología se seleccionaron como fuentes celulares las células madre adultas derivadas de la médula ósea y las movilizadas a la sangre periférica. Para facilitar la extensión del tratamiento a otros centros hospitalarios, se estandarizó una técnica para la movilización de las células madre hematopoyéticas a la sangre periférica, mediante un factor estimulador de colonias de granulocitos (Filgrastim, de producción nacional) y se desarrolló un método simple, económico y también más tolerable para los enfermos. De esta forma, se ha extendido la terapia celular a 6 provincias cubanas y hasta abril del año 2009 se habían tratado 563 casos con trasplante de células madre adultas autólogas, de los cuales el 81,7 por ciento corresponde a pacientes con enfermedades angiológicas, en los que se ha logrado disminuir significativamente la indicación de amputaciones mayores. También los resultados han sido muy prometedores en las lesiones óseas y procesos periodontales, entre otras enfermedades tratadas. Los resultados obtenidos hasta el momento se pueden considerar como un nuevo logro de la ciencia revolucionaria y de nuestros sistemas nacionales de salud y de ciencia y técnica. El método empleado es un proceder económico y factible para instituciones con recursos limitados

The basic and clinical researches carried out during past years on the stem cells and its therapeutic possibilities are at present times, one of the most interesting subjects of the contemporaneous medicine. There are advances in the study and application of adult stem cells showing remarkable advantages on the embryonic ones, since its handling is more simple, economic and they are obtained from the own subject to be treated. For the introduction in Cuba of the regenerative cellular therapy in the Institute of Hematology and Immunology the cellular sources selected were the adult stem cells derived from bone marrow and the mobilized ones to the peripheral blood. To make easy the expansion of treatment to other hospital centers, authors standardized a technique for the mobilization of the hematopoietic stem cells to peripheral blood using a granulocyte colony-stimulating factor (Filgrastim, of national production) developing a simple, economic and more tolerable method for patients. In this way, the cellular therapy has been expanded to 6 Cuban provinces and until April, 2009 562 cases with autologous adult stem cells transplant have been treated, from which the 81.7 percent to correspond to patients presenting with Angiology diseases with a significant reduction of major amputations. Also, the results have been very promising in the bone lesions and periodontal processes among other diseases treated. The results obtained until now may be considered as a new achievement of revolutionary science and of our national health systems and of science and technique. The method used is an economic and feasible procedure for the institutions with scarce resources

El caudal de lo pueblos son sus heroes: dr. pedro antonio brunet pedroso / The wealth of population is its heroes: Dr. Antonio Brunet Pedroso

Convertir la vida cotidiana en un proceso extraordinario en beneficio de la sociedad y que incluso ello sea reconocido por los semejantes hace que el hombre común ascienda a la condición de héroe. En nuestras instituciones de salud, encontramos a estas personalidades relevantes y debemos reconocerlas si queremos ganar en una formación en valores. Por ello, hemos tenido el privilegio de examinar la historia de la vida de un Profesor Consultante de Cirugía y Angiología, quien alcanza las cumbres del conocimiento, en la ciencia, la docencia y el trabajo asistencial, con obras que aportan a la especialidad y a la educación popular, y todo ello junto a la constitución de una familia honorable. Se trata del doctor Brunet Pedroso, en activo dentro del Hospital Militar Central Carlos J. Finlay, de Ciuda de La Habana. Su trayectoria es ejemplo y estímulo. Reconocer héroes los hace. Contribuir a este propósito, se encamina el presente trabajo.

To turn the daily life into an extraordinary process in behalf of the society and that even it being recognized by others, causes that the common man ascends to the condition of hero. In our institutions of health we found these kind of excellent personalities and we must recognize them if we want to win in a formation in values. For that reason we have had the privilege to examine the history of life of the Surgery and Angiology Consultant Professor summit of the knowledge, in science, teaching, the welfare work, with papers that contribute to the specialty and the popular education. One is doctor Brunet Pedroso,an active-duty within the Military Hospital Central “Carlos J. Finlay”, of Havana . Its trajectory is example and stimulus. The present work is about recognition of those heroes.

Topografía y Biometría del Sistema Venoso Coronario y de sus tributarias / Topography and Biometry of the Coronary Venous System and its Tributaries

El seno coronario es la principal terminación de las venas cardiacas, recibiendo toda su sangre, excepto aquella conducida por las venas cardíacas anteriores y venas cardíacas mínimas.Está localizado en la porción posterior del surco coronario, entre el atrio y ventrículo izquierdos. Sus afluentes directos son las vv cardiacas magna (VCM), media (VCMe), parva (VCP), oblicua del atrio izquierdo (VOAI) y posteriores del ventrículo izquierdo (VPVI). Estudiamos el seno coronario y sus afluentes en 26 corazones de cadáveres de individuos brasileños, adultos, de ambos sexos, con el propósito de obtener datos biométricos del mismo. El calibre en la parte central del tercio izquierdo del seno coronario varió entre 4 y 10 mm, con un promedio de 6,34mm; el del tercio medio varió entre 7 y 14 mm, con un promedio de 9,13mm y en el tercio derecho, a nivel de su desembocadura, varió entre 5 y 16 mm con promedio de 9,28mm. Su longitud se ubicó entre 27 y 54 mm, con un promedio de 40,3 mm. En todos los corazones la VCM se continuó con el extremo izquierdo del seno coronario. En 22 de ellos (84,6%), la VOAI desembocó en su tercio izquierdo y en los 4 restantes ésta estuvo ausente. El seno coronario recibió la vena marginal izquierda en 3 casos (11,5%). En todos los casos, la VCMe desembocó en el tercio derecho del seno. En 16 casos (61,5%) alguna VPVI desembocó en su tercio izquierdo.De éstos, hubo una VPVI en 10 corazones (38,5%), dos VPVI en 4 (15,3%) y tres VPVI en 2 (7,7%). En 23 corazones (88,5%), alguna VPVI lo hizo en su tercio medio y de estos casos, una VPVI terminó en 15 (57,7%) y dos VPVI en los 8 restantes (30,8%). En 21 casos (80,8%) alguna VPVI terminó en su tercio derecho y de éstos, se observó una VPVI en 14 corazones (53,9%), dos en 5 (19,2%) y tres en 2 (7,7%). La biometría del seno coronario es muy variable, así como la disposición de sus tributarias, por lo que esperamos que los datos obtenidos sirvan de soporte morfológico a la anatomía ...

The coronary sinus (SC) is the main end of the cardiac veins, being the principal vein of the heart, draining all its blood, except that driven by the anterior cardiac veins and the minimum cardiac veins. Its location is well-defined in the posterior portion of the coronary sulcus between left atrium and ventricle. Its direct tributaries are the cardiac veins: magna (VCM), media (VCMe), parva (VCP), oblique of the left atrium (VOAE), posterior veins of the left ventricle (VPVE). The diameter in the middle of the distal third of the coronary sinus ranged from 4 to 10 mm (mean 6,34 mm); about its medium third, such value ranged from 7 to 14 mm (mean 9,13 mm) and in its proximal third, its diameter ranged from 5 to 16 mm (mean 9,28 mm). Its length ranged from 27 to 54 mm (mean 40,3 mm). In 26 hearts (100 % of the cases), the VCM continued into the SC in its left side; in 22 cases (84,6%), the VOAE flowed into its left third; in the remaining 4 (15,4%), it was absent; The SC received the left marginal vein in 3 hearts (11,5%). In 26 cases (100%), the VCMe discharged in the right extremity of the SC; in 16 hearts (61,5%), some VPVE drained into the left third of the SC, in these there was 1 VPVE in 10 (38,5%), 2 VPVE in 4 (15,3%) and 3 VPVE in 2 (7,7%). In 23 hearts (88,5%), some VPVE discharged in the middle third of the SC; in these, there was 1 VPVE in 15 cases (57,7%) and 2 VPVE in 8 (30,8%). In 21 hearts (80,8%), some VPVE drained into the right third of the SC, in these, there was 1 VPVE in 14 (53,9%), 2 VPVE in 5 (19,2%), 3 VPVE in 2 (7,7 %). One of the most polemic aspects in the study of the coronary sinus is its own biometry, contributing to this divergence the absence of a standart location to its beginning and a pattern on tributaries disposition.