Peliminary experience of transcatheter aortic valve implantation with VENUS-Avalve / 中国介入心脏病学杂志

Objective To summarize the experience of transcatheter aortic valve implantation (TAVI) in the treatment of severe aortic stenosis (AS) with VENUS-A valve. Methods Retrospectively collected and analyzed the baseline characteristics,preoperative assessment, surgery details,early and mid-term clinical outcome of 10 patients who underwent TAVI. Results From April 2016 to April 2017,10 patients with severe AS were treated with TAVI at the Guangdong General Hospital. The median age was 75 (65,81)years old and 5(5/10)were males. The median Society of Thoracic Surgery score was 5% (2%,11%). TAVI was successful in 10 patients (10/10),and percutaneous coronary intervention was performed in two cases (2/10) at the same time. The median operation time was 190 (150,225) minutes,the ICU monitoring time was 113 (49, 231) hours,and the hospital stay was 12 (6,25) days. After the procedure,the mean aortic-valve gradient reduced to 10(6,21)mmHg(1 mmHg=0.133 kPa). There was minimal or mild marginal periprosthetic leak in five patients(5/10)and moderate leak in one patient(1/10). During the 30 days of follow up,one patient(1/10)die due to perioperative myocardial infarction and ventricular fibrillation. One patient(1/10)was implanted with a permanent pacemaker for severe arrhythmia. Two patients(2/10)occurred vascular complications. The median follow-up was 3(1,15)months. One patient had syncope at 6 months post operation with R-R interval up to 7 seconds and he was implanted with a permanent pacemaker. There was no death,stroke,surgical surgery intervention and rehospitallization due to heart failure during the follow up. Conclusions It is feasible,safe and effective to use VENUS-A valve for TAVI treatment in serve AS.

Peliminary experience of transcatheter aortic valve implantation with VENUS-Avalve / 中国介入心脏病学杂志

Objective To summarize the experience of transcatheter aortic valve implantation (TAVI) in the treatment of severe aortic stenosis (AS) with VENUS-A valve. Methods Retrospectively collected and analyzed the baseline characteristics,preoperative assessment, surgery details,early and mid-term clinical outcome of 10 patients who underwent TAVI. Results From April 2016 to April 2017,10 patients with severe AS were treated with TAVI at the Guangdong General Hospital. The median age was 75 (65,81)years old and 5(5/10)were males. The median Society of Thoracic Surgery score was 5% (2%,11%). TAVI was successful in 10 patients (10/10),and percutaneous coronary intervention was performed in two cases (2/10) at the same time. The median operation time was 190 (150,225) minutes,the ICU monitoring time was 113 (49, 231) hours,and the hospital stay was 12 (6,25) days. After the procedure,the mean aortic-valve gradient reduced to 10(6,21)mmHg(1 mmHg=0.133 kPa). There was minimal or mild marginal periprosthetic leak in five patients(5/10)and moderate leak in one patient(1/10). During the 30 days of follow up,one patient(1/10)die due to perioperative myocardial infarction and ventricular fibrillation. One patient(1/10)was implanted with a permanent pacemaker for severe arrhythmia. Two patients(2/10)occurred vascular complications. The median follow-up was 3(1,15)months. One patient had syncope at 6 months post operation with R-R interval up to 7 seconds and he was implanted with a permanent pacemaker. There was no death,stroke,surgical surgery intervention and rehospitallization due to heart failure during the follow up. Conclusions It is feasible,safe and effective to use VENUS-A valve for TAVI treatment in serve AS.

Implementación y evaluación de un curso de accesos venosos centrales ecoguiados para hemodiálisis con simuladores / Implementation and evaluation of a course on central venous access for hemodialysis with simulators

Introducción: el uso de simuladores en el aprendizaje de maniobras invasivas contribuye a la seguridad del paciente. Objetivos: diseñar y evaluar un curso para aprendizaje de la realización de vías venosas centrales con ecografía Doppler y uso de simuladores. Material y método: se definieron objetivos de aprendizaje, contenidos y metodología didáctica. Se realizaron pruebas de evaluación de destrezas, inicial y final, mediante una evaluación clínica objetiva estructurada (ECOE). Se evaluó la opinión de los estudiantes y el nivel de autoconfianza adquirido. El impacto en la práctica clínica se determinó a través del registro de las maniobras de colocación de vía venosa central (VVC) en el semestre siguiente. Resultados: el curso se realizó en el primer semestre 2015 para los siete estudiantes de posgrado de Nefrología de primer año y constó de cuatro instancias (tres horas), con introducción teórica y actividades prácticas con retroalimentación docente inmediata. La encuesta de satisfacción fue Muy Satisfactorio-Excelente en 7/7 y el nivel de autoconfianza aumentó en 4/7 participantes. Se observó una mejora significativa en los ECOE inicial vs final (test de t muestras pareadas p < 0,05). Se realizó una instancia de reparación. Se registraron las 64 VVC realizadas por los participantes, en el semestre siguiente al curso, y las complicaciones experimentadas: dos punciones arteriales, tres hematomas localizados, un aneurisma arterial y un neumotórax (10%), todos con buena evolución. Conclusiones: el uso de simuladores en el aprendizaje de maniobras invasivas logró un alto grado de satisfacción de los participantes, un aumento de su autoconfianza y una mejora significativa en el aspecto técnico

Abstract Introduction: the use of simulators for learning invasive maneuvers contributes to patients’ safety. Objectives: to design and evaluate a course for learning how to introduce central venous catheters with Doppler ultrasound and the use of simulators. Method: learning objectives, contents and didactics were defined. Initial and final skills were evaluated by means of an objective structured clinical evaluation (OSCE). The opinion of students and the level of self confidence achieved were evaluated. The impact on the clinical practice was determined by means of a record of the maneuvers of introduction of the central venous line in the following semester. Results: the course was carried our in the first semester of 2015 for the seven Nephrology postgraduate students. It consisted of four modules (three hours) which comprised a theoretical introduction and practical activities, with the immediate feedback by professors. The satisfaction survey revealed the following: very satisfactory-excellent in 7/7 and the level of self-confidence increased in 4/7 participants. A significant improvement was noticed in the initial vs final OSCE (paired samples T-Test 0.05). A repairing instance was prepared. 64 central central venous lines were introduced by participants in the following course, and complications found included the following: two artery punctures, three hematomas localized, an artery aneurysm and a pneumothorax (10%), all of them evidenced a positive evolution. Conclusions: the use of simulators in the learning of invasive maneuvers achieved a high level of satisfaction among participants, an increase in self-confidence and a significant improvement in technical aspects.

Resumo Introdução: o uso de simuladores para a aprendizagem de manobras invasivas contribui para a segurança do paciente. Objetivos: planejar e avaliar um curso para aprendizagem da realização de vias venosas centrais com ultrassom Doppler e uso de simuladores. Material e método: foram definidos os objetivos de aprendizagem, conteúdos e metodologia didática. Foram realizadas provas de avaliação de destrezas, inicial e final, utilizando uma avaliação clínica objetiva estruturada (ECOE). Também foram avaliados a opinião dos estudantes e o nível de autoconfiança adquirido. O impacto na prática clínica foi determinado pelo registro das manobras de colocação de via venosa central (VVC) no semestre seguinte. Resultados: o curso foi realizado no primeiro semestre de 2015 com os sete estudantes do primeiro ano de pós-graduação em Nefrologia constava de quatro módulos de três horas cada, com introdução teórica e atividades práticas com retroalimentação docente imediata. A pesquisa de satisfação mostrou um resultado Muito Satisfatório-Excelente em 7/7 e o nível de autoconfiança aumentou em 4 dos 7 participantes. Foi observada uma melhoria significativa nos ECOE inicial vs final (teste de t para amostras pareadas p < 0,05). Também foi realizada um módulo de reparação. No semestre seguinte ao curso foram registradas as 64 VVC realizadas pelos participantes e as complicações observadas: duas punções arteriais, três hematomas localizados, um aneurisma arterial e um pneumotórax (10%), todos com boa evolução. Conclusões: o uso de simuladores na aprendizagem de manobras invasivas teve um alto grado de satisfação dos participantes, mostrou um aumento da autoconfiança dos mesmos e uma melhoria significativa dos aspectos técnicos.

Creando desde Afrodita o Venus: una representación femenina arquetípica del amor, la sexualidad, el cuerpo y la función alquímica de transformación / Creating from Aphrodite or Venus: an archetypal female representation of love, sexuality, the body and the alchemical transformation function

La pregunta por la psique y su relación con lo femenino se encuentra soterrada en la actualidad por una sociedad que privilegia el logos y la tecnología como maneras de hacer lecturas efectivas del mundo y los sujetos. Venus o Afrodita, según su versión griega o romana, plantea en su mito una posibilidad de reflexión profunda acerca de lo femenino en íntima conexión con el psiquismo y el ejercicio de la psicoterapia. El privilegio de lo masculino y sus expresiones sociales en la forma de razón, competitividad, guerra y consumismo, han velado a lo femenino con representaciones que lo proscriben y desvalorizan mediante figuras como Eva o Pandora, en tanto sus presentaciones. La revisión de la "Gran Diosa" antigua y la exaltación de lo femenino como fuerza creadora y transformadora, permiten entenderlo como algo que está más allá de su reducción a la condición de objeto y restituyen al mito su capacidad de comprensión del ser humano a la luz de la psicoterapia como actividad de creación y transformación, en relación con los temas que encarna la Diosa como las emociones, la sexualidad y el cuerpo. Su análisis otorgará interrogantes que podrán contribuir en las construcciones acerca del psiquismo y de las fuerzas que intervienen en su dinámica.

The question for the psyche and its relationship with the feminine thing is buried at the present time by a society that privileges the logoses and the technology like ways of making effective readings of the world and the fellows. Venus or Aphrodite, according to their Greek or Roman version, outline in their myth a possibility of deep reflection about the feminine thing in intimate connection with the psyche and the exercise of the psychotherapy. The privilege of the masculine thing and their social expressions in the reason form, competitiveness, war and consumerism, they have veiled to the feminine thing with representations that outlaw him and they devaluate by means of figures as Eva or Pandora, as long as their presentations. The Great old Goddess's revision and the exaltation of the feminine thing as force creator and transformer, they allow to understand it as something that is beyond their reduction to the condition of objects and they restore to the myth their capacity of the human being understanding by the light of the psychotherapy like creation activity and transformation, in connection with the topics that it embodies the Goddess like the emotions, the sexuality and the body. Their analysis will grant queries that you/they will be able to contribute in the constructions about the psyche and of the forces that intervene in its dynamics.

Trauma renal, a propósito de un caso / Renal trauma, case report

Se presenta el caso de una paciente de 9 años de edad con antecedente de trauma renal grado IV, a la que tubo que realizarse nefrectomía. La conducta quirúrgica se determino por los hallazgos de exámenes complementarios como la urografía endovenosa. Actualmente se considera que el tratamiento conservador es una opción en la mayoría de los paciente con trauma renal, existiendo pocas indicaciones para una conducta quirúrgica en este tipo de pacientes. Es de vital importancia la adecuada interpretación de los exámenes complementarios para determinar una conducta. Se aprovecha el caso clínico para realizar una revisión de la literatura.

The case of a patient of 9 years of age with antecedent of renal trauma appears degree IV, to which to be made nefrectomy. The conduct I determine myself by the complementary findings of examines like urografhy. At the moment it is considered that the preservative treatment is an option in mayor of the patient with renal trauma, existing few indications for a quirurgica conduct in this type of patients. It is of vital importance the suitable interpretation of examination complementary to determine a conduct.