Descripción de la afectación de la destreza y función manual en pacientes con distonía focal de la mano / Alterations in dexterity and manual function in patients with focal hand dystonia

Introducción: La distonía focal de la mano es un trastorno del movimiento cuya sintomatología produce una alteración en el desempeño de tareas que requieren un nivel de destreza alto. Actualmente no se dispone de un modelo de interpretación de la enfermedad y son escasos los estudios que identifican las dificultades de las personas con distonía al desempeñar las actividades de la vida diaria (AVD). Por todo ello, el objetivo del estudio es describir la destreza manipulativa y su influencia en las AVD de los pacientes con distonía focal de la mano.Material y métodoSe realizó un estudio observacional, transversal, tipo casos y controles. Se reclutaron 24 participantes: 12 pacientes y 12 sujetos control. Los pacientes fueron derivados por el Servicio de Neurología del Hospital Ramón y Cajal. Se obtuvieron datos sociodemográficos y clínicos retrospectivos en el grupo de casos. Posteriormente, se administraron pruebas de evaluación, en el siguiente orden: Nine Hole Peg Test (NHPT), Box and Blocks Test (BBT), Purdue Pegboard Test (PPT) y Jebsen-Taylor Test of Hand Function (JTTHF).ResultadosEn la muestra del estudio participaron un total de 24 personas, siete mujeres y 17 hombres, con una media de edad de 50,79 ± 14,40 años. Del total de participantes con distonía focal se observó que, aunque la mitad de la muestra no identificó signos de afectación neuromuscular, ni problemas psicoemocionales, un menor porcentaje de estos pacientes identificaron dificultades asociadas con el hombro derecho (25%) y el estado ansioso (33,3%).ConclusionesLos hallazgos encontrados en el presente trabajo señalan que la distonía focal de la mano afecta a la destreza manipulativa de estos pacientes, presentando una peor ejecución y requiriendo más tiempo para su ejecución. (AU)

Introduction: Focal hand dystonia is a movement disorder whose symptoms cause alterations in the performance of tasks requiring a high level of dexterity. Currently, there is no model for interpreting the disease and few studies have identified the difficulties of patients with dystonia in carrying out activities of daily living (ADL). This study aims to describe manipulative dexterity and its influence on ADLs in patients with focal hand dystonia.Materials and methodsWe performed an observational, cross-sectional, case-control study including 24 participants (12 patients with focal hand dystonia and 12 controls). The patients were referred by the neurology department of Hospital Ramón y Cajal. We gathered sociodemographic data, as well as retrospective clinical data for patients. We subsequently administered evaluation tests, in the following order: Nine-Hole Peg Test (NHPT), Box and Blocks Test (BBT), Purdue Pegboard Test (PPT), and Jebsen-Taylor Test of Hand Function (JTTHF).ResultsThe study sample included a total of 24 participants, 7 women and 17 men, with a mean age (standard deviation) of 50.79 (14.40) years. In the patient group, neuromuscular involvement or psycho-emotional problems were not detected in half of cases; smaller numbers of patients presented difficulties associated with the right shoulder (25%) and anxious state (33.3%).ConclusionsOur results indicate that focal hand dystonia affects manipulative dexterity in these patients, who showed poorer performance and required more time to complete the tasks. (AU)

Alterations in dexterity and manual function in patients with focal hand dystonia.

INTRODUCTION: Focal hand dystonia is a movement disorder whose symptoms cause alterations in the performance of tasks requiring a high level of dexterity. Currently, there is no model for interpreting the disease and few studies have identified the difficulties of patients with dystonia in carrying out activities of daily living (ADL). This study aims to describe manipulative dexterity and its influence on ADLs in patients with focal hand dystonia. MATERIALS AND METHODS: We performed an observational, cross-sectional, case-control study including 24 participants (12 patients with focal hand dystonia and 12 controls). The patients were referred by the neurology department of Hospital Ramón y Cajal. We gathered sociodemographic data, as well as retrospective clinical data for patients. We subsequently administered evaluation tests, in the following order: Nine-Hole Peg Test (NHPT), Box and Blocks Test (BBT), Purdue Pegboard Test (PPT), and Jebsen-Taylor Test of Hand Function (JTTHF). RESULTS: The study sample included a total of 24 participants, 7 women and 17 men, with a mean age (standard deviation) of 50.79 (14.40) years. In the patient group, neuromuscular involvement or psycho-emotional problems were not detected in half of cases; smaller numbers of patients presented difficulties associated with the right shoulder (25%) and anxious state (33.3%). CONCLUSIONS: Our results indicate that focal hand dystonia affects manipulative dexterity in these patients, who showed poorer performance and required more time to complete the tasks.

Alterations in dexterity and manual function in patients with focal hand dystonia. / Descripción de la afectación de la destreza y función manual en pacientes con distonía focal de la mano.

INTRODUCTION: Focal hand dystonia is a movement disorder whose symptoms cause alterations in the performance of tasks requiring a high level of dexterity. Currently, there is no model for interpreting the disease and few studies have identified the difficulties of patients with dystonia in carrying out activities of daily living (ADL). This study aims to describe manipulative dexterity and its influence on ADLs in patients with focal hand dystonia. MATERIALS AND METHODS: We performed an observational, cross-sectional, case-control study including 24 participants (12 patients with focal hand dystonia and 12 controls). The patients were referred by the neurology department of Hospital Ramón y Cajal. We gathered sociodemographic data, as well as retrospective clinical data for patients. We subsequently administered evaluation tests, in the following order: Nine-Hole Peg Test (NHPT), Box and Blocks Test (BBT), Purdue Pegboard Test (PPT), and Jebsen-Taylor Test of Hand Function (JTTHF). RESULTS: The study sample included a total of 24 participants, 7 women and 17 men, with a mean age (standard deviation) of 50.79 (14.40) years. In the patient group, neuromuscular involvement or psycho-emotional problems were not detected in half of cases; smaller numbers of patients presented difficulties associated with the right shoulder (25%) and anxious state (33.3%). CONCLUSIONS: Our results indicate that focal hand dystonia affects manipulative dexterity in these patients, who showed poorer performance and required more time to complete the tasks.

[Effectiveness of the virtual reality in the rehabilitation of the upper limb in the spinal cord injury. A systematic review]. / Efectividad de la realidad virtual en la rehabilitacion del miembro superior en la lesion de la medula espinal. Revision sistematica.

INTRODUCTION: Spinal cord injury is a complex and life-disrupting condition. The functional recovery of the upper limb has been considered as an important objective in tetraplegia because it improves significantly the quality of living in these patients. Virtual reality is a new emerging tool of rehabilitation in spinal cord injured patients. AIM: To carry out a systematic review about the information about the application of these systems in spinal cord injury in the rehabilitation of the upper limb. PATIENTS AND METHODS: This review includes clinical trials dated until April 2018, which investigate the functional recovery of the upper limb through virtual reality systems in patients with complete or incomplete tetraplegia. The following databases were used to search for those clinical trials: Scopus, Web of Science, PubMed, Medline Complete, Science Direct, CINHAL and Brain. RESULTS: Five articles were selected for this review, including randomized clinical trials and clinical trials. The main results show a good tendency on the functional recovery with the combination of virtual reality systems and conventional therapy. CONCLUSIONS: The main limitations and the low quality of the studies show the necessity of further investigations with this new tool of rehabilitation. However, the incorporation of virtual reality systems as a rehabilitation supplement might be a beneficial tool on the functional recovery in spinal cord injury.

TITLE: Efectividad de la realidad virtual en la rehabilitacion del miembro superior en la lesion de la medula espinal. Revision sistematica.Introduccion. La lesion de la medula espinal es un estado funcional complejo que limita gravemente la vida de la persona. Por ello, la recuperacion de la funcionalidad del miembro superior en la tetraplejia se considera un objetivo primordial, ya que mejora significativamente la calidad de vida de estas personas. Ademas de las terapias convencionales, la realidad virtual supone un nuevo enfoque terapeutico en la rehabilitacion del lesionado medular. Objetivo. Realizar una revision sistematica sobre la efectividad de la rehabilitacion del miembro superior en pacientes con lesion medular a traves de la realidad virtual. Pacientes y metodos. Se recopilaron datos de ensayos clinicos hasta abril de 2018 que investigaran la rehabilitacion con sistemas de realidad virtual en los miembros superiores de pacientes con lesion medular completa e incompleta. Las bases de datos consultadas en esta revision incluyeron: Scopus, Web of Science, PubMed, Medline Complete, Science Direct, CINHAL y Brain. Resultados. Se analizaron cinco articulos, los cuales incluyeron ensayos controlados aleatorizados y ensayos clinicos. Los principales resultados de los estudios muestran buena tendencia de la rehabilitacion a traves de la realidad virtual en combinacion con terapia convencional. Conclusiones. Las limitaciones encontradas en los estudios, asi como su baja calidad metodologica, suponen la necesidad de mayores investigaciones acerca de la efectividad de esta nueva herramienta. Aun asi, la buena tendencia de los estudios se considera de interes para futuras investigaciones.

Adaptación inicial de un cuestionario de autopercepción de calidad de vida en pacientes con disfagia / Initial adaptation of a questionnaire on selfperception of quality of life in patients with dysphagia

El propósito de este estudio fue realizar una adaptación inicial a la población chilena del Swallowing Quality of Life Questionnaire (SWAL-QOL), instrumento diseñado para conocer la autopercepción de la calidad de vida que informan las personas con disfagia orofaríngea.La adaptación se realizó mediante el proceso de traducción y retrotraducción y se obtuvo una versión final del cuestionario a través del consenso de expertos.Posteriormente, el cuestionario se aplicó a diez personas con disfagia a consecuencia de un accidente cerebrovascular. Los resultados evidenciaron que la adaptación del instrumento puede ser considerada adecuada. Los valores de consistencia interna para todas las escalas son buenos, con coeficientes de α de Cronbach entre 0.71 y 0.90. Los pacientes con disfagia reportaron una percepción disminuida de su calidad de vida, los puntajes más bajos se presentaron en duración de la alimentación (47.00 ± 9.90) y salud mental (48.00 ± 17.78). La versión adaptada del SWAL-QOL que se presenta es de fácil aplicación en la práctica clínica y entrega información valiosa acerca de la autopercepción de la calidad de vida de las personas con disfagia

The purpose of this study was to carry out an initial adaptation to the Chilean population of the Swallowing Quality of Life Questionnaire (SWAL-QOL) instrument designed to know the perception of quality of life in persons with oropharyngeal dysphagia.The adaptation of the instrument was carried out via translation and back-translations, which resulted in a final version of the questionnaire through consensus of experts. It was applied to ten people with dysphagia due to stroke.The adaptation of the instrument was considered appropriate and values of internal consistency for all scales were adequate, with coefficients α Cronbach ranging between 0.71 and 0.90. Dysphagia patients reported a decrease in their perception of quality of life, with the lowest scores observed for feeding duration (47.00 ± 9.90) and mental health (48.00 ± 17.78).The present study presents an adapted version of the SWAL-QOL, which is easy to apply in clinical practice

Removal of sulfur-containing organic molecules adsorbed on inorganic supports by Rhodococcus Rhodochrous spp.

OBJECTIVE: To remove dibenzothiophene (DBT) and 4,6-dimethyl-dibenzothiophene (4,6-DMDBT) adsorbed on alumina, silica and sepiolite through biodesulfurization (BDS) using Rhodococcus Rhodochrous spp., that selectively reduce sulfur molecules without generating of gaseous pollutants. RESULTS: The adsorption of DBT and 4,6-DMDBT was affected by the properties of the supports, including particle size and the presence of surface acidic groups. The highest adsorption of both sulfur-containing organic molecules used particle sizes of 0.43-0.063 mm. The highest percentage removal was with sepiolite (80 % for DBT and 56 % for 4,6-DMDBT) and silica (71 % for DBT and 37 % for 4,6-DMDBT). This is attributed to the close interaction between these supports and the bacteria. CONCLUSIONS: Biodesulfurization is effective for removing the sulfur-containing organic molecules adsorbed on inorganic materials and avoids the generation of gaseous pollutants.

4-Phenylbutyric acid prevent cytotoxicity induced by thapsigargin in rat cardiac fibroblast.

Cardiac fibroblast (CF) survival is important for the maintenance of the extracellular matrix homeostasis in the heart; providing a functional support to cardiomyocytes necessary for the correct myocardial function. Endoplasmic reticulum (ER) stress causes cellular dysfunction and cell death by apoptosis; and thapsigargin is a well-known ER stress inducer. On the other hand, the chemical chaperone, 4-phenylbutyric acid (4-PBA) had showed to prevent ER stress; however, in cardiac fibroblast both the ER stress induced by thapsigargin and prevention by 4-PBA, have not been studied in detail. Neonate rat CF were treated with thapsigargin in presence or absence of 4-PBA, and cell viability was evaluated by trypan blue exclusion and apoptosis by flow cytometry; whereas CHOP, BIP, PDI, ATF4 and procollagen protein levels were assessed by western blot. In CF, thapsigargin triggered the unfolded protein response detected by early increases in ATF4, CHOP, PDI and BIP protein levels as well as, the accumulation of intracellular procollagen. Thapsigargin also stimulated CF death in a time and concentration-dependent manner. ER stress, CF death and apoptosis induced by thapsigargin were prevented by 4-PBA. Conclusion our data suggest that 4-PBA prevent ER stress, intracellular procollagen accumulation, CF death and apoptosis induced by thapsigargin.

Biodesulfurization of dibenzothiophene and gas oil using a bioreactor containing a catalytic bed with Rhodococcus rhodochrous immobilized on silica.

Biodesulfurization (BDS) in a bioreactor packed with a catalytic bed of silica containing immobilized Rhodococcus rhodochrous was studied. Various bed lengths and support particle sizes were evaluated for BDS of dibenzothiophene (DBT) and gas oil. The sulfur-containing substrates were introduced separately into the bioreactor at different feed flows. Higher removal of sulfur from DBT and gas oil was achieved with a long bed, lower substrate flow, and larger sizes of immobilization particles. The packed bed bioreactor containing metabolic active cells was recycled and maintained BDS activity.

[Outbreaks of acute gastroenteritis in Antofagasta Region, Chile 2010]. / Brote de gastroenteritis aguda en la Región de Antofagasta,Chile: 2010.

Outbreaks of acute gastroenteritis are a public health problem. Norovirus is known as the most common cause (50%). In Chile, immediate notification allows surveillance of these events. We describe an acute gastroenteritis outbreak that occurred in Antofagasta region, between March and April 2010. An observational study was conducted to perform the outbreak investigation. Local residents who met case definition were included. Stool samples, epidemiological surveys and environmental samples were requested. The outbreak began approximately on March 8, 2010 and lasted until April 28 with 31,036 reported cases (rate 54 per 1000 inhabitants). The most affected age group was between 25 and 44 years, and diarrhea was the main symptom (97% of cases). We determined the presence of norovirus genogroup II in clinical and environmental samples. This outbreak was caused by consumption of raw vegetables from La Chimba, which were watered and contaminated with treated sewage containing low concentration of free residual chlorine. Subsequently, the outbreak spread from person to person in a poor sanitary environment.

Brote de gastroenteritis aguda en la Región de Antofagasta,Chile: 2010 / Outbreaks of acute gastroenteritis in Antofagasta Region: Chile 2010

Outbreaks of acute gastroenteritis are a public health problem. Norovirus is known as the most common cause (50%). In Chile, immediate notification allows surveillance of these events. We describe an acute gastroenteritis outbreak that occurred in Antofagasta region, between March and April 2010. An observational study was conducted to perform the outbreak investigation. Local residents who met case definition were included. Stool samples, epidemiological surveys and environmental samples were requested. The outbreak began approximately on March 8, 2010 and lasted until April 28 with 31,036 reported cases (rate 54 per 1000 inhabitants). The most affected age group was between 25 and 44 years, and diarrhea was the main symptom (97% of cases). We determined the presence of norovirus genogroup II in clinical and environmental samples. This outbreak was caused by consumption of raw vegetables from La Chimba, which were watered and contaminated with treated sewage containing low concentration of free residual chlorine. Subsequently, the outbreak spread from person to person in a poor sanitary environment.

Antecedentes: Los brotes por gastroenteritis aguda constituyen un problema de salud pública. Se conoce al norovirus como la causa más común (50%). En Chile, la vigilancia de estos eventos, se establece mediante la notificación inmediata. Objetivo: Investigar y caracterizar el brote de gastroenteritis aguda ocurrido en la Región de Antofagasta, durante los meses de marzo y abril de 2010. Método: Se efectuó un estudio observacional descriptivo para realizar la investigación de brote. Se incluyó a residentes de la región que cumplían con la definición de caso. Se solicitó muestras de deposición, encuesta epidemiológica y muestras ambientales. Resultados: Se estimó que el brote comenzó el 8 de marzo de 2010 y duró hasta el 28 de abril del mismo año; se notificaron 31. 036 casos (tasa 54 por 1.000 habitantes). El grupo de 25 y 44 años de edad fue el más afectado y la diarrea fue el síntoma predominante (97% de los casos). Se determinó la presencia de norovirus genogrupo II en muestras clínicas y ambientales. Conclusiones: El brote se originó por el consumo crudo de hortalizas que provenían del sector La Chimba, las que fueron regadas y contaminadas con agua servida tratada que contenía baja concentración de cloro libre residual y posteriormente se propagó por transmisión persona-persona, en un ambiente sanitario deficiente.

Estenosis aórtica: implante de prótesis valvular aórtica transcatéter (TAVI ) en el adulto mayor / Aortic stenosis: transcatheter aortic-valve implantation (TAVI ) in the elderly

Actualmente la estenosis aórtica (EA) degenerativa es la valvulopatía adquirida más frecuente en la población mayor, y debido al envejecimiento de ésta su número absoluto continua incrementándose. La obstrucción mecánica a la salida de sangre a través de la válvula estenótica determina una serie de cambios morfo-funcionales del corazón que luego de un período de latencia relativamente largo son sobrepasados apareciendo los síntomas. Una vez que un paciente se hace sintomático, se establece un punto de quiebre tanto en su calidad de vida como en su pronóstico. Tradicionalmente estos pacientes son sometidos a cirugía de reemplazo valvular aórtico, considerando que esta terapia mejora el pronóstico y la calidad de vida. Sin embargo, dado que la población portadora de EA es una población mayor con múltiples co-morbilidades, hasta un 30-60 por ciento se considera fuera del alcance quirúrgico. Recientemente se desarrollaron dos dispositivos valvulares biológicos para la corrección de la EA, a través de la implantación valvular aórtica transcatéter (TAVI), procedimiento menos invasivo que la cirugía. Se revisaron los antecedentes que apoyan las bases fisiopatológicas, dispositivos, complicaciones y proyecciones de esta novedosa técnica en pacientes mayores, sintomáticos e inoperables. Este procedimiento no solo constituye un gran adelanto técnico y conceptual, sino que ha permitido abordar pacientes antes considerados inoperables. Los resultados han permitido un crecimiento de las TAVI a nivel mundial de aproximadamente de 10.000 válvulas implantadas el 2010 a más de 90.000 hoy. Un crecimiento como éste en la población de más alto riesgo solo demuestra su eficiencia y seguridad. Probablemente estemos asistiendo a un cambio conceptual en el enfrentamiento de esta patología.

Currently degenerative aortic stenosis is the most common acquired valvular heart disease in the elderly population, and because the aging of this, the absolute patient number continues to increase. Mechanical obstruction to the out flow of blood through the stenotic valve causes a series of morpho-functional changes of the heart after a relatively long latency period are outweighed symptoms appear. Once a patient becomes symptomatic establishing a turning point in terms of quality of life and in its forecast. Traditionally, these patients undergo aortic valve replacement surgery, considering that this therapy improves prognosis and improved quality of life. However, given that patient with aortic stenosis is an aging population with multiple co-morbidities, up to 30-60 percent of them does not undergo surgery. Recently, two heart biological valve devices have been develope for the correction of aortic stenosis through transcatheter aortic valve implantation (TAVI), less invasive procedure than surgery. We reviewed the backgrounds that support the pathophysiological bases, devices, complications and projections of this novel technique in older patients, symptomatic and inoperable. This procedure is not only a technical and conceptual breakthrough, but allowed to treat patients previously considered inoperable. The results have enabled a huge growth in worldwide TAVI approximately 10,000 valves implanted in 2010 to over 90,000 today. Growth like this in the highest risk population only proves its efficiency and safety. We are probably witnessing a conceptual change in dealing with this disease.

Eficacia de un programa intensivo de terapia ocupacional para niños amputados / Efficacy of an intensive occupational therapy programme for amputated children

Objetivo: Analizar si los niños con prótesis mioeléctricas pueden mejorar sus destrezas motoras necesarias para la realización de las actividades de la vida diaria (AVD) de manera independiente. Material y método: Se realizó un programa estructurado de terapia ocupacional, basado en actividades de coordinación motora fina y gruesa, así como un refuerzo constante de las AVD, durante 6 días en 10 niños amputados (4 chicos y 6 chicas) usuarios de prótesis mioeléctricas, con edades comprendidas entre 4-0 años. Se administró el Assessment of Process and Motor Skills (AMPS) para evaluar las destrezas motoras al inicio y al finalizar la estancia en el campamento. Resultados: En la primera valoración y en la segunda obtuvieron respectivamente los siguientes resultados por destrezas: alcanza (2,0-1,4), se inclina (1,8-1,2), manipula (2,1-1,6), coordina (2,3-2,0), mueve (2,1-1,7), posiciona (2,0-1,7), camina (1,2-1,1), transporta (1,7-1,6). Todos los participantes mejoraron en las habilidades referidas a la posición corporal, obtener y sujetar objetos, y movilización de si mismos y de los objetos. Conclusiones: Los programas intensivos de terapia ocupacional en los niños usuarios de prótesis mioeléctricas son eficaces, ya que mejoran la calidad en la realización de las AVD lo que redunda en la mejora de la autoestima y en la calidad de vida de los niños (AU)

Objective: To analyse myoelectric prostheses in amputated children on fulfilling activities of daily life (ADL) independently. Material and method: A structured occupational therapy programme was performed, based on fine and gross motor coordination activities as well as constant reinforcement of ADL for 6 days in 10 amputated children (4 boys and 6 girls) using myoelectric prostheses, aged within 4-0 years. The Assessment of Process and Motor Skills (AMPS) was administered to evaluate motor skills at the start and at the end of stay in the camp. Results: The following results were obtained in the first and the second assessment, by skills, respectively: reaches (2.0-1.4), bends (1.8-1.2), manipulates (2.1-1.6), coordinates (2.3-2.0), moves (2.1-1.7), positions (2.0- 1.7), walks (1.2-1.1), carries (1.7-1.6). All participants improved their skills referring to body position, obtaining and holding objects and moving themselves and objects. Conclusion: Invasive occupational therapy programmes in children using myoelectric prostheses are effective, as they improve quality in fulfilling ADL, leading to an improved self-esteem and quality of life of children (AU)

Biodesulfurization of gas oil using inorganic supports biomodified with metabolically active cells immobilized by adsorption.

The immobilization of Pseudomonas stutzeri using adsorption on different inorganic supports was studied in relation to the number of adsorbed cells, metabolic activity and biodesulfurization (BDS). The electrophoretic migration (EM) measurements and Tetrazolioum (TTC) method were used to evaluate adsorption and metabolic activity. Results indicate that maximal immobilization was obtained with an initial load of 14 x 10(8) cells mL(-1) for Al and Sep, whereas Ti requires 20 x 10(8) cells mL(-1). The highest interaction was observed in the P. stutzeri/Si and P. stutzeri/Sep biocatalysts. The IEP values and metabolic activities indicate that P. stutzeri change the surface of supports and maintains metabolic activity. A direct relation between BDS activity and the adsorption capacity of the bacterial cells was observed at the adsorption/desorption equilibrium level. The biomodification of inorganic supports by the adsorption process increases the bioavailability of sulphur substrates for bacterial cells, improving BDS activity.

Asistencia ventricular mecánica como puente al trasplante en pacientes en shock cardiogénico: Experiencia preliminar en Chile con ABIOMED BVS 5000® / Ventricular assist device as a bridge to transplant in patients with cardiogenic shock: Report of four patients

Hospitalization and death due to heart failure and cardiogenic shock is frequent and currently is increasing among the adult population. Although cardiac transplantation is the most effective treatment in patients with end-stage heart failure, its availability is limited. While waiting for transplantation, some patients become refractory to treatment and deteriorate progressively. Secondary multi-organ damage could highly compromise the transplant success and also could contraindicate it. Mechanical ventricular assist devices allow reestablishing normal cardiac output and they have been used as a bridge to recovery and transplantation. We report four patients that underwent mechanical ventricular support using the ABIOMED BVS 5000® system as a bridge for transplantation. Two patients were connected to biventricular assistance; a third patient was connected to a left ventricular support and the fourth to a right ventricular support. Three were successfully transplanted and one died of refractory non-cardiogenic shock. There were no complications related to the support system, such as infection, hemorrhage or stroke. In our experience, the ABIOMED BVS 5000® was an effective strategy as a bridge to heart transplant in patients in cardiogenic shock.

[Partial or total replacement of the aortic arch. Experience in 23 patients]. / Reemplazo parcial o total del arco aórtico. Experiencia en 23 pacientes.

BACKGROUND: Surgery of the aortic arch is a very complex procedure since it requires protective strategies for the brain, heart and rest of the body. AIM: To communicate our experience in the first 23 total or partial replacements of aortic arch. MATERIAL AND METHODS: Retrospective search in the database of the Cardiovascular Surgery Unit for patients subjected to partial or total replacement of the aortic arch since 1998. RESULTS: Between 1988 and 2002, 23 patients were operated. Seventeen had aortic dissection (10 acute and 7 chronic), five had an atherosclerotic aneurysm and one had a traumatic lesion. Thirteen patients were subjected to a replacement of the arch plus ascending aorta, six to a replacement of the arch plus descending aorta and four to a replacement of the arch, ascending and descending aorta. Seven patients had previous operation of the thoracic aorta. Arterial perfusion was done via the femoral artery, axillary artery or a combination of both. A hypothermic circulatory arrest was induced in 22; it was associated with cerebral retro perfusion alone in 8 patients, antegrade cerebral perfusion in 5; isolated or associated axillary perfusion was used in five patients. In seven, procedures on the aortic or mitral valve, or coronary artery operations were added. Operative mortality was 26%, 3 of the 8 patients operated as an emergency and 3 of 15 elective operations. There was no mortality among those without dissection and of 7 chronic dissections, one died. All patients were followed for an average of 45 months. Two patients required reinterventions on the aorta and one for colon cancer. There was one late death of unknown cause. Postoperative complications were agitation, bleeding and temporary vocal cord dysfunction. CONCLUSIONS: There is a learning curve, where more extensive operations, particularly those done as emergency or for dissections, had an increased operative risk.

Reemplazo parcial o total del arco aórtico: Experiencia en 23 pacientes / Partial or total replacement of the aortic arch: Experience in 23 patients

Background: Surgery of the aortic arch is a very complex procedure since it requires protective strategies for the brain, heart and rest of the body. Aim: To communicate our experience in the first 23 total or partial replacements of aortic arch. Material and methods: Retrospective search in the database of the Cardiovascular Surgery Unit for patients subjected to partial or total replacement of the aortic arch since 1998. Results: Between 1988 and 2002, 23 patients were operated. Seventeen had aortic dissection (10 acute and 7 chronic), five had an atherosclerotic aneurysm and one had a traumatic lesion. Thirteen patients were subjected to a replacement of the arch plus ascending aorta, six to a replacement of the arch plus descending aorta and four to a replacement of the arch, ascending and descending aorta. Seven patients had previous operation of the thoracic aorta. Arterial perfusion was done via the femoral artery, axillary artery or a combination of both. A hypothermic circulatory arrest was induced in 22; it was associated with cerebral retro perfusion alone in 8 patients, antegrade cerebral perfusion in 5; isolated or associated axillary perfusion was used in five patients. In seven, procedures on the aortic or mitral valve, or coronary artery operations were added. Operative mortality was 26%, 3 of the 8 patients operated as an emergency and 3 of 15 elective operations. There was no mortality among those without dissection and of 7 chronic dissections, one died. All patients were followed for an average of 45 months. Two patients required reinterventions on the aorta and one for colon cancer. There was one late death of unknown cause. Postoperative complications were agitation, bleeding and temporary vocal cord dysfunction. Conclusions: There is a learning curve, where more extensive operations, particularly those done as emergency or for dissections, had an increased operative risk.

[Endovascular treatment of descending aorta trauma]. / Tratamiento endovascular del trauma de aorta descendente.

BACKGROUND: Mortality of traumatic aortic lesions is over 80%. A group of those who survive, develop a chronic pseudo aneurism, usually asymptomatic, that is detected during imaging studies. Since conventional surgical treatment of traumatic aortic lesions has a great mortality, endovascular treatment has been used as an alternative treatment in the last decade. AIM: To report our experience with endovascular treatment of traumatic aortic lesions. PATIENTS AND METHODS: Report of seven patients aged 22 to 65 years, with traumatic aortic lesions. Under general anesthesia an endovascular prosthesis was inserted through the femoral artery. RESULTS: No complications were observed in the postoperative period, and after a follow up ranging from 4 to 40 months, no endoleaks or other complications have been detected. CONCLUSIONS: Endovascular treatment of traumatic aortic lesions has good immediate and midterm results.

AngioTAC como método de diagnóstico y decisión quirúrgica en el tromboembolismo pulmonar crónico: Discusión a propósito de un caso / CT angiography as the diagnostic and decision making method used for surgical indication in pulmonary hypertension due to chronic thromboembolism: Report of one case

Pulmonary hypertension due to chronic pulmonary thromboembolism is frequently underdiagnosed and has a very poor prognosis if untreated. When the presence of central pulmonary artery thrombus is confirmed, thromboendarterectomy is the treatment of choice, with very good results. We report a 28 years old male with two previous episodes of deep venous thrombosis (DVT) who was admitted due to 8 months of progressive shortness of breath and a syncope. He underwent a CT pulmonary angiogram and an echocardiogram. Severe pulmonary hypertension was confirmed, secondary to a chronic pulmonary thromboembolism with an overlapped acute component. He received systemic thrombolysis with partial thrombus disappearance. Therefore a pulmonary thromboendarterectomy was performed and an inferior vena cava filter was placed. The patient was discharged with marked improvement in his functional capacity.

Tratamiento endovascular del trauma de aorta descendente / Endovascular treatment of descending aorta trauma

Background: Mortality of traumatic aortic lesions is over 80 percent. A group of those who survive, develop a chronic pseudo aneurism, usually asymptomatic, that is detected during imaging studies. Since conventional surgical treatment of traumatic aortic lesions has a great mortality, endovascular treatment has been used as an alternative treatment in the last decade. Aim: To report our experience with endovascular treatment of traumatic aortic lesions. Patients and methods: Report of seven patients aged 22 to 65 years, with traumatic aortic lesions. Under general anesthesia an endovascular prosthesis was inserted through the femoral artery. Results: No complications were observed in the postoperative period, and after a follow up ranging from 4 to 40 months, no endoleaks or other complications have been detected. Conclusions: Endovascular treatment of traumatic aortic lesions has good immediate and midterm results.