Tumor inflamatorio de Pott en escolar de 7 años: a propósito de un caso

El tumor inflamatorio de Pott (PPT) es una osteomielitis del hueso frontal con un absceso subperióstico concomitante, principalmente secundario a sinusitis frontal complicada. Es infrecuente, pero puede tener consecuencias fatales debido a su alta asociación con complicaciones intracraneales. Presentamos el caso de una escolar de 7 años sin antecedentes, que consulta en el Servicio de Urgencia por un cuadro de 5 semanas de rinorrea mucopurulenta derecha y aumento de volumen frontal progresivo, habiendo recibido antibioticoterapia sin respuesta. Se realizan neuroimágenes que confirman el diagnóstico de rinosinusitis aguda fronto-etmoidal complicada con absceso subperióstico frontal compatible con PPT, asociado a un absceso epidural. Se manejó con antibiótico endovenoso prolongado y aseo quirúrgico mediante craniectomía por abordaje bi-coronal con drenaje de ambas colecciones y reconstrucción de base de cráneo con colgajo de pericráneo, evolucionando favorablemente. El diagnóstico del tumor inflamatorio de Pott es clínico y radiológico, siendo el aumento de volumen frontal el signo cardinal. La tomografía computarizada es útil para establecer el diagnóstico diferencial con otras entidades y la resonancia magnética permite con mayor sensibilidad y especificidad detectar complicaciones intracraneales. El tratamiento es médico y quirúrgico mediante antibioticoterapia endovenosa y aseo quirúrgico oportuno.

Pott's inflammatory tumor is an osteomyelitis of the frontal bone with a concomitant subperiosteal abscess, mainly secondary to complicated frontal sinusitis. It is rare entity but may have fatal consequences due to its high association with intracranial complications. We present the case of a healthy 7-year-old girl who presented to the emergency department with a 5-week history of mucopurulent right rhinorrhea and progressive forehead swelling without response to oral antibiotic therapy. Neuroimaging confirms the diagnosis of acute frontoethmoidal rhinosinusitis complicated with frontal subperiosteal abscess compatible with PPT and an epidural abscess. She received prolonged intravenous antibiotics for six weeks and surgical treatment with craniectomy by bi-coronal approach with drainage of both collections and reconstruction of the skull base with pericranial flap, progressing favorably. The diagnosis of Pott's inflammatory tumor is clinical and radiological. The increased frontal volume is the cardinal sign, and computed tomography is the image of choice, which is also helpful in establishing the differential diagnosis with other entities. Magnetic resonance imaging is practical, given its greater sensitivity and specificity to detect intracranial complications. Treatment is imperative and is based on adequate antibiotic therapy and prompt surgical debridement.

Colesteatoma del conducto auditivo externo: Experiencia de 5 años Hospital del Salvador / External ear canal cholesteatoma: 5-year experience Hospital del Salvador

Introducción: El colesteatoma del conducto auditivo externo (CCAE) es una estructura quística revestida por epitelio escamoso estratificado queratinizado que tiene la capacidad de invadir y erosionar localmente al hueso temporal. Su incidencia es de 0,19 a 0,3/100.000 habitantes siendo 60 veces menos frecuente que el de oído medio. Objetivo: Describir las características epidemiológicas, clínicas, imagenológicas y tratamiento de los pacientes diagnosticados con CCAE en el Servicio de Otorrinolaringología Hospital del Salvador. Material y Método: Se presenta una serie de ocho casos clínicos recopilados durante el período 2017 y 2021. Se realizó revisión de fichas clínicas, biopsias y tomografías computadas de oídos (TC oídos). Se describen los hallazgos y tratamiento efectuado. Resultados: El promedio de edad fue de 65,6 años, correspondiente a 5 mujeres y 3 hombres con presencia de tabaquismo y diabetes en la mitad de los casos. Los síntomas y signos más frecuentes fueron otalgia e hipoacusia seguido de otorrea. 7 pacientes se presentaron con tímpano íntegro y el compromiso de la pared inferior del conducto se evidenció en 6 de 8 pacientes. La TC oídos mostró erosión ósea del conducto, con o sin compromiso de estructuras adyacentes, en todos los casos y el diagnóstico histológico fue efectuado en el 100% de los pacientes. Se privilegió el tratamiento conservador mediante curaciones óticas periódicas asociado a ácido salicílico al 3% y/o antibióticos tópicos en 6/8 pacientes. Conclusiones: El CCAE es una entidad poco frecuente sin signos ni síntomas patognomónicos por lo que el diagnóstico histológico junto con el estudio imagenológico es perentorio. El tratamiento conservador es una alternativa terapéutica válida que ofrece buenos resultados en pacientes con adecuada adherencia al tratamiento y posibilidad de seguimiento estricto.

Introduction: External ear canal cholesteatoma (EECC) is a cystic structure lined by keratinized stratified squamous epithelium that has the ability to locally invade and erode the temporal bone. Its incidence is 0.19 to 0.3 / 100,000 habitants, being 60 times less frequent than that of the middle ear. Aim: To describe the epidemiological, clinical, imaging and treatment characteristics of patients diagnosed with EECC in the Hospital del Salvador ENT department. Material and Methods: A series of eight clinical cases collected during the period 2017 and 2021 is presented. A review of clinical records, biopsies and computed tomography of the ear (ear CT) was carried out. The findings and treatment carried out are described. Results: The average age was 65.6 years corresponding to 5 women and 3 men with the presence of smoking and diabetes in half of the cases. The most frequent symptoms and signs were earache and hearing loss followed by otorrhea. 7 patients presented with an intact eardrum and compromise of the inferior wall of the canal was evidenced in 6 of 8 patients. Ears CT showed bone erosion of the canal with or without compromise of adjacent structures in all cases and the histological diagnosis was made in 100% of the patients. Conservative treatment with periodic ear dressings associated with 3% salicylic acid and / or topical antibiotics was favored in 6/8 patients. Conclusion: EECC is a rare entity without pathognomonic signs or symptoms, therefore the histological diagnosis together with the imaging study is peremptory. Conservative treatment is a valid therapeutic alternative that offers good results in patients with adequate adherence to treatment and the possibility of strict follow-up.

The fluctuation-dissipation measurement instrument at the Linac Coherent Light Source.

The development of new modes at x-ray free electron lasers has inspired novel methods for studying fluctuations at different energies and timescales. For closely spaced x-ray pulses that can be varied on ultrafast time scales, we have constructed a pair of advanced instruments to conduct studies targeting quantum materials. We first describe a prototype instrument built to test the proof-of-principle of resonant magnetic scattering using ultrafast pulse pairs. This is followed by a description of a new endstation, the so-called fluctuation-dissipation measurement instrument, which was used to carry out studies with a fast area detector. In addition, we describe various types of diagnostics for single-shot contrast measurements, which can be used to normalize data on a pulse-by-pulse basis and calibrate pulse amplitude ratios, both of which are important for the study of fluctuations in materials. Furthermore, we present some new results using the instrument that demonstrates access to higher momentum resolution.

Injerto de hueso calvarial envuelto en colgajo pediculado de fascia temporo-parietal para reconstrucción de reborde cigomático-maxilar e infraorbitario: reporte de caso / Calvarial bone graft wrapped in temporo-parietal fascia pedicled flap for zygomatico-maxillary and infraorbital rim reconstruction: case report

La reconstrucción posterior a una cirugía oncológica resectiva maxilar es todo un desafío. Debido a esto, existen diversas técnicas quirúrgicas cuyo objetivo apunta a mantener no solo la funcionalidad, sino también la estética facial, especialmente en el área del reborde infraorbitario. El injerto de hueso calvarial es una opción segura y versátil para realizar una reconstrucción primaria en el reborde infraorbitario. Esta técnica está indicada en aquellos pacientes en los cuales la resección cutánea y exenteración orbitaria no son necesarias. Por este motivo, a continuación, analizaremos este tipo de injerto a propósito de un caso clínico en el que se usó asociado a un colgajo pediculado de fascia temporoparietal.

Reconstruction after maxillary resective oncological surgery is a challenge. Because of this, there are many surgical techniques whose objective is to maintain not only function but also facial aesthetics, especially in the infraorbital rim area. The calvarial bone graft is a safe and versatile option to perform a primary infraorbital rim reconstruction. This technique is indicated in those patients in whom skin resection and orbital exenteration are not necessary. For this reason, we will now analyze this type of graft in relation to a case in which it was used associated with a temporo-parietal fascia flap.

Fístula de líquido cefalorraquídeo después de hisopado nasofaríngeo en pandemia COVID-19. A propósito de dos casos

Resumen Uno de los pilares fundamentales en el manejo de la pandemia por SARS-CoV2 es la detección temprana de la presencia del virus en pacientes. El método más utilizado es mediante hisopado nasofaríngeo para amplificar ácidos nucleicos mediante reacción en cadena de polimerasa (PCR). Las complicaciones asociadas a la técnica de hisopado aún no están completamente caracterizadas. Hasta ahora hay un caso reportado internacionalmente de fístula de líquido cefalorraquídeo poshisopado nasofaríngeo. Presentamos dos casos de fístula posterior a dicho examen: el primer caso un paciente de género femenino con sospecha de hipertensión intracraneal idiopática, cuya brecha se reparó quirúrgicamente; el segundo caso un paciente de género masculino con antecedente de hidrocefalia y meningitis neonatal que, al estudio por rinorraquia, se encuentra un meningoencefalocele en el receso frontal derecho, también reparado quirúrgicamente.

Abstract One of the cornerstones in the management of coronavirus pandemic is the early identification of virus presence in patients. The most used test is the nasopharyngeal swab, used to amplify nucleic acids through polymerase chain reaction. Complications with this test have not been completely characterized. Until now, only one international report of cerebrospinal fluid leak has been reported. We present two cases of leak after nasopharyngeal swab test: the first case corresponded to an adult feminine gender patient with suspected idiopathic intracranial hypertension, whose gap was surgically repaired; the second case adult male patient with medical history of hydrocephalus and neonatal meningitis who was further studied for rhinoliquorrhea that showed a meningoencephalocele occupying the right frontal recess.

Scaling of domain cascades in stripe and skyrmion phases.

The origin of deterministic macroscopic properties often lies in microscopic stochastic motion. Magnetic fluctuations that manifest as domain avalanches and chaotic magnetization jumps exemplify such stochastic motion and have been studied in great detail. Here we report Fourier space studies of avalanches in a system exhibiting competing magnetic stripe and skyrmion phase using a soft X-ray speckle metrology technique. We demonstrate the existence of phase boundaries and underlying critical points in the stripe and skyrmion phases. We found that distinct scaling and universality classes are associated with these domain topologies. The magnitude and frequency of abrupt magnetic domain jumps observed in the stripe phase are dramatically reduced in the skyrmion phase. Our results provide an incisive way to probe and understand phase stability in systems exhibiting complex spin topologies.

Publisher Correction: Scaling of domain cascades in stripe and skyrmion phases.

The original version of this Article contained an error in Fig. 4d, in which the label of the region to the left of the white dashed lines incorrectly read 'Order stripes'. The correct version states 'Disorder stripes'. This has been corrected in both the PDF and HTML versions of the Article.

Arteritis de células gigantes en el sistema vertebrobasilar, isquemias cerebelo-occipitales y parálisis III par: caso clínico / Giant cell arteritis of the vertebrobasilar system, posterior ischemia and palsy of the third nerve: report of one case

Giant cell arteritis is the most common vasculitis in patients aged over 50 years. We report an 89-year-old woman with significant weight loss and persistent frontal-occipital headaches lasting two months. The neurological examination at admission identified a decrease in visual acuity of the left eye, paralysis of the third cranial nerve of the right eye and alterations of body motility without objective signs of damage of the motor or sensitive pathways. Magnetic resonance imaging showed changes of the temporal artery wall and in both vertebral arteries, as well as bilateral cerebellar and occipital ischemic lesions. The Doppler ultrasound of the temporal arteries was compatible with Giant cell arteritis. Treatment with steroids was started. While receiving oral prednisone, the patient suffered new infarcts of the posterior territory, documented with a CAT scan.

Síndrome de Susac: caso clínico y revisión / Susac syndrome: clinical case and literature review

RESUMEN El síndrome de Susac (SS) es una enfermedad autoinmune microangiopática poco frecuente, caracterizada por la tríada clínica: encefalopatía, alteraciones visuales e hipoacusia. Es una entidad de prevalencia desconocida dado su difícil diagnóstico debido a que la mayoría de las veces no se presenta con la tríada clínica clásica, y, dado que presenta múltiples diagnósticos diferenciales. Se reporta un caso de SS presentado en el Hospital del Salvador, con descripción de sus manifestaciones clínicas, estudio y manejo inicial. Además de una revisión en la literatura sobre la variabilidad de los hallazgos clínicos y el manejo de esta patología.

ABSTRACT Susac syndrome (SS) is a rare autoimmune micronagiopathic disease, characterized by the clinical triad of, encephalopathy, visual impairment and hearing loss. It is a difficult entity to diagnose since most of the time it does not present itself with the classical clinical triad, and it may be confused with other differential diagnoses. One clinical case of a patient with SS is described, its clinical manifestations, diagnosis and initial treatment. In addition, a literature review about the multiple clinical findings and management of these disease.

[Giant cell arteritis of the vertebrobasilar system, posterior ischemia and palsy of the third nerve. Report of one case]. / Arteritis de células gigantes en el sistema vertebrobasilar, isquemias cerebelo-occipitales y parálisis III par. Caso clínico.

Giant cell arteritis is the most common vasculitis in patients aged over 50 years. We report an 89-year-old woman with significant weight loss and persistent frontal-occipital headaches lasting two months. The neurological examination at admission identified a decrease in visual acuity of the left eye, paralysis of the third cranial nerve of the right eye and alterations of body motility without objective signs of damage of the motor or sensitive pathways. Magnetic resonance imaging showed changes of the temporal artery wall and in both vertebral arteries, as well as bilateral cerebellar and occipital ischemic lesions. The Doppler ultrasound of the temporal arteries was compatible with Giant cell arteritis. Treatment with steroids was started. While receiving oral prednisone, the patient suffered new infarcts of the posterior territory, documented with a CAT scan.

Resultados a corto y medio plazo en el tratamiento endovascular de aneurismas aortoiliacos o iliacos mediante el uso del dispositivo de rama iliaca / Short and medium-term outcomes in the endovascular treatment of aorto-iliac or iliac aneurysms with the use of an iliac branch device

Objetivo: El uso del dispositivo de rama iliaca (DRI) es una técnica para evitar complicaciones derivadas de la oclusión de las arterias hipogástricas (AH). Nuestro objetivo es analizar los resultados del uso del DRI a corto y medio plazo en nuestro centro. Material y métodos: Estudio descriptivo, 28 AH, 14 pacientes con aneurismas aortoiliacos tratados con DRI entre 2011 y 2015. Catorce (100%) aneurismas iliacos bilaterales, 11 (78,6%) aneurismas aórticos asociados y 4 (14,3%) con aneurisma hipogástrico. De 28 AH, 19 (67,8%) se trataron con DRI (5 bilaterales), 4 (14,3%) fueron cubiertas con endoprótesis, 2 (7,1%) embolizadas, 2 intactas y una con stent cubierto para tratar un aneurisma. En todos los casos quedó al menos una AH permeable. Analizamos mortalidad, permeabilidad del DRI, endofugas, claudicación glútea, disfunción eréctil e isquemia pélvica. Para realizar el seguimiento se utilizaron angio-TAC y ecodoppler. Resultados: El 100% eran varones, con una edad de 74,6 ± 13,6 años, permeabilidad al mes 94,7%, al año 80%, a los 2 años 77,8%, 0% de mortalidad, de endofugas, de claudicación glútea en el lado permeabilizado, de disfunción eréctil de nueva aparición y de isquemia pélvica. Hubo dos casos de claudicación glútea contralateral, un caso de trombosis arterial iliaca contralateral, resuelta mediante bypass femorofemoral, una trombosis del DRI intraoperatoria e isquemia aguda de la extremidad, resuelta mediante trombolisis y embolectomía, e imposibilidad para colocar el DRI por dificultad técnica en un caso. El seguimiento medio fue de 23,3 meses (rango 1-67), y hubo 2 pérdidas en el seguimiento. Conclusión: En nuestra experiencia, el DRI es una técnica eficaz y segura con pocas complicaciones y buena permeabilidad; no obstante, son necesarios estudios a largo plazo (AU)

Objective: An iliac branch device (IBD) is used as a technique to avoid or minimise the complications associated with the occlusion of the hypogastric artery (HA). The purpose of this paper is to analyse the short and medium-term outcomes with the use of an IBD in our centre. Material and methods: A descriptive study that included 28 HA of 14 patients with an aorto-iliac aneurysm treated with an IBD between 2011 and 2015. There were 14 (100%) bilateral iliac artery aneurysms, 11 (78.6%) associated with an aortic aneurysm, and 4 (14.3%) with HA aneurysm. Of the 28 HA, 19 (67.8%) where treated with an IBD (5 bilateral), 4 (14.3%) were covered with the endoprosthesis, 2 (7.1%) were embolised, 2 were not treated, and one was treated with a covered stent graft in order to treat the hypogastric aneurysm. In all of the cases one HA was patent. An analysis is presented of the mortality, patency, endoleaks, buttock claudication, erectile dysfunction, and pelvic ischaemia. CT angiogram and doppler ultrasound were used in the follow-up. Results: All (100%) the patients were male, with a mean age of 74.6 ± 13.6 years. Patency at one month was 94.7%, 80% at one year, and 77.7% at 2 years. There was 0% mortality, endoleaks, buttock claudication of the side treated, erectile dysfunction, and pelvic ischaemia. There were 2 cases of contralateral buttock claudication, one of contralateral iliac artery thrombosis, resolved through a femoro-femoral bypass, and one case of intra-operative IBD thrombosis that was treated favourably with thrombolysis. Mean follow-up was 23.3 months (range 1-67) with 2 losses in the study. Conclusion: In our experience, IBD is a safe and efficient technique, with few complications and good patency. Longer follow-up studies should be performed (AU)

Nanosecond X-Ray Photon Correlation Spectroscopy on Magnetic Skyrmions.

We report an x-ray photon correlation spectroscopy method that exploits the recent development of the two-pulse mode at the Linac Coherent Light Source. By using coherent resonant x-ray magnetic scattering, we studied spontaneous fluctuations on nanosecond time scales in thin films of multilayered Fe/Gd that exhibit ordered stripe and Skyrmion lattice phases. The correlation time of the fluctuations was found to differ between the Skyrmion phase and near the stripe-Skyrmion boundary. This technique will enable a significant new area of research on the study of equilibrium fluctuations in condensed matter.

Neumoperitoneo poscolonoscopia sin evidencia de perforación colónica / Post-Colonoscopy neumoperitoneum without evidence of colonic perforation

Objetivo: Reportar el caso de una complicación poscolonoscopia de tratamiento complejo. Caso clínico: Presentamos el caso de una mujer de 82 años, a quien se practicó una colonoscopia total por sangrado rectal, reportando úlcera anal. Dos días después presentó dolor abdominal y distensión abdominal. En las imágenes se encontró gran neumoperitoneo; se realizó laparotomía exploradora sin encontrar lesión en el colon. Presentó buena evolución postoperatoria. Se hace una revisión de la literatura respectiva.

Aim: To report a case of one of the most complex complication post-colonoscopy and is treatment. Case report: We report the case of a 82 years old woman, who was taken to complete colonoscopy for rectal bleeding, then reporting an anal ulcer. Two days later, she has abdominal pain and bloating. In images she has a great pneumoperitoneum. At laparotomy it was not found any injury to the colon. She has a good post-operative evolution. Respective literature review is done.

Spontaneous photosensitization by Heterophyllaea pustulata Hook. f. (Rubiaceae), in sheep from Northwestern Argentina.

Heterophyllaea pustulata Hook. f. (Rubiaceae) is a phototoxic plant. It grows in the Andean area of northwest of Argentina, and it causes significant economic losses in the livestock. This plant induces dermal lesions by photosensitization probably due to its content of photosensitizing anthraquinones. This paper describes an outbreak of poisoning in Corriedale sheepfold, which had an incidence of 49%. Ear skin biopsies and blood samples were collected of six affected animals. Liver enzymes remained within the reference limits. Histopathologically, a deep necrotizing dermatitis was identified in all samples. H. pustulata was identified in the areas of grazing. Anthraquinone concentration in leaves was 0.84% p/p, expressed as rubiadin. All findings allow us to conclude that the diagnosis is a primary photosensitization. Huge regional economic losses could be attributed to H. pustulata poisoning, although its toxicity has been little studied.

Reestenosis asintomáticas de stents de arteria femoral superficial: ¿tratamiento endovascular o manejo conservador? / Asymptomatic restenosis of superficial femoral artery stents: Endovascular treatment or conservative management

Objetivo: Comparar la evolución clínica de las reestenosis > 70% asintomáticas de los stents de arteria femoral superficial (AFS) con tratamiento endovascular vs. tratamiento conservador. Pacientes: Estudio descriptivo de cohortes históricas de pacientes con stent femoral con reestenosis del 70-99% asintomática, desde enero del 2010 a diciembre del 2015. Se formaron 2 grupos de pacientes: manejo conservador vs. tratamiento endovascular. Material y métodos: Comparamos: curvas de superviencia libre de amputación mayor (SLA) y supervivencia libre de isquemia crítica o claudicación limitante (< 250m) (SLIC) desde la colocación del primer stent hasta la aparición de isquemia crítica o realización de amputación mayor (log-rank, Kapplan-Meier). Analizamos la permeabilidad primaria y la permeabilidad primaria asistida. Resultados y conclusiones: Se diagnosticaron un total de 23 reestenosis >70% en 20 pacientes de 78 años de edad media (DE 9,6). Seguimiento medio: 30,1 meses. En 12 pacientes (52,2%) se realizó tratamiento médico (AAS y estatinas) + endovascular, y en 11 (47,8%) únicamente tratamiento médico. No hubo diferencias en la SLA (p = 0,967). Observamos que la SLIC fue mayor en el grupo de manejo conservador que en el de tratamiento endovascular (p = 0,031). La permeabilidad primaria fue de 14,2 meses (IC 8,2-20,2), y la permeabilidad primaria asistida de 65,5 meses (IC 57,4-77,5). En nuestra experiencia tratar las lesiones graves asintomáticas de los stents de AFS no disminuye el riesgo de amputación, isquemia crítica o claudicación limitante respecto a la evolución natural de las mismas. En pacientes asintomáticos la conducta expectante puede ser una buena opción, sin que ello suponga un aumento del riesgo de amputación o isquemia crítica a medio plazo (AU)

Objective: To compare the clinical outcomes of asymptomatic >70% in-stent restenosis in the superficial femoral artery (SFA) treated using an endovascular procedure or conservative treatment. Patients: A historical cohort study was performed on patients with femoral artery stent with an asymptomatic in-stent restenosis of 70-99% from January 2010 to December 2015. The patients were divided into two groups: conservative management vs. endovascular treatment. Material and methods: The variables compared were, limb salvage and critical ischaemia or limiting claudication free survival rates (<250m) from initial stent treatment until the appearance of critical ischaemia or major amputation (log-rank, Kaplan Meier). Primary patency and assisted primary patency were analysed. Results and conclusions: A total of 23 >70% in-stent restenosis were diagnosed in 20 patients who had a mean age of 78 years old (SD 9.6). The mean follow-up was 30.1 months. Medical (aspirin and statins) and endovascular treatment was received by 12 patients (52.2%), and 11 patients (47.8%) received medical treatment only. No differences were seen in limb salvage. Critical ischaemia or limited claudication free survival rates were higher in the conservative treatment group than in the endovascular group (P = .031). Primary patency was 14.2 months (95% CI: 8.2-20.2), and assisted primary patency was 65.5 months (95% CI: 57.4-77.5). In our experience, treatment of severe asymptomatic lesions of in-stent stenosis in the SFA does not reduce the risk of amputation, critical ischaemia or limiting claudication. Conservative treatment could be a good option in asymptomatic patients, without increasing the risk in amputation and critical ischaemia (AU)

Luminescent hyperbolic metasurfaces.

When engineered on scales much smaller than the operating wavelength, metal-semiconductor nanostructures exhibit properties unobtainable in nature. Namely, a uniaxial optical metamaterial described by a hyperbolic dispersion relation can simultaneously behave as a reflective metal and an absorptive or emissive semiconductor for electromagnetic waves with orthogonal linear polarization states. Using an unconventional multilayer architecture, we demonstrate luminescent hyperbolic metasurfaces, wherein distributed semiconducting quantum wells display extreme absorption and emission polarization anisotropy. Through normally incident micro-photoluminescence measurements, we observe absorption anisotropies greater than a factor of 10 and degree-of-linear polarization of emission >0.9. We observe the modification of emission spectra and, by incorporating wavelength-scale gratings, show a controlled reduction of polarization anisotropy. We verify hyperbolic dispersion with numerical simulations that model the metasurface as a composite nanoscale structure and according to the effective medium approximation. Finally, we experimentally demonstrate >350% emission intensity enhancement relative to the bare semiconducting quantum wells.

Indicadores de calidad en patología vascular: estudio piloto multicéntrico nacional / Quality indicators in vascular disease: National multicentre pilot study

INTRODUCCIÓN: Desde hace más de una década ha surgido un interés creciente por evaluar la calidad de la atención sanitaria que prestamos. Los indicadores de calidad son la medida instrumental de esa calidad asistencial. Diferentes sociedades científicas internacionales están desarrollando iniciativas para monitorizar sus procesos quirúrgicos más frecuentes. OBJETIVOS: El Grupo de Calidad de la Sociedad Española de Angiología Cirugía Vascular consideró que sería de interés empezar a desarrollar una estructura básica de indicadores dentro de nuestra sociedad. Para ello se propuso como objetivo seleccionar 4-5 patologías vasculares frecuentes y elaborar 1-2 indicadores de esos procesos, para de esta forma demostrar que esta iniciativa es factible y puede dar lugar a unos resultados útiles para mejorar la calidad de nuestro trabajo diario y poder hacer «benchmarking» europeo. MATERIAL Y MÉTODOS: Se seleccionaron 17 Servicios de Cirugía Vascular, 5 de las patologías más frecuentes y 2 indicadores clave por cada una de ellas: aneurismas de aorta abdominal, patología arterial periférica, patología carotídea extracraneal, trombosis venosa profunda y fístulas arteriovenosas para hemodiálisis. Para seleccionar los indicadores clave (key performance indicators) se recurrió a las guías de práctica clínica, documentos de consenso y estudios publicados de gran relevancia científica. Por consenso de expertos se escogieron preferentemente indicadores de proceso y se elaboró una ficha para la recogida uniformada de información. RESULTADOS: Los resultados mostraron una gran variabilidad entre los centros, siendo alguno de ellos imposible de cuantificar, dada la ausencia de bases de datos informatizadas que permitieran su análisis. Los detalles concretos de cada indicador se describen exhaustivamente en el contenido de este artículo. CONCLUSIONES: Este trabajo nos ha permitido mostrar que la elaboración de indicadores de calidad es factible, útil y una oportunidad de mejora válida. Como en otras sociedades científicas internacionales, y después de esta positiva experiencia, deberíamos ampliar estos indicadores y crear una base de datos nacional para monitorizarlos

INTRODUCTION: There is growing interest in evaluating the quality of vascular care. The quality indicators are the tool to measure this. Different international vascular scientific societies are developing initiatives to monitor the most frequent surgical procedures. OBJECTIVES: The Quality Group of the Spanish Society of Angiology and Vascular Surgery considered it of interest to begin developing a basic structure of indicators in our Society. To this end, it was proposed to select 4-5 vascular diseases and 1-2 indicators of these processes, thus demonstrating that this initiative is feasible and can lead to useful results to improve the quality of our daily work. MATERIAL AND METHODS: Seventeen Spanish Vascular Surgery Units were selected, together with 5 of the most common diseases and two key indicators for each: abdominal aortic aneurysms, peripheral arterial disease, extracranial carotid disease, venous thrombosis and arteriovenous fistulas for haemodialysis. Practice guidelines, consensus documents and published studies of great scientific importance were used to select the indicators (key performance indicators). Through expert consensus process indicators were selected. RESULTS: The results showed a great variability between centres, few of them being impossible to quantify, because of the absence of computer databases to be able to analyse them. The specific details of each indicator are fully described in this article. CONCLUSIONS: This report has allowed us to show that the development of quality indicators is feasible, useful, and a valid opportunity to improve. As in other international scientific societies and after this positive experience, we should increase these indicators and create a national database to monitor them