Aortic root anatomy: insights into annular and root enlargement techniques.

The introduction of the Y(ang)-technique for aortic root enlargement has sparked a renewed interest in annular and root enlargement procedures world-wide. In order to execute these procedures proficiently however, it's important to understand the complex three-dimensional structure of the aortic root and left ventricular outflow tract, and also be familiar with the different enlargement techniques. Herein, we are providing a description of the aortic root anatomy and the most commonly utilized root enlargement procedures. This should facilitate clinical decision making and guidance of patients towards the most appropriate procedure, which should not only treat the patients' acute symptoms, but should also set the patient up for potentially needed future procedures and respective life-time management of aortic valve disease.

Congenital unicuspid aortic valve repair without cusp patch augmentation.

Unicuspid aortic valves are rare congenital malformations. Surgical repair is feasible in aortic regurgitation, and in some cases of aortic stenosis. The standard surgical approach is a bicuspidization and symmetrization with pericardial patch augmentation of valve leaflets. Herein, we are describing our original technique for bicuspidization of a unicuspid aortic valve in adults without leaflet patch augmentation. We also address the surgical management of a commissural diastasis.

Aortic annulus elevation for aortic valve and root replacement.

Aortic valve and root replacements require an in-depth understanding of the aortic root and annulus. Both structures can be asymmetric at times, and this needs to be recognized and taken into consideration when performing valve-sparing operations or other root-replacement procedures. Moreover, the geometry of the aortic annulus can be altered, and when performing an aortic root replacement this can distort the geometry of a neoaortic valve for instance, and lead to valve dysfunction, which is difficult to reverse. We are describing an altered aortic annulus, which required modification through annulus elevation before proceeding with aortic root replacement with a graft-reinforced pulmonary-autograft.

Rectosigmoidectomía perineal: alternativa quirúrgica inevitable en el prolapso rectal total irreductible / Perineal rectosigmoidectomy: one surgical alternative for complete and non reducible rectal prolapse

El prolapso rectal es la protrusión circunferencial de todo el espesor de las paredes del recto a través del esfínter anal. Cuando es irreductible y con estados de comorbilidad significativos asociados se plantea la opción del abordaje perineal al abdominal. Una serie de 6 pacientes a los que se le practicó una rectosigmoidectomia perineal, en el contexto de taras clínicas importantes indica que este abordaje es válido para solucionar quirúrgicamente el prolapso con una tasa de morbilidad y mortalidad bajas.

The rectal prolapse is the circumferential protrusion of the entire thickness of the rectal wall through the anal sphincter. When it is irreductible and with significant morbidity an option of the perineal approach is preferred over the abdominal approach. A series of six patients who have undergone perineal rectosigmoidectomy, in situations of major clinical conditions, indicates that this approach is valid to resolve surgically the prolapse, with a low morbidity and mortality outcome.

Sentido, criterios y utilidades de la evaluación del aprendizaje basado en problemas / Sense, criteria, and usefulness of learning assessment based on problems

En este artículo se planteó que considerando las características didácticas del aprendizaje basado en problemas, se requiere de un cambio de mentalidad de los docentes universitarios para apropiarse de una nueva racionalidad evaluativa, la que debe estar constituida por elementos teóricos, conceptuales y prácticos, a fin de evaluar el conocimiento, las habilidades y las actitudes de los estudiantes, además de promover en ellos su participación en el proceso evaluativo.

In present paper it is expound that considering didactic features of based on-learning problem, it is necessary a mentality change of university professors to achieve a new evaluation rationality, which must to include theoretical, conceptual, and practical elements, to assess knowledge, abilities, and attitudes of students, in addition to their involvement in assessing process.