Uterine laceration - a rare case of postpartum hemoperitoneum.

Postpartum haemorrhage is a major cause of maternal morbidity and mortality worldwide. Early dia-gnosis and treatment are essential to prevent sequelae or even death. We describe a rare case of early postpartum haemorrhage with hemoperitoneum due to a laceration of the uterine serosa with exposure of a uterine vessel solved by laparotomy.

Esperança e bem-estar psicológico durante a crise sanitária pela COVID-19: estudo com estudantes de enfermagem / Hope and psychological well-being during the sanitary crisis by COVID-19: a study with nursing students / Esperanza y bienestar psicológico durante la crisis sanitaria por COVID-19: estudio con estudiantes de enfermería

Objetivo: analisar as relações entre a esperança e o bem-estar psicológico de estudantes de enfermagem portugueses durante a crise pandêmica pela COVID-19. Método: estudo descritivo-correlacional, com recurso a questionário online para coleta de dados. Participaram 705 estudantes de enfermagem com idade média de 21,74 anos (DP=4,44). Os instrumentos de coleta de dados utilizados foram a Escala de Esperança de Herth (HHI-PT) e a Escala de Medida de Manifestação de Bem-Estar Psicológico (EMMBEP). Foi utilizada a estatística descritiva e inferencial. Resultados: na HHI-PT, o domínio afectivo-comportamental obteve a pontuação média mais alta, 3,30 (DP=0,45); no EMMBEP, foi o domínio sociabilidade, 3,64 (DP=0,77). Havia correlações moderadas a fortes (0,383

Aim: to analyze the relationship between hope and the psychological well-being of Portuguese nursing students during the COVID-19 pandemic crisis. Method: this is a descriptive-correlational study using an online questionnaire for data collection. 705 nursing students participated, with a mean age of 21.74 years (SD=4.44). The data collection instruments used were the Herth Hope Index (HHI-PT) and the Well-Being Manifestations Measure Scale (WBMMS). Descriptive and inferential statistics were used. Results: in the HHI-PT, the affective-behavioral domain had the highest mean score (3.30; SD=0.45), while in the WBMMS, it was the sociability domain, 3.64 (SD=0.77). There were moderate to strong correlations (0.383

Objetivo: analizar la relación entre la esperanza y el bienestar psicológico de los estudiantes portugueses de enfermería durante la crisis pandémica por COVID-19. Método: estudio descriptivo-correlacional mediante cuestionario online para la recogida de datos. Participaron 705 estudiantes de enfermería, con una edad promedio de 21,74 años (DE=4,44). Los instrumentos de recolección de datos utilizados fueron la Escala de Esperanza de Herth (HHI-PT) y la Escala de Medida de Manifestación de Bienestar Psicológico (EMMBEP). Se utilizó estadística descriptiva e inferencial. Resultados: en HHI-PT, fue el dominio afectivoconductual el que obtuvo la puntuación promedio más alta, 3.30 (DE=0.45), en EMMBEP, fue el dominio de sociabilidad, 3.64 (DE=0.77). Hubo correlaciones de moderadas a fuertes (0.383

Adaptación y validación al español de la escala de Bienestar Psicológico EMMBEP en estudiantes de Enfermería / Adaptation and validation into Spanish of the EMMBEP Psychological Well-being scale in Nursing students

INTRODUCCIÓN: La pandemia por CO-VID-19 podría estar dejando secuelas de tipo psicológico en la población. Tanto el hecho esperable de una reinfección de ámbito mundial, como la distribución temporal desigual entre países, nos imponen la necesidad de estar preparados y contar con herramientas que tengan la capacidad de medir en el contexto adecuado la respuesta personal ante esta crisis. OBJETIVO: Llevar a cabo la traducción, adaptación transcultural y validación para estudiantes de Grado en Enfermería de España de la "Escala de Medida de las Manifestaciones del Bienestar Psicológico". MÉTODO: La población diana fueron los estudiantes de los cuatro cursos del Grado en Enfermería de la Universidad Católica de Valencia. La recogida de datos se implementó a través de un cuestionario on line dentro del protocolo @student-sONquarentine. La muestra final quedó constituida por 375 estudiantes. RESULTADOS Y CONCLUSIÓN: Se mantiene la estructura factorial de la escala portuguesa. KMO: 0,923; T. de Bartlett: 4552,347 (p =.000) y r de Pearson por factores entre .702 y .861. Por lo que contamos con un instrumento con criterios óptimos de validez de constructo y fiabilidad para la medida del Bienestar Psicológico en estudiantes de Grado en Enfermería en condiciones de aislamiento

INTRODUCTION: The COVID-19 pandemic could be leaving psychological consequences in the population, both the expected fact of a global reinfection, and the unequal temporal distribution between countries, impose on us the need to be prepared and have tools with the ability to measure in the appropriate context the personal response to this crisis. OBJECTIVE: To carry out the translation, cross-cultural adaptation and validation for students of Bachelor of Nursing in Spain of the "Measurement Scale of the Manifestations of Psychological Well-being". METHOD: The target population was the students of the four courses of the Nursing Degree of the Catholic University of Valencia. Data collection was implemented through an online questionnaire within the @studentsONquarentine protocol. The final sample was made up of 375 students. RESULTS AND CONCLUSION: The factorial structure of the Portuguese scale is maintained. KMO: 0.923; Bartlett's T. 4552.347 (p = .000) and Pearson's r by factors between .702 and .861. Therefore, we have an instrument with optimal criteria of construct validity and reliability for the measurement of Psychological Well-being in Nursing Degree students in conditions of isolation

[Abdominal angina due to fibromuscular dysplasia of the celiac axis. Surgical management]. / Angina abdominal por displasia fibromuscular do tronco celíaco. Tratamento cirúrgico.

The clinical case of a 27-year old man with the diagnosis of chronic mesenteric ischemia ("abdominal angina") is reported, whose chief complaints were severe postprandial pain and remarkable weight loss, for the last 4 months. Following na inconclusive observation in gastroenterology, he underwent an angiographic-CT examination, that disclosed a critical stenosis at the origin of the celiac axis. The remaining digestive vessels, superior and inferior mesenteric arteries, were found free of lesions. The patient was submitted to a revascularization procedure, consisting in the celiac axis resection and its replacement by a prosthetic graft, arising from the supraceliac aorta. The post-operative course was uneventfull, followed by a complete remission of the pain and a progressive weight gain. The histopathological study of the removed artery revealed the diagnosis of arterial fibrodysplasia, a very rare entity in clinical practice, of unknown etiology, affecting predominantely young people and in a decreasing order of frequency the renals, the internal carotids and the external iliac arteries. The localization of the fibrodysplastic disease to the celiac áxis seems to be a unique case, never reported before in the literature, thus justifying its publication and dissemination.

[Chronic mesenteric ischemia revisited]. / Isquemia mesentérica crónica revisitada.

The authors report two clinical cases of rare and complex situations - an aortic dissection and an aortitis -, which had as a common denominator a chronic mesenteric ischemia. They discuss the indications and surgical strategies adopted.

[Conventional open surgery of a splenic artery aneurysm following failure of endovascular management]. / Tratamento cirúrgico convencional de um aneurisma da artéria esplénica após fracasso de intervenção endovascular.

The clinical case of a 73 years old man is reported, complaining for a long time of a persistent abdominal pain in the left upper quadrants, without irradiation and no identified causative factor. These symptoms affected notoriously his quality of life, becoming disabling for his social and professional activities. The investigation by means of CT-scans disclosed a spheric mass, partially calcified, having 44x41mms of maximum size, located between the pancreatic tail and the splenic hilum. A subsequent angio-CT confirmed the diagnosis of a large splenic artery aneurysm and the patient underwent the attempt of an endovascular exclusion by means of an endoprosthesis, which could not be successfully accomplished due to the multiple kinkings and coilings of the splenic artery. Several coils were then used to occlude the aneurismal sac. Contrarily to the expectations, the pain did not disappear after the procedure, becoming even worse, and an open surgical approach was then advised, in another hospital institution, which he promptly accepted. The operation consisted in the resection of the aneurysm and an associated splenectomy, due to multiple infarcts identified in the spleen, consequence of the previous endovascular management. The post operative course was uneventful and he was discharged on day 3. One and four months later he was found in excellent condition and totally pain-free, having resumed his social and professional activities. Based on this clinical case, the authors intend to put an emphasis on this constraint of the endovascular management of peripheral arterial aneurysms, namely on those causing external compression syndromes, painful or others, which can not be relieved by the endovascular exclusion of the aneurysm, as it happened with this patient, thus justifying its presentation and dissemination.

["Ex-vivo" surgical repair of renal artery branches aneurysms]. / Tratamento cirúrgico "ex-vivo" de aneurismas de ramos da artéria renal.

The authors report the clinical case of complex aneurysms of intra-hilar branches of the renal artery, managed recently through a renal auto-transplantation procedures with "ex-vivo" repair, discussing the technique, the principles and the indications for this kind of procedure.

[Surgical management of a spontaneous dissection of the celiac axis caused by fibromuscular dysplasia. First clinical report]. / Tratatmento cirúrgico de uma dissecção expontânea do tronco celíaco causada por displasia fibromuscular. Primeiro caso da literatura.

The clinical case of a 46 years old male is reported, who complained of a sudden and sharp epigastric pain, with no other accompanying symptoms or signs. The patient was evaluated in the emergency department of a local hospital and the clinical and laboratory analysis excluded the occurrence of a common acute abdominal pathology. A CT and an angio CT study disclosed a spontaneous dissection and aneurismal dilatation of the celiac axis, along its extension. The patient underwent surgical management, consisting in the resection and prosthetic replacement of the celiac axis and the pathological studies of the specimen revealed a fibromuscular dysplasia, which seems to be, according to the literature, an exceptional situation, never reported before, thus justifying its publication and dissemination.

[Synchronous revascularization surgery of supraaortic trunks and abdominal visceral arteries. Case report]. / Revascularização simultânea dos troncos supraórticos e das artérias viscerais do abdómen. Caso clínico.

The clinical case of a 50 years old female is reported, who was admitted at our hospital in very poor general condition, in a physical and psychologic state of exhaustion, due to a mesenteric vascular insufficiency syndrome (abdominal angina), for the last three years. She underwent a conventional angiographic evaluation, disclosing an occlusion of both the celiac axis and superior mesenteric artery and at the level of the aortic arch, an occlusion of the innominate artery associated to an ostial stenosis of the left common carotid artery was also found. The coronary circulation was normal. The patient underwent surgical management consisting in the bowel revascularization trough a supraceliac aortic bypass to both the hepatic and superior mesenteric arteries, followed by a supraaortic trunks revascularization by means of a bypass graft from the ascending aorta to both common carotid arteries. The extensive procedure was well tolerated by the patient and the post-operative course was normal, with the exception of an acute respiratory insufficiency promptly managed with intensive and non-invasive care and she was discharged on day 14th, asymptomatic and with a gain weight of 7 kilos. The unusual and eventually unique character of this simultaneous surgery justifies its presentation, as well as a discussion on the advantages and contraindications of such approach, that revealed itself as an efficient and extremely well succeeded procedure.

[Secondary aortoenteric fistula, multidisciplinary surgical management]. / Fístula aorto-entérica secundária, tratamento cirúrgico multidisciplinar.

The authors report the clinical case of a 77-year old man, who underwent the surgical treatment of an abdominal aortic aneurism 11 years before, admitted in the hospital emergency department complaining of abdominal pain and melena. Clinical and laboratorial findings, together with CT-scan and endoscopy data, lead to the diagnosis of secondary aortoenteric fistula. This is a rare clinical entity, coursing with high morbimortality levels of and is still one of the most controversial issues in vascular surgery. The successful surgical treatment of this patient is described and the solution of choice is discussed, as well as other alternative approaches.

[Reconstructive surgery of deep veins of the lower extremities: the Palma operation revisited]. / Cirurgia reconstrutiva das veias profundas dos membros inferiores: a operação de Palma revisitada.

It has been grossly estimated that one fifth of the patients with post thrombotic chronic venous diseases suffer from obstructive or hypertensive symptoms, due to a failure of the physiologic repermeabilization mechanisms. In clinical practice, only a small group of these patients, with disabling symptoms, fill the essential requirements for a deep vein reconstructive surgery. The authors report the clinical case of a 27 years old male, with a chronic segmentar thrombotic occlusion of the right external iliac and common femoral veins, causing disabling symptoms to his normal professional activity. The patient underwent a surgical reconstructive surgery, consisting in the classic Palma operation followed by an excellent anatomic and functional result. The main features of this procedure, its indications and results are discussed, based on the most recent data published in the literature.

[Large post traumatic internal carotid artery aneurysm simulating a neurogenic tumor. Surgical management]. / Volumoso aneurisma pós-traumático da carótida interna simulando tumor neurogénio. Tratamento cirúrgico.

The clinical case of a 60 year old female is reported who, incidentally, had the diagnosis of a retropharyngeal tumor, causing the anterior dislocation of the right tonsil. Imagiological studies (CT and NMR scans) were compatible with the diagnosis of "neurogenic tumor" or "vagal paraganglioma" and an attempt to a biopsy was failed, having collected only blood. An angio-RM allowed the definitive diagnosis of a large sacular aneurysm of the internal carotid artery, of unknown etiology. The patient underwent surgical management, consisting in the resection of the aneurysm and re-establishment of the arterial continuity by end-to-end anastomosis. Pathological studies of the specimen revealed an unsuspected traumatic etiology, probably related to a violent cervical blunt trauma occured several years before. The main features of the pathogenesis, topography, clinical manifestations and treatment of this condition are discussed, based on the most recent data published in the literature.

[Non-atherosclerotic lower limbs ischemia in young athletes]. / Isquemia cronica dos membros inferiores, de etiologia não aterosclerótica, em desportistas jovens.

Although rare, the iliac endofibrosis and the popliteal artery entrapment syndrome are undoubtfully recognised as causes of intermittent claudication in young patients, particularly in athletes. The authors report the clinical case of a young female athlete, with disabling claudication of the right lower limb due to a stenosis of the external iliac artery and a case of an acute ischemia in a male cyclist owing to an extrinsic compression of the popliteal artery by anomalous muscular bundles. Both cases underwent successful surgical management. The early suspicion and diagnosis of these situations is of utmost importance to prevent complications that may be particularly severe.

A new approach for the surgical management of unilateral iliac artery occlusive disease: the iliofemoral crossover transposition.

Aortobifemoral bypass remains the standard therapy for aortoiliac occlusive disease. Extraanatomic revascularization has been considered as an acceptable alternative and provides reasonable long-term results. Because some of the causes for its failure are related to the prosthetic material used, a technique that uses autologous material and is applicable in patients with unilateral common iliac lesions was developed. Iliofemoral crossover transposition is a femorofemoral bypass procedure in which the external iliac artery is used as a graft. The procedure is easily performed and avoids the use of prosthetic materials, minimizing the risks of their related complications. Because its biologic behavior, including hemodynamic performance, has proven to be excellent, satisfactory long-term results can be anticipated.