The Modulation of Septic Shock: A Proteomic Approach.

Sepsis poses a significant challenge due its lethality, involving multiple organ dysfunction and impaired immune responses. Among several factors affecting sepsis, monocytes play a crucial role; however, their phenotype, proteomic profile, and function in septic shock remain unclear. Our aim was to fully characterize the subpopulations and proteomic profiles of monocytes seen in septic shock cases and discuss their possible impact on the disease. Peripheral blood monocyte subpopulations were phenotype based on CD14/CD16 expression by flow cytometry, and proteins were extracted from the monocytes of individuals with septic shock and healthy controls to identify changes in the global protein expression in these cells. Analysis using 2D-nanoUPLC-UDMSE identified 67 differentially expressed proteins in shock patients compared to controls, in which 44 were upregulated and 23 downregulated. These proteins are involved in monocyte reprogramming, immune dysfunction, severe hypotension, hypo-responsiveness to vasoconstrictors, vasodilation, endothelial dysfunction, vascular injury, and blood clotting, elucidating the disease severity and therapeutic challenges of septic shock. This study identified critical biological targets in monocytes that could serve as potential biomarkers for the diagnosis, prognosis, and treatment of septic shock, providing new insights into the pathophysiology of the disease.

Penetrating injury of the common femoral vein followed by local deep vein thrombosis: A case report.

This case report discusses a unique scenario in which a 19-year-old patient with a penetrating wound in the common femoral vein developed deep vein thrombosis in response to life-threatening bleeding. The report highlights our thoughts on managing an isolated truncal venous injury leading to deep vein thrombosis, emphasizing the significance of surgical exploration in vascular trauma and the feasibility of employing non-invasive imaging diagnosis in preoperative planning.

Incidence of vascular injury associated with knee arthroplasty: series of cases.

INTRODUCTION: The incidence of vascular injury associated with knee arthroplasty is scarce, but, when they occur, the consequences are serious. OBJECTIVES: Describe the incidence of vascular lesions in our center and evaluate time to diagnosis, resolution and follow-up. MATERIALS AND METHODS: Retrospective cohort during the 2010-2019 period of primary arthroplasties and knee revision. The incidence of vascular lesions and their demographic characteristics were analyzed. Type of lesion, diagnostic method and treatment were recorded. It was evaluated in distant follow-up of pain and functionality. RESULTS: 7.940 primary total knee arthroplasty and revision surgeries were recorded, and a report of 7 emergency cases for vascular lesions was also recorded, with an incidence of 0.088%. 3 vascular lesions were caused by direct laceration of the popliteal artery, 1 case of thrombosis of the popliteal artery and 3 cases of pseudoaneurysmal lesion of the superior genicular artery. Three vascular lesions that occurred in primary arthroplasty were immediately repaired by a vascular surgeon. Pseudoaneurysm lesions and thrombosis were resolved by angiographic procedure. DISCUSSION: Vascular complications around the knee are rare. Time to diagnosis and treatment is essential. Digital angiography is a diagnostic and therapeutic tool. There are various repair techniques, whether it's embolization, cauterization, stenting or endoprosthesis; therefore, digital angiography is a safe method with a low complication rate. CONCLUSION: The incidence of vascular lesions in knee arthroplasty in our center is very low. The cases were diagnosed and resolved early, without registering subsequent complications with good functional results in distant follow-up.

Eucommia granules activate Wnt/ß-catenin pathway, and improve oxidative stress, inflammation, and endothelial injury in preeclampsia rats

Purpose: Pre-eclampsia (PE) is a pregnancy-related complication. Eucommia is effective in the treatment of hypertensive disorders in pregnancy, but the specific effects and possible mechanisms of Eucommia granules (EG) in PE remain unknown. The aim of this study was to investigate the effects and possible mechanisms of EG in PE rats. Methods: Pregnant Sprague Dawley rats were divided into five groups (n = 6): the control group, the model group, the low-dose group, the medium-dose group, and the high-dose group of EG. The PE model was established by subcutaneous injection of levonitroarginine methyl ester. Saline was given to the blank and model groups, and the Eucommia granules were given by gavage to the remaining groups. Blood pressure and urinary protein were detected. The body length and weight of the pups and the weight of the placenta were recorded. Superoxide dismutase (SOD) activity and levels of malondialdehyde (MDA), placental growth factor (PIGF), and soluble vascular endothelial growth factor receptor-1 (sFIt-1) were measured in the placenta. Pathological changes were observed by hematoxylin-eosin staining. Wnt/ß-catenin pathway-related protein expression was detected using Western blot. Results: Compared with the model group, the PE rats treated with EG had lower blood pressure and urinary protein. The length and weight of the pups and placental weight were increased. Inflammation and necrosis in the placental tissue was improved. SOD level increased, MDA content and sFIt-1/PIGF ratio decreased, and Wnt/ß-catenin pathway-related protein expression level increased. Moreover, the results of EG on PE rats increased with higher doses of EG. Conclusions: EG may activate the Wnt/ß-catenin pathway and inhibit oxidative stress, inflammation, and vascular endothelial injury in PE rats, thereby improving the perinatal prognosis of preeclamptic rats. EG may inhibit oxidative stress, inflammation, and vascular endothelial injury through activation of the Wnt/ß-catenin pathway in preeclampsia rats, thereby improving perinatal outcomes in PE rats.

Case report: Endovascular stent-graft repair of aortic penetrating trauma, literature review, and case report.

Penetrating aortic injuries are infrequent. Its incidence is unknown because most patients die of hemorrhage even before they receive adequate treatment. Aortic wounds generally require conventional thoracotomy/laparotomy repair and are related to high mortality rates. Recently with the advent of endovascular techniques, most authors prefer endovascular management when feasible due to better (still poor) outcomes. The short- and mid-term results of immediate endovascular repair of traumatic aortic injuries are promising, especially when compared with open surgical treatment, indicating that endovascular therapy is preferable in patients with multi-trauma and traumatic ruptures of the thoracic aorta. Here we present the diagnosis and treatment of a 30 years-old male patient with multiple traumatic stab wounds, including anterior aortic laceration with a grade II aortic lesion successfully managed with an endovascular stent graft.

Management of traumatic superficial palmar arch pseudoaneurysm: a therapeutic challenge.

Pseudoaneurysm of the palmar arch is a rare entity. Diagnosis is dependent on high clinical suspicion. We present a case referred to the emergency department, with a history of glass penetrating trauma to the palmar surface with a pulsatile mass and jet bleeding. Doppler ultrasound evidenced a partially thrombosed pseudoaneurysm. A CT angiography examination showed a saccular formation arising from the superficial palmar arch. A conventional surgical approach was indicated. A clinical suspicion must be ventured to arrive at the correct diagnosis. Imaging modalities are needed to identify the pseudoaneurysm and plan the treatment course. Nonetheless, the sequence of diagnosis is individual, because further evaluation with different imaging methods may not change the rationale for the intervention. In our experience, conventional surgical removal is preferable, due to its safety and well-established outcomes.

O pseudoaneurisma do arco palmar é uma entidade rara, cujo diagnóstico depende de alta suspeição clínica. Apresentamos o caso de um paciente encaminhado ao pronto-socorro com história de traumatismo penetrante por vidro na face palmar, com massa pulsátil e sangramento em jato. A ultrassonografia com Doppler evidenciou pseudoaneurisma parcialmente trombosado, e a angiotomografia demonstrou formação sacular originada do arco palmar superficial. Uma abordagem cirúrgica convencional foi indicada. Para prosseguir com o diagnóstico correto, essa suspeita clínica deve ser aventada. Modalidades de imagem são necessárias para identificar o pseudoaneurisma e planejar o curso do tratamento. No entanto, a sequência diagnóstica é individual, pois uma avaliação mais aprofundada, com diferentes métodos de imagem, pode não alterar o racional da intervenção. Em nossa experiência, a remoção cirúrgica convencional é preferível, visto sua segurança e seus resultados bem estabelecidos.

Immediate identification and management of an open posterior knee dislocation: Important lessons from a case report.

Traumatic knee dislocation represents a rare event, contributing to less than 0.02 % of all orthopedic trauma and 0.05 % of joint dislocations, respectively. It is critically important to recognize, identify, and appropriately manage such cases as 'time' is implicated as an outcome-determining factor. Thus, such cases warrant quick consideration and appropriate management to mitigate the possibility of neurovascular damage and long-term sequelae. We report a case of a 59-year-old man struck by a motor vehicle in a remote rural community in northern Mexico managed with external fixation 16 h after the initial trauma, and later resulting in a supracondylar amputation. The authors of this case report underline the importance of timely intervention strategies when faced with such cases of knee dislocation and promote enhanced training of peripheral trauma-care providers to help improve patient outcomes.

Pathophysiological and Clinical Significance of Crotalus durissus cascavella Venom-Induced Pulmonary Impairment in a Murine Model.

Crotalus venom has broad biological activity, including neurotoxic, myotoxic, hematologic, and cytotoxic compounds that induce severe systemic repercussions. We evaluated the pathophysiological and clinical significance of Crotalus durissus cascavella (Cdc) venom-induced pulmonary impairment in mice. We conducted a randomized experimental study, involving 72 animals intraperitoneally inoculated with saline solution in the control group (CG), as well as venom in the experimental group (EG). The animals were euthanized at predetermined intervals (1 h, 3 h, 6 h, 12 h, 24 h, and 48 h), and lung fragments were collected for H&E and Masson histological analysis. The CG did not present inflammatory alterations in pulmonary parenchyma. In the EG, interstitial and alveolar swelling, necrosis, septal losses followed by alveolar distensions, and areas of atelectasis in the pulmonary parenchyma were observed after three hours. The EG morphometric analysis presented pulmonary inflammatory infiltrates at all time intervals, being more significant at three and six (p = 0.035) and six and 12 h (p = 0.006). The necrosis zones were significant at intervals of one and 24 h (p = 0.001), one and 48 h (p = 0.001), and three and 48 h (p = 0.035). Crotalus durissus cascavella venom induces a diffuse, heterogeneous, and acute inflammatory injury in the pulmonary parenchyma, with potential clinical implications for respiratory mechanics and gas exchange. The early recognition and prompt treatment of this condition are essential to prevent further lung injury and to improve outcomes.

Incidence of vascular lesions associated with disruption of the bile duct secondary to cholecystectomy.

BACKGROUND: One of the most serious complications of cholecystectomy is bile duct disruption, which can be associated with concomitant vascular injury in up to 3.4%. The incidence, demographic characteristics and treatment are underreported worldwide. OBJECTIVE: To determine the incidence of vascular lesions in patients with a diagnosis of bile duct disruption secondary to cholecystectomy from January 1, 2015 to December 31, 2019, confirmed by preoperative CT angiography or intraoperative findings. METHOD: Retrospective, observational and analytical study of a series of cases between 2015 and 2019. Where a total of 144 cases of bile duct disruption were found, 15 cases (10%) with concomitant vascular injury. RESULTS: The most frequent vascular injury was of the right hepatic artery in 13 patients (87%). The level of biliary disruption most frequently associated was Strasberg E3 and E4 in 5 patients (36%), respectively. The treatment of vascular injury was ligation of the injured vessel in 11 patients (73%). The treatment established for the repair of biliary disruption was the hepatic jejunum anastomosis in 14 patients (93%). CONCLUSIONS: The presence of injury at the level of the right hepatic artery is the most frequent and its ligation did not show a significant impact on biliodigestive reconstruction, as long as an adequate technique is performed (Hepp-Couinaud).

ANTECEDENTES: Una de las complicaciones más serias de la colecistectomía es la disrupción de la vía biliar, la cual puede estar asociada con lesión vascular concomitante hasta en un 3.4%. Su incidencia, características demográficas y tratamiento son infrarreportados en todo el mundo. OBJETIVO: Conocer la incidencia de las lesiones vasculares en pacientes con diagnóstico de disrupción de la vía biliar secundaria a colecistectomía, del 1 de enero de 2015 al 31 de diciembre de 2019, confirmado por angiotomografía preoperatoria o por hallazgos transoperatorios. MÉTODO: Estudio retrospectivo, observacional y analítico de una serie de casos del 2015 al 2019. Encontrando 144 casos de disrupción de la vía biliar, 15 (10%) con lesión vascular concomitante. RESULTADOS: La lesión vascular más frecuente fue la de arteria hepática derecha, en 13 pacientes (87%). El nivel de disrupción biliar más habitualmente asociado fue Strasberg E3 y E4, en 5 pacientes (36%) cada uno. El tratamiento de la lesión vascular fue ligadura del vaso en 11 pacientes (73%). El tratamiento de la disrupción de vía biliar fue anastomosis hepático-yeyunal en 14 pacientes (93%). CONCLUSIONES: La presencia de lesión de la arteria hepática derecha es la más frecuente y su ligadura no tiene una repercusión significativa en la reconstrucción biliodigestiva, siempre y cuando se realice una técnica adecuada (Hepp-Couinaud).

Management of traumatic superficial palmar arch pseudoaneurysm: a therapeutic challenge / Manejo de pseudoaneurisma do arco palmar superficial traumático: desafio terapêutico

Abstract Pseudoaneurysm of the palmar arch is a rare entity. Diagnosis is dependent on high clinical suspicion. We present a case referred to the emergency department, with a history of glass penetrating trauma to the palmar surface with a pulsatile mass and jet bleeding. Doppler ultrasound evidenced a partially thrombosed pseudoaneurysm. A CT angiography examination showed a saccular formation arising from the superficial palmar arch. A conventional surgical approach was indicated. A clinical suspicion must be ventured to arrive at the correct diagnosis. Imaging modalities are needed to identify the pseudoaneurysm and plan the treatment course. Nonetheless, the sequence of diagnosis is individual, because further evaluation with different imaging methods may not change the rationale for the intervention. In our experience, conventional surgical removal is preferable, due to its safety and well-established outcomes.

Resumo O pseudoaneurisma do arco palmar é uma entidade rara, cujo diagnóstico depende de alta suspeição clínica. Apresentamos o caso de um paciente encaminhado ao pronto-socorro com história de traumatismo penetrante por vidro na face palmar, com massa pulsátil e sangramento em jato. A ultrassonografia com Doppler evidenciou pseudoaneurisma parcialmente trombosado, e a angiotomografia demonstrou formação sacular originada do arco palmar superficial. Uma abordagem cirúrgica convencional foi indicada. Para prosseguir com o diagnóstico correto, essa suspeita clínica deve ser aventada. Modalidades de imagem são necessárias para identificar o pseudoaneurisma e planejar o curso do tratamento. No entanto, a sequência diagnóstica é individual, pois uma avaliação mais aprofundada, com diferentes métodos de imagem, pode não alterar o racional da intervenção. Em nossa experiência, a remoção cirúrgica convencional é preferível, visto sua segurança e seus resultados bem estabelecidos.

Intraoperative Complications of Anterior Lumbar Interbody Fusion: A 5-Year Experience of a Group of Spine Surgeons Performing Their Own Approaches.

BACKGROUND: Spine surgery has evolved at an accelerated pace, allowing the development of more efficient surgical techniques while providing a decreasing rate of morbimortality. One example of these approaches is the anterior lumbar interbody fusion (ALIF). The aim of this study was to evaluate the surgical complication rate when performing ALIF without the help of a vascular "access" surgeon. METHODS: A retrospective descriptive study was conducted at the Hospital Universitario San Ignacio between 2014 and 2018 and included all patients who underwent ALIF during this time. A nonsystematic review was performed assessing approach-related complications in ALIF and the impact of "access" surgeons in surgical outcomes. RESULTS: A total of 337 patients were included and 508 levels were fused. ALIF was performed as ALIF-360° (27%), ALIF-lateral lumbar interbody fusion (LLIF) (8.9%), and stand-alone ALIF (62%). Most procedures were single-level fusions (51.9%), 45.4% involved 2 levels, and 2.6% were 3-level fusions. The mortality rate was 0%, and only 9 cases of vascular injury were observed and described. Left and common iliac veins were the predominant affected structures. Only a single case required blood transfusion without any other treatment or intensive care unit surveillance. CONCLUSIONS: Our study is consistent with literature reports about ALIF complications, finding an incidence of 1.7%. Therefore, ALIF is an excellent alternative for spine procedures, especially for the levels L5-S1 that require sagittal balance restoration. The approaches were performed without a vascular "access" surgeon and presented complication rates similar to those described in the literature.

Gunshot-related giant brachial artery pseudoaneurysm: Case report.

Pseudoaneurysms are late and rare complications in the upper limbs due to penetrating vascular trauma. Although endovascular management is offered as the ideal approach, there are some anatomical conditions to consider surgical treatment. An 18-year-old patient was admitted into our hospital two months later after suffering a single gunshot on the left arm. The arteriography showed loss of most of the branchial artery (BA) course, which was replaced by an unusual 14 ∗ 10 cm pseudoaneurysm. The increasing deformity within the anterior compartment of the arm generated neuropathic and ischemic symptoms (NIS) that were resolved after the drainage and reconstruction of BA. An autologous, ipsilateral basilic vein (BV) graft was used for this purpose. After 26 months, the normal hemodynamic conditions of the treated limb allowed the patient to remain asymptomatic.

Scapulothoracic dissociation and blunt vertebral vascular injury: case report / > Disociación escapulo-torácica y trauma cerrado de arteria vertebral: reporte de un caso

Abstract Case Description: A 24-year-old male suffers from a motor vehicle accident with penetrating neck trauma and concomitant closed left cervicothoracic trauma. Clinical Findings: High impact trauma causing hypovolemic shock, left zone I penetrating neck trauma, ischemia due to blunt trauma to the axillary vessels, and brachial plexus injury. Transection of the vertebral artery on angiotomography. Diagnosed with scapulothoracic dissociation and vertebral artery trauma. Treatment and outcome: Axillary arteriovenous reconstruction, fasciotomies, non-surgical approach of the vertebral artery trauma, and deferred treatment of the brachial plexus trauma were performed. Survival of the patient and his limb, with major neurologic sequelae Clinical Relevance: The case presented here is an example of scapulothoracic dissociation with associated trauma to the vertebral artery, injuries that are uncommon and associated with high morbidity and mortality. Early recognition of the injuries and a multidisciplinary approach for this complex case by surgical board reviews at various levels within the course of care were key determinants in the patient's improved prognosis. This case report presents an analysis of the diagnostics, treatment, and course; considering in-hospital care and the decision-making process as determinants for the prognosis in a polytrauma patient.

Resumen Descripción del caso: Varón de 24 años que sufre accidente automovilístico con trauma penetrante de cuello y trauma cerrado cervico torácico izquierdo concomitante. Hallazgos clínicos: Shock hipovolémico, trauma en zona I cuello izquierdo, isquemia por trauma cerrado de vasos axilares y lesión por trauma cerrado del plexo braquial; producto de trauma de alto impacto. Sección de arteria vertebral por angiotomografia. Se diagnostica disociación escapulo-torácica y trauma de arteria vertebral. Tratamiento y resultado: Reconstrucción vascular arterio-venosa axilar, fasciotomías y abordaje no operatorio del trauma de arteria vertebral, con manejo diferido del trauma del plexo braquial. Sobrevida del paciente y su extremidad, con secuelas neurológicas mayores. Relevancia clínica: Es un caso de disociación escapulotorácica y lesión de arteria vertebral concomitante, siendo esta una asociación infrecuente y de alta morbi-mortalidad. El reconocimiento temprano de las lesiones y un abordaje multidisciplinario de este escenario de complejidad por medio de juntas quirúrgicas en varios niveles del proceso de atención, fueron determinantes para cambiar el pronóstico del paciente. Se presenta un análisis del diagnóstico, manejo y evolución; considerando el proceso de atención hospitalaria, toma consensuada de decisiones y el pronóstico en un paciente politraumatizado.

Superficial femoral artery pseudoaneurysm, compartment syndrome, and deep vein thrombosis after total knee arthroplasty.

Vascular injuries after total knee arthroplasty are highly infrequent, especially in the femoral artery. These lesions can cause severe damage. Early diagnosis is important to prevent catastrophic complications (such as loss of limb) and to offer adequate treatment. This study reports a patient with femoral artery injury of unknown etiology after total knee arthroplasty. Progressive and insidious symptoms from deep vein thrombosis to compartment syndrome made management even more challenging, requiring amputation of the extremity.

Varus mechanism is associated with high incidence of popliteal artery lesions in multiligament knee injuries.

PURPOSE: This study aims to identify multiple ligament knee injury patterns that possess a high-risk of vascular lesion. METHODS: We retrospectively compared torn ligament patterns and the presence of vascular lesions confirmed by magnetic resonance imaging and computed tomography angiography from 122 consecutive patients with diagnoses of multiple ligament knee injury made at the emergency department between January 2012 and December 2017. Patients were not eligible if they had an ipsilateral lower extremity lesion (dislocations or fractures at another level), initial evaluation at another hospital, or follow-up for less than 12 months. The primary outcomes were the comparison between the imaging findings of torn structures patterns and the presence of a vascular lesion. RESULTS: We identified 48 eligible patients (50 knees) with multiligamentary knee lesions, of whom eight had popliteal artery damage, yielding an incidence of 16%. Our clinical examination detected six of these patients that were classified, according to the Schenck system, as KD-IIIL (6 knees) and KD-IIIM (2 knees). The odds of having a popliteal artery injury is 4.69 to 1 with a KD-IIIL injury that with any other type of injury on that classification (95% CI 0.960-22.98). CONCLUSIONS: This data suggests that varus forces causing enough energy to produce a KD-IIIL lesion possess a higher popliteal artery injury risk, making recommendable a thorough examination of the vascular integrity when diagnosing a KD-IIIL lesion.

Total Panax notoginseng saponin inhibits balloon injury-induced neointimal hyperplasia in rat carotid artery models by suppressing pERK/p38 MAPK pathways

Total Panax notoginseng saponin (TPNS) is the main bioactivity compound derived from the roots and rhizomes of Panax notoginseng (Burk.) F.H. Chen. The aim of this study was to investigate the effectiveness of TPNS in treating vascular neointimal hyperplasia in rats and its mechanisms. Male Sprague-Dawley rats were randomly divided into five groups, sham (control), injury, and low, medium, and high dose TPNS (5, 10, and 20 mg/kg). An in vivo 2F Fogarty balloon-induced carotid artery injury model was established in rats. TPNS significantly and dose-dependently reduced balloon injury-induced neointimal area (NIA) (P<0.001, for all doses) and NIA/media area (MA) (P<0.030, for all doses) in the carotid artery of rats, and PCNA expression (P<0.001, all). The mRNA expression of smooth muscle (SM) α-actin was significantly increased in all TPNS groups (P<0.005, for all doses) and the protein expression was significantly increased in the medium (P=0.006) and high dose TPNS (P=0.002) groups compared to the injury group. All the TPNS doses significantly decreased the mRNA expression of c-fos (P<0.001). The medium and high dose TPNS groups significantly suppressed the upregulation of pERK1/2 protein in the NIA (P<0.025) and MA (P<0.004). TPNS dose-dependently inhibited balloon injury-induced activation of pERK/p38MAPK signaling in the carotid artery. TPNS could be a promising agent in inhibiting cell proliferation following vascular injuries.

Scapulothoracic dissociation and blunt vertebral vascular injury: case report.

CASE DESCRIPTION: A 24-year-old male suffers from a motor vehicle accident with penetrating neck trauma and concomitant closed left cervicothoracic trauma. CLINICAL FINDINGS: High impact trauma causing hypovolemic shock, left zone I penetrating neck trauma, ischemia due to blunt trauma to the axillary vessels, and brachial plexus injury. Transection of the vertebral artery on angiotomography. Diagnosed with scapulothoracic dissociation and vertebral artery trauma. TREATMENT AND OUTCOME: Axillary arteriovenous reconstruction, fasciotomies, non-surgical approach of the vertebral artery trauma, and deferred treatment of the brachial plexus trauma were performed. Survival of the patient and his limb, with major neurologic sequelae. CLINICAL RELEVANCE: The case presented here is an example of scapulothoracic dissociation with associated trauma to the vertebral artery, injuries that are uncommon and associated with high morbidity and mortality. Early recognition of the injuries and a multidisciplinary approach for this complex case by surgical board reviews at various levels within the course of care were key determinants in the patient's improved prognosis. This case report presents an analysis of the diagnostics, treatment, and course; considering in-hospital care and the decision-making process as determinants for the prognosis in a polytrauma patient.

DESCRIPCIÓN DEL CASO: Varón de 24 años que sufre accidente automovilístico con trauma penetrante de cuello y trauma cerrado cervico torácico izquierdo concomitante. HALLAZGOS CLÍNICOS: Shock hipovolémico, trauma en zona I cuello izquierdo, isquemia por trauma cerrado de vasos axilares y lesión por trauma cerrado del plexo braquial; producto de trauma de alto impacto. Sección de arteria vertebral por angiotomografia. Se diagnostica disociación escapulo-torácica y trauma de arteria vertebral. TRATAMIENTO Y RESULTADO: Reconstrucción vascular arterio-venosa axilar, fasciotomías y abordaje no operatorio del trauma de arteria vertebral, con manejo diferido del trauma del plexo braquial. Sobrevida del paciente y su extremidad, con secuelas neurológicas mayores. RELEVANCIA CLÍNICA: Es un caso de disociación escapulotorácica y lesión de arteria vertebral concomitante, siendo esta una asociación infrecuente y de alta morbi-mortalidad. El reconocimiento temprano de las lesiones y un abordaje multidisciplinario de este escenario de complejidad por medio de juntas quirúrgicas en varios niveles del proceso de atención, fueron determinantes para cambiar el pronóstico del paciente. Se presenta un análisis del diagnóstico, manejo y evolución; considerando el proceso de atención hospitalaria, toma consensuada de decisiones y el pronóstico en un paciente politraumatizado.

Traumatic pseudoaneurysm in brachial artery after removal of a subdermal contraceptive implant.

The frequency of invasive therapeutic procedures has increased as medicine evolves, and the number of complications related to them has increased as a consequence. Subdermal contraceptive implants (SCI) offer benefits for female contraception, but implant and removal are associated with a complication rate of around 3%. In this article, we report and discuss a case of traumatic brachial artery pseudoaneurysm after an attempt to remove an SCI, complicated by compression of the median nerve.

Fractura supracondílea de húmero y extremidad sin pulso. Uso de oximetría de pulso como predictor de lesión vascular en un caso pediátrico / Pulseless limb and supracondylar humeral fracture; use of pulse oximetry as a predictor of vascular injury in a pediatric case

Las fracturas supracondíleas del húmero (FSCH) representan la segunda lesión más frecuente en la infancia. La clasificación de Gartland, de acuerdo con la dirección y magnitud del desplazamiento orienta hacia su tratamiento. Las fracturas grado I solo requieren inmovilización y los grados del II al IV necesitan reducción generalmente cerrada, y fijación con agujas de Kirschner percutáneas. En los grados III y IV las lesiones neuro-vasculares se pueden presentar debido a las relaciones anatómicas de la fractura. La lesión vascular se debe sospechar y tener siempre en cuenta, debido a las secuelas que se pueden presentar de no tomar una conducta adecuada a tiempo. Actualmente existe controversia acerca de cuándo realizar la exploración quirúrgica ante una extremidad bien perfundida, sin pulso radial como resultado de una FSCH. Varios autores han reportado la utilidad de la onda de pulso en la oximetría como predictor de lesión vascular. En este artículo se presenta un caso clínico de FSCH con extremidad sin pulso y lesión de la arteria braquial, su manejo y evolución final.

Supracondylar fractures of the humerus are the second most frequent lesion of infancy. Gartland's classification uses the direction and magnitude of the displacement to determine its treatment. Grade I fractures need only immobilization and grades II to IV need reduction, generally closed, and percutaneous fixation with Kirschner needles. Neurovascular lesions may be present in grades III and IV because of the anatomic relations to the fracture. Vascular injury must always be suspected and taken into consideration because of the sequelae that may occur if not given adequate treatment promptly.There is currently controversy over when to do a surgical exploration in a well-perfused limb with absent radial pulse resulting from a supracondylar humeral fracture. Several authors have reported the usefulness of the waveformof the pulse oximeter in predicting vascular injury. In this article we present a clinical case of supracondylar humeral fracturewithpulseless limb and brachial artery injury, its management, and the outcome.

Pseudoaneurisma traumático em artéria braquial após retirada de implante contraceptivo subdérmico / Traumatic pseudoaneurysm in brachial artery after removal of a subdermal contraceptive implant

Resumo Os procedimentos terapêuticos invasivos têm aumentado frequentemente com a evolução da medicina, consequentemente aumentando o número de complicações decorrentes deles. O dispositivo contraceptivo subdérmico (DCS) tem um benefício para a contracepção feminina, mas o implante e a retirada apresentam uma taxa de complicações em torno de 3%. Neste artigo, relatamos e discutimos um caso de pseudoaneurisma traumático da artéria braquial após tentativa de retirada do implante, complicada com a compressão do nervo mediano.

Abstract The frequency of invasive therapeutic procedures has increased as medicine evolves, and the number of complications related to them has increased as a consequence. Subdermal contraceptive implants (SCI) offer benefits for female contraception, but implant and removal are associated with a complication rate of around 3%. In this article, we report and discuss a case of traumatic brachial artery pseudoaneurysm after an attempt to remove an SCI, complicated by compression of the median nerve.