Fístula carótida-yugular debido a trauma vascular con sierra de cadena. Enfoque diagnóstico y quirúrgico / Carotide-jugular fistula due to vascular trauma with chain saw. Diagnostic and surgical approach

INTRODUCCIÓN: el trauma carotídeo es una patología infrecuente pero generalmente devastadora, requiere un manejo diagnóstico y terapéutico oportuno. En los casos donde no hay inestabilidad hemodinámica o lesiones severas se puede incluir en el diagnóstico a la angiotomografía e incluso a la angiografía, que puede aportar datos fundamentales en el tratamiento. La cirugía convencional es de elección en muchos casos, determinada especialmente por las características de la lesión carotídea y por la disponibilidad de insumos endovasculares. CASO CLÍNICO: presentamos el caso de un paciente con lesión carotídea causada por un fragmento de sierra de cadena, que provocó una fístula carótido-subclavia. Se optó por la cirugía convencional que consistió en el cierre de la fístula y la angioplastia de la carótida interna con el uso de un parche en pantalón de safena mayor. DISCUSIÓN: el paciente se recuperó sin focalidades neurológicas

BACKGROUND: carotid trauma is an infrequent but generally devastating disease, requiring timely diagnostic and therapeutic management. In cases where there is no hemodynamic instability or severe injuries, angiotomography and even angiography can be included in the diagnosis, which can provide fundamental data in treatment. Conventional surgery is the choice in many cases, especially determined by the characteristics of the carotid lesion and by the availability of endovascular supplies. CASE REPORT: we present the case of a patient with a carotid lesion caused by a chainsaw fragment, which caused a carotid-subclavian fistula. Conventional surgery was chosen, which consisted of closing the fistula and angioplasty of the internal carotid with the use of a patch in the pants of the greater saphenous vein. DISCUSSION: the patient recovered without neurological focalities

Úlcera aórtica torácica e isquemia aguda de extremidad inferior debido a proyectil de bala / Thoracic aortic ulcer and acute lower limb ischemia due to bullet

La fisiopatología de la embolización arterial de una bala con la formación de una úlcera aórtica puede ser un cuadro confuso y extraordinariamente raro. Es evidente suponer daños severos de tipo vascular, cardíaco o pulmonar como consecuencia del orificio de puerta de entrada, lo que puede llevar a una hemorragia severa y, por lo tanto, representa un riesgo vital grave, pero resulta sorprendente que este traumatismo vascular se asocie a una isquemia de una extremidad. De hecho, este tipo de lesiones han sido raramente reportadas y sus complicaciones suelen subestimarse o son tardíamente diagnosticadas. Este raro suceso se describió por primera vez durante la Primera Guerra Mundial, pero ahora este fenómeno suele asociarse a violencia civil por arma de fuego, algo que va en progresivo aumento. En este caso clínico informamos de un caso que fue tratado en nuestro centro

The pathophysiology of a bullet arterial embolization with the formation of an aortic ulcer can be a confusing and extraordinarily rare picture. It is evident to suppose severe vascular, cardiac or pulmonary damage as a consequence of the point of entry, which can lead to severe bleeding and thus represents a serious life risk, however it is surprising that this vascular trauma is associated with ischemia of a limb. In fact, these types of injuries have been rarely reported and their complications are often underestimated or are late diagnosed. This rare event was described for the first time during the First World War, but now this phenomenon is usually associated with civil violence by firearm witch is gradually increasing. In this document, we report a case that was treated in our center by thoracic endoprosthesis and surgical resection of the foreign body though arterial surgery

Complicaciones tardías de la disección aórtica tipo B tratada con TEVAR / Late complications of type B aortic dissection treated with TEVAR

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Pectin Methacrylate (PEMA) and Gelatin-Based Hydrogels for Cell Delivery: Converting Waste Materials into Biomaterials.

The emergence of nontoxic, eco-friendly, and biocompatible polymers derived from natural sources has added a new and exciting dimension to the development of low-cost and scalable biomaterials for tissue engineering applications. Here, we have developed a mechanically strong and durable hydrogel composed of an eco-friendly biopolymer that exists within the cell walls of fruits and plants. Its trade name is pectin, and it bears many similarities with natural polysaccharides in the native extracellular matrix. Specifically, we have employed a new pathway to transform pectin into a ultraviolet (UV)-cross-linkable pectin methacrylate (PEMA) polymer. To endow this hydrogel matrix with cell differentiation and cell spreading properties, we have also incorporated thiolated gelatin into the system. Notably, we were able to fine-tune the compressive modulus of this hydrogel in the range ∼0.5 to ∼24 kPa: advantageously, our results demonstrated that the hydrogels can support growth and viability for a wide range of three-dimensionally (3D) encapsulated cells that include muscle progenitor (C2C12), neural progenitor (PC12), and human mesenchymal stem cells (hMSCs). Our results also indicate that PEMA-gelatin-encapsulated hMSCs can facilitate the formation of bonelike apatite after 5 weeks in culture. Finally, we have demonstrated that PEMA-gelatin can yield micropatterned cell-laden 3D constructs through UV light-assisted lithography. The simplicity, scalability, processability, tunability, bioactivity, and low-cost features of this new hydrogel system highlight its potential as a stem cell carrier that is capable of bridging the gap between clinic and laboratory.

Bioprinting technologies for disease modeling.

There is a great need for the development of biomimetic human tissue models that allow elucidation of the pathophysiological conditions involved in disease initiation and progression. Conventional two-dimensional (2D) in vitro assays and animal models have been unable to fully recapitulate the critical characteristics of human physiology. Alternatively, three-dimensional (3D) tissue models are often developed in a low-throughput manner and lack crucial native-like architecture. The recent emergence of bioprinting technologies has enabled creating 3D tissue models that address the critical challenges of conventional in vitro assays through the development of custom bioinks and patient derived cells coupled with well-defined arrangements of biomaterials. Here, we provide an overview on the technological aspects of 3D bioprinting technique and discuss how the development of bioprinted tissue models have propelled our understanding of diseases' characteristics (i.e. initiation and progression). The future perspectives on the use of bioprinted 3D tissue models for drug discovery application are also highlighted.

Does anticoagulation in Eisenmenger syndrome impact long-term survival?

OBJECTIVE: To determine the impact of anticoagulation on survival in Eisenmenger syndrome. BACKGROUND: The use of anticoagulation for primary prevention of adverse events in patients with Eisenmenger syndrome has been proposed but not studied. Strong arguments have been made both for and against anticoagulation based on the known risk of hemoptysis and pulmonary vascular thrombosis. DESIGN AND SETTING: Retrospective cohort study at a tertiary referral hospital. PATIENTS AND INTERVENTIONS: One hundred forty-four patients with established Eisenmenger physiology all underwent initial laboratory, echocardiographic, and catheterization evaluation after initial referral. We retrospectively identified patients who were started on anticoagulation (AC) and compared them to patients who did not receive anticoagulation therapy (non-AC). Baseline variables were compared between groups, as well as between survivors and nonsurvivors. Analyses of prognostic factors and survival were done using Cox and Kaplan-Meier methods. OUTCOME MEASURES: The primary outcome was death since time of baseline evaluation. RESULTS: We identified 48 anticoagulated and 44 non-anticoagulated patients with Eisenmenger physiology (oxygen saturation 82 ± 9%, PaO(2) 48 ± 8 mm Hg, hemoglobin 18.6 ± 4 g/dL). More atrial septal defect patients were in the AC group, but there were no other baseline differences in clinical, functional, or hemodynamic data. After mean follow-up of 7 ± 5.4 years (range 1-31), 11 patients died in the AC and 10 died in the non-AC group. There was no survival difference between groups (log rank test = 1.78; P is not significant). For the entire cohort, mortality was significantly associated with New York Heart Association class 3-4 (hazard ratio = 4.2), evidence of right heart failure (hazard ratio = 13.6), and a mean corpuscular volume <80 fL (hazard ratio = 3.8). Use of anticoagulation did not impact survival. Bleeding complications occurred in seven (16%) of AC patients, including two fatalities. CONCLUSIONS: Anticoagulation had no impact on long-term survival in this limited study. These data may be useful in considering future studies addressing this question.

Digital enhancement of stent images in primary and secondary percutaneous coronary revascularisation.

Inadequate stent expansion and apposition during percutaneous coronary intervention increases the risk of subsequent restenosis and thrombosis. In repeat and complex percutaneous interventions, such as treatment of stent restenosis or bifurcation techniques, these aspects present a renewed importance. Intravascular ultrasound (IVUS) constitutes the standard technique to assess stent expansion, but its use in clinical practice is far from being universal. Although most current stent designs are radiolucent, new radiological imaging modalities, specifically tailored to coronary stent imaging, can render images with enough quality to visualise stent sub-expansion. While this approach might be complementary to IVUS in clinical practice, few in vivo studies comparing both techniques are available. In this article we review the principles of digital enhancement of stent images and the available validation studies. Furthermore, we report on a comparison between IVUS and digital enhancement stent images performed after coronary stenting.

Estereotaxis: una nueva alternativa para el tratamiento de lesiones con angulación y tortuosidad extrema que previamente se han fallado con técnicas convencionales / Stereotaxis: a new approach to treating highly tortuous and angulated coronary lesions after conventional techniques have failed

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Guía para la formulación y ejecución de proyectos de investigación

Este libro de fluida y fácil lectura, ofrece a estudiantes e investigadores una guía integral del proceso de investigación desde la formulación de una propuesta de estudio hasta la presentación de los resultados y conclusiones.Para elllo combina de manera ágil la presentación de modos concretos de proceder en cada etapa de la investigación con ls cuestiones teóricas que están en la base de las metodologías

Formulación de proyectos de investigación

El libro ofrece a estudiantes e investigadores una guía integral del proceso de investigación, desde la formulación de una propuesta de estudio hasta la presentación de los resultados y conclusiones.

Formulación de proyectos de investigación

Contiene: Principios básicos del trabajo académico y de la investigación - Armando un proyecto de investigación - La estratégia metodológica - La presentación del proyecto y los trabajos de investigación - Técnicas de redacción para artículos e informes científicos en ciencias sociales - Fuentes de información

Hernia hiatal por deslizamiento: revisión bibliográfica y caso clínico / Sliding hiatus hernia: bibliographic review and case report

Paciente ingresada en el Hospital Luis Vernaza con diagnóstico de hernia hiatal por deslizamiento, 69 años; manifestaciones clínicas principales: llenado gástrico rápido y pérdida progresiva de peso; se decide tratamiento conservador descartándose corrección quirúrgica, debido a lo poco agresivo del cuadro y la ancianidad de la paciente evoluciona sin novedad.

Confesiones fundamentalistas en El >alto. Disidencia religiosa y sectores urbano populares

Contiene: Problematica general - La reflexion teorica sobre la disidencia religiosa - Objeto de analisis sociologico - Metodologia de la investigacion - Formacion y estructura del campo religioso fundamentalista en El Alto - Confesiones fundamentalistas y estratos urbano-populares - Los estratos sociales mas abiertos al discurso religioso disidente - Los dos caminos del fundamentalismo religioso - Confesiones religiosas y acceso a la informacion formal - Estratificacion social de los productores del discurso fundamentalista - Confesiones fundamentalistas y practicas culturales - Los procesos culturales en el ambitp urbano popular - El idioma como fuente de identidad - Inmigrantes altiplanicos y confesiones - Las reformulacions andinas de las practicas fundamentalistas - Confesiones fundamentalistas y estructuras de poder - Confesiones religiosas y participacion institucional - Confesiones religiosas y conciencia social - Conciencia social y productores del discurso fundamentalista