Dispositivos de modificación de placa en oclusiones coronarias crónicas totales: estudio PLACCTON / Plaque modification in calcified chronic total occlusions: the PLACCTON study

Introducción y objetivos: La calcificación grave está presente en más del 50% de las oclusiones coronarias crónicas totales (OCT) tratadas mediante intervención percutánea. Nuestro objetivo fue describir el uso contemporáneo de los dispositivos de modificación de placa (DMP) en este contexto. Métodos: Los pacientes se incluyeron en el Registro Ibérico de OCT de forma prospectiva y consecutiva (32 centros de España y Portugal), de 2015 a 2020. Se compararon en función del uso o no de DMP. Resultados: Se incluyó a 2.235 pacientes, en 1.900 de los cuales se logró cruzar con éxito la lesión con guía. Se utilizó al menos un DMP en un 7% (134 pacientes) y más de uno en 24 pacientes (1%). Los DMP seleccionados fueron: aterectomía rotacional (35,1%), litotricia (5,2%), láser (11,2%), balones de corte (27,6%), balones OPN (2,9%) o combinaciones de más de uno (18%). Se utilizaron DMP en pacientes más ancianos, con mayor riesgo cardiovascular y puntuaciones Syntax y J-CTO más elevados. Esta mayor complejidad se asoció con procedimientos más prolongados, pero similar longitud total de stent (52 frente a 57mm; p=0,105). Cuando la guía cruzó con éxito la oclusión, la tasa de éxito final del procedimiento fue del 87,2%, pero se incrementó al 96,3% cuando se utilizaron DMP (p=0,001). Por el contrario, los DMP no se asociaron con mayor tasa de complicaciones en el procedimiento (3,7 frente a 3,2%; p=0,615). Pese al peor perfil de riesgo basal, a los 2 años de seguimiento no hubo diferencias en la tasa de supervivencia (94,3% DPM frente a no-DMP: 94,3% no-DPM, respectivamente, p=0,967). Conclusiones: Cuando la guía cruzó con éxito una OCT, la tasa de uso de los DMP fue del 7% y se asoció a una tasa de éxito final del procedimiento significativamente mayor. Los resultados a medio plazo fueron comparables cuando se precisaron DMP pese a su mayor riesgo basal, lo que sugiere que un mayor uso adecuado de estas técnicas en este contexto (AU)

Introduction and objectives: Severe calcification is present in> 50% of coronary chronic total occlusions (CTOs) undergoing percutaneous intervention. We aimed to describe the contemporary use and outcomes of plaque modification devices (PMDs) in this context. Methods: Patients were included in the prospective, consecutive Iberian CTO registry (32 centers in Spain and Portugal), from 2015 to 2020. Comparison was performed according to the use of PMDs. Results: Among 2235 patients, wire crossing was achieved in 1900 patients and PMDs were used in 134 patients (7%), requiring more than 1 PMD in 24 patients (1%). The selected PMDs were rotational atherectomy (35.1%), lithotripsy (5.2%), laser (11.2%), cutting/scoring balloons (27.6%), OPN balloons (2.9%), or a combination of PMDs (18%). PMDs were used in older patients, with greater cardiovascular burden, and higher Syntax and J-CTO scores. This greater complexity was associated with longer procedural time but similar total stent length (52 vs 57mm; P=.105). If the wire crossed, the procedural success rate was 87.2% but increased to 96.3% when PMDs were used (P=.001). Conversely, PMDs were not associated with a higher rate of procedural complications (3.7 vs 3.2%; P=.615). Despite the worse baseline profile, at 2 years of follow-up there were no differences in the survival rate (PMDs: 94.3% vs no-PMDs: 94.3%, respectively; P=.967). Conclusions: Following successful wire crossing in CTOs, PMDs were used in 7% of the lesions with an increased success rate. Mid-term outcomes were comparable despite their worse baseline profile, suggesting that broader use of PMDs in this setting might have potential technical and prognostic benefits (AU)

The warmer the ocean surface, the shallower the mixed layer. How much of this is true?

Ocean surface warming is commonly associated with a more stratified, less productive, and less oxygenated ocean. Such an assertion is mainly based on consistent projections of increased near-surface stratification and shallower mixed layers under global warming scenarios. However, while the observed sea surface temperature (SST) is rising at midlatitudes, the concurrent ocean record shows that stratification is not unequivocally increasing nor is MLD shoaling. We find that while SST increases at three study areas at midlatitudes, stratification both increases and decreases, and MLD deepens with enhanced deepening of winter MLDs at rates over 10 m  decade-1. These results rely on the estimation of several MLD and stratification indexes of different complexity on hydrographic profiles from long-term hydrographic time-series, ocean reanalysis, and Argo floats. Combining this information with estimated MLDs from buoyancy fluxes and the enhanced deepening/attenuation of the winter MLD trends due to changes in the Ekman pumping, MLD variability involves a subtle interplay between circulation and atmospheric forcing at midlatitudes. Besides, it is highlighted that the density difference between the surface and 200 m, the most widely used stratification index, should not be expected to reliably inform about changes in the vertical extent of mixing.

Comparación analgésica postquirúrgica de la infiltración corticoanestésica y la anestésica pura tras meniscectomía artroscópica de rodilla / Postoperative pain comparison between steroids anesthetic infiltration, and pure anesthetic infiltration after arthoscopic knee menisectomy

Objetivo: Evaluar la efectividad de las infiltraciones postquirúrgicas de anestésico local solo y combinado con corticoide, para el tratamiento del dolor e inflamación en el postoperatorio temprano en pacientes intervenidos de menisco artroscópicamente. Material y método: Estudio clínico prospectivo randomizado de 60 pacientes a los que se les practicó menisectomía artroscópica. Finalizada la intervención, los pacientes fueron asignados aleatoriamente a uno de los dos grupos de estudio y se infiltró en un grupo 10 ml de clorhidrato de bupivacaína al 0,5% y en el otro el mismo anestésico, asociado a triamcinolona acetónido (solución de 40 mg). La percepción del dolor fue medida objetivamente por la Escala Visual Análoga (EVA), registrándose el dolor postquirúrgico a las 2, 4 y 24 horas y a los 15 días y al mes, después de la intervención. Resultados: No se encontraron diferencias significativas entre los diferentes grupos de estudio. Conclusión: La infiltración anestésica postquirúrgica en dosis única es un procedimiento muy útil para el manejo del dolor postoperatorio en pacientes que requieren la realización de una menisectomía artroscópica (AU)

Objective: To evaluate the effectiveness of postoperative local anesthetic infiltration alone and combined with corticosteroid for the treatment of pain and inflammation in the early postoperative period in patients undergoing arthroscopic meniscal pathology. Material and method: A prospective randomized clinical study, 60 patients who underwent arthroscopic meniscectomy. After surgery, patients were randomly assigned to one of two study groups and infiltrated a group 10 ml of bupivacaine hydrochloride 0.5% and on the other the same anesthetic, associated with triamcinolone acetonide (solution of 40 mg). Pain perception was objectively measured by the Visual Analog Scale (VAS), postoperative pain recorded at 2, 4 and 24 hours and 15 days and a month after the intervention. Results: No significant differences were found between the different groups. Conclusion: Postoperative anesthetic infiltration single dose is a very useful procedure for the management of postoperative pain in patients requiring arthroscopic meniscectomy performing (AU)

Rehabilitation of edentulous posterior atrophic mandible: inferior alveolar nerve lateralization by piezotome and immediate implant placement.

The height and consistency of the bone tissue located above the inferior alveolar nerve (IAN) represents an important challenge when a patient's atrophied posterior mandible is rehabilitated with an osseointegrated implant. Usually, the surgical reconstruction of atrophic ridges is performed using several different techniques. The purpose of this study is to demonstrate the effectiveness and safety of the inferior alveolar nerve lateralization (IANL) technique performed with ultrasonic cutting technology (piezotome). To demonstrate this, 38 osseointegrated implants (11-15 mm in length) were performed during 19 procedures on 15 different patients. After 8 weeks, 14 of those 15 patients (18 of 19 sites: 94.73%) showed normal IAN function. The implant success rate was 97.36%.

Intraarterial guidewire external compression: a simple technique for successful LIMA angiography through the right radial approach.

Specific techniques have been described for performing a left internal mammary artery (LIMA) angiography through the right radial approach. The unsuccessful LIMA angiography in anatomic situations, such as aorta dilatation or a far distal anatomical origin of the LIMA, among others, is a main problem not yet solved even with these techniques. In this report, we describe a simple and ready maneuver that can be helpful for a successful LIMA angiography in such situations.

Técnica de sacrectomía para resección de metástasis de leiomiosarcoma uterino / The use of sacrectomy for the resection of uterine leiomyosarcoma methastases

Las metástasis son probablemente los tumores malignos de sacro más frecuentes. Su detección suele ser habitualmente tardía. La resección de los tumores metastáticos malignos es siempre compleja, especialmente cuando afecta al sacro por su proximidad con órganos y estructuras vasculonerviosas importantes. Se presenta el caso de un sarcoma de sacro derecho con extensión intrapélvica y a masa muscular glútea, en una mujer de 49 años de edad con antecedentes de histerectomía y salpingooforectomía bilateral por leiomiosarcoma uterino pT1N0M0, G1 en 1996. La paciente es tratada quirúrgicamente mediante hemisacrectomía derecha y resección de masa tumoral. El interés del trabajo es aportar información sobre una técnica quirúrgica infrecuente

Methastases are probably the most frequent malignant tumors of the sacrum. They are more often than note detected at a late phase in their development. The resection of methastatic malignant tumors is invariably complex, especially when they involve the sacrum, which in the vicinity of vital organs and vascular-nervous structures. The case presented is a right sacrum sarcoma that extends to the intrapelvic area and to the gluteus muscle in a 49-year-old woman with a history of hysterectomy and bilateral salpingoophorectomy resulting from a pT1N0M0-G1 uterine leiomyosarcoma developed in 1996. The patient was treated surgically by means of a right hemisacrectomy and the resection of the tumoral mass. The purpose of this study was to shed light on this infrequent surgical technique

[The World Health Organization Report 2000: a politically incorrect computer game]. / El informe de la Organización Mundial de la Salud 2000: un juego de ordenador políticamente incorrecto.

The World Health Organization Report 2000 is aimed at supporting an evidence-based development of health care systems in the world. The report has brought about a significant political and academic debate. This article reviews the contribution of the WHO Report to current health care policy, as well as analyzes and comments the main published critiques. Through a commented compilation of the health care reforms implemented over the last fifteen years in the world, WHO shifts radically its traditional position supporting now universal access to health care and a strong government's conduction role, but within a financial risk sharing environment, public and private co-operation and deregulation of the public management of health care institutions. WHO ranks in this report the 191 countries according to their health care systems' goal attainment and performance using a very weak, obscure and artificial methodology which has been opposed internationally. WHO is, however, committed to continue this initiative without apparently any major changes in the general and methodological approach.

El informe de la Organización Mundial de la Salud 2000: un juego de ordenador políticamente incorrecto / The World Health Organization Report 2000: a politically incorrect computer game

El Informe de la Organización Mundial de la Salud 2000 trata de fundamentar el desarrollo de los sistemas de salud en el mundo en la evidencia disponible sobre políticas sanitarias. El informe ha suscitado un importante debate político y académico. Este artículo revisa las aportaciones del informe a la política de salud, y además analiza y comenta las principales críticas publicadas. A través de una recapitulación de la reformas acontecidas en los últimos 15 años en el panorama internacional, la OMS realiza un cambio sustancial en los planteamientos clásicos que ha mantenido, decantándose por los sistemas de salud con financiación universal y conducción gubernamental, donde exista una mayor compartición de riesgo financiero, colaboración público-privada y desregulación de la gestión pública. La OMS realiza al mismo tiempo una baremación de los 191 sistemas de salud de acuerdo con su (..) (AU)

The World Health Organization Report 2000 is aimed at supporting an evidence-based development of health care systems in the world. The report has brought about a significant political and academic debate. This article reviews the contribution of the WHO Report to current health care policy, aswell as analyzes and comments the main published critiques. Through a commented compilation of the health care reforms implemented over the last fifteen years in the world, WHO shifts radically its traditional position supporting now universal access to health care and a strong government’s conduction role, but within a financial risk sharing environment, public and private co-operation and deregulation of the public management (..) (AU)

Las fisuras anales

Las fisuras anales son la causa más frecuente del dolor anal y sangrado tras la defecación. Se presentan como laceraciones o ulceraciones cortas (< 1 cm) de la dermis, entre el orificio anal y la línea dentada. Su patogenia continúa sin esclarecerse totalmente.Más del 85 por ciento de las mismas se presentan en la región posterior de la línea media. La presencia de fisuras fuera de esta localización obliga a descartar una enfermedad inflamatoria intestinal, entre otros diagnósticos.La aproximación terapéutica clásica nos llevaba a recomendar la cirugía, mediante esfinterotomía lateral, tras el fracaso del tratamiento conservador.En la última década se han realizado multitud de ensayos de distintas sustancias, algunas de las cuales han empezado a utilizarse en atención primaria de salud. Nuestro trabajo pretender revisar la bibliografía que sobre esta afección se ha publicado desde 1975 hasta la actualidad. Se ha profundizado más en estas últimas posibilidades y en su aplicación en atención primaria de salud (AU)

Dark solitary waves in the nonlinear Schrödinger equation with third order dispersion, self-steepening, and self-frequency shift.

We solve the higher order nonlinear Schrödinger equation describing the propagation of ultrashort pulses in optical fibers. By means of the coupled amplitude-phase formulation fundamental (solitary wave) dark soliton solutions are found.

[Current and suitable organization of the Basque Health System. Opinion of the managing level]. / Cultura organizativa actual e idónea del Sistema Vasco de Salud. Opinión del nivel directivo.

Osasuna Zainduz (caring our health), a planned change tor the public health care services, is being implemented in the Basque Country. A questionnaire discriminant terms passed to all the managers of the Basque Health Service is analysed to assess its actual and optimum organizational culture. We looked at significant differences between means, comparing actual and optimum profiles. All the differences of means were highly significant (P < 0.00001); performance based salaries (6.19) and identification with the organization (5.82) were the highest. New management styles based on information and communication, tolerance with conflicts and risks, as well as support from managers were identified through regression analysis as key success criteria for such our organization.

[Cutaneous infiltration in multiple myeloma]. / Infiltración cutánea en el mieloma múltiple.

A 44 year old woman with multiple myeloma and cutaneous involvement is presented. She had a painless tumor over the malar region. Microscopic study showed a cutaneous infiltration of plasma cells. Survival from diagnosis lasted 5 months. Over this period, multiple and progressive cutaneous nodules appeared, having the same structural characteristics.