Modulo móvil de educación de la energía solar

El Módulo Móvil de Educación consiste en una casilla rodante totalmente equipada con elementos de aprovechamiento de la Energía Solar. La misma estará destinada a la educación, participando en exposiciones, charlas, conferencias, cursos, mesas redondas, sobre el tema difundiendo conocimientos teóricos y prácticos del aprovechamiento de la Energía Solar. El móvil estará equipado con las luces, agua caliente heladera TV color, vídeo, computadora hornos, cocina, potabilizador de agua, radio, ventiladores, etcétera, todas funcionando a Energía Solar, como demostrando, en forma práctica y didáctica, todas la formas de aprovechamiento.Asociación Argentina de Energías Renovables y Medio Ambiente (ASADES

Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis

The initial management of patients with suspected acute biliary infection starts with the measurement of vital signs to assess whether or not the situation is urgent. If the case is judged to be urgent, initial medical treatment should be started immediately including respiratory/circulatory management if required, without waiting for a definitive diagnosis. The patient's medical history is then taken; an abdominal examination is performed; blood tests, urinalysis, and diagnostic imaging are carried out; and a diagnosis is made using the diagnostic criteria for cholangitis/cholecystitis. Once the diagnosis has been confirmed, initial medical treatment should be started immediately, severity should be assessed according to the severity grading criteria for acute cholangitis/cholecystitis, and the patient's general status should be evaluated. For mild acute cholangitis, in most cases initial treatment including antibiotics is sufficient, and most patients do not require biliary drainage. However, biliary drainage should be considered if a patient does not respond to initial treatment. For moderate acute cholangitis, early endoscopic or percutaneous transhepatic biliary drainage is indicated. If the underlying etiology requires treatment, this should be provided after the patient's general condition has improved; endoscopic sphincterotomy and subsequent choledocholithotomy may be performed together with biliary drainage. For severe acute cholangitis, appropriate respiratory/circulatory management is required. Biliary drainage should be performed as soon as possible after the patient's general condition has been improved by initial treatment and respiratory/circulatory management. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47 . Related clinical questions and references are also include

Tokyo Guidelines 2018 diagnostic criteria and severity grading of acute cholecystitis (with videos)

The Tokyo Guidelines 2013 (TG13) for acute cholangitis and cholecystitis were globally disseminated and various clinical studies about the management of acute cholecystitis were reported by many researchers and clinicians from all over the world. The 1st edition of the Tokyo Guidelines 2007 (TG07) was revised in 2013. According to that revision, the TG13 diagnostic criteria of acute cholecystitis provided better specificity and higher diagnostic accuracy. Thorough our literature search about diagnostic criteria for acute cholecystitis, new and strong evidence that had been released from 2013 to 2017 was not found with serious and important issues about using TG13 diagnostic criteria of acute cholecystitis. On the other hand, the TG13 severity grading for acute cholecystitis has been validated in numerous studies. As a result of these reviews, the TG13 severity grading for acute cholecystitis was significantly associated with parameters including 30-day overall mortality, length of hospital stay, conversion rates to open surgery, and medical costs. In terms of severity assessment, breakthrough and intensive literature for revising severity grading was not reported. Consequently, TG13 diagnostic criteria and severity grading were judged from numerous validation studies as useful indicators in clinical practice and adopted as TG18/TG13 diagnostic criteria and severity grading of acute cholecystitis without any modification. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also include

Delphi consensus on bile duct injuries during laparoscopic cholecystectomy:An evolutionary cul-de-sac or the birth pangs of a new technical framework?

Bile duct injury (BDI) during laparoscopic cholecystectomy remains a serious iatrogenic surgical complication. BDI most often occurs as a result of misidentification of the anatomy; however, clinical evidence on its precise mechanism and surgeons' perceptions is scarce. Surgeons from Japan, Korea, Taiwan, and the USA, etc. (n=614) participated in a questionnaire regarding their BDI experience and near-misses; and perceptions on landmarks, intraoperative findings, and surgical techniques. Respondents voted for a Delphi process and graded each item on a five-point scale. The consensus was built when 80% of overall responses were 4 or 5. Response rates for the first- and second-round Delphi were 60.6% and 74.9%, respectively. Misidentification of local anatomy accounted for 76.2% of BDI. Final consensus was reached on: (1) Effective retraction of the gallbladder, (2) Always obtaining critical view of safety, and (3) Avoiding excessive use of electrocautery/clipping as vital procedures; and (4) Calot's triangle area and (5) Critical view of safety as important landmarks. For (6) Impacted gallstone and (7) Severe fibrosis/scarring in Calot's triangle, bail-out procedures may be indicated. A consensus was reached among expert surgeons on relevant landmarks and intraoperative findings and appropriate surgical techniques to avoid BD

TG18 management strategies for gallbladder drainage in patients with acute cholecystitis: Updated Tokyo Guidelines 2018 (with videos)

Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard drainage method for surgically high-risk patients with acute cholecystitis and the latest developed endoscopic gallbladder drainage techniques described in the updated Tokyo Guidelines 2018 (TG18). Our study confirmed that percutaneous transhepatic gallbladder drainage should be considered the first alternative to surgical intervention in surgically high-risk patients with acute cholecystitis. Also, endoscopic transpapillary gallbladder drainage or endoscopic ultrasound-guided gallbladder drainage can be considered in high-volume institutes by skilled endoscopists. In the endoscopic transpapillary approach, either endoscopic naso-gallbladder drainage or gallbladder stenting can be considered for gallbladder drainage. We also introduce special techniques and the latest outcomes of endoscopic ultrasound-guided gallbladder drainage studies. Free full articles and mobile app of TG18 are available at: . Related clinical questions and references are also include

Manejo quirúrgico de aneurismas poscirugía de coartación aórtica

Introducción y objetivos: La coartación aórtica es una de las enfermedades congénitas cardiovasculares más frecuentes, y su resolución quirúrgica se acompaña de un 11% de complicaciones a largo plazo, entre las cuales se encuentran los aneurismas y pseudoaneurismas. El objetivo del presente trabajo consiste en reportar la experiencia de nuestro centro en el manejo quirúrgico de los aneurismas de aorta descendente poscirugía de coartación aórtica. Métodos: Trabajo retrospectivo de 6 casos intervenidos desde enero de 2006 hasta abril de 2014, con antecedentes de corrección quirúrgica de coartación aórtica con parche en la infancia y diagnóstico de aneurisma de aorta descendente en el seguimiento. Resultados: De 6 pacientes, 4 eran varones y 2 mujeres; la edad promedio al momento de la primera cirugía fue de 8,2 ± 2,9 años, y la de la corrección del aneurisma de aorta descendente fue de 34,3 ± 5,1 años; el tiempo transcurrido desde la primera cirugía a la reintervención fue de 26 ± 5 años. Se realizó el reemplazo de la aorta descendente con prótesis de PTRC y se emplearon 2 estrategias de perfusión: en 5 pacientes se utilizó circulación extracorpórea y en uno se llevó a cabo derivación auriculofemoral con centrífuga. Cuatro pacientes registraron complicaciones menores (hemotórax, neumotórax, quilotórax, síndrome de Horner, disfonía y cefalea), y un paciente falleció. Los pacientes se encontraron asintomáticos durante un seguimiento promedio de 44,8 meses. Conclusiones: En pacientes jóvenes y con escasas comorbilidades, la cirugía ofrece una resolución definitiva para los aneurismas poscirugía de coartación aórtica, presentando una morbimortalidad aceptabl