TIPS treatment in a patient with severe lower gastrointestinal bleeding with a misdiagnosis of cirrhotic portal hypertension.

Abernethy malformation is a rare abnormal embryological development of splanchnic venous system characterised by the presence of a congenital extrahepatic portosystemic shunt. We present a rare case of an adult male patient that was admitted with severe lower gastrointestinal bleeding, requiring multiple blood transfusions. The patient's medical history and the laboratory tests performed led to the misdiagnosis of a congenital Abernethy malformation. We present a rare case, discussing the reasons for the misdiagnosis and we conclude that management of clinical data and imaging are highly important to discard these types of congenital malformations that can mimic a portal hypertension condition

Congenital Pulmonary Sequestration Supplied by the Right Coronary Artery

A 67-year-old patient, with no respiratory symptoms, underwent coronary catheterization for revascularization of stenosis in the right coronary artery, during which we observed a large caliber artery, apparently bronchial, extending toward the left lung base..

Enteral stents: Complications and their management

The treatment of malignant colonic and gastric outlet obstruction with self-expanding metallic stents (SEMS) is an established technique that can be performed by radiologic or a combination of radiologic and endoscopic guidance. The procedure is very effective to relieve the obstructive symptoms of advanced malignancies, with important clinical benefits and significant improvement in quality of life for the patients. Despite much advancement in the designs of SEMS, enteral stent placement is still associated with some significant early and late complications. Stent dysfunction mainly caused by tumor ingrowth/over growth, and stent migration when covered stent are used, are relatively common complications and many times require reinterventions

Patologías congénitas más frecuentes de corazón y grandes vasos derivadas de errores embriológicos. Fisiopatología y comparación de prevalencias en pequeños animales y humanos.

Las patologías congénitas de corazón y grandes vasos son un grupo de enfermedades caracterizado por la presencia de alteraciones estructurales del corazón y los principales vasos, producidas por defectos en la formación de los mismos durante el periodo embrionario. Son los defectos de nacimiento más comunes, pero la incidencia varía según la especie. Las estudiadas en este trabajo son el perro, con una incidencia descrita entre el 6,8 y el 8 por 1000, los gatos entre el 0,2 y el 1 por 1000 y los humanos entre 8 y 10 de cada 1000 recién nacidos. El objetivo de este Trabajo de Fin de Grado es analizar y comparar la incidencia de las malformaciones cardíacas congénitas más frecuentes en tres especies: perro, gato y humano. El método utilizado es mediante revisión bibliográfica y estudio comparativo. Se han obtenido diferentes resultados para cada una de las especies: en perros los defectos cardíacos congénitos más comunes son la estenosis aórtica (25,81%), el conducto arterioso persistente (24,59%) y la estenosis pulmonar (21,21%); En gatos son el defecto del septo ventricular (29%) y la displasia de la válvula tricúspide (13,01%); y en humanos, el defecto del septo auricular (30,76%), defecto del septo ventricular (20,9%) y el conducto arterioso persistente (11,49%). Se desconoce el porqué de las variaciones de frecuencia en las tres especies, aunque en los animales domésticos la incidencia real es probablemente más alta, ya que algunas malformaciones provocan la muerte neonatal y no son descritas

El papel de los videojuegos en tres dimensiones en el aprendizaje de cirugía laparoscópica.

El objetivo principal de este estudio es comparar las diferencias en la capacidad de aprendizaje de habilidades quirúrgicas laparoscópicas entre dos grupos de estudiantes de veterinaria, con y sin experiencia previa en el manejo de videojuegos en primera persona.Los objetivos secundarios son:1. Diseñar un cuestionario que sea capaz de valorar la experiencia previa del individuo en el manejo de videojuegos que precisen orientación espacial tridimensional para poder clasificarlos en dos grupos.2. Diseñar una batería de pruebas, basadas en el test de evaluación del sistema FLS(Fundamentals, of Laparoscopic Surgery) que pueda aplicarse a estudiantes sin experienciaprevia en cirugía laparoscópica, con objeto de valorar su habilidad en el manejo del material<br /

A Two-Point Ultrasound-Guided Injection Technique for the Transversus Thoracis Plane Block: A Canine Cadaveric Study.

The transversus thoracis plane (TTP) block desensitizes the intercostal nerves that run through this plane, providing analgesia to the ventral thoracic wall. Two canine cadavers were used to assess the feasibility of the transverse approach for the TTP (t-TTP) under ultrasound guidance to inject a solution at the third and sixth intercostal spaces. Eight cadavers were used to compare the spread and number of intercostal nerves that were stained when a low volume (LV) 0.5 mL kg-1 or a high volume (HV) 1 mL kg-1 of a dye-lidocaine solution was injected into the same hemithorax, injecting the volume equally at these intercostal spaces using the transverse approach. Fisher's exact test and Wilcoxon signed-rank test were used to contrast the spread of the different volume solutions. The injectate spread along the TTP after all injections, dying a median number (range) of 3 (2-5) and 6 (5-6) nerves with LV and HV, respectively (p = 0.011). The two-point injection of HV, using the t-TTP approach, is a feasible technique that provides a consistent staining from T2 to T7 intercostal nerves. The injection of HV instead of LV increases the spread and enhances the number of stained intercostal nerves

Percutaneous ultrasound-guided carotid access and puncture closure with angio-seal in horses

Background: There are different indications for endovascular surgery in horses, mainly the treatment of guttural pouch mycosis. Traditionally, these procedures are carried out by open arteriotomy of the common carotid artery (CCA), although less invasive percutaneous ultrasound-guided carotid access (PUGCA) has been described in experimental horses. In human medicine, commercial closure systems are used to seal these arterial puncture sites and reduce complications. The aims of this study are to retrospectively describe our experience with PUGCA in clinical cases and to report, for the first time, the use of the commercial vascular closure device Angio-Seal after PUGCA in horses. Methods: Retrospective study of clinical case records. Collected parameters, including the feasibility of the PUGCA and variables related to the safety and efficacy of the use of the Angio-Seal. Results: Twelve PUGCA procedures in 11 horses were included. In all cases, the artery was effectively accessed, and the planned procedure could be performed. In two cases, haematoma/bleeding due to incorrect use of the Angio-Seal was recorded. This complication rate (16.66%) was lower than that obtained in other studies using PUGCA in horses, but where the puncture was sealed by manual compression only. Main limitations: A control group of clinical cases with PUGCA but without using Angio-Seal is not available. Conclusions: Clinical data confirm previous experimental results, which showed that PUGCA is safe and effective in horses. The Angio-Seal system, regardless of possible complications due to incorrect use, can be used safely and effectively in horses. Further studies comparing arterial access site management using manual compression or Angio-Seal would be necessary to state if its routine use in horses is advisable

Stent Supera. Tratamiento endovascular de aneurisma poplíteo trombosado, a propósito de un caso

Los aneurismas de la arteria poplítea (AAP) son los más frecuentes de todos los que afectan a arterias periféri-cas. Es habitual su concurrencia con otros aneurismas, el 70 % de los pacientes con un aneurisma poplíteo padecen de una dilatación aneurismática de la aorta abdominal. La causa más común para los AAPs es la arteriosclerosis, aunque algunos autores la han aso-ciado a la enfermedad de Marfan y Ehlers-Danlos1. Los AAPs afectan preferentemente a varones en la década 60-70 años siendo bilaterales en el 50-70 % de los pacientes2. Cerca del 50 % son asintomáticos, sin embargo el riesgo de obstrucción por trombosis es muy alto provocando una claudicación o isquemia de grado variable..

Retrievable inferior vena cava filters for pulmonary embolism prevention: long-term clinical and CT follow-up after retrieval

To study long-term adverse events, complications and anatomical modifications after the bearing and retrieval of inferior vena cava filters (IVCF) for pulmonary embolism (PE) prevention. Material and methods: This retrospective study included 158 IVCF placed from April 2007 to January 2014 with intention of retrieval. All patients were telephonically located and scheduled for IR inquiry. They were asked about symptoms related to recurrent PE, DVT and postphlebitic syndrome. An abdominal CT was performed in patients who gave their consent to evaluate IVC alterations. We recorded any adverse event observed during implantation, dwell time, recovery, 1-year follow-up and the current inquiry

Tracheal self-expandable metallic stents: A comparative study of three different stents in a rabbit model

Introduction: The objective of this study was to assess tracheal reactivity after the deployment of different self-expandable metal stents (SEMS). Material and methods: Forty female New Zealand rabbits were divided into four groups. Three groups received three different SEMS: steel (ST), nitinol (NiTi), or nitinol drug-eluting stent (DES); the fourth group was the control group (no stent). Stents were deployed percutaneously under fluoroscopic guidance. Animals were assessed by multislice, computed tomography (CT) scans, and tracheas were collected for anatomical pathology (AP) study. Data from CT and AP were statistically analyzed and correlated. Results: The DES group had the longest stenosis (20.51±14.08 mm vs 5.84±12.43 and 6.57±6.54 mm in NiTi and ST, respectively, day 30; P<.05), and higher granuloma formation on CT (50% of cases). The NiTi group showed the lowest grade of stenosis (2.86±6.91% vs 11.28±13.98 and 15.54±25.95% in DES and ST, respectively; P<.05). The AP study revealed that the ST group developed intense proliferative reactivity compared to the other groups. In the DES group, a destructive response was observed in 70% of the animals, while the NiTi was the least reactive stent. CT was more effective in detecting wall thickening (positive correlation of 68.9%; P<.001) than granuloma (not significant). Conclusions: The ST group developed granulomas and significant stenosis. NiTi was the least reactive stent, while DES caused significant lesions that may be related to drug dosage. This type of DES stent is therefore not recommended for the treatment of tracheobronchial stenosis. Introducción: El objetivo de este estudio es evaluar la reactividad traqueal tras la implantación de distintos stents metálicos autoexpandibles (SMAE). Material y métodos: Se utilizaron 40 conejos hembra de raza neozelandesa, que se dividieron en 4 grupos. En 3 grupos se implantaron SMAE: de acero (SA), de nitinol (NiTi) o stents liberadores de nitinol (SLF). El cuarto grupo fue el grupo de control (sin stent). Los stents se implantaron por vía percutánea bajo control fluoroscópico. Los animales se evaluaron mediante tomografía axial computarizada (TAC) multicorte y las tráqueas se extirparon para su estudio anatomopatológico (EAP). Los datos de la TAC y el EAP se analizaron estadísticamente y se correlacionaron Resultados: El grupo que recibió SLF presentaba la mayor longitud de estenosis (20,51±14,08 mm frente a 5,84±12,43 y 6,57±6,54 mm en los grupos NiTi y SA, día 30; p < 0,05) y el mayor índice de formación de granulomas evidenciados mediante TAC (50% de los casos). El grupo al que se implantaron stents NiTi mostró el menor grado de estenosis (2,86±6,91% frente a 11,28±13,98 y 15,54±25,95% en los grupos SLF y SA; p < 0,05). En el estudio AP, el grupo SA presentó reactividad proliferativa intensa en comparación con los otros 2 grupos. En el grupo SLF se observó una respuesta destructiva en el 70% de animales, mientras que el stent NiTi fue el que menos reacción provocó. La TAC resultó ser superior para detectar el engrosamiento (correlación positiva de un 68,9%; p < 0,001) que para la observación de granulomas (n.s.). Conclusiones: El grupo SA desarrolló granulomas y estenosis significativas. El stent NiTi fue el que menos reacción indujo, mientras que el SLN provocó lesiones importantes que podrían estar relacionadas con la dosis de fármaco. Por consiguiente, este tipo de SLF no se recomienda para el tratamiento de la estenosis traqueobronquial