Deterioro cognitivo, cirugía cardíaca y circulación extracorpórea

El deterioro cognitivo postoperatorio junto con otras alteraciones neurológicas suponen unas de las complicaciones más frecuentes tras la cirugía cardíaca. Para evaluar los efectos cognitivos de esta cirugía, hemos realizado este estudio donde se evalúan diferentes dominios neurocognitivos mediante una batería de test incluyendo la evaluación preoperatoria y un seguimiento hasta un año posterior, convertiéndose en el primer estudio de estas características en población española

Deterioro cognitivo postquirúrgico en pacientes con enfermedad coronaria y/o valvulopatía aórtica

Se muestra la presencia de deterioro cognitivo postquirúrgico en pacientes con enfermedad coronaria y/o valvulopatía aórticaUniversidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Delay effects in the response of low-grade gliomas to radiotherapy: a mathematical model and its therapeutical implications

Low-grade gliomas (LGGs) are a group of primary brain tumours usually encountered in young patient populations. These tumours represent a difficult challenge because many patients survive a decade or more and may be at a higher risk for treatment-related complications. Specifically, radiation therapy is known to have a relevant effect on survival but in many cases it can be deferred to avoid side effects while maintaining its beneficial effect. However, a subset of LGGs manifests more aggressive clinical behaviour and requires earlier intervention. Moreover, the effectiveness of radiotherapy depends on the tumour characteristics. Recently Pallud et al. (2012. Neuro-Oncology, 14, 1-10) studied patients with LGGs treated with radiation therapy as a first-line therapy and obtained the counterintuitive result that tumours with a fast response to the therapy had a worse prognosis than those responding late. In this paper, we construct a mathematical model describing the basic facts of glioma progression and response to radiotherapy. The model provides also an explanation to the observations of Pallud et al. Using the model, we propose radiation fractionation schemes that might be therapeutically useful by helping to evaluate tumour malignancy while at the same time reducing the toxicity associated to the treatmen

Escoliosis congénitas causadas por hemivertebras

Presentamos un estudio retrospectivo de 26 pacientes diagnosticados de escoliosis congénitas causadas por hemivertebras, liemos analizado la evolución de las curvas según el tipo de hemivértebra, su localización y el tratamiento recibido. Se han obtenido los peores resultados en las niñas, cuando el diagnóstico se realizó después de los 10 años de edad, en las curvas localizadas en la región toracolumbar, en las hemivértebras múltiples y, dentro de ellas, en las unilaterales segmentadas no adyacentes y en los pacientes tratados ortopédicamente.A retrospective study of 26 patients with congenital scoliosis due to hemivertebra was conducted. Curve progression was analysed regarding the type of hemivertebra, its localization, and the applied treatment. The worst results were found in girls, in cases who were diagnosed with more than to years of age, in thoraco-lumbar curves, in multiple hemivertebra, especially in non-adjacent segmented unilateral hemivertebra and, finally, in patients treated with orthopaedic methods

Repair of complete bilateral cleft lip with severely protruding premaxilla performing a premaxillary setback and vomerine ostectomy in one stage surgery

Background: The authors present a technique for selected cases of CBCL. The primary repair of the CBCL with a severely protruding premaxilla in one stage surgery is very difficult, essentially because a good muscular apposition is difficult, forcing synchronously to do a premaxillary setback to facilitate subsequent bilateral lip repair and, thus, achieving satisfactory results. We achieve this by a reductive ostectomy on the vomero- premaxillary suture. Material and Methods: 4 patients with CBCL and severely protruding premaxilla underwent premaxillary setback by vomerine ostectomy at the same time of lip repair in the past 24 months. The extent of premaxillary setback varied between 9 and 16 mm. The required amount of bone was removed anterior to the vomero-premaxillary suture. The authors did an additional simultaneous gingivoperiosteoplasty in all patients, achieving an enough stability of the premaxilla in its new position, to be able to close the alveolar gap bilaterally. The authors have examined the position of premaxilla and dental arch between 6 and 24 months. We did not do the primary nose correction, because this increased the risk of impairment of the already compromised vascularity of the philtrum and premaxilla. Results : The follow-up period ranged between 6 and 24 months. None of the patients had any major complication. During follow-up, the premaxilla was minimally mobile. We achieved a good lip repair in all cases: adequate muscle repair, symmetry of the lip, prolabium and Cupid’s bow, as well as good scars. Conclusions : To our knowledge, there are few reports of one stage surgery with vomerine ostectomy to repair CBCL with severely protruding premaxilla. Doing this vomerine ostectomy, we don’t know how it will affect the subsequent growth of the premaxila and restrict the natural maxillary growth. Applying this alternative treatment for children with CBCL and protruded premaxilla without any preoperative orthopedic, we can successfully perform, in a single-stage surgery, a good primary lip repair at our center. Further confirmations of this surgery with follow up and anthropometric studies of these patients during childhood and adolescence are require

Vericiguat, nuevo pilar en el tratamiento de la insuficiencia cardiaca con fracción de eyección reducida

Heart failure with reduced ejection fraction (HFrEF) is associated with high morbidity and mortality, conditioned by multiple hospitalizations. Vericiguat has currently beenshown to be effective and safe in patients with a recent decompensation. We present a series of three cases using vericiguat in different clinical scenarios: an elderly patient with dilated cardiomyopathy of ischemic origin, a patient with alcoholic cardiomyopathy and polyvalvular heart disease, and a young patient with idiopathic cardiomyopathy. In the 3 cases vericiguat was effective and safe. This medication has been tested and monitored in other studies and we consider it plays an important role in the therapeutic armamentarium of this population, although it is necessary to accumulate more clinical experience.La insuficiencia cardiaca con fracción de eyección reducida (ICFEr) se asocia con una elevada morbimortalidad, condicionada por múltiples hospitalizaciones. Actualmente vericiguat ha mostrado ser eficaz y seguro en pacientes con una descompensación reciente. Presentamos una serie de tres casos clínicos usando vericiguat en diferentes perfiles clínicos: paciente de edad avanzada con miocardiopatía dilatada de origen isquémico, paciente con miocardiopatía de origen enólico y enfermedad polivalvular y paciente joven con miocardiopatía de origen idiopático. En los 3 casos el vericiguat mostró resultados eficaces y seguros. Este fármaco ha sido monitorizado en otros estudios y creemos que constituye un arma terapéutica importante para pacientes con ICFEr, aunque es necesario acumular mayor experiencia clínica

Primary Melanoma of the Small Intestine with a Metastatic Lymph Mass in the Inguinal Canal: A Case Report

Objectives: We report a case of primary melanoma of the small intestine. Primary intestinal melanoma (PIM) is an extremely rare neoplasm for which the cause is unknown. Materials and methods: A 67-year-old man was admitted to our department due to abdominal pain, constipation, a large, hard inguinal mass and severe anaemia. Results: After laboratory data, imaging techniques and histopathological examination, the diagnosis was confirmed. A surgical resection of the intestinal neoplasm, treatment with BRAF inhibitors and radiation therapy to the inguinal mass were performed. Conclusion: PIM is rare and it is usually difficult to establish its exact origin

Mala adherencia terapéutica en un paciente de edad avanzada, deterioro cognitivo y polimedicado con diabetes mellitus tipo 2

A 84-years-old woman with long-duration type 2 diabetes, severe cognitive impairment, frailty and polypharmacy came with episodes of dizziness and palpitations that improved after eating, but occasionally causing secondary falls. Frequently, the caretaker did not give her the antidiabetic medication, suspecting drug-induced hypoglycemia. After antidiabetic treatment optimization, the hypoglycemias were avoided and the therapeutic adherence was safely improved.Mujer de 84 años con diabetes mellitus tipo 2 de larga duración, deterioro cognitivo severo, fragilidad y polimedicación que consultaba por presentar episodios de mareos y palpitaciones que mejoraban con la ingesta de alimentos, pero provocando algunas veces caídas traumáticas secundarias. La cuidadora frecuentemente no le daba la medicación por sospecha de hipoglucemias asociadas al tratamiento antidiabético. Tras la optimización del tratamiento antidiabético, se consiguieron evitar las hipoglucemias y mejorar de forma segura la adherencia terapéutica.

Kissing molars extraction: case series and review of the literature

Kissing molars are a very rare form of inclusion defined as molars included in the same quadrant, with occlusal surfaces contacting each other within a single dental follicle. We present four cases of this pathology: a 35 year-old male, referred to the Oral and Maxillofacial Surgery Department of the Hospital Virgen del Rocio in Seville, and three females of 24, 26, and 31 years, all of which had kissing molars that were treated by tooth extraction. We have found only 10 cases published in the medical literature in which this type of inclusion is briefly described, none of which elaborate on the surgical technique employed. In these cases, the indication for surgery is established when there is a history of recurring infections or cystic lesions associated with dental inclusions. The extraction of kissing molars requires an exhaustive comprehension of the anatomy of the region involved, sufficiently developed surgical abilities, and an extensive planning proces

Open Innovation for Sustainability or Not: Literature Reviews of Global Research Trends

The demand for innovative approaches applied to productive sectors is a reality present in the circular economy and open innovation is a relatively new concept that has revolutionized the literature about innovation management. Since the concept appeared in 2003, many articles have focused on its development and application. Although some studies have connected open innovation with sustainability, the relevance of this current on the global literature about open innovation is still unidentified. In this context, this paper tries to cover this gap with a bibliometric analysis focused on the evolution of the open innovation paradigm and the relevance of sustainability in this field of research. A sample of 3087 papers published between 2003 and 2019 in the Scopus database was obtained. The analysis revealed the main topics and the most prolific journals, authors, institutions, and countries, in terms of productivity, citations, and h-indexes. Besides of these contributions, keywords analysis reveals that, in recent years, sustainability and ecosystems are decisive variables in open innovation research