Resultados del tratamiento quirúrgico de los aneurismas de aorta abdominal infrarrenal

Introduction: Surgical treatment outcomes for infrarenal abdominal aortic aneurysm repair depend on patient factors and attending vascular team expertise. Objetives: To describe the outcomes of surgical treatment of abdominal aortic aneurysm performed by an interdisciplinary team and to evaluate the effects of annual caseload and acquired expertise. Methods: Historic cohort of patients with abdominal aortic aneurysm diagnosis surgically trea-ted from January 1994 to June 2013. Three groups were established: Group 1 was for openruptured abdominal aortic aneurysm repair, Group 2 was for open elective repair and Group 3 was for elective endovascular aneurysm repairs. Primary outcome was in-hospital mortality, andsecondary outcomes were peri-procedural morbidity. For analysis the cohort was divided in two: cases repaired from 1994 to 2002 and from 2002 to 2013. This was based in the implementation of endovascular therapy from 2002 at the institution.Results: 573 patients were treated; Group 1: 65 patients; Group 2: 433 patients; Group 3: 75 patients. Mortality was 28.6%, 2.8% and 1.3% respectively. A significant rise in annual case-load (233%) was demonstrated and a trend toward lowering in surgical mortality (4.8 vs. 2.0%,p = 0.19) after 2002. Conclusions: Implementation of endovascular repair has contributed to rising annual caseloadof patients with abdominal aortic aneurysm at our institution. This rising in volume correlateswith effective lowering in mortality. © 2015 Sociedad Colombiana de Cardiología y Cirugía Cardiovascular

Burdigalian deposits of the Santa Cruz Formation in the Sierra Baguales, Austral (Magallanes) Basin: Age, depositional environment and vertebrate fossils

Indexación: Web of Science; Scielo.ABSTRACT. A succession of marine and continental strata on the southern flank of Cerro Cono in the Sierra Baguales, northeast of Torres del Paine, can be correlated with stratigraphic units exposed along the southern border of the Lago Argentino region in Santa Cruz Province, Argentina. These include the Estancia 25 de Mayo Formation and the basal part of the Santa Cruz Formation. The lithological correlation is also confirmed by detrital zircon ages (maximum age of 18.23±0.26 Ma) and a rich assemblage of terrestrial vertebrate fossils, biostratigraphically equivalent to a postColhuehuapian, pre-Santacrucian South American Land Mammal Age (SALMA) fauna, suggesting a range of 19 to 17.8 Ma. Similar ages have been obtained from the basal part of the Santa Cruz Formation at Estancia Quién Sabe in southwestern Argentina, supporting the assumption of a regional continuity between these deposits. A measured lithostratigraphic column is presented and the depositional environment is interpreted as a coastal plain with small, meandering rivers and ephemeral floodplain lakes. The sedimentation coincides with intensified uplift of the Patagonian Andes during the ‘Quechua Phase’ of Andean tectonism, which is reflected by a change in paleocurrent directions from northwest to east-northeast. Keywords: Burdigalian, Santa Cruz Formation, Santacrucian SALMA, ‘Notohippidian’ fauna, Meandering rivers.RESUMEN. Una sucesión de estratos marinos y continentales en el flanco meridional del cerro Cono, en la sierra Baguales, al noreste de Torres del Paine, se correlaciona con estratos al sur de la región de lago Argentino en la Provincia de Santa Cruz, República Argentina. Estas unidades incluyen la Formación Estancia 25 de Mayo y la parte basal de la Formación Santa Cruz. La correlación litológica es, además, confirmada por datación de circones detríticos (edad máxima de 18,23±0,26 Ma) y un variado ensamble de vertebrados fósiles terrestres de edad post-Colhuehuapense a pre-Santacrucense en la escala de Edades Mamífero Sudamericanas (EMAS), con un rango temporal de entre 19 a 17,8 Ma. Edades similares han sido reportadas para la parte basal de la Formación Santa Cruz, en estancia Quién Sabe, en el suroeste de Argentina, ratificando la continuidad regional entre estos depósitos. Se presenta una columna estratigráfica y se interpreta el ambiente de depositación como una llanura costera con pequeños ríos sinuosos y lagos efímeros. La edad de sedimentación coincide con el solevantamiento de los Andes Patagónicos durante la 'Fase Quechua', lo que se ve reflejado por un cambio en la dirección de las paleocorrientes desde el noroeste hacia el este-noreste.http://ref.scielo.org/csxwd

Quemadura corneal grave debida a la aplicación accidental de ácido salicílico envasado en un frasco gotero plástico

Eye burns due to the accidental application of pharmacological or nonpharmacological substances packaged in plastic dropper bottles have been described for more than three decades and continue to occur. These burns can cause potentially serious corneal injuries. We report the case of a patient who mistakenly applied salicylic acid to the right eye after confusing it with an eye lubricant, which caused him a severe corneal burn. Fortunately, after aggressive medical and surgical management (including oxygen therapy and amniotic membrane grafting), the visual results were good.We suggest conducting educational campaigns and taking legislative measures in our country to avoid packaging corrosive substances in this type of dropper bottle to reduce the risk of accidental burns.Las quemaduras oculares por aplicación accidental de sustancias farmacológicas o no farmacológicas envasadas en frascos goteros plásticos, se han descrito desde hace más de tres décadas y siguen ocurriendo. Estas quemaduras pueden causar lesiones potencialmente graves de la córnea.Se presenta el caso de un paciente que se aplicó ácido salicílico en el ojo derecho al confundir el envase con el de un lubricante ocular, lo que le causó una grave quemadura corneal. Afortunadamente, tras un manejo médico y quirúrgico agresivo (incluida oxigenoterapia e injerto de membrana amniótica) los resultados visuales fueron buenos.Se sugiere hacer campañas educativas y adoptar normas en el país para evitar el envase de sustancias corrosivas en este tipo de frascos goteros, con el fin de disminuir el riesgo de quemaduras accidentales

Es el reimplante valvular mejor que el bentall biológico modificado para tratar aneurismas de la raíz asociados a insuficiencia?

Es el reimplante valvular mejor que el Bentall Biológico Modificado para tratar aneurismas de la raíz asociados a insuficiencia? Obando CE; Gutiérrez HF; Santamaría G, Bresciani R; Camacho J; Sandoval N; Umaña J. Departamento de Cirugía Cardiovascular, Fundación Cardio Infantil, Bogotá, Colombia. Objetivo: comparar resultados funcionales, morbilidad y sobrevida a corto y mediano plazo, tras la realización de Bentall modificado con prótesis Freestyle vs reimplante valvular de Tirone David, en insuficiencia aortica secundaria a aneurisma de la raíz. Diseño: revisión de registros institucionales de 88 pacientes tratados entre enero de 2003 y agosto de 2009 con insuficiencia aortica secundaria a aneurisma de la raíz sin daño valvular, distribuidos en dos cohortes: Grupo 1 (Bentall modificado) y Grupo 2 (reimplante valvular). Se evaluaron complicaciones perioperatorias, transfusiones, estancias hospitalarias y en el seguimiento a mediano plazo insuficiencia valvular, clase funcional, función ventricular y sobrevida. Solidez de los resultados verificada mediante análisis de propensidad con balanceo de grupos. Resultados: Grupo (1) 51(57.9%) pacientes y grupo (2) 37(42.1%). Aunque el grupo 2 es mas joven, patrones similares de coomorbilidad, anatomía de la raíz, función y diámetros ventriculares hacen comparables los dos grupos. Seguimiento de 3.3 años (IQR 2.0-4.4). Mortalidad temprana 2(3.8%) vs 0 p =0.2 y tardía de 2(4.1%) vs 0 p=0.33. El análisis estratificado de covariables en bloques de distribución tampoco identifica diferencias en mortalidad. El análisis de sobrevida de mortalidad y sobrevida libre de eventos identifica desenlaces similares entre los grupos (Log-Rank chi2=0.9, p=0.3); incluyendo Insuficiencia aortica = II temprana (3.8% vs 0, p=0.2) y tardía (3.8%vs 0, p=0.1), transfusiones perioperatorias, reintervenciones por sangrado (2.3% vs 3.4%, p=0.4), arritmias (25.5% vs 13.5%, p=0.2) y disfunción neurológica (5.7% vs 2.9%, p=0.9). Finalmente la hospitalización total (6.5 {1-35} vs 4{3-16} p=0.001) y estancia en Cuidado intensivo (2.5 {1-21} vs 1{1-16} p=0.001) es superior en el grupo1. Conclusiones: el tratamiento de los aneurismas de la raíz aortica asociados a insuficiencia valvular sin daño estructural, mediante reimplante valvular o Bentall biológico modificado ofrece resultados similares a corto y mediano plazo. La preservación valvular se asocia a estancias mas cortas, pero no hay diferencia en complicaciones postoperatorias, estatus funcional, insuficiencia valvular, función ventricular, mortalidad y sobrevida libre de eventos adversos.Compare functional results, Morbility and median and short term survival, after modified Bentall procedure with Freestyle valve vs. Valvular Reimplantation Tirone David, for the aortic valve insufficiency secondary to aortic root aneurysm. DESIGN: Revision of institutional registers of 88 patients treated from January 2003 to august 2009 with aortic insufficiency secondary to aortic root aneurysm without valve damage, distributed in two cohorts: Group 1 (Modified Bentall), Group 2 (Valvular Reimplantation). Perioperative complications were evaluated as well as transfusions, hospitalization days, median term observation for valve insufficiency, functional class, ventricular function and survival. The solidity of the results were verified by propensity analysis with balance of groups. RESULTS: Group (1) 51(57.9%) patients and group (2) 37(42.1%). Although group 2 is younger, similar patterns of comorbility, aortic root anatomy, function and ventricular diameters of both groups make them comparable. Follow up for 3.3 years (IQR 2.0-4.4). Early Mortality 2(3.8%) vs. 0 p =0.2 and late 2(4.1%) vs. 0 p=0.33. The analysis of stratified co variables in blocks of distribution does not identify differences in mortality. The analysis of survival of mortality and survival free of events identifies similar results between the groups (Log-Rank chi2=0.9, p=0.3); including aortic insufficiency = II early (3.8% vs. 0, p=0.2) and late (3.8%vs 0, p=0.1), perioperative transfusions, reinterventions by bleeding (2.3% vs. 3.4%, p=0.4), arrhythmias (25.5% vs. 13.5%, p=0.2), and neurologic dysfunction(5.7% vs. 2.9%, p=0.9). Finally total hospitalization (6.5 {1-35} vs. 4{3-16} p=0.001) and Intensive care staying (2.5 {1-21} vs. 1{1-16} p=0.001) is superior in group 1. CONCLUSIONS: The treatment of aortic root aneurysm associated to aortic valve insufficiency without structural damage, with valve reimplantation or Modified Bentall (Biological) offers similar results. Valve preservation is associated to shorter hospitalization stay, but there is no difference in post operative complications, functional status, valve insufficiency, ventricular function, mortality, and survival free of adverse events

Factores asociados a insuficiencia renal postoperatoria en cirugía de revascularización miocárdica

Motivation: To determine which medical history and surgical procedure factors are associated to the onset of postoperative kidney failure in patients undergoing myocardial revascularisation. Methods: Case-control cohort study carried out between January 2005 and December 2013 which included patients who had undergone elective myocardial revascularisation and showed postoperative kidney failure immediately after surgery and until discharge. Controls consisted of patients who had undergone elective myocardial revascularisation and did not develop postoperative kidney failure immediately after surgery. A logistic regression model was used to determine the factors associated to postoperative kidney failure. Associations were expressed as grounds of disparity with their corresponding confidence intervals. Results: old age [OR 1.03 CI 95% (1.01-1.04)], preoperative presence of diabetes mellitus [OR 1.8 CI 95% (1.9-3.4)], cardiac insufficiency [OR 2.7 CI 95% (1.1-6.7)] and a longer perfusion time [OR 1.02 CI 95% (1.01-1.03)] were associated to a higher risk of postoperative kidney failure, while higher hematocrit [OR 0.86 CI 95% (0.82-0.91)] and higher ejection fraction [OR 0.94 CI 95% (0.92-0.96)] were associated with a decrease of the risk of postoperative kidney failure. Conclusions: In patients who had undergone myocardial revascularisation, risk factors associated to postoperative kidney failure where comorbidities related to internal and external gradual kidney damage outside the context of the surgery. This implies that strategies to minimise this event should be focused on identifying these patients in a timely manner and offering appropriate nephroprotection. © 2015 Sociedad Colombiana de Cardiología y Cirugía Cardiovascular

Massive Hyphaema Following Laser Iridotomy in a Patient on Dual Antiplatelet Therapy (Aspirin plus Ticagrelor): Case report and literature review

Massive hyphaema presentation after a laser iridotomy is very rare. We report a 63-year-old man with ischaemic heart disease on dual antiplatelet therapy (aspirin plus ticagrelor) who was diagnosed as a primary angle-closure suspect and was to undergo a neodymium-doped yttrium aluminium garnet laser iridotomy at Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia in 2016. While performing the iridotomy in the left eye, active bleeding occurred that finally filled approximately 75% of the anterior chamber. Intraocular pressure (IOP) increased to 62 mmHg. Mannitol and a topical dorzolamide/timolol were used to control the increase in IOP. The hyphaema slowly resolved over the following week without sequelae. This case revealed that massive hyphaema can complicate laser iridotomy in patients on dual antiplatelet therapy, although this is rare. Therefore, if patients are taking aspirin and ticagrelor, it would be advisable to stop the second medication if possible. In addition, sequential application of photocoagulation and photodisruption lasers might diminish the risk of significant bleeding. Keywords: Iridectomy; Nd-YAG Laser; Hyphema; Platelet Aggregation Inhibitors; Angle-Closure Glaucoma; Ocular Hypertension; Case Report; Columbia

El cristalino para el médico general

ResumenEl cristalino es un componente fundamental del órgano de la visión, y una de sus enfermedades, la catarata, es la primera causa de ceguera en el mundo. Actualmente contamos con técnicas quirúrgicas seguras y efectivas para solucionar esta patología. Es fundamental que el profesional de atención primaria provea la información adecuada al paciente, para que lo guíe en su búsqueda de la solución de su catarata. En este artículo revisamos libros de texto reconocidos y empleando Medline, algunos artículos representativos sobre este tema. Mostramos un panorama general del estado actual, clínico e investigativo, de la cirugía de catarata[Galvis V, Tello A, Carreño N. El cristalino para el médico general. MedUNAB 2008; 11: 225-230]Palabras clave:  Cristalino, Catarata, Facoemulsificación, Lente intraocular

Severe pigment dispersion after iris-claw phakic intraocular lens implantation

A 23-year-old female patient presented 3 months after the implantation of an Artisan® phakic intraocular lens with a severe depigmentation of the iris and peripheral anterior synechiae. Explantation of the intraocular lens and goniosynechialysis were performed. Eleven months after the explantation appearance of the iris significantly improved. There was no loss of lines of corrected distance visual acuity. Severe pigment dispersion after the implantation of an Artisan® phakic intraocular lens may happen and may require explantation of the lens. Iris depigmentation may improve with time

Diseño de una Unidad Didáctica sobre propiedades de la materia en las ciencias naturales, por medio de un dispositivo tecnológico “Arduino®”

El presente ejercicio de investigación busca reconocer la importancia de la interdisciplinariedad en las áreas experimentales como ciencias naturales y tecnología e informática, en el Colegio Agustiniano Norte de la ciudad de Bogotá específicamente en el grado noveno (2021), a través de un diseño de unidad didáctica, tomando como herramienta fundamental el uso de un dispositivo tecnológico “Arduino®”. Dicho ejercicio de investigación es de carácter cualitativo, tipo descriptivo y la técnica de investigación que se implementa es de estudio de caso; apoyado en una revisión bibliográfica de trabajos en proyectos de ciencias naturales. Basado en los resultados del estudio de caso se realizó el diseño de una unidad didáctica que permitió proponer conceptos, actividades y justificar la importancia de Arduino en las prácticas experimentales de ciencias naturales. El aporte de este trabajo al área de la pedagogía consiste en establecer la relación directa entre los conceptos básicos de ciencias naturales y el uso de dispositivos tecnológicos mejorando la enseñanza en estos campos del conocimiento.This exercise of investigation seeks to recognize the importance of interdisciplinarity in experimental areas like natural science, technology and informatics. The Colegio Agustiniano Norte in Bogota city specifically in ninth grade (2021) through of a didactic unit design, taking as the main tool the use of technologic device “Arduino®”. This exercise is qualitative matter, descriptive and the research technique that is implemented is a case study; supported by a bibliographic review of works of which include this type of instruments in natural science projects. Based on the results of the case study, a didactic unit was designed that allowed proposing concepts, activities and justifying the importance of Arduino in the experimental practices of natural sciences. The contribution of this work to the area of pedagogy consists of establishing the direct relationship between the basic concepts of natural sciences and the use of technological devices, improving teaching in these fields of knowledge