¿Viable o no viable? El problema del manejo de la enfermedad coronaria muy avanzada

Patients with very advanced coronary disease are a hard challenge for the clinician. This clinical report is a good example, with a patient with very extensive and severe arteriosclerosis in several vascular territories that debuted as acute leg arterial ischemia but in which the coronary disease became the worst problem. Despite myocardial viability demonstration, the extent and complexity of coronary lesions made it impossible treat them. In this kind of cases, although we know what the ideal treatment should be, the trip ends without reaching the goal of the revascularization.Los pacientes con enfermedad coronaria muy avanzada son todo un reto para el clínico. Este caso clínico es un buen ejemplo de ello, con un paciente con arterioesclerosis muy extensa y grave en varios territorios vasculares que debuta con isquemia arterial aguda, pero en el que la evolución predomina la disfunción ventricular por enfermedad coronaria. A pesar de demostrar viabilidad miocárdica en las pruebas de imagen, la extensión y complejidad de las lesiones hizo que no fuera posible tratarlas. En casos como éste, a pesar de que se conoce cuál es el tratamiento ideal, el viaje termina sin alcanzar la orilla de la revascularización

Ductus arterioso persistente en el adulto: a propósito de un caso

Patent ductus arteriosus is a rare congenital heart disease in adults and usually presents as a single anomaly. It is important for the clinical cardiologist to identify cases with patent ductus whose resultant left-to-right shunt is causing pressure overload in cardiac cavities as well as pulmonary hypertension due to hyperaflux. In these cases, closure is indicated, and currently the percutaneous occlusion is the first line of treatment, if the anatomy allows it. Surgical closure in adults involves risks due to anatomical and histological changes, and is relegated a second line.El conducto arterioso persistente es una cardiopatía congénita poco frecuente en el adulto y suele presentarse como anomalía única. Es importante para el cardiólogo clínico la identificación de los casos con ductus permeable cuyo cortocircuito izquierda-derecha resultante está causando sobrecarga de presiones en las cavidades cardíacas, así como hipertensión pulmonar por hiperaflujo. En estos casos está indicado el cierre, siendo en la actualidad la oclusión percutánea la primera línea de tratamiento, si la anatomía lo permite. El cierre quirúrgico en adultos implica un mayor riesgo debido a sus cambios anatómicos e histológicos, y se considera una opción de segunda línea

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

A new methodology for assessing SAR despeckling filters

Supervised learning requires labeled data to train models and then make predictions from new input data. Deep Learning (DL) methods require immense amounts of training data and processing power to provide reasonable results. In computer vision applications, and more specifically in despeckling SAR (Synthetic Aperture Radar) images, due to the speckle content, there is no ground truth available. To test the performances of despeckling filters, the common approach is tocorrupt synthetic images with a suitable speckle model and then, after filtering, well-known metrics are obtained. Then, filters are tested on actual SAR data, and specific metrics for SAR are evaluated. However, even the most elaborated speckle models are far from accounting for the complex mechanisms related to SAR images. In this paper, a methodology to design a realistic dataset to overcome these limitations is proposed. Actual SAR images of the same scene but acquired with the same sensor on different dates are downloaded from one of the available satellite platforms. Images are properly co-registered and averaged to get a ground truth-like reference image to objectively evaluate the performance of a despeckling method. To show the benefits of the proposed methodology, an on-the-shelf deep learning approach is used to filter the data, and compared with the standard approach using synthetic corrupted images with a speckle model. The final validation on actual SAR data not included in the training phase validates the proposed dataset. From the results shown, it is recommended to test filters on the proposed more realistic dataset and abandon the usual approach.</p