Shotgun wound and pellet embolism to the intracranial carotid artery

Producción CientíficaMissile embolism into the cerebral circulation is a very unusual complication of shotgun wounds to the chest or neck. We report a case of an 11-year-old boy who sustained an air gunshot wound and pellet embolism to the intracranial carotid artery. The cerebral artery pellet embolus resulted in contralateral hemiplegia. The patient was successfully treated by emergency flow reversal and embolectomy. Because this injury is extremely rare, the literature is reviewed, and several principles are suggested to improve the management. ( J Vasc Surg 2012;55:535-7.

Oclusión arterial atraumática con poloxámero 407: nueva técnica en arterias calcificadas

Producción CientíficaVariosartículoshanevaluadoelempleodelpoloxámero 407 enlaoclusióntemporaldearteriascoronariasenciru- gía cardiaca7,8, odearteriasrenalesdurantenefrectomías robóticas9. Elpoloxámero407suponeunmétodoalternativo a lainterrupcióndelflujosanguíneoqueevitaelproblema de lalesiónporclampaje.Esindependientedelacalcifica- ción parietalodelaslesionesateroscleróticasdelapared del vaso

Reparación endovascular de endoleak

Producción CientíficaLos endoleaks son la complicación más común tras TEVAR. Diferentes procedimientos son empleados para tratar este tipo de fugas, pero la proximidad de arterias vitales dificulta su tratamiento y aumenta el riesgo de complicaciones. Presentamos un caso en el que se empleó la Técnica de Chimenea (Chimney Graft Technique) para tratar un endoleak tipo IA tras TEVAR. Caso Clínico. Se presenta el caso de un varón de 73 años. Intervenido quirúrgicamente de disección aórtica tipo A (esternotomía en dos ocasiones) y de endoprótesis en aorta torácica descendente con oclusión de arteria subclavia izquierda por disección tipo B. Ingresa por presentar endofuga proximal tipo IA a nivel de endoprótesis torácica, evidenciada en angioTAC de control. Dada su elevada comorbilidad, se planteó realizar “Chimney Graft Technique”, mediante colocación de una endoprotesis Gore TAG® a nivel de aorta ascendente y cayado aortico; asociándose una endoprótesis Endurant® desde aorta ascendente a tronco braquicefálico. A ello se le sumó la revascularización de troncos supraaórticos mediante la realización de un bypass carótido-carotídeo derecho-izquierdo. Ausencia de complicaciones postoperatorias. Tras 6 meses postcirugía, el paciente se encuentra asintomático, con permeabilidad de las endoprótesis y del bypass carótidocarotídeo, sin evidenciarse endofugas en angioTAC de control. Borja Merino Díaz, et al. Reparación endovascular de endoleak tipo IA en el arco aórtico mediante endoprótesis paralelas

Tratamiento endovascular en paciente neoplásico con edema y congestión de hemicuerpo superior

Producción CientíficaIntroducción: El síndrome de vena cava su- perior (SVCS) está producido por la dificul- tad del retorno venoso a través de dicho vaso,produciendo clínica general de edema y con-gestión del hemicuerpo superior del organis-mo. Su etiología es neoplásica en la mayoría de los casos. Caso Clínico: Se presenta el caso de un varón de 65 años diagnosticado de carcinoma mi- crocítico de pulmón, que ingresa nuestro ser- vicio por presentar cuadro de edema en escla- vina y disnea, siendo diagnosticado de SVCS. Es tratado primeramente con medidas gene- rales y tratamiento médico, realizándose en los días posteriores tratamiento endovascular con éxito técnico y resolución completa de la clínica de congestión venosa en el primer día postoperatorio. Conclusión: El tratamiento endovascular del SVCS es un procedimiento eficaz y seguro, que proporciona una rápida mejoría en la calidad de vida del paciente y en los síntomas compresivos. El régimen de anticoagulación óptimo debe ser definido

Tratamiento quirúrgico del síndrome de atrapamiento de arteria poplítea : nuestra experiencia

Producción CientíficaEl síndrome de atrapamiento de la arteria poplítea (SAAP) es una entidad poco frecuente cuya incidencia varía del 0,17 al 3,5 %. Objetivo: Revisamos a los pacientes tratados quirúrgicamente en nuestro servicio durante los últimos 15 años. Material y métodos: Estudio retrospectivo entre 1995 y 2009, en que se registraron variables demográfi cas, comorbilidad, clínica, exploración física, pruebas complementarias, tratamiento quirúrgico realizado, así como evolución a los 15 años. Resultados: Se intervino quirúrgicamente a 8 pacientes (el 50 %, varones) por SAAP con una mediana de edad de 41,5 (intervalo, 16-62) años; 2 pacientes (25 %) presentaron claudicación invalidante, 5 (62,5 %), dolor de reposo y en 1 caso (12,5 %), lesiones trófi cas. La prueba de elección en todos ellos fue la arteriografía, aunque también en 2 casos se realizó TC y en 3, angio-RM. El tratamiento quirúrgico fue miotomía con liberación de la arteria poplítea en 3 pacientes (37,5 %) (en uno de ellos se asoció injerto venoso), miotomía junto a trombectomía poplítea en 2 pacientes (25 %), bypass poplíteo-poplíteo con vena en otros 2 (25 %) y un caso de simpatectomía lumbar (12,5 %). La arteriografía intraoperatoria fue normal. Durante el seguimiento a 15 años (mediana de seguimiento 7,5 ± 3,98 años) el 50 % de los pacientes estaba asintomático, el 25 % presentaba claudicación no invalidante y otro 25 % falleció como consecuencia de su afección concomitante. Conclusiones: En nuestra experiencia, la liberación de la arteria poplítea mediante miotomía del tendón de inserción anómalo, asociada o no a la realización de un bypass poplíteo-poplíteo, es el tratamiento quirúrgico de elección

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Predicting critical illness on initial diagnosis of COVID-19 based on easily obtained clinical variables: development and validation of the PRIORITY model

Objectives: We aimed to develop and validate a prediction model, based on clinical history and examination findings on initial diagnosis of coronavirus disease 2019 (COVID-19), to identify patients at risk of critical outcomes. Methods: We used data from the SEMI-COVID-19 Registry, a cohort of consecutive patients hospitalized for COVID-19 from 132 centres in Spain (23rd March to 21st May 2020). For the development cohort, tertiary referral hospitals were selected, while the validation cohort included smaller hospitals. The primary outcome was a composite of in-hospital death, mechanical ventilation, or admission to intensive care unit. Clinical signs and symptoms, demographics, and medical history ascertained at presentation were screened using least absolute shrinkage and selection operator, and logistic regression was used to construct the predictive model. Results: There were 10 433 patients, 7850 in the development cohort (primary outcome 25.1%, 1967/7850) and 2583 in the validation cohort (outcome 27.0%, 698/2583). The PRIORITY model included: age, dependency, cardiovascular disease, chronic kidney disease, dyspnoea, tachypnoea, confusion, systolic blood pressure, and SpO2 ≤93% or oxygen requirement. The model showed high discrimination for critical illness in both the development (C-statistic 0.823; 95% confidence interval (CI) 0.813, 0.834) and validation (C-statistic 0.794; 95%CI 0.775, 0.813) cohorts. A freely available web-based calculator was developed based on this model (https://www.evidencio.com/models/show/2344). Conclusions: The PRIORITY model, based on easily obtained clinical information, had good discrimination and generalizability for identifying COVID-19 patients at risk of critical outcomes

The genomic history of the Iberian Peninsula over the past 8000 years

We assembled genome-wide data from 271 ancient Iberians, of whom 176 are from the largely unsampled period after 2000 BCE, thereby providing a high-resolution time transect of the Iberian Peninsula. We document high genetic substructure between northwestern and southeastern hunter-gatherers before the spread of farming. We reveal sporadic contacts between Iberia and North Africa by ~2500 BCE and, by ~2000 BCE, the replacement of 40% of Iberia’s ancestry and nearly 100% of its Y-chromosomes by people with Steppe ancestry. We show that, in the Iron Age, Steppe ancestry had spread not only into Indo-European–speaking regions but also into non-Indo-European–speaking ones, and we reveal that present-day Basques are best described as a typical Iron Age population without the admixture events that later affected the rest of Iberia. Additionally, we document how, beginning at least in the Roman period, the ancestry of the peninsula was transformed by gene flow from North Africa and the eastern Mediterranean.J.M.F., F.J.L.-C., J.I.M., F.X.O., J.D., and M.S.B. were supported by HAR2017-86509-P, HAR2017-87695-P, and SGR2017-11 from the Generalitat de Catalunya, AGAUR agency. C.L.-F. was supported by Obra Social La Caixa and by FEDER-MINECO (BFU2015- 64699-P). L.B.d.L.E. was supported by REDISCO-HAR2017-88035-P (Plan Nacional I+D+I, MINECO). C.L., P.R., and C.Bl. were supported by MINECO (HAR2016-77600-P). A.Esp., J.V.-V., G.D., and D.C.S.-G. were supported by MINECO (HAR2009-10105 and HAR2013-43851-P). D.J.K. and B.J.C. were supported by NSF BCS-1460367. K.T.L., A.W., and J.M. were supported by NSF BCS-1153568. J.F.-E. and J.A.M.-A. were supported by IT622-13 Gobierno Vasco, Diputación Foral de Álava, and Diputación Foral de Gipuzkoa. We acknowledge support from the Portuguese Foundation for Science and Technology (PTDC/EPH-ARQ/4164/2014) and the FEDER-COMPETE 2020 project 016899. P.S. was supported by the FCT Investigator Program (IF/01641/2013), FCT IP, and ERDF (COMPETE2020 – POCI). M.Si. and K.D. were supported by a Leverhulme Trust Doctoral Scholarship awarded to M.B.R. and M.P. D.R. was supported by an Allen Discovery Center grant from the Paul Allen Foundation, NIH grant GM100233, and the Howard Hughes Medical Institute. V.V.-M. and W.H. were supported by the Max Planck Society

The genomic history of the Iberian Peninsula over the past 8000 years

We assembled genome-wide data from 271 ancient Iberians, of whom 176 are from the largely unsampled period after 2000 BCE, thereby providing a high-resolution time transect of the Iberian Peninsula. We document high genetic substructure between northwestern and southeastern hunter-gatherers before the spread of farming. We reveal sporadic contacts between Iberia and North Africa by ~2500 BCE and, by ~2000 BCE, the replacement of 40% of Iberia's ancestry and nearly 100% of its Y-chromosomes by people with Steppe ancestry. We show that, in the Iron Age, Steppe ancestry had spread not only into Indo-European-speaking regions but also into non-Indo-European-speaking ones, and we reveal that present-day Basques are best described as a typical Iron Age population without the admixture events that later affected the rest of Iberia. Additionally, we document how, beginning at least in the Roman period, the ancestry of the peninsula was transformed by gene flow from North Africa and the eastern Mediterranean.J.M.F., F.J.L.-C., J.I.M., F.X.O., J.D., and M.S.B. were supported by HAR2017-86509-P, HAR2017-87695-P, and SGR2017-11 from the Generalitat de Catalunya, AGAUR agency. C.L.-F. was supported by Obra Social La Caixa and by FEDER-MINECO (BFU2015- 64699-P). L.B.d.L.E. was supported by REDISCO-HAR2017-88035-P (Plan Nacional I+D+I, MINECO). C.L., P.R., and C.Bl. were supported by MINECO (HAR2016-77600-P). A.Esp., J.V.-V., G.D., and D.C.S.-G. were supported by MINECO (HAR2009-10105 and HAR2013-43851-P). D.J.K. and B.J.C. were supported by NSF BCS-1460367. K.T.L., A.W., and J.M. were supported by NSF BCS-1153568. J.F.-E. and J.A.M.-A. were supported by IT622-13 Gobierno Vasco, Diputación Foral de Álava, and Diputación Foral de Gipuzkoa. We acknowledge support from the Portuguese Foundation for Science and Technology (PTDC/EPH-ARQ/4164/2014) and the FEDER-COMPETE 2020 project 016899. P.S. was supported by the FCT Investigator Program (IF/01641/2013), FCT IP, and ERDF (COMPETE2020 – POCI). M.Si. and K.D. were supported by a Leverhulme Trust Doctoral Scholarship awarded to M.B.R. and M.P. D.R. was supported by an Allen Discovery Center grant from the Paul Allen Foundation, NIH grant GM100233, and the Howard Hughes Medical Institute. V.V.-M. and W.H. were supported by the Max Planck Society