Transperineal vascular grafts

Varias situaciones clínicas de etiologías distintas, onco-urológicas, infecciones protésicas, traumatismos con graves pérdidas de sustancia, etc. pueden requerir la revascularización de la extremidad por áreas vasculares alejadas de la zona inguinal. El bypass cruzado fémoro-femoral con tunelización transperineal es una técnica de recurso fiable y válida en estas situaciones donde no podemos obtener con seguridad un aporte sanguíneo por vía ortoanatómica. En este artículo sistematizamos sus características técnicas y las indicaciones de este inusual bypass con el objetivo de que esté presente en el arsenal terapéutico de aquellos cirujanos vasculares que se enfrentan a situaciones de emergencia.Several clinical situations of different etiologies, onco-urologic, graft infections, groin traumatism with loss of substance, etc. may require urgent revascularization away from the groin area. The femoro-femoral bypass with transperineal tunneling technique is a reliable and valid resource in these situations where we cannot get safe blood supply via orthoanatomic ways. This article systematize their technical characteristics and indications of this unusual bypass in order to be present in the armamentarium of vascular surgeons those facing emergencies

Modelos didácticos para el autoaprendizaje

Definir el exacto papel del profesor en el proceso de enseñanza-aprendizaje constituye un objetivo esencial en la estrategia docente de dicho proceso educativo. El trabajo realizado identifica y describe dos modelos didácticos (el autoaprendizaje por identificación inducida y el autoaprendizaje por coordinación lógica) implantados como modelos educativos en la enseñanza, en los que se define el papel del profesor en los ámbitos cognitivos y técnicos que se deben impulsar, al objeto de que el alumno alcance por sí mismo sus objetivos docentes.To define the specific role that the professor and teacher play in the teaching-learning process is one of the main goals of the educational strategy of the teaching-learning process. In this work, we have identified and described two different didactic models (self-learning by inducted identification and self-learning by logic coordination) that were implanted as educational models. Then, we define the role that the teacher plays in the cognitive and technical areas that must be implemented in order to help the student to reach his educational objectives.Financiado por: PID 08/2

Carotid atherosclerosis: clinical-histological correlation in vulnerable plaques

Objetivos: Caracterizar histológicamente placas humanas carotídeas vulnerables para plantear nuevas opciones diagnósticas y terapéuticas mediante la aplicación de nanomateriales en pacientes asintomáticos. Métodos: Se incluyeron tres pacientes varones, con enfermedad carotidea e indicación quirúrgica (endarterectomía). Las placas fueron teñidas con hematoxilina-eosina, tricrómico de Masson, picrosirius y orceína. Se analizaron histológicamente, determinando su remodelamiento, núcleo lipídico, infiltración inflamatoria, presencia de células espumosas, calcificación y neovascularización con hemorragia. Se realizo un análisis estadístico comparativo del porcentaje de fibrosis, así como de su intensidad por tercios entre las muestras e intramuestra. Resultados: A nivel clínico, la placa 1 era sintomática, correspondía a un paciente con antecedente de accidente isquémico transitorio, el paciente 2 presentaba un aneurisma carotideo con gran trombo mural y la placa 3 era asintomática. A nivel histológico, las placas 1 y 2 se asociaban con un estadio más evolucionado que la placa 3. Las placas 1 y 2 presentaron ruptura de su pared, intenso infiltrado de macrófagos, abundante calcificación y neovascularización con hemorragia intraplaca. Las placas carotídeas diferían principalmente en el grado de fibrosis. En concreto, la placa 3 destacó por la presencia de células espumosas migrando hacia el núcleo lipídico y la formación de líneas de calcificación. El estudio estadístico mostró una notable fibrosis de la placa 1 (5,4%), siendo inferior en la placa 3 (2,51%) y en la 2 (1,84%). Así mismo, se observaron diferencias estadísticamente significativas al comparar el tercio inferior de las placas 1 y 3, y en el análisis intramuestra de la placa 2. Conclusiones: El presente estudio permitió determinar las características histológicas de placas vulnerables que se pueden asociar con la manifestación de síntomas clínicos. Estos hallazgos, sugieren un conocimiento potencial para el desarrollo de nuevas opciones diagnósticas y terapéuticas que mejoren las herramientas actualmente disponibles.Objectives: Histological characterization of vulnerable human carotid plaques to propose new diagnostic and therapeutic options through the application of tissue engineering strategies in asymptomatic patients. Methods: In this study three male patients were included who presented carotid disease with surgical criteria (classic endarterectomy). The plaques were stained with hematoxylin-eosin, Masson’s trichrome, picrosirius and orcein. All samples were histologically analyzed to study remodeling capability, lipid nucleus, inflammatory infiltration, presence of foam cells, calcification, neovascularization and intraplaque hemorrhage. In addition, we performed a comparative statistical analysis of the fibrosis percentage, as well as its intensity by thirds between samples and intra-sample. Results: Clinical analysis revealed that Plaque 1 was syntomathic, trigging a stroke. Plaque 2 set up a carotid aneurism with a large mural thrombus. Plaque 3 was asynthomatic. Histologycal analysis from Plaques 1 and 2 determined they had developed a more advanced stage than Plaque 3. Plaques 1 and 2 were rupture plaques with a severe macrophages infiltrated and overall calcification and neovascularization with hemorrage. All plaques differed in the degree of fibrosis. At Plaque 3 foams cells were standing out, migrating to lipidic nucleous, as well as calcification lines. Statistic analysis presented a notorious Plaque 1 fibrosis (5,4%), below Plaque 3 (2,51%), and Plaque 2 (1,84%). They were statistically significant differences between the lower third of Plaques 1 and, 3, and at intra-sample analysis of Plaque 2. Conclusions: The present study allowed us to determine the histological characteristics of vulnerable plaques that can be associated with the manifestation of clinical symptoms. These findings suggest a potential knowledge for the development of new diagnostic and therapeutic options that improve clinical currently available tools

Histological analysis of the wall of a healthy and varicose vein and their correlation with their biomechanical properties

Objetivos: Las varices son una enfermedad muy frecuente en la población, cuya patogenia aun no está clara. Los cambios en la pared de la vena varicosa respecto a la sana determinan su comportamiento biomecánico y la aparición de varices. El presente estudio tiene por objetivo establecer dichas características estructurales en la pared de la vena sana y varicosa, su correlación con los cambios biomecánicos y su contribución a la patogenia de las varices. Métodos: Se llevó a cabo un estudio descriptivo tomando 10 muestras de vena varicosa de pacientes intervenidos de varices mediante crosectomía de la unión safenofemoral, y 4 muestras de vena sana en pacientes sometidos a amputación en los que se descartó enfermedad venosa previa. Las muestras fueron procesadas para su análisis histológico con microscopía óptica con las tinciones de hematoxilina-eosina, orceína y picrosirius. Se determinaron las propiedades biomecánicas en ambos grupos, calculándose el esfuerzo y deformación de ruptura, así como el módulo elástico medio. Resultados: Se han observado cambios histológicos en la pared de la vena varicosa respecto de la sana, con engrosamiento a nivel intimal y en la capa media, aumento de fibras colágenas, disminución de elásticas y alteración de la morfología de las células musculares lisas que pierden su orientación característica. Asimismo se ha encontrado un menor esfuerzo y deformación de ruptura y una mayor rigidez en el grupo de venas varicosas. Dichas alteraciones contribuyen a la deformidad de la pared venosa y la incompetencia valvular, implicados en la aparición de varices. Conclusiones: Las alteraciones histológicas observadas en la pared de la vena varicosa pueden correlacionarse con los cambios en las características biomecánicas y con el proceso patogénico que favorece la aparición de varices.Purpose: Varicose veins are a very common disease, whose pathogeny still remains unclear. Changes in the varicose vein wall in relation to the normal vein, determine its biomechanical behaviour and the appearance of varicose veins. The purpose of this study is to correlate structural and biomechanical properties of healthy and varicose veins, and its contribution to the appearance of varicose veins. Methods: A descriptive study was performed. 10 samples were taken from patients who underwent varicose vein surgery, which consisted in crosectomy of the safeno-femoral junction, and 4 samples of healthy vein from patients who underwent major amputation after dismissing those with signs or symptoms of venous disease. Results: Histological changes have been observed in the varicose vein wall in relation to the healthy vein, consisting in intimal and media thickening, increased amount of collagen fibres, decrease of elastic fibres, and lack of characteristic morphology and orientation in muscular cells. In addition, a lower strain and deformation rupture, and high stiffness has been observed in varicose veins. These changes contribute to varicose vein deformation, valvular incompetence and the appearance of varicose veins. Conclusion: Histological changes in varicose veins correlate with biomechanical properties and pathogenic process leading to varicose veins appearance

Microscopía electrónica analítica de la célula endotetial. Sistematización de los patrones microscópicos y microanalíticos

Tesis Univ. Granada. Departamento de Histología.Tesis Univ. Granada. Departamento de Cirugía y sus Especialidades . Leída el 2 de diciembre de 200

Endovascular Technique for Ascending Aorta Repair Based on TEVAR and TAVI Procedures

Purpose: Ascending aorta (AAo) acute pathology still has an open-surgery indication with a high mortality rate associated to cardiopulmonary bypass and circulatory arrest. In these cases, the endovascular aortic approach could be an excellent option. The aim of the present study is to detail an optimized technique for the endovascular treatment of AAo diseases, based on thoracic endovascular aortic repair (TEVAR) and transcatheter aortic valve implantation (TAVI) procedures. Technique: The procedure implies the usual preparation for TEVAR and TAVI implants. A transient pacemaker lead is necessary to deliver the prosthesis under "rapid pacing." As in the TAVI technique, a final high-support guidewire is placed at the left ventricle. The proximal landing zone is the sinotubular junction (zone 0B). Transesophageal echocardiography is essential to ensure aortic valve function and patency in coronary arteries during the delivery. To assess a potential occlusion of the brachiocephalic artery, a guidewire is positioned in the descending aorta from the axillary artery. Finally, a noncovered stent is implanted to stabilize the AAo prosthesis. Conclusion: The technique presented here can standardize a safe and reproducible procedure to endovascular repair of AAo diseases. However, new devices specifically designed for the AAo could facilitate the transcatheter approach. Clinical impact: Ascending aorta acute pathology still has an open-surgery indication with high mortality rate associated to cardiopulmonary bypass and circulatory arrest. Moreover, near 30% of patients are not considered suitable for surgery because of age, critical situation or the presence of severe comorbidities. The present study provides a detailed and optimized technique for the endovascular treatment of ascending aorta disease, based on TEVAR and TAVI procedures

Modelos didácticos para el autoaprendizaje

Definir el exacto papel del profesor en el proceso de enseñanza-aprendizaje constituye un objetivo esencial en la estrategia docente de dicho proceso educativo. El trabajo realizado identifica y describe dos modelos didácticos (el autoaprendizaje por identificación inducida y el autoaprendizaje por coordinación lógica) implantados como modelos educativos en la enseñanza, en los que se define el papel del profesor en los ámbitos cognitivos y técnicos que se deben impulsar, al objeto de que el alumno alcance por sí mismo sus objetivos docentes.To define the specific role that the professor and teacher play in the teaching-learning process is one of the main goals of the educational strategy of the teaching-learning process. In this work, we have identified and described two different didactic models (self-learning by inducted identification and self-learning by logic coordination) that were implanted as educational models. Then, we define the role that the teacher plays in the cognitive and technical areas that must be implemented in order to help the student to reach his educational objectives.Financiado por: PID 08/2

Atypical Vascular Involvement in a Case of Behçet's Disease

Introduction. Behçet's disease (BD) is a form of vasculitis of unknown etiology which is rare in our environment. It is characterized by a variety of clinical manifestations and usually affects young adults. Recurrent oral and genital ulcers are a characteristic and extremely frequent symptom, but mortality is linked with more significant symptoms such as aortic pseudoaneurysm, pulmonary pseudoaneurysm, and cerebral venous thrombosis. Patient and Method. We present a case of a young male with atypical BD and severe polyvascular involvement (previous cerebral venous thrombosis and current peripheral venous thrombosis, acute ischemia, and peripheral arterial pseudoaneurysm) who required urgent surgical intervention due to a symptomatic external iliac pseudoaneurysm. Result. The pseudoaneurysm was successfully treated, we performed an iliofemoral bypass, and we treated it with steroids and immunosuppressive therapy. Conclusions. These rare clinical manifestations highlight the importance of considering BD in young patients, even in usual cases of vascular intervention, whether arterial or venous in nature

Educational system and mass media as determinants of medical vocation

La investigación realizada en este trabajo ha sido premiado con el Premio de la Delegación de Educación que otorga la Real Academia de Medicina de Cádiz.Introducción: La vocación médica se manifiesta a través del desarrollo de un proceso interactivo entre el individuo y la sociedad, y por tanto entre la voluntad de autorrealización de la persona y el modo de realización social de la medicina. Dos sistemas básicos de inserción social transmiten y vinculan dicha interrelación. Se trata del sistema escolar y del sistema de medios de comunicación social. Material y Métodos: El estudio realizado a través de cuestionarios en alumnos de primer curso de medicina pone de relieve que existe una correlación estadísticamente significativa entre la vocación existente en varones y los tres niveles del sistema escolar así como con los medios de comunicación escrito y audiovisual. En la mujer la correlación existe solo con los dos primeros niveles del sistema educativo. Ambos grupos varones y mujeres muestran niveles de correlación significativa con los valores transversales –curar, cooperar, etc.- pero no con la adhesión imitativa personal, ni la investigación, ni la tradición familiar, ni la figura del profesor. El estudio revela un cambio de paradigma en relación con los factores clásicos que inciden en la decisión vocacional así como diferentes patrones conductuales en relación con el sexo.Medical vocation is due to an interaction between the individual and the society and therefore between the will of self-fulfiltment and the way medicine is present in the society. Two basic systems of social insertion support such interaction: The educative system and the mass media.. Our study was carried out using a questionnaire in first year medical school students. The results showed a statistical significant correlation between vocation in males and the three levels of the educative system and written and audiovisual mass media. In females there is only statistical correlation with the first and the second level of the educative system. Both groups, males and females, showed a significant statistical correlation with transversal values such a healing or cooperation. No correlation was observed with personal imitation, research, family tradition or the professor figure. The study revealed not only different patterns of sex behaviour but also a change in the paradigme of the classic factors which are determining the vocational decision

El sistema escolar y los medios de comunicación social como determinantes de la vocación médica

Medical vocation is due to an interaction between the individual and the society and therefore between the will of self-fulfiltment and the way medicine is present in the society. Two basic systems of social insertion support such interaction: The educative system and the mass media.. Our study was carried out using a questionnaire in first year medical school students. The results showed a statistical significant correlation between vocation in males and the three levels of the educative system and written and audiovisual mass media. In females there is only statistical correlation with the first and the second level of the educative system. Both groups, males and females, showed a significant statistical correlation with transversal values such a healing or cooperation. No correlation was observed with personal imitation, research, family tradition or the professor figure. The study revealed not only different patterns of sex behaviour but also a change in the paradigme of the classic factors which are determining the vocational decision