Reemplazo valvular aórtico con prótesis biológica St. Jude Trifecta®. Evaluación posoperatoria a mediano plazo del comportamiento clínico y hemodinámico / Mid term posoperative evaluation of aortic valve replacement with St. Jude Trifecta™ bioprosthesis

Resumen Introducción: la válvula St. Jude Trifecta® es una bioprótesis diseñada para implante en posición aórtica supraanular. Objetivo: Evaluar el comportamiento hemodinámico de la válvula y el estadio clínico de los pacientes, entre 3 a 72 meses luego del implante. Materiales y método: Estudio de cohorte en el que se incluyeron pacientes mayores de 18 años, llevados a cambio valvular aórtico en quienes se implantó una bioprótesis St. Jude Trifecta® entre marzo de 2012 a diciembre de 2018, y se hizo un seguimiento mediante evaluación clínica y ecocardiográfica desde tres meses hasta seis años posquirúrgicos. Resultados: Se incluyeron 165 pacientes, 53.3% hombres. Edad promedio 69.6 años (30-90). El 66.7% con estenosis valvular aórtica y el 21.2% con insuficiencia. El promedio de EuroSCORE II fue 4.18 (0.56-24.35). En el preoperatorio, 60.6%, 29.6% y 9.69% de los pacientes se encontraban en clase funcional NYHA II, III y IV, respectivamente. Luego del implante, el promedio de área del orificio efectivo indexado fue 1.025 cm2/m2 para bioprótesis N.o 19 1.089cm2/m2, 1.085 cm2/m2 y 1.069 cm2/m2 para prótesis N.o 21, 23 y 25, respectivamente. El gradiente medio transvalvular en el posoperatorio inmediato (en sala de cirugía) fue 3.08 mmHg. Durante el seguimiento ecocardiográfico a 3, 6, 12, 24, 36 y 72 meses, el gradiente medio fue de 4.2, 5.7, 6.3, 7.1, 8.3 y 9.1 mmHg, respectivamente. La mortalidad quirúrgica fue del 2.42%. Ningún paciente presentó desproporción prótesis-paciente, accidente cerebrovascular o endocarditis. Durante el tiempo del estudio ninguno ha requerido reintervención por deterioro valvular estructural. Al seguimiento, 83.6% se encontraron en NYHA I. Conclusión: En el grupo estudiado, el reemplazo valvular aórtico con bioprótesis St. Jude Trifecta® demostró excelentes resultados clínicos (NYHA I, 83%) y hemodinámicos (no reoperación por deterioro valvular estructural, bajos gradientes transvalvulares y adecuado orificio efectivo indexado), durante el tiempo de evaluación clínica y ecocardiográfica (3 a 72 meses).

Abstract Background: The St. Jude Trifecta™ valve is a latest generation bioprosthetic designed for supra annular aortic placement. The study main objective is the evaluation of the hemodynamic valve performance and the 3 to 72 months post implantation clinical status of the patients. Method and materials: Cohort study on patients older than 18 years, undergoing aortic valve replacement with St. Jude Trifecta™biological valve prosthesis between march 2012 and december 2018. The follow up was made by clinical evaluation and serial echocardiogram from 3 months to 6 years after surgery. Results: 165 patients where included, 53.3% male. Mean age 69.6 years (30-90). The main indication for valve replacement was aortic stenosis (66.7%). Mean EuroSCORE II was 4.18 (0.56-24.35). Preoperative 60.6%, 29.6% and 9.69% of patients where in New York Heart Association functional class (NYHA) II, III and IV respectively. After the surgery, the mean effective orifice area index (IEOA) was 1.025 cm2/m2 for prosthesis N.o 19; 1.089cm2/m2 (prosthesis 21); 1.085 cm2/m2 (prosthesis 23) and 1.069 cm2/m2 (prosthesis 25). The mean transvalvular gradient was 3.08 mmHg at the immediate posoperative period, and the mean gradient at 3,6,12,24,36 and 72 months was 4.2, 5.7, 6.3, 7.1, 8.3 and 9.1 mmHg, respectively. 30 days mortality was 2.42%. None of the patients have a posoperative patient-prosthesis mismatch (PPM), neither thromboembolic events or endocarditis. There is no patients with re-operation for structural valve deterioration. After follow up, 83.6% of the patients are in NYHA I functional class. Conclusion: In this Study group, St. Jude Trifecta™ valve for aortic valve replacement provides excellent clinical (NYHA I, 83%) and hemodynamic outcomes (demostrated by no patients with re-operation for structural valve deterioration, a low post operative transvalvular gradients; IEOA that avoid PPM; excellent clinical and echocardiographic outcome during follow up (3 to 72 months).

In vitro antibacterial activity, biofilm formation inhibition and chromatographic profile of methanolic extracts of two Pterocaulon species against MRSA.

The methanolic extracts of Pterocaulon alopecuroides and Pterocaulon angustifolium were assayed for antibacterial activity and biofilm formation inhibition of four community-acquired-MRSA isolates representative of ST30 t975, ST30 t021, ST5 t311, and ST4335 t008 clones that are responsible for invasive infections in Paraguayan children. Both Pterocaulon extracts showed significant antibacterial activity with a minimum inhibitory concentration of 200 µg/mL against the four isolates. P. angustifolium showed inhibition of biofilm formation for the four isolates, whereas P. alopecuroides showed inhibition for three of them. The chemical constituents were identified by liquid chromatography coupled to tandem mass spectrometry. Phenolic compounds were detected in the two species as well as coumarins. These results showed that these plants are sources of compounds with activity against MRSA.

Platelet activation and platelet-monocyte aggregate formation trigger tissue factor expression in patients with severe COVID-19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emergent pathogen responsible for the coronavirus disease 2019 (COVID-19). Since its emergence, the novel coronavirus has rapidly achieved pandemic proportions causing remarkably increased morbidity and mortality around the world. A hypercoagulability state has been reported as a major pathologic event in COVID-19, and thromboembolic complications listed among life-threatening complications of the disease. Platelets are chief effector cells of hemostasis and pathological thrombosis. However, the participation of platelets in the pathogenesis of COVID-19 remains elusive. This report demonstrates that increased platelet activation and platelet-monocyte aggregate formation are observed in severe COVID-19 patients, but not in patients presenting mild COVID-19 syndrome. In addition, exposure to plasma from severe COVID-19 patients increased the activation of control platelets ex vivo. In our cohort of COVID-19 patients admitted to the intensive care unit, platelet-monocyte interaction was strongly associated with tissue factor (TF) expression by the monocytes. Platelet activation and monocyte TF expression were associated with markers of coagulation exacerbation as fibrinogen and D-dimers, and were increased in patients requiring invasive mechanical ventilation or patients who evolved with in-hospital mortality. Finally, platelets from severe COVID-19 patients were able to induce TF expression ex vivo in monocytes from healthy volunteers, a phenomenon that was inhibited by platelet P-selectin neutralization or integrin αIIb/ß3 blocking with the aggregation inhibitor abciximab. Altogether, these data shed light on new pathological mechanisms involving platelet activation and platelet-dependent monocyte TF expression, which were associated with COVID-19 severity and mortality.

Effect of moderate thermal treatments on the inactivation of a strain of Listeria monocytogenes and physicochemical properties of soursop pulp.

Soursop (Annona muricata L.) is a commercially important tropical fruit, whether fresh or processed as a pasteurized or frozen pulp used to prepare juice, drinks, nectar, ice cream, popsicles, and desserts. Besides preserving quality, another preoccupation in the processing of fruit pulps is product safety. Several studies show the association between pulp processing and the development of various microorganisms; however, few have focused on the association between L. monocytogenes and the pulp of sour fruits. The objective was to evaluate the effect of moderate thermal treatments on the inactivation of L. monocytogenes and the physicochemical properties in soursop pulp in order to determine the best processing conditions that will allow to maintain quality as well as to achieve an adequate level of safety. Thermal inactivation kinetics were obtained for L. monocytogenes inoculated in soursop pulp at five levels of temperature (50, 52.5, 55, 57.5, and 60 ℃) and different exposure times (0-60 min). The survival curves did not suggest a log-linear relationship, and were, consequently, fitted to the modified Gompertz equation. The results indicated that the modified Gompertz equation provided an acceptable goodness of fit. Five-log10 cycles reductions of L. monocytogenes were achieved at 50 ℃/60 min, 52.5 ℃/16 min, 55 ℃/10 min, 57.5 ℃/5 min, and 60 ℃/1.25 min. These 5-log10 treatments applied to the soursop pulp indicated that the soursop pulp showed changes in the color parameters and a decrease in the content of total sugars, reducing sugars, ascorbic acid, total phenols, and pH.

Hemorragia intracerebral como primera manifestación de un coriocarcinoma metastásico: reporte de caso / Intracerebral hemorrhage as the first manifestation of a metastatic choriocarcinoma: case report

RESUMEN El coriocarcinoma es una variante muy vascularizada, invasiva y poco común de la enfermedad trofoblástica gestacional. Es potencialmente fatal sin tratamiento adecuado y se caracteriza por la proliferación maligna de tejido trofoblástico con una alta tasa de metástasis. Se presenta el caso de una paciente joven con hemorragia intracerebral como primera manifestación de un coriocarcinoma metástasico. Se describen las características clínicas e imagenológicas y se hace una revisión de la literatura actual, con énfasis en los detalles más relevantes respecto al diagnóstico diferencial de la hemorragia intracerebral de presentación atípica y el tratamiento más apropiado.

SUMMARY Choriocarcinoma is an invasive, highly vascularized, rare gestational trophoblastic disease. It is potentially fatal without proper treatment and is characterized by malignant proliferation of trophoblastic tissue with a high rate of metastases. We present the case of a young patient with intracerebral hemorrhage as the first manifestation of metasta-tic choriocarcinoma. We describe the clinical and imaging characteristics and review current literature, with emphasis on the most relevant details regarding the differential diagnosis of intracerebral hemorrhage atypical presentation and the most appropriate treatment.

Adaptação do jovem à universidade e o impacto no bem-estar psicológico do estudante de licenciatura em pedagogia / Adaptation of the youth to the university and the impact on the psychological well-being of the undergraduate student in pedagogy

Investigar a formação docente é essencial à universidade com o intuito de alcançar melhorias. Neste sentido, a temática deste estudo está inserida no projeto "Os fatores de acesso e permanência que envolvem a formação docente na UFRGS e seus contrastes com as expectativas e demandas do mundo do trabalho em escolas públicas da rede básica no Estado do RS". O objetivo é contribuir para a compreensão dos fatores que levam à adaptação do estudante à universidade e o impacto deste processo no bem-estar do aluno de Licenciatura em Pedagogia a partir de cinco dimensões de adaptação (pessoal, interpessoal, carreira, estudo e institucional). Para verificar a adaptação do aluno ao curso utilizou-se o Questionário de Vivências Acadêmicas, com amostra estudantil dos alunos da Pedagogia, em versão adaptada ao contexto brasileiro. Os dados foram analisados a partir de estatística descritiva e relacionados com a fundamentação teórica apresentada, permitindo, assim, uma interpretação referencial apoiada desses dados. Em suma, poucos estudantes apresentaram sintomas relacionados à ansiedade, depressão ou estresse na pesquisa. A maioria dos alunos demonstrou-se satisfeitos com sua escolha pelo curso, seu desempenho acadêmico e os recursos oferecidos pela universidade. Além disso, apesar de demonstrarem algum nível de ansiedade e altas expectativas, isso não interfere de forma direta em seu desempenho acadêmico ou desejo de concluir o curso.

Investigating teacher education is essential to the university in order to design improvements and achieve challenges. The theme of this study is part of a larger project on the factors of access and permanence that involve teacher education and its contrasts with the expectations and demands of the working world in public schools of the basic network. The objective is to contribute to the understanding of the factors that lead to the adaptation of the student to the university and the impact of this process on the well-being of undergraduate student in Pedagogy from five dimensions of adaptation (personal, interpersonal, career, study and institutional). In order to verify the student's adaptation to the course, the Student Experience Questionnaire was used, with a student sample of Pedagogy students, in a version adapted to the Brazilian context. The data were analyzed from descriptive statistics and related to the theoretical basis presented, allowing, therefore, a supported reference interpretation of these data. In short, few students had symptoms related to anxiety, depression or stress in the research. Most students were satisfied with their choice of course, their academic performance, and the resources offered by the university. In addition, although they demonstrate some level of anxiety and high expectations, this does not seem to interfere directly with their academic performance or desire to complete the course.

Epidemiologia da leishmaniose visceral no município de Fortaleza, Ceará / Epidemiology of visceral leishmaniasis in Fortaleza, Ceará, Brazil

O objetivo do trabalho foi analisar os dados relacionados à transmissão da leishmaniose visceral (LV), no município de Fortaleza, e discutir a respeito da distribuição do vetor, reservatório doméstico e casos humanos ocorridos no período de 2009 a 2013. O presente estudo é do tipo descritivo realizado por meio de levantamento de dados secundários. A correlação entre casos humanos, caninos e número de flebotomíneos foi feita pelo teste de correlação de Spearman, com nível de significância de 5%. No período de 2009 a 2013 foram confirmados 941 casos e 55 óbitos. A letalidade média no período foi de 5,84%. Na distribuição por sexo, houve uma maior proporção de casos no sexo masculino em todos os anos analisados. A faixa etária de 1 a 4 anos apresentou a maior porcentagem de casos, destacando-se o ano de 2010 com 31,5% dos casos. A distribuição média de casos por regional demonstrou um predomínio nas regionais I, V e VI. Em relação aos flebotomíneos, a espécie encontrada em maior abundância foi Lutzomyia (Lutzomyia) longipalpis, seguido de Lutzomyia (Lutzomyia) migonei e Lutzomyia (Lutzomyia) lenti. Segundo os registros da Secretaria Municipal de Saúde de Fortaleza, 39.626 cães foram soro reagentes para LV nos anos de 2009 a 2013, destes 14.313 foram eutanasiados. O ano de 2013 destacou-se com 17.808 cães soro reagentes, sendo 1.273 da SER (Secretaria Executiva Regional) III, 2.572 da SER V e 1.909 da SER VI. Não foi observada correlação significativa entre o número de flebotomíneos capturados e o número de casos caninos de LV(p>0,05). Houve correlação negativa entre casos humanos e caninos (r=-0,0388) e correlação positiva entre casos humanos e número de flebotomíneos (r=0,7469). Os achados criam perspectivas para a identificação de outros fatores que podem influenciar a incidência de casos humanos e caninos, como a participação de outros possíveis reservatórios e vetores na cadeia de transmissão da leishmaniose visceral no município de Fortaleza.(AU)

The objective was to analyze the data relating to the transmission of visceral leishmaniasis (LV) in Fortaleza municipality, and discuss about the vector distribution, domestic reservoir and human cases from 2009 to 2013.This study is descriptive conducted through a survey of secondary data. The correlation between human and canine cases and sandflies number was taken by Spearman correlation test, with 5% significance level. In the period 2009 to 2013, 941 cases and 55 deaths were confirmed. The mortality rate for the period was 5.84%. There was a higher proportion of cases among men in all the years analyzed. The age group 1-4 years old had the highest percentage of cases, highlighting the year 2010 with 31.5% of the cases. The average distribution of cases by SER demonstrated a predominance in SER I, V and VI. With regard to the vector species found in greater abundance was Lutzomyia (Lutzomyia) longipalpis, followed by Lutzomyia (Lutzomyia) migonei and Lutzomyia (Lutzomyia) lenti. According to the records, 39,626 dogs were serum reagents for LV in the years 2009-2013, these 14,313 were killed. The year 2013 stood out with 17,808 dogs serum reagents, and 1,273 of SER III, 2572 of SER V and 1909 of SER VI. There was no significant correlation between the number of sand flies and the number of canine VL cases (p?γτ;0.05). There was a negative correlation between human and canine cases (r = -0.0388) and correlation was observed between human cases and number of sand flies (r= 0.7469).Our findings create prospects for the identification of other factors that may influence the incidence of human and canine cases, such as the participation of other possible reservoirs and vectors in the transmission of the visceral leishmaniasis in Fortaleza.(AU)

[Posterior reversible encephalopathy syndrome: Report of a fatal case and analysis of predictive factors of a poor prognosis].

Posterior reversible encephalopathy syndrome is an illness with multiple causes and distinctive clinicalradiological characteristics that should be known by intensivists and emergency room physicians for a timely diagnosis and treatment. A fatal case of posterior reversible encephalopathy syndrome is presented, and the risk factors related to the outcome are identified.A 60-year-old man without a relevant medical history arrived at the emergency room presenting with depressed consciousness, seizures, and high blood pressure. Tomographic images revealed a posterior cerebellar hematoma. Resonance images showed ischemic zones, vasogenic edema from the thalamus to the brain stem, middle cerebellar peduncles, deep white matter of the cerebral hemispheres, and zones of hemorrhagic transformation. Despite medical-surgical management, the patient died. The risk factors described as the cause of the fatal outcome were identified. This case demonstrates that posterior reversible encephalopathy syndrome can occur without triggering risk factors and highlights the need for early recognition to establish an appropriate intervention to avoid injury or a fatal outcome. Cases of posterior reversible encephalopathy syndrome provide opportunities to investigate the susceptibility for the development of this condition and to establish appropriate preventive measures.

Síndrome de encefalopatía posterior reversible: reporte de un caso fatal y análisis de factores predictores de mal pronóstico / Posterior reversible encephalopathy syndrome: Report of a fatal case and analysis of predictive factors of a poor prognosis

El síndrome de encefalopatía posterior reversible es una condición que responde a múltiples causas y presenta características clínicas o radiológicas distintivas; los intensivistas y los médicos de urgencias deben conocerlo con el fin de hacer el diagnóstico y ordenar el tratamiento oportuno. Se presenta un caso fatal de síndrome de encefalopatía posterior reversible, en el cual se determinaron los factores de riesgo relacionados con el resultado final. Un hombre de 60 años sin antecedentes médicos ingresó por urgencias con depresión de la conciencia, convulsiones y tensión arterial elevada. Las imágenes de la tomografía revelaron un hematoma cerebeloso posterior, y las de resonancia magnética mostraron zonas isquémicas, edema vasogénico que se extendía desde los tálamos hacia el tallo cerebral, los pedúnculos cerebelosos medios y la sustancia blanca profunda de los hemisferios cerebelosos, así como zonas de transformación hemorrágica. A pesar del tratamiento médico y quirúrgico recibido, el paciente falleció. Se determinaron los factores de riesgo que se han descrito como causa de muerte en este síndrome. Este caso demuestra que dicho síndrome puede ocurrir sin que se hayan detectado factores de riesgo desencadenantes y pone en evidencia la necesidad de su reconocimiento temprano para establecer una intervención adecuada y evitar daños o un desenlace fatal. Además, abre el camino a nuevos estudios sobre la propensión a desarrollarlo y las medidas preventivas que pueden adoptarse.

Posterior reversible encephalopathy syndrome is an illness with multiple causes and distinctive clinicalradiological characteristics that should be known by intensivists and emergency room physicians for a timely diagnosis and treatment. A fatal case of posterior reversible encephalopathy syndrome is presented, and the risk factors related to the outcome are identified. A 60-year-old man without a relevant medical history arrived at the emergency room presenting with depressed consciousness, seizures, and high blood pressure. Tomographic images revealed a posterior cerebellar hematoma. Resonance images showed ischemic zones, vasogenic edema from the thalamus to the brain stem, middle cerebellar peduncles, deep white matter of the cerebral hemispheres, and zones of hemorrhagic transformation. Despite medical-surgical management, the patient died. The risk factors described as the cause of the fatal outcome were identified. This case demonstrates that posterior reversible encephalopathy syndrome can occur without triggering risk factors and highlights the need for early recognition to establish an appropriate intervention to avoid injury or a fatal outcome. Cases of posterior reversible encephalopathy syndrome provide opportunities to investigate the susceptibility for the development of this condition and to establish appropriate preventive measures.

Contrast-enhanced T2-FLAIR MR imaging in patients with uveitis.

To report MRI findings which reflect a pathological inflammatory condition of the uveal tract. This study includes single-center retrospective case series of five patients with clinical diagnosis of uveitis. There were 1 male (20 %) and 4 female patients (80 %). The average age was 29.6 years (range 25-38 years). Patients and 50 age-range-matched control subjects were scanned using a 1.5 T scanner. Ten additional control subjects scanned at 3 T were evaluated to have reference images at that high field. All patients (n = 5, 100 %) presented uveal tract enhancement on post-contrast T2-FLAIR fat-suppressed images and only 2 (40 %) had enhancement on T1-weighted images. The enhancement was anterior in 2 (40 %), pan-uveal in 2 (40 %), and posterior in 1 patient (20 %). Two patients (40 %) had unilateral increased vitreous signal on T2-FLAIR. One patient (20 %) had bilateral retrobulbar fat enhancement in both post-contrast T2-FLAIR and T1-weighted images. Post-contrast T2-FLAIR images can reveal abnormal enhancement of the uveal tract and retrobulbar fat as well as increased vitreous signal in patients with uveitis. In our small series, the sensitivity of post-contrast T2-FLAIR was higher than the conventional post-contrast T1-weighted images. Nonetheless, when bilateral uveal tract enhancement is present, there should be discretion before calling uveitis because the finding has been reported in different eye conditions as well as in a small percentage of healthy subjects at 1.5 T. In addition, it should be noted that post-contrast T2-FLAIR enhancement of the uveal tract is a normal finding at 3 T imaging.

Carbohydrate mouth rinse reduces rating of perceived exertion but does not affect performance and energy systems contribution during a high-intensity exercise

Aim: The study aimed to verify the effect of carbohydrate (CHO) mouth rinse on time to exhaustion, energy systems contribution and rating of perceived exertion (RPE) during a high-intensity exercise. Methods Fourteen men performed an incremental exercise test to determine their maximal oxygen uptake and peak power output (PPO) and two time-to-exhaustion tests at 110% of PPO. Participants rinsed their mouth with 25ml of 6.4% of CHO or placebo (PLA) solution immediately before the time-to-exhaustion test, using a crossover design. The contribution of the energy systems was calculated using the free software GEDAE-LaB®. Results: Time to exhaustion was similar between the conditions (CHO:174.3±42.8s; PLA:166.7±26.3s; p=0.33). In addition, there was no difference between the CHO and PLA condition for aerobic (CHO:135.1±41.2kJ and PLA:129.8±35.3kJ, p=0.34), anaerobic lactic (CHO:57.6±17.1kJ and PLA:53.4±15.1kJ, p=0.10), and anaerobic alactic (CHO:10.4±8.4kJ and PLA:13.2±9.2kJ, p=0.37) contribution. Consequently, total energy expenditure was similar between conditions (CHO:203.2±46.4kJ and PLA:196.5±45.2kJ, p=0.15). However, CHO mouth rinse reduced the RPE at the moment of exhaustion (CHO:18.2±1.0units and PLA:19.1±1.1units; p=0.02). Conclusion: CHO mouth rinse neither increased time to exhaustion nor altered energy systems contribution during a high-intensity exercise, but reduced the perceived effort at the exhaustion.(AU)

Tratamiento quirúrgico de la endocarditis infecciosa / Surgical treatment of infective endocarditis

Objetivo: describir las características epidemiológicas y los resultados del tratamiento quirúrgico temprano de los pacientes con diagnóstico de endocarditis infecciosa intervenidos en el Departamento de Cirugía Cardiovascular de la Clínica Medellín, Colombia. Métodos: estudio observacional, descriptivo, retrospectivo, de todos los pacientes con diagnóstico de endocarditis infecciosa tratados mediante cirugía en la Clínica Medellín, entre enero de 2003 y enero de 2010. Resultados: se incluyeron en total 54 pacientes, 37 (68,5%) de ellos de género masculino. La mediana de la edad fue 57,5 años (9 - 76 años). El 77,7% tenía algún factor de riesgo para desarrollar endocarditis infecciosa; entre los más destacados insuficiencia renal crónica (IRC) en hemodiálisis (18,5%) y prótesis valvulares cardiacas (18,5%). El 66,7% de los hemocultivos fue positivo. Staphylococcus aureus fue el principal germen aislado en el 40,7% del total de pacientes. El 81,4% de las válvulas comprometidas eran nativas con predominio de la válvula mitral (44,5%) y el 7,5% presentaba compromiso de dos válvulas. En el 68,5% el motivo de consulta fue falla cardiaca y 35,3% presentaron fenómenos embólicos como manifestación inicial o asociada (cerebral 16,7%, pulmonar 13%, esplénica 5,6%). En el 83,3% de los casos se realizó cirugía temprana; 66% recibieron válvulas mecánicas. La mortalidad total a tres meses fue del 13% (muerte intraoperatoria 3,7%, mortalidad a 30 días, 9%). La mediana en el tiempo de estancia hospitalaria fue de 36 días (7 a 130 días). En este estudio se reporta una mortalidad total que se encuentra en el límite inferior de lo reportado en el mundo. Una de las razones atribuibles a este hallazgo es el manejo quirúrgico temprano que se protocoliza en el servicio.

Objective: to describe the epidemiological characteristics and the results of early surgical treatment of patients diagnosed with infectious endocarditis who underwent surgery in the Department of Cardiovascular Surgery in the Medellin Clinic, Colombia. Methods: observational, descriptive, retrospective study of all the patients diagnosed with infective endocarditis treated by surgery in the Medellin Clinic between January 2003 and January 2010. Results: a total of 54 patients were included. 37 (68.5%) were male. Mean age was 57.5 years (9-76 years). 77.7% had a risk factor for developing infective endocarditis; among the most prominent risk factors were chronic renal failure (CRF), patients on hemodialysis (18.5%) and heart valve prostheses (18.5%). 66.7% of the blood cultures were positive. Staphylococcus aureus was the main germ isolated in 40.7% of patients. 81.4% of the involved valves were native, with mitral valve predominance (44.5%) and 7.5% had involvement of two valves. In 68.5% the reason for the consultation was heart failure and 35.3% had embolic phenomena as the initial manifestation or associated (16.7% cerebral, pulmonary 13%, spleen 5.6%). In 83.3 % of cases early surgery was performed: 66% received mechanical valves. The three-month total mortality was 13% (3.7% intraoperative death, mortality at 30 days 9%). The median length of hospital stay was 36 days (7-130 days). In this study the total mortality reported is at the lower limit of the reported in the world. One of the reasons attributed to this finding is the early surgical management that is the protocol in the service.

Anatomical variations in the aortic bifurcation in new zealand white rabbits on arteriography.

The radiologic anatomy of the aortic bifurcation in the rabbit has received little study but it is important as this anatomical area is widely used in atherosclerosis research. Thirty rabbits were used to study the aortic bifurcation and subsequent branching patterns on arteriography. Fifteen different arteries were identified. Mean arterial diameters of 2.88 ± 0.7 and 2.27 ± 0.55 mm were obtained for the aorta and external iliac arteries, respectively. The cranial and middle aspects at the seventh lumbar vertebra (L7) were the most frequent anatomical landmarks (53.3% of the cases) for aortic and common iliac bifurcations, respectively. The caudal aspect of L6 was the most frequent origin (50% of the cases) for the median sacral artery. Deep circumflex iliac arteries originated from common iliac arteries and not the abdominal aorta in the rabbit, showing anatomical asymmetry in 73.3% of the cases. No gender disparity was found in the anatomical location of any of the arteries of the study. Knowledge of normal vascular landmarks for the aortic bifurcation as well as anatomical variations should be helpful to future experimental studies.

Tratamiento quirúrgico en el manejo de los defectos del septum atrial / Surgical treatment in the management of atrial septal defects

Objetivo: describir las características epidemiológicas y los resultados del tratamiento quirúrgico de los defectos septales atriales en los pacientes intervenidos por esta patología en un centro de alta complejidad en Colombia. Métodos: estudio observacional de tipo descriptivo, retrospectivo, de una cohorte que incluye todos los pacientes intervenidos mediante cirugía por defectos septales atriales en el periodo comprendido entre octubre de 1996 y julio de 2012. Resultados: se incluyeron en total 329 pacientes, de los cuales 216 (65,6%) pertenecía al género femenino. La mediana de la edad fue de 34 años (RIC 15-49). El 77,8% de los defectos fueron tipo ostium secundum. En 80% se realizó reparo del defecto mediante parche de pericardio autólogo. En 7,6% de los casos se utilizó técnica de cirugía cardiaca mínimamente invasiva. Se realizaron cuatro cirugías de rescate (1,21%) por complicaciones relacionadas con la colocación de dispositivos percutáneos. Se documentó una sola muerte intraoperatoria (tasa de mortalidad del 0,3%) y una morbilidad global asociada de 7,6%, sin ninguna secuela y representada por: reintervención por sangrado en ocho casos (2,4%), infección profunda de la herida esternal en tres pacientes (0,9%), empiema en tres pacientes (0,9%), colecciones pleurales residuales en cuatro pacientes (1,2%), infecciones superficiales en cinco pacientes (1,5%), disección arterial femoral secundaria a canulación arterial en un paciente (0,3%) y bloqueo cardiaco completo con necesidad de marcapaso permanente en un paciente (0,3%). La mediana del tiempo de estancia en UCI fue de 24 horas (RIC 20 – 25). La mediana del tiempo de ventilación mecánica fue de 3 horas (RIC 0-5). La mediana del tiempo de estancia hospitalaria fue de 4 días (RIC 3-5). Conclusiones: los resultados obtenidos reflejan que en nuestro medio la corrección quirúrgica de los defectos septales atriales es segura y efectiva, con una tasa de mortalidad con tendencia al 0% y una muy baja morbilidad asociada, acorde con los estándares internacionales. De igual forma, la cirugía cardiaca mínimamente invasiva ha permitido mejorar los resultados del procedimiento y ha tenido gran aceptación por parte de los pacientes, por lo que constituye el abordaje de elección actual para el manejo quirúrgico de esta patología en el servicio de Cardiología de la institución.

Objective: to describe the epidemiological characteristics and outcomes of surgical treatment of atrial septal defects in patients operated for this condition on a tertiary care center in Colombia. Methods: an observational, descriptive, retrospective study of a cohort including all patients undergoing surgery for atrial septal defects in the period between October 1996 and July 2012. Results: we included a total of 329 patients, were 216 (65.6%) were female. The mean age was 34 years (IQR 15-49). 77.8% of the defects were ostium secundum type. In 80% the defect repair was performed using autologous pericardial patch. In 7.6% of cases we used minimally invasive cardiac surgery technique. Four rescue surgeries (1.21%) were performed due to complications related to the placement of percutaneous devices. We documented only one operative death (mortality rate 0.3%) and an associated overall morbidity of 7.6% without any sequelae and represented by re-operation for bleeding in eight cases (2.4%), deep sternal wound infection in three patients (0.9%), empyema in three patients (0.9%), residual pleural collections in four patients (1.2%), superficial infections in five patients (1.5%), femoral arterial dissection secondary to arterial cannulation in one patient (0.3%) and complete heart block requiring permanent pacemaker in one patient (0.3%). The median length of stay in ICU was 24 hours (IQR 20-25). The median duration of mechanical ventilation was 3 hours (IQR 0-5). The median hospital stay was 4 days (IQR 3-5). Conclusions: the results obtained show that in our environment, surgical correction of atrial septal defects is safe and effective, with a mortality rate tending to 0% and a very low associated morbidity, in line with international standards. Similarly, minimally invasive cardiac surgery has improved the results of the procedure and has been widely accepted by the patients, thus constituting the current preferred approach in the Cardiology service of the institution for the surgical management of this pathology.

[High-risk massive pulmonary thromboembolism associated with patent foramen ovale]. / Tromboembolismo pulmonar masivo de alto riesgo asociado a foramen oval permeable.

High mortality rate associated with massive pulmonary embolism requires an aggressive invasive approach including surgical pulmonary embolectomy when thrombolytic therapy has failed or is contraindicated. We describe a case of high-risk massive pulmonary embolism who underwent surgical treatment due to the presence of a mobile intracardiac clot in a patent foramen ovale, and the possible risk of paradoxical arterial embolism.