A Systematic Review of International Affective Picture System (IAPS) around the World.

Standardized Emotion Elicitation Databases (SEEDs) allow studying emotions in laboratory settings by replicating real-life emotions in a controlled environment. The International Affective Pictures System (IAPS), containing 1182 coloured images as stimuli, is arguably the most popular SEED. Since its introduction, multiple countries and cultures have validated this SEED, making its adoption on the study of emotion a worldwide success. For this review, 69 studies were included. Results focus on the discussion of validation processes by combining self-report and physiological data (Skin Conductance Level, Heart Rate Variability and Electroencephalography) and self-report only. Cross-age, cross-cultural and sex differences are discussed. Overall, IAPS is a robust instrument for emotion elicitation around the world.

Offline tDCS modulates prefrontal-cortical-subcortical-cerebellar fear pathways in delayed fear extinction.

Transcranial direct current stimulation (tDCS) has been studied to enhance extinction-based treatments for anxiety disorders. However, the field shows conflicting results about its anxiolytic effect and only a few studies have observed the extinction of consolidated memories. We looked to study the effect of offline 1 mA tDCS over the right dorsolateral pre-frontal cortex across the fear pathways, in consolidated fear response during delayed extinction. Participants (N = 34 women) underwent in a two-day fear conditioning procedure. On day 1, participants were assigned to the control group (N = 18) or the tDCS group (N = 16) and went through a fear acquisition procedure. On day 2, the tDCS group received 20 min tDCS before extinction and while inside the MRI scanner. The control group completed the extinction procedure only. The tDCS session (for the tDCS group) and the fMRI scan (for both groups) were completed just on the second day. Univariate fMRI analysis showed stimulation-dependent activity during late extinction with the tDCS group showing decreased neural activity during the processing of threat cues (CS +) and increased activity during the processing of safety cues (CS -), in prefrontal, postcentral and paracentral regions, during late extinction. ROI to whole-brain psychophysiological interaction (PPI) analysis showed the tDCS effect on the connectivity between the left dorsolateral prefrontal cortex three cortical-amygdalo-hippocampal-cerebellar pathway clusters during the processing of the CS + in late extinction (TFCE corrected; p < 0.05). Increased neuronal activity during the processing of safety cues and stronger coupling during the processing of threat cues might be the mechanisms by which tDCS contributes to stimuli discrimination.

Cortical auditory evoked potentials in 1-month-old infants predict language outcomes at 12 months.

The neurophysiological assessment of infants in their first developmental year can provide important information about the functional changes of the brain and supports the study of behavioral and developmental characteristics. Infants' cortical auditory evoked potentials (CAEPs) reflect cortical maturation and appear to predict subsequent language abilities. This study aimed to identify CAEP components to two auditory stimulus intensities in 1-month-old infants and to understand how these are associated with social interactive and self-regulatory behaviors. In addition, it examined whether CAEPs predicted developmental outcomes when infants were assessed at 12 months of age. At 1 month, P2 and N2 components were present for both auditory stimulus intensities, with an increased P2 amplitude being observed for the higher-intensity stimuli. We also observed that an increased P2 amplitude in the lower intensity predicted receptive and expressive language competencies at 12 months. These results are consistent with previous findings indicating an association between auditory processing and developmental outcomes in infants. This study suggests that specific auditory neurophysiological markers are associated with developmental outcomes in the first developmental year.

Behavioral response to tactile stimuli relates to brain response to affective touch in 12-month-old infants.

Affective touch activates a brain network responsible for processing social-emotional stimuli in infants, children, and adults, with a core node in the superior temporal sulcus (STS). STS is known to be a region highly susceptible to individual variability, including for tactile stimuli processing. However, little is known about how this region is recruited to process affective touch in infancy. The aim of this study was to examine brain activity to affective touch in the temporal region (STS) and understand if it relates to behavioral patterns of sensory-over responsivity (SOR) to touch. Twelve-month-old infants (n = 24) were given affective and discriminative stimuli to the forearm while they were watching a silent movie. Brain activation was recorded in the STS for measures of oxy-hemoglobin (HbO2 ) and deoxy-hemoglobin (Hbb) using functional near infra-red spectroscopy (fNIRS). Aversive responses to tactile stimuli were measured using the Infant-Toddler Sensory Profile. A significant hemodynamic response increase in HbO2 to affective touch was observed in the STS for infants with less aversive behavioral responses to tactile stimuli. The findings suggest that brain activity in the STS for affective touch might be related to individual differences in the affective reaction toward touch.

Psychophysiological Synchrony During Verbal Interaction in Romantic Relationships.

Previous studies about romantic relationships have shown that the reciprocal influence between partners occurs not only at the behavioral and socio-emotional levels, but also at the psychophysiological level. This reciprocal influence is expressed in a pattern of physiological synchrony between partners (i.e., coordinated dynamics of the physiological time series). The main aim of the present study was to explore the presence of a pattern of physiological synchrony in electrodermal activity (EDA) during a couple interaction task. A second objective was to compare the synchrony levels during a negative interaction condition versus a positive interaction condition. Finally, we analyzed the association between synchrony and self-perception of empathy, dyadic empathy, and relationship satisfaction. Thirty-two couples (64 individuals) participated in this study. Each couple performed a structured interaction task while the EDA of both partners was being registered. The quantification of synchrony was based on the cross-correlation of both members' EDA time-series. In order to control for coincidental synchrony, surrogate datasets were created by repeatedly shuffling the original data of spouses X and Y of a dyad and computing synchronies on the basis of the shuffled data (pseudosynchrony values). Our results confirmed the presence of significant EDA synchrony during the interaction. We also found that synchrony was higher during the negative interactions relative to the positive interactions. Additionally, physiological synchrony during positive interaction was higher for those couples in which males scored higher in dyadic empathy. The clinical implications of these findings are discussed.

Estudios anteriores acerca de las relaciones amorosas han demostrado que la influencia recíproca entre las parejas no solo ocurre en los niveles conductuales y socioemocionales, sino también en el nivel psicofisiológico. Esta influencia recíproca se expresa en un patrón de sincronía fisiológica entre los integrantes de la pareja (p. ej.: la dinámica coordinada de las series temporales fisiológicas). El objetivo principal del presente estudio fue analizar la presencia de un patrón de sincronía fisiológica en la actividad electrodérmica (AED) durante una tarea de interacción de la pareja. Un segundo objetivo fue comparar los niveles de sincronía durante una situación de interacción negativa frente a una situación de interacción positiva. Finalmente, analizamos la asociación entre la sincronía y la autopercepción de empatía, la empatía diádica y la satisfacción con la relación. Treinta y dos parejas (64 personas) participaron en este estudio. Cada pareja llevó a cabo una tarea de interacción estructurada mientras se registraba la AED de ambos integrantes de la pareja. La cuantificación de la sincronía se basó en la correlación cruzada de las series temporales de la AED de ambos miembros. A fin de controlar la sincronía simultánea, se crearon conjuntos de datos sustitutos entremezclando continuamente los datos originales de los cónyuges X e Y de una díada y computando las sincronías sobre la base de los datos mezclados (valores de seudosincronía). Nuestros resultados confirmaron la presencia de una sincronía considerable de la AED durante la interacción. También descubrimos que la sincronía fue mayor durante las interacciones negativas respecto de las interacciones positivas. Además, la sincronía fisiológica durante la interacción positiva fue mayor en aquellas parejas en las cuales los hombres obtuvieron un puntaje más alto en la empatía diádica. Se debaten las consencuencias clínicas de estos resultados.

[Aortic mural thrombus]. / Trombo aórtico mural.

Aortic mural thrombus is a rare clinical finding in the absence of aneurysm or atherosclerosis but an important source of noncardiogenic emboli with a difficult diagnosis and a high rate of complications, including high mortality. It appears to occur more frequently in young adults usually with underlying pro-thrombotic disorder. With the increasing use of high resolution imaging, the asymptomatic mural thrombus became an increasingly frequent finding, but its potential for embolization or the best treatment are still a matter of debate. The management of mural thrombus in non-atherosclerotic aorta represents a challenge because no guidelines are available, and should be individualized. The therapeutic approach should include the triple aspects of aortic mural thrombus: primary disease anticoagulation treatment, surgical thrombectomy to solve embolic complications and endovascular/classical surgery to exclude the thrombus from the aorta. Historically therapeutic anticoagulation was proposed as first-line therapy and surgical intervention was reserved for mobile thrombus, recurrent embolism and contraindication for anticoagulation. However, it is associated with a 25-50% embolic recurrence rate, thrombus persistence in 35% and secondary aortic surgery in up to 31% of the cases. Recent data suggest that endovascular coverage of the aortic thrombus, when feasible, appears to be an effective and safe procedure with a low recurrence and re-embolization rates. In this article we review the published literature concerning this topic.

O trombo aórtico mural é uma entidade rara na ausência de doença aterosclerótica ou aneurismática, mas uma causa importante de embolia não cardioembólica, com diagnóstico de presunção difícil e alta incidência de complicações, incluindo mortalidade elevada. Afeta mais frequentemente o adulto jovem geralmente com um distúrbio pró-trombótico subjacente. Com o maior acesso a exames de imagem de alta resolução, o trombo mural assintomático tornou-se um achado crescente, sem que se saiba atualmente prever o seu potencial embolígeno ou melhor orientação terapêutica. O seu tratamento representa um desafio, dada a ausência de guidelines disponíveis, devendo este ser individualizado. A abordagem terapêutica deve incluir os aspetos tríplices do trombo mural aórtico: anticoagulação para tratamento do distúrbio primário, trombectomia cirúrgica para resolução das complicações embólicas e a cirurgia endovascular/clássica para excluir o trombo da aorta. Historicamente a anticoagulação foi proposta como terapêutica de primeira linha e a intervenção cirúrgica reservada para os casos de trombo móvel, embolia recorrente refratária ou contra-indicação da mesma. No entanto o uso da AC isolado está associada a recorrência embólica em 25-50% dos casos, persistência do trombo em 35% e necessidade de cirurgia aórtica secundária em até 31%. Dados recentes sugerem que a técnica endovascular, quando possível, parece ser um procedimento eficaz e seguro com baixa incidência de recorrência ou re-embolização. Este artigo visa realizar uma revisão da literatura publicada.

Unusual Presentation of Ruptured Abdominal Aortic Aneurysm.

Abdominal aortic aneurysm affects 5-9% of the population over the age of 65 years; is more common in male smokers and in patients with a positive family history of aortic aneurysms. Most patients are asymptomatic; rupture is the most common and dreaded complication. The classical triad of back pain, hypotension and pulsatile mass is the most common presentation but is present in only 25-50% of patients. Clinical presentation seems dependent on rupture site. Our report illustrate a rare clinical presentation for a serious clinical condition. Knowledge of different presentations can lead to timely diagnosis and management and decrease in rupture related morbidity and mortality.

O aneurisma da aorta abdominal é uma doença que afecta 5-9% da população com mais de 65 anos. É mais comum em homens fumadores e em casos de história familiar de aneurisma da aorta. A maioria são assintomáticos. A rotura é a complicação mais frequente e fatal. A apresentação mais comum da rotura é a tríade clássica: dor lombar súbita e intensa, síncope/hipotensão e massa abdominal pulsátil. Contudo, apenas 25-50% dos casos se apresentam desta forma. O local de rotura parece influenciar o quadro clínico. Serve este caso para documentar uma apresentação clínica rara de uma patologia com morbi-mortalidade muito elevada. O conhecimento das diversas apresentações clínicas poderá levar ao diagnóstico e tratamento atempados, com impacto positivo na morbi-mortalidade do aneurisma da aorta abdominal em rotura.

[True Aneurysms of the Upper Limb: a Single-Centre Experience]. / Aneurismas Verdadeiros do Membro Superior: Revisão da Experiência de um Serviço.

INTRODUCTION: True arterial aneurysms of the upper limb are rare and their treatment is intended to avoid complications as distal embolization, compression of surrounding neurovascular structures or rupture. OBJECTIVE: The purpose of this study is to review the experience of a department in the surgical treatment of true arterial aneurysms of the upper limb. METHODS: A retrospective study was performed between January 2007 and August 2017. RESULTS: From a total of eleven patients, nine were male and two were female. One of the patients had surgery twice because of two consecutive aneurysms of the upper limb. From a total of twelve cases, two were subclavian, one was axillary and nine were brachial aneurysms. Three of them had degenerative/idiopathic aetiology, one was associated to a cervical rib and seven occurred in the setting of arteriovenous fistula or kidney graft. Five patients had emergent surgery and the others had elective surgery. All of the patients were submitted to aneurysmectomy. As 30-day complications, there were two haematomas, one compartment syndrome and two early graft occlusions. Four patients needed re-intervention. During the follow-up period, all the grafts initially preserved were patent. There were no further known complications or amputation procedures. CONCLUSION: In this review most of the aneurysms were found in patients with haemodialysis vascular access or kidney grafts. Despite the need for early re-intervention in some cases, the surgical treatment of true arterial aneurysms of the upper limb is a low morbidity procedure.

complicações como a embolização distal, a compressão de estruturas neurovasculares adjacentes ou a rotura. Objetivo: O objetivo deste estudo é rever a casuística de um serviço no tratamento cirúrgico de aneurismas verdadeiros do membro superior. Métodos: Foi realizado um estudo retrospetivo entre Janeiro de 2007 e Agosto de 2017. Resultados: De um total de onze doentes, nove eram do sexo masculino e dois do sexo feminino. Um dos doentes foi submetido a duas cirurgias por aneurismas consecutivos do membro superior. De um total de doze casos, dois tinham localização na artéria subclávia, um na axilar e nove na braquial. Três aneurismas eram de etiologia degenerativa/idiopática, um estava associado à presença de costela cervical e sete ocorreram no contexto de fístula arteriovenosa para hemodiálise e/ ou transplante renal. Cinco doentes foram submetidos a cirurgia em contexto de urgência e os restantes em contexto eletivo. Todos os pacientes foram submetidos a aneurismectomia. A morbilidade aos 30 dias correspondeu a dois hematomas, um síndrome do compartimento e duas oclusões precoces com um total de quatro pacientes a necessitarem de reintervenção. Durante o período de follow-up todos os doentes com o enxerto inicialmente preservado apresentaram permeabilidade dos enxertos. Não houve necessidade de cirurgia mutiladora. Conclusão: Neste estudo, a maioria dos aneurismas do membro superior ocorreram em doentes com fistulas arteriovenosas para hemodiálise e/ou transplantados renais. Apesar da necessidade de reintervenção em alguns casos, o tratamento cirúrgico dos aneurismas do membro superior acarreta uma baixa morbilidade.

[The Impact of Patient Transfer After Rupture of an Abdominal Aortic Aneurysm]. / O Impacto da Transferência de Doentes após Rutura de Aneurisma da Aorta Abdominal.

OBJECTIVE: determine whether patient transfer adversely affects the survival of ruptured abdominal aortic aneurysm (rAAA) patients after conventional surgery. METHODS: We performed a retrospective review of all patients undergoing attempted repair of an rAAA at a tertiary center, over January 2008 and December 2014. Patients were divided into those presenting directly to our center and those transferred from another hospital. The main outcome variable was 24-hour or 30-day mortality, with secondary variables including time to surgical treatment, length of intensive care unit stay and total length hospitalization. RESULTS: 78 patients (88% men) underwent attempted open repair of an rAAA during this period, 69% (54 cases) were transferred from another institution. Both groups were similar in terms of demographic characteristics, comorbidities and hemodynamic stability. The overall mortality rate was 51% at 30 days. Transferred patients took twice as long as direct patients to get to the operating room (median 7,9 vs. 3,9 horas, p < 0,05), Although the difference for surgery treatment, there was no difference in 24-hour and 30-day mortality between the transferred group and direct group (26% e 50% vs. 29% e 58%, p < 0,05). Mean intensive care unit stay (median, 12 vs. 4 dias, p = 0,04) and total hospitalization (median 11 vs. 4 dias, p = 0,04) were sustantially superior in the transferred group. CONCLUSIONS: Transfer of patients with RAAA in this series results in a doubling of the time interval between initial patient presentation and arrival in the operating room. This, however, did not result in any disadvantage in the survival rate between the groups. The total length and resources consumption were higher in the transfer group. These results may be attributed to a pre-selection of patients (clinically stable) who are able to tolerate such a delay in surgical treatment, secondary to transfer.

Objetivo: Determinar se a transferência inter-hospitalar afecta adversamente a sobrevida de doentes com rutura de aneurisma da aorta abdominal (rAAA), submetidos a cirurgia convencional. Métodos: Efetuamos uma análise retrospetiva dos rAAA tratados sequencialmente por cirurgia convencional, num centro de referenciação terciária, no período compreendido entre janeiro 2008 e dezembro de 2014. Os casos foram divididos entre os que se apresentram diretamente neste centro e os que foram alvo de transferência. Analisou-se a mortalidade às 24 horas, a mortalidade aos 30 dias e, como outcomes secundários, incluíram-se o tempo de chegada ao bloco operatório, duração de internamento na unidade de cuidados intensivos (UCI) e o tempo de internamento total. Resultados: Neste período, um total de 78 casos (88% do género masculino) foram submetidos a cirurgia convencional por rAAA, 69% (54 casos) transferidos de outra instituição. Ambos os grupos mostraram semelhanças nas características demográficas, bem como no perfil de comorbilidades e estadio de estabilidade hemodinâmica. A mortalidade global foi de 51% aos 30 dias. O tempo de chegada ao bloco operatório do grupo transferido foi 2 vezes superior (mediana 7,9 vs. 3,9 horas, p < 0,05). Apesar da diferença para início da prestração de cuidados cirúrgicos específicos, a mortalidade às 24 horas e aos 30 dias não diferiu entre entre o grupo transferido e o direto (26% e 50% vs. 29% e 58%, p < 0,05) respectivamente. O tempo de internamento na UCI (mediana, 12 vs. 4 dias, p = 0,04) e a duração total de internamento (mediana 11 vs. 4 dias, p = 0,04) foram substancialmente maiores para o grupo transferido. Conclusões: O resultado da transferência inter-hospitalar, nesta série de doentes, resultou numa duplicação do tempo de admissão no bloco operatório Contudo, não se verificou qualquer desvantagem em relação à sobrevida entre os grupos. A duração da hospitalização e consumo de recursos foi maior no grupo transferido. Estes resultados podem dever-se à possível seleção de doentes transferidos (clinicamente estáveis) que conseguem tolerar o atraso na instituição do tratamento cirúrgico, decorrente da transferência.

Endovascular Treatment of Femoral Anastomotic Aneurysm: Case Report and Review of Published Cases.

Anastomotic aneurysm is a possible complication after arterial reconstruction with highest incidence at femoral anastomosis; open surgery is the standard treatment, but endovascular exclusion can be useful in selected cases. The authors report a case of femoral anastomotic aneurysm, 19 years after aortobifemoral grafting, treated successfully using stent grafts, under local anesthesia and percutaneous brachial access. Review of published articles regarding endovascular management of femoral anastomotic aneurysm was performed. Endovascular exclusion of femoral anastomotic aneurysm is safe and feasible.

Neuromodulating Attention and Mind-Wandering Processes with a Single Session Real Time EEG.

Our minds are continuously alternating between external attention (EA) and mind wandering (MW). An appropriate balance between EA and MW is important for promoting efficient perceptual processing, executive functioning, decision-making, auto-biographical memory, and creativity. There is evidence that EA processes are associated with increased activity in high-frequency EEG bands (e.g., SMR), contrasting with the dominance of low-frequency bands during MW (e.g., Theta). The aim of the present study was to test the effects of two distinct single session real-time EEG (rtEEG) protocols (SMR up-training/Theta down-training-SMR⇑Theta⇓; Theta up-training/SMR down-training-Theta⇑SMR⇓) on EA and MW processes. Thirty healthy volunteers were randomly assigned to one of two rtEEG training protocols (SMR⇑Theta⇓; Theta⇑SMR⇓). Before and after the rtEEG training, participants completed the attention network task (ANT) along with several MW measures. Both training protocols were effective in increasing SMR (SMR⇑Theta⇓) and theta (Theta⇑SMR⇓) amplitudes but not in decreasing the amplitude of down-trained bands. There were no significant effects of the rtEEG training in either EA or MW measures. However, there was a significant positive correlation between post-training SMR increases and the use of deliberate MW (rather than spontaneous) strategies. Additionally, for the Theta⇑SMR⇓ protocol, increase in post-training Theta amplitude was significantly associated with a decreased efficiency in the orientation network.

Aneurysms of the Upper Limb: Review of an Experience.

INTRODUCTION: True arterial aneurysms of the upper limb are rare and their treatment is intended to avoid complications as distal embolization or compression of surrounding neurovascular structures. The purpose of this study is to review the experience in the surgical treatment of true arterial aneurysms of the upper limb. METHODS: Retrospective study of patients with true arterial aneurysms of the upper limb surgically treated between January 2007 and August 2017. Nine patients were identified and data was collected regarding sex, age, past medical history, aneurysm's aetiology, surgical procedure, complications and the need for re-intervention. RESULTS: From a total of nine patients, seven were male and two were female, with ages between 29 and 68 years old (medium age of 55,5). One of the patients had surgery twice because of two aneurysms of the upper limb. From a total of 10 cases, two were subclavian, one was axillary and seven were brachial aneurysms. Three of them had degenerative/idiopathic aetiology, one was associated to a cervical rib and six occurred in the setting of arteriovenous fistula or kidney graft. Three patients had emergent surgery and the others had elective surgery. All of them were submitted to aneurysmectomy. As 30-day complications, there were two haematomas, one compartment syndrome and two early graft occlusions. Four patients needed re-intervention. During the follow-up period, all the grafts initially preserved were patent. There were no further known complications or amputation procedures. One of the patients who had emergent surgery and presented with finger paresis remained with hypomotility after the surgery. CONCLUSION: True arterial aneurysms of the upper limb are uncommon. In this review most of the aneurysms were found in patients with haemodialysis vascular access or kidney grafts. Despite the need for early re-intervention in some cases, the surgical treatment of true arterial aneurysms of the upper limb is a low morbidity procedure.

Endovascular Removal of Foreign Bodies.

INTRODUCTION: Intravascular or catheter embolization of a foreign body, either by fracture or migration, is a rare condition, occurring in approximately 1%. This study is focused on the migration of catheters since they represent the majority of cases of embolization. We present one of the largest published series of removal of foreign bodies with endovascular techniques. The objective of the present study is to demonstrate the different locations where foreign bodies, in most cases catheters, can reach, the technique used to remove them and the affected population. METHODS: This is a 9 years retrospective study in which we report the cases of foreign bodies removal performed by an endovascular approach between 2009 and 2017 in our institution. It includes 53 patients: 28 women and 25 men. The average age was 58 years (ranging from 15 to 87 years). The catheters were implanted by a heterogeneous group of professionals. RESULTS: Thirty three totally implantable catheters (Implantofix ®), sixteen peripheral inserted central catheter, three Guide Wires, one angioplasty balloon and one Amplazer vascular plug were extracted. The most common sites for the lodging of one of the ends of the intravascular foreign bodies were the right atrium (35,8%) the superior vena cava (11,3%) and the right ventricle (11,3%). In 98,1% of the cases, only one venous access was used for extraction of foreign bodies, and in 96,2% of the cases the right femoral access was used. The loop-snare technique was used in 45 cases (84,9%) and in 8 cases a basket was the option. The most common cause of catheter embolization was the disconnection between the catheter and the port during the surgery for its removal, which occurred in 55,1% of the cases. Fracture of totally implantable catheters occurred in 12,2%. The fracture of a peripheral inserted central catheter represents 32,7% of cases of embolization. Atrial fibrillation, occurred in 8 cases. The mortality rate during the procedure was zero. Technical performance was 100% successful. CONCLUSION: Percutaneous intervention for removal of intravascular foreign bodies is currently the best treatment option for patients. It is a minimally invasive, procedure, with low complication rates. Embolised material can be quite safely retrieved, and presents an attractive alternative to surgical removal of these devices. However, this work should serve as a consideration about the safety of the removal of catheters as well as their quality in order to reduce this type of complications.

Endovascular Treatment of Carotid Blowout Syndrome.

INTRODUCTION: Carotid blowout syndrome (CBS) is a life threatening complication associated with head and neck cancers (HNC) and its treatment. The mortality rate was reported to range from 3% to over 50% in the literature. Direct surgical repair of the ruptured internal carotid artery is often not technically possible due to the difficult anatomy and underlying poor co-morbid status. Endovascular techniques such as coil embolization and stent grafting offer an alternative to surgical ligation with better patient outcomes. METHODS: We describe the successful use of an endovascular approach in a case of emergent rupture of the common carotid artery (CCA) with massive bleeding in a patient submitted to radiotheraphy for the treatment of a neck malignancy. RESULTS: A 75-year-old man with a squamous cell carcinoma of the esophagus having undergone chemotherapy and radiotherapy, was admitted to the emergency room with haematemesis with approximately 1 hour of evolution. An angiogram revealed, in the right common carotid artery, contrast extravasation with a possible fistula communicating to the esophagus. A self-expandable covered stent was deployed in the right common carotid artery. Successful repair of the vessel was confirmed in the control angiogram. The patient was discharged 10 days later without neurological deficit or recurrent bleeding. Carotid blowout syndrome is one of the most complex bleeding complications that may occur in HNC patients. It is usually a life-threatening event and is accompanied with unexpectedly massive bleeding and high mortality/morbidity rates. Short and long term effects of radiation over arteries have been reported. Radiation can induce damage to the vasa vasorum of large arteries and it might lead to the rupture of arteries. In the HNC population with previous surgery or radiotherapy, a high index of suspicion must be maintained for CBS in patients presenting with any recent history of oral bleeding or haemorrhaging from an exposed neck wound. CONCLUSION: Current evidence shows that there was no significant difference in technical and hemostatic outcomes between the reconstructive and deconstructive endovascular methods. Permanent vessel occlusion resulted in higher immediately cerebral ischemia and stent grafting induced the more potentially delayed complications, such as infection, rebleeding, and stent thrombosis. In the present case, the endovascular management of CBS of the common carotid artery had high technical success and allowed immediate haemostasis. It has been suggested that self-expanding stent-grafts are useful for the initial control of carotid bleeding but are associated with more delayed complications.

Endovascular Treatment of a Complicated Type B Acute Aortic Dissection with 3-D ultrasound Control.

INTRODUCTION: Acute type B aortic dissection (ATBAD), identified within 2 weeks of symptom onset, accounts for 25%-40% of all aortic dissections. Approximately 25% of patients presenting with ATBAD are complicated at admission by malperfusion syndrome or hemodynamic instability, resulting in a high risk of early death when untreated. METHODS: We present a case of a patient with a complicated type B dissection treated by an endovascular technique with control of the sealing zone with transesophageal Echocardiogram (TEE) and 3-D images. RESULTS: A 56-year-old patient was admitted to the intensive care unit for having a type B aortic dissection complicated by persistent chest pain and uncontrolled hypertension. We perform a TEVAR (thoracic endovascular aortic repair) with a GORE® TAG® conformable thoracic stent graft with active control system to seal the primary entry tear, which covered the left subclavian artery. The origin of the left subclavian artery was covered by the stent graft and a vascular plug was put in place, to avoid endoleak. The procedure was performed with transesophageal echocardiogram with 3-D images to determine if the stent graft was in the true lumen. CONCLUSION: The treatment of acute, complicated type B aortic dissection has evolved in the past several years. Thoracic endovascular aortic repair when anatomy is suitable, has been regarded as the preferable treatment to seal the primary entry tear, redirect and re-establish adequate true lumen flow, and thereby promote aortic remodeling. The availability of TEVAR, albeit applied until recently as an off- -label treatment, has clearly produced better results than procedures such as open surgical or endovascular fenestration. However, the results of this treatment may improve when associated with other imaging tests. The TEE has a high performance in the diagnosis of this pathology, especially in regard to the detection of the flap and the two lumens, as well as for the calculation of the size of the entrance tear. It presents an added value in the endovascular treatment, since it helps in the implantation of the devices both for the location of the true lumen, its definitive position and the result of the procedure. TEVAR is the preferred treatment for acute, complicated type B aortic dissection with improved late survival and positive aortic remodelling. The efficacy of this treatment is significantly increased in association with other imaging techniques such as transesophageal echography.

True Brachial Artery Aneurysm in a Patient with Vascular Access for Haemodialysis and Kidney Graft.

INTRODUCTION: True brachial artery aneurysms are rare and some of them have been described as a late complication in patients with vascular access for haemodialysis and kidney graft. The purpose of this paper is to present a clinical case of a patient with a true brachial artery aneurysm and its following treatment. METHODS: This case concerns a caucasian male patient with 43 years old who had vesicoureteral reflux at 7 years old, and subsequent end-stage renal disease, and started on haemodialysis at the age of twelve. The patient had homolateral radial and brachiocephalic arteriovenous fistulas (AVF), two sequential kidney grafts and was under immunosuppressant therapy for several years. As part of the medical history he also had bilateral amaurosis, Hepatitis B and C and was submitted to total parathyroidectomy and a following auto-transplant. In the latest years the patient presented with several aneurysms related to the vascular access. After the finding of an anastomotic false aneurysm and venous aneurysms complicating the AVF, the patient had removal of the aneurysms and ligation of the AVF. Later, he was diagnosed, in different times, with two true brachial artery aneurysms. At the time of the diagnosis of the first true aneurysm, the patient presented with local pain and occasional paraesthesias relative to compression symptoms. At physical examination the patient had a brachial pulsatile mass and a palpable radial pulse. The Doppler ultrasound exam revealed a true brachial artery aneurysm with 4,5 cm diameter. After two years, the patient was once again diagnosed with a true brachial artery aneurysm with 3,1 cm diameter. At this time the patient was asymptomatic and had palpable brachial mass and radial pulse. RESULTS: At the time of the diagnosis of the first true brachial aneurysm the patient was submitted to partial aneurysmectomy and brachiobrachial graft with PTFE 8. The patency of the graft persisted until the diagnosis of the second aneurysm. After two years, the patient was submitted to partial aneurysmectomy and axilobrachial graft with PTFE 8. During the follow-up period, the patient remained asymptomatic, had palpable radial pulse and the Doppler ultrasound exam confirmed the patency of the graft. CONCLUSION: The surveillance of patients with long duration AVF and kidney grafts might be advantageous in the early detection of arterial aneurysms. The surgical treatment in this group of patients is a first treatment option that is associated to a low morbidity.

Carotid Paraganglioma - Classical Surgical Technique.

INTRODUCTION: A carotid body tumor is a rare neoplasm, generally benign, that predominantly affects people between their fourth and fith decades of life. It manifests as a pulsatile and generally painless cervical mass with firm consistency, located below the angle of the jaw. Clinically it can cause localized pain, dysphagia, hiccups, hoarseness and hypersensitive carotid body syndrome. Surgery is the treatment of choice, bearing in mind the possibility of malignant transformation, peritumoral invasion and metastasis. The most widely-used technique is surgical resection, with or without concomitant preoperative endovascular embolisation. Overall complication rates, stroke rates between 0 and 8% and cranial nerve palsy less than 1% to 49%. Mortality rates vary from 0 to 3%. METHODS: Clinical case of a 69 years old male patient diagnosed with a carotid body tumor in a routine ultrasound exam. The patient was asyntomatic. Complementary exams were then conducted - CT scan and MRI supported the diagnosis. Neck CT scan: Well defined, nodular formation, enhanced after intravenous contrast, localized on the jugular-carotid region, with an aproximate diameter of 36 mm. Neck MRI: Expansive heterogenous solid lesion, localized on carotid bulb, well defined, enhanced after intravenous contrast, compatible with carotid paraganglioma - Shamblin's II. RESULTS: Patient was submited to a complete surgical classic ressection of the tumor, without any previously procedure. Proximal dissection was made with a help of a nose and ear surgeon. No post-surgery complications, except wound infection at week 3. No nerve damage. CONCLUSION: Follow up to 1 year without any complain and no lesions. In an era of multiple techniques there should always be a place for classic, well planned surgeries.

Traumatic Carotid-Jugular Av Fistula in a Child.

INTRODUCTION: Traumatic Arteriovenous fistulae of the neck vessels are a rare condition, comprising less than 4% of traumatic fistulae found anywhere else in the body. METHODS: The authors propose to report a clinical case of such a condition in a 10-year-old boy who sustained a gunshot wound in the left side of the neck. RESULTS: Shortly after the event, the patient was admitted to paediatric ICU and intubated for airway protection. A palpable thrill in the left side of the neck was noticed, giving rise to the need of imaging study. A communication between the left common carotid artery and the internal jugular vein was confimed by AngioCT. No signs of cerebral hypoperfusion or cardiac overload were present. The surgical correction was performed by direct suture repair of both vessels involved. No complications on the postoperative period. During follow up, antiagregation with acetilsalicilic acid for 1 month was prescribed and no complications occured. CONCLUSION: The patient lives a normal life with no limitations.

Abdominal Aortic Aneurysm in Women: Retrospective Analysis of the Cases that Undergo Surgical Repair.

INTRODUCTION: The prevalence of infra-renal aortic abdominal aneurysms (AAA) is about 3 to 4 times higher in men, with a recommendation I 1a for screening men > 65y. Althoug women only represente 20% of the total AAAs they have a significant higher rupture rate - threefold higher - and a worse outcome after ruptured AAA repair. Screening is not consensual but can be recommended for women > 65y who have smoked or have a family history of AAA. Against screening is the fact that the AAA in women have not only a lower incidence but also a late presentation (>80y) but references have been made to the fact that smoking became popular more than 30 years after than men and so the effects just now can start to be seen. METHODS: A retrospective review was made to all women with an infra- renal AAA who undergo a surgical treatment, elective or urgent, in the past 7 years (January 2010 - August 2017) in our hospital. Information was obtained through the clinical process. It was made an evaluation of the demographic information and anatomic features. RESULTS: 15 cases were reviewed, 4 elective and 11 ruptured surgical repairs. The mean age was 74 and only 4 women were more than 80 years old, with a minium age of 57. More than half the patients were previously diagnosis with hypertension but only 30% had high cholesterol. Only one was a known smoker. None had a diagnosis of cardiac disease. One had a sintomatic cerebrovascular disease. Within the elective cases, all open repair, the intra-hospitalar mortality was zero with a mean stay of 7,5 days. The ruptured cases, 1 endovascular, had a perioperative mortality of 50% The mean aortic diametre at rupture was less than 6 cm. CONCLUSION: Data supports the evidence of the morbidity of a ruptured AAA and the high intra-hospitalar mortality in women. Early detection and elective repair should be considered. Sex-specific research is needed to provide the best medical treatment.

The effects of stimulus complexity on the preattentive processing of self-generated and nonself voices: An ERP study.

The ability to differentiate one's own voice from the voice of somebody else plays a critical role in successful verbal self-monitoring processes and in communication. However, most of the existing studies have only focused on the sensory correlates of self-generated voice processing, whereas the effects of attentional demands and stimulus complexity on self-generated voice processing remain largely unknown. In this study, we investigated the effects of stimulus complexity on the preattentive processing of self and nonself voice stimuli. Event-related potentials (ERPs) were recorded from 17 healthy males who watched a silent movie while ignoring prerecorded self-generated (SGV) and nonself (NSV) voice stimuli, consisting of a vocalization (vocalization category condition: VCC) or of a disyllabic word (word category condition: WCC). All voice stimuli were presented as standard and deviant events in four distinct oddball sequences. The mismatch negativity (MMN) ERP component peaked earlier for NSV than for SGV stimuli. Moreover, when compared with SGV stimuli, the P3a amplitude was increased for NSV stimuli in the VCC only, whereas in the WCC no significant differences were found between the two voice types. These findings suggest differences in the time course of automatic detection of a change in voice identity. In addition, they suggest that stimulus complexity modulates the magnitude of the orienting response to SGV and NSV stimuli, extending previous findings on self-voice processing.