Study of nitrogen implantation in Ti surface using plasma immersion ion implantation & deposition technique as biocompatible substrate for artificial membranes.

The present investigation reports the modification of Ti substrates by a plasma technique to enhance their physio-chemical properties as biocompatible substrates for the deposition of artificial membranes. For that purpose, nitrogen ions are implanted into Ti substrate using the plasma immersion ion implantation & deposition (PIII&D) technique in a capacitively coupled radio frequency plasma. The plasma was characterized using optical emission spectroscopy, together with radio frequency compensated Langmuir probe, while the ion current towards the substrate was measured during the implantation process using an opto-electronic device. X-ray photoelectron spectroscopy (XPS) was used for chemical analysis of the surface, confirming the presence of δ-TiN. The penetration depth of the nitrogen ions into the Ti substrate was measured using secondary ions mass spectroscopy (SIMS) while the morphological changes were observed using atomic force microscopy (AFM). A calorimetric assay was used to prove that the TiN samples maintain the biocompatibility of the untreated Ti surface with its native oxide layer. The ion implantation increases the load bearing ability of Ti surface by the formation of α-Ti(N) and δ-TiN phases on the sub-surface of Ti, and maintains the bio compatibility of Ti surface. After the plasma treatment a thin layer of chitosan (CH) was deposited in order to provide a moisturizing matrix for the artificial membrane of 1,2-dipalmitoyl-sn-3- phosphor glycerocholine (DPPC). The CH and subsequently the DPPC were deposited on the plasma deposited TiN substrate by using physical vapor deposition. The formation of artificial membranes was confirmed by AFM, measuring the topography at different temperatures and performing force curves.

Sangrado intraoperatorio de amigdalectomía en población pediátrica. Influencia de factores quirúrgicos y anestésicos / Intraoperative bleeding of tonsillectomy in pediatric patients. Effects of surgical and anesthesia technique

INTRODUCTION: Tonsillectomy with or without adenoidectomy is one of the most frequent surgeries in the pediatric population. It has become predomi- nantly an outpatient procedure. Therefore, it is of utmost importance identi- fying the factors that influence the intraoperative bleeding to prevent posto- perative complications and rehospitalization. MATERIAL AND METHODS: An observational cross-sectional study was carried out. Patients between 1 and 14 years old that underwent to tonsillectomy with or without adenoidectomy since November 2015 to May 2017 were included. 709 cases were evaluated. Intraoperative bleeding was assessed by the volumetric method. A multivariate analysis was performed using a generalized linear regression model. RESULTS: The average intraoperative bleeding was estimated in 1.9 ml/kg (95% CI: 1.7 -2.05). The use of propofol (30% increase in bleeding) and surgical time (2% increase for every minute) were risk factors. The use of electrocautery was as- sociated with a 50% decrease in bleeding in comparison with conventional dis- section (p = 0.001). CONCLUSION: The use of propofol and a prolonged surgical time were risk factors for intraoperative bleeding. The use of electrosurgery was a protective factor.

INTRODUCCIÓN: La amigdalectomía con o sin adenoidectomía, es una de las cirugías más frecuente en población pediátrica. Desde hace varios años se ha vuelto una intervención predominantemente ambulatoria, por lo que lograr identificar los factores que influyen en el sangrado intraoperatorio es de suma importancia para prevenir complicaciones postoperatorias y reshospitalización. MATERIAL Y MÉTODO: Se realizó un estudio observacional de corte-transversal. Se incluyó a pacientes entre 1 y 14 años sometidos a amigdalectomía con o sin adenoidectomía entre noviembre de 2015 y mayo de 2017, obteniendo un total de 709 casos evaluados. Se determinó el sangrado intraoperatorio de forma volumétrica. Posteriormente, se realizó un análisis multivariado con un modelo de regresión lineal generalizado. RESULTADOS: Se cuantificó el sangrado intraoperatorio promedio en 1,9 ml/kg (IC 95%; 1,7-2,05). El uso de propofol (aumento del 30% del sangrado) y tiempo quirúrgico (2% por cada incremento de un minuto) fueron factores de riesgo. Mientras que el uso de electro bisturí se asoció con una disminución del 50% en relación al no uso (p = 0,001). CONCLUSIONES: Fueron factores de riesgo para sangrado intraoperatorio el uso de propofol y un tiempo quirúrgico prolongado. El uso de electrobisturí constituyó un factor protector.

Breakdown of species boundaries in Mandevilla: floral morphological intermediacy, novel fragrances and asymmetric pollen flow.

Phenotypic intermediacy is an indicator of putative hybrid origin and has provided the main clues to discovering hybrid plants in nature. Mandevilla pentlandiana and M. laxa (Apocynaceae) are sister species with clear differences in floral phenotype and associated pollinator guilds: diurnal Hymenoptera and nocturnal hawkmoths, respectively. The presence of individuals with intermediate phenotypes in a wild population raises questions about the roles of visual and olfactory signals (i.e. corolla morphology and floral fragrances) as barriers to interbreeding, and how the breakdown of floral isolation occurs. We examined phenotypic variation in a mixed Mandevilla population, analysing the chemical composition of floral fragrances, characterising floral shape through geometric morphometrics and assessing individual grouping through taxonomically relevant traits and an unsupervised learning algorithm. We quantified the visitation frequencies of floral visitors and tracked their foraging movements using pollen analogues. The presence of morphologically intermediate individuals and pollen analogue movement suggested extensive hybridisation between M. laxa and M. pentlandiana, along with asymmetrical rates of backcrossing between these putative hybrids and M. laxa. Floral volatiles from putative hybrid individuals showed a transgressive phenotype, with additional compounds not emitted by either parental species. Our results suggest the presence of a hybrid swarm between sympatric M. pentlandiana and M. laxa and indicate that initial hybridisation events between these parental species are rare, but once they occur, visits between putative hybrids and M. laxa are common and facilitate continued introgression.

Desarrollo de un curriculum de radiología para la formación médica de pregrado: experiencia de una escuela de medicina de Chile / Development of radiology curriculum in undergraduate medical education: experience of a chilean school of medicine

Existe consenso por parte de las autoridades académicas y los estudiantes de Medicina de pregrado que es necesaria la incorporación de la Imagenología a los planes de estudio de la carrera. Sin embargo, esto no se ha traducido en una participación constante de los médicos radiólogos en la formación de los futuros médicos. Nuestra Escuela de Medicina implementó un nuevo plan de estudios el año 2015 el que, entre otros aspectos, acortó la duración de la carrera de 7 a 6 años e integró la Imagenología en forma longitudinal a lo largo de la malla curricular. Para llevar a cabo este proceso de integración curricular fue necesario la decisión departamental y de la Dirección de Pregrado, para así identificar las oportunidades de incorporación de médicos radiólogos en la educación médica de pregrado.

There is wide agreement between teachers, students and authorities in the Schools of Medicine regarding the need of incorporating Medical Imaging teaching for undergraduates. Nonetheless, there is no active nor constant participation of radiologists in teaching for Medicine students. In our Medical School a new program was implemented in 2015, with a duration of 6 years (instead of 7 years, as previously), incorporating Medical Imaging teaching across the curriculum. To achieve the latter objective it was necessary to actively involve the Radiology (Medical Imaging) Department and the Undergraduate Director, identifying the opportunities to incorporate radiologists in medical teaching.

Rocuronio en obesos: ¿debe dosificarse por peso real o por peso ideal? / Rocuronium in obese: should be dosed by actual weight or ideal weight?

El aumento universal en la prevalencia de obesidad ha causado que los anestesiólogos se vean frecuentemente enfrentados a anestesiar pacientes obesos. Pese a esto aún existen dudas respecto a cómo dosificar las drogas en estos pacientes. La literatura recomienda dosificar el rocuronio en obesos en base al peso ideal (IBW, iniciales del inglés Ideal Body Weight) pero esta sugerencia está basada más bien en la prudencia que en la evidencia. Se decidió explorar con análisis de sobrevida (análisis tiempo-evento), la duración del rocuronio en obesos al ser dosificado por peso ideal (IBW) y por peso real (TBW, iniciales del inglés de peso corporal total). Al administrar el rocuronio en base al peso real (TBW) se observó una prolongación en su duración de acción con un acortamiento de su latencia en relación con la dosificación en base al peso ideal (IBW). Hubo una marcada prolongación de la duración de acción y el índice de recuperación tanto al dosificar por peso real como peso ideal. Debido a esta sensibilidad aumentada al rocuronio en pacientes obesos recomendamos dosificarlo en base al peso ideal, excepto si se necesita intubar rápidamente...

The universal increase in prevalence of obesity has caused that anesthesiologist are frequently encountered with anesthetizing obese patients. There stills exists doubt on how to dosage drugs to these patients. Literature recommends dosing rocuronium in the obese based on ideal weight (IBW), being this suggestion based more on prudence than on evidence. Randomized control trial was designed for obese patients scheduled for bariatric surgery to study the pharmacodynamics of rocuronium in this population. Patients were randomly assigned into two groups: rocuronium dosage 0.6 mg•kg-1 for real weight (TBW) or rocuronium dosage of 0.6mg•kg-1 for ideal weight (IBW). Ideal weight was calculated according to Lemmens formula. The reference group was the dosage based on IBW. Previous calibration, evaluating the first twitch of train-of-four (T1), we registered onset time, clinical duration, recovery index, level of muscle relaxation to which the first reinforcement was administered and clinical duration of rocuronium reinforcement. A total of 100 patients were part of the study: 54 in group TBW and 46 in group IBW. When administering rocuronium based on real weight (TBW) a prolongation in clinical duration was found: Medium (IQR*); 79.5 (67 - 105) minutes versus 44.5(33 - 63.5 minutes) in the IBW group (p < 0.001) with a decrease in latency in the TBW group 120 (90-150secs.) versus the IBW group 180 (120 - 270 secs.) (p < 0.001). There were no differences in the recovery index between both levels of dosing. There was a marked prolongation of both clinical duration and recovery index in both groups, as supported in some literature. Based on the evidence, we recommend to dose rocuronium in obese patients based on ideal weight, with the exception of cases were quick intubation is required...

Acid rock drainage and rock weathering in Antarctica: important sources for iron cycling in the Southern Ocean.

Here we describe biogeochemical processes that lead to the generation of acid rock drainage (ARD) and rock weathering on the Antarctic landmass and describe why they are important sources of iron into the Antarctic Ocean. During three expeditions, 2009-2011, we examined three sites on the South Shetland Islands in Antarctica. Two of them displayed intensive sulfide mineralization and generated acidic (pH 3.2-4.5), iron-rich drainage waters (up to 1.78 mM Fe), which infiltrated as groundwater (as Fe(2+)) and as superficial runoff (as Fe(3+)) into the sea, the latter with the formation of schwertmannite in the sea-ice. The formation of ARD in the Antarctic was catalyzed by acid mine drainage microorganisms found in cold climates, including Acidithiobacillus ferrivorans and Thiobacillus plumbophilus. The dissolved iron (DFe) flux from rock weathering (nonmineralized control site) was calculated to be 0.45 × 10(9) g DFe yr(-1) for the nowadays 5468 km of ice-free Antarctic rock coastline which is of the same order of magnitude as glacial or aeolian input to the Southern Ocean. Additionally, the two ARD sites alone liberate 0.026 and 0.057 × 10(9) g DFe yr(-1) as point sources to the sea. The increased iron input correlates with increased phytoplankton production close to the source. This might even be enhanced in the future by a global warming scenario, and could be a process counterbalancing global warming.

Functional recovery following musculoskeletal injury in hospital workers.

BACKGROUND: Hospital workers are at high risk of work-related musculoskeletal disorders (WRMSDs), but outcomes following such injuries have not been well studied longitudinally. AIMS: To ascertain functional recovery in hospital workers following incident WRMSDs and identify predictors of functional status. METHODS: Cases (incident WRMSD) and matched referents from two hospitals were studied at baseline and at 2 year follow-up for health status [SF-12 physical component summary (PCS)], lost workdays, self-rated work effectiveness and work status change (job change or work cessation). Predictors included WRMSD and baseline demographics, socio-economic status (SES), job-related strain and effort-reward imbalance. Logistic regression analysis tested longitudinal predictors of adverse functional status. RESULTS: The WRMSD-associated risk of poor (lowest quartile) PCS was attenuated from a baseline odds ratio (OR) of 5.2 [95% confidence interval (CI) 3.5-7.5] to a follow-up OR of 1.5 (95% CI 1.0-2.3) and was reduced further in multivariate modelling (OR = 1.4; 95% CI 0.9-2.2). At follow-up, WRMSD status did not predict significantly increased likelihood of lost workdays, decreased effectiveness or work status change. In multivariate modelling, lowest quintile SES predicted poor PCS (OR = 2.0; 95% CI 1.0-4.0) and work status change (OR = 2.5; 95% CI 1.1-5.8). High combined baseline job strain/effort-reward imbalance predicted poor PCS (OR = 1.7; 95% CI 1.1-2.7) and reduced work effectiveness (OR = 2.6; 95% CI 1.6-4.2) at follow-up. CONCLUSIONS: Baseline functional deficits associated with incident WRMSDs were largely resolved by 2 year follow-up. Nonetheless, lower SES and higher combined job strain/effort-reward imbalance predicted adverse outcomes, controlling for WRMSDs.

[Refractory dermatomyositis associated with chronic organizing pneumonia treated with rituximab: report of one case]. / Dermatomiositis refractaria asociada a neumonía en organización tratada con rituximab: reporte de un caso.

Chronic organizing pneumonia (COP) has often been reported as a pulmonary manifestation of collagen vascular diseases, mainly rheumatoid arthritis, but the association of COP and dermatomyositis (DM) has rarely been documented. We report a 55 year-old woman with well-documented DM and a COP. She was refractory to steroids and two other immunosuppressive agents therapy (cyclophosphamide and azathioprine). Therefore, rituximab (2 x 1 g infusions) was used for treatment. During the following weeks her strength gradually increased while creatine kinase (CK), C reactive protein and erythrocyte sedimentation rate normalized. After 6 months, she had a relapse with increased muscle enzymes, fever and moderate muscle weakness. After a second course of rituximab (2 x 1 g infusions), the patient demonstrated a remarkable clinical response as indicated by an increase in muscle strength and moderate decline in creatine kinase levels. Lung abnormalities resolved significantly on high resolution chest CT scan. Thus, B-cell depletion therapy with rituximab used alone or in combination with other immunosuppressants may be a viable option in patients with polymyositis-dermatomyositis and pneumonia refractory to current therapies.

Dermatomiositis refractaria asociada a neumonía en organización tratada con rituximab: Reporte de un caso / Refractory dermatomyositis associated with chronic organizing pneumonia treated with rituximab: Report of one case

Chronic organizing pneumonia (COP) has often been reported as a pulmonary manifestation of collagen vascular diseases, mainly rheumatoid arhritis, but the association of COP and dermatomyositis (DM) has rarely been documented. We report a 55 year-old woman with well-documented DM and a COP. She was refractory to steroids and two other immunosuppressive agents therapy (cyclophosphamide and azathioprine). Therefore, rituximab (2 x 1 g infusions) was used for treatment. During the following weeks her strength gradually increased while creatine kinase (CK), C reactive protein and erythrocyte sedimentation rate normalized. After 6 months, she had a relapse with increased muscle enzymes, fever and modérate muscle weakness. After a second course of rituximab (2 x 1 g infusions), the patient demonstrated a remarkable clinical response as indicated by an increase in muscle strength and moderate decline in creatine kinase levels. Lung abnormalities resolved significantly on high resolution chest CT sean. Thus, B-cell depletion therapy with rituximab used alone or in combination with other immunosuppressants may be a viable option in patients with polymyositis-dermatomyositis and pneumonia refractory to current therapies.

Ateroesclerosis en enfermedades reumatológicas: ¿mito o realidad? / Atherosclerosis in rheumatic diseases: myth or reality?

The first cause of morbidity and mortality among patients with Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA) is atherosclerotic vascular disease. This has been demonstrated in several epidemiological, clinical and mortality studies. Compared with the general population, these patients have a greater number of clinical events (myocardial ischemia, angina pectoris and cerebrovascular events), more subclinical vascular diseases (detected by carotid ultrasound, stress thallium scans, echocardiograms and vascular stiffness) and a higher rate of standardized mortality ratios. Framingham oe traditional cardiovascular risk factors do not seem to be wholly responsible for the increased vascular risk. Current evidence indicates that atherosclerosis is an inflammatory disease that may be initiated by endothelial injury. A prolonged inflammatory response is characteristic of SLE and RA, and may actually be an important facilitator of atherogenesis in these patients. High levels of circulating C-reactive protein, inflammatory cytokines (ICAM-1, CCAM-1, E-selectins and IL-6), antibodies, complement-fixing immune complexes, clonal expansion of certain types of lymphocytes and others that could be the source of endothelial injury in these patients are described. This article reviews the literature relating to the epidemiology of vascular disease, related risk factors and the suggested management strategies.

Neumonía cavitada por Rhodococcus equi en paciente inmunocomprometido no infectado por virus de inmunodeficiencia humana: Caso clínico y revisión / Necrotizing pneumonia due to Rhodococcus equi in non HIV immunocompromised host: Case report and review

Rhodococcus equi, es un bacilo grampositivo intracelular que causa infecciones mayoritariamente en pacientes inmunodeprimidos. Reportamos el caso de una mujer de 52 años, en tratamiento de lupus eritematoso sistémico, con historia progresiva de 10 meses de evolución caracterizada por tos, disnea progresiva, expectoración muco-purulenta, ocasionalmente hemoptoica, fiebre intermitente, y pérdida de peso del 10 por ciento. Tuvo respuesta parcial a diversos cursos de tratamiento antimicrobiano y el seguimiento radiológico evidenció la aparición de múltiples focos de consolidación bilaterales, algunos de ellos nodulares. El estudio microbiológico de un lavado broncoalveolar y de una biopsia pulmonar percutánea permitió la identificación de R. equi y la histología de la biopsia pulmonar fue compatible. Recibió tratamiento antimicrobiano bi-asociado prolongado con buena respuesta clínica y radiológica. Se debe considerar este agente en el estudio de pacientes inmunocomprometidos que cursan con neumonías de evolución prolongada.

Manifestaciones clínicas de la granulomatosis de Wegener y la poliangeítis microscópica en Santiago-Chile, 1990-2001 / Clinical features of Wegener granulomatosis and microscopic polyangiitis in Chilean patients

Background: Systemic vasculitis are a group of heterogeneous diseases characterized by inflammation and necrosis of blood vessel walls. The etiology is not known, but geographic and environmental factors are implicated. Aim: To describe the clinical features of microscopic polyangiitis (MPA) and Wegener's granulomatosis (WG) in a Chilean cohort of patients. Patients and methods: Retrospective review of the medical records of 123 patients with the diagnosis of systemic vasculitis (65 MPA and 58 WG), seen from 1990 to 2001. The diagnosis were made based on the American College of Rheumatology and Chapel Hill criteria. Results: The mean follow-up for MPA was 15 months (1-120) and for WG, 20 months (1-120). The median age (years) at diagnosis for MPA was 61 (19-82) and WG 50 (20-82). Gender distribution was similar in both groups (male: 68percent and 57percent respectively).The main clinical features in the MPA group were renal involvement (68percent), peripheral nervous system involvement (57percent), pulmonary hemorrhage (28percent), and skin disease (32percent). In the WG group were alveolar hemorrhage (62percent), renal involvement (78percent), paranasal sinus involvement (57percent), and ocular disease (26percent). In both, creatinine levels above 2.0 mg/dl were associated with a higher mortality (p< 0.01). ANCA by immunofluorescence was performed in 56 MPA patients (75percent had pANCA, 4percent had cANCA and 21percent were ANCA negative) and in 55 WG patients (17percent had pANCA, 79percent had cANCA and 4percent were ANCA negative). Global mortality was 18percent and 17percent respectively, and the most common causes of death were infections. Conclusions: The clinical features of our patients are similar to other published data. In our WG and MPA patients the main predictor for death was a serum creatinine above 2 mg/dl.

A national study of medical care expenditures for respiratory conditions.

This study was undertaken to estimate the magnitude of medical care expenditures among persons with respiratory conditions in the USA in 1996, and the increment in expenditures attributable to these conditions. The study data were derived from the 1996 Medical Expenditure Panel Survey, a national sample of 21,571 persons. Of the 21,571, 1,027 reported one or more respiratory condition. After weighting, the individuals may represent about 12.1 million persons in the USA. All medical care expenditures of these individuals were tabulated, stratified by comorbidity status, and then compared to those among persons with nonrespiratory conditions or with no conditions. Regression techniques were then used to estimate the increment of healthcare expenditures attributable to the respiratory conditions. From a national total of $45.3 billion, medical care expenditures averaged $3,753 among persons with respiratory conditions. Hospital stays comprised the largest component (45%). The per capita increment in total expenditures attributable to respiratory conditions ranged from $1,003-2,588, from a national total ranging from $12.1-31.3 billion. The total medical care expenditure of persons with respiratory conditions was estimated to be $45.3 billion, of which $12.1-31.3 billion represents an increment in expenditures associated with the conditions themselves.

First report on chlorinated pesticide deposition in a sediment core from a small lake in central Chile.

This paper presents a first report on chlorinated pesticide deposition analyzed through sedimentary records in a small mesotrophic lake (Chica de San Pedro) in central Chile. The sediment core was sliced and dated using 210Pb, 137Cs and pollen analyses. Organochlorine pesticides were analyzed by gas chromatography with electron capture detection (GC-ECD). From these results, pesticide deposition over the last 50 years was estimated. No pesticides were detected below the 1940 slice of the core. Concentrations were in the range 0.640-1.4 ng/g d.w. for total DDTs, 0.046-0.362 ng/g d.w. for lindane and 0.015-0.310 ng/g d.w. for alpha-hexachlorohexane. Highest concentrations of pp'DDT were found in 1993-1996 and higher concentrations of pp'-DDE and pp'-DDD were found in the seventies (1972-1978). Total organic carbon (TOC) normalized data were used for statistical analysis. Although significant correlation was observed between concentrations of DDE and DDD, no correlation was found for DDT, suggesting that it had a different source. Factorial analysis grouped DDE together with DDD, while DDT was grouped together with gamma- and alpha-HCH. Total DDT fluxes were highest during the 1970s, while those for HCHs have been increasing in the 1990s. In Chile, organochlorine compounds were banned in 1985, and the historical deposition patterns seem to indicate that such measures have been effective. On the other hand, results point out a relatively new occurrence of pp'-DDT in the watershed, but the source remains unknown.

Catastrophic antiphospholipid syndrome associated with crescentic glomerulonephritis: a clinicopathologic case.

The association of renal failure with catastrophic antiphospholipid syndrome has been reported in the context of microvascular occlusions and/or malignant hypertension. We describe a 36-year-old woman who died of multiorgan failure with the laboratory, clinical and histopathological characteristics of catastrophic antiphospholipid syndrome associated with a crescentic glomerulonephritis and renal failure.

Use of the Health Utilities Index with stroke patients and their caregivers.

BACKGROUND AND PURPOSE: Few studies currently assess the health-related quality of life of individuals following a stroke. One of the major challenges of assessing quality of life is the high likelihood that after a stroke a patient will not be able to complete such an assessment. One practical solution is to have a family caregiver complete the assessment on behalf of these individuals. This current pilot study examined the interrater reliability of having family caregivers complete the Health Utilities Index (HUI) on behalf of stroke patients. METHODS: A total of 74 patients who experienced an ischemic stroke and 37 family caregivers completed the interviewer-administered HUI (data were available for 33 pairs). The HUI is designed to produce a single summary measure of health-related quality of life, the global multiattribute utility score, as well as descriptive information on each of its attributes. Interrater reliability was measured by evaluating the percent agreement, Cohen's kappa statistics, intraclass correlation coefficients (ICCs), Pearson's R correlations, and paired t tests between the patient and caregiver responses. RESULTS: In most instances interrater reliability was acceptable, with values suggesting moderate to high agreement. The mean global multiattribute utility scores for the HUI 2 were identical for patients and caregivers (0.64 +/- 0.29), with an ICC of .72. A preponderance of patients reported decrements in several attributes of the HUI. CONCLUSIONS: These data indicate a substantial decrement in functioning in stroke patients and suggest that family caregivers can complete the HUI reliably when patients are unable to do so.

Lesión traumática de la aorta descendente por desaceleración / Traumatic injury of descending aorta by disacceleration

La mortalidad por accidentes en menores de 40 años ocupa un lugar prioritario en Chile. Los traumatismos de aorta torácica contribuyen en forma importante a la mortalidad y son rara vez diagnosticados. Presentamos nuestra experiencia con 5 casos operados de dislaceración traumática de aorta descendente. El diagnóstico se sospechó por un mediastino ancho a la Rx de tórax y se confirmó con TAC y angiografía en 3, sólo TAC en 1 y angiografía exclusiva en otro. Se intervienen entre 3 y 19 horas después del ingreso accediendo a la aorta descendente por toracotomía posterolateral izquierda con pinzamiento directo de la aorta en dos y con apoyo atrio-distal con bomba centrífuga en los otros 3. En todos se reemplazó el segmento lesionado con prótesis de Dacrón precoagulada. Un paciente fallece por isquemia visceral masiva y los otros 4 sobreviven. Todos los sobrevivientes se incorporan a una vida normal

Assessing health-related quality-of-life and health state preference in persons with obesity: a validation study.

The objective of this study was to assess the reliability, validity and responsiveness of a new health-related quality-of-life (HRQOL) measure containing global and obesity-specific domains and an obesity-specific health state preference (HSP) assessment. A total of 417 obese and 'normal' weight individuals completed these assessments. Internal consistency and test-retest reliability were demonstrated, with Cronbach's alpha, intraclass correlation coefficient and kappa values well above the acceptable level for most scales. Construct validity hypotheses were confirmed by examining scale correlations. The normal weight individuals reported statistically significantly better functioning and well-being on the majority of the HRQOL scales and HSP than obese individuals. Guyatt's statistic of responsiveness was moderate to high for all the scales and items in the weight-loss and weight-gain groups; however, many of the scales and items in the weight-stable group also displayed responsiveness. The results of this study support the reliability and validity of these assessments. However, further testing is needed to evaluate the responsiveness of both assessments in a weight-stable group.