The Transbrachial Venous Approach for Pelvic Congestion Syndrome Embolization: An Easy Way to Outpatient Procedure.

BACKGROUND: Pelvic congestion syndrome (PCS) is a frequent finding in adult women and transcatheter embolization of dilated and refluxing veins is the treatment of choice. The procedure can be performed through different venous accesses such as the transfemoral, transjugular, and the transbrachial access. The aim of this study was to demonstrate the feasibility and safety of the transbrachial approach for transcatheter embolization in this pathology in 201 women. Advantages and disadvantages of this access were discussed. METHODS: Between January 2007 and October 2020, female patients who underwent transcatheter embolization for PCS were selected. Embolization procedural details such as venous access sites and embolized veins were collected. RESULTS: Two hundred and one patients were selected for pelvic vein embolization due to PCS. The basilic vein was punctured in 103 patients (51.2%), the cephalic vein was chosen in 76 patients (37.8%) and deep brachial veins in 19 (9.6%). Technical success was observed in 198 (98.5%) cases. Only one major adverse effect was registered; one patient presented with hematoma of the arm that could be managed conservatively. CONCLUSION: The transbrachial venous approach for PCS embolization is safe, effective and minimal invasive. It provides a significant patient comfort, has a low complication rate and can be performed on an outpatient basis.

Atypical Renal Artery Preservation with an Iliac Branch Device in an Infrarenal Abdominal Aortic Aneurysm.

Anatomical variations of the renal arteries may complicate endovascular repair of infrarenal abdominal aortic aneurysms (AAA). Occlusion of renal branches may be necessary to seal the aneurysm sac efficiently. Depending on the size of the affected renal arteries and the supplied parenchyma, this can lead to loss of renal function. Iliac branch devices (IBDs) have been created in order to preserve the internal iliac artery in aortoiliac or isolated iliac aneurysms; however, IBDs have the potential to maintain patency of other arteries as well. This case report describes the off-label use of an IBD inside the main body of a bifurcated endoprosthesis in a patient with an AAA and multiple renal arteries in order to preserve the main renal artery that emerges directly out of the aneurysm sac. Special considerations such as limited craniocaudal dimensions for endoprosthesis placement and the reduced vascular space are discussed.

Primary peritoneal clear cell carcinoma. A case report and literature review.

Primary peritoneal malignant tumors are exceptional. Among them, clear cell carcinoma is extremely rare, being only thirteen cases previously reported in the literature since 1990. We report a case of a 48-year-old Caucasian woman who was treated at the University General Hospital of Alicante. She consulted because of progressive abdominal pain over the last seven months, with the initial diagnosis of renal-ureteral colic. Ultrasound and computed tomography of the abdomen and pelvis revealed a 25 × 15 cm, well-defined cystic lesion with papillary projections, centrally located in the abdomen. The radiology report suggested a primary ovarian tumor versus peritoneal implant as the first option. The patient underwent an exploratory laparotomy showing a large cystic mass located in the urinary bladder peritoneum, firmly attached to the mesentery. The entire abdominal tumor was completely excised, and total hysterectomy with bilateral salpingo-oophorectomy and infra-colical omentectomy were performed. The final histological study revealed a new case of primary peritoneal clear cell carcinoma located in the urinary bladder peritoneum, firmly attached to the mesentery. Grossly, it was well-circumscribed and multicystic with papillary growth involving part of the inner wall. Microscopically, it showed tubulocystic and papillary patterns with highly atypical tumor cells. After an extensive immunohistochemical analysis, the most relevant finding was an ARID1A loss that was corroborated by molecular analysis showing an ARID1A deletion. The patient received systemic chemotherapy with carboplatin and paclitaxel protocol (Å ~ 4 cycles). Patient follow-up after the eighth month showed peritoneal implants predominantly in the right diaphragmatic cupule that were histologically confirmed as recurrence. She has just received another six cycles of chemotherapy with carboplatin and paclitaxel. Recognition of primary peritoneal clear cell carcinoma in this uncommon location, and exclude metastasis from the ovary, represents a diagnostic challenge.

Investigation of chitosan's antibacterial activity against vancomycin resistant microorganisms and their biofilms.

Vancomycin-resistant microorganisms are a hurdle that traditional antibiotics struggle to overcome. These difficulties have led to search for new solutions based on natural products. Chitosan has been recognized as an effective antibacterial agent against a vast array of microorganisms including antibiotic resistant ones. As such, this work aimed to evaluate chitosan as an alternative to traditional antibiotics in the management/control of two vancomycin-resistant microorganisms, VRSA and VREF, in planktonic and sessile settings. The results obtained showed that chitosan was highly effective in inhibiting VRSA and VREF planktonic growth and reduced VREF viable counts by 6 log CFU in 30min. Additionally, chitosan was active upon several phases of VRSA and VREF sessile growth inhibiting adhesion, biofilm formation and dual-species biofilms at concentrations as low as 0.0125mg/mL. In lieu of these results chitosan shows great potential as a possible alternative for the control of vancomycin-resistant microorganisms in recalcitrant wound infections.

DNA agarose gel electrophoresis for antioxidant analysis: Development of a quantitative approach for phenolic extracts.

Most of the fast in vitro assays proposed to determine the antioxidant capacity of a compound/extract lack either biological context or employ complex protocols. Therefore, the present work proposes the improvement of an agarose gel DNA electrophoresis in order to allow for a quantitative estimation of the antioxidant capacity of pure phenolic compounds as well as of a phenolic rich extract, while also considering their possible pro-oxidant effects. The result obtained demonstrated that the proposed method allowed for the evaluation of the protection of DNA oxidation [in the presence of hydrogen peroxide (H2O2) and an H2O2/iron (III) chloride (FeCl3) systems] as well as for the observation of pro-oxidant activities, with the measurements registering interclass correlation coefficients above 0.9. Moreover, this method allowed for the characterization of the antioxidant capacity of a blueberry extract while demonstrating that it had no perceived pro-oxidant effect.

Trombectomía mecánica primaria como tratamiento de la oclusión aguda de arterias intracerebrales / Primary mechanical thrombectomy for acute occlusions of cerebral arteries

La isquemia cerebral por oclusión de las arterias principales intracraneales causa una importante morbimortalidad. Nuevos dispositivos para la trombectomía mecánica permiten la extracción del trombo en un tiempo reducido. Se muestran los resultados de la trombectomía mecánica primaria sin el uso de fibrinolisis intravenosa utilizando el dispositivo Solitaire. Desde enero de 2010 hasta abril de 2013, 24 pacientes presentaron una oclusión de vasos intracerebrales principales y fueron tratados mediante trombectomía primaria. El tiempo de inicio de síntomas hasta la recanalización fue de 268 (11,3) min (rango: 143-486 min). La recanalización se consiguió en 19 pacientes (79,2%), con un tiempo punción-revascularización de 63,9 (35,5) min. El NIHSS (National Institute of Health Stroke Scale) al ingreso fue de 21 (7,5) (7-38). Un mRS (modified Rankin scale) inferior o igual a 2 al alta se observó en 15 pacientes (62,5%) y en 13 a los 3 meses. Tres pacientes (12,5%) fallecieron por hemorragia cerebral o infarto. Se concluye que aproximadamente dos de cada tres pacientes se beneficiaron de la extracción mecánica primaria con ninguna o mínima discapacidad al alta, después de un ictus isquémico de vasos principales y sin utilizar la fibrinolisis intravenosa (AU)

Cerebral ischemia due to occlusion of the principal intracranial arteries is a significant cause of morbidity and mortality. New devices for mechanical thrombectomy can facilitate rapid extraction of the thrombus. This paper describes the results of primary mechanical thrombectomy with the Solitaire revascularization device without intravenous fibrinolysis. From January 2010 to April 2013, 24 patients with occlusions of the main intracerebral arteries were treated by primary thrombectomy. The mean (SD) time elapsed from onset of symptoms until revascularization was 268 (11.3) minutes (range, 143-486 minutes). Revascularization was achieved in 19 patients (79.2%) within a punctureto-revascularization time of 63.9 (35.5) minutes. The mean score on the National Institute of Health Stroke Scale on admission was 21 (7.5) (range, 7-38). A score on the modified Rankin scale of 2 or lower was recorded for 15 patients (62.5%) on discharge and for 13 patients at 3 months. Three patients (12.5%) died from cerebral hemorrhage or infarct. It can be concluded that after ischemic stroke from occlusions of the main cerebral arteries, about 2 out of 3 of our patients benefited from primary mechanical extraction without intravenous fibrinolysis and had no or minimal disability on discharge (AU)

[Primary mechanical thrombectomy for acute occlusions of cerebral arteries]. / Trombectomía mecánica primaria como tratamiento de la oclusión aguda de arterias intracerebrales.

EN: Cerebral ischemia due to occlusion of the principal intracranial arteries is a significant cause of morbidity and mortality. New devices for mechanical thrombectomy can facilitate rapid extraction of the thrombus. This paper describes the results of primary mechanical thrombectomy with the Solitaire revascularization device without intravenous fibrinolysis. From January 2010 to April 2013, 24 patients with occlusions of the main intracerebral arteries were treated by primary thrombectomy. The mean (SD) time elapsed from onset of symptoms until revascularization was 268 (11.3) minutes (range, 143-486 minutes). Revascularization was achieved in 19 patients (79.2%) within a punctureto- revascularization time of 63.9 (35.5) minutes. The mean score on the National Institute of Health Stroke Scale on admission was 21 (7.5) (range, 7-38). A score on the modified Rankin scale of 2 or lower was recorded for 15 patients (62.5%) on discharge and for 13 patients at 3 months. Three patients (12.5%) died from cerebral hemorrhage or infarct. It can be concluded that after ischemic stroke from occlusions of the main cerebral arteries, about 2 out of 3 of our patients benefited from primary mechanical extraction without intravenous fibrinolysis and had no or minimal disability on discharge.

ES: La isquemia cerebral por oclusión de las arterias principales intracraneales causa una importante morbimortalidad. Nuevos dispositivos para la trombectomía mecánica permiten la extracción del trombo en un tiempo reducido. Se muestran los resultados de la trombectomía mecánica primaria sin el uso de fibrinolisis intravenosa utilizando el dispositivo Solitaire. Desde enero de 2010 hasta abril de 2013, 24 pacientes presentaron una oclusión de vasos intracerebrales principales y fueron tratados mediante trombectomía primaria. El tiempo de inicio de síntomas hasta la recanalización fue de 268 (11,3) min (rango: 143-486 min). La recanalización se consiguió en 19 pacientes (79,2%), con un tiempo punción-revascularización de 63,9 (35,5) min. El NIHSS (National Institute of Health Stroke Scale) al ingreso fue de 21 (7,5) (7-38). Un mRS (modified Rankin scale) inferior o igual a 2 al alta se observó en 15 pacientes (62,5%) y en 13 a los 3 meses. Tres pacientes (12,5%) fallecieron por hemorragia cerebral o infarto. Se concluye que aproximadamente dos de cada tres pacientes se beneficiaron de la extracción mecánica primaria con ninguna o mínima discapacidad al alta, después de un ictus isquémico de vasos principales y sin utilizar la fibrinolisis intravenosa.

Chimney and periscope grafts to facilitate endovascular treatment of aortic transection in a patient with aberrant right subclavian artery.

PURPOSE: To report the use of parallel grafts to extend the proximal landing zone for stent-graft repair of aortic transection involving an aberrant right subclavian artery (ARSA). CASE REPORT: A 28-year-old patient was referred for treatment of traumatic aortic transection with contained rupture at the level of an ARSA. Immediate thoracic endovascular aortic repair (TEVAR) was planned because of hemodynamic instability. To achieve rapid sealing and maintain perfusion to both subclavian arteries, a chimney stent to the left subclavian artery (LSA) and a periscope stent-graft to the ARSA were deployed successfully. After surgical repair of all fractures, the patient was discharged 1 month after the initial injury in good condition. Imaging follow-up at 10 months showed a stable repair, patent parallel grafts, and no complications. CONCLUSION: TEVAR with chimney and periscope grafts proved to be a safe and quick treatment for a patient requiring ARSA repair in acute aortic transection. This technique maintained blood flow to the ARSA and LSA in a totally endovascular approach, which could be very valuable in transection cases where bypass surgery to supra-aortic branches is compromised or deemed challenging due to thoracic wall and/or neck trauma. Parallel grafting can be a valuable tool to address any acute aortic pathology as it can be performed with off-the-shelf devices.

Leiomyosarcoma of the deep femoral vein. A rare cause of venous obstruction in lower limbs and an alternative diagnosis to chronic venous thrombus.

Primary venous leiomyosarcoma of the extremities is an uncommon, but aggressive, tumoral entity with a high rate of local recurrence and early hematogenous metastasis. In the present article, we report a case of leiomyosarcoma of the vena profunda femoris. This pathology causes deep venous thrombosis-like symptoms. No improvement in lower limb status and a significant and progressive increase in the diameter of the vein as seen using ultrasonography could indicate tumor disease. Particular care must be taken to avoid biopsies due to the possible dissemination. We must complete the medical study with imaging techniques, and the tumor must be removed as soon as possible for histopathological diagnosis. After a follow-up of 12 months, there was no evidence of local or metastatic recurrence in our patient.

Contenidos televisivos violentos asociados a la conducta agresiva de niños de 8 a 12 años / Violent television content associated with aggressive behaviorof children 8 to 12 year

Objetivo: determinar el nivel de exposición a contenidos televisivos violentos y su asociación con la conducta agresiva en niños de 8 a 12 años de una institución educativa del distrito de Comas en Lima, Perú. Material y métodos: se realizó un estudio descriptivo y de corte transversal. La población estuvo conformada por 350 niños que cumplieron los criterios de inclusión, la muestra de 115 niños fue seleccionada utilizando el muestreo sistemático. Los instrumentos usados fueron estructurados y previamente validados. Resultados: los resultados mostraron que del total de niños evaluados el 67,83% mostró riesgo de presentar conductas agresivas. Quince escolares presentaron bajo nivel de exposición a contenidos televisivos violentos. Entre ellos, el 93,3% no presentó conductas agresivas. Entre el total de escolares con alto nivel de exposición a contenidos televisivos violentos, hubo una igualdad de porcentaje de 45,5%, tanto en riesgo de conducta agresiva, como en conducta agresiva. Se observa que el mayor porcentaje de niños (77,4%) presentó un nivel de exposición medio a contenidos televisivos violentos. Conclusiones: cerca de las trescuartas partes de los niños encuestados tienen un nivel de exposición medio. Si este porcentaje se suma al 10% del nivel de exposición alto, se tiene un total de más del 87% de niños expuestos a contenidos televisivos violentos. Asimismo, los niños presentaron riesgo de conducta agresiva, existiendo asociación entre el nivel de exposición acontenidos televisivos violentos y la conducta agresiva en los niños de 8 a 12 años.

Objetive: The objective was to determine the level of exposure to violent television content and its association with aggressive behavior in children 8 to 12 years in an educational institution Comas district in Lima, Peru. Material and Methods: We performed a descriptive and cross-sectional. Population consisted of 350 children who met the inclusion criteria, the sample of 115 children was selected using systematic sampling. The instruments used were structured and previously validated. Results: The results showed that the total of children assessed 67.83% showed the risk of aggressive behavior. Fifteen students showed low levels of exposure to violent television content. Among them, 93.3% had no aggressive behavior. Among the total number of schoolchildren with high exposure to violent television content,there was an equal percentage of 45.5%, both at risk of aggressive behavior, such as aggressive behavior. It is observed that the highest percentage of children (77.4%) had an average exposure level to violent television content. Conclusion. Nearly three quarters of the children surveyed have an average exposure level. If this percentage is added to 10% higher exposure level, it has a total of more than 87% of children exposed to violent television content. Similarly, children for risk of aggressive behavior, existing association between the level of exposure to violent television content and aggressive behavior in children 8 to 12.

Renal embolization and nephrectomy in a single surgical act in high-risk renal tumor pathology.

BACKGROUND: Renal artery embolization is a procedure that has been shown to be useful as a concomitant treatment for the resection of large renal tumors. Over the years, preoperative renal artery embolization concomitant with nephrectomy as a treatment option has proved to be useful in reducing morbi-mortality rates; however this procedure is not exempt from significant iatrogenia. Performing this technique in conjunction with nephrectomy in a single surgical act helps to maintain the advantages of this treatment, which in turn considerably reduces the associated morbi-mortality rates. METHODS: This study presents seven patients selected by the Urology Service in a nonconsecutive manner who underwent renal artery embolization concomitant with nephrectomy in a single surgical procedure for large renal tumors, thus presenting a variation to the usual techniques to improve and simplify the procedure. RESULTS: General data were obtained from all patients including age, gender, characteristics of the tumor, and symptomatology at the time of diagnosis. For all the cases, use of resources was analyzed in terms of duration of surgery, the amount of iodinated contrast medium used during the embolization procedure, and the mean duration of hospital and intensive care unit stay. Complications were evaluated with respect to general morbi-mortality associated with the complete procedure, hematic losses during the procedure, transfusion requirements, and renal function (calculated by measuring preoperative and 48-hour postoperative serum creatinine levels). All patients reported having symptoms at the time of diagnosis, all of them had tumors measuring >13 cm in diameter (major). In all the cases, 100% technical success was obtained with the embolization and nephrectomy. The mean duration of surgery in the case of embolization with coils was 45 minutes, and 25 minutes in the case of embolization with Amplatzer. A mean volume of 115 mL of contrast medium was used in the case of embolization with coils, whereas for the other cases, a mean volume of 71 mL of iodinated contrast was used. Among all the patients, only two of them required to be cared at the intensive care unit during 24 hours. On an average, reported blood loss was 380 mL. During the procedure, two patients (28.6%) required a transfusion of two units of red cells. No cases of perioperative or postoperative mortality were reported. With respect to morbidity, only one patient (14.3%) experienced a complication in the form of a superficial infection of the surgical wound, which was later resolved by antibiotic therapy. One patient (14.3%) presented a slightly higher preintervention level of creatinine (1.42). Two patients (28.6%), both of whom underwent embolization by using coils, experienced deterioration of postoperative renal function. CONCLUSION: Preoperative embolization of the renal artery as a coadjuvant treatment option in high-risk renal neoplasia has clear technical benefits for the subsequent nephrectomy and also medical benefits for the patients. Performing both the procedures concomitantly as a single surgical act seems to retain the advantages of the embolization procedure, by reducing mortality rates and producing little associated morbidity. Technically, embolization with Amplatzer plugs seems to be faster and easier as compared with embolization with coils.