Experiencia en el tratamiento endovascular de pseudoaneurismas arteriales infecciosos: presentación de tres casos / Endovascular treatment experience on arterial pseudoaneurysms: a presentation of three cases

En los últimos años con la llegada del tratamiento endovascular, se ha visto una importante disminución de la morbimortalidad de pacientes con pseudoaneurismas arteriales. Continúa siendo controversial su uso en un contexto de infección. El objetivo de este trabajo es reportar la experiencia del servicio en el manejo endovascular de pseudoaneurismas arteriales infecciosos (PAI).Un estudio retrospectivo y observacional, incluye pacientes con diagnóstico de pseudoaneurisma infeccioso arterial tratados de forma endovascular en nuestro centro en un periodo de dos años, de junio 2016 a junio 2018.(AU)

In last few years, with the arrival of endovascular treatments, we have seen an important decrease of morbimortality in patients with arterial pseudoaneurysms. Its use is still controversial in an infectious context. The main objective of the present article is to report our experience of endovascular management of infectious arterial pseudoaneurysms (IAP).A retrospective and observational study, it includes patients with a diagnosis of infectious arterial pseudoaneurysms treated with endovascular procedures in our centre between June 2016 and June 2018.(AU)

Colocación de catéter de hemodiálisis transceldas de stent en paciente con agotamiento de acceso venoso / Trans-cells of stent hemodialysis catheter placement in patients with exhausted central venous Access

INTRODUCCIÓN: el agotamiento vascular es un problema sanitario significativo, sobre todo en pacientes renales que no sean aptos para otro tipo de terapia de sustitución renal (trasplante o diálisis peritoneal). Se describen distintas alternativas para estos pacientes, de acuerdo a las posibilidades. CASO CLÍNICO: exponemos el caso de una mujer de 37 años, con enfermedad renal terminal desde hace más de treinta años por esclerohialinosis focal y segmentaria de variante colapsante y agotamiento del capital venoso central. Acude a nuestro centro con infección de Splithcath III(R) (MedComp), que se retira para colocar dos catéteres venosos simples de 6 Fr a nivel del tronco innominado vía yugular interna izquierda, al fallar en una navegación más central. Se destaca que la paciente presenta una vena yugular, vena subclavia y tronco innominado derechos ocluidos, con oclusión larga en el sitio donde se colocó un stent Palmaz(R) (Genesis Medical Group) en contexto de confección de fístula protésica, que cruza completamente la vena cava superior impidiendo el paso desde las venas izquierdas. Se optó por la implantación de un catéter de larga duración a través de las celdas del stent, llevada a cabo con éxito, con síndrome de vena cava superior de resolución posterior como complicación. DISCUSIÓN: lo más significativo de esta presentación es el implante a través de las celdas de un stent de catéteres de diálisis. Hasta ahora, encontramos descrita solo la colocación endoluminal y no esta técnica. Creemos que se trata de una alternativa válida en casos puntuales, como el analizado

INTRODUCTION: exhausted vascular access in chronic renal disease patients represents a significant issue for national health systems all around. It is fundamentally worse for those patients who have already surpassed or have no indication for other methods (renal transplant, peritoneal dilalysis). Different alternatives are assessed for each of these patients according to individual history. CASE REPORT: we assess the case of a 37 year old female patient with end-stage renal disease secondary to focal esclerohialinosis. Said patient has exhausted vascular access, as a consult for infected Splithcath III(R) (MedComp) for retrieval. Two simple 6Fr standard venous catheters were placed instead through the left jugular vein, with their tips in the left innominate vein lumen for a fail in mor central navigation. Patient concomitantly presented right jugular, subclavian and innominate veins obstructed, treated with a Palmaz(R) (Genesis Medical Group) metallic stent prior to right arteriovenous graft confection. That stent was across the lumen of the superior vena Cava. We opted for the implantation of a long-lasting dialysis catheter through the cells of the mentioned stent, which was successful despite complicaciones (superior vena cava syndrome). DISCUSSION: the most relevant topic of this case is the trans-stent cell implant of dialysis catheters. Research finds evidence only of transluminal stent central vein catheters implanted. We believe it constitutes a valid alternative in special cases such as the one being exposed

Aneurisma del arco aórtico. Tratamiento con stent multicapa diversor de flujo más embolización con coils / Aortic arch aneurysm. Treatment with multilayer flow modulator plus coil embolization

Para el tratamiento de la patología del arco aórtico, la cirugía abierta continúa siendo el gold standard. Debido a sus altas morbilidad y mortalidad se han desarrollado diferentes técnicas alternativas. Entre estas, destacan los tratamientos híbridos y exclusivamente endovasculares. En el marco de la investigación, se ha utilizado un stent multicapa diversor de flujo. Presentamos nuestra experiencia en un caso en el que implantamos un stent multicapa diversor de flujo en un paciente con aneurisma del arco aórtico. En la evolución requirió técnica de coiling del aneurisma trans-stent con éxito técnico. No logramos evaluar el éxito clínico en un plazo suficiente debido a muerte precoz por una causa no relacionada

Currently open surgery continues to be the gold standard for the treatment of aortic arch pathology. Due to its high morbidity and mortality, different alternative techniques such as hybrid or endovascular treatment have been developed. In the framework of these investigations, the multilayer flow modulator stent has been used with technical success. We present our early experience in a male patient with an aortic arch aneurysm, using an MFM and also a trans stent coiling technique. Despite technical success, long-term outcomes could not be assessed due to premature death from unrelated causes

Prenatal detection of congenital anomalies and related factors in Argentina.

Congenital anomalies (CAs) are a leading cause of neonatal death. Many CAs can be diagnosed prenatally. To estimate the prenatal detection rate (PDR) of CA in hospitals participating in the RENAC (National Network of Congenital Anomalies of Argentina) and to analyze the PDR according to different factors. Sources were reports of RENAC from the 2013-2016 period. Congenital anomalies included were those detectable by ultrasound or by a prenatal karyotype. PDR was calculated by region, health subsector, clinical presentation, maternal age, sex, and twining. Using multiple logistic regression analysis, we evaluated predictors of prenatal detection. In total, 9976 cases were defined as prenatal detectable; 5021 were detected (PDR = 50.3%). Multiple presentation increased the chances of prenatal detection (Adj. OR = 1.6; 95%CI 1.4-1.9). Prenatal detection was lower in the public subsector (Adj. OR = 0.8; 95%CI 0.7-0.9) and in the northern regions of the country. PDR was higher than 75% in isolated cases of urinary malformation, anencephaly, and gastroschisis. Prenatal detection increased the chance of birth in higher complexity-level hospitals (Adj. OR = 2.5; 95%CI 2.3-2.8). PDR was within the range previously reported. Heterogeneity between regions and health subsector suggests the need for training to achieve equity in detection.

Birth prevalence of Down syndrome in Argentina. / Prevalencia del síndrome de Down al nacimiento en Argentina.

The aim of this study was to describe the prevalence at birth of Down syndrome in Argentina. The prevalence by jurisdiction and maternal age was calculated for the 2009-2015 period and the prevalence and proportion of prenatal diagnosis was compared according to sub-sector (public and private) and complexity level of the maternity wards. The association of Down syndrome with birth weight and gestational age was analyzed. The data source was the National Network of Congenital Anomalies of Argentina [Red Nacional de Anomalías Congénitas] (RENAC). The prevalence was 17.26 per 10,000 births; by jurisdictions it varied between 10.99 and 23.71; and by maternal age, between 10.32 in women <20 years of age and 158.06 in those ≥45 years of age. In hospitals of the private subsector there was a higher prevalence, attributable to differences in the structure of maternal age, and a greater proportion of prenatal diagnosis. There was a negative correlation between birth weight and Down syndrome (ß=-294.7; p<0.001). No difference in the median gestational age at birth between Down syndrome newborns and newborns without major anomalies was found, but the distribution of gestational age differed. Knowledge of certain epidemiological characteristics of this health issue could contribute to the implementation of health policies.

El objetivo de este trabajo fue describir la prevalencia al nacimiento del síndrome de Down en Argentina. Se calculó la prevalencia por jurisdicción y edad materna para el período 2009-2015 y se comparó la prevalencia y proporción del diagnóstico prenatal según subsector (público y privado) y nivel de complejidad de las maternidades. Se analizó la asociación con el peso y la edad gestacional al nacer. La fuente de datos fue la Red Nacional de Anomalías Congénitas (RENAC). La prevalencia fue de 17,26 por cada 10.000 nacimientos; por jurisdicciones varió entre 10,99 y 23,71, y por edad materna entre 10,32 en <20 años y 158,06 en ≥45 años. En hospitales del subsector privado hubo una mayor proporción de diagnóstico prenatal y una mayor prevalencia, esta última atribuible a diferencias en la estructura de edad materna. Se observó una correlación negativa entre el peso al nacer y este síndrome (ß=-294,7; p<0,001). No se evidenció diferencia en la mediana de la edad gestacional al nacer entre recién nacidos con síndrome de Down y neonatos sin anomalías mayores, pero sí en la distribución de la edad gestacional. El conocimiento de ciertas características epidemiológicas podrá contribuir a la implementación de políticas de salud.

Birth defects surveillance: experiences in Argentina and Colombia.

Birth defects (BDs) are structural or functional anomalies, sporadic or hereditary, of prenatal origin. Public health surveillance is defined as the ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in the planning, implementation, and evaluation of public health practice. BD surveillance systems may have different characteristics according to design, coverage, type of surveillance, case ascertainment, case definition, BD description, maximum age of diagnosis, pregnancy outcomes, coding systems, and the location of the coding process (central or local). The aim of this article is to describe and compare methodology, applications, and results of birth defect surveillance systems in two South-American countries: Colombia and Argentina. In both countries, the surveillance systems developed activities in relation to the Zika virus emergency. For most BDs, a statistically significant higher prevalence is observed in Argentina-RENAC than in Colombian registries. This may be due to methodological reasons or real differences in prevalence. The strengths, weaknesses, and the future perspectives of the Argentine and Colombian systems are presented. When developing a surveillance system, the objectives, the available resources, and previous experiences in similar contexts must be taken into account. In that sense, the experience of Argentina and Colombia can be useful for others when developing a birth defect surveillance system.

Bone dysplasias in 1.6 million births in Argentina.

Currently accepted birth prevalence for osteochondrodysplasias (OCDs) is about 2 per 10,000 births. Our main goal is to estimate the prevalence of OCDs in Argentina and compare it with other surveillance systems. We examined 1,663,610 births among 160 hospitals of RENAC (Red Nacional de Anomalías Congénitas - National Network of Congenital Anomalies) between November 2009 and December 2016. Cases were detected and registered according to a pre-established protocol, ranked in three diagnostic evidence levels according to available clinical documentation, and categorized according to the 9th edition of the nosology and classification of genetic skeletal disorders. Within our dataset, the most frequent groups were Group-1 (FGFR3, chondrodysplasia) and Group-25 (Osteogenesis Imperfecta and decreased bone density). Birth prevalence per 10,000 for the main OCD types, were: Achondroplasia 0.47 (95% CI: 0.38-0.59), Thanatophoric Dysplasia 0.37 (95% CI: 0.29-0.48), and the Osteogenesis Imperfecta group 0.34 (95% CI: 0.26-0.44). For total OCD, birth prevalence was 2.20 per 10.000 births (95% CI: 1.98-2.44). RENAC prevalence of total OCDs was found to be lower than that reported by the Latin-American Study of Congenital Malformations (ECLAMC) and Utah Birth Defect Network but higher than EUROCAT. Our investigation is the first study of OCD prevalence in Argentina using data from every jurisdiction of the country.

Prevalencia del síndrome de Down al nacimiento en Argentina / Birth prevalence of Down syndrome in Argentina

RESUMEN El objetivo de este trabajo fue describir la prevalencia al nacimiento del síndrome de Down en Argentina. Se calculó la prevalencia por jurisdicción y edad materna para el período 2009-2015 y se comparó la prevalencia y proporción del diagnóstico prenatal según subsector (público y privado) y nivel de complejidad de las maternidades. Se analizó la asociación con el peso y la edad gestacional al nacer. La fuente de datos fue la Red Nacional de Anomalías Congénitas (RENAC). La prevalencia fue de 17,26 por cada 10.000 nacimientos; por jurisdicciones varió entre 10,99 y 23,71, y por edad materna entre 10,32 en <20 años y 158,06 en ≥45 años. En hospitales del subsector privado hubo una mayor proporción de diagnóstico prenatal y una mayor prevalencia, esta última atribuible a diferencias en la estructura de edad materna. Se observó una correlación negativa entre el peso al nacer y este síndrome ( ß=-294,7; p<0,001). No se evidenció diferencia en la mediana de la edad gestacional al nacer entre recién nacidos con síndrome de Down y neonatos sin anomalías mayores, pero sí en la distribución de la edad gestacional. El conocimiento de ciertas características epidemiológicas podrá contribuir a la implementación de políticas de salud.

ABSTRACT The aim of this study was to describe the prevalence at birth of Down syndrome in Argentina. The prevalence by jurisdiction and maternal age was calculated for the 2009-2015 period and the prevalence and proportion of prenatal diagnosis was compared according to sub-sector (public and private) and complexity level of the maternity wards. The association of Down syndrome with birth weight and gestational age was analyzed. The data source was the National Network of Congenital Anomalies of Argentina [Red Nacional de Anomalías Congénitas] (RENAC). The prevalence was 17.26 per 10,000 births; by jurisdictions it varied between 10.99 and 23.71; and by maternal age, between 10.32 in women <20 years of age and 158.06 in those ≥45 years of age. In hospitals of the private subsector there was a higher prevalence, attributable to differences in the structure of maternal age, and a greater proportion of prenatal diagnosis. There was a negative correlation between birth weight and Down syndrome ( ß=-294.7; p<0.001). No difference in the median gestational age at birth between Down syndrome newborns and newborns without major anomalies was found, but the distribution of gestational age differed. Knowledge of certain epidemiological characteristics of this health issue could contribute to the implementation of health policies.

[Descriptive epidemiology of major structural congenital anomalies in Argentina]. / Epidemiología descriptiva de las anomalías congénitas estructurales mayores en Argentina.

The objective of the study is to present the frequency of congenital anomalies (CA) reported to the National Network of Congenital Anomalies of Argentina (RENAC) in the year 2016, as part of its monitoring activities. RENAC is an official, national and hospital-based surveillance system of CA. The case definition includes newborns with major structural CA, external or internal, identified from birth until hospital discharge and detected by physical examination, complementary studies, interventions or autopsy. All live newborns and stillbirths of 500 grams or more were included. The prevalence of CA at birth was calculated as the quotient between the number of live newborns and stillbirths with CA, and the total number of live newborns and stillbirths, for a given period. According to their presentation, the cases with specific CA were classified into isolated, multiple and syndromes. The prevalence at birth of major structural CA was 1.59% (95% confidence intervals 1.55-1.64). The most frequent specific anomalies were: cleft lip and palate, gastroschisis, hydrocephalus, talipes equinovarus, spina bifida, postaxial polydactyly, anorectal malformation, diaphragmatic hernia, renal cysts and esophageal atresia. The most frequent syndrome was Down's. The expected annual cases and the prevalence of selected specific CA were estimated. RENAC data are within values reported in the literature.

Epidemiología descriptiva de las anomalías congénitas estructurales mayores en Argentina / Descriptive epidemiology of major structural congenital anomalies in Argentina

El objetivo del trabajo es presentar las frecuencias de anomalías congénitas (AC) estructurales mayores obtenidas por la Red Nacional de Anomalías Congénitas de Argentina (RENAC) correspondientes al año 2016, como parte de sus actividades de vigilancia de salud pública de AC. La RENAC es un sistema de vigilancia de AC oficial, nacional y de base hospitalaria. La definición de caso corresponde a recién nacidos con AC estructurales mayores, externas o internas, identificadas desde el nacimiento hasta el alta del hospital y detectadas en el examen físico, estudios complementarios, intervenciones o autopsia. Se incluyeron todos los recién nacidos vivos y los fetos muertos de 500 gramos o más. La prevalencia de AC al nacimiento se calculó como el cociente entre el número de recién nacidos vivos y fetos muertos con AC, y el número total de recién nacidos vivos y fetos muertos, en un período determinado. Según su presentación los casos con AC específicas fueron clasificados en aislados, múltiples y síndromes. La prevalencia al nacimiento de AC estructurales mayores fue de 1.59% (Intervalo de confianza del 95%: 1.55-1.64). Las anomalías específicas más frecuentes fueron: fisuras labiopalatinas, gastrosquisis, hidrocefalia, talipes equinovarus, espina bífida, polidactilia postaxial, malformación anorrectal, hernia diafragmática, quistes renales y atresia de esófago. El síndrome más frecuente fue Down. Se estimaron los casos anuales esperados y la prevalencia de AC específicas seleccionadas. En general, los datos de RENAC están dentro de los valores informados en la literatura.

The objective of the study is to present the frequency of congenital anomalies (CA) reported to the National Network of Congenital Anomalies of Argentina (RENAC) in the year 2016, as part of its monitoring activities. RENAC is an official, national and hospital-based surveillance system of CA. The case definition includes newborns with major structural CA, external or internal, identified from birth until hospital discharge and detected by physical examination, complementary studies, interventions or autopsy. All live newborns and stillbirths of 500 grams or more were included. The prevalence of CA at birth was calculated as the quotient between the number of live newborns and stillbirths with CA, and the total number of live newborns and stillbirths, for a given period. According to their presentation, the cases with specific CA were classified into isolated, multiple and syndromes. The prevalence at birth of major structural CA was 1.59% (95% confidence intervals 1.55-1.64). The most frequent specific anomalies were: cleft lip and palate, gastroschisis, hydrocephalus, talipes equinovarus, spina bifida, postaxial polydactyly, anorectal malformation, diaphragmatic hernia, renal cysts and esophageal atresia. The most frequent syndrome was Down´s. The expected annual cases and the prevalence of selected specific CA were estimated. RENAC data are within values reported in the literature.

Sonic hedgehog (Shh)/Gli modulates the spatial organization of neuroepithelial cell proliferation in the developing chick optic tectum.

BACKGROUND: Sonic hedgehog (Shh)/Gli pathway plays an important regulatory role on the neuroepithelial cells (NEc) proliferation in the dorsal regions of the developing vertebrate Central Nervous System. The aim of this paper was to analyze the effect of the Shh/Gli signaling pathway activation on the proliferation dynamics and/or the spatial organization of the NEc proliferation activity during early stages of the developing chick optic tectum (OT). In ovo pharmacological gain and loss of hedgehog function approaches were complemented with in vivo electroporation experiments in order to create ectopic sources of either Shh or Gli activator (GliA) proteins in the OT. NEc proliferating activity was analyzed at ED 4/4.5 by recording the spatial co-ordinates of the entire population of mitotic NEc (mNEc) located along OT dorsal-ventral sections. Several space signals (numerical sequences) were derived from the mNEc spatial co-ordinate records and analyzed by different standardized non-linear methods of signal analysis. RESULTS: In ovo pharmacologic treatment with cyclopamine resulted in dramatic failure in the OT expansion while the agonist purmorphamine produced the opposite result, a huge expansion of the OT vesicle. Besides, GliA and Shh misexpressions interfere with the formation of the intertectal fissure located along the dorsal midline. This morphogenetic alteration is accompanied by an increase in the mNEc density. There is a gradient in the response of NEcs to Shh and GliA: the increase in mNEc density is maximal near the dorsal regions and decrease towards the OT-tegmental boundary. Biomathematical analyses of the signals derived from the mNEc records show that both Shh and GliA electroporations change the proliferation dynamics and the spatial organization of the mNEc as revealed by the changes in the scaling index estimated by these methods. CONCLUSIONS: The present results show that the Shh/Gli signaling pathway plays a critical role in the OT expansion and modelling. This effect is probably mediated by a differential mitogenic effect that increases the NEc proliferation and modulates the spatial organization of the NEc proliferation activity.

Optic tectum morphogenesis: a step-by-step model based on the temporal-spatial organization of the cell proliferation. Significance of deterministic and stochastic components subsumed in the spatial organization.

BACKGROUND: Cell proliferation plays an important morphogenetic role. This work analyzes the temporal-spatial organization of cell proliferation as an attempt to understand its contribution to the chick optic tectum (OT) morphogenesis. RESULTS: A morphogenetic model based on space-dependent differences in cell proliferation is presented. Step1: a medial zone of high mitotic density (mZHMD) appears at the caudal zone. Step2: the mZHMD expands cephalically forming the dorsal curvature and then duplicates into two bilateral ZHMDs (bZHMD). Step3: the bZHMDs move toward the central region of each hemitectum. Step4: the planar expansion of both bZHMD and a relative decrement in the dorsal midline growth produces a dorsal medial groove separating the tectal hemispheres. Step5: a relative caudal displacement of the bZHMDs produces the OT caudal curvature. Numerical sequences derived from records of mitotic cells spatial coordinates, analyzed as stochastic point processes, show that they correspond to 1/f((ß)) processes. The spatial organization subsumes deterministic and stochastic components. CONCLUSIONS: The deterministic component describes the presence of a long-range influence that installs an asymmetric distribution of cell proliferation, i.e., an asymmetrically located ZHMD that print space-dependent differences onto the tectal corticogenesis. The stochastic component reveals short-range anti-correlations reflecting spatial clusterization and synchronization between neighboring cells.

The chick optic tectum developmental stages. A dynamic table based on temporal- and spatial-dependent histogenetic changes: A structural, morphometric and immunocytochemical analysis.

Development is often described as temporal sequences of developmental stages (DSs). When tables of DS are defined exclusively in the time domain they cannot discriminate histogenetic differences between different positions along a spatial reference axis. We introduce a table of DSs for the developing chick optic tectum (OT) based on time- and space-dependent changes in quantitative morphometric parameters, qualitative histogenetic features and immunocytochemical pattern of several developmentally active molecules (Notch1, Hes5, NeuroD1, ß-III-Tubulin, synaptotagmin-I and neurofilament-M). Seven DSs and four transitional stages were defined from ED2 to ED12, when the basic OT cortical organization is established, along a spatial developmental gradient axis extending between a zone of maximal and a zone of minimal development. The table of DSs reveals that DSs do not only progress as a function of time but also display a spatially organized propagation along the developmental gradient axis. The complex and dynamic character of the OT development is documented by the fact that several DSs are simultaneously present at any ED or any embryonic stage. The table of DSs allows interpreting how developmental cell behaviors are temporally and spatially organized and explains how different DSs appear as a function of both time and space. The table of DSs provides a reference system to characterize the OT corticogenesis and to reliably compare observations made in different specimens.