Perforación esofágica durante el monitoreo intraoperatorio con ecocardiografía transesofágica. Reparación en el mismo acto quirúrgico / Esophageal injury secondary to transesophageal ecocardiography monitoring and repair

Monitoring with intraoperative Transesophageal Echocardiography (TEE) has proven to be a tool of very high utility for both control of the hemodynamic status, cardiac function and to make new diagnoses. It is a minimally invasive technique and, like any medical procedure, it is not exempt from complications that do not exceed 1%. These range from mild oropharyngeal lesions to the most serious lesion, esophageal perforation. We describe a case of esophageal perforation from the esophagogastric junction to the middle third of the esophagus in the intraoperative period of laparoscopic Nissen surgery. The injury was repaired immediately and the closure of the lesion was verified with pneumatic maneuvers through the nasogastric tube. The patient was discharged after 35 days

El monitoreo con Ecocardiografía Transesofágica intraoperatorio (ETE) ha demostrado ser una herramienta de muy alta utilidad tanto para control del estado hemodinámico, función cardíaca y para realizar nuevos diagnósticos. Se trata de una técica seiinvasiva y como todo procedimiento médico no está exento de complicaciones que no superan al 1%. Estas son desde lesiones leves orofaríngeas hasta la lesión más grave que es la perforación esofágica. Se describe un caso de perforación esofágica con desgrarro de éste desde la unión esofagogástrica hacia el tercio medio del esófago en el íntraoperatorio de cirugía de Nissen laparoscópico. La reparación de la injuria se realizó en forma inmediata y se comprobó con maniobras neumáticas a través de la sonda nasogástrica el cierre de la lesión. La paciente fue dada de alta a los 35 días.

Depth profiling by confocal Raman microspectroscopy: semi-empirical modeling of the Raman response.

It has been well documented that the use of dry optics in depth profiling by confocal Raman microspectroscopy significantly distorts the laser focal volume, thus negatively affecting the spatial resolution of the measurements. In that case, the resulting in-depth confocal profile is an outcome of several contributions: the broadening of the laser spot due to instrumental factors and diffraction, the spreading of the illuminated region due to refraction of the laser beam at the sample surface, and the influence of the confocal aperture in the collection path of the laser beam. Everall and Batchelder et al. developed simple models that describe the effect of the last two factors, i.e., laser refraction and the diameter of the pinhole aperture, on the confocal profile. In this work, we compare these theoretical predictions with experimental data obtained on a series of well-defined planar interfaces, generated by contact between thin polyethylene (PE) films (35, 53, 75, and 105 microm thickness) and a much thicker poly(methyl methacrylate) (PMMA) piece. We included two refinements in the above-mentioned models: the broadening of the laser spot due to instrumental factors and diffraction and a correction for the overestimation in the decay rate of collection efficiency predicted by Batchelder et al. These refinements were included through a semiempirical approach, consisting of independently measuring the Raman step-response in the absence of refraction by using a silicon wafer and the actual intensity decay of a thick and transparent polymer film. With these improvements, the model reliably reproduces fine features of the confocal profiles for both PE films and PMMA substrates. The results of this work show that these simple models can not only be used to assist data interpretation, but can also be used to quantitatively predict in-depth confocal profiles in experiments carried out with dry optics.

Interphase evolution in polymer films by confocal Raman microspectroscopy.

Liquid-glassy polymer diffusion is an important topic in polymer physics, with several mechanistic aspects that still remain unclear. Here we describe the use of confocal Raman microspectroscopy (CRM) to study directly several features of interphase evolution in a system of this type. The interphase studied was generated by contact between liquid polystyrene (PS) and glassy polyphenylene oxide (PPO). Interphase evolution on thin films made from these polymers was followed by depth profiling in combination with immersion optics. We also applied regularized deconvolution to improve the spatial resolution of the measurements. With the help of these techniques, we examined interphase PPO concentration profiles and kinetics of interphase evolution in the range 120-180 degrees C, well below the glass transition temperature of the PPO-based films (185 degrees C). Overall, the experiment captures the most important features needed to discern the mechanistic factors that control this process. In this sense, confocal Raman microspectroscopy emerges as one of the best experimental techniques for the study of diffusion kinetics in this type of system.

Eficacia, e influencia sobre la función ventilatoria de la analgesia regional intrapleural / Efficacy of regional interpleural analgesia and its influence on ventilatory function

Se estudiaron en el postoperatorio inmediato 20 pacientes A.S.A. I-II de cirugía electiva de tórax, abdomen superior, mama y cirugía renal, con el propósito de investigar un nuevo método de analgesia regional: la Analgesia Regional Intrapleural. Una vez finalizada la cirugía pero con el paciente aún dormido, se colocó en el octavo espacio intercostal por vía posterior un catéter epidural dentro del espacio intrapleural. Se describe la técnica de acceso al espacio pleural, y se discute el mecanismo de acción. Cuando los pacientes manifestaron dolor, se inyectaron 20 ml. de bupivacaína al 0,5 por ciento con epinefrina por el catéter intrapleural. Se evaluó la analgesia, su duración y la función ventilatoria mediante gasometría arterial y espirometría dinámica. Se consiguió analgesia completa de larga duración a los pocos minutos de inyectada la droga sin efectos secundarios significativos. (AU)

Eficacia, e influencia sobre la función ventilatoria de la analgesia regional intrapleural / Efficacy of regional interpleural analgesia and its influence on ventilatory function

Se estudiaron en el postoperatorio inmediato 20 pacientes A.S.A. I-II de cirugía electiva de tórax, abdomen superior, mama y cirugía renal, con el propósito de investigar un nuevo método de analgesia regional: la Analgesia Regional Intrapleural. Una vez finalizada la cirugía pero con el paciente aún dormido, se colocó en el octavo espacio intercostal por vía posterior un catéter epidural dentro del espacio intrapleural. Se describe la técnica de acceso al espacio pleural, y se discute el mecanismo de acción. Cuando los pacientes manifestaron dolor, se inyectaron 20 ml. de bupivacaína al 0,5 por ciento con epinefrina por el catéter intrapleural. Se evaluó la analgesia, su duración y la función ventilatoria mediante gasometría arterial y espirometría dinámica. Se consiguió analgesia completa de larga duración a los pocos minutos de inyectada la droga sin efectos secundarios significativos.