Treatment strategies for patients with concurrent blunt cerebrovascular and traumatic brain injury.

Patients who present with traumatic brain injury (TBI) combined with blunt cerebrovascular injuries (BCVI) are difficult to manage, in part because treatment for each entity may exacerbate the other. It is necessary to develop a treatment paradigm that ensures maximum benefit while mitigating the opposing risks. A cohort of 150 patients from 2015 to present, with either internal carotid artery (ICA) and/or vertebral artery (VA) dissections or pseudoaneurysms, was cross-referenced with those who had sustained TBI. Of the 38 patients identified with both TBI and BCVI, 25 suffered ICA injuries, 10 had VA injuries and 3 had combined ICA/VA injuries. Unilateral BCVI occurred in 30 patients, while 8 had bilateral BCVI. Two patients required surgical intervention for TBI, and 5 patients required endovascular intervention for BCVI. Positive emboli detection studies (EDS) on transcranial dopplers (TCD) were demonstrated in 19 patients, with 9 patients having radiographic evidence of stroke. Anti-platelet therapy was initiated in 32 patients, and anti-coagulation in 10 patients, without new or worsening intracranial hemorrhages (ICH). Overall, 76% of patients were able to be discharged home or to rehabilitation, with good recovery demonstrated in 73% of the patients who had appropriate follow-up. In the setting of concurrent TBI and BCVI, use of anti-platelet/coagulation to prevent stroke can be safe if monitored closely. Here we describe a treatment paradigm which weighs the risk and benefits of therapies based on severity of ICH and stroke prevention, which tended to result in good disposition and recovery.

The Effects of Lockdown During the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic on Neurotrauma-Related Hospital Admissions.

BACKGROUND: The response to the global severe acute respiratory syndrome coronavirus 2 pandemic culminated in mandatory isolation throughout the world, with nationwide confinement orders issued to decrease viral spread. These drastic measures were successful in "flattening the curve" and maintaining the previous rate of coronavirus disease 2019 infections and deaths. To date, the effects of the coronavirus disease 2019 pandemic on neurotrauma has not been reported. METHODS: We retrospectively analyzed hospital admissions from Ryder Trauma Center at Jackson Memorial Hospital, during the months of March and April from 2016 to 2020. Specifically, we identified all patients who had cranial neurotrauma consisting of traumatic brain injury and/or skull fractures, as well as spinal neurotrauma consisting of vertebral fractures and/or spinal cord injury. We then performed chart review to determine mechanism of injury and if emergent surgical intervention was required. RESULTS: Compared with previous years, we saw a significant decline in the number of neurotraumas during the pandemic, with a 62% decline after the lockdown began. The number of emergent neurotrauma surgical cases also significantly decreased by 84% in the month of April. Interestingly, although the number of vehicular traumas decreased by 77%, there was a significant 100% increase in the number of gunshot wounds. CONCLUSIONS: Population seclusion had a direct effect on the frequency of neurotrauma, whereas the change in relative proportion of certain mechanisms may be associated with the psychosocial effects of social distancing and quarantine.

El papel de la videocápsula endoscópica en la hemorragia digestiva / The role of the endoscopic videocapsule in digestive hemorrhage

Introducción: desde el advenimiento de la cápsula endoscópica, la hemorragia digestiva del intestino delgado ha cambiado su epidemiología y se ha podido identificar diversas causas que antes no se las entendía. Este estudio enmarca nuestra experiencia en esta nueva técnica de gran utilidad en el Hospital Metropolitano para estudiar el sangrado del intestino delgado. Objetivo: determinar los hallazgos identificados por cápsula endoscópica y su utilidad en los 3 grupos de hemorragia digestiva del intestino delgado que son: 1) sangrado evidente, 2) sangrado oculto y 3) anemia ferropénica. Metodología: se realizó un estudio descriptivo retrospectivo transversal. Se revisaron 201 historias clínicas de las cuales se seleccionaron aquellas cuyos pacientes acudían a realizarse un estudio de cápsula endoscópica debido a sospecha de sangrado digestivo del intestino delgado. Variables que se analizaron: edad, sexo, hallazgos y una variable de utilidad del estudio en el sangrado digestivo. El sistema de la cápsula endoscópica que se utilizó fue Pill Cam 2 de la GIVEN de intestino delgado. Resultados: distribución etaria promedio de 58±17 años (56% menores de 65 años y 44% mayores de 65 años). Las causas de sangrado del intestino delgado de los 3 grupos estudiados fue angiodisplasia (9%), múltiples erosiones (8%), tumores del intestino delgado erosionados (5%). La cápsula endoscópica para detectar la etiología de sangrado digestivo fue útil en 84% de los casos: sangrado evidente (85%), en el grupo de anemia (84%) y en el grupo de sangrado oculto (85%). Conclusión: la hemorragia digestiva del intestino delgado se puede presentar en cualquier edad y sexo. Los hallazgos más frecuente de hemorragia del intestino delgado son las angiodisplasias, las cuales se relacionan con la edad y múltiples erosiones de la mucosa intestinal. La cápsula endoscópica es un método de gran utilidad para detectar la detección etiología de la hemorragia de intestino delgado. (AU)

Introduction: Since the advent of the endoscopic capsule, digestive hemorrhage of the small intestine has changed in its epidemiology and it has been possible to identify several causes not previously understood. This study frames our experience in this new technology at the Metropolitan Hospital in the study of small bowel bleeding and its great utility. Objective: The objective of the study was to determine the findings identified by endoscopic capsule and its usefulness in the three groups of digestive hemorrhage of the small intestine, that are evident bleeding, occult bleeding and iron deficiency anemia. Methodology: A transversal retrospective descriptive study was carried out. In the study, 201 clinical records of patients were reviewed and those who attended an endoscopic capsule study with suspicion of digestive bleeding of small bowel origin were selected. The variables analyzed were age, sex, findings and a useful variable of the study in digestive bleeding. The system of the endoscopic capsule that was used was the Pill Cam 2 of the GIVEN of small intestine. Results: Among the results, an average age distribution of 58±17 years of age was found, of which 56% were patients under 65 years of age and 44% were older than 65 years. The most frequent cause of bleeding in the small intestine of the three groups studied was angiodysplasias in 9%. Multiple erosions were found in 8% of the patients. The presence of erosionaded small bowel tumors was observed in 5%. The endoscopic capsule in the detection of causes of digestive bleeding was useful in determining the etiology in 84% of cases. In the evident bleeding it was useful in 85%, in the anemia group 84% and in the group of occult bleeding in 85%. Conclusion: Small intestine digestive hemorrhage can occur at any age and in any gender. The most common findings of small bowel hemorrhage are angiodysplasias that are related to age, as well as multiple erosions of the intestinal mucosa. The endoscopic capsule is a very useful method in the etiological detection of small bowel hemorrhage. (AU)

Esófago negro: necrosis esofágica aguda. Serie de casos / Black esophagus: acute esophageal necrosis. Number of cases

La necrosis esofágica aguda, también conocida como esófago negro, es una patología poco común que se diagnostica mediante endoscopia que muestra una mucosa esofágica de aspecto negro. Presentamos 3 casos de necrosis esofágica aguda cuya patogénesis multifactorial correspondió a nuestros pacientes, especialmente la hipoperfusión; que es probablemente el factor clave de las lesiones esofágicas. Los pacientes presentaron las mismas características endoscópicas, y las biopsias esofágicas de 2 pacientes tenían un patrón histológico de inflamación severa y necrosis, uno de ellos asociado con infección micótica. Aunque la evolución fue favorable en todos, uno se complicó con estenosis esofágica

Acute esophageal necrosis also known as black esophagus is a rare disease diagnosed by endoscopy esophageal mucosa showing a black appearance. We present three cases of acute esophageal necrosis, the multifactorial pathogenesis was in our patients, especially hypoperfusion being probably the key factor for esophageal lesions. Patients had the same characteristics and samples endoscopic esophageal biopsies from two patients had a histological pattern of severe inflammation and necrosis, one associated with fungal infection. All had a favorable outcome, and presented as a complication esophageal stenosis in one of the cases presented.

PlayStation PortableTM como tratamiento de la ambliopía en los niños / PlayStation PortableTM as treatment for children with amblyopia

Objetivo: Determinar la efectividad de la terapia visual con el uso del PlayStation PortableTM en la ambliopía. Método: Se incluyeron 40 pacientes de 5-10 años de edad con ambliopía estrábica, anisometrópica o ambas, aleatorizados en 4 grupos según el tipo de terapia a utilizar (10 pacientes por grupo): grupo 1, PlayStation PortableTM y lentes rojo-verde; grupo 2, PlayStation PortableTM y lentes con vidrio esmerilado en el ojo fijador (no ambliope); grupo 3, PlayStation PortableTM y parche oclusivo en el ojo fijador; grupo 4, parche oclusivo en el ojo fijador sin el PlayStation PortableTM. Todos los pacientes utilizaron su refracción. Las actividades de los grupos 1 al 3 incluyeron jugar videojuegos y ver películas 1-2 horas al día; el grupo 4 podía realizar cualquier actividad. Se valoró la agudeza visual mejor corregida semanalmente, hasta completar 3 meses de tratamiento. En el postratamiento se valoró la agudeza visual mejor corregida mensualmente durante 3 meses. Resultados: En total se estudiaron 40 pacientes, de los cuales el 60 por ciento fueron del sexo femenino, con un promedio de edad de 8,2 años, rango de 5-10 años. El tipo más frecuente de ambliopía fue la estrábica (55 por ciento), seguido de la anisometrópica (37,5 por ciento) y ambas (7,5 por ciento). En cuanto al ojo afectado, en el 62,5 por ciento fue el ojo izquierdo y en el 37,5 por ciento el ojo derecho. Conclusiones: En este estudio el grupo con mejores resultados fue el de filtro rojo-verde. Al suspender la terapia se observó un deterioro visual en los cuatro grupos, sin regresar a la basal. Se demuestra que el PlayStation PortableTM funciona como terapia en la ambliopía con una mejoría en la agudeza visual mejor corregida(AU)

Objective: Determine the effectiveness of visual therapy with PlayStation PortableTM for amblyopia. Methods: The study sample was composed of 40 patients aged 5-10 years with strabismic amblyopia, anisometropic amblyopia or both, randomized to 4 groups according to the therapy to be used (10 patients per group): Group 1: PlayStation PortableTM and red-green lenses; Group 2: PlayStation PortableTM and frosted glass lenses on the fixating (non-amblyopic) eye; Group 3: PlayStation PortableTM and occlusive patch on the fixating eye; Group 4: occlusive patch on the fixating eye without PlayStation PortableTM. All the patients used their refraction. The activities performed by Groups 1-3 included playing video games and watching movies 1-2 hours per day; Group 4 could perform any activity. Best corrected visual acuity was measured weekly until completing 3 months of treatment. In the post-treatment period best corrected visual acuity was measured monthly for 3 months. Results: A total 40 patients were studied, of whom 60 percent were female, with a mean age of 8.2 years, range of 5-10 years. Strabismic amblyopia was the most common type (55 percent), followed by anisometropic amblyopia (37,5 percent) and both (7.5 percent). The affected eye was the left eye in 62.5 percent and the right eye in 37.5 percent. Conclusions: It was found that PlayStation PortableTM is effective as therapy for amblyopia, improving best corrected visual acuity. The group with the best results was the red-green filter group. Upon suspension of the therapy, visual deterioration was observed in the 4 groups, without returning to baseline values(AU)

Reporte de cáncer colorrectal atendido en el Hospital Metropolitano de Quito, 2013-2016 / Colorectal cancer report treated in the Metropolitan Hospital of Quito, 2013-2016

Resumen: En la revisión retrospectiva se contabilizó un total de 57 casos de cáncer colorrectal (CCR) atendidos en esta casa de salud: 32 (56%) hombres y 25 (44 %) mujeres; el grupo etario con mayor frecuencia es de >40 años; el sitio predominante es el recto (15 casos = 26%). Según el tipo histológico son: adenocarcinomas 47 casos (82%); de acuerdo a la diferenciación histológica la mayoría son moderadamente diferenciados: 24 casos (42%) y, finalmente, según el estadiaje de piezas quirúrgicas, la mayoría son CCR avanzados en estadio T4 (48%).

Abstract: In the retrospective review, a total of 57 cases of RCC attended in this health home were counted, of which 32 (56%) men and 25 (44%) women; The age group is most often 40 years or older. The predominant site is the rectum with 15 cases corresponding to 26%. According to the histological type, adenocarcinomas with 47 cases (82%); according to the histological differentiation of the most moderately differentiated cases with 24 cases (42%); and finally in relation to the set of surgical pieces, most of their children CCR advanced stage T4 (48%).

Neoplasia endocrina múltiple tipo 1 A propósito de un caso / Multiple endocrine neoplasia type 1 About a case

La neoplasia endocrina múltiple tipo 1 (NEM1) es un raro síndrome hereditario, autosómico dominante, clásicamente caracterizado por tumores en varias glándulas (paratiroides, adenohipófisis e islotes pancreáticos). La prevalencia del NEM1 es de aproximadamente 2 por 100.000 habitantes.El síndrome de Zollinger Ellison (SZE) es una de las 3 neoplasias que forman parte del NEM1 y corresponde al 20 a 60%. A continuación se presenta el caso clínico de un paciente de sexo masculino, 66 años de edad, con cuadro clínico de síndrome de Zollinger Ellison que, en investigación posterior, evidencia alteración funcional de las glándulas paratiroides, cumpliendo criterios diagnósticos de neoplasia endocrina múltiple tipo 1 (NEM1).(AU)

Multiple endocrine neoplasia type 1 (MEN1) is a rare autosomal dominant hereditary syndrome, classically characterized by the presence of tumors in several glands (parathyroid, anterior pituitary and pancreatic islets) The prevalence of MEN 1 is approximately 2 per 100,000 inhabitants. The Zollinger Ellison syndrome (ZES) is one of the three neoplasias that form part of the MEN 1, and corresponds to 20 to 60%. The clinical case of a 66-year-old male patient, with a clinical of Zollinger Ellison Syndrome, who in a subsequent investigation shows functional abnormality of the parathyroid glands, fulfilling diagnostic criteria of Multiple Endocrine Neoplasia type 1 (NEM1) (AU)

Growing cava vein anastomosis: comparison of cross-clamping and suture times using VCS metallic clips, interrupted nonabsorbable, or continuous absorbable suturing techniques.

BACKGROUND: The latest generation in titanium clip application systems, the AnastoClip Vessel Closure System (VCS; LeMaitre Vascular, Burlington, MA), allows surgeons to perform vascular anastomosis more easily and faster than conventional sutures. This system may become the option of choice for vascular reconstruction in pediatric surgery where, as in the case transplant surgery, decreasing vascular occlusion times may influence outcome. The aim of this study was to determine whether VCS metallic clips would allow shorter anastomosis times than conventional interrupted polypropylene or running polyglycolic acid suturing in end-to-end anastomosis performed in the abdominal cava of young pigs. METHODS: Thirty-two domestic swine, 45 days old, were used for this study. All animals were subjected to an end-to-end anastomosis in the abdominal cava. RESULTS: VCS clips are easier to use for the surgeon, significantly decreasing cross-clamping time in caval anastomosis (VCS 10.33 ± 1.75 min vs. interrupted polypropylene sutures 46.00 ± 6.16 min vs. continuous polyglycolic acid sutures 18.16 ± 1.47 min). CONCLUSIONS: VCS clips significantly decrease the time needed for performing an end-to-end anastomosis in the abdominal cava, decreasing cross-clamping time when compared to interrupted polypropylene or running polyglycolic acid sutures.

Heterotopic renal transplantation in piglets using vascular closure stapler metallic clips or conventional suturing techniques: comparison of vessel growth and macroscopical study.

BACKGROUND/PURPOSE: Our aim was to perform a macroscopic and imaging (ultrasonographic and angiographic) evaluation of vascular closure stapler (VCS) metallic clips for renal transplantation in growing piglets to assess their role for transplantation surgery in young children. If these techniques are to be useful, it is necessary to prove that their use avoids one of the main pitfalls of conventional sutures in this setting, namely lack of growth in the suture line. METHODS: Twenty-four piglets were used for this study. Animals were subjected to a heterotopic renal autotransplantation when they were 45 days old. The right kidney was moved from its normal location to the cranial area of the iliac fossa. The end-to-side anastomoses between the renal artery and vein and the aorta and vena cava, respectively, were performed using VCS metallic clips in 6 animals. Continuous polypropylene suturing was used in another 6 piglets, and continuous polyglycolic acid suture was used in 6 additional piglets. A control group of 6 animals without renal autotransplantation was also included in the study. All animals were allowed to grow for 6 months, during which time serial angiographic and ultrasonographic studies were carried out to assess the existence of vascular flow disturbances or stenosis. Similarly, angiographic measurements were obtained to document growth at the anastomotic site. Longitudinal growth was evaluated postmortem after the 6-month growing period. RESULTS: Angiography showed significant (P < .001) transverse growth in both arteries and veins belonging to the VCS clips, running absorbable suture, or control groups. No significant difference was observed among the 3 groups. Vascular growth in the running nonabsorbable suture (polypropylene) group, however, was significantly less than in the other 3 groups and did not significantly differ from baseline. Baseline luminal diameters at the anastomotic site as measured by angiography in the VCS group were 3.64 ± 0.40 mm in the artery and 5.30 ± 1.43 mm in the vein. After growth, these values increased to 6.87 ± 0.90 mm and 11.27 ± 2.53 mm, respectively. Significant longitudinal growth was evidenced macroscopically after 6 months in both aorta and vena cava in all groups. On the other hand, significant longitudinal growth in the renal artery and vein were only observed in the control, VCS, and absorbable suture groups. CONCLUSIONS: In this experimental setting, satisfactory macroscopic and angiographic vascular growth results were obtained using the VCS clips, suggesting that this suture could be the technique of choice in pediatric transplantation surgery.

[Ultrasonographic histological study on the evolution of a canine model of hormone-induced benign prostatic hyperplasia]. / Estudio ultrasonográfico e histológico de la evolución de un modelo canino de hiperplasia benigna de próstata inducida por hormonas.

INTRODUCTION: Despite exhibiting histological differences from the human process, canine hormone-induced benign prostatic hyperplasia (BPH) is still the most widely used animal model for evaluating treatment strategies. OBJECTIVES: The aim of this study is to determine the optimal moment for starting a therapeutic trial in this animal model. MATERIAL AND METHODS: Six male beagle dogs over one year of age were used in this study. All animals received a combination of steroid hormones, namely 17beta-estradiol and 5alpha-androstene 3alpha 17beta-diol, every other day during three (Group 1, n=3) or five months (Group 2, n=3). Transrectal ultrasonographic examinations to measure prostate volume were performed monthly. Animals were euthanized after five months for histological study of their prostates. RESULTS: All animals developed BPH, with prostate volume increasing over time as hormones were administered (r=0,910). All ultrasonographic studies performed up to the third month evidenced a significant increase in prostate volume when compared to the prior ultrasound measurement. A significant decrease in prostate volume was seen in Group 1 once hormone administration was interrupted, whereas Group 2 animals showed a continuing increase in prostate size. Histological examination showed almost no evidence of BPH in Group 1 animals, while Group 2 animals clearly exhibited moderate epithelial hyperplasia. CONCLUSIONS: The administration of a combination of steroid hormones is effective in inducing benign prostatic hyperplasia in canines, but this hyperplasia disappears when hormone treatment is interrupted. In order to be useful for experimental studies, hormones should be administered for at least three months before commencing any treatment, and they should be continued throughout the length of the study..

Estudio ultrasonográfico e histológico de la evolución de un modelo canino de hiperplasia benigna de próstata inducida por hormonas / Ultrasonographic histological study on the evolution of a canine model of hormone-induced benign prostatic hyperplasia

Introducción: A pesar de exhibir diferencias histológicas con el proceso en humanos, la hiperplasia benigna de prostáta (HBP) inducida por hormonas en perros representa el modelo más utilizado actualmente para la evaluación de tratamientos. Objetivos: El objetivo del presente estudio es determinar el momento óptimo para la realización de un ensayo terapéutico en este modelo. Material y métodos: En el estudio se utilizaron 6 perros beagle, machos mayores de un año, a los que se administró una combinación de hormonas, 17b-estradiol y 5a-androsteno 3a17b-diol, en días alternos durante 3 (grupo 1, n = 3) o 5 meses (grupo 2, n = 3). Se realizaron seguimientos ultrasonográficos mensuales, con determinación del tamaño prostático. A los 5 meses se procedió al sacrificio de todos los animales y el estudio histológico de las glándulas prostáticas. Resultados: Todos los animales desarrollaron una HBP, con un volumen prostático que aumentaba con el tiempo de administración hormonal (r = 0,910), evidenciándose en todos los estudios ecográficos hasta el tercer mes un aumento significativo de tamaño frente al estudio anterior. El tamaño prostático disminuyó considerablemente en el grupo 1 al retirarla hormonoterapia, al tiempo que en el grupo 2 continuó aumentando. Los animales del grupo 1 apenas evidenciaron signos histológicos de HBP, frente a los del grupo 2, que presentaron una clara hiperplasia del epitelio glandular. Conclusiones: La administración de una combinación de hormonas esteroides es efectiva para inducir hiperplasia de próstata en perro, si bien ésta desaparece en el momento que se retira la hormonoterapia. Para utilizar este modelo en estudios experimentales, se deben administrar hormonas al menos durante 3 meses antes de la actuación terapéutica, y continuar durante todo el ensayo (AU)

Introduction: Despite exhibiting histological differences from the human process, canine hormone-induced benign prostatic hyperplasia (BPH) is still the most widely used animal model for evaluating treatment strategies. Objectives: The aim of this study is to determine the optimal moment for starting a therapeutic trial in this animal model. Material and methods: Six male beagle dogs over one year of age were used in this study. All animals received a combination of steroid hormones, namely 17b-estradiol and 5a-androstene 3a 17b-diol, every other day during three (Group 1, n=3) or five months (Group 2, n=3). Transrectal ultrasonographic examinations to measure prostate volume were performed monthly. Animals were euthanized after five months for histological study of their prostates. Results: All animals developed BPH, with prostate volume increasing over time as hormones were administered (r=0,910). All ultrasonographic studies performed up to the third month evidenced a significant increase in prostate volume when compared to the prior ultrasound measurement. A significant decrease in prostate volume was seen in Group 1 once hormone administration was interrupted, whereas Group 2 animals showed a continuing increase in prostate size. Histological examination showed almost no evidence of BPH in Group 1 animals, while Group 2 animals clearly exhibited moderate epithelial hyperplasia. Conclusions: The administration of a combination of steroid hormones is effective in inducing benign prostatic hyperplasia in canines, but this hyperplasia disappears when hormone treatment is interrupted. In order to be useful for experimental studies, hormones should be administered for at least three months before commencing any treatment, and they should be continued throughout the length of the study (AU)

[Titanium metallic clips: easier and faster than conventional suturing for heterotopic renal autotransplant in growing pigs]. / Clips metálicos de titanio: una técnica de sutura más rápida y fácil de utilizar que las suturas convencionales en autotrasplantes renales heterotópicos en cerdos en crecimiento.

INTRODUCTION: When performing vascular reconstruction in growing elements, specifically in paediatric transplant surgery, where a short vascular occlusion time is mandatory, master and easily handled suturing methods are needed. Thus the present study compares conventional continuous suturing with polypropylene and dexon versus easier and faster to apply titanium clips in heterotopic renal autotransplants. MATERIAL AND METHODS: 24 growing pigs were used for this study. Heterotopic renal autotransplant was performed when the animals were 45-days-old using VCS clips, continous Polypropylene or Dexon suturing when anastomosing the renal artery and vein to the aorta and cava in an end-to-side fashion RESULTS: VCS clips were easy to use for the surgeon, significantly (P < or = 0.001) decreasing the time needed for end-to-side anastomosis of the renal artery to the aorta (clips, 5.31 +/- 0.80 min/Polypropylene, 14.25 +/- 2.25 min/Dexon, 14.37 +/- 2.97 min); and also the time needed for end-to-side anastomosis of the renal veins to the cava (clips, 8.25 +/- 1.98 min/Polypropylene, 16.25 +/- 2.96 min/Dexon, 19.00 +/- 4.50 min). CONCLUSIONS: The use of VCS clips in heterotopic renal autotransplants significantly decreases the time needed for vascular reconstruction, compared to conventional suturing.

Clips metálicos de titanio: una técnica de sutura más rápida y fácil de utilizar que las suturas convencionales en autotrasplantes renales heterotópicos en cerdos en crecimiento / Titanium metallic clips: easier and faster than conventional suturing for heterotopic renal autotransplant in growing pigs

Introducción: En reconstrucciones de elementos vasculares en crecimiento y concretamente en la cirugía de trasplantes pediátricos donde disminuir el tiempo de clampado es muy importante se necesitan métodos de sutura que aporten rapidez y facilidad de manejo al cirujano, es así que hemos planteado un nuevo estudio experimental donde frente a las técnicas de sutura convencionales continuas con polipropileno y Dexon, planteamos el uso de clips de titanio con el objetivo de conseguir su fácil y rápida aplicación en Autotrasplantes Renales Heterotópicos. Material y métodos: Se utilizan 24 cerdos en crecimiento, que son sometidos a los 45 días de edad a un Autotrasplante Renal Heterotópico, con clips metálicos VCS, con técnicas de sutura convencionales continuas con polipropileno y con Dexon en anastomosis término-laterales de arteria y vena renal a la arteria aorta y vena cava. Resultados: Confirmamos que los aplicadores de clips VCS son más fáciles de utilizar para el cirujano y disminuyen significativamente (P≤0,001) el tiempo empleado en las anastomosis término- laterales de las arterias renales a la arteria aorta (clips, 5,31±0,80min/Polipropileno, 14,25±2,25 min/Dexon, 14,37±2,97 min); disminuyendo significativamente también (P≤0,001) el tiempo empleado en las anastomosis término- laterales de las venas renales a la vena cava (clips, 8,25±1,98 min/Polipropileno, 16,25±2,96 min/Dexon, 19,00±4,50 min). Conclusiones: Los clips VCS aplicados en Autotrasplantes Renales Heterotópicos reducen significativamente con respecto a las suturas convencionales el tiempo empleado en realizar las reconstrucciones vasculares (AU)

Introduction: When performing vascular reconstruction in growing elements, specifically in paediatric transplant surgery, where a short vascular occlusion time is mandatory, master and easily handled suturing methods are needed. Thus the present study compares conventional continuous suturing with polypropylene and dexon versus easier and faster to apply titanium clips in heterotopic renal autotransplants. Material and methods: 24 growing pigs were used for this study. Heterotopic renal autotransplant was performed when the animals were 45 days old using VCS clips, continous Polypropylene or Dexon suturing when anastomosing the renal artery and vein to the aorta and cava in an end-to-side fashion Results: VCS clips were easy to use for the surgeon, significantly (P≤0.001) decreasing the time needed for end-to-side anastomosis of the renal artery to the aorta (clips, 5.31±0.80 min/ Polypropylene, 14.25±2.25 min/Dexon, 14.37±2.97 min); and also the time needed for end-to-side anastomosis of the renal veins to the cava (clips, 8.25±1.98 min/Polypropylene, 16.25±2.96 min/ Dexon, 19.00±4.50 min). Conclusions: The use of VCS clips in heterotopic renal autotransplants significantly decreases the time needed for vascular reconstruction, compared to conventional suturing (AU)

Bursitis por norcardia / Bursitis by norcardia

Presentamos un caso interesante, con el hallazgo de una bacteria poco frecuente, que no esperábamos. En las enfermedades músculo-esqueléticas, las infecciones es una causa en la que siempre debemos pensar, también en los casos crónicos. Hay muy pocos reportes de bursitis por nocardia. A nivel de piel se encuentra como piodermitis o el llamado micetoma. En nuestro caso no encontramos manifestaciones pulmonares, que el la forma más frecuente de presentación. Pensamos que la puerta de entrada para la infección fue un manejo intervensionista o por la infiltración de corticoide en la articulación afectada.