3D impression to facilitate in situ surgical renal segmental artery aneurysm repair: A novel open approach option for an unusual vascular condition.

OBJECTIVES: Renal Artery Aneurysms (RAA) affect approximately 0.01%-0.97% of the population. Early diagnosis, thorough 3D-preoperative planning, and timely surgical treatment may offer effective and safe management. METHODS: We report the open reparation of a segmental renal artery saccular aneurysm close to the bifurcation with detailed preoperative planning based on 3D printing, and with successful postoperative results. RESULTS: We report the case of a 36-year-old man with a 3.5 × 5 cm segmental renal artery saccular aneurysm close to the bifurcation, for which endovascular management was ruled out and open management was chosen with detailed preoperative planning based on 3D printing and with successful postoperative results. CONCLUSIONS: When an open approach is chosen in the RAA treatment, a detailed study of the anatomical configuration of the RAAs is mandatory, and life-size 3D printing is a valuable tool that could contribute to the operative technique, reduce surgical times associated with renal ischemia and provide minute details that would make a clear anatomical difference during in situ repair.

Survival, Short And Long-Term Outcomes Of Open And Endovascular Surgical Repair Of Unruptured Infrarenal Abdominal Aortic Aneurysms.

INTRODUCTION: Endovascular Aortic Repair (EVAR) has become the standard management of Unruptured Infrarenal Abdominal Aortic Aneurysm (UIAAA); however, current evidence is limited and uncertain in our environment compared to Open repair. Our study aimed to determine the survival, short and long-term outcomes of EVAR vs. Open in a Peruvian cohort of UIAAA. METHODS: A single-center observational, analytical, longitudinal study using a retrospective registry of 251 patients treated (EVAR=205 vs Open=46) for UIAAA from 2000 to 2017. Variables considered were baseline, comorbidities, type of treatment, short-term (<30 days) and long-term (<5 years) outcomes, postoperative mortality according to the Vascular Quality Initiative (VQI) Risk Score, survival curves including reoperation-free rate and according to size (<65 mm vs. >65 mm) of long-term UIAAA. All variables were grouped according to the treatment performed (EVAR vs. Open) and we used the descriptive, multivariate, Cox regression, and Kaplan-Meier survival statistical analyses. RESULTS: 251 UIAAA were evaluated and the mean age was 74.5 years [±13.32], smoking, family members with UIAAA, and previous abdominal surgery were the main antecedents. Diabetes mellitus 2 was the main comorbidity; more than 50% of patients with UIAAA had diameters greater than 65 mm (p=0.021). The calculated mortality (VQI) was Open=2.21% vs. EVAR=1.65%. The outcomes in short-term were mortality (Open=2.92% vs. EVAR=0%; p=0.039), blood transfusion >4 Units (Open=72.68% vs. EVAR=17.39%; p=0.021) and overall hospital stay (Open=14 vs. EVAR=5 days; p=0.049. A reduction in mortality (HR 0.76, 95% CI, 0.62-0.96, p=0.045) and readmission for aneurysmal rupture was identified for EVAR (HR 0.81, 95% CI, 0.79-0.85, p=0.031). In long-term outcomes, mortality (Open=3.41% vs. EVAR=19.56%; p=0.047), aneurysmal rupture (Open=0% vs. EVAR 13.04%; p=0.032) and reinterventions (Open=2.43% vs. EVAR=10.86%; p=0.002). An 86% risk of mortality (HR 1.86, 95% CI, 1.32-2.38, p=0.039) and elevated risk of readmission for aneurysmal rupture was identified for EVAR (HR 2.21, 95% CI, 1.98-2.45, p=0.028). At 5 years, survival for Open=93.67% vs. EVAR=80.44% (p=0.043), reintervention-free survival for Open=89.26% vs. EVAR=47.82% (p=0.021), survival for treated IUAAA <65 mm for Open=95.77% vs. EVAR=63.63% (p=0.019) and >65 mm for Open=92.53% vs. EVAR=85.71% (p=0.059). CONCLUSION: EVAR has shown better short-term benefits and survival than Open management; however, the latter still prevails in the long term in our Peruvian UIAAA cohort. Further follow-up studies are required to demonstrate the long-term benefit of EVAR in our population.

[Atypical presentation of ruptured aneurysmal right sinus of Valsalva with severe aortic insufficiency]. / Presentación atípica de rotura de seno de Valsalva derecho aneurismático con insuficiencia aortica severa.

Aneurysm of the Sinus of Valsalva (ASV) is a rare abnormality and affects less than 0.1% of the general population. We describe the case of a 37-year-old woman with a clinical picture characterized by dyspnea, palpitations, and syncope of 6 years of evolution. The echocardiographic study revealed a right ASV with a sub pulmonary interventricular perforation of 8mm and producing a regurgitant jet into the right ventricle, causing dilatation of the right ventricular outflow tract, pulmonary artery, and severe aortic insufficiency Carpentier DI. The patient underwent successful repair of the defect and interventricular perforation, and valve replacement was not necessary. Timely echocardiographic diagnosis and early surgery are the main predictors that make the difference between an excellent outcome and certain death.

Analysis of congenital heart disease research: Mapping impact, production and global collaboration.

Background: Congenital heart disease (CHD) is a severe childhood health problem worldwide. This study analyzes the scientific production on CHD published in Scopus during the last decade. Methods: This study assessed the research on CHD conducted during the 2011-2020 period. Indexed publications were identified using a list of keywords consisting of MeSH (Medical Subject Heading) and Emtree (EMBASE) terms for the category "Congenital Heart Defects." The studies obtained were analyzed using the SciVal platform, and the production, impact, and collaboration indicators were considered. Additionally, an analysis of co-occurrence between countries and keywords was carried out with the VOSviewer software. Results: The study found 8934 articles on CHD. A growing trend was observed during the last decade. The distribution of the scientific production at the international level shows that most publications are from the United States, China, and the United Kingdom, whereas Latin American countries have the lowest production. The articles analyzed contain a total of 89,835 citations. Most studies are published in high-impact journals (Q1), with 3273 studies corresponding to 39.3% of the total production analyzed. In the keyword analysis, we found five areas investigated. Conclusions: Scientific production has shown sustained growth in the past years. Increased scientific production in specific research areas may have helped decrease morbimortality due to CHD.

Congenital Gerbode defect in an adult patient: report of an extremely rare case.

Gerbode Defect (GD) is a rare congenital heart disease that mainly affects the upper portion of the membranous septum, generating a shunt between the left ventricle and the right atrium. Even though most cases are congenital, it has also been reported acquired cases due to cardiac surgery, infective endocarditis, acute ischemic heart disease, and invasive percutaneous procedures. The diagnostic workup includes the clinical evaluation and the echocardiographic study. Here, we present the case of a 43-year-old adult patient with an incidental finding of a congenital GD in the context of acute appendicitis. Imaging plays a role in the diagnostic workup of congenital diseases; in this case, it allowed us to identify more details and the decision-making for our patient.

El defecto de Gerbode (DG) es una cardiopatía congénita rara que afecta principalmente a la porción superior del tabique membranoso, generando un shunt entre el ventrículo izquierdo y la aurícula derecha. Aunque la mayoría de los casos son congénitos, también se han descrito casos adquiridos debidos a cirugía cardiaca, endocarditis infecciosa, cardiopatía isquémica aguda y procedimientos percutáneos invasivos. El estudio diagnóstico incluye la evaluación clínica y el estudio ecocardiográfico. Presentamos el caso de un paciente adulto de 43 años con un hallazgo incidental de un DG congénito en el contexto de una apendicitis aguda. La imagen desempeña un papel importante en el estudio diagnóstico de las enfermedades congénitas; en este caso nos permite identificar más detalles y sirve para la toma de decisiones como en nuestro paciente.

Bentall surgery and total arch repair with debranching of supra-aortic vessels: a case report.

BACKGROUND: The surgical approach to pathologies of the Ascending Thoracic Aorta (ATA) that compromise aortic root and the aortic arch is currently one of the most complex interventions in the spectrum of cardiac surgery, where circulatory arrest with cerebral perfusion plays an important role for Success postoperative and patient survival. CASE PRESENTATION: We present the case of a 57-year-old patient with the only history of arterial hypertension and an ATA Aneurysm that compromised segment of the aortic root up to segment 2 of the aortic arch. A successful Bentall surgery was performed, debranching supra-aortic vessels with Total Circulatory Arrest with Deep Hypothermic Cerebral Perfusion-Antegrade Bilateral. CONCLUSIONS: With the advent of new anesthetic and neuroprotection techniques, perioperative imaging protocols, advanced hemodynamic monitoring, and invaluable advances in perfusion and Extracorporeal Circulation with circulatory arrest, they have made this surgical challenge a valuable tool for today's cardiovascular surgeon.

Acute Limb Ischemia in a Peruvian Cohort Infected by COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) infection can cause alterations in the coagulation mechanism conditioning thrombotic phenomena such as acute limb ischemia (ALI) as the only manifestation of the infection. The aim of the study was to describe clinical and surgical characteristics of a group of patients infected with severe acute respiratory syndrome coronavirus 2 who presented ALI in the context of the COVID-19 pandemic at Lima, Peru. METHODS: A multicenter, observational, and retrospective study was performed in six general hospitals, from March to July 2020. The variables considered were the pathological history and associated habits, laboratory tests, the severity of COVID-19 infection and ALI, the anatomic location of the lesion, treatment, evolution, and discharge conditions. RESULTS: Thirty patients with ALI infected with COVID-19 were evaluated. Their mean age was 60 ± 15 years, the condition being more frequent in men (76.6%). The main comorbidities were arterial hypertension (33.3%), obesity (33.3%), and diabetes mellitus 2 (26.6%). There were 23.3% asymptomatic patients, and their only manifestation was ALI. Rutherford IIA and IIB stage included 93.2% of patients. The most frequent location of the thrombosis was the lower limbs (73.3% vs. 26.6%). Thrombectomy was performed in 76.6% of the patients, and amputation (primary and secondary) was performed in 30% of the patients. The mortality rate was 23.3%, all of it because of acute respiratory distress syndrome. CONCLUSIONS: ALI is a vascular pathology associated with embolic and thrombotic processes. COVID-19 infection can cause severe alterations in coagulation mechanisms, leading some patients to present severe acute arterial complications such as thrombosis, as the only associated manifestation. We report a younger cohort than those described in other studies and with a high frequency of amputations despite adequate surgical treatment.

Ankle-brachial index: more than a diagnostic test?

The ankle-brachial index (ABI) is the relationship between the systolic blood pressure taken at the ankle level and the brachial artery. A pathological ABI (<0.90 or >1.40) indicates the presence of peripheral artery disease (PAD). Many studies indicate the great utility of this test in the diagnosis of PAD due to its ease of use, reproducibility, low cost, and high cost-effectiveness. This evaluation can be directly correlated with cardiovascular morbidity and mortality; however, it has recently been confirmed that a low ABI can be a predictor of major cardiovascular events, as it is related to diabetes mellitus, chronic coronary disease, stroke, and more. The objective of this work was to review the current evidence on the importance of ABI in the diagnosis of PAD and its main role as a predictor of cardiovascular morbidity and mortality.

El índice tobillo-brazo (ITB) es la relación entre la presión arterial sistólica tomada entre el tobillo y la arteria braquial. Un ITB patológico (<0,90 o >1,40) indica la presencia de enfermedad arterial periférica (EAP). Muchos estudios muestran la gran utilidad de esta prueba en el diagnóstico de la EAP debido a su facilidad de uso, reproducibilidad, bajo coste y alta rentabilidad. Esta evaluación puede correlacionarse directamente con la morbilidad y mortalidad cardiovascular; sin embargo, recientemente se ha confirmado que un ITB bajo puede ser un predictor de eventos cardiovasculares mayores, ya que está relacionado con la diabetes mellitus, la enfermedad coronaria crónica y el ictus, entre otros. El objetivo de este trabajo fue revisar la evidencia actual sobre la importancia del ITB en el diagnóstico de la EAP y su papel principal como predictor de morbilidad y mortalidad cardiovascular.

Survival and adequate preoperative staging in patients undergoing gastric cancer surgery at a Peruvian Police Hospital.

INTRODUCTION: Gastric cancer is the fifth most common malignant neoplasm and the third leading cause of cancer-related death worldwide. In Peru, its incidence is 15.8 per 100,000 population, and it is associated with high mortality rates, especially in areas with low socioeconomic status. The aim of this study was to compare preoperative, postoperative, and anatomopathological staging results and their relation to disease recurrence and survival. METHODS: We conducted a retrospective cohort study of patients undergoing surgery for gastric cancer with a definitive postoperative anatomopathological diagnosis from 2005 to 2014 at the Hospital Nacional Luis N. Sáenz. Statistical analyses included descriptive and correlation statistics using the κ index, determination of associations between preoperative and postoperative staging and surgical reintervention and recurrence using the χ2  test, as well as Kaplan Meier survival analysis. RESULTS: There was little correlation between preoperative staging and final anatomopathological diagnosis, while there was a good correlation with postoperative staging. A significant association was found between preoperative staging and cancer recurrence. In the survival analysis, survival was lower among patients with underestimated staging. CONCLUSIONS: The survival of patients with gastric cancer can be affected by an overestimation of preoperative staging, therefore improvements in preoperative staging could lengthen the survival of patients undergoing gastric cancer surgery.

Teratoma quístico maduro de ovario, experiencia en un hospital del norte del perú: reporte de caso / Mature cystic teratoma of the ovary, experience in a hospital in northern perú: case report

Los Teratomas Quísticos son tumores de origen embrionario que están compuestos por células germinales pluripotenciales. Se presenta el caso de una mujer de 57 años, que ingresa al servicio de emergencia por presentar como molestia principal una tumoración abdominal dolorosa a predominio de región mesogástrica. En los estudios realizados, se determinó por imagen una masa anexial derecha asociada a valores elevados del marcador tumoral Antígeno Carcinogénico 125 (CA-125). Bajo la sospecha clínica de la presencia de una neoplasia maligna de ovario, sumado a los hallazgos clínicos e imagenológicos se optó por una conducta quirúrgica. Se llevó a cabo una cirugía radical (Cistectomía, histerectomía radical ampliada, apendicectomía, omentectomía, disección ganglionar y lavado peritoneal). Los estudios anatomopatológicos postoperatorios concluyeron con el diagnóstico de un Teratoma Quístico Benigno de Ovario. Se ha demostrado que esta patología representa un cuadro clínico de comportamiento benigno, pero ante la existencia de pequeños porcentajes que podrían tener un curso maligno, se recomienda el principio de la detección y manejo temprano con la finalidad de reducir cualquier posibilidad de malignidad mediante una intervención médica oportuna.

Cystic Teratomas are tumors of embryonic origin that are composed of pluripotent germ cells. It was presented the case of a 57-year-old woman admitted to the emergency department for presenting as a major annoyance due to a painful abdominal mass to a predominance of the mesogastric region. In the studies performed, a right adnexal mass associated with high values of the tumor marker 125 Carcinogenic Antigen (CA-125) is determined. Under the suspicion of a malignant ovarian neoplasm, added to the clinical and imaging findings, a surgical approach was chosen. Radical surgery was performed (cystectomy, extended radical hysterectomy, appendectomy, omentectomy, lymph node dissection and peritoneal lavage). The postoperative anatomopathological studies concluded with the diagnosis of a Benign Ovarian Cystic Teratoma. It has been demonstrated that this pathology represents a clinical picture of benign behavior, but in the presence of small percentages that may have a malignant course. Therefore, the principle of detection and early management for unidentified purposes of a timely medical entity is recommended.

Lesiones cutáneas como manifestación de una histoplasmosis diseminada en un hospital del Perú / Skin lesions of a disseminated histoplasmosis in Peru

The dermatological manifestations of disseminated histoplasmosis present in about 17% of the cases, is a challenge for its diagnosis. We report the case of a patient from the northern coast of Peru, who presented diffuse dermal lesions, erythema-violaceous nodules, and ulcers histopathologically compatible with the infection of the genus Histoplasma var. capsulatum

[Skin lesions of a disseminated histoplasmosis in Peru]. / Lesiones cutáneas como manifestación de una histoplasmosis diseminada en un hospital del Perú.

The dermatological manifestations of disseminated histoplasmosis present in about 17% of the cases, is a challenge for its diagnosis. We report the case of a patient from the northern coast of Peru, who presented diffuse dermal lesions, erythema-violaceous nodules, and ulcers histopathologically compatible with the infection of the genus Histoplasma var. capsulatum.