Outcomes in patients managed with endovascular stent for malignant superior vena cava syndrome.

Background: Malignant Superior Vena Cava Syndrome (SVCS) corresponds to the clinical manifestations due to the restriction of venous return to the right atrium secondary to obstruction of the superior vena cava and/or its main tributaries for a tumor. Endovascular management has proven to be safe, effective and cause a fast symptomatic relief in patients with SVCS. There is limited evidence in factors associated with outcomes in malignant setting for this procedure. Materials and methods: An analytical retrospective study was conducted and included patients that underwent endovascular management for malignant SVCS at the National Cancer Institute of Colombia between May 2016 and May 2021. Clinical and technical variables were analyzed to found associations with outcomes in these patients. Results: 54 patients were analyzed. Successful procedure rate was 94.4 %. At 10 months, the OS of the entire cohort of patients was 25 %. Patients with breast or lung cancer (P = 0.031), unsuccessful procedure (P = 0.011), and also with short time of symptoms to the date of the endovascular procedure (P = 0.027) had worse OS. Multivariate analysis showed that lung cancer [HR = 2.55, 95%IC:(1.21-5.36)] and left internal jugular vein or left Innominate vein distal stent attachment [HR = 3.27, 95%IC:(1.31-8.15)] were independent factors for worst OS. Conclusions: Based in the high success rate of the endovascular management and the better outcome in patients with early and successful procedure, this procedure should be considered as part of the multimodal treatment in patients with SVCS independent of the clinical scenario and the oncological diagnosis.

Prevalence of systemic lupus erythematosus in Colombia: data from the national health registry 2012-2016.

INTRODUCTION: Registries are essential to keep track of systemic lupus erythematosus (SLE) epidemiology and to provide better care to patients. The Colombian Ministry of Health has adopted a registry (SISPRO) to gather comprehensive information coming from the Colombian health system, which provides close to universal coverage (around 95%). The information collected from SISPRO is available for scientific analysis. OBJECTIVES: We used data collected by SISPRO to estimate prevalence and specific characteristics of patients with SLE registered from January 2012 to December 2016. METHODS: This is a descriptive epidemiological study using the International Statistical Classification of Diseases and Related Health Problems as search terms related to SLE, based on SISPRO data. Criteria for diagnosis are not explicitly addressed in each individual case. RESULTS: National records report 41,804 patients with a diagnosis of SLE for an estimated prevalence of 91.9/100,000 subjects (based on a total population of 47,663,162), being more frequent in women (89% cases). When adjusted, female and male prevalences were 204.3 and 20.2 per 100,000 (ratio 10.1) with a 7.9:1 female:male ratio, and were highest in the 45-49-year age group. CONCLUSIONS: This is the first study that describes demographic characteristics of SLE in Colombia, with useful information for decision makers. It also suggests a similar prevalence to other countries.

Uso de inhibidores de la bomba de protones en Atención Primaria ¿correcto? / Use of proton pump inhibitors in primary care. Always right?

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Neural maps for target range in the auditory cortex of echolocating bats.

Computational brain maps as opposed to maps of receptor surfaces strongly reflect functional neuronal design principles. In echolocating bats, computational maps are established that topographically represent the distance of objects. These target range maps are derived from the temporal delay between emitted call and returning echo and constitute a regular representation of time (chronotopy). Basic features of these maps are innate, and in different bat species the map size and precision varies. An inherent advantage of target range maps is the implementation of mechanisms for lateral inhibition and excitatory feedback. Both can help to focus target ranging depending on the actual echolocation situation. However, these maps are not absolutely necessary for bat echolocation since there are bat species without cortical target-distance maps, which use alternative ensemble computation mechanisms.

Abordaje de las emociones en gestalt y en psicodrama. Del lenguaje a la imagen / No disponible

El objetivo de este trabajo es analizar de una forma vivencial y por medio de la práctica de distintas técnicas tanto gestálticas como psicodramáticas, la aparición de la emoción, su grado e intensidad y cómo se ponen de manifiesto al uso de cada una de las mismas. A la vez, estudiaré las diferencias que sobre las emociones ejercen tanto el uso del lenguaje por parte del terapeuta, más propio de la técnica gestáltica, como el uso de la imagen, más propia de la técnica psicodramática (AU)

The objective of this work is to analyze in an experiential way and through the practice of various techniques both gestalt as psychodrama, the emergence of emotion, its degree and intensity and how are shown the use of each of them. At the same time, I will study differences that over emotions exert both the use of language by the therapist, more typical of the gestalt technique, such as the use of the image, most of the Psicodramatic technique (AU)

Banco de cerebros. ¿Conocidos por nuestros pacientes? / Brain banks. Do our patients know about them?

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Continuously evaluating performance in deceased donation: the Spanish quality assurance program.

The Spanish Quality Assurance Program applied to the process of donation after brain death entails an internal stage consisting of a continuous clinical chart review of deaths in critical care units (CCUs) performed by transplant coordinators and periodical external audits to selected centers. This paper describes the methodology and provides the most relevant results of this program, with information analyzed from 206,345 CCU deaths. According to the internal audit, 2.3% of hospital deaths and 12.4% of CCU deaths in Spain yield potential donors (clinical criteria consistent with brain death). Out of the potential donors, 54.6% become actual donors, 26% are lost due to medical unsuitability, 13.3% due to refusals to donation, 3.1% due to maintenance problems and 3% due to other reasons. Although the national pool of potential donors after brain death has progressively decreased from 65.2 per million population (pmp) in 2001 to 49 pmp in 2010, the number of actual donors after brain death has remained at about 30 pmp. External audits reveal that the number of actual donors could be 21.6% higher if all potential donors were identified and preventable losses avoided. We encourage other countries to develop similar comprehensive approaches to deceased donation performance.

Plan de formación y docencia en un centro integral de cáncer: estrategia e implementación / Continuing education and teaching plans in a comprehensive cancer centre: strategy and implementation

Introducción. El Institut Català d’Oncologia (ICO) puso en marcha la Unidad de Formación y Docencia (UFiD), en el año2006, con el objetivo de potenciar el desarrollo profesional, la difusión del conocimiento y la calidad de la atención oncológica. En el presente artículo se describe el proceso de puesta en marcha de la UFiD, los resultados del estudio de las necesidades formativas realizada por los profesionales y colectivos de la institución, las acciones formativas organizadas, y en el área de docencia, los resultados de la reorganización de las trayectorias docentes de los diferentes servicios, así como el apoyo de nuevas iniciativas. Materiales y métodos. Durante el periodo 2008-2009, se implantaron acciones formativas y docentes en concordancia con los resultados del estudio de necesidades y con las líneas estratégicas de la institución. Se realizaron un total de 71actividades formativas, con 898 participantes de todas las categorías profesionales, con una tasa de satisfacción de los participantes de 7,8 sobre 10. En el apartado de docencia, durante el mismo periodo se realizaron 3 másteres, 3 posgrados,59 cursos de actualización con metodología semipresencial y 19 cursos con metodología online, todos ellos con acreditación académica. La satisfacción media fue de 8 sobre 10.Resultados y conclusiones. La actividad llevada a cabo por la UFiD ha permitido, por una parte, articular la formación continuada en base al estudio de las necesidades de los profesionales, lo que ha contribuido a promover el desarrollo profesional y la calidad asistencial de éstos, y por otra parte, dar soporte a las actividades docentes ya existentes y promover nuevas iniciativas para favorecer la difusión de conocimientos en el área oncológica, lo que ha posicionado al ICO como un centro absolutamente comprometido con la formación oncológica (AU)

Introduction. The Oncology Catalonian Institute (ICO) launched the training and education unit (UFiD) in 2006, in order to enhance professional development, dissemination of knowledge and quality of the oncology care. Here are described the tune-up of this process and the results of the training needs survey carried out among the professionals and collectives of the centre. Materials and methods. Training and educational actions deployed during 2008 and 2009 and its evaluation results are presented. A total of 60 training activities were carried out in which 719 students of all professional categories participated, and with a score of participant’s satisfaction of 7.8 out of 10. In the area of education, the paths of the different services were reorganized and new initiatives were supported. A total of 3 masters, 3 post-graduate degrees, 59 update courses with semi-presential (blended learning) methodology and 19 on-line methodology courses, all of them with academicaccreditation were imparted with a satisfaction average score of 8 out of 10.Results and conclusions. The activity carried out by the UFiD during this period, has made possible to articulate the continuing training based on the study of the professionals needs. This has allowed promoting the professional development and the quality of the care. Supporting existing training activities and promoting new initiatives encourage the dissemination of knowledge in the area of oncology and has positioned us as a centre committed to oncology training (AU)

Rotura del tendón del tríceps asociada a bursitis olecraniana e infiltraciones con corticoides / Triceps tendon rupture associated with olecranon bursitis and steroid injections

Se presenta un estudio anatomopatológico que demuestra la relación existente entre la rotura iterativa distal del tendón del tríceps y la historia previa de varias infiltraciones de corticoides para el tratamiento de una bursitis olecraniana, así como los resultados satisfactorios obtenidos tras la reparación primaria mediante sutura transósea en el olécranon a las 6 semanas de la rotura. El tratamiento de los tejidos inflamados con inyecciones locales de esteroides presenta riesgos, sobre todo si se hacen de forma repetida y directamente sobre el tendón, especialmente en atletas de fuerza, y por extensión en trabajadores de fuerza, quienes hacen una alta demanda de su estructura músculoesquelética

An anatomopatologic study appears that demonstrates the existing relation between the iterative distal triceps tendon rupture and the previous history of several steroid injections for the treatment of olecranon bursitis, as well as the obtained satisfactory results after the primary repair through drill holes in the olecranon to the 6 weeks of the rupture. The treatment of weaves inflamed with local steroid injections present risks, mainly if they become of repeated form and directly of the tendon, specialing in athletes of force and, by they extension in working of force, who make a high demand of their musculoesqueletic structure

Specializations for aerial hawking in the echolocation system of Molossus molossus (Molossidae, Chiroptera).

While searching for prey, Molossus molossus broadcasts narrow-band calls of 11.42 ms organized in pairs of pulses that alternate in frequency. The first signal of the pair is at 34.5 kHz, the second at 39.6 kHz. Pairs of calls with changing frequencies were only emitted when the interpulse intervals were below 200 ms. Maximum duty cycles during search phase are close to 20%. Frequency alternation of search calls is interpreted as a mechanism for increasing duty cycle and thus the temporal continuity of scanning, as well as increasing the detection range. A neurophysiological correlate for the processing of search calls was found in the inferior colliculus. 64% of neurons respond to frequencies in the 30- to 40-kHz range and only in this frequency range were closed tuning curves found for levels below 40 dB SPL. In addition, 15% of the neurons have double-tuned frequency-threshold curves with best thresholds at 34 and 39 kHz. Differing from observations in other bats, approach calls of M. molossus are longer and of higher frequencies than search calls. Close to the roost, the call frequency is increased to 45.0-49.8 kHz and, in addition, extremely broadband signals are emitted. This demonstrates high plasticity of call design.

Mortalidad hospitalaria en unidades de críticos y muertes encefálicas según los códigos de la Clasificación Internacional de Enfermedades / In-hospital mortality in critical care units and brain death according to the International Classification of Diseases codes

Fundamento. Caracterizar el potencial de donación de órganos en los hospitales según la enfermedad neurológica atendida y los procedimientos de neurocirugía y neurorradiología intervencionista realizados, codificados mediante la Novena Clasificación Internacional de Enfermedades (CIE-9).Material y método. Estudio multicéntrico de tipo transversal, realizado en 3 hospitales españoles con servicios de neurocirugía y 2 sin neurocirugía. Las principales variables de interés son: número de altas hospitalarias, número de fallecidos en el hospital y en las unidades de cuidados intensivos (UCI) y número de muertes encefálicas (ME) en pacientes con alguna de las enfermedades, o que se les practicó alguno de los procedimientos, correspondientes a los códigos de la CIE seleccionados. Resultados. Las principales causas de diagnósticos al alta hospitalaria fueron las mismas en ambos tipos de hospitales (contusión craneal, hemorragia intracerebral, accidentes cerebrovasculares [ACV] isquémicos y enfermedad cerebrovascular aguda mal definida). Sin embargo, las principales causas de ME difieren; la hemorragia intracerebral y los ACV isquémicos son más frecuentes en los hospitales sin neurocirugía, mientras que los traumatismos craneoencefálicos y la hemorragia subaracnoidea predominan en los hospitales con neurocirugía. Las 5 primeras causas de ME en los hospitales con neurocirugía representaron el 76,1 por ciento del total, y en los hospitales sin neurocirugía, el 86,7 por ciento. Respecto a los procedimientos seleccionados, la evolución a ME fue del 10,4 por ciento de las embolizaciones intracraneales, del 6,4 por ciento en el caso de la neurocirugía y del 2,3 por ciento en las arteriografías. Conclusiones. Es difícil obtener una información homogénea en los hospitales a partir de fuentes administrativas. Existen grandes diferencias entre hospitales con y sin neurocirugía respecto a las causas específicas de ME. Mediante el análisis de tan sólo 5 de los códigos seleccionados, se puede predecir un alto porcentaje de pacientes que fallecen en ME. En los hospitales con neurocirugía y neurorradiología intervencionista es más útil la información de diagnósticos que de procedimientos para predecir el porcentaje de fallecimientos en ME (AU)

Catastrophic antiphospholipid syndrome complicating orthotopic liver transplantation.

Catastrophic antiphospholipid syndrome (CAPS) is an acutely devastating situation characterized by widespread thrombotic microangiopathy in the presence of elevated titers of antiphospholipid antibodies. We describe a 57-year old woman who underwent liver transplantation for primary sclerosing cholangitis and developed this malignant variant of the antiphospholipid syndrome.

Utilización de la ventilación mecánica en 72 unidades de cuidados intensivos en España / Utilization of mechanical ventilation in 72 Spanish intensive care units

Fundamento. La ventilación mecánica es una técnica fundamental en las unidades de cuidados intensivos (UCI). El objetivo es conocer su utilización y las diferencias en su aplicación en 72 UCI españolas. Métodos. Estudio de cohortes de los pacientes ventilados durante más de 12 h. Se registraron datos demográficos, indicación de la ventilación mecánica, parámetros ventilatorios, modos de ventilación y desconexión, y días de soporte ventilatorio, días de estancia y situación al alta. Resultados. Se incluyó a 1.103 pacientes (29 per cent) de los ingresados, un 66 per cent de varones, con una mediana de edad de 65 años y del SAPS II de 43.No se observaron diferencias geográficas en la aplicación de la ventilación mecánica ni en los desenlaces principales. En el 64 per cent la indicación de ventilación fue insuficiencia respiratoria. Al inicio, la modalidad asistida-controlada fue la más utilizada (90 per cent), con un volumen tidal medio (desviación estándar [DE]) 8,9 (2,0) ml/kg y PEEP 5,5 (2,2) cmH2O. El 4 per cent recibió ventilación no invasora, el 68 per cent de los enfermos no precisó intubación. La duración de la ventilación fue 7 (8) días. El método de desconexión más utilizado fue una prueba única diaria de respiración espontánea (58 per cent). La duración fue de 3 (5) días. La incidencia de traqueostomía fue 15 per cent y se realizó a los 14 (8) días. La mortalidad en la UCI fue del 32,8 per cent y en el hospital del 42,8 per cent. Conclusiones. La comparación de la utilización de la ventilación mecánica en 72 UCI españolas evidencia una práctica similar, con mínimas diferencias en el uso de los modos de ventilación y desconexión y una similar mortalidad y días de estancia (AU)

Toxoplasma gondii pneumonia in liver transplantation: survival after a severe case of reactivation.

Toxoplasmosis is an infrequent infection in solid organ transplantation, except in heart transplantation, where the grafting of a positive organ in a negative recipient transmits the infection in a high percentage of cases, in the absence of prophylaxis. We report a case of pneumonia by Toxoplasma gondii in a woman who received a liver transplant and had pre-transplant positive serology. Diagnosis was made by cytologic examination of bronchoalveolar lavage fluid, where the parasite was observed with hematoxylin-eosin and Giemsa staining. That finding was confirmed by direct immunofluorescence and positive polymerase chain reaction. The patient had a favorable outcome, although she had not initially received first-choice drugs. This was a case of severe illness secondary to reactivation of Toxoplasma infection, diagnosed pre-mortem and with a favorable outcome. Duration of treatment and need for secondary prophylaxis in these patients are discussed in the literature. Although infrequent, toxoplasmosis must be considered among the differential diagnoses of pulmonary infiltrates in solid organ transplantation.

Radiografía simple de tórax

Hansen CP, Holtveg H, Franxis D, Rasch L, Bertelsen S. Pulmonary hamartoma. J Thorac Cardiovasc Surg 1992; 104:674-678.Meyer CA, White CS. Cartilaginous disorders of the chest. Radiographics 1998; 18:1.109-1.123.Ramírez-Chávez G, Trucy E, Félix-Page D. Le diagnostic des hamartomes pulmonaires. Ann Radiol 1985; 28:35-42.Reed JC. Radiología torácica. Patrones radiológicos y diagnóstico diferencial (2.a ed). Barcelona: Doyma, 1985.Sigelman SS, Khouri NF, Scott WW Jr, Leo FP, Hamper UM, Jishman EK, Zerhoumi E. Pulmonary hamartoma: CT findings. Radiology 1986; 160:313-317. (AU)

Polyacrylonitrile membrane interposition between a xenograft and a patient in fulminant liver failure: the concept of xenohemodiafiltration in clinical practice.

Fulminant hepatic failure is an important cause of morbidity and mortality in intensive care units. Conventional therapies are not sufficiently effective. Liver transplantation may be life saving, but a "bridge therapy" is needed until transplantation is performed. Hepatic extracorporeal xenohemodiafiltration (XHDF) is aimed at the transitory support of a patient with fulminant hepatic failure. The first clinical case of XHDF is presented. The system consisted of cross-circulation between a porcine liver and a patient with fulminant liver failure through a polyacrylonitrile membrane. The procedure lasted for 5 hours and produced hemodynamic, biochemical, and metabolic improvements. Intracranial pressure decreased from 34 to 5 cm H2O, serum ammonia fell from 673 to 370 ng/dl, lactic acid from 11 to 5.3 mmol/L, and bilirubin from 7.4 to 2.5 mg/dl. Hemodynamic values were maintained stable throughout the procedure. The patient was able to undergo transplantation and remains alive 11 months later. XHDF is a clinical experimental method that can constitute an alternative clinical therapy to support patients with fulminant hepatic failure until an organ is available for transplantation.

Tránsito intestinal

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