The Tropical Andes Biodiversity Hotspot: A Comprehensive Dataset for the Mira-Mataje Binational Basins.

We present a flora and fauna dataset for the Mira-Mataje binational basins. This is an area shared between southwestern Colombia and northwestern Ecuador, where both the Chocó and Tropical Andes biodiversity hotspots converge. We systematized data from 120 sources in the Darwin Core Archive (DwC-A) standard and geospatial vector data format for geographic information systems (GIS) (shapefiles). Sources included natural history museums, published literature, and citizen science repositories across 13 countries. The resulting database has 33,460 records from 6,821 species, of which 540 have been recorded as endemic, and 612 as threatened. The diversity represented in the dataset is equivalent to 10% of the total plant species and 26% of the total terrestrial vertebrate species in both hotspots. The dataset can be used to estimate and compare biodiversity patterns with environmental parameters and provide value to ecosystems, ecoregions, and protected areas. The dataset is a baseline for future assessments of biodiversity in the face of environmental degradation, climate change, and accelerated extinction processes.

Agreement about Availability of Alternative Treatments for Innovative Drugs Assessed by the EMA and HTA Organizations.

The European Medicines Agency (EMA) and European national/regional health technology assessment (HTA) organizations consider the availability of existing treatments when evaluating a new drug. Since disagreement about the availability of alternative treatments may impact patient access to new drugs, this study aimed to investigate whether the EMA and HTA organizations agreed on the availability of alternative treatments and whether a lack of alternative treatments was associated with HTA organizations' added benefit assessment outcomes. For 97 innovative drugs authorized in 2019-2021 (excluding vaccines and diagnostic tools), assessments by the EMA and AEMPS (Spain), AIFA (Italy), HAS (France), IQWiG/G-BA (Germany), NICE (England and Wales), and ZIN (the Netherlands) were identified. Until 1 June 2022, 429 HTA drug-indication combinations were identified for these 97 drugs, of which 205 exactly matched the EMA's indication. For those, the overall agreement between the EMA and HTA organizations on whether alternative treatments were available was 87%. The agreement of HTA organizations with the EMA on whether available treatments were either pharmacological on-label, pharmacological off-label, or non-pharmacological was 87%, 21%, and 57%, respectively. For all 429 HTA drug-indication combinations, absence of alternative treatments as considered by HTA organizations was associated with a higher chance to provide added benefit: risk ratio 1.8 (95%-CI 1.4-2.3). In conclusion, although there was high overall agreement between the EMA and HTA organizations about whether alternative treatments exist, there were differences in the types of treatment considered. Parallel joint scientific consultations could inform drug developers about relevant alternative treatments to facilitate patient access to innovative drugs.

Colgajo supraclavicular como herramienta en el manejo multidisciplinar de un cordoma cervical c2-c4. A propósito de un caso / Supraclavicular flap as a tool in the multidisciplinary management of a cervical c2-c4 chordoma. Purpose of a case

Los cordomas son tumores óseos poco frecuentes, de crecimiento lento, derivados de remanentes de la notocorda. Se localizan predominantemente en la base del cráneo y la región sacrococcígea. La columna cervical se ve afectada únicamente en el 6 % de los casos. El tratamiento de elección incluye la resección en bloque, radioterapia y en ocasiones quimioterapia.Presentamos el caso de un paciente con diagnóstico de cordoma cervical sin respuesta a un tratamiento previo con radioterapia, que se somete a cirugía de rescate para resección, corpectomía C2-C3 y fijación con material protésico. Presentó una dehiscencia de herida quirúrgica en región orofaríngea en el postoperatorio, con exposición del material protésico. Se resolvió con un colgajo supraclavicular pediculado para cobertura del defecto en pared faríngea posterior. (AU)

Chordomas are rare, slow-growing bone tumors derived from remnants of the notochord. They are located predominantly at the skull base and the sacrococcygeal region. The cervical spine is affected in only 6 % of cases. The treatment of choice includes resection, radiotherapy and sometimes chemotherapy.A case of a patient diagnosed with cervical chordoma without response to previous radiotherapy treatment is presented. The patient underwent surgical rescue including tumor excision, C2-C3 corpectomy and fixation with prosthetic material. He presented a surgical wound dehiscence in the oropharyngeal region in the postoperative period, with exposure of the prosthetic material. It was resolved with a pedicled supraclavicular flap to cover the defect in the posterior pharyngeal wall. (AU)

Tumor de Buschke-Löwenstein en una niña. A propósito de un caso

El tumor de Buschke-Löwenstein es un condiloma acuminado gigante, benigno, cuyas lesiones clínicas son mayores de 10 cm, por lo que el tratamiento de elección debería ser siempre quirúrgico. Se presenta el caso de una niña de un año con condiloma gigante en la vulva, tumor de Buschke-Löwenstein de rápida evolución, a quien se le practicó resección quirúrgica satisfactoria. Se revisó la literatura respecto a su diagnóstico y tratamiento.

Buschke-Löwenstein tumor is a benign giant condyloma acuminatum, whose clinical lesions are larger than 10 cm, so the treatment of choice should always be surgical. We present the case of a one-year-old girl with giant condyloma of the vulva, a rapidly evolving Buschke-Löwenstein tumor, who underwent successful surgical resection. The literature was reviewed regarding its diagnosis and treatment.

Bullying and Psychological Dating Violence: The Relation Between two Aggressive Peer-Behaviours / Bullying y Violencia Psicológica en el Cortejo: Relación Entre dos Comportamientos Agresivos Entre Iguales

BACKGROUND: Previous research has suggested that bullying could be related to teen dating violence; there may be a psycho-developmental transition between bullying and other forms of violence during adolescence as an evolution of the aggressive pattern. This study attempts to identify the role of bullying as a risk factor for psychological violence in adolescents' dating relationships, and the relationship between these two aggressive behaviours. METHOD: The participants were 3,144 adolescents from Valencia (50.6% girls), enrolled in Primary Education (50.4%) and Secondary Education (49.6%). RESULTS: The results showed rates of involvement in bullying as high as 46.2%, while the rates of psychological dating aggression were 31.4%. The multinomial logistic regression analysis identified aggression in bullying as a predictive variable for psychological aggression during dating, while the predictors of victimization were also linked to those for victimization in bullying. After analysing the interactions, the results showed that particularly in boys, previous experience of indirect perpetration of bullying is a risk variable of later psychological dating aggression, and that this kind of experience in Primary School is a significant predictor variable for both aggression and victimization in dating. CONCLUSIONS: The results are discussed in terms of the psycho-developmental pattern of these aggressive behaviours

ANTECEDENTES: trabajos previos apuntan a una posible relación, como transición psico-evolutiva, entre el bullying y otras formas de violencia durante la adolescencia, en términos de evolución en la manifestación del mismo patrón de comportamiento agresivo. Este estudio trata de identificar el rol del bullying como factor de riesgo para la violencia psicológica en las relaciones sentimentales adolescentes y la relación que se da entre ambos comportamientos agresivos. MÉTODO: 3.144 jóvenes valencianos (50,6% chicas) de Educación Primaria (50,4%) y Secundaria Obligatoria (49,6%) participaron en el estudio. RESULTADOS: las tasas de implicación en bullying alcanzaban el 46,2% y las de violencia psicológica en el cortejo el 31,4%. Análisis de regresiones logísticas multinomiales identificaron como variable predictora de la perpetración psicológica en el cortejo la agresión previa en bullying, mientras que las predictoras de la victimización fueron las relacionadas con la victimización en bullying. El análisis de las interacciones muestra que la experiencia previa en perpetración indirecta de los chicos es una variable predictora de la perpetración psicológica, así como la experiencia en Primaria es una variable predictora significativa para ambas formas de implicación. CONCLUSIONES: estos resultados son discutidos en términos del carácter psicoevolutivo del comportamiento agresivo durante la adolescencia

Bullying and Psychological Dating Violence: The Relation Between two Aggressive Peer-Behaviours.

BACKGROUND: Previous research has suggested that bullying could be related to teen dating violence; there may be a psycho-developmental transition between bullying and other forms of violence during adolescence as an evolution of the aggressive pattern. This study attempts to identify the role of bullying as a risk factor for psychological violence in adolescents' dating relationships, and the relationship between these two aggressive behaviours. METHOD: The participants were 3,144 adolescents from Valencia (50.6% girls), enrolled in Primary Education (50.4%) and Secondary Education (49.6%). RESULTS: The results showed rates of involvement in bullying as high as 46.2%, while the rates of psychological dating aggression were 31.4%. The multinomial logistic regression analysis identified aggression in bullying as a predictive variable for psychological aggression during dating, while the predictors of victimization were also linked to those for victimization in bullying. After analysing the interactions, the results showed that particularly in boys, previous experience of indirect perpetration of bullying is a risk variable of later psychological dating aggression, and that this kind of experience in Primary School is a significant predictor variable for both aggression and victimization in dating. CONCLUSIONS: The results are discussed in terms of the psycho-developmental pattern of these aggressive behaviours.

Constrictive Pericarditis with Extensive Calcification and Caseous Necrosis.

Constrictive pericarditis is a disease where loss of pericardial elasticity and restriction of filling of the cardiac chambers occurs. It is most often seen as an associated symptom of heart failure. Pericardiectomy provides effective treatment for patients with symptomatic constrictive pericarditis, although high rates of morbidity and mortality are related to the procedure. We present a case with extensive calcification, massive caseous necrosis and an important impairment of right ventricular function successfully operated in our institution.

Constrictive pericarditis with extensive calcification and caseous necrosis

Abstract Constrictive pericarditis is a disease where loss of pericardial elasticity and restriction of filling of the cardiac chambers occurs. It is most often seen as an associated symptom of heart failure. Pericardiectomy provides effective treatment for patients with symptomatic constrictive pericarditis, although high rates of morbidity and mortality are related to the procedure. We present a case with extensive calcification, massive caseous necrosis and an important impairment of right ventricular function successfully operated in our institution.

Pandemia de Covid-19 y efecto de medidas de contención en población Peruana: Un modelamiento matemático SIR / Covid-19 pandemic and effect of containment measures in the Peruvian population: A SIR mathematical modeling

Introducción: La evolución de la pandemia del COVID-19 varía en cada población; complicando los sistemas de salud a nivel mundial. Objetivo: analizar la evolución de la pandemia Covid-19 estimando el efecto de las medidas de contención realizadas en Perú. Material y Métodos: Se aplicó el modelamiento matemático epidemiológico SIR, estimando la evolución COVID-19 en nuestra población. Se realizó el análisis de datos siguiendo el modelo matemático SIR con ecuaciones diferenciales ordinarias definidas para simular el comportamiento epidemiológico; y fue ejecutado en el lenguaje de programación RStudio. Resultados: En el estudio las medidas de contención disminuyeron la tasa de propagación, redujeron el 30% de casos infectados hasta el día pico de infección; sin embargo, ésta aún se encuentra por encima del número reproductivo efectivo para control de la epidemia y presenta una tendencia errática, el resultado de las acciones gubernamentales es del 61% en la práctica de medidas de contención. Conclusiones: Las medidas de contención son necesarias; siempre que, se consideren estrategias que permitan hacer efectivo su rol en nuestra población

Introduction: The evolution of the COVID-19 pandemic varies in each population; it has been complicating health systems worldwide. Objective: to analyze the evolution of the Covid-19 pandemic, estimating the effect of the containment measures practiced in Peru. Material and Method: The SIR epidemiological mathematical modeling was applied, estimating the COVID-19 evolution in our population. Data analysis was performed following the SIR mathematical model with defined ordinary differential equations to simulate epidemiological behavior; and it was executed in the RStudio programming language. Results: Containment measures decreased the propagation rate, reducing 30% of infected cases until the peak day of infection; however, it is still above the effective reproductive number to control the epidemic and it shows an erratic trend, the result of government actions being 61% in the practice of containment measures. Conclusions: Containment measures are necessary if strategies are considered to make their role effective in our population.

Global socio-economic losses and environmental gains from the Coronavirus pandemic.

On 3 April 2020, the Director-General of the WHO stated: "[COVID-19] is much more than a health crisis. We are all aware of the profound social and economic consequences of the pandemic (WHO, 2020)". Such consequences are the result of counter-measures such as lockdowns, and world-wide reductions in production and consumption, amplified by cascading impacts through international supply chains. Using a global multi-regional macro-economic model, we capture direct and indirect spill-over effects in terms of social and economic losses, as well as environmental effects of the pandemic. Based on information as of May 2020, we show that global consumption losses amount to 3.8$tr, triggering significant job (147 million full-time equivalent) and income (2.1$tr) losses. Global atmospheric emissions are reduced by 2.5Gt of greenhouse gases, 0.6Mt of PM2.5, and 5.1Mt of SO2 and NOx. While Asia, Europe and the USA have been the most directly impacted regions, and transport and tourism the immediately hit sectors, the indirect effects transmitted along international supply chains are being felt across the entire world economy. These ripple effects highlight the intrinsic link between socio-economic and environmental dimensions, and emphasise the challenge of addressing unsustainable global patterns. How humanity reacts to this crisis will define the post-pandemic world.

Anticuerpos anti-SARS-COV-2 en gestantes en un hospital nivel III de Perú / SARS-COVID-19 antibodies in pregnant women at a level III hospital in Peru / SARS-COVID-19 antibodies in pregnant women at a level III hospital in Peru

RESUMEN Introducción . La enfermedad de COVID-19 se propaga rápidamente. Se desconoce la seroprevalencia en mujeres embarazadas que ingresan a hospitalización y sus características propias en este tipo de población en Perú. Objetivo . Determinar la prevalencia y características clínico-epidemiológicas de gestantes con anticuerpos anti-SARS-CoV-2 en un hospital nivel III de Perú. Métodos . Estudio observacional de tipo transversal, realizado en el Instituto Nacional Materno Perinatal de Perú, entre el 15 de abril y 15 de mayo de 2020. Participaron todas las gestantes que ingresaron a hospitalización y fueron tamizadas para la infección por SARS-CoV-2 mediante pruebas serológicas, cuyos resultados fueron analizados conjuntamente con sus características clínicas y epidemiológicas, utilizando estadígrafos descriptivos e intervalos de confianza al 95%, y mediante la prueba de independencia de chi cuadrado con una significancia de 0,05. Resultados . Se tamizaron 2 419 embarazadas, identificando una prevalencia de 7,0% con resultados positivos a los anticuerpos anti-SARS-CoV-2 (IC95%: 6,1% a 8,1%). Se observó IgM en 10% (IC95%: 6,1% a 15,8%), IgM/IgG en 78,8% (IC95%: 71,8% a 84,6%), IgG en 11,2% (IC95%: 7% a 17,1%). El 89,4% de gestantes seropositivas fueron asintomáticas. Se observó como complicaciones obstétricas más frecuentes la rotura prematura de membranas (11,8%) y la preeclampsia (6,5%). No se halló asociación de las características clínico epidemiológicas y el tipo de respuesta serológica para el virus SARS-CoV-2 (p>0,05). Conclusiones . Las gestantes con ingreso hospitalario en el periodo estudiado presentaron prevalencia de anticuerpos anti-SARS-CoV-2 de 7,0%, siendo mayormente asintomáticas. No se evidenció asociación entre las características clínico-epidemiológicas analizadas y el tipo de respuesta de los anticuerpos anti- SARS-CoV-2.

ABSTRACT Introduction: COVID-19 disease spreads rapidly. Seroprevalence in pregnant women entering for hospitalization and clinical characteristics in this type of population in Peru is not known. Objective: To determine the prevalence and clinical-epidemiological characteristics of pregnant women with anti-SARS-CoV-2 antibodies at a level III hospital in Peru. Methods: Observational and cross-sectional study performed at the National Maternal Perinatal Institute of Peru. Pregnant women admitted for hospitalization were screened for COVID-19 infection. Results of anti-SARSCoV-2 serological tests and information on maternal and perinatal characteristics were obtained. Data analysis was performed using descriptive statistics and 95% confidence intervals. Results: In 2 419 pregnant women screened we identified a prevalence of 7.0% of anti-SARS-CoV-2 antibodies (95% IC: 6.1% to 8.1%), including IgM in 10% (95% IC: 6.1% to 15.8%), IgM / IgG in 78.8% (95% IC: 71.8% to 84.6%), IgG in 11.2% (95% IC: 7.0% to 17.1%). 89.4% of the seropositive pregnant women were asymptomatic. Most frequent complications were premature rupture of membranes (11.8%) and preeclampsia (6.5%). No association was found between clinical and epidemiologic characteristics and type of serological response to SARS-CoV-2 (p > 0.05). Conclusions: Pregnant women had prevalence of anti-SARS-CoV-2 antibodies of 7.0% on admission to the hospital; most of them were asymptomatic. There was no association between clinical-epidemiological characteristics analyzed and type of anti-SARS-CoV-2 antibody response.

Healthy Operator 4.0: A Human Cyber-Physical System Architecture for Smart Workplaces.

Recent advances in technology have empowered the widespread application of cyber-physical systems in manufacturing and fostered the Industry 4.0 paradigm. In the factories of the future, it is possible that all items, including operators, will be equipped with integrated communication and data processing capabilities. Operators can become part of the smart manufacturing systems, and this fosters a paradigm shift from independent automated and human activities to Vhuman-cyber-physical systems (HCPSs). In this context, a Healthy Operator 4.0 (HO4.0) concept was proposed, based on a systemic view of the Industrial Internet of Things (IIoT) and wearable technology. For the implementation of this relatively new concept, we constructed a unified architecture to support the integration of different enabling technologies. We designed an implementation model to facilitate the practical application of this concept in industry. The main enabling technologies of the model are introduced afterward. In addition, a prototype system was developed, and relevant experiments were conducted to demonstrate the feasibility of the proposed system architecture and the implementation framework, as well as some of the derived benefits.

Transmandibular Approach in Head and Neck Oncological Surgery.

Objective: To evaluate the advantages and disadvantages of the transmandibular approach to the posterior area of the maxilla, oropharyngeal region and the hypopharynx in head and neck surgery. Methods: A series of 42 patients who underwent a lip-split mandibulotomy procedure to access malignant tumours affecting deep areas of the head and neck region between 2008 and 2018 in the Department of Oral and Maxillofacial Surgery at the Ramón y Cajal University Hospital (Madrid, Spain) were retrospectively reviewed. The diagnosis and operations data of the patients were collected and analysed. Results: Using the transmandibular approach, 42 patients were operated on to access malignant tumours located in the oropharynx (n = 23, 54.76%) including the posterior third of the tongue, tonsil and soft palate, retromolar trygone (n = 9, 21.43%), floor of the mouth (n = 3, 7.14%), skull base (n = 2, 4.76%), superior maxilla (n = 3, 7.14%) and deep lobe of the parotid gland (n = 2, 4.76%). Primary reconstruction was carried out in all cases. The most used flap reconstruction method was the forearm fasciocutaneous flap in 48.71% of cases, followed by the anterolateral thigh flap in 20.51% of cases. The remaining cases were treated with other methods. The most frequent complication was surgical wound infection. Conclusion: The transmandibular approach is a good alternative to provide access for the removal of complex tumours affecting the oropharyngeal region. This approach facilitates direct visualisation of the lesion and bleeding control, allowing tumour resection with wide margins and making primary reconstruction easier. Although further progress in the transoral robotic approach could be a good option in selected cases, given the current state of knowledge, the transmandibular approach is a good option to access tumours affecting deep areas of the oral cavity and oropharynx.

Heart Injury with Projectile Lodged Inside the Heart.

Penetrating heart injuries present high mortality rates. Increasing rates of urban violence have contributed to a significant rise in the number of heart injuries by firearm projectiles. Such injuries are associated with the highest mortality rates among penetrating cardiac injuries and may involve one or more cardiac chambers. We present the case of a police officer who, in an approach to five robbers, suffered a transfixed cardiac injury by firearm with the projectile having been lodged inside the right ventricle. This patient was successfully operated, 65 days after the injury, at our institution.

Heart injury with projectile lodged inside the heart

Abstract Penetrating heart injuries present high mortality rates. Increasing rates of urban violence have contributed to a significant rise in the number of heart injuries by firearm projectiles. Such injuries are associated with the highest mortality rates among penetrating cardiac injuries and may involve one or more cardiac chambers. We present the case of a police officer who, in an approach to five robbers, suffered a transfixed cardiac injury by firearm with the projectile having been lodged inside the right ventricle. This patient was successfully operated, 65 days after the injury, at our institution.

Anisakiasis y endometriosis intestinal, entidades infravaloradas en el diagnóstico diferencial de abdomen agudo / Anisakiasis and intestinal endometriosis: under-recognized conditions in the differential diagnosis of acute abdomen

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Anisakiasis and intestinal endometriosis: under-recognized conditions in the differential diagnosis of acute abdomen.

Anisakiasis and endometriosis is rare cause of intestinal obstruction and even perforation, the latter being extremely rare. We report the case of a patient with intestinal obstruction that progress to perforation and whose differential diagnosis is complex. The interest in this clinical case lies in the unexpected histology of the surgical specimen after the intervention of the patient, because the intestinal endometriosis as intestinal anisakiasis are rare entities that make diagnosis difficult.

TIPIFICACIÓN DE LA GALLINA CRIOLLA EN LOS AGROECOSISTEMAS CAMPESINOS DE PRODUCCIÓN EN LA ZONA DE INFLUENCIA DE LA SELVA DE FLORENCIA (CALDAS) / CHARACTERIZATION OF THE CREOLE HEN IN THE PEASANT PRODUCTION AGRO-ECOSYSTEM IN THE RAIN-FOREST AREA OF INFLUENCE IN FLORENCIA (CALDAS)

La avicultura de traspatio es una actividad pecuaria de gran importancia en las comunidades rurales del país, caracterizada por la baja inversión requerida y por la facilidad para efectuarla; las especies más utilizadas son las criollas dado que se adaptan a las condiciones adversas para su crianza, esta actividad fortalece el bienestar de las familias campesinas que aprovechan al máximo la mano de obra familiar y es una fuente generadora de bienes para el hogar campesino. Objetivo: Caracterizar los diferentes sistemas de producción avícola de traspatio en la zona de influencia de la Selva de Florencia del municipio de Samaná del departamento de Caldas. Metodología: De las 103 fincas del área de estudio se encuestaron 76 fincas, correspondientes a la totalidad de los predios con producción de gallinas criollas, en las que se recolectó la información en un formato integrado por variables cuantitativas y cualitativas, de los aspectos socioculturales, económicos, medioambientales, y de manejo de las aves, que permitieron determinar la interacción de estas y así agrupar los diferentes sistemas de producción. El análisis de la información se realizó mediante el análisis de clusters a partir de la aplicación de técnicas multivariadas. Se consideraron las 25 variables cuantitativas de mayor poder discriminatorio y se redujo la dimensionalidad del problema, descartando aquellas variables de bajo poder discriminante. Resultados: El análisis permitió identificar nueve componentes principales, que explican el 71% de la varianza total; para así establecer seis sistemas finca, donde las aves representan desde el 65% hasta el 2,8% del capital pecuario, en relación directa con la extensión de la finca y la vocación agrícola principal. Conclusiones: La explotación de gallinas es una actividad de importancia en las comunidades rurales, que se complementa con otras actividades productivas realizadas en el campo. Aporta nutrientes a la dieta cumpliendo la función de transformar productos de origen vegetal y residuos en proteína de origen animal.

Backyard hen farming is an important farming activity in the rural communities in the country characterized by the low investment required and for the easiness to carry it out. Creole hens are mostly used because of their adaptability to adverse conditions for breeding. This activity strengthens the peasant families' welfare since they take the most out of the family workforce and it is a generating source for peasant household goods. Objective: To characterize the different backyard hen production systems in the rainforest influence area of Florencia, municipality of Samaná in the Department of Caldas. Methodology: From the 103 farms in the area of study, 76 farms corresponding to all the properties with Creole hen farming were surveyed and information was collected using a quantitative and qualitative integrated variables format dealing with socio-cultural, economic, environmental and chicken management aspects which allowed determining their interaction and grouping the different production systems. The analysis of the information was carried out through cluster analysis parting from multivariate techniques application. The Twenty-five qualitative variables with the highest discriminatory power were considered and the dimensionality of the problem was reduced discarding those variables with a low discriminant power. Results: The analysis allowed identifying nine main components that explain 71% of the total variance in order to establish six farm systems where the hens represent from 65% to 2.8% of the farming capital in direct relation with the farm extension and the main farming vocation. Conclusions: Hen production is an important activity in rural communities which is complemented with other productive activities developed in the land. It contributes with nutrients to the diet accomplishing the function of transformation of vegetal origin products and residues into animal origin protein.

Medida do fluxo intraoperatório com fluxômetro TTFM nos enxertos coronários: resultados de amostra nacional / Intraoperative coronary grafts flow measurement using the TTFM flowmeter: results from a domestic sample

OBJETIVO: Avaliar a perviedade dos enxertos no intraoperatório e identificar enxertos com risco de oclusão precoce. MÉTODOS: Cinquenta e quatro pacientes foram submetidos à revascularização do miocárdio e foi utilizado o fluxômetro (Medtronic Medi-Stim) que utiliza o método de tempo de trânsito (TTFM) para avaliação do fluxo nos enxertos. Três pacientes tinham lesão de tronco de artéria coronária esquerda e 48 apresentavam função ventricular normal ou pouco comprometida. RESULTADOS: A mortalidade hospitalar foi de dois (3,7%) pacientes, um por trombose mesentérica e outro por choque cardiogênico. Dezessete (31,4%) pacientes foram operados sem circulação extracorpórea (CEC). O fluxo no enxerto arterial variou de 8 a 106 ml/min, com média de 31,14 ml/min, e nos enxertos venosos de 9 a 149 ml/min, com média de 50,42 ml/min. CONCLUSÃO: O fluxômetro representa maior segurança para o cirurgião e para o paciente. Até mesmo sob o aspecto legal essa documentação dos enxertos pérvios evitará questionamentos futuros.

OBJECTIVE: To evaluate intraoperative graft patency and identify grafts under risk of early occlusion. METHODS: Fifty four patients were submitted to coronary artery bypass surgery and the graft flow was assessed by the Flowmeter (Medtronic Medistim), which utilizes the TTFM method. Three patients had left main disease and 48 had normal or mildly reduced left ventricular function. RESULTS: In hospital mortality was 3.7% (two patients), one for mesenteric thrombosis and one due to cardiogenic chock. Seventeen patients (34%) were submitted to off pump CABG. Arterial Graft flow measures ranged from 8 to 106 ml/min (average 31.14 ml/min), and venous grafts flow ranged from 9 to 149 ml/min (average 50.42 ml/min). CONCLUSION: Flowmeter use represents higher safety both for patients and surgeons. Even under legal aspects, the documentation provided by the device can avoid future questionings.

Intraoperative coronary grafts flow measurement using the TTFM flowmeter: results from a domestic sample.

OBJECTIVE: To evaluate intraoperative graft patency and identify grafts under risk of early occlusion. METHODS: Fifty four patients were submitted to coronary artery bypass surgery and the graft flow was assessed by the Flowmeter (Medtronic Medistim), which utilizes the TTFM method. Three patients had left main disease and 48 had normal or mildly reduced left ventricular function. RESULTS: In hospital mortality was 3.7% (two patients), one for mesenteric thrombosis and one due to cardiogenic chock. Seventeen patients (34%) were submitted to off pump CABG. Arterial Graft flow measures ranged from 8 to 106 ml/min (average 31.14 ml/min), and venous grafts flow ranged from 9 to 149 ml/min (average 50.42 ml/min). CONCLUSION: Flowmeter use represents higher safety both for patients and surgeons. Even under legal aspects, the documentation provided by the device can avoid future questionings.