Manejo percutáneo de infarto con elevación del ST sin colocación de stent: reporte de un caso / Percutaneous management of ST elevation myocardial infarction without stent placement: a case report

Resumen Reportamos el caso de manejo percutáneo de un infarto agudo al miocardio utilizando una combinación atípica de estrategias cuyo resultado fue seguro y costoefectivo, que consistió en tromboaspiración, angioplastía con balón y utilización de la reserva fraccional de flujo para descartar la necesidad de colocación de stent.

Abstract Percutaneous management of ST elevation myocardial infarction without stent placement : a case report We herein report the case of percutaneous management of an acute myocardial infarction using an atypical combination of strategies whose outcome was safe and costeffective, which consisted of thrombus aspiration, balloon angioplasty and use of fractional flow reserve to rule out the need for stent placement.

Plexiform fibromyxoma, a rare mesenchymal gastric tumor / Fibromixoma plexiforme, un tumor gástrico mesenquimal poco frecuente

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Hemoperitoneo: una complicación infrecuente de la colonoscopia diagnóstica / Hemoperitoneum: A rare complication after diagnostic colonoscopy

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Colitis por Aeromonas hydrophila como primera manifestación de un cáncer de colon / Aeromonas hydrophila colitis as the initial presentation of colon cancer

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Temperature Effects of Sputtering of Langmuir-Blodgett Multilayers.

Time-of-flight secondary ion mass spectrometry (TOF-SIMS) and atomic force microscopy (AFM) are employed to characterize a wedge-shaped crater eroded by a 40 keV C(60) (+) cluster ion beam on an organic thin film of 402 nm of barium arachidate (AA) multilayers prepared by the Langmuir-Blodgett (LB) technique. Sample cooling to 90 K was used to help reduce chemical damage, improve depth resolution and maintain constant erosion rate during depth profiling. The film was characterized at 90 K, 135 K, 165 K, 205 K, 265 K and 300 K. It is shown that sample cooling to 205 K or lower helps to inhibit erosion rate decay, whereas at 300 K and 265 K the erosion rate continues to drop after 250 nm of erosion, reaching about half of the initial value after removal of the entire film. Depth profiles are acquired from the SIMS images of the eroded wedge crater. The results suggest that sample cooling only slightly improves the altered layer thickness, but eliminates the decrease in erosion rate observed above 265 K.

Talidomida en dosis altas para la hemorragia digestiva oscura grave idiopática en una paciente de alto riesgo trombótico / High-dose thalidomide for severe idiopathic obscure gastrointestinal bleeding in a patient at high-thrombotic risk

Se presenta el caso de una mujer de 81 años con accidentes vasculares cerebrales (ACV) recurrentes con doble antiagregación y hemorragia digestiva de origen oscuro. No se encontró el origen del sangrado con cápsula endoscópica, enteroscopia de doble balón, laparotomía exploradora y enteroscopia intraoperatoria bidireccional desde boca a ano. La paciente requirió la transfusión de 117 concentrados de hematíes durante 2 años pese a suspensión de la medicación antiagregante y tratamiento con análogos de la somatostatina. Por ello, se inició terapia con dosis crecientes de talidomida, hasta 300mg, asociadas a profilaxis tromboembólica durante 3 meses, sin respuesta. Al suspender la heparina, la hemorragia se controló durante 3 meses, pero se retiró la talidomida por efectos secundarios. Dado que la hemorragia recidivó al mes de la suspensión, se realizó un segundo ciclo de 3 meses de tratamiento con talidomida. Durante un año de seguimiento, la paciente no ha precisado transfusión de hemoderivados (AU)

We report the challenging case of an 81-year-old woman on dual antiplatelet therapy with recurrent strokes, who presented with severe obscure gastrointestinal bleeding. A thorough diagnostic work-up, including capsule endoscopy, double balloon enteroscopy, arteriography, exploratory laparotomy and mouth-to-anus intraoperative enteroscopy, failed to reveal the source of the bleeding. During a 2-year period, the patient required 117 packed red blood cell units, despite withdrawal of antiplatelet drugs and empirical therapy with high-dose somatostatin analogues. The patient was administered an increasing dosage of thalidomide, up to 300mg/day, with thromboembolism prophylaxis for 3 months, with no clinical response. The bleeding stopped for 3 months after heparin was discontinued, but thalidomide had to be withdrawn owing to adverse effects. Since bleeding recurred a month later, the patient underwent another 3-month course of thalidomide. The patient has not required further blood transfusion after a 1-year follow-up (AU)

An experimental and theoretical view of energetic C60 cluster bombardment onto molecular solids.

Recent experimental measurements and calculations performed by molecular dynamics computer simulations indicate, for highly energetic C60 primary ions bombarding molecular solids, the emission of intact molecules is unique. An energy- and angle-resolved neutral mass spectrometer coupled with laser photoionization techniques was used to measure the polar angle distribution of neutral benzo[a]pyrene molecules desorbed by 20-keV [Formula: see text] primary ions and observed to peak at off-normal angles integrated over all possible emission energies. Similarly, computer simulations of 20-keV C60 projectiles bombarding a coarse-grained benzene system resulted in calculations of nearly identical polar angle distributions. Upon resolving the measured and calculated polar angle distributions, sputtered molecules with high kinetic energies are the primary contributors to the off-normal peak. Molecules with low kinetic energies were measured and calculated to desorb broadly peaked about the surface normal. The computer simulations suggest the fast deposition of energy from the C60 impact promotes the molecular emission by fluid-flow and effusive-type motions. The signature of off-normal emission angles is unique for molecules because fragmentation processes remove molecules that would otherwise eject near normal to the surface. Experimental measurements from a Ni {001} single crystal bombarded by 20-keV [Formula: see text] demonstrate the absence of this unique signature.

[High-dose thalidomide for severe idiopathic obscure gastrointestinal bleeding in a patient at high-thrombotic risk]. / Talidomida en dosis altas para la hemorragia digestiva oscura grave idiopática en una paciente de alto riesgo trombótico.

We report the challenging case of an 81-year-old woman on dual antiplatelet therapy with recurrent strokes, who presented with severe obscure gastrointestinal bleeding. A thorough diagnostic work-up, including capsule endoscopy, double balloon enteroscopy, arteriography, exploratory laparotomy and mouth-to-anus intraoperative enteroscopy, failed to reveal the source of the bleeding. During a 2-year period, the patient required 117 packed red blood cell units, despite withdrawal of antiplatelet drugs and empirical therapy with high-dose somatostatin analogues. The patient was administered an increasing dosage of thalidomide, up to 300 mg/day, with thromboembolism prophylaxis for 3 months, with no clinical response. The bleeding stopped for 3 months after heparin was discontinued, but thalidomide had to be withdrawn owing to adverse effects. Since bleeding recurred a month later, the patient underwent another 3-month course of thalidomide. The patient has not required further blood transfusion after a 1-year follow-up.

Cluster secondary ion mass spectrometry and the temperature dependence of molecular depth profiles.

The quality of molecular depth profiles created by erosion of organic materials by cluster ion beams exhibits a strong dependence upon temperature. To elucidate the fundamental nature of this dependence, we employ the Irganox 3114/1010 organic delta-layer reference material as a model system. This delta-layer system is interrogated using a 40 keV C(60)(+) primary ion beam. Parameters associated with the depth profile such as depth resolution, uniformity of sputtering yield, and topography are evaluated between 90 and 300 K using a unique wedge-crater beveling strategy that allows these parameters to be determined as a function of erosion depth from atomic force microscope (AFM) measurements. The results show that the erosion rate calibration performed using the known Δ-layer depth in connection with the fluence needed to reach the peak of the corresponding secondary ion mass spectrometry (SIMS) signal response is misleading. Moreover, we show that the degradation of depth resolution is linked to a decrease of the average erosion rate and the buildup of surface topography in a thermally activated manner. This underlying process starts to influence the depth profile above a threshold temperature between 210 and 250 K for the system studied here. Below that threshold, the process is inhibited and steady-state conditions are reached with constant erosion rate, depth resolution, and molecular secondary ion signals from both the matrix and the Δ-layers. In particular, the results indicate that further reduction of the temperature below 90 K does not lead to further improvement of the depth profile. Above the threshold, the process becomes stronger at higher temperature, leading to an immediate decrease of the molecular secondary ion signals. This signal decay is most pronounced for the highest m/z ions but is less for the smaller m/z ions, indicating a shift toward small fragments by accumulation of chemical damage. The erosion rate decay and surface roughness buildup, on the other hand, exhibit a rather sudden delayed onset after erosion of about 150 nm, indicating that a certain damage level must be reached in order to influence the erosion dynamics. Only after that onset does the depth resolution become compromised, indicating that the temperature reduction does not significantly influence parameters like ion-beam mixing or the altered-layer thickness. In general, the wedge-crater beveling protocol is shown to provide a powerful basis for increased understanding of the fundamental factors that affect the important parameters associated with molecular depth profiling.

Fluid Flow and Effusive Desorption: Dominant Mechanisms of Energy Dissipation after Energetic Cluster Bombardment of Molecular Solids.

The angular distribution of intact organic molecules desorbed by energetic C(60) primary ions was probed both experimentally and with molecular dynamics computer simulations. For benzo[a]pyrene, the angular distribution of intact molecules is observed to peak at off-normal angles. Molecular dynamics computer simulations on a similar system show the mechanism of desorption involves fast deposition of energy followed by fluid-flow and effusive-type emission of intact molecules. The off-normal peak in the angular distribution is shown to arise from emission of intact molecules from the rim of a crater formed during the cluster impact. This signature is unique for molecules because fragmentation processes remove molecules that would otherwise eject at directions near-normal to the surface.