Resultados a cinco años de la reparación electiva del aneurisma de aorta abdominal infrarrenal en un hospital universitario de Argentina

Objective:

Few data about outcomes of elective infrarenal abdominal aortic aneurysm (AAA) repair in Latin America have been published. The objective of the present study is to address this aspect in our population.

Method:

Retrospective cohort, in which patients with infrarenal AAA undergoing elective surgical or endovascular repair from January 2011 to May 2017 at a university hospital in Autonomous City of Buenos Aires were consecutively included. The primary endpoints were perioperative mortality and all-cause mortality during follow-up. Among the secondary endpoints, the requeriment of reinterventions was assessed.

Results:

195 patients were included. Open surgery was performed in 72 patients (36.9%) and endovascular aortic repair (EVAR) in 123 (63.1%). Perioperative mortality in the surgery group was 2.8%, while no deaths were recorded in the endovascular group (p = 0.06). The median follow-up was 38 months. No statistically significant difference was found in long-term mortality incidence rate between patients who underwent EVAR and those who underwent open surgery (7% per year vs. 6.7% per year, p = 0.8). The requirement of reinterventions was significantly higher in the endovascular group (9.0% vs. 0%, p = 0.01).

Conclusions:

Survival analyses demonstrated no statistically significant differences in perioperative and long-term mortality for patients who underwent EVAR compared with those who underwent open surgery, while the former had a higher rate of reinterventions. The results observed in our population do not differ from those published in the United State or Europe.     

Multi-Response Optimization of Abrasive Waterjet Machining of Ti6Al4V Using Integrated Approach of Utilized Heat Transfer Search Algorithm and RSM

Machining of Titanium alloys (Ti6Al4V) becomes more vital due to its essential role in biomedical, aerospace, and many other industries owing to the enhanced engineering properties. In the current study, a Box–Behnken design of the response surface methodology (RSM) was used to investigate the performance of the abrasive water jet machining (AWJM) of Ti6Al4V. For process parameter optimization, a systematic strategy combining RSM and a heat-transfer search (HTS) algorithm was investigated. The nozzle traverse speed (T_v), abrasive mass flow rate (A_f), and stand-off distance (S_d) were selected as AWJM variables, whereas the material removal rate (MRR), surface roughness (SR), and kerf taper angle (θ) were considered as output responses. Statistical models were developed for the response, and Analysis of variance (ANOVA) was executed for determining the robustness of responses. The single objective optimization result yielded a maximum MRR of 0.2304 g/min (at T_v of 250 mm/min, A_f of 500 g/min, and S_d of 1.5 mm), a minimum SR of 2.99 µm, and a minimum θ of 1.72 (both responses at T_v of 150 mm/min, A_f of 500 g/min, and S_d of 1.5 mm). A multi-objective HTS algorithm was implemented, and Pareto optimal points were produced. 3D and 2D plots were plotted using Pareto optimal points, which highlighted the non-dominant feasible solutions. The effectiveness of the suggested model was proved in predicting and optimizing the AWJM variables. The surface morphology of the machined surfaces was investigated using the scanning electron microscope. The confirmation test was performed using optimized cutting parameters to validate the results.     

Biochemical results of reoperations for medullary thyroid carcinoma

BACKGROUND: The calcitonin is a sensitive marker for the presence of medullary thyroid carcinoma, therefore, invaluable in the follow-up of patients who have been treated. Biological cure of the medullary thyroid cancer refers to a basal plasma calcitonin of less than 10 ng/l without elevation after stimulation tests. STUDY DESIGN: Biochemical results of reoperations for medullary thyroid carcinoma were reviewed from a series of 35 patients who underwent 47 reinterventions. RESULTS: The indications for reoperation were: hypercalcitoninemia with clinical evidence of the disease (32 cases); hypercalcitoninemia after an inadequate primary surgery (6 cases); persistent hypercalcitoninemia with biochemical evidence of the disease (2 cases); liver metastases (1 case); and palliative surgery for relieving symptoms (1 case). Only three patients of the series had biochemical cure after reoperation (patients with an inadequate primary surgery). CONCLUSIONS: This study is consistent with the bibliographic reviews supporting that the cervical reoperation, eventually mediastinal, for residual hypercalcitoninemia after primary surgical treatment is indicated when the initial intervention did not follow the French Calcitonin Tumour Study Group (GETC) recommendations or when a specific lesion is evidenced by imaging studies without systemic dissemination.     

Early and long-term results of pneumatic dilation in the treatment of oesophageal achalasia

Summary Between 1967 and 1989, 60 patients underwent pneumatic dilation of the cardia at our institution. Of these, 33 had not undergone any previous treatment (group 1), whereas 27 presented with recurrent dysphagia after a failure of surgical treatment (group 2). In this series there was no procedure-related mortality and a perforation occurred only in 1 patient who was treated conservatively. The mean follow-up was similar in both groups (44 and 49 months, respectively). The results of pneumatic dilation were either excellent or good in 61% of group 1 patients, and in 76% of group 2 patients. Reflux oesophagitis requiring medical therapy occurred in 1 group 2 patient. We conclude that pneumatic dilation is a safe and relatively effective procedure in patients with achalasia. Patients with a failed Heller myotomy seem to respond better than patients without previous surgery. However, the risk of gastro-oesophageal reflux after pneumatic dilation should not be underestimated.     

Aggressiveness induced by marihuana and other psychotropic drugs in REM sleep deprived rats

In 96 hr REM sleep deprived rats given 5–40 mg/kg of Δ⁹-THC and several alcoholic extracts of marihuana induce dose dependent aggressive behavior. The aggressiveness appears after the first application of the drugs and is observable for at least 4 hr following the injection. The rats also develop a high degree of irritability. LSD-25 (0.02–0.08 mg/kg), mescaline (80 mg/kg), d-amphetamine (1.0 to 4.0 mg/kg) and ethanol (0.8–1.6 g/kg) failed to elicit either aggressiveness or irritability in the REM sleep deprived rats. On the other hand, 8 and 16 mg/kg of d-amphetamine induced aggressiveness which was, however, far below that observed in the marihuana treated animals. These data add further support to the previous findings that the acute effects of marihuana can be dramatically changed from depression, as observed in normal rats, to irritability and aggressiveness as observed in stressed animals.     

Sleep-Related Painful Erection in a 50-Year-Old Man Successfully Treated with Cinitapride

IntroductionThe sleep-related painful erection (SRPE) is a well-established parasomnia characterized by episodes of penile pain during an erection and typically appears during REM sleep. It is associated with nocturnal awakenings, anxiety, and irritability.AimTo report a case study that highlights the successful treatment of SRPE with cinitapride.MethodsWe present a case report of a 50-year-old man suffering from SRPE that was studied by polysomnography.ResultsSevere fragmentation of rapid eye movement (REM) sleep was observed, and nine episodes of sleep-related erections were observed through the night; they were associated with REM sleep, and five of them were classified as SRPE. Cinitapride before the onset of sleep was started. Both the frequency and intensity of SRPE gradually decreased during a period of 6 months with the maintenance of normal sexual function.ConclusionCinitapride can play a role in reducing SRPE at night probably due to central modulation of neurotransmitters mediating erection. Chiner E, Sancho-Chust JN, Llombart M, Camarasa A, Senent C, Mediero G, and Gómez-Merino E. Sleep-related painful erection in a 50-year-old man successfully treated with cinitapride.     

Early inflammatory markers in elicitation of allergic contact dermatitis

Background  

Allergic Contact Dermatitis (ACD) is regarded as a T-cell-mediated delayed-type hypersensitivity reaction. We studied the kinetics of the expression of CS-1 fibronectin, thymus and activation-regulated chemokine (CCL17/ TARC) and different chemokine receptors (CR) in skin biopsies from individuals suffering from back problems, with the antigen responsible of their contact dermatitis and an irrelevant antigen.     

Palliative treatment of esophageal and cardial carcinoma

Recent series reported increasing incidence of esophageal and cardial cancers with prognosis still severe in spite of surgical progress. The late diagnosis reduces the chance of radical surgery; on the other hand about 80-90% of patients develop local or distant recurrence. Therefore the treatment of esophageal and cardial cancer is often palliative: surgical resection is reserved only to selected cases. Endoscopic palliation was the treatment of choice in a total of 265 patients 174 of which received laser therapy and 91 prosthesis intubation. The results it good in about 80% of cases.