Persistent left superior vena cava in cardiac congenital surgery

La persistance d'une veine cave supérieure gauche (VCSG) est une entité relativement fréquente dans le cadre des malformations cardiaques congénitales. Le but de cette étude est d'analyser à quel moment le diagnostic de la persistance de la VCSG est effectué, à quel moment le diagnostic des éventuelles anomalies du sinus coronarien associées est effectué, et de l'impact global de la persistance d'une VCSG sur la mortalité et la morbidité des patients après chirurgie cardiaque pour une malformation cardiaque congénitale. Analyse rétrospective d'une cohorte d'enfants ayant subi une chirurgie cardiaque avec circulation extracorporelle pour une malformation cardiaque congénitale. Trois-cent septante et un patients ont été inclus dans l'étude avec un âge médian de 2.75 ans (IQR 0.65-6.63). Parmi eux, 47 patients présentaient une persistance de la VCSG (12.7%), et cette persistance de la VCSG a été identifiée par échocardiographie dans le cadre du bilan préopératoire chez 39 patients (83%). Trois patients (6.4%) présentant une persistance de la VCSG, ont développé après chirurgie cardiaque, une obstruction significative de la voie d'entrée du ventricule gauche qui a aboutit à un débit cardiaque anormal ou à une hypertension pulmonaire secondaire. Chez huit patients (17%), la persistance de la VCSG, était associée à un défaut partiel ou total de fermeture du sinus coronarien et dans deux cas (4%) à une atrésie de l'ostium du sinus coronarien. La durée de la ventilation mécanique était plus courte de façon significative dans le groupe contrôle (1.2 vs. 3.0 jours, p = 0.004), tandis que la durée de séjour aux soins intensifs ne différait pas. La mortalité était significativement moins élevée dans le groupe contrôle que dans le groupe de patient avec persistance de la VCSG (2.5 vs. 10.6 %, p = 0.004). Les résultats de cette étude montrent que la persistance de la VCSG en association avec une malformation cardiaque congénitale augmente le risque de mortalité chez les enfants qui subissent une chirurgie cardiaque avec circulation extracorporelle. La mise en évidence d'une persistance de la VCSG et des anomalies associées, s'impose pour éviter des complications pendant et après une chirurgie cardiaque.

Successful bilateral lung transplantation after previous pneumonectomy

Objective: To present the feasibility of bilateral lung transplantation after previously performed pneumonectomy.Methods: A 32 years old women underwent right pneumonectomy for bronchiectasis-related destroyed lung. Eight months later, she developed a vascular post-pneumonectomy syndrome and underwent realigning of the mediastinum by an intrathoracic expander that was complicated by an adult respiratory distress syndrome of the left lung requiring mechanical ventilation, arterio-venous CO2 removal (Novalung) and finally bilateral lung transplantation. Via clamshell incision, the post-pneumonectomy cavity was dissected and the superior vena cava (SVC) and carina were exposed. The pulmonary vessel stumps were dissected intrapericardically after realization of a right-sided hemi-pericardectomy. Extracorporeal circulation was started after central cannulation of the aorta and the inferior vena cava. A right upper lobe sleeve resection of the donor lung was performed. The intermediate bronchus was then implanted in the dissected recipient carina after realization of a hilar release maneuver. The right pulmonary artery was clamped between SVC andthe ascending aorta followed by end -to-end anastomosis of the donor and recipient artery and left atrial cuffs, respectively. Satisfactory graft function allowed decanulation and standard transplantation of the left lung without extracorporeal circulation.Results: Bronchoscopy and trans-esophageal echocardiography demonstrated a patent airway and vascular anastomoses without stenosis. Follow-up revealed excellent gas exchanges, no airway complications and well-functioning grafts on both sides with right-sided ventilation and perfusion two months after transplantation of 37% and 22%, respectively.Conclusion: This is to our knowledge the first report of successful bilateral lung transplantation after previous pneumonectomy unrelated to transplantation.

Aportaciones al proceso de iberización en el curso inferior del Ebro: el ejemplo de Sebes (Flix, Ribera d’Ebre, Tarragona)

Presentamos en este trabajo el resultado de las intervenciones efectuadas en el yacimiento de Sebes entre los años 2010 y 2011, donde hemos podido documentar la existencia de un asentamiento ibérico de nueva planta fechado en la segunda mitad del siglo vi a.C., poco tiempo después del abandono del asentamiento del Hierro I, ubicado en la parte más alta de la colina de Sebes. La proximidad entre los dos asentamientos y los restos materiales recuperados parecen indicar un ligero traslado poblacional, dentro de una dinámica interna de cambio en la sociedad ibérica, en una etapa de transición previa a la consolidación de un nuevo modelo poblacional durante el siglo v a.C.

Persistent left superior vena cava in cardiac congenital surgery.

Persistent left superior vena cava (LSVC) is a relatively frequent finding in congenital cardiac malformation. The scope of the study was to analyze the timing of diagnosis of persistent LSVC, the timing of diagnosis of associated anomalies of the coronary sinus, and the global impact on morbidity and mortality of persistent LSVC in children with congenital heart disease after cardiac surgery. Retrospective analysis of a cohort of children after cardiac surgery on bypass for congenital heart disease. Three hundred seventy-one patients were included in the study, and their median age was 2.75 years (IQR 0.65-6.63). Forty-seven children had persistent LSVC (12.7 %), and persistent LSVC was identified on echocardiography before surgery in 39 patients (83 %). In three patients (6.4 %) with persistent LSVC, significant inflow obstruction of the left ventricle developed after surgery leading to low output syndrome or secondary pulmonary hypertension. In eight patients (17 %), persistent LSVC was associated with a partially or completely unroofed coronary sinus and in two cases (4 %) with coronary sinus ostial atresia. Duration of mechanical ventilation was significantly shorter in the control group (1.2 vs. 3.0 days, p = 0.04), whereas length of stay in intensive care did not differ. Mortality was also significantly lower in the control group (2.5 vs. 10.6 %, p = 0.004). The results of study show that persistent LSVC in association with congenital cardiac malformation increases the risk of mortality in children with cardiac surgery on cardiopulmonary bypass. Recognition of a persistent LSVC and its associated anomalies is mandatory to avoid complications during or after cardiac surgery.

Incidence and management of pulmonary embolism following spinal surgery occurring while under chemical thromboprophylaxis.

Patients undergoing spinal surgery are at risk of developing thromboembolic complications even though lower incidences have been reported as compared to joint arthroplasty surgery. Deep vein thrombosis (DVT) has been studied extensively in the context of spinal surgery but symptomatic pulmonary embolism (PE) has engaged less attention. We prospectively followed a consecutive cohort of 270 patients undergoing spinal surgery at a single institution. From these patients, only 26 were simple discectomies, while the largest proportion (226) was fusions. All patients received both low molecular weight heparin (LMWH) initiated after surgery and compressive stockings. PE was diagnosed with spiral chest CT. Six patients developed symptomatic PE, five during their hospital stay. In three of the six patients the embolic event occurred during the first 3 postoperative days. They were managed by the temporary insertion of an inferior vena cava (IVC) filter thus allowing for a delay in full-dose anticoagulation until removal of the filter. None of the PE patients suffered any bleeding complication as a result of the introduction of full anticoagulation. Two patients suffered postoperative haematomas, without development of neurological symptoms or signs, requiring emergency evacuation. The overall incidence of PE was 2.2% rising to 2.5% after exclusion of microdiscectomy cases. The incidence of PE was highest in anterior or combined thoracolumbar/lumbar procedures (4.2%). There is a large variation in the reported incidence of PE in the spinal literature. Results from the only study found in the literature specifically monitoring PE suggest an incidence of PE as high as 2.5%. Our study shows a similar incidence despite the use of LMWH. In the absence of randomized controlled trials (RCT) it is uncertain if this type of prophylaxis lowers the incidence of PE. However, other studies show that the morbidity of LMWH is very low. Since PE can be a life-threatening complication, LMWH may be a worthwhile option to consider for prophylaxis. RCTs are necessary in assessing the efficacy of DVT and PE prophylaxis in spinal patients.

Anterior inferior cerebellar artery aneurysms mimicking vestibular schwannomas.

BACKGROUND AND PURPOSE: Unruptured anterior inferior cerebellar artery (AICA) aneurysms are rare but potentially lethal cerebellopontine angle (CPA) lesions that may be misdiagnosed as vestibular schwannomas when they present with vestibulo-cochlear symptoms. METHODS: We report two cases of unruptured but symptomatic AICA aneurysms initially referred to us as atypical vestibular schwannomas requiring surgery. Two discriminant MR features are described. RESULTS: One patient refused treatment. The other was successfully treated by coil occlusion. CONCLUSIONS: Caution is advised before suspecting a CPA mass to be a purely extra-canalicular schwannoma, given its extreme rarity. Deafness and cerebellar ischemia may be prevented if AICA aneurysms are correctly identified preoperatively. In the absence of specific arterial imaging, two MR features may distinguish them from vestibular schwannomas: (1) the absence of internal auditory canal enlargement and (2) the "blurry dot sign," representing blood flow artefacts on pre- and postcontrast studies.

Los inicios de la conquista romana de Iberia: los campamentos de campaña del curso inferior del río Ebro

La investigación arqueológica de los campamentos de campaña romano-republicanos localizados en el curso inferior del río Ebro permite una nueva perspectiva de estudio sobre los inicios de la conquista romana en la península ibérica.

Espigueo por la toponimia mayor del Valle Medio e Inferior del Ésera (Huesca)

El present treball pretén donar llum a una sèrie de topònims majors de la Ribagorça occidental, tot al llarg de la vall mitjana i inferior del riu Éssera. Aquests topònims es remunten a temps molt antics: preromans, romans i germànics bàsicament. Aquesta anàlisi permet apreciar l'estratigrafi a lingüística de la zona. La no-aparició de topònims d'origen àrab en el nostre treball no vol dir que no hi hagués penetració àrab a la zona, sinó que la seva arribada va ser posterior a la creació dels principals nuclis de població. Sí que hi ha topònims àrabs a la toponímia menor, que resta fora del present treball.

Unidades fototérmicas e temperatura-base inferior de frutos de Mangueira Alfa, na Baixada Cuiabana

O objetivo deste trabalho foi determinar a temperatura-base inferior (Tb) a partir da unidade fototérmica (UF) para o cultivo experimental de manga Alfa sob condições de cerrado. Foram utilizados dados diários da temperatura do ar disponibilizados pela Estação Agrometeorológica Padre Ricardo Remetter, localizada em Santo Antônio do Leverger-MT (15,8° S e 56,1° W, 140 m), e avaliação sensorial do estádio de maturação dos frutos de manga. A Tb foi determinada pelo método da menor variabilidade das unidades fototérmicas (UF) acumuladas do período da floração à colheita dos frutos, variabilidade avaliada pelo coeficiente de variação (cv) simulado para diferentes valores da Tb. De julho a novembro de 2007, em três plantas de um pomar demonstrativo irrigado, foram identificados 82 frutos para o acompanhamento do crescimento e maturação. Entre esses frutos, em meados de dezembro de 2007, foi possível identificar 13 frutos que atingiram a maturidade fisiológica, após um período médio de observação de 112 dias. Para exigência fototérmica de 1.878.166,1 UF, encontrou-se Tb de 10 °C, valor consistente com os apresentados na literatura para a cultivar de manga, o que comprova a eficiência do método que combina a ação da temperatura e do fotoperíodo sobre a maturação dos frutos e que confere um caráter mais racional que o método tradicional da soma térmica.

Pisolitos ferruginosos en el Mioceno inferior-medio de Mallorca.

El registro sedimentario Burdigaliense-Langhiense de Mallorca refleja el relleno de pequeños surcos de antepaís que se generaron por subsidencia flexural frente al orógeno bético. Este registro sinorogénico incluye una unidad inferior que caracteriza la sedimentación en una plataforma marina somera (Fm. Sant Elm) y otra superior turbidítica (Fm. Banyalbufar). En el límite entre ambas unidades se ha reconocido, en la zona central de la isla, la existencia de un nivel de pisolitos ferruginosos de menos de 20 cm de potencia. Los pisolitos llegan a superar los 6 mm de diámetro, son esféricos y están constituidos casi exclusivamente por delgadas envueltas concéntricas de goethita, aunque en los pisolitos de mayor tamaño alguna envuelta es de calcita. La posición estratigráfica del nivel de pinolitos coincide, aproximadamente, con el límite entre las dos unidades anteriormente citadas, localizándose inmediatamente antes del inicio de la sedimentación turbidítica, y se correspondería con el máximo transgresivo en la cuenca marina. Tanto el vulcanismo Burdigaliense que ha sido reconocido en la zona como la removilización de suelos lateríticos en relación con la transgresión marina pudieron haber actuado como fuentes suministradoras del hierro.

Los inicios de la conquista romana de Hispania. Los campamentos de campaña del curso inferior del rio Ebro.

La investigación arqueológica de los campamentos de campaña romano-republicanos localizados en el curso inferior del río Ebro permite una nueva perspectiva de estudio sobre los inicios de la conquista romana en la península ibérica.

Evolución tectónica y sedimentaria durante el Priaboniense superior-Mioceno inferior, en el frente de cabalgamiento de las Sierras Marginales occidentales

Se han distinguido cuatro complejos sedimentarios del Eoceno superior-Mioceno inferior en los depósitos continentales del margen norte de la cuenca del Ebro...

Influencia de la tectónica en la sedimentación continental de la cuenca del Vallés-Penedés (Prov.Barcelona, España) durante el Mioceno inferior.

A very important alluvial fan clastic sedimentation, took place in the NNESSW trending Valles-Penedes graben (northeastem Spain) during Miocene time. Shallow lacustrine and paludine areas developed in distal zones of these alluvial fan complexes during Burdigalian (Early Miocene). At that time both facies development and their distribution were closely controlled by tectonic activity. Fault scarp retreat and back-faulting processes in the southeastem edge of the basin (observed in westem Valles afea), originated an expansive advance of distal alluvial-fan facies in that direction. The decreasing or cessation of the activity of the southeastern margin fault ca~sedi,n Late Burdigalian time (while faults in the northwestern margin were still active) facies redistribution, and gave way to the assymetry of the basin. Finally lacustrine, marine and transitional deposits of late burdigalian and langhian age, were laid down overlapping the southeastem inactive margins.