La comunicación científica en neumología y cirugía torácica relacionada con la medicina del deporte

[ES] Este capítulo pretende dar una visión general del movimiento del Acceso Abierto y, por ende, su aplicabilidad a los investigadores del área de neumología y cirugía torácica interesados en la medicina el deporte. Nos basaremos en dos conjuntos de publicaciones, por una parte las incluidas en el Journal Citation Report, Science Edition, 2011 (Subject: Respiratory System)1; y por otra las incluidas en el Scimago Journal Ranking, 2011 (Subject: Pulmonary and Respiratory Medicine)2. Analizaremos el estado de la cuestión en relación al modelo del Acceso Abierto de cada publicación utilizando la herramienta Sherpa/Romeo3 para conocer la situación de cadapublicación con respecto al modelo antes mencionado.

Stima della complianza arteriosa totale dalla misura della velocita d'onda in aorta

Descrizione del metodo proposto da Stergiopulos N. per la stima della complianza arteriosa totale tramite misura della velocità d'onda in aorta.

Realizzazione di un simulatore biomeccanico del sistema ventricolo-aorta e studio della contropulsazione passiva

La sinergia tra diverse aree scientifiche svolge oggi un ruolo preminente nella risoluzione di problematiche molto complesse: in ambito medico, un massiccio intervento delle scienze fisico-matematiche ha portato, grazie alla ricerca sulle proprietà subatomiche (NMR), sulla funzione elettromeccanica tissutale (pace-makers) e sulla biocompatibilità di materiali innovativi, ad un completo rinnovamento e miglioramento delle terapie tradizionali, delineando nuove strategie terapeutiche. In questo quadro di attiva collaborazione si colloca la ricerca in ambito biomeccanico cardiovascolare che, approfondendo la funzionalità del cuore e dei vasi in condizioni normali e patologiche, propone soluzioni terapeutiche alternative all'approccio farmacologico, impensabili fino a pochi anni fa. Uno di questi ambiti è l'insufficienza cardiaca: al ventricolo incapace di produrre l'energia necessaria alla perfusione ematica viene associato un sistema di pulsazione meccanica che riduce il carico durante l'eiezione ed aumenta la perfusione coronarica in diastole. Tuttavia, benché l'efficacia della contropulsazione intra-aortica sia riconosciuta da decenni, alcune problematiche rimangono irrisolte: l'inapplicabilità su pazienti aritmici, l'eccessiva sollecitazione meccanica in pazienti vasculopatici, la complessità e l'alto costo dell'apparecchiatura. Questo lavoro affronta la validazione e la caratterizzazione di una soluzione terapeutica alternativa, di tipo completamente passivo, il cui effetto non è basato sulla somministrazione di energia meccanica dall'esterno, attraverso la pulsazione, ma sull'adattamento di impedenza biomeccanica tra la sorgente elastica pulsatile (il ventricolo) ed il carico (l'aorta). Per verificare l'ipotesi funzionale è stato realizzato un sistema contrattile che simulasse diversi livelli di insufficienza ventricolare ed un sistema vascolare con resistenza idraulica ed elastanza variabili. Sono stati rilevati i parametri fisiologici (pressioni, flusso, potenza ed efficienza) nelle diverse condizioni di accoppiamento biomeccanico e si sono ripetuti i rilievi inserendo il dispositivo di contropulsazione passiva. La validazione sperimentale ha prodotto risultati coerenti con quanto atteso ed è stata indispensabile per l'ottenimento, da parte del Comitato Etico, dell'autorizzazione per la sperimentazione clinica del sistema in oggetto.

An unusual cause of hemoptysis--aberrant origin of the left pulmonary artery from the ascending aorta in the adult

Aberrant origin of a pulmonary artery from the ascending aorta is an uncommon congenital vascular malformation with poor survival without surgery. In this case report, we describe the unusual late diagnosis of this congenital malformation in an otherwise asymptomatic young man presenting with mild hemoptysis. We review the natural and modified history of this defect and the relevant aspects of follow-up in adult life.

Long-term results of thoracic endovascular aortic repair in atherosclerotic aneurysms involving the descending aorta

This study evaluated long-term results of thoracic endovascular aortic repair for atherosclerotic aneurysms involving descending aorta.

Midterm results of thoracic endovascular aortic repair in patients with aneurysms involving the descending aorta originating from chronic type B dissections

Midterm results of TEVAR (thoracic endovascular aortic repair) in patients with aneurysms involving the descending aorta originating from chronic type B dissections are not known.

Symptomatic spinal cord malperfusion after stent-graft coverage of the entire descending aorta

The study aims to identify risk constellations for symptomatic spinal cord malperfusion in patients undergoing extensive stent-graft coverage of the thoracic aorta.

Dose modulated retrospective ECG-gated versus non-gated 64-row CT angiography of the aorta at the same radiation dose: Comparison of motion artifacts, diagnostic confidence and signal-to-noise-ratios

To compare ECG-gated and non-gated CT angiography of the aorta at the same radiation dose, with regard to motion artifacts (MA), diagnostic confidence (DC) and signal-to-noise-ratios (SNRs).

Ascending thoracic aorta dimension and outcomes in acute type B dissection (from the International Registry of Acute Aortic Dissection [IRAD])

It is not well known if the size of the ascending thoracic aorta at presentation predicts features of presentation, management, and outcomes in patients with acute type B aortic dissection. The International Registry of Acute Aortic Dissection (IRAD) database was queried for all patients with acute type B dissection who had documentation of ascending thoracic aortic size at time of presentation. Patients were categorized according to ascending thoracic aortic diameters ≤4.0, 4.1 to 4.5, and ≥4.6 cm. Four hundred eighteen patients met inclusion criteria; 291 patients (69.6%) were men with a mean age of 63.2 ± 13.5 years. Ascending thoracic aortic diameter ≤4.0 cm was noted in 250 patients (59.8%), 4.1 to 4.5 cm in 105 patients (25.1%), and ≥4.6 cm in 63 patients (15.1%). Patients with an ascending thoracic aortic diameter ≥4.6 cm were more likely to be men (p = 0.01) and have Marfan syndrome (p <0.001) and known bicuspid aortic valve disease (p = 0.003). In patients with an ascending thoracic aorta ≥4.1 cm, there was an increased incidence of surgical intervention (p = 0.013). In those with an ascending thoracic aorta ≥4.6 cm, the root, ascending aorta, arch, and aortic valve were more often involved in surgical repair. Patients with an ascending thoracic aorta ≤4.0 were more likely to have endovascular therapy than those with larger ascending thoracic aortas (p = 0.009). There was no difference in overall mortality or cause of death. In conclusion, ascending thoracic aortic enlargement in patients with acute type B aortic dissection is common. Although its presence does not appear to predict an increased risk of mortality, it is associated with more frequent open surgical intervention that often involves replacement of the proximal aorta. Those with smaller proximal aortas are more likely to receive endovascular therapy.

Transposition of the supra-aortic vessels before stent grafting the aortic arch and descending aorta

Thoracic endovascular aortic repair has broadened the spectrum of treatment options for various acute and chronic thoracic aortic diseases. In clinical practice, aneurysms of the descending aorta are rarely limited to 1 segment. Thus, various surgical and endovascular options have been developed to offer treatment to those patients with more extended descending thoracic aortic disease. We have summarized the most common methods of arch rerouting, depending on the aortic involvement, emphasizing that these techniques should be used very selectively by experienced cardiovascular surgery teams.

Huge ruptured and infected pseudoaneurysm of the ascending aorta and aortic arch with erosion of sternum after previous cardiac surgery

A 77-year-old woman underwent aortic valve replacement and coronary bypass grafting in 2007 in the Emirates. Evolution was uneventful until December 2011. After repeated episodes of unspecific infections, a computed tomographic scan showed a large pseudoaneurysm of the distal ascending aorta. The site of aortic rupture was closed with a Gore-Tex patch and a Staphylococcus aureus infection treated appropriately. Two months later, a small cutaneous lesion on the cranial part of the sternotomy started bleeding. Computed tomographic scan demonstrated recurrence of a false aneurysm with erosion of the sternum and a large subcutaneous hematoma caused by the fistula. The patient was transferred to our institution. The challenges of this case included safe surgical approach (sternotomy, cannulation, perfusion, cerebral protection) as well as complete removal and extensive debridement of the infected material and reconstruction of the aortic arch. Using fully biological material, reconstruction of the ascending aorta and proximal arch was successfully performed.

Huge aneurysm of the ascending aorta in a patient with adult-type Pompe's disease: histological findings mimicking fibrillinopathy

Adult-type Pompe's disease (glycogen storage disease type II) has rarely been shown to present with dilatative arteriopathy, suggesting potential smooth muscle involvement in addition to lysosomal glycogen deposits usually restricted to skeletal muscle tissue. We report the case of a middle-aged man under enzyme replacement therapy presenting with an exceedingly large thoracic aortic aneurysm. Surprisingly, the histological work-up of resected aortic tissue revealed changes mimicking those observed in patients with classic connective tissue diseases. Enzyme replacement therapy, in addition to musculoskeletal and pulmonary treatment for patients with Pompe's disease, may prolong survival and lead to patients presenting with vascular alterations that may pose surgical and potential diagnostic challenges in the future.