Aim: To describe the experience of the Maxillofacial Surgical team of Hospital del Trabajador de Santiago in the management of orbital fractures. Materials and Methods: Retrospective study of 42 patients operated consecutively between January of 2016 and November of 2017 at Hospital del Trabajador de Santiago by the Maxillofacial Surgery team due to orbital fracture. The demographic data was tabulated and then a comparison between isolated and combined orbital fractures was made. Results: Of 42 patients most were men (73.8%) with an average age of 40±12.24 years. At admission the main symptoms were ecchymosis (64.3%), periorbital edema (54.8%), subconjunctival hemorrhage (33.3%) and diplopia (26.2%). The most frequently affected orbital wall was the floor (85.7%). Isolated fractures accounted for 35.7% of the cases and those associated with other facial fractures for 64.3%. The postoperative complication rate was 16.7% due to diplopia and enophthalmos. Both complications were mild and only required conservative management. Discussion: The low complication rate might be due to the experience of the surgical team in the management of orbital fractures, long-term following, orbital volume measurements, intraoperative imaging, the use of prefabricated mesh and endoscopic guidance. Conclusión: An adequate diagnosis and evaluation are fundamental for orbital fracture treatment. Demographic data, fracture characteristics and the complications described were similar to those reported by other studies, while the rate of complications was lower than those experiences.

Resumen Objetivo: Describir la experiencia del equipo de cirugía maxilofacial del Hospital del Trabajador en el manejo de las fracturas de órbita. Materiales y Método: Estudio retrospectivo de 42 pacientes consecutivos operados por fractura de órbita en el Servicio de Cirugía Maxilofacial del Hospital del Trabajador entre enero de 2016 y diciembre de 2017. Se tabularon datos demográficos, información del trauma, tipo de fractura, fracturas asociadas, tratamiento y seguimiento. Resultado: De los 42 pacientes, la mayoría eran hombres (73,8%) con edad promedio de 40 ± 12,24 años. Los principales síntomas al ingreso fueron equimosis (64,3%), edema periocular (54,8%), hemorragia subconjuntival (33,3%) y diplopía (26,2%). La pared orbitaria más frecuentemente afectada fue el piso de la órbita (85,7%). Las fracturas se presentaron de forma aislada en 35,7% de los casos y asociada a otra fractura de la cara en 64,3%. Post cirugía, la tasa de complicación fue de 16,7%, producto de diplopía y enoftalmos leves que solo requirieron tratamientos conservadores para su resolución. Discusión: La baja tasa de complicaciones se debe a la experiencia del equipo médico con un seguimiento a largo plazo, la medición de volúmenes orbitarios, imagenología intraoperatoria, utilización de malla prefabricada y asistencia endoscópica. Conclusiones: Un adecuado diagnóstico y evaluación son fundamentales para el tratamiento de la fractura de órbita. Los datos demográficos, las características de las fracturas y las complicaciones descritas fueron muy similares a lo reportado por otras experiencias, mientras que la tasa de complicaciones fue menor.

ABSTRACT The aneurysm of the vein of Galen is a rare condition that generates high morbidity and mortality in neonates and infants. It presents as an arteriovenous fistula with direct communication between the pial arteries and venous channels with drainage to the vein of Galen. Its clinic varies according to the age of presentation, it can manifest with or without heart failure, as well as other neurological findings and other cerebral vascular malformations. The diagnosis can be made in the prenatal stage, through ultrasound and the Doppler study, while the gold standard for postnatal diagnosis is angiography. Endovascular treatment as in the case presented below is the proper management through embolization. The objective of this research was to present the clinical elements that allowed the diagnosis of this rare malformation in a 4-month-old child.

RESUMEN El aneurisma de la vena de Galeno es una afectación poco frecuente que genera una elevada morbilidad y mortalidad en neonatos y lactantes. Se presenta como una fístula arteriovenosa con comunicación directa entre las arterias piales y los canales venosos con drenaje a la vena de Galeno. Su clínica es variable de acuerdo con la edad de presentación, puede manifestarse con o sin fallo cardiaco, así como otros hallazgos neurológicos y otras malformaciones vasculares cerebrales. El diagnóstico se puede realizar en etapa prenatal, a través de ecografía y del estudio Doppler, mientras que el estándar de oro para el diagnóstico posnatal es la angiografía. El tratamiento endovascular como en el caso que se presenta es el manejo adecuado a través de una embolización. El objetivo de esta investigación fue dar a conocer los elementos clínicos que permitieron el diagnóstico de esta rara malformación en un niño de 4 meses de edad.

Abstract Background: Implantable cardiac defibrillators (ICDs) therapy for primary prevention (PP) of sudden cardiac arrest (SCA) is well-established but underutilized globally. The Improve SCA study has identified a cohort of patients called 1.5 primary prevention (1.5PP), based on PP patients with the presence of documented risk factors: non-sustained ventricular tachycardia, frequent premature ventricular contractions, left ventricular ejection fraction < 25%, and pre-syncope or syncope. Objective: This study evaluated the cost-effectiveness of ICD therapy compared to no ICD among 1.5PP patients in the Brazilian public healthcare system. Methods: Modified inputs to a published Markov model were applied to compare costs and outcomes of ICD therapy to no ICD therapy from the Brazilian payer’s perspective. Mortality and utility estimates were obtained from the IMPROVE SCA trial. Additional effectiveness inputs were sourced from the literature. Cost inputs were obtained from the Brazilian Unified Health System and the Ministry of Health. Costs were discounted at 4.7%; quality-adjusted life years (QALYs) were discounted at 1.45%. This study applied a willingness-to-pay (WTP) value of three times Brazil’s gross domestic product (GDP) in 2017, R$105,723 (Brazilian Real). Results: The total discounted lifetime costs for ICD therapy were R$100,920 compared to R$43,866 for no ICD therapy. Total discounted QALYs for ICD therapy and no ICD therapy were 9.85 and 7.15, respectively. The incremental cost effectiveness ratio was R$21,156 per QALY and less than the R$105,723 WTP threshold. Results from sensitivity analyses were consistent with base case results. Conclusions: ICD therapy compared to no ICD therapy is cost-effective in the 1.5PP population in Brazil. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

ABSTRACT Following classical literature in herpetology, we built two five-stage life tables for the endangered hawksbill sea turtle Eretmochelys imbricata in the Gulf of Paria, eastern Venezuela, using data from incidental captures by industrial trawl fisheries from 1991 until 2000, artisanal fisheries effect and regional stranding from 1999 to 2017, and a local conservation project with the nesting females from 2003 to 2018. We estimated the survivorship for the managed, translocated nests, and a portion of the natural in situ nests (≈31%). We used the resultant life graph and matrices to estimate the hawksbills population status in the region and determine differences in population growth rate and elasticity between translocated and in situ nests. Eggs/hatchlings (stage 1) and small juveniles of less than three years old (stage 2), had high mortalities. We controlled stage 1 mortality by translocating nests into a hatchery. The in situ nests suffered almost 88% predation or poaching. Conversely, these non-translocated nests' emergence success was greater than that of managed nests, but overall survivorship was the lower. We propose that fecundity could begin with sub-adults (stage 4) after the 7th year with 60 cm of curved carapace length. Finite rates of increase of both populations, managed and natural, were significantly higher than 1, and that of the managed population is significantly higher than that of the natural one, meaning that both populations would grow and that the managed one would grow faster than the natural one. Then protection of stage 1 is essential to the population of hawksbills in the region, although uncertainties of survivorship of stage 2 and fecundity of stage 4 were not properly confirmed locally. Notwithstanding, elasticity analysis indicated that the population growth rate was more affected by proportional changes in sub-adults and adults' fecundity than any other life-history element.

RESUMO: Cistos aracnoide são acúmulos de líquido cefalorraquidiano que ocorre dentro da membrana aracnoide devido à divisão ou duplicação desta estrutura. O objetivo desse estudo retrospectivo é relatar a ocorrência dessa condição em 26 cães, assim como descrever os aspectos de imagem pela tomografia computadorizada e ressonância magnética e correlacionar com os sinais clínicos. No estudo observamos a prevalência em machos, em raças de pequeno porte, com predomínio de Pinscher miniatura e Shih Tzu, com idade variando de dois meses a nove anos. Os principais sinais neurológicos observados nestes animais foram crises epiléticas e ataxia cerebelar. Foi possível concluir que em 17 cães o cisto aracnoide quadrigeminal foi considerado um achado incidental, em seis cães essa condição foi considerada a causa determinante dos sinais clínicos, e em três cães alguns sinais estavam associados com o cisto aracnoide, porém esses animais apresentaram sinais clínicos relacionados a outros sítios de lesão intracraniana.

ABSTRACT: Arachnoid cysts are accumulations of cerebrospinal fluid that occur within the arachnoid membrane due to the splitting or duplication of this structure. The aim of this retrospective study is to report the occurrence of this condition in 26 dogs, as well as to describe the findings of computed tomography imaging and magnetic resonance image scans and to correlate these with the clinical signs. A prevalence of the condition was observed in males, predominantly in the small breeds Miniature Pinscher and Shih Tzu, with age raging from 2 months to 9 years. The mainly clinical signs observed in these dogs were seizures and cerebellar ataxia. The study concluded that in 17 dogs the quadrigeminal arachnoid cyst was regarded as an incidental finding, in 6 dogs this condition was regarded as the determinant cause of the clinical signs, and in 3 dogs some clinical signs were associated with arachnoid cyst, but they also presented clinical signs involving others sites of intracranial lesion.

We report the ablation of an atrial flutter with a 260 ms cycle length in a 28-year-old patient with left isomerism and interrupted left inferior vena cava. We showed the participation of the suprahepatic - tricuspid isthmus in the macro reentry circuit by the entrainment maneuver.

Se comunica la ablación de un flúter auricular con una longitud de ciclo de 260 ms en un paciente de 28 años con isomerismo izquierdo y vena cava inferior izquierda interrumpida. Mediante encarrilamiento, demostramos la participación del istmo suprahepático tricuspídeo en el circuito de macroreentrada. Realizamos líneas de ablación con radiofrecuencia que detuvieron la arritmia primaria y culminó en ritmo de escape nodal.

Calcula-se que em 2010 havia provavelmente 60,5 milhões de pessoas com glaucoma, com aumento previsto para 79,6 milhões em 2020; a cegueira bilateral por glaucoma era detectada em 8,4 milhões de pessoas, em 2010, e com aumento estimado para 11,2 milhões em 2020. Dispositivos especiais foram desenvolvidos para reduzir a pressão intraocular em pacientes com glaucoma refratário, chamados implantes de filtragem. A taxa de sucesso destes implantes é relativamente baixa, e sabe-se que elas continuam a diminuir ao longo do tempo. Para evitar as falhas produzidas pela cicatrização de tecido em torno dos implantes, foram feitas tentativas de drenagem do humor aquoso para diferentes locais, tais como o sistema venoso, saco lacrimal, os seios paranasais e fórnice conjuntival. Revendo o tratamento atual da hidrocefalia, uma técnica de derivação a partir da câmara anterior para o peritônio foi desenvolvida. A técnica cirúrgica desenvolvida é uma modificação da técnica atualmente utilizada por neurocirurgiões para o tratamento de hidrocefalia. Apresentamos o primeiro caso operado com esta técnica.

In 2010, there were estimated to be approximately 60.5 million people with glaucoma. This number is expected to increase to 79.6 million by 2020. In 2010, there were 8.4 million people with bilateral blindness caused by glaucoma, and this number is expected in increase to 11.2 million by 2020. Filtering implants are special devices that have been developed to reduce intraocular pressure in patients with refractory glaucoma. The success rate of these implants is relatively low, and they continue to fail over time. To avoid failure caused by the formation of scar tissue around the implants, attempts have been made to drain the aqueous humor to various sites, including the venous system, lacrimal sac, sinuses, and conjunctival fornix. Recently, a system to shunt aqueous humor from the anterior chamber to the peritoneum has been developed. The surgical technique involved in this system is a modification of the technique currently used by neurosurgeons for the treatment of hydrocephalus. We present the first case operated using this technique.