Abstract Introduction: The initial treatment of stenosing tenosynovitis is usually conservative. When there is no good response, it must be resolved by surgically releasing the A1 pulley, traditionally with open release (OR). However, there is the alternative of ultrasound-guided percutaneous A1 pulley release (UPAR), which has shown similar results. Objective: To evaluate the effectiveness and costs of UPAR compared to OR at our center. Method: A retrospective study was carried out in patients undergoing UPAR. Information on pain scale, mechanical symptoms (Quinnell grades), and disability (QuickDASH) was obtained before and after the procedure. The costs of UPAR and OR alternatives were evaluated. Results: A statistically significant improvement in pain, mechanical symptoms and disability was observed after the procedure. No complications were reported. UPAR was found to be 63% less expensive than the most economical OR alternative. Conclusion: UPAR is a safe and effective alternative to treat “trigger finger or thumb”, with low costs and a shorter recovery period compared to OR. UPAR should be considered as the initial treatment when other options have not been successful.

Resumen Introducción: El tratamiento inicial de la tenosinovitis estenosante suele ser conservador. Cuando no hay buena respuesta debe resolverse liberando quirúrgicamente la polea A1, tradicionalmente con liberación abierta (LA), sin embargo, existe la alternativa de la liberación percutánea de la polea A1 guiada por ultrasonido (LPAUS), que ha mostrado similares resultados. Objetivo: Evaluar la eficacia y costos de LPAUS en comparación con la LA en nuestro centro. Método: Se llevó a cabo un estudio retrospectivo en pacientes sometidos a LPAUS. Se obtuvo información sobre escala del dolor, síntomas mecánicos (grados de Quinnell) y discapacidad (QuickDASH) antes y después del procedimiento. Se evaluaron los costos de este y las alternativas de LA. Resultados: Se observó una mejora estadísticamente significativa en dolor, síntomas mecánicos y discapacidad después del procedimiento. No se informaron complicaciones. La LPAUS resultó ser un 63% menos costosa que la alternativa de LA más económica. Conclusión: La LPAUS es una alternativa segura y efectiva para tratar el «dedo o pulgar en gatillo», con bajos costos y un periodo de recuperación más corto en comparación con la LA. La LPAUS se debe considerar como tratamiento inicial cuando otras opciones no han tenido éxito.

Abstract The use of supplementary cementitious materials to replace Portland clinker is one of the most effective strategies adopted by cement companies to reduce CO 2 emission on large-scale. However, due to the limited availability of traditional materials, alternative options are being investigated. The main objective of this research is to evaluate the characteristics and effect of different replacement levels of cement by dregs and grits on compressive strength. The wastes were ground and particles smaller than 75 µm were used. Chemical and physical were performed to characterize the dregs and grits. For both wastes, replacement levels of 0, 5, 10, 20 and 30% of cement mass were evaluated in the mortar production. The water-cement ratio and superplasticizer admixture content were kept constant. In fresh state, the consistency index and incorporated air content were obtained. Mortars made with dregs had higher strength compared to grits due to the higher combined water content. The results showed that it is possible to replace up to 36% of cement with dregs to obtain a strength of 25 MPa; and 15% for 40 MPa. largescale. largescale large scale. scale large-scale However investigated 7 used 0 5 10 30 production watercement constant state obtained 36 MPa 15 4 1 3

Resumo Ouso de adições minerais em substituição ao clínquer Portland é uma das medidas mitigadoras de emissão de CO2, mais promissoras em larga escala, adotadas pelas cimenteiras. Dada a limitação de disponibilidade de algumas, materiais alternativos vêm sendo investigados. A presente pesquisa teve como objetivo caracterizar e avaliar o efeito de diferentes teores de dregs e grits em substituição parcial ao cimento na resistência à compressão. Os resíduos foram submetidos à moagem, utilizando-se partículas inferiores a 75 µm. Foram realizados ensaios para caracterização química e física dos dregs e grits. Para ambos os resíduos, foram analisados os teores de 0, 5, 10, 20 e 30% em substituição à massa de cimento na produção de argamassas. A relação água/finos e o teor de aditivo superplastificante foram mantidos constantes. No estado fresco, foram avaliados o índice de consistência e o teor de ar incorporado. As argamassas com dregs proporcionaram maior resistência em relação às com grits devido ao maior teor de água combinada. Os resultados mostraram que é possível substituir até 36% do cimento por esse resíduo para obtenção de resistência à compressão de 25 MPa e 15% para 40 MPa. CO2 CO escala cimenteiras algumas investigados moagem utilizandose utilizando se 7 µm 0 5 10 2 30 águafinos finos constantes fresco incorporado combinada 36 15 4 1 3

Resumen Objetivo: desarrollar un método para la cobertura delta de portafolios de opciones europeas listadas con base en la teoría del cálculo conformable que mejora la precisión de las predicciones usando la aproximación de primer orden. Metodología: permitimos que la primera derivada en el modelo clásico de Black-Scholes-Merton tenga un orden fraccional 0 ≤ α ≤ 1 y calculamos la delta correspondiente de un portafolio como función de este parámetro conformable. Resultados: aplicando este método a un portafolio conformado de ocho opciones europeas listadas sobre el índice SPX, encontramos que la cobertura conformable genera predicciones más precisas, en promedio, que la cobertura tradicional. Limitaciones: este método es aplicable solamente a la cobertura delta (hedging) de opciones europeas. Originalidad: esta es la primera aplicación exitosa del cálculo conformable a la cobertura delta en opciones europeas. Conclusiones: la aplicación del cálculo conformable permite mayor flexibilidad en la aproximación local implícita en la cobertura delta de portafolios de acciones europeas y se ofrece como una metodología novel y de mayor precisión que la tradicional.

Abstract Objective: we aim to develop a method for delta hedging portfolios of European options based on the theory of conformable calculus which improves accuracy of risk management of listed options in a first-order approximation. Methodology: we allow the time derivative in the classic Black-Scholes-Merton model to have a fractional order 0 ≤ α ≤ 1 and calculate the corresponding delta of a portfolio of listed options as a function of this conformable parameter. Results: applying this method to a portfolio consisting of eight European options on the SPX index, we find that conformable delta hedging offers more accurate average predictions than classical delta hedging. Limitations: this method is applicable for delta hedging in European options only. Originality: this is the first successful application of conformable calculus to delta hedging in European options. Conclusions: application of Conformable Calculus allows for a greater flexibility in the local approximation to price in delta-hedging European options and offers a new and more precise methodology to this objective.

ABSTRACT Introduction: The introduction of Single-Port (SP) platform opened the field to new surgical options, allowing to perform major urological robot-assisted procedures extraperitoneally and with a supine patient positioning (1–3). Nevertheless, a comprehensive description of different supine access options is still lacking (4–6). In this light, we provided a step-by-step guide of SP extraperitoneal supine access options also exploring preliminary surgical outcomes. Materials and methods: Transvesical access was performed by a transversal incision 3cm above the pubic bone, after the anterior abdominal sheet incision, the bladder was insufflated with a flexible cystoscope and the detrusor muscle was incised at the level of the bladder dome. Similarly, the extraperitoneal access was carried out with a 4cm incision above the pubic bone, once visualized the preperitoneal space the prevesical fat was gently spread. The Low Anterior Access was performed with a 3cm incision at the McBurney point, the abdominal muscles were then spread. A gentle dissection was used laterally to develop the retroperitoneal space. Results: Overall, sixteen different procedures were performed with supine extraperitoneal access on 623 consecutive patients. No intraoperative conversions occurred. The median access time was 16 (IQR 12-21), 11 (IQR 7-14) and 14 (IQR 10-18) minutes in case of transvesical, extraperitoneal and low anterior access, respectively. Notably, 81.5 % of patients were discharged on the same day with a postoperative opioid free rate of 73%. Conclusion: The Atlas provides a comprehensive step-by-step guide to successfully perform all major urological SP procedures extraperitoneally and with supine patient positioning. Introduction SinglePort Single Port (SP robotassisted robot assisted 1–3. 13 1–3 . 1 3 (1–3) Nevertheless 4–6. 46 4–6 4 6 (4–6) light stepbystep step outcomes methods cm bone dome Similarly spread point Results Overall 62 occurred IQR 1221, 1221 12 21 , 12-21) 714 7 7-14 1018 10 18 10-18 transvesical respectively Notably 815 81 5 81. 73 73% Conclusion 1– (1–3 4– (4–6 122 2 12-21 71 7-1 101 10-1 8 (1– (4– 12-2 7- 10- (1 (4 12- (

Resumo: Objetivo: determinar habilidades e conhecimentos sobre as tecnologias da informação e comunicação (TIC) dos calouros no curso de bacharelado em enfermagem em uma instituição pública de ensino superior na cidade de Bahía Blanca, província de Buenos Aires, Argentina. Metodologia: estudo observacional, descritivo, transversal e quantitativo. Foi utilizado um instrumento composto por 59 perguntas com opções de resposta fechada para avaliar as competências digitais dos calouros do curso. Resultados: Participaram 386 estudantes, em sua maioria do gênero feminino (85,49 %), do primeiro ciclo estudantil (74,35 %) e com idade igual ou inferior a 20 anos (47,15 %). 98,19 % tinham acesso à internet, 79,27 % tinham computador e mais de 80 % usavam amplamente as redes sociais (WhatsApp, Instagram) e o e-mail. Os calouros se auto-avaliaram competentes no programa MS Word, enquanto no MS Excel se declararam menos competentes. Há desconhecimento e baixo desenvolvimento de habilidades para gerar conteúdo e uma ampla demonstração de habilidades para pesquisar e baixar informações da web. A idade, o gênero, o tempo diário de uso da Internet e o ciclo de ingresso estudantil mostraram relação com o domínio das ferramentas digitais aplicadas à educação. Conclusões: Foi identificado um desenvolvimento intermediário de competências digitais aplicadas à educação, o que poderia demandar a concepção de programas que nivelem essas competências durante o processo de admissão ou durante a formação.

Abstract: Objective: To determine the skills and knowledge about information and communication technologies (ICT) of entrants to the Bachelor’s Degree in Nursing at a public higher institution in Bahía Blanca, Province of Buenos Aires, Argentina. Methodology: Observational, descriptive, transversal and quantitative study. An instrument was implemented consisting of 59 questions with closed response options aimed at assessing digital competencies in those entering the career. Results: 386 entrants participated, mostly female (85.49 %), from the first cycle (74.35 %) and 20 years old or younger (47.15%). 98.19 % had access to the internet, 79.27 % have a computer and more than 80 % have extensive use of social networks (WhatsApp, Instagram) and email. The entrants evaluated themselves as competent in the MS Word program, while in MS Excel they declared themselves less competent. There is a lack of knowledge and low development of skills to generate content and a wide range of skills to search and download information from the web. Age, gender, daily time of Internet use and entry cycle showed a relationship with the mastery of digital tools applied to education. Conclusions: An intermediate development of digital competencies applied to education was identified, and a high one for the use of social networks. The variables age, gender, daily time of Internet use and entry cycle were related to the knowledge and skills for using ICT applied to education.

Resumen: Objetivo: Determinar las habilidades y conocimientos sobre las tecnologías de la información y la comunicación (TIC) de los ingresantes a la carrera de Licenciatura en Enfermería de una institución superior pública de Bahía Blanca, Provincia de Buenos Aires, Argentina. Metodología: Estudio observacional, descriptivo, transversal y cuantitativo. Se implementó un instrumento conformado por 59 preguntas con opciones de respuesta cerrada orientado a valorar las competencias digitales en los ingresantes a la carrera. Resultados: Participaron 386 ingresantes, mayormente de género femenino (85.49 %), del primer ciclo (74.35 %) y con 20 años o menos de edad (47.15 %). El 98.19 % tenía acceso a internet, el 79.27 % tiene computadora y más del 80 % tiene un amplio uso de redes sociales (WhatsApp, Instagram) y correo electrónico. Los ingresantes se autoevaluaron competentes en el programa MS Word, mientras que en MS Excel se declararon menos competentes. Hay desconocimiento y bajo desarrollo de habilidades para generar contenido, y un amplio despliegue de habilidades para buscar y descargar información de la web. La edad, el género, el tiempo diario de uso de internet y el ciclo de ingreso mostraron relación con el dominio de las herramientas digitales aplicadas a la educación. Conclusiones: Se identificó un desarrollo intermedio de competencias digitales aplicadas a la educación, lo que podría ameritar el diseño de programas que nivelen estas habilidades durante el proceso de ingreso o durante la formación.

Abstract The evolution of scientific collaboration is analyzed based on a highly representative sample of Spanish researchers from all areas of knowledge and the publications in which they have participated. The study examines the number of authors listed in the published works between the years 1990 and 2022. Two types of results are offered: presenting the evolution in the number of authors participating in publications across twenty-five thematic disciplines and providing a percentage comparison of the evolution of co-authorships in five major thematic areas. Finally, options for possible future studies in this field are presented.

Resumen Se analiza la evolución que ha habido en materia de colaboración científica, a partir de una muestra muy representativa de investigadores españoles de todas las áreas de conocimiento y de las publicaciones en las que estos han participado, estudiando el número de autores que figuran en los trabajos publicados entre los años 1990 y 2022. Se ofrecen dos tipos de resultados, presentando la evolución que ha habido en el número de autores que participan en las publicaciones en veinticinco disciplinas temáticas y haciendo una comparativa porcentual de la evolución de las coautorías en cinco grandes ámbitos temáticos. Finalmente se presentan opciones de posibles futuros estudios en este ámbito.

There is widespread agreement that skills development is a vital dimension of the just energy transition (JET). Skills development for JET is rapidly emerging and involves complex inter-sectoral systems of skills development and new methods for demand analysis. Currently in South Africa, learning pathways into green jobs, enterprise development and more sustainable job options, including those required for JET at entry and technical levels, are unclear, ad hoc and fragmented. At best, we have fragmented offerings of courses and qualifications and few systemic approaches to skills analysis and development. There is also a narrow reliance on supply and demand discourses that are ill-fitting for the type of skills that need to be developed. Drawing on a group of regional and local studies focusing on skills supply and demand for JET, the paper analyses the responsiveness of skills systems, with specific focus on institutions and institutional arrangements that underpin skills planning and anticipation. The paper critiques the metaphor of 'supply' and 'demand', which, it argues, is the wrong lens, as it focuses attention on certain parts of the skills system dislocated from the broader conditions that they are imbedded in. We pose new methodological questions for engaged skills research that can enable a green and just future, and the systemic transformations that are needed to catalyse a low-carbon transition. SIGNIFICANCE: The research findings offer a critical reflection on the current approach to research focused on skills for the just energy transition. The review highlights the limitations of the dominant supply-demand approach of skills analysis, and we argue that it promotes a neoliberal, market-led discourse on skills that privileges industry and excludes the voices of communities and workers.

Resumen: La investigación, con enfoque epistemológico cuantitativo y el paradigma positivista, tiene como objetivo definir la relación entre el marco regulatorio del sector financiero ecuatoriano y las condiciones de financiamiento a las pymes. Esta fue de tipo descriptivo-correlacional, permitiendo realizar un análisis descriptivo y factorial de variables vinculadas al conocimiento y aplicación de leyes y códigos regulatorios de 54 oficiales de crédito del sector bancario de El Oro, Ecuador. Se identificaron dos dimensiones: una relacionada con el marco regulatorio monetario y otra con códigos orgánicos. Las encuestas señalan que las leyes más aplicadas son: Ley General de Instituciones del Sector Financiero y Ley de Compañías. La primera regula la creación, funcionamiento y cierre de instituciones financieras privadas para proteger a la población y asegurar la estabilidad financiera; su cumplimiento es supervisado por la Superintendencia de Bancos. La segunda simplifica el proceso de constitución de empresas, permitiendo diversos tipos de compañías y flexibilidad en su estructura. Las regulaciones bancarias ecuatorianas han experimentado reformas para fortalecer la solidez y transparencia del sistema, como la Ley de Mercado de Valores y la Ley de Instituciones del Sistema de Seguros Privados, que contribuyen a la estabilidad, regulación, protección al consumidor financiero y promoción de la competencia, generando condiciones de financiamiento favorables, que incluyen confianza, tasas de interés competitivas y amplias opciones financieras.

Abstract: The research, with a quantitative epistemological approach and the positivist paradigm, aims to define the relationship between the regulatory framework of the Ecuadorian financial sector and the financing conditions for SMEs. This was of a descriptive-correlational type, allowing a descriptive and factorial analysis of variables linked to the knowledge and application of laws and regulatory codes of 54 credit officers from the banking sector of El Oro, Ecuador. Two dimensions were identified: one related to the monetary regulatory framework and another with organic codes. Surveys indicate that the most applied laws are: General Law of Financial Sector Institutions and Companies Law. The first regulates the creation, operation and closure of private financial institutions to protect the population and ensure financial stability; Its compliance is supervised by the Superintendency of Banks. The second simplifies the business incorporation process, allowing various types of companies and flexibility in their structure. Ecuadorian banking regulations have undergone reforms to strengthen the soundness and transparency of the system, such as the Securities Market Law and the Law of Institutions of the Private Insurance System, which contribute to stability, regulation, financial consumer protection and promotion of competition, generating favorable financing conditions, which include confidence, competitive interest rates and broad financial options.

INTRODUCTION: The undergraduate dental students at the higher learning institutes are expected to acquire clinical skills to deliver proper oral healthcare to patients. Various teaching strategies are used by lecturers to teach the students, and these teaching strategies need to be reviewed by obtaining feedback to improve teaching and learning Aims and objectives: To describe the experiences of dental students regarding the teaching and learning strategies being used in the Prosthetic Dentistry module. METHODS: Final year dental students were asked to participate in the study since they were recipients of teaching and learning in the department of Prosthetic Dentistry. Semi-structured interviews were conducted and the data captured in this study were analysed by means of a six-phase approach to thematic analysis RESULTS: The participants' responses to teaching strategies revealed that students perceived that in preclinical teaching, different teaching strategies were used. However, a few participants perceived some of these strategies were not effective CONCLUSION: The recommended methods of teaching were those that promoted active student participation. Lecturers in the department of Prosthetic Dentistry use didactic teaching and this may be due to a lack of knowledge regarding other teaching strategies as options in health professions' education

Abstract Endometriosis is a chronic disease, characterized by the presence of endometrium outside the uterine cavity, which affects around 10% of women of reproductive age. Symptoms vary widely and can be absent or severe, debilitating and highly restrictive of quality of life. Pain, in different forms, intensities and associations, is the most striking symptom. The endometriosis is often associated with infertility and other comorbidities that represent additional risks for patients. Diagnosing is a major challenge. It is often delayed, for reasons rooted in the unspecific nosology of the disease, which is confused with common conditions. Another major challenge is treatment, since it is a chronic, multifaceted disease, sometimes with systemic repercussions, for which it is essential to find a personalized response. This review highlights the most recent aspects of pathogenesis and treatment options, particularly the new pharmacological options with GnRH antagonists, reserving surgery for specific situations. New molecular agents are being developed for the diagnosis and potential treatment of this disease. The configuration of clinical guidelines for optimizing the fertility potential of these patients remains to be defined.

Resumo A endometriose é uma doença crónica, caracterizada pela presença de endométrio fora da cavidade uterina, que afeta cerca de 10% das mulheres em idade reprodutiva. A sua expressão sintomática é muito variada, pode estar ausente ou ser grave, debilitante e altamente condicionante da qualidade de vida. A dor, com matizes e associações diversas, é o sintoma mais marcante. Associa-se com frequência a infertilidade e outras comorbilidades que representam riscos adicionais para as doentes. O diagnóstico da endometriose é um grande desafio. O atraso é frequente, por razões que radicam na nosologia pouco especifica da doença, que se confunde com situações comuns. Outro grande desafio é o tratamento, uma vez que é uma doença crónica, multifacetada, por vezes com repercussão sistémica, para a qual é indispensável encontrar uma resposta personalizada. Esta revisão destaca os aspetos mais recentes da patogénese e opções do tratamento, nomeadamente as novas opções farmacológicas com antagonistas da GnRH, reservando a cirurgia para situações específicas. Estão em desenvolvimento novos agentes moleculares para o diagnóstico e potencial tratamento desta doença. A configuração de orientações clínicas para a otimização do potencial de fertilidade dessas doentes continua por definir.

Abstract Peace education aims to influence the development of a healthy and peaceful coexistence, both in the classroom and in other broader social structures such as the family and the local and global community; It also involves motivating students to understand human rights, multiculturalism and conflict management. The funds of knowledge applied to education constitute a theoretical and methodological approach that values a nd takes into account the experiences and knowledge of families to enrich the design and implementation of sensitive and contextualized educational practices. Here we delve into the importance of implementing funds of knowledge in teaching practices as an approach that promotes peace, because it is based on the principles of inclusion, equity, participation, democracy, solidarity and respect for human rights. The funds of knowledge approach constitutes a contribution to socially just and culturally relevant education that promotes peace because, to live peacefully in a society where people of different cultures, ethnicities, ideologies and languages converge, it is important to live the experience of recognizing, value and respect diversity as the axis that drives the well-being of people and communities.

Resumen La educación para la paz tiene como objetivo incidir en el desarrollo de una convivencia sana y pacífica, tanto en el aula como en otras estructuras sociales más amplias como la familia y la comunidad local y global; implica, además, motivar a los estudiantes a comprender los derechos humanos, la multiculturalidad y el manejo de conflictos. Los fondos de conocimiento aplicados a la educación constituyen un enfoque teórico y metodológico que valora y toma en cuenta las experiencias y conocimientos de las familias para enriquecer el diseño e implementación de prácticas educativas sensibles y contextualizadas. Aquí se profundiza en la importancia de la implementación de los fondos de conocimiento en las prácticas docentes como un enfoque que promueve la paz, porque se basa en los principios de inclusión, equidad, participación, democracia, solidaridad y respeto a los derechos humanos. El enfoque de fondos de conocimiento constituye un aporte a la educación socialmente justa y culturalmente relevante que promueve la paz porque, para convivir de forma pacífica en una sociedad donde convergen personas de diferentes culturas, etnias, ideologías e idiomas, es importante vivir la experiencia de reconocer, valorar y respetar la diversidad como eje que impulsa el bienestar de las personas y las comunidades.

RESUMEN El Colesteatoma del Conducto Auditivo Externo (CCAE) constituye una patología poco frecuente. Su diagnóstico es fundamentalmente clínico, se apoya en los estudios de imagen y confirmación final anatomopatológica. Algunos casos pueden ser asintomáticos y otros casos pueden presentar complicaciones como parálisis facial, afectación del oído medio, etc. Su tratamiento es quirúrgico con una serie de técnicas denominadas canaloplastias, las cuales tienen como objetivo retirar el tejido colesteatomatoso y crear un mecanismo de autoevacuación. Presentamos la descripción de un caso de colesteatoma del conducto auditivo complicado con absceso retroauricular en una paciente joven con estenosis congénita, discutimos los aspectos relevantes respecto a la clínica, diagnósticos diferenciales y opciones terapéuticas en una revisión de la literatura disponible.

ABSTRACT Cholesteatoma of the External Auditory Canal (CCAE) is a rare pathology. Its diagnosis is fundamentally clinical, based on imaging studies and final anatomopathological confirmation. Some cases can be asymptomatic and other cases can present complications such as facial paralysis, middle ear involvement, etc. Its treatment is surgical with a series of techniques called canaloplasties, which aim to remove the cholesteatomatous tissue and create a self-evacuation mechanism. We present the description of a case of cholesteatoma of the auditory canal complicated with retroauricular abscess in a young patient with congenital stenosis, discuss the relevant aspects regarding the clinic, differential diagnoses, and therapeutic options in a review of the available literature.

RESUMEN Las hernias lumbares son defectos infrecuentes de la pared abdominal con pocos casos publicados en la literatura. En la región lumbar existen dos zonas de debilidad, un triángulo superior de Grynfeltt y otro inferior de Petit. Se presenta el caso de una mujer que consultó por dolor y tumoración lumbar derecha. Ante sospecha de hernia lumbar se realizó una tomografía computarizada que informó una hernia de Grynfeltt con contenido de grasa retroperitoneal. Se realizó una plástica protésica por abordaje abierto. No se observaron complicaciones post posoperatorias. Las hernias lumbares pueden ser congénitas o adquiridas, y estas primarias o secundarias. La tomografía computarizada (TC) es el procedimiento de referencia (gold standard) para su diagnóstico. La plástica protésica es el tratamiento de elección. El abordaje abierto y laparoscópico constituyen opciones válidas, y se deben valorar según las características del defecto, el paciente y la experiencia del equipo quirúrgico para su selección.

ABSTRACT Lumbar hernias are rare abdominal wall defects with few cases published in the literature. Two welldefined areas of weakness are identified in the lumbar region, the superior lumbar (Grynfeltt-Lesshaft) triangle and the inferior lumbar (Petit) triangle. We report the case of a female patient who sought medical care due to low back pain and a tumor in the right lumbar region. A lumbar hernia was suspected, and a computed tomography scan was performed, which revealed a Grynfeltt hernia with retroperitoneal fat content. The defect was repaired with mesh placement through an open approach. There were no postoperative complications. Lumbar hernias can be congenital or acquired (primary or secondary). Computed tomography scan is the gold standard for the diagnosis. Mesh repair is the treatment of choice. The open approach and laparoscopy are valid and safe options, and their implementation should be considered based on the characteristics of the defect, the patient, and the experience of the treating team.

RESUMEN La comprensión de los mecanismos para el desarrollo de la ascitis ha evolucionado a lo largo de los años, involucrando al hígado, peritoneo, corazón y riñones, pero no al intestino, como responsable clave en su formación. Poco se ha descripto tanto de su papel fisiopatológico como de las posibles alternativas terapéuticas clínicas y quirúrgicas. A fin de validar empíricamente este concepto se relata la situación de un hombre de 39 años, con trombosis aislada de la vena mesentérica superior y fallo intestinal. La necesidad de realizar una derivación quirúrgica nos llevó a construir un shunt desde una vena colateral de la mesentérica superior a la vena esplénica. La reducción de la presión del sistema mesentérico superior de 35 a 6 mm Hg sirvió para la resolución de los signos y síntomas clínicos en un mes. Este caso obliga a revisar conceptos fisiopatológicos básicos sobre la producción de ascitis, contribuye a la descripción de un nuevo tipo de shunt y amplía las opciones terapéuticas quirúrgicas en el tratamiento de la hipertensión venosa esplácnica.

ABSTRACT The understanding of the mechanisms for the development of ascites has evolved over the years to include the liver, peritoneum, heart and kidneys, but not the intestine, as key players in its formation. The pathophysiological role of the intestine as well as the possible clinical and surgical therapeutic options have been poorly described. In order to empirically validate this concept, we report the situation of a 39-year-old man with isolated thrombosis of the superior mesenteric vein and intestinal failure. The need to perform a surgical shunt led us to construct a shunt from a collateral vein of the superior mesenteric vein to the splenic vein. The reduction in pressure in the superior mesenteric venous system from 35 to 6 mm Hg resulted in resolution of clinical signs and symptoms within one month. This case study forces us to review the basic pathophysiological concepts of ascites formation, contributes to the description of a new type of shunt, and expands the surgical therapeutic options in the treatment of splanchnic venous hypertension.