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Aortopathies associated to Marfan syndrome (MFS) are important causes of maternal death during pregnancy. We present a 27-year-old and 24-week pregnant MFS woman who arrived to the emergency department with increasing abdominal pain; an obstetric ultrasound showed an Abdominal Aortic Aneurysm (AAA), a multislice computed tomography angiography (CTA) confirmed and demonstrated a 7.3 centimeter (cm) infrarenal AAA without evidence of dissection. A multidisciplinary committee determined that an open repair would lead to a significantly high maternal-fetal morbidity and mortality. Although endovascular repair (EVAR) in MFS patients remains controversial, an urgent bridge therapy was considered to be the best option. She was transferred to the angiography suite for EVAR to prevent AAA rupture and ensure a satisfactory pregnancy. The patient and fetus presented no complications during the procedure and were discharged 3 days later. She continued her pregnancy without eventualities and an elective C-section was performed on week 36. A CTA imaging at 12 months revealed type 1A and 3 endoleaks, we decided to perform endograft explant and a definitive open repair, there were no complications during the procedure, the patient is currently asymptomatic. Our case illustrates a complex decision and management that successfully avoid morbidity and mortality of a MFS mother and her product; additionally, this experience reinforces the need for lifelong and close surveillance in these patients.

Iodinated contrast is the most common contrast agent used during endovascular abdominal aneurysm repair (EVAR). However, its use may worsen kidney function in patients with renal insufficiency. Previous studies have demonstrated the safety and effectiveness of carbon dioxide (CO2)-EVAR. Here, we report cases of three male patients with mild renal insufficiency (mean age: 79 years) that successfully underwent CO2-EVAR using INCRAFT ultra-low profile endografts. CO2 angiography provided the necessary vascular roadmap for safe and effective percutaneous EVAR, eliminating the need for iodinated contrast media and preventing contrast-induced nephropathy.

Objectives Post-thrombotic syndrome is the commonest long-term sequela of deep venous thrombosis. Severe post-thrombotic syndrome reduces importantly the quality of life of patients and tissue hypoxia is associated with ulceration. Transcutaneous oxygen pressure (tcPO2) provides information on the delivery of oxygen through the microvascular circulation and measuring tcPO2 might detect values at which patients with post-thrombotic syndrome might ulcerate. The aim of our study is to determine tcPO2 in post-thrombotic syndrome patients and compare the values with a control group. Methods A cross-sectional study was performed. Periflux 5000 monitor (Perimed) was used to measure tcPO2 in patients with mild-moderate, severe post-thrombotic syndrome and control groups. In patients with ulceration, two measurements were obtained, the first around the ulcer and the second 10 cm away from the lesion. Categorical data were analyzed with Fisher’s exact test and a p value Results Twelve patients with post-thrombotic syndrome and 13 patients (control group) were enrolled. Post-thrombotic syndrome patients’ mean age was 58 years (47–72 years) and eight (67%) patients were males. The overall mean tcPO2 measurement in post-thrombotic syndrome group was 35.5 mm Hg (SD ± 11), while in the severe post-thrombotic syndrome was 23.2 mm Hg (SD ± 9). All severe post-thrombotic syndrome patients had measurements 50 mm Hg (SD ± 4) in all patients, with a mean value of 58.2 mm Hg. During comparison of severe post-thrombotic syndrome subgroup versus control group, we found that patients with venous ulcers had 50 mm Hg ( p Conclusions Our results demonstrate that severe post-thrombotic syndrome patients have significantly lower TcPO2 values compared to a healthy control group and non-severe post-thrombotic syndrome ( p = 0.0001). Further research is necessary to establish cut-off point values of tcPO2 in this debilitating disease for possible clinical applications and determination of ulcer healing predictors.

Primary aortitis (PA) secondary to Listeria monocytogenes is extremely rare with only a few cases reported in the literature. Presently, there is no consensus concerning the best treatment when no complications are found in the thoracic computed tomography (CT) imaging. This report illustrates the clinical presentation and favorable clinical course of a rare case of PA secondary to Listeria monocytogenes in an 82-year-old diabetic woman, successfully treated with conservative management with 18 months of follow up. Included in this article, we additionally present a review of the literature of this uncommon etiology of infectious aortitis.

Abdominal Aortic Aneurysms are rare in the infant population, when these occur are secondary to connective tissue diseases, vasculitis, and infectious etiology or in relation with tuberous sclerosis. We herein present an 11 month-girl who was diagnosed with a translocation Xp11.2 associated left renal cell carcinoma (RCC). In addition to this finding, a Computed Tomography Angiography (CTA) revealed a 2.8 centimeters (cm) dilatation of the infrarenal aorta consistent with a fusiform aneurysm. She underwent concomitant left nephrectomy and aneurysm repair with a 14 millimeters (mm) expanded polytetrafluoroethylene (ePTFE) graft. Following the procedure the patient recovered without complications and she was discharged five days later. To our knowledge this is the first concomitant presentation of an abdominal aortic aneurysm and a translocation Xp11.2 RCC in an infant patient treated successfully by tumor resection and aortic reconstruction. At one year of follow up she is developing according to her age without complications.

Objetivo: Aplicar el estudio de tiempos que se relaciona con la productividad en condiciones de laboratorio en la Escuela de Ingeniería Industrial de la Universidad Nacional José Faustino Sánchez Carrión, Huacho año 2017. Métodos: Se trabajó con una población de N=37 observaciones, analizando una muestra de n=13 del total de los 37 tiempos tomados en el laboratorio, ya que es el número recomendado de ciclos de observaciones. Eliminamos aquellos datos que están fuera del 10% de la media. Luego con las tablas Westinghouse calculamos el factor de valoración que ayudará a hallar el valor del Tiempo Normal. Los suplementos que brinda la Organización Internacional del trabajo son 9%. Todo para hallar el Tiempo Estándar, los cuales se compararán con los mismos datos al ser insertados al software Crystal Ball con un nivel de confianza del 95%. Resultados: El tiempo medio de nuestros datos es 146,5 segundos nuestro Factor de Valoración es 1.16 lo que resulta un Tiempo normal de 166,46 segundos. Por último, multiplicado con los suplementos el tiempo estándar nos resulta 181,40. Corriendo 10000 veces nuestros datos en el simulador Crystal Ball nos arroja un tiempo estándar de 183,73 segundos. Conclusiones: El estudio de tiempos, se relaciona con la productividad del operador en nuestro laboratorio de estudio de tiempos, el presente estudio permitirá saber cómo el estudio de tiempos influye en el incremento de la productividad, con un menor tiempo de armado del lego en nuestro laboratorio, así mejorando el proceso con un nuevo método de trabajo.Palabras clave: simulación, productividad, tiempo estándar, mejoramiento, eficacia.

Objective: The aim of this study was to compare two complex vascular access techniques that utilize the axillary artery as inflow and accesses were created with early cannulation grafts: the axillary-atrial arteriovenous graft versus axillary-iliac arteriovenous graft. Methods: This is a retrospective study of end-stage renal disease patients with occluded intrathoracic central veins that underwent complex hemodialysis access creation in our institution after failed endovascular recanalization attempts. Patients’ demographics, comorbidities, number and types of previous accesses, intraoperative variables, and clinical outcomes were collected and compared. Results: Four patients underwent axillary-atrial arteriovenous graft creation with Flixene™ (Atrium™, Hudson, NH, USA) grafts, through a midline sternotomy to expose the right atrium; all were successfully implanted and used for hemodialysis within the first 72 h; one patient developed a pseudoaneurysm in the mid-graft portion, requiring surgical repair, and it is currently functional. Eight axillary-iliac arteriovenous grafts were created; all grafts were patent and were utilized within 96 h after placement. At 6 months of follow-up period, five (62 %) of our patients underwent graft thrombectomy, one (12 %) balloon angioplasty at the vein anastomosis secondary to stenosis, and two (25 %) grafts were removed due to infectious complications. Axillary-atrial arteriovenous graft and axillary-iliac arteriovenous graft primary patency rates at 6 months were 75% and 48%, respectively; 6-month secondary patency of the axillary-atrial arteriovenous graft compares favorably against that of axillary-iliac arteriovenous graft (100% vs 75%, respectively). Conclusion: Despite the invasiveness, direct atrial outflow procedures remain a valid alternative in carefully selected patients with adequate cardiopulmonary reserve.

The middle aortic syndrome (MAS) is an uncommon clinical expression as a result of isolated stenosis or complete occlusion of the descending thoracic and/or abdominal aorta; Takayasu's arteritis (TA) is a rare vasculitis and a recognized etiology of MAS. We herein present the case of a 52-year-old woman with refractory renovascular hypertension and progressive bilateral lower extremity claudication; she had known history of TA. A computed tomography angiography demonstrated an aortic occlusive lesion compromising the origin of the celiac trunk, superior mesenteric, and bilateral renal arteries. The patient underwent a complex aortic reconstruction with visceral and renal vessels revascularization utilizing a back-table hand-crafted 4-branch Dacron graft through a left thoracoabdominal approach. The patient recovered uneventfully and was discharged on postoperative day 5, and at 36 months from her surgery, she remains symptoms-free and without antihypertensive agents.

Los tefrítidos, constituyen un grave problema fitosanitario para diversas especies de frutales. Para México el género Rhagoletis está representado por 35 especies reunidas en 10 grupos, de los cuales el grupo "pomonella", “suavis” “nova” y “cingulata” tiene un gran impacto económico en tejocote, manzana, capulín, nueces y arándanos. Dada la importancia de especies del género Rhagoletis (Foote, 1981), se calculó el nicho ecológico y se proyectó la distribución potencial de ocho especies de importancia económica en México, para determinar su distribución y diseñar en dónde se implementarían programas de monitoreo, trampeo, inspección, y/o cuarentena. Se emplearon 850 datos de distribución de Rhagoletis en el país y se calculó la disponibilidad ambiental utilizando un modelo de nicho correlativo con el algoritmo Maxent este se desarrolló integrando registros de ocurrencia del genero Rhagoletis con variables climáticas globales. La mayor disponibilidad ambiental de Rhagoletis en México fue proyectada en áreas de las provincias biogeográficas del Eje Volcánico Transmexicano (centro), Sierra Madre Oriental, al centro-sur del Altiplano Mexicano. Las variables que influyeron en la distribución potencial de la especie: Isotermalidad, temperatura y precipitación. La distribución de estos tefrítidos comprende todas las áreas de producción comercial del tejocote, manzana y nuez por lo que futuras medidas de manejo deberán aplicarse en estos espacios y en los alrededores si se desea regular las poblaciones de Rhagoletis. Tephritids are a serious phytosanitary problem for various fruit species. For Mexico, the genus Rhagoletis is represented by 35 species gathered in 10 groups, of which the group "pomonella", "suavis" "nova" and "cingulata" have a great economic impact on tejocote, apple, capulín, walnuts, cranberries. Given the importance of species of the genus Rhagoletis (Foote, 1981), the ecological niche was calculated and the potential distribution of eight economically important species in Mexico was projected to determine their distribution and design where monitoring, trapping, and monitoring programs would be implemented. inspection, and / or quarantine. 850 Rhagoletis distribution data were used in the country and the environmental availability was calculated using a correlation niche model with the Maxent algorithm. This was developed by integrating Rhagoletis occurrence records with global climatic variables. The greater environmental availability of Rhagoletis in Mexico was projected in areas of the biogeographical provinces of the Transmexican Volcanic (center), the Sierra Madre Oriental, the south-central part of the Mexican Altiplano. The variables that influenced the potential distribution of the species: Isothermality, temperature and precipitation. The distribution of these tephritids includes all areas of commercial production of the tejocote, apple and walnut so future management measures should be applied in these spaces and in the surrounding area if you want to regulate the populations of Rhagoletis.

Background Carotid body tumors (CBTs) are rare neoplasms located in the carotid bifurcation. The majority of these tumors are unilateral; bilateral CBTs represent approximately 5% of all affected patients, and the recommended treatment is to surgically remove them in staged-planned surgeries. We describe the experience, outcomes, and the surgical management of bilateral CBTs in our institution. Methods A retrospective review of CBTs patients was completed; patient demographics, comorbidities, lesion location, anatomic characteristics, surgical techniques, complications, reinterventions, and other factors that may influence outcomes were evaluated. Results A total of 109 patients with CBTs were treated surgically; of these, 8 had bilateral CBTs (7%); the mean age was 56 years, and 7 (87%) were females. Thirteen surgical resections were performed, and in 2 of the cases, the pathology report was malignant (15%). Five were classified as Shamblin I (31%), 5 as Shamblin II (31%), and remaining 6 as Shamblin III (38%). The mean time between the first and second procedure was of 10.7 months. Complications included one case of neck hematoma requiring evacuation and postoperative neurologic complications occurred in three patients (one patient with facial and two with vocal cord palsies). None of the studied individuals had a family history of CBT, and all of them lived in altitude areas higher than 2000 meters above mean sea level (mamsl). The mean tumor size was 3.55 cm and 2.75 cm for right and left CBTs, respectively. Conclusions A better understanding of the clinical characteristics of patients with bilateral CBTs may lead to a more standardized and optimal management with fewer complications and a better quality of life afterward.