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Background: Acute mesenteric ischemia is a vascular emergency with mortality above 60%, which requires opportune treatment. However, due to its heterogeneous pathophysiology and differences in degree and extent of ischemic damage, the clinical and radiological manifestations are varied and often nonspecific; consequently, a thorough analysis of antecedents, laboratory studies, and clinical and radiological findings is recommended in order to establish a timely diagnosis. Objective: Identify the most common findings, direct and indirect, by computed tomography and determine low, intermediate, and high probability of a patient's suffering from acute mesenteric ischemia on the basis of risk factors and clinical, biochemical, and radiological findings. Material and methods: We performed a retrospective, observational, cross-sectional study, with analysis of findings from computed tomography images, of a series of cases of patients with diagnosis of acute mesenteric ischemia in a period of 9 years, 3 months and literature review. The purpose was to analyze the risk factors and clinical and biochemical data most commonly associated with acute mesenteric ischemia. Results: Our universe included tomographic studies of 27 cases of acute mesenteric ischemia, with average age of 60.8 years. The most common clinical datum was acute abdominal pain syndrome in 19 patients (70%); the most commonly associated antecedents were type 2 diabetes mellitus and systemic high blood pressure in 7 (26%) patients each; 13 patients (48%), per clinical notes, had laboratory studies, of whom 11 (85%) had leukocyte values of 9,200 to 68,000; the most commonly identified findings were: arterial filling defect 48%, intestinal pneumatosis 29%, venous filling defect 22%, bowel obstruction syndrome 22%, and identification of free fluid 22%. Conclusion: It is recommendable to conduct a quantitative analysis giving a specific value to the different findings, including risk factors, physical exploration, laboratory studies, and image findings, to determine the risk of acute mesenteric ischemia in a patient with acute abdominal pain syndrome. Angiotomography is the study with the greatest diagnostic precision. [ABSTRACT FROM AUTHOR]

Introduction: Pseudomembranous colitis is an infectious, potentially lethal colitis, caused by the release of one or more toxins produced by the unopposed proliferation of the bacterium Clostridium dif^cile. Pseudomembranous colitis is a predominantly hospital-acquired infection, secondary to complications from antibiotic treatment; it is also associated with abdominal surgery and with debilitating diseases such as lymphoma or AIDS. Objective: Recognize the diagnostic code to identify and differentiate pseudomembranous colitis from other types of colitis by means of tomography, analyzing distribution, signs of accordion, double, and bull's-eye sign; morphology of colon wall, mucosa, and pericolic fat; adenopathies or ascites; and some other specific extracolonic intra-abdominal findings. We relate the different patterns of these points with the corresponding types of colitis, focusing on pseudomembranous colitis. Material and methods: We conducted a descriptive, observational, cross-section, retrospective, single-site study which included patients admitted to Hospital Central Militar with various clinical diagnoses, over a 3-year period (January 1, 2012, through December 31, 2014) and in whom the possibility of pseudomembranous colitis was identified based on history of pseudomembranous colitis or tomography findings. Results: Our universe included 53 patients (45% men and 55% women) in orders for studies which required computed tomography; in none of them was use of antibiotics, type, time, or number specified. In relation to history of use of antibiotics associated with pseudomembranous colitis, 50 patients (94%) were identified. In 4% use of antibiotics was not associated with identification of pseudomembranous colitis by computed tomography. Only 2% were on treatment with unspecified oral antibiotics. Conclusion: The colitides are part of highly common emergency abdominal pathology. Tomography findings, in their etiological diagnosis, are not pathognomonic; however, knowing them helps establish a correct diagnostic approach. Tomographic images are not pathognomonic but, combined with epidemiology and clinical findings, can support a diagnosis of strong probability, if not certainty. To arrive at a correct diagnosis of pseudomembranous colitis, we need to carefully analyze the points we have discussed in this article: distribution, sign of ac-cordion or halo, colon wall morphology, mucosa, fat, adenopathies, ascites, and characteristic findings. [ABSTRACT FROM AUTHOR]

Background: Artificial intelligence (AI) in radiology has improved diagnostic performance and shortened reading times of coronavirus disease 2019 (COVID-19) patients' studies., Objectives: The objectives pf the study were to analyze the performance of a chest computed tomography (CT) AI quantitative algorithm for determining the risk of mortality/mechanical ventilation (MV) in hospitalized COVID-19 patients and explore a prognostic multivariate model in a tertiary-care center in Mexico City., Methods: Chest CT images of 166 COVID-19 patients hospitalized from April 1 to 20, 2020, were retrospectively analyzed using AI algorithm software. Data were collected from their medical records. We analyzed the diagnostic yield of the relevant CT variables using the area under the ROC curve (area under the curve [AUC]). Optimal thresholds were obtained using the Youden index. We proposed a predictive logistic model for each outcome based on CT AI measures and predetermined laboratory and clinical characteristics., Results: The highest diagnostic yield of the assessed CT variables for mortality was the percentage of total opacity (threshold >51%; AUC = 0.88, sensitivity = 74%, and specificity = 91%). The AUC of the CT severity score (threshold > 12.5) was 0.88 for MV (sensitivity = 65% and specificity = 92%). The proposed prognostic models include the percentage of opacity and lactate dehydrogenase level for mortality and troponin I and CT severity score for MV requirement., Conclusion: The AI-calculated CT severity score and total opacity percentage showed good diagnostic accuracy for mortality and met MV criteria. The proposed prognostic models using biochemical variables and imaging data measured by AI on chest CT showed good risk classification in our population of hospitalized COVID-19 patients.

Background: Aortic stenosis (AS) is one of the most frequent valvulopathies in elderly patients. The treatment for AS is heart surgery; however, many patients do not benefit from this treatment because they are considered to be at high surgical or inoperable risk. Transcatheter aortic valve implantation (TAVI) was developed for these patients., Objective: To disseminate the feasibility and safety of other access routes for the implantation of transcatheter aortic valves and that it can also be performed in the hemodynamic laboratory. In addition to the rapid growth in technology and knowledge, there is a lot of experience with TAVI already., Methodology: One of the limitations is the diameter of the femoral, subclavian, and axillary vascular accesses. This is why other approaches such as the direct aortic approach are sought after, despite the invasive nature of mini-thoracotomy and aortotomy is technically feasible, familiar, and easy to learn for cardiac surgeons., Results: In addition, it has been associated with favorable outcomes and a lower rate of complications (bleeding and risk of myocardial injury) and shorter length of stay in the intensive care unit compared to surgery or transapical access., Conclusions: Our center successfully implanted the self-expandable aortic valve Evolut™ through direct aortic for presenting a dissection in transverse aorta with possibilities of embolization., (Copyright: © 2019 Permanyer.)

Background: Aortic stenosis is one of the most frequent valvulopathies in the elderly patient. The treatment for aortic stenosis is heart surgery, however many patients do not benefit from this treatment because they are considered to be at high surgical or inoperable risk. Transcatheter aortic valve (TAVI) was developed for these patients., Objective: To make known the feasibility and safety of other access routes for the implantation of transcatheter aortic valves and that it can also be performed in the hemodynamic laboratory. In addition to rapid growth in technology and know-how, TAVI is already very experienced., Methodology: One of the limitations is the diameter of the femoral, subclavian, and axillary vascular accesses. This is why other approaches such as the direct aortic approach are sought, despite the invasive nature of mini-thoracotomy and aortotomy is technically feasible, familiar and easy to learn for cardiac surgeons., Results: In addition, it has been associated with favorable outcomes and a lower rate of complications (bleeding, risk of myocardial injury) and shorter length of stay in the Intensive Care Unit compared to surgery or transapical access., Conclusion: Our center successfully implanted the self-expandable aortic valve Evolut™ via direct aortic for presenting a dissection in transverse aorta with possibilities of embolization., (Copyright: © 2019 Permanyer.)

Purpose: To describe the case of orbital subcutaneous emphysema who was successfully treated with hyperbaric oxygen therapy., Observations: Case report. Retrospective analysis of medical records and computer tomography images. A 40 years-old female, with retinal detachment who was seen at the emergency department, two weeks after undergoing a combined procedure of pars plana vitrectomy, scleral buckle and Sulfur hexafluoride tamponade. The patient complained of pain, decrease eye movement and edema of the upper eyelid. Clinical examination revealed periorbital crepitus. She was treated immediately with soft tissue decompression with small-gauge needle. Orbital emphysema recurred quickly, indicating possible gas trapped in the soft tissue. Using the US NAVY decompression protocol we were able to achieve fast clinical improvement. The protocol was repeated in several occasions until complete resolution., Conclusion and Importance: Hyperbaric oxygen therapy is an effective treatment for orbital and periorbital emphysema, due to its property of helping accelerate N 2 elimination from adipose tissue.

Objective: Transcatheter aortic valve implantation (TAVI) is an alternative treatment for patients with severe symptomatic aortic stenosis, inoperable or at high surgical risk. The purpose of this communication is to report the results of the experience of this new technique and compare them with literature., Methods: Review of 17 patients data with symptomatic severe aortic stenosis at high surgical risk or inoperable, treated with a transcatheter implantation aortic valve (TAVI) via femoral surgical access with Core Valve (Medtronic, EE.UU.) between September 2013 and July 2014., Results: All patients had severe aortic stenosis with a mean gradient of 46̊æ14 mmHg received CoreValveTM (Medtronic, USA). Half of patients was performed under general anesthesia, the other half with regional and local anesthesia. In-hospital mortality was 11.7% and one death in follow-up from September 2013 until the time of preparing this report (5.9%).Total mortality at one year follow-up was 17.6%. The technical success rate was 82.4%, with an immediate post-implantation gradient of 5.4̊æ3.4 mmHg. Aortic regurgitation I degree was observed in 5 patients (29.4%); 2 patients (11.7%) had aortic regurgitation grade II. Post dilatation was made in 6 patients (35.2%). We did not have any vascular complications. Permanent pacemaker implantation was needed in 6 patients (35.2%). One patient complicated with acute renal failure, 2 had in-hospital ischemic stroke (11.7%), none had need for cardiac surgery; 2 patients had major bleeding complications that required transfusion., Conclusions: In patients with high surgical risk or inoperable, TAVI is a treatment option that improves life quality, survival and diminsh the need of hospitalizations. There can be some complications and even death, so that a proper patient selection and a multidisciplinary team is needed and fundamental for a successful procedure., (Copyright © 2015. Published by Masson Doyma México S.A.)