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ResumenLa tomografía de coherencia óptica es una técnica de diagnóstico intracoronario con una alta resolución, su advenimiento ha permitido llevar a cabo un mejor diagnóstico para el tratamiento de las afecciones vasculares. El desarrollo de nuevos sistemas de esta tomografía, que evitan la oclusión de la arteria, favorece que esta técnica tenga mayor utilidad y se convierta en práctica habitual en los laboratorios de hemodinámica, para la caracterización de la placa aterosclerótica coronaria y la evaluación del stent implantado. Se presenta un paciente que en el curso de un síndrome coronario agudo con elevación del segmento ST, fue tratado con trombolíticos y no se lograron signos de reperfusión. La coronariografía realizada no demostró estenosis significativa en relación con la topografía del infarto, por lo que se realizó tomografía de coherencia óptica y se diagnosticó una imagen compatible con proliferación neointimal y presencia de trombo dentro del stent previamente implantado en la arteria circunfleja, que se correspondía con los cambios del electrocardiograma. Se decidió aplicar tratamiento percutáneo con implantación de stent fármaco-activo. La tomografía de coherencia óptica permitió diagnosticar y tratar una imagen angiográfica dudosa. / AbstractOptical coherence tomography is an intracoronary diagnostic technique of high resolution, and its arrival has allowed a better diagnosis for the treatment of vascular diseases. The development of new systems for this tomography, which prevent artery occlusion, allows this technique to have greater utility and become standard practice in the hemodynamic laboratories for the characterization of coronary atherosclerotic plaque and for evaluating the inserted stent. The case of a patient that during an acute coronary syndrome with ST segment elevation was treated with thrombolytics and no signs of reperfusion were achieved is presented. Coronary angiography showed no significant stenosis regarding infarct topography, so an optical coherence tomography was performed and an image compatible with neointimal proliferation and thrombus within the previously inserted stent in the circumflex artery was diagnosed, which corresponded with ECG changes. It was decided to apply percutaneous treatment with drug-eluting stent implantation. Optical coherence tomography allowed diagnosing and treating a dubious angiographic image.

Introduccion y objetivos Los pacientes diabeticos tienenun alto riesgo de reestenosis tras angioplastia coronariacon balon. La influencia de la implantacion de stenten estos pacientes no es bien conocida. El objetivo deeste estudio fue comparar la evolucion clinica y angiograficade pacientes diabeticos frente a los no diabeticos,tratados con angioplastia convencional o con implantacionde stent en arterias coronarias nativas. Material y metodos Se incluyeron en el estudio 302 pacientes(58 diabeticos y 244 no diabeticos) sometidos a angioplastiasimple (una lesion/un vaso) sobre lesion en arteriacoronaria nativa con exito inicial y seguimiento clinico yangiografico a los 6 meses, de los cuales 100 fueron tratadoscon cateter balon convencional y en 202 se implantostent. Se analizaron los eventos clinicos adversos mayoresy la reestenosis angiografica al final del seguimiento. Resultados La edad media de los pacientes fue de 65anos y el 74% eran varones. La tasa de reestenosis angiograficafue similar entre los pacientes diabeticos y no diabeticostratados con stent (el 24 frente al 23%, respectivamente).Sin embargo, los pacientes diabeticos tratados conbalon tuvieron una mayor tasa de reestenosis (el 64 frenteal 24%; p Conclusiones La angioplastia con balon convencionalen pacientes diabeticos con lesion severa de un vaso seasocia a una alta frecuencia de reestenosis y conlleva unapeor evolucion clinica. La implantacion de stent en estospacientes diabeticos disminuye la tasa de eventos clinicosadversos mayores y la frecuencia de reestenosis en comparacioncon el tratamiento convencional con balon.

Introduccion y objetivos. Tras la angioplastia con balon convencional, la incidencia de reestenosis es elevada en las lesiones del segmento proximal de la arteria descendente anterior, por lo que se ha recomendado alternativamente el empleo electivo del stent . El objetivo de este estudio fue analizar los principales factores clinicos y anatomoangiograficos relacionadas con el resultado a corto plazo de la dilatacion sobre lesiones en el segmento proximal de la arteria descendente anterior con y sin implante de stent . Material y metodos. Estudiamos a 87 pacientes dilatados con exito por estenosis severa ( 3 70%) del segmento proximal de la arteria descendente anterior. En 54 pacientes (62%) se utilizo solo balon (grupo A) y en 33 (38%) se implanto un stent (grupo B). Resultados. La edad media fue de 61,9 ± 12 anos, el 74% eran varones y se efectuo revascularizacion por angina inestable en el 72%. Al final del periodo de seguimiento (media 6,3 ± 1,5 meses), un 21% de pacientes en el grupo B tenian angina frente a un 54% de pacientes en el grupo A (p = 0,03). La incidencia de reestenosis (el 30 frente al 50%; p = 0, 07) y la necesidad de una nueva angioplastia coronaria transluminal percutanea (el 21 frente al 33%; p = NS) fueron tambien menores en el grupo B. Estos resultados se mantuvieron independientemente del calibre del vaso ( 3 3 mm) o de la obtencion de un resultado optimo (£ 25%) tras la angioplastia con balon. Conclusiones. En la poblacion estudiada, la implantacion de un stent en lesiones localizadas en el segmento proximal de la arteria descendente anterior parece comportar un mejor pronostico clinico y angiografico a corto plazo, con una menor incidencia de reestenosis, frente a la angioplastia con balon, a pesar de un resultado optimo e independientemente del tamano del vaso. Seran necesarios futuros estudios para confirmar estos resultados.

O estudo investiga as representações sociais de mulheres com relação à violência doméstica, e, particularmente, da violência contra mulher. O objetivo geral é identificar os significados atribuídos pelas mulheres ao fenômeno da violência de gênero, buscando compreender categorias próprias de interpretação do fenômeno da violência doméstica, assim como os recursos disponíveis para apoiar às mulheres em situação de violência. Metodologicamente, o estudo lança mão de uma abordagem triangulada entre a Teoria das Representações Sociais e a Etnografia. Foram realizadas entrevistas com 30 mulheres que concordaram em participar do estudo. As entrevistas foram processadas pelo software AlCESTE, que distribuiu as falas das entrevistadas em quatro classes, onde a 1 e a 4 remetem, respectivamente, à prática da violência e à forma como ela se perpetua, seu conceito e representação social, enquanto que as categorias classificadas como 2 e 3 dizem respeito à fragilidade da lei Maria da Penha e a falta de credibilidade na sua aplicação. ______________________________________________________________________________________________________ ABSTRACT The study investigates the social representations of women in regard to domestic violence, and, particularly, of intimate violence against woman. The main purpose is to identify the meanings attributed by these women to the gender violence phenomenon, aiming the identification of native categories of the domestic violence event, as well as to recognize available resources for supporting women in a violence situation. It was applied a triangulation methodological approach between the Theory of Social Representations and Ethnography. Interviews were carried out with 30 women who voluntarily agreed to participate in the study. The interviews were processed by the Alceste software, which distributed women’s narratives in four different classes. Fist and fourth relate, respectively, to the practice of violence and to the way it is perpetuated, its concept and social representation. Categories classified as 2 and 3 concern to the fragility of the national law Maria da Penha and the lack of credibility in its application. ______________________________________________________________________________________________________ RESUMEN El estudio investiga las representaciones sociales con relación a la violencia doméstica y, particularmente, de la violencia contra la mujer entre mujeres habitantes de esas comunidades El objetivo general es identificar los significados atribuidos por las mujeres al fenómeno de la violencia de género, tratando de comprender categorías propias de interpretación del fenómeno de la violencia doméstica, así como los recursos disponibles para apoyar a las mujeres en situación de violencia. Metodológicamente, el estudio se basa en un enfoque triangulado entre la Teoría de las Representaciones Sociales y la Etnografía. Fueron llevadas a cabo 30 entrevistas con mujeres que estuvieron de acuerdo en participar del estudio. las entrevistas se procesaron por medio del software Alceste, que distribuyó las narrativas de las entrevistadas en cuatro clases. Las clases 1 y 4 se refieren, respectivamente, a la práctica de la violencia y a la forma como ésta se perpetúa, su concepto y representación social. Las categorías clasificadas como 2 y 3 indican la fragilidad de la ley Maria da Penha y a la falta de credibilidad en su aplicación.

Despite the preliminary nature of data presented in this brief it is evident that information is lacking in several areas of direct relevance for policy development aimed at dealing with issues of migrating fishers. Below we list a number of pressing issues that deserve the attention of policy and research in the near future to address the issue of fisher’s migration and fisheries management. 1. Better monitoring of migrant fishers (both Kenyan and non-Kenyan) at landing sites is a prerequisite for improved understanding of fishers’ movements and the effects of such mobility on coastal resources. 2. Significant gaps in the information about the status of many coastal and marine resources limits the ability of both BMUs and the Fisheries Authorities to make informed decisions about the number of fishers, types of gears and catches to allow into any given area. 3. The type of systematically collected information required would include recording of all fishers and crews not members of local BMUs, their origin, time of arrival, gears used, species and quantities landed. This could be collected by BMUs in collaboration with, and with the support from, the Fisheries Department. 4. Collection of such information would constitute a first step towards forming a solid base in which to ground more informed recommendations on restrictions of migrant fishing operations. It would also allow local management institutions (BMUs and Fisheries Department Offices) to better anticipate and plan for influx of non-local fishers into their management area. 5. Given the conflictual issue over use of ring nets, this issue would benefit from a thorough investigation into who is involved in such fishing practices. A working group should be convened to address this issue. 6. The invisibility of fishers’ mobility in policy means that institutions developed to deal with coastal management at the community level may not have sufficient support from legal and policy documents, and may not be developed or equipped to handle the possible conflicts and difficult trade-offs that need to be addressed as a result of fishers’ mobility. 7. Any policy decision needs to consider the trade-offs between both benefits and negative effects as perceived by members of communities hosting migrant fishers. Published

Introduccion y objetivo La implantacion de stents coronarios ha contribuido a mejorar el re- sultado angiografico inicial, a disminuir la reestenosis tardia y a minimizar el problema de la oclu- sion aguda y subaguda. A pesar de ello, continua sin resolverse completamente el problema de la reestenosis tardia. El objetivo del presente estudio fue identificar las variables clinicas, angiograficas y del procedimiento predictivas de reestenosis des- pues de la implantacion de un stent coronario con exito. Material y metodos Se analizaron retrospectivamente 202 lesiones, en 176 pacientes consecutivos a los que se les habia implantado un stent coronario con exito en nuestro hospital entre enero de 1995 y agosto de 1998. A todos ellos se les realizo un control angiografico a los seis meses de la implantacion del stent. Resultados De las 202 lesiones evaluadas, 47 evolucionaron con reestenosis (23%) y 155 lesio- nes sin reestenosis. En el analisis multivariado las unicas variables que se mostraron como predictivas independientes de reestenosis fueron: estar re- cibiendo tratamiento hipolipemiante en el momento de realizar el procedimiento (OR: 0,3; IC: 0,1–0,8), implantar los stents a presiones > 10 at- mosferas (OR: 0,4; IC: 0,2–0,9), implantar stents en vasos 30% (OR: 13; IC: 1,5–120). Conclusiones En relacion con el fenomeno de reestenosis intra-stent, los unicos factores protecto- res, con significacion estadistica independiente, fueron: estar recibiendo tratamiento hipolipemiante en el momento de realizar el procedimiento e implantar stents a altas atmosferas, mientras que aparecieron como factores de riesgo: implantar stents en vasos

Registro de caso de paciente no oitavo mês de gestação que desenvolveu hematoma epidural espinal espontâneo dorsolombar. A gravidez, determinando aumento da pressão intra-abdominal e, como consequência, aumento da pressão venosa no plexo epidural, poderia ter sido o fator desencadeante no hematoma- A paciente foi submetida a cirurgia precocemente, porém não apresentou recuperação do déficit sensitivo-motor. São discutidos aspectos clínicos, do tratamento cirúrgico, da evolução e da etiologia dos hematomas epidurals espinais espontâneos. A case of spontaneous dorso-lombar spinal epidural hematoma during pregnancy is reported. The hematoma was removed 8 hours after the onset of paraplegia, and there was no evidence of vascular malformation. The motor deficit remained unchanged post-operatively. The etiology, clinical findings and the value of early laminectomy are discussed.

Coronary angioplasty is recognized nowadays as the first-choice therapeutic strategy for acute coronary syndrome with ST-segment elevation. Atherosclerotic disease is still the main cause ofthis sickness; however, other disturbances, such is dilated coronariopathy, may favor this coronary event. Although some authors raise that atherosclerosis is the main cause of coronary dilation, it is uncommon that this lipid disorder promotes consequences early in life. We present the case of a 33-year-old female (oral contraceptive user - etinor) who had not any apparent coronary risk factor but suffered from inferior acute myocardial infarction. The thrombolysis failed, and fortunately we could perform the angioplasty. Intracoronary thrombosis with distal embolism occurred, that waswhy we administered streptokinase. Possible mechanisms that involve oral contraceptives and dilated coronariopathy are discussed, and angiographic images are shown.

Introduction: Ischemic heart disease is the leading cause of death in Cuba. Coronary angioplasty with stenting is an excellent treatment option, but restenosis overshadows its prognosis and is more common with the use of bare metal stents. Objective: To characterize restenosis after coronary bare-metal stent from the clinical and angiographic points of view. Method: A descriptive cross-sectional study was conducted in 59 patients with a diagnosis of restenosis after coronary bare-metal stent confirmed by angiography in the Interventional Cardiology Unit of Cardiocentro Ernesto Che Guevara of Villa Clara, Cuba, from February 2010 to April 2012. The variables analyzed were age, sex, coronary risk factors, previous history of angina or heart attack, vessel involved, type of restenosis and treated lesion, vessel diameter and lesion length. Results: Predominance of male patients (76.27 %), aged 60-69 years (40.66 %). The most common risk factors were hypertension (76.27 %), smoking (37.28 %) and type II diabetes mellitus (33.89 %). The most affected vessel was the left anterior descending (28.81 %), arterial diameters were predominantly ≤ 2.5 mm (54.2%) and lesion length > 20 mm (65, 97). Type B injuries (52.5) and focal restenosis (57.62 %) were more frequent. Conclusions: Patients with restenosis were predominantly male, between 60-69 years old, with a history of hypertension, smoking and diabetes mellitus type II. Left anterior descending disease, diameter ≤ 2.5 mm, lesion length > 20 mm, type B coronary lesion and focal restenosis were more frequent.