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La inteligencia artificial tiene el potencial de transformar la forma en que se brinda la atención médica. Puede respaldar mejoras en los resultados y aumentar la productividad y la eficiencia de la prestación de los servicios. En servicios de las diferentes especialidades los avances realizados a nivel hardware deben desarrollarse en paralelo con los métodos de aprendizaje automático, aspectos que la inteligencia artificial contribuye para promover un cambio de paradigma significativo en las más diversas áreas de la medicina. Es importante en la educación médica como eje para el conocimiento y en la toma de decisiones que pueden mejorar el desempeño de los profesionales. Los estudiantes de medicina de nueva generación pueden adaptarse perfectamente a los nuevos métodos digitalizados en un contexto médico globalizado, incluida la inteligencia artificial. Por ello es importante tener como objetivos a implementar en los planes de estudio e introducir programas educativos representativos de esta tecnología. Es fundamental que todas las áreas del Sistema de Salud tengan confianza en los sistemas informáticos específicamente en el aprendizaje profundo, no solo por la información concreta y objetiva que de él se deriva sino también por la posibilidad de predecir eventos futuros, brindando alta certeza en cuanto al diagnóstico y tratamiento de enfermedades.

La actualidad está marcada por el desarrollo cada vez más vertiginoso de la tecnología. Este hecho incide necesariamente en el proceso formativo de nuestros estudiantes Los EVA (entornos virtuales del aprendizaje) son herramientas para facilitar la transmisión del conocimiento mediado por la informática

A 3 yr old spayed female Cavalier King Charles spaniel was referred for insidious ataxia and paraparesis. A thoracolumbar lesion was suspected. Computed tomography showed focal osteolysis of the vertebral body and pedicles of T5. In addition, a hyperdense, extradural material within the vertebral canal, causing spinal cord compression on the right side, was present. The lesion was confirmed with magnetic resonance imaging. A T4-T5 hemi-dorsal laminectomy was performed to decompress the spinal cord. Histopathological examination was consistent with vertebral angiomatosis. After the surgery, the dog rapidly improved; however, 5 mo later the clinical signs relapsed. Vertebral angiomatosis is a vasoproliferative disorder, rarely reported as a cause of myelopathy in cats. This condition has not previously been reported in dogs. This case report describes the clinical features, the diagnostic findings, and the follow-up of a young dog with vertebral angiomatosis., (© 2024 by American Animal Hospital Association.)

Objectives Recurrent varicose veins following surgery is a common, complex and costly problem in vascular surgery. Treatment for RVV is technically more difficult to perform and patient satisfaction is poorer than after primary interventions. Nevertheless, traditional vein surgery has largely been replaced by percutaneous office-based procedures, and the patients with recurrent varicose veins have not benefited from the same advantages. In this paper, we propose an endovascular laser treatment that allows reducing the invasiveness and complications in case of SFJ and SPJ reflux after ligation and stripping of the great and small saphenous vein. Methods 8 SFJ and 1 SPJ stumps were treated by endovascular laser treatment in out-patient clinic. Endovascular laser treatment was performed with a 1470 nm diode laser and a 400 µc radial slim™ fiber. Intraoperative ultrasoud was used to guide the fiber position and the delivery of tumescent anesthesia. The gravity of chronic venous disease was determined according to the CEAP classification and the severity of symptoms was scored according to the revised Venous Clinical Severity Score (VCSS). Results The average linear endovenous energy density was 237 J/cm. Patients return to daily activities after a mean of 1.9 days after. The VCSS improved drastically from a mean of 8 pre-interventional to 1 at day 30 and until one year. During the follow-up period (mean 8 months, range: 5-17 months), all the stumps except one were occluded. All patients were very satisfied or satisfied with the method. No severe complications occurred. Conclusions Office-based endovascular laser treatment of groin and popliteal recurrent varicose veins with 1470 nm diode laser and radial-slim fiber is a safe and highly effective option, with a high success rate in the early post-operative period.

Aim: Endovenous laser treatment (EVLT) is an accepted form of axial vein ablation for symptomatic venous reflux but its role in the treatment of anterior accessory saphenous vein (AASV) has not been well characterized. The aim of this paper is to show the short-term result of EVLT with a ball-tipped fiber and a 1540 nm diode laser of the AASV with preservation of a competent great saphenous vein (GSV)., Methods: Nine incompetent AASV veins in 8 patients (6 female) were treated. The gravity of chronic venous disease was determined according to the CEAP classification and the severity of symptoms was scored according to the revised Venous Clinical Severity Score. Patient satisfaction was assessed by a 0 to 3 scale., Results: The average linear endovenous energy density was 60.5 J/cm vein (SD: 7.5). Patients returned to daily activities after a mean of 3.8 days (SD: 1.4). 5 patients (63%) have had pain but of mild intensity. No patients developed paresthesia or phlebitis reactions in the treated area. Post-operative ecchymoses are frequent (89%). During the follow-up period (mean 13 months, range: 7-17 months) all the veins were occluded. The VCSS improved drastically from a mean of 3.2 (SD: 1.3) preinterventional to 0 (SD: 0.38) at 17 months. All patients were satisfied or very satisfied with the method. No severe complications occurred., Conclusion: EVLT of an incompetent AASV with a 1540 nm diode laser is a safe and efficient therapy option, with a high success rate and with no evidence of GSV neo-reflux or recurrent varicosities during the follow-up period.

Background: In recent years, laser systems with higher wavelengths, associated with new optical fibers, have shown excellent short-term results in treating saphenous veins and reducing the side effects and, in particular, the postoperative pain. However, if the patients are not anesthetized, they may feel pain even when using low energy with the high-wavelength laser; the only tumescent local anesthesia often does not guarantee a complete pain control during endovenous laser ablation (EVLA). Aim of this study was to demonstrate that the local anesthesia during EVLA of great saphenous veins (GSVs) is not essential for the perioperative comfort of the patient if a mild sedation is made., Methods: Forty-nine incompetent GSVs were treated by EVLA with a cold saline tumescent solution (CSTS) without local anesthetic drugs. EVLA was performed with a 1540-nm diode laser and a 600-μc ball-tipped fiber. Intraoperative ultrasonography was then used to guide delivery of CSTS (cold saline solution 0.9% at 5°C) using a motor pump under intravenous sedation. The gravity of chronic venous disease was determined according to the clinical-etiology-anatomy-pathophysiology classification. Patients rated surgery global pain according to 4 types: "extremely," "rather," "slightly," and "not at all" painful., Results: Twenty-five cases (51%) were classified as C3, 20 (41%) as C2, 6 (13%) as C4, and 1 (2%) as C6. Midazolam 2.5 mg + a mean of 0.16 mg of fentanil (minimum: 0.10; maximum: 0.20; standard deviation [SD]: 0.4) + a mean of 178.21 mg of propofol (minimum: 100; maximum: 300; SD: 47.1) were administrated as intravenous sedation. The total average linear endovenous energy density was 57.7 J/cm. Approximately 250 mL (minimum: 100; maximum: 780) of CSTS was administered. No Patient has had pain during the procedure. All patients were discharged 2.5 hrs after surgery., Conclusions: EVLA under sedation using CSTS without diluted anesthetic drugs is a suitable technique in an outpatients clinic, especially useful if the ablation of the saphenous vein is combined with an extended phlebectomy or if a bilateral treatment is performed, to eliminate the risks of overdose with local anesthesia and with the aim of improving the comfort of the patient., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Endovenous laser ablation (EVLA) is an efficient method to treat incompetent saphenous veins with high occlusion rates. The major side effects are postoperative pain and bruising. Laser systems with higher wavelengths, associated with new energy delivery devices, have recently shown excellent short-term results, while reducing the previously reported side effects. The aim of this study is to show the first outcome after EVLA of incompetent saphenous veins with a newly developed ball-tipped fiber and a new wavelength 1,540-nm diode laser., Methods: Forty-five incompetent saphenous veins in 35 patients (27 women) were treated: 33 great saphenous veins, 6 short saphenous veins, and 6 anterior saphenous veins. The gravity of chronic venous disease was determined according to the clinical-etiology-anatomy-pathophysiology (CEAP) classification, and the severity of symptoms was scored according to the revised Venous Clinical Severity Score. Patient satisfaction was assessed on a 0-3 scale., Results: The average linear endovenous energy density was 63.5 J/cm of vein length. Patients returned to daily activities after a mean of 1.7 days (SD: 2) after treatment. The modified CEAP clinical severity score improved drastically from a preintervention mean of 4.9 (SD: 2.6) to 0.17 (SD: 0.38) at day 30. During the follow-up period (mean: 168 days [range: 90-240 days]), all the veins were occluded. All patients except 1 were satisfied or very satisfied with the method. No severe complications occurred. Two patients (5%) developed mild paresthesia in the treated area, which spontaneously resolved after 3 months. Postoperative ecchymoses are frequent (83%). Sixteen patients (43%) experienced pain, but only 5 patients (14%) described it as quite intense and required analgesic therapy., Conclusion: EVLA of saphenous veins with a 1,540-nm diode laser using a ball-tipped fiber is a safe and efficient therapy option, with a high success rate in the early postoperative period., (Copyright © 2014 Elsevier Inc. All rights reserved.)

This article discusses the development of the first regional computerized database for the epidemiological evaluation of maxillofacial trauma and tests its usefulness by evaluating the appropriateness and completeness of the resulting information.The database was developed using Microsoft Access, implemented using Visual Basic. Data were entered in the database by 4 different maxillofacial specialists, one from each of the 4 main regional hospitals where maxillofacial trauma is treated. Clinical information was taken from 100 complete records of patients hospitalized for maxillofacial fractures at the Maxillofacial Division of San Giovanni Battista Hospital in Turin from January to June 2009.Thirteen database fields were used: general information, cause and mechanism of injury, fracture site, Facial Injury Severity Scale, head and neck examination, associated injuries, timing and type of surgery, and days of hospitalization.Overall, the data entered were 99.45% complete and 99.5% accurate. Thus, our regional maxillofacial database can be considered complete and accurate. Some of the errors, mainly in the fields "fracture site" and "Facial Injury Severity Scale," were attributable to an incorrect interpretation of facial fracture diagnoses, based on the medical records that were provided.

Purpose: Endovenous laser treatment is a minimally invasive technique for ablation of the incompetent great (GSV) and small saphenous vein (SSV). Compared with the GSV, fewer data are available on SSV laser ablation and are not validated. This multicenter prospective study evaluated the feasibility, safety, and efficacy of endovenous laser ablation to treat SSVs., Methods: Between January 2003 and January 2007, 204 patients (229 limbs) with CVD and incompetent SSVs (evaluated by the CEAP classification) who were eligible for surgery underwent consecutive laser ablation procedures. Many required additional treatment for varicose tributaries and perforator veins with phlebectomy and foam sclerotherapy, Energy was delivered to the vein wall by a 600-microm optical fiber using 810-nm or 980-nm diode laser. Ablations were performed with duplex ultrasound (DU) guidance and tumescent anesthesia. Follow-up was with clinical examination and DU imaging., Results: DU imaging showed immediate occlusion of the SSV with no thrombosis in the proximal veins. No complications occurred intraoperatively. All patients had postoperative ecchymosis, but it was minimal. Three patients had distal thrombotic complications. Superficial phlebitis after complementary surgery occurred in three cases. Complete occlusion with absence of flow 2 to 3 days postoperatively and persisted in the follow-up. No paresthesia occurred in our last series whenever a larger amount of tumescent cold saline was infused around the vein., Conclusion: Endovenous laser ablation of the SSV has excellent early and midterm results. The prevalence of thrombosis and paresthesia is very low. Symptom relief is very good.

Endovenous laser treatment is a new, minimally invasive technique for ablation of the incompetent great and small saphenous vein and their tributaries. Although the satisfactory safety/efficacy results of this technique, literature is poor regarding standardization of the energy needed to ablate the incompetent vein in order to have success and durability of the procedure. The aim of this paper is a review of the literature to find out if authors with large experience on endovenous laser treatment achieved a standardization of the delivered energy at the incompetent vein wall and if new concepts proposed by the authors, like cold saline anesthesia, echogenic vein occlusion and regular distribution of laser energy to the vein wall, can improve the technique in order to have optimum results.

The incidence of inflammatory abdominal aortic aneurysm (IAAA) in a late review of the literature is estimated about 2-15% overall aortic aneurysms. In our data this type of aneurysm is 3.6 overall aortic aneurysms treated. In the majority of the cases, IAAA is juxtarenal or infrarenal. Ethiopathogenesis of IAAA till today is not certain. Recent hypothesis on IAAA attribute the same ethiopathogenesis in both atherosclerotic and inflammatory aneurysm. The interaction of genetic, environmental and infective factors should be able to determine an autoimmune inflammatory reaction of variable severity. 80% of the patients suffering from IAAA present abdominal or lumbar pain, loss of weight and increase of the RC sedimentation velocity. The IAAA's natural history goes to rupture. Entrapment of nearstanding organs totally involved in the fibrotic process is the most frequent complication. Usually there is a compression of the ureter and the duodenum with consequenced hydroureteronephrosis and bowel obstruction. Preoperative diagnosis is possible; CT scan and MRI guarantee and accuracy about 90%. Intraoperatively the external wall of IAAA appears whitish and translucent and always there are tenacious adhesion given by the avventital wounds inflammation. Confirm is given by the histological examination of the aneurysmatic wall and peravventitial tissues. Our experience and a late review of the literature concorde that surgical indication for the treatment of IAAA is the same for the atherosclerotic one. This conviction is supported by the fact that the diagnostic methodical evolution and the improvement in mininvasive surgical technique lowered perioperating morbility and mortaliy. We prefer, according with many authors, retroperitoneal approach to juxtarenal IAAA, instead of standardized transperitoneal access with xifo-pubical or transversal under costal incision. This approach offers some advantages as easier exposition of aorta, whose postero-lateral wall is hardly ever involved in inflammatory process, little duodenum's and left renal veins manipulation and low incidence of paralytic ileum and respiratory disease. Endovascular surgery hasn't in this moment any role in juxtarenal IAAA treatment because this type of aneurysm has inadequate proximal neck. In the future, probably, endovascular repair will be possible using a new type of endograft with renal legs. Often surgical treatment is inadequate to control retroperitorenal fibrosis and so surgeon has to use perioperating pharmacolocical therapy.

The examination after fifteen years of five cases of mandibular adamantinoma treated with an operation performed in two stages (graft of metallic prosthesis and osseous autograft) has confirmed the success of this surgical method. In particular from the clinical and radiological examination it turns out that the essential requisites for a therapeutical success have been respected: the anatomical restoration and the aesthetical and function rehabilitation.