Este procedimiento se realizó con el total de hombro invertida Aequalis prótesis Tornier Inc. Consulte Tornier Inc. Para obtener más información: <a href="http://www.tornier-us.com/">http://www.tornier-us.com/</a> .

1. Introducción: La articulación glenohumeral es una articulación compleja. Tiene un mínimo de limitaciones óseas y se basa en un complejo equilibrio de las tensiones entre el apoyo a los tejidos blandos para el funcionamiento normal. Esta relación esencial que permite el hombro para tener una amplia gama de movimiento funcional. Cuando este equilibrio se desacopla, grados variables de disfunción ocurrir. Una pérdida de la función del manguito rotador, como una lágrima grande, puede causar una traducción superior de la cabeza humeral en la cavidad glenoidea. Esto cambia el centro de rotación de la articulación glenohumeral y, posteriormente, los brazos de la tensión y el momento de la musculatura restante, disminución de la función. Además, los cambios en la posición de la cabeza humeral y los cambios subsiguientes en las presiones de contacto puede llevar a un daño progresivo del cartílago articular y la artritis que resulta doloroso. El uso de la artroplastia de hombro estándar en estos casos ha dado resultados óptimos y catastrófico a veces. Artroplastia total de hombro inversa (tsa) ofrece una solución para estos problemas tan complejos ofreciendo mejoras significativas en el dolor, la amplitud de movimiento y función. El diseño rtsa medializes el centro de rotación del húmero y lleva a una posición más inferior. Este cambio en la biomecánica restaura la tensión en el vientre del músculo deltoides y el brazo de palanca funcional, la mejora de la capacidad de deltoides para mover el brazo en el espacio. Además, el cartílago artrítico doloroso se elimina con el proceso, mejorando significativamente el dolor del paciente. 2. Presentación del caso: Este paciente es de 71 años de edad, mujeres sanas con una historia de un &quot;mini-open&quot; manguito de los rotadores quince años antes. Durante el año pasado, ha experimentado un aumento del dolor y debilidad en el hombro con una disminución asociada en su rango de movimiento. Su abducción activa fue de 30 º, flexión anterior activa fue de 40 °, rotación externa activa fue de 10 ° y rotación interna activa a su glúteo. Su modificación oso abrazo prueba demostró debilidad mínima en el tendón del subescapular y tuvo un efecto negativo de cuerno soplador de signo y prueba de demora negativo. Su rango de movimiento pasivo mostró que el 75 º de flexión hacia adelante con una prueba de caída del brazo positivo. El examen neurovascular fue normal y no hay signos de infección asociada con la reparación del manguito rotador anterior. 3. Tratamiento / procedimiento de diagnóstico: Evaluación radiológica inicial del paciente debe incluir una visión de toma de escapulario, una visión Grashey, y una vista axilar. Dependiendo de la apariencia de la glenoides, estudios posteriores con un TC puede ser necesario evaluar la cantidad de erosión ósea, la presencia de displasia y reserva ósea disponibles. En nuestro paciente, las radiografías iniciales mostraron moderados cambios degenerativos con migración superior del húmero se evidencia por una disminución del acromio-humeral distancia. No hubo pérdida ósea asociada con significativa la glenoides. La combinación de la historia del paciente, examen físico y análisis radiológicos son compatibles con artropatía del manguito rotador con seudoparálisis. Otros estudios de diagnóstico no estaría indicado en este paciente. Antes de la consideración de cualquier artroplastia importante en cualquier paciente de un curso de tratamiento conservador debe llevarse a cabo. Estos deben incluir el tratamiento médico con medicamentos anti-inflamatorios, inyecciones de corticosteroides en el subacromial comunicación y espacios intracapsular y la terapia física para el fortalecimiento y la amplitud de movimiento. Después de este curso de tratamiento, el paciente debe ser evaluado por su dolor, la función actual y realista las necesidades funcionales y los deseos, la calidad de vida y las comorbilidades asociadas. Si los riesgos asociados con el procedimiento se determina que es aceptable para los pacientes espera que los beneficios, la técnica de seguimiento para la artroplastia total de hombro inversa se puede utilizar. 4. Invertir artroplastia total de hombro <ol><li> El paciente se coloca en la posición beachchair y el brazo está preparada y envuelta libre de la forma habitual. </li><li> La incisión deltopectoral estándar y el enfoque se hace la exposición del manguito de los rotadores y el espacio subacromial. Disección roma se utiliza para liberar el deltoides superficie inferior de cualquier adherencia a los tejidos subyacentes. </li><li> El manguito rotador es examinado por lacrimógeno y evaluados por la posibilidad de reparación. Si los tejidos parecen ser reparable, la reparación y la artroplastia convencional puede ser considerado. De lo contrario, cualquier manguito inútiles pueden ser extirpados </li><li> El nervio axilar es la identificación y protección del tendón del subescapular se identifica y se libera de la tuberosidad menor y el tendón proximal se libera de cualquier adherencia sin soltar el origen </li><li> La cápsula inferior está dado de alta del húmero proximal del húmero y se rota externamente dislocando tque la cabeza del húmero en la articulación </li><li> El canal medular se encuentra con el punzón de entrada que se han sustituido por la guía de la cabeza humeral y la resección del corte proximal del húmero se hace a 0 ° de la versión. La guía intramedular tendrá que ser removido para completar el corte </li><li> Escariado metáfisis y diáfisis es el hecho en el tamaño adecuado a la anatomía del paciente </li><li> Componentes de prueba se ensamblan y se coloca en el húmero en la versión adecuada con un protector de corte para la preparación glenoidea </li><li> El labrum se extirpa la cápsula anterior e inferior son liberados de la cavidad glenoidea y se colocan retractores de la exposición de la cavidad glenoidea </li><li> La guía de broca es la utilizada para colocar el taladro central utilizando el taladro de 6 mm </li><li> El fresado glenoideo es en preparación para la placa base de la creación de una ranura perimetral </li><li> El agujero central es entonces ampliado a 7,5 mm para el de 8 mm el centro de la clavija y la placa base se coloca, impactando a ras con el fresado glenoideo </li><li> Los tornillos se colocan en la placa base con fijación cortical trans. Los tornillos anterior y posterior tiene un arco de 30 ° para la colocación y son estándar tornillos corticales. Los tornillos superior e inferior se fijan los tornillos de bloqueo con un arco de 30 ° en los planos superiores e inferiores, respectivamente, </li><li> El glenosphere luego se impactó en la placa base y el tornillo central se aprieta asegurar la glenosphere </li><li> Un trazador de líneas de prueba se coloca en el tallo humeral ensayo y el hombro se reduce. El examen de la ROM y la estabilidad se hace entonces para hacer los ajustes necesarios </li><li> Implantes de prueba se retira del húmero, los componentes finales se ensamblan y se inserta y se impactó en el húmero en la versión adecuada </li><li> El hombro es reducido y un examen final de la ROM y la estabilidad de hecho es </li><li> Tendón del subescapular luego se dirigió al húmero proximal y la herida se cierra de manera estándar </li></ol> 5. Resultados: A los 6 meses de seguimiento el paciente calificó su dolor post-operatorio como un cero de diez en la escala analógica visual. Su rango activo de movimiento incluye la flexión de 140 º, rotación externa activa de 25 ° y rotación interna de sus glúteos. Este paciente no tuvo complicaciones intraoperatorias o postoperatorias en el último seguimiento. 6. Conclusión: En la experiencia del autor, tsa, proporciona a un paciente con artropatía del manguito rotador con el alivio del dolor fiable y mejoras en el rango de movimiento y los resultados funcionales. Este paciente estaba satisfecho con los resultados de esta cirugía.

<ol>
	<li>Boileau, P., Sinnerton, R. J., Choinard, C., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Arthroplasty+of+the+Shoulder.">Arthroplasty of the Shoulder.</a> J Bone Joint Surgery Br. 88, 562-575 (2006).</li><li>Boileau, P., Watkinson, D., Hatzidakis, A. M., Hovorka, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neer+Award+2005:+The+Grammont+reverse+shoulder+prosthesis:results+in+cuff+tear+arthritis,+fracture+sequelae,+and+revision+arthroplasty.">Neer Award 2005: The Grammont reverse shoulder prosthesis:results in cuff tear arthritis, fracture sequelae, and revision arthroplasty.</a> J Shoulder Elbow Surg. 15, 527-540 (2006).</li><li>Boileau, P., Watkinson, D. J., Hatzidakis, A. M., Balg, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Grammont+reverse+prosthesis:+design,+rationale,+and+biomechanics.">Grammont reverse prosthesis: design, rationale, and biomechanics.</a> J Shoulder Elbow Surg. 14, 147S-161S (2005).</li><li>Cuff, D., Pupello, D., Virani, N., Levy, J., Frankle, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+shoulder+arthroplasty+for+the+treatment+of+rotator+cuff+deficiency.">Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency.</a> J Bone Joint Surg Am. 90, 1244-1251 (2008).</li><li>Edwards, T. B., Boulahia, A., Kempf, J. F., Boileau, P., Nemoz, C., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+influence+of+rotator+cuff+disease+on+the+results+of+shoulder+arthroplasty+for+primary+osteoarthritis:+results+of+a+multicenter+study.">The influence of rotator cuff disease on the results of shoulder arthroplasty for primary osteoarthritis: results of a multicenter study.</a> J Bone Joint Surg Am. 84, 2240-2248 (2002).</li><li>Frankle, M., Siegal, S., Pupelo, D., Saleem, A., Mighell, M., Vasey, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=There+reverse+shoulder+prosthesis+for+glenohumeral+arthritis+associated+with+severe+rotator+cuff+deficiency.+A+minimum+two-year+follow-up+study+of+sixty+patients.">There reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients.</a> J Bone Joint Surg Am. 87, 1697-1705 (2005).</li><li>Guery, J., Favard, L., Sirveaux, F., Oudet, D., Mole, D., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+total+shoulder+arthroplasty.+Survivorship+analysis+of+eighty+replacements+followed+for+five+to+ten+years.">Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years.</a> J Bone Joint Surg Am. 88, 1742-1747 (2006).</li><li>Martin, T. G., Lanotti, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+total+shoulder+arthroplasty+for+acute+fractures+and+failed+management+after+proximal+humerus+fractures.">Reverse total shoulder arthroplasty for acute fractures and failed management after proximal humerus fractures.</a> Orthop Clin North Am. 39, 451-457 (2008).</li><li>Wall, B., Nove-Josserand, L., O'Conner, D. P., Edwards, T. B., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+total+shoulder+arthroplasty:+a+review+of+results+according+to+etiology.">Reverse total shoulder arthroplasty: a review of results according to etiology.</a> J Bone Joint Surg Am. 89, 1476-1485 (2007).</li><li>Werner, C. M., Steinmann, P. A., Gilbart, M., Gerber, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+painful+pseudoparesis+due+to+irreparable+rotator+cuff+dysfunction+with+the+delta+III+reverse-ball-and-socket+total+shoulder+prosthesis.">Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the delta III reverse-ball-and-socket total shoulder prosthesis.</a> J Bone Joint Surg Am. 87, 1476-1486 (2005).</li></ol>

El uso de rtsa para la artropatía del manguito rotador ofrece mejoras significativas en el dolor, la amplitud de movimiento y las puntuaciones de los resultados funcionales. Satisfacción de los pacientes en general ha oscilado entre un 80-95% en la literatura actual. Al igual que todos los procedimientos, tsa, no está exenta de riesgos. Los informes iniciales de las complicaciones fueron tan altas como 60%. Como las técnicas han mejorado las tasas de complicaciones han disminuido.

<table border="1"><tbody><tr><td> Nombre del reactivo </td><td> Empresa </td><td> Número de catálogo </td><td> Comentarios </td></tr><tr><td> Aequalis invertida de hombro </td><td> Tornier, Inc. </td><td> ninguno </td><td> Para más información, visite <a href="http://www.tornier-us.com/">http://www.tornier-us.com/</a> </td></tr></tbody></table>

reverse total shoulder arthroplasty

Artroplastia total de hombro inversa fue aprobado inicialmente para su uso en la artropatía del manguito rotador y así como seudoparálisis crónica sin artritis en pacientes que no eran apropiados para las reconstrucciones de transferencia tendinosa. Tradicionales opciones quirúrgicas para estos pacientes son limitados y los resultados funcionales son sub-óptimos y, a veces catastróficos. El uso de la artroplastia de hombro invertida se ha encontrado para restablecer efectivamente el funcionamiento de estos pacientes y aliviar los síntomas asociados con la enfermedad. El procedimiento se puede realizar a través de dos enfoques, el deltopectoral o superolateral el. Las tasas de complicaciones asociadas con el uso de la prótesis se han extendido desde 8 hasta 60% con los informes más recientes tiende a la baja que se gana experiencia. Salvamento opciones para una prótesis de hombro invertida no son limitados y con frecuencia tienen una discapacidad significativa asociada. Indicaciones para el uso de esta prótesis continúan siendo evaluados como su uso para la artroplastia de revisión, la fractura del húmero proximal y el tumor. Cuidadosa selección del paciente es esencial debido a los riesgos significativos asociados con el procedimiento.

Watch this Scientific Journal Video about Reverse Total Shoulder Arthroplasty at JoVE.com

Reverse Total Shoulder Arthroplasty

Artroplastia total de hombro inversa está indicado para el tratamiento de condiciones que no pueden ser tratados con la artroplastia convencional u otros procedimientos. Estos incluyen, principalmente, enfermedades degenerativas e incapacitantes con manguito de los rotadores y la pérdida irreparable de la biomecánica normal de acoplamiento del hombro.

Invertir artroplastia total de hombro

Reverse total shoulder arthroplasty was initially approved for use in rotator cuff arthropathy and well as chronic pseudoparalysis without arthritis in ...

Research

JoVE Journal

Medicine

43.0K vistas.  Case Western Reserve University. Artroplastia total de hombro inversa está indicado para el tratamiento de condiciones que no pueden ser tratados con la artroplastia convencional u otros procedimientos. Estos incluyen, principalmente, enfermedades degenerativas e incapacitantes con manguito de los rotadores y la pérdida irreparable de la biomecánica normal de acoplamiento del hombro.

Video: Reverse Total Shoulder Arthroplasty

Implantation of the Syncardia Total Artificial Heart

With advances in technology, the use of mechanical circulatory support devices for end stage heart failure has rapidly increased. The vast majority of such patients are generally well served by left ventricular assist devices (LVADs). However, a subset of patients with late stage biventricular failure or other significant anatomic lesions are not adequately treated by isolated left ventricular mechanical support. Examples of concomitant cardiac pathology that may be better treated by resection and TAH replacement includes: post infarction ventricular septal defect,&#160;aortic root aneurysm / dissection, cardiac allograft failure, massive ventricular thrombus, refractory malignant arrhythmias (independent of filling pressures), hypertrophic / restrictive cardiomyopathy, and complex congenital heart disease. Patients often present with cardiogenic shock and multi system organ dysfunction. Excision of both ventricles and orthotopic replacement with a total artificial heart (TAH) is an effective, albeit extreme, therapy for rapid restoration of blood flow and resuscitation. Perioperative management is focused on end organ resuscitation and physical rehabilitation. In addition to the usual concerns of infection, bleeding, and thromboembolism common to all mechanically supported patients, TAH patients face unique risks with regard to renal failure and anemia. Supplementation of the abrupt decrease in brain natriuretic peptide following ventriculectomy appears to have protective renal effects. Anemia following TAH implantation can be profound and persistent. Nonetheless, the anemia is generally well tolerated and transfusion are limited to avoid HLA sensitization. Until recently, TAH patients were confined as inpatients tethered to a 500 lb pneumatic console driver. Recent introduction of a backpack sized portable driver (currently under clinical trial) has enabled patients to be discharged home and even return to work. Despite the profound presentation of these sick patients, there is a 79-87% success in bridge to transplantation.

The purpose of this manuscript is to briefly review indications, management, and outcomes for the total artificial heart. Video operative techniques for device implantation are presented.

Implantación del Corazón Artificial Total SynCardia

With advances in technology, the use of mechanical circulatory support devices for end stage heart failure has rapidly increased. The vast majority of ...

Investigación

Medicina

Implantation of Total Artificial Heart in Congenital Heart Disease

In patients with end-stage heart failure (HF), a total artificial heart (TAH) may be implanted as a bridge to cardiac transplant. However, in congenital heart disease (CHD), the malformed heart presents a challenge to TAH implantation. 
In the case presented here, a 17 year-old patient with congenital transposition of the great arteries (CCTGA) experienced progressively worsening HF due to his congenital condition. He was hospitalized multiple times and received an implantable cardioverter defibrillator (ICD). However, his condition soon deteriorated to end-stage HF with multisystem organ failure. 
Due to the patient's grave clinical condition and the presence of complex cardiac lesions, the decision was made to proceed with a TAH. The abnormal arrangement of the patient's ventricles and great arteries required modifications to the TAH during implantation.
With the TAH in place, the patient was able to return home and regain strength and physical well-being while awaiting a donor heart. He was successfully bridged to heart transplantation 5 months after receiving the device. This report highlights the TAH is feasible even in patients with structurally abnormal hearts, with technical modification.

This is a case report of a patient with congenitally corrected transposition of the great arteries (CCTGA) who received a total artificial heart (TAH) as a bridge to heart transplant. The TAH was successfully implanted with modifications to accommodate the patient's congenitally malformed heart.

El implante de corazón artificial total en las cardiopatías congénitas

In patients with end-stage heart failure (HF), a total artificial heart (TAH) may be implanted as a bridge to cardiac transplant. However, in congenital ...

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction

In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of arthroplasty. Infection requires complex treatment, may result in long hospitalization and causes considerable costs. Multiple surgical revisions can be necessary in these patients, with a loss in function as well as in quality of life.
The routine preoperative diagnostics include blood examination for C-reactive protein (CRP) and other biomarkers, as well as joint aspirate analysis for cell count, differentiation, and culture. Intraoperative specimens for histology and microbiology are also standard procedure. The microbiological examination of removed implants with sonication, in combination with the implementation of molecular biology techniques in microbiology, represent two novel techniques currently employed to enhance the differential diagnostics of PJI.
We present here the step-wise procedure of analyzing joint aspirate and sonication fluid, using a cartridge-based multiplex polymerase chain reaction (PCR) system. Results were matched against conventional cultures and consensus criteria for PJI. Conventional microbiological cultures from tissue biopsies, joint aspirate and sonication fluid showed a sensitivity of 66.7%, 66.7%, and 88.9%, respectively, and a specificity of 82.3%, 54.6%, and 61.5%, respectively. The PCR diagnostic of the sonication fluid and the joint fluid showed a sensitivity of 50.0% and 55.6%, respectively, and both a specificity of 100.0%. Both PCR diagnostics combined had a sensitivity of 66.7% and a specificity of 100.0%. The multiplex PCR therefore presents a rapid diagnostic tool with moderate sensitivity but high specificity in diagnosing PJI.

Differential diagnostics in painful arthroplasty is crucial for treatment success. Joint aspiration is routinely performed preoperatively. Multiplex polymerase chain reaction of the joint aspirate and the sonication fluid, a feasible tool for quick pathogen detection from these samples is described.

Nuevos diagnósticos en artroplastia de revisión: reacción en cadena múltiplex de polimerasa y sonicación del implante

In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of ...

Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart

Mechanical circulatory support (MCS) has been introduced as a viable alternative to heart transplantation primarily through the use of intracorporeal ventricular assist devices (VADs) for support of the left ventricle. However, certain clinical scenarios warrant biventricular mechanical support. One strategy for some patients is the excision of both ventricles and the implantation of two VAD pumps as a total artificial heart (TAH). This has recently been made possible by the improvements in device design and the small profile of centrifugal devices. This TAH approach remains experimental with many important challenges such as the device settings to balance the right and left circulation, the orientation of the devices and the outflow graft with their influence on hemolysis and stability, and the outcome of chronic support using such an orientation. This protocol aims to provide a reproducible approach for total artificial heart replacement with two intracorporeal centrifugal VADs in a cow model.

Here, we present a protocol using two centrifugal pumps as a total artificial heart replacement.

Uso de dos dispositivos de asistencia Ventricular intracorpórea como un corazón Artificial Total

Mechanical circulatory support (MCS) has been introduced as a viable alternative to heart transplantation primarily through the use of intracorporeal ...

Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty

Bone- and soft-tissue sparing short stems are increasingly used in total hip arthroplasty (THA). However, there are a large variety of models of short stems, differing in design and function. Calcar-guided short stems provide an anatomical curvature in the medial calcar region, thus, positioning is done individually alongside the calcar in the "round-the-corner" technique. Depending on the level of the neck's osteotomy, stems can be aligned individually in a large bandwidth of varus- and valgus anatomies. This differs from conventional total hip arthroplasty and potentially includes a severe learning curve. Given that a great variety of caput-collum-diaphyseal (CCD)-angles can be retained, the reconstruction of femoro-acetabular offsets can be achieved precisely. However, particularly extensive varus- and valgus positioning has raised concerns in regard to stability and bone remodeling. The purpose of the present manuscript is to showcase the implantation technique in calcar-guided short-stem THA and to summarize short-term clinical and radiological results.

This protocol describes the round-the-corner technique and the individualized stem-positioning of calcar-guided short stems alongside the medial calcar, depending on the level of the osteotomy. This differs from conventional total hip arthroplasty and includes a learning curve.

Vástago-posicionamiento individualizado en Calcar guiado vástago corto Total artroplastia de cadera

Bone- and soft-tissue sparing short stems are increasingly used in total hip arthroplasty (THA). However, there are a large variety of models of short ...

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol

Fluid retention is the most common risk factor for mortality and cardiovascular complications in patients with volume-overloaded disease states. The extent of diuresis or fluid removal is frequently determined by physical examination which is subject to inaccuracies.
Bedside ultrasound (US) is a portable tool that brings real-time diagnostic imaging to the patient's bedside. This versatile modality makes it possible for the clinician to investigate patients' extravascular and intravascular volume states. The extravascular volume, particularly in the case of pulmonary edema, can be quantitatively assessed by US of the anterior chest. Intravascular volume is estimated by visualizing the inferior vena cava (IVC) caliber. Taken together, the degree of extravascular lung water and the IVC caliber provide objective data that can guide the clinician to determine the level of diuresis needed to effectively yet safely treat pulmonary edema. 
The objective of this article is threefold: 1) to summarize the findings of previous studies on the efficacy of portable US to guide fluid management, 2) to describe a proposed ultrasound protocol to help guide fluid management, and 3) to elucidate techniques that address the measurement of intravascular and extravascular volumes using portable US.

We describe an imaging protocol that enables the clinician to visualize, in real-time, the patient&#39;s intravascular and extravascular space volumes and set diuresis and fluid removal parameters accordingly for the safe and efficient treatment of pulmonary edema.

Cabecera ultrasonido para el retiro líquido guía en pacientes con Edema pulmonar: el protocolo de caídas de reversa

Fluid retention is the most common risk factor for mortality and cardiovascular complications in patients with volume-overloaded disease states. The ...

Studying Left Ventricular Reverse Remodeling by Aortic Debanding in Rodents

To better understand the left ventricular (LV) reverse remodeling (RR), we describe a rodent model wherein, after aortic banding-induced LV remodeling, mice undergo RR upon removal of the aortic constriction. In this paper, we describe a step-by-step procedure to perform a minimally invasive surgical aortic debanding in mice. Echocardiography was subsequently used to assess the degree of cardiac hypertrophy and dysfunction during LV remodeling and RR and to determine the best timing for aortic debanding. At the end of the protocol, terminal hemodynamic evaluation of the cardiac function was conducted, and samples were collected for histological studies. We showed that debanding is associated with surgical survival rates of 70-80%. Moreover, two weeks after debanding, the significant reduction of ventricular afterload triggers the regression of ventricular hypertrophy (~20%) and fibrosis (~26%), recovery of diastolic dysfunction as assessed by the normalization of left ventricular filling and end-diastolic pressures (E/e&#39;&#160;and LVEDP). Aortic debanding is a useful experimental model to study LV RR in rodents. The extent of myocardial recovery is variable between subjects, therefore, mimicking the diversity of RR that occurs in the clinical context, such as aortic valve replacement. We conclude that the aortic banding/debanding model represents a valuable tool to unravel novel insights into the mechanisms of RR, namely the regression of cardiac hypertrophy and the recovery of diastolic dysfunction.

Here we describe a step-by-step protocol of surgical aorta debanding in the well-established mice model of aortic-constriction. This procedure not only allows studying the mechanisms underlying the left ventricular reverse remodeling and regression of hypertrophy but also to test novel therapeutic options that might accelerate myocardial recovery.

Estudio de la remodelación inversa del ventrículo izquierdo por desbanding aórtico en roedores

To better understand the left ventricular (LV) reverse remodeling (RR), we describe a rodent model wherein, after aortic banding-induced LV remodeling, ...

An In Vivo Mouse Model of Total Intravenous Anesthesia During Cancer Resection Surgery

Anesthesia is a routine component of cancer care that is used for diagnostic and therapeutic procedures. The anesthetic technique has recently been implicated in impacting long-term cancer outcomes, possibly through modulation of adrenergic-inflammatory responses that impact cancer cell behavior and immune cell function. Emerging evidence suggests that propofol-based total intravenous anesthesia (TIVA) may be beneficial for long-term cancer outcomes when compared to inhaled volatile anesthesia. However, the available clinical findings are inconsistent. Preclinical studies that identify the underlying mechanisms involved are critically needed to guide the design of clinical studies that will expedite insight. Most preclinical models of anesthesia have been extrapolated from the use of anesthesia in in vivo research and are not optimally designed to study the impact of anesthesia itself as the primary endpoint. This paper describes a method for delivering propofol-TIVA anesthesia in a mouse model of breast cancer resection that replicates key aspects of clinical delivery in cancer patients. The model can be used to study mechanisms of action of anesthesia on cancer outcomes in diverse cancer types and can be extrapolated to other non-cancer areas of preclinical anesthesia research.

An In Vivo Mouse Model of Total Intravenous Anesthesia During Cancer Resection Surgery

This paper describes a method for modeling total intravenous anesthesia (TIVA) during cancer resection surgery in mice. The goal is to replicate key features of anesthesia delivery to patients with cancer. The method allows investigation of how anesthetic technique affects cancer recurrence after resection surgery.

Un modelo de ratón in vivo de anestesia intravenosa total durante la cirugía de resección del cáncer

Anesthesia is a routine component of cancer care that is used for diagnostic and therapeutic procedures. The anesthetic technique has recently been ...

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex procedures. The high-quality 3-D visual, multijoint arm and natural tremor filtration allow the surgeon to expose and dissect more accurately with minimal invasion. Total mesorectal excision is the standard surgical technique for the treatment of resectable rectal cancer. To reduce the lateral recurrence rate, lateral pelvic lymph node dissection can be performed, as it is a safe and feasible procedure for locally advanced middle-low rectal cancer with a high possibility of metastasis to the lateral lymph nodes. However, the complexity of the anatomic structures and the high postoperative complication rate limit its application. Recently, several surgeons have increasingly used robotic techniques for total mesorectal excision and lateral pelvic lymph node dissection. Compared with open and laparoscopic surgery, the robotic technique has several advantages, such as less blood loss, fewer blood transfusions, minimal trauma, shorter postoperative hospitalization, and quicker recovery. A robotic approach is generally regarded as a reasonable alternative for complicated procedures such as lateral pelvic lymph node dissection, although there are a limited number of high-quality prospective randomized controlled studies reporting direct evidence. Here, we provide the detailed steps of robot-assisted total mesorectal excision and lateral pelvic lymph node dissection performed at the First Affiliated Hospital of Xi&#39;an Jiaotong University.

The robotic technique described herein aims to detail a stepwise approach to robot-assisted total mesorectal excision and lateral pelvic lymph node dissection for locally advanced (T3/T4) rectal cancer located below the peritoneal reflection.

Escisión mesorrectal total asistida por robot y disección lateral de ganglios linfáticos pélvicos para el cáncer de recto medio-bajo localmente avanzado

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex ...

The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report

The technology of 3D printing and visualization of anatomical structures is rapidly growing in various fields of medicine. A custom-made implant and mixed reality were used to perform complex revision hip arthroplasty in January 2019. The use of mixed reality allowed for a very good visualization of the structures and resulted in precise implant fixation. According to the authors' knowledge, this is the first described case report of the combined use of these two innovations. The diagnosis preceding the qualification for the procedure was the loosening of the left hip's acetabular component. Mixed reality headset and holograms prepared by engineers were used during the surgery. The operation was successful, and it was followed by early verticalization and patient rehabilitation. The team sees opportunities for technology development in joint arthroplasty, trauma, and orthopedic oncology.

A complex revision hip arthroplasty was performed using a custom-made implant and mixed reality technology. According to the authors&#39; knowledge, this is the first report of such procedure described in the literature.

El uso de la realidad mixta en la artroplastia de cadera de revisión personalizada: un primer caso clínico

The technology of 3D printing and visualization of anatomical structures is rapidly growing in various fields of medicine. A custom-made implant and mixed ...