Summary:
A significant proportion of high-flow arteriovenous malformations (AVMs) in the hand are complex to treat due to their multicentricity, size, and risk of jeopardizing distal circulation. Therefore, AVMs are frequently considered “inoperable.” We present the case of a multifocal recurrent AVM treated in conjunction with the interventional radiology department, with intra-arterial embolization and excision followed by immediate distal revascularization to replace the resulting arterial deficit. This is a case of a 24-year-old woman with a high-flow multifocal AVM in her right hand, partially excised 2 years ago, showing a pulsatile mass in the palm and dorsum of the right hand, and a reporting pain of 8 of 10 on the visual analogue scale. The procedure was performed in our hybrid operating room. This procedure lasted 4 hours, with intraoperative bleeding of 75 mL. Three weeks after the procedure, patency and good circulation of the three revascularized fingers was demonstrated using arteriography and no evidence of vascular anomalies were found. No skin loss occurred, and no reintervention was required. For radical excision of this complex high-flow recurrent AVM, detailed intraoperative documentation of its afferent and immediate embolization with gelatin-based hemostatic agents allowed its obliteration with a low reactive material. We consider that this approach might be an option to treat AVMs that are currently considered inoperable.
A través del análisis de un fragmento escrito probablemente en torno a 1818, intento mostrar en este artículo cómo el descubrimiento del origen de la prosa significó un hito relevante en el pensamiento de Samuel Taylor Coleridge acerca de la distinción entre verso y prosa. Esta marca se fundó en sus estudios de los presocráticos y coincidió con su teoría estética enraizada en el pensamiento de Plotino. Intento poner en evidencia, entonces, cómo una discusión estilística adquirió un alcance filosófico e incluso teológico.
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