Open repair of native and recurrent adult aortic coarctation has acceptable morbidity and low mortality. Especially in patients with concomitant aneurysm, resection with interposition graft replacement provides a safe and durable repair option.
Extracorporeal membrane oxygenation (ECMO) is generally used as a last resort toE xtracorporeal membrane oxygenation (ECMO) is a short-term mechanical circulatory support system for patients who are in advanced cardiac, pulmonary, or combined cardiopulmonary failure. Patients in cardiac failure are typically placed on venoarterial ECMO, and patients in respiratory failure are placed on venovenous ECMO. Large-diameter cannulas are needed to maintain high blood flow through the mechanical circulatory support system. However, upon insertion into blood vessels, these cannulas can reduce native blood flow, especially when vessel diameters are small. Acute limb ischemia can necessitate vascular reconstruction or amputation of the patient's extremities. We describe a modified T-graft technique that we used in order to avoid acute limb ischemia from ECMO in a young woman whose femoral arteries (FAs) were small. Case ReportIn April 2012, an 18-year-old woman presented with viral cardiomyopathy, systolic heart failure, and acute respiratory distress syndrome. She was intubated and was started on full mechanical ventilation. However, her pulmonary status continued to deteriorate, so we emergently placed her on ECMO. A 15F cannula was inserted in her right common FA, and a 19F cannula was inserted in her right common femoral vein. Several attempts to percutaneously place an antegrade distal-perfusion catheter in the right superficial FA failed because of small vessel size (diameter, 3-4 mm) and vasoconstriction. Critical limb ischemia subsequently developed in the patient's right leg. She remained hemodynamically unstable and would not have been able to tolerate a limb-revascularization procedure. During the next few days, her hemodynamic status improved; however, she became increasingly acidotic and sustained rhabdomyolysis and renal failure as the limb ischemia progressed. To prevent progression of the renal failure secondary to rhabdomyolysis, an emergency guillotine amputation of her right leg was performed, above the knee. At the same time, we decided to switch the ECMO to left femoral access by means of a modified T-graft technique, to avoid critical limb ischemia of her left leg.
The necessity of introducing telework and online education due to the COVID-19 crisis has drawn attention to the problem of digital inequalities among young people. Besides access and connectivity problems, the lockdown has shown a gap between young people’s self-perceived level of digital skills (which is generally high) and their actual digital performance, they tend to experience important difficulties associated with the second-level digital divide. Most of the empirical evidence about digital skills relies on index construction based on variables about digital tasks or practices that people can fulfill. Nevertheless, there is no evidence about the sociological and biographical determinants that influence subjects’ self-perception of their level of digital skills, particularly among young people, since this generational group is generally associated with a high level of digital skills. Therefore, in this article we will measure the influence of different sociological and biographical aspects (gender, age, education, forms of digital accessibility, digital practices, itineraries of digital literacy along their life, etc.) over declaring a certain level of digital skills. The outcomes show the importance of socio-demographic factors and of the processes of appropriation of technology when young people perceive their level of digital performance, which are only partially related to socioeconomic situations, since digital vulnerability is mediated by acquired cultural patterns over the use of technology.
La cobertura de heridas complejas en extremidades inferiores es un desafío de difícil manejo. Se realizó un estudio retrospectivo, analizando el resultado y las complicaciones en el uso del colgajo sural a pedículo distal para cobertura de defectos de extremidad inferior. Material y Método: Revisión de fichas clínicas de todos los pacientes sometidos a colgajo sural en los Hospitales Militar y Trabajador de Santiago entre los años 1995 y 2005, analizando características epidemiológicas, técnica quirúrgica y complicaciones del procedimiento. Resultados: Colgajos surales totales: 40 casos. Etiología de lesión: Fracturas: 33 casos (82,5%), heridas complejas (infectadas, inestables) 4 casos (10%), desforrramiento: 2 casos (5%) y quemadura: 1 caso (2,5%). En 20 casos no hubo complicación, y dentro de las complicaciones se encontraron necrosis parcial: 8 casos (20%), infección: 5 casos (12,5%), epidermolísis: 4 casos (10%) y seroma en 3 casos (7,5%). No se reportaron casos de necrosis total. Conclusión: El colgajo sural a pedículo distal es una alternativa válida de cobertura en lesiones complejas de extremo distal de extremidad inferior, con complicaciones de manejo aceptables, y con buen resultado a largo plazo.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.