Abstract Background: To report the initial experience performing thoracic endovascular aortic repair thoracic aortic endovascular repair (TEVAR) with double chimney in patients with aortic dissection (Stanford A) which had previous emergency open surgery, with replacement of ascending aorta and valve replacement. Material and methods: A series of 6 consecutive cases is reported from August 2017 to August 2019 managed with TEVAR with double chimney. All patients were followed up at 1, 6 and 12 months. Results: In all cases a C-TAG stent graft was used, five innominate arteries were treated using a Viabahn and one case with excluder iliac extension. All the left common carotid arteries were treated with Viabahn. There was no post-surgical mortality, the overall mortality was 16%. There was a Type I endoleak detected during surgery, treated with balloon dilation. Hematoma occurred in 50% and one patient developed post implant syndrome. No endoleak were identified during follow up at 6 and 12 months. At 12 months there is an overall mortality of 16%. Conclusion: Double chimney technique is an alternative with lower morbidity and mortality compared to open surgery in patients with previous ascending aortic surgery. However, further experience and long term follow up is necessary to confirm its long-term safety and efficacy.

Resumen Objetivo: Reportar la experiencia inicial realizando reparación endovascular de la aorta torácica (TEVAR) con doble chimenea en pacientes con disección aórtica Stanford A, los cuales fueron intervenidos previamente con cirugía de urgencia mediante el manejo de la aorta ascendente y el recambio valvular. Material y métodos: Se reporta una serie de seis casos consecutivos de agosto de 2017 a agosto de 2019 a los que se realizó TEVAR con doble chimenea. Se llevó un seguimiento a los 1, 6 y 12 meses. Resultados: En todos se usó C-TAG, en 5 arterias innominadas se desplegó un Viabahn y en 1 caso se colocó una extensión ilíaca Excluder invertida, en todas las carótidas izquierdas se colocó un Viabahn. No hubo mortalidad posquirúrgica, la mortalidad global fue del 16%, y se encontró una endofuga tipo IA en el angiograma final, la cual revirtió a la dilatación con balón. Se presentó hematoma en el 50% de los casos, un paciente cursó con síndrome postimplante. No se identificaron endofugas en el seguimiento a los 6 y 12 meses. A los 12 meses se cuenta con una mortalidad global del 16%. Conclusión: La técnica de doble chimenea es una alternativa de menor morbimortalidad a la cirugía abierta en pacientes con cirugía aórtica ascendente previa. Es necesario realizar nuevos estudios a largo plazo.

The aim of this study was to determine the selection of bedding material by broiler chickens during the rearing period and whether the choice was determinant to their performing a specific behavior. To achieve this objective, a choice test was designed. A choice pen was constructed where birds could move freely around the four selected materials (straw, wood shavings, rice hulls and sand). Chickens were introduced in this pen in four groups of eight birds, three days a week for one hour per day and group, for four weeks. The location and the activity performed by each broiler were recorded every five minutes. Results showed a preference for sand compared with the other three substrates. However, differences between the behaviors performed in each bedding material were shown mainly for resting (preferably performed on wood shavings and straw), dust bathing (on sand), pecking and scratching (on rice hulls). Other factors, such as the time of day, were also found to have effects on fighting and drinking, and changes in behavioral patterns (resting, preening, eating, standing and pecking) were also detected as broilers grew older.

Clinical case of a microbiologist with wide experience, which is inoculated accidental when Mycobacterium's pure strain manipulates tuberculosis; it (she) pricks itself in the lateral external face of the phalanx distal of the forefinger, crossing the glove with the contaminated needle. Immediate treatment of the wound. The Service of Prevention, he registers the inoculation as accident of work. To three weeks a slightly painful pápula eritematosa appears in the place of the inoculation to the pressure that is growing until a size reaches 1,5-2 cm., without adenopatías axyllaris, not general clinic. Exéresis and biopsy of the same one, pathological anatomy: chronic inflammation very suggestive granulomatosa tuberculoide of cutaneous tuberculosis, microbiology: doubtful BAAR (Acid bacillus resistant alcohol), I cultivate: positive to Mycobacterium tuberculosis. Both vine-stocks present the same identity. Diagnosis: cutaneous tuberculosis. The occupational risk prevention department realizes the communication of Occupational disease according to the RD 1299/2006, of December 10. Follow-up for Internal Medicine, starting treatment of TB.

Caso clínico de una microbióloga con amplia experiencia, que sufre una inoculación accidental al manipular una cepa pura de Mycobacterium tuberculosis. Se pincha en la cara lateral externa de la falange distal del dedo índice, atravesando el guante con la aguja contaminada. (Imagen 1). La trabajadora procede de forma inmediata a la limpieza de la herida. El Servicio de Prevención, registra la inoculación como accidente de trabajo. A las tres semanas del accidente, aparece en el lugar de la inoculación una pápula eritematosa levemente dolorosa a la presión que va creciendo hasta alcanzar un tamaño de 1,5-2 cm., sin adenopatías axilares, ni clínica general. (Imagen 2) Se procede a la exéresis y biopsia de la lesión. Informe anatomopatológico: Inflamación crónica granulomatosa tuberculoide muy sugestiva de tuberculosis cutánea. Microbiología: dudosos bacilos ácido alcohol resistentes (BAAR) Cultivo: positivo a Mycobacterium tuberculosis. Ambas cepas presentan la misma identidad. Diagnóstico: tuberculosis cutánea. El SPRL realiza la comunicación de Enfermedad Profesional según el RD 1299/2006, de 10 de diciembre. Se realiza valoración y seguimiento en el Servicio de Medicina Interna, iniciando tratamiento de tuberculosis.