Sample records for CLEVELAND (cleveland)
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Sample records 1 - 10 shown.



1

Gongbusaurus and the early phylogeny of the Neornithischia

Knoll, Fabien ; Dong, Zhiming

Poster contributed to the 68th Annual Meeting of the Society of Vertebrate Paleontology (SVP), Cleveland, OH, Oct 15-18, 2008.-- Published in the JVP 2008, 28(3) Book of abstracts. | Gongbusaurus shiyii (type species of the genus) is based on a premaxillary tooth anda cheek tooth from the Oxfordian...

DRIVER (Spanish)

2

Nefrectomía parcial laparoscópica: Técnica y resultados/ Laparoscopic partial nephrectomy: technique and outcomes

Colombo, J.R. Jr; Gill, I.S.
2006-05-01

Resumen en español La indicación de la Nefrectomía Parcial Laparoscópica (NPL) ha evolucionado considerablemente y la técnica se está convirtiendo en una opción establecida en nuestro centro. En los últimos 5 años, el autor principal ha realizado más de 450 nefrectomías parciales laparoscópicas en la Clínica Cleveland. Presentamos seguidamene nuestra técnica y revisamos los datos actuales y los resultados oncológicos de la NPL. Resumen en inglés The indication of laparoscopic partial nephrectomy (LPN) has evolved considerably, and the technique is approaching established status at our institution. Over the past 5 years, the senior author has performed more than 450 laparoscopic partial nephrectomies at the Cleveland Clinic. Herein we present our current technique, review contemporary data and oncological outcomes of LPN.

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3

Neuromodulación de raíces sacras como tratamiento de la incontinencia fecal: Resultados preliminares/ Sacral root neuromodulation as treatment for fecal incontinence: Preliminary results

Navarro, J. M.; Arroyo Sebastián, A.; Pérez Vicente, F.; Sánchez Romero, A. M.; Pérez Legaz, J.; Serrano Paz, P.; Fernández Frías, A. M.; Candela Polo, F.; Calpena Rico, R.
2007-11-01

Resumen en español Presentamos nuestra experiencia inicial en el tratamiento de la incontinencia fecal (IF) mediante neuromodulación de raíces sacras (NRS), a través de los resultados de un estudio prospectivo realizado con 26 pacientes en el que se comparan los valores basales en la escala de continencia de Wexner-Cleveland y en la capacidad para el retraso de la defecación, con los obtenidos tras un año de terapia con NRS. El estudio inicial de cada paciente incluía anamnesis, explo (mas) ración general, ecografía y manometría rectal, así como unos diarios de continencia y de calidad de vida específicos para la IF de 3 semanas. Antes de la terapia con NRS, el valor medio en la escala Wexner-Cleveland fue de 15,00 ± 1,81 y el 62,50% de los pacientes tenía una capacidad de retraso de la defecación menor de 1 minuto. Tras un año de terapia con NRS, el valor medio en la escala de Wexner-Cleveland fue de 4,87 ± 2,54 (p = 0,0031) y el 75,01% de los pacientes presentaba una capacidad de retraso defecatorio mayor de 15 minutos (p = 0,0018). Hacemos, además, una descripción detalla de la técnica quirúrgica de la NRS, haciendo referencia a sus indicaciones y finalizamos revisando las distintas opciones terapéuticas para la IF mostrando nuestro algoritmo terapéutico para esta patología. La NRS es una técnica eficaz para el tratamiento de la IF en pacientes seleccionados que no han respondido a tratamiento conservador, biofeedback o correcciones anatómicas (esfinteroplastia), con una mínima morbilidad y susceptible de realizarse en un programa de cirugía ambulatoria. Resumen en inglés We present our initial experience in the treatment of fecal incontinence (FI) with sacral root neuromodulation (SRN) by reporting the results of a prospective study with 26 patients where baseline Wexner-Cleveland scale scores and ability to delay defecation were compard to results after one year with SRN. The initial study of patients included history taking, general examination, anal ultrasonography, and manometry, and a three-week diary of continence and quality of lif (mas) e specific for FI was used. Before SRN the mean baseline Wexner-Cleveland score was 15.00 ± 1.81, and 62.50% of patients could only delay defecation for less than a minute. After a year with NRS the mean Wexner-Cleveland score was 4.87 ± 2.54 (p = 0.0031), and 75.01% of patients could delay defecation above fifteen minutes (p = 0.0018). We also describe the surgical technique and its indications, and finally review the various therapeutical options for FI and show our algorithm for this condition. SRN is an effective technique for the treatment of FI in properly selected patients with no response to medical therapies (including biofeedback) or anatomic correction (sphincteroplasty), with efficacy, little morbidity, and a short hospital stay.

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4

Dr René Favaloro (1923-2000)/ Rene Favaloro MD (1923-2000)

Morán V, Sergio
2000-09-01

Resumen en inglés René Favaloro MD, was born in La Plata, Argentina, in July 1923. He studied medicine in La Plata and made his cardiology residence in the Cleveland Clinic, where he developed coronary bypass surgery for the treatment of ischemic heart disease. At the present time, this surgical procedure is a well recognized therapy for coronary artery disease that has benefited millions of patients. Back in Argentina, he founded in 1992 the Institute of Cardiology and Cardiovascular Sur (mas) gery that had an important research and teaching activity. Dr Favaloro wanted to be remembered as a teacher rather than as a surgeon, but he really was a great Master of Surgery in the Americas (Rev Méd Chile 2000; 128: 1065-6)

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5

Validación prospectiva de siete sistemas locales e internacionales de evaluación del riesgo en cirugía cardíaca/ Prospective Validation of Seven Local and International Systems for Risk Assessment in Cardiac Surgery

Borracci, Raúl A.; Rubio, Miguel; Cortés y Tristán, Gonzalo; Giorgi, Mariano; Ahuad Guerrero, Rodolfo A.
2006-12-01

Resumen en español Introducción En la Argentina se elaboraron varios modelos de ajuste por riesgo (scores) de mortalidad en cirugía cardíaca que en general no fueron validados en poblaciones diferentes de las que les dieron origen. Asimismo, distintos cirujanos utilizan diferentes scores para comparar y presentar sus resultados. Objetivos El presente trabajo se llevó a cabo con el propósito de evaluar el desempeño de siete scores de riesgo de mortalidad en cirugía cardíaca de uso co (mas) rriente en nuestro medio. Material y métodos Se analizaron prospectivamente 502 pacientes sometidos a cirugía cardíaca entre 2004 y 2005. Se identificaron las variables preoperatorias para el cálculo de siete scores de riesgo de mortalidad, cuatro internacionales, Parsonnet, Ontario, EuroSCORE y Cleveland, y tres locales, CONAREC, Español y Favaloro. Para determinar la discriminación, la precisión y la calibración de cada score, se calculó el riesgo esperado promedio de cada uno, la bondad de ajuste de Hosmer y Lemeshow, el coeficiente Q, las áreas ROC, el índice de Shannon y tres métodos gráficos. Resultados La comparación de las áreas ROC para todo tipo de cirugía cardíaca mostró que el EuroSCORE tuvo la mejor área (78,7%), junto con el score del Español (78,6%). Aunque estos modelos tuvieron el valor predictivo más alto, no se encontraron diferencias estadísticas al compararlos con el resto de los modelos. Para la cirugía coronaria, el EuroSCORE nuevamente mostró la mejor predicción (76,3%), y luego el de Cleveland (76,0%), a pesar de que tampoco se hallaron diferencias estadísticas con el resto de los scores. Para todo tipo de cirugía, el Ontario tuvo el mejor índice de Shannon global (0,913), pero el peor índice de fallecidos (0,074), lo cual indica que otorgó riesgos esperados más bajos a los sobrevivientes, pero también riesgos bajos a los que murieron. Por su parte, el EuroSCORE se ubicó en segundo lugar para el índice global (0,905) y el de fallecidos (0,106). Para la cirugía coronaria, el Español tuvo el índice global más alto (0,945), pero también el índice de fallecidos más bajo (0,050), lo que señala una buena precisión en el primer caso y una mala precisión cuando sólo se consideran los fallecidos. En el EuroSCORE, los índices de Shannon de 0,926 y 0,073 lo ubican ligeramente en mejor posición al evaluar los dos tipos de valores. Conclusiones La comparación de siete scores para estratificar el riesgo de mortalidad en la cirugía cardíaca demostró que el EuroSCORE tuvo el mejor desempeño, tanto para los procedimientos valvulares como para los coronarios. Por su parte, el score del Español tuvo un desempeño similar cuando se consideraron todos los tipos de cirugía, mientras que el de Cleveland fue mejor para estratificar el riesgo de los coronarios. De acuerdo con el índice de Shannon, la precisión para predecir mortalidad a nivel del paciente individual fue pobre con todos los modelos. Resumen en inglés Background In Argentina, several models of risk adjustment (scores) in cardiac surgery have been proposed, which generally have not been validated in populations other than those originally described. Additionally, different surgeons utilize different scores to compare and present their results. Objectives This study was performed with the goal of assessing the performance of seven scores of mortality risk in cardiac surgery, which are commonly used in our country. Materi (mas) al and Methods A group of 502 patients who underwent surgery between 2004 and 2005 were analyzed prospectively. Preoperative variables were identified for the calculation of seven mortality risk scores: four international scores: Parsonnet, Ontario, EuroSCORE and Cleveland, and three local scores: CONAREC, Español and Favaloro. To assess the discrimination, accuracy and calibration of each score, the following were calculated: expected average risk of each score, Hosmer and Lemeshow goodness of fit, coefficient Q, ROC areas, Shannon index and three graphic methods. Results A comparison of the ROC areas for all types of cardiac surgery showed that the EuroSCORE had the best area (78.7%), together with the Español score (78.6%). Although these models had the higher predictive value, no statistical differences were found when they were compared to the other models. For coronary surgery, the EuroSCORE again was the most predictive (76.3%), followed by the Cleveland (76%), although here too, there were no statistical difference with the other scores. For all types of surgery, the Ontario score had the best global Shannon index (0.913), but had the worst index of deaths (0.074), which shows that it assigned lower expected risks to survivors, but it also assigned low risks to those who died. The EuroSCORE ranked second for the global index (0.905) and for deaths (0.106). For coronary surgery, the Español score had the higher global index (0.945), but also the lowest index of deaths (0.050), which indicates good accuracy in the first case and poor accuracy only when the deceased are taken into account. The EuroSCORE is positioned slightly better by the Shannon indices of 0.926 and 0.073, when assessing both types of values. Conclusions The comparison of seven scores to stratify mortality risk in cardiac surgery showed that the EuroSCORE had the best performance, for valvular as well as for coronary procedures. As to the Español score, it had a similar performance when all types of surgery were considered, whereas the Cleveland score was better to stratify risk in coronary disease. According to Shannon's index, the accuracy to predict mortality in the individual patient was poor with all the models assessed.

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6

Sedoanalgesia pediátrica en lugares fuera de quirófano/ Pediatric sedoanalgesia outside the operating theatre

Castilla-Moreno, M.; Castilla-García, M.
2004-12-01

Resumen en español Objetivo: Analizar las sedaciones que se realizan en pediatría, fuera del área quirúrgica. Esto siempre es un reto para el anestesiólogo pero más si los pacientes son niños. Creemos que una de las claves es tener protocolizados los fármacos a utilizar y sus vías de administración, la monitorización, tener una enfermera dedicada a ayudar al anestesiólogo y por supuesto seleccionar muy bien los procedimientos; de hecho, a pesar de los muchos trabajos que hay publ (mas) icados sobre sedación, muchas de ellas fracasan por no estar bien indicadas o porque el personal que la realiza no es un anestesiólogo. Nuestro método de trabajo fue: -Hacer una búsqueda bibliográfica sobre un fármaco básico: propofol. -En cuanto a los procedimientos a realizar bajo sedación en niños, contactamos con varios hospitales de gran reconocimiento en el mundo de la Anestesia Pediátrica con una lista de dichos procedimientos. Los hospitales consultados fueron: Children's Hospital de Pittsburgh, Cleveland Clinic Foundation, Departamento de Anestesia Pediátrica de la Universidad de Varsovia, Children's Hospital de Colonia (Alemania), Sick Great Ormond Street de Londres; todos coinciden en seguir los siguientes pasos: baño del niño quemado, radioterapia, resonancia nuclear magnética (RNM), tomografía axial computerizada (TAC) y tomografía de emisión de positrones (PET). La ecocardiografía en niños pequeños se realiza la mayor parte con hidrato de cloral, bien por vía oral (85%) o rectal. Material y método: Se revisa literatura reciente mediante buscadores de internet, destacando que la mayoría emplean propofol; se cruzan palabras claves: propofol and children, propofol and infants y propofol and neonates. Conclusiones: Los procedimientos de sedación en niños necesitan como otro tipo de anestesia los siguientes documentos: 1. Consentimiento informado. 2. Ayuno, según edad. 3. Acceso venoso disponible. 4. Monitorización adecuada según procedimiento. Resumen en inglés Objective: To review the sedations that are performed in pediatric care outside the surgical area. This is always a challenge for the anesthesiologist, but particularly when the patients are children. We believe that the keys are: a protocol that establishes the drugs to be used and their routes of administration, monitoring, appointment of a nurse for the support of the anesthesiologist and, of course, a very good selection of the procedures. In fact, despite the many st (mas) udies that have been published about sedation, many of these fail because the indications are not appropriate or because the person that performs them is not an anesthesiologist. Our working method has been the following: -We carried out a literature search of a basic drug: propofol. -In order to establish the procedures that have to be conducted under sedation in children, we contacted several hospitals with a recognized prestige in Pediatric Anesthesia with a list of procedures. The hospitals consulted were: Children's Hospital de Pittsburgh, Cleveland Clinic Foundation, Department of Pediatric Anesthesia of the Varsaw University, Children's Hospital of Colonia (Alemania ) and Sick Great Ormond Street of London. All of them agreed on the need of sedation for the following procedures: bath of burned children, radiotherapy, nuclear magnetic resonance (NMR), computerized axial tomography (CAT), positron emission tomography (PET). The echocardiography in small children is mostly performed with chloral hidrate, either orally (85%) or rectally administered. Material and method: We reviewed recently published literature with Internet search tools, in most cases using the propofol word and crossing-over the key words: propofol and children, propofol and infants y propofol and neonates. Conclusions: Sedation procedures in children require, such as any other type of anesthesia, the following: 1. Informed consent. 2. Fasting, depending on age. 3. Availability of a venous access. 4. Appropriate monitoring depending on the procedure.

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7

Análisis de facies y paleoambiental de alta resolución de la Aloformación Punta San Andrés (Plio-Pleistoceno), provincia de Buenos Aires, Argentina

Beilinson, Elisa
2009-07-01

Resumen en español La Aloformación Punta San Andrés aflora principalmente a lo largo de las barrancas costeras que se desarrollan desde la ciudad de Mar del Plata hasta la ciudad de Miramar y comprende las sedimentitas de edad plio-pleistocenas interpretadas como depósitos continentales de planicies aluviales, sistemas fluviales de baja sinuosidad y cuerpos de agua someros. El presente trabajo tiene por finalidad efectuar un análisis de alta resolución de facies sedimentarias así como (mas) de asociaciones de facies y arquitectura de los cuerpos sedimentarios presentes en los afloramientos de Baliza San Andrés y Complejo Turístico Chapadmalal de la Aloformación Punta San Andrés con el propósito de elaborar un modelo conceptual y dinámico de los ambientes depositacionales que la conformaron. Basado en el trabajo de campo y de laboratorio realizado, se definieron en primera instancia dos grandes grupos de facies, unas de origen depositacional y otras de origen postdepositacional, las cuales se agruparon en cuatro asociaciones de facies según los procesos que le dieron origen y según su arquitectura (AF I a IV: canales fijos de baja sinuosidad, canales móviles de alta sinuosidad, lóbulo de explayamiento y planicie de inundación pedogenizada). El análisis de estas asociaciones permitió definir ambientes depositacionales cuya sucesión e interrelación permite inferir un cambio progresivo en las condiciones de acomodación y paleoclimáticas imperantes durante su desarrollo. Resumen en inglés The continental deposits of the Punta San Andrés Alloformation (Plio-Pleistocene) crop out in the marine cliffs of south eastern Buenos Aires province (Fig. 1). The deposits of this unit have been assigned to different continental sub-environments such as floodplains, fluvial channels and temporary water bodies (Zárate, 1989). The aim of this work is to perform a high-resolution facies and facies association analysis as well as an architectural characterization of the s (mas) edimentary bodies cropping out in Baliza San Andrés and Complejo Turístico Chapadmalal (Fig. 1). This information will be used to elaborate a conceptual and dynamic model of the depositional environments present in the Punta San Andrés Alloformation and to define main controlling factors over its accumulation. The study area is located in a typical passive margin controlled by transversal extensional systems that originated rift basins (aulacogens) with very little basaltic magmatism (Ramos, 1996; Parker et al. 2008). This area experienced block rotation due to isostatic equilibrium and sedimentary overload. Accumulation of post-Miocene deposits was favored by a high sedimentary dynamic associated with the rise of the Andean Cordillera (Turic et al. 1996; Parker et al. 2008). More specifically, the study area is located in the southeastern part of the Tandilia Geological Province (Rolleri, 1975, Fig. 1). The pioneer papers on stratigraphy of the Mar del Plata and Miramar marine cliffs were carried out by Ameghino (1908), Frenguelli (1921) and Kraglievich (1952, 1953, 1959) (Figs.2, 3). The sedimentological characterization of these deposits was made by Teruggi et al. (1956) and Zárate (1989). This last author also proposed an allostratigraphic framework which intended to unify and simplify the late Cenozoic stratigraphy (Fig. 2). The rich vertebrate fauna present in the Punta San Andrés Alloformation and related units was studied since the first contributions by Ameghino (1908). These studies were the basis for the South American Late Cenozoic biostratigraphic scheme (Fig. 2; Marshall, 1985; Cione and Tonni, 1995, 1999). According to Zárate (1989), the Punta San Andrés Alloformation unconformably overlays the Pliocene continental deposits of the Punta Martínez de Hoz, Playa Los Lobos and Playa San Carlos alloformations. Its lateral extent is about 15 km from the Arroyo Lobería to Punta Vorohué (Fig. 1) and it also crops out between Arroyo Lobería and Playa San Carlos (Fig. 1). The mean thickness of the Punta San Andrés Alloformation is 15 meters. Internally, it is subdivided into three allomembers limited by discontinuity surfaces with a lateral extent that allows mapping them at 1:25.000 scale (Zárate, 1989; Fig. 2). Because of the high mineralogical and textural homogeneity (silty sand and reworked loessoid silt) of the cenozoic deposits in the study area (Teruggi et al., 1956) the discrimination amongst the different units is based on the abundance of the channelized facies, the carbonatic precipitation and the degree of development and maturity of paleosoils (Zárate, 1989). During field work 10 detailed, 1:50 scaled sedimentological profiles were made at Baliza San Andrés and Complejo Turístico Chapadmalal (Fig. 1) from which the 4 more complete are shown in figure 4. All stratigraphic logs were described in detail and focus was made in grain size, lithology, primary sedimentary structures, bioturbation, fossil content, scale and geometry of the lithosomes; all of these useful features to define sedimentary facies (Reading and Levell, 1996). The abundance of post depositional features (mainly pedogenetic) in the Punta San Andrés Alloformation made necessary the subdivision of sedimentary facies into two groups: depositional and post-depositional. The depositional facies were classified and described according to Miall´s scheme (1978, 2006), which was modified to facilitate their description and interpretation (Table 1). The post-depositional carbonatic facies were described according to Zárate´s scheme (1989) in which the studied features are the geometry of the calcareous accumulation (development in one, two or three dimensions), internal structure, hardness, abundance and lateral extent. The analysis of the seven depositional facies (Table 1) led to interpret a continental environment where unidirectional streams allowed the migration of 3D and 2D dunes as well as the lateral migration of side bars (facies Cig, ACt, ACs, Ah and Ae). It also made clear the presence of paleosoils developed on sheet-flood or splay deposits (facies Alp) and of suspension-related sediments (facies Pm). The analysis of the three post-depositional facies (Table 1) led to the identification of carbonatization processes related to pedogenesis (facies Bc and Tm) and to diagenesis in a vadose environment (facies Tp). The sedimentary facies were grouped into four facies associations (FA; Table 2). Facies associations I and II are related to fluvial channels and FA III and IV are related to floodplains. In the first group, fixed, lowsinuosity channels were differentiated from mobile, high-sinuosity channels based on their symmetric, simple ribbon geometry (Friend et al. 1979; Gibling, 2006) and their constituent facies (Cig, ACt and Ae) as opposed to multiepisodic, complex ribbons (Friend et al., 1979) with participation of Cig, ACt, ACs, Ah and Ae facies. The floodplain associations were divided in crevasse-splay and calcic paleosoils associations. The first one is composed of Alp facies, has a wedge-like geometry, a coarsening-upward arrangement, laterally related to fixed, low-sinuosity channels and a lateral extension over 3 kilometers (Figs. 10a, b). The former is mainly composed of Tp and Tm facies, has a tabular geometry, also laterally related to fixed, low-sinuosity channel and a lateral extension of hundreds of meters. Even though these four facies associations can be found all over the Punta San Andrés Alloformation, it is possible to identify three different sections (A, B and C, Figs. 9 and 11) in which their arrangement and proportions vary. Each of these sections is associated with specific depositional conditions that determined a characteristic fluvial system. Section A involves the lower and middle allomembers (Fig. 2). It is represented by floodplain deposits (both crevasse-splay and calcic paleosoils associations in a rhythmic arrangement) that are considered to represent a terminal fluvial system. The calcic paleosoils are interpreted to represent a dry and arid climate (Marriott and Wright, 1993; Balin, 2000) under a reduced rate of accommodation creation (Marriott and Wright, 1993; Cleveland et al., 2007). Because of the presence of iron nucleids and clay coatings, the crevasse-splay deposits are interpreted to represent wetter climatic conditions (Davies-Vollum and Kraus, 2001) and developed under a greater rate of accommodation creation (Cleveland et al., 2007). Section B (upper allomember) is also made up of floodplain deposits, although coarser and much more dissected by a larger proportion of complex channels. Hence, they are interpreted as a proximal floodplain. Finally, section C is represented by mobile, highsinuosity channel deposits in such a high proportion that in some parts of the outcrops there is no preservation of floodplain deposits. To summarize, for the Punta San Andrés Alloformation deposits cropping out in Baliza San Andrés and Complejo Turístico Chapadmalal, four facies associations can be proposed based on the facies analysis of the sediments and its geometry. The analysis of these associations allowed defining depositional environments whose interrelation reflected a progressive change in the paleoclimatic and accommodation conditions, probably related to base-level changes. For section A, climate is interpreted to have been dry and arid and related to low accommodation space. During deposition of section B, climate became wetter and accommodation space was increased. Section C is characterized by a lowering in the local base level that led to negative accommodation with fluvial incision. Deposition of channel fills and floodplain deposits indicate the return of positive accommodation space and wet climate.

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