Abstract: This research proves that the notion of attunement constitutes an interdisciplinary encounter/space between musical and theatrical training. On this dissertation, I take a look at several notions of attunement to prove It is a physical phenomenon that implies a bodily transformation. Dalcroze's method is the point of departure to define a historical conception of physical training in music and theatre education. However, further developments of his contribution to theatre consider training as a psycho-physical attunement; a method to achieve corporeal plasticity. Next to that, meaningful findings on the study of motion and action in the field of cognitive neuroscience show that the brain works under its independent plasticity, suggesting a more complicated process that attunes two distinct intentionalities in the relation body/mind. This scientific conception of attunement exposes an intricate dialogue between inner and outer bodily dimensions and reveals a relation between individual and collective processes of communication. Neuroscience call to this the mirror mechanism; a system that explains how the process of synapsis occurs as a complex integration that depends on the relation of action and perception of self, others and the environment. Finally, all this knowledge related with instrumental practice will be analyzed and compared with the outcomes of two cases of study; a workshop with members of the Youth Philharmonic Orchestra of Bogotá 2015-2018 and the experience of the performance ‘Blended Affor-dances of Gozo’ at the Royal Central School of Speech and Drama in 2019. Based on this study, I will demonstrate the suitability of conceiving instrumental practice as a collective physical training. A possible emerging method that conceives the development of artistic skills through the practice of physical activity, beyond the childhood period, in later stages of life.

Resumen: Introducción: El neumotórax es una de las enfermedades pleurales más frecuentes en la práctica médica, siendo excepcional su asociación con el embarazo, existiendo pocos casos reportados en la literatura mundial. La linfangioleiomiomatosis es una enfermedad multisistémica poco frecuente, que afecta predominante al sexo femenino en edad fértil y puede verse exacerbada por el embarazo. Objetivo: Realizar el reporte de un caso y la revisión del tema que permitan un diagnóstico precoz y una conducta de forma temprana. Caso clínico: Paciente gestante de 15 semanas, de 36 años de edad, con antecedentes de salud anterior, que debuta súbitamente con disnea a los medianos esfuerzos, tos, dolor torácico y neumotórax derecho espontáneo, recurrente en su evolución y posteriormente bilateral. Su curso fue tórpido requiriendo tratamiento en Unidad de Cuidados Intensivos por fallo respiratorio agudo, falleciendo luego de 3 meses del inicio del cuadro. Se le realizó, Radiografía de tórax: patrón reticular de tipo panal de abejas, tomografía de tórax: imágenes quísticas múltiples en todo parénquima pulmonar de predominio basal. Biopsia pulmonar compatible con linfangioleiomiomatosis. Conclusiones: La aparición de disnea súbita, dolor pleurítico y neumotórax en una gestante, deben ser siempre suficientes para tener en cuenta la presencia de una linfangioleiomiomatosis. Su inespecificidad sintomática inicial se traduce en un diagnóstico tardío, lo que empobrece su pronóstico. Abstract: Introduction: pneumothorax is one of the most frequent pleural diseases in medical practice, its association with pregnancy has being exceptional, with few cases reported in the world literature. Lymphangioleiomyomatosis is a rare multisystem disease, which predominantly affects females of childbearing age and can be exacerbated by pregnancy. Objective: due to the poor prognosis of this condition influenced by the delay in its diagnosis and the absence of a treatment that can modify its progression, evolving to global respiratory failure and death, it is decided to review the current literature and the presentation of one case. Clinical case: pregnant patient of 15 weeks, of 36 years, with antecedents of previous health, who debuted suddenly with dyspnea to the medium efforts, cough, chest pain and spontaneous right pneumothorax, recurrent and later bilateral. His course was torpid requiring treatment in the ICU due to acute respiratory failure, dying after 3 months of the onset of symptoms. Chest x-ray pattern reticular, chest CT: multiple cystic images throughout lung parenchyma with basal predominance. Lung biopsy compatible with Lymphangioleiomyomatosis. Conclusions: the appearance of sudden dyspnea, pleuritic pain and pneumothorax in a pregnant woman must always be sufficient to take into account the presence of an Lymphangioleiomyomatosis. Its initial symptomatic inespecificity results in a late diagnosis, which impoverishes its prognosis.

Resumen: Introducción: La estimulación epicárdica permanente es una alternativa cuando existen contraindicaciones para el abordaje endocavitario. Métodos y resultados: Se presentan dos casos, con bloqueo aurículo ventricular completo y contraindicación para la estimulación endocavitaria, a quienes se le implantó electrodo epicárdico por cirugía subxifoidea mínima invasiva. Se empleó anestesia endovenosa e infiltración local (lidocaína 2%); pero sin necesidad de entubación endotraqueal. Se abordó por vía sub-xifoidea con incisión cutánea de 2-3 cm y sin resección del apéndice xifoides. Se resecó el pericardio y el electrodo epicárdico unipolar modelo 5071 [Medtronic (Minneapolis, Minnesota)], se avanzó hasta la cara diafragmática del ventrículo derecho y con buen apoyo se liberó el mecanismo de fijación, posteriormente, se midieron los parámetros de estimulación. Se realizó un bolsillo subcutáneo en la zona abdominal pararectal izquierda, submuscular y se colocó el marcapasos unicameral VVIR Efecta [Biotronik (Berlín, Alemania)]. Se realizó profilaxis antibiótica según el protocolo del servicio. Al mes de seguimiento los parámetros de estimulación eran estables y no se reportaba infección en los sitios quirúrgicos. Conclusiones: El implante de marcapasos epicárdico por técnica mínima invasiva subxifoidea es eficaz, seguro y reproducible. Abstract: Introduction: Permanent epicardial stimulation is an alternative when there are contraindications to the endocavitary approach. Methods and results: Two cases are presented with complete ventricular atrial block and contraindication for endocavitary stimulation. In both cases, an epicardial electrode was implanted by minimally invasive subxiphoid surgery. Intravenous anesthesia and local infiltration (lidocaine 2%) were used; endotracheal intubation was not required. Subxiphoid approach was performed with a 2-3 cm skin incision and without resection of the xiphoid appendix. The pericardium was resected and the unipolar epicardial electrode model 5071 [Medtronic (Minneapolis, Minnesota)] was advanced to the diaphragmatic face of the right ventricle and with good support, the fixation mechanism was released; subsequently the stimulation parameters were measured. A subcutaneous pocket was made in the left pararectal abdominal area, submuscular and the VVIR Efecta unicameral pacemaker [Biotronik (Berlin, Germany)] was placed. Antibiotic prophylaxis was performed according to the service protocol. At one month of follow-up, the stimulation parameters were stable and no infection was reported at the surgical sites. Conclusions: The implantation of an epicardial pacemaker using minimally invasive subxiphoid technique is effective, safe and reproducible.

Resumen: Introducción: La cirugía de revascularización miocárdica ha sido ratificada como el tratamiento de elección ante las enfermedades complejas del árbol coronario, fundamentado en que en estos pacientes, el ICP (intervencionismo coronario percutáneo) presenta mayor necesidad de repetición de la revascularización (14,1% vs. 20,9%, P=0,11), aumento en las cifras de eventos cardíacos y cerebrovasculares mayores al año (12,4% vs. 17,8%, P<0,005) y a los 5 años (24,1% vs. 41,9%; P<0,0005) y mayor mortalidad (14,1% vs. 20,9%, P=0,11). Este último aspecto es el más influyente, se hace necesario conocer su comportamiento e identificar los diferentes factores que influyeron en ella. Material y métodos: Se realizó un estudio longitudinal, en el Hospital Clínico-Quirúrgico Hermanos Ameijeiras, en 291 pacientes operados durante el período comprendido entre marzo de 2012 y noviembre del 2015 seguidos hasta junio de 2016. Resultados: La mortalidad durante todo el período de estudio y seguimiento fue del 13,7%. El 2,4% falleció durante las primeras 24 horas y 8,6% al primer mes. Los factores que más se asociaron fueron: preoperatorios (diabetes mellitus); operatorios (revascularización incompleta e isquemia perioperatoria), y posoperatorios (la aparición de bajo gasto cardíaco y arritmias malignas). Conclusiones: Aunque la mortalidad tuvo un comportamiento similar al de series internacionales en las primeras 24 horas y al año, a los 30 días existió un aumento significativo que se relaciona principalmente con las características clínicas al ingreso de los pacientes. Abstract: Introduction: Myocardial revascularization surgery remains the treatment of choice in patients with complex diseases of the coronary tree since percutaneous coronary intervention presents a greater need for repeat revascularization (14.1% vs. 20.9%, P = 0.11), an increase in the number of cardiac and cerebrovascular events beyond one year (12.4% vs. 17.8%, P < 0.005) and at 5 years (24.1% vs. 41.9%; P < 0.0005) and a higher mortality (14.1% vs. 20.9%, P = 0.11). With mortality being the most influential aspect, it becomes necessary to understand its behavior and identify its different contributing factors. Material and Methods: A longitudinal study was carried out at the “Hermanos Ameijeiras” Clinical-Surgical Hospital in 291 patients operated between March 2012 and November 2015 and followed-up until June 2016. Results: Mortality during the whole study and follow-up period was 13.7%. 2.4% of the patients died during the first 24 hours and reached 8.6% in the first month. Factors most associated with mortality were: preoperative—diabetes mellitus; operative—incomplete revascularization and perioperative ischemia; and postoperative—low cardiac output and malignant arrhythmias. Conclusions: Although mortality had a similar behavior to international series in the first 24 hours and at one year, a significant increase was observed at 30 days, mainly related to the clinical characteristics at the patients’ admission.