[Improving the outcomes in spontaneous subarachnoid haemorrhage: the EHSA project]. / Mejora de los resultados en la hemorragia subaracnoidea espontánea: proyecto EHSA.

AIM: To investigate our clinical practices with the aim of identifying opportunities to improve the medico-surgical management of spontaneous subarachnoid haemorrhages (SAH). PATIENTS AND METHODS A prospective, longitudinal cohort study was conducted of the cases of SAH attended consecutively in the critical care and emergency services in 29 public hospitals in Andalusia over a period of 20 months, between the years 2000 and 2002. SAH were considered to be acute haemorrhagic cerebrovascular accidents diagnosed as such by imaging. Results at 12 months and care management (medical and surgical therapy, diagnostic techniques, care times and specific neurological complications) were analysed and the latter was then compared with the clinical practices that scientific evidence has proved to be the most useful. Deaths due to rebleeding in patients with no arteriographic study or without exclusion of the aneurysm were catalogued as potentially avoidable deaths. RESULTS: A total of 506 SAH were included. During the follow-up 5% of the sample were lost. In all 155 patients died. The non-modifiable independent risk variables for mortality were: age, being male, history of arterial hypertension, coma on arrival at the hospital and hydrocephalus. The independent risk variables for death that can be influenced were: absence of urgent analgesic, no arteriographic diagnosis, appearance of ischaemic neurological impairment and rebleeding. Twenty per cent of the overall mortality could be considered potentially avoidable. CONCLUSIONS: Although fatality is mostly dependent on variables that cannot be influenced (sex, age, history, clinical severity and hydrocephalus), 20% of deaths are associated to modifiable factors.

[The EHSA project: the study of spontaneous subarachnoid haemorrhages in Andalusia. Incidence and results]. / Proyecto EHSA: estudio de hemorragias subaracnoideas espontáneas en Andalucia. Incidencia y resultados.

AIM: To evaluate the incidence and results of spontaneous subarachnoid haemorrhages (SAH) in Andalusia. PATIENTS AND METHODS: We conducted a longitudinal prospective study of the cases of SAH attended in 28 hospitals in Andalusia over a three month period in 2000. SAH was defined as cases of acute haemorrhagic strokes diagnosed by tomography. The gross incidence rate (GR) was determined from census information from the Instituto Andaluz de Estad stica. Standard rates (SR) were estimated with relation to the European population. Results were evaluated on hospital discharge according to the Glasgow Outcome Score (GOS) and at 12 months, according the Barthel index (BI). RESULTS: The GR per 100,000 inhabitants/year was found to be 5.7 cases and the SR was 5.8. A comparison of incidences by province or sex showed no statistically significant differences. The period of maximum risk was the age bracket between 55 74 years (GR: 14.1). The acute fatality GR and SR rose to 1.9 per 100,000 inhabitants and year. Mortality was concentrated in a statistically significant way (p< 0.01) among those over the age of 65; sex did not exert any influence, but clinical gravity (p< 0.001) and the amount of bleeding did (p< 0.005). CONCLUSIONS: The incidence of spontaneous SAH in Andalusia was found to be within the average rates. Unfavourable results were high, although similar to those in other series. Fatality is significantly associated with factors that cannot be modified medically (age, clinical gravity and volume of bleeding)

[Sudden death as presentation form of papillary fibroelastoma of mitral valve]. / Muerte súbita como presentación de un fibroelastoma papilar de la válvular mitral.

We describe the case of a 35-year-old male, who presented with sudden death, secondary to anterior miocardial infarction due to embolism. Echocardiography, transthoracic and transesophageal, revealed a tumor in the anterior mitral leaflet. Tumor, histopathologically an papillary fibroelastoma, was excised and the mitral valve was replaced with a mechanical prosthetic valve. We revised the current literature on intracardiac papillary fibroelastoma.

[Non-Hodgkin's disease of the skull in a patient with AIDS]. / Linfoma no hodgkiniano de cráneo en un paciente con SIDA.

The involvement of bone in non-Hodgkin's lymphoma (NHL) is rare and usually occurs in the late stages of the disease. The involvement of the cranial vault is exceptional and we have found only eleven cases previously reported in the revised literature, none of them in an AIDS patient. We report a case of a 38 years old man, intravenous drug abuser with AIDS diagnosed who presented with coma. Computed tomography scan showed a left frontal intra-parenchymatous haematoma and multiple osteolytic lesions in the whole of the cranial vault, that involved outertable, diploe and innertable. Intra-parenchymatous haematoma was removed and a biopsy of the osteolytic lesions was performed. Histology showed features of a large B-cell NHL. Patient died of infectious pulmonary complications. The incidence of NHL in patients with congenital or acquired immunodeficiencies is increasing and Epstein-Barr virus and other factors have been involved in its pathogenesis. That's the first AIDS patient reported to have a NHL involving the cranial vault. Tumour was limited to the cranial vault without involvement of soft-tissue. An intra-parenchymatous haematoma was associated without an explained cause.