TICI-RANKIN mismatch: Poor clinical outcome despite complete endovascular reperfusion in the ETIS Registry.

INTRODUCTION: Endovascular treatment (EVT) is a well-established technic for acute ischemic stroke, but despite a high recanalization rate of near 80%, at 3 months roughly 50% of patients have a poor functional outcome with a modified Rankin score (mRS) ≥3. The aim of this study was to determine predictive factors of poor functional outcomes in patients with complete recanalization after EVT, defined as modified thrombolysis in cerebral infarction (mTICI) 3. PATIENTS AND METHODS: This retrospective analysis based on the prospective multicenter ETIS registry (endovascular treatment in ischemic stroke) in France included 795 patients from January 2015 and November 2019 with acute ischemic stroke due to anterior circulation occlusion and prestroke mRS 0-1, treated with EVT and who achieved complete recanalization. Univariate and multivariate logistic regression models were used to identify predictive factors of poor functional outcome. RESULTS: 365 patients (46%) showed a poor functional outcome (mRS>2). In backward-stepwise logistic regression analysis, poor functional outcome was independently associated with older age (OR per 10-year increase, 1.51; 95%CI, 1.30 to 1.75), higher admission NIHSS (OR per 1 point increase, 1.28; 95%CI, 1.21 to 1.34), absence of prior intravenous thrombolysis (OR, 0.59; 95%CI, 0.39 to 0.90), and an unfavorable 24-hour NIHSS change (24h-baseline) (OR, 0.82; 95%CI, 0.79 to 0.87). We calculated that patients whose 24h NIHSS decreased by less than 5 points are more at risk of a poor outcome, with a sensitivity and a specificity of 65.0%. CONCLUSION: Despite complete reperfusion after EVT, half of patients had a poor clinical outcome. These patients, who were mainly older with a high initial NIHSS and an unfavorable post-EVT 24h NIHSS change, could represent a target population for early neurorepair and neurorestorative strategies.

[Intracerebral hemorrhage as the cause of low-flow priapism : A rare association]. / Intrazerebrale Blutung als Ursache eines Low-flow-Priapismus : Eine seltene Assoziation.

Priapism is a painful erection of the penis lasting for more than 4h and is independent of sexual stimulation. It represents a urological emergency and necessitates rapid treatment. Etiologically, approximately 20% are caused by drugs, 50% are a combination of hematological diseases (e.g. sickle cell anemia), leukemia, injections in the corpora cavernosa, paraneoplastic processes and neurological or infectious causes. Ultimately, 30% have an idiopathic origin. Priapism as a result of traumatic intracerebral hemorrhage has so far rarely been described. This article presents the case of a 48-year-old male patient who presented to the emergency department with a traumatic subarachnoid hemorrhage. During the hospital stay the patient suffered from low-flow priapism, which was initially punctured and ultimately operatively treated.

Sample procurement for cultures of infected wounds: a systematic review.

OBJECTIVE: Identifying the responsible pathogen is required in order to select optimum antimicrobial therapy for infected wounds, but the best techniques to use remain the subject of debate. Our aim was to assess the evidence on the value of wound swabs compared with biopsies. METHOD: We conducted a systematic literature review with the terms 'wound infection', 'wound swab', 'wound swab technique', 'wound biopsy', 'wound culture', 'wound swab comparison', 'Levine swab technique', 'microbiological technique', 'specimen handling', 'bacterial load', 'perioperative care', 'swab', and 'culture'. We examined yields in identifying relevant pathogens, summarised salient features of qualifying studies, and defined knowledge gaps and endpoints that future studies should address. RESULTS: Studies have been inconsistent, lacking specificity regarding wound types, clinical features, and sampling methods. We found moderate quality evidence that punch biopsies provide qualitative and quantitative information about the bacterial load and tissue reaction with nearly 100% sensitivity, 90% specificity and 95% accuracy for predicting wound closure. Biopsies are relatively invasive, costly, require skilled operators, and potentially exacerbate infection. Needle aspiration samples a limited portion and may enter uninfected tissue and extend infection. Wound swabs are minimally invasive, easier to perform and widely employed in clinical practice, but techniques vary. In comparative studies, the Levine technique was superior to the Z-swab techniques, and biopsies were more sensitive for antibiotic-resistant wounds than Levine or Levine-like swabs, suggesting that swabs may be useful for initial wound monitoring, but biopsies are preferred when antibiotic resistance is suspected. CONCLUSION: The Levine swab is superior to the Z-swab technique and may be useful for initial wound monitoring, but quantitative biopsies are preferred for evaluation of antibiotic-resistant wounds and to monitor the response to treatment. There is limited evidence on the role of wound swabs for detecting wound colonisation versus infection and the impact of culture-guided therapy on such clinical outcomes as eradication of infection and accelerated healing. Future studies should specify patient populations, wound types, sampling protocols, and outcomes based on culture yield and treatment results, using rigorous statistical methodology.

Non-invasive method for assessment of inflammation.

This article explores the potential of non-invasive measurement for elevated levels of erythrocyte aggregation in vivo, which have been correlated with a higher risk of inflammatory processes. The study proposes utilizing a dynamic light scattering approach to measure aggregability. The sensor modules, referred to as "mDLS," comprise VCSEL and two photodiodes. Two of these modules are placed on an inflatable transparent cuff, which is then fitted to the subject's finger root, with one sensor module positioned on each side. By temporarily halting blood flow for one minute using over-systolic inflation of the cuff, signals from both sensors are recorded. The study involved three distinct groups of subjects: a control group consisting of 65 individuals, a group of 29 hospitalized COVID-19 patients, and a group of 34 hospitalized patients with inflammatory diseases. Through experimental results, significant differences in signal kinetic behavior were observed between the control group and the two other groups. These differences were attributed to the rate of red blood cell (RBC) aggregation, which is closely associated with inflammation. Overall, the study emphasizes the potential of non-invasive diagnostic tools in evaluating inflammatory processes by analyzing RBC aggregation.

Scattering-driven PPG signal model.

This article discusses the origin of PPG signals. Two plausible hypotheses are analyzed: the volumetric hypothesis and a model wherein the PPG is driven by the RBC aggregation process. To verify the model predictions, the PPG signals at the fingertip were measured. External pressure was applied to the fingertip, presumably reducing the blood flow. The results expressed in terms of gamma, used in pulse-oximetry, agree with the aggregation model. In addition, the oscillometric signal and the PPG signal amplitude were simultaneously measured in the fingertip. All of the experimental results favor the proposed aggregation mechanism as responsible the PPG signal.

A noninvasive method of examination of the hemostasis system.

We propose a noninvasive method of in vivo examination the hemostasis system based on speckle pattern analysis of coherent light scattering from the skin. We compared the results of measuring basic blood coagulation parameters by conventional invasive and noninvasive methods. A strict correlation was found between the results of measurement of soluble fibrin monomer complexes, international normalized ratio (INR), prothrombin index, and protein C content. The noninvasive method of examination of the hemostatic system enable rough evaluation of the intensity of the intravascular coagulation and correction of the dose of indirect anticoagulants maintaining desired values of INR or prothrombin index.

Biomechanical comparison of techniques to reduce the bulk of lacerated flexor tendon ends within digital sheaths of the porcine forelimb.

PURPOSE: Zone II flexor tendon repairs may create a bulging effect with increased bulk and resistance to tendon gliding. A biomechanical time 0 study was performed to assess 2 methods of tendon antibulking for work of flexion and strength characteristics. METHODS: We placed 24 fresh-frozen porcine forelimb tendons in a custom jig. Deep flexor tendon was sectioned just distal to the intact A1 and A2 pulleys. Specimens were divided into 3 groups before repair: group 1, nonmodified tendon; group 2, 30 degrees bilateral notch excised from both tendon ends; and group 3, triangular longitudinal central wedge excised from both tendon ends. All repairs used a 4-strand modified Kessler core suture and running circumferential epitendinous suture. Work of flexion, 2-mm gap formation, and ultimate load to failure were tested. RESULTS: Both antibulking techniques (groups 2 and 3) had significantly less work of flexion than group 1 (36.3 and 34.9 J vs 142.9 J, p < .001). There was no significant change in work of flexion between groups 2 and 3 (p > .05). There was no significant difference in terms of 2-mm gap formation among the 3 groups (p > .05). Groups 1 and 3 exhibited a significantly higher load to failure compared with group 2 (p < .05). CONCLUSIONS: The antibulking repair techniques used in this study decrease the work of flexion with no significant change in force to 2-mm gap formation. Group 2, however, did have significantly lower load to failure. These techniques might be beneficial in zone II flexor tendon injury, in which the tight annular pulley system restricts tendon gliding. However, this is a time 0 study and the potential adverse effects of increase tendon manipulation and trauma were not analyzed, which might increase adhesions and scar during the healing phase of tendon repair.

Impact of Fitness Status on the Optically Measured Hemodynamic Indexes.

The physiological characteristics of skin blood flow can be described in terms of the hemodynamic indices (HI). The HI is derived from the laser speckle characteristics, which are governed by the cutaneous blood flow. A miniaturized dynamic light-scattering sensor was used to measure the speckle pattern from the finger root. Three groups of subjects from 15 to 25 years of age were tested. The first group included subjects who are actively engaged in sport activities; the second group included subjects with low level of physical activity; and the third group included healthy controls with moderate physical activity. The HI parameters were measured prior to and after the performance of a determined physical load. As a marker of cardiovascular fitness (CVF), we used the postload decay rate of HI. We found that the hemodynamic response to the physical load provides a statistically significant correlation with the postload heart rate decay. It was also found that postocclusion increase of the arterial HI is more prominent in the group with higher physical activity. These results indicate that hemodynamic indices can be used as an additional marker for cardiovascular fitness level.

[Emergencies of the external genital area]. / Notfälle im Bereich des äußeren Genitale.

BACKGROUND: In addition to epididymitis and testicular torsion, emergencies of the external genital are rare. Rapid diagnosis and therapy are essential so that immediate therapy can be provided, which is important for survival (Fournier gangrene) of the patient or for the preservation of erectile function (priapism and penile fracture). A detailed patient history and clinical examination are generally sufficient for correct diagnosis. RESULTS: Under certain circumstances, it might be useful to perform ultrasound, computed tomography scan or magnetic resonance imaging or retrograde urethrography. A urine analysis is obligatory. In case of penetrating injuries and genital trauma in females, additional imaging should be performed because these are often associated with concomitant injuries of the rectum, vagina, or bladder. Special cases are gunshot wounds, in which caliber and type of weapon play an important role for the degree of damage, and animal or human bites. For animal bites, the risk for rabies infection and in case of a human bite the risk for transmission of HIV and hepatitis should be taken into consideration and post-exposure prophylaxis should possibly be offered.

Open-label 24-month study evaluating infliximab therapy in patients with psoriatic spondyloarthropathy.

Psoriatic spondyloarthropathy (PsSA) is a common and relatively typical form of spondyloarthropathy, affecting the axial skeleton with peripheral synovitis. Also, extraarticular as well as skin manifestations are sometimes difficult to diagnose and to treat. Recent studies demonstrated that anti-tumor necrosis factor therapies are useful in treating and controlling disease activity. We conducted an open-label 2-year study in 16 patients to evaluate the efficacy and safety of long-term compliance with intravenous infliximab therapy in patients with severe skin and refractory PsSA, with an incomplete response to methotrexate, azathioprine, cyclosporine, and/or sulfasalazine. Patients continued to receive only weekly methotrexate therapy during the study that included 16 patients (9 men, 7 women; mean age 38 +/- 12.5 years [SD]) with psoriatic spondyloarthropathy for 16.4 +/- 9.2 years. Each patient underwent complete physical examination before treatment and at each visit until the end of the study. Results of patient global pain assessment (VAS scale), investigator opinion on global assessment of disease activity (100 mm VAS), patient body weight and blood pressure, ACR response (20%, 50%, and 70%), laboratory parameters (CRP, ESR, WBC, RBC, liver enzymes, etc.), and PASI (skin score) were recorded. We conclude that infliximab therapy was effective in controlling joint and skin disease, having an acceptable safety profile and very good compliance when considering this type of patient. However, further long-term, double-blind, placebo-controlled trials are necessary to validate these results.

[Diagnosis and management of priapism]. / Diagnostik und Therapie des Priapismus.

Priapism is defined as an erection for more than 4 h without sexual stimulation. The most common form with nearly 95% is the ischemic or low-flow form, which is very painful. The other 5% are comprised of nonischemic high-flow type usually caused by a blunt perineal trauma and the recurrent or intermittent so-called stuttering priapism. Anamnesis as well as physical and laboratory examination are important during the diagnostic workup. Patients who suffer from sickle cell anemia are predestined to develop priapism. Priapism constitutes a urological emergency because especially the low-flow type has to be treated immediately to prevent a long-lasting fibrosis of the corpus cavernosa and a consecutive erectile dysfunction. The first step is the puncture and aspiration of blood from the corpus cavernosa if necessary combined with the injection of α-agonists. In case detumescence is not achieved, an operative shunt should be placed after an MRI. If there is a complete fibrosis of the corpus cavernosa possibly combined with penis deviation the implantation of a penile prosthesis is an option. The therapy of high-flow priapism is not as urgent as that of low-flow priapism because there is no risk of ischemia. If conservative therapeutic options fail, the superselective embolization of the fistula is the treatment of choice. In recurrent or intermittent priapism, the goal is to avoid new episodes with drug treatment. Because of the low incidence of priapism, it is very difficult to recommend and favor one therapeutic procedure.

Complete duplication of urethra.

Complete duplication of the urethra with a single bladder is an exceptional finding. The anomalous urethral canal originates from the bladder separately, runs parallel and usually dorsal to the normally situated urethra, and opens on the dorsum of the penis. To our knowledge there are 41 reported cases of this anomaly. We present 2 cases of complete urethral duplication originating from a single bladder, one in a male patient and the other in a female. It is concluded that conservative therapy is the treatment of choice, and that surgery should be reserved for incontinent patients only. The complications of surgery have been emphasized.

Superoxide production and antioxidant enzymes in ammonia intoxication in rats.

Injection of large doses of ammonium salts lead to the rapid death of animals. However, the molecular mechanisms involved in ammonia toxicity remain to be clarified. We have tested the effect of injecting 7 mmol/kg of ammonium acetate on the production of superoxide and on the activities of some antioxidant enzymes in rat liver, brain, erythrocytes and plasma. Glutathione peroxidase, superoxide dismutase and catalase activities were decreased in liver and brain (both in cytosolic and mitochondrial fractions) and also in blood red cells, while glutathione reductase activity remained unchanged. Superoxide production in submitochondrial particles from liver and brain was increased by more than 100% in both tissues. Both diminished activity of antioxidant enzymes and increased superoxide radical production could lead to oxidative stress and cell damage, which could be involved in the mechanism of acute ammonia toxicity.

Palmar subcutaneous lipoma.

We report the case of a patient with a large palmar subcutaneous lipoma. The unusual site of the lesion and the importance of a differential diagnosis to rule out angiolipoma are stressed.

[The hypertrophic scar]. / La cicatriz hipertrófica.

The authors briefly review the literature about hypertrophic scars, emphasizing the etiopathogenesis and treatments, taking in account, the good therapeutic results of pressure-treated scars.

[Basal and spinous cell epitheliomas]. / Epiteliomas baso y espinocelulares

A study on 502 epithelial cutaneous cancers was carried out by the authors. The study included 377 basal cell carcinomas (57,5% in males and 42,4% in females) and 125 squamous cell carcinomas (78,4% in males and 21,6% in females). The basal cell carcinomas in both sexs had an earlier onset than the squamous cell carcinomas.

[Benign circinated pityriasic erythema in children]. / Eritema circinado pitiriásico benigno del niño.

The case is report of a boy aged 6 months whose dermatosis had set in suddenly 15 days before in the form of large round circinate patches on the face, thorax, abdomen, dorsum and extremities. These patches were limited by a slightly elevated erythematous border, the inside of which was constituted by collarette-like epidermal desquamations with central parakerotosis. The patches impairment was observed in the child's general condition. A histopathological study was carried out.

[Trichodiscomas associated with fibrofolliculomas and acrochordons]. / Tricodiscomas asociados a fibrofoliculomas y acrocordones.

A case of trichodiscomas associated to fibrofolliculomas and acrochordons is presented. The histological and histogenic characteristics are discussed. Bibliographic revision is made. It is possible to consider the case above mentioned as a Birt-Hogg-Dubé syndrome.