Major Internal Carotid Artery Injury During Endoscopic Skull Base Surgery: Case Report.

Major vascular structures are always at risk during complex skull base surgery, particularly with use of the endoscopic endonasal approach, and intraoperative damage of the internal carotid artery (ICA) can be a devastating complication. Herein, we report a case of a young patient who had a major injury of the left ICA during endoscopic resection of a recurrent petrous bone chordoma. Massive bleeding was controlled by a Foley balloon inserted and kept in the resection area. Urgent angiography revealed a persistent leak from the petrous segment of the left ICA, and the vessel was sacrificed with coiling, since a balloon occlusion test showed good collateral blood flow. The patient woke up from anesthesia without a neurological deficit. Salvage resection of recurrent skull base neoplasms deserves specific attention because of the possibility of major vascular damage. In cases of intraoperative ICA injury, its management requires immediate decisions, and the available possibilities for endovascular therapy should always be considered.

A single-oral bolus of 100,000 IU of cholecalciferol at hospital admission did not improve outcomes in the COVID-19 disease: the COVID-VIT-D-a randomised multicentre international clinical trial.

BACKGROUND: Vitamin D status has been implicated in COVID-19 disease. The objective of the COVID-VIT-D trial was to investigate if an oral bolus of cholecalciferol (100,000 IU) administered at hospital admission influences the outcomes of moderate-severe COVID-19 disease. In the same cohort, the association between baseline serum calcidiol levels with the same outcomes was also analysed. METHODS: The COVID-VIT-D is a multicentre, international, randomised, open label, clinical trial conducted throughout 1 year. Patients older than 18 years with moderate-severe COVID-19 disease requiring hospitalisation were included. At admission, patients were randomised 1:1 to receive a single oral bolus of cholecalciferol (n=274) or nothing (n=269). Patients were followed from admission to discharge or death. Length of hospitalisation, admission to intensive care unit (ICU) and mortality were assessed. RESULTS: In the randomised trial, comorbidities, biomarkers, symptoms and drugs used did not differ between groups. Median serum calcidiol in the cholecalciferol and control groups were 17.0 vs. 16.1 ng/mL at admission and 29.0 vs. 16.4 ng/mL at discharge, respectively. The median length of hospitalisation (10.0 [95%CI 9.0-10.5] vs. 9.5 [95%CI 9.0-10.5] days), admission to ICU (17.2% [95%CI 13.0-22.3] vs. 16.4% [95%CI 12.3-21.4]) and death rate (8.0% [95%CI 5.2-12.1] vs. 5.6% [95%CI 3.3-9.2]) did not differ between the cholecalciferol and control group. In the cohort analyses, the highest serum calcidiol category at admission (>25ng/mL) was associated with lower percentage of pulmonary involvement and better outcomes. CONCLUSIONS: The randomised clinical trial showed the administration of an oral bolus of 100,000 IU of cholecalciferol at hospital admission did not improve the outcomes of the COVID-19 disease. A cohort analysis showed that serum calcidiol at hospital admission was associated with outcomes. TRIAL REGISTRATION: COVID-VIT-D trial was authorised by the Spanish Agency for Medicines and Health products (AEMPS) and registered in European Union Drug Regulating Authorities Clinical Trials (EudraCT 2020-002274-28) and in ClinicalTrials.gov ( NCT04552951 ).

Shunt independence in paediatric hydrocephalus: our 16-year experience and review.

PURPOSE: Shunt independence remains a matter of debate for neurosurgeons, and little information on this subject is available in the literature. The aims of the study were to analyse the incidence of shunt removal in a series of paediatric patients and to describe our experience with attempts at shunt removal. METHODS: Thirty of 212 paediatric patients shunted between 2000 and 2016 at our institution were studied for shunt independence. Variables related to hydrocephalus aetiology, shunt complications, independence trial peculiarities and follow-up were recorded and a descriptive analysis of the data was performed. RESULTS: Two patients (0.94%) refused to be included in a shunt independence trial and were analysed separately. In the other 28 patients, 29 shunt independence trials were performed, of which 19 (65.52%) were successful, giving a global rate of shunt independence of 8.96% (19/212) in our population. Secondary endoscopic third ventriculostomy was the most frequent type of independence trial and achieved the highest success rate (75%). Spontaneous independence was achieved in just 4/7 cases (57.14%). Planned removal of the shunt in overdrainage cases had a 50% success rate, with transient measures to control intracranial pressure frequently required. CONCLUSIONS: Shunt independence trials should be considered for selected patients in a closely monitored setting. Secondary endoscopic third ventriculostomy at the time of shunt malfunction has the highest success rate whereas planned removal of the shunt in overdrainage is an invasive procedure with more likelihood of failure. Shunt independence should not be presumed.

Shunt overdrainage syndrome: review of the literature.

Shunt overdrainage in patients with hydrocephalus still represents a challenge for neurosurgeons, in part due to the lack of agreement or uniformity concerning the entity. Important problems exist relating to the real incidence of the entity, its definition, classification, and the pathophysiological theories behind the various treatment strategies proposed. Recent reports have suggested that the evidence about overdrainage and its consequences is not so robust as presumed. Consequently, the topic requires more detailed examination. In this review, we comment on all the main facets related with shunt overdrainage.

Variabilidad anatómica de la vena yugular interna por ecografía en voluntarios sanos y pacientes en hemodiálisis / Anatomical variation of internal jugular vein by sonography in healthy volunteers and patients on hemodialysis

Introducción: se han descrito varias técnicas para canalizar la vena yugular interna, pero su canulación sobre la base de las referencias anatómicas tropieza con la variabilidad anatómica. Objetivo: identificar la disposición anatómica de los vasos del cuello en voluntarios sanos y en pacientes en hemodiálisis crónica y su relación con variables demográficas, antropométricas y clínicas. Métodos: estudio observacional, analítico, transversal, de individuos aparentemente sanos que asistieron al Servicio de Ultrasonido, entre mayo de 2011 y agosto de 2012, y todos los pacientes en hemodiálisis del Instituto de Nefrología. Se realizó ecografía por RABM, con equipo Toshiba Nemio XG Model SSA-580A con efecto Doppler, utilizando transductor lineal de 7,5 MHz. Las comparaciones iniciales entre los grupos fueron realizadas mediante el test de homogeneidad o la prueba t para muestras independientes. Para identificar la posible relación de la disposición de los vasos del cuello y las características estudiadas se utilizó el test de independencia. Resultados: más del 74 por ciento de los individuos de ambos grupos presentó una posición anatómica adecuada de las vena yugular interna. La variación más frecuente en los dos grupos fue la cabalgadura parcial; desde 6,1 por ciento en el hemicuello derecho de los voluntarios sanos, hasta 12 por ciento en el hemicuello izquierdo de los pacientes en hemodiálisis. Solo en los pacientes en hemodiálisis se encontró asociación entre el antecedente de más de 3 abordajes venosos con la variación anatómica de la vena yugular interna, tanto derecha (p= 0,04), como izquierda (p= 0,00)(AU)

Introduction: several techniques have been described for channeling the internal jugular vein, but the approach based on the anatomical references encounters anatomical variability. Objective: identify the anatomical arrangement of the neck vessels in healthy volunteers and in patients who hemodialysis for long, and its relationship to demographic, anthropometric and clinical variables applied. Methods: an observational, analytical, cross study was conducted in apparently healthy individuals who attended the ultrasound service, from May 2011 to August 2012, and in all hemodialysis patients at the Nephrology Institute. Ultrasonography was performed by AMFN, with Nemio XG Toshiba Model SSA-580A Doppler Effect, using 7.5 MHz linear transducer. The initial comparisons between groups were performed using the homogeneity test or t test for independent samples. Chi-Square Test of Independence was used to identify the possible relationship of the arrangement of the neck vessels and the characteristics studied. Results: more than 74 percent of patients in both groups presented a proper anatomical position of the internal jugular vein. The most frequent variation in the two groups was the partial overriding from 6.1 percent of right hemi-neck in healthy volunteers to 12 percent of left hemi-neck in patients on hemodialysis. Only in hemodialysis patients association was found between a history of more than 3 venous approaches to anatomical variation of the internal jugular vein, both right (p = 0.04) and left (p = 0.00)(AU)

Variabilidad anatómica de la vena yugular interna por ecografía en voluntarios sanos y pacientes en hemodiálisis / Anatomical variation of internal jugular vein by sonography in healthy volunteers and patients on hemodialysis

Introducción: se han descrito varias técnicas para canalizar la vena yugular interna, pero su canulación sobre la base de las referencias anatómicas tropieza con la variabilidad anatómica.Objetivo: identificar la disposición anatómica de los vasos del cuello en voluntarios sanos y en pacientes en hemodiálisis crónica y su relación con variables demográficas, antropométricas y clínicas.Métodos: estudio observacional, analítico, transversal, de individuos aparentemente sanos que asistieron al Servicio de Ultrasonido, entre mayo de 2011 y agosto de 2012, y todos los pacientes en hemodiálisis del Instituto de Nefrología. Se realizó ecografía por RABM, con equipo Toshiba Nemio XG Model SSA-580A con efecto Doppler, utilizando transductor lineal de 7,5 MHz. Las comparaciones iniciales entre los grupos fueron realizadas mediante el test de homogeneidad o la prueba t para muestras independientes. Para identificar la posible relación de la disposición de los vasos del cuello y las características estudiadas se utilizó el test de independencia.Resultados: más del 74 por ciento de los individuos de ambos grupos presentó una posición anatómica adecuada de las vena yugular interna. La variación más frecuente en los dos grupos fue la cabalgadura parcial; desde 6,1 por ciento en el hemicuello derecho de los voluntarios sanos, hasta 12 por ciento en el hemicuello izquierdo de los pacientes en hemodiálisis. Solo en los pacientes en hemodiálisis se encontró asociación entre el antecedente de más de 3 abordajes venosos con la variación anatómica de la vena yugular interna, tanto derecha (p= 0,04), como izquierda (p= 0,00).Conclusiones: la malposición de la vena yugular interna se presenta en más de un décimo de los sujetos y es más frecuente entre los pacientes en hemodiálisis, que han utilizado con anterioridad varios catéteres(AU)

Introduction: several techniques have been described for channeling the internal jugular vein, but the approach based on the anatomical references encounters anatomical variability.Objective: identify the anatomical arrangement of the neck vessels in healthy volunteers and in patients who hemodialysis for long, and its relationship to demographic, anthropometric and clinical variables applied.Methods: an observational, analytical, cross study was conducted in apparently healthy individuals who attended the ultrasound service, from May 2011 to August 2012, and in all hemodialysis patients at the Nephrology Institute. Ultrasonography was performed by AMFN, with Nemio XG Toshiba Model SSA-580A Doppler Effect, using 7.5 MHz linear transducer. The initial comparisons between groups were performed using the homogeneity test or t test for independent samples. Chi-Square Test of Independence was used to identify the possible relationship of the arrangement of the neck vessels and the characteristics studied.Results: more than 74 percent of patients in both groups presented a proper anatomical position of the internal jugular vein. The most frequent variation in the two groups was the partial overriding from 6.1 percent of right hemi-neck in healthy volunteers to 12 percent of left hemi-neck in patients on hemodialysis. Only in hemodialysis patients association was found between a history of more than 3 venous approaches to anatomical variation of the internal jugular vein, both right (p = 0.04) and left (p = 0.00).Conclusions: malposition of the internal jugular vein occurs in more than one tenth of the subjects and it is more common among patients undergoing hemodialysis who have previously used several catheters(AU)

Disfunción endotelial en hipertensos de reciente diagnóstico / Endothelial Dysfunction in Newly Diagnosed Hypertensive Patients

INTRODUCCIÓN: la aterosclerosis, la disfunción endotelial y la hipertensión arterial están estrechamente relacionadas. La vasorreactividad dependiente del endotelio es un equivalente de disfunción endotelial. OBJETIVO: evaluar la utilidad del diámetro basal de la arteria braquial medido por técnicas ultrasonográficas en el diagnóstico de disfunción endotelial como lesión vascular subclínica, su asociación con factores de riesgo cardiovascular y el riesgo cardiovascular global. MÉTODOS: investigación analítico transversal en 60 hipertensos de reciente diagnóstico sin lesión en órgano diana en comparación con 60 no hipertensos. Se pesquisaron los factores de riesgo cardiovascular, se les realizó microalbuminuria, colesterol total, colesterol HDL, triglicéridos, colesterol no HDL, medición por ultrasonografía del grosor íntima media carotídeo y del diámetro basal de la arteria braquial y se calculó el riesgo cardiovascular global. RESULTADOS: en el grupo de hipertensos, el sexo masculino constituyó el 55 % del total y en el de los no hipertensos, el sexo femenino representó el 78,3 %. La microalbuminuria estuvo presente en 25 % de los hipertensos por el 13,3 % de los no hipertensos. Se encontraron valores medios más altos de colesterol total y colesterol-no HDL en los hipertensos (4,6 mmol/L y 3,6 mmol/L, respectivamente). La media del grosor íntima media en los hipertensos fue 0,6 mm y la de los no hipertensos fue 0,4 mm. En los hipertensos, el valor medio de diámetro basal de la arteria braquial fue 3,8 mm frente a 3,5 mm en los no hipertensos. En ambos grupos de estudio, a mayores valores medios de colesterol-HDL, hubo mayores valores medios de diámetro basal de la arteria braquial. CONCLUSIONES: se encontró asociación positiva para el colesterol total, el colesterol-HDL, el grosor íntima media carotídeo, la microalbuminuria y el riesgo cardiovascular global con el diámetro basal de la arteria braquial. Se concluye que la determinación del diámetro basal de la arteria braquial mostró resultados promisorios como marcador de disfunción endotelial en la hipertensión arterial.

IINTRODUCTION: atherosclerosis, endothelial dysfunction and hypertension are closely related. Endothelium-dependent vasoreactivity is an equivalent of endothelial dysfunction. OBJECTIVE: To evaluate the usefulness of baseline diameter of the brachial artery measured by ultrasonographic techniques in the diagnosis of endothelial dysfunction and subclinical vascular lesion, its association with cardiovascular risk factors, and overall cardiovascular risk. METHODS: Across-sectional analytical research was conducted in 60 newly diagnosed hypertensive patients without target organ damage. They were compared with 60 non-hypertensive subjects. Cardiovascular risk factors were screened; these patients underwent several tests such as microalbuminuria, total cholesterol, HDL cholesterol, triglycerides, non-HDL cholesterol, ultrasound measurement of carotid intima-media thickness and basal diameter of the brachial artery. The global cardiovascular risk was calculated. RESULTS: In the hypertensive group, males constituted 55 % of the total and in the non-hypertensive group, females accounted for 78.3 %. Microalbuminuria was present in 25 % of hypertensive subejcts by 13.3 % of patients without the disease. Higher mean values of total cholesterol and non-HDL in hypertensive subjects (4.6 mmol / L and 3.6 mmol / L, respectively) were found. The mean intima-media thickness was 0.6 mm in hypertensive patients and 0.4 mm in non hypertensive subjects. In hypertensive patients, the mean baseline brachial artery diameter was 3.8 mm versus 3.5 mm in non-hypertensive subjects. In both study groups, higher mean levels of baseline diameter of the brachial artery when there were higher mean values of HDL-cholesterol. CONCLUSIONS: There is a positive association for total cholesterol, HDL-cholesterol, the carotid intima media thickness, microalbuminuria and global cardiovascular risk in basal diameter of the brachial artery. The determination of basal diameter of the brachial artery is concluded to show promising results as a marker of endothelial dysfunction in hypertension.

Disfunción endotelial en hipertensos de reciente diagnóstico / Endothelial Dysfunction in Newly Diagnosed Hypertensive Patients

Introducción: la aterosclerosis, la disfunción endotelial y la hipertensión arterial están estrechamente relacionadas. La vasorreactividad dependiente del endotelio es un equivalente de disfunción endotelial. Objetivo: evaluar la utilidad del diámetro basal de la arteria braquial medido por técnicas ultrasonográficas en el diagnóstico de disfunción endotelial como lesión vascular subclínica, su asociación con factores de riesgo cardiovascular y el riesgo cardiovascular global. Métodos: investigación analítico transversal en 60 hipertensos de reciente diagnóstico sin lesión en órgano diana en comparación con 60 no hipertensos. Se pesquisaron los factores de riesgo cardiovascular, se les realizó microalbuminuria, colesterol total, colesterol HDL, triglicéridos, colesterol no HDL, medición por ultrasonografía del grosor íntima media carotídeo y del diámetro basal de la arteria braquial y se calculó el riesgo cardiovascular global. Resultados: en el grupo de hipertensos, el sexo masculino constituyó el 55 por ciento del total y en el de los no hipertensos, el sexo femenino representó el 78,3 por ciento. La microalbuminuria estuvo presente en 25 por ciento de los hipertensos por el 13,3 por ciento de los no hipertensos...

Introduction: atherosclerosis, endothelial dysfunction and hypertension are closely related. Endothelium-dependent vasoreactivity is an equivalent of endothelial dysfunction. Objective: To evaluate the usefulness of baseline diameter of the brachial artery measured by ultrasonographic techniques in the diagnosis of endothelial dysfunction and subclinical vascular lesion, its association with cardiovascular risk factors, and overall cardiovascular risk. Methods: Across-sectional analytical research was conducted in 60 newly diagnosed hypertensive patients without target organ damage. They were compared with 60 non-hypertensive subjects. Cardiovascular risk factors were screened; these patients underwent several tests such as microalbuminuria, total cholesterol, HDL cholesterol, triglycerides, non-HDL cholesterol, ultrasound measurement of carotid intima-media thickness and basal diameter of the brachial artery. The global cardiovascular risk was calculated...

Cinco años de experiencia en consulta especializada de hipertensión arterial complicada (2008-2012) / Five years of experience in specialized consultation of complicated hypertension (2008-2012)

Objetivo: evaluar los resultados obtenidos en la aplicación del protocolo asistencial de HTA complicada. Métodos: se realizó investigación descriptiva y longitudinal en la que se incluyeron 390 pacientes hipertensos esenciales con lesión en órgano diana evaluados en la Consulta Especializada de Hipertensión Arterial Complicada del Hospital Hermanos Ameijeiras durante los años 2008 al 2012. Se confeccionó historia clínica y se realizaron investigaciones, se evaluó el perfil de riesgo cardiovascular y la repercusión en órganos diana acorde al protocolo asistencial diseñado para la consulta. Resultados: las lesiones más frecuentemente encontradas fueron la retinopatía con 92,3 por ciento a hipertrofia ventricular izquierda con 89,7 por ciento la nefropatía con 36,4 por ciento el riesgo cardiovascular fue muy alto en 37,7 por ciento de los pacientes estudiados. El 50,6 por ciento cumplió criterios de hipertensión arterial resistente. Los fármacos antihipertensivos más utilizados fueron los inhibidores de la enzima conversora de la angiotensina, los anticálcicos y las tiazidas. Conclusión: la aplicación del protocolo asistencial demostró ser de gran utilidad en la evaluación, la estratificación del riesgo cardiovascular, el control y seguimiento de los pacientes

Objective: to evaluate the results obtained in the implementation of care protocol for complicated hypertension. Methods: a longitudinal descriptive study was carried out in 390 patients with essential hypertension with damaged target organ. They were assessed in the Specialized Consultation of Complicated Hypertension at Hermanos Ameijeiras Hospital from 2008 to 2012. Clinical record and researches were performed. Their cardiovascular risk profile and impact on target organs were evaluated according to the care protocol designed for clinical consultation. Results: the most frequent injuries found were hypertensive retinopathy (92,3 percent) left ventricular hypertrophy (89,7 percent ) and hypertensive nephropathy (36,4 por ciento ). Cardiovascular risk was very high (37,7 percent) in the studied patients. 50.6 percent) met criteria for resistant hypertension. Inhibitors of the angiotensin converting enzyme, calcium antagonist, and thiazide were the most frequently antihypertensive drugs used. Conclusion: the application of care protocol showed to be very useful in assessing, stratifying, controlling, and following up these patients

Cinco años de experiencia en consulta especializada de hipertensión arterial complicada (2008-2012) / Five years of experience in specialized consultation of complicated hypertension (2008-2012)

Objetivo: evaluar los resultados obtenidos en la aplicación del protocolo asistencial de HTA complicada. Métodos: se realizó investigación descriptiva y longitudinal en la que se incluyeron 390 pacientes hipertensos esenciales con lesión en órgano diana evaluados en la Consulta Especializada de Hipertensión Arterial Complicada del Hospital Hermanos Ameijeiras durante los años 2008 al 2012. Se confeccionó historia clínica y se realizaron investigaciones, se evaluó el perfil de riesgo cardiovascular y la repercusión en órganos diana acorde al protocolo asistencial diseñado para la consulta. Resultados: las lesiones más frecuentemente encontradas fueron la retinopatía con 92,3 por ciento a hipertrofia ventricular izquierda con 89,7 por ciento la nefropatía con 36,4 por ciento el riesgo cardiovascular fue muy alto en 37,7 por ciento de los pacientes estudiados. El 50,6 por ciento cumplió criterios de hipertensión arterial resistente. Los fármacos antihipertensivos más utilizados fueron los inhibidores de la enzima conversora de la angiotensina, los anticálcicos y las tiazidas. Conclusión: la aplicación del protocolo asistencial demostró ser de gran utilidad en la evaluación, la estratificación del riesgo cardiovascular, el control y seguimiento de los pacientes(AU)

Objective: to evaluate the results obtained in the implementation of care protocol for complicated hypertension. Methods: a longitudinal descriptive study was carried out in 390 patients with essential hypertension with damaged target organ. They were assessed in the Specialized Consultation of Complicated Hypertension at Hermanos Ameijeiras Hospital from 2008 to 2012. Clinical record and researches were performed. Their cardiovascular risk profile and impact on target organs were evaluated according to the care protocol designed for clinical consultation. Results: the most frequent injuries found were hypertensive retinopathy (92,3 percent) left ventricular hypertrophy (89,7 percent ) and hypertensive nephropathy (36,4 por ciento ). Cardiovascular risk was very high (37,7 percent) in the studied patients. 50.6 percent) met criteria for resistant hypertension. Inhibitors of the angiotensin converting enzyme, calcium antagonist, and thiazide were the most frequently antihypertensive drugs used. Conclusion: the application of care protocol showed to be very useful in assessing, stratifying, controlling, and following up these patients(AU)

Factores relacionados con el pronóstico de la ventriculostomía premamilar endoscópica en pacientes pediátricos / No disponible

La ventriculostomía premamilar endoscópica (VPME) en edad pediátrica tiene tasas de éxito publicadas variables, que hacen controvertida su recomendación. Factores como la falta de consenso en la definición de éxito de la VPME, la etiología de la hidrocefalia o la edad del paciente podrían influir en el resultado del procedimiento. El objetivo del trabajo consiste en el análisis de una serie propia y el estudio de los factores relacionados con el éxito de la VPME. Estudio retrospectivo de 45 pacientes tratados entre 2003 y 2009 mediante VPME en nuestro hospital infantil. Se definió éxito de VPME como mejoría o estabilidad clínica acompañada de al menos un parámetro radiológico indicativo de buen pronóstico y se analizó la relación de la edad, la etiología de la hidrocefalia, la existencia o no de shunt previo y el tipo de procedimiento endoscópico con el pronóstico de la VPME. Un 29% de los pacientes eran menores de un año. Las causas más frecuentes de hidrocefalia fueron: tumores, estenosis de acueducto y mielomeningocele. El éxito de la VPME se obtuvo en un 69% de casos, con un seguimiento medio de 26 meses y una supervivencia media de la VPME de 14 meses. Se obtuvieron diferencias significativas en el éxito de la VPME según la edad del paciente fuera superior o inferior a 6 meses. La tasa de éxito de la VPME en nuestro medio la hacen recomendable para el tratamiento de la hidrocefalia en edad pediátrica. La VPME es más efectiva en pacientes de edad mayor o igual a 6 meses (AU)

[Factors related to endoscopic third ventriculostomy prognosis in the paediatric population]. / Factores relacionados con el pronóstico de la ventriculostomía premamilar endoscópica en pacientes pediátricos.

Endoscopic third ventriculostomy (ETV) for paediatric patients has different success rates between the published series, making its recommendation controversial. Different definitions of ETV success, hydrocephalus aetiology or patient age at diagnosis may influence the outcome of the ETV procedure. The aim of this work was to analyse our clinical series and to examine the influence of different factors on ETV outcome. This was a retrospective study of 45 patients who had undergone ETV at our Paediatric Hospital between 2003 and 2009. Successful outcome was defined as a combination of features including clinical improvement or stability, with at least 1 positive radiological parameter. The influence of age, hydrocephalus aetiology, existence or not of previous shunt and the type of endoscopic procedure were analysed in relation to ETV outcome. Up to 29% of patients were younger than 1 year. The most frequent causes of hydrocephalus were: brain tumour, aqueductal stenosis and myelomeningocele. The overall success rate was 69%, with a mean follow-up period of 26 months and mean ETV survival of 14 months. We obtained statistically significant differences in ETV success between patients aged over and under 6 moths. Our ETV success rate can be considered safe and effective for the treatment of paediatric hydrocephalus. To our knowledge, ETV is most effective in patients aged 6 months and over.

Success criteria in pediatric neuroendoscopic procedures. Proposal for classification of results after 67 operations.

PURPOSE: Controversial issues exist concerning criteria for patient selection and long-term success in pediatric neuroendoscopic procedures. We designed a classification of success grades applicable to high-pressure and chronic hydrocephalus and also to those cases in which different endoscopic maneuvers are performed during the same procedure. We then evaluated the success rate and complications in our series. METHODS: A total of 59 patients underwent 67 neuroendoscopic procedures between January 2003 and January 2011. A retrospective study was made of the preoperative history, operative reports, and postoperative imaging findings and medical records. A 5-grade scale was developed to assess the type of success depending on clinical and radiological data. Complications related to the surgical procedure were also recorded. RESULTS: Two patients were excluded from the success analysis due to insufficient follow-up time. The final results for the first procedures in 57 patients were complete and permanent success (grade I) in 49.1%, complete but transitory success (grade II) in 10.5%, partial success (grade III) in 12.3%, doubtful success (grade IV) in 5.3%, and failure (grade V) in 22.8%. In eight cases a second procedure followed the failure of the first: grade I success was achieved in seven cases (87.5%) and grade V in one case (12.5%). The highest success rates were achieved in cases of hydrocephalus caused by tumors or arachnoid cysts and the lowest in slit ventricle syndrome. CONCLUSIONS: A common classification of degrees of success, such as that proposed here, would aid the development of comparative and cooperative studies.

Tratamiento combinado de Inhibidores de la Enzima Convertidora de Angiotensina y Bloqueadores de los receptores de Angiotensina II en la detención de la progresión de la enfermedad renal crónica / Processing combined of Inhibiting of the Enzyme Convertidora of Angiotensina and Blockers of the receivers of Angiotensina II in the detention of the progression of the chronic renal illness

Se hace un breve recuento sobre la aproximación al tema del tratamiento combinado de Inhibidores de la Enzima Convertidora de Angiotensina (IECA) y Bloqueadores de los receptores de Angiotensina II en la detención de la progresión de la enfermedad renal crónica

Anesthetic management of a patient in prone position with a drill bit penetrating the spinal canal at C1-C2, using a laryngeal mask.

UNLABELLED: Airway management in patients with penetrating neck trauma must guarantee cervical spine stability. Moreover, the prone position increases the risk of difficult ventilation and cervical spine injury. A 19-yr-old patient was brought to the emergency room in prone position with a drill bit protruding from the posterolateral aspect of his neck. The bit had entered the spinal canal below the first cervical vertebra, and placed near the odontoid peg. He was referred for surgical removal of the drill. The use of an inhaled induction of anesthesia, avoiding muscle relaxants, and ventilation through a laryngeal mask airway inserted in the prone position seemed to offer a satisfactory approach. IMPLICATIONS: Management of patients with penetrating neck trauma must guarantee cervical spine stability. Moreover, the prone position increases the risk of difficult ventilation and cervical spine injury. Anesthesia may be induced and the airway can be managed with the patient already in the prone position for surgery.