Aneurisma intracraneal distal con presentación atípica, localización y evolución en una mujer joven / Atypical presentation of a distal cerebral aneurysm: location and outcome in a young woman

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Endovascular treatment of intracranial aneurysms using the Pipeline Flex embolization device: a case series of 30 consecutive patients.

BACKGROUND: The Pipeline Flex embolization device has some peculiarities in comparison with the previous generation device. Despite recent reports of the modified delivery system, its safety is still unknown. OBJECTIVE: To illustrate the intraprocedural and periprocedural complication rate with this new device in 30 consecutive patients. MATERIAL AND METHODS: Clinical, procedural, and angiographic data, including aneurysm size and location, device or devices used, angiographic and clinical data were analyzed. RESULTS: 30 patients harboring 30 aneurysms were analyzed. 39 devices were placed properly. Multiple Pipeline embolization devices (PEDs) were used in 7 cases. In 28 devices the distal end opened fully from the beginning with a complete wall apposition. In the remaining 11 devices, distal-end opening of the devices was instant but partial, but fully opened easily after recapture. Among the 30 procedures, recapture and reposition of the Pipeline Flex was performed four times owing to proximal migration/malposition of the device during delivery. Four intraprocedural/periprocedural complications occurred, of which 2 resulted in major complications, with neurologic deficits persisting for longer than 7 days. The 30-day morbidity rate was 6.6%, with no deaths. No aneurysm rupture or parenchymal hemorrhage was seen. CONCLUSIONS: The Pipeline Flex embolization device allows more precise and controlled deployment than the first-generation device. The number of devices and the complication rate during the learning curve are lower than reported with the first-generation PED. The new delivery system and the resheathing maneuvers do not seem to increase the intraprocedural complication rate in comparison with the first-generation PED.

Preliminary experience with the Pipeline Flex Embolization Device: technical note.

BACKGROUND: Clinical experience with the Pipeline Embolization Device (PED) has been widely described in the literature since it obtained its European CE and FDA approvals in 2008 and 2011, respectively. The new generation of PED, the Pipeline Flex Embolization Device, received the CE mark of approval in March 2014. While the implant composition has not changed, its new delivery system has some differences. One of the main changes from the previous generation is a new delivery system that makes the device resheathable until deployed over 90% of its length. We present our preliminary experience using this device. METHODS: Between May and June 2014, six patients with six aneurysms were treated with the Pipeline Flex device. RESULTS: All devices were placed properly, without technical difficulties. We successfully resheathed and repositioned the device in two cases. Minor and major intraprocedural or periprocedural events were noted. CONCLUSIONS: The Pipeline Flex device allows more precise and controlled deployment than the current PED device. Although this preliminary experience seems positive, multicenter larger series will be needed to confirm the safety and durability of this new device.

Pipeline endovascular device for the treatment of intracranial aneurysms at the level of the circle of Willis and beyond: multicenter experience.

BACKGROUND AND PURPOSE: The aim of our study was to evaluate the safety and efficacy of the pipeline endovascular device for the treatment of anterior circulation aneurysms at the level of the circle of Willis and beyond. METHODS: A consecutive series of 25 patients (24 unruptured and one ruptured) with anterior circulation aneurysms treated with a pipeline endovascular device were included in the analysis. RESULTS: We found two minor clinical events (resolved within 7 days of the procedure), one major event (symptoms present after 7 days), and no mortality. There were no aneurysm ruptures or parenchymal hemorrhages during follow-up. The modified Rankin Scale (mRS) scores at 3 and 6 months did not change from the prior mRS score for all cases except 1. There was one asymptomatic periprocedural event. There were three intraprocedural complications which resolved without clinical consequences. Six month follow-up angiograms were obtained for 22 aneurysms, showing complete occlusion in 14 (64%) and significantly decreased residual filling in 8 (36%). The status of branches originating from the aneurysm sacs was evaluated in 14 angiograms: 11 were patent (79%), 2 had moderate reduction (14%) and 1 (7%) was occluded. We found six cases of in-stent stenosis (27%) on 6 month DSA, with only one symptomatic case. CONCLUSIONS: The pipeline embolization device provides a feasible and technically safe solution for aneurysms at and beyond the circle of Willis. Preliminary results are promising but larger series with longer term follow-up examinations are required to show the long term safety and durability of this treatment alternative.

Y-stent-assisted coil embolization of anterior circulation aneurysms using two Solitaire AB devices: a single center experience.

Wide-neck intracranial aneurysms remain a challenge to endovascular treatment. We describe our experience in repairing wide-neck aneurysms of the anterior circulation located at arterial branch points using coil embolization assisted by Y-stenting using two Solitaire(®) stents.Six wide-neck intracranial aneurysms located on the middle cerebral artery bifurcation( 3), pericallosal artery( 1), and anterior communicating artery( 2) were repaired by Y-stent-assisted coil embolization using two Solitaire(®) stents. Four cases were incidental findings of aneurysm and two cases were previously treated ruptured aneurysms that had undergone recanalization. All the cases were successfully treated without complications. Follow-up by digital subtraction angiography and magnetic resonance angiography at six months showed the stents to be patent with no recanalization of the aneurysm sacs. Repairing wide-neck aneurysms of the anterior circulation by Y-stent-assisted coil embolization using two Solitaire(®) stents is a simple and safe method of treating complex aneurysms. While the results are promising, larger series with longer term follow-ups are needed to corroborate that this treatment method is superior to other techniques.

El sueño en ambientes extremos / Sleep under extreme environments

El sueño humano es sensible al medio ambiente. Las exposiciones al calor y al frío nocturno provocan reacciones en el sueño S WS (Slow-Wave Sleep) de ondas lentas y en el sueño REM (Rapid Eyes Movement) de movimientos oculares rápidos. La altitud y alta presión tienenefectos perjudiciales para el sueño, especialmente en individuos no aclimatados. Jet Lag es un trastorno aeronáutico del sueño que ocurrecomo consecuencia del cruce rápido de zonas horarias. En su entorno controlado los astronautas pueden dormir bien en ambiente de microgravedad.E l presente artículo examina el conocimiento actual de los patrones de sueño humano en diferentes ambientes: exposición al calory al frío, la altitud, la aviación y la microgravedad en el espacio (AU)

Human sleep is sensitive to the individual’s environment. Heat and nocturnal cold exposures provokes reactions in S WS and REM sleep.Altitude and high pressure are deleterious to sleep, especially in non-acclimatized individuals. Jet lag is a recognized aeronautical sleepdisorder that results from crossing time zones too rapidly for the circadian clock to keep pace. I n their controlled environment, astronautscan sleep well in microgravity. T he present article examines current knowledge of human sleep patterns under different environments: heatexposure, cold exposure, altitude, aviation and microgravity in space (AU)

Intracranial perianeurysmal cyst: still a dilemma. A case report with endovascular management.

Intracranial perianeurysmal cysts constitute an extremely rare entity with very few cases reported in the literature. These cysts present an unknown mechanism of formation and clinical significance. Several theories based on isolated cases have been proposed, without drawing a clear conclusion. It is also unknown if follow-up with imaging techniques is required or which is the most appropriate treatment. We describe an atypical case handled with a satisfactory outcome after endovascular treatment, suggesting the importance of hydrodynamic forces as the key factors in the mechanism of formation. We believe that this case can help in future analysis of this rare entity.

Gliomatosis cerebri que simula encefalitis / Gliomatosis cerebri mimicking encephalitis

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Hemorragias intracraneales como primera manifestación de leucemia mieloide aguda / Intracranial hemorrhages as first manifestation of acute myeloid leukemia

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Control de la abstinencia tabáquica con bupropión mediante determinación de la cotinina acumulada en sudor en parche dérmico. Estudio preliminar / Control of smoking abstinence with bupropion by measuring accumulated cotinine in skin patch sweat. Preliminary study

Objetivos: Principal: comprobar la utilidad de la determinación de la cotinina en sudor en la confirmación de la abstinencia durante la deshabituación tabáquica. Secundarios: comprobar la relación entre niveles de cotinina en sudor y número de cigarrillos diarios consumidos, y entre número de intentos para dejar de fumar y abstinencia tabáquica conseguida tras tratamiento con bupropión; comprobar si la ausencia del consumo coincide con niveles nulos de cotinina en sudor, y si la eficacia del tratamiento con bupropión depende de la dosis utilizada y de la concentración de cotinina en sudor. Pacientes y método: Estudio piloto descriptivo longitudinal no controlado, mediante determinación de cotinina en sudor, acumulado en parche dérmico, en 9 de 20 sujetos fumadores sometidos a tratamiento con bupropión, durante 6 meses consecutivos (144 muestras). Resultados: Existe una relación estadísticamente significativa entre consumo inicial de cigarrillos y niveles de cotinina basal; pero no entre intentos previos de abandono del consumo tabáquico y logro de abandono tras tratamiento con bupropión. Tras tratamiento con bupropión nose detecta cotinina en sudor en sujetos que dejan de fumar. En fumadores con dependencia y consumo moderado-bajo, bupropión 150 mg/día, parece ser tan eficaz como bupropión 300 mg/día. Conclusiones: La detección de la cotinina en el sudor acumulado en parche dérmico, puede ser un método útil para el control de la abstinencia tabáquica conseguida tras tratamiento con bupropión (AU)

Objectives: Main: to verify the utility of the determination fromcotinine in accumulated sweat in skin path in the control of the abstinence from tobacco. Secondaries objectives: to verify if the relationship between the cotinine levels of cotinine in sweat and the number of cigarettes which are consumed daily exists, and if there is some relation between the number of attempts to give up smoking and tobacco abstinence after treatment with bupropion; to verify if the absence of the consumption of tobacco agrees with non-existents levels of cotinine in sweat; and if the success of the treatment with bupropion is dependent on the doses and the levels of cotinine in sweat. Patients and method: A descriptive longitudinal not controlled pilot study, based on the periodic determination of the levels of cotinine in sweat, accumulated in a skin patch, in 9 out of 20 smokers studied, and on criteria of nicotine dependence, during a period of 6 consecutive months, put under farmacological treatment with bupropion (total samples 144). Results: There exist statistically significant relationship between consumption of cigarettes and cotinine levels in sweat; but don't between previous attempts of give up the consumption of tobacco and success of give up after treatment with bupropion. After treatment with bupropion, cotinine in sweat is not detected in those who gived up the consumption. In smokers with moderate dependence and consumption, bupropion 150 mg qd seems to be as effective as bupropion 300 mg qd. Conclusions: The detection of cotinine in the accumulated sweat in skin patch, could be a useful method for the control of the abstinence from tobacco obtained after treatment with bupropion (AU)

Tratamiento farmacológico de la dependencia de opiáceos / Advances in the opiate dependence treatment. Clinical perspectives

Los avances científicos han permitido conocer mejor los mecanismos fisiopatológicos (celulares, moleculares y genéticos) de las drogodependencias, lo que se ha traducido en una concepción actual de la misma como una verdadera enfermedad cerebral y mental, crónica, recidivante y tratable mediante fármacos específicos. Sin embargo, el tratamiento farmacológico de las mismas no ha experimentado grandes cambios en los últimos años, al menos en lo que se refiere a nuevos fármacos. Es el caso de la dependencia de opiáceos, una dependencia que parece estabilizada, tras unas consecuencias históricas dramáticas, pero que puede resurgir con otros nuevos patrones de consumo. En efecto, el tratamiento de la intoxicación aguda, de la desintoxicación y de la deshabituación siguen, desde hace años, protocolos similares en todos los dispositivos asistenciales para heroinómanos. Salvo pequeñas novedades farmacológicas, finalmente abandonadas en España (levo-alfa-acetil-metadol), y ciertos estudios de investigación en el campo de la reducción de daños con suministro contralado de heroína, que no han probado claramente su efectividad, los tratamientos farmacológicos siguen siendo los tradicionales (sustitutivos con agonistas y no sustitutivos con antagonistas), si bien se intenta modificar y simplificar el protocolo terapéutico mediante, por ejemplo, pautas rápidas y ultrarrápidas de desintoxicación, dosis individualizadas de metadona y de buprenorfina en deshabituación, etc. Este trabajo pretende revisar los avances farmacológicos más significativos en la dependencia de opiáceos y, por ende, los avances en los mecanismos de acción de los mismos (AU)

The scientific advance have allowed to know the cellular, molecular and genetic mechanism of the drugs dependence, what it has been translated in a present conception of the same one like a true brain and mental disease, chronic, relapse and by treatable means of specific drugs. Nevertheless, the pharmacological treatment of the same ones has not experienced great changes in the last years, at least in which one talks about new drugs. It is the case of the opiate dependence, a dependency that seems stabilized, after dramatic historical consequences, but that can resurge with other new patterns of consumption. In effect, the treatment of the acute poisoning, of the chemical desintoxication and the maintenance dependence they follow, for years, similar protocols in all the welfare devices for heroin addicts. Except for small pharmacological new features, finally left in Spain (levo-alpha-acetyl-methadol), and certain studies of investigation in the field of the reduction of damages with controlled provision of heroin, that they have not proven clearly its effectiveness, the pharmacological treatments continue being the traditional ones (substitute with agonists, and non substitute with antagonists9, although it is tried to modify and to simplify the therapeutic protocol by means of, for example, fast and high speed guidelines of chemical desintoxication, doses individualized of methadone and buprenorfine in maintenance dependence, etc. this work tries to review more significant the pharmacological advances in the opiate dependence and therefore, the advances in the mechanisms of action of such (AU)