Importancia de la arteriografía cerebral y la monitorización neurofisiológica intraoperatoria en la endarterectomía carotídea / Importance of cerebral angiography and intraoperative neuromonitoring in carotid endarterectomy

Cada vez es más frecuente indicar una endarterectomía carotídea en función de la información proporcionada por pruebas no invasivas, como la eco-Doppler, la angio-RM o la angio-TAC, obviando la necesidad de la arteriografía. Presentamos un caso de estenosis carotídea sintomática izquierda del 80% en la que la arteriografía cerebral constató la ausencia del segmento A1 derecho y llenado del territorio cerebral anterior bilateral solo desde el lado izquierdo. A los 90 segundos del pinzamiento de las arterias en el cuello se produjo una disminución brusca de la oximetría cerebral y de la amplitud de los potenciales somatosensoriales, que cedieron tras el despinzamiento inmediato. Se desestimó realizar la endarterectomía y se colocó un stent carotídeo sin complicaciones. Este caso ejemplifica la importancia de conocer el estado de la circulación cerebral distalmente a la estenosis. De haberse intentado realizar la endarterectomía sin tener en cuenta la información proporcionada por la arteriografía, posiblemente habría ocurrido una isquemia bihemisférica grave (AU)

It is an increasingly common practice to indicate a carotid endarterectomy procedure based on the information provided by non-invasive tests like Duplex ultrasound, MR angiography or CT angiography, thereby obviating the performance of a conventional cerebral angiography. We present a case of symptomatic left carotid artery 80% stenosis in which cerebral angiography showed absence of the right A1 segment and bilateral anterior cerebral artery territories that filled only from a left injection. Just 90 seconds after carotid artery clamping at the neck, brain oximetry and somatosensory evoked potentials significantly dropped, that recovered after immediate clamp removal. Endarterectomy was dismissed and a carotid stent was successfully placed. This case highlights the importance of knowing the dynamics of cerebral blood circulation distal to the stenosis. If endarterectomy had been attempted, unawareness of the information provided by the cerebral angiography would have likely result in severe bi-hemispheric ischemia (AU)

Association Between Substance Use Behaviors, Developmental Assets and Mental Health: A Glance at Latin American Young College Students.

Positive Youth Development (PYD) is an approach that promotes resilience and focuses on youth strengths rather than their weaknesses as done by the traditional deficit-based perspective. Research in Europe and North America show that developmental assets are associated with school success, psychological well-being, and lower health risks among youth and young adults. However, not much research has been done on these associations in Latin American contexts. The purpose of this research study is to assess the association between substance use behaviors, such as drunkenness and the use of illicit drugs, and mental health, together with the mediating role of developmental assets representing youth strengths (e.g., social competence) and contextual resources (e.g., social support at home or school). Cross-national data was collected from Colombian (n = 210; 70.4% females) and Peruvian (n = 349; 66.5% females) 1st year university students. Results shed light on the protective role of developmental assets regarding substance use behaviors and mental well-being. Specifically, the results showed direct negative associations between developmental assets and substance use behaviors and positive associations of developmental assets with mental health indicators. Internal assets appear to be a stronger predictor of social, emotional, and psychological well-being compared to external assets. We did not find any statistical significance in the association of substance use behavior and mental health. We discuss implications regarding research, policy, and practice.

Importance of cerebral angiography and intraoperative neuromonitoring in carotid endarterectomy. / Importancia de la arteriografía cerebral y la monitorización neurofisiológica intraoperatoria en la endarterectomía carotídea.

It is an increasingly common practice to indicate a carotid endarterectomy procedure based on the information provided by non-invasive tests like Duplex ultrasound, MR angiography or CT angiography, thereby obviating the performance of a conventional cerebral angiography. We present a case of symptomatic left carotid artery 80% stenosis in which cerebral angiography showed absence of the right A1 segment and bilateral anterior cerebral artery territories that filled only from a left injection. Just 90seconds after carotid artery clamping at the neck, brain oximetry and somatosensory evoked potentials significantly dropped, that recovered after immediate clamp removal. Endarterectomy was dismissed and a carotid stent was successfully placed. This case highlights the importance of knowing the dynamics of cerebral blood circulation distal to the stenosis. If endarterectomy had been attempted, unawareness of the information provided by the cerebral angiography would have likely result in severe bi-hemispheric ischemia.

Radiofrequency Ablation of Thyroid Nodules: A Long-Term Prospective Study of 24 Patients.

PURPOSE: To evaluate the volume reduction rate (VRR) of thyroid nodules over a long period of time after radiofrequency (RF) ablation treatment in both solid and mixed nodules; to determine ablation parameters; and to evaluate complications and success rates and safety of RF ablation. MATERIAL AND METHODS: In this prospective study, 24 patients (83% females and 17% males; age 50.17 ± 13.6 years) underwent ultrasound-guided percutaneous RF ablation of benign thyroid nodules with radiologic follow-up at 1, 3, 6, 12, 24, and 36 months after treatment. All patients presented with compressive or cosmetic complaints and with Thyroid Imaging Reporting and Data System 1 or 2 nodules under ultrasound and were confirmed to be Bethesda Category II after 2 fine-needle aspirations. RESULTS: A total of 24 nodules (54.2% solid, 37.5% solid predominance, and 8.3% cystic predominance) were included in this study. Significant results in VRR (%) were found at 24 months and 36 months of 69.92 ± 19.23 and 76.84 ± 15.92, respectively. Furthermore, a logarithmic relationship was found when VRR was plotted over time, in both solid and mixed nodules. No correlations were found with any of the ablation parameters. The success rate reached 72.22% at 12 months, and the total complication rate was 16.67% (12.5% minor complications and 4.2% major complications-1 laryngeal nerve palsy), reaching an 83.3% safety. CONCLUSIONS: RF ablation can be an alternative treatment modality in the management of benign symptomatic thyroid nodules. The results show that it is a safe and effective treatment if trans-isthmic approach and moving-shot techniques are correctly followed.

Hemorragia subaracnoidea aneurismática: resultados tras la introducción de la terapia endovascular en un centro de medio-bajo volumen / Aneurysmal subarachnoid haemorrhage: Results after introducing endovascular therapy in a medium-low volume centre

Objetivos: Valorar el impacto de la introducción del tratamiento endovascular en pacientes con hemorragia subaracnoidea espontánea aneurismática (HSAa) en un centro de medio-bajo volumen. Material y métodos: Estudio observacional retrospectivo donde se comparan los resultados clínicos de pacientes con HSAa en 2 períodos, antes y después de disponer de tratamiento embolizador. Las variables estudiadas más relevantes fueron: modalidad de tratamiento, mortalidad intrahospitalaria y diferida, complicaciones intraprocedimiento, tasas de resangrado y vasoespasmo, y resultados al final del seguimiento medidos mediante la escala de resultado de Glasgow (GOS). Resultados: Se trató en total a 71 pacientes en 2 períodos: 2010-2011 (32 pacientes; 19 clipajes, 6 embolizaciones,7 no tratados) y 2012-2013 (39 pacientes; 3 clipajes, 34 embolizaciones, 2 no tratados). Ambas cohortes no presentaron diferencias significativas en cuanto a edad, sexo, grado clínico al ingreso, tipo y localización de los aneurismas y puntuación de Fisher, así como en mortalidad intrahospitalaria (28,1% vs. 25,6%, p = 0,35), resultado clínico valorado según la puntuación de GOS (salvo en GOS 5: 43,37% vs. 53,8%, p = 0,045), tasa de hidrocefalia e incidencia de vasoespasmo sintomático. La segunda cohorte obtuvo mejores resultados agregados respecto a la primera para GOS 1+2+3 (36,3% vs. 43,75%, p = 0,034) y para GOS 4+5 (61,5% vs. 56,25%, p = 0,078). El porcentaje de pacientes que no fueron tratados fue significativamente inferior en el segundo período (5,1% vs. 21,8%, p < 0,01), así como la tasa de resangrados (0% vs. 9,4%, p < 0,01). En el segundo período se trataron los pacientes de forma más precoz (2,51 vs. 3,95 días) y la estancia en Unidad de Cuidados Intensivos y total fueron menores (15,2 y 24,6 vs. 10,3 y 18 días), diferencias en el límite de la significación estadística. Conclusiones: El tratamiento endovascular permitió tratar un porcentaje mayor de pacientes con HSAa con una disminución en la tasa de resangrados. Este hecho se tradujo en una modesta reducción en la morbimortalidad

Objective: To evaluate the impact of introducing endovascular therapy for patients with aneurysmal subarachnoid haemorrhage (aSAH) in a medium-low volume centre. Material and methods: A retrospective observational study was conducted by comparing the clinical outcome of patients with aSAH before and after introducing endovascular therapy in our centre. The main variables analysed were: type of treatment, hospital and late mortality, intra-procedural morbidity, rate of re-bleeding and vasospasm, and clinical outcome according to the Glasgow Outcome Score (GOS). Results: Seventy-one patients were treated in two periods: 2010-2011 (32 patients; 19 clipped, 6 coiled, 7 untreated), and 2012-2013 (39 patients, 3 clipped, 34 coiled, 2 untreated). No significant differences were found in age, sex, clinical grade at admission, type and location of aneurysm, Fisher score, or in hospital mortality (28.1% vs 25.6%, P = .35), GOS (except for GOS 5: 43.37% vs 53.8%, P = .045), rate of hydrocephalus and rate of vasospasm. The second cohort obtained better results for aggregated GOS 1+2+3 (36.3% vs 43.75%, P = .034) and for GOS 4 + 5 (61.5% vs 56.25%, P=.078). The percentage of patients left untreated was significantly lower in the second period (5.1% vs 21.8%, P < .01), as well as the rate of re-bleeding (0% vs 9.4%, P < .01). Patients were treated earlier (2.51 vs 3.95 days), and hospital and total stay were lower (15.2 and 24.6 vs 10.3 and 18 days) in the second period, these differences not reaching statistical significance. Conclusions: Endovascular therapy allowed treating more patients with aSAH, and with a lower re-bleeding rate. This led to a modest reduction in morbidity and mortality

[Aneurysmal subarachnoid haemorrhage: Results after introducing endovascular therapy in a medium-low volume centre]. / Hemorragia subaracnoidea aneurismática: resultados tras la introducción de la terapia endovascular en un centro de medio-bajo volumen.

OBJECTIVE: To evaluate the impact of introducing endovascular therapy for patients with aneurysmal subarachnoid haemorrhage (aSAH) in a medium-low volume centre. MATERIAL AND METHODS: A retrospective observational study was conducted by comparing the clinical outcome of patients with aSAH before and after introducing endovascular therapy in our centre. The main variables analysed were: type of treatment, hospital and late mortality, intra-procedural morbidity, rate of re-bleeding and vasospasm, and clinical outcome according to the Glasgow Outcome Score (GOS). RESULTS: Seventy-one patients were treated in two periods: 2010-2011 (32 patients; 19 clipped, 6 coiled, 7 untreated), and 2012-2013 (39 patients, 3 clipped, 34 coiled, 2 untreated). No significant differences were found in age, sex, clinical grade at admission, type and location of aneurysm, Fisher score, or in hospital mortality (28.1% vs 25.6%, P=.35), GOS (except for GOS 5: 43.37% vs 53.8%, P=.045), rate of hydrocephalus and rate of vasospasm. The second cohort obtained better results for aggregated GOS 1+2+3 (36.3% vs 43.75%, P=.034) and for GOS 4+5 (61.5% vs 56.25%, P=.078). The percentage of patients left untreated was significantly lower in the second period (5.1% vs 21.8%, P<.01), as well as the rate of re-bleeding (0% vs 9.4%, P<.01). Patients were treated earlier (2.51 vs 3.95 days), and hospital and total stay were lower (15.2 and 24.6 vs 10.3 and 18 days) in the second period, these differences not reaching statistical significance. CONCLUSIONS: Endovascular therapy allowed treating more patients with aSAH, and with a lower re-bleeding rate. This led to a modest reduction in morbidity and mortality.