Mortalidad a 30 días en pacientes con fractura de fémur proximal durante la pandemia COVID-19 en Vizcaya (País Vasco) / Thirty-day mortality in patients with a proximal femur fracture during the COVID-19 pandemic in Biscay (Basque Country)

Objetivos: Comparar la tasa de mortalidad a 30 días en pacientes con fractura de fémur proximal (FFP) y coinfección por SARS-CoV-2 vs. FFP sin coinfección. Diseño: Estudio retrospectivo comparativo. Escenario: Tres hospitales universitarios en Vizcaya (País Vasco, España). Pacientes: Setenta y siete pacientes mayores de 65 años con FFP (AO 31-A y 31-B). Intervención: Entre el 9 de marzo y el 15 de abril de 2020. El grupo COVID-19 incluía pacientes con infección confirmada mediante el test PCR-RT. Medidas de resultados principales: Tasa de mortalidad a 30 días y factores de riesgo de mortalidad. Resultados: Diez de los 77 pacientes presentaron coinfección por SARS-CoV-2. La edad media fue de 85 años. Los pacientes infectados presentaban un IMC mayor (29,53 kg/m2) frente a los no infectados (24,09 kg/m2) (p = 0,001). No hubo diferencias significativas en el índice de comorbilidad de Charlson, la puntuación ASA, el uso de anticoagulantes o el deterioro cognitivo. Siete pacientes del grupo COVID-19 (7/10) desarrollaron neumonía (vírica), frente a un solo caso(1/67) de neumonía (bacteriana) en el grupo control (p < 0,001). La mortalidad a 30 días fue mayor (p = 0,03) en los pacientes con COVID-19 (40%) que en el grupo control (11,9%). La edad ≥ 91 años, la clase IV ASA y el IMC > 25 kg/m2 fueron predictores significativos de mortalidad a 30 días. Todas las muertes en el grupo COVID-19 ocurrieron intrahospitalariamente. Conclusiones: La infección por SARS-CoV-2 en pacientes con PFF resultó en tasas más altas de mortalidad temprana, siendo la neumonía por COVID-19 la principal causa directa de mortalidad. Nivel de evidencia: Estudio nivel III.(AU)

Objectives: Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. Design: Retrospective comparative study. Setting: Three university hospitals in Biscay province (Basque Country, Spain). Patients: 77 patients over 65 years-old with PFF (AO 31-A and 31-B). Intervention: Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. Main outcome measurements: 30-Day mortality rate and risk factors for mortality. Results: Of a total 77 patients, 10 were diagnosed with SARS-CoV-2 infection. Mean age was 85 years. Patients with SARS-CoV-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥ 91 years-old, ASA class IV and BMI > 25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. Conclusions: SARS-CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality. Level of evidence: Level III study.(AU)

Thirty-day mortality in patients with a proximal femur fracture during the COVID-19 pandemic in Biscay (Basque Country) / Mortalidad a 30 días en pacientes con fractura de fémur proximal durante la pandemia COVID-19 en Vizcaya (País Vasco)

Objectives: Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. Design: Retrospective comparative study. Setting: Three university hospitals in Biscay province (Basque Country, Spain). Patients: 77 patients over 65 years-old with PFF (AO 31-A and 31-B). Intervention: Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. Main outcome measurements: 30-Day mortality rate and risk factors for mortality. Results: Of a total 77 patients, 10 were diagnosed with SARS-CoV-2 infection. Mean age was 85 years. Patients with SARS-CoV-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥ 91 years-old, ASA class IV and BMI > 25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. Conclusions: SARS-CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality.(AU)

Objetivos: Comparar la tasa de mortalidad a 30 días en pacientes con fractura de fémur proximal (FFP) y coinfección por SARS-CoV-2 vs. FFP sin coinfección. Diseño: Estudio retrospectivo comparativo. Escenario: Tres hospitales universitarios en Vizcaya (País Vasco, España). Pacientes: Setenta y siete pacientes mayores de 65 años con FFP (AO 31-A y 31-B). Intervención: Entre el 9 de marzo y el 15 de abril de 2020. El grupo COVID-19 incluía pacientes con infección confirmada mediante el test PCR-RT. Medidas de resultados principales: Tasa de mortalidad a 30 días y factores de riesgo de mortalidad. Resultados: Diez de los 77 pacientes presentaron coinfección por SARS-CoV-2. La edad media fue de 85 años. Los pacientes infectados presentaban un IMC mayor (29,53 kg/m2) frente a los no infectados (24,09 kg/m2) (p = 0,001). No hubo diferencias significativas en el índice de comorbilidad de Charlson, la puntuación ASA, el uso de anticoagulantes o el deterioro cognitivo. Siete pacientes del grupo COVID-19 (7/10) desarrollaron neumonía (vírica), frente a un solo caso(1/67) de neumonía (bacteriana) en el grupo control (p < 0,001). La mortalidad a 30 días fue mayor (p = 0,03) en los pacientes con COVID-19 (40%) que en el grupo control (11,9%). La edad ≥ 91 años, la clase IV ASA y el IMC > 25 kg/m2 fueron predictores significativos de mortalidad a 30 días. Todas las muertes en el grupo COVID-19 ocurrieron intrahospitalariamente. Conclusiones: La infección por SARS-CoV-2 en pacientes con PFF resultó en tasas más altas de mortalidad temprana, siendo la neumonía por COVID-19 la principal causa directa de mortalidad. Nivel de evidencia: Estudio nivel III.(AU)

Thirty-day mortality in patients with a proximal femur fracture during the COVID-19 pandemic in Biscay (Basque Country). / [Artículo traducido] Mortalidad a 30 días en pacientes con fractura de fémur proximal durante la pandemia COVID-19 en Vizcaya (País Vasco).

OBJECTIVES: Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. DESIGN: Retrospective comparative study. SETTING: Three university hospitals in Biscay province (Basque Country, Spain). PATIENTS: 77 patients over 65 years-old with PFF (AO 31-A and 31-B). INTERVENTION: Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. MAIN OUTCOME MEASUREMENTS: 30-Day mortality rate and risk factors for mortality. RESULTS: Of a total 77 patients, 10 were diagnosed with SARS-CoV-2 infection. Mean age was 85 years. Patients with SARS-CoV-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥ 91 years-old, ASA class IV and BMI > 25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. CONCLUSIONS: SARS-CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality. LEVEL OF EVIDENCE: Level III study.

Thirty-day mortality in patients with a proximal femur fracture during the COVID-19 pandemic in Biscay (Basque Country).

Objectives: Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. Design: Retrospective comparative study. Setting: Three university hospitals in Biscay province (Basque Country, Spain). Patients: 77 patients over 65 years-old with PFF (AO 31-A and 31-B). Intervention: Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. Main outcome measurements: 30-day mortality rate and risk factors for mortality. Results: Of a total 77 patients, 10 were diagnosed with SARS CoV-2 infection. Mean age was 85 years. Patients with SARS-Cov-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥91 years-old, ASA class IV and BMI >25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. Conclusions: SARS CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality.

Objetivos: Comparar la tasa de mortalidad a 30 días en los pacientes con fractura de fémur proximal (FFP) y coinfección por SARS-CoV-2 frente a FFP sin coinfección. Diseño: Estudio retrospectivo comparativo. Escenario: Tres hospitales universitarios en Vizcaya (País Vasco, España). Pacientes: Setenta y siete pacientes mayores de 65 años con FFP (AO 31-A y 31-B). Intervención: Entre el 9 de marzo y el 15 de abril de 2020. El grupo COVID-19 incluía pacientes con infección confirmada mediante el test PCR-RT. Medidas de resultados principales: Tasa de mortalidad a 30 días y factores de riesgo de mortalidad. Resultados: Diez de los 77 pacientes presentaron coinfección por SARS-CoV-2. La edad media fue de 85 años. Los pacientes infectados presentaban un IMC mayor (29,53 kg/m2) frente a los no infectados (24,09 kg/m2) (p = 0,001). No hubo diferencias significativas en el índice de comorbilidad de Charlson, la puntuación ASA, el uso de anticoagulantes o el deterioro cognitivo. Siete pacientes del grupo COVID-19 (7/10) desarrollaron neumonía (vírica), frente a un solo caso (1/67) de neumonía (bacteriana) en el grupo control (p < 0,001). La mortalidad a 30 días fue mayor (p = 0,03) en los pacientes con COVID-19 (40%) que en el grupo control (11,9%). La edad ≥ 91 años, la clase IV ASA y el IMC > 25 kg/m2 fueron predictores significativos de mortalidad a 30 días. Todas las muertes en el grupo COVID-19 ocurrieron intrahospitalariamente. Conclusiones: La infección por SARS-CoV-2 en pacientes con PFF resultó en tasas más altas de mortalidad temprana, siendo la neumonía por COVID-19 la principal causa directa de mortalidad.Nivel de evidencia: Estudio nivel III.

Understanding the local and remote source contributions to ambient O3 during a pollution episode using a combination of experimental approaches in the Guadalquivir valley, southern Spain.

The Guadalquivir Valley is one of three major O3 hotspots in Spain. An airborne and surface measurement campaign was carried out from July 9th to 11th, 2019 to quantify the local/regional O3 contributions using experimental approaches. Air quality and meteorology data from surface measurements, a microlight aircraft, a helium balloon, and remote sensing data (TROPOMI-NO2-ESA) were used to obtain the 3D distribution of O3 and various tracer pollutants. O3 accumulation over 2.5 days started with inputs from oceanic air masses transported inland by sea breezes, which drew O3 and its precursors from a local/regional origin to the northeastern end of the basin. The orographic-meteorological setting of the valley caused vertical recirculation of the air masses inside the valley that caused the accumulation by increasing regional background O3 concentration by 25-30 ppb. Furthermore, possible Mediterranean O3 contributions and additional vertical recirculation through the entrainment zone of the convective boundary layer also contributed. Using particulate matter finer than 2.5 µm (PM2.5), ultrafine particles (UFP), and black carbon (BC) as tracers of local sources, we calculated that local contributions increased regional O3 levels by 20 ppb inside specific pollution plumes transported by the breeze into the valley, and by 10 ppb during midday when flying over an area with abundant agricultural burning during the morning. Air masses that crossed the southern boundaries of the Betic system at mid-altitude (400-1850 m a.s.l.) on July 10th and 11th may have provided additional O3. Meanwhile, a decreasing trend at high altitudes (3000-5000 m a.s.l.) was observed, signifying that the impact of stratospheric O3 intrusion decreased during the campaign.

Factores pronósticos tras una luxación traumática de cadera. Estudio retrospectivo a largo plazo / Prognostic factors after a traumatic hip dislocation. A long-term retrospective study

Introducción. Las luxaciones o fracturas-luxaciones de la cadera pueden suponer severas complicaciones como la artrosis o la necrosis. El objetivo de este estudio fue identificar las variables y los factores pronósticos asociados con resultados clínicos y radiológicos a largo plazo tras una luxación traumática de cadera. Material y métodos. Se realizó un estudio retrospectivo de todas las luxaciones y fracturas-luxaciones tratadas desde enero de 1999 a diciembre de 2012. Una tomografía axial computerizada fue realizada tras la reducción en todos los casos. Para la evaluación de los resultados clínicos se utilizó el Harris Hip Score y la escala Merlé-d'Aubigné-Postel, mientras que los resultados radiológicos se evaluaron con la clasificación de Thompson-Epstein. Resultados. Se identificaron 30 casos en 29 pacientes, con un seguimiento medio de 11 años (rango 4-17). Existió una mayor frecuencia de luxaciones simples (21; 70%) respecto a luxaciones complejas (9; 30%). Se realizó una reducción cerrada en menos de 6h en todos los casos excepto en uno (29; 96,7%). Todos los pacientes con luxaciones simples tuvieron excelente resultado sin signos radiológicos de artrosis al final del seguimiento (p<0,01). Del total de la muestra, 4 pacientes desarrollaron signos artrósicos (13,3%) y 3 pacientes presentaron necrosis avascular (10%). Cinco pacientes con fragmentos intraarticulares fueron tratados de forma conservadora, y 3 de ellos desarrollaron artrosis (p<0,05). Conclusión. Nuestro estudio muestra que las luxaciones complejas tienen peores resultados funcionales y radiológicos que las luxaciones simples. Hemos encontrado una fuerte asociación entre cuerpos libres intraarticulares y artrosis, por lo que la extracción de esos fragmentos podría ser considerada (AU)

Introduction. Traumatic hip dislocations can have devastating complications such as osteoarthritis or osteonecrosis. The aim of this study was to identify the variables and prognostic factors associated with clinical and radiological outcome after a traumatic hip dislocation at long-term follow-up. Material and methods. A review was performed of all dislocations and fracture-dislocations of the hip from January 1999 to December 2012. A computed tomography scan was performed after reduction in all cases. The Harris Hip Score and modified Merle-d'Aubigné-Postel method were used for clinical evaluation and radiological assessment was performed according to the Thompson and Epstein classification. Results. There were 30 cases in 29 patients with a mean follow-up of 11 years (range, 4-17). The great majority were simple dislocations (21; 70%) vs. complex dislocations (9; 30%). Closed reduction was performed in less than 6h in all except one case (29; 96.7%). All of the patients with simple dislocations had an excellent outcome without radiological signs of osteoarthritis at the end of the follow-up (P<.01). Overall, arthritic signs had developed in 4 patients (13.3%) and avascular necrosis was noted in 3 patients (10%). Five patients with intraarticular fragments were treated non-operatively, and 3 of them developed arthritic changes (P<.05). Conclusion. Our study suggests that complex dislocations are associated with poorer functional and radiological outcomes than simple dislocations. We also found a strong association between intraarticular fragments and osteoarthritis, so surgical fragment removal could be considered in these cases (AU)

Prognostic factors after a traumatic hip dislocation. A long-term retrospective study. / Factores pronósticos tras una luxación traumática de cadera. Estudio retrospectivo a largo plazo.

INTRODUCTION: Traumatic hip dislocations can have devastating complications such as osteoarthritis or osteonecrosis. The aim of this study was to identify the variables and prognostic factors associated with clinical and radiological outcome after a traumatic hip dislocation at long-term follow-up. MATERIAL AND METHODS: A review was performed of all dislocations and fracture-dislocations of the hip from January 1999 to December 2012. A computed tomography scan was performed after reduction in all cases. The Harris Hip Score and modified Merle-d'Aubigné-Postel method were used for clinical evaluation and radiological assessment was performed according to the Thompson and Epstein classification. RESULTS: There were 30 cases in 29 patients with a mean follow-up of 11 years (range, 4-17). The great majority were simple dislocations (21; 70%) vs. complex dislocations (9; 30%). Closed reduction was performed in less than 6h in all except one case (29; 96.7%). All of the patients with simple dislocations had an excellent outcome without radiological signs of osteoarthritis at the end of the follow-up (P<.01). Overall, arthritic signs had developed in 4 patients (13.3%) and avascular necrosis was noted in 3 patients (10%). Five patients with intraarticular fragments were treated non-operatively, and 3 of them developed arthritic changes (P<.05). CONCLUSION: Our study suggests that complex dislocations are associated with poorer functional and radiological outcomes than simple dislocations. We also found a strong association between intraarticular fragments and osteoarthritis, so surgical fragment removal could be considered in these cases.

Presentación tardía de lesión del nervio ciático secundaria a compresión por placa de osteosíntesis acetabular / Late sciatic nerve axonotmesis following acetabular reconstruction plate

Las lesiones del nervio ciático asociadas a fracturas acetabulares pueden ser postraumáticas, perioperatorias o postoperatorias. Las lesiones postoperatorias tardías son extremadamente raras y pueden deberse a osificaciones heterotópicas, cicatrización hipertrófica o migración del material de osteosíntesis. Presentamos el caso de una paciente de 39 años con antecedente de una fractura transversa de acetábulo izquierdo intervenida mediante placa de reconstrucción en la columna posterior. Tras 17 años asintomática, comenzó con dolor progresivo y paresia de varios meses de evolución en territorio ciático. Tras el pertinente estudio neurofisiológico y radiológico, se decidió intervenir quirúrgicamente a la paciente, constatándose una transección del nervio ciático por compresión prolongada de uno de los tornillos de la placa de osteosíntesis. A los 4 años tras la descompresión quirúrgica, la paciente presentaba mejoría significativa del dolor neurógeno, sin parestesias. No obstante, no ha experimentado recuperación motora. Este caso clínico suscita interés dada la excepcionalidad de esta presentación tardía de lesión nerviosa, producida por la compresión prolongada del material de osteosíntesis (AU)

Sciatic nerve injuries associated with acetabular fractures can be post-traumatic, perioperative or postoperative. Late postoperative injury is very uncommon and can be due to heterotopic ossifications, muscular scarring, or implant migration. A case is presented of a patient with a previous transverse acetabular fracture treated with a reconstruction plate for the posterior column. After 17 years, she presented with progressive pain and motor deficit in the sciatic territory. Radiological and neurophysiological assessments were performed and the patient underwent surgical decompression of the sciatic nerve. A transection of the nerve was observed that was due to extended compression of one of the screws. At 4 years postoperatively, her pain had substantially diminished and the paresthesias in her leg had resolved. However, her motor symptoms did not improve. This case report could be relevant due to this uncommon delayed sciatic nerve injury due to prolonged hardware impingement (AU)

Síndrome de cauda equina por hernia discal lumbar: demora quirúrgica y su relación con el pronóstico / Cauda equina syndrome secondary to lumbar disc herniation: Surgical delay and its relationship with prognosis

Objetivo. Constatar si la demora en más de 48 h en el tratamiento quirúrgico de los pacientes con síndrome de cauda equina (SCE) influyó en el resultado clínico de nuestros pacientes. Material y métodos. Estudio retrospectivo de 18 pacientes intervenidos en nuestro centro desde marzo de 2000 a enero de 2012, tras presentar SCE. Se recogió la situación clínica pre- y postoperatoria: existencia de dolor lumbar y/o ciático, alteración sensitiva en periné, déficit motor y sensitivo en extremidades inferiores y el grado de incontinencia esfinteriana (SCE completo o incompleto). Se realizó una valoración mediante el índice de discapacidad de Oswestry. Resultados. Teniendo en cuenta el inicio de los síntomas, el 44% (8 de 18) de los pacientes se intervinieron de forma precoz (menos de 48 h). Ninguno de los pacientes con SCE completo intervenidos precozmente tuvieron incontinencia urinaria residual, presentando además mayor grado de recuperación motora. De los 5 pacientes con SCE completo intervenidos de forma tardía (más de 48 h), 3 continuaron con incontinencia urinaria residual. Al final del seguimiento se obtuvo una media de 12,55 en las escala de discapacidad de Oswestry. Conclusión. Aunque no se han encontrado diferencias estadísticamente significativas, en nuestra serie hemos observado mayor recuperación motora y esfinteriana en los pacientes que fueron intervenidos antes de las 48 h (AU)

Objective. To determine whether surgical treatment delayed for more than 48 hours in patients with cauda equina syndrome (CES) influenced the clinical outcome. Material and methods. A retrospective study of 18 patients treated in our hospital from March 2000 to January 2012, after presenting with CES. The pre- and post-operative clinical status was determined: existence of back pain and/or sciatica, sensory disturbance in the perineum, sensory and motor deficits in the lower extremities, and the degree of sphincter incontinence (complete or incomplete CES). A clinical assessment was performed using the Oswestry disability index. Results. As regards the onset of symptoms, 44% (8 of 18) of patients were treated at an early stage (within 48 hours). None of the patients with complete CES operated in the early stage had urinary incontinence, and also had greater motor recovery. Of the 5 patients with complete CES who underwent delayed surgery, 3 showed residual urinary incontinence. A mean of 12.55 was obtained on the Oswestry disability index scale at the end of follow-up. Conclusion. Although no statistically significant difference was found in our study, we observed greater motor and sphincter recovery in patients who were operated on within 48 hours (AU)

Cauda equina syndrome secondary to lumbar disc herniation: Surgical delay and its relationship with prognosis. / Síndrome de cauda equina por hernia discal lumbar: demora quirúrgica y su relación con el pronóstico.

OBJECTIVE: To determine whether surgical treatment delayed for more than 48 hours in patients with cauda equina syndrome (CES) influenced the clinical outcome. MATERIAL AND METHODS: A retrospective study of 18 patients treated in our hospital from March 2000 to January 2012, after presenting with CES. The pre- and post-operative clinical status was determined: existence of back pain and/or sciatica, sensory disturbance in the perineum, sensory and motor deficits in the lower extremities, and the degree of sphincter incontinence (complete or incomplete CES). A clinical assessment was performed using the Oswestry disability index. RESULTS: As regards the onset of symptoms, 44% (8 of 18) of patients were treated at an early stage (within 48 hours). None of the patients with complete CES operated in the early stage had urinary incontinence, and also had greater motor recovery. Of the 5 patients with complete CES who underwent delayed surgery, 3 showed residual urinary incontinence. A mean of 12.55 was obtained on the Oswestry disability index scale at the end of follow-up. CONCLUSION: Although no statistically significant difference was found in our study, we observed greater motor and sphincter recovery in patients who were operated on within 48 hours.

Late sciatic nerve axonotmesis following acetabular reconstruction plate. / Presentación tardía de lesión del nervio ciático secundaria a compresión por placa de osteosíntesis acetabular.

Sciatic nerve injuries associated with acetabular fractures can be post-traumatic, perioperative or postoperative. Late postoperative injury is very uncommon and can be due to heterotopic ossifications, muscular scarring, or implant migration. A case is presented of a patient with a previous transverse acetabular fracture treated with a reconstruction plate for the posterior column. After 17 years, she presented with progressive pain and motor deficit in the sciatic territory. Radiological and neurophysiological assessments were performed and the patient underwent surgical decompression of the sciatic nerve. A transection of the nerve was observed that was due to extended compression of one of the screws. At 4 years postoperatively, her pain had substantially diminished and the paresthesias in her leg had resolved. However, her motor symptoms did not improve. This case report could be relevant due to this uncommon delayed sciatic nerve injury due to prolonged hardware impingement.

Tratamiento de los puentes fisarios centrales postraumáticos mediante resección-interposición asistida por artroscopio / Arthroscopy- assisted resection-interposition of post-traumatic central physeal bridges

Introducción. La resección-interposición de los puentes fisarios presenta tasas de éxito variables en la literatura. Respecto al uso de escisión asistida por artroscopio, se han descrito buenos resultados. El objetivo ha sido valorar los resultados del tratamiento de puentes fisarios centrales postraumáticos mediante resección asistida por artroscopio e interposición de grasa. Background. Estudio retrospectivo sobre 5 pacientes (6 procedimientos), los cuales desarrollaron puentes fisarios tras una fractura fisaria. En todos los pacientes se realizó de forma preoperatoria RMN o TAC para cuantificar el tamaño del puente óseo, y se utilizó la clasificación de Peterson para definir el tipo (periférico, alargado o central). Los criterios de inclusión fueron: puentes fisarios < 50% del cartílago fisario total, deformidad progresiva o discrepancia de longitud, y un crecimiento potencial restante de al menos 2 años. Los resultados se evaluaron mediante los criterios de Marsch y Polzhofer en excelentes, buenos o malos. SCAD is a rare but challenging clinical entity. Resultados. Se obtuvieron resultados excelentes en 2 pacientes, bueno en uno, y malos resultados en los 2 casos restantes. Respecto a los pacientes con mal resultado, hemos identificado la asociación de mecanismos de alta energía en ambos casos, asociándose también un incorrecto tratamiento inicial o resección del puente de forma tardía. Conclusiones. La asociación de un artroscopio a la resección de un puente fisario permite una excelente visualización con baja morbilidad. Los resultados obtenidos no son tan positivos como los mostrados por otros autores, si bien no podemos atribuir los malos resultados a la técnica propiamente dicha al haber asociación de factores de mal pronóstico(AU)

Introduction: Physeal bridge resection and insertion of interposition material has had mixed success rates in the literature. Using the arthroscopic approach, some authors have reported good results in their patients. The aim of the study was to evaluate the treatment of post-traumatic central physeal bridges with arthroscopically assisted resection and fat interposition. Material and methods: A retrospective study was conducted on 5 patients (6 procedures), who developed a physeal bridge after a traumatic injury. A CT or MRI scan was performed preoperatively in all patients to assess the size of the physeal bridge. Inclusion criteria were patients with documented existing or developing deformities, a physeal bridge <50% of the physeal area, and with at least 2 years of growth remaining. Clinical outcomes were classified according to Marsch and Polzhofer criteria (excellent, good or poor). Results: Excellent results were obtained in two patients, good in one, and the other two cases were rated as poor. In patients with a poor outcome, high energy trauma mechanisms were identified in both cases. Moreover, incorrect initial treatment or delayed physeal bridge resection was identified. Conclusions: The arthroscopically assisted technique provides best visualization with minimal morbidity. Although our results are not as good as previous studies, it cannot be considered that the technique itself is the cause of the failure, as several risk factors associated to bad prognosis of these injuries were found (AU)

[Arthroscopy- assisted resection-interposition of post-traumatic central physeal bridges]. / Tratamiento de los puentes fisarios centrales postraumáticos mediante resección-interposición asistida por artroscopio.

INTRODUCTION: Physeal bridge resection and insertion of interposition material has had mixed success rates in the literature. Using the arthroscopic approach, some authors have reported good results in their patients. The aim of the study was to evaluate the treatment of post-traumatic central physeal bridges with arthroscopically assisted resection and fat interposition. MATERIAL AND METHODS: A retrospective study was conducted on 5 patients (6 procedures), who developed a physeal bridge after a traumatic injury. A CT or MRI scan was performed preoperatively in all patients to assess the size of the physeal bridge. Inclusion criteria were patients with documented existing or developing deformities, a physeal bridge <50% of the physeal area, and with at least 2 years of growth remaining. Clinical outcomes were classified according to Marsch and Polzhofer criteria (excellent, good or poor). RESULTS: Excellent results were obtained in two patients, good in one, and the other two cases were rated as poor. In patients with a poor outcome, high energy trauma mechanisms were identified in both cases. Moreover, incorrect initial treatment or delayed physeal bridge resection was identified. CONCLUSIONS: The arthroscopically assisted technique provides best visualization with minimal morbidity. Although our results are not as good as previous studies, it cannot be considered that the technique itself is the cause of the failure, as several risk factors associated to bad prognosis of these injuries were found.

The G1359A-CNR1 gene polymorphism is associated to glioma in Spanish patients

INTRODUCTION: The cannabinoid receptor gene 1 (CNR1) encodes the human cannabinoid receptor CB1. This receptor has a widespread distribution in the central nervous system (CNS), the main ligands being anandamide, 2-araquidonoil glycerol and marijuana constituents. There is evidence to suggest an anti-neoplastic effect of these ligands in glial tissues mediated through stimulation of the receptor. MATERIAL AND METHODS: We have studied the G1359A polymorphism of the gene CNR1 with a TaqMan allelic discrimination assay in 200 patients diagnosed with glioma, 109 patients diagnosed with meningioma and 403 healthy subjects. Results Genotypic distribution of the G1359A CNR1 polymorphism in glioma patients showed significant differences when compared to the control group. DISCUSSION: Our results suggest that allele G of the CNR1 gene could be associated with a lower susceptibility to glioma (AU)

[Endoscopic third ventriculostomy: risk factors for failure and evolution of ventricular size]. / Ventriculostomía endoscópica: influencia de factores predisponentes al fallo y evolución del tamaño ventricular.

INTRODUCTION: Endoscopic third ventriculostomy is the treatment of choice for non communicating hydrocephalus at our institution. Several factors have been associated with failure of endoscopic third ventriculostomy. The goals of the study have been to evaluate the outcome, the influence of factors theoretically prone to failure of ventriculostomy and the evolution of ventricular size. MATERIAL AND METHODS: Fifty-six patients (mean age 48.5 yrs) treated with an endoscopic third ventriculostomy during the period 1997-2002 were analysed retrospectively. Hydrocephalus was classified as acute (68%) and chronic forms. Etiology was classified in space-occupying lesions (59%), primary aqueductal stenosis (34%) and Chiari malformation (7%). The presence of the following factors theoretically prone to failure was considered: age below one year, history of mielomeningocele, cerebrospinal fluid (CSF) infection, intracranial haemorrhage, radiotherapy, craniotomy and previous treatment of hydrocephalus with a shunt. Ventricular size was measured linearly with four ventricular index pre- and postoperatively. RESULTS: The global success rate was 71.4% (mean follow-up 26 months). Endoscopic third ventriculostomy for hydrocephalus secondary to cerebral metastases obstructing CSF pathways was associated with a higher risk of failure (p=0.006). None of the risk factors considered was associated with a higher risk of failure. The evolution of the ventricular size measured with linear methods is associated with outcome. Evans ratio, third ventricle index, cella media index and ventricular score decreased in patients whose outcome is satisfactory and increased in those cases deemed clinical failures (p< 0.05). CONCLUSION: The risk of failure increases in patients with cerebral metastases close to CSF pathways, likely due to the concurrence of mechanisms other than obstruction. Changes in ventricular size are associated with outcome.

[Evaluation of microsurgical treatment in a series of 121 intracranial aneurysms]. / Evaluación del tratamiento microquirúrgico de 121 aneurismas intracraneales.

OBJECTIVE: The results obtained with therapy of intracranial aneurysms, in terms of morbidity and mortality, are very important when the patient has to choose between microsurgical techniques or endovascular management. The aim of this paper is to review the information regarding current microsurgical treatment of intracranial aneurysms, and presenting our experience over the last five years. MATERIAL AND METHODS: We studied 101 consecutive patients with 121 intracranial aneurysms admitted between 1996 and 2000 with the initial diagnosis of subarachnoid hemorrhage. We paid special attention to the day of admission from the onset of the symptomatic hemorrhage to the grade of Hunt&Hess scale and the possibility of early or delayed microsurgical treatment. The diagnosis was based on four vessels cerebral angiography and in a few cases with CT-angiography. All patients were treated by microsurgical technique and such treatment was completed by nimodipine, intensive care unit management and in some cases of postoperative suspected vasospasm, induced arterial hypertension was applied. Post surgical angiography was carried out in all patients to confirm the clipping of the cerebral aneurysm. The 12 months assessment was based on the Glasgow Outcome Scale (GOS). RESULTS: The 92.1% of the patients were admitted with a grade equal or below III in the Hunt&Hess scale. A 80% were operated within the 72 hours of admission and in the remaining cases, the surgical treatment was delayed due to a grade IV or V or to a medical contraindication. Four patients died (3.9%). At 12 months follow up, 88.9% presented a score I or II in the GOS. CONCLUSION: According to our results, there are a substantial improvements in the microsurgical treatment of cerebral aneurysms, specially in patients admitted early after the onset of the symptoms of their hemorrhage, who have a grade I to III in the Hunt&Hess scale and showed a good level of consciousness. We think that the improvement of our results are due to: l. the high percentage of patients admitted with grades I to III. 2. the high percentage of patients operated within the first 72 hours from the onset of their symptomatic hemorrhage. 3. surgery was always carried out by the same two experienced vascular neurosurgeons. 4. intraoperative measures taken to prevent the rupture of the aneurysm. 5. early administration of nimodipine, ICU management, doppler studies and in seldom cases, induced hypertension therapy to treat the vasospasm and postoperative hypotension.

Evaluación del tratamiento microquirúrgico de 121 aneurismas intracraneales / Evaluation of microsurgical treatment in a series of 121 intracraneal aneurysms

Objetivo: Los resultados, tanto de morbilidad como de mortalidad, en pacientes con aneurismas intracraneales, son de gran importancia a la hora de presentarle a un enfermo la posibilidad de elegir entre realizar un tratamiento, vía técnica microquirúrgica o endovascular. La idea de este artículo es, fundamentalmente, dar una información reciente sobre el estado actual del tratamiento microquirúrgico de los aneurismas intracraneales, presentando nuestra experiencia y resultados de los últimos cinco años. Material y métodos: Se han estudiado 101 pacientes con 121 aneurismas intracraneales que ingresaron de forma consecutiva entre los años de 1996 al 2000, bajo el diagnóstico de hemorragia subaracnoidea. Especial atención se prestó al día de su ingreso en relación con el comienzo de su hemorragia subaracnoidea, grado de Hunt&Hess y a la posibilidad de una cirugía precoz o demorada. El diagnóstico se realizó mediante examen panagiográfico y en algún caso aislado con Angio-TC. Todos fueron intervenidos mediante téc-nica microquirúrgica y dicho tratamiento fue completado mediante nimodipino, UCI y en algunos casos de sospecha de vaso espasmo postoperatorio, mediante hipervolemia. Su seguimiento fue evaluado mediante angiografía postoperatoria y la GOS. Resultados: 92.1 por ciento de los pacientes ingresaron con un grado igual o menor de III en la escala de Hunt&Hess. 80.8 por ciento fueron intervenidos en las primeras 72 horas y en el resto se demoró este tratamiento, bien por presentar el enfermo un grado IV ó V de Hunt&Hess o por causas médicas. Cuatro enfermos fallecieron (3.9 por ciento). El examen de la GOS a los doce meses de la cirugía mostró que el porcentaje de excelentes o buenos resultados alcanzó un 88.9 por ciento. Conclusión: De acuerdo con los resultados, se puede decir que existe un avance en la mejoría del tratamiento microquirúrgico de los aneurismas intracraneales en Neurocirugía 2003; 14: 5-15 general y sobre todo en aquellos pacientes que ingresan de forma inmediata a su sangrado y con buen nivel de conciencia grado I-III de Hunt&Hess).Por parte de nuestro estudio, la mejoría de los resultados pueden justificarse por: 1° el alto porcentaje de enfermos con HSA ingresados en grado I-III de Hunt&Hess e intervenidos precozmente. 2° la cirugía fue siempre realizada por los mismos dos cirujanos, con larga experiencia en patología vascular cerebral. 3° las medidas tomadas para disminuir la incidencia intra operatoria de rotura aneurismática. 4° el uso de nimodipino, la vigilancia en UCI, la utilidad del doppler y el tratamiento de hipervolemia en casos de sospecha de vaso espasmo o hipotensión postoperatoria (AU)

Analysis of internal transcribed spacer (ITS) regions of rRNA genes in fungal communities in a southeastern U.S. salt marsh.

The ascomycete community colonizing decaying Spartina alterniflora blades in a southeastern U.S. salt marsh was characterized by analysis of internal transcribed spacer (ITS) regions of fungal rRNA genes. ITS sequences were amplified with ascomycete-specific primers from DNA extracted from S. alterniflora blades at two stages of decay (early and late) and were identified based on sequence analysis of a companion ascomycete culture collection. The S. alterniflora ITS libraries were dominated by clones from three species of ascomycetes: Mycosphaerella sp. 2, Phaeosphaeria spartinicola, and Phaeosphaeria halima. ITS sequences from five other less abundant ascomycete species were also found in the clone libraries, only two of which could be identified based on the culture collection, Hydropisphaera erubescens and a new species nicknamed '4clt'. Ascospore expulsion assays indicated dominance by the same three species as the ITS analysis, although this non-molecular approach differed from the molecular method in relative ranking of the dominant species and in characterization of minor species. Analysis of ITS amplicons from three replicate plots by terminal restriction fragment length polymorphism (T-RFLP) analysis showed significant spatial homogeneity in ascomycete community composition for both early- and late-stage decay. ITS sequence analysis identified morphologically cryptic subgroups for two of the three dominant salt marsh ascomycetes.

Déficit neurológico transitorio secundario a quiste leptomeníngeo en un paciente adulto / Transient neurological deficit secondary to a leptomeningeal cyst in an adult patient

Introducción. Una complicación poco frecuente de las fracturas craneales en la infancia es el quiste leptomeníngeo, también denominado fractura evolutiva. El quiste leptomeníngeo postraumático puede ocurrir en sujetos adultos pero es mucho más raro y se atribuye a una fractura craneal sufrida en la infancia. Esta complicación se origina por un desgarro de la duramadre a través del cual se hernia la aracnoides por las pulsaciones del líquido cefalorraquídeo. La manifestación clínica más frecuente consiste en una tumoración o abultamiento de partes blandas que aparece en la cabeza. Caso clínico. Se describe el caso de un varón de 47 años con antecedentes de traumatismo craneal en la infancia que presentó un cuadro de acorchamiento en miembro superior derecho y desviación de la comisura bucal del que se recuperó en una hora. Los estudios de neuroimagen mostraron una destrucción irregular del hueso temporal derecho y una hipodensidad en el tejido cerebral subyacente.La intervención quirúrgica y el estudio histológico del hueso demostraron que se trataba de un quiste leptomeníngeo asociado a un infarto cerebral en el seno de una fractura craneal antigua. Conclusiones. El quiste leptomeníngeo postraumático en un paciente adulto se origina por un desgarro de la duramadre producido por una fractura craneal en la infancia, puede asociarse con un infarto cerebral y es posible que debute exclusivamente con síntomas neurológicos focales transitorios (AU)

[Transient neurological deficit secondary to a leptomeningeal cyst in an adult patient]. / Déficit neurológico transitorio secundario a quiste leptomeníngeo en un paciente adulto.

INTRODUCTION: An uncommon complication of fractures of the skull in infancy is a leptomeningeal cyst, which is also known as a growing skull fracture. A post traumatic leptomeningeal cyst may occur in adults, but is much rarer and may be attributed to a fracture of the skull which occurred in childhood. This complication is caused by a tear in the dura mater, through which pulsation of the cerebro spinal fluid forces the arachnoid layer to herniate. The commonest clinical finding is a soft tissue swelling or tumour appearing on the head. CLINICAL CASE: We report the case of a 47 year old man, with a past history of a head injury in childhood. He presented complaining of loss of sensation in the right arm and deviation of the mouth, from which he recovered within an hour. Neuro imaging studies showed irregular destruction of the right temporal bone and hypodensity of the underlying brain tissue. Surgical operation and histological study of the bone removed showed that it was a leptomeningeal cyst, associated with a cerebral infarct at the site of an old skull fracture. CONCLUSIONS: A post traumatic leptomeningeal cyst in an adult patient is caused by a tear in the dura mater caused by a skull fracture during childhood. It may be associated with a cerebral infarct. It may present with only transient focal neurological symptoms.