Effects of calcium ammonium nitrate fed to dairy cows on nutrient intake and digestibility, milk quality, microbial protein synthesis, and ruminal fermentation parameters.

We evaluated the effects of supplemental calcium ammonium nitrate (CAN) fed to dairy cows on dry matter (DM) intake, nutrient digestibility, milk quality, microbial protein synthesis, and ruminal fermentation. Six multiparous Holstein cows at 106 ± 14.8 d in milk, with 551 ± 21.8 kg of body weight were used in a replicated 3 × 3 Latin square design. Experimental period lasted 21 d, with 14 d for an adaptation phase and 7 d for sampling and data collection. Cows were randomly assigned to receive the following treatments: URE, 12 g of urea/kg of DM as a control group; CAN15, 15 g of CAN/kg of DM; and CAN30, 30 g of CAN/kg of DM. Supplemental CAN reduced DM intake (URE 19.0 vs. CAN15 18.9 vs. CAN30 16.5 kg/d). No treatment effects were observed for apparent digestibility of DM, organic matter, crude protein, ether extract, and neutral detergent fiber; however, CAN supplementation linearly increased nonfiber carbohydrate digestibility. Milk yield was not affected by treatments (average = 23.1 kg/d), whereas energy-corrected milk (ECM) and 3.5% fat-corrected milk (FCM) decreased as the levels of CAN increased. Nitrate residue in milk increased linearly (URE 0.30 vs. CAN15 0.33 vs. CAN30 0.38 mg/L); however, treatments did not affect nitrite concentration (average: 0.042 mg/L). Milk fat concentration was decreased (URE 3.39 vs. CAN15 3.35 vs. CAN30 2.94%), and the proportion of saturated fatty acids was suppressed by CAN supplementation. No treatment effects were observed on the reducing power and thiobarbituric acid reactive substances of milk, whereas conjugated dienes increased linearly (URE 47.6 vs. CAN15 52.7 vs. CAN30 63.4 mmol/g of fat) with CAN supplementation. Treatments had no effect on microbial protein synthesis; however, molar proportion of ruminal acetate and acetate-to-propionate ratio increased with CAN supplementation. Based on the results observed, supplementing CAN at 30 g/kg of DM should not be recommended as an optimal dose because it lowered DM intake along with ECM and 3.5% FCM, although no major changes were observed on milk quality and ruminal fermentation.

Enzymatic effects of Pleurotus ostreatus spent substrate on whole-plant corn silage and performance of lactating goats.

Pleurotus ostreatus (oyster mushroom) synthesizes enzymes that degrade lignin, cellulose, and hemicellulose. The objectives of this study were to evaluate the effect of Pleurotus ostreatus spent substrate (POSS) on whole-plant corn silage (WPCS) chemical composition, antioxidant capacity, lignin monomers, and in vitro digestibility, as well as the performance of lactating goats fed corn silage treated with different levels of POSS. In experiment 1, 4 levels of lignocellulolytic enzymes were tested in a complete randomized design: 0, 10, 20, and 30 mg of lignocellulosic enzymes per kilogram of fresh matter, 4 replicates per treatment (vacuum-sealed bags). The bags were opened 60 d after ensiling. In experiment 2, corn silage treated with 3 enzyme levels (0, 10, or 30 mg/kg of fresh matter) was fed to lactating goats as part of the total mixed ration. Nine lactating Saanen goats (62.68 ± 7.62 kg BW; 44 ± 8 d in milk; 2.91 ± 0.81 kg of milk/day, mean ± SD) were assigned to three 3 × 3 Latin squares. Data were analyzed using the GLIMMIX procedure of SAS (version 9.4, SAS Institute Inc.), and means were compared by linear and quadratic orthogonal contrast. In experiment 1, neutral detergent fiber (NDF), acid detergent fiber (ADF), lignin, and cellulose quadratically decreased in the WPCS treated with POSS. At the nadir point, POSS decreased NDF by 14.1%, ADF by 19.5%, lignin by 9.07%, and cellulose by 22.1% compared with the untreated silage. Therefore, POSS led to a quadratic increase in in vitro dry matter digestibility of WPCS (+8.88% at the vertex) compared with the untreated silage. In experiment 2, POSS quadratically increased the in vivo total-tract ADF digestibility. Also, the concentration of polyphenols in the milk of goats linearly increased with the addition of POSS, and no differences were observed among treatments for milk yield and composition. In summary, adding 10 mg of lignocellulolytic enzymes from POSS per kilogram of fresh matter of whole-plant corn at ensiling had a more evident reduction in lignin and cellulose concentration, leading to greater in vitro digestibility, as well as greater in vivo ADF digestibility; however, milk yield was not different among treatments.

Pyramidal core-shell quantum dot under applied electric and magnetic fields.

We have theoretically investigated the electronic states in a core/shell pyramidal quantum dot with GaAs core embedded in AlGaAs matrix. This system has a quite similar recent experimental realization through a cone/shell structure [Phys. Status Solidi-RRL 13, 1800245 (2018)]. The research has been performed within the effective mass approximation taking into account position-dependent effective masses and the presence of external electric and magnetic fields. For the numerical solution of the resulting three-dimensional partial differential equation we have used a finite element method. A detailed study of the conduction band states wave functions and their associated energy levels is presented, with the analysis of the effect of the geometry and the external probes. The calculation of the non-permanent electric polarization via the off-diagonal intraband dipole moment matrix elements allows to consider the related optical response by evaluating the coefficients of light absorption and relative refractive index changes, under different applied magnetic field configurations.

[Diagnostic, prognostic and therapeutic implications of transcranial color-coded duplex sonography in acute ischemic stroke: TIBI and COGIF scores validation]. / Implicaciones diagnosticas, pronosticas y terapeuticas del duplex color transcraneal en el ictus isquemico agudo: validacion de los grados TIBI y COGIF.

AIM: To describe the information provided by transcranial color-coded duplex (TCCD) sonography for therapeutic decision-making in patients with acute ischemic stroke and to analyze the relationship between TCCD findings and the severity and prognosis of stroke. PATIENTS AND METHODS: TCCD performed within the six first hours after an acute ischemic stroke were analyzed in our institution. The presence of an arterial occlusion and its location were collected using TIBI (Thrombolysis in Brain Ischemia) and COGIF (Consensus on Grading Intracranial Flow Obstruction) criteria. Arterial recanalization within 24 hours after stroke was determined using TIBI and COGIF criteria. Favorable functional outcome was defined as a modified Rankin scale from 0 to 2 at three months. RESULTS: TCCD was performed in 104 patients, 85 were treated with intravenous thrombolysis. Arterial occlusion was detected in 79.8% of patients. The detection of arterial occlusion with TCCD allowed the selection for endovascular treatment in 23.1% of patients. Arterial occlusion was associated with a higher severity of stroke. Recanalization was detected in 44.1% using TIBI and 45.8% according to COGIF criteria. 80.8% of recanalized patients and only 39.5% of not recanalized had a favorable functional outcome at three months. Recanalization rate depended on the location of arterial occlusion. CONCLUSION: TCCD is a useful technique for the detection and location of arterial occlusion. It provides valuable prognostic information and allows selecting patients for endovascular recanalizing therapies. TIBI and COGIF scores provide a comparable information.

TITLE: Implicaciones diagnosticas, pronosticas y terapeuticas del duplex color transcraneal en el ictus isquemico agudo: validacion de los grados TIBI y COGIF.Objetivo. Describir la informacion aportada por el duplex color transcraneal (DCTC) en pacientes con ictus isquemico agudo, analizando la relacion entre los hallazgos del DCTC, la gravedad y el pronostico, asi como su utilidad en la toma de decisiones terapeuticas. Pacientes y metodos. Analizamos los DCTC realizados a pacientes con ictus agudo de menos de seis horas de evolucion. Recogimos la existencia de oclusion arterial empleando las clasificaciones TIBI (Thrombolysis in Brain Ischemia) y COGIF (Consensus on Grading Intracranial Flow Obstruction). Determinamos la recanalizacion arterial a las 24 horas del ictus empleando criterios TIBI y COGIF. Consideramos buena evolucion funcional puntuaciones en la escala de Rankin de 0 a 2 a los tres meses. Resultados. Realizamos DCTC en 104 pacientes, 85 tratados con trombolisis intravenosa. Objetivamos oclusion arterial en el 79,8%. La deteccion de una oclusion arterial mediante DCTC permitio indicar tratamiento endovascular en el 23,1% de los pacientes. La presencia de oclusion arterial se asocio a mayor gravedad del ictus. Detectamos recanalizacion arterial en el 44,1% segun los criterios TIBI y en el 45,8% segun los criterios COGIF. El 80,8% de los pacientes que recanalizaron y solo el 39,5% de los que no recanalizaron obtuvieron una buena evolucion funcional a los tres meses. La recanalizacion dependio de la localizacion de la oclusion arterial. Conclusiones. El DCTC es util para deteccion y localizacion de oclusion arterial, aporta informacion pronostica valiosa y permite seleccionar pacientes para el empleo de terapias endovasculares. La informacion aportada por las clasificaciones TIBI y COGIF es equiparable.

Endovascular treatment of cerebral venous sinus thrombosis (CVST): Is a complete recanalization required for a good clinical outcome?

The usual therapy in cerebral venous sinus thrombosis (CVST) is based on anticoagulant treatment with adjusted-dose unfractionated heparin. When medical treatment fails, endovascular techniques, such as mechanical thrombectomy, are available. We report a case of a 21-year-old woman with a diagnosis of left CVST, treated by a neurointerventional approach with mechanical thrombectomy using the Penumbra(®) System. Despite the fact that only incomplete recanalization was achieved, a gradual resolution of the thrombus and a progressive clinical improvement occurred.

Factors associated with in-hospital delays in treating acute stroke with intravenous thrombolysis in a tertiary centre. / Identificación de los factores que influyen en el retraso intrahospitalario del inicio de trombólisis intravenosa en el ictus agudo en un hospital terciario.

OBJECTIVE: This study aims to determine which factors are associated with delays in door-to needle (DTN) time in our hospital. This will help us design future strategies to shorten time to treatment with intravenous thrombolysis (IVT). METHODS: Retrospective analysis of a prospective cohort of patients with ischaemic stroke treated with IVT in our hospital between 2009 and 2012. We analysed the relationship between DTN time and the following variables: age, sex, personal medical history, onset-to-door time, pre-hospital stroke code activation, blood pressure and blood glucose level, National Institutes of Health Stroke Scale (NIHSS), computed tomography angiography (CTA) and/or doppler/duplex ultrasound (DUS) performed before IVT, time to hospital arrival, and day of the week and year of stroke. RESULTS: Our hospital treated 239 patients. Median time to treatment in minutes (IQR): onset-to-door, 84 (60-120); door-to-CT, 17 (13-24.75); CT-to needle, 34 (26-47); door-to-needle, 52 (43-70); onset-to-needle, 145 (120-180). Door-to-needle time was significantly shorter when code stroke was activated, at 51 vs. 72min (P=0.008), and longer when CTA was performed, at 59 vs. 48.5min (P=0.004); it was also longer with an onset-to-door time<90min, at 58 vs. 48min (P=0.003). The multivariate linear regression analysis detected 2 factors affecting DTN: code stroke activation (26.3% reduction; P<0.001) and onset-to-door time (every 30min of onset-to-door delay corresponded to a 4.7min increase in DTN time [P=0.02]). On the other hand, CTA resulted in a 13.4% increase in DTN (P=0.03). No other factors had a significant influence on door-to-needle time. CONCLUSIONS: This study enabled us to identify CTA and the «3-hour effect¼ as the 2 factors that delay IVT in our hospital. In contrast, activating code stroke clearly reduces DTN. This information will be useful in our future attempts to reduce door-to-needle times.

[Differences in health-related quality of Life between men and women with sleep-disordered breathing]. / Diferencias en la calidad de vida relacionada con la salud entre hombres y mujeres con trastorno respiratorio del sueño.

INTRODUCTION: Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS) increases cardiovascular risk and has a negative impact on neurocognitive functioning. Health Related Quality of Life (HRQL) is impaired in OSAHS patients, differently in men and women, but its evaluation is difficult by primary care providers. OBJECTIVE: To screen for OSAHS in patients with cardiovascular disease or cardiovascular risk factors, under the hypothesis of gender differences in HRQL. METHODOLOGY: Cross-sectional study including 75 consecutive patients (39 male, 36 female) with cardiovascular disease or cardiovascular risk factors, without acute disease. Anthropometric, demographic, and laboratory data were collected. The STOP-BANG questionnaire, for the screening of OSASH, and the COOP/WONCA charts for HRQL evaluation, were administered at the primary care setting. RESULTS: Women with clinical finding evocative of OSAHS had lower HRQL than men with the same condition, as indicated by higher summation scores for COOP/WONCA charts (P=.002) and for dimensions of Physical Fitness (P<.001), Daily Activities (P=.040) and Change in health (P=.004), with a trend to a be into a lower social class. Summation scores for COOP/WONCA correlates with social class (P=.008) pointing out to a parallel improvement of HRQL with social status. CONCLUSIONS: OSAHS screening along with HRQL measurement is feasible at the primary care level, revealing a distinctive feature in women with sleep-disordered breathing, a lower HRQL, undetectable by the instrumental sleep study.

Spontaneous spinal epidural haematoma: a retrospective study of a series of 13 cases.

INTRODUCTION: Spontaneous spinal epidural haematoma (SSEH) has an estimated incidence of one per million inhabitants. It is classified as spontaneous when no identifiable cause can be linked to its onset. OBJECTIVE: To describe a sample of patients with SSEH and analyse variables related to its functional prognosis. PATIENTS AND METHODS: Retrospective study carried out in patients diagnosed with SSEH between 2001 and 2013 in our hospital. RESULTS: We included 13 subjects (7 men) with a mean age of 71 years. Of the total, 62% had hypertension and 54% were treated with oral anticoagulants; of the latter, 57% had an International Normalised Ratio above 3. The most frequent manifestation was spinal column pain (85%). Nearly all subjects presented an associated neurological deficit, whether sensory-motor (70%), pure motor (15%), or pure sensory (7%). Five patients underwent surgical treatment and 8 had conservative treatment. After one year, 3 of the patients treated surgically and 4 of those on conservative treatment had a score of 2 or lower on the modified Rankin Scale. Poorer prognosis was observed in patients with anticoagulant therapy, large haematomas, location in the lumbar region, and more pronounced motor disability at onset. CONCLUSIONS: Old age, hypertension, and anticoagulant therapy are the main risk factors for SSEH. The typical presentation consists of back pain with subsequent motor deficit. In patients with established motor symptoms, surgical treatment within the first 24hours seems to be the best option.

[Exceptional causes of hematuria in childhood and infancy]. / Causas excepcionales de hematuria en la infancia y en la adolescencia.

INTRODUCTION: Hematuria is not uncommon in pediatric patients, even though it remains a diagnostic challenge in many cases. In this study we aim to draw attention to health professionals to have in mind rare diseases as a cause of hematuria. CASE REPORTS: We report 3 representative clinical cases of hematuria from very different origins: traumatic, congenital and infectious, illustrating the broad spectrum of causes of hematuria. COMMENTS: There are exceptional causes of hematuria which should be considered in clinical practice. The study of hematuria should always include a complete personal and familiar medical history, a careful physical examination and urine cultures. It is important to try to propose an algorithm study, avoiding unnecessary and invasive diagnostic tests that can be associated with complications.

INTRODUCCION: La hematuria es un signo frecuente en pediatría, siendo un reto diagnóstico en muchos casos. El objetivo de este trabajo es llamar la atención a los profesionales de la salud sobre la necesidad de tener presentes enfermedades infrecuentes como causa de hematuria. CASOS CLINICOS: Exponemos 3 tres casos clínicos representativos de formas de hematuria de orígenes muy distintos: traumático, congénito e infeccioso, que ilustran el amplio espectro de causas en la hematuria. COMENTARIOS: Existen causas de hematuria de presentación excepcional que debemos tener en cuenta en la práctica clínica. El estudio de la hematuria debe incluir siempre una completa anamnesis personal y familiar, una cuidada exploración física, análisis y cultivo de la orina. Es importante intentar proponer un algoritmo de estudio, evitando pruebas diagnósticas innecesarias e invasivas que no están exentas de complicaciones.

[Aetiological classification of ischaemic strokes: comparison of the new A-S-C-O classification and the classification by the Spanish Society of Neurology's Cerebrovascular Disease Study Group]. / Clasificación etiológica del ictus isquémico: comparación entre la nueva clasificación A-S-C-O y la clasificación del Grupo de Estudio de Enfermedades Cerebrovasculares de la Sociedad Española de Neurología.

INTRODUCTION: The A-S-C-O classification may be better than other methods for classifying ischaemic stroke by aetiology. Our aims are to describe A-S-C-O phenotype distribution (A: atherosclerosis, S: small vessel disease, C: cardiac source, O: other causes; 1: potential cause, 2: causality uncertain, 3: unlikely to be a direct cause although disease is present) and compare them to the Spanish Society of Neurology's Cerebrovascular Disease Study Group (GEECV/SEN) classification. We will also find the degree of concordance between these classification methods and determine whether using the A-S-C-O classification delivers a smaller percentage of strokes of undetermined cause. METHODS: We analysed those patients with ischaemic stroke admitted to our stroke unit in 2010 with strokes that were classified according to GEECV/SEN and A-S-C-O criteria. RESULTS: The study included 496 patients. The percentages of strokes caused by atherosclerosis and small vessel disease according to GEECV/SEN criteria were higher than the percentages for potential atherosclerotic stroke (A1) (14.1 vs. 11.9%; P=.16) and potential small vessel stroke (S1) (14.3 vs. 3%; P<.001). Cardioembolic stroke (C1) was more frequent (22.2 vs. 31%; P<.001). No differences between unusual cause of stroke and other potential causes (O1) were observed. Some degree of atherosclerosis was present in 53.5% of patients (A1, A2, or A3); 65.5% showed markers of small vessel disease (S1, S2, or S3), and 74.9% showed signs of cardioembolism (C1, C2, or C3). Fewer patients in the group without scores of 1 or 2 for any of the A-S-C-O phenotypes were identified as having a stroke of undetermined cause (46.6 vs. 29.2%; P<.001). The agreement between the 2 classifications ranged from κ<0.2 (small vessel and S1) to κ>0.8 (unusual causes and O1). CONCLUSION: Our results show that GEECV/SEN and A-S-C-O classifications are neither fully comparable nor consistent. Using the A-S-C-O classification provided additional information on co-morbidities and delivered a smaller percentage of strokes classified as having an undetermined cause.

[Multicystic Kidney: is there any new scientific evidence to recommend nephrectomy?]. / Riñón multiquístico: existe alguna nueva evidencia científica que recomienda la nefrectomía?

With the aim to create a scientific evidence of the convenience or not of removing the Multicystic Kidney (MK), a systematic review has been done over the last 20 years, selecting those articles with determinant criterions. Our experience has been also evaluated. We have obtained an evidence table of 1082 MK, with a follow-up from 2 to 7 years. No case degenerated. The complications were: urinary tract infection (UTI) in 5% and hipertensión (HTA) in 0.7%. In our serie (68 cases): nephrectomy was done in 10 cases. 82% completely involved (66.6% before 5 years and 15.6% from 5 to 15 years of follow-up). 18% involved partially. No case degenerated. The complications were UTI (6 cases) and HTA in one. Periodical ultrasound follow-up is our recommendation for MK due to the results of our serie and from the systematic review of the literature.

Riñón multiquístico: ¿existe alguna nueva evidencia científica que recomienda la nefrectomía? / Multicystic kidney: is there any new scientific evidence to recommend nefrectomy?

Con el fin de tratar de crear evidencia científica sobre la conveniencia o no de la extirpación del riñón multiquístico (RM), se ha realizado una revisión sistemática de la bibliografía de las últimas 2 décadas, seleccionando los estudios con determinados criterios. Asimismo se analiza nuestra casuística en los últimos 20 años. Se ha obtenido una tabla de evidencia con 1.082 casos de RM, con un seguimiento entre 2 y 7 años. Ningún caso malignizó. Las complicaciones han sido infección urinaria (IU) en un 5% e hipertensión arterial (HTA) en un 0,7%. En nuestra serie (68 casos) se realizó nefrectomía en 10 casos. El 82% desaparecieron totalmente (66,6% antes de los 5 años y 15,6% entre los 5 y 15 años de seguimiento). El 18% involucionó parcialmente. No ha aparecido ningún caso de malignización, limitándose las complicaciones a IU (6) e HTA en un caso. El seguimiento ecográfico periódico en el RM continúa siendo la aproximación terapéutica más razonable según los resultados de nuestra serie y de la revisión sistemática de la literatura relacionada (AU)

With the aim to create a scientific evidence of the convenience or not of removing the Multicystic Kidney (MK), a systematic review has been done over the last 20 years, selecting those articles with determinant criterions. Our experience has been also evaluated. We have obtained an evidence table of 1082 MK, with a follow-up from 2 to 7 years. No case degenerated. The complications were: urinary tract infection(UTI) in 5% and hipertensión(HTA) in 0.7%. In our serie (68 cases): nephrectomy was done in 10 cases. 82% completely involved (66.6% before 5 years and 15.6% from 5 to 15 years of follow-up). 18% involved partially. No case degenerated. The complications were UTI (6 cases) and HTA in one. Periodical ultrasound follow-up is our recommendation for MK due to the results of our serie and from the systematic review of the literature (AU)

[Diagnosis and surgical treatment for male pseudohermaphroditism in a multidisciplinary unit of intersexual conditions]. / Diagnóstico y tratamiento quirúrgico del pseudohermafroditismo masculino en una unidad multidisciplinaria de estados intersexuales.

The birth of a child with ambiguous genitalia represents a very stressing situation for the family, and afterwards has great social and psychological repercussion for the patient itself. Until now, the sex assignation is being done according to the phenotype. Now, with the molecular diagnosis of the genes that play a role in the sexual development, the assignation must also take into account the prognosis of response to androgens. The aim of this work is to review the 40 male pseudohermaphroditism cases controlled in our hospital and the genetic molecular diagnosis done in 19 cases, thus obtaining the certainty diagnosis. In 15 patients the mutations were located in the AR gene (androgen receptor). In 2 cases the mutation affected the SRD5A2 gene (deficiency of 5a-reductase) and in the other 2 cases it affected the HSD17BIII gene (deficiency of 17-ketoreductase). If the mutations affect the AR gene they must be assigned to the feminine sex, because of the impossibility of virilisation at puberty (lack of response to androgens). If the mutations are located in the other 2 genes they can be assigned to the masculine sex, since in puberty, they will present good response to androgens and will virilize. The molecular diagnosis offers us also the possibility to establish a prenatal diagnosis and to offer genetic advice.

[Treatment of proximal hypospadias: the onlay technique]. / [Tratamiento de los hipospadias proximales: técnica de "onlay"]

UNLABELLED: In 1987 Elder and Duckett published a modification of the Duckett technique for hypospadias repair, substituting the transverse preputial island flap for the onlay island. This modification preserves the urethral plate and has no circular anastomoses, the most common cause of fistulas and stenosis. MATERIAL AND METHODS: We present our experience in 67 cases with hypospadias (60 with chordee). The meatus was in the superior third of the penis in 15 cases, in the middle third in 29, at the base of the penis in 11, and interscrotal in 12 patients. Preoperative hormonal substitution was administer in 12 patients, correction of the chordee was possible in 66 cases, the urethral plate was dissected in 18 cases, and the Nesbit procedure in 16 cases. RESULTS: A good result was obtained in 59 cases a straight penis, meatus at the tip of the penis, good calibre of the urinary stream and a satisfactory esthetic result. Our rate of complication was of 12%, five fistulas, two partial deshicences of the preputioplasty and in one case a discrete chordee. CONCLUSIONS: We believe this is an surgical technique for one stage procedure in severe cases of proximal hypospadias with chordee with a good functional and esthetic result and few complications.

[Severe epispadias: the Mitchell's technique]. / Epispadias severos: técnica de Mitchell.

UNLABELLED: Epispadias associated or not to bladder extrophy is a congenital malformation with a difficult surgical correction. Mitchell published his technique in 1996, and it's based in the complete dissection of the uretheral band, ventral peneal skin and both corporas including their proximal insertion, that in next steps will be separated in all the length. These manoeuvres permit to: 1) Correct the dorsal incurvation; 2) Locate the urethra in a ventral position; 3) Locate the meatus at the tip of the penis with a vertical orientation. MATERIAL AND METHODS: We have performed these surgical procedure in 6 patients, 4 of them were epispadias (a 23 years old patient who had there surgical procedure, with persistent incurvation), the others two were associated with bladder extrophy, 3 had hormonal treatment previous surgery, due to a hypoplastic penis. In the two patients with bladder extrophy we used a labial mucosa graft sutured to the tubularized urethral plate to relocate the meatus at the tip of the penis. RESULTS: The esthetic results were good in all cases, 2 had a fistula that was corrected surgically.

[Transient ischemic attacks: risk factors, duration and neuroimaging in a series of 173 patients]. / Ataques isquémicos transitorios: factores de riesgo, duración y neuroimagen en una serie de 173 pacientes.

INTRODUCTION: The appearance of transient ischemic attacks (TIA) is an important sign of vascular risk. The maximum time the deficit lasts has been set arbitrarily at 24 hours. It is assumed that TIA does not entail permanent vascular lesions. PATIENTS AND METHODS: A retrospective review of the clinical records of patients diagnosed as suffering from TIA in our centre between 1996 and 1997. Analysis of associated risk factors (RF), duration and findings in neuroimaging. RESULTS: The clinical records of 173 patients (106 males) were examined. The RF identified were similar to those described for ischemic strokes. 45.6% of patients with a history of vascular pathologies received no preventative treatment. 58% of the TIA were resolved within the first 30 minutes and 71% within the first hour. Cranial CT was normal in 69%, showed old lesions in 26% and lesions that were compatible with the clinical signs of TIA in 5% (in the latter case the duration of the episodes was greater). CONCLUSIONS: TIA shares the same RF and aetiopathogenic mechanisms as ischemic stroke and should, therefore, be considered as such. There is a need to revise the concept of TIA paying special attention to the findings of neuroimaging or to establish duration limits that are better matched to the practical reality. TIA maintains a practical interest since it provides a simple method of identifying patients with a high vascular risk.