Leukoaraiosis May Confound the Interpretation of CT Perfusion in Patients Treated with Mechanical Thrombectomy for Acute Ischemic Stroke.

BACKGROUND AND PURPOSE: Leukoaraiosis frequently coexists in patients with acute stroke. We studied whether leukoaraiosis could confound the interpretation of CTP findings in patients treated with mechanical thrombectomy. MATERIALS AND METHODS: We analyzed 236 patients with stroke treated with mechanical thrombectomy and studied with CTP, of whom 127 (53.8%) achieved complete reperfusion. Periventricular white matter hyperintensities on MR imaging and hypodensities on NCCT were assessed through the Fazekas score. CTP-predicted nonviable tissue was defined as relative CBF <30%, and final infarct volume was quantified in DWI. We estimated mean MTT, CBV, and CBF in the asymptomatic hemisphere. In patients achieving complete reperfusion, we assessed the accuracy of nonviable tissue to predict final infarct volume using the intraclass correlation coefficient across periventricular hyperintensity/hypodensity Fazekas scores and variable relative CBF cutoffs. RESULTS: MTT was longer (Spearman ρ = 0.279, P < .001) and CBF was lower (ρ = -0.263, P < .001) as the periventricular hyperintensity Fazekas score increased, while CBV was similar across groups (ρ = -0.043, P = .513). In the subgroup of patients achieving complete reperfusion, nonviable tissue-final infarct volume reliability was excellent in patients with periventricular hyperintensity Fazekas score grade 0 (intraclass correlation coefficient, 0.900; 95% CI, 0.805-0.950), fair in patients with periventricular hyperintensity Fazekas scores 1 (intraclass correlation coefficient, 0.569; 95% CI, 0.327-0.741) and 2 (intraclass correlation coefficient, 0.444; 95% CI, 0.165-0.657), and poor in patients with periventricular hyperintensity Fazekas score 3 (intraclass correlation coefficient, 0.310; 95% CI, -0.359-0.769). The most accurate cutoffs were relative CBF <30% for periventricular hyperintensity Fazekas score grades 0 and 1, relative CBF <25% for periventricular hyperintensity Fazekas score 2, and relative CBF <20% for periventricular hyperintensity Fazekas score 3. The reliability analysis according to periventricular hypodensity Fazekas score grades on NCCT was similar to that in follow-up MR imaging. CONCLUSIONS: In patients with stroke, the presence of leukoaraiosis confounds the interpretation of CTP despite proper adjustment of CBF thresholds.

Evolución histórica de la Enfermedad de Chagas. Prevención y Tratamiento / No disponible

La enfermedad de Chagas es todavía un importante problema de salud pública en América Latina, donde afecta especialmente a las personas con menos recursos económicos de las áreas rurales. Fue descubierta en 1909 por el médico brasileño Carlos Chagas y, aunque durante muchos años los resultados obtenidos en la lucha contra la enfermedad fueron limitados, a partir de 1991, gracias a las iniciativas llevadas a cabo por los países del Cono Sur, se logra-ron avances importantes. La prevención de la enfermedad se basa en tres pila-res fundamentales, la lucha contra el vector, la prevención centrada en los mecanismos de transmisión y la mejora de las viviendas de las áreas rurales y la realización precoz del diagnóstico y el tratamiento. En cuanto al tratamiento, se siguen utilizando toda-vía dos preparados, comercializados en los años 60-70 del siglo pasado, Nifurtimox y Benznidazol, que presentan con frecuencia reacciones adversas. Sería fundamental, disponer de preparados con mayor eficacia, menor coste y con menos efectos adversos

Chagas disease still is an important problem of public health in Latin America. It especially affects people in the rural areas and with restricted economic resources.Chagas disease was first discovered by a Brazilian medical doctor named Carlos Chagas in 1909. In spite of limited results for years, from 1991 on, and thanks to initiatives taken by the Southern Cone countries, some important advantages were obtained. Prevention of this disease is based on three fundamental pillars: fight against the vector; education of population regarding the different mechanisms of transmission and the symptoms presented by the disease.These educational measures should be complement-ed by the improvement of the housing in the rural areas and the early diagnosis and treatment.Regarding treatment, two preparations are still in use since the ́60 and ́70 decades of the last century: Nifurtinox and Benznidazul. Both present frequent adverse reactions. It would be of fundamental impor-tance to count on medications that would be more efficient, less expensive and with less adverse effects

[Evolution of treatment of syphilis through history]. / Evolución del tratamiento de la sífilis a lo largo de la historia.

In this article, we present a historical revision of syphilis treatment since the end of the XV century up until the current days. For centuries, it was understood that syphilis had been brought to Spain by Columbus after coming back from America. It became an epidemic soon after. Later on, it was spread all over Europe. The chronologic and geographic origin of this illness have been debated in recent years, however, there has been no agreement about it as yet. Mercury was the main used therapy for four and a half centuries, until the discovery of penicillin in 1943. This discovery changed the therapeutic approach to syphilis since then. Other remedies were used during this period. Guaiacum was one of them, but it was dismissed in the mid-sixteenth century. Iodides were also used, especially in the tertiary symptoms of the disease. The discovery of arsphenamine (Salvarsan) at the beginning of the XX century, used by itself at its onset and associated to mercury or bismuth later on, was a significant therapeutic contribution. Bismuth was in itself a great therapeutic asset. It displaced the use of mercury in an important way until 1943, when the appearance of penicillin became the treatment of choice.

El tifus epidémico. Prevención y tratamiento a través de la historia / No disponible

El tifus epidémico, está causado por Rickettsia Prowazekii, y es transmitido por el piojo del cuerpo. Durante siglos, ha producido epidemias devastadoras, considerándose que esta infección ha causado más muertes que todas las guerras juntas. La primera epidemia de la que existe constancia tuvo lugar durante el cerco de Granada por los Reyes Católicos, en 1489. Desde entonces hasta el siglo XX, ha acompañado en numerosas ocasiones a los ejércitos, habiendo sido la enfermedad decisiva en algunos casos, para el resultado de los conflictos, debido al número de fallecidos que ocasionó. Algunas situaciones concretas, como guerras, campamentos de refugiados, hacinamiento e inadecuadas condiciones higiénicas, favorecen el desarrollo de la enfermedad. El descubrimiento por Charles Nicolle (1856-1936) del vector de transmisión, el piojo del cuerpo, supuso un avance sustancial en el control de la misma y la llegada de los antibióticos hizo posible su curación

Epidemic typhus is caused by Rickettsia prowazekii and it is transmitted through body lice. For centuries, due to devastating epidemics it has caused more casualties than all wars known in humanity. The first epidemic of which we have record, took place during the siege of Granada by the Spanish Catholic King and Queen in 1489. Since then, and up to the 20th. century, typhus has been linked to armies in combat. Given the large number of deaths caused by this disease, its presence has been crucial in the results of certain conflicts. Certain situations favor the development of typhus epidemics such as wars, overcrowding, refugee camps and inadecuate hygienic conditions. The discovery by Charles Nicolle (1856-1936) of the transmission mechanism by body lice, was a substantial step towards controlling the disease. The appearance of antibiotics determined its definite healing

La brucelosis humana, ayer y hoy / No disponible

La brucelosis es una zoonosis distribuida por la mayor parte del mundo. En España tuvo una incidencia importante, estimándose en 5.000 los casos anuales al final de la primera mitad del s.XX, llegando a 8.692 casos en 1984, lo que hizo que se pusieran en marcha programas de control, que contribuyeron a reducir el número de casos, hasta los 103 declarados en 2013. La enfermedad, ha tenido una importante repercusión sanitaria y socioeconómica por la afectación del hombre y de los animales. Su pronóstico en general, ha sido bueno, salvo complicaciones. El tratamiento en las primeras décadas del s. XX, era básicamente sintomático, al no disponerse de ningún remedio efectivo. Posteriormente, los arsenicales, las sales de oro y la vacuna intravenosa, entre otros, tuvieron una aportación destacable, hasta la llegada de los antibióticos, que supuso un cambio radical en la evolución de la enfermedad (AU)

Brucellosis is a zoonosis spread throughout the world. It had a rather important incidence in Spain. An estímate of of 5000 cases per year took place in Spain during the first half of the 20th. century, reaching a peak of 8,692 in 1984. This fact promoted the establishment of control mechanisms that contributed to gradually diminish the number of cases to 103 in 2013. Brucellosis has had a considerable importance both in the health and socioeconomic fields due to vulnerability in humans and animals. The disease had a good prognosis, putting aside possible complications. Treatment, in the first decades of the 20th. Century was basically symptomatic, given the lack of effective remedies. Later, arsenic components, gold salts and the intravenous vaccine, among others, had a relevant importance in treatment until the appearance of antibiotics. These had a radical influence in the natural evolution of the disease (AU)

La tos ferina, pasado y presente / No disponible

La tos ferina es una enfermedad infecciosa, desconocida durante siglos, a la que no se hace referencia en la Grecia clásica y en Roma, habiéndose realizado su primera descripción en el s. XVI. En los últimos años, se ha observado un incremento en el número de casos, incluso en países que han logrado buenas en lactantes, especialmente en aquellos que no han iniciado o completado la primovacunación, ocupando de acuerdo con la OMS, el quinto lugar entre las causas de muerte prevenibles por vacuna. Aunque se dispone de una profilaxis eficaz desde hace más de medio siglo, no se ha logrado aún el control de la enfermedad, por lo que se han propuesto algunas estrategias, como la vacunación de adolescentes y adultos, de la embarazada y de los contactos del lactante, con el fin contribuir a mejorar el control de la misma

The whooping cough is an infectious disease. Unknown for centuries, there are no references of this disease in classic Greece nor in Rome, and its first description appears only in the WVI century. There has been an increase in the number of cases in the latter years, even in countries with good vaccine - coverage. This disease presents a high mortality rate in infants, especially in those that have not started or completed primal vaccination. According to WHO, this disease is fifth among the different causes of death that could be prevented by the use of the vaccine. In spite of having and efficient prophylaxis for oven fifty years, control of the disease has not been yet achieved. For this reason, some strategies have been proposed such as vaccination of adolescents and adults, pregnant women, and those in contact with infants so that these may contribute to the control of the disease

Long-term outcome in heart transplant patients with pretransplant malignancies.

INTRODUCTION: Neoplasms have classically been considered a contraindication for heart transplantation (HT) because of the possibility of recurrence during immunosuppressive therapy. There are few cases of patients who suffered a pretransplant malignancy (PTM); however the appropriate interval free of a malignancy (IFoM) before heart transplantation is unclear. Our study sought to determine the long-term outcomes after transplantation among patients who had suffered a prior neoplasm compared with our overall cohort. METHODS: This retrospective, single-center study included 595 heart transplant recipients ungrafted between 1991 and 2009. We determined PTM location, histology, and IFoM. We examined donor and recipient factors and post-HT data of rejections, infections, neoplasms, and survival associated with a poor prognosis. RESULTS: Twelve patients with different types, locations, and histological grades of PTM represented 66.7% women versus 16.1% women in the overall series (P<.01). There were no differences in recipient age or clinical characteristics (diabetes mellitus, arterial hypertension, previous renal failure, or New York Heart Association class), number of emergency cases, or graft ischemia time. Mean IFoM was 114.3 months (range=5.3-350.4). After heart transplantation, there were no significant differences between the number of infections (47.9%; n=[279] vs 33.3% n=4; P=.39), rejection episodes (44.4% [259] vs 50% [6], P=0.77) or post-HT malignancies (12.2% [70] vs 0%, P=0.37) between the overall series and the patients with PTM. None of the patients with PTM suffered a recurrence of the neoplasm. Actuarial survivals at 1, 3, and 5 years were 82%, 76%, and 70% among patients without PTM and 75%, 75%, and 56% among those with PTM (P=.70). CONCLUSION: Patients with PTM and an appropriate IFoM with regard to tumor lineage showed similar rates of survival and complications as those of the overall series. This series suggested that appropriately selected patients with a cured PTM can be candidates for HT.