Flow recovery after posterior clinoidectomy for surgical clipping of anterior choroidal aneurysm

Inadvertent flow alterations in the parent artery during microsurgical clipping might produce postoperative ischemic complications. Intraoperative recognition of such alterations and its correction might improve operative outcomes in these patients. We present the case of a thirty-five-year-old male with an incidental small left anterior choroidal aneurysm. Microsurgical clipping induced an external compression of the anterior choroidal artery against the posterior clinoidal process which was identified in situ through surgical exploration and the loss of arterial doppler signal in the vessel. After failed attempts at clip repositioning, a posterior clinoidectomy was performed to decompress the artery. This resulted in arterial flow recovery. The aneurysm was successfully treated, and a severe ischemic complication was likely avoided. This intraoperative phenomenon has not yet been described in the literature.

Descriptive study of the Specialized Care of the Spanish Health System / Estudio descriptivo de la Atención Especializada del Sistema Sanitario de España

ABSTRACT OBJECTIVE The objective of this study is to analyze the trend of the Key Indicators of the National Health System of Spain and its autonomous communities, related to Specialized Care, from the publication of the Law of Cohesion and Quality. METHODS This is an ecological study of temporary series of Spain and its autonomous communities from 2003 to 2014. We have analyzed 10 indicators related to Specialized Care (percentage of expenditure, professionals, waiting lists, surgical activity, average duration, infections, and mortality) using the Prais-Winsten regression method. We have obtained data from the health information system of the Spanish Ministry of Health, Social Services, and Equality. RESULTS Specialized care expenditure (APC = 0.059, 95%CI 0.041-0.074), number of medical professionals (APC = 0.0006, 95%CI 0.0003-0.0009) and nursing professionals (APC = 0.001, 95%CI 0.0005-0.0016), hospital infections (APC = 0.0003, 95%CI 0.0002-0.0004), and in-hospital mortality (APC = 0.0008, 95%CI 0.0006-0.001) had an increasing trend in Spain. Average duration presented a decreasing trend (APC = -0.0017, 95%CI -0.002- -0.0014). The trend of waiting lists (specialized appointment and non-urgent surgical interventions) was static. The trend of these indicators varied in the Autonomous Communities. CONCLUSIONS We have observed a non-compliance with the principles of equity and quality of the services offered. Increased aging, technological development, and inadequate strategies taken to reduce health costs may be the main causes.

RESUMEN OBJETIVO Analizar la tendencia de los Indicadores Clave del Sistema Nacional de Salud de España y sus comunidades autónomas, relacionados con la Atención Especializada, desde la publicación de la Ley de Cohesión y Calidad. MÉTODOS Estudio ecológico de series temporales de España y sus comunidades autónomas desde 2003 hasta 2014. Se analizaron 10 indicadores relacionados con Atención Especializada (porcentaje de gasto, profesionales, listas de espera, actividad quirúrgica, estancia media, infecciones y mortalidad) utilizando el método de auto-regresión de Prais-Winsten. Los datos se obtuvieron del sistema de información sanitaria del Ministerio de Sanidad, Servicios Sociales e Igualdad español. RESULTADOS Existió una tendencia creciente del gasto en atención especializada (APC = 0,059; IC95% 0,041-0,074), número de profesionales de medicina (APC = 0,0006; IC95% 0,0003-0,0009) y enfermería (APC = 0,001; IC95% 0,0005-0,0016), infecciones hospitalarias (APC = 0,0003; IC95% 0,0002-0,0004) y mortalidad intrahospitalaria (APC = 0,0008; IC95% 0,0006-0,001) en España. La estancia media presentó una tendencia decreciente (APC = -0,0017; IC95% -0,002- -0,0014). La tendencia de las listas de espera (consulta especializada e intervenciones quirúrgicas no urgentes) fue estática. La tendencia de estos indicadores varió en las Comunidades Autónomas. CONCLUSIONES Se observa un incumplimiento de los principios de equidad y calidad de las prestaciones ofrecidas. El aumento del envejecimiento, el desarrollo tecnológico y estrategias poco adecuadas tomadas para reducir los costes sanitarios pueden ser las principales causas.

Síndrome metabólico e inflamación en adultos: un estudio poblacional / Association of C reactive protein levels with metabolic syndrome in adults: a population-based study

Background: Metabolic syndrome is highly prevalent among adults in Chile and represents a health risk. Aim: To determine the relationship between metabolic syndrome (MetS) and its components, with C reactive protein levels (CRP) as an inflammation marker. Material and Methods: The population studied consisted of 736 individuals born in a hospital from Valparaíso Region, aged between 32-38 years at the time of the study. MetS was identified according to the Adult Treatment Panel (ATP) III guidelines and inflammation was measured using ultra-sensitive CRP. This parameter was classified as normal for values from 0 to 3 mg/L, high for values from 3.01 to 10 mg/L and very high for values > 10 mg/L. Results: Median CRP was in the normal range (1.9 mg/L, interquartile range 0.7-5.2) and was higher among women than men (2.2 and 1.4 mg/L respectively, p < 0.01). Twenty seven percent of participants had MetS. One-fourth had high blood glucose values, one-third had high triglyceride levels and 28% had blood pressure values over those established as normal in MetS. Elevated waist circumference (WC) and low HDL cholesterol were found among almost 50% of participants. A relationship between MetS and high CRP was only found among men with an Odds ratio (OR) of 2.04 (95% confidence intervals (CI): 1.11-3.73). The same association was observed for high triglyceride levels with an OR of 2.02 (CI: 1.17-3.49) and high WC with an OR of 3.89 (CI: 2.06-7.36). Among women, the only relationship observed was between abdominal obesity and very high CRP with an OR of 2. 65 (CI: 1.20-5.84). Conclusions: Metabolic syndrome, high triglyceride levels, and abdominal obesity were associated with inflammation only in men.

Estudio prospectivo de microcirugía experimental en neurorrafias con tensión / Prospective study of experimental microsurgery in stressor neurorefias

Objetivo: analizar en forma prospectiva la viabilidad de una neurorrafia mediante técnicas microquirúrgicas, en un modelo experimental con diferentes grados crecientes de pérdida de tejido nervioso periférico. Introducción: Para reparar un nervio periférico que tiene pérdida de tejido, clásicamente este defecto se suple por un injerto autólogo. Sin embargo, se produce comorbilidad en el sitio dador y sus resultados siempre son inferiores a la sutura directa sin tensión. Existe una opción para evitar el uso de injertos cuando el defecto es escaso, colocando puntos epineurales distales (PED) a la neurorrafia, eliminando así la tensión en dicha unión. Materiales y métodos: Se utilizaron 40 ratas Wistar, dividiéndose aleatoriamente en 4 grupos. Bajo anestesia general se abordó al nervio ciático y se efectuó sección trasversal y sutura simple con nylon 10.0 al grupo A (control). Se realizó exéresis de 2 mm de nervio al grupo B, de 4 mm al grupo C y de 6 mm al grupo D; para luego realizar PED. Se realizaron determinaciones de índice de función ciático (análisis de las huellas), velocidad de conducción (electrofisiología) e índice de regeneración (histopatología) para evaluar la viabilidad de la neurorrafia. Se confrontaron los diferentes grupos planteados con ANOVA, considerando significativo un valor de p < 0.05. Conclusiones:La neurorrafia simple no evidencia diferencias estadísticamente significativas con la reparación de 2mm de pérdida de tejido mediante PED en la rata Wistar.

Objective: To analyze, in a prospective way, the viability of a neurorraphy by a microsurgical technique, in an experimental model with different increasing grades of peripheral nerve tissue loss.Introduction: In order to repair a peripheral nerve that has experienced some grade of substance loss, autologous grafts have been used by most neurosurgeons. However, comorbidities in the donor site are produced, and the results obtained are always inferior compared to the ones achieved by using a direct suture without tension. There is an option to avoid using grafts when the defect is scarce, which is the confection of distal epineural sutures (DES) to the neurorraphy, discarding any tension in this junction site.Materials and methods: We have used 40 Wistar rats, randomly separated into 4 groups. In ‘Group A’, under complete anesthesia, the sciatic nerve was dissected and transversely sectioned and then sutured with a 10.0 nylon suture. Furthermore we made a 2 mm extirpation in ‘Group B’, a 4 mm one in ‘Group C’ and a 6 mm one in ‘Group C’, in order to perform a DES technique. Our group also ran a sciatic nerve function test (footprint analysis), conduction speed (by electrophysiology), and even determined the nerve regeneration index (histopathology) to estimate the viability of the neurorraphy. The different groups were confronted with ANOVA, considering a value of p<0.05 as statistically significative.Conclusions: Simple neurorraphy exposed no statistically significative differences in comparison to the reparation of a 2 mm tissue loss with DES technique, in the Wistar rat model.