Endarterectomía de carótida bilateral en un mismo tiempo quirúrgico / Bilateral carotid endarterectomy at the same surgical time

Los pacientes con estenosis bilateral presentan una elevada incidencia de clínica hemisférica e infartos cerebrales en relación con la primera carótida y en espera de una segunda cirugía de la carótida contralateral estenótica. La endarterectomía de carótida bilateral en un mismo tiempo quirúrgico representa todo un reto para el cirujano vascular por las complicaciones que puede conllevar. Pero puede realizarse una correcta selección del paciente con bajo riesgo quirúrgico, un análisis de la localización y las características de las placas que provocan la estenosis, y una técnica analgésica que permita monitorear constantemente la disfunción cerebral y siga los principios técnicos. Este estudio tuvo el objetivo de asociar los criterios anteriores a un caso de la endarterectomía de carótida bilateral en un mismo tiempo quirúrgico. Se seleccionó un paciente masculino de 72 años que había sufrido ataques transitorios de isquemia sin secuelas neurológicas. Se realizó el procedimiento sin complicaciones perioperatorias ni posoperatorias, por lo que se propone como una alternativa segura a llevar a cabo en pacientes con estenosis bilateral(AU)

Patients with bilateral stenosis have a high incidence of hemispheric clinical and cerebral infarctions in relation to the first carotid and waiting for a second surgery of the stenotic contralateral carotid. Bilateral carotid endarterectomy at the same surgical time represents a challenge for the vascular surgeon because of the complications it can entail. But a correct selection of the patient with low surgical risk can be made, an analysis of the location and characteristics of the plaques that cause stenosis, and also an analgesic technique that allows constant monitoring of brain dysfunction and follows technical principles. This study aimed to associate the above criteria with a case of bilateral carotid endarterectomy at the same surgical time. A 72-year-old male patient who had suffered transient ischemic attacks without neurological sequelae was selected. The procedure was performed without perioperative or postoperative complications, so it is proposed as a safe alternative to be carried out in patients with bilateral stenosis(AU)

Indicadores de salud mental asociados a riesgo psicosocial laboral en un hospital público / Psychosocial stress among health care workers

Background: Health care workers are exposed to high stress levels and psychosocial risks. The imbalance between the invested efforts and received rewards acquires special importance in this setting. Aim: To assess the psychosocial risk level and its relationship with depression, distress and psychotropic drug use among health care workers. Material and Methods: Seven hundred eighty two workers (602 females; 180 males) answered self-administered questionnaires to measure psychosocial risk and mental health. Results: Twenty five percent of respondents used psychotropic drugs, 34% had a high level of distress and 23% had depressive symptoms. They also reported a low level of decisional latitude (48%), high emotional demands (47%), low social support (41%) and a significant effort-reward imbalance (67%). Those exposed to job strain (high demands and low decisional latitude), iso-strain (job strain plus low social support), and effort-reward imbalance were twice as likely to suffer symptoms of depression and elevated distress compared to non-exposed subjects. Conclusions: There are high levels of psychosocial stress among health care workers.

Ataque transitorio de isquemia, el heraldo del ictus / Transient ischemic attack: the herald of stroke

Introducción: el ataque transitorio de isquemia constituye una parte fundamental de la enfermedad cerebrovascular, en muchas ocasiones no bien diagnosticado por su corta duración, lo difícil de ver y sus variadas manifestaciones clínicas. Esta investigación se realizó con el propósito de caracterizar a los pacientes con ictus isquémico y previo ataque transitorio de isquemia, atendidos en el servicio de consulta externa no. 3 del Instituto de Neurología y Neurocirugía (INN) entre febrero de 2006 y noviembre de 2009. Métodos: se realizó un estudio observacional, descriptivo en 50 pacientes que, previo al ictus isquémico, habían presentado cuadros de ataques transitorios de isquemia. Se describieron las manifestaciones clínicas de presentación de estos, se analizaron los factores de riesgo, el territorio vascular afectado y el tiempo transcurrido entre el ataque transitorio de isquemia y el ictus isquémico. Resultados: en el 100 porciento de los pacientes, los ictus isquémicos dañaron el mismo territorio vascular afectado por los ataques transitorios de isquemia que le antecedieron. Conclusiones: quedó demostrada la importancia del ataque transitorio de isquemia como piedra angular fundamental en la enfermedad cerebrovascular. El infarto cerebral ocurrió con más frecuencia en los primeros meses secundarios al ataque transitorio de isquemia. La hipertensión arterial, los inadecuados hábitos de vida y la diabetes mellitus, constituyeron los principales factores de riesgo en la población estudiada

Introduction: transient ischemic attack constitutes a major part of cerebrovascular disease. In many cases it is not well diagnosed, due to its short duration, its many clinical manifestations and the difficulty to spot it. This study was conducted with the purpose of characterizing patients with ischemic stroke and a previous transient ischemic attack cared for at Outpatient Service No. 3 of the Institute of Neurology and Neurosurgery (INN) between February 2006 and November 2009. Methods: an observational descriptive study was conducted with 50 patients who had had a transient ischemic attack before they had their stroke. A description was made of the clinical manifestations at presentation, and an analysis was performed of the risk factors, the affected vascular territory, and the time elapsed between the transient ischemic attack and the ischemic stroke. Results: in 100 porciento of the patients the vascular territory affected by the ischemic stroke was the same as that affected by the preceding transient attacks. Conclusions: it was demonstrated that the transient ischemic attack is a fundamental component of cerebrovascular disease. Cerebral infarction was more frequent during the first months following the transient ischemic attack. Arterial hypertension, inadequate life styles and diabetes mellitus were the main risk factors in the population studied

Accidente cerebrovascular isquémico en mayores de 80 años / Acute ischemic stroke in patients aged 80 or older

En los pacientes de edad avanzada, el perfil de factores de riesgo vascular y el subtipo de accidente cerebrovascular (ACV) es diferente en comparación con pacientes más jóvenes. El objetivo del presente trabajo fue describir el perfil de factores de riesgo y subtipo de ACV isquémico en nuestra población de pacientes ancianos. Incluimos a pacientes mayores de 80 años con diagnóstico de ACV isquémico y ataque isquémico transitorio (AIT) entre junio de 2003 y junio de 2006. De 535 pacientes con eventos cerebrovasculares isquémicos, en 366 casos el diagnóstico fue de ACV y 169 de AIT. El 33.5% (179 pacientes) fueron mayores de 80 años. La edad media fue de 84.4 ± 4.4 años. Los factores de riesgo más frecuentes fueron: hipertensión arterial 82.7%, dislipemia 40.2% y fibrilación auricular 24.6%. El subtipo de ACV que se presentó con mayor frecuencia fue la enfermedad de pequeñas arterias en un 41.7%, seguido por el evento cardioembólico en el 19.7%, enfermedad de gran arteria 6%, otras causas en el 0.8%. De los factores de riesgo vasculares tradicionales, los más significativos fueron hipertensión e hipercolesterolemia. Estos datos son coincidentes con estudios epidemiológicos previos y explican la mayor incidencia de infartos lacunares.

Young and old age stroke groups have different vascular risk profiles for cerebral ischemic events. The objective of the study was to describe the risk factor profile and stroke subtype in this population of very elderly people. We included patients over 80 years old with diagnosis of ischemic stroke and transient ischemic attack registered between June 2003 and June 2006. We described the demographic data and subtype of ischemic stroke. Of 535 patients with cerebrovascular ischemic events, the final diagnosis was stroke in 366 cases and transient ischemic attack in 169. Of these patients 33.5% were over 80 years old (179). The mean age was 84.4 ± 4.4 years. The most frequent risk factors were: hypertension 82.7%, dyslipemia 40.2% and atrial fibrillation 24.6%. Stroke subtype was: large artery disease 6%, cardioembolic stroke 19.7%, small artery disease 41.7%, and other causes 0.8%. Among traditional risk factors for stroke in our very elderly patients, the most significant were hypertension and dyslipemia. This agrees with previous epidemiological studies. The high incidence of small artery disease in our patients may be explained by the risk factor profile.

Prevalence of cardiovascular conditions and health services utilization in Puerto Rico, 2001

OBJECTIVE To study the prevalence of cardiovascular conditions and health services utilization in Puerto Rico, 2001. METHODS All medical claims for coronary heart disease (ICD-9 410-414), hypertension (ICD-9 401-405), congestive heart failure (ICD-9 428) and cerebrovascular accidents and transient ischemia (ICD-9:430-438.9) submitted for reimbursement purposes to an insurance company (private and public sector) in Puerto Rico in 2001 were identified. Prevalence and medical care utilization concerning cardiovascular conditions was estimated with 95% confidence. RESULTS Overall prevalence of cardiovascular conditions was 13.5% (95% CI: 11.68%-15.44%), being larger in the private sector (16.0%; 95% CI: 15.98%-16.08% vs. 11.7%; 95% CI: 11.62%-11.77%). Although in both sectors prevalence increased with age, at same age groups was two times higher in the private sector. Hypertension was the most prevalent condition (9.7; 95% CI: 8.14%-11.41%) being higher in females (10.4; 95% CI: 10.37%-10.51%) than in males (8.9; 95% CI: 8.81%-8.96%). The health service utilization (physician's office visits, emergency room visits, and hospital admissions) was higher in males. However, it varies by sectors. CONCLUSIONS Significant difference exists in the prevalence of cardiovascular conditions and health services utilization among private and public sectors in Puerto Rico. The observed differences among the private and public populations imply that there are factors such as socioeconomic status, education, lifestyles, environmental hazards in neighborhoods, and health habits that could be involved in the differences

Crisis isquémicas transitorias en Chile y su relación con el patrón de enfermedad cerebrovascular chileno / Transient ischemic attacks in Chile and it relation with chilean cerebrovascular disease standard

Patients and methods: One hundred forty nine patientes admitted to a Neurology service of a public hospital in Santiago, with an acute stroke, were studied. Patients and close relatives were interrogated about previous symptoms of TIA using a structured questionnaire. Results: One hundred nine patients had an ischemic and 40 patients a hemorrhagic stroke. Twenty patients with ischemic stroke had a history of TIA (18 percent). Fifteen out of 74 patients without a cardiac source of emboli (20 percent) and five out of 354 cases with an embolic source (14 percent) had a TIA preceding their stroke. Three out of 40 patients (8 percent) with hemorrhagic stroke had a history of TIA. Conclusions: This study does not support nor reject the hypothesis of a Chilean pattern of cerebrovascular disease unlike that found in Northern Caucasians

Estudio epidemiológico de las enfermedades neurológicas en Santiago Metropolitano, Chile / Epidemiological study of neurological diseases in Metropolitan Santiago, Chile

Se formó un equipo multidisciplinario con en el fin de determinar la prevalencia de las principales enfermedades neurológicas en Santiago, Chile. Se utilizó una muestra de 1.710 hogares encuestados a 7.195 personas. Se aplicó el protocolo elaborado por la OMS y describimos el método utilizado en detalle. La prevalencia de los desórdenes neurológicos fue de 102,4 por mil, distribuyéndose en un 62% en el sexo femenino. Los cuadros de mayor prevalencia fueron la cefalea (19,2 por mil), epilepsia (16,5 por mil) y migraña (14,9 por mil). En cuanto a los cuadros vasculares representan todos por AVC (5,9 por mil), TIA (2,9 por mil). En los relativos a la infancia y adolescencia destacan la convulsión febril con un 38,1 por mil, trastornos del aprendizaje con 20,6 por mil y trastornos del lenguaje con 5,8 por mil