Clasificación del patrón transversal de las fracturas de la cabeza del radio tipo Mason II y su utilidad en la osteosíntesis mediante técnica artroscópica. Estudio anatomoquirúrgico / Classification of the transverse pattern of Mason II radial head fractures and its usefulness in arthroscopic osteosynthesis. Anatomo-surgical study

Objetivo: La reducción y fijación de la fractura de la cabeza del radio tipo MasonII asistida por artroscopia es una técnica válida que proporciona buenos resultados. El objetivo de este estudio es llamar la atención sobre la utilidad de la localización de la fractura en la cabeza del radio en cuadrantes definidos con respecto a la tuberosidad bicipital mediante la TC. Ello ayudaría a planificar la posición del antebrazo óptima para acceder a cada cuadrante y prever las dificultades específicas de cada uno. Material y método: Se ha procedido a la disección de 4 especímenes de cadáver criopreservado. Hemos dividido la cabeza del radio en 4 cuadrantes con respecto a la tuberosidad bicipital objetivando el cambio de posición en pronación y en supinación máxima con respecto a la cavidad sigmoidea menor y a las estructuras neurovasculares. Resultados: La cabeza del radio se desplaza con la pronosupinación, por lo que existen áreas de convergencia entre los distintos cuadrantes. El cuadrante1 se aborda en supinación por un portal anteromedial. El cuadrante2 se aborda en pronación máxima mediante un portal lateral. El cuadrante3 se puede abordar a través de portales laterales, con el antebrazo en posición neutra y en pronación. El cuadrante4 es accesible con el antebrazo en posición neutra y en supinación a través de un portal lateral. Conclusiones: Según la localización de la fractura en la cabeza del radio con respecto a la tuberosidad bicipital, necesitaremos acceder por un portal artroscópico determinado, siendo los cuadrantes mediales (anteromedial y posteromedial) los más exigentes técnicamente

Objective: The management of MasonII fracture pattern assisted by arthroscopy is a valid technique that provides good results. The objective of this study was to draw attention to the usefulness of the location of the fracture in the head of the radius in defined quadrants with respect to the bicipital tuberosity through CT. This would help to plan the optimal forearm position to access each quadrant and foresee the specific difficulties of each one. Material and method: We dissected 4 specimens of cryopreserved cadaver. We divided the radial head into 4 quadrants with regard to the bicipital tuberosity, objectifying the change of position in pronation and maximum supination with respect to the sigmoid cavity and neurovascular structures. Results: The head of the radio moves with pronosupination, so there are areas of convergence between the different quadrants. Quadrant1 is approached in supination via an anteromedial portal. Quadrant2 is approached in maximum pronation through a lateral portal. Quadrant3 can be approached through lateral portals, with the forearm in neutral position and in pronation. Quadrant4 is accessible with the forearm in a neutral position and in supination through a lateral portal. Conclusions: Depending on the location of the fracture in the head of the radius with respect to the bicipital tuberosity, we will need access through a specific arthroscopic portal, with the medial quadrants (anteromedial and posteromedial) being the most technically demanding

Classification of the transverse pattern of Mason II radial head fractures and its usefulness in arthroscopic osteosynthesis. Anatomo-surgical study. / Clasificación del patrón transversal de las fracturas de la cabeza del radio tipo Mason II y su utilidad en la osteosíntesis mediante técnica artroscópica. Estudio anatomoquirúrgico.

OBJECTIVE: The management of MasonII fracture pattern assisted by arthroscopy is a valid technique that provides good results. The objective of this study was to draw attention to the usefulness of the location of the fracture in the head of the radius in defined quadrants with respect to the bicipital tuberosity through CT. This would help to plan the optimal forearm position to access each quadrant and foresee the specific difficulties of each one. MATERIAL AND METHOD: We dissected 4 specimens of cryopreserved cadaver. We divided the radial head into 4 quadrants with regard to the bicipital tuberosity, objectifying the change of position in pronation and maximum supination with respect to the sigmoid cavity and neurovascular structures. RESULTS: The head of the radio moves with pronosupination, so there are areas of convergence between the different quadrants. Quadrant1 is approached in supination via an anteromedial portal. Quadrant2 is approached in maximum pronation through a lateral portal. Quadrant3 can be approached through lateral portals, with the forearm in neutral position and in pronation. Quadrant4 is accessible with the forearm in a neutral position and in supination through a lateral portal. CONCLUSIONS: Depending on the location of the fracture in the head of the radius with respect to the bicipital tuberosity, we will need access through a specific arthroscopic portal, with the medial quadrants (anteromedial and posteromedial) being the most technically demanding.

Infecciones necrosantes de partes blandas atendidas en un servicio de urgencias de tercer nivel: evolución y correlación con la escala laboratory risk indicator for necrotizing fasciitis (LRINEC) / Necrotizing fasciitis attended in the Emergency Department in a tertiary Hospital: evaluation of the LRINEC scale

Objetivo. Describir la mortalidad y las complicaciones de pacientes atendidos en urgencias, con diagnóstico de infección necrosante de partes blandas (INPB) y su correlación con la escala Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC). Método. Estudio observacional retrospectivo con inclusión de pacientes con diagnóstico de INPB en urgencias de un hospital terciario durante 7 años. Los resultados se muestran como mediana, rango intercuartílico y rango absoluto para las variables cuantitativas. En el caso de las variables cualitativas, como frecuencias absoluta y relativa. La comparación se ha llevado a cabo mediante comparación post-hoc a partir de un análisis ANOVA con aproximación no paramétrica. Las comparaciones entre grupos de LRINEC en las variables cualitativas se han realizado con la prueba exacta de Fisher. Resultados. Se identificaron 24 pacientes con edad media de 51,9 años. La escala LRINEC se determinó en 21 pacientes: en 10 indicó bajo riesgo (<6), en 4 riesgo intermedio (6 o 7) y en 7 alto riesgo (≥8). La tasa de amputación en riesgos bajo, intermedio y alto fue del 10, 25 y 66%, respectivamente, con una mortalidad del 4,2%. Se observa un aumento en la estancia hospitalaria entre los niveles bajo y alto de la escala (p=0,007). Conclusiones. En general no se ha podido constatar un cambio en el pronóstico entre los niveles medio y alto de la escala LRINEC. Pero sí entre la estancia hospitalaria entre el nivel bajo y el alto, triplicando prácticamente la mediana de días de estancia hospitalaria (AU)

Aim. To describe mortality and complications of patients seen in the emergency room, diagnosed with necrotizing soft tissue infection (NSTI) and the correlation of such complications with the Laboratory Risk Indicator for Necrotizing fasciitis scale (LRINEC). Methods. Retrospective observational study including patients with a diagnosis of NSTI in the emergency room of a tertiary hospital over 7 years. The results are shown as median, interquartile range and absolute range for quantitative variables. In the case of qualitative variables, the results are shown as absolute and relative frequency. The comparison between the categories of the LRINEC scale was performed through a post-hoc comparison from a non-parametric ANOVA analysis. Comparisons between LRINEC groups in the qualitative variables were performed using Fisher's Exact test. Results. 24 patients with a mean age of 51.9 years were identified. The LRINEC scale was used on 21 patients: in 10, the value indicated low risk (<6), in 4 it indicated intermediate risk (6 or 7) and in 7 it indicated high risk (≥8). The amputation rate in patients with low, intermediate and high risk was 10%, 25% and 66% respectively with a mortality of 4.2%. There was an increase in hospital stay between the low and high level of the scale (p=0,007). Conclusions. In general, a change in the prognosis between the medium and high levels of the LRINEC scale could not be recorded, but was recorded in hospital stay between the low and the high level, practically tripling the median of days of hospital stay (AU)

Necrotizing fasciitis attended in the Emergency Department in a tertiary Hospital: Evaluation of the LRINEC scale. / Infecciones necrosantes de partes blandas atendidas en un servicio de urgencias de tercer nivel: evolución y correlación con la escala laboratory risk indicator for necrotizing fasciitis (LRINEC).

AIM: To describe mortality and complications of patients seen in the emergency room, diagnosed with necrotizing soft tissue infection (NSTI) and the correlation of such complications with the Laboratory Risk Indicator for Necrotizing fasciitis scale (LRINEC). METHODS: Retrospective observational study including patients with a diagnosis of NSTI in the emergency room of a tertiary hospital over 7 years. The results are shown as median, interquartile range and absolute range for quantitative variables. In the case of qualitative variables, the results are shown as absolute and relative frequency. The comparison between the categories of the LRINEC scale was performed through a post-hoc comparison from a non-parametric ANOVA analysis. Comparisons between LRINEC groups in the qualitative variables were performed using Fisher's Exact test. RESULTS: 24 patients with a mean age of 51.9 years were identified. The LRINEC scale was used on 21 patients: in 10, the value indicated low risk (<6), in 4 it indicated intermediate risk (6 or 7) and in 7 it indicated high risk (≥8). The amputation rate in patients with low, intermediate and high risk was 10%, 25% and 66% respectively with a mortality of 4.2%. There was an increase in hospital stay between the low and high level of the scale (p=0,007). CONCLUSIONS: In general, a change in the prognosis between the medium and high levels of the LRINEC scale could not be recorded, but was recorded in hospital stay between the low and the high level, practically tripling the median of days of hospital stay.

Abordaje anterior limitado del codo para la reducción abierta y fijación interna de las fracturas del capitellum. Técnica quirúrgica y experiencia clínica en 2casos con más de 2 años de seguimiento / The limited anterior approach of the elbow for open reduction and internal fixation of capitellum fractures. Surgical technique and clinical experience in 2 cases with more than 2 years follow-up

Objetivo. Las fracturas que afectan al capitellum pueden ser tratadas quirúrgicamente mediante escisión del fragmento, o mediante reducción y fijación interna con tornillos con o sin cabeza. El abordaje lateral de Kocher es el más usado para la reducción abierta. Creemos que el abordaje anterior limitado del codo podría ser una opción válida para tratar este tipo de fracturas, ya que no implica la desinserción de ningún grupo muscular ni de ningún ligamento y facilita la colocación anteroposterior de los tornillos, que ha demostrado ser biomecánicamente superior. Material y método. Describimos la técnica quirúrgica y evaluamos los resultados en 2casos clínicos con una fractura de tipo 1 de Bryan y Morrey (tipo 1A de Dubberley) mediante evolución clínica y radiológica. Dos cuestionarios diferentes sobre calidad de vida fueron realizados por teléfono: el EuroQol Five Dimensions Questionnaire (EQ-5D) y la porción contestada por el paciente del Liverpool Elbow Score (PAQ-LES). Resultados. Los 2pacientes presentaron una evolución clínica favorable a los 36 y 24 meses, respectivamente con un arco de movimiento de extensión/flexión de −5°/145° y −10°/145°, así como una pronosupinación de 85°/80° y de 90°/90°. Los 2pacientes presentaron consolidación radiológica sin signos de osteonecrosis, con el EQ-5D de 0,857 y 0,910 (rango: 0,36-1) y el PAQ-LES de 35 y 35 (rango: 17-36), respectivamente. Conclusiones. Creemos que el abordaje anterior limitado del codo es una opción técnica que tener en cuenta en caso de decidirse un tratamiento quirúrgico abierto de una fractura de capitellum, si bien necesitamos de estudios posteriores que demuestren su superioridad y seguridad clínica con respecto al abordaje clásico lateral de Kocher (AU)

Objective. Fractures involving the capitellum can be treated surgically by excision of the fragment, or by reduction and internal fixation with screws, with or without heads. The lateral Kocher approach is the most common approach for open reduction. We believe that the limited anterior approach of the elbow, could be a valid technique for treating these fractures, as it does not involve the detachment of any muscle group or ligament, facilitating the recovery process. Material and method. A description is presented of the surgical technique, as well as of 2cases with a Bryan-Morrey type 1 fracture (Dubberley type 1A). Two different final quality of life evaluation questionnaires were completed by telephone: the EuroQol Five Dimensions Questionnaire (EQ-5D), and the patient part of the Liverpool Elbow Score (PAQ-LES) questionnaire. Results. The 2patients showed favourable clinical progress at 36 and 24 months, respectively, with an extension/flexion movement arc of −5°/145° and −10°/145°, as well as a pronosupination of 85°/80° and 90°/90°. The 2patients showed radiological consolidation with no signs of osteonecrosis. The EQ-5D score was 0.857 and 0.910 (range: 0.36-1), and a PAQ-SLE of 35 and 35 (range: 17-36), respectively. Conclusions. We believe that the limited anterior approach of the elbow is a technical option to consider for the open surgical treatment of a capitellum fracture, although further studies are needed to demonstrate its superiority and clinical safety compared to the classical lateral Kocher approach (AU)

The limited anterior approach of the elbow for open reduction and internal fixation of capitellum fractures. Surgical technique and clinical experience in 2 cases with more than 2 years follow-up. / Abordaje anterior limitado del codo para la reducción abierta y fijación interna de las fracturas del capitellum. Técnica quirúrgica y experiencia clínica en 2casos con más de 2 años de seguimiento.

OBJECTIVE: Fractures involving the capitellum can be treated surgically by excision of the fragment, or by reduction and internal fixation with screws, with or without heads. The lateral Kocher approach is the most common approach for open reduction. We believe that the limited anterior approach of the elbow, could be a valid technique for treating these fractures, as it does not involve the detachment of any muscle group or ligament, facilitating the recovery process. MATERIAL AND METHOD: A description is presented of the surgical technique, as well as of 2cases with a Bryan-Morrey type 1 fracture (Dubberley type 1A). Two different final quality of life evaluation questionnaires were completed by telephone: the EuroQol Five Dimensions Questionnaire (EQ-5D), and the patient part of the Liverpool Elbow Score (PAQ-LES) questionnaire. RESULTS: The 2patients showed favourable clinical progress at 36 and 24 months, respectively, with an extension/flexion movement arc of -5°/145° and -10°/145°, as well as a pronosupination of 85°/80° and 90°/90°. The 2patients showed radiological consolidation with no signs of osteonecrosis. The EQ-5D score was 0.857 and 0.910 (range: 0.36-1), and a PAQ-SLE of 35 and 35 (range: 17-36), respectively. CONCLUSIONS: We believe that the limited anterior approach of the elbow is a technical option to consider for the open surgical treatment of a capitellum fracture, although further studies are needed to demonstrate its superiority and clinical safety compared to the classical lateral Kocher approach.

Embolization of Intracranial Dural Arteriovenous Fistulas Using PHIL Liquid Embolic Agent in 26 Patients: A Multicenter Study.

BACKGROUND AND PURPOSE: The introduction of liquid embolic agents has revolutionized endovascular approach to cranial vascular malformations. The aim of the study was to retrospectively assess the efficacy and safety of Precipitating Hydrophobic Injectable Liquid (PHIL), a new nonadhesive liquid embolic agent, in the treatment of patients with cranial dural arteriovenous fistulas. The primary end point was the rate of complete occlusion of dural arteriovenous fistulas. Secondary end points included the incidence of adverse events and clinical status at 3-month follow-up. MATERIALS AND METHODS: This was a retrospective multicenter study. Twenty-six consecutive patients with dural arteriovenous fistulas (de novo or previously treated) treated by injection of PHIL only or with PHIL in combination with other embolization products (such as Onyx or detachable coils) were included in the study. Recruitment started in August 2014 and ended in September 2015. RESULTS: Twenty-two (85%) patients were treated with PHIL only, with 3 patients treated with both PHIL and Onyx, and 1, with both PHIL and coils. Immediate complete angiographic occlusion was achieved in 20 (77%) patients. Of the 6 patients with residual fistulas, 3 were retreated with PHIL and 1 achieved angiographic cure. An adverse event was seen in 1 patient who developed worsening of preexisting ataxia due to acute thrombosis of the draining vein. CONCLUSIONS: PHIL appears to be safe and effective for endovascular treatment of cranial dural arteriovenous fistulas. Short-term angiographic and clinical results are comparable with those of Onyx, with the added advantage of easier preparation and improved homogeneous cast visualization. The use of iodine as a radio-opacifier also produces considerably less artifacts on CT compared with tantalum-based embolic materials.

La responsabilidad profesional médica y la seguridad clínica en el ejercicio de la Cirugía Ortopédica y Traumatología / Medical professional responsibility and clinical safety in the the practice of Orthopaedic Surgery and Traumatology

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Safety and effectiveness of endovascular treatment of stroke with unknown time of onset.

BACKGROUND: Currently, treatment options for patients with strokes with unknown time of onset (UKO) remain limited. With the advance of neuroimaging and endovascular treatment (EVT), selected patients might have a chance of a therapeutic option. We sought to compare clinical outcome after EVT in patients with known time of stroke onset (KO) and in those with UKO. METHODS: We prospectively registered consecutive patients with acute large artery occlusion of the anterior territory who underwent EVT. Multimodal MR or Alberta Stroke Program early CT score (ASPECTS) and transcranial color-coded Duplex sonography were used to select patients for EVT. Recanalization, periprocedural complications, intracranial hemorrhage (ICH) and outcome were recorded. Symptomatic ICH (sICH) was defined as a worsening of ≥4 points in the National Institutes of Health Stroke Scale (NIHSS) score within 36 h in any bleeding. Favorable outcome was defined as a modified Rankin score ≤2 at 3 months. RESULTS: A total of 141 patients were studied, 109 with KO and 32 with UKO. Mean age was 66.5 versus 64.7 years (p = 0.005) and median baseline NIHSS was 18 versus 17 (p = 0.095), respectively. Prior IV tPA was more frequently administered to KO patients (62.4 vs. 9.4%, p < 0.001), whereas patient selection using multimodal MR was more frequent in patients with UKO (78.1 vs. 45.4%, p < 0.001). Median time from stroke onset or from the last time the patient was seen well to groin puncture and to recanalization was significantly longer in patients with UKO, but no differences were found in the duration of the procedure. For KO/UKO patients recanalization was seen in 77.1 vs. 65.7% (p = 0.084), sICH occurred in 10 versus 0% (p = 0.061) and favorable outcome at 3 months was achieved in 41.3 versus 50% (p = 0.382), respectively. CONCLUSIONS: Clinical outcomes in this series of EVT in ischemic stroke patients due to large anterior arterial occlusion with salvageable brain are similar for patients treated with KO and UKO. These data support a randomized study of EVT in extended or uncertain time windows..

Cultura de seguridad clínica en cirugía ortopédica y traumatología. Influencia de una intervención formativa / Patient safety culture in orthopaedics surgery. Influence of a training activities plan

Objetivo: Conocer las características de la cultura de seguridad clínica en cirugía ortopédica y traumatología, valorando la influencia de una intervención formativa en su tendencia evolutiva. Población y metodología: Estudio observacional ecológico con intervención formativa. La población objeto de estudio fueron los profesionales del Servicio de Cirugía Ortopédica y Traumatología del Hospital Clínic Universitario de Barcelona. Se utilizó la versión española del cuestionario HSOPS para valorar la cultura de seguridad clínica. Resultados: El porcentaje de respuestas válidas obtenidas fue superior al 60% en las dos mediciones de la cultura realizadas. Las 12 dimensiones consideradas mejoraron su tendencia. El trabajo en equipo dentro del servicio se identificó como una dimensión de fortaleza del modelo. Conclusiones: La intervención formativa ha consolidado una tendencia favorable. La mejora de la cultura de seguridad clínica requiere tiempo y actuaciones periódicas (AU)

Objective: The purpose of this paper is to measure patient safety culture in orthopaedics surgery and to assess the influence of a training activities plan. Methodology: We performed an ecological observational study with a training intervention. Study population included all professionals of Orthopaedics and Traumatology Service of the Clinic Hospital of Barcelona. We used the Spanish version questionnaire HSOPS in order to evaluate safety culture among staff. Results: The percentage of valid questionnaires obtained was above 60% in the two surveys of patient safety culture. The twelve dimensions considered have improved trend. Teamwork climate inside the unit has been identified as a stronghold dimension. Conclusions: The training intervention developed has consolidate a positive trend. The improvement of the patient safety culture needs time and continual actions (AU)

Time to recanalization and risk of symptomatic intracerebral haemorrhage in patients treated with intravenous thrombolysis.

BACKGROUND AND PURPOSE: To test whether time to recanalization is associated with a progressive risk of symptomatic intracerebral haemorrhage (SICH) after intravenous alteplase (IVT), we conducted a serial transcranial duplex monitoring study up to 24 h after IVT in a cohort of 140 patients with acute ischaemic stroke attributed to large artery occlusion in the anterior circulation. METHODS: Patients were classified in four groups according to the time to complete recanalization (Thrombolysis in Brain Ischaemia, TIBI grades 4 or 5) after alteplase bolus: <2 h (n = 53), 2-6 h (n = 9), 6-24 h (n = 32) and no recanalization (NR) at 24 h (n = 46). SICH was defined as any haemorrhagic transformation with National Institute of Health Stroke Scale (NIHSS) score worsening ≥ 4 points (European Australian Acute Stroke Study II, ECASS II criteria) or parenchymal haematoma type 2 with neurological worsening (SITS-MOST criteria) in the 24-36 h CT. Favourable outcome was defined as modified Rankin score ≤ 2 at 3 months. RESULTS: There were no differences between the groups of patients who recanalized at each time frame regarding localization of the occlusion (P = 0.29), stroke severity at baseline (P = 0.22) and age (P = 0.06). SICH (ECASS/SITS-MOST) was observed in 5.7%/5.7% of the patients who recanalized in <2 h, in 0%/0% of the patients who recanalized between 2-6 h, in 3.1%/3.1% of the patients who recanalized within 6-24 h and in 2.2%/0% of those patients who did not recanalize at 24 h. The rate of favourable outcome according to the time of recanalization was 79.2%, 50%, 46.9% and 34.1% (P < 0.001). CONCLUSIONS: Our findings are in line with the literature showing a relationship between time to recanalization and functional outcome after IVT in acute stroke, but they do not confirm a progressive increase in the rate of SICH.

Resección percutánea guiada por tomografía computarizada en el osteoma osteoide / No disponible

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Factor XII C46T gene polymorphism and the risk of cerebral venous thrombosis.

BACKGROUND: The TT genotype of a functional factor XII (FXII) C46T gene polymorphism was shown to be a risk factor for peripheral venous thrombosis. We tested whether this genetic variant also increases the risk for cerebral venous thrombosis (CVT). METHODS: We performed a case-control study including 78 consecutive patients with proven CVT and 201 healthy population controls from South Germany. The FXII C46T genotype was assessed using a PCR technique. RESULTS: The TT genotype of the FXII C46T polymorphism was more common in patients (16.7%) than in controls (5.5%). A strong association of the TT genotype with CVT was found, which was independent of covariables (adjusted odds ratio 4.57; 95% CI 1.55 to 13.41; p = 0.006). CONCLUSION: The TT genotype of the functional factor XII C46T gene polymorphism may be a new independent risk factor for cerebral venous thrombosis (CVT). Our finding warrants confirmation in an independent study before this genetic variant should be added to the panel of established risk factors for CVT.

Long-standing pain in a 25-year-old patient with a non-diagnosed cervical osteoblastoma: a case report.

Benign osteoblastomas are infrequent tumors, representing less than 1% of all bone tumors. The spinal location accounts for 40-50% of all osteoblastomas from which only 20% are located in the cervical spine. The majority of the spinal osteoblastomas arise from the posterior elements: pedicles, laminas, transverse or spinous processes. We present a case report of a young male that due to the lack of specific symptoms was diagnosed of a cervical osteoblastoma 14 months after the first symptoms. The tumor was located in the right C7 pedicle. We then operated, resected the tumor and a posterior C6-T1 bilateral instrumentation was performed to stabilize the spine. Nowadays, this delay in diagnosis may be avoided by the routine use of MRI or CT for unspecific cervical symptoms. The treatment of this lesion is the complete surgical resection based on a correct preoperative planning with CT and MRI in order to define precisely the location, size and extension of the tumor. Currently, percutaneous or minimally invasive surgery is not commonly used in the treatment of this lesion.

Anatomic results and complications of stent-assisted coil embolization of intracranial aneurysms.

SUMMARY: The purpose of this study was to evaluate and report our anatomic results and complications associated with stent-assisted coil embolization of intracranial aneurysms using the Neuroform stent. From September 2003 to August 2007, 127 consecutive patients (ruptured 50, 39.4%; unruptured 77, 60.6%) underwent 129 stent-assisted coil embolization procedures to treat 136 aneurysms at our institution. Anatomic results at follow-up, procedure-related complications, and morbidity/mortality were retrospectively reviewed. Stent deployment was successful in 128 out of 129 procedures (99.2%). Forty-seven patients presented with 53 procedure-related complications (37.0%, 47/127). Thromboembolic events (n=17, 13.4%) were the most common complications, followed by intraoperative rupture (n=8, 6.3%), coil herniation (n=5, 3.9%), and postoperative rupture (n=4, 3.1%). For thromboembolic events, acute intra-procedural instent thromboses were observed in two patients and subacute or delayed in-stent thromboses in three patients. Overall mortality rate was 16.5% (21/127) and procedure-related morbidity and mortality rates were 5.5% (7/127) and 8.7% (11/127) retrospectively. Patients with poor grade subarachnoid hemorrhage (Hunt and Hess grade IV or V; 25/127, 19.7%) exhibited 56% (14/25) overall mortality rate and 24% (6/25) procedure-related mortality rate. Immediate angiographic results showed complete occlusion in 31.7% of aneurysms, near-complete occlusion in 45.5%, and partial occlusion in 22.8%. Sixty nine patients in 70 procedures with 77 aneurysms underwent angiographic followup at six months or later. Mean follow-up period was 13.7 months (6 to 45 months). Complete occlusion was observed in 57 aneurysms (74.0%) and significant in-stent stenosis was not found. Thromboembolism and intra/postoperative aneurysm ruptures were the most common complications and the main causes of procedure-related morbidity and mortality. Patients with poor grade subarachnoid hemorrhage showed poor clinical outcomes. Since most complications were induced by stent manipulation and deployment, it is mandatory to utilize these devices selectively and cautiously. While the follow- up angiographic results are promising, further studies are essential to evaluate safety, efficacy, and durability of the Neuroform stent.

[Transthoracic echocardiography in stroke performed by neurologist: pilot study]. / Ecocardiografía transtorácica realizada por neurólogos en patología vascular: estudio piloto.

INTRODUCTION: The aim of this study is to assess concordance between transthoracic echocardiography (TTE) performed by neurologists and cardiologists for the screening of cardioembolic sources in patients with ischemic stroke. METHODS: We examined prospectively 27 consecutive patients with ischemic stroke. A potential source of embolism in all of the patients was sought by means of a TTE study. This study was performed by one neurologist after one-month full-time training on the technique and independently by one cardiologist whose results were considered as the reference standard. Regarding the risk of cardioembolism, findings from TTE studies were considered as normal, or indicative of either moderate or high risk, according to the TOAST criteria. Agreement between the two observers on the diagnosis of cardioembolic source was analyzed with the Cohen's Kappa Test (K). A K > 0,6 was considered as good agreement. RESULTS: The 27 patients studied had a mean age of 68,7 +/- 10,2 years and 70 % were men. A cardioembolic source was detected in 9 patients by the cardiologist and 8 of these were also identified by the neurologist: in 1 patient a mitral annulus calcification was not detected in the examination performed by the neurologist. In 2 patients with poor echocardiographic window, the neurologist underestimated the left ventricular function. Diagnostic agreement between both examinations was 88,9 % (K: 0,77; p = 0,001). CONCLUSION: Compared with cardiologists, trained neurologists show a fairly high degree of accuracy in the TTE screening of patients with stroke. Those cases with poor echocardiographic window or with abnormal findings should be confirmed by the cardiologists.

Ecocardiografía transtorácica realizada por neurólogos en patología vascular: estudio piloto / Transthoracic echocardiopraphy in stroke performed by neurologist: pilot study

El objetivo de nuestro estudio es comparar la concordancia entre la ecocardiografía transtorácica (ETT) realizada por neurólogos y cardiólogos en el cribado de fuentes cardioembólicas en pacientes con isquemia cerebral. Métodos. Evaluamos de forma prospectiva y consecutiva 27 pacientes con isquemia cerebral. A todos se les realizó una ETT por un neurólogo que había sido entrenado previamente durante un mes en la técnica, e independientemente, por un cardiólogo cuyos resultados fueron considerados como la referencia estándar. Según el riesgo de cardioembolismo, los hallazgos en la ETT fueron clasificados como normales, de moderado o alto riesgo según los criterios TOAST. La concordancia en el diagnóstico de fuente cardioembólica entre ambos exploradores fue evaluado con el test Kappa de Cohen (K). Una K>0,6 se consideró como buena concordancia. Resultados. De 27 pacientes con isquemia cerebral, la edad media fue de 68,7 ± 10,2 años y 70 % fueron hombres. En 9 pacientes el cardiólogo detectó una fuente cardioembólica, y de ellos, 8 pacientes también por el neurólogo (1 paciente con calcificación del anillo mitral no fue detectado). En 2 pacientes con mala ventana ecocardiográfica, el neurólogo infraestimó la función ventricular. El diagnóstico fue concordante entre ambas exploraciones en un 88,9 % de los pacientes (K: 0,77; p = 0,001). Conclusiones. Comparado con el cardiólogo, un neurólogo entrenado realiza la ETT con una buena fiabilidad. En los casos con mala ventana ecocardiográfica o con hallazgos patológicos, éstos deberían ser confirmados por el cardiólogo (AU)

Introduction. The aim of this study is to assess concordance between transthoracic echocardiography (TTE) performed by neurologists and cardiologists for the screening of cardioembolic sources in patients with ischemic stroke. Methods. We examined prospectively 27 consecutive patients with ischemic stroke. A potential source of embolism in all of the patients was sought by means of a TTE study. This study was performed by one neurologist after one-month full-time training on the technique and independently by one cardiologist whose results were considered as the reference standard. Regarding the risk of cardioembolism, findings from TTE studies were considered as normal, or indicative of either moderate or high risk, according to the TOAST criteria. Agreement between the two observers on the diagnosis of cardioembolic source was analyzed with the Cohen's Kappa Test (K). A K > 0,6 was considered as good agreement. Results. The 27 patients studied had a mean age of 68,7 ± 10,2 years and 70 % were men. A cardioembolic source was detected in 9 patients by the cardiologist and 8 of these were also identified by the neurologist: in 1 patient a mitral annulus calcification was not detected in the examination performed by the neurologist. In 2 patients with poor echocardiographic window, the neurologist underestimated the left ventricular function. Diagnostic agreement between both examinations was 88,9 % (K: 0,77; p = 0,001). Conclusion. Compared with cardiologists, trained neurologists show a fairly high degree of accuracy in the TTE screening of patients with stroke. Those cases with poor echocardiographic window or with abnormal findings should be confirmed by the cardiologists (AU)

Pathological femur fracture secondary to radiation therapy for soft tissue sarcoma.

Bone fracture is a well known possible late complication of radiation treatment. Little has been written about fractures of long bones after irradiation. We present a case of femur bone necrosis secondary to postoperative radiation for a soft tissue sarcoma of the thigh 20 years earlier. Fixation of the diaphyseal fracture and radiological evolution are described.

Pathological femur fracture secondary to radiation therapy for soft tissue sarcoma

Bone fracture is a well known possible late complication of radiation treatment. Little has been written about fractures of long bones after irradiation. We present a case of femur bone necrosis secondary to postoperative radiation for a soft tissue sarcoma of the thigh 20 years earlier. Fixation of the diaphyseal fracture and radiological evolution are described (AU)