Minimally invasive surgical treatment options for osteoporotic vertebral fractures OF4. / Opciones de tratamiento quirúrgico mínimamente invasivo en las fracturas vertebrales osteoporóticas OF4.

INTRODUCTION AND OBJECTIVE: The incidence of osteoporotic vertebral fractures (OVF) is increasing. The importance of their diagnosis and treatment lies in their frequency and the morbidity they cause in patients. The classification proposed for OVFs by the German Society of Orthopaedics and Traumatology (DGOU) recommends surgical treatment for vertebral fractures classified as OF4. Most of these fractures will require anterior bracing as an adjunct to posterior fixation because of the significant loss of vertebral body structure. In elderly patients, minimally invasive surgery (MIS) allows their treatment given the lesser tissue aggression and systemic repercussions. We present the results of the treatment of OF4 vertebral fractures using minimally invasive techniques in the Spine Unit of our hospital. MATERIAL AND METHODS: Retrospective study of 21 patients with OF4 osteoporotic fractures in the thoracolumbar transition treated in our centre. Six patients who underwent open posterolateral fusion or isolated vertebroplasty were excluded. The series consists of 15 cases (13 females and 2 males), with a mean age of 72.2, studied by computed tomography and magnetic resonance imaging. Clinical and analytical data were collected to decide the most appropriate surgical technique. In six cases a retropleural/retroperitoneal MIS approach was performed for partial corpectomy with expandable vertebral substitute plus long posterior percutaneous fixation (technique 1). In the remaining nine cases long posterior percutaneous fixation + vertebroplasty of the fractured vertebra (technique 2). Radiological measurements were taken pre-surgically, post-surgically, at 6 weeks and 3 months, determining the fracture angle, kyphotic deformity, compression and wedging percentage and deformation angle. To assess functional outcome, patients completed the Oswentry Disability Index before surgery and at 3 months. RESULTS: There were no intraoperative complications of note. In the corpectomy group the mean hospital stay was 9.4 days, with a mean operative time of 250 min, a postoperative haemoglobin loss of 3.3 g/dL and two patients were transfused. In the percutaneous fixation and vertebroplasty group the mean was 5.55 days, surgery time 71 min and loss of 1.6 g/dL haemoglobin. There was one post-surgical haematoma requiring transfusion. None of the patients had to be reoperated during follow-up. Radiological measurements showed adequate correction with both techniques which was maintained over time with minimal loss. In functional outcomes assessed with the Oswentry, patients following technique 1 suffered greater worsening (15%) than those treated with technique 2 (10%). CONCLUSIONS: In OWF classified as OF4, percutaneous fixation associated with vertebroplasty could be an alternative to corpectomy in older patients with comorbidities, in whom functional recovery is more important than radiological correction. The use of MIS surgery together with improvements in the prevention and treatment of osteoporosis may improve clinical outcomes in the treatment of this type of fracture.

Opciones de tratamiento quirúrgico mínimamente invasivo en las fracturas vertebrales osteoporóticas OF4 / Minimally invasive surgical treatment options for osteoporotic vertebral fractures OF4

Introducción y objetivo: La incidencia de las fracturas vertebrales osteoporóticas (FVO) está en aumento. La importancia de su diagnóstico y tratamiento radica en su frecuencia y morbilidad que producen en los pacientes. En la clasificación propuesta para las FVO por la Sociedad Alemana de Ortopedia y Traumatología (DGOU) recomienda el tratamiento quirúrgico en las fracturas vertebrales clasificadas como OF4. La mayoría de estas fracturas van a requerir un soporte anterior como complemento a la fijación posterior, por la importante pérdida de estructura del cuerpo vertebral. En pacientes de edad avanzada, la cirugía mínimamente invasiva (MIS) permite su tratamiento gracias a la menor agresión tisular y repercusión sistémica. Se presentan los resultados del tratamiento de fracturas vertebrales OF4 mediante técnicas mínimamente invasivas en la Unidad de Raquis de nuestro hospital.Material y métodos: Estudio retrospectivo de 21 pacientes con fractura osteoporótica OF4 en el tránsito toracolumbar tratados en nuestro centro. Han sido excluidos seis pacientes a los que se les realizó fusión posterolateral abierta o vertebroplastia aislada. La serie se compone de 15 casos (13 mujeres y dos varones), con edad media de 72,2 estudiados mediante tomografía computerizada y resonancia magnética. Se recogen datos clínicos y analíticos para decidir la técnica quirúrgica más adecuada. En seis casos se realizó abordaje retropleural/retroperitoneal MIS para corpectomía parcial con sustituto vertebral expansible más fijación percutánea posterior larga (técnica 1). En los nueve casos restantes fijación percutánea posterior larga + vertebroplastia de la vértebra fracturada (técnica 2). Se han realizado mediciones radiológicas prequirúrgicas, postquirúrgicas, a las seis semanas y tres meses, determinando el ángulo fracturario, deformidad cifótica, porcentaje de compresión y de acuñamiento y ángulo de deformación.(AU)

Introduction and objective: The incidence of osteoporotic vertebral fractures (OVF) is increasing. The importance of their diagnosis and treatment lies in their frequency and the morbidity they cause in patients. The classification proposed for OVFs by the German Society of Orthopaedics and Traumatology (DGOU) recommends surgical treatment for vertebral fractures classified as OF4. Most of these fractures will require anterior bracing as an adjunct to posterior fixation because of the significant loss of vertebral body structure. In elderly patients, minimally invasive surgery (MIS) allows their treatment given the lesser tissue aggression and systemic repercussions. We present the results of the treatment of OF4 vertebral fractures using minimally invasive techniques in the Spine Unit of our hospital. Material and methods: Retrospective study of 21 patients with OF4 osteoporotic fractures in the thoracolumbar transition treated in our centre. Six patients who underwent open posterolateral fusion or isolated vertebroplasty were excluded. The series consists of 15 cases (13 females and 2 males), with a mean age of 72.2, studied by computed tomography and magnetic resonance imaging. Clinical and analytical data were collected to decide the most appropriate surgical technique. In six cases a retropleural/retroperitoneal MIS approach was performed for partial corpectomy with expandable vertebral substitute plus long posterior percutaneous fixation (technique 1). In the remaining nine cases long posterior percutaneous fixation + vertebroplasty of the fractured vertebra (technique 2). Radiological measurements were taken pre-surgically, post-surgically, at 6 weeks and 3 months, determining the fracture angle, kyphotic deformity, compression and wedging percentage and deformation angle. To assess functional outcome, patients completed the Oswentry Disability Index before surgery and at 3 months.(AU)

Minimally invasive surgical treatment options for osteoporotic vertebral fractures OF4 / Opciones de tratamiento quirúrgico mínimamente invasivo en las fracturas vertebrales osteoporóticas OF4

Introduction and objective: The incidence of osteoporotic vertebral fractures (OVF) is increasing. The importance of their diagnosis and treatment lies in their frequency and the morbidity they cause in patients. The classification proposed for OVFs by the German Society of Orthopaedics and Traumatology (DGOU) recommends surgical treatment for vertebral fractures classified as OF4. Most of these fractures will require anterior bracing as an adjunct to posterior fixation because of the significant loss of vertebral body structure. In elderly patients, minimally invasive surgery (MIS) allows their treatment given the lesser tissue aggression and systemic repercussions. We present the results of the treatment of OF4 vertebral fractures using minimally invasive techniques in the Spine Unit of our hospital. Material and methods: Retrospective study of 21 patients with OF4 osteoporotic fractures in the thoracolumbar transition treated in our centre. Six patients who underwent open posterolateral fusion or isolated vertebroplasty were excluded. The series consists of 15 cases (13 females and 2 males), with a mean age of 72.2, studied by computed tomography and magnetic resonance imaging. Clinical and analytical data were collected to decide the most appropriate surgical technique. In six cases a retropleural/retroperitoneal MIS approach was performed for partial corpectomy with expandable vertebral substitute plus long posterior percutaneous fixation (technique 1). In the remaining nine cases long posterior percutaneous fixation + vertebroplasty of the fractured vertebra (technique 2). Radiological measurements were taken pre-surgically, post-surgically, at 6 weeks and 3 months, determining the fracture angle, kyphotic deformity, compression and wedging percentage and deformation angle. To assess functional outcome, patients completed the Oswentry Disability Index before surgery and at 3 months.(AU)

Introducción y objetivo: La incidencia de las fracturas vertebrales osteoporóticas (FVO) está en aumento. La importancia de su diagnóstico y tratamiento radica en su frecuencia y morbilidad que producen en los pacientes. En la clasificación propuesta para las FVO por la Sociedad Alemana de Ortopedia y Traumatología (DGOU) recomienda el tratamiento quirúrgico en las fracturas vertebrales clasificadas como OF4. La mayoría de estas fracturas van a requerir un soporte anterior como complemento a la fijación posterior, por la importante pérdida de estructura del cuerpo vertebral. En pacientes de edad avanzada, la cirugía mínimamente invasiva (MIS) permite su tratamiento gracias a la menor agresión tisular y repercusión sistémica. Se presentan los resultados del tratamiento de fracturas vertebrales OF4 mediante técnicas mínimamente invasivas en la Unidad de Raquis de nuestro hospital.Material y métodos: Estudio retrospectivo de 21 pacientes con fractura osteoporótica OF4 en el tránsito toracolumbar tratados en nuestro centro. Han sido excluidos seis pacientes a los que se les realizó fusión posterolateral abierta o vertebroplastia aislada. La serie se compone de 15 casos (13 mujeres y dos varones), con edad media de 72,2 estudiados mediante tomografía computerizada y resonancia magnética. Se recogen datos clínicos y analíticos para decidir la técnica quirúrgica más adecuada. En seis casos se realizó abordaje retropleural/retroperitoneal MIS para corpectomía parcial con sustituto vertebral expansible más fijación percutánea posterior larga (técnica 1). En los nueve casos restantes fijación percutánea posterior larga + vertebroplastia de la vértebra fracturada (técnica 2). Se han realizado mediciones radiológicas prequirúrgicas, postquirúrgicas, a las seis semanas y tres meses, determinando el ángulo fracturario, deformidad cifótica, porcentaje de compresión y de acuñamiento y ángulo de deformación.(AU)

Syndromic clubfoot beyond arthrogryposis and myelomeningocele: orthopedic treatment with Ponseti method. / Pie zambo sindrómico más allá de la artrogriposis y el mielomeningocele: tratamiento ortopédico con el método de Ponseti.

INTRODUCTION: Talipes equinovarus or clubfoot is a congenital deformity of the foot with bone, muscle, and tendon involvement. It's one of the most frequent foot malformations in pediatric orthopedics. Although generally idiopathic, it may have a syndromic cause and be associated with musculoskeletal, neurological, or connective tissue conditions. The treatment of choice in idiopathic clubfoot is the Ponseti method based on manipulation and fixation with serial casts that seek progressive correction of the deformity. The Ponseti method effectiveness has been demonstrated in arthrogryposis and myelomeningocele clubfoot. There are few clinical studies demonstrating the efficacy of this therapeutic option in patients with syndromic clubfoot. MATERIAL AND METHODS: Retrospective study with 6 patients (9 feet) with syndromic clubfoot treated in a tertiary center with the Ponseti method with a minimum follow up of two years (2-18). The results were evaluated with the Pirani classification, assessing clubfoot severity before and after treatment. RESULTS: Of the six patients treated were used an average of 6.5 casts. The Pirani scale obtained a mean score of 5.2 before treatment, with a decrease to 1.27 after treatment, with a mean improvement of 3.93 points. In more than half of the cases it was necessary to lengthen the Achilles tendon to correct the equine deformity. In addition, an ankle-foot orthosis was used to reduce recurrences in patients with dysmetria or psychomotor retardation. The most frequently observed residual deformity was the adduct. A patient relapsed twice. CONCLUSIONS: The Ponseti method obtains effective results in the correction of syndromic clubfoot, although it requires a greater number of corrective casts than other pediatric foot pathologies.

Large vessel stroke in six patients following SARS-CoV-2 infection: a retrospective case study series of acute thrombotic complications on stable underlying atherosclerotic disease.

BACKGROUND AND PURPOSE: Ischaemic stroke has been described in association with COVID-19. Several pathophysiological mechanisms have been suggested, i.e. prothrombotic state, cardiac injury etc. It was sought to assess the potential association between ischaemic stroke associated with SARS-CoV-2 infection and underlying atherosclerotic lesions. METHODS: A retrospective analysis of stroke related to large vessel occlusion was conducted amongst patients with SARS-CoV-2 infection and underlying mild atherosclerotic disease, between 19 March and 19 April 2020 in six different stroke centers in the Île-de France area, France. RESULTS: The median age was 52 years, median body mass index was 29.5 kg/m2 . All patients displayed previous vascular risk factors such as high blood pressure, diabetes, dyslipidemia or body mass index > 25. The delay between the first respiratory symptoms of COVID-19 and stroke was 11.5 days. At baseline, all had tandem occlusions, i.e. intracerebral and extracerebral thrombus assessed with computed tomography or magnetic resonance imaging. Cases displayed a large thrombus in the cervical carotid artery with underlying mild non-stenosing atheroma, after an etiological workup based on angio-computed tomography or magnetic resonance imaging and/or cervical echography. CONCLUSION: Our study should alert clinicians to scrutinize any new onset of ischaemic stroke during COVID-19 infection, mainly in patients with vascular risk factors or underlying atherosclerotic lesions.

Endothelial markers are associated with thrombolysis resistance in acute stroke patients.

BACKGROUND AND PURPOSE: The endothelium is crucial in maintaining the haemostatic balance between pro- and anti-thrombotic factors. In this pilot study, the association of endothelial biomarkers with arterial recanalization and clinical outcome in the setting of acute ischaemic stroke (AIS) was evaluated amongst patients treated with recombinant tissue plasminogen activator (rt-PA). METHODS: Sixty-four AIS patients treated with rt-PA were prospectively recruited. Blood was collected before thrombolysis and analysed for von Willebrand factor (vWF), soluble thrombomodulin (sTM) and soluble endothelial protein C receptor (sEPCR). Complete recanalization was defined by a Thrombolysis in Myocardial Infarction Score of 3. Favourable clinical outcome was defined by a modified Rankin Score of 0-2 at 90 days. RESULTS: Amongst the 64 patients, 31 had no documented occlusion, 19 had persistent occlusion and 14 had complete recanalization. After adjustment for confounding factors, these patients presented lower sTM and sEPCR levels than patients with persistent occlusion (median sTM, 21 vs. 48 ng/ml, P = 0.008; median sEPCR, 78 vs. 114 ng/ml, P = 0.018), but similar levels compared with patients without occlusion. vWF levels did not differ between groups. None of these biomarkers was significantly associated with favourable outcome. CONCLUSIONS: Recanalization after thrombolytic therapy is associated with low sTM and sEPCR levels but not with vWF levels. If corroborated in further larger studies, these findings could be helpful in the identification of patients resistant to rt-PA thrombolysis who could benefit from a modified recanalization therapy.

Prevalence of subdiaphragmatic visceral infarction in cardioembolic stroke.

BACKGROUND: A substantial proportion of ischemic strokes have an embolic mechanism, but the source of embolism is not detected. Coexistence of subdiaphragmatic visceral infarction (SDVI; e.g., renal, splenic, hepatic, bowel infarction) may be a suggestion of a common source of embolism. One large autopsy study found SDVI in 21.5% of patients with fatal stroke. METHOD: We performed diffusion-weighted magnetic resonance abdominal imaging and subsequently performed it in consecutive patients with stroke or TIA and a history of nonvalvular atrial fibrillation. RESULTS: Among 27 patients, 6 had SDVI (3 recent renal, 1 recent splenic, and 3 old splenic infarction). The median time between onset of ischemic stroke and abdominal MRI was 8 days (interquartile range 3-15 days). No predictive factor of SDVI was found in this study population with respect to demographic or ultrasound characteristics. CONCLUSIONS: One in 5 patients with nonfatal cardioembolic stroke or TIA may be associated with subdiaphragmatic visceral infarction (SDVI). Further study should evaluate the frequency of SDVI in patients with stroke of unknown cause.

[Vascular risk factors in patients with ischaemic stroke. Distribution according to age, sex and stroke subtype]. / Factores de riesgo vascular en pacientes con ictus isquémico. Distribución según edad, sexo y subtipo de ictus.

INTRODUCTION: Cardiovascular diseases are one of the leading health problems in developed countries. This term covers conditions such as coronary vascular disease, cerebrovascular diseases and peripheral vascular disease. Ischaemic cerebrovascular disease accounts for 80% of all cerebrovascular diseases. From a clinical point of view it is interesting to distinguish between modifiable and non-modifiable vascular risk factors. AIM: To analyse the prevalence of modifiable vascular risk factors and their different combinations in a case-control study on ischaemic cerebrovascular disease in the Spanish population, and also the differences in the distribution of the risk factors according to the type of stroke (TOAST classification), age and sex. SUBJECTS AND METHODS: The study was conducted on 308 patients with ischaemic stroke who were paired by age (+/- 5 years) and sex, with 307 controls with no prior history of thrombosis. The statistical analysis was performed using the software application SAS v. 9.1. RESULTS: The results suggest that the risk factors are subject to an adding effect, as well as pointing to the presence of a specific profile of these factors depending on the subtype of stroke that is developed. CONCLUSION: The addition of cardiovascular risk factors is associated with an increased risk of vascular events. The distribution of the modifiable vascular risk factors differs according to the type of stroke and the patient's sex and age.

Factores de riesgo vascular en pacientes con ictus isquémico. Distribución según edad, sexo y subtipo de ictus / Vascular risk factors in patients with ischaemic stroke distribution according to age, sex and stroke subtype

Las enfermedades cardiovasculares constituyen uno de los principales problemas de salud en los paísesdesarrollados. Esta entidad engloba la patología vascular coronaria, las enfermedades cerebrovasculares y la patología vascular periférica. La enfermedad cerebrovascular isquémica supone el 80% de las enfermedades cerebrovasculares. Desdeun punto de vista clínico, es interesante diferenciar los factores de riesgo vascular modificables de los no modificables. Objetivo. Analizar la prevalencia de factores de riesgo vascular modificables y sus distintas combinaciones en un estudio de casos y controles en enfermedad cerebrovascular isquémica en población española, así como las diferencias en la distribución de los factores de riesgo según el tipo de ictus (clasificación TOAST), edad y sexo. Sujetos y métodos. El estudio se llevó a cabo en 308 pacientes con ictus isquémico emparejados por edad (± 5 años) y sexo con 307 controles sin historia trombótica previa.El análisis estadístico se realizó con el programa SAS v. 9.1. Resultados. Los resultados sugieren un efecto aditivo de los factores de riesgo, así como la presencia de un determinado perfil de estos factores en función del subtipo de ictus que se desarrolle. Conclusión. La adición de factores de riesgo cardiovascular se asocia a un aumento de riesgo de acontecimientos vasculares. Existen diferencias en la distribución de los factores de riesgo vascular modificables en función del tipo de ictus, el sexo y la edad del paciente

Cardiovascular diseases are one of the leading health problems in developed countries. This termcovers conditions such as coronary vascular disease, cerebrovascular diseases and peripheral vascular disease. Ischaemic cerebrovascular disease accounts for 80% of all cerebrovascular diseases. From a clinical point of view it is interesting to distinguish between modifiable and non-modifiable vascular risk factors. Aim. To analyse the prevalence of modifiablevascular risk factors and their different combinations in a case-control study on ischaemic cerebrovascular disease in the Spanish population, and also the differences in the distribution of the risk factors according to the type of stroke (TOAST classification), age and sex. Subjects and methods. The study was conducted on 308 patients with ischaemic stroke who werepaired by age (± 5 years) and sex, with 307 controls with no prior history of thrombosis. The statistical analysis was performed using the software application SAS v. 9.1. Results. The results suggest that the risk factors are subject to an adding effect, as well as pointing to the presence of a specific profile of these factors depending on the subtype of stroke that isdeveloped. Conclusion. The addition of cardiovascular risk factors is associated with an increased risk of vascular events. The distribution of the modifiable vascular risk factors differs according to the type of stroke and the patient’s sex and age

[Diagnostic and treatment of necrotizing cervical fascitis. Clinical course after a Ludwig angina]. / Diagnóstico y tratamiento de la fascitis necrotizante cervical. Evolución tras una angina de Ludwig.

The Ludwig angina is an infection of the base of the mouth and submandibular region, frecuently after a dental extraction or a piece in bad state. When it surpassees the milohioid muscle it extends dissecting the superficial aponeurotic planes, and can evolve to a necrotisant fascitis. We present the case of a 67 years old man with a painful tumefaction of the mouth base and submandibular region. The CT reflected an heterogenous submaxilar lesion that extended by the deep cervical fascia introducing itself in the thorax. Under antibiotic treatment the pus was drained by cervicotomy, with daily cures during 3 weeks.

Diagnóstico y tratamiento de la fascitis necrotizante cervical. Evolución tras una angida de Ludwig / Diagnostic and treatment of necrotizing cervical fascitis. Evolution after a ludwig angina

La «angina de Ludwig» es una infección del suelo de la boca y región submandibular, frecuentemente tras una extracción dental o por una pieza en mal estado. Cuando sobrepasa el músculo milohiodeo se extiende disecando los planos aponeuróticos superficiales, pudiendo evolucionar hacia una fascitis necrotizante. Presentamos el caso de un hombre de 67 años con tumefacción dolorosa del suelo de la boca y región submandibular. La TC reflejaba una lesión heterogénea submaxilar que se extendía por la fascia profunda cervical hasta introducirse en el tórax. Bajo tratamiento antibiótico se drenó el pus mediante cervicotomía, con curas diarias durante 3 semanas

The Ludwig angina is an infection of the base of the mouth and submandibular region, frecuently after a dental extraction or a piece in bad state. When it surpassees the milohioid muscle it extends dissecting the superficial aponeurotic planes, and can evolve to a necrotisant fascitis. We present the case oía 67 years old man with a painful tumefaction of the mouth base and submandibular region. The CT reflected an heterogenous submaxilar lesion that extended by the deep cervical fascia introducing itself in the thorax. Under antibiotic treatment the pus was drained by cervicotomy, with daily cures during 3 weeks

Nasal septal perforation in a patient with subclinical celiac disease: a possible new association.

A female patient presented with nasal septal perforation that did not respond to conventional therapeutic management. Later, because of a malabsorption problem in one of her children, she underwent analytic tests and distal duodenal biopsy, which revealed that she was suffering from subclinical/silent celiac disease. The treatment, a gluten-free diet, unexpectedly resulted in the cessation of the destructive nasal process. Four years later, the patient remains asymptomatic. Nasal septal perforation might constitute a new entity associated with celiac disease hitherto not described in the literature.

[Progression of botulinum toxin type A dosage in craniocervical dystonias. An eight year comparative study]. / Evolucion de la dosis de toxina botulinica tipo A en distonias craneocervicales. Estudio comparativo a lo largo de ocho años.

INTRODUCTION: Botulinum toxin type A (BTA) is currently the choice treatment for focal dystonias; yet long term response to therapy is still not known with total accuracy. PATIENTS AND METHODS: In this study we analysed the dose of BTA used in the first eight years' treatment of 17 patients with cervical dystonia and 16 patients with blepharospasm who received treatment at our hospital. RESULTS: It was found that in the patients with cervical dystonia there was a significant increase in the dosage of BTA (41%) which rose in a linear fashion from the fourth year onwards. On the other hand, in the group of patients with blepharospasm, the dosage of BTA tended to drop with time and this reduction (16%) occurred essentially during the first four years of treatment. CONCLUSIONS: These findings clearly highlight the clinical and functional differences between the two types of craniocervical dystonia.

[Prothrombotic factors in stroke]. / Factores protrombóticos en la enfermedad cerebrovascular isquémica.

INTRODUCTION: Factor V Leiden and prothrombin 20210A polymorphisms are the most common mutations related to deep vein thrombosis, however their relationship with stroke is debated. This paper studies the possible relationship between both entities. MATERIAL AND METHODS: A case-control study was conducted during 27 months to study their association. A total of 312 stroke cases were included, 73 were under 60 years. Control group was obtained from blood donors. Factor V Leiden and prothrombin 20210A polymorphism prevalence was studied. Results were analyzed according to the age and the type of stroke (TOAST classification, 1993). RESULTS: Factor V Leiden was not related to stroke in the general population (OR: 0.65; 95 % CI: 0.18-2.27). The study according to age did not show any association (younger than 60 years: OR: 1.12; 95 % CI: 0.21-5.90; older than 60 years: OR: 0.50; 95 % CI: 0.11-2.14). However, prothrombin 20210A polymorphism OR in cases under 60 was OR: 2.92; 95 % CI: 0.71-11.92 suggesting a possible association between this mutation and stroke. There was no association in the general population (OR: 2.0; 95 % CI: 0.63-6.29) or in people over 60 (OR: 1.73; 95 % CI: 0.51- 5.83). The analysis according to stroke subtype did not show any association in the distribution of any of the polymorphisms studied. CONCLUSION: This study suggests that prothrombin 20210A polymorphism may play a role in stroke under 60 years of age. Factor V Leiden does not seem to be related to stroke.

Evolución de la dosis de toxina botulínica tipo A en distonías craneocervicales. Estudio comparativo a lo largo de ocho años / Progression of botulinum toxin type a dosage in craniocervical dystonias. An eight-year comparative study

Introducción. En la actualidad, la toxina botulínica de tipo A (TBA) es el tratamiento de elección de las distonías focales; sin embargo, no se conoce con precisión la respuesta al tratamiento a largo plazo. Pacientes y métodos. En este estudio analizamos la dosis de TBA utilizada en los ocho primeros años de tratamiento de 17 pacientes con distonía cervical y 16 pacientes con blefaroespasmo tratados en nuestro hospital. Resultados. Observamos que en los pacientes con distonía cervical se produjo un incremento significativo de la dosis de TBA, del 41 por ciento que ocurre de forma lineal solamente a partir del cuarto año. En contraste, la dosis de TBA en el grupo de pacientes con blefaroespasmo tiende a reducirse con el tiempo, y esta reducción, del 16 por ciento, se produce fundamentalmente en los cuatro primeros años de tratamiento. Conclusión: Estos resultados reflejan claramente las diferencias clínicas y funcionales de estos dos tipos de distonía craneocervical (AU)

Introduction. Botulinum toxin type A (BTA) is currently the choice treatment for focal dystonias; yet long-term response to therapy is still not known with total accuracy. Patients and methods. In this study we analysed the dose of BTA used in the first eight years’ treatment of 17 patients with cervical dystonia and 16 patients with blepharospasm who received treatment at our hospital. Results. It was found that in the patients with cervical dystonia there was a significant increase in the dosage of BTA (41%) which rose in a linear fashion from the fourth year onwards. On the other hand, in the group of patients with blepharospasm, the dosage of BTA tended to drop with time and this reduction (16%) occurred essentially during the first four years of treatment. Conclusions. These findings clearly highlight the clinical and functional differences between the two types of craniocervical dystonia (AU)

[Paraganglioma of the vagus. A case report and review of literature]. / Paraganglioma del nervio vago. Presentación de un caso y revisión de la literatura.

The vagal nerve paraganglioma is a rare tumor over all the head and neck tumours. It presents with a insidious clinic, appearing usually as a asymptomatic laterocervical mass of low growth pattern. We present a case of a 53 years old woman with a left of painless laterocervical mass that produced cough with the palpation. We pretend to review the most relevant aspects of the diagnosis and treatment of the paraganglioma and therefore include this pathology in the differential diagnosis of laterocervical tumor.

[Laryngeal neurofibroma. A case report and literature review]. / Neurofibroma laríngeo. Presentación de un caso y revisión bibliográfica.

Neurofibroma is a rare pathology on the larynx. We distinguish two types of neurofibromas: plexiform and not plexiform in which the difference is at the cytoarchitectural level. The plexiform type is usually associated to the Von Recklinhausen disease, also know as neurofibromatosis type 1. They usually affect the supraglottic structure, and more frequently they are described in aritenoids, ariepiglottic folds, and posterior commissure. We present a case located at the glottic level of plexiform type, with a postsurgical follow-up of five years. We make a revision of the aethiopathogenesis, evolution and prognostic of these pathology in the bibliography.

Neurofibroma laríngeo. Presentación de un caso y revisión de la bibliografía / Neurofibroma of the larynx. Presentation of one case and revision of bibliography

El neurofibroma es una patología infrecuente a nivel laríngeo. Se distinguen dos tipos de neurofibromas: plexiforma y no plexiforme, cuya diferencia es a nivel de la citoarquitectura. El tipo plexiforme suele asociarse a la enfermedad de Von Recklinghausen, también conocida como neurofibromatosis tipo I. Suelen afectar a la estructura supraglótica, y con mayor frecuencia se les describe en aritenoides, pliegues ariepiglóticos y comisura posterior. Presentamos un caso localizado a nivel glótico de tipo plexiforme, con seguimiento posquirúrgico de cinco años. Se realiza revisión bibliográfica de la etiopatogenia, evolución y pronóstico de dicha patología (AU)

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Paraganglioma del nervio vago. Presentación de un caso y revisión de la literatura / Paraganglioma of the vagal nerve. Presentation of a case and revision of literature

El paraganglioma del nervio vago es un tumor poco frecuente entre los tumores de cabeza y cuello. Se caracteriza por presentar una clínica insidiosa, apareciendo más frecuentemente como un bultoma laterocervical asintomático y de lento crecimiento. Presentamos un caso de una mujer de 53 años de edad con una masa laterocervical izquierda indolora que producía tos a la palpación. Pretendemos revisar los aspectos más relevantes acerca de su diagnóstico y tratamiento, con el objetivo de que esté presente en nuestro diagnóstico diferencial (AU)

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