Carotid cavum aneurysm treated with Solitaire™ AB stent. Case report.

BACKGROUND: In the cavum segment the internal carotid artery has more susceptibility formation of aneurysms. The Solitaire™ AB stent is a scaffold that do flow blood diversion and promotes the aneurysms exclusion by thrombosis. CASE REPORT: 63 year old female present pulsatile headache, diplopia, III left cranial nerve paresis and carried a cavum carotid saccular aneurysms of the left carotid artery. By endovascular procedure, we placed a Solitaire™ AB stent. She recovered the III left cranial nerve function in to 2 month and we observed exclusion of the aneurysms by DynaCT in 3 months. CONCLUSION: The reconstruction of an artery by endovascular therapy is an alternative treatment for no ruptured paraclinoid aneurysms.

ANTECEDENTES: La arteria carótida interna a nivel del cavum es más susceptible de formación de aneurismas. El Solitaire™ AB condiciona una redirección del flujo de la sangre que favorece la exclusión por trombosis del aneurisma. CASO CLÍNICO: Mujer de 63 años que presentó cefalea, diplopía, paresia del III nervio craneal y portadora de aneurisma sacular en la arteria carótida interna izquierda a nivel del cavum carotídeo. Se colocó una endoprótesis Solitaire™ AB por procedimiento endovascular. Recuperó la función del III nervio craneal izquierdo a los 2 meses y se observó la exclusión del aneurisma a los 3 meses por DynaCT. CONCLUSIÓN: La endoprótesis para reconstrucción arterial intracraneal es una alternativa terapéutica en aneurismas paraclinoideos no rotos.

Traumatic brain injury with a machete penetrating the dura and brain: Case report from southeast Mexico.

INTRODUCTION: Traumatic Brain Injury (TBI) is a major cause of death and disability in our society, we present the first case report of non-missile penetrating (NMP) cranial trauma with a machete in Mexico, and our objective by presenting this case is to prove the usefulness of recently proposed algorithms in the treatment of NMP PRESENTATION OF CASE: We present the case of a 47 year old woman who received a machete hit to the right side of her head during an assault., she arrived fully conscious to the emergency department (ED), computed tomography was performed and based on the findings of this study and in accordance to recently proposed algorithms for managing NMP cranial trauma a craniotomy was performed, at follow-up the patient presented wtih minor neurological disability in the form of left hemiparesis. DISCUSSION: Non-missile penetrating (NMP) lesions are defined as having an impact velocity of less than 100m/s, causing injury by laceration and maceration, An algorithm for treating NMP cranial trauma has been recently published in the Journal World Neurosurgery by De Holanda et al., in this case we followed the algorithm in order to provide best care available for our patient with good results. CONCLUSION: The use of current algorithms for managing NMP cranial trauma has proved to be very useful when applied on this particular case. GCS on admission is an important prognostic factor in NMP cranial trauma.

Prevalence of Pulmonary Hypertension in the General Population: The Rotterdam Study.

BACKGROUND: Pulmonary hypertension is characterized by increased pulmonary artery pressure and carries an increased mortality. Population-based studies into pulmonary hypertension are scarce and little is known about its prevalence in the general population. We aimed to describe the distribution of echocardiographically-assessed pulmonary artery systolic pressure (ePASP) in the general population, to estimate the prevalence of pulmonary hypertension, and to identify associated factors. METHODS: Participants (n = 3381, mean age 76.4 years, 59% women) from the Rotterdam Study, a population-based cohort, underwent echocardiography. Echocardiographic pulmonary hypertension was defined as ePASP>40 mmHg. RESULTS: Mean ePASP was 26.3 mmHg (SD 7.0). Prevalence of echocardiographic pulmonary hypertension was 2.6% (95%CI: 2.0; 3.2). Prevalence was higher in older participants compared to younger ones (8.3% in those over 85 years versus 0.8% in those between 65 and 70), and in those with underlying disorders versus those without (5.9% in subjects with COPD versus 2.3%; 9.2% in those with left ventricular systolic dysfunction versus 2.3%; 23.1% in stages 3 or 4 left ventricular diastolic dysfunction versus 1.9% in normal or stage 1). Factors independently associated with higher ePASP were older age, higher BMI, left ventricular diastolic dysfunction, COPD and systemic hypertension. CONCLUSION: In this large population-based study, we show that pulmonary hypertension as measured by echocardiography has a low prevalence in the overall general population in the Netherlands, but estimates may be higher in specific subgroups, especially in those with underlying diseases. Increased pulmonary arterial pressure is likely to gain importance in the near future due to population aging and the accompanying prevalences of underlying disorders.

Reslizumab for inadequately controlled asthma with elevated blood eosinophil counts: results from two multicentre, parallel, double-blind, randomised, placebo-controlled, phase 3 trials.

BACKGROUND: Elevated numbers of blood eosinophils are a risk factor for asthma exacerbations. Reslizumab is a humanised anti-interleukin 5 monoclonal antibody that disrupts eosinophil maturation and promotes programmed cell death. We aimed to assess the efficacy and safety of reslizumab in patients with inadequately controlled, moderate-to-severe asthma. METHODS: We did two duplicate, multicentre, double-blind, parallel-group, randomised, placebo-controlled phase 3 trials. Both trials enrolled patients with asthma aged 12-75 years (from 128 clinical research centres in study 1 and 104 centres in study 2) from Asia, Australia, North America, South America, South Africa, and Europe, whose asthma was inadequately controlled by medium-to-high doses of inhaled corticosteroid based therapy and who had blood eosinophils of 400 cells per µL or higher and one or more exacerbations in the previous year. Patients were randomly assigned (1:1) to receive either intravenous reslizumab (3·0 mg/kg) or placebo every 4 weeks for 1 year by computerised central randomisation. Patients and investigators were masked to treatment assignment during the study. Each patient received a specific volume of study drug (reslizumab or matching placebo) on the basis of the patient's body weight and randomly assigned treatment group. Additionally, the sponsor's clinical personnel involved in the study were masked to the study drug identity until the database was locked for analysis and the treatment assignment revealed. The primary outcome was the annual frequency of clinical asthma exacerbations and was analysed by intention to treat. We assessed safety outcomes in the patients who had received one or more dose of the drug. The trials have been completed and are registered with ClinicalTrials.gov, numbers NCT01287039 (study 1) and NCT01285323 (study 2). FINDINGS: Study 1 was done between April 12, 2011, and March 3, 2014 and study 2 between March 22, 2011, and April 9, 2014. Of 2597 patients screened, 953 were randomly assigned to receive either reslizumab (n=477 [245 in study 1 and 232 in study 2]) or placebo (n=476 [244 and 232]). In both studies, patients receiving reslizumab had a significant reduction in the frequency of asthma exacerbations (study 1: rate ratio [RR] 0·50 [95% CI 0·37-0·67]; study 2: 0·41 [0·28-0·59]; both p<0·0001) compared with those receiving placebo. Common adverse events on reslizumab were similar to placebo. The most common adverse events were worsening asthma symptoms (127 [52%] for placebo and 97 [40%] for reslizumab in study 1; 119 [51%] for placebo and 67 [29%] for reslizumab for study 2), upper respiratory tract infections (32 [13%] and 39 [16%]; 16 [7%] and eight [3%]), and nasopharyngitis (33 [14%] and 28 [11%]; 56 [24%] and 45 [19%]). Two patients in the reslizumab group had anaphylactic reactions; both responded to standard treatment at the study centre and resolved, and the patients were withdrawn from the study. INTERPRETATION: These results support the use of reslizumab in patients with asthma and elevated blood eosinophil counts who are inadequately controlled on inhaled corticosteroid-based therapy. FUNDING: Teva Branded Pharmaceutical Products R&D.

Estudio piloto para evaluar la utilización de tecnología CAD/CAM en la fabricación central de cuencas prótesicas en México / Pilot trial for assessment of CAM-CAD computerized technology for unified manufacturing of external prosthetic sockets for amputees

Por vez primera se realizó un estudio piloto entre México (centro de rehabilitación) y Canadá (centro de manufactura) para evaluar la fabricación central de cuencas protésicas utilizando tecnología CAD/CAM. En CRIMAL (Querétaro), se tomó el molde negativo de tres muñones trans-tibiales y las medidas anatómicas de cuatro muñones trans-femorales. Las medidas trans-femorales fueron capturadas y modificadas por computadora en CRIMAL. La geometría digital generada por CAD fue transmitida vía modem a The Rehabilitation Center (Ottawa) para fabricar las cuencas por CAM. Estas cuencas fueron enviadas por mensajería a México y por autobús a Querétaro. Los moldes trans-tibiales fueron trasladados a Ottawa donde se digitalizaron y modificaron numéricamente para despúes fabricar las cuencas y transportarlas a Querétaro. Las siete cuencas se adaptaron exitosamente a los pacientes y fueron utilizadas para fabricar prótesis finales. Si bien el método de molde-digitalización tuvo ventajas clínicas sobre el método de medición, el transporte de moldes, el costo de digitalizarlos y la disminución en la portabilidad del sistema podría reducir su eficiencia en zonas de difícil acceso en México. Resumiendo, este estudio piloto confirmó la utilidad de la tecnología CAD/CAM para la fabricación central de cuencas protésicas en México