New reference nomograms for the study of ventricular size in preterm infants.

INTRODUCTION: Transfontanellar brain ultrasound is an essential tool for monitoring the size of the ventricles in preterm neonates and has many advantages over other alternative diagnostic techniques, including its accessibility and non-use of ionizing radiation. When considering the normal ventricular size, it is essential to have reference measurements based on age-matched populations. The objective of this article is to present our reference measures, based on a sample of preterm infants that we have studied. METHODS: A retrospective observational study was conducted. Measurements of the Levene index, frontal horn thickness, and Evans index were obtained in preterm neonates from 25 to 45 weeks, over a period of 5 years, between January 2016 and December 2020. After applying the exclusion criteria, a sample of 199 patients and 350 ultrasound scans were obtained. The independent samples t-test and the Mann-Whitney test were used for the comparison of samples. RESULTS: The distribution of the right and left Levene indices was normal (Shapiro-Wilk test with p = 0.16 and 0.05, respectively), unlike the thickness distribution of the frontal horns (p < 0.05 on both sides). No significant differences were detected between the sexes (p = 0.08). A linear correlation was found between the biparietal diameter and the Levene index. CONCLUSION: From the results obtained in our study, we present reference tables for ventricular size, with the 3rd, 25th, 50th, 75th, and 97th, being the first ones made in our country.

Actualización sobre el meningioma: correlación clínico-radiológica y radio-patológica / Update on meningioma: Clinical-radiological and radio-pathological correlation

Los meningiomas son tumores que se originan en las vellosidades aracnoideas y que constituyen la neoplasia no glial más común en el sistema nervioso central. Las manifestaciones clínicas asociadas al meningioma dependen, fundamentalmente, de su localización. La ubicación en la convexidad cerebral es las más frecuente, especialmente en lóbulos frontales, manifestándose con cefalea, alteraciones motoras, convulsiones e, incluso, con trastornos neurocognitivos. Existen 15 subtipos histológicos de meningioma y 3 grados histológicos. Dentro de estos, los grados 2 y 3 tienen un peor pronóstico y una mayor tasa de recurrencia, así como un comportamiento radiológico, por lo general, más agresivo. Aunque existen algunas características de imagen que pueden permitir demostrar un subtipo concreto, el diagnóstico definitivo siempre requerirá la confirmación histológica/molecular.(AU)

Meningiomas are tumors that originate in the arachnoid villi and are the most common non-glial neoplasm in the central nervous system. The clinical manifestations associated with meningioma depend, fundamentally, on its location. The location in the cerebral convexity is the most frequent, especially in the frontal lobes, manifesting with headache, motor disturbances, seizures and even neurocognitive disorders. There are 15 histologic subtypes of meningioma and three histologic grades. Within these, grades two and three have a worse prognosis and a higher rate of recurrence, as well as a radiological behavior that is generally more aggressive. Although there are some imaging features that can suggest a specific subtype, the definitive diagnosis will always require histological/molecular confirmation.(AU)

Update on meningioma: Clinical-radiological and radio-pathological correlation.

Meningiomas are tumors that originate in the arachnoid villi and are the most common non-glial neoplasm in the central nervous system. The clinical manifestations associated with meningioma depend, fundamentally, on its location. The location in the cerebral convexity is the most frequent, especially in the frontal lobes, manifesting with headache, motor disturbances, seizures and even neurocognitive disorders. There are 15 histologic subtypes of meningioma and three histologic grades. Within these, grades two and three have a worse prognosis and a higher rate of recurrence, as well as a radiological behavior that is generally more aggressive. Although there are some imaging features that can suggest a specific subtype, the definitive diagnosis will always require histological/molecular confirmation.

Biomedical Serious Game System for Lower Limb Motor Rehabilitation of Hemiparetic Stroke Patients.

Hemiparesis resulting from a stroke has a direct impact on patients' daily activities. New approaches for motor rehabilitation include Serious Games (SG) because they include (in a motivating way) the three fundamental elements for rehabilitation: intensive, repetitive and task-oriented training. This study aims to evaluate the therapeutic effects of a biomedical SG and a scoring system developed for lower limb motor rehabilitation of hemiparetic stroke patients. The SG was inspired by the classic videogame called Pong, where the goal is to control a tennis racquet, but using muscular strength. A knee extensor apparatus was adapted with a load cell and mechanical adjustments for measuring the muscular strength of the quadriceps femoris (QFG) and hamstrings (HSG). A scoring system was proposed to evaluate muscular control. Eleven hemiparetic stroke patients participated in an exercise program using the SG twice a week for ten weeks and only the paretic side was trained. Significant Effect Sizes ( d ) were found for QFG strength ( d=0.5;p=0.021 ), QFG control ( ), HSG strength ( d=1.1; p = 0.001 ), HSG control ( d=1.5; p = 0.003 ), functional mobility ( ), gait speed ( d=0.4; p=0.007 ) and motor recovery ( ). Results indicate that the intervention of a SG with both proper apparatus and evaluation system may effectively promote lower limb motor rehabilitation of hemiparetic stroke patients.

Cost-effectiveness of hydrogel plugs in CT-guided lung biopsies. / Estudio de coste-efectividad sobre la utilización de un tapón de hidrogel en las biopsias pulmonares guiadas por tomografía computarizada.

OBJECTIVE: Using a hydrogel plug decreases the number of cases of pneumothorax and reduces the need for pleural drainage tubes in CT-guided lung biopsies. We aimed to analyze the cost-effectiveness of using hydrogel plugs. MATERIAL AND METHODS: We analyzed 171 lung biopsies divided into three groups: Group 1 (n=22): fine-needle aspiration cytology (FNAC) without hydrogel plugs; Group 2 (n=89): FNAC with hydrogel plugs; and Group 3 (n=60): FNAC plus core-needle biopsy (CNB) with hydrogel plugs. We calculated the total costs (direct and indirect) in the three groups. We analyzed the percentage of correct diagnoses, the average and incremental rations, and the most cost-effective option. RESULTS: Total costs: Group 1 = 1,261.28 + 52.65 = € 1,313.93; Group 2 = 1,201.36 + 67.25 = € 1,268.61; Group 3 = 1,220.22 + 47.20 = € 1,267.42. Percentage of correct diagnoses: Group 1 = 77.3%, Group 2 = 85.4%, and Group 3 = 95% (p = 0.04). Average cost-effectiveness ratio: Group 1 = 16.99; Group 2 = 14.85; and Group 3 = 13.34. CONCLUSIONS: Group 3 was the best option, with the lowest average cost-effectiveness ratio; therefore, the most cost-effective approach is to do FNAC and CNB using a dehydrated hydrogel plug at the end of the procedure.

Oxidative and endoplasmic reticulum stress is impaired in leukocytes from metabolically unhealthy vs healthy obese individuals.

BACKGROUND: Oxidative stress and inflammation are related to obesity, but the influence of metabolic disturbances on these parameters and their relationship with endoplasmic reticulum (ER) stress is unknown. Therefore, this study was performed to evaluate whether metabolic profile influences ER and oxidative stress in an obese population with/without comorbidities. SUBJECTS AND METHODS: A total of 113 obese patients were enrolled in the study; 29 were metabolically healthy (MHO), 53 were metabolically abnormal (MAO) and 31 had type 2 diabetes (MADO). We assessed metabolic parameters, proinflammatory cytokines (TNFα and IL-6), mitochondrial and total reactive oxygen species (ROS) production, glutathione levels, antioxidant enzymes activity, total antioxidant status, mitochondrial membrane potential and ER stress marker expression levels (glucose-regulated protein (GRP78), spliced X-box binding protein 1 (XBP1), P-subunit 1 alpha (P-eIF2α) and activating transcription factor 6 (ATF6). RESULTS: The MAO and MADO groups showed higher blood pressure, atherogenic dyslipidemia, insulin resistance and inflammatory profile than that of MHO subjects. Total and mitochondrial ROS production was enhanced in MAO and MADO patients, and mitochondrial membrane potential and catalase activity differed significantly between the MADO and MHO groups. In addition, decreases in glutathione levels and superoxide dismutase activity were observed in the MADO vs MAO and MHO groups. GRP78 and CHOP protein and gene expression were higher in the MAO and MADO groups with respect to MHO subjects, and sXBP1 gene expression was associated with the presence of diabetes. Furthermore, MAO patients exhibited higher levels of ATF6 than their MHO counterparts. Waist circumference was positively correlated with ATF6 and GRP78, and A1c was positively correlated with P-Eif2α. Interestingly, CHOP was positively correlated with TNFα and total ROS production and GRP78 was negatively correlated with glutathione levels. CONCLUSIONS: Our findings support the hypothesis that both inflammation and oxidative stress are involved in the induction of ER stress signaling pathways in the leukocytes of metabolically unhealthy obese vs healthy obese subjects.

The cost effectiveness of vacuum-assisted versus core-needle versus surgical biopsy of breast lesions. / Estudio de costo-efectividad de la biopsia mamaria asistida por vacío versus biopsia con aguja gruesa o arpón.

OBJECTIVES: To determine the cost effectiveness of breast biopsy by 9G vacuum-assisted guided by vertical stereotaxy or ultrasonography in comparison with breast biopsy by 14G core-needle biopsy and surgical biopsy. MATERIAL AND METHODS: We analyzed a total of 997 biopsies (181 vacuum-assisted, 626 core, and 190 surgical biopsies). We calculated the total costs (indirect and direct) of the three types of biopsy. We did not calculate intangible costs. We measured the percentage of correct diagnoses obtained with each technique. To identify the most cost-effective option, we calculated the mean ratios for the three types of biopsies. RESULTS: Total costs were €225.09 for core biopsy, €638.90 for vacuum-assisted biopsy, and €1780.01 for surgical biopsy. The overall percentage of correct diagnoses was 91.81% for core biopsy, 94.03% for vacuum-assisted biopsy, and 100% for surgical biopsy; however, these differences did not reach statistical significance (p=0.3485). For microcalcifications, the percentage of correct diagnoses was 50% for core biopsy and 96.77% for vacuum-assisted biopsy (p<0.0001). For nodules, there were no significant differences among techniques. The mean cost-effectiveness ratio considering all lesions was 2.45 for core biopsy, 6.79 for vacuum-assisted biopsy, and 17.80 for surgical biopsy. CONCLUSION: Core biopsy was the dominant option for the diagnosis of suspicious breast lesions in general. However, in cases with microcalcifications, the low percentage of correct diagnoses achieved by core biopsy (50%) advises against its use in this context, where vacuum-assisted biopsy would be the technique of choice because it is more cost-effective than surgical biopsy, the other technique indicated for biopsying microcalcifications.

Impacto de un centro terciario de ictus en la atención de pacientes con ictus isquémico agudo por disección de arterias cervicales / Impact of a comprehensive stroke centre on the care of patients with acute ischaemic stroke due to cervical artery dissection

Introducción: La disección de arterias cervicales (DAC) es la causa del 2-3% de ictus isquémicos y del 10-25% en pacientes jóvenes. Nuestro objetivo es evaluar si la implementación de un centro terciario de ictus (CTI) facilita el diagnóstico y modifica el pronóstico de los pacientes con ictus agudo por DAC. Pacientes y métodos: Estudio retrospectivo de un registro de pacientes consecutivos con ictus agudo por DAC. Se clasificaron según el periodo de atención: pre-CTI (octubre 2004-marzo 2008, 42 meses) o post-CTI (abril 2008-junio 2012, 51 meses). Se compararon las características basales, el método diagnóstico, el tratamiento y la evolución de estos pacientes entre ambos periodos. Resultados: Se diagnosticó a 9 pacientes con DAC en el periodo pre-CTI y 26 en el post-CTI, representando el 0,8 y el 2,1% de los ictus isquémicos atendidos en cada periodo. El diagnóstico de DAC se realizó en las primeras 24 h en el 42,3% de pacientes en el periodo post-CTI frente al 0% en el pre-CTI, gracias al uso de la arteriografía cerebral urgente como prueba diagnóstica en el 46,2% de los casos en el segundo periodo frente al 0% en el primero. La gravedad del ictus (mediana puntuación escala NIHSS 11 vs. 3, p = 0,014) y el tiempo hasta la atención neurológica (265 minutos vs. 148, p = 0,056) fueron mayores en la fase post-CTI. Se realizó tratamiento endovascular en el 34,3%, todos en el periodo post-CTI. El pronóstico funcional fue comparable en ambos periodos. Conclusiones: La implementación de un CTI incrementa la frecuencia en el diagnóstico de DAC y aumenta las opciones terapéuticas en la fase aguda del ictus en estos pacientes

Introduction: Cervical artery dissection (CAD) is the cause of 2% to 3% of ischaemic strokes and 10% to 25% of the ischaemic strokes in young people. Our objective is to evaluate whether implementation of a comprehensive stroke centre (CSC) improves the diagnosis and modifies the prognosis of patients with acute stroke due to CAD. Patients and methods: Retrospective study of a registry of consecutive patients with acute stroke due to CAD. They were classified according to the period of care at our centre: pre-CSC (October 2004-March 2008, 42 months) or post-CSC (April 2008-June 2012, 51 months). We compared baseline characteristics, methods of diagnosis, treatment and outcome of these patients in both periods. Results: Nine patients were diagnosed with CAD in pre-CSC and 26 in post-CSC, representing 0.8% and 2.1% of all ischaemic strokes treated in each period, respectively. The diagnosis of CAD was made within the first 24 hours in 42.3% of the patients in post-CSC versus 0% in pre-CSC, by using urgent cerebral angiography as a diagnostic test in 46.2% of cases in the second period compared to 0% in the first. Both severity of stroke (median NIHSS score 11 vs. 3, P = .014) and time to neurological care (265 min vs 148,P = .056) were higher in the post-CSC period. Endovascular treatment was performed in 34.3%, and all treatments were post-CSC. The functional outcome was comparable for both periods. Conclusions: Implementation of a CSC increases the frequency of the diagnosis of CAD, as well as the treatment options for these patients in the acute phase of stroke

[Update on the radiological study of pulmonary tuberculosis]. / Puesta al día en el estudio radiológico de la tuberculosis pulmonary.

Tuberculosis has made a comeback in recent years. This upsurge has been attributed to factors such as increased immigration and the human immunodeficiency virus epidemic. Primary pulmonary tuberculosis manifests radiologically with parenchymal involvement, lymph node involvement, pleural effusion, and/or miliary disease. In post-primary tuberculosis, the earliest radiological sign is small nodules and branching centrilobular lesions that increase in size and coalesce to form ill-defined patchy consolidations; cavitations are very characteristic of active disease. The aim of this article is to describe the radiologic findings for pulmonary tuberculosis and its complications.

Impact of a comprehensive stroke centre on the care of patients with acute ischaemic stroke due to cervical artery dissection.

INTRODUCTION: Cervical artery dissection (CAD) is the cause of 2% to 3% of ischaemic strokes and 10% to 25% of the ischaemic strokes in young people. Our objective is to evaluate whether implementation of a comprehensive stroke centre (CSC) improves the diagnosis and modifies the prognosis of patients with acute stroke due to CAD. PATIENTS AND METHODS: Retrospective study of a registry of consecutive patients with acute stroke due to CAD. They were classified according to the period of care at our centre: pre-CSC (October 2004-March 2008, 42 months) or post-CSC (April 2008-June 2012, 51 months). We compared baseline characteristics, methods of diagnosis, treatment and outcome of these patients in both periods. RESULTS: Nine patients were diagnosed with CAD in pre-CSC and 26 in post-CSC, representing 0.8% and 2.1% of all ischaemic strokes treated in each period, respectively. The diagnosis of CAD was made within the first 24 hours in 42.3% of the patients in post-CSC versus 0% in pre-CSC, by using urgent cerebral angiography as a diagnostic test in 46.2% of cases in the second period compared to 0% in the first. Both severity of stroke (median NIHSS score 11 vs. 3, P=.014) and time to neurological care (265 min vs 148, P=.056) were higher in the post-CSC period. Endovascular treatment was performed in 34.3%, and all treatments were post-CSC. The functional outcome was comparable for both periods. CONCLUSIONS: Implementation of a CSC increases the frequency of the diagnosis of CAD, as well as the treatment options for these patients in the acute phase of stroke.

Hyperintensity of distal vessels on FLAIR is associated with slow progression of the infarction in acute ischemic stroke.

BACKGROUND: Hyperintensity of distal vessels on FLAIR-MRI has been associated with a higher grade of arterial collaterals and a smaller infarct volume in acute stroke patients. No studies analyze the influence of the hyperintense vessel (HV) sign on the speed of the ischemia progression during the first hours. Our aim was to study the association of the HV sign with progression of infarction in acute stroke patients. METHODS: From a prospectively derived stroke database, we retrospectively selected acute stroke patients with a large artery occlusion of the anterior circulation admitted to our comprehensive stroke center with available baseline CT scan and a multimodal MRI carried out thereafter to make a decision about endovascular treatment. Progression of the ischemic area was calculated as the difference in the Alberta Stroke Program Early CT Scan (ASPECTS) score between CT scan and diffusion-weighted imaging (DWI). Slow progression was considered as no change or 1 point decrease on the ASPECTS score between both exams. The presence of HV on FLAIR sequence was graded as absent, subtle or prominent by two readers. RESULTS: A total of 70 patients were included in the study. Mean time between baseline CT and MRI was 124 ± 82 min. ASPECTS score on baseline CT was 10 in 34% of patients, 9 in 49% and 8 or less in 17%. ASPECTS score was 2 (1-3) points lower in the DWI and this decrease did not correlate with the time elapsed between the two exams. Distal HV sign was observed in 57/70 (81%) patients (subtle in 33 and prominent in 24). HV was more frequently observed in patients with proximal artery occlusion. There were no differences regarding stroke severity, stroke subtype and ASPECTS score on baseline CT between groups. Patients with prominent HV showed a lower progression of the ischemic area [median ASPECTS score decrease, 1 (1-0)] compared with patients with subtle HV [median ASPECTS score decrease, 2 (2-1)] and patients with absence of HV [median ASPECTS score decrease, 3 (4-3)] (p < 0.001). Prominent HV was independently associated with slow progression of ischemia in a multivariate logistic regression analysis adjusted by systolic blood pressure on admission, site of occlusion and time elapsed between both neuroimaging exams compared to the absence of HV (OR, 16.2; 95% CI, 2.1-123.1) and to subtle HV sign (OR, 6.1; 95% CI, 1.5-23.9). CONCLUSION: HV sign on FLAIR, especially if prominent, is associated with a slow progression of the ischemic area in acute stroke patients with cerebral artery occlusion of the anterior circulation. This radiological sign may predict the speed of the ischemia progression, opening an opportunity for reperfusion therapies in longer time windows.

[Experimental validation of calcium phosphate precipitation modeling in a pellet reactor]. / Validation expérimentale d'un modèle pour la précipitation de phosphates de calcium en lit fluidisé.

Calcium phosphate precipitation is studied in this article. The P-recovery process is carried out in a fluidized sand bed, the so-called pellet reactor which presents major advantages from the hydrodynamical viewpoint. The associated chemistry is yet relatively complex, due to pH gradient along the column and to the residence time of the various precipitates. The experimental observations showed three different phenomena: first, an agglomeration of fines around the sand grains is observed, second, a stagnation of fines in the bed occurs while a significant amount of fines also leaves the bed with the liquid effluent. The purpose of this work is to validate the thermodynamical model developed in our previous works on a semi-industrial sized pilot. Additional experimental runs carried out for various operating conditions showed the robustness of the model. These results open some interesting perspectives for the determination of optimized operating conditions at industrial scale.

Determination of insolubles in diesel lubricating oil by FIA-visible spectrometry.

Insolubles determination is one of the parameters usually recommended to evaluate the residual life of oil because their presence at elevated levels in diesel lubricating oil changes the viscosity, prematurely clogs filters and is one of the major factors in causing abrasive engine wear. The proposed method employs visible spectrophotometric detection in association with flow injection analysis. The results obtained by this method were compared with the ones obtained by Fourier transform infrared spectrometry (FT-IR) since this is the most employed method for insolubles determination. The proposed method presented a linear response from 0 to 3% (w/w) of insolubles in pentane (ASTM D-893). The sampling frequency was about 30 samplesh(-1), with a relative standard deviation (n=5) of 2.4% or better. Accuracy was evaluated analysing 98 real samples and the results obtained with the FIA-spectrophotometric method were plotted against those obtained by the FT-IR method by means of linear regression. Slope and intercept of the straight line obtained were compared with the theoretical values of 1 and 0 by means of the joint-confidence ellipse F-test. At the confidence level of 95% no evidence of a difference was found between both methods.

Clinically significant skeletal variations of the shoulder and the wrist: role of MR imaging.

Several skeletal variations of the upper extremity may cause painful conditions or precipitate early degenerative changes, either spontaneously or in response to overuse and trauma. Magnetic resonance imaging has proved particularly useful for accurate interpretation of many of these clinically significant skeletal variations; however, the widespread use of MR imaging may have contributed to over-emphasizing their clinical importance, which is still controversial in many cases. We review, illustrate, and discuss clinically significant skeletal variations of the upper extremity as seen on MR images, particularly those involving the shoulder and the wrist. In the shoulder region, we evaluate variations of acromial and coracoid processes as well as variations and minor dysplastic deformities of the glenoid fossa. We also review different skeletal variations of the carpal region, including ulnar variance, ulnar styloid, lunate morphology, carpal coalition, and carpal accessory ossicles. The role of MR imaging in assessing the clinical importance of such conditions, whether potential, controversial, or well established, is emphasized in this review.

Rotura masiva del manguito de los rotadores. Resultados del tratamiento quirúrgico / Massive rupture of the rotator cuff. Results of surgical treatment

Objetivo: Evaluar de forma retrospectiva los resultados clínicos de 25 pacientes diagnosticados de rotura masiva del manguito de los rotadores tratados quirúrgicamente, de forma consecutiva. Pacientes: La serie está compuesta por 13 hombres y 12 mujeres con una edad media de 57 años. La indicación para el tratamiento quirúrgico ha sido el dolor importante después de un período de tratamiento conservador superior a 3 meses. El diagnóstico de rotura masiva se ha realizado en el momento de la intervención quirúrgica cuando el tamaño de la rotura, en su diámetro mayor ha sido = 5 cm. Se han excluido aquellos pacientes con rotura masiva del manguito con excentricidad de la cabeza humeral respecto a la glenoides por subluxación proximal con signos de artropatía secundaria a lesión del manguito. Se ha realizado una descompresión del espacio subacromial a cielo abierto mediante la técnica de Neer y reparación de la lesión después de movilización de los extremos tendinosos siguiendo un proceso sistemático, sutura tendinosa por convergencia de márgenes y sutura al troquíter mediante anclajes óseos. Los pacientes se han evaluado desde el punto de vista clínico mediante la escala de UCLA con un seguimiento mínimo de 1 año. Resultados: Antes de la intervención la puntuación media fue de 11,6; mientras que en la revisión fue de 32,2 (13 resultados excelentes, 8 buenos, 3 regulares y 1 malo). Los 3 pacientes que tenían un antecedente traumático de luxación glenohumeral obtuvieron los peores resultados. Conclusiones: Con el tratamiento quirúrgico de las roturas masivas del manguito de los rotadores puede obtenerse un nivel de resultados satisfactorios parecido a los obtenidos con el tratamiento de lesiones de menor tamaño. (AU)

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Sonographically guided percutaneous biopsy of gastrointestinal tract lesions.

OBJECTIVE: Our objective was to evaluate the role and safety of sonographically guided percutaneous biopsy in the diagnosis of digestive tract lesions when the lesions are not suitable to biopsy by endoscopy and safely reachable by sonography. MATERIALS AND METHODS: We performed 42 biopsies in 41 patients (age range, 14-81 years; mean age, 57.5 years). We performed biopsies with real-time sonographic guidance using graded compression, with a 3.5-5-MHz microconvex transducer. In 39 biopsies, core specimens were obtained with an 18-gauge automatic needle gun; fine-needle aspiration biopsy was obtained in 28 patients with a 22-gauge needle and in the other four patients with a 21-gauge needle. In the remaining three patients, a coaxial technique with 20- and 22-gauge needles for cytology was used. RESULTS: In 40 (95.2%) of 42 core biopsies performed, a specific diagnosis was obtained. A positive diagnosis was obtained in 16 (45.7%) of 35 fine-needle aspirations. The lesions were located from the pharynx to the sigmoid colon. Twenty-eight patients had malignant lesions, and 13 had benign lesions. Only one serious complication, bile peritonitis, was observed. CONCLUSION: Percutaneous biopsy with sonographic guidance can be used safely and efficiently to diagnose digestive tract lesions that can be visualized on sonography and are not accessible endoscopically.

Ultrasound-guided skeletal biopsies.

OBJECTIVE: Percutaneous biopsy of skeletal lesions is a widely used diagnostic technique that involves fluoroscopic or computerized tomography guidance. The objective of this report is to describe the use of ultrasonography in the guidance of percutaneous biopsy of skeletal lesions. DESIGN AND PATIENTS: We employed ultrasound to guide percutaneous biopsy in 65 skeletal lesions in 63 patients (30 male and 33 female) whose ages ranged from 1 to 82 years (mean 47.2 years ). The lesions were divided into four groups: group 1 ( n=41) were lytic with a soft tissue mass, group 2 ( n=14) were lytic with a disrupted cortex without a soft tissue mass, group 3 ( n=4) were lytic with an intact cortex and group 4 ( n=6) were sclerotic lesions. Different techniques and materials were used in each group. RESULTS: Cytologic assessment obtained the diagnosis in 50 cases, (success rate 76.9%), histology in 56 cases (86.1%) and a combination of both in 60 cases (92.3%). There were no complications. CONCLUSIONS: Ultrasound is a highly accurate and safe method of guidance in percutaneous biopsy of bone lesions, either lytic or sclerotic, because it can identify subtle changes in the cortical and the associated soft tissue component.

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La tomografía axial computarizada en la enfermedad cerebrovascular

En los Estados Unidos, la información sobre los factores de riesgo combinada con el control de la hipertensión ha reducido los ictus y las muertes relacionadas con ellos en un 50 por ciento en las tres últimas décadas. Sin embargo, el ictus sigue siendo una de las causas principales de discapacidad y la tercera causa de muerte tras la enfermedad cardiovascular no cerebral y el cáncer. Con la llegada de nuevos tratamientos, agresivos pero prometedores, la identificación precoz de la isquemia cerebral sitúa el diagnóstico por la imagen en la vanguardia del control de los accidentes cerebrovasculares (AU)