Effectiveness of the MELD/Na Score and the Child-Pugh Score for the Identification of Palliative Care Needs in Patients with Cirrhosis of the Liver.

OBJECTIVE: Identification of palliative care needs in patients with liver cirrhosis using the MELD/Na score and the Child-Pugh score. MATERIALS AND METHODS: A retrospective study of hospitalized patients with hepatic cirrhosis between January 2015 and December 2016 using the Child-Pugh score and the MELD/Na score in January 2018. RESULTS: Recognizing end-of-life patients (the past 12 months of life) is a challenge for health professionals, especially in diseases with poorly defined criteria, such as cirrhosis of the liver. The verification of rapid functional decline and health indicators can be verified using already defined scales such as the Child-Pugh score and the MELD/Na score. Patients were classified according to the Child-Pugh score in Class A (17%), Class B (48.9%), and Class C (34%). The corresponding survival rate was as follows: class A (87.5%), Class B (30.4%), and Class C (31.25%). The MELD/Na score intervals were >9 (2.15%), score 10-19 (46.8%), score 20-29 (27.7%), score 30-40 (19.1%), and score >40 (4.3%). Nearly 51.1% had a MELD/Na score >20 and 48.9% <20. The study revealed that 59.6% of patients died before 12 months. They were end-of-life patients who needed palliative care to reduce the impact of the disease. CONCLUSIONS: The Child-Pugh score and the MELD/Na score represent a viable and easy-to-use tool to identify patients in need of palliative care, among those with liver cirrhosis. Early identification, timely evaluation, and effective treatment of physical, spiritual, family, and social problems improve the quality of life of people with incurable diseases and their families.

Complicaciones trombóticas y hemorrágicas en pacientes con aneurismas cerebrales tratados por vía endovascular y su relación con el uso de antiagregantes plaquetarios: evaluación descriptiva / Thrombotic and haemorrhagic complications in patients with cerebral aneurysms treated by endovascular approach and their association with the use of antiplatelet agents: Descriptive evaluation

Objetivo: El protocolo de medicación antiplaquetaria óptimo para prevenir las complicaciones trombóticas después de embolización de aneurismas cerebrales no es claro. Nuestro objetivo es describir las características de los pacientes que presentan complicaciones trombóticas o hemorrágicas secundarias al tratamiento endovascular. Métodos: Se realizó un estudio descriptivo de corte transversal. Se incluyó a todos los pacientes que requirieron manejo endovascular de aneurismas cerebrales en el Hospital Universitario San Ignacio desde noviembre del 2007 hasta enero del 2016. Se evaluaron las complicaciones trombóticas o hemorrágicas durante 6 meses de seguimiento, teniendo en cuenta el esquema de premedicación con antiagregantes plaquetarios, localización, tamaño del aneurisma y técnica de embolización utilizada. Resultados: Se evaluó a 122 pacientes en los cuales se realizaron 130 procedimientos para tratamiento endovascular de aneurismas cerebrales. Las complicaciones trombóticas fueron más frecuentes en pacientes que no recibieron premedicación (25%) comparados con aquellos que recibieron algún esquema de antiagregación (estándar 3,87% o carga 8,70%); esta diferencia fue estadísticamente significativa (p=0,043). Conclusiones: Los eventos tromboembólicos son la complicación más frecuente de la embolización de aneurismas cerebrales. Nuestro trabajo, al igual que la literatura revisada, sustenta el uso de terapia antiplaquetaria dual con ácido acetilsalicílico y clopidogrel para disminuir la tasa de complicaciones tromboembólicas sintomáticas independientemente del protocolo de administración

Objective: The protocol for optimal antiplatelet therapy to prevent thrombotic complications following brain aneurysm embolisation is not clear. Our objective is to describe the characteristics of patients presenting with thrombotic or haemorrhagic complications secondary to endovascular treatment. Methods: A cross sectional descriptive study was performed, which included all patients that required endovascular treatment for brain aneurysm at San Ignacio University Hospital from November 2007 to January 2016. Thrombotic and haemorrhagic complications over six months of follow-up were assessed, considering the premedication regimen with antiplatelet agents, location, size of the aneurysm and embolisation technique performed. Results: 122 patients were evaluated, on whom 130 procedures were performed for endovascular treatment of brain aneurysms. Thrombotic complications were more frequent in patients who did not receive premedication (25%) compared to those who did receive an antiplatelet treatment regimen (standard dose 3.87% or loading dose 8.70%), and this difference was statistically significant (P=.043). Conclusions Thromboembolic events are the most common complication of brain aneurysm embolisation. Both our study and the literature suggest that the use of dual antiplatelet therapy with aspirin and clopidogrel lowers the rate of symptomatic thromboembolic complications, regardless of the administration protocol

[Thrombotic and haemorrhagic complications in patients with cerebral aneurysms treated by endovascular approach and their association with the use of antiplatelet agents: Descriptive evaluation]. / Complicaciones trombóticas y hemorrágicas en pacientes con aneurismas cerebrales tratados por vía endovascular y su relación con el uso de antiagregantes plaquetarios: evaluación descriptiva.

OBJECTIVE: The protocol for optimal antiplatelet therapy to prevent thrombotic complications following brain aneurysm embolisation is not clear. Our objective is to describe the characteristics of patients presenting with thrombotic or haemorrhagic complications secondary to endovascular treatment. METHODS: A cross sectional descriptive study was performed, which included all patients that required endovascular treatment for brain aneurysm at San Ignacio University Hospital from November 2007 to January 2016. Thrombotic and haemorrhagic complications over six months of follow-up were assessed, considering the premedication regimen with antiplatelet agents, location, size of the aneurysm and embolisation technique performed. RESULTS: 122 patients were evaluated, on whom 130 procedures were performed for endovascular treatment of brain aneurysms. Thrombotic complications were more frequent in patients who did not receive premedication (25%) compared to those who did receive an antiplatelet treatment regimen (standard dose 3.87% or loading dose 8.70%), and this difference was statistically significant (P=.043). CONCLUSIONS: Thromboembolic events are the most common complication of brain aneurysm embolisation. Both our study and the literature suggest that the use of dual antiplatelet therapy with aspirin and clopidogrel lowers the rate of symptomatic thromboembolic complications, regardless of the administration protocol.

Effectiveness of Bilateral Inferior Petrosal Sinuses Sampling in Tumor Lateralization: Intraoperative Findings and Postoperative Results.

Object Diagnosis and treatment of Cushing's disease (CD) is a demanding endeavor. We evaluated the effectiveness of inferior petrosal sinus sampling (IPSS) in preoperative tumor lateralization and surgical outcomes. Methods Fifty-two consecutive patients with CD and normal magnetic resonance imaging (MRI) were enrolled between 2009 and 2015. Selective catheterization of petrosal sinuses for IPSS was performed. All patients underwent microsurgical dissection, and if a lesion was found, underwent lesion resection. Demographic, biochemical, and intraoperative findings were prospectively collected and reviewed 6 and 12 months postoperatively. Results Forty-five patients (86.4%) had clear lateralization while seven patients had bilateral elevation. Twenty-two patients (42%) were found to have a macroscopic lesion, defined as an abnormal tissue during microsurgical dissection, which was thus resected. No patient had a lesion larger than 4 mm. Eighty-one percent of patients had the lesion where IPSS had been predicted. Hemi-hypophysectomy was performed on twenty-eight patients based on IPSS findings, since no lesion was found. Eighty-six percent of patients with lesion resection had biochemical remission by 12 months. Biochemical remission was documented in 78 and 71% of patients who underwent hemi-hypophysectomy by 6 and 12 months, respectively. Conclusion With careful microsurgical dissection, a macroscopic lesion could be found in a significant number of patients with normal MRI. When no lesion was found, we recommend performing a hemi-hypophysectomy based on IPSS findings, since prediction accuracy was high and remission rates were significant.

Tratamiento endovascular de las malformaciones arteriovenosas cerebrales y de las malformaciones arteriovenosas durales / Endovascular treatment of cerebral arteriovenous malformations and dural arteriovenous malformations

Objetivo: Reportar una experiencia en el manejo endovascular de las malformaciones arteriovenosas cerebrales y las fistulas arteriovenosas durales. Método: Se recolectó una muestra por conveniencia desde septiembre del 2007 hasta abril del 2010. Fueron tratados 50 pacientes, 34 con diagnóstico de malformación arteriovenosa cerebral y 16 con diagnóstico de fístula arteriovenosa dural, mediante terapia endovascular. De ellos el 66 corresponde a hombres, y el 34 a mujeres. Se realizaron en total 84 sesiones de embolización según una técnica endovascular para cada material de embolización. Se utilizó N-butil cianoacrilato, Histoacryl® en el 76 de los procedimientos; Onyx® en el 20, y una combinación de estos con poroespirales en el 3,6 de los procedimientos. Resultados: Los síntomas más frecuentes de manifestación fueron cefalea, convulsión y hemorragia intracerebral. En el 32 de los casos se alcanzó la curación con el manejo endovascular como técnica única, logrando mayor número de curaciones con una sola sesión de embolización. El 38 de los pacientes fueron enviados a radioterapia o a manejo quirúrgico complementario luego de disminuir el tamaño de la lesión por medio endovascular. Las complicaciones alcanzaron el 5,9. Conclusiones: Las malformaciones arteriovenosas cerebrales y fístulas arteriovenosas durales son lesiones complejas que conllevan un riesgo potencial de sangrado para los pacientes con sus consecuencias. El tratamiento endovascular es seguro y efectivo, y se constituye en parte fundamental dentro del esquema de manejo multidisciplinario con la radiocirugía y cirugía.