Resultados a largo plazo de prótesis de cúbito distal como cirugía de rescate en un caso de técnica de Sauvé-Kapandji fallida

La técnica de Sauvé-Kapandji se emplea como tratamiento de rescate en la patología de la articulación radiocubital distal (ARCD). Los resultados postoperatorios son buenos, aunque a largo plazo pueden surgir complicaciones como dolor, muñón cubital inestable y pérdida de fuerza de prensión. Presentamos un caso de cirugía de rescate de esta técnica mediante prótesis de cúbito distal. A los cuatro años de seguimiento, el paciente presenta desaparición completa del dolor y recuperación de la fuerza de prensión, lo que hace pensar que la prótesis cubital puede ser un buen método de rescate cuando fracasa un Sauvé-Kapandji.

Tratamiento percutáneo de las fracturas de escafoides

Las fracturas de escafoides son las más frecuentes de todos los huesos del carpo suponiendo un 60-70% del total. La mayoría de ellas se localizan a nivel de la cintura. Clásicamente, las fracturas no desplazadas se han tratado de manera conservadora durante largos periodos de inmovilización con férulas u ortesis, obteniéndose buenas tasas de consolidación. Una de las alternativas al tratamiento conservador es la osteosíntesis percutánea con tornillo a compresión; técnica que ha demostrado ser efectiva en el tratamiento de este tipo de fracturas obteniendo excelentes tasas de consolidación, con menor tiempo de recuperación y escaso número de complicaciones relacionadas con el acto quirúrgico. El menor tiempo de inmovilización y la rápida reincorporación del paciente a sus actividades cotidianas ha supuesto un auge de este método frente a la decadencia cada vez mayor del tratamiento ortopédico. El objetivo de este artículo es revisar conceptos actuales en la fijación percutánea del escafoides.

Accuracy of Diffusion-Weighted Imaging in the Diagnosis of Stroke in Patients With Suspected Cerebral Infarct

Background and Purpose—

The accuracy of diffusion-weighted imaging (DWI) for the diagnosis of acute cerebral ischemia among patients with suspected ischemic stroke arriving to an emergency room has not been studied in depth.

Methods—

DWI was performed in 712 patients with acute or subacute focal symptoms that suggested an acute ischemic stroke (AIS), 609 of them with AIS.

Results—

DWI demonstrated a sensitivity of 90% and specificity of 97%, a positive likelihood ratio of 31 and a negative likelihood ratio of 0.1 for detecting AIS. The overall accuracy was 95%. Of those patients who demonstrated abnormal DWI studies, 99.5% were AIS patients, and of those patients with normal DWI studies 63% were stroke mimics.

Conclusions—

DWI is accurate in detecting AIS in unselected patients with suspected AIS; a negative study should alert for nonischemic conditions.

Exclusion criteria for intravenous thrombolysis in stroke mimics: an observational study

BACKGROUND

Stroke mimics (SMs) are frequent in emergency departments (EDs), but are treated infrequently with intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis. We aimed at identifying the factors that lead to the exclusion of SMs from thrombolytic therapy.

METHODS

Consecutive patients presenting to the ED between December 2004 and March 2011 with symptoms that suggested acute ischemic stroke were included.

RESULTS

Eight hundred forty-two patients were included in this study; 113 (13.4%) were considered SMs; these patients were younger (P = .01), more frequently diabetic (P = .001), arrived later to the ED (P = .03), had lower National Institutes of Health Stroke Scale scores (P < .001), and higher frequencies of negative diffusion-weighted imaging studies (P = .002). The most common causes of cases of SM were toxic metabolic disorders (n = 34 [30.1%]) and seizures (n = 22 [19.5%]). The most frequent cause of consultation was aphasia (n = 43 [37.6%]). SM patients had a total of 152 contraindications for rt-PA, with 34 (30%) patients having >1 contraindication. The most frequent of these were being beyond the therapeutic window for thrombolysis (n = 96) and having deficits not measurable by the National Institutes of Health Stroke Scale or very mild symptoms before the start of rt-PA (n = 37). Twenty-four (21.2%) patients had both contraindications simultaneously. Two patients (1.76%) in the SM group were candidates for rt-PA but did not receive this treatment because they or their family rejected it. Of 729 stroke patients, 87 (11.9%) did receive rt-PA.

CONCLUSIONS

SM patients frequently had exclusion criteria for systemic thrombolysis, the most frequent being presenting beyond the established thrombolytic window.

Transcranial Doppler in a Hispanic-Mestizo population with neurological diseases: a study of sonographic window and its determinants

Between 5% and 37% of patients are not suitable for transtemporal insonation with transcranial Doppler (TCD). This unsuitability is particularly frequent in elderly females and non-Caucasians. We aim to evaluate TCD efficiency in a mixed Hispanic population in Santiago, Chile and to determine whether factors associated with the presence of optimal windows depend exclusively on patient-related elements. Seven hundred forty-nine patients were evaluated with power mode TCD. Optimal temporal windows (TWs) included detection of the middle, anterior, posterior cerebral arteries and terminal carotid. The patient's age and sex, the location of the examination, the time of day, whether the test was conducted on weekends and whether mechanical ventilation was used were recorded. Percentages of optimal windows were calculated. Examinations were deemed ideal if both TWs were optimal. TWs were obtained in 82% of cases. In univariate analyses, male sex (P < 0.001), an age below 60 years (P < 0.0001) and mechanical ventilation (P= 0.04) correlated with ideal TWs. Using logistic regression where dependent variable was a non-ideal window only male sex odds ratio (OR) 2.3 (1.51-3.45) and age below 60 OR 13.8 (7.8-24.6) were statistically significant. Our findings indicate that Hispanic populations have detection rates for TWs similar to Europeans and are affected by patient-related elements.

Towards establishing MS prevalence in Latin America and the Caribbean

A very high prevalence of multiple sclerosis (MS) has been reported in some Western European and North American countries. The few surveys of MS epidemiology in South America reveal lower prevalence rates, implying that susceptibility varies between distinct ethnic groups, thus forming an important determinant of the geographic distribution of the disease. The objective of this study is to review MS prevalence estimates in different Latin American and Caribbean countries. We reviewed surveys of regional MS prevalence from 1991 to 2011. Sources included an online database, authors' reports and proceedings or specific lectures from regional conferences. We obtained a total of 30 prevalence surveys from 15 countries, showing low/medium MS prevalence rates. Both the number and the quality of prevalence surveys have greatly improved in this region over recent decades. This is the first collaborative study to map the regional frequency of MS. Establishment of standardized methods and joint epidemiological studies will advance future MS research in Latin America and the Caribbean.

Incidence of multiple sclerosis in Chile. A hospital registry study

OBJECTIVE

To study the incidence of MS in Chile by examining the hospitalizations across all geographical regions of the country and to examine whether there is a correlation between these rates and the latitude or ultraviolet radiation.

METHODS

This is a descriptive study examining the national registry of hospitalizations because of MS (code G35 in ICD-10) from January 1, 2001, to December 31, 2006. Incidence rates were calculated by gender and geographical region and standardized to the world population estimated for 2010.

RESULTS

A total of 6857 hospitalizations were analyzed. There were 935 individuals; 63.9% were women. The mean incidence rate for 2002-2006 period was 0,90 (95% CI: 0.75-1.05). The annualized incidence rates for regions from North to South were as follows: I Tarapaca 0.54 (95% CI: 0.0-1.21), II Antofagasta 0,93 (0.10-1.75), III Atacama 1.07 (0.0-2.31), IV Coquimbo 0.63 (0.01-1.24), V Valparaiso 0.83 (0.38-1.27), VI O'Higgins 0.72 (0.14-1.30), VII Maule 0.52 (0.06-0.98), VIII BIO BIO 0.81 (0.41-1.21), IX Araucanía 0.43 (0.0-0.86), X Los Lagos 0.91 (0.35-1.46), XI Aysen 0.99 (0.0-2.98), XII Magallanes 3.54 (0.57-6.51), and XIII Metropolitana 1.10 (0.84-1.36). There were no significant correlations between hospitalization rates and latitude, except for region XII. UV radiation levels showed significant differences only for region XII.

CONCLUSION

There is a moderate risk of MS in Chile. The southernmost region showed significantly higher incidence rates than those in the rest of the country (a cluster zone). We did not find any correlation between incidence rates and latitude or UV radiation.

Determinants of time trial performance and maximal incremental exercise in highly trained endurance athletes

Human endurance performance can be predicted from maximal oxygen consumption (Vo(2max)), lactate threshold, and exercise efficiency. These physiological parameters, however, are not wholly exclusive from one another, and their interplay is complex. Accordingly, we sought to identify more specific measurements explaining the range of performance among athletes. Out of 150 separate variables we identified 10 principal factors responsible for hematological, cardiovascular, respiratory, musculoskeletal, and neurological variation in 16 highly trained cyclists. These principal factors were then correlated with a 26-km time trial and test of maximal incremental power output. Average power output during the 26-km time trial was attributed to, in order of importance, oxidative phosphorylation capacity of the vastus lateralis muscle (P = 0.0005), steady-state submaximal blood lactate concentrations (P = 0.0017), and maximal leg oxygenation (sO(2LEG)) (P = 0.0295), accounting for 78% of the variation in time trial performance. Variability in maximal power output, on the other hand, was attributed to total body hemoglobin mass (Hb(mass); P = 0.0038), Vo(2max) (P = 0.0213), and sO(2LEG) (P = 0.0463). In conclusion, 1) skeletal muscle oxidative capacity is the primary predictor of time trial performance in highly trained cyclists; 2) the strongest predictor for maximal incremental power output is Hb(mass); and 3) overall exercise performance (time trial performance + maximal incremental power output) correlates most strongly to measures regarding the capability for oxygen transport, high Vo(2max) and Hb(mass), in addition to measures of oxygen utilization, maximal oxidative phosphorylation, and electron transport system capacities in the skeletal muscle.

Kinetics of electro-oxidation of ammonia-N, nitrites and COD from a recirculating aquaculture saline water system using BDD anodes

The viability of the electro-oxidation technology provided with boron doped diamond (BDD) electrodes for the treatment and reuse of the seawater used in a Recirculating Aquaculture System (RAS) was evaluated in this work. The influence of the applied current density (5-50 A m(-2)) in the removal of Total Ammonia Nitrogen (TAN), nitrite and chemical oxygen demand (COD) was analyzed observing that complete TAN removal together with important reductions of the other considered contaminants could be achieved, thus meeting the requirements for reuse of seawater in RAS systems. TAN removal, mainly due to an indirect oxidation mechanism was described by a second order kinetics while COD and nitrite removal followed zero-th order kinetics. The values of the kinetic constants for the anodic oxidation of each compound were obtained as a function of the applied current density (k(TAN) = 7.86 × 10(-5) · exp(6.30 × 10(-2) J); kNO2 = 3.43 × 10(-2) J; k(COD) = 1.35 × 10(-2) J). The formation of free chlorine and oxidation by-products, i.e., trihalomethanes (THMs) was followed along the electro-oxidation process. Although a maximum concentration of 1.7 mg l(-1) of total trihalomethanes was detected an integrated process combining electrochemical oxidation in order to eliminate TAN, nitrite and COD and adsorption onto activated carbon to remove the residual chlorine and THMs is proposed, as an efficient alternative to treat and reuse the seawater in fish culture systems. Finally, the energy consumption of the treatment has been evaluated.

The Electrochemical Development of Pt(111) Stepped Surfaces and Its Influence on Methanol Electrooxidation

The progress in the preparation of new electrode surfaces by electrochemical treatments exhibiting high faradaic efficiencies towards industrial electrocatalytic processes has gained more attention in today's scientific community. Most of the papers report new catalysts dispersed on different substrates, but some fundamental studies required for electrochemical and physical characterizations are sometimes forgotten. In this paper, we make a full staging of two electrochemical treatments that can be conducted to enhance the electrocatalytic activity of platinum surfaces, such as, electrofacetting through square wave potential programs and constant cathodic polarizations in the net hydrogen evolution region. The cathodic treatment applied at −2 V clearly develops (111) stepped planes similarly to the electrofacetting performed after applying the square wave program between 1.40 V and 0.70 V at 2.5 kHz. The X-ray diffraction patterns of both surfaces as well as on other electrofacetted platinum electrodes are obtained for comparison purposes. Moreover, the electrocatalytic activity towards methanol electrooxidation also exhibits equivalent coulombic efficiencies and 200% higher than on polycrystalline platinum as demonstrated by linear sweep voltammetry and potentiostatic current decays.

Frequency and determinants of poststroke cognitive impairment at three and twelve months in Chile

BACKGROUND

A higher risk of poststroke cognitive impairment (CI) has been reported in Hispanics in a US cohort but has not been systematically studied in Latin America.

OBJECTIVES

Our purpose was to investigate the frequencies and determinants of poststroke CI in the hispano-mestizo population of Santiago, Chile.

METHODS

A prospective study of hospitalized patients aged >60 years admitted with an ischemic or hemorrhagic stroke was conducted. The cognitive status was determined at 3 and 12 months after the stroke by informant questionnaires, neuropsychological testing and clinical diagnosis. Cardiovascular risk factors, brain imaging and stroke features were analyzed using regression models to establish determinants for poststroke CI.

RESULTS

A total of 164 patients (mean age = 72 +/- 7.5 years) were recruited. Out of 122 patients (74%) evaluated at 3 months, 81 (66%) had CI. Out of 101 patients (62%) evaluated at 12 months, 39 (39%) had CI no dementia, and 22 (22%) were demented. The new-onset dementia frequency at 1 year was 16%. Independent determinants for dementia were higher functional impairment at hospital egress (OR = 4.0), left-hemisphere large-vessel infarction (OR = 6.9) and a larger amount of white matter changes (OR = 1.3).

CONCLUSIONS

In this first study on poststroke CI in Latin America, the frequencies and determinants of poststroke CI were similar to those in other cohorts of different ethnic origin.