Papers by Héctor A. Rodríguez-Rubio
World neurosurgery. X, Jul 1, 2024
Acta Neurochirurgica
Background Paraclinoid aneurysms represent a challenge for neurosurgeons due to the anatomical co... more Background Paraclinoid aneurysms represent a challenge for neurosurgeons due to the anatomical complexity of this region. Then, innovative techniques such as the extradural sphenoid ridge approach are suitable for a safe microsurgical clipping. Method A description of the surgical technique was made by the senior author, a vascular neurosurgeon experienced with the use of this approach in the management of paraclinoid aneurysms exemplified through a clinical case. Conclusion Microsurgical clipping through an extradural sphenoid ridge keyhole approach for small and midsize paraclinoid aneurysms is an excellent treatment modality with good clinical and surgical results.
Journal of Cerebrovascular and Endovascular Neurosurgery, Nov 23, 2023
Background
Early treatment of intracranial lesions in the emergency department is crucial, but it... more Background
Early treatment of intracranial lesions in the emergency department is crucial, but it can be challenging to differentiate between them. This differentiation is essential because the treatment of each type of lesion is different. Cerebral computed tomography perfusion (CTP) imaging can help visualize the vascularity of brain lesions and provide absolute quantification of physiological parameters. Compared to magnetic resonance imaging, CTP has several advantages, such as simplicity, wide availability, and reproducibility.
Purpose
This study aimed to assess the effectiveness of Hounsfield units (HU) in measuring the density of hypercellular lesions and the ability of CTP to quantify hemodynamics in distinguishing intracranial space-occupying lesions.
Methods
A retrospective study was conducted from March 2016 to March 2022. All patients underwent CTP and CT scans, and relative cerebral blood volume (rCBV) and HU were obtained for intracranial lesions.
Results
We included a total of 244 patients in our study. This group consisted of 87 (35.7%) individuals with glioblastomas (GBs), 48 (19.7%) with primary central nervous system lymphoma (PCNSL), 45 (18.4%) with metastases (METs), and 64 (26.2) with abscesses. Our study showed that the HUs for METs were higher than those for GB (S 57.4% and E 88.5%). In addition, rCBV values for PCNSL and abscesses were lower than those for GB and METs. The HU in PCNSL was higher than those in abscesses (S 94.1% and E 96.6%).
Conclusion
PCT parameters provide valuable information for diagnosing brain lesions. A comprehensive assessment improves accuracy. Combining rCBV and HU enhances diagnostic accuracy, making it a valuable tool for distinguishing between lesions. PCT's widespread availability allows for the use of both anatomical and functional information with high spatial resolution for diagnosing and managing brain tumor patients.
Surgical Neurology International, 2023
Background: Hemifacial spasm (HFS) is characterized by involuntary, progressive, and intermittent... more Background: Hemifacial spasm (HFS) is characterized by involuntary, progressive, and intermittent spasms in the upper and lower facial muscles. Due to the high success rate, microvascular decompression (MVD) is the treatment of choice, and intraoperative neuromonitoring (INM) is considered useful for achieving safe surgery. Still, most centers do not have this technology.
Methods: We analyzed 294 patients with HFS treated with MVD without INM. We only included patients with a neurovascular etiology while excluding other causes, such as tumors. As part of the postoperative evaluation, we assessed preoperative magnetic resonance imaging and pure-tone audiometry.
Results: The main complication was peripheral facial paralysis in 50 patients, followed by hypoacusis in 22 patients and deafness in 17 patients, associated with a failed surgical outcome (P = 0.0002). The anterior inferior cerebellar artery (AICA) was an offending vessel, and the involvement of more than one vessel was significantly associated with the development of facial nerve palsy (P = 0.01). AICA was also associated with hearing impairment (P = 0.04). Over 90% of immediate complications improve in the follow-up (6 months), and one patient did not show a cure for initial HFS.
Conclusion: MVD is the method with the highest long-term cure rates for treating HFS; however, we must inquire into the multiple factors of the patient and the surgeon to predict surgical outcomes. INM is not a must during MVD for HFS. We recommend its use depending on the availability and mainly on the surgeon’s skills, for surgeons.
Journal of Cerebrovascular and Endovascular Neurosurgery, 2023
Since the first description of the possible utilization of the internal maxillary artery for bypa... more Since the first description of the possible utilization of the internal maxillary artery for bypass surgery, there are some reports of its use in aneurysm cases; however, there is no information about the possible advantages of this type of bypass for cerebral ischemic disease. We present a 77-year-old man with a history of diabetes, hypertension, systemic atherosclerosis, and two acute myocardial infarctions with left hemiparesis. Imaging studies reported total occlusion of the right internal carotid artery and 75% occlusion on the left side, with an old opercular infarction and repeated transient ischemic attacks in the right middle cerebral artery territory despite medical treatment. After a consensus, we decided to perform a bypass from the internal maxillary artery to the M2 segment of the middle cerebral artery using a radial artery graft. After performing the proximal anastomosis, the calculated graft's free flow was 216 ml/min. Subsequently, after completing the bypass, the patency was confirmed with fluorescein videoangiography and intraoperative Doppler. Postoperatively, imaging studies showed improvement in the perfusion values and the hemiparesis from 3/5 to 4+/5. The patient was discharged one week after the operation, with a modified Rankin scale of 1, without added deficits. The use of revascularization techniques in steno-occlusive disease indicates a select group of patients that may benefit from this procedure. In addition, internal maxillary artery bypass has provided a safe option for large areas of ischemia that cannot be supplied with a superficial temporal artery - middle cerebral artery bypass.
Revista de la Escuela de Medicina Dr. José Sierra Flores. Universidad del Noreste, 2024
Introduction: Acute pancreatitis is an acute inflammatory process of the pancreas with variable i... more Introduction: Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of other tissues. It is mentioned that 15 to 20% of the cases present severe symptoms that can put the patient's life at risk in the short and long term. Several parameters have been studied as prognostic severity factors in patients with acute pancreatitis.
Objective: To determine the distribution of acute pancreatitis's most important severity factors. Methods: Retrospective, observational, descriptive, cross-sectional study. The data for the variables evaluated were obtained from the review of clinical histories. SPSS 25 software was used to see the population distribution with qualitative and quantitative variables.
Results: We reviewed 67 clinical histories, of which 51 (76.1%) patients developed Mild Acute Pancreatitis (PAL) and 16 (23.9%) had Moderate or Severe Acute Pancreatitis (MAP or SAP). Most of them were of biliary origin, with 80.6%. There were no cases of MAP and SBP in <20 years, with the prevalence of PAL up to 34 years of age. The age of 35 years was determined as the cut-off point at which a greater number of cases of MAP and SBP were identified, reaching 45 years of age, where more cases of ALP were observed. The most frequently observed factors in PAM/PAS included age range 30 to 45 years, BUN 25.8±26.1, creatinine of 1.3±1.1, and APACHE score ≥ 8.
Conclusions: The factors with the highest frequency found in severe acute pancreatitis were age 30 to 45 years, BUN of 25.8±26.1, creatinine of 1.3±1.1, and APACHE II score ≥ 8. Keywords: pancreatitis; APACHE; Prognosis; Severity.
Cureus
Introduction Understanding when and how systemic complications can occur after an acute stroke is... more Introduction Understanding when and how systemic complications can occur after an acute stroke is crucial. It is important to identify patients who are at higher risk for these complications. Early and effective treatment based on this knowledge can significantly improve patient outcomes. The objective of this study was to identify the risk factors associated with neurological and extra-neurological complications and mortality in stroke patients treated at a secondary care hospital. Methods Of a total of 170 patients diagnosed with hemorrhagic/ischemic stroke and transient cerebral ischemia at a secondary care hospital in Mexico, the records of 125 were reviewed and of these, 86 were included in the study. The study group comprised 86 adult patients (&gt; 18 years of age) diagnosed with ischemic or hemorrhagic stroke or transient cerebral ischemia. Their demographics, clinical characteristics, in-hospital complications, and mortality were retrospectively analyzed. Results Of the 86 patients examined, 34.9% experienced complications, regardless of the type of stroke. The most significant factor associated with mortality and complications during hospitalization in patients with stroke was previous diseases. Other factors that were linked to higher mortality were pre-existing medical conditions. The most common neurological complication among patients with stroke during hospitalization was intracranial hypertension (3.5%). As for extra-neurological complications, pressure ulcers and nosocomial pneumonia had an occurrence rate of 4.7%. Conclusions The main neurological complication during hospitalization of patients with stroke was intracranial hypertension, while the extra neurological complications were pressure ulcers and nosocomial pneumonia.
Surgical Neurology International
Background: The middle cerebral artery (MCA) is a common site of cerebral aneurysms and 82.6% occ... more Background: The middle cerebral artery (MCA) is a common site of cerebral aneurysms and 82.6% occur at the bifurcation. When surgery is selected as a therapeutic option, it intends to clip the neck completely because if some remnant occurs, there exists the possibility of regrowth and bleeding in the short- or long-term. Methods: We analyzed one drawback of the fenestrated clips of Yasargil and Sugita types to occlude the neck totally at a specific point formed by the union of the fenestra with the blades, creating a triangular space where the aneurysm can protrude, giving place to a remnant that can lead to a future recurrence and rebleeding. We show two cases of ruptured MCA aneurysms in which a cross-clipping technique occluded a broad base and dysmorphic aneurysm using straight fenestrated clips. Results: In both cases (one using a Yasargil clip and the other with a Sugita clip), a small remnant was visualized when fluorescein videoangiography (FL-VAG) was used. In both cases, t...
Cureus
Introduction Understanding when and how systemic complications can occur after an acute stroke is... more Introduction Understanding when and how systemic complications can occur after an acute stroke is crucial. It is important to identify patients who are at higher risk for these complications. Early and effective treatment based on this knowledge can significantly improve patient outcomes. The objective of this study was to identify the risk factors associated with neurological and extra-neurological complications and mortality in stroke patients treated at a secondary care hospital. Methods Of a total of 170 patients diagnosed with hemorrhagic/ischemic stroke and transient cerebral ischemia at a secondary care hospital in Mexico, the records of 125 were reviewed and of these, 86 were included in the study. The study group comprised 86 adult patients (&gt; 18 years of age) diagnosed with ischemic or hemorrhagic stroke or transient cerebral ischemia. Their demographics, clinical characteristics, in-hospital complications, and mortality were retrospectively analyzed. Results Of the 86 patients examined, 34.9% experienced complications, regardless of the type of stroke. The most significant factor associated with mortality and complications during hospitalization in patients with stroke was previous diseases. Other factors that were linked to higher mortality were pre-existing medical conditions. The most common neurological complication among patients with stroke during hospitalization was intracranial hypertension (3.5%). As for extra-neurological complications, pressure ulcers and nosocomial pneumonia had an occurrence rate of 4.7%. Conclusions The main neurological complication during hospitalization of patients with stroke was intracranial hypertension, while the extra neurological complications were pressure ulcers and nosocomial pneumonia.
Cureus
Spontaneous intracranial hemorrhage associated with an intracranial meningioma is rare, with a re... more Spontaneous intracranial hemorrhage associated with an intracranial meningioma is rare, with a reported incidence of below 2.4% of all meningiomas. Such cases are described with a cause subdural with intratumoral hemorrhage, which is a challenge for patients and healthcare professionals because it can occur spontaneously without other pathological antecedents. We describe the case of a 55-year-old woman with subdural hemorrhage over the frontoparietal region of the right hemisphere associated with a meningioma, generating a mass effect and shifting the third ventricle and lateral ventricle. Therefore, urgent surgical treatment was decided. A tumor lesion was found with apoplexy, soft consistency, and violaceous color with abundant vascularity in the lesion’s center, suggesting a probable angiomatous meningioma. The histopathological evaluation confirmed meningothelial hemorrhagic meningioma grade I, according to the World Health Organization grading. This article discusses the causes, risk factors, diagnosis, and surgical treatment for hemorrhage associated with intracranial meningioma.
Surgical Neurology International
Background: Lhermitte-Duclos disease (LDD) or dysplastic gangliocytoma of the posterior fossa is ... more Background: Lhermitte-Duclos disease (LDD) or dysplastic gangliocytoma of the posterior fossa is a slow-growing and extremely rare mass lesion that involves the Purkinje neurons and the granular layer of the cerebellum. It is characterized by specific neuroradiological features and secondary hydrocephalus. However, documentation of surgical experience is scarce. Case Description: A 54-year-old man with LDD manifesting as progressive headache is presented with vertigo and cerebellar ataxia. Magnetic resonance imaging demonstrated a right cerebellar mass lesion with the characteristic “tiger-striped appearance.” We decided to perform partial resection with reduction of tumor volume improving symptomatology as a result of the mass effect in the posterior fossa. Conclusion: Surgical resection is a good alternative for the management of LDD, especially when neurological compromise exists due to mass effect.
Surgical Neurology International, Mar 10, 2023
Surgical Neurology International
Background: Anomalies of the middle cerebral artery (MCA) are rare; among the different types of ... more Background: Anomalies of the middle cerebral artery (MCA) are rare; among the different types of anomalies, the aplastic or twig-like (Ap/T) MCA is extremely rare and has been reported under various names, including aplastic, unfused, or rete type anomaly. The occurrence of a brain aneurysm associated with this anatomic variant is an even rare event, and probably their development and rupture are related to hemodynamic stress of the tinny wall of vessels forming the network. Case Description: We present a 43-year-old male patient with an explosive and persistent right orbitofrontal headache. A computed tomography showed a right frontobasal hematoma with intraventricular disruption. Magnetic resonance angiography showed a right MCA aneurysm and what seems to be a MCA trunk stenosis. Cerebral digital subtraction angiography demonstrated a plexiform arterial network and one aneurysm arising from the network. The patient was successfully treated by surgical clipping to evacuate the hema...
Introduction Glioblastoma is one of the most common brain tumors in adult populations, usually ca... more Introduction Glioblastoma is one of the most common brain tumors in adult populations, usually carrying a poor prognosis. While several studies have researched the impact of anti-angiogenic therapies, especially anti VEFG treatments in glioblastoma, few have attempted to assess its progress using imaging studies. Purpose We attempted to analyze whether cerebral blood volume (rCBV) from dynamic susceptibility-weighted contrast-enhanced MRI (DSC-MRI) could predict a response in patients with glioblastoma undergoing Bevacizumab (BVZ) treatment. Methods We performed a retrospective study evaluating patients with recurrent glioblastoma receiving anti-angiogenic therapy with BVZ between 2012 and 2017 in our institution. Patients were scheduled for routine MRI at baseline and first month follow up visits. Studies were processed for DSC-MRI, cT1 and FLAIR images, from which relative cerebral blood volume measurements were obtained. We assessed patient response using the Response Assessment ...
Cureus
Intracranial aneurysms in children account for 4%-5% of all cases, with 20% being considered gian... more Intracranial aneurysms in children account for 4%-5% of all cases, with 20% being considered giant (>25 mm). The main sites of occurrence are the internal carotid artery (ICA) and the middle cerebral artery (MCA). Rupture and secondary subarachnoid hemorrhage occur in approximately 55%-72.5% of cases, with a 10%-23% mortality rate. We report the case of a previously healthy nine-year-old girl who developed sudden, severe right retroocular pain and a holocranial headache as a mode of onset. Besides, the patient presented with double vision, and her relatives sought medical attention. Paresis of the right III, IV, and VI cranial nerves was found at physical examination. An MRI and digital subtraction angiography showed the presence of a giant aneurysm in the cavernous portion of the ICA with a mass effect. The patient was treated surgically through a high-flow bypass using a radial artery graft and trapping of the aneurysm. She had an uneventful postoperative course and was discharged three days after the operation to continue follow-up at the outpatient clinic. The therapeutic options were: a) an endovascular approach using flow diverters or stenting and coiling; or b) surgical treatment with proximal closure of the ICA if the patient had good collateral circulation or trapping the aneurysm combined with a high-flow bypass if the collateral circulation was not good or absent. After discussion, we decided on the surgical option. Even when the surgery was successful in this case, there is no consensus about the best way to treat it; the selection should be based on the center´s experience when confronting this rare entity.
ESTRATEGIAS DE APRENDIZAJE EN MEDICINA DE PREGRADO. PERCEPCIÓN DEL ESTUDIANTE, 2019
Introduccion: Una de las funciones de la educación actual y futura debe ser promover la capacidad... more Introduccion: Una de las funciones de la educación actual y futura debe ser promover la capacidad de los alumnos de gestionar sus propios aprendizajes, adoptar una autonomía creciente en su carrera académica y disponer de herramientas intelectuales y sociales que les permitan un aprendizaje continuo a lo largo de toda su vida.
Objetivo: Determinar los métodos de aprendizaje sugeridos por los estudiantes de medicina de una Universidad Privada.
Material y método: Se realizó un estudio observacional, descriptivo, prolectivo y transversal, en estudiantes de la carrera de medicina de una universidad privada. Se incluyeron en el estudio un total de 166 estudiantes a los cuales se les aplicó una encuesta construida para tal fin y validada, para determinar las estrategias de aprendizaje sugeridas. Para el análisis de los datos se utilizó estadística descriptiva.
Resultados: Se encuestaron 166 estudiantes, las estrategias más recomendadas por los estudiantes fueron: Prácticas en el CEDAM en un 15.0%; seguido de Trabajo colaborativo en un 17.0% y la realización de prácticas de laboratorio/anfiteatro en un porcentaje del 19.0.
Conclusiones: Los estudiantes de medicina incluidos en el estudio recomiendan actividades de aprendizaje que conlleven el desarrollo de habilidades y destrezas y trabajo colaborativo.
Risk Factors Associated With Neurological and Extra-Neurological Complications and Mortality in Patients With Stroke, 2023
Introduction
Understanding when and how systemic complications can occur after an acute stroke is... more Introduction
Understanding when and how systemic complications can occur after an acute stroke is crucial. It is important to identify patients who are at higher risk for these complications. Early and effective treatment based on this knowledge can significantly improve patient outcomes. The objective of this study was to identify the risk factors associated with neurological and extra-neurological complications and mortality in stroke patients treated at a secondary care hospital.
Methods
Of a total of 170 patients diagnosed with hemorrhagic/ischemic stroke and transient cerebral ischemia at a secondary care hospital in Mexico, the records of 125 were reviewed and of these, 86 were included in the study. The study group comprised 86 adult patients (> 18 years of age) diagnosed with ischemic or hemorrhagic stroke or transient cerebral ischemia. Their demographics, clinical characteristics, in-hospital complications, and mortality were retrospectively analyzed.
Results
Of the 86 patients examined, 34.9% experienced complications, regardless of the type of stroke. The most significant factor associated with mortality and complications during hospitalization in patients with stroke was previous diseases. Other factors that were linked to higher mortality were pre-existing medical conditions. The most common neurological complication among patients with stroke during hospitalization was intracranial hypertension (3.5%). As for extra-neurological complications, pressure ulcers and nosocomial pneumonia had an occurrence rate of 4.7%.
Conclusions
The main neurological complication during hospitalization of patients with stroke was intracranial hypertension, while the extra neurological complications were pressure ulcers and nosocomial pneumonia.
Limitation of fenestrated clips during clipping of middle cerebral artery aneurysm, 2023
Background: The middle cerebral artery (MCA) is a common site of cerebral aneurysms and 82.6% occ... more Background: The middle cerebral artery (MCA) is a common site of cerebral aneurysms and 82.6% occur at the bifurcation. When surgery is selected as a therapeutic option, it intends to clip the neck completely because if some remnant occurs, there exists the possibility of regrowth and bleeding in the short- or long-term.
Methods: We analyzed one drawback of the fenestrated clips of Yasargil and Sugita types to occlude the neck totally at a specific point formed by the union of the fenestra with the blades, creating a triangular space where
the aneurysm can protrude, giving place to a remnant that can lead to a future recurrence and rebleeding. We show two cases of ruptured MCA aneurysms in which a cross-clipping technique occluded a broad base and
dysmorphic aneurysm using straight fenestrated clips.
Results: In both cases (one using a Yasargil clip and the other with a Sugita clip), a small remnant was visualized when fluorescein videoangiography (FL-VAG) was used. In both cases, the small remnant was clipped with a 3 mm straight miniclip.
Conclusion: We should be aware of this drawback when clipping aneurysms using fenestrated clips to ensure a complete obliteration of the aneurysm’s neck
Spontaneous Intracranial Hemorrhage Associated With an Intracranial Meningioma, 2023
Spontaneous intracranial hemorrhage associated with an intracranial meningioma is rare, with a re... more Spontaneous intracranial hemorrhage associated with an intracranial meningioma is rare, with a reported incidence of below 2.4% of all meningiomas. Such cases are described with a cause subdural with intratumoral hemorrhage, which is a challenge for patients and healthcare professionals because it can occur spontaneously without other pathological antecedents. We describe the case of a 55-year-old woman with subdural hemorrhage over the frontoparietal region of the right hemisphere associated with a meningioma, generating a mass effect and shifting the third ventricle and lateral ventricle. Therefore, urgent surgical treatment was decided. A tumor lesion was found with apoplexy, soft consistency, and violaceous color with abundant vascularity in the lesion’s center, suggesting a probable angiomatous meningioma. The histopathological evaluation confirmed meningothelial hemorrhagic meningioma grade I, according to the World Health Organization grading. This article discusses the causes, risk factors, diagnosis, and surgical treatment for hemorrhage associated with intracranial meningioma.
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Papers by Héctor A. Rodríguez-Rubio
Early treatment of intracranial lesions in the emergency department is crucial, but it can be challenging to differentiate between them. This differentiation is essential because the treatment of each type of lesion is different. Cerebral computed tomography perfusion (CTP) imaging can help visualize the vascularity of brain lesions and provide absolute quantification of physiological parameters. Compared to magnetic resonance imaging, CTP has several advantages, such as simplicity, wide availability, and reproducibility.
Purpose
This study aimed to assess the effectiveness of Hounsfield units (HU) in measuring the density of hypercellular lesions and the ability of CTP to quantify hemodynamics in distinguishing intracranial space-occupying lesions.
Methods
A retrospective study was conducted from March 2016 to March 2022. All patients underwent CTP and CT scans, and relative cerebral blood volume (rCBV) and HU were obtained for intracranial lesions.
Results
We included a total of 244 patients in our study. This group consisted of 87 (35.7%) individuals with glioblastomas (GBs), 48 (19.7%) with primary central nervous system lymphoma (PCNSL), 45 (18.4%) with metastases (METs), and 64 (26.2) with abscesses. Our study showed that the HUs for METs were higher than those for GB (S 57.4% and E 88.5%). In addition, rCBV values for PCNSL and abscesses were lower than those for GB and METs. The HU in PCNSL was higher than those in abscesses (S 94.1% and E 96.6%).
Conclusion
PCT parameters provide valuable information for diagnosing brain lesions. A comprehensive assessment improves accuracy. Combining rCBV and HU enhances diagnostic accuracy, making it a valuable tool for distinguishing between lesions. PCT's widespread availability allows for the use of both anatomical and functional information with high spatial resolution for diagnosing and managing brain tumor patients.
Methods: We analyzed 294 patients with HFS treated with MVD without INM. We only included patients with a neurovascular etiology while excluding other causes, such as tumors. As part of the postoperative evaluation, we assessed preoperative magnetic resonance imaging and pure-tone audiometry.
Results: The main complication was peripheral facial paralysis in 50 patients, followed by hypoacusis in 22 patients and deafness in 17 patients, associated with a failed surgical outcome (P = 0.0002). The anterior inferior cerebellar artery (AICA) was an offending vessel, and the involvement of more than one vessel was significantly associated with the development of facial nerve palsy (P = 0.01). AICA was also associated with hearing impairment (P = 0.04). Over 90% of immediate complications improve in the follow-up (6 months), and one patient did not show a cure for initial HFS.
Conclusion: MVD is the method with the highest long-term cure rates for treating HFS; however, we must inquire into the multiple factors of the patient and the surgeon to predict surgical outcomes. INM is not a must during MVD for HFS. We recommend its use depending on the availability and mainly on the surgeon’s skills, for surgeons.
Objective: To determine the distribution of acute pancreatitis's most important severity factors. Methods: Retrospective, observational, descriptive, cross-sectional study. The data for the variables evaluated were obtained from the review of clinical histories. SPSS 25 software was used to see the population distribution with qualitative and quantitative variables.
Results: We reviewed 67 clinical histories, of which 51 (76.1%) patients developed Mild Acute Pancreatitis (PAL) and 16 (23.9%) had Moderate or Severe Acute Pancreatitis (MAP or SAP). Most of them were of biliary origin, with 80.6%. There were no cases of MAP and SBP in <20 years, with the prevalence of PAL up to 34 years of age. The age of 35 years was determined as the cut-off point at which a greater number of cases of MAP and SBP were identified, reaching 45 years of age, where more cases of ALP were observed. The most frequently observed factors in PAM/PAS included age range 30 to 45 years, BUN 25.8±26.1, creatinine of 1.3±1.1, and APACHE score ≥ 8.
Conclusions: The factors with the highest frequency found in severe acute pancreatitis were age 30 to 45 years, BUN of 25.8±26.1, creatinine of 1.3±1.1, and APACHE II score ≥ 8. Keywords: pancreatitis; APACHE; Prognosis; Severity.
Objetivo: Determinar los métodos de aprendizaje sugeridos por los estudiantes de medicina de una Universidad Privada.
Material y método: Se realizó un estudio observacional, descriptivo, prolectivo y transversal, en estudiantes de la carrera de medicina de una universidad privada. Se incluyeron en el estudio un total de 166 estudiantes a los cuales se les aplicó una encuesta construida para tal fin y validada, para determinar las estrategias de aprendizaje sugeridas. Para el análisis de los datos se utilizó estadística descriptiva.
Resultados: Se encuestaron 166 estudiantes, las estrategias más recomendadas por los estudiantes fueron: Prácticas en el CEDAM en un 15.0%; seguido de Trabajo colaborativo en un 17.0% y la realización de prácticas de laboratorio/anfiteatro en un porcentaje del 19.0.
Conclusiones: Los estudiantes de medicina incluidos en el estudio recomiendan actividades de aprendizaje que conlleven el desarrollo de habilidades y destrezas y trabajo colaborativo.
Understanding when and how systemic complications can occur after an acute stroke is crucial. It is important to identify patients who are at higher risk for these complications. Early and effective treatment based on this knowledge can significantly improve patient outcomes. The objective of this study was to identify the risk factors associated with neurological and extra-neurological complications and mortality in stroke patients treated at a secondary care hospital.
Methods
Of a total of 170 patients diagnosed with hemorrhagic/ischemic stroke and transient cerebral ischemia at a secondary care hospital in Mexico, the records of 125 were reviewed and of these, 86 were included in the study. The study group comprised 86 adult patients (> 18 years of age) diagnosed with ischemic or hemorrhagic stroke or transient cerebral ischemia. Their demographics, clinical characteristics, in-hospital complications, and mortality were retrospectively analyzed.
Results
Of the 86 patients examined, 34.9% experienced complications, regardless of the type of stroke. The most significant factor associated with mortality and complications during hospitalization in patients with stroke was previous diseases. Other factors that were linked to higher mortality were pre-existing medical conditions. The most common neurological complication among patients with stroke during hospitalization was intracranial hypertension (3.5%). As for extra-neurological complications, pressure ulcers and nosocomial pneumonia had an occurrence rate of 4.7%.
Conclusions
The main neurological complication during hospitalization of patients with stroke was intracranial hypertension, while the extra neurological complications were pressure ulcers and nosocomial pneumonia.
Methods: We analyzed one drawback of the fenestrated clips of Yasargil and Sugita types to occlude the neck totally at a specific point formed by the union of the fenestra with the blades, creating a triangular space where
the aneurysm can protrude, giving place to a remnant that can lead to a future recurrence and rebleeding. We show two cases of ruptured MCA aneurysms in which a cross-clipping technique occluded a broad base and
dysmorphic aneurysm using straight fenestrated clips.
Results: In both cases (one using a Yasargil clip and the other with a Sugita clip), a small remnant was visualized when fluorescein videoangiography (FL-VAG) was used. In both cases, the small remnant was clipped with a 3 mm straight miniclip.
Conclusion: We should be aware of this drawback when clipping aneurysms using fenestrated clips to ensure a complete obliteration of the aneurysm’s neck
Early treatment of intracranial lesions in the emergency department is crucial, but it can be challenging to differentiate between them. This differentiation is essential because the treatment of each type of lesion is different. Cerebral computed tomography perfusion (CTP) imaging can help visualize the vascularity of brain lesions and provide absolute quantification of physiological parameters. Compared to magnetic resonance imaging, CTP has several advantages, such as simplicity, wide availability, and reproducibility.
Purpose
This study aimed to assess the effectiveness of Hounsfield units (HU) in measuring the density of hypercellular lesions and the ability of CTP to quantify hemodynamics in distinguishing intracranial space-occupying lesions.
Methods
A retrospective study was conducted from March 2016 to March 2022. All patients underwent CTP and CT scans, and relative cerebral blood volume (rCBV) and HU were obtained for intracranial lesions.
Results
We included a total of 244 patients in our study. This group consisted of 87 (35.7%) individuals with glioblastomas (GBs), 48 (19.7%) with primary central nervous system lymphoma (PCNSL), 45 (18.4%) with metastases (METs), and 64 (26.2) with abscesses. Our study showed that the HUs for METs were higher than those for GB (S 57.4% and E 88.5%). In addition, rCBV values for PCNSL and abscesses were lower than those for GB and METs. The HU in PCNSL was higher than those in abscesses (S 94.1% and E 96.6%).
Conclusion
PCT parameters provide valuable information for diagnosing brain lesions. A comprehensive assessment improves accuracy. Combining rCBV and HU enhances diagnostic accuracy, making it a valuable tool for distinguishing between lesions. PCT's widespread availability allows for the use of both anatomical and functional information with high spatial resolution for diagnosing and managing brain tumor patients.
Methods: We analyzed 294 patients with HFS treated with MVD without INM. We only included patients with a neurovascular etiology while excluding other causes, such as tumors. As part of the postoperative evaluation, we assessed preoperative magnetic resonance imaging and pure-tone audiometry.
Results: The main complication was peripheral facial paralysis in 50 patients, followed by hypoacusis in 22 patients and deafness in 17 patients, associated with a failed surgical outcome (P = 0.0002). The anterior inferior cerebellar artery (AICA) was an offending vessel, and the involvement of more than one vessel was significantly associated with the development of facial nerve palsy (P = 0.01). AICA was also associated with hearing impairment (P = 0.04). Over 90% of immediate complications improve in the follow-up (6 months), and one patient did not show a cure for initial HFS.
Conclusion: MVD is the method with the highest long-term cure rates for treating HFS; however, we must inquire into the multiple factors of the patient and the surgeon to predict surgical outcomes. INM is not a must during MVD for HFS. We recommend its use depending on the availability and mainly on the surgeon’s skills, for surgeons.
Objective: To determine the distribution of acute pancreatitis's most important severity factors. Methods: Retrospective, observational, descriptive, cross-sectional study. The data for the variables evaluated were obtained from the review of clinical histories. SPSS 25 software was used to see the population distribution with qualitative and quantitative variables.
Results: We reviewed 67 clinical histories, of which 51 (76.1%) patients developed Mild Acute Pancreatitis (PAL) and 16 (23.9%) had Moderate or Severe Acute Pancreatitis (MAP or SAP). Most of them were of biliary origin, with 80.6%. There were no cases of MAP and SBP in <20 years, with the prevalence of PAL up to 34 years of age. The age of 35 years was determined as the cut-off point at which a greater number of cases of MAP and SBP were identified, reaching 45 years of age, where more cases of ALP were observed. The most frequently observed factors in PAM/PAS included age range 30 to 45 years, BUN 25.8±26.1, creatinine of 1.3±1.1, and APACHE score ≥ 8.
Conclusions: The factors with the highest frequency found in severe acute pancreatitis were age 30 to 45 years, BUN of 25.8±26.1, creatinine of 1.3±1.1, and APACHE II score ≥ 8. Keywords: pancreatitis; APACHE; Prognosis; Severity.
Objetivo: Determinar los métodos de aprendizaje sugeridos por los estudiantes de medicina de una Universidad Privada.
Material y método: Se realizó un estudio observacional, descriptivo, prolectivo y transversal, en estudiantes de la carrera de medicina de una universidad privada. Se incluyeron en el estudio un total de 166 estudiantes a los cuales se les aplicó una encuesta construida para tal fin y validada, para determinar las estrategias de aprendizaje sugeridas. Para el análisis de los datos se utilizó estadística descriptiva.
Resultados: Se encuestaron 166 estudiantes, las estrategias más recomendadas por los estudiantes fueron: Prácticas en el CEDAM en un 15.0%; seguido de Trabajo colaborativo en un 17.0% y la realización de prácticas de laboratorio/anfiteatro en un porcentaje del 19.0.
Conclusiones: Los estudiantes de medicina incluidos en el estudio recomiendan actividades de aprendizaje que conlleven el desarrollo de habilidades y destrezas y trabajo colaborativo.
Understanding when and how systemic complications can occur after an acute stroke is crucial. It is important to identify patients who are at higher risk for these complications. Early and effective treatment based on this knowledge can significantly improve patient outcomes. The objective of this study was to identify the risk factors associated with neurological and extra-neurological complications and mortality in stroke patients treated at a secondary care hospital.
Methods
Of a total of 170 patients diagnosed with hemorrhagic/ischemic stroke and transient cerebral ischemia at a secondary care hospital in Mexico, the records of 125 were reviewed and of these, 86 were included in the study. The study group comprised 86 adult patients (> 18 years of age) diagnosed with ischemic or hemorrhagic stroke or transient cerebral ischemia. Their demographics, clinical characteristics, in-hospital complications, and mortality were retrospectively analyzed.
Results
Of the 86 patients examined, 34.9% experienced complications, regardless of the type of stroke. The most significant factor associated with mortality and complications during hospitalization in patients with stroke was previous diseases. Other factors that were linked to higher mortality were pre-existing medical conditions. The most common neurological complication among patients with stroke during hospitalization was intracranial hypertension (3.5%). As for extra-neurological complications, pressure ulcers and nosocomial pneumonia had an occurrence rate of 4.7%.
Conclusions
The main neurological complication during hospitalization of patients with stroke was intracranial hypertension, while the extra neurological complications were pressure ulcers and nosocomial pneumonia.
Methods: We analyzed one drawback of the fenestrated clips of Yasargil and Sugita types to occlude the neck totally at a specific point formed by the union of the fenestra with the blades, creating a triangular space where
the aneurysm can protrude, giving place to a remnant that can lead to a future recurrence and rebleeding. We show two cases of ruptured MCA aneurysms in which a cross-clipping technique occluded a broad base and
dysmorphic aneurysm using straight fenestrated clips.
Results: In both cases (one using a Yasargil clip and the other with a Sugita clip), a small remnant was visualized when fluorescein videoangiography (FL-VAG) was used. In both cases, the small remnant was clipped with a 3 mm straight miniclip.
Conclusion: We should be aware of this drawback when clipping aneurysms using fenestrated clips to ensure a complete obliteration of the aneurysm’s neck