ObjectivesThis study examines the relationship between spheno-occipital synchondrosis (SOS) closure and puberty onset in a modern American population. It also investigates the timing and the rate of SOS closure in males and females.Materials and methodsThe sample includes cross-sectional and longitudinal 3D Cone Beam Computed Tomography (CBCT) scans of 741 individuals (361 males and 380 females) aged 6–20 years. Each CBCT scan is visualized in the mid-sagittal plane, and the spheno-occipital synchondrosis (SOS) is scored as completely open, partially fused, mostly fused, and completely fused. The Menarche commencement is used as an indicator of puberty onset in females.ResultsMean ages of open, partially-fused, mostly-fused, and completely fused SOS were 11.07, 12.95, 14.44, and 16.41 years in males, and 9.75, 11.67, 13.25, and 15.25 in females, respectively. The results show there is a significant association between the SOS closure stage and the commencement of menarche (Fisher's Exact Test p < 0.001). It was found that females had a higher SOS closure rate (38.60%) per year than males at the age of 10 years. The closure rate in males appears slower than females at age 10, but it lasts a longer time, ranging between 22 and 26% per year from age 11 to 14 years.ConclusionThere is a significant relationship between puberty onset and SOS closure, suggesting its closure is at least partially affected by systemic, hormonal changes in the growing adolescent. Also, SOS closure occurs at a faster rate and at an earlier age in females compared to males.
Wolff I, G.A. Una nueva experiencia clínica: Colgajo safeno interno diferidoA new clinical experience: the delayed reverse saphenous flap ResumenLos defectos de tejidos blandos de la pierna y el pie cuasados por traumatismos, tumores o infecciones, requieren frecuentemente procedimientos de cobertura mediante el empleo de colgajos. El colgajo safeno interno ha demostrado ser una excelente opción por su versatilidad y su poca morbilidad en el área donante. El diferimiento es un procedimiento útil para reducir las complicaciones vasculares de los colgajos, en pacientes con factores de riesgo añadidos. Su fisiología ha sido estudiada detalladamente, pero aún persisten interrogantes en torno a su uso y al periodo de diferimiento.Presentamos nuestra experiencia clínica con el uso de colgajos diferidos en 2 casos de reconstrucción de pie y tobillo secundarios a traumatismos, en los que se presentó sufrimiento vascular agudo al realizar el colgajo safeno interno reverso. El período de diferimiento varió entre los 7 y los 10 días.Los resultados postoperatorios fueron satisfactorios. Se presentó solo un complicación consistente en necrosis de los bordes de uno de los colgajos (menor del 1%).En conclusión, creemos que el diferimiento de los colgajos regionales es una herramienta útil para reducir la tasa de complicaciones vasculares en los mismos. Nuestra experiencia con el colgajo safeno interno diferido, reportada por primera vez según nuestro conocimiento, confirma la utilidad del procedimiento en este tipo de colgajo, demostrando que aún en condiciones de riesgo vascular esta modificación del colgajo se presenta como una opción alternativa para la reconstrucción exitosa de este tipo de defectos. AbstractComplex soft tissue defects of the distal third of the leg and foot represent a challenge in the reconstructive. The internal saphenous flap is a frequently used option for lower leg reconstruction because its versatility and minimal donor site morbidity. The commonly known delay procedure is an alternative. The concept of delay was clearly explained years ago, but still there is no consensus about the surgical technique and the delay period.This report presents our experience with delayed reverse saphenous flaps in 2 cases where acute vascular compromise was evident when the flap was rotated to the defect. The delay period was between 7 to 10 days.All flaps survived.Only one complication was presented in one of the flaps showing minimal necrosis that was debridated on the second procedure.As a conclusión, the delay procedure used in regional flaps for soft tissue coverage of lower leg and foot, is a useful tool in order to reduce vascular complication rates. Our experience with delayed reverse saphenous flaps, reported for the first time to our knowledge, confirms the utility of this procedure, proving that even when there are vascular risk factors, this flap modification is a successful alternative for lower leg and foot reconstruction.
BackgroundLarge French (Fr) sheaths are commonly used to obtain optimum common femoral artery (CFA) access while performing acute stroke endovascular treatments. The StarClose Vascular Closure System (Abott Vascular) is currently indicated for the percutaneous closure of CFA access sheaths of 5 Fr or 6Fr procedural size. Limited data exists regarding off-label use of the StarClose device in patients who had 7–9 French CFA access.ObjectivesTo evaluate the safety and efficacy of the StarClose extravascular closure device in achieving post femoral artery catheterization hemostasis after placement of large Fr femoral sheath.MethodsRetrospective chart review was performed between 2009 and 2011 of 73 patients who underwent endovascular treatment for acute stroke who were closed with the StarClose device. The study included 39 females and 34 males with mean age 68.1 years. 86.4% (n=63) had hypertension, 26% (n=19) had diabetes mellitus, 75.34% (n=55) had dyslipidemia, 42.5% (n=31) had coronary artery disease, and 39.7% had (n=29) had atrial fibrillation. The primary endpoints were successful hemostasis and sheath related post procedure major and minor complication rates.ResultsA 5Fr (1.4%) sheath was used in 1 patient, 6Fr sheaths in 37 (58.7%) patients, 7Fr sheaths in 2 (2.7%) patients, 8Fr sheaths in 14 (19%) patients, and 9Fr sheaths in 19 (26%) patients during acute stroke interventions. Overall, successful hemostasis was achieved in 72 (99%) cases. One (0.95%) minor complication was observed post procedure in the patient with a 6Fr access size. The patient had intermittent minor bleeding from the groin site and was found to have a CFA pseudoaneursym. No mortality or significant morbidity was observed associated with groin site closure in this study.ConclusionThe StarClose vascular closure device is safe and effective in achieving hemostasis during acute stroke endovascular interventions while using large French procedural access sheaths.Competing interestsNone.
BackgroundEndovascular intervention is an important treatment option for patients with acute ischemic stroke who are ineligible for intravenous thrombolysis or fail to respond to such therapy. Endovascular treatments include intra-arterial thrombolysis (IAT) and mechanical thrombectomy (MT). Limited data exists regarding the safety and efficacy of a combination approach using IAT and MT.ObjectivesTo assess the safety and efficacy of combined mechanical and IAT therapy compared to MT alone.MethodsRetrospective chart review was performed in 200 consecutive patients who underwent endovascular treatments for acute ischemic stroke at our center between 2007 and 2011. 115 patients met inclusion criteria of MT alone versus combined MT and IAT. We compared outcome parameters between these two groups including discharge NIHSS, modified Rankin Score (mRS), rate of partial to complete recanalization (TIMI 2–3), symptomatic intracerebral hemorrhage, and all cause mortality.ResultsA total of 115 patients underwent MT alone or received combined therapy. In the MT only group, mean age was 69±13.32 and median initial NIHSS was 17. Of the combined therapy group, 66±16 was the mean age and median initial NIHSS was 18.ConclusionsIn our experience combination MT and IAT in the treatment of acute ischemic stroke had a trend toward higher recanalization rates and number of patients with clinical improvement, as well as, lower discharge NIHSS and higher percentage of independently ambulating patients discharged as compared to MT alone. Despite higher hemorrhage and slightly increased mortality rates, the combined therapy group trended toward better clinical outcomes.Competing interestsNone.Abstract P-042 Table 1Primary outcomes between MT only and combined therapy groupsOutcomeMechanical thrombectomy only (N=40)Combined MT and IAT (N=75)Discharge NIHSS129Clinical improvement (NIHSS >4)19 (47.5%)37 (55.2%)TIMI 2–325 (62.5%)57 (76.0%)Discharge mRS ≤33 (7.5%)10 (13.3%)Symptomatic ICH3 (7.5%)13 (17.0%)Mortality8 (20%)20 (26.7%)
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