Full breastfeeding and paediatric cancer

Aim: It has been suggested that there is an inverse association between breastfeeding and the risk of childhood cancer. We investigated the association between full breastfeeding and paediatric cancer (PC) in a case control study in Spain. Methods: Maternal reports of full breastfeeding, collected through personal interviews using the Paediatric Environmental History, were compared among 187 children 6 months of age or older who had PC and 187 age-matched control siblings. Results: The mean duration of full breastfeeding for cases were 8.43 and 11.25 weeks for controls. Cases had been significantly more often bottle-fed than controls (odds ratio (OR) 1.8; 95% confidence interval (CI) 1.1-2.8). Cases were significantly less breastfed for at least 2 months (OR 0.5; 95% CI 0.3-0.8), for at least 4 months (OR 0.5; 95% CI 0.3-0.8), and for 24 weeks or more (OR 0.5; 95% CI 0.2-0.9). Conclusions: Breastfeeding was inversely associated with PC, the protection increasing with the duration of full breastfeeding. Additional research on possible mechanisms of this association may be warranted. Meanwhile, breastfeeding should be encouraged among mothers

Endovascular treatment for acute stroke: An open field to begin

Introduction: The evidence that recanalization and reperfusion of the distal vascular bed in appropriately selected patients is crucial to achieve good functional outcome has triggered interest and research into endovascular treatment of acute ischemic stroke. Development: Intravenous (iv) thrombolytic therapy is the treatment of choice in patients with acute ischemic stroke; however, it has certain limitations. Endovascular treatment is a promising alternative with theoretical advantages over IV therapy, such as an increased frequency of recanalization and longer therapeutic windows. Endovascular reperfusion strategies include intra-arterial fibrinolysis with drugs, or endovascular mechanical devices for thrombectomy or thrombus disruption, thromboaspiration, or thrombus entrapment in the vessel wall. The ideal of comprehensive treatment of acute stroke would provide specificity to treat an individual patient: with specific arterial occlusion and collaterals and a determined physiology of acute cerebral ischemia. With all this information, we would decide the best therapeutic strategy for the patient, and move from just a time-based approach to include a pathophysiology approach as well, and thus different patients could have different therapeutic windows. The endovascular treatment situation in Spain is heterogeneous and requires human and material resources to enable it to be implemented throughout the country. Conclusions: Endovascular treatment of stroke is a new therapeutic tool for achieving reperfusion safely in patients ineligible for Alteplase or who have failed reperfusion with an IV fibrinolytic. Resumen: Introducción: La evidencia de que la recanalización y la reperfusión del lecho vascular distal de pacientes adecuadamente seleccionados son fundamentales para lograr un buen pronóstico funcional ha disparado el interés y la investigación sobre el tratamiento endovascular del ictus isquémico agudo. Desarrollo: La fibrinólisis intravenosa (i.v.) es el tratamiento de elección en pacientes con ictus isquémico agudo, aunque presenta ciertas limitaciones. El tratamiento endovascular supone una alternativa prometedora con ventajas teóricas sobre el tratamiento i.v., como una mayor frecuencia de recanalización y mayor ventana terapéutica. Las estrategias de reperfusión endovascular incluyen fibrinólisis intraarterial con fármacos o tratamiento mecánico con dispositivos que permiten extracción, aspiración, disrupción o atrapamiento del trombo en la pared. El ideal del tratamiento integral del ictus agudo sería aportar especificidad al paciente individual: tratar una oclusión arterial con unas colaterales y con una fisiología de la isquemia cerebral aguda determinadas. Con todos estos datos, ante cualquier paciente podremos decidir la mejor estrategia terapéutica y pasar de un enfoque del paciente basado únicamente en el tiempo a un enfoque basado también en la fisiopatología; por lo tanto, distintos pacientes tendrían diferentes ventanas terapéuticas. La situación del tratamiento endovascular en España es heterogénea y precisa de recursos materiales y humanos para conseguir su implantación en todo el territorio. Conclusiones: El tratamiento endovascular del ictus supone una nueva herramienta terapéutica para lograr la reperfusión de una forma segura en los pacientes no candidatos a alteplasa o que no han conseguido reperfundir con el fibrinolítico i.v. Keywords: Acute stroke, Endovascular treatment, Intra-arterial fibrinolysis, Acute ischemic stroke, Palabras clave: Ictus agudo, Tratamiento endovascular, Fibrinólisis intraarterial, Ictus isquémico agud

Tratamiento endovascular del ictus agudo: un campo muy abierto que está por iniciar

Resumen: Introducción: La evidencia de que la recanalización y la reperfusión del lecho vascular distal de pacientes adecuadamente seleccionados son fundamentales para lograr un buen pronóstico funcional ha disparado el interés y la investigación sobre el tratamiento endovascular del ictus isquémico agudo. Desarrollo: La fibrinólisis intravenosa (i.v.) es el tratamiento de elección en pacientes con ictus isquémico agudo, aunque presenta ciertas limitaciones. El tratamiento endovascular supone una alternativa prometedora con ventajas teóricas sobre el tratamiento i.v., como una mayor frecuencia de recanalización y mayor ventana terapéutica. Las estrategias de reperfusión endovascular incluyen fibrinólisis intraarterial con fármacos o tratamiento mecánico con dispositivos que permiten extracción, aspiración, disrupción o atrapamiento del trombo en la pared. El ideal del tratamiento integral del ictus agudo sería aportar especificidad al paciente individual: tratar una oclusión arterial con unas colaterales y con una fisiología de la isquemia cerebral aguda determinadas. Con todos estos datos, ante cualquier paciente podremos decidir la mejor estrategia terapéutica y pasar de un enfoque del paciente basado únicamente en el tiempo a un enfoque basado también en la fisiopatología; por lo tanto, distintos pacientes tendrían diferentes ventanas terapéuticas. La situación del tratamiento endovascular en España es heterogénea y precisa de recursos materiales y humanos para conseguir su implantación en todo el territorio. Conclusiones: El tratamiento endovascular del ictus supone una nueva herramienta terapéutica para lograr la reperfusión de una forma segura en los pacientes no candidatos a alteplasa o que no han conseguido reperfundir con el fibrinolítico i.v. Abstract: Introduction: The evidence that recanalization and reperfusion of the distal vascular bed in appropriately selected patients is crucial to achieve good functional outcome has triggered interest and research into endovascular treatment of acute ischemic stroke. Development: Intravenous (iv) thrombolytic therapy is the treatment of choice in patients with acute ischemic stroke, however, it has certain limitations. Endovascular treatment is a promising alternative with theoretical advantages over iv therapy, such as an increased frequency of recanalization and longer therapeutic windows. Endovascular reperfusion strategies include intra-arterial fibrinolysis with drugs, or endovascular mechanical devices for thrombectomy or thrombus disruption, thromboaspiration, or thrombus entrapment in the vessel wall. The ideal of comprehensive treatment of acute stroke would provide specificity to treat an individual patient: with specific arterial occlusion and collaterals and a determined physiology of acute cerebral ischemia. With all this information, we would decide the best therapeutic strategy for the patient, and move from just a time-based approach to include a pathophysiology approach as well, and thus different patients could have different therapeutic windows. The endovascular treatment situation in Spain is heterogeneous and requires human and material resources to enable it to be implemented throughout the country. Conclusions: Endovascular treatment of stroke is a new therapeutic tool for achieving reperfusion safely in patients ineligible for Alteplase or who have failed reperfusion with an iv fibrinolytic. Palabras clave: Ictus agudo, Tratamiento endovascular, Fibrinólisis intraarterial, Ictus isquémico agudo, Keywords: Acute stroke, Endovascular treatment, Intraarterial fibrinolysis, Acute ischemic strok

Síndrome de Sturge Weber con crisis epilépticas y calcificaciones intracraneales bilaterales en el periodo neonatal

El síndrome de Sturge Weber es un trastorno neurocutáneo infrecuente, caracterizado por la asociación de un angioma venoso de la piamadre con un nevus rojo-vinoso en la cara. La afectación bilateral del nevus no es infrecuente, habiéndose observado en el 30% de los pacientes; sólo el 25% de los mismos muestran angiomatosis leptomeníngea bilateral. Las crisis parciales son generalmente la primera manifestación neurológica y se inician habitualmente en los primeros meses de vida. La TAC craneal puede revelar las calcif!caciones intracraneales características, aunque rara vez están presentes al nacimiento. Presentamos un caso de Sturge Weber con crisis de inicio precoz, nevus facial y calcificaciones intracraneales bilaterales presentes en el periodo neonatal

Supplementary Material for: Endovascular Treatment of Distal Internal Carotid Artery Occlusions with Retrievable Stents

<b><i>Background:</i></b> Acute stroke due to distal intracranial internal carotid artery (ICA) occlusion has a poor natural history. Outcome in patients who receive intravenous tissue plasminogen activator (tPA) is also unsatisfactory. The objective of this study is to evaluate the effectiveness and safety of endovascular treatment with retrievable stents in these patients. <b><i>Methods:</i></b> Data from a prospective register of patients with acute stroke treated with an endovascular procedure in a single centre were analysed. <b><i>Results:</i></b> A total of 20 patients with distal ICA occlusion were collected. Mean baseline National Institutes of Health Stroke Scale score was 18. Eight cases (40%) had received previous intravenous tPA. Mean time from stroke to recanalization was 393 min. Retrievable stents with proximal occlusion and aspiration were used in all cases. In 3 patients, 2 retrievable stents were used simultaneously. Complete recanalization (thrombolysis in cerebral infarction 2b/3) was accomplished in 85% of cases. A favourable clinical outcome (modified Rankin Scale score 0-2) was achieved in 13 patients (65%). Mortality occurred in 2 cases (10%). <b><i>Conclusions:</i></b> Endovascular treatment of patients with distal ICA occlusion seems safe and effective. Retrievable stents may be the treatment of choice, although randomized clinical trials are necessary. The use of 2 retrievable stents at the same time could be an alternative technique useful in thrombi of larger size