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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar a los pacientes con hemorragia subaracnoidea &#40;HSA&#41; aneurism&#225;tica confirmada&#44; en el Hospital de Le&#243;n&#44; durante los a&#241;os 2001 a 2003&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El protocolo de tratamiento incluye&#58; traslado r&#225;pido al Centro de Referencia&#44; control de la tensi&#243;n arterial e infusi&#243;n de nimodipino&#44; arteriograf&#237;a y tratamiento endovascular en las primeras 72 horas del ingreso&#46; Si no es posible embolizar&#44; cirug&#237;a lo m&#225;s precoz posible&#46; Manejo agresivo antiisquemia y utilizaci&#243;n de doppler transcraneal para el diagn&#243;stico y seguimiento del vasoespasmo&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Los 54 pacientes ingresados vivos con el diagn&#243;stico principal de HSA se clasificaron seg&#250;n las escalas de Hunt-Hess y Fisher&#44; al ingreso&#46; El seguimiento se hizo hasta el alta del Hospital&#59; analizando morbilidad &#40;presencia de un d&#233;ficit neurol&#243;gico al alta&#44; de cualquier grado&#44; diferente a la par&#225;lisis de un par craneal&#41; y la mortalidad&#46; Se consider&#243; estad&#237;sticamente significativa una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Durante el periodo de estudio&#44; el 86&#37; de los pacientes que ingresaron con HSA lo hicieron en las 24 horas siguientes al sangrado&#46; Cinco pacientes no fueron tratados por presentar HSA masiva con Hunt- Hess V&#44; de los que fallecieron 4&#46; En los 49 &#40;90&#44;74&#37;&#41; restantes la embolizaci&#243;n se llev&#243; a cabo con &#233;xito en 28 &#40;54&#37;&#41; y en 21 &#40;38&#37;&#41; no se pudo realizar por las caracter&#237;sticas del aneurisma&#59; se operaron en las siguientes 72 horas&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Seis pacientes &#40;16&#44;8&#37;&#41; embolizados y 3 &#40;14&#44;2&#37;&#41; operados tuvieron secuelas neurol&#243;gicas &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Fallecieron 3 &#40;14&#44;2&#37;&#41; enfermos con tratamiento endovascular y 4 &#40;19&#37;&#41; quir&#250;rgicos &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La frecuencia de vasoespasmo fue de un 20&#37; y la de resangrado de un 16&#37;&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La estancia en UCI de los pacientes embolizados fue de 6&#44;1 d&#237;as y la de los pacientes con tratamiento quir&#250;rgico fue de 8&#44;8&#46; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0 5&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El tratamiento endovascular se puede realizar con &#233;xito en m&#225;s de la mitad de los pacientes&#46; Hay relaci&#243;n entre el nivel de conciencia al ingreso y el pron&#243;stico&#46; No encontramos diferencias significativas&#44; desde el punto de vista estad&#237;stico&#44; en la morbi-mortalidad entre los pacientes embolizados y los intervenidos quir&#250;rgicamente&#44; pero s&#237; en cuanto a la estancia en UCI &#40;menor en los pacientes tratados por procedimiento endovascular&#41;&#46;</p>"
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        "titulo" => "Summary"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">This study was designed to evaluate patients with confirmed aneurismal SAH &#40;subarachnoid haemorrhage&#41; in Le&#243;n Hospital between 2001 and 2003&#46;</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The treatment protocol includes&#58; rapid transfer to the reference centre&#44; blood pressure control and nimodipine infusion&#44; arteriography and endovascular treatment within the first 72 hours after admission&#46; Surgery is performed as soon as possible if embolization is not possible&#46; Aggressive antiaeschemic handling and transcranial Doppler are used for diagnosis and vasospasm monitoring&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The patients were classified on admission according to the Hunt-Hess scale&#46; Monitoring continued until discharge&#44; and morbidity &#40;any degree of neurological deficiency on discharge&#44; not paralysis of a cranial pair&#41; and mortality were analysed&#46; P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered statistically significant&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">During the study period 54 patients had SAH on admission&#44; 86&#37; of whom were admitted to Intensive Care Unit 24 hours after bleeding&#46; Five patients were not treated as they had massive SAH with Hunt-Hess V&#46; Four of them died&#46; Of the remaining 49 patients &#40;90&#46;74&#37;&#41; embolization was successful in 28 &#40;54&#37;&#41; but 21 &#40;38&#37;&#41; were not embolized due to the characteristics of the aneurysm&#59; they were operated on within the following 72 hours&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Six embolized 16&#46;8&#37;&#41; and 3 &#40;14&#46;2&#37;&#41; patients operated on had neurological sequelae &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Three endovascularly treated patients &#40;14&#46;2&#37;&#41; and 4 &#40;19&#37;&#41; surgically treated died &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The frequency of clinical vasospasm was 20&#37; an rebleeding occurred in 16&#37;&#46; The length of stay in the ICU of embolized patients was significantly shorter than the operated patients &#40;6&#46;1 vs 8&#46;8&#41;days&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The endovascular treatment can be successfully carried out in over half of the patients with ruptured aneurysms&#46; There is a significant relationship between the degree of consciousness on admission and the prognosis&#46; We found no statistically significant differences in morbid-mortality between the embolized patients and those undergoing conventional surgery&#46; However&#44; there was a difference in length of stay in the ICU &#40;shorter in patients treated by endovascular coiling&#41;&#46;</p>"
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Resultado del tratamiento de la hemorragia subaracnoidea debida a rotura de aneurismas cerebrales
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