Role of deep brain stimulation therapy in the magnetic resonance-guided high-frequency focused ultrasound era: current situation and future prospects.

Introduction: Deep brain stimulation (DBS) is a well-established treatment of movement disorders; but recently there has been an increasing trend toward the ablative procedure magnetic resonance-guided focused ultrasound (MRgFU). DBS is an efficient neuromodulatory technique but associated with surgical complications. MRIgFUS is an incision-free method that allows thermal lesioning, with fewer surgical complications but irreversible effects.Areas covered: We look at current and prospective aspects of both techniques. In DBS, appropriate patient selection, improvement in surgical expertise, target accuracy (preoperative and intraoperative imaging), neurophysiological recordings, and novel segmented leads need to be considered. However, increased number of older patients with higher comorbidities and risk of DBS complications (mainly intracranial hemorrhage, but also infections, hardware complications) make them not eligible for surgery. With MRgFUS, hemorrhage risks are virtually nonexistent, infection or hardware malfunction are eliminated, while irreversible side effects can appear.Expert commentary: Comparison of the efficacy and risks associated with these techniques, in combination with a growing aged population in developed countries with higher comorbidities and a preference for less invasive treatments, necessitates a review of the indications for movement disorders and the most appropriate treatment modalities.

Incidencia de enfermedad pulmonar obstructiva crónica en pacientes con el virus de la inmunodeficiencia humana. Análisis post-hoc del estudio viva / Incidence of chronic obstructive pulmonary disease in patients with human immunodeficiency virus. Post-hoc analysis of the viva study

Introducción: desde la aparición de la terapia antiretroviral la supervivencia de los pacientes infectados por el virus de la inmunodeficiencia humana (VIH) ha aumentado considerablemente tomando importancia la aparición de otras patologías crónicas en estos pacientes como puede ser la enfermedad pulmonar obstructiva crónica (EPOC). Nuestro objetivo fue conocer la incidencia de EPOC en una cohorte de pacientes VIH derivados en un programa de detección de hipertensión pulmonar (HTP). Material y Métodos: análisis post-hoc, de un prospectivo, pseudo-experimental de pacientes con infección del VIH a los que se les preguntaba por disnea y en caso afirmativo eran derivados a consultas de neumología para despistaje de HTP. Resultado: desde 2014 hasta 2016, reclutamos un total de 32 pacientes, con un predominio de varones (75%). La disnea según la mMRC (Medical Reserach Council) fue grado 1, 2 y 3 en el 37,5%, 43,8% y 18,8%, respectivamente. La prevalencia de tabaquismo fue del 87,1% (intervalo de confianza [IC] 95%: 71- 96,4%), y 18 pacientes fueron catalogados de EPOC (62%; IC95%: 42,2 - 79,3%). Conclusión: la incidencia de EPOC en nuestra serie fue muy superior a la de la población general. Es necesario plantear estrategias de búsqueda activa de EPOC en estos pacientes para un diagnóstico y tratamiento precoz

Introduction: Since the advent of antiretroviral therapy, the survival of patients infected with the human immunodeficiency virus (HIV) has considerably increased, with the occurrence of other chronic diseases such as chronic obstructive pulmonary disease (COPD) gaining importance in these patients. Our objective was to find out the incidence of COPD in a cohort of HIV patients that were referred to a program to detect pulmonary hypertension (PH). Materials and Methods: Post hoc analysis of a prospective, quasi-experimental study on HIV-infected patients who were asked whether they had dyspnea. If this was the case, they were referred to a pulmonologist for PH screening. Results: From 2014 to 2016, we recruited a total of 32 patients, with a predominance of male recruits (75%). According to the mMRC (Modified Medical Research Council) Dyspnea Scale, 37.5%, 43.8% and 18.8% were classified as Grade 1, 2 and 3, respectively. The prevalence of smoking was 87.1% (95% confidence interval [CI]: 71 - 96.4%), and 18 patients were classified with COPD (62%; 95% CI: 42.2 - 79.3%). Conclusion: The incidence of COPD in our sample was much higher than that of the general population. It is necessary to plan active search strategies for COPD in these patients for early diagnosis and treatment

FPI: Consolidando alternativas de tratamiento / No disponible

La fibrosis pulmonar idiopática es una patología sobre la cual se está incidiendo tanto en el diagnóstico, a través de estudios acerca de las alteraciones genéticas que modifican el curso de la enfermedad, como en estudios que nos aportan diferentes alternativas en cuanto al tratamiento. Actualmente disponemos de dos fármacos que han demostrado mejorar tanto el pronóstico de la enfermedad como la calidad de vida de los pacientes que se someten a dichos tratamientos, ellos son Pirfenidona y Nintedanib

Idiopathic pulmonary fibrosis is a pathology that is affecting both the diagnosis, through studies about genetic alterations that modify the course of the disease and studies that provide us with different treatment alternatives. We currently have two drugs that have been shown to improve both the prognosis of the disease and the quality of life of patients who undergo such treatments, such as Pirfenidone and Nintedanib

Prebiotic synthesis of aminooxazoline-5'-phosphates in water by oxidative phosphorylation.

RNA is essential to all life on Earth and is the leading candidate for the first biopolymer of life. Aminooxazolines have recently emerged as key prebiotic ribonucleotide precursors, and here we develop a novel strategy for aminooxazoline-5'-phosphate synthesis in water from prebiotic feedstocks. Oxidation of acrolein delivers glycidaldehyde (90%), which directs a regioselective phosphorylation in water and specifically affords 5'-phosphorylated nucleotide precursors in upto 36% yield. We also demonstrated a generational link between proteinogenic amino acids (Met, Glu, Gln) and nucleotide synthesis.

Association of ficolin-3 with abdominal aortic aneurysm presence and progression.

Essentials Abdominal aortic aneurysm (AAA) is asymptomatic and its evolution unpredictable. To find novel potential biomarkers of AAA, microvesicles are an excellent source of biomarkers. Ficolin-3 is increased in microvesicles obtained from activated platelets and AAA tissue. Increased ficolin-3 plasma levels are associated with AAA presence and progression. SUMMARY: Background Abdominal aortic aneurysm (AAA) patients are usually asymptomatic and AAA evolution is unpredictable. Ficolin-3, mainly synthesized by the liver, is a molecule of the lectin complement-activation pathway involved in AAA pathophysiology. Objectives To define extra-hepatic sources of ficolin-3 in AAA and investigate the role of ficolin-3 as a biomarker of the presence and progression of AAA. Methods Microvesicles (exosomes and microparticles) were isolated from culture-conditioned medium of ADP-activated platelets, as well as from AAA tissue-conditioned medium (thrombus and wall). Ficolin-3 levels were analyzed by western-blot, real-time PCR, immunohistochemistry and ELISA. Results Increased ficolin-3 levels were observed in microvesicles isolated from activated platelets. Similarly, microvesicles released from AAA tissue display increased ficolin-3 levels as compared with those from healthy tissue. Moreover, ficolin-3 mRNA levels in the AAA wall were greatly increased compared with healthy aortic walls. Immunohistochemistry of AAA tissue demonstrated increased ficolin-3, whereas little staining was present in healthy walls. Finally, increased ficolin-3 levels were observed in AAA patients' plasma (n = 478) compared with control plasma (n = 176), which persisted after adjustment for risk factors (adjusted odds ratio [OR], 5.29; 95% confidence interval [CI], 3.27, 8.57)]. Moreover, a positive association of ficolin-3 with aortic diameter (Rho, 0.25) and need for surgical repair was observed, also after adjustment for potential confounding factors (adjusted hazard ratio, 1.55; 95% CI, 1.11, 2.15). Conclusions In addition to its hepatic expression, ficolin-3 may be released into the extracellular medium via microvesicles, by both activated cells and pathological AAA tissue. Ficolin-3 plasma levels are associated with the presence and progression of AAA, suggesting its potential role as a biomarker of AAA.

Expression of insulin receptor (IR) A and B isoforms, IGF-IR, and IR/IGF-IR hybrid receptors in vascular smooth muscle cells and their role in cell migration in atherosclerosis.

BACKGROUND: Abnormal proliferation and migration of vascular smooth muscle cells (VSMCs) is a major contributor to the development of atherosclerotic process. In a previous work, we demonstrated that the insulin receptor isoform A (IRA) and its association with the insulin-like growth factor-I receptor (IGF-IR) confer a proliferative advantage to VSMCs. However, the role of IR and IGF-IR in VSMC migration remains poorly understood. METHODS: Wound healing assays were performed in VSMCs bearing IR (IRLoxP+/+ VSMCs), or not (IR-/- VSMCs), expressing IRA (IRA VSMCs) or expressing IRB (IRB VSMCs). To study the role of IR isoforms and IGF-IR in experimental atherosclerosis, we used ApoE-/- mice at 8, 12, 18 and 24 weeks of age. Finally, we analyzed the mRNA expression of total IR, IRB isoform, IGF-IR and IGFs by qRT-PCR in the medial layer of human aortas. RESULTS: IGF-I strongly induced migration of the four cell lines through IGF-IR. In contrast, insulin and IGF-II only caused a significant increase of IRA VSMC migration which might be favored by the formation of IRA/IGF-IR receptors. Additionally, a specific IGF-IR inhibitor, picropodophyllin, completely abolished insulin- and IGF-II-induced migration in IRB, but not in IRA VSMCs. A significant increase of IRA and IGF-IR, and VSMC migration were observed in fibrous plaques from 24-week-old ApoE-/- mice. Finally, we observed a marked increase of IGF-IR, IGF-I and IGF-II in media from fatty streaks as compared with both healthy aortas and fibrolipidic lesions, favoring the ability of medial VSMCs to migrate into the intima. CONCLUSIONS: Our data suggest that overexpression of IGF-IR or IRA isoform, as homodimers or as part of IRA/IGF-IR hybrid receptors, confers a stronger migratory capability to VSMCs as might occur in early stages of atherosclerotic process.

Ensayo clínico aleatorizado para la comparación de dos métodos de cura de traqueotomía en una Unidad de Cuidados Intensivos / Randomised clinical trial to compare two tracheotomy care methods in an Intensive Care Unit

Introducción: La traqueotomía es una técnica habitual en las Unidades de Cuidados Intensivos (UCI). Es sabido que los cuidados enfermeros durante y posteriores al procedimiento están directamente relacionados con el éxito del mismo, minimizando el riesgo de aparición de complicaciones como la infección del estoma y favoreciendo la adecuada evolución del paciente crítico. Objetivos: Comparar la incidencia de infección en las traqueotomías realizadas en UCI según el antiséptico empleado: cura con polihexanida (PLX) y cura con suero fisiológico + povidona yodada (PY). Material y método: Ensayo experimental, aleatorizado y abierto, realizado en una UCI polivalente de 32 camas durante 2 años. El estudio fue aprobado por el Comité Ético de Investigación del Principado de Asturias. Resultados: La tasa observada de infecciones por 100 pacientes-día de traqueotomía fue de 1,34 (IC del 95%, 0,81-2,01): 1,46 en PLX y 1,21 PY (p valor 0,685). Conclusiones: A pesar de que el tratamiento experimental (PLX) ha mostrado su eficacia en otro tipo de heridas, en nuestro estudio no se encontraron diferencias significativas entre esta técnica y la estándar. Dado que no existe un registro nacional de incidencia de infección asociada a traqueotomías, no se puede saber si la observada está dentro de los parámetros habituales

Introduction: Tracheotomy is a common technique in Intensive Care Units (ICU). It is known that nursing care during and after that procedure is directly related to its success, by reducing the possible complications to a minimum, such as the stoma infection, and contributing to a favourable outcome in critical patients. Objectives: To compare the use of polyhexanide (PLX) versus saline + povidone iodine (PY) as antiseptics and infection incidence in tracheostomies performed in Intensive Care Units. Material and method: A 2-year, experimental, randomised, open-label trial carried out in a multidiscipline ICU with 32 beds. The study was approved by the Research Ethics Committee of Principality of Asturias. Results: The overall infection rate observed for every hundred patients was 1.34 (95% CI; 0.81-2.01), with 1.46 when using PLX and 1.21 for PY (P=.685). Conclusions: In spite of the experimental treatment (PLX) was shown to be effective in other types of wounds in our study. No significant differences were found between this technique and the standard one. Since there is no national registry of tracheotomy- associated infections, it is not possible to know whether the rate observed is within the usual parameters

[Randomised clinical trial to compare two tracheotomy care methods in an Intensive Care Unit]. / Ensayo clínico aleatorizado para la comparación de dos métodos de cura de traqueotomía en una Unidad de Cuidados Intensivos.

INTRODUCTION: Tracheotomy is a common technique in Intensive Care Units (ICU). It is known that nursing care during and after that procedure is directly related to its success, by reducing the possible complications to a minimum, such as the stoma infection, and contributing to a favourable outcome in critical patients. OBJECTIVES: To compare the use of polyhexanide (PLX) versus saline+povidone iodine (PY) as antiseptics and infection incidence in tracheostomies performed in Intensive Care Units. MATERIAL AND METHOD: A 2-year, experimental, randomised, open-label trial carried out in a multidiscipline ICU with 32 beds. The study was approved by the Research Ethics Committee of Principality of Asturias. RESULTS: The overall infection rate observed for every hundred patients was 1.34 (95% CI; 0.81-2.01), with 1.46 when using PLX and 1.21 for PY (P=.685). CONCLUSIONS: In spite of the experimental treatment (PLX) was shown to be effective in other types of wounds in our study. No significant differences were found between this technique and the standard one. Since there is no national registry of tracheotomy- associated infections, it is not possible to know whether the rate observed is within the usual parameters.

Neumorraquis y neumomediastino espontaneo, rara complicación asmática / Pneumorrhachis and spontaneous pneumomediastinum, asthmatic rare complication

No disponible

Parkinsonismo farmacológico frente a demencia con cuerpos de Lewy / Pharmacological Parkinsonismo opposite to dementia with Lewy's bodies

No disponible

No disponible

Rehabilitación tras reconstrucción del LCA con plastia H-T-H / Rehabilitation after-tendon-bone ACL plastia

Los protocolos de rehabilitación tras reconstrucción del LCA han sufrido notables transformaciones en las últimas décadas, desde los protocolos clásicos y conservadores de Paulos hasta los actuales y más agresivos de Beynnon. El proceso de reeducación ha de sustentarse en la evidencia científica en cada uno de los diferentes elementos que lo componen. Los protocolos acelerados actuales se basan en una período de enfriamiento y rehabilitación preoperatoria con el objetivo de conseguir un balance articular y muscular adecuados. La reeducación postoperatoria se iniciará de forma precoz, con un buen control del dolor, buscando la rápida recuperación del balance articular, la carga completa y un refuerzo muscular intensivo inicialmente en cadena cerrada y a partir de la sexta semana en cadena cinética abierta, junto con un programa de reeducación neuromuscular propioceptiva. La utilización de técnicas de electromioestimulación ayudará en las fases iniciales en la recuperación de los desequilibrios del balance muscular. Las ortesis desempeñan todavía un papel discutido durante el proceso de rehabilitación, pudiendo ser utilizadas en las primeras fases de rehabilitación para el mayor confort del paciente. Es fundamental la valoración y monitorización mediante los tests funcionales, las escalas de valoración funcional y los tests instrumentados isocinéticos. El cumplimiento de estas premisas minimizará las complicaciones(artrofibrosis, síndromes rotulianos y algodistrofia) permitiendo el retorno a la práctica deportiva al mismo nivel prelesional (AU)

Rehabilitation protocols after ACL reconstruction has undergone remarkable transformations in recent decades, from the classic and conservative Paulos’ protocols to the current most aggressive of Beynnon. The rehabilitation process must be supported by scientific evidence in each of the different elements that compose it. The current accelerated protocols are based on a period of cooling and pre-operative rehabilitation in order to achieve a suitable joint and muscle balance. The postoperative rehabilitation starts early, with good pain control, for the speedy recovery of the joint stock, the full load and intensive muscle strengthening initially using closed chain and from the sixth week open kinetic chain, along with a proprioceptive neuromuscular re-education program. The electromios estimulation techniques helps in the initial stages in the recovery of muscle imbalances. Orthoses still play a discussed role during the rehabilitation process and can be used in the early stages of rehabilitation for greater patient comfort. It is essential to the assessment and monitoring by the functional tests, functional assessment scales and isokinetic instrumented test. The fulfillment of these assumptions will minimize complications (Arthrofibrosis, patellar syndrome and reflex sympathetic dystrophy) allowing the return to sports at the same level before de injury (AU)

Distrofia miotónica congénita. Hallazgos clínicos, electrofisiológicos y genéticos de nuestra casuística / Congenital myotonic dystrophy. Clinical, electrophysiological and genetic findings of our casuistry

Introducción. La distrofia miotónica congénita es una enfermedad multisistémica de herencia autosómica dominante, heredada generalmente a través de la madre, y que se caracteriza porque al nacimiento, el recién nacido presenta hipotonía, problemas respiratorios y alimenticios, debilidad facial y general. Objetivos. Estudio descriptivo de nuestra experiencia en la distrofia miotónica congénita. Pacientes y métodos. Se estudiaron 12 pacientes con distrofiamiotónica congénita, pertenecientes a 9 familias donde las madres eran portadoras de la enfermedad, y se analizaron las características clínicas, electromiográficas y genéticas. Resultados. El retraso motor era manifiesto en todos los pacientes, así como el retraso intelectual, la disartria y la voz nasal. Los niños afectados presentaban más de 1.500 repeticiones del trinucleótido citosina-timina-guanina del cromosoma 19 determinadas por la técnica de Southern Blot. Las alteraciones electromiográficas de tipo miopático estaban presentes en todos ellos. La biopsia muscular realizada a 8 pacientes mostraba atrofia y predominio de fibras tipo 1 con núcleos centrales e hipertrofia de fibras tipo 2. Conclusión. Es necesario sospechar la distrofia miotónicaante casos de recién nacidos con hipotonía, en madres conhistoria de abortos o recién nacidos muertos. Una vez superados los primeros años de vida, su desarrollo es similar al dela distrofia miotónica del adulto. Es fundamental realizar el estudio genético a los afectados y portadores de esta enfermedad (AU)

Introduction. Congenital myotonic dystrophyis an autosomal dominant inherited generally transmitted multisystemic disease that is generally inherited through themother. It is characterized by the birth the newborn baby with hypotonia, respiratory and nutritional problems, and facial and general weakness. Objective. Descriptive study of our experience in congenital myotonic dystrophy. Patients and methods. Twelve patients with congenital myotonicdy strophy, belonging to 9 families in which the mother was a carrier of the disease have been studied. The clinical, electromyographic and genetic characteristics of their familieswere analyzed. Results. Motor retardation as well as the intellectual retardation,dysarthria and nasal voice was clear in all the patients.The affected children had more than 1,500 repetitions of the cytosine-thymine-guanine (CTG) trinucleotide on chromosome 19 determined by the Southern Blot technique. Myopathictype alterations were found in the electromyographsof all of the subjects. The muscular biopsy done in 8 patients showed atrophy and predominance of type 1 fibers with centralnuclei and type 2 fiber hypertrophy. Conclusion. Myotonic dystrophy should be suspected incases of newborn babies with hypotonia, in mothers with a back ground of abortions or stillborn babies. After surviving the first years of life, their development is similar to the myotonicdy strophy of the adult. It is fundamental to perform agenetic study in those who are affected by or carriers of the disease (AU)

Abscesos hepáticos: análisis retrospectivo de 68 casos / Liver abscess: retrospective review of 68 cases

Objetivos: Conocer las características clínicas y de las pruebas complementarias de pacientes con abscesos hepáticos (AH) y establecer factores pronósticos. Pacientes y métodos: Análisis retrospectivo de pacientes diagnosticados de AH en el Hospital Severo Ochoa, entre 1989 y 2005. Resultados: Se recogieron 68 pacientes: 39 hombres y 29 mujeres; incidencia: 26 casos/100.000 ingresos hospitalarios; edad (Me): 63 años. El origen fue: biliar (37%), portal (16%), por diseminación hematógena (7%), por inoculación directa (4%), desconocido (35%). La ecografía fue diagnóstica en 43% de casos y la tomografía computarizada en 57%. Los AH fueron mayores a 3 cm de diámetro en 62% de casos y en 28% fueron AH múltiples. Fueron positivos 71% de cultivos de pus y 52% de hemocultivos. Se aisló el germen causal en 73,5% de AH. Se realizó antibioterapia en 100% de pacientes, drenaje percutáneo en 56% y cirugía en 25%. Evolución: 13% de complicaciones, 9% de recidivas y 19% de mortalidad. Conclusiones: Cuadro clínico mal definido del AH. Factores asociados a complicaciones: enfermedad neurológica o tumoral abdominal, previas y AH múltiples. Factores asociados a mortalidad: índice de comorbilidad de Charlson corregido por la edad > 5, índice de Quick < 60% y aparición de complicaciones. Es necesario individualizar la indicación de drenaje en cada paciente

Objetive: To assess clinical and laboratory features of patients with liver abscesses (LA), and determine prognostic features. Methods: We performed a retrospective analysis of medical records of patients receiving a diagnosis of LA in the Hospital Severo Ochoa, between 1989-2005. Results: We were able to find 68 patients: 39 males and 29 females; the incidence amounts 26 cases/100,000 hospital admissions; mean age 63 years. A biliary source accounted for 37%, 16% were of portal origin, 7% were ascribed to hematogenous dissemination, 4% direct inoculation during a procedure and no cause could be found in 35%. Liver ultrasonography allowed diagnosis in 43% of cases, and CT scan un 57%. Sixty-two percent of LA were larger than 3 cm in diameter; 28% of cases had multiple abscesses. Cultures of abscess fluid were positive in 71%,and blood cultures in 52%. Globally, we were able to isolate the causal microorganism in 73.5% of cases. Hundred percent of patients received antimicrobials, 56% had percutaneous drainage performed and 25% were surgically managed. There were complications in 13%, 9% suffered recurrences and we found a 19% mortality rate. Conclusions: LA has an ill-defined clinical picture. A history of neurological disease or abdominal tumor, and multiple LA are associated with an increased complication rate. Following factors correlated with increased mortality: Age-adjusted Charlson’s morbidity index >=5; Quick index < 60% and development of complications. Drainage indication has to be individualized

Nuestra experiencia en el estudio clínico y electrofisiológico de pacientes con la enfermedad de Charcot-Marie-Tooth tipo 1 / Our experience in the clinical and electrophysiological study of patients with Type 1 Charcot-Marie-Tooth disease

Introducción. Las neuropatías sensitivo-motoras hereditarias tipo Charcot-Marie-Tooth (CMT) son el grupo de enfermedades neurológicas hereditarias más frecuentes. La variedad CMT tipo 1 es una enfermedad que comienza en la primera o segunda décadas y se caracteriza por debilidad progresiva e hipoestesia distal, caídas frecuentes, esguinces de tobillo, atrofia peroneal, desarrollo progresivo de pies cavos y posterior afectación de miembros superiores. El objetivo de este estudio es determinar las características clínicas y electrofisiológicas de la enfermedad CMT tipo 1 en nuestra casuística. Pacientes y métodos. Fueron evaluados clínica y electrofisiológicamente 18 pacientes con la enfermedad de CMT tipo 1 (10 mujeres y 8 hombres), pertenecientes a 13 familias, con un rango de edad de entre 3-77 años. Resultados. Quince pacientes tenían pies cavos. Todos los pacientes habían tenido caídas frecuentes desde la infancia o adolescencia así como esguinces de repetición y 10 de ellos sufrían calambres gemelares. En todos los pacientes se observaba abolición de reflejos osteotendinosos. Las conducciones nerviosas sensitivas de los nervios sural, mediano y cubital estaban ausentes en 15 pacientes. Las velocidades de conducción motora en los nervios ciático poplíteo externo, mediano y cubital estaban por debajo de 35 m/s. Discusión. A pesar de la evolución lenta de la enfermedad, se presentan síntomas funcionalmente limitantes. El parámetro más importante para el diagnóstico electrofisiológico de CMT tipo 1 es la disminución de la velocidad de conducción motora por debajo de 35 m/s

Introduction. Hereditary motor-sensory neuropathies or Charcot-Marie-Tooth disease (CMT) is the most common hereditary neurological diseases. The CMT Type 1 variety is a disease that begins in the first two decades of life and that is characterized by progressive weakness and distal hypoesthesia, frequent falls, ankle sprains, peroneal atrophy, progressive appearance of pes cavus and posterior affectation of upper limbs. This study aims to determine the clinical and electrophysiological findings in CMT Type 1 disease in our statistics. Patients and methods. A total of 18 patients, 10 women and 8 men with CMT Type 1, were studied clinically and electrophysiologically. Their ages ranged from 3-77 years. Results. Fifteen out of the 18 patients had pes cavus. All of the patients have suffered frequent falls since their infancy or adolescence as well as repetitive sprains, and 10 of them were suffering calf muscle cramps. In all the patients absence of reflexes or areflexia was observed. The sensitive nerve conduction evaluated in sural, median and ulnar nerves was absent in 15 patients. Motor nerve conduction in the peroneal, median and ulnar nerves was below 35 m/s. Discussion. In spite of the slow evolution of the disease, it entails symptoms with functional limitations. The most important parameter of electrophysiology for diagnosis of CMT Type 1 is the decrease of motor conduction velocities below 35 m/s

[Liver abscess: retrospective review of 68 cases]. / Abscesos hepáticos: análisis retrospectivo de 68 casos.

OBJECTIVE: To assess clinical and laboratory features of patients with liver abscesses (LA), and determine prognostic features. METHODS: We performed a retrospective analysis of medical records of patients receiving a diagnosis of LA in the Hospital Severo Ochoa, between 1989-2005. RESULTS: We were able to find 68 patients: 39 males and 29 females; the incidence amounts 26 cases/100,000 hospital admissions; mean age 63 years. A biliary source accounted for 37%, 16% were of portal origin, 7% were ascribed to hematogenous dissemination, 4% direct inoculation during a procedure and no cause could be found in 35%. Liver ultrasonography allowed diagnosis in 43% of cases, and CT scan un 57%. Sixty-two percent of LA were larger than 3 cm in diameter; 28% of cases had multiple abscesses. Cultures of abscess fluid were positive in 71%, and blood cultures in 52%. Globally, we were able to isolate the causal microorganism in 73.5% of cases. Hundred percent of patients received antimicrobials, 56% had percutaneous drainage performed and 25% were surgically managed. There were complications in 13%, 9% suffered recurrences and we found a 19% mortality rate. CONCLUSIONS: LA has an ill-defined clinical picture. A history of neurological disease or abdominal tumor, and multiple LA are associated with an increased complication rate. Following factors correlated with increased mortality: Age-adjusted Charlson's morbidity index > or =5; Quick index < 60% and development of complications. Drainage indication has to be individualized.

Artroplastia vertebral / Vertebral arthroplasty

La artroplastia vertebral es una alternativa terapéutica a la fusión lumbar en el tratamiento de la enfermedad degenerativa discal, que tiene como finalidad restaurar la altura discal, mantener una adecuada movilidad y minimizar las complicaciones, básicamente el deterioro de los segmentos vertebrales adyacentes. Se han desarrollado tres tipos diferentes de artroplastias: las totales, las endoprótesis nucleares y las facetarias, utilizándose fundamentalmente en la columna lumbar y en menor grado en la columna cervical. La indicación de la artroplastia ha de seguir un estricto protocolo de selección del paciente y un programa de rehabilitación específico que garantice su viabilidad. La evidencia actual permite concluir resultados similares entre las artroplastias y las fusiones vertebrales, con algunas ventajas para las primeras en relación con el índice de reintervenciones y movilidad, aunque el avance en los modelos y técnicas quirúrgicas permitirá en un futuro cercano su mayor utilización y mejoría de los actuales resultados clínicos

Intervertebral arthroplasty is an alternative therapeutic option to lumbar fusion for surgical treatment of lumbar degenerative disc disease. Its purpose is to restore disc height, maintain adequate motion and minimize complications, basically deterioration of the adjacent vertebral segments. Three different kind of arthroplasty have been developed: total lumbar joint replacement, nucleus pulposus replacement and facet joints posterior dynamic stabilization, currently used more in lumbar surgery than cervical surgery. Arthroplasty indication has to follow a strict patient selection protocol and specific rehabilitation program that assures its viability. Current evidence makes it possible to conclude similar results between arthroplasties and vertebral fusions. There are some added benefits of restoring and maintaining segmental motion in the arthroplasty surgery, although advances in orthopedic surgical procedures will allow for better clinical results than now in the near future

Artroplastia vertebral / Vertebral arthroplasty

La artroplastia vertebral es una alternativa terapéutica a la fusión lumbar en el tratamiento de la enfermedad degenerativa discal, que tiene como finalidad restaurarla altura discal, mantener una adecuada movilidad y minimizarlas complicaciones, básicamente el deterioro de los segmentos vertebrales adyacentes. Se han desarrollado tres tipos diferentes de artroplastias: las totales, las endoprótesis nucleares y las facetarias, utilizándose fundamentalmente en la columna lumbar y en menor grado en la columna cervical. La indicación de la artroplastia ha de seguir un estricto protocolo de selección del paciente y un programa de rehabilitación específico que garantice su viabilidad. La evidencia actual permite concluir resultados similares entre las artroplastias y las fusiones vertebrales, con algunas ventajas para las primeras en relación con el índice de reintervenciones y movilidad, aunque el avance en los modelos y técnicas quirúrgicas permitirá en un futuro cercano su mayor utilización y mejoría de los actuales resultados clínicos (AU)

Intervertebral arthroplasty is an alternative therapeutic option to lumbar fusion for surgical treatment of lumbar degenerative disc disease. Its purpose is to restore disc height, maintain adequate motion and minimize complications, basically deterioration of the adjacent vertebral segments. Three different kind of arthroplasty have been developed: total lumbar joint replacement, nucleus pulposus replacement and facet joints posterior dynamic stabilization, currently used more in lumbar surgery than cervical surgery. Arthroplasty indication has to follow a strict patient selection protocol and specific rehabilitation program that assures its viability. Current evidence makes it possible to conclude similar results between arthroplasties and vertebral fusions. There are some added benefits of restoring and maintaining segmental motion in the arthroplasty surgery, although advances in orthopedic surgical procedures will allow for better clinical results than now in the near future (AU)