Trends in the mortality of diabetes in Mexico from 1998 to 2022: a joinpoint regression and age-period-cohort effect analysis.

OBJECTIVE: The purpose was to analyze age-standardized trends in diabetes mortality rates (DMR) from 1998 to 2022, stratified by sex and Mexican state, and the effects attributable to age, period, and cohort by sex. STUDY DESIGN: Joinpoint regression and age-period-cohort effect analysis. METHODS: Based on the tenth revision of the International Classification of Diseases, E11, E12, E13, and E14 codes of the death certificate, a daily record of mortality was extracted from the death certificate attributable to diabetes as the main cause. From 1998 to 2022, sexes and ages (≥20 years) were used to calculate the crude mortality rates and standardized at the national and Mexican state levels. Additionally, the age-period-cohort model was used to examine age, period, and cohort effects. RESULTS: From 1998 to 2005, the age-adjusted DMR increased by 3.6% (95% confidence interval [CI]: 2.7, 4.5) for the total population, as shown by the joinpoint regression analysis at a national level; from 2017 to 2020, it increased by 7.4% (95% CI: 0.6, 14.8). The DMR with the highest increase during the study period came mainly from states in the country's southeastern region, 2.3% to 3.7% per year. The net age and period effects showed that mortality increased with advancing age and with going time, respectively; and the net cohort effect revealed that mortality increased in more recent birth cohorts, mainly in men Rate Ratio (RR) = 2.37 (95% CI: 2.29, 2.46) vs RR = 1.13 (95% CI: 1.09, 1.17). CONCLUSION: The DMR increased among older age groups. The period effect showed that mortality increased over time. Furthermore, the cohort effect showed that mortality increased in more recent birth cohorts, especially among men.

[Omental infarction, unusual cause of abdominal pain]. / Infarto omental, causa poco común de dolor adbominal.

INTRODUCTION: Omental infarction describes ischemic torsion of the distal portion of the omentum and constitutes an infrequent cause of acute abdominal pain in childhood of which few cases are known. Objec tive: To analyze through a clinical case the characteristics and management of this pathology, to consider this entity in the differential diagnosis of acute abdominal pain. CLINICAL CASE: An 11-year- old child consulted the emergency department due to a 48-hour history of continuous abdominal pain, which had progressively increased. On the physical examination, the patient presented pain in the right side of the abdomen and the epigastric area, with no signs of peritoneal irritation, and was overweight (BMI 91st percentile). Biochemical analysis showed a slight increase in c-reactive protein (CRP) 41.31 mg/L (reference value < 3.0 mg/L) without leukocytosis and normal ultrasound study, without visualization of the appendix. Due to persistent pain, increased CRP, and absence of appen dix visualization in the ultrasound, the study was completed with an abdomen and pelvis CT scan which showed trabeculation of the fat of the anterior right subhepatic space, thus diagnosing omental infarction. The patient was hospitalized for conservative management with analgesia, anti-inflamma tory drugs, and fluid therapy, presenting good evolution in the first 48 hours. CONCLUSION: Omental infarction is an infrequent cause of acute abdominal pain in childhood. Imaging studies play a funda mental role in the differential diagnosis of this entity with other clinical conditions of similar course, thus avoiding unnecessary surgical interventions.

Selective CD8 cell reduction by SARS-CoV-2 is associated with a worse prognosis and systemic inflammation in COVID-19 patients.

The lymphopenia exhibited in patients with COVID-19 has been associated with a worse prognosis in the development of the disease. To understand the factors associated with a worse evolution of COVID-19, we analyzed comorbidities, indicators of inflammation such as CRP and the ratio of neutrophils/lymphocytes, as well as the count of blood cells with T-lymphocyte subtypes in 172 hospitalized patients with COVID-19 pneumonia. Patients were grouped according to their needs for mechanical ventilation (ICU care) or not. Within the comorbidities studied, obesity was the only associated with greater severity and ICU admission. Both the percentage and the absolute number of neutrophils were higher in patients needing ICU care than non-ICU patients, whereas absolute lymphocyte count, and especially the percentage of lymphocytes, presented a deep decline in critical patients. There was no difference between the two groups of patients for CD4 T-lymphocytes, neither in percentage of lymphocyte nor in absolute number, however for CD8 T-cells the differences were significant for both parameters which were in decline in ICU patients. There was a firm correlation between the highest values of inflammation indicators with the decrease in percentage of CD8 T-lymphocytes. This effect was not seen with CD4 cells. Obesity together with lymphopenia, especially whether preferentially affects to CD8 T- lymphocytes, are factors that can predict a poor prognosis in patients with COVID-19.

A survey of moral distress in staff working in intensive care in the UK.

Elevated rates of burnout and post-traumatic stress have been found in staff working in critical care settings, but the aspect of moral distress has been harder to quantify until a recent revision of a scale previously designed for nurses, was adapted for use with a range of health professionals, including physicians. In this cross-sectional survey, n = 171 nurses and physicians working in intensive care in the United Kingdom completed the Moral Distress Scale-Revised in relation to their experiences at work. Mean (SD) Moral Distress Scale-Revised score was 70.2 (39.6). Significant associations were found with female gender (female 74.1 (40.2) vs. male 55.5 (33.8), p = 0.010); depression (r = 0.165, p = 0.035) and with intention to leave job (considering leaving 85.5 (42.4) vs. not considering leaving 67.2 (38.6), p = 0.040). These results highlight the importance of considering the moral impact of work-related issues when addressing staff wellbeing in critical care settings.

Safety and Efficacy of Prolonged Use of Dalbavancin in Bone and Joint Infections.

Dalbavancin is a lipoglycopeptide with potent activity against Gram-positive microorganisms, a long half-life, a favorable safety profile, and a high concentration in bone, which makes it an interesting alternative for treatment of osteoarticular infections. We performed a multicentric retrospective study of all patients with an osteoarticular infection (septic arthritis, spondylodiscitis, osteomyelitis, or orthopedic implant-related infection) treated with at least one dose of dalbavancin between 2016 and 2017 in 30 institutions in Spain. In order to evaluate the response, patients with or without an orthopedic implant were separated. A total of 64 patients were included. Staphylococcus epidermidis and Staphylococcus aureus were the most frequent microorganisms. The reasons for switching to dalbavancin were simplification (53.1%), adverse events (25%), or failure (21.9%). There were 7 adverse events, and no patient had to discontinue dalbavancin. In 45 cases, infection was related to an orthopedic implant. The implant material was retained in 23 cases, including that in 15 (65.2%) patients that were classified as cured and 8 (34.8%) that presented improvement. In 21 cases, the implants were removed, including those in 16 (76.2%) cases that were considered successes, 4 (19%) cases were considered improved, and 1 (4.8%) case that was considered a failure. Among the 19 cases without implants, 14 (73.7%) were considered cured, 3 (15.8%) were considered improved, and 2 (10.5%) were considered failures. The results show that dalbavancin is a well-tolerated antibiotic, even when >2 doses are administered, and is associated with a high cure rate. These are preliminary data with a short follow-up; therefore, it is necessary to gain more experience and, in the future, to establish the most appropriate dose and frequency.

Resultados de la Colecistectomía Video-laparoscópica en pacientes con Colecistostomía Percutánea por Colecistitis Aguda Litiásica / 7 EVALUATION OF VIDEOLAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH PREVIOUS PERCUTANEOUS CHOLECYTOSTOMY FOLLOWING LITHIASIC ACUTE CHOLECYSTITIS

Cholecystitis is the inflammation of the gallbladder wall. The Tokio 2013 guidelines classify this pathology in light , moderate and severe, being the latest the most commonly associated with organic dysfunction. Although videolaparoscopic cholecystectomy (VLPC) is the gold standard for the management of a lithiasic biliary tract pathology, those patients with organic dysfunction are benefitiated with an urgent or earlier drainage of the gallbladder through a percutaneous approach. This is due because the risks for these patients are greater under general anesthesia. This temporization could allow an improvement of the comorbidities and then perform an elective cholecystectomy. The placement of a percutaneous cholecystectomy (PC) originates a process of adherencies that could make difficult the surgical act of the cholecystectomy, extending the operative time or increasing the risk for lesions on the biliary tract. The reports related to the results of VLPC in patients with PC are scarce. The aim of the present report was to present a revision of the authors´ experience with the videolaparoscopic cholecystectomy in patients with previous percutaneous cholecystectomy.

Cortisol levels and history of depression in acute coronary syndrome patients.

BACKGROUND: Depressed mood following an acute coronary syndrome (ACS) is a risk factor for future cardiac morbidity. Hypothalamic-pituitary-adrenal (HPA) axis dysregulation is associated with depression, and may be a process through which depressive symptoms influence later cardiac health. Additionally, a history of depression predicts depressive symptoms in the weeks following ACS. The purpose of this study was to determine whether a history of depression and/or current depression are associated with the HPA axis dysregulation following ACS. METHOD: A total of 152 cardiac patients completed a structured diagnostic interview, a standardized depression questionnaire and a cortisol profile over the day, 3 weeks after an ACS. Cortisol was analysed using: the cortisol awakening response (CAR), total cortisol output estimated using the area under the curve method, and the slope of cortisol decline over the day. RESULTS: Total cortisol output was positively associated with history of depression, after adjustment for age, gender, marital status, ethnicity, smoking status, body mass index (BMI), Global Registry of Acute Cardiac Events (GRACE) risk score, days in hospital, medication with statins and antiplatelet compounds, and current depression score. Men with clinically diagnosed depression after ACS showed a blunted CAR, but the CAR was not related to a history of depression. CONCLUSIONS: Patients with a history of depression showed increased total cortisol output, but this is unlikely to be responsible for associations between depression after ACS and later cardiac morbidity. However, the blunted CAR in patients with severe depression following ACS indicates that HPA dysregulation is present.

Emotional triggering and low socio-economic status as determinants of depression following acute coronary syndrome.

BACKGROUND: The determinants of depression following acute coronary syndrome (ACS) are poorly understood. Triggering of ACS by emotional stress and low socio-economic status (SES) are predictors of adverse outcomes. We therefore investigated whether emotional triggering and low SES predict depression and anxiety following ACS. METHOD: This prospective observational clinical cohort study involved 298 patients with clinically verified ACS. Emotional stress was assessed for the 2 h before symptom onset and compared with the equivalent period 24 h earlier using case-crossover methods. SES was defined by household income and education. Depression was measured with the Beck Depression Inventory and the Hamilton Rating Scale for Depression and anxiety with the Hospital Anxiety and Depression Scale 3 weeks after ACS and again at 6 and 12 months. Age, gender, ethnicity, marital status, the Global Registry of Acute Coronary Events risk score, duration of hospital stay and history of depression were included as covariates. RESULTS: Emotional stress during the 2-h hazard period was associated with increased risk of ACS (odds ratio 1.88, 95% confidence interval 1.01-3.61). Both low income and emotional triggering predicted depression and anxiety at 3 weeks and 6/12 months independently of covariates. The two factors interacted, with the greatest depression and anxiety in lower income patients who experienced acute emotional stress. Education was not related to depression. CONCLUSIONS: Patients who experience acute emotional stress during their ACS and are lower SES as defined by current affluence and access to resources are particularly vulnerable to subsequent depression and anxiety.

Analysis of global variability in 15 established and 5 new European Standard Set (ESS) STRs using the CEPH human genome diversity panel.

The CEPH human genome diversity cell line panel (CEPH-HGDP) of 51 globally distributed populations was used to analyze patterns of variability in 20 core human identification STRs. The markers typed comprised the 15 STRs of Identifiler, one of the most widely used forensic STR multiplexes, plus five recently introduced European Standard Set (ESS) STRs: D1S1656, D2S441, D10S1248, D12S391 and D22S1045. From the genotypes obtained for the ESS STRs we identified rare, intermediate or off-ladder alleles that had not been previously reported for these loci. Examples of novel ESS STR alleles found were characterized by sequence analysis. This revealed extensive repeat structure variation in three ESS STRs, with D12S391 showing particularly high variability for tandem runs of AGAT and AGAC repeat units. The global geographic distribution of the CEPH panel samples gave an opportunity to study in detail the extent of substructure shown by the 20 STRs amongst populations and between their parent population groups. An assessment was made of the forensic informativeness of the new ESS STRs compared to the loci they will replace: CSF1PO, D5S818, D7S820, D13S317 and TPOX, with results showing a clear enhancement of discrimination power using multiplexes that genotype the new ESS loci. We also measured the ability of Identifiler and ESS STRs to infer the ancestry of the CEPH-HGDP samples and demonstrate that forensic STRs in large multiplexes have the potential to differentiate the major population groups but only with sufficient reliability when used with other ancestry-informative markers such as single nucleotide polymorphisms. Finally we checked for possible association by linkage between the two ESS multiplex STRs closely positioned on chromosome-12: vWA and D12S391 by examining paired genotypes from the complete CEPH data set.

Adoption and maintenance of a Mediterranean diet in patients with coronary heart disease from a Northern European population: a pilot randomised trial of different methods of delivering Mediterranean diet advice.

BACKGROUND: A Mediterranean diet has been shown to protect against coronary heart disease (CHD). Adherence to a Mediterranean diet can be assessed using a Mediterranean diet score. The primary aim of this pilot study was to examine whether CHD patients in a Northern European population would adopt and maintain a Mediterranean diet, with a secondary aim of comparing the effectiveness of different methodologies aimed at improving compliance. METHODS: Sixty-one patients with a diagnosis of CHD were randomised to one of three groups: either to receive conventional dietetic advice for CHD or advice to implement a Mediterranean-style diet using either behavioural counselling or nutritional counselling. Patients received a follow-up assessment at 6 months (adoption) and a subset of patients was followed up at 12 months (maintenance). The primary outcome measure was the between-group difference in the mean change in Mediterranean diet score (MDS). RESULTS: The change in MDS was not significantly different between groups. However, all three groups reported a significant within-group increase in MDS (P < 0.01) at 6 and 12 months follow-up. CONCLUSIONS: All three groups made dietary changes towards a Mediterranean diet, but behavioural counselling did not have significant additional benefit over nutritional counselling in initiating and maintaining dietary change, and neither method offering specific Mediterranean diet advice had any significant benefit in terms of improvement in MDS over conventional dietetic practice.

Genetic variability of the SNPforID 52-plex identification-SNP panel in Central West Colombia.

A set of autosomal single nucleotide polymorphism (SNP) loci was analyzed using the 52-plex assay previously described by Sanchez et al. [J.J. Sanchez, C. Phillips, C. Borsting, K. Balogh, M. Bogus, M. Fondevila, C.D. Harrison, E. Musgrave-Brown, A. Salas, D. Syndercombe-Court, P.M. Schneider, A. Carracedo, N. Morling, A multiplex assay with 52 single nucleotide polymorphisms for human identification, Electrophoresis 27 (2006) 1713-1724] in 140 samples of unrelated individuals born in the Colombian regions of, Risaralda, Caldas, Quindio, Antioquia, Tolima and Valle, and 164 samples of unrelated individuals with declared Native American ancestry from Colombia. Allele frequencies and statistical parameters of forensic interest are presented for the 52 SNPs. All loci were in agreement with Hardy-Weinberg equilibrium while comparisons with population samples of Argentina, Portugal, Spain, Mozambique, and Taiwan revealed significant differences in allele frequency distributions.

Genetic polymorphism of 15 STR loci in central western Colombia.

Fifteen autosomal short tandem repeat (STR) loci were analyzed using the AmpFISTR Identifiler PCR Amplification Kit in 1944 samples of healthy unrelated individuals, born in the regions of Caldas, Quindio and Risaralda, Colombia. Allele frequencies and statistical parameters of forensic interest are presented for all markers (D8S1179, D21S11, D7S820, CSF1PO, D3S1358, THO1, D13S317, D16S539, D2S1338, D19S433, vWA, TPOX, D18S51, D5S818 and FGA). All loci of the pooled data were in agreement with Hardy-Weinberg equilibrium, after Bonferroni correction. Comparisons with neighboring Latin American populations and Andalucia (Spain) revealed significant differences in allele distributions. Genetic data presented in this study can be used for routine forensic applications in the region.

Laparoscopic bile duct reexploration for retained duct stones.

BACKGROUND: Failure of endoscopic sphincterotomy (ES) for retained bile duct stones occurs in 4% to 10% of cases and was traditionally managed with open bile duct reexploration. METHODS: This study uses retrospective analysis of a consecutive series of cases of laparoscopic bile duct reexploration for retained bile duct stones after unsuccessful ES. RESULTS: Thirty-one cases were operated over a 7-year period. Seventy percent had a previous open cholecystectomy. Ten cases were successfully treated with a transcystic approach and 19 with laparoscopic choledochotomy. Two patients were converted to open surgery. Morbidity was 3.22% with no mortality. CONCLUSION: Laparoscopic bile duct reexploration can be safely performed and should be considered as an alternative to open surgery.

The partial labyrinthectomy petrous apicectomy approach to petroclival meningiomas. A quantitative anatomic comparison with other approaches to the same region.

The partial labyrinthectomy petrous apicectomy (PLPA) approach is a transpetrous route that provides the advantages of the labyrinthine removal but with hearing preservation. Using seven temporal bone tissue blocks and three formaldehyde-fixed cadaveric heads we have made a morphometric and comparative study on this approach that summarizes the invasiveness, the optimal surgical exposure, the anatomic complexity of the skull base approaches and, on the other hand, the spirit of preservation that is the constant aim of modern neurosurgery. The morphometric analysis is designed to make the bony phase of the PLPA approach safer and to define the relationship between petrous landmarks. The comparative study is made between the PLPA and other neurosurgical routes enhancing the potentiality of the PLPA approach that permits a wider angle of incidence towards the brainstem than with the retrosigmoid routes.

The partial labyrinthectomy petrous apicectomy approach to petroclival meningiomas. A quantitative anatomic comparison with other approaches to the same region

La laberintectomía parcial con apicectomía petrosa (PLPA) es una vía de abordaje que proporciona las ventajas de la extirpación parcial del laberinto preservando la audición. Trabajando sobre 7 piezas anatómicas de hueso temporal y 3 cabezas de cadáver fijadas con formaldehido, hemos realizado un estudio morfométrico y comparativo de este abordaje interesándonos los aspectos de la invasividad del abordaje, óptima exposición quirúrgica obtenida, complejidad anatómica de la entrada a la base craneal, y por otra parte, la actitud conservadora de la moderna neurocirugía. El análisis morfométrico tiene como objetivo hacer la fase ósea de la PLPA más segura al definir la relación entre los puntos de referencia petrosos. El estudio comparativo entre la PLPA y otros abordajes neuroquirúrgicos exalta la posibilidades de la PLPA ya que proporciona un ángulo de incidencia hacia el tronco cerebral más amplio que el que proporcionan las vías retrosigmoideas

The partial labyrinthectomy petrous apicectomy (PLPA) approach is a transpetrous route that provides the advantages of the labyrinthine removal but with hearing preservation. Using seven temporal bone tissue blocks and three formaldehyde-fixed cadaveric heads we have made a morphometric and comparative study on this approach that summarizes the invasiveness, the optimal surgical exposure, the anatomic complexity of the skull base approaches and, on the other hand, the spirit of preservation that is the constant aim of modern neuro surgery. The morphometric analysis is designed to make the bony phase of the PLPA approach safer and to define the relationship between petrous landmarks. The comparative study is made between the PLPA and other neurosurgical routes enhancing the potentiality of the PLPA approach that permits a wider angle of incidence towards the brainstem than with the retro sigmoid routes

Gastroenteroanastomosis laparoscópica como tratamiento paliativo en la obstrucción duodenal tardía por cáncer de páncreas irresecable / Laparoscopic gastroenteroanastomosis as palliative treatment in duodenal obstruction late unresectable pancreatic cancer

Antecedentes: Los pacientes con obstruccion duodenal tardía por tumor de páncreas irresecable requieren algún tipo de paliación, ya sea endoscópica o quirúrgica. Objetivo: Presentar nuestra experiencia con la gastroenteroanastomosis videopaparoscópica como método paliativo en el tratamiento de la obstrucción duodenal tardía. Lugar de aplicación: Centro Terciario de Referencia. Diseño: Retrospectivo. Población: Pacientes con obstrucción duodenal tardía por tumor de páncreas irresecable. Método: Mediante un análisis retrospectivo de una base de datos se analizaron los resultados de la gastroenteroanastomosis videolaparoscópica para el tratamiento de la obstrucción duodenal. Resultados: veinticuatro pacientes fueron tratados con gastroenteroanastomosis laparoscópica, veintidos de estos 24 pacientes tuvieron una supervivencia entre 2 y 4 meses. Cuatro enfermos (16%) presentaron retardo del vaciamiento gástrico, recibiendo tratamiento médico 2 pacientes y tratamiento quirúrgico los otros 2. El resto pudo alimentarse por vía oral hasta el momento de su muerte. Conclusiones: la gastroenteroanastomosis laparoscópica es un método válido, seguro, con baja incidencia de fístula, de bajo costo y eficaz para el tratamiento paliativo de la obstrucción duodenal tardía en los tumores de páncreas irresecables.

El profesor-tutor. Transformador de la práctica profesional / The tutor-professor, transformer of professional practice

La conceptualización emergente del proceso de enseñanza-aprendizaje conlleva una modificación del rol docente del profesor universitario. Pensar la función del profesor-tutor desde la complejidad, ayudará a que los profesionales se formen bajo este paradigma, facilitando la construcción del pensamiento en redes integradoras de los diferentes saberes que sustituyan al saber fragmentado y lineal característico del pensamiento positivista. Desde el paradigma complejo, el aprendizaje adquiere un nuevo sentido. La mirada compleja es rica en matices, complaciente con la diversidad, integradora con las diferencias. La finalidad de la educación es el acompañamiento del alumno en el descubrimiento e interpretación de la realidad. La función más importante del tutor es permitir que el alumno se construya a sí mismo, a través del diálogo reflexivo con su propia experiencia de aprendizaje. El rol del tutor debe propiciar que el alumno haga uso de su propia palabra, ofreciéndole espacios de seguridad donde pueda encontrar la ubicación apropiada, y donde la presión de la evaluación sea más un estímulo para el aprendizaje, que una dificultad para su desarrollo(AU)

The emerging conceptualization of the teaching-learning process brings with it a modification in the teaching role of a university professor. To think of the function of a tutor-professor from a complex perspective will help professors to develop underneath this paradigm, facilitating the construction of thinking in integrated networks having different types of knowledge which substitute fragmented and lineal knowledge characteristic to positivist thinking. From a complex paradigm, learning acquires a new sense. The complex viewpoint is rich in matrixes, complacent with diversity, capable to integrate difficulties. The final objective of teaching is to accompany a student as he/she discovers and interprets reality. The most important function of a tutor is to permit a student to construct himself/herself by means of reflexive dialogue with the student’s own learning experience. The tutor’s role should enable a student to make use of his/her own speech, offering secure places where a student can find his/her appropriate spot, and where the pressure of an exam becomes more a stimulus to learn than a difficulty for his/her development(AU)

Bypass gástrico por videolaparoscopia para el tratamiento de la obesidad mórbida. Experiencia clínica inicial / Gastric Bypass by videolaparoscopia for the treatment of the morbid obesity. Initial clinical experience

Antecedentes: El único tratamiento eficaz a largo plazo para la obesidad mórbida es el quirúrgico. El bypass gástrico es la técnica más utilizada mundialmente. Objetivos: Evaluar los resultados obtenidos con los primeros 70 bypass gástricos videolaparoscópicos para el tratamiento de la obesidad mórbida. Lugar de aplicación: Centro Terciario de Referencia. Diseño: Retrospectivo. Población: 70 pacientes consecutivos sometidos a bypass gástrico videolaparoscópico. Método: Análisis retrospectivo de base prospectiva de datos. La población fue dividida en dos períodos, representado cada uno una mitad de la experiencia, para su posterior análisis. Medidas de evaluación: Características demográficas, IMC, comorbilidades y evolución de las mismas, descenso ponderal, tiempo operatorio, días de internación, morbilidad, índice de conversión, mortalidad, etc. Resultados: 68% de pacientes correspondieron al sexo femenino con una edad e IMC promedio que fue de 42,6 años y 50,25 Kg/m2 respectivamente. El promedio de comorbilidades fue de 2,7 por paciente. El índice de conversión fue del 8,57% y la morbilidad global del 15,28%. No hubo mortalidad. Diferencias significativas fueron encontradas entre ambos períodos en tiempo operatorio y días de internación. El ERR a 6 y 12 meses fue del 44 y 56%, respectivamente. Conclusiones: La realización de bypass gástrico videolaparoscópico con buenos resultados es factible, siempre que sea realizado por un equipo quirúrgico entrenado, en el contexto de un quipo multidisciplinario.

[Bilateral pure T11-T12 facet dislocation without neurologic residual deficit]. / Luxación pura de facetas articulares T11-T12 sin secuelas neurológicas. Caso clínico.

Bilateral pure facets dislocation in the thoracic spine is rare, but when it does occur in almost every instance produces a severe spinal cord lesion. It is thought to be caused by a flexion distraction mechanisms in most of the cases. A case is presented of a male suffered a polytrauma with important thoracic, abdominal, and esqueletic injuries in a car accident. The patient was in a hospital during two weeks, and one month after the trauma a bilateral pure dislocation of T11-T12 facets was diagnosed. Diagnosis was made with radiographs and CT with sagittal reconstruction. After an open reduction and fixation, recovery was complete within the first postoperative week. Facet dislocation in the thoracic spine is associated in many cases with thoracic and abdominal injuries that worsen the clinical picture, and thus it may contribute to misdiagnosis of the facet dislocation, specially in the cases with no neurological symptoms, adding a risk of secondary spinal cord damage. High-resolution CT with sagittal reconstruction provides an adequate and rapid demonstration of the luxation and associated thoraco-abdominal damages. Facet dislocation are unstable injuries that require open reduction and fixation. Recovery of patients with incomplete lesions is frequent, however, recovery from complete lesions did not occur.