Thrombotic Event Prevention in Patients Undergoing Posterior Lumbar Arthrodesis: our experiencie. A retrospective case series study. / Prevención de eventos trombóticos en pacientes sometidos a cirugía de artrodesis lumbar por vía posterior: experiencia en nuestro centro. Estudio retrospectivo de casos.

INTRODUCTION: There is no generalized consensus regarding perioperative prophylaxis of venous thromboembolism (VTE), either on using or timing it in patients undergoing spine surgery. VTE is a current concern because, even though being an uncommon event, it can cause serious complications. The aim of the present study is to propose guidelines for the prevention of thrombotic events in posterior spinal surgery, either as deep vein thrombosis or pulmonary thromboembolism. If the number of patients getting prophylaxis drugs is reduced a subsequent reduction of the incidence of epidural hematoma can be expected. MATERIALS AND METHODS: A number of 235 patients who had undergone posterior spinal arthrodesis in the previous five years were studied. Mechanical thromboprophylaxis measures consisting of compression stockings were applied in all of them. Anticoagulant drugs were also applied whenever risk factors for thrombosis were observed. Early weight-bearing was resumed immediately after surgery. Demographic, clinical, and surgical variables were collected, as well as complications appearing during the follow-up period, that was scheduled at one, two, four, six and twelve months after the surgery. Thrombotic events, if present, were diagnosed by clinical and imaging tests such as ultrasound and CT angiography. RESULTS: From the total 235 patients of this series, one hundred and fifty-three cases met the study inclusion criteria. A total of four thrombotic events appeared, one in the form of deep vein thrombosis and other three in the form of pulmonary thromboembolism. These last patients suffering an embolism died because of it. None of the variables studied had statistical significance for the occurrence of a thrombotic event. All four patients who suffered thrombotic events were receiving anticoagulant drugs, in addition to mechanical compression stockings, because of the presence of risk factors for thrombosis. CONCLUSIONS: By applying the fore mentioned protocol, adequate prevention of thromboembolic events was achieved in this study population of patients undergoing posterior spinal surgery.

Hematoma espinal epidural espontáneo: estudio retrospectivo de una serie de 13 casos / Spontaneous spinal epidural haematoma: A retrospective study of a series of 13 cases

Introducción: El hematoma espinal epidural espontáneo (HEEE) tiene una incidencia estimada de un caso por millón de habitantes al año. Se considera espontáneo cuando no se logra relacionar ninguna causa de forma directa con su aparición. Objetivo: Describir una muestra de pacientes con HEEE y analizar las variables relacionadas con el pronóstico funcional del mismo. Pacientes y métodos: Estudio retrospectivo de pacientes diagnosticados de HEEE en nuestro centro entre 2001 y 2013. Resultados: Trece pacientes, 7 varones, con edad media de 71 años. El 62% presentaba hipertensión arterial (HTA) y el 54% utilizaba anticoagulantes orales, teniendo una razón normalizada internacional > 3 el 57% de ellos. La presentación clínica más frecuente fue dolor en columna vertebral (85%). El 92% asoció déficit neurológico en forma de síndrome sensitivo-motor (70%), motor puro (15%) o sensitivo puro (7%). Cinco pacientes recibieron tratamiento quirúrgico y 8 fueron tratados de forma conservadora. Al año, 3 de los pacientes tratados de forma quirúrgica y 4 de los de manejo conservador tenían una puntuación igual o menor de 2 en la Escala Rankin Modificada. Se observó peor pronóstico en pacientes anticoagulados, en hematomas de mayor extensión, en hematomas localizados en región lumbar y cuando el compromiso motor inicial era mayor. Conclusiones: La edad avanzada, la HTA y la anticoagulación son los principales factores asociados con el HEEE. La presentación típica consiste en dolor en la columna vertebral seguido de déficit motor. En pacientes con déficits motores establecidos, el tratamiento quirúrgico dentro de las primeras 24 h parece ser la mejor opción terapéutica

Introduction: Spontaneous spinal epidural haematoma (SSEH) has an estimated incidence of one per million inhabitants. It is classified as spontaneous when no identifiable cause can be linked to its onset. Objective: To describe a sample of patients with SSEH and analyse variables related to its functional prognosis. Patients and methods: Retrospective study carried out in patients diagnosed with SSEH between 2001 and 2013 in our hospital. Results: We included 13 subjects (7 men) with a mean age of 71 years. Of the total, 62% had hypertension and 54% were treated with oral anticoagulants; of the latter, 57% had an International Normalised Ratio above 3. The most frequent manifestation was spinal column pain (85%). Nearly all subjects presented an associated neurological deficit, whether sensory-motor (70%), pure motor (15%), or pure sensory (7%). Five patients underwent surgical treatment and 8 had conservative treatment. After one year, 3 of the patients treated surgically and 4 of those on conservative treatment had a score of 2 or lower on the modified Rankin Scale. Poorer prognosis was observed in patients with anticoagulant therapy, large haematomas, location in the lumbar region, and more pronounced motor disability at onset. Conclusions: Old age, hypertension, and anticoagulant therapy are the main risk factors for SSEH. The typical presentation consists of back pain with subsequent motor deficit. In patients with established motor symptoms, surgical treatment within the first 24 hours seems to be the best option

Spontaneous spinal epidural haematoma: a retrospective study of a series of 13 cases.

INTRODUCTION: Spontaneous spinal epidural haematoma (SSEH) has an estimated incidence of one per million inhabitants. It is classified as spontaneous when no identifiable cause can be linked to its onset. OBJECTIVE: To describe a sample of patients with SSEH and analyse variables related to its functional prognosis. PATIENTS AND METHODS: Retrospective study carried out in patients diagnosed with SSEH between 2001 and 2013 in our hospital. RESULTS: We included 13 subjects (7 men) with a mean age of 71 years. Of the total, 62% had hypertension and 54% were treated with oral anticoagulants; of the latter, 57% had an International Normalised Ratio above 3. The most frequent manifestation was spinal column pain (85%). Nearly all subjects presented an associated neurological deficit, whether sensory-motor (70%), pure motor (15%), or pure sensory (7%). Five patients underwent surgical treatment and 8 had conservative treatment. After one year, 3 of the patients treated surgically and 4 of those on conservative treatment had a score of 2 or lower on the modified Rankin Scale. Poorer prognosis was observed in patients with anticoagulant therapy, large haematomas, location in the lumbar region, and more pronounced motor disability at onset. CONCLUSIONS: Old age, hypertension, and anticoagulant therapy are the main risk factors for SSEH. The typical presentation consists of back pain with subsequent motor deficit. In patients with established motor symptoms, surgical treatment within the first 24hours seems to be the best option.

Episiotomía: ventajas e inconvenientes de su uso / Episiotomy: benefits and risks of its practice

Objetivo: Conocer las ventajas e inconvenientes del uso de la episotomía. Método: Revisión bibliográfica de los últimos 20 años en las bases de datos bibliográficas IME, Medline, CUIDEN y BDIE con los descriptores episotomía, desgarros, suelo pélvico. Resultados: La prevalencia de la episotomía en nuestro país oscila entre el 70-90 por ciento, cifra similar a la de otros países de nuestro nivel asistencial, a excepción del Reino Unido, y muy por encima del 30 por ciento recomendado por la OMS. La episotomía sólo previene de desgarros de grado III y IV cuando es mediolateral y se realiza en primíparas. Genera morbilidad en cuanto al dolor posparto y dispareunia se refiere y, sobre todo, si es mediolateral. Para el alivio del dolor son útiles diferentes formas de aseo y baño, el fomento del autocuidado y la lidocaína al 5 por ciento en base acuosa. Los fármacos utilizados son paracetamol e ibuprofeno. La incontinencia urinaria no está relacionada con la episiotomía. Conclusiones. El uso restrictivo de la episiotomía tiene más beneficios que el uso rutinario. Es necesario valorar los antecedentes y los factores implicados en el periodo expulsivo y actuar en consecuencia (AU)

Hipertensión arterial vasculorrenal en varón joven / Vasculo-renal arterial hypertension in a young male patient

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Detection of Chamydia psittaci in enteric subclinical infections in adult sheep, through cell culture isolation

Con excepción de México, la clamidiasis en ovinos es una entidad bien determinada en países donde se desarrolla la ovinocultura. A fin de determinar la presencia de Chlamydia psittaci en hatos ovinos en nuestro país, 10 explotaciones de 5 diferentes áreas del altiplano fueron muestreadas, colectándose un total de 267 muestras viables de heces de hembras adultas en SPG (92 de ellas se obtuvieron en un segundo muestreo efectuado en 5 explotaciones elegidas al azar). Las muestras fueron procesadas e inoculadas en células L-929 con medio Iscove's suplementado, realizándose la identificación de las inclusiones intracitoplasmáticas características mediante tinción de Giemsa, e inmunofluorescencia indirecta en muestras sospechosas. Se obtuvo 92.88 por ciento de aislamientos sin observarse diferencias significativas entre los diferentes hatos analizados ni entre los dos muestreos efectuados. Es necesario, en consecuencia, realizar estudios que conduzcan a la identificación del posible papel patógeno de C. psittaci en nuestros ovinos

Detection of Chlamydia psittaci in enteric subclinical infections in adult sheep, through cell culture isolation.

Ovine chlamydiasis is a well known disease in countries with a good practice of breeding sheep herds, not so in Mexico. Aiming to determine Chlamydia psittaci presence in sheep herds in Mexico, we sampled 10 different farmlands in 5 geographical zones on the highlands, gathering a total of 267 viable samples from adult ewes in SPG (92 of them were obtained in a second sampling carried out in five randomly chosen farms). Samples were treated and inoculated on L-929 cells grown in Iscove's supplemented medium; identification of the characteristic intracytoplasmic inclusions was performed by Giemsa stain, and indirect immunofluorescence in suspected samples. Isolation was successful in 92.88% of the trials. No significant differences were observed among the studied herds nor between the two samplings. This high incidence leads to consider seriously the possible pathogenic role of C. psittaci in Mexico.