Epilepsia postraumática, evaluación de los criterios de causalidad. A propósito de un caso / Posttraumatic epilepsy and its differential diagnosis in impairment evaluation. Case report

Objetivo: Se presenta un caso de valoración pericial de nexo de causalidad en una epilepsia postraumática, entre un traumatismo craneoencefálico (TCE) ocurrido cuatro años antes y una agresión con resultado de lesiones leves, en un varón de 21 años, consumidor ocasional de alcohol, cannabis y cocaína. El objetivo de este artículo es el análisis de los criterios médico-legales aplicables al caso y la correcta evaluación del estado anterior del paciente. La valoración pericial resulta afectada por la complejidad de los mecanismos desencadenados en el TCE, por la intervención de otros factores que pueden contribuir a la aparición de epilepsia, y por la existencia de una extensa literatura sobre el tema, en muchos casos con hallazgos dispares y contradictorios. Conclusiones: En el presente caso, evaluados los criterios de causalidad, la epilepsia se considera secundaria al TCE sufrido cuatro años antes (AU)

Introduction: This report shows a case of posttraumatic epilepsy related to head injury four years ago and aggression with result in mild injury, in a 21-year-old male, alcohol, cannabis and cocaine user. The aim of this report is to review the expert evaluation of the link between head injury or aggression and posttraumatic epilepsy by the analysis of the causal relationship factors and the influence of previously existing pathology. The expert evaluation is awkward and difficult to deal with, because of the different mechanisms of Traumatic Brain Injury (TBI) and other factors that could lead to epilepsy. Also the extensive bibliography on the subject is controversial. Conclusions: In this case the posttraumatic epilepsy can be reasonably linked to the TBI that had been undergone 4 years ago (AU)

Nexo causal de neumotórax asociado con acupuntura. A propósito de un caso / Pneumothorax related to acupuncture therapy. A case report of pneumothorax

Se describe el caso de un paciente sometido a tratamiento con acupuntura y electroestimulación que sufrió un cuadro de neumotórax al terminar una de las sesiones. Se trata de un varón de 26 años, diagnosticado de fractura tercio distal del radio derecho tratado quirúrgicamente. En su evolución presentó algodistrofia de la muñeca y la mano derechas, fue sometido a tratamiento con acupuntura y electroestimulación y presentó, al terminar una de las sesiones, un neumotórax derecho. El interés que presenta este caso es la valoración pericial del nexo causal entre el neumotórax y el tratamiento con acupuntura, mediante el análisis de los criterios de causalidad médico-legal aplicables al caso. Aunque los efectos adversos graves debidos a la acupuntura son raros y la literatura médica no proporciona adecuados datos relacionados con la incidencia de tales complicaciones, la mayoría de los autores atribuyen el neumotórax, en general, a un error del terapeuta y no a los riesgos específicos de la acupuntura

A case-report of pneumothorax related to acupuncture therapy and electrostimulation is described. A 26-year-old male had an accident and as a result, a right distal radius fracture. After surgery, he developed algodystropy of the right wrist and hand and underwent treatment with acupuncture and electrostimulation. At the end of one of the sessions, he suffered an immediate right pneumothorax. The interest of this case is the expert evaluation of the causal connection between the pneumothorax and treatment with acupuncture by means of the analysis of the medical-legal causality criteria applicable to the case. Although serious adverse events due to acupuncture therapy are rare, the medical literature does not provide data about the incidence of such complications. The majority of the authors generally attribute the pneumothorax to an error by the therapist and not to the specific risks of the acupuncture

Valoración médico forense del esguince cervical / Medico legal evaluation of whyplash injury

El esguince cervical es la patología traumática más frecuente en el ámbito de la valoración médico forense. Se realiza una aproximación a la misma a través de las peritaciones realizadas por 22 médicos forenses de 15 partidos judiciales españoles, sobre un total de 572 lesionados. Se concluye la mayor incidencia en el sexo femenino (57.52%), en el rango de edades entre 21 y 40 años (58%), siendo conductor de un turismo (54.7%) que recibe un golpe posterior (59%). Con un tiempo de sanidad entre los 31 y 90 días (52%), resultando en un mayor porcentaje con secuelas (64,3%), comúnmente SPC o cervicalgia, generalmente (56%) de grado leve

Whiplash is the leading traumatic cause concerning the evaluation in forensic activity. It has been carried out an approximation through the reports done by 22 forensic examiners working in 15 Spanish jurisdictions, over a total amount of 572 injured people. In fact there is a bigger incidence of damage in female gender (57.52%), in the age ranging from 21 to 40 years (58%), driving a car (54.7%), following a rear-end collision (59%). The healing time varies from 31 to 90 days (52%), and mostly with sequels (64.3%), commonly Cervical Post-Traumatic Syndrome or cervical pain, usually (56%) in a low degree

[The current panorama of euthanasia in Spain]. / Panorama actual de la eutanasia en España.

Due to the fact of the continuous advances of medical technology, physicians are able to prolong life even in those patients who suffer from a terminal illness to whom no hope to recover from it is left. Frequently the use or not of different therapies on these type of patients is questioned, who demand the autonomy over the self person to decide the cessation of a treatment. That is why it was proposed to investigate on the opinions and attitudes on the omission or cessation of treatments which could prolong life (passive euthanasia) or active euthanasia in terminal patients. A survey, which preserved the confidentiality of patients, was done in which 1,109 individuals took part coming from three different sectors of the population: hospital health professionals (physicians n = 346 and nurses n = 346) from San Carlos University Hospital, Madrid; students (n = 261) from Madrid Complutense University, and retired individuals (n = 156) from an elderly people club located at the Madrid province (Pinto). Sample was formed by 40% of males and 60% of females, with ages between 20 and 90 years. Most of the surveyed people agreed in certain circumstances or totally agree with omission or cessation of drugs which could prolong life (passive euthanasia) in terminal patients (70%). Regarding active euthanasia more than half (55%) opposed to it, 34% agreed in certain circumstances and 10% agreed completely. Significant differences were detected (p < 0.05) related to age, religious beliefs and political thoughts of the subjects. These results are compared to others already available.

[Attitudes towards active euthanasia and its legislation in Spain]. / Actitudes ante la eutanasia activa y su legislación en España.

BACKGROUND: The present forms of carrying out public health care have lead to probably more effective medicine but which at the same time has led to greater risks in violating patients' rights and welfare. At present, a series of arguments are been debated for soliciting the legalization of euthanasia as a form of avoiding possible abuses. Thus, the opinions and attitudes concerning legislation for active euthanasia in terminally ill patients were herein investigated. METHODS: An anonymous survey was elaborated in which 1,109 subjects from three sectors of the population participated: a) hospital personnel (doctors n = 346 and nurses n = 346) of the University Hospital San Carlos in Madrid, b) students (n = 261) of the University Complutense of Madrid, and c) retired people (n = 156) in an old age residence in the province of Madrid (Pinto). The sample was made up of a total of 446 males and 657 females with ages of between 20 and 90 years. RESULTS: Most of those surveyed were in agreement in determined circumstances or totally in agreement with legislation for active euthanasia in terminally ill patients (63%). With respect to acceptation to the practice of legislation for active euthanasia 63% were in agreement in determined circumstances or totally in agreement. Significant differences were found (p less than 0.05) in relation to age, sex, marital status, religion and political ideology of the subjects. CONCLUSIONS: Although the results found in this study concerning the opinions and attitudes on legislation for active euthanasia in terminally ill patients coincided when compared with other existing studies with respect to acceptation for legislation, a less favorable tendency to the same was evident.