Factores de riesgo de infección de fracturas de meseta tibial / Risk factors for infection of tibial plateau fractures

Introducción: Las fracturas de meseta tibial (FMT) son lesiones propensas a infecciones postoperatorias, siendo la incidencia descrita superior a la del resto de fracturas, entre un 5 y un 12%. Los objetivos primarios de este estudio fueron cuantificar la tasa de infección postoperatoria de osteosíntesis de FMT e identificar los factores de riesgo de esta. Material y métodos: Estudio de cohorte retrospectiva incluyendo a pacientes intervenidos de osteosíntesis de FMT entre 2015 y 2020, en un mismo centro. La población del estudio se dividió en 2 grupos, según la presencia o no de infección postoperatoria. Se recogieron variables demográficas relacionadas con la fractura, parámetros quirúrgicos, así como necesidad de reintervención. Finalmente, en caso de desbridamiento, se recogieron número de cultivos positivos y patógeno responsable de infección, así como el tratamiento aplicado. Resultados: Se incluyeron un total de 124 pacientes, con un total de 14 infecciones (tasa global de infección de 11,3%). Se identificaron como factores de riesgo para desarrollar infección el hecho de tratarse de fracturas abiertas (p=0,002), fracturas tipo Schatzker V y VI (p=0,002) y el uso de fijador externo (p<0,001). En lo que respecta a las variables quirúrgicas solo se identificó el mayor tiempo de isquemia (p=0,032) como factor de riesgo. S. aureus fue el microorganismo más frecuentemente identificado (43%), seguido de E. cloacae (35,7%). Conclusión: La tasa global de infección tras osteosíntesis de fractura de meseta tibial fue del 11,3%. Diferentes factores se asocian a más riesgo de infección, entre ellos la diabetes mellitus, las fracturas abiertas, el uso de fijador externo, un mayor grado en la clasificación de Schatzker o un mayor tiempo de isquemia intraoperatoria.(AU)

Introduction: Tibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPF) and to identify the risk factors for this. Material and methods: Retrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied. Results: One hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (P=.002), Schatzker V and VI type fractures (P=.002) and the use of external fixation (P<.001). Regarding the surgical variables, only the longest ischemia time (P=.032) was identified as a risk factor. S. aureus was the most frequently identified microorganism (43%), followed by E. cloacae (35.7%). Conclusion: The overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.(AU)

[Translated article] Risk factors for infection of tibial plateau fractures / Factores de riesgo de infección de fracturas de meseta tibial

Introducción: Las fracturas de meseta tibial (FMT) son lesiones propensas a infecciones postoperatorias, siendo la incidencia descrita superior a la del resto de fracturas, entre un 5 y un 12%. Los objetivos primarios de este estudio fueron cuantificar la tasa de infección postoperatoria de osteosíntesis de FMT e identificar los factores de riesgo de esta. Material y métodos: Estudio de cohorte retrospectiva incluyendo a pacientes intervenidos de osteosíntesis de FMT entre 2015 y 2020, en un mismo centro. La población del estudio se dividió en 2 grupos, según la presencia o no de infección postoperatoria. Se recogieron variables demográficas relacionadas con la fractura, parámetros quirúrgicos, así como necesidad de reintervención. Finalmente, en caso de desbridamiento, se recogieron número de cultivos positivos y patógeno responsable de infección, así como el tratamiento aplicado. Resultados: Se incluyeron un total de 124 pacientes, con un total de 14 infecciones (tasa global de infección de 11,3%). Se identificaron como factores de riesgo para desarrollar infección el hecho de tratarse de fracturas abiertas (p=0,002), fracturas tipo Schatzker V y VI (p=0,002) y el uso de fijador externo (p<0,001). En lo que respecta a las variables quirúrgicas solo se identificó el mayor tiempo de isquemia (p=0,032) como factor de riesgo. S. aureus fue el microorganismo más frecuentemente identificado (43%), seguido de E. cloacae (35,7%). Conclusión: La tasa global de infección tras osteosíntesis de fractura de meseta tibial fue del 11,3%. Diferentes factores se asocian a más riesgo de infección, entre ellos la diabetes mellitus, las fracturas abiertas, el uso de fijador externo, un mayor grado en la clasificación de Schatzker o un mayor tiempo de isquemia intraoperatoria.(AU)

Introduction: Tibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPF) and to identify the risk factors for this. Material and methods: Retrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied. Results: One hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (P=.002), Schatzker V and VI type fractures (P=.002) and the use of external fixation (P<.001). Regarding the surgical variables, only the longest ischemia time (P=.032) was identified as a risk factor. S. aureus was the most frequently identified microorganism (43%), followed by E. cloacae (35.7%). Conclusion: The overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.(AU)

[Translated article] Risk factors for infection of tibial plateau fractures.

INTRODUCTION: Tibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPFs) and to identify the risk factors for this. MATERIAL AND METHODS: Retrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied. RESULTS: One hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (p=.002), Schatzker V and VI type fractures (p=.002) and the use of external fixation (p<.001). Regarding the surgical variables, only the longest ischemia time (p=.032) was identified as a risk factor. Staphylococcus aureus was the most frequently identified microorganism (43%), followed by Enterobacter cloacae (35.7%). CONCLUSION: The overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.

Risk factors for infection of tibial plateau fractures. / Factores de riesgo de infección de fracturas de meseta tibial.

INTRODUCTION: Tibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPF) and to identify the risk factors for this. MATERIAL AND METHODS: Retrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied. RESULTS: One hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (P=.002), Schatzker V and VI type fractures (P=.002) and the use of external fixation (P<.001). Regarding the surgical variables, only the longest ischemia time (P=.032) was identified as a risk factor. S. aureus was the most frequently identified microorganism (43%), followed by E. cloacae (35.7%). CONCLUSION: The overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.

New Sensor Device to Accurately Measure Cable Tension in Cable-Driven Parallel Robots.

Cable-driven parallel robots are a special type of robot in which an end-effector is attached to a fixed frame by means of several cables. The position and orientation of the end-effector can be controlled by controlling the length of the cables. These robots present a wide range of advantages, and the control algorithms required have greater complexity than those in traditional serial robots. Measuring the cable tension is an important task in this type of robot as many control algorithms rely on this information. There are several well-known approaches to measure cable tension in cable robots, where a trade-off between complexity and accuracy is observed. This work presents a new device based on strain gauges to measure cable tension specially designed to be applied in cable-driven parallel robots. This device can be easily mounted on the cable near the fixed frame, allowing the cable length and orientation to change freely, while the measure is taken before the cable passes through the guiding pulleys for improved accuracy. The results obtained from the device show a strong repeatability and linearity of the measures.

A new approach to road accident rescue.

OBJECTIVE: This article develops and validates a new methodology and tool for rescue assistance in traffic accidents, with the aim of improving its efficiency and safety in the evacuation of people, reducing the number of victims in road accidents. METHOD: Different tests supported by professionals and experts have been designed under different circumstances and with different categories of damaged vehicles coming from real accidents and simulated trapped victims in order to calibrate and refine the proposed methodology and tool. RESULTS: To validate this new approach, a tool called App_Rescue has been developed. This tool is based on the use of a computer system that allows an efficient access to the technical information of the vehicle and sanitary information of the common passengers. The time spent during rescue using the standard protocol and the proposed method was compared. CONCLUSION: This rescue assistance system allows us to make vital information accessible in posttrauma care services, improving the effectiveness of interventions by the emergency services, reducing the rescue time and therefore minimizing the consequences involved and the number of victims. This could often mean saving lives. In the different simulated rescue operations, the rescue time has been reduced an average of 14%.

Bioinspired chemistry based on minimalistic pseudopeptides.

For years researchers have tried to understand the molecular behavior of complex biomolecules through the development of small molecules that can partially mimic their function. Now researchers are implementing the reverse approach: using the structural and mechanistic knowledge obtained from those complex systems to design small molecules with defined properties and for specific applications. One successful strategy for constructing bioinspired, minimalistic molecules is to combine natural building blocks that provide functional elements with abiotic fragments that serve as structural scaffolds. Therefore pseudopeptidic compounds, most of them based on C2 symmetric structures, represent a unique opportunity to explore and evaluate this approach. Some of these molecules are as simple as two amino acids connected by a diamino spacer. The results in this Account show how bioinspired minimalistic pseudopeptides can form ordered structures, participate in the recognition and transcription of information events in molecular devices, and catalyze reactions. This strategy allows researchers to design and prepare a variety of open-chain and macrocyclic compounds leading to systems that can self-aggregate to form hierarchically ordered micro- and nanostructures. In addition, small changes in the molecule or external stimuli can regulate the self-aggregation pattern. In the same way, researchers can also tune the molecular movements of simple pseudopeptides through environmental factors, providing a means to control new molecular devices. In addition, some of the prepared model compounds have shown interesting properties in molecular recognition and even as sensors for several targets of interest. Finally we have observed remarkable catalytic activities from these types of molecules, although those results are still far from the efficiency shown by natural peptides. This family of pseudopeptidic compounds offers the opportunity for the more elaborate design of relatively simple abiotic but bioinspired systems that display specific properties. In addition, the results can provide additional information that will increase the molecular understanding of the basic principles that underlie the extraordinary behavior of natural systems.

Inyección intratumoral versus subareolar en el diagnóstico de la biopsia del ganglio centinela, en el carcinoma de mama. A propósito de un caso / Intratumoral versus subareolar injection in breast cancer sentinel lymph node biopsy. A case report

La utilización de las vías de administración profunda (intratumoral, peritumoral) y superficial (subdérmica, subareolar) están reconocidas como válidas en la biopsia del ganglio centinela en el cáncer de mama. Presentamos un caso clínico en donde la individualización de la metodología fue determinante en la estadificación axilar. Inicialmente se administra el radiotrazador por vía intratumoral guiada por ecografía. En dicha exploración se identifica una adenopatía axilar no conocida previamente, con engrosamiento cortical focal, hallazgo ecográfico inespecífico, pero subsidiario de biopsia. La linfogammagrafía no mostró captación en dicho ganglio, por lo que se decide reinyección de una 2.ª dosis por vía subareolar. En esta ocasión la linfogammagrafía detecta drenaje a dicho ganglio centinela, siendo el único de los analizados que resultó positivo para micrometástasis(AU)

The use of deep (intratumoral, peritumoral) and superficial (subdermal, subareolar) administration is recognized as valid in sentinel lymph node biopsy for breast cancer. Herein, we are presenting a clinical case in which a personalized methodology was a determining factor in axillary staging. Initially, the radiotracer was injected intratumorally guided by ultrasound. The ultrasound scan identified a previously unknown axillary lymphadenopathy, with focal cortical thickening, this being a non-specific ultrasound finding, but with possibility of biopsy. The lymphoscintigraphy did not show uptake in the mentioned node, hence, a second subareolar dose was administered. On this occasion, the lymphoscintigraphy detected drainage to the sentinel node, which was the only one positive for micrometastases(AU)

[Intratumoral versus subareolar injection in breast cancer sentinel lymph node biopsy. A case report]. / Inyección intratumoral versus subareolar en el diagnóstico de la biopsia del ganglio centinela, en el carcinoma de mama. A propósito de un caso.

The use of deep (intratumoral, peritumoral) and superficial (subdermal, subareolar) administration is recognized as valid in sentinel lymph node biopsy for breast cancer. Herein, we are presenting a clinical case in which a personalized methodology was a determining factor in axillary staging. Initially, the radiotracer was injected intratumorally guided by ultrasound. The ultrasound scan identified a previously unknown axillary lymphadenopathy, with focal cortical thickening, this being a non-specific ultrasound finding, but with possibility of biopsy. The lymphoscintigraphy did not show uptake in the mentioned node, hence, a second subareolar dose was administered. On this occasion, the lymphoscintigraphy detected drainage to the sentinel node, which was the only one positive for micrometastases.

[Training of executive function in preschool children with combined attention deficit hyperactivity disorder: a prospective, controlled and randomized trial]. / Entrenamiento de la función ejecutiva en preescolares con trastorno por déficit de atención/hiperactividad combinado: estudio prospectivo, controlado y aleatorizado.

INTRODUCTION: School-age children with attention deficit hyperactivity disorder, combined type (ADHD-C) have executive function (EF) alterations. ADHD-C and EF alterations improve with methylphenidate or after training of working memory. AIM: To determine EF training effect on ADHD-C and EF alterations in preschoolers. INCLUSION CRITERIA: randomly assigned, 2-4 years old with ADHD-C, from 7-1-2004 to 6-30-2005, normal neurological examination, no evidences of underlying chronic disorders, no taking long term medications and parents agree to train or no EF daily. Parents filled out DSM-IV diagnostic criteria form for ADHD-C and children were tested with the Standard Dimensional Change Card Sort Task at the first visit and once a year from 1 to 3 years. Inattention, hyperactivity/impulsivity and EF average scores were statistically analyzed by the t Student for significance. RESULTS: Of 25, 13 were trained. ADHD-C incidence went down to 16 (64%), 6 (24%) and 10 (40%) trained and untrained. Incidence was 50, 40 and 25% 100, and 66.66 y 100 after 1, 2 and 3 years with and without training. Inattention average score was 8.25, 8.4 and 7 before and 6, 5.8, and 5.5 before and after 1, 2 and 3 years of training. Hyperactivity/impulsivity average score was 8.5, 8.4 and 7.75 before and 5.75, 5.6, and 5.25 after 1, 2 and 3 years of training. EF average score was 5.2, 4.8, and 5.5 before and 8.5, 10 and 9.5 after 1, 2 and 3 years of training. Degree of improving of inattention, hyperactivity/impulsivity and EF were statistically significant for training of EF for 1, 2 and 3 years (p = 0.013, 0.002, 0.0249). CONCLUSIONS: Children with preschool ADHD-C and EF disorders should receive training of EF for at least 3 years from age of diagnoses to improve their condition.

Entrenamiento de la función ejecutiva en preescolares con trastorno por déficit de atención/hiperactividad combinado: estudio prospectivo, controlado y aleatorizado / Training of executive function in preschool children with combined attention deficit hyperactivity disorder: A prospective, controlled and randomized trial

Introducción. Los escolares con trastorno por déficit de atención/hiperactividad combinado (TDAH-C) presentan alteraciones de la función ejecutiva (FE) que mejoran mediante la administración de metilfenidato o con el entrenamiento de la memoria de trabajo. Objetivo. Determinar el efecto del entrenamiento de las FE sobre sus alteraciones y sobre el TDAH-C en preescolares. Sujetos y métodos. Criterio de inclusión: distribución aleatoria, niños de 2 a 4 años de edad, afectados de TDAH-C, incluidos entre el uno de julio de 2004 y el 30 de junio de 2005, con examen neurológico normal, sin enfermedades crónicas, que no estaban recibiendo tratamiento farmacológico a largo plazo y cuyos padres estaban de acuerdo en entrenar o no entrenar a sus hijos. Los padres completaron el cuestionario del DSM-IV para determinar la presencia o la ausencia de TDAH-C y las FE se evaluaron mediante la Dimensional Change Card Sort Task en la primera evaluación y una vez al año durante tres años. El promedio de puntuación de la inatención, hiperactividad/impulsividad y FE en los grupos entrenado o no entrenado se analizaron estadísticamente mediante la t de Student. Resultados. De 25 niños, 13 recibieron entrenamiento. La incidencia de TDAH-C descendió a 16 casos (64%), 6 niños (24%) con entrenamiento y 10 niños (40%) sin él. La incidencia de TDAH-C fue del 50, 40 y 25% y del 100, 66,66 y 100% después de uno, dos y tres años con entrenamiento o sin él. El promedio de puntuación de la inatención fue de 8,25, 8,4 y 7 antes del entrenamiento y de 6, 5,8, y 5,5 después de uno, dos y tres años. El promedio de la hiperactividad/impulsividad fue de 8,5, 8,4 y 7,75 antes del entrenamiento y de 5,75, 5,6 y 5,25 después de uno, dos y tres años, y el de las FE, de 5,2, 4,8 y 5,5 antes del entrenamiento y de 8,5, 10 y 9,5 después de uno, dos y tres años de entrenamiento. El grado de mejora de la inatención, de la hiperactividad/impulsividad y de las FE fue estadísticamente significativo con el entrenamiento de las FE durante uno, dos y tres años (p = 0,013, 0,002, 0,0249). Conclusiones. Los preescolares con TDAH-C y alteraciones de las FE deberían recibir entrenamiento de éstas durante, como mínimo, tres años desde el momento del diagnóstico para mejorar su condición (AU)

Introduction. School-age children with attention deficit hyperactivity disorder, combined type (ADHD-C) have executive function (EF) alterations. ADHD-C and EF alterations improve with methylphenidate or after training of working memory. Aim. To determine EF training effect on ADHD-C and EF alterations in preschoolers. Subjects and methods. Inclusion criteria: randomly assigned, 2-4 years old with ADHD-C, from 7-1-2004 to 6-30-2005, normal neurological examination, no evidences of underlying chronic disorders, no taking long term medications and parents agree to train or no EF daily. Parents filled out DSM-IV diagnostic criteria form for ADHD-C and children were tested with the Standard Dimensional Change Card Sort Task at the first visit and once a year from 1 to 3 years. Inattention, hyperactivity/impulsivity and EF average scores were statistically analyzed by the t Student for significance. Results. Of 25, 13 were trained. ADHD-C incidence went down to 16 (64%), 6 (24%) and 10 (40%) trained and untrained. Incidence was 50, 40 and 25% 100, and 66.66 y 100 after 1, 2 and 3 years with and without training. Inattention average score was 8.25, 8.4 and 7 before and 6, 5.8, and 5.5 before and after 1, 2 and 3 years of training. Hyperactivity/impulsivity average score was 8.5, 8.4 and 7.75 before and 5.75, 5.6, and 5.25 after 1, 2 and 3 years of training. EF average score was 5.2, 4.8, and 5.5 before and 8.5, 10 and 9.5 after 1, 2 and 3 years of training. Degree of improving of inattention, hyperactivity/impulsivity and EF were stadistically significant for training of EF for 1, 2 and 3 years (p = 0.013, 0.002, 0.0249). Conclusions. Children with preschool ADHD-C and EF disorders should receive training of EF for at least 3 years from age of diagnoses to improve their condition (AU)

La gestión del conocimiento en las organizaciones de información: procesos y métodos para medir / Knowledge management in the information organizations: measurement processes and methods

Se analizan los procesos estratégicos de la gestión del conocimiento específicamente en las organizaciones de información, con énfasis en el proceso de medición. Se identifican los métodos más importantes para medir el conocimiento. Se reflexiona sobre cuales pueden utilizarse en las organizaciones de información. A partir de criterios preestablecidos, se comenta una comparación realizada entre varias metodologías de medición, que muestra, en forma general, su aplicación en las organizaciones de información.

The strategic processes of knowledge management, specifically in the information organizations, are analyzed making emphasis on the process of measurement. The most important methods to measure knowledge are identified. Reflections are made on how they can be used in information organizations. Based on preestablished criteria, a comparison made among several measurement methodologies, which shows in a general way their application in the organizations of information, is commented.

La gestión del conocimiento en las organizaciones de información: procesos y métodos para medir / Knowledge management in the information organizations: measurement processes and methods

Se analizan los procesos estratégicos de la gestión del conocimiento específicamente en las organizaciones de información, con énfasis en el proceso de medición. Se identifican los métodos más importantes para medir el conocimiento. Se reflexiona sobre cuales pueden utilizarse en las organizaciones de información. A partir de criterios preestablecidos, se comenta una comparación realizada entre varias metodologías de medición, que muestra, en forma general, su aplicación en las organizaciones de información

The strategic processes of knowledge management, specifically in the information organizations, are analyzed making emphasis on the process of measurement. The most important methods to measure knowledge are identified. Reflections are made on how they can be used in information organizations. Based on preestablished criteria, a comparison made among several measurement methodologies, which shows in a general way their application in the organizations of information, is commented

[Treatment of herpes simplex encephalitis in children]. / Tratamiento de las encefalitis herpéticas en niños.

INTRODUCTION: Herpes simplex encephalitis (HSE) is a focal infectious disease of the central nervous system (CNS) acknowledged the world over as being severe. DEVELOPMENT: The epidemiology is well known in developed countries. It presents in patients over the age of 3 months. The mechanism by which the virus reactivates and penetrates into the CNS is still not fully understood. A timely diagnosis is crucial so that early treatment can be established within the first four days of the infectious process. By so doing, it becomes possible to raise the chances of survival by over 50%. The physician should have a strong suspicion when faced with a patient with symptoms of encephalitis, especially if he or she has focal neurological manifestations, including manifestations in the neuropsychiatric sphere. The non-invasive diagnostic method par excellence is high-sensitivity magnetic resonance imaging studies of the brain within the first 24-48 hours following the onset of the clinical signs and symptoms. Determination of viral DNA in cerebrospinal fluid by the polymerase chain reaction method is the technique with the highest degree of sensitivity and specificity available for carrying out the diagnosis. Effective treatment is intravenous acyclovir: 30 mg/kg/day in three doses. CONCLUSIONS: Encephalitis produced by the herpes virus is a disease that is dreaded because of the high mortality rate and the devastation it causes in the living conditions of survivors. Our aim is to stimulate the clinical suspicion of HSE so that pharmacological treatment can be established even while diagnostic tests are being carried out. We suggest early neuropsychological evaluation and follow-up of the manifestations of focal sequelae related to the frontotemporal regions.

[Cerebrovascular accidents in full-term newborn infants]. / Accidentes vasculares encefálicos en neonatos a término.

INTRODUCTION: The purpose of this paper is to review the role of the neurologist in the management of cerebrovascular accidents (CVA) (insults resulting from a sudden obstruction or rupture of an intracranial vessel). This was accomplished by reviewing the literature (PubMed) under the heading of stroke and term neonate. DEVELOPMENT: CVA in full-term neonates are classified as hematomas and infarcts. Hematomas are classified according to: location, structure (arterial, venous, or sinus), type of malformation (aneurysm, venous malformation, and telangiectasia), and cause of the bleed (vessel wall rupture or hypo-coagulation). Classification according to location is based on compartment supra or infratentorial; space -extra-axial (epidural, subdural, or subarachnoid) or intra-axial (parenchymal or ventricular)-; and region -parietal, temporal, thalamic, etc.-. Infarcts are classified according to vascular and parenchymal factors. The vascular factors are the structure, the cause of the obstruction -extramural, mural or intramural (thrombus or embolus)-. The parenchymal factors are type of damage (pale vs hemorrhagic) and location. Patients with suspected embolism should have ultrasound neck. Coagulation studies should be done in patients with hematomas and infracts. Multiple causes may be present in each case. Anticoagulation is only used in small pale infarcts of cardiac embolic origin. CONCLUSION: The neurologist roles in the management of CVA are to classify the event, select the appropriate investigation, and implement treatment.

[Executive function disorders]. / Trastornos de las funciones ejecutivas.

AIM: To review the development, anatomy and physiology of executive functions (EF) in normal and pathological conditions. DEVELOPMENT: EF consist of several internal mental process design to solve mental and environmental complex problems in an efficient and acceptable way to the person and the society. EF include inhibition of behavior and irrelevant information, nonverbal working memory, verbal working memory, self-regulation of affect, motivation and arousal, planning, decision making, self monitoring of the entire solving problem process and self evaluation of the results of the action taken. The anatomical substrate is at the prefrontal lobe cortex and its afferent and efferent structures. Neurotransmitters involved in activation of neurons at the prefrontal cortex are dopamine and norepinephrine and in less degree acetylcholine and serotonine. CONCLUSIONS: Disorders of one or more of the EF in children and adolescents are found in attention deficit/hyperactivity disorder, Tourette syndrome, bipolar disease, depression, obsessive-compulsive disorders, autism and traumatic brain injury.

Accidentes vasculares encefálicos en neonatos a término / Cerebrovascular accidents in full-term newborn infants

Introducción. El propósito de este artículo es revisar elpapel del neurólogo en el manejo de los recién nacidos a términocon accidentes vasculares encefálicos (AVE) (lesiones debidas auna súbita obstrucción o ruptura de un vaso intracraneal). Coneste fin se revisaron las fuentes bibliográficas (PubMed) mediantela búsqueda de los términos ‘stroke’ y ‘term neonate’. Desarrollo.Los AVE se dividen en hematomas e infartos. Los hematomas debenclasificarse de acuerdo con su localización; estructura vascularenvuelta (arteria, vena o seno), el tipo de anomalía vascular (aneurisma,malformaciones venosas, telangiectasia) y la causa de laextravasación de la sangre (ruptura de la pared vascular o hipocoagulación).La clasificación de acuerdo con la localización incluye:compartimentos (supra e infratentoriales), espacios –extraaxial(epidural, subdural o aracnoideo) o intraaxial (parénquima oventrículos)– y regiones –parietal, temporal, talámica, etc.–. Losinfartos se clasifican de acuerdo con factores vasculares y parenquimatosos;los factores vasculares son el tipo de estructura vascularenvuelta, causa de la obstrucción –extramural, mural o intramural(émbolo o trombo)–; los factores parenquimatosos son el tipode infarto –pálido o hemorrágico– y la localización de éste. Lospacientes con procesos embólicos requieren ecografía del corazóny del cuello. La posibilidad de causas múltiples debe sospecharse.Se deben realizar estudios de coagulación. La cirugía puede sernecesaria en determinados casos. En pacientes con cardioembolismose sugiere la anticoagulación en infartos pálidos y pequeños.Conclusión. La función del neurólogo en estos pacientes consisteen clasificar el evento, guiar las investigaciones y decidir el tratamiento

Introduction. The purpose of this paper is to review the role of the neurologist in the management of cerebrovascularaccidents (CVA) (insults resulting from a sudden obstruction or rupture of an intracranial vessel). This was accomplished byreviewing the literature (PubMed) under the heading of stroke and term neonate. Development. CVA in full-term neonates areclassified as hematomas and infarcts. Hematomas are classified according to: location, structure (arterial, venous, or sinus), typeof malformation (aneurysm, venous malformation, and telangiectasia), and cause of the bleed (vessel wall rupture or hypocoagulation).Classification according to location is based on compartment supra or infratentorial; space –extra-axial (epidural,subdural, or subarachnoid) or intra-axial (parenchymal or ventricular)–; and region –parietal, temporal, thalamic, etc.–.Infarcts are classified according to vascular and parenchymal factors. The vascular factors are the structure, the cause of theobstruction –extramural, mural or intramural (thrombus or embolus)–. The parenchymal factors are type of damage (pale vshemorrhagic) and location. Patients with suspected embolism should have ultrasound neck. Coagulation studies should be donein patients with hematomas and infracts. Multiple causes may be present in each case. Anticoagulation is only used in small paleinfarcts of cardiac embolic origin. Conclusion. The neurologist roles in the management of CVA are to classify the event, selectthe appropriate investigation, and implement treatment

Trastornos de las funciones ejecutivas / Executive function disorders

Objetivo. Revisar el desarrollo, la anatomía y la fisiologíade las funciones ejecutivas (FE) en condiciones normales y patológicas.Desarrollo. Las FE consisten en varios procesos mentalesdiseñados para resolver problemas mentales y medioambientalescomplejos con eficiencia y el beneplácito de la persona y lasociedad. Las FE incluyen inhibición de la conducta y la informaciónirrelevante, memoria de trabajo no verbal, memoria de trabajoverbal, autorregulación de las emociones, motivaciones y gradode alerta, planeamiento, tomar decisiones, automonitorización delproceso y autoevaluación de los resultados de la acción tomada.Las estructuras anatómicas involucradas incluyen la corteza prefrontaly sus áreas aferentes y eferentes. Los neurotransmisoresimplicados son la dopamina y la norepinefrina y, en menor grado,la acetilcolina y la serotonina. Conclusiones. Se han encontradoalteraciones de una o varias de las FE en niños y adolescentes contrastorno por déficit de atención e hiperactividad, síndrome deTourette, enfermedad bipolar, depresión, trastorno obsesivo-compulsivo,autismo y postraumatismo cerebral

Aim. To review the development, anatomy and physiology of executive functions (EF) in normal and pathologicalconditions. Development. EF consist of several internal mental process design to solve mental and environmental complexproblems in an efficient and acceptable way to the person and the society. EF include inhibition of behavior and irrelevantinformation, nonverbal working memory, verbal working memory, self-regulation of affect, motivation and arousal, planning,decision making, self monitoring of the entire solving problem process and self evaluation of the results of the action taken.The anatomical substrate is at the prefrontal lobe cortex and its afferent and efferent structures. Neurotransmitters involved inactivation of neurons at the prefrontal cortex are dopamine and norepinephrine and in less degree acetylcholine and serotonine.Conclusions. Disorders of one or more of the EF in children and adolescents are found in attention deficit/hyperactivitydisorder, Tourette syndrome, bipolar disease, depression, obsessive-compulsive disorders, autism and traumatic brain injury