Documento de consenso para la monitorización neurofisiológica intraoperatoria multimodal en procedimientos neuroquirúrgicos. Fundamentos básicos / Consensus document for multimodal intraoperatory neurophisiological monitoring in neurosurgical procedures. Basic fundamentals

El presente trabajo pretende establecer una guía de actuación consensuada entre anestesiólogos y neurofisiólogos para realizar una monitorización neurofisiológica intraoperatoria efectiva en procedimientos tanto neuroquirúrgicos, como en aquellos en los que existe un riesgo de lesión neurológica funcional. En la primera parte, se describen las principales técnicas utilizadas en la actualidad para la monitorización neurofisiológica intraoperatoria. En segundo lugar, se describen los factores anestésicos y no anestésicos que pueden afectar al registro eléctrico de las estructuras del sistema nervioso. Posteriormente, se analizan los efectos adversos de las técnicas más comunes derivados de su utilización. Y, por último, se describen las diferentes pautas a seguir tras la aparición de los diferentes eventos clínicos intraoperatorios.(AU)

The present work aims to establish a guide to action, agreed by anaesthesiologists and neurophysiologists alike, to perform effective intraoperative neurophysiological monitoring for procedures presenting a risk of functional neurological injury, and neurosurgical procedures. The first section discusses the main techniques currently used for intraoperative neurophysiological monitoring. The second exposes the anaesthetic and non-anaesthetic factors that are likely to affect the electrical records of the nervous system structures. This section is followed by an analysis detailing the adverse effects associated with the most common techniques and their use. Finally, the last section describes a series of guidelines to be followed upon the various intraoperative clinical events.(AU)

Consensus document for multimodal intraoperatory neurophisiological monitoring in neurosurgical procedures. Basic fundamentals. / Documento de consenso para la monitorización neurofisiológica intraoperatoria multimodal en procedimientos neuroquirúrgicos. Fundamentos básicos.

The present work aims to establish a guide to action, agreed by anaesthesiologists and neurophysiologists alike, to perform effective intraoperative neurophysiological monitoring for procedures presenting a risk of functional neurological injury, and neurosurgical procedures. The first section discusses the main techniques currently used for intraoperative neurophysiological monitoring. The second exposes the anaesthetic and non-anaesthetic factors that are likely to affect the electrical records of the nervous system structures. This section is followed by an analysis detailing the adverse effects associated with the most common techniques and their use. Finally, the last section describes a series of guidelines to be followed upon the various intraoperative clinical events.

Fractura de fémur en un recién nacido: cuando la radiografía no es diagnóstica / Congenital femur fracture: when the radiograph undiagnosed

Se presenta el caso de un recién nacido con una fractura de fémur asociada al nacimiento. Aparte de la escasa incidencia de estas fracturas, se demuestra la importancia de la ecografía para el diagnóstico de estas lesiones óseas en algunos casos (AU)

The case of a newborn with a femur fracture associated with the birth is presented. Apart from the low incidence of these fractures, it stresses the importance of ultrasonography in the diagnosis of some of these bone lesions (AU)

Adecuación del manejo diagnóstico del traumatismo craneoencefálico leve en menores de 24 meses a las guías de práctica clínica de PECARN y AEP / Compliance with the PECARN and AEP guidelines in diagnostic approach of mild head trauma in patients younger than 24 months old

INTRODUCCIÓN: El traumatismo craneoencefálico leve es una causa común de atención en Urgencias Pediátricas. En los últimos años se han publicado diversos protocolos y guías de manejo de estos pacientes, pero aún existe una amplia variabilidad, especialmente en lo que a la realización de pruebas de imagen se refiere. El objetivo de este estudio es analizar el grado de concordancia del manejo de los pacientes menores de 24 meses a la guía clínica de la PECARN y al protocolo de la AEP en 4 centros diferentes. PACIENTES Y MÉTODOS: Estudio retrospectivo multicéntrico en el que se analiza a pacientes atendidos por traumatismo craneoencefálico leve entre el 1 de octubre del 2011 y el 31 de marzo del 2013 en los Servicios de Urgencias de 4 hospitales. RESULTADOS: Al analizar la concordancia del manejo de los pacientes con el protocolo de la AEP vemos que tan solo uno de los centros supera el 50% de los pacientes con un manejo acorde con el mismo. Los otros 3 centros mostraron un grado de concordancia inferior a esta cifra. El manejo sí es más adecuado para los estándares de las guías clínicas de PECARN, superando 3 de los centros el 50%, aunque el hospital con mejores cifras presentó un 70% solamente. CONCLUSIONES: Nuestro estudio muestra que la concordancia con las recomendaciones de las guías clínicas en el manejo del traumatismo craneoencefálico leve en los menores de 2 años es, en general, baja

INTRODUCTION: Mild head trauma is a frequent complaint in Pediatric Emergency Departments. Several guidelines have been published in the last few years. However, significant variability can be appreciated in terms of the demand for image tests. The aim of this study is to determine the level of compliance with PECARN and AEP guidelines in the management of patients younger than 24 months old in four different hospitals. PATIENTS AND METHODS: A multicenter retrospective study was conducted on patients presenting with mild head trauma between October 1st, 2011 and March 31st, 2013 in the Emergency Departments of four hospitals. RESULTS: In the analysis of the results obtained, only one of the four hospitals complied with the AEP guidelines in more than 50% of the patients. The other three hospitals had a level of compliance lower than 50%. Management was more suitable according to PECARN guidelines, with 3 of the 4 hospitals having a level of compliance greater than 50%. However, the best compliance achieved by a hospital was only of 70%. CONCLUSIONS: The study shows that the level of compliance with guidelines for management of mild head trauma in patients younger than 24 months old is low

[Compliance with the PECARN and AEP guidelines in diagnostic approach of mild head trauma in patients younger than 24 months old]. / Adecuación del manejo diagnóstico del traumatismo craneoencefálico leve en menores de 24 meses a las guías de práctica clínica de PECARN y AEP.

INTRODUCTION: Mild head trauma is a frequent complaint in Pediatric Emergency Departments. Several guidelines have been published in the last few years. However, significant variability can be appreciated in terms of the demand for image tests. The aim of this study is to determine the level of compliance with PECARN and AEP guidelines in the management of patients younger than 24 months old in four different hospitals. PATIENTS AND METHODS: A multicenter retrospective study was conducted on patients presenting with mild head trauma between October 1st, 2011 and March 31st, 2013 in the Emergency Departments of four hospitals. RESULTS: In the analysis of the results obtained, only one of the four hospitals complied with the AEP guidelines in more than 50% of the patients. The other three hospitals had a level of compliance lower than 50%. Management was more suitable according to PECARN guidelines, with 3 of the 4 hospitals having a level of compliance greater than 50%. However, the best compliance achieved by a hospital was only of 70%. CONCLUSIONS: The study shows that the level of compliance with guidelines for management of mild head trauma in patients younger than 24 months old is low.

Aneurisma de la arteria gastroduodenal: tratamiento mediante embolización selectiva / An aneurysm for the gastroduodenal artery: its treatment via selective embolization

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[Percutaneous endoscopic feeding gastrostomy. Initial experience with 6 cases]. / Gastrostomía endoscópica percutánea de alimentación. Experiencia inicial en seis casos.

Over the past two years we have performed percutaneous endoscopic feeding gastrostomy (PEFG) in 5 patients, 4 males and 1 female, aged 42 to 89. All of them suffered from either incurable or severe illness which prevented their oral feeding. PEFG was performed following the method described by Gauderer and Ponsky or traction method. Only in one case it was difficult to perform and in another case a second PEFG was needed because of unintentional catheter extraction. PEFG allowed an adequate feeding in all of the patients until their death due to underlying disorder or to other causes during the follow-up period. The complications found included ascites infection in a patient with cirrhosis and pneumoperitoneum which resolved spontaneously in another case. No mortality was observed related to the procedure.

Infected intraabdominal hematomas: percutaneous drainage.

Percutaneous drainage of infected intraabdominal hematomas has often been contraindicated due to its greater number of complications. The results of percutaneous drainage of infected localized hematomas in five cases are described, two in the lesser sac and three in the right subphrenic space. The catheter size ranged from 8.4 to 24 French. Mean maintenance time of the drainage was 37 days. Drainage tube obstruction occurred in three patients, in two of whom the drainage tube had to be changed for one with a broader gauge. Hematomas were completely resolved in all the cases. We describe our experience with one patient in whom we used intracavitary urokinase who showed successful results. Percutaneous drainage is not contraindicated in the management of infected hematomas, although the drainage tube must be closely controlled; drainage time may be longer than in other types of abscesses.