[Detection of episodes of ischemic tissue hypoxia by means of the combined intraoperative neurophysiologic monitoring with the tissue oxygenation monitoring in aneurysm surgery]. / Detección de episodios de hipoxia tisular isquémica mediante la monitorizaciónneurofisiológica intraoperatoria combinada con la monitorización de la oxigenacióntisular en la cirugía aneurismática.

INTRODUCTION: Intraoperative neuromonitoring in aneurysm surgery can be very useful to determine inadequate positions of the vascular clip that cause partial or complete compromise of the cerebral sanguineous flow in the vascular territories irrigated by the arteries related to aneurysm. The direct visualization of these arteries after the application of the surgical clip can be insufficient in detecting this potentially detrimental situation. Knowing this circumstance on the onset would allow the neurosurgeon to correct it and to avoid, therefore, cerebral ischemic tissue hypoxia. We show the utility of the intraoperative monitoring of the oxygen tissue pressure (PtiO2) and the somatosensorial evoked potential (SSEP) for the detection of these situations with the example of a clinical case. CLINICAL CASE: We present the case of a 62 year-old woman, that presented with subarachnoid hemorrhage of aneurysmal origin. The cerebral arteriography demonstrated the existence of an aneurysm of the posterior communicating artery that was treated initially by endovascular procedure with partial exclusion of the aneurysm. For this reason it was decided to complete the treatment with a programmed surgery. The patient was put on an intraoperative monitoring system with a PtiO2 sensor located in the risk area and with SSEP. After positioning the surgical clip the partial oxygen pressure decreased rapidly, as well as the amplitude of the cortical potential of the left posterior tibial nerve. The knowledge of this situation allowed the detection of a trapped posterior communicating artery. After correcting this situation by replacing the surgical clip, both variables recovered to their basal values. CONCLUSIONS: The intraoperative PtiO2 monitoring, combined with neurophysiologic monitoring during aneurysm surgery offers a fast and trustworthy form of early detection of ischemic phenomena caused by bad positioning of the surgical clip.

Guía de manejo clínico de la artrosis de cadera y rodilla / Guide for the clinical management of osteoarthritis of the hip and the knee

Las guías de práctica clínica son importantes a la horade tomar decisiones basadas en la evidencia y centradasen el paciente, no debiéndose interpretar como mandatosrígidos sino como recomendaciones basadas en estudiosde efectividad clínica, siendo el médico quien está en lamejor situación a la hora de decidir entre las distintasaproximaciones terapéuticas para cada uno de sus pacientes.Estas guías surgen de la revisión actualizada de la literaturamédica en combinación con la opinión de los expertosen la materia.Recientemente han sido publicadas varias guías para elmanejo de la artrosis de cadera y rodilla con el objeto deayudar al clínico en el tratamiento de pacientes con tal patología;a pesar de basarse en una misma evidencia, existenpuntos discrepantes en las recomendaciones hechaspor distintos grupos de trabajo.El objetivo de este trabajo es revisar el manejo clínicoactual de la artrosis de cadera y rodilla así como identificarel abordaje óptimo de la misma en función de la medicinabasada en la evidencia

Guides of clinical practice can help to take evidencebasedand patient-focused decisions. However, these mustnot be understood as strict rules, but as recommendationsbased on clinical effectiveness studies. The physician is inthe best position to decide between the different therapeuticoptions available for each individual patient.These guides are based on the updated review of themedical literature, combined with the opinion of experts inthe relevant field.Different guides have been published recently for themanagement of osteoarthritis of the hip and the knee thathelp the physician to decide the best treatment for the patientswith such condition. Despite being based on thesame evidences, recommendations issued by different workgroups are in disagreement.This work has aimed to review the current clinical managementof osteoarthritis of the hip and the knee, as wellas to identify its optimum approach according to the evidence-based medicine