Risk factors related to adjacent segment degeneration: retrospective observational cohort study and survivorship analysis of adjacent unfused segments.

OBJECT: Adjacent segment disease (ASD) has been described as a frequent complication after a lumbar spinal fusion procedure, though its incidence and the factors related to its appearance are not well established. The radiographic signs that identify ASD in unfused segments may be a consequence of biomechanical changes induced by the fusion procedure. This study sought to analyse the incidence of radiographic changes (radiographic ASD) in all adjacent unfused segments, the clinical changes that require a second procedure (clinical ASD), and the risk factors of their appearance evaluated at different follow-up times. METHODS: We conducted a retrospective cohort study of patients fused for degenerative spine disease and instability to analyse ASD risk factors using actuarial estimation, comparison of the Kaplan-Meier survival curves of each variable, and Cox proportional-hazards regression analysis. RESULTS: Among the 263 patients included in the study, radiographic changes were observed in 57.4% and related clinical changes in 20.2%. The univariate analysis showed a higher risk of ASD in patients with smaller post- vs. pre-operative lumbar lordosis (p = .018), diagnosis of lumbar canal stenosis (p = .019), fusion of three or more vs. fewer levels (p = .009) and those fixed with top-loading screws vs. side-connecting screws (p = .001). Cox proportional-hazards regression analysis showed that the use of top-loading pedicle screws and three or more levels of fusion led to a 3- and 2-fold higher risk of degeneration in adjacent unfused segments respectively. CONCLUSIONS: Risk of a second surgical procedure due to clinical changes is 3-fold higher in patients with three or more levels of fusion, and 2.5-fold higher in patients intervened with top-loading pedicle screws.

Isolation and first total synthesis of PM050489 and PM060184, two new marine anticancer compounds.

Microtubules continue to be one of the most successful anticancer drug targets and a favorite hit for many naturally occurring molecules. While two of the most successful representative agents in clinical use, the taxanes and the vinca alkaloids, come from terrestrial sources, the sea has also proven to be a rich source of new tubulin-binding molecules. We describe herein the first isolation, structural elucidation and total synthesis of two totally new polyketides isolated from the Madagascan sponge Lithoplocamia lithistoides . Both PM050489 and PM060184 show antimitotic properties in human tumor cells lines at subnanomolar concentrations and display a distinct inhibition mechanism on microtubules. The development of an efficient synthetic procedure has solved the supply problem and, following pharmaceutical development, has allowed PM060184 to start clinical studies as a promising new drug for cancer treatment.

Synthesis of 3,4-Dihydropyrimidin(thio)one Containing Scaffold: Biginelli-like Reactions.

The interest in 3,4-dihydropyrimidine-2(1H)-(thio)ones is increasing every day, mainly due to their paramount biological relevance. The Biginelli reaction is the classical approach to reaching these scaffolds, although the product diversity suffers from some limitations. In order to overcome these restrictions, two main approaches have been devised. The first one involves the modification of the conventional components of the Biginelli reaction and the second one refers to the postmodification of the Biginelli products. Both strategies have been extensively revised in this manuscript. Regarding the first one, initially, the modification of one of the components was covered. Although examples of modifications of the three of them were described, by far the modification of the keto ester counterpart was the most popular approach, and a wide variety of different enolizable carbonylic compounds were used; moreover, changes in two or the three components were also described, broadening the substitution of the final dihydropyrimidines. Together with these modifications, the use of Biginelli adducts as a starting point for further modification was also a very useful strategy to decorate the final heterocyclic structure.

Didactic platform for DC motor speed and position control in Z-plane.

This paper describes how to implement a low-cost didactic platform designed to teach or reinforce discrete control theory concepts. The controllers used in this work (P, PI, PD, and PID) are suitable for undergraduate students but the same platform could be used to explain and test advanced controllers to graduate students. This document shows, step by step, how to control a DC motor speed and position, along with the most common problems and its solutions, commonly overlooked in the literature. It also explains how to simulate the system behavior and compares the simulations with the real data, showing an average correlation coefficient of ρ=0.983.

Bridges of biomaterials promote nigrostriatal pathway regeneration.

Repair of central nervous system (CNS) lesions is difficulted by the lack of ability of central axons to regrow, and the blocking by the brain astrocytes to axonal entry. We hypothesized that by using bridges made of porous biomaterial and permissive olfactory ensheathing glia (OEG), we could provide a scaffold to permit restoration of white matter tracts. We implanted porous polycaprolactone (PCL) bridges between the substantia nigra and the striatum in rats, both with and without OEG. We compared the number of tyrosine-hydroxylase positive (TH+) fibers crossing the striatal-graft interface, and the astrocytic and microglial reaction around the grafts, between animals grafted with and without OEG. Although TH+ fibers were found inside the grafts made of PCL alone, there was a greater fiber density inside the graft and at the striatal-graft interface when OEG was cografted. Also, there was less astrocytic and microglial reaction in those animals. These results show that these PCL grafts are able to promote axonal growth along the nigrostriatal pathway, and that cografting of OEG markedly enhances axonal entry inside the grafts, growth within them, and re-entry of axons into the CNS. These results may have implications in the treatment of diseases such as Parkinson's and others associated with lesions of central white matter tracts. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 107B: 190-196, 2019.

11PS04 is a new chemical entity identified by microRNA-based biosensing with promising therapeutic potential against cancer stem cells.

Phenotypic drug discovery must take advantage of the large amount of clinical data currently available. In this sense, the impact of microRNAs (miRs) on human disease and clinical therapeutic responses is becoming increasingly well documented. Accordingly, it might be possible to use miR-based signatures as phenotypic read-outs of pathological status, for example in cancer. Here, we propose to use the information accumulating regarding the biology of miRs from clinical research in the preclinical arena, adapting it to the use of miR biosensors in the earliest steps of drug screening. Thus, we have used an amperometric dual magnetosensor capable of monitoring a miR-21/miR-205 signature to screen for new drugs that restore these miRs to non-tumorigenic levels in cell models of breast cancer and glioblastoma. In this way we have been able to identify a new chemical entity, 11PS04 ((3aR,7aS)-2-(3-propoxyphenyl)-7,7a-dihydro-3aH-pyrano[3,4-d]oxazol-6(4H)-one), the therapeutic potential of which was suggested in mechanistic assays of disease models, including 3D cell culture (oncospheres) and xenografts. These assays highlighted the potential of this compound to attack cancer stem cells, reducing the growth of breast and glioblastoma tumors in vivo. These data demonstrate the enhanced chain of translatability of this strategy, opening up new perspectives for drug-discovery pipelines and highlighting the potential of miR-based electro-analytical sensors as efficient tools in modern drug discovery.

La aplicación WhatsApp como herramienta de aprendizaje en la enseñanza médica / WhatsApp application as a learning tool in medical teaching

Introducción: La función del tutor en la educación médica virtual deja de ser la de un transmisor de conocimiento a un facilitador del aprendizaje. La aplicación WhatsApp es uno de los recursos que se utiliza para este fin. Objetivo: Describir los resultados del uso de la aplicación informática WhatsApp como herramienta de interacción educativa en el servicio de Anestesiología del Hospital Universitario "Manuel Ascunce Domenech". Métodos: Estudio observacional, descriptivo y transversal para determinar la utilidad de WhatsApp, como herramienta de comunicación entre el tutor y un grupo de alumnos de la Especialidad de Anestesiología y Reanimación, desde junio del año 2020 hasta junio del año 2021. La población fue de 40 estudiantes y la muestra de 15, los cuales cumplieron los criterios de inclusión. Se realizó comunicación docente semanal o a demanda del alumno, sin horario fijo, mediante WhatsApp. Al año se aplicó un cuestionario basado en los objetivos de la investigación. Resultados: Todos los alumnos tenían menos de 30 años, pero predominaron las edades entre 23-26 años (60 por ciento), el sexo femenino representó el 66,66 por ciento de los participantes, el 73,33 por ciento estableció conexión mediante un teléfono inteligente, las principales ventajas referidas fueron la inmediatez (93,33 por ciento), el vínculo con el tutor y distanciamiento físico (86,66 por ciento), y la privacidad (80 por ciento). Las principales desventajas fueron: alto costo de conectividad (100 por ciento), pantalla pequeña para leer (46,66 por ciento), horario inapropiado (40 por ciento). La mayoría reportó alto grado de satisfacción (86,66 por ciento). Conclusiones: El uso de WhatsApp ofrece múltiples ventajas para la relación entre el tutor y los estudiantes, y propicia un desenlace exitoso en el proceso de aprendizaje(AU)

Introduction: The role of the tutor in virtual medical education seems to be that of a transmitter of knowledge to a facilitator of learning. WhatsApp application is one of the resources that is used for this purpose. Objective: Describe the results of the use of WhatsApp application for computers as a tool for educational interaction in the Anesthesiology Service of "Manuel Ascunce Domenech" University Hospital. Methods: Observational, descriptive and cross-sectional study to determine the usefulness of WhatsApp, as a communication tool between the tutor and a group of students of the Specialty of Anesthesiology and Resuscitation, from June 2020 to June 2021. The population was of 40 students and the sample was of 15, who met the inclusion criteria. Weekly teaching communication was carried out or at the request of the student, without a fixed schedule, through WhatsApp. A questionnaire based on the objectives of the research was applied after one year. Results: All students were under 30 years of age, but the ages between 23-26 years (60 percent) predominated, the female sex represented 66.66 percent of the participants, 73.33 percent established a connection through a smartphone, the main advantages referred to were: immediacy (93.33 percent), the link with the tutor and physical distancing (86.66 percent), and privacy (80 percent). The main disadvantages were: high cost of connectivity (100 percent), small screen to read (46.66 percent), inappropriate hours (40 percent). The majority reported a high degree of satisfaction (86.66 percent). Conclusions: The use of WhatsApp offers multiple advantages for the relationship between the tutor and the students, and promotes a successful outcome in the learning process(AU)

Ossifying fibroma of long bones in adults: a case report.

Ossifying fibroma (osteofibrous dysplasia) is a rare fibro-osseous lesion made up of fibrous tissue with woven bone formation. It is most commonly found in the tibia and fibula of children ten years of age or younger. The most important differential diagnosis is monostotic fibrous dysplasia, which is radiologically similar but without woven bone rimmed by active osteoblasts like ossifying fibroma on histological examination. No epitheloid cells are found as in adamantinoma. We report the case of a 45-year-old woman who had a 12-month history of pain and slight swelling. Radiographs showed a multilocular radiolucent lesion with sclerotic rim in the proximal tibia. The lesion was curetted and the defect was packed with bone graft and acrylic cement. Microscopic examination showed active osteoblasts rimming the irregulary woven bone. One-year follow-up showed good functional recovery without recurrence of the lesion.

Incidence and significance of clinically unsuspected thyroid tissue in lymph nodes found during neck dissection in head and neck carcinoma patients.

OBJECTIVES/HYPOTHESIS: The objectives were to quantify the incidence of clinically unsuspected thyroid tissue in cervical lymph nodes encountered during neck dissection in patients with head and neck carcinoma, to describe the location and histological aspect of these inclusions, and to assess their clinical significance. STUDY DESIGN: Retrospective study. METHODS: The histological records of 1123 neck dissections in 752 patients with head and neck carcinoma were reviewed. In cases with thyroid inclusions, the pathological diagnosis was reviewed and an immunohistochemical study against thyroglobulin and calcitonin was carried out. RESULTS: Clinically unsuspected thyroid tissue was found in lymph nodes in 11 of the 752 patients with head and neck carcinoma treated with neck dissection. In five cases, the thyroid inclusion was compatible with a metastases of an occult papillary thyroid carcinoma. In the other six cases, a collection of thyroid follicles without malignant characteristics was found beneath the lymph node capsule. These latter cases were considered benign thyroid inclusions. A thyroidectomy was performed in three of the patients with lymph node metastases of the papillary carcinoma. An occult papillary carcinoma was found in only one case. The other two patients had been treated previously with radiotherapy for an early-stage glottic carcinoma. Immunohistochemical study did not find calcitonin-positive cells within the benign thyroid inclusions. After a follow-up period ranging from 1.2 to 8.2 years, no patient had any kind of local, regional, or distant relapse related to the thyroid disease. CONCLUSION: The incidence of unsuspected thyroid tissue in lymph nodes of patients with head and neck carcinoma treated with neck dissection was 1.5%. Both lymph node metastases of a papillary carcinoma and benign thyroid inclusions were found. The study results suggest that the incidental finding of thyroid tissue in the lymph nodes during a neck dissection in patients with head and neck carcinoma does not necessarily indicate the need for aggressive therapy.

Standardized approach for microsatellite instability detection in gastric carcinomas.

Microsatellite instability (MSI) defines a specific type of genetic instability. Although consensus diagnostic criteria for MSI definition in colorectal cancer have been established, their utility in other tumor types remain to be proven. Previously we developed a mathematical model for MSI definition in colorectal cancer. The aim of this study was to establish diagnostic criteria for MSI evaluation in human gastric cancer. We designed an algorithm for the efficient characterization of MSI and used it to analyze data on 7 microsatellite markers in 35 gastric carcinomas. Theoretical models considering 1, 2, or 3 populations were tested against the data collected. Also, hypermethylation of hMLH1 gene promoter and hMLH1 protein expression were studied. The observed frequencies of MSI in our series of samples best fit a 2-population model: stable and unstable, defined by instability in 2 or more of a minimum of 7 markers analyzed. MSI was observed in 29% of the tumors. Misclassification rate was <4% when any 7 loci were analyzed. MSI(+) tumors inversely associated with p53 protein overexpression. A good correlation between hMLH1 status (either protein or promoter hypermethylation) and MSI classification was observed. We have developed a simple, sensitive, and specific approach to assess the presence of MSI in gastric cancer that may have clinical applications.

Evaluación del sulfato de magnesio en el tratamiento del broncoespasmo / Assessment of magnesium sulfate in bronchospasm treatment

Introducción: Una de las urgencias más temidas durante la instrumentación de la vía respiratoria es el broncoespasmo. El sulfato de magnesio, administrado por vía endovenosa, tiene un efecto broncodilatador al antagonizar los canales del calcio, inhibir la contracción muscular mediada por el calcio y favorecer la relajación del músculo liso bronquial. Objetivo: Evaluar la eficacia del sulfato de magnesio endovenoso en pacientes con broncoespasmo durante broncoscopias. Métodos: Estudio observacional, descriptivo y transversal en 20 pacientes, con broncoespasmo, desencadenado por manipulación de la vía respiratoria con broncoscopio flexible, tratados con sulfato de magnesio 50 mg/kg, (máximo 2 g), por vía endovenosa durante 5 min. Resultados: Predominaron los hombres entre 50-59 años (75 por ciento), todos los pacientes eran fumadores, 15 pacientes fueron clasificados como estado físico ASA III. Sufrieron broncoespasmo de intensidad moderada 60 por ciento, clasificado según la clínica y monitorización de SpO2. En 75 por ciento de los pacientes cedió el broncoespasmo tras el tratamiento sin administrar otro medicamento. No se registraron efectos adversos. Ningún paciente necesitó intubación orotraqueal para ventilación ni requirió hospitalización por más de 8 h. Conclusiones: El sulfato de magnesio es una buena opción farmacológica para el tratamiento de urgencia del broncoespasmo desencadenado por manipulación de la vía respiratoria(AU)

Introduction: One of the most feared emergencies during the instrumentation of the respiratory tract is bronchospasm. Magnesium sulfate, administered intravenously, has a bronchodilation effect by antagonizing calcium channels, inhibiting muscle contraction mediated by calcium and promoting bronchial smooth muscle relaxation. Objective: To evaluate the efficacy of magnesium sulfate administered intravenously in patients with bronchospasm during bronchoscopy. Methods: Observational, descriptive and cross-sectional study carried out with 20 patients, with bronchospasm, triggered by airway manipulation with flexible bronchoscope, treated with 50 mg/kg of magnesium sulfate, (maximum 2 g), administered intravenously for 5 min. Results: Men between 50-59 years (75 percent) predominated. All patients were smokers. 15 patients were classified with physical state ASA III. They suffered bronchospasm of mild intensity 60 percent, classified according to the clinic and monitoring of oxygen saturation. In 75 percent of the patients, the bronchospasm ceased after the treatment without administering any other medication. No adverse effects were recorded. No patient needed orotracheal intubation for ventilation or required hospitalization for more than 8 hours. Conclusions: Magnesium sulfate is a good pharmacological option for the emergency treatment of bronchospasm triggered by manipulation of the respiratory tract(AU)

Olfactory ensheathing glia enhances reentry of axons into the brain from peripheral nerve grafts bridging the substantia nigra with the striatum.

Reconstruction of lost axonal pathways in the central nervous system (CNS) is possible with the use of peripheral nerve grafts (PNG). However, these permit the entry of axons, while their reentry back into the CNS is compromised. Olfactory ensheathing glia (OEG) may permit this reentry of axons if cografted with PNG. We compared the number of tyrosine-hydroxylase positive (TH+) fibers reinnervating PNGs and crossing the graft-striatum interface in PNG placed between the substantia nigra and the striatum in rats receiving both PNG and OEGs and animals receiving PNG only. More TH fibers were seen inside the grafts when OEG was cografted. Although the number of fibers decreases along the graft's length, this effect is less severe when OEG is present. TH+ fibers are seen crossing the PNG-striatum interface in the OEG group. This is correlated with a higher synaptic density at the striatum near the graft when OEG is co-grafted. While these results must be replicated in animal models of Parkinsonism, their implications may apply both to the treatment of Parkinson's disease and to other pathologies, such as spinal cord lesions, where regeneration of long axonal pathways is necessary.

[Head and neck sarcomas. Our experience]. / Sarcomas de cabeza y cuello. Nuestra experiencia.

INTRODUCTION: Head and neck sarcomas are a heterogeneous group of malignant tumours that vary greatly in clinical presentation, with different histopathological and biological characteristics. MATERIAL AND METHODS: This was a retrospective study of patients with sarcoma located in the head and neck treated in our centre over a period of 25 years. RESULTS: During the study period, a total of 25 patients were diagnosed with sarcomas in the head and neck, accounting for 0.5% of all malignancies at this level. The most common treatments included surgical resection of the tumour, often supplemented with radiotherapy and/or adjuvant chemotherapy. The final local control, including the salvage, was 52%, with an adjusted survival of 51% at 5 years and 32% at 12 years. CONCLUSIONS: Surgical treatment of patients with head and neck sarcomas achieves acceptable results of local control and survival.

Lesion de Monteggia equivalente de presentacion tardia en una nina de 6 anos. A proposito de un caso / Late equivalent Monteggia injury in a 6-year-old girl: a case report

Las lesiones de Monteggia en los niños pueden pasar desapercibidas con facilidad, sobre todo, las variantes equivalentes. Es importante su diagnóstico y tratamiento precoces para evitar una cronificación de la lesión y, por lo tanto, una secuela funcional y cosmética, cuyo tratamiento es controvertido y puede conllevar graves complicaciones. Se presenta un caso poco frecuente de lesión de Monteggia equivalente en una niña de 6 años, que consiste en una deformidad plástica del cúbito proximal con un desplazamiento posterolateral de la cabeza del radio. Se trató al mes de la lesión mediante una reducción cerrada de la cabeza del radio, asociada a una osteotomía dorsal en cuña de cierre y extensora de unos 2 mm del cúbito proximal; se obtuvo un buen resultado.

Monteggia injuries in children can be missed easily, especially the equivalent variants. Early diagnosis and treatment are important to prevent chronicity of the injury, because treatment is controversial and it can cause serious complications. A rare case of Monteggia equivalent lesion in a 6-year-old girl is presented. It consists of a plastic deformity of the proximal ulna with posterolateral displacement of radio head. Patient was successfully treated with a closed reduction of radial head and a dorsal closing-wedge osteotomy (2 mm wedge) of the proximal ulna, one month after injury, with good results.

Neutrophilic dermatoses in a patient with collagenous colitis.

We report the case of a 75-year old woman with collagenous colitis who presented with erythematous and edematous plaques on the periorbital and eyelid regions, accompanied by oral ulcers. Histopathology showed a dermal neutrophilic infiltrate plus mild septal and lobular panniculitis with lymphocytes, neutrophils and eosinophils. Five years earlier she had presented a flare of papules and vesicles on the trunk, together with oral ulcers; a skin biopsy revealed a neutrophilic dermal infiltrate and Sweet's syndrome was diagnosed. Both the neutrophilic panniculitis and the Sweet's syndrome were accompanied by fever, malaise and diarrhea. Cutaneous and intestinal symptoms disappeared with corticoid therapy. The two types of neutrophilic dermatoses that appeared in periods of colitis activity suggest that intestinal and cutaneous manifestations may be related.

Injection of embryonic median ganglionic eminence cells or fibroblasts within the amygdala in rats kindled from the piriform cortex.

BACKGROUND: Intracerebral infusion of anticonvulsant agent secreting cells has proven to raise the threshold for seizure generation in epileptogenic areas. Median ganglionic eminence (MGE) is the main embryonic region where future GABAergic cells originate. Here we report the results of intraamygdaline grafting of MGE cells versus fibroblasts in a piriform cortex kindling model of epilepsy in the rat. MATERIAL AND METHODS: Rats were implanted with an electrode in the left piriform cortex and subjected to infusion at the left basolateral amygdala of cells obtained from the MGE of embryos or fibroblasts. Some of the donor cells were obtained from transgenic rats expressing the green fluorescent protein (GFP). Seizure and neurologic behavior were recorded, and inmunohistochemical and ultrastructural studies were carried out. RESULTS: Cells obtained from the embryonic MGE elevated both the afterdischarge and the seizure threshold progressively, being significant 3 weeks after their injection. On the contrary, fibroblasts injected into the amygdala raised the seizure thresholds the first week, the effect weaning during the following weeks. Fibroblasts and MGE cells were shown at the injected amygdala. No behavioral side effects were recorded in either experimental group. CONCLUSION: MGE cells implanted at the amygdala may control the focal component of temporolimbic seizures. This effect may be mediated by local release of GABA.

Suspensión de la intervención quirúrgica electiva no cardiaca en el paciente hipertenso / Suspension of Elective No Cardiac Surgery in hypertensive patients

Introducción: la suspensión del acto quirúrgico electivo implica el hecho de que no se realice la intervención quirúrgica cuando ya está asignado día y hora, situación que molesta a los pacientes y que es un parámetro de calidad de la atención sanitaria. Objetivo: identificar las causas que influyen en la suspensión del paciente hipertenso propuesto para intervención quirúrgica electiva. Métodos: se realizó un estudio, descriptivo y transversal, en 80 pacientes propuestos para intervención quirúrgica electiva en el Hospital Universitario Manuel Ascunce Domenech en el período 2010 y 2011. Se procesó los datos mediante el paquete estadístico SPSS para Windows versión 15.0. Resultados: el 67,5 por ciento de los pacientes eran fumadores y la diabetes mellitus fue la enfermedad asociada con mayor significación, seguido de la cardiopatía isquémica. Más del 50 por ciento de los pacientes propuestos para intervención quirúrgica se suspendió con cifras de tensión arterial iguales o mayores que 180/110 mmHg; fueron los inhibidores de la enzima convertidora en angiotensina los medicamentos más utilizados como tratamiento de base. Conclusiones: la mayor parte de los pacientes, se suspenden con cifras mayores e iguales a 180/110 mmHg sin tratamiento antihipertensivo. La medicación antihipertensiva más utilizada fueron los inhibidores de la enzima convertidora en angiotensina(AU)

Introduction: the suspension of elective surgery involves the fact that surgery is not performed when it is already assigned day and time, a situation that bothers patients and it is a parameter of health care quality. Objective: Identify the causes influencing the suspension of proposed elective surgery in hypertensive patients. Methods: A descriptive, cross-sectional study was conducted in 80 patients proposed for elective surgery at Manuel Ascunce Domenech University Hospital from 2010 to 2011. Data were processed using SPSS for Windows version 15.0. Results: 67.5 percent of patients were smokers and diabetes mellitus was the most significant associated disease, followed by ischemic heart disease. More than 50 percent of the proposed surgery was suspended; and blood pressure levels were equal to or higher than 180/110 mmHg; the most widely used drugs for primary treatment were the angiotensin converting enzyme inhibitor. Conclusion: most patients are suspended with readings equal and higher than 180/110 mmHg without antihypertensive treatment. The most antihypertensive medication used was angiotensin converting enzyme inhibitors(AU)

Morbilidad anestésica y factores de riesgo de mortalidad en cirugía de guerra / Anesthetic morbidity and mortality risk factors in war surgery

Introducción: participar como anestesiólogos en la atención de heridos de guerra con alarmante morbilidad y mortalidad, motiva su identificación y acciones tempranas que contribuyan a disminuir un desenlace fatal. Objetivo: identificar la morbilidad anestésica en cirugía de guerra y los factores de riesgo de mortalidad. Métodos: Estudio observacional analítico, longitudinal prospectivo en 120 heridos para determinar morbilidad anestésica en cirugía de guerra y factores de riesgo de mortalidad. Se consideraron las variables: riesgo quirúrgico, zona operatoria, complicaciones (intraoperatorias y posoperatorias) y egreso. Resultados: alcanzó riesgo quirúrgico malo 40 por ciento y regular 60 por ciento. Las zonas operatorias fueron: cabeza 20 por ciento, extremidades 18 por ciento, tórax y abdomen 11,7 por ciento respectivamente. Desde el punto de vista intraoperatorio apareció hipotensión arterial en 35,8 por ciento, asociación de complicaciones en 31,7 por ciento y shock hipovolémico en 17,5 por ciento. El posoperatorio mostró asociación de complicaciones en 34,2 por ciento, shock hipovolémico en 17,5 por ciento, insuficiencia renal aguda en 15,8 por ciento, e insuficiencia respiratoria en 10,8 por ciento de los heridos. Egresaron 60,8 por ciento vivos y 39,2 por ciento fallecidos. Conclusiones: la morbilidad fue dada por las complicaciones intraoperatorias y posoperatorias. La mortalidad fue alta asociada a riesgo quirúrgico malo, a zonas operatorias: cabeza, tórax y abdomen, y a complicaciones intraoperatorias y posoperatorias La morbilidad intraoperatoria y posoperatoria y el riesgo quirúrgico malo, representaron factores de riesgo de mortalidad en el estudio(AU)

Introduction: anesthesiologists involved in the care of combat casualties with alarming morbidity and mortality are always keen on determining the identity of the injured and performing early actions aimed at reducing death rates. Objective: identify anesthetic morbidity and mortality risk factors in war surgery. Methods: observational analytical prospective longitudinal study of 120 casualties to determine anesthetic morbidity and mortality risk factors in war surgery. The variables considered were surgical risk, surgical site, intra and post-operative complications, and discharge. Results: surgical risk was bad in 40 percent and fair in 60 percent. The surgical sites were the following: head 20 percent, extremities 18 percent, and chest and abdomen 11.7 percent. Intraoperative complications were arterial hypotension in 35.8 percent, an association of complications in 31.7 percent, and hypovolemic shock in 17.5percent. Post-operative complications were an association of complications in 34.2 percent, hypovolemic shock in 17.5percent, acute renal failure in 15.8 percent, and respiratory failure in 10.8 percent of the cases. 60.8 percent were discharged alive and 39.2 percent died. Conclusions: morbidity consisted in intra and post-operative complications. The high mortality was associated with bad surgical risk, the surgical sites head, chest and abdomen, and intra and post-operative complications. Intra and post-operative morbidity and bad surgical risk were mortality risk factors in the study(AU)