[Health care in Spain and Europe. Basic health legislation]. / La asistencia sanitaria en España y Europa. Legislación básica sanitaria.

The health system is part of the social system and is conditioned by health, political, educational and economical factors. In the European Union, the health assistance is in good situation, covering the disease-disability risk. Solidarity, equity and universality are the principles that govern the European health systems; public financing is of high relevance. The organization of these systems is ruled by each country; nevertheless, the countries of the European Union are carrying out sanitary reforms that follow common directives. In the medical assistance, the state members have decided to reach accessibility for all, quality and financial sustainability, without forgetting the demographic aging, the appearance of new technologies and therapies, or the improvement of the well-being and standard of life. The organization of the Spanish National Health System is based on policies of the community, fitting the normative frame to the communitarian laws and the present needs on health.

[Jurisdiction and imputability]. / Competencia e imputabilidad.

Validity, efficacy and responsibility of acts depend on the intelligence and will of the acting subject; therefore when they are reduced or debilitated, these acts may be declared as non-valid and the author, not-responsible for the acts. Some neurological pathologies may generate physical and/or psychic permanent deficiencies, which prevent subjects from acting on their own. For these cases, the law establishes the incapacity state, in order to protect the disabled and complete the reduced ability, guaranteeing their rights and security. The disabled state will be determined by a legal sentence, which states the lack of ability to manage. In that sentence extension and limits of the disability will be determined; disability level will be proportional to the insight degree.Similarly, a subject suffering a pathological condition that invalidates his/her will and intelligence will be considered non-responsible and not imputable, since there is no culpability ability. The Penal Code establishes the criteria that will determine the possibility of imputability or its absence, as well as modifying circumstances.

[Wernicke encephalopathy in patients given parenteral nutrition]. / Encefalopatía de Wernicke en pacientes sometidos a nutrición parenteral.

Wernicke's encephalopathy is caused by thiamin deficiency and can be recognized by severe neurological symptoms that are occasionally accompanied by systemic signs. The syndrome is often found in alcoholics, although other causes have also been identified, such as intravenous feeding, in which the main pathogenic mechanisms are the administration of carbohydrates and the low standard dose of vitamin B1--in relation to the increase in metabolic load--delivered in a medium of substances that favor inactivation of the vitamin. We present 3 intravenously fed patients who developed the syndrome, even though in 2 cases they were given thiamin. Only the third patient's history included chronic alcoholism, and this patient also suffered severe cardiac symptoms and amaurosis. We believe that the amount of thiamin provided through parenteral nutrition, as well as the medium in which it is delivered, must be reviewed.

[Cerebral cavernous angiomas in pregnancy. Two cases and a review of literature]. / Angiomas cavernosos cerebrales en gestantes: estudio de dos casos y revisión de la literatura.

Whether pregnancy increases the risk of bleeding of cavernous angioma, as it does with other types of cerebral vascular malformation, is not known at present. We monitored the pregnancies of two patients with cerebral cavernous angiomas. One patient, whose long-standing epilepsy had until then been considered cryptogenic, with seizure occurring every 3 to 5 years, remained asymptomatic throughout her pregnancy which ended in spontaneous abortion. The parietal cavernous angioma was partially calcified and the tissue showed signs of earlier hemorrhage. The first symptom in the second patient was first-trimester hemorrhage from inside and around the angioma which was located in the optic chiasm. The lesion was fully excised in both patients. We review the literature and analyze the mechanisms that may be implicated in the clinical presentation during pregnancy of this type of cerebral vascular malformation.