ABSTRACT
La fisiopatología del trauma raquimedular (TRM) es compleja y aún no se conoce completamente. La lesión al cordón espinal está determinada por procesos primarios y secundarios. La lesión primaria se debe a la transmisión de energía mecánica a la médula y las estructuras neurales durante el evento traumático. La lesión secundaria, que compromete estructuras que habían permanecido indemnes después del trauma inicial, desencadena alteraciones en: la perfusión microvascular, la liberación de radicales libres y de neurotransmisores, la peroxidación lipídica, la concentración iónica y la consecuente muerte celular tanto por necrosis como por apoptosis. La investigación en el tratamiento del TRM, basada en el conocimiento actual de estos mecanismos de lesión, ha buscado el desarrollo de intervenciones terapéuticas tempranas que atenúen el efecto de estos mecanismos fisiopatológicos secundarios, tanto en el sitio del accidente, como después del ingreso a un centro de trauma. Dentro de la intervención farmacológica se ha descrito, por su teórico efecto protector en el pronóstico neurológico de los pacientes con TRM, el uso de metil-prednisolona, gangliósidos y medicamentos antagonistas de los opiáceos, del receptor de glutamato y de los canales iónicos. Sin embargo, aún no se ha identificado ninguna intervención que modifique este pronóstico en forma significativa.
A fisiopatologia da lesão de medula espinal (LME) é complexa e não está completamente esclarecida. A LME é determinada por processos primários e secundários. A lesão inicial é produzida pela transmissão de energia mecânica para a medula espinal e as estruturas neurais. A lesão secundária atua sobre as estruturas que são poupadas pelo trauma inicial, afetando a perfusão microvascular e as concentrações iônicas, desencadeando a liberação de radicais livres e neurotransmissores e ativando a peroxidação lipídica, o que produz a morte celular. A pesquisa recente sobre o tratamento da LME concentra-se no desenvolvimento de intervenções oportunas que possam atenuar os efeitos dos mecanismos fisiopatológicos secundários. Entre as intervenções farmacológicas, têm sido usados: metilprednisolona, gangliosídeos e antagonistas de opiáceos, de receptores de glutamato e de canais iônicos, considerando seu efeito protetor teórico sobre o prognóstico neurológico dos pacientes com LME. Contudo, nenhuma dessas intervenções modificou significativamente esse prognóstico até agora.
The pathophysiology of spinal cord injury (SCI) is complex and still not fully elucidated. Primary and secondary processes determine SCI. The initial injury is produced by the transmission of the mechanical energy of the trauma to the spinal cord and neural structures. The secondary injury acts on those structures that were spared by the initial trauma, affecting microvascular perfusion and ionic concentrations, inducing the liberation of free radicals and neurotransmitters and activating lipid peroxidation, thus producing cellular death. Recent research in the treatment of SCI is focused on the development of timely therapeutic interventions that could attenuate the effects of these secondary pathophysiological mechanisms. Among the pharmacological interventions, methyl-prednisolone, gangliosides and antagonists of opiod, glutamate receptor and ionic channels have been used, advocating their theoretical protective effect in the neurological prognosis of patients with SCI. Nevertheless, none of these interventions has yet significantly modified this prognosis.
Subject(s)
Spinal Cord Injuries/etiology , Spinal Cord Injuries/physiopathology , Spinal Cord Injuries/historySubject(s)
Humans , History, Ancient , History, Medieval , History, 15th Century , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History of Medicine , History, 21st Century , Spinal Injuries/history , Spinal Cord Injuries/historyABSTRACT
Gabriel Cano de Aponte was Governor of Chile since 1717 and util his death in 1733, being 68 years old. As a soldier, he was an experimented horse rider. The sequence ofevents that caused his death three months after an equestrian accident are unclear. A systematic clinical analysis of the later is the main objective of this review. Historians have documented Cano de Aponte's "inclination for unbridled fun and equestrian exercises". During a holiday Cano de Aponte suffered a horse fall and subsequent crushing by the latter. It has been stated that a spinal lesion caused by the accident kept him bedridden for a period of three months, clear in reason and with intense pain, before his death. However, there is no evidence on historie data that conveys any typical sign associated to spinal injury following the accident. Therefore we suggest that Cano de Aponte suffered a complex pelvic ring fracture. The fact that he was prostrated, lucid, but suffered and intense pain best sustains the hypothesis of a pelvic fracture. After the initial period, one ofthe most common causes of death resulting from a pelvic fracture is deep venous thrombosis with secondary pulmonary thromboembolism. This must have been the sequence ofevents that most probably caused Cano de Aponte's death).
Subject(s)
History, 18th Century , Athletic Injuries/history , Spinal Cord Injuries/history , ChileABSTRACT
La fractura del ahorcado es la lesión traumática del arco neural del axis. El entendimiento de esta afección comenzó a desarrollarse a principios de este siglo, aunque el proceder del ahorcamiento judicial se utilizaba desde cientos de años con anterioridad. Este trabajo se propone revisar los antecedentes históricos hasta el momento actual en el conocimiento de dicha afección, su presentación natural, el diagnóstico imagenológico y las alternativas del tratamiento(AU)
Hangmans fracture is the traumatic injury of the neural arch of the axis. This affection started to be understood at the beginning of the last century, though the procedure of the judicial hanging had been used hundreds of years before. The objective of this paper is to review the historical antecedents of the knowledge of this affection, its natural presentation, the imaging diagnosis and the treatment alternatives up to now(AU)