Localización de la membrana cricotiroidea en varones: influencia de las características morfológicas del cuello / Locating the cricothyroid membrane in males: Influence of the morphological characteristics of the neck

Introducción: La cricotirotomía es una técnica que forma parte de los algoritmos de manejo de vía aérea difícil. Para su adecuada realización se precisa una correcta localización de la membrana cricotiroidea (MCT). Diversos estudios han encontrado una alta tasa de error en la localización por palpación, lo que condiciona un fracaso en el resultado de la técnica. Objetivos: El propósito del estudio fue determinar si las características morfológicas del cuello del paciente influyen en la correcta localización de la MCT y en el tiempo empleado. Materiales y métodos: Estudio observacional donde participaron voluntariamente anestesiólogos e intensivistas en una simulación consistente en un escenario de «cannot intubate, cannot oxygenate» donde tenían que localizar en el menor tiempo posible la MCT en 2 varones seleccionados con diferentes características morfológicas de cuello. Se cronometró el tiempo empleado desde que el sujeto comenzaba a localizar la MCT hasta que la marcaba con un rotulador. Resultados y conclusiones: Se encontró que el modelo con mayor índice de masa corporal y mayor perímetro cervical tenía una tasa de fracaso en la localización de un 70%, empleando, además, mayor tiempo, comparado con el modelo de características estándares

Introduction: Cricothyrotomy is a recommended technique to restore oxygenation in most of guidelines for difficult airway management. A correct location of the cricothyroid membrane (CTM) is fundamental for a proper performance of the technique. Several studies have shown poor accuracy with the identification the CTM by palpation, resulting in a high failure rate of the technique. Objective: The aim of this study was to determine the impact of the patient's neck morphology on the accurate location of the CTM and on the time employed. Materials and method: Observational study in which anaesthesiologists and intensivists voluntarily participated in a simulation that consisted of a «cannot intubate, cannot oxygenate» scenario, where they had to locate the CTM, as soon as possible, in 2 selected male patients with different morphological characteristics of the neck. The time was measured from the beginning of CTM palpation to locating it with a marker. Results and Conclusions: A higher body mass index and a higher neck circumference correlated with a 70% location failure rate and with a longer time as compared with a standard model

Locating the cricothyroid membrane in males: Influence of the morphological characteristics of the neck. / Localización de la membrana cricotiroidea en varones: influencia de las características morfológicas del cuello.

INTRODUCTION: Cricothyrotomy is a recommended technique to restore oxygenation in most of guidelines for difficult airway management. A correct location of the cricothyroid membrane (CTM) is fundamental for a proper performance of the technique. Several studies have shown poor accuracy with the identification the CTM by palpation, resulting in a high failure rate of the technique. OBJECTIVE: The aim of this study was to determine the impact of the patient's neck morphology on the accurate location of the CTM and on the time employed. MATERIALS AND METHOD: Observational study in which anaesthesiologists and intensivists voluntarily participated in a simulation that consisted of a «cannot intubate, cannot oxygenate¼ scenario, where they had to locate the CTM, as soon as possible, in 2 selected male patients with different morphological characteristics of the neck. The time was measured from the beginning of CTM palpation to locating it with a marker. RESULTS AND CONCLUSIONS: A higher body mass index and a higher neck circumference correlated with a 70% location failure rate and with a longer time as compared with a standard model.

Dolor lumbar crónico de origen facetario. Eficacia del tratamiento mediante rizolisis percutánea / Chronic low back pain from facet joint origin. Efficacy of treatment with percutaneous rizhotomy

El dolor lumbar es el motivo más frecuente de consulta médica por patología del aparato locomotor de la población. Se estima que el 70-80% de la población sufrirá algún episodio de dolor lumbar durante su vida. Las articulaciones interapofisarias son el origen del dolor en un gran porcentaje de los casos. La denervación percutánea facetaria lumbar por radiofrecuencia o rizolisis es una técnica mínimamente invasiva para el tratamiento sintomático del dolor lumbar crónico de origen facetario. Su principio se basa en dañar de forma controlada las fibras transmisoras del dolor mediante el calor aplicado por medio de un electrodo en el ramo posterior, causando una lesión que provoca el cese de la transmisión del dolor. Una meticulosa selección de los pacientes y una correcta indicación, considerando que la mayoría de las veces se aplicara a pacientes en el que suelen existir diversas implicaciones (i.e. socioeconómicas, afectivas, laborales,...) obtienen resultados duraderos en el tiempo ayudando a disminuir el impacto sobre la actividad cotidiana de estos pacientes

Low back pain is the most frecuent reason for musculoskeletal medical consultation. It is estimated that betwen 70% to 80% of the population will suffer at least one episode of low back pain during his life. The zygoapophyseal joints represent the origin of the pain in most part of the cases. Percutaneous radiofrecuency lumbar facet joint denervation also called rizhotomy, is a minimally invasive procedure for the symptomatic treatment of low back pain from facet joint origin. The heat transmitted by an electrode placed percutaneously colse to the dorsal rami, produces an injury to the nervous fibres that conduces the pain that stops the transmision of the painful information originated on its inervation area. A careful patient selection and an adequate indication for rizhotomy, considering that in most part of the cases patients suffering for low back pain presents as well some other considerations (i.e. finantial motivation, affective, work problems,...) obtains long lasting good results and helps to diminish the impact of the low back pain over the patients life

Nutrient status and plant growth effects of forest soils in the Basin of Mexico.

The nutrient status of forest soils in the Mexico City Air Basin was evaluated by observing plant growth responses to fertilization with N, P or both nutrients combined. P deficiency was the most frequent condition for soil from two high pollution sites and N deficiency was greatest at a low N deposition site. Concentrations of Pb and Ni, and to a lesser extent Zn and Co, were higher at the high pollution sites. However, positive plant growth responses to P and sometimes to N, and results of wheat root elongation bioassays, suggest that heavy metal concentrations were not directly phytotoxic. Further studies are needed to determine if heavy metal toxicity to mycorrhizal symbionts of eucalyptus (Eucalyptus camaldulensis Dehnh.) from high pollution sites may explain the P deficiency and stunted growth. P deficiency is expected to limit the capacity for biotic N retention in N saturated forested watersheds in the Basin of Mexico dominated by Andisols.

Trastornos de personalidad y esquizofrenia: ¿comorbilidad o artificio diagnóstico? / Personality disorders and schizophrenia: comorbidity or diagnostic artifact?

Objetivo: Las publicaciones sobre la comorbilidad de los trastornos de personalidad con otras entidades clínicas han proliferado en los últimos años y se ha señalado la alta frecuencia de su presentación. Se ha argumentado que dicha comorbilidad no es real, sino un artificio de los actuales sistemas diagnósticos. La comorbilidad de trastornos de personalidad y esquizofrenia no es una excepción, aunque su frecuencia es menor que en el caso de otros trastornos mentales. Los problemas metodológicos que esta comorbilidad plantea son complejos y ponen en cuestión los fundamentos de los actuales sistemas diagnósticos. El objetivo de este trabajo es plantear las debilidades de estos sistemas diagnósticos, tomando como referencia la aparente comorbilidad de los trastornos de personalidad y la esquizofrenia. Material y método: Se estudia a una población de 60 sujetos diagnosticados de esquizofrenia, siguiendo los criterios de la décima edición de la Clasificación Internacional de Enfermedades (CIE-10). Mediante el instrumento diagnóstico confeccionado por el grupo SECOR, se valoran los criterios diagnósticos de trastornos de personalidad (LIDTP) y los criterios diagnósticos para la esquizofrenia (LIDESQ). Resultados: El 91,6% de los pacientes cumplía criterios para, al menos, 1 trastorno de personalidad, y el 41,7%, entre 3 y 9. Los trastornos más comórbidos eran los pertenecientes al grupo A (esquizotípico, esquizoide y paranoide), como era de esperar. Sin embargo, es sorprendente que un 31,7% de los pacientes esquizofrénicos cumpliese criterios para el trastorno de personalidad ansioso-evitativo y un 26,7% para el de inestabilidad emocional, tipo impulsivo. Conclusiones: La alta comorbilidad de esquizofrenia y trastornos de personalidad es un artificio de los actuales sistemas diagnósticos, que se debe revisar al menos en 3 aspectos: la jerarquización diagnóstica, el solapamiento de los síntomas y la redefinición de los criterios sobre los que se establece el diagnóstico de trastorno de personalidad

Objective: Publications on the comorbidity of personality disorders with other diseases have increased over the last few years, indicating its high frequency. It has been argued that this comorbidity is not real but is rather an artifact of currently used diagnostic criteria. The comorbidity of personality disorders and schizophrenia is not an exception, although its frequency is lower than in the case of other mental disorders. The methodological problems posed by this comorbidity are rather complex, casting doubt on current diagnostic criteria. The aim of this study was to show the weaknesses of these diagnostic systems, taking as a reference the apparent comorbidity of personality disorders and schizophrenia. Material and method: A population of 60 subjects with a diagnosis of schizophrenia following the CIE-10 criteria was studied. Using the diagnostic instrument designed by the SECOR group, the diagnostic criteria for personality disorders (LIDTP) and schizophrenia (LIDESQ) were analyzed. Results: A total of 91.6% of the patients fulfilled the criteria for at least one personality disorder, and 41.7% fulfilled the criteria for between three and nine personality disorders. As expected, the most comorbid disorders belonged to cluster A (schizotypal, schizoid, and paranoid). Surprisingly, however, 31.7% of patients with schizophrenia fulfilled the criteria for anxious/avoidant personality disorder, while 26.7% did so for emotionally unstable personality disorder, impulsive type. Conclusions: The high comorbidity between schizophrenia and personality disorders is an artifact of today's diagnostic criteria, which should be revised in at least three different aspects: diagnostic organization (hierarchical), symptom overlap, and redefinition of the criteria upon which personality disorders are diagnosed

EEG signs of "relaxation behavior" during breast-feeding in a nursing woman.

The presence of electroencephalographic signs of "relaxation behavior"; i.e., groups of synchronic, 6-10 Hz, 100-150 microV EEG waves mainly appearing in parieto-occipital regions, have been investigated in a nursing woman during breast-feeding. EEG was recorded once a week from right and left frontal-central, central-parietal, parietal-temporal and parietal-occipital derivations of the mother during breast-feeding of her own child throughout 16 weeks of nursing (from the 4th to the 20th week after delivery). Groups of synchronic 6-10 Hz, 100-150 microV EEG waves were recorded in central-parietal and parietal-temporal derivations, 15-80 sec after starting of suckling of either breast. Proportions of this synchronic EEG activity ranged between 5 to 28% in the central-parietal and 6 to 22% in the parietal-temporal derivations, and significantly higher proportions were found in the right hemisphere. Similarities between EEG signs of "relaxation behavior" elicited by suckling in nursing cats and those elicited by suckling in a nursing woman lead to the possibility that the above described EEG phenomena are an expression of a functional state of the central nervous system which is a part of the integral response involved in the consummatory activity of nursing behavior in women.