[Posterior corpectomy, transpedicular fixation and expandable cage placement in thoracolumbar fractures]. / Corporectomía por acceso único posterior con colocación de caja expandible y fijación transpedicular en fracturas toracolumbares.

OBJECTIVE: The objective is to evaluate the outcome of vertebral corpectomy and placement of an expandable cage in patients with thoracolumbar fractures, using a posterior-only approach. MATERIAL AND METHODS: A retrospective, case series study in the period from May 2011 to May 2014, in which eight patients with thoracolumbar burst fractures were treated surgically with corpectomy of fractured spinal body, placement of expandable box and fixation with transpedicular system, via posterior-only approach. Neurologic examination was done pre- and postoperatively with the ASIA score in a one year span. The angular deformity correction was also measured. RESULTS: The mean age was 38 years (24 to 58 years); five male and three female patients. All the patients had burst fracture, one of them with aggregate rotational component. Only one vertebral level was worked with corpectomy in all patients. Mean surgical time was 236 minutes (195-330 min). Mean surgical bleeding was 1,731 ml. CONCLUSION /DISCUSSION: Patients who underwent posterior approach corpectomy showed favorable clinical results. None presented neurological damage or surgical-related injury. This technique can be a useful option to avoid complications related to anterior vertebral approach or double approach.

OBJETIVO: Evaluar el resultado de la corporectomía por acceso único posterior con colocación de caja expandible y fijación transpedicular en pacientes con fracturas toracolumbares. MATERIAL Y MÉTODOS: Estudio retrospectivo en el que se evaluaron ocho pacientes con fracturas por estallido entre Mayo de 2011 y Mayo de 2014, quienes fueron tratados de manera quirúrgica mediante corporectomía, colocación de caja expandible y fijación transpedicular con abordaje posterior. El estado neurológico fue valorado a través de la escala de ASIA prequirúrgico y postquirúrgico a un año de evolución y se midió la corrección angular de las deformidades. RESULTADOS: El estudio comprendió cinco personas de sexo masculino y tres de sexo femenino, con un promedio de edad de 38 años (de 24 a 58 años). Todos los pacientes presentaron fracturas por estallido del cuerpo vertebral, uno de ellos con componente rotacional. A los ocho se les realizó solamente la corporectomía de un nivel vertebral. El tiempo quirúrgico promedio fue de 236 minutos (rango: 195-330 min). El sangrado quirúrgico en promedio fue de 1,731 ml. CONCLUSIÓN/DISCUSIÓN: Los pacientes que se sometieron a corporectomía por vía posterior mostraron resultados clínicos favorables, sin presentar lesiones neurológicas o lesiones asociadas al procedimiento, por lo que esta técnica puede ser una opción terapéutica al disminuir las complicaciones de una vía anterior o de un doble abordaje.

[Surgical management of spinal deformity in a patient with Escobar syndrome: review of the literature]. / Manejo quirúrgico de la deformidad vertebral en un paciente con síndrome de Escobar: revisión de la literatura.

BACKGROUND: The non-lethal variant of the Escobar or multiple pterygium syndrome is an entity of autosomal recessive inheritance linked to the X chromosome; it is characterized by multiple pterygia (hence its name) located mainly in the neck (95%) and armpits (55%), as well as other orthopedic malformations such as a vertical talus, congenital hip dislocation, and congenital scoliosis. OBJECTIVE: To present an optional surgical technique for the management of severe spinal deformities. CASE REPORT: Twelve-year-old female diagnosed with Escobar syndrome with severe scoliosis which conditions malformations of the chest with lung involvement, producing mechanical ventilatory restriction and increasing the risk of severe lower respiratory tract infection. We performed a hands-free posterior instrumentation with PASS LP system and Smith-Petersen osteotomies. CONCLUSIONS: The Cobb angle improved from 62° to 23° and the sagittal balance from 125 mm to 73 mm.

El síndrome de Escobar o de pterigium múltiple en su variante no letal es una entidad con tipo de herencia autosómica recesiva ligada al cromosoma X; se caracteriza por presentar múltiples pterigiones de ahí su nombre, principalmente localizados en cuello (95%) y axilas (55%), así como otras malformaciones de tipo ortopédico como astrágalo vertical, luxación congénita de cadera y escoliosis congénita.

Malaria control: achievements, problems and strategies.

Even if history has not always been the Magistra vitae, Cicero expected it to be, it should provide, as Baas said, a mirror in which to observe and compare the past and present in order to draw therefrom well-grounded conclusions for the future. Based on this belief, this paper aims to provide an overview of the foundations and development of malaria control policies during the XX century. It presents an analysis of the conflicting tendencies which shaped the development of these policies and which appear to have oscillated between calls for frontal attack in an all-out campaign and calls for sustainable gains, even if slow. It discusses the various approaches to the control of malaria, their achievements and their limitations, not only to serve as a background to understand better the foundations of current policies, but also to prevent that simplistic generalisations may again lead to exaggerated expectations and disillusion. The first part of the paper is devoted to the development of malaria control during the first half of the century, characterised by the ups and downs in the reliance on mosquito control as the control measure applicable everywhere. The proliferation of "man-made-malaria", which accompanied the push for economic development in most of the endemic countries, spurred the need for control interventions and, while great successes were obtained in many specific projects, the general campaigns proposed by the enthusiasts of vector control faced increasing difficulties in their practical implementation in the field. Important events, which may be considered representative of this period are, on the campaign approach, the success of Gorgas in the Panama Canal, but also the failure of the Mian Mir project in India; while on the developmental approach, the Italian and Dutch schools of malariology, the Tennessee Valley and the development of malaria sanitation, included the so called species sanitation. The projection of these developments to a global scale was steered by the Malaria Commission of the League of Nations and greatly supported by the Rockefeller Foundation. Perhaps the most important contribution of this period was the development of malaria epidemiology, including the study of the genesis of epidemics and their possible forecasting and prevention. Although the great effectiveness of DDT was perhaps the main determinant for proposing the global eradication of the disease in the 1950s, it was the confidence in the epidemiological knowledge and the prestige of malariology, which gave credibility to the proposal at the political level. The second part deals with the global malaria eradication campaign of the 1950s and 1960s. It recognises the enormous impact of the eradication effort in the consolidation of the control successes of the first half of the century, as well as its influence in the development of planning of health programmes. Nevertheless, it also stresses the negative influence that the failure to achieve its utopian expectations had on the general disappointment and slow progress of malaria control, which characterised the last third of the century. The paper then analyses the evolution of malaria control funding, which often appears out of tune with political statements. The fourth part is devoted to the search for realistic approaches to malaria control, leading to the adoption of the global malaria control strategy in Amsterdam in 1992, and the challenge, at the end of the century, to rally forces commensurate with the magnitude of the problem, while aiming at realistic objectives. After discussing the conflicting views on the relations between malaria and socio-economic development and the desirable integration of malaria control into sustainable development, the paper ends with some considerations on the perspectives of malaria control, as seen by the author in early 1998, just before the launching of the current Roll Back Malaria initiative by WHO.

Epidemiology in the strategies for malaria control.

A rapid overview is presented of the evolution of the main orientations of malaria control, since the discovery of mosquito transmission. Stated control objectives appear to have oscillated between expectations to eradicate the vector, or at least the disease, and more modest approaches to minimise the effects of the infection. High optimism was raised when a new control measure, or new combination of existing measures, appeared to be highly effective and was expected to have universal applicability. The implementation of large scale campaigns eventually found the limits of applicability of the proposed strategy and the exaggerated expectations soon gave way to disillusion and, eventually, to a revival of research. The longest and most impacting period of exaggerated expectations was the global malaria eradication campaign of the 1950s and 1960s, which completely disregarded the study of local epidemiology, considering that all it was needed was to know if an area was "malarious" or not. Research was practically abandoned and, even when reinstated after the recognised failure of the campaign, it has retained an almost exclusive orientation towards the development of control tools, drugs or eventually vaccines. One of the earliest victims of the eradication campaign was the study of epidemic malaria and its determinants in different epidemic prone areas. In spite of an extremely long period of disillusion, lasting for almost two decades, the reality of the malaria problem led WHO and member countries to agree on a global strategy of control, aiming at a realistic use of existing tools, to at least reduce or prevent mortality. An essential element of this strategy is the prevention or control of malaria epidemics and the selective use of vector control, both of which have to be based on a solid knowledge of local epidemiology, the study of which has to rejoin the path abandoned fifty years ago.

Prevention and control of malaria epidemics.

Malaria epidemics have recently occurred in many areas of the world, particularly in the irregular fringe, along the limits of distribution of malaria endemicity, whether the limiting factors are temperature (latitude or altitude) or relative humidity (deserts), which were the scene of the major epidemics of the past. A review is made of the current approaches to epidemic prevention and control in line with the global malaria control strategy, of which it constitutes an essential element. The different components are discussed, including the identification and study of epidemic prone areas, the search for indicators of epidemic risk, their monitoring, and the early detection and control of actual epidemics. The potential implementation of preventive and control activities depends, nevertheless, on the degree of preparedness of the health services to detect alarm signals, the real time left for action and their capacity of implementation within that time. Recent developments in geographical information systems (GIS) and satellite derived meteorological information offer most useful tools for precise and timely epidemic forecasting, although it should be recognised that such information is only useful if based on a real understanding of their local significance. There remains an urgent need to develop and support local capabilities for the ground truthing of satellite information and for translating it into preventive and control actions.

The control of tropical diseases and socioeconomic development (with special reference to malaria and its control).

Malaria, as the most important and widespread of the tropical diseases, is taken as representative of the approaches to their control and the perception of their influence in socioeconomic development. An analysis is presented of the evolution of the main policy orientations for malaria control, since the discovery of mosquito transmission, identifying a quasi cyclical alternance between expectations to interrupt transmission and eliminate the parasite, and more modest approaches to minimize the effects of the infection, which cannot be eradicated, except under rather special circumstances. These apparent cycles have nevertheless yielded a wealth of experience which the current global strategy of malaria control tries to assimilate, recognizing the interdependence of socioeconomic sustainable development and malaria control.

[Malaria and activities of the World Health Organization]. / El paludismo y las actividades de la Organización Mundial de la Salud.

Malaria has been one of the main health problems demanding the attention of WHO from the time the Organization was created. This review of the historical record analyzes the different approaches to the malaria problem in the past 40 years and shows how WHO tried to fulfill its constitutional mandate. The article exposes the historical roots of the present situation and helps towards an understanding of current problems and approaches to malaria control.

Malaria control: present situation and need for historical research.

A rapid review is made of the history of malaria control, calling attention to differences between the evolution of the technical concepts, the formulated strategies and their implementation. Particular emphasis is placed on the discussion of the present situation of the world malaria problem and the difficulties faced by many endemic countries in adopting a malaria control strategy, based on primary health care, while their services are vertically organized for the performance of routines, which are irrelevant for disease control. The present malaria control strategy recognizes local variability, but it is possible to identify a limited number of types of situations, likely to respond to similar approaches. The definition not only of the control approaches but also of their conditions of applicability will become more precise as experiences are accumulated and adequately documented from different types of epidemiological situations. It is postulated that historical research on the malaria control and public health approaches, with proper attention being given to their socioeconomic and political context, in the countries which succeeded in controlling endemic malaria, will make an important contribution to such a definition.

Malaria and the work of WHO.

Malaria has been one of the main health problems demanding the attention of WHO from the time the Organization was created. This review of the historical record analyses the different approaches to the malaria problem in the past 40 years and shows how WHO tried to fulfil its constitutional mandate. The article exposes the historical roots of the present situation and helps towards an understanding of current problems and approaches to malaria control.

Malaria and the work of WHO

Malaria has been one of the main health problems demanding the attention of WHO from the time the Organization was created. This review of the historical record analyses the different approaches to the malaria problem in the past 40 years and shows how WHO tried to fulfill its constitutional mandate. The article exposes the historical roots of the present situation and helps towards an understanding of current problems and approaches to malaria control(AU)

Operational and epidemiological field research activities for the implementation of malaria control through primary health care in Africa.

The magnitude of the malaria problem in tropical Africa has been a deterrent to a large-scale control effort as long as the aim was conceived to be only a reduction in transmission. The focus on local priorities brought about by the primary health care approach has resulted in the formulation of a strategy of malaria control that envisages the progressive incorporation of antimalaria activities as peripheral and supportive primary health care structures are developed.The local application of this strategy requires a new approach to the study of the epidemiology of malaria as a disease, with greater emphasis on the reasons for its focalization or intensification in space, time, and social groups and the implications for control measures.The primary health care approach opens up a wide area for field and health services research into the deployment of different technical resources for malaria control, as well as into the setting up of monitoring systems for the detection of technical problems, such as drug and insecticide resistance, or for the early recognition of epidemic outbreaks.

Development of a continental program of applied field research in malaria

Meeting of the Advisory Committee on Medical Research, 19. Pan American Health Organization; 9-13 Jun. 1980