[Radiation exposure of the spine surgeon]. / Exposición a radiación del cirujano de columna.

INTRODUCTION: in general, spine surgeons seek to minimize soft tissue damage by using less invasive approaches, which causes them to use intraoperative images much more frequently than other surgical specialties; therefore, they are at increased risk of radiation exposure. OBJECTIVE: the aim of this work was to analyse the amount of radiation to which the spine surgeon is exposed in different scenarios. MATERIAL AND METHODS: a prospective study with a descriptive, longitudinal non-randomized data source. We carried out this study in the period from 2015 to 2019, the radiologic protection consisted in lead apron, thyroid shield and leaded glasses, there were 10 badge dosimeters. RESULTS: only 4 dosimeters were included in the study, the other six were excluded. During the study period one surgeon suffered thyroid cancer and other suffered of liposarcoma. In the protected group were two surgeons, in the group of aleatory exposition was one surgeon and in the unprotected group was one surgeon. In the study the dosimeter in the unprotected group received more amount of radiation in all the years, we did an inferential analysis per year related with the number of surgeries without significant correlation, we attribute this result because we didn't classified the type of surgery realized by each surgeon. CONCLUSION: we conclude that the spine surgeon must apply the primary methods of radiological protection and that the unprotected spine surgeon receives more amount of radiation in comparison of the protected ones.

INTRODUCCIÓN: en general, los cirujanos de columna buscan minimizar el daño a tejidos blandos empleando abordajes menos invasivos, lo que ocasiona que utilicen imágenes intraoperatorias de una manera mucho más habitual que el resto de las especialidades quirúrgicas; por lo tanto, están en mayor riesgo de exposición de radiación. OBJETIVO: el propósito del trabajo es analizar la cantidad de radiación a la cual está expuesto el cirujano de columna en diferentes escenarios. MATERIAL Y MÉTODOS: estudio prospectivo con una fuente de datos descriptiva, longitudinal, no aleatorizada. Se llevó a cabo el estudio en el período del año 2015 al 2019; la protección radiológica consistió en chaleco plomado, protector de tiroides y lentes plomados; se usaron 10 dosímetros. RESULTADOS: cuatro dosímetros fueron incluidos en el estudio, los otros seis fueron excluidos. Durante el estudio, un cirujano sufrió de cáncer de tiroides y otro de liposarcoma. En el grupo de protegidos se incluyeron dos cirujanos, en el grupo de protección aleatorizada se incluyó un cirujano y en el grupo sin protección se incluyó un cirujano. El dosímetro del grupo sin protección recibió mayor cantidad de radiación en todos los años, se realizó un análisis inferencial por año relacionado con el número de cirugías no encontrando correlación significativa, atribuimos este resultado a que no clasificamos el tipo de cirugía realizada por cada cirujano. CONCLUSIÓN: el cirujano de columna debe de aplicar los métodos primarios de protección radiológica, ya que los cirujanos de columna sin equipo de protección reciben mayor cantidad de radiación en comparación con los protegidos.

Exposición a radiación del cirujano de columna / Radiation exposure of the spine surgeon

Resumen: Introducción: en general, los cirujanos de columna buscan minimizar el daño a tejidos blandos empleando abordajes menos invasivos, lo que ocasiona que utilicen imágenes intraoperatorias de una manera mucho más habitual que el resto de las especialidades quirúrgicas; por lo tanto, están en mayor riesgo de exposición de radiación. Objetivo: el propósito del trabajo es analizar la cantidad de radiación a la cual está expuesto el cirujano de columna en diferentes escenarios. Material y métodos: estudio prospectivo con una fuente de datos descriptiva, longitudinal, no aleatorizada. Se llevó a cabo el estudio en el período del año 2015 al 2019; la protección radiológica consistió en chaleco plomado, protector de tiroides y lentes plomados; se usaron 10 dosímetros. Resultados: cuatro dosímetros fueron incluidos en el estudio, los otros seis fueron excluidos. Durante el estudio, un cirujano sufrió de cáncer de tiroides y otro de liposarcoma. En el grupo de protegidos se incluyeron dos cirujanos, en el grupo de protección aleatorizada se incluyó un cirujano y en el grupo sin protección se incluyó un cirujano. El dosímetro del grupo sin protección recibió mayor cantidad de radiación en todos los años, se realizó un análisis inferencial por año relacionado con el número de cirugías no encontrando correlación significativa, atribuimos este resultado a que no clasificamos el tipo de cirugía realizada por cada cirujano. Conclusión: el cirujano de columna debe de aplicar los métodos primarios de protección radiológica, ya que los cirujanos de columna sin equipo de protección reciben mayor cantidad de radiación en comparación con los protegidos.

Abstract: Introduction: in general, spine surgeons seek to minimize soft tissue damage by using less invasive approaches, which causes them to use intraoperative images much more frequently than other surgical specialties; therefore, they are at increased risk of radiation exposure. Objective: the aim of this work was to analyse the amount of radiation to which the spine surgeon is exposed in different scenarios. Material and methods: a prospective study with a descriptive, longitudinal non-randomized data source. We carried out this study in the period from 2015 to 2019, the radiologic protection consisted in lead apron, thyroid shield and leaded glasses, there were 10 badge dosimeters. Results: only 4 dosimeters were included in the study, the other six were excluded. During the study period one surgeon suffered thyroid cancer and other suffered of liposarcoma. In the protected group were two surgeons, in the group of aleatory exposition was one surgeon and in the unprotected group was one surgeon. In the study the dosimeter in the unprotected group received more amount of radiation in all the years, we did an inferential analysis per year related with the number of surgeries without significant correlation, we attribute this result because we didn't classified the type of surgery realized by each surgeon. Conclusion: we conclude that the spine surgeon must apply the primary methods of radiological protection and that the unprotected spine surgeon receives more amount of radiation in comparison of the protected ones.

[Classification of continuous multilevel vertebral fractures]. / Clasificación de las fracturas vertebrales multinivel continuas.

Currently there is still little information about multilevel vertebral fractures (MVF), in addition to the fact that there are no classifications that help us group them in a simpler way, and guide us on their prognosis. The objective of this work is to propose a new classification of continuous type MVF, based on the number of end plates injured of the vertebral bodies and their severity, where we form four groups. A review of continuous MVF cases that we found in our hospital over a 6-year period was carried out, managing to designate 100% of the fractures, by their characteristics, to the corresponding group. In addition, we observed a better neurological prognosis in group 1. This classification is a proposal that will help us to group these injuries, that can be very varied, in only four groups; with the aim of later creating a more standardized management proposal, and knowing its neurological prognosis.

Actualmente aún existe poca información acerca de las fracturas vertebrales multinivel (MVF), además de que no hay clasificaciones que nos ayuden a agruparlas de una manera más sencilla y nos orienten sobre su pronóstico. El objetivo del presente trabajo es proponer una nueva clasificación de MVF del tipo continuas, basada en el número de plataformas lesionadas de los cuerpos vertebrales y su gravedad, donde formamos cuatro grupos. Se realizó la revisión de casos de MVF continuas que encontramos en nuestro hospital en un período de seis años; logrando designar cada fractura, debido a sus características, al grupo correspondiente en 100% de los casos. Además, se observó un mejor pronóstico neurológico en el grupo 1. Esta clasificación es una propuesta que nos ayudará a agrupar estas lesiones, que pueden ser muy variadas, en sólo cuatro grupos; con el objetivo de posteriormente crear una propuesta de manejo más estandarizado y conocer su pronóstico neurológico.

Espondiloptosis traumática C7-T1 sin compromiso neurológico / Traumatic spondyloptosis C7-T1 without neurologic deficit

Resumen: La espondiloptosis traumática es una lesión muy rara y grave generalmente causada por traumatismos de alta energía. Consiste en la dislocación anterior o posterior de 100% o más al cuerpo vertebral subyacente, lo que puede generar compresión y lesión total de la médula espinal, produciendo déficit neurológico; este tipo de lesión representa la etapa 4 y 5 de Allen. Caso clínico: Masculino de 50 años quien sufre accidente automovilístico al colisionar contra muro de contención, generándose lesión de tipo hiperextensión-compresión cervicotorácica, manejado con hemicorpectomía C7, discectomía C7-T1, espondilodesis con placa anterior (C6-C7, C7-T1), toma y aplicación de injerto, abordaje posterior + fascetectomías de C7 + fijación transfacetaria C6 y transpedicular de T1. Discusión: Encontramos que la estabilización temprana con pinza de Gardner más el abordaje anterior y posterior brindan adecuados resultados en cuanto a integridad sensitiva y motora del paciente así como una pronta rehabilitación.

Abstract: Traumatic spondyloptosis is a serious injury usually caused by high-energy trauma; It consists of the anterior or posterior dislocation of 100% or more of the underlying vertebral body, which can become a total injury of the spinal cord, producing a neurological deficit; this type of injury represents stage 4 and 5 of Allen-Ferguson. Clinical case: A 50-year-old man who suffers a car accident, he receive frontal impact when he was a driver, colliding with the retaining wall, referred from another hospital to emergency room, managed with C7 hemicorpectomy, c7-t1 discectomy, spondylodesis with anterior plate (C6-T1), and posterior approach + Fascetectomies of C7-T1, facet joint screws C6 and transpedicular fixation of T1. Discussion: Subaxial cervical spondyloptosis is relatively rare clinical entity, a complete clinical examination is important in diagnosis, taking in considerations the injury mechanism. For treatment we have a multiple options, at this case anterior-posterior (360 degrees) treatment it was the better option for Us; however, must be personalized and consider the early rehabilitation of patient.

[Traumatic spondyloptosis C7-T1 without neurologic deficit]. / Espondiloptosis traumática C7-T1 sin compromiso neurológico.

Traumatic spondyloptosis is a serious injury usually caused by high-energy trauma; It consists of the anterior or posterior dislocation of 100% or more of the underlying vertebral body, which can become a total injury of the spinal cord, producing a neurological deficit; this type of injury represents stage 4 and 5 of Allen-Ferguson. Clinical case: A 50-year-old man who suffers a car accident, he receive frontal impact when he was a driver, colliding with the retaining wall, referred from another hospital to emergency room, managed with C7 hemicorpectomy, c7-t1 discectomy, spondylodesis with anterior plate (C6-T1), and posterior approach + Fascetectomies of C7-T1, facet joint screws C6 and transpedicular fixation of T1. Discussion: Subaxial cervical spondyloptosis is relatively rare clinical entity, a complete clinical examination is important in diagnosis, taking in considerations the injury mechanism. For treatment we have a multiple options, at this case anterior-posterior (360 degrees) treatment it was the better option for Us; however, must be personalized and consider the early rehabilitation of patient.

La espondiloptosis traumática es una lesión muy rara y grave generalmente causada por traumatismos de alta energía. Consiste en la dislocación anterior o posterior de 100% o más al cuerpo vertebral subyacente, lo que puede generar compresión y lesión total de la médula espinal, produciendo déficit neurológico; este tipo de lesión representa la etapa 4 y 5 de Allen. Caso clínico: Masculino de 50 años quien sufre accidente automovilístico al colisionar contra muro de contención, generándose lesión de tipo hiperextensión-compresión cervicotorácica, manejado con hemicorpectomía C7, discectomía C7-T1, espondilodesis con placa anterior (C6-C7, C7-T1), toma y aplicación de injerto, abordaje posterior + fascetectomías de C7 + fijación transfacetaria C6 y transpedicular de T1. Discusión: Encontramos que la estabilización temprana con pinza de Gardner más el abordaje anterior y posterior brindan adecuados resultados en cuanto a integridad sensitiva y motora del paciente así como una pronta rehabilitación.

Dexmedetomidina versus lidocaína endovenosa en el control de dolor irruptivo y la funcionalidad en pacientes con canal lumbar estrecho / Dexmedetomidine versus endovenous lidocaine in breakthrough pain control and functionality in patients with lumbar stenosis

Introducción: El dolor es un motivo de ausentismo laboral, en especial el dolor irruptivo secundario a canal lumbar estrecho. La dexmedetomidina como analgésico actúa inhibiendo la liberación de sustancia P en la vía nociceptiva y bloquea los receptores de aspartato y glutamato. Por otro lado, la lidocaína también previene y alivia el dolor mediante la interrupción de la neuroconducción, uniéndose a su receptor específico dentro de los canales de sodio. Objetivo: Evaluar la eficacia analgésica de la dexmedetomidina versus lidocaína en perfusión endovenosa como tratamiento del dolor irruptivo secundario a canal lumbar estrecho. Material y métodos: Ensayo clínico controlado, aleatorizado, triple ciego, realizado en la clínica del dolor del HGM, se evaluaron dos grupos de pacientes con diagnóstico de dolor irruptivo secundario a canal lumbar estrecho; un grupo tratado con dexmedetomidina (0,3 mcg/kg) y otro grupo tratado con lidocaína (2 mg/kg) en perfusión endovenosa. Se realizó medición de la intensidad del dolor y el estado de sedación antes de iniciar el tratamiento y posteriormente a los 30, 60 y 120 minutos. También se evaluó la funcionalidad de los pacientes a través del índice de discapacidad de Oswestry antes y a los siete días del tratamiento. Se evaluó de forma secundaria el efecto de los tratamientos sobre los signos vitales. Resultados: No hubo diferencia estadísticamente significativa en la reducción de la intensidad del dolor a los 120 minutos entre los pacientes tratados con dexmedetomidina (EVA 1,29 ± 1,63) comparados con los tratados con lidocaína (EVA 1 ± 1,19, p = 0,594). Se observó que al final de la perfusión de los fármacos, la dexmedetomidina produjo mayor sedación a diferencia de la lidocaína (p = 0,003). Ambos tratamientos mejoran la funcionalidad en todos los pacientes sin haber diferencia estadísticamente significativa entre los tratamientos (p = 0,508) no se observaron efectos depresores sobre los signos vitales. Conclusiones: La dexmedetomidina y la lidocaína son igual de eficaces para el tratamiento del dolor irruptivo, con inicio de acción en los primeros 30 minutos de iniciada la perfusión hasta las siguientes 2 horas. No se observaron eventos adversos medicamentosos a las dosis recomendadas

Introduction: The pain is a reason for absenteeism labour, especially breakthrough pain secondary to narrow lumbar canal. Dexmedetomidine is an analgesic, act by inhibiting the release of substance P in the nociceptive pathway and blocks the aspartate and glutamate receptors. On the other hand, lidocaine also prevents and relieves pain by interrupting neuroconduction, binding to its specific receptor within the sodium channels. Objective: To evaluate the analgesic efficacy of dexmedetomidine versus lidocaine in intravenous perfusion as a treatment for breakthrough pain secondary to narrow lumbar canal. Material and methods: Controlled clinical trial, randomized, triple-blind, performed at the HGM pain clinic, two groups of patients with diagnosis of breakthrough pain secondary to narrow lumbar canal were evaluated; group one was treated with dexmedetomidine (0.3 mcg/kg) and the other group was treated with lidocaine (2 mg/kg) in intravenous infusion. Measurement of pain intensity and sedation status was made before starting the treatment and after 30, 60 and 120 minutes. The functionality of the patients was also assessed through the Oswestry disability index before and seven days after treatment. Secondarily evaluated the effect of treatments on vital signs. Results: There was not any statistically significant difference in the reduction of pain intensity at 120 minutes between patients treated with dexmedetomidine (EVA 1.29 ± 1.63) compared with those who were treated with lidocaine (EVA 1 ± 1.19, p = 0.594), it was observed that at the end of drugs perfusion, dexmedetomidine produced greater sedation, unlike lidocaine (p = 0.003), both treatments improved functionality in all patients without having a statistically significant difference between treatments (p = 0.508), they were not observed depressant effects on vital signs. Conclusions: Dexmedetomidine and lidocaine are just as equally effective for the treatment of breakthrough pain, with onset of action in the first 30 minutes after the infusion started until the next 2 hours, no adverse drug events were observed at the recommended doses

Comparación entre dexmedetomidina en infusión intravenosa vs. lidocaína en infusión intravenosa para el control de dolor refractario a tratamiento opioide en pacientes de cuidados paliativos / Comparison between dexmedetomidine infusion vs. lidocaine intravenous infusion for treatment of severe pain in palliative care patients under opioid treatment

Introducción: se define dolor refractario como aquel que se mantiene persistente (EVA 6 o más) a pesar de tratamiento con opioides (con 1 o más rotaciones previas) + antiinflamatorios (AINE o corticoides). Para tratamiento se han utilizado agonistas alfa-2 y/o anestésicos locales. La respuesta analgésica a la administración de dexmedetomidina parece producirse a nivel de la neurona de la raíz dorsal, donde los agonistas alfa-2 bloquean la liberación de la sustancia P en la vía nociceptiva. El efecto analgésico central está mediado por la activación de las vías inhibitorias descendentes gracias al bloqueo de los receptores del aspartato y glutamato. La utilización de lidocaína intravenosa puede suprimir descargas neurales ectópicas procedentes de fibras aferentes primarias lesionadas debido a sus propiedades de bloqueo dependiente de canales de voltaje de sodio Además se ha evidenciado la activación endógena del sistema de opioides por infusión de lidocaína por vía sistémica. Objetivo: evaluar el efecto analgésico de la infusión de dexmedetomidina intravenosa comparada con infusión de lidocaína intravenosa para dolor refractario a opioides en pacientes bajo cuidados paliativos. Material y métodos: se trata de un ensayo clínico aleatorizado, triple ciego, con muestreo consecutivo. El análisis de resultados con medidas de tendencia central y de dispersión. Para comparar variables cuantitativas se usó t de Student para muestras independientes. Se construyeron tablas de contingencia y gráficos a través del programa estadístico SPSS versión 17. Población de estudio: pacientes con dolor refractario, hospitalizados dentro del Programa de Cuidados Paliativos asignados aleatoriamente a uno de los 2 grupos cuyo número de muestra (n = 14) se obtuvo por fórmula de diferencia de proporciones. Resultados: en cuanto a la analgesia con ambas infusiones no hubo diferencias significativas. De los 16 pacientes, 18 % (n: 3) requirieron terapia de rescate durante la infusión y 18 % (n: 3) requirieron rescate durante las 48 horas postinfusión. Durante la infusión el 42 % del grupo de lidocaína necesitó rescate (n: 3) y en el tiempo postinfusión antes de 48 horas se administraron 3 rescates: 42 % de los pacientes del grupo de lidocaína (n: 2) y 14 % de los pacientes del grupo dexmedetomidina (n: 1). En cuanto a sedación durante la infusión se reportaron diferencias significativas (p: -0,01) reportándose mayor sedación en el grupo de dexmedetomidina. No se presentaron complicaciones cardiovasculares y/o respiratorias en ninguno de los dos grupos. Conclusiones: el grupo de dexmedetomidina requirió menos rescates con opioides durante la infusión y posterior a ella. Se presentó mayor sedación en el grupo de dexmedetomidina sin presencia de complicaciones cardiovasculares y/o respiratorias durante o posterior a la infusión (AU)

Introduction: Refractory pain is defined as that which remains persistent (EVA 6 or more) despite treatment with opioids (with 1 or more previous rotations) + anti-inflammatory drugs (NSAIDs or corticosteroids). Alpha-2 agonists and/or local anesthetics have been used for treating. Analgesic response to the administration of dexmedetomidine appears to occur at the level of dorsal root neuron, where the alpha-2 agonists block the release of substance P in the nociceptive pathway. The central analgesic effect is mediated by the activation of descending inhibitory pathways, by blocking the receptors of aspartate and glutamate. The use of intravenous lidocaine can suppress ectopic neural discharges primary afferents from injured due to its blocking voltage-dependent sodium channels. Furthermore it has been demonstrated activation of endogenous opioid system lidocaine infusion systemically. Objective: To evaluate the analgesic effect of intravenous dexmedetomidine infusion compared with intravenous lidocaine infusion for pain refractory to opioids in palliative care patients. Material and methods: This is a randomized, triple-blind study with consecutive sampling. The analysis of results with measures of central tendency and dispersion. To compare quantitative variables T test was used for independent samples. Contingency tables were constructed and graphics through SPSS version 17. Study population: Patients with refractory pain, hospitalized within the Palliative Care Program randomly assigned to one of 2 groups whose sample number (n = 14) was obtained by difference formula proportions. Results: For both infusions analgesia with no significant differences. Of the 16 patients, 18 % (n = 3) required rescue therapy during infusion and 18 % (n = 3) required rescue within 48 hours post-infusion. During infusion of the 42 % lidocaine group need rescue (n = 3) and time within 48 hours post infusion was administered three rescues: 42 % of patients in the lidocaine group (n = 2), and 14 % of dexmedetomidine group patients (n: 1). Regarding sedation during the infusion were reported significant differences (p -0.01) increased sedation reporting for dexmedetomidine group. No complications cardiovascular and / or respiratory none of the two groups. Conclusions: The dexmedetomidine group required less opioid bailouts during infusion and after it. Sedation was greater in the group of dexmedetomidine without presence of cardiovascular and/or respiratory during or after the infusion (AU)

Benzimidazole-resistant gastrointestinal nematodes in indigenous Chiapas and Pelibuey sheep breeds from Chiapas, Mexico.

Because of the natural adaptation of Mexican sheep, the aim of the present study was to identify the presence or absence of gastrointestinal parasitic nematodes (GIN) resistant to benzimidazole (BZ) in both Chiapas and Pelibuey sheep breeds on local farms. Both male and female GIN-infected grazing sheep of the two breeds were selected. Sheep faecal samples were collected to obtain infective larvae (L3). This evolving stage of the parasite was used for taxonomic identification of the genus, based on its morphological characteristics. BZ anthelmintic resistance was evaluated using a nematode-compound in vitro interaction bioassay and the allele-specific polymerase chain reaction technique to detect mutations of residues 198 and 200 on isotype 1 of the ß-tubulin gene. Three BZ-based compounds (febendazole (FBZ), tiabendazole (TBZ) and albendazole (ABZ)) at concentrations of 1, 0.5, 0.25, 0.125, 0.062 and 0.03 mg/ml were used to estimate the anthelmintic efficacy and lethal dose (LD50, LD90 and LD99) of the drugs. Two parasitic nematodes, Haemonchus and Teladorsagia, were identified in both isolates. Also, the proportions of anthelmintic resistance identified in GIN of the two sheep breeds were 68% in isolates from the Chiapas breed and 71.8% in the Pelibuey breed. The specific lethal activity obtained with FBZ was higher than 90%. However, TBZ and ABZ showed a lethal activity lower than 50%. High variability in the discriminating dose values was found among the BZ drugs. For example, FBZ LD ranged from 0.01 to 1.20 mg/ml; on the other hand, TBZ and ABZ required a dose ranging from 0.178 to 759 mg/ml. In addition, amino acid changes of Phe (TTC) to Tyr (TAC) at codon 200 of the ß-tubulin gene, showing resistance to BZ, and no changes at codon 198 Glu (GAA) to Ala (GCA) were observed for both isolates. These results confirmed the presence of a genetic mutation associated with BZ in both Chiapas and Pelibuey nematode isolates.

Fracturas múltiples de la columna cervical: Reporte de un caso / Multiple cervical spine fractures: Case report

Introducción: Las fracturas múltiples en la columna cervical son una entidad relativamente infrecuente, acerca de la cual la información disponible a nivel mundial es escasa. Existe una tendencia en los casos reportados a manejar dicha entidad de manera conservadora, con combinación de tracciones esqueléticas y diversas órtesis, con resultados variables. Existen pocos reportes de fracturas múltiples manejadas quirúrgicamente. Objetivo: Reportar un caso clínico de fractura múltiple cervical manejado quirúrgicamente en dos tiempos y su seguimiento, en el Centro de Atención a Lesionados Raquimedulares de la Ciudad de México, en el Hospital General "La Villa" de los SSDF. Material y métodos: Se presenta el caso clínico de un paciente masculino de 46 años de edad quien sufre accidente automovilístico con trauma raquimedular con fracturas de C2 a C6, ASIA C. Se decide su tratamiento quirúrgico a dos tiempos con instrumentación posterior y anterior sucesivamente. Se reporta el seguimiento clínico y radiológico a casi dos años de evolución. Resultados: A 19 meses de seguimiento el paciente se encuentra neurológicamente en ASIA D, con un leve déficit motor en el miembro torácico izquierdo. Reincorporado a su trabajo habitual y con movilidad aceptable en la columna cervical. Conclusiones: La evolución satisfactoria presentada por el paciente, tanto en su recuperación neurológica como en la reincorporación a sus labores cotidianas permite recomendar el manejo quirúrgico de fracturas múltiples, individualizando cada caso e interviniendo de acuerdo con la personalidad de cada fractura, con lo cual se puede esperar la obtención de resultados favorables.

Introduction: Multiple cervical spine fractures are a relatively infrequent entity and thus the available information on them is scarce worldwide. The cases reported are usually managed conservatively, with a combination of skeletal traction and various braces, with variable results. There are only a few reports of multiple fractures treated surgically. Objective: This is a report of a clinical case of a multiple cervical fracture treated surgically in 2 stages at the Mexico City Center for Patients with Spine and Spinal Cord Injury (Centro de Atención a Lesionados Raquimedulares de la Ciudad de México), located at "La Villa" General Hospital, SSDF. Material and methods: We report the clinical case of a male, 46 year-old patient involved in a motor vehicle accident who sustained spine and spinal cord injuries consisting of ASIA C C2-C6 fractures. It was decided to perform two-stage surgery with posterior and anterior instrumentation. We report the 19-month clinical and radiological follow-up. Results: In the 19-month follow-up visit, the patient was found to be ASIA D according to the neurological assessment, with mild motor deficit of the left thoracic limb. The patient had returned to his usual job and had acceptable cervical spine mobility. Conclusions: The patient's appropriate course from the neurological perspective and his return to his daily activities leads to recommending the surgical management of multiple fractures, customizing it in each case according to the fractures' characteristics. Favorable results may be expected from this approach.

[Multiple cervical spine fractures. Case report]. / Fracturas múltiples de la columna cervical. Reporte de un caso.

INTRODUCTION: Multiple cervical spine fractures are a relatively infrequent entity and thus the available information on them is scarce worldwide. The cases reported are usually managed conservatively, with a combination of skeletal traction and various braces, with variable results. There are only a few reports of multiple fractures treated surgically. Objective: This is a report of a clinical case of a multiple cervical fracture treated surgically in 2 stages at the Mexico City Center for Patients with Spine and Spinal Cord Injury (Centro de Atenci6n a Lesionados Raquimedulares de la Ciudad de Mexico), located at "La Villa" General Hospital, SSDF. MATERIAL AND METHODS: We report the clinical case of a male, 46 year-old patient involved in a motor vehicle accident who sustained spine and spinal cord injuries consisting of ASIA C C2-C6 fractures. It was decided to perform two-stage surgery with posterior and anterior instrumentation. We report the 19-month clinical and radiological follow-up. RESULTS: In the 19-month follow-up visit, the patient was found to be ASIA D according to the neurological assessment, with mild motor deficit of the left thoracic limb. The patient had returned to his usual job and had acceptable cervical spine mobility. CONCLUSIONS: The patient's appropriate course from the neurological perspective and his return to his daily activities leads to recommending the surgical management of multiple fractures, customizing it in each case according to the fractures' characteristics. Favorable results may be expected from this approach.

[Morphometric analysis of cervical pedicles in a Mexican population]. / Análisis morfométrico de los pedículos cervicales en una población mexicana.

BACKGROUND: Knowledge of the morphometric anatomy of cervical pedicles is essential for the safe and accurate placement of pedicle screws during instrumentation of the cervical spine. Screw placement in the lumbar and thoracic vertebrae is considered as a safe practice, unlike the cervical vertebrae due to the risks involved. There are few reports on this technique. The little available information comes from populations different from the Mexican population. Knowing the measurements of each cervical vertebra will provide proper screw orientation and selection at the time of screw placement. METHODS: Prospective, cross-sectional, descriptive study in subjects who presented at the outpatient and emergency services. Patient's in whom a CAT scan of the cervical spine was ordered as part of the work-up protocol, from April 1st 2010 to October 31st 2010, were included. A morphometric anatomic study was undertaken using the CAT software. In a saggital view: a) Saggital angle, b) Saggital diameter. In an axial view: a) Work distance, b) Cross-sectional angle and c) Cross-sectional diameter. RESULTS: The following measurements were obtained for each segment from C2 to C7: mean, standard deviation, range and minimal and maximal values. CONCLUSIONS AND CLINICAL RELEVANCE: Appropriate preoperative planning prior to cervical transpedicular instrumentation is essential to achieve greater accuracy during screw placement. The information obtained allows performing the procedure. As a result of this, a report based on out center's experience may be disseminated thus sharing our technique with the medical community.

Inactivation of Cryptosporidium parvum oocysts in water using ultrasonic treatment.

Ultrasound in a liquid phase cause mass and heat transfer across the liquid through cavitational processes which act as nanoreactors to generate unstable mechanical equilibrium. The effect of 1 MHz ultrasound on the inactivation of Cryptosporidium parvum was investigated. Continuous irradiation of ultrasound (20 min) increased temperature due to cavitational phenomena. Ultrasound irradiation of liquid containing C. parvum showed significant quantitative changes in pH, temperature and inactivation of C. parvum (102.7 oocysts killed/s) with a minimum energy consumption (0.05 oocysts/s).

Réplica. El zumo de Tahitian Noni® no es hepatotóxico: nuestros comentarios / No disponible

No disponible

Hepatotoxicidad grave asociada al consumo de Noni (Morinda citrifolia) / Hepatotoxicity caused by a Noni (Morinda citrifolia) preparation

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Ki67 expression in different epithelial types in columnar lined oesophagus indicates varying levels of expanded and aberrant proliferative patterns.

AIMS: To evaluate proliferative patterns in metaplastic columnar epithelia of the oesophagus, classified as oxynto-cardiac (n = 43), cardiac (n = 45) intestinal without dysplasia (n = 41), dysplastic intestinal epithelium (n = 25), and adenocarcinoma (n = 15) by Ki67 immunohistochemistry. METHODS AND RESULTS: Abnormal patterns of Ki67 immunoreactivity were classified into (i) expanded proliferation, characterized by increased levels of Ki67 expression in the deep and mid third of the foveolar pit; and (ii) aberrant proliferation, characterized by positive staining in the surface epithelium and superficial third of the foveolar pit. A significant step-wise increase in the frequency of expanded proliferation was seen in oxynto-cardiac, cardiac, intestinal and dysplastic intestinal epithelium indicative of increasing levels of damage. Aberrant proliferation was absent in oxynto-cardiac mucosa, present at a low and similar level in cardiac, intestinal and low-grade dysplastic epithelia and at a significantly increased frequency in high-grade dysplasia. CONCLUSIONS: These findings suggest that oxynto-cardiac mucosa occurs in a low damage environment and intestinal metaplasia in a high damage environment along the length of the columnar lined oesophageal segment. Aberrant proliferative patterns with Ki67 staining are not useful in differentiating reactive epithelia from low-grade dysplasia, but may prove useful in the diagnosis of high-grade dysplasia.