[The effect of age on the prognosis of patients with traumatic brain injury who undergo a craniotomy: analysis of a surgical series]. / Efecto de la edad en el pronostico de pacientes con traumatismo craneoencefalico sometidos a craneotomia: analisis de una serie quirurgica.

INTRODUCTION: In our setting, the ageing of the population has led to management of traumatic brain injury (TBI) in the later stages of life becoming an increasingly frequent problem. AIM: To evaluate the association between age and the functional and survival prognosis of patients who have undergone surgery due to TBI. PATIENTS AND METHODS: We performed a retrospective analysis of a series of 404 patients submitted to surgery between the years 2000 and 2015: 144 youngsters (12-44 years), 77 adults (45-64 years), 148 geriatric patients (65-79 years) and 26 'super geriatric' patients (> 80 years). We reviewed the demographic and nosological characteristics of the population, the survival and functional prognosis (Glasgow Outcome Scale, GOS) on discharge and at six months. RESULTS: Age presents a positive linear association with both intra-hospital mortality and the proportion of patients with an unfavourable prognosis (GOS 1-3) on hospital discharge and at six months (p < 0.001). Taking the population of youngsters as a reference, the relative risk for an unfavourable prognosis at six months was 1.5 (95% CI: 1.04-2.19) for adults; 2.37 (95% CI: 1.77-3.17) for the geriatric patients; and 3.5 (95% CI: 2.63-4.7) for the 'super geriatric' patients. These latter present a mortality rate while in hospital of 77.78% and a percentage of poor functional prognosis at six months of 94.44%. CONCLUSION: Increased age is a major negative determining factor in the prognosis of patients who undergo a craniotomy due to TBI. More precise knowledge of these outcomes and an adequate pre-operative discussion with the family will be an invaluable aid in the decision-making process.

TITLE: Efecto de la edad en el pronostico de pacientes con traumatismo craneoencefalico sometidos a craneotomia: analisis de una serie quirurgica.Introduccion. En nuestro entorno, el envejecimiento poblacional ha convertido el manejo del traumatismo craneoencefalico (TCE) en etapas avanzadas de la vida en un problema de frecuencia creciente. Objetivo. Valorar la asociacion entre la edad y el pronostico vital y funcional de pacientes intervenidos por TCE. Pacientes y metodos. Analizamos retrospectivamente una serie de 404 pacientes intervenidos en nuestro centro entre los años 2000 y 2015: 144 jovenes (12-44 años), 77 adultos (45-64 años), 148 pacientes geriatricos (65-79 años) y 26 supergeriatricos (> 80 años). Revisamos las caracteristicas demograficas y nosologicas de la poblacion, y el pronostico vital y funcional (escala pronostica de Glasgow, GOS) en el momento del alta y a los seis meses. Resultados. La edad presenta asociacion lineal positiva tanto con la mortalidad intrahospitalaria como con la proporcion de pacientes con pronostico desfavorable (GOS 1-3) en el alta y a los seis meses (p < 0,001). Tomando como referencia la poblacion de jovenes, el riesgo relativo para pronostico desfavorable a los seis meses fue de 1,5 (IC 95%: 1,04-2,19) para los adultos, 2,37 (IC 95%: 1,77-3,17) para los geriatricos y 3,5 (IC 95%: 2,63-4,70) para los supergeriatricos. Estos ultimos presentan una mortalidad durante el ingreso del 77,78% y un porcentaje de mal pronostico funcional a los seis meses del 94,44%. Conclusion. El aumento de la edad es un factor determinante negativo mayor en el pronostico de pacientes sometidos a craneotomia por TCE. Un conocimiento preciso de estos resultados y una adecuada discusion preoperatoria con la familia resultaran de gran ayuda en el proceso de toma de decisiones.

Relevance of sampling and DNA extraction techniques for the analysis of salivary evidence from bite marks: a case report.

Bite mark evidence has been repeatedly found in criminal cases. Physical comparison of a bite mark to the teeth of available suspects may not always be possible. Experimental studies have shown that the analysis of DNA present in the saliva recovered from bite marks might help in the identification of individuals. However, the application of this approach to an actual criminal case has been reported only once before in forensic literature. Therefore, there is very limited scientific and technical information available on this subject. The current study focuses on a woman found dead in her home; the autopsy ruled the death to be a result of manual strangulation. A bite mark was found on each breast. The single swab technique was used to collect evidence from these bite marks, and an organic extraction method was employed for DNA isolation. Short tandem repeat (STR) sequence typing was performed using a commercially available kit, and the result was compared to the STR profile of a suspect. A full single-source STR profile was obtained from both bite marks, which matched the STR profile of the suspect. To the best of our knowledge, this is the second report on the analysis of DNA isolated from bite marks on the victim used to identify the crime perpetrator. Our results indicated that, contrary to most theoretical indications, a single swab technique for evidence collection and an organic method for DNA isolation could be very useful in solving this class of criminal cases.

Polymorphisms in GSTM1, GSTT1, GSTP1, and GSTM3 genes and breast cancer risk in northeastern Mexico.

Glutathione S-transferases (GSTs) are a family of phase II metabolizing enzymes involved in carcinogen detoxification and the metabolism of various bioactive compounds. Several genes that code for these enzymes are polymorphic in an ethnicity-dependent manner, with particular genotypes previously associated with an increased risk of breast cancer. The purpose of this study was to determine the frequencies of polymorphisms in the genes GSTM1, GSTT1, GSTP1, and GSTM3 and to investigate whether an association exists between these genes and breast cancer risk in subjects from northeastern Mexico. Genotypes were determined for 243 women with histologically confirmed breast cancer and 118 control subjects. Gene polymorphisms were analyzed using a DNA microarray. We found an increased breast cancer risk associated with the GSTM1 gene deletion polymorphism (OR = 2.19; 95%CI = 1.50-3.21; P = 0.001). No associations between the GSTT1, GSTP1, and GSTM3 genotypes and neoplasia risk were observed. In conclusion, we determined the genotype distribution of GST polymorphisms in control subjects and breast cancer patients from northeastern Mexico. The GSTM1 null genotype was associated with breast cancer risk. Our findings may be used to individualize breast cancer screening and therapeutic intervention in our population, which displays ethnic characteristics that differentiate it from other populations in Mexico.

[Fluorescence-guided resection with 5-aminolevulinic acid of an intramedullary tumor]. / Resección de tumor intramedular guiada por fluorescencia con ácido aminolevulínico.

Fluorescence-guided resection with 5-aminolevulinic acid (5-ALA) has demonstrated its usefulness in the resection of malignant cerebral gliomas. It also seems useful for the treatment of other types of cerebral and intramedullary neoplasms. We present the case of a patient with an intramedullary tumor in who fluorescence- guided resection was useful for intraoperative localization, definition of small tumor nodules and in order to achieve a complete resection of the tumor.

Resección de tumor intramedular guiada por fluorescencia con ácido aminolevulínico / Fluorescence-guided resection with 5-aminolevulinic acid of an intramedullary tumor

La resección guiada por fluorescencia con ácidoaminolevulínico (5-ALA) se ha demostrado útil para el tratamiento quirúrgico de los gliomas cerebrales malignos.También parece útil en el tratamiento de otros tipos de tumores, tanto cerebrales como intramedulares. Presentamos el caso de un paciente con un tumor intramedular en el que la fluorescencia con 5-ALA fue de utilidad para la localización intraoperatoria de la lesión, para la identificación de pequeños nódulos en el parénquima medular y para lograr la exéresis completa del tumor (AU)

Fluorescence-guided resection with 5-aminolevulinicacid (5-ALA) has demonstrated its usefulness in the resection of malignant cerebral gliomas. It also seems useful for the treatment of other types of cerebral and intramedullary neoplasms. We present the case of a patient with an intramedullary tumor in who fluorescence-guided resection was useful for intraoperative localization, definition of small tumor nodules and in order to achieve a complete resection of the tumor (AU)

[Intramedullary schwannomas. Report of two cases]. / Neurinomas intramedulares. Presentación de dos casos de un tumor infrecuente.

Intramedullary schwannomas are benign tumors that arise from clusters of Schwann cells embedded in the medullary parenchyma. They are very rare and account for 0.3 to 1.5 % of all spinal schwannomas. It is not known for certain why this happens, and several theories have been put forward. They do not exhibit any characteristic clinical picture, being pain the most frequent symptom. Imaging is also not specific and the correct diagnosis is attained most of the times after pathological examination. The goal of treatment must be complete removal, which is curative. We are presenting two patients in whom an intramedullary tumor was removed. The true nature of the lesions was suspected during the operation, but only after pathological examination was confirmed. A review of the literature has been undertaken, with special attention to the theories about the origin of these uncommon tumors.

Neurinomas intramedulares. Presentación de dos casos de un tumor infrecuente / Intramedullary schwannomas. Report of two cases

Los schwannomas intramedulares son tumoresbenignos derivados de células de Schwann localizadasen el parénquima medular. Son muy infrecuentes, constituyendoentre el 0,3 y el 1,5% de los schwannomasespinales. Existen varias teorías que intentan explicarla presencia de células de Schwann intramedularesa partir de las que derivarían estas neoplasias. Lasintomatología no es específica, siendo el dolor elsíntoma más frecuente, pudiéndose añadir, además,cualquier signo de afectación medular según el nivelde localización. En las pruebas de neuroimagen, la sospechade otras lesiones intramedulares de origen glialmás frecuentes hace que el diagnóstico de schwannomaintramedular sea postquirúrgico la mayoría de lasveces. El tratamiento es quirúrgico, pudiendo llevarse acabo, habitualmente, una resección completa.En este artículo presentamos dos casos de pacientesintervenidas quirúrgicamente de sendas lesionesintramedulares, que resultaron ser neurinomas. Hacemosuna revisión de otros casos publicados en la literatura,exponiendo las teorías existentes acerca del origende estos tumores poco frecuentes (AU)

Intramedullary schwannomas are benign tumorsthat arise from clusters of Schwann cells embeddedin the medullary parenchyma. They are very rare andaccount for 0.3 to 1.5 % of all spinal schwannomas. Itis not known for certain why this happens, and severaltheories have been put forward. They do not exhibitany characteristic clinical picture, being pain the mostfrequent symptom. Imaging is also not specific and thecorrect diagnosis is attained most of the times afterpathological examination. The goal of treatment mustbe complete removal, which is curative.We are presenting two patients in whom an intramedullarytumor was removed. The true nature ofthe lesions was suspected during the operation, butonly after pathological examination was confirmed. Areview of the literature has been undertaken, with specialattention to the theories about the origin of theseuncommon tumors (AU)

[Isolated mesencephalic stroke related to a ruptured intracranial dermoid cyst]. / Ictus isquémico mesencefálico aislado secundario a ruptura de quiste dermoide.

Dermoids cysts are embrionary benign lesions that comprise approximately 0.04-0.25% of all intracranial tumors. Occasionally they break and spread their content into subarachnoid space and/or lateral ventricles causing several acute or delayed symptoms. Debut of this type of tumor as acute stroke is poorly reflected in literature. We present a 26-year-old woman with a isolated mesencephalic infarct secondary to spontaneous rupture of a dermoid cyst. We discuss the possible pathophysiological mechanisms for this condition and review the literature.

Ictus isquémico mesencefálico aislado secundario a ruptura de quiste dermoide / Isolated mesencephalic stroke related to a ruptured intracranial dermoid cyst

Los quistes dermoides son lesiones benignas deorigen embrionario que representan del 0.04 a 0,25%de todos los tumores intracraneales. Estos quistesocasionalmente pueden romperse diseminándose elcontenido graso intraquístico al espacio subaracnoideoy/o los ventrículos laterales. En este caso puede provocardiversas manifestaciones clínicas de forma agudao retardada. El debut de este tipo de tumor con unictus agudo está escasamente reflejado en la literatura.Presentamos el caso de una mujer de 26 años con uninfarto mesencefálico aislado secundario a la rupturade un quiste dermoide. Discutimos el mecanismofisiopatológico supuesto y realizamos una revisión delos casos recogidos en la literatura (AU)

Dermoids cysts are embrionary benign lesions thatcomprise approximately 0.04-0.25% of all intracranialtumors. Occasionally they break and spread their contentinto subarachnoid space and/or lateral ventriclescausing several acute or delayed symptoms. Debut ofthis type of tumor as acute stroke is poorly reflected inliterature. We present a 26-year-old woman with a isolatedmesencephalic infarct secondary to spontaneousrupture of a dermoid cyst. We discuss the possiblepathophysiological mechanisms for this condition andreview the literature (AU)

[Remote cerebellar hemorrhage after lumbar spinal fluid drainage. Report of two cases and literature review]. / Hematomas de cerebelo como complicación de drenaje lumbar. Presentación de dos casos y revisión de la literatura.

Remote cerebellar hematoma, a cerebellar hematoma occurring after performing a surgical procedure in an anatomical distant area from the cerebellum, is a rare complication. It has been reported after supratentorial surgery and, less often, after spinal surgery with dural opening with important loss of cerebrospinal fluid. We report the occurrence of remote cerebellar hemorrhage after lumbar spinal fluid drainage in two patients with suspected normal pressure hydrocephalus. They were managed conservatively with good outcome. We review the pathologic mechanism, diagnostic procedures, management and prognosis of remote cerebellar hemorrhage.

Hematomas de cerebelo como complicación de drenaje lumbar. Presentación de doscasos y revisión de la literatura / Remote cerebellar hemorrhage after lumbar spinal fluid drainage. Report of two cases and literature review

Los hematomas de cerebelo a distancia (HCD) sonuna complicación rara, consistente en la aparición deun hematoma en el cerebelo tras intervenciones quirúrgicasen áreas que no guardan relación anatómicacon él. Esta complicación ha sido descrita tras cirugíasupratentorial y, menos frecuentemente, tras cirugíaraquídea con apertura dural con importante pérdidade líquido cefalorraquídeo (LCR).Presentamos dos pacientes con un hematoma decerebelo tras la colocación de un drenaje lumbarexterno (DLE) por sospecha diagnóstica de hidrocefaliacrónica del adulto (HCA). Ambos evolucionaronfavorablemente tras la retirada de los DLE. Así mismo,realizamos una revisión de la literatura sobre los mecanismosetiopatogénicos, diagnóstico, tratamiento y pronósticode los HCD (AU)

Remote cerebellar hematoma, a cerebellar hematomaoccurring after performing a surgical procedure in ananatomical distant area from the cerebellum, is a rarecomplication. It has been reported after supratentorialsurgery and, less often, after spinal surgery with duralopening with important loss of cerebrospinal fluid. Wereport the occurrence of remote cerebellar hemorrhageafter lumbar spinal fluid drainage in two patients withsuspected normal pressure hydrocephalus. They weremanaged conservatively with good outcome. We reviewthe pathologic mechanism, diagnostic procedures, management and prognosis of remote cerebellar hemorrhage (AU)

Diffuse leptomeningeal seeding from benign choroid plexus papilloma.

Choroid plexus papillomas (CPP) are rare intracranial tumours with a favourable long-term outcome after surgical excision. Although they are histologically benign, local recurrences may occasionally occur, but leptomeningeal dissemination is exceptional. We report an unusual example of a fourth ventricle choroid plexus papilloma with diffuse leptomeningeal seeding. Neither the initial tumour nor the recurrence showed malignant histological features. Treatment with systemic and intrathecal chemotherapy was ineffective in this patient. We review the literature concerning leptomeningeal dissemination of benign choroid plexus papillomas.

Ultrastructure of the seminiferous epithelium of ethyl methanesulphonate-treated mouse.

Ethyl methanesulphonate (EMS) is a mutagenic alkylating agent that induces marked elevations of sperm abnormalities in mice. In this paper, we report the ultrastructural findings on the morphology of the seminiferous epithelium of mice resulting from EMS administration. Eight- to twelve-weeks-old male mice were injected intraperitoneally with EMS at 200 mg kg(-1) body weight daily for five consecutive days. Analysis of smears of epididymis and semi-thin sections of testes revealed that the more suitable specimens for the ultrastructural analysis were tissues of mice killed at the third week, following EMS administration. At this time, the spermatid was the damaged cell type. Abnormalities were mainly observed in the morphology of the nucleus, the acrosome, chromatin distribution and in the arrangement of the cytoplasmic microtubules, and binucleated spermatids were also observed. EMS has the capacity to penetrate the blood-testis barrier, and thus it can damage post-meiotic spermatogenic cells. However, morphological abnormalities could be the consequence of damage exerted on the differentiated spermatogonia stage, the most sensitive spermatogenic cell to the action of chemical agents or drugs. Our findings contribute to elucidate the action mechanism of the damage exerted by EMS administration on the germinal male cells.

[Chordoid glioma of the III ventricle. Case report and revision of the literature]. / Glioma cordoide del III ventrículo. Nuevo caso y revisión de la literatura.

Chordoid glioma of the third ventricle is an infrequent brain tumour that was described for the first time by Brat et al. in 1998; since then, only 39 cases have been reported. We present a new case of chordoid glioma of the third ventricle in a 51-year-old-man that was treated with total surgical removal, with a good initial postoperative evolution. Sudden death, most likely due to a massive pulmonary embolism, occurred in the third postoperative day. We present the histological characteristics of the tumour and review the literature regarding this entity.

Glioma cordoide del III ventrículo. Nuevo caso y revisión de la literatura / No disponible

El glioma cordoide del tercer ventrículo es una entidadtumoral muy infrecuente descrita por primeravez en 1998 por Brat y colaboradores; desde entoncesse han descrito en la literatura tan sólo 39 casos. Presentamosun nuevo caso de glioma cordoide del tercerventrículo en un paciente varón de 51 años, que fuetratado mediante resección quirúrgica completa, conbuena evolución en el postoperatorio inmediato, peroque falleció súbitamente tres días después de la intervenciónpor un probable embolismo pulmonar. Presentamoslas características histológicas del tumor yrealizamos una revisión de la literatura

Chordoid glioma of the third ventricle is an infrequentbrain tumour that was described for the firsttime by Brat et al. in 1998; since then, only 39 caseshave been reported. We present a new case of chordoidglioma of the third ventricle in a 51-year-old-man thatwas treated with total surgical removal, with a good initialpostoperative evolution. Sudden death, most likelydue to a massive pulmonary embolism, occurred in thethird postoperative day. We present the histologicalcharacteristics of the tumour and review the literatureregarding this entity

Hernias discales calcificadas en la infancia / Calcified disc herniation in childhood

Las calcificaciones de los discos intervertebrales son muy infrecuentes en la infancia. Aunque su etiologíano está clara, se sabe que no se relacionan con procesos degenerativos. Cursan con clínica inespecífica de raquialgias, contracturas musculares y, a veces, febrícula. Aunque ocasionalmente estos discos se hernian, causando dolor radicular o, mucho más raramente, déficits neurológicos o disfagia, la clínica desaparece en la mayor parte de los casos con tratamiento conservador, y sólo excepcionalmente se precisan tratamientos más agresivos. En nuestra revisión de la literatura hemos encontrado solamente17 casos que requirieron tratamiento quirúrgico. En dos de estos casos el paciente estaba previamente diagnosticado de calcificaciones intervertebrales idiopáticas, pero no se habían descartado hernias preexistentes mediante resonancia magnética (RM). Presentamos un nuevo caso de una paciente diagnosticada a la edad de 10 años decalcificaciones discales idiopáticas, sin hernias discales en la RM, en la que 4 años después uno de los discos cervicales calcificados se hernió presentando un cuadro de radiculopatía cervical con déficit motor, precisando discectomía y artrodesis intersomática. Consideramos que este caso prueba definitivamente la teoría de Heinrichy cols., que considera la hernia calcificada en la infancia como la complicación de una patología previa, la calcificación del disco intervertebral. Se discuten los aspectos clínicos y terapéuticos de esta entidad

Calcification of intervertebral discs is a rare occurrence in children. Although the etiology of the calcification remains uncertain, it is no related with degenerative diseases. The clinical picture is non specific with neck pain, muscle contractures and, sometimes, low-grade fever. These symptoms generally disappear spontaneously, and surgery rarely becomes necessary. In our review of the literature, we have found only seventeen cases requiring surgical management. Two of these children had been previously diagnosed with calcified intervertebral discs, but at the time no herniation had been ruled out with magnetic resonance imaging (MRI). We report the case of a girl who was diagnosed, when she was ten years old, with intervertebral idiopatic calcifications. Four years later she presented with radiculopathy caused by the posterolateral displacement of a calcified cervical disc, wich required operative management. We think that this case supports the theory of Heinrich et al. that considers that the calcified hernia is a complication of a previous pathology, namely intervertebral calcification. Clinical and therapeutic aspects of this entity are discussed

[Calcified disc herniation in childhood]. / Hernias discales calcificadas en la infancia.

Calcification of intervertebral discs is a rare occurrence in children. Although the etiology of the calcification remains uncertain, it is no related with degenerative diseases. The clinical picture is non specific with neck pain, muscle contractures and, sometimes, low-grade fever. These symptoms generally disappear spontaneously, and surgery rarely becomes necessary. In our review of the literature, we have found only seventeen cases requiring surgical management. Two of these children had been previously diagnosed with calcified intervertebral discs, but at the time no herniation had been ruled out with magnetic resonance imaging (MRI). We report the case of a girl who was diagnosed, when she was ten years old, with intervertebral idiopatic calcifications. Four years later she presented with radiculopathy caused by the posterolateral displacement of a calcified cervical disc, which required operative management. We think that this case supports the theory of Heinrich et al. that considers that the calcified hernia is a complication of a previous pathology, namely intervertebral calcification. Clinical and therapeutic aspects of this entity are discussed.

[Bilateral pure T11-T12 facet dislocation without neurologic residual deficit]. / Luxación pura de facetas articulares T11-T12 sin secuelas neurológicas. Caso clínico.

Bilateral pure facets dislocation in the thoracic spine is rare, but when it does occur in almost every instance produces a severe spinal cord lesion. It is thought to be caused by a flexion distraction mechanisms in most of the cases. A case is presented of a male suffered a polytrauma with important thoracic, abdominal, and esqueletic injuries in a car accident. The patient was in a hospital during two weeks, and one month after the trauma a bilateral pure dislocation of T11-T12 facets was diagnosed. Diagnosis was made with radiographs and CT with sagittal reconstruction. After an open reduction and fixation, recovery was complete within the first postoperative week. Facet dislocation in the thoracic spine is associated in many cases with thoracic and abdominal injuries that worsen the clinical picture, and thus it may contribute to misdiagnosis of the facet dislocation, specially in the cases with no neurological symptoms, adding a risk of secondary spinal cord damage. High-resolution CT with sagittal reconstruction provides an adequate and rapid demonstration of the luxation and associated thoraco-abdominal damages. Facet dislocation are unstable injuries that require open reduction and fixation. Recovery of patients with incomplete lesions is frequent, however, recovery from complete lesions did not occur.

Luxación pura de facetas articulares T11-T12 sin secuelas neurológicas. Caso clínico / Bilateral pure T11-T12 facet dislocation without neurologic residual deficit

La luxación bilateral pura de facetas articulares(LFA) a nivel de la columna torácica, es una entidad rara pero que da lugar a graves lesiones medulares en un alto porcentaje de casos. En la gran mayoría de los casos se produce por un mecanismo de flexión distracción. Presentamos el caso de un varón que sufrió un politraumatismo con importantes lesiones toraco-abdominales y esqueléticas, por lo que estuvo ingresado en un hospital comarcal, y al que, un mes después, se le diagnosticó una luxación bilateral de facetas articulares a nivel T11-T12, que en un principio pasó desapercibida. El diagnóstico se obtuvo mediante las radiografías simples y la TC con reconstrucción sagital. Fue intervenido quirúrgicamente para realizar la reducción dela luxación y fijación instrumentada a nivel T11-T12.La recuperación fue completa en la primera semana postoperatoria. La LFA pura a nivel torácico, en un elevado porcentaje, se asocia a lesiones toraco abdominales que agravan el proceso y pueden contribuir a que las LFA pasen inadvertidas inicialmente, sobre todo en pacientes sin afectación neurológica, con riesgo de provocar un daño neurológico secundario. La TC con reconstrucción sagital nos permite realizar un diagnóstico adecuado y precoz. El tratamiento es quirúrgico, tanto para la reducción como para la fijación posterior, ya que se trata de una lesión altamente inestable. El pronóstico es malo en pacientes con lesiones medulares completas, mientras que la mejoría es frecuente en los casos de lesión incompleta

Bilateral pure facets dislocation in the thoracic spineis rare, but when it does occur in almost every istance produces a severe spinal cord lesion. It is thought to becaused by a flexion distraction mechanisms in most of the cases. A case is presented of a male suffered a polytrauma with important thoracic, abdominal, and esqueletic injuries in a car accident. The patient was in a hospital during two weeks, and one month after the trauma a bilateral pure dislocation of T11-T12 facets was diagnosed. Diagnosis was made with radiographs and CT with sagittal reconstruction. After an open reduction and fixation, recovery was complete within the first postoperative week. Facet dislocation in the thoracic spine is associated in many cases with thoracic and abdominal injuriesthat worsen the clinical picture, and thus it may contribute to misdiagnosis of the facet dislocation, specially in the cases with no neurological symptoms, adding a risk of secondary spinal cord damage. High-resolution CT with sagittal reconstruction provides an adequate and rapid demonstration of the luxation and associated thoraco-abdominal damages. Facet dislocation are unstable injuries that require open reduction and fixation. Recovery of patients with incomplete lesions is frequent, however, recovery from complete lesions did not occur

[Pyogenic brain abscesses: experience with 60 consecutive cases]. / Abscesos piógenos encefálicos. Nuestra experiencia en 60 casos consecutivos.

INTRODUCTION: Brain abscess is a focal suppurative process in the brain parenchyma that still carries high mortality rates. Outcome is closely related with a correct and early management. In order to evaluate this management we have reviewed the brain abscesses treated in our Department during the last 14 years. MATERIAL AND METHODS: The authors present a retrospective series of 60 consecutive patients with pyogenic brain abscess treated between January of 1990 and February of 2004 paying attention to the epidemiology, etiology, clinical data, microbiology, treatment modalities and outcome. RESULTS: The male to female rate was 5.6 to 1. The average age was 47 years. Hematogenous spread was most frequent, followed by contiguous spread. In 22% of the cases, the origin was unknown. Regarding the causative pathogens, Gram positive cocci are the most frequent (44%), with a 40% incidence of anaerobics. A mixed infection occurred in 39% of the abscesses. Three modalities of treatment were used: non surgical, catheter drainage-aspiration and surgical excision. Outcome was excellent in 52 patients (86.7%) and 4 patients (6.7%) died. Although outcome was similar in both surgical modalities, drainage-aspiration required a second procedure in 20% of the cases while this was necessary in only 10% of the patients with abscess excision. Length of admission was shorter in the drainage-aspiration group than in the excision group (13 and 26 days respectively). Mortality was higher in patients with low level of consciousness and age over 70 years. CONCLUSIONS: The shorter admission time associated with drainage-aspiration of brain abscesses together with its high efficacy and low morbidity suggests that drainage-aspiration should be used as the first mode of treatment.