Evolución de la artrodesis cervical postdisectomía: injerto óseo,placa,caja intersomática y placa-caja

Se revisan las técnicas de artrodesis cervical anterior postdiscectomía con injerto óseo, placa cervical, caja intersomática y placa-caja, discutiendo las ventajas mecánicas que aporta cada sistema. La alternativa a la artrodesis es la discectomía simple o la artroplastia con prótesis discal. Los sistemas placa-caja integrados pueden considerase como el resultado final de la evolución de los conceptos de artrodesis cervical. Se describen detalladamente los sistemas placa-caja actualmente disponibles

La estimulación eléctrica de la corteza motora para el tratamiento del dolor central y dolor periférico por desaferentización

Central pain and peripheral pain caused by desafferentation are difficult to treat even with last generation drugs. Electric stimulation of several structures has shown to be scarcely effective in general. Stimulation of motor cortex is a relatively new technique that seems to offer promising results in these disorders. While it is a simple technique from the surgical point of view, the adequate location of the motor cortex is not so easy, this being a significant condition for its effectiveness. In this paper we review the literature that has been published on the matter. Currently, its major indications are central pain, mainly thalamic, and trigeminal pain caused by desafferentation. The response to barbiturates without response to opiates, the relative preservation of motor and sensitive pathways and the response to transcranial magnetic stimulation predict a good result. Several methods are used to determine the area that has to be stimulated: SSEP, intraoperatory stimulation, neuronavegation, functional MRI. The stimulation parameters recommended vary according to the author. Its mechanism of action is still not well understood, but the most accepted theories are the activation of areas that modulate pain and the inhibition of the transmission of nociceptive stimuli at the medullar level.El dolor central y el dolor periférico por desaferentización son de difícil tratamiento incluso con fármacos de última generación. La estimulación eléctrica sobre diversas estructuras ha demostrado en general ser poco efectiva. La estimulación sobre la corteza motora es una técnica relativamente nueva que parece ofrecer resultados prometedores en estos cuadros. Aunque desde el punto de vista quirúrgico es una técnica sencilla, no lo es tanto la localización adecuada de la corteza motora, lo cual es una condición importante para su efectividad. En este trabajo ofrecemos una revisión bibliográfica sobre ella. Sus indicaciones fundamentales actualmente son el dolor central fundamentalmente talámico, y el dolor trigeminal por desaferentización. La respuesta a barbitúricos sin respuesta a opioides, la conservación relativa de las vías motoras y sensitivas, y la respuesta a la estimulación magnética transcraneal predicen un buen resultado. Diversos métodos son utilizados para determinar la zona a estimular: PESS, estimulación intraoperatoria, neuronavegación, RNM funcional. Los parámetros de estimulación recomendados varían de unos autores a otros. Su mecanismo de actuación no es en la actualidad bien conocido aunque las teorías más aceptadas son la activación de zonas que modulan el dolor y la inhibición de la transmisión de los estímulos nociceptivos a nivel medular

Angioma cavernoso del trígono ventricular: caso clínico

Se presenta un caso de cavernoma intraventricular de trígono derecho en un hombre de 25 años con sangrado espontáneo predominantemente intralesional. Las técnicas de imagen permitieron el diagnóstico preoperatorio de la lesión, aunque faltaba el anillo perilesional de gliosis y hemosiderina. La lesión fue extirpada microquirúrgicamente sin incidencias por vía temporal posterior trans-sulcal y con guía estereotáctica

Desarrollo de un nuevo sistema de fijación cervical anterior. Placa cervical GD

The section of Implants and Surgical Equipment of the IBV has developed with the Valencian company NEUROIMPLANT a novel implant for anterior surgery of cervical spine. This implant displays suggestive improvements on the existing models in the market. The development of this new product, based on the criteria defined by José M. González-Darder (Service of Neurosurgery of the Hospital General de Castellón) and supervised by him, has been carried out with the co-operation of Industrias Quirúrgicas de Levante (IQL). It is a cervical plate incorporating an intersomatic box and that solves many of the problems that the cervical fixation systems present at the moment.LA SECCIÓN DE IMPLANTES E INSTRUMENTAL QUIRÚRGICO DEL IBV HA DESARROLLADO con la empresa valenciana NEUROIMPLANT un novedoso implante para cirugía anterior del raquis cervical, Este implante aporta sugerentes mejoras sobre los modelos existentes en el mercado. El desarrollo de este nuevo producto, basado en los criterios definidos por José M. González-Darder (Servicio de Neurocirugía del Hospital General de Castellón) y supervisado por él, se ha materializado con la colaboración de Industrias Quirúrgicas de Levante (IQL). Se trata de una placa cervical que incorpora una caja intersomática y que soluciona muchos de los problemas que actualmente presentan los sistemas de fijación cervical

Using NMR in saliva to identify possible biomarkers of glioblastoma and chronic periodontitis

<div><p>Nowadays there is increasing interest in identifying–and using–metabolites that can be employed as biomarkers for diagnosing, treating and monitoring diseases. Saliva and NMR have been widely used for this purpose as they are fast and inexpensive methods. This case-control study aimed to find biomarkers that could be related to glioblastoma (GBL) and periodontal disease (PD) and studied a possible association between GBL and periodontal status. The participants numbered 130, of whom 10 were diagnosed with GBL and were assigned to the cases group, while the remaining 120 did not present any pathology and were assigned to the control group. On one hand, significantly increased (p < 0.05) metabolites were found in GBL group: leucine, valine, isoleucine, propionate, alanine, acetate, ethanolamine and sucrose. Moreover, a good tendency to separation between the two groups was observed on the scatterplot of the NMR. On the other hand, the distribution of the groups attending to the periodontal status was very similar and we didn´t find any association between GBL and periodontal status (Chi-Square 0.1968, p = 0.91). Subsequently, the sample as a whole (130 individuals) was divided into three groups by periodontal status in order to identify biomarkers for PD. Group 1 was composed of periodontally healthy individuals, group 2 had gingivitis or early periodontitis and group 3 had moderate to advanced periodontitis. On comparing periodontal status, a significant increase (p < 0.05) in certain metabolites was observed. These findings along with previous reports suggest that these could be used as biomarkers of a PD: caproate, isocaproate+butyrate, isovalerate, isopropanol+methanol, 4 aminobutyrate, choline, sucrose, sucrose-glucose-lysine, lactate-proline, lactate and proline. The scatter plot showed a good tendency to wards separation between group 1 and 3.</p></div

Metabolites identified and compared attending the periodontal satatus.

<p>* p < 0.05 and ** p < 0.01.</p

Distribution of case and control groups attending to the periodontal status.

<p>Distribution of case and control groups attending to the periodontal status.</p

Distribution of case and control groups.

<p>Distribution of case and control groups.</p

Metabolites identified and compared between GBM and control groups.

<p>* p < 0.05 and ** p < 0.01.</p

Metabolites identified and compared attending the periodontal satatus.

<p>* p < 0.05 and ** p < 0.01.</p