Recomendaciones –guía– en la lesión aguda medular intraoperatoria en cirugía correctora del raquis

Producción CientíficaEl objetivo del tratamiento quirúrgico para la escoliosis, cifosis y otro tipo de deformidades del raquis es la fusión de las vértebras para que la columna vertebral no pueda curvarse. Se colocan implantes metálicos (barras, tornillos, alambres, placas, etc.), para mantener el raquis mientras las vértebras se fusionan. La artrodesis vertebral se potencia con injerto (autogénico y/o alogénico) de hueso. El abordaje quirúrgico puede ser posterior, anterior o combinación de ambos. La cirugía toracoscópica se puede utilizar en el abordaje anterior del raquis dorsal. La cirugía correctora del raquis en pediatría y adultos es un procedimiento prolongado (en general más de 4 horas), tiene las complicaciones potenciales de la cirugía mayor (hemorragia grave, hipotermia, infección, embolismo graso o aéreo, hipotensión arterial, etc.)1,2 y entre las patrimoniales, las neurológicas (plejia, paresia) son las más catastróficas3,

Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study

Purpose: To determine the frequency of limitations on life support techniques (LLSTs) on admission to intensive care units (ICU), factors associated, and 30-day survival in patients with LLST on ICU admission. Methods: This prospective observational study included all patients admitted to 39 ICUs in a 45-day period in 2011. We recorded hospitals’ characteristics (availability of intermediate care units, usual availability of ICU beds, and financial model) and patients’ characteristics (demographics, reason for admission, functional status, risk of death, and LLST on ICU admission (withholding/withdrawing; specific techniques affected)). The primary outcome was 30-day survival for patients with LLST on ICU admission. Statistical analysis included multilevel logistic regression models. Results: We recruited 3042 patients (age 62.5 ± 16.1 years). Most ICUs (94.8%) admitted patients with LLST, but only 238 (7.8% [95% CI 7.0–8.8]) patients had LLST on ICU admission; this group had higher ICU mortality (44.5 vs. 9.4% in patients without LLST; p < 0.001). Multilevel logistic regression showed a contextual effect of the hospital in LLST on ICU admission (median OR = 2.30 [95% CI 1.59–2.96]) and identified the following patient-related variables as independent factors associated with LLST on ICU admission: age, reason for admission, risk of death, and functional status. In patients with LLST on ICU admission, 30-day survival was 38% (95% CI 31.7–44.5). Factors associated with survival were age, reason for admission, risk of death, and number of reasons for LLST on ICU admission. Conclusions: The frequency of ICU admission with LLST is low but probably increasing; nearly one third of these patients survive for ≥ 30 days

Variscan Metamorphism

Various segments of Variscan crust are currently exposed in Iberia in response to successive tectonic events during the Variscan orogeny itself and subsequent extensional and compressive events during the Alpine cycle, all accompanied by surface erosion, and collectively contributing to their exhumation. We review the main characteristics and geodynamic contexts of the metamorphic complexes developed in Iberia during the Variscan cycle, which include: (i) LP-HT complexes associated to the Cambrian-Early Ordovician rift stage; (ii) HP-LT complexes associated to subduction; and (iii) syn-to-post-collisional, MP and LP/HT complexes from the hinterland to the foreland fold-and thrust belts. All the above contexts are illustrated with case studies. Finally, a review of Variscan metamorphism in the Pyrenees and Catalan Coastal Ranges, located far away from the Rheic suture is also presented