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Bibliographic Details
Main Author:	Erick Héctor Hernández González
Format:	Artículo científico
Language:	es
Published:	Centro Provincial de Información de Ciencias Médicas de Camagüey 2013
Subjects:	Medicina TERAPIA diagnóstico ESTENOSIS ESPINAL CONDUCTO VERTEBRAL HERENCIA MULTIFACTORIAL
Online Access:	https://www.redalyc.org/articulo.oa?id=211129320009
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Estenosis espinal lumbar degenerativa Erick Héctor Hernández González Antonio Puente Álvarez Gretel Mosquera Betancourt Medicina TERAPIA diagnóstico ESTENOSIS ESPINAL CONDUCTO VERTEBRAL HERENCIA MULTIFACTORIAL Fundamento: el aumento progresivo de la esperanza de vida viene acompañado de una mayor incidencia de las enfermedades degenerativas del raquis como la estenosis espinal. Objetivo: actualizar y sistematizar los conocimientos sobre la estenosis espinal degenerativa del canal espinal lumbar. Método: se realizó una revisión de la literatura de los último cinco años. Se insistió en la clasificación, patogenia, diagnóstico y tratamiento. Desarrollo: la estenosis espinal degenerativa del canal lumbar es un desorden multifactorial caracterizado por un estrechamiento del canal vertebral, del receso lateral o de los agujeros de conjunción secundaria a hipertrofia degenerativa y progresiva de cualquiera de las estructuras óseas, cartilaginosas o ligamentosas que culmina en una compresión neurológica y vascular. La claudicación neurogéna es de los síntomas más característicos. El diagnóstico se basa en las mediciones realizadas en las imágenes de tomografía axial computarizada y en la resonancia nuclear magnética. Las opciones terapéuticas incluyen el tratamiento conservador y el quirúrgico, con las técnicas descompresivas convencionales y las de mínima invasión, preferidas en la actualidad. Conclusiones: la estenosis espinal degenerativa es una enfermedad multifactorial. El diagnóstico se fundamenta en la sospecha clínica confirmada en los estudios imagenológicos. Para la elección del tratamiento deben tenerse en cuenta factores relacionados con el paciente, con las características de la estenosis y con la disponibilidad de la tecnología. El objetivo de la cirugía se encaminará a descomprimir las estructuras neurovasculares y respetar la estabilidad del raquis para disminuir la morbilidad posoperatoria. 2013 artículo científico 1025-0255 https://www.redalyc.org/articulo.oa?id=211129320009 es http://www.redalyc.org/revista.oa?id=2111 Archivo Médico de Camagüey application/pdf Centro Provincial de Información de Ciencias Médicas de Camagüey Archivo Médico de Camagüey (Cuba) Num.4 Vol.17

if (filemtime($filename) + $maxlifetime < time()) { unlink($filename); $count++; } } return $count; } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ protected function saveSession($sessId, $data): bool { $sessFile = $this->path . '/sess_' . $sessId; if ($handle = fopen($sessFile, 'w')) { $return = false; // Lock the file for exclusive access to avoid issues with multiple // processes writing session simultaneously: if (flock($handle, LOCK_EX)) { $return = fwrite($handle, $data); // Make sure that there's no trailing data by truncating the file to // the correct length: ftruncate($handle, strlen($data)); fflush($handle); flock($handle, LOCK_UN); } fclose($handle); if ($return !== false) { return true; } } // If we got this far, something went wrong with the file output... // It is tempting to throw an exception here, but this code is called // outside of the context of exception handling, so all we can do is // echo a message.

// Anecdotal testing Today and Yesterday seems to indicate destroy() // is called by the garbage collector and everything is good. // Something to keep in mind though. return 0; } /** * Write function that is called when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ public function write($sessId, $data): bool { if ($this->writesDisabled) { return true; } return $this->saveSession($sessId, $data); } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ abstract protected function saveSession($sessId, $data): bool; }

* * @return void */ public function writeClose() { // The assumption is that we're using PHP's ext/session. // session_write_close() will actually overwrite $_SESSION with an // empty array on completion -- which leads to a mismatch between what // is in the storage object and $_SESSION. To get around this, we // temporarily reset $_SESSION to an array, and then re-link it to // the storage object. // // Additionally, while you _can_ write to $_SESSION following a // session_write_close() operation, no changes made to it will be // flushed to the session handler. As such, we now mark the storage // object isImmutable. $storage = $this->getStorage(); if (! $storage->isImmutable()) { $_SESSION = $storage->toArray(true); session_write_close(); $storage->fromArray($_SESSION); $storage->markImmutable(); } } /** * Attempt to set the session name * * If the session has already been started, or if the name provided fails * validation, an exception will be raised. * * @param string $name * @return SessionManager * @throws Exception\InvalidArgumentException */ public function setName($name) { if ($this->sessionExists()) { throw new Exception\InvalidArgumentException( 'Cannot set session name after a session has already started'

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