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Autor principal:	José Antonio Delgado-Pérez
Formato:	Artículo científico
Lenguaje:	es
Publicado:	Instituto Nacional de Pediatría 2019
Materias:	Medicina espinal cifosis enfermedad de Pott Tuberculosis espinal prótesis e implantes
Acceso en línea:	https://www.redalyc.org/articulo.oa?id=423665714004 https://www.redalyc.org/journal/4236/423665714004/ https://www.redalyc.org/journal/4236/423665714004/html/ https://www.redalyc.org/journal/4236/423665714004/423665714004.epub https://www.redalyc.org/journal/4236/423665714004/movil
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Enfermedad de Pott infantil. Reporte de caso José Antonio Delgado-Pérez Óscar Colín-Martínez Medicina espinal cifosis enfermedad de Pott Tuberculosis espinal prótesis e implantes ANTECEDENTES: La tuberculosis extrapulmonar representa un problema de salud pública en México y la población pediátrica es un grupo especialmente susceptible. Establecer el diagnóstico y el tratamiento es un proceso complejo en este grupo de edad porque solo 5% de los estudios microscópicos son positivos. CASO CLÍNICO: Paciente de 2 años 3 meses con diagnóstico de tuberculosis espinal a nivel torácico (T7a T9). La evolución fue tórpida debido a las características clínicas de la enfermedad y la baja respuesta a los diversos tratamientos. Como opciones diagnósticas se consideraron múltiples padecimientos pero, finalmente, el tratamiento fue médico-quirúrgico, con esquema de quimioterapia y resección quirúrgica de la lesión, por medio de corporectomía anterior, colocación de una malla injerto e instrumentación posterior con barra de Luque y alambrado sublaminar. CONCLUSIÓN: El déficit neurológico y la importante evolución de la cifosis hacen que el tratamiento quirúrgico agregado a la quimioterapia sea la mejor opción. El tratamiento quirúrgico con doble acceso permitió frenar la evolución del déficit neurológico, requisito indispensable para obtener resultados favorables. En la actualidad, el paciente evoluciona satisfactoriamente sin evidencia, clínica o radiográfica, de infección, permanece neurológicamente íntegro, con adecuado desarrollo de acuerdo con su edad. 2019 otro 0186-2391 https://www.redalyc.org/articulo.oa?id=423665714004 https://www.redalyc.org/journal/4236/423665714004/ https://www.redalyc.org/journal/4236/423665714004/html/ https://www.redalyc.org/journal/4236/423665714004/423665714004.epub https://www.redalyc.org/journal/4236/423665714004/movil es http://www.redalyc.org/revista.oa?id=4236 Acta Pediátrica de México application/pdf Instituto Nacional de Pediatría Acta Pediátrica de México (México) Num.3 Vol.40

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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