ABSTRACT
Resumen: Introducción: La luxación tibiofibular proximal (LTFP) es una lesión poco frecuente y no diagnosticada. De no ser tratada a tiempo, puede generar una sintomatología crónica de dolor e inestabilidad. La escasa evidencia disponible no entrega un protocolo de enfrentamiento ni consenso respecto a su manejo. Con el objetivo de asistir al enfrentamiento de esta lesión, se presenta una revisión de la literatura de una LTFP con reducción espontánea. Caso clínico: Hombre de 22 años consulta por dolor intenso en su rodilla derecha, posterior a caída en cuatrimoto. Al examen físico con aumento de volumen doloroso en cara lateral de la rodilla y pierna proximal, con movilidad completa y estable. Radiografías son informadas sin alteraciones. Se mantiene la sospecha clínica de LTFP, se continúa estudio con resonancia magnética (RM), la que es sugerente de LTFP. Dentro de las 24 horas de evolución, el paciente indica haber sentido un clank espontáneo en su rodilla afectada con cese completo de sintomatología. Se sigue al paciente por tres meses con RM de control, manteniendo una rodilla asintomática; examen físico y funcionalidad normal. Conclusión: El diagnóstico de las LTFP requiere un adecuado uso de imágenes. Su manejo consiste en una reducción cerrada de urgencia y de no lograrse, una reducción abierta, reparación y fijación interna. El pronóstico de las reducciones espontáneas es incierto, por lo que deben ser seguidas de forma seriada y en caso de recidiva, manejadas quirúrgicamente según el tiempo de evolución.
Abstract: Introduction: Proximal tibiofibular joint dislocations (PTFJD) are uncommon and underdiagnosed injuries. Urgent reduction is mandatory to avoid chronic disfunction. The scarcely available literature does not present a unified management guideline. An acute PTFJD case report with spontaneous reduction and a review of the literature is presented, aiming to assist the diagnosis and management of this pathology. Case report: A 22-years old male presented to the emergency department with high intensity right knee pain after falling in a four-wheel motorcycle. The physical exam revealed a prominent painful mass on the lateral aspect of his knee and proximal leg. His range of motion and knee stability were unremarkable. X-rays were informed negative for musculoskeletal injuries. According to a sustained suspicion of PTFJD, the study was continued with a magnetic resonance imaging (MRI), which suggested PTFJD. During the following 24 hours, the patient referred he was entirely asymptomatic after feeling a loud «clank¼. He has been followed for three months with MRI, and remains asymptomatic with full functions. Conclusion: PTFJD diagnosis requires appropriate images. Urgent close reduction is mandatory; if unsuccessful, open reduction, primary repair and internal fixation are indicated. The prognosis of spontaneous reduction remains uncertain and requires a serial clinical evaluation. In the case of recurrence, the appropriate surgical management is indicated according to the elapsed time from the injury.
ABSTRACT
The decrease in mortality in critical patient units led to an increase in intensive care unit acquired weakness (ICUAW), which significantly affects the functional performance and quality of life of patients. There are several scales that measure functionality in critical patients. The aim of this systematic review is to determine the criterion validity and reliability of the scales that evaluate functionality in critically ill adult patients. We considered studies in critically ill adult subjects of both genders that determined the psychometric properties of the scales that evaluate functionality. Six minutes' walk test (6MWT), timed up and go (TUG), the Medical Research Council sum score (MRC-SS), grip strength, discharge destination and need for rehabilitation at discharge were considered as gold standards. Three scales were identified: PFIT-s, Perme MS, and DEMMI. PFIT-s has a positive correlation with 6MWT, MRC-SS and grip strength, and a negative correlation with TUG. It also predicts the need for rehabilitation at discharge and discharge to the home. DEMMI has a positive correlation with MRC-SS. the interobserver reliability was evaluated in three articles, demonstrating an almost perfect association. The intraobserver agreement was considered good in one report. With this information, it is not possible to determine which is the instrument with better measurement properties.
Subject(s)
Humans , Male , Female , Critical Illness/rehabilitation , Disability Evaluation , Patient Outcome Assessment , Reference Standards , Observer Variation , Reproducibility of Results , Exercise Test/methods , Intensive Care UnitsABSTRACT
Our experience with 30 unselected patients on periodic hemodialysis over a three and a half year period has been presented. Treatment ranged between one month and 17 months. The longest surviving patient has been on hemodialysis for 17 monthsThe goal of dialysis was achieved in 50% of cases, partially in 23% of patients while it was not realized in the remaining 8 patients. The survival rate is limited by lack of patients cooperation and financial supportThe cost of hemodialysis has been reduced considerably by a modified technique of reusing formerly disposable kidney coils for 10 to 20 times. (Summary)
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1. Diagnosis of H. mole is difficult because of pitfalls2. A definitive diagnosis must be established before attempting evacuation3. Hysterogram with "moth eaten" appearance or "honeycombed" pattern gives a positive diagnosis of mole4. The vest radiograph is after one minute of injection5. Two scout films and one film after one minute injection are sufficient for economy6. No complications7. Hysterography is very simple and economical and does not need any special equipment and training8. In conclusion, we strongly endorse the widespread use of hysterography by specialists and general practitioners for its accuracy, simplicity, safety and economy. (Summary and conclusions)
ABSTRACT
La Escherichia coli enteropatogena (ECE) puede causar una enfermedad muy seria en el recien nacido (Hanson, L.A.). Su mecanismo patogenico aun es oscuro y discutible: sin embargo, estudios recientes indican que la diarrea puede ser causada por dos mecanismos: uno, discreto por Mc.Neish y cols., y el otro por Guerrant y cols.Con objeto de establecer nuestra propia experiencia al respecto, se estudiaron, en secuencia, 200 recien nacidos en las salas de cuna de los hospitales Juarez y Maternidad 2 A del IMSS. Se encontraron, en 60 de los casos, cepas de E. coli enteropatogenea (ECE) 086:B7 y 0126:B 16 y que respondieron satisfactoriamente al tratamiento. Nuestros hallazgos coinciden con los de otros investigadores