La enfermedad trauma / Trauma disease

Reports of the World Health Organization make known that the non-intentional lesions and the violence (intentional injuries) are a threatening possibility for the world's health and they represnt a 9 per cent of the whole mortality. Around 5,804,000 subjects die yearly due to lesions (16,000 subjects each day). Eight of the 15 causes of death, of the persons between 15 through 25 years old are related to violence or non-intentional injuries, whether they are produced by vehicular collisions, suicides, homicides, suffocation, burns, wars, poisoning or fallz. In Argentina, each year 8,000 subjects die due to vehicular collisions. According with the National Ministry of health, this number represents the 25 per cent of the deaths due to trauma. We think that it is interesing to present two aspects that require a conceptualization with a scientific support: The recognition of trauma as a disease (the disease trauma), and the necessity to not use the term accident to design the lesional mechanism described for non-intentional truama. The participation of institutions in the control of the disease trauma is considered by the authors.

La enfermedad trauma / The disease trauma

Reports of the World Health Organization make known that the non-intentional lesions and the violence (intentional injuries) are a threatening possibility for the world's health and they represent a 9% of the whole mortality. Around 5.840.000 subjects die yearly due to lesions (16.000 subjects each day). Eight of the 15 causes of death, of the persons between 15 trough 25 years old are related to violence or non-intentional injuries, whether they are produced by vehicular collisons, suicides, homicides, suffocation, burns, wars, poisoning or falls. In Argentina, each year 8.000 subjects die due to vehicular collisions. According with the National Ministery of Health, this number represents the 25% of the deaths due to trauma. We think that it is interesting to present two aspects that require a conceptualization with a scientific support: The recognition of trauma as a disease (the disease trauma), and the necessity to not use the term accident to design the lesional mechanism described for non-intentional trauma. The participation of Institutions in the control of the disease trauma is considered by the authors.

Cirugía neonatal inmediata: experiencia inicial en el tratamiento de gastrosquisis y onfalocele en el noroeste de México / Immediate neonatal surgery: initial experience in gastroschisis and omphalocele treatment in Northwestern Mexico

Immediate neonatal surgery (INS) has the purpose of achieving surgical treatment of a congenital malformation in a newborn within the first few minutes after delivery. Since 1993, we have invited 15 pregnant women with sonographic diagnosis of fetal abdominal wall defect to participate in INS. All were treated by means of elective (eight cases) or emergent (seven cases) cesarean section between 33 and 38 gestational weeks. The neonates were immediately operated on the procedure beginning between 17 and 35 min after delivery. Eleven neonates had gastroschisis and primary closure was accomplished in five cases with application of auxiliary plastic patch (45.5) and in four cases with use of native tissues only (36.4); nine neonates survived (81.8), and were able to be fed by mouth at 14 +/- 4.5 days. Four had omphalocele, and in three primary closure and feeding by mouth before 1 week was attained; the fourth neonate died because of coexisting malformations. The present series, even if small, is useful to affirm the safety of a procedure such as INS for both mother and child; it may contribute to improve the results of treatment of fetuses with abdominal wall defects.

Uso de prostaglandinas E2 por vía vaginal para inducción del trabajo de parto / Use of prostaglandines E2 vaginally for labor induction

Las prostaglandinas se han usado para favorecer, la maduración cervical, la expulsión del producto y diminuir el número de maniobras obstétricas quirúrgicas. En el trabajo se pretende demostrar la utilidad de este fármaco administrado por vía tópica vaginal; en 40 pacientes con embarazo a término, sin trabajo de parto, con un índice de Bishop de 2 (rango o 4) que acudieron al Servicio de Obstetricia, distribuidas en dos grupos de 20 c/u que recibieron prostaglandinas 0.70 mg. por vía intracervical, y 20 con oxitocina 2 ml. unidad por minuto hasta obtener respuesta, se realizó un estudio longitudinal prospectivo y abierto; se excluyó del grupo de pacientes de alto riesgo; en ambos grupos se registraron partogramas en forma cuidadosa, los resultados se validaron obteniendo un promedio y desviación stándar; la edad promedio 25.15 años, edad gestacional 39.4 semanas. Indice de Bishop 2, en el grupo I y en grupo testigo la edad promedio 24.9 años, edad gestacional 40.4 semans y un índice de Bishop de 3.7ñ el tiempo de inducción del ler. grupo fué de 4.65 horas; en el grupo II 7.9 horas P< 0.05, condicionando en 40% menos tiempo de inducción de la maduración cervical, y el trabajo de parto. No se presentaron accidentes fetoplacentarios. La cesárea se redujo, en el grupo de prostaglandinas, un caso contra 6 del grupo testigo, el número de fórceps fué de mayor en este ler. grupo (7 casos contra 2 casos) del testigo. El estado de los poductos no tuvo diferencias significativas. Se puede concluir que es un fármaco de gran ayuda en la práctica obstétrica manejando cuidadosamente considerándolo como un medicamento de elección para la maduración cervical.