Morbi-mortalidad de la enfermedad tromboembólica venosa en el Hospital Universitario "Arnaldo Milián Castro" / Morbi-mortality of venous thromboembolic disease at "Arnaldo Milián Castro" University Hospital

Introducción: La enfermedad tromboembólica venosa es un proceso grave y mortal, considerado un problema de salud a escala mundial. Objetivo: Caracterizar la morbi-mortalidad por enfermedad tromboembólica venosa en el Hospital Universitario "Arnaldo Milián Castro". Métodos: Se realizó un estudio descriptivo retrospectivo de corte transversal a una muestra de 290 casos atendidos en el Hospital Universitario "Arnaldo Milián Castro" de Villa Clara, entre febrero de 2014 y febrero de 2016. Las variables fueron: edad, sexo, factores de riesgo, forma de presentación de la enfermedad y tipo de diagnóstico. Resultados: Se observó un predominio del sexo femenino y de los pacientes mayores de 70 años, independientemente del sexo y la inmovilidad como factor de riesgo. La trombosis venosa profunda del sector íleo-femoral fue la forma de presentación más común. El diagnóstico clínico primó, aunque el tromboembolismo pulmonar, como la complicación principal, se diagnosticó por necropsia. La mayor cantidad de trombosis venosa profunda se registró en el Servicio de Angiología, mientras que las muertes por embolia pulmonar predominaron en el Servicio de Terapia Intensiva. El tratamiento médico más utilizado fue la heparina sódica más warfarina; el profiláctico se realizó solo en el 24,7 por ciento de los casos. La heparina sódica se utilizó más en los servicios de Terapia Intensiva. Conclusiones: La enfermedad tromboembólica venosa fue la principal causa de muerte prevenible en el hospital, lo que sugiere que la profilaxis antitrombótica debe resultar una práctica esencial en los pacientes hospitalizados(AU)

Introduction: Venous thromboembolic disease is a serious and fatal process considered a health problem on a global scale. Objective: Characterize morbidity and mortality due to venous thromboembolic disease at "Arnaldo Milián Castro" University Hospital. Methods: A retrospective descriptive cross-sectional study was conducted on a sample of 290 cases treated at "Arnaldo Milián Castro" University Hospital in Villa Clara between February 2014 and February 2016. The variables were: age, sex, risk factors, form of presentation of the disease and type of diagnosis. Results: A predominance of the female sex and patients over 70 years of age was observed, regardless of sex and immobility as risk factors. Deep vein thrombosis of the ileus-femoral sector was the most common form of presentation. Clinical diagnosis prevailed, although pulmonary thromboembolism, as the main complication, was diagnosed by necropsy. The highest amount of deep vein thrombosis was recorded in the Angiology Service, while deaths from pulmonary embolism predominated in the Intensive Care Service. The most commonly used medical treatment was sodium heparin plus warfarin; prophylaxis was performed only in 24.7 percent of cases. Sodium heparin was more used in Intensive Care services. Conclusions: Venous thromboembolic disease was the leading cause of preventable death in the hospital, suggesting that antithrombotic prophylaxis should be an essential practice in hospitalized patients.

Mitos y realidades del Síndrome del Túnel Carpiano

1. El adormecimiento en las manos más la remisión de un informe electrofisiológico sugestivo, no significa necesariamente que el paciente tenga in síndrome del Túnel carpiano. 2. El cuadro clínico de parestesias y disestesias intermitentes de predominio nocturno, lo encontramos en el 100 por ciento de los pacientes con un síndrome compresivo simple. Las latencias sensitivas se deben considerar anormales cuando se encuentran por encima de 3.5 milisegundos. 4. La valoración clínica de la sensibilidad superficial mediante los test descritos, es una excelente ayuda diagnóstica. 5. En los casos en que el paciente refiere dolor irradiado proximalmente (semáforo en rojo), es necesario hacer un diagóstico diferencial. 6. Finalmente podemos reconocer dos grandes grupos de pacientes, aquellos que tienen una neuropatía por compresión y que se benefician con una descompresión y que se benefician con una descompresión simple y aquellos que tienen una neuropatía por tracción, y que necesitan de una cirugía más extensa

Osteosíntesis Estable en Fracturas Conminutas de la Cúpula Radial

The goal of treatment of fractures of the radial head is full recovery of function with preservation of the elbow flexion and extension as well as pronation and supination of the forearm. Considerable confusion, however, continues to exist on how best to treat this type of fractures and that incluides: Type of classification. Type of treatment: 1. Conservative: there is no agreement concerning the period of movilization, should it be 1 week, 10 days, 3 weeks? 2.Operative: Parcial or total excision? head substitution? Timing of surgery: inmediate, delay? Long-term functional results have not been satisfactory in a considerable number of patients using these convetional techniques. Residual pain, and post-traumatic arthritis are not infrequent. Modern operative treatment of major intra-articular fractures according to the AO/ASIF methods and techniques have dramatically improved the overall results and we feel that these principles are perfectly valid in small joints like the radial head. Excellent preliminary results in 5 selected cases are presented and discussed

Actualización en el Manejo de las Fracturas Abiertas

1. Initial gram stains at the emergency room are mandatory 2. Careful and sistematic irrigation and debridement have to be performed in every case. 3.Type II and III open fractures must be taken back to the O.R. 24-48 hours later and revised personally by the attending Phisician. 4. No primary closure should be performed of type II and III open fractures. We recomend delay primary closure by means of direct suture or diferents plastic procedures. 5. A succesful end result will mainly depend of the quality of the initial management. The prophilactic antibiotics are useful in the treatment of open fractures. They should be used for a short period op time ( 24-72 hrs). No mixture of antibiotics will substitute meticulous decontamination and debridement of the wound. Established infection must be treated following the basic principles of antibiotics therapy. The use and indications of common local antiseptics have to be resised. Early operative stabilization by means of internal or external fixation plays a definitive role in the management of open fractures and associated lesions. The traditional approach of treat the wounds firs and then the fracture has changed, specially for type II and III injures. The agressive trauma treatment in politrauma patients with multiple lesions has many advantages for the post-operative care and rapid recovery, but this type of treatment should only be performed by well-trained surgeons with experience in the techniques of stable osteosynthesis. Finally, unilateral external fixation with the improvements in the materials and the mode of applications has add a new dimension for the patients and their lesions as it is a simple methos, versatile and allows early weght-bearing