Application of blood purification technology in children with acute and critical diseases / 中国小儿急救医学

Objective:To explore the scope, mode, anticoagulation mode and complications of blood purification in children with acute and critical illness.Methods:A total of 377 times of treatment of 102 children treated with blood purification in PICU at the First Affiliated Hospital of Xinxiang Medical College from January 2018 to December 2020 were retrospectively analyzed.Results:Among 102 critically ill children treated with blood purification, acute and chronic renal failure ranked the first in terms of disease distribution, with 23 cases in total, followed by 16 cases of severe viral encephalitis (meningoencephalitis), 11 cases of septic shock, seven cases of acute poisoning, five cases of severe allergic purpura, five cases of necrotic encephalopathy.In terms of clinical prognosis, 51(50.0%) cases were cured, 29(28.4%) cases were improved, 10(9.8%) cases died, and 12 cases abandoned treatment.In 2019, the blood purification application frequency was the highest, with a total of 47 cases, which was higher than those in 2018 and 2020( P<0.05). Continuous veno-venous hemofiltration was used in the largest number of children, with a total of 56 cases.There was a statistically significant difference in the application ratio of this mode during 3 years ( P<0.05), while there was no statistically significant difference in the application ratio of other modes.In terms of the selection of anticoagulation methods, the proportions of systemic anticoagulation and extracorporeal anticoagulation had significantly difference among different years( P<0.05), and the application of extracorporeal anticoagulation had increased year by year.There was no statistically significant difference in the proportion of patients without anticoagulants.The incidence of complications of blood purification was the highest in 2019, with catheter related thrombus in the majority (30 person-times), followed by hypothermia, catheter filter coagulation, hematoma formation, catheter related infection, hypotension, heparin-induced thrombocytopenia, etc.There was statistically significant difference in the total complications among different years( P<0.05). Conclusion:Blood purification is widely used in children with acute and critical illness, with a variety of diseases.The most commonly used mode is continuous veno-venous hemofiltration and in vitro anticoagulation.Catheter-related thrombosis is the most common complication.

Construção e validação de um instrumento sobre manejo de ferida neoplásica para capacitação de enfermeiros / Construction and validation of an instrument on neoplastic wound management for training nurses

Introdução: Cerca de 5% a 10% dos pacientes com câncer avançado irão desenvolver feridas neoplásicas durante os seis últimos meses de vida. O tratamento das feridas neoplásica é complexo, pois exige avaliação de etiologia oncológica, características e estadiamento da lesão, estado físico, emocional, social e espiritual do paciente, bem como produtos e coberturas específicos para o controle dos sinais e sintomas. O conhecimento de enfermeiros sobre avaliação e tratamento de feridas neoplásicas, apresenta limitações, bem como déficit de capacitação para a assistência à pessoa com esse tipo de lesão. Objetivo: Propor um instrumento para capacitação de enfermeiros no manejo de ferida neoplásica. Métodos: Pesquisa metodológica. O estudo compreendeu a construção do instrumento por meio de revisão de escopo da literatura; validação do conteúdo e aparência por juízes especialistas. A coleta de dados ocorreu entre outubro/2021 e fevereiro/2022, a análise foi feita pelo Índice de Validação de Conteúdo e Fleiss generalized Kappa. Este projeto de pesquisa, foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina da Universidade Federal Fluminense (FMUFF) com o registro CAAE: 50525121.0.0000.5243, atendendo à Resolução nº 466/12, das Diretrizes e Normas de Pesquisa Envolvendo Seres Humanos do Conselho Nacional de Saúde. Resultados: Os juízes especialistas recrutados validaram o conteúdo e aparência do instrumento relacionado a exatidão científica, conteúdo, apresentação textual e diagramação, ilustração e compreensão do instrumento, atingindo um IVC > 0.80, kappa satisfatório e nível de concordância entre os juízes > 75%. Conclusões: As categorias de validação atingiram o índice de validação de conteúdo e de aparência adequados, além de reunir as evidências para o manejo adequado da ferida neoplásica e contribuir para a capacitação dos enfermeiros na aérea, gerando um produto ­ material didático - a ser utilizado na assistência de enfermagem. Como limitação o estudo apresenta a ausência de validação clínica do instrumento. Como perspectivas futuras, esta pesquisa proporciona a oportunidade de expandir as informações contidas no instrumento, englobando os aspectos sociais e emocionais que envolvem o cuidado da pessoa com ferida neoplásica. Também há a implementação do instrumento como material didático de programas de educação permanente que abordem esta temática.

Introduction: About 5% to 10% of patients with advanced cancer will develop malignant fungating wounds during the last six months of life. The treatment of malignant fungating wounds is complex, as it requires evaluation of oncological etiology, characteristics, and staging of the lesion, physical, emotional, social, and spiritual state of the patient, as well as specific products and dressings for the control of signs and symptoms. The knowledge of nurses about the assessment and treatment of malignant fungating wounds presents limiting factors, as well as lower training to take care of people with this type of injury. Objective: Propose an instrument for training nurses in malignant fungating wound management. Methods: Methodological research. The study comprised the construction of the instrument through a literature scoping review; content and appearance validation by expert judges. Data collection occurred between October/2021 and February/2022, analysis was done by the Content Validation Index and Fleiss generalized Kappa. This research project was approved by the Research Ethics Committee of the Faculdade de Medicina of Universidade Federal Fluminense (FMUFF) with CAAE registration: 50525121.0.0000.5243, meeting Resolution No. 466/12, of the Guidelines and Standards for Research Involving Human Beings of the National Health Council. Results: The expert judges recruited validated the content and appearance of the instrument related to scientific accuracy, content, textual presentation and layout, illustration, and understanding of the instrument, reaching the CVI > 0.80, a satisfactory kappa, and agreement level among the expert judges > 75%. Conclusions: The validation categories reached the appropriate content and appearance validation index, in addition to gathering evidence for the proper management of the neoplastic wound and contributing to the training of nurses in the field, also developed a product -courseware- to help out at nursing care.

Regressões em análise: contribuições de Ferenczi e Balint para a técnica psicanalítica / Regressions in psychoanalysis: Ferenczi's and Balint's contributions to the psychoanalytic technique / Regresiones en análisis: contribuciones de Ferenczi y Balint a la técnica psicoanalítica

Na clínica psicanalítica contemporânea temos nos defrontado, cada vez mais, com impasses técnicos que nos exigem repensar a teoria sobre a técnica psicanalítica. Essa revisão teórica se justifica a partir de uma maior incidência de quadros clínicos cujo dinamismo psíquico não se encontra balizado hegemonicamente pela lógica do recalque, mas pela predominância de outros mecanismos defensivos, como a clivagem/splitting do eu, e formas de expressão não verbais como passagens ao ato e acting outs. Diante da necessidade de reconfigurar alguns parâmetros da técnica psicanalítica, delimitamos como objetivo deste artigo a investigação do tema do manejo clínico das regressões em análise a partir das contribuições teórico-clínicas de Sándor Ferenczi e de seus desdobramentos e avanços propostos Michael Balint. Assim, pretendemos extrair das modificações no dispositivo analítico propostas por esses autores, elementos que nos ajudem a pensar o manejo clínico com pacientes cujo sofrimento remete às falhas traumáticas dos primórdios da constituição subjetiva.

In contemporary psychoanalytic clinic we have faced increasingly technical deadlocks that require to rethink the psychoanalytic technique theory. This situation requires a revision of psychoanalysis technical theory. This theoretical revision is justified by a higher incidence of clinical conditions whose psychic dynamic is not hegemonic marked by the logic of repression, but the predominance of other defensive mechanisms, e.g. splitting, and non-verbal forms of expression such as acting out. Given the need to reconfigure some parameters of the psychoanalytic technique, we set as the objective of this article the investigation of clinical management of regressions under analysis from the theoretical and clinical contributions of Sándor Ferenczi and from developments and advances by Michael Balint. Therefore, from the changes proposed by these authors, we will attempt to extract elements that will help us think different clinical management of patients whose suffering refers to traumatic failures in the early stages of development, in an analytical setting.

En la clínica psicoanalítica contemporánea nos hemos enfrentado, cada vez más, con impases técnicos que nos obligan a repensar la teoría sobre la técnica psicoanalítica. Esta revisión teórica se justifica por una mayor incidencia de cuadros clínicos cuyo dinamismo psíquico no responde a la lógica de la represión, sino por el predominio de otros mecanismos defensivos, como el clivaje / escisión del yo, y formas de expresión no verbal como pasajes al acto y "acting outs". Ante la necesidad de reconfigurar algunos parámetros de la técnica psicoanalítica, el objetivo de este artículo es delinear la investigación del tema del manejo clínico de las regresiones en análisis, a partir de las contribuciones teórico-clínicas de Sándor Ferenczi y sus desdoblamientos y avances en la teoría de Michael Balint. Así, pretendemos extraer, de las modificaciones en el dispositivo analítico propuestas por esos autores, elementos que nos ayuden a pensar sobre el manejo clínico con pacientes cuyo sufrimiento remite a los fracasos traumáticas de los primordios de la constitución subjetiva.

Uso de un poste y núcleo de fibra de vidrio compuesto fabricados con CAD / CAM para restaurar un diente tratado endodónticamente: reporte de caso / Use of a CAD / CAM-fabricated composite fiberglass post and core to restore an endodontically treated tooth: case report

En la actualidad existe un amplio uso de los postes de fibra de vidrio. Sin embargo, tienen la desventaja que su forma no se pueden cambiar y son inadecuadas para casos de dientes con amplia destrucción coronal y conductos radiculares amplios. Este reporte de caso clínico describe el uso de un poste y núcleo de fibra de vidrio fabricados con un sistema CAD/CAM para restaurar un diente premolar inferior tratado endodónticamente. Este poste de fibra de vidrio CAD/CAM se adapta mejor al conducto radicular que un poste prefabricado, sin necesidad de emplear resina compuesta para el muñón y reduce el espesor de la capa de cemento.

Currently, there is a wide use of fiberglass post. However, they have the disadvantage that their shape can not be changed and are inadequate for cases of teeth with extensive coronal destruction and wide root canals. This case report describes the use of a fiberglass post and core manufactured with a CAD / CAM system to restore a lower premolar tooth treated endodontically. This CAD / CAM fiberglass post adapts better to the root canal than a prefabricated post, without the need to use composite resin for the stump and reduces the thickness of the cement layer.

Factores asociados para el procedimiento de administración de medicamentos mediante el sistema de dosis unitaria / Associated factors for the procedure of administration of medicines through the system of unitary dose

El sistema de distribución de medicamentos en dosis unitarias es un método de dispensación y control de la medicación en servicios de salud,es organizado y coordinado por la farmacia institucional. Objetivo.Analizar los factores asociados para el procedimiento de administración de medicamentos mediante el sistema de dosis unitaria en el hospital de Instituto Ecuatoriano Seguridad Social de la ciudad de Babahoyo. Metodología. Diseño observacional, descriptivo de corte transversal. Institución: Hospital del IESS. Revisión sistemática documental nacional e internacional sobre SDUM y la aplicación de una encuesta a la población objetivo del estudio: 92 médicos, 118 enfermeras, 2 químicos farmacéuticos. Resultados.Confirmaron que el sistema tradicional afecta la racionalización de medicamentos; existiendoescasez de recursos humanos, espacio físico inadecuado, incumplimiento de normas vigentes.Serequiere la capacitación del recurso humano en el 100%. Existiendo la necesidad imperiosa de implementar el sistema de dosis unitaria en el 100% de los servicios de hospitalización del IESS Babahoyo. Conclusión.Los factores que mayor incidencia tienen en la implementación del nuevo sistema son conocimiento del sistema, las normas legales y reglamentación farmacéutica y el número insuficiente de profesionales químicos farmacéuticos especializados, a esto se une el factor presupuesto a nivel central que influye en la adquisición de equipamiento e implementación de las áreas funcionales según el Acuerdo Ministerial 00000569 del 6 de julio de 2011 Norma para la Aplicación del Sistema de Dispensación/Distribución de Medicamentos por Dosis Unitaria -Ministerio de Salud Pública, enero 2013.

Introduction.The system of distribution of medications in unit doses is a method of dispensing and control of medication in health services is organized and coordinated by the institutional pharmacy. Objective.To analyze the factors associated with the benefits of the medication administration procedure through the unit dose system at the Instituto Ecuatoriano Seguridad Social in the city of Babahoyo. Methodology. Observational design, descriptive cross-section. Institution: IESS Hospital. Systematic national and international documentaryreview on SDUM and the application of a survey to the target population of the study: 92 doctors, 118 nurses, 2 pharmaceutical chemists. Results They confirmed that the traditional system affects the rationalization of medicines; There is a shortage of human resources, inadequate physical space, non-compliance with current regulations. 100% human resource training is required. There is a pressing need to implement the unit dose system in 100% of the IESS hospitalization services. Babahoyo.Conclusion: The factors that have the greatest impact on the implementation of the new system are knowledge of the system, legal regulations and pharmaceutical regulation and the insufficient number of specialized pharmaceutical chemists, to this is added the budget factor at the central level that influences the acquisition of equipment and implementation of the functional areas according to the Ministerial Agreement 00000569 of July 6, 2011 Standard for the Application of the Dispensing System / Distribution of Drugs by Unit Dose -Ministry of Public Health, January 2013.

Application of 3D printing in aesthetic oral rehabilitation / 华西口腔医学杂志

3D printing technology can be used in prosthodontics to obtain detailed structures. The technique offers a possible supersession for the most conventional restorations technologies. Contemporary aesthetic restorations encounter difficulties in the consistency between the analysis and design stages and the clinical implementation stage. 3D printing transfers aesthetic designs to customize the finial restoration fabrication, which could be an appropriate optimization to the aformentioned problem. Meanwhile, 3D printing technology can be employed to manufacture target restoration space guide (TRS guide), which is a blueprint for the aesthetic ceramic restorations and presents a general functional and aesthetic situation of patients. The guidance provided by TRS guide ensures precision and minimal invasive operation in aesthetic restorations. These new digital technologies have revolutionized aesthetic rehabilitation. This paper introduces the application of 3D printing in aesthetic oral rehabilitation.

Certificado de boas práticas de fabricação e controle como requisito de qualificação técnica em licitações / Certificate of good manufacturing practices and control as technical qualification requirement in bidding / Certificación de buenas prácticas en fabricación y control como requisito de calificación técnica en pliegos

Trata-se de estudo da legalidade da exigência em licitações públicas, a título de qualificação técnica, de apresentação de Certificado de Boas Práticas de Fabricação e Controle ­ CBPFC, dos produtos sujeitos à Vigilância Sanitária, documento expedido pela Agência Nacional de Vigilância Sanitária ­ ANVISA, a partir da legislação brasileira que rege a matéria, contextualizando com a doutrina pátria e o entendimento do Tribunal de Contas da União ­ TCU. A análise do tema revela o aspecto polêmico da questão e nos permitiu firmar o entendimento pela regularidade da obrigação, pois se conclui que o bem principal a ser tutelado é o direito à saúde dos cidadãos, visto que consumir produto sem a antecedente e imprescindível inspeção sanitária e consequente certificação, pode ocasionar a exposição a grave risco à saúde dos usuários, assumindo maior importância a exigência de qualificação técnica, uma vez que a qualidade do objeto contratado pela Administração Pública está diretamente relacionada à proteção da saúde da população.

Study of the legality of the requirement in public bidding, by way of technical qualification, the presentation of the Certificate of Good Manufacturing Fabrication Practices and Control - CBPFC of the products susceptible to Sanitary Surveillance, document issued by the National Agency of Sanitary Surveillance - ANVISA, from the Brazilian legislation that rule the matter, contextualizing with the homeland doctrine and the understanding of the Court Union Account - TCU. The theme analysis shows the polemic aspect of the question e allowed us to firm the understanding for the regularity of the obligation, because it concludes that the main good to be pupil is the citizens right to health, since consuming a product without the antecedent and indispensable sanitary inspection and consequent certification, may cause the exposure to serious health risk to the consumers, assuming more importance on technical qualification requirement, once the quality of the contracted object for the Public Administration is directly related to the population health protection.

Estudio acerca de la legalidad de la exigencia en pliegos gubernamentales, a título de calificación técnica, de presentación de la "Certificación de Buenas Prácticas en Fabricación y Control (CBPFC)", expedido por la Agencia Nacional de Vigilancia Sanitaria (ANVISA), con base en la normatividad brasileña acerca del tema, y teniendo en cuenta la doctrina brasileña y la jurisprudencia de la Corte de Cuentas de Brasil (TCU). El análisis del tema comprueba el aspecto controvertido de esa cuestión y se nos permite suponer tratarse de obligación regular, una vez que se concluye ser el derecho de los ciudadanos a salud el bien más relevante, pues el consumo de productos sin la previa y necesaria inspección sanitaria y la certificación resultante puede generar la exposición a severos riesgos a la salud de los usuarios. Resulta por lo tanto aún más importante la exigencia de calificación técnica pues la calidad del objeto contratado por la Administración Pública está directamente vinculada a la protección de la salud de la población.

Estudio comparativo de los eventos adversos entre el abordaje posterolateral y lateral directo para artroplastía primaria de cadera no cementada en pacientes mayores de 65 años con fracturas del cuello femoral / Comparative study of adverse events between a posterolateral and a direct lateral approach for uncemented primary hip arthroplasty in patients over 65 years of age with femoral neck fractures

Introducción: Las fracturas del cuello del fémur, constituyen un capítulo muy importante en la práctica de la Traumatología, debido a su alta incidencia principalmente en los pacientes mayores de 65 años, suponiendo cerca de 65% de las intervenciones en Traumatología. Es de vital importancia la funcionalidad temprana de un paciente con fractura del cuello de la cadera, ya que la supervivencia disminuye en los primeros 12 meses. El objetivo de este trabajo fue comparar la evolución trans- y postquirúrgica de los pacientes sometidos a cirugía articular primaria de cadera con el abordaje lateral de Hardinge y el posterolateral de Moore. Material y métodos: Se seleccionaron 79 pacientes mayores de 65 años, con fracturas del cuello del fémur y se dividieron en dos grupos según el estudio. Representando al abordaje lateral de Hardinge (32 pacientes) y abordaje posterolateral de Moore (47 pacientes) en el período de Marzo de 2011 a Abril 2013. Resultados: Tomando en consideración las variables estudiadas se observó una diferencia estadísticamente significativa (p < 0.005) en el número de paquetes transfundidos por pacientes manejados mediante el abordaje lateral directo de Hardinge. Conclusiones: Coincidimos con la literatura en que hay diferencia significativa en la evolución trans- y postquirúrgica de los pacientes con fracturas del cuello del fémur manejado mediante abordaje lateral de Hardinge. Se demostró una diferencia estadísticamente significativa en el número de paquetes transfundidos por paciente, lo cual en nuestro medio representa una mejor utilización de los recursos.

Introduction: Femoral neck fractures represent an important chapter in the practice of Traumatology, due to their high incidence, mainly among patients over 65 years of age; they account for around 65% of surgeries in Traumatology. Early function of patients who sustained a femoral neck fracture is of the utmost importance, as survival decreases within the first 12 months. The purpose of this paper is to compare the intra- and postoperative course of patients who underwent primary hip surgery using Hardinge's direct lateral approach versus Moore's posterolateral approach. Material and methods: 79 patients over 65 years of age with femur fractures were selected and divided into 2 groups according to the approach used. Hardinge's direct lateral approach was used in 32 patients and Moore's posterolateral approach in 47 patients, from March 2011 to April 2013. Results: Considering the variables studied, a statistically significant difference (p < 0.005) was seen in the number of blood units transfused to patients in whom Hardinge's direct lateral approach was used. Conclusions: We agree with the literature in that there is a significant difference in the intra- and post-operative course of patients with femur neck fractures managed using Hardinge's direct lateral approach. A statistically significant difference was seen in the number of blood units transfused per patient, something that in our setting represents better resource utilization.

Tratamiento artroscópico de las lesiones de Hill-Sachs en la inestabilidad glenohumeral: Técnica de "remplissage" / Arthroscopic treatment of Hill-Sachs lesions in glenohumeral instability: "Remplissage" technique

La lesión de Hill-Sachs es un defecto de la parte posterosuperior de la cabeza humeral que se produce durante el episodio de inestabilidad. En abducción y rotación externa esta lesión puede engranarse con un margen anterior de la glenoides, favoreciendo la inestabilidad. Su presencia puede ser la causa de un gran número de fracasos de la estabilización quirúrgica. Describimos la técnica de remplissage artroscópico que consiste en el relleno de la lesión mediante una capsulotenodesis del tendón del músculo infraespinoso. Este gesto debe realizarse siempre conjuntamente con la reparación cápsulo-labral anterior. Los resultados obtenidos por los autores y publicados en la literatura son buenos con pérdida de movilidad similar a la obtenida con técnica de Bankart artroscópica aislada. Recomendamos la realización de un remplissage conjuntamente con un Bankart en aquellos pacientes con inestabilidad glenohumeral que presenten lesiones de Hill-Sachs significativas sin defecto glenoideo o con defectos menores de 25%...

Hill-Sachs lesion is a defect of the posterosuperior aspect of the humeral head that occurs during an episode of instability. Under abduction and external rotation, this lesion may engage the anterior glenoid border, thus favoring instability. It may be the cause of many failed surgical stabilization procedures. We herein describe the arthroscopic remplissage technique, which consists of filling the lesion through capsulotenodesis of the infraspinatus tendon. This maneuver should be always be performed together with anterior capsulolabral repair. The results obtained by the authors and published in the literature are good, with a loss of mobility similar to the one resulting from the isolated arthroscopic Bankart technique. We recommend performing remplissage together with Bankart repair in patients with glenohumeral instability with significant Hill-Sachs lesions without a glenoid defect or with defects less than 25%...

Tradição e fundamentos éticos hipocráticos aplicáveis à terminalidade da vida / Hippocratic tradition and ethical foundations applicable to the life terminality

A medicina ocidental tem sua origem na Grécia antiga, quando o pensamento mítico e a prática médica sobrenatural e empírica dão lugar a uma racionalidade médica - tékhnē-iatrikē - baseada na observação da natureza. A tékhnē-iatrikē compreende a enfermidade e o enfermo como partes constitutivas da natureza, regidas por leis universais e normas preconcebidas, não devendo, por isso, ser utilizados meios irracionais para superá-las. A racionalidade técnica dominante na medicina atual afastou a prática médica contemporânea da arte hipocrática, e os avanços da ciência e da tecnologia proporcionam condições de manutenção da vida que geram dilemas éticos em pacientes terminais, relegando a dignidade humana a segundo plano. A ética hipocrática, baseando-se no respeito às leis naturais e à pessoa humana, é importante instrumento que, aliado à cultura, à técnica e à arte, proporcionam ao médico o exercício da medicina em conformidade com os preceitos de sua tradição...

Occidental medicine has its origins in ancient Greece, when mythical thoughts and supernatural and empirical medical practice gave place to ideas which favored the development of the pre-technical era of medicine - tékhnē iatrikē - based on observations of nature. tékhnē iatrikē understands the illness and the sick as constitutive parts of nature, driven by universal laws and preconceived rules, and, as a consequence, no irrational means should be used to surpass them. The technical rationality dominant in current medicine has departed contemporary medical practice from the Hippocratic art, and advances in science and technology allow conditions of maintenance of life that bring ethical dilemmas in terminal patients, not considering human dignity. Hippocratic ethics, based on the respect for natural laws and the human being is an important instrument that, allied to culture, to technique and to art allow doctors to practice medicine in conformity with the precepts of its traditions...

La medicina occidental tiene sus orígenes en la antigua Grecia, cuando el pensamiento mítico y la práctica médica sobrenatural y empírica dan lugar a una racionalidad médica - tékhnē iatrikē - basado en la observación de la naturaleza. La tékhnē iatrikē entiende la enfermedad y el enfermo como partes constituyentes de la naturaleza, que se rigen por leyes universales y normas preconcebidas, y por eso no se debe utilizarse medios irracionales para superarlas. La racionalidad técnica dominante en la medicina actual distanció la práctica de la medicina contemporánea del arte hipocrático, y los avances de la ciencia y la tecnología ofrecen condiciones del mantenimiento de la vida que generan dilemas éticos en los pacientes terminales, relegando la dignidad humana a un segundo plano. La ética hipocrática, basándose en el respeto a las leyes naturales y a la persona humana, es una importante herramienta que, combinada con la cultura, el arte y la técnica, proporcionan al médico la práctica de la medicina de acuerdo con los preceptos de su tradición...

Reparación artroscópica de la luxación anterior recidivante de hombro: ¿Existe la curva de aprendizaje? / Arthroscopic repair of anterior relapsing shoulder dislocation: Is there a learning curve?

Objetivo: Se realiza una revisión de los primeros casos intervenidos en nuestro centro de inestabilidad glenohumeral recidivante de hombro por vía artroscópica. El objetivo del trabajo es analizar la influencia de la curva de aprendizaje en los resultados obtenidos. Material y métodos: Estudiamos 137 pacientes intervenidos en el Hospital 12 de Octubre de Madrid, entre Febrero de 1999 y Marzo de 2010; 101 pacientes cumplían los criterios de inclusión, y dichos pacientes fueron divididos en dos grupos por orden cronológico: los 50 primeros y los 50 segundos. No existieron diferencias estadísticamente significativas en cuanto a sexo, edad y lateralidad entre ambos grupos (p = 0.51, p = 0.15 y p = 0.23, respectivamente), siendo por tanto los grupos comparables. Comparamos entre ambos grupos los resultados clínicos, evaluados por el número de luxaciones, reintervenciones y complicaciones: migración de los implantes, artrosis y neuropatía del nervio axilar. Comparamos también los resultados funcionales valorados por las escalas de Constant y Rowe. Resultados: Se produjeron cuatro episodios de reluxación en el grupo 1 y seis episodios en el grupo 2. Respecto al número de reintervenciones, se realizaron tres en el grupo 1 y seis en el grupo 2. No existen diferencias estadísticamente significativas en el número de episodios de reluxación y reintervención (p = 50 y p = 0.48, respectivamente). En nuestra serie la curva de aprendizaje no parece asociarse con mayor número de complicaciones ni índice de reluxaciones.

Objective: We reviewed the first cases that underwent arthroscopic surgery at our center due to relapsing glenohumeral stability of the shoulder. The objective of this paper is to analyze the influence of the learning curve on the results obtained. Material and methods: We analyzed 137 patients who underwent surgery at Hospital 12 de Octubre in Madrid, Spain between February 1999 and March 2010. A total of 101 patients met the inclusion criteria, and these patients were divided into two groups using a chronological order, the first 50 patients and the second 50 patients. There were no statistically significant differences in sex, age and laterality between both groups (p = 0.51, p = 0.15 and p = 0.23, respectively), so the groups were comparable. We compared the following between both groups: clinical outcomes, number of dislocations, reoperations and complications, i.e., implant migration, arthrosis and axillary nerve neuropathy. We also compared the functional results, which were measured using the Constant and Rowe scales. Results: Four episodes of redislocation occurred in group 1 and 6 in group 2. Three reoperations were performed in group 1 and 6 in group 2. No statistically significant differences were found in the number of redislocations and reoperations (p = 50 and p = 0.48, respectively).

Calidad de vida de la luxación acromioclavicular / Quality of life of patients with acromioclavicular dislocation

Objetivo: Comparar la calidad de vida en pacientes con luxación acromioclavicular tipo III de Tossy tratados mediante técnica RAFI de placa gancho, técnica Weaver Dunn y técnica Bosworth. Material y métodos: Se realizó una encuesta transversal, analítica, de Enero de 2012 a Abril 2013, en pacientes con diagnóstico de luxación acromioclavicular tipo III de Tossy intervenidos con la técnica de RAFI con placa gancho, técnica Weaver y Dunn y técnica de Bosworth. Se incluyeron a los pacientes con edades de entre 18 y 70 años y cirugía realizada dentro de las primeras tres semanas del diagnóstico. El grado de calidad de vida fue evaluado mediante el cuestionario de DASH heteroadministrado, previo consentimiento informado. Resultados: Se operaron 47 pacientes divididos en 3 grupos, técnica RAFI placa gancho 26 pacientes, técnica Weaver y Dunn 11 pacientes y la técnica de Bosworth, 10 pacientes. El sexo y la edad fueron similares en los tres grupos con una p = 0.137 y p = 0.252 respectivamente. El tiempo de evolución de la cirugía fue similar en los tres grupos, con una p = 0.051. La técnica, RAFI placa gancho fue la más empleada con 26 cirugías; 96.4% de pacientes mostró discapacidad leve y síntomas leves con técnica RAFI placa gancho y 100% en la técnica Bosworth y Weaver y Dunn. Conclusiones: La calidad de vida fue similar con las tres técnicas quirúrgicas con una discapacidad y síntomas leves. La técnica RAFI placa gancho fue la más utilizada.

To compare quality of life in patients with Tossy type III acromioclavicular dislocation treated with the hook-plate ORIF technique, the Weaver & Dunn technique and the Bosworth technique. Material and methods: A cross-sectional analytical survey was conducted from January 2012 to April 2013 in patients with a diagnosis of Tossy type III acromioclavicular dislocation treated surgically with the hook-plate ORIF technique, the Weaver & Dunn technique, and the Bosworth technique. We included patients ages 18 to 70 years old, operated within three weeks after the diagnosis. Quality of life was assessed using the hetero-administered DASH questionnaire once the informed consent was obtained. Results: Forty-seven patients were operated on. They were divided into 3 groups: hook-plate ORIF technique, with 26 patients: Weaver & Dunn technique, 11 patients; and Bosworth technique, 10 patients. Sex and age distribution were similar in all 3 groups, with p = 0.137 and p = 0.252, respectively. Time elapsed after surgery was similar in all 3 groups, with p = 0.051. The hook-plate ORIF technique was the most frequently used one, in 26 surgeries. 96.4% of patients had mild disability and symptoms with the hook-plate ORIF technique, and 100% with the Bosworth and Weaver & Dunn techniques. Conclusions: Quality of life was similar with all 3 surgical techniques and involved mild disability and symptoms. The hook-plate ORIF technique was the most frequently used technique.

Plastía del tendón de Aquiles en lesiones inveteradas: Técnica modificada de Pérez Teuffer / Achilles tendon plasty in inveterate lesions: Pérez Teuffer modified technique

El propósito del presente trabajo es transmitir la experiencia que se tuvo con la técnica utilizada en lesiones crónicas de tendón de Aquiles en el Hospital Regional "1º de Octubre" del ISSSTE. Se realizó un estudio prospectivo con seguimiento longitudinal descriptivo de 30 pacientes con ruptura de tendón de Aquiles con más de 10 días de evolución tratados con una técnica modificada de Pérez Teuffer realizada en el Servicio de Ortopedia y Traumatología de Marzo de 2004 a Marzo de 2008. Se efectuó una plastía con transposición de peroneo lateral corto a muñón de tendón. El lado derecho fue el más afectado en 70%; el promedio de edad fue 31.1 años; predominó el sexo masculino con 90%. El tiempo de evolución fue de 10 días a 62, con una media de 26 días. Obtuvimos resultados excelentes en 90%. Con 10% de buenos resultados; un caso presentó necrosis de piel y limitación para la movilidad y dos más con dolor. No se consideraron como malos por no interferir con los resultados funcionales finales.

The purpose of this paper is to convey our experience with the technique used to treat chronic Achilles tendon lesions at ISSSTE "1º de Octubre" Regional Hospital. A prospective study with descriptive longitudinal follow-up was conducted in 30 patients with Achilles tendon rupture that occurred more than 10 days earlier. They were treated with the modified Pérez-Teuffer technique at the Orthopedics and Trauma Service from March 2004 to March 2008. Plasty with transposition of the lateral peroneus brevis to the tendon stump was performed. The right side was affected in 70% of patients, mean age was 31.1 years, and males were predominant and accounted for 90%. Time elapsed since the lesion was 10-62 days with a mean of 26 days. We obtained excellent results in 90%, and good results in 10% of patients. One case had skin necrosis and limited mobility and two had pain. They were not considered as poor results as this did not interfere with the final functional results.

Apertura del primer espacio en pacientes con artrogriposis múltiple congénita y pulgar aducto con técnica de colgajo dorsorradial del índice / Opening of the first web space in patients with multiple congenital arthrogryposis and adducted thumb with a dorsoradial index finger flap

Introducción: La artrogriposis múltiple congénita es un síndrome progresivo caracterizado por articulaciones deformadas y rígidas, atrofia o ausencia muscular, contractura y engrosamiento del tejido articular capsular y periarticular y estado psíquico normal. Material y métodos: Se realizó un estudio retrospectivo de carácter descriptivo, con un nivel III de evidencia, sobre el manejo quirúrgico que recibieron pacientes con artrogriposis múltiple congénita y pulgar aducto congénito, en un período entre enero de 2005 y diciembre de 2010. Se realizaron 27 aperturas con técnica de colgajo dorso radial de índice, en 16 pacientes. En 80% de los pacientes se inició con la mano dominante, fueron nueve pacientes de sexo masculino y siete de sexo femenino, las manos operadas fueron 15 derechas y 12 izquierdas. Resultados: El diseño del colgajo permite un mejor avance y profundización del espacio y una mejoría cosmética. El ángulo intermetacarpiano primero y segundo preoperatorio fue en promedio de 20.5º, siendo el mínimo de 14º y el máximo de 27º. El promedio del ángulo intermetacarpiano primero y segundo postoperatorio fue de 50º, siendo el mínimo de 36º y el máximo de 65º, esto se observó en la clínica con una extensión activa de los pulgares así como una buena oposición del pulgar. Conclusiones: El diseño del colgajo permite un mejor avance y profundización del espacio, con un mejor balance entre los flexores y extensores, todos los pacientes tuvieron una mejor función de la extremidad y una mejoría cosmética.

Introduction: Arthrogryposis multiplex congenita is a progressive syndrome characterized by deformed and stiff joints, atrophy or absence of muscles, contracture and thickening of the capsular articular and periarticular tissue, and normal psychic status. Material and methods: A retrospective, descriptive, evidence level III study was conducted on the surgical management of patients with Arthrogryposis multiplex congenita and congenital adducted thumb between January 2005 and December 2010. Twenty-seven opening procedures were performed in 16 patients with a dorsoradial index finger flap technique. In 80% of patients the dominant hand was operated first; patients included nine males and seven females; the operated hands included 15 right and 12 left hands. Results: Flap design permits better advancement and space deepening, and cosmetic improvement. The mean preoperative first and second intermetacarpal angle was 20.5º on average, with a minimum of 14º and a maximum of 27º. The mean postoperative first and second intermetacarpal angle was 50º, with a minimum of 36º and a maximum of 65º. This was observed at the clinic with active thumb extension as well as proper thumb apposition. Conclusions: Flap design permits better advancement and space deepening, with a better balance between flexors and extensors. All patients had better limb function and cosmetic improvement.

Three port laparoscopic appendectomy technique with low cost and aesthetic advantage / Técnica de apendicectomia laparoscópica com três portais de baixo custo e benefício estético

INTRODUCTION: Despite dating more than 30 years after the first laparoscopic appendectomy, ileocecal appendix resection is still performed by laparotomy in more than 90% of cases, in our country. AIM: To describe a technique for laparoscopic removal of the ileocecal appendix with three portals, at low cost and very good aesthetic appearance. TECHNIQUE: Three incisions, one umbilical and two suprapubic are made; permanent material used comprises: grasping forceps, hook, scissors, needle holders, three metal trocars and four other usual instruments, and a single strand of cotton. There is no need to use of operative extractors bags, clips, endoloops, staples or bipolar or harmonic energy instruments. Allows triangulation and instrumentation in the conventional manner. CONCLUSION: The proposed technique is safe and reproducible, easily teachable, at very low cost and can be applied in general hospitals with conventional laparoscopic equipment. .

INTRODUÇÃO: Apesar de datar mais de 30 anos da primeira apendicectomia videolaparoscópica, a apendicectomia ainda é realizada por laparotomia em mais de 90% dos casos em nosso país. OBJETIVO: Descrever uma técnica para retirada laparoscópica do apêndice ileocecal com três portais, com muito baixo custo em insumos e de muito bom aspecto estético. TÉCNICA: São feitas três punções, uma umbilical e duas suprapúbicas; o material permanente utilizado compreende: pinça de apreensão, gancho, tesoura, porta-agulhas, três trocárteres metálicos e outros quatro instrumentos usuais, além de um único fio de algodão. Não há necessidade do uso de bolsas extratoras da peça operatória, clipes, alças, grampeadores ou instrumentos de energia especial, bipolar ou harmônica. Permite triangulação e instrumentação da forma convencional. CONCLUSÃO: A técnica proposta é segura e reprodutível, facilmente ensinada, de muito baixo custo podendo ser aplicada em hospitais gerais com equipamento laparoscópico convencional. .

A fotografia em Walter Benjamin: a dialética na imobilidade e a segunda técnica / Photography in Walter Benjamins work: frozen dialectic and the second technic / La fotografía en Walter Benjamin: la dialéctica en la inmovilidad y la segunda técnica

O texto apresenta a teoria da fotografia de Walter Benjamin mostrando a sua relação com as teorias da fotografia de sua época assim como sua articulação com os conceitos benjaminianos de “dialética na imobilidade” e de “imagem dialética”. A sua filosofia da história é interpretada também a partir de sua ideia de que o passado deixou nos textos imagens que precisam ser reveladas por cada agora. Por fim, o ensaio analisa o conceito de “segunda técnica” que Benjamin desenvolve na segunda versão de seu trabalho sobre a obra de arte, no qual a técnica é vista como aliada ao jogo e como um meio de emancipação.

The text presents Walter Benjamin's photography theory showing its relation with the photography theory of his period as well as its connection with the Benjaminian concepts of “frozen dialectic” and “dialectical image”. His philosophy of history is interpreted departing from his idea that the past has leaved on the texts, images that each now needs to develop. Concluding, the essay analyses the concept of “second technic”, that Benjamin develops in his work about the artwork in the era of it's technical reproduction, where technic is seen close to the concept of play/game and as a means to emancipation.

El texto presenta la teoría de la fotografía de Walter Benjamin mostrando su relación con las teorías de la fotografía de su época, así como su articulación con los conceptos benjaminianos de “dialéctica en la inmovilidad” y de “imagen dialéctica”. Además, su filosofía de la historia es interpretada a partir de su idea, según la cual el pasado dejó en los textos imágenes que precisan ser reveladas por cada ahora. Finalmente, el ensayo analiza el concepto de “segunda técnica” que Benjamin desarrolla en la segunda versión de su trabajo sobre la obra de arte, en el que la técnica es vista como aliada al juego y como un medio de emancipación.

Canulación biliar con guía en el conducto pancreático / Biliary cannulation with a guidewire in pancreatic duct

Antecedentes y objetivos. La piedra angular en la colangiografía radica en una canulación biliar atraumática y rápida, lo que redunda en el éxito del procedimiento. En esta serie de 10 pacientes se describe una técnica simple que ayuda a canular la vía biliar difícil. Métodos. En los casos en que repetidamente se canula el conducto pancreático y no selectivamente la vía biliar, se sugiere dejar la punta de la guía en la mitad del conducto Wirsung y retirar la cánula o esfinterótomo. La cánula o el esfinterótomo se reintroduce por el canal de trabajo al lado de la guía en el conducto pancreático y desde allí se avanza encontrando un mejor direccionamiento, estabilidad y firmeza de la papila. Resultados. Se usó esta técnica en 10 casos (6 hospitalizados y 4 ambulatorios) y fue exitosa en todos los pacientes, obviando la necesidad del acceso a la vía biliar por la técnica del precorte. Ninguna complicación fue documentada. Conclusiones. El uso de esta técnica puede ayudar a reducir el número de esfinterotomías por precorte, con su riesgo incrementado e inherente de pancreatitis, sangrado y perforación. La técnica propuesta puede ayudarnos en cualquier canulación difícil de la vía biliar.

Background and objectives. The angular stone in endoscopic colangiography is an atraumatic and fast biliary cannulation, which results in the success of the procedure. In this series of 10 patients an easy technique is described that helps to cannulate a difficult biliary conduit. Methods. In cases of repeatedly cannulation of pancreatic duct and not selectively the biliary tract; it is suggested to leave the guide wire in the middle of the Wirsung duct and to retire the cannula or sphincterotome. The cannula or sphincterotome is reintroduced by the work channel next to the guide wire in the pancreatic conduit. With the guide in the pancreatic duct the cannula advances with better direction, stability and firmness of papilla. Results. This technique cases was used in 10 patients (6 hospitalized and 4 ambulatory) and was successful in all the patients, avoiding the necessity of the access to the biliary route by the technique of the precut. No complication was documented.Conclusions. Use of this technique can help to reduce the number of sphincterotomies by precuts, with increased risks of pancreatitis, bleeding and perforation. The proposed technique can help us in any difficult cannulation of the biliary route.

Current Prevention Situation of Clinical Laboratory Standard in Grass-roots Hospital:Investigation and Analysis / 中华医院感染学杂志

OBJECTIVE To invesitigate the prevention knowledge and executing situation of clinical laboratory standard in grass-roots hospitals,then give improvement measure.METHODS A total of 342 clinical laboratory staffs in 45 hospitals were investigated using self-designed questionnaire.RESULTS The prevention knowledge rate of clinical laboratory staff was low and the standard prevention technique execution was not good.The protecting consciousness of the staff was low.The protection equipment and the organization system were not complete.The situation of grass-roots hospitals is not as good as the secondary care level hospitals.CONCLUSIONS The standard prevention capability of clinical laboratory staffs in the grass-roots hospitals must be improved necessarily.The hospital leader should attend to the laboratory staff′s standard prevention knowledge,complete the organization system and reduce the nosocomial infection rate.

Puncture technic of the transabdominal L5/S1 lumbar diskectomy / 介入放射学杂志

Objective To explore the puncture technic and method of the transabdominal L5/S1 lumbar diskectomy (TALD). Methods Two cases of cadaver were dissected and L5/S1 intervertebral disks were explored and punctured from different angles in order to probe the proper puncture angle for the needling. The radiographs of the lumbar and sacral vertabral samples of 30 cases were scrutinized and analysed to find the pancture imaging marks of the bones. When performing barium meal examinations, the lumbar and sacral spine of 200 cases were inspected to figure out the opacification of the rate imaging marks. 68 cases TALD were reviewed. Results The most pivotal process of the TALD is the needle puncture should be in parallel direction with lumbosacral interspace and then be pushed into the intervertebral disk. In order to make sure of the puncture point two sticking points should be fixed, on the abdomen and the another at the front edges of L5/S1 intervertebral disks. The five imaging makes of the lumbar, sacral, spine together with the neighboring L5/S1 intervertebral disks are of important help to find the front edges. Conclusion The correct puncture method is very important for performing TALD.

Effect of propofol on ion channels in acutely dissociated dorsal raphe neuron of Sprague-Dawley rats

To investigate propofol's effects on ionic currents induced by gamma-aminobutyric acid (GABA) and glycine as well as on those produced by the nicotinic acetylcholine- and glutamate-responsive channels, rat dorsal raphe neurons were acutely dissociated and the nystatin-perforated patch-clamp technique under voltage-clamp conditions was used to observe their responses to the administration of propofol. Propofol evoked ion currents in a dose-dependent manner, and propofol (10-4 M) was used to elicit ion currents through the activation of GABAA, glycine, nicotinic acetylcholine and glutamate receptors. Propofol at a clinically relevant concentration (10-5 M) potentiated GABAA-, glycine- and NMDA receptor-mediated currents. The potentiating action of propofol on GABAA-, glycine- and NMDA receptor-mediated responses involved neither opioid receptors nor G-proteins. Apparently, propofol modulates inhibitory and excitatory neurotransmitter-activated ion channels either by acting directly on the receptors or by potentiating the effects of the neurotransmitters, and this modulation appears to be responsible for the majority of the anaesthetic and/or adverse effects.