Aspects cliniques et évolutifs de la pré-éclampsie sévère traitée à la maternité Befelatanana, Madagascar / Clinical aspects and outcome of severe pre-eclampsia treated at the Befelatanana maternity hospital, Madagascar

Pre-eclampsia is a major public health problem and is one of the main causes of maternal-fetal morbidity. The main objective of this study is to describe the clinical and evolutionary aspects of severe pre-eclampsia. Methods: This was a retrospective, monocentric, descriptive, observational and cross-sectional study of 6 months, from January 01, 2019 to June 30, 2019, conducted at the level of the resuscitation service of the university hospital of gynecology obstetrics Befelatanana (CHU GOB). Results: Three hundred and fourteen (5.10%) cases out of 6153 admissions of severe pre-eclampsia were collected in the study; the average age was 27.29 ±7.47 years. Eclampsia (30.25%, n= 95), retroplacental hematoma (13.38%, n= 42) and acute renal failure (7.96%, n= 25) were the most frequent maternal complications. Maternal prognosis was favorable in 92.36% of cases (n= 290). Maternal death represented 3.18% (n= 10). Prematurity (44.82%, n= 95), fetal hypotrophy (37.26%, n= 79) and fetal asphyxia (14.15%, n= 30) were the most common fetal complications. Fetal death was 26.47% (n= 81). Conclusion: It is necessary to reinforce the information and education of parturients on the first signs for an early detection, diagnosis and management

Obstrucción intestinal secundaria a hematoma intramural espontáneo: Caso clínico / Bowel obstruction secondary to a spontaneous intramural hematoma. Report of one case

Spontaneous intramural hematoma (IMH) is an uncommon cause of bowel obstruction, generally secondary to trauma. Even rarer is the spontaneous hematoma, mainly described in anticoagulated patients. We report a 73-year-old female in anticoagulant therapy who presented with a bowel obstruction. A computed tomography (CT) of the abdomen showed a segmentary wall thickening of the distal jejunum, compatible with an IMH which obliterated the lumen and produced dilatation of the proximal bowel loops. Support management was initiated, achieving satisfactory evolution, allowing her discharge 12 days after admission.

Revisión Anatómica de Sistema Venoso Intrahepático. Hematoma Intrahepático Subcapsular en Colecistectomia Laparoscópica / Anatomical Review of Intrahepatic Venous System. Subcapsular Intrahepatic Hematoma In Laparoscopic Cholecystectomy

La aparición del hematoma intrahepático subcapsular (SHI) después de la colecistectomía laparoscópica es una complicación poco frecuente. El estudio anatómico de las venas suprahepáticas nos permitió observar que existen numerosos patrones de ramificación de estos. Presentamos el caso de una mujer de 37 años que, durante la intervención de colecistectomía laparoscópica, se observa en el acto quirúrgico, la formación espontánea de hematomas subcapsulares, secundario a la tracción forzada del fondo del órgano

The appearance of subcapsular intrahepatic hematoma (SHI) after laparoscopic cholecystectomy is an infrequent complication.The anatomical study of the suprahepatic veins allowed us to observe that there are numerous branching patterns of these. We present the case of a 37-year-old female who, during the laparoscopic cholecystectomy intervention, is observed in the surgical act, the spontaneous formation of subcapsular hematomas, secondary to forced traction of the fundus of the organ

Assessment of main complications of regional anesthesia recorded in an acute pain unit in a tertiary care university hospital: a retrospective cohort

Abstract Background Regional anesthesia has been increasingly used. Despite its low number of complications, they are associated with relevant morbidity. This study aims to evaluate the incidence of complications after neuraxial block and peripheral nerve block. Methods A retrospective cohort study was conducted, and data related to patients submitted to neuraxial block and peripheral nerve block at a tertiary university hospital from January 1, 2011 to December 31, 2017 were analyzed. Results From 10,838 patients referred to Acute Pain Unit, 1093(10.1%) had side effects or complications: 1039 (11.4%) submitted to neuraxial block and 54 (5.2%) to peripheral nerve block. The most common side effects after neuraxial block were sensory (48.5%) or motor deficits (11.8%), nausea or vomiting (17.5%) and pruritus (8.0%); The most common complications: 3 (0.03%) subcutaneous cell tissue hematoma, 3 (0.03%) epidural abscesses and 1 (0.01%) arachnoiditis. 204 of these patients presented sensory or motor deficits at hospital discharge and needed follow-up. Permanent peripheral nerve injury after neuraxial block had an incidence of 7.7:10,000 (0.08%). The most common side effects after peripheral nerve block were sensory deficits (52%) and 21 patients maintained follow-up due to symptoms persistence after hospital discharge. Conclusion Although we found similar incidences of side effects or even lower than those described, major complications after neuraxial block had a higher incidence, particularly epidural abscesses. Despite this, other serious complications, such as spinal hematoma and permanent peripheral nerve injury, are still rare.

Aplicación de árnica en gel para el manejo del dolor y reabsorción del hematoma profundo / Application of arnica gel for pain management and deep hematoma reabsorption

Árnica es una planta medicinal de la especie Arnica montana, endémica en Europa Central y Meridional, perteneciente a la familia Asteracae; rica en flavonoides y compuestos fenólicos, lactonas, helenalina y ácido hexurónico que le dan propiedades cicatrizantes, antiinflamatorias, analgésicas, antimicrobianas y anticoagulantes. Se utiliza en casos de contusiones, dolores musculares, reumáticos y hematomas profundos. El artículo describe ocho casos, que presentaron hematoma profundo por punción infructuosa, en pacientes con insuficiencia renal crónica terminal con esquema de hemodiálisis, donde se aplicó árnica en gel. Por medio de fotografías se registró cómo los hematomas revirtieron a partir del tercer día, mientras que el dolor disminuyó en un 50% al tercer día. (AU)

Arnica is a medicinal plant of the species Arnica Montana, endemic in Central and Southern Europe, it belongs to the Asteracae family, rich in flavonoids and phenolic compounds, lactones, helenalin and hexuronic acid that give it healing, anti-inflammatory, analgesic, antimicrobial and anticoagulant properties. It is used in cases of bruises, muscle pain, rheumatic pain and deep bruises. The article describes eight patients with terminal chronic renal failure under hemodialysis, who presented deep hematoma due to unsuccessful puncture of their dialysis fistula. All patients were treated with local gel arnica. Verbal analogue scale (VAS) and qualitative visual image analysis (photography) on how the hematomas reverted on the third day was analyzed. (AU)

Hematoma orbitario secundario a cirugía endoscópica nasosinusal / Orbital hematoma secondary to endoscopic sinus surgery

Resumen Durante la cirugía endoscópica nasosinusal, la sección inadvertida y retracción hacia la órbita de la arteria etmoidal anterior (AEA) es el mecanismo habitual del hematoma orbitario (HO); éste se manifiesta con proptosis, dolor y déficit visual potencialmente irreversible. El déficit visual es secundario a isquemia del nervio óptico por aumento de la presión intraocular, siendo suficientes treinta minutos para que ocurra daño visual permanente. Por sus secuelas el tratamiento del HO debe ser rápido y agresivo. Presentamos el caso de un varón de 72 años con diagnóstico de rinosinusitis crónica con pólipos nasales refractaria a tratamiento médico que se sometió a cirugía endoscópica nasal y que desarrolló en el posoperatorio inmediato con un HO. Se manejó precozmente con cantotomía-cantolisis, descompresión orbitaria medial endoscópica y control vascular de la AEA. El paciente evoluciona favorablemente, sin déficit visual. En este artículo se discutirán el diagnóstico y manejo oportunos del hematoma orbitario iatrogénico.

Abstract During endoscopic sinonasal surgery, inadvertent section of the anterior ethmoidal artery (AEA) with retraction into the orbit is the usual mechanism of orbital hematoma (OH), leading to proptosis, pain, and potentially irreversible visual loss. Thirty minutes is sufficient for retinal ischemia and permanent visual loss. The explanation for blindness is due to increased intraorbital pressure. The treatment of iatrogenic HO must be quick and aggressive, because if it is not managed in time, it can cause a permanent visual deficit. We present the case of a 72-year-old man with a diagnosis of chronic rhinosinusitis with nasal polyps refractory to medical treatment who underwent nasal endoscopic surgery, evolving in the immediate postoperative period with an HO, requiring canthotomy - cantolysis and early surgical reintervention for endoscopic medial orbital decompression and vascular control of AEA. The patient evolves favorably, without visual deficit. This article will discuss the timely diagnosis and management of iatrogenic orbital hematoma.

Caracterización de enfermos con cáncer de tiroides operados en el Hospital Clínico Quirúrgico General "Freyre de Andrade" / Characterization of Patients with Thyroid Cancer Operated on in "Freyre de Andrade" General Clinical Surgical Hospital

Introducción: El cáncer de tiroides es el tumor más común de los malignos originados en órganos endocrinos (más del 92 por ciento) y comprende un grupo de tumores que son diferentes clínicamente, epidemiológicamente y en cuanto a pronóstico. Objetivo: Caracterizar a los enfermos con cáncer de tiroides operados en el Hospital Clínico Quirúrgico General "Freyre de Andrade". Métodos: Se realizó un estudio descriptivo, retrospectivo de corte longitudinal en el Hospital Clínico Quirúrgico General "Freyre de Andrade" en el período 2014-2019. El universo estuvo constituido por 32 enfermos operados de cáncer de tiroides. Fueron analizadas variables sociodemográficas, clasificación de Bethesda, diagnóstico histológico, técnica quirúrgica empleada y complicaciones. Resultados: El cáncer de tiroides predominó en mujeres (87,5 por ciento) entre 51 - 60 años (25,0 por ciento). Según la clasificación de Bethesda prevaleció la categoría VI (15,62 por ciento). Predominó el carcinoma papilar (65,62 por ciento). A todos los enfermos se le realizó una tiroidectomía total y las complicaciones fueron el hematoma posoperatorio (6,25 por ciento) y el granuloma (6,25 por ciento). Conclusiones: El cáncer tiroideo predomina en mujeres entre la quinta y sexta década de la vida. La técnica quirúrgica que se utiliza es la tiroidectomía total con baja morbilidad. Predomina la variante histológica del carcinoma papilar(AU)

Introduction: Thyroid cancer is the most common malignant tumor originating in endocrine organs (more than 92 percent) and comprises a group of clinically, epidemiologically and prognostically different tumors. Objective: To characterize patients with thyroid cancer operated on at Freyre de Andrade General Clinical Surgical Hospital. Methods: A descriptive, retrospective and longitudinal study was carried out at Freyre de Andrade General Clinical Surgical Hospital in the period 2014-2019. The universe consisted of 32 patients operated on for thyroid cancer. Sociodemographic variables, Bethesda classification, histological diagnosis, used surgical technique and complications were analyzed. Results: Thyroid cancer predominated in women (87.5 percent) between 51 and 60 years of age (25.0 percent). According to the Bethesda classification, category VI prevailed (15.62 percent). Papillary carcinoma predominated (65.62 percent). All patients underwent total thyroidectomy, while the complications were postoperative hematoma (6.25 percent) and granuloma (6.25 percent. Conclusions: Thyroid cancer predominates in women between the fifth and sixth decades of life. The used surgical technique is total thyroidectomy, reporting low morbidity. The histological variant of papillary carcinoma predominates(AU)

Tratamiento mininvasivo de las complicaciones del traumatismo hepático cerrado / Minimally invasive management of blunt hepatic trauma complications

RESUMEN Antecedentes: el manejo no operatorio del traumatismo hepático cerrado es exitoso en el 95% de los pacientes hemodinámicamente normales. Las lesiones de alto grado presentan una tasa de complicaciones de hasta un 14%, y una mortalidad del 27% cuando requieren cirugía abierta. Material y métodos: estudio descriptivo de informe de casos. Resultados: 3 casos con traumatismo hepático de alto grado. "A": manejo no operatorio inicial, lavado laparoscópico por hemoperitoneo sintomático, drenaje percutáneo de absceso hepático, recambio de catéter y CPRE, por fístula biliar persistente. "B": cirugía de control de daño inicial sin hepatectomía, drenaje percutáneo de absceso hepático y posterior recambio. "C": manejo no operatorio inicial, lavado laparoscópico por hemoperitoneo sintomático, posterior drenaje percutáneo de absceso hepático y recambio de drenajes. No presentaron mortalidad. Conclusión: estos casos resumen la utilización de las diferentes modalidades del manejo del traumatismo hepático cerrado y la posibilidad del manejo mininvasivo de las complicaciones.

ABSTRACT Background: Nonoperative management of blunt hepatic trauma is successful in 95% of hemodynamically stable patients. The complication rate of high-grade injuries is 14% and mortality reaches 27% when they require open surgery. Material and methods: We conducted a descriptive study of case reports. Results: Three cases of high-grade hepatic trauma are reported. "A": initial nonoperative management, laparoscopic lavage due to symptomatic hemoperitoneum, percutaneous drainage of liver abscess, catheter replacement and ERCP due to persistent biliary fistula. "B": initial damage control surgery without liver resections, percutaneous drainage of liver abscess and catheter replacement. "C": initial nonoperative management, laparoscopic lavage due to symptomatic hemoperitoneum, percutaneous drainage of liver abscess and catheter replacement. None of the patients died. Conclusion: These cases summarize the use of different management modalities of blunt hepatic trauma and the possibility of minimally invasive management of the complications.

Hematoma retropúbico masivo posterior a TVT: enfrentamientos diferentes para una complicación infrecuente / Massive retropubic hematoma after TVT: different approaches for an uncommon complication

INTRODUCCIÓN: La TVT (tension-free vaginal tape) es una cirugía efectiva, pero no exenta de riesgos. Las complicaciones vasculares ocurren en un 0,9-1,7%; solo el 0,33% se presentan como hematoma masivo, en general asociado a la lesión de variante anatómica corona mortis (CM). OBJETIVO: Reportar tres tipos de manejo en pacientes con hematomas masivos después de cirugía para la incontinencia. MÉTODO: Revisión de casos de hematomas masivos tras TVT. Análisis de tres casos con diferente manejo. RESULTADOS: 1086 pacientes operadas en 10 años, 1% hematomas sintomáticos, 0,36% hematomas masivos. Se presentan tres casos. Caso 1: presenta inestabilidad hemodinámica sin respuesta a volumen ni vasoactivos, requirió laparotomía exploradora y se encontró un vaso sangrante retropúbico, compatible con CM, y un hematoma de 1000 cc. Caso 2: hipotensión que responde a volumen, asintomática al día siguiente de alta, reingresó 12 días después con caída de 6 puntos en la hemoglobina y la tomografía computarizada (TC) mostró un hematoma de 550 cc; recibió drenaje percutáneo. Caso 3: asintomática, alta el primer día posoperatorio, reingresa al quinto día con descenso de 4 puntos en la hemoglobina y la TC informa hematoma de 420 cc, que drena espontáneamente por vía vaginal. Todas las pacientes recibieron 14 días de antibióticos, y permanecieron continentes. CONCLUSIONES: Los hematomas retropúbicos masivos son una complicación poco frecuente. Su manejo considera la estabilización hemodinámica, el control del sangrado y el drenaje.

INTRODUCTION: TVT (tension-free vaginal tape) is an effective surgery, not without risks. Vascular complications occur in 0.9 to 1.7%, of which 0.33% present as massive hematoma, generally associated with injury of an anatomical variant, Corona Mortis (CM). OBJECTIVE: To report three types of management in patients with massive hematomas after anti-incontinence surgery. METHOD: Review of cases of massive hematomas after TVT surgery. Analysis of three cases with different management. RESULTS: 1086 patients operated in 10 years, 1% symptomatic hematomas, 0.36% massive. Three cases are presented. Case 1: hemodynamic instability without response to volume or vasoactive agents, required reoperation with exploratory laparotomy, a retropubic bleeding vessel, compatible with CM, and hematoma 1000 cc was found. Case 2: hypotension responds to volume, asymptomatic at next day in discharge conditions, she was readmitted 12 days later with falled 6-point in Hb, and CT showed hematoma 550 cc; she received percutaneous drainage. Case 3: asymptomatic, discharge on the first day after TVT, readmitted on the 5th day with falled 4-point in Hb, CT informed hematoma 420 cc, spontaneously drains vaginally. Patients received 14 days of antibiotics, remained continent. CONCLUSIONS: Massive retropubic hematomas are an infrequent complication, and management considers hemodynamic stabilization, bleeding control and drainage.

Surgical Repair of a Ruptured Giant Abdominal Aortic Aneurysm in a 16-Year-Old with Takayasu's Arteritis: Case Report and Etiological Review

Abstract Takayasu's arteritis is a type of primary systemic vasculitis that affects medium and large arteries, including the aorta and its main branches, as well as the pulmonary and coronary arteries. Although rare in children, it is the third most common vasculitis in the pediatric population, often with delayed diagnosis due to the nonspecific presentation of clinical symptoms in its initial phase. This is a case of a 16-year-old girl with a giant ruptured abdominal aortic aneurysm, who needed surgery on an emergency basis. The etiological aspects involved in aneurysms in young patients are also addressed.

Effects of MCC950 on nerve injury in rats with intracerebral hemorrhage / 中国应用生理学杂志

Objective: To investigate the effects of the pyrin domain-containing protein 3 (NLRP3) inflammasome inhibitor MCC950 on nerve injury in rats with intracerebral hemorrhage(ICH). Methods: Seventy-two SD rats were randomly divided into three groups (n=24): Sham group, ICH group and MCC950 group. ICH group and MCC950 group rats were injected with autogenous non-anticoagulant blood to establish ICH model, and then the rats in MCC950 group were intraperitoneally injected with MCC950 at the dose of 10 mg/kg(2 mg/ml) for 3 days after ICH model was established. Seventy-two hours after the establishment of the model, the forelimb placement test, the corner test and mNSS score were performed to observe the neurological function of the rats with ICH. The volume of hematoma was observed in fresh brain tissue sections. HE staining was used to observe the pathological changes of brain tissue. The dry-wet weight ratio was calculated to evaluate the changes of brain tissue edema. The degeneration of neurons was observed by FJC staining. The neuronal apoptosis was observed by TUNEL staining. The protein expression and activation levels of NLRP3, ASC, caspase-1, IL-1β, IL-18 and GSDMD were determined by Western blot. Results: Compared with sham group, the percentage of successful placement of left forelimb and left turn was decreased significantly (P＜0.01, P＜0.05), mNSS score was increased significantly (P＜0.01) in ICH group. Hematoma volume was increased significantly, the number of microglial cells around the hematoma was increased, the number of neurons was decreased, nerve cell swelled, some cells showed pyknotic necrosis, and the staining was deepened. The water content of the right base was increased significantly (P＜0.05). The number of FJC positive and TUNEL positive cells around the hematoma was increased significantly (P＜0.05). The levels of NLRP3, ASC, caspase-1, pro-caspase-1, caspase-1/pro-caspase-1 ratio, GSDMD-N, GSDMD, GSDMD-N/GSDMD ratio, IL-1β and IL-18 were increased significantly (P＜0.01, P＜ 0.05). Compared with ICH group, the percentage of successful placement of left forelimb and left turn was increased significantly in MCC950 group (P＜0.05), while the mNSS score and the volume of hematoma were decreased significantly (P＜0.01), the swelling degree of nerve cells around the hematoma was reduced significantly, and the number of pyrotic necrotic cells was decreased. The water content of the right base was decreased significantly (P＜0.05), and the number of FJC positive and TUNEL positive cells around the hematoma was decreased significantly (P＜0.05). The levels of NLRP3, ASC, caspase-1, pro-caspase-1, caspase-1/pro-caspase-1 ratio, GSDMD-N, GSDMD, GSDMD-N/GSDMD ratio, IL-1β and IL-18 were decreased significantly (P＜0.05). Conclusion: MCC950 can ameliorate nerve injury after ICH by inhibiting NLRP3 inflammasome mediated inflammation and pyroptosis.

Topical sirolimus for the treatment of angiofibromas in a child with tuberous sclerosis complex: First reported case in the Philippines

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder causing a mutation in the tumor suppressor genes, TSC1 or TSC2. Loss of function of these genes leads to dysfunction of hamartin and tuberin, resulting in hamartoma formation. It usually manifests with cutaneous manifestations at childhood. However, it also affects other organ systems. Based on the Philippine Dermatological Society Health Information System census, there have been 104 cases of TSC from 2011-2018. Currently, limited data is available regarding the treatment options in the local setting.</p><p style="text-align: justify;"><strong>CASE REPORT:</strong> The case involves a 4 year-old boy, with a two year history of flesh-colored to dusky red fi rm papules on the centrofacial areas and neck. Lesions have been increasing in number since first appearance. He had a normal birth history. Family history was insignificant. However, delay in expressive speech development was noted. Physical examination revealed multiple well-defined angiofibromas on centrofacial areas and neck; fibrous cephalic plaque on the left temporal area, and several ash-leaf spots on the trunk. Periungual and subungual fibromas, confetti macules, shagreen patch and dental pits were absent. Based on the clinical manifestations, he was diagnosed with TSC. Histopathology of a papule on the chin was consistent with angiofibroma. Parents were concerned with the appearance of the lesions and preferred conservative management. Hence, topical sirolimus 0.2% ointment was applied once daily on the angiofibromas for 4 months. Monthly follow-up showed marked improvement, manifested by the decrease in number and by flattening of the lesions.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> To the best of our knowledge, this is the fi rst case report of successful treatment of topical sirolimus for TSC in the Philippines.</p><p style="text-align: justify;"><strong>KEYWORDS:</strong> tuberous sclerosis complex, topical, treatment success, conservative management, hematoma</p>

Hematoma espontáneo del músculo psoas ilíaco secundario a anticoagulación como causa de muerte: reporte de caso / Spontaneous hematoma of the iliac psoas muscle secondary to anticoagulation as cause of death: case report

Resumen El uso de tromboprofilaxis posterior a las cirugías cervicales es una práctica recomendada a nivel mundial debido a que este tipo de pacientes presentan un mayor riesgo de desarrollar tromboembolismos venoso. Dentro de los efectos adversos de esta terapia se ha descrito la epistaxis, hematuria, formación de hematomas y sangrados. El hematoma espontáneo del músculo psoas iliaco, se considera una entidad poco frecuente, que suele asociarse a alteraciones de la coagulación, hemofilia o discrasias sanguíneas y como terapia anticoagulante, siendo este último la principal causa. En la autopsia médico legal, el hematoma del músculo psoas iliaco, suele ser un hallazgo incidental y en la mayoría de casos no contribuye en la causa de muerte. En el presente artículo se expone el caso de un masculino conocido con una enfermedad renal crónica, el cual desarrolló un hematoma espontáneo del músculo psoas iliaco, secundario al uso de enoxaparina como tromboprofilaxis posterior a una intervención quirúrgica en el cuello, que lo condujo a un shock mixto ocasionándole la muerte.

Abstract The use of thromboprophylaxis after cervical surgeries is a recommended practice worldwide due to the fact that these types of patients have a higher risk of developing venous thromboembolisms. Among the adverse effects of this therapy it has been described epistaxis, hematuria, formation of hematomas and bleeding. Spontaneous hematoma of the iliac psoas muscle is considered a rare entity, which is usually associated with coagulation disorders, hemophilia or blood dyscrasias and anticoagulant therapy, the latter being the main cause. In the medico-legal autopsy, the hematoma of the iliopsoas muscle is usually an incidental finding and in most cases does not contribute to the cause of death. This article describes the case of a male known with chronic kidney disease, who developed a spontaneous hematoma of the iliac psoas muscle, secondary to the use of enoxaparin as thromboprophylaxis after a surgical intervention in the neck, which led to a mixed shock causing death.

Diagnóstico posnatal de hematoma de cordón umbilical: reporte de un caso / Postnatal diagnosis of umbilical cord hematoma: case report

ANTECEDENTES: El hematoma espontáneo del cordón umbilical es una complicación rara del embarazo que representa una causa grave de morbilidad y mortalidad fetal. Se han descrito numerosos factores de riesgo, pero aún se desconoce su etiología exacta. CASO CLÍNICO: Mujer de 28 años, en su octava gestación, que consultó en urgencias por disminución de los movimientos fetales de varias horas de evolución tras una caída accidental traumática. La monitorización fetal mostró un patrón cardiotocográfico no tranquilizador, con disminución de la variabilidad y sin aceleraciones. Se realizó una cesárea urgente, sin complicaciones, con el nacimiento de un varón vivo de 4560 g, con Apgar 8/10/10 y pH de sangre de cordón umbilical 7.08, que precisó ingreso en la unidad de neonatología por hallazgo de un soplo cardíaco. Tras el alumbramiento se objetivó una gran colección hemática en el cordón umbilical. MÉTODO: Se aplicó una estrategia de búsqueda sistemática en Medline, PubMed y Cochrane de todos los artículos en inglés y español que tuvieran como palabras clave "Umbilical", "Cordón" y "Hematoma". RESULTADOS: Se encontraron 13 publicaciones de 15 casos de hematoma del cordón umbilical en los años 2008-2020. Se realizó una revisión sistemática de los informes de casos descritos en los últimos 12 años en la literatura para evaluar la epidemiología, los factores predisponentes, los resultados potenciales, el diagnóstico prenatal y el manejo clínico. CONCLUSIONES: Debido a la rareza de esta afección, se deben informar todos los casos nuevos de hematoma del cordón umbilical para mejorar el conocimiento de los factores predisponentes, el diagnóstico prenatal y el manejo clínico.

BACKGROUND: Spontaneous umbilical cord hematoma is a rare complication of pregnancy which represents a serious cause of fetal morbidity and mortality. There are many risk factors, but the exact etiology is still unknown. CASE REPORT: 28-year-old woman, eighth gestation, who consulted due to decreased fetal movements of several hours of evolution after traumatic accidental fall. Fetal monitoring showed a non-reassuring cardiotocographic pattern, with decreased fetal variability, without accelerations. An emergency cesarean section was performed without complications, with the birth of a living male weighing 4560 grams, with an 8/10/10 Apgar test, and an arterial pH of the umbilical cord 7.08, which required admission to the neonatology unit. After delivery, a large blood collection was observed in the umbilical cord. METHOD: A systematic search strategy was applied to several electronic bibliographic databases: Medline, PubMed and Cochrane. Key words used were "Umbilical", "Cord", "Hematoma". RESULTS: 13 publications of 15 cases of umbilical cord hematoma were reported in the years 2008-2020. A systematic review of the reports of cases, described in the last twelve years in the literature was carried out to evaluate the epidemiology, predisposing factors, potential results, prenatal diagnosis and clinical management of this phenomenon. CONCLUSIONS: Due to the rarity of this condition, every new case of umbilical cord hematoma should be reported in order to improve the knowledge of predisposing factors, prenatal diagnosis, and clinical management.

Hematoma de tabique: informe de dos casos pediátricos / Septal hematoma: Report of two pediatric cases

Los hematomas y abscesos septales constituyen una urgencia en rinología y requieren tratamiento quirúrgico temprano debido al riesgo de complicaciones infecciosas, funcionales y estéticas. Suelen aparecer como consecuencia de un traumatismo nasal, aunque también se han descrito en relación con otros desencadenantes. La acumulación de sangre o pus entre el mucopericondrio y el cartílago septal causa lesión por necrosis avascular en el cartílago y la destrucción de este.Desde el punto de vista clínico, se presenta como insuficiencia ventilatoria nasal y dolor facial. Con menor frecuencia, el motivo de consulta es deformidad del dorso nasal, epistaxis, rinorrea purulenta y fiebre.Se presentan en este trabajo dos casos clínicos con diagnóstico de hematoma septal que requirieron cirugía.

Hematomas and septal abscesses are an emergency in rhinology and require early surgical treatment due to the risk of infectious, functional, and aesthetic complications. They generally occur as a consequence of nasal trauma, although they have also been described in relation to other triggers. Accumulation of blood or pus between the mucoperichondrium and septal cartilage, causes avascular necrosis injury to the cartilage with cartilage destruction.Clinically it presents as nasal ventilatory insufficiency and facial pain. In a lower percentage, the reason for consultation was nasal dorsal deformity, epistaxis, purulent rhinorrhea and fever.We present two clinical cases with septal hematoma. Both required surgery.

Hematoma subcapsular del hígado: morfología y resultados del tratamiento quirúrgico / Hepatic subcapsular hematoma: morphology and results of surgical treatment

RESUMEN: El hematoma subcapsular del hígado (HSH), es una entidad poco frecuente. La mayoría de casos reportados se asocian al embarazo, en el contexto de síndrome de recuento bajo de plaquetas, elevación de enzimas hepáticas, y hemólisis. Otras patologías relacionadas son ruptura de carcinoma hepatocelular, adenoma, hiperplasia nodular focal; y amilosis. El objetivo de este artículo fue reportar morfología y resultados del tratamiento quirúrgico observados en una serie de pacientes con HSH, en términos de morbilidad postoperatoria (MPO). Serie de casos retrospectiva de pacientes con HSH intervenidos de forma consecutiva en Clínica RedSalud Mayor Temuco, entre 2004 y 2019. La variable resultado fue MPO. Otras variables de interés fueron edad, sexo, etiología, diámetro, necesidad de transfusión y tiempo de hospitalización. Se utilizó estadística descriptiva. Se trató a 7 pacientes (71,4 % mujeres), con una mediana de edad de 46 años. La mediana del diámetro del HSH, tiempo quirúrgico y estancia hospitalaria fueron 11 cm, 105 min y 5 días, respectivamente. No hubo necesidad de reintervenciones. Con una mediana de seguimiento de 31 meses, no se verificó MPO ni mortalidad. El HSH es una condición poco frecuente, y la evidencia disponible escasa. Puede asociarse a condiciones benignas y malignas. Requiere un alto índice de sospecha para un diagnóstico oportuno.Su pronóstico depende de la etiología.

SUMMARY: Subcapsular hematoma of the liver (SHL) is a rare entity. The majority of cases are associated with pregnancy, in the context of low platelet count syndrome, elevated liver enzymes, and hemolysis. Other related pathologies are ruptured hepatocellular carcinoma, adenoma, focal nodular hyperplasia, and amyloidosis. The aim of this article was to report morphology and results of the surgical treatment observed in a series of patients with SHL, in terms of postoperative morbidity (POM). Retrospective case series of patients with SHL who were intervened consecutively at Clínica RedSalud Mayor Temuco, between 2004 and 2019. The results variable was MPO. Other variables of interest were age, sex, etiology, diameter, need for transfusion, and length of hospitalization. Descriptive statistics were used; 7 patients (71.4% women) were treated with a median age of 46 years. The median diameter of SHL, surgical time, and hospital stay were 11 months, no POM and mortality were verified. SHL is a rare condition, and the available evidence is scarce. It can be associated with benign and malignant diseases. It requires a high index of suspicion for a timely diagnosis. Its prognosis depends on the etiology.

Hematoma duodenal posvideoendoscopia digestiva alta para diagnóstico de enfermedad de injerto contra huésped en pediatría: a propósito de dos casos / Duodenal hematoma after upper gastrointestinal endoscopy in pediatric graft vs host disease: Report of two cases

La enfermedad de injerto contra huésped es una complicación grave que se presenta después del trasplante de médula ósea, con morbilidad y mortalidad elevadas. El patrón de oro para evaluar su compromiso gastrointestinal es la endoscopia digestiva alta y baja con toma de biopsia. El desarrollo de hematoma duodenal intramural es una complicación poco frecuente asociada con este procedimiento .Se presentan dos casos de hematoma duodenal intramural posendoscopia en pacientes con trasplante y sospecha de enfermedad injerto contra huésped que presentaron un cuadro agudo de dolor abdominal y sangrado intestinal. El diagnóstico se realizó por tomografía y recibieron tratamiento conservador, con un resultado favorable. En ambos casos, el diagnóstico de enfermedad injerto contra huésped gastrointestinal se hizo a través de las biopsias colónicas con histología duodenal normal, lo que sugiere evitar la toma de muestras duodenales para prevenir esta grave complicación en pacientes de alto riesgo y, de este modo, disminuir la morbilidad.

Graft versus host disease is a serious complication that occurs following bone marrow transplant with significant morbidity and mortality. The gold standard to diagnose gastrointestinal graft versus host disease is upper and lower gastrointestinal endoscopy with histological validation. The development of intramural duodenal hematoma is a rare complication associated with this procedure. We present two cases of intramural duodenal haematoma after duodenal biopsies in bone marrow transplant patients that presented clinically with severe abdominal pain and intestinal bleeding. In both cases, CT scans confirmed the diagnosis and they were treated conservatively with favorable outcomes.Final diagnosis of gastrointestinal graft versus host disease was based on the colonic samples with normal duodenal histoarchitecture, which could lead to avoiding duodenal samples in future patients in order to prevent this serious complication and thus diminish morbidity.