Prevalencias de complicaciones asociadas a la instalación de catéter venoso central para hemodiálisis / Prevalence of complications associated with central venous catheter instalation for hemodyalisis

Background: Placing central venous lines under ultrasonographic guidance reduces the complications of the procedure. Aim: To compare prevalences of complications of central venous line placements with or without ultrasonographic guidance. Material and Methods: Descriptive study that contemplated the comparison of two groups of patients subjected to a central venous line placement at a nephrology service for renal replacement therapy. In one group of 100 patients, the line was placed without ultrasonographic guidance between 2008 and 2012. Between 2015 and 2017 the line was placed in 138 patients using ultrasonographic guidance. The prevalences of complications with both types of procedures were recorded. Results: The frequency of complications of procedures with and without ultrasonographic guidance was 0.7 and 18% respectively (prevalence ratio 0.04, 95% confidence interval 0-0.3). Ninety five percent of recorded complications were arterial puncture, followed by hematomas in 10% and pneumothorax in 5%. The higher prevalence of complications was observed in emergency line placement without ultrasonographic guidance. There was a direct association between the number of line placement attempts in a single procedure and the prevalence of complications. Conclusions: Ultrasonographic guidance is associated with a reduction in the prevalence of central venous line complications.

Hematoma de Morel Lavallée gigante en la rodilla derecha: reporte de un caso / Giant Morel Lavallée hematoma in the right knee: case report

RESUMEN Se presenta el caso del paciente de 36 años de edad, con antecedentes de acondroplasia que desde hace 7 meses sufrió una lesión traumática no de gravedad en la rodilla derecha. La cual comienza a aumentar de volumen con contenido líquido fluctuante. Fue puncionado en dos ocasiones obteniéndose líquido serohemático; al no resolver y continuar aumentando de tamaño, se le plantea que es portador de un hematoma seroso de Morel Lavallée, que se produce por la fricción entre el tejido celular subcutáneo y la fascia. Su localización es infrecuente en la rodilla por lo que se decide presentar el caso ya que en la literatura revisada; no aparece ningún caso descrito. Por lo que constituye el objetivo principal de este trabajo, describir su proceder y la eficacia del tratamiento quirúrgico, con el que se obtuvo resultado satisfactorio (AU).

ABSTRACT We present the case of a patient aged 36 years, with antecedents of achondroplasia who 7 months ago suffered a non serious traumatic lesion in the right knee. The volume of the lesion began to increase with a fluctuant fluid contain. It was punctured twice draining serohematic fluid; it did not solve and the size increased more and more, so the patient was said that he had a serous Morel Lavallée hematoma, produced by the friction between the subcutaneous cell tissue and fascia. Its location in the knee is infrequent and it was not found any case like this in the reviewed literature; therefore we decided to present the case. The main objective of our work was describing it, showing the procedure and efficacy of the surgical that gave a satisfactory result (AU).

Efficacy of Drainless Total Thyroidectomy in Intrathyroidal Lesions of Thyroid

Abstract Introduction There is difference of opinion about the placement of the drain in thyroid surgeries, and, to the best of our knowledge, the efficacy of drainless total thyroidectomy regarding various parameters of thyroid lesions has not been well-established. Objective To report our experience with drainless total thyroidectomy, and to define an appropriate patient population for its performance. Methods This is a retrospective case analysis of the patients who underwent total thyroidectomy for intrathyroidal lesions with or without central neck dissection in a tertiary referral hospital (number = 74). The patients, who had undergone total thyroidectomy without any drain insertion, were analyzed, and the relationships among various parameters of thyroid lesions were noted in relation to seroma and hematoma formation. Results Seroma formation was noted only in 5 out of 74 patents (6.75%). All of the seromas that occurred were observed in patients with thyroid lesions < 4 cm, and 4 out of 5 seromas were observed in patients with a malignant pathology. There was no statistically significant difference in seroma formation between patients younger or older than 50 years of age. The nature of the lesion, whether benign or malignant, did not affect the formation of seroma. Of interest is the fact that none of the 10 patients who had central neck dissection performed as part of their treatment developed seroma. Conclusions Drainless total thyroidectomy is safe across all age groups for patients harboring either benign or malignant thyroid pathologies. However, caution is to be observed in opting for drainless total thyroidectomy in patients with large lesions (> 5 cm)

Canalización vascular ecoguiada: Experiencia en el paciente pediátrico crítico / Ultrasound-guided vascular cannulation: Experience in critically-ill pediatric patients

Introducción. La canalización vascular central en niños presenta alta complejidad técnica y dificultades. La ecografía vascular puede facilitar este procedimiento. Objetivo. Describir las características de las canalizaciones vasculares ecoguiadas en el paciente pediátrico crítico. Población y métodos. Las variables de interés registradas prospectivamente fueron los vasos más comúnmente canalizados, su localización, la medición del diámetro/profundidad, la tasa de éxito y las complicaciones presentadas, entre otras. Resultados. En 86 pacientes pediátricos, se realizaron 124 punciones vasculares. Los accesos vasculares fueron la vena femoral (39,7%), seguida de la arteria femoral (27,2%) y la vena yugular interna (14,7%). Los vasos femorales se localizaron a una profundidad de 0,75 ± 0,25 mm con un diámetro medio de 0,31 ± 0,16 mm. La profundidad de los vasos venosos yugulares fue menor (0,64 ± 0,24 mm) y su diámetro global, mayor (0,44 ± 0,19 mm). El número medio de intentos en las canalizaciones vasculares ecoguiadas fue de 2,2 ± 1,3. La tasa de éxito fue del 79% asociada a un mayor diámetro del vaso (0,39 ± 0,20 mm vs. 0,28 ± 0,13 mm, p 0,01) y un menor número de intentos (1,90 ± 1,16 vs. 3,45 ± 1,77, p= 0,001). Las complicaciones, fueron la punción accidental de otro vaso (5,3%) y el desarrollo de un hematoma durante la punción (2,3%). Conclusiones. La canalización vascular ecoguiada en los pacientes pediátricos estudiados permite visualizar los vasos y medir su profundidad y diámetro; presenta una alta tasa de éxito y se asocia a una baja tasa de complicaciones.

Introduction. Central vascular cannulation in children is a highly complex technique and poses many difficulties. Vascular ultrasound can make this procedure easier. Objective. To describe the characteristics of ultrasound-guided vascular cannulation in critically-ill pediatric patients. Population and methods. Outcome measures prospectively recorded were vessels most frequently cannulated, their localization, the measurement of their diameter/depth, the success rate and complications developed, among others. Results. One hundred and twenty four vascular punctures were performed in 86 pediatric patients. Vascular accesses were the femoral vein (39.7%), followed by the femoral artery (27.2%) and the internal jugular vein (14.7%). Femoral vessels were localized at a depth of 0.75 ± 0.25 mm, with a mean diameter of 0.31 ± 0.16 mm. The depth of jugular vein vessels was smaller (0.64 ± 0.24 mm) and their overall diameter, larger (0.44 ± 0.19 mm). The mean number of attempts in ultrasound-guided cannulations was 2.2 ± 1.3. The success rate was 79% and was associated to a larger vessel diameter (0.39 ± 0.20 mm vs. 0.28 ± 0.13 mm, p= 0.01) and a lower number of attempts (1.90 ± 1.16 vs. 3.45 ± 1.77, p= 0.001). Complications were accidental puncture of another vessel (5.3%) and hematoma formation during puncture (2.3%). Conclusions. In the pediatric patients studied, ultrasound-guided vascular cannulation allowed vessel visualization and measurement of their depth and diameter; the success rate was high and it was associated to a low complication rate.

Factores de riesgo asociados a traumatismo al nacimiento / Risk factors associated with birth trauma

ANTECEDENTES: Se define trauma al nacimiento las lesiones sufridas por el feto durante el trabajo de parto o expulsión. OBJETIVO: Identificar los factores de riesgo asociados a lesiones originadas durante el nacimiento en recién nacidos. MÉTODO: Estudio casos y controles, realizado en el período de julio/2004 a diciembre/2005, en la División de Ginecología y Obstetricia del Hospital General de Caxias do Sul/ Facultad de Medicina, Universidad de Caxias do Sul, RS, Brasil. Fueron analizadas variables maternas, del parto y fetales, utilizando el programa estadístico SPSS versión 19.0. Los factores que obtuvieron nivel significativo <0,10 en los análisis bivariado fueron insertas en la regresión logística. Se utilizó el modelo de entrada por bloques (block entry) para selección del modelo final de la regresión. RESULTADOS: En el período citado nacieron 2.137 infantes, 26 de ellos (1,2%) sufrieron trauma al nacimiento. La fractura de clavícula fue la lesión más frecuente (n=14; 53,8%), seguida del cefalohematoma (n=5; 19,2%). Las variables gasométricas no presentaron diferencia estadística. En la regresión logística, las únicas variables independientes asociadas a traumatismo al nacimiento fueron parto vaginal (OR-A: 11,08; IC95%: 2,45-49,98; p=0,002) y perímetro torácico >33 cm (OR-A: 3,36; IC95%: 1,35-9,73; p=0,010). CONCLUSIÓN: Los factores de riesgo asociados a lesiones durante el nacimiento involucran el parto vaginal y el perímetro torácico igual o superior a 33cm.

BACKGROUND: Obstetrics injuries can be defined as fetal lesions suffered by the fetus during labor or expulsion. OBJECTIVE: Identify risk factors for fetal birth trauma. METHOD: Case-control study conducted from July 2004 to December 2005. We analyzed maternal and fetal variables using software SPSS 19.0. The variables showing a significance level <0.10 in the bivariate analysis were included in the logistic regression analysis. We used the block entry model for selection of the final regression model. RESULTS: During these period, we identified 2137 births and 26 (1.2%) were related to fetal birth injury. Clavicle fracture was the most frequent injury (n = 14; 53.8%), followed by cephalohematoma (n = 5; 19.2%). Umbilical cord blood gas analysis did not show statistical significance. In the regression analysis of the variables that had significance level <0.10, the only independent variables associated with fetal birth injury were vaginal delivery (OR-A: 11.08; 95%CI: 2.45-49.98; p=0.002) and thorax circumference > 33 cm (OR-A: 3.36; 95%CI: 1.35-9.73; p=0.010). CONCLUSION: The risk factors for fetal birth injury were vaginal delivery and chest circumference equal to or larger than 33 cm. Other variables were not associated with the outcome in discussion.

Early post-operative complications after thyroidectomy for benign goiters

To find frequency of early complications after thyroid surgery for benign thyroid conditions. Quasi-experimental study. Combined Military Hospital [CMH] Lahore, from March 2005 to Sep 2007.Early complications after thyroid surgery for benign thyroid conditions were studied. One hundred patients with FNAC confirmed benign goiter or follicular growth admitted for elective thyroidectomies were included in the study. Data was collected in the pre-designed proforma and entered in SPSS-10 version. Descriptive statistics was used to calculate frequency of each complication in the early post-thyroidectomy period. The frequency of complications after thyroidectomy was 27%. Out of them 8 patients [8%] developed subcutaneous haematoma, 5 patients [5%] wound infection, 4 patients [4%] tension haematoma, 4 patients [4%] hypocalcaemia, 3 patients [3%] respiratory obstruction and 3 patients [3%] developed recurrent laryngeal nerve paralysis. Surgery for benign thyroid enlargement but may be associated with significant numbers of post operative complications including wound haematoma, wound infection and hypocalcaemia

Hemorragia intraparenquimatosa encefálica espontânea: achados à tomografia computadorizada / Spontaneous intraparenchymatous hemorrhage: findings at computed tomography

Foram analisados os exames de tomografia computadorizada de crânio de 250 pacientes com hematoma intraparenquimatoso encefálico espontâneo em três diferentes hospitais na cidade do Rio de Janeiro, com o objetivo de se levantar os aspectos mais freqüentes desta doença. O hematoma intraparenquimatoso cerebral profundo foi o de maior incidência, seguido do lobar. Mais raramente foi observado sangramento cerebelar e do tronco cerebral. A faixa etária de acometimento mais freqüente foi entre 61 e 70 anos de idade. Não houve diferença expressiva quanto ao sexo predominante ou ao lado mais acometido, porém verificou-se que os homens são mais acometidos em uma faixa etária mais precoce do que as mulheres. A cefaléia foi o sintoma de maior freqüência e a hipertensão arterial esteve presente na maioria dos casos. A drenagem da hemorragia para o sistema ventricular ocorreu mais comumente nos hematomas profundos.

Lacunar syndromes due to small haemorrhagic lesions.

OBJECTIVE: To study the frequency, clinical presentations and prognostic aspects of haemorrhagic lacunar syndromes. MATERIAL AND METHODS: 375 patients of cerebrovascular accidents admitted in neurology wards over 2 years were studied. Based on CT findings, 114 patients were diagnosed as intra cerebral haemorrhage (ICH). They were assessed in detail by careful history and examination of neurological status. Coagulation studies, MRI and angiography were done in selected cases. RESULTS: In 17 (15%) patients, size of hematoma was < 2 cms as seen in CT scan. The sites of these small haemorrhages were in basal ganglia (6 patients), internal capsule (3 patients), thalamus (5 patients) and pons (3 patients). Depending on their location they presented as pure motor stroke, pure sensory stroke, ataxic hemiparesis, sensorimotor stroke and clumsy hand-dysarthia syndrome. Three patients showed interesting phenomena like transient ischemic attack caused by bleed or previous disease showing improvement after bleed. Prognosis of these small ICH was excellent with 100% survival rate and lesser disability as shown by good functional recovery. CONCLUSIONS: Haemorrhagic lacunar syndromes are not just the statistical curiosities but could have significant prognostic bearing.

Trauma facial perinatal / Birth facial trauma

Se presenta un trabajo de investigación clínica sobre la prevalencia de trauma facial perinatal detectado en el Departamento de Ginecología y Obstetricia del Hospital Central "Dr. Ignacio Morones Prieto" de San Luis Potosí, en un periodo comprendido del 1§ de febrero de 1993 al 31 de enero de 1994. Hubo un total de 4,466 nacimientos vivos, de los cuales 3,166 fueron partos normales, 529 se utilizaron forceps, 771 fueron por cesárea existiendo un total de 22 casos de traumatismo facial. Esto representó un total de 0.49 por ciento de todos los nacimientos. En los que se usaron forceps hubo 14 con trauma facial (2.6 por ciento), en los que se realizó cesárea se presentaron 3 (0.38 por ciento) y de los 3,166 nacimientos normales hubo (0.15 por ciento)

Incidencia de hematomas intrahepáticos y subcapsulares post punción biopsia percutánea del hígado / Incidence of intrahepathic and subcapsular hematomas after percutaneous needle biopsy

Intrahepatic and subcapsular hematomas are described as complications of percutaneous liver biopsy. Even though, its incidence is not clearly stablished. Through this study we try to sert which is the real incidence of this complication in our medium. To comply with this, we control our patients by ultrasonography before, after, and even seven days after procedure has been carried out

Hematoma intra-hepático e subcapsular do fígado após biópsia hepática sob visäo laparoscópica: contribuiçäo ao seu estudo através da ultra-sonografia / Intrahepatic and subcapsular hematoma after laparoscopic liver biopsy: the contribution of ultrasound

Nos ultimos anos a ultra-sonografia assume importância na caracterizaçäo de lesöes sólidas que ocupam espaço no fígado. Recentemente autores canadenses empregam esta metodologia e descrevem a incidência de 23% de seus pacientes evoluindo com hematoma intra-hepático ou subcapsular após biopsia hepática. Avaliou-se prospectivamente a incidência desta complicaçäo após feitura de punçäo do fígado sob visäo laparoscópica em oito pacientes cirróticos, sete com esteatose hepática, sete com hepatite crônica ativa e quatro com colestase intra-hepática. Apenas foram biopsiados pacientes sob anestesia geral e que tinham atividade de protrombina superior a 50%, fibrinogênio acima de 100% e contagem de plaquetas além de 50.000 mm3. Em nenhum destes 26 pacientes consecutiva e prospectivamente examinados, observou-se o aparecimento de hematoma intra ou subcapsular do fígado

Fracturas lineales del craneo com factor de riesgo de hematoma intracraneal

Un total de 61 pacientes con traumatismo craneano y fractura lineal del cráneo fue admitido al Servicio de Neurocirugía del Hospital Santo Tomás, durante el año de 1985. Escogimos para este estudio los pacientes con alteración en el nivel de conciencia, para cuya determinación utilizamos la Escala de Coma de Glasgow. la incidencia del hematoma intracreaneal en los pacientes con fractura lineal fue de 67% en los caos en que la Escala demostró que era < ou = 9 y de 25% demostró que era de > ou = 10. La mortalidad fue de 85% en los casos con Escala de Coma de Glasgow de < ou = 9 y de 4%, en los casos de > ou 10

Deteccion con ultrasonido abdominal de hematomas intrahepáticos y/o subcapsulares posterior a la biopsia hepática / Abdominal ultrasound detection of intra-hepatic hematomas and/or subcapsular after hepatic biopsy

En Venezuela este es el primer reporte de la incidencia de hematomas hepáticos posterior a la biopsia con aguja Jamshidi 1.6 mm. Realizamos el procedimiento en 7 casos y los seguimos desde el punto de vista clínico y con ultrasonido abdominal de tiempo real pre-biopsia, 24 horas depués, 72-96h más tarde y a la semana siguiente. Solamente detectamos un hematoma intrahepático y otro subcapsular en un mismo paciente, que presentó fuerte dolor que ameritó analgesia, disminución de la hemoglobina, hamatocrito, aumento de la TGO, no tuvimos necesidad de transfundirlo y evolucionó satisfactoriamente. La verdadera incidencia de hematomas hepáticos posterior a la biopsia no está bien determinada y en nuestro grupo fue de 1,75%. Su importancia será motivo de estudios más grandes