Dolor en amigdalectomía: técnica fría versus electrobisturí monopolar: estudio prospectivo randomizado / Postoperative tonsillectomy pain: cold versus monopolar electrocautery technique: prospective randomized trial

Introducción: Existen diferentes técnicas para realizarla amigdalectomía. Dentro de las más frecuentes está la técnica fría (bisturí frío, tijera y asa), y la técnica con electrobistrurí monopolar. No hay consenso que alguna de estas técnicas sea claramente superior a la otra respecto al dolor posoperatorio. Objetivo: Evaluar si la técnica quirúrgica (técnica fría-electrobisturí monopolar) repercute sobre la percepción de dolor posoperatorio. Material y método: Ensayo clínico prospectivo, ciego y randomizado. Se incluyeron 17 pacientes (34 amígdalas), mayores de 5 años sin antecedentes de riesgo, con indicación de amigdalectomía. A cada paciente, previo consentimiento informado y randomización, se le extrajo una amígdala con técnica fría y la contralateral con técnica electrobisturí monopolar. La percepción del dolor se midió con escala visual análoga (EVA) durante los primeros siete días posquirúrgicos. Paciente y familiares fueron enmascarados respecto a la técnica usada a cada lado. Resultados: Se encontraron diferencias en la percepción del dolor entre los días 3 a 7 (p <0,05) y al evaluarse la evolución del dolor en función del tiempo, ésta fue mayor con la técnica de electrobisturí (sin diferencias significativas en los 2 primeros días). Conclusión: En los casos evaluados en este estudio, la amigdalectomía con técnica fría se asocia a menor dolor a contar del tercer día posquirúrgico.

Introduction: There are different techniques for carrying out tonsillectomy. Among the mostcommon ones are the "cold technique" (scalpel, scissors and handle), and the monopolar electrocautery technique. No consensus is available to define which technique is less painful. Aim: To assess the effect of the surgical technique ("cold" vs monopolar electrocautery) on post-operative pain perception. Material ana method: Prospective blind randomized clinical trial. 17 patients with tonsillectomy indication (34 tonsils) over 5 years old, without major surgical risk, and after randomization and obtaining an informed consent, received a tonsillectomy using cold technique and the contra lateral side was removed using monopolar electrocautery technique. Pain perception was measured with visual analogue scale (VAS) during the firstseven days after surgery. Patients and relatives were unaware ofthe technique used on each side. Results: There were differences in pain perception between day 3 and 7 (p <0.05). Assessing evolution across time, pain was higher with the electrocautery technique (no significant difference was found in the first 2 days). Conclusion: Based on our results tonsillectomy using cold technique appears to be associated with less post-operative pain, starting on the third post-surgery day.

Neumomediastino espontáneo (síndrome de Hamman): Una enfermedad benigna mal diagnosticada / Spontaneous pneumomediastinum: Review of eight cases

Background: Hamman syndrome or spontaneous pneumomediastinum is uncommon and its clinical manifestations are chest pain, dyspnea and subcutaneous emphysema. Aim: To report a series of patients with spontaneous pneumomediastinum. Material and methods: Medical records of patients with the diagnosis of pneumomediastinum, managed between 2002 and 2007 in a public hospital, were retrieved and reviewed. Results: Eight patients aged between 16 and 41 years (five males) were identified. The most common symptom was chest pain and the most common sign was subcutaneous emphysema. A chest X ray was performed in all and a chest CT scan in seven. AH were managed conservatively with oxygen, analgesia and rest. No patient required surgery and the evolution was favorable. Conclusions: The most common presenting complaint of spontaneous pneumomediastinum is chest pain and its management does not require surgery.

Qualitative feed restriction on productive performance and lipid metabolism in broiler chickens / Restrição alimentar qualitativa sobre o desempenho produtivo e o metabolismo lipídico em frango de corte

A trial was carried out to evaluate the effect of qualitative restriction at different rearing phases on liver fatness and plasma triglycerides without impairing the productive performance of broiler chickens. One hundred and seventy-six male chicks were randomly assigned to four treatments and reared in battery brooders (16 pens with 11 birds each) from 1 to 49-day-old. In the control group, chicks were fed a starter diet (1 to 28-day-old) with 3,300kcal ME/kg of diet and 22.5 percent CP; grower diet (29 to 42-day-old) 3,300kcal ME/kg of diet and 18.2 percent CP; and the finisher diet (43 to 49-day-old) 3,300kcal ME/kg and 18.2 percent CP. Three restrict groups were fed a low 2,800kcal ME/kg of diet and 24 percent CP from 7 to 14-day-old (treatment 1); from 7 to 21-day-old (treatment 2); and from 22 to 35-day-old (treatment 3). All treatments were fed control diet before and after the feed restriction period. Feed intake was not affected during the feed restriction period; nevertheless, weight gain was lower (P<0.05) for chicks fed restricted diet from 7 to 21 and from 21 to 35-day-old. At the end of each restriction period, scores of liver for fatty infiltration were higher in restricted birds compared to control birds, although no changes were detected in plasma triglyceride levels. On the 49th day of age, less intracellular fatty infiltration was observed in the liver of previously restricted birds compared to control birds, and weight gain was also lower in the restricted groups. Moreover, triglyceride plasma levels were similar among treatments, but decreased in 12-hour-fasted broilers compared to non-fasted birds. The low energy:protein ratio diet affected weight gain and fatty infiltration in the liver, but had no effect on plasma levels of triglycerides

Aplicou-se restrição alimentar qualitativa em frangos de corte, em diferentes fases do crescimento, para reduzir a infiltração gordurosa do fígado e os triglicerídeos plasmáticos, sem influir nas respostas produtivas. Distribuíram-se aleatoriamente 176 pintos machos em quatro tratamentos. As aves foram alojados em baterias (16 gaiolas com 11 aves cada) e foram criados de 1 a 49 dias de idade. No grupo controle as aves foram alimentadas com dieta inicial (1-28 dias) com 3.300kcal EM/kg/dieta e 22,5 por cento de proteína bruta (PB; dieta de crescimento (29-42 dias) com 3.300kcal EM/kg/dieta e 20,9 por cento de PB; dieta de acabamento (43-49 dias de idade) 3.300kcal EM/kg/dieta e 18,2 por cento de PB. As aves nos três grupos sob restrição foram alimentadas com dieta com 2.800kcal de EM/kg/dieta e 24 por cento de PB de 7 aos 14 dias de idade (tratamento 2), de 7 aos 21 dias de idade (tratamento 2) e de 22 aos 35 dias de idade (tratamento 3). Todas as aves dos tratamentos sob restrição foram alimentadas com a dieta controle antes e depois do período de restrição alimentar. Ao final de cada período de restrição foi observada uma maior infiltração gordurosa no fígado (representado pela composição química e escore histológico). Também não houve diferenças entre os triglicerídeos plasmáticos, quando comparado com o controle. Aos 49 dias de idade, o ganho de peso total e a infiltração gordurosa no fígado, foram menores nos grupos restritos. Os níveis de triglicérides plasmáticos, entretanto, foram semelhantes entre os tratamentos, mas reduziram nas aves com aplicação de jejum de 12 horas, quando comparados com aves sem jejum. A baixa relação energia/proteína da dieta afetou o ganho de peso e a infiltração gordurosa no fígado, mas não alterou os valores de triglicérides plasmáticos

Alternativa quirúrgica para la corrección del ectropión: huincha tarsal / Surgical alternative for ectropion correction: tarsal strips

Se presentan 11 pacientes con ectropión del párpado inferior operados con la técnica de la huincha tarsal. La técnica consiste en disecar una porción de tarso lateral y suturarla a nivel del canto lateral. Sin recidiva en la serie. Es una técnica rápida y sencilla con cicatrices mínimas

Hemotórax traumático / traumatic hemothorax

Se presenta un estudio prospectivo y descriptivo de 155 pacientes con hemotórax y hemoneumotórax traumático estabilizado en que predominan hombres de 20 a 29 años. A través del estudio se comparan técnicas de toracocentesis y pleurotomía como métodos de drenaje, concluyéndose que el primer método tiene una eficacia mayor. Igualmente, se analiza el uso profiláctico de penicilina + cloranfenicol en éste grupo de pacientes, no encontrándose beneficios en su administración

Empiemas pleurales / Pleural empyemas

Se estudian 51 pacientes portadores de empiema pleural tratados en el Servicio de Cirugía del Hospital Barros Luco-Trudeau, entre enero 1982 y diciembre 1985. El 75% correspondió al sexo masculino, con edades entre 19 y 75 años. El diagnóstico se realizó por toracocentesis (72,5%), tubo de drenaje (19,6%) o toracotomía (7,9%). El 96% tenía líquido purulento en la cavidad. Los cultivos fueron positivos en un 71% de los casos (aerobios y/o anaerobios). La infección fue aerobia en el 51%, anaerobia el 9,8% y de ambas en el 7,8% de los casos positivos. Los aerobios frecuentemente aislados fueron Pseudomonas, Staohylococcus uy Streptococcus (63%), y entre los anaerobios Bacteroides y Fusobacterium. La mayoría de los pacientes recibió como primera medida terapéutica drenaje cerrado, con 67% de éxito. Otros tratramientos utilizados fueron la foracotomía de aseo más decorticación y el drenaje abierto (fenestración). La mortalidad fue 3,9%