Queratoplastia penetrante con fines ópticos. Presentación de cuatro casos / Penetrating keratoplasty with optical aims. Presentation of four cases

RESUMEN La queratoplastia penetrante ha sido el procedimiento empleado, de forma casi universal, para el tratamiento de las patologías corneales que afectan de forma irreversible a la visión. Se reportaron 4 casos clínicos de pacientes con afecciones corneales con compromiso visual severo, dado por visión de cuenta dedos y percepción luminosa. Luego de la evaluación completa en cada caso, se decidió realizar la queratoplastia penetrante con fines ópticos, con el objetivo de recuperar la transparencia de la córnea y la calidad visual. No existieron complicaciones transquirúrgicas y fueron seguidos según protocolo de evaluación postoperatoria de trasplante corneal. Los resultados y evaluación fueron satisfactorios, al año mantenían la transparencia del injerto y se logró mejoría considerable de la agudeza visual (AU).

ABSTRACT Penetrating keratoplasty has been a procedure used, almost universally, to treat corneal diseases affecting vision in an irreversible way. Four clinical cases are reported of patients with corneal affections severely compromising vision, given by short vision and luminous perception. After completely evaluating each case, the authors decided to perform the penetrant keratoplasty with optical aims, to recover cornea transparency and the vision quality. There were not transurgical complications and the patients were followed up according to the protocols of post-surgery evaluation of corneal graft. The results and evaluation were satisfactory; after a year, the transparency of the graft was maintained and visual acuity substantially improved (AU).

Trauma cardiaco en pediatría / Cardiac trauma in pediatrics

El trauma cardiaco constituye una entidad infrecuente en pediatría que requiere de toma de decisiones rápidas y oportunas, además de un manejo óptimo para obtener una mejor sobrevida de los pacientes. En esta revisión en base a un caso clínico, se actualiza el tema de trauma cardiaco, se describen los tipos más frecuentes, las diferentes formas clínicas de presentación y el enfrentamiento terapéutico. Palabras clave: Trauma cardiaco, penetrante cardiaca, cirugía cardiaca.

Cardiac trauma is an uncommon entity in pediatrics that requires quick and timely decision making, as well as optimal management to obtain a better survival of patients. In this review based on a case report, the issue of cardiac trauma is updated, the most frequent types, the different clinical forms of presentation and the therapeutic confrontation are described.

Penetrating Neck Injuries Following a Case Report of a Successfully Healed Penetrating Neck Injuries Inflicted by a Sharp Tool.

Introduction: The penetrating neck injuries belong to the group of the most urgent conditions in medicine. Large blood vessels and nerves that connect the head with the body are situated in the neck as well as the important parts of respiratory and digestive system. The penetrating neck injuries inflicted by the sharp object cause damage to organs that are placed in the neck which directly treatens life of the injured person. Bleedings that occur in such conditions, as well as other complications, could be the immediate cause of death. Aim: The aim of our work is to present the case of a female patient with a penetrant and perforant neck injury and the state of the hemorrhagic shock, successfully treated in our institution. Case Report: Female patient, 37 years old, was injured by the two stabbs into the left side of the neck caused by kitchen knife. As the injury occurred 40 km from our center the first aid was administered at the regional center, so she arrived to our clinic already intubated, with heavy mouth bleeding despite tampooning of the mouth cavity, unconscious, with administered transfusion. Two sutured wounds were present on the left lateral side of the neck, each about 2 cm long, one along the front SCM edge, localized in its middle third and the other placed laterally to the neck line, at about 2 cm below the left ramus of the lower jaw. She immediately underwent general anesthesia and the team work was organized to explore the above mentioned wounds. Two large injuries were noticed as dominant there: penetration of the internal jugular vein in the length of 3 cm and penetration of the lateral wall of hypopharinx. Primary vein wall plastic and hypopharynx reconstruction provided satisfactory haemostasis. The success of the intervention was checked by directoscopy. The nasogastric tube was immediately placed. In the postoperative period, the patient was extubated the following day, the nasogastric tube was removed after 7 days and there were no complica­tions detected. She was released home fully recovered on the tenth day. Discussion and Conclusion: The penetrant and perforant neck injuries belong to the group of the most urgent conditions in medicine since they directly threatens patient’s life. In taking care of these injuries, the most important thing is to secure breathing, by intubation or tracheotomy, to stop the bleeding, if not permanently, then at least temporarily, to provide for compensation of fluids by infusion or transfusion, as well as to organaize safe transport to the medical institution where patient can receive final treatment. The approach to such injuries requires team work, while being aware that the size of the entering wound does not implicate the size of the injury.

Transdermal therapeutic systems: A brief overview of factors affecting penetration and permeation.

The term percutaneous absorption covers the entire process by which a drug applied to the outer surface of the skin is taken up into the systemic circulation. This requires penetration into the layers of the skin with subsequent permeation across each layer and finally uptake into the capillary blood vessels in the upper region of the dermis. It is necessary to consider both the structure of the membrane and the interactions of the three components – membrane, penetrant and vehicle to determine the physical and chemical factors which assist or hinder the process. Not all drug substances are suitable for transdermal delivery. Among the factors playing a part in percutaneous absorption are the physical and chemical properties of the drug, including its molecular weight, solubility, partition coefficient, dissociation constant (pKa), the nature of the carrier vehicle, and the condition of the skin. Although general statements applicable to all possible combinations of drug, vehicle, and skin condition are difficult to draw, most research findings were tried to summarize in this review article.