Acute Care/Trauma Surgeon's role in obstetrical/ gynecologic emergencies (The OBCAT Alert) / 世界急诊医学杂志（英文）

@#BACKGROUND: Overwhelming hemorrhage or other intra-abdominal complications may be associated with obstetrical or gynecologic (OB/GYN) procedures and may require the surgical training of an Acute Care/Trauma Surgeon. The OB Critical Assessment Team (OBCAT Alert) was developed at our institution to facilitate a multidisciplinary response to complex OB/GYN cases. We sought to review and characterize the Acute Care/Trauma Surgeon's role in these cases. METHODS: We conducted a retrospective review of all emergency consults during an OB/GYN case at our institution from 2008 to 2015. An OBCAT is a hospital based alert system designed to immediately notify OB/GYN, anesthesiology, Acute Care/Trauma, the intensive care unit (ICU), and the blood bank of a potential emergency during an OB/GYN case. RESULTS: There were 7±3 OBCAT alerts/year. Seventeen patients required Acute Care/Trauma surgery intervention for hemorrhage. Thirteen patients required damage control packing during their hospitalization. Blood loss averaged 6.8±5.5 L and patients received a total of 21±14 units during deliveries with hemorrhage. There were 17 other surgical interventions not related to hemorrhage; seven of these cases were related to adhesions or intestinal injury. Seven additional cases required evaluation post routine OB/GYN procedure; the most common reason was for severe wound complications. There were three deaths during this study period. CONCLUSION: Emergency OB/GYN cases are associated with high morbidity and may require damage control or other surgical techniques in cases of overwhelming hemorrhage. Acute Care/Trauma Surgeons have a key role in the treatment of these complex cases.

Niveles de dosis en radiología convencional / Radiation doses in conventional radiology

Se ha medido la dosis en la superficie de entrada de ojos, tiroides y gónadas en pacientes sometidos a estudio de radiografía de tele de tórax mediante dosimetría termoluminiscente. Se usaron 5 dosímetros en cada una de las exploraciones; encontrándose los siguientes rangos de dosis: 20 mGy a 350 mGy. En el caso de los pacientes pediátricos se propone incluir la información de las dosis recibidas en su cartilla de vacunación con el fin de hacer un seguimiento de los posibles efectos nocivos en su salud.

Doses have been measured at the entrance surface of eyes, thyroid and gonads in patients undergoing chest x-ray studies, using thermo-luminiscent dosimetry. Five dosimeters were used in each investigation, and doses ranged from 20 mGy to 350 mGy. In the case of pediatric patients, it is proposed that dose information from diagnostic examinations is included in the vaccination chart in order to correlate with findings at follow-up.

Neutron KERMA factors of human tissues

A program to calculate the neutron KERMA in human tissues has been developed. The program was developed in Mathcad and contains the neutron kerma factors of those elements that are present in different human tissues. Having the elemental composition of any human tissue the neutron kerma can be easily calculated. The program was tested using the elemental composition of tumor tissues such as sarcoma, melanoma, carcinoma and adenoid cystic. Neutron kerma for adipose and muscle tissue for normal adult was calculated. The results are in agreement with those published in literature. The neutron kerma for water was also calculated because in some dosimetric calculations water is used to describe normal and tumor tissues. From this comparison was found that at larger energies kerma factors are approximately the same, but energies less than 100 eV the differences are large.

Campos neutrónicos producidos por un acelerador lineal para radioterapia / Neutron fields produced by linear accelerator for radiotherapy

Mediante una serie de medidas y cálculos Monte Carlo se han determinado las características dosimétricas y los espectros de los fotoneutrones que se producen en torno a un acelerador lineal para radioterapia de 18 MV. Las medidas se realizaron con dosímetros termoluminiscentes TLD 600 y TLD 700 que se expusieron desnudos y emparedados con Cd, así como dentro de una esfera de parafina y dentro de esferas Bonner.

Measurements and Monte Carlo calculations has been utilized to determine the dosimetric features as well as the neutron spectra of photoneutrons produced around an 18 MV linear accelerator for radiotherapy. Measurementes were carried out with bare and Cd covered thermolumiscent dosimeters, TLD600 and TLD700, as well as inside a paraffine moderator. TLD pairs were also utilized as thermal neutrons inside a Bonner sphere spectrometer.

Cierre quirurgico del conducto arterioso en recien nacidos de pretermino Cinco anos de experiencia / Surgical closure of patent ductus arteriosus in pre-term newborn infants: 5 years' experience

Se refere la experiencia de los primeros cinco anos de trabajo en la Unidad de Cuidados Intensivos Neonatales del Centro Hospitalario 20 de Noviembro del ISSSTE, en el diagnostico y tratamiento quirurgico del conducto arterioso persistente en neonatos con sindrome de dificultad respiratoria sometidos a ventilacion mecanica. Se senalan los datos clinicos para su diagnostico; la edad gestacional, peso, dia promedio en que se efectuo el diagnostico, dia promedio en que fueron sometidos a la cirugia y se comparan estos datos observando su influencia entre el grupo de supervivientes y el grupo que sufrio una defuncion temprana