Comportamiento del lesionado en el Hospital Universitario "General Calixto García" / Conduct of Injured Patients in General Calixto Garcia University Hospital

Introducción: En el mundo moderno, el traumatismo es la primera causa de mortalidad y discapacidad en menores de 35 años. Múltiples son los esfuerzos para tratar de definir su pronóstico desde el momento en que se produce. Con el decurso de los años se han creado varias escalas, para describir la gravedad de las lesiones, las alteraciones fisiológicas que se producen, así como para evaluar los sistemas de atención. Objetivo: Describir el comportamiento de los lesionados en el Hospital "Calixto García" según variables. Métodos: Se realizó un estudio observacional descriptivo, prospectivo y longitudinal en 1582 lesionados atendidos en el servicio de Cirugía General. Resultados: El intervalo trauma/ingreso superó los 60 minutos en un número elevado y la mitad de ellos presentó parámetros clínicos de inestabilidad hemodinámica en la recepción; se logró su compensación en la primera hora de admitidos en 7 de cada 10 lesionados. Más de la mitad desarrolló alguna complicación y predominó la estadía hospitalaria entre 15 y 21 días. Conclusiones: Algunas de las variables estudiadas se comportaron similar a la literatura consultada. Los resultados sugieren la necesidad de implementar un programa de atención prehospitalaria al lesionado más efectivo para mejorar la atención y el índice de sobrevida en los mismos(AU)

Introduction: In the modern world, trauma is the leading cause of death and disability in people under 35 years of age. Multiple efforts are made to define its prognosis from the moment it occurs. Over the years, several scales have been created to describe the severity of injuries, the physiological changes that occur, as well as to assess care systems. Objective: To describe the behavior of injured patients in Calixto García Hospital according to variables. Methods: A observational, descriptive, prospective and longitudinal study was carried out with 1582 injured patients treated in the general surgery service. Results: The trauma/admission interval exceeded sixty minutes in a high number of cases. Half of them presented clinical parameters of hemodynamic instability at admission. Compensation was achieved at the first hour of admission in seven out of ten injured patients. More than half the patients developed some complication. There was a predomination of hospital stay between 15 and 21 days. Conclusions: Some of the variables studied behaved similarly to the way described in the consulted literature. The results suggest the need to implement a more effective prehospital care program for the injured patients to improve care and survival rate(AU)

Craniectomía descompresiva en el trauma encefalocraneano grave: factores pronósticos y complicaciones / Decompressive craniectomy in severe traumatic brain injury: prognostic factors and complications

RESUMEN Objetivo: Análisis de las características clínicas, las complicaciones y los factores asociados al pronóstico de los pacientes con trauma encefalocraneano grave en los que se realizó craniectomía descompresiva. Métodos: Estudio retrospectivo de los pacientes asistidos en una Unidad de Cuidados Intensivos, con trauma encefalocraneano grave en los que se realizó craniectomía descompresiva, entre los años 2003 y 2012. Se siguieron los pacientes hasta el egreso de la unidad de cuidados intensivos, analizándose sus características clínico-tomográficas, las complicaciones y los factores asociados al pronóstico (análisis uni y multivariado). Resultados: Se estudiaron 64 pacientes. Se realizó craniectomía descompresiva primaria y lateral en la mayoría de los pacientes. Se halló una alta incidencia de complicaciones (78% neurológicas y 52% no neurológicas). 42 pacientes (66%) presentaron mala evolución y 22 (34%) tuvieron una buena evolución neurológica. De los pacientes que sobrevivieron, el 61% tuvo una buena evolución neurológica. En el análisis univariado, los factores asociados significativamente con mala evolución neurológica fueron: la hipertensión intracraneana post-craniectomía descompresiva, la mayor gravedad y el peor estado neurológico al ingreso. En el análisis multivariado, solo la hipertensión intracraneana post-craniectomía descompresiva se asoció significativamente con mala evolución. Conclusión: Se trata de un grupo de pacientes muy grave, de difícil manejo, con elevada morbimortalidad, donde la hipertensión intracraneana es un factor principal de mala evolución. .

ABSTRACT Objective: To analyze the clinical characteristics, complications and factors associated with the prognosis of severe traumatic brain injury among patients who undergo a decompressive craniectomy. Methods: Retrospective study of patients seen in an intensive care unit with severe traumatic brain injury in whom a decompressive craniectomy was performed between the years 2003 and 2012. Patients were followed until their discharge from the intensive care unit. Their clinical-tomographic characteristics, complications, and factors associated with prognosis (univariate and multivariate analysis) were analyzed. Results: A total of 64 patients were studied. Primary and lateral decompressive craniectomies were performed for the majority of patients. A high incidence of complications was found (78% neurological and 52% nonneurological). A total of 42 patients (66%) presented poor outcomes, and 22 (34%) had good neurological outcomes. Of the patients who survived, 61% had good neurological outcomes. In the univariate analysis, the factors significantly associated with poor neurological outcome were postdecompressive craniectomy intracranial hypertension, greater severity and worse neurological state at admission. In the multivariate analysis, only postcraniectomy intracranial hypertension was significantly associated with a poor outcome. Conclusion: This study involved a very severe and difficult to manage group of patients with high morbimortality. Intracranial hypertension was a main factor of poor outcome in this population. .

Optic nerve injury model in rats set up by fluid percussion brain injury device / 中华眼底病杂志

Objective To observe whether the animal model of optic nerve injury in rats can be set up by fluid percussion brain injury device (FPI) or not.Methods Seventy-one healthy female Wister rats were randomly divided into 2 groups,inlcuding model group with 66 rats and control group with 5 rats.The rats in model group were randomly divided into 3 groups.Eight rats in group 1 were examined by flash-visual evoked potential (F-VEP) and magnetic resonance imaging (MRI) examines before and 1,3 days,1,2,4,6,and 8 weeks after injury;56 rats in group 2 were randomly divided into 7 subgroups with 8 rats in each subgroup,and were detected by histopathologieal and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) apoptosis examines 1,3 days,1,2,4,6,8 weeks after injury;2 rats in group 3 were examined by electron microscopy 4 and 8 weeks aher injury.According to the degree of injury,the injured eyes were divided into 2 groups including severe injury group with the beat pressure of (699.14±60.79) kPa and mild injury group with the beat pressure of (243.18±20.26) kPa.The right and left eyes in rats in each group were in severe and mild injury group,respectively.Results One day after injury,the latency duration of F-VEP prolonged in severe injury group,wich differed much form which in the normal control group (P<0.05);the amplitude was gradually reduced during the first 2 weeks after injury and kept steady after that (P>0.05).The latency duration prolonged in mild injury group,and its difference with the normal control group was statistically significant (P<0.05);the amplitude was gradually reduced during the first 4 weeks after injury and kept steady after that (P>0.05).The abnormal high signal could be seen on optic nerve 1 day after injury,and was still obvious 8 weeks later.The results of histopathological examination showed ruptured capillary in ganglion cell layer 1 day after injury;retinal ganglion ceils without nucleus could be seen 4 weeks after injury.The apoptosis of positive cells was found in each layer of the retina 3 days after injury.TUNEL results indicated that the number of apoptotic positive cells increased significantly 1-2 weeks after injury.Conclusion An animal model of optic nerve injury can be successfully set up using FPI in rats.