Hematoma sofocante, su fisiopatología / Suffocating hematoma, its pathophysiology

Se revisan la fisiopatología y los mecanismos que producen la sofocación en el hematoma cervical y se determina que el único tratamiento con posibilidades de éxito vital es el inmediato drenaje del hematoma.

In this article are reviewed the physiopathology and the mechanisms that causes suffocation in the cervical hematoma. It is determined that the only treatment with possibilities of vital success is the immediate drainage of the hematoma.

Blood loss and transcapillary refill in uncontrolled treated hemorrhage in dogs

Objetive: This study evaluated retroperitoneal hematomas produced by bilateral injury of iliac arteries (uncontrolled hemorrhage), blood volume loss, transcapillary refill, the effects of volume replacement on retroperitoneal bleeding and the hemodynamic changes with and without treatment. Methods: Initial blood volume was determined with Tc99m-labelled red cells, and bleeding was evaluated by means of a portable scintillation camera positioned over the abdomen. Previously splenectomized mongrel dogs (16.8 ± 2.2 kg) were submitted to hemorrhage for 30 minutes and randomized into three groups: I - no treatment (n=7); II - treatment with 32 mL/kg of Lactated Ringer's for three to five minutes (n=7); and III - treatment with 4 mL/kg of 7.5 percent NaCl plus 6.0 percent dextran 70 for three to five minutes (n=7). They were studied for an additional 45 minutes. Results: Volume replacement produced transitory recovery in hemodynamic variables, including mean pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac index, with significant increase in dogs treated with 32 mL/kg of Lactated Ringer's and 7.5 percent NaCl plus 6.0 percent dextran 70 (p<0.001, against no treatment), along with a decrease (p<0.001) in the systemic vascular resistance index. Groups II and III had significant initial decreases in hematocrit and hemoglobin. The treated dogs (groups II and III) presented rebleeding, which was greater during treatment with 32 mL/kg of Lactated Ringer's (group II). Conclusions: Despite the rebleeding observed in treated groups, the utilization of hypertonic saline solution with dextran proved to be effective in the initial reanimation, producing evident transcapillary refill, while the Lactated Ringer's solution produced capillary extravasation and was ineffective in the initial volume replacement in this model of uncontrolled hemorrhage.

Recuperacao da funcao nervosa apos hematoma intraneural: estudo experimental comparativo em ratos submetidos a neurolise interna imediata / Backup of the nervous function after intraneural hematoma: comparative experimental study in rats submitted to the immediate internal neurolisis

O trauma de nervos perifericos constitui uma situacao comum, porem com apresentacao clinica extremamente variavel. Quando associado a grandes contusoes, em particular no trauma fechado de membros, pode levar a alteracoes sensitivas e motoras no territorio do nervo comprometido sem que haja necessariamente seccao nervosa. A opcao pela conduta expectante ou pela abordagem cirurgica descompressiva frente a essa situacao e muito pouco estudada. Diante disso, desenvolveu-se um...

Hematoma de esófago: a propósito de un caso / Esophagus hematoma

Objetivo: El hematoma espontáneo de la pared del esófago es una entidad clínica poco frecuente y sólo recientemente reconocida. Se presenta un caso diagnosticado mediante Rx de esófago y tomografía computada, confirmado por esofagoscopia. Material y métodos: Se trata de una paciente de 61 años, que consulta por dolor epigástrico de inicio súbito, sin cambios del ECG ni de las enzimas cardíacas. Se pide TC de tórax, y posteriormente Rx de esófago. Resultados: La TC muestra engrosamiento de la pared del esófago en región media, con áreas hipodensas, la Rx de esófago muestra una extensa lesión elevada con integridad de la mucosa. Se efectuó una endoscopia de esófago que mostró extenso hematoma de pared. Conclusión: Si bien en este caso el diagnóstico definitivo se realizó con endoscopia, esta entidad debe ser reconocida por Rx de esófago, puesto que la introducción del endoscopio puede lesionar la pared. Hasta el momento sólo 22 casos fueron publicados en la literatura mundial

Pontine tegmentum hematoma: a case report with the "one-and-a-half" syndrome without pyramidal tract deficit

O autor relata o caso de um paciente de sexo masculino de 54 anos com hematoma pontino que se manifestou por síndrome "one-and-a-half" e ataxia cerebelar mas sem sinais de acometimento do trato piramidal. A ausência de acometimento do trato piramidal é decorrente possivelmente de uma variaçäo da anatomia vascular do segmento pontino do tronco cerebral. Os achados clínicos do caso e os mecanismos fisiopatológicos da síndrome "one-and-a-half" säo discutidos