Desenlace de craniectomía descompresiva primaria y secundaria en pacientes con trauma craneoencefálico severo en la Clínica Universidad de La Sabana / Outcomes of Primary and Secondary Decompressive Craniectomy in Patients with Severe Traumatic Brain Injury at Clínica de la Universidad de La Sabana

RESUMEN Objetivos: El propósito de este estudio fue determinar el desenlace en el egreso y en el seguimiento a un año de los pacientes con trauma craneoencefálico severo sometidos a craniectomía descompresiva primaria y secundaria en la Clínica de la Universidad de La Sabana, en un periodo de cinco años. Pacientes y métodos: Se llevó a cabo una serie de casos retrospectiva de pacientes con trauma craneoencefálico severo sometidos a craniectomía descompresiva entre 2008 y 2013. Los desenlaces primarios fueron la sobrevida y el estado funcional medido por la escala de desenlace de Glasgow al momento del egreso hospitalario y al año de seguimiento. Como desenlaces secundarios se incluyeron el tiempo de latencia para la realización de la craniectomía, las complicaciones intra- y postoperatorias, días de hospitalización y estancia en la unidad de cuidados intensivos, tiempo de ventilación, resultados de la craneoplastia y causa de muerte. Resultados: Treinta y cinco pacientes con trauma craneoencefálico severo fueron sometidos a craniectomía descompresiva en el periodo de estudio, 29 primarias y 6 secundarias, con una latencia mediana de 5 horas y 57 horas, respectivamente. Se observó una sobrevida del 51,4 % de los pacientes, de los cuales 39 % presentó recuperación funcional satisfactoria en la escala de desenlace de Glasgow en el momento del egreso y al año. Conclusiones: En este grupo de pacientes sometidos a craniectomía descompresiva primaria o secundaria, junto con un manejo interdisciplinario y rehabilitación precoz, se presentaron desenlaces funcionales favorables en el seguimiento a largo plazo.

ABSTRACT Aim: The purpose of this study was to determine the outcome, at discharge and at one-year follow-up, of patients with severe traumatic brain injury undergoing primary and secondary decompressive craniectomy at Clinica Universidad de La Sabana, over a period of five years. Patients and methods: We conducted a retrospective case series of patients with severe traumatic brain injury undergoing decompressive craniectomy between 2008 and 2013. Te primary outcomes were survival and functional status, measured by the Glasgow Outcome Scale, both at discharge, and at the one year follow-up. Secondary outcomes included latency time for craniectomy, intra and postoperative complications, days of hospitalization and intensive care unit stay, ventilation time, cranioplasty results, and cause of death. Results: Thirty-five patients with severe traumatic brain injury underwent decompressive craniectomy in the study period, 29 of which were primary and 6, secondary, with a median latency of 5 hours and 57 hours, respectively. A survival of 51.4% of the patients was observed, of which 39% presented satisfactory functional recovery on the Glasgow outcome scale at the time of discharge and one year later. Conclusions: In this group of patients who underwent primary or secondary decompressive craniectomy, together with interdisciplinary management and early rehabilitation, favorable functional outcomes were found in the long-term follow-up.

[Percutaneous nephrolithotomy in supine decubitus. Valdivia's position]. / Nefrolitotomía percutánea en decúbito supino. Posición de Valdivia.

OBJECTIVES: The accidental puncture of the renal cavities and the performance of anterograde pyelogram by Goodwin in 1955 gave way to the beginning of modern endourology. The possibility to insert thick caliber catheters in the excretory system through the renal parenchyma had led to the current state of percutaneous surgery techniques in the treatment of urinary lithiasis. Percutaneous nephrolithotomy (PNL) in the supine position makes possible, nowadays, to treat a high number of patients with outstanding results and a fast recovery. METHODS: We describe the technique used for the surgical treatment of renal lithiasis in supine position and the established indications. RESULTS: From 2004 to 2007 we treated 150 patients using the PNL technique in supine position. We show a brief analysis of the results obtained while applying these techniques and evaluated the trans and post operative complications, post operative stay, evolution and kind of technique used for the extraction of the gravel. CONCLUSIONS: The good results achieved during the application of the supine position gives credit to its use for the treatment of renal lithiasis.

Clinical evolution in patients with penile prosthesis implant.

OBJECTIVES: 1). To evaluate the satisfaction and clinical outcome in patients with penile prosthesis implant as a treatment to Severe Biogenic Erectile Dysfunction. 2). To identify the most frequent complications associated with the surgical intervention. 3). To compare the behaviour of sexual satisfaction in partners and patients with penile prosthesis implant before and after the application of the treatment. METHODS: A descriptive, (longitudinal) study with quantitative and qualitative methodology was done, where 25 men with penile prosthesis implants, performed at Faustino Perez Hospital, were evaluated. RESULTS: The complications presented in the procedures were perforation of the tunica albuginea, postoperatory pain, thin penis and the expulsion of one or two cylinders, this latter case in a patient who presented periprosthetic sepsis. CONCLUSIONS: The penile prosthetic implant constitutes an option of effective treatment which achieves an 88 % of sexual satisfaction in patients. Both partners and patients treated with penile prosthetic implantation referred increase in erotism, satisfactory sexual activity, improvement of self-esteem, quality of communication with their partner, better labour results, interpersonal and social relationships and strengthening of couple's bonds.

Clinical Evolution in Patients with Penile Prosthesis Implant

OBJETIVOS: 1) Evaluar la satisfacción y evolución clínica de los pacientes con prótesis peneana, como tratamiento de la disfunción eréctil biogénica severa. 2) Identificar las complicaciones más frecuentes asociadas a la intervención quirúrgica. 3) Comparar el comportamiento de la satisfacción sexual de los pacientes con implante de prótesis peneana y su pareja, antes y después de aplicado el tratamiento. MÉTODO: Se realizó un estudio descriptivo longitudinal con metodología cuantitativa y cualitativa donde se evaluaron a 25 hombres a los cuales se les había insertado prótesis peneana en el Hospital Faustino Pérez de Matanzas. RESULTADOS: Las complicaciones que se presentaron en nuestra casuística fueron la perforación de la albugínea, el dolor post operatorio, el pene fino y la expulsión de uno o dos cilindros, esta última en un paciente que presentó sepsis peri protésica. CONCLUSIONES: El implante de prótesis peneana constituyó una opción de tratamiento efectiva que logró un 88 por ciento de satisfacción sexual en los pacientes implantados. Los pacientes tratados con la implantación de prótesis peneana y sus parejas refirieron incremento en el erotismo, la actividad sexual satisfactoria, mejoría en la auto estima, la comunicación de pareja, el rendimiento laboral, las relaciones personales y sociales y el fortalecimiento del vínculo de la pareja(AU)

OBJECTIVES: 1) To evaluate the satisfaction and clinical outcome in patients with penile prosthesis implant as a treatment to Severe Biogenic Erectile Dysfunction. 2) To identify the most frequent complications associated with the surgical intervention. 3) To compare the behaviour of sexual satisfaction in partners and patients with penile prosthesis implant before and after the application of the treatment. METHODS: A descriptive, (longitudinal) study with quantitative and qualitative methodology was done, where 25 men with penile prosthesis implants, performed at Faustino Perez Hospital, were evaluated. RESULTS: The complications presented in the procedures were perforation of the tunica albuginea, postoperatory pain, thin penis and the expulsion of one or two cylinders, this latter case in a patient who presented periprosthetic sepsis. CONCLUSIONS: The penile prosthetic implant constitutes an option of effective treatment which achieves an 88 percent of sexual satisfaction in patients. Both partners and patients treated with penile prosthetic implantation referred increase in erotism, satisfactory sexual activity, improvement of self-esteem, quality of communication with their partner, better labour results, interpersonal and social relationships and strengthening of couples bonds(AU)

Percutaneous nephrolithotomy in supine decubitus: Valdivia´s position

OBJETIVO: La punción accidental de las cavidades renales y la realización de la pielografía anterógrada en 1955 por Goowin marcó el inicio de la endourología moderna. La posibilidad de introducir catéteres de grueso calibre en el sistema excretor a través del parénquima renal ha llevado al estado actual de las técnicas de cirugía percutánea en el tratamiento de la litiasis urinaria.La nefrolitotomía percutánea en decúbito supino permite en la actualidad tratar un alto número de pacientes con resultados excelentes que permiten una recuperación rápida del paciente. MÉTODOS: Se describe la técnica utilizada para el tratamiento quirúrgico de la litiasis renal en posición supina así como las indicaciones establecidas. RESULTADOS: Han sido tratadas del año 2004 al 2007 un total de 150 pacientes con técnicas de Nefrolitotomía Percutánea en decúbito supino se muestra análisis de resultados obtenidos durante su aplicación evaluando complicaciones trans y post operatoria, estadía post operatoria, evolución, tipo de técnicas para la extracción. CONCLUSIONES: Los buenos resultados obtenidos en la aplicación de posición supina para la NLP avalan su uso en el tratamiento de la litiasis renal(AU)

OBJECTIVES: The accidental puncture of the renal cavities and the performance of anterograde pyelogram by Goodwin in 1955 gave way to the beginning of modern endourology. The possibility to insert thick caliber catheters in the excretory system through the renal parenchyma had led to the current state of percutaneous surgery techniques in the treatment of urinary lithiasis.Percutaneous nephrolithotomy (PNL) in the supine position makes possible, nowadays, to treat a high number of patients with outstanding results and a fast recovery. METHODS: We describe the technique used for the surgical treatment of renal lithiasis in supine position and the established indications. RESULTS: From 2004 to 2007 we treated 150 patients using the PNL technique in supine position. We show a brief analysis of the results obtained while applying these techniques and evaluated the trans and post operative complications, post operative stay, evolution and kind of technique used for the extraction of the gravel. CONCLUSIONS: The good results achieved during the application of the supine position gives credit to its use for the treatment of renal lithiasis(AU)