ABSTRACT
OBJETIVO: Analizar las características de presentación, complicaciones y secuelas, de las fracturas de temporal ingresadas en UCIP.MATERIAL Y MÉTODOS: Análisis descriptivo retrospectivo de las historias clínicas y TC craneal. RESULTADOS: Veintisiete pacientes ingresados en UCIP presentaron fractura del temporal: 13 (48%) sin afectación de peñasco (grupo 1) y 14 (52%) con afectación de peñasco (grupo 2). El grupo 2 presentó mayor estancia en la UCIP: 4,5 días (RI: 2,75-22,25) vs. 2 (RI: 1-3) (p = 0,018), mayor frecuencia de secuelas (p = 0,04) y presencia de fístula del LCR (p < 0,02). Los scores de PRIMS III e índice de traumatismo pediátrico no mostraron diferencias significativas. El 31% presentó hipoacusia, 2 pacientes fallecieron y 4 (15%) presentaron secuelas permanentes. CONCLUSIONES: Las fracturas temporales pueden ser graves, especialmente si incluyen al peñasco, bien por las lesiones asociadas, que marcan el riesgo vital, como por las secuelas (déficit auditivo o fístula LCR). Los autores indican el seguimiento de estos pacientes a largo plazo por Otorrinolaringología
OBJECTIVES: To evaluate the clinical presentation, complications and sequelae in patients with temporal bone fracture in the last 11 years. MATERIAL AND METHODS: A total of 27 patient medical records were retrospectively analysed. RESULTS: Of the 27 patients who were admitted for temporal bone fracture from 2001 to 2012, 13 (48%) had no petrous involvement (Group 1), and 14 (52%) with petrous involvement (Group 2). Patients in Group 2 had a longer P-ICU stay: median 4.5 days (RI: 2.75-22.25 d) vs 2 (RI: 1-3 d) (P=.018); more days on mechanical ventilation support: median 3 days (RI: 1.50-17 d) vs 1 (RI: 1-1.25 d). This group also had a higher frequency in sequelae (P=.04 OR = 1.4 (95% CI: 1.05-1.95)) and a higher incidence in cerebrospinal fluid (CSF) fistula (P<.02; OR 2.33; 95% CI (1.27-4.27)). Severity scores (PRIMS III and PTI) showed no significant differences. Some degree of hearing loss was observed in 31% of the patients. Traffic accident was the main cause of trauma (33%), followed by falls (27%). There were 2 deaths and 4 (15%) had permanent sequelae. CONCLUSIONS: Isolated temporal bone fractures usually have a good outcome in children, but in some cases they can be fatal or have permanent sequelae. Long term follow up is recommendedby authors
Subject(s)
Humans , Male , Female , Child , Temporal Bone/abnormalities , Temporal Bone/injuries , Otolaryngology/instrumentation , Otolaryngology/methods , Peripheral Nervous System Agents/administration & dosage , Peripheral Nervous System Agents/analysis , Temporal Bone/growth & development , Temporal Bone/metabolism , Otolaryngology/standards , Peripheral Nervous System Agents/adverse effects , Peripheral Nervous System Agents/chemical synthesisABSTRACT
OBJECTIVES: To evaluate the clinical presentation, complications and sequelae in patients with temporal bone fracture in the last 11 years. MATERIAL AND METHODS: A total of 27 patient medical records were retrospectively analysed. RESULTS: Of the 27 patients who were admitted for temporal bone fracture from 2001 to 2012, 13 (48%) had no petrous involvement (Group 1), and 14 (52%) with petrous involvement (Group 2). Patients in Group 2 had a longer P-ICU stay: median 4.5 days (RI: 2.75-22.25 d) vs 2 (RI: 1-3 d) (P=.018); more days on mechanical ventilation support: median 3 days (RI: 1.50-17 d) vs 1 (RI: 1-1.25 d). This group also had a higher frequency in sequelae (P=.04 OR=1.4 (95% CI: 1.05-1.95)) and a higher incidence in cerebrospinal fluid (CSF) fistula (P<.02; OR 2.33; 95% CI (1.27-4.27)). Severity scores (PRIMS III and PTI) showed no significant differences. Some degree of hearing loss was observed in 31% of the patients. Traffic accident was the main cause of trauma (33%), followed by falls (27%). There were 2 deaths and 4 (15%) had permanent sequelae. CONCLUSIONS: Isolated temporal bone fractures usually have a good outcome in children, but in some cases they can be fatal or have permanent sequelae. Long term follow up is recommended by authors.
Subject(s)
Fractures, Bone/complications , Fractures, Bone/diagnosis , Temporal Bone/injuries , Child, Preschool , Female , Humans , Injury Severity Score , Male , Retrospective Studies , Time FactorsABSTRACT
El hombro doloroso es un motivo de consulta frecuente en centros de Atención Primaria y urgencias hospitalarias pediátricas. Establecer un correcto diagnóstico diferencial evitará la iatrogenia sobre el paciente. Presentamos un caso de Síndrome de Parsonage-Turner (también conocido como neuritis braquial aguda) que, aunque es causa infrecuente de hombro doloroso, presenta una clínica muy sugestiva caracterizada por dolor agudo seguido de síntomas neurológicos de instauración tórpida. Como pruebas complementarias (se trata de un diagnóstico de exclusión) son de utilidad el electromiograma y la resonancia magnética. Presenta una evolución favorable con resolución espontánea, aunque está demostrado el beneficio del tratamiento antiinflamatorio y rehabilitador (AU)
The painful shoulder is a common condition for visiting in primary care and hospital emergencies. Establishing a correct differential diagnosis would prevent the iatrogenic patient. Therefore we consider appropriate presenting a case of Parsonage-Turner Syndrome (also known as acute brachial neuritis) which, although it is a rare cause of painful shoulder, it has a very suggestive clinical presentation: acute pain is followed by torpid onset of neurological symptoms. It is an exclusion diagnosis, although electromyogram and magnetic resonance imaging are useful tests. It presents a favourable prognosis with spontaneous resolution although anti-inflammatory treatment and rehabilitation show benefits (AU)
Subject(s)
Humans , Female , Child , Brachial Plexus Neuritis/complications , Brachial Plexus Neuritis/diagnosis , Turner Syndrome/complications , Electromyography/methods , Magnetic Resonance Imaging/methods , Shoulder Pain/complications , Shoulder Pain/diagnosis , Primary Health Care/methods , Diagnosis, Differential , Neuritis/complications , Neuritis/physiopathology , Neuritis , Shoulder/pathology , ShoulderABSTRACT
La ictiosis ligada al cromosoma X está causada por mutación o deleción del gen STS asociado a la deficiencia dela enzima sulfatasa esteroidea, localizada en la parte distal del brazo corto del cromosoma X (Xp22.3-pter), cerca de la región pseudoautosómica. Dependiendo de su extensión, puede presentarse como una entidad aislada o en combinación con un síndrome de genes contiguos, asociándose a otras enfermedades monogénicas, así como a otros trastornos mentales.Se revisa la bibliografía, destacando la importancia de la región Xp22.3-pter y la mayor incidencia de trastornos neurológicos en varones (trastorno por déficit de atención/hiperactividad, autismo y retraso mental ligado a X). Se discuteel papel e implicación de estos genes en la enfermedad y se propone la posible contribución del gen PNPLA4, originalmente descrito como GS2 y codificante de la fosfolipasa A2 independiente del calcio-eta, involucrada en el metabolismolipoproteico, como una de las causas de autismo. Se ha objetivado mejoría tras el tratamiento con citicolina, a través del papel que este nootropo desempeña en la biosíntesis de fosfolípidos estructurales involucrados en la formación y reparación de la membrana neuronal (AU)
X-chromosome-linked ichthyosis is caused by mutation or deletion of the STS gene associated with a deficiency of the enzyme steroid sulphatase, located in the distal part of the short arm of the X chromosome (Xp22.3-pter), close tothe pseudo-autosomal region. Depending on its size, it can present as an isolated entity or combined with a syndrome caused by neighbouring genes, thus associating itself with other monogenic diseases as well as other mental disorders.The most relevant findings from the literature review are the importance of the Xp22.3-pter region and the higher incidence of neurological disorders among males (attention deficit hyperactivity disorder, autism and X-linked mental retardation). The role and implication of these genes in the disease are discussed and the authors suggest a possiblecontribution of the gene PNPLA4, which was originally described as GS2 and codes for calcium-independent phospholipase A2 beta, involved in lipoprotein metabolism, as one of the causes of autism. Improvements have been observed followingtreatment with citicoline, thanks to the role this nootropic plays in the biosynthesis of structural phospholipids involved inthe formation and repair of the neuronal membrane (AU)
