Estudio ADENI-UCI: Análisis de las decisiones de no ingreso en UCI como medida de limitación de los tratamientos de soporte vital / ADENI-UCI Study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments

Objetivo: Analizar las variables asociadas a las decisiones de rechazo al ingreso en una Unidad de Cuidados Intensivos (UCI) como medida de limitación de tratamiento de soporte vital. Diseño: Prospectivo, multicéntrico. Ámbito: Sesenta y dos UCI de España entre febrero de 2018 y marzo de 2019. Pacientes: Mayores de 18 años a los que se les negó el ingreso a una UCI como medida de limitación de tratamiento de soporte vital. Intervenciones: Ninguna. Variables de interés principals: Comorbilidades de los pacientes, situación funcional previa medida por la escala KNAUS y Karnosfky; escalas pronósticas de Lee y Charlson; gravedad del enfermo medida por las escalas APACHE II y SOFA, motivo que justifica la toma de la decisión, persona a la cual es trasmitida la información; fecha de alta o fallecimiento intrahospitalario, destino al alta hospitalaria. Resultados: Se registraron un total de 2.312 decisiones de no ingreso como medida de limitación del tratamiento de soporte vital (LTSV), de las cuales se analizaron 2.284. El principal motivo de consulta fue la insuficiencia respiratoria (1.080 [47,29%]). La pobre calidad de vida estimada de los enfermos (1.417 [62,04%]), la presencia de una enfermedad crónica grave (1.367 [59,85%]) y la limitación funcional previa de los pacientes (1.270 [55,60%]) fueron los principales motivos esgrimidos para denegar el ingreso. La tasa de mortalidad intrahospitalaria fue del 60,33%. La futilidad del tratamiento se constató como factor de riesgo asociado a mortalidad (OR: 3,23; IC 95%: 2,62-3,99). Conclusiones: Las decisiones para limitar el ingreso en UCI como medida de LTSV se basan en los mismos motivos que las decisiones tomadas dentro de la UCI. La futilidad valorada por el intensivista se relaciona adecuadamente con el resultado final de muerte (AU)

Objective: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. Design: Prospective, multicentrico. Scope: 62 ICU from Spain between February 2018 and March 2019. Patients: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. Interventions: None. Main interest variables: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. Results: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). Conclusions: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death (AU)

ADENI-UCI study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments.

OBJECTIVE: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DESIGN: Prospective, multicentrico. SCOPE: 62 ICU from Spain between February 2018 and March 2019. PATIENTS: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. INTERVENTIONS: None. MAIN INTEREST VARIABLES: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. RESULTS: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). CONCLUSIONS: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.

ADENI-UCI Study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments. / Estudio ADENI-UCI: Análisis de las decisiones de no ingreso en UCI como medida de limitación de los tratamientos de soporte vital.

OBJECTIVE: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DESIGN: Prospective, multicentrico SCOPE: 62 ICU from Spain between February 2018 and March 2019. PATIENTS: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure. INTERVENTIONS: None. MAIN INTEREST VARIABLES: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. RESULTS: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99). CONCLUSIONS: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.

Efecto del uso de Bundles en las infecciones hematógenas asociadas a catéteres venosos centrales en una unidad de terapia intensiva pediátrica / Effect of the use of Bundles in bloodstream infections associated to central venous catheter in a pediatric intensive care unit

Objetivos: las Infecciones Hematógenas Asociadas a Catéter Venoso Central (IHACVC) producen mayor morbilidad y mortalidad, se podría disminuir esta tasa con la implementación de guías de buenas prácticas (GBP) y bundles. El estudio pretende determinar la incidencia de IHACVC, después de la aplicación de bundles validados de inserción y mantenimiento de CVC. Métodos: se plantea un estudio de tipo observacional, descriptivo de corte longitudinal realizado en el Hospital del Niño Manuel Ascencio Villarroel, en 94 pacientes portadores de CVC, estratificados en dos grupos: grupo de pacientes con CVC insertados sin aplicación de bundles y los insertados con la aplicación de los bundles. Realizando en ellos seguimiento de la presentación de infecciones y colonizaciones del CVC. Resultados: la incidencia de IHACVC fue 3,9/1000 días de CVC, se detectaron 12 casos de colonización asociadas a CVC. Los gérmenes aislados fueron gramnegativos intrahospitalarios multiresistentes. La adherencia a los bundles durante la inserción del CVC se cumplen 5,8 (DS 0,8) criterios de 6; y durante el mantenimiento se cumplen 4,6 (DS 1,3) de 6. Conclusiones: la tasa de IHACVC es baja debida al uso de CVC de corto plazo, la colonización o formación del biofilm, se pudo evidenciar por encima de los 10 días de exposición y en pacientes en los que no se siguieron los criterios recomendados. La reducción de las IAAS debe ser una tarea permanente del hospital, recomendamos mantener la aplicación de los bundles, enfatizando a la educación permanente del personal y los mecanismos de vigilancia activa.

Objectives: Bloodstream Central Venous Catheter Infections (BCVCI) leads increased morbidity and mortality. This rate could be reduced by the implementation of good practice guidelines (GBP) and bundles. The study aims to determine the incidence of IHACVC, after application of insertion and maintenance CVC validate bundles. Methods: An observational, descriptive longitudinal study was performed at Manuel Ascencio Villarroel Children Hospital, in 94 patients with CVC, stratified into 2 groups: CVCs inserted without application of bundles and those inserted with the application of bundles. Performing following-up on infections and colonizations presentation. Results: The incidence of BCVCI was 3.9 / 1000 days of CVC, 12 cases of colonization associated to CVC were detected. Isolated pathogens were multiresistant Gram-negative. Adherence to bundles during insertion of the CVC met 5.8 (SD 0.8) criteria of 6; And during maintenance, 4.6 (DS 1.3) of 6 are met. Conclusions: The rate of BCVCI is low due to the use of short-term CVC, colonization or biofilm formation could be evidenced after 10 days of exposure and in patients in whom the recommended criteria were not followed. Reduction of IAAS should be a permanent task of the hospital; we recommend to maintain the application of bundles, emphasizing the permanent education of staff and mechanisms of active surveillance.

Paediatric radial neck fractures: One-step percutaneous reduction and fixation.

INTRODUCTION: Dislocated radial neck fractures of the third and fourth degree, according to the Judet classification, are rare events in children. These fractures account for 1% of all paediatric fractures. Their relatively low incidence is inversely proportional to the serious morphofuntional alterations that can follow without treatment. MATERIALS AND METHODS: Nine paediatric patients with an average age of 9.1 years (range 6-12 years), with radial neck fractures of the third and fourth degree, according to the Judet classification, were treated between 2010 and 2011. All patients underwent percutaneous reduction and fixation using only one K-wire by the same surgeon in a surgery time of 20 min (range 15-25 min). The average follow-up was 26.6 months (range 12-36 months), with X-rays and clinical evaluations conducted at four time points. The results were assessed radiologically (Métaizeau classification) and clinically (Mayo Clinic Elbow Performance Score). RESULTS: X-ray results (according to Métaizeau) were excellent in eight cases and good in one case. Clinical results were excellent in all cases. There was only one minor complication: a superficial skin infection that was treated with an oral antibiotic. DISCUSSION: The purpose of this study was to evaluate the results achieved in our hospital with a percutaneous reduction and fixation technique using only one K-wire in children with dislocated radial neck fractures of the third and fourth degree. The results obtained indicate that a single percutaneous surgery act that circumvents further operations is the best option for these patients. CONCLUSION: Although the number of patients in the study was small, the results are encouraging and support the continued use of this one-step percutaneous reduction and fixation technique.

Impacto del virus de la gripe A (H1N1) 2009 en un servicio de urgencias de un hospital de tercer nivel / Impact of the 2009 influenza A (H1N1) virus pandemic on the emergency department of a tertiary hospital

Introducción: La pandemia por el virus de la gripe A (H1N1) 2009 ha supuesto un gran reto para el sistema sanitario a nivel mundial. Material y métodos: Se analizaron prospectivamente los pacientes con sospecha clínica de gripe A (H1N1) 2009 que cumplían criterios de estudio microbiológico de julio a diciembre de 2009 atendidos en un servicio de urgencias pediátricas. La confirmación microbiológica se realizó mediante reacción de la cadena de polimerasa en transcripción reversa. Se analizaron el número de consultas e ingresos desde urgencias. Se compararon los casos confirmados de gripe A (H1N1) 2009 con los negativos. Resultados: Se atendió a 1.144 pacientes con criterios de estudio microbiológico. Ingresaron 513 (44,8%) pacientes, 12 de ellos (1%) en UCIP y 3 fallecieron (0,3%). En 824 pacientes (72%) se detectaron factores de riesgo para complicaciones. 412 (36%) pacientes fueron positivos para gripe A (H1N1) 2009 y 732 (64%) fueron negativos. Al comparar ambos grupos, los pacientes positivos fueron de mayor edad (edad media: 7,4 vs 4,1 años, p < 0,001), tuvieron más factores de riesgo (OR: 2,21 [1,65-2,96]), menos neumonía (OR: 0,33 [0,23-0,49]) e ingresaron menos (OR: 0,19 [0,14-0,24]). Hubo un incremento del 12% de urgencias y del 5,7% de ingresos respecto al año 2008. Conclusiones: El virus de la gripe A (H1N1) 2009 ha presentado una elevada morbilidad con baja incidencia de casos graves y baja mortalidad incluso en población con factores de riesgo (AU)

Background: The 2009 H1N1 influenza A virus infection pandemic was an important challenge for public health systems worldwide. Material and methods: A prospective study including all patients with an influenza-like illness, with microbiological criteria for 2009 H1N1 virus, from July to December 2009 seen in the paediatric emergency department. Viral testing was performed using multiplex real-time reverse transcription polymerase chain reaction (RT-PCR). We analysed the number of visits to, and hospital admissions from, our emergency department. We compared patients with laboratoryconfirmed2009 H1N1 virus with non-confirmed ones. Results: A total of 1144 patients with microbiological criteria were identified. Of these, 513 (44.8%) were admitted to hospital, 12 of them (1%) to the PICU and 3 (0.3%) died. The majority of the patients (824; 72%) had some underlying medical condition. Of the 1144 patients, 412 (36%) had RT-PCR confirmed 2009 H1N1 infection, and 732 (64%) were not confirmed. The mean age of patients with 2009 H1N1 infection was higher than those not infected (median age: 7.4vs 4.1 years; p < .001). Laboratory-confirmed 2009 pandemic H1N1 influenza patients had more underlying high-risk conditions (OR: 2.21 [1.65-2.96]), suffered from pneumonia in less cases (OR: 0.33 [0.23-0.49]) and were admitted to hospital in less cases (OR: 0.19 [0.14-0.24]). In our emergency department, we identified an important increase in the number of visits (12%) and admissions (5.7%) compared to the previous year, 2008. Conclusions: The 2009 pandemic H1N1 influenza caused significant morbidity but the mortality was not significant. The majority of children with laboratory-confirmed 2009 H1N1 virus had uncomplicated illnesses despite the increased presence of high-risk conditions (AU)

[Impact of the 2009 influenza A (H1N1) virus pandemic on the emergency department of a tertiary hospital]. / Impacto del virus de la gripe A (H1N1) 2009 en un servicio de urgencias de un hospital de tercer nivel.

BACKGROUND: The 2009 H1N1 influenza A virus infection pandemic was an important challenge for public health systems worldwide. MATERIAL AND METHODS: A prospective study including all patients with an influenza-like illness, with microbiological criteria for 2009 H1N1 virus, from July to December 2009 seen in the paediatric emergency department. Viral testing was performed using multiplex real-time reverse transcription polymerase chain reaction (RT-PCR). We analysed the number of visits to, and hospital admissions from, our emergency department. We compared patients with laboratory-confirmed 2009 H1N1 virus with non-confirmed ones. RESULTS: A total of 1144 patients with microbiological criteria were identified. Of these, 513 (44.8%) were admitted to hospital, 12 of them (1%) to the PICU and 3 (0.3%) died. The majority of the patients (824; 72%) had some underlying medical condition. Of the 1144 patients, 412 (36%) had RT-PCR confirmed 2009 H1N1 infection, and 732 (64%) were not confirmed. The mean age of patients with 2009 H1N1 infection was higher than those not infected (median age: 7.4 vs 4.1 years; p<.001). Laboratory-confirmed 2009 pandemic H1N1 influenza patients had more underlying high-risk conditions (OR: 2.21 [1.65-2.96]), suffered from pneumonia in less cases (OR: 0.33 [0.23-0.49]) and were admitted to hospital in less cases (OR: 0.19 [0.14-0.24]). In our emergency department, we identified an important increase in the number of visits (12%) and admissions (5.7%) compared to the previous year, 2008. CONCLUSIONS: The 2009 pandemic H1N1 influenza caused significant morbidity but the mortality was not significant. The majority of children with laboratory-confirmed 2009 H1N1 virus had uncomplicated illnesses despite the increased presence of high-risk conditions.

Pruebas de laboratorio en atención primaria (II) / Laboratory tests in primary care (II)

La anamnesis y la exploración física son las herramientas básicas con las que cuenta el médico de familia en la consulta diaria. Se definen las pruebas diagnósticas en atención primaria (AP) como aquellas pruebas que son solicitadas directamente por el médico de AP y, aun siendo realizadas fuera de la consulta, no suponen una transferencia en la responsabilidad clínica sobre el paciente. El objetivo de esta segunda parte es revisar los aspectos más importantes de las pruebas bioquímicas de laboratorio que solicitamos diariamente en nuestras consultas de AP (AU)

Anamnesis and physical examination are the basic tools of the Family Doctor in daily routine practice. Diagnostic tests in Primary Care are defined as these tests that are directly requested by the Primary Care doctor, and although being performed outside the clinic, there is no transfer of clinical responsibility of the patient. The purpose of this second part is to review the most important aspects of the biochemistry tests that are requested daily in Primary Care clinics (AU)

Pruebas de laboratorio en Atención Primaria (I) / Laboratory Tests in Primary Care (I)

La anamnesis y la exploración física son las herramientas básicas con las que cuenta el médico de familia en la consulta diaria. Se definen las pruebas diagnósticas en Atención Primaria como aquellas pruebas que son solicitadas directamente por el médico de Atención Primaria y, aún siendo realizadas fuera de la consulta, no suponen una transferencia en la responsabilidad clínica sobre el paciente. Debemos tener claras cuáles son sus indicaciones y una serie de cuestiones básicas para poder realizar un uso racional de las mismas (AU)

The anamnesis and the physical examination are the basic tools of the Family Doctors in their daily clinics. Diagnostic tests in Primary Care are defined as those tests that are requested directly by the Primary Care doctor and, although they are performed outside the clinic, this does not assume a transfer of clinical responsibility of the patient. We must be clear what their indications are and a have series of basic questions to be able to make rational use of them (AU)

Síndrome de Klinefelter, insuficiencia venosa crónica y tromboembolismo pulmonar: a propósito de un caso / Klinefelter syndrome, chronic venous insufficiency and pulmonary thromoembolism: presentation of a case

El síndrome de Klinefelter (SK) es la forma más frecuente de hipogonadismo hipergonadotrófico del varón. Su asociación con la enfermedad tromboembólica venosa es bien conocida. La enfermedad tromboembólica venosa engloba la trombosis venosa profunda y el tromboembolismo pulmonar). Esta última patología es una entidad de difícil diagnóstico y potencialmente mortal que requiere una adecuada anamnesis y exploración física. Presentamos el caso de un paciente de 36 años con síndrome de Klinefelter que solicitó la asistencia de su médico de Atención Primaria por disnea (AU)

Klinefelter Syndrome is the most common form of hypergonadotrophic hypogonadism in the male. Its association with venous thromboembolic disease is well known. Venous thromboembolic disease includes deep vein thrombosis and pulmonary thromboembolism). This last condition is difficult to diagnose and is potentially fatal and requires na adequate anamnesis and physical examination. We present a case of a 36 year-old patient with Klinefelter syndrome who visited his Primary Care doctor for dyspnoea (AU)

Isquemia periférica tras intoxicación crónica por ergóticos / Peripheral ischaemia after chronic ergot poisoning

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Opinión y motivación del médico de Atención Primaria sobre la obesidad y el sobrepeso / No disponible

INTRODUCCIÓN. El objetivo del estudio fue conocer la opinión del médico de Atención Primaria (AP) ante la obesidad y su motivación para atender a estos pacientes. MATERIAL Y MÉTODOS. Estudio descriptivo transversal.Mil doscientos médicos españoles de AP, muestreo aleatorio estratificado por comunidades autónomas. Encuesta de63 ítems autocumplimentable, datos sociodemográficos, salud del encuestado, opinión sobre la obesidad, motivación para atender a estos pacientes y tratamiento. RESULTADOS. Se repartieron 897 encuestas, respondieron519 (57,9%). Entre estos, el 63,5% eran hombres, grupo de edad entre 45-54 años (61,0%). Un 18,5% fumaban, un91,7% consumió alcohol y un 45,5% practicaban ejercicio. El35,5% tenía sobrepeso y el 4,9%, obesidad. De estos, el15,4% nunca realizó dieta. El 91,9% tenía una percepción buena, muy buena o excelente de su propia salud. El 90,7% (IC 95%; 88,2-93,2) considera la obesidad una enfermedad y el 71,9% causa de muerte prevenible (64,4%zona norte de España p < 0,05). El 58,7% diagnosticó hipertensión o diabetes antes que obesidad. Un 88,3% observó un incremento de la tasa de obesidad entre sus pacientes. El54,1% (IC 95%; 49,8-58,4) consideraban tener habilidad para motivar al paciente. El 50,1% (IC 95%; 45,8-54,4) prefería trabajar con pacientes con normo peso. Un 61,9% veía al obeso como gran comedor, inactivo y que no hacía caso al consejo médico, el 81,3% creían que el obeso se resiste a cambios del estilo de vida a largo plazo. Un 31,8% cree que los profesionales presentan actitudes negativas hacia estos pacientes (20% en la zona sur-este, p < 0,05). Un 52,3% había leído el último año 1-5 artículos sobre obesidad, 34,7% más de seis (44,2% en la zona centro, p < 0,05)...(AU)

INTRODUCTION. The main objective of this study was to know the opinion of primary care physicians (AP) toward obesity and their motivation to attend to these patients. MATERIAL AND METHODS. This was a cross-sectional study that included 1200 Spanish primary care physicians, obtained by stratified random sampling by the Autonomous Communities. Data were obtained regarding a 63 self-administered item survey, socio demographic aspects, health survey, opinion on obesity, motivation to care for these patients and treatment. RESULTS. A total of 897 surveys were distributed, obtaining519 responses (57.9%). Among these, 63.5% were men, with an age group 45-54 years (61.0%), 18.5% smoked,91.7% consumed alcohol, 45.5% practiced exercise, 35.5%were overweight and 4.9% obese. A total of 15.4% had never gone on a diet and 91.9% had a good, very good or excellent perception of their own health. It was found that 90.7% (95% CI; 88.2-93.2) consider obesity as a disease and 71.9% consider that it is a preventable case if death (64.4% north zone of Spain p < 0.05). Hypertension or diabetes, had been diagnosed in 58.7% rather than obesity and 88.3% observed an increase in the rate of obesity among their patients. A total of 54.1% (95% CI; 49.8-58.4) believed that they have ability to motivate the patient, but 50.1% (95% CI; 45.8-54.4) would rather work with normal weight patients. The obese patients are considered to be overeaters, inactive and those who do not follow medical advice by 61.9% and 81.3% believe that obese patients are resistant to long-term lifestyle change. A total of 31.8% believe that the professionals have negative attitudes towards these patients (20% south-east, p < 0.05); 52.3% have read 5articles on obesity, 34.7% more than six (44.2% in the center zone, p < 0.05) in the last year...(AU)

Shoulder evaluation with isokinetic strength testing after arthroscopic rotator cuff repairs.

HYPOTHESIS: The purpose of this study was to evaluate, with isokinetic testing, the recovery of strength in patients with rotator cuff tears treated with two different arthroscopic repair techniques. MATERIALS AND METHODS: From September 2004 to September 2006, patients with a full-thickness supraspinatus tear were randomized to two different groups. Patients in group 1 underwent side-to-side repair with permanent sutures, whereas those in group 2 underwent tendon-to-bone fixation with 1 metal suture anchor loaded with double sutures. The same independent examiner evaluated the outcomes using the Constant score and isokinetic strength testing preoperatively and at 3, 6, and 12 months postoperatively. Data analysis was also performed in three subgroups: small, medium, and large tears. RESULTS: Constant scores improved from preoperatively to 12 months postoperatively. In group 1, the mean Constant score was 32 points before surgery and 78 points at 12 months postoperatively. In group 2, the mean Constant score was 30 points before surgery and 88 points at 12 months after surgery. Strength increased gradually during the first postoperative year. In group 1, preoperative mean peak torque was 34% and 39% in internal rotation and external rotation, respectively. After repair, it decreased to 17% and 21%, respectively, at 12 months. In group 2, preoperative mean peak torque was 32% and 37% in internal rotation and external rotation, respectively; after surgery, it decreased to 9% and 12%, respectively, at 12 months. Data analysis showed that the difference in improvement in Constant scores and in strength recovery from preoperatively to postoperatively in groups 1 and 2 was statistically significant (p < .05). CONCLUSION: We showed a strength difference between patients with side-to-side repairs and those with tendon-to-bone repairs. LEVEL OF EVIDENCE: Level 1; Prospective randomized study.

Hematoma epidural espinal secundario a un mal control del tratamiento con anticoagulantes orales: a propósito de un caso / Spinal epidural hematoma secondary to poorly controlled treatment with oral anticoagulants: a case report

El hematoma epidural espontáneo (HEE) es una entidad poco habitual que se caracteriza por dolor cervical, dorsal o lumbar severo e irradiación radicular que a veces se acompaña de síntomas de compresión medular. Existen numerosas causas que pueden ocasionarlo (traumatismos, tumores, malformaciones arteriovenosas o mal control de los anticoagulantes orales [AO]). Su sospecha tras una adecuada anamnesis y exploración física es fundamental, puesto que requiere un tratamiento quirúrgico precoz. Presentamos el caso de una paciente de 80 años en tratamiento con AO (con un mal control de los mismos) que acudió a la consulta de su médico de Atención Primaria por lumbalgia (AU)

The spontaneous epidural hematoma (SEH) is an uncommon disease characterized by severe cervical, dorsal or lumbar pain and radicular irradiation that is sometimes accompanied by spinal cord compression symptoms. It can occur from by many causes (traumatisms, tumors, arteriovenous malformations or poor control of oral anticoagulants [OAC]). Its suspicion after an adequate anamnesis and physical examination is fundamental since it requires early surgical treatment. We present the case of an 80-year old female patient under treatment with OAC (with poor control of them) who came to the medical consultation of Primary Care complained of low back pain (AU)

[The ultrasonographic characteristics of the endometrium during the spontaneous ovulatory menstrual cycle]. / Caracterización ultrasonográfica del endometrio durante el ciclo menstrual ovulatorio espontáneo.

Six hundred and four serial transvaginal sonograms were performed in 70 normal and healthy women throughout an ovulatory cycle. The endometrium was classified in 4 types (0, 1, 2 and 3) according to: the aspect of the myometria-endometrium and endometrium-endometrium interfaces, and the texture and thickness of the functional layer. Type 0 appears as a smooth, pencil line endometrium. Type 1 has a trilaminar structure with an iso or hypoechoic functional layer. Type 2 is also trilaminar, but myometria-endometrium interfaces are thicker than type 1. Type 3 appears as a thick and homogeneously echogenic image. The relative frequency of each type of endometrium was determined for every day of the menstrual cycle. Day 0 was defined sonographically as the day of follicle rupture. Type 0 was found during and immediately after menstruation. Type 1 was seen during mid-follicular phase and until day +2. Types 2 and 3 were observed post ovulatory in 100% of the cases. The endometrium increases in thickness more during preovulatory phase (mean: 5.5 mm), than in the luteal phase (mean: 2.6 mm). We conclude that this working classification of the endometrium is useful in clinical practice when associated to the ultrasonographic aspect of the ovaries and the moment of the menstrual cycle.

[Intravascular fetal transfusion in the management of perinatal hemolytic disease]. / Transfusión fetal intravascular en el manejo de la enfermedad hemolítica perinatal.

Five pregnancies with severe blood cell isoimmunization were managed with intrauterine intravascular transfusions. The procedures were performed percutaneously under direct ultrasound visualization. A total of 14 transfusions, of 16 attempted, were successfully performed. The 5 fetuses required more than one transfusion. Only one died before been born. The other four are alive and without sequelae. Technical aspects of the procedure as well as its indications, advantages, and historical drawbacks are discussed.

[An analog-digital system of external pressure for loco-regional treatment of deep venous thrombosis with fibrinolytics]. / Sistema analógico-digital de presión externa para tratamiento loco-regional de las trombosis venosas profundas con fibrinolíticos.

A new method, by external pressure, analogic-digital system, is presented to be used in loco-regional treatment of "Deep Venous Thrombosis" with fibrinolytic agents; in order to allow a great concentration of drug and a better derivation of it toward the deep venous system.