Percutaneous tracheostomy in COVID patients. Experience in our hospital center after one year of pandemic and review of the literature.

BACKGROUND: The pandemic caused by SARS-COV-2 has caused an increase in the need of tracheostomies in patients affected with respiratory distress syndrome. In this article we report our experience during a year of pandemic, we develop our surgical technique to perform percutaneous tracheostomy with the patient in apnea and we compare our results with those of other centers through a bibliographic review. MATERIAL AND METHODS: A one-year retrospective clinical study was carried out on tracheotomies performed on patients admitted to the intensive care unit with severe SARS-CoV-2, with difficulty for ventilation or weaning. The technique performed was percutaneous, with fibroscopic control through the endotracheal tube, keeping the patient under apnea during the opening of the airway, reducing by this method the risk of exposure to the virus. RESULTS: From 35 percutaneous tracheotomies performed, 31% of the patients died from respiratory complications due to SARS-COV-2, but none due to the surgical procedure. The most frequent complication (8.5% of patients) was bleeding around the tracheostoma, resolved with local measures. No healthcare provider involved in the performance of the technique had symptoms or was diagnosed with COVID-19. CONCLUSIONS: Our technique of performing percutaneous tracheostomy maintaining apnea during the procedure, under fibroscopic control, has proven to be safe for all those involved in the procedure, and for the patient.

Experience over 12 years with home enteral nutrition in a healthcare area of Spain.

BACKGROUND: The wide spread use of long-term enteral nutrition and the substantive costs dictate a need to study the outcome, as well as the clinical and epidemiological characteristics, of these patients. The present study aimed to analyse the incidence and characteristics of a cohort of patients on home enteral nutrition (HEN) over 12 years. MATERIALS AND METHODS: A prospective observational study was performed between January 1999 and December 2010. All adult patients living in Valladolid West area who were discharged from the hospital on HEN were prospectively studied and followed up. RESULTS: The incidence of HEN ranged between 9.52 per 100, 000 inhabitants in 2001 to 30.0 per 100,000 inhabitants in 2009. HEN was administered orally in 472 patients (68.28%) (group 1), and through a nasogastric tube in 168 patients (24.30%), a percutaneous enteral gastrostomy tube in 47 patients (6.80%) and a jejunostomy in four patients (0.60%) (group 2; 219 patients). During the course of HEN, 31 patients had diarrhoea (4.5%), 17 patients had constipation and 12 patients had nausea. The mean (SD) duration of HEN was 159.9 (97) days. In multivariable analysis, an independent factor associated with death was age (hazard ratio = 1.03; 95% confidence interval - 1.01-1.05), adjusted by sex, route and diagnosis. CONCLUSIONS: HEN has a high incidence in our area and it is a valid and safe technique for nutrition support.

Experience of 6 years with home enteral nutrition in an area of Spain.

OBJECTIVE: The wide spread use of long-term enteral nutrition and the substantive costs dictate a need to study outcome, clinical and epidemiological characteristics of these patients. The aim of our study was to analyze incidence and characteristics of a cohort of patients on HEN during 6 years, after our previous pilot study of 3 years. DESIGN: Prospective observational study. SETTING: Tertiary care. SUBJECTS: Between January 1999 and December 2004, all adult patients living in Valladolid West area who were discharged from the hospital on HEN were prospectively studied and followed up. INTERVENTIONS: Information for each patient was prospectively recorded by the dietitian of the team, and include age, sex, body mass index, tricipital skinfold, midarm circumference, underlying disease, exitus, dates of initiation and discontinuation of HEN, nutrient formula, mode of administration and complications of HEN. During HEN, physicians supervised the home patients and the patients themselves or their close relative, were asked to contact our nutrition team if any problem occurred. Finally the yearly incidence of HEN was calculated each year on the basis of the estimated population in our area of recruitment, assuming almost all HEN patients were reported. RESULTS: In our previous study, incidence of HEN in 1999 was patients 15 per 100,000 inhabitants, 21.3 in 2000 and decreased to 9.52 in 2001. In the new 3 years, the incidence remained in the mean levels of 1999 and 2000, the data were 17.1 per 100,000 inhabitants 26.5 in 2003 and 25.6 in 2004. The mean age of all patients was 56.4+/-17 years. The distribution of patients by diseases was; (43.8%) had a head and neck cancer, (26.8%) had human immunodeficiency virus infection, (9.6%) had a neurological disorders affecting swallowing (cerebrovacular accident and/or dementia), (4.7%) had diseases in digestive tract (fistulae, pancreatic disease, inflammatory bowel disease), (2.5%) had tumors in different locations with anorexia, (5%) had head trauma, and (7.6%) had one of several miscellaneous diseases inducing dysphagia or anorexia. HEN was administered via oral in 258 patients (70.6%) (group I), via a NGT in 95 patients (26.1%), a PEG in 9 patients (2.5%), and a jejunostomy in 3 patients (0.8%) (group II=107 patients). During the course of HEN, 12 patients had diarrhea (3.3%) and 8 (2.2%) constipation, and 4 vomiting (1.1%) that did not require cessation of HEN. No lung aspiration was detected. Hypernatremia (sodium >145 meq/l) appeared only in six cases (1.64%) and 12 cases of hyperglycaemia (3.28%). Ten patients (2.8%) reported a least one problem with the tube. The mean duration of HEN was 148.2+/-104 days. After the follow-up, 19 of the 365 patients (5.2%) had died, 346 (94.8%) were alive. In multivariant analysis, an independent factor associated with death was age (hazard ratio: 1.22; 95% CI: 1.06-1.39), adjusted by sex, route and diagnosis. CONCLUSIONS: HEN has a high incidence in our area and it is a valid and safe technique for nutrition support.

Estudio epidemiológico de las urgencias en cirugía oral y maxilofacial en un hospital general / Epidemiological study of oral and maxillofacial emergencies in a general hospital

Objetivo. La demanda de asistencia en los Servicios de Urgencias Hospitalarias está en constante crecimiento desde hace varias décadas y en especial en la Cirugía Maxilofacial. El objetivo de este estudio es realizar un análisis epidemiológico de las urgencias que se producen en dicha especialidad.Diseño del estudio. Estudio transversal y observacional de pacientes atendidos por Cirugía Maxilofacial en el Servicio de Urgencias del Hospital Río Hortega de Valladolid durante el año 2002. Se analizaron 1.970 pacientes y 10 variables. Resultados. Se atendieron 1.970 pacientes, de los cuales el 55,8 por ciento fueron hombres. La mayor presión asistencial se produjo en domingo (15,8 por ciento) y en el mes de junio (10,9 por ciento). El rango de edad con mayor demanda asistencial fue de los 0 a los 10 años (22,6 por ciento). La etiología más común por la que los pacientes fueron atendidos resultaron ser los accidentes (55,1 por ciento) y el grupo diagnóstico los traumatismos (55,6 por ciento). El tipo de tratamiento inmediato más frecuente fue el médico (58,5 por ciento). Fueron ingresados el 9,4 por ciento de los pacientes y revisados en consulta un 33,1 por ciento. El 90,3 por ciento de los pacientes pertenecían al área del hospital. Conclusiones. El rango de edad más frecuente de los pacientes atendidos es de 0 a 10 años y la mayoría de los pacientes que acuden a urgencias son hombres. El día con mayor presión asistencial es el domingo y el mes con mayor número de urgencias y de ingresos es junio. La etiología por la que acuden más frecuentemente a urgencias son los accidentes y la traumatología configura la patología maxilofacial con mayor demanda de atención urgente en nuestro hospital. El tratamiento más frecuente es el médico (AU)

Quiste hemático crónico orbitario / Chronic hematic cyst of the orbit

No disponible

Hiperaldosteronismo primario / Primary hyperaldosteronism

El hiperaldosteronismo primario es la causa principal de hipertensión secundaria. Su presentación inicial ha cambiado y presenta normopotasemia como expresión de formas hormonales más leves (hiperplasia adrenal idiopática bilateral).Presentamos un caso de hiperaldosteronismo primario en un hombre de 71 años de edad, sin hipertensión, que presentó debilidad muscular y una concentración de potasio plasmático de 2,6 mEq/l. El diagnóstico requiere ser confirmado mediante una sobrecarga salina o una prueba con fludrocortisona. La caracterización de los subtipos se realiza con pruebas de imagen y una prueba postural, valoradas conjuntamente. La espironolactona es la base del tratamiento médico cuando la intervención quirúrgica no está indicada o cuando el paciente la rechaza. Próximamente, el tratamiento del hiperaldosteronismo primario puede modificarse con un nuevo antagonista selectivo de los receptores de la aldosterona, la eplerenona (AU)

Clinical and biochemical characteristics of patients with home enteral nutrition in an area of Spain.

OBJECTIVE: The widespread use of long-term enteral nutrition and the substantive costs dictate a need to study outcome, clinical and epidemiological characteristics of these patients. The aim of our study was to analyze incidence, clinical and biochemical characteristics of a cohort of patients on home enteral nutrition (HEN). DESIGN: Prospective observational study. SETTING: Tertiary care. SUBJECTS: Between January 1999 and December 2001, all adult patients living in Valladolid West area who were discharged from the hospital on HEN were prospectively studied and followed up. INTERVENTIONS: Information for each patients was prospectively recorded by the dietitian of the team, and include age, sex, body mass index, tricipital skinfold, midarm circumference, underlying disease, exitus, dates of initiation and discontinuation of HEN, nutrient formula, mode of administration and complications of HEN. During HEN, physicians supervised the home patients and the patients themselves or their close relative were asked to contact our nutrition team if any problem occurred. Finally the yearly incidence of HEN was calculated each year on the basis of the estimated population in our area of recruitment, assuming almost all HEN patients were reported. RESULTS: In 1999, the incidence of HEN in our area was patients 15 per 100000 inhabitants. This incidence rate rose to 21.3 in 2000 and decreased to 9.52 in 2001. The mean age of all patients was 58.7+/-13 y. The distribution of patients by diseases was: 71 (69.6%) had a head and neck cancer; 14 (13.7%) had a neurological disorder affecting swallowing (cerebrovacular accident and/or dementia); 6 (5.9%) had tumors in different locations with anorexia; and 11 (10.8%) had one of several miscellaneous diseases inducing dysphagia or anorexia. HEN was administered orally in 81 patients (79.4%), via a nasogastric tube (NGT) in 15 patients (14.7%), via a percutaneous gastrostomy (PEG) in five patients (4.9%), and via a jejunostomy in one patient (1%). The mean duration of HEN was 101+/-46.9 days. During the course of HEN, six patients had diarrhea (5.9%), and four (3.9%) constipation, and two vomiting (2%) that did not require cessation of HEN. Albumin, prealbumin, transferrin and lymphocytes improved in all the groups, when comparing the first review with the last. After the follow-up (3 y) with review, each 3 months, 10 of the 102 patients (9.8%) had died, and 92 (90.2%) were alive. Survival probability was influenced by the access route, with the worse outcome in patients with no oral nutrition (NGT, PEG and jejunostomy; hazard ratio: 24.9; 95% CI: 4.1-52), adjusted by age, sex and diagnosis. CONCLUSIONS: In conclusion, HEN is a valid and safe technique for nutrition support, with a good clinical outcome in our area.

[Anabolic steroids and gynecomastia. Review of the literature]. / Anabolizantes esteroideos y ginecomastia. Revisión de la literatura.

Gynaecomastia is a common situation, with a proliferation of glandular component of male breast secondary to an imbalance in sexual hormones in mammary tissue. A main cause of gynaecomastia is anabolic steroids consumption. Few studies have been performed in patients with high consumption of anabolic steroids, showing a high prevalence (52%). In this article we present a case of bilateral gynaecomastia secondary to anabolic steroids intake, with a partial response to tamoxifen. In summary, a patient with sportive habits and gynaecomastia, an early suspicious diagnosis is anabolic steroid intake. After suppression of anabolic steroid intake and treatment with tamoxifen, a high remission rate can be achieved. If gynaecomastia persisted, surgery is a good option.

Anabolizantes esteroideos y ginecomastia. Revisión de la literatura / Anabolic steroid and gynecomastia. Review of literature

La ginecomastia es una situación común consistente en la proliferación del componente glandular de la mama masculina como resultado de un disbalance en la acción de estrógenos y andrógenos a nivel del tejido glandular. La etiología es muy variable, destaca en el momento actual los anabolizantes esteroideos. Los estudios realizados analizando este problema en pacientes que toman anabolizantes son escasos aunque la prevalencia de ginecomastia entre estos pacientes es de hasta un 52 por ciento. Presentamos un caso clínico donde se muestra el desarrollo en pocos meses de ginecomastia bilateral asimétrica secundaria a la toma de anabolizantes, con respuesta parcial al tamoxifen. Por tanto ante un paciente con hábitos deportivos que presente ginecomastia, una de nuestras primeras sospechas debe ser la toma de anabolizantes. Tras la suspensión de los anabolizantes y la instauración de un ciclo de tratamiento oral preferentemente con tamoxifen, la tasa de remisiones puede ser alta en función del tiempo de duración de la ginecomastia y del tamaño. Si no se consigue la remisión la cirugía es una buena opción (AU)