Embolización de arterias uterinas como tratamiento de la hemorragia obstétrica / Uterine artery embolization for the treatment of obstetric haemorrhage

Objetivo: Describir los casos de hemorragia obstétrica que han precisado embolización de arterias uterinas (EAU), evaluando la eficacia de dicha técnica y su tasa de éxito. Establecer su seguridad mediante la detección de complicaciones durante el procedimiento y con posterioridad al mismo. Material y método: Se estudia, desde el 1 de enero del año 2006, hasta el 31 de diciembre del año 2012, a pacientes que precisaron EAU tras fracaso del tratamiento médico en casos de hemorragia posparto, en el Hospital General de Albacete, con posterior seguimiento, analizando la aparición de complicaciones inmediatas y tardías, así como su posterior fertilidad. Resultados: Se presentan 8 casos de EAU en hemorragia posparto. El éxito de la técnica se demostró en 6 de los 8 casos, estableciendo una tasa de éxito global del 75%. De los 6 casos en los que se produce un éxito de la EAU se constata gestación posterior en 5 de ellos. Conclusión: La EAU en la hemorragia obstétrica ofrece buenos resultados, pocas complicaciones y preserva la fertilidad

Objective: To describe cases of obstetric hemorrhage that required uterine artery embolization (UAE) and evaluate the effectiveness of this technique and its success rate. To establish its safety by detecting complications during and after the process. Material and methods: We studied patients who required UAE after medical treatment failed to resolve postpartum hemorrhage at the General Hospital of Albacete from January 1st 2006 until December 31st 2012. The occurrence of immediate and late complications and the subsequent fertility of these patients were evaluated during follow-up. Results: Eight patients with postpartum hemorrhage required UAE. The technique was successful in 6 of the 8 patients, representing an overall success rate of 75%. Of the 6 patients with successful EAU, 5 subsequently became pregnant. Conclusion: UAE for obstetric hemorrhage provides good results with few complications and preserves fertility

Complicaciones postoperatorias tras adenoamigdalectomía en niños con síndrome de apnea-hipopnea del sueño severo. ¿Requieren ingreso en unidad de cuidados intensivos? / Post-operative complications following adenotonsillectomy in children with severe sleep apnea-hypopnea syndrome. Do they need to be admitted to an intensive care unit?

Introducción y objetivos: En los últimos años, con el auge de la enfermedad del sueño, están surgiendo publicaciones relacionadas con las complicaciones postoperatorias de la adenoamigdalectomía en niños con síndrome de apnea-hipopnea del sueño (SAHS), especialmente en aquellos con un grado severo. El objetivo del estudio fue evaluar las complicaciones postoperatorias de los niños con SAHS severo comparado con aquellos niños en los que se ha realizado la misma intervención, pero por diferente motivo, y establecer si precisan cursar el postoperatorio en una unidad de cuidados intensivos. Métodos: Estudio retrospectivo en el que se han incluido todos los niños adenoamigdalectomizados en nuestro hospital en los últimos 5 años y se han analizado las complicaciones presentadas. Resultados: Doscientos veintinueve niños de los intervenidos en ese periodo fueron finalmente analizados, de los cuales solo 8 niños han presentado algún tipo de complicación (3,5%), siendo el riesgo de complicaciones respiratorias del 2,2%. Comparando el porcentaje de complicaciones respiratorias en el grupo de SAHS (3,22% frente a 1,47%, p = 0,39) o en el subgrupo de SAHS severo (3,77% frente a 1,70%, p = 0,32) con respecto al resto, se encuentra ligeramente elevado, pero sin diferencias estadísticamente significativas y muy inferiores a lo publicado por otros autores. Además todas las complicaciones respiratorias se presentaron en el postoperatorio inmediato (quirófano y recuperación) y ninguna en planta. Conclusiones: En nuestra población la realización de una adenoamigdalectomía (si el paciente no presenta ningún síndrome malformativo o enfermedad neuromuscular, tiene más de 2 años y el postoperatorio inmediato ha transcurrido sin incidencias) no implica complicaciones significativas a posteriori, y el paciente puede ser ingresado en planta y no en una unidad de cuidados intensivos, independientemente de que el motivo de la cirugía sea un SAHS severo (AU)

Introduction and objectives: In recent years, with the rise of sleep-disordered breathing, we have been seeing more articles related to post-operative complications after adenotonsillectomy in children with sleep apnea-hypopnea syndrome (OSAS), especially in those with severe sleep apnea. The objective of this study was to evaluate post-operative complications in children with severe OSAS compared to children who had adenotonsillectomy for a different reason, and establish whether they needed admission to an intensive care unit or not. Methods: All children undergoing adenotonsillectomy in our hospital in the last 5 years were initially included in this study. Complications were analysed with a retrospective review. Results: Two hundred and twenty nine children admitted for adenotonsillectomy were finally included. In the whole group, complications occurred in 3.5% of children, 2.2% corresponding to respiratory complications. Children with sleep apnea (3.23% vs 1.47%, P = 0.39) or severe sleep apnea (3.77% vs 1.70%, P =0.32) presented a higher incidence of respiratory complications, which was not statistically significant and was far below those published by other authors. All respiratory complications took place in the immediate post-operative period (operating theatre or anaesthesia recovery), with none in the paediatric ward. Conclusions: In our population, children who undergo adenotonsillectomy, without any other comorbidities, malformation syndrome or neuromuscular disease, are more than 2 years old and have an immediate postoperative period without incidence, do not need to be systematically admitted to an intensive care unit, even if they present with severe OSAS (AU)

Post-operative complications following adenotonsillectomy in children with severe sleep apnea-hypopnea syndrome. Do they need to be admitted to an intensive care unit?

INTRODUCTION AND OBJECTIVES: In recent years, with the rise of sleep-disordered breathing, we have been seeing more articles related to post-operative complications after adenotonsillectomy in children with sleep apnea-hypopnea syndrome (OSAS), especially in those with severe sleep apnea. The objective of this study was to evaluate post-operative complications in children with severe OSAS compared to children who had adenotonsillectomy for a different reason, and establish whether they needed admission to an intensive care unit or not. METHODS: All children undergoing adenotonsillectomy in our hospital in the last 5 years were initially included in this study. Complications were analysed with a retrospective review. RESULTS: Two hundred and twenty nine children admitted for adenotonsillectomy were finally included. In the whole group, complications occurred in 3.5% of children, 2.2% corresponding to respiratory complications. Children with sleep apnea (3.23% vs 1.47%, P=.39) or severe sleep apnea (3.77% vs 1.70%, P=.32) presented a higher incidence of respiratory complications, which was not statistically significant and was far below those published by other authors. All respiratory complications took place in the immediate post-operative period (operating theatre or anaesthesia recovery), with none in the paediatric ward. CONCLUSIONS: In our population, children who undergo adenotonsillectomy, without any other comorbidities, malformation syndrome or neuromuscular disease, are more than 2 years old and have an immediate postoperative period without incidence, do not need to be systematically admitted to an intensive care unit, even if they present with severe OSAS.

Patient satisfaction and quality of life following laparoscopic Nissen fundoplication.

BACKGROUND: Today, antireflux surgery has an established position in the management of gastroesophageal reflux disease. Some case series have shown good short-term results, but there is still little information regarding long-term results. Studies have recently focused on evaluating residual symptomatology and its impact on quality of life. OBJECTIVES: To determine the postoperative quality of life and degree of satisfaction in patients that underwent laparoscopic Nissen fundoplication. PATIENTS AND METHODS: A total of 100 patients (59 women and 41 men) were studied after having undergone laparoscopic Nissen fundoplication. The variables analyzed were level of satisfaction, gastrointestinal quality of life index (GIQLI), residual symptoms, and the Visick scale. RESULTS: No variation was found in relation to sex; 49 men and 51 women participated in the study. The mean age was 49 years. The degree of satisfaction encountered was: satisfactory in 81 patients, moderate in 3, and bad in 2 patients. More than 90% of the patients would undergo the surgery again or recommend it. The Carlsson score showed improvement at the end of the study (p<0.05). In relation to the GIQLI, a median of 100.61 points±21.624 was obtained. Abdominal bloating, regurgitation, and early satiety were the most frequent residual symptoms. The effect on lifestyle measured by the Visick scale was excellent. CONCLUSIONS: The level of satisfaction and quality of life obtained were comparable with reported standards; and the residual symptoms after antireflux surgery were easily controlled.

Entorno laboral, satisfacción y burnout de las enfermeras de unidades de cuidados críticos y unidades de hospitalización. Proyecto RN4CAST-España / Work setting, satisfaction and burnout of the nurses in critical care units and hospitalization units. RN4CAST-Spain project

OBJETIVO: Conocer si existen diferencias en la percepción del entorno laboral, el nivel de burnout y la satisfacción con el trabajo entre enfermeras de unidades de cuidados críticos (UC) y de hospitalización en hospitales del Sistema Nacional de Salud. Método Estudio transversal realizado con 6.417 enfermeras de unidades médicas y quirúrgicas (UMQ) y con 1.122 de UC en 59 hospitales de más de 150 camas. Se recogieron datos sociodemográficos, satisfacción laboral, percepción del entorno laboral (cuestionario Practice Environment Scale of the Nursing Work Index [PES-NWI]) y burnout (Maslach Burnout Inventory [MBI]).Resultados El PES-NWI presentó diferencias en 4 de sus 5 factores, mostrando mejores valores en UMQ con excepción de la dotación y adecuación de recursos (p < 0,001) donde las UC mostraron un grado de acuerdo medio de 2,41 frente al 2,19 de las unidades de hospitalización. El burnout fue más elevado en las UMQ (p = 0,039) con el 23% (952) de las enfermeras con valores altos. La satisfacción laboral fue inferior en las UC (p = 0,044) con el 70% (578) de las enfermeras muy o moderadamente satisfechas. Conclusiones Las enfermeras de las UC clasifican al hospital más desfavorable y muestran niveles más bajos de burnout que las de las unidades de hospitalización

OBJECTIVE: To know if there are differences between the critical care units and the medical-surgical care units regarding the perception of the nurses working in National Health System hospitals about their work environment, burnout level and job satisfaction. METHOD: A cross-sectional study was conducted with 6,417 nurses from the medical-surgical care units and with 1,122 nurses from critical care units of 59 Spanish hospitals with more than 150 beds. Socio-demographic, job satisfaction, perception of work environment (Practice Environment Scale of the Nursing Work Index [PES-NWI questionnaire]) and burnout measured with the Maslach Burnout Inventory (MBI) data were collected. RESULTS: The PES-NWI showed differences in 4 out of its 5 factors. It showed better values in medical-surgical units in all the factors, except for Staffing and resource adequacy (P < .001), where critical care units showed a mean level of agreement of 2.41 versus 2.19 for the medical-surgical units. Regarding burnout, this was higher in the medical-surgical care units (P = .039) where 23% (952) of the nurses had high levels. Job satisfaction was lower in the critical care units (P = .044) with 70% (578) of nurses being very or strongly satisfied. CONCLUSIONS: The opinion of the nurses, working in critical care units about their hospital is unfavorable. They showed lower levels of burnout than those working in medical-surgical units

[Work setting, satisfaction and burnout of the nurses in critical care units and hospitalization units. RN4CAST-Spain project]. / Entorno laboral, satisfacción y burnout de las enfermeras de unidades de cuidados críticos y unidades de hospitalización. Proyecto RN4CAST-España.

OBJECTIVE: To know if there are differences between the critical care units and the medical-surgical care units regarding the perception of the nurses working in National Health System hospitals about their work environment, burnout level and job satisfaction. METHOD: A cross-sectional study was conducted with 6,417 nurses from the medical-surgical care units and with 1,122 nurses from critical care units of 59 Spanish hospitals with more than 150 beds. Socio-demographic, job satisfaction, perception of work environment (Practice Environment Scale of the Nursing Work Index [PES-NWI questionnaire]) and burnout measured with the Maslach Burnout Inventory (MBI) data were collected. RESULTS: The PES-NWI showed differences in 4 out of its 5 factors. It showed better values in medical-surgical units in all the factors, except for Staffing and resource adequacy (P<.001), where critical care units showed a mean level of agreement of 2.41 versus 2.19 for the medical-surgical units. Regarding burnout, this was higher in the medical-surgical care units (P=.039) where 23% (952) of the nurses had high levels. Job satisfaction was lower in the critical care units (P=.044) with 70% (578) of nurses being very or strongly satisfied. CONCLUSIONS: The opinion of the nurses, working in critical care units about their hospital is unfavorable. They showed lower levels of burnout than those working in medical-surgical units.

Características clínicas y polisomnográficas de pacientes con apnea central. ¿Se benefician de servoventilación adaptativa? / No disponible

Objetivo: Describir las características clínicas y polisomnográficas de los pacientes en tratamiento con servoventilación adaptativa (ASV) en nuestro centro. Métodos: Estudio retrospectivo en el que se incluyen 26 pacientes que requirieron tratamiento con ASV para alcanzar un adecuado control clínico y polisomnográfico de los eventos respiratorios. Los pacientes acudieron a la Unidad Multidisciplinar de Sueño de la Fundación Jiménez Díaz entre mayo de 2009 y noviembre de 2011. Todos los pacientes iniciaron tratamiento con CPAP, y posteriormente fueron evaluados y revisados en la consulta de trastornos respiratorios del sueño. Tras un periodo de tres meses con dicho tratamiento, se realizó una titulación manual con polisomnografía (PSG). El tratamiento se cambiaba a ASV si se objetivaba escaso control clínico o polisomnográfico o si aparecía síndrome de apneas complejas (CompSAS). Resultados: De los 26 pacientes incluidos en el estudio, 15 pacientes presentaban un síndrome de apnea central (CSA) en su primer estudio polisomnográfico, mientras que los otros 11 pacientes presentaban un síndrome de apnea obstructiva severa. Tras el tratamiento inicial, este segundo grupo desarrolló compSAS. Todos los pacientes incluidos fueron varones, con una edad media de 61 años y una media de 67 eventos respiratorios por hora (IAH). La nicturia, la fragmentación en el sueño, el cansancio y el insomnio fueron los síntomas clínicos referidos con mayor frecuencia. La somnolencia fue evaluada con la escala de Epworth con un valor medio de 13 puntos antes del tratamiento. El tratamiento con CPAP se realizó con una presión media de 8 cm de H2O. Tras cumplir tres meses con el tratamiento, se realizaba una titulación manual con PSG que mostró un IAH medio de 40. Ante estos hallazgos estos pacientes fueron cambiados a servoventilación. Una segunda titulación manual de PSG mostró un IAH final de 11. Aquellos pacientes con somnolencia residual refirieron también una mejora cínica con el servoventilador. Conclusiones: La servoventilación adaptativa es una herramienta terapéutica eficaz en pacientes con CSA y compSAS para el control de eventos respiratorios y sus síntomas. La titulación manual con PSG es necesaria para asegurar el correcto diagnóstico de compSAS y como parte del seguimiento de estos pacientes (AU)

AIMS of the study: To describe clinical characteristics and polysomnographic parameters of patients treated with adaptative servoventilation (ASV) in our centre. Methods: Retrospective and descriptive study of 26 patients who required ASV to obtain a clinical and polisomnographic control of respiratory events. The patients were admitted in our Multidisciplinary Sleep Unit (MDSU) at Fundación Jiménez Díaz from may 2009 to november 2011. Continuous positive airway pressure (CPAP) treatment was the initial treatment for all patients; they were followed in our outpatient sleep-disorders consults. After three months with CPAP, we conducted a manual titration PSG. The treatment was switched to ASV if there was poor clinical or polisomnographic control or if complex sleep apnea (CompSAS) appeared. Results: 15 out of the 26 patients who were treated with ASV presented Central sleep apnea (CSA) on their first PSG study, while the remaining 11 patients were diagnosed as having severe obstructive sleep apnea. After the initial treatment with CPAP, the later group developed compSAS. All patients were male, with an average age of 61 years and a mean AHI of 67 events per hour. Nocturnal sleep fragmentation, tiredness and insomnia were the most frequent clinical symptoms. Sleepiness was evaluated with the Epworth scale with a mean value previous to treatment of 13. The initial treatment with CPAP had a medium pressure of 8 cm H2O. After three months on this treatment a manual titration PSG showed a mean AHI of 40. Thus, all the patients were switched to servoventilation. A second manual titration PSG showed a mean AHI of 11. Those patients with residual somnolence reported clinical improvement under treatment with ASV. Conclusions: ASV is an effective therapeutic tool for CSA and CPAP refractory/resistant compSAS, for controlling both apneic events and symptoms. A manual titration PSG is necessary for a correct diagnosis of compSAS and as part of the follow up of these patients (AU)

Perforación uterina secundaria a una mola invasiva aparecida sobre un coriocarcinoma / Uterine perforation due to a choriocarcinoma progressing to an invasive mole

Dentro de la enfermedad trofoblástica gestacional encontramos el coriocarcinoma, un tumor raro de gran agresividad local y a distancia, a pesar de lo cual presenta una alta tasa de curación. Presentamos el caso de una paciente joven con una perforación uterina y hemoperitoneo, secundario a un coriocarcinoma, surgido a partir de un aborto espontáneo que se transformó en mola invasiva. Tras intervenir quirúrgicamente a la paciente y tras un exhaustivo control, se consiguió la recuperación total de la misma, sin necesidad de añadir quimioterapia a su tratamiento. Realizamos una revisión de la literatura científica analizando los factores de riesgo de coriocarcinoma, sus técnicas diagnósticas y las opciones terapéuticas (AU)

Gestational trophoblastic disease includes choriocarcinoma, a singular and highly aggressive tumor both at local and distant sites. Nevertheless, the recovery rate is high. We report the case of a young patient with uterine perforation and hemoperitoneum secondary to a choriocarcinoma that developed after a spontaneous abortion and progressed to an invasive mole. After surgery and exhaustive follow-up, complete recovery was achieved with no need for chemotherapy. We review the scientific literature and analyze the risk factors for choriocarcinoma, diagnostic techniques and therapeutic options (AU)

Neumotórax de repetición / Recurrent pneumothorax

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Identificación de pacientes con un tromboembolismo pulmonar de bajo riesgo / Identification of patients with low risk pulmonary thromboembolism

Objetivo. Determinar las características de los pacientes diagnosticados de tromboembolismo pulmonar (TEP) en el Servicio de Urgencias del Hospital Gregorio Marañón, para valorar la aplicabilidad de un modelo basado en criterios clínicos que permite identificar a pacientes con bajo riesgo de complicaciones. Material y métodos. Se evaluaron todos los pacientes que ingresaron por urgencias con el diagnóstico de TEP agudo. Se recogieron las siguientes variables: edad, sexo, comorbilidad (antecedentes personales de insuficiencia cardiaca, enfermedad pulmonar crónica, enfermedad renal crónica, enfermedad cerebrovascular y cáncer), tensión arterial, frecuencia cardiaca, saturación arterial de oxígeno y estado mental. También se recogió el tratamiento recibido y la presencia de complicaciones durante su estancia en el hospital. Se identificó como enfermos con TEP de bajo riesgo a aquellos pacientes que no presentaban ninguna de estas características en la evaluación inicial. Resultados. Se incluyeron en el estudio 101 pacientes, de los que 16 cumplían todos los criterios para ser considerados de bajo riesgo (15,8%). Al comparar este subgrupo con el resto de los enfermos, se detectaron diferencias en la edad, que fue significativamente menor en los pacientes de bajo riesgo. También se apreciaron diferencias estadísticamente significativas en la frecuencia cardiaca y en la saturación arterial de oxígeno. Todos los pacientes, excepto 1 que se encontraba en situación terminal, recibieron tratamiento anticoagulante. La evolución de los enfermos durante el ingreso fue satisfactoria en el 100% de los individuos del grupo de bajo riesgo frente al 88,1% en el de pacientes de no bajo riesgo. En este último grupo 7 enfermos (6,93%) presentaron complicaciones durante el ingreso y se produjeron 5 fallecimientos (4,95%). Conclusiones. La aplicación de un modelo basado en criterios clínicos permite identificar a un subgrupo de pacientes con TEP con bajo riesgo de complicaciones. Dicho subgrupo de enfermos no se beneficia por tanto de un ingreso hospitalario, con la ventaja del confort que proporciona al paciente el tratamiento ambulatorio y de la disminución de costes que dicha estrategia supone (AU)

Objective. Determine the characteristics of the patients diagnosed of pulmonary thromoembolism (PTE) in the Emergency Service of the Hospital Gregorio Marañón, in order to evaluate the applicability of a clinical-criteria based model that makes it possible to identify patients at low risk of complications. Material and methods. All the patients who were admitted to emergency with the diagnosis of acute PTE were evaluated. The following variables were collected: age, gender, comorbidity (personal background of heart failure, chronic pulmonary disease, chronic renal disease, cerebrovascular disease and cancer), blood pressure, heart rate, arterial oxygen saturation and mental condition. The treatment received and the presence of complications during the patient’s stay in the hospital were also collected. Those patients with PTE who did not present any of these characteristics in the initial evaluation were identified as being at low risk. Results. A total of 101 patients, 16 of whom fulfilled all the criteria to be considers at low risk (15.8%), were included in the study. When this subgroup was compared with the rest of the patients, differences in age that were significantly lower in the low risk patients were detected. Statistically significant differences in heart rate and in arterial oxygen saturation were also observed. All the patient, except for one who was in end-state condition, received anticoagulant treatment. The evolution of the patients during admission was satisfactory in 100% of the low risk group individuals versus 88.1% of the non-low risk patients. In the latter group, 7 patients (6.93%) presented complications during admission and there were 5 deaths (4.95%). Conclusions: Application of the clinical-criteria based model makes it possible to identify a subgroup of patients with PTE at low risk of complications. Thus, this subgroup of patients does not benefit from hospitalization, with the advantage of the comfort provided to the patient of by out-patient treatment and of the decrease in costs obtained from this strategy (AU)