Derrame paraneumónico complicado: análisis de 2 cohortes consecutivas tratadas con distinto criterio / Complicated pleural infection: Analysis of 2 consecutive cohorts managed with a different policy

INTRODUCCIÓN: El tratamiento del derrame pleural paraneumónico complicado (DPC) es controvertido. Las principales guías recomiendan el drenaje, pero con el menor nivel de evidencia. Recientes trabajos han observado buenos resultados solo con antibióticos. Hemos comparado retrospectivamente nuestros resultados en 2 cohortes consecutivas de pacientes tratados con distinto criterio: en el grupo 1 (2005-2009, actitud intervencionista) el drenaje se decidía en función de las características del líquido pleural, de acuerdo con las principales guías; en el grupo 2 (2010-2013, actitud conservadora) el drenaje se decidía en función de la evolución clínica del paciente. MÉTODOS: Se revisaron las historias clínicas de los pacientes tratados por DPC entre 2005 y 2013. Las principales variables analizadas fueron la proporción de pacientes drenados y la duración de la estancia hospitalaria. RESULTADOS: Se analizó a 109 pacientes (64 grupo 1 y 45 grupo 2). Se colocó un tubo de drenaje en el 83% de los pacientes del grupo 1 y en el 47% de los del grupo 2 (p < 0,001). La duración media de la estancia hospitalaria fue de 11,4 días en el grupo 1 y 12,3 días en el grupo 2 (p = 0,45). No se observaron otras diferencias destacables. CONCLUSIÓN: Nuestros resultados coinciden con los de otros estudios recientes que han observado una buena evolución en niños tratados solo con antibióticos y cuestionan la necesidad del drenaje en muchos de los niños que presentan un DPC. Son necesarios ensayos clínicos para identificar las circunstancias en las que se puede obtener un beneficio del drenaje en el DPC

INTRODUCTION: The treatment of complicated pleural infection (CPI) is controversial. Clinical guidelines recommend drainage, but with the lowest grade of evidence. Recent reports have observed good outcomes with antibiotics alone. We retrospectively compared the outcomes in two consecutive cohorts treated with different policies: the first treated according to pleural fluid charactersitics (2005-2009, interventional-prone, group 1) and the second according to clinical assessment (2010-2013, conservative-prone, group 2). METHODS: The clinical records of all children treated for CPI in our hospital between 2005 and 2013 were thoroughly reviewed. Primary outcomes were the proportion of children drained and the length of hospital stay (LHS). RESULTS: One hundred and nine patients (64 group 1 and 45 group 2) were analyzed. A chest tube was placed in 83% of patients in group 1 and 47% in group 2 (P<0.001). The mean LHS was 11.4 days for patients in group 1 and 12.3 for patients in group 2 (P=0.45); no differences were observed in other outcomes. CONCLUSION: Our results add to few recent observations reporting good outcomes in many children treated with antibiotics alone and challenge the need to drain most children with CPI. Clinical trials are now needed to identify when a drainage procedure would be useful

[Complicated pleural infection: Analysis of 2 consecutive cohorts managed with a different policy]. / Derrame paraneumónico complicado: análisis de 2 cohortes consecutivas tratadas con distinto criterio.

INTRODUCTION: The treatment of complicated pleural infection (CPI) is controversial. Clinical guidelines recommend drainage, but with the lowest grade of evidence. Recent reports have observed good outcomes with antibiotics alone. We retrospectively compared the outcomes in two consecutive cohorts treated with different policies: the first treated according to pleural fluid charactersitics (2005-2009, interventional-prone, group 1) and the second according to clinical assessment (2010-2013, conservative-prone, group 2). METHODS: The clinical records of all children treated for CPI in our hospital between 2005 and 2013 were thoroughly reviewed. Primary outcomes were the proportion of children drained and the length of hospital stay (LHS). RESULTS: One hundred and nine patients (64 group 1 and 45 group 2) were analyzed. A chest tube was placed in 83% of patients in group 1 and 47% in group 2 (P<0.001). The mean LHS was 11.4 days for patients in group 1 and 12.3 for patients in group 2 (P=0.45); no differences were observed in other outcomes. CONCLUSION: Our results add to few recent observations reporting good outcomes in many children treated with antibiotics alone and challenge the need to drain most children with CPI. Clinical trials are now needed to identify when a drainage procedure would be useful.

Diode laser in the treatment of epistaxis in patients with hereditary haemorrhagic telangiectasia.

Periodic and spontaneous nosebleed is the most common clinical manifestation of hereditary haemorrhagic telangiectasia (HHT), present in 95% of patients suffering from this syndrome. The purpose of this retrospective study was to evaluate the effectiveness and safety of diathermocoagulation of telangiectasia on the nasal mucosa with a diode laser in the treatment of epistaxis in patients with HHT. From 2005 to 2010, 24 patients diagnosed with HHT and with mild-severe nosebleed were treated in our hospital with diode laser. Patients were given a pre- and post-operation evaluation questionnaire to determine the frequency and severity of nosebleed, the recurrence-free period of time after treatment and quality of life. We compared the pre- and post-operation haemoglobin values three months after the last treatment. After treatment, a decrease in the weekly frequency and entity of nosebleed was observed, together with substantial improvement in the quality of life and an increase in haematic haemoglobin. Diode laser treatment of telangiectasia on nasal mucosa represents a valuable, safe, effective and repeatable therapeutic option in treating mild and severe nosebleed, and it is associated with improvement in quality of life from psychological, social and clinical points of view.

Normas de diagnostico y tratamiento del maltrato infantil

Presenta las normas adoptadas por el hospital para el diagnostico y el tratamiento del maltrato infantil.

[The madness of "The Quixote"]. / La locura del Quijote.

The aim of this fiction psychiatric article, is to take a psychiatric look to El Quijote and to determine his strange and fascinating madness. His symptoms are analyzed as those of any patient and the conclusion is that he had a pre senile paranoia. This diagnosis, that gratifies clinicians curiosity, says nothing about the charm of his unusual mental profile or the captivating fascination of his nobility and poetry.

[Tubular sclerosis]. / In tema di sclerosi tubulare.

Tubular sclerosis is a pulp-dentin complex defensive response to several physiologic and pathologic stimuli; it leads to an increasing tubular obliteration which enormously reduces dentinal permeability. Its typical structural features are either increased peritubular dentin thickness or "caries crystals". Pathogenesis is a much debated question: some authors assert that peritubular dentin thickening is the main liable for sclerosis while others support a centrifugal theory. Another point of view considers its pathogenesis the result of many integrated mechanism.

Pharmacodynamics of troxerutine in patients with chronic venous insufficiency: correlations with plasma drug levels.

In a double-blind study the effects of troxerutine were assessed in patients with chronic venous insufficiency. The aim of this clinical pharmacological research was to evaluate, after a single oral dose: haemocoagulative and fibrinolytic balance, haemorheological changes and venous function. Correlation between such changes and simultanously assayed plasma drug levels was evaluated. The data obtained seems to give to troxerutine a more enlarged pharmacological characterization, especially regarding its demonstrated profibrinolytic and rheological activities. The maximal pharmacodynamic effects appeared simultaneous with the plasma drug peak.

[Psychodrama in psychotic patients]. / Psicodrama en psicóticos.

This experience was carried out over the years 1979/81 and 1983/4 at the Magnan ward of the Braulio Moyano Women's Neuropsychiatric Hospital in Buenos Aires, Argentina. Theory and the techniques of Psychodrama were applied to different groups of chronic psychotics, one of those groups being in a deep state of deterioration. Objects and therapeutic aims were to achieving changes in the patients' behavior, improving their socialization level as well as their communication links with their inmates and both their doctors and nurses. By means of both role playing and the nucleus of both the Ego and Scheme of Roles as a frame of reference it was aimed at recovering patients' integrative activity, thus increasing their re-adaptability to the familiar group an the society structure as well.

Psicodrama en psicóticos. / [Psychodrama in psychotic patients]

This experience was carried out over the years 1979/81 and 1983/4 at the Magnan ward of the Braulio Moyano Womens Neuropsychiatric Hospital in Buenos Aires, Argentina. Theory and the techniques of Psychodrama were applied to different groups of chronic psychotics, one of those groups being in a deep state of deterioration. Objects and therapeutic aims were to achieving changes in the patients behavior, improving their socialization level as well as their communication links with their inmates and both their doctors and nurses. By means of both role playing and the nucleus of both the Ego and Scheme of Roles as a frame of reference it was aimed at recovering patients integrative activity, thus increasing their re-adaptability to the familiar group an the society structure as well.