ABSTRACT
Background Penetrating neck injuries represent 510% of all traumatic injuries, these bring with them a high rate of morbidity and mortality due to vital structures that could be injured in this area. The aim of this study was to determine the epidemiological and clinical characteristics of penetrating neck injuries. Methods This was a retrospective, unicentric and descriptive study that included all patients who underwent neck exploration surgery. Results A total of 70 neck exploration cases were reviewed, 34 (49%) didnt had any injury. Thirty (43%) had at least one hard sign, 42 (60%) patients showed at least one soft sign. Statistical analysis showed only surgical time (252±199.5 vs. 155±76.4; p=0.020) and transfusions (1.87±3 vs. 0.4±0.856; p=0.013) were statistically significant. We report a mortality of 2 (3%) patients. Conclusions Our prevalence of neck surgical exploration without vascular injury was slightly higher (49% vs. 40%) than literature. We highlight the importance of not performing neck explorations in all patients who present a penetrating injury. We did not obtain differences between groups for hard signs and soft signs. We were not able to identify whether or not there would be an injury based on clinical characteristics. Imaging studies should be performed to avoid unnecessary neck explorations; however, depending on the clinical scenario some surgery cannot be avoided (AU)
Antecedentes Las lesiones penetrantes de cuello representan entre el 5-10% de todas las lesiones traumáticas, estas traen consigo una alta tasa de morbimortalidad por estructuras vitales que podrían lesionarse en esta área. El propósito de este estudio fue determinar las características epidemiológicas y clínicas del trauma penetrante de cuello. Métodos Estudio retrospectivo, unicéntrico y descriptivo que incluyó a todos los pacientes sometidos a cirugía de exploración de cuello. Resultados Se revisaron un total de 70 casos de exploración de cuello, 34 pacientes (49%) no presentaron ninguna lesión. Treinta pacientes (43%) tenían al menos un signo duro, 42 pacientes (60%) mostraron al menos un signo blando. El análisis estadístico mostró que solo el tiempo quirúrgico (252±199,5 vs. 155±76,4; p=0,020) y las transfusiones (1,87±3 vs, 0,4±0,856; p=0,013) fueron estadísticamente significativas. Reportamos la mortalidad de 2 pacientes (3%). Conclusiones Nuestra prevalencia de exploración quirúrgica de cuello sin lesión vascular fue ligeramente superior (49 vs. 40%) que la literatura. Destacamos la importancia de no realizar exploraciones de cuello en todos los pacientes que presentan una lesión penetrante. No obtuvimos diferencias entre grupos para signos duros y signos blandos. No pudimos identificar si hubiera o no una lesión en función de las características clínicas. Se deben realizar estudios de imagen para evitar exploraciones innecesarias del cuello; sin embargo, dependiendo del escenario clínico, no se pueden evitar algunas cirugías (AU)
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Wounds, Penetrating/surgery , Neck Injuries/surgery , Emergency Medical Services , Treatment Outcome , Retrospective StudiesSubject(s)
Allergens/immunology , Cocos/adverse effects , Desensitization, Immunologic , Food Hypersensitivity/etiology , Food Hypersensitivity/therapy , Immune Tolerance , Administration, Oral , Allergens/administration & dosage , Animals , Female , Food Hypersensitivity/diagnosis , Humans , Middle Aged , Severity of Illness Index , TherapeuticsABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Allergens/immunology , Cocos/adverse effects , Desensitization, Immunologic , Food Hypersensitivity/etiology , Allergens/administration & dosage , Food Hypersensitivity/therapy , Food Hypersensitivity/diagnosis , Severity of Illness Index , Immune Tolerance , Administration, OralSubject(s)
Capsicum/immunology , Food Hypersensitivity/immunology , Adolescent , Adult , Allergens/immunology , Female , Humans , Male , Middle Aged , Young AdultABSTRACT
No disponible
Subject(s)
Humans , Pimenta/adverse effects , Capsicum/adverse effects , Food Hypersensitivity/diagnosis , Anaphylaxis/diagnosis , Eosinophilic Esophagitis/diagnosis , Cross Reactions/immunology , Immunoblotting/methods , Cellulase/adverse effects , Peroxidase/adverse effects , Allergens/isolation & purificationABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Ulcer/complications , Atherosclerosis/complications , Aortic Aneurysm, Abdominal/complications , Aneurysm, Ruptured/complications , Laparotomy , Electrocardiography , Treatment OutcomeABSTRACT
BACKGROUND: Kidney transplantation is the most cost-effective therapy for end-stage renal disease. Post-operative complications account for 15%-17% of all cases and are associated with significant morbidity. Currently 4.8% of post-transplantation patients have returned to dialysis. Our center's main transplant origin is cadaveric donation. OBJECTIVE: To review surgical complications of kidney transplantation over the past 5 years. METHODS: This was an observational descriptive study that included all patients from 2011 to 2015. RESULTS: A total of 55 cases were reviewed. Diabetic nephropathy was the etiology in 30.9% of cases. Post-surgical complications occurred in 12.7% of patients with a post-operative mortality of 4%. Graft survival at 1 year was 82.4% with a 91% 1-year patient survival. CONCLUSION: Early identification and treatment of surgical complications are critical for patient and graft survival. Complications are low but significant.
Subject(s)
Angioedemas, Hereditary/therapy , Electroconvulsive Therapy , Female , Humans , Middle AgedABSTRACT
INTRODUCTION: This study aims to identify the causes for the incomplete donation process at a tertiary care hospital. MATERIALS AND METHODS: A descriptive, retrospective study was performed; all potential donors reported to the Transplant Service within the period of 2005 to 2014 were included. Descriptive statistics were used across frequencies and proportions for categorical variables, central tendency, and dispersion for continuous variables. RESULTS: The total number of deaths reported at the University Hospital (HU) was 8472, of which 815 (n = 815) were reported to COETRA ("Consejo Estatal de Trasplantes"). Among organ or tissue donors, the main known cause of death was head trauma (HT) in 26% (72). Cardiac arrest (CA) as cause of death provided the largest number of donations (141, 57%); of these, 102 (41%) were male and 39 (16%) were female. In comparison, brain death (BD) provided 104 (43%); of these, 65 (27%) were male, and 39 (16%) were female. The age interval was with a higher donation rate was 45 to 49 y (BD 18, CA 22). Donation request was not performed in 359 patients because of medical contraindication 60% (215), rapid deterioration 18% (64), and incomplete donation process 8% (27). Of 452 organ requests, 207 were not accomplished, because of body integrity 28% (57), family disagreement 20% (42), and no acceptance of BE 13% (26). CONCLUSIONS: Opportunity areas: (1) Ensure the notification of all deaths to Transplant Department for identification of potential donors; (2) Reduce rapid deterioration and raise number of completed donation protocols; (3) Increase the donation rate.
Subject(s)
Tertiary Healthcare , Tissue Donors/supply & distribution , Tissue and Organ Procurement/statistics & numerical data , Female , Humans , Male , Mexico , Middle Aged , Retrospective StudiesABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Complement C1 Inhibitor Protein/analysis , Complement C1 Inhibitor Protein/immunology , Hereditary Angioedema Types I and II/diagnosis , Hereditary Angioedema Types I and II/immunology , Electroconvulsive Therapy , Depression/therapy , Hereditary Angioedema Types I and II/complications , Complement C1 Inhibitor Protein/administration & dosage , Complement C1 Inhibitor Protein/adverse effectsSubject(s)
Anti-Bacterial Agents/immunology , Cephalosporins/immunology , Drug Hypersensitivity/immunology , Penicillins/immunology , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/adverse effects , Biomarkers/blood , Cephalosporins/adverse effects , Child , Cross Reactions , Drug Hypersensitivity/blood , Drug Hypersensitivity/diagnosis , Female , Humans , Immunoglobulin E/blood , Intradermal Tests , Male , Middle Aged , Penicillins/adverse effects , Predictive Value of Tests , Retrospective StudiesABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Cephalosporins/analysis , Cephalosporins/immunology , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/drug therapy , Drug Hypersensitivity/immunology , beta-Lactams , Penicillins/adverse effects , Penicillins/immunology , Cross Reactions , Skin Tests/methods , Skin TestsABSTRACT
Presentamos un caso de proteinosis alveolar pulmonar primaria en un varón de 46 años en el que la aproximación diagnóstica por criterios clínicos, técnicas de imagen, estudios complementarios y muestras obtenidas por broncofibroscopia (bioquímica, celularidad e histología) confirman el diagnóstico. Se plantean controversias con las opciones terapéuticas actuales relacionadas con el lavado terapéutico y el uso de factores estimulantes del crecimiento de macrófagos
We report a case of primary alveolar proteinosis in a 46 years man with a diagnostic approach based on clinical criteria, imaging, complementary studies and samples obtained by bronchoscopy (biochemistry, cellularity and histology) confirmed the diagnosis. Disputes arise with current therapeutic options related to therapeutic lavage and use of growth factors stimulating macrophages
Subject(s)
Humans , Male , Middle Aged , Pulmonary Alveolar Proteinosis/therapy , Bronchoalveolar Lavage , Macrophage Colony-Stimulating Factor/therapeutic use , Radiography, ThoracicABSTRACT
Diseño: Un estudio aleatorio prospectivo, longitudinal, consecutiva o no.Métodos: Análisis de los factores relacionados con la decanulación de un grupo de pacientes traqueostomizados ingresados en una sala de neumológica proveniente de la unidad de cuidados intensivos, todos ellos con ventilación mecánica prolongada. Resultados : Se estudiaron los pacientes fueron estudiados entre enero de 1994 y diciembre de 2001 (72 varones y 28 mujeres). Edad: 59,26 ± 12,98 años. 92% provenían de una UCI médica y el 8% a partir de una UCI quirúrgica. 59% de los pacientes eran fumadores. Los diagnósticos fueron: esclerosis lateral amiotrófica (5), los posibles defectos de la caja torácica (16), EPOC (29), síndrome de hipoventilación-obesidad (11), complicaciones posquirúrgicas (9); NMD (14), síndrome de apnea del sueño (15); Bronchiestasis (1) . Tiempo para la traqueotomía: 9,8 ± 2,9 días. Hora de llegada a la sala de neumológica: 28,6 ± 36,2 días. Total de la estancia 64,4 ± 44,5 días (la estancia en UCI: 38,4 ± 36,4; sala de estancia: 25,6 ± 18,8 días). 88% de los pacientes fueron decanulated. El 64% de los pacientes recibieron algún tipo de soporte ventilatorio domiciliario (la presión o el volumen). La supervivencia al año fue del 92%. El análisis multivariante muestran que la edad, el sexo y la enfermedad de motoneurona como factores negativos relacionados con la decanulación. Conclusiones: La mayoría de los pacientes ingresados en nuestra sala neumológica procedentes de la UCI y que recibieron asistencia respiratoria por traqueotomía, pueden ser candidatos a la decanulación segura de forma no invasiva la ventilación mecánica. Pacientes con ALS no pudo ser decanulados (AU)
Design: A prospective, longitudinal, consecutive and non randomised study.Methods: Analysis of the factors related to the decannulation of a group of tracheostomized patients admitted in a pneumological ward coming from the intensive care unit, all of them with prolonged mechanical ventilation.Results: One hundred patients were studied between January 1994 and December 2001 (72 males, 28 females). Age: 59,26 ± 12,98 years old. 92% were coming from a medical ICU and 8% from a surgical ICU. 59% of patients were smokers. The diagnoses were: ALS (5); Thoracic cage defects (16); COPD (29); Obesity hypoventilation syndrome (11); Postsurgical complications (9); NMD (14); Sleep apnea syndrome (15); Bronchiestasis (1). Time to tracheotomy: 9,8 ± 2,9 days. Time to arrival to pneumological ward: 28,6 ± 36,2 days. Total stay 64,4 ± 44,5 days (ICU stay: 38,4 ± 36,4; ward stay: 25,6 ± 18,8 days). 88% of the patients were decanulated. The 64% of the patients received any kind of domiciliary ventilation support (pressure or volume). One year survival was 92%. Multivariant analysis shown age, sex and motoneuron disease as factors negatively related to decanulation. Conclusions: Most patients admitted in our pneumological ward coming from the ICU and receiving ventilatory support by tracheotomy, can be candidates to safe decannulation using non-invasive mechanical ventilation. ALS patients could not be decannulated (AU)
Subject(s)
Humans , /methods , Tracheotomy/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Prospective Studies , Aftercare/methods , Oxygen Inhalation TherapyABSTRACT
Resumen. La amiloidosis pulmonar primaria o localizada es una patología poco frecuente que aparece en adultos a partir de la quinta década de vida. Se describen 5 formas de presentación. Describimos el caso de una mujer de 35 años que cursa de forma excepcional con una doble presentación de amiloidosis pulmonar traqueobronquial y nodular múltiple (AU)
Abstract: Primary or localized pulmonary amyloidosis is an uncommon condition that appears in adults after 50 years of age. Five presentation forms have been described. We describe the case of a 35-year old woman who had a rare form with double presentation of tracheobronchial pulmonary amyloidosis and multiple nodular amyloidosis (AU)
Subject(s)
Humans , Female , Adult , Amyloidosis/complications , Multiple Pulmonary Nodules/diagnosis , Calcinosis/diagnosis , BronchoscopyABSTRACT
El diagnóstico diferencial de los nódulos pulmonares múltiples siempre supone un reto. La forma de presentación es muy variada, y la rapidez en el crecimiento de los mismos nos obliga a un diagnóstico y tratamiento certeros. Presentamos el caso de un paciente detectado de forma casual en un control rutinario tras una neumonía pasada. La batería de pruebas que nos condujo al diagnóstico de sarcoma de partes blandas fue muy amplia. La evolución del paciente fue rápidamente mortal, dada la extensión de la enfermedad en el momento del diagnóstico. El comportamiento maligno de los sarcomas de partes blandas es poco frecuente, y su presentación como metástasis a distancia sólo aparece un bajo porcentaje de casos. El único tratamiento posible en este estadio es paliativo, con una tasa de supervivencia de alrededor de un año (AU)
Differential diagnosis of multiple pulmonary nodules, always suppose a challenge.The form of presentation is very varied and the speed of growth force us to a diagnosis and accurate treatment. We show the case of a patient, who was detected of chance form in a routine control after a past pneumonia. A multiple tests were needed to led us to the final diagnosis of soft tissue sarcoma. The evolution of the patient was rapidly mortal, given the extension of the disease in the moment of the diagnosis. Soft tissue sarcoma with a malignant behaviour is slightly common, and the initial presentation as a metastasized neoplasia is described in low percentage of cases. Palliative treatment is the only alternative in this moment with a rate of survival of about one year (AU)
Subject(s)
Humans , Male , Middle Aged , Multiple Pulmonary Nodules/pathology , Soft Tissue Neoplasms/pathology , Diagnosis, Differential , Early Detection of Cancer , Incidental Findings , Neoplasm Metastasis/pathologyABSTRACT
Objetivo: evaluar el grado de satisfacción de los familiares con la asistencia prestada por el Grupo de Atención al paciente Terminal del Centro de Salud (CS) Método: estudio descriptivo transversal retrospectivo. Población: cuidadores principales de los 57 pacientes atendidos desde el 1 de mayo de 2004 al 31 de diciembre de 2005. Se les realizó una encuesta de satisfacción mediante entrevista personal o telefónicamente según posibilidades. Variables: datos de filiación del cuidador, parentesco, lugar de trabajo, psicopatología concomitante, asistencia a talleres, datos socioeconómicos, datos sobre el conocimiento del paciente en relación con el diagnóstico y pronóstico, y datos sobre opinión general del cuidador acerca del funcionamiento del grupo. Resultados: obtuvimos datos de 47 de los 57 cuidadores incluidos en principio (10 pérdidas). El cuidador tipo resultó ser una mujer de 51 años de media, casada, hija del paciente, que no trabajaba fuera de casa y sí residía en el mismo domicilio. Cuarenta y dos cuidadores (89%) estaban de acuerdo con el lugar del fallecimiento. Los 47 consideraron que la información recibida era buena o muy buena y que la accesibilidad era adecuada o muy adecuada. Treinta y nueve cuidadores (68,5%), consideraron el alivio de síntomas adecuado o muy adecuado. Treinta y cuatro cuidadores (59,6%) expresaron tener una muy buena opinión de del Grupo de Atención a enfermos paliativos. Conclusiones: integrar la atención al paciente con enfermedad en estadio terminal en la AP hace que se obtengan beneficios que quedan reflejados en la evaluación positiva que realizan los cuidadores principales de estos pacientes
Objective: to assess family members´ degree of satisfaction with patient care in a Health Center. Method: a descriptive, cross-sectional retrospective method. Population: focused on the main caregivers who assisted an average of fifty-seven patients from May 2004 to December 31, 2005. Ultimately a survey was carried out (by telephone or personally, depending on circumstances) to detect patient level of satisfaction. Variables: the following should be highlighted: caregiver demographic data, kinship, working place, concomitant psychopathology, workshop attendance, socio-economic data, and patient knowledge on diagnosis and prognosis. Results: relevant data from 47 caregivers were obtained (from an average of 57 professionals). A prototypical caregiver had the following characteristics: 51 years of age, female, married, daughter of patient, unemployed, sharing the patients home. Moreover, 42 caregivers (89%) agreed on the place where the patient dies. Even 47 of them considered the information and accessibility given good or excellent. Furthermore, 34 caregivers (59.6%), held the care provided by the palliative staff in quite high esteem. Conclusion: by integrating end-stage patient care into Palliative Care a higher percentage of deaths are occurring at home. This means not only improved family satisfaction, but also better patient quality of life
Subject(s)
Humans , Patient Satisfaction/statistics & numerical data , Caregivers/statistics & numerical data , Terminally Ill , Palliative Care/statistics & numerical data , Epidemiology, Descriptive , Retrospective Studies , Socioeconomic FactorsABSTRACT
Existe una amplia evidencia científica de la presencia de enfermedades cardiovasculares en los pacientes con síndrome de apnea-hipoapnea del sueño (SAHS); sin embargo, se desconoce la incidencia de angina vasoespástica en estos pacientes, debido a una baja prevalencia de la angina de Prinzmetal y su dificultad para el diagnóstico. Se expone el caso de un paciente que presentó un episodio de angina vasoespástica durante la realización de una poligrafía cardiorrespiratoria nocturna hospitalaria (AU)
There is an extensive evidence of cardiovascular disease in patients with sleep apnea syndrome, but the incident of coronary artery disease with coronary spasm in these patients is unknown, because of a low prevalence and a difficult diagnosis. We describe a patient who present an episode of variant angina during a nocturnal respiratory polygraphy (AU)
