Análisis de la casuística de 5 años en la Unidad de Quemados del Hospital Luis Vernaza, Guayaquil, Ecuador / Analysis of a 5-year casuistry in the Burn Unit of Luis Vernaza Hospital, Guayaquil, Ecuador

En el periodo comprendido entre 2006 y 2010 registramos 646 ingresos a la Unidad de Quemados del Hospital Luis Vernaza, en Guayaquil, Ecuador. El género masculino fue más afectado que el femenino (70,7% frente a 29,3%). El domicilio fue el lugar donde más ocurrieron los accidentes. La llama fué la etiología más común (n=233). El 85% de los pacientes ingresados requirió algún tipo de tratamiento quirúrgico. La estancia media hospitalaria no tuvo diferencias al comparar género o edad, pero fue mayor para aquellos pacientes con lesiones de más del 30% de la superficie corporal total (46,9 frente a 25,1 días; p < 0,05) y en pacientes con quemaduras de tercer grado (34,6 frente a 20,8 días; p < 0,05). Según los criterios de la American Burn Association, los pacientes con quemaduras de grado moderado a mayor tuvieron una estancia superior a la de los pacientes en la primera categoría (p < 0,05). No observamos diferencias entre los pacientes con quemaduras de grado moderado y mayor (AU)

From 2006 to 2010, 646 patients were treated at the Burn Unit of Luis Vernaza Hospital, Guayaquil, Ecuador. Men were more affected than women (70,7% versus 29,3%). The domestical enviroment was the commonest location where accidents happened. Flame was the most frequent cause (n=233); 85% of patients required surgical management. No differences regarding mean hospital stay were observed when gender and age were analyzed, but it was longer in patients with lesions that affected at least 30% of total body surface (46,9 versus 25,1 days; p < 0,05) and among patients with third degree lesions (34,6 versus 20,8 days; p < 0,05). According to American Burn Association Criteria, patients with moderate - major burns had a longer hospital stay compared to those in the first category (p < 0,05). No differences were observed between patients with moderate or major injuries (AU)

Fuentes vasculares de los colgajos V-Y en la extremidad inferior. Revisión de casos clínicos / Vascular supply of V-Y flap in lower extremity: clinical review

Los colgajos V-Y fueron descritos por primera vez en el siglo XIX para la reconstrucción de pequeños defectos en la cabeza y en el cuello, aprovechando las ideales condiciones de estas zonas, abundancia vascular y exceso relativo de piel y tejido subcutáneo para lograr el avance del colgajo y el cierre directo de la zona donante. Las condiciones locales del miembro inferior, caracterizadas por el escaso aporte vascular y la escasez de tejidos, condicionan que la reconstrucción de calidad de defectos no susceptible de cierre directo en esta zona continúe siendo un desafío para el cirujano plástico. En los últimos años el aumento de nuestros conocimientos sobre las distintas fuentes vasculares del miembro inferior ha posibilitado el desarrollo de nuevos colgajos fasciales o de perforantes que han permitido la cobertura de defectos moderados y grandes a este nivel; sin embargo la mayoría de estos colgajos han sido descritos de manera que no es posible obtener el cierre directo de la zona donante secundaria. La adaptación del colgajo V-Y a las nuevas fuentes vasculares descritas ha permitido la utilización de este colgajo a pesar de las adversas condiciones locales del miembro inferior, posibilitando la cobertura de defectos cutáneos moderados y el cierre directo de la zona donante (AU)

The V-Y flaps were, first described at XIX century for reconstruction of little defects in head and neck. They were based on subcutaneous vascular supply and they used the ideal condition of this area, vascular plenty and relative excess of skin and subcutaneous tissue, to obtain the flap’s advancement and a direct close of the donor zone. The local conditions in the lower extremity are distinguished for the shortage vascular supply and the lack of tissue excess. This hard condition explains that the quality reconstruction of moderate defects in the lower limb remains a challenge for the plastic surgeon. In the last years, the increase of our knowledge about the different vascular supply of the skin in the lower extremity have made possible the development of new flaps which allow the covering of middle and big defects in the leg; however, most of this flaps fail to accomplish a direct closure of the donor zone. The combination of this new vascular knowledge with the V-Y design has allowed the use of the classic advantages of this flap in the adverse condition of the lower extremity. We explain the different vascular supply of the V-Y flaps in the lower extremity using different clinical cases (AU)

Una nueva modificación en la clasificación TNM del cáncer mamario / A new revision of the breast cancer TNM staging

Recientemente se han propuesto (American Joint Committee on Cancer, AJCC) cambios de importancia en la clasificación TNM del cáncer mamario dirigidos a una más completa y significativa estratificación de las pacientes atendiendo a las nuevas técnicas diagnósticas y a la introducción de la biopsia del ganglio centinela. Los principales cambios se refieren a: distinción basada en el tamaño tumoral entre micrometástasis y células tumorales aisladas; empleo de identificadores de las nuevas técnicas, inmunohistoquímicas y moleculares, utilizadas; clasificación del estado ganglionar según el número de ganglios con metástasis y una nueva clasificación de las metástasis de ganglios infraclaviculares, de la cadena mamaria interna y supraclaviculares (AU)

[A prospective study on the time elapsed until admission at the coronary unit of patients with acute myocardial infarct. Apropos of 180 cases]. / Estudio prospectivo sobre el tiempo transcurrido hasta el ingreso en la unidad coronaria de los enfermos con infarto agudo de miocardio. A propósito de 180 casos.

We have carried out a prospective study to evaluate the time from the onset of symptoms until the admission to coronary care unit in 180 patients with acute myocardial infarction. We have evaluated the causes resulting in a delay and their consequences on the prognosis. The data were obtained with a clinical questionnaire from the patients and/or his family and from a review of the clinical records. The mean time since the onset of symptoms until the admission to the coronary care unit was 5.4 hours, being significantly shorter in the patients who did not call for prehospital attention. The major delay was attributable to the patient (delay in asking for medical attention); therefore, it is mandatory to implement measures of health education. Prehospital attention did not provide any diagnostic or therapeutic improvement in 30% of patients. Thus, we suggest that community care education on coronary artery disease should be improved.

[Myocardial disease in acute idiopathic pericarditis (author's transl)]. / Afección miocárdica en la pericarditis aguda idiopática.

Acute idopathic pericarditis can be accompanied by myocarditis, and in all types of acute pericarditis there are electrocardiographic signs of myocardial lesions. In order to determine the severity of the myocardial disease in acute idiopathic pericarditis, a prospective study has been carried out in a group of 25 patients with this diagnosis. The clinical evaluation included phonomecardiographic measurements of the systolic intervals, Weissler index in 24 cases, and echocardiographic study of the left ventricle in eight cases. Besides that, the serum levels of the myocardial enzymes (GOT, GPT, CPK, and LDH and its isoenzymes) were determined in all cases. The results showed a gallop rhythm in 8 percent of the cases, supraventricular arrhythmias in 4 percent, dysfunction of the left ventricle by systolic intervals and/or echocardiography in 32 percent, and increase of the myocardial enzymes in 24 percent, which represents a global incidence of myocardial disease of 44 percent. However, only three patients presented clinical manifestations of myocardial disease, although the congestive cardiac failure was always secondary to cardiac tamponade and not to myocardial failure. The increase of myocardial enzymes can determine important problems of differential diagnosis with an acute myocardial infarction. The clinical course was favourable in all of the cases, including the ones which showed myocardial disease.

[Paradox arterial embolism: diagnosis during life]. / Embolia arterial paradójica: diagnóstico en vida.

Paradoxical systemic embolism in the absence of congenital heart disease is often considered a clinical or pathologic rarity. We have recently observed two cases of paradoxical systemic emboli, secondary to massive pulmonary embolization in the presence of a patient foramen ovale in an otherwise normal heart. One case was lethal and the diagnosis was confirmed at autopsy. The other case was diagnosed by cardiac catheterization with dye dilution curves and the patient recovered after recurrences were prevented by the placement of an inferior vena cava umbrella-filter. Paradoxical embolization should be suspected when systemic emboli occur without an apparent cause. The diagnosis can be established by cardiac catheterization, pulmonary angiography and phlebography, and recurrences can be prevented by anticoagulation and partial interruption of the inferior vena cava, when the emboli arise from its territory.