ABSTRACT
Antecedentes: La rotura traqueal completa y la lesión de conducto torácico representan complicaciones raras del trauma torácico cerrado. Método: Se presenta el caso de un paciente con rotura completa de la tráquea asociada a rotura del conducto torácico que fue operado en el Hospital del Trabajador. Discusión y conclusiones: La identificación y el manejo oportuno de estas lesiones disminuyen la morbimortalidad asociada a trauma.
Background: Tracheal rupture and thoracic duct lesion are rare complications of blunt thoracic trauma. Method: We present in this article the case of a patient with complete tracheal rupture and thoracic duct lesion treated in Hospital del Trabajador. Discussion and conclusions: Early identification and prompt management of this conditions reduce morbimortality associated with trauma.
Subject(s)
Humans , Male , Adult , Young Adult , Thoracic Injuries/complications , Trachea/surgery , RuptureABSTRACT
INTRODUCTION: Trauma is a leading cause of mortality and disability in children worldwide. The World Health Organization reports that 95% of all childhood injury deaths occur in Low-Middle-Income Countries (LMIC). Injury scores have been developed to facilitate risk stratification, clinical decision making, and research. Trauma registries in LMIC depend on adapted trauma scores that do not rely on investigations that require unavailable material or human resources. We sought to review and assess the existing trauma scores used in pediatric patients. Our objective is to determine their wideness of use, validity, setting of use, outcome measures, and criticisms. We believe that there is a need for an adapted trauma score developed specifically for pediatric patients in low-resource settings. MATERIALS AND METHODS: A systematic review of the literature was conducted to identify and compare existing injury scores used in pediatric patients. We constructed a search strategy in collaboration with a senior hospital librarian. Multiple databases were searched, including Embase, Medline, and the Cochrane Central Register of Controlled Trials. Articles were selected based on predefined inclusion criteria by two reviewers and underwent qualitative analysis. RESULTS: The scores identified are suboptimal for use in pediatric patients in low-resource settings due to various factors, including reliance on precise anatomic diagnosis, physiologic parameters maladapted to pediatric patients, or laboratory data with inconsistent accessibility in LMIC. CONCLUSION: An important gap exists in our ability to simply and reliably estimate injury severity in pediatric patients and predict their associated probability of outcomes in settings, where resources are limited. An ideal score should be easy to calculate using point-of-care data that are readily available in LMIC, and can be easily adapted to the specific physiologic variations of different age groups.
Subject(s)
Benchmarking/methods , Developing Countries , Needs Assessment , Outcome Assessment, Health Care/methods , Poverty , Wounds and Injuries/therapy , Child , Humans , RegistriesABSTRACT
Bariatric surgery is considered the most effective treatment for severe obesity and its benefits include improvement in medical comorbidities. However, a higher rate of suicides after this type of surgery has been reported. We performed a literature review on the subject, and concluded that the mentioned increase in suicide rates, compared to the general population, is probably caused by conditions that the patient had before surgery, especially psychiatric disorders such as depression or eating disorders. These are risk factors for suicide, and are more common in the population with indication for bariatric surgery. Therefore, it is necessary to thoroughly evaluate these patients before surgery searching for suicide risk factors, deriving them to a mental health professional if necessary and follow their mental health after surgery. Considering that the literature on the topic is inconsistent, further research is needed.
Subject(s)
Humans , Suicide/psychology , Obesity, Morbid/epidemiology , Bariatric Surgery/psychology , Mental Disorders/epidemiology , Suicide/statistics & numerical data , Obesity, Morbid/surgery , Obesity, Morbid/psychology , Comorbidity , Risk Factors , Mental Disorders/psychologyABSTRACT
Bariatric surgery is considered the most effective treatment for severe obesity and its benefits include improvement in medical comorbidities. However, a higher rate of suicides after this type of surgery has been reported. We performed a literature review on the subject, and concluded that the mentioned increase in suicide rates, compared to the general population, is probably caused by conditions that the patient had before surgery, especially psychiatric disorders such as depression or eating disorders. These are risk factors for suicide, and are more common in the population with indication for bariatric surgery. Therefore, it is necessary to thoroughly evaluate these patients before surgery searching for suicide risk factors, deriving them to a mental health professional if necessary and follow their mental health after surgery. Considering that the literature on the topic is inconsistent, further research is needed.
Subject(s)
Bariatric Surgery/psychology , Mental Disorders/epidemiology , Obesity, Morbid/epidemiology , Suicide/psychology , Comorbidity , Humans , Mental Disorders/psychology , Obesity, Morbid/psychology , Obesity, Morbid/surgery , Risk Factors , Suicide/statistics & numerical dataABSTRACT
BACKGROUND: Morbid obesity is a chronic inflammatory condition due to the production of several cytokines from the adipose tissue. However, what happens with some of these parameters the first days after surgery is unknown. Therefore, the objective of the present study was to determine, through a prospective and descriptive study, the behavior of the C-reactive protein (CRP), the white blood cell count, and the body temperature prior to a gastric bypass and for 5 days afterwards. METHODS: A total of 156 patients with morbid obesity were included in this prospective study. There were 120 women and 36 men, with a mean age of 41 years and a body mass index of 43 kg/m(2). They were submitted either to a laparotomic resectional gastric bypass or to a laparoscopic gastric bypass. Body temperature was measured every 8 h during 5 days. CPR and white blood cells were measured at the first, third, and fifth day after surgery. RESULTS: All patients had a normal postoperative course. Body temperature showed no change. White blood cells increased significantly at the first and third day after surgery but normalized by the fifth day. However, the third day after surgery, laparotomic gastric bypass patients showed a significantly greater increase in the total white blood cell count as well as in segmented neutrophil cells compared to laparoscopic surgery patients. CRP exhibited a similar increase and was more pronounced after a laparotomic approach. CONCLUSION: During the 5 days after gastric bypass, a significant increase in white blood cells and CRP was observed. The increase was significantly greater after a laparotomic bypass compared to the laparoscopic approach.
