Sistema de presión negativa como tratamiento de la venta torácica: informe de caso / Negative pressure system as a thoracic window treatment: a case report

Introducción: Se presenta un caso clínico de sistema de presión negativa como tratamiento de ventana torácica derecha, realizado en la clínica de heridas. Se describe el tiempo y proceso de cicatrización, desde la llegada del paciente hasta la cicatrización total. Caso: Hombre de 24 años, postoperado de toracotomía, se le colocó terapia de presión negativa inicial a -75mmHg con intensidad media y modalidad continua; se aplicó esponja blanca para proteger el pulmón expuesto y esponja de plata, con tres cambios cada siete días. Posteriormente, se realizaron diez cambios de esponjas cada cuatro días, identificando disminución de las dimensiones de la ventana torácica. En la semana once inició tratamiento con terapia húmeda y fibrina rica en plaquetas, la cual se colocó en el lecho de la herida, aplicándose una vez por semana durante un mes. A partir de la semana quince se realizó curación diaria con aplicación de sulfadiazina de plata. El paciente fue dado de alta en la semana veinte con la herida 100% epitelizada. Conclusiones: El uso de la terapia de presión negativa acelera el proceso de curación, reduce las complicaciones y la carga bacteriana del tejido, debido a que la esponja de plata actúa como barrera antimicrobiana.

Introduction: A clinical case of negative pressure system as a right thoracic window treatment, performed in the wound clinic, is presented. The time and healing process from patient arrival to complete healing is described. Case: A 24-year-old man, postoperative thoracotomy, was placed on negative pressure therapy at -75mmHg with medium intensity and continuous mode; white sponge was applied to protect the exposed lung and silver sponge, with three changes every seven days. Subsequently, ten sponge changes were performed every four days, identifying a decrease in the dimensions of the thoracic window. In week eleven, the patient started treatment with wet therapy and platelet-rich fibrin, which was placed in the wound bed and applied once a week for a month. From week fifteen onwards, daily healing was performed with silver sulfadiazine application. The patient was discharged at week twenty with the wound 100% epithelialized. Conclusions: The use of negative pressure therapy accelerates the healing process, reduces complications and tissue bacterial load, due to the silver sponge acting as an antimicrobial barrier.

[Utility of morphogenetic protein for the treatment of congenital pseudoarthrosis of the tibia]. / Utilidad de la proteína morfogenética en el tratamiento de la seudoartrosis congénita de la tibia.

OBJECTIVE: To report the ability of bone morphogenetic protein to achieve bone healing in patients with congenital pseudoarthrosis of the tibia. PATIENTS AND METHODS: Three patients with a diagnosis of congenital pseudoarthrosis of the tibia were followed-up for six months. Bone healing and functional capacity of the limb were observed. RESULTS: Bone healing occurred in all cases at a mean of three and half months of treatment. CONCLUSIONS: Morphogenetic protein is useful as an adjuvant to achieve bone regeneration and healing in patients with congenital pseudoarthrosis of the tibia.

Trastorno por déficit de atención/hiperactividad: validación de la escala EDAH en población canaria de educación primaria / Attention deficit hyperactivity disorder: validation of the EDAH scale in a primary school population in the Canary Island

Objetivo. Validar la escala de evaluación del trastorno por déficit de atención/hiperactividad (EDAH) en la población canaria de educación primaria. Sujetos y métodos. A partir de una muestra de 2.500 niños y niñas, se obtiene una submuestra con aquellos participantes que presentan puntuaciones mayores al percentil 75 en cada uno de los factores que componen la prueba (n = 614), de los cuales 222 son niñas (36,2%) y 392 niños (63,8%). Con respecto a la edad, el rango oscila entre los 6 y los 12 años. Resultados y conclusiones. El análisis factorial con rotación Varimax realizado obtiene como principal resultado la aparición del factor ‘problemas de interacción social’, tal y como ocurre en la validación realizada para población adolescente, manteniendo los tres factores de la prueba original, aunque con alguna diferencia en su composición. Asimismo, se obtuvo una alta consistencia interna mediante el coeficiente alfa de Cronbach (0,86), lo que confirma la fiabilidad de la escala. En cuanto a las variables sociodemográficas analizadas, la variable número de suspensos explica significativamente parte de la varianza en todos los factores que componen la escala, siendo la única variable significativa en los factores déficit de atención y problemas de interacción social. La variable sexo resulta significativa en los factores problemas de conducta e hiperactividad, mientras que la edad sólo lo es en el factor hiperactividad (AU)

Aim. To validate the rating (assessment) scale for attention-deficit/hyperactivity disorder (EDAH) in Canarian population of primary education. Subjects and methods. From a sample of 2,500 children, you get a subsample with those participants who have a higher scores at 75 percentile in each of the factors that make up the test (n = 614), of which 222 are girls (36.2 %) and 392 boys (63.8 %). With regard to the age, the rank ranges between 6 and 12 years. Results and conclusions. Factorial analysis with Varimax rotation obtained as the main factor resulting in the emergence of social interaction problems such as in the validation performed for teens population, keeping the three factors of the original test, although with some differences in their composition. It also had a high internal consistency by Cronbach alpha coefficient (0.86) which confirms the reliability of the scale. In terms of demographics variables analyzed, the variable number of failures significantly explains the variance of all factors that make up the scale, being the only significant variable in the factor of attention deficit and problems with social interaction. The sex variable is significant in the factor behavior problems and hyperactivity whereas age is only in the hyperactivity facto (AU)

Syringe pressure irrigation of subdermic tissue after appendectomy to decrease the incidence of postoperative wound infection.

To evaluate syringe pressure irrigation of the surgical wound to decrease its infection after appendectomy, we designed a randomized control trial at the Emergency Department of Mexico City General Hospital, including 350 patients with acute abdomen suggestive of appendicitis, without any other infection clinically evident. The trial was randomized into 2 groups. Group I patients received prophylactic systemic antibiotics before surgery. Group II patients received the same prophylactic systemic antibiotics plus syringe pressure irrigation of the surgical wound with 300 ml of saline solution using a 20-ml syringe with 19-gauge intravenous (IV) catheter to measure the incidence of postoperative wound infection. In our results, 283 patients had appendicitis. Of these, 188 were uncomplicated (66.4%) and 95 (33.6%) were complicated. Of the complicated cases, 40 were assigned to group I, and of these, 29 (72. 5%) developed wound infection. In group II there were 55 patients and only 9 (16.3%) developed wound infection after syringe pressure irrigation [p = 0.000001; 95% confidence interval (CI) = 0.02-0.22]. We conclude that syringe pressure irrigation of the surgical wound after appendectomy contributes significantly to decrease the incidence of postoperative wound infection in complicated cases. It is a cheap, safe, and accessible method in any surgical room.

Irrigación a presión de la herida quirúrgica en apendicitis complicada / Pressure irrigation of the surgical wound in complicated appendicitis

Antecedentes: El objetivo de este estudio fue evaluar la utilidad de la irrigación a presión de la herida quirúrgica para disminuir su infección en enfermos apendicectomizados. Para ello se realizó un ensayo clínico aleatorio en enfermos con apendicitis. Material y métodos: Fueron incluidos 95 enfermos con apendicitis complicada. Los enfermos fueron asignados aleatoriamente a uno de dos grupos: Grupo I:40 pacientes apendicectomizados en los que sólo se empleó antibioticoprofilaxis y grupo II:55 enfermos apendicectomizados en los que además se realizó irrigación a presión de la herida quirúrgica. En ambos grupos se determinó la frecuencia de infección de la herida. Resultados: De los 95 casos incluidos, 67 correspondieron al sexo masculino (70.5 por ciento) y 28 al femenino (29.5 por ciento); la edad promedio fue de 28 años. Veintinueve casos (72.5 por ciento) presentaron infección de la herida quirúrgica en el grupo I y sólo nueve (16 por ciento) en el grupo II; esta diferencia fue estadísticamente significativa (p= 0.000001). Conclusiones: la irrigación a presión de la herida quirúrgica en enfermos con apendicitis complicada contribuye a disminuir la frecuencia de infección de la misma. Es barata, segura y accesible en cualquier quirófano

Venom from two sub-species of Heloderma horridum (Mexican beaded lizard): general characterization and purification of N-benzoyl-L-arginine ethyl ester hydrolase.

The venom from the lizards Heloderma horridum horridum and Heloderma horridum alvarezi was obtained at a protein concentration of 80 mg/ml with a pH value of 6.9-7.0. The volume of venom obtained is approximately 0.5 ml per extraction. The i.p. LD50 value in mice for both sub-species is 2 mg/kg body weight. The electrophoretic pattern of the venom applied to polyacrylamide gels shows at least 18 protein bands and this pattern is constant for the same animal during all 12 months of the year, although different animals from the same population may present a slightly different pattern. The venom has the following enzymatic activities: phospholipase A, hyaluronidase, and Bz-Arg-OEt and Bz-Tyr-OEt hydrolase. Some of the venom components can be selectively and reversibly precipitated at acidic pH (4.7). The venom is very immunogenic and the sheep anti-sera against both sub-species cross-react quite extensively. A Bz-Arg-OEt hydrolase was purified from the venom of H. h. horridum by column chromatography in Sephadex G-75 followed by two steps on DEAE-cellulose columns at two different pH values (7.55 and 8.6). The last step was chromatography in a phenyl-sepharose column. The molecular weight of this enzyme, as obtained by SDS-gel electrophoresis, is approx. 65,000.