RESUMEN
INTENTION: Thorax trauma (TT) is associated with a high rate of pulmonary failure and increased mortality. To prevent these complications, the German trauma system recommends intubation and chest tube insertion at the scene of the accident, even in cases without acute respiratory dysfunction. Due to the possible life threatening complications of the therapy, the emergency surgeon should be able to correctly identify a TT at the scene. Therefore, we retrospectively compared the evaluation of chest trauma by the emergency surgeon with objective injury severity according to the Abbreviated Injury Scale (AIS). METHOD: Data from 2,392 patients (aged 39+/-1 years, Injury Severity Score 27+/-0.3) were taken from the multiple trauma database of the German Trauma Society. The evaluation of TT (absent, light, medium, severe) by the emergency surgeon was compared with objective injury severity (AIS=0: absent, 0>AIS<3: light, AIS=3: medium, AIS>3: severe). If the difference between the subjective and objective injury severity increased or decreased two and more levels, a substantial misclassification was assumed. The influence of the estimate on outcome was tested by comparing the predicted (TRISS-method) with the observed fatalities. RESULTS: Absence of TT was estimated correctly in 62%, light in 24%, medium in 40% and severe TT in 46% of cases. Thus a correct estimate of TT was made for 49% of the patients. The chest injury severity was substantially overrated by the emergency surgeon in 20% and substantially underestimated in 17% of cases. In patients with the correct classification at the scene, a total of 81% received a chest tube. Of these patients, only 50% received their chest tube at the scene. Of the patients with an initially overlooked TT, only 37% received a chest tube and nearly all were placed in the emergency room. The number of fatalities was lower than predicted in all groups, even in patients with correctly estimated severe TT (observed: 34%, estimated: 42+/-2%), and also in patients with initially overlooked TT (observed: 16%, estimated: 24+/-2%). CONCLUSION: Due to the high rate of misclassification and possible severe complications caused by therapy, and without having any benefit in terms of outcome, intubation and chest tube insertion should not be carried out in vital, stable patients.
Asunto(s)
Traumatismo Múltiple/diagnóstico , Traumatismos Torácicos/diagnóstico , Traumatología , Adulto , Diagnóstico Diferencial , Urgencias Médicas , Servicios Médicos de Urgencia , Femenino , Humanos , Intubación Intratraqueal , Masculino , Traumatismo Múltiple/mortalidad , Traumatismo Múltiple/terapia , Índice de Severidad de la Enfermedad , Traumatismos Torácicos/mortalidad , Traumatismos Torácicos/terapia , Índices de Gravedad del Trauma , Resultado del TratamientoRESUMEN
In the majority of patients hepatocellular carcinoma (HCC) is associated with liver cirrhosis. Advanced or decompensated liver cirrhosis, comorbidity and multicentricity make 70-80% of HCCs inoperable at the time of diagnosis. Therefore, percutaneous ethanol injection (PEI) and radiofrequency thermal ablation (RFTA) are non-surgical therapeutic options for patients with small HCCs. In patients with advanced tumor stage transarterial chemoembolization (TACE) and its variants showed no survival benefit on the basis of randomized trials. In several studies, however, combined treatment strategies like TACE and PEI or RFTA after occlusion of tumor blood supply in the treatment of advanced HCC seems to result in a survival benefit. All HCC patients should be included in randomized treatment studies.
Asunto(s)
Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica , Etanol/administración & dosificación , Hipertermia Inducida , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/mortalidad , Terapia Combinada , Humanos , Inyecciones Intralesiones , Neoplasias Hepáticas/mortalidad , Tasa de SupervivenciaRESUMEN
BACKGROUND: It has been hypothesized that changes in heating systems and insulation of homes in developed countries have generated an indoor climate favorable to organisms that excrete allergens inducing sensitization and allergic disease. The purpose of this study was to determine the influence of the installation of highly insulated windows and central heating systems on indoor climate, and mite-allergen (Der f 1) and mold spore concentrations. METHODS: The bedrooms of 98 apartments were examined before and 7 months (mean) after installation of insulated windows and central heating systems. The air-exchange rate, temperature, and humidity were measured. In settled dust on carpets and mattresses, the number of colony-forming mold spores and the Der f 1 concentration were determined. The inhabitants completed a questionnaire about their lifestyles and housing conditions. RESULTS: The air-exchange rate decreased from geometric mean 0.73 to 0.52 per hour (P=0.029). Temperature (mean 13.4 vs 17.5 degrees C, P<0.001), and absolute humidity (mean 4.6 g vs 6.2 g H2O/kg air, P<0.001) increased. Relative humidity remained nearly unchanged (mean 47.6 vs 49.1%). Der f 1 concentrations on carpets (geometric mean 0.65 vs 1.28 microg/g dust, P < 0.001) and mattresses (geometric mean 1.56 vs 2.40 microg/g, P=0.002) increased. Among the fungi that were analyzed, only the thermotolerant species Aspergillus fumigatus increased (geometric mean 20 vs. 60 colony-forming units/g carpet dust, P = 0.02). CONCLUSIONS: The findings of this study suggest that the installation of insulated windows and central heating systems is associated with an increase of Der f 1 concentrations in carpet and mattress dust and of A. fumigatus in carpet dust in apartment bedrooms.
Asunto(s)
Contaminación del Aire Interior/análisis , Alérgenos/análisis , Glicoproteínas/análisis , Vivienda , Esporas Fúngicas/aislamiento & purificación , Animales , Antígenos Dermatofagoides , Lechos/microbiología , Microbiología Ambiental , Calefacción/efectos adversos , Humedad/efectos adversos , Ácaros/química , TemperaturaRESUMEN
PURPOSE: Evaluation of MRI in radiotherapy of humeroscapular periarthritis. PATIENTS AND METHODS: Seventy-seven patients with humeroscapular periarthritis prospectively underwent MRI before radiotherapy. RESULTS: Six months after radiotherapy, 34% of the patients had achieved complete pain relief, 35% major pain relief. Twenty percent had only slight improvement and 12% no improvement. Positive correlation of radiotherapy outcome and MRI findings could be shown for acute tendinitis, erosions, and complete and incomplete ruptures of the supraspinatus tendon. CONCLUSIONS: Radiotherapy is highly effective in the treatment of humeroscapular periarthritis. The indication can be improved using MRI.
Asunto(s)
Periartritis/radioterapia , Fotones/uso terapéutico , Articulación del Hombro/efectos de la radiación , Anciano , Campos Electromagnéticos , Femenino , Estudios de Seguimiento , Humanos , Húmero/efectos de la radiación , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Escápula/efectos de la radiación , Resultado del TratamientoRESUMEN
In spite of procedures such as CT angiography, MR angiography, and rotation angiography, panangiography is still indispensable in therapeutic planning for cerebral aneurysms. It is the only method that provides exact details about the size, anatomic localization, and multiplicity of aneurysms as well as relation to surrounding vessels, the presence of an aneurysmal neck, and for the evaluation of the collateral circulation required to answer the question if endovascular therapy is possible. In addition, panangiography still exhibits the highest selectivity in the detection of cerebral aneurysms.
Asunto(s)
Angiografía/métodos , Aneurisma Intracraneal/diagnóstico por imagen , Circulación Cerebrovascular , Circulación Colateral , Humanos , Aneurisma Intracraneal/diagnóstico , Angiografía por Resonancia Magnética , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos XRESUMEN
We report an eight years old boy presenting with a pyogenic granuloma of the scalp, generalized alopecia, descamative plates in the neck, trunk and limbs and nail involvement. Cultures for fungus of all these lesions disclosed Microspore canis. The patient was treated with oral griseofulvin, miconazole and topical tolnaftate. Five years later and after several incomplete treatments, the patient returns with a fistulous mass of 15 x 8 cm in the dorsal area whose culture revealed Microspore canis. The mass was excised and oral ketoconazole was indicated. After three months of follow up, the patient was lost from control.
Asunto(s)
Microsporum/aislamiento & purificación , Micetoma/microbiología , Antifúngicos/uso terapéutico , Niño , Humanos , Masculino , Micetoma/tratamiento farmacológico , Micetoma/patología , Onicomicosis/microbiologíaRESUMEN
The purpose of this work was to evaluate the enhancement of different concentrations of gadolinium (Gd), ytterbium (Yb) and iodine in vitro and in vivo. Comparisons were made of the enhancement (HU) of Gd, Yb and iodine in concentrations ranging from 0.1 to 30 mg/ml. In vivo dynamic CT studies were performed in ten dogs with 0.5 M Gd, Yb and iodine. Time-density curves were achieved in aorta and liver. The in vitro studies confirmed a decrease in the enhancement in this order: Gd (120 kV) > Gd (137 kV) > Yb (120 kV) > Yb (137 kV) > iodine (120 kV) > iodine (137 kV). The specific enhancement of Gd was 40.8 (120 kV), of Yb 34.2 and of iodine 29.6 HU. The enhancement of the liver decreases from 21 HU (Gd) to 19 HU (Yb) and 12 HU (iodine). Gd and Yb achieved a higher aortal enhancement than iodine (190 vs 157 HU) All contrast media were well tolerated. Equimolar concentrations of Gd and Yb show a higher in vitro contrast and enhancement than iodine.
Asunto(s)
Medios de Contraste , Tomografía Computarizada por Rayos X , Animales , Aortografía , Perros , Gadolinio , Gadolinio DTPA , Yodo , Hígado/diagnóstico por imagen , Compuestos Organometálicos , Ácido Pentético/análogos & derivados , Fantasmas de Imagen , IterbioRESUMEN
Monostotic Paget's disease has a well known appearance in radiography. Only in exceptions is a further diagnostic procedure necessary. The value of MRI and scintigraphy is demonstrated on an osteolytic lesion of the tibia.
Asunto(s)
Imagen por Resonancia Magnética , Osteítis Deformante/diagnóstico , Osteólisis/diagnóstico , Cintigrafía , Tibia , Anciano , Diagnóstico Diferencial , Humanos , Masculino , Tibia/patologíaAsunto(s)
Medios de Contraste/administración & dosificación , Yohexol/análogos & derivados , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Velocidad del Flujo Sanguíneo/fisiología , Medios de Contraste/farmacocinética , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Yohexol/administración & dosificación , Yohexol/farmacocinética , Masculino , Persona de Mediana EdadAsunto(s)
Neoplasias Hepáticas/secundario , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Medios de Contraste , Femenino , Humanos , Hígado/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Sistemas de Información RadiológicaRESUMEN
20 patients with hepatocellular carcinomas (HCC) and 18 patients with tumours of the biliary passages and gallbladder (CAC)) were examined via angio-CT without table increment and via spiral CT. Evaluation of the time-density curve of angio-CT showed more rapid and greater enhancement in case of HCC, whereas CAC were characterised by slower and lesser contrast medium uptake than the surrounding hepatic tissue. Superior differential diagnostic information was obtained via angio-CT, whereas spiral CT yields the best information on extent and number of hepatic tumours.
Asunto(s)
Neoplasias de los Conductos Biliares/diagnóstico por imagen , Conductos Biliares Intrahepáticos/diagnóstico por imagen , Carcinoma Hepatocelular/diagnóstico por imagen , Neoplasias de la Vesícula Biliar/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Neoplasias de la Mama , Linfoma , Neoplasias Primarias Múltiples , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bleomicina/uso terapéutico , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/tratamiento farmacológico , Ciclofosfamida/uso terapéutico , Doxorrubicina/uso terapéutico , Etopósido/uso terapéutico , Femenino , Humanos , Linfoma/diagnóstico , Linfoma/tratamiento farmacológico , Imagen por Resonancia Magnética , Mamografía , Persona de Mediana Edad , Prednisona/uso terapéutico , Trasplante de Células Madre , Tomografía Computarizada por Rayos X , Vincristina/uso terapéuticoAsunto(s)
Aneurisma/complicaciones , Hidronefrosis/etiología , Hipertensión Renovascular/etiología , Arteria Renal , Aneurisma/diagnóstico , Angiografía de Substracción Digital , Enfermedad Crónica , Femenino , Humanos , Hidronefrosis/diagnóstico , Hipertensión Renovascular/diagnóstico , Persona de Mediana Edad , Arteria Renal/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
In general, renal artery aneurysms occur very rarely. This study reports on a 9-cm renal artery aneurysm which was erroneously thought to be a renal cyst, and which, as a result of depression of the renal parenchym and the ureteropelvic junction, led to arterial hypertension and consecutive, reduced function hydronephrosis.
Asunto(s)
Aneurisma/complicaciones , Hidronefrosis/etiología , Hipertensión Renovascular/etiología , Arteria Renal , Aneurisma/diagnóstico por imagen , Angiografía de Substracción Digital , Errores Diagnósticos , Femenino , Humanos , Hidronefrosis/diagnóstico por imagen , Enfermedades Renales Quísticas/diagnóstico por imagen , Persona de Mediana Edad , Arteria Renal/diagnóstico por imagen , UltrasonografíaRESUMEN
Se estudiaron 78 muestras de uñas de manos y pies de 74 pacientes con diagnóstico de onimicosis. Para la obtención de la muestra se raspó la lámina interna de la uña, excepcionalmente la lámina externa y se efectuó el examen microscópico directo ya sea en koh-20 porciento-tinta parker 51 azul permanente o con koh-20 porciento-chloroback e. Todas las muestras fueron sembradas en agar sabouraud dextrosado, agar lactrimel y agar selectivo para dermatofitos (dim) e incubadas a 28ºC por 10-15 días. De las muestras estudiadas, en el 79,5 porciento se observaron hongos al examen microscópico directo, aislándose estos en el 61,5 porciento de los cultivos. La frecuencia de agentes de onimicosis fue: c. albicans (43,75 porciento), t. rubrum (31,25 prociento) y t. mentagrophytes (10,42 porciento). C.albicans se aisló en el 70,8 porciento de las onimicosis en manos de mujeres. T.rubrum se aisló en un 50 y 25 porciento de hombres y mujeres respectivamente. En pie se aisló en el 52,9 porciento y en mano en un 19,3 porciento. S. brevicaulis fue aislado en un solo caso
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Adolescente , Adulto , Arthrodermataceae/aislamiento & purificación , Hongos/aislamiento & purificación , Onicomicosis/microbiología , Candida albicans/aislamiento & purificación , Trichophyton/aislamiento & purificación , Levaduras/aislamiento & purificaciónRESUMEN
We report six patients with Kerion Celsi due to Trichophyton verrucosum. Five of the patients were hospitalized with the diagnosis of Staphylococcal abscess. This confusion is due to that highly suppurative and inflammatory nature of the infection. Griseofulvin is the antimicrobial of choice for treatment, associated with imidazolics and corticosteroids to prevent alopecia. The authors suggest that an adequate use of simple microbiological diagnostic tests in the diagnosis of pyodermitis in rural children, may prevent unnecessary hospitalizations and permanent hair loss.
Asunto(s)
Dermatomicosis/diagnóstico , Dermatosis del Cuero Cabelludo/diagnóstico , Niño , Preescolar , Dermatomicosis/tratamiento farmacológico , Femenino , Griseofulvina/uso terapéutico , Humanos , Masculino , TrichophytonRESUMEN
Se presentan dos casos de onixis por sarcoptes scabei; el primero concomitante con síndrome de Down y el segundo en lactante. Caso 1: ácaro test positico en piel y en uña con alteraciones. Se efectúa tratamiento con vaselina azufrada al 5 por ciento por 8 meses (1 en piel y 7 en uña). El ácaro test es negativo post tratamiento. No se encontró asociación bacteriana ni micótica. Caso 2: lactante de 10 meses con ácaro test positivo en piel y uñas con alteración clínica. Portadora de un Cushing secundario por bronconeumonía y diarrea
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Infestaciones por Ácaros/complicaciones , Sarcoptes scabiei/patogenicidad , Uñas Encarnadas/complicaciones , Betametasona/efectos adversos , Betametasona/uso terapéutico , Síndrome de Down , Recuento de Huevos de Parásitos , Vaselina/uso terapéutico , Población Rural , Síndrome de Cushing/etiología , Uñas Encarnadas/diagnóstico , Uñas Encarnadas/etiología , Uñas Encarnadas/tratamiento farmacológicoRESUMEN
Se realizó estudio microbiológico de raspado uretral de 142 pacientes de sexo masculino que consultaron al policlínico de Venéreas del Hospital Base de Valdivia durante 1989, los cuales fueron enviados al Instituto de Microbiología Clínica de la Universidad Austral de Chile con diagnóstico clínico de uretritis. La prevalencia de Uretritis Gonocócicas (UG) y Uretritis no Gonocócica (UNG) fue de un 50 por ciento para ambos tipos. U. urealyticum fue aislado en el 38 por ciento de los casos de UG y en el 59.2 por ciento de las UNG. Además se evaluó la efectividad del tratamiento de las uretritis por U. urealyticum con tetraciclina en base a tres esquemas: 2g/día durante 7 días, 2 g/día durante 14 días y 2 g/dia durante 21 días. Por este motivo, se seleccionaron 59 pacientes con uretritis por U. urealyticum, obteniéndose un 57,6 por ciento de éxito en el total de los pacientes estudiados. La mayor efectividad en el tratamiento fue para el esquema de 21 días (77.8 por ciento) además a medida que aumentó la edad de los pacientes la efectividad fue disminuyendo y cuando U. urealyticum se encontró asociado a otros microorganismos se obtuvo un mayor éxito en los tratamientos
Asunto(s)
Humanos , Masculino , Adolescente , Adulto , Persona de Mediana Edad , Ureaplasma urealyticum/aislamiento & purificación , Uretritis/microbiología , Esquema de Medicación , Eritromicina/administración & dosificación , Estado Civil , Neisseria gonorrhoeae/aislamiento & purificación , Tetraciclina/administración & dosificación , Ureaplasma urealyticum/efectos de los fármacos , Ureaplasma urealyticum/patogenicidadRESUMEN
From 1985 to 1987 we obtained urethral samples from 453 patients with a clinical diagnosis of urethritis. N gonorrhoeae was isolated in 55%, a rate that increased along the study period. The most common other agent was U urealyticum alone or in combination with other organisms. Among 82 patients, the incidence of chlamydia trachomatis was 19%. The proportion of Beta-lactamase producing strains among N gonorrhoeae varied form 7% in 1985 to 13% in 87 and 3% in 1988.
Asunto(s)
Neisseria gonorrhoeae/aislamiento & purificación , Ureaplasma/aislamiento & purificación , Uretritis/microbiología , Adolescente , Adulto , Violeta de Genciana , Humanos , Masculino , Persona de Mediana Edad , FenazinasRESUMEN
The presence of Chlamydia trachomatis was studied by the direct immunofluorescence test, as also was that of Neisseria gonorrhoeae, Mycoplasma and Ureaplasma by the standard methods, in 82 patients with urethral discharge. Ch. trachomatis was found in 19.5% (16) of the cases and in 11 of them (68.8%) there was association with the other bacteria investigated. This eleven patients presented a scanty gelatinous discharge.