Traumatismo abdominal como causa de muerte en el maltrato infantil: descripción de un caso / Abdominal traumatism as cause of death in child abuse: report of a case

Presentamos un caso de muerte en un niño de de 11 meses de edad, que ingresó cadáver en el servicio de urgencias de su hospital de referencia, con lesiones traumáticas en cabeza y abdomen, poniéndose el caso en conocimiento del juzgado de guardia. Durante la autopsia médico-legal, se apreció la existencia de excoriaciones lineales en mejilla izquierda, equimosis periorbitaria izquierda, así como en zona mandibular derecha; llamando especialmente la atención la presencia de múltiples equimosis redondeadas y ovaladas de entre 0.3 y 2 cm de diámetro ubicadas en el tronco, fundamentalmente en la zona abdominal. El examen interno evidenció un hemoperitoneo con desgarros en diferentes serosas y mesos, con importante infiltrado hemorrágico a nivel de retroperitoneo y zona mesentérica. Se concluyó que se trataba de una muerte violenta de etiología médico-legal homicida, siendo su causa inmediata una hemorragia intraabdominal y su causa fundamental el traumatismo abdominal múltiple por compresión. Existe plena coincidencia entre el cuadro descrito y el referenciado en la bibliografía revisada, relativo a lesiones abdominales por maltrato infantil (AU)

We present the case of the death of an 11 months old child, who was dead on arrival at the Accident and Emergency Service of his local hospital. He had traumatic wounds to the head and abdomen. The case was brought to the attention of the judge on duty. During the medico-legal autopsy, lineal excoriations were noted on the left cheek, and left periorbital ecchymosis, as well as ecchymosis of the right mandibular area. The presence of multiple round and oval ecchymoses of between 0.3 and 2 cm on the trunk, principally in the abdominal area, was particularly noticeable. The internal examination found a hemoperitoneum with tears in different serous and mesothelial membranes, with significant haemorrhagic infiltration at a retroperitoneal level and in the mesenteric area. It was concluded that it was a case of violent death caused, in medico-legal aetiology, by homicide. The immediate cause of death was an intra-abdominal haemorrhage and its fundamental cause was multiple abdominal traumas through compression. The situation described fully matches that found in the bibliography reviewed concerning abdominal wounds caused by child abuse (AU)

Reduction in injury rates in nursing personnel through introduction of mechanical lifts in the workplace.

BACKGROUND: Health care workers incur frequent injuries resulting from patient transfer and handling tasks. Few studies have evaluated the effectiveness of mechanical lifts in preventing injuries and time loss due to these injuries. METHODS: We examined injury and lost workday rates before and after the introduction of mechanical lifts in acute care hospitals and long-term care (LTC) facilities, and surveyed workers regarding lift use. RESULTS: The post-intervention period showed decreased rates of musculoskeletal injuries (RR = 0.82, 95% CI: 0.68-1.00), lost workday injuries (RR = 0.56, 95% CI: 0.41-0.78), and total lost days due to injury (RR = 0.42). Larger reductions were seen in LTC facilities than in hospitals. Self-reported frequency of lift use by registered nurses and by nursing aides were higher in the LTC facilities than in acute care hospitals. Observed reductions in injury and lost day injury rates were greater on nursing units that reported greater use of the lifts. CONCLUSIONS: Implementation of patient lifts can be effective in reducing occupational musculoskeletal injuries to nursing personnel in both LTC and acute care settings. Strategies to facilitate greater use of mechanical lifting devices should be explored, as further reductions in injuries may be possible with increased use.

Paucicellular variant of anaplastic thyroid carcinoma: report of two cases.

The paucicellular variant of anaplastic carcinoma is an infrequent type of thyroid tumor. It was described as a tumor characterized by very low cellularity and prominent fibrosis, probably secondary to extensive infarction. These features could lead to an erroneous diagnosis of Riedel's thyroiditis. In this paper, we report the clinical and pathological features of two new cases of this unusual entity. Tumor cells were negative for thyroglobulin immunostaining and positive for keratins and p53. Although the number of reported cases is small, the cumulative data on these two cases and the previously reported ones lead us to suggest that the paucicellular variant may occur in younger patients than the conventional anaplastic thyroid carcinoma and that the tumor may be associated with a less aggressive tendency to local progression and metastasis.

Injury in laparoscopic surgery.

A prospective study was made to evaluate injury caused by laparoscopic surgery, in terms of physiological response. Two groups of patients were established: Group 1 (laparoscopic surgery, n = 26) and Group 2 (open surgery, n = 18). The groups were homogeneous in terms of age, sex, body mass index (BMI), duration of surgery, and anesthetic technique. Both groups exhibited significant postoperative increases in plasma adrenocorticotropic hormone (ACTH), growth hormone (GH), insulin, and cortisol (p < 0.05), with a significant decrease in follicle-stimulating hormone (FSH) and T3 (p < 0.05). Significant increases were noted in 24-h urine cortisol and catecholamine levels in Group 2 (p < 0.05). No correlation was noted between the duration of surgery and the intensity of neuroendocrine response. Acute-phase postoperative metabolic response was greater in Group 2 and was correlated to the duration of surgery. No postoperative hydrosaline or acid-base alterations were recorded in either group. Injury was graded in terms of neuroendocrine and metabolic response and proved highest in Group 2. Complex laparoscopic surgery (e.g., sigmoid colon and esophageal hiatus) exhibited the least neuroendocrine response, whereas laparoscopic inguinal hernioplasty involved the least metabolic response. To conclude, laparoscopic surgery globally involves less neuroendocrine and metabolic response than does open surgery.

[Food poisoning outbreak probably of viral etiology caused by Norwalk virus]. / Brote de toxiinfección alimentaria de probable etiología vírica por virus Norwalk.

In May 1989, a foodborne outbreak of acute gastroenteritis was identified in a state school in Adzaneta, Castellón. A dtudy was undertaken to describe it, investigate its causes, and recommend adequate control measures. Sixteen children and 2 teachers were affected (attack rate: 28.57%). Kaplan and cols clinical and epidemiological criteria for Norwalk-like virus as the responsible agent were present. The probable origin of the outbreak was a foodhandler who was already ill beforehand. The examination of stools of the foodhandler and a patient showed small round structures similar to the Norwalk virus. In Spain, the number of foodborne outbreaks without known causal agent has steadily increased in recent years. It may be that this microorganism is responsible for some of these outbreaks in which, for several reasons, the causal agent cannot be identified.

[A case of succinylcholine apnea. Identification of genetic variants]. / A propos d'un cas d'apnée succinylcholinique. Identification des variants génétiques.

A report of a case of prolonged apnoea after succicurarium in a female patient with abnormal pseudo-cholinesterases is followed by a presentation of a study of pseudo-cholinesterases in 12 members of the family. The value of the use of 4 tests of inhibition of cholinesterase activity in determining the genotype of an individual is emphasised.