Extravasación intraabdominal de líquido posterior a artroscopía de cadera: Reporte de un caso / Intraabdominal fluid extravasation after hip arthroscopy: Case report

Intraabdominal fluid extravasation (IAFE) is a rare complication of hip arthroscopy which has a wide range of clinical presentations, from mild abdominal distention to abdominal compartment syndrome and cardiorespiratory arrest. There are few detailed reports of cases in literature, therefore, considering risk factors, high pathological suspicion and training in ultrasound are key points to prevent complications and health costs. In this report, the case of a 29 year old male patient with severe abdominal pain during the immediate postoperative period of an arthroscopic hip surgery is presented, which led to a review of the literature on the subject.

La extravasación intraabdominal de líquido es una complicación poco frecuente de la artroscopia de cadera que presenta un amplio rango de manifestaciones clínicas, desde leve distensión abdominal hasta síndrome compartimental y paro cardiorrespiratorio. Hay escasos reportes de casos en la literatura, por lo que la alta sospecha considerando factores de riesgo y el ultrasonido son claves para prevenir sus complicaciones y costos asociados. En este reporte, se presenta el caso de un paciente masculino de 29 años con dolor abdominal intenso durante el postoperatorio inmediato de una artroscopia de cadera, lo que llevó a una revisión de la literatura sobre el tema.

Convalidación del título de Medicina Intensiva en el Reino Unido / Validation of Intensive Medicine Degree in the United Kingdom

La especialidad de Medicina Intensiva vía MIR se estableció en España hace más de 20 años. La Unión Europea permite la libre circulación de trabajadores y el reconocimiento multilateral de sus estudios universitarios de posgrado. Desgraciadamente, eso no ocurre en nuestra especialidad, hecho que dificulta el ejercicio de este derecho europeo y la movilidad de los intensivistas formados en nuestro país. El objetivo de este artículo es ofrecer una guía práctica de cómo convalidar el título de especialista en Medicina Intensiva en el Reino Unido. Esta revisión ha sido realizada por varios intensivistas españoles con amplia experiencia laboral en Reino Unido (AU)

The speciality of Intensive Care Medicine was established over twenty years ago in Spain as part of the MIR (Resident training) system. The European Union allows for free circulation of its workers and the multilateral recognition of their university degrees as well as their postgraduate training. Unfortunately, our speciality is excluded from such a privilege. This limits our European rights and hinders the mobility of the intensivists trained in our country. The main objective of this article is to provide a practical guide on how to obtain recognition of the Spanish Certificate of Training (MIR system) in Intensive Care Medicine in the United Kingdom (UK). This review has been done by several Spanish intensivists with vast professional experience in the UK (AU)

[Validation of intensive medicine degree in the United Kingdom]. / Convalidación del título de Medicina Intensiva en el Reino Unido.

The specialty of Intensive Care Medicine was established over twenty years ago in Spain as part of the MIR (Resident training) system. The European Union allows for free circulation of its workers and the multilateral recognition of their university degrees as well as their postgraduate training. Unfortunately, our specialty is excluded from such a privilege. This limits our European rights and hinders the mobility of the intensivists trained in our country. The main objective of this article is to provide a practical guide on how to obtain recognition of the Spanish Certificate of Training (MIR system) in Intensive Care Medicine in the United Kingdom (UK). This review has been done by several Spanish intensivists with vast professional experience in the UK.

Cohort study of an outbreak of viral gastroenteritis in a nursing home for elderly, Majorca, Spain, February 2008.

An outbreak of acute gastroenteritis occurred in a nursing home for elderly in Majorca between 4 and 23 February 2008. To know its aetiology and mechanism of transmission a retrospective cohort study was conducted with a fixed cohort including 146 people (96 residents and 50 employees). The data were collected from clinical histories and through a survey by questionnaire. In total 71 cases were identified (53 residents, 18 employees), corresponding to an overall attack rate (AR) of 48.6%.

Neuralgia supraorbitaria: una alternativa intervencionista / Supraorbital neuralgia: an interventionist alternative

No disponible

Fibromialgia: diagnóstico y tratamiento. El estado de la cuestión / Fibromyalgia: diagnosis and treatment. Current knowledge

La fibromialgia es una patología crónica y compleja que provoca dolor muscular generalizado que puede llegar a ser invalidante, asociado a mal descanso nocturno y fatigabilidad, y que afecta a las esferas biológica, psicológica y social de los pacientes. Además su elevada prevalencia hace de ella un problema sanitario de primera magnitud. Dificultad añadida supone el que sus criterios diagnósticos únicamente sean clínicos y que su etiopatogenia todavía no haya sido aclarada, lo que dificulta aún más su estudio y por supuesto su abordaje terapéutico. En su tratamiento resulta fundamental el abordaje multidisciplinar en contraposición a un abordaje biomédico tradicional, dada la enorme complejidad que suelen presentar estos pacientes. En esta revisión intentamos aunar los conocimientos actuales en la literatura médica aunque hay que resaltar que diariamente multitud de estudios y referencias médicas y paramédicas abordan el tema con mayor o menor rigor científico (AU)

Diez años de investigación en la Revista de la Sociedad Española del Dolor: análisis de los grupos de trabajo / Ten years of research in the Revista de la Sociedad Española del Dolor: analysis of working groups

Introducción: El desarrollo de la ciencia depende de dos dimensiones que interactúan entre sí, el desarrollo de ideas, y la interacción social de quienes las desarrollan. Muchas son las investigaciones que analizan la primera dimensión, pero son limitados los estudios que abordan la segunda. En el ámbito del estudio del dolor estos estudios son inexistentes. Coincidiendo con el décimo aniversario de la Revista de la Sociedad Española del Dolor, nuestro objetivo es analizar las relaciones de los grupos de trabajo que aparecen durante ese periodo en la mencionada revista, realizando un análisis cuantitativo de los autores que firman los trabajos en ella publicados entre 1994 y 2003.Material y método: Se han analizado los artículos de revisión, originales, notas clínicas, colaboraciones especiales, casos clínicos y los artículos incluidos en formación continuada de la Revista de la Sociedad Española del Dolor entre 1994 y 2003, realizándose un análisis cuantitativo de los firmantes y de los artículos en el periodo estudiado y de los grupos de trabajo y los colegios invisibles. Resultados y conclusiones: Son 520 trabajos los incluidos en nuestro estudio, firmados por un total de 1172 autores. La media de firmas por artículo es de 3,5. Analizando las relaciones entre los autores surgen 5 colegios invisibles que publican en el periodo estudiado más de 10 artículos. Más del 75 por ciento de los autores son considerados transeúntes ya que sólo firman un único artículo en el periodo mencionado. Se analizan y discuten los resultados (AU)

Prevalence of Helicobacter pylori infection in 190 control subjects and in 236 patients with gastroesophageal reflux, erosive esophagitis or Barrett's esophagus.

A prospective study was performed in 190 control subjects and in 236 patients with different degrees of endoscopic esophagitis in order to determine the prevalence of Helicobacter pylori infection at duodenal gastric and esophageal mucosa and its correlation with histological findings. All patients with pathologic gastroesophageal reflux had 24-h pH monitoring studies confirming the presence of acid reflux into the esophagus. Besides the endoscopic findings, biopsies were taken from the duodenal bulb, gastric antrum, gastric fundus and distal esophagus or at the specialized columnar epithelium in patients with Barrett's esophagus. Patients with pathological gastroesophageal reflux were divided into three groups: 55 with absence of endoscopic esophagitis (gastroesophageal reflux), 81 patients with erosive esophagitis and 100 patients with Barrett's esophagus. There was no H. pylori infection present at duodenal or esophageal mucosa or at the specialized columnar epithelium of the distal esophagus in any case. The prevalence of H. pylori infection at gastric antrum was similar in controls and in any group of patients with reflux disease (20-25% of H. pylori infection). No differences in age and sex distribution were seen. H. pylori infection at gastric fundus was very low (less than 5%). The presence of HP infections was correlated with the finding of chronic active superficial or athrophic gastritis while, in the absence of H. pylori infection, gastric mucosa was normal. In the presence of intestinal metaplasia, no H. pylori infection occurred. Based on these findings, it seems that there is no significant evidence for an important pathogenic role for H. pylori infection in the development of pathologic chronic gastroesophageal reflux, erosive esophagitis or Barrett's esophagus, and the presence of antral gastritis in patients with Barrett's esophagus is closely related to the presence of H. pylori infection, and probably not related to an increased duodenogastric reflux.

[Pneumonia caused by Pneumocystis carinii in immunodepressed patients: clinical picture, treatment, and prognosis]. / Neumonia por Pneumocystis carinii en inmunodeprimidos: cuadro, clínico, tratamiento y pronostico.

Pneumocystis carinii pneumonia is frequent in patients with cellular immunity impairments, specially those with AIDS. We communicate our experience in 20 patients (15 with AIDS) with Pneumocystis carinii pneumonia confirmed by the finding of trophozoites or cysts. Clinical manifestations were cough in 75% of cases, dyspnea in 70% and fever in 65%. Eighty five percent of cases had diffuse reticular and nodular radiological densities. Nineteen patients had an increased alveolar-arterial O2 gradient. Nineteen patients were treated with trimethropim-sulphamethoxazole (TMP-SMX) and 4 with pentamidine isethionate (1 due to previous allergy and 3 due to poor response to TMP-SMX). Three patients died during the acute episode. Of the survivors, 13 died within 2 to 44 months later (14.5 +/- 12 months). It is concluded that AIDS is the most frequent underlying condition in patients with Pneumocysts carinii pneumonia and that long term survival is low.

[The bradycardia-tachycardia syndrome]. / El sindrome de bradicardia-taquicardia

Disorders of the heart rhythm which consist basically of sinus bradicardia or sinus arrest correspond to a syndrome which has been named the sick sinus syndrome. Within the framework of this syndrome, there is a subgroup of alternating atrial bradycardia with episodes of atrial tachyarrhythmia. Generally known as the bradycardia-tachycardia syndrome, this subgroup is both electrophysiologically interesting and therapeutically challenging. This report is concerned with the experience obtained at the emergency ward and coronary care unit of the Instituto Nacional de Cardiología de México on the diagnosis and management of 8 patients with this syndrome. Various underlying heart conditions were present with predominance of ischemic heart disease. The clinical picture was dependent upon the hypoperfusion of vital organs secondary to the cardial arrhythmia. The most common symptoms were derived from cerebral circulatory deficit and coronary insufficiency. Half of the patients had moderate cardiac failure. All patients had spontaneous and transient loss of sinus function which lasted more than 2,000 msec. in seven. The bradycardia had a rate below 50 beats per minute in all cases except one. The tachyarrhythmias observed were atrial flutter, atrial fibrillation and paroxysmal supraventricular tachycardia. Three of the patients had more than one of these these tachyarrhythmias during the period of study. A discussion is made on the diagnosis of this syndrome by means of atrial pacing and interventions which modify either vagal or sympathetic tone. Considerations are also made on the frequent associated abnormality of the A-V functional tissues. Emphasis is placed on the problems encountered in the management of these patients. It is concluded that, in most cases, a satisfactory result may be obtained by the implantation of a permanent demand pacemaker associated to the administration of antiarrhythmic drugs.