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BACKGROUND: Renal graft injury is a challenging condition that can endanger function or become a life-threatening event. Although the most common cause of renal graft injury is trauma, some cases of injuries associated with surgical procedures have been described. Here, we present a case of a transplant patient who experienced a grade IV renal graft injury after an open oophorectomy. CLINICAL CASE: A 31-year-old woman received a renal transplant from a cadaveric donor. During her follow-up, a multilocular cyst with a solid mural nodule tumor of the left ovary was documented, with an 84% risk for malignancy as determined by the International Ovarian Tumour Analysis score. Therefore, an open unilateral (left) oophorectomy was scheduled. RESULTS: The patient was readmitted 2 days after surgery and was hemodynamically stable despite intense pain in the right iliac fossa, sudden creatinine elevation, and hematuria. Tomography revealed a peri-graft hematoma with a mass effect. An exploratory laparotomy was performed, and 2 lacerations with an exposed collecting system and without urinary leakage were identified. These were repaired with absorbable barbed sutures reinforced with Teflon patches on the edges, with cellulose hemostatic mesh and fibrin adhesive on top of these patches. In the postoperative period, creatinine decreased to its baseline levels, but a urinary leak was noted, which was corrected by ureteral stent placement. CONCLUSION: The management of renal graft trauma requires closer monitoring and stricter criteria for reaching a definitive therapeutic decision to prevent the deterioration of the graft and the patient.
Assuntos
Transplante de Rim , Rim , Humanos , Feminino , Adulto , Creatinina , Rim/cirurgia , Transplante de Rim/efeitos adversosRESUMO
Resumen El desmembramiento del territorio de Quintana Roo, y su restablecimiento durante el gobierno cardenista establecieron las bases para que Payo Obispo iniciara su desarrollo como ciudad y capital del territorio; al mismo tiempo cambió su nombre por el de Chetumal. La destrucción de la ciudad ocasionada por el paso del huracán Janet, dio la oportunidad para reconstruir la ciudad y establecer las instituciones de salud actuales. En esta segunda parte, expondremos las contribuciones de la medicina militar a la capital de Quintana Roo en la segunda mitad del siglo XX y principios del siglo XXI.
Abstract The partition of the Territory of Quintana Roo, and its reestablishment during the government of the president Cardenas established the bases for Payo Obispo`s city to begin its development as a capital of the territory; at the same time it was renaimed as Chetumal. The destruction of the city caused by the passage of Hurricane Janet, gave the opportunity to rebuild the city and establish the current health institutions. In this second part, we will expose the contributions of military medicine to the capital of Quintana Roo, in the second half of the 20th century and the beginning of the 21st century.
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Resumen La ciudad de Payo Obispo (hoy Chetumal) fue fundada en 1898, como punto estratégico militar y político para limitar el tráfico de armas y el comercio ilegal en la frontera con Belice. Las condiciones insalubres y sus limitadas vías de comunicación favorecieron la aparición de problemas serios de salud pública, como los brotes de enfermedades tropicales. En este trabajo abordaremos la participación de los médicos militares que se establecieron en Payo Obispo, durante la primera mitad del siglo XX, y cuyas contribuciones sentaron las bases del actual sistema de salud del estado de Quintana Roo.
Abstract The city of Payo Obispo (currently called Chetumal) was founded in 1898 as a strategic military and political point to limit arms trafficking and illegal trade on the border with Belize. The unhealthy conditions and limited communication routes favored the appearance of serious public health problems, such as outbreaks of tropical diseases. In this paper we will address the participation of the military doctors who settled in Payo Obispo, during the first half of the 20th century, and whose contributions laid the foundations of the current health system in Quintana Roo.
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BACKGROUND: Maternal morbidity and mortality pose a significant impact on national public health, being medical attention of obstetric emergencies (OE) and non-emergencies (ONE) of capital importance. METHODS: Descriptive and epidemiologic analysis of OE/ONE at a 3rd level military echelon. RESULTS: During a 34-months span, 48 patients were approached at the emergency department (1.4 admissions/month). Mean age: 29 ± 3 years (17-41). Eight patients (17%) were considered OE and 40 (83%) ONE. Fifty-eight percent (n = 28) of patients were admitted to our institution; 32% (n = 9) were managed under non-surgically basis and 68% (n = 19) underwent surgical therapy. Most important cause of admission: postoperative hemorrhage (22%; n = 6). Most frequent operative interventions: surgical hemostasis maneuvers (31.5%; n = 6). Eighty-two percent (n = 23) of admissions required management at intensive care unit (ICU), with mean length of stay of 6.4 ± 4.9 days (2-21). Thirty-five percent (n = 8) required mechanical ventilation. Mean score of APACHE II at ICU: 19.4 ± 8.4; predicted probability of death: 35.5%. Global morbidity rate: 27% (1.8 complications/patient). Global mortality rate: 6.2%; specific mortality for pregnant patients 0% (n = 0) and for post-partum patients12.5% (n = 3). Mortality rate at ICU: 4.3% (n = 1). CONCLUSIONS: Central Military Hospital has delineated and defined several procedures to decrease maternal morbidity and mortality. Appropriate practice of these procedures contributes to reach the desired institutional objectives.
INTRODUCCIÓN: La morbimortalidad materna posee un significativo impacto en la salud pública nacional, siendo la atención médica de las emergencias obstétricas (EO) y urgencias obstétricas (UO) de capital importancia. MÉTODO: Análisis descriptivo y epidemiológico de EO/UO en un escalón militar de tercer nivel. RESULTADOS: Durante 34 meses se abordaron en el departamento de urgencias 48 pacientes (1.4 admisiones/mes). La edad media fue de 29 ± 3 años (rango: 17-41). Ocho pacientes (17%) se consideraron EO y 40 (83%) UO. El 58% (n = 28) de las pacientes se admitieron a la institución; el 32% (n = 9) se manejaron médicamente y el 68% (n = 19) con tratamiento quirúrgico. La causa más importante de admisión fue la hemorragia posoperatoria (22%; n = 6). Las intervenciones quirúrgicas más frecuentes fueron maniobras de hemostasia quirúrgica (31.5%; n = 6). El 82% (n = 23) de las admisiones requirieron manejo en la unidad de medicina intensiva (UMI), con una estancia media de 6.4 ± 4.9 días (rango: 2-21). El 35% (n = 8) requirieron ventilación mecánica. La puntuación media APACHE II en la UMI fue de 19.4 ± 8.4, y la probabilidad predicha de muerte fue del 35.5%. La tasa global de morbilidad fue del 27% (1.8 complicaciones/paciente). La tasa de mortalidad global fue del 6.2%; la mortalidad específica para pacientes embarazadas del 0% (n = 0) y para pacientes puérperas del 12.5% (n = 3). La tasa de mortalidad en la UMI fue del 4.3% (n = 1). CONCLUSIONES: El Hospital Central Militar ha delineado y definido diversos procedimientos para abatir la morbimortalidad maternas. La correcta práctica de estos procedimientos contribuirá a alcanzar los objetivos institucionales deseados.