Secuestro pulmonar: a propósito de un caso / Pulmonary sequestration: a case report

Resumen Introducción El secuestro pulmonar es un segmento anormal de tejido pulmonar sin comunicación con el árbol traqueobronquial e irrigado por una arteria aberrante de origen sistémico. El secuestro pulmonar puede ser intralobar o extralobar. Caso Clínico Presentamos el caso de un neonato con dificultad respiratoria debido a secuestro pulmonar. El tratamiento quirúrgico consiste en la resección del segmento pulmonar con la ligadura y corte de su arteria. Se describe el manejo realizado y la revisión de la literatura indexada.

Introduction Pulmonary sequestration is an abnormal segment of lung tissue without communication with the tracheobronchial tree and irrigated by an aberrant artery of systemic origin. Can be intralobar or extralobar. Case report We present the case of a neonate with respiratory distress due to pulmonary sequestration. Surgical treatment consists in the resection of the lung segment with the ligature and cut of its artery. Is describe the management carried out and the review of the indexed literature.

[Parents separation or divorce. Potential effects on children and recommendations to parents and pediatricians]. / Separación o divorcio de los padres. Consecuencias en los hijos y recomendaciones a los padres y pediatras.

When divorce or separation of a couple occurs, children will no longer live with both parents at the same time. There may be multiple causes for divorce, and both literature and our own experien ce as child mental health providers, report some short- and long-term consequences for children, especially where the divorce has been conflictive. In these cases, increased risk of developing be havioral disorders, poor school performance, and substance abuse has been documented as well as consequences in adult life with higher risk of psychiatric pathologies or difficulties in interpersonal relationships, if an intervention that addresses some potentially traumatic situations for children is not done. Pediatricians are in a privileged relationship with children and their families in order to detect signs of parental discord and altered mental health in children. Children behaviors as a result of divorce and parental conflict will depend on the age of the child and stage of development, and it is important to recognize them in order to intervene properly. This article proposes some guidelines for parents. Good management of high conflict situations related to divorce may prevent some of the consequences that these can have on children.

Separación o divorcio de los padres: consecuencias en los hijos y recomendaciones a los padres y pediatras / Parents separation or divorce: potential effects on children and recommendations to parents and pediatricians

El divorcio o separación de una pareja con hijos pone fin a la convivencia de ambos padres en con junto con sus hijos. Puede haber múltiples causas para un divorcio y tanto la literatura como la ex periencia de los autores trabajando con familias en esta situación, dan cuenta de algunas consecuen cias a corto y largo plazo para los niños, especialmente en aquellos casos en que el divorcio ha sido conflictivo. En estos casos, se ha observado mayor riesgo de presentar trastornos de conducta, bajo rendimiento escolar y abuso de sustancias. Por otra parte puede tener consecuencias en la vida adulta, presentando mayor riesgo de patologías psiquiátricas o dificultades en las relaciones interpersonales si no se realiza una intervención que aborde algunas situaciones potencialmente traumáticas para los niños. Los pediatras se encuentran en una relación privilegiada con respecto a los niños y sus familias para detectar signos de discordia parental y alteración de la salud mental infantil. Las conductas que se manifiesten en los niños a consecuencia del divorcio y el conflicto parental van a depender de la edad y etapa de desarrollo del niño, siendo importante reconocerlas para poder intervenir de forma adecuada. El presente artículo propone directrices para guiar a los padres, ya que con un adecuado manejo de las situaciones de conflicto que ocurren alrededor del divorcio es posible prevenir algunas de las consecuencias que éste puede tener en los hijos.

When divorce or separation of a couple occurs, children will no longer live with both parents at the same time. There may be multiple causes for divorce, and both literature and our own experien ce as child mental health providers, report some short- and long-term consequences for children, especially where the divorce has been conflictive. In these cases, increased risk of developing be havioral disorders, poor school performance, and substance abuse has been documented as well as consequences in adult life with higher risk of psychiatric pathologies or difficulties in interpersonal relationships, if an intervention that addresses some potentially traumatic situations for children is not done. Pediatricians are in a privileged relationship with children and their families in order to detect signs of parental discord and altered mental health in children. Children behaviors as a result of divorce and parental conflict will depend on the age of the child and stage of development, and it is important to recognize them in order to intervene properly. This article proposes some guidelines for parents. Good management of high conflict situations related to divorce may prevent some of the consequences that these can have on children.

The International Mood Network (IMN) Nosology Project: differentiating borderline personality from bipolar illness.

OBJECTIVE: The differential diagnosis of bipolar illness vs. borderline personality is controversial. Both conditions manifest impulsive behavior, unstable interpersonal relationships, and mood symptoms. This study examines whether and which mood clinical features can differentiate between both conditions. METHOD: A total of 260 patients (mean ± standard deviation age 41 ± 13 years, 68% female) attending to a mood clinic were examined for diagnosis of bipolar illness and borderline personality disorder using SCID-I, SCID-II, and clinical mood criteria extracted from Mood Disorder Questionnaire (MDQ). They were analyzed using diagnoses as dependent variables. Predictors of bipolar and borderline diagnoses were identified by multivariable logistic regressions, and predictive validity of models was assessed using ROC curve analysis. RESULTS: Bipolar illness was strongly predicted by elevated mood (OR = 4.02, 95% CI: 1.80-9.15), increased goal-directed activities (OR = 3.90, 95% CI: 1.73-8.96), and episodicity of mood symptoms (OR = 3.48, 95% CI 1.49-8.39). This triad model predicted bipolar illness with 88.7% sensitivity, 81.4% specificity, and obtained an auROC of 0.91 (95% CI: 0.76-0.96) and a positive predictive value of 85.1%. For borderline personality disorder, only female gender was a statistically significant predictor (OR = 3.41, 95% CI: 1.29-13.7), and the predictive model obtained an auROC of 0.67 (95% CI: 0.53-0.74). CONCLUSION: In a mood disorder clinic setting, manic criteria and episodic mood course distinguished bipolar illness from borderline personality disorder.

Manejo de obstrucción de vía lagrimal en niños mediante intubación con sonda Monoka®: experiencia inicial en HCUCh / Management of lacrimal duct obstruction in children by intubation with Monoka®: initial experience at HCUCh

Introducción: La obstrucción congénita del ducto nasolacrimal (DNL) es motivo de consulta frecuente en menores de un año. Se encuentra en 6% de los recién nacidos, la mayoría de las veces secundario a la persistencia de una membrana mucosa en la porción distal del DNL (membrana de Hassner). Generalmente se presenta como epífora patológica, es decir, presente después del 3º mes de vida. Esta obstrucción puede evolucionar con resolución espontánea los primeros 12 meses de vida, requerir terapias complementarias o resolución quirúrgica. Objetivo: Analizar los casos de obstrucción de la vía lagrimal en población pediátrica usando sonda Monoka® en pacientes intervenidos en el Hospital Clínico de la Universidad de Chile, que consultaron por epifora; verificando tasas de éxito, complicaciones del procedimiento y seguimiento. Material y método: Se realizó un estudio descriptivo retrospectivo, incluyendo todos aquellos pacientes con diagnóstico de obstrucción de vía lagrimal, mayores de 24 meses de edad, que consultaron en el HCUCh entre julio 2012 y marzo 2014, que requiriesen resolución quirúrgica de su cuadro. Se realizó instalación de sonda Monoka® con la participación conjunta de oftalmología y otorrinolaringología. Resultados: Se reunieron 7 pacientes, obteniendo éxito de 85,7% (6) y 100% de mejoría respecto a los síntomas iniciales. Un paciente presentó una complicación intraoperatoria, definida como un sondeo frustro. La sonda permaneció instalada un promedio de 7,7 meses y fue retirada sin complicaciones. Conclusión: La instalación de sonda Monoka® como procedimiento quirúrgico destinado a la resolución de la obstrucción de vía lagrimal es una técnica sencilla, de fácil acceso, moderado costo y que constituye una solución exitosa para aquellos pacientes afectados. Presenta excelentes resultados a mediano plazo, sin recidiva de la obstrucción de la vía lagrimal y con baja tasa de complicaciones. Es una técnica exitosa que, luego de esta experiencia, podría ser considerada de primera línea en nuestro hospital para aquellos pacientes con diagnóstico de epífora patológica, mayores de 24 meses.

Introduction: Congenital nasolacrimal duct obstruction (DNL) is frequent complaint in under a year. It is found in 6% of infants, the most often secondary to the persistence of a mucous membrane in the distal portion of the nasolacrimal duct (Hassner membrane). It usually occurs as pathological epifora present after the 3rd month of life. This obstruction can evolve spontaneously resolved the first 12 months of life, require complementary therapies or surgical treatment. Aim: To analyze where we have used the Monoka® probe in pediatric population operated in the Clinical Hospital of the University of Chile, who consulted for pathological epiphora; verifying success rates, procedure complications and monitoring. Material and method: A retrospective descriptive study, which were included all patients with the diagnosis of pathological epiphora over 12 months old, who consulted in the HCUCH between July 2012 and March 2014, that required surgical resolution of their condition. Monocanalicular installation silicone catheter was used with the joint participation of ophthalmology and otorhinolaryngology. Results: We had a total of 7 patients with a success rate of 85.7% (6) and 100% improvement over the initial symptoms. Only one patient presented an intraoperative complication, defined as failed intubation. The probe remained installed an average of 7.7 months and was removed without complications. Conclusions: The installation of Monoka® probe as surgical intervention to resolve the pathological epiphora is a simple, easily accessible and amoderate cost procedure. It's a successful solution for those patients affected. It has excellent mid-term results, no recurrence of obstruction of DNL and low complication rate. It is a successful technique that would be considered frontline in our hospital for patients diagnosed with pathological epiphora over 12 months old.

Fisioterapia para el manejo del edema posterior a una fractura de radio distal. Revisión sistemática / Physiotherapy for management of edema after a distal radius fracture. A systematic review

Objetivo: Determinar si existe evidencia científica que avale la efectividad clínica de las diferentes modalidades fisioterapéuticas utilizadas para el manejo del edema secundario a una fractura de radio distal. Estrategia de búsqueda: Se incluyeron en la búsqueda estudios clínicos aleatorizados. Las bases de datos usadas fueron: Medline, PEDro, Lilacs, Central, Cinahl y SPORTDiscus. Selección de estudios: Se seleccionaron 6 artículos que cumplían con nuestros criterios de elegibilidad. Síntesis de resultados. Dos estudios muestran disminución significativa a corto plazo (p < 0,05) adicionando drenaje manual linfático al tratamiento convencional. Conclusión: Existe moderada evidencia a corto plazo de que la movilización manual y la hidroterapia no son más efectivas que un tratamiento estándar, y adicionar drenaje manual linfático a un tratamiento convencional produce una disminución significativa del edema en pacientes con fractura de radio distal

Aim: To determine whether there is scientific evidence supporting the clinical effectiveness of different physiotherapy modalities used for the management of edema secondary to distal radius fracture. Search strategy. Randomized clinical trials were included, using the databases: Medline, PEDro, Lilacs, Central, Cinahl and SPORTDiscus. Study selection: Six studies fulfilling our eligibility criteria were selected. Summary of results: Two studies showed significant short-term decrease when manual lymphatic drainage was added to the conventional treatment (P < .05). Conclusion: There is moderate short term evidence that manual edema mobilization and whirlpool hydrotherapy are not more effective than standard treatment. There is also moderate evidence that adding manual lymph drainage to a conventional treatment produces a significant decrease in edema in patients with distal radius fracture

[Generic drugs: good or bad? Physician's knowledge of generic drugs and prescribing habits]. / Genéricos: ¿buenos o malos? Conocimientos y actitudes de los médicos ante los medicamentos genéricos.

In this article we analyze the responses of 1220 Spanish physicians who participated in a survery about generic drugs. A previously validated questionnaire was sent to physicians through the Spanish Medical Councils of the different provinces. Four items were analyzed: what doctors know about generic drugs (knowledge); physicians' prescribing habits concerning these drugs (attitude and professional competence); how prescription of generic drugs effects pharmaceutical costs amd, finally, what doctors believe a generic drug should be. The influence of physician-related variables (age, type of contract, specialty, workload, etc.) on prescribing of generic drugs was also analyzed. In view of the results, we believe that to rationalize expenditure through and appropriate policy on generic drugs Spanish health authorities should offer more and better training and information (clear and independent) about what generic drugs are.

Genéricos: ¿buenos o malos? Conocimientos y actitudesde los médicos ante los medicamentos genéricos / Generic drugs: good or bad? Physician's knowledge of generic drugs and prescribing habits

En este artículo se analizan y exploran las respuestas de 1.220 médicos españoles que respondieron a una encuesta sobre medicamentos genéricos enviada a través de los colegios oficiales de médicos provinciales. A partir de los datos de la encuesta, que fue previamente validada, se obtuvieron 4 factores analizados: qué saben los médicos sobre los medicamentos genéricos (conocimiento); cómo se comportan ante la prescripción de estos medicamentos (actitudes y competencia profesional); cómo influirá las prescripción de estos medicamentos en el control del gasto farmacéutico y, finalmente, qué piensan los médicos sobre lo que debe ser un medicamento genérico. También se ha analizado qué factores o variables del médico (edad, tipo de contrato, especialidad, presión asistencial, etc.) influyen en esta opiniones y en qué sentido. En vista de los resultados obtenidos, creemos que la primera medida que habría que adoptar por parte de las autoridades sanitarias de nuestro país, si se quiere racionalizar el gasto mediante una buena política de medicamentos genéricos, será la de ofrecer más y mejor formación e información (clara e independiente) de lo que son las especialidades farmacéuticas genéricas (AU)

In this article we analyze the responses of 1220 Spanish physicians who participated in a survery about generic drugs. A previously validated questionnaire was sent to physicians through the Spanish Medical Councils of the different provinces. Four items were analyzed: what doctors know about generic drugs (knowledge); physicians' prescribing habits concerning these drugs (attitude and professional competence); how prescription of generic drugs effects pharmaceutical costs amd, finally, what doctors believe a generic drug should be. The influence of physician-related variables (age, type of contract, specialty, workload, etc.) on prescribing of generic drugs was also analyzed. In view of the results, we believe that to rationalize expenditure through and appropriate policy on generic drugs Spanish health authorities should offer more and better training and information (clear and independent) about what generic drugs are (AU)

[Variations in the application of medical techniques in primary health care]. / Variaciones en la aplicación de técnicas médicas en atención primaria.

OBJECTIVES: To describe the application of medical techniques (ATM) in Spain and to analyze the relationship with diverse characteristics related to general practitioners and the center of primary health. DESIGN: Multicenter cross-sectional study. SETTING: Three hundred nineteen general practitioners working in primary care centers in the restructured public sector of the Autonomous Communities of Andalusia, Basque Country and Catalonia in Spain. MAIN MEASUREMENTS: Structured and validated questionnaire comprising 100 items in four sections: general characteristics of the physician and health center, task profile, and job satisfaction. The questionnaire was sent by mail to the health center (Andalusia and Basque Country) or to the home (Catalonia). For the analysis an index variable was created from the answers to the questions on AMT. RESULTS: The index variable of AMT obtained a mean value of 10.02 (SD = 4.55). Andalusia obtained the highest value (median: 11.11; SD: 4.33) of the three Autonomous Communities in the study (p =.012). AMT acquired significantly higher values when associated with: masculine sex (sample from the three autonomous communities; p =.046), rural environment, teamwork, availability of basic equipment, fewer patients, and reduced work load. CONCLUSIONS: Index of ATM in Spain is significantly different in the three Spanish communities under study. The quality of the sanitary services evaluated from the dimension of the ATM seems to be much related with demographic characteristics, the readiness in the consultations of scientific-technical stuff and the appropriate time for medical consultations.

Variaciones en la aplicación de técnicas médicas en atención primaria / Variations in the application of medical techniques in primary health care

Objetivo: Describir la aplicación de técnicas médicas (ATM) en tres comunidades autónomas españolas (Andalucía, Cataluña y País Vasco) y analizar sus relaciones con diversas características relacionadas con los médicos de atención primaria y el centro de salud. Diseño: Estudio multicéntrico, transversal. Emplazamiento: Un total de 319 médicos generales que trabajaban en los centros de atención primaria del sector público reformado en las comunidades de Andalucía, País Vasco y Cataluña. Mediciones principales: Cuestionario estructurado y validado de 100 preguntas en cuatro apartados: características generales del profesional y centro de trabajo, perfil de actividad y satisfacción laboral. Éste fue enviado por correo al centro de trabajo (Andalucía y Euskadi) o domicilio particular (Cataluña). Para el análisis se creó una variable índice a partir de las respuestas de las preguntas de ATM. Resultados: La variable índice de ATM obtuvo un valor medio (desviación estándar [DE]) de 10,02 (4,55) y Andalucía el valor más alto (media [DE]: 11,11 [4,33]) de las tres comunidades del estudio (p = 0,012). La variable índice ATM adquiere valores significativamente más altos en relación con: el sexo masculino (muestra de tres comunidades autónomas; p = 0,046), el ámbito rural, el trabajo en equipo, la disponibilidad de equipamiento básico, el número de pacientes más reducido y menor carga asistencial. Conclusiones: Los índices de ATM en España son significativamente distintos en las tres comunidades españolas estudiadas. La calidad de la asistencia sanitaria evaluada desde la dimensión de la ATM parece estar muy relacionada con características demográficas, la disponibilidad en las consultas del material científico-técnico y el tiempo adecuado de las visitas médicas (AU)

Objectives: To describe the application of medical techniques (ATM) in Spain and to analyze the relationship with diverse characteristics related to general practitioners and the center of primary health. Design: Multicenter cross-sectional study. Setting: Three hundred nineteen general practitioners working in primary care centers in the restructured public sector of the Autonomous Communities of Andalusia, Basque Country and Catalonia in Spain. Main measurements: Structured and validated questionnaire comprising 100 items in four sections: general characteristics of the physician and health center, task profile, and job satisfaction. The questionnaire was sent by mail to the health center (Andalusia and Basque Country) or to the home (Catalonia). For the analysis an index variable was created from the answers to the questions on AMT. Results: The index variable of AMT obtained a mean value of 10.02 (SD = 4.55). Andalusia obtained the highest value (median: 11.11; SD: 4.33) of the three Autonomous Communities in the study (p = .012). AMT acquired significantly higher values when associated with: masculine sex (sample from the three autonomous communities; p = .046), rural environment, teamwork, availability of basic equipment, fewer patients, and reduced work load. Conclusions: Index of ATM in Spain is significantly different in the three Spanish communities under study. The quality of the sanitary services evaluated from the dimension of the ATM seems to be much related with demographic characteristics, the readiness in the consultations of scientific-technical stuff and the appropriate time for medical consultations (AU)

Calidad de vida en pacientes con carcinoma de colon y recto / Quality of life in patients with colorectal carcinoma

Fundamento: importancia de la valoración de la calidad de vida del paciente oncológico como medida de resultados en salud. Objetivos: valorar factores relacionados con la calidad de vida en pacientes con carcinoma colorrectal sometidos a cirugía curativa. Diseño: observacional descriptivo. Ámbito de estudio: 2 centros hospitalarios de la provincia de Málaga. Sujetos: 170 pacientes sometidos a cirugía entre 1990 y 1995. Mediciones e intervenciones: Variables de pendientes: Salud autopercibida: Cuestionario del Grupo Europeo para Investigación y Tratamiento del Cáncer QLQ-C-30. Variables independientes: edad; género; tipo de carcinoma; localización; técnica quirúrgica; ausencia colostomía; dinámica familiar. Consentimiento escrito de los pacientes. Entrevista domiciliaria. Revisión de historias clínicas. Análisis estadístico: estadísticos descriptivos; t de Student, Kruskall-Wallis, Mann-Whitney. Resultados: 67 porciento mayores de 60 años; 49,3 porciento hombres. Test Apgar Familiar: 80,0 porciento de pacientes > 7 puntos (adecuada función familiar). EORTC-QLQ-C-30 (puntuación máxima 100): subescalas de funcionamiento: físico 68,77ñ27,28; cognitivo 81,51ñ18,12; de rol 85,16ñ23,99; emocional 76,83ñ23,54; social 85,39ñ20,40; calidad de vida global 75,46ñ20,07; subescalas de síntomas puntuaciones bajas (escasa presencia de síntomas). La conservación del esfínter anal, se relacionó con un mejor funcionamiento social (p=0,045). La buena dinámica familiar se asoció con dimensiones de la calidad de vida: funcionamiento físico (p=0,0050); funcionamiento emocional (p = 0,0131); funcionamiento cognitivo (p = 0,0038); fatiga (p=0,0231) y disnea (p=0,0336). Conclusiones: los pacientes con carcinoma colorrectal sometidos a cirugía correctiva presentaron apoyo familiar y calidad de vida satisfactorios. La ausencia de colostomía se relacionó con un mejor funcionamiento social (AU)

Doctor-patient communication in different European health care systems: relevance and performance from the patients' perspective.

Our aim is to investigate differences between European health care systems in the importance attached by patients to different aspects of doctor-patient communication and the GPs' performance of these aspects, both being from the patients' perspective. 3658 patients of 190 GPs in six European countries (Netherlands, Spain, United Kingdom, Belgium, Germany, Switzerland) completed pre- and post-visit questionnaires about relevance and performance of doctor-patient communication. Data were analyzed by variance analysis and by multilevel analysis. In the non-gatekeeping countries, patients considered both biomedical and psychosocial communication aspects to be more important than the patients in the gatekeeping countries. Similarly, in the patients' perception, the non-gatekeeping GPs dealt with these aspects more often. Patient characteristics (gender, age, education, psychosocial problems, bad health, depressive feelings, GPs' assessment of psychosocial background) showed many relationships. Of the GP characteristics, only the GPs' psychosocial diagnosis was associated with patient-reported psychosocial relevance and performance. Talking about biomedical issues was more important for the patients than talking about psychosocial issues, unless the patients presented psychosocial problems to the GP. Discrepancies between relevance and performance were apparent, especially with respect to biomedical aspects. The implications for health policy and for general practitioners are discussed.

Meningitis aséptica tras anestesia intradural / Aseptic meningitis after spinal anesthesia

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Luxofractura de Monteggia en el niño / Monteggia fractures-dislocation in the child

Se presenta la experiencia sobre 20 niños portadores de luxo-fractura de Monteggia. Se hace consideraciones sobre diagnóstico y tratamiento. Se señalan las complicaciones observadas y los resultados obtenidos