Neumoperitoneo benigno en paciente con ventilación mecánica no invasiva y gastrostomía / Bening pneumoperitoneum in patient trying non invasive mechanical ventilation and gastrostomy

No disponible

Intraventricular hemorrhage treated with intraventricular fibrinolysis. A 10-year experience

Purpose We evaluate the results and complications of our intraventricular fibrinolysis protocol. Material and methods A retrospective analysis was made of the cases of intraventricular hemorrhage with 13-bed Intensive Care Unit. Graeb score 6 or above subjected to intraventricular fibrinolysis. We gathered demographic parameters, clinical risk scores, tomography data and case histories showing neurological status and complications related to intraventricular treatment. The results between those who died and the survivors were compared. Results Intraventricular fibrinolysis was performed in 42 patients (69% males) with intraventricular hemorrhage. The average age was 58.36 years (SD 16.67), with a median APACHE II score of 17.5 (r 3–29). A total of 16.7% were receiving acenocoumarol, and 7.1% were on antiplatelet drugs. The median Glasgow Coma Score at the start of treatment was 8 (r 3–13). The median Graeb score was 9 (r 6–12), and was severe (Graeb 9–12) in almost 62%. In turn, 26.2% of the patients developed ventriculitis, and there was further bleeding in 7.1%. Death occurred in 50% of the cases. None of the analyzed variables were significantly related to increased mortality. In the 21 survivors, the Glasgow Outcome Score at 3 months was 2 in 23.8% of the cases, 3 in 28.57%, 4 in 23.8% and 5 in 28.57% of the patients. Conclusions Intraventricular fibrinolysis does not appear to involve a high rate of complications, and may result in lesser mortality, with a better functional outcome after three months than that estimated and published in the literature in reference to intraventricular hemorrhage (AU)

Objetivo Evaluar los resultados y complicaciones de un protocolo de fibrinólisis intraventricular empleado durante 10 años. Ámbito de aplicación y métodos Servicio de Medicina Intensiva de 13 camas. Análisis retrospectivo de nuestra base prospectiva de pacientes con hemorragia intraventricular con Graeb mayor de 5 tratados con fibrinólisis intraventricular. Registramos datos demográficos, escalas de gravedad, datos tomográficos y evolutivos neurológicos, y complicaciones relacionadas con la fibrinólisis. Comparamos los resultados entre fallecidos y supervivientes. Resultados Recibieron fibrinolíticos intraventriculares 42 pacientes (69% varones) con hemorragia intraventricular. La edad media fue 58,36 años (DE 16,67), con una mediana de APACHE II de 17,5 (rango 3-29). El 16,7% tomaban acenocumarol y el 7,1% estaban en tratamiento antiagregante. La mediana del Glasgow Coma Score en el momento de inicio de la fibrinólisis fue de 8 (rango 3-13), y la mediana de Graeb fue 9 (rango 6-12). Más del 62% de las hemorragias fueron clasificadas como graves (Graeb 9-12). Se complicaron con ventriculitis el 26,2% y con sangrado el 7,1%. Falleció el 50% de la serie. Ninguna de las variables analizadas se relacionó de modo significativo con la mortalidad. De los 21 supervivientes, el Glasgow Out come Score a los 3 meses fue de 2 en el 23,8%, de 3 en el 28,57%, de 4 en el 23,8% y de 5 en el 28,57%.ConclusionesLa fibrinólisis intraventricular no parece asociar una alta tasa de complicaciones, y puede contribuir a una menor mortalidad con mejor resultado funcional a los 3 meses que la estimada y publicada en la hemorragia intraventricular (AU)

Intraventricular hemorrhage treated with intraventricular fibrinolysis. A 10-year experience.

PURPOSE: We evaluate the results and complications of our intraventricular fibrinolysis protocol. MATERIAL AND METHODS: A retrospective analysis was made of the cases of intraventricular hemorrhage with 13-bed Intensive Care Unit. Graeb score 6 or above subjected to intraventricular fibrinolysis. We gathered demographic parameters, clinical risk scores, tomography data and case histories showing neurological status and complications related to intraventricular treatment. The results between those who died and the survivors were compared. RESULTS: Intraventricular fibrinolysis was performed in 42 patients (69% males) with intraventricular hemorrhage. The average age was 58.36 years (SD 16.67), with a median APACHE II score of 17.5 (r 3-29). A total of 16.7% were receiving acenocoumarol, and 7.1% were on antiplatelet drugs. The median Glasgow Coma Score at the start of treatment was 8 (r 3-13). The median Graeb score was 9 (r 6-12), and was severe (Graeb 9-12) in almost 62%. In turn, 26.2% of the patients developed ventriculitis, and there was further bleeding in 7.1%. Death occurred in 50% of the cases. None of the analyzed variables were significantly related to increased mortality. In the 21 survivors, the Glasgow Outcome Score at 3 months was 2 in 23.8% of the cases, 3 in 28.57%, 4 in 23.8% and 5 in 28.57% of the patients. CONCLUSIONS: Intraventricular fibrinolysis does not appear to involve a high rate of complications, and may result in lesser mortality, with a better functional outcome after three months than that estimated and published in the literature in reference to intraventricular hemorrhage.

Un reto de esperanza: el relato de una mujer con cáncer vesical / No disponible

El cáncer vesical se sitúa el noveno en el ránking entre todos los tipos de cáncer a nivel mundial y su tasa de incidencia mundial es de 10,1por 100.000 habitantes. En los países occidentales, el hábito tabáquico se relaciona con el 50% de los casos en hombres y el 35% en mujeres. Las enfermeras tienden a trabajar bajo condiciones de trabajo especialmente estresantes y se centran en la parte técnica del cuidado, infravalorándose a veces la visión del paciente sobre sus sentimientos y afrontamiento ante la enfermedad. Con este estudio pretendemos explorar y reflejar los sentimientos, experiencia y opinión de una mujer con padecimiento de cáncer vesical. Material y métodos Se trata de un estudio de investigación descriptivo de enfoque fenomenológico que intenta explorar los sentimientos, experiencia y opinión de una mujer con cáncer vesical. A través de una paciente, que voluntariamente se ofreció para este estudio, se obtuvieron una serie de datos cualitativos por medio de una entrevista que previamente había sido concertada. A continuación se transcribió la entrevista literalmente y fue analizada detalladamente, prestando atención a los temas emergentes según el orden lógico que la metodología cualitativa establece. Se optó por este método porque se considera que aspectos del cuidado de Enfermería como la perspectiva holística de la reacción humana al enfermar son mejor abordados desde este paradigma de investigación, que resalta la visión subjetiva frente al positivismo del ángulo cuantitativo. Discusión/resultados Encontramos cinco ejes fundamentales en la entrevista a nuestra paciente: VIDA, FAMILIA, ENFERMEDAD, LUCHA y PERSONAL SANITARIO. En torno a ellos, la paciente planteó una serie de visiones relativas a sus preocupaciones, miedos, sentimientos de pérdida, cambio de valores y percepciones profundas experimentadas. Es de destacar el (..) (AU)

Bladder cancer ranks ninth among all kinds of cancer worldwide and its age standardized incidence rate (ASR) in the world is 10.1 per100,000. In Western countries, the smoking habit accounts for 50% of the cases in men and 35% in women. We nurses tend to workunder important stressful work burdens and focus in the technical part of care, under estimating sometimes the patient´s vision of his/herdealing with disease and his/her feelings. Material and methods This is a qualitative descriptive research based on a phenomenological bias which tries to explore the feelings, experience and opinion of a woman suffering from bladder cancer. Through a volunteer woman patient regularly attending our ambulatory unit of urological cares, we obtained the qualitative data by means of an interview previously appointed. Next we transcribed the interview literally and analys edit carefully, drawing emerging issues from it in a logical order according to the Qualitative Methodology. We opted for this method because we consider that Nursing care aspects such as holistic perspective of the human being reacting against illness are better dealt with from this kind or research, which enhances the subjective vision above the positivist one Discussion/results(..) (AU)

Metronidazole resistance in Clostridium difficile is heterogeneous.

At our institution, the prevalence of clinical isolates of Clostridium difficile with resistance to metronidazole is 6.3%. We observed that initial metronidazole MICs of 16 to 64 mg/liter against toxigenic, primary fresh C. difficile isolates, as determined by agar dilution, decreased to 0.125 mg/liter after the isolates were thawed. In this study, we examined the possibility of heterogeneous or inducible resistance. Totals of 14 metronidazole-resistant and 10 metronidazole-susceptible clinical isolates of toxigenic C. difficile were studied. The isolates were investigated for the presence of nim genes by PCR. After the isolates were thawed, susceptibility testing was done by agar dilution, by disc diffusion using a 5-mug metronidazole disc, and by the Etest method. An experiment for determining the effect of prolonged exposure to metronidazole was applied to all resistant isolates and to susceptible control strains. None of the isolates presented the nim genes. All initially metronidazole-resistant C. difficile isolates became susceptible after thawing; however, they presented slow-growing subpopulations within the inhibition zones of both the disk and the Etest strip. All metronidazole-susceptible isolates remained homogeneously susceptible by both methods. After prolonged exposure in vitro to metronidazole, no zone of inhibition was found around the 5-microg disk in any of the metronidazole-resistant isolates, and the MICs as determined by the Etest method ranged from 0.125 to >256 mg/liter, with colonies growing inside the inhibition zone. Our results indicate that (i) resistance to metronidazole was not due to the presence of nim genes, (ii) resistance to metronidazole in toxigenic C. difficile isolates is heterogeneous, and (iii) prolonged exposure to metronidazole can select for in vitro resistance. We recommend routine performance of the disk diffusion method (5-microg metronidazole disk) with primary fresh C. difficile isolates in order to ensure that metronidazole-heteroresistant populations do not go undetected.

In vitro activity of ramoplanin against Clostridium difficile, including strains with reduced susceptibility to vancomycin or with resistance to metronidazole.

We evaluated the in vitro activity of ramoplanin, an antimicrobial compound that inhibits cell wall synthesis by acting at the level of lipid intermediate formation, against Clostridium difficile. We included strains with reduced susceptibilities to vancomycin (vancomycin-intermediate [Van(i)] strains) or with resistance to metronidazole (Mtz(r)), in order to assess the potential utility of ramoplanin for the treatment of C. difficile-associated diarrhea. We tested the activity of ramoplanin against a total of 105 nonduplicate clinical isolates of toxigenic C. difficile, including 8 Van(i) isolates and 6 Mtz(r) isolates, obtained from our laboratory. Ramoplanin was active against all strains tested at concentrations ranging from 0.03 to 0.5 microg/ml (MICs at which 50 and 90% of isolates were inhibited, 0.25 microg/ml; geometric mean MIC, 0.22 microg/ml). All isolates, independently of their levels of susceptibility to vancomycin or metronidazole, were considered susceptible to ramoplanin (MICs, < or =0.5 microg/ml).

Carcinoma metaplásico de mama. Revisión a propósito de un caso / Breast metaplasic carcinoma. Report of a case and review

- Propósito: presentamos un caso de carcinoma metaplásico de mama de nuestro centro, con revisión y discusión de la literatura.- Material y métodos: paciente de 79 años con carcinoma de células fusiformes de mama en cuadrante ínfero-interno de la mama izquierda. Se realizó tratamiento conservador con cuadrantectomía y radioterapia postquirúrgica. Describimos los hallazgos anatomo-patológicos.- Conclusiones: el carcinoma metaplásico de mama es más frecuente en mujeres mayores de 55 años, presentándose como una masa grande (5 cm) y de rápido crecimiento. Las áreas ganglionares suelen estar libres de enfermedad y los receptores hormonales suelen ser negativos. En cuanto al tratamiento, se tiende a tratar como el resto de carcinomas incluyéndolos en el grupo de alto riesgo para tratamiento complementario. Su pronóstico parece ser peor que los carcinomas convencionales de mama. (AU)

[Retroperitoneal tumors. Retroperitoneal myxoid liposarcoma. Report of a new case]. / Tumores retroperitoneales. Liposarcoma mixoide retroperitoneal. Presentación de un nuevo caso.

OBJECTIVE: To describe an additional case of a large retroperitoneal liposarcoma. METHODS/RESULTS: A case of a large retroperitoneal liposarcoma in a young male is presented. Treatment was by surgery. The clinical and pathological features, diagnosis, course and treatment of this lesion are discussed. CONCLUSIONS: Retroperitoneal tumors constitute a heterogeneous group of uncommon neoplasms of unknown etiology. Liposarcoma is the most frequent lesion in this group. It is usually asymptomatic and is often identified by the presence of a large abdominal mass. It is considered to be a peculiar lesion because of its biological and morphological features and course.

[Spontaneous retroperitoneal hemorrhage]. / Hemorragia retroperitoneal espontánea.

OBJECTIVE: The etiology of spontaneous retroperitoneal hemorrhage is analyzed and the clinical, diagnostic and therapeutic aspects are discussed. METHODS/RESULTS: Two cases of spontaneous retroperitoneal hemorrhage from a ruptured adenocarcinoma of the kidney are reported. Both patients presented the characteristic Lenk's triad. Definitive diagnosis was made on the CT findings and treatment was by nephrectomy. CONCLUSIONS: The most common cause of retroperitoneal hemorrhage arising from the kidney is a tumor. Treatment is based on the underlying cause of the underlying cause of the hemorrhage and the patient's hemodynamic status.

[Ongoing improvement in the quality of chronic prescriptions at a primary care center: a 5-year follow-up]. / Mejora continua de la calidad de la prescripción crónica en un centro de atención primaria: seguimiento de 5 años.

OBJECTIVE: To find how the indicators for prescriptions for the chronically ill during the 1988-1992 period evolved, based on the analysis of the repeat prescription archive; and to assess the persistence of the effect of the 1989 corrective intervention. DESIGN: A retrospective and longitudinal evaluation study. SETTING: Primary Care Centre. PATIENTS AND OTHER PARTICIPANTS: Four representative samples of patients with an ongoing prescription card for 1988 (n = 549), 1989 (n = 211), 1990 (n = 193) and 1992 (n = 126). MEASUREMENTS AND RESULTS: Indicators used were: percentage of patients in treatment with some medication of low intrinsic value (LIV), benzodiazepines, peripheric vasodilators (PV), oral non-steroidal anti-inflammatories (NSAID), external NSAID and the percentage of each one of these out of the prescription total. A progressive decrease in the percentage of LIV medication in the 1988-1992 period was detected. There were significant differences, both for oral anti-diabetes drugs of high intrinsic value (HIV) (24.4 and 12.7%), and of LIV (26.6 and 16.9%) (p < 0.001 in both cases). Benzodiazepines went down from 5.4 to 1.2% (p = 0.0006), PVs from 4.4 to 1.2% (p = 0.003) and oral NSAID from 4.7 to 2.4% (p = 0.049). The percentage of patients treated with LIV medication went down from 46.1 to 29.4% (p < 0.001) and from 52.4 to 38.1% (p = 0.004), for HIV and LIV oral anti-diabetes drugs, respectively. Patients treated with benzodiazepines went down from 14.7 to 4.0% (p = 0.0017), with PV from 12.0 to 3.2% (p = 0.005) and with oral NSAID from 12.7 to 7.9% (ns). CONCLUSION: A continuous improvement in the quality of prescription for the chronically ill has been observed over the last 5 years and can be attributed to the primary care team.

La proteina C reactiva como elemento diagnostico etiologico de las infecciones respitatorias en el nino. / C-reactive protein as etiologic element for diagnosis of respiratory infections in the child

En todo servicio de enfermedad respiratoria se plantea con frecuencia la interrogante del uso o el no uso del tratamiento antibiotico. Se estudiaron 424 ninos con una edad comprendida entre 29 dias y 14 anos ingresados en la sala 2 del hospital pediatrico docente "A. A. Aballi" en el periodo de un ano con infeccion respiratoria aguda. A todos los pacientes se les tomo muestra de sangre venosa para realizarles leucograma, eritrosedimentacion y Proteina C Reactiva. A todos los ninos se les realizo rayos X de torax. Se llego a la conclusion de que a pesar de que la Proteina C Reactiva positiva es mas definitiva que la leucocitosis, la eritrosedimentacion o la fiebre, para identificar el origen bacteriano, pueden ocurrir resultados falsos positivos o negativos. La Proteina C Reactiva debe ser usada conjuntamente con la clinica y la radiologia en la discusion del tratamiento

La proteina C reactiva como elemento diagnostico etiologico de las infecciones respitatorias en el nino. / C-reactive protein as etiologic element for diagnosis of respiratory infections in the child

En todo servicio de enfermedad respiratoria se plantea con frecuencia la interrogante del uso o el no uso del tratamiento antibiotico. Se estudiaron 424 ninos con una edad comprendida entre 29 dias y 14 anos ingresados en la sala 2 del hospital pediatrico docente "A. A. Aballi" en el periodo de un ano con infeccion respiratoria aguda. A todos los pacientes se les tomo muestra de sangre venosa para realizarles leucograma, eritrosedimentacion y Proteina C Reactiva. A todos los ninos se les realizo rayos X de torax. Se llego a la conclusion de que a pesar de que la Proteina C Reactiva positiva es mas definitiva que la leucocitosis, la eritrosedimentacion o la fiebre, para identificar el origen bacteriano, pueden ocurrir resultados falsos positivos o negativos. La Proteina C Reactiva debe ser usada conjuntamente con la clinica y la radiologia en la discusion del tratamiento

[Immunoelectrophoretic and functional evidence in various infants of a transient variant of the fibrinogen (fetal fibrinogen?)]. / Evidencia inmunoelectroforética y funcional, en algunos recién nacidos, de una variante transitoria del fibrinógeno (fibrinógeno fetal?).

In 21 out of 466 full term newborn babies (4.5%) and in 5 out of 50 prematures (10%) a transient fibrinogen electrophoretic abnormality, anodic and cathodic, was found. The observation that the thrombin time in full term newborn babies is prolonged, compared with the adult levels, was confirmed (p less than 0.0005). The difference between the thrombin time in full term newborn babies without fibrinogen electrophoretic abnormalities and those who had them, was statistically significant (p = 0.005) suggesting that the abnormality is associated with the protein function. The normal electrophoretic component could be the "adult" equivalent of the protein and the cathodic variant, the "fetal" type of fibrinogen. This hypothesis could explained why the thrombin time of plasma in newborn normal babies is enriched with the "fetal" fibrinogen in variable proportion, and is delayed compared with that of the adults.