[Morbi-mortality of medical and surgical treatments in the intracranial bleeding like complication of therapy with drugs that modifies normal coagulation]. / Morbimortalidad del tratamiento médico conservador y del tratamiento neuroquirúrgico en los casos de hemorragia intracraneal como complicación del empleo de fármacos que modifican la hemostasia.

INTRODUCTION: Antiaggregant and anticoagulant therapy has possible sever secondary effects, being the most serious intracranial bleeding. OBJECTIVES: Compare morbi-mortality between surgical and medical treatments in anticoagulated and/or antiaggregated patients with any kind of intracranial bleeding. Also risk factors and main indications of those treatments are studied. PATIENTS AND METHODS: Descriptive and retrospective study including 105 patients admitted in our Critical Care Unit, with intracranial bleeding, under anticoagulant or antiaggregant treatment. We study the type of bleeding (subarachnoid, epidural, subdural and intraparenchimal bleeding) and the relation between morbi-mortality and treatment applicated using relative risk like analytic tool. RESULTS: Major bleeding risk appears after the six first months from the beginning of the treatment. Thirty-four patients died with a relative risk of 1.55 in the surgical patients from the medical treatment patients. Relative risk between anticoagulated patients and antiaggregated ones was 1.16. Serious consequences happened on eight of the 49 patients under surgical treatment, and on 13 of the 52 patients under medical treatment. CONCLUSIONS: Surgical treatment has more morbi-mortality. Oral anticoagulation has only a little more relative risk than treatment with antiaggregants. Both groups had serious consequences.

[Nutritional support in patients with thoracic trauma. Usefulness of an enteral diet with a high fat content]. / Soporte nutricional en el paciente con trauma torácico. Utilidad de una dieta enteral con alto contenido en grasas.

The purpose of this study is to evaluate the effects and clinical tolerance of an enteral diet containing 55% "AET" in the form of fat and only 28% in the form of H. C. in a group of 17 polytraumatized patients admitted to the Intensive Care Unit with assisted ventilation as a result of thoracic traumatism. The average age of the patients was 36.6 +/- 17 years, and they remained in Intensive Care for more than 10 days. Energetic requirements were estimated at 1,800 +/- 180 Kcal per day. Enteral intake commenced on day 4.5 +/- 1.2 and 90% of the estimated requirements was achieved at 8.5 +/- 2.9 days. Average duration of the Enteral Nutrition was 15 +/- 3.7 days, Tolerance of the diet was considered good and problems due to intolerance leading to suspension of the diet were mainly related to worsening of the clinical condition. The volumen per minute expired per Kg of weight descended gradually and assisted ventilation was removed at 16 +/- 5.4 days, 5 patients died, mainly due to septic problems. There was a significant improvement in surviving patients with regard to levels of transferrin (p less than 0.01), prealbumin (p less than 0.001) and RBP (p less than 0.05), and no improvement was observed in the patients who had died. The nitrogenated balance was positive from the ninth day onwards in surviving patients, and remained negative in the patients who had died. In conclusion, this enteral diet with a high intake of fats, showed good tolerance and is beneficial in patients with thoracic traumas which require assisted ventilation.