Apendicitis aguda en el niño: la edad como factor pronóstico / Acute appendicitis in children: age as a prognostic factor

Con el objetivo de determinar el comportamiento de la apendicitis aguda y su relación con la edad se realizó un estudio descriptivo comparativo retrospectivo en los pacientes apendicectomizados en el Hospital Pediátrico Provincial Universitario José Luis Miranda de Santa Clara en todo el año 2009. La muestra estuvo constituida por 156 pacientes con edades comprendidas entre tres y 15 años, se estudiaron variables clínicas y de laboratorio, así como el estado del apéndice en la intervención en tres grupos de edades diferentes, en los pacientes menores de cinco años predominaron signos y síntomas inespecíficos como el dolor generalizado sin secuencia de Murphy y la distensión generalizada, así como las formas complicadas de la enfermedad; en este grupo de edad es en el que aparecen mayores dificultades para el diagnóstico de la enfermedad(AU)

Efficacy and safety of parecoxib in the treatment of acute renal colic: a randomized clinical trial

PURPOSE: Although nonselective nonsteroidal anti-inflammatory drugs (nsNSAIDs) and opioids are effective treatments for acute renal colic, they are associated with adverse events (AEs). As cyclooxygenase-2 selective NSAIDs may provide a safer alternative, we compared the efficacy and safety of parecoxib versus an nsNSAID in subjects with acute renal colic. MATERIALS AND METHODS: Phase IV., multicenter, double-blind, noninferiority, active-controlled study: 338 subjects with acute renal colic were randomized to parecoxib 40 mg i.v. plus placebo (n = 174) or ketoprofen 100 mg IV plus placebo (n = 164). 338 subjects with acute renal colic were randomized to parecoxib 40 mg IV (n = 174) or ketoprofen 100 mg IV(n = 164) plus placebo. Subjects were evaluated 15, 30, 45, 60, 90 and 120 minutes after treatment start and 24 hours after discharge. Primary endpoint was the mean pain intensity difference (PID) at 30 minutes by visual analog scale (VAS) (per-protocol population). An ANCOVA model was used with treatment group, country, and baseline score as covariates. Non-inferiority of parecoxib to ketoprofen was declared if the lower bound of the 95 percent confidence interval (CI) for the difference between the two groups excluded the pre-established margin of 10 mm for the primary endpoint. RESULTS: Baseline demographics were similar. The mean (SD) mPID30 min was 33.84 (24.61) and 35.16 (26.01) for parecoxib and ketoprofen, respectively. For treatment difference (parecoxib-ketoprofen) the lower bound of the 95 percent CI was 6.53. The mean change from baseline in VAS 30 minutes after study medication was ~43 mm; AEs were comparable between treatments. CONCLUSIONS: Parecoxib is as effective as ketoprofen in the treatment of pain due to acute renal colic, is well tolerated, and has a comparable safety profile.

Efficacy and safety of parecoxib in the treatment of acute renal colic: a randomized clinical trial.

PURPOSE: Although non-selective non-steroidal anti-inflammatory drugs (nsNSAIDs) and opioids are effective treatments for acute renal colic, they are associated with adverse events (AEs). As cyclooxygenase-2 selective NSAIDs may provide a safer alternative, we compared the efficacy and safety of parecoxib versus an nsNSAID in subjects with acute renal colic. MATERIALS AND METHODS: Phase IV., multicenter, double-blind, noninferiority, active-controlled study: 338 subjects with acute renal colic were randomized to parecoxib 40 mg i.v. plus placebo (n = 174) or ketoprofen 100 mg IV plus placebo (n = 164). 338 subjects with acute renal colic were randomized to parecoxib 40 mg IV (n = 174) or ketoprofen 100 mg IV(n = 164) plus placebo. Subjects were evaluated 15, 30, 45, 60, 90 and 120 minutes after treatment start and 24 hours after discharge. Primary endpoint was the mean pain intensity difference (PID) at 30 minutes by visual analog scale (VAS) (per-protocol population). An ANCOVA model was used with treatment group, country, and baseline score as covariates. Non-inferiority of parecoxib to ketoprofen was declared if the lower bound of the 95% confidence interval (CI) for the difference between the two groups excluded the pre-established margin of 10 mm for the primary endpoint. RESULTS: Baseline demographics were similar. The mean (SD) mPID30 min was 33.84 (24.61) and 35.16 (26.01) for parecoxib and ketoprofen, respectively. For treatment difference (parecoxib-ketoprofen) the lower bound of the 95% CI was 6.53. The mean change from baseline in VAS 30 minutes after study medication was ~43 mm; AEs were comparable between treatments. CONCLUSIONS: Parecoxib is as effective as ketoprofen in the treatment of pain due to acute renal colic, is well tolerated, and has a comparable safety profile.

[Echography performed by surgeons in the management of patients with trauma]. / Ecografía realizada por cirujanos en el manejo de pacientes con trauma.

BACKGROUND: Ultrasonography is useful in trauma patients to detect pleural effusions or peritoneal fluid. AIM: To assess the value of ultrasonography performed by surgeons in the assessment of trauma patients. MATERIAL AND METHODS: A retrospective review of ultrasonography reports and clinical history of 284 trauma patients. RESULTS: One hundred fifty six patients had blunt trauma and 128 had penetrating trauma. Ultrasonography detected peritoneal fluid in 20%, pericardial effusion in 1% and pleural effusion in 1%. Eight percent had visceral damage or hematomas, without peritoneal fluid. None of the patients with a normal ultrasonography required surgery for hemoperitoneum; however, four patients had intestinal perforations and required surgery. CONCLUSIONS: Ultrasonography had a 100% sensitivity and specificity for the detection of clinically significant hemoperitoneum. Emergency ultrasonography performed by surgeons is useful and accurate.