Differences in clinical outcomes and resource utilization in pediatric traumatic brain injury between countries of different sociodemographic indices.

OBJECTIVE: The burden of traumatic brain injury (TBI) is disproportionately high in low- and middle-income countries (LMICs). This study aimed to compare clinical outcomes and healthcare utilization for children with moderate to severe TBIs between LMICs and non-LMICs in Asia and Latin America. METHODS: The authors performed an observational multicenter study from January 2014 to February 2023 among children with moderate to severe TBIs admitted to participating pediatric intensive care units (PICUs) in the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) and Red Colaborativa Pediátrica de Latinoamérica (LARed Network). They classified sites according to their 2019 sociodemographic index (SDI). Low, low-middle, and middle SDI sites were considered LMICs, while high-middle and high SDI sites were considered non-LMICs. The authors documented patient demographics and TBI management. Accounting for death, they recorded 14-day PICU-free and 28-day hospital-free days, with fewer free days indicating poorer outcome. The authors compared children who died and those who had poor functional outcomes (defined as Pediatric Cerebral Performance Category [PCPC] level of moderate disability, severe disability, or vegetative state or coma) between LMICs and non-LMICs and performed a multivariable logistic regression analysis for predicting poor functional outcomes. RESULTS: In total, 771 children with TBIs were analyzed. Mortality was comparable between LMICs and non-LMICs (9.6% vs 12.9%, p = 0.146). Children with TBIs from LMICs were more likely to have a poor PCPC outcome (31.0% vs 21.3%, p = 0.004) and had fewer ICU-free days (median [IQR] 6 [0-10] days vs 8 [0-11] days, p = 0.004) and hospital-free days (median [IQR] 9 [0-18] days vs 13 [0-20] days, p = 0.007). Poor functional outcomes were associated with LMIC status (adjusted OR [aOR] 1.53, 95% CI 1.04-2.26), a lower Glasgow Coma Scale score (aOR 0.83, 95% CI 0.78-0.88), and the presence of multiple trauma (aOR 1.49, 95% CI 1.01-2.19). Children with TBIs in LMICs required greater resource utilization in the form of early intubation and mechanical ventilation (81.6% vs 73.2%, p = 0.006), use of hyperosmolar therapy (77.7% vs 63.6%, p < 0.001), and use of antiepileptic drugs (73.9% vs 53.1%, p < 0.001). CONCLUSIONS: Within Asia and Latin America, children with TBIs in LMICs were more likely to have poor functional outcomes and required greater resource utilization. Further research should focus on investigating causal factors and developing targeted interventions to mitigate these disparities.

Initial dysnatremia and clinical outcomes in pediatric traumatic brain injury: a multicenter observational study.

PURPOSE: We aimed to investigate the association between initial dysnatremia (hyponatremia and hypernatremia) and in-hospital mortality, as well as between initial dysnatremia and functional outcomes, among children with traumatic brain injury (TBI). METHOD: We performed a multicenter observational study among 26 pediatric intensive care units from January 2014 to August 2022. We recruited children with TBI under 18 years of age who presented to participating sites within 24 h of injury. We compared demographics and clinical characteristics between children with initial hyponatremia and eu-natremia and between those with initial hypernatremia and eu-natremia. We defined poor functional outcome as a discharge Pediatric Cerebral Performance Category (PCPC) score of moderate, severe disability, coma, and death, or an increase of at least 2 categories from baseline. We performed multivariable logistic regression for mortality and poor PCPC outcome. RESULTS: Among 648 children, 84 (13.0%) and 42 (6.5%) presented with hyponatremia and hypernatremia, respectively. We observed fewer 14-day ventilation-free days between those with initial hyponatremia [7.0 (interquartile range (IQR) = 0.0-11.0)] and initial hypernatremia [0.0 (IQR = 0.0-10.0)], compared to eu-natremia [9.0 (IQR = 4.0-12.0); p = 0.006 and p < 0.001]. We observed fewer 14-day ICU-free days between those with initial hyponatremia [3.0 (IQR = 0.0-9.0)] and initial hypernatremia [0.0 (IQR = 0.0-3.0)], compared to eu-natremia [7.0 (IQR = 0.0-11.0); p = 0.006 and p < 0.001]. After adjusting for age, severity, and sex, presenting hyponatremia was associated with in-hospital mortality [adjusted odds ratio (aOR) = 2.47, 95% confidence interval (CI) = 1.31-4.66, p = 0.005] and poor outcome (aOR = 1.67, 95% CI = 1.01-2.76, p = 0.045). After adjustment, initial hypernatremia was associated with mortality (aOR = 5.91, 95% CI = 2.85-12.25, p < 0.001) and poor outcome (aOR = 3.00, 95% CI = 1.50-5.98, p = 0.002). CONCLUSION: Among children with TBI, presenting dysnatremia was associated with in-hospital mortality and poor functional outcome, particularly hypernatremia. Future research should investigate longitudinal sodium measurements in pediatric TBI and their association with clinical outcomes.

A multicenter observational study on outcomes of moderate and severe pediatric traumatic brain injuries-time to reappraise thresholds for treatment.

PURPOSE: Children with moderate traumatic brain injury (modTBI) (Glasgow Coma Scale (GCS) 9-13) may benefit from better stratification. We aimed to compare neurocritical care utilization and functional outcomes between children with high GCS modTBI (hmodTBI, GCS 11-13), low GCS modTBI (lmodTBI, GCS 9-10), and severe TBI (sTBI, GCS ≤ 8). We hypothesized that patients with lmodTBI have higher neurocritical care needs and worse outcomes than patients with hmodTBI and are similar to patients with sTBI. METHODS: Prospective observational study from June 2018 to October 2022 in 28 pediatric intensive care units (PICU) in Asia, South America, and Europe. We included children (age < 18 years) with modTBI and sTBI admitted to PICU and measured functional outcomes at 3 months using the Glasgow Outcome Scale-Extended Pediatric Revision (GOS-E Peds, scale 1-8, 1 = upper good recovery, 8 = death). RESULTS: We analyzed 409 patients: 98 (24%) and 311 (76%) with modTBI and sTBI, respectively. Patients with lmodTBI (vs. hmodTBI) were more likely to have invasive ICP monitoring (32.3% vs. 4.5%, p < 0.001), longer PICU stay (days, median [IQR]; 5.00 [4.00, 9.75] vs 4.00 [2.00, 5.00], p = 0.007), and longer hospital stay (days, median [IQR]: 13.00 [8.00, 17.00] vs. 8.00 [5.00, 12, 25], p = 0.015). Median GOS-E Peds scores were significantly different (hmodTBI (1.00 [1.00, 3.00]), lmodTBI (3.00 [IQR 2.00, 5.75]), and sTBI (5.00 [IQR 1.00, 6.00]) (p < 0.001)). After adjusting for age, sex, presence of polytrauma and cerebral edema, lmodTBI, and sTBI remained significantly associated with higher GOS-E scores (adjusted coefficient (standard error): 1.24 (0.52), p = 0.018, and 1.27 (0.33), p < 0.001, respectively) compared with hmodTBI. CONCLUSIONS: Children with lmodTBI have higher rates of neurocritical care utilization and worse functional outcomes than those with hmodTBI but better than those with sTBI. Children with lmodTBI may benefit from guideline-based management similar to what is implemented in children with sTBI. This work was performed in hospitals within the PACCMAN and LARed networks. No reprints will be ordered.

Prehospital and emergency management of pediatric traumatic brain injury: a multicenter site survey.

OBJECTIVE: There is a paucity of information on pediatric traumatic brain injury (TBI) care in Asia and Latin America. In this study, the authors aimed to describe the clinical practices of emergency departments (EDs) participating in the Saline in Asia and Latin-America Neurotrauma in the Young (SALTY) study, by comparing designated trauma centers (DTCs) and nontrauma centers (NTCs) in their networks. METHODS: The authors performed a site survey study on pediatric TBI management in the EDs in 14 countries. Two European centers joined other participating sites in Asia and Latin America. Questions were formulated after a critical review of current TBI guidelines and published surveys. The authors performed a descriptive analysis and stratified centers based on DTC status. RESULTS: Of 24 responding centers (70.6%), 50.0% were DTCs, 70.8% had academic affiliations, and all centers were in urban settings. Patients were predominantly transferred to DTCs by centralized prehospital services compared to those sent to NTCs (83.3% vs 41.7%, p = 0.035). More NTCs received a majority of their patients directly from the trauma scene compared to DTCs (66.7% vs 25.0%, p = 0.041). Ten centers (41.7%) reported the use of a TBI management guideline, and 15 (62.5%) implemented CT protocols. Ten DTCs reported implementation of intervention strategies for suspected raised intracranial pressure (ICP) before conducting a CT scan, and 6 NTCs also followed this practice (83.3% vs 50.0%, p = 0.083). ED management for children with TBI was comparable between DTCs and NTCs in the following aspects: neuroimaging, airway management, ICP monitoring, fluid resuscitation, anticoagulant therapy, and serum glucose control. Hyperventilation therapy for raised ICP was used by 33.3% of sites. CONCLUSIONS: This study evaluated pediatric TBI management and infrastructure among 24 centers. Limited differences in prehospital care and ED management for pediatric patients with TBI were observed between DTCs and NTCs. Both DTCs and NTCs showed variation in the implementation of current TBI management guidelines. There is an urgent need to investigate specific barriers to guideline implementation in these regions.

Scale-up of electrokinetic permeable reactive barriers for the removal of organochlorine herbicide from spiked soils.

This work aims to shed light on the scale-up a combined electrokinetic soil flushing process (EKSF) with permeable reactive barriers (PRB) for the treatment of soil spiked with clopyralid. To do this, remediation tests at lab (3.45 L), bench (175 L) and pilot (1400 L) scales have been carried out. The PRB selected was made of soil merged with particles of zero valent iron (ZVI) and granular activated carbon (GAC). Results show that PRB-EKSF involved electrokinetic transport and dehalogenation as the main mechanisms, while adsorption on GAC was not as relevant as initially expected. Clopyralid was not detected in the electrolyte wells and only in the pilot scale, significant amounts of clopyralid remained in the soil after 600 h of operation. Picolinic acid was the main dehalogenated product detected in the soil after treatment and mobilized by electro-osmosis, mostly to the cathodic well. The transport of volatile compounds into the atmosphere was promoted at pilot scale because of the larger soil surface exposed to the atmosphere and the electrical heating caused by ohmic losses and the larger interelectrode gap.

Uso de dermis artificial (Integra®) en reparación de lesiones traumáticas extensas de cuero cabelludo / Use of artificial dermis (INTEGRA®) in repair of extensive traumatic scalp injuries

Resumen Objetivo: Presentar 4 casos clínicos en los cuales el uso de dermis artificial Integra® resultó ser una solución segura y confiable para defectos de cuero cabelludo. Materiales y Método: Revisión de fichas clínicas de pacientes ingresados al Departamento de Cirugía Plástica y Quemados del Hospital del Trabajador de Santiago con diagnóstico de lesión traumática extensa de cuero cabelludo entre los años 2005-2013 que se resolvieron con uso de Integra®. Resultados: 4 pacientes de sexo femenino con lesión traumática que comprometían entre 70-98% de la superficie de cuero cabelludo, tiempo promedio entre aplicación de Integra® e injerto dermoepidérmico fue 18 días con 100% de cobertura; solo hubo complicaciones menores (ulceración crónica de vertex y dolor neuropático). El tiempo promedio de alta laboral fue 368 días, usando órtesis capilar. Discusión: La cobertura inmediata del tejido es fundamental para la reconstrucción exitosa del cuero cabelludo. Aparte del tejido autólogo, la dermis artificial constituye una alternativa para la reconstrucción rápida del cuero cabelludo con excelentes resultados. Conclusiones: Integra® es una solución segura y confiable para reconstruir defectos complejos del cuero cabelludo.

Aim: To present 4 clinical cases in which the use of artificial dermis (Integra®) turned out to be a safe and reliable solution for scalp defects. Materials and Method: review of clinical records of patients admitted to the Department of Plastic Surgery and Burns of the Hospital of the Worker of Santiago with a diagnosis of extensive traumatic injury of the scalp between the years 2005-2013 that were resolved with use of Integra®. Results: 4 female patients with traumatic injury that compromised between 70-95% of the surface of scalp, average time between application of integra and dermoepidermal graft was 18 days with 100% coverage; there were only minor complications (chronic vertex ulceration and neuropathic pain). The average time of high labor was 368 days, using capillary orthosis. Discussion: The immediate coverage of the tissue is essential for the successful reconstruction of the scalp. Apart from autologous tissue, the artificial dermis is an alternative for rapid reconstruction of the scalp with excellent results. Conclusions: Integra is a safe and reliable solution to reconstruct complex defects of the scalp.

Modo de Vida de un grupo de trabajadores informales, Bogotá D.C., 2014 / Mode of Life of an informal group of workers, Bogotá D.C., 2014 / Sustento de um grupo de trabalhadores informais, Bogotá D.C., 2014

Objetivo: Comprender el Modo de vida de un grupo de trabajadores informales vendedores de productos agrícolas en carreta, en el territorio de Corabastos, Bogotá D.C., como aproximación al Perfil Epidemiológico del grupo. Metodología: Estudio cualitativo, descriptivo, participaron 29 trabajadores informales, la recolección de la información se realizó por medio de cuatro técnicas cualitativas y fue analizada por medio del método de análisis de contenido temático. Resultados: El MV se describió a partir del reconocimiento del territorio, las condiciones grupales de trabajo, la calidad y disfrute de bienes de consumo del grupo, capacidad para crear y reproducir valores culturales e identidad, capacidad para empoderamiento, organización y soporte en beneficios del grupo y calidad de las relacionesecológicas de estos trabajadores informales Discusión y conclusiones: El concepto de MV que se describió es amplio y recoge categorías que no han sido evaluadas en otras investigaciones, específicamente en relación a los trabajadores informales y la inserción en un espacio social, un espacio ambiental, en la relación con instituciones estatales, valores culturales y su capacidad organizativa.

Objective: To understand the mode of life of a group of informal work sellers of agricultural products, who use, as a working tool, a wooden cart. The place for this economical activity is a place named Corabastos, a gathering place of agricultural products. It is located in Bogotá D.C. This is an approximation to the epidemiological profile of the group. Methodology: Qualitative, 29 informal workers participated, Data collection was conducted through four qualitative techniques and it was analyzed using the method of analysis of thematic content. Results:The mode of life of this group, was described taking a as a starting point some specific aspects: The recognition of the territory (Corabastos), the group working conditions, the quality and enjoyment of consumer goods in the group, the ability to create and reproduce cultural values and identity, the ability to empowerment, organization and support in order to benefit the group Finally, the ecological relationships of the group were also taken into account. Discussion and conclusions: The concept was described MV is broad and includes categories that have not been evaluated in other investigations, specifically in relation to informal workers and insertion in a social space, environmental space, in the relationship with state institutions, cultural values and its organizational capacity.

Objetivo: compreender o modo de vida de um grupo de trabalhadores vendedores informais de produtos agrícolas no carro no território de Corabastos, Bogotá DC, como um perfil epidemiológico aproximação do grupo. Metodologia: estudo qualitativo envolvendo 29 trabalhadores informais. A recolha de dados foi realizada por quatro métodos qualitativos e foi analisada pelo método de análise de conteúdo. Resultados: A MV é descrito com base no reconhecimento do território, o grupo de condições de trabalho, qualidade e satisfação do grupo de bens de consumo, a capacidade de criar e reproduzir valores culturais e de identidade, capacidade de capacitação, organização e benefícios de suporte grupo ea qualidade das relações ecológicas desses trabalhadores informais. Discussão econclusões: o conceito foi descrito MV é amplo e inclui categorias que ainda não foram avaliados em outros estudos, especificamente em relação aos trabalhadores informais e inserção em um espaço social , um espaço ambiental, em relação às instituições do estado, valores culturais e capacidade organizacional.

Colgajos en reconstrucción de la región calcánea lateral / Flaps in reconstruction of the lateral calcaneal region: case series and treatment algorithm for soft-tissue complications of the lateral approach for calcaneal fractures

Introduction: Calcaneal fractures are the most frequent tarsal bone fracture. A high complication rate has been reported for the L-shaped lateral calcaneus surgical approach. Coverage of the resulting defect can be challenging. The aim of this article is to report a case series and propose a new treatment algorithm. Materials and Methods: Between January 2011 and December 2013 ninety-five patients underwent a close calcaneus fracture surgery by lateral approach. Ten patients suffered from surgical wound complications. Defects were classified as small (< 2 cm), medium (2-5 cm) or big size (> 5 cm). Results: Small size defects were covered with local fasciocutaneous advancement and rotation flaps. Medium size defect were covered either with a distally based sural neurocutaneous flap or propeller flap based on peroneal artery perforators. A free flap was used in the big size defect presented. Mean follow-up was 16 month (range 5-41 month). Stable coverage was achieved in all cases and no revision surgery was needed. Conclusions: Soft-tissue complications associated to lateral approach for calcaneal fractures needs an ordered approach. The algorithm presented including propeller perforator flaps proved to be safe and useful.

Introducción: Las fracturas de calcáneo son las fracturas más frecuentes de los huesos del tarso. Diversos estudios han mostrado alta tasa de complicaciones del abordaje que requieren cobertura. El objetivo principal es presentar un nuevo algoritmo de tratamiento para estos defectos de cobertura. Material y Métodos: Entre el 2011 y el 2013 se operaron 95 pacientes con fractura cerrada de calcáneo. Diez pacientes presentaron defectos de cobertura de la herida operatoria. Los defectos se clasificaron en pequeños (< 2 cm), medianos (2-5 cm) y grandes (> 5 cm). Resultados: Se realizaron 11 colgajos en 10 pacientes. Seis pacientes presentaron un defecto pequeño y fueron tratados mediante colgajos locales; cuatro casos de defectos medianos se resolvieron mediante tres colgajos perforantes de arteria peronea de tipo propeller y un colgajo sural. Todos los defectos de la zona dadora, tanto en el colgajo sural como en los colgajos propeller, fueron cerrados de manera primaria sin requerir injertos. Hubo un defecto grande que fue necesario cubrir con un colgajo libre. El período de seguimiento promedio fue 16 meses, con un rango de 5 a 41 meses. En todos los casos se proporcionó una cobertura estable que no requirió revisiones. Conclusiones: Es necesario un enfrentamiento ordenado y protocolizado para resolver estos defectos. En nuestro trabajo, proponemos un algoritmo simple basándonos en el ancho del defecto, incorporando como alternativa el colgajo perforante pediculado tipo propeller para defectos medianos, con el cual se logran coberturas estables y planas, con cierre primario de la zona dadora.

Rol del colgajo perforante pediculado en hélice (propeller flap) en reconstruccción post traumática de extremidades / Propeller flap in post-traumatic lower limb defects

Aim: To describe indications and results obtained in distal lower leg post traumatic reconstruction using pediculated perforator propeller flap. Patients and Methods: Prospective series of consecutive patients treated with propeller flaps between March 2011 and March 2014. Patient’s characteristics, defects and flaps characteristics and post operative complications were recorded. Descriptive statistical methods were used in this study. Results: Eight patients were included with a median age of 40 years. The injuries were caused by degloving (one case) and fractures (seven cases), including four calcaneal fractures, two open tibial fractures and one ankle fracture. Three cases were reconstructed with posterior tibial artery pedicled perforator flaps, and five cases with peroneal artery perforator flaps. The median average area of the flaps was 55.8 cm² (range 40-117.8 cm²). Coverage was achieved in all cases. No total flap necrosis was reported. Discussion: Propeller flaps are a useful tool in reconstruction of medium size defects of the distal third of the lower limb. They allow primary closure of the donor site and have a low rate of complications.

Objetivos: Evaluar los resultados obtenidos en cobertura cutánea post traumática con colgajos pediculados basados en perforantes distales en extremidades inferiores. Pacientes y Método: Se realizó un registro prospectivo de todos los pacientes con lesiones post traumáticas tratados con colgajos perforantes pediculados en hélice entre marzo de 2011 y marzo de 2014. Se registró datos demográficos, características del defecto cutáneo, características de los colgajos utilizados, así como la presencia de complicaciones post operatorias. Se utilizó medidas de tendencia central y de dispersión para describir la serie de pacientes. Resultados: La serie analizada incluyó ocho pacientes con una mediana de 40 años (27-59 años). El mecanismo de lesión fue desforramiento (un caso) y fracturas de la extremidad inferior (siete casos), de las cuales, 4 fueron fracturas de calcáneo, 2 fracturas expuestas de tibia y 1 fractura de tobillo. En tres casos se realizaron colgajos basados en perforantes de arteria tibial posterior y en cinco casos se utilizó perforantes de arteria peronea. El área de los colgajos tuvo una mediana de 55,8 cm² (rango 40-117,8 cm²). Un caso presentó una necrosis distal, dos dehiscencia del borde distal y un hematoma. Se logró cobertura en todos los casos y la zona dadora fue cerrada en forma primaria. No hubo necrosis totales de colgajos. Discusión: El colgajo perforante pediculado de tipo propeller es una herramienta útil en la cobertura de defectos de extensión menor del tercio distal de la extremidad inferior con una baja tasa de complicaciones.

Colgajo perforante en hélice basado en arteria peronea para reconstrucción distal de extremidad inferior / Peroneal artery propeller perforator flap for distal lower limb reconstruction

Introduction: propeller flaps are local pedicle flaps, based on a perforator vessel, which acts as the pivot point for the skin island that can be rotated up to 180°. These flaps can be performed wherever a perforator vessel of adequate size is encountered, expanding the reconstructive options for lower limb defects. Clinical case: we present a case of reconstruction of soft-tissue defect of the leg using a peroneal artery propeller perforator flap. A review of the main advantages of this technique for reconstruction of lower limb defects is also presented.

Introducción: el colgajo en hélice (propellerflap) corresponde a un tipo de colgajo local pediculado, basado en vasos perforantes, que actúan como punto pivote sobre el cual se rota la isla cutánea hasta en 180°. Este tipo de colgajo puede ser efectuado en cualquier sitio donde exista un vaso perforante de calibre adecuado, ampliando las alternativas de cobertura para defectos de extremidad inferior. Caso clínico: presentamos un caso de cobertura de defecto de partes blandas secundario a aplastamiento de tobillo, utilizando un colgajo en hélice basado en perforante de arteria peronea. Se discuten las principales consideraciones respecto al uso de esta técnica en reconstrucción de extremidad inferior.

Contractura axilar por quemadura tratada con Integra® / Axillary burn contracture treated with Integra®

Introduction: Severe axillary burn is an unusual accident that frequently evolves to contracture generating important cosmetic and functional deficiencies. Contracture scars in this region are difficult to treat because of the anatomic characteristics of the area that has multiple power vectors. Functional restoration has to be one of the main goals in the management of burns in the axilla and flaps have shown high rate of morbidity. Integra® provides satisfactory elasticity and dermal resistance which results in positive functional results. Objective: Analyze the results of the use of Integra® in axillary burn contracture scars at a specialized Burns Center. Materials and Methods: There were 4 patients who underwent reconstructive surgery using Integra® for axillary burn contractures between January 2002 and March 2006. Follow-up was divided into perioperative and late. Early follow-up checked general post-operative evolution and late follow-up was focused on functionality and patient independence evaluated using Barthel's index of daily living activities. Results: There were 3 males and 1 female, average age 27 (18-41) with a minimum follow up of 9 months. There were no perioperative complications and good or very good range of motion results. Conclusions: Our results are similar to artificial skin substitutes used in other anatomical regions.

Las quemaduras axilares severas son un accidente infrecuente que evolucionan a la retracción generando deficiencias cosméticas y funcionales. Estas cicatrices son difíciles de tratar por las características anatómicas del área, donde la corrección de un vector de movimiento puede alterar otro. Objetivo: Mostrar nuestros resultados utilizando el sustituto cutáneo Integra® en el tratamiento de cicatrices retráctiles axilares por quemadura. Pacientes y Métodos: Se recolectaron antecedentes médicos y fotográficos de pacientes portadores de cicatrices retráctiles axilares por quemadura entre enero de 2002 y marzo de 2006 en el Hospital del Trabajador de Santiago. Se evaluó pre y postoperatoriamente a los pacientes en forma subjetiva por fisiatra y con el Test de Barthel. Resultados: Se incluyeron 4 pacientes en el estudio (3 mujeres y 1 hombre), edad media 27 años (18-41). Todas las quemaduras fueron producidas por fuego. Índice de Barthel preoperatorio fue de 87,5 (levemente dependiente para las actividades de la vida diaria) y rango de movimiento moderadamente afectado. En el postoperatorio los pacientes fueron catalogados como independientes según el Test de Barthel y el rango de movimiento fue descrito como bueno o muy bueno por el fisiatra. No hubo complicaciones peri operatorias, Integra® prendió adecuadamente en todos los casos. Los pacientes fueron seguidos en promedio 16 meses (9-22). Conclusiones: Los sustitutos dérmicos han sido usados para la corrección de cicatrices de quemaduras con buenos resultados, pero no hay reportes en la axila. El pequeño número de pacientes que presentamos tienen un excelente resultado funcional, lo que nos estimula a seguir trabajando en este rumbo.

Quemaduras faciales: manejo inicial y tratamiento / Facial burns: initial management and treatment

Las quemaduras faciales constituyen un grupo dentro de las quemaduras consideradas como en zona especial dada las potenciales secuelas estéticas y funcionales que pueden resultar de su tratamiento, por este motivo, un adecuado manejo reducirá estos riesgos. La cara posee una rica irrigación de tal forma que el manejo deberá ser más conservador que en otras zonas del cuerpo. Las quemaduras superficiales requieren de un tratamiento basado en ungüentos antibióticos y cobertura con apósitos sintéticos transitorios en esperade epidermización. En quemaduras faciales profundas el tratamiento consistirá en escarectomía química y quirúrgica una vez definida la quemadura y su posterior cobertura con tejido autólogo o sustitutos dérmicos definitivos respetando las unidades estético-funcionales de la cara. Este grupo de quemadura luego de la primera atención deberá ser derivadaa un centro de quemados para su manejo integral.

Facial burns constitute a group within the burns considered as in special area given the potential aesthetic and functional sequel that can result from their treatment. For this reason, an appropriate management reduced these risks. The face has a rich irrigation in such a way that management should be more conservative than in other areas of the body. Superficial burns require a treatment based on antibiotic ointments and coverage with transient synthetic dressings in hopes of epimerization. In deep facial burns the treatment will be chemical and surgical scarectomy once defined the burn and its subsequent coverage with autologous tissue or dermal substitutes respecting the aesthetic and functional units of the face. This group of burn after the first attention must be referred to a burn center for integral management.

Quemaduras por frío: Revisión de 10 Años / Cold injuries in ten years

La injuria por frío ha sido objeto de estudio desde la década de 1960, Este trabajo entrega los resultados de una revisión retrospectiva de un grupo de 10 pacientes ingresados al Hospital del Trabajador de Santiago (HTS) en un periodo de 10 años producto de accidentes laborales de distintas etiologías. Cabe señalar que solo encontramos reportes aislados de casos en la literatura revisada. Se revisaron retrospectivamente las fichas clínicas de 10 pacientes en el periodo 1993-2003. Las edades fluctuaron entre los 17 y 68 años (27,6 años). Todos pacientes de sexo masculino. Las substancias líquidas y gaseosas frías causaron sus lesiones en su mayoría (90 por ciento), 1 paciente sufrió congelamiento por temperatura ambiental <-25º C. En cuanto a la profundidad de las lesiones, 3 pacientes presentaron quemaduras tipo A pura, en el resto el compromiso fue mixto con quemaduras A/AB (1 paciente), AB (3 pacientes), AB/B (2 pacientes), y B en 1 paciente al ingreso, según la clasificación de Benaim. El porcentaje de superficie corporal total (SCT) comprometida consignado (6 pacientes) fue de 1,6 por ciento en promedio. En todos los pacientes la lesión se circunscribió a las manos y solo en 1 hubo compromiso además de los antebrazos (4 por ciento SCT). El promedio de días de hospitalización fue de 9,1 días excluyendo a un paciente que se trasladó a EE.UU. al primer día de hospitalización. El tratamiento se realizó según el protocolo de manejo para quemaduras del Hospital del Trabajador de Santiago (HTS). De los pacientes que se sometieron a cirugía (4 pacientes) el promedio de intervenciones fue de 3,5 cirugías. Un paciente requirió de amputaciones digitales y otros 2 pacientes resultaron con secuela funcional al final del tratamiento.

Background: Cold injuries are usually caused by gases or liquids at very low temperatures or by exposure to extremely cold environments. Aim: To review the experience with cold injuries. Material and methods: Retrospective review of medical records of 10 patients admitted to Hospital del Trabajador with cold injuries, between 1993 and 2003. Results: All patients were male and their ages ranged between 17 and 68 years. Nine patients were injured by cold gases or liquids and one patient was exposed to an environmental temperature of -25 ºC. Three had solely type A burns, one had A/AB burns, three had AB/B burns and one, B burns. The mean injured body surface area was 1.6 percent. In all, lesions were restricted to the hands and only one had involvement of the forearms. Mean hospital stay was 9 days, excluding one patient that was transferred to United States on the first day of admission. Four patients required surgery and were subjected to a mean of 3.5 interventions. One patient required finger amputation and two had functional sequelae at the end of treatment. Conclusions: The objectives of the treatment of cold injuries should be to prevent sequelae, avoid amputations and obtain a rapid healing of lesions.

Divertículo de Zenker como causa de disfagia en el anciano / Zenker's diverticulum as a cause of dysphagia in elderly people

No disponible

Osteopoikilosis and chondrocalcinosis.

Osteopoikilosis is a benign and rare disorder characterized by abnormal calcium phosphate deposition in the articular cartilage. It usually is an incidental radiologic finding. Chondrocalcinosis is characterized by calcium pyrophosphate deposition in the articular cartilage. Both diseases can be asymptomatic. We describe some radiographic features that distinguish osteopoikilosis from other similar conditions and report a young female patient with osteopoikilosis associated with chondrocalcinosis. To the best of our knowledge, this is the first time these processes have been found in the same patient.

Colgajos adipofaciales como cobertura en miembro superior / Adipofacial flaps as covering in superior member

Las lesiones graves de extremidades superiores constituyen un serio desafío de reparación. A pesar de existir múltiples técnicas descritas es bueno incorporar nuevas posibilidades que pueden resolver problemas complejos. El tejido fasciosubcutáneo constituye una unidad anatómica independiente con irrigación rica y bien establecida que permite levantar con seguridad Colgajos Adipofasciales, de reciente aplicación en nuestro medio. Se presentan dos casos de déficit de cobertura en extremidades superiores utilizando Colgajos Adipofasciales con buen resultado. Caso 1: Desforramiento y quemadura profunda extensa de miembro superior derecho con fractura conminuta de codo expuesta. Caso 2: Quemadura eléctrica grave de mano derecha con exposición de tendón y superficie articular metacarpofálica. Los Colgajos Adipofasciales ofrecen múltiples ventajas que favorecen su uso como: Fácil y rápida disección, flexible, deja mínima secuela en zona dadora y permite una rehabilitación precoz reduciendo la estadía hospitalaria

[The function of the group tutorial in training human resources in public health]. / La función de la tutoría grupal en la formación de recursos humanos en salud pública.

Within the educational system, the method of group tutor was developed as a teaching strategy: the tutor goes along with a group of students to field training and works with them on the systematization and analysis of the study to obtain the final report. The purpose of this paper is to recuperate the work experience of the Department of Didactics of the School of Public Health of Mexico during 1991. A relevant conclusion is that this form of work needs to be studied and developed, since it demands a greater amount of independence from the students and requires a different participation from the teacher, both as coordinator and advisor.

Ileo biliar: presentación de 5 casos / Biliary ileus: presentation of 5 cases

Se presenta una revision retrospectiva de 5 pacientes femeninas mayores de 74 años con diagnostico de ileo biliar, tratadas en tres instituciones hospitalarias universitarias. Las caracteristicas clinicas y terapeuticas están acordes con los resultados de diversos estudios analizados. Se revisa la literatura referente al tema y se concluye como procedimiento quirurgico de eleccion la cirugia en un tiempo: enterolitotomia, colecistectomía, resección y reparacion de la fistula bilioenterica en los pacientes adecuadamente reanimados y preparados en el preoperatorio. Son de invaluable importancia en la conducta quirurgica elegida para cada paciente, los siguientes factores: edad, enfermedades asociadas, respuesta a la reanimacion, severidad del ileo, hallazgos locales en el area hepatobiliar y pericia del cirujano. La morbimortalidad sera la medida de la manera como se afronta cada uno de estos factores.

Tumor trofoblástico del lecho placentario de útero reporte de un caso / Placental site trophoblastic tumor of the uterus: report of the case

Describimos un caso de tumor trofoblástico del lecho placentario del útero haciendo énfasis en su patrón histopatológico, el cual fue diagnosticado en una paciente de veintiocho años, histerectimizada por hemorragia genital en su puerperio inmediato de un parto quirúrgico. Así mismo, hacemos comentario acerca del diagnóstico y manejo de esta entidad, luego de revisar bibliografia nacional e internacional