Traumatismo ungueal, ¿qué es? y ¿cómo tratarlo? / Nail trauma, what is it? and how to treat it?

La placa ungueal es una capa de queratina que protege el dorso de los extremos distales de los dedos, tanto de las manos como de los pies. Es un aparato con funciones muy importantes, ya que estabiliza la porción distal del dedo y aporta resistencia al pulpejo, contribuyendo de esta manera en la manipulación de pequeños objetos y en el tacto fino. Los traumatismos ungueales constituyen un motivo de consulta en los servicios de urgencias tanto hospitalarias como de atención primaria, llegando a representar hasta el 8% de las urgencias de la mano. El tratamiento inadecuado de estos traumatismos puede generar importantes secuelas estéticas y funcionales, muy complejas incluso de corregir posteriormente (uñas distróficas, disminución de la discriminación entre 2 puntos...). Las 2 lesiones más frecuentes son el hematoma subungueal y la avulsión ungueal, con sus diferentes grados de afectación ósea subyacente

The nail plate is a layer of keratin that protects the back of the ends of the fingers and toes. It is a system with many important functions, since it stabilises the distal portion of the finger and toe and provides resistance to the fleshy part, thus contributing to the handling of small objects and fine sense of touch. Nail injuries are a reason for visits to Emergency Departments and Primary Care, representing up to 8% of hand emergencies. The inappropriate treatment of these injuries can lead to important aesthetic and functional sequelae. These can be very complex even to correct later (dystrophic nails, decrease in discrimination between 2 points...). The 2 most common lesions are subungual haematoma and subungual avulsion, with their different degrees of adjacent bone involvement

[Nail trauma, what is it? and how to treat it?] / Traumatismo ungueal, ¿qué es? y ¿cómo tratarlo?

The nail plate is a layer of keratin that protects the back of the ends of the fingers and toes. It is a system with many important functions, since it stabilises the distal portion of the finger and toe and provides resistance to the fleshy part, thus contributing to the handling of small objects and fine sense of touch. Nail injuries are a reason for visits to Emergency Departments and Primary Care, representing up to 8% of hand emergencies. The inappropriate treatment of these injuries can lead to important aesthetic and functional sequelae. These can be very complex even to correct later (dystrophic nails, decrease in discrimination between 2 points…). The 2 most common lesions are subungual haematoma and subungual avulsion, with their different degrees of adjacent bone involvement.

Perspectiva actual de la cirugía de las cardiopatías congénitas / Current perspective of congenital heart disease surgery

La cirugía cardiovascular pediátrica ha experimentado avances significativos en los últimos años, beneficiándose de los avances tecnológicos conseguidos no solo en la especialidad de la Cirugía Cardiovascular, sino también de los avances y la implicación de profesionales de Anestesia, Cuidados Intensivos, Neonatología y especialmente la Cardiología Pediátrica. Es muy amplio el espectro de pacientes que son intervenidos en nuestro ámbito asistencial: desde el neonato nacido pretérmino a las 24-25 semanas de gestación con ductus arterioso persistente hasta el adolescente o adulto joven con cardiopatía congénita que pudo ser o no intervenido durante su infancia y ha sido seguido evolutivamente hasta llegar a esa edad. Las intervenciones se centran preferentemente cada vez más en los grupos extremos de edad, con tendencia clara hacia la cirugía precoz y correctora en el primer año de vida. Por tanto una buena parte de los procedimientos son en la actualidad realizados en lactantes y neonatos. La progresiva mejora de resultados en los últimos años y la transparencia en el conocimiento y utilización de los mismos hace que en la actualidad el listón esté muy alto en cuanto a la exigencia en la mejora continua y la evaluación periódica de las distintas unidades. En este artículo describimos los avances más importantes que se han producido en los últimos años en el campo de la cirugía de las cardiopatías congénitas así como una breve mención de la actividad realizada en nuestro centro (AU)

Paediatric cardiac surgery has undergone significant improvements over the last years, due to the technological advances made in this area, as well as advances and implication of other disciplines, mainly Anesthesia, Intensive Care, Neonatology and especially Pediatric cardiology. There is a wide range of patients that are operated, from the premature baby with patent ductus arteriosus born at 24-25 weeks of gestation, to the grown-up congenital heart disease patient. Operations currently performed are focused on the end groups of age. There is a very clear tendency towards early corrective surgery; therefore most of interventions are done preferentially in neonates and infants. The btter outcomes that have been produced over the last years and the transparency of results have made most surgical groups take action towards continuous medical improvements and periodical evaluation of the different units. In this article the most important advances in the field of congenital heart surgery are described and a brief summary from our results is given (AU)

ICU outcomes in adult cardiac surgery patients in relation to ultrafiltration type.

Ultrafiltration (UF) is used to ameliorate the deleterious effects of cardiopulmonary bypass (CPB) in cardiac surgery patients. There are two different methods; conventional ultrafiltration (CUF), performed during CPB, and modified ultrafiltration (MUF), performed after CPB is finished. It has not been established which is better, and controversy remains regarding the optimal UF strategy. The objective of this study was to evaluate if MUF alone, or combined with CUF, could achieve greater fluid removal and contribute to better postoperative clinical outcomes. Also, the potential technique complications were studied. This was a prospective study which enrolled 125 consecutive adult patients receiving elective cardiac surgery with CPB. We analysed three treatment groups: MUF, CUF and both. Ultrafiltration was performed using a non-pulsatile CPB with a non-occlusive roller pump, Sarns 9000, and a polysulfone ultrafilter, Minntech. We studied pre- and intraoperative data and immediate postoperative clinical outcomes: total amount of drainage, transfusion needs, respiratory outcome, cardiac, renal and neurologic complications. Statistical analysis was performed using SPSS 11.0. All three groups were homogeneous and did not have differences in terms of demographic factors, previous history, risk scores, intervention and operative data. Volume of filtrate removal in the group which applied both techniques was larger than in the CUF or MUF groups alone (2569+/-823 vs 1679+/-651 vs 1398+/-353 ml, respectively, p=0.0001); however, despite this difference, there was no difference in the immediate postoperative fluid balances between the groups (596+/-1244 vs 880+/-1054 vs 986+/-1190 ml, p=0.30). Respiratory parameters and postoperative morbidity data analysed (total amount of drainage, transfusion needs, haemoglobin, acute lung injury, time with inotropes, ventricular failure, cardiogenic shock, neurologic complications and renal failure) were similar in all three groups, without statistical differences. Extubation time (10+/-7 vs 8.9+/-3 vs 9.4+/-7.9 hours, p=0.72) and ICU stay (56.6+/-72 vs 66.5+/-109 vs 44.2+/-25 hours, p=0.43) also were similar between the groups. We did not find any technique complication associated with any patient. In the present study, with adult patients receiving elective cardiac surgery, the combined ultrafiltration group had a larger fluid removal. However, neither type of ultrafiltration nor amount of filtered volume was accompanied by different postoperative ICU clinical outcomes. Ultrafiltration was considered a safe and reliable technique, with no related complications.

Faloplastia en un cambio de sexo de mujer a hombre con un colgajo sensible pediculado anterolateral de muslo / Phalloplasty in female –to– male transsexual with a sensate pedicled anterolateral thigh flap

Se presente un caso clínico de faloplastia con un colgajo sensible anterolateral de muslo pediculado en un transexual mujer a hombre. El colgajo permite la construcción de pene y uretra en un único tiempo quirúrgico, con una zona donante razonablemente ocultable. Aunque el colgajo libre antebraquial radial es la técnica de elección en la construcción peneana, el colgajo anterolateral de muslo podría ser una excelente alternativa en pacientes que desestimen la cicatriz antebraquial, superior en nuestra opinión al resto de opciones pediculadas (AU)

We describe a phalloplasty with a sensate pedicled anterolateral thigh flap in a female to male transsexual. The flap allows the construction of penis and urethra in one stage with a conceivable donor scar. Although the radial forearm flap is the technique of choice in most phalloplasties, the sensate pedicled anterolateral thigh flap might be an excellent alternative in those patients reluctant to the forearm scar (AU)