[Care for patients with altered states of consciousness in a hospital for chronic and long-stay patients]. / Atencion a pacientes con estados alterados de conciencia en un hospital de pacientes cronicos y larga estancia.

INTRODUCTION: Between 30% and 40% of patients with brain damage present alterations in their level of consciousness and, in some cases, altered states of consciousness: unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS). Recovery varies and survival is threatened by a number of complications. AIMS: The purpose of this study is to present the working methodology used at the Hospital La Pedrera (HLP) for patients in UWS or MCS and to analyse the clinical characteristics of the patients attended to, their progress, and the functional and cognitive situation at the time of their discharge from hospital. PATIENTS AND METHODS: The work consisted in a prospective descriptive study of patients seen at the HLP over the period 2009-2013, who had been diagnosed with UWS or MCS. RESULTS: The HLP uses the case management method, offering integrated care dispensed by a multidisciplinary team. Patients are classified according to healthcare goals. Patients with UWS or MCS are included in the integrated care and adaptation programme. A total of 23 patients (86.9% males) were attended to, the mean age being 54.9 years. Aetiology: brain haemorrhage, 30.4%; anoxic encephalopathy, 26.6%; metabolic encephalopathy, 17.3%; and other causes, 17.3%. Altogether 73.9% were admitted in UWS and the rest in MCS. COURSE: 43.4% improved their initial cognitive situation and 88.8% presented a situation of total dependence at the time of discharge. The most frequent complications were respiratory and urinary infections (53.6%). Death occurred in 65.2% of cases. CONCLUSIONS: Medical attention in UWS or MCS is complex and requires multidisciplinary care. Almost half of the patients improved their cognitive situation, which justifies a proactive attitude that attempts to improve the quality of life of both patients and their families.

TITLE: Atencion a pacientes con estados alterados de conciencia en un hospital de pacientes cronicos y larga estancia.Introduccion. Un 30-40% de los pacientes con daño cerebral presenta alteraciones del nivel de conciencia, y algunos casos, estados alterados de conciencia: sindrome de vigilia sin respuesta (SVSR) o estado de minima conciencia (EMC). La recuperacion es variable y la supervivencia esta amenazada por multiples complicaciones. Objetivos. Presentar la metodologia de trabajo del Hospital La Pedrera (HLP) para pacientes en SVSR o EMC y analizar las caracteristicas clinicas de los pacientes atendidos, la evolucion, y la situacion funcional y cognitiva en el momento del alta. Pacientes y metodos. Estudio descriptivo prospectivo de pacientes atendidos en el HLP durante el periodo 2009-2013, con diagnostico de SVSR o EMC. Resultados. El HLP trabaja mediante el metodo gestion de caso, ofreciendo una atencion integral por un equipo multidisciplinar. Los pacientes se clasifican segun objetivos asistenciales. Los pacientes con SVSR o EMC se incluyen en el programa de cuidados integrales y adaptacion. Se atendio a 23 pacientes (86,9% varones), con una edad media de 54,9 años. Etiologia: hemorragia cerebral, 30,4%; encefalopatia anoxica, 26,6%; encefalopatia metabolica, 17,3%; y otras causas, 17,3%. El 73,9% ingreso en SVSR y el resto en EMC. Evolucion: el 43,4% mejoro su situacion cognitiva inicial y el 88,8% presentaba una situacion de dependencia total en el momento del alta. Las complicaciones mas frecuentes fueron infecciones respiratorias y urinarias (53,6%). El 65,2% de los casos fueron exitus. Conclusiones. La asistencia en SVSR o EMC es compleja y precisa cuidados multidisciplinares. Casi la mitad de los pacientes mejoro su situacion cognitiva, lo que justifica una actitud proactiva que intente mejorar la calidad de vida de los pacientes y sus familias.

Atención a pacientes con estados alterados de conciencia en un hospital de pacientes crónicos y larga estancia / Care for patients with altered states of consciousness in a hospital for chronic and long-stay patients

Introducción. Un 30-40% de los pacientes con daño cerebral presenta alteraciones del nivel de conciencia, y algunos casos, estados alterados de conciencia: síndrome de vigilia sin respuesta (SVSR) o estado de mínima conciencia (EMC). La recuperación es variable y la supervivencia está amenazada por múltiples complicaciones. Objetivos. Presentar la metodología de trabajo del Hospital La Pedrera (HLP) para pacientes en SVSR o EMC y analizar las características clínicas de los pacientes atendidos, la evolución, y la situación funcional y cognitiva en el momento del alta. Pacientes y métodos. Estudio descriptivo prospectivo de pacientes atendidos en el HLP durante el período 2009-2013, con diagnóstico de SVSR o EMC. Resultados. El HLP trabaja mediante el método gestión de caso, ofreciendo una atención integral por un equipo multidisciplinar. Los pacientes se clasifican según objetivos asistenciales. Los pacientes con SVSR o EMC se incluyen en el programa de cuidados integrales y adaptación. Se atendió a 23 pacientes (86,9% varones), con una edad media de 54,9 años. Etiología: hemorragia cerebral, 30,4%; encefalopatía anóxica, 26,6%; encefalopatía metabólica, 17,3%; y otras causas, 17,3%. El 73,9% ingresó en SVSR y el resto en EMC. Evolución: el 43,4% mejoró su situación cognitiva inicial y el 88,8% presentaba una situación de dependencia total en el momento del alta. Las complicaciones más frecuentes fueron infecciones respiratorias y urinarias (53,6%). El 65,2% de los casos fueron exitus. Conclusiones. La asistencia en SVSR o EMC es compleja y precisa cuidados multidisciplinares. Casi la mitad de los pacientes mejoró su situación cognitiva, lo que justifica una actitud proactiva que intente mejorar la calidad de vida de los pacientes y sus familias (AU)

Introduction. Between 30% and 40% of patients with brain damage present alterations in their level of consciousness and, in some cases, altered states of consciousness: unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS). Recovery varies and survival is threatened by a number of complications. Aims. The purpose of this study is to present the working methodology used at the Hospital La Pedrera (HLP) for patients in UWS or MCS and to analyse the clinical characteristics of the patients attended to, their progress, and the functional and cognitive situation at the time of their discharge from hospital. Patients and methods. The work consisted in a prospective descriptive study of patients seen at the HLP over the period 2009-2013, who had been diagnosed with UWS or MCS. Results. The HLP uses the case management method, offering integrated care dispensed by a multidisciplinary team. Patients are classified according to healthcare goals. Patients with UWS or MCS are included in the integrated care and adaptation programme. A total of 23 patients (86.9% males) were attended to, the mean age being 54.9 years. Aetiology: brain haemorrhage, 30.4%; anoxic encephalopathy, 26.6%; metabolic encephalopathy, 17.3%; and other causes, 17.3%. Altogether 73.9% were admitted in UWS and the rest in MCS. Course: 43.4% improved their initial cognitive situation and 88.8% presented a situation of total dependence at the time of discharge. The most frequent complications were respiratory and urinary infections (53.6%). Death occurred in 65.2% of cases. Conclusions. Medical attention in UWS or MCS is complex and requires multidisciplinary care. Almost half of the patients improved their cognitive situation, which justifies a proactive attitude that attempts to improve the quality of life of both patients and their families (AU)

[Streptococcal toxic shock syndrome: ten years' experience at a tertiary hospital]. / Síndrome del shock tóxico estreptocócico: experiencia de los últimos 10 años en un hospital terciario.

INTRODUCTION: In the last two decades there has been a reported increase in the incidence of streptococcal toxic shock syndrome (STSS). The objective of this study was to determine the clinical and epidemiological characteristics of this infection. METHODS: Retrospective study of all cases of STSS diagnosed at a single tertiary hospital over the last ten years. RESULTS: We report 13 cases of STSS (8 men, mean age 62 years). The mean annual incidence was 0.19 episodes/100,000 population from 1994 to 1998 and 0.53 episodes/100,000 population from 1999 to 2003 (p = 0.059). All patients had at least one underlying disease and there were no intravenous drug users. The most common portals of entry were the skin and soft tissues (85%) and all but one patient had a positive blood culture. Two cases were nosocomial and five patients required surgery (amputation and/or debridement). There was a high mortality rate (85%) and a rapid course from onset to death; nine patients died within four days after establishing the diagnosis. CONCLUSION: The incidence of SSTS has increased over the last five years at our hospital. Elderly patients with underlying medical conditions were more susceptible to acquiring this infection. Early mortality was very high.

Síndrome del shock tóxico estreptocócico: experiencia de los últimos 10 años en un hospital terciario / Streptococcal toxic shock syndrome: ten years, experience at a tertiary hospital

Introducción. En las dos últimas décadas, diferentes estudios han señalado un aumento de la incidencia del síndrome del shock tóxico estreptocócico (SSTE). El objetivo de este estudio ha sido determinar las características clinicoepidemiológicas del SSTE en nuestro medio. Métodos. Estudio retrospectivo de los casos de SSTE diagnosticados en los últimos 10 años en un hospital terciario. Resultados. Se diagnosticaron 13 casos de SSTE (edad media: 62 años, 8 varones). La tasa de incidencia media anual entre 1994 y 1998 fue de 0,19 casos/100.000 habitantes, y entre 1999 y 2003, de 0,53 casos/100.000 habitantes (p 5 0,059). Todos los pacientes presentaron alguna enfermedad subyacente, pero ninguno fue adicto a drogas por vía parenteral. El foco de origen más frecuente se localizó en la piel y los tejidos blandos (85%). Hubo bacteriemia en 12 casos y la infección fue nosocomial en 2 casos; se realizó cirugía mayor (amputación y/o desbridamiento) en 5 casos. La mortalidad fue muy elevada (85%), y la mayoría (82%) fallecieron en los primeros 4 días tras el diagnóstico. Conclusión. La incidencia del SSTE aumentó en los últimos 5 años. Afectó sobre todo a pacientes de edad avanzada con importante comorbilidad y la mortalidad precoz fue muy elevada (AU)

Introduction. In the last two decades there has been a reported increase in the incidence of streptococcal toxic shock syndrome (STSS). The objective of this study was to determine the clinical and epidemiological characteristics of this infection. Methods. Retrospective study of all cases of STSS diagnosed at a single tertiary hospital over the last ten years. Results. We report 13 cases of STSS (8 men, mean age 62 years). The mean annual incidence was 0.19 episodes/100,000 population from 1994 to 1998 and 0.53 episodes/100,000 population from 1999 to 2003 (p 5 0.059). All patients had at least one underlying disease and there were no intravenous drug users. The most common portals of entry were the skin and soft tissues (85%) and all but one patient had a positive blood culture. Two cases were nosocomial and five patients required surgery (amputation and/or debridement). There was a high mortality rate (85%) and a rapid course from onset to death; nine patients died within four days after establishing the diagnosis. Conclusion. The incidence of SSTS has increased over the last five years at our hospital. Elderly patients with underlying medical conditions were more susceptible to acquiring this infection. Early mortality was very high (AU)

[Primary melanoma of the rectum: an infrequent neoplasia with an atypical presentation]. / Melanoma primario de recto: una neoplasia infrecuente con una forma de presentación atípica.

Primary anorectal melanoma is a rare malignancy with an extremely aggressive biological behaviour. The main clinical presentations are local symptoms such as rectal bleeding, anal mass or pain, or a change in bowel habits. The tumour is frequently mistaken for benign conditions as haemorrhoids or rectal polyps. Many treatments can be used: surgery, chemotherapy, radiotherapy, immunotherapy and even bio-therapy. Despite this, the disease has a very poor prognosis and 10% of patients survive 5 years.

Melanoma primario de recto: una neoplasia infrecuente con una forma de presentación atípica / Primary melanoma of the rectum: an infrequent neoplasia with an atypical presentation

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Primary anorectal melanoma is a rare malignancy with an extremely aggressive biological behaviour. The main clinical presentations are local symptoms such as rectal bleeding, anal mass or pain, or a change in bowel habits. The tumour is frequently mistaken for benign conditions as haemorrhoids or rectal polyps. Many treatments can be used: surgery, chemotherapy, radiotherapy, immunotherapy and even biotherapy. Despite this, the disease has a very poor prognosis and 5 years