RESUMEN
METHODS: In order to know the characteristics of these lesions in our environment and compare with those the adults, a transversal and descriptive study of adolescents between 12 and 18 years who were hospitalized for thoracic and lumbar fracture in two centers of high level trauma in our country for 8 years was performed. The variables studied were applied statistical analysis descriptive and correlation. RESULTS: They were found significant date by associating the causes of damage with associated lesions (p = 0.006) and the initial neurological damage associated with the final neurological damage (p = 0.000). DISCUSSION: They were registered seven teenagers with 10 fractures firearm, as rare cause of injury. An increase in the frequency of thoracic and lumbar fractures in adolescents with increasing age was found. The thoracic and lumbar fractures in adolescents caused by road accidents are associated with lesions in the chest and abdomen. And when are caused by falls are associated with lower extremity fractures. In addition, 13.5% of cases showed significant changes toward improvement in the initial neurological damage.
Asunto(s)
Vértebras Lumbares/lesiones , Fracturas de la Columna Vertebral/epidemiología , Vértebras Torácicas/lesiones , Traumatismos del Sistema Nervioso/epidemiología , Accidentes por Caídas/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Distribución por Edad , Niño , Femenino , Hospitalización , Humanos , Masculino , Fracturas de la Columna Vertebral/etiología , Traumatismos del Sistema Nervioso/etiologíaRESUMEN
UNLABELLED: OBJECT.: A previous study published by the authors showed that a single intervention could not change the baseline attitudes toward neurotrauma prevention. The present study was designed to evaluate the effectiveness of multiple interventions in modifying knowledge and attitudes for the prevention of neurotrauma in Brazilian preteens and adolescents. METHODS: In a randomized controlled trial, fifth-year primary school (PS) and second-year high school (HS) students were divided into a control and 2 intervention (single/multiple) groups. The study was conducted in the following 8 stages: T1, questionnaire to measure baseline characteristics; T2, lecture on trauma prevention; T3, reapplying the questionnaire used in T1; T4, Traffic Department intervention; T5, a play about trauma and its consequences; T6, Fire Department intervention; T7, Emergency Medical Service intervention; and T8, reapplying the questionnaire used in T1 and T3. Positive answers were considered those affirming the use of safety devices "always or sometimes" and negative as "never" using safety devices. RESULTS: The sample consisted of 535 students. Regarding attitudes, students in all groups at any stage of measurement showed protective behavior more than 95% of the time about seat belt use. There were only differences between attitudes in PS and HS students on T8 assessment concerning the use of safety equipment on bikes in the multiple-intervention group and concerning the use of safety equipment on skateboards and rollerblades in single- and multiple-intervention groups. These differences were caused mainly by the reduction in positive answers by the HS group, rather than by the increase in positive or protective answers by the PS group. However, there was no difference when the control and intervention groups were compared, independent of the attitudes or the student groups studied. The most important reason for not using protective devices was the belief that they would not get hurt. CONCLUSIONS: Multiple and different types of educational interventions, such as lectures, scenes from plays about trauma and its consequences, traffic and fire department intervention, and medical emergency intervention directed to preteens and adolescents from public and private schools did not modify most students' attitudes toward injury prevention. Clinical trial registration no: U1111-1121-0192 (National System of Ethics and Research in Brazil).
Asunto(s)
Prevención de Accidentes/métodos , Accidentes de Tránsito/prevención & control , Conductas Relacionadas con la Salud , Traumatismos del Sistema Nervioso/prevención & control , Adolescente , Actitud , Brasil , Niño , Femenino , Humanos , Masculino , Prevención Primaria/métodos , Estudios Prospectivos , Seguridad , Instituciones Académicas , Estudiantes/estadística & datos numéricos , Encuestas y Cuestionarios , Traumatismos del Sistema Nervioso/etiología , Insuficiencia del TratamientoRESUMEN
During implant placement and surgical practice, it is not uncommon the contact or the violation of the continuity of important nerve fibers from the region of the mouth, resulting in characteristic symptoms in patients. Such injuries can result in legal repercussions against the dental surgeon, who to avoid them shall establish specific actions in his proceeding. Purpose: The objectives of this study were to present a forensic case, emphasizing the legal care that the dentist must have in the course of treatment and to guide forensic dentistry experts during the expertise exam. Case description: In this case, the patient had complications after the autogenous bone graft surgery. The graft was resorbed, and the patient had hypoesthesia in the graft donor area. The dental surgeon had not informed her about the risks of surgery, and had not applied the Consent Form. With proof of damage, there was disruption of the doctor-patient relationship and patient sought rights in court. Conclusion: The correct diagnosis and planning, the prior written consent, including the risks of the procedure, and appropriate management of patients decrease the clinical and legal complications in cases of dental error. Similarly, the expert must have a competent clinical approach, performing the indicated and appropriated tests for the proper valuation of the damage generated...
Durante a prática cirúrgica e implantodôntica, não é raro ocorrer o contato ou a violação da continuidade de fibras nervosas importantes da região bucal, resultando em sintomas característicos nos pacientes. Tais injúrias podem resultar em repercussões legais contra o cirurgião dentista, que, para evitá-las, deve estabelecer medidas específicas durante sua atuação. Objetivo: O objetivo do trabalho foi apresentar um caso pericial, enfatizando os cuidados legais que o cirurgião-dentista deve ter no decorrer do tratamento, bem como orientar peritos da área durante o exame pericial. Descrição do caso: No caso relatado, a paciente apresentou complicações após cirurgia de enxerto ósseo autógeno para a colocação de implantes. O enxerto foi reabsorvido, e a paciente apresentou hipoestesia na região doadora do enxerto. O cirurgião dentista não a tinha informado sobre os riscos da cirurgia, e não houve aplicação de Termo de Consentimento. Com a comprovação do dano, ocorreu o rompimento da relação profissionalpaciente e a paciente procurou os direitos judicialmente. Conclusão: O correto diagnóstico e planejamento, o consentimento escrito prévio, incluindo os riscos do procedimento, e a adequada abordagem do paciente diminuem as complicações de natureza clínica e legal nos casos de erro odontológico. Da mesma forma, o perito deve ter uma abordagem clínica competente, realizando testes indicados e apropriados para a avaliação adequada do dano gerado...
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Implantación Dental/efectos adversos , Responsabilidad Legal , Complicaciones Posoperatorias , Trasplante Óseo/efectos adversos , Testimonio de Experto , Odontología Forense , Decisiones Judiciales , Traumatismos del Sistema Nervioso/etiologíaAsunto(s)
Humanos , Masculino , Adulto , Femenino , Persona de Mediana Edad , Anciano , Punción Espinal/efectos adversos , Anestesia Raquidea/efectos adversos , Anestesia Raquidea , Anestesia Raquidea/métodos , Aracnoiditis/terapia , Complicaciones Posoperatorias , Traumatismos del Sistema Nervioso/diagnóstico , Traumatismos del Sistema Nervioso/etiología , Traumatismos del Sistema Nervioso/terapia , Anestésicos Locales/efectos adversos , Antiinflamatorios/administración & dosificación , Fármacos Neuroprotectores/administración & dosificaciónAsunto(s)
Humanos , Masculino , Adulto , Femenino , Persona de Mediana Edad , Anestesia Raquidea , Anestesia Raquidea/efectos adversos , Anestesia Raquidea/métodos , Punción Espinal/efectos adversos , Antiinflamatorios/administración & dosificación , Fármacos Neuroprotectores/administración & dosificación , Anestésicos Locales/efectos adversos , Aracnoiditis/terapia , Complicaciones Posoperatorias , Traumatismos del Sistema Nervioso/diagnóstico , Traumatismos del Sistema Nervioso/etiología , Traumatismos del Sistema Nervioso/terapiaRESUMEN
Cuando se comparan las consecuencias de los accidentes anestésicos reclamados que constan en la base de datos del ASA CCP (Closed Claims Project), es significativo señalar que hubo un alto porcentaje de lesiones temporarias o no incapacitantes en los casos de anestesia regional (64 por ciento vs 46 por ciento p<0,05). Entre las lesiones incapacitantes permanentes derivadas de injurias del sistema nervioso periférico se hallan manifestaciones como la paraplejía y la cuadriplejía. Catorce de las reclamaciones legales asociadas con la paraplejía se debieron a síndromes de la anestesia espinal anterior. Los daños neurológicos permanentes fueron la causa más común de los daños incapacitantes, el más frecuente de los cuales (23 por ciento) fue asociado a bloqueos nerviosos para anestesia ocular (13 retrobulbares, 3 peribulbares) en los que hubo pérdida de la visión del ojo afectado. De todas maneras, se debe señalar que las complicaciones neurológicas como manifestaciones secundarias a la utilización de anestésicos locales para anestesia regional son muy poco frecuentes (0,02 y 0,07 por ciento de los casos), aunque es bastante común observar la aparición de manifestaciones neurológicas transitorias (entre 0,01 y 0,8 por ciento). La parestesia y el dolor durante la inyección son señales peligrosas ya que anuncian la posibilidad de la complicación. Se han descripto también abscesos peridurales y meningitis, en especial cuando se realizan bloqueos centrales con catéteres de pequeño diámetro a fin de alcanzar analgesia central para el dolor crónico. En la base de datos de la Mutual de Médicos Anestesiólogos de Buenos Aires están registradas las demandas realizadas contra anestesiólogos y los casos en los cuales los médicos, enfrentados a un incidente crítico, notifican la situación en previsión de una eventual demanda. Al igual que en el estudio de la ASACCP, desconocemos el número total de anestesia realizadas por los colegas adheridos. Hasta el 2004 hubo 339 notificaciones que incluyen 74 demandas, 24 causas penales y 50 causas civiles; 124 casos correspondieron a la anestesia regional, mientras que 215 formaron el grupo de pacientes que recibieron anestesia general. En 8 de los pacientes que presentaron radiculopatías se realizó una anestesia subaracnoidea con bupivacaína al 0,5 por ciento en solución hiperbara, habiéndose inyectado 15 mg (3 ml) de la solución anestésica...(AU)