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BACKGROUND: Reported risk of bleeding complications after central catheter access in patients with thrombocytopenia is highly variable. Current guidelines recommend routine prophylactic platelet (PLT) transfusion before central venous catheter placement in patients with severe thrombocytopenia. Nevertheless, the strength of such recommendations is weak and supported by observational studies including few patients with very low PLT counts (<20 × 109 /L). This study aims to assess the risk of bleeding complications related to using or not using prophylactic PLT transfusion before ultrasound-guided central venous access in patients with very low PLT counts. METHODS: This was a retrospective cohort study of patients with very low PLT counts (<20 × 109 /L) subjected to ultrasound-guided central venous catheterization between January 2011 and November 2019 in a university hospital. Bleeding complications were graded according to the Common Terminology Criteria for Adverse Events. A multivariate logistic regression was conducted to assess the risk of major and minor bleeding complications comparing patients who did or did not receive prophylactic PLT transfusion for the procedure. Multiple imputation by chained equations was used to handle missing data. A two-tailed p < 0.05 was considered statistically significant. RESULTS: Among 221 patients with very low PLT counts, 72 received prophylactic PLT transfusions while 149 did not. Baseline characteristics were similar between transfused and nontransfused patients. No major bleeding events were identified, while minor bleeding events were recognized in 35.7% of patients. Multivariate logistic regression analysis showed no significant differences in bleeding complications between patients who received prophylactic PLT transfusions and those who did not (odds ratio 0.83, 95% confidence interval 0.45-1.55, p = 0.567). Additional complete case and sensitivity analyses yielded results similar to those of the main analysis. CONCLUSIONS: In this single-center retrospective cohort study of ultrasound-guided central venous access in patients with very low PLT counts, no major bleeding was identified, and prophylactic PLT transfusions did not significantly decrease minor bleeding events.

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BACKGROUND: Radial arterial catheters (RAC) are commonly used in emergency services and intensive care units (ICU) for continuous invasive monitoring of blood pressure and arterial blood gas sampling. Complications associated with RAC are rare. Regarding length of RAC catheters and complications, few studies were found in the literature. The present study seeks to provide health care professionals with scientific evidence to select an optimal length of RAC, based on the difference in the incidence of complications between ultrasound-guided catheters of the same diameter but different lengths. METHODS: Observational, descriptive, retrospective study. Patients older than 17 years admitted to the emergency department or ICU were included. RAC were placed with diameters of 20 gauge, between 5 and 8 cm (Arrow-Teleflex), and 22 gauge diameters between 4 and 8 cm (Vygon). Univariate analysis was made to determine behavior of the numerical variables. Normality of variables was determined through a Shapiro-Wilk-test. Qualitative variables were expressed in percentages, quantitative variables in means and standard deviation, or with median and quartiles in the case of a non-normal distribution. Chi-square or Fisher method was used for qualitative variables and the t-test for symmetric quantitative variables. Asymmetric distributions were processed with the Mann-Whitney U test. A value p < 0.05 was considered statistically significant. The statistical analysis was performed with Stata 14.1 program. RESULTS: About 793 RAC were placed between 2016 and 2019 were included, median age was 60 (37-73) (RIQ) years, 49% male. Complications were reported in all groups on average 17.5%, the most frequent being dysfunction/occlusion of the catheter. Given complications of the same diameter and different catheter lengths, there were no statistical differences between groups. CONCLUSION: Selecting one length or another with a catheter of the same diameter does not have statistically significant differences, in terms of the complications this device may cause-meaning that size does not matter.

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Background: The use of implantable cardiac devices in patients with sudden cardiac arrest has contributed to their survival. Aim: To determine the survival rate at 30 days and one year after hospital discharge of patients who had a cardiac arrest with subsequent placement of an implantable cardiac device. Material and Methods: Twenty-three patients older than 18 years who presented sudden extra-institutional or intra-institutional death with subsequent implantation of an implantable cardiac device and whose survival was recorded at 30 days and one year, were included. A univariate analysis was performed. Results: Eighteen patients had an extra institutional cardiac arrest. All patients were discharged alive. We could not ascertain the health status of one patient at follow-up. Twenty-one patients had a Cerebral Performance Category (CPC) of 1 at discharge. One patient died of a stroke within 30 days and one patient died due to an arrhythmic electrical storm one year later. Twenty patients survived at least one year after hospital discharge. Conclusions: Survival at 30 days and one year, was high in patients with sudden death or cardiac arrest who required intracardiac devices.

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BACKGROUND: The use of implantable cardiac devices in patients with sudden cardiac arrest has contributed to their survival. AIM: To determine the survival rate at 30 days and one year after hospital discharge of patients who had a cardiac arrest with subsequent placement of an implantable cardiac device. MATERIAL AND METHODS: Twenty-three patients older than 18 years who presented sudden extra-institutional or intra-institutional death with subsequent implantation of an implantable cardiac device and whose survival was recorded at 30 days and one year, were included. A univariate analysis was performed. RESULTS: Eighteen patients had an extra institutional cardiac arrest. All patients were discharged alive. We could not ascertain the health status of one patient at follow-up. Twenty-one patients had a Cerebral Performance Category (CPC) of 1 at discharge. One patient died of a stroke within 30 days and one patient died due to an arrhythmic electrical storm one year later. Twenty patients survived at least one year after hospital discharge. CONCLUSIONS: Survival at 30 days and one year, was high in patients with sudden death or cardiac arrest who required intracardiac devices.

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BACKGROUND: Tracheobronchial injury is one of the least common injuries in the scenario of blunt chest trauma. However, around 81% of patients with airway injury die immediately or before arriving at the emergency department due to tension pneumothorax. It presents with non-specific signs and symptoms challenging prompt diagnosis. CASE PRESENTATION: A 15-year-old adolescent who was riding a bicycle suffered an accident when he fell down a cliff, approximately 5 m deep. Upon admission to the emergency department, he presented with signs of respiratory distress. The airway was secured and a thoracoabdominal angiography was performed. The image reported pneumomediastinum, a small right pneumothorax, areas of pulmonary contusion, and an image of loss of continuity in the anterior superior wall of the right main bronchus highly suggestive of bronchial rupture. The bronchial lesion was then confirmed by fiberoptic bronchoscopy. Taking into account the patient's characteristics, conservative management was chosen, and the patient was transferred to the intensive care unit (ICU) where protective tracheal intubation was performed. CONCLUSIONS: A delay in diagnosis increases the rate of complications, mainly infectious complications and the formation of granulation tissue that could potentially obstruct the airway, impacting the patient's outcome. The first step in the management of these patients is securing the airway, which should be done immediately. The gold standard for the diagnosis and characterization of airway injuries is bronchoscopy as it is the most effective tool to assess topography, extent, and depth of the lesion.

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BACKGROUND: The laparoscopic cholecystectomy has allowed the detection of an increasing number of incidental gallbladder cancers (IGBC). Although laparoscopy is employed in the management of a variety of abdominal tumors, its use in gallbladder cancer is reduced and controversial. This study analyzes the role of laparoscopy in gallbladder cancer with the focus in IGBC. METHOD: We evaluated our prospective series of 51 patients with an IGBC who were treated by laparoscopy between 2006 and 2016 at the Clinica Alemana in Santiago, Chile. RESULTS: The series comprised 7 men and 44 women. Age ranged from 43 to 76 years (mean age 60). Regarding wall involvement, 29 patients had a T2 tumor, which was the most common. 8 and 14 patients had T1b and T3 tumors, respectively. Of the patients, 17 underwent only laparoscopic exploration. This was due to the presence tumor dissemination not being observed in the preoperative staging. 10 patients had to be converted to complete the resection, whereas 24 patients were laparoscopically resected. The quality of the resected material was not different between those who were converted and those who were treated by laparoscopy. In the laparoscopic group, the average number of harvested lymph nodes was 7.9, not statistically different from the converted group. The mean of hospital stay in the laparoscopic group (4.3 days) was significantly lower than the converted group. CONCLUSIONS: Laparoscopy has been shown to be a safe and feasible method for the management of IGBC. This method not only allows for a complete exploration, identifying a previously unseen residual tumor, but also makes it possible to accomplish the same oncology objectives as the open procedure. Therefore, laparoscopy should be considered a valid alternative in the management of IGBC.

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Objetivo Desarrollar un instrumento destinado a evaluar las estrategias de afrontamiento ante la enfermedad crónica en población adolescente. Sujetos y método Con base a una revisión teórica y entrevistas semiestructuradas a adolescentes, se construye un cuestionario que es finalmente evaluado por jueces expertos en tanto comprensión, pertinencia y viabilidad. Resultados Se propone una escala compuesta por 60 reactivos agrupados en 12 familias de afrontamiento. Conclusión La escala puede ser una herramienta útil para un clínico al entregar información clave sobre la vivencia y las formas de afrontar la enfermedad en un adolescente.

Objective To develop a tool to evaluate coping strategies for chronic illness in adolescents. Subjects and method Based on a theoretical review and semi-structured interviews with adolescents, a questionnaire was prepared that was finally evaluated by judges experienced in in understanding, relevance and viability. Results A scale is proposed that consists of 60 items grouped into 12 coping families. Conclusion The scale may be a useful clinical tool to provide key information about the experience and ways to cope with illness in adolescents.

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OBJECTIVE: To develop a tool to evaluate coping strategies for chronic illness in adolescents. SUBJECTS AND METHOD: Based on a theoretical review and semi-structured interviews with adolescents, a questionnaire was prepared that was finally evaluated by judges experienced in in understanding, relevance and viability. RESULTS: A scale is proposed that consists of 60 items grouped into 12 coping families. CONCLUSION: The scale may be a useful clinical tool to provide key information about the experience and ways to cope with illness in adolescents.

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Background:Overexpression/amplification of the HER2 gene in advanced gastric cancer is a predictor of response to adjuvant therapy with monoclonal antibodies.Aim: To determine the frequency of HER2 gene overexpression and amplificationin advanced gastric cancer. Material and Methods: One hundred nine advancedgastric cancer biopsy specimens, from 76 men and 33 women aged 67 ± 14 and 62± 12 years respectively, were selected. Three histological patterns (diffuse, intestinaland mixed) were recognized. Automated immunohistochemistry was performedwith monoclonal c-erbB-2 (NCL-356) Novocastra. Fluorescent in situ hybridization (FISH) for HER2 was performed in positive cases. Results: In 39% of cases,immunohistochemical staining was negative. It was 1+, 2+ and 3+ positive in 15,36 and 11% of cases, respectively. It was positive in 16% and 3% of intestinal typeand mixed carcinomas, respectively. It was negative in all diffuse carcinomas. FISHwas performed in 39 (2 +) cases and in 11 (3 +) cases. The gene amplification waspositive in two (2 +) and 11 (3 +) cases (11.9%). The overall concordance betweenimmunohistochemical staining and in situ hybridization was 85%. Conclusions: Inadvanced gastric cancer, HER2 gene overexpression or amplification was observed in11% and 12% of cases, respectively.

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BACKGROUND: Overexpression/amplification of the HER2 gene in advanced gastric cancer is a predictor of response to adjuvant therapy with monoclonal antibodies. AIM: To determine the frequency of HER2 gene overexpression and amplification in advanced gastric cancer. MATERIAL AND METHODS: One hundred nine advanced gastric cancer biopsy specimens, from 76 men and 33 women aged 67 ± 14 and 62 ± 12 years respectively, were selected. Three histological patterns (diffuse, intestinal and mixed) were recognized. Automated immunohistochemistry was performed with monoclonal c-erbB-2 (NCL-356) Novocastra. Fluorescent in situ hybridization (FISH) for HER2 was performed in positive cases. RESULTS: In 39% of cases, immunohistochemical staining was negative. It was 1+, 2+ and 3+ positive in 15, 36 and 11% of cases, respectively. It was positive in 16% and 3% of intestinal type and mixed carcinomas, respectively. It was negative in all diffuse carcinomas. FISH was performed in 39 (2 +) cases and in 11 (3 +) cases. The gene amplification was positive in two (2 +) and 11 (3 +) cases (11.9%). The overall concordance between immunohistochemical staining and in situ hybridization was 85%. CONCLUSIONS: In advanced gastric cancer, HER2 gene overexpression or amplification was observed in 11% and 12% of cases, respectively.

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El el Hospital Juan XXIII, respecto a la etiología más frecuente, la coxalgia, se constata que la más alta incidencia está en la artritis séptica de cadera, por lo general en lsa edades de 1 a 3 años, siendo los gérmenes más frecuentes el Stafilococo y el Streptococo

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