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1.
Rev. ecuat. pediatr ; 23(2)15 de agosto 2022.
Artigo em Espanhol | LILACS | ID: biblio-1411199

RESUMO

Introducción: El hígado se lesiona con mayor frecuencia en un trauma de abdomen de alta energía, con una incidencia entre 1 % y 8 %. Las lesiones traumáticas de las vías biliares son muy raras. Casos clínicos: Presentamos dos pacientes con trauma hepático grave, y compromiso ex-trahepático vascular y de la vía biliar; y el abordaje quirúrgico para preservar funcional-mente ambos lóbulos: Masculino de 1 año, trauma hepático grado V, lesión incompleta de vena porta derecha, a nivel de la bifurcación y del conducto biliar hepático izquierdo. Se reparó el daño portal y de la vía biliar. Femenina de dos años, trauma cerrado de abdomen, lesión del parénquima de lóbulo derecho del hígado, sección total del conducto hepático izquierdo, y contusión pancreática asociada. En ambos casos se realizó una hepáticoyeyunostomía en Y de Roux y conservación de ambos lóbulos. Conclusión: En los traumas complejos hepáticos que involucran ambos lóbulos, la evolución depende de calidad de la masa residual. La cirugía conservadora con reconstrucciones vasculares y biliares, evita un fallo hepático agudo, permite ganar tiempo hasta la regeneración funcional del parénquima y proteger de una eventual insuficiencia hepática post-operatoria.


Introduction: The liver is more frequently injured in high-energy abdominal trauma, with an incidence between 1% and 8%. Traumatic injuries to the bile ducts are infrequent. Clinical cases: We present two patients with severe liver trauma and extrahepatic vascular and bile duct involvement and the surgical approach to preserve both lobes functionally: 1-year-old male, grade V liver trauma, incomplete injury to the right portal vein, at the level of the bifurca-tion and the left hepatic bile duct. The portal and bile duct damage was repaired. Two-year-old female, blunt abdominal trauma, injury to the parenchyma of the right lobe of the liver, whole section of the left hepatic duct, and associated pancreatic contusion. In both cases, a Roux-en-Y hepatic jejunostomy was performed, and both lobes were preserved. Conclusion: In complex liver trauma involving both lobes, the evolution depends on the quality of the residual mass. Conservative surgery with vascular and biliary reconstructions avoids acute liver failure, allows time to gain until the funct.


Assuntos
Humanos , Pré-Escolar , História do Século XX , Relatos de Casos , Anastomose em-Y de Roux , Criança , Fígado , Hepatectomia , Traumatismos Abdominais
2.
Trauma Surg Acute Care Open ; 6(1): e000758, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34869909

RESUMO

BACKGROUND: Hemorrhagic shock is a major cause of mortality in low-income and middle-income countries (LMICs). Many institutions in LMICs lack the resources to adequately prescribe balanced resuscitation. This study aims to describe the implementation of a whole blood (WB) program in Latin America and to discuss the outcomes of the patients who received WB. METHODS: We conducted a retrospective review of patients resuscitated with WB from 2013 to 2019. Five units of O+ WB were made available on a consistent basis for patients presenting in hemorrhagic shock. Variables collected included gender, age, service treating the patient, units of WB administered, units of components administered, admission vital signs, admission hemoglobin, shock index, Revised Trauma Score in trauma patients, intraoperative crystalloid (lactated Ringer's or normal saline) and colloid (5% human albumin) administration, symptoms of transfusion reaction, length of stay, and in-hospital mortality. RESULTS: The sample includes a total of 101 patients, 57 of which were trauma and acute care surgery patients and 44 of which were obstetrics and gynecology patients. No patients developed symptoms consistent with a transfusion reaction. The average shock index was 1.16 (±0.55). On average, patients received 1.66 (±0.80) units of WB. Overall mortality was 13.86% (14 of 101) in the first 24 hours and 5.94% (6 of 101) after 24 hours. DISCUSSION: Implementing a WB protocol is achievable in LMICs. WB allows for more efficient delivery of hemostatic resuscitation and is ideal for resource-restrained settings. To our knowledge, this is the first description of a WB program implemented in a civilian hospital in Latin America. LEVEL OF EVIDENCE: Level IV.

3.
Rev. méd. Hosp. José Carrasco Arteaga ; 13(1): 61-65, 15/03/2021. ilus
Artigo em Espanhol | LILACS | ID: biblio-1337904

RESUMO

INTRODUCCIÓN: Las apendicitis atípicas corresponden aproximadamente a un 39.2% de todos los casos de apendicitis. La apendicitis de ubicación típica inicia con un dolor agudo alrededor del ombligo que posteriormente migrará a la fosa ilíaca derecha; sin embargo, la condición de cada paciente debe ser orientada en detalles que surgen de una minuciosa anamnesis, contemplando los antecedentes del paciente y el desarrollo de la sintomatología. CASO CLÍNICO: Paciente masculino de 17 años, con antecedente de hepatectomía derecha hace 15 años. Acude con por dolor abdominal continuo de cinco días de evolución localizado en hipocondrio derecho, náusea, vómito y fiebre. En exámenes complementarios se evidenció: leucocitosis, neutrofilia, procalcitonina y PCR ambas elevadas. Tomografía fue sugerente de proceso inflamatorio en región torácica derecha baja e hipocondrio derecho. Se realizó una laparoscopía diagnóstica con conversión a laparotomía exploratoria; evidenciando líquido purulento en corredera parietocólica derecha, adherencias, plastrón apendicular en región sub y retro hepática derecha formado por ciego, íleon distal, epiplón y apéndice. Se realizó apendicetomía, lavado de cavidad y colocación de drenaje. EVOLUCIÓN: En el post-quirúrgico el paciente tuvo mala evolución clínica, con neumonía asociada a los cuidados de la salud, además con necesidad de una segunda intervención quirúrgica por formación de colección sub-hepática. Luego de 13 días de cuidados hospitalarios, luego de la segunda intervención quirúrgica, presentó adecuada recuperación y fue dado de alta médica. CONCLUSIÓN: El médico debe poseer una alta sospecha clínica de apendicitis de ubicación atípica ante cuadros de abdomen agudo; ya que cuando estos casos son subdiagnosticados se incrementa el riesgo de complicaciones, con perforación y peritonitis y con estancia hospitalaria prolongada. El tratamiento de primera elección frente a una apendicitis complicada es la intervención quirúrgica.


BACKGROUND: Atypical appendicitis corresponds to approximately 39.3% of all appendicitis cases. Typically located appendicitis begins with acute pain around the belly button, which will later migrate to the right iliac fossa; however, the patient's condition must be oriented in details that arise from a meticulous anamnesis, considering the patients history and the development of the symptoms. CASE REPORTS: 17-year-old male patient with history of right hepatectomy 15 years ago. He presented with five day evolution continuous abdominal pain, located in the right upper quadrant, nausea, vomiting and fever. Complementary laboratory tests evidenced: leukocytosis, neutrophilia, elevated procalcitonin and CRP. Tomography was suggestive of an inflammatory process in the lower right thoracic region and the right upper quadrant. A diagnostic laparoscopy was performed, it was converted into an exploratory laparotomy, showing purulent fluid in the right parietocolic gutter, adhesions, appendicular plastron in the right sub and retrohepatic region formed by the cecum, distal ileum, omentum and appendix. Retrohepatic appendix with perforation in the middle third, appendicular base and poor quality cecum. An appendectomy, cavity lavage was performed, with placement of a drain. EVOLUTION: During the postoperative period, the patient had a poor clinical evolution, with health care associated pneumonia, in addition to the need for a second surgical intervention due to the formation of a sub-hepatic collection. After 13 days of hospital care, after the second surgical intervention, he presented an adequate recovery and was discharged from the hospital. CONCLUSION: Physicians must have a high clinical suspicion of atypical location appendicitis in the presence of acute abdomen; since a late diagnosis of this cases increases the risk of complications, with perforation and peritonitis and prolonged hospital stay. The first-line treatment for complicated appendicitis is surgical intervention.


Assuntos
Humanos , Masculino , Adolescente , Apendicite/diagnóstico , Peritonite , Perfuração Intestinal , Laparotomia/métodos , Diagnóstico Diferencial , Complicações Intraoperatórias
4.
Rev. Fac. Cienc. Méd. Univ. Cuenca ; 34(1): 56-64, Mayo 2016. tab
Artigo em Espanhol | LILACS | ID: biblio-999887

RESUMO

Objetivo: Determinar los factores de riesgo para hipertensión arterial, su prevalencia y análisis multivariable en los conductores de taxis de la ciudad de Cuenca - Ecuador, 2014.Materiales y métodos: Estudio de prevalencia de corte transversal, desarrollado en conductores de taxis residentes en Cuenca - Ecua-dor. Con un universo de 3 594 taxistas, para la definición del tamaño de la muestra se consideró error de estimativa de 5% y confiabilidad y precisión de la muestra en 95%, acrecidos 15% para posibles pérdidas, resultando en 377 individuos. Previo consentimiento informado y para la obtención de los datos, se realizó la medición de peso, talla, índice de masa corporal y presión arterial, además se aplicó un formulario para determinar los posibles facto-res de riesgo. La información se analizó con el software SPSS 18.0.Resultados: La prevalencia de hipertensión arterial fue del 15.6%. Se asoció positivamente a: edad >45 años (razón de prevalencia - RP: 2.23, intervalo de confianza - IC (95%): 1.22- 4.06, p=0.005), índice de masa corporal >25 (RP: 3.19, IC: 1.19- 8.51, p=0.010), antecedentes familiares (RP 3.01. (IC: 1.83-4.96) y p=0.000), consumir más de 5 comidas al día (RP 3.50, IC: 2.22-5.50 y p= 0.000), agregar sal extra a la comida preparada (RP 2.00 IC: 1.26-3.18 y p=0.003), trabajar más de 8 horas (RP 1.51, IC: 1.32-1.81 y p = 0.005), estrés (RP 2.15, IC: 1.36- 3.41 y p= 0.001). Conclusión: La prevalencia de HTA en taxis-tas fue del 15.6%. Se determinó asociación significativa entre la HTA y factores de riesgo: IMC>25, antecedentes familiares, consumir >5 comidas al día, agregar sal extra a la co-mida preparada, trabajar >8 horas, inactivi-dad y estrés.


Objective: To determine risk factors for hypertension, its prevalence and multivariable analysis in taxi drivers in Cuenca - Ecuador, 2014.Materials and methods: It is a cross-sectional prevalence study, developed in taxis drivers' residents in Cuenca - Ecuador. With a universe of 3,594 taxi drivers, for defining the sample size, it was estimated an error of 5% and reliability and accuracy of the sample it was considered in 95%, a 15% accreted for possible losses, resulting in 377 individuals. Prior informed consent and to obtain data, measuring weight, height, body mass index and blood pressure were carried out and a form was applied to determine the possible risk factors. Data was analyzed using SPSS 18.0 software.Results: The prevalence of hypertension was 15.6%. It was associated positively: age> 45 years (prevalence ratio - RP: 2.23, confidence interval - CI (95%): 1.22- 4.06, p = 0.005), body mass index> 25 (RP: 3.19, CI: 1.19- 8.51, p = 0.010), family history (RP 3.01 (CI. 1.83-4.96) p = 0.000), consuming more than 5 meals a day (RP 3.50, CI: 2.22-5.50 p = 0.000), add extra salt to prepared food (RP 2.00 CI: 1.26-3.18 p = 0.003), work more than 8 hours (RP 1.51, CI: 1.32-1.81 p = 0.005), stress (RP 2.15, CI: 1.36- 3.41 and p = 0.001 ).Cconclusion: The prevalence of hypertension in taxi drivers was 15.6%. A significant association between hypertension and risk factors were determined: BMI> 25, family history, consuming> 5 meals a day, adding extra salt to prepared food, work> 8 hours, inactivity and stress.


Assuntos
Humanos , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Hipertensão , Comportamento Alimentar , Pressão Arterial , Estilo de Vida
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