RESUMO
RESUMEN La hemorragia hepática espontánea (HHE) es una afección rara que resulta de una lesión en el parénquima hepático producida sin una causa externa. Presentamos el caso de una mujer de 74 años que, durante una internación por reagudización de su enfermedad pulmonar obstructiva crónica (EPOC), desarrolla episodio de hemorragia hepática espontánea que evoluciona a shock hemorrágico. Se realiza cirugía con resección atípica de carcinoma hepatocelular (HCC) con hemorragia activa en segmento III hepático. La paciente responde al tratamiento inicial, pero a los 16 días posoperatorios fallece en Unidad de Terapia Intensiva (UTI) debido a una afección respiratoria.
ABSTRACT Spontaneous hepatic hemorrhage (SHH) is a rare condition resulting from a breach in the hepatic parenchyma that occurs without an external cause. We report the case of a 74-year-old woman who, while being hospitalized due to exacerbation of chronic obstructive pulmonary disease (COPD), presented an episode of SHH with hemorrhagic shock. She underwent atypical resection of a hepatocellular carcinoma (HCC) with active bleeding in liver segment III. The patient had a favorable response to the initial treatment but died in the intensive care unit (ICU) on postoperative day 16 due to a respiratory tract complication.
RESUMO
RESUMEN Antecedentes: el manejo no operatorio del traumatismo hepático cerrado es exitoso en el 95% de los pacientes hemodinámicamente normales. Las lesiones de alto grado presentan una tasa de complicaciones de hasta un 14%, y una mortalidad del 27% cuando requieren cirugía abierta. Material y métodos: estudio descriptivo de informe de casos. Resultados: 3 casos con traumatismo hepático de alto grado. "A": manejo no operatorio inicial, lavado laparoscópico por hemoperitoneo sintomático, drenaje percutáneo de absceso hepático, recambio de catéter y CPRE, por fístula biliar persistente. "B": cirugía de control de daño inicial sin hepatectomía, drenaje percutáneo de absceso hepático y posterior recambio. "C": manejo no operatorio inicial, lavado laparoscópico por hemoperitoneo sintomático, posterior drenaje percutáneo de absceso hepático y recambio de drenajes. No presentaron mortalidad. Conclusión: estos casos resumen la utilización de las diferentes modalidades del manejo del traumatismo hepático cerrado y la posibilidad del manejo mininvasivo de las complicaciones.
ABSTRACT Background: Nonoperative management of blunt hepatic trauma is successful in 95% of hemodynamically stable patients. The complication rate of high-grade injuries is 14% and mortality reaches 27% when they require open surgery. Material and methods: We conducted a descriptive study of case reports. Results: Three cases of high-grade hepatic trauma are reported. "A": initial nonoperative management, laparoscopic lavage due to symptomatic hemoperitoneum, percutaneous drainage of liver abscess, catheter replacement and ERCP due to persistent biliary fistula. "B": initial damage control surgery without liver resections, percutaneous drainage of liver abscess and catheter replacement. "C": initial nonoperative management, laparoscopic lavage due to symptomatic hemoperitoneum, percutaneous drainage of liver abscess and catheter replacement. None of the patients died. Conclusion: These cases summarize the use of different management modalities of blunt hepatic trauma and the possibility of minimally invasive management of the complications.
Assuntos
Humanos , Adulto , Adulto Jovem , Infecções por Acinetobacter , Procedimentos Cirúrgicos Minimamente Invasivos , Fígado/lesões , Epidemiologia Descritiva , Laparoscopia , Lacerações/complicações , Lacerações/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Traumatismos Abdominais/complicações , Abscesso Hepático/diagnóstico por imagemRESUMO
Althought it may vary between countries, since the prostate specific antigen screening era, metastasic prostate cancer at diagnosis accounts for approximately 10% of cases. Intracranial dural metastases are uncommon, but when present they may lead to an increase in intracranial pressure that can subsequently damage intracranial structures, such as the cranial nerves. Prolonged intracranial hypertension can cause optic nerve ischemia, leading to progressive and irreversible vision loss if untreated, hence the importance of anamnesis, complete physical examination, and clinical suspicion.
RESUMO
Psychological aggression is a widespread form of abuse in dating relationships, especially in collectivist societies with ties to patriarchal beliefs. Despite the prevalence of psychological aggression, it has seldom been studied in connection with known antecedents of interpersonal violence, including dominance, attitudes supportive of violence, and violence socialization processes during childhood. The present study sought to test relationships among these variables in young men and women. A total of 500 Mexican undergraduate students in northern Mexico reported on their experiences with psychological aggression, the dominance of a dating partner, and violent socialization during childhood, as well as on their approval of violence within and outside the family. The results indicate that the dominance of a dating partner is directly linked to male and female intimate partner violence (IPV) perpetration. Violent socialization and proviolent attitudes appear to be related to female dominance. Female and male psychological aggression victimization was predicted by the participant's own perpetration. In general, a dyadic approach appears to be useful for explaining psychological aggression perpetration and victimization in a collectivist society, in light of recent changes in normative beliefs held by young educated Mexicans. Implications for future research and public policy are discussed.
Assuntos
Vítimas de Crime , Violência por Parceiro Íntimo , Agressão , Atitude , Criança , Feminino , Humanos , Masculino , México , Socialização , ViolênciaRESUMO
A solid-phase extraction method is presented for micro-extraction of three progestins (levonorgestrel, 19-norethisterone acetate and medroxyprogesterone acetate) from water samples. A mini-column was packed with 60 mg of oxidized multiwalled carbon nanotubes and coupled to a flow injection assembly. The extraction parameters, such as washing solution, eluent type, eluent volume, flow rate and sample volume, were optimized. Separation and determination were performed by HPLC with UV detection. The method has a good linear range (0.90-9.0 µg L-1), acceptable limits of detection (0.05-0.14 µg L-1) and low RSDs (0.8-4.6%). Attractive features of the method include low consumption of organic solvents and preconcentration factors of up to 100. The method was applied to analyze stream, underground and effluent water samples, and recoveries between 74 and 121% were obtained. Graphical abstractSchematic representation of the flow injection assembly couples to an ox-MWCNTs extraction column used to perform the solid phase extraction procedure of progestins in environmental water samples.
RESUMO
This study explored patterns of controlling behavior, physical violence, and attitudes toward social limits in young Mexican university students in light of the effect that socialization processes have in attitudes toward social norms and violent behavior as indicated in some of the literature. A total of 437 male and female heterosexual participants residing in Ciudad Juárez, Mexico, provided information on their perpetration/victimization experiences of controlling behavior (by means of the Controlling Behaviors Scale) and physical violence (using the Revised Conflict Tactics Scales [CTS2]) and their attitudes toward social limits (using the Attitudes Toward Social Limits scale). Results indicate similar chronicity levels of experienced controlling behavior and physical violence perpetration/victimization between the sexes. Participants expressed major tendency to adjust to a social norm rather than overstepping it. Males tend to overstep social limits more often than females, although no significant linear relationship was found between abusive behavior and attitudes promoting the infringement of social norms. Higher chronicity levels were rather found by dyadic type, relationships with mutual physical intimate partner violence (IPV), and controlling behavior in comparison with relationships where unidirectional violence prevails. Implications of findings involve the acknowledgment of change in dynamics used by more educated young Mexicans, and the recognition of IPV in these populations as a heterogeneous phenomenon for primary and secondary interventions.
Assuntos
Atitude , Violência por Parceiro Íntimo/psicologia , Comportamento Social , Normas Sociais , Estudantes/psicologia , Adolescente , Feminino , Identidade de Gênero , Humanos , Masculino , México , Universidades , Adulto JovemRESUMO
Parotid gland hemangiomas represent <0.6% of the total tumors of the gland and there are <50 tumors reported during adult age, so there is no standard treatment. A 18-year-old female presents with a mass in the right parotid gland of 18 months of a slow progressive asymptomatic growth; on physical examination, only the mass was detected. An angiography was performed, and it reported a possible hemangioma that depends on the right internal maxillary artery and right facial artery and was not suitable for embolization. Total parotidectomy was performed with prior ligation of the right external carotid artery, complete resection was achieved and preservation of the facial nerve and all branches with minimal loss of blood (150 cc). External carotid artery ligation is a safe technique that can be considered in carefully selected patients with vascular tumors that affect the head and neck to achieve a clean and safe surgery with minimal sequels.
RESUMO
BACKGROUND: The 25% of traumatic deaths are due to chest trauma with a mortality of 28%, and closed trauma is the most common mechanism of injury. The use of firearms increases the relative risk of death. The five more frequent specific chest injuries are lung contusion (31.8%), hemothorax/pneumothorax (19.4%), rib fractures (13.2%), and diaphragmatic injury (7.5%). CLINICAL CASE: Patient of 25 years with a single firearm projectile wound in the chest who assisted to the emergency room (ER) with significant respiratory distress and meriting surgical emergency airway, documenting double pneumothorax, aortic laceration and rupture of the trachea, which required management in the ER with bilateral chest tube placement and subsequent surgical repair. CONCLUSION: Anatomical and pathophysiological knowledge and the standardized management of the international guidelines are the key to keep a high level of suspect with a patient with chest penetrating trauma. Besides they improve the possibility of diagnosis and timely treatment.
Introducción: el 25% de las muertes traumáticas son secundarias a trauma de tórax con una mortalidad de 28%. De estas, el trauma cerrado es el mecanismo de lesión más común, en el que el uso de armas de fuego eleva el riesgo relativo. Las cinco lesiones especificas de tórax mas frecuentes son la contusión pulmonar (31.8%), el hemotórax/neumotórax (19.4%), la fractura costal (13.2%) y la lesión diafragmática (7.5%). Caso clínico: paciente de 25 años con herida por único proyectil de arma de fuego en tórax, la cual le condicionó dificultad respiratoria importante y ameritó vía aérea quirúrgica de urgencia. Se documentó doble neumotórax, laceración aórtica y ruptura de traquea, lo cual requirió manejo en la sala de Emergencias con colocación de sonda endopleural bilateral y posterior reparación quirúrgica. Conclusión: el conocimiento anatómico y fisiopatológico y el manejo estandarizado con guías internacionales son la base para mantener un elevado índice de sospecha ante un paciente con trauma penetrante de tórax. Además, mejoran la posibilidad de diagnóstico y tratamiento oportuno.
Assuntos
Pneumotórax/etiologia , Ferimentos por Arma de Fogo/complicações , Adulto , Humanos , Masculino , Pneumotórax/diagnóstico , Ferimentos por Arma de Fogo/diagnósticoRESUMO
INTRODUCCIÓN: pocos estudios exploran la percepción de los pacientes sobre su seguridad de atención y, en general, lo hacen desde la perspectiva de la calidad de atención y la satisfacción respecto a los cuidados recibidos. OBJETIVOS: Describir la percepción de los pacientes sobre su seguridad durante la estadía hospitalaria. MÉTODOS: Se realizó un estudio cualitativo con técnica de gruposfocales. Se incluyó a pacientes internados durante 2010 en doshospitales de la ciudad de Bahía Blanca, convocados telefónicamente a partir de un muestreo no probabilístico. RESULTADOS: Se realizaron cuatro grupos focales con un total de 28 pacientes. Se definieron dimensiones y categorías con los conceptos aportados por los participantes. Se construyó una matriz en la que se volcaron los datostranscriptos. El criterio de análisis fue la espontaneidad, el consenso y eldisenso. Las dimensiones definidas fueron: relación equipo de salud paciente; derechos del paciente; calidad del proceso de atención; vulnerabilidad percibida; eventos adversos y error. CONCLUSIONES: Los resultados obtenidos son exploratorios y no generalizables. La investigación permitió explorar, describir y comprender vivencias y perspectivas de los pacientes, profundizando acerca de su percepción sobre la seguridad en el sistema de salud y su forma de comunicarla. Los hallazgos proporcionan la base metodológica para desarrollar iniciativas destinadas a mejorar la seguridad en entornos de salud.
INTRODUCTION: few studies explore patients perception about health care safety. In general, they considerthe perspective of quality of care and satisfaction with received treatment. OBJECTIVES: To describe the perception of patients about their safety during hospital stay. METHODS: A qualitative study with focus group technique was performed. It included patients admitted in 2010 in two hospitals of Bahía Blanca city, who were invited by phone from anon-probabilistic sample. RESULTS: A total of 28 patients participated in four focus groups. Dimensions and categories were defined using concepts provided by the participants. A matrix was built for data transfer. The analysis criteria were spontaneity, consensus and dissent. The defined dimensionswere: health care team-patient relationship; patient´s rights; quality of care; perceived vulnerability; error and adverse events. CONCLUSIONS: The results are exploratory and notgeneralizable. The research allowed to explore, describe and understand patients experiences and perspectives,deeply examining their perception of health care safety and their way to communicate it. These findings provide the methodological basis to develop initiatives for improving safety in health environments.
Assuntos
Humanos , Segurança do Paciente , Pacientes , Percepção , Qualidade da Assistência à SaúdeRESUMO
Introducción: La seguridad del paciente ha adquirido gran relevancia en los últimos años. Involucrar a los pacientes en los diferentes aspectos de la sanidad puede mejorar la seguridad y el servicio prestado. Existen diferentes cuestionarios relacionados con la percepción del paciente en cuanto a la seguridad de servicios sanitarios. El Ministerio de Sanidad y Política Social de España validó en 2009 un instrumento. Objetivo: Describir la percepción de seguridad de los pacientes respectos a la atención sanitaria recibida durante su internación. Materiales y Métodos: Estudio cuantitativo descriptivo de corte transversal realizado en dos hospitales de la ciudad de Bahía Blanca. Muestreo no probabilístico, por conveniencia. Se encuestaron a 35 pacientes mediante el "Cuestionario sobre la percepción de seguridad de la atención sanitaria en el ámbito hospitalario", heteroadministrado. Resultados: de 24 encuestas, el puntaje obtenido fue una media de 81.16/100, lo cual indica un alto nivel de seguridad percibida. Sólo un paciente refirió haber sufrido un incidente durante la estadía hospitalaria y 6 pacientes refirieron haber tenido errores clínicos durante la hospitalización. Discusión: La seguridad percibida por los pacientes en la atención sanitaria fue similar a la descripta en el trabajo original, lo que indica en ambos casos un alto nivel de seguridad percibida. Las respuestas de los pacientes a la encuesta manifiestan su grado de satisfacción con la atención percibida y no el grado de seguridad, ya que aún habiendo incidentes reconocidos no se perciben como falta de seguridad.
Introduction: Patient safety has become very important in recent years. Involving patients in the different aspects of healthcare can improve safety and service provision. Different surveys were developed related to the patient's perception of safety in health services. The Ministry of Health and Social Policy of Spain validated an instrument in 2009. Objective: To describe the healthcare safety perceived by patients during their stay in hospital. Materials and Methods: Descriptive quantitative cross-sectional study conducted in two hospitals in the city of Bahía Blanca. A convenience nonprobability sampling method was used. Thirty five patients were surveyed by the hetero-administered "Survey on the healthcare safety perceived in hospitals". Results: 24 surveys were finally available for analysis. The score obtained was an average of 81.16/100, indicating a high level of perceived safety. Only one patient reported to have suffered an incident during hospital stay and 6 patients reported having clinical errors during hospitalization. Discussion: Health care safety perceived by patients was similar to that described in the original work, indicating in both cases a high level of perceived safety. Patients' answers expressed their satisfaction with the perceived healthcare and not the degree of safety. The incidents acknowledged were not perceived as lack of safety.
Assuntos
Humanos , Atenção Primária à Saúde , Erros Médicos , Segurança do Paciente , Doença IatrogênicaRESUMO
A simple and fast method for determining the content of Na, K, Ca, Mg, P, and 20 heavy metals in biodiesel samples with inductively coupled plasma optical emission spectrometry (ICP OES) using a two-nozzle Flow Blurring(®) multinebulizer prototype and on-line internal standard calibration, are proposed. The biodiesel samples were produced from different feedstock such as sunflower, corn, soybean and grape seed oils, via a base catalyst transesterification. The analysis was carried out without any sample pretreatment. The standards and samples were introduced through one of the multinebulizer nozzles, while the aqueous solution containing yttrium as an internal standard was introduced through the second nozzle. Thus, the spectral interferences were compensated and the formation of carbon deposits on the ICP torch was prevented. The determination coefficients (R(2)) were greater than 0.99 for the studied analytes, in the range 0.21-14.75 mg kg(-1). Short-term and long-term precisions were estimated as relative standard deviation. These were acceptable, their values being lower than 10%. The LOQ for major components such as Ca, K, Mg, Na, and P, were within a range between 4.9 ng g(-1) for Mg (279.553 nm) and 531.1 ng g(-1) for Na (588.995 nm), and for the other 20 minor components they were within a range between 1.1 ng g(-1) for Ba (455.403 nm) and 2913.9 ng g(-1) for Pb (220.353 nm). Recovery values ranged between 95% and 106%.
Assuntos
Biocombustíveis/análise , Metais/análise , Fósforo/análise , Espectrofotometria Atômica/métodos , Fatores de Tempo , Água/químicaRESUMO
Biodiesel is considered an alternative energy because it is produced from fats and vegetable oils by means of transesterification. Furthermore, it consists of fatty acid alkyl esters (FAAS) which have a great influence on biodiesel fuel properties and in the storage lifetime of biodiesel itself. The biodiesel storage stability is directly related to the oxidative stability parameter (Induction Time - IT) which is determined by means of the Rancimat® method. This method uses condutimetric monitoring and induces the degradation of FAAS by heating the sample at a constant temperature. The European Committee for Standardization established a standard (EN 14214) to determine the oxidative stability of biodiesel, which requires it to reach a minimum induction period of 6h as tested by Rancimat® method at 110°C. In this research, we aimed at developing a fast and simple alternative method to determine the induction time (IT) based on the FAAS ultrasonic-accelerated oxidation. The sonodegradation of biodiesel samples was induced by means of an ultrasonic homogenizer fitted with an immersible horn at 480Watts of power and 20 duty cycles. The UV-Vis spectrometry was used to monitor the FAAS sonodegradation by measuring the absorbance at 270nm every 2. Biodiesel samples from different feedstock were studied in this work. In all cases, IT was established as the inflection point of the absorbance versus time curve. The induction time values of all biodiesel samples determined using the proposed method was in accordance with those measured through the Rancimat® reference method by showing a R(2)=0.998.
Assuntos
Biocombustíveis/análise , Ácidos Graxos não Esterificados/química , Ondas de Choque de Alta Energia , Óleos de Plantas/química , Sonicação , Biocombustíveis/efeitos da radiação , Biocombustíveis/normas , Esterificação , Ácidos Graxos não Esterificados/efeitos da radiação , Ácidos Graxos não Esterificados/normas , Oxirredução , Óleos de Plantas/efeitos da radiação , Óleos de Plantas/normasRESUMO
We discuss the utility of the guinea pig model in audiology research and describe the different surgical accesses to the middle and inner ear in order to use these techniques for the production of experimental deafness. In addition, we describe a surgical technique for laryngeal denervation. Finally, we discuss the auditory-evoked potentials obtained in newborn and mature animals, in whom experimental deafness was produced. Our purpose was to confirm the use of the guinea pig as an ideal model for audiologic studies and for neck surgery.
Assuntos
Audiometria , Modelos Animais de Doenças , Orelha/cirurgia , Nervos Laríngeos/cirurgia , Pescoço/cirurgia , Animais , Orelha/fisiologia , CobaiasRESUMO
INTRODUCTION: Spleen abscesses are considered as an infrequent infectious disease. An increase in its presentation has been seen due to certain pathologies or clinical conditions associated with immune suppression, endocarditis being one of the most frequent causes. Gram-positive aerobes are the main causal agents with non-specific clinical manifestations. CT scan and ultrasound are the elective choices for diagnosis and imaging support for punction and drainage. OBJECTIVE: To describe the case of a patients with splenic abscess and its possible association with massive bee bite. CASE REPORT: A 51-year-old man, with no important medical history, suffered a massive bee bite and developed anaphylactic shock. He was managed at the emergency room where 116 bee stings were removed from the patient. He was discharged after 3 days. Eight days later he complained of abdominal pain localized in the left upper quadrant, persisting for 3 weeks. Abdominal pain increased and was accompanied by malaise, vomiting, fever, signs of peritonitis and leucocytosis. CT scan showed left pleural effusion, a single hypodense lesion in the inferior pole of the spleen, and thickness of the parenchyma. The patient was diagnosed with spleen abscess drained to cavity and was submitted to surgery. Surgical findings included localized peritonitis, friable spleen, and 200 ml of pus. Splenectomy was performed and IV antibiotic therapy was started. Blood culture, viral profile, Widal reactions, and serological test for HIV were negative. Secretion (pus) culture was positive for Enterococcus faecium. CONCLUSIONS: Spleen abscess is a rare entity and unusual diagnosis, representing a high mortality in non-treated patients. According to our search, there is no literature-based evidence of a similar case with this association. This report represents the first case of the association between spleen abscess and massive bee bite.
Assuntos
Abscesso/etiologia , Abelhas , Enterococcus faecium , Infecções por Bactérias Gram-Positivas/etiologia , Mordeduras e Picadas de Insetos/complicações , Esplenopatias/etiologia , Animais , Humanos , Imunocompetência , Masculino , Pessoa de Meia-IdadeAssuntos
Humanos , Masculino , Feminino , Surdez , Perda Auditiva , Congresso , Otosclerose , Perda Auditiva Condutiva/cirurgia , Cirurgia do EstriboRESUMO
Aborda uno de los receptores del arco reflejo de la comunicación humana: el oído, como factor para la adquisición del lenguaje y elemento fundamental en dicha comunicación. Contenido: 1) Prevención e investigación sociomédica. 2) Orígenes y antecedentes relevantes del Instituto Nacional de la Comunicación Humana (INCH). 3) Detección, ratreo y diagnóstico en problemas auditivos. 4) Niveles de contaminación por ruido en una de las principales avenidas de la Ciudad de México. 5) Potenciales provocados auditivos del tallo cerebral en recién nacidos de bajo y alto riesgo. 6) proyección docente. 7) Programa de residencia. 8) Lenguaje de señas como una estrategia de rehabilitación dentro de la estimulación temprana del niño. 9) Lenguaje de signos ¿lengua natural y lengua materna?. 10) Lengua de signos y desarrollo de los niños sordos. 11) Emisiones otoacústicas. 12) La otoneurología mexicana. 13) Diagnóstico psicológico del niño sordo. 14) Escuela para padres. 15) Audición binaural. 16) prevención de la otitis media crónica. 17) La presbiacusia. 18) Cuidados en salud del oído
Assuntos
Transtornos da Comunicação , Surdez , Orelha , Transtornos da AudiçãoRESUMO
Introducción. La literatura mundial consigna que aproximadamente 50 por ciento de los casos de hipoacusia neurosensorial son atribuidos a factores genéticos; el resto son adquiridos en un alto porcentaje en la etapa perinatal. En población mexicana las características etiológicas de la sordera prelingüística no genética no han sido establecidas. Material y métodos. Se realizó una búsqueda de factores de riesgo para sordera consignados en la literatura mundial, tomando como base el Registro de Alto Riesgo para Sordera del Comité para la Audición Infatil de Estados Unidos de América. El grupo en estudio lo constituyeron 49 lactantes con sordera prelingüística de etiología no genética. El análisis se realizó a través de cálculo de frecuencias y proporciones. Resultados. La presencia de algún factor adverso perinatal (FAP) se documentó en 22 casos (0.45), la sordera fue adquirida durante la etapa de lactancia en 7 casos (0.14), en los 20 casos (0.41) restantes la etiología no fue determinada. De los 22 casos con algún FAP, 7 (0.32) tuvieron un solo factor y resultaron ser en su mayoría recién nacidos de término autróficos que presentaron infección viral congénita, principalmente rubéola; los 15 restantes (0.68) presentaron 2 o más factores y fueron predominantemente pretérminos. Los antecedentes de septicemia, uso de aminoglucósidos e hiperbilirrubinemia se presentaron en alrededor de 75 por ciento de los casos perinatales. La edad de sospecha y el tiempo transcurrido entre la sospecha y el diagnóstico de pérdida auditiva fue menor en los pacientes con FAP. Conclusiones. En alrededor de la mitad de la población se pudo documentar el antecedente de por lo menos un FAP, destacando por su frecuencia los antecedentes de: septicemia, tratamiento con aminoglucósidos, hiperbilirrubinemia e infección congénita por rubéola. El comportamiento de la asociación de factores de riesgo fue diferente de acuerdo a la madurez de los sujetos al nacimiento, pues mientras en la población de término predominó un solo factor de riesgo, en la pretémino en su mayoría se documentó asociación de dos o más factores. La menor edad de sospecha de sordera y el menor tiempo transcurrido entre la sospecha y diagnóstico de deficiencia auditiva en pacientes con FAP...