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PURPOSE: Although Damage Control Thoracic Surgery (DCTS) has become a provocative alternative to treat patients with chest injuries who are critically ill and physiologically depleted, the management approaches of chest-packing and the measurement of clinically relevant outcomes are not well established. In this paper, we systematically reviewed the available knowledge and evidence about intra-thoracic packing during DCTS for trauma patients. We furthermore inform on the management approaches, surgical strategies, and mortality associated with this intervention. METHODS: We identified articles in MEDLINE and SCOPUS. We reviewed all studies that included trauma patients with chest injuries and managed with intrathoracic packing during DCTS. Studies were eligible if the use of intrathoracic packing in trauma populations was reported. RESULTS: We identified 14 studies with a total of 211 patients. Overall, intrathoracic packing was used in 131 trauma patients. Packing was most commonly used to arrest persistent coagulopathic bleeding or oozing either from raw surfaces or repaired structures and in conjunction with other operative techniques. Pneumonectomy was a deadly intervention; however, one study reported survivors when pneumonectomy was deferred. CONCLUSION: Packing is a feasible, reliable and potentially effective complementary method for hemorrhage control. Therefore, we recommend that packing can be used liberally as a complement to rapid lung-sparing techniques.
Assuntos
Traumatismos Torácicos , Cirurgia Torácica , Procedimentos Cirúrgicos Torácicos , Bandagens , Hemorragia , Humanos , Traumatismos Torácicos/cirurgiaRESUMO
PURPOSE: We compared a cohort of Haitian immigrants with residents in Haiti with breast cancer (BC) to evaluate the effects of location on presentation, treatment, and outcomes. PATIENTS AND METHODS: Participants were Haitian women with BC living in Miami who presented to the University of Miami/Jackson Memorial Hospital and women with BC living in Haiti who presented to the Innovating Health International Women's Cancer Center. The primary outcome was the relationship between location, cancer characteristics, and survival. The secondary objective was to compare our results with data extracted from the SEER database. Cox regression was used to compare survival. RESULTS: One hundred two patients from University of Miami/Jackson Memorial Hospital and 94 patients from Innovating Health International were included. The patients in Haiti, compared with the patients in Miami, were younger (mean age, 50.2 v 53.7 years, respectively; P = .042), presented after a longer duration of symptoms (median, 20 v 3 months, respectively; P < .001), had more advanced stage (44.7% v 25.5% with stage III and 27.6% v 18.6% with stage IV BC, respectively), and had more estrogen receptor (ER) -negative tumors (44.9% v 26.5%, respectively; P = .024). The percentage of women who died was 31.9% in Haiti died compared with 17.6% in Miami. Median survival time was 53.7 months for women in Haiti and was not reached in Miami. The risk of death was higher for women in Haiti versus women in Miami (adjusted hazard ratio, 3.09; P = .0024). CONCLUSION: Women with BC in Haiti experience a significantly worse outcome than immigrants in Miami, which seems to be related to a more advanced stage and younger age at diagnosis, more ER-negative tumors, and lack of timely effective treatments. The differences in age and ER status are not a result of access to care and are unexplained.
RESUMO
BACKGROUND: Although hematology and oncology research is a highly relevant and evolving field, research contributions by Latin American countries, apart from Brazil, remain unclear. METHODS: The authors performed a bibliometric analysis through a methodical search of the Latin American abstracts presented at 4 main hematology and oncology annual scientific meetings from 2000 to 2010. Latin American regional and national productivity was described through distribution and trend analyses; the subsequent percentage of full-text publications was also determined. RESULTS: In total, 2871 abstracts were identified, of which 1972 abstracts (68.7%) were determined to be original Latin American research and were included in the analysis. Brazil produced by far the most abstracts, with 51.1% of the total, followed by Argentina, Mexico, Peru, Chile, and Uruguay. Together, these 6 countries accounted for 95.2% of the abstracts. Latin America had a positive trend, registering an average increase of 21.5 abstracts per year (P < .001). Significant positive growth trends were observed for Brazil, Mexico, Peru, and Uruguay. Argentina and Uruguay were the most productive countries when considering the rate of abstract presentation per population. The full-text publication rate was 17.9%, and the median time to publication after presentation was 1 year. Brazil prevailed as the leading publishing country (60%), followed by Mexico, Argentina, Peru, Chile, and Cuba, all of which together published 96% of the full-text articles. CONCLUSIONS: Hematology and oncology research is increasing in Latin America, but this contribution remains limited to a few countries. There is also a low rate of full-text articles derived from annual scientific meetings. More extensive research is recommended.
Assuntos
Pesquisa Biomédica/tendências , Hematologia/tendências , Oncologia/tendências , Bibliometria , Eficiência , Humanos , América Latina , Publicações/estatística & dados numéricosRESUMO
La prevalencia actual del consumo de cocaína hace necesario conocer las complicaciones cardiovasculares derivadas de su uso, como lo es el síndrome coronario agudo, condición que se presenta en personas jóvenes que consultan a los servicios de Urgencias con dolor torácico y alteraciones electrocardiográficas. El consumo de esta sustancia se asocia con aterosclerosis acelerada, vasoconstricción de arterias coronarias, vasoespasmo, arritmias, miocardiopatía, endocarditis, disección y ruptura aórtica, y muerte cardiaca súbita. Aunque la incidencia de aneurismas de arterias coronarias es extremadamente baja en la población general, existe una asociación con el consumo de cocaína que debe ser considerada en estos pacientes.
The current prevalence of cocaine use makes necessary to know the cardiovascular complications derived from its use such as acute coronary syndrome, a condition that occurs in young people who consult the emergency departments with chest pain and electrocardiographic alterations. The consumption of this substance is associated with accelerated atherosclerosis, coronary artery vasoconstriction, vasospasm, arrhythmias, cardiomyopathy, endocarditis, aortic dissection and rupture, and sudden cardiac death. Although the incidence of coronary artery aneurysms is extremely low in the general population, there is an association with cocaine consumption that must be considered in these patients.
Assuntos
Humanos , Masculino , Adulto Jovem , Aneurisma , Doenças Cardiovasculares/complicações , Cocaína , Síndrome Coronariana AgudaRESUMO
Objetivo: identificar evidencia bibliográfica del uso de la música como herramienta en procesos de inclusión de personas con discapacidad, que permitiera ofrecer sustento teórico al proyecto del convenio establecido entre la Fundación Saldarriaga Concha y la Fundación Nacional Batuta. Materiales y métodos: como estrategia de búsqueda se utilizaron los temas "música", "inclusión" y "discapacidad" y el booleano AND en tres bases de datos: Ebsco, Medline y Lilacs. Los análisis fueron realizados mediante el establecimiento de frecuencias para variables como revista, país, tipo de estudio y años de publicación. Se localizaron veintidós artículos que incluyeron los criterios de búsqueda definidos por los autores. Resultados: los resultados muestran que la mayoría de publicaciones se encuentra en la base de datos Ebsco, en la revista Music Educators Journal, en el período comprendido entre el año 2004 a 2006 (40,9%). Estados Unidos es el país que más publicaciones ha realizado (81,8%). El tipo de estudio más frecuente es la revisión de tema (86,4%) y la temática más utilizada incorpora aspectos como música-discapacidad. De acuerdo con Rumbo, Aranton y García, el grado de evidencia de los documentos analizados es 3, lo que indica que son principalmente estudios descriptivos y de opinión de expertos. Conclusiones: después de realizar la búsqueda sistemática se puede concluir que las publicaciones que incorporan el uso de la música como herramienta para facilitar procesos de inclusión social de niños y adolescentes es escasa, por lo que se sugiere sistematizar y publicar resultados de las intervenciones en este campo de la Terapia Ocupacional. El presente documento proporciona una posible ruta para el desarrollo de futuras investigaciones referentes al tema.
Objective: to identify literature and bibliographical evidence regarding, the use of music as a tool during social inclusion processes of people with disabilities; this was done in order to obtain and supply theoretical bases to the project which pertains and arises from the agreement between the Fundación Saldarriaga Concha and the Fundación Nacional Batuta. Materials and methods: as the research strategy implemented during the investigation, "music", "inclusion" and "disability" with the Boolean AND were used as the search criteria in three different databases: Ebsco, Medline and Lilacs. The analysis was elaborated considering the frequency of different variables/ characteristics of the articles such as, journal, country, type of study and the year it was published. Twenty two articles met the search criteria defined by the authors. Results: the results indicated that the database which contained the most amount of evidence is Ebsco, specifically in the Music Educators Journal, during the years of 2004-2006 (40,9%) and the majority of articles were published in the United States (81,8%). The most common and frequent type of study found was the subject review (86,4%), mainly incorporating search topics like music-disability. Agreeing with Rumbo, Aranton and García, the level of evidence of the analyzed documents is generally 3, indicating that, above all, the studies tend to be descriptive and based on the opinion of experts. Conclusions: after systematically carrying out the research, it is possible to conclude that the publications which consider the use of music as a tool to facilitate social inclusion processes in children and teenagers, is low. Due to the results obtained, it is strongly suggested that, writers begin to systemize and publish the results evidenced in this field of Occupational Therapy. This paper provides a possible route for future research regarding the topic.
Objetivo: identificar evidencia bibliográfica do uso da música como ferramenta em processos de inclusão de pessoas com deficiência, que permitira oferecer sustento teórico ao projeto do convênio estabelecido entre a Fundação Saldarriaga Concha e a Fundação Nacional Batuta. Materiais e métodos: como estratégia de procura utilizaram-se os temas "música", "inclusão" e "deficiência" e o booleano AND em três bases de dados: Ebsco, Medline y Lilacs. As análises foram realizadas mediante o estabelecimento de frequências para variáveis como revista, país, tipo de estudo e anos de publicação. Localizaram-se vinte e dois artigos que incluíram os critérios de procura definidos pelos autores. Resultados: os resultados evidenciam que a maioria de publicações encontra-se na base de dados Ebsco, na revista Educators Journal, no período compreendido entre o ano 2004 e o ano 2006 (40,9%). Os Estados Unidos é o país que mais publicações tem realizado (81,8%). O tipo de estudo mais frequente é a revisão de temas (86,4%) e a temática mais utilizada incorpora aspectos como a música-deficiência. De acordo com Rumbo, Aranton e García, o grau de evidencia dos documentos analisados é 3, o que indica que são principalmente estudos descritivos e de opinião de expertos. Conclusãoes: depois de realizar a procura sistemática pode-se concluir que as publicações que incorporam o uso da música como ferramenta para facilitar processos de inclusão social de crianças e adolescentes é escassa, pelo que se sugere sistematizar e publicar resultados das intervenções neste campo da Terapia Ocupacional. O presente documento proporciona uma possível direção para o desenvolvimento de futuras pesquisas referentes ao tema.
Assuntos
Humanos , Inclusão Social , Bibliometria , Criança , Adolescente , Terapia Ocupacional , Pessoas com Deficiência , MúsicaRESUMO
En este estudio exploramos la posiblidad de ofrecer una opción quirúrgica menor para lograr una estimulación Fisiaria controlada y predecible al paciente con discrepancias menores de miembros inferiores. Ese trabajo experimental en conejos está diseñado para determinar los efectos de la implantación percutánea de un material bioabsorbible en la cercanía de la fisis de fémur y tibia. Se trata de determinar si existe una estimulación vascular de la fisis que resulte en un sobrecrecimiento controlado respecto al mismo contralateral. Para responder a estas preguntas de investigación, se realizó el implante de Pon-P-Dioxanona (PDS) en el fémur distal y la tibia proximal de conejos en fase de crecimiento rápido, y se analizaron sus efectos histológicos, gamagráficos y de crecimiento en longitud. Los animales fueron divididos en 8 grupos de estudio, 5 especímenes cada uno. Cuatro de estos grupos recibieron implante de PDS en fémur y tibia, y otros cuatro grupos solamente se les realizaron perforaciones exactamente iguales pero sin la implantación del PDS. Los animales fueron sacrificados a los 30, 60, 90 y 150 días de la Cirugía. En este trabajo se presentan los resultados de la primera fase de este estudio. Existe un efecto de estimulación fisiaria por la Poli-P-Dioxanona que resulta en un sobrecrecimiento de las extremidades posteriores del conejo expensas de la tibia.