RESUMO

Malnutrition (undernutrition) encompasses low intake or uptake, loss of fat mass, and muscle wasting and is associated with worse outcomes. Ultrasound has been introduced in the intensive care unit as a tool to assess muscle mass. The aim of the present study is to explore the relation between initial muscle mass and mortality in adult patients admitted to the intensive care unit. Methods. Rectus femoris and vastus intermedius thicknesses were measured by B-mode ultrasound in adult patients at admission, along with demographic characteristics, illness severity, comorbidities, biochemical variables, treatments, and in-hospital mortality as main outcomes. Analysis was made comparing survivors versus nonsurvivors and finally using binary logistic regression with mortality as dependent variable. Results. 59 patients were included in the analysis, severity measured by sequential organ failure assessment (SOFA) score was greater in nonsurvivors (17 (7) versus 24 (10) and 3 (1-5) versus 7 (3-10), resp.). Also, muscle thickness was lower in the latter group (1.44 (0.59) cm versus 0.98 (0.3) cm). Logistic regression showed severity by SOFA score as a risk factor and muscle thickness as a protective factor for mortality. Conclusion. Muscle mass showed to be a protective factor despite severity of illness; there is much more work to do regarding interventions and monitoring in order to prevent or overcome low muscle mass at admission to the intensive care unit.

RESUMO

Intensive care unit acquired weakness is a long-term consequence after critical illness; it has been related to muscle atrophy and can be considered as one of the main nutritional support challenges at the intensive care unit. Measuring muscle mass by image techniques has become a new area of research for the nutritional support field, extending our knowledge about muscle wasting and the impact of nutritional approaches in the critical care setting, although currently there is no universally accepted technique to perform muscle measurements by ultrasound. Because of this, we present this tutorial for nutrition support clinicians, in order to understand and perform muscle measurements by this reliable, accessible, low-cost, and easy-to-use technique. Reviewing issues such as quadriceps muscle anatomy, correct technique (do's and don'ts), identification of structures, and measurement of the rectus femoris and vastus intermedius muscles helps to acquire the basic concepts of this technique and encouraging more research in this field.

RESUMO

Son raros los casos de leiomiomas intravenosos con extensión intracardiaca. En pacientes con manifestaciones de sobrecarga de cavidades derechas o quienes debutan con síntomas de insuficiencia cardiaca aguda y cuyos síntomas no mejoran con el manejo convencional, se debe considerar esta entidad, y es importante evaluar de forma integral con estudios de gabinete como electrocardiograma, ecocardiograma, tomografía o resonancia magnética. Reportamos el caso de una mujer de 46 años que manifiesta síntomas de insuficiencia cardiaca aguda e inadecuada respuesta a los fármacos convencionales. Con hallazgos ecocardiográficos de tumoración en atrio derecho que protruye a ventrículo derecho y causa insuficiencia tricuspídea. Por estudio tomográfico se confirma la extensión del tumor a vena cava inferior y ventrículo derecho; se resuelve de forma quirúrgica con resección radical y se confirma la extirpación histológica mediante estudio anatomopatológico.

Cases of intravenous leiomyoma with intracardiac extension are rare. Patients with signs of right-sided overload who present symptoms of acute heart failure and whose symptoms do not improve with conventional management, we must consider this entity. It is important to comprehensively assess with imaging studies such as electrocardiogram, echocardiogram, Tomography (CT scan) or magnetic resonance. The following is a report of the case of a 46 year old woman with symptoms of acute heart failure and inadequate response to conventional drugs. The echocardiographic show findings of a tumor in the right atrium, protruding to the right ventricle causing tricuspid regurgitation. The CT scan confirmed the extent of the tumor to the inferior vena cava and right ventricle, and was resolved surgically with radical resection and histology lineage confirmed by pathologic examination.

RESUMO

Los trastornos temporomandibulares (TTM), abarcan un conjunto de problemas clínicos que comprometen diferentes estructuras anatómicas como son: músculos de la masticación, la articulación temporomandibular y estructuras asociadas. Se consideran como una subclasificación de desórdenes musculoesqueléticos y han sido identificados como una causa importante de dolor en la región facial de origen no dentario. Los trastornos temporomandibulares se caracterizan clínicamente por dolor en músculos de la masticación, área preauricular o directamente en la articulación (usualmente agravado por la manipulación y alteración de los movimientos mandibulares principalmente debido a limitación del movimiento), presencia de ruidos articulares como crepitación y chasquidos (clicking). Epidemiológicamente la prevalencia va del 20 al 70% en la población general, motivo por el que creemos que es importante que el médico general tenga el conocimiento básico sobre estos trastornos que generalmente los desconoce y los delega al médico odontólogo. El tratamiento de los TTM va desde fomentar el autocuidado, tratamiento conservador y, de ser necesario, tratamiento quirúrgico.

Temporomandibular disorders (TMDs) are a set of clinical problems that involve different anatomical structures such as masticatory muscles, the temporomandibular joint and related anatomical structures. They are considered a subclass of musculoskeletal disorders and have been identified as a major cause of non-dental facial pain. TMDs are characterized by pain in the masticatory muscles, either in the pre-auricular area or directly in the joint (usually worsened by manipulation or altered movement of the jaw, mainly due to movement limitation) and the presence of clicking sounds during movement. Epidemiologically, TMDs have a prevalence ranging from 20% to 70% in the general population, that is why we believe it is important for the general practitioner to have the basic knowledge about these disorders, often unknown to the general practitioner who leaves the to the odontologist. Treatment includes fostering self-care measures, conservative treatment, or surgical treatment when necessary.

RESUMO

Las fisuras oblicuas faciales son anormalidades poco frecuentes, aunque la incidencia exacta es desconocida, se reporta una incidencia de 1.5 a 5 por 100,000 nacimientos. Tessier en 1976 propuso una clasificación de las fisuras faciales, craneofaciales y laterofaciales. Morian describió la fisura oral nasoorbitaria (fisura número 3), que representa una de las malformaciones más difíciles de corregir para el cirujano plástico y reconstructivo. Reportamos un caso de fisura craneofacial Tessier número 3 así como la técnica de corrección quirúrgica empleada. Los autores enfatizan en el análisis de la embriología facial.

The oblique facial clefts are extremely rare facial anomalies, although the exact incidence of these facial clefts is unknown, is reported an incidence de 1.5 to 5 per 100,000 births. Tessier in 1976 proposed an anatomic classification of the facial, craniofacial, and laterofacial clefts. Number 3 clefts o oral-nasal-ocular cleft was described by Morian and represents one of the most difficult malformations to correct for the reconstructive surgeon. We report a case of unilateral Tessier No 3 craniofacial cleft and our approach to surgical correction. The authors emphasize in the analysis of the facial embryology.