RESUMO
Revisar la experiencia en trauma renal en el Hospital San Juan de Dios, Servicio de Salud Metropolitano Occidente. Se revisan todos los registros de alta con diagnóstico de trauma renal entre los años 1994 y 2000. Se estudian retrospectivamente todos los registros caracterizando pacientes por edad, sexo, tipo trauma, estudio imagenológico y necesidad de cirugía. Durante el período se hospitalizaron 20 pacientes con diagnóstico de trauma renal. Sus edades oscilan entre los 17 y 64 años (mediana 33), 17 (85 por ciento) corresponden a sexo masculino. 4 (20 por ciento) sufren trauma penetrante, todos ellos por arma blanca, 16 (80 por ciento) presentan trauma contuso, principalmente por accidente automovilístico y caída de altura (66 por ciento). Dieciséis pacientes fueron manejados conservadoramente. De los pacientes que fueron a cirugía, en 2 de ellos se realizó nefrectomía por trauma contuso en riñón patológico. Los otros 2 presentaban trauma penetrante y se realizó nefrorrafia. En 3 pacientes del estudio no se realizó TAC. De los 20 pacientes, 9 fueron GI, 8 GII, 1 GIII, 2 GIV. La experiencia de nuestro servicio reproduce lo publicado. El trauma renal es más frecuente en hombres 4:1, el trauma cerrado es responsable del 80 por ciento de los mecanismos, siendo su génesis los accidentes automovilísticos y caídas. Las lesiones penetrantes se asocian a traumas de mayor grado. El manejo conservador es una alternativa en pacientes con trauma renal penetrante bien etapificado.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Pessoa de Meia-Idade , Ferimentos e Lesões/epidemiologia , Rim/lesões , Unidade Hospitalar de Urologia/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Acidentes por Quedas/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Chile , Ferimentos Perfurantes/epidemiologia , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/etiologia , Estudos RetrospectivosRESUMO
Spinal cord metastases are an uncommon secondary location of a malignant neoplasm. They are rarely diagnosed during life and when that is the case, it is in the clinical setting of a disseminated cancer and very seldom as the first clinical manifestation. We report two patients, with no previous disease, who developed a progressive myelopathy. An intramedullary spinal cord tumor was diagnosed, based on the clinical picture and imaging studies. They were operated and biopsies showed spinal cord metastases whose primary tumor was a lung neoplasm. We discuss the clinical features in these patients, the diagnosis of progressive myelopathy in cancer patients, treatment and prognosis of this unusual secondary cancer location.
Assuntos
Adenocarcinoma de Células Claras/secundário , Neoplasias Pulmonares/patologia , Neoplasias da Medula Espinal/secundário , Adenocarcinoma de Células Claras/diagnóstico por imagem , Adulto , Evolução Fatal , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Neoplasias da Medula Espinal/diagnóstico por imagemRESUMO
BACKGROUND: Cerebral metabolic monitoring in critical neurological patients allows the assessment of neuronal tissue response to injury and to plan the best therapy to correct each critical brain situation. AIM: To evaluate the usefulness of cerebral metabolic monitoring in patients with acute cerebral injury. PATIENTS AND METHODS: A retrospective analysis of 29 patients with acute brain injury, in whom a catheter was located in the bulb of the jugular vein to perform a cerebral metabolic monitoring. These patients were compared with others that were not subjected to this monitoring. The evolution at six months of follow up was assessed using the Glasgow outcome score, considering a favorable evolution when this score was 4 or greater. RESULTS: Patients with an hyperemic state on admission or after optimization of therapy did not have hospital mortality, and 73% had Glasgow outcome score of 4 or greater at six months of follow up. On the other hand, 50% of those with hypoperfusion or global ischemia died during hospitalization and 72% had a Glasgow outcome score of 3 or less at six months. Patients not subjected to cerebral metabolic monitoring behave as those with hypoperfusion or global ischemia. CONCLUSIONS: Cerebral metabolic monitoring is an useful tool to optimize the management of patients with acute cerebral injury, and those patients with an hyperemic cerebral state have the best prognosis.
Assuntos
Encéfalo/metabolismo , Transtornos Cerebrovasculares/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Circulação Cerebrovascular , Transtornos Cerebrovasculares/mortalidade , Cuidados Críticos , Estudos Transversais , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Estudos RetrospectivosRESUMO
Corticograms of the mesial structures of the temporal lobe may be obtained with the recently developed foramen ovale electrodes. Since their installation is easy and of low risk, they will probably displace other invasive techniques routinely used up to the moment for the localization and lateralization of epileptic foci originated in the temporal lobe. For the first time in our country, we have used this technique in 7 patients with medically intractable complex partial epilepsy. In all the patients, the study allowed to clear doubts about the laterality of the start of ictal activity and to define irritative foci not found with conventional continuous superficial electroencephalographic recordings. The procedure was uneventful and the implanted electrodes were optimally tolerated. Foramen ovale electrodes are an effective diagnostic method for temporal lobe epilepsies and their features are specially appropriate for our milieu.
Assuntos
Epilepsia do Lobo Temporal/diagnóstico , Adolescente , Adulto , Eletrodos Implantados , Eletroencefalografia , Epilepsia do Lobo Temporal/fisiopatologia , Feminino , Humanos , MasculinoRESUMO
We performed cerebral biopsy in 4 patients with AIDS and evidence of expanding intracerebral lesions. Three patients had cerebral toxoplasmosis and the fourth had Chagas encephalitis. No patient developed complications. We feel that cerebral biopsy is warranted and safe in patients with AIDS and intracerebral lesions of uncertain origin.
Assuntos
Complexo AIDS Demência/patologia , Encéfalo/patologia , HIV-1 , Complexo AIDS Demência/diagnóstico por imagem , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico por imagem , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adulto , Biópsia , Encéfalo/diagnóstico por imagem , Doença de Chagas/diagnóstico por imagem , Doença de Chagas/patologia , Craniotomia , Encefalite/diagnóstico por imagem , Encefalite/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Toxoplasmose Cerebral/diagnóstico por imagem , Toxoplasmose Cerebral/patologiaAssuntos
Fístula Arteriovenosa/diagnóstico , Lesões Encefálicas/etiologia , Artérias Carótidas , Seio Cavernoso , Órbita/lesões , Ferimentos por Arma de Fogo , Adolescente , Lesões Encefálicas/diagnóstico , Angiografia Cerebral , Diagnóstico Diferencial , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
The authors analyzed the clinicoangiographic correlation of cerebral vasospasm in a series of 120 cases of subarachnoid hemorrhage due to aneurysmal rupture. They made such correlation in the pre and postoperative course, in the follow-up, and in relation with the pathological findings. All patients were studied with one to three angiographies in the pre and postoperative course. For the clinical grading the authors have used the classification of Botterell modified by Hunt et al, and for the cerebral vasospasm, the classification of Pool and Potts and Saito et al. They found a good correlation between the cerebral vasospasm and the disorders of consciousness or motility, i.e. when both of them are considered separately, and only in patients with neurological injury. In comparing Botterell grade I and grades II-V, in 25% of the grade I patients, cerebral vasospasm was observed without neurologic injury. The incidence of cerebral vasospasm was lower in grades II-V patients and the severity of the clinical picture was in relation with other factors such as hematoma, infarct, hydrocephalus, etc. The authors consider the possibility of a personal variability of the cerebral vasospasm in relation with a different susceptibility to the spasmogenic substances.