Gaceta Medica de Bilbao最新文献

Neck masses and their surgical approach form part of standard practice for the general surgeon. Surgeons are usually aware of what they will find before the intervention. However, despite adequate preoperative evaluation, sometimes the definitive diagnosis will only be established during surgery or, in particular, after pathological analysis.

Introduction

Before human life evolved, electricity was in contact with the earth. Electrical injuries are notoriously different from heat burns.

Objective

To determine the differences between high and low voltage injuries in a tertiary hospital in the west of the country.

Material and methods

We performed a descriptive and prospective study in patients presenting to the emergency room of the Hospital Civil de Guadalajara in 2010 with a diagnosis of electrical injury. Patients with high and low voltage injuries were compared. We used the chi-squared test to compare non-parametric variables and Student's t-test to compare parametric variables. A P-value of .05 or less was considered significant.

Results

We included 22 adult patients (19 men and 3 women). There were 8 patients with a high voltage injury and 14 with a low voltage injury. All the patients arrived at the emergency room within 24 hours of the accident. Hospital stay was longer in patients with high voltage injuries (P = .0035). Mortality was associated only with high voltage injuries.

Conclusion

In agreement with previous studies, we found that high voltage injuries conferred greater morbimortality and longer hospital stay than low-voltage injuries. Prevention is the key to reducing the terrible consequences of electrical injury.

Traumatic brain injury is the first cause of death in persons younger than 45 years in Spain. Swallowing disorders are common in the initial phase of a severe traumatic brain injury. The incidence of dysphagia varies between 25 and 61% of patients and the prognosis depends on correct evaluation and early and appropriate treatment. The outcome of dysphagia depends on a low score in the Rancho Los Amigos Cognitive Scale and the Glasgow Coma Scale, orotracheal intubation and the presence of tracheostomy. The most widely used instrumental assessment tool for the diagnosis of dysphagia is videofluoroscopy. This procedure consists of swallowing a variety of liquids and foods mixed with barium. Swallowing maneuvres and oral motor exercises are useful in the rehabilitation of swallowing. Functional magnetic resonance imaging of the brain shows the cortical areas that are activated during the application of rehabilitation treatment.

Desmoplastic small-round-cell tumor is an uncommon highly aggressive type of cancer that affects young men. We present the case of a 31-year-old man with stage iv desmoplastic small-round-cell tumor, diagnosed in the context of abdominal pain and hemoperitoneum. Surgery confirmed extensive hemoperitoneum and revealed multiple peritoneal nodules. Hemostasis was performed, a biopsy was taken, and chemotherapy was initiated. Seven months after surgery, the patient is still alive. Desmoplastic small-round-cell tumor usually occurs in the abdominal or pelvic peritoneum and is associated with nonspecific signs and symptoms but with a unique cytogenetic profile [a translocation t(11;22)(p13;q12) affecting the EWS and WT1 genes]. The best outcomes are produced by a combination of chemotherapy, radiotherapy and surgery. Nevertheless, the prognosis of desmoplastic small-round-cell tumor is poor, with an overall 5-year survival rate of 15%.

Objectives

This study aimed to provide experimental data that could enhance understanding of the cardiovascular function of 2 hormones, ghrelin and leptin, which are involved in energy homeostasis. Recent data indicate that serum ghrelin is associated with right ventricular cardiovascular indexes and serum leptin and its soluble receptor are associated with resting heart rate. These associations indicate a close interaction between the endocrine and cardiovascular systems in obesity. Therefore, we sought to evaluate these associations and their clinical significance by measuring ghrelin, leptin and leptin soluble receptor levels in both obese and non-obese patients with cardiac insufficiency.

Methods

We measured serum ghrelin, leptin and soluble leptin receptor levels in 87 patients diagnosed with cardiac insufficiency (classified into 2 groups: obese and non-obese, according to body mass index) and 25 lean controls, using commercially available immunoassays. We also investigated the association of serum ghrelin and leptin levels with brain natriuretic peptide (BNP) as a diagnostic cardiac marker, using a statistical analysis.

Results

Ghrelin levels were decreased in cardiac insufficiency. Both leptin and its soluble receptor plasma levels were increased and both correlated with BNP. Serum ghrelin levels differed significantly between patients with cardiac insufficiency and controls (P < .05). Statistically significant differences were also found in serum leptin levels between obese patients with cardiac insufficiency and healthy controls (P < .05). However, no relationship was found between ghrelin levels in obese and non-obese patients with cardiac insufficiency.

Conclusions

Some of the metabolic and/or hormone differences between obese patients with heart failure and non-obese individuals, such as elevated leptin levels, may be cardioprotective.

Objective

To assess whether there is scientific evidence that minimally invasive total hip arthroplasty provides better results than the standard approach.

Material and methods

A review of the literature was performed. Well-designed, prospective studies with a high level of evidence that compared the 2 techniques in terms of aggressiveness, correct component placement, bleeding, early outcomes, midterm results and complications rates were chosen.

Results

Seventy-four articles explicitly analyzed minimally-invasive hip arthroplasty but only 10 were comparative studies providing a high level of evidence.

Discussion

There are few well-designed studies that compare the results of minimally invasive total hip arthroplasty with those of standard techniques. Most of these articles found no significant differences in any of the factors evaluated to indicate the superiority of one or other technique.