RESUMEN
The diagnosis and treatment of patients with chronic wounds is an enormous challenge in various disciplines of medicine. These very complex processes usually involve several experts of different medical specialties with varying educational backgrounds. A necessary basis for consistent communication and documentation is the use of unambiguous nomenclature. Therefore, the board of the German wound association, Initiative for Chronic Wounds (ICW) e.V., has started to define various terms and procedures. An easy to remember algorithm, in the form of the ABCDE rule, has been developed for the structured diagnosis of chronic wounds. The successful therapy of chronic wounds is then based on the causal treatment of the underlying, pathophysiological relevant diseases. M.O.I.S.T. a concept which helps health professionals in the systematic approach to the local treatment of patients with chronic wounds, in conforming to the most up-to-date scientific knowledge. By using consistent definitions and standards in wound care, it is possible to optimise current diagnostic and treatment strategies as well as to make them more easily understandable.
Asunto(s)
Algoritmos , Terminología como Asunto , Infección de Heridas/diagnóstico , Heridas y Lesiones/diagnóstico , Enfermedad Crónica , Comunicación , Documentación , Alemania , Personal de Salud , Humanos , Estándares de Referencia , Infección de Heridas/terapia , Heridas y Lesiones/terapiaAsunto(s)
Terminología como Asunto , Heridas y Lesiones/terapia , Arteriopatías Oclusivas/clasificación , Arteriopatías Oclusivas/terapia , Capilares , Enfermedad Crónica , Consenso , Pie Diabético/clasificación , Pie Diabético/terapia , Eccema/clasificación , Eccema/terapia , Humanos , Cooperación del Paciente , Relaciones Médico-Paciente , Úlcera por Presión/clasificación , Úlcera por Presión/terapia , Recurrencia , Úlcera Varicosa/clasificación , Úlcera Varicosa/terapia , Enfermedades Vasculares/clasificación , Enfermedades Vasculares/terapia , Heridas y Lesiones/clasificaciónAsunto(s)
Gangrena/clasificación , Gangrena/diagnóstico , Laceraciones/clasificación , Úlcera Cutánea/clasificación , Piel/lesiones , Terminología como Asunto , Enfermedad Aguda/clasificación , Enfermedad Crónica/clasificación , Humanos , Laceraciones/diagnóstico , Piel/patología , Úlcera Cutánea/diagnósticoRESUMEN
This study was performed to evaluate the hemodynamic status of children admitted to the intensive care unit, using suprasternal and transesophageal Doppler ultrasound, and to establish a suitable noninvasive technique to monitor trends in cardiac output in critically ill children. Twenty children were studied over a period of 6 months. The median age was 32.5 months and weight 14.5 kg. Minute distance (MD), which is a linear cardiac output parameter, was assessed. Seven simultaneous pairs of measurements of MD were made using transesophageal Doppler (TED) and suprasternal Doppler (SSD) by the same operator. Following a fluid challenge, seven repeat pairs of measurements were made. The mean percentage changes for MD by TED and SSD were 21.84 (SD 9.97) and 5.75 (SD 7.32). The average coefficients of variation for measurements of MD by TED and SSD were 2.34% and 15.98%, respectively. The mean difference in percentage change between MD, measured by TED and SSD, was 27.59 with a 95% confidence interval and wide limits of agreement. The repeatability of TED measurements was good, but the measurements by SSD were wide and erratic with poor reproducibility. Our study shows that TED is easy to use, reliable, and very useful for monitoring hemodynamic changes in critically ill children.
Asunto(s)
Gasto Cardíaco , Cuidados Críticos/métodos , Ecocardiografía Transesofágica , Adolescente , Niño , Preescolar , Ecocardiografía Doppler , Femenino , Humanos , Lactante , MasculinoRESUMEN
BACKGROUND AND AIMS: The case fatality rate from meningococcal disease (MD) has remained relatively unchanged in the post antibiotic era, with 20-50% of patients who develop shock still dying. In 1992 a new paediatric intensive care unit (PICU) specialising in MD was opened. Educational information was disseminated to local hospitals, and a specialist transport service was established which delivered mobile intensive care. The influence of these changes on mortality of children with MD was investigated. METHODS: A total of 331 consecutive children with meningococcal disease admitted to the PICU between 1992 and 1997 were studied. Severity of the disease on admission was assessed using the paediatric risk of mortality (PRISM) score. Logistic regression analysis was used to correct for clinical severity, age, and sex; death was the outcome, and year of admission, a temporal trend variable, was the primary exposure. RESULTS: The case fatality rate fell year on year (from 23% in 1992/93 to 2% in 1997) despite disease severity remaining largely unchanged. After adjustment for age, sex, and disease severity, the overall estimate for improvement in the odds of death was 59% per year (odds ratio for the yearly trend 0.41). CONCLUSIONS: A significant improvement in outcome for children admitted with MD to a PICU has occurred in association with improvements in initial management of patients with MD at referring hospitals, use of a mobile intensive care service, and centralisation of care in a specialist unit.
Asunto(s)
Cuidados Críticos/organización & administración , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Infecciones Meningocócicas/mortalidad , Programas Médicos Regionales/organización & administración , Adolescente , Atención Ambulatoria/organización & administración , Bacteriemia/mortalidad , Niño , Preescolar , Cuidados Críticos/normas , Femenino , Mortalidad Hospitalaria , Humanos , Lactante , Modelos Logísticos , Londres/epidemiología , Masculino , Infecciones Meningocócicas/terapia , Garantía de la Calidad de Atención de Salud , Índice de Severidad de la Enfermedad , Especialización , Tasa de Supervivencia , Transporte de Pacientes/organización & administraciónAsunto(s)
Vasculitis por IgA/tratamiento farmacológico , Infecciones Meningocócicas/tratamiento farmacológico , Activador de Tejido Plasminógeno/uso terapéutico , Preescolar , Humanos , Vasculitis por IgA/fisiopatología , Lactante , Infecciones Meningocócicas/fisiopatología , Proteínas Recombinantes/uso terapéuticoRESUMEN
A 2-month-old boy presented with cartilage calcification, brachytelephalangism, peripheral pulmonary stenosis, hearing loss, short stature and slight psychomotor delay. This case is similar to the two cases described by Keutel in 1972. Since then, four other cases have been reported; we report the seventh case and discuss the clinical findings and the incidence of the disease.
Asunto(s)
Enfermedades de los Cartílagos/congénito , Anomalías Múltiples/diagnóstico , Anomalías Múltiples/diagnóstico por imagen , Huesos/diagnóstico por imagen , Calcinosis/congénito , Calcinosis/diagnóstico por imagen , Cartílago/diagnóstico por imagen , Enfermedades de los Cartílagos/diagnóstico por imagen , Condrodisplasia Punctata/diagnóstico por imagen , Constricción Patológica , Cara/anomalías , Humanos , Lactante , Masculino , Arteria Pulmonar/anomalías , Radiografía , SíndromeRESUMEN
The purpose of this review of the literature on nonimmune hydrops fetalis was to evaluate whether recent clinicopathologic studies have modified the relative incidence of the different associated conditions and the management of these pregnancies. We found 600 cases of nonimmune hydrops fetalis published since 1982. These cases were reviewed with particular attention to genetic causes and were compared with a literature review of 298 cases published before 1982. The mean gestational age at diagnosis varied from 24-29 weeks in the recent series, compared with 31-33 weeks in the earlier series. Genetically transmitted conditions accounted for more than 35% of the fetal and maternal disorders associated with nonimmune hydrops fetalis in the recent series, compared with 21% before 1982. The most frequently identified genetic abnormalities in our review were chromosomal disorders (15.7%), alpha-thalassemia (10.3%), skeletal dysplasia (4%), arthrogryposis multiplex syndromes (1.8%), multiple pterygium syndrome (1.5%), and lysosomal storage disorders (1.0%). These results confirm the need for systematic chromosome analysis in fetuses with nonimmune hydrops. From this review, we conclude that prenatal noninvasive and invasive techniques combined with detailed pathologic studies have improved the accuracy of diagnosis of the underlying causes of nonimmune hydrops fetalis and have influenced the management of these pregnancies.
Asunto(s)
Enfermedades Genéticas Congénitas , Hidropesía Fetal/complicaciones , Enfermedades del Desarrollo Óseo/complicaciones , Enfermedades del Desarrollo Óseo/genética , Aberraciones Cromosómicas , Trastornos de los Cromosomas , Femenino , Enfermedades Hematológicas/complicaciones , Enfermedades Hematológicas/genética , Humanos , Errores Innatos del Metabolismo/complicaciones , Embarazo , SíndromeRESUMEN
Embryonic vestiges of the umbilical cord are classic findings in routine morphologic examination of the placenta. In order to evaluate their clinicopathologic significance, we examined samples from the fetal and placental ends of 1,000 umbilical cords and collected the principal clinical findings of the corresponding newborns. Microscopic evidence of embryonic remnants were found in 231 cases (23.1%) divided into remnants of the allantoic duct (63%), the omphalomesenteric duct (6.6%), and the embryonic vessels (30.4%), including one case of hemangioma and an accessory small artery. There were no significant clinical differences between the three vestigial groups, and no particular association with congenital malformations or perinatal complications. In 70.9% of the cases, the embryonic remnants were found at the fetal end of the umbilical cord, where most tumors of the cord develop.