[Traumatic bilateral chylothorax (author's transl)]. / Quilotórax bilateral traumático.

A case is presented of a bilateral chylothorax caused by rupture of the thoracic duct, secondary to a closed traumatism of the thorax in a polytraumatized patient, and produced by a mechanism of hyperextension of the dorsal segment of the vertebral column. Considerations are made with reference to the anatomy of the thoracic duct, the rupture mechanism, diagnosis, complications and treatment. The chylothorax could not be distinguished clinically and by simple radiology from the traumatic hemothorax. The preliminary diagnosis will be made according to the macroscopic appearance of the drained fluid, and the definite diagnosis by the analytical and histopathologic characteristics of the same fluid. The lymphographic examination reveals the exact point of the lesion. The immediate complications are related to the respiratory insufficiency due to the occupation of the pleural space, and under a long period of time undernutrition provoked by the loss of fats and proteins. The treatment of choice is based upon the early drainage of the chylothorax and on the absolute suppression of the oral intake, establishing a complete parenteral feeding during at least 15 days. Afterwards oral diet can be initiated with a gradual increase in its quantity and always without fat content, while at the same time the parenteral nutrition is reduced. Following this protocol a great number of ruptures of the thoracic duct can be corrected, achieving a spontaneous closure of the duct. In the cases in which this not occur, at the end of 15 days it would be advisable to perform a surgical operation according to the Lampson's ligature technique.

[The evaluation of the operation of and the pathology cared for at a rural outpatient emergency service]. / Valoración del funcionamiento y de la patología asistida en un servicio de urgencia extrahospitalario rural.

We investigated the emergency service at Reinosa to evaluate the following: equipment, characteristics, performance (policies, criteria of use of transport), and the type of the attending patients, demand for care and severity. Attention was given to 8,039 patients, with a monthly mean of 674,416 +/- 21,750 and male predominance. The severity index was distributed between "consultation" (48.36%) and "emergencies" (51.44%). The conditions with a higher demand for care were: accidents, trauma, poisoning and aggression injuries; and respiratory, infective and parasitic diseases. 3.66% of patients were referred to the hospital, using ambulance (57.3%), private means of transportation (32.2%), and mobile intensive care unit (10.4%). Our study shows that 96.34% of the demand can be correctly cared for with an adequate equipment. This type of services should be encouraged as they are highly cost effective from the social, health care and economic points of view.