[Renal brucelloma. A rare possible diagnosis]. / Bruceloma renal. Una rara posibilidad diagnóstica.

Presentation of one case of renal Brucelloma in a 61-year old patient. The emphasis is placed in the pathophysiology of the condition and the extraordinary rarity of its renal location. Also an explanation is proposed for the diagnostic methodology and the dissociation, typical in chronic brucellosis, of the different serologic testing. Finally, the increased incidence experimented by this condition in our environment, which involves the reappearance of clinical pictures today thought eradicated, is pointed out.

[Abscessed brucellar prostatitis. An infrequent location]. / Prostatitis brucelar abscesificada. Una localización poco frecuente.

Explanation of one case of abscessified brucellar prostatitis in a 44-year old patient. The emphasis is placed on the high incidence of brucellosis in the province of Soria and the rarity of the prostatic location of this condition. Also, a revision is made of the diagnostic methodology and current therapeutical approaches. The crucial role of the endocavitary ultrasound techniques both for diagnosis as well as treatment and case follow-up is highlighted.

[Brucellar orchitis. Report of a series of 16 cases]. / Orquitis brucelar. Aportación de una serie de 16 casos.

A retrospective study of orchiepididymitis, diagnosed and admitted to our Unit over the 1989-94 period was conducted. there were 125 orchiepididymitis, of which 16 (12.8%) had a brucellar etiology, and three had simultaneously become abscessified (18.75%). Considering that our working area is located within an endemic region, and even more, our province has the country's highest incidence rate (112.8/100000 inh.), this prompted us to study the conditions' morbidity in the testicular location, while we make a superficial revision of this disease. Brucellar orchitis is a diagnostic option to be taken into account in endemic regions, and the clinical picture associated to the orchiepididymal process should make us suspect its diagnosis and trigger follow-up of these patients.

Estudio clínico retrospectivo del uso de un sistema de hidrocirugía en pacientes lesionados medulares con úlceras por presión crónicas / Retrospective clinical study of an hydrogurgery system on spinal cord injured patients with chronic pressure ulcers

Realizamos un estudio clínico retrospectivo con pacientes lesionados medulares crónicos en el Hospital Nacional de Parapléjicos (Toledo, España), intervenidos quirúrgicamente por una o varias úlceras por presión de carácter crónico durante el año 2008. Revisamos 84 historias clínicas de pacientes a los cuales se realizaron 141 procedimientos quirúrgicos. Sólo en 8 casos se realizó una cirugía puramente de limpieza (bisturí más hidrocirugía) sin realizar consecutivamente el tratamiento de cobertura de la lesión. Los restantes 133 procedimientos de limpieza más cobertura inmediata se distribuyeron en 2 grupos según el tipo de desbridamiento realizado: grupo I (n=71), sólo desbridamiento quirúrgico con bisturí y grupo II (n=62) desbridamiento con bisturí más uso posterior de un sistema de hidrocirugía de flujo continuo a alta presión. Según la localización, las lesiones ulcerosas tratadas fueron: isquiáticas 69 (48,94%), sacras 49 (34,75%), trocantéreas15 (10,63%) y otras (talones y maléolos) 8 (5,67%). Como conclusiones, establecemos que más del 54% de los procedimientos llevados a cabo (72 de 133) curaron en la primera intervención y no necesitaron más cirugías; un 38%(51 de 133) fueron intervenciones realizadas en pacientes con úlceras muy evolucionadas y/o de difícil solución; la tasa de recidivas al año fue del 4,4%; no encontramos diferencias significativas en cuanto a la tasa de curación entrelos grupos I y II (p<0,05) y, sin embargo el sistema de hidrocirugía se mostró muy efectivo (100% de éxito) en los 5casos que precisaron autoinjerto de piel parcial (AU)

We carried out a retrospective study on spinal cordinjured patients from the National Hospital for Paraplegics (Toledo, Spain), who were surgically treated during 2008 to alleviate the problems elicited by one or more pressure ulcers of chronic nature. We reviewed the clinical histories of 84 patients that received 141 surgical procedures, 8 were of radical nature (scalpel plus hidrosurgery) without wound covering. The remaining 133 procedures of surgical cleaning and immediate wound covering have been devided in 2 groups according to the type of debridement performed: Group I (n= 71) with only surgical debridement and Group II (n=62) with surgical excision followed by hydro surgery procedure consisting of a high pressure continuous flow of physiological saline fluid. Based on ulcers location, the procedures were: sciatic(n=69; 49,94%), sacral (n=49; 34,75%), trochanteric (n=15;10,63%) and others (n=8; 5,67%): heels and malleolus. Our results indicate that more than 54% of the procedures (72out of 133) healed; the procedures were carried out on patients with an advanced stage of pressure ulcers hence, the wounds were resilient to treatment; the observed annual rate of relapse was 4,4%; respecting to the rate of healing, no significant differences were found between group I and II(p<0,05) and nevertheless, the hidrosurgery system has been proven very effective (100% success) in 5 patients that required partial skin auto-transplant (AU)

[Nursing care for patients with toxic epidermal necrolysis]. / Cuidados de enfermería en el paciente con necrólisis epidérmica tóxica.

Toxic Epidermal Necrolysis (TEN) is a severe skin disorder characterised by separation of the dermal-epidermal junction, as it is observed in second degree superficial burns, and it may also involve any mucosal surface area (otic, buccal, conjunctival, respiratory, genital). This condition is generally induced by the ingestion of drugs, particularly certain antibiotics, nonsteroidal antiinflammatory drugs, and antiepileptic drugs. Mortality has decreased over the last decades, from 80% to about 25% in recent series. This improvement in survival rate has been related to early diagnosis, management in specialized burn units, proper immunosuppressive treatment and intensive specialised nursing care. The main nursing diagnosis include abnormalities in the skin and mucose membranes integrity, risk of infection, loss of blood volume, risk of hypothermia, acute pain, upper airway insufficiency and anxiety. We here review the nursing care of patients with TEN. We emphasize the daily skin and mucose membranes care, and the prevention of conjunctival sinequiae, including daily conjunctival cleaning and debridement of necrotic tissue and fibrin debris using a handle needle.

Cirugía menor de la falange distal de la mano / Fingertip´s ambulatory surgical procedures

La patología de la falange distal de los dedos de la mano es atendida con frecuencia en los Servicios de Urgencias de Atención Primaria. Se trata de procesos médico-quirúrgicos muy habituales y de fácil resolución. En el presente manuscrito se revisan la patología infecciosa y traumática de la falange distal de la mano que requieren un tratamiento quirúrgico que puede ser realizado sin problemas en cualquier Centro de Salud. Consideramos que en un ámbito de primer nivel mínimamente dotado se pueden llevar a cabo, en el área descrita, los siguientes procedimientos: drenajes de colecciones purulentas o hematomas subungueales, exéresis de la uña encarnada, fijación de una avulsión ungueal, sutura de heridas incisas que no afecten al aparato flexo-extensor o al paquete vascular, pérdidas de sustancia del pulpejo sin exposición ósea y si hay disponibilidad de equipo de rayos X, fijación de una fractura de penacho ungueal y el tratamiento conservador del dedo en martillo (AU)