ABSTRACT
Abstract Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients.
Resumen El manejo definitivo de los pacientes hemodinámicamente estables con heridas cardíacas penetrantes continúa siendo controversial con abordajes invasivos versus manejos conservadores. Estas posiciones contrarias se extienden hasta aquellos casos de pacientes hemodinámicamente inestables donde se ha descrito y considerado la cirugía de control de daños como un procedimiento útil y efectivo. El objetivo de este artículo es presentar la experiencia en el manejo quirúrgico de heridas cardíacas penetrantes con la creación de un algoritmo práctico que incluye los principios básicos del control de daños. Se recomienda que a todos los pacientes con heridas precordiales penetrantes se les debe realizar un ultrasonido torácico como componente integral de la evaluación inicial. Aquellos que presenten un ultrasonido torácico positivo y se encuentren hemodinámicamente estables se les debe realizar una ventana pericárdica con posterior lavado. Se ha demostrado que el 25% de las ventanas pericárdicas positivas no se benefician ni requieren de posteriores abordajes quirúrgicos invasivos. Antes de este concepto, todos los pacientes con ventana pericárdica positiva terminaban en una exploración abierta del tórax y del pericárdico. Los pacientes hemodinámicamente inestables requieren de una cirugía de control de daños para un adecuado y oportuno control del sangrado. Con este propósito, se propone un algoritmo de manejo quirúrgico que incluye todos estos aspectos esenciales en el abordaje de este grupo de pacientes.
ABSTRACT
Introducción: la rehabilitación sobre implantes con sobredentaduras mejora la calidad de vida de los pacientes y las técnicas para la rehabilitación son simples y preserva mayor cantidad de tejido dentario. Objetivo: caracterizar el comportamiento de la rehabilitación protésica implantomucosoportada en el desdentado total. Material y método: se realizó un estudio descriptivo, longitudinal y retrospectivo en los pacientes rehabilitados con sobredentaduras implantomucosoportadas en la Clínica Estomatológica "Antonio Briones Montoto" de Pinar del Río, en el período comprendido entre el año 2013 y 2014. El universo estuvo constituido por 28 pacientes, coincidente con la muestra. La información se recopiló a través de datos obtenidos en la historia clínica. Resultados: se encontró la mayor cantidad de implantes en la mandíbula. Se comprobó que la mayoría de los pacientes con mucositis perimplantaria el 14,3%, presentaban una higiene bucal regular o mala. Existió una dependencia estadísticamente significativa entre los períodos de tiempo en que les fue necesario el cambio de la cápsula de teflón. Conclusiones: se caracterizó el comportamiento de la rehabilitación protésica implantomucosoportada en el desdentado total.
Introduction: overlay dentures rehabilitation improves the quality of life of patients, while the rehabilitation techniques are simple and more dental tissue is preserved. Objective: to characterize the behavior of removable prosthetic rehabilitation in the total toothless patient. Material and method: a descriptive, longitudinal and retrospective study was performed in patients rehabilitated with overlay dentures in Antonio Briones Montoto Dental Clinic of Pinar del Río, in the time between the years 2013 and 2014. The target group consisted of 28 patients and coincided with the sample. Data was compiled from the clinical records. Results: most dentures were localized in the mandible. The majority of the patients with peri-implant mucositis (14.3%) practiced fair or bad oral hygiene. A statistically significant dependency existed between the two periods of time when changing the Teflon capsule was required. Conclusions: the behavior of removable prosthetic rehabilitation in the total toothless patient was characterized.
ABSTRACT
Twenty (20) Large White male pigs (n=20) divided in groups of ten were used to observe the effects produced by the use of expanded polytetrafluoroethylene (e-PTFE) mesh, in the preperitoneal space. The operative approach was the laparoscopic transabdominal technique. On one side, in the inguinal region, the preperitoneal space was dissected and the mesh was fixed. On the other side, as a control, the same procedure has been done without the utilization of mesh. The local parietal peritoneum was approximated with a polyglactin 910 continuous suture. The animals were submitted to euthanasia at the 7th and the 21th days of postoperative evolution. In the first group, one animal presented adhesion formation where the mesh was placed and, in the second group, there was also one animal with adhesion formation but in the control side. It was concluded that e-PTFE mesh did not incited significant adhesion formation when placed in the preperitoneal space in a swine model.
Com o objetivo de observar os efeitos produzidos pela tela de politetrafluoroetileno expandido (PTFE-e), no espaço pré-peritoneal, foram utilizados 20 suínos (n=20) da raça Large White, todos machos, distribuídos em dois grupos de dez animais. A técnica operatória utilizada foi a videolaparoscopia transabdominal. De um lado, na região inguinal, o espaço pré-peritoneal foi dissecado e a tela fixada; na região contralateral, o procedimento foi o mesmo, sem a colocação da tela, servindo como controle. O peritônio parietal local foi aproximado com uma sutura contínua de poliglactina 910. A eutanásia foi realizada aos sete e vinte um dias de pós-operatório. No primeiro grupo, um animal apresentou aderência no local de implantação da tela e, no segundo grupo, um animal também apresentou aderência, mas no lado controle. Concluiu-se, baseado na presente pesquisa, que a tela de PTFE-e não provocou a formação de aderências, quando colocada no espaço pré-peritoneal em suínos.