"Perimortem" total body CT-scan examination in severely injured children: an informative insight into the causes of death.

OBJECTIVE: To report routine practice of "perimortem" CT-scan imaging to determine the causes of death in children dying from severe accidental injuries within the first hours following hospital admission. SETTINGS: Trauma center of a University Pediatric Hospital. METHODS: A retrospective study was conducted in children (0 to 15 years old) referred for severe trauma (GCS ≤ 8) to a regional pediatric trauma center, presenting with at least spontaneous cardiac rhythm and dying within the first 12 h after admission. "Perimortem" CT-scan consisted in high-resolution, contrast-enhanced, full-body CT-scan imaging, performed whatever child's clinical status. Lethal and associated lesions found were analyzed and classified according to validated scales. The comparison between clinical and radiological examinations and CT-scan findings evaluated the accuracy of clinical examination to predict lethal lesions. RESULTS: CT-scan performed in 73 children detected 132 potentially lethal lesions, at least 2 lesions in 63%, and 1 in 37% of the cases. More frequent lethal lesions were brain (43%), and chest injuries (33%), followed by abdominal (12%), and cervical spine injuries (12%). Clinical and minimal radiological examinations were poorly predictive for identifying abdominal/chest lesions. Clinical and imaging data provided to the medical examiner were considered sufficient to identify the cause of death, and to deliver early burial certificates in 70 children. Only three legal autopsies were commanded. CONCLUSIONS: Perimortem CT imaging could provide an insight into the causes of death in traumatized children. Performed on an emergency basis near death, it eliminates the difficulties encountered in forensic radiology. It could be a possible alternative to full-scale forensic examination, at least regarding elucidation of the potential, or highly probable causes of death.

Scaphocephaly: Part I: indices for scaphocephalic frontal and occipital morphology evaluation: long-term results.

UNLABELLED: Scaphocephaly is the most frequent craniosynostosis. Many correction techniques have been proposed. Their relevance is not completely appreciated by means of the Cranial Index, which cannot differentiate specifically the anterior and posterior modifications.The aim of this study was to propose a new fronto-occipital morphologic evaluation technique and its validation in normal and scaphocephalic patients, operated or nonoperated. PATIENTS AND METHODS: Two evaluation measures (indices) were developed for frontal and occipital deformities, traced over a standard skull radiograph. It was initially applied in 16 normal skull radiographs. Forty-two scaphocephalies were evaluated before and after linear perisutural craniectomy technique. Short- and long-term evaluations were performed in the 42 operated cases, with a follow-up period of 10 or more years.The created indices were named Frontal Sagittal Index (FSI) and Occipital Sagittal Index (OSI). They are proportional measures between 2 cranial lengths. RESULTS: A significant difference was found for the FSI and the OSI between scaphocephalies and normal skulls. A significant difference was also found between indices before and after surgery, whether it was short- or long-term follow-up. No significant differences were found between the indices for the short- and long-term follow-up. CONCLUSIONS: The FSI and the OSI were more precise measuring methods than the Cranial Index for the scaphocephaly anterior posterior morphologic evaluation and follow-up. There was also a stability of the results in the long-term follow-up with the technique used. We recommend these indices for the presurgical and result evaluation rather than the Cephalic Index.

Niveles de ansiedad y depresión en el personal médico en formación del Hospital Militar "Dr. Carlos Arvelo" / Levels of anxiety and depression in the medical personnel in formation of the Hospital Militar \"Dr. Carlos Arvelo\"

Se estudió la prevalencia de ansiedad y depresión en una muestra de 44 médicos residentes de post-grado e internos del Hospital Militar "Dr. Carlos Arvelo", para lo cual se utilizaron las escalas de Hamilton para depresión y ansiedad, ademas de un cuestionario elaborado por los autores, contestando por los sujetos a manera de autoevaluación. El 40,91 por ciento presentó depresión menor y un 2,27 por ciento depresión mayor, sin encontrarse índices de ansiedad en la muestra estudiada. Los niveles de presión no se correlacionaron en forma estadísticamente significativa con las variables sexo, especialidad, nivel socioeconómico, edad y carga horaria. Los ítems de la HAM-D con mayor puntuación promedio entre los sujetos deprimidos fueron el 4, 10, 13, 2 y 16, detectando alteraciones de las áreas somáticas, afectiva e intelectual. Con este trabajo se pretende obtener información sobre el estado emocional del personal médico en formación y de los factores relacionados con el mismo.

Lactancia materna: caracterización de la población del sur de Aragua. Ago./Sept. 1993 / Breast feeding: characterization of the south population of Aragua Aug./Sept. 1993

Este estudio busca describir las características de la lactancia materna en las mujeres en edad fértil del Sur de Aragua. Se tomó una muestra de 210 mujeres, cuyas edades estaban comprendidas entre 15 y 44 años, seleccionadas mediante el método de muestreo por conglomerado, siendo aleatoria la selección de casas a encuestar. No se encontró correlación alguna entre las variables en estudio (p<0.05). Se encontró que las nulíparas reciben información predominante de madre y familiares (40 por ciento) al igual que las mujeres de San Sebastián que habían gestado, contrastando con las de San Casimiro, cuya fuente principal son los médicos. La mayoría (90,95 por ciento) tiene una buena opinión sobre la lactancia materna. El 61,8 por ciento de las madres dió lactancia exclusiva. La causa de la no exclusividad fue la poca cantidad de leche según referencia de las madres. el tiempo de duración de la lactancia fue menor de 6 meses (47,10 por ciento). La tendencia en dicha zona hacia la práctica de la lactancia materna es alta, pero no adecuada