«RETRATO» (REgistro de TRAuma grave de la provincia de TOledo): visión general y mortalidad / «RETRATO» (REgistro de TRAuma grave de la provincia de TOledo): General view and mortality

Objetivo: Análisis del tratamiento y de la evolución del enfermo traumático crítico. Diseño: Estudio descriptivo y retrospectivo. Ámbito: Las UCI de la provincia de Toledo. Pacientes: Todos los pacientes con enfermedad traumática ingresados durante el período 2001-2007 (7 años). Variables de interés principales: Variables en el lugar del accidente, prehospitalarias, durante el transporte; variables de ingreso hospitalario y de evolución hasta el alta o el fallecimiento. Resultados: Se incluyó a 1.090 pacientes traumáticos ingresados. El 79,5% eran varones. La edad mediana fue de 36,5 años (>65 años [16%]). El descenso fue progresivo desde el año 2001 (142 pacientes) hasta el año 2007 (133 pacientes). El 46,9% ingresó entre mayo y septiembre. El 29,4% no pertenecía al área sanitaria. Las causas fueron accidente de coche (43,3%), precipitación/caída (20,8%), accidente de moto (13,8%) y atropello de peatón (6,6%). Hubo 2.172 lesiones. El 30,1% tenía 3 lesiones y el 8,4% tenía 4 o más lesiones. La lesión más frecuente fue el traumatismo craneoencefálico (33,7%), seguido por el trauma torácico (20,2%) y el trauma ortopédico (15,6%). El 36,4% necesitó cirugía en el primer día. La estancia media en la UCI fue de 10,4±13,2 días. El tiempo de ventilación mecánica fue de 7,3±12 días (mediana de 1 día). El 15% falleció en la UCI. Permanecieron en modelo multivarible de predicción de mortalidad en la UCI incluyendo las variables prehospitalarias: edad (OR: 1,05; IC95%: 1,03-1,06), midriasis (OR: 2,6; IC95%:1,3-5,3), componente motor del Glasgow Coma Score (OR: 0,7; IC95%: 0,6-0,8), shock prehospitalario (OR: 3,2; IC95%: 1,8-5,5) e Injury Severity Score (OR: 1,1; IC95%: 1,05-1,1). Conclusiones: La utilización de registros de trauma multicéntricos da una idea global del tratamiento y permite incidir en la mejora de los cuidados (AU)

Objective: To analyze the management and progression of the critical trauma patient. Design: A retrospective, descriptive analysis. Setting: The ICU in the province of Toledo. Patients: All patients with traumatic injury admitted during the 2001-2007 period (7 years). Main variables of interest: These include the variables at the scene of the accident, pre-hospitalization, during transportation, variables on admission and during development until discharge or death. Results: A total of 1090 trauma patients admitted were included. Of these, 79.5% were male, with an average age of 36.5 years (16% >65 years). There was a progressive decrease of patients from 2001 (142 patients) to 2007 (133 patients), with 46.9% admissions between May and September. A total of 29.4% did not belong to the health area. The causes were car accident (43.3%), fall from a height/fall (20.8%), motorcycle accident (13.8%), pedestrian being run over (6.6%). There were 2172 injuries; 30.1% had 3 injuries and 8.4% >4. The most frequently occurring injury was a head injury (33.7%), followed by thoracic trauma (20.2%) and orthopedic trauma (15.6%). 36.4% required surgery on the first day. Average length of stay in the ICU was 10.4±13.2 days. Time on mechanical ventilation was 7.3±12 days (median 1 day). Fifteen percent died in the ICU. This remains within the multivariable ICU mortality prediction model, including the pre-hospitalization variables: age (OR 1.05; 95% CI: 1.03-1.06), mydriasis (OR 2.6; 95% CI: 1.3-5.3), motor component of the Glascow Coma Score (GCS) (OR 0.7; 95% CI: 0.6-0.8), pre-hospitalization shock (OR 3.2; 95% CI: 1.8-5.5) and Injury Severity Score (ISS) (OR 1.1; 95% CI: 1.05-1.1). Conclusions: The use of multicenter trauma registers gives an overall view of trauma management and helps improve the care (AU)

[<> (REgistro de TRAuma grave de la provincia de TOledo): general view and mortality]. / <> (REgistro de TRAuma grave de la provincia de TOledo): visión general y mortalidad.

OBJECTIVE: To analyze the management and progression of the critical trauma patient. DESIGN: A retrospective, descriptive analysis. SETTING: The ICU in the province of Toledo. PATIENTS: All patients with traumatic injury admitted during the 2001-2007 period (7 years). MAIN VARIABLES OF INTEREST: These include the variables at the scene of the accident, pre-hospitalization, during transportation, variables on admission and during development until discharge or death. RESULTS: A total of 1090 trauma patients admitted were included. Of these, 79.5% were male, with an average age of 36.5 years (16% ≥ 65 years). There was a progressive decrease of patients from 2001 (142 patients) to 2007 (133 patients), with 46.9% admissions between May and September. A total of 29.4% did not belong to the health area. The causes were car accident (43.3%), fall from a height/fall (20.8%), motorcycle accident (13.8%), pedestrian being run over (6.6%). There were 2172 injuries; 30.1% had 3 injuries and 8.4% ≥ 4. The most frequently occurring injury was a head injury (33.7%), followed by thoracic trauma (20.2%) and orthopedic trauma (15.6%). 36.4% required surgery on the first day. Average length of stay in the ICU was 10.4+/-13.2 days. Time on mechanical ventilation was 7.3+/-12 days (median 1 day). Fifteen percent died in the ICU. This remains within the multivariable ICU mortality prediction model, including the pre-hospitalization variables: age (OR 1.05; 95% CI: 1.03-1.06), mydriasis (OR 2.6; 95% CI: 1.3-5.3), motor component of the Glascow Coma Score (GCS) (OR 0.7; 95% CI: 0.6-0.8), pre-hospitalization shock (OR 3.2; 95% CI: 1.8-5.5) and Injury Severity Score (ISS) (OR 1.1; 95% CI: 1.05-1.1). CONCLUSIONS: The use of multicenter trauma registers gives an overall view of trauma management and helps improve the care.

[Neurological sequelae following electrocution. A case report and review of the literature]. / Secuelas neurológicas tras electrocución. Presentación de un caso y revisión de la bibliografía.

INTRODUCTION: Electrocution is the cause of a large number of accidents and, of these, a considerable percentage result in death. Several factors affect the severity and distribution of the injuries. It is known that for low voltages the characteristics of alternating current make it three times more dangerous than continuous current. The high percentage of neurological sequelae can be accounted for by the fact that nerves are the tissue with the lowest resistance in the body and electricity tends to follow the path that offers the least resistance. CASE REPORT: A 16-year-old male who was accidentally electrocuted by an electric guitar and later suffered a cardiorespiratory arrest; the patient required intubation. After withdrawing sedation, the patient was found to be blind in both eyes and could not remember what had happened. FLAIR MR imaging revealed oedema in both occipital lobes and, to a lesser extent, in the junction between the parietooccipital and temporooccipital lobes. Treatment with steroids was established for three days. After approximately one month, the patient had recovered his sight and the brain injuries had disappeared. CONCLUSIONS: The neurological manifestations secondary to accidents caused by electricity are usually divided into two types -immediate and delayed. Blindness has rarely been reported as a sequela in those who have survived fulguration due to a lightning strike. The patient's recovery after administering treatment with steroids and the reversibility of the oedema could lead us to think that the mechanism producing this sequela was the damage to the nervous system caused directly by the electricity, which is known as the 'phenomenon of electroporation'.

Secuelas neurológicas tras electrocución. Presentación de un caso y revisión de la bibliografía / Neurological sequelae following electrocution. A case report and review of the literature

Introducción. La electrocución genera un gran númerode accidentes y, de éstos, un porcentaje no desestimable termina enmuerte. Existen factores que influyen en la gravedad y la distribuciónde las lesiones. Se conoce que, debido a sus características, lacorriente alterna para voltajes bajos es tres veces más peligrosa quela continua. El alto porcentaje de secuelas neurológicas se explicadebido a que los nervios son el tejido que menor resistencia poseedentro del organismo y la electricidad tiende a escoger el camino demenor resistencia. Caso clínico. Varón de 16 años que sufrió unaelectrocución accidental por una guitarra eléctrica, con posteriorparada cardiorrespiratoria; precisó intubación. Tras la retirada dela sedación, el paciente presentaba una ceguera bilateral con amnesiade lo sucedido. La resonancia magnética mostró, en la secuenciaFLAIR, edema en ambos lóbulos occipitales y, en menor grado,en la unión parietooccipital y temporooccipital. Se instauró empíricamenteun tratamiento esteroideo durante tres días. Aproximadamenteal cabo de un mes, el paciente había recuperado totalmentela visión y habían desaparecido las lesiones cerebrales. Conclusiones.Las manifestaciones neurológicas secundarias a los accidentespor electricidad se suelen dividir en inmediatas y tardías. La ceguerase ha descrito raramente como secuela de los supervivientes a lafulguración por rayos. La recuperación tras la administración deltratamiento esteroideo y la reversibilidad del edema podrían hacerpensar que el mecanismo de producción de esta secuela fuera el dañodirecto de la electricidad en el sistema nervioso, conocido como ‘fenómenode electroporación

Introduction. Electrocution is the cause of a large number of accidents and, of these, a considerable percentage resultin death. Several factors affect the severity and distribution of the injuries. It is known that for low voltages the characteristicsof alternating current make it three times more dangerous than continuous current. The high percentage of neurologicalsequelae can be accounted for by the fact that nerves are the tissue with the lowest resistance in the body and electricity tendsto follow the path that offers the least resistance. Case report. A 16-year-old male who was accidentally electrocuted by anelectric guitar and later suffered a cardiorespiratory arrest; the patient required intubation. After withdrawing sedation, thepatient was found to be blind in both eyes and could not remember what had happened. FLAIR MR imaging revealed oedema inboth occipital lobes and, to a lesser extent, in the junction between the parietooccipital and temporooccipital lobes. Treatmentwith steroids was established for three days. After approximately one month, the patient had recovered his sight and the braininjuries had disappeared. Conclusions. The neurological manifestations secondary to accidents caused by electricity are usuallydivided into two types –immediate and delayed. Blindness has rarely been reported as a sequela in those who have survivedfulguration due to a lightning strike. The patient’s recovery after administering treatment with steroids and the reversibility ofthe oedema could lead us to think that the mechanism producing this sequela was the damage to the nervous system causeddirectly by the electricity, which is known as the ‘phenomenon of electroporation’

[Aphasia and parietal syndrome as the presenting symptoms of a demyelinating disease with pseudotumoral lesions]. / Afasia y síndrome parietal como forma de presentación de una enfermedad desmielinizante con lesión pseudotumoral.

INTRODUCTION: Multiple sclerosis (MS) often presents with sensory symptoms, which are usually due to spinothalamic or spinal cord disorders; parietal syndrome is, however, very rare as the initial symptom. Likewise, aphasia is also an infrequent symptom of MS; in the few cases that have been reported, it is usually linked to the existence of important pseudotumoral lesions. CASE REPORT: We describe the case of a 31-year-old female with a 48-hour history of a progressive clinical picture consisting in nominal aphasia and a sensory parietal syndrome. Magnetic resonance imaging showed a lesion 3.6 cm in diameter that was hyperintense in T2 with perilesional edema and minimal gadolinium uptake, along with other images that revealed increased signal intensity in the periventricular subcortical white matter on the right-hand side and in the left-hand frontal subcortical region. A spectroscopic analysis of the largest lesion revealed that this lesion showed evidence of inflammation, with cell destruction and replacement, although it was not possible to distinguish between a demyelinating disease and a high grade glioma. Hence, a brain biopsy was required in order to reach the final diagnosis of demyelinating pseudotumoral lesion. CONCLUSIONS: Giant pseudotumoral plaques are a rare form of presenting symptom in MS; use of the clinical features, simple images and spectroscopy is not a very reliable means of reaching a differential diagnosis with a tumour and this often makes it necessary to conduct a biopsy study of the lesion.

Afasia y síndrome parietal como forma de presentación de una enfermedad desmielinizante con lesión pseudotumoral / Aphasia and parietal syndrome as the presenting symptoms of a demyelinating disease with pseudotumoral lesions

Introducción. Las manifestaciones sensitivas son frecuentes como síntomas iniciales de la esclerosis múltiple (EM), generalmente por alteración espinotalámica o medular; pero es excepcional un síndrome parietal como forma de inicio. Igualmente, la afasia es una manifestación infrecuente en la EM; en los pocos casos descritos suele asociarse a la existencia de grandes lesiones pseudotumorales. Caso clínico. Mujer de 31 años con un cuadro progresivo de 48 horas de evolución, consistente en afasia nominal y un síndrome sensitivo parietal. En la resonancia magnética se observó una lesión de 3,6 cm de diámetro hiperintensa en T2 con edema perilesional y con mínima captación de gadolinio, además de otras imágenes de aumento de intensidad de señal en sustancia blanca subcortical periventricular derecha y en zona subcortical frontal izquierda. El análisis espectroscópico de la lesión de mayor tamaño reveló que dicha lesión presentaba datos de inflamación, con destrucción y recambio celular, sin poder distinguir entre enfermedad desmielinizante o glioma de alto grado; se precisó para ello la realización de una biopsia cerebral para alcanzar el diagnóstico final de lesión pseudotumoral desmielinizante. Conclusiones. Las placas gigantes pseudotumorales constituyen una forma infrecuente de inicio de la EM; su diagnóstico diferencial con un tumor por la clínica, la imagen simple y la espectroscopia son poco fiables, por lo que, con frecuencia, es preciso recurrir a la biopsia de la lesión

Introduction. Multiple sclerosis (MS) often presents with sensory symptoms, which are usually due to spinothalamic or spinal cord disorders; parietal syndrome is, however, very rare as the initial symptom. Likewise, aphasia is also an infrequent symptom of MS; in the few cases that have been reported, it is usually linked to the existence of important pseudotumoral lesions. Case report. We describe the case of a 31-year-old female with a 48-hour history of a progressive clinical picture consisting in nominal aphasia and a sensory parietal syndrome. Magnetic resonance imaging showed a lesion 3.6 cm in diameter that was hyperintense in T2 with perilesional edema and minimal gadolinium uptake, along with other images that revealed increased signal intensity in the periventricular subcortical white matter on the right-hand side and in the left-hand frontal subcortical region. A spectroscopic analysis of the largest lesion revealed that this lesion showed evidence of inflammation, with cell destruction and replacement, although it was not possible to distinguish between a demyelinating disease and a high grade glioma. Hence, a brain biopsy was required in order to reach the final diagnosis of demyelinating pseudotumoral lesion. Conclusions. Giant pseudotumoral plaques are a rare form of presenting symptom in MS; use of the clinical features, simple images and spectroscopy is not a very reliable means of reaching a differential diagnosis with a tumour and this often makes it necessary to conduct a biopsy study of the lesion