Análisis de las fracturas mandibulares causadas por accidentes laborales: estudio descriptivo retrospectivo / Analysis of mandibular fractures caused by work related accidents: retrospective descriptive study

El objetivo de este estudio fue evaluar la tendencia de los pacientes con fracturas mandibulares asociados a accidentes laborales. Se realizó un estudio descriptivo retrospectivo en todos los casos de fracturas mandibulares que asistieron al servicio de cirugía maxilofacial del Hospital Clínico Mutual de Seguridad C.Ch.C., Santiago de Chile en un periodo de 4 años (enero 2009 - diciembre 2012). Todas las fracturas mandibulares fueron consignadas. La información fue recopilada a través de revisión de fichas clínicas electrónicas. Entre los años 2009 al 2012 se presentaron un total de 74 pacientes incluidos en el estudio con 102 rasgos de fracturas mandibulares. La fractura más común fue la de cóndilo mandibular (35 pacientes). Se observó una tasa de complicaciones del 8%. Los resultados mostrados en este estudio están en línea con la literatura y el análisis de este reporte provee información para el diseño de planes de prevención de riesgos, especialmente para desarrollar medidas de protección facial. Nivel de Evidencia: Tipo II. Estudio descriptivo.

The objective of this study was to evaluate the tendency of patients with mandibular fractures associated with working accidents. A retrospective descriptive study was performed in all cases of mandibular fractures who attended the maxillofacial surgery service at the Clinical Hospital Mutual Seguridad C.CH.C. Santiago de Chile, in a 4-year period (January 2009 - December 2012). All mandibular fractures were recorded. The information was collected through review of electronic medical records. Between 2009 and 2012, 74 patients were included in the study with 102 lines of mandibular fractures. The most common fracture was the mandibular condyle (35 patients). The complication rate was 8%. The results shown in this study are in line with the literature and the analysis of this report provides information for the design of risk prevention plans, especially in developing measures of facial protection.

The use of the Dornier MPL-9000 lithotripter in the treatment of gallbladder and renal stones. Early experience.

The experience of two units (Gastroenterology and Urology) of Clínica La Luz, Madrid, in the treatment of gallbladder and renal lithiasis using the Dornier MPL-9000 lithotripter is reported herein. This lithotriptor has been utilized in the treatment of all cases of gallbladder calculi for which it is indicated and renal calculi localized high up (kidney), and in those cases that are difficult to treat with other lithotriptors such as patients with kyphoscoliosis, radiolucent calculi, elderly patients, children, etc.). During the first year the gallstone lithotripsy unit was utilized, 401 patients were referred for treatment. Of these, 180 met the criteria for patient selection. (Over 360 have been treated to date.) Sixty of these 180 patients had a single gallstone of up to 2.5 cm. These 60 patients were selected for the study since they comprised a group where the best results could be expected. The aim of studying this patient group was to evaluate the results achieved by lithotripsy and the short and medium-term outcome in this ideal group of patients. Concerning renal lithiasis, these are the first 100 cases treated with the MPL-9000 (currently over 420 have been treated). Eighty cases had a single calculus (60 caliceal and 20 pyelic), 15 had multiple calculi, and 5 had a staghorn stone. Treatment for gallbladder and renal lithiasis was exclusively by shock waves; i.e., as monotherapy with no other auxiliary procedure. The average number of shock waves used was 2,350 with a mean kV of 18 for gallbladder lithiasis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Extracorporeal biliary lithotripsy: results in 60 cases of single calculus]. / Litotricia biliar extracorpórea: resultados en 60 casos de cálculo único.

The outcome of 60 cases of single biliary stone with a maximum diameter of 25 mm was evaluated. The patients were symptomatic, with functioning gallbladder, and were selected from a group of 180 to evaluate the effects of electrohydraulically generated shockwaves on a priori ideal cases for this procedure. In seven patients fragmentation was not achieved, probably because of the pigmentary character of the stone, that was later verified at cholecystectomy. In 20 out of the 53 in whom fragmentation was satisfactory (38%), fragments were not observed after 24 hours. 32 patients (54%) had a stone-free gallbladder 3 months afterwards; at six months, the number had increased to 40 (66%). This rate becomes 77% if only the cases with fragmentation are considered. In 29% of patients episodes of colicky biliary pain developed as complication. No case of pancreatitis or stuck in gallstone were observed. We conclude that shock waves appear as an excellent therapeutic alternative in single gallstones up to 25 mm in size.

Ticlopidine as a hemorrhagic risk factor in coronary surgery.

We retrospectively reviewed the postoperative hemorrhagic risk in patients undergoing surgery for coronary revascularization who had received platelet antiaggregants preoperatively. A significant increase in postoperative hemorrhage and a higher percentage of reoperations for this reason was observed in the patients treated with ticlopidine. However, there were no major differences in the platelet counts among the groups compared.

Hypoglycemic coma after cardiac surgery.

Hypoglycemic coma occurring 5 h after cardiac surgery in a nondiabetic adult patient was primarily triggered by: low cardiac output leading to severe hepatic functional derangement; metabolic acidosis, probably secondary to peripheral hypoperfusion; and possible inhibition of the adrenergic response due to anesthesia with fentanyl. Glucose infused at 8 g/h progressively increased the blood glucose level and paralleled hemodynamic improvement.

Cardiomyopathy and phaeochromocytoma.

A case is presented of phaeochromocytoma with catecholamine-induced cardiomyopathy. The difficulties in the management when left ventricular failure occurred are reported and the importance of monitoring pulmonary artery pressure during the anaesthetic procedure is stressed.