Celulitis orbitaria y empiema subdural como complicación de una extracción dentaria / Orbital cellulitis and subdural empyema as a complication of dental extraction

No disponible

Características y pronóstico de los pacientes mayores con estancia muy prolongada en una Unidad de Cuidados Intensivos / Characteristics and prognosis of patients with very long stay in an intensive care unit

Objetivo. Describir las características y los factores pronósticos de los pacientes mayores ingresados de forma prolongada en nuestra Unidad de Cuidados Intensivos (UCI). Diseño. Se trata de un análisis retrospectivo de datos recogidos prospectivamente durante 6 años consecutivos. Ámbito. Una UCI polivalente del Hospital Universitario Insular de Gran Canaria. Pacientes. El estudio se centra en pacientes adultos mayores de 70 años que permanecieron ingresados en la UCI durante un período igual o superior a 30 días. Variables de interés principales. Se recogieron datos demográficos y diagnósticos de los pacientes al ingreso, Apache II y los días que precisaron de terapias de reemplazamiento renal (RRT) y de ventilación mecánica. También se estudió la mortalidad al año de los pacientes que sobrevivieron. Resultados. Durante el período de estudio ingresaron 3.786 pacientes en la UCI. Ochocientos cincuenta y tres (22,5%) tenían más de 70 años y sólo 42 (4,92%) de ellos permanecieron en la UCI durante 30 o más días. Comparamos estos últimos con los pacientes mayores de 70 años pero con una estancia en la UCI inferior a 30 días y no encontramos diferencias estadísticamente significativas ni en la mortalidad en la UCI, ni en el Apache II, la edad, el sexo o la necesidad de RRT. El análisis multivariado mostró como variables in- dependientes asociadas a la estancia prolongada solamente los días de ventilación mecánica (p < 0,05). Los pacientes de ≥ 70 años y con una estancia ≥ 30 días que sobrevivieron eran más mayores y 21 (65,62%) estaban vivos al año. Conclusiones. Los índices de mortalidad en los pacientes de ≥ 70 años con una estancia < o ≥ 30 días en la UCI fueron similares. La supervivencia al año de los pacientes de ≥ 70 años con una estancia ≥ 30 días en la UCI fue alta. Los resultados del estudio justifican el cuidado de los pacientes ancianos con estancias prolongadas en UCI (AU)

Objective. To describe the characteristics and prognostic factors of elderly patients hospitalized for ≥ 30 days in an Intensive Care Unit (ICU). Design. Retrospective analysis of prospectively collected simple data over 6 consecutive years. Setting. Polyvalent ICU of the Insular University Hospital in the Canary Islands (Spain). Patients. Adult patients ≥ 70 years who were hospitalized in the ICU for a period of 30 or more days. Primary variables of interest. Demographic data, clinical diagnosis on ICU admission, Apache II, days of renal replacement therapy (RRT), days of mechanical ventilation and the outcome of the survivors one year later were collected. Mortality at one year of the surviving patients was studied. Results. During the study period, 3,786 patients were admitted to the ICU. Of these, 853 (22.5%). patients were ≥ 70 years old and only 42 (4.92%) of these patients remained in the ICU for ≥ 30 days. We compared the latter with the ≥ 70 year old patients whose stay in the ICU stay was < 30 days. No statistically significant differences in ICU mortality, Apache II, age, gender and the need for RRT were found. As independent variables associated with the long stay, the multivariate analysis showed only the days of mechanical ventilation (p < 0.05). The surviving patients (≥ 70 years old and whose stay in the ICU was ≥ 30 days) were older and 21 (65.62%) were still alive one year later. Conclusions. ICU mortality rates in elderly patients with a stay < or ≥ 30 days in the ICU were comparable. Survival at one year of the ≥ 70 year- old patients whose long-term intensive care unit stay was ≥ 30 days was high. These results are sufficient in our unit to justify prolonged ICU care for elderly patients (AU)

[Characteristics and prognosis of patients with very long stay in an Intensive Care Unit]. / Características y pronóstico de los pacientes mayorescon estancia muy prolongadaen una Unidad de Cuidados Intensivos.

OBJECTIVE: To describe the characteristics and prognostic factors of elderly patients hospitalized for > or = 30 days in an Intensive Care Unit (ICU). DESIGN: Retrospective analysis of prospectively collected simple data over 6 consecutive years. SETTING: Polyvalent ICU of the Insular University Hospital in the Canary Islands (Spain). PATIENTS: Adult patients > or = 70 years who were hospitalized in the ICU for a period of 30 or more days. PRIMARY VARIABLES OF INTEREST: Demographic data, clinical diagnosis on ICU admission, Apache II, days of renal replacement therapy (RRT), days of mechanical ventilation and the outcome of the survivors one year later were collected. Mortality at one year of the surviving patients was studied. RESULTS: During the study period, 3,786 patients were admitted to the ICU. Of these, 853 (22.5%) patients were > or = 70 years old and only 42 (4.92%) of these patients remained in the ICU for > or = 30 days. We compared the latter with the > or = 70 year old patients whose stay in the ICU stay was < 30 days. No statistically significant differences in ICU mortality, Apache II, age, gender and the need for RRT were found. As independent variables associated with the long stay, the multivariate analysis showed only the days of mechanical ventilation (p < 0.05). The surviving patients (> or = 70 years old and whose stay in the ICU was > or = 30 days) were older and 21 (65.62%) were still alive one year later. CONCLUSIONS: ICU mortality rates in elderly patients with a stay < or > or = 30 days in the ICU were comparable. Survival at one year of the > or = 70 year-old patients whose long-term intensive care unit stay was > or = 30 days was high. These results are sufficient in our unit to justify prolonged ICU care for elderly patients.

[Acute coronary syndrome without ST elevation during pregnancy. A case report]. / Síndrome coronario agudo sin elevación del ST durante el embarazo. A propósito de un caso.

Ischemic heart disease in the young woman is rare, and even more so in the pregnant woman, but it is reasonable to expect an increase with the increasing average age of children bearing. The etiology of acute coronary syndrome during pregnancy can be divided into two main groups: atherosclerotic mechanisms, more common in older mothers, and non-atherosclerotic mechanisms like dissection, coronary spasm and thrombosis. Management of these patients remains difficult; the treatment should follow the usual principles of care for acute coronary syndrome but taking in account that many standard treatments, such the angiotensin converting enzyme inhibitors, are contraindicated. There is also little experience with many of the newer treatments such as clopidogrel and IIb/IIIa glycoprotein inhibitors or percutaneous coronary intervention. We describe a case of a 38-week pregnant woman who suffered an acute myocardial infarction without ST segment elevation and review the literature.

Síndrome coronario agudo sin elevación del ST durante el embarazo. A propósito de un caso / Acute coronary syndrome without ST elevation during pregnancy. A case report

La enfermedad isquémica en la mujer joven es rara, y es más infrecuente aún en la embarazada, aunque es razonable esperar un aumento de su incidencia ya que la edad de las gestantes aumenta. La etiología del síndrome coronario agudo durante el embarazo se divide en dos grupos: ateroesclerótica, más común en aquellas mujeres de mayor edad, y no ateroesclerótica como la disección, espasmo o trombosis coronaria. El manejo de estas pacientes continúa siendo complejo; deben utilizarse los mismos principios que en la población general, teniendo en cuenta que muchos de los tratamientos utilizados habitualmente como los inhibidores de la enzima convertidora de angiotensina están contraindicados en la embarazada y que existe poca experiencia con tratamientos más recientes como el clopidogrel, los inhibidores de la glucoproteína IIb/IIIa o la revascularización percutánea. Presentamos un caso de síndrome coronario agudo en una gestante de 38 semanas, y revisaremos la literatura más reciente

Ischemic heart disease in the young woman is rare, and even more so in the pregnant woman, but it is reasonable to expect an increase with the increasing average age of children bearing. The etiology of acute coronary syndrome during pregnancy can be divided into two main groups: atherosclerotic mechanisms, more common in older mothers, and non-atherosclerotic mechanisms like dissection, coronary spasm and thrombosis. Management of these patients remains difficult; the treatment should follow the usual principles of care for acute coronary syndrome but taking in account that many standard treatments, such the angiotensin converting enzyme inhibitors, are contraindicated. There is also little experience with many of the newer treatments such as clopidogrel and IIb/IIIa glycoprotein inhibitors or percutaneous coronary intervention. We describe a case of a 38-week pregnant woman who suffered an acute myocardial infarction without ST segment elevation and review the literature