Manejo conservador de la placenta ácreta / Conservative management of placenta accreta

El acretismo placentario es una importante causa de morbimortalidad materna. El tratamiento clásico de la placenta ácreta es la histerectomía tras la extracción fetal, sin embargo, el manejo conservador es una opción en pacientes con deseos genésicos (AU)

Placenta accreta is a major cause of maternal morbidity and mortality. The classic treatment of placenta accrete is hysterectomy after fetal extraction, however, conservative management is an option in patients with full reproductive desires (AU)

Intoxicación aguda por monóxido de carbono durante la gestación / Acute carbon monoxide poisoning during pregnancy

La intoxicación aguda por monóxido de carbono durante el embarazo es poco frecuente, aunque grave. La clínica inespecífica puede dificultar el diagnóstico. Es necesario un conocimiento y un manejo adecuados del cuadro para evitar casos de muerte fetal o secuelas neurológicas severas por la hipoxia intrauterina (AU)

Acute carbon monoxide intoxication during pregnancy is rare but serious. Diagnosis can be hampered by the nonspecific symptoms of this entity. Physicians should be well versed in the existence and proper management of carbon monoxide poisoning during pregnancy to avoid cases of fetal death or neurological damages due to intrauterine hypoxia (AU)

Complicaciones asociadas al catéter venoso central en pacientes hematológicos / Complications associated to central venous catheters in hematology patients

OBJETIVO: Conocer la incidencia de complicaciones asociadas a los catéteres venosos centrales (tunelizados, reservorios y PICC), en pacientes con patología oncohematológica, ingresados en Unidades de Hematología o Trasplantes de Progenitores Hematopoyéticos, en dos hospitales terciarios. METODOLOGÍA: Se desarrolló un estudio descriptivo transversal donde se recogieron datos sociodemográficos, clínicos, complicaciones y seguimiento del protocolo de cuidados. A cada catéter se le asignó un número de identificación correlativo. Se recogió información de 366 catéteres: 185 en el Hospital Universitario Ramón y Cajal (HURYC): 80 tunelizados, 40 reservorios y 65 PICC; 181 en el Hospital Universitario Gregorio Marañón (HUGM): 101 tunelizados y 80 reservorios. RESULTADOS: Las principales complicaciones en los tunelizados fueron las infecciones (13,7% en el HURYC vs.6,8% en el HUGM; p < 0,001) y las oclusiones (al menos una vez 3,8% vs.21,8%). En los reservorios se confirmaron un 5% de infecciones en el HURYC frente a 1,2% en el HUGM; se ocluyeron al menos una vez un 10% en el HUGM. No se detectaron otras complicaciones significativas. Respecto a los PICC solo se recogió información en el HURYC, donde las complicaciones fueron: flebitis 10,8%; trombosis 7,7%; infección o sospecha 4,6%; oclusión al menos una vez 7,7%. CONCLUSIONES: La diferencia entre hospitales respecto a la infección y oclusión, puede asociarse a las distintas pautas de cuidados. Destaca la alta incidencia de flebitis y trombosis en PICC

OBJECTIVE: To discover the incidence of central venous catheters (tunnelled, subcutaneous and PICC) in patients with onco-hematological conditions, hospitalized in the Hematology or Transplantations of Hematopoietic Stem Cells Units, in two tertiary care hospitals. METHODOLOGY: A cross-sectional, descriptive study form was developed in order to gather sociodemographic, clinical data as well as complications and follow-up of the care protocol. Each catheter was assigned a correlative identification number. Information was collected on 366 catheters: 185 in the University Hospital Ramón y Cajal (HURYC), 80 tunnelled, 40 subcutaneous venous access and 65 PICC, and 181 in the University Hospital Gregorio Marañón (HUGM), 101 tunnelled and 80 subcutaneous venous access. Findings: Major complications in the tunnellized were infections (13.7% in HURYC vs.6.8% in HUGM - p < 0 .001) and occlusions (at least once in 3.8% vs.21.8%). In subcutaneous venous access, infections were confirmed in 5% in HURYC vs.1.2% in HUGM. There were occlusions at least once in 10% in HUGM and no other significant complications were detected. Regarding PICC, information was only collected in HURYC, where complications were phlebitis 10.8%, thrombosis 7.7%, confirmed or suspected infection 4.6%, occlusion at least once 7.7%. CONCLUSIONS: Differences between hospitals with regard to major complications, infection and occlusion may be related to different care protocol. We need to stress the high incidence of phlebitis and thrombosis in PICC catheters, compared with data of lower incidence of other papers

[Complications associated to central venous catheters in hematology patients]. / Complicaciones asociadas al catéter venoso central en pacientes hematológicos.

OBJECTIVE: To discover the incidence of central venous catheters (tunnelled, subcutaneous and PICC) in patients with onco-hematological conditions, hospitalized in the Hematology or Transplantations of Hematopoietic Stem Cells Units, in two tertiary care hospitals. METHODOLOGY: A cross-sectional, descriptive study form was developed in order to gather sociodemographic, clinical data as well as complications and follow-up of the care protocol. Each catheter was assigned a correlative identification number. Information was collected on 366 catheters: 185 in the University Hospital Ramón y Cajal (HURYC), 80 tunnelled, 40 subcutaneous venous access and 65 PICC, and 181 in the University Hospital Gregorio Marañón (HUGM), 101 tunnelled and 80 subcutaneous venous access. FINDINGS: Major complications in the tunnellized were infections (13.7% in HURYC vs. 6.8% in HUGM - p<0.001) and occlusions (at least once in 3.8% vs. 21.8%). In subcutaneous venous access, infections were confirmed in 5% in HURYC vs. 1.2% in HUGM. There were occlusions at least once in 10% in HUGM and no other significant complications were detected. Regarding PICC, information was only collected in HURYC, where complications were phlebitis 10.8%, thrombosis 7.7%, confirmed or suspected infection 4.6%, occlusion at least once 7.7%. CONCLUSIONS: Differences between hospitals with regard to major complications, infection and occlusion may be related to different care protocol. We need to stress the high incidence of phlebitis and thrombosis in PICC catheters, compared with data of lower incidence of other papers.