Rotura bronquial en traumatismo torácico cerrado / Bronchial rupture in closed chest trauma

La rotura bronquial es una complicación infrecuente pero potencialmente grave en el traumatismo torácico cerrado, con una mortalidad asociada del 30 por ciento. En las últimas décadas se está presenciando un incremento en su incidencia paralelamente al desarrollo de los medios de transporte. El 80 por ciento de las lesiones se localizan a 2,5 cm de la carina. El diagnóstico está basado en las manifestaciones clínicas, hallazgos radiológicos y en la broncoscopia. El enfisema subcutáneo y la insuficiencia respiratoria son los síntomas más frecuentes. A escala radiológica destaca la presencia de neumotórax, neumomediastino o ambos. La broncoscopia es el método diagnóstico de elección y se debe realizar de forma temprana. El tratamiento es el restablecimiento de la continuidad anatómica del árbol traqueobronquial mediante la reparación quirúrgica de la lesión, tan pronto como sea posible, si ésta es mayor de un tercio de la circunferencia y/o el neumotórax no se resuelve con dos drenajes torácicos. Es muy importante que este tipo de lesión sea reconocida y tratada de forma temprana, tanto para restaurar con éxito la función pulmonar, como para evitar las complicaciones asociadas con el retraso diagnóstico y terapéutico. No obstante, los hallazgos iniciales son a menudo inespecíficos, y requieren un alto índice de sospecha, por lo que en un porcentaje elevado de pacientes el diagnóstico es tardío. (AU)

[Bronchial rupture in blunt thoracic trauma]. / Rotura bronquial en traumatismo torácico cerrado.

In closed chest trauma, bronchial rupture is an unusual but potentially serious complication, with an associated mortality rate of 30%. Recent decades have seen an increase in incidence parallel to greater use of transport. Eighty percent of injuries are located 2.5 cm from the carina. Diagnosis is based on clinical signs, imaging and bronchoscopy. Subcutaneous emphysema and respiratory insufficiency are the most common findings. Images show the presence of pneumothorax, pneumomediastinum or both. Bronchoscopy is the diagnostic method of choice and must be performed early. Treatment consists of reestablishing anatomical continuity of the tracheobronchial tree by surgical repair if the lesion affects more than a third of the circumference and/or pneumothorax is not resolved after two chest drainages. This type of injury should be recognized and treated early, both to restore lung function and to prevent associated complications caused by delay. However, initial findings are seldom specific, requiring the physician to display a high degree of suspicion and explaining why diagnosis often comes late.

Differential effect of haloperidol and clozapine on plasma homovanillic acid in elderly schizophrenic patients with or without tardive dyskinesia.

BACKGROUND: Plasma homovanillic acid (HVA) changes in response to a challenge of several days with haloperidol have been found to be predictive of the therapeutic response to haloperidol over a longer period of treatment. METHODS: Twenty-six elderly women who gave informed consent were divided into two groups, with or without tardive dyskinesia, and subjected to an 80-day washout, after which both the dyskinetic and nondyskinetic group was divided, and half of each group given haloperidol or clozapine. CONCLUSIONS: The nondyskinetic group had a brief rise in plasma HVA, then a decline. The dyskinetic group had no change in plasma HVA. Neither group challenged with clozapine had any change in plasma HVA.