Heminegligencia espacial secundaria a traumatismo craneoencefálico / Hemispatial neglect secondary to a traumatic brain injury

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Estudio descriptivo de las desintoxicaciones de alcohol en un Servicio de Medicina Interna / No disponible

La dependencia al alcohol es una enfermedad crónica y su tratamiento comienza con la desintoxicación, continuándose con la rehabilitación. Se presenta un estudio descriptivo y retrospectivo de las desintoxicaciones de alcohol en 147 pacientes ingresados en nuestra unidad en el periodo 2003-2005. La media de edad es de 46.07 años, 77.6% hombres y 22.4% mujeres. Ingreso por síndrome de deprivación alcohólica en 31 pacientes (21.1%), desintoxicación programada en 116 pacientes (78.9%). Según la escala CIWA-Ar: abstinencia grado leve 100 pacientes (68.5%), moderada35 (24%), grave 11 (7.5%). La estancia media global fue de 11.5 días, sin diferencias estadísticamente significativas. Grupo Leve con proporción significativamente menor de hepatopatía, grupos Moderado y Grave proporción significativamente alta. Al compararla media de la edad, estancia, cantidad de alcohol y parámetros de consumo crónico (ferritina, fe, VCM, UBE, GPT, GGT, bilirrubina y Mg), se encuentran diferencias significativas entre las medias de los grupos Leve y Grave para la GPT y bilirrubina total. Se produjeron crisis epilépticas en 11 pacientes, 4 pertenecían al grupo programado,7 con intensidad moderada-grave. No se ha evidenciado relación entre la intensidad del síndrome de deprivación, edad y sexo. Mayor intensidad en la escala CIWA-Ar (grados moderado y grave) entre los pacientes con síndrome de deprivación ya iniciado comparados con los ingresados programados, que predominantemente presentaban un grado leve. La CIWA-Ar es un instrumento útil para evaluar los síntomas de deprivación, el riesgo de complicaciones y planificar el tratamiento. La actitud clínica debe facilitar el acceso del paciente a los recursos sanitarios para el tratamiento de su adicción, normalizando la asistencia durante el ingreso hospitalario

Alcohol dependence is a chronic disease whose treatment begins with detoxification, followed by rehabilitation. We present a descriptive and retrospective study of 147 patients admitted to our unit during the period 2003-2005. Median age was 46.07 years, with 77.6% men and 22.4% women. Admission diagnosis was alcohol with drawal syndrome in 31 patients (21.1%) and programmed alcohol detoxification in 116 patients (78.9%). On the CIWA-Ar scale: mild withdrawal, 100 patients (68.5%), moderate, 35 patients (24%), severe, 11 patients (7.5%). Mild group showed a statistically significantly lower proportion of hepatopathy, by comparison with the moderate and severe groups. Statistically significant differences were found between the mild and severe groups on comparing mean age, duration of stay, quantity of alcohol and parameters of chronic consumption (ferritine, fe, VCM, UBE,AST, bilirubin and Mg) for AST and bilirubin. There were 11 seizures: 4 patients from the programmed group, with mild with drawal on the CIWA-Ar scale, and 7 patients with moderate-severe with drawal. No relationship was found between patients’ intensity of with drawal syndrome, age or sex. There was higher intensity on the CIWA-Ar score (moderate and severe) among patients who had already begun with drawal syndrome, compared to those admitted on a planned detoxification programme. The CIWA-Ar is a useful tool for assessing with drawal symptoms and risks of complication and for planning treatment. Clinical practice must provide patients with access to health resources for the appropriate treatment of their addiction, with standardized assistance during their stay in hospital

Posttraumatic diaphragmatic hernia and death--etiologic factor or putrefactive artifact?

Late-presenting diaphragmatic hernias, whether congenital or acquired, may remain clinically undetected until mediastinal shift with cardiorespiratory compromise or intestinal or gastric infarction with perforation occur. A right-sided diaphragmatic hernia with herniation of small intestine into the adjacent pleural cavity is described in a 72-year-old man who was found dead at home in a putrefactive state. Subsequently, a history of a motor vehicle accident 8 years previously was obtained. Although postmortem herniation due to extensive putrefactive change may have occurred, producing gaseous distention and migration of the intestine, tight twisting of the herniated intestine several times around a pleural fibrous adhesion suggested that the herniation could have been an antemortem event. Unfortunately, marked tissue autolysis prevented assessment of possible ischemic changes in the herniated intestine. Although diaphragmatic hernia may be a contributing factor to death at all ages, it may not be possible to exclude it as an artifact of putrefaction in a predisposed individual.