Development and validation of a multivariate prediction model for patients with acute pancreatitis in Intensive Care Medicine.

BACKGROUND/OBJECTIVES: Development and validation of a multivariate prediction model for patients with acute pancreatitis (AP) admitted in Intensive Care Units (ICU). METHODS: A prospective multicenter observational study, in 1 year period, in 46 international ICUs (EPAMI study). PATIENTS: adults admitted to an ICU with AP and at least one organ failure. INTERVENTIONS: Development of a multivariate prediction model, using the worst data of the stay in ICU, based in multivariate analysis, simple imputation in a development cohort. The model was validated in another cohort. RESULTS: 374 patients were included (mortality of 28.9%). Variables with statistical significance in multivariate analysis were age, no alcoholic and no biliary etiology, development of shock, development of respiratory failure, need of continuous renal replacement therapy, and intra-abdominal pressure. The model created with these variables presented an AUC of ROC curve of 0.90 (CI 95% 0.81-0.94) in the validation cohort. We developed a multivariable prediction model, and AP cases could be classified as low mortality risk (between 2 and 9.5 points, mortality of 1.35%), moderate mortality risk (between 10 and 12.5 points, 28.92% of mortality), and high mortality risk (13 points of more, mortality of 88.37%). Our model presented better AUC of ROC curve than APACHE II (0.91 vs 0.80) and SOFA in the first 24 h (0.91 vs 0.79). CONCLUSIONS: We developed and validated a multivariate prediction model, which can be applied in any moment of the stay in ICU, with better discriminatory power than APACHE II and SOFA in the first 24 h.

Percepción de seguridad del paciente en salas quirúrgicas y quirófano respecto a otras salas en un hospital español de segundo nivel / Perception of patient safety in surgical room and operating ward compared to other wards in a second-level spanish hospital

Introducción: La seguridad del paciente es un pilar básico de la asistencia sanitaria. El enfermo quirúrgico parece tener singularidades frente a otros pacientes hospitalizados. Objetivos: Entregar el cuestionario HSOPS al personal sanitario de varios servicios de nuestro hospital, y comparar las respuestas de las áreas del bloque quirúrgico (quirófano central y sala quirúrgica) frente a otras áreas asistenciales evaluadas, para obtener información descriptiva sobre el ambiente de seguridad en nuestro hospital, la capacidad de detección de problemas y la notificación de eventos adversos. Métodos: Estudio observacional transversal descriptivo. Se valoraron porcentajes de respuestas positivas, intermedias y negativas de las preguntas y dimensiones del cuestionario. Resultados: Se recogieron 194 encuestas (38,5% de cumplimentación), de los que 94 (48,5%) fueron enfermeras. La “Dotación de personal” y el “Apoyo de la gerencia en la Seguridad del paciente” fueron debilidades en ambos bloques. La “Percepción de seguridad” y el “Trabajo en equipo entre unidades” fueron debilidades sólo en el bloque quirúrgico. Las “Expectativas de acciones de seguridad por parte de jefe de servicio / supervisora”, sin ser una debilidad, fueron menores en el bloque quirúrgico. La notificación de eventos adversos por el personal sanitario es muy baja. Conclusiones: Debemos seguir trabajando en la evaluación de la cultura de seguridad y en la notificación de eventos adversos para mejorar la atención a nuestros pacientes. (AU)

Introduction: Patient safety is a basic pillar of healthcare. The surgical patient seems to have singularities compared to other hospitalized patients. Objectives: Give the HSOPS questionnaire to the health personnel of various departments of our hospital and compare the responses of the areas of the surgical block (central operating room and surgical ward) against other health care areas evaluated, to obtain descriptive information on the safety environment in our hospital, the ability to detect problems and the notification of adverse events. Methods: Descriptive cross-sectional observational study. Percentages of positive, intermediate, and negative responses to the questions and dimensions of the questionnaire were assessed. Results: 194 questionnaire answers were collected (38.5% completion), of which 94 (48.5%) were nurses. “Staffing” and “Management Support for Patient Safety” were weaknesses in both blocks. "Perception of security" and "Teamwork between units" were weaknesses only in the surgical block. The "Expectations of safety actions by the head of service/ supervisor", without being a weakness, were lower in the surgical block. Reporting of adverse events by health personnel is very low. Conclusions: We must continue working on evaluating the safety culture and reporting adverse events to improve care for our patients. (AU)

[Voiding syndrome of gynaecological origin: the importance of good physical examination]. / Síndrome miccional de origen ginecológico: La importancia de una Buena exploración física.

OBJECTIVES: Urologists daily evaluate many women with voiding disturbances, but proper physical examination has only rarely been previously performed. CASE DESCRIPTION: Case 1: 16-year-old woman presenting augmented daytime urinary frequency and nocturia without enuresis, with drop-by-drop micturition. Case 2: 80-year-old woman with urgency. She referred normal voiding with insensitive urinary loss the hour after. PHYSICAL EXAMINATION: adhesion of the labia minora. TREATMENT: Surgical section of the adhered area in the midline was performed with satisfactory aesthetic and clinical results. CONCLUSIONS: The adhesion of the labia minora is an acquired disease, more frequent in girls under 2 years. Several predisposing factors have been proposed: oestrogen deprivation, inadequate personal care, local irritants, infections or previous trauma. Differential diagnosis is required among three congenital pathologies: vaginal agenesis, imperforated hymen and ambiguous genitalia. Cases in postpubertal or postmenopausal women, or refractory to medical treatment are considered for surgery.

Evaluación del clima de seguridad en varios servicios con labor asistencial de un hospital valenciano de segundo nivel / Assessment of the safety climate in several services with assistance work in a second-level valencian hospital

INTRODUCCIÓN: Durante la atención sanitaria se producen incidentes derivados de su alta complejidad, con impacto sobre la seguridad difícilmente cuantificable. MÉTODOS: Estudio observacional descriptivo, de evaluación del cuestionario HSOPS sobre la percepción de seguridad, distribuido en 2021 en varios servicios de un hospital de segundo nivel. Los hallazgos se compararon con una encuesta nacional de 2009. RESULTADOS: Se recogen 194 encuestas de trabajadores sanitarios, 76,29 % mujeres. Del total, 48,5% son enfermeras, 26,29% TCAEs, 23,19% médicos, 1,55% celadores y 0,51% trabajadora de limpieza. Hasta 11,86% proceden de Planta Médica, 24,74% de Planta Quirúrgica 4,08% de Quirófano, 15,46% de Pediatría / Maternidad, 6,63% de Oncología y 35,05% de UCI. La puntuación de calidad es 7,84 +/- 1,53, con valores superiores a 2009. En este trabajo observamos un mayor porcentaje de respuestas positivas en todas las dimensiones que en 2009. Las dimensiones 1ª “Frecuencia de eventos adversos notificados”, 2ª “Percepción de seguridad”, 6ª “Franqueza en la comunicación”, 7ª “Feed-back y comunicación sobre errores” y 11ª “Trabajo en equipo entre unidades” fueron Debilidades en el estudio nacional y no en el nuestro. En ambos las dimensiones 9ª “Dotación de personal” y 10ª “Apoyo de la gerencia del hospital” son Debilidades. Las dimensiones 3ª “Expectativas de acciones por jefe de servicio / supervisora” y 5ª “Trabajo en equipo en mi servicio” no son Fortalezas en 2009 y sí ahora. CONCLUSIONES: Este estudio permite comprender mejor la seguridad de los pacientes, recoger información sobre la percepción de condiciones laborales y planear acciones de mejora. (AU)

INTRODUCTION: Incidents arise from their high complexity occur during healthcare, with an impact on safety that is difficult to quantify. METHODS: Descriptive observational study, evaluation of the HSOPS questionnaire on the perception of security, distributed in 2021 in several services of a second level hospital. Findings were compared to a 2009 national survey. RESULTS: 194 answers of health workers were collected, 76.29% women. Of the total, 48.5% are nurses, 26.29% TCAEs, 23.19% doctors, 1.55% warders and 0.51% cleaning workers. Up to 11.86% come from the Medical Plant, 24.74% from the Surgical Plant, 4.08% from the Operating Room, 15.46% from Paediatrics/Maternity, 6.63% from Oncology and 35.05% from the ICU. The quality score is 7.84 +/- 1.53, with values ​​higher than 2009. In our study, we observed a higher percentage of positive responses in all dimensions than in 2009. Dimensions 1st “Frequency of events reported”, 2nd “Overall perception of patient safety”, 6th “Communication openness”, 7th “Feed-back and communication about errors” and 11th “Teamwork between units” were Weaknesses in the national study and not in ours. In both dimensions 9th “Staffing” and 10th “Management support for patient safety” are Weaknesses. The 3rd dimension “Expectations of actions by service manager/supervisor” and the 5th “Teamwork in my service” are not Strengths in 2009 and they are now. CONCLUSIONS: Our study allows us to better understand the safety of our patients, collect information on the perception of working conditions and plan improvement actions. (AU)

Análisis de coste-efectividad de la terapia de resincronización cardíaca en pacientes con insuficiencia cardíaca grave / Custo-efetividade da terapia de ressincronização cardíaca em pacientes com insuficiência cardíaca grave / Cost-effectiveness of cardiac resynchronization therapy in patients with severe heart failure

Introducción. La terapia de resincronización cardíaca es un tratamiento eficaz para el tratamiento de la insuficiencia cardíaca, que reduce la mortalidad y el número de hospitalizaciones, y mejora la calidad de vida. Material y métodos. Se evalúa la eficiencia de la resincronización cardíaca comparada con el mejor tratamiento farmacológico mediante una evaluación económica adaptada a nuestro entorno sanitario. Se realizan varios modelos económicos de Markov. Se usa la perspectiva del sistema sanitario; el horizonte temporal es la duración prevista del dispositivo, estimada en 7 años. Se incluyen parámetros derivados de ensayos clínicos y estudios observacionales, tanto de pacientes ambulatorios como hospitalizados, y de un meta-análisis. Los participantes son pacientes con insuficiencia cardíaca sintomática en estadios funcionales III-IV según New York Heart Association, con QRS ancho, depresión grave de la función sistólica y ritmo sinusal. Se compara la resincronización cardíaca añadida al mejor tratamiento médico, frente a ese tratamiento médico óptimo. Las variables de resultado fueron años de vida y años de vida ajustados por calidad. Resultados. La resincronización cardíaca, añadida al mejor tratamiento médico, es un tratamiento coste-efectivo, con valores de ratio coste-efectividad de € 6.627 - 8.739 por año de vida ajustado a calidad de vida. Conclusiones. La resincronización cardíaca es un tratamiento eficiente, o coste-efectiva, para estos pacientes seleccionados. Este resultado varía poco al modificar las variables incluidas en el modelo. La inclusión de dispositivos con funcionalidad desfibrilador automático implantable no se ha incluido en nuestro trabajo, pero su valor probablemente sea mucho mayor.

Introduction. The therapy of cardiac resynchronization is effective for the treatment of the heart failure, which reduces mortality and number of hospitalizations, and improves quality of life. Material and methods. We evaluate the efficiency of the cardiac resynchronization compared with the best pharmacological therapy by means of an economic evaluation adapted to our sanitary environment. We developed several economic models of Markov. The perspective of the sanitary system is used; the temporary horizon is the duration foreseen of the device, estimated in 7 years. There are included parameters derived from clinical trials and observational studies, with ambulatory and hospitalized patients, and from a meta-analysis. They are patients with symptomatic heart failure with functional class NYHA III-IV, with wide QRS, severe depression of systolic function and sinusal rhythm. We compare cardiac resynchronization added to the best medical treatment, opposite to this medical treatment. Measured variables are years of life and years of life adjusted by quality. Results. The cardiac resynchronization added to the best medical treatment, is a cost- effective treatment, with values of incremental cost - effectiveness of € 6,627 - 8,739 for year of life adjusted to quality of life. Conclusions. The cardiac resynchronization is a cost-effective treatment for these patients. This result changes little on having modified the variables included in the model. The incorporation of devices with implantable cardioverter defibrillator functionality has not been included in our work, but his value probably is greater.

Introdução. A terapia de ressincronização cardíaca é um tratamento eficaz para a insuficiência cardíaca, que reduz a mortalidade e hospitalizações, e melhora a qualidade de vida. Material e métodos. É avaliada a eficiência da terapia de ressincronização cardíaca em comparação com o melhor tratamento de drogas através de uma avaliação econômica adaptada ao nosso ambiente de saúde. Vários modelos econômicos de Markov são realizados. A perspectiva do sistema de saúde é usada; o horizonte de tempo é o tempo de vida do dispositivo, estimada em 7 anos. Parâmetros derivados de ensaios clínicos e estudos observacionais, tanto ambulatoriais e internações, e uma meta-análise está incluída. Os participantes são pacientes com insuficiência cardíaca sintomática com NYHA III- IV, com QRS largo, depressão grave da função sistólica e do ritmo sinusal estágios funcionais. Ressincronização cardíaca adicionada a melhor terapia médica é comparado com o tratamento clínico otimizado. As variáveis respostas foram anos de vida e anos de vida ajustados pela qualidade. Resultados. Terapia de ressincronização cardíaca, somada à melhor terapia médica, é um tratamento de baixo custo com valores de relação custo- eficácia dos € 6627-8739 por ano de vida ajustado por qualidade de vida. Conclusões. Terapia de ressincronização cardíaca é um tratamento de baixo custo para esses pacientes selecionados. Esse resultado varia pouco alterando as variáveis incluídas no modelo. A inclusão de dispositivos com funcionalidades cardioversor desfibrilador implantável não foi incluído em nosso trabalho, mas o seu valor é, provavelmente, muito maior.

Diagnostic accuracy of sTREM-1 to identify infection in critically ill patients with systemic inflammatory response syndrome.

OBJECTIVES: To assess the accuracy of plasma levels of soluble Triggering Receptor Expressed on Myeloid cells (sTREM)-1 to diagnose infection in critical patients with systemic inflammatory response syndrome (SIRS). DESIGN AND METHODS: We prospectively studied 114 patients with SIRS criteria. The patients' plasma levels of sTREM-1 were measured within 24h of admission to the intensive care unit. The final diagnosis of infection was made independently by two investigators, who were blinded to the levels of sTREM-1. RESULTS: The area under the ROC curve of sTREM-1 for the diagnosis of sepsis was 0.62 (95% confidence interval [95% CI] 0.51-0.72). The diagnostic odds ratio of sTREM-1 after adjusting for the Infection Probability Score and procalcitonin plasma levels was 1.81 (95% CI 0.66-4.98; p=0.2508). CONCLUSIONS: In critical patients admitted with SIRS, sTREM-1 has poor discriminative power to identify patients with infection, and sTREM-1 levels do not add diagnostic information to that provided by other routinely available clinical tests.

[Horseshoe kidney rupture]. / Rotura de riñón en herradura.

BACKGROUND: We report a rare case of horses-hoe kidney trauma. METHODS: 67 years old man with a horseshoe kidney, which presented a fracture of the isthmus after falling. RESULTS: The diagnosis was made by IV contrast CT scan. He underwent exploratory laparotomy due to hemodynamic instability and radiologic findings on the CT scan. CONCLUSIONS: The rupture of a horseshoe kidney is a rare injury. CT scan is the test of choice to classify the degree of injury. Depending on the patient's hemodynamic stability and the findings on the CT scan the options are conservative orimmediate surgical treatment.

[Usefulness of phyto-oestrogens in reduction of blood pressure. Systematic review and meta-analysis]. / Utilidad de los fitoestrógenos en la reducción de la presión arterial. Revisión sistemática y metaanálisis.

OBJECTIVES: To determine whether treatment with phyto-oestrogens or soya protein succeeds in lowering blood pressure. DESIGN: A systematic review, evaluating all the observation studies and clinical trials, was conducted, followed by a meta-analysis to evaluate blood pressure variations in patients treated with phyto-oestrogens. SEARCH: The search strategy adopted used the terms "phyto-oestrogens," "soya meals," "hypertension," and "blood pressure." DATA SOURCES: The data bases MEDLINE, EMBASE, Cochrane, OVID were used, without time or language restrictions. References in the relevant articles were searched for manually. STUDY SELECTION: Two independent reviewers analysed the studies found in the search. DATA EXTRACTION: The Jadad scale was used for the clinical trials and the numerical data in the text or referred to in tables were extracted. Evaluation was made of which observational and experimental articles showed a drop in blood pressure with phyto-oestrogens and which did not. In the meta-analysis, data on sample size, difference in blood pressure before and after intervention and standard deviation were extracted from each study. The weighted difference of means was used with the model of randomised effects. The Review Manager v4.2.9 programme was used. RESULTS: No significant variations in blood pressure were found, whether systolic (-1.20 mm Hg; 95% CI, -2.80 to 0.41 mm Hg) or diastolic (-1.31 mm Hg; 95% CI, -2.73 to 0.11). If there were any variations, they are clinically of little importance. There was also an important degree of both statistical and clinical heterogeneity. CONCLUSIONS: There are no statistically significant or clinically important differences in blood pressure between patients treated with phyto-oestrogens and those not treated.

Síndrome miccional de origen ginecológico: la importancia de una buena exploración física / Voiding syndrome of gynaecological origin: the importance of good physical examination

OBJETIVOS: A diario acuden a la consulta pacientes remitidas por alteraciones miccionales, pero en pocas ocasiones han sido exploradas ni se les ha realizado una anamnesis adecuada previa. Descripción de los casos: Caso nº 1: Mujer de 16 años remitida por polaquiuria diurna y nocturna sin enuresis, con micción a gotas. Caso nº 2: Mujer de 80 años remitida por urgencia miccional. Micciones normales con incontinencia urinaria insensible durante la hora siguiente. No escapes urinarios relacionados con la urgencia. Exploración física: fusión de los labios menores de la vulva. Tratamiento: Sección quirúrgica en la línea media el área fusionada. Resultados clínicos y estéticos satisfactorios. CONCLUSIONES: La fusión de labios de la vulva es una enfermedad adquirida más frecuente en niñas menores de dos años de edad. Se postulan diversos factores favorecedores: deprivación estrogénica, higiene inadecuada, irritantes locales, infección o traumatismo previos. Debemos establecer el diagnóstico diferencial con tres patologías congénitas: agenesia vaginal, himen imperforado, y ambigüedad genital. En casos refractarios al tratamiento médico o en mujeres jóvenes y postmenopáusicas, se recomienda cirugía

OBJECTIVES: Urologists daily evaluate many women with voiding disturbances, but proper physical examination has only rarely been previously performed. Case description: Case 1: 16-year-old woman presenting augmented daytime urinary frequency and nocturia without enuresis, with dropby-drop micturition. Case 2: 80-year-old woman with urgency. She referred normal voiding with insensitive urinary loss the hour after. Physical examination: adhesion of the labia minora. Treatment: Surgical section of the adhered area in the midline was performed with satisfactory aesthetic and clinical results. CONCLUSION: The adhesion of the labia minora is an acquired disease, more frequent in girls under 2 years. Several predisposing factors have been proposed: oestrogen deprivation, inadequate personal care, local irritants, infections or previous trauma. Differential diagnosis is required among three congenital pathologies: vaginal agenesis, imperforated hymen and ambiguous genitalia. Cases in postpubertal or postmenopausal women, or refractory to medical treatment are considered for surgery

Micosis Nasosinusal. Espectro de la Enfermedad / Rhino-sinusal mycosis: range of the disease

Introducción. Las micosis de senos paranasales se han clasificado en invasiva y no invasiva; el tipo de micosis y su comportamiento clínico depende de la interacción entre la competencia inmunológica del paciente y la patogenicidad del microorganismo, en un determinado micro ambiente. Material y Métodos. Se realizó un estudio clínico prospectivo para evaluar las características de pacientes con sinusitis micótica. Se presentan todos los pacientes diagnosticados y tratados como sinusitis micótica en el periodo de 1994-1997. Resultados. Se encontraron 10 pacientes que correspondieron al 6 por ciento de los casos de sinusitis crónica tratados quirúrgicamente; Todos los pacientes con mucormicosis aguda invasiva recibieron tratamiento medico con anfotericina B, Insulina y refección quirúrgica con debridación extensa del tejido necrótico, resultando en control de la enfermedad subyacente y sobrevida del 50 por ciento de los pacientes. Conclusión. Es necesario diagnosticar precozmente, y dar tratamiento multi disciplinario médico y quirúrgico para lograr una mejor supervivencia de los pacientes

Enfermedad de castleman de presentación cervical. reporte de un caso / Cervical presentation of castleman disease. case report

La enfermedad de Castleman es una enfermedad poco frecuente, caracterizada por proliferación masiva de tejido linfoide. Aparece en 70 por ciento de los casos como un tumor solitario en el mediastino. La presentación primaria en el cuello ocurre en 6 por ciento de los casos. Se reporta un caso de enfermedad de Castleman que se manifestó como un tumor cervical solitario asintomático

Utilidad de los fitoestrógenos en la reducción de la presión arterial. Revisión sistemática y metaanálisis / Usefulness of phyto-oestrogens in reduction of blood pressure. Systematic review and meta-analysis

Objetivos. Determinar si el tratamiento con fitoestrógenos o proteína de soja logra descensos de la presión arterial. Diseño. Se realizó una revisión sistemática, valorando todos los estudios observacionales y ensayos clínicos, y un metaanálisis para evaluar la variación de la presión arterial en pacientes tratados con fitoestrógenos. Búsqueda. Se usó una estrategia de búsqueda con los términos «fitoestrógenos» o «comidas de soja» e «hipertensión» o «tensión arterial». Fuentes de datos. Se utilizaron las bases de datos MEDLINE, EMBASE, Cochrane Database y OVID sin restricción temporal ni de idioma. Se realizó una búsqueda manual de las referencias de los artículos de interés. Selección de estudios. Dos evaluadores independientes analizaron los trabajos obtenidos en la búsqueda. Extracción de datos. Se aplicó la escala de Jadad a los ensayos clínicos, y se extrajeron los datos numéricos del texto o referidos en tablas. Se valoró qué artículos observacionales y experimentales mostraban descenso de la presión arterial con fitoestrógenos y cuáles no. Se realizó el metaanálisis, extrayendo de cada estudio datos de tamaño muestral, diferencia de presión arterial tras la intervención y basalmente y desviación estándar. Se usó la diferencia ponderada de medias con el modelo de efectos aleatorios. Se utilizó el programa Review Manager v4.2.9. Resultados. No se observaron variaciones significativas de la presión arterial, tanto sistólica (­1,20 mmHg; intervalo de confianza [IC] del 95%, ­2,80 a 0,41 mmHg) como diastólica (­1,31 mmHg; IC del 95%, ­2,73 a 0,11); si las hay, estas variaciones parecen clínicamente poco importantes. También hay un grado importante de heterogeneidad, tanto estadística como clínica. Conclusiones. No hay diferencias estadísticamente significativas ni clínicamente importantes de presión arterial en tratados con fitoestrógenos frente a no tratados

Objectives. To determine whether treatment with phyto-oestrogens or soya protein succeeds in lowering blood pressure. Design. A systematic review, evaluating all the observation studies and clinical trials, was conducted, followed by a meta-analysis to evaluate blood pressure variations in patients treated with phyto-oestrogens. Search. The search strategy adopted used the terms "phyto-oestrogens," "soya meals," "hypertension," and "blood pressure." Data sources. The data bases MEDLINE, EMBASE, Cochrane, OVID were used, without time or language restrictions. References in the relevant articles were searched for manually. Study selection. Two independent reviewers analysed the studies found in the search. Data extraction. The Jadad scale was used for the clinical trials and the numerical data in the text or referred to in tables were extracted. Evaluation was made of which observational and experimental articles showed a drop in blood pressure with phyto-oestrogens and which did not. In the meta-analysis, data on sample size, difference in blood pressure before and after intervention and standard deviation were extracted from each study. The weighted difference of means was used with the model of randomised effects. The Review Manager v4.2.9 programme was used. Results. No significant variations in blood pressure were found, whether systolic (­1.20 mm Hg; 95% CI, ­2.80 to 0.41 mm Hg) or diastolic (­1.31 mm Hg; 95% CI, ­2.73 to 0.11). If there were any variations, they are clinically of little importance. There was also an important degree of both statistical and clinical heterogeneity. Conclusions. There are no statistically significant or clinically important differences in blood pressure between patients treated with phyto-oestrogens and those not treated

Dispositivo GUTI-VAL. Insuficiencia respiratoria con ventilación no invasiva / GUTI-VAL apparatus: respiratory deficiency and non-invasive ventilation

La ventilación mecánica no invasiva (VMNI) supone una opción terapéutica útil en el tratamiento de ciertos tipos de insuficiencia respiratoria. Mejora las tasas de morbi-mortalidad y acorta la estancia hospitalaria, sobre todo al evitar la intubación, pero puede producir inconvenientes. Se evalúa la eficacia del dispositivo de sujeción GUTI-VAL en el tratamiento de la insuficiencia respiratoria con la mascarilla CPAP en términos de comodidad y aceptación del paciente, prevención de la intubación de lesiones cutáneas. Se trata de pacientes ingresados a lo largo de 13 meses en nuestra UCI, unidad polivalente de un hospital comarcal, por insuficiencia respiratoria aguda o crónica agudizada, a los que se trató con VMNI modo CPAP con el dispositivo GUTI-VAL. Se concluye que dicho dispositivo se asocia a baja morbilidad, escasas complicaciones y buena tolerancia

Mechanical non-invasive ventilation provides a useful therapeutic option to treat some types of respiratory deficiencies. This apparatus improves the morbid mortality rate and shortens hospital stays especially since it prevents tracheotomy, but it can produce some inconveniences. The authors evaluate the efficiency of the GUTI-VAL Connection Apparatus in the treatment of patients suffering from a respiratory deficiency used along with a CPAP mask in terms of the degree of comfort and acceptance patients have, the prevention of a tracheotomy and of cutaneous lesions. This study, run over a 13 month period, dealt with patients checked into our Intensive Care Unit, a multidimensional unit in a county hospital, suffering from acute respiratory deficiencies or chronic acute deficiencies to whom treatment with mechanical non-invasive ventilation type CPAP with a GUTI-VAL apparatus was applied. The authors conclude that this apparatus proved to have a low mortality rate, few complications and good patient tolerance

Angina de Ludwig: experiencia de 12 años en su diagnóstico y tratamiento / Ludwig's angina: 12 years experience en its diagnosis and treatment

En 1836 Von Ludwin describió una induración gangrenosa bilateral del tejido conectivo cervical y del piso de la boca, la cual causaba la muerte cuando se presentaba. Gracias a los avances en el desarrollo de antibióticos, así como el uso de diferentes métodos quirúrgicos para su drenaje, su morbi-mortalidad ha disminuido importantemente. En 36 pacientes atendidos en el departamento de Otorrinolaringología del Hospital General Dr. Manuel Gea González durante el período 1982-1993, se demostraron como factores causales o coadyuvantes, infecciones dentarias en 72 por ciento de los pacientes, trauma facial en 19 por ciento y diabetes mellitus en 34 por ciento. Un paciente estaba inmunosuprimido. Se usaron antibióticos y drenaje quirúrgico en todos los pacientes y traqueostomía en 10 (28 por ciento). Hubo medistinitis en dos casos (5 por ciento), septicemia en tres (8 por ciento) y cinco pacientes fallecieron