RESUMO
Anaphylactic shock is the most severe form of an acute systemic allergic reaction and can be potentially lethal if left untreated. Here, we present the case of a 51-year-old male with no significant medical history, who arrived at our hospital's emergency trauma bay following a motor vehicle accident caused by a sudden onset of malaise while driving. Upon arrival, the patient's airway was patent, but he reported a sensation of a foreign body in his larynx. He also had an oxygen saturation of 88%, although no abnormal breath sounds were auscultated. The patient was also hypotensive and tachycardic, with no favorable response after crystalloid administration. He had no neurological alterations but was diaphoretic, with hives spreading across his trunk and all four extremities. Upon further interrogation, we identified that he had consumed diclofenac, a non-steroidal anti-inflammatory drug (NSAID), 45 minutes before the driving incident. Prompt recognition and management of the anaphylactic shock were initiated alongside the assessment and treatment of the traumatic injuries. This case highlights the importance of considering unusual causes of shock in trauma patients. It underscores the need for a comprehensive approach to patient care in trauma settings, where multiple etiologies of shock should be considered and managed simultaneously.
RESUMO
INTRODUCCIÓN: Un trauma penetrante puede dañar una variedad de órganos. Dado que el hígado es un órgano sólido inelástico, no tiene la tolerancia al estiramiento necesaria para hacer frente a una herida por proyectil de arma de fuego (GSW). MÉTODOS: Este fue un estudio retrospectivo, observacional y descriptivo de 53 registros clínicos de pacientes ingresados en el Departamento de Cirugía por trauma hepático (LT) por un GSW. RESULTADOS: Del total de historias clínicas analizadas, el 89% de los pacientes presentaron una lesión asociada con LT. La lesión orgánica asociada más frecuente fue la torácica, específicamente la lesión pulmonar, en el 58%. El predictor más importante de mortalidad fue una estancia en la unidad de cuidados intensivos (UCI), que aumentó el riesgo unas 21 veces. CONCLUSIÓN: Una estadía en la UCI, seguida de la presencia de fracturas, fue el predictor más importante de mortalidad. Se necesitan nuevas medidas de pronóstico para contrarrestar las variables que ha creado el aumento de GSW, además de disminuir el tiempo de espera desde el evento traumático hasta el tratamiento relevante. INTRODUCTION: A penetrating trauma can damage a variety of organs. Since the liver is an inelastic solid organ, it does not have the necessary stretch tolerance to cope with a gunshot wound (GSW). METHODS: This was a retrospective, observational, and descriptive study of 53 clinical records of patients admitted to the Department of Surgery for liver trauma (LT) by a GSW. RESULTS: Of the total clinical records analyzed, 89% of the patients presented a lesion associated with LT. The most common associated organic lesion was thoracic, specifically lung injury, in 58%. The most important predictor of mortality was a stay in the intensive care unit (ICU), which increased the risk about 21 times. CONCLUSION: A stay in the ICU, followed by the presence of fractures, was the most important predictor of mortality. New prognostic measures are needed to counteract the variables that the increase in GSWs has created, in addition to decreasing the waiting time from the traumatic event to relevant treatment.
Assuntos
Ferimentos por Arma de Fogo , Humanos , Unidades de Terapia Intensiva , Fígado/cirurgia , Estudos Retrospectivos , Ferimentos por Arma de Fogo/cirurgiaRESUMO
Epitheloid hemangioendothelioma is a very rare tumor, with a variable presentation and unpredictable clinical behavior. The etiology and the triggering risk factors have not been specified. Unlike other primary liver tumors, it does not arise in the background of chronic liver disease. The approach is challenging due to the spectrum of possibilities and the need for immunohistochemistry to establish the definitive diagnosis. The information available so far is limited due to the few published cases, this favors that the therapeutic options are few or that there is insufficient evidence to standardize them when the lesion is not resectable.
El hemangioendotelioma epiteloide es un tumor muy infrecuente, con una presentación variable y un comportamiento clínico impredecible. No se han precisado la etiología ni los factores de riesgo desencadenantes. A diferencia de otros tumores hepáticos primarios, no surge en el contexto de una enfermedad crónica del hígado. El abordaje es un reto debido al espectro de posibilidades y la necesidad de inmunohistoquímica para establecer el diagnóstico definitivo. La información disponible hasta el momento es limitada por los escasos casos publicados, lo que favorece que las opciones terapéuticas sean pocas o no exista la evidencia suficiente para estandarizarlas cuando la lesión no sea resecable.
Assuntos
Hemangioendotelioma Epitelioide , Neoplasias Hepáticas , Neoplasias Vasculares , Hemangioendotelioma Epitelioide/diagnóstico , Hemangioendotelioma Epitelioide/cirurgia , Humanos , Imuno-Histoquímica , Neoplasias Hepáticas/diagnósticoRESUMO
BACKGROUND: Biliopleural fistula is a rare communication between the biliary system and the pleural space secondary to ruptured hydatid cysts, hepatobiliary surgeries or penetrating wounds. There is not so much of the subject in the literature, so there is no standardized protocol for its management. OBJECTIVE: The objective of this work is to determine advantages and disadvantages of the use of ERCP as a conservative initial treatment for biliopleural fistulas. METHOD: Our retrospective study included patients with a diagnosis of biliopleural fistula who underwent ERCP as initial treatment, older than 18 years in a period from August 2016 to August 2019. RESULTS: Eight patients with a diagnosis of biliopleural fistula were included, 75% men and 25% women with a mean age of 24.5 years; the traumatic etiology was predominant in our group (89%), the diagnosis was made between days 3 and 14 after chest tube placement and we were successful in treating the fistula with ERCP in 87.5% of our patients. CONCLUSIONS: The use of ERCP as initial treatment for biliopleural fistula should be considered as the initial tool in the algorithm of management of this entity.
ANTECEDENTES: La fístula biliopleural es una comunicación poco frecuente entre el sistema biliar y el espacio pleural secundario a ruptura de quistes hidatídicos, cirugías hepatobiliares o heridas penetrantes Existe poco sobre el tema en la literatura por lo que no existe un protocolo estandarizado para su manejo. OBJETIVO: El objetivo de este trabajo es determinar ventajas y desventajas del uso de CPRE como tratamiento inicial conservador para fístulas biliopleurales. MÉTODO: Nuestro estudio retrospectivo incluyó pacientes con diagnóstico de fístula biliopleural quienes fueron sometidos a CPRE como tratamiento inicial, mayores de 18 años en un período de Agosto de 2016 a Agosto de 2019. RESULTADOS: Se incluyeron 8 pacientes con diagnístico de fístula biliopleural, 75% hombres y 25% mujeres con una media de edad de 24.5 años; la etiología traumática fue a predominante en nuestro grupo (89%), el diagnóstico se realizó entre los días 3 y 14 post colocación de sonda torácica y obtuvimos éxito en el tratamiento de la fístula con CPRE en el 87.5% de nuestros pacientes. CONCLUSIONES: El uso de CPRE como tratamiento inicial para fístula biliopleural debe ser considerada como la herramienta inicial en el algoritmo de manejo de esta entidad.
Assuntos
Fístula Biliar , Colangiopancreatografia Retrógrada Endoscópica , Adulto , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/etiologia , Fístula Biliar/cirurgia , Tubos Torácicos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Esfinterotomia Endoscópica , Adulto JovemRESUMO
BACKGROUND: The wounds caused by the firearm projectile are published to date in a public health problem in the world. As an example, we mentioned the injuries caused by firearms are the first cause of death in the age group between 1 to 19 years in the United States, as in Mexico. OBJECTIVE: Analysis of the prognostic factors of mortality and evaluation of the evolution in patients with TPD due to abdominal HPPAF. METHOD: Retrospective, observational, descriptive study. Helped by 49 clinical files of patients who were admitted to the department of surgery of the University Hospital José Eleuterio González, between 2011 to 2015 and whose diagnosis was due to pancreatic trauma (TP), duodenal trauma (TD) or pancreatoduodenal trauma (TPD) by wounds caused by the firearm projectile. RESULTS: During a collection period of 5 years, a total of 49 clinical records applicable to the study were obtained according to the inclusion criteria, of which 36 (73%) suffered only from TD, 37 (75%) from TP and 24 (49%) about TPD. Significant differences were obtained for mortality associated with TD and TPD, but not for TP. The most affected organ as a lesion associated with a TPD was the liver, followed by thoracic structures and the stomach. The most significant risk factor for mortality was a prolonged stay in the intensive care unit. CONCLUSIONS: Data obtained are consistent with those consulted, providing new reproducible statistics for future studies regarding the increasing violence in our country and around the world.
ANTECEDENTES: Las heridas por proyectil de arma de fuego constituyen un problema de salud pública en el mundo. Como ejemplo mencionamos que este tipo de lesiones son la primera causa de muerte en el grupo de edad de 1 a 19 años en los EE.UU., al igual que en México. OBJETIVO: Análisis de los factores pronósticos de mortalidad y evaluación de la evolución en pacientes con TPD por HPPAF abdominal. MÉTODO: Estudio retrospectivo, observacional y descriptivo, realizado con 49 expedientes clínicos de pacientes que fueron admitidos en el departamento de cirugía del Hospital Universitario José Eleuterio González entre los años 2011 y 2015, cuyo diagnostico fue herida por proyectil de arma de fuego con trauma pancreático (TP), duodenal (TD) o pancreatoduodenal (TPD). RESULTADOS: Durante un periodo de recolección de 5 años se obtuvieron 49 expedientes clínicos aplicables al estudio según los criterios de inclusión, de los cuales 36 pacientes (73%) sufrieron únicamente TD, 37 (75%) TP y 24 (49%) TPD. Se obtuvieron diferencias significativas para la mortalidad asociada a TD y TPD, pero no para TP. El órgano más afectado como lesión asociada a un TPD fue el hígado, seguido de las estructuras torácicas y el estómago. El factor de riesgo para mortalidad más significativo fue una estancia prolongada en la unidad de cuidados intensivos. CONCLUSIONES: Los datos conseguidos concuerdan con los consultados, otorgando nueva estadística reproducible para futuros estudios respecto a la violencia creciente en nuestro país y alrededor del mundo.
Assuntos
Duodeno/lesões , Pâncreas/lesões , Ferimentos por Arma de Fogo/mortalidade , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Fígado/lesões , Masculino , Prognóstico , Estudos Retrospectivos , Estômago/lesões , Traumatismos TorácicosRESUMO
ANTECEDENTES: Una de las principales complicaciones de la diabetes mellitus es la amputación de alguna extremidad. En todo el mundo, la prevalencia de amputaciones asociadas a la diabetes es muy variada y tiene un impacto considerable en la calidad de vida del paciente. OBJETIVO: Analizar la frecuencia de las amputaciones en el Hospital Universitario Dr. José E. González y evaluar si se presenta un patrón estacional. MÉTODO: Se realizó un estudio retrospectivo de 2009 a 2012, en el que se revisaron los expedientes de pacientes diabéticos que se sometieron a amputación. La estacionalidad se analizó con la bondad de ajuste de ji al cuadrado. RESULTADOS: Se analizaron 456 amputaciones. Los resultados muestran que febrero es el mes que presenta la mayor frecuencia de amputaciones. La estación anual con mayor número de amputaciones fue el invierno. CONCLUSIONES: Las amputaciones en pacientes diabéticos del área metropolitana de Monterrey presentan un patrón estacional, siendo los meses de invierno los de mayor frecuencia. BACKGROUND: The amputation of an extremity is a main complication of Diabetes mellitus. Worldwide the prevalence of amputations associated with diabetes mellitus is variable and had a considerable impact in the quality of life. OBJECTIVE: Analyze the frequency of amputations in the University Hospital, Dr José E González and evaluate if a seasonal pattern is present. METHOD: A retrospective analysis from 2009 to 2012 was carried out. Clinical files of diabetic patients undergoing to amputation were studied. The seasonality was evaluated with a chi square goodness of fit. RESULTS: A total of 456 amputations were studied. Results shown that February was the month with highest frequency of amputations while winter was the annual season with highest frequency of amputations. CONCLUSIONS: Amputations of diabetic patients from Metropolitan Monterrey Mexico show a seasonal pattern being the winter months those that present highest frequency.
Assuntos
Amputação Cirúrgica/estatística & dados numéricos , Idoso , Complicações do Diabetes/cirurgia , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , México , Pessoa de Meia-Idade , Razão de Chances , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Estudos Retrospectivos , Estações do Ano , Fatores SocioeconômicosRESUMO
BACKGROUND AND AIMS: The protective effect of ischemic preconditioning (IP) in liver transplantation (LT) has been studied with controversial results. We undertook this study to investigate whether IP of cadaveric donor livers is protective to allografts. METHODS: IP (LT + IP, n = 6) was induced by 10-min hilar clamping. These were compared to cadaver donors with no IP (LT, n = 7). Clinical data and blood were obtained in donors and recipients for biochemical and inflammatory mediator (IM) measurements (P-selectin, leukotriene B4, myeloperoxidase, ICAM-1, IL-1, IL-6, and TNF-α). Liver tissue samples were obtained from donors and recipients (90 min after reperfusion). RESULTS: No significant differences were found in demographic characteristics between donors and recipients. When comparing both groups (LT + IP vs. LT only), ICU stay was longer in LT + IP group. For biochemical parameters, a significant difference was found only with a higher total bilirubin at postoperative day 3 in LT + IP group. There was no statistical difference in IM between LT and LT + IP groups at different stages of the study. Histological analysis of donor grafts indicated the presence of steatosis (50%) in one graft from the LT + IP group. However, in post-reperfusion biopsies neither neutrophil infiltration nor grade of necrosis showed significant difference between groups. No incidence of primary graft nonfunction (PGNF) was observed and graft and patient survival was similar in the two groups at 24 months. CONCLUSION: IP does not seem to protect against I/R injury in cadaveric LT, and no PGNF was seen.