Sylvia Elena Totsuka Sutto

Prognostic value of the lethal triad among patients with multiple trauma

Se define como paciente politraumatizado aquel que presenta dos o mas lesiones, que ponen en riesgo la vida. Los cambios fisicos y metabolicos que se desarrollan conllevan a complicaciones como acidosis, hipotermia y coagulopatia, la combinacion de estas alteraciones es conocida como ¨Triada Mortal¨ y podria ser indicativo de un mal pronostico. El objetivo del presente trabajo fue determinar si la presencia de la Triada Mortal en pacientes politraumatizados se relaciona con mortalidad y mayor Indice de severidad del dano (ISS) Material y Metodos; Se diseno un estudio observacional analitico para comparar la mortalidad de pacientes con y sin la presencia de la triada mortal, se incluyeron 100 pacientes politraumatizados, que llegaron al servicio de Urgencias Adultos del Antiguo Hospital Civil de Guadalajara “Fray Antonio Alcalde”, a su ingreso se les tomo temperatura corporal, tiempo de protrombina, tiempo de tromboplastina parcial, recuento de plaquetas y gasometria arterial, y se calculo su ISS Resultados: El 26% del total presentaron la triada mortal, de los cuales el 15.4% fallecieron en el servicio de urgencias dentro de las primeras 6 horas y su indice de severidad de la lesion (ISS) fue de 31.7, mientras que el resto de los paciente el 74% no presentaron la triada mortal de los cuales ninguno fallecio, con un ISS de 25.6 Conclusion: La coexistencia de la triada mortal en un paciente politraumatizado que llega al servicio de urgencias, es un indicador de mayor severidad del dano, por lo que se deben proporcionar estrategias terapeuticas eficaces y oportunas para reducir su mortalidadBackground Patients who have suffered multiple traumatic injuries, have a serious risk for death. Hypothermia, acidosis and coagulopathy are three complications in these patients, whose presence is known as lethal triad and indicates bad prognosis. Aim To determine if the lethal triad in multiple trauma patients is associated with higher mortality and Injury Score Severity (ISS). Material and methods One hundred multiple trauma patients aged 26 to 56 years (90 males), admitted to an emergency room, were studied. Body temperature, prothrombin time, partial thromboplastin time, platelet count and blood gases were determined on admission. Results Twenty six patients had the lethal triad and 15% died in the emergency room within the first 6 hours. No death was recorded among the 74 patients without the lethal triad. The mean ISS among patients with and without the lethal triad was 31.7 and 25.6, respectively (p Conclusions The presence of the lethal triad among patients with multiple trauma is associated with a higher mortality and ISS.

Efficacy and safety of the combination of isosorbide dinitrate spray and chitosan gel for the treatment of diabetic foot ulcers: A double-blind, randomized, clinical trial

AIM To evaluate whether a combination of isosorbide dinitrate spray and chitosan gel (10%) topically applied can have additive benefits for management of diabetic foot ulcers. METHODS In a randomized, placebo-controlled, double-blinded clinical trial, 68 patients were divided into four groups: Group 1: treated with chitosan gel; Group 2: isosorbide dinitrate spray; Group 3: combination of isosorbide dinitrate spray and chitosan gel; Group 4: placebo. RESULTS Histological analyses showed a significant regeneration in all groups ( p < 0.001). On the final assessment of the ulcer, using the combination was found a wound closure percentage of 71 ± 30, 70 ± 27 using isosorbide dinitrate, 58 ± 30 with chitosan and 50 ± 16 with placebo. The number of patients who achieved complete ulcer closure was six using the combination, four with isosorbide dinitrate, three with chitosan and one with placebo. The progression in the healing process of the ulcer showed marked inmunohistochemical differences of Von Willebrand Factor, desmin, vascular endothelial growth factor-A and α-smooth muscle actin in all groups ( p < 0.001), but without notable differences between them. CONCLUSION The combination was better than placebo to reduce the dimensions of the ulcer, accelerate healing and increase the number of patients who achieved complete closure of the ulcer, but the combination was not better than chitosan or isosorbide dinitrate used separately.AIM To evaluate whether a combination of isosorbide dinitrate spray and chitosan gel (10%) topically applied can have additive benefits for management of diabetic foot ulcers. METHODS In a randomized, placebo-controlled, double-blinded clinical trial, 68 patients were divided into four groups: Group 1: treated with chitosan gel; Group 2: isosorbide dinitrate spray; Group 3: combination of isosorbide dinitrate spray and chitosan gel; Group 4: placebo. RESULTS Histological analyses showed a significant regeneration in all groups ( p < 0.001). On the final assessment of the ulcer, using the combination was found a wound closure percentage of 71 ± 30, 70 ± 27 using isosorbide dinitrate, 58 ± 30 with chitosan and 50 ± 16 with placebo. The number of patients who achieved complete ulcer closure was six using the combination, four with isosorbide dinitrate, three with chitosan and one with placebo. The progression in the healing process of the ulcer showed marked inmunohistochemical differences of Von Willebrand Factor, desmin, vascular endothelial growth factor-A and α-smooth muscle actin in all groups ( p < 0.001), but without notable differences between them. CONCLUSION The combination was better than placebo to reduce the dimensions of the ulcer, accelerate healing and increase the number of patients who achieved complete closure of the ulcer, but the combination was not better than chitosan or isosorbide dinitrate used separately.

Effectiveness of degradable and non-degradable implants to close large septal perforations in an experimental model.

Abstract Background Reparation of large nasal septum perforations continues to be challenging. Bipedicled mucoperichondrial and inter-positional grafts currently show the most promising results. New implants have emerged to be used as a support membrane to carry on the mucosal cells, taking advantage of the innate proliferative properties of the mucosal tissue. Objective To compare the effectiveness of two kinds of material; non-absorbable dimethylsiloxane (silicone elastomers) and absorbable porcine small intestinal submucosa (Surgisis), both used as an inter-positional graft without neighbouring flaps to close nasal septal perforations in an experimental model. Methods Fifteen dogs were divided into three groups. One group received Surgisis, the other sheets of dimethylsiloxane and the last group a sham group. The dogs were followed for 6 weeks. Results The initial perforation of the nasal septum showed complete mucosal closure in the dimethylsiloxane group. The Surgisis group, on the other hand, had a smaller reduction than that at the beginning (final mean area = 23.0 ± 5.4 mm2 (p < 0.05); however, complete closure was not achieved. Sham animals showed an inconstant and slight reduction in dimension from 100 mm2 to 70 ± 16 mm2 of mucosa and cartilage, but closure was not achieved. A significantly higher number of capillaries were observed in the Surgisis group compared to the dimethylsiloxane group (p < 0.05) without differences in inflammation, fibrosis, or necrosis. Conclusions The non-absorbable implant; dimethylsiloxane facilitates a better closure of the nasal septum.Background Reparation of large nasal septum perforations continues to be challenging. Bipedicled mucoperichondrial and inter-positional grafts currently show the most promising results. New implants have emerged to be used as a support membrane to carry on the mucosal cells, taking advantage of the innate proliferative properties of the mucosal tissue. Objective To compare the effectiveness of two kinds of material; non-absorbable dimethylsiloxane (silicone elastomers) and absorbable porcine small intestinal submucosa (Surgisis), both used as an inter-positional graft without neighbouring flaps to close nasal septal perforations in an experimental model. Methods Fifteen dogs were divided into three groups. One group received Surgisis, the other sheets of dimethylsiloxane and the last group a sham group. The dogs were followed for 6 weeks. Results The initial perforation of the nasal septum showed complete mucosal closure in the dimethylsiloxane group. The Surgisis group, on the other hand, had a smaller reduction than that at the beginning (final mean area = 23.0 ± 5.4 mm(2) (p < 0.05); however, complete closure was not achieved. Sham animals showed an inconstant and slight reduction in dimension from 100 mm(2) to 70 ± 16 mm(2) of mucosa and cartilage, but closure was not achieved. A significantly higher number of capillaries were observed in the Surgisis group compared to the dimethylsiloxane group (p < 0.05) without differences in inflammation, fibrosis, or necrosis. Conclusions The non-absorbable implant; dimethylsiloxane facilitates a better closure of the nasal septum.

Triada mortal en pacientes politraumatizados, relación con mortalidad y severidad

Se define como paciente politraumatizado aquel que presenta dos o mas lesiones, que ponen en riesgo la vida. Los cambios fisicos y metabolicos que se desarrollan conllevan a complicaciones como acidosis, hipotermia y coagulopatia, la combinacion de estas alteraciones es conocida como ¨Triada Mortal¨ y podria ser indicativo de un mal pronostico. El objetivo del presente trabajo fue determinar si la presencia de la Triada Mortal en pacientes politraumatizados se relaciona con mortalidad y mayor Indice de severidad del dano (ISS) Material y Metodos; Se diseno un estudio observacional analitico para comparar la mortalidad de pacientes con y sin la presencia de la triada mortal, se incluyeron 100 pacientes politraumatizados, que llegaron al servicio de Urgencias Adultos del Antiguo Hospital Civil de Guadalajara “Fray Antonio Alcalde”, a su ingreso se les tomo temperatura corporal, tiempo de protrombina, tiempo de tromboplastina parcial, recuento de plaquetas y gasometria arterial, y se calculo su ISS Resultados: El 26% del total presentaron la triada mortal, de los cuales el 15.4% fallecieron en el servicio de urgencias dentro de las primeras 6 horas y su indice de severidad de la lesion (ISS) fue de 31.7, mientras que el resto de los paciente el 74% no presentaron la triada mortal de los cuales ninguno fallecio, con un ISS de 25.6 Conclusion: La coexistencia de la triada mortal en un paciente politraumatizado que llega al servicio de urgencias, es un indicador de mayor severidad del dano, por lo que se deben proporcionar estrategias terapeuticas eficaces y oportunas para reducir su mortalidadBackground Patients who have suffered multiple traumatic injuries, have a serious risk for death. Hypothermia, acidosis and coagulopathy are three complications in these patients, whose presence is known as lethal triad and indicates bad prognosis. Aim To determine if the lethal triad in multiple trauma patients is associated with higher mortality and Injury Score Severity (ISS). Material and methods One hundred multiple trauma patients aged 26 to 56 years (90 males), admitted to an emergency room, were studied. Body temperature, prothrombin time, partial thromboplastin time, platelet count and blood gases were determined on admission. Results Twenty six patients had the lethal triad and 15% died in the emergency room within the first 6 hours. No death was recorded among the 74 patients without the lethal triad. The mean ISS among patients with and without the lethal triad was 31.7 and 25.6, respectively (p Conclusions The presence of the lethal triad among patients with multiple trauma is associated with a higher mortality and ISS.

The Diabetic Charcot Foot – New Insights on Treatment

The association between Charcot neuroarthropathy (CN) and diabetes mellitus was first described by Jordan in 1936 (Jordan WR, 1936). Since that time numerous treatment protocols have been proposed for this potentially devastating condition. Early diagnosis and swift care are the keys to reducing amputation risk in this patient population. Conservative management remains efficacious for certain clinical scenarios. Treatment of the patient should take into account the stage of CN, site(s) of involvement, presence or absence of ulceration, presence or absence of infection, overall medical status, and level of compliance. The most commonly used classification is the three-staged system described by Eichenholtz: Stage I is the developmental or acute phase, Stage II is the coalescent or quiescent phase, and Stage III is the consolidation or reconstruction and reconstitution phase (Eichenoltz SN, 1966). Involvement of the midfoot is most common in the diabetic population and this site tends to be more amenable to conser‐ vative options versus hindfoot or ankle CN. Generally, conservative care for the CN foot and ankle has been recommended for the following scenarios: joints in the acute phase, deformities that are clinically stable and that do not compromise the soft tissue envelope, stable deformities without soft tissue or bone infection, patients who do not have adequate arterial perfusion to support surgical reconstruction, and those patients who are extremely high risk for anesthesia and surgical intervention due to the presence of multiple severe comorbid conditions. In this