Conflicto de intereses: Los autores declaran no tener ningún interés financiero relacionado con el contenido de este artículo. Financiación: No hubo fuentes externas de financiación para este trabajo.
Seventy-four neonates with respiratory distress syndrome had cytologic study of tracheal aspirates. Thirteen, all of whom were receiving intravenous lipid and nothing orally had abundant macrophages with foamy cytoplasm, positive for intracytoplasmic lipid by Sudan black stain, in the tracheal aspiration specimens. Cytologic surveillance of tracheal aspiration specimens may be a useful method of monitoring infants receiving intravenous lipid infusions.
Introduction There is a high incidence of hand fractures, and a high percentage of them require surgical treatment. The functional result depends, to a large extent, on the technique used. The use of retrograde intramedullary screws allows for early mobilization and minimal dissection of soft tissues. The objective of the present study is to analyze the clinical results and complications with this type of osteosynthesis.
Methods A total of 96 fractures in 81 patients were analyzed. There were 62 metacarpal fractures, 60% of which involved the 5th finger, 29% involved the 4th, 5% involved the 3rd, and 6% involved the 2nd finger. There were 34 fractures of the phalanxes, 27 of which (79.5%) involved the proximal phalanx, and 20.5% involved the middle phalanx. The range of active mobility, the time spent at work, and intraoperative complications were assessed.
Results The average active mobility obtained was 260° (230–270°). Patients resumed their normal activity within an average time of 5 weeks (between 3 and 32 weeks). There was a 6% rate of intraoperative complications and a 13% rate of postoperative complications in the metacarpals, and an 8% rate of intraoperative complications and 11% of postoperative complications in the phalanxes.
Conclusion The use of cannulated screws is a safe and effective option for the treatment of different types of fractures, obtaining a good range of mobility, early reintegration, and with an acceptable number of complications.
Utilización de los tornillos canulados sin cabeza intramedulares en el tratamiento de las fracturas de la mano -estudio anatomico en los dedos largos
AbstractObjective To quantify the cartilaginous and tendinous lesions produced upon percutaneous introduction of intramedullary cannulated screws as osteosynthesis material in metacarpal and phalangeal fractures. Materials and Methods Seven anatomical models and one non-replanted hand were used. The measurements of 30 metacarpals and proximal and middle phalanges were taken. Cannulated screws with complete and partial threads were placed percutaneously through the metacarpal head and the proximal and middle phalanges, reproducing the actions performed in the clinic. The following measurements were performed: A) Percentage of the damaged cartilaginous area and its location. B) Damage to the extensor apparatus and its distance to the bone insertion point. C) Bone marrow size. Results (A) The percentages of the damaged areas in the metacarpals, proximal and middle phalanges were 5.7%, 13.35% and 9.62%, respectively. (B) The damage to the extensor apparatus was less than 3 mm with a 4-mm distance to the bone insertion point and (C) We have obtained the measurements of the intramedullary bone and from them, we calculated the width of the most appropriate screw. Conclusion In conclusion, the use of retrograde and percutaneous cannulated screws is a reliable technique with regard to the associated morbidity, and we present an approximation regarding the most appropriate screw for each location.
ResumenObjetivo El objetivo de este estudio es cuantificar las lesiones cartilaginosas y tendinosas que se producen al introducir tornillos canulados intramedulares percutá-neos como material de osteosíntesis en fracturas de metacarpianos y falanges.
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IntroducciónA finales del siglo XIX, Volkman describió el síndrome compartimental (SC), haciendo hincapié en la secuela que producía. Publicó varios casos de contracturas causadas por la compresión de vendajes y atribuyó su patogenia a la isquemia que se había producido. Bardenheuer, a principios del siglo XX, relacionó su fisiopatología con el aumento de la Palabras Clave ► mordeduras de serpientes ► envenenamiento por serpiente ► síndrome compartimental ► antivenenos
ResumenLa mordedura de víbora en España es un hecho infrecuente pero que puede ser grave y presentar potenciales complicaciones tales como el síndrome compartimental. Conocer su manejo es clave para evitar secuelas. La extremidad superior es la localización más frecuente de la mordedura. Sin embargo, existe controversia acerca de cuál es el tratamiento indicado, y aunque tradicionalmente se ha abogado por las fasciotomías, publicaciones más recientes apoyan el uso de antivenenos como principal tratamiento por su gran efectividad y tolerabilidad. En el presente trabajo de actualización, se realiza una puesta al día con las publicaciones más relevantes, proponiendo el manejo mediante la administración de faboterápicos (antivenenos) y la medición de la presión intracompartimental antes de realizar una fasciotomía.
Keywords► snake bite ► snake envenomation ► compartment síndrome ► upper limb ► antivenoms
AbstractViper envenomation in Spain is an uncommon event, but it could be severe and with complications such as a compartment syndrome. Upper extremity is the most frequent site of the bite. Knowledge of the management of this pathology is essential to avoid serious long-term sequels. However, there exist a controversy as to which is the best treatment. Although traditionally the "gold standard" treatment has been a fasciotomy, recent publications indicate/propose the use of antivenoms which are very effective and with great tolerability. An update of the topic is made with the most relevant papers with a proposal for the simple management by means of the administration of antivenom and measurement of the intracompartmental pressure before carrying out a fasciotomy.
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