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Biomedical subjects

E de Tomás

Publications and source records attributed to E de Tomás.

8 recordsLinked to original sources
PubMed2004

[Impact of formation programs in initial management of injured children].

INTRODUCTION: In 1997 we developed the "Pediatric Trauma Life Support Course"applied to every one who provide care for the pediatric trauma patient. Since November 1997 until December 2000, 14 courses were imparted inside of the "Comunidad de Madrid" with total number of 289 students. Thirty-eight students have been people who worked in the prehospital area inside of our Community. The aim of this paper is to determinate the possible impact of these Courses in the prehospital management of the pediatric trauma patient. MATERIAL AND METHODS: We reviewed the Pediatric Trauma Registry inputs of our hospital since January 1995 until December 2000. A total number of 2166 patients required admission in our hospital after the injuries. 495 patients which moved to our Institution by medical people and a special transport (ambulance/medical van) were enrolled. The patients were classified into two groups. In the first group were included the children admitted between 1995 to 1997 (group 1, n = 232), before we had applied our Courses and in the second group, the patients admitted between 1998 to 2000 (group II, n = 263), after The Pediatric Trauma Life Support Course was conducted. Both groups seems to be equal if we compare the age, sex and severity of the injuries. We analysed the infant orotracheal intubation in a coma patient, gastric intubation in the several trauma patient, vascular access and apply a semirigid cervical collar into a head injury. If we think that the application of these manouvers will be a good quality index of the management of these patients in the prehospital area, we compare the index of application of these variables according to the years before and after the Courses were imparted. For this pourpose we used the X2 test shows significant differences within both groups if p < 0.05. RESULTS: All paramethers analyzed were better in group II than in group I (p < 0.05). CONCLUSIONS: The results of this paper shows that the use of this program for the management of the pediatric trauma patient is going well and the assessment is doing better than few years before.

Child↗
PubMed2004

[Events related with injury severity in pediatric multiple trauma].

AIMS: Epidemiological analysis of main factors affecting multiple trauma in children in our environment. METHODS: We reviewed the data collected from the patients (n = 2.166) admitted to our hospital because of trauma and included in our Registry from January 1995 to December 2000. Among this group 79 patients were considered severely injured trauma patients according Injury Severity Score (ISS) (ISS > 15) and selected for the study. Statistical analysis was done using chi2 and Student t test, p values under 0.01 were considered significant. RESULTS: Group gender distribution was 49 males and 30 females, age average was 9.7 years (range 0-15 years) Traffic related injuries were the leading cause of trauma in this group (77,2%). Initial triage by using the Pediatric Trauma Score allowed identifying the injury severity in 73,4% of patients (58 children obtained a PTS < or = 8). In 32,9% of the cases the patient was in coma at admission in the Emergency (Glasgow Coma Scale < or = 8, n = 26). ISS average was 23.4 (range 16-75). Most patients suffered from multiple injuries (87,3%), average of injuries number was 4,7 (range 1-9). The most frequent trauma localization was cranial trauma. Admission in the intensive care unit was necessary in 65,8% of patients, and any kind of surgical procedure was done in 35,4%. Average length of stay was 17,1 days (range 0-214 days). Injury severity was higher in automotive patients without restraining systems (I.S.S. average 27,2, mortality 16,6%). Overall mortality was 11,4% (n = 9), and 94.3% of patients presented any functional or anatomic disability. CONCLUSIONS: Traffic related injuries are the main cause of multiple trauma in children. The severity and high mortality of these injuries make imperative polytonal education systems and the use of restraining devices.

Adolescent↗
PubMed1995

[Nontraumatic rhabdomyolysis: its etiology and the predictive factors of acute kidney failure].

BACKGROUND: The aim of this study was to determine the causes of non traumatic or medical rhabdomyolysis (RM) and analyze the clinical and biologic characteristics, as well as the predictive factors of acute renal failure (ARF). METHODS: Fifty-nine patients with RM admitted to the Internal Medicine Department over an 18-month period were prospectively studied. The patients were classified into etiologic groups. Anamnesis, physical exploration and general analytical studies including creatinkinase, myoglobin, aldolase, magnesium and proteinogram were performed. Urine sodium was determined in patients with ARF> RESULTS: Myalgias in 14 patients (23.7%) and a decrease in strength in 11 patients (18.6%) were the main clinical manifestations observed. As a sole cause, convulsion was the most frequent manifestation in 11 patients (18.6%) followed by muscular compression in 10 patients (16.9%). In the plurietiologic group the most frequent manifestation was muscular compression in 5 patients (16.9%) followed by alcoholism in 4 patients (6.7%). No differences were found in either the clinical manifestation or the biology of the RM among the different etiologies. Eight patients presented ARF (13.5%) with one patient requiring dialysis, and good response being observed with conservative treatment in 5 patients. On multivariant analysis the statistically significant ARF predictive factors were: age over 70 years (p = 0.003), nonketotic hyperosmolar diabetic coma (p = 0.01), previous dehydration (p = 0.001) and initial uric acid levels greater than or equal to 6 mg/dl (p = 0.002). CONCLUSIONS: The clinical expression of rhabdomyolysis was small with the most frequent manifestations being convulsions and muscular compression. The predictive factors for acute renal failure were advanced age, nonketotic hyperosmolar diabetic coma, dehydration, and hyperuricemia.

Acute Kidney Injury↗
PubMed1995

Peno-scrotal transposition.

Peno-scrotal transposition is an infrequent genital malposition due to a defect in the caudal migration of the inchoate scrotum during intrauterine life. It is frequently associated with urogenital and/or gastrointestinal malformations. Glenn and Anderson (1973) have classified the abnormality into the following categories, according to severity: Bifid scrotum Incomplete or partial peno-scrotal transposition Complete peno-scrotal transposition or pre-penile scrotum Ectopic scrotum We analyse corrective surgical techniques for this malposition and we present our experience.

Cryptorchidism↗
PubMed1995

[Outcome of anatomical correction of transposition of the great vessels in the neonatal period].

Between february 1992 to January 1994, anatomic correction was performed on 15 patients with transposition of the great arteries and intact ventricular septum. The mean age was 8.3 +/- 2.9 days and the mean weight 3.39 +/- 0.39 Kg. Before the operation, 13 patients (86.6%) received prostaglandin El infusion and 13 patients (86.6%) underwent Rashkind septostomy. Mean aortic cross-clamps was 56 +/- 11 minutes and mean cardiopulmonary bypass was 108 +/- 91 minutes. Hospital mortality rate was 13%. Mean extubation period was mean discharge from ICU was 13.1 +/- 12.3 days and discharge of hospital was 17.8 +/- 7.5 days. The mean followup period was 11.4 months. All the patients remained asymptomatic with adequate psychomotor and ponderal development. All patients remained in sinus rhythm. Pulmonary suture gradient was over 60 mm Hg in five patients (33%). One patient needed reintervention and four pulmonary artery angioplasty (PAA) that was successful. In the midterm follow-up pulmonary stenosis suture was the most common complication. If the stenosis is severe and PAA should be the initial approach.

Age Factors↗