PubMed | University of Pittsburgh, University of Valle and Hospital Universitario del Valle
Type: Journal Article | Journal: European journal of trauma and emergency surgery : official publication of the European Trauma Society | Year: 2016
Popliteal arterial injuries carry a high risk of amputation. The currently available literature from both civilian and military experiences is characterized by a wide variation of recommendations for surgical management. We questioned how these recommendations have been applied in our practice. Therefore, we aimed to identify predictors of amputation after popliteal arterial injury.We conducted an observational study of 175 patients with popliteal arterial injuries who underwent surgical treatment from 1992 to 2006 at a level I trauma center in Cali, Colombia. Information on demographic characteristics, clinical information, and surgical management was collected from clinical records. The outcome measure was amputation within 30days following the first surgical intervention.The amputation rate was 17.1%. A multivariable logistic regression model indicates that blunt mechanism (odds ratio [OR] 4.79, 95% confidence interval [CI] 1.49-15.42), signs of ischemia (OR 5.29, 95% CI 1.48-18.91), ligation of the popliteal vein of the compromised limb during surgical exploration (OR 3.83, 95% CI 1.20-12.18), and the development of arterial thrombosis (OR 56.51, 95% CI 12.36-258) were found to be independent predictors of amputation. Fractures, popliteal venous injuries, prolonged time between injury and surgery, fasciotomies, and graft arterial repair were not statistically significant predictors of amputation.Emphasis on the early assessment and prompt identification of signs of ischemia after popliteal arterial injury continue to be the most important factor for reducing the risk of amputation, especially in blunt trauma. Vascular trauma teams must emphasize the need for the specialized management of popliteal veins. Clinical research is needed in order to identify means of decreasing arterial thrombosis after popliteal repair.
PubMed | Virginia Commonwealth University, University of Valle, Fundacion Valle de Lili and Hospital Universitario del Valle
Type: Journal Article | Journal: Colombia medica (Cali, Colombia) | Year: 2016
Trauma information systems are needed to improve decision making and to identify potential areas of intervention.To describe the first year of experience with a trauma registry in two referral centers in southwest Colombia.The study was performed in two referral centers in Cali. Patients with traumatic injuries seen between January 1 and December 31, 2012, were included. The collected information included demographics, mechanism of trauma, injury severity score (ISS), and mortality. A descriptive analysis was carried out.A total of 17,431 patients were registered, of which 67.8% were male with an average age of 30 (20) years. Workplace injuries were the cause of emergency consultations in 28.2% of cases, and falls were the most common mechanism of trauma (37.3%). Patients with an ISS 15 were mostly found in the 18-35-year age range (6.4%). Most patients who suffered a gunshot wound presented an ISS 15. A total of 2.5% of all patients died, whereas the mortality rate was 54% among patients with an ISS 15 and a gunshot wound.Once the trauma registry was successfully implemented in two institutions in Cali, the primary causes of admission were identified as falls and workplace injuries. The most severely compromised patients were in the population range between 18 and 35 years of age. The highest mortality was caused by gunshot wounds.
Caicedo Y.,Hospital Universitario del Valle |
Paez A.,Instituto Nacional Of Salud Ins |
Kuzmin I.,Centers for Disease Control and Prevention |
Kuzmin I.,Medical College of Wisconsin |
And 7 more authors.
Pediatric Infectious Disease Journal | Year: 2015
Background: Rabies is an acute fatal encephalitis caused by all members of the Lyssavirus genus. The first human rabies survivor without benefit of prior vaccination was reported from Milwaukee in 2005. We report a second unvaccinated patient who showed early recovery from rabies and then died accidentally during convalescence, providing an unparalleled opportunity to examine the histopathology as well as immune and virological correlates of early recovery from human rabies. Methods: Case report, rapid fluorescent focus inhibition test, enzyme-linked immunosorbent assay, indirect and direct fluorescent antibody assays, reverse-transcriptase polymerase chain reaction, phylogenetic reconstruction, isolation in tissue culture, pathology and immunohistochemistry. Results: The 9 year old died 76 days after presenting with rabies of vampire bat phylogeny transmitted by cat bite. Antibody response in serum and cerebrospinal fluid was robust and associated with severe cerebral edema. No rabies virus was cultured at autopsy. Rabies virus antigen was atypical in size and distribution. Rabies virus genome was present in neocortex but absent in brainstem. Conclusions: Clinical recovery was associated with detection of neutralizing antibody and clearance of infectious rabies virus in the central nervous system by 76 days but not clearance of detectable viral subcomponents such as nucleoprotein antigen or RNA in brain. © 2015 Wolters Kluwer Health, Inc.
Parra B.,Hospital Universitario Del Valle |
Lizarazo J.,University of Pamplona |
Jimenez-Arango J.A.,University of Antioquia |
Zea-Vera A.F.,Hospital Universitario Del Valle |
And 16 more authors.
New England Journal of Medicine | Year: 2016
BACKGROUND Zika virus (ZIKV) infection has been linked to the Guillain-Barré syndrome. From November 2015 through March 2016, clusters of cases of the Guillain-Barré syndrome were observed during the outbreak of ZIKV infection in Colombia. We characterized the clinical features of cases of Guillain-Barré syndrome in the context of this ZIKV infection outbreak and investigated their relationship with ZIKV infection. METHODS A total of 68 patients with the Guillain-Barré syndrome at six Colombian hospitals were evaluated clinically, and virologic studies were completed for 42 of the patients. We performed reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays for ZIKV in blood, cerebrospinal fluid, and urine, as well as antiflavivirus antibody assays. RESULTS A total of 66 patients (97%) had symptoms compatible with ZIKV infection before the onset of the Guillain-Barré syndrome. The median period between the onset of symptoms of ZIKV infection and symptoms of the Guillain-Barré syndrome was 7 days (interquartile range, 3 to 10). Among the 68 patients with the Guillain-Barré syndrome, 50% were found to have bilateral facial paralysis on examination. Among 46 patients in whom nerve-conduction studies and electromyography were performed, the results in 36 patients (78%) were consistent with the acute inflammatory demyelinating polyneuropathy subtype of the Guillain-Barré syndrome. Among the 42 patients who had samples tested for ZIKV by RT-PCR, the results were positive in 17 patients (40%). Most of the positive RT-PCR results were in urine samples (in 16 of the 17 patients with positive RT-PCR results), although 3 samples of cerebrospinal fluid were also positive. In 18 of 42 patients (43%) with the Guillain-Barré syndrome who underwent laboratory testing, the presence of ZIKV infection was supported by clinical and immunologic findings. In 20 of these 42 patients (48%), the Guillain-Barré syndrome had a parainfectious onset. All patients tested were negative for dengue virus infection as assessed by RT-PCR. CONCLUSIONS The evidence of ZIKV infection documented by RT-PCR among patients with the Guillain-Barré syndrome during the outbreak of ZIKV infection in Colombia lends support to the role of the infection in the development of the Guillain-Barré syndrome.
Pachajoa H.,ICESI University |
Carlos Quintero J.,Hospital Universitario del Valle
Revista Cubana de Obstetricia y Ginecologia | Year: 2015
The cerebro-óculo-nasal syndrome is characterized by central nervous system abnormalities, ocular and nasal. The prevalence of this syndrome is very low, and has not yet identified the etiology of this condition. We report the case of a patient with suspected PJS cynical prenatal diagnosis by 2D and 3D ultrasound. A review of the literature of previously reported cases. © 2015, International Agency for Research on Cancer. All rights reserved.
Castro L.A.,University of Valle |
Alvarez M.I.,University of Valle |
Martinez E.,University of Valle |
Martinez E.,Hospital Universitario del Valle
Colombia Medica | Year: 2010
Schizophyllum commune is a basidiomycete fungus with broad distribution in nature; however, it is a rare cause of infectious disease. We report the isolation of this mould in a 46 year-old immunocompetent patient with chronic sinusitis previously treated with multiple antibiotics and topical nasal steroids. Material obtained via a left maxillary sinus antrostomy showed septate hyaline hyphae with clamp connections on direct examination with KOH and histopathological studies. Further growth on Sabouraud agar produced a white mould that, based on its microscopic and macroscopic characteristics, was identified as S. commune. Despite its low frequency, this fungus should be considered a possible pathogen, particularly in samples obtained from paranasal sinuses. © 2010 Universidad del Valle, Facultad de Salud.
Cardenas M.L.,University of Valle |
Diaz C.J.,University of Valle |
Rueda P.R.,Hospital Universitario del Valle
Colombia Medica | Year: 2013
The eccrine poroma or Hidracanthoma Simplex is a rare benign adnexal tumor of ephitelial cells, with an incidence of 0.001 to 0.008%1. In two thirds of the patients it appears on the soles and lateral borders of the feet. We report the case of a patient with pigmented eccrine poroma in abdominal skin, of a rare entity presentation with a single report in the literature in that location.
Radial artery catheterism for invasive monitoring: Preventing complications, a challenge in anesthesia [Cateterismo de la arteria radial para monitorización invasiva: Evitar las complicaciones, un reto en anesthesia]
Mendoza K.C.,Hospital Universitario del Valle
Revista Colombiana de Anestesiologia | Year: 2012
Introduction: Radial artery line placement is a common intervention in anesthesia. There is a sensation of false safety generated by the relatively low complication incidence. Identification of the primary association factors and controversies on the matter are key for prevention of complications. Methods: We present the case of a female patient who suffered permanent ischemia in her hand after inserting a catheter in the radial artery. A reflexive review of the literature on risk factors and controversies on interventions that have been implemented is included. Results: Placing a line in the radial artery may cause permanent ischemic injuries in as much as 0.09% of cases. 38% of cases develop thrombosis with the procedure, the risk of thrombosis increases over time and remains even after removing the cannula. The Allen test has shown to be a poor predictor of ischemic lesions. Age, use of tobacco, diabetes, renal failure and arterial hypertension are all risk factors for radial artery atheromatosis. Other elements such as the size and the material the catheter is made of, have also been related to the risk of complications. Infusions through the catheter remain a controversy. Ultrasound guides for catheterism eases the procedure. Conclusions: This procedure is definitely not without risks. Even though many factors have been carefully documented they cannot be fully controlled and interventions aimed at prevention have not been proven to be effective. © 2012 Published by Elsevier España.
Robayo C.A.M.,Hospital Universitario del Valle |
Ortiz C.P.G.,University of Valle
Colombia Medica | Year: 2014
Laryngeal histoplasmosis usually occurs in immunocompromised patients through the dissemination of the fungus from the lungs to other organs. Histoplasmosis isolated laryngeal (primary) is rare. If a patient presents with a history of renal transplant immunosuppression, primary histoplasmosis with laryngeal supraglottic granulomatous inflammation that was treated with amphotericin B and itraconazole, with complete resolution of laryngeal lesions. © 2014 Universidad del Valle.
Cobo V.D.G.,Hospital Universitario del Valle
Revista Colombiana de Anestesiologia | Year: 2012
Proper airway management is a challenge for every anesthesiologist. During a shift in the emergency room, a difficult airway often appears both in cases of trauma and medical pathology. The tracheotomy cannula is a device suited to ensure airway opening of patients with obstruction or lesion of the upper respiratory tract. In this medical case, a 7 year old female child is admitted at the emergency service with an episode of respiratory distress caused by rupture of a silver tracheotomy cannula, previously implanted due to a submandibular tumoral lesion. This is a rare case with little investigation in international medical literature The case was approached with interdisciplinary management including Pediatric surgery and Pulmonology with satisfactory outcome. © 2011 Sociedad Colombiana de Anestesiología y Reanimación.