O uso crescente da angio-TAC nos protocolos de avaliação dos doentes politraumatizados abdominopélvicos, veio mostrar que as lesões arteriais não são exclusivas das ruturas pélvicas, estendendo-se às fraturas acetabulares, e a sua incidência não é de menosprezar. Os autores descrevem o caso clínico de um doente de 53 anos, que sofreu traumatismo do membro inferior direito, com consequente fratura transversa do acetábulo, desviada e com invasão da grande chanfradura ciática. À entrada no serviço de urgência encontrava-se hemodinamicamente instável com necessidade de reposição de volume e foi transferido para uma unidade de cuidados intensivos. Foi programada uma intervenção cirurgia aos 15 dias após a fratura. Intra-operatoriamente ocorreu uma inesperada e grave hemorragia, durante o desbridamento do foco de fratura, na área da grande chanfradura ciática. Realizado tamponamento imediato, transferência para sala de hemodinâmica com realização de angiografia que mostrou lesão da artéria nadegueira superior, e foi feita a sua embolização. Nos doentes com fraturas acetabulares com instabilidade hemodinâmica, sem outra causa que a justifique, deverá levantar-se a suspeita de lesão arterial. Os pacientes devem realizar angio-TAC e no caso de se manter a suspeição da lesão arterial, encaminhados para centros de trauma, com apoio de angiografia para despiste da mesma e sua embolização, evitando desta forma complicações potencialmente fatais.

The increasing use of angio CT in the evaluation protocols of polytrauma abdominopelvic patients, has shown that arterial lesions are not exclusive of pelvic disruptions, extending to acetabular fractures, and it´s impact is not insignificant. The authors describe a case of a 53 years patient who suffered trauma of the right lower limb, with consequent transverse displaced fracture of the acetabulum, with invasion of great sciatic nocth. On admittance, in the emergency department, presented hemodynamically unstable with need for volume replacement and transfer to the intensive care unit. Open surgery done 15 days after the fracture with unexpected major bleeding occurrence during the debridement of fracture site, in the area of great sciatic notch. Tamponated immediately, and the patient was transferred to hemodynamic room, performed angiography and diagnosed injury of the superior gluteal artery and made it´s embolization. Patients with acetabular fractures and hemodynamic instability, without other cause justifying it, should raise suspicion of arterial injury. Under these circumstances should do angio-CT and in the case of maintaining the suspicion, referred to trauma centers, supported by angiography and embolization, avoiding life-threatening complications.

Fundamento: A classificação ou índice de gravidade de insuficiência cardíaca em pacientes com infarto agudo do miocárdio (IAM) foi proposta por Killip e Kimball com o objetivo de avaliar o risco de mortalidade hospitalar e o potencial benefício do tratamento especializado em unidades coronárias (UCO) na década de 1960. Objetivos: Validar a classificação de Killip para mortalidade total em longo prazo e comparar o valor prognóstico em pacientes com IAM sem elevação do segmento ST (IAMSEST) em relação àqueles com elevação do segmento ST (IAMCEST), na era pós-reperfusão e de terapia antitrombótica moderna. Métodos: Foram avaliados 1906 pacientes com IAM confirmado, admitidos em UCO entre 1995 e 2011, com seguimento médio de cinco anos, para avaliação da mortalidade total. Curvas de Kaplan-Meier foram construídas para comparação da sobrevida por classe Killip e IAMSEST versus IAMCEST. Modelos de regressão de risco proporcional de Cox foram construídos para determinar a associação independente entre a classe Killip e a mortalidade, com análises de sensibilidade por tipo de IAM. Resultados: As proporções de óbitos e as distribuições das curvas de sobrevida foram diferentes conforme a classe Killip >1 (p <0,001) e similares entre IAMSEST e IAMCEST. Os modelos de risco identificaram a classificação de Killip como preditor significante, sustentado, consistente e independente de covariáveis relevantes (Wald χ2 16,5 [p = 0,001], IAMSEST) e (Wald χ2 11,9 [p = 0,008], IAMCEST). Conclusão: A classificação de Killip e Kimball desempenha papel prognóstico relevante na mortalidade em seguimento médio de cinco anos pós-IAM e, de modo similar, entre pacientes com IAMSEST e IAMCEST.

Background: The classification or index of heart failure severity in patients with acute myocardial infarction (AMI) was proposed by Killip and Kimball aiming at assessing the risk of in-hospital death and the potential benefit of specific management of care provided in Coronary Care Units (CCU) during the decade of 60. Objective: To validate the risk stratification of Killip classification in the long-term mortality and compare the prognostic value in patients with non-ST-segment elevation MI (NSTEMI) relative to patients with ST-segment elevation MI (STEMI), in the era of reperfusion and modern antithrombotic therapies. Methods: We evaluated 1906 patients with documented AMI and admitted to the CCU, from 1995 to 2011, with a mean follow-up of 05 years to assess total mortality. Kaplan-Meier (KM) curves were developed for comparison between survival distributions according to Killip class and NSTEMI versus STEMI. Cox proportional regression models were developed to determine the independent association between Killip class and mortality, with sensitivity analyses based on type of AMI. Results: The proportions of deaths and the KM survival distributions were significantly different across Killip class >1 (p <0.001) and with a similar pattern between patients with NSTEMI and STEMI. Cox models identified the Killip classification as a significant, sustained, consistent predictor and independent of relevant covariables (Wald χ2 16.5 [p = 0.001], NSTEMI) and (Wald χ2 11.9 [p = 0.008], STEMI). Conclusion: The Killip and Kimball classification performs relevant prognostic role in mortality at mean follow-up of 05 years post-AMI, with a similar pattern between NSTEMI and STEMI patients.

Objetivo: Caracterizar el nivel de desarrollo coordinativo (CoM), describir su distribución percentílica, e identificar la prontitud coordinativa de niños peruanos en función de la edad, sexo y estatus socioeconómico. Metodología: El tamaño de la muestra comprendió a 4,007 niños (femenino= 1889; masculino= 2118) entre los 6 y los 11 años de edad (niñas= 8,99; niños= 9,07) de escuelas del área metropolitana de Lima, Perú. La CoM fue determinado a través de la batería de pruebas KTK que comprende cuatro pruebas: equilibrio a la retaguardia (ER), saltos laterales (SL), saltos monopedales (SM) y transposición lateral (TL). El estatus socioeconómico (ESE) fue evaluado según la localización física de cada escuela (tipo de vecindad). Los análisis estadísticos exploratorios, descriptivos e inferenciales: análisis de varianza multivariable, función discriminante y chi cuadrado fueron realizados en SPSS 15. Las cartas percentílicas fueron elaboradas en el software LMS versión 1.32. Resultados: Existen incrementos significativos de valores medios de las pruebas de KTK en ambos sexos y a lo largo de la edad. Valores de reclasificación de los escolares en sus edades originales es bajo y presenta tendencia decreciente a lo largo de la edad (30% a 23% y 30% a 20% en niñas y niños, respectivamente). La pertenencia a un determinado ESE no expresa la presencia de perfiles de desarrollo coordinativo diferenciados. Conclusiones. El desarrollo coordinativo es altamente específico a cada género. Se constata una tendencia generalizada en ambos sexos de expresar perfiles de desarrollo coordinativo inferiores a lo esperado para su edad. El ESE no es un predictor concluyente en el desarrollo de la coordinación motora de los niños.

Purpose:To describe motor coordination levels (CoM), their centile distribution, as well as identify the coordinative readiness of Peruvian children as a function of age, sex and socioeconomic status. Methodology: Sample size included4007 children (n=1889 females; n=2118 males) between 6 and 11 years of age (young = 8,99; children = 9,07) from several schools of the metropolitan area of Lima, Perú. CoM was assessed with the KTK, a battery of tests that includes: balancing backward (BB), hopping on one leg (HO), jumping sideways (JS) and shifting platforms (SP). Socioeconomic status (SES) was assessed according to the physical localization of each school (type of neighborhood). Exploratory, descriptive and inferential statistical analyses were used, including: multivariate analysis of variance, discriminant function and chi square. Percentile charts were constructed in the LMS software version 1.32. Results: Significant increases in mean values of CoM were found in both sexes, and across age groups. Reclassification values of CoM in their original ages are low and presents a decreased tendency throughout age (30% to 23% and 30% to 20% in girls and boys, respectively). SES is not a relevant predictor of differences in coordination profiles of children. Conclusions: The development of coordination is highly gender specific. There is a clear trend, in boys and girls, to show a coordination profile that is lower than expected for their chronological age. SES is not a conclusive predictor in the development of motor coordination profiles of children.

OBJECTIVE: To assess the short- and long-term results of the use of streptokinase (SK) for the treatment of thromboses in cardiac valvular prostheses. METHODS: Seventeen patients with cardiac prosthetic thrombosis diagnosed by clinical, echocardiographic, and radioscopic findings underwent fibrinolytic treatment with a streptokinase bolus of 250,000 U followed by 100.000 U/hour. Short- and long-term results were assessed by radioscopy and echocardiography. RESULTS: Of the 17 patients, 12 had mechanical double-disk prostheses (4 aortic, 6 mitral, 2 tricuspid), 4 had single-disk prostheses (2 aortic, 1 mitral, and 1 tricuspid), and 1 had a tricuspid bioprosthesis. The success rate was 64.8%, the partial success rate was 17.6%, and the nonsuccess rate was 17.6%. All patients with a double-disk prosthesis responded, completely or partially, to the treatment. None of the patients with a single-disk prosthesis had complete resolution of the thrombosis. The time of streptokinase infusion ranged from 6 to 80 hours (mean of 56 h). The mortality rate due to the use of streptokinase was 5.8% and was secondary to cerebral bleeding. During streptokinase infusion, 3 (17.6%) embolic episodes occurred as follows: 1 cerebral, 1 peripheral, and 1 coronary. The rethrombosis index was 33% in a mean follow-up of 42 months. CONCLUSION: The use of fibrinolytic agents was effective and relatively safe in patients with primary thrombosis of a double-disk prosthesis. A fatal hemorrhagic complication occurred in 1 (5.8%) patient, and embolic complications occurred in 3 (17.6%) patients. In a mean 42-month follow-up, 67% of the patients were free from rethrombosis.

OBJECTIVE: To analyze the early and late results of cardiopulmonary resuscitation in a cardiology hospital and to try to detect prognostic determinants of both short- and long-term survival. METHODS: A series of 557 patients who suffered cardiorespiratory arrest (CRA) at the Dante Pazzanese Cardiology Institute over a period of 5 years was analyzed to examine factors predicting successful resuscitation and long-term survival. RESULTS: Ressuscitation maneuvers were tried in 536 patients; 281 patients (52.4%) died immediately, and 164 patients (30.6%) survived for than 24 hours. The 87 patients who survived for more than 1 month after CRA were compared with nonsurvivors. Coronary disease, cardiomyopathy, and valvular disease had a better prognosis. Primary arrhythmia occurred in 73.5% of the >1-month survivor group and heart failure occurred in 12.6% of this group. In those patients in whom the initial mechanism of CRA was ventricular fibrillation, 33.3% survived for more than 1 month, but of those with ventricular asystole only 4.3% survived. None of the 10 patients with electromechanical dissociation survived. There was worse prognosis in patients included in the extreme age groups (zero to 10 years and 70 years or more). The best results occurred when the cardiac arrest took place in the catheterization laboratories. The worst results occurred in the intensive care unit and the hemodialysis room. CONCLUSION: The results in our series may serve as a helpful guide to physicians with the difficult task of deciding when not to resuscitate or when to stop resuscitation efforts.