ABSTRACT
Resumen: Introducción: El objetivo general de la investigación fue describir la epidemiología y estimar los costos médicos directos de la fractura de cadera en el adulto mayor en México. Material y métodos: Se realizó un estudio observacional y transversal retrospectivo. Se utilizaron dos bases de datos obtenidas de la Dirección General de Información en Salud del período 2013-2018: egresos hospitalarios y procedimientos quirúrgicos. Las variables incluidas fueron: sexo, entidad federativa, edad, año de registro y tipo de fractura de acorde a la CIE-10; de igual forma, todos los insumos necesarios para la realización del procedimiento quirúrgico. Resultados: Se registraron 16,829 ingresos de pacientes con fractura de cadera. Las mujeres representaron 69% del total de pacientes, la edad en promedio fue de 79 años y la estancia hospitalaria fue de nueve días, 77% de las fracturas fueron de cuello de fémur y el promedio de los costos médicos directos de los procedimientos ascendieron a USD $45,122,228.00 para el período estudiado. Conclusión: El riesgo de caídas aumenta con la edad, especialmente en el grupo etario de 80-89 años, por lo que se espera que este tipo de patologías se incremente en los próximos años. De igual forma, los costos para la atención de estas fracturas representan un impacto económico para los sistemas de salud. De manera que la implementación de estrategias de prevención, por ejemplo, en caídas es el método más eficiente para contribuir al envejecimiento saludable.
Abstract: Introduction: The aim of this study was to describe the epidemiology and to estimate the direct medical costs of hip fracture among elderly patients in Mexico. Material and methods: An observational, cross sectional and retrospective study was undertaken. Hospital discharge and surgical procedures for the period 2013-2018 were the databases used for the analysis, and obtained from General Directorate of Health Information. Variables included were sex, federal entity, age, year of discharge, and fracture type according to the CIE-10; and also, the supplies needed for the surgical procedures. Results: A total of 16,829 patients with hip fracture were discharge, 69% were women, and the mean for age was 79 years old and for the hospital stay length was nine days. The most frequent fracture type was the femur neck with 77% and the average medical costs was USD$45,122,228.00. Conclusion: Falling risks increase with age, especially in patients among 80-89 years of age, hence, is expected that this type of pathology increases in the following years. The medical costs for treatment of hip fracture represents an economic impact on health services. For that reason, the implementation of prevention strategies, risk of falling for example, is the one of most efficient approach.
ABSTRACT
Twenty-four patients with various types of cancer were given transfer and Direct-Specific Immunizations which at times were reinforced with BCG under conditions of exigency. The patients were grouped as follows: Group 1 - Tumors adequately removed, no metastasis or spread, Group 2 - Tumors adequately removed previously but with existing spread or metastasis at time of immunotherapy, Group 3 - Tumors not adequately removed, with local or systemic spread, Group 4 - Tumors not removed, with local or systemic spreadIn group 1, all are alive except one (7/8 or 87.5%) between 9 to 96 months (mean 35.8 mo.) with recurrence of tumor only in one patient. In Group 2 (6 patients), four had dramatic dissolution of the spread and recurrence, two had growth slowing and all are alive except one (5/6 or 83.3%) 6 to 60 months (mean 27.1 mo.). In Group 3 (2 patients), all died with a mean survival time of 16 months,. In Group 4 (8 patients), only one is alive (12.5%) after 72 months, with a mean survival time of 12.2 months. Control studies in 33 advanced cancer patients without Immunotherapy revealed a mean survival time of 2.7 months, with no living patient after that period. Survival time was calculated from the first visit or institution of immunotherapy and not from the previous operation. Comparison with Villasors series was discussed. Included in this study was an experience with local immunotherapy for cutaneous lesionsTumor burden was a critical factor as shown in Groups 3 and 4. The results in Groups 1 and 2 were encouraging and invite more attention, study and employment of bigger series"Post-Surgical" Immunoprophylaxis was discussed relative to its effectivity (7/8 or 87.5%) in Group 1 and an overall survial rate of 53.8% for all groupsThe role of lymphocytes as cytopathic effectors of cell-mediated immunity as well as the prognostic significance of its peripheral population has been emphasized. The presence of atypical cells and significant eosinophilia in some patients and their relationship to antigenic recognition and tumor antigen-antibody interaction was mentioned. Finally, the regenerative potential of Amino-acids combined with Inosine in conjunction with Immunotherapy was revealed by improvement in lymphocyte levels which cannot to explained solely by immunotherapy alone.(Summary)
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Achalasia occurring in a 25-year old, six-month pregnant patient who underwent a rough but successful course after a modified Hellers esophagomyotomy was described. The different aspects of the therapeutic problem including the pros and cons of surgery, radiation risk during dignostic fluoroscopy, anesthetic and surgical tolerance, and the uterine effects of postsurgical routines imposed on a post thoracotomy pregnant patient were discussed. The initial two-month follow-up was satisfactory.(Summary)
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376 specimens consisting of 339 tumors and 37 alien tissues in the human host were studied with regards to the density of immunocellular infiltration (DI) at the tumor-stroma junction. The DI was read as 0,1,2,3,4, with 0 representing absence of the infiltrating immunocytes according to the authors proposed classificationThere was total disparity between the results of the control and that of the tumor group. Whereas the control group showed a 70.2% incidence, at DI 3 and 4 combined, the whole tumor group had only 18.1% and, therefore, a low immunocellular index (ICI) of 25.7% of the control (Group X). On the other hand, at DI 0 and 1, the tumor group had an incidence of 66.9%, while the control had only a 2.7% incidence at DI 1 and none at 0. It is striking that the high group incidences at DI 0 and 1 combined were sent in the invasive and metastic-embolic groups (73.7%) and 84.1%, respectively)The quantitative differences between the benign-preinvasive groups (A and B) and the invasive-metastatic groups (C and D) which have similar descending trends clearly point to their clearout behaviors, namely: the "host-dependent" and the "autonomous", respectively. The results of this study proved beyond doubt the immunosuppressive property of cancer. The experimental and clinical correlations with the above results were discussed. Mention was made also of the significance of the trophoblastic nature of cancer in relation to the authors findings. Fiscally, a hypothesis of "Cancer Rejection" was presented. and its various facets discussed. Preliminary clinical experimentation seems to support the hypothesis. These experiences may be the beginning of a relatively new challenge in oncotherapy. It can be said in closing that the various aspects of cancer immunology deserve an aggressive reappraisal, for this author is confident that in the not-too-distant future a much more simple, safe, and physiological method in the conquest of malignancy can become a living reality.(Summary)
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Fifty-two cases who underwent mitral commissurotomy were studied for complications. Twenty-two or 42.3 per cent developed twenty-nine complications including four deaths, an immediate mortality of 7.6 per cent. The role of various factors were studied in order to ascertain why complications occur with such a relatively innocuous procedure as mitral commissurotomy, The following seem to be operative: functional classification, duration of symptoms, history and number of congestive heart failures, pre-existing atrial fibrillation, previous embolic history, previous hemoptysis, concomitant lung pathology, extreme heart size, recent infetion or rheumatic activity, transcommissural calcification or clot, and presence of associated cardiac pathologyFactors such as intracardiac instrumentation, too early removal of thoracotomy tubers, too early use of steroids, pre-operative antiarrhythmic medication were also discussed. The responsibility of the internist regarding early referral of the patient to the cardiac surgeon is stressed in an effort to reduce mortality as well as the incidence of complications. (Summary)
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The pathophysiologic changes in hypothermia have been discussed with particular reference to open cardiotomy. Mention has been made of the clinical methods of hypothermic induction as well as the indications of hypothermia in cardiac surgery. Although hypothermia has three major drawbacks, namely: ventricular fibrillation, clotting deviations, and air embolism, in addition to the relatively short permissible operative time it affords, it is less complicated than cardiopulmonary bypass using non-biological machines with their physical disadvantages and profound physiological circulatory alterations. It is hoped that further biological strides will be accomplished to attenuate its seeming disadvantages in the not-too-distant future. (Summary)
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An extreme case of pectus excavatum with sterno-dorsal "kissing", axaggerated levocardia, and right lung atelectasis is described in an eight-year old male. Successful surgical repair without internal or external fixation was done utilizing the ingenious Humphreys-Connolly technique. The initial two-month follow-up is satisfactory. The technique is described and rationalizedThe case is correlated with previous experiences regarding hemodynamic, cardiologic, and respiratory alterations and their bearing on surgical results. (Summary)
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Two cases of pulmonic valvular stenosis were performed under hypothermia utilizing a media sternotomy. The stenosed valves were incised in one and finger-fractured in the other under direct vision through an anterior pulmonary arteriotomy. Complete circulatory occlusion during the procedure averaged one to two minutes. Recovery was rapid in both and clinical improvement was evident from the second week up. There were no serious complications except for a transient hypotension in the younger patientThe clinical features, the technical aspects, as well as the merits and pitfalls of the procedures are discussed. (Summary)