Removing a broken guidewire in the hip joint: treatment options and recommendations for preventing an avoidable surgical catastrophe. A case report / Removendo um fio-guia quebrado na articulação do quadril: opções de tratamento e recomendações para prevenir uma evitável catástrofe cirúrgica. Um relato de caso

ABSTRACT CONTEXT: Hardware breakage during hip surgery can pose challenging and difficult problems for orthopedic surgeons. Apart from technical difficulties relating to retrieval of the broken hardware, complications such as adjacent joint arthritis and damage to neurovascular structures and major viscera can occur. Complications occurring during the perioperative period must be informed to the patient and proper documentation is essential. The treatment options must be discussed with the patient and relatives and the implant company must be informed about this untoward incident. CASE REPORT: We report a case of complete removal of the implant and then removal of the broken guidewire using a combination of techniques, including a cannulated drill bit, pituitary forceps and Kerrison rongeur. CONCLUSIONS: We suggest some treatment options and recommendations for preventing an avoidable surgical catastrophe.

RESUMO CONTEXTO: Ruptura de material de síntese durante a cirurgia de quadril pode representar problemas desafiadores e difíceis para cirurgiões ortopédicos. Além de dificuldades técnicas com recuperação do material quebrado, complicações como artrite na articulação adjacente, danos às estruturas neurovasculares e às principais vísceras podem ocorrer. A complicação durante o período perioperatório deve ser informada ao paciente e documentação apropriada é essencial. As opções de tratamento devem ser discutidas com o paciente e seus familiares e a empresa do implante deve ser informada sobre este incidente desagradável. RELATO DE CASO: Nós relatamos um caso da remoção completa do implante e, em seguida, a remoção do fio-guia quebrado usando uma combinação de técnicas, incluindo uma broca canulada, fórceps da hipófise e rongeur de Kerrison. CONCLUSÕES: Sugerimos algumas opções de tratamento e recomendações para prevenir uma evitável catástrofe cirúrgica.

Clinical profile of pneumonia and its association with rain wetting in patients admitted at a tertiary care institute during pandemic of influenza A (H1N1) pdm09 virus infection.

Background. Influenza pneumonia often occurs as epidemics in the Asian countries and have significant impact on the health of world population. Methods. We studied the association of rain-wetting with occurrence of pneumonia during the outbreak of the influenza A (H1N1) pdm09 virus infection. All patients admitted with community-acquired pneumonia during the period 13th September to 10th October 2010 were recruited in the present study. The diagnosis of influenza was established by realtime polymerase chain reaction (RT-PCR). The demographic data and clinical profile of the patients were recorded with a special consideration to record of possible risk factors. Results. Of the 123 patients studied, 39 (32%) patients had tested positive for influenza A (H1N1) pdm09; 12 (10%) tested positive for influenza A and remaining 72 (58%) patients were negative for influenza virus. Pattern of illness was almost identical in H1N1-positive and-negative groups. History of rain-wetting was present in 48 patients (39%) preceding the onset of illness. Getting wet in the rain was significantly higher in patients with pneumonia than control subjects [odds ratio 2.53, 95% confidence intervals (CI) 1.301 - 4.91; p=0.009)]. The number of pneumonia patients was also higher on rainy days and the numbers started declining a week later. Conclusion. More pneumonia patients are admitted during the periods of greater rainfall and rain-wetting may be an important risk factor for the occurrence of pneumonia.