ABSTRACT
OBJECTIVES: To assess the prevalence of surgical site infection (SSI) after elective operations for colon and rectal cancer after the application of evidence-based preventive measures and to identify risk factors for SSI. DESIGN: Prospective, observational, multicenter. SETTING: Tertiary and community public hospitals in Catalonia, Spain. PATIENTS: Consecutive patients undergoing elective surgical resections for colon and rectal cancer during a 9-month period. MAIN OUTCOME MEASURES: The prevalence of SSI within 30 days after the operations and risk factors for SSI. RESULTS: Data from 611 patients were documented: 383 patients underwent operations for colon cancer and 228 underwent operations for rectal cancer. Surgical site infection was observed in 89 (23.2%) colon cancer patients (superficial, 12.8%; deep, 2.1%; and organ/space, 8.4%) and in 63 (27.6%) rectal cancer patients (superficial, 13.6%; deep, 5.7%; and organ/space, 8.3%). For colon procedures, the following independent predictive factors were identified: for incisional SSI, open procedure vs laparoscopy; for organ/space SSI, hyperglycemia at 48 hours postoperatively (serum glucose level, >200 mg/dL), ostomy, and National Nosocomial Infection System index of 1 or more. In rectal procedures, no risk factors were identified for incisional SSI; hyperglycemia at 48 hours postoperatively (serum glucose level, >200 mg/dL) and temperature lower than 36°C at the time of surgical incision were associated with organ/space SSI. CONCLUSION: The prevalence of SSI in elective colon and rectal operations remains high despite the application of evidence-based preventive measures.
Subject(s)
Colonic Neoplasms/surgery , Cross Infection/epidemiology , Cross Infection/prevention & control , Evidence-Based Medicine , Rectal Neoplasms/surgery , Surgical Wound Infection/epidemiology , Surgical Wound Infection/prevention & control , Cross-Sectional Studies , Elective Surgical Procedures , Hospitals, Community/statistics & numerical data , Hospitals, Public/statistics & numerical data , Hospitals, University/statistics & numerical data , Humans , Incidence , Laparoscopy/statistics & numerical data , Length of Stay/statistics & numerical data , Multivariate Analysis , Perioperative Care/standards , Perioperative Care/statistics & numerical data , Prospective Studies , Risk Factors , SpainABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Catheter Ablation/methods , Ventriculoperitoneal Shunt/methods , Abdominal Pain/complications , Abdominal Pain/etiology , Peritonitis/complications , Colon/pathology , Colon/surgery , Colon , Ventriculoperitoneal Shunt/trendsABSTRACT
The most frequent tumors that grow in the retrorectal space are embryological. Their management requires adequate knowledge of the characteristics of these lesions. We present five cases of retrorectal tumors.
Subject(s)
Pelvic Neoplasms/surgery , Sacrococcygeal Region , Adult , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Pelvic Neoplasms/diagnostic imaging , Pelvic Neoplasms/pathology , Rectal Neoplasms/diagnostic imaging , Rectal Neoplasms/pathology , Rectal Neoplasms/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Los tumores retrorrectales pueden ser los propios de los tejidos de la zona o fruto de remanentes embriológicos (más frecuente). Su manejo exige un conocimiento de sus características. Se presentan 5 casos de tumores retrorrectales (AU)
The most frequent tumors that grow in the retrorectal space are embryological. Their management requires adequate knowledge of the characteristics of these lesions. We present five cases of retrorectal tumors (AU)
Subject(s)
Male , Female , Adult , Middle Aged , Humans , Colonoscopy/methods , Proctoscopy/methods , Biopsy/methods , Rectal Neoplasms/diagnosis , Rectal Neoplasms/surgery , Rectum/injuries , Rectum/pathology , Rectum/surgery , Case-Control Studies , Retrospective Studies , Rectal Neoplasms/classification , Rectal Neoplasms/drug therapy , Rectal Neoplasms/radiotherapyABSTRACT
Comunicamos el caso de un paciente varón de 48 años que presentó un cuadro de insuficiencia respiratoria aguda y requirió ingreso en la unidad de cuidados intensivos y que, una vez dado de alta, presentó un cuadro de neumoperitoneo masivo. Ninguna de las exploraciones complementarias realizadas aportó información relevante para el diagnóstico, y el paciente fue intervenido pero no se halló una causa aparente para explicar el neumoperitoneo. Creemos que este caso es interesante, ya que es una entidad frecuente que conduce a numerosas laparotomías de urgencia, y la mayoría de las veces su causa es la perforación de una víscera hueca, pero en un porcentaje importante es un neumoperitoneo no quirúrgico o idiopático (AU)
We report the case of a 48-year-old man who was admitted to the intensive care unit for acute respiratory distress. After discharge, the patient showed massive pneumoperitoneum. None of the complementary investigations provided information on the cause. The patient underwent surgery but no intraoperative diagnosis was reached. We believe that this case is of interest since pneumoperitoneum is a frequent entity that often leads to emergency laparotomy. The cause is usually perforation, although in a substantial proportion of cases the pneumoperitoneum is non-surgical, or idiopathic (AU)
Subject(s)
Male , Middle Aged , Humans , Pneumoperitoneum/etiology , Respiratory Insufficiency/complications , Tomography, X-Ray ComputedABSTRACT
We report the case of a 48-year-old man who was admitted to the intensive care unit for acute respiratory distress. After discharge, the patient showed massive pneumoperitoneum. None of the complementary investigations provided information on the cause. The patient underwent surgery but no intraoperative diagnosis was reached. We believe that this case is of interest since pneumoperitoneum is a frequent entity that often leads to emergency laparotomy. The cause is usually perforation, although in a substantial proportion of cases the pneumoperitoneum is non-surgical, or idiopathic.
Subject(s)
Pneumoperitoneum/etiology , Humans , Male , Middle Aged , Pneumoperitoneum/surgeryABSTRACT
BACKGROUND: Myasthenia gravis is by far the most common paraneoplastic syndrome of thymomas. There is little information regarding the influence of clinical variables and thymoma-associated factors on biologic development of myasthenia gravis. The aim of the study was to determine independent predictors of clinical outcome in thymoma with myasthenia gravis. METHODS: We studied 108 patients with thymoma-associated myasthenia gravis undergoing removal of the mediastinal mass between 1967 and 2000. Clinical and pathologic variables associated with clinical outcome of myasthenia were assessed by multivariate Cox regression analysis. RESULTS: Patients were followed for a mean period of 10 years (9 months to 33 years). A total of 38 patients died (35.2%), in 14 cases (37%) because of myasthenia gravis and in 6 (16%) because of recurrence of thymoma. With respect to clinical outcome of myasthenia gravis, at the end of the follow-up period, the rate of remission was 16% (n = 17). Of the 91 patients in whom remission was not achieved, 55 had no symptoms with immunosuppressive medication and 36 had symptoms with medication. CONCLUSIONS: In patients with thymoma-associated myasthenia gravis, well-differentiated thymic carcinoma (Müller-Hermelink system), age more than 55 years, and interval from the onset of symptoms to thymectomy of less than 1 year were found to be independent predictors of nonremission of myasthenia gravis after thymectomy.
Subject(s)
Myasthenia Gravis/epidemiology , Myasthenia Gravis/pathology , Thymoma/epidemiology , Thymoma/surgery , Thymus Neoplasms/epidemiology , Thymus Neoplasms/surgery , Adolescent , Adult , Age Distribution , Aged , Cohort Studies , Comorbidity , Female , Humans , Incidence , Male , Middle Aged , Multivariate Analysis , Predictive Value of Tests , Probability , Prognosis , Proportional Hazards Models , Retrospective Studies , Risk Assessment , Severity of Illness Index , Sex Distribution , Survival Rate , Thymectomy/methods , Thymoma/pathology , Thymus Neoplasms/pathology , Treatment OutcomeABSTRACT
BACKGROUND AND OBJECTIVE: Myasthenia Gravis (MG) and Thymoma have different clinical evolutions and survival. There are few studies grying to describe the prognosis factors in patients with both thymoma and MG. We have evaluated all patients with thymoma and associated MG who were treated in our unit in order to identify possible predictors of survival. PATIENTS AND METHOD: There were 108 patients with thymoma and associated MG treated at our center from 1967 to 2000. All data were analyzed by multivariate Cox regression analysis, which allowed quantification of the independent predictive value of prognostic indicators. RESULTS: Median follow-up was 10 years. Mortality was 35.2% (38 patients). In 14 (36.8%) cases, death was related to MG, and 6 (15.8%) patients died from a cause directly related to thymoma. Cox regression analysis found a predictive value for both an age older than 55 years and the need for tracheostomy during the postoperative period. CONCLUSIONS: In our series of patients with thymoma and associated MG, age older than 55 years and the need for postoperative tracheostomy were independent predictors of poorer overall survival.
Subject(s)
Myasthenia Gravis/mortality , Thymoma/mortality , Thymus Neoplasms/mortality , Adolescent , Adult , Age Factors , Aged , Disease-Free Survival , Female , Humans , Male , Middle Aged , Myasthenia Gravis/complications , Myasthenia Gravis/therapy , Neoplasm Staging , Postoperative Complications , Regression Analysis , Retrospective Studies , Survival Rate , Thymectomy/adverse effects , Thymectomy/mortality , Thymoma/complications , Thymoma/pathology , Thymoma/therapy , Thymus Neoplasms/complications , Thymus Neoplasms/therapy , Treatment OutcomeABSTRACT
FUNDAMENTO Y OBJETIVO: La miastenia grave (MG) y el timoma varían en términos de comportamiento clínico y de supervivencia global cuando se consideran de forma individual. Existen pocos estudios que evalúen los posibles factores predictivos independientes que puedan influir en la supervivencia de los pacientes con MG y timoma asociados. En el presente trabajo se han buscado factores predictivos independientes que puedan influir en la supervivencia de estos pacientes. PACIENTES Y MÉTODO: Entre el 1 de enero de 1967 y el 31 de marzo de 2000 se estudió a 108 pacientes con el diagnóstico de MG con timoma. Todos los datos fueron analizados mediante regresión de Cox para cuantificar los factores predictivos independientes. RESULTADOS: El período medio de seguimiento fue de 10 años. Durante este período fallecieron 38 pacientes (35,2 por ciento), en 14 casos (36,8 por ciento) debido a la MG, y en 6 (15,8 por ciento) debido al timoma. Mediante un análisis de regresión de Cox sólo la edad superior a 55 años y la práctica de una traqueostomía en el postoperatorio resultaron tener un valor predictivo independiente en la supervivencia de estos pacientes. CONCLUSIONES: La edad mayor de 55 años y la práctica de una traqueostomía en el postoperatorio han resultado tener un valor predictivo independiente para la supervivencia de los pacientes con MG y timoma (AU)
