Causas de ingresos no deseados tras la realización de procedimientos quirúrgicos de cirugía ortopédica y traumatología en cirugía mayor ambulatoria / Causes of unplanned admission after orthopedic procedures in ambulatory surgery

OBJETIVO: Los procedimientos de cirugía ortopédica y traumatología realizados en unidades de cirugía mayor ambulatoria ofrecen importantes ventajas que desaparecen cuando la recuperación postoperatoria no es la esperada y los pacientes precisan ingresar. El objetivo de este estudio es analizar las causas de ingresos no deseados tras intervenciones quirúrgicas de cirugía ortopédica y traumatología en una unidad de cirugía mayor ambulatoria en relación con variables como edad, riesgo anestésico, tipo de anestesia, procedimiento o duración. MÉTODOS: Estudio de cohorte ambispectivo sobre 5.085 pacientes intervenidos desde 1995 a 2017. Se analizaron 39 variables proporcionadas por la base de datos de la unidad que se abre al ingreso en la misma y se cierra el día 30 postoperatorio. RESULTADOS: El 98,2% de los pacientes fueron dados de alta de la unidad. Precisaron ingresar 74 (1,5%). Este porcentaje demostró diferencias significativas en relación con el tipo de procedimiento, el tipo de anestesia y la duración, que condicionaron el ingreso inmediato por mal control del dolor agudo postoperatorio, náuseas o alteraciones de la herida. Diecisiete pacientes (0,3%) precisaron un ingreso diferido por complicaciones surgidas en el domicilio, siendo la más frecuente la infección de la herida. CONCLUSIONES: Los ingresos no deseados se relacionan con mayor frecuencia con el empleo de anestesia general, con operaciones de mayor duración y con procedimientos como la cirugía artroscópica, las correcciones de hallux valgus o las retiradas de material de osteosíntesis, siendo las causas de ingreso más importantes el mal control del dolor agudo postoperatorio en los inmediatos y la infección de la herida en los diferidos

OBJECTIVE: Orthopaedic procedures performed in Day Surgery Units provide important advantages which disappear when patients require admission when postoperative recovery is not as expected. The aim of this study was to analyse the reasons for unplanned hospital admissions after orthopaedic procedures in a Day Surgery Unit and their relationship between variables such as patient age, anaesthetic risk and technique, procedure or duration. METHODS: Ambispective cohort study of 5,085 patients who underwent surgical orthopaedic procedures between 1995 and 2017. Thirty-nine variables provided by the Unit's database were analysed. The database was opened on the day of admission and closed the 30th postoperative day. RESULTS: Of the patients, 98.2% were discharged from the Unit. Seventy-four (1.5%) required overnight admission. This percentage showed significant differences in relation to the type of procedure, type of anaesthesia and duration, which conditioned overnight admission due to inadequate postoperative pain management, nausea or wound complications. Seventeen patients (0.3%) required readmission after discharge due to complications that arose at home, such as wound infection, which was the most common. CONCLUSIONS: Unplanned admissions are more frequently related to general anaesthesia, lengthy surgeries and procedures such as arthroscopy, hallux valgus corrections or removal of osteosynthesis material. The major reasons for unplanned admissions were inadequate postoperative pain management for overnight admissions and wound infection for admissions after discharge

Causes of unplanned admission after orthopedic procedures in ambulatory surgery. / Causas de ingresos no deseados tras la realización de procedimientos quirúrgicos de cirugía ortopédica y traumatología en cirugía mayor ambulatoria.

OBJECTIVE: Orthopaedic procedures performed in Day Surgery Units provide important advantages which disappear when patients require admission when postoperative recovery is not as expected. The aim of this study was to analyse the reasons for unplanned hospital admissions after orthopaedic procedures in a Day Surgery Unit and their relationship between variables such as patient age, anaesthetic risk and technique, procedure or duration. METHODS: Ambispective cohort study of 5,085 patients who underwent surgical orthopaedic procedures between 1995 and 2017. Thirty-nine variables provided by the Unit's database were analysed. The database was opened on the day of admission and closed the 30th postoperative day. RESULTS: Of the patients, 98.2% were discharged from the Unit. Seventy-four (1.5%) required overnight admission. This percentage showed significant differences in relation to the type of procedure, type of anaesthesia and duration, which conditioned overnight admission due to inadequate postoperative pain management, nausea or wound complications. Seventeen patients (0.3%) required readmission after discharge due to complications that arose at home, such as wound infection, which was the most common. CONCLUSIONS: Unplanned admissions are more frequently related to general anaesthesia, lengthy surgeries and procedures such as arthroscopy, hallux valgus corrections or removal of osteosynthesis material. The major reasons for unplanned admissions were inadequate postoperative pain management for overnight admissions and wound infection for admissions after discharge.

Desarrollo histórico de la traumatología y de la cirugía ortopédica a partir del siglo XV / Historical development of traumatology and orthopedic surgery from the XV century

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Estudio epidemiológico de las urgencias pediátricas del aparato locomotor / No disponible

Objetivo. Analizar las características epidemiológicas de las urgencias pediátricas del aparato locomotor en nuestro medio. Pacientes y métodos. Estudio epidemiiológico restrospectivo de niños menores de 17 años atendidos en urgencias en el período comprendido entre el 1 de enero de 1994 y el 31 de diciembre del año 2000. Resultados. Los pacientes incluidos en el estudio fueron 28.664. Incidencia: 29%. Sexo. Varones 55,7% y mujeres 44,3%. El grupo de edades más frecuente es el de 12-16 años (56,3%). Lesión más frecuente: contusión 46,5%. El número de pacientes ingrresados fue de 481 (1,67%). El porcentaje de accidentes de tráfico fue de 2,45%. Conclusiones. Predominio de los varones en un 55,7%, siendo el grupo de edad más frecuente el de 12-16 años (56,3%). El análisis del estudio nos ha permitido conocer los aspectos epidemiológicos de la población pediátrica que se trata en nuestro Centro. La mayoría de accidentes ocurren en gente joven y son necesarias campañas de prevención (AU)

Objective. To analyze the epidemiology of trauma emergencies in the pediatric population in our setting. Pattients and methods. We performed a epidemiological retrospective study in patients younger than 17 years attended in emergency area carried out between January 1, 1994 and December 31, 2000. Results. The patients included in the study were 28.664, Incidence: 29% Sex: males 55,7% and females 44,3%. The predominant age group was 12-16 years (56,3%). Most frequent lesions: contusion 46.5%. Admission to the hospital was deemed necessary in 481 (1.67%) of the children. Motor vehicle accidents accounted for 2.45%. Conclusions. We found that pediatric trauma were more frequent in males(55.7%) than in females. The predominant age group was 12-16 years (56.3%). The utility of this study is the knowledge of the epidemiology of our pediatric population. Most accidents occur in young people and educational campaigns to prevent accidents are clearly needed (AU)

[Osteonecrosis and HIV]. / Osteonecrosis y VIH.

An increase of the incidence of osteonecrosis in subjects infected with the HIV has been reported. It is unknown if osteonecrosis is an HIV infection consequence, or just the consequence of so many risk factors present among HIV infected subjects. We report five osteonecrosis cases found in our series of 534 HIV patients, and we review the related bibliography. All cases have some conventional risk factor different to the HIV or the antiviral treatment. We can't conclude antiviral treatments are not involved in osteonecrosis, but they have been the only risk factor in none of our patients.

[Forearm malignant epithelioid schwannoma associated with melanoma]. / Schwannoma maligno epitelioide en antebrazo asociado a melanoma.

Tumours originating in peripheric nerves usually appear in patients with neurofibromatosis (NF) signs, presenting frequent combinations of tumours in nerves and cutaneous lesions. Nevertheless, this association is very rare in cases without NF. Therefore, the aim of the present article is to present a case of malignant melanoma and malignant schwannoma, without any described NF. A 69-year-old woman with antecedents of malignant melanoma diagnosed two years previously in the dorsum of the fifth finger of the left hand, treated by means of amputation of the finger. The patient presented a malignant epithelioid schwannoma adhered to the median nerve that required elbow amputation. One month later lung metastases appeared and the patient died. This case presented no known NF sign. However, a relationship must be searched for in the common origin of melanoma and schwannoma from the embryonic neural crest.

Osteonecrosis y VIH / Osteonecrosis and hiv

En la literatura aparece un incremento de la incidencia de osteonecrosis de cabeza femoral entre sujetos infectados por el VIH, si bien se desconoce si ésto es consecuencia directa o indirecta de la enfermedad infecciosa o más bien se debe al acúmulo de factores que en estos pacientes se da por su pluripatología. En este trabajo describimos cinco casos de osteonecrosis ocurridos entre los 534 pacientes VIH vistos en nuestro hospital y repasamos la bibliografía relacionada. Todos los casos presentan alguno de los factores de riesgo convencional ya relacionados con el desarrollo de osteonecrosis. Si bien no puede descartarse el papel del tratamiento o del VIH en el desarrollo de osteonecrosis, no hemos detectado ningún caso entre nuestros pacientes en que éste haya sido el único factor (AU)

An increase of the incidence of osteonecrosis in subjects infected with the HIV has been reported. It is unknown if osteonecrosis is an HIV infection consequence, or just the consequence of so many risk factors present among HIV infected subjects. We report five osteonecrosis cases found in our series of 534 HIV patients, and we review the related bibliography. All cases have some conventional risk factor different to the HIV or the antiviral treatment. We can’t conclude antiviral treatments are not involved in osteonecrosis, but they have been the only risk factor in none of our patients (AU)

Schwannoma maligno epitelioide en antebrazo asociado a melanoma / Forearm malignant epithelioid schwannoma asociated with melanoma

Las tumoraciones originadas en los nervios periféricos ocurren mayoritariamente en individuos con signos típicos de neurofibromatosis (NF), apareciendo en estos una asociación de tumoraciones nerviosas y cutáneas, combinación muy extraña en ausencia de NF. Por ello, el objeto de este trabajo es presentar un caso de asociación de melanoma y schwannoma epiteliode maligno en ausencia de alguna de las NF conocidas. Mujer de 69 años de edad con antecedentes de melanoma en el dorso del 5ª dedo de la mano izq. dos años antes, tratada mediante amputación del dedo, que presentó un schwanoma maligno epitelioide (SME) de alta malignidad dependiente del nervio mediano en el antebrazo izquierdo, por lo que se procedió a la amputación por encima del codo. Un mes más tarde se descubrieron nódulos de aspecto metastático en ambos hemitórax, falleciendo posteriormente la paciente. En ningún momento apareció evidencia alguna de pertenecer a alguna neurofibromatosis conocida. Sin embargo, creemos que la relación etiológica debe buscarse en el hecho de que tanto el SME como el melanoma sean tumores de células procedentes de la cresta neural embrionaria (AU)

Tumours originating in peripheric nerves usually appear in patients with neurofibromatosis (NF) signs, presenting frequent combinations of tumours in nerves and cutaneous lesions. Nevertheless, this association is very rare in cases without NF. Therefore, the aim of the present article is to present a case of malignant melanoma and malignant schwannoma, without any described NF. A 69-year-old woman with antecedents of malignant melanoma diagnosed two years previously in the dorsum of the fifth finger of the left hand, treated by means of amputation of the finger. The patient presented a malignant epithelioid schwannoma adhered to the median nerve that required elbow amputation. One month later lung metastases appeared and the patient died. This case presented no known NF sign. However, a relationship must be searched for in the common origin of melanoma and schwannoma from the embryonic neural crest (AU)

Osteoma osteoide de cuello femoral: una causa infrecuente de dolor de cadera en niños / Osteoid osteoma in the femoral neck: a rare cause of hip pain in children

El dolor de cadera en el niño es uno de los motivos más frecuentes de consulta. Uno de los diagnósticos que deben ser considerados es el osteoma osteoide. Este es un tumor óseo benigno de características clínicas y radiológicas específicas que genera dificultades diagnósticas. Presentamos dos casos clínicos infrecuentes de osteoma osteoide de cadera en el niño y se revisa la bibliografía sobre el tema (AU)

[A case of multiple malignant schwannoma as the only disease in a 40-year-old patient: is this a new type of neurofibromatosis?]. / A propósito de un caso de schwannoma maligno múltiple como única patología en un paciente de 40 años: un nuevo tipo de neurofibromatosis?

We present the case of a 40-year-old man that presented a fast growing tumour on the external side of the left elbow. The tumour was extirpated by means of marginal exerectomy. The microscopic study corresponded to epithelioid malignant schwannoma, and the patient received radiotherapy and adjuvant chemotherapy. During the following years two local recidives and two new malignant schwannomas, one in the left sciatic common trunk and another paraspinal one, appeared and were extirpated. Radiotherapy and chemotherapy were again administered. In the last year, four new tumours have appeared: in the supraclavicular space, right posterior costofrenic, left costovertebral, and in the inferior abdominal wall, none of them has been extirpated or has hystologic diagnosis at the moment, however radiologic findings suggest malignant schwannomas. In this moment there is no neurologic deficiency except for the secondary ones to surgical procedures, and no neurofibromatosis types I to VII signs have been observed. So, the possibility of a new neurofibromatosis type is appointed.

A propósito de un caso de schwannoma maligno múltiple como única patología en un paciente de 40 años: ¿un nuevo tipo de neurofibromatosis? / A case of multiple malignant schwannoma as the only disease in a 40-year-old patient: is this a new type of neurofibromatosis?

Se describe el caso de un paciente de 40 años de edad cuya clínica comenzó con la aparición de una tumoración en el codo izquierdo. Se realizó exéresis quirúrgica, siendo el diagnóstico anatomopatológico de "schwannoma maligno", por lo que se aplicó radioterapia local y quimioterapia. Durante los años siguientes aparecieron, y se extirparon, dos recidivas locales y dos nuevos schwannomas malignos uno en el nervio ciático izquierdo y otro paravertebral derecho, que también fueron tratados con radioterapia y quimioterapia. Últimamente han aparecido cuatro tumoraciones más: en zona supraclavicular derecha, seno costofrénico posterior derecho, costovertebral izquierdo y en la pared abdominal inferior derecha, aún no operados y sin que se haya realizado el diagnóstico anatomopatológico, pero con aspecto radiológico de schwannomas. Actualmente, el paciente, que ya tiene 46 años, se encuentra en buen estado general, no presenta defectos funcionales ajenos a las intervenciones quirúrgicas y, en especial, no se han observado estigmas de neurofibromatosis tipo I a tipo VII. Por todo ello se plantea la posibilidad de que se trate de un nuevo tipo de neurofibromatosis no descrito anteriormente (AU)

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[The effect of cervical arthrosis in the etiopathogenesis of vertebrobasilar insufficiency]. / Influencia de la artrosis cervical en la etiopatogenia de la insuficiencia vertebrobasilar.

We studied four groups of one hundred patients older than forty years. A group with radiological signs of cervical arthrosis was statistically compared with another one without such signs. There was no significant difference between the two groups with regard to the presence of vertebrobasilar insufficiency. Then we compared one hundred patients diagnosed of vertebrobasilar insufficiency with another group without this disease. When cervical arthrosis cases in these two groups were statistically compared, we could not find any significant differences. We think cervical arthrosis is not an important etiologic factor in vertebrobasilar insufficiency. Our results point to atherosclerotic lesions as the main cause of this entity.