Thromboembolism prophylaxis in orthopaedic surgery and trauma. / Profilaxis tromboembólica en cirugía ortopédica y traumatología.

Thromboembolism prophylaxis is well-established in major orthopaedic surgery (hip and knee arthroplasty and hip fracture surgery), with low-molecular-weight heparins the most often chosen agent. In recent years, however, direct-acting anticoagulants have been gaining ground and can be used in this scenario (except for hip fracture surgery). In the US, even aspirin could be indicated for low-risk patients who undergo hip or knee arthroplasty. For other orthopaedic procedures (leg surgery below the knee, ankle and foot; knee arthroscopy; arm surgery; and spine surgery), thromboembolism prophylaxis requires individualisation based on the patient's risk factors and the surgery's characteristics, given that the risk of venous thromboembolic disease is minor. In this patient group, the agent of choice is low-molecular-weight heparin, given that direct-acting anticoagulants are not approved for these types of surgery.

Pronóstico de la enfermedad tromboembólica venosa en cirugía ortopédica o pacientes traumatológicos y uso de tromboprofilaxis / Prognosis of venous thromboembolism in orthopaedic surgery or trauma patients and use of thromboprophylaxis

Antecedentes: Hay escasa evidencia sobre el pronóstico de la tromboembolia venosa en pacientes sometidos a cirugía ortopédica y en pacientes que sufren un trauma no quirúrgico. Métodos: Utilizamos la base de datos RIETE (Registro Informatizado de pacientes con Enfermedad TromboEmbólica) para comparar el pronóstico del tromboembolismo venoso y el uso de tromboprofilaxis en pacientes sometidos a diferentes procedimientos ortopédicos y en pacientes con traumatismo que no requiere cirugía. Resultados: Desde marzo de 2001 a marzo de 2015, se inscribieron un total de 61.789 pacientes en RIETE. De estos, 943 (1.52%) desarrollaron tromboembolismo venoso después de artroplastia electiva, 445 (0.72%) después de fractura de cadera, 1.045 (1.69%) después de cirugía ortopédica no mayor y 2,136 (3.46%) después de trauma no quirúrgico. En general, 2.283 pacientes (50%) presentaron inicialmente embolia pulmonar. En los primeros 90 días de tratamiento, 30 pacientes (0.66%, IC 95% 0.45-0.93) murieron por embolia pulmonar. La tasa de embolia pulmonar fatal fue significativamente mayor después de cirugía de fractura de cadera (n = 9 [2.02%]) que después de la artroplastia electiva (n = 5 [0.53%]), cirugía ortopédica no mayor (n = 5 [0.48%]) o traumatismo no quirúrgico (n = 11 [0,48%]). La tromboprofilaxis se utilizó con mayor frecuencia para la fractura de cadera (93%) o la artroplastia electiva (94%) que para la cirugía ortopédica no mayor (71%) o traumatismo no quirúrgico (32%). La hemorragia mayor fue significativamente mayor después de la cirugía de fractura de cadera (4%) que después de artroplastia electiva (1,6%), cirugía ortopédica no mayor (1,5%) o traumatismo no quirúrgico (1,4%). Conclusiones: La tromboprofilaxis se utilizó con menos frecuencia en los procedimientos de menor riesgo a pesar del número absoluto de embolia pulmonar fatal después de cirugía ortopédica no mayor o traumatismo no quirúrgico, excedieron los observados después de procedimientos de alto riesgo

Background: There is scarce evidence about the prognosis of venous thromboembolism in patients undergoing orthopedic surgery and in patients suffering non-surgical trauma. Methods: We used the RIETE database (Registro Informatizado de pacientes con Enfermedad Trombo Embólica) to compare the prognosis of venous thromboembolism and the use of thromboprophylaxis in patients undergoing different orthopedic procedures and in trauma patients not requiring surgery. Results: From March 2001 to March 2015, a total of 61,789 patients were enrolled in RIETE database. Of these, 943 (1.52%) developed venous thromboembolism after elective arthroplasty, 445 (0.72%) after hip fracture, 1,045 (1.69%) after non-major orthopedic surgery and 2,136 (3.46%) after non-surgical trauma. Overall, 2,283 patients (50%) initially presented with pulmonary embolism. Within the first 90 days of therapy, 30 patients (0.66%; 95% CI 0.45-0.93) died from pulmonary embolism. The rate of fatal pulmonary embolism was significantly higher after hip fracture surgery (n = 9 [2.02%]) than after elective arthroplasty (n = 5 [0.53%]), non-major orthopedic surgery (n = 5 [0.48%]) or non surgical trauma (n = 11 [0.48%]). Thromboprophylaxis was more commonly used for hip fracture (93%) or elective arthroplasty (94%) than for non-major orthopedic surgery (71%) or non-surgical trauma (32%). Major bleeding was significantly higher after hip fracture surgery (4%) than that observed after elective arthroplasty (1.6%), non-major orthopedic surgery (1.5%) or non-surgical trauma (1.4%). Conclusions: Thromboprophylaxis was less frequently used in lower risk procedures despite the absolute number of fatal pulmonary embolism after non-major orthopedic surgery or non-surgical trauma, exceeded that observed after high risk procedures

Prognosis of venous thromboembolism in orthopaedic surgery or trauma patients and use of thromboprophylaxis. / Pronóstico de la enfermedad tromboembólica venosa en cirugía ortopédica o pacientes traumatológicos y uso de tromboprofilaxis.

BACKGROUND: There is scarce evidence about the prognosis of venous thromboembolism in patients undergoing orthopedic surgery and in patients suffering non-surgical trauma. METHODS: We used the RIETE database (Registro Informatizado de pacientes con Enfermedad Trombo Embólica) to compare the prognosis of venous thromboembolism and the use of thromboprophylaxis in patients undergoing different orthopedic procedures and in trauma patients not requiring surgery. RESULTS: From March 2001 to March 2015, a total of 61,789 patients were enrolled in RIETE database. Of these, 943 (1.52%) developed venous thromboembolism after elective arthroplasty, 445 (0.72%) after hip fracture, 1,045 (1.69%) after non-major orthopedic surgery and 2,136 (3.46%) after non-surgical trauma. Overall, 2,283 patients (50%) initially presented with pulmonary embolism. Within the first 90 days of therapy, 30 patients (0.66%; 95% CI 0.45-0.93) died from pulmonary embolism. The rate of fatal pulmonary embolism was significantly higher after hip fracture surgery (n = 9 [2.02%]) than after elective arthroplasty (n = 5 [0.53%]), non-major orthopedic surgery (n = 5 [0.48%]) or non surgical trauma (n = 11 [0.48%]). Thromboprophylaxis was more commonly used for hip fracture (93%) or elective arthroplasty (94%) than for non-major orthopedic surgery (71%) or non-surgical trauma (32%). Major bleeding was significantly higher after hip fracture surgery (4%) than that observed after elective arthroplasty (1.6%), non-major orthopedic surgery (1.5%) or non-surgical trauma (1.4%). CONCLUSIONS: Thromboprophylaxis was less frequently used in lower risk procedures despite the absolute number of fatal pulmonary embolism after non-major orthopedic surgery or non-surgical trauma, exceeded that observed after high risk procedures.

Accidentes biológicos: estudio descriptivo de los trabajadores accidentados (junio de 2005-marzo 2009) en seguimiento por Asepeyo Madrid (AU) / Biological accidents: a descriptive study of workers who suffered accidents between june 2005 and march 2009 in Asepeyo, Madrid

La exposición laboral a agentes biológicos afecta a una gran variedad de actividades y ocupaciones, siendo los trabajadores del sector sanitario uno de los colectivos laborales más expuestos a este tipo de riesgo. Los virus de la hepatitis B (VHB), el virus de la inmunodeficiencia humana (VIH) y el virus de la hepatitis C (VHC) son agentes patógenos frecuentemente implicados en este tipo de accidentes. Es sabido que el método más efectivo para prevenir estas infecciones es un buen cumplimiento de la práctica de precauciones estándar para evitar accidentes. Si el accidente se produce, es importante el análisis de las circunstancias que llevaron al mismo para evitar que se repita. En este contexto hemos realizado un estudio descriptivo de las características de los trabajadores accidentados con riesgo de infección por VHB, VHC y VIH y las circunstancias que rodearon al accidente (AU)

Occupational exposure to biological agents is common to a great variety of professional activities. Sanitation workers are among the most exposed to this kind of risk. Hepatitis B virus (HBV), human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are pathogen agents frecuently linked to this kind of accidents. It is well known that the most effective method to prevent this kind of infections involves following standard precautoniary measures. In case of accidents, it is important to analyze the circumstances surronding such events, so that new episodes can be prevented. In this framework we have conducted a descriptive study of the characteristics of the workers that suffered HBV, HCV and HIV inffections, as well as the circumstances surronding those accidents (AU)

Prevalencia de síndrome metabólico en población laboral. El corazón de Asepeyo / Prevalence of metabolic syndrome (MS) in laboral population. The heart of Asepeyo

Introducción: El espectacular aumento que el síndrome metabólico (SM) está teniendo en las sociedades occidentales, conduce inevitablemente al incremento de la enfermedad cardiovascular. Por ello y puesto que su presencia indica la necesidad de aplicar medidas activas para reducir el riesgo cardiovascular, nos propusimos estudiar la prevalencia del síndrome metabólico y los factores de riesgo asociados a él, en nuestra población laboral. Material y métodos: El estudio incluyó 345 trabajadores, 191 mujeres y 154 hombres, sometidos a un reconocimiento laboral durante el año 2006. Resultados: El 12,5 % de la población presentó obesidad, siendo esta mayor en hombres (16,9%) que en mujeres (8,9%). La prevalencia de SM fue del 7,8%, siendo mayor en hombres que en mujeres. El 57,7% de los hombres y el 29,4% de las mujeres con obesidad presentaban SM. Los trabajadores con más edad, tuvieron mayor prevalencia de SM. El criterio de SM más prevalente fue la hipertensión arterial. Todos los criterios de SM predominaron en varones a excepción del perímetro abdominal, que lo hizo en las mujeres. Conclusiones:1. Casi 8 de cada 100 trabajadores presentaron SM, siendo mayor la prevalencia en los varones. La obesidad aumentó de forma importante la prevalencia de SM. Los trabajadores con más edad, tuvieron mayor prevalencia de SM.2. El perímetro abdominal se asoció significativamente con todos los factores de riesgo relacionados con el SM con excepción de la glucosa elevada en los hombres

Background: The high increase of the metabolic syndrome (MS) on the occidental World, is increasing the cardiovascular disease. Since, as the presence of metabolic syndrome suggests the application of preventive measure neccesary, We studied, the prevalence of metabolic syndrome and the cardiovascular risk factors (RF) in our laboral population. Methods: The sample included 345 workers, 191 females and 154 males. All the people passed a laboral chec-up at the year 2006. Results: Obesity was presented in 12.5% of the sample, 16.9% inmales, 8.9% in females. The prevalence of MS was 7.8%, being higher inmales than in females. 57.7% of obeses males presented MS and 29.4% of obeses females presented MS. The older worker presented higher prevalence of MS. The high blood pressure was the factor more prevalent, in worker with MS. All the factors of MS were more pevalent inmales, to exception of waist circumference.Conclusions:1. Almost 8% of workers presented MS, being higher the prevalance in males. The obesity increased of important manner the MS. The older worker had higher prevalence of MS.2. The waist circumference associated with all the FR related with MS

[Prevalence of metabolic syndrome (MS) in laboral population. The heart of Asepeyo]. / Prevalencia de síndrome metabólico en población laboral: El corazón de Asepeyo.

BACKGROUND: The high increase of the metabolic syndrome (MS) on the occidental World, is increasing the cardiovascular disease. Since, as the presence of metabolic syndrome suggests the application of preventive measure necessary, We studied, the prevalence of metabolic syndrome and the cardiovascular risk factors (RF) in our laboral population. METHODS: The sample included 345 workers, 191 females and 154 males. All the people passed a laboral check-up at the year 2006. RESULTS: Obesity was presented in 12.5% of the sample, 16.9% in males, 8.9% in females. The prevalence of MS was 7.8%, being higher in males than in females. 57.7% of obese males presented MS and 29.4% of obese females presented MS. The older worker presented higher prevalence of MS. The high blood pressure was the factor more prevalent, in worker with MS. All the factors of MS were more prevalent in males, to exception of waist circumference. CONCLUSIONS: 1. Almost 8% of workers presented MS, being higher the prevalence in males. The obesity increased of important manner the MS. The older worker had higher prevalence of MS. 2. The waist circumference associated with all the FR related with MS.

[Report of 8 cases of dermatomyositis: does association of this entity and neoplasms exist?]. / Presentación de ocho casos de dermatomiositis: existe asociación de esta entidad con neoplasia?

BACKGROUND: To review eight cases of dermatomyositis (DM) and investigate the association of DM with cancer and mortality rate in this group of patients. MATERIALS AND METHODS: Retrospective study of DM cases at Fundación Jiménez Díaz from January 1991 and March 1996. RESULTS: Only two out of the eight patients with DM had concomitant carcinomas (undifferentiated medium cell lung carcinoma and infiltrating ductal carcinoma of the breast). The mean age was 62 years (the two patients with carcinoma exceeded this age). As for gender incidence, one of the two male patients in this study had cancer, compared with one out of the six female patients. The cause of death in the three patients who died was an infection and so far none of the two patients with associated cancer has died. CONCLUSIONS: Despite our small series, the incidence of cancer in patients with DM (25%) is similar to that observed in larger series (15%-30%). All patients presented with cutaneous lesions. Only one of them had also hemoptysis and was diagnosed of lung cancer. The diagnosis of breast cancer was obtained with a control mammography. The mortality rate in these two patients was not higher. The incidence of cancer is higher in older DM patients.

[Psoas abscess: report of 8 cases and review of the literature]. / Abscesos del psoas: presentación de ocho casos y revisión de la literatura.

Eight cases of psoas abscesses (PA) are reported and a comparative study is made with other series as well as a review of the literature. Cases in our series are analysed and an assessment is made of microbiological etiologies, the presence of an origin and its spreading into the surrounding tissues or their primary character, and particularly the diagnostic and therapeutic usefulness of CT-guided percutaneous drainage. Diagnosis was ascertained by CT in all seven cases in which it was performed; percutaneous drainage was performed in five cases and allowed the microbiological categorization of the abscess and an appropriate antibiotic therapy. Laparotomy was performed in only one case; and in two other cases only antibiotics were administered. A favourable outcome occurred in seven out of the eight cases. One of the two patients treated with antibiotics only died. Blood cultures were positive in only three patients. In summary, PA in our series were secondary to bone, urologic or digestive origins in 87.5% of cases. With regard to the causative agent, 37.5% of cases were caused by S. aureus and 50% by gram negative and/or anaerobic organisms. The diagnostic yields of echocardiography and CT were 40% and 100%, respectively. Percutaneous drainage ascertained the microbiological diagnosis in 100% of cases when it was performed, as well as a therapeutic regimen associated with the use of antibiotics. No relapses were recorded in the follow-up of patients. Therefore, we believe that therapy of PA should be based on the association of percutaneous drainage and antibiotics.

[Spontaneous bacterial peritonitis in the cirrhotic patient]. / Peritonitis bacteriana espontánea en el paciente cirrótico.

Spontaneous bacterial peritonitis in cirrhotic patients is a severe complication which frequently decompensate the underlying disease and which is associated, even in our days, to a 50% mortality. Hence, the relevance of an adequate exploration, as weil as an early treatment. The acknowledge of several variants, as are the concepts of bacterascites and neutrocytic ascites with negative culture required the use of updated diagnostic criteria. In addition to the already known clinical and bacteriological characteristics of the ascitic fluid infection, we have also intended to review new aspects of this entity referred to in the literature published in the past years, as are the followings; study of possible predictive factors of this complication and factors which have an influence on its mortality, in order to be able to implement the most adequate preventive its mortality, in order to be able to implement the most adequate preventive its mortality, in order to be able to implement the most adequate preventive and curative therapeutics.