Seguimiento clínico de pacientes en los servicios de traumatología. Respuesta del autor / Clinical follow-up of patients in traumatology departments. Reply

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[Prognostic factors of clinical outcome of the tuberculous pleural effusion]. / Factores pronósticos de la evolución clínica del derrame pleural tuberculoso.

BACKGROUND AND OBJECTIVE: To date, no studies have been reported analyzing the prognosis factors related to severe clinical complications in tuberculous pleural effusion (TPE). We studied clinical, biochemical, radiological, and microbiological factors that could help establish the clinical outcome of TPE. PATIENTS AND METHOD: Retrospective study of > or = 15 years old patients diagnosed of TPE along 9 years. Patients were classified in two groups: a group without complications (NCG), and a group with complications (CG) on the basis of residual pleural thickening (RPT) > or = 10 mm, need of surgery or death. RESULTS: Sixty six patients were included, mean age 35.3 years, 53% male, 47 in the NCG group and 19 in the CG (1 died, 4 needed surgery, 14 had RPT). The evolution of clinical symptoms was 20.7 days in the NCG and 45.6 in the CG. 94.7% of the CG patients had loculations (23.4% in the NCG). We observed significant differences in the pH (7.34 vs 7.11), glucose (78 vs 30 mg/dl) and lactic dehydrogenase (925 vs 3,235 U/l). CONCLUSIONS: Severe TPE has similar characteristics to complicated parapneumonic pleural effusion. Loculations, pH < 7.25 and glucose < 50 mg/dl were indicative of a poorly outcome in our study.

Factores pronósticos de la evolución clínica del derrame pleural tuberculoso / Prognostic factors of clinical outcome of the tuberculous pleural effusion

FUNDAMENTO Y OBJETIVO: No hay publicaciones sobre factores pronósticos de complicaciones clínicas graves en el derrame pleural tuberculoso(DPT). El objetivo de este trabajo fue estudiar la existencia de factores clínicos, bioquímicos, radiológicos microbiológicos que puedan establecer el pronóstico clínico del DPT.PACIENTES Y MÉTODO: Estudio retrospectivo de los pacientes de 15 años o mayores diagnosticados de DPT durante 9 años, divididos en un grupo sin complicaciones (SC) y un grupo con complicaciones (CC) si presentaron engrosamiento pleural residual (EPR) de 10 mm o más, precisaron cirugía o fallecieron. RESULTADOS: El estudio incluyó a 66 pacientes con una edad media de 35,3 años; un 53%eran varones. Había 47 pacientes en el grupo SC y 19 en el CC (1 fallecido, 4 intervenidos quirúrgicamente, 14 con EPR). El tiempo de evolución de los síntomas fue de 20,7 días en el grupo SC y de 45,6 en el CC. El 94,7% delos pacientes CC presentó loculaciones frente al 23,4% en el grupo SC. Encontramos diferencias significativas en el pH (7,34 frente a7,11), glucosa (78 frente a 30 mg/dl) y lactato deshidrogenasa(925 frente a 3.235 U/l).CONCLUSIONES: El DPT grave tiene características similares al derrame para neumónico complicado. El perfil pronóstico de mala evolución clínica está compuesto por la presencia de loculaciones, pH inferior a 7,25 y glucosa menor de 50 mg/dl

BACKGROUND AND OBJECTIVE: To date, no studies have been reported analyzing the prognosis factors related to severe clinical complications in tuberculous pleural effusion (TPE). We studied clinical, biochemical, radiological, and microbiological factors that could help establish the clinical outcome of TPE.PATIENTS AND METHOD: Retrospective study of ≥15 years old patients diagnosed of TPE along 9years. Patients were classified in two groups: a group without complications (NCG), and a group with complications (CG) on the basis ofresidual pleural thickening (RPT) ≥10 mm, need of surgery or death. RESULTS: Sixty six patients were included, meanage 35.3 years, 53% male, 47 in the NCGgroup and 19 in the CG (1 died, 4 needed surgery,14 had RPT). The evolution of clinical symptoms was 20.7 days in the NCG and 45.6in the CG. 94.7% of the CG patients had loculations(23.4% in the NCG). We observed significant differences in the pH (7.34 vs 7.11), glucose(78 vs 30 mg/dl) and lactic dehydrogenase(925 vs 3,235 U/l)

[Effect derived by the adscription of internist to a surgical department]. / Efecto de la adscripción de internistas a un servicio quirúrgico.

BACKGROUND AND OBJECTIVE: Although surgical units commonly request the collaboration of internists via medical consultation, the efficiency of this system is low and expensive. We studied the effect of the integration of full-time internists in a surgical department. PATIENTS AND METHOD: The study group consisted of the patients admitted during intervention in the Orthopedic Surgery and Traumatology Department. Those patients admitted during the same period of the previous year made up the control group. We analyzed pre-surgical stay, post-surgical stay and total stay. We also studied in-hospital mortality, re-admissions and those patients who were not submitted to surgery (NSS). Control variables were age, sex, type of admission (programmed/emergency) and main diagnosis. RESULTS: 1,216 patients were included, 599 in the control group and 617 in the study group, 48.0% were emergency admissions and 11.7% NSS patients. Study of programmed patients did not suggest any differences between both groups in any of the analyzed variables. In emergency patients, the total stay was decreased in 18.2%, and it was reduced in 40.2% of the NSS. The distribution of the re-admissions was similar in both study and control groups. We observed a decrease in the NSS and a 50% decrease in the deaths of the study group. The obtained saving was 329,170 Euros. CONCLUSIONS: The adscription of full-time internists to a surgical service clearly improves the quality of the service it provides, with important hospital savings.

Efecto de la adscripción de internistas a un servicio quirúrgico / Effect derived by the adscription of internist to a surgical department

FUNDAMENTO Y OBJETIVO: Los servicios quirúrgicos solicitan la colaboración de internistas por medio de la interconsulta médica. Este sistema es poco eficaz y caro. Estudiamos el efecto de la integración de internistas a tiempo completo en un servicio quirúrgico. PACIENTES Y MÉTODO: El grupo estudiado estuvo constituido por los pacientes ingresados en el Servicio de Cirugía Ortopédica y Traumatología durante los 5 meses que estuvieron adscritos los internistas. El grupo control lo integraron los pacientes ingresados en el mismo período del año anterior. Se analizó la estancia prequirúrgica, posquirúrgica y total, la mortalidad intrahospitalaria, los reingresos y los pacientes no sometidos a cirugía (NSC). Las variables de control fueron la edad, el sexo, el tipo de ingreso (programado/urgente) y el diagnóstico principal. RESULTADOS: Estudiamos a 1.216 pacientes con una edad media de 53,2 años (599 en el grupo control y 617 en el de estudio). El 51,9% fueron mujeres; el 48,0%, ingresos urgentes y el11,7%, pacientes NSC. Los programados no presentaron diferencias entre ambos grupos en ninguna de las variables analizadas. En los urgentes la estancia total disminuyó el 18,2%, la posquirúrgica el 24,2% y los NSC el 40,2%. En los ingresos totales, la estancia total disminuyó el 14,0%, la posquirúrgica el 17,9% y la de los pacientes NSC un 37,0%. La distribución de reingresos fue similar. Se observó un descenso de los NSC así como una disminución del 50%de los fallecimientos del grupo con internistas. El ahorro conseguido fue de 329.170 € .CONCLUSIONES: La adscripción de internistas a tiempo completo a un servicio quirúrgico mejora claramente la calidad de la asistencia prestada, con un ahorro importante en los costes

BACKGROUND AND OBJECTIVE: Although surgical units commonly request the collaboration ofinternists via medical consultation, the efficiency of this system is low and expensive. We studied the effect of the integration of full-time internists in a surgical department. PATIENTS AND METHOD: The study group consisted of the patients admitted during intervention in the Orthopedic Surgery and Traumatology Department. Those patients admitted during the same period of the previous year made up the control group. We analyzed pre-surgical stay, post-surgical stay and total stay. We also studied in-hospital mortality, re-admissions and those patients who were not submitted to surgery (NSS). Control variables were age, sex, type of admission (programmed/emergency) and main diagnosis. RESULTS: 1,216 patients were included, 599 in the control group and 617 in the study group,48.0% were emergency admissions and 11.7% NSS patients. Study of programmed patients did not suggest any differences between both groups in any of the analyzed variables. In emergency patients, the total stay was decreased in 18.2%, and it was reduced in 40.2% of the NSS. The distribution of the readmissions was similar in both study and control groups. We observed a decrease in the NSS and a 50% decrease in the deaths of the study group. The obtained saving was 329 170 Euros. CONCLUSIONS: The adscription of full-time internists to a surgical service clearly improves the quality of the service it provides, with important hospital saving

[Treatment of empyema and complicated pleural effusion with intrapleural fibrinolysis]. / Tratamiento con fibrinolisis intrapleural del empiema y el derrame pleural complicado.

BACKGROUND AND OBJECTIVE: Intrapleural fibrinolysis (IPF) can avoid surgery in patients with loculated pleural effusions. Few clinical trials on IPF for the treatment of empyemas (PEM) and complicated pleural effusions (CPE) have been reported. We describe here our experience with IPF in the treatment of PEM/CPE patients. PATIENTS AND METHOD: 81 patients with PEM/CPE were included. Urokinase, 100000 U, was instilled into the pleural cavity, three times a day. A mean of 12.9 doses of urokinase were administered. RESULTS: The mean of days having a chest tube was 7.7 days and the mean hospital stay was 22.2 days. No radiological sequelae were observed or these were mild in 66 cases (81.5%). There were four deaths and three patients needed surgery. CONCLUSIONS: IPF is an efective and reliable method for the treatment of PEM/CPE.

Tratamiento con fibrinolisis intrapleuraldel empiema y el derrame pleural complicado / Treatment of empyema and complicated pleural effusion with intrapleural fibrinolysis

FUNDAMENTO Y OBJETIVO: La fibrinolisis intrapleural (FIP) puede evitar la cirugía en pacientes con derrames pleurales loculados. Son escasos los ensayos clínicos y las series publicadas sobre su utilización en empiemas y derrames pleurales complicados (DPC).Describimos nuestra experiencia con la FIP en el tratamiento de empiemas y DPC.PACIENTES Y MÉTODO: El estudio incluyó a 81 pacientes con empiema y DPC, a los que se administró 100.000 U de urocinasa intrapleural cada 8 h, con una media de 12,9 dosis por paciente. RESULTADOS: El drenaje torácico permaneció una media de 7,7 días y la estancia media hospitalaria fue de 22,2 días. No se observaron secuelas radiológicas o fueron leves en 66 casos (81,5 por ciento). Cuatro pacientes fallecieron y tres requirieron cirugía. CONCLUSIONES: La FIP es una modalidad terapéutica efectiva y segura en el tratamiento de los empiemas y DPC. (AU)