ABSTRACT
Objetivo. Analizar las características de los pacientes hospitalizados con fractura de cadera y su evolución clínica, así como evaluar qué factores se asocian a un mayor riesgo de complicaciones médicas durante el ingreso. Métodos. Estudio prospectivo de los enfermos mayores de 65 años ingresados con fractura de cadera en el Servicio de Traumatología del Complexo Hospitalario Xeral-Calde de Lugo durante el año 2008. Se recogieron diferentes datos clínicos analíticos relativos al estado basal de salud, las características de la fractura y las complicaciones hospitalarias. Se determinaron los factores asociados al desarrollo de la variable compuesta por aparición de complicaciones médicas mayores o fallecimiento durante el ingreso hospitalario, mediante análisis univariable y multivariable. Resultados. Se estudió a 258 pacientes, media (DE) de edad 82,2 (9,5) años, el 76% mujeres. La fractura fue osteoporótica en el 96,8% y fueron operados el 92,6% de los enfermos. El índice de Barthel medio fue 72,9 (25,7) y el de comorbilidad de Charlson medio ajustado por edad 5,2 (1,5). El 63,9% presentó alguna complicación médica mayor durante el ingreso hospitalario. Fallecieron 15 enfermos (5,8%). Las siguientes variables se asociaron al riesgo de aparición de complicaciones médicas: índice de Barthel (OR=2,21; IC del 95%, 1,1-4,25; p=0,01), edad (OR=1,09; IC del 95%, 1,02-1,12; p=0,006), hemoglobina al ingreso (OR=0,76; IC del 95%, 0,62-0,93; p=0,01). Conclusiones. Los enfermos con fractura de cadera son ancianos frágiles, con un importante grado de dependencia y comorbilidad. Es posible identificar al ingreso a aquellos con un mayor riesgo de presentar complicaciones médicas durante su estancia hospitalaria(AU)
Objective. To evaluate the clinical features and outcome of inpatients with hip fracture and to investigate the clinical variables associated with the risk of medical complications. Methods. Prospective study of hip fracture patients aged 65 or more, admitted to the Department of Orthopaedic Surgery of the Xeral-Calde Hospital, in Lugo, Spain, in 2008. The different clinical and biochemical variables as regards the baseline health status and presentation features of the hip fracture and its complications were all recorded. The factors associated with the development of medical inpatient complications, including death, were determined, using univariate and multivariate analyses. Results. A total of 258 patients were studied. The mean age was 82.2 (9.5) years, and 76% were women. The fracture was osteoporotic in 96.8%, and 92.6% were treated surgically. The mean Barthel index was 72.9 (25.7) and the age adjusted Charlson comorbidity index was 5.2 (1.5). A total of 63.9% patients had a major medical complication during their hospital stay. Mortality was 5.8%. The following variables were associated with the development of medical inpatient complications: Barthel index (OR=2.21; 95% CI, 1.1-4.25; p=0,01), age (OR=1.09; 95% CI, 1.02-1.12; p=0.006), haemoglobin at admission (OR=0.76; 95% CI, 0.62-0.93; p=0.01). Conclusions. Patients with hip fracture are fragile elderly with a high degree of functional dependence and comorbidity. Those with a high risk of developing medical inpatient complications can be identified at admission(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Risk Factors , Hip Fractures/complications , Internal Medicine/methods , /trends , Comorbidity , Internal Medicine/organization & administration , Internal Medicine/trends , Hospitalization/trends , Prospective Studies , Hospital Mortality/trends , 28599 , Multivariate AnalysisABSTRACT
OBJECTIVE: To evaluate the clinical features and outcome of inpatients with hip fracture and to investigate the clinical variables associated with the risk of medical complications. METHODS: Prospective study of hip fracture patients aged 65 or more, admitted to the Department of Orthopaedic Surgery of the Xeral-Calde Hospital, in Lugo, Spain, in 2008. The different clinical and biochemical variables as regards the baseline health status and presentation features of the hip fracture and its complications were all recorded. The factors associated with the development of medical inpatient complications, including death, were determined, using univariate and multivariate analyses. RESULTS: A total of 258 patients were studied. The mean age was 82.2 (9.5) years, and 76% were women. The fracture was osteoporotic in 96.8%, and 92.6% were treated surgically. The mean Barthel index was 72.9 (25.7) and the age adjusted Charlson comorbidity index was 5.2 (1.5). A total of 63.9% patients had a major medical complication during their hospital stay. Mortality was 5.8%. The following variables were associated with the development of medical inpatient complications: Barthel index (OR=2.21; 95% CI, 1.1-4.25; p=0,01), age (OR=1.09; 95% CI, 1.02-1.12; p=0.006), haemoglobin at admission (OR=0.76; 95% CI, 0.62-0.93; p=0.01). CONCLUSIONS: Patients with hip fracture are fragile elderly with a high degree of functional dependence and comorbidity. Those with a high risk of developing medical inpatient complications can be identified at admission.
Subject(s)
Hip Fractures/complications , Adrenal Cortex Hormones/adverse effects , Aged , Aged, 80 and over , Anemia/epidemiology , Bone Neoplasms/complications , Bone Neoplasms/epidemiology , Bone Neoplasms/secondary , Cardiovascular Diseases/epidemiology , Cognition Disorders/epidemiology , Comorbidity , Confusion/epidemiology , Confusion/etiology , Female , Fractures, Spontaneous/epidemiology , Fractures, Spontaneous/etiology , Hip Fractures/epidemiology , Hip Fractures/surgery , Humans , Independent Living , Infections/epidemiology , Inpatients , Male , Osteoporosis/epidemiology , Postoperative Complications/epidemiology , Prospective Studies , Risk Factors , Spain/epidemiologyABSTRACT
Pacemaker endocarditis (PME) is a rare but severe complication of endocardial pacemaker implantation. Fungal PME is extremely uncommon. The case of a 66-year-old female patient who was diagnosed as having a pulmonary embolus based upon the patient's clinical presentation and computed tomography angiography findings is presented. Transthoracic echocardiography demonstrated a huge vegetation attached to the pacemaker wire. The pacemaker system was removed surgically during cardiovascular bypass. The vegetation was cultured, the results of which were positive for Aspergillus spp. No risk factors for Aspergillus infection were found in the patient. She was treated with liposomal amphotericin B for 3 weeks, followed by itraconazole for 40 weeks. At 1 year later, the patient remains asymptomatic.
Subject(s)
Aspergillosis/complications , Aspergillus/isolation & purification , Endocarditis/complications , Pacemaker, Artificial/adverse effects , Prosthesis-Related Infections/complications , Pulmonary Embolism/etiology , Aged , Aspergillosis/diagnosis , Aspergillosis/microbiology , Diagnosis, Differential , Echocardiography, Transesophageal , Endocarditis/diagnosis , Endocarditis/microbiology , Female , Follow-Up Studies , Humans , Pacemaker, Artificial/microbiology , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/microbiology , Pulmonary Embolism/diagnosis , Tomography, X-Ray ComputedABSTRACT
La piomiositis es una infección bacteriana espontánea de los músculos esqueléticos, que no es secundaria a una infección de tejidos contíguos (piel, huesos, etc.). Existen diversos factores predisponentes para la misma, que incluyen la diabetes mellitus, neoplasias, conectivopatías, infección por virus de la inmunodeficiencia humana, o cirugía/traumatismos previos. En un tercio de los casos no existe un factor predisponente. Dada su relativa poca frecuencia, su diagnóstico puede retrasarse si no existe un alto grado de sospecha clínica. Se presenta un caso de piomiositis de músculo pectoral mayor (AU)
Pyomyositis is a spontaneous bacterial infection of the skeletal muscles which is not secondary to infection of adjoining tissues (skin, bone, etc.) there are a number of predisposing factors including diabetes mellitus, neoplasms, connective tissue diseases, human immunodeficiency virus (HIV) infection or previous surgery/trauma. In one-third of the cases no predisposing factor is discerned. Because of its relatively low frequency, the diagnosis may be delated if there is not a high degree of clinical suspicion. We report one case of M. pectoralis major pyomyositis (AU)
Subject(s)
Male , Adult , Humans , Bacterial Infections/complications , Bacterial Infections/pathology , Staphylococcus aureus/physiology , Musculoskeletal Diseases/complications , Musculoskeletal Diseases/pathology , Bacterial Infections/etiology , Drug Resistance, Microbial/physiology , Musculoskeletal Diseases/etiology , Musculoskeletal Diseases , Risk FactorsABSTRACT
We present a case of a pneumoscrotum and pneumopenis which appeared after a trocar drainage placement for treatment of a recidivated expontaneous pneumothorax. In spite of is an entity with easy diagnosis and conservative management, maybe be confused with other more aggressive entities which treatment should be invasive.
Subject(s)
Drainage/adverse effects , Penile Diseases/etiology , Scrotum , Subcutaneous Emphysema/etiology , Aged , Genital Diseases, Male/etiology , Humans , Male , Pneumothorax/therapyABSTRACT
Presentamos un caso excepcional de presentación de un neumoescroto y neumopene que apareció tras la colocación de un tubo de tórax para el drenaje de un neumotórax espontáneo recidivado. A pesar de tratarse de una entidad de fácil diagnóstico y tratamiento conservador, puede confundirse con otros cuadros más graves y cuyo tratamiento es mas invasivo
We present a case of a pneumoscrotum and pneumopenis which appeared after a trocar drainage placement for treatment of a recidivated expontaneous pneumothorax. In spite of is an entity with easy diagnosis and conservative management, maybe be confused with other more agresive entities which treatment should be invasive
Subject(s)
Male , Middle Aged , Humans , Subcutaneous Emphysema/complications , Subcutaneous Emphysema/diagnosis , Subcutaneous Emphysema/therapy , Pneumothorax/complications , Pneumothorax/diagnosis , Pneumothorax/therapy , Drainage/methods , Tomography, Emission-Computed/methods , Radiography, Thoracic/methods , Radiography, Thoracic/trends , Radiography, Thoracic , Scrotum/pathology , ScrotumSubject(s)
Cough/diagnosis , Endocarditis, Subacute Bacterial/diagnosis , Streptococcal Infections/diagnosis , Streptococcus bovis/isolation & purification , Anti-Bacterial Agents/therapeutic use , Aortic Valve/diagnostic imaging , Aortic Valve/microbiology , Aortic Valve/pathology , Ceftriaxone/therapeutic use , Chronic Disease , Cough/drug therapy , Diagnosis, Differential , Echocardiography, Transesophageal , Endocarditis, Subacute Bacterial/drug therapy , Humans , Male , Middle Aged , Streptococcal Infections/drug therapy , Streptococcus bovis/drug effects , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Middle Aged , Male , Humans , Streptococcus bovis , Endocarditis, Subacute Bacterial , Treatment Outcome , Streptococcal Infections , Diagnosis, Differential , Cough , Chronic Disease , Ceftriaxone , Aortic Valve , Anti-Bacterial Agents , Echocardiography, TransesophagealABSTRACT
El tromboembolismo pulmonar (TEP) es una patología muy frecuente, considerándose la causa prevenible más frecuente de muerte hospitalaria. Las estrategias diagnósticas tradicionales incluyen en la mayoría de las ocasiones una gammagrafía pulmonar de ventilación/perfusión (V/Q), combinada en general con distintas pruebas diagnósticas no invasivas, como realización de eco-doppler de extremidades inferiores, determinación de dímero D, etc. La tomografía computarizada (TC) torácica está cada vez más implantada en el diagnóstico de esta enfermedad. Los trabajos publicados muestran que la TC es una técnica útil, presentando un porcentaje de exploraciones inconcluyentes mucho menor que la gammagrafía de V/Q, y una concordancia interobservador más alta. La principal crítica que recibe es una sensibilidad relativamente baja para detectar el TEP exclusivamente subsegmentario. Sin embargo, se han presentado ya varios trabajos que evalúan la evolución de los pacientes a los que se retira (o no se inicia) la anticoagulación en base a una TC negativa, y los resultados demuestran que esta exploración tiene un elevado valor predictivo negativo, que la hace equivalente a otras estrategias diagnósticas aceptadas en la enfermedad. Como valor adicional, la TC puede ofrecer información útil para el diagnóstico en pacientes en que se sospecha un TEP, pero que tienen otra enfermedad. Este trabajo revisa la literatura sobre el tema, con el fin de ofrecer una perspectiva sobre la utilidad de la TC en la valoración del paciente con sospecha de TEP (AU)
Subject(s)
Humans , Pulmonary Embolism/diagnosis , Tomography, X-Ray Computed/methods , Ventilation-Perfusion Ratio/physiology , Angiography/methods , Radiography, Thoracic/methods , Pulmonary Embolism , Sensitivity and Specificity , Predictive Value of TestsSubject(s)
Bronchoscopy/adverse effects , Pulse , Adult , Aged , Aged, 80 and over , Anesthesia, Local , Electrocardiography , Female , Heart Rate , Humans , Lidocaine , Male , Middle Aged , Oxygen/therapeutic use , Retrospective Studies , Sensitivity and Specificity , Spirometry , Tachycardia/etiologyABSTRACT
No disponible
Subject(s)
Middle Aged , Aged , Aged, 80 and over , Adult , Male , Female , Humans , Pulse , Spirometry , Sensitivity and Specificity , Tachycardia , Giant Cell Arteritis , Temporal Arteries , Prednisone , Oxygen , Retrospective Studies , Biopsy , Anti-Inflammatory Agents , Bronchoscopy , Cough , Anesthesia, Local , Lidocaine , Electrocardiography , Heart Rate , FeverABSTRACT
No disponible
Subject(s)
Aged , Female , Humans , Tobacco Use Disorder , Paracentesis , Punctures , Pulmonary Disease, Chronic Obstructive , Asthma , Mediastinal Emphysema , Forced Expiratory VolumeABSTRACT
OBJECTIVE: To report a case of pulmonary embolism secondary to chronic over-distended bladder, responsible for iliac vein obstruction. CLINICAL CASE: A 73-year-old patient presented with sudden onset of pulmonary embolism, confirmed by isotope lung scan, after drainage of 2,300 cc of urine from an over-distended bladder, responsible for bilateral iliac vein obstruction and a bilateral obstructive uropathy. The patient had a favourable course after anticoagulation with heparin and temporary bladder catheterization, leading to resolution of the peripheral oedema and obstructive uropathy. CONCLUSION: About thirty cases of obstruction of large pelvic vessels due to over-distended bladder have been reported to date. However, and after an extensive review of the literature, this case appears to be the first report of pulmonary embolism secondary to chronic over-distended bladder.
Subject(s)
Pulmonary Embolism/etiology , Urinary Retention/complications , Aged , Chronic Disease , Humans , MaleABSTRACT
No disponible
Subject(s)
Aged , Male , Humans , Respiration, Artificial/adverse effects , Hypercapnia/etiology , Lung Diseases, Obstructive/therapy , Carbon DioxideABSTRACT
OBJECTIVE: To assess inhalation technique in out-patient attending a respiratory ward who were using inhaler devices, and to identify factors associated with misuse of these therapies. METHOD: One hundred and seven patients were prospectively studied, of whom 100 completed the study; Inhalation technique was evaluated using a previously elaborated check list. We searched for significant differences between individuals with good or bad inhalation technique. RESULTS: Mean age: 68 +/- 11 years. 68 males and 32 females. Only 31% of cases were observed to make no inhalation errors when first evaluated. Individuals using metered-dose inhalers without spacer chamber made significantly more mistakes than patients using other devices. The main factor associated with poor inhalation technique was found to be the absence of adequate supervised instruction when the treatment was first prescribed. General practitioners were less likely to offer this instruction than other specialists. We did not find significant associations between inhaler misuse and patients' age, sex or the setting (hospital or ambulatory ward) where the treatment was first prescribed. CONCLUSIONS: Incorrect use of inhalers is a frequent finding, and an adequate instruction seems to associate with improvement of patients' skills with use of these devices. Health personnel should be aware that inhalation technique instruction is essential ingredient of patients' management.
