ABSTRACT
BACKGROUND: Little is known about the occurrence of subclinical new-onset atrial fibrillation (NOAF) after transcatheter aortic valve implantation (TAVI). AIMS: We aimed to evaluate the incidence, predictors, and clinical impact of subclinical NOAF after TAVI. METHODS: This was a multicentre study, including patients with aortic stenosis (AS) and no previous atrial fibrillation undergoing TAVI, with continuous ambulatory electrocardiogram (AECG) monitoring after TAVI. RESULTS: A total of 700 patients (79±8 years, 49% female, Society of Thoracic Surgeons score 2.9% [1.9-4.0]) undergoing transarterial TAVI were included (85% balloon-expandable valves). AECG was started 1 (0-1) day after TAVI (monitoring time: 14121314 days). NOAF was detected in 49 patients (7%), with a median duration of 185 (43-421) minutes (atrial fibrillation burden of 0.7% [0.3-2.8]). Anticoagulation was started in 25 NOAF patients (51%). No differences were found in baseline or procedural characteristics, except for a higher AS severity in the NOAF group (peak gradient: no NOAF: 71.9±23.5 mmHg vs NOAF: 85.2±23.8 mmHg; p=0.024; mean gradient: no NOAF: 44.4±14.7 mmHg vs NOAF: 53.8±16.8 mmHg; p=0.004). In the multivariable analysis, the baseline mean transaortic gradient was associated with a higher risk of NOAF after TAVI (odds ratio 1.04, 95% confidence interval: 1.01-1.06 for each mmHg; p=0.006). There were no differences between groups in all-cause mortality (no NOAF: 4.7% vs NOAF: 0%; p=0.122), stroke (no NOAF: 1.4% vs NOAF: 2.0%; p=0.723), or bleeding (no NOAF: 1.9% vs NOAF: 4.1%; p=0.288) from the 30-day to 1-year follow-up. CONCLUSIONS: NOAF detected with AECG occurred in 7% of TAVI recipients and was associated with a higher AS severity. NOAF detection determined the start of anticoagulation therapy in about half of the patients, and it was not associated with an increased risk of clinical events at 1-year follow-up.
Subject(s)
Aortic Valve Stenosis , Atrial Fibrillation , Electrocardiography, Ambulatory , Transcatheter Aortic Valve Replacement , Humans , Atrial Fibrillation/diagnosis , Atrial Fibrillation/physiopathology , Female , Male , Transcatheter Aortic Valve Replacement/adverse effects , Aged , Aortic Valve Stenosis/surgery , Aged, 80 and over , Electrocardiography, Ambulatory/methods , Risk Factors , Treatment OutcomeABSTRACT
A giant cell tumor of the tendon sheath (GCTTS) presents as a rare neoplasm demanding a heightened index of suspicion for precise diagnostic evaluation, especially when manifesting in the digital phalanges, as it is part of a group of neoplasms known as tenosynovial giant cell tumors (TCGTs). An accurate and timely diagnosis is crucial, as it significantly enhances treatment outcomes for this heterogeneous group of lesions. We describe the case of a male patient who presented with multiple nodules in the fourth finger of his left hand and was ultimately diagnosed with a localized form of a GCTTS, an unusual presentation for localized forms of this entity. Our objective is to outline the diagnostic and therapeutic approach, discussing options for differential diagnosis and treatment modalities. To achieve this, we conducted a literature review and compared our findings and the observed evolution in our patient. Early recognition of hand tumors allows for timely diagnosis, facilitating optimal resections during surgical procedures. This, in turn, reduces morbidity and enhances the functionality of the affected extremity, as detailed in the current case.
ABSTRACT
Resumen El divertículo de Meckel (DM) es el remanente del conducto onfalomesentérico y se considera la malformación congénita más común del tracto gastrointestinal. La mayoría de los pacientes son asintomáticos; sin embargo, aquellos en los que se desarrollan síntomas, estos pueden manifestarse como: dolor abdominal, hemorragia de tracto gastrointestinal, perforación u obstrucción intestinal. El objetivo de este reporte es presentar un caso de hernia interna secundaria a un divertículo de Meckel, siendo esta una causa poco frecuente de obstrucción intestinal.
Abstract Meckel's diverticulum is the remnant of the omphalomesenteric duct and is considered the most common congenital malformation of the gastrointestinal tract. Most patients are asymptomatic, however patients who develop symptoms can manifest: abdominal pain, gastrointestinal tract bleeding, intestinal perforation or obstruction. The objective of this report is to present a case of internal hernia secondary to a Meckel's diverticulum, a rare cause of bowel obstruction.
ABSTRACT
Resumen Presentar la experiencia en el diagnóstico clínico-radiológico y tratamiento de vólvulo sigmoideo. Se incluyeron casos con clínica sugestiva de obstrucción intestinal secundaria a vólvulo de sigmoides. Los factores de riesgo fueron: sexo masculino, mayor estancia hospitalaria, edad mayor a 70 años y la tríada clásica. Los estudios de imagen resultaron concluyentes, siendo la radiografía de abdomen y la tomografía simple de abdomen, los de elección para el abordaje diagnóstico. El vólvulo de sigmoides tiene un patrón clínico-radiológico predecible, un examen físico minucioso y estudios de gabinete de primera línea pueden ser concluyentes. La opción terapéutica para estos pacientes fue la cirugía.
Abstract To present the experience in clinical/radiological diagnosis and treatment of sigmoid volvulus. Cases with symptoms suggestive of intestinal obstruction secondary to sigmoid volvulus were included. The risk factors were: male sex, longer hospital stay, age over 70 years and the classic triad. Imaging studies were conclusive, with abdominal radiography and simple abdominal tomography being the tests of choice for the diagnostic approach. Sigmoid volvulus has a predictable clinical-radiological pattern, a thorough physical examination and first-line cabinet studies can be conclusive. The therapeutic option for these patients was surgery.
ABSTRACT
BACKGROUND: Leprosy is is still considered a public health issue and in Colombia 7-10% of new cases are found in children, indicating both active transmission and social inequality. We hypothesized that circulating antibodies against Natural Octyl Disaccharide-Leprosy IDRI Diagnostic (NDO-LID) (a combination of Mycobacterium leprae antigens) could reveal the social and environmental aspects associated with higher frequencies of M. leprae infection among children and adolescents in Colombia. METHODS: An observational cross-sectional study was conducted involving sampling from 82 children and adolescents (younger than 18 years of age) who had household contact with index leprosy patients diagnosed in the last 5 years. Data were analyzed through bivariate analysis made by applying a Pearson x2 test for qualitative variables, while quantitative variables, depending on their distribution, were analyzed using either a Student's t-test or Mann-Whitney U test. Multivariate analysis was performed using a multiple regression and binomial logistic approach. RESULTS: A bivariate analysis demonstrated that antibody titers against NDO-LID were significantly greater in children and adolescents with a low socioeconomic status that had: lived in vulnerable areas of the UAChR shared region; eaten armadillo meat; exposure of over 10 years to an index case and; not received BCG immunization. Moreover, a multivariate analysis showed that residing in the UAChR region has a strong association with a greater possibility of M. leprae infection. CONCLUSIONS: M. leprae transmission persists among young Colombians, and this is associated with social and environmental conditions. An intensification of efforts to identify new leprosy cases in vulnerable and forgotten populations where M. leprae transmission continues therefore appears necessary.
Subject(s)
Leprosy/diagnosis , Mycobacterium leprae/isolation & purification , Adolescent , Animals , Antibodies, Bacterial/blood , Armadillos , BCG Vaccine/immunology , Child , Child, Preschool , Colombia/epidemiology , Cross-Sectional Studies , Enzyme-Linked Immunosorbent Assay , Female , Humans , Infant , Leprosy/epidemiology , Leprosy/transmission , Logistic Models , Male , Meat/analysis , Meat/microbiology , Mycobacterium leprae/immunology , Social Class , Statistics, NonparametricABSTRACT
OBJECTIVE: To determine the microbiological and resistance profiles of community acquired and nosocomial intra abdominal infections (IAIs) at the Surgery Service of Emergency and surgery critical care units from the Hospital Nacional Guillermo Almenara Irigoyen. MATERIAL AND METHODS: From August 1st, 2013 till July 31st, 2014, patients undergoing surgery/interventional drainage for IAIs were included. RESULTS: The suitable cultures for the analysis were 169 (74 bile and 95 no bile cultures; 142 community acquired and 27 nosocomials). The microorganims more frequently isolated were E. coli (63.3%), K. pneumoniae (12%) and Enterococcus spp. (10%). The 43.5% of E. coli and the 21.23% of Klebsiella were ESBL producers. The carbapenems were the most active agents in vitro (100%), while the quinolones showed high resistance (>50%). CONCLUSIONS: E. coli was the most common microorganism in the IAIs. Because of the quinoloneâ™s high âÅin vitroâ resistance, they should not be recommended as initial empirical therapy.
Subject(s)
Anti-Bacterial Agents/pharmacology , Cross Infection/microbiology , Drug Resistance, Bacterial , Gram-Negative Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/microbiology , Intraabdominal Infections/microbiology , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Community-Acquired Infections/surgery , Cross Infection/diagnosis , Cross Infection/drug therapy , Cross Infection/surgery , Drainage , Female , Gram-Negative Bacteria/drug effects , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/surgery , Gram-Positive Bacteria/drug effects , Gram-Positive Bacteria/isolation & purification , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/surgery , Hospitals, Public , Humans , Intraabdominal Infections/diagnosis , Intraabdominal Infections/drug therapy , Intraabdominal Infections/surgery , Male , Microbial Sensitivity Tests , Middle Aged , Peru , Prospective Studies , Young AdultABSTRACT
Determinar el perfil microbiológico y de resistencia de las infecciones intra abdominales (IIA) adquiridas en la comunidad y nosocomiales en el Servicio de Cirugía de Emergencia y Cuidados Críticos Quirúrgicos del Hospital Nacional Guillermo Almenara Irigoyen. Material y métodos: Desde el 1 de agosto del 2013 al 31 de julio del 2014, se incluyeron a los pacientes con drenaje quirúrgico o intervencionista de las IIA. Resultados: Los cultivos aptos para el análisis fueron 169 (74 biliares y 95 no biliares; 142 de la comunidad y 27 nosocomiales). Los gérmenes más frecuentemente aislados fueron E. coli (63,3%), K. pneumoniae (12%) y Enterococcus spp. (10%). El 43,5% de E. coli y el 21,23% de Klebsiella fueron productoras de BLEE. Los carbapenems mostraron el 100% de suceptibilidad in vitro para las IIA mientras que las quinolonas mostraron una alta resistencia bacteriana (> del 50%). Conclusiones: El microorganismo de mayor prevalencia en las IIA fue la E.coli. Dada la alta resistencia in vitro de los microorganismos a las quinolonas, éstas no deberían recomendarse como tratamiento empírico inicial...
To determine the microbiological and resistance profiles of community acquired and nosocomial intra abdominal infections (IAIs) at the Surgery Service of Emergency and surgery critical care units from the Hospital Nacional Guillermo Almenara Irigoyen. Material and methods: From August 1st, 2013 till July 31st, 2014, patients undergoing surgery/interventional drainage for IAIs were included. Results: The suitable cultures for the analysis were 169 (74 bile and 95 no bile cultures; 142 community acquired and 27 nosocomials). The microorganims more frequently isolated were E. coli (63.3%), K. pneumoniae (12%) andEnterococcus spp. (10%). The 43.5% of E. coli and the 21.23% of Klebsiella were ESBL producers. The carbapenems were the most active agents in vitro (100%), while the quinolones showed high resistance (>50%). Conclusions: E. coli was the most common microorganism in the IAIs. Because of the quinoloneÆs high ôin vitroõ resistance, they should not be recommended as initial empirical therapy...
Subject(s)
Humans , Microbiological Techniques , Intraabdominal Infections , Cross Infection , Epidemiology, Descriptive , Observational Study , Prospective Studies , PeruABSTRACT
OBJECTIVE: In a series of patients with residual endocrine-inactive macroadenomas who underwent repeat surgery, we assess possible reasons for prior subtotal removal, reoperative success, complication rates, and patient impressions. METHODS: All patients were identified who had a prior subtotal removal of an endocrine-inactive macroadenoma and were reoperated on for residual sellar tumor via an endonasal approach. RESULTS: Over 6 years, of 188 consecutive patients with endocrine-inactive adenomas, 30 (16%) had repeat surgery (age, 15-77 yr; median interval between surgeries, 25 mo; median follow-up, 20 mo). Maximal tumor diameter averaged 2.4 +/- 0.9 cm. At reoperation, a suboptimal bony exposure was seen in all 30 patients: at the sphenoid keel, the sella, or both in 97, 93, and 90% of patients, respectively. Cavernous sinus invasion was seen in 16 (53%) patients and a fibrous/rubbery consistency in 12 (40%). Gross total tumor removal was achieved in 17 (57%) patients, including 12 of 14 (86%) with noninvasive tumors and 5 of 16 (31%) with invasive tumors, (P < 0.01). All six fibrous/rubbery but noninvasive tumors were totally removed. Of 16 patients with preoperative visual loss, 15 (94%) improved. Complications included one each of cerebrospinal fluid leak, delayed sinusitis, and new hypothyroidism. In 17 patients with prior sublabial surgery who completed questionnaires, the second (endonasal) surgery was associated with an easier recovery, less pain, and better nasal airflow in 82, 88, and 93%, respectively (P < 0.0001). CONCLUSION: In patients with residual sellar endocrine-inactive adenomas, a suboptimal opening at the sphenoid keel or sella at the first surgery and a high proportion of fibrous/rubbery tumors likely contributed to prior subtotal removal of otherwise accessible tumor. With a wider exposure, most noninvasive tumors can be totally removed, whereas invasive tumors can be effectively debulked. An endonasal reoperation is well tolerated with a low complication rate.