ABSTRACT
OBJECTIVE: The differentiation between delayed aseptic and septic complications of total hip arthroplasty is crucial to allow appropriate surgical planning and timely antimicrobial treatment. The aim of this study was to investigate the utility of multidetector computed tomography (CT) findings to diagnose aseptic mechanical loosening, granulomatous reaction, and periprosthetic joint infection in patients who underwent total hip arthroplasty before revision surgery. MATERIALS AND METHODS: Ninety-six consecutive patients with a clinical suspicion of periprosthetic complications underwent revision surgery over an 8-year period. All patients had been evaluated preoperatively using multidetector CT without contrast media. Two blinded musculoskeletal radiologists reviewed multidetector CT images, including periprosthetic soft-tissue accumulation, prosthetic acetabular malposition, periprosthetic osteolysis, enlarged iliac lymph nodes, and heterotopic ossification. Risk factors for aseptic and septic loosening were identified using multivariate analysis. RESULTS: Multidetector CT-related variables independently associated with periprosthetic joint infection were high periprosthetic soft-tissue accumulation, periprosthetic osteolysis without expansile periosteal reaction and enlarged iliac lymph nodes. On the other hand, the absence of the following radiological signs: low or high periprosthetic soft-tissue accumulation, mild or severe periprosthetic osteolysis, and enlarged iliac lymph nodes, were predictors of aseptic mechanical loosening. Low periprosthetic soft-tissue accumulation, severe periprosthetic osteolysis with expansile periosteal reaction, and mild acetabular malposition were significant variables associated with granulomatosis. CONCLUSION: Multidetector CT findings are useful to differentiate between aseptic and septic complications before revision surgery. The presence of osteolysis with expansile periosteal reaction appeared to be a time-dependent variable.
Subject(s)
Arthritis, Infectious/diagnostic imaging , Arthroplasty, Replacement, Hip , Multidetector Computed Tomography/methods , Prosthesis Failure , Prosthesis-Related Infections/diagnostic imaging , Adult , Aged , Aged, 80 and over , Arthritis, Infectious/microbiology , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Pain Measurement , Prosthesis-Related Infections/microbiology , Reoperation , Retrospective Studies , Risk FactorsABSTRACT
OBJECTIVES: To evaluate the current clinical practice for patients with Prostate Cancer (CP) in the Health Areas of Castilla y León (CyL) in 2014. METHODS: A retrospective multicenter study was designed to provide data on the diagnosis and treatment of PC in CyL: 87.8% of patients were screened. Descriptive statistics on variables related to characteristics of the patient, the tumor and the treatment modality of the first line to which it was submitted are provided. RESULTS: A total of 1156 new cases of PC were analyzed with a mean age of 68.2 years and a mean PSA of 8.40 ng/ml. The Gleason score (GS) showed 538 (46.2%), 418 (35.9 %) and 200 (17.1%) patients for GS ≤ 6, 7 and ≥ 8 respectively. 91% of patients (1053 patients) are diagnosed at a localized stage. 56 (4.8%) patients received treatment with active surveillance/ watchful waiting, 423 (36.6%) radical prostatectomy (PR), 348 (30.1%) radiotherapy (RT), 98 (8.4%) brachytherapy (BT) and 170 (14.7%) hormone therapy (HT) respectively. CONCLUSIONS: Differed strategies still accounted for a small percentage of treatments. PR and RT/BT were of choice in patients with localized stages of the disease and younger than 70 years. More advanced stages and older patients were treated with HT mainly. Age is postulated as the main factor involved in therapeutic decision making.
OBJETIVO: Conocer la práctica clínica real en pacientes con Cáncer de Próstata (CP) en las Áreas Sanitarias de Castilla y León (CyL) en el año 2014. MATERIAL Y MÉTODOS: Se diseña un estudio multicéntrico con carácter retrospectivo para disponer de datos sobre el diagnóstico y tratamiento del CP en CyL: se logra una cobertura del 87,8% de los pacientes comunitarios. Se aporta estadística descriptiva sobre las variables referentes a características del paciente, del tumor y de la modalidad de tratamiento de primera línea a la que fue sometido. RESULTADOS: Se analizan 1.156 nuevos casos de CP con una edad media de 68,2 años y una mediana de PSA de 8,4 ng/ml. La puntuación de Gleason (PG) muestra 538 (46,2%), 418 (35,9%) y 200 (17,1%) pacientes para PG ≤ 6, 7 y ≥ 8 respectivamente. El 91,0% de los pacientes (1.053 pacientes) son diagnosticados en estadio localizado. 56 pacientes (4,8%) son tratados con estrategias diferidas (EDs), vigilancia activa/ observación, 423 (36,6%) con prostatectomia radical (PR), 348 (30,1%) con radioterapia, 98 (8,4%) con braquiterapia (BT) y 170 (14,7%) con hormonoterapia (HT). CONCLUSIONES: Las EDs aún supusieron un porcentaje pequeño de los tratamientos. PR y RT/BT fueron de elección en pacientes con estadios localizados de la enfermedad y menores de 70 años. Estadios más avanzados y pacientes mayores fueron tratados con HT principalmente. La edad se postula como el principal factor implicado en la toma de decisiones terapéuticas.
Subject(s)
Prostate-Specific Antigen , Prostatic Neoplasms , Aged , Humans , Male , Neoplasm Grading , Prostatectomy , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/surgery , Retrospective StudiesABSTRACT
Objetivo: Conocer la práctica clínica real en pacientes con Cáncer de Próstata (CP) en las Áreas Sanitarias de Castilla y León (CyL) en el año 2014. Material y métodos: Se diseña un estudio multicéntrico con carácter retrospectivo para disponer de datos sobre el diagnóstico y tratamiento del CP en CyL: se logra una cobertura del 87,8% de los pacientes comunitarios. Se aporta estadística descriptiva sobre las variables referentes a características del paciente, del tumor y de la modalidad de tratamiento de primera línea a la que fue sometido. Resultados: Se analizan 1.156 nuevos casos de CP con una edad media de 68,2 años y una mediana de PSA de 8,4 ng/ml. La puntuación de Gleason (PG) muestra 538 (46,2%), 418 (35,9%) y 200 (17,1%) pacientes para PG ≤ 6, 7 y ≥ 8 respectivamente. El 91,0% de los pacientes (1.053 pacientes) son diagnosticados en estadio localizado. 56 pacientes (4,8%) son tratados con estrategias diferidas (EDs), vigilancia activa/ observación, 423 (36,6%) con prostatectomia radical (PR), 348 (30,1%) con radioterapia, 98 (8,4%) con braquiterapia (BT) y 170 (14,7%) con hormonoterapia (HT). Conclusiones: Las EDs aún supusieron un porcentaje pequeño de los tratamientos. PR y RT/BT fueron de elección en pacientes con estadios localizados de la enfermedad y menores de 70 años. Estadios más avanzados y pacientes mayores fueron tratados con HT principalmente. La edad se postula como el principal factor implicado en la toma de decisiones terapéuticas
Objectives: To evaluate the current clinical practice for patients with Prostate Cancer (CP) in the Health Areas of Castilla y León (CyL) in 2014. Methods: A retrospective multicenter study was designed to provide data on the diagnosis and treatment of PC in CyL: 87.8% of patients were screened. Descriptive statistics on variables related to characteristics of the patient, the tumor and the treatment modality of the first line to which it was submitted are provided. Results: A total of 1156 new cases of PC were analyzed with a mean age of 68.2 years and a mean PSA of 8.40 ng/ml. The Gleason score (GS) showed 538 (46.2%), 418 (35.9 %) and 200 (17.1%) patients for GS ≤6, 7 and ≥8 respectively. 91% of patients (1053 patients) are diagnosed at a localized stage. 56 (4.8%) patients received treatment with active surveillance/ watchful waiting, 423 (36.6%) radical prostatectomy (PR), 348 (30.1%) radiotherapy (RT), 98 (8.4%) brachytherapy (BT) and 170 (14.7%) hormone therapy (HT) respectively. Conclusions: Differed strategies still accounted for a small percentage of treatments. PR and RT/BT were of choice in patients with localized stages of the disease and younger than 70 years. More advanced stages and older patients were treated with HT mainly. Age is postulated as the main factor involved in therapeutic decision making
Subject(s)
Humans , Male , Aged , Prostate-Specific Antigen , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/surgery , Neoplasm Grading , Prostatectomy , Retrospective StudiesABSTRACT
BACKGROUND: Failure after a 2-stage exchange surgery for periprosthetic joint infection (PJI) is high. Previous studies demonstrated that positive cultures at reimplantation are associated with failure afterward. The aim of this multicenter study was to define the role of antibiotics in the cement spacer in relation to reimplantation cultures and subsequent failure. METHODS: We retrospectively evaluated 2-stage exchange procedures between 2000 and 2015. Culture-negative PJIs, cases in which no cultures were obtained during reimplantation, and cases without data on cement spacers were excluded. RESULTS: Three hundred forty-four cases were included. The rate of positive cultures during reimplantation was 9.5% for cement spacers containing a glycopeptide (27/284) (with or without an aminoglycoside) vs 21.7% for those containing monotherapy with an aminoglycoside (13/60) (P = .008), and was mostly attributed by a reduction in coagulase-negative staphylococci (CoNS) (17% vs 2%, P < .001). The failure rate was >2-fold higher at 40.0% (16/40) in cases with positive cultures at reimplantation compared to 15.8% (48/304) for those with negative cultures (P < .001). Overall, a glycopeptide in the cement spacer was not associated with a lower failure rate (18% vs 23%, P = .3), but was associated with lower failure due to CoNS (2.5% vs 13.3%, P < .001). CONCLUSIONS: In a 2-stage exchange procedure for PJI, adding a glycopeptide to the cement spacer reduces the rate of positive cultures during reimplantation and is associated with a lower failure rate due to CoNS afterward.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Prosthesis-Related Infections/etiology , Prosthesis-Related Infections/therapy , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/methods , Arthroplasty, Replacement, Knee/methods , Female , Humans , Male , Prosthesis-Related Infections/diagnosis , Retrospective Studies , Treatment Failure , Treatment OutcomeABSTRACT
This article reports the case of a patient with chronic disseminated intravascular coagulation that led to the diagnosis of an otherwise asymptomatic aorto-bifemoral aneurysm. The bleeding disorder completely resolved with the surgical resection of the aneurysm. Fibrinogen replacement therapy prior to invasive diagnostic procedures resulted in good hemosthasia.
ABSTRACT
Se estudia la correlación de la contaminación del agua, aire y suelo en las zonas rurales y su relación con algunas enfermedades. Se establecen pautas y recomendaciones para el consumo y abastecimiento del agua y para la eliminación de excretas
Subject(s)
Rural Sanitation , Waterborne Diseases , Parasitic Diseases , Insect Control , Water Supply, Rural , Water Quality , Excreta DisposalABSTRACT
Se estudia la correlación de la contaminación del agua, aire y suelo en las zonas rurales y su relación con algunas enfermedades. Se establecen pautas y recomendaciones para el consumo y abastecimiento del agua y para la eliminación de excretas
Subject(s)
Water Supply, Rural , Insect Control , Parasitic Diseases , Waterborne Diseases , Excreta Disposal , Water Quality , Rural SanitationABSTRACT
Obra de divulgación que describen las diversas enfermedades que pueden presentarse en el medio rural. Analiza su relación con la contaminación de aire, agua y suelos, y la presencia de distintos vectores. Finalmente realiza recomendaciones sobre el abastecimiento de agua potable y la eliminación de excretas en el medio rural
Subject(s)
Water Supply, Rural , Waterborne Diseases , Excreta Disposal , Rural Sanitation , Disease VectorsABSTRACT
Obra de divulgación que describen las diversas enfermedades que pueden presentarse en el medio rural. Analiza su relación con la contaminación de aire, agua y suelos, y la presencia de distintos vectores. Finalmente realiza recomendaciones sobre el abastecimiento de agua potable y la eliminación de excretas en el medio rural
Subject(s)
Rural Sanitation , Waterborne Diseases , Disease Vectors , Water Supply, Rural , Excreta DisposalABSTRACT
Los autores exponen en este trabajo los requisitos o fundamentos que deben cumplirse en el saneamiento rural en cuanto al abastecimiento de agua potable, eliminación de excretas y todas las enfermedades consideradas de origen hídrico en el medio estudiado
Subject(s)
Rural Sanitation , Drinking Water , Water Supply , Feces , Excreta Disposal , Waterborne Diseases , Brucellosis , Chagas Disease , Parasitic DiseasesABSTRACT
Los autores exponen en este trabajo los requisitos o fundamentos que deben cumplirse en el saneamiento rural en cuanto al abastecimiento de agua potable, eliminación de excretas y todas las enfermedades consideradas de origen hídrico en el medio estudiado
