Anterior elbow dislocation with potential compartment syndrome: a case report.

Anterior elbow dislocation is an infrequent lesion, usually produced by direct trauma to the proximal ulna after a fall on the elbow in flexion, and is often associated with soft tissue injuries. The authors report a case of a complex injury produced by a high-energy trauma in the right arm of a 65-year-old patient. His limb was trapped inside an industrial spin-dryer, resulting in a closed anterior elbow dislocation, diaphyseal ulnar shaft, radial styloid process fractures, and an associated compartment syndrome. The injury mechanism and its treatment are described to better manage the soft tissue injury and early elbow mobilization using the FEARM hinged external fixator. A good result was achieved, with almost complete restoration of the patient's arm functions, and he has returned to his previous working activities.

[Risk factors in bronchogenic carcinoma surgery]. / Parámetros de riesgo en la cirugía del carcinoma broncogénico.

OBJECTIVE: To analyze the factors that determine the risk of morbidity and mortality associated with lung resection in patients with bronchogenic carcinoma. PATIENTS AND METHODS: Prospective multicenter study conducted between October 1, 1993 and September 30, 1997 in the 19 hospitals that make up the Bronchogenic Carcinoma Cooperative Group. During the study period, 2994 patients with bronchogenic carcinoma underwent surgery. The morbidity and mortality data at 30 days from all centers were recorded in a single registry. RESULTS: Major resection was performed in 2491 patients, whereas 212 underwent minor resection. The resection had to be extended in 296 and exploratory thoracotomy was carried out in 291. Postoperative complications were reported in 1057 patients (35.2%). Complications directly related to surgery were the most common (22.9%), followed by respiratory (19.5%) and cardiovascular (10.7%) complications. Of the patients with complications, 654 patients (21.8%) had only 1, whereas 403 (13.4%) had more than 1. After classification of complications, 21% were found to be minor and 14.2% were major. Mortality at 30 days was 6.8% (204 patients), and strongly linked to the presentation of major complications--40.8% of those with such complications died. CONCLUSIONS: Surgical treatment of bronchogenic carcinoma in Spain is associated with high morbidity and mortality. The morbidity reported in the present study lies in the middle of the ranges found in the literature, whereas mortality lies at the high end of the range. The presence of major complications and/or multiple complications should be considered as strong risk factors.

Parámetros de riesgo en la cirugía del carcinoma broncogénico / Risk factors in bronchogenic carcinoma surgery

Objetivo: Analizar la morbilidad y mortalidad asociadas a la cirugía de exéresis pulmonar por carcinoma broncogénico, como parámetros definitorios del riesgo inherente a este tratamiento. Pacientes y métodos: Estudio prospectivo y multicéntrico, realizado en los 19 hospitales integrantes del Grupo Cooperativo de Carcinoma Broncogénico entre el 1 de octubre de 1993 y el 30 de septiembre de 1997. En este tiempo fueron sometidos a toracotomía 2.994 pacientes con carcinoma broncogénico. La morbilidad y mortalidad a los 30 días se recogieron mediante un registro de datos unificado para todos los hospitales. Resultados: Se practicaron 2.491 exéresis mayores y 212 menores. Se precisó resección extendida en 296 pacientes, mientras que en 291 se efectuó toracotomía exploradora. En 1.057 pacientes (35,2%) se objetivaron complicaciones postoperatorias, de las que las más frecuentes fueron las relacionadas directamente con la intervención quirúrgica (22,9%), seguidas por las respiratorias (19,5%) y las cardiovasculares (10,7%). En 654 casos (21,8%) las complicaciones fueron de carácter único, mientras que 403 (13,4%) presentaron más de una. Atendiendo a su categoría, el 21% de las complicaciones fueron menores, en tanto que las complicaciones mayores sucedieron en el 14,2% de los casos. El análisis de la mortalidad en los 30 primeros días mostró una incidencia del 6,8% (204 pacientes), y estuvo notablemente vinculada con la aparición de complicaciones mayores (40,8%). Conclusiones: En nuestro medio el tratamiento quirúrgico del carcinoma broncogénico genera una morbilidad y una mortalidad elevadas, en el rango de las habitualmente referidas en relación con la morbilidad y en el límite alto cuando se considera la mortalidad. La presencia de complicaciones mayores y/o su multiplicidad deben considerarse elementos sustancialmente moduladores del incremento del riesgo

Objective: To analyze the factors that determine the risk of morbidity and mortality associated with lung resection in patients with bronchogenic carcinoma. Patients and methods: Prospective multicenter study conducted between October 1, 1993 and September 30, 1997 in the 19 hospitals that make up the Bronchogenic Carcinoma Cooperative Group. During the study period, 2994 patients with bronchogenic carcinoma underwent surgery. The morbidity and mortality data at 30 days from all centers were recorded in a single registry. Results: Major resection was performed in 2491 patients, whereas 212 underwent minor resection. The resection had to be extended in 296 and exploratory thoracotomy was carried out in 291. Postoperative complications were reported in 1057 patients (35.2%). Complications irectly related to surgery were the most common (22.9%), followed by respiratory (19.5%) and cardiovascular (10.7%) complications. Of the patients with complications, 654 patients (21.8%) had only 1, whereas 403 (13.4%) had more than 1. After classification of complications, 21% were found to be minor and 14.2% were major. Mortality at 30 days was 6.8% (204 patients), and strongly linked to the presentation of major complications--40.8% of those with such complications died. Conclusions: Surgical treatment of bronchogenic carcinoma in Spain is associated with high morbidity and mortality. The morbidity reported in the present study lies in the middle of the ranges found in the literature, whereas mortality lies at the high end of the range. The presence of major complications and/or multiple complications should be considered as strong risk factors

Cervical spondylotic myelopathy due to chronic compression: the role of signal intensity changes in magnetic resonance images.

OBJECT: Although there is agreement that low-intensity signal changes on T1-weighted magnetic resonance (MR) images are a prognostic factor for poor outcome after surgical treatment of cervical myelopathy due to chronic cord compression, the role of high-intensity signal changes on T2-weighted images is still controversial. The aim of the present study was to determine whether T2-weighted MR imaging can help assess the prognosis of the disease. METHODS: A prospective case series study was conducted. The population comprised 67 patients who underwent surgery between 1994 and 2004 to treat myelopathy caused by chronic cervical cord compression. The mean follow-up period was 39 months. Preoperative and postoperative functional status was evaluated using a modified Japanese Orthopaedic Association scale, and the recovery rate was calculated using the Hirabayashi method. Magnetic resonance images were acquired 3 months or less before surgery. High-intensity signal changes were evaluated according to the extent of these changes on T2-weighted sequences; low-intensity T1-weighted signal changes were also evaluated. In patients with low-intensity changes on T1-weighted images and in those with high-intensity changes spanning multiple levels on T2-weighted images, the authors documented a poor functional recovery. CONCLUSIONS: Multisegmental high-intensity change on T2-weighted MR imaging is a more sensitive indicator of outcomes than T1-weighted signal changes because of its higher frequency in patients with advanced myelopathy.