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1.
Curr Vasc Pharmacol ; 21(1): 59-68, 2023.
Article in English | MEDLINE | ID: mdl-36165517

ABSTRACT

BACKGROUND: Currently, studies are underway to determine whether coronary stent implantation with percutaneous transluminal coronary angioplasty before a coronary artery bypass graft (CABG) influences the prognosis of surgery. This study aimed to assess the need for future revascularisation or all-cause mortality as a composite endpoint after CABG surgery among patients with previous stent implantation. METHODS: A retrospective, non-randomised study was performed on 721 patients who underwent CABGin our centre between 2012 and 2017. This single-centre study compared two groups: 1) the previous stent group, patients with previous stent implantation (n=144), and 2) the non-previous stent group, patients without previous stent implantation (n=577). RESULTS: After a median follow-up of 36 months, the previous stent group presented a decreased combined event-free survival at 1, 3 and 5 years compared with the non-previous stent group (67.4, 43.5 and 23.0% vs. 91.0, 80.3 and 63.0%, respectively; p<0.01). There was also higher mortality in the previous stent group than in the non-previous stent group (96.1, 90.5 and 79.4 vs. 91.9, 75.9 and 51.0, respectively; p=0.01). The multivariable analysis of demographics, baseline comorbidity and surgical data showed previous stent implantation as an independent predictor of the composite endpoint (Hazard Ratio=3.00 and 95% confident interval=2.09-4.32; p<0.01). CONCLUSION: Patients with percutaneous coronary intervention before CABG present higher comorbidities and clinical events during follow-up than those who do not undergo stenting.


Subject(s)
Myocardial Revascularization , Stents , Humans , Prognosis , Retrospective Studies , Treatment Outcome , Myocardial Revascularization/adverse effects
2.
Rev. ORL (Salamanca) ; 13(4): 319-332, noviembre 2022.
Article in Spanish | IBECS | ID: ibc-212416

ABSTRACT

Introducción: Se han incrementado los casos de sordera súbita, acúfeno y neuritis vestibular relacionados con la infección por SARS-CoV-2. Objetivo: Realizar una revisión sistemática de los casos publicados de hipoacusia súbita en el contexto de una infección por SARS-CoV-2 y discutir la potencial asociación de la infección como posible agente etiológico. Material y método: Se realizó una búsqueda sistemática en PubMed, EMBASE, Cochrane Library y Scielo, sin restricción de idioma, incluyendo todos los artículos publicados desde marzo del 2020 hasta el 31 de enero de 2022. Resultados: Un total de 16 artículos cumplieron los criterios de inclusión, obteniendo 30 pacientes con sordera súbita y COVID-19. El 53% fueron mujeres y el 47% hombres con una edad media de 46,75 años. 4 pacientes presentaron factores de riesgo cardiovascular, uno asma, otro artritis reumatoide y 10 no presentaron antecedentes. 25 tuvieron una sordera unilateral y en 5 casos fue bilateral. Se encontraron todos los grados de hipoacusia, desde leves a cofosis. El acúfeno fue el síntoma más comúnmente asociado la mitad de los pacientes, acompañado de vértigo en un 10%. 14 pacientes precisaron ingreso en UCI, 9 no recibieron tratamiento para la infección, un paciente recibió hidroxicloroquina, 2 favipavir y enoxaparina y 2 azitromicina y prednisona. El implante coclear fue el tratamiento de la hipoacusia en 2 casos, uno fue tratado con hidroxicloroquina y 23 con corticoides intravenosos y/o orales y/o intratimpánicos. Conclusiones: La hipoacusia súbita es un síntoma recientemente asociado a la infección por SARS-CoV-2 y de prevalencia incierta. Se debe considerar la presencia de hipoacusia como parte de la evaluación clínica de estos pacientes para garantizar un diagnóstico y tratamiento tempranos. (AU)


Subject(s)
Humans , Hearing Loss, Sudden , Coronavirus , Severe acute respiratory syndrome-related coronavirus , Tinnitus , Hydroxychloroquine
7.
Acta otorrinolaringol. esp ; 72(2): 71-79, mar.-abr. 2021. ilus, tab
Article in Spanish | IBECS | ID: ibc-202563

ABSTRACT

INTRODUCCIÓN: Los abscesos retrofaríngeos constituyen una entidad grave. Debido a su escasa frecuencia y a compartir sintomatología con otros procesos, constituyen un reto diagnóstico para el clínico, siendo esencial realizar un diagnóstico temprano para no demorar el tratamiento y evitar así complicaciones. OBJETIVOS: Conocer la epidemiología, etiopatogenia, manifestaciones clínicas, microorganismos más frecuentemente implicados, tipo de tratamiento realizado y morbimortalidad de los abscesos retrofaríngeos en un hospital terciario en 25 años. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo descriptivo mediante la revisión de historias clínicas de todos los pacientes diagnosticados con absceso retrofaríngeo en un centro entre el 1 de enero de 1990 hasta el 31 de febrero de 2016. Treinta y tres pacientes diagnosticados con absceso retrofaríngeo durante dicho periodo fueron incluidos en nuestro estudio. De la historia clínica se recogieron diferentes variables que fueron agrupadas en las siguientes categorías: antecedentes personales, enfermedad actual, procedimientos diagnósticos realizados y tratamiento. RESULTADOS: La incidencia durante los años de estudio fue de 0,2 casos/100.000 habitantes/año. Los factores de riesgo más frecuentemente asociados fueron la diabetes de tipo II y la obesidad, siendo la impactación de un cuerpo extraño la etiología más frecuentemente encontrada (sobre todo, espina de pescado). Los síntomas/signos más frecuentes de presentación fueron la odinofagia y fiebre. La traqueotomía preventiva en el manejo inicial del paciente se realizó en nueve pacientes (27%). La complicación más frecuente fue la mediastinitis necrosante descendente. Se precisó un drenaje quirúrgico del absceso en 27 pacientes (82%), sobre todo con abordajes por vía externa (17 casos). Dos pacientes presentaron secuelas relacionadas con el tratamiento quirúrgico: una parálisis de cuerda vocal unilateral y un síndrome de Horner. No se objetivó mortalidad en los pacientes del estudio. CONCLUSIONES: Los abscesos retrofaríngeos deben ser considerados urgencias médico-quirúrgicas, ya que son susceptibles de producir complicaciones graves. Debemos prestar atención a los síntomas de alarma como son la odinofagia y el dolor cervical, asociado o no, disnea, estridor, trismus, rigidez cervical y síndrome febril. Los avances en procedimientos diagnósticos, terapéuticos y en los cuidados del paciente crítico han sido decisivos en la mejora del pronóstico y mortalidad de estos pacientes


INTRODUCTION: Retropharyngeal abscess is a serious condition. Its rare occurrence, thus sharing symptoms with other processes, make it a diagnostic challenge for the clinician. Therefore, it is critical to make an early diagnosis to prevent delaying treatment and avoid complications. OBJECTIVES: To gain knowledge of the epidemiology, pathogenesis, clinical manifestations, the most commonly implicated microorganisms, the type of treatment used, morbidity and mortality of retropharyngeal abscesses at a tertiary institution over the last 25 years. METHODS: A retrospective study was conducted by reviewing medical records of all patients diagnosed with retropharyngeal abscess in a single centre between 1 January 1990 and 31 February 2016. Thirty-three patients were included in our study. Data such as personal history, present illness, diagnoses and treatment procedures were collected from the medical records. RESULTS: The incidence during the years of study was 0.2 cases/100 000 inhabitants/year. Personal medical histories most often associated were alcoholism, smoking, diabetes and obesity. The most common aetiology found was impaction of a foreign body (especially fishbone). The most common presenting symptoms were odynophagia and neck pain accompanied by fever. Preventive tracheotomy was performed in the initial management of the patient in 9 cases (27%). The most frequent complication was descending necrotizing mediastinitis. Surgical drainage of the abscess was required in 27 patients (82%), especially with external approaches (17 cases). Two patients had sequelae: paralysis of unilateral vocal cord and Horner's syndrome. No mortality was observed in the patients of the study. CONCLUSION: Retropharyngeal abscesses must be considered medical-surgical emergencies as they are likely to produce serious complications. We must pay attention to the warning symptoms such as odynophagia and cervical pain, associated or otherwise with dyspnoea, stridor, trismus, and neck stiffness. Advances in diagnostic and therapeutic procedures together with advances in critical care have been a key factor in improving the prognosis and mortality of these patients


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Young Adult , Adult , Middle Aged , Aged , Retropharyngeal Abscess/epidemiology , Retropharyngeal Abscess/therapy , Retrospective Studies , Retropharyngeal Abscess/microbiology , Incidence , Risk Factors , Comorbidity , Neck , Spain/epidemiology
8.
Article in English, Spanish | MEDLINE | ID: mdl-32487430

ABSTRACT

INTRODUCTION: Retropharyngeal abscess is a serious condition. Its rare occurrence, thus sharing symptoms with other processes, make it a diagnostic challenge for the clinician. Therefore, it is critical to make an early diagnosis to prevent delaying treatment and avoid complications. OBJECTIVES: To gain knowledge of the epidemiology, pathogenesis, clinical manifestations, the most commonly implicated microorganisms, the type of treatment used, morbidity and mortality of retropharyngeal abscesses at a tertiary institution over the last 25 years. METHODS: A retrospective study was conducted by reviewing medical records of all patients diagnosed with retropharyngeal abscess in a single centre between 1 January 1990 and 31 February 2016. Thirty-three patients were included in our study. Data such as personal history, present illness, diagnoses and treatment procedures were collected from the medical records. RESULTS: The incidence during the years of study was 0.2 cases/100 000 inhabitants/year. Personal medical histories most often associated were alcoholism, smoking, diabetes and obesity. The most common aetiology found was impaction of a foreign body (especially fishbone). The most common presenting symptoms were odynophagia and neck pain accompanied by fever. Preventive tracheotomy was performed in the initial management of the patient in 9 cases (27%). The most frequent complication was descending necrotizing mediastinitis. Surgical drainage of the abscess was required in 27 patients (82%), especially with external approaches (17 cases). Two patients had sequelae: paralysis of unilateral vocal cord and Horner's syndrome. No mortality was observed in the patients of the study. CONCLUSION: Retropharyngeal abscesses must be considered medical-surgical emergencies as they are likely to produce serious complications. We must pay attention to the warning symptoms such as odynophagia and cervical pain, associated or otherwise with dyspnoea, stridor, trismus, and neck stiffness. Advances in diagnostic and therapeutic procedures together with advances in critical care have been a key factor in improving the prognosis and mortality of these patients.

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