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INTRODUCTION: Rotational ankle fractures are common, have diverse personalities and affect both robust and fragile patients. Postoperative complications are frequent, creating a sizeable economic burden. The primary purpose of this study was to expand current knowledge on predictors of postoperative complications after low-energy ankle fracture fixation. MATERIALS AND METHODS: A retrospective single-center cohort study was completed of patients undergoing internal fixation OF low-energy ankle fractures. The primary outcome was first-year postoperative complications, classified as major (surgical) or minor (non-surgical). Data on patients, their injuries, and treatments were collected. To identify potential predictors of outcomes, logistic regression methods were used, with a backward-stepwise method used for model fitting. RESULTS: In total, 663 patients of median age 59 years were analysed. We found a high rate of complications (28.4%), with wound-healing issues and infections predominant. Overall, 14.8% had minor complications, while 13.6% required an unplanned reoperation. On multivariable analysis, the most consistent predictors of complications were older age (OR: 1.02 per year), longer operating time (3.32 per hour), and smoking (2.91). CONCLUSIONS: Older patients and smokers who sustain fractures requiring more complex surgery are at higher risk of postoperative complications.
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INTRODUCTION: The main complication of percutaneous iliosacral screw fixation is implant malposition, which can lead to vascular and nerve damage. The anatomical variability of the sacrum can make screw insertion difficult under fluoroscopic guidance. Among the methods described to improve the accuracy of this technique, stands out the use of computed tomography (CT). The aim of this study is to compare the results of iliosacral screw insertion with fluoroscopy or CT navigation. METHODOLOGY: Retrospective cohort study of 66 iliosacral screws in 56 patients during 11 years. The screws were inserted with fluoroscopy in the operating room or with CT in the radiodiagnosis area. We collected data on patient characteristics, lesions, treatment, and clinical and radiological results. RESULTS: Forty-seven screws were inserted with fluoroscopy and 19 with CT. A percentage of 18.2 of screws perforated the S1 osseous corridor. All of them were inserted with fluoroscopy guidance (0 vs. 34%; p<0.01). Those operated with CT accumulated more sacral dysmorphism criteria than those operated with fluoroscopy (2.2 vs. 1.6; p=0.02). The S1 corridor on the axial CT view was narrower in those in whom perforation had occurred (18.8 vs. 21.0mm; p=0.02). Two cases with perforation developed S1 radiculalgia. Two endopelvic screws had to be removed. CONCLUSION: We advise the use of CT guidance for iliosacral screw insertion in patients with sacral dysmorphism or narrow S1 corridors in facilities where other navigation methods are not available.
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INTRODUCTION: Rotational ankle fractures are common, have diverse personalities and affect both robust and fragile patients. Postoperative complications are frequent, creating a sizeable economic burden. The primary purpose of this study was to expand current knowledge on predictors of postoperative complications after low-energy ankle fracture fixation. MATERIALS AND METHODS: A retrospective single-center cohort study was completed of patients undergoing internal fixation OF low-energy ankle fractures. The primary outcome was first-year postoperative complications, classified as major (surgical) or minor (non-surgical). Data on patients, their injuries, and treatments were collected. To identify potential predictors of outcomes, logistic regression methods were used, with a backward-stepwise method used for model fitting. RESULTS: In total, 663 patients of median age 59 years were analyzed. We found a high rate of complications (28.4%), with wound-healing issues and infections predominant. Overall, 14.8% had minor complications, while 13.6% required an unplanned reoperation. On multivariable analysis, the most consistent predictors of complications were older age (OR=1.02 per year), longer operating time (3.32 per hour), and smoking (2.91). CONCLUSIONS: Older patients and smokers who sustain fractures requiring more complex surgery are at higher risk of postoperative complications.
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Xanthogranulomatous endometritis (XGE) is an uncommon inflammatory benign condition that can mimic endometrial cancer. The majority of the reported cases of XGE have been observed in postmenopausal women, often presenting clinically as haematometra or benign senile pyometra. We report a case of XGE in a 73-year-old woman who presented with pyometra. Diagnostic hysteroscopy is an important tool when accompanied by endometrial samples for histology in suspected cases. Knowledge of this uncommon disease is crucial for accurate diagnosis. XGE is a benign condition, however, there have been reported cases of chronic active XGE and bacterial infection in which hysterectomy was required due to complications.
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INTRODUCTION: The main complication of percutaneous iliosacral screw fixation is implant malposition, which can lead to vascular and nerve damage. The anatomical variability of the sacrum can make screw insertion difficult under fluoroscopic guidance. Among the methods described to improve the accuracy of this technique, stands out the use of computed tomography (CT). The aim of this study is to compare the results of iliosacral screw insertion with fluoroscopy or CT navigation. METHODOLOGY: Retrospective cohort study of 66 iliosacral screws in 56 patients during 11 years. The screws were inserted with fluoroscopy in the operating room or with CT in the radiodiagnosis area. We collected data on patient characteristics, lesions, treatment, and clinical and radiological results. RESULTS: Forty-seven screws were inserted with fluoroscopy and 19 with CT. A percentage of 18.2 of screws perforated the S1 osseous corridor. All of them were inserted with fluoroscopy guidance (0 vs. 34%; p<0.01). Those operated with CT accumulated more sacral dysmorphism criteria than those operated with fluoroscopy (2.2 vs. 1.6; p=0.02). The S1 corridor on the axial CT view was narrower in those in whom perforation had occurred (18.8 vs. 21.0mm; p=0.02). Two cases with perforation developed S1 radiculalgia. Two endopelvic screws had to be removed. CONCLUSION: We advise the use of CT guidance for iliosacral screw insertion in patients with sacral dysmorphism or narrow S1 corridors in facilities where other navigation methods are not available.
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SARS-CoV-2 infection causes a wide spectrum of symptoms with varying degrees of severity, from asymptomatic cases or cases in the form of self-limiting influenza-like illness to cases of rapidly progressing respiratory distress syndrome due to an anomalous immune system response in the form of a cytokine storm. Thrombotic complications are also common. Multiple antiviral treatments have been tested in COVID-19 without favorable outcomes. Only remdesivir may be useful, but not in all cases, and its use is controversial. On the contrary, immunomodulating treatments have the most solid evidence, particularly glucocorticoids. Other more specific immunosuppressors, such as interleukin-6 inhibitors, have also shown favorable results and many others are currently being studied. Thromboprophylaxis is the other pillar of COVID-19 treatment, although the anticoagulant dose to be used is still being discussed.
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La COVID-19 se convirtió en una amenaza para el sistema de salud público, comprometiendo la salud de la población. Los pacientes con fractura de cadera, debido a su edad y comorbilidad, fueron pacientes de alto riesgo en esta pandemia. La finalidad de este estudio fue observar cómo afectó la pandemia al manejo de las fracturas de cadera del paciente anciano. Métodos: Se trata de un estudio descriptivo, retrospectivo de todos los pacientes mayores de 65 años diagnosticados de fractura de cadera que acudieron a urgencias del Hospital Universitario Vall dHebron en el periodo de pandemia COVID-19 comprendido entre el 11 de marzo y el 24 de abril de 2020. Fueron seguidos durante su ingreso hospitalario y a los 30 días de la fractura. Resultados: Se incluyeron un total de 63 pacientes, 18 (28,6%) de los cuales tenían una RT-qPCR positiva para COVID-19. Cuatro no pudieron ser operados debido a la gravedad que presentaban al ingreso, falleciendo a los pocos días. Tres de estos pacientes tenían la COVID-19. El 83,3% de los pacientes con RT-qPCR positiva presentaron clínica respiratoria durante su hospitalización. La duración de la estancia hospitalaria de los pacientes con RT-qPCR positiva (18,25±8,99 días) fue mayor que los pacientes no COVID (10,9±4,52 días) (p=0,01). La mortalidad intrahospitalaria de los pacientes intervenidos fue del 20% en los pacientes con RT-qPCR positiva en comparación con el 2,3% del grupo de pacientes que testaron negativo (p=0,018). La mortalidad a los 30 días fue del 40% en el grupo con RT-qPCR positiva vs. el 6,8% de los pacientes no infectados por SARS-CoV-2 (p=0,002). Conclusión: La infección por SARS-CoV-2 en pacientes ancianos con fractura de cadera aumenta tanto el tiempo de ingreso hospitalario como la mortalidad intrahospitalaria y a los 30 días.(AU)
COVID-19 became a threat to the public health system, compromising the health of the population. Patients with hip fractures, due to their age and comorbidity, were high-risk patients in this pandemic. The purpose of this study was to observe how the pandemic affected the management of hip fractures in elderly patients. Methods: This is a descriptive, retrospective study of all patients over the age of 65 diagnosed with a hip fracture that came to the emergency room of Vall dHebron University Hospital in the COVID-19 pandemic period, from the 11th of March to the 24th of April 2020. They were followed up during their hospital stay and 30 days after the fracture. Results: A total of 63 patients were included, 18 (28.6%) of whom had a positive RT-qPCR for COVID-19. Four could not be operated on due to the severity of the disease they presented with upon admission, dying a few days afterwards. Three of these patients had COVID-19. The 83.3% of the patients with positive RT-qPCR presented respiratory symptoms during their hospitalization. The length of hospital stays of patients with a positive RT-qPCR (18.25±8.99 days) was longer than that of patients that were RT-qPCR negative (10.9±4.52 days) (P=.01). In-hospital mortality in operated patients was 20% in patients with a positive RT-qPCR, compared with 2.3% in the group of patients who tested negative (P=.018). Mortality at 30 days was 40% in the group with positive RT-qPCR vs 6.8% in patients not infected by SARS-CoV-2 (P=.002). Conclusion: SARS-CoV-2 infection in elderly patients with hip fractures increases both the length of hospital stay, as well as in-hospital and 30-day mortality.(AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Fraturas do Quadril/mortalidade , /epidemiologia , Comorbidade , Período Perioperatório/mortalidade , Anestesia/métodos , Epidemiologia Descritiva , Estudos Retrospectivos , Espanha , AnestesiologiaRESUMO
COVID-19 became a threat to the public health system, compromising the health of the population. Patients with hip fractures, due to their age and comorbidity, were high-risk patients in this pandemic. The purpose of this study was to observe how the pandemic affected the management of hip fractures in elderly patients. METHODS: This is a descriptive, retrospective study of all patients over the age of 65 diagnosed with a hip fracture that came to the emergency room of Vall d'Hebron University Hospital in the COVID-19 pandemic period, from the 11th of March to the 24th of April 2020. They were followed up during their hospital stay and 30 days after the fracture. RESULTS: A total of 63 patients were included, 18 (28.6%) of whom had a positive RT-qPCR for COVID-19. Four could not be operated on due to the severity of the disease they presented with upon admission, dying a few days afterwards. Three of these patients had COVID-19. The 83.3% of the patients with positive RT-qPCR presented respiratory symptoms during their hospitalization. The length of hospital stays of patients with a positive RT-qPCR (18.25±8.99 days) was longer than that of patients that were RT-qPCR negative (10.9±4.52 days) (P=.01). In-hospital mortality in operated patients was 20% in patients with a positive RT-qPCR, compared with 2.3% in the group of patients who tested negative (P=.018). Mortality at 30 days was 40% in the group with positive RT-qPCR vs 6.8% in patients not infected by SARS-CoV-2 (P=.002). CONCLUSION: SARS-CoV-2 infection in elderly patients with hip fractures increases both the length of hospital stay, as well as in-hospital and 30-day mortality.
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COVID-19/mortalidade , Fraturas do Quadril/mortalidade , Mortalidade Hospitalar , Pandemias , SARS-CoV-2 , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Teste de Ácido Nucleico para COVID-19/estatística & dados numéricos , Feminino , Fraturas do Quadril/cirurgia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Prevalência , Estudos Retrospectivos , Fatores Sexuais , Espanha/epidemiologiaRESUMO
La COVID-19 se convirtió en una amenaza para el sistema de salud público, comprometiendo la salud de la población. Los pacientes con fractura de cadera, debido a su edad y comorbilidad, fueron pacientes de alto riesgo en esta pandemia. La finalidad de este estudio fue observar cómo afectó la pandemia al manejo de las fracturas de cadera del paciente anciano. MÉTODOS: Se trata de un estudio descriptivo, retrospectivo de todos los pacientes mayores de 65 años diagnosticados de fractura de cadera que acudieron a urgencias del Hospital Universitario Vall d'Hebron en el periodo de pandemia COVID-19 comprendido entre el 11 de marzo y el 24 de abril de 2020. Fueron seguidos durante su ingreso hospitalario y a los 30 días de la fractura. RESULTADOS: Se incluyeron un total de 63 pacientes, 18 (28,6%) de los cuales tenían una RT-qPCR positiva para COVID-19. Cuatro no pudieron ser operados debido a la gravedad que presentaban al ingreso, falleciendo a los pocos días. Tres de estos pacientes tenían la COVID-19. El 83,3% de los pacientes con RT-qPCR positiva presentaron clínica respiratoria durante su hospitalización. La duración de la estancia hospitalaria de los pacientes con RT-qPCR positiva (18,25±8,99 días) fue mayor que los pacientes no COVID (10,9±4,52 días) (p = 0,01). La mortalidad intrahospitalaria de los pacientes intervenidos fue del 20% en los pacientes con RT-qPCR positiva en comparación con el 2,3% del grupo de pacientes que testaron negativo (p = 0,018). La mortalidad a los 30 días fue del 40% en el grupo con RT-qPCR positiva vs. el 6,8% de los pacientes no infectados por SARS-CoV-2 (p = 0,002). CONCLUSIÓN: La infección por SARS-CoV-2 en pacientes ancianos con fractura de cadera aumenta tanto el tiempo de ingreso hospitalario como la mortalidad intrahospitalaria y a los 30 días
COVID-19 became a threat to the public health system, compromising the health of the population. Patients with hip fractures, due to their age and comorbidity, were high-risk patients in this pandemic. The purpose of this study was to observe how the pandemic affected the management of hip fractures in elderly patients. METHODS: This is a descriptive, retrospective study of all patients over the age of 65 diagnosed with a hip fracture that came to the emergency room of Vall d'Hebron University Hospital in the COVID-19 pandemic period, from the 11th of March to the 24th of April 2020. They were followed up during their hospital stay and 30 days after the fracture. RESULTS: A total of 63 patients were included, 18 (28.6%) of whom had a positive RT-qPCR for COVID-19. Four could not be operated on due to the severity of the disease they presented with upon admission, dying a few days afterwards. Three of these patients had COVID-19. The 83.3% of the patients with positive RT-qPCR presented respiratory symptoms during their hospitalization. The length of hospital stays of patients with a positive RT-qPCR (18.25±8.99 days) was longer than that of patients that were RT-qPCR negative (10.9±4.52 days) (P=.01). In-hospital mortality in operated patients was 20% in patients with a positive RT-qPCR, compared with 2.3% in the group of patients who tested negative (P=.018). Mortality at 30 days was 40% in the group with positive RT-qPCR vs 6.8% in patients not infected by SARS-CoV-2 (P=.002). CONCLUSION: SARS-CoV-2 infection in elderly patients with hip fractures increases both the length of hospital stay, as well as in-hospital and 30-day mortality
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Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Pandemias , Fraturas do Quadril/mortalidade , Tempo de Internação , Estudos RetrospectivosRESUMO
Presentamos un caso de hipofisitis linfocitaria que se desarrolla durante el embarazo. La paciente ingresa en el tercer trimestre por hipertensión e insuficiencia cardíaca, desarrollando diabetes gestacional y cuadro confusional agudo. Presenta una lesión hipocaptante en adenohipófisis y eclampsia, por lo que se realiza una cesárea. En el puerperio desarrolla hipotiroidismo e insuficiencia gonadotropa y cortico suprarrenal. Tras el tratamiento con corticoides se normaliza la resonancia y la función tiroidea y gonadotropa, persistiendo la insuficiencia corticosuprarrenal. El agrandamiento pituitario asociado a hipopituitarismo durante el embarazo y puerperio, puede llevarnos a un diagnóstico incorrecto de tumor hipofisario
We present a case of lymphocytic hypophysitis that is developed during preguancy. The patient enters in the third trimester for hypertension and heart failure, developing diabetes gestacional and acute con Dusional syndrome. She presents a hypointensity of the anterior pituitary and eclampsia, for what a caesarean section is made. In the postpartum she develops hypo thyroidism and lost of adrenal cortical andgonadotropic function. With a corticosteroid theraphy the resonance, thyroid and gonadotro picfunctios is normalized, persisting adrenal cortical insufficiency. The pituitary enlargement associated to hipopituitarismo during the pregnancy and postpartum, it can take us to an incorrect diagnosis of pituitary tumor
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Feminino , Gravidez , Adulto , Humanos , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Hipertensão/complicações , Hipertensão/diagnóstico , Insuficiência Cardíaca/complicações , Diabetes Gestacional/complicações , Eclampsia/complicações , Eclampsia/diagnóstico , Hipopituitarismo/complicações , Hipopituitarismo/diagnóstico , Telangiectasia Hemorrágica Hereditária/complicações , Hipófise/patologia , Hipófise/fisiopatologiaRESUMO
No disponible
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Masculino , Feminino , Adulto , Humanos , Satisfação do Paciente/economia , Satisfação do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Coleta de Dados , Qualidade da Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/tendências , Qualidade da Assistência à Saúde , Pesquisas sobre Atenção à Saúde/métodos , Pesquisas sobre Atenção à Saúde , Recursos Humanos em Hospital/ética , Recursos Humanos em Hospital/normas , Recursos Humanos em Hospital , Satisfação Pessoal , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/normas , Controle de Qualidade , Qualidade de VidaRESUMO
No disponible
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Feminino , Adulto , Humanos , Coleta de Dados/métodos , Inquéritos e Questionários , Procedimentos Cirúrgicos Ambulatórios/métodos , Procedimentos Cirúrgicos Ambulatórios/tendências , Satisfação do Paciente , 28640/métodos , Curetagem/métodos , Laparoscopia/métodos , Cerclagem Cervical/métodos , Planejamento em Saúde/métodos , Planejamento em Saúde/normas , Planejamento em SaúdeRESUMO
Objetivo: comparar la eficacia de la dinoprostona vaginal frente a la oxitocina intravenosa en la inducción del parto con cérvix inmaduro y rotura prematura de membranas. Diseño: estudio prospectivo, comparativo de dos grupos homogéneos. Ámbito: Servicio de Obstetricia del Hospital Universitario Maternal La Fe. Material y métodos: en cada grupo, de forma aleatoria, se incluyen 40 pacientes con indicación de finalizar gestación mediante inducción, con menos de tres partos previos, con gestación única en cefálica, test de Bishop menor de 4 y rotura prematura de membranas o amniorrexis precoz. El grupo estudio se induce con liberación controlada de dinoprostona vaginal y el grupo control mediante perfusión intravenosa de oxitocina. Análisis estadístico: test de Student para muestras independientes, test de chi cuadrado. Resultados: la tasa de éxitos fue del 77,5 por ciento en el grupo dinoprostona frente al 55 por ciento en el grupo oxitocina (p<0,05) (AU)