Causes of unplanned admission after orthopedic procedures in ambulatory surgery. / Causas de ingresos no deseados tras la realización de procedimientos quirúrgicos de cirugía ortopédica y traumatología en cirugía mayor ambulatoria.

OBJECTIVE: Orthopaedic procedures performed in Day Surgery Units provide important advantages which disappear when patients require admission when postoperative recovery is not as expected. The aim of this study was to analyse the reasons for unplanned hospital admissions after orthopaedic procedures in a Day Surgery Unit and their relationship between variables such as patient age, anaesthetic risk and technique, procedure or duration. METHODS: Ambispective cohort study of 5,085 patients who underwent surgical orthopaedic procedures between 1995 and 2017. Thirty-nine variables provided by the Unit's database were analysed. The database was opened on the day of admission and closed the 30th postoperative day. RESULTS: Of the patients, 98.2% were discharged from the Unit. Seventy-four (1.5%) required overnight admission. This percentage showed significant differences in relation to the type of procedure, type of anaesthesia and duration, which conditioned overnight admission due to inadequate postoperative pain management, nausea or wound complications. Seventeen patients (0.3%) required readmission after discharge due to complications that arose at home, such as wound infection, which was the most common. CONCLUSIONS: Unplanned admissions are more frequently related to general anaesthesia, lengthy surgeries and procedures such as arthroscopy, hallux valgus corrections or removal of osteosynthesis material. The major reasons for unplanned admissions were inadequate postoperative pain management for overnight admissions and wound infection for admissions after discharge.

[Forearm malignant epithelioid schwannoma associated with melanoma]. / Schwannoma maligno epitelioide en antebrazo asociado a melanoma.

Tumours originating in peripheric nerves usually appear in patients with neurofibromatosis (NF) signs, presenting frequent combinations of tumours in nerves and cutaneous lesions. Nevertheless, this association is very rare in cases without NF. Therefore, the aim of the present article is to present a case of malignant melanoma and malignant schwannoma, without any described NF. A 69-year-old woman with antecedents of malignant melanoma diagnosed two years previously in the dorsum of the fifth finger of the left hand, treated by means of amputation of the finger. The patient presented a malignant epithelioid schwannoma adhered to the median nerve that required elbow amputation. One month later lung metastases appeared and the patient died. This case presented no known NF sign. However, a relationship must be searched for in the common origin of melanoma and schwannoma from the embryonic neural crest.

[Osteonecrosis and HIV]. / Osteonecrosis y VIH.

An increase of the incidence of osteonecrosis in subjects infected with the HIV has been reported. It is unknown if osteonecrosis is an HIV infection consequence, or just the consequence of so many risk factors present among HIV infected subjects. We report five osteonecrosis cases found in our series of 534 HIV patients, and we review the related bibliography. All cases have some conventional risk factor different to the HIV or the antiviral treatment. We can't conclude antiviral treatments are not involved in osteonecrosis, but they have been the only risk factor in none of our patients.

[The effect of cervical arthrosis in the etiopathogenesis of vertebrobasilar insufficiency]. / Influencia de la artrosis cervical en la etiopatogenia de la insuficiencia vertebrobasilar.

We studied four groups of one hundred patients older than forty years. A group with radiological signs of cervical arthrosis was statistically compared with another one without such signs. There was no significant difference between the two groups with regard to the presence of vertebrobasilar insufficiency. Then we compared one hundred patients diagnosed of vertebrobasilar insufficiency with another group without this disease. When cervical arthrosis cases in these two groups were statistically compared, we could not find any significant differences. We think cervical arthrosis is not an important etiologic factor in vertebrobasilar insufficiency. Our results point to atherosclerotic lesions as the main cause of this entity.

[A case of multiple malignant schwannoma as the only disease in a 40-year-old patient: is this a new type of neurofibromatosis?]. / A propósito de un caso de schwannoma maligno múltiple como única patología en un paciente de 40 años: un nuevo tipo de neurofibromatosis?

We present the case of a 40-year-old man that presented a fast growing tumour on the external side of the left elbow. The tumour was extirpated by means of marginal exerectomy. The microscopic study corresponded to epithelioid malignant schwannoma, and the patient received radiotherapy and adjuvant chemotherapy. During the following years two local recidives and two new malignant schwannomas, one in the left sciatic common trunk and another paraspinal one, appeared and were extirpated. Radiotherapy and chemotherapy were again administered. In the last year, four new tumours have appeared: in the supraclavicular space, right posterior costofrenic, left costovertebral, and in the inferior abdominal wall, none of them has been extirpated or has hystologic diagnosis at the moment, however radiologic findings suggest malignant schwannomas. In this moment there is no neurologic deficiency except for the secondary ones to surgical procedures, and no neurofibromatosis types I to VII signs have been observed. So, the possibility of a new neurofibromatosis type is appointed.