RESUMEN
PURPOSE: In acute epiglottitis (AE) or acute supraglottitis (AS), the management of the airway is crucial. We hypothesized that tracheotomized patients recover faster than intubated patients do. METHODS: We retrospectively reviewed all adult AE and AS patients, who underwent intubation or tracheotomy between 2007 and 2018 in a tertiary care center. Patient demographics, treatment, and complications were analyzed. RESULTS: The cohort comprised 42 patients. The airway was secured with intubation in 50% and with tracheotomy in 50%. All intubated patients (n = 21) and three tracheotomized patients were treated in the intensive care unit (p < 0.0001). Procedure-related complications were encountered in three intubated and eight tracheotomized patients (p = 0.892). Median overall treatment cost was 11.547 and 5.856 in the intubated and tracheotomized patient groups, respectively (p < 0.001). The median duration of sick leave after discharge from hospital was 13 days in the tracheotomy group and 7 days in the intubation group (p = 0.097). CONCLUSION: Tracheotomy resulted in a less expensive management in securing the airway in AE or AS, but tracheotomized patients had a trend towards more complications and longer sick leaves compared to intubated patients. LEVEL OF EVIDENCE: 2b.
Asunto(s)
Epiglotitis , Intubación Intratraqueal , Atención al Paciente , Complicaciones Posoperatorias , Supraglotitis , Traqueotomía , Enfermedad Aguda , Adulto , Costos y Análisis de Costo , Epiglotitis/fisiopatología , Epiglotitis/cirugía , Femenino , Finlandia , Humanos , Intubación Intratraqueal/efectos adversos , Intubación Intratraqueal/economía , Intubación Intratraqueal/métodos , Masculino , Persona de Mediana Edad , Atención al Paciente/economía , Atención al Paciente/métodos , Atención al Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Supraglotitis/fisiopatología , Supraglotitis/cirugía , Traqueotomía/efectos adversos , Traqueotomía/economía , Traqueotomía/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: According to the literature the three stone diseases, sialolithiasis (SL), urolithiasis (UL) and cholelithiasis (CL) share comorbidities. We assess familial and spouse risks between these stone disease and compare them to familial risks for concordant (same) stone disease. METHODS: Study population including familiar relationships was obtained from the Swedish Multigeneration Register and stone disease patients were identified from nation-wide medical records. Standardized incidence ratios (SIRs) were calculated for 0-83 year old offspring when their first-degree relatives were diagnosed with stone disease and the rates were compared to individuals without a family history of stone disease. Numbers of offspring with SL were 7906, for UL they were 170,757 and for CL they were 204,369. RESULTS: SIRs for concordant familial risks were 2.06 for SL, 1.94 for UL and 1.82 for CL. SIRs for SL and UL were slightly higher for women than for men. Familial risks between stone diseases were modest. The highest risk of 1.17 was for UL when family members were diagnosed with CL, or vice versa. The SIR for UL was 1.15 when family members were diagnosed with SL. Familial risks among spouses were increased only for UL-CL pairs (1.10). CONCLUSIONS: Familial risks for concordant SL were 2.06 and marginally lower for the other diseases. Familial risks between stone diseases were low but higher than risks between spouses. The data show that familial clustering is unique to each individual stone disease which would imply distinct disease mechanisms. The results cast doubt on the reported comorbidities between these diseases.
Asunto(s)
Colelitiasis/genética , Predisposición Genética a la Enfermedad/genética , Vigilancia de la Población , Cálculos de las Glándulas Salivales/genética , Urolitiasis/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Colelitiasis/diagnóstico , Colelitiasis/epidemiología , Femenino , Predisposición Genética a la Enfermedad/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Vigilancia de la Población/métodos , Cálculos de las Glándulas Salivales/diagnóstico , Cálculos de las Glándulas Salivales/epidemiología , Suecia/epidemiología , Urolitiasis/diagnóstico , Urolitiasis/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Although needle biopsy is widely used in work-up of lymphadenopathy, lymph node excision (LNE) is often required especially in lymphoma diagnostics. LNE is an invasive procedure, which carries a potential risk of complications. However, comprehensive studies evaluating the spectrum and occurrence of complications are lacking. AIMS/OBJECTIVES: This study addresses the role of preoperative needle biopsies in patients who underwent LNE. Furthermore, surgical complications related to LNE are analyzed. MATERIALS AND METHODS: Altogether 321 patients, who underwent LNE in two-year period in 2018-19, and fulfilled our study criteria, were included. Patients' data were retrieved from the electronic patient records. RESULTS: The surgical complication rate was 5.9%. Most of the complications (n = 16; 84.2%) were categorized as minor (I-II) according to the Clavien-Dindo scale. The remaining three (15.8%), all hemorrhages, were categorized as major complications and required intervention. Preoperative needle biopsy might have avoided the need for LNE in some patients, which we discuss in this study. CONCLUSIONS AND SIGNIFICANCE: Surgical complications after LNE in the head and neck area are rare and mostly minor. Needle biopsy is often recommended preoperatively to avoid unnecessary operations and to refrain performing LNE for patients with non-lymphatic malignancy.