ABSTRACT
BACKGROUND: The American College of Surgeon (ACS) Surgical Risk Calculator is an online tool that helps surgeons estimate the risk of postoperative complications for numerous surgical procedures across several surgical specialties. METHODS: We evaluated the predictive performance of the calculator in 385 cancer patients undergoing breast surgery. Calculator-predicted complication rates were compared with observed complication rates; calculator performance was evaluated using calibration and discrimination analyses. RESULTS: The mean calculator-predicted rates for any complication (4.1%) and serious complication (3.2%) were significantly lower than the observed rates (11.2% and 5.2%, respectively). The area under the curve was 0.617 for any complication and 0.682 for serious complications. p Values for the Hosmer-Lemeshow test were significant (<.05) for both outcomes. Brier scores were 0.102 for any complication and 0.048 for serious complication. CONCLUSIONS: The ACS risk calculator is not an ideal tool for predicting individual risk of complications following breast surgery in a Mexican cohort. The most valuable use of the calculator may reside in its role as an aid for patient-led surgery planning. The possibility of introducing breast surgery-specific data could improve the performance of the calculator. Furthermore, a disease-specific calculator could provide more accurate predictions and include complications more frequently found in breast cancer surgery.
Subject(s)
Breast Neoplasms/surgery , Mastectomy/adverse effects , Postoperative Complications/diagnosis , Quality Improvement , Risk Assessment/standards , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Female , Follow-Up Studies , Humans , Postoperative Complications/etiology , Prognosis , Prospective Studies , Risk FactorsABSTRACT
Objetivo: Las Sociedades Españolas de Ginecología y Obstetricia, de Medicina Interna y de Reumatología han constituido un grupo de trabajo paritario para la elaboración de tres documentos de consenso sobre el control del embarazo en mujeres con lupus eritematoso sistémico y síndrome antifosfolípido. Métodos: Cada una de las sociedades científicas implicadas propuso cinco representantes en base a su experiencia en el área del control del embarazo en pacientes con enfermedades autoinmunes. Las recomendaciones se elaboraron siguiendo la metodología Delphi.Resultados: En este tercer documento se incluyen las recomendaciones que abordan el manejo del parto, puerperio y lactancia, incluyendo el manejo de los diferentes fármacos en estos periodos. Además se incluye una sección sobre los cuidados iniciales del recién nacido y sobre anticoncepción. Conclusiones: Estas recomendaciones multidisciplinares se consideran herramientas en la toma de decisiones para los clínicos involucrados en la asistencia a pacientes con lupus eritematoso sistémico/síndrome antifosfolípido durante el embarazo.(AU)
Objective: In order to agree on the fundamental aspects related to the management of pregnancy in patients with systemic lupus erythematosus and antiphospholipid syndrome, the Spanish Societies of Gynaecology and Obstetrics, Internal Medicine and Rheumatology have set up a working group for the preparation of three consensus documents. Methods: Each of the Scientific Societies involved proposed five representatives based on their experience in the field of pregnancy control in patients with autoimmune diseases. The recommendations were developed following the Delphi methodology. Results: This third document contains the recommendations regarding the management of delivery, puerperium and lactation, including medication use during these periods and the care of the newborn. In addition, a section on contraception is included. Conclusions: These multidisciplinary recommendations are considered decision-making tools for clinicians involved in the care of patients with systemic lupus erythematosus/antiphospholipid syndrome during pregnancy.(AU)
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Infant , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/therapy , Postpartum Period , Pregnancy Complications , Parturition , Antiphospholipid Syndrome , Contraception , Rheumatology , Rheumatic DiseasesABSTRACT
Objetivo: Las sociedades españolas de ginecología y obstetricia, de medicina interna y de reumatología han constituido un grupo de trabajo paritario para la elaboración de 3 documentos de consenso sobre el control del embarazo en mujeres con lupus eritematoso sistémico (LES) y síndrome antifosfolípido (SAF). Métodos: Cada una de las sociedades científicas implicadas propuso 5 representantes en base a su experiencia en el área del control del embarazo en pacientes con enfermedades autoinmunes. Las recomendaciones se elaboraron siguiendo la metodología Delphi. Resultados: En este segundo documento se incluyen las recomendaciones que abordan el manejo del embarazo normal y sus complicaciones en mujeres con LES/SAF. Se presentan las recomendaciones relacionadas con el seguimiento del embarazo, la actividad lúpica, el bloqueo cardíaco congénito, las manifestaciones trombóticas y obstétricas del SAF y los defectos de placentación. Conclusiones: Estas recomendaciones multidisciplinares se consideran herramientas en la toma de decisiones para los clínicos involucrados en la asistencia a pacientes con LES/SAF durante el embarazo.(AU)
Objective: In order to agree on the fundamental aspects related to the management of pregnancy in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), the Spanish Societies of Gynaecology and Obstetrics, Internal Medicine and Rheumatology set up a working group for the preparation of three consensus documents. Methods: Each of the Scientific Societies involved proposed five representatives based on their experience in the field of pregnancy control in patients with autoimmune diseases. The recommendations were developed following the Delphi methodology. Results: This second document contains the recommendations regarding the management of pregnancy in women with SLE and APS, including complications such as lupus activity, congenital heart block, thrombotic and obstetric manifestations of APS and placental vascular disease. Conclusions:These multidisciplinary recommendations are considered decision-making tools for clinicians involved in the care of patients with SLE/APS during pregnancy.(AU)
Subject(s)
Humans , Female , Lupus Erythematosus, Systemic , Pregnancy , Antiphospholipid Syndrome , Pregnancy Complications , Lactation , Contraception , Postpartum Period , Gynecology , Obstetrics , RheumatologyABSTRACT
OBJECTIVE: In order to agree on the fundamental aspects related to the management of pregnancy in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), the Spanish Societies of Gynaecology and Obstetrics, Internal Medicine and Rheumatology set up a working group for the preparation of three consensus documents. METHODS: Each of the Scientific Societies involved proposed five representatives based on their experience in the field of pregnancy control in patients with autoimmune diseases. The recommendations were developed following the Delphi methodology. RESULTS: This second document contains the recommendations regarding the management of pregnancy in women with SLE and APS, including complications such as lupus activity, congenital heart block, thrombotic and obstetric manifestations of APS and placental vascular disease. CONCLUSIONS: These multidisciplinary recommendations are considered decision-making tools for clinicians involved in the care of patients with SLE/APS during pregnancy.
ABSTRACT
OBJECTIVE: In order to agree on the fundamental aspects related to the management of pregnancy in patients with systemic lupus erythematosus and antiphospholipid syndrome, the Spanish Societies of Gynaecology and Obstetrics, Internal Medicine and Rheumatology have set up a working group for the preparation of three consensus documents. METHODS: Each of the Scientific Societies involved proposed five representatives based on their experience in the field of pregnancy control in patients with autoimmune diseases. The recommendations were developed following the Delphi methodology. RESULTS: This third document contains the recommendations regarding the management of delivery, puerperium and lactation, including medication use during these periods and the care of the newborn. In addition, a section on contraception is included. CONCLUSIONS: These multidisciplinary recommendations are considered decision-making tools for clinicians involved in the care of patients with systemic lupus erythematosus/antiphospholipid syndrome during pregnancy.
ABSTRACT
El tratamiento de pacientes con estenosis ateromatosa carotídea responsable de cuadros de isquemia cerebrovascular es una práctica común para el cirujano vascular, a cuya disposición existen abundante literatura y estudios científicos en los que se apoyan las indicaciones quirúrgicas de esta patología. La existencia concomitante de otras patologías carotídeas no ateromatosas (como son las tortuosidades del eje carotídeo, las ectasias y aneurismas y las fibrosis periarteriales) complican tanto la indicación del procedimiento quirúrgico como la elección de la técnica a emplear, obligando con frecuencia a combinar diferentes métodos terapéuticos. Presentamos el caso de un varón de 71 años remitido por la sección de Neurología de nuestro centro para valorar la posibilidad de tratamiento tras haber sufrido dos accidentes isquémicos transitorios en forma de amaurosis fugax derecha. En los estudios realizados con eco- Doppler y angiorresonancia magnética se detectaron lesiones carotídeas ateromatosas estenosantes significativas desde el punto de vista hemodinámico, tortuosidades del eje arterial y ectasias bulbares. No se constataron antecedentes previos de traumatismos cervicales, operaciones en la zona ni radioterapia. Se indicó cirugía revascularizante a la vista de la clínica y de los hallazgos radiológicos. El acto quirúrgico reveló la presencia de una notable fibrosis periarterial, que dificultó de manera notable la manipulación quirúrgica, además de un bucle carotídeo interno con una angulación próxima a los 90º y elongación posterior de la arteria. Se optó por practicar una endarterectomía carotídea longitudinal para resolver las lesiones ateromatosas responsables de la estenosis y se efectuó un cierre de la arteriotomía mediante una plicatura de los bordes de la arteria, lo que permitió normalizar la ectasia y corregir de manera parcial el bucle y la elongación. Se primó en el acto quirúrgico la adopción de una técnica que resolviera la estenosis y que ofreciera un buen resultado hemodinámico, relegando a un segundo plano una solución enfocada en la recuperación de la morfología carotídea. La evolución postoperatoria del paciente no presentó ninguna incidencia y, tras nueve meses, permanece asintomático y el estudio con eco-Doppler no detecta alteraciones hemodinámicas en el sector. Se realiza una revisión de la bibliografía más reciente
The treatment of patiens with carotid stenosis responsible for squares of ischemic cerebrovascular disease is a common practice for the Vascular Surgeon to whose disposition abundant literature and scientific studies exist in those that lean on the surgical indications of this pathology. The concomitant existence of other non atherosclerotic carotid pathologies (like they are the tortuosities of the carotid axis, the ecstasies and aneurisms and the periarterial fibrosis) they complicate the indication of the surgical procedure so much as the election of the technique to use, frequently forcing to combine different therapeutic methods. We present the case of a 71 year-old male remitted by the section of Neurology of our centre to value the treatment possibility after having suffered two transitory ischemic accidents in form of right amaurosis fugax. In the studies carried out with echo-doppler and magnetic resonance was detected significant atherosclerotic stenosis from the hemodynamic point of view, torsions of the arterial axis and ecstasies blares. Previous antecedents of cervical traumatisms were not verified, operations in the area neither radiotherapy. Surgery was indicated in view of the clinic and of the radiological discoveries. The surgical act revealed the presence of a remarkable periarterial fibrosis, whose hindered in a remarkable way the surgical manipulation, besides a internal carotid loop with a next angle to the 90º and later elongation of the artery. It was opted to practice a carotid endarterectomy to solve the stenosis and a closing of the arteriotomy was made by means of a gathering of the borders of the artery, what allowed to normalize the ecstasy and to correct in a partial way the loop and the elongation. You prevailed at once surgical the adoption of a technique that solved the stenosis and that offered a good hemodynamic result, relegating to a second plane a solution focused in the recovery of the carotid morphology . The patient's postoperative evolution did not present any incidence and, after nine months, it remains asymptomatic and the study with echo-doppler does not detect hemodynamic alterations in the sector. We are carried out a revision of the most recent bibliography
