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AIM: Heparin induced thrombocytopenia (HIT) and end stage kidney disease (ESKD) are independent conditions associated with increased mortality and morbidity, however, whether ESKD is an independent risk factor for increased mortality in HIT admissions is not well studied. Therefore, we aimed to compare in-hospital mortality in HIT admissions based on their ESKD status. METHODS: This is a retrospective cohort study of HIT hospitalizations aged 18 and older using the 2016-2019 national inpatient sample (NIS) database. RESULTS: From 2016 to 2019 we had 12 161 admissions for HIT among 28 484 087 total hospitalizations. The annual incidence rate for HIT admissions per 100 000 admissions were: 47, 46, 41.1, and 36.6, respectively (p < .001) in 2016, 2017, 2018, and 2019 respectively. Among HIT admissions, the mean age was 64.3 years, 46.8% were females, 68% were Whites and 16% were Blacks. Black patients have a significantly higher likelihood of in-hospital mortality than White patients (aOR 1.25; 95% CI: 1.06, 1.48; p = .007). Patients who did not have any insurance or self-pay had higher mortality compared to Medicare (aOR 1.64; 95% CI: 1.13, 2.38; p = .009). ESKD status was not associated with higher or lower in-hospital mortality among HIT admissions (aOR 1.002; 95% CI: 0.84, 1.19; p = .981) after adjusting for age, sex, race, and insurance status. CONCLUSION: There are no higher or lower odds of in-hospital mortality in the ESKD subgroup in HIT admissions in adults. Decreasing incidence of HIT hospitalizations was seen over the years from 2016 to 2019.
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Fallo Renal Crónico , Trombocitopenia , Adulto , Femenino , Humanos , Anciano , Estados Unidos , Persona de Mediana Edad , Masculino , Estudios Retrospectivos , Estudios de Cohortes , Mortalidad Hospitalaria , Medicare , Heparina/efectos adversosRESUMEN
Introducción. Melanoma es un cáncer de piel de mortalidad alta, cuya incidencia ha aumentado mundialmente en los últimos años. El siguiente estudio está destinado a detectar el conocimiento de la población sobre melanoma y las medidas de protección frente a la radiación UV (RUV), considerando que las dos terceras partes de los casos de melanoma se asocian al sol. Objetivo general. Detectar el conocimiento sobre melanoma y las prácticas de protección solar, en pacientes que consultan en el Servicio de Dermatología e internados en Clínica Médica del Hospital José M. Cullen. Materiales y métodos. Estudio observacional, prospectivo, longitudinal y descriptivo. La población abarcó 275 pacientes, entre 16 y 85 años, voluntarios del consultorio de Dermatología e internados en Clínica Médica del Hospital José M. Cullen. Mediante el programa Statistical Package for the Social Sciences 15.0, se realizó un análisis descriptivo y la prueba de Chi cuadrado, para determinar asociación estadística, entre variables cualitativas con significancia de p<0,05. Resultados. El conocimiento resultó escaso, sólo el 53% relacionó correctamente melanoma con cáncer de piel. El elemento de protección a la RUV más utilizado fue el sombrero y más frecuente en hombres (p<0,001). El uso de FPS es más común en mujeres (p= 0,003); de hecho, fueron las que en mayor frecuencia (p=0,011) lo utilizaron el verano pasado y en personas menores de 40 años (p=0,002). La utilización de ropas largas es más frecuente en hombres (p=0,006) y en personas mayores de 40 años (p=0,002). Se encontró un resultado significativo entre la utilización de FPS y su renovación periódica (p<0,001), entre la práctica de no utilizar ningún elemento de protección frente al sol y considerar que un lunar puede transformarse en cáncer de piel (p=0,014). Conclusión. Existe poco conocimiento, lo que se refleja en las prácticas inadecuadas de protección frente a RUV.
Background. Melanoma is one of the deadliest forms of skin cancer, showing an increasing incidence worldwide over the past years. The aim of this study was to assess people's knowledge about melanoma, and their protective measures against UV radiation, considering that two-thirds of melanoma cases are associated to sun exposure. General objective. To assess the knowledge about melanoma and the sun protective practices in patients who attended the Department of Dermatology and in those admitted to the General Internal Medicine Unit of José M. Cullen Hospital. Material and methods. It was an observational, prospective, longitudinal, descriptive study. A sample of 275 participants aged between 16-85 years was included, composed of voluntary patients from the Department of Dermatology and inpatients from the General Internal Medicine Unit of José M. Cullen Hospital. The Statistical Package for the Social Sciences 15.0 software was used to make a descriptive analysis; the chi-square test was performed with a significance level of p < 0.05 to determine the statistical association among qualitative variables. Results. The knowledge was poor, since only 53% of respondents associated melanoma to skin cancer correctly. Hats were the most used sun protection choice, specially in men (p < 0.001). The use of sunscreen was more common among women (p= 0.003) - in fact, they were the ones who used it more regularly (p= 0.011) last summer - and among people under 40 (p= 0.002). Using long clothing was more common in men (p= 0.006) and in people over 40 (p= 0.002). A significant result was found between the use of SPF and its daily reapplication (p < 0.001), between not using any sun protection element and considering that a mole can develop skin cancer (p= 0.014). Conclusion. There is little knowledge among people, which is reflected on the inadequate protective practices against UV radiation.
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A new paramagnetic crystalline material, namely, lithium naphthalocyanine (LiNc), whose electron-paramagnetic-resonance (EPR) line width is highly sensitive to oxygen content, has been evaluated for use as oximetry probe in cells and tissues. Previously,we reported on the synthesis, structural framework,magnetic and oxygen-sensing properties of LiNc microcrystalline powder (Pandian et al, J. Mater. Chem. 19, 4138, 2009). The material exhibited a single, sharp EPR line that showed a highly linear response of its width to surrounding molecular oxygen (pO(2)) with a sensitivity of 31.2 mG/mmHg. In the present study, we evaluated the suitability of this material for in vivo oximetry in biological systems. We observed that the probe was stable in tissues for more than two months without any adverse effect on its oxygen-sensing properties. We further demonstrated that the probe can be prepared in sub-micron sizes for uptake by stem cells. Thus, the high oxygen sensitivity, biocompatibility, and long-term stability in tissues may be useful for high-resolution EPR oximetry.
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Espectroscopía de Resonancia por Spin del Electrón , Oximetría/instrumentación , Oxígeno/metabolismo , Porfirinas/química , Marcadores de Spin , Animales , Cristalización , Femenino , Ratones , Ratones Endogámicos C3H , Ratas , Ratas Endogámicas F344RESUMEN
Stem cells transplanted to the ischemic myocardium usually encounter massive cell death within a few days of therapy. Hypoxic preconditioning (HPC) is currently employed as a strategy to prepare stem cells for increased survival and engraftment in the heart. However, HPC of stem cells has provided varying results, supposedly due to the differences in the oxygen concentration, duration of exposure, and passage conditions. In the present study, we determined the effect of HPC on rat mesenchymal stem cells (MSCs) exposed to 0.5% oxygen concentration for 24, 48, or 72 h. We evaluated the expression of prosurvival, proangiogenic, and functional markers such as hypoxia-inducible factor-1α, VEGF, phosphorylated Akt, survivin, p21, cytochrome c, caspase-3, caspase-7, CXCR4, and c-Met. MSCs exposed to 24-h hypoxia showed reduced apoptosis on being subjected to severe hypoxic conditions. They also had significantly higher levels of prosurvival, proangiogenic, and prodifferentiation proteins when compared with longer exposure (72 h). Cells taken directly from the cryopreserved state did not respond effectively to the 24-h HPC as those that were cultured under normoxia before HPC. Cells cultured under normoxia before HPC showed decreased apoptosis, enhanced expression of connexin-43, cardiac myosin heavy chain, and CD31. The preconditioned cells were able to differentiate into the cardiovascular lineage. The results suggest that MSCs cultured under normoxia before 24-h HPC are in a state of optimal expression of prosurvival, proangiogenic, and functional proteins that may increase the survival and engraftment in the infarct heart. These results could provide further insights into optimal preparation of MSCs which would greatly influence the effectiveness of cell therapy in vivo.
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Precondicionamiento Isquémico Miocárdico , Trasplante de Células Madre Mesenquimatosas/métodos , Células Madre Mesenquimatosas/metabolismo , Neovascularización Fisiológica , Animales , Apoptosis , Caspasa 3/análisis , Caspasa 7/análisis , Hipoxia de la Célula , Línea Celular , Conexina 43/análisis , Citocromos c/análisis , Corazón , Subunidad alfa del Factor 1 Inducible por Hipoxia/análisis , Proteínas Asociadas a Microtúbulos/análisis , Cadenas Pesadas de Miosina/análisis , Molécula-1 de Adhesión Celular Endotelial de Plaqueta/análisis , Proteínas Proto-Oncogénicas c-akt/análisis , Proteínas Proto-Oncogénicas c-met , Ratas , Receptores CXCR4/análisis , Survivin , Factor A de Crecimiento Endotelial Vascular/análisis , Proteínas de Unión al GTP rho/análisisRESUMEN
Stem cell therapy for myocardial tissue repair is limited by the poor survival of transplanted cells, possibly because of inadequate supply of oxygen and nutrients. The purpose of this study was to assess the oxygenation level and functional recovery after allogenic transplantation of mesenchymal stem cells (MSC) in a rat model of myocardial infarction (MI). Myocardial oxygen tension (Po(2)) was measured by electron paramagnetic resonance oximetry using an implantable oxygen-sensing spin probe (OxySpin). MSCs incubated with OxySpins showed substantial uptake of the probe without affecting its oxygen sensitivity or calibration. The cells internalized with OxySpins were able to differentiate into osteogenic, adipogenic, cardiomyocyte, and endothelial cell lineages. The labeled cells tested positive for CD44 and CD29 markers and negative for the hematopoietic markers CD14 and CD45. For the in vivo studies, MI was induced in rats by permanently ligating the left anterior descending coronary artery. MSCs with OxySpins were transplanted in the infarct region of hearts. A significant increase in Po(2) was observed in the MSC group compared with the untreated MI group (18.1 +/- 2.6 vs. 13.0 +/- 1.8 mmHg, n = 4, P < 0.05) at 4 wk after transplantation. Echocardiography showed a significant improvement in ejection fraction and fraction shortening, which inversely correlated with the magnitude of fibrosis in the treated hearts. The cell-transplanted hearts also showed an increase in vascular endothelial growth factor level and capillary density in the infarct region. The study established our ability to measure and correlate changes in myocardial tissue oxygenation with cardiac function in infarcted rat hearts treated with MSCs.
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Trasplante de Células Madre Mesenquimatosas , Células Madre Mesenquimatosas/metabolismo , Infarto del Miocardio/cirugía , Miocardio/metabolismo , Consumo de Oxígeno , Oxígeno/metabolismo , Regeneración , Función Ventricular Izquierda , Animales , Diferenciación Celular , Proliferación Celular , Células Cultivadas , Modelos Animales de Enfermedad , Ecocardiografía , Espectroscopía de Resonancia por Spin del Electrón , Endocitosis , Fibrosis , Sondas Moleculares/metabolismo , Sondas Moleculares/toxicidad , Contracción Miocárdica , Infarto del Miocardio/metabolismo , Infarto del Miocardio/fisiopatología , Miocardio/patología , Neovascularización Fisiológica , Oximetría/métodos , Ratas , Ratas Endogámicas F344 , Recuperación de la Función , Volumen Sistólico , Factores de Tiempo , Trasplante HomólogoRESUMEN
Stem cell transplantation is a possible therapeutic option to repair ischemic damage to the heart. However, it is faced with a number of challenges including the survival of the transplanted cells in the ischemic region. The present study was designed to use stem cells preconditioned with trimetazidine (1-[2,3,4-trimethoxybenzyl]piperazine; TMZ), a widely used anti-ischemic drug for treating angina in cardiac patients, to increase the rate of their survival after transplantation. Bone marrow-derived rat mesenchymal stem cells (MSCs) were subjected to a simulated host tissue environment by culturing them under hypoxia (2% O(2)) and using hydrogen peroxide (H(2)O(2)) to induce oxidative stress. MSCs were preconditioned with 10 microM TMZ for 6 h followed by treatment with 100 microM H(2)O(2) for 1 h and characterized for their cellular viability and metabolic activity. The preconditioned cells showed a significant protection against H(2)O(2)-induced loss of cellular viability, membrane damage, and oxygen metabolism accompanied by a significant increase in HIF-1alpha, survivin, phosphorylated Akt (pAkt), and Bcl-2 protein levels and Bcl-2 gene expression. The therapeutic efficacy of the TMZ-preconditioned MSCs was evaluated in an in vivo rat model of myocardial infarction induced by permanent ligation of left anterior descending coronary artery. A significant increase in the recovery of myocardial function and up-regulation of pAkt and Bcl-2 levels were observed in hearts transplanted with TMZ-preconditioned cells. This study clearly demonstrated the potential benefits of pharmacological preconditioning of MSCs with TMZ for stem cell therapy for repairing myocardial ischemic damage.
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Ciclina D1/biosíntesis , Trasplante de Células Madre Mesenquimatosas , Células Madre Mesenquimatosas/efectos de los fármacos , Infarto del Miocardio/terapia , Estrés Oxidativo/efectos de los fármacos , Trimetazidina/uso terapéutico , Vasodilatadores/uso terapéutico , Animales , Western Blotting , Hipoxia de la Célula/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Modelos Animales de Enfermedad , Células Madre Mesenquimatosas/metabolismo , Infarto del Miocardio/metabolismo , Consumo de Oxígeno , Ratas , Ratas Endogámicas F344 , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Trimetazidina/administración & dosificación , Trimetazidina/farmacología , Vasodilatadores/administración & dosificación , Vasodilatadores/farmacologíaRESUMEN
We have developed a noninvasive EPR (electron paramagnetic resonance) oximetry, based on a new class of oxygen-sensing nano-particulate probe (LiNc-BuO), for simultaneous monitoring of stem-cell therapy and in situ oxygenation (partial pressure of oxygen, pO2) in a mouse model of acute myocardial infarction (AMI). AMI was induced by a permanent occlusion of left-anterior-descending (LAD) coronary artery. Skeletal myoblast (SM) cells were used for therapy. The oximetry probe was implanted in the mid-ventricular region using a needle. Tissue histological studies after 3 weeks of implantation of the probe revealed significant fibrosis, which was solely due to the needle track and not due to the probe particles. The feasibility of long-term monitoring of pO2 was established in control (non-infarct) group of hearts (> 3 months; pO2 = 15.0 +/- 1.2 mmHg,). A mixture of the probe with/without SM cells (1 x 10(5)) was implanted as a single injection in the infarcted region and the myocardial tissue pO2 at the site of cell therapy was measured for 4 weeks. The pO2 was significantly higher in infarcted hearts treated with SM cells (pO2 = 3.5 +/- 0.9 mmHg) compared to untreated hearts (pO2 = 1.6 +/- 0.7 mmHg). We have demonstrated, for the first time, the feasibility of monitoring pO2 in mouse hearts after stem cell therapy.
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Modelos Animales de Enfermedad , Espectroscopía de Resonancia por Spin del Electrón/métodos , Infarto del Miocardio/fisiopatología , Oxígeno/análisis , Trasplante de Células Madre , Animales , Técnicas de Cultivo de Célula , Células Cultivadas , Medios de Cultivo , Estudios de Factibilidad , Miembro Posterior , Masculino , Ratones , Ratones Endogámicos C57BL , Mioblastos Esqueléticos/metabolismo , Mioblastos Esqueléticos/trasplante , Infarto del Miocardio/etiología , Infarto del Miocardio/metabolismo , Infarto del Miocardio/patología , Miocardio/metabolismo , Miocardio/patología , Oximetría , Consumo de Oxígeno , Presión Parcial , Factores de TiempoRESUMEN
It is unclear whether oxygen plays a role in stem cell therapy. Hence, the determination of local oxygenation (Po(2)) in the infarct heart and at the site of transplantation may be critical to study the efficacy of cell therapy. To demonstrate this, we have developed an oxygen-sensing paramagnetic spin probes (OxySpin) to monitor oxygenation in the region of cell transplantation using electron paramagnetic resonance (EPR) spectroscopy. Skeletal myoblast (SM) cells isolated from thigh muscle biopsies of mice were labeled with OxySpin by coculturing the cells with submicron-sized (270 +/- 120 nm) particulates of the probe. Myocardial infarction was created by left coronary artery ligation in mice. Immediately after ligation, labeled SM cells were transplanted in the ischemic region of the heart. The engraftment of the transplanted cells and in situ Po(2) in the heart were monitored weekly for 4 wk. EPR measurements revealed the retention of cells in the infarcted tissue. The myocardial Po(2) at the site of SM cell therapy was significantly higher compared with the untreated group throughout the 4-wk period. Histological studies revealed differentiation and engraftment of SM cells into myotubes and increased incidence of neovascularization in the infarct region. The infarct size in the treated group was significantly decreased, whereas echocardiography showed an overall improvement in cardiac function when compared with untreated hearts. To our knowledge, this the first report detailing changes in in situ oxygenation in cell therapy. The increased myocardial Po(2) positively correlated with neoangiogenesis and cardiac function.
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Espectroscopía de Resonancia por Spin del Electrón/métodos , Mioblastos Esqueléticos/trasplante , Contracción Miocárdica , Infarto del Miocardio/cirugía , Oxígeno/metabolismo , Trasplante de Células Madre , Animales , Diferenciación Celular , Proliferación Celular , Células Cultivadas , Vasos Coronarios/cirugía , Modelos Animales de Enfermedad , Estudios de Factibilidad , Miembro Posterior , Ligadura , Imagen por Resonancia Magnética , Masculino , Ratones , Ratones Endogámicos C57BL , Fibras Musculares Esqueléticas/metabolismo , Mioblastos Esqueléticos/metabolismo , Infarto del Miocardio/metabolismo , Infarto del Miocardio/patología , Infarto del Miocardio/fisiopatología , Neovascularización Fisiológica , Consumo de Oxígeno , Presión Parcial , Reproducibilidad de los Resultados , Factores de Tiempo , Función Ventricular Izquierda , Remodelación VentricularRESUMEN
We report the labeling (internalization) of skeletal myoblasts (SMs) with a novel class of oxygen-sensing paramagnetic spin probe for noninvasive tracking and in situ monitoring of oxygenation in stem cell therapy using electron paramagnetic resonance (EPR) spectroscopy. SM cells were isolated from thigh muscle biopsies of mice and propagated in culture. Labeling of SM cells with the probe was achieved by coincubating the cells with submicron-sized (270 +/- 120 nm) particulates of the probe in culture for 48 h. The labeling had no significant effect on the viability or proliferation of the cells. The SM cells labeled with the probe were transplanted in the infarcted region of mouse hearts. The engraftment of the transplanted cells in the infarct region was verified by using MY-32 staining for skeletal myocytes. The in situ Po(2) in the heart was determined noninvasively and repeatedly for 4 wk after transplantation. The results showed significant enhancement of myocardial oxygenation at the site of cell transplant compared with untreated control. In conclusion, labeling of SM cells with the oxygen-sensing spin probe offers a unique opportunity for the noninvasive monitoring of transplanted cells as well as in situ tissue Po(2) in infarcted mouse hearts.
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Tratamiento Basado en Trasplante de Células y Tejidos/métodos , Corazón/fisiología , Corazón/fisiopatología , Músculo Esquelético/fisiología , Infarto del Miocardio/fisiopatología , Oxígeno/análisis , Animales , Técnicas de Cultivo de Célula , Supervivencia Celular , Espectroscopía de Resonancia por Spin del Electrón , Citometría de Flujo , Ratones , Modelos Animales , Músculo Esquelético/citología , Miocardio/citologíaRESUMEN
UNLABELLED: Hyperthyroidism in elderly patients is not to be under-evaluated, since it is characterized in such age range by particular clinical and prognostic features. Based upon literature survey and their clinical experience, the authors discuss in the present paper clinical, diagnostic and therapeutic problems of hyperthyroidism in geriatric patients. MATERIAL AND METHOD: In the period between 1978-2003 out of 1804 patients surgically treated for thyroid disease (non neoplastic in 1470 pts.), 180 subjects presented hyperthyroidism (17%). 36 were in geriatric age-range (mean age 76 yr.; 29 females and 7 males). 26 presented a Multinodular Toxic Goiter (72.2%), whereas 9 patients complained of Plummer Adenoma (25%); only 1 patient showed Basedow disease (2.7%). RESULTS: As far as ASA classification, there were 7 ASA I, 27 ASA II and 2 ASA III. Compression of digestive tract and/or respiratory airway represented a surgical indication in 15 patients (41.6%). 12 (33.4%) were operated due to predominant cardiac symptoms (tachycardia, atrial fibrillation). The remaining 9 patients (25%) were treated for the concomitance of atypical symptoms of hyperthyroidism. We performed 15 total thyroidectomy, 7 "near totally", 8 sub-total, 6 hemithyroidectomy in case of Plummer adenoma. Postoperative mortality was nihil; p.o. morbidity was 5.5% for medical conditions (pneumonia) and surgery-related (1 laryngeal recurrent paralysis and 1 hypoparathyroidism) in 5.5%. Post-operative follow-up, conducted at 6 and 12 months from the operation, showed regression of hyperthyroidism and regression or improvement of all clinical symptoms complained by the patient. CONCLUSION: Surgical treatment seems to be the only immediate and definitive cure for hyperthyroidism. Geriatric age does not seem to be a surgical contraindication.
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Hipertiroidismo/diagnóstico , Hipertiroidismo/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , TiroidectomíaRESUMEN
AIM: The authors report the preliminary results of a prospective comparison of IPOM (group A) and "open tension free" (group B) hernioplasty in 50 patients having a mono or bilateral primitive hernia. METHODS: In group A (26 patients) hernia repair was performed using "Gore-Tex DualMesh Plus biomaterial with holes Corduroy" and in group B (24 patients) using the patch and plug technique with Marlex prosthesis. RESULTS: No intraoperative complications occurred and, in group A, no conversion was necessary. Four minor complications were obser-ved in group A (10.8%): 3 seromas and 1 transient paresthesia; 5 in group B (16%): 4 hematomas and 1 wound infection (p=n.s.). In group A only 2 patients (7.6%) needed analgesics after the first 24 hours and 12 patients (50%) in group B (p<0.001). Mean resumption of normal activity was 8 days in group A and 17 days in group B (p<0.001). At a 12-month-follow-up, no recurrence was reported in both groups. CONCLUSIONS: The results of this prospective randomized study show that IPOM may be not only a feasible and effective procedure in the treatment of recurrent and bilateral hernia or when hernia repair is performed during other laparoscopic procedures, but also in particular cases of primitive hernia such as in very active young males or heavy duty workers. However it is necessary to definitely ascertain the true incidence of recurrence in non limited series and in longer follow-up and the preliminary results of this study encourage the authors to complete the randomized study.
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Hernia Inguinal/cirugía , Laparoscopía/métodos , Mallas Quirúrgicas , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND: The aim of the study was to demonstrate the importance of early laparoscopic cholecystectomy for acute cholecystitis. METHODS: From 1998 to 2000, 66 patients were submitted to laparoscopic cholecystectomy. All patients were submitted to US scans preoperatively and operated on by surgeon skilled in emergency laparoscopic operative technique. RESULTS: Only one patient (1.5%) had conversion to open cholecystectomy. There was no mortality and no bile duct or major vascular injuries. The overall operative morbidity rate was 3%. The mean postoperative hospital stay was 3.1 days. CONCLUSIONS: Author's experience and results support the validity of early laparoscopic cholecystectomy in the treatment of acute cholecystitis, since it reduces the postoperative length of hospital stay and hospital costs. Early treatment is always helpful for inflamed and oedematous tissue which favours dissection.
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Colecistectomía Laparoscópica , Colecistitis/cirugía , Enfermedad Aguda , Adulto , Anciano , Colecistectomía Laparoscópica/economía , Colecistectomía Laparoscópica/estadística & datos numéricos , Urgencias Médicas , Femenino , Costos de Hospital , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Resultado del TratamientoRESUMEN
The authors report their experience on laparoscopic hernioplasty using the Intraperitoneal Onlay Mesh Repair (IPOM) in 56 patients. 34 patients had a bilateral hernia, 6 of which were recurrent and 22 had a monolateral hernia, of which 9 had recurrent hernia. Overall, a total of 90 hernias were treated. The hernia repair was performed utilizing "GORE-TEX DualMesh Plus biomaterial with holes" in the first 32 cases and the latest "...Corduroy" type in the remaining 24 cases. The prostheses were fixed with titanium spiral tacks (Protack, AutoSuture, Tyco Healthcare). No intraoperative complications occurred and no conversion was necessary. Five minor post-operative complications (5.5%), 2 seromas and 3 transient paresthesias, were observed. Four patients (7.1%) needed analgesics after the first 24 hours. Mean hospital stay was 36 hours, with a minimum of 24 and a maximum of 48. Mean resumption of normal activity was 8 days with return to work within two weeks. At an average 18 months follow-up, 3 recurrences were recorded (3.3%). The results of this study as well as the meta-analysis of the series presented in the Literature, indicate that the IPOM may be a feasible, safe and effective procedure in the treatment of recurrent and bilateral hernias or when a hernia repair is performed during other laparoscopic procedures. The IPOM has infact been shown to be faster and easier than the other more commonly performed laparoscopic hernioplasties (TAPP and TEP). These data may also suggest to utilize this technique in particular cases of primitive hernia such as very active young males or heavy duty workers. However the limited series and the short follow-up ask for randomized prospective long term studies to definitely ascertain the true incidence of recurrence and therefore the effectiveness of this attractive procedure.
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Hernia Inguinal/cirugía , Laparoscopía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Parastomal hernia is a frequent complication of stoma surgery. The results of parastomal hernia repair however are poor, showing an high incidence of postoperative recurrences. In the last years, hernia repair with prosthetic mesh has given better postoperative results. The parastomal hernia, however, is associated with middle incisional hernia. The authors review the problem of surgical repair of parastomal hernia and report a case of recurrent parastomal hernia associated to middle incisional hernia. The technique of surgical repair using, through midline incision, one, wide, prosthetic polypropylene mesh, in sublay position, according to Rives' technique, is described. The mesh has been incised in a trasverse direction for the stoma crossing. At 6 years follow-up the patient does not show postoperative recurrence. According literature and the authors' results, the parastomal hernia might be considered an incisional hernia and, therefore, a sing of diffuse abdominal wall disease. The Rives' surgical technique might be the gold standard for treatment of parastomal hernia, even if not associated to incisional hernia. The more complexity of Rives' technique compared to local fascial mesh repair is compensated by the result of total abdominal wall reinforcement.
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Colostomía , Hernia Ventral/etiología , Hernia Ventral/cirugía , Anciano , Estudios de Seguimiento , Humanos , Masculino , Polipropilenos , Recurrencia , Mallas Quirúrgicas , Factores de TiempoRESUMEN
Tufted angiomas are rare lesions described as slowly growing/spreading erythematous macules especially located in the upper trunk and neck. Herein we report the case of perianal location of a tufted angioma in a young pregnant woman. She came to our observation complaining of perianal pain accompanied by bleeding at defecation. A lesion resembling a perianal fissure was observed. Mild hypertonia of the internal sphincter was confirmed at manometry. After one week of ineffective medical treatment, surgery was planed at the end of the sixteenth week under local anaesthesia. The lesion was excised and a minimal sphincterotomy was performed; histopathology report described features of a tufted angioma. The pregnancy proceeded regularly, without anal symptoms, followed by normal vaginal delivery at the thirty-eighth week. This case showed three peculiar features: the association of tufted angioma and pregnancy, the perianal location, and the clinical appearance suggestive of an anal fissure. The clinical manifestation of a perianal tufted angioma, mimicking an anal fissure, is of utmost importance to the differential diagnosis and treatment plan, especially in a pregnant woman.
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Canal Anal/patología , Canal Anal/cirugía , Fisura Anal/patología , Hemangioma/patología , Hemangioma/cirugía , Complicaciones del Embarazo/patología , Complicaciones del Embarazo/cirugía , Adulto , Diagnóstico Diferencial , Femenino , Humanos , EmbarazoRESUMEN
BACKGROUND: Gallstone disease is the most common surgical indication in the elderly. Post-operative prognosis is severe in elderly with acute cholecystitis. Aim of this paper is to investigate the factors responsible for the severe prognosis and to detect how it could be improved. METHODS: One hundred fifty-seven patients, aged between 70 and 85 years (average 82 years), undergoing cholecystectomy between the years 1990 and 2000 have been studied; 65 patients (group A) had acute cholecystitis; 92 (group B) had uncomplicated gallbladder stones. RESULTS: Acute cholecystitis was the first symptom of gallstone disease in 69.2%. Laparocholecystectomy was performed in 31 cases (47.6%) of group A and in 58 cases (63.7%) of group B. In those cases with acute cholecystitis the postoperative morbidity (18.4%) was higher than in group B (1.0%), (A vs B: chi(2)=15.3; p<0.001). Similarly, postoperative mortality was higher (6.1% vs 1.0%; chi(2)=3.2; p<0.05) The severe postoperative prognosis was correlated significantly to index ASA (ASA II vs IV: chi(2)=7.0; p<0.001) but not to the technique adopted for cholecystectomy (VLC vs open: (chi)2=0.01; p=n.s.). The results obtained seem to confirm that the high incidence of postoperative complications in acute cholecystitis is due to the presence of associated diseases in elderly patients accompanied by the septic state. CONCLUSIONS: Early colecystectomy, in those cases with symptomatic, uncomplicated gallstone disease, might avoid severe postoperative prognosis in the elderly.
Asunto(s)
Colecistitis , Enfermedad Aguda , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , MasculinoRESUMEN
Diagnostic and therapeutic laparoscopy is a safe procedure, which, however, is not without complications. The rare occurrence of subcutaneous emphysema, as a consequence of pneumoperitoneum, following laparoscopic cholecystectomy, is reported. The mechanism for the development of this complication and its management are discussed.
Asunto(s)
Colecistectomía Laparoscópica/efectos adversos , Complicaciones Intraoperatorias/etiología , Neumoperitoneo Artificial/efectos adversos , Enfisema Subcutáneo/etiología , Cirugía Asistida por Video , Colecistectomía Laparoscópica/métodos , Femenino , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: Early laparoscopy plays a very important role in the diagnosis and treatment of uncertain surgical diseases. Its use is not very clear, in part because it is a very new technique and secondly because its application in emergency surgery is very recent. The aim of this study is to evaluate the efficacy of this surgical approach. METHODS: In the last six years, during emergency laparoscopy, we diagnosed various gynaecological diseases. We performed 4 ovarian cystectomies (25%), 2 salpingectomies (12.5%), 6 salpingo-oophorectomies (37.5%), 2 myomectomies (18.75%), 1 endocoagulation (6.25%). RESULTS: Neither conversion in open surgery, nor major postoperatory complications were noted. Intervention time was shorter than that of the open technique. Return to normal activity was earlier. CONCLUSIONS: The results of this study contribute to demonstrate that, in emergency surgery, laparoscopy constitute a valid and efficient diagnostic and therapeutic technique. It is indicated for the treatment of acute abdomen of unknown origin.
Asunto(s)
Enfermedades de los Genitales Femeninos/cirugía , Laparoscopía , Adulto , Anciano , Anciano de 80 o más Años , Urgencias Médicas , Endometriosis/cirugía , Femenino , Fibroma/cirugía , Estudios de Seguimiento , Humanos , Leiomioma/cirugía , Persona de Mediana Edad , Quistes Ováricos/cirugía , Enfermedades del Ovario/cirugía , Embarazo , Embarazo Tubario/cirugía , Factores de Tiempo , Neoplasias Uterinas/cirugíaRESUMEN
BACKGROUND: Acute biliary pancreatitis (ABP) still retains high morbidity (15-50%) and mortality (20-35%). Therefore it appears to be crucial to clearly assess the aetiological factors (50% of idiopathic are in fact biliary pancreatitis) and to establish their severity in order to plan the appropriate treatment. METHODS: 58 ABP patients were diagnosed by ultrasound (77.5%) or by laboratory findings (22.4%). Following Ranson and APACHE II scoring 17 cases (29.3%) were classified as severe, 41 (70.6%) as mild. All patients with severe ABP, had emergency ERCP + ES (within 24-48 hrs) followed by LC (< or = 10 days). Patients with mild ABP had LC within 10 days; in these cases IOC was always done. RESULTS: In severe cases operative endoscopy cured pancreatic inflammation in 12 cases. Subsequent LC never showed serious morbidity, apart from subcutaneous emphysema in one case. In 5 cases laparotomy was required since pancreatic necrosis was present, with 60% mortality. In patients with mild pancreatitis LC was successfully performed in all cases, with 7.3% morbidity. IOC showed choledochal stones in 31.7% of cases, while in severe cases stones in the biliary tree were shown in 88.2% of cases. CONCLUSIONS: In conclusion ABP treatment is always surgical, and almost always with minimally-invasive procedures in severe cases (ERCP + ES with LC < or = 10 days) if surgery is performed within 24-48 hrs as well as in mild cases (LC + IOC) when surgery is done within 10 days.
Asunto(s)
Colecistectomía Laparoscópica , Colelitiasis/complicaciones , Pancreatitis/diagnóstico , Pancreatitis/cirugía , APACHE , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Colangiopancreatografia Retrógrada Endoscópica , Colelitiasis/diagnóstico , Colelitiasis/cirugía , Urgencias Médicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Pancreatitis/etiología , Índice de Severidad de la EnfermedadRESUMEN
Hypocholesterolemia seems to represent a significant predictive factor of morbidity and mortality in critically ill patients. The authors, on the basis of recent literature data, aim to clarify the possible correlation between preoperative hypocholesterolemia and the risk of septic postoperative complications .205 patients undergoing to surgery for gastrointestinal diseases were the object of the study. Patients undergoing "minor" abdominal surgery or video-laparoscopic surgery and classified ASA III-IV were excluded. In all the patients, we considered retrospectively risk factors for postoperative septic complications as follows: preoperative blood concentration of cholesterol, malnutrition, obesity, diabetes, neoplasm, preoperative sepsis, type and duration of operations, antibiotics and regimen of use. Type and incidence of postoperative local or systemic septic complications were recorded. The patients have been stratified according to blood concentration of cholesterol and to the presence or absence of other risk factors. The incidence of postoperative sepsis was 35.1%. The highest incidence of postoperative septic complications (72.7%) was encountered, significantly (X2 = 7.6, p < 0.001), in the patients (11 cases, 5.9%) with cholesterol levels below 105 mg/dl). The results of this study seems to indicate a significant relationship between preoperative hypocholesterolemia and the incidence of septic complications after surgery. Moreover, evaluation of blood cholesterol levels before major surgery might represent a predictive factor of septic risk in the postoperative period.