Utilidad del índice de Mannheim en pacientes con peritonitis difusa. 2012 -2014 / Usefulness of the Mannheim index in patients with diffuse peritonitis. 2012 -2014

Evaluar la viabilidad y utilidad del uso del índice de Mannheim en pacientes con peritonitis difusa como predictor de mortalidad en el Servicio de Cirugía General del Hospital Dr. Luis Razetti de Barinas, Venezuela. Métodos: Estudio observacional, descriptivo y transversal, enmarcado en una investigación epidemiológica de campo no experimental, del 01 de enero 2012 hasta 30 junio 2014. Resultados: Se incluyeron 156 pacientes, 88 hombres (56,4 %) y 68 mujeres (43,6 %), con una edad promedio de 49,44 años. Índice de Mannheim promedio de 27,21 puntos. Mortalidad general de 22,4 % (35 fallecidos). Setenta y cuatro pacientes con puntaje menor de 26 y mortalidad específica de 1,35 %, 82 pacientes con puntaje mayor de 26 y mortalidad específica de 41,46 %. La falla orgánica estuvo en el 41,7% de los casos y en el 100 % de los fallecidos. Estancia hospitalaria promedio de 6,45 días. Sensibilidad del índice de Mannheim del 97,14 % y especificidad del 60,33 % como predictor de mortalidad. Conclusiones: el índice de peritonitis de Mannheim constituye una herramienta útil, reproducible y de fácil aplicación por el cirujano para el pronóstico de mortalidad en pacientes con peritonitis del Hospital Dr. Luis Razetti de Barinas, los pacientes con índice igual o mayor de 26 puntos presentan un peor pronóstico y mayor mortalidad, por lo que deben ir a sala de cuidados intermedios o críticos, aplicando y ajustando un adecuado manejo y tratamiento(AU)

To evaluate the feasibility and usefulness of the use of the Mannheimen index in patients with diffuse peritonitis as a predictor of mortality in the General Surgery Service of the Dr. Luis Razetti Hospital in Barinas, Venezuela. Method: Observational, descriptive and cross-sectional study, framed in a non-experimental field epidemiological investigation, from January 1, 2012 to June 30, 2014. Results: A total of 156 patients, 88 men (56.4 %) and 68 women (43.6 %), with an average age of 49.44 years. Average Mannheim index of 27.21 points. Overall mortality of 22.4 % (35 deaths). 74 patients with a score below 26 and specific mortality of 1.35 %, 82 patients with a score greater than 26 and a specific mortality of 41.46 %. Organic failure was in 41.7% of cases and 100 % of those killed. Hospital stay of 6.45 days on average. The study favors the Mannheim index as a predictor of mortality with a sensitivity of 97.14 %, and a specificity of 60.33 %. Conclusion: the Mannheim peritonitis index is a useful, reproducible and easily applied tool by the surgeon for the prognosis of mortality in patients with peritonitis, patients with an index equal to or greater than 26 points have a worse prognosis and higher mortality. what should go to the intermediate or critical care room, applying and adjusting proper management and treatment(AU)

Medicación prehospitalaria sin diagnóstico en los pacientes intervenidos por apendicitis aguda y suimpacto en la evolución hacia peritonitis / Prehospital medication without diagnosis in patients underwent to acute appendicitis and its impact on the evolution to peritonitis

Objetivo: Determinar el volumen de pacientes medicados previo a su ingreso a nuestro centro asistencial sin haberse establecido el diagnóstico de apendicitis aguda y su impacto en la evolución hacia peritonitis. Servicio de Cirugía del Hospital "Dr. Luis Razetti" de Barinas, 2014-2015.Métodos: Estudio observacional descriptivo Resultados: Un total de 506 pacientes, edad promedio 27,4años, masculinos 51,4%, tiempo promedio desde inicio de los síntomas hasta ingreso 21,29 horas y hasta la cirugía 30,8 horas.55,5% recibió atención médica previa al ingreso sin diagnóstico,49,6% en un centro de salud, 31,8% por médicos, 13% analgésicos no esteroideos, 12,6% antiespasmódicos, 9,9% analgésicos esteroideos, 7,1% analgésicos más antiespasmódicos. En el 33,1% delos casos se encontró algún grado de peritonitis. Conclusión: La medicación de los dolores abdominales sin diagnóstico retrasa el mismo y se refleja en un tratamiento quirúrgico tardío con incremento de la morbimortalidad y estadía hospitalaria(AU)

Objective: To determine the volume of medicated patients priorto joining our medical center without the diagnosis of acuteappendicitis and its impact have been established in the evolution towards peritonitis. Surgery Department of Hospital "Dr. Luis Razetti" Barinas, 2014-2015 Methods: Descriptive observational studyResults: A total of 506 patients, average age 27.4 years, 51.4% male, average time from on set of symptoms to admission 21.29 hours and up to 30.8 hours of surgery. 55.5% received medical attention un diagnosed before admission, 49.6% in a health center,31.8% of physicians, 13% nonsteroidal analgesics, antispasmodics 12.6 %, 9.9% steroidal analgesics 7, up 1% antispasmodic analgesics. In 33.1% of cases some degree of peritonitis was found. Conclusion: Medication undiagnosed abdominal pains and delays the same is reflected in a late surgical treatment with increased morbidity and hospital stay(AU)

Internal snapping hip syndrome: treatment by endoscopic release of the iliopsoas tendon.

PURPOSE: The internal snapping hip syndrome is caused by slippage of the iliopsoas tendon over the iliopectineal eminence or the femoral head. Open surgical techniques have been successfully used to treat this condition. More recently, endoscopic techniques have become available to address this problem. The purpose of this study was to investigate an endoscopic technique for release of the iliopsoas tendon and its short-term results. TYPE OF STUDY: Consecutive case series. METHODS: Six patients (7 hips) with an average age of 38.5 years had an endoscopic release of the iliopsoas tendon for internal snapping hip syndrome. Hip arthroscopy was performed in every patient. Special inferior portals were used for psoas bursoscopy. The iliopsoas tendon was identified and released at the level of the lesser trochanter in all cases. RESULTS: Intra-articular concomitant injuries were identified and treated in 4 cases. No snapping symptoms were present in any patient after surgery nor at the last follow-up at, on average, 21 months. Significant loss of flexion strength was present after surgery but had improved by 8 weeks. CONCLUSIONS: In our hands, the endoscopic technique for iliopsoas tendon release was effective and reproducible and our results compare well with results of open procedures in the short term. LEVEL OF EVIDENCE: Level IV.

Hip arthroscopy after previous acetabular osteotomy for developmental dysplasia of the hip.

PURPOSE: The purpose of this study was to examine the arthroscopic findings in the hips of patients with long-term follow-up of Chiari osteotomies. TYPE OF STUDY: Prospective consecutive series of patients. METHODS: Seven consecutive patients (1 male, 6 female; average age, 23 years) having a Chiari osteotomy performed in 1 hip during childhood or adolescence for developmental dysplasia of the hip were studied. They presented mechanical hip symptoms and had adequate head coverage as a result of the osteotomy with preservation of joint space. Hip arthroscopy was performed in all cases. RESULTS: A massive labral tear dislocated in the midportion of the joint was found in all cases with varying degrees of cartilage damage in the acetabulum or femoral head. The labral tear was resected, cartilage lesions were repaired, and microfracturing of the exposed subchondral bone was performed. Mechanical symptoms improved after surgery and all of the patients were able to go back to activities of daily living. CONCLUSIONS: In the Chiari osteotomy, medial displacement of the acetabulum leaves the labrum in the center of the load-bearing area of the resulting acetabulum. Over time this can produce a tear of the labrum, which may be the cause of the mechanical symptoms in our series. It has been documented that labral tears can lead to early degenerative hip disease and, combined with the cartilage lesions, may explain in part the long-term bad results of the Chiari osteotomy. LEVEL OF EVIDENCE: Level IV.

An aiming guide for anterior portal placement in hip arthroscopy.

Hip arthroscopy has become a standard surgical procedure. Specific portals and portal placement techniques are well described and routinely used. The anterior portal placement relies on the ability of the surgeon to introduce a needle into the joint from the landmark located at the crossing of a vertical line from the anterior superior iliac spine and a horizontal line from the greater trochanter. Directing the needle at 30 degrees medially and 45 degrees proximally is recommended, but some adjustment is always necessary to access the joint. Multiple punctures are often needed to place the needle in the correct path into the hip. This increases the risk of injury by puncture of the structures adjacent to the site of the anterior portal and increases surgical time. This study reports the use of a guide device we developed to assist anterior portal placement. The device consists of an intra-articular probe attached to an extra-articular aiming guide that introduces the needle into the hip joint. The needle enters at the previously described landmark and is directed towards the tip of the probe inside the joint. Early clinical results are presented.