Health care-related infections are frequent and among them surgical site infection (SSI) are the most frequent in hospitals. The objective was to evaluate the adequacy of antibiotic prophylaxis in patients undergoing neck surgery and its relationship with the incidence of surgical site infection (SSI). Prospective cohort study. The adequacy of antibiotic prophylaxis in patients undergoing neck surgery was evaluated. Antibiotic prophylaxis was considered adequate when it conformed to all items of the protocol (antibiotic used, time of administration, administration route, dose and duration). The cumulative incidence of SSI was calculated, and the relationship between SSI and antibiotic prophylaxis adequacy was determined using adjusted relative risk (RR). Antibiotic prophylaxis was administered in 63 patients and was adequate in 85.7% (95% CI 75.0-92.3) of them. The cumulative incidence of SSI was 6.4% (95% CI 3.4-11.8). There was no significant relationship between antibiotic prophylaxis inadequacy and the incidence of SSI (RR = 2.4, 95% CI 0.6-10.6). Adequacy of antibiotic prophylaxis was high and it did not affect the incidence of SSIs.
Anti-Bacterial Agents/therapeutic use , Neck/microbiology , Neck/surgery , Surgical Wound Infection/drug therapy , Aged , Antibiotic Prophylaxis/methods , Female , Humans , Incidence , Male , Prospective Studies , Surgical Wound Infection/microbiology
BACKGROUND: Surgical wound infection is one of the leading causes of healthcare-associated infections. One of the most common measures for its reduction is the pre-surgical preparation. The aim of this study was to evaluate the adequacy to the pre-surgical protocol in patients undergoing neck surgery and the relationship with the incidence of surgical wound infection. MATERIAL AND METHODS: Observational cohort study, conducted from January 2011 to December 2017. Variables related to patient, pre-surgical preparation and infection were collected. Infection rate was calculated after a maximum period of 30days after surgery. The effect of the pre-surgical preparation's adequacy and infection was evaluated. RESULTS: The study included 131 patients. The global adequacy of the pre-surgical protocol was 84.7%, being the main cause of inadequacy the application of the mouthwash (7.6% of the interventions). The overall incidence of surgical wound infection during the follow-up period was 4.6% (95%CI: 1.0%-8.2%). No relationship between the adequacy to the protocol and the presence of infection was found (P=.59). CONCLUSIONS: Adequacy of the pre-surgical preparation in our hospital was high and the incidence of surgical wound infection was low, and no relationship was found between the two. The results show a high safety culture in this surgery. However, there is still room for improvement in the quality of care of our patients.
Clinical Protocols/standards , Neck/surgery , Preoperative Care/standards , Quality Improvement , Quality of Health Care/standards , Surgical Wound Infection/prevention & control , Aged , Cohort Studies , Female , Humans , Incidence , Male , Middle Aged , Surgical Wound Infection/epidemiology
The type I Chiari malformation consists of an caudal descent of the cerebellar tonsils through the foramen magno towards the spinal cervical channel. The usual clinical presentation are occipital headaches and cervical pain, as well as some otoneurological symptoms. Among them are common dizziness and crisis of central positional vertigo in which down beating nystagmus can be observed. We present our experience with three cases presenting with neurotological manifestations in which MRI showed a type I Chiari malformation. Case 1: a patient of 24 years that had frequent instability, and common crisis ofpositional vertigo. It was possible to see the presence of positional down-beating nystagmus, of central characteristics, that improved after neurosurgical treatment. Case 2: patient of 11 years who suffered from occasional headaches, dizziness and positional vertigo, without severe handicap, and did not need surgery. Case 3: lady of 63 years who had common episodes of vertigo with head tilt, and unsteadiness during walks. Due to the coexistence of hydrocephalus and syringomyelia, surgery was indicated. A revision is done on otoneurological presentation of type I Chiari malformation, especially as differential diagnosis on central positional vertigo.
Arnold-Chiari Malformation/complications , Nystagmus, Pathologic/etiology , Vertigo/etiology , Adult , Arnold-Chiari Malformation/diagnosis , Arnold-Chiari Malformation/surgery , Child , Craniotomy , Decompression, Surgical , Electronystagmography , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Nystagmus, Pathologic/diagnosis , Nystagmus, Pathologic/therapy , Treatment Outcome , Vertigo/diagnosis , Vertigo/therapy
La malformación de Chiari tipo I consiste en un desplazamiento caudal de las amígdalas cerebelosas a través del foramen magno hacia el canal cervical espinal. La presentación clínica habitual de esta anomalía son las cefaleas y dolores cervicales, así como algunos síntomas otoneurológicos. Entre ellos son comunes los cuadros de inestabilidad y episodios de vértigo posicional central en los que se objetiva nistagmo vertical hacia abajo. Presentamos nuestra experiencia en tres casos con alteraciones otoneurológicas en los que la resonancia magnética craneal demostró el diagnóstico de malformación de Chiari tipo I. En primer lugar, una paciente de 24 años que consultó por un cuadro de inestabilidad habitual y frecuentes episodios de vértigo posicional, en los que presentaba nistagmo posicional hacia abajo, que mejoraron tras tratamiento neuroquirúrgico. En segundo lugar, un paciente de 11 años que presentó episodios esporádicos de cefalea, asociada a inestabilidad y vértigo posicional, sin incapacidad evidente, por lo que no se derivó para tratamiento quirúrgico. En tercer lugar, una paciente de 63 años que padecía crisis de vértigo con los movimientos cefálicos, así como inestabilidad en la marcha. Ante la coexistencia de hidrocefalia y siringomielia, se derivó a la paciente para tratamiento neuroquirúrgico. Realizamos una revisión de las alteraciones otoneurológicas con las que puede presentarse la malformación de Chiari tipo 1, especialmente como diagnóstico diferencial dentro de los cuadros de vértigo posicional central
The type I Chiari malformation consists of an caudal descent of the cerebellar tonsils through the foramen magno towards the spinal cervical channel. The usual clinical presentation are occipital headaches and cervical pain, as well as some otoneurological symptoms. Among them are common dizziness and crisis of central positional vertigo in which down beating nystagmus can be observed. We present our experience with three cases presenting with neurotological manifestations in which MRI showed a type I Chiari malformation. Case 1: a patient of 24 years that had frequent instability, and common crisis of positional vertigo. It was possible to see the presence of positional down-beating nystagmus, of central characteristics, that improved after neurosurgical treatment. Case 2: patient of 11 years who suffered from occasional headaches, dizziness and positional vertigo, without severe handicap, and did not need surgery. Case 3: lady of 63 years who had common episodes of vertigo with head tilt, and unsteadiness during walks. Due to the coexistence of hydrocephalus and syringomyelia, surgery was indicated. A revision is done on otoneurological presentation oftype I Chiari malformation, especially as differential diagnosis on central positional vertigo
Child , Adult , Middle Aged , Humans , Arnold-Chiari Malformation/complications , Nystagmus, Pathologic/etiology , Vertigo/etiology , Arnold-Chiari Malformation/diagnosis , Arnold-Chiari Malformation/surgery , Craniotomy , Decompression, Surgical , Electronystagmography , Nystagmus, Pathologic/diagnosis , Nystagmus, Pathologic/therapy , Treatment Outcome , Vertigo/diagnosis , Vertigo/therapy
Although newborn screening of congenital hearing loss through otoacustic emissions allow prompt recognition, imaging techniques, such as CT and MRI are needed to get a morphological diagnosis. Furthermore they can be very useful in unilateral cases, whose clinical presentation is belated and more insidious. Our aim is to show the utility of MRI in the study of inner ear congenital anomalies, whose presentation is belated. Thus from a series of 88 consecutive patients in which a MRI was performed as screening of assymetric sensorineural hearing loss, we selected 6 cases aged between 6 and 20. Four of them showed an inner ear anomaly on MRI. We present these anomalies commenting the findings on CT and MRI. Imaging techniques are required to start hearing rehabilitation programs early on patients with bilateral inner ear anomalies. But also they are very useful in the evaluation of unilateral assymetric sensorineural hearing loss, in young patients, even if only some frequencies are damned, to determine the nature of hearing loss.
Cerebellopontine Angle/pathology , Hearing Loss, Sensorineural/diagnosis , Magnetic Resonance Imaging , Adolescent , Child , Cochlea/abnormalities , Cochlea/physiopathology , Cochlear Diseases/classification , Cochlear Diseases/congenital , Cochlear Diseases/diagnosis , Cochlear Diseases/physiopathology , Female , Hearing Loss, Sensorineural/physiopathology , Humans , Male , Severity of Illness Index
Analysis of smell disturbances in the ENT outpatients department of in a General Hospital. A retrospective and descriptive study. We include all patients with olfactory alterations as the main reason for consultation. The sample was 38 patients. Viral, postraumatic, toxic, drug-induced and inflammatory. We performed anamnesis, nasal endoscopic and scan images on all patients. Olfactory disturbances were more frequent in women older than 55 (2:1). The viral cause was the most frequent aethiology (55.3%). Nasal endoscopic exploration was normal in 68.4% patients. The CT scan was the main imaging study used (68.4%). The younger patients recovered better than the older ones. Smell disorders provoked by virus, toxic and medical drugs do have a better.
Olfaction Disorders/epidemiology , Adult , Aged , Female , Humans , Male , Middle Aged , Olfaction Disorders/diagnosis , Otolaryngology , Retrospective Studies
We show a case of right neck abscess, in which the Eikenella corrodens, acted as pathogen together which other microorganism. We call attention to this germ that has a slow growing in culture and generally intervene in infections in which it is assumed the presence of anaerobic germs (intrathoracic abscess, neck abscess, etc.) and the are habitually treated with clindamycin, antibiotic which Eikenella corrodens is systematically resistant (to this antibiotic).
Abscess , Eikenella corrodens , Gram-Negative Bacterial Infections , Abscess/microbiology , Adult , Gram-Negative Bacterial Infections/microbiology , Humans , Male , Neck
