Amoebic toxic colitis: analysis of factors related to mortality.

BACKGROUND: Toxic or fulminant colitis due to Entamoeba histolytica infrequently presents but is very serious. Unfortunately, there are numerous contradictory factors related to mortality. METHODS: We analyzed several cases of E. histolytica infection to determine the factors related to mortality. We included patients >15 years of age who were histopathologically diagnosed with amoebic toxic colitis and treated from January 2000 through December 2006. We evaluated demographic, clinical, laboratorial, surgical, and histopathological characteristics. RESULTS: We examined 24 patients and recorded 12 deaths (50%). Twenty patients underwent surgery within a mean time of 24 hours (range: 8-120 hours). Tenesmus and intestinal perforation were determined to be statistically significant (P<0·05) by univariate analysis. Three models of logistic regression were able to determine three statistically significant factors that affected mortality: (1) tenesmus and a lymphocyte count <1·5×10(3) cell/µl; 2) depth of invasion beyond the mucosa and a lymphocyte count <1·5×10(3) cell/µl; 3) time spent with symptoms and perforation. CONCLUSIONS: The mortality rate determined in this study is similar to previously reported series. A low lymphocyte count, significant depth of invasion, and intestinal perforation were determined to be the factors related to increased mortality, while tenesmus and limited amount of time spent with symptoms were associated with survival. Quick diagnosis and appropriate treatment are important factors that reduce mortality.

Primary closure in colon trauma.

BACKGROUND: Primary repair of colon injuries is an accepted therapeutic option; however, controversy persists regarding its safety. Our objective was to report the evolution and presence of complications in patients with colon injury who underwent primary closure and to determine if the time interval (>6 h), degree of injury, contamination, anatomic site injured, PATI (Penetrating Abdominal Trauma Index) >25, and the presence of other injuries in colon trauma are associated with increased morbidity and mortality. METHODS: This was a prospective, observational, longitudinal and descriptive study conducted at the Central Hospital "Dr. Ignacio Morones Prieto," San Luis Potosí, Mexico, from January 1, 2003 to December 31, 2007. We included patients with abdominal trauma with colon injury subjected to surgical treatment. chi(2) was used for basic statistical analysis. RESULTS: There were 481 patients with abdominal trauma who underwent surgery; 77(16.1%) had colon injury. Ninety percent (n = 69) were treated in the first 6 h; 91% (n = 70) were due to penetrating injuries, and gunshot wound accounted for 48% (n = 37). Transverse colon was the most frequently injured (38%) (n = 29). Grade I and II injuries accounted for 75.3% (n = 58). Procedures included primary repair (76.66 %) (n = 46); resection with anastomosis (8.3%) (n = 5); and colostomy (15%) (n = 9). Associated injuries were present in 76.6% (n = 59). There was some degree of contamination in 85.7% (n = 66); 82.8% (58) had PATI <25. Complications associated with the surgical procedure were observed in 28.57% (n = 22). Reoperation was necessary in 10% (n = 8). Average hospital stay was 11.4 days. Mortality was 3.8% (n = 3); none of these were related to colon injury. CONCLUSIONS: Primary repair is a safe procedure for treatment of colon injuries. Patients with primary repair had lower morbidity (p <0.009). Surgery during the first 6 h (p <0.006) and in hemodynamically stable patients (p <0.014) had a lower risk of complications.

Cierre primario en trauma de colon / Primary closure in colon trauma

Objetivo: Informar si la evolución > 6 horas, grado de contaminación y lesión, sitio anatómico lesionado, PATI (penetrating abdominal trauma index) > 25 y presencia de otras lesiones en trauma de colon, se asocian a mayor morbimortalidad en pacientes con lesión colónica a quienes se les realizó cierre primario. Material y métodos: Estudio prospectivo, observacional, longitudinal, descriptivo, en el Hospital Central “Dr. Ignacio Morones Prieto”, San Luis Potosí. Se incluyeron pacientes con trauma abdominal sometidos a cirugía que presentaron lesión colónica. Análisis estadístico básico con χ2. Resultados: 481 pacientes fueron intervenidos por trauma abdominal; 77 (16.1 %) tuvieron lesión colónica, de los cuales 90 % (n = 69) se intervino en las primeras seis horas; 91 % fue lesión penetrante. El colon transverso fue el más lesionado (38 %, n = 29); las lesiones grado I y II representaron 75.3 % (n = 58). Se efectuó cierre primario en 76.66 % (n = 46), resección con anastomosis en 8.3 % (n = 5) y colostomía en 15 % (n = 9). Hubo lesiones asociadas en 76.6 % (n = 59) y contaminación en 85.7 % (n = 66); 82.8 % (58) tuvo PATI < 25; complicaciones asociadas al procedimiento operatorio, 28.57 % (n = 22); reintervenciones, 10 % (n = 8); estancia hospitalaria promedio, 11.4 días; mortalidad no relacionada a lesión de colon, 3.8 % (n = 3). Conclusiones: El cierre primario es un procedimiento seguro para el tratamiento de lesiones colónicas. Los pacientes con cierre primario presentaron menor morbilidad (p < 0.009). Los pacientes con cirugía en las primeras seis horas (p < 0.006) y estabilidad hemodinámica (p < 0.014) tuvieron menor riesgo de complicación.

BACKGROUND: Primary repair of colon injuries is an accepted therapeutic option; however, controversy persists regarding its safety. Our objective was to report the evolution and presence of complications in patients with colon injury who underwent primary closure and to determine if the time interval (>6 h), degree of injury, contamination, anatomic site injured, PATI (Penetrating Abdominal Trauma Index) >25, and the presence of other injuries in colon trauma are associated with increased morbidity and mortality. METHODS: This was a prospective, observational, longitudinal and descriptive study conducted at the Central Hospital "Dr. Ignacio Morones Prieto," San Luis Potosí, Mexico, from January 1, 2003 to December 31, 2007. We included patients with abdominal trauma with colon injury subjected to surgical treatment. chi(2) was used for basic statistical analysis. RESULTS: There were 481 patients with abdominal trauma who underwent surgery; 77(16.1%) had colon injury. Ninety percent (n = 69) were treated in the first 6 h; 91% (n = 70) were due to penetrating injuries, and gunshot wound accounted for 48% (n = 37). Transverse colon was the most frequently injured (38%) (n = 29). Grade I and II injuries accounted for 75.3% (n = 58). Procedures included primary repair (76.66 %) (n = 46); resection with anastomosis (8.3%) (n = 5); and colostomy (15%) (n = 9). Associated injuries were present in 76.6% (n = 59). There was some degree of contamination in 85.7% (n = 66); 82.8% (58) had PATI <25. Complications associated with the surgical procedure were observed in 28.57% (n = 22). Reoperation was necessary in 10% (n = 8). Average hospital stay was 11.4 days. Mortality was 3.8% (n = 3); none of these were related to colon injury. CONCLUSIONS: Primary repair is a safe procedure for treatment of colon injuries. Patients with primary repair had lower morbidity (p <0.009). Surgery during the first 6 h (p <0.006) and in hemodynamically stable patients (p <0.014) had a lower risk of complications.

Neumotórax espontáneo en el embarazo: presentación de un caso / Spontaneous pneumothorax in pregnancy: case report

Introducción: el neumotórax espontáneo es poco frecuente durante el embarazo. La causa más común es la ruptura de una bula o burbuja subpleural apical a causa de incremento en la demanda respiratoria durante el periodo periparto. El principal riesgo materno es compromiso respiratorio; los riesgos fetales, reducción en el aporte de oxígeno y trabajo de parto pretérmino. El riesgo de recurrencia es de 30 a 40 %, particularmente durante el trabajo de parto. El tratamiento se basa en la magnitud del neumotórax; hasta 75 % de los casos se trata con pleurostomía cerrada. Caso clínico: mujer de 22 años de edad, segundo embarazo intrauterino, de 24.2 semanas de gestación, sin antecedente de tabaquismo ni otras toxicomanías, sin sintomatología respiratoria ni historia de neumotórax previo. Presentó dolor pleurítico en hemitórax derecho de inicio súbito, transfictivo y pungitivo, acompañado de disnea. A la exploración física, síndrome de rarefacción pulmonar, sin compromiso obstétrico. La radiografía simple de tórax en proyección posteroanterior mostró neumotórax derecho con colapso pulmonar total. Conclusiones: debe considerarse el diagnóstico en casos de dolor torácico y disnea durante el embarazo y trabajo de parto. El caso reseñado se manejó conservadoramente de manera exitosa con drenaje intercostal a mediano plazo, sin recurrencia ni complicaciones.

BACKGROUND: Spontaneous pneumothorax is a rare condition during pregnancy. The most common cause is the rupture of a subpleural apical bulla or bleb, due to the increased respiratory demand of the peripartum period. The main risk for the mother is respiratory compromise; fetal risks include reduction in oxygen supply and preterm labor. The risk of recurrence is 30-40%, particularly during labor. Treatment is based on the magnitude of pneumothorax. Up to 75% of patients are treated with chest tube drainage. We present the case report of a previously healthy patient. CASE REPORT: Our patient was a 22-year-old female at 24.2 weeks of her second pregnancy. The patient was a non-smoker, had no history of any drug addictions, and no history of previous pulmonary disease. The patient presented with sudden onset of pleuritic right-sided pleuritic chest pain associated with dyspnea. Chest examination was notable for decreased breath sounds and hyperresonance over the right hemithorax. Chest radiography showed right spontaneous pneumothorax with total lung collapse. CONCLUSIONS: Diagnosis of pneumothorax should be considered in any pregnant woman with chest pain and dyspnea. The presented case was successfully treated with closed intercostal chest tube thoracostomy for 7 weeks.

[Spontaneous pneumothorax in pregnancy. Case report]. / Neumotórax espontáneo en el embarazo. Presentación de un caso.

BACKGROUND: Spontaneous pneumothorax is a rare condition during pregnancy. The most common cause is the rupture of a subpleural apical bulla or bleb, due to the increased respiratory demand of the peripartum period. The main risk for the mother is respiratory compromise; fetal risks include reduction in oxygen supply and preterm labor. The risk of recurrence is 30-40%, particularly during labor. Treatment is based on the magnitude of pneumothorax. Up to 75% of patients are treated with chest tube drainage. We present the case report of a previously healthy patient. CASE REPORT: Our patient was a 22-year-old female at 24.2 weeks of her second pregnancy. The patient was a non-smoker, had no history of any drug addictions, and no history of previous pulmonary disease. The patient presented with sudden onset of pleuritic right-sided pleuritic chest pain associated with dyspnea. Chest examination was notable for decreased breath sounds and hyperresonance over the right hemithorax. Chest radiography showed right spontaneous pneumothorax with total lung collapse. CONCLUSIONS: Diagnosis of pneumothorax should be considered in any pregnant woman with chest pain and dyspnea. The presented case was successfully treated with closed intercostal chest tube thoracostomy for 7 weeks.