¿Se deben tratar quirúrgicamente las fracturas de extremidad inferior en pacientes con lesiones medulares crónicas? Experiencia en un centro de referencia / Should lower limb fractures be treated surgically in patients with chronic spinal injuries? Experience in a reference centre

Objetivo. Conocer los resultados del tratamiento quirúrgico de las fracturas de extremidad inferior en los pacientes con lesiones medulares crónicas. Material y método. Entre el 2003-2012 se trataron 37 fracturas de extremidad inferior, divididas en 2 grupos según su tratamiento, 25 en el grupo quirúrgico y 12 en el grupo conservador. Resultados. El grupo quirúrgico presentó mejores resultados en cuanto a balance articular, consolidación ósea, alineación radiológica y menor número de úlceras por presión. No se detectaron diferencias entre grupos en cuanto a estancia hospitalaria, número de complicaciones médicas y control del dolor. Discusión. Actualmente no hay consenso respecto al manejo de las fracturas de extremidad inferior en lesionados medulares crónicos, pero la tendencia ha sido el tratamiento conservador escudándose en la alta tasa de complicaciones del tratamiento quirúrgico. Conclusiones. En fracturas de extremidad inferior en lesionados medulares crónicos, la estabilización quirúrgica presenta mejores resultados de consolidación ósea, un balance articular prácticamente libre, una baja tasa de complicaciones cutáneas y dolor asociado a la fractura. Todo ello permite un rápido retorno al nivel previo de la lesión, por lo que se debe tener en cuenta como alternativa al tratamiento conservador (AU)

Objective. To report the outcomes of surgical treatment of lower limb fractures in patients with chronic spinal cord injuries. Material and method. A total of 37 lower limb fractures were treated from 2003 to 2010, of which 25 fractures were treated surgically and 12 orthopaedically. Results. Patients of the surgical group had better clinical results, range of motion, bone consolidation, and less pressure ulcers and radiological misalignment. No differences were detected between groups in terms of pain, hospital stay, and medical complications. Discussion. There is no currently consensus regarding the management of lower limb fractures in patients with chronic spinal cord injuries, but the trend has been conservative treatment due to the high rate of complications in surgical treatment. Conclusions. Chronic spinal cord injuries patients with lower limb fractures who are treated surgically achieved a more reliable consolidation, practically a free range of motion, low rate of cutaneous complications, and pain associated with the fracture. This allows a quick return to the previous standard of living, and should be considered as an alternative to orthopaedic treatment in these patients (AU)

Should lower limb fractures be treated surgically in patients with chronic spinal injuries? Experience in a reference centre. / ¿Se deben tratar quirúrgicamente las fracturas de extremidad inferior en pacientes con lesiones medulares crónicas? Experiencia en un centro de referencia.

OBJECTIVE: To report the outcomes of surgical treatment of lower limb fractures in patients with chronic spinal cord injuries. MATERIAL AND METHOD: A total of 37 lower limb fractures were treated from 2003 to 2010, of which 25 fractures were treated surgically and 12 orthopaedically. RESULTS: Patients of the surgical group had better clinical results, range of motion, bone consolidation, and less pressure ulcers and radiological misalignment. No differences were detected between groups in terms of pain, hospital stay, and medical complications. DISCUSSION: There is no currently consensus regarding the management of lower limb fractures in patients with chronic spinal cord injuries, but the trend has been conservative treatment due to the high rate of complications in surgical treatment. CONCLUSIONS: Chronic spinal cord injuries patients with lower limb fractures who are treated surgically achieved a more reliable consolidation, practically a free range of motion, low rate of cutaneous complications, and pain associated with the fracture. This allows a quick return to the previous standard of living, and should be considered as an alternative to orthopaedic treatment in these patients.

Exposure to medicines among patients admitted for hip fracture and the case-fatality rate at 1 year: a longitudinal study.

PURPOSE: To describe the demographic and clinical characteristics and the pre-fracture exposure to medicines of patients admitted for a hip fracture, and to explore their association with fatal outcome 1 year after the fracture. METHODS: All patients ≥ 65 years old admitted for a hip fracture in a tertiary hospital in Barcelona between January 1 and December 31 2007 were included. Data on the patients' clinical characteristics before and during hospital admission and on pre-fracture exposures to medicines were collected from the clinical records. One-year mortality was checked by approaching the patients and their families and was cross-checked with the national mortality statistics database. A Cox proportional hazards analysis was carried out. RESULTS: Four hundred and fifty-six patients [mean age (SD) 82.9 (7.2) years, 73.5 % female], were admitted with hip fracture during the study period. Almost 80 % of the patients (363, 79.6 %) had three or more associated conditions, and 41.7 % received pre-fracture treatment with five or more drugs. The case-fatality rate during hospital admission was 4.6 % (21 patients). One hundred and seven patients died within 1 year (23.5 %). Advanced age, male gender, two or more associated chronic conditions, cancer, severe cognitive impairment, and treatment with opiates before fracture were significantly associated with the risk of dying. An inverse association was recorded between mortality and pre-hospital exposure to medicines for osteoporosis. CONCLUSIONS: One-quarter of patients admitted for hip fracture died within 1 year after the fracture. Exposure to opiates before hip fracture was associated with an increased 1-year death rate, whereas treatment with drugs for osteoporosis was associated with a decrease in death rate. These results should be confirmed in studies with detailed prospective collection of information on exposure to medicines.

Differentiating between malignant and idiopathic pleural effusions: the value of diagnostic procedures.

BACKGROUND: Which diagnostic procedures should be used to differentiate between idiopathic and malignant pleural effusions, is not well established. AIM: To identify which parameters allow differentiation between idiopathic and malignant pleural effusions. DESIGN: Case-note review. METHODS: Over a 12-year period, we treated 1014 consecutive pleural effusion patients, of whom 346 were diagnosed as having an idiopathic or malignant aetiology. We analysed medical history, chest X-ray, pleural fluid analysis (biochemical, microbiological and cytological), chest CT scan and additional examinations that were used according to clinical findings, and compared them with the eventual diagnosis and outcome. RESULTS: Eighty-three patients with idiopathic effusions and 263 with malignant effusions were included. Idiopathic pleural effusion resolved in 47 patients, improved in 20 and persisted in 16. Biochemical pleural fluid analysis did not predict these outcomes. A history of neoplasm, chest X-ray and CT features, as well as additional examinations according to clinical findings, established a diagnosis or suspicion of malignancy in 256 (97.7%) of the 263 patients who received a diagnosis of malignant effusion. Diagnostic thoracoscopy was helpful in seven patients in whom malignant disease was strongly suspected, despite the absence of other pathological findings. DISCUSSION: Non-invasive complementary examinations generally allowed accurate differentiation between malignant and idiopathic effusions. Patients with idiopathic pleural effusions generally had favourable outcomes.

El presente y futuro de la investigación biomédica en España / Present and future of biomedical research in Spain

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[Reimplantation lesion in the postoperative period of lung transplantation. Incidence, predictive factors, prognosis and outcome. The Lung Transplantation Group of Vall d'Hebron University General Hospital]. / Lesión de reimplantación en el postoperatorio del trasplante pulmonar. Incidencia, factores predictivos, pronósticos y evolución. Grupo de Trasplante Pulmonar del Hospital General Universitari Vall d'Hebron.

BACKGROUND: Reimplantation disease (RD) is a postoperative complication in lung transplantation. It is defined as hypoxemia (PaO2/FiO2 ratio < 150 mmHg), radiologic infiltrates and decrease of lung compliance. The aim of the study was to analyze the incidence, predictive factors, prognosis and outcome of the patients with RD. PATIENTS AND METHOD: 49 patients submitted to lung transplantation (June 1991-December 1996) were admitted in our intensive care unit (ICU). Donor and recipient conditions, surgical parameters and outcome in ICU were analyzed. Mann-Whitney, Kruskall-Wallis, Fisher, Pearson and ANOVA-Friedman tests were used for statistical analysis according to the different variables. RESULTS: 49% of the patients (29/49) developed RD, which was influenced neither by lung disease, nor by the kind of transplantation or by ischemia time. All patients with a long surgical time developed RD, versus only 41% in those where surgery was undertaken in a shorter period of time, OR: 2.8 (1.5-5.7; p = 0.0016). The patients with RD improved showing a PaO2/FiO2 ratio of 176 and 235 mmHg at 24 and 48 h respectively (ANOVA, p < 0.00001). The patients with RD needed 14 days of mechanical ventilation versus 7 days in those without RD (p = 0.013). There were no statistically significant differences in stay and mortality in ICU. CONCLUSIONS: RD is a common complication in the postoperative phase of lung transplantation. It is present in almost all the patients with long surgical time. Almost all of them improve, with the same survival but a longer period of mechanical ventilation.

Abdominoscrotal hydrocele.

Abdominoscrotal hydrocele is a very rare finding, especially in infants. The authors describe the case of a 7-month-old boy presenting an abdominoscrotal mass, the diagnosis of which was made by sonography and which was excised totally through an extensive inguinal incision.