Posicionamiento postoperatorio de la cabecera tras drenaje de hematomas subdurales crónicos por trepanación: Revisión sistemática y metaanálisis de estudios controlados aleatorizados / Postoperative bed header position after burr-hole drainage of chronic subdural haematoma: Systematic review and meta-analysis of randomised controlled trials

INTRODUCCIÓN: Algunos estudios han señalado la posible influencia del posicionamiento postoperatorio de la cabecera sobre el riesgo de recurrencias y complicaciones médicas en los pacientes intervenidos por hematomas subdurales crónicos; sin embargo, esta hipótesis aún no se ha evaluado mediante un metaanálisis. MÉTODOS: Se incluyeron todos los estudios prospectivos controlados aleatorizados que analizaron la frecuencia de recurrencias sintomáticas en los pacientes operados por hematomas subdurales crónicos mediante trepanación, con relación al posicionamiento postoperatorio de la cabecera. El desenlace primario fueron las recurrencias sintomáticas y los secundarios, las reintervenciones y las complicaciones médicas postoperatorias. Los resultados se presentaron en riesgos relativos combinados, con sus intervalos de confianza del 95%. RESULTADOS: Fueron incluidos un total de 4 estudios controlados aleatorizados. Los riesgos relativos combinados fueron: recurrencias sintomáticas, 0,51 ([IC 95%: 0,22-1,16]; p = 0,11); reintervenciones, 1,07 ([IC 95%: 0,42-2,69]; p = 0,89) y complicaciones, 1,15 ([IC 95%: 0,7-1,91]; p = 0,58). No se encontró heterogeneidad estadísticamente significativa en ninguno de los análisis. CONCLUSIÓN: No se encontraron diferencias en el riesgo de recurrencias sintomáticas, reintervenciones ni complicaciones médicas en los pacientes que fueron mantenidos con la cabecera plana, en comparación con aquellos en quienes fue elevada en el postoperatorio. Aunque los resultados fueron consistentes entre los estudios incluidos, existe un potencial riesgo de sesgos, lo que proscribe emitir recomendaciones definitivas antes de contarse con estudios de mayor calidad metodológica

INTRODUCTION: Several studies have suggested the possible influence of postoperative bed header position on the risk of symptomatic recurrences and medical complications in patients who have been intervened due chronic subdural haematomas. Nevertheless, this hypothesis has not been assessed by a meta-analysis. METHODS: All randomised controlled trials analysing symptomatic recurrence rates in patients who underwent burr-hole drainage of chronic subdural haematomas, describing postoperative bed header positioning, were included. The primary outcome was risk of recurrence and the secondary outcome were the risks of reoperation and medical complications. Results were presented as pooled relative risks, with 95% confidence intervals. RESULTS: A total of 4 controlled studies were included. Pooled relative risks were: symptomatic recurrences 0.51 ([95% CI: 0.22-1.16]; P = .11), reoperations, 1.07 ([95% CI: 0.42-2.69]; P = .89) and medical complications, 1.15 ([95% CI: 0.7-1.91]; P = .58). No statistically significant heterogeneity was found in any of the analyses. CONCLUSION: There were no differences regarding frequency of symptomatic recurrences, reoperations or medical complications in patients who were maintained in a flat position compared with those whose bed header was elevated during the postoperative course. Despite there being consistency between the results, there is a potential risk of bias; thus proscribing definitive recommendations until studies with higher methodological quality are available

[Phaco-aspiration and phaco-emulsification of cataract--personal experience]. / Fakoaspiracja i fakoemulsyfikacja zacmy--doswiadczenia wlasne.

The authors present material collected in the course of 10 years of applying the surgical technique of cataract extraction by means of a Cavitron-Kelman model 8000 V. The age of the patients oscillated between 4 months and 80 years. Phacoaspiration was performed in 4416 eyes and phacoemulsification in 2195 eyes. Following intraoperative complications were observed during surgery; rupture of the posterior lens capsule occurred in 9.75 p.c. of eyes in the course of the phacoaspiration and in 12.4 p.c. of phacoemulsification. The endothelial corneal degeneration occurred after phacoaspiration in 0.13 p.c., after phacoemulsification in 3 p.c. of cases; cystic macular oedema after phacoemulsification in 0.95 p.c. of cases. Visual acuity 5/25 to 5/10 was attained in 47.1 p.c. and visual acuity of 5/10-5/5 in 37.3 p.c. of the eyes. A larger number of complications after phacoemulsification--in spite of the time of application of the ultrasound considered as a safe one--caused a reduction in application of this method.