Percutaneous endoscopic debridement and irrigation for thoracic infections

SUMMARY OBJECTIVE: To investigate the safety and efficacy of percutaneous endoscopic debridement and irrigation for thoracic infections and to make an appropriate choice according to the patient's condition. METHODS. Thirty patients with thoracic infections who received surgical treatment from August 2014 to December2016 were retrospectively analyzed. There were 16 males and 14 females, aged from 41 to 90 years, with an average of 64.4 years. A total of 9 cases were treated with percutaneous endoscopic debridement and irrigation (minimal group), and 21 cases were treated with open debridement in combination with pedicle screw fixation (conventional group). Patients underwent follow-up for 1 month. General condition, operative index, laboratory results, and imaging features were recorded. RESULTS. Compared with the conventional group, there were more comorbidities in patients in the minimal group (8 cases in the minimal group, 10 cases in the conventional group, P=0.049), shorter hospital stay (10.1 + 2.26 days in the minimal group, 16.1 + 6.81 days in the conventional group, P=0.016), less bleeding volume (383.3 + 229.86ml in the minimal group, 90 + 11.18ml in the conventional group, P=0.000), lower VAS score at discharge (2.9 + 0.93 in the minimal group, 3.9 + 0.91 in the conventional group, P=0.013). There was no spinal instability case in the minimal group, 10 cases in the conventional group, P=0.013. There were significant differences. The C reaction protein prior to operation in the minimal group was 28.4±7.50mg/L. Compared with 45.1 + 15.78mg/L in the conventional group, P=0.005, it was lower. CONCLUSIONS. Percutaneous endoscopic debridement and irrigation are an effective surgery for treatment of thoracic infections, especially suitable for patients with comorbidities and poor general condition. However, for severe infection and spinal instability, we tend to choose open surgery in combination with fixation.

RESUMO OBJETIVOS: Investigar a eficácia e segurança de desbridamento endoscópico percutâneo e irrigação torácica para infecções e fazer uma escolha adequada de acordo com a condição do paciente. MÉTODOS: Trinta pacientes com infecção torácica que receberam tratamento cirúrgico de agosto de 2014 a dezembro de 2016 foram analisadosretrospectivamente. Havia 16 homens e 14 mulheres, de 41 a 90 anos, com uma média de 64,4 anos. Nove casos foram tratados com desbridamento endoscópico percutâneo e irrigação (grupo mínimo) e 21 casos foram tratados com desbridamento aberto em combinação com fixação do parafuso pedicular(grupo convencional). Os pacientes foram submetidos a acompanhamento durante um mês. Estado geral, índice operacional, resultados de laboratório e imagem e funcionalidades foram gravados. RESULTADOS: Em comparação com o grupo convencional, há mais comorbidades em pacientes do grupo mínimo (8 casos no grupo mínimo, 10 casos no grupo convencional, P = 0,049), menos tempo no hospital (10,1 + 2,26 dias no grupo mínimo, 16,1 + 6,81 dias no grupo convencional, P = 0,016), menos volume de sangramento (383,3 + 229,86 ml no grupo mínimo, 90 + 11,18 ml no grupo convencional, P = 0,000), menor pontuação no VAS a quitação (2,9 + 0,93 no grupo mínimo, 3,9 + 0,91 no grupo convencional, P = 0,013). Não houve nenhum caso de instabilidade espinhal no grupo mínimo, e 10 casos no grupo convencional, P = 0,013. Houve diferenças significativas. O nível de proteína C-reativa antes da operação no grupo mínimo era de 28,4±7,50mg/L. Em comparação com 45,1 + 15,78 mg/L no grupo convencional, P = 0,005, era mais baixa. CONCLUSÃO: O método de desbridamento endoscópico percutâneo e irrigação é eficaz para o tratamento de infecções em cirurgia torácica, especialmente adequado para pacientes com comorbidades e mau estado geral. Mas, para a infecção grave e instabilidade vertebral, tendemos a escolher a cirurgia aberta em combinação com a fixação.

Espaciador interespinoso tipo DIAM: experiencia en Puerto Montt / DIAM interspinous spacer type: experience in Puerto Montt

El lumbago crónico constituye un problema de salud pública por su frecuencia y afección a población joven, económicamente activa. Se presenta en el presente artículo, un análisis de la biomecánica de la columna lumbar, y la importancia de los vectores de carga en la génesis del dolor, y las posibilidades de intervenir sobre ellos con la instalación de dispositivos interespinosos. Se exponen las distintas alternativas de espaciadores interespinosos y se presenta la experiencia con el DIAM. Se analizan los resultados de 17 pacientes sometidos a cirugía por lumbago crónico por fracaso a tratamiento médico quinésico, con la instalación de 26 dispositivos, destacando la buena evolución de la mayoría de ellos, con reducción significativa del dolor (EVA pre y postoperatorio) y análisis de capacidad funcional por escala de Oswestry luego de la cirugía. Todos los pacientes fueron intervenidos por el autor.

Chronic low back pain constitutes a public health problem by its frequency and affection in young population, economically active. This article presents an analysis of the biomechanics of the lumbar spine, and the importance of load vectors in pain genesis, and the possibilities to act on them with interspinous device installation. Here are exposed interspinous spacers alternatives and presents experience with the DIAM. We analyze the results of 17 patients undergoing surgery for chronic low back pain by failure of kinesics medical treatment, with the installation of 26 devices, highlighting the good performance of most of them with significant reduction in pain (VAS pre-and postoperative) and functional capacity analysis Oswestry scale after surgery. All patients were operated on by the author.

Complicaciones en las fracturas complejas de la meseta tibial y factores asociados / Complications in complex fractures of the tibial plateau and associated factors

Objetivo: identificar factores asociados a complicaciones con el manejo quirúrgico de las fracturas complejas de la meseta tibial. Material y métodos: estudio de casos y controles. Muestra integrada con expedientes de 56 pacientes diagnosticados con fractura compleja de la meseta tibial (tipos IV, V y VI de Schatzker), tiempo de seguimiento promedio de 12.9 ± 3.2 meses (8 a 18), y con uno o más de los siguientes factores de riesgo: edad mayor de 50 años, comorbilidad, tiempo de isquemia mayor de 60 minutos y fractura tipo IV, V o VI. Se consideró caso al paciente que presentara una o más complicaciones. Resultados: la edad promedio fue de 50.1 ± 15.7 años (17 a 87); 35 pacientes (62.5 %) pertenecieron al sexo masculino. Los pacientes con o sin complicaciones mostraron homogeneidad respecto a edad, sexo, lado, tipo de fractura y tiempo de seguimiento; 41.1 % presentó antecedentes patológicos. En todos los procedimientos se utilizó torniquete neumático. El tiempo promedio de cirugía fue de 91 ± 27.2 minutos (40 a 175). Los tratamientos empleados fueron placa más tornillos (53.6 %), fijadores externos más tornillos (35.7 %), doble placa y clavo centromedular. 37.5 % desarrolló complicaciones: infección superficial, 16.1 %; deformidades angulares residuales, 10.7 % (varo, 7.1 %); lesión del nervio peroneo, 5.4 %, pseudoartrosis, 3.5 %; trombosis venosa profunda, 1.8 %. Presentó más de una complicación, 22.2 %. Conclusiones: los factores de riesgo asociados significativamente a complicaciones con el manejo de la fractura compleja de la meseta tibial, fueron la edad mayor de 60 años y el tiempo de isquemia transoperatoria mayor de 120 minutos. Los pacientes en estas condiciones presentaron tres veces más riesgo para desarrollar complicaciones.

BACKGROUND: We undertook this study to identify factors associated with surgical complications of complex fractures of the tibial plateau. METHODS: We designed a case-control study with 56 patients with a diagnosis of complex fracture in the tibial plateau (IV-VI Schatzker) and with 12.9 +/- 3.2 (8-18) months of follow-up. Risk factor exposure was defined as having one or more of the following characteristics: age >60 years; co-morbidity (diabetes mellitus, systemic arterial hypertension); time of [quot ]Kidde[quot ] (>60, >90, >120 min) and fracture type IV, V or VI. A case was considered with one or more complications. Results: Mean age was 50.1 +/- 15.7 (17-87) years old; 35 patients (62.5%) were males. Homogeneity between groups was shown for age, sex, side effects, type of fracture and time of follow-up; 41.1% of patients had pathological history. All surgeries used pneumatic compression (Kidde) for 91 +/- 27.2 (40-175) min. The implants used were plate plus cancellous screws (53.6%), external fixators plus cancellous screws (35.7%), double plate and intramedullary nail. Complications appeared in 37.5% of all patients. Complications reported were superficial infection (16.1%), residual angular deformities (10.7%, varum [7.1%]), peroneal nerve injury (5.4%), non-union (3.5%) and deep venous thrombosis (1.8%); 22.2% of all patients presented more than one complication. CONCLUSIONS: Statistically significant risk factors were age >60 years and pneumatic compression >120 min. Patients with one of these characteristics had a three-times risk of complications. No association was demonstrated between type of fracture, surgical treatment, time between injury and the surgery, with development of complications.