Skin infections in Europe: a retrospective study of incidence, patient characteristics and practice patterns.

OBJECTIVE: Acute bacterial skin and skin structure infections (ABSSSIs) are associated with considerable morbidity and a heavy healthcare burden. The primary objectives of this two-phase study were to determine the incidence of skin infections and ABSSSIs in hospitalized patients (Phase A), and to describe the characteristics and treatment of hospitalized patients with ABSSSIs (Phase B). METHODS: This non-interventional, retrospective study was based on data collected from adult patients hospitalized for skin infections in six European countries (Czech Republic, Greece, Italy, Portugal, Russia and Spain) between January 2014 and June 2016. RESULTS: In Phase A, the total hospital incidence of skin infections and ABSSSIs was 2.4 and 1.8 per 1000 patient-days, respectively. Overall, 73.6% of 50,469 hospitalizations for skin infections were for ABSSSIs. Among the 750 patients with ABSSSIs included in Phase B, Gram-positive bacteria were isolated in 24.9%, most commonly methicillin-susceptible Staphylococcus aureus (11.5%). Empirical therapy was administered to 98.1% of patients, most often with a penicillin, with or without a ß-lactamase inhibitor (42.1%). Complete cure was achieved in 46.5% and 34.5% of patients after initial treatment and treatment modification, respectively. Overall, 22.7% of patients had at least one additional ABSSSI-related hospitalization, 47.1% of patients visited the emergency room, 19.3% of patients visited primary care clinics, and 34.8% of patients visited a specialist. CONCLUSION: Treatment of ABSSSIs in Europe is associated with a heavy healthcare burden, highlighting the need for optimized management strategies that may reduce healthcare utilization.

Comparison of changes in lipid profile after bilio-intestinal bypass and gastric banding in patients with morbid obesity.

BACKGROUND: The presence of hypercholesterolemia is currently not considered a selection criteria for performing gastric restrictive or diversionary bariatric surgery. METHODS: We prospectively investigated the effects of the bilio-intestinal bypass (BI-bypass) with a wide cholecysto-jejunal anastomosis and of adjustable gastric banding (AGB) on blood lipid concentrations in obese patients. To clarify the mechanism of the hypocholesterolemic effect of the BI-bypass, daily fecal sterol excretion was measured by gas-liquid chromatography (GLC). RESULTS: At 1 year after BI-bypass compared to baseline, the hypercholesterolemic (n=18) and the normocholesterolemic (n=19) patients significantly reduced total (-38% and -27%, respectively), LDL (-47% and -24%, respectively) and HDL (-11% and -13%, respectively) cholesterol and total / HDL cholesterol ratio (-25% and -13%, respectively). At 1 year after AGB, the total / HDL cholesterol ratio was significantly decreased (-11%) compared to baseline in hypercholesterolemic (n=12) but not in normocholesterolemic (n=6) patients, while total and LDL cholesterol were not affected in both groups. At 3 years after BI-bypass compared to baseline, the hypercholesterolemic (n=9) and the normocholesterolemic (n=11) patients significantly reduced total (-43% and -28%, respectively) and LDL (-53% and -29%, respectively) cholesterol and total / HDL cholesterol ratio (-38% and -21%, respectively). The BI-bypass induced a significant (P <0.005; n=7) 6-fold increase in mean fecal cholesterol output. CONCLUSIONS: The BI-bypass but not the AGB leads to a persistent and marked beneficial effect on blood LDL cholesterol associated with an increased cholesterol fecal output. BI-bypass but not AGB is indicated in morbidly obese patients with hypercholesterolemia.

Tratamiento de las seudoartrosis asépticas con osteosíntesis rígidas (placas y tornillos) / Treatment of aseptic pseudarthrosis with rigid internal fixation (plates and screws)

Se presentan 360 casos de seudoartrosis asépticas (SA) tratados por el Grupo Hospital Ramos Mejía con osteosíntesis rígidas (placas, tornillos), lográndose la consolidación ósea primaria en el 94,72 por ciento debiéndose recurrir a otros procedimientos en 19 pacientes (5,27 por ciento) en los que esta consolidación no se logró. Se destaca la manera de tratar la SA considerando 5 items: a) se debe asegurar el diagnóstico tipificando la SA en viable o no viable ; b) el tratamiento dependerá de la viabilidad de los extremos seudoartrósicos ; c) las seudoartrosis viables no necesitan de injerto óseo, sólo el reposo del foco mediante fijación rígida y continuada ; d) la seudoartrosis no viable, si hay necrosis ósea, requiere injerto óseo. En las seudoartrosis por defecto, la pérdida ósea será sustituida por hueso esponjoso. En ambas, la estabilidad mecánica es fundamental ; e) la consolidación en una SA viable se realiza en un tiempo promedio de 3 a 4 meses. En las no viables, este lapso se duplica. Se insiste en no "abrir" la SA avivando los extremos óseos resecando tejido fibroso, ni alesando la cavidad medular, lo cual retarda la curación. La carga gravitacional no se permite, hasta la consolidación. Se considera el método empleado eficaz, de bajo costo, que requiere un conocimiento perfecto de la técnica, indicaciones y oportunidad

Luxación recidivante de hombro: técnica de Bristow-Latarjet sin secciones musculares (57 casos) / Shoulder recurrent dislocation: Bristow-Latarjet procedure

Presentamos una serie de 57 luxaciones recidivantes de hombro operados personalmente en los últimos 20 años, la mayoría en deportistas (63 por ciento) que han continuado prácticas muy competitivas y traumáticas (rugbyers en su mayoría), con 2 recidivas postoperatorias (3,5 por ciento), utilizando la técnica de Bristow-Latarjet modificada. Consideramos fundamental usar un método que no limite la movilidad glenohumeral, para lo cual efectuamos una operación extraarticular, sin acortamientos musculares, y que dicha técnica nos permite una rehabilitación postoperatoria inmediata, lo que se logra fijando correctamente el tope coracoideo al cuello glenoideo, prescindiendo de toda inmovilización externa. De esta manera, en casi todos los casos logramos movilidad normal del hombro (87,7 por ciento), salvo en 7 pacientes (12,2 por ciento) que sufrieron 5 grados de pérdida de la rotación externa

Condromas de la vaina de los tendones de la mano: presentación de un caso y revisión de la literatura / Digital synovial chondromatosis of the tendon sheath of the hand

Se presenta un caso de la poco frecuente condromatosis sinovial digital, en la vaina tendinosa de los flexores del dedo medio de mano derecha, en una mujer cauc sica de 56 años de edad. Se comenta el procedimiento quirúrgico, se describe el estudio histopatológico y se discute la bibliografía, las distintas interpretaciones etiopatogénicas y el tratamiento quirúrgico de elección