Asunto(s)
Colitis Ulcerosa/etiología , Neoplasias Colorrectales/patología , Enfermedad de Crohn/complicaciones , Leucemia Mielógena Crónica BCR-ABL Positiva/patología , Examen de la Médula Ósea , Colitis Ulcerosa/patología , Colitis Ulcerosa/cirugía , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/cirugía , Enfermedad de Crohn/patología , Enfermedad de Crohn/cirugía , Resultado Fatal , Humanos , Leucemia Mielógena Crónica BCR-ABL Positiva/complicaciones , Leucemia Mielógena Crónica BCR-ABL Positiva/cirugía , Masculino , Persona de Mediana Edad , Proctocolectomía Restauradora/efectos adversos , Reoperación , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/cirugía , Resultado del Tratamiento , Cicatrización de HeridasAsunto(s)
Vértebras Cervicales , Perforación del Esófago/etiología , Mediastinitis/etiología , Traumatismos del Cuello/complicaciones , Osteofito/complicaciones , Espondiloartritis/complicaciones , Heridas no Penetrantes/complicaciones , Accidentes por Caídas , Anciano , Perforación del Esófago/diagnóstico , Humanos , Masculino , Enfisema Mediastínico/diagnóstico por imagen , Enfisema Mediastínico/etiología , Mediastinitis/cirugía , Osteofito/diagnóstico , Radiografía , Espondiloartritis/diagnóstico , Supuración/etiología , Supuración/terapia , Irrigación Terapéutica , ToracotomíaRESUMEN
OBJECTIVES: To determine whether emergency colectomy reduces mortality in patients with fulminant Clostridium difficile-associated disease (CDAD), and to identify subgroups of patients more likely to benefit from the procedure. SUMMARY BACKGROUND DATA: Many hospitals in Quebec, Canada, have noted since 2003 a dramatic increase in CDAD incidence and in the proportion of cases severe enough to require intensive care unit (ICU) admission. The decision to perform an emergency colectomy remains largely empirical. METHODS: Retrospective observational cohort study of 165 cases of CDAD that required ICU admission or prolongation of ICU stay between January 2003 and June 2005 in 2 tertiary care hospitals of Quebec. Multivariate analysis was performed through logistic regression; adjusted odds ratios (AOR) and their 95% confidence intervals (CI) were calculated. The primary outcome was mortality within 30 days of ICU admission. RESULTS: Eighty-seven (53%) cases resulted in death within 30 days of ICU admission, almost half (38 of 87, 44%) within 48 hours of ICU admission. The independent predictors of 30-day mortality were: leukocytosis >or=50 x 10(9)/L (AOR, 18.6; 95% CI, 3.7-94.7), lactate >or=5 mmol/L (AOR, 12.4; 95% CI, 2.4-63.7), age >or=75 years (AOR, 6.5; 95% CI, 1.7-24.3), immunosuppression (AOR, 7.9; 95% CI, 2.3-27.2) and shock requiring vasopressors (AOR, 3.4; 95% CI, 1.3-8.7). After adjustment for these confounders, patients who had an emergency colectomy were less likely to die (AOR, 0.22; 95% CI, 0.07-0.67, P = 0.008) than those treated medically. Colectomy seemed more beneficial in patients aged 65 years or more, in those immunocompetent, those with a leukocytosis >or=20 x 10(9)/L or lactate between 2.2 and 4.9 mmol/L. CONCLUSION: Emergency colectomy reduces mortality in some patients with fulminant CDAD.
Asunto(s)
Clostridioides difficile/patogenicidad , Colectomía/métodos , Brotes de Enfermedades , Urgencias Médicas , Enterocolitis Seudomembranosa , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Enterocolitis Seudomembranosa/epidemiología , Enterocolitis Seudomembranosa/microbiología , Enterocolitis Seudomembranosa/cirugía , Femenino , Estudios de Seguimiento , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Quebec/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Resultado del Tratamiento , VirulenciaRESUMEN
Seat-belt aorta, a dissection of the intima caused by direct compression of the vessel between the horizontal part of the seat belt and the vertebrae, is a rare but classical injury associated with blunt abdominal trauma. High index of suspicion is critical since this potentially lethal lesion can be asymptomatic initially. Understanding the mechanisms of injury and being aware of the frequently associated clinical signs and injuries should allow for prompt recognition and treatment without delay.