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Antivirales/administración & dosificación , COVID-19/prevención & control , Personal de Salud , Hidroxicloroquina/administración & dosificación , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Profilaxis Pre-Exposición , Antivirales/efectos adversos , COVID-19/diagnóstico , COVID-19/transmisión , COVID-19/virología , Humanos , Hidroxicloroquina/efectos adversos , India , Cumplimiento de la Medicación , Exposición Profesional/efectos adversos , Salud Laboral , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Resultado del TratamientoAsunto(s)
Anomalías Múltiples , Aneurisma/complicaciones , Arteria Pulmonar , Atresia Pulmonar/complicaciones , Tetralogía de Fallot/complicaciones , Anomalías Múltiples/diagnóstico , Adulto , Aneurisma/diagnóstico , Humanos , Masculino , Atresia Pulmonar/diagnóstico , Tetralogía de Fallot/diagnósticoRESUMEN
BACKGROUND: This study examines if bilateral internal thoracic artery (BITA) grafting provides improved outcomes compared with single internal thoracic artery (SITA) grafting, in the modern era, in which diabetes mellitus and obesity are more prevalent. METHODS: The Society of Thoracic Surgeons database at a single large academic center was reviewed for all consecutive isolated coronary artery bypass grafting patients with two or more distal anastomoses from January 1, 2002, through December 31, 2010. Propensity-adjusted logistic and Cox regression models were used to estimate the effect of BITA on short-term outcomes and long-term survival for diabetic and nondiabetic patients. RESULTS: A total of 3,527 coronary artery bypass grafting operations (812 BITA, 2,715 SITA) were performed. Fewer BITA than SITA patients had diabetes (28.6% vs 44.7% p<0.001). There was no significant difference in 30-day rates of death, stroke, or myocardial infarction between nondiabetic patients who had BITA vs SITA, or between diabetic patients who had BITA vs SITA. BITA grafting conferred a 35% reduction (95% confidence interval, 12% to 52%, p=0.006) in the long-term hazard of death equally for nondiabetic and diabetic patients (p=0.93). Deep sternal wound infection was more common among diabetic than among nondiabetic patients (1.5% vs 0.7%), but was similar within nondiabetic (1.0% vs 0.6%) and diabetic patients (1.7% vs 1.5%) who had BITA vs SITA. Overall, BITA and SITA patients had similar rates of deep sternal wound infection (1.2% vs 1.0%). CONCLUSIONS: BITA grafting confers a long-term survival advantage and should be performed whenever suitable coronary anatomy exists and patient risk factors allow an acceptable risk of deep sternal wound infection.
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Puente de Arteria Coronaria/mortalidad , Puente de Arteria Coronaria/métodos , Diabetes Mellitus/mortalidad , Diabetes Mellitus/cirugía , Arterias Mamarias/trasplante , Centros Médicos Académicos , Anciano , Estudios de Cohortes , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/cirugía , Bases de Datos Factuales , Diabetes Mellitus/diagnóstico , Femenino , Estudios de Seguimiento , Rechazo de Injerto , Supervivencia de Injerto , Humanos , Anastomosis Interna Mamario-Coronaria/métodos , Anastomosis Interna Mamario-Coronaria/mortalidad , Estimación de Kaplan-Meier , Modelos Logísticos , Masculino , Arterias Mamarias/cirugía , Persona de Mediana Edad , Oportunidad Relativa , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
Esophageal carcinoma has, over the past decade, undergone a sea of change, not only in its pathological distribution, but also in the diagnosis, staging and subsequent management. Although the advent of better imaging techniques has helped in diagnosing patients at an earlier period, the majority of them have unresectable disease at the time of presentation. Despite aggressive treatment protocols involving either one or a combination of the options of surgery, radiation, and chemotherapy, the five-year survival remains dismal in the order of 10 to 15%. The two most commonly used surgical techniques for resecting the esophagus, the Ivor Lewis and the trans-hiatal esophagectomy, have similar results in terms of morbidity, mortality and, more importantly, five-year survival following resection. There has been an increasing interest in the surgical treatment of carcinoma esophagus by a minimally invasive approach, as meta-analysis of clinical series have shown that a faster recovery time without any statistically significant difference in the in-hospital mortality or morbidity when compared to conventional surgery. Nonrandomized studies suggest that patients receiving neoadjuvant chemo-radiation have a five year survival advantage compared with those treated with surgery alone, especially if they had a complete histological response to the preoperative regimen. Lastly, palliative procedures, form the mainstay of management of patients with non-resectable disease.
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Ecocardiografía Transesofágica , Defectos del Tabique Interventricular/diagnóstico por imagen , Defectos del Tabique Interventricular/cirugía , Monitoreo Intraoperatorio , Ecocardiografía Transesofágica/métodos , Atrios Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Lactante , Masculino , Monitoreo Intraoperatorio/métodosRESUMEN
INTRODUCTION: Percutaneous device closure of atrial septal defect (ASD) has emerged as an alternative to traditional surgical closure. Although reduced hospital stay, decreased morbidity and absence of a surgical incision are beneficial, other procedure- or device-related complications are coming into light. We report a rare complication of early embolization of the Blockaid septal occluder into the main pulmonary artery bifurcation associated with 'aortic rim' erosion and present a brief review of literature pertaining to the high incidence of complications associated with deficient or eroded 'aortic rims' necessitating surgical intervention. MATERIALS AND METHODS: An 18-year-old male underwent successful percutaneous device closure of a 24.5 mm ASD after fulfilling institutional criteria for the procedure. The device used was a Blockaid septal occluder, a device morphologically similar to the Amplatzer device. The subsequent day, he had embolization of the device into the main pulmonary artery bifurcation, and underwent emergency surgical retrieval of the same with closure of the ASD. At surgery the ASD was found to have an eroded aortic rim. COMMENTS: We believe that embolization of the percutaneous septal occluder in our patient was due to a combination of factors including an inadequate aortic rim; a grossly oversized device which eroded the aortic rim; and the Blockaid septal occluder, whose formally untested design and configuration could have led to its migration. CONCLUSION: Strict selection criteria governing an 'adequate' aortic rim, the size of the device, and the choice of the device may help reduce the incidence of complications like the rare, but potentially fatal embolization of the device into the pulmonary artery following percutaneous device closure of an ASD.
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Oclusión con Balón/efectos adversos , Defectos del Tabique Interatrial/terapia , Embolia Pulmonar/etiología , Adolescente , Aorta Torácica/lesiones , Aorta Torácica/cirugía , Oclusión con Balón/instrumentación , Ecocardiografía , Defectos del Tabique Interatrial/diagnóstico por imagen , Humanos , Masculino , Arteria Pulmonar/cirugía , Embolia Pulmonar/diagnóstico por imagen , RadiografíaRESUMEN
BACKGROUND: Tetralogy of Fallot presenting in adulthood is a surgical challenge. We present the long-term outcomes of surgical correction in this subset of patients, including results of postoperative effort tolerance as assessed by treadmill testing. METHODS: Fifty-eight patients older than 18 years operated on between January 1995 and June 2004 are included in the study. Mean age at surgery was 22.5 +/- 5 years. Forty-seven patients were in New York Heart Association functional class II and 11 were in class III. Two patients had previous shunts. Forty-four patients received a transannular patch, and 14 had a right ventricular outflow tract patch. The prospective arm objectively assessed postoperative ventricular function by treadmill testing and echocardiography. RESULTS: Hospital mortality was 6.9%. Follow-up was 89% complete, with mean follow-up of 69.9 +/- 43 months. Late mortality occurred in 2 patients, both with infective endocarditis. Significant improvement in functional class was demonstrated (p < 0.001). Eight patients had significant pulmonary regurgitation on follow-up. The probability of survival after repair was 89% at 15 years. Thirty-five of 36 patients who underwent treadmill testing had good effort tolerance, with an average of 10.47 +/- 1.4 metabolic equivalents achieved. None had a positive result. One patient with transannular patch, in functional class III, had fair exercise tolerance with severe pulmonary regurgitation on echocardiography. CONCLUSIONS: Repair of adult tetralogy of Fallot has acceptable morbidity and mortality rates with good long-term surgical outcome in terms of effort tolerance as demonstrated by treadmill testing. Transannular patching does not appear to be a significant risk factor for right ventricular failure at long-term follow-up.
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Tetralogía de Fallot/cirugía , Adolescente , Adulto , Ecocardiografía , Prueba de Esfuerzo , Tolerancia al Ejercicio/fisiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Recuperación de la Función , Tetralogía de Fallot/fisiopatología , Resultado del Tratamiento , Función Ventricular/fisiologíaRESUMEN
OBJECTIVE: To evaluate the efficacy of endoscopic meatotomy in the treatment of ureterocele in adults and to determine the incidence of its main complication, vesico-ureteric reflux. MATERIAL AND METHOD: Retrospective study of 14 cases of ureterocele in adults observed between March 1989 and August 2004, corresponding to 7 males and 7 females with a mean age of 39 years (range: 17-73 years). The ureterocele was observed in a context of single ureter in 13 cases (94%) and duplicated ureter arising from the superior renal unit in one patient (7%). The ureterocele was complicated by stones in 9 cases (64%). Endoscopic meatotomy was performed in 13 patients, while immediate resection of the ureterocele followed by Hendren ureterovesical reimplantation was performed in one patient with major proximal repercussions. RESULTS: The postoperative course was uneventful in all patients including the patient treated by conventional surgery. Postoperative follow-up consisted of clinical and radiological assessment at 3 months and 6 months. Endoscopic treatment was effective in every case with resolution of low back pain and absence of residual stones when the ureterocele was initially complicated by stones. In contrast, de novo vesicoureteric reflux appeared secondarily in 5 patients (38.5%) but persisted at 6 months in only one patient, who required re-operation: resection of the ureterocele and Hendren ureteric reimplantation. CONCLUSION: Endoscopic meatotomy can be considered to be the firstline treatment for ureterocele in adults in the absence of severe dilatation of the proximal urinary tract. Its main complication remains vesico-ureteric reflux. Radiological surveillance by urethrocystography therefore appears to be essential.
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Ureterocele/cirugía , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Ureterocele/diagnóstico por imagenRESUMEN
Scimitar syndrome is a rare variant of partial anomalous pulmonary venous connection. The combination of scimitar syndrome with anomalous connection of the left superior pulmonary vein to the left innominate vein is extremely rare, and is yet to be documented in literature. We report the successful single-stage correction of such a rare type of anomalous pulmonary venous connection.
RESUMEN
OBJECTIVE: There is currently no consensus concerning the age limit for the surgical management of kidney tumours and very limited data are available in the literature. The objective of this study was to evaluate the morbidity of renal cancer surgery in elderly patients in order to determine the benefit/risk balance. MATERIAL AND METHODS: A retrospective study was conducted in 157 patients operated for kidney tumour in our department. Two groups were defined: one group of 40 patients over the age of 80 years and another group of 117 patients under the age of 80 years at the time of surgery. The following elements were compared in the 2 groups: presence or absence of symptoms, general state (evaluated by the Eastern Cooperative Oncology Group score), associated comorbidities (evaluated by the American Society of Anesthesiologists score), preoperative haemoglobin and serum creatinine, histological examination of the tumour, medical and surgical complication rate, postoperative mortality, length of hospital stay and specific survival. RESULTS: Tumour characteristics were identical in each group except for the presence of distant metastases which were more frequent in the group of patients young than 80. Older patients had a significantly higher preoperative serum creatinine (p = 0.01), a higher ASA score (p = 0.001), a higher medical complication rate (p < 0.00001) and a higher mortality (p = 0.04). At the end of follow-up, the specific survival was comparable in the two groups (32.5% versus 40%). CONCLUSION: Tumour characteristics and specific survival after surgical management of kidney tumours are comparable in elderly patients and younger patients. The risks of complications and impaired renal function were higher in elderly patients undergoing total nephrectomy. Close surveillance as well as minimally invasive alternatives will probably have an increasingly important place in the future, especially in patients presenting a major surgical risk.