RESUMEN
Chronic hepatitis C virus (HCV) infection is a major cause of chronic liver disease and liver-related death. Recently, multiple regimens of different direct-acting antiviral agents (DAAs) have been registered. Although treatment with sofosbuvir (SOF) and simeprevir (SMV) is registered for the treatment of genotype 4 patients in some countries, data on efficacy of this combination are lacking. We aimed to assess the efficacy of SOF and SMV with or without RBV during 12 weeks in a real-life cohort of genotype 4 HCV patients. A retrospective multicentre observational study was conducted in 4 hospitals in Amsterdam, the Netherlands, including patients with advanced liver fibrosis or liver cirrhosis treated with SOF plus SMV with or without RBV during 12 weeks for a genotype 4 chronic HCV infection from 1 January 2015 to 1 August 2015. Sustained viral response (SVR) was established at week 12 after end of treatment. A total of 53 patients with genotype 4 HCV infection, treatment naïve and experienced, were included. SVR was achieved in 49 of 53 patients (92%). The four failures all had a virological relapse and did not receive ribavirin. Three were nonresponder to earlier interferon-based treatment, and one was treatment naive. In this real-life cohort of patients with HCV genotype 4 infection and advanced liver fibrosis/cirrhosis, we show that treatment with SOF and SMV is effective. The addition of RBV could be considered in treatment-experienced patients as recommended in guidelines.
Asunto(s)
Antivirales/uso terapéutico , Genotipo , Hepacivirus/genética , Hepatitis C Crónica/tratamiento farmacológico , Cirrosis Hepática/patología , Simeprevir/uso terapéutico , Sofosbuvir/uso terapéutico , Adulto , Anciano , Femenino , Hepacivirus/clasificación , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/virología , Humanos , Cirrosis Hepática/virología , Masculino , Persona de Mediana Edad , Países Bajos , Inhibidores de Proteasas , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Anemia Aplásica/virología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Parvovirus B19 Humano , Anciano , Anemia Aplásica/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Humanos , Masculino , Infecciones por Parvoviridae , Prednisona/administración & dosificación , Vincristina/administración & dosificaciónRESUMEN
This paper gives recommendations for treatment of thoracolumbar and lumbar spine injuries. The recommendations are based on the experience of the involved spine surgeons, who are part of a study group of the "Deutsche Gesellschaft für Unfallchirurgie" and a review of the current literature. Basics of diagnostic, conservative, and operative therapy are demonstrated. Fractures are evaluated by using morphologic criteria like destruction of the vertebral body, fragment dislocation, narrowing of the spinal canal, and deviation from the individual physiologic profile. Deviations from the individual sagittal profile are described by using the monosegmental or bisegmental end plate angle. The recommendations are developed for acute traumatic fractures in patients without severe osteoporotic disease.
Asunto(s)
Vértebras Lumbares/lesiones , Vértebras Lumbares/cirugía , Fusión Vertebral/normas , Traumatismos Vertebrales/terapia , Vértebras Torácicas/lesiones , Vértebras Torácicas/cirugía , Vertebroplastia/normas , Alemania , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/normas , Guías de Práctica Clínica como AsuntoRESUMEN
Combined injuries of the upper cervical spine are rare and can lead to life-threatening positional changes of the respiratory tract. Hence, it is very important to recognize tracheal and soft tissue injuries and to treat these adequately. We report on the clinical course and outcome of a case with a delayed high-grade tracheal stenosis after cervical spine injury, which could only be treated by emergency tracheotomy and partial transverse trachea resection.The 25-year-old female suffered a complex dislocated upper cervical spine fracture with a Jefferson fracture, an odontoid fracture and a dislocated C6/7 luxation fracture after a motor vehicle accident. Immediately after trauma inspiratory stridor was reported. Postoperatively, the tracheal stenosis increased and the histological examination of tissue collected during emergency bronchoscopy showed granulation tissue.Even if fractures of cervical spine injuries are treated successfully, soft tissue and tracheal injuries cannot be precluded. Therefore, it is most important that such patients are followed-up closely to classify the problem and to determine the ideal time for surgical treatment of tracheal injuries and stenoses.
Asunto(s)
Vértebras Cervicales/cirugía , Traumatismos Vertebrales/complicaciones , Traumatismos Vertebrales/cirugía , Estenosis Traqueal/etiología , Adulto , Vértebras Cervicales/diagnóstico por imagen , Femenino , Humanos , Radiografía , Estenosis Traqueal/diagnóstico , Resultado del TratamientoRESUMEN
Aneurysmal bone cysts (ABC) are rare, benign, but locally destructive bone tumors. They occur in the spine in 14% of cases, but only 2% are found in the cervical spine. This case report presents a 16-year-old female with an expansive aneurysmatic bone cyst with extensive bone destruction and instability in the cervical segments C1 and C2. In CT and MRI, there was a soft-tissue tumor mass with multiple cysts and fluid-fluid levels within these cysts, as well as contrast enhancement of the cyst wall and the tissue among the cysts. The typical macroscopic and histological findings were present. The tumor was resected en bloc, after which the patient underwent adjuvant radiation therapy. The patient made a complete recovery.
Asunto(s)
Quistes Óseos Aneurismáticos/diagnóstico , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/patología , Imagen por Resonancia Magnética , Enfermedades de la Columna Vertebral/diagnóstico , Tomografía Computarizada por Rayos X , Adolescente , Femenino , HumanosRESUMEN
Patients with bony defects of the proximal femur after trochanteric fracture, implant failure (cut-out), periprosthetic fracture or aseptic loosening of prosthesis are difficult to treat with primary or revision endoprosthesis. Modular femoral hip prosthesis (MHP) with stems of different length and the possibility of distal interlocking screws are an operative solution for those patients. In a prospective study from January 1996 to January 2002 all patients treated with a MHP because of proximal and / or distal femoral bony defect or fracture were included. Follow-up after 6 to 30 months was evaluated clinically and radiologically in hospital. Change of modified Harris Hip Score and radiological signs of loosening (radiolucent line, migration of MHP, breaking interlocking screw) were documented. 106 patients with a follow-up of 58.5 % were included in the study. At time of follow-up clinical and radiological outcome after trochanteric fracture was good. Harris Hip Score was comparable to the situation of patients before fracture, only one MHP was loose. However in patients after revision arthroplasty 25 % of MHP were loose and in many patients the interlocking screw was broken. Distal interlocking screw in MHP prevents stability after trochanteric fracture to achieve osseointegration. However in case of periprosthetic fracture or revision arthroplasty MHP shows insufficient stability in many cases.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Tornillos Óseos , Fracturas de Cadera/cirugía , Prótesis de Cadera , Complicaciones Posoperatorias/cirugía , Falla de Prótesis , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Curación de Fractura , Fracturas de Cadera/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Oseointegración/fisiología , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Prospectivos , Diseño de Prótesis , Ajuste de Prótesis , Radiografía , ReoperaciónRESUMEN
OBJECTIVE: Spinal trauma is frequently found in multiply injured patients. To gain more insight into the epidemiology and the clinical course of this entity, we analyzed the relevant data held in the German Trauma Registry (German Trauma Society, DGU). The Registry provides prospective, standardized and anonymous documentation on severely injured patients at different predetermined time points from the site of the accident until they are discharged from hospital. METHODS: Out of 8,057 patients whose details are recorded in the German Trauma Registry, 772 (approximately 10%) with severe spine trauma (AIS>/=3) patients were identified. Far more men (72%) than women (28%) had such spinal injuries. The mean age of the patients with severe spine injury was 37+/-17 years; their mean Injury Severity Score (ISS) was 29+/-15 (range 9-75) points. RESULTS: The age group 15-54 years was the largest (80%). Motor vehicle accidents (MVA) were the most frequent cause of severe spine trauma (49%), followed by falls from a great height (20%). About half of all severe spine injuries were not suspected in the prehospital setting. Symptoms of incomplete paraplegia were found in 20% of the patients and symptoms of complete paraplegia, in 27%. Patients with injuries to the thoracic spine more often had a lengthy average stay in the intensive care unit, because they were accompanied by thoracic trauma significantly more often than were injuries to the other spinal segments (96% vs 37%). Patients who underwent spinal surgery at an early stage (70% operated on <72 h after their injuries were sustained) showed a tendency to shorter periods ventilatory support and did not remain in the intensive care unit or indeed in the hospital as long as the other patients. Seventy-eight percent of the patients had survived for 90 days after sustaining their injuries. CONCLUSION: Almost 10% of all documented cases of patients with severe injuries in the German Trauma Registry had severe spinal injuries. These injuries were frequently not recognized or their extent underestimated in the preclinical setting. About 70% underwent spine stabilization within 72 h after being injured. These results support previous findings suggesting that early stabilization of vertebral fractures might be beneficial in multiply injured patients.
Asunto(s)
Traumatismo Múltiple/epidemiología , Sistema de Registros , Fracturas de la Columna Vertebral/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios Transversales , Femenino , Alemania , Humanos , Incidencia , Lactante , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/mortalidad , Fracturas de la Columna Vertebral/mortalidad , Análisis de SupervivenciaRESUMEN
Aneurysmal bone cysts are not counted among the classic malignant tumors, although they are destructive locally as blood filled reactive bone lesions. Typically, they are found in the metaphysis of the long bones, while localizations on the spine are rare. A 16-year-old female patient presented with unspecific, progressive neck pain which had been present for half a year. The initial x-ray showed no noticeable pathology whatsoever. Subsequently, the complete destruction of the first cervical vertebrae was found. The tumor had completely infiltrated and completely surrounded the spinal chord. A combined approach was used as therapy: resection of the dorsal tumor portion with occipitocervical spondylodesis (C0-C4) and postoperative radiation of the remaining ventral portions. Currently, the patient is free of complaints and recurrence. The differential diagnosis of an aneurysmal bone cyst should also be considered in cases of unspecific cervical vertebral complaints in adolescents that are not otherwise explainable.
Asunto(s)
Quistes Óseos Aneurismáticos/diagnóstico , Quistes Óseos Aneurismáticos/cirugía , Vértebras Cervicales/cirugía , Enfermedades de la Médula Espinal/diagnóstico , Enfermedades de la Médula Espinal/cirugía , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/cirugía , Adolescente , Quistes Óseos Aneurismáticos/complicaciones , Femenino , Humanos , Dolor de Cuello/diagnóstico , Dolor de Cuello/etiología , Dolor de Cuello/prevención & control , Enfermedades de la Médula Espinal/complicaciones , Enfermedades de la Columna Vertebral/complicaciones , Resultado del TratamientoRESUMEN
Clinical conditions in which crossover extremity transfer should be considered are rare. In the case of bilateral amputation associated with extensive proximal segmental injury, ectopic implantation could be an additional concept for two-stage limb salvage. If replantation is impossible due to segmental damage of the amputated part, at least uninvolved tissue should be harvested for stump lengthening or improving soft-tissue at the ends. The case of a 34-year-old man with segmental amputation of the left forearm and left lower leg and mutilated amputation of the right hand caused by a train accident is presented. Limb salvage was performed by cross-hand replantation and modified rotationplasty of the left foot as a stump lengthening procedure.
Asunto(s)
Amputación Traumática/cirugía , Traumatismos del Antebrazo/cirugía , Traumatismos de la Mano/cirugía , Traumatismos de la Pierna/cirugía , Recuperación del Miembro/métodos , Traumatismo Múltiple/cirugía , Reimplantación/métodos , Trasplante Heterotópico/métodos , Adulto , Muñones de Amputación/cirugía , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Humanos , Masculino , Microcirugia/métodos , Grupo de Atención al Paciente , Recuperación de la Función/fisiología , Recolección de Tejidos y Órganos/métodos , Cicatrización de Heridas/fisiologíaRESUMEN
BACKGROUND: Proper timing of stabilization for spinal injuries is discussed controversially. Whereas early repair of long bone fractures is known to reduce complications, few studies exist that investigate this issue in acute spinal trauma. In particular, the importance of coexisting lung injuries has to be determined, as it might influence clinical course and outcome. MATERIAL AND METHODS: We investigated retrospectively 30 severely injured patients who were stabilized dorsally for fractures of the thoracic and upper lumbar spine. The mean Injury Severity Score (ISS) was 41 points. Patients were divided into two groups: group I: acute trauma/stabilization <72 h and group II: acute trauma/stabilization >72 h. All patients in groups I and II presented radiological or clinical signs of lung contusion. RESULTS: The average duration of the procedures in group I was 199 min (115-312 min) and in group II 139 min (98-269 min). Intraoperative blood loss and P(a)O(2)/F(i)O(2)-ratio did not differ significantly between the two groups. The overall in ICU and hospital stay was significantly shorter in group I: 16 days (1-78 days) versus 24 days (7-86 days) in the late group II. Postoperative respirator therapy was necessary in group I for 15 days (0-79 days) and in group II for 19 days (4-31 days). The mortality rate was 10% in this series. CONCLUSION: Our data provide further evidence that early stabilization of spinal injuries is safe in severely injured patients, does not impair perioperative lung function, and results in a reduced overall ICU and hospital stay. Further prospective randomized investigations are warranted to prove these results.
Asunto(s)
Fijación Interna de Fracturas , Traumatismo Múltiple/cirugía , Insuficiencia Respiratoria/etiología , Fracturas de la Columna Vertebral/cirugía , Vértebras Torácicas/lesiones , Adolescente , Adulto , Anciano , Tornillos Óseos , Contusiones/complicaciones , Contusiones/mortalidad , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Tiempo de Internación , Vértebras Lumbares/lesiones , Vértebras Lumbares/cirugía , Lesión Pulmonar , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/complicaciones , Traumatismo Múltiple/mortalidad , Insuficiencia Respiratoria/mortalidad , Estudios Retrospectivos , Fracturas de la Columna Vertebral/complicaciones , Fracturas de la Columna Vertebral/mortalidad , Análisis de Supervivencia , Vértebras Torácicas/cirugía , Factores de TiempoRESUMEN
METHODS: A total of 60 patients with solely dorsally reconstructed type C fractures of the thoracic spine admitted between January 2000 and December 2003 were retrospectively evaluated. Stability was determined by measuring kyphosis of the vertebral body, the operated segments and of lateral bending on the basis of plain films and computed tomography immediately postoperatively and after 2 and 19 months. RESULTS: There were 48% C2, 38% C1 and 13% C3 fractures. Of the injuries, 28% were caused by motorbike accidents, 25% by car accidents, 23% by falling from a height, 13% by suicidal jumps, 3% by ski accidents and 3% for other reasons. A total of 92% of the patients had severe thoracic trauma as attendant injuries, 42% further vertebral fractures, 35% a head injury, 30% an extremity fracture, 15% a clavicle fracture, 8% an abdominal trauma and 7% a fractured pelvis. At 19+/-12 months postoperatively, the angle of the operated segments increased by 4.7 degrees +/-4.0 degrees and that of lateral bending of the operated segments by 0.7 degrees +/-1.8 degrees compared to the immediate postoperative values. CONCLUSION: In spite of the high instability of the injured spine, the collective examined had no relevant postoperative loss of correction and no increase in lateral bending. Therefore, a solely dorsal reconstruction is sufficient, reasonable and economical.
Asunto(s)
Traumatismo Múltiple , Fracturas de la Columna Vertebral/cirugía , Fusión Vertebral/métodos , Vértebras Torácicas/lesiones , Traumatismos Abdominales/complicaciones , Accidentes por Caídas , Accidentes de Tránsito , Adolescente , Adulto , Traumatismos Craneocerebrales/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Cifosis/etiología , Masculino , Persona de Mediana Edad , Motocicletas , Estudios Retrospectivos , Rotación , Esquí/lesiones , Fracturas de la Columna Vertebral/complicaciones , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/etiología , Intento de Suicidio , Vértebras Torácicas/diagnóstico por imagen , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Dislocated combined injuries of the upper cervical spine such as C 1/2 fractures require occipitocervical fusion, especially if the dislocation can not be redressed using halo vest immobilisition. We report on the clinical course and outcome of a young woman who sustained complex cervical spine injuries. Closed reduction and a percutaneous transfixation of C 1/2 with k-wires (Magerl) and an additional halo vest immobilisition was performed to avoid permanent fusion. The 25 year old patient was involved in a motor vehicle accident that resulted in a dislocated Jefferson's fracture, an odontoid fracture type II (Anderson and d'Alonso) with protrusion into the foramen magnum, and a dislocated C 6/7 fracture. A ventral spondylodesis C6/7 was followed by temporary dorsal spondylodesis C1/2 with k-wires (Magerl) and additional halo vest immobilisition after closed reduction. The temporary percutaneous fixation C1/2 was removed after 11 weeks, as was the halo vest immobilisition. After removing the temporary percutaneous fixation (k-wires) and the halo system, the patient showed very good functional results in terms of range of motion with only minor discomfort. Complex injuries of the upper cervical spine that cannot be retained by external fixation often require an occipitocervical fusion or fixation of C1/2. In the case presented, the temporary percutaneous fixation (Magerl) with k-wires was terminated after 3 months to avoid significant functional impairment. Younger patients benefit most from temporary fusion of the upper cervical spine, which results in better functional outcome and only minor pain.
Asunto(s)
Inmovilización/métodos , Luxaciones Articulares/cirugía , Apófisis Odontoides/lesiones , Fracturas de la Columna Vertebral/cirugía , Fusión Vertebral/métodos , Traumatismos Vertebrales/cirugía , Tracción/métodos , Adulto , Placas Óseas , Trasplante Óseo , Hilos Ortopédicos , Femenino , Estudios de Seguimiento , Curación de Fractura/fisiología , Humanos , Luxaciones Articulares/diagnóstico por imagen , Apófisis Odontoides/diagnóstico por imagen , Apófisis Odontoides/cirugía , Rango del Movimiento Articular/fisiología , Fracturas de la Columna Vertebral/diagnóstico por imagen , Traumatismos Vertebrales/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Spondylodiscitis is a rare bacterial infection of the spine with an inflammatory, destructive course. To obtain further information on the therapeutic management and clinical course of spondylodiscitis, we retrospectively investigated 78 patients after surgical intervention. Mean age was 64 years (+/-4.6 years; range 21-80 years), the mean length of stay 49 days (+/-8.2 days; 3-121 days) including 24 days (+/-4.7 days; 0-112 days) in ICU. In hospital mortality was 9%. The cervical spine was affected in 10%, the thoracic spine in 35% and the lumbar/sacral spine in 55% of patients. Abscess formation occurred in 65% and destruction of the vertebral body in 74%. A total of 75% of patients presented with neurological deficits which could be improved by surgical intervention in 82% of cases. 24 patients were treated by ventral debridement and stabilization alone, 20 patients with a combined dorsoventral method. Most patients (n=34) were stabilized via dorsal bridging instrumentation without ventral debridement of the focus. Of this group, 23 patients were initially scheduled for secondary ventral debridement but complete healing was achieved prior to this, so further surgical therapy was unnecessary. Successful cure was obtained in 92% of cases. Based on our findings, we favor a split surgical approach: initially with dorsal internal fixation only. Abscesses can be drained percutaneously. Ventral debridement and stabilization is only recommended if insufficient stability can be obtained by dorsal fixation alone, as shown by the persistence of infection or pain.
Asunto(s)
Vértebras Cervicales , Discitis/cirugía , Vértebras Lumbares , Sacro , Vértebras Torácicas , Adulto , Anciano , Anciano de 80 o más Años , Desbridamiento , Discitis/diagnóstico , Drenaje , Femenino , Humanos , Tiempo de Internación , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Fusión Vertebral , Resultado del TratamientoRESUMEN
BACKGROUND: Proper timing of stabilization for spine injuries is discussed controversially. Whereas early repair of long bone fractures is known to reduce complications. PATIENTS AND METHODS: We investigated retrospectively 48 patients who were stabilized in a ventrodorsal approach for fractures of the thoracic spine. Patients were divided into three groups. All patients in groups I and II presented radiological or clinical signs of lung contusion. Patients were stabilized in the prone position via single-step dorsal stabilization with internal transpedicular fixation and ventral fusion with titanium cage or autologous bone graft using a minimally invasive video-assisted thoracotomy. RESULTS: The average duration of the procedures in group I was 213+/-40 min, in group II 250+/-75 min, and in group III 255+/-65 min (p: n.s.). Intraoperative blood loss did not differ significantly between the three groups. The PaO(2)/FiO(2) ratio improved in groups I and III, whereas in group II an significant impairment of lung function occurred perioperatively. Postoperative ICU stay was comparable in groups I and II (I: 10+/-5 days; II: 9+/-7 days); overall ICU stay tended to be shorter in group I versus II. The postoperative dependence on ventilator support did not differ significantly among the three groups. The mortality rate was 0% in this series. CONCLUSION: Our data provide further evidence that early stabilization of combined thoracic and thoracic spine injuries is safe, does not alter perioperative lung function, and results in a reduced overall ICU stay.
Asunto(s)
Contusiones , Lesión Pulmonar , Pulmón/fisiología , Traumatismo Múltiple , Fracturas de la Columna Vertebral/cirugía , Vértebras Torácicas/lesiones , Adolescente , Adulto , Anciano , Trasplante Óseo , Contusiones/complicaciones , Contusiones/terapia , Femenino , Fijación Interna de Fracturas , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Fracturas de la Columna Vertebral/complicaciones , Fusión Vertebral/métodos , Cirugía Torácica Asistida por Video , Toracotomía , Factores de Tiempo , TitanioRESUMEN
Infection can involve all layers of soft tissue. The severity of infection can range from a simple cutaneous infection to widespread necrosis of the skin, muscle, and fascia. While infections of soft tissue are common, and can usually be managed using conservative therapy or local surgery, clinicians should be aware of less commonly seen invasive infections that need immediate radical surgical débridement to treat the source adequately, contributing to improved survival.
Asunto(s)
Enfermedades Cutáneas Bacterianas/diagnóstico , Enfermedades Cutáneas Bacterianas/terapia , Infecciones de los Tejidos Blandos/diagnóstico , Infecciones de los Tejidos Blandos/terapia , Humanos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , PronósticoAsunto(s)
Desbridamiento/métodos , Enfermedades Cutáneas Bacterianas/diagnóstico , Enfermedades Cutáneas Bacterianas/cirugía , Infecciones de los Tejidos Blandos/diagnóstico , Infecciones de los Tejidos Blandos/cirugía , Humanos , Necrosis/patología , Necrosis/cirugía , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , Pronóstico , Resultado del TratamientoRESUMEN
Hospital mortality after hip fracture in elderly patients has decreased significantly in previous years. However, patients often show reduction of daily life activity. The aim of the following study was to assess clinical and radiological results nine months after operation of hip fracture. A total of 127 patients (mean age 77.2 years) were stabilized by arthroplasty because of femoral neck fractures or by gamma locking nail because of trochanteric fractures. Modified Harris-Hip-Score as well as social situation at time of follow-up compared to pretrauma situation were evaluated. Hospital mortality was 3.2 percent. Follow-up could be performed in 78 patients clinically and radiologically by examination in the hospital. At time of follow-up 19.7 percent of patients had already died independent of the operative procedure. Only 65 percent of patients were able to live at home. Modified Harris-Hip-Score at follow-up was decreased significantly by 16 points compared to the situation before the trauma. The reduction of the score was caused mainly by deterioration of hip function and less by femoral or hip pain. In future the main scope after hip fracture must be an improvement of rehabilitation of elderly patients.
Asunto(s)
Actividades Cotidianas , Fracturas del Cuello Femoral/rehabilitación , Fracturas de Cadera/rehabilitación , Accidentes por Caídas , Factores de Edad , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera , Clavos Ortopédicos , Interpretación Estadística de Datos , Terapia por Ejercicio , Femenino , Fracturas del Cuello Femoral/etiología , Fracturas del Cuello Femoral/cirugía , Estudios de Seguimiento , Fijación Interna de Fracturas/instrumentación , Fracturas de Cadera/etiología , Fracturas de Cadera/cirugía , Mortalidad Hospitalaria , Humanos , Masculino , Complicaciones Posoperatorias , Estudios Prospectivos , Factores Sexuales , Factores de Tiempo , CaminataRESUMEN
AIM: Endotoxin is known to be a primary initiator of sepsis and septic shock. Migration of immunocompetent cells due to chemotactic attraction plays a central role in the initiation of the immune response. Two major groups of chemokines can be distinguished: C-x-C chemokines like Interleukin-8 attract mainly neutrophils, C-C chemokines (e.g. RANTES) attract monocytes and T-cells. The aim of this study was to get further insight into chemokine profiles after a single endotoxin bolus in man. MATERIALS AND METHODS: We investigated the effect of systemically administered endotoxin (4ng/kg BW i.v.) in 8 healthy volunteers. Clinical data (heart rate, mean arterial pressure, temperature), serum levels of IL-8, and RANTES, as well as white blood cell count were obtained before and hourly for five hours after endotoxin administration. RESULTS: Heart rate and MAP showed significant changes (p<0.05) after 2-3 hours. All volunteers presented with low-grade fever after 2 hours. WBC was elevated 43% and 63% after 4 and 5 hours, respectively. Both chemokines were significantly different from baseline two hours after endotoxin challenge: While IL-8 was significantly increased RANTES serum levels were diminished. CONCLUSION: From our data we conclude that this endotoxin model was effective to mimic the clinical appearance of sepsis. Chemokines like IL-8 and RANTES are integrated in the early immune response to endotoxin challenge in man.
Asunto(s)
Quimiocina CCL5/sangre , Endotoxinas/administración & dosificación , Interleucina-8/sangre , Adulto , Presión Sanguínea , Femenino , Frecuencia Cardíaca , Humanos , Recuento de Leucocitos , Masculino , Sepsis/diagnósticoRESUMEN
In spite of the well-known immunoregulatory effects of recombinant human interferon-gamma (rHuIFN-gamma), in vitro clinical trials in trauma patients remain inconclusive. In vitro studies have shown that IFN-gamma has an effect on lymphocyte responses in addition to immunomodulatory effects on the monocyte/macrophage system. To investigate the in vivo effect of rHuIFN-gamma perioperatively on lymphocyte behavior in surgical patients, we studied 46 anergic patients undergoing major surgery. Treated patients (T, n = 24) received 100 microg rHuIFN-gamma subcutaneously (s.c.), and control patients (C, n = 22) received a placebo on preoperative days -7, -5, and -3 in a controlled, double-blinded placebo trial. Whole blood cultures were stimulated with mitogen on perioperative days, and cytokines were investigated in the supernatants. Interleukin-2 receptor (IL-2R) levels were significantly elevated in the treatment arm during the postoperative period (p < 0.05). The postoperative enhancement of IL-4 in C was completely attenuated in T (p < 0.05). IL-2 levels were elevated perioperatively in T but not in C. No significant effect of rHuIFN-gamma could be demonstrated on IL-10 or lymphocyte proliferation in vitro. From this pilot study, we conclude that preoperative in vivo immunomodulation of lymphocyte function with rHuIFN-gamma in anergic patients is effective. It improves immunoreactivity, as shown by elevated IL-2R levels. Elevated IL-2 and suppressed IL-4 levels indicate a shift toward a Th1-driven lymphocyte response.
Asunto(s)
Interferón gamma/uso terapéutico , Linfocitos T/efectos de los fármacos , Anciano , Anticoagulantes/farmacología , División Celular/efectos de los fármacos , Citocinas/sangre , Relación Dosis-Respuesta Inmunológica , Método Doble Ciego , Ácido Edético/farmacología , Femenino , Humanos , Interferón gamma/inmunología , Interleucina-10/biosíntesis , Interleucina-10/inmunología , Interleucina-2/biosíntesis , Interleucina-2/inmunología , Interleucina-4/biosíntesis , Interleucina-4/inmunología , Activación de Linfocitos/efectos de los fármacos , Activación de Linfocitos/inmunología , Masculino , Monocitos/efectos de los fármacos , Monocitos/metabolismo , Atención Perioperativa , Fitohemaglutininas/farmacología , Plasma/citología , Plasma/efectos de los fármacos , Plasma/inmunología , Estudios Prospectivos , Receptores de Interleucina-2/biosíntesis , Receptores de Interleucina-2/inmunología , Proteínas Recombinantes , Linfocitos T/citología , Linfocitos T/inmunología , Factores de TiempoRESUMEN
Anastomotic leakage is a serious complication in abdominal surgery. We report on two cases of spondylodiscitis L5/S1 following anastomotic leakage with fistula after low anterior rectal resection. Within five months after rectal resection two patients with massive back pain were admitted to our department. MRI established the diagnosis of spondylodiscitis. Ventral debridement, spondylodesis and protective stoma were performed. With this procedure we were able to achieve control of infection. There were no further complications in the follow-up. Stability of the spinal column was restored and massive back pain was entirely relieved. No signs of rectal cancer recurrence were seen in both cases during the observation period.