RESUMEN
Wound infection is frequently reported following snakebite (SB). This study is retrospective. It was conducted in the emergency department and the Intensive Care Unit (ICU) of Cayenne General Hospital between 1 January 2016 and 31 July 2021. We included 172 consecutive patients hospitalized for SB envenoming. All patients were monitored for wound infection. Sixty-three patients received antibiotics at admission (36.6%). The main antibiotic used was amoxicillin-clavulanate (92.1%). Wound infection was recorded in 55 cases (32%). It was 19% in grade 1, 35% in grade 2, and 53% in grade 3. It included abscess (69.1%), necrotizing fasciitis (16.4%), and cellulitis (21.8%). The time from SB to wound infection was 6 days (IQR: 3-8). The main isolated microorganisms were A. hydrophila and M. morganii (37.5% and 18.8% of isolated organisms). Surgery was required in 48 patients (28.1%), and a necrosectomy was performed on 16 of them (33.3%). The independent factors associated with snakebite-associated infection were necrosis (p < 0.001, OR 13.15, 95% CI: 4.04-42.84), thrombocytopenia (p = 0.002, OR: 3.37, 95% CI: 1.59-7.16), and rhabdomyolysis (p = 0.046, OR: 2.29, 95% CI: 1.02-5.19). In conclusion, wound infection following SB is frequent, mainly in grade 2 and 3 envenomed patients, especially those with necrosis, thrombocytopenia, and rhabdomyolysis. The main involved bacteria are A. hydrophila and M. morganii.
Asunto(s)
Infecciones Bacterianas/etiología , Mordeduras de Serpientes/complicaciones , Infección de Heridas/etiología , Adulto , Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/cirugía , Vesícula/complicaciones , Vesícula/tratamiento farmacológico , Vesícula/cirugía , Femenino , Guyana Francesa , Humanos , Masculino , Persona de Mediana Edad , Necrosis/complicaciones , Necrosis/tratamiento farmacológico , Necrosis/cirugía , Estudios Retrospectivos , Rabdomiólisis/complicaciones , Rabdomiólisis/tratamiento farmacológico , Rabdomiólisis/cirugía , Mordeduras de Serpientes/tratamiento farmacológico , Mordeduras de Serpientes/cirugía , Trombocitopenia/complicaciones , Trombocitopenia/tratamiento farmacológico , Trombocitopenia/cirugía , Infección de Heridas/tratamiento farmacológico , Infección de Heridas/cirugíaRESUMEN
Definir los criterios de diagnóstico de la enfermedad y las pruebas que se deben realizar al paciente para su evaluación. Brindar indicaciones de manejo de PTI aguda, crónica y persistente. Proponer opciones de tratamiento de acuerdo a la evidencia disponible. Dar indicación de manejo en PTI con riesgo de sangrado que pueda comprometer la vida.
Asunto(s)
Humanos , Esplenectomía , Trombocitopenia/cirugía , Trombocitopenia/diagnóstico , Trombocitopenia/terapia , Recuento de Plaquetas , Dexametasona/uso terapéutico , Receptores de Trombopoyetina/agonistas , Rituximab/uso terapéutico , Anemia HemolíticaRESUMEN
We present a case of a patient with hypersplenism secondary to portal hypertension due to hepato-splenic schistosomiasis, which was accompanied by severe and refractory thrombocytopenia. We performed spleen ablation and measured the total spleen and ablated volumes with contrast-enhanced computed tomography and volumetry. No major complications occurred, thrombocytopenia was resolved, and platelet levels remained stable, which allowed for early treatment of the patient's underlying disease. Previous work has shown that splenic radiofrequency ablation is an attractive alternative treatment for hypersplenism induced by liver cirrhosis. We aimed to contribute to the currently sparse literature evaluating the role of radiofrequency ablation (RFA) in the management of hypersplenism. We conclude that splenic RFA appears to be a viable and promising option for the treatment of hypersplenism.
Asunto(s)
Ablación por Catéter , Hiperesplenismo/cirugía , Parasitosis Hepáticas/parasitología , Esquistosomiasis mansoni/parasitología , Trombocitopenia/cirugía , Medios de Contraste , Humanos , Hiperesplenismo/diagnóstico , Hiperesplenismo/parasitología , Hipertensión Portal/diagnóstico , Hipertensión Portal/parasitología , Parasitosis Hepáticas/complicaciones , Parasitosis Hepáticas/diagnóstico , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Valor Predictivo de las Pruebas , Esquistosomiasis mansoni/complicaciones , Esquistosomiasis mansoni/diagnóstico , Trombocitopenia/diagnóstico , Trombocitopenia/parasitología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: Laparoscopic splenectomy (LS) is considered the standard treatment for patients with refractory primary immune thrombocytopenia (ITP). PATIENTS AND METHODS: All patients with ITP who underwent LS during the last 17 years and who had a minimum follow-up of 1 year were included. Several perioperative variables such as age, platelet count, and duration of preoperative therapy were recorded and analyzed, looking for potential predictive variables of clinical response. RESULTS: In total, 150 patients were included: 108 (72%) women and 42 (28%) men, with a mean age of 37.3±15.8 years. In the evaluation 1 year after surgery, 133 (88.7%) patients had achieved complete response, 4 (2.7%) had a response, and in 13 (8.6%) there was no response. None of the analyzed preoperative variables was identified as a predictive factor of response at 1 year. Immediate responders after surgery (≥150,000 platelets/mL during the first week) had a higher platelet count and rate of complete response at 1 year (94.2%). CONCLUSIONS: LS has a high success rate in patients with refractory ITP. Potential predictive indicators of success remain to be determined.
Asunto(s)
Laparoscopía/métodos , Púrpura Trombocitopénica Idiopática/cirugía , Esplenectomía/métodos , Trombocitopenia/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Laparoscopía/efectos adversos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Inducción de Remisión , Esplenectomía/efectos adversos , Resultado del TratamientoRESUMEN
La trombocitopenia es la más común de las alteraciones en la serie plaquetaria encontrada en los pacientes infectados por VIH. El mecanismo etiopatogénico más frecuente es la precipitación de complejos inmunes sobre la superficie plaquetaria, resultando en el clearence de estas células por el sistema retículo endotelial. Los recursos terapéuticos', disponibles son: uso de inmunoglobulina potivalente intravenosa (IVIG), corticoides y esplenectomía. Se presentan tres casos clínicos con diagnóstico de trombocitopenia inmune (PTI), en los cuales debido a la refractariedad al tratamiento médico clásico, se realizó esplenectomía paliativa. Se destaca la buena tolerancia al procedimiento quirúrgico, la respuesta plaquetaria y la evolución favorable de esos pacientes(AU)
Asunto(s)
INFORME DE CASO , Humanos , Masculino , Femenino , Adulto , Infecciones por VIH/complicaciones , Esplenectomía , Trombocitopenia/cirugíaRESUMEN
En Pediatría al día vol.10, n§1 se dio a conocer la primera parte de este artículo en el que se abordó la evaluación global del paciente, los tipos de anemia y las anormalidades de los leucocitos, de interés para el cirujano. En esta segunda parte el Dr. Pesse comenta el rol de la hemostasis en el paciente quirúrgico y los criterios básicos en la terapia transfusional perioperatoria
Asunto(s)
Recién Nacido , Lactante , Preescolar , Niño , Hemostasis/fisiología , Transfusión Sanguínea/métodos , Pérdida de Sangre Quirúrgica , Técnicas de Laboratorio Clínico , Hemofilia A/cirugía , Periodo Posoperatorio , Cuidados Preoperatorios , Trombocitopenia/diagnóstico , Trombocitopenia/etiología , Trombocitopenia/cirugíaRESUMEN
A two-year-old girl with thrombocytopenia-absent radii syndrome underwent transplantation of allogeneic bone marrow from her histocompatible sibling to correct her persistently low platelet count. Six years after transplantation, she has durable engraftment of allogeneic marrow and a normal platelet count that will allow her to undergo necessary corrective orthopedic procedures.
Asunto(s)
Trasplante de Médula Ósea , Radio (Anatomía)/anomalías , Trombocitopenia/cirugía , Preescolar , Femenino , Humanos , Recuento de Plaquetas , Síndrome , Trombocitopenia/sangreRESUMEN
A young girl who presented with raised intracranial pressure was thought to have a tumour in the parieto-temporal region, where a "tumour circulation" was seen on carotid angiography. However this lesion proved not to be a tumour but intra-cerebral and subdural haematomata, secondary to thrombocytopaenic purpura for which she has since be treated by splenectomy. (AU)