Surgical complications in cirrhotic patients. Analysis of 102 cases Background: Cirrhotic patients have an increased surgical risk due to potential intra and postoperative complications. Aim: To describe the clinical characteristics and surgical complications of cirrhotic patients undergoing surgery in a Chilean university hospital. Patients and Methods: Review of medical records of 102 cirrhotic patients aged 60 ± 11 years (52% males) who underwent elective or urgency surgery at an university hospital between 2010 and 2016. General, pre-surgical, and post-surgical complications were recorded. Results: The main etiologies of cirrhosis were non-alcoholic steatohepatitis (31%), and alcoholic cirrhosis (28%). Child-Pugh scores were A, B and C in 50, 28 and 22% of cases respectively. Median MELD (Model for End-stage Liver Disease) score was 11 (interquartile range: 10-15). The surgical procedure was elective in 71% of cases, with predominance of abdominal surgery (86%). The American Society of Anesthesiologists (ASA) score was three or more in 52% of patients. The frequency of any adverse outcome was 62%.The frequency increased along with the severity of cirrhosis and when surgery was urgent. The most common complications were acute renal failure (24%), increased ascites (23%) and encephalopathy (22%). Admission to intensive care unit occurred on 26% of patients, with six hospital deaths. Conclusions: In these patients, surgical complications were common, although with low mortality.
Primary malignant hepatic tumors other than hepatocarcinoma or cholangiocarcinoma. A series of casesBackground: There are several types of primary malignant hepatic tumors (PMHT) other than hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC): they are infrequent and poorly known. Imaging studies could help characterize the lesions and may guide the diagnosis. However, the definitive diagnosis of PMHT is made by pathology. Aim: To review a registry of liver biopsies performed to diagnose hepatic tumors. Patients and Methods: Review of a pathology registry of liver biopsies performed for the diagnosis of liver tumors. Among these, 25 patients aged 57 ± 17 years, 60% males, in whom a liver tumor other than a HCC or CC was diagnosed, were selected for review. The medical records of these patients were reviewed to register their clinical characteristics, imaging and the pathological diagnosis performed during surgery and/ or with the percutaneous liver biopsy. Results: Ten patients (40%) had neuroendocrine tumors, six (24%) had a lymphoma and four (16%) had hepatic hemangioendothelioma. Angiosarcoma and sarcomatoid carcinoma were diagnosed in one patient each. In 22 patients (88%), neither clinical features nor imaging studies gave the correct diagnosis. Four patients (16%) had chronic liver disease. The most frequent symptoms were weight loss in 28% and abdominal pain in 24%. Conclusions: The most common PMHT other than HCC and CC were neuroendocrine tumors and lymphomas. Imaging or clinical features were not helpful to reach the correct diagnosis. (Rev Med Chile 2019; 147: 751-754)
Category: Sports Introduction/Purpose: Study Design: Case-control Objective: To determine whether patients presenting with an Achilles tendon rupture are at greater risk of rupturing their contralateral tendon when compared to general population. Summary of Background Data: Extrinsic risk factors for Achilles tendon rupture, such as fluoroquinolones or local injections with corticosteroids, are well recognized. Genetic predisposition is another factor that has been proposed, since this pathology is more frequently seen in certain populations. Thus, it can be theorized that patients who have presented an Achilles tendon rupture are at higher risk of rupturing their contralateral tendon compared to general population. Previous reports by Arøen et al suggest than 10 out of 154 patients presented a contralateral injury (OR:176). Methods: Data from patients operated on from an acute Achilles tendon rupture were retrospectively retrieved from two academic centers. Patients were included if they had at least 2 years since their surgery and were willing to participate in the study. Each patient answered a telephone questionnaire regarding prior symptoms, contralateral rupture and risk factors (flouroquinolones, local corticosteroids and tobacco). Patients were excluded if they did not answer all questions or were unable to be contacted. Since data in our population is lacking, we used the overall incidence of Achilles tendon rupture published by Sheth et al. as the expected rate of Achilles tendon rupture in the general population. This value was compared to our cohort’s contralateral injury incidence to obtain an effect measure (odds ratio). Results: 246 consecutive Achilles tendon ruptures were treated during a 6-year follow-up period (2008-2016). 25 patients (8.5%) ruptured their contralateral tendon, equivalent to an incidence of 1407 ruptures per 100.000 inhabitants per year. Reported incidence of Achilles tendon rupture in the general population is 29 per 100.000 inhabitants per year. Odds ratio compared to the general population was 49.2 (95% CI: 34.1 – 73.7) (p <0.0001). Median time to contralateral rupture was 21.6 months (12 – 55) after the initial injury. There were no significant differences regarding age, sex, presence of external risk factors or prior symptoms in the group with a contralateral rupture. 81 patients (33%) experienced tendon pain of at least two weeks duration in relation to their initial rupture. Conclusion: Conclusion: Patients who sustain an Achilles tendon rupture are at higher risk (OR 49.2) of rupturing their contralateral tendon when compared to the general population. In our group, median time for the contralateral injury was 21.6 months. Discussion: Preventive strategies should be directed and conducted in this high risk population. Orthopedic surgeons should consider this information when counseling patients who sustained an Achilles tendon rupture.
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