IntroductionTo assess the possible role and the interaction of cerebrovascular disease and vascular stenosis on the necessity of shunt insertion during carotid endarterectomy (CEA).Material and methodsEighty consecutive patients undergoing CEA under regional anaesthesia were prospectively enrolled. Patients were divided into two groups depending on whether they were shunted or not. The measured end-points were co-morbidities degree of contralateral and carotid stenosis and other intra- and postoperative outstanding parameters. ANOVA, Student's t and χ2 tests were used (p<0.05). Variables differing significantly between groups and potential confounders were used in backward stepwise logistic regression to estimate the relative risk (RR, 95% CI) of shunt. In addition Wald's test (p<0.05) with and without adjustments for potential confounders was used with various different multivariate analysis models.ResultsContralateral stenosis and cerebral vascular accidents (CVA) were more frequently observed in shunted patients. The RR for patients with contralateral stenosis ≥ 50% was 1.3 (95% CI 1.0-1.5) and for patients with previous CVA was 1.2 (95% CI 1.0-1.4). For contralateral stenosis and CVA together the RR increased to 7.7 (95% CI 1.0-14.4). A model based on contralateral stenosis and CVA was found to be statistically significant (p=0.003) for shunt (RR=1.1, 95% CI 1.0-2.1). Relative excess risk due to interaction of both factors was 6.2.ConclusionsThe findings suggest that patients with contralateral stenosis ≥ 50% and previous CVA have a higher risk of requiring shunt use during CEA than patients with these risk factors separately.
Background Chronic back pain is a prevalent disease and has a high impact in daily life.
Implantable devices (IDs) for chronic pain management include spinal cord stimulation (SCS)
systems and intrathecal drug delivery (ITDD) pumps. The number of ITDD implants have increased
exponentially in the last decade. The number of complications, such as infections, are also more
prevalent. Infection management guidelines are needed to standarize our clinical practice and
define protocols of explantation.
Objectives: The primary outcome is to define the likelihood of device explantation regarding
some covariates related to the patient, antibiotic therapy or surgerical procedures. The secondary
outcome is to evaluate performance compared to the results published in the literature.
Study Design: Retrospective study.
Setting: Hospital General of Valencia. Valencia. Spain.
Methods: A retrospective study of 288 implantable device surgeries was conducted at the Hospital
General Universitary of Valencia (Spain) from 1994 to 2015. Demographical and infection data
were collected. We have followed the “guidelines for the diagnosis, prevention and management
of implantable electronic cardiac device infection” due to the lack of a specific guideline in our
field.
Results: Forty-three out of 288 procedures were identified as suspected device-infected
interventions. Half of the patients had microbiologically confirmed infection after wound, blood or
lumbar fluid culture. The odds ratio (OR) for explantation of the device was 19 for the presence of
decubitus, a sign of medical device related pressure injury (P < 0.0005) and 5 for positive wound
culture (P < 0.0452). Medical indication leading to device implantation and the antibiotics on
discharge also played a role in the decision of device explantation.
Limitations: Lack of external validity and others.
Conclusion: In this study, presence of decubitus is the defining variable for device explantation
when a infection is suspected rather than waiting to culture results. Due to a high variability in
infection rates, multidisciplinary guidelines are needed to provide an approach that focuses on
accurate data monitoring, rigurous implantation technique and standardized protocols.
Key Words: Chronic pain, spinal cord stimulation infection, neurostimulator, intrathecal drug
delivery pump, complication, infection, explantation
Objectives
COVID-19 was declared pandemic by March 2020. Clinical, analytical, and radiological findings have been reported. Detailed different evolution of patients of the same local outbreak has been scarcely reported. We report 6 selected cases of such an evolution.
Clinical cases
The clinical, radiological, analytical evolution of 6 patients is reported. Patients were selected as it were epidemiological close contacts, and showed particular different clinical evolution.
Results
The clinical course at the start of infection (first week) was similar among patients. In relationship with clinical evolution, middle to severe course were related with inflammation markers levels evolution (D-dimer, IL-6, ferritin, lymphocytes count, etc.). Specially lung alterations were observed, but neurological/neuropsychiatric findings are still common. In evolution, 2 patients showed middle symptoms, but the 2 most severely affected died.
Conclusions
It remains to be elucidated the different evolutive pathways and outcomes of COVD-19. In our 6 patients of the same local outbreak, clinical, laboratory and radiological features were different. We discuss some aspects of the pathophysiology of the disease, otherthan the widely described of the respiratory system.
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