Neurovascular Structures at Risk During Anterolateral and Medial Arthroscopic Approaches of the Hip

To describe the safety areas for placement of 5 anterolateral portals (anterior, anterior lateral, posterior lateral, proximal anterior medial and distal anterior medial portals) and 3 recently described medial portals (anterior medial, posterior medial and distal posterior medial portals) to provide topographical description of the safety of each. A descriptive, observational and crosssectional study in which femoral triangle dissection was performed in 12 hips. 5 lateral portals and the 3 medial portals were placed. Clinically relevant neurovascular structures associated with each portal, were identified measured and documented. The lateral portal with the highest risk of injury to a nearby neurovascular structure was the anterior portal, the most adjacent to the femoral cutaneous nerve, 1.42 cm (±0.85) lateral to the portal. In the medial portals, the anterior medial portal has the narrowest margin in relation to the femoral artery, 2.14 cm (±0.35) lateral to the portal and medial to the obturator nerve by 0.87 cm (±0.62). The lateral portals have a higher safety margin; the portal with the most proximity to a neurovascular structure is the anterior portal, associated laterally with the femoral cutaneous nerve, presenting a higher risk of injury. Medial portals have a higher risk of injuring the femoral neurovascular bundle as well as the obturator nerve

Visible erbium luminescence in SiO2-TiO2-Er3+ sol-gel powders

Background: Suprahepatic inferior vena cava anastomosis stricture is an unusual vascular complication after orthotopic liver transplantation with the "piggyback" technique. Clinical manifestations are dependent upon the severity of the stenosis. Portopulmonary hypertension after orthotopic liver transplantation is a complication that carries high mortality due to cardiopulmonary dysfunction. The pathogenesis of pulmonary vascular disorders after orthotopic liver transplantation remains uncertain. Case Report: We report a case of acute right heart pressure overload after surgical correction of the suprahepatic inferior vena cava anastomotic stricture in a 54-year-old woman who had preexisting pulmonary arterial hypertension associated with portal hypertension after orthotopic liver transplantation. Twenty months posttransplantation, she developed fatigue and progressive ascites. On admission, the patient had hepatomegaly, ascites, and lower limb edema. Symptoms in the patient developed gradually over time. Conclusions: Recurrent portal hypertension by vascular complications is a cause of pulmonary arterial hypertension after orthotopic liver transplantation. Clinical manifestations of suprahepatic inferior vena cava anastomotic stenosis are dependent upon their severity. Sildenafil is an effective drug for treatment of pulmonary arterial hypertension after portal hypertension by vascular complications. " Am J Case Rep, 2013.",,,,,,"10.12659/AJCR.889261",,,"http://hdl.handle.net/20.500.12104/45670","http://www.scopus.com/inward/record.url?eid=2-s2.0-84884388524&partnerID=40&md5=b4b92534994062b8edf5804196c8b16

Venous outflow obstruction and portopulmonary hypertension after orthotopic liver transplantation

Background: Suprahepatic inferior vena cava anastomosis stricture is an unusual vascular complication after orthotopic liver transplantation with the "piggyback" technique. Clinical manifestations are dependent upon the severity of the stenosis. Portopulmonary hypertension after orthotopic liver transplantation is a complication that carries high mortality due to cardiopulmonary dysfunction. The pathogenesis of pulmonary vascular disorders after orthotopic liver transplantation remains uncertain. Case Report: We report a case of acute right heart pressure overload after surgical correction of the suprahepatic inferior vena cava anastomotic stricture in a 54-year-old woman who had preexisting pulmonary arterial hypertension associated with portal hypertension after orthotopic liver transplantation. Twenty months posttransplantation, she developed fatigue and progressive ascites. On admission, the patient had hepatomegaly, ascites, and lower limb edema. Symptoms in the patient developed gradually over time. Conclusions: Recurrent portal hypertension by vascular complications is a cause of pulmonary arterial hypertension after orthotopic liver transplantation. Clinical manifestations of suprahepatic inferior vena cava anastomotic stenosis are dependent upon their severity. Sildenafil is an effective drug for treatment of pulmonary arterial hypertension after portal hypertension by vascular complications. © Am J Case Rep, 2013

Asymptomatic Bacteriuria (AB) and pyuria in the elderly ambulatory women

Bacteriuria has come to be synonymous of urinary tract infection (UTI), although this approach has never been validated with AB in elderly women. In the absence of symptoms, pyuria is the most suggestive factor of true urinary tract asymptomatic infection. Objective: To determine the prevalence and microbiological differences between AB in elderly ambulatory women with and without pyuria. Methods: During a 12-month period, from January to December of 1995, a cross-sectional study of elderly ambulatory women residing in 7 nursing homes was undertaken. All elderly ambulatory women without symptoms of UTI were evaluated for bacteriuria and pyuria. Results: Of 178 elderly women, AB was found in 44 (24.7%). The mean age of those with bacteriuria was 81±8 years whereas the mean age of those without bacteriuria, was 78±9 years;P <0.050. The association between bacteriuria and pyuria was found in 77%. The presence of pyuria had a sensitivity of 61% for bacteriuria, with a specificity of 91%. The positive predictive value for the presence of pyuria predicting those with bacteriuria was 69.2% and the negative predictive value for the absence of pyuria predicting those without bacteriuria was 87.7%. Escherichia coli was the most common organism isolated in 81.8% women. Conclusion: In elderly women with AB, bacteriuria associated with pyuria should be the diagnostic criterion for infection. Women without bacteriuria but with pyuria should be studied for other causes of tract urinary inflammation

Acinetobacter baumannii blood infections in intensive care patients [Bacteremia por Acinetobacter baumannii en pacientes en estado crftico]

Objective: Determine the severity and the course of Acinetobacter baumannii blood infections (AbBI). Methods: We carried out a prospective review of all Acinetobacter baumannii (A.baumannii) isolated from the Intensive Care Unit (ICU) of a medical facility. Results: During the study period, 46 patients were identified with AbBI. The rate of AbBI was 14per 1,000 admissions. A.baumannii was ICU acquired in 85% of cases studied. The median time frame between ICU admission and acquisition of AbBI was 9�7 days. 31 patients displayed blood infection (BI) by A.baumannii alone and 15 with polymicrobial BI. The clinical manifestation of the 31 patients with AbBI included the following symptoms: 42% presented with septic shock, 42% had severe sepsis and 16% had sepsis. Two or more episodes of AbBI were observed among 13% of patients. Of A. baumannii isolates, 17% were resistant to imipenem. Patient mortality with AbBI alone was 45% and 40% for polymicrobial BI. Patient mortality for septic shock was 60%, 70% died during the first 72 hrs after AbBI. Conclusions: AbBI displayed an endemic pattern during the study period. Severe sepsis and septic shock were the most common clinical presentations of AbBI. AbBI are associated with a significant increase in the death rate of patient in the ICU studied

Asymptomatic bacteriuria and inflammatory response to urinary tract infection of elderly ambulatory women in nursing homes

Background. Bacteriuria ? 105 CFU/ml is evidence of urinary tract infection in the absence of associated signs or symptoms. The presence of pyuria with asymptomatic bacteriuria established the response of elderly women against microorganisms capable of causing invasiveness or tissue injury of the urinary tract. Methods. The association between bacteriuria and pyuria was determined in 178 elderly, ambulatory women without symptoms of urinary tract infection in seven nursing homes. Urine culture results were subsequently analyzed in conjunction with absolute leukocyte count in urine. In this cross-sectional study, asymptomatic bacteriuria in elderly women was classified with and without pyuria. Results. The prevalence of asymptomatic bacteriuria was found in 44 (24.7%) elderly women. The presence of pyuria had a sensitivity of 63.6% for bacteriuria and a specificity of 91%. The positive predictive value for the presence of pyuria predicting those with bacteriuria was 70%, and the negative predictive value for the absence of pyuria predicting those without bacteriuria was 88.4%. Escherichia coli was the most common organism isolated in 81.8% of the women. Conclusions. Bacteriuria ? 105 CFU/ml associated with pyuria was detected in 77% of elderly women with asymptomatic urinary tract infections. Bacteriuria of &lt; 105 CFU/ml with pyuria proves less sensitive as an indicator of urinary tract infection. Elderly women with pyuria but without bacteriuria should be studied for other causes of urinary tract inflammation