Prevalencia de las complicaciones asociadas a la cirugía de resección del tumor del cuerpo carotídeo

Antecedentes: Glomus o tumores del cuerpo carotídeo (TCC), conocidos como quimiodectoma o paraganglioma, son generalmente benignos. El diagnóstico se obtiene por estudios de imagen; la angiografía es el método de referencia. Tratamiento definitivo, resección quirúrgica. Las complicaciones asociadas son lesión de nervios craneales, ruptura arterial, evento vascular cerebral (EVC) y muerte. Objetivo: Determinar la prevalencia de las complicaciones asociadas a resección de TCC. Métodos: Estudio retrospectivo y analítico. Se evaluaron expedientes de pacientes sometidos a resección de TCC, periodo del 1 de enero de 2017 al 31 de diciembre de 2020. Resultados: Se evaluaron 31 pacientes sometidos a resección TCC, 94% mujeres. Se dividieron en: grupo 1 (TCC sin complicaciones, n = 13) y grupo 2 (TCC con complicaciones, n = 18). Complicaciones: vasculares 36%; lesión nerviosa en el 23%. Conclusiones: Las lesiones vasculares son la principal complicación en nuestro estudio (36%), sin embargo, son transitorias. Las lesiones nerviosas fueron permanentes en el 7% de los casos

Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure. the SEMICA-2 study

Objective: Little is known about treatments provided by advanced life support (ALS) ambulance teams to patients with acute heart failure (AHF) during the prehospital phase, and their influence on short-term outcome. We evaluated the effect of prehospital care in consecutive patients diagnosed with AHF in Spanish emergency departments (EDs). Methods: We selected patients from the EAHFE registry arriving at the ED by ALS ambulances with available follow-up data. We recorded specific prehospital ALS treatments (supplemental oxygen, diuretics, nitroglycerin, non-invasive ventilation) and patients were grouped according to whether they received low- (LIPHT; 0/1 treatments) or high-intensity prehospital therapy (HIPHT; > 1 treatment) for AHF. We also recorded 46 covariates. The primary endpoint was all-cause 7-day mortality, and secondary endpoints were prolonged hospitalisation (> 10 days) and in-hospital and 30-day mortality. Unadjusted and adjusted odds ratios were calculated to compare the groups. Results: We included 1493 patients [mean age 80.7 (10) years; women 54.8%]. Prehospital treatment included supplemental oxygen in 71.2%, diuretics in 27.9%, nitroglycerin in 13.5%, and non-invasive ventilation in 5.3%. The LIPHT group included 1041 patients (70.0%) with an unadjusted OR for 7-day mortality of 1.770 (95% CI 1.115–2.811; p = 0.016), and 1.939 (95% CI 1.114–3.287, p = 0.014) after adjustment for 16 discordant covariables. The adjusted ORs for all secondary endpoints were always > 1 in the LIPHT group, but none reached statistical significance. Conclusions: Patients finally diagnosed with AHF at then ED that have received LIPHT by the ALS ambulance teams have a poorer short-term outcome, especially during the first 7 days