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ABSTRACT BACKGROUND: Laparoscopic Nissen fundoplication fails to control the gastroesophageal reflux in almost 15% of patients, and most of them must be reoperated due to postoperative symptoms. Different surgical options have been suggested. AIMS: This study aimed to present the postoperative outcomes of patients submitted to three different procedures: redo laparoscopic Nissen fundoplication alone (Group A), redo laparoscopic Nissen fundoplication combined with distal gastrectomy (Group B), or conversion to laparoscopic Toupet combined with distal gastrectomy with Roux-en-Y gastrojejunostomy (Group C). METHODS: This is a prospective study involving 77 patients who were submitted initially to laparoscopic Nissen fundoplication and presented recurrence of gastroesophageal reflux after the operation. They were evaluated before and after the reoperation with clinical questionnaire and objective functional studies. After reestablishing the anatomy of the esophagogastric junction, a surgery was performed. None of the patients were lost during follow-up. RESULTS: Persistent symptoms were observed more frequently in Group A or B patients, including wrap stricture, intrathoracic wrap, or twisted fundoplication. In Group C, recurrent symptoms associated with this anatomic alteration were infrequently observed. Incompetent lower esophageal sphincter was confirmed in 57.7% of patients included in Group A, compared to 17.2% after Nissen and distal gastrectomy and 26% after Toupet procedure plus distal gastrectomy. In Group C, despite the high percentage of patients with incompetent lower esophageal sphincter, 8.7% had abnormal acid reflux after surgery. CONCLUSIONS: Nissen and Toupet procedures combined with Roux-en-Y distal gastrectomy are safe and effective for the management of failed Nissen fundoplication. However, Toupet technique is preferable for patients suffering from mainly dysphagia and pain.
RESUMO RACIONAL: A fundoplicatura de Nissen laparoscópica falha em controlar o refluxo gastroesofágico em quase 15% dos pacientes e a maioria deles deve ser reoperada devido aos sintomas. Diferentes técnicas cirúrgicas têm sido sugeridas. OBJETIVOS: Apresentar os resultados pós-operatórios de pacientes submetidos a 3 procedimentos diferentes: Reoperação e fundoplicatura de Nissen laparoscópica apenas (Grupo A), reoperação e fundoplicatura de Nissen laparoscópica combinado com gastrectomia distal (Grupo B) ou reoperação e conversão para Toupet laparoscópico combinado com gastrectomia distal e reconstrução em Y-Roux (Grupo C). MÉTODOS: estudo prospectivo incluindo 77 pacientes submetidos inicialmente a fundoplicatura de Nissen laparoscópica que apresentaram recidiva do refluxo gastroesofágico após a operação. Eles foram avaliados antes e após a reoperação com questionário clínico e estudos funcionais específicos. Reestabelecida a anatomia da junção esôfago-gástrica, procedeu-se às referidas cirurgias. Nenhum paciente perdeu seguimento. RESULTADOS: Os sintomas persistentes foram observados com maior frequência nos pacientes dos Grupos A ou B, associados à estenose da fundoplicatura, fundoplicatura intratorácico ou fundoplicatura torcida. No Grupo C, os sintomas recorrentes associados a essa alteração anatômica foram observados com pouca frequência. Esfincter esofágico inferior incompetente foi confirmado em 57,7% dos pacientes pertencentes ao Grupo A em comparação com 17,2% após fundoplicatura de Nissen laparoscópica combinado com gastrectomia distal, e 26% após a Toupet laparoscópico combinado com gastrectomia distal e reconstrução em Y-Roux. Nesse grupo, apesar do alto percentual de pacientes com esfincter esofágico inferior incompetente, 8,7% apresentaram refluxo ácido anormal após a cirurgia. CONCLUSÕES: As técnicas de Nissen ou Toupet combinados com a gastrectomia distal em Y de Roux são seguras e eficazes para o manejo da falha da fundoplicatura a Nissen. A técnica de Toupet é preferível para pacientes que sofrem principalmente com disfagia e dor.
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Introduction: Brucellosis is a zoonosis caused by Brucella spp. It may be acquired by consuming unpasteurized dairy products. Brucellosis has a low incidence in Chile, thus, we have a scarce data. Aim: To report and to characterize the first series of clinical cases of adult patients diagnosed with brucellosis in Chile. Methods: We describe a series of 13 clinical cases in patients diagnosed between 2000 and 2016 in three different centers in the Metropolitan Region, Chile. A retrospective analysis was performed on clinical presentation, laboratory, antibiotic treatment, morbidity and mortality. Results: The mean age was 50 years old. Eight cases had a record of consumption of unpasteurized dairy products. The most frequently reported complaints were fever. The most frequent focal point involved was the spine. Only one patient had a positive blood culture, while the diagnosis was made using serological techniques in the other part of the group. The most indicated antibiotic regimens were doxycycline-rifampicin and doxycycline-gentamicin. The hospital stay was 20 days approximately as an average. Clinical cure was achieved in all cases. Conclusions: Brucellosis is an infrequent zoonosis in Chile, and it produces a nonspecific clinical picture, so it is necessary to have high suspicion to make the diagnosis based in the antecedent of consumption of unpasteurized dairy or raw meat.
Introducción: La brucelosis es una zoonosis provocada por Brucella spp, cuyo principal mecanismo de transmisión es mediante el consumo de lácteos no pasteurizados. Es de baja ocurrencia en Chile, por lo que los datos locales son escasos. Objetivo: Reportar y caracterizar la primera serie de casos clínicos de pacientes adultos con diagnóstico de brucelosis en Chile. Material y Método: Se describe una serie de 13 casos clínicos en pacientes diagnosticados entre el año 2000 y el 2016 en tres centros de la Región Metropolitana, Chile. Se realizó un análisis retrospectivo acerca de la presentación clínica, laboratorio, tratamiento antimicrobiano y morbi-mortalidad. Resultados: El promedio de edad fue 50 años. Ocho casos tenían antecedente de consumo de lácteos no pasteurizados. El motivo de consulta más frecuente fue sensación febril. El compromiso focal más frecuente fue el de columna vertebral. Sólo en un paciente se encontró hemocultivo positivo; en el resto el diagnóstico se hizo mediante técnicas serológicas. Los esquemas antimicrobianos más indicados fueron doxiciclina-rifampicina y doxiciclina-gentamicina. La estadía hospitalaria fue en promedio de 20 días. En todos los casos se logró curación clínica. Conclusiones: La brucelosis es una zoonosis infrecuente en Chile, produce un cuadro clínico inespecífico, por lo que se debe tener una alta sospecha para realizar el diagnóstico, basada en el antecedente del consumo de productos lácteos no pasteurizados o de carne mal cocida.
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Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Brucellosis/diagnosis , Rifampin/administration & dosage , Urban Population , Brucellosis/etiology , Brucellosis/drug therapy , Brucellosis/epidemiology , Gentamicins/administration & dosage , Chile/epidemiology , Retrospective Studies , Doxycycline/administration & dosage , Dairy Products/microbiology , Drug Therapy, Combination , Length of StayABSTRACT
INTRODUCTION: The deleterious effects of aging are well known. However, not all reach this stage in similar circumstances, which relates to the cumulative functional reserve, where the history of physical activity (PA) is critical. Thus, physical performance is directly linked to functional capacity (FC), thats why studies that investigate the impact of PA in life are needed. PURPOSE: To determine the difference in functional fitness components between life-long physically active, currently active and sedentary older adults. METHODS: This is a cross-sectional observational analytic study. We evaluated 76 independent older adults (OA), divided into 3 groups according to PA history: life-long physically active (ATV) (n=20), currently active (AA) (n=38) and sedentary (S) (n=18). Senior Fitness Test (SFT) battery was applied to evaluate the FC components. RESULTS: In AA and S groups, the predominant sex was female. The average age of participants was 66.4 + 5.4 years for ATV, 70.9 + 6.6 years for AA and 71.4 + 5.8 years for S. Among the ATV and S, and between ATV and AA differences were significant (p <0.01) in the performance of the sit to stand test, arm curl test, 2 minutes step test, and 4,8 mts. Up and Go test. There were no significant differences between AA and S groups for the variables studied. CONCLUSION: The AA and S groups shows no significant differences in the components of the CF, but both showed inferior performance than ATV group.
INTRODUCTION: Los deterioros del envejecimiento son ampliamente conocidos. Sin embargo, no todos alcanzamos esta etapa en iguales condiciones, lo cual se relaciona con la reserva funcional acumulada, donde el historial de actividad física (AF) es fundamental. Así, el rendimiento físico está vinculado directamente a la capacidad funcional (CF), haciéndose necesario su estudio para indagar el impacto de la AF realizada durante la vida. OBJETIVO: Determinar la diferencia en los componentes de la capacidad funcional de adultos mayores, activos de toda la vida, actualmente activos y sedentarios de diversas asociaciones de Valdivia. MÉTODO: Estudio observacional analítico de corte transversal. Se evaluaron a 76 adultos mayores(AM) autovalentes divididos en 3 grupos según historial de AF: activos de toda la vida (ATV) (n=20), actualmente activos (AA) (n=38) y sedentarios (S) (n=18). En todos fue aplicada la batería Senior Fitness Test (SFT) para evaluarla CF. RESULTADOS: En los AM AA y S predominó el sexo femenino. El promedio de edad fue 66,4 + 5,4 años para los AM ATV, 70,9 + 6,6 años para los AA y 71,4 + 5,8 años para los S. Entre los ATV-S y ATVAA existieron diferencias significativas (p<0,01)en las pruebas pararse-sentarse, flexiones de brazo, pasos 2 minutos e ir y venir en 4,8 metros. No existieron diferencias significativas entre los AM AA y S para las variables estudiadas. CONCLUSIONES: Los AM AA y S no muestran diferencias significativas en los componentes de la CF, pero ambos registraron un rendimiento inferior al compararse con los AM ATV.