Acercamiento de los procesos alveolares mediante ortopedia prequirúrgica en pacientes con labio y paladar fisurado / Approaching of the alveolar processes using presurgical orthopedics in patients with cleft lip and palate

Las fisuras orales son un grupo heterogéneo de malformaciones congénitas de origen multifactorial. La fisura labio-palatina es una de las más frecuentes, producto de la alteración en la fusión de los procesos labiales mediales, laterales y palatinos durante el desarrollo embrionario, y Chile presenta una prevalencia mayor a la mundial. Su tratamiento contempla diversos procedimientos como la técnica prequirúrgica. El objetivo fue evaluar si el tratamiento prequirúrgico prepara a los pacientes con labio y/o paladar fisurado para la cirugía primaria. Se realizó un estudio retrospectivo, que incluyo a 100 pacientes de ambos sexos con fisura de labio y/o paladar atendidos bajo tratamiento de ortopedia prequirúrgica en el Consultorio Miraflores, Temuco, entre los años 2003 y 2012. Las fisuras fueron categorizadas según la clasificación de Kernahan. El 46% de los tratamientos logró un acercamiento adecuado para la cirugía y 20% sólo requirió manejo de tejidos blandos. Un 8% no logró un acercamiento adecuado. Veinticuatro porciento de los pacientes abandono el tratamiento. No se observaron diferencias entre la edad de inicio de tratamiento vs. acercamiento de los procesos alveolares. El manejo de tejidos blandos tuvo una correlación significativa con el tiempo total de tratamiento y el acercamiento de los procesos alveolares. Determinar la cantidad de pacientes que logran un acercamiento adecuado de los procesos alveolares mediante la técnica prequirúrgica, permite al clínico dimensionar el efecto del tratamiento y encontrar problemas que se puden estar presentando e impiden un mejor resultado

Oral clefts are a heterogeneous group of congenital malformations of multifactorial origin. Cleft lip and palate is one of the most frequent alterations of the fusion of the labial medial, lateral and palatal processes during embryonic development with Chile having a higher prevalence than the rest of the world. Treatment includes various procedures such as preoperative techniques. The objective of this study was to evaluate whether preoperative treatment prepares patients with cleft lip and/or cleft palate for primary surgery. We performed a retrospective study involving 100 male and female patients with cleft lip and/or palate admitted for presurgical orthopedic treatment at the Miraflores primary healthcare service, Temuco, Chile, between 2003 and 2012. Clefts were categorized according to Kernahan classification. Of the treatments, 46% achieved a suitable approach for surgery and 20% required only soft tissue management. Additionally, 8% percent did not achieve an adequate approach and twenty-four percent of patients discontinued therapy. No differences were observed between age at onset of treatment vs. alveolar process approach. Soft tissue management was significantly correlated with the total treatment time and the approach of the alveolar processes. To determine the number of patients achieving an adequate approach to the alveolar process by preoperative technique, allows the clinician to gauge the effect of treatment, find and prevent problems thereby obtaining better results

Evaluación de la eficacia del nutrial II como nutrición enteral suplementaria preoperatoria en lesionados complejos / Assessment of the effectiveness of Nutrial II as preoperative supplementary enteral feeding in complicated patients

Objetivo: evaluar la eficacia del nutrial II como nutrición enteral suplementaria en el preoperatorio del lesionado complejo. Métodos: se realizó un estudio experimental, longitudinal y prospectivo de forma aleatoria en los pacientes lesionados complejos que ingresaron en la Unidad de Cuidados Intermedios Quirúrgicos del Hospital Militar Central "Dr. Luis Díaz Soto", en el periodo comprendido desde el 1ro. de enero de 2006 hasta el 1ro. de enero de 2009. Se conformaron 2 grupos y fue posible estudiar a 100 pacientes. A ambos grupos se les suministró la dieta libre establecida. Al grupo 2 se le adicionó un producto cubano, llamado nutrial II. Resultados: el grupo 2, que consumió el suplemento nutricional, mostró en el preoperatorio elevación hasta 82 por ciento de los pacientes con buen estado nutricional. Se evidenció una estadía hospitalaria más corta en el grupo que consumió el suplemento nutricional. Los lesionados del grupo 2 tuvieron menor estadía preoperatoria; en este grupo se logró que los pacientes asistieran al acto operatorio con una pérdida de nitrógeno cerca de los valores límites de la normalidad, al igual que la albúmina y el colesterol, y solo el 20 por ciento de los pacientes del grupo que recibió el suplemento por vía oral presentó algún tipo de complicación. Conclusiones: las variables que miden el estado nutricional de los lesionados complejos se mantuvieron dentro de límites aceptables para una intervención quirúrgica a corto plazo en el grupo que recibió el nutrial II. Se mostró reducción del número de complicaciones posoperatorias infecciosas en el grupo de lesionados que recibieron el nutrimento, el cual se considera útil para disminuir la morbilidad

Objective: to assess the effectiveness of Nutrial II as supplementary enteral nutrition in the postoperative stage of complicated injured patient. Methods: a randomized, prospective, longitudinal and experimental study was conducted in complicated injured patients admitted in the Surgical Intermediate Care Unit of the "Dr. Luis Díaz Soto" Central Military Hospital from January 1, 2006 to January 1, 2009. Two groups were created and it was possible to study 100 patients. Both groups received the established free diet and to group 2 a Cuban product called Nutrial II was added. Results: the group 2 had the nutritional supplement and in the postoperative stage showed a rise up to 82 percent of patients with a good nutritional status. It was evidenced a shorter hospital stay in the group consumed the nutritional supplement. The injured ones of the group 2 had less postoperative stay; in this group authors achieved that patients went to surgery with a loss of nitrogen near of limit values of the normality like the albumin and cholesterol, and only the 20 percent of patients from the group with oral supplement had some type of complication. Conclusions: the variables measuring the nutritional status of the complicated injured remained within the acceptable limits for a short term surgical intervention in the group with Nutrial II. There was a reduction in the number of postoperative infectious complications in the injured group under nourishment, which is considered as useful to decrease the morbility

Prognosis of Patients with Non-Small Cell Lung Cancer after Surgery / 결핵

BACKGROUND: Lung cancer continues to be the leading cause of cancer death in the United States and it's incidence has been rapidly increasing in Korea, too. The overall cure rate for non-small cell lung cancer(NSCLC) is approximately 10%, and the cure is generally achieved by surgery. Unfortunately, however, less than 15% of all patients and less than 25% of those who present with localized disease are candidates for curative surgical resection. So preoperative staging evaluation followed by curative resection has a major role in determining the long term prognosis of NSCLC patients. Therefore, we have conducted this study to compare pre-operative and post-operative staging and the long-term relapse-free survival rates in NSCLC patients according to its stage. METHODS: We analyzed the medical records of 217 NSCLC patients who were operated on for curative resection in Seoul National University Hospital, retrospectively. Among them, 170 patients who were completely resected were selected to determine the long term relapse-free survival rates. RESULTS: Among 217 NSCLC patients, men were 157 and women were 30. The median age was 58 and the difference between men and women was not found. The discrepancy rate between preoperative and postoperative staging was 40.1%. Its major cause was due to the difference of nodal staging. The 3-year relapse-free survival rates were 73%, 53% and 48% in stage I, II and IIIa, respectively. There was no difference of relapse-free duration in recurred patients according to the stage or histologic types. CONCLUSION: The postoperative pathologic staging determines the long term prognosis of patients with NSCLC after surgery, but current preoperative clinical staging can not predict the postoperative pathologic staging correctly. So the improved modality of staging system is required to predict the pathologic staging more correctly.