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@#Objective To analyze the clinical efficacy of transthoracic occlusion via a right subaxillary incision and conventional surgery in the treatment of ventricular septal defect (VSD). Methods The clinical data of patients with congenital VSD undergoing right subaxillary incision surgery in our hospital from January 2017 to January 2020 were retrospectively analyzed. According to the surgical methods, the patients were divided into two groups: a conventional surgery group (conventional group) and a transthoracic occlusion group (occlusion group). There were 221 patients in the conventional group, including 97 males and 124 females, with an average age of 2.6±2.2 years and an average weight of 13.4±6.2 kg; there were 185 patients in the occlusion group, including 90 males and 95 females, with an average age of 3.2±2.6 years and an average weight of 14.7±6.6 kg. The clinical effectiveness was compared. Results The success rate of surgery was 100% in both groups. The intraoperative blood loss was less in the occlusion group (P<0.05). The incision length, operation time, postoperative mechanical ventilation time, retention time in the intensive care unit, the time to resume normal diet and normal activities after operation were all shorter than those in the conventional group (P all <0.05). The total cost during hospitalization of the conventional group was less than that of the occlusion group (P<0.001). There was no statistical difference in the incidence rate of perioperative complications between the two groups (P>0.05). During the follow-up (15.8±8.8 months), the incidence of complications in the conventional group was higher than that in the occlusion group with a statistical difference (P<0.001). Conclusion Compared with conventional surgery, transthoracic occlusion for VSD via right subaxillary incision has the advantages of smaller incision, shorter operation time, less blood loss, shorter postoperative recovery time and less long-term complications. However, the total hospitalization cost is relatively high, mainly because of the high consumables cost, and the long-term effects still need further comparative observation.
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Introduction: Dental implant may serve as a choice of treatment for replacement of missing tooth in diabetic patients with their well-controlled glycemic index. To minimize postoperative complications, dental surgical procedures comprises mainly two types, namely conventional and flapless surgery. Objective: The aim of this review is to find the survival rate of the dental implant when placed with either of the technique, that is, conventional or flapless in patients with controlled Type 2 diabetes mellitus from published studies. Materials and Methods: A total of 14 studies were included from PubMed database related to the survival rate of dental implant placement by conventional or flapless surgery among patients with controlled diabetes mellitus. The cumulative mean of dental implant survival rate by conventional and flapless techniques calculated from included studies is 94.2% and 92.3%, respectively. Conclusion: The survival rate of dental implant placement by conventional and flapless techniques is similar. As few studies on flapless technique are available, therefore researchers in future should explore its advantages and disadvantages.
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Contexto: la cirugía ha sufrido variaciones históricas y se ha expandido a través del tiempo de forma progresiva y constante. Objetivo: describir la enseñanza de la cirugía a través de la historia en Ecuador. Discusión: la realización de modelos anatómicos para procedimientos quirúrgicos proporciona una importante experiencia al cirujano en formación y una mejora su desempeño al perfeccionarse su técnica quirúrgica con el beneficio de acortar la curva de aprendizaje. La posibilidad de certificación de todas las especialidades quirúrgicas y la educación médica continua, es una tarea pendiente para nuestro país. El progreso de la Cirugía General, haciendo uso de los avances tecnológicos, ha permitido el perfeccionamiento de la especialidad y ha motivado al resto de especialidades quirúrgicas afines a adoptar estas nuevas tecnologías e incursionar en las súper especialidades. La elaboración de este artículo constituye un primer esfuerzo, para con mayor investigación y testimonios ir completando este fascinante recorrido histórico de la especialidad, del cual somos testigos presenciales en las tres últimas décadas. Conclusión: la enseñanza tradicional de cirugía abierta ha requerido adaptarse al vertiginoso advenimiento de la cirugía mínimamente invasiva, desde finales de la década de 1980 hasta 1991, donde aparece en Ecuador. (AU)
Context: surgery has undergone historical variations and has expanded over time in a progressive and constant manner. Objective: to describe the teaching of surgery through history in Ecuador. Discussion: the realization of anatomical models for surgical procedures provides an important experience to the surgeon in training and improves its performance by perfecting its surgical technique with the benefit of shortening the learning curve. The possibility of certification of all surgical specialties and continuing medical education is a pending task for our country. The progress of General Surgery, making use of technological advances, has allowed the improvement of the specialty and has motivated the rest of surgical specialties related to adopt these new technologies and venture into the super specialties. The preparation of this article constitutes a first effort, with more research and testimonies, to complete this fascinating historical tour of the specialty, of which we are eyewitnesses in the last three decades. Conclusion: the traditional teaching of open surgery has required adapting to the vertiginous advent of minimally invasive surgery, from the late 1980s to 1991, where it appears in Ecuador. (AU)
Subject(s)
Humans , Male , Female , History, Ancient , General Surgery , Surgical Procedures, Operative , Bariatric Surgery , Teaching , Technological Development , Models, AnatomicABSTRACT
Objetivo: comparar los resultados motores y sensoriales de los pacientes con esotropía residual tratados con toxina botulínica A con el grupo que recibe cirugía convencional. Métodos: se realizó un estudio experimental (analítico), longitudinal y prospectivo en 27 pacientes que cumplieron con los criterios de inclusión: esotropía residual de 20 a 30 dioptrías independientemente de la edad. Se analizaron las siguientes variables: edad, sexo, diagnóstico previo, tipo de cirugía previa, número de inyección de toxina botulínica A empleada o cirugía realizada en la reintervención, efectos secundarios, complicaciones, ángulo de desviación, fusión y estereopsis preoperatorio y posoperatorio al año. Se consideró éxito quirúrgico la desviación postratamiento igual o menor de 10 dioptrías prismáticas. Resultados: el ángulo de desviación preoperatorio promedio del grupo toxina botulínica A fue de 24,0 ± 1,2 dioptrías y el de cirugía convencional de 25,8 ± 1,1, en oposición con el ángulo de desviación posoperatorio promedio, donde hallamos diferencias significativas (p= 0,003) entre ambos grupos (10,3 ± 1,1 versus 6,0 ± 0,80). El 64,3 por ciento, del grupo de toxina botulínica A y el 92,3 por ciento de cirugía convencional obtuvieron éxito quirúrgico. No se encontraron diferencias significativas ( p= 0,165). Se encontró ptosis palpebral como efecto secundario en el grupo toxina botulínica A y ninguna complicación en ningún grupo. El 44,4 por ciento de los pacientes obtuvo fusión postratamiento pero ninguno alcanzó estereopsis(AU) Conclusiones: en las esotropías residuales de 20 a 30 dioptrías prismáticas tratadas con toxina botulínica se obtienen resultados motores y sensoriales similares al del grupo de cirugía convencional
Objective: to compare the motor and sensory results of patients with residual esotropia, who were treated with botulinum toxin A, and of a group undergoing conventional surgery. Methods: a prospective, longitudinal and experimental (analytical) study was conducted in 27 patients who fulfilled the inclusion criteria: residual esotropia from 20 to 30 dioptries independently of the age. The following variables were analyzed: age, sex, previous diagnosis, type of previous surgery, number of injection of botulinum toxin A applied or type of surgery performed in the reintervención, secondary effects, complications, deviation angle, coalition and preoperative and postoperative estereopsis to the year. It was considered surgical success the deviation same post-treatment or smaller than 10 prismatic dioptries. Results: the angle of preoperative deviation average of the group toxin botulínica A was of 24,0 ± 1,2 dioptres and the one of conventional surgery of 25,8 ± 1,1, in opposition with the angle of posoperative deviation average, where find significant differences ( p= 0,003) between both groups (10,3 ± 1,1 versus 6,0 ± 0,80). The 64,3 percent of the group of toxin botulínica A and the 92,3 percent of conventional surgery obtained surgical success. Significant differences were not find (p= 0,165). Palpebral ptosis was found as secondary effect in the group toxin botulínica A, and any complication in any group. The 44,4 percent of the patients obtained post-treatment fusion but any reached to estereopsis(AU) Conclusions: the residual esotropias of 20 to 30 prismatic dioptres treated with toxin botulínica shows resulted engines and sensory similar to the group of conventional surgery
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Blepharoptosis , Botulinum Toxins, Type A/therapeutic use , Esotropia/surgery , Longitudinal Studies , Prospective StudiesABSTRACT
Con la llamada era laparoscópica, lejos de disminuir la incidencia de las lesiones iatrogénicas de las vías biliares, se ha producido un aumento de ésta y se han añadido otras que no se presentaban en la cirugía convencional y por lo general son más graves y complejas por su localización más proximal, su frecuente asociación con lesión vascular y por el mecanismo térmico involucrado. Estas lesiones trascienden el orden científico, para constituir un problema socioeconómico, pues además de lacerar el prestigio de los cirujanos y de las instituciones médicas donde laboran, y de encarecer los servicios de salud que se brindan a la población, pueden determinar incapacidad laboral en los enfermos y ocasionar la pérdida de vidas humanas en edades productivas. Se evidencian insuficiencias en la identificación y reparación oportunas de dichas lesiones, así como escasos reportes en la bibliografía médica sobre este tema. Con esta revisión se pretende profundizar en los diversos aspectos cognoscitivos actuales relacionados con esta lamentable complicación quirúrgica y fundamentalmente para su prevención(AU)
With the so called laparoscopic age, far from a decrease in the incidence of iatrogenic injuries of the biliary ducts, an increase has taken place, and others have been added that are not commonly present in conventional surgery and which are generally more serious and complex for their more proximal localization, their frequent association with vascular injury, and for the involved thermal mechanism. These injuries go beyond the scientific scope, and become a socioeconomic problem, since they not only damage the surgeon prestige and that of medical institutions where they work, or make healthcare services provided to the population more difficult based on the expenses, but also determine disability in ill patients and produce the loss of humans lives at productive ages. Inadequacies are shown in the identification and opportune repair of these injuries, as well as few reports in the medical literature about this topic. With this review, it is sought to deepen in the diverse updated cognitive aspects related to this regrettable surgical complication, and mainly for its prevention(AU)
Subject(s)
Humans , Bile Ducts/injuries , Cholangiography/statistics & numerical data , Iatrogenic Disease , Laparoscopy/methods , Medical Errors/adverse effects , Review Literature as TopicABSTRACT
Introducción para el tratamiento de pacientes con apendicitis aguda, la vía videolaparoscópica se ha convertido en la técnica de elección. Desafortunadamente, en ocasiones es necesario convertir el procedimiento a cirugía convencional. Objetivo: identificar los factores predictivos de conversión en la apendicectomía videolaparoscópica. Métodos: se realizó un estudio longitudinal, prospectivo, de cohorte, en 131 pacientes operados de apendicitis aguda mediante cirugía videolaparoscópica en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero del 2010 hasta diciembre del 2014. Para identificar dichos factores, el análisis de los datos se basó en la construcción de un modelo multivariado (regresión logística multivariable). Resultados: se halló predominio de los pacientes jóvenes del sexo masculino. La construcción del modelo de regresión logística estuvo sustentado por 8 variables posiblemente predictoras de conversión, de las cuales 4 resultaron altamente influyentes. Se estimó una sensibilidad de 70,6, una especificidad de 97,4 y un porcentaje global predictivo de 93,9 del modelo de regresión calculado. Conclusiones: los factores de mayor influencia para la conversión de cirugía videolaparoscópica a convencional fueron: laparotomía previa en hemiabdomen inferior, presencia de adherencias diagnosticadas por laparoscopia, ubicación retrocecal y apendicitis perforada
Introduction: the videolaparoscopic procedure has become the election technique for the treatment of patients with acute appendicitis. Unfortunately, in occasions it is necessary to convert the procedure to conventional surgery. Objective: to identify the predictive factors of conversion in the videolaparoscopic appendectomy. Methods: a longitudinal, prospective, cohort study was carried out in 131 patients operated on for acute appendicitis by means of videolaparoscopic surgery in the General Surgery Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, from January, 2010 to December, 2014. The analysis of the data was based on the construction of a multivaried model to identify these factors (multivariable logistical regression). Results: there was a prevalence of young male patients. The construction of the pattern of logistical regression was sustained by 8 possibly predictive variables of conversion, 4 of which were highly influential. Sensibility of 70.6, a specificity of 97.4 and a predictive global percentage of 93.9 of the calculated regression pattern were considered. Conclusions: the most influencial factors for the conversion of videolaparoscopic surgery to conventional surgery were: previous laparotomy in lower hemiabdomen, presence of adherences diagnosed by laparoscopy, retrocaecal location and perforated appendicitis
Subject(s)
Humans , Appendectomy , Appendicitis/surgery , Laparoscopy/methods , Microscopy, Video/instrumentation , Conversion to Open Surgery , Surgical Procedures, Operative , Prospective Studies , Longitudinal Studies , Video-Assisted Surgery , ForecastingABSTRACT
La tetralogía de Fallot es la forma más frecuente de cardiopatía congénita cianótica que se presenta en los neonatos. Los cuatro componentes de la enfermedad son: la alineación anormal de la comunicación interventricular, la obstrucción infundibular del ventrículo derecho, el cabalgamiento aórtico de la comunicación interventricular y la hipertrofia del ventrículo derecho. En este trabajo se trata un caso que se presentó para una cirugía convencional frecuente, la Histerectomía Abdominal Total debido a un mioma uterino, en una paciente que padecía de tetralogía de Fallot, con 43 años de edad, situación poco frecuente en la práctica diaria. El objetivo de este trabajo es exponer la experiencia del caso, que necesitó un manejo cuidadoso y que no aparece en la literatura básica. Habitualmente se aplica anestesia para niños con esta malformación para mejorar la calidad de vida o corregirla definitivamente, y porque precisamente solo el 2 % de los pacientes con esta enfermedad, que no han sido tratados quirúrgicamente, pueden arribar a la cuarta década de vida (AU).
The tetralogy of Fallot is the most frequent form of cyanotic congenital heart diseases presented in newborns. The disease’s four components are: abnormal alignment of intraventricular communication, right ventricle infundibular obstruction, aortic straddling of intraventricular communication, and right ventricle hypertrophy. The case presented is a case of a frequent conventional surgery, the total abdominal hysterectomy due to a uterine myoma, in a patient, aged 43 years, suffering for tetralogy of Fallot, a little frequent situation in the daily practice. The objective is exposing the experience of the case, demanding a careful management, which was not found in the main literature sources. Anesthesia is usually used in children with this malformation to improve their life quality or it is definitively corrected; only 2 % of the patients suffering this disease that have not been surgically treated are still alive in the fourth decade of life (AU).
Subject(s)
Humans , Female , Young Adult , General Surgery/methods , Tetralogy of Fallot/surgery , Tetralogy of Fallot/diagnosis , Tetralogy of Fallot/epidemiology , Hysterectomy/methods , Anesthesia/methods , Anesthesia/standards , Myoma/surgery , Myoma/complicationsABSTRACT
Objective To observe the effects of Er-YAG and surgical resection in the treatment of oral cav-ity mucous cyst. Methods A total of 63 patients with oral cavity mucous cyst ,selected in our hospital from March 2013 to May 2014,were divided into control group(n=31)and experimental group(n=32)based on dif-ferent therapies. The oral cavity mucous cysts in the experimental group and the control group were treated with Er-YAG and surgical resection ,respectively. The two groups were compared in terms of therapeutic effect. Results The cure rate in the two groups had no significant difference (P>0.05). The operation time in the experiment group was significantly shorter than the control group(P0.05). The SAS scores had no significant difference between the two groups at 1 week after operation (P > 0.05),but they were significantly higher in the experiment group than in the control group before operation and 3 days after op-eration(P 0.05). Conclusions The curative effect of Er-YAG in the treatment of oral mucous cysts is close to that by the conventional surgery,but the former is advantageous for easier operation,less postoperative complications and alle-viation of patientspsychology pressure,worthy of clinical spreading.
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Background: High grade gliomas (HGGs) are locally invasive brain tumours that carry a dismal prognosis. Although complete resection increases median survival, the difficulty in reliably demonstrating the tumour border intraoperatively is a norm. The Department of Neurosurgery, Hospital Sungai Buloh is the first public hospital in Malaysia to overcome this problem by adopting fluorescence-guided (FG) surgery using 5-aminolevulinic acid (5-ALA). Methods: A total of 74 patients with histologically proven HGGs treated between January 2008 and December 2014, who fulfilled the inclusion criteria, were enrolled. Kaplan-Meier survival estimates and Cox proportional hazard regression were used. Results: Significant longer survival time (months) was observed in the FG group compared with the conventional group (12 months versus 8 months, P 80 (P = 0.010), histology (P < 0.001), surgical method (P < 0.001) and adjuvant therapy (P < 0.001). Conclusion: This study showed a significant clinical benefit for HGG patients in terms of overall survival using FG surgery as it did not result in worsening of post-operative function outcome when compared with the conventional surgical method. We advocate a further multicentered, randomised controlled trial to support these findings before FG surgery can be implemented as a standard surgical adjunct in local practice for the benefit of HGG patients.
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Se realizó un estudio observacional, descriptivo y prospectivo de 23 pacientes con desprendimiento primario de retina, intervenidos quirúrgicamente en el Hospital General "Dr. Juan Bruno Zayas Alfonso" desde enero hasta diciembre de 2012, a fin de describir los resultados anatómicos y funcionales de la cirugía convencional, para lo cual se utilizaron variables de interés para la investigación. Entre los hallazgos principales predominaron: el sexo masculino (73,9 %), los desprendimientos parciales con desgarros temporales superiores (73,9%), la miopía elevada como antecedente patológico personal (39,1 %), el ojo derecho como el más afectado (60,9 %), la rotura en herradura (30,4 %), fundamentalmente en los cuadrantes superiores, y las técnicas combinadas (91,3 %), por citar algunos. Con la aplicación de dichas técnicas se logró la reaplicación de la mayoría de los casos. El éxito anatómico logrado no fue siempre sinónimo de éxito funcional, aunque lo primero es condición obligada para lo segundo.
An observational, descriptive and prospective study of 23 patients with primary detached retina, undergoing surgery in "Dr. Juan Bruno Zayas Alfonso" General Hospital was carried out from January to December, 2012, in order to describe the anatomical and functional results of the conventional surgery, for which variables of interest for the investigation were used. Among the main findings, the male sex (73.9%), the partial detachment with superior temporary lacerations (73.9%), the high myopia as personal pathological history (39.1%), the right eye as the most affected (60.9%), the horseshoe rupture(30.4%), fundamentally in the superior quadrants, and the combined techniques (91.3%), to mention some, prevailed. With the use of these techniques the new implementation was achieved in most of the cases. The anatomical success achieved was not always synonym of functional success, although the first thing is was necessary for the second one.
Subject(s)
Retinal Detachment , Retinal Detachment/surgeryABSTRACT
Se realizó un estudio descriptivo de 35 pacientes intervenidos quirúrgicamente mediante las técnicas convencional y laparoscópica, quienes presentaron lesiones iatrogénicas de las vías biliares, en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, en un período de 8 años (2007-2014), con vistas a caracterizarles según algunas variables de interés y determinar la mortalidad asociada. Entre los resultados preponderantes figuraron el sexo femenino y las edades de 35 a 54 años, las lesiones producidas de la colecistectomía videolaparoscópica electiva por litiasis vesicular, las formas clínicas de presentación el absceso intraabdominal con signos de peritonitis e ictericia, cuyo diagnóstico fue confirmado mediante la ecografía. Asimismo, las lesiones de tipo A y C, según la clasificación de Strasberg, fueron las más reiteradas y el procedimiento técnico reparador más común fue el drenaje y lavado de la cavidad abdominal; 88,6 % de los pacientes egresaron vivos y 4 féminas fallecieron (11,4 %), cuya causa de muerte fue el choque séptico. Pudo concluirse que el momento del diagnóstico de estas lesiones se efectuaba tardíamente, y que a pesar de la complejidad de la reparación quirúrgica, existió baja mortalidad.
A descriptive study of 35 surgically treated patients by means of conventional and laparoscopic techniques who presented iatrogenic injuries of the biliary system, was carried out in the General Surgery Service of "Saturnino Lora Torres" Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, in a 8 year period (2007-2014), with the aim of characterizing them according to some variables of interest and of determining the associated mortality. Among the predominant results there were the female sex and the ages from 35 to 54 years, the produced lesions of the elective videolaparoscopic cholecystectomy for vesicular lithiasis, the clinical forms of presentation the intraabdominal abscess with peritonitis signs and jaundice, diagnosis confirmed by means of the echography. Also, injuries A and C, according to the classification of Strasberg, were those most reiterated and the most common restorative technical procedure was drainage and washing of the abdominal cavity; 88.6% of the patients were discharged alive and 4 female patients died (11.4%) whose cause of death was the septic shock. It could be concluded that the moment of diagnosis for these lesions took place late, and that in spite of the complexity of the surgical repair, there was low mortality.
Subject(s)
Iatrogenic Disease , Intraoperative Complications , Bile Ducts/surgery , LaparoscopyABSTRACT
La apendicitis aguda es la causa más común de abdomen agudo que requiere tratamiento quirúrgico inmediato. A pesar de que muchos pacientes han recibido los beneficios de la apendicectomía videolaparoscópica, existen controversias respecto a su empleo sistemático en esta enfermedad. A tales efectos se realizó una revisión bibliográfica en la que se exponen algunos elementos actualizados sobre esta técnica, la cual, dada su utilidad diagnóstica y terapéutica, va ocupando progresivamente su lugar como proceder de elección en cualquier fase en que se encuentre el proceso morboso. Todo ello justifica la necesidad de profundizar en los principales aspectos cognoscitivos relacionados con este tema, pues solo así podrá elevarse la calidad asistencial en los hospitales y, con esa premisa, contar con protocolos de actuación uniformes, que beneficiarán a quienes presenten esta enfermedad tan frecuente.
Acute appendicitis is the most common cause of acute abdomen requiring immediate surgical treatment. Although many patients have received the benefits of the videolaparoscopic appendicectomy, there are controversies regarding its systematic use in this disease. To achieve this, a literature review was carried out in which some updated elements on this technique are exposed, which, given its diagnostic and therapeutic usefulness, is progressively occupying its place as election procedure in any phase during the morbid process. All these justifies the necessity of deepening in the main cognitive aspects related to this topic, because this is the way to rise the assistance quality in hospitals and, with that premise, to have uniform performance protocols that will benefit those who present this frequent disease.
Subject(s)
Appendectomy , Laparoscopy , Appendicitis , General Surgery , Secondary Care , Emergency Medical ServicesABSTRACT
Se realizó un estudio descriptivo, observacional y longitudinal de 478 pacientes egresados con el diagnóstico histopatológico de apendicitis aguda, que habían sido operados mediante apendicectomía videolaparoscópica, en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba durante el quinquenio 2008-2012, con vistas a identificar las particularidades de este tipo de cirugía. En la serie predominaron los varones de 21-30 años, clasificados como ASA 2 según el examen físico preoperatorio, la apendicitis supurada como diagnóstico histopatológico, el tiempo de evolución entre 24-48 horas, el tiempo quirúrgico de 30-60 minutos y el promedio de estancia hospitalaria de 4,6 días. Las complicaciones posoperatorias más frecuentes resultaron ser las infecciones del sitio quirúrgico y los abscesos intraabdominales. El índice de conversión fue 5,7 % y no hubo fallecidos. La cirugía videolaparoscópica sistemática es un procedimiento seguro en pacientes con apendicitis aguda en cualquier fase evolutiva en que se encuentre el proceso morboso, con escasa morbilidad posoperatoria y corta estadía hospitalaria.
A descriptive, observational and longitudinal study of 478 patient discharged with the histopathological diagnosis of acute appendicitis who had been operated by means of videolaparoscopic appendicectomy, in the General Surgery Service of "Saturnino Lora Torres" Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba was carried out during the five year period 2008-2012, aimed at identifying the particularities of this surgery type. The 21-30 years males, classified as ASA 2, according to the preoperative physical examination, the festered appendicitis as histopathological diagnosis, the clinical course between 24-48 hours, the surgical time 30-60 minutes and the average of hospital stay 4,6 days prevailed in the series. The most frequent postoperative complications turned out to be the infections of the surgical site and the intraabdominal abscesses. The conversion index was 5.7% and there were no deaths. The systematic videolaparoscopic surgery is a save procedure in patients with acute appendicitis in any phase of the clinical course during the morbid process, with scarce postoperative morbidity and short hospital stay.
Subject(s)
Appendectomy , Appendicitis/surgery , Laparoscopy , General Surgery , Abdomen, AcuteABSTRACT
Introducción: en la actualidad existen controversias con respecto al empleo sistemático de la apendicectomía videolaparoscópica en la apendicitis aguda. Métodos: se realizó un estudio descriptivo de 720 enfermos egresados con diagnóstico histopatológico de apendicitis aguda que habían sido operados de urgencia en el Servicio de Cirugía General del Hospital Provincial Universitario Saturnino Lora de Santiago de Cuba durante el trienio 2007-2009. La muestra incluyó a 458 operados mediante acceso videolaparoscópico y a 262 operados por laparotomía convencional. Resultados: predominaron los pacientes del sexo masculino, de 21 a 30 años, con examen físico preoperatorio ASA II y diagnóstico histopatológico de apendicitis supurada. En ambas vías de acceso, la evolución preoperatoria de la enfermedad fluctuó entre 24 y 48 h, el tiempo quirúrgico entre 30 y 60 min y la estancia hospitalaria entre 4 y 7 días. El promedio de estadía de los operados mediante videolaparoscopia y laparotomía fue 4,6 y 5,4 días, respectivamente. El porcentaje de complicaciones en operados mediante laparotomía duplicó el de los intervenidos por videolaparoscopia, aunque las infecciones del sitio quirúrgico predominaron en los primeros y los abscesos intraabdominales se presentaron en igual proporción en ambas vías de acceso. El índice de conversión alcanzó el 5,7 por ciento. Hubo un solo fallecido laparotomizado cuya causa de muerte fue una sepsis generalizada. Conclusión: la cirugía videolaparoscópica sistemática es un procedimiento seguro para el tratamiento de la apendicitis aguda en cualquier fase evolutiva en que se encuentre el proceso morboso, con escasa morbilidad posoperatoria y corta estadía hospitalaria.
Introduction: the systematic use of laparoscopic appendectomy to manage acute appendicitis is a controversial issue nowadays. Methods: a descriptive study of 720 patients with histopathological diagnosis of acute appendicitis, who had been operated on under emergency circumstances at the general surgery service of "Saturnino Lora"provincial university hospital in Santiago de Cuba from 2007 to 2009. The sample included 458 patients operated on by the laparoscopic appendectomy and 262 by conventional laparotomy. Results: males aged 21-30 prevailed, with preoperative physical exam of ASA II and histopathological diagnosis of supurative appendicitis. In both ways of access, the preoperative progression of disease ranged 24 to 48 h, the surgical time was 30 to 60 minutes and the length of stay at hospital ranged 4 to 7 days. The average of length of stay was 4.6 for laparoscopic appendectomy and 5.4 for conventional laparotomy. The percentage of complications in laparotomy-operated patients doubled that of the laparoscopic appendectomy, the surgical site infections prevailed in the former and the intra-abdominal abscesses were present in equal proportion in both ways of access. The conversion index reached 5.7 per cent. Only one laparotomy-operated patient died from generalized sepsis. Conclusions: systematic laparoscopic appendectomy is a safe procedure to treat acute appendicitis in any phase of progression of this morbid process since it brings low postoperative morbidity and short length of stay at hospital.
Subject(s)
Humans , Male , Adult , Female , Young Adult , AppendectomyABSTRACT
Se exponen las consecuencias a largo plazo del uso del implante de miragel como tratamiento del desprendimiento de retina. Se presentan las características durante la cirugía y el postoperatorio de la explantación de este tipo de implante en 3 pacientes que acudieron a la consulta de Retina del Hospital Oftalmológico ®Amistad Argelia Cuba¼ en Djelfa, Republica Popular y Democrática de Argelia, con el diagnóstico de cirugía convencional de retina con implante de miragel realizado en Francia en la primera mitad de la década del 90. Predominó el disconfort por la limitación de los movimientos oculares. Dos casos presentaban exposición del implante y sepsis periocular. A los tres casos se les retiró el implante que se fragmentaba con mucha facilidad y dificultaba su extracción, además se encontró marcada distensión muscular que se recuperó paulatinamente en el postoperatorio al igual que los movimientos oculares
The long-term consequences of the use of Miragel implant as treatment of retinal detachment were set forth in this article. The characteristics of the Mirage explant during surgery and postoperatively in three cases, who went to the retinal service of "Amistad Algeria-Cuba" ophthalmological hospital in Djelfa, Democratic People's Republic of Algeria, were presented. They had been operated on by conventional retinal surgery and implanted a Mirage implant in France in the first half of the 90's. The predominant symptom was discomfort due to limited eye movements. Two cases presented with implant exposure and periocular sepsis. The implants were removed from the three patients; they fragmented very easily and made their extraction difficult in addition to marked muscular distension. The latter gradually disappeared and the eye movements were recovered in the postoperative phase
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Retinal Detachment/surgery , Ophthalmologic Surgical Procedures , Prosthesis Failure , Prostheses and Implants/adverse effectsABSTRACT
PURPOSE: To compare postoperative outcomes according to surgical method in partially accommodative esotropia in patients over 4 years of age. METHODS: We compared motor and sensory outcomes between conventional and augmented surgery in 66 patients. The postoperative follow-up period was at least 24 months. The formula for the amount of the rectus muscle recession was based on the distant angle deviation after hyperopic correction in the conventional group and the average amounts of the distant angle deviation with and without full correction of hyperopia in the augmented group. In addition, the conventional group was divided into 2 sub-groups to compare surgical outcomes. The A group consisted of patients who underwent surgery with the amount of surgical correction based on distant angle deviation after full hyperopic correction. The B group consisted of patients under the same condition after reduced hyperopic correction to achieve best corrected visual acuity (BCVA). RESULTS: Among the patients who had an ocular alignment less than 10 PD, orthophoria was significantly higher in the conventional group than in the augmented group on the last follow-up. When comparing the 2 conventional sub-groups, the postoperative stereoacuity was better in group B than in group A. Among patients with a postoperative overcorrected alignment of more than 10 PD who underwent augmented surgery, 75% showed decreased postoperative stereoacuity compared to preoperative stereoacuity. CONCLUSIONS: In partially accommodative esotropia in patients over 4 years of age, conventional surgery compared to augmented surgery after reduced hyperopic correction is better in order to achieve BCVA for postoperative stereoacuity as well as ocular alignment.
Subject(s)
Humans , Esotropia , Follow-Up Studies , Hyperopia , Muscles , Visual AcuityABSTRACT
Se realizó una revisión bibliográfica con el objetivo de conocer los orígenes del tratamiento quirúrgico del desprendimiento regmatógeno de retina, el desarrollo de la técnica quirúrgica mediante implantes esclerales y su introducción en Cuba, así como su utilización hasta nuestros días. Son abordados tópicos como la creación del primer servicio de retina en el Hospital Ramón Pando Ferrer, la visita de Charles Schepens a La Habana y la labor de importantes profesores vinculados al desarrollo de la especialidad en Cuba. Se consultó una bibliografía que abarca un período de varios años hasta el presente para conocer los resultados de la utilización de esta técnica quirúrgica en la actualidad y demostrar, de esa forma, su vigencia
A bibliographic review was conducted to know the origins of the surgical treatment of the retina regmatogen detachment, the development of the surgical technique using scleral transplantations, as well as its introduction in Cuba and its use until nowadays. Subjects like the creation of our first Retina Service, the visit of Charles Schepens to La Habana and the work of important professors linked with development of the specialty in Cuba were approached. The bibliography covering a period of some years until now was looked up to know the results of the use of such surgical technique in present time and to demonstrate its validity
Subject(s)
Humans , Male , Female , Retinal Detachment/surgery , Retinal Detachment/history , Sclera/surgery , Orbital Implants/history , Bibliographies as TopicABSTRACT
Objective To compare the efficacy and complications of Chinese Shang Ring circumcision with conventional circumcisiom Methods Clinical data of 479 cases of Chinese Shang Ring circumcision and 354 cases of conventional circumcision with complete follow-up were analyzed.Comparisons were made between the two groups on operation time,pain score,blood loss,postoperative complications,postoperative satisfaction with penile appearance,wound healing time and treatment costs. Results There was no statistical difference in age and foreskin status between the two groups (P＞0.05).For the Shang Ring group,the operation time was(5±1)rain,blood loss was (0.98±1.14)ml,pain score during operation was 0.25±0.54,24-hour pain score after operation was 1.63±0.87,the postoperative complication rate was 6.89% (33/479),wound healing time was (20±5)d,the satisfaction rate of appearance was 99.79% (478/479),and treatment cost was (871±52) yuan.For the conventional group,the operation time was (27±5) min,blood loss was (8.30±3.60)ml,pain score during operation was 3.29±1.57,24-hour pain score after operation was 5.56±1.42,the postoperative complication rate was 13.28%(47/354),wound healing time was (13±2)d,satisfaction rate of appearance was 92.37% (327/354),and treatment cost was (554±46) yuan.Compared with the conventional group,the Shang Ring group had a shorter operation time,less blood loss,less pain score,higher appearance satisfaction rate and a lower complication rate (P＜0.05).But wound healing time was longer and treatment cost was higher in the Shang Ring group (P＜0.05). Conclusions Chinese Shang Ring circumcision is simpler and an improved approach over conventional circumeision with shorter operative time,less blood loss,less pain,relatively lower complication rate and higher satisfaction and acceptability.
ABSTRACT
Se hizo un estudio descriptivo, transversal y prospectivo de los 285 pacientes con diagnóstico clínico de apendicitis aguda, predominantemente del sexo masculino, atendidos en el Servicio de Cirugía General del Hospital Provincial Dr Joaquín Castillo Duany de Santiago de Cuba, desde enero del 2003 hasta diciembre del 2008, a fin de precisar la efectividad de la cirugía mayor ambulatoria en ellos. La afección primó en el grupo etáreo de 15-30 años y se aplicaron las técnicas quirúrgicas convencional o laparoscópica, con el uso de anestesia general orotraqueal en todos los integrantes de la casuística. El diagnóstico preoperatorio se realizó precozmente en 80,7 por ciento de la serie (antes de las 6 horas), con primacía de la apendicitis catarral como forma anatomopatológica. No hubo complicaciones graves, por lo cual la recuperación de los operados fue buena antes de las 24 horas de haber sido intervenidos. Dicha modalidad terapéutica resultó ventajosa para los pacientes y la institución
A descriptive, cross-sectional and prospective study of 285 patients with clinical diagnosis of acute appendicitis, predominantly of the male sex, assisted in the Service of General Surgery of Dr Joaquín Castillo Duany Provincial Hospital from Santiago de Cuba was carried out from January, 2003 to December, 2008, in order to specify the effectiveness of the ambulatory major surgery in them. The affection prevailed in the 15-30 age group and the conventional or laparoscopic surgical techniques were applied, with the use of general orotracheal anesthesia in all the patients of the case material. The preoperative diagnosis was early carried out in 80,7 per cent of the series (before the 6 hours), with predominance of the catarrhal appendicitis as pathological form . There were not serious complications, reason why the recovery of those operated was good before the 24 hours of their surgical treatment. This therapeutic modality was advantageous for the patients and for the institution
Subject(s)
Humans , Male , Female , Ambulatory Surgical Procedures , Anesthesia, General , Appendicitis , Laparoscopy , Secondary Care , Cross-Sectional Studies , Epidemiology, Descriptive , Prospective StudiesABSTRACT
Las cualidades necesarias en el cirujano han constituido históricamente un tema excepcional en la bibliografía médica. El presente artículo busca caracterizarlas tanto en el cirujano que practica la cirugía convencional como en el que utiliza las nuevas tecnologías, y enfatizar en sus principios éticos. Las tecnologías no significan la deshumanización del cirujano; implican el desarrollo de nuevas habilidades para tratar mejor a los pacientes, pero la aplicación de la cirugía tradicional se impone cuando estas nuevas modalidades fallan. Los principios éticos que han definido siempre los valores del cirujano son laboriosidad, dedicación a los pacientes, deseo permanente de progreso científico, serenidad, estabilidad emocional y desinterés(AU)
The necessary qualities in surgeon are historically an exceptional subject in the medical bibliography. Present paper looks for its characterization for surgeon practices the conventional surgery and for surgeon using the new technologies and to emphasizes on its ethical principles. The technologies no means the surgeon dehumanization; they implicate the development of new abilities to achieve a better treatment to patients, but the application of the traditional surgery is imposed when these new modalities fails. The ethical principles that always have defined the surgeon values are the laboriousness, the dedication to patients, the permanent desire of scientific progress, calm, emotional stability and disinterest(AU)