Factores predictivos de conversión en la apendicectomía videolaparoscópica / Predictive factors of conversion in the videolaparoscopic appendectomy

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

Utilização do programa Cells Analyser® no estudo comparativo entre imagens do endotélio de córneas obtidas por microscopia especular / Using of Cells Analyser® software in the study of image of corneal specular microscope endothelial samples

OBJETIVOS: Conhecer diferenças entre o número de células, área endotelial avaliada e erro amostral, comparando amostras endoteliais de uma única imagem endotelial, com amostras endoteliais constituídas pelo número de células e imagens, orientadas por software específico. MÉTODOS: Foi realizado estudo transversal, comparando as amostras endoteliais com e sem a intervenção do software. A amostra foi composta de 157 olhos. Foram criados 2 grupos: Grupo 1: composto pelos dados amostrais da primeira imagem dos exames; Grupo 2: composto pelos dados amostrais que consideram o número de imagens necessárias para que o exame seja considerado completo pelo software Cells Analyzer PAT. REC. (Grau de confiança 95 por cento e erro relativo 0,05). Os dados amostrais comparados foram número de células contadas, área da amostra endotelial e erro amostral. Utilizou-se o teste t Student bicaudal, para amostras pareadas, com nível de 99 por cento (p<0,01). RESULTADOS: 157 (52,69 por cento) exames necessitaram de mais de uma imagem endotelial para que se superasse o número mínimo de células endoteliais necessárias. Evidenciou-se diferença estatisticamente significativa, do número de células das amostras endoteliais (p= 4x10-24), da área endotelial avaliada (p= 2x10-18) e do erro amostral (p= 1x10-21) entre o Grupo 1 e o Grupo 2. CONCLUSÃO: O estudo dos dados amostrais sem e com a intervenção do software Cells Analyser®, mostraram-se estatisticamente diferentes, com amostras maiores e erros amostrais menores, o que evidencia a importância do seu uso para se obter exames de microscopia especular de córnea com baixos erros (menor que 5%), conferindo-lhes representatividade e reprodutibilidade.

PURPOSE: To describe differences between number of cells, evaluated endothelial area and relative error comparing endothelial samples from one endothelial image with endothelial samples obtained by guidance of a specific software, with number of cells and images as many as necessary. METHODS: A transversal study was performed, comparing the endothelial samples with and without intervention of the software. The sample consisted of 157 eyes. They were divided into 2 groups. Group 1 consisted of data of the first image and group 2 consisted of data from as many images as necessary for a complete examination guided by the Cells Analyser software (95 percent confidence interval and 0.05 relative error). The evaluated data were number of counted cells, equivalent evaluated field (mm²) and relative error. Student's t test with 99 percent confidence interval (p<0.01) was used. RESULTS: The compared data showed statistically significant differences between groups 1 and 2 in cell count (p=4x10-24), evaluated endothelial field (p=2x10-18) and relative error (p=1x10-21). CONCLUSION: The study of the sample data with and without intervention of the Cells Analyzer® software showed them to be statistically different with greater samples and smaller sample errors, evidencing the importance of their use in order to obtain specular microscopic cornea tests with small errors (less than 5%), giving them representativeness and reproducibility.

Estudo morfologico de Triatoma guazu Lent & Wygodzinsky, 1979 (Hemiptera, Reduviidae, Triatominae) / Morphologic study of Triatoma guazu Lent & Wygodzinsky, 1979 (Hemiptera, Reduviidae, Triatominae)

A female of triatoma of Triatoma guazu & Wygodzinsky, 1979, a rare species from which the allotype was recently described, was studied by scanning electronic microscopy and videomicroscope. Some structures of the head and the thorax are shown. Some of them could have taxonomic importance, as the oculto-ocellar region, the buccula, the anterolateral angle of the collar, the scutellum, wings and the stridulatory sulcus, which has as unusual lateral high rim.

Colecistectomia laparoscopica indicaciones y contraindicaciones / Laparoscopic cholecystectomy; ibdication and conbtraindications

La tecnica video laparoscopica constituye una forma novedosa y en apariencia mas ventajosa para los pacientes, de extirpar las vesiculas biliares enfermas, por lo tanto constituye otra forma de operar, no es una operacion nueva,