Repercusión de la colecistectomía laparoscópica en el paciente geriátrico / Repercussion of laparoscopic cholecistectomy on elderly patient

Introducción: Cada día resulta mayor la proporción de ancianos que asiste a los quirófanos. El manejo de estos pacientes ha ido evolucionando aparejadamente a las técnicas mínimamente invasivas, encaminadas a evitar la hospitalización, las complejas pruebas complementarias y los costosos tratamientos. Objetivo: Determinar los factores que repercuten en la hemodinamia del paciente geriátrico durante la colecistectomía laparoscópica. Material y Métodos: Se realizó un estudio prospectivo, longitudinal y analítico de 132 pacientes mayores de 60 años intervenidos por colecistectomía laparoscópica electiva, en el Hospital clínico-quirúrgico Julio Trigo López durante el período comprendido desde enero de 2014 hasta junio de 2016. Resultados: Predominó el grupo correspondiente a los 60 - 69 años de edad, el sexo femenino y el estado físico ASA II. El 75 por ciento de los pacientes no sufrió cambios hemodinámicos. Se presentó un 25 por ciento de variabilidades hemodinámicas predominantes en el grupo de 70-79 años de edad. La diferencia en la variabilidad hemodinámica entre los grupos etarios resultó altamente significativa. La hipertensión arterial (51,5 por ciento) y la taquicardia (27,3 por ciento) fueron las variaciones más frecuentes. Los factores determinantes en los cambios fueron dependientes del proceder quirúrgico: mayor presión intrabdominal posneumoperitoneo (22 por ciento) y Trendelenburg superior a 10 grados (93,9 por ciento). Conclusiones: Los factores determinantes en la hemodinamia fueron dependientes del acto quirúrgico. Se presentaron variaciones significativas entre los diferentes grupos etarios, sugiriendo cierta influencia del factor edad, pero la mayor longevidad no constituyó un aspecto decisivo. La colecistectomía laparoscópica es una valiosa alternativa terapéutica para los pacientes ancianos(AU)

Introduction: The number of elderly patients undergoing surgery is greater every day. The management of these patients has been evolving together with minimal invasive techniques, aimed at avoiding hospitalization, complex complementary tests, and expensive treatments. Objective: To determine the factors that have an effect on the hemodynamics of the geriatric patient during laparoscopic cholecystectomy. Material and Methods: A prospective, longitudinal, and analytic study was conducted in 132 patients older than 60 years of age who underwent elective laparoscopic cholecystectomy at the Julio Trigo López Clinical and Surgical Hospital during the period between January 2014 to June 2016. Results: Subjects aged 60 to 69 years, the female sex, and the physical state ASA II predominated in the study. 75% of these patients did not suffer hemodynamic changes. 25 percent of predominant hemodynamic variabilities were present especially in the group aged 70 to 79 years. The difference in hemodynamic variability between the age groups was highly significant. Arterial hypertension (51,5 percent and tachycardia (27,3 percent) were the most frequent variations. The determining factors in the changes were dependent on the surgical procedure: higher intra-abdominal pressure after pneumoperitoneum (22 percent) and Trendelenburg higher than 10 degrees (93.9 percent). Conclusions: The determining factors in hemodynamics were dependent on the surgical act. There were significant variations among the different age groups, suggesting a certain influence of the age factor, but the greatest longevity didn't constitute a decisive aspect. Laparoscopic cholecystectomy is a valuable therapeutic alternative for elderly patients(AU)

Colecistectomía transvaginal asistida por minilaparoscopia: con uso de instrumental convencional: experiencia inicial / Transvaginal cholecystectomy assisted with minilaparoscopy: with conventional instruments: initial experience

Describir la técnica quirúrgica en la colecistectomía transvaginal sin cicatriz visible con el uso de instrumental laparoscópico convencional, en el Hospital “Dr. Domingo Luciani”. Caracas. Se presenta caso de paciente femenina de 52 años de edad, con litiasis vesicular sintomática a quien se le practica colecistectomía transvaginal. Se realizó colecistectomía transvaginal sin complicaciones intraoperatorias. No se administraron analgésicos orales ni parenterales, el alta hospitalaria se dio a las 12 horas del procedimiento. Evolución satisfactoria de la paciente con un seguimiento de 30 días. La cirugía asistida por minilaparoscopia puede considerarse intermedia entre el NOTES, y la cirugía laparoscópica. El siguiente caso demuestra la factibilidad y seguridad del procedimiento realizado por cirujanos generales con entrenamiento laparoscópico y con el uso de instrumental convencional.

Describe the surgical technique in the transvaginal cholecystectomy without a scar using conventional laparoscopic instruments, in the “Dr. Domingo Luciani” Hospital. Caracas. Presents female patient 52 years old, with sintomatic gallstones who is practicing transvaginal cholecystectomy. Was performed transvaginal cholecystectomy without intraoperative complications. No analgesics were administered oral or parenteral, was discharged at 12 hours of the procedure. There was a satisfactory progress of the patient with a follow upof 30 days. Minilaparoscopy assisted surgery can be considered intermediate between NOTES, and laparoscopic surgery. The following case demonstrates the feasibility and safety of the procedure performed by general surgeons with laparoscopic training and the use of conventional instruments.

Prevalencia de alteraciones posturales en niños de Arica -Chile: efectos de un programa de mejoramiento de la postura / Prevalence of postural alterations and effects of a program to improve the posture in children from Arica-Chile

Los objetivos de este trabajo fueron calcular el índice de prevalencia de alteraciones posturales en una muestra de 120 alumnos (10,4 por ciento del universo total), de 4 años de edad de la ciudad de Arica y determinar el efecto de un programa de mejoramiento postural. Las alteraciones posturales más frecuentes corresponden a: inclinación de hombros (86 por ciento), escápula alada y escápula descendida (82 por ciento), proyección anterior de hombros (79 por ciento), pie plano (58 por ciento), columna lumbar hiperlordótica (51 por ciento) e inclinación de cabeza (50 por ciento). Posteriormente, se aplicó al grupo experimental un programa de ejercicio muscular y de reeducación postural, por un período de 8 meses. Al final del tratamiento se realizó un análisis post test a todos los sujetos del estudio. Los resultados en el grupo experimental muestran una disminución significativa de los índices iniciales de prevalencia, en todas las alteraciones en estudio. Los diferenciales de recuperación muestran diferencias significativas entre los grupos de estudio, con un 31 por ciento para inclinación de hombros, seguida de hiperlordosis lumbar con un 29 por ciento e inclinación de cabeza con 20 por ciento. La recuperabilidad más baja se observó en pie plano con un 7 por ciento (p≤0,05). El alto porcentaje de alteraciones posturales presentes en niños de 4 años, de la ciudad de Arica, podría ser producto de actitudes viciosas que, a futuro producen una estructuración inadecuada del cuerpo, entonces la aplicación de un programa de ejercitación muscular y de reeducación postural, dirigido por un equipo de Salud multiprofesional disminuirían significativamente estas alteraciones.

At present the educational institutions do not have an adequate system of Health to detect early changes in postural alteration in children. The aim of this study was to determine the most common postural changes in a sample of 120 students (10,4 percent of total universe), of 4 years old from Arica-Chile and to determine the effect of a program to improve the posture. The prevalence of the most frequent postural alterations relate to: inclination of shoulders (86 percent), winged scapula and descend scapula (82 percent), projection front shoulders (79 percent), flat feet (58 percent), lumbar hyperlordosis (51 percent) and inclination of head (50 percent). Subsequently in the experimental group was applied a program of exercise muscle and postural reeducation for a period of 8 months. At the end of treatment was applied a post-test to all children. The results in the experimental group showed a significant decrease in initial prevalence rates in all alterations. The differential recovery shows significant differences among the study groups, with 31 percent for inclination of shoulders, followed by lumbar hyperlordosis (29 percent) and inclination of head (20 percent). The recoverability lowest level was observed in flat feet with 7 percent (p≤0,05).The high percentage of postural disturbances in children aged 4 years in the city of Arica, could be the result of vicious attitudes that in the future produce an improper structuring of the body. Then the implementation of a program of exercise muscles and postural reeducation, led by a multiprofesional health team, decline rates of postural abnormalities present in children.

Pneumoperitônio com dióxido de carbono associado a três posiçöes para laparoscopia em cäes / Pneumoperitoneum using carbon dioxide associated with three positions for laparoscopy in dogs

Doze cäes foram submetidos ao pneumoperitônio com dióxido de carbono, em pressäo constante de 15mmHg, e posicionados em Trendelenburg, Trendelenburg reverso e decúbito horizontal. As variáveis de saturaçäo de oxigênio na hemoglobina, freqüência cardíaca, freqüência respiratória, pressäo arterial média, sistólica e diastólica, o pH, a pressäo parcial de CO2 e a pressäo parcial de O2 foram mensurados. Somente a freqüência cardíaca, a freqüência respiratória, o pH e a pressäo parcial de CO2 apresentaram diferença estatisticamente significativa em relaçäo ao tempo.

Cardiovascular responses to head-down-body-up postural exercise (Sarvangasana).

Sarvangasana (SVGN) is a head-down-body-up postural exercise in a 'negative g' condition. Though highly recommended as one of the three best of all the asanas it has not yet been studied for its very obvious effects on the cardiovascular (CV) functions. This paper reports the results of the first systematic investigation on SVGN employing echocardiographic analysis in eight healthy male subjects before and after a practice of this asana twice daily for two weeks. The resting heart rate (HR) and left ventricular end-diastolic volume (LVEDV) were significantly reduced (P < 0.02, P < 0.01 respectively) after practising this asana. A tendency toward a mild regression of the left ventricular mass was noticed, though it was not statistically significant. The CV responses to acute 45 degrees head-down tilt (HDT) in a tilt table was not altered after practising this asana. Also there was no orthostatic intolerance during the 3-5 min period of 70 degrees head-up tilt (HUT). These results strongly indicate that further studies of this asana performed for a longer period is most likely to yield very significant observations of applied value.