Caracterización de los pacientes reingresados por postoperatorio complicado en el servicio de Cirugía General. Hospital Universitario Comandante Faustino Pérez. Matanzas / Characterization of the patients readmitted in the service of General Surgery of the University Hospital "Faustino Perez Hernandez" of Matanzas, due to complicated post-surgery evolution

RESUMEN Introducción: la cirugía como ciencia médica tuvo grandes retos para llegar a tener una forma de tratamiento quirúrgico seguro y viable, entre estos uno de los mayores era como evitar los resultados adversos. Se realizó un análisis de los pacientes que reingresaron en el servicio de cirugía general por post operatorio complicado. Objetivo: determinar las causas de reingresos por postoperatorio complicado en el servicio de cirugía general. Material y métodos: se realizó un estudio prospectivo - descriptivo- observacional sobre el universo, que fueron todos los pacientes reingresados por postoperatorio complicados, por el servicio de Cirugía General. Se analizaron múltiples variables que pudieran estar en relación con los reingresos las cuales fueron obtenidas a través de una planilla de recolección de datos y procesadas por el programa computadorizado Microsoft Office 2009. Resultados: los pacientes que reingresaron, el mayor porcentaje son del sexo masculino, de la raza blanca y los mayores de 60 años. Los reingresos por complicaciones postquirúrgicas representan un bajo por ciento respecto al volumen de casos que son intervenidos y la principal causa de reingreso fue la infección del sitio quirúrgico, las variables analizadas las que más se relacionaron con los reingresos fueron las operaciones realizadas por vía convencional, atendidos en salas abiertas, con operaciones limpias contaminadas. Conclusiones: de los pacientes que reingresaron 6 de cada 10 son del sexo masculino de la raza blanca y su edad mayor de 60 años (AU).

SUMMARY Introduction: Surgery, as a medical science, faced big challenges to become a form of a safe, feasible surgical treatment; among them, one of the biggest was avoiding adverse outcomes. The authors carried out an analysis of the patients readmitted in the service of General Surgery of the University Hospital "Faustino Perez Hernandez" of Matanzas due to complicated post-surgery evolution in the period from January 2016 to December 2018. Objective: to determine the causes of readmissions due to complicated post-surgery evolution in the service of General Surgery of the University "Hospital Faustino Perez Hernandez". Materials and methods: a prospective, descriptive, observational study was carried out on a universe of all patients readmitted in the service of General Surgery due to complicated post-surgery evolution. The authors analyzed several variables that could be related to readmissions and were obtained from a data collection form and processed with the computer program Microsoft Office 2009. Results: the main results were that among readmitted patients, the highest percent were male, white and elder than 60 years old. Readmissions due to post-surgery complications represent a low percent with respect to the quantity of patients who underwent surgery, and the main cause of readmission was infection at the surgery site. From the analyzed variables the once related the most with readmissions were conventional surgeries, patients looked after in open wards, with contaminated clean operations. Conclusions: six from each ten patients were male, white, and aged more than 60 years (AU).

Histeroscopía quirúrgica: experiencia, resultados y complicaciones según clasificación Clavien-Dindo / Surgical hysteroscopy: experience, results and complications according to Clavien-Dindo classification

OBJETIVO: Describir y analizar la experiencia clínica, resultados y complicaciones según Clavien-Dindo de las histeroscopías quirúrgicas realizadas en pabellón. MÉTODOS: Estudio descriptivo retrospectivo de las histeroscopías quirúrgicas realizadas entre el 1 de enero de 2012 y 1 de enero de 2018 en el Hospital Clínico de la Universidad de Chile. RESULTADOS: Hubo 613 histeroscopías quirúrgicas en el período analizado, de las cuales 593 cumplieron con los requisitos para incluirse en este estudio. Las indicaciones para realizar el procedimiento fueron: pólipo endometrial (56,3%), miomas uterinos (22,1%), sangrado uterino anormal (4,3%) y otras (17,7%). Hubo un 89,2% de concordancia entre el diagnóstico intraoperatorio y el estudio histopatológico. Se pesquisaron 11 hiperplasias endometriales sin atipías, 3 con atipías y 10 neoplasias malignas. Cabe destacar que, del total de pólipos resecados, hubo 8 casos (2,5%) con potencial malignidad (atipías o neoplasia maligna). Según la clasificación Clavien Dindo, hubo 22 complicaciones intraoperatorias (3,7%) grado I o II, cuyo diagnóstico fue realizado en el acto quirúrgico. No hubo complicaciones grado III o más (severas, con reintervención). CONCLUSIÓN: La tasa de éxito, correlación histeroscópica - anatomopatológica final y complicaciones fue similar a lo publicado en la literatura disponible. El diagnóstico intraoperatorio de la lesión y su reparación en el mismo acto quirúrgico, disminuye el riesgo de morbimortalidad de las pacientes, haciéndolo similar al de una paciente sin complicación. Utilizar la clasificación Clavien Dindo para evaluar las complicaciones nos permitirá en adelante, objetivar, mejorar aspectos del procedimiento quirúrgico y plantear estrategias de prevención y manejo de dichos eventos adversos.

OBJECTIVE: To describe and analyze the clinical experience, results and complications according to Clavien-Dindo of surgical hysteroscopies performed in the ward. METHODS: Retrospective descriptive study of surgical hysteroscopies performed between January 1, 2012 and January 1, 2018 at the Hospital Clinico of the University of Chile. RESULTS: There were 613 surgical hysteroscopies in the analyzed period of which 593 fulfilled the requirements to be included in this study. The indications to perform the procedure were: endometrial polyp (56.3%), uterine fibroids (22.1%), abnormal uterine bleeding (4.3%) and others (17.7%). There was an 89.2% agreement between the intraoperative diagnosis and the histopathological study. Eleven endometrial hyperplasias without atypia, 3 with atypia and 10 malignant neoplasms were investigated. It should be noted that, of the total of resected polyps, there were 8 cases (2.5%) with potential malignancy (atypia or malignant neoplasm). According to the Clavien Dindo classification, there were 22 intraoperative complications (3.7%) grade I or II, the diagnosis of which was made during surgery. There were no grade III or more complications (severe, with reoperation). CONCLUSION: The success rate, final hysteroscopic-pathological correlation and complications was similar to that published in the available literature. The intraoperative diagnosis of the lesion and its repair in the same surgical act, reduces the risk of morbidity and mortality of the patients, making it similar to that of a patient without complication. Using the Clavien Dindo classification to assess complications will henceforth allow us to objectify, improve aspects of the surgical procedure and propose strategies for the prevention and management of such adverse events.

Cirugía endoscópica avanzada de base de cráneo, cavidad nasal y senos paranasales: experiencia de 40 meses en un hospital universitario / Advanced endoscopic surgery of skull base, nasal cavity and paranasal sinus: experience of 40 months in a university hospital / Cirugia endoscopica avançada de base de craneo, cavidade nasal e seios paranasales: experiência de 40 meses num hospital universitário

INTRODUCCIÓN: El uso del endoscopio junto con el avance de la tecnología ha facilitado la extensión de los límites tradicionales en la cirugía de la base del cráneo, la cavidad nasal y los senos paranasales. OBJETIVO: Describir los hallazgos epidemiológicos, clínicos e histopatológicos en los pacientes intervenidos por cirugía endoscópica avanzada en una unidad de Otorrinolaringología en 40 meses. MATERIAL Y MÉTODOS: Estudio retrospectivo. Los protocolos quirúrgicos e historias clínicas fueron revisados. Se realizó un análisis univariado descriptivo con aplicación de test de Chi-cuadrado para significancia estadística (p<0,05)...

INTRODUCTION: The use of the endoscope and the advance of the technology has facilitated the extension of the traditional limits in the surgery of skull base, nasal cavity and paranasal sinuses. OBJECTIVE: To describe the epidemiologic, clinical and histopathological findings in patients intervened under advanced endoscopic surgery in an Otorhinolaryngology unit in 40 months. MATERIAL AND METHODS: Retrospective study. Surgical protocols and medical records were reviewed. A descriptive univariate analysis was performed with the application of Chi-square test for statistical significance (p <0.05)...

INTRODUÇÃO: O uso do endoscópio junto com o avanço da tecnologia facilitou a extensão dos limites tradicionais na cirurgia da base do crânio, a cavidade nasal e os seios paranasais. OBJETIVO: Descrever os achados epidemiológicos, clínicos e histopatológicos em pacientes submetidos a cirurgia endoscópica avançada em uma unidade de Otorrinolaringologia em 40 meses. MATERIAL E MÉTODOS: Estudo retrospectivo. Os protocolos cirúrgicos e os registros médicos foram revisados. Uma análise descritiva univariada foi realizada com a aplicação do teste Qui-quadrado para significância estatística...

Achados da avaliação clínica da deglutição em lactentes cardiopatas pós-cirúrgicos / Findings of postoperative clinical assessment of swallowing in infants with congenital heart defect

RESUMO Objetivo Descrever os achados da avaliação clínica da deglutição em lactentes cardiopatas pós-cirúrgicos de um hospital de referência do sul do Brasil. Método Trata-se de um estudo transversal, realizado em uma Unidade de Terapia Intensiva Pediátrica, no qual participaram lactentes com diagnóstico médico de cardiopatia congênita e idade entre 0 e 6 meses, após procedimento cirúrgico. Foram excluídos da amostra aqueles que apresentaram: comprometimento neurológico, malformação craniofacial, alterações estruturais de vias aéreas superiores, comprometimento respiratório, suspeita ou diagnóstico de síndrome genética. A avaliação clínica foi realizada por meio de aplicação parcial do Protocolo de Avaliação da Disfagia Pediátrica. Em relação às análises estatísticas, as variáveis quantitativas foram descritas por mediana e amplitude interquartílica e as variáveis qualitativas foram descritas por frequências absolutas e relativas. Testes não paramétricos foram aplicados para avaliar as associações. Resultados Dos 31 lactentes que compuseram a amostra, 23 (74,2%) foram classificados com algum grau de disfagia. Houve diferença significativa na avaliação clínica realizada com a oferta de mamadeira quando comparada à oferta em seio materno, em mamadeira também foi observado maior número de alterações da deglutição. A relação entre o tempo de intubação orotraqueal maior que 24 horas e a presença de disfagia apresentaram associação estatisticamente significativa. Conclusão Por meio da ACD foi possível descrever as alterações de deglutição em lactentes cardiopatas após procedimento cirúrgico, independentemente do modo de oferta. Além de identificar a presença de disfagia em número elevado da amostra e sua associação com o período de IOT maior de 24 horas.

ABSTRACT Purpose Describe the findings of postoperative clinical evaluation of swallowing in infants with congenital heart disease (CHD) in a reference hospital in southern Brazil. Methods This is a cross-sectional study conducted postoperatively with infants with medical diagnosis of CHD aged 0-6 months in a Pediatric Intensive Care Unit. Exclusion criteria comprised infants with neurological and respiratory impairments, craniofacial malformation, structural alteration in the upper airways, and suspicion or diagnosis of genetic syndromes. Clinical evaluation was performed through partial application of the Assessment of Pediatric Dysphagia protocol. Regarding statistical analysis, the quantitative variables were described by median and interquartile range and the qualitative variables were described by absolute and relative frequencies. Non-parametric tests were used to evaluate the associations. Results Of the 31 infants in the sample, 23 (74.2%) were classified with some degree of dysphagia. Significant difference was observed in the clinical evaluation performed with bottle-feeding compared with breast-feeding; a larger number of swallowing disorders was also found in bottle-feeding. Statistically significant correlation was observed between duration of orotracheal intubation (OTI) >24 h and presence of dysphagia. Conclusion Postoperative clinical evaluation enabled description of swallowing impairments in infants with CHD regardless of the type of feeding offered, as well as identification of presence of dysphagia in a large number of individuals in the sample and its association with duration of OTI >24 h.

Peritoneal adhesions type i, iii and total collagen on polypropylene and coated polypropylene meshes: experimental study in rats / Aderências peritoneais tipo i, iii e colágeno total em telas de polipropileno e revestidas: estudo experimental em ratos

ABSTRACT Background: Hernia correction is a routinely performed treatment in surgical practice. The improvement of the operative technique and available materials certainly has been a great benefit to the quality of surgical results. The insertion of prostheses for hernia correction is well-founded in the literature, and has become the standard of treatment when this type of disease is discussed. Aim: To evaluate two available prostheses: the polypropylene and polypropylene coated ones in an experimental model. Methods: Seven prostheses of each kind were inserted into Wistar rats (Ratus norvegicus albinus) in the anterior abdominal wall of the animal in direct contact with the viscera. After 90 days follow-up were analyzed the intra-abdominal adhesions, and also performed immunohistochemical evaluation and videomorphometry of the total, type I and type III collagen. Histological analysis was also performed with hematoxylin-eosin to evaluate cell types present in each mesh. Results: At 90 days the adhesions were not different among the groups (p=0.335). Total collagen likewise was not statistically different (p=0.810). Statistically there was more type III collagen in the coated polypropylene group (p=0.039) while type I was not different among the prostheses (p=0.050). The lymphocytes were statistically more present in the polypropylene group (p=0.041). Conclusion: The coated prosthesis was not different from the polypropylene one regarding the adhesion. Total and type I collagen were not different among the groups, while type III collagen was more present on the coated mesh. There was a greater number of lymphocytes on the polypropylene mesh.

RESUMO Racional: A correção herniária é tratamento realizado rotineiramente na prática cirúrgica. O aprimoramento da técnica operatória e dos materiais disponíveis trouxe grande benefício na qualidade dos resultados cirúrgicos. A inserção de próteses para correção herniária é bem embasada na literatura e tornou-se o padrão de tratamento. Objetivo: Avaliar em modelo experimental dois tipos de próteses diferentes, de polipropileno e polipropileno revestido. Métodos: Foram inseridas sete próteses de cada tipo em ratos Wistar (Ratus norvegicus albinus) na parede abdominal anterior do animal em contato direto com as vísceras. Após o seguimento de 90 dias analisaram-se as aderências intra-abdominais, bem como avaliação por imunoistoquímica e videomorfometria do colágeno total, tipo I e tipo III. Também, fez-se análise histológica com hematoxylina-eosina para avaliação dos tipos celulares presentes em cada tela. Resultados: Aos 90 dias as aderências não foram diferentes entre os grupos (p=0,335). O colágeno total igualmente não foi estatisticamente diferente (p=0,810). O colágeno tipo III foi estatisticamente maior no grupo polipropileno revestido (p=0,039) enquanto o tipo I não diferiu entre as próteses (p=0,050). Os linfócitos foram estatisticamente mais presentes no grupo polipropileno (p=0,041). Conclusão: A prótese revestida não foi diferente da de polipropileno na variável aderência. O colágeno total e tipo I não foram diferentes entre os grupos enquanto que o colágeno tipo III foi mais presente na tela revestida. O número de linfócitos foi maior na tela de polipropileno.

Presentation and surgery outcomes in elderly with pheocromocytoma: a comparative analysis with young patients

ABSTRACT Purpose: To evaluate the presentation and early surgical outcomes of elderly patients undergoing adrenalectomy for phaeochromocytoma. Patients and Methods: A retrospective search was performed of our adrenal disorders database for patients who underwent surgery for phaeochromocytoma or paraganglioma between 2009 and 2014. Patients >60 years old were classified as elderly. The clinical manifestations, intraoperative course, and early postoperative outcomes of elderly patients were compared to those of younger individuals (<60 years old). Results: The mean (±standard deviation) age in the older (n=10) and younger (n=36) groups was 69.6±5.3 years and 34.0±12.9 years. Germ-line mutations were more common in younger patients (50.0% versus 0%; p=0.004), whereas incidental lesions were more common in the elderly (40.0% versus 5.3%; p=0.003). In both groups, surgery was most commonly performed by videolaparoscopy (90% in the elderly and 82% in the younger group), with similar intraoperative anesthetic and surgical outcomes. Postoperatively, the older group more commonly received vasoactive drugs (60.0% versus 10.5%; p<0.001) and had a longer intensive care unit stay (3.1±2.8 versus 1.4±1.0 days; p=0.014), more clinical complications (60% versus 18.9%; p=0.01), and longer hospital stay (10.2±8.4 versus 5.7±4.9 days; p=0.028). Conclusions: Although all patients received the same preoperative preparation, the elderly group exhibited a slower and more complicated recovery after adrenalectomy. Meticulous perioperative care should be used in the elderly when treating phaeochromocytoma; nevertheless, adrenalectomy is a relatively safe procedure in this patient population.

Calidad en cirugía: hacia una mejor comprensión de las complicaciones quirúrgicas / Quality assessment in surgery

This paper deals with quality from the perspective of structure, processes and indicators in surgery. In this specialty, there is a close relationship between effectiveness and quality. We review the definition and classification of surgical complications as an objective means of assessing quality. The great diversity of definitions and risk assessments of surgical complications hampered the comparisons of different surgical centers or the evaluation of a single center along time. We discuss the different factors associated with surgical risk and some of the predictive systems for complications and mortality. At the present time, standarized definitions and comparisons are carried out correcting for risk factors. Thus, indicators of mortality, complications, hospitalization length, postoperative quality of life and costs become comparable between different groups. The volume of procedures of a determinate center or surgeon as a quality indicator is emphasized.

Cultural adaptation and the Clavien-Dindo surgical complications classification translated to Brazilian Portuguese / Adaptação cultural e teste da escala de complicações cirúrgicas de Clavien-Dindo traduzida para o Português do Brasil

ABSTRACT Objective: to generate a translated and validated version of the Clavien-Dindo Classification of Surgical Complications (CDC) to Brazilian Portuguese (CDC-BR). Methods: the process of translation and adaptation followed the guideline of Beaton et al., 2000. We divided 76 participating surgeons, in different levels of experience, from the Department Surgery of the Hospital de Clínicas de Porto Alegre, into two groups: Group I applied the original version (CDC, n=36);r Group II used the modified version (CDC-BR, n=40). Each group classified 15 clinical cases of surgical complications. We compared performance between the groups (Mann-Whitney test) relating to the level of experience of the surgeon (Kruskal-Wallis test), considering p value <0.05 as significant. Results: the performance of the Group II (CDC-BR) was higher, with 85% accuracy, compared with 79% of Group I (CDC), p-value =0.012. The performance of the groups as for surgeons experience displayed p=0.171 for Group I, p=0.528 for Group II, and p=0.135 for overall performance. Conclusion: we produced a translated and validated version of the CDC for Brazilian Portuguese. The instrument will be a useful tool in the production of evidence on surgical outcomes.

RESUMO Objetivo: gerar uma versão traduzida e validada da Classificação de Complicações Cirúrgicas de Clavien-Dindo (CCD) para o Português-Brasileiro (CCD-BR). Métodos: o processo de tradução e adaptação seguiu a diretriz de Beaton et al., de 2000. Formaram-se dois grupos, Grupo I, que utilizou a versão original (CCD, n=36) testado em relação ao Grupo II, com a versão modificada (CCD-BR, n=40), com um total de 76 cirurgiões participantes em níveis de experiência distintos do Departamento de Cirurgia do Hospital de Clínicas de Porto Alegre. Quinze casos clínicos de complicações cirúrgicas foram classificados em cada grupo. Comparou-se o desempenho entre grupos (teste de Mann-Whitney) relacionando ao nível de experiência dos cirurgiões (teste de Kruskal-Wallis). Valor de p<0,05 como significativo. Resultados: o desempenho do Grupo II (CCD-BR) foi superior, com 85% de acertos, contra 79% do Grupo I (CCD), p-valor=0,012 do teste de Mann-Whitney. O desempenho dos grupos em relação à experiência dos cirurgiões foi p-valor=0,171 para o Grupo I, p-valor=0,528 para o Grupo II, e p-valor=0,135 para o desempenho geral, teste de Kruskal-Wallis. Conclusão: foi produzida uma versão traduzida e validada da CCD para o Português-Brasileiro. O instrumento produzido será ferramenta útil na produção de evidências sobre os resultados cirúrgicos.

Complicaciones postoperatorias asociadas a la cirugía del tercer molar inferior retenido / Postoperative complications associated with impacted lower third molar surgery

Antecedentes: La cirugía del tercer molar inferior retenido es unprocedimiento de rutina en la práctica de la cirugía bucal. Varias complicaciones surgen como resultado de esta intervención quirúrgica. Entre las más frecuentes se encuentran: dolor, infl amación, trismo, hemorragia, equimosis, alveolitis, infección, parestesia y dificultad para comer. Objetivos: El propósito de este estudio fue evaluar la incidencia de complicaciones postoperatorias en la cirugía del tercer molar inferior retenido en pacientes de la Unidad Académica deOdontología de la Universidad Autónoma de Nayarit a fin de tenerlas en cuenta y tomar las respectivas precauciones, ya sea para tratar de evitarlas en lo sucesivo o bien, para reconocerlas y darles tratamiento. No se incluye dolor, infl amación ni trismo. Material y métodos: Este estudio fue longitudinal y prospectivo de siete días consecutivos y de 30 días en total en 38 pacientes entre 16 y 38 años de edad. Se evaluaron las complicaciones postoperatorias relacionadas con la cirugía del tercer molar inferior. Resultados: Participaron 38 pacientes; 29 del género femenino (76.3 por ciento) y 9 del masculino (23.7 por ciento) de entre 16 y 38 años, con un promedio de edad de 23.16 ± 5.2 años. La complicación más frecuente fue la difi cultad para masticar seguida de equimosis...

Background: Impacted lower third molar surgery is a routine pro-cedure in the practice of oral surgery. However, there are various complications associated with the extraction of impacted mandibular third molars, the most common being pain, swelling, trismus, hemor-rhaging, ecchymosis, dry socket, infection, paresthesia, and diffi culty with chewing. Objectives: The aim of this study was to evaluate the incidence of postoperative complications following impacted lower third molar surgery in patients at the Academic Unit of Dentistry of the Autonomous University of Nayarit, so as to ensure these are taken into account and that the respective precautions are taken, either by attempting to avoid them in the future or to recognize and treat them. Pain, infl ammation and trismus are not analyzed in this paper. Material and methods: A longitudinal prospective study of 38 patients between the ages of 16 and 38 years old (with an average age 23.1) was carried out over seven consecutive days, with follow up examination performed at 15 and 30 days. The postoperative complications associated with lower third molar surgery were assessed. Results: 38 patients took part; 29 females (76.3%) and 9 males (23.7%) between the ages of 16 and 38 years, with a mean age of 23.16 ± 5.2 years old. The most common complication was diffi culty with chewing followed by ecchymosis...

Complicaciones intra y postquirúrgicas de exodoncias en un programa de atención comunitaria de la FOUBA en Junín de los Andes / Intra and postsurgical tooth extraction complications at a FOUBA community dentistry program in Junin de los Andes

El objetivo de este estudio fue analizar la incidencia de complicaciones intra y postquirúrgicas de extracciones simples en 5 días de atención comunitaria en Junín de los Andes, provincia de Neuquén, Argentina. Se realizaron 109 extracciones dentales en 74 de los pacientes que concurrieron al centro único de atención, entre el 27 y 31 de octubre de 2014, presentando piezas dentarias con indicación de extracción. Las complicaciones más frecuentemente encontradas fueron la fractura de la tabla ósea vestibular, la fractura de la corona de la pieza dentaria y el dolor posoperatorio. Complicaciones de frecuencia intermedia fueron el trismus, la alveolitis, la laceración de los tejidos blandos y la fractura de la raíz de la pieza dentaria. Se registró un caso de hemorragia primaria y una inyección accidental dentro de un vaso sanguíneo. Cuando se comparó estadísticamente la presencia de complicaciones pre y posquirúrgicas entre cirugías que duraron menos de 30 minutos y 30 minutos más, se encontró una asociación significativa; para ambas complicaciones, el porcentaje fue mayor en el segundo grupo. La práctica de extracciones simples ocasionalmente conlleva tener que manejar complicaciones. Es importante que el odontólogo general sea capaz de prevenirlas, diagnosticarlas y tratarlas. Reducir los tiempos operatorios parecería ser una medida clave para disminuir las probabilidades de aparición de complicaciones intra y posquirúrgicas.

The objective of this study was to analyze the incidence of intra and postoperative complications of simple extractions in 5 days of community care in Junín de los Andes, province of Neuquén, Argentina. A total of 109 dental extractions were performed in 74 patients who attended the single care center between October 27 and 31, 2014, presenting teeth with indication of extraction. The most frequent complications were the fracture of the buccal bone table, the fracture of the crown of the tooth and the postoperative pain. Complications of intermediate frequency were trismus, alveolitis, laceration of the soft tissues and fracture of the root of the tooth. There was a case of primary haemorrhage and an accidental injection into a blood vessel. When statistically comparing the presence of pre and postsurgical complications between surgeries that lasted less than 30 minutes and 30 minutes more, a significant association was found; for both complications, the percentage was higher in the second group. The practice of simple extractions occasionally entails having to handle complications. It is important that the general dentist be able to prevent, diagnose and treat them. Reducing operative times seems to be a key measure to decrease the chances of intraoperative and postoperative complications.

Complicaciones en cirugía ortognática: conceptos actuales y revisión de la literatura / Complications in orthognathic surgery: current concepts and review of the literature

La cirugía ortognática es el tratamiento de elección para corregir deformidades dentofaciales congénitas o adquiridas en menor cantidad de casos, estas técnicas pueden ser aplicadas en la resección de tumores y apnea del sueño. Usualmente se lleva a cabo entre la segunda y tercera década de vida. Dentro de los benefi cios que se obtienen se incluyen una mejor función masticatoria, resultados estables en discrepancias dentofaciales severas y un mejor aspecto estético facial. Sin embargo, aun el cirujano más experimentado puede enfrentar complicaciones, entre las que destacan las vasculares, técnicas, nerviosas, periodontales, infecciosas, oftálmicas, de oclusión, psicológicas y necrosis ósea. Algu-nas de estas complicaciones pueden discutirse en detalle con el paciente antes del procedimiento. A pesar de lo anterior, el tratamiento de cirugía ortognática puede ser considerado como un procedimiento seguro. Las complicaciones se pueden dividir en preoperatorias, transoperatorias y postoperatorias, teniendo en las dos últimas una mayor incidencia.

Orthognathic surgery is the treatment of choice for the correction of congenital or acquired dentofacial deformities; in a minority of cases, the techniques involved can be applied to tumor resection and to treat sleep apnea. This type of surgery is usually performed between the second and third decades of life. The benefi ts obtained include a better chewing function, stable results in severe dentofacial anomalies, and improved facial aesthetics. However, even the most experienced surgeon can encounter a range of issues, most notably vascular, technical, ner-vous, periodontal, infectious, ophthalmic, psychological, those related to occlusion, and bone necrosis. Some of these can be discussed in detail with the patient prior to the procedure. Nevertheless, orthognathic surgery treatment can be considered a safe procedure. Complications can be classifi ed into three types: preoperative, intraoperative, and postoperative, the latter two being the most common.

Morbilidad postoperatoria en pacientes con hidatidosis hepática complicada / Post surgery morbidity in patients with complicated hepatic hydatidosis

Introduction: Hepatic echinococcosis (HE) surgery is common in southern's Chile hospitals; however, related publications are scarce and with conflicting results, especially with regard to postoperative morbidity (POM), due to the diversity in it severity. The aim of this study is to determine POM in patients undergoing surgery for complicated HE (CHE). Material and Methods: Case series part of a prospective cohort. Patients undergoing surgery for CHH in hospitals Hernán Henríquez Aravena hospital and Clínica Mayor of Temuco, between 2000 and 2012 were included. The main outcome variable was development of POM using the Clavien scale. Other variables of interest were hospital stay, mortality and recurrence. Descriptive statistics were applied and incidence of POM was determined. Results: 73 patients with a median age of 41 years and 58.9% female were studied. The median ultrasound diameter cysts were 15.0 cm. The average surgical time was 125.4 ± 26.3 min. The surgical procedure used most often was the pericystectomy (84.9%); and 84.9% of cases was performed concomitantly some other surgical procedure. The incidence of POM was 19.2%, 78.6% of whose cases were Grade I or II Clavien. The aetiology was 10.9% of medical complications and 8.2% of surgical complications. 1.4% of mortality was recorded; and with a median follow up of 97 months, no recurrence was verified. Conclusions: POM in a cohort of patients with CHE is lower than the published and low severity. Subgroups with higher POM were: patients with coexistence of more than one complication, those with colangiohydatidosis and patients with liver abscess of hydatid origin.

Introducción: La cirugía de la hidatidosis hepática (HH) es habitual en hospitales del sur de Chile; sin embargo, las publicaciones relacionadas son escasas y sus resultados disímiles, en especial respecto de la morbilidad postoperatoria (MPO), debido a la diversidad en la gravedad. El objetivo de este estudio es determinar la incidencia de MPO en pacientes intervenidos quirúrgicamente por HH complicada. Material y Método: Serie de casos, parte de una cohorte prospectiva. Se incluyeron pacientes intervenidos quirúrgicamente por HH complicada, en el hospital Hernán Henríquez Aravena y en la Clínica Mayor de Temuco, entre 2000 y 2012. La variable resultado principal fue desarrollo de MPO aplicando la escala de Clavien. Otras variables de interés fueron estancia hospitalaria, mortalidad y recurrencia. Se aplicó estadística descriptiva y, se determinó incidencia de MPO. Resultados: 73 pacientes, con mediana de edad de 41 años (16 a 84 años); 58,9% de género femenino. La mediana del diámetro ultrasonográfico de los quistes fue de 15,0 cm. El tiempo quirúrgico promedio fue de 125,4 ± 26,3 min. El procedimiento quirúrgico utilizado con mayor frecuencia fue periquistectomía (84,9%); y en 84,9% de los casos se realizó de forma concomitante algún otro procedimiento quirúrgico. La incidencia de MPO fue 19,2% (10,9% de tratamiento médico y 8,2% de tratamiento quirúrgico); 78,6% de cuyos casos eran Grado I o II de Clavien. Se registró 1,4% de mortalidad; y con una mediana de seguimiento de 97 meses, no se verificó recurrencia. Conclusiones: La incidencia de MPO en pacientes con HH complicada es inferior a la publicada y de bajo nivel de gravedad. Los subgrupos de complicaciones evolutivas con mayor MPO fueron la co-existencia de más de una complicación, la colangiohidatidosis y el absceso hepático de origen hidatídico.

Manejo quirúrgico de la hiperplasia prostática benigna y evaluación de eventos adversos según Clavien. Experiencia en Hospital de Villarrica / Surgical management of benign prostatic hyperplasia and evaluationof adverse events according to Clavien. Experience in the Hospital of Villarrica

INTRODUCCIÓN: La hiperplasia prostática benigna (HPB) representa una de las condiciones más importantes en la práctica urológica. En el año 2009 se crea la Unidad de Urología del Hospital de Villarrica. El Objetivo de este trabajo es evaluar la cirugía de la hiperplasia prostática benigna entre los años 2009 y 2012 (adenomectomía transvesical y resección transuretralcon equipo monopolar) y analizar las complicaciones según la clasifi cación de Clavien. MATERIAL Y MÉTODO: Estudio observacional,de corte transversal. Se incluyó la totalidad de los pacientes intervenidos, no existiendo criterios de exclusión.Evaluación de significancia en las diferencias de promedio en las variables continuas a través de la utilización de prueba estadística T de Student. (se consideró significativo un valor de p < 0.05.) Se analizan variables epidemiológica, clínicas y complicaciones postoperatorias...

INTRODUCTION: Benign prostatic hyperplasia (BPH) is one of the most important conditions in urological practice. In 2009the Urology Unit of Villarrica Hospital is created. The objective of this work is to evaluate surgery of benign prostatic hyperplasiabetween 2009 and 2012 (transvesical prostatectomy and monopolar transurethral) and to analyze the complicationsas rated by Clavien. MATERIAL AND METHOD: Observational, cross-sectional. All operated patients were included, with noexclusion criteria. Assessment of signifi cance of diff erences in average continuous variables through the use of Studentt test. (signifi cance was p <0.05.) Epidemiological and clinical variables and postoperative complications were analyzed...

Piercing y lesiones bucodentales / Piercing and oral and perioral lesions

La instalación de piercing oral y perioral aumentó su popularidad en los años recientes, sobre todo en la población adulta joven. En este trabajo se analizan los riesgos, complicaciones y contraindicaciones de esos aditamentos. También se consideran las lesiones de tejidos duros y blandos de la boca producidas por los piercings

A idade influencia os desfechos em pacientes com idade igual ou superior a 70 anos submetidos à cirurgia de revascularização miocárdica isolada / Age influences outcomes in 70-year or older patients undergoing isolated coronary artery bypass graft surgery

OBJETIVO: Analisar os resultados da cirurgia de revascularização miocárdica (CRVM) isolada com circulação extracorpórea em pacientes com idade > 70 anos em comparação àqueles com < 70 anos. MÉTODOS: Pacientes submetidos consecutivamente à CRVM isolada. Os pacientes foram agrupados em G1 (idade e" 70 anos) e G2 (idade < 70 anos). Os desfechos analisados foram letalidade hospitalar, infarto agudo miocárdio (IAM), acidente vascular encefálico (AVE), reoperação para revisão de hemostasia (RRH), necessidade de balão intra-aórtico (BIA), complicações respiratórias, insuficiência renal aguda (IRA), mediastinite, sepse, fibrilação atrial (FA) e bloqueio atrioventricular total (BAVT). RESULTADOS: Foram estudados 1033 pacientes, 257 (24,8%) do G1 e 776 (75,2%) do G2. A letalidade hospitalar foi significantemente maior no G1 quando comparado ao G2 (8,9% vs. 3,6%, P=0,001), enquanto a incidência de IAM foi semelhante (5,8% vs. 5,5%; P=0,87). Maior número de pacientes do G1 necessitou de RRH (12,1% vs. 6,1%; P=0,003). Da mesma forma, no G1 houve maior incidência de complicações respiratórias (21,4% vs. 9,1%; P<0,001), mediastinite (5,1% vs. 1,9%; P=0,013), AVE (3,9% vs. 1,3%; P=0,016), IRA (7,8% vs. 1,3%, P<0,001), sepse (3,9% vs. 1,9%; P=0,003), fibrilação atrial (15,6% vs. 9,8%; P=0,016) e BAVT (3,5% vs. 1,2%; P=0,023) do que o G2. Não houve diferença significante na necessidade de BIA. Na análise regressão logística multivariada "forward stepwise", a idade >70 anos foi fator preditivo independente para maior letalidade operatória (P=0,004) e para RRH (P=0,002), sepse (P=0,002), complicações respiratórias (P<0,001), mediastinite (P=0,016), AVE (P=0,029), IRA (P<0,001), FA (P=0,021) e BAVT (P=0,031) no pós-operatório. CONCLUSÃO: Este estudo sugere que pacientes com idade > 70 anos estão sob maior risco de morte e outras complicações no pós-operatório de CRVM em comparação aos pacientes mais jovens.

OBJECTIVE: To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients >70 years-old in comparison to patients <70 years-old. METHODS: Patients undergoing isolated CABG were selected for the study. The patients were grouped in G1 (age > 70 years-old) and G2 (age <70 years-old). The endpoints were in-hospital mortality, acute myocardial infarction (AMI), stroke, reexploration for bleeding, intra-aortic balloon for circulatory shock, respiratory complications, acute renal failure, mediastinitis, sepsis, atrial fibrillation, and complete atrioventricular block (CAVB). RESULTS: 1,033 patients were included, 257 (24.8%) in G1 and 776 (75.2%) in G2. Patients in G1 were more likely to have in-hospital mortality than G2 (8.9% vs. 3.6%, respectively; P=0.001), while the incidence of AMI was similar (5.8% vs. 5.5%; P=0.87) than G2. More patients in G1 had re-exploration for bleeding (12.1% vs. 6.1%; P=0.003). G1 had more incidence of respiratory complications (21.4% vs. 9.1%; P<0.001), mediastinitis (5.1% vs. 1.9%; P=0.013), stroke (3.9% vs. 1.3%; P=0.016), acute renal failure (7.8% vs. 1.3%; P<0.001), sepsis (3.9% vs. 1.9%;P=0.003), atrial fibrillation (15.6% vs. 9.8%; P=0.016), and CAVB (3.5% vs. 1.2%; P=0.023) than G2. There was no significant difference in the use of intra-aortic balloon. In the forward stepwise multivariate logistic regression analysis age > 70-year-old was an independent predictive factor for higher in-hospital mortality (P=0.004), reexploration for bleeding (P=0.002), sepsis (P=0.002), respiratory complications (P<0.001), mediastinitis (P=0.016), stroke (P=0.029), acute renal failure (P<0.001), atrial fibrillation (P=0.021) and CAVB (P=0.031). CONCLUSION: This study suggests that patients > 70 years-old were at increased risk of death and other complications in the CABG's postoperative period in comparison to younger patients.

Complicações cirúrgicas das cirurgias conservadoras de mama segundo a classificação de Clavien / Surgical complications of conservative breast surgery by Clavien classification

Introdução: pela alta taxa de mortalidade, o câncer de mama é uma das neoplasias mais estudadas no mundo. Metodologia: o presente artigo é um estudo epidemiológico, transversal e retrospectivo analítico que teve como objetivo avaliar a gravidade das complicações, utilizando, para isso, a classificação das complicações cirúrgicas de Clavien. Foi realizada numa coleta de dados de prontuário físico e eletrônico de pacientes com câncer de mama ductal ou lobular invasor, submetida à cirurgia conservadora de mama, realizada entre janeiro de 2009 e dezembro de 2010 no Hospital Erasto Gaertner. Resultados: foram analisados 298 casos de quadrantectomia de mama. Destes, 117 foram ressecção do linfonodo sentinela, nos quais foram verificadas complicações em aproximadamente 30% das pacientes, sendo predominante as de 1º Grau. Com esvaziamento axilar, foram 181 cirurgias, das quais 86 apresentaram complicações, sendo predominante as de 2º e 3º Grau. Conclusõses: A classificação de Cavien-Dindo permite observar que há menos complicações quando as pacientes são submetidas à quadrantectomia com linfonodo sentinela em comparação às com esvaziamento axilar.

Introduction: Due to the high mortality rate, breast cancer is one of the most studied neoplams in the world. Methods: This article is an epidemiological cross-sectional and retrospective analytical study aimed to evaluate the rate of surgical complications of breast conservative surgery and assess the severity of complications, using, for it, the classification of surgical complications of Clavien. We performed a data collection of physical and electronic medical records of patients with breast cancer or ductal lobular invasive, underwent breastconserving surgery, performed between January 2009 and December 2010 at the Hospital Erasto Gaertner. Results: We analyzed 298 cases of breast quadrantectomy. Of these, 117 were with sentinel lymph node resection and these complications were found in approximately 30% of patients, predominantly the 1st degree. With axillary dissection, were 181 surgeries, of which 86 had complications, complications predominant 2nd and 3rd degree. Conclusion: The Clavien-Dindo classification allows us to observe that there are fewer complications when patients are undergoing quadrantectomy with sentinel node compared with the axillary dissection.

Glicemia perioperatória e complicações pós-operatórias em cirurgia cardíaca pediátrica / Perioperative blood glucose level and postoperative complications in pediatric cardiac surgery

FUNDAMENTO: Anestesia para cirurgia cardíaca pediátrica é sistematicamente realizada em pacientes graves sob condições fisiológicas anormais. No intraoperatório, existem variações significativas da volemia, temperatura corporal, composição plasmática e fluxo sanguíneo tecidual, além de ativação da inflamação, com consequências importantes. Medidas seriadas da glicemia podem indicar estados de exacerbação da resposta neuroendocrinometabólica ao trauma servindo como marcadores prognóstico de morbidade nessa população. OBJETIVO: Correlacionar os níveis de glicemia do período perioperatório de crianças submetidas a cirurgia cardíaca com a ocorrência de complicações no pós-operatório e comparar os níveis intraoperatórios de glicemia de acordo com as condições perioperatórias. MÉTODOS: Informações referentes ao procedimento anestésico-cirúrgico e condições perioperatórias dos pacientes foram coletadas em prontuário. Comparações das médias dos valores perioperatórios da glicemia nos grupos de pacientes que apresentaram, ou não, complicações pós-operatórias e as frequências referentes às condições perioperatórias foram estabelecidas conforme cálculo da razão de chances e em análises univariáveis não paramétricas. RESULTADOS: Valores mais elevados de glicemia intraoperatória foram observados nos indivíduos que apresentaram complicações pós-operatórias. Prematuridade, faixa etária, tipo de anestesia e caráter do procedimento não apresentaram influência na média glicêmica do intraoperatório. O emprego de Circulação Extracorpórea (CEC) esteve associado a maiores valores de glicemia durante a cirurgia. Nos procedimentos com CEC, maiores níveis glicêmicos foram observados nos indivíduos que evoluíram com infecção e complicações cardiovasculares, nas cirurgias sem CEC essa mesma associação ocorreu com complicações infecciosas e hematológicas. CONCLUSÃO: Níveis intraoperatórios mais elevados de glicemia estão associados com maior morbidade no pós-operatório de cirurgia cardíaca pediátrica.

BACKGROUND: Anesthesia for pediatric cardiac surgery is systematically performed in severely ill patients under abnormal physiological conditions. In the intraoperative period, there are significant variations in blood volume, body temperature, plasma composition, and tissue blood flow, in addition to activation of inflammation, with important consequences. Serial measurements of blood glucose levels can indicate states of exacerbation of the neuroendocrine-metabolic response to trauma, serving as prognostic markers of morbidity in that population. OBJECTIVE: To correlate perioperative blood glucose levels of children undergoing cardiac surgery with the occurrence of postoperative complications, and to compare intraoperative blood glucose levels according to perioperative conditions. METHODS: Information regarding the surgical/anesthetic procedure and perioperative conditions of patients was collected from the medical records. The mean perioperative blood glucose levels in the groups of patients with and without postoperative complications and the frequencies of perioperative conditions were compared by use of odds ratio and non-parametric univariate analyses. RESULTS: Higher intraoperative blood glucose levels were observed in individuals who had postoperative complications. Prematurity, age group, type of anesthesia, and character of the procedure did not influence the mean intraoperative blood glucose level. The use of extracorporeal circulation (ECC) was associated with higher blood glucose levels during surgery. In procedures with ECC, higher blood glucose levels were observed in individuals who had infectious and cardiovascular complications. In surgeries without ECC, that association was observed with infectious and hematological complications. CONCLUSION: Higher intraoperative blood glucose levels are associated with higher morbidity in the postoperative period of pediatric cardiac surgery.

Tratamento cirúrgico da persistência do canal arterial na população adulta / Surgical treatment of patent ductus arteriosus in adults

OBJETIVO: Analisar uma série de 34 pacientes adultos submetidos ao tratamento cirúrgico da persistência do canal arterial. MÉTODOS: Estudo retrospectivo, com coleta de dados dos prontuários de 34 pacientes consecutivos, com idade superior a 18 anos, com persistência do canal arterial submetidos a correção cirúrgica, no período de 1997 a 2008, no Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo. RESULTADOS: A idade média foi de 28,7 (18 a 53) anos e 22 (64,7%) pacientes eram do sexo feminino. O sintoma mais frequente foi dispneia (76,5%). A toracotomia lateral esquerda foi utilizada em 33 (97,1%) pacientes e o canal arterial foi seccionado e suturado em 25 (73,5%). A circulação extracorpórea (CEC) foi necessária em um paciente. Observou-se calcificação em oito (23,5%) pacientes e 12 (35,3%) haviam sido submetidos à tentativa de fechamento percutâneo. A incidência de complicações foi de 32%, sendo uma permanente, com paralisia de corda vocal (2,9%). Dois (5,8%) pacientes permaneceram com shunt residual e três (8,8%) apresentaram paralisia de corda vocal esquerda transitória. A cirurgia realizada efetivamente levou à melhora da classe funcional (P< 0,0001). Não houve óbitos. CONCLUSÃO: Nesta série de pacientes, o tratamento cirúrgico do canal arterial com técnica convencional em adultos pode ser realizado com baixa morbidade e baixa incidência de complicações.

OBJECTIVE: To analyze 34 patients submitted to surgical treatment of patent arterial duct with age beyond 18 years old. METHODS: Retrospective data collected from patient's charts with more than eighteen years old, submitted to surgical correction of patent arterial duct between 1997 and 2008 at Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo. RESULTS: The mean age was 28.7 (18 a 53) years and 22 (64.7%) were female. The more prevalent symptom was dyspnea (76.5%). Left lateral thoracotomy was used in 33 (97.1%); the DA was sectioned and sutured in 25 (73.5%) cases and one patient needed cardiopulmonary bypass support. There were eight (23.5%) calcified arterial duct and 12 (35.3%) previous treatment with transcatheter devices were performed. The complication rate was 32%, with one (2.9%) permanent vocal cord palsy. Two (5.8%) patients had residual shunt less than 2mm. Transient left cord voice palsy was observed in 3 (8.8%) The procedure improves functional class (P< 0.0001) and no mortality was observed. CONCLUSION: In this series, the surgical treatment of patent arterial duct in adults could be done without mortality and low incidence of complications.