Resultados de la esofaguectomía mínimamente invasiva por cáncer de esófago a medio y largo plazo

Introducción: La esofagectomía es actualmente el tratamiento curativo del cáncer de esófago. El objetivo de este trabajo es conocer los resultados de la esofaguectomía mínimamente invasiva a corto y medio plazo en pacientes intervenidos de carcinoma epidermoide y adenocarcinoma de esófago en nuestro hospital. Material y Métodos: Se recogieron 19 pacientes desde enero de 2020 hasta junio de 2021 y se realizó el seguimiento a todos ellos durante 20 meses. Se recogieron diferentes variables relacionadas con el paciente, el tumor, la cirugía y referentes al postoperatorio. Los datos fueron almacenados y procesados usando el software estadístico R-Comander asumiendo un error α de 0,05. Resultados: La mediana de estancia hospitalaria total fue de 29 días. Seis pacientes, precisaron de reingreso en Reanimación: dos por shock séptico secundario a la fuga de anastomosis grado III, uno por hemorragia digestiva alta y los tres por insuficiencia respiratoria. A los 90 días reingresaron un 5,3% del total de pacientes. No se produjeron fallecimientos en los tres meses siguientes a la cirugía. Todos los pacientes presentaron una supervivencia mayor de seis meses. La supervivencia global a seis, 12 y 18 meses se sitúa en 100, 84 y 63%. La supervivencia libre de enfermedad a los tres meses fue del 84%, a los 6 meses del 63% y al año el 58%. Discusión: Los resultados obtenidos en nuestro estudio coinciden con lo que hay reflejado en la literatura. Por tanto, la esofagectomía mínimamente invasiva es una técnica efectiva en el tratamiento del cáncer de esófago.

Introduction: Oesophagectomy is currently the curative treatment for oesophageal cancer. The aim of this study is to know the results of minimally invasive oesophagectomy in the short and medium term in patients operated on for squamous cell carcinoma and adenocarcinoma of the oesophagus in our hospital. Material and Methods: 19 patients were collected from January 2020 to June 2021 and all of them were followed up for 20 months. Different variables related to the patient, tumour, surgery and postoperative period were collected. Data were stored and processed using R-Comander statistical software assuming an α-error of 0.05. Results: The median total hospital stay was 29 days. Six patients required readmission to resuscitation: two for septic shock secondary to grade III anastomotic leak, one for upper gastrointestinal haemorrhage and three for respiratory failure. At 90 days, 5.3% of the total number of patients were re-admitted. There were no deaths in the three months following surgery. All patients had a survival of more than six months. Overall survival at six, 12 and 18 months was 100, 84 and 63%. Disease-free survival at three months was 84%, at six months 63% and at one year 58%. Discussion: The results obtained in our study coincide with those reported in the literature. Minimally invasive oesophagectomy is therefore an effective technique in the treatment of oesophageal cancer.

Complicaciones por cirugía oncológica mamaria / Complications due to oncological breast surgery

RESUMEN Introducción: Cada año en América Latina, más de 200,000 mujeres son diagnosticadas con cáncer de mama. Como parte del tratamiento de esta enfermedad, la cirugía es uno de los pilares fundamentales. El acto quirúrgico es una experiencia extrema para el paciente y el cirujano, necesaria en esta patología para el tratamiento completo y, como todo acto médico, no está exento de complicaciones. En Paraguay no se cuentan con estadísticas sobre la prevalencia de las complicaciones debidas a cirugías por cáncer de mama, por lo que este trabajo tiene como principal objetivo establecer dicha frecuencia en un hospital de cuarto nivel de complejidad. Materiales y métodos: Estudio retrospectivo, observacional, de corte transversal. Muestreo no probabilístico de casos consecutivos. La selección de sujetos de estudios se realizó de la población de pacientes que fueron sometidos a cirugía por cáncer de mama, en el Hospital de Clínicas en el periodo enero de 2018 a agosto 2022, y que cumplan con los criterios de inclusión y exclusión. Todas las variables han sido extraídas de la ficha clínica y fueron documentadas en el formulario de registro de datos. Se esperaba una frecuencia de 42 % de complicaciones post quirúrgicas utilizando el programa estadístico EPIINFO 7 para un IC de 95% a precisión de 5%, el tamaño mínimo a incluir debía ser de 143 pacientes. Resultados: Se analizaron 203 historias clínicas de pacientes con diagnóstico de cáncer de mama que fueron sometidas a cirugía como parte del tratamiento, correspondientes al periodo comprendido entre enero de 2018 a agosto de 2022. Cumplieron con los criterios de inclusión 201 pacientes. Se registraron un total de 92 pacientes que presentaron alguna complicación relacionada a la cirugía, que corresponden 46 % del total de pacientes en el periodo de tiempo estudiado. De las complicaciones encontradas, 40 desarrollaron seromas, representando el 43% del total de pacientes con complicaciones; 18 pacientes tuvieron infección de la herida operatoria, representando el 20%. 7 pacientes presentaron dehiscencia de la herida operatoria, siendo el 7,5% del total; y 5 desarrollaron un hematoma, siendo el 5,3%. Entre otras complicaciones encontradas, 4 pacientes presentaron linfedema (4,3%), 4 dolor crónico (4,3%), 3 extrusión de prótesis mamaria (3,2 %), 2 de celulitis del miembro superior afecto (2,1%), 2 presentaron necrosis del complejo areola-pezón (2,1%), 1 sufrimiento de piel sin necrosis, 1 sufrimiento del complejo areola-pezón sin necrosis (1% ambos), 1 presentó fistula (1%), 1 disfunción del miembro superior homolateral (1%), y una contractura capsular (1%). Discusión: Se registraron 92 pacientes con una complicación post quirúrgica luego de una cirugía por cáncer de mama; representa así el 46% del total de pacientes estudiados. Esta prevalencia se corresponde con lo publicado en la literatura. En cuanto a las complicaciones encontradas, la más frecuente en nuestra revisión fue el seroma, que se presentó en un 40% de las complicaciones. Las publicaciones describen a esta como una de las complicaciones más frecuentemente relacionadas a la cirugía mamaria, con frecuencias que varían desde 18 al 86% según diversos autores. Conclusión: De 201 pacientes que cumplieron con los criterios de inclusión y exclusión, se registraron un total de 92 pacientes que presentaron alguna complicación relacionada a la cirugía, que corresponden 46 % del total de pacientes en el periodo de tiempo estudiado. La complicación más frecuente fue el seroma. Todos los hallazgos de este estudio se correlacionan con lo encontrado en la literatura.

Introduction: Every year in Latin America, more than 200,000 women are diagnosed with breast cancer. As part of the treatment of this disease, surgery is one of the fundamental pillars. The surgical act is an extreme experience for the patient and the surgeon, necessary in this pathology for complete treatment and, like any medical act, it is not exempt from complications. In Paraguay there are no statistics on the prevalence of complications due to surgeries for breast cancer, so the main objective of this work is to establish said frequency in a hospital of fourth level of complexity. Materials and methods: retrospective, observational, cross-sectional study. non-probabilistic sampling of consecutive cases. The selection of study subjects was made from the population of patients who underwent surgery for breast cancer, at the Hospital de Clínicas in the period January 2018 to August 2022, and who met the inclusion and exclusion criteria. All the variables have been extracted from the clinical record and were documented in the data recording form. A frequency of 42% of post-surgical complications was expected using the statistical program EPIINFO 7 for a CI of 95% with a precision of 5%, the minimum size to include had to be 143 patients. Results: 203 medical records of patients diagnosed with breast cancer who underwent surgery as part of the treatment, corresponding to the period from January 2018 to August 2022, were analyzed. 201 patients met the inclusion criteria. A total of 92 patients who presented some complication related to surgery were registered, corresponding to 46% of the total number of patients in the period of time studied. Of the complications found, 40 developed seromas, representing 43% of all patients with complications; 18 patients had surgical wound infection, representing 20%. 7 patients presented dehiscence of the surgical wound, being 7.5% of the total; and 5 developed a hematoma, being 5.3%. Among other complications found, 4 patients presented lymphedema (4.3%), 4 chronic pain (4.3%), 3 extrusion of breast prosthesis (3.2%), 2 cellulitis of the affected upper limb (2.1%), 2 presented necrosis of the nipple-areola complex (2.1%), 1 suffering from skin without necrosis, 1 suffering from the nipple-areola complex without necrosis (1% both), 1 presented fistula (1%), 1 homolateral upper limb dysfunction (1%), and capsular contracture (1%). Discussion: 92 patients with a post-surgical complication after surgery for breast cancer were registered; thus represents 46% of all patients studied. This prevalence corresponds to what has been published in the literature. Regarding the complications found, the most frequent in our review was seroma, which occurred in 40% of the complications. The publications describe this as one of the complications most frequently related to breast surgery, with frequencies ranging from 18 to 86% according to various authors. Conclusion: Of 201 patients who met the inclusion and exclusion criteria, a total of 92 patients who presented some complication related to surgery were registered, corresponding to 46% of the total number of patients in the period of time studied. The most frequent complication was seroma. All the findings of this study correlate with what is found in the literature.

Value of preoperative quantitative ultrasound analysis of quadriceps femoris in predicting chronic post-surgical pain after total knee arthroplasty / 中国组织工程研究

BACKGROUND:Total knee arthroplasty is one of the effective methods to treat end-stage knee osteoarthritis.However,some patients still experience chronic post-surgical pain.It is significant to find out the influencing factors of chronic post-surgical pain.Demographic factors,social psychological factors and perioperative pain were the focus of previous studies,but muscle factors closely related to the occurrence and development of knee osteoarthritis were rarely reported. OBJECTIVE:To evaluate the value of preoperative quantitative ultrasound analysis of quadriceps femoris in predicting chronic post-surgical pain after total knee arthroplasty. METHODS:A total of 250 patients with knee osteoarthritis who underwent the first unilateral total knee arthroplasty under elective general anesthesia from January to August 2022 in the Affiliated Hospital of Xuzhou Medical University were selected.All patients were treated with the same anesthesia and operative methods.Before the surgery,clinical data were recorded,and the thickness and echo intensity of quadriceps femoris on the operated side were measured by ultrasound imaging,which could quantify the degree of quadriceps femoris atrophy.Multivariate logistic regression was used to analyze the independent factors affecting the occurrence of chronic post-surgical pain,and receiver operating characteristic curves were used to evaluate its predictive value. RESULTS AND CONCLUSION:(1)250 subjects were involved in the result analysis,and 91 of them had chronic post-surgical pain,with an incidence of 36.4%.(2)There were significant differences between the chronic pain and non-chronic pain groups in preoperative pain score during movement,preoperative Western Ontario and McMaster University Osteoarthritis Index,preoperative anxiety and depression scale score,preoperative muscle thickness and echo intensity of quadriceps femoris,and postoperative acute pain score(P<0.05).(3)Multivariate logistic regression analysis showed that preoperative thickness of quadriceps femoris was an independent protective factor for chronic post-surgical pain and preoperative pain score during movement was an independent risk factor for chronic post-surgical pain.(4)Receiver operating characteristic curves showed that the area under the curve of the preoperative thickness of quadriceps femoris was 0.625(95%CI:0.555-0.695),and the critical value was 2.78 cm,sensitivity was 0.802,specificity was 0.415.(5)It is concluded that the preoperative thickness of quadriceps femoris is an independent protective factor for chronic post-surgical pain,but its predictive efficacy is low,and its clinical application needs to be further verified or modified.

Prevalencia de complicaciones en pacientes mastectomizadas por cáncer de mama

Introducción: la mujer de hoy exige una cirugía lo más efectiva, segura y estética posible. Objetivo: determinar la prevalencia de las complicaciones posquirúrgicas en pacientes mastectomizadas por cáncer de mama. Materiales y métodos: se realizó un estudio cuantitativo, observacional y descriptivo en un universo de 137 pacientes sometidas a mastectomía, por cáncer de mama comprobado histológicamente, en 2019, en los hospitales General Provincial Carlos Manuel de Céspedes y Clínico Quirúrgico Docente Celia Sánchez Manduley, de Granma. Se evaluaron las variables edad, extensión de la mastectomía, lateralidad, aparición de complicaciones, tipo de complicación, estadio tumoral y diagnóstico histológico. Resultados: la media de edad de las pacientes mastectomizadas fue de 56,53 años, y la mastectomía radical modificada fue el proceder quirúrgico más realizado (76 mamas). La incidencia de complicaciones fue del 52,17 % (1,24 % intraoperatoria), siendo la complicación de mayor prevalencia el linfedema (29,63 %). En relación con el tipo histológico, el carcinoma ductal infiltrante sin especificar (77,54 %) fue el más frecuente, y con los estadios tumorales, el IIIB (22,46 %) y el IV (22,46 %) fueron los de mayor prevalencia. La incidencia de las complicaciones aumentó en la medida en que se elevó el estadio tumoral. Conclusiones: la incidencia de las complicaciones posquirúrgicas en la mastectomía fue elevada, relacionándose con el estadio tumoral.

Introduction: today's woman demands the most effective, secure and esthetic surgery possible. Objective: to determine the prevalence of post-surgery complications in patients mastectomized by breast cancer Materials and methods: a quantitative, observational and descriptive study was carried out in a universe of 137 patients who underwent a mastectomy by histologically proven breast cancer, in 2019, in the General Provincial Hospital Carlos Manuel de Cespedes and in the Clinical Surgical Teaching Hospital Celia Sanchez Manduley, of Granma. The variables age, extension of mastectomy, laterality, appearance of complications; type of complication, tumoral stage and histologic diagnosis were evaluated. Results: the mean age of mastectomized patients was 56.53 years, and modified radical mastectomy was the most performed procedure (76 mammae). The incidence of complications was 52.17% (1.24% intra-operatory), being lymphedema (29.63%) the most prevalent complication. In relation to the histologic type, unspecified infiltrating ductal carcinoma (77.54%) was the most frequent one, and tumoral stages IIIB (22.46%) and IV (22.46%) were the most prevalent. The incidence of complications increased as the tumor stage increased. Conclusions: the incidence of postsurgical complications in mastectomy was high, in relation with the tumor stage.

Lesión carotídea arteriosclerótica en pacientes con cirugía coronaria / Carotid atherosclerotic lesion in patients with coronary surgery

Introducción: Las enfermedades cardiovasculares isquémicas constituyen la primera causa de muerte en el mundo desarrollado o en vías de serlo, por encima de las oncológicas, de los accidentes del tránsito y de las enfermedades vásculo-cerebrales. El diagnóstico temprano de una lesión coronaria permite lograr la prevención del ataque isquémico agudo, y realizar el tratamiento revascularizador oportuno con evaluación de riesgo quirúrgico, que permita obtener cifras de morbimortalidad aceptables. Objetivo: Describir las características ultrasonográficas de las arterias carotídeas como riesgo de accidente cerebro-vascular en pacientes con revascularización miocárdica. Métodos: Se realizó un estudio observacional, descriptivo y longitudinal en 208 pacientes revascularizados del sector coronario, con estudio ultrasonográfico prequirúrgico de las arterias carotídeas como método predictivo de enfermedad vásculo-cerebral isquémica. Resultados: En 20 pacientes se presentaron síntomas cerebrales que se clasificaron en menores y mayores. Existió preponderancia de los menores y, entre ellos, de la agitación. Se evaluaron los factores de riesgo primarios y en las características de las placas ateroescleróticas se destacó el grado de irregularidad. Conclusiones: El estudio ultrasonográfico del árbol arterial carotídeo debe formar parte esencial del estudio predictivo del paciente que va a ser sometido a una revascularización coronaria(AU)

Introduction: Ischemic cardiovascular diseases are the leading cause of death in the developed world or in the process of becoming so, above oncological ones, traffic accidents and vascular-cerebral diseases. The early diagnosis of a coronary lesion allows to achieve the prevention of acute ischemic attack, and to perform the appropriate revascularization treatment with surgical risk assessment, which allows to obtain acceptable morbidity and mortality figures. Objective: To describe the ultrasonographic characteristics of carotid arteries as a risk of stroke in patients with myocardial revascularization. Methods: An observational, descriptive and longitudinal study was conducted in 208 coronary sector´s revascularized patients, with pre-surgical ultrasonographic study of the carotid arteries as a predictive method of ischemic cerebral vascular disease. Results: In 20 patients there were brain symptoms that were classified into minor and major. There was a predominance of minors and, among them, of agitation. The primary risk factors were evaluated and the degree of irregularity was highlighted in the characteristics of the atherosclerotic plaques. Conclusions: The ultrasonographic study of the carotid arterial tree should be an essential part of the predictive study of the patient who is undergoing coronary revascularization(AU)

Effect of nursing care by using Extended Nursing Care Model on quality of life of patients after coronary artery bypass graft

Background: Though coronary artery bypass graft (CABG) is a life-saving surgery and a standardized procedure, the aim of the surgery is survival with quality of life (QOL). The extended role of the nurse was well recommended in community and clinical settings with the support of multidisciplinary team for safe care. The Extended Nursing Care Model (ENCM) provides the framework to facilitate early recovery and thereby improve the QOL and overall productivity after CABG. Aim and Objective: The aim of this article is to compare the difference in QOL of CABG patients with and without ENCM. Materials and Methods: Quasi-experimental Time Series Design with Comparison Group was used to study the effectiveness of ENCM. Among CABG patients enrolled on the day of admission with non-probability purposive sampling technique, 140 patients were randomly and equally distributed in the study and control groups on the day of discharge for recovery management. Generic EQ-5D-5L scale and MacNew Heart Disease-related QOL (MNHDRQOL) questionnaire were used to collect data at frequent intervals. The data obtained successfully from 69 patients in the study group and 63 patients in the control group were analyzed by using SPSS-21 Statistical Software, Mann–Whitney U-test, and Wilcoxon signed-rank test. Results: There was an improvement in the EQ-5D-5L score and MNHDRQOL score from baseline (before surgery) to 6th week and 12th week after surgery. This difference is statistically higher in the study group than in the control group (P <0.05) in all five domains of Euro QOL and all three domains of MNHDRQOL. Conclusion: Nursing care provided by using ENCM is effective in improving the QOL of CABG patients.

Dolor crónico posoperatorio: Una revisión necesaria de un problema ignorado / Chronic post-surgical pain: A necessary review for a disregarded problem

INTRODUCTION: Postoperative chronic pain (PCP) is defined as a discomfort that lasts more than expected or beyond 3 months after surgery. The recognition and study of this clinical entity has been gaining interest in the past few years. One of the main reasons is the great impact it can have on the quality of life of patients who suffer from it. OBJECTIVE: To describe the prevalence, risk factor and impact of PCP on patients subjected to different surgical procedures. MATERIALS AND METHODS: Search on MED- LINE/Pubmed, using the following terms: "chronic postsurgical pain", "chronic post operative pain", "chronic post operative pain", "chronic post surgical pain". Publications were then sieved using their title and abstract. RESULTS: Fifty-seven articles were analyzed. Ten to fifty percent of patients were reported as suffering PCP, with up to 10% incidence of severe pain. The main risk factors identified were the use of analgesics, pre-operative pain and type of surgery. Orthopedic surgery was highly associated with moderate to severe PCP within the first year. Twenty-one percent of patients referred PCP affected their quality of life and sleep; ability to carry out physical activity and return to work. CONCLUSION: The first approach to PCP is getting to know its impact and epidemiology. Surgical treatments can cause PCP, which will affect patient recovery and increase costs. Recognizing those patients at risk and establishing preventive management protocols could improve the quality of life of postsurgical patients.

INTRODUCCIÓN: El dolor crónico posoperatorio (DCPO) es aquel que aparece tras un procedimiento quirúrgico y se mantiene por más tiempo de lo esperado o más de tres meses luego de la cirugía. Es una entidad de reciente estudio y que tiene un gran impacto en la calidad de vida de los pacientes postoperados. OBJETIVO: Describir la prevalencia, factores de riesgo y el impacto del DCPO en pacientes sometidos a diferentes procedimientos quirúrgicos. MATERIAL Y MÉTODO: Se realizó una revisión de la literatura utilizando la base de datos MEDLINE/Pubmed. Los términos libres fueron "chronic postsurgical pain", "chronic postoperative pain", "chronic post operative pain", "chronic post surgical pain". Se realizó un cribado según título y resumen. RESULTADOS: Fueron analizados 57 artículos. De 10%-50% de los pacientes presentan DCPO y hasta 10% puede ser severo. El uso de analgésicos, presencia de dolor preoperatorio y especialidad quirúrgica han sido señalados como los principales factores de riesgo. La cirugía traumatológica aparece como la más asociada a DCPO moderado y severo a un año. Hasta 21% de los pacientes refieren que afecta su calidad de vida, el sueño, actividad física y reincorporación laboral. CONCLUSIÓN: El conocimiento de la epidemiología e impacto del DCPO es un primer acercamiento a este problema. Patologías de resolución quirúrgica pueden evolucionar con DCPO, afectando su recuperación y aumentando los costos que se desea contener. El reconocimiento de la población de riesgo y la instauración de protocolos preventivos pudiera mejorar la calidad de vida de los pacientes postoperados.

Anesthetic considerations and postoperative pain management in radical penectomy: Case report / Penectomía radical, consideraciones anestésicas y manejo del dolor postoperatorio: Reporte de un caso

Abstract Radical penectomy (RP) is infrequently performed as it is reserved for specific cases of penile cancer, hence the paucity of reports regarding surgical and anesthetic considerations. Acute postoperative pain, chronic post-surgical pain, concomitant mood disorders as well as a profound impact on the patient's quality of life have been documented. This case is of a patient with diabetes and coronary heart disease, who presented with advanced, over infected penile cancer, depressive disorder and a history of pain of neuropathic characteristics. The patient underwent radical penectomy using a combined spinal-epidural technique for anesthesia. Preoperatively, the patient was treated with pregabalin and magnesium sulphate, and later received a blood transfusion due to intraoperative blood loss. Adequate intra and postoperative analgesia was achieved with L-bupivacaine given through a peridural catheter during one week. Recovery was good, pain was stabilized to preoperative levels and the patient received pharmacological support and follow-up by psychiatry and the pain team.

Resumen La penectomía radical (PR) es una cirugía infrecuente, reservada para casos específicos de cáncer de pene, por lo que hay escasos informes sobre sus consideraciones quirúrgicas y anestésicas. Se ha documentado dolor agudo postoperatorio, dolor crónico posquirúrgico y alteraciones del estado de ánimo concomitantes, así como un profundo impacto en la calidad de vida posterior del paciente. Se presenta el caso de un paciente diabético y cardiópata coronario con cáncer de pene avanzado y sobreinfectado, trastorno depresivo y dolor previo de características neuropáticas, que recibe técnica combinada espinal-peridural para cirugía de penectomía radical. Se le trata también con pregabalina preoperatoria, sulfato de magnesio y transfusión por sangrado quirúrgico. Se otorgó una adecuada analgesia intra y postoperatoria, mediante catéter peridural con L-bupivacaína hasta por una semana. El paciente tuvo una buena recuperación, estabilización del dolor a niveles preoperatorios, controles y apoyo farmacológico por psiquiatría de enlace y equipo del dolor.

Complicaciones posquirúrgicas en pacientes con aneurisma de la aorta abdominal operados electivamente / Post-surgical complications in patients with electively operated abdominal aortic aneurysm

Introducción: Los aneurismas aórticos abdominales constituyen un problema de salud por la alta mortalidad que provocan. Su seguimiento y tratamiento son fundamentales para evitar las complicaciones posquirúrgicas. Objetivo: Caracterizar las principales complicaciones posquirúrgicas de los pacientes con aneurisma de la aorta abdominal operados electivamente. Métodos: Se realizó un estudio observacional y descriptivo en 94 pacientes operados de forma electiva en el Instituto Nacional de Angiología y Cirugía Vascular por presentar un diagnóstico de aneurisma de la aorta abdominal. Las variables de estudio fueron: edad, sexo, color de la piel, enfermedades asociadas, diámetro del aneurisma, profilaxis antibiótica, tiempo quirúrgico, tipo de prótesis vascular, tipo de complicación posoperatoria, tiempo de aparición de las complicaciones, estadía hospitalaria posoperatoria y estado al egreso. Se determinaron las frecuencias absolutas y relativas. Resultados: El 56,4 por ciento de los pacientes operados presentó algún tipo de complicación, las cuales fueron más frecuentes en el sexo masculino por encima de los 60 años. Las más predominantes resultaron la bronconeumonía (24,5 por ciento) y las arritmias cardíacas (20,8 por ciento). La proporción de complicaciones se mostró mayor en los pacientes con injertos bifurcados, así como en aquellos sin profilaxis y con un tiempo quirúrgico prolongado. Hubo mayor frecuencia de enfermedades cardiovasculares entre los fallecidos. Conclusiones: En los pacientes operados de forma electiva de aneurisma de la aorta abdominal predominaron las complicaciones respiratorias y cardiovasculares, estas últimas provocaron un aumento en la mortalidad(AU)

Introduction: Abdominal aortic aneurysms are a health problem because of the high mortality they cause. Their follow-up and treatment are essential to avoid post-surgical complications. Objective: Characterize the main post-surgical complications of patients with electively operated abdominal aortic aneurysm. Methods: An observational and descriptive study was conducted in 94 electively operated patients at the National Institute of Angiology and Vascular Surgery after having a diagnosis of abdominal aortic aneurysm. The study variables were: age, sex, skin color, associated diseases, aneurysm diameter, antibiotic prophylaxis, surgical time, type of vascular prosthesis, type of postoperative complication, time of onset of complications, postoperative hospital stay, and state at discharge moment. Absolute and relative frequencies were determined. Results: 56.4 percent of operated patients had some form of complication, which were more common in the males over 60 years. The most predominant complications were bronchopneumonie (24.5 percent) and cardiac arrhythmias (20.8 percent). The proportion of complications was shown to be higher in patients with forked grafts, as well as in those without prophylaxis and with prolonged surgical time. There was a higher frequency of cardiovascular diseases among the deceased patients. Conclusions: In patients electively operated of abdominal aortic aneurysm, there was a predominance of respiratory and cardiovascular complications, and the latter caused an increase in mortality(AU)

Complicaciones pulmonares tempranas en pacientes operados de cirugía cardiaca / Early pulmonary complications in cardiac surgery patients / Complicações pulmonares precoce em pacientes pós-operados de cirurgia cardíaca

Resumen: Introducción: Las complicaciones pulmonares postoperatorias tempranas (CPPT) son la principal causa de complicaciones no relacionadas con el procedimiento quirúrgico en la población de cirugía cardiaca. Material y métodos: Se realizó un estudio retrospectivo, observacional y descriptivo del 01 de enero de 2006 al 31 de diciembre de 2018 en pacientes sometidos a cirugía cardiaca que ingresaron a la Unidad de Cuidados Postquirúrgicos. Resultados: Se incluyeron 323 pacientes, 107 (33.1%) presentaron CPPT, siendo las más frecuentes las atelectasias (n = 60, 18.6%), derrame pleural (n = 39, 12%), neumonía (n = 5, 1.5%) y SIRA (n = 3, 1%). Los pacientes que presentaron CPPT tuvieron un EURO SCORE II más alto (3.9 ± 4.7 vs. 2.7 ± 2.2, p = 0.001), mayor tiempo de derivación cardiopulmonar (119.6 ± 40.2 vs. 75.5 ± 36.6, p = 0.001) y tiempo de pinzamiento (84.9 ± 30.5 vs. 53.5 ± 29.7, p = 0.001). La supervivencia en UCI de los pacientes con CPPT fue menor (74.8 vs. 88.4%, p = 0.002, OR = 2.6). La supervivencia hospitalaria también fue menor en los pacientes con CPPT (72.8 vs. 84.2%, p = 0.015). Conclusiones: La incidencia de CPPT posterior a la cirugía cardiaca en nuestro centro hospitalaria fue alta. Es necesaria la implementación de medidas preventivas como el retiro temprano de la ventilación mecánica y rehabilitación cardiopulmonar.

Abstract: Introduction: Early postoperative pulmonary complications (EPPC) are the main cause of complications unrelated to the surgical procedure in the cardiac surgery population. Material and methods: A retrospective, observational and descriptive study was conducted from January 1, 2006 to December 31, 2018 in patients undergoing cardiac surgery admitted to the post-surgical care unit. Results: 323 patients were included, 107 (33.1%) presented EPPC, the most frequent being atelectasis (n = 60, 18.6%), pleural effusion (n = 39, 12%), pneumonia (n = 5, 1.5%) and ARDS (n = 3, 1%). Patients who presented EPPC had a higher EURO SCORE II (3.9 ± 4.7 vs. 2.7 ± 2.2, p = 0.001), longer cardiopulmonary bypass time (119.6 ± 40.2 vs. 75.5 ± 36.6, p = 0.001) and clamping time (84.9 ± 30.5 vs. 53.5 ± 29.7, p = 0.001). The ICU survival of patients with EPPC was lower (74.8 vs. 88.4%, p = 0.002, OR = 2.6). Hospital survival was also lower in patients with EPPC (72.8 vs. 84.2%, p = 0.015). Conclusions: The incidence of EPPC after cardiac surgery in our hospital was high. The implementation of preventive measures such as early removal of mechanical ventilation and cardiopulmonary rehabilitation is necessary.

Resumo: Introdução: As complicações pulmonares pós-operatórias precoces (CPPP) são a principal causa de complicações não relacionadas ao procedimento cirúrgico na população de cirurgia cardíaca. Material e métodos: Estudo retrospectivo, observacional e descritivo realizado no período de 1o de janeiro de 2006 a 31 de dezembro de 2018 em pacientes submetidos à cirurgia cardíaca internados na unidade de recuperação pós-cirúrgica. Resultados: Foram incluídos 323 pacientes, 107 (33.1%) apresentavam TPPP, sendo os mais frequentes atelectasia (n = 60, 18.6%), derrame pleural (n = 39, 12%), pneumonia (n = 5, 1.5%) e SIRA (n = 3, 1%). Pacientes que apresentaram CPPP tiveram maior EURO SCORE II (3.9 ± 4.7 vs 2.7 ± 2.2, p = 0.001), maior tempo de circulação extracorpórea (119.6 ± 40.2 vs 75.5 ± 36.6, p = 0.001) e tempo de pinçamento (84.9 ± 30.5 vs 53.5 ± 29.7, p = 0.001). A sobrevida na UTI de pacientes com CPPP foi menor (74.8% vs 88.4%, p = 0.002, OR = 2.6). A sobrevivência hospitalar também foi menor em pacientes com CPPT (72.8% vs 84.2%, p = 0.015). Conclusões: A incidência de CPPP após cirurgia cardíaca em nosso centro hospitalar foi alta. É necessária a implementação de medidas preventivas como a retirada precoce da ventilação mecânica e a reabilitação cardiopulmonar.

Incidence of clinical and subclinical macular edema in patients submitted to phacoemulsification in a university health service

INTRODUCTION: The incidence of cystoid macular edema (CME) after cataract surgery varies substantially and depending on the diagnostic method used. In addition, other factors that influence the incidence of CME are the technique of surgery and the associated comorbidities. OBJECTIVE: The aim of the present study was to evaluate the incidence of EMC after uncomplicated phacoemulsification surgery, using the spectral domain optical coherence tomography (OCT). METHODS: The incidence of subclinical and clinical CME was evaluated in 14 patients who underwent uncomplicated phacoemulsification surgery, using OCT before the surgical procedure and after seven and 28 days after it. The volunteers could not use a prostaglandin analogue or present any retinopathy that compromised visual acuity. RESULTS: The incidence of clinically significant CME was 6.4%, however retinal thickening by OCT was observed in all patients in the fourth postoperative week. Regarding gender and laterality, the percentages were similar. CONCLUSION: In this study, we obtained a low incidence of EMC in patients assisted at this center, corroborating multicenter studies.

Prospective Analysis of Post-Operative Admissions in the Intensive Care Unit of a Tertiary Care Hospital

Background: The Intensive Care Unit (ICU) is a special unitprimarily concerned with the care of patients with acute,recoverable, life- threatening, critical illness and injuries, whichrequire constant close monitoring and support. ICU servicesare expensive and limited resources require stratification ofpatients. The present prospective study was undertaken toevaluate the post-operative admissions in the intensive careunit of a tertiary care hospital.Materials and Methods: Present study was conducted toevaluate all the post-operative admission in the Intensive CareUnit for a period of one year (Nov 2013 and Nov 2014). Allpost-operative patients were divided into three groups: Group 1– Informed Admissions, Group 2 – Uninformed Admissions,Group 3 – Post surgical Admissions. At the time of admissionto ICU, the following data were noted: demographic data, initialdiagnosis, vital parameters, pre-operative and peri-operativevariables were collected from patient’s case sheet andanaesthesia case sheet. Additionally, various hemodyanamicsvariables, duration of stay at ICU and outcome of the patientswere noted. All the statistical analysis was performed usingSPSS version 20. A p value of <0.05 was consideredsignificant.Results: The present study is a prospective evaluation studyconducted on 341 patients who were admitted in the ICU of atertiary care hospital from the operating room. On the basis ofgender distribution more males were admitted in the ICU(61.6% in compare to 38.4% females) among the total ICUadmissions within a year. For hemoglobin percentage inplanned admissions and in unplanned admission was notsignificant with P-value of<0.001. The average duration ofanaesthesia is more in planned admissions of total postoperative ICU admissions. This was not significant with P-valueof< 0.001. In planned admission to ICU, males are 47.2%,females 29.0%, in unplanned admissions male are 14.4%,female 8.8 % and in emergency condition males are 0.0%,females 0.6%. This was significant with P-value of>0.001. Thepost-operative Oxygen desaturation was not significant with Pvalue of <0.001. The post-operative admissions were notsignificant with P-value of <0.001. The total post-operative ICUadmissions were able to sustain head for more than 5 sec. Thiswas not significant with P-value of <0.001. The post-operativeICU admissions had hypotension was not significant with Pvalue of <0.001. In post-operative ICU admissions, tachycardiain was not significant with P-value of <0.001. Maximum numberof hospital stay was 2-4 days of total post-operative ICUadmissions. And minimum days for ICU stay was > 7 days Thiswas significant with P-value of >0.001.Conclusion: It was observed that the unplanned admission toICU rates in thiscentre was 0.40%. The predominant reasonsfor unplanned post-operative admissions to ICU were intraoperative complications. Nearly 50% of admissions were purelyfor monitoring and observation. Early recognition ofcomplications, timely intervention and timely intensive care andmonitoring are essential to improve outcomes.

Post Surgical Cutaneous Nocardiosis Mimicking Hypertrophic Scar: A Case Report

@#Nocardia species are gram-positive, aerobic, acid-fast bacteria which exist as saprophytes in nature. Invasive disseminated infections are particularly common in immunocompromised or debilitated hosts. Superficial infections with Nocardia species occur as a result of local trauma and contamination of the wound. Clinically, it may manifest as an acute infection (abscesses or cellulitis), mycetoma, or sporotrichoid infection. Herein we report a rare case of cutaneous nocardiosis following surgery mimicking a hypertrophic scar.

Contaminación bacteriana de cámara anterior durante la cirugía de catarata / Anterior chamber bacterial contamination during cataract surgery

RESUMEN Objetivo: Determinar la existencia de contaminación bacteriana en cámara anterior durante la cirugía de catarata. Métodos: Se realizó un estudio transversal de serie de casos, en el cual participaron los pacientes sometidos a cirugía de catarata en el Servicio de Microcirugía Ocular del Instituto Cubano de Oftalmología Ramón Pando Ferrer, en el período comprendido de enero del año 2015 a diciembre 2016. Se relacionaron los antecedentes patológicos personales oculares y sistémicos, los factores de riesgo asociados y las complicaciones transoperatorias con la presencia de bacterias en la cámara anterior al final de la cirugía. Los pacientes fueron seleccionados aleatoriamente en el salón de cirugía. La muestra quedó constituida por 200 pacientes y divididos en tres grupos dependiendo de la experiencia de los cirujanos. Resultados: Al inicio del proceder quirúrgico, el 100 por ciento de los cultivos fueron negativos, mientras que al final de la cirugía se detectó crecimiento bacteriano en el 3 por ciento. Los gérmenes Gram positivos fueron los de mayor frecuencia (66,6 por ciento) donde el Staphylococcus epidermidis se aisló en un 50 por ciento de los casos. No existió relación significativa entre antecedentes patológicos personales oculares, sistémicos y los factores de riesgo asociados. La ruptura de la cápsula posterior fue la complicación transoperatoria más frecuente y al 4,7 por ciento se le detectó crecimiento bacteriano. Conclusión: Se detecta una baja frecuencia de contaminación de la cámara anterior al final de la cirugía de catarata y los gérmenes comúnmente encontrados están relacionados con la microbiota de la superficie ocular(AU)

ABSTRACT Objective: Determine the presence of anterior chamber bacterial contamination during cataract surgery. Methods: A cross-sectional case-series study was conducted of patients undergoing cataract surgery at the Ocular Microsurgery Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from January 2015 to December 2016. Personal ocular and systemic pathological antecedents, associated risk factors and perioperative complications, were related to the presence of anterior chamber bacterial contamination at the end of surgery. Patients were randomly selected in the operating room. The sample was composed of 200 patients, who were divided into three groups according to the surgeons' experience. Results: At the start of the surgical procedure, 100 percent of the cultures were negative, whereas at the end 3 percent bacterial growth was detected. Gram-positive germs were the most common (66.6 percent), with Staphylococcus epidermidis isolated in 50 percent of the cases. No significant relationship was found between personal ocular or systemic pathological antecedents and associated risk factors. Posterior capsule rupture was the most frequent intraoperative complication, with 4.7 percent bacterial growth detected. Conclusion: Low frequency of anterior chamber contamination was detected at the end of cataract surgery, and the germs commonly found are related to the ocular surface microbiota(AU)

Post-surgical atypical mycobacteriosis in 125 patients in Rio de Janeiro

Abstract INTRODUCTION: The growing incidence of post-surgical atypical mycobacteriosis (PSAM) may be related to the increased use of low- and medium-complexity video-assisted surgery. METHODS: Between April 2007 and June 2009, 125 patients were referred from the State Health Department of Rio de Janeiro for the treatment of confirmed, probable, or suspected PSAM. RESULTS: Laparoscopic cholecystectomy was the most frequent surgical procedure (48.8%) among patients. Clarithromycin, ethambutol, and terizidone were used to treat 113 patients for a mean duration of 226 days. CONCLUSIONS: Despite the need for multidrug therapy and long treatment duration, most included patients adhered to treatment and experienced cure without relapse.

Diagnóstico clínico, ultrasonográfico y citohistológico del carcinoma diferenciado del tiroides / Clinical, ultrasonographic and cytohistological diagnosis of differentiated thyroid carcinoma

Introducción: el carcinoma diferenciado del tiroides representa la neoplasia maligna más frecuente en Endocrinología. Su presentación clínica y su diagnóstico se han modificado gracias a la disponibilidad de herramientas diagnósticas, tales como, el ultrasonido tiroideo y la biopsia aspirativa con aguja fina. Objetivos: describir las características clínicas, ultrasonográficas y citohistológicas de los pacientes intervenidos quirúrgicamente por enfermedad tiroidea maligna, y evaluar en ellos la prevalencia de hipocalcemia crónica y el valor de la hormona estimulante del tiroides. Métodos: se realizó un estudio descriptivo retrospectivo, en el cual se revisaron los informes consecutivos de Anatomía Patológica de todos los pacientes intervenidos quirúrgicamente por enfermedad tiroidea nodular en el Hospital General Provincial Camilo Cienfuegos en el periodo comprendido de enero de 2012 a diciembre 2014. La muestra estuvo conformada por 118 historias clínicas de pacientes operados por enfermedad tiroidea nodular que reunieron los criterios siguientes: datos clínicos, resultados según los criterios de Bethesda de la punción aspirativa con aguja fina, del ultrasonido del tiroides y la biopsia. A estos pacientes se les citó para una evaluación clínica y se les determinó en ayunas, la hormona estimulante del tiroides y en 2 días diferentes, la calcemia. Los pacientes fueron clasificados en portadores de: enfermedad tiroidea maligna (n= 39) y enfermedad tiroidea benigna (n= 79). Resultados: clínicamente solo el 15,4 por ciento de los pacientes con enfermedad tiroidea maligna presentaron dolor o molestia espontánea y/o a la palpación de la glándula del tiroides. La enfermedad tiroidea maligna se diagnosticó en todas las categorías del citodiagnóstico: I: 1/1 (100 por ciento), II: 8/83 (9,6 pòr ciento), III: 4/6 (66,7 por ciento), IV: 2/2 (100 por ciento), V: 18/20 (90 por ciento), VI: 6/6 (100 por ciento). El carcinoma papilar representó la neoplasia más frecuentemente diagnosticada (37/39 pacientes), el 33,3 por ciento de estos enfermos mostraron cifras de hormona estimulante del tiroides por encima de 2,0 mU/L, y hubo un 46,15 por ciento de hipocalcemia crónica. Conclusiones: el carcinoma papilar fue la neoplasia más frecuentemente diagnosticada en los pacientes operados por enfermedad tiroidea maligna. La mayoría de estos pacientes tuvieron un comportamiento subclínico, un tercio de valores no óptimos de la hormona estimulante del tiroides y una prevalencia alta de hipocalcemia crónica(AU)

ntroduction: differentiated thyroid carcinoma represents the most frequent malignant neoplasia in Endocrinology. Its clinical presentation and diagnosis have been modified thanks to the availability of diagnostic tools, such as thyroid ultrasound and fine needle aspiration biopsy. Objectives: to describe the clinical, ultrasonographic and cytohistological characteristics of patients undergoing surgery for malignant thyroid disease, and to evaluate in them the prevalence of chronic hypocalcemia and the value of the thyroid´s stimulating hormone. Methods: a retrospective descriptive study was carried out, in which consecutive reports of Pathological Anatomy of all patients surgically treated for nodular thyroid disease at Camilo Cienfuegos Provincial General Hospital in the period from January 2012 to December 2014 were reviewed. The sample consisted of 118 medical records of patients operated on for nodular-thyroid disease that met the following criteria: clinical data, results according to the Bethesda criteria of fine needle aspiration, thyroid ultrasound and biopsy. These patients were called for a clinical evaluation and they were indicated to be fasting. The patients were classified into carriers of: ETM (n=. 39) and benign thyroid disease (n= 79). Results: in clinical terms, only 15.4 percent of the patients with malignant thyroid disease presented spontaneous pain or discomfort, and / or during palpation of the thyroid glands. Malignant thyroid disease was diagnosed in all categories of cytodiagnosis: I: 1/1 (100 percent), II: 8/83 (9.6 percent), III: 4/6 (66.7 percent), IV: 2/2 (100 percent), V: 18/20 (90 percent), VI: 6/6 (100 percent). Papillary carcinoma represented the most frequently diagnosed neoplasm (37/39 patients); 33.3 percent of these patients showed thyroid stimulating hormone levels above 2.0 mU / L, and there was 46.15 percent of chronic hypocalcemia. Conclusions: papillary carcinoma was the most frequently diagnosed neoplasm in patients operated of malignant thyroid disease. The majority of these patients had a subclinical behavior, a third of non-optimal values of the thyroid stimulating hormone and a high prevalence of chronic hypocalcemia(AU)

Satisfacción de las pacientes y síntomas pélvicos posterior a colpocleisis / Patient's satisfaction and pelvic symptoms after colpocleisis technique

La colpocleisis como técnica obliterante se va realizando desde el año 1823 y se ofrece como alternativa para tratamiento quirúrgico de prolapso tipo III y IV a pacientes sin deseo de vida sexual y con riesgos de morbilidad transquirúrgica. No existe mucha evidencia del grado de satisfacción post-quirúrgica de las pacientes Objetivo: determinar el grado de satisfacción de las pacientes sometidas a colpocleisis y los síntomas pélvicos más frecuentemente encontrados a lo largo del primer año post- quirúrgico. Método: studio transversal no experimental. Se aplicó cuestionario validado de satisfacción post-quirúrgica en pacientes sometidas a colpocleisis durante periodos 2013 a 2014, vía telefónica, dentro de su primer año post-quirúrgico. Se tabularon los datos obtenidos. Resultados: El total de pacientes encuestadas se encontraban entre satisfechas y muy satisfechas e indicaban que volverían a someterse a la cirugía. La edad promedio de las pacientes fue de 76 años. El 50% de las pacientes presentaron incontinencia urinaria de urgencia, 15% incontinencia anal, el restante 35% no presentó ninguna sintomatología. Los síntomas pélvicos se presentaron con más frecuencia en las pacientes con prolapsos tipo IV. Conclusiones: el nivel de satisfacción delas pacientes sometidas a colpocleisis es alto, se puede seguir ofreciendo como alternativa quirúrgica en mujeres sin actividad sexual, la sintomatología pélvica más frecuente fue incontinencia urinaria de urgencia e incontinencia anal, en las pacientes con mayor grado de prolapso.

The colpocleisis as obliterans technique is conducted since 1823 and is offered as an alternative to surgical treatment of prolapse type III and IV patients with no sexual desire for life and morbidity risks transsurgical. There is much evidence of the degree of post-surgical patient satisfaction Objective: to determine the degree of satisfaction of patients undergoing colpocleisis and urinary symptoms most frequently encountered throughout the first year post-surgery Methods:cross-sectional study is not experimental. validated questionnaire post-surgical satisfaction in patients undergoing colpocleisis during periods 2013-2014, by telephone, in his first post-surgical year was applied. The data obtained are tabulated Results: total patients were surveyed between satisfied and very satisfied and indicated they would undergo surgery. The average age of patients was 76 years. 50% of patients had urinary urge incontinence, anal incontinence 15%, 35% showed no symptoms. Patients who had type IV prolapses, presented some pelvic symptoms. Conclusion: The level of satisfaction delas patients undergoing colpocleisis is high, you can continue to offer as surgical alternative for women without sexual activity, the most common pelvic symptoms were urinary urge incontinence and anal incontinence in patients with higher degree of prolapse.

La vida cambia después de la cirugía bariátrica: un estudio cualitativo en pacientes chilenos / Life changes after Bariatric Surgery: a qualitative study about how pre-surgery conditions and time affect life after surgery in Chilean patients

ANTECEDENTES: La cirugía bariátrica (CB) provoca una rápida pérdida de peso y una mejoría en las complicaciones de salud concomitantes de obesidad. Sin embargo, incluso cuando la calidad de vida tiende a mejorar durante los primeros años después de la cirugía, no está claro qué sucede después y cuáles son los cambios que experimentan los pacientes. OBJETIVO: El objetivo de este estudio fue determinar la evolución de la vida después de la cirugía bariátrica en diferentes momentos posteriores a la cirugía y determinar los factores preoperatorios que afectan la calidad de vida después. MÉTODO: Las cinco mujeres que participaron se ofrecieron voluntariamente para formar parte del estudio. Se utilizaron métodos cualitativos de investigación (entrevistas en profundidad) para identificar cómo cambió la vida de las participantes luego de la cirugía y cuáles fueron los principales inconvenientes a los que se vieron enfrentadas. Los datos recopilados fueron analizados mediante Análisis de Contenido. RESULTADOS Y CONCLUSIÓN: La cirugía bariátrica permite a las personas obesas mejorar su salud y calidad de vida en corto tiempo, pero experimentando más dificultades en términos de bienestar psicológico, social y sexual. Por ello se recomienda evaluar y abordar los aspectos psicológicos y nutricionales antes de la cirugía para asegurar un mejor resultado post-quirúrgico.

BACKGROUND: Bariatric surgery causing rapid weight loss and an improvement in the concomitant health complications of obesity. However, even when quality of life tends to improve during the first few years after surgery, it is unclear what happens next and what changes patients experience. OBJECTIVE: The objective of this study was to determine the evolution of life after bariatric surgery in different moments after surgery and to determine the preoperative factors that affect the quality of life afterwards. METHOD: The five women who participated volunteered to be part of the study. Qualitative research methods (in-depth interviews) were used to identify how the participants' lives changed after surgery and what were the major drawbacks they faced. The data collected were analyzed using Content Analysis. RESULTS AND CONCLUSION: Bariatric surgery allows obese people to improve their health and quality of life in a short time, but experiencing more difficulties in terms of psychological, social and sexual well-being. However, it is recommended to evaluate and address the psychological and nutritional aspects prior to surgery to ensure a better post-surgical outcome.