Gastrectomía totalmente laparoscópica por neoplasias gástricas: Experiencia en un centro público / Totally laparoscopic gastrectomy for the treatment of gastric tumors

Background: The laparoscopic approach for the treatment of gastric tumors has many advantages. Aim: To evaluate the results of a laparoscopic gastrectomy program developed in a public hospital. Patients and Methods: Retrospective review of epidemiological, perioperative and follow-up data of patients who were treated with a laparoscopic gastrectomy due to gastric tumors between 2006 and 2013. A totally laparoscopic technique was used for all cases. Complications were evaluated according to the Clavien-Dindo classification. Results: Fifty one patients, aged 65 (36-85) years, underwent a laparoscopic gastrectomy. In 22 patients a total gastrectomy was performed. Conversion rate to open surgery was 8%. Operative time was 330 (90-500) min and bleeding was 200 (20-500) ml. Median hospital stay was 7 (3-37) days. Postoperative morbidity was present in 17 (33%) patients, 3 (6%) patients had complications grade 3 or higher and one patient died (1.9%). Tumor pathology was adenocarcinoma in 39 patients. A complete resection was achieved in 97%. Twenty nine patients (74%) with gastric adenocarcinoma had early gastric cancer and 84% of patients were in stage one. Median lymph node count was 24. Median follow-up was 26 (1-91) months. There was no cancer related mortality among patients subjected to a curative resection. Overall survival for patients with adenocarcinoma was 92% at 3 years. Conclusions: This study supports the feasibility and safety of a laparoscopic gastrectomy program in a public hospital; with low morbidity, adequate lymph node dissection and long-term survival. This approach must be considered an option for selected patients with gastric cancer.

Lipoma gástrico gigante sintomático tratado con gastrectomía subtotal laparoscópica: caso clínico / Gastric lipoma removed by laparoscopic subtotal gastrectomy: Report of one case

Gastric lipoma is a rare benign gastric tumor. We report a 62-year-old man, who presented with abdominal pain, vomiting and weight loss. An upper gastrointestinal endoscopy showed a gastric antral, submucosal tumor. Abdominal ultrasound and computed tomography revealed a large antral lesion with content of high echogenicity and fat density, measuring 11 x 6 cm. The patient was treated with a laparoscopic distal subtotal gastrectomy, and a Roux-en-Y reconstruction. The patient had no postoperative morbidity, was started on a liquid diet on the third postoperative day and was discharged on the third postoperative day. The pathological study revealed a gastric lipoma with clear margins. This laparoscopic procedure represents a good alternative in the treatment of this benign gastric tumor.

Resultados actuales de la pancreatoduodenectomía para el tratamiento de los tumores periampulares y análisis de factores pronósticos de sobrevida / Results of pancreaticoduodenectomy in the treatment of periampullary tumors

Background: The diagnosis and treatment of periampullary tumors represents a challenge for current medicine. Aim: To review the results of pancreaticoduodenectomy (PDD) in the treatment of periampullary tumors and to identify risk factors that impact the long-term survival. Patients and Methods: We performed a retrospective study of patients who underwent a PDD for periampullary tumors between 1993 and 2009. We reviewed perioperative results and long term survival. We performed a multivariate analysis for long-term survival. Results: A PDD was performed in 181 patients aged 58 ± 12 years (98 females). Piloric preservation was done in 53 percent and a pancreatogastric anastomosis was used in 94 percent of cases. Morbidity was 62 percent and postoperative mortality was 5.5 percent. Pancreatic cancer was the most frequent pathological finding in 41 percent, followed by ampullary cancer in 28 percent and distal bile duct cancer in 16 percent. Median survival was 17 months, with a five years survival of 24 percent. Survival for ampullary tumors was 28 months with a five years survival of 32 percent. The median and five years survival were 14 months and 16 percent for bile duct cancer and 11 months and 14 percent for pancreatic cancer. Multivariate analysis identified tumor type (pancreas /bile duct) and lymph node dissemination as independent predictors of mortality. Conclusions: One quarter of patients experienced long term survival. Mortality predictors were tumor type and lymph node dissemination.

Características y riesgo de las personas con diabetes y EPOC registrados en las empresas sociales del Estado de la red pública del departamento de Risaralda, durante el período comprendido entre el primero de julio 2002 al 30 de junio del 2005 / Characteristic and Risks of People with diabetes and Chronic Obstructive Pulmonary Disease Registered in the Public Network of Social Services of the Department of Risaralda from July 2002 to June 30, 2005

La Diabetes Mellitus y la Enfermedad Pulmonar Obstructiva Crónica, EPOC, hacen parte de las patologías que clásicamente se han definido como degenerativas y crónicas. La mortalidad en Risaralda reporta la EPOC sistemáticamente entre las tres primeras causas de defunción en la serie desde 1997. La tendencia es al descenso y aunque que la mortalidad por Diabetes Mellitus parece tener una tendencia al descenso, en el último año presenta alza en las tasas de mortalidad. A pesar que existe un sistema de información de morbilidad y mortalidad para la Secretaría Departamental de Salud de Risaralda, no son suficientes las políticas de promoción de la salud con la información reportada por los certificados de defunción, al punto que actualmente se desconocen las características de los factores de riesgo de las personas con diagnóstico de DIABETES y/o EPOC, registrados en las Empresas Sociales del Estado de la red pública del departamento Risaralda.

Seguimiento normas de bioseguridad personal auxiliar de enfermería servicio de urgencias E.S.E. Hospital de Santa Mónica. Dosquebradas

El presente trabajo pretende identificar la aplicación de las Normas de Bioseguridad en los procedimientos realizados en el servicio de Urgencias de la E.S.E. Hospital Santa Mónica de Dosquebradas, por parte del personal auxiliar de enfermería, durante el período comprendido entre el 23 de junio y el 5 de agosto de 2005. En un primer momento se verificó mediante la observación directa, el cumplimiento de dichas normas de bioseguridad en el personal auxiliar de enfermería, obteniendo los siguientes resultados: el 30 por cien del personal no utiliza la blusa de bioseguridad, ni manipula adecuadamente la ropa contaminada; el 40 por cien no realiza el lavado de manos antes, durante y después de la administración de medicamentos; el 20 por cien maneja inadecuadamente las jeringas y el 40 por cien no aplica la norma establecida al manejar equipos de oxigenoterapia. Con base en los resultados obtenidos se diseñó un folleto y se realizó una intervención educativa con el personal evaluado, haciéndose seguimiento posterior de las actividades realizadas en el servicio de urgencias.