Cumplimiento de las recomendaciones de la guía clínica ministerial para diabetes mellitus tipo 1 en un centro de nivel secundario / Compliance with the recommendations of the ministerial guideline for type 1 diabetes mellitus in a center of secondary level

Introduction: diabetes mellitus type 1 (DM1) is incorporated into the Law of Universal Access with Explicit Guarantees (AUGE) and the Ministry of Health issued a clinical guideline. There is an association between compliance with clinical guidelines and health outcomes. Metabolic control reduces the risk of vascular complications. Objective: To describe the implementation of the guidelines for DM1 AUGE 2013, in patients treated in the endocrinological adult polyclinic hospital Carlos Van Buren. Methods: observational, descriptive and cross-sectional study. A simple random sampling was performed. A sample size of 139 patients was calculated. Quality indicators was drawn up to determine compliance with the recommendations. Quantitative variables were described with median and interquartile range (IQR), and qualitative, with absolute frequency and percentages. Results: Age had a median of 30 years (interquartile range 22 to 42 years). The time since diagnosis had a median of 14 years (interquartile range of 9-22 years). 61 patients were female (43.9 percent) sex. The recommendation was greater proportion of compliance scheme using intensified insulin (89.9 percent). Conducting an annual foot exam showed the lowest compliance (3.6 percent). Discussion: There are no similar studies on these guidelines. It is concerned about the low implementation of the recommendations, especially therapeutic goals. Among the limitations is the quality of the registration system and the systematic omission of variables. It is necessary to determine the cause of low compliance with recommendations for action.

Estruma ovarii maligno / Malignant struma ovarii

The Malignant Struma ovarii (SO) is a thyroid carcinoma generated in a mature teratoma, constitutes 0.8-3percent of ovarian tumors. Then, two cases will be reviewed. Case 1: 46 year old woman with no known morbid consulted for right iliac fossa pain requiring exploratory laparotomy with findings of an ovarian tumor, the biopsy reported mature ovarian teratoma SO type microfocus papillary thyroid carcinoma. Case 2: 59 year old female with a history of dyslipidemia and knee osteoarthritis in controls in gynecology since 2010 on the right adnexal mass of cystic type of 5x3 cm. The study showed only free fluid dissemination ovarian, oofectomía bilateral was performed and biopsy showed minimally invasive follicular carcinoma (2.8 cm) developed by SO, serosa without invasion of the ovary. Is derived of endocrinology and the study showed: thyroid stimulating hormone (TSH) 3.3 uIU/ ml; Peroxidase antibody (anti-TPO) and thyroglobulin antibody (antiTG) negative. Ultrasonography exhibited thyroid nodule of 0.8 x 0.6 cm, hipovascularizado with normal thyroid cintigraphy and cytology negative for neoplastic cells in fine needle aspiration (FNA). Discussion: It’s a rare condition, which requires a multidisciplinary approach to treatment...

Análisis de las complicaciones de la anastomosis ileo-cólica grapada: técnica de Barcelona / Assessment of mechanical ileocolic anastomosis using Barcelona technique

Background: Mechanical ileocolic anastomosis for bowel reconstruction after a right hemicolectomy, using Barcelona technique, is a simple technique that requires two loads of the stapler for excision and anastomosis. This technique reduces costs in terms of instrument use and operative time. Aim: To analyze the results of mechanical sutures using Barcelona technique, after a right hemicolectomy. Material and Methods: Review of medical records of 74 consecutive patients aged 21 to 92 years (38 females) subjected to right hemicolectomy and ileo-tranverse anastomosis, using Barcelona technique. Results: Two patients had an anastomotic leak and one had a wound infection. No patient died. The mean operative time was 105 minutes and the hospital stay ranged from six to 10 days. Conclusions: Barcelona technique is easy, had a low incidence of complications and reduced the costs of mechanical ileocolic anastomosis.

La introducción de la sutura mecánica en las anastomosis gastro-intestinales, ha permitido la realización de éstas, en forma más rápida, segura y con mínima contaminación local. La incidencia de complicaciones tales como dehiscencia, infección y fístula, son bajas, siendo la hemorragia post operatoria leve y autocontrolada, algo más frecuente. Uno de los principales factores limitantes del uso de las suturas mecánicas, es el costo; por eso la utilización de la técnica de Barcelona en la anastomosis íleo-cólica, que permite el ahorro de un stapler, se compara más favorablemente de este punto de vista, con las técnicas manuales. En este trabajo se analizan las complicaciones de la sutura mecánica en 74 pacientes consecutivos sometidos a hemicolectomía derecha con técnica de Barcelona, entre enero de 2000 y diciembre de 2006 en el Hospital Naval Almirante Nef de Viña del Mar. Hubo un 4,5 por ciento de complicaciones, correspondientes a 2 dehiscencias y 1 infección de la herida operatoria. No hubo complicaciones intraoperatorias ni mortalidad relacionadas con la técnica. La duración promedio del acto operatorio fue de 105,39 minutos y la moda de estadía fue de 6 a 10 días. La técnica de Barcelona es sencilla y segura y, en ésta experiencia, con baja morbilidad, sin mortalidad y con menor costo que las técnicas habituales.