Fístula enterocutánea: un enfoque desde las generalidades y el estado nutricional / Enterocutaneous fistula: An approach based on generalities and nutritional status

Introducción. Una fístula es una conexión anormal entre dos superficies epitelizadas. Cerca del 80 % de las fístulas entero-cutáneas son de origen iatrogénico secundarias a cirugía, y un menor porcentaje se relacionan con traumatismos, malignidad, enfermedad inflamatoria intestinal o isquemia. La morbilidad y las complicaciones asociadas pueden ser significativas, como la desnutrición, en la que intervienen múltiples factores. Métodos. Se realizó una búsqueda de la literatura en las bases de datos de PubMed, Google Scholar y SciELO, utilizando las palabras claves descritas y se seleccionaron los artículos más relevantes de los últimos años. Resultados. La clasificación de las fístulas se basa en su anatomía, su gasto o secreción diaria y su localización. Existe una tríada clásica de las complicaciones: sepsis, desnutrición y anomalías electrolíticas. El control del gasto de la fístula, el drenaje adecuado de las colecciones y la terapia antibiótica son claves en el manejo precoz de estos pacientes. Los estudios recientes hacen hincapié en que la sepsis asociada con la desnutrición son las principales causas de mortalidad. Conclusiones. Esta condición representa una de las complicaciones de más difícil y prolongado tratamiento en cirugía abdominal y colorrectal, y se relaciona con importantes tasas de morbilidad, mortalidad y altos costos para el sistema de salud. Es necesario un tratamiento multidisciplinario basado en la reanimación con líquidos, el control de la sepsis, el soporte nutricional y el cuidado de la herida, entre otros factores.

Introduction. A fistula is an abnormal connection between two epithelialized surfaces. About 80% of enterocutaneous fistulas are of iatrogenic origin secondary to surgery, and a smaller percentage are related to trauma, malignancy, inflammatory bowel disease or ischemia. The associated morbidity and complications can be significant, such as malnutrition, in which multiple factors intervene. Methods. A literature search was carried out in the PubMed, Google Scholar and SciELO databases using the keywords described and the most relevant articles from recent years were selected. Results. The classification of fistulas is based on their anatomy, their daily secretion output, and their location. There is a classic triad of complications: sepsis, malnutrition and electrolyte abnormalities. Control of fistula output, adequate drainage of the collections and antibiotic therapy are key to the early management of these patients. Recent studies emphasize that sepsis associated with malnutrition are the main causes of mortality. Conclusions. This condition represents one of the most difficult and prolonged complications to treat in abdominal and colorectal surgery, and is related to significant rates of morbidity, mortality and high costs for the health system. Multidisciplinary treatment based on fluid resuscitation, sepsis control, nutritional support, and wound care, among other factors, is necessary.

What is the applicability of tubal ligation with the vaginal natural orifice transluminal endoscopic surgery technique and its value in patient comfort?

SUMMARY OBJECTIVE: The aim of this study was to observe the feasibility of the tubal/adnexal approach using vaginal natural orifice transluminal endoscopic surgery and compare its contribution with surgeon ergonomics and postoperative patient comfort with that of conventional laparoscopy. METHODS: We completed this study retrospectively with 47 patients. Patients were followed at their postoperative first month. We analyzed the usability of the vaginal natural orifice transluminal endoscopic surgery method over conventional laparoscopy by comparing the demographics, surgical data, and postoperative findings collected between the two groups. RESULTS: Patients in the conventional laparoscopy group were older (39.1±3.3 years) than those in the vaginal natural orifice transluminal endoscopic surgery patient group (p=0.005). Pain intensity 24 h after surgery was lower in the vaginal natural orifice transluminal endoscopic surgery group (p=0.003), while sexual function and dyspareunia did not differ between the two groups in the first month. Patients in the vaginal natural orifice transluminal endoscopic surgery group were more relieved about painlessness and the comfort it brought than the conventional laparoscopy group (p=0.027, χ2=12.56). CONCLUSION: Patients subjected to the vaginal natural orifice transluminal endoscopic surgery procedure showed higher levels of satisfaction, less postoperative pain, and greater comfort than those subjected to conventional laparoscopy.

Bentall-De Bono Reoperation Associated With Pseudoaneurysm and Infectious Endocarditis

Abstract We present the case of a 55-year-old patient who underwent the Bentall-De Bono procedure with mechanical prosthesis in 2005 and was admitted to the emergency department in July 2020 with mixed shock. Complementary exams showed an abscess involving the prosthetic tube, two thirds of the aortic valve circumference and the left ventricle, with a neocavity of about 45 mm in diameter from the aortic sinus to the ascending aorta. The patient underwent surgical repair, with a new procedure using the Bentall-De Bono technique, now associated with coronary artery bypass grafting with a great saphenous vein graft between the aorta and the anterior descending artery. Culture of samples collected intraoperatively showed Staphylococcus epidermidis. The patient received antibiotic therapy for 30 days, evolving favorably, and is under regular outpatient follow-up.

COVID-19 Impact on Operative Management of Pediatric Neck Abscesses

Abstract Introduction For multiple reasons, elective pediatric otolaryngology surgical procedures have declined during the COVID-19 pandemic. Objective The purpose of the present study was to assess whether the prevalence of pediatric neck abscesses managed with operative drainage decreased compared with previous years. Methods Medical records of all pediatric cases at a tertiary care children's hospital diagnosed with abscess of the neck and treated with incision and drainage were evaluated between the dates of April 1 and November 30 from 2015 to 2020. Outcomes were compared for each year from 2015 to 2019 to 2020, which included location, abscess size, duration of antibiotic treatment, microbiology, and the number of cases per year. Results A total of 201 cases were included. The mean ± standard deviation (SD) presenting age in the 2015 to 2019 group was 5.05 ± 5.03 years old and 2.24 ± 1.91 years old in the 2020 group. The mean number of cases between 2015 and 2019 was 35.6 ± 4.2, whereas the number of cases in 2020 was 23 (p = 0.002). Of those patients who underwent IV antibiotic therapy prior to presentation (n = 43), the mean number of days before admission was 1.98 ± 2.95 (n = 40) from 2015 to 2019 and 12.00 ± 10.39 (n = 3) in 2020 (p = 0.008). The percent of cases with multiple strains cultured between 2015 and 2019 was 13.4% versus 18.2% in 2020 (p = 0.007). Conclusion There was a decrease in the number of operative neck abscesses in 2020 compared with the mean number per year from 2015 to 2019. COVID-19 mitigation strategies leading to reduced transmission of other viral and bacterial illnesses and a tendency toward prolonged medical management to avoid surgery are two possible explanations.

The cemented double mobility cup in hip revision: different possibilities of use / Acetábulo cimentado de dupla mobilidade em revisão de quadril: distintas possibilidades de uso

ABSTRACT Introduction: The aim of our work is to review those patients who underwent prosthetic hip revision surgery in our hospital considered to be patients at high risk of dislocation or recurrent dislocation, and who underwent a double mobility cemented cup (CMD). Analyzing the different ways to place these cups and the clinical results and reluxations. Material and methods: The 69 cases comprised 34 men and 35 women with a mean age of 77,39 years. The mean follow-up was 4.7536 years. The type of intervention performed varied according to the cause of the intervention, the acetabular bone stock and the state of the primary cup. In the cases in which there was a good fixation of the primary metalback, we opted to carry out a cementation of the cemented DMC into the existing well-fixed metal acetabular shell, this occurred in 23 cases. In the cases where there was loosening of the primary cup but there was a good bone stock, a CMD was cemented into the bone (21 cases). In the cases where there was a Paprosky type III we cemented a DMC to a Bursch-Schneider reinforcement ring together with the placement of a cancellous bone graft (25 cases). Results: The clinical evaluation at the end of the follow-up, according to the MD Scale, showed the mean value was 16.454 (SD 0.79472), with a survival at the end of the follow-up of 100% of the placed DMC. Conclusion: The use of cemented DMC is a good solution in the replacement of THA, especially in cases of reluxation or risk of dislocation due to personal or technical predisposing factors. The use of these DMC cemented can be directly to the bone, into the existing well-fixed metal Shell, or cemented to a reinforcing ring, depending on the acetabular defect. Evidence Level III; Comparative Case Series.

RESUMO Introdução: Revisar os pacientes que foram submetidos à cirurgia de revisão protética de quadril neste hospital, considerados como pacientes com alto risco de luxação ou luxação recorrente, submetidos a cirurgia por acetábulo cimentado de dupla mobilidade (CMD). Analisando as diferentes formas de posicionamento desses copos, seus resultados clínicos e reluxações. Material e métodos: Os 69 casos correspondiam a 34 homens e 35 mulheres com uma idade média de 77,39 anos. O tempo médio de acompanhamento foi de 4,7536 anos. O tipo de intervenção realizada variou de acordo com a causa da intervenção, o estoque ósseo acetabular e o estado do copo primário. Nos casos em que houve uma boa fixação do metal primário, optouse por realizar uma cimentação do DMC cimentado na cúpula acetabular metálica firme existente, o que ocorreu em 23 casos. Nos casos em que houve um afrouxamento acetabular primário com um bom estoque ósseo disponível, cimentou-se um CMD (21 caixas). Nos casos em que havia um Paprosky tipo III, cimentou-se um DMC a um anel de reforço Bursch-Schneider juntamente com a colocação de um enxerto ósseo esponjoso (25 caixas). Resultados: A avaliação clínica realizada no final do acompanhamento, de acordo com a Escala MD, mostrou que o valor médio foi de 16,454 (DP 0,79472), com uma sobrevivência ao final do acompanhamento de 100% do DMC inserido. Conclusão: O uso do DMC cimentado pode ser uma boa solução para substituição do THA, especialmente em casos de reluxação ou risco de deslo-camento devido a fatores de predisposição pessoais ou técnicos. O uso destes DMC cimentados pode ser realizado diretamente ao osso, dentro da cúpula metálica fixa existente, ou cimentados a um anel de reforço, dependendo do defeito acetabular. Nível de Evidência III; Série de Casos Comparativos.

Reinternações não planejadas após cirurgias em um hospital do norte do Brasil: coorte prospectiva / Reingresos no planificados después de la cirugía en un hospital del norte de Brasil: cohorte prospectiva / Unplanned readmissions after surgery in a hospital in northern Brazil: prospective cohort

Objetivo:analisar as reinternaçõesnão planejadas após procedimentos cirúrgicos e seus fatores de risco em um hospital de grande porte no Norte do Brasil. Método:coorte prospectiva, com dados coletados de prontuários e à cabeceira do leito. Foram realizadas análises descritivas, análise bivariada e múltipla por meio da regressão de Poisson no Stata® v.16.0. Resultados:do total de 486 pacientes, 1,47% reinternaram. A incidência de reinternação foi 68 a cada 1.000 procedimentos (IC95%: 47,10; 93,85). Na análise ajustada apresentaram-se comofatores de risco não ser branco (RR: 2,06; IC95% 1,13; 3,75), usar implante na cirurgia (RR: 2,00; IC95%: 1,05; 3,81) e procedimentos das especialidades urologia/renal (RR: 3,17; IC95%:1,59-6,31) e ginecologia (RR: 2,18; IC95%:1,06-4,49). Conclusão:a incidência de reinternação nesta região é maior do que outras regiões. Características demográficas e tipo de procedimento cirúrgico foram fatores de risco para o desfecho

Objective:to analyze unplanned readmissions after surgical procedures and their risk factors in a large hospital in Northern Brazil. Method:prospective cohort, with data collected from medical records and at the bedside. Descriptive, bivariate and multiple analysis were performed using Poisson regression in Stata® v.16.0. Results: of the total of 486 patients, 1.47% were readmitted. The incidence of readmissions was 68 per 1,000 procedures (95%CI: 47.10; 93.85). In the adjusted analysis, the risk factors were not being white (RR: 2.06; 95%CI 1.13; 3.75), using implants in surgery (RR: 2.00; 95%CI: 1.05; 3.81) and procedures of the urology/renal specialties (RR: 3.17; 95%CI: 1.59-6.31) and gynecology (RR: 2.18; 95%CI: 1.06-4.49). Conclusion:the incidence of readmissions in this region is higher than in other regions. Demographic characteristics and type of surgical procedure were risk factors for the outcome

Objetivo:analizar los reingresos no planificados después de procedimientos quirúrgicos y sus factores de riesgo en un gran hospital del norte de Brasil. Método:cohorte prospectiva, con datos recolectados de historias clínicas y al lado de la cama. Se realizaron análisis descriptivos, bivariados y múltiples mediante regresión de Poisson en Stata® v.16.0. Resultados:del total de 486 pacientes, el 1,47% reingresó. La incidencia de reingresos fue de 68 por 1.000 procedimientos (IC del 95%: 47,10; 93,85). En el análisis ajustado, los factores de riesgo fueron no ser blanco (RR: 2,06; IC 95% 1,13; 3,75), uso de implantes en cirugía (RR: 2,00; IC 95%: 1,05; 3,81) y procedimientos de la urología/especialidades renales (RR: 3,17; IC 95%: 1,59-6,31) y ginecología (RR: 2,18; IC 95%: 1,06-4,49). Conclusión: la incidencia de reingresos en esta región es mayor que en otras regiones. Las características demográficas y el tipo de procedimiento quirúrgico fueron factores de riesgo para el resultado

Placenta Accreta Spectrum Prenatal Diagnosis Performance: Are Ultrasound False-positive Results Acceptable in Limited-resources Settings? / Desempenho do diagnóstico pré-natal do espectro da placenta acreta: Os resultados falso-positivos do ultrassom são aceitáveis em ambientes com recursos limitados?

Abstract Objective The immediate referral of patients with risk factors for placenta accreta spectrum (PAS) to specialized centers is recommended, thus favoring an early diagnosis and an interdisciplinary management. However, diagnostic errors are frequent, even in referral centers (RCs). We sought to evaluate the performance of the prenatal diagnosis for PAS in a Latin American hospital. Methods A retrospective descriptive study including patients referred due to the suspicion of PAS was conducted. Data from the prenatal imaging studies were compared with the final diagnoses (intraoperative and/or histological). Results A total of 162 patients were included in the present study. The median gestational age at the time of the first PAS suspicious ultrasound was 29 weeks, but patients arrived at the PAS RC at 34 weeks. The frequency of false-positive results at referring hospitals was 68.5%. Sixty-nine patients underwent surgery based on the suspicion of PAS at 35 weeks, and there was a 28.9% false-positive rate at the RC. In 93 patients, the diagnosis of PAS was ruled out at the RC, with a 2.1% false-negative frequency. Conclusion The prenatal diagnosis of PAS is better at the RC. However, even in these centers, false-positive results are common; therefore, the intraoperative confirmation of the diagnosis of PAS is essential.

Resumo Objetivo Recomenda-se o encaminhamento imediato de pacientes com fatores de risco para espectro placentário acreta (PAS, na sigla em inglês) para centros especializados, favorecendo assim o diagnóstico precoce e o manejo interdisciplinar. No entanto, erros diagnósticos são frequentes, mesmo em centros de referência (CRs). Buscou-se avaliar o desempenho do diagnóstico pré-natal para PAS em um hospital latino-americano. Métodos Um estudo descritivo retrospectivo incluindo pacientes encaminhados por suspeita de SAP foi realizado. Os dados dos exames de imagem do pré-natal foram comparados com os diagnósticos finais (intraoperatórios e/ou histológicos). Resultados Foram incluídos 162 pacientes no presente estudo. A idade gestacional mediana no momento da primeira ultrassonografia suspeita de PAS foi de 29 semanas, mas as pacientes chegaram ao CR de PAS com 34 semanas. A frequência de resultados falso-positivos nos hospitais de referência foi de 68,5%. Sessenta e nove pacientes foram operadas com base na suspeita de PAS com 35 semanas e houve 28,9% de falso-positivos no CR. Em 93 pacientes, o diagnóstico de PAS foi descartado no CR, com frequência de falso-negativos de 2,1%. Conclusão O diagnóstico pré-natal de PAS é melhor no CR. Entretanto, mesmo nestes centros, resultados falso-positivos são comuns; portanto, a confirmação intraoperatória do diagnóstico de SAP é essencial.

Caracterización de las infecciones posoperatorias en un servicio de cirugía general / Characterization of Postoperative Infections in a General Surgery Service

Introducción: Las infecciones del sitio quirúrgico u operatorio constituyen un grave problema sanitario por lo que su prevención y tratamiento representan un reto para las instituciones hospitalarias. Objetivo: Describir las características de las infecciones posoperatorias según las principales causas relacionadas con su aparición. Métodos: Se realizó un estudio descriptivo y observacional con 207 pacientes ingresados y operados de cirugías mayores que presentaron infecciones posoperatorias en el Servicio de Cirugía General del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba, durante 2018-2020. Resultados: La tasa global de infecciones posquirúrgicas fue de 4,18 pr ciento. Las infecciones incisionales superficiales, seguidas de las profundas fueron las más frecuentes. El número de pacientes infectados se triplicó en los operados con urgencia respecto a los electivos, con predominio de los apendicectomizados. El tiempo quirúrgico y la estadía hospitalaria promedio se elevaron en los pacientes infectados. Fallecieron 12 integrantes de la casuística, atribuible a la infección generalizada y el choque séptico. Conclusiones: La aparición de las infecciones posquirúrgicas se relacionan con factores dependientes del enfermo; de la propia cirugía como es la calificación del cirujano actuante, así como la presencia de factores de riesgos preoperatorios y durante la intervención. La infección incisional superficial es la más frecuente, en tanto que la mayoría de los pacientes que fallecen corresponden a aquellos con infección de órganos y espacios(AU)

Introduction: Surgical (or operative) site infections are a serious health problem, a reason why their prevention and treatment represent a challenge for hospital institutions. Objective: To describe the characteristics of postoperative infections according to the main causes related to their occurrence. Methods: A descriptive and observational study was carried out with 207 patients admitted and operated on in major surgeries who presented postoperative infections in the general surgery service of Saturnino Lora Provincial Teaching Hospital of Santiago de Cuba, during 2018-2020. Results: The overall rate of postoperative infections was 4.18 percent. Superficial incisional infections, followed by deep incisional infections, were the most frequent. The number of infected patients was tripled in those operated on urgently compared to electively, with a predominance of appendectomized patients. Surgical time and average hospital stay were higher in infected patients. 12 members of the casuistics have passed, attributable to generalized infection and septic shock. Conclusions: The occurrence of postoperative infections is related to factors depending on the patient; on the surgery itself, such as the qualification of the surgeon; as well as on the presence of preoperative and intraoperative risk factors. Superficial incisional infection is the most frequent, while most of the patients who die correspond to those with infection of organs and spaces(AU)

Prolapso rectal completo procedimiento de Delorme / Complete rectal prolapse Delorme procedure / Procedimento completo de prolapso retal Delorme

Introducción: el prolapso rectal es una invaginación del recto que produce su exteriorización a través del ano. Se denomina completo cuando está constituido por todo el espesor de la pared rectal. En su incidencia están vinculados factores como el sexo femenino, los pacientes añosos y el parto. Etiopatogenia: es multifactorial, se plantean varias teorías. Entre ellas, un fondo de saco peritoneal recto vaginal o recto vesical anormalmente profundo, la falta de fijación normal del recto a su lecho, la consecuencia de una invaginación idiopática de la parte superior del recto y un estado de relajación y atonía de la musculatura del suelo de la pelvis y del canal anal. Caso Clínico: mujer, 64 años. Prolapso rectal completo por debilidad de la musculatura del piso pélvico y canal anal. Se plantean la valoración diagnóstica y exámenes paraclínicos preoperatorios. Se describe el procedimiento de Delorme como solución técnica a su prolapso rectal. Se destaca que la paciente evolucionó favorablemente. Conclusiones: el objetivo del tratamiento es solucionar el prolapso y restaurar la función anorrectal sin provocar efectos nocivos. El prolapso que presenta esta paciente es multifactorial e incluye el conjunto de las siguientes anomalías, afecta a las mujeres de edad avanzada y multíparas, está exteriorizado permanentemente y forma parte de una enfermedad degenerativa difusa del periné. El mismo fue solucionado según el procedimiento de Delorme. La evolución de la paciente fue satisfactoria, no se objetivaron complicaciones ni recidiva en el post operatorio precoz o alejado.

Introduction: rectal prolapse is an invagination of the rectum that produces its exteriorization through the anus. It is called complete when it is constituted by the whole thickness of the rectal wall. Factors such as female sex, elderly patients and childbirth are linked to its incidence. Etiopathogenesis: it is multifactorial, and several theories have been put forward. Among them, an abnormally deep peritoneal rectal vaginal or rectal vesical fornix, the lack of normal fixation of the rectum to its bed, the consequence of an idiopathic invagination of the upper part of the rectum and a state of relaxation and atony of the muscles of the pelvic floor and the anal canal. Case report: female, 64 years old. Complete rectal prolapse due to weakness of the pelvic floor muscles and anal canal. The diagnostic evaluation and preoperative paraclinical examinations are presented. The Delorme procedure is described as a technical solution to her rectal prolapse. It is emphasized that the patient evolved favorably. Conclusions: The goal of treatment is to resolve the prolapse and restore anorectal function without causing harmful effects. The prolapse presented by this patient is multifactorial and includes all of the following anomalies, affects elderly and multiparous women, is permanently externalized and is part of a diffuse degenerative disease of the perineum. It was solved according to the Delorme procedure. The patient's evolution was satisfactory, no complications or recurrence were observed in the early or distant postoperative period.

Introdução: O prolapso retal é uma invaginação do reto que resulta em sua externalização através do ânus. É chamado completo quando consiste de toda a espessura da parede retal. Fatores como sexo feminino, pacientes mais velhos e parto estão ligados a sua incidência. Aetiopatogênese: é multifatorial, e várias teorias foram apresentadas. Estes incluem um fórnix peritoneal rectovaginal ou retal vesical anormalmente profundo, a falta de fixação normal do reto em seu leito, a conseqüência da invaginação idiopática da parte superior do reto e um estado de relaxamento e atonia dos músculos do assoalho pélvico e do canal anal. Relato de caso: mulher, 64 anos de idade. Prolapso retal completo devido à fraqueza dos músculos do assoalho pélvico e do canal anal. São apresentados a avaliação diagnóstica e os exames paraclínicos pré-operatórios. O procedimento Delorme é descrito como uma solução técnica para seu prolapso retal. Observa-se que o paciente evoluiu favoravelmente. Conclusões: O objetivo do tratamento é resolver o prolapso e restaurar a função anorretal sem causar efeitos nocivos. O prolapso apresentado por esta paciente é multifatorial e inclui todas as seguintes anomalias, afeta mulheres idosas e multíparas, é externalizado permanentemente e faz parte de uma doença degenerativa difusa do períneo. Foi tratado de acordo com o procedimento Delorme. A evolução do paciente foi satisfatória, não foram observadas complicações ou recidivas no período pós-operatório precoce ou distante.

Intervenciones de enfermería en la práctica social para la salud de la persona post-operada por lesión medular / Nursing interventions in social practice for the health of people post-operated by spinal injury

INTRODUCCIÓN: El profesional de enfermería colabora en la prestación de cuidado de la salud de personas que presentan invalidez congénita y adquirida. Las consecuencias asociadas a lesiones medulares no se derivan de la lesión en sí, sino de la falta de efectividad de los servicios de atención médica. OBJETIVO: Identificar intervenciones de enfermería en la práctica social para la salud de la persona posoperada por lesión medular. MÉTODO: Estudio cualitativo, abordaje descriptivo-exploratorio. Paciente posoperado por lesión medular, (Durango, México). Se utilizó la entrevista semiestructurada en el año 2020, a través del análisis de discurso oral. RESULTADOS: Se evidenció, la presencia de barreras sociales, que coartan el pleno desarrollo y participación de la persona con discapacidad por lesión medular en su diario vivir con la familia, comunidad y sociedad. También la autonomía de la persona no sólo se coarta al hecho de realizar tareas o labores o participar con otras personas. Incluso engloba las capacidades de pensar, de decidir por ellos, decidiendo por sí solo y que estas decisiones sean respetadas por los demás. CONCLUSIONES: Se hace necesaria la contribución del profesional de enfermería en las Políticas Públicas en el ámbito local y del país donde se propongan y establezcan, estrategias acordes a la prestación de servicios: atención a la enfermedad, promoción, prevención y rehabilitación incluyéndolo en las actividades y servicios sociales; por otra parte las necesidades de las personas con discapacidades deben considerarse también en las políticas, programas y proyectos desarrollados a nivel local y nacional. Estas personas deben tener acceso a los servicios acostumbrados, sostenidos con servicios especializados para mejorar de esta manera la calidad de vida de la persona con discapacidad.

INTRODUCTION: The nursing professional collaborates in the provision of health care for people with congenital and acquired disabilities. The consequences associated with spinal cord injuries do not derive from the injury itself, but from the lack of effectiveness of medical care services. OBJECTIVE: To identify nursing interventions in social practice for the health of the post-operated person for spinal cord injury. Method: Qualitative study, descriptive-exploratory approach. Postoperative patient for spinal cord injury, (Durango, Mexico). The semi-structured interview was used in the year 2020, using oral discourse analysis. RESULTS: The presence of social barriers was evidenced, which restrict the full development and participation of the person with disabilities due to spinal cord injury in her daily life with the family, community and society. Also the autonomy of the person is not only limited to the fact of carrying out tasks or tasks or participating with other people. It even encompasses the ability to think, to decide for them, deciding for themselves and for these decisions to be respected by others. CONCLUSIONS: The contribution of the nursing professional is necessary in Public Policies at the local level and in the country where strategies according to the provision of services are proposed and established: care for illness, promotion, prevention and rehabilitation, including it in the activities and social services; on the other hand, the needs of people with disabilities must also be considered in the policies, programs and projects developed at the local and national levels. These people must have access to the usual services, supported by specialized services to improve the quality of life of the person with disabilities.

Estrategia de enfermería para disminuir ansiedad del paciente en procedimientos endoscópicos: ensayo clínico aleatorizado

Objetivo: Determinar la efectividad de una intervención de enfermería de acompañamiento significativo estructurado para disminuir la ansiedad en pacientes que van a ser sometidos a una endoscopia digestiva alta en un hospital público, Región del Biobío, Chile. Material y Método: Ensayo clínico aleatorizado, simple ciego, con evaluación por terceros, realizado entre enero y junio de 2021, con una muestra de 126 pacientes. Los instrumentos y parámetros hemodinámicos que midieron variables sociodemográficas, psicológicas, fisiológicas y bioquímicas fueron: Cuestionario sociodemográfico, Cuestionario de ansiedad Estado-Rasgo, Escala Visual Análoga, Frecuencia cardiaca, Presión arterial (PA) sistólica, media y diastólica, Oximetría de pulso, Glicemia y Potasio sanguíneo. La intervención consistió en la presencia visual y táctil de un acompañante significativo, antes, durante y después del procedimiento endoscópico. El análisis de datos con SPSS v.18 consideró estadística descriptiva e inferencial (valor p= 5%) con T-Student y U de Mann-Whitney. Resultados: Edad promedio 52 años, educación media completa, casados y con hijos; hubo diferencias significativas en variables psicológicas (p< 0,05) en las tres etapas, variables fisiológicas (PA media (p= 0,0025) y diastólica (p= 0,0002) intraprocedimiento; PA media (p= 0,0021) y diastólica (p= 0,0021) postprocedimiento, pulso medio o mediano (p< 0,05) en pre (p= 0,0035) y postprocedimiento endoscópico (p= 0,0003)). En la oximetría de pulso y las variables bioquímicas no se advirtieron diferencias significativas. Conclusión: A través del acompañamiento significativo, intervención simple, fácil, bajo costo y no farmacológica, disminuye la ansiedad y riesgo del paciente, se mejora la satisfacción usuaria y la relación equipo de salud/comunidad.

Objective: To determine the effectiveness of a significant structured follow-up nursing intervention to reduce anxiety in patients undergoing upper digestive endoscopy in a public hospital in the Biobío Region, Chile. Material and Method: Randomized, single-blind clinical trial, with evaluation by third parties, carried out between January and June 2021, with a sample consisting of 126 patients. The instruments and hemodynamic parameters that measured sociodemographic, psychological, physiological, and biochemical variables were: Sociodemographic Questionnaire, State-Trait Anxiety Questionnaire, Visual Analog Scale, heart rate, systolic, mean, and diastolic blood pressure (BP), pulse oximetry, glycemia and blood potassium. The intervention consisted of the visual and tactile presence of a significant companion, before, during, and after the endoscopic procedure. Data analysis with SPSS v.18 considered descriptive and inferential statistics (p value= 5%) with T-Student and Mann-Whitney U test. Results: Average age 52 years, completed secondary education, married with children; there were significant differences in psychological variables (p< 0.05) in the three stages, physiological variables (mean (p= 0.0025) and diastolic (p= 0.0002) intra-procedure BP, mean (p= 0.0021) and diastolic (p= 0.0021) post-procedure BP, average or median pulse (p< 0.05) in the pre (p= 0.0035) and post-endoscopic procedures (p= 0.0003). No significant differences were observed in pulse oximetry and biochemical variables. Conclusion: Through significant follow-up, simple, easy, low-cost and non-pharmacological intervention, patient anxiety and risk were reduced, user satisfaction and the health team/community relationship were improved.

Objetivo: Determinar a eficácia de uma intervenção de enfermagem estruturada de acompanhamento significativo para reduzir a ansiedade em pacientes que vão se submeter a uma endoscopia digestiva alta em um hospital público na Região de Biobío, Chile. Material e Método: Ensaio clínico randomizado, simples-cego, com avaliação por terceiros, realizado entre janeiro e junho de 2021, com uma amostra de 126 pacientes. Os instrumentos e parâmetros hemodinâmicos que mediram as variáveis sociodemográficas, psicológicas, fisiológicas e bioquímicas foram: Questionário Sociodemográfico, Questionário de Ansiedade Traço-Estado, Escala Visual Analógica, frequência cardíaca, pressão arterial (PA) sistólica, média e diastólica, oximetria de pulso, glicemia e potássio sanguíneo. A intervenção consistiu na presença visual e tátil de um acompanhante significativo, antes, durante e após o procedimento endoscópico. Análise dos dados com SPSS v.18, considerada estatística descritiva e inferencial (valor de p= 5%) com T-Student e teste U de Mann-Whitney. Resultados: Média de idade 52 anos, ensino médio completo, casado e com filhos; houve diferenças significativas nas variáveis psicológicas (p< 0,05) nas três etapas, variáveis fisiológicas (PA média (p= 0,0025) e diastólica (p= 0,0002) intra-procedimento, PA média (p= 0,0021) e diastólica (p= 0,0021) pós-procedimento, pulso médio ou mediano (p< 0,05) no pré (p= 0,0035) e pós-procedimento endoscópico (p= 0,0003). Não foram observadas diferenças significativas na oximetria de pulso e nas variáveis bioquímicas. Conclusão: Através de acompanhamento significativo, intervenção simple, fácil, de baixo custo e não farmacológica foi possível conseguir a redução da ansiedade e do risco do paciente, a melhora da satisfação do usuário e da relação equipe de saúde/comunidade.

Effectiveness of supplemental oxygenation to prevent surgical site infections: A systematic review with meta-analysis / Efetividade da oxigenação suplementar para prevenção de infecção de sítio cirúrgico: revisão sistemática com metanálise / Efectividad de la oxigenación suplementaria para prevenir la infección del sitio quirúrgico: revisión sistemática con metaanálisis

Abstract Objective: to assess the effectiveness of supplemental oxygenation with high FiO2 when compared to conventional FiO2 in the prevention of surgical site infection. Method: an effectiveness systematic review with meta-analysis conducted in five international databases and portals. The research was guided by the following question: Which is the effectiveness of supplemental oxygenation with high FiO2 (greater than 80%) when compared to conventional FiO2 (from 30% to 35%) in the prevention of surgical site infections in adults? Results: fifteen randomized clinical trials were included. Although all the subgroups presented a general effect in favor of the intervention, colorectal surgeries had this relationship evidenced with statistical significance (I2=10%;X2=4.42; p=0.352). Conclusion: inspired oxygen fractions greater than 80% during the perioperative period in colorectal surgeries have proved to be effective to prevent surgical site infections, reducing their incidence by up to 27% (p=0.006). It is suggested to conduct new studies in groups of patients subjected to surgeries from other specialties, such as cardiac and vascular. PROSPERO registration No.: 178,453.

Resumo Objetivo: avaliar a efetividade da oxigenação suplementar com FiO2 elevada comparada com FiO2 convencional na prevenção de infecção de sítio cirúrgico. Método: revisão sistemática de efetividade com metanálise em cinco bases de dados e portais internacionais. A pesquisa foi norteada pela pergunta: Qual a efetividade da oxigenação suplementar com FiO2 elevada (maior que 80%) comparada com FiO2 convencional (de 30 a 35%) na prevenção de infecção de sítio cirúrgico em adultos? Resultados: foram incluídos quinze ensaios clínicos randomizados. Embora todos os subgrupos tenham apresentado um efeito geral a favor da intervenção, as cirurgias colorretais tiveram essa relação evidenciada com significância estatística (I2=10%; X2=4,42; p=0,352). Conclusão: uma fração inspirada de oxigênio maior que 80% durante o período perioperatório em cirurgias colorretais tem se mostrado efetiva para prevenir a infecção de sítio cirúrgico, reduzindo sua incidência em até 27% (p=0,006). Sugere-se a realização de novos estudos em grupos de pacientes submetidos a cirurgias de outras especialidades, tais como cardíacas e vasculares. Registro PROSPERO: 178453.

Resumen Objetivo: evaluar la efectividad de la oxigenación suplementaria con FiO2 elevada en comparación con la FiO2 convencional para prevenir la infección del sitio quirúrgico. Método: revisión sistemática de eficacia con metaanálisis en cinco bases de datos y portales internacionales. La investigación se guio por la pregunta: ¿Qué tan eficaz es la oxigenación suplementaria con FiO2 alta (más del 80%) en comparación con la FiO2 convencional (del 30 al 35%) para prevenir la infección del sitio quirúrgico en adultos? Resultados: se incluyeron quince ensayos clínicos aleatorizados. Aunque todos los subgrupos mostraron un efecto general a favor de la intervención, en las cirugías colorrectales esa relación tenía significancia estadística (I2=10%; X²=4,42; p=0,352). Conclusión: una fracción inspirada de oxígeno superior al 80% durante el perioperatorio en cirugías colorrectales ha demostrado ser eficaz en la prevención de la infección del sitio quirúrgico, reduciendo su incidencia hasta en un 27% (p=0,006). Se sugiere realizar más estudios en grupos de pacientes sometidos a cirugías en otras especialidades, como cardiaca y vascular. Registro PROSPERO: 178453.

Análise das variáveis perioperatórias e sua relação com as complicações em Sala de Recuperação Pós-Anestésica / Analysis of perioperative variables and their relationship with complications in the Post-Anesthetic Care Unit / Análisis de variables perioperatorias y su relación con complicaciones en la Unidad de Cuidados Postanestésicos

Objetivo: analisar as frequências das complicações em Sala de Recuperação Pós-Anestésica (SRPA) por especialidades cirúrgicas e sua associação com variáveis pré, intra e pós-operatórias imediatas. Método: estudo transversal, com 98 pacientes. Utilizaram-se dados perioperatórios, coletados por meio de entrevista, exame físico e prontuário eletrônico; e análises descritivas, bivariadas e regressão logística. Resultados: hipotermia foi mais frequente nas cirurgias geral e ginecológica em mulheres, sendo associada às anestesias geral ou raquidiana e ao posicionamento litotômico (p<0,05). Náuseas em cirurgias gerais e ginecológicas (p=0,05), e vômitos nas gerais (p=0,01). Dor nas cirurgias gerais, associada à anestesia geral e à prescrição de analgésicos no intraoperatório (p<0,05). Cirurgia geral aumenta 3,5 vezes as chances de dor em SRPA (p=0,01). Conclusão: encontrou-se maior frequência de hipotermia, dor e náuseas/vômitos, associadas às especialidades ginecológica e geral, ao sexo feminino, posicionamento cirúrgico litotômico, à prescrição de analgésicos no intraoperatório e às anestesias raquidiana e geral.

Objective: to analyze the frequencies of complications in the Post-Anesthetic Care Unit (PACU) by surgical specialties and their association with pre-, intra- and immediate postoperative variables. Method: cross-sectional study with 98 patients. Perioperative data were used, collected through interviews, physical examination and electronic medical records; and descriptive, bivariate and logistic regression analyses. Results: hypothermia was more frequent in general and gynecological surgeries in women, being associated with general or spinal anesthesia and lithotomy positioning (p<0.05); nausea in general and gynecological surgeries (p=0.05), and vomiting in general (p=0.01); pain in general surgeries, associated with general anesthesia and intraoperative prescription of analgesics (p<0.05). General surgery increased the chances of pain in the PACU by 3.5 times (p=0.01). Conclusion: there was a higher frequency of hypothermia, pain and nausea/vomiting associated with gynecological and general specialties, female sex, lithotomy surgical position, intraoperative analgesic prescription and spinal and general anesthesia.

Objetivo: analizar las frecuencias de las complicaciones en la Unidad de Cuidados Post Anestésicos (UCPA) por especialidades quirúrgicas y su asociación con variables pre, intra y postoperatorias inmediatas. Método: estudio transversal con 98 pacientes. Se utilizaron datos perioperatorios, recolectados a través de entrevistas, examen físico y prontuario electrónico; y análisis de regresión descriptiva, bivariada y logística. Resultados: la hipotermia fue más frecuente en cirugías generales y ginecológicas en mujeres, asociándose a anestesia general o espinal y posicionamiento litotómico (p<0.05). Náuseas en general y cirugías ginecológicas (p=0.05), y vómitos en general (p=0.01). Dolor en cirugías generales, asociado a anestesia general y prescripción intraoperatoria de analgésicos (p<0.05). La cirugía general aumenta las posibilidades de dolor en la UCPA 3.5 veces (p=0.01). Conclusión: hubo mayor frecuencia de hipotermia, dolor y náuseas/vómitos, asociados a especialidades ginecológicas y generales, sexo femenino, posicionamiento quirúrgico litotómico, prescripción analgésica intraoperatoria y anestesia raquídea y general.

Public-private relationship in surgical hospitalizations through the Unified Health System / Relação público-privado nas internações cirúrgicas pelo Sistema Único de Saúde / Relación público-privado en los ingresos quirúrgicos a través del Sistema Único de Salud

Objective: to characterize surgical hospitalizations, length of stay, cost and mortality, according to the legal nature (public and private) of the hospital institution linked to the Unified Health System (Sistema Único de Saúde, SUS). Method: a descriptive study, of the survey type, with retrospective data collection (2008 to 2017) and a quantitative approach. The dependent variables surgical hospitalizations in Brazil, costs, length of stay and mortality and the independent variables regime/legal nature (public and private) were obtained from the Informatics Department of the Unified Health System. The Mann-Whitney test was used for analysis. Results: the average number of hospitalizations through the Unified Health System was 4,214,083 hospitalizations/year, 53.5% occurred in private hired hospitals and 46.5% in public hospitals (p=0.001). The financial transfer was greater for the private sector (60.6%) against 39.4% for the public (p=0.001). The average stay was 4.5 days in the public hospital and 3.1 days in its private counterpart (p<0.001). Mortality was higher in the public (1.8%) than in the private hospital (1.4%) (p<0.001). Conclusion: there was predominance of surgical hospitalizations through the Unified Health System in private hospitals with greater financial transfer to this sector, to the detriment of the public. The diverse evidence produced contributes to the debate and actions to avoid budgetary asphyxiation in the public sector in favor of the private sector.

Objetivo: caracterizar as internações cirúrgicas, permanência, custo e mortalidade, conforme a natureza jurídica (público e privado) da instituição hospitalar ligada ao Sistema Único de Saúde. Método: estudo descritivo, tipo levantamento, com coleta de dados retrospectiva (2008 a 2017) e abordagem quantitativa. As variáveis dependentes internações cirúrgicas ocorridas no Brasil, custos, permanência e mortalidade e as variáveis independentes regime/natureza jurídica (público e privado) foram obtidas do Departamento de Informática do Sistema Único de Saúde. O teste de Mann-Whitney foi empregado para análise. Resultados: a média das internações pelo Sistema Único de Saúde foi de 4.214.083 internações/ ano, 53,5% ocorridas nos hospitais privados contratados e 46,5% em hospitais públicos (p=0,001). O repasse financeiro foi maior para o setor privado (60,6%) contra 39,4% para os públicos (p=0,001). A média de permanência foi de 4,5 dias no público e 3,1 dias no privado (p<0,001). A mortalidade foi maior no público (1,8%) do que no privado (1,4%) (p<0,001). Conclusão: houve predomínio das internações cirúrgicas pelo Sistema Único de Saúde nos hospitais privados com repasse financeiro maior para este setor em detrimento do público. As evidências produzidas contribuem para o debate e ações para evitar o asfixiamento orçamentário do setor público em privilégio do privado.

Objetivo: caracterizar los ingresos quirúrgicos, la estancia, el costo y la mortalidad, según la naturaleza jurídica (público y privado) del hospital vinculado al Sistema Único de Salud. Método: se trata de estudio descriptivo, tipo encuesta, con recolección de datos retrospectiva (2008 a 2017) y enfoque cuantitativo. Las variables dependientes ingresos quirúrgicos en Brasil, costos, estancia y mortalidad y las variables independientes régimen/naturaleza jurídica (público y privado) se obtuvieron del Departamento de Informática del Sistema Único de Salud. Para el análisis se utilizó la prueba de MannWhitney. Resultados: el promedio de hospitalizaciones a través del Sistema Único de Salud fue de 4.214.083 hospitalizaciones/ año, 53,5% ocurrieron en hospitales privados contratados y 46,5% en hospitales públicos (p=0,001). La transferencia financiera fue mayor para el sector privado (60,6%) y del 39,4% para el público (p=0,001). La estancia media fue de 4,5 días en el público y 3,1 días en el privado (p<0,001). La mortalidad fue mayor en los hospitales públicos (1,8%) que en los privados (1,4%) (p<0,001). Conclusión: hubo un predominio de los ingresos quirúrgicos a través del Sistema Único de Salud en los hospitales privados con mayor transferencia económica a este sector en detrimento de la población. La evidencia producida contribuye al debate y las acciones para evitar la asfixia presupuestaria del sector público que privilegia al sector privado.

Avaliação dos efeitos do jejum prolongado no pré e pós-operatórios / Evaluation of the effects of prolonged furniture prior to and after operating / Evaluación de los efectos del jejum prolongado en el pré y post operatorios

Objetivo: Investigar o jejum prolongado em pacientes que submeteram-se a procedimentos cirúrgicos abdominais e do trato gastrointestinal com uso de anestesia geral, e as possíveis complicações no pré, intra e pós-operatório. Método: um estudo exploratório-descritivo, com recorte transversal retrospectivo-documental e abordagem quali-quantitativa, realizado num Hospital Federal do Rio de Janeiro, com análise documental referente ao período de janeiro de 2013 a abril de 2018. Resultado: houve uma grande variação no tempo de jejum pré-operatório, 0,3% dos pacientes fizeram jejum até 8 horas e 11,3% até 12 horas, alguns casos chegaram a fazer mais de 24 horas de jejum. Conclusão: foi perceptível que dentre prontuários analisados, os pacientes permaneceram em jejum perioperatório muito superiores fora dos padrões de segurança estipulados, gerando intercorrências que causam desconforto ao paciente, prejudicam a reabilitação, aumentam o tempo de internação e oneram o sistema

Objective:To investigate prolonged fasting in patients who underwent abdominal and gastrointestinal surgical procedures with general anesthesia, and possible complications in the pre, intra and postoperative periods. Method: an exploratory-descriptive study, with retrospective-documental cross-section and qualitative-quantitative approach, performed at a Federal Hospital of Rio de Janeiro, with documentary analysis from January 2013 to April 2018. Result: there was a great variation in time of preoperative fasting, with 0.3% of patients fasted for up to 8 hours and 11.3% for up to 12 hours, some cases reaching more than 24 hours fasting. Conclusion: Patients were found to be in perioperative fasting far beyond the stipulated safety standards, generating complications that cause discomfort to the patient, impair rehabilitation, increase length of hospital stay, and burden the system

Objetivo: Investigar el ayuno prolongado en pacientes que se sometieron a procedimientos quirúrgicos abdominales y del tracto gastrointestinal con uso de anestesia general, y las posibles complicaciones en el pre, intra y postoperatorio. Metodo: un estudio exploratório y descriptivo, con recorte transversal retrospectivo y documental con el abordaje cuali y cuantitativo, realizado en un Hospital Federal de Rio de Janeiro, con análisis documental referente al período de enero de 2013 a abril de 2018. Resultado:ocorrió una gran variación en el tiempo de ayuno preoperatorio, 0,3% de los pacientes hicieron ayuno hasta 8 horas y 11,3% hasta 12 horas, algunos casos llegaron a hacer más de 24 horas de ayuno. Conclusión: fue notable que entre los prontuarios analizados, los pacientes permanecieron en ayuno perioperatorio muy superiores fuera de los estándares de seguridad estipulados, generando intercurrencias que causan incomodidad al paciente, perjudican la rehabilitación, aumentan el tiempo de internación y el sistema

Inappropriate screening of obstructive coronary artery disease during pre-anesthesia assessment of candidates for non-cardiac surgery

Preoperative evaluation in elective surgeries has been associated with successful surgical treatment. However, there is no solid scientific evidence that screening for coronary artery disease (CAD) reduces surgical risk. The aims of this study were to describe the frequency of inappropriate investigation of obstructive CAD induced by pre-anesthetic assessment in individuals without cardiovascular symptoms (candidates for low- to intermediate-risk surgeries) and to evaluate predictors of this conduct. We performed a retrospective evaluation of medical records of anesthesiology services from patients undergoing pre-anesthesia assessment between May 2015 and May 2016, including those with functional capacity ≥4 metabolic equivalents without a diagnosis of heart disease. A total of 778 medical records (47±16 years of age, 62.6% female) were studied. A private hospital performed 50.1% of the surgeries and 60.4% were of intermediate risk. Only 2.7% (95%CI: 1.7-4.1%) were screened for CAD, and 91% of these requests were mediated by cardiology consultations performed during pre-anesthetic testing visits. Factors associated with screening for CAD were hypertension, diabetes, moderate systemic disease (ASA III), cardiac consultation, previous diagnosis of CAD, and admission to a private hospital. Independent predictors were private hospitals (OR: 3.9; 95%CI: 1.3-11.0), ASA III (OR: 5.3; 95%CI: 1.7-16.2), and hypertension (OR: 3.8; 95%CI: 1.5-9.8). The frequency of inappropriate requests for CAD screening in asymptomatic individuals without untreated systemic diseases was low in pre-anesthetic visits. Although infrequent, screening for CAD is more common in the private setting, in patients with poorer health status, and is usually prescribed during cardiology consultation.

Tratamiento de las malformaciones en extremidades en el síndrome de bridas amnióticas: a propósito de un caso / Amniotic band syndrome: management of skeletal limb abnormalities. A case report

El síndrome de bridas amnióticas es un complejo de anomalías congénitas causadas por la rotura prematura del amnios, por lo que se originan bandas fibrosas que comprimen determinadas regiones del feto. Afecta a entre 1:1200 y 1:15 000 recién nacidos vivos según las series consultadas.La clínica típica consiste en alteraciones en las extremidades (anillos de constricción, amputaciones asimétricas más o menos distales, sindactilias y pie zambo), y se han descrito alteraciones toracoabdominales o faciales. Recientes trabajos han demostrado la utilidad del método de Ponseti en el tratamiento del pie zambo asociado al síndrome de bridas amnióticas. Se presenta el caso de un recién nacido que padecía un síndrome de bridas amnióticas y se ahonda en el manejo y la resolución quirúrgica de las malformaciones en las extremidades. En especial, se analiza la utilización del método de Ponseti en el tratamiento del pie zambo congénito sindrómic

Amniotic band syndrome consists in a group of congenital abnormalities caused by strands of the amniotic sac that entangle some parts of the fetus. Those strands result from premature rupture of amnios. The incidence of amniotic band syndrome is 1:1200 to 1:15,000 live births, depending on case studies.Mostly affected parts of fetus are limbs (asymmetric amputations, syndactyly and clubbed foot) but facial and thoracoabdominal abnormalities have also been described.Recent works have proved the utility of Ponseti method to treat clubfoot associated with amniotic band syndrome. We report the case of a newborn with amniotic band syndrome focusing on management and surgical repair of limbs deformities. Especially, we highlight the use of Ponseti method in treatment of syndromic clubfoot

Manejo quirúrgico de nariz mestiza con injerto de extensión septal / Surgical management of the mongrel nose with graft of septal extension

Resumen Objetivo: La nariz mestiza presenta características muy diferentes de la caucásica resultando en un desafío quirúrgico para el cirujano estético facial. El objetivo del estudio fue describir el manejo quirúrgico de la nariz mestiza con injerto de extensión septal y evaluar los resultados estéticos. Materiales y Método: Estudio de una serie de casos de corte longitudinal, muestra de 25 pacientes. Se realizó un plan quirúrgico mediante abordaje abierto y el uso de injerto de extensión septal, se compararon las fotos pre y postoperatorias midiendo el ángulo y la proyección de la punta nasal, junto con el nivel de satisfacción postoperatoria de los pacientes. Se utilizó estadística descriptiva que incluyó frecuencias absolutas y relativas. Resultados: 56% de los pacientes corresponden al sexo femenino, al 52% se colocó injertos espaciadores, 8% necesitó alotomía, el 100% mejoró el ángulo nasolabial y solo un paciente presentó hematoma septal a los 10 días postquirúrgico, se resolvió con drenaje, la encuesta de satisfacción realizada a los pacientes postquirúrgicos mostró un resultado satisfactorio. Conclusiones: La técnica quirúrgica con injerto de extensión septal es de gran utilidad, se logró una correcta definición, proyección/rotación de la punta nasal y mayor estabilidad estructural del trípode central, con resultados armónicos satisfactorios en su apariencia de frente y de perfil, evitando colocar injertos en la punta nasal.

Aim: The mongrel nose has very different characteristics from the caucasian one resulting in a surgical challenge for the facial cosmetic surgeon. The objective of the study was to describe the surgical management of the mongrel nose with graft of septal extension and to evaluate the aesthetic results. Materials and Method: Study of a series of cases of longitudinal section, sample of 25 patients. A surgical plan was performed using an open approach and the use of graft of septal extension, the pre and postoperative photos were compared by measuring the angle and projection of the nasal tip, together with the level of postoperative satisfaction of the patients. Descriptive statistics that included absolute and relative frequencies were used. Results: 56% belong to the female sex, 52% were placed spacer grafts, 8% needed an allotomy, 100% improved the nasolabial angle and only one patient presented septal hematoma at 10 days post surgery, it was resolved with drainage, the satisfaction survey of post-surgical patients showed a satisfactory result. Conclusions: The surgical technique with graft of septal extension is very useful, a correct definition, projection/rotation of the nasal tip and greater structural stability of the central tripod were achieved, with satisfactory harmonic results in its front and profile appearance, avoiding place grafts on the nasal tip.

Hidatidosis pulmonar: hallazgos y tratamiento quirúrgico en quistes complicados versus no complicados / Pulmonary hydatidosis: findings and surgical treatment in complicated versus uncomplicated cysts

Resumen Introducción: La hidatidosis humana es una zoonosis prevalente en nuestro medio, causada principalmente por el parásito Echinococcus granulosus. Las complicaciones más frecuentes en el pulmón son la rotura y la infección del quiste. Objetivos: Describir y comparar características clínicas, tratamiento, morbilidad y mortalidad de los pacientes hospitalizados por quiste hidatídico pulmonar (QHP) complicado versus no complicado. Materiales y Método: Estudio analítico longitudinal. Período enero de 1973 - diciembre de 2017 en Hospital Clínico Regional de Concepción "Dr. Guillermo Grant Benavente", Chile. Revisión de base de datos, protocolos de QHP y fichas clínicas. Se utilizó planilla Microsoft Excel® y programa SPSS24®, con función chi cuadrado y t de Student. Se consideró significativo p < 0,05. Resultados: Total 364 episodios de QHP, complicados 179 (49,2%) versus no complicados 185 (50,8%). Edad promedio 36,4 ± 18,9 versus 32,4 ± 19,1 años, hombres 114 (63,7%) versus 107 (57,8%), respectivamente. Se encontró diferencia estadísticamente significativa en: sintomatología tos 147 (82,1%) versus 120 (64,9%), hemoptisis 93 (52,0%) versus 45 (24,3%), respectivamente; QHP derecho 115 (64,2%) versus 99 (53,5%), respectivamente; cirugía conservadora 139 (77,7%) versus 167 (90,3%), reoperaciones 22 (12,3%) versus 8 (4,3%), respectivamente; morbilidad 47 (26,3%) versus 30 (16,2%), mortalidad 6 (3,4%) versus 0 (0%), estadía hospitalaria postoperatoria promedio 16,1 ± 14,3 versus 10,7 ± 7,7 días, recidivas 15 (8,4%) versus 13 (7,0%), respectivamente. Discusión: Aproximadamente la mitad de los QHP son complicados. Los QHP complicados presentan diferencias estadísticamente significativas en su clínica, tratamiento, morbilidad, mortalidad y estadía hospitalaria postoperatoria.

Background: Human hydatidosis is a prevalent zoonosis in our environment, caused mainly by the Echinococcus granulosus parasite. The most common complications in the lung are cyst rupture and infection. Aim: To describe and compare clinical characteristics, treatment, morbidity and mortality of patients hospitalized for complicated versus uncomplicated hydatid pulmonary cyst (HPC). Materials and Method: Longitudinal analytical study. Period January 1973 - December 2017 at the Regional Clinical Hospital of Concepción "Dr. Guillermo Grant Benavente", Chile. Database, prospective protocols and medical records were reviewed. Microsoft Excel® spreadsheet and SPSS24® program with chi square and Student's t-test were used. It was considered significant p < 0.05. Results: Total 364 episodes of HPC, complicated 179 (49.2%) versus uncomplicated 185 (50.8%). Average age 36.4 ± 18.9 versus 32.4 ± 19.1 years, male 114 (63.7%) versus 107 (57.8%), respectively. A statistically significant difference was found in: symptomatology cough 147 (82.1%) versus 120 (64.9%), hemoptysis 93 (52.0%) versus 45 (24.3%), respectively; HPC right 115 (64.2%) versus 99 (53.5%), respectively; resective cyst surgery 139 (77.7%) versus 167 (90.3%), reoperation 22 (12.3%) versus 8 (4.3%), respectively; morbidity 47 (26.3%) versus 30 (16.2%), mortality 6 (3.4%) versus 0 (0%), average postoperative hospital stay 16.1 ± 14.3 versus 10.7 ± 7.7 days, recurrence 15 (8.4%) versus 13 (7.0%), respectively. Conclusions: Approximately half of the HPCs are complicated. Complicated HPCs present statistically significant differences in their clinical, treatment, morbidity, mortality and postoperative hospital stay.

Hernia de Grynfelt resuelta por vía laparoscópica: reporte de un caso / Grynfelt ́s hernia resolved laparoscopically: a case report

RESUMEN Las hernias lumbares son una patología rara que involucra herniación de los contenidos intraabdominales o retroperitoneales a través de debilidades congénitas o adquiridas en la pared abdominal posterolateral. El tratamiento quirúrgico es el recomendado, sin embargo, la vía de abordaje aún no está estandarizada en la literatura, pero existe mucha evidencia a favor de la laparoscopía con mejores resultados en el control del dolor posoperatorio, resultados estéticos y menor estancia hospitalaria. Se presenta el caso clínico de una paciente feme-nina de 55 años con cuadro de dolor lumbar izquierdo de 6 meses de evolución que fue diagnosticada de hernia del triángulo posterior por estudio de imagen. La reparación de su defecto herniario fue con tratamiento quirúrgico por vía laparoscópica.Palabras claves: Hernia; cirugía laparoscópica; procedimientos quirúrgicos operativos; patología quirúrgica; informes de caso.

ABSTRACT Lumbar hernia are a rare pathology that involves herniation of the intra-abdominal or retroperitoneal contents through congenital or ac-quired weaknesses in the posterolateral abdominal wall. Surgical treatment is recommended, however, the approach is not yet standard-ized in the literature, but there is much evidence in favor of laparoscopy with better results in postoperative pain control, cosmetic results, and shorter hospital stay. We present the clinical case of a 55-year-old female patient with a 6-month history of left lumbar pain who was diagnosed with posterior triangle hernia by imaging study. The repair of her hernia defect was with laparoscopic surgical treatment.Keywords: Hernia; laparoscopic surgery; operative surgical procedures; surgical pathology; case report.