Resultados de los pacientes operados de queratoplastia terapéutica en la provincia de Matanzas

Introducción: la queratoplastia terapéutica se define como un procedimiento cuyo propósito es contribuir a erradicar o reducir la infección cuando la terapia médica máxima no es eficaz para lograr este fin. Objetivo: evaluar la evolución y resultados de los pacientes operados de queratoplastia terapéutica. Materiales y métodos: se realizó un estudio descriptivo transversal en un universo de 15 pacientes con diagnóstico de úlcera grave corneal. Dichos pacientes fueron operados de queratoplastia terapéutica en el Servicio de Córnea del Hospital Universitario Comandante Faustino Pérez Hernández, de la provincia de Matanzas, entre abril de 2017 y febrero de 2020, y dieron su consentimiento informado para participar en la investigación. Resultados: predominó el sexo masculino, con un 53,3 % y una media de edad de 58,8 años. Como factores predisponentes, prevaleció el antecedente de trauma en el 33,3 %, seguido del uso de lentes de contacto y la diabetes mellitus como enfermedad sistémica asociada. Las úlceras de etiología micótica predominaron en el 26,6 % de los casos; la perforación corneal y el descemetocele se presentaron en el 40 % y 26,6 % de los pacientes respectivamente. Durante el primer mes, las complicaciones postoperatorias más frecuentes fueron la recidiva de la sepsis y la necrosis del injerto. Por su parte, la opacidad y vascularización corneal fueron las secuelas más frecuentes. Conclusiones: la demora en iniciar el protocolo de tratamiento adecuado provoca cuadros severos de la enfermedad, realizando queratoplastia "en caliente" en córneas perforadas o con necrosis, que devienen complicaciones postoperatorias y secuelas no alentadoras para los pacientes.

Introduction: therapeutic keratoplasty is defined as a procedure whose purpose is to help eradicate or reduce the infection when maximum medical therapy is not efficacious to achieve this end. Objective: to evaluate the evolution and results of the patients operated on therapeutic keratoplasty. Materials and methods: a cross-sectional, descriptive study was carried out in a universe of 15 patients with a diagnosis of severe corneal ulcer. The patients underwent therapeutic keratoplasty surgeries in the Cornea Service of the Clinical Surgical University Hospital Comandante Faustino Perez Hernandez, in the province of Matanzas, between April 2017 and May 2020, and gave their informed consent to participate in the research. Results: male gender predominated, with 53.3% and a mean age of 58.8 years. As predisposing factors, trauma antecedent predominated in 33.3%, followed by the use of contact lenses and diabetes mellitus as associated systemic disease. Ulcers of mycotic etiology predominated in 26.6% of the cases; corneal perforation and descemetoceles occurred in 40% and 26.6% of the cases respectively. During the first month, the most frequent postsurgery complications were recidival sepsis and graft necrosis. On the other hand, corneal opacity and vascularization were the most frequent sequels. Conclusions: the delay in initiating the adequated protocol treatment causes severe symptoms of the disease that lead to "in hot" keratoplasty in perforated or necrosed corneas, causing postsurgery complications and non-encouraging sequels for patients.

Complicaciones en la cirugía ginecológica / Complications in gynecological surgery

Introducción: Los procedimientos quirúrgicos tienen riesgos y complicaciones, que determinan el pronóstico de los pacientes. La tasa de mortalidad de la cirugía ginecológica, es inferior al 1 por ciento, la de complicaciones varía de 0,2 a 26 por ciento. Ambas están determinadas por factores de riesgo como la edad, enfermedad médica preexistente, obesidad, cirugías previas, anemia y cáncer. Objetivo: Determinar las principales complicaciones, su asociación con el diagnóstico preoperatorio, el tipo de operación realizada y la comorbilidad en pacientes intervenidas por afecciones ginecológicas. Métodos: Estudio descriptivo en pacientes intervenidas quirúrgicamente por vía convencional y de forma electiva. Se seleccionó una serie de 616 pacientes tributarias de cirugía mayor electiva por vía convencional. Las variables utilizadas fueron la comorbilidad asociada, diagnóstico preoperatorio, operación realizada y complicaciones postquirúrgicas. Resultados: Se produjeron complicaciones postquirúrgicas en 96 pacientes (15,5 por ciento). Las de mayor frecuencia fueron el íleo paralítico (4,2 por ciento de la serie y 26,04 por ciento de las complicaciones) y el absceso de cúpula (2,75 por ciento de la serie y 17,7 por ciento de las complicaciones), fundamentalmente en quienes presentaron antecedentes de obesidad y asociación de factores de riesgo. Conclusiones: Las principales complicaciones de la cirugía ginecológica fueron el íleo paralítico y el absceso de la cúpula, las complicaciones se presentaron fundamentalmente en pacientes operadas por mioma uterino y tumor de ovario. De acuerdo con el tipo de operación, ocurrieron en pacientes operadas por histerectomía total abdominal con doble anexectomía y la histerectomía total abdominal sin anexectomía, y las comorbilidades más frecuentes fueron la obesidad y la asociación de comorbilidad(AU)

Introduction: Surgical procedures have risks and complications, which determine the prognosis of patients. The mortality rate of gynecological surgery is less than 1 percent, that of complications varies from 0.2 to 26 percent. Both are determined by risk factors such as age, pre-existing medical illness, obesity, previous surgeries, anemia, and cancer. Objective: To determine the main complications, their association with the preoperative diagnosis, the type of operation performed and the comorbidity in patients operated on for gynecological conditions. Methods: Descriptive study in patients operated on by conventional and elective route. A series of 616 tributary patients of major elective surgery by conventional route were selected. The variables used were associated comorbidity, preoperative diagnosis, operation performed, and postoperative complications. Results: Post-surgical complications occurred in 96 patients (15.5 percent). The most frequent were paralytic ileus (4.2 percent of the series and 26.04 percent of complications) and dome abscess (2.75 percent of the series and 17.7 percent of complications), mainly in who presented a history of obesity and association of risk factors. Conclusions: The main complications of gynecological surgery were paralytic ileus and abscess of the cupola, complications mainly occurred in patients operated on for uterine myoma and ovarian tumor. According to the type of operation, they occurred in patients operated on for total abdominal hysterectomy with double adnexectomy and total abdominal hysterectomy without adnexectomy, and the most frequent comorbidities were obesity and the association of comorbidity(AU)

Comparación entre hernioplastia inguinal convencional vs laparoscópica en el Hospital General Riobamba, IESS. 2018 / Comparison between conventional vs laparoscopic inguinal hernioplasty in the Riobamba General Hospital, IESS. 2018

"Objetivo: Contrastar la hernioplastia inguinal mediante cirugía convencional vs. laparoscópica en el Hospital General Riobamba durante el año 2018. Método: estudio observacional retrospectivo. Se recuperó información de los casos intervenidos (demografía, técnica quirúrgica, tiempo operatorio, estancia hospitalaria y complicaciones postquirúrgicas). Los resultados entre ambas técnicas fueron contrastados mediante las pruebas estadísticas de Fisher (variables cualitativas), t de Student y U de Mann-Whitney (cuantitativas). Resultados: Se incluyó un total de 106 casos sometidos a hernioplastia inguinal, 74 por cirugía convencional y 32 por laparoscopía. Se estimó una tasa de complicaciones entre quienes fueron intervenidos mediante ciru- gía convencional fue del 18.9% (14/74), mientras que en el grupo intervenido mediante cirugía laparoscópica fue del 18.8% (6/32) (p=0.95). Comparado con la cirugía convencional, en los pacientes intervenidos mediante laparoscopía se estimó además un menor tiempo operatorio (65 vs. 50 minutos; p=0.3) y estancia hospitalaria (53 vs. 46 horas; p=0.31) Conclusión: En el contexto del manejo quirúrgico de la hernia inguinal, el abordaje mediante laparoscopía está asociada a una reducción no significativa en el tiempo operatorio, estancia hospitalaria y tasa de complicacio- nes postoperatorias, en comparación para con la cirugía convencional. Palabras clave: Cirugía convencional, complicaciones postquirúrgicas, hernia inguinal, laparoscopía."

"Aim: to dure at the Riobamba General Hospital during 2018. Method: retrospective observational study. Information was retrieved from the operated cases (demography, surgical technique, operative time, hospital stay, and postoperative complications). The results between both techniques were contrasted using the Fisher test (qualitative variables), Student's t and Mann-Whitney U test (quantitative). Results: A total of 106 cases underwent inguinal hernioplasty were included, 74 by conventional surgery and 32 by laparoscopy. A complication rate among those who underwent conventional surgery was estimated to be 18.9% (14/74), while in the group who underwent laparoscopic surgery it was 18.8% (6/32) (p = 0.95). Compared with conventional surgery, a shorter operative time (65 vs. 50 minutes; p = 0.3) and hospital stay (53 vs. 46 hours; p = 0.31) was also estimated in patients operated on by laparoscopy. Conclusion: In the context of surgical management of inguinal hernia, the laparoscopic approach is associated with a non-significant reduction in operative time, hospital stay and rate of postoperative complications, com- pared to open surgery. Key words: Open surgery, postsurgical complications, inguinal hernia, laparoscopy."

Therapeutic Observation of Acupuncture-moxibustion for Postsurgical Gastroparesis and Effect on Gastrin and Motilin / 上海针灸杂志

Objective To observe the clinical efficacy of acupuncture-moxibustion in treating postsurgical gastroparesis syndrome (PGS) and the effect on gastrin (GAS) and motilin (MTL).Method Fifty PGS patients were randomized into a treatment group and a control group, 25 cases in each group. The control group was intervened by conventional medication, including effective gastrointestinal decompression, nutrition support, and psychotherapy; the treatment group was by acupuncture-moxibustion therapy in addition to the intervention given to the control group. The time of restoring gastric motility, the distention and fullness grading score, and serum GAS and MTL levels were observed, and the clinical efficacies were also compared.Result The total effective rate was 100.0% in the treatment group versus 92.0% in the control group, and the between-group difference was statistically insignificant (P>0.05). According to statistical analysis, there was a significant difference in comparing the time of restoring gastric motility between the two groups (P<0.01). The distention and fullness grading scores, GAS and MTL levels were significantly changed after intervention in both groups (P<0.01). The distention and fullness grading score, GAS and MTL levels of the treatment group were significantly different from that of the control group after intervention (P<0.01).Conclusion Acupuncture- moxibustion plus medication is an effective approach in treating PGS, and it can up-regulate the GAS and MTL levels.

Effect of anesthetic, tag size, and surgeon experience on postsurgical recovering after implantation of electronic tags in a neotropical fish: Prochilodus lineatus (Valenciennes, 1837) (Characiformes: Prochilodontidae)

Implantation of telemetry transmitters in fish can be affected by different parameters. This study aimed to evaluate the effect of type of anesthetic, tag size, and surgeon experience on surgical and postsurgical wound healing in the neotropical fish Prochilodus lineatus . In total, eighty fish were surgically implanted with telemetry transmitters and forty fish were kept as controls. Forty fish were implanted with a small tag and other forty were implanted with a large tag. Similarly, forty fish were anesthetized with eugenol and forty fish were anesthetized by electroanesthesia, and forty surgeries were performed by an expert surgeon and forty surgeries were performed by novice surgeons. At the end of the experimental period seventeen (21.3%) tagged fish had postsurgical complications, including death (1.3%), tag expulsion (2.5%), antenna migration (2.5%), and infection (15%). Tag size was the key determinant for postsurgical complications. Surgical details and postsurgical wound healing were not affected by type of anesthetic. Incision size, duration of surgery, and wound area were significantly affected by tag size and surgeon experience, and the number of sutures was significantly affected by tag size only. The results indicate that successful implantation of telemetry transmitters is dependent upon surgeon experience and tag size.(AU)

A implantação de transmissores em peixes pode ser afetada por diversos aspectos. Este estudo objetivou avaliar a influência do tamanho do transmissor, do tipo de anestésico e da experiência do cirurgião em parâmetros cirúrgicos e recuperação pós-cirúrgica do peixe neotropical Prochilodus lineatus . Foram marcados oitenta indivíduos com transmissores de telemetria, enquanto outros quarenta foram utilizados como controle. Quarenta indivíduos foram marcados com um transmissor pequeno e outros quarenta com um transmissor maior. Foram utilizados dois tipos de anestésico sendo quarenta indivíduos anestesiados por eletronarcose e outros 40 por eugenol e as cirurgias foram realizadas por dois grupos de cirurgiões, experientes e inexperientes com quarenta peixes em cada grupo. Dezessete peixes (21,3%) apresentaram impactos diretos resultantes da cirurgia como o óbito (1,3%), perda do transmissor (2,5%), migração da antena (2,5%) e infecções internas (15%). Estes efeitos estão ligados ao tamanho do transmissor utilizado. A experiência do cirurgião possui relação direta em três parâmetros cirúrgicos (tamanho da incisão, tempo de cirurgia e área de cicatrização). O tamanho dos transmissores utilizados possui relação com quatro parâmetros (tamanho da incisão cirúrgica, número de suturas utilizadas, tempo de cirurgia e área de cicatrização). O anestésico não teve relação com os parâmetros cirúrgicos. Os resultados indicam que tanto a dimensão dos transmissores quanto a experiência dos cirurgiões têm impacto direto no sucesso de implantação dos transmissores.(AU)

Evolución de apendicitis aguda y pronóstico / Evolution of acute appendicitis and prognosis

Introducción: la apendicitis aguda es la afección de resolución quirúrgica que se presenta con mayor frecuencia en la guardia médica hospitalaria. Se considera que un 7% de la población general es afectada. Etiológicamente, se ha considerado como mecanismo principal de inicio de la apendicitis aguda la obstrucción de la luz apendicular. Objetivo: identificar factores relacionados a complicaciones en los pacientes apendicectomizados concernientes a: edad, tiempo de evolución y formas anátomo-patológicas. Material y métodos: se realizó un estudio con 223 pacientes operados por vía laparotómica, en el Servicio de Cirugía General del Nuevo Hospital San Roque, con diagnóstico histopatológico de apendicitis aguda, durante un período de 6 meses, Enero a Junio del año 2013. Ochenta y ocho fueron del sexo femenino y 135 masculinos. Resultados: la edad promedio fue de 29,5 años. Las formas anátomo-patológicas que se registraron fueron edematosa 29 (13%), flegmonosa 92 (41,2%) y gangrenosa 102 (45,7%). Las complicaciones estuvieron presentes en 21,9% de los operados, siendo consideradas en este estudio el absceso de pared, el hemoperitoneo, el íleo postoperatorio, las colecciones abdominales, la evisceración, el hematoma de pared y óbitos. Conclusiones: en las apendicitis agudas con una evolución entre 24 y 48 horas prevalecen las formas gangrenosas, lo que produce un mayor número de complicaciones, aumentando la morbi-mortalidad y consecuentemente el tiempo de internación.

Background: acute appendicitis is the condition of surgical resolution that occurs most frequently in hospital medical ward. It is considered that 7% of the general populations are affected. Etiologically, it has been considered as the main mechanism of onset of acute appendicitis appendicular obstruction light. The aim of this study was to identify factors related to complications in patients appendectomy concerning: age, duration and anatomic-pathological forms. Objective: to identify factors related to complications in appendectomy patients regarding age, time evolution and histopathological forms. Material and methods: we conducted a study with 223 patients operated by laparotomy in the General Surgery Service of the Nuevo Hospital San Roque with histopathological diagnosis of acute appendicitis, for a period of six months, from January to June of 2013. Eighty-eight were female and 135 male. Results: the average age was 29.5 years. Histopathological forms recorded were edematous 29 (13%), Phlegmonous 92 (41.2%) and gangrenous 102 (45.7%). Complications were present in 21.9% of the operated patients being considered in this study the wall abscess, hemoperitoneum, postoperative ileus, abdominal collections, evisceration, wall hematoma and deaths. Conclusion: in acute appendicitis with an evolution between 24 and 48 hours gangrenous forms prevail, resulting in a greater number of complications, increased morbidity and mortality and consequently the length of stay.