Apendicitis aguda perforada con diagnóstico prequirúrgico y hernia inguinal bilateral en recién nacido de pretérmino / Acute perforated appendicitis with pre-surgical diagnosis and bilateral inguinal hernia in preterm infants

INTRODUCCIÓN: La apendicitis aguda neonatal es una patología de muy baja frecuencia, con escasos reportes en los últimos 30 años. La clínica e imágenes son inespecíficas, diagnosticándose la mayoría de las veces durante el procedimiento quirúrgico. OBJETIVO: Presentar un caso de apendicitis aguda perfora da en paciente prematura, con diagnóstico prequirúrgico y resolución laparoscópica, asociada a aparición posterior de hernia inguinal. CASO CLÍNICO: Recién nacido femenino de 34 semanas que a los 17 días de vida presentó fiebre, irritabilidad y aumento del residuo lácteo. Al examen físico destacaba distensión y sensibilidad del abdomen y tanto la radiografía como ecografía abdominales eran compatibles con apendicitis aguda perforada, por lo cual ingresó a pabellón para laparoscopía. Confirmado el diagnóstico, se realizó apendicectomía. Dos semanas después en consulta ambulatoria, se evidenció y confirmó con ecografía una hernia inguinal bilateral que se corrigió quirúrgicamente. CONCLUSIÓN: La apendicitis aguda debe considerarse dentro de los diagnósticos diferenciales en neonatos con clínica de abdomen agudo, principalmente en prematuros. En este caso, la ecografía permitió realizar el diagnóstico pre-operatorio. La posible asociación con hernia inguinal, debiera motivar a examinar siempre conductos inguinales durante la evaluación con imá genes y en el procedimiento quirúrgico.

INTRODUCTION: Acute neonatal appendicitis is a rare pathology, with few reports in the last 30 years. Since its clinical presentation and imaging studies are non-specific, most cases are diagnosed during a surgical pro cedure. OBJECTIVE: To describe a neonatal case of acute perforated appendicitis associated with later appearance of inguinal hernia, with pre-surgical diagnosis and treated through laparoscopy. CLINICAL CASE: A 17-day-old preterm female newborn presented with fever, irritability, and increased milk intolerance. Physical examination showed abdominal distention, tenderness and both, abdominal X- ray and ultrasound showed compatible images with acute perforated appendicitis. Once the diagnosis was confirmed, we performed an appendicectomy through laparoscopy. Two weeks later, during an outpatient visit, we observed a bilateral inguinal hernia which was confirmed by ultrasound, and then it was surgically corrected. CONCLUSION: Acute appendicitis should be considered within the differential diagnosis in neonates with acute abdominal symptoms, mainly in premature infants. In this case, ultrasound scan allowed us to make the pre-operative diagnosis. The possible association with inguinal hernias should motivate to examine inguinal ducts during imaging assessment and surgical procedure.

Caracterización de las reintervenciones en cirugía general / Characterization of the reoperations in general surgery

Introducción: a pesar del avance en los métodos diagnósticos y terapéuticos actuales, la morbilidad y la mortalidad a causa de las reintervenciones por complicaciones posoperatorias continúan elevadas. Objetivos: caracterizar a los pacientes reintervenidos quirúrgicamente según variables seleccionadas e identificar los niveles de mortalidad . Métodos: se efectuó un estudio observacional y descriptivo de 172 casos reintervenidos en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, durante el quinquenio 2007-2011. Resultados: la mayoría de las reintervenciones se efectuaron durante la primera semana del período posoperatorio a pacientes del sexo masculino con edades avanzadas y cuya cirugía inicial se había realizado de urgencia. Las principales complicaciones que las motivaron fueron: absceso intraabdominal, evisceración y hemorragia posquirúrgica, aunque el mayor porcentaje correspondió al neumotórax y la neoplasia de colon. La mortalidad alcanzó 24,5 % y preponderó en enfermos con diagnósticos iniciales de neoplasia de colon, úlcera gastroduodenal complicada y oclusión intestinal. Conclusiones: la edad, el número de reintervenciones y el tiempo transcurrido desde la cirugía inicial hasta la reintervención elevaron el índice de mortalidad, asociada a fallos múltiples de órganos.

Introduction: in spite of the advance in the current diagnostic and therapeutic methods, the morbidity and mortality caused by reoperations due to postoperative complications continue to be high. Objectives: to characterize reoperated patients according to selected variables and to identify the mortality levels. Methods: an observational and descriptive study of 172 reoperated cases was carried out in the Service of General Surgery from "Saturnino Lora Torres" Clinical Surgical Teaching Provincial Hospital in Santiago de Cuba, during the five year period 2007-2011. Results: most of the reoperations were carried out during the first week of the postoperative period to patients of the male sex with advanced ages and whose initial surgery had been an emergency. The main complications motivating them were: intraabdominal abscess, evisceration and postsurgical hemorrhage, although the highest percentage corresponded to pneumothorax and colon neoplasia. Mortality reached 24.5% and it prevailed in patients with initial diagnosis of colon neoplasia, complicated gastroduodenal ulcer and intestinal occlusion. Conclusions: the age, the number of reoperations and the lapsed time from the initial surgery to the reoperation elevated the mortality rate, associated with multiple organs failures.

Mortalidad y reintervenciones en cirugía general / Mortality and reoperations in general surgery

Introducción: A pesar de que el gran avance tecnológico actual en los métodos diagnósticos y terapéuticos ha permitido que los pacientes con complicaciones posquirúrgicas sean reintervenidos con mayor seguridad, la morbilidad y la mortalidad a causa de estas continúan elevadas. Métodos: Se efectuó un estudio observacional y descriptivo de 42 fallecidos que habían sido reintervenidos en el Servicio de Cirugía General del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba, durante el quinquenio 2007-2011.Objetivo: Caracterizar a dichos pacientes según variables seleccionadas e identificar la mortalidad y sus causas. Resultados: El mayor número de fallecimientos se relacionó con la realización de varias reintervenciones después de 10 días de la operación inicial en pacientes de edades avanzadas. Las principales complicaciones que las motivaron fueron: absceso intraabdominal, evisceración, peritonitis residual y dehiscencia de suturas intestinales. Esta serie representó 24,5 por ciento del total de reintervenidos y preponderó en los diagnósticos operatorios iniciales: neoplasia de colon, úlcera gastroduodenal complicada y oclusión intestinal. Conclusiones: La edad, el número de reintervenciones, así como el tiempo entre la cirugía inicial y la reintervención elevan el índice de mortalidad, asociada a fallos multiorgánicos.

Introduction: Although the current technological breakthrough in diagnostic and therapeutic methods has allowed patients with postoperative complications are more safely reoperated, morbidity and mortality because of these complications are still high. Methods: An observational and descriptive study in 42 dead patients was carried out who had been reoperated at the General Surgery Department of Saturnino Lora Provincial Teaching Hospital in Santiago de Cuba during the period 2007-2011. Objective: To characterize these patients according to selected variables and identify mortality and its causes. Results: The highest number of deaths was related to several reoperations after 10 days of the initial surgery in aged patients. The main complications were intraabdominal abscess, evisceration, residual peritonitis and dehiscence of intestinal sutures. This series represented 24.5 percent of the total of reoperated patients, and colon neoplasia, complicated peptic ulcer and intestinal occlusion prevailed in the initial preoperative diagnosis. Conclusions: Age, number of reoperations and the time between the initial surgery and reoperation increase the mortality rate associated with multiple organ failure.

Contraindicaciones de la cirugía de catarata en pacientes del municipio Maracaibo / Cataract surgery contraindications for patients from Maracaibo municipality

Se hizo un estudio descriptivo y transversal de 76 pacientes con catarata, que no pudieron ser intervenidos quirúrgicamente en el Centro Oftalmológico del municipio de Maracaibo, perteneciente al estado de Zulia (Venezuela), desde junio hasta julio del 2009, a fin de identificar las principales causas que estaban contraindicando la operación de esa oftalmopatía, para lo cual se examinó un ojo de cada integrante de la serie. En la casuística predominaron el grupo etario de 60-69 años y el sexo masculino, así como la agudeza visual por debajo de 0,3 y el diagnóstico prequirúrgico de catarata senil. La degeneración macular asociada a la edad prevaleció como la enfermedad más frecuente que invalidara la cirugía, con primacía de la opacidad lenticular nuclear en cuanto a la clasificación morfológica. Se concluyó que no siempre la opacidad del cristalino causa la mala visión, por lo que es necesario realizar un detallado examen oftalmológico.

A descriptive and cross-sectional study of 76 patients with cataract, who could not be surgically treated at the Ophthalmological Center from Maracaibo municipality, belonging to Zulia State (Venezuela), was carried out from June to July, 2009 in order to identify the main causes that were contraindicating the ophthalmopathy surgery, for which each participant's eye was examined. The 60-69-year-old age group and male sex, as well as the visual sharpness under 0,3 and pre-surgical diagnosis of senile cataract, were predominant in the case material. Macular degeneration associated with age prevailed as the most frequent disease invalidating the surgery, giving some priority to nuclear lenticular opacity according to morphological classification. It was concluded that opacity of crystalline lens does not always cause bad vision, thus it is necessary to carry out a detailed ophthalmological test.

The Surgical Diagnosis for Detecting Early Gastric Cancer and Lymph Node Metastasis: Its Role for Making the Decision of the Limited Surgery

PURPOSE: The aim of this study is to evaluate the accuracy of surgically diagnosing early gastric cancer (EGC) and lymph node metastasis, and to determine its role for performing limited surgery for EGC. MATERIALS AND METHODS: We reviewed 369 patients who underwent gastrectomy for primary gastric carcinoma. The surgical diagnosis was evaluated by determining its sensitivity, specificity and accuracy, and this was compared with the preoperative examinations. RESULTS: The sensitivity, specificity, and accuracy of the intraoperative diagnosis for EGC were 74.5%, 95.7% and 83.7%, respectively. The predictive value for EGC according to the intraoperative diagnosis was 95.7%. The surgical diagnosis of EGC showed higher specificity and a higher predictive value than preoperative examinations, which significantly reduced the risk of underestimating advanced gastric cancer (AGC) to EGC. The sensitivity, specificity, and accuracy for lymph node metastasis according to the surgical diagnosis were 73.2%, 78.1% and 76.4%, respectively. For 70 patients with a discrepancy in the diagnosis of EGC between the pre- and intra-operative diagnosis, the surgical diagnosis was correct in 63 (90%) patients, but the preoperative examinations were correct in only 7 (10%) patients. CONCLUSION: The surgical diagnosis showed better accuracy than the preoperative examinations for detecting EGC and lymph node metastasis. Our results suggest that the decision for conducting limited surgery based on the surgical diagnosis might reduce the risk of under-treatment of AGC to EGC better than the preoperative examinations.

Surgical Diagnosis and Treatment of Empyema in Children / 医学研究杂志

Objective To explore the surgical diagnosis of pediatric empyema, treatment and surgical operation opportunity. Methods From July 2003 to March 2009, 55 cases were treated , and plcural effusion was punctured in 2 cases. Closed drainage of thoracic cavitythe was done under local anesthesia in rest cases. 21 case fully recovered and 32 cases were taken pleural decortication. One case was taken pleural decortication and thoracoplasty. Results There was no operative mortality. After follow - up of 3 to 24 months, there was no recurrence , no complications such as thoracic deformity. Conclusion Pediatric empyema need timely diagnosis and active conservative treatment. Once fluidify absorbed slowly and there was persistent tendency, operation need to be done as soon as possible. After pleural decortication, we can get satisfied therapeutic effect.