Rotura de colon durante una colonoscopia secundaria a la torsión de un apéndice epiploico / Colonic perforation during a colonoscopy secondary to a torsión of an epiploic appendix

No disponible

Resultados de la hospitalización en pacientes con pie diabético / Results of hospitalization in patients with diabetic foot

Objetivo. Conocer la evolución clínica y el coste durante la hospitalización de los pacientes diabéticos ingresados a causa de complicaciones infecciosas y/o isquémicas relativas a los pies. Pacientes y método. Estudio retrospectivo de todos los casos ingresados con los diagnósticos de úlcera, celulitis, isquemia y gangrena del pie en diabéticos, en un servicio de cirugía general de un hospital de área durante los años 1999-2001. Resultados. Se incluyó a 249 pacientes (el 41 por ciento mujeres y el 51 por ciento varones), con una edad media de 67 años. El 23,7 por ciento precisó una amputación mayor, el 35,7 por ciento una amputación menor y el resto, el 40,6 por ciento, no precisó amputación alguna. La edad media de los pacientes con amputación mayor fue de 76,8 años. La mortalidad global fue del 4,8 por ciento, siendo del 10 por ciento en los pacientes que precisaron amputación mayor. La estancia media fue de 11 días. El coste medio por proceso osciló entre 1.165 y 1.830 € para los pacientes sin amputación alguna, entre 2.840 y 2.900 € para los pacientes con amputación menor y 3.400-4.000 € para los pacientes con amputación mayor. La hospitalización anual supuso un coste global entre 200.000 y 230.000 € para este grupo de pacientes. Conclusiones. El pie diabético es una patología frecuente en un servicio de cirugía general de un hospital de área. Afecta habitualmente a pacientes de avanzada edad y hasta el 40 por ciento de los casos concluye con amputaciones de diverso grado. La mortalidad es elevada y las repercusiones socioeconómicas son muy altas (AU)

Contribution of the outpatient surgery unit ITO the general surgery department of a district hospital.

Introduction: The creation of Outpatient Surgery (OPS) units to combine the quality of medical attention and rationalize costs allows for greater efficiency in the use of resources. Aim: To report our series of patients undergoing surgery at the OPS units integrated into our Hospital (Type II): Patients and method: Between May 1994 and March 1998, 832 outpatients, of a total of 5230, underwent surgery at our General Surgery Unit. The criteria for exclusion from the programme depended on the patient and the enviroment or resulted from the operation itself. Results: Mean patient age was 47.5 years; there were 420 males and 412 females. Surgery was performed for 229 inguinofemoral hernias, 47 umbilical-epigastric hernias, nine incisional hernias, 193 pilonidal sinuses, 156 mammary nodules, 65 varicose veins, 64 arteriovenous fistulae and 69 proctology operations. The most common anesthesia techniques performed were rachianesthesia and local anesthesia. Eight point seven percent of the patients required admission (OPS failure), the most frequent causes being excessive pain, orthostatic-syncopal hypotension, nausea and vomiting and urine retention. There was no morbidity or mortality. Conclusion: OPS is a highly efficient procedure for resolving the most common pathologies in General Surgery. The anesthesia technique was an important factor in the rate of failure.

Treatment of the abdominal wall defects in an ambulatory surgical setting: our experience.

Introduction: The creation of Outpatient Surgery (OPS) units has allowed to reduce the costs and the waiting lists in an efficient fashion. We describe our series of patients operated on for abdominal wall defects, a pathology suitable for ambulatory surgery. Patients and methods: Between May 1994 and March 1998, 206 inguinal hernias, 23 femoral hernias, 47 umbilical-epigastric hernias and nine incisional hernias were operated on in an ambulatory surgical setting. The patients were selected following the selection criteria previously established (related to the patient, the environment and the surgical procedure). The average age was 45 years, and the distribution by sex, 210 men and 75 women. Spinal anesthesia was preferently performed. The surgical techniques employed were Lichtenstein's hernioplasty and Shouldice and Bassini procedures for inguinal hernias; Lichtenstein's plug technique for femoral hernias and simple closure or preperitoneal mesh for the middle line defects. Results: 44 patients needed readmitttance to hospital (failure of OPS), the most important causes being excessive pain, urinary retention and nausea/vomiting. There was no severe morbidity nor mortality. Conclusion: Surgery for abdominal wall defects constitutes a group of procedures suitable for efficient and low risk OPS programs.