La técnica del "recorta y pega" en publicaciones científicas / "Copy-paste" techniques in scientific publications

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Colecistectomía laparoscópica en el paciente geriátrico con edad superior a 80 años / No disponible

Fundamentos. En el presente artículo analizamos los resultados y complicaciones de la colecistectomía laparoscópica en pacientes octogenarios. El objetivo es establecer si la cirugía endoscópica, programada o urgente, es el tratamiento electivo de la colelitiasis en edades extremas. Métodos: Realizamos un estudio retrospectivo sobre pacientes con edad igual o superior a 80 años, sometidos a una colecistectomía laparoscópica entre enero de 2002 y enero de 2006. Los principales parámetros analizados fueron: epidemiología, forma de presentación, valoración del estado general y del riesgo anestésico, tasa de conversión, morbilidad y estancia hospitalaria. Resultados: En el periodo estudiado se intervinieron 43 pacientes, 27 mujeres (63%) y 16 hombres con una edad media de 83.5 años (máxima 92). La cirugía fue programada en 28 casos (65%) y urgente en 15. La tasa de conversión a colecistectomía abierta fue del 11.6% y la estancia hospitalaria media de 3.9 días. Dos enfermos precisaron de una reintervención y hubo un fallecido. Conclusiones: La colecistectomía laparoscópica es la técnica de elección para el tratamiento de la colelitiasis sintomática en octogenarios. La colecistitis aguda del anciano debe ser tratada mediante abordaje laparoscópico, salvo contraindicación, preferentemente antes de aparezcan complicaciones (AU)

Background: In the current article, we analyse the results and complications of laparoscopic cholecystectomy in octogenarian patients. The aim is to determine whether the open procedure (either programmed or emergent surgery) is the elective treatment of cholelithiasis in extremely elderly patients. Methods: We implement a retrospective study in patients aged 80 years or older. They under went laparoscopic cholecystectomy between January 2002 and January 2006. Variables analysed were epidemiology, initial presentation, assessment of physical condition and anesthetic risk, conversion rate, morbidity and hospital stay. Results: The study group consisted of 43 patients, 27 women (63%) and 16 men, mean age 83.5 years (maximum 92). Programmed surgery was attempted in 28 cases (65%) and emergent 15 cases. The conversion rate to open cholecystectomy was 11.6% and the average hospital stay was 3.9 days. Two patients required reintervention and one patient died. Conclusions: Laparoscopic cholecystectomy is elective treatment for symptomatic cholelithiasis in octogenarian people. The management of acute cholecystitis in the extremely elderly should be considered for laparoscopic approach (except contraindication) before the development of complications (AU)

Hospital-in-the-home treatment of surgical infectious diseases: an economic analysis.

BACKGROUND: A growing number of surgical infections can be treated safely and effectively with parenteral antimicrobial therapy in the patient's home. Our objective was to define the economic impact of a hospital-in-the-home unit (HITH) introduced into a surgical unit. METHODS: Patients admitted to the HITH must be assessed thoroughly for suitability, including clinical stability and social circumstances, and both patient and caregiver consent must be obtained. The HITH received all stable surgical patients with complicated infections and an expected long-term stay. A total of 150 patients were enrolled during a 12-month period. Patients were reviewed daily to monitor the progress of therapy and check for possible complications. Antibiotic selection was based on appropriate prescribing principles rather than dosing convenience. Innovative dosing regimens were included, such as once-daily aminoglycosides, continuous-infusion beta-lactams, once- or twice-daily cephalosporins, and oral fluoroquinolones in order to provide effective therapy for a wide range of infections that previously would have required in-hospital care. Economic efficiency for both the surgical and the HITH unit was assessed by examining Diagnosis-Related Group (DRG)-based clinical processes, profits and losses of each clinical process, and a quantitative model for performance evaluation and benchmarking (data envelopment analysis; DEA). RESULTS: The mean stay in the surgical unit was decreased (3.95 days) while increasing the case mix (1.42). At the same time, HITH patients had a mean stay of 8.69 days with a stable case mix of 1.61. The economic benefit of both units increased in the surgical unit because of a shorter stay and in the HITH secondary to greater impact of the case mix while maintaining the mean stay. CONCLUSIONS: Appropriate use of HITH leads to greater patient and caregiver satisfaction, efficient in-hospital bed use, and financial efficiencies. Patients receiving intravenous antibiotics, wound care, parenteral nutrition, or transfusions do not always need to be in the hospital.

Indicaciones y técnica de la esclero-microcirugía en flebología estética / Indications and technique for combined (surgery-sclerotherapy) treatment of varicosities in esthetic phlebology

Objetivo: analizar las complicaciones y resultados de la esclerosis y la esclero-microcirugía en el tratamiento estético de las varices en las extremidades inferiores. Método: Se realizó un estudio prospectivo, observacional y no randomizado a pacientes sometidos a esclerosis de varices entre enero de 2001 y enero de 2006. el esclerosante elegido fue polidocanol y la técnica francesa. Como técnicas quirúrgicas complementarias se practicaron desconexiones selectivas y flebectomías. Se registraron todas las complicaciones y se valoró estéticamente el resultado final, por el paciente y el facultativo, mediante una escala subjetiva. Resultados: Fueron tratados 141 pacientes, 95 mediante esclerosis pura y 46 con esclero-microcirugía, todos del sexo femenino, con una edad media de 41.5 años. En un 42% de los casos habían recibido terapia hormonal anticonceptiva o sustitutiva y un 325 tratamiento previo de sus varices. El número medio de sesiones fue de 5 (máximo 21). La complicación más frecuente fue la presencia de tenues hiperpigmentaciones postesclerosis (16%). Se revisó a los enfermos dos meses después de la finalización de la terapia. Los resultados fueron buenos o muy buenos para un 94% de los pacientes encuestados. Durante el seguimiento a largo plazo un 24% presentaron recidivas varicosas subsidiarias de un nuevo tratamiento. conclusiones: La esclerosis, con o sin microcirugía, es un buen tratatmiento estético para las varices conexcelente tolerancia y baja morbilidad

Objective: To analyse complications and results of sclerotherapy and sclero-microsurgery in the cosmetic varicose veins treatment placed on lower limbs. Method: We made a prospective, observational and non-randomised study addressed to patients submitted to sclerotherapy for varicose veins between January 2001 and January 2006. We choose polydocanol as sclerosant and the French technique. the complementary surgical tecniques were selective disconnections and phlebectomies. all complications were recorded and the final outcome was evaluated in aesthetic terms by both, patients and clinician through a subjective rating scale. Results: A total of 141 patients were treated, 95 by means of pure sclerotherapy and 46 with microsurgery. all of them were female patients with a mean age of 41.5 years, 42% of whom had received contraceptive or replacement hormonetherapy and another 32% had already been treated for varicose veins. The average number of sclerotherapy sessions was 5 (with a maximum of 21). the most frequent complication was the presence of faint hyperpigmentation following sclerotherapy (16%). Patients were reviewed two months after therapy had finished. Results were good or very good in 94% of the patients surveyed. During the long term follow-up 24%presented recurrent varicose veins that could benefit from renewed treatment. Conclusions: Sclerotherapy, with or without microsurgery, is good cosmetic therapy for varicose veins with high tolerance and low morbidity rates

Safenectomía ambulatoria y con ingreso de 12 horas. Revisión crítica y líneas de mejora / Ambulatory and short-stay saphenectomy. A review of current practice and suggestions for improvement

El tratamiento de la insuficiencia venosa crónica mediante safenectomía sin ingreso mejora la calidad del proceso quirúrgico: menos morbilidad, elevada satisfacción del paciente y contención del gasto sanitario. El desarrollo de una trayectoria clínica específica dentro de la Vía Clínica de la Safenectomía permite una buena selección de candidatos para la cirugía sin hospitalización y estandarizar las diversas actuaciones médicas, administrativas y logísticas. En el presente artículo realizamos una revisión de nuetras pautas terapéuticas actuales y estudiamos el desarrollo de una trayectoria clínica para la safenectomía ambulatoria en nuestro centro hospitalario

Treatment of chronic venous insufficiency by means of ambulatory saphenectomy improves the quality of surgical process: low morbidity, great patient satisfaction and the most cost-effective way. Implementation of an Anticipated Recovery Pathway allows a good selection of candidates for Day surgery and hte standarization of different medical, administrative and logistical actions. In this article, we study the development of an anticipated Recovery pathway of ambulatory saphenectomy in our hospital

Integración de sistemas de control de calidad y gestión en unidades de hospitalización domiciliaria / Integration of quality assurance and management systems in domiciliary care units

Objetivos: Delimitar los indicadores establecidos en un plan de implantación de una unidad de hospitalización domiciliaria empleando 2 herramientas de gestión de calidad: el cuadro de mandos integral (CMI) y un proceso asistencial que sigue la normativa ISO 9001:2000 (PA). Método: Durante el proceso de creación de una nueva unidad de hospitalización a domicilio en nuestro centro, se ha procedido a alinear los indicadores de calidad establecidos por el PA y los objetivos estratégicos establecidos por la dirección para esta unidad incluidos en su mapa estratégico diseñado siguiendo un modelo de CMI. Como norma general, se ha buscado que los indicadores asistenciales y los de gestión estuviesen incluidos en datos comparables, recogidos de bases de datos exportadas de los sistemas de información HP-HIS, Gacela, Doctor y Navisión. Resultados: Se seleccionaron 15 indicadores estratégicos en el cuadro de mandos (los 7 asistenciales del PA, 6 indicadores de gestión asistencial y 2 económico-financieros) y 10 indicadores del PA (8 asistenciales y 2 de gestión). La concordancia entre los indicadores estratégicos fue estandarizada para poder relacionar los indicadores de calidad asistencial puros con los de gestión económica. Conclusiones: Que se pueda exportar mensualmente a los cuadros de mandos los datos incluidos en ellos permite imbricar el proceso de gestión con el asistencial de forma coordinada y asimilar los flujos de demanda asistencial con refuerzos de recursos logísticos y humanos

Objectives: To determine the health management indicators established during the implantation a new domiciliary care unit using 2 defined management tools: the balanced scorecard (BSC) and the patient management process following the norms defined by ISO 9002. Method: During the creation of the new domiciliary care unit, the quality indicators defined by the ISO model and the strategic and management indicators established by the BSC for the unit were aligned. As a general rule, the healthcare indicators were established by well defined and parametric variables defined in the health management programs (HP-HIS, Gacela, Doctor and Navision). Results: Fifteen strategic indicators were included in the BSC (7 from the ISO process, 6 from health management and 2 economic) and 10 in the ISO process (8 intrinsic to the quality of care and 2 from health management). The agreement between strategic indicators was standardized so that both healthcare quality and economic management indicators could be integrated. Conclusions: The ability to export data included in the BSC to the management BSC each month allows us to coordinate both systems, thus permitting logistic and human resources to be adjusted to variations in clinical workload

Beneficios tangibles e intangibles de las nuevas tecnologías sanitarias / Tangible and intangible benefits of the new sanitary technologies

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Intraoperative monitoring of kinetic total serum calcium levels in primary hyperparathyroidism surgery.

BACKGROUND: In the setting of minimal approach Sestamibi-guided parathyroid surgery for primary hyperparathyroidism we evaluated if total serum calcium level monitoring is as valuable as intraoperative parathyroid hormone (iPTH) monitoring. STUDY DESIGN: Prospective open single-blinded efficacy trial of two intraoperative diagnostic monitoring methods (iPTH and total serum calcium level) on a cohort of surgical patients. All patients (n = 35) were undergoing parathyroid surgery at the Department of General Surgery at B Cruces' Hospital, Vizcaya, Spain, between October 1999 and March 2001. Kinetics of serum levels of Ca and iPTH during surgery and time of prediction of cure for each method (measured in the clinic, admission, and intraoperatively, such as induction of anesthesia, and every 5 minutes after removal of adenoma) were analyzed. RESULTS: Hypercalcemia and iPTH levels became corrected in 34 patients. Average serum calcium levels dropped from pathologic 11.07 +/- 0.41 mg/dL (mean +/- standard deviation) to normal values 9.7 +/- 0.82 mg/dL during the first intraoperative determination (minute 5), but mean iPTH decreased from pathologic (192 +/- 98 pg/mL) to normal values (39.93 +/- 25.12 pg/mL) during the third intraoperative determination (minute 15). Serum calcium level at 5 minutes after removal decreased by 100% in 34 patients, but iPTH only showed a similar drop during the third determination at 15 minutes. Frozen sections were conclusive for parathyroid tissue (20.56 +/- 10.3 minutes after removal). CONCLUSIONS: Intraoperative measurement of total calcium level might be an easier and less expensive method than iPTH measurement in the prediction of cure during surgery for primary hyperparathyroidism resulting from adenoma.

Trypsinogen activation peptide (TAP) expression in gallbladder bile identifies bilio-pancreatic carcinoma.

BACKGROUND: The prognosis of bilio-pancreatic cancer (pancreas, bile duct and gallbladder) is poor due to the fact of late diagnosis. The only curative treatment for such tumors is surgery. The 5-year survival rate is still below 5% and less than one-third of patients suffering from such carcinomas are resectable at the time of diagnosis. Although specific tumor markers do exist, to date there is no screening marker for these diseases. MATERIALS AND METHODS: Gallbladder bile of 44 consecutive cholecystectomized patients were prospectively analyzed for TAP concentrations. Group one (n = 14) consisted of the patients suffering from malignancies of the bilio-pancreatic system, group 2 (n = 22) comprised patients suffering from benign biliar or pancreatic diseases and group 3 (n = 6) included patients suffering from gastrointestinal carcinoma outside the bilio-pancreatic system with no affection of the bilio-pancreatic system. RESULTS: The median TAP gallbladder bile concentration in malignant disease of the bilio-pancreatic system was 1328.00 nmol/l (range: 83.69-5133.00). Benign bilio-pancreatic disease revealed a median TAP bile concentration of 2.02 nmol/l equaling the concentration of patients suffering from other gastrointestinal carcinomas with a median of 2.00 nmol/l. In the control groups (2 + 3) there was a significant difference for TAP bile concentrations with an increase in the case of acute inflammation. CONCLUSION: Gallbladder bile TAP concentration discriminates between benign and malignant lesions of the bilio-pancreatic system. In the case of benign disease there is a significantly higher TAP concentration in the case of acute inflammation.

Abdomen agudo por linfangioma quístico multilocular / Acute abdomen due to multilocular cystic lymphangioma

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Bacteriología en el paciente quirúrgico de edad avanzada. ¿Aplicamos correctamente los antimicrobianos? / Bacteriology in the elderly surgical patient. We apply correctly the antibiotics?

Introducción: la infección quirúrgica en el paciente de edad avanzada presenta una incidencia superior a la del resto de la población, conllevando a un severo compromiso de la morbimortalidad del paciente. Objetivo del estudio: reconocer las particularidades microbiológicas de las infecciones quirúrgicas en mayores de 65 años. Establecer las diferencias cuanti-cualitativas comparándolas con el del resto de la población. Pacientes y métodos: en los últimos 2 años se han intervenido un total de 2,064 pacientes, 1,367 (66,7 por ciento) 65 años. Fueron analizados los datos demográficos de los pacientes, la cirugía realizada y las características del procedimiento quirúrgico. Se remitieron para estudio microbiológico 1.562 muestras. El espectro microbiológico responsable de la infección se comparó entre ambas poblaciones empleando el estadístico x2. Resultados: los pacientes de más de 65 años evidenciaron modificaciones cuantitativas y cualitativas en el patrón microbiológico. Las diferencias más significativas correspondieron a las cirugías limpiacontaminada, contaminada y sucia. La presencia de levaduras adquirió especial relevancia en este grupo de pacientes. Conclusiones: las enterobacterias, los cocos grampositivos aerobios y los hongos, constituyeron los microorganismos más significativos en la infección quirúrgica del paciente de edad, condicionando una adecuación de la antibioticoterapia en el mismo. (AU)