ABSTRACT
Se presenta la experiencia en el tratamiento quirúrgico de la patología vesicular litiásica, mediante videolaparoscopia, en una serie prospectiva de 119 pacientes de 60 o más años de edad, de ambos sexos, operados entre Marzo de 2003 y Marzo de 2004, en el Departamento y Servicio de Cirugía del Hospital Barros Luco Trudeau analizando la patología médica asociada, presente en el 70 por ciento, los hallazgos relevantes del estudio ecotomográfico preoperatorio (99,1 por ciento), las cifras de conversión a cirugía laparotómica (19 por ciento), la morbilidad (8,4 por ciento) y la mortalidad (0 por ciento).
We report our surgical experience in videolaparoscopic cholecystectomy in 119 patients with 60 or more years old, operated between March 2003 and March 2004, at the Barros Luco's Surgical Department and Service. We analized the medical pathology (70 percent of patients); the relevant finding at the preoperative ultrasonic study (99,2 percent of patients); the conversion rate (19 percent) and postoperatory results.
Subject(s)
Humans , Male , Female , Middle Aged , Aged, 80 and over , Cholecystectomy, Laparoscopic/methods , Cholecystitis/surgery , Cholelithiasis/surgery , Video-Assisted Surgery , Chile/epidemiology , Cholecystectomy, Laparoscopic/statistics & numerical data , Cholecystitis/complications , Cholecystitis/epidemiology , Cholelithiasis/complications , Cholelithiasis/epidemiology , Postoperative Care/mortality , Postoperative Complications , Prospective Studies , Treatment OutcomeABSTRACT
INTRODUCTION: Osteopenia and osteoporosis after renal transplantation have been associated with factors related to the cause of end-stage renal disease, as well as to clinical events and therapeutic factors in the posttransplant period. We studied the prevalence of low bone density (LBD) according to WHO criteria. METHODS: A cross-sectional study was performed in a cohort of 106 patients (54 men and 52 women) with functioning renal allografts, who underwent bone densitometry (DEXA) of the lumbar spine and femoral neck. Patients were grouped according to DEXA into those with normal bone density (NBD) or LBD. We studied clinical, analytical, and therapeutic variables. RESULTS: Thirtysix patients (34%) had NBD and 70 patients (66%) LBD. Weight was the only parameter showing a significant difference (P = .034), namely, among NBD it was 80.44+/-15.13 versus LBD 73.94 +/- 14.54 kg, respectively. Creatinine clearance (CCr) tended to be lower among patients with LBD 59.62 +/- 22.73 versus 69.59 +/- 28.15 mL/min in patients with NBD (P = .052). PTHi levels were higher in patients with LBD (149.39 +/- 110.75) than those with NBD (110.94 +/- 82.61) (P = .069). In the multivariate analysis the important determinants were weight Exp(ss) = 0.967 [CI = 0.939 to 0.996] (P = .036); CCr Exp(ss) = 0.982 [CI = 0.965 to 1.000] (P = .055); and PTHi levels Exp(ss) = 1.003 [CI = 0.932 to 0.994] (P = .059). CONCLUSIONS: Osteopenia and osteoporosis are frequent among kidney transplant patients (66%), with a similar distribution between the lumbar spine and femoral neck. Excess weight and possibly better renal function may be protective factors. The cumulative steroid dose showed a significant effect on bone density. As expected, secondary hyperparathyroidism in patients with renal impairment seemed to be a risk factor for LBD.
Subject(s)
Bone Density/physiology , Kidney Transplantation/physiology , Absorptiometry, Photon , Adult , Bone Diseases, Metabolic/epidemiology , Cohort Studies , Cross-Sectional Studies , Female , Fractures, Bone/epidemiology , Humans , Male , Middle Aged , Osteoporosis/epidemiology , Postmenopause , Postoperative Complications/epidemiologyABSTRACT
Se presentan y analizan los resultados en el manejo de la peritonitis aguda grave con la técnica de la laparostomía; son 12 pacientes tratados por los autores desde agosto 1983 a agosto 1984. Corresponden a 6 mujeres y 6 hombres, con una edad promedio de 37 años. Se describe el grupo en cuanto a la etiología de la peritonitis y a la indicación de la laparostomía, como asimismo las características de gravedad del cuadro séptico simpre presente, identificada por el número de sistemas comprometidos. Las complicaciones de la técnica estuvieron representadas por una fístula intestinal múltiple (8,3%), y la mortalidad por 3 pacientes (25%) que son analizados. Se comentan las ventajas del procedimiento. Se concluye: 1) Es un excelente recurso para ser agregado al manejo médico-quirúrgico de la peritonitis aguda grave y debe utilizarse siempre que ella se acompañe de una septicemia no controlada. 2)Es de gran efectividad para evitar los focos residuales intraperitoneales y para recuperar, tratar y evitar las infecciones severas de la pared abdominal por gérmenes anaerobios u otros
