Factores relacionados con eventos adversos reportados por enfermería en unidades de cuidados intensivos. Proyecto multicéntrico / Factors related to nursing-reported adverse events in intensive care units: Multicenter project / Fatores relacionados com a presença de eventos adversos informados pela enfermagem na unidade de cuidados intensivos. Projeto multicêntrico

La atención a la salud a veces puede representar un riesgo para los pacientes, que puede derivar en daño físico, psicológico, social, económico, e incluso la muerte. Estos incidentes se denominan eventos adversos (EA) y se presentan durante el proceso de atención. Objetivo: Determinar la ocurrencia de los EA en las áreas de cuidados intensivos y conocer los factores intrínsecos, extrínsecos y del sistema que están presentes en la aparición de un EA, así como su evitabilidad y gravedad. Métodos: Estudio multicéntrico, analítico, transversal y observacional, en siete instituciones de salud de carácter público y de alta especialidad en México. La muestra estuvo compuesta por 137 personas durante el periodo comprendido del 1-04-2012 al 31-01-2013. Los datos se recolectaron con la ficha de notificación de EA tomada y adaptada del proyecto SYREC 2007. Se utilizó el programa estadístico SPSS versión 17. Se realizaron pruebas de correlación de Spearman y phi, U de Mann-Witney, Kruskal-Wallis y Chi2. Resultados: El 58% de los EA se presentaron en pacientes masculinos, el 60% en edad pediátrica. Los EA relacionados con el cuidado fueron los más frecuentes con un 29.9%. En el 51% estuvieron relacionados con invalidez temporal. En un 75% de los casos se pudieron evitar. Sobresalen los factores del sistema con un 98%.Conclusiones: La población más vulnerable son los niños y los adultos mayores, los EA están relacionados directamente con el cuidado de enfermería y su mayoría son evitables. Es necesario implementar estrategias para la gestión de la seguridad del paciente para detectar, registrar, prevenir y minimizar su frecuencia.

Health treatment can sometimes involve risk for patients, which can result in physical, psychological, social, or financial damage, and even death. These incidents are called adverse events (AE) and occur during the treatment process.ObjectiveTo determine the occurrence of AE in intensive care areas, and identify the intrinsic, extrinsic, and systemic factors involved in an AE, and to assess their severity and how to avoid them. Methods Multi-centric, analytic, transversal, and observational study conducted on 7 public and high specialty health institutions in Mexico with a sample of 137 individuals. The study was carried out from 04/01/2012 to 01/31/2013. Data were collected through SYREC 2007 project adapted AE notification charts. SPSS version 17 was used. Spearman, Phi, Mann-Whitney U, Kruskal-Wallis and Chi2 tests were performed. Results:58% of AE occurred among male patients, 60% among the pediatric population. The most frequent AE were those related to care (29.9%). 51% were related to temporal disability. 75% of the cases could not be avoided. Systemic factors were the prevalent ones with 98%. Conclusions: The most vulnerable populations are children and the elderly. AE are directly related to nursing care and most are avoidable. It is necessary to implement strategies to manage patient safety in order to detect, register, prevent, and minimize the frequency of AE.

A atenção à saúde representa em vários momentos um risco para os pacientes, que pode derivar em dano físico, psicológico, social, económico, inclusivé a morte. Estes incidentes denominam-se eventos adversos (EA), apresentam-se durante o processo de atenção. Objetivo Determinar a ocorrência dos EA nas áreas de cuidados intensivos e conhecer fatores intrínsecos, extrínsecos e do sistema que estão presentes no aparecimento de um EA, bem como a possibilidade de evita-los e a sua gravidade. Métodos: Estudo multicêntrico, analítico, transversal e observacional, em 7 instituições de saúde pública e de alta especialidade no México. A amostra foi de (n = 137) durante o periodo compreendido entre 01-04-2012 e 31-01-2013. Os dados foram recolhidos com a ficha de notificação de EA tomada e adaptada do projeto SYREC 2007. Utilizou-se o programa estatístico SPSS versão 17. Realizaram-se testes de correlação de Spearman e Phi, U de Mann-Witney, Kruskal-Wallis e Chi2. Resultados: Os 58% dos EA apresentaram-se nos pacientes masculinos, os 60% na idade pediátrica. Os EA mais frequentes foram relacionados com o cuidado, com 29.9%. 51% estiveram relacionados com incapacidade temporária. Em 75% dos casos pôde-se evitar. Sobressaem os fatores do sistema com 98%. Conclusões: A população mais vulnerável são as crianças e os idosos, os EA relacionam-se diretamente com o cuidado da enfermagem e a sua maioria são evitáveis. É necessário implementar estratégias para a gestão da segurança do paciente para detectar, registrar, prevenir e minimizar a sua frequência.

Conservative management of epithelial ovarian cancer.

We are currently faced with a progressive delay in the age at which women conceive for the first time. This raises the possibility of the appearance of gynecologic disorders that may affect fertility, including neoplasms of the ovary. Fertility-sparing surgery is defined as the preservation of ovarian tissue in one or both adnexa and/or the uterus. Borderline ovarian tumor should be treated with conservative surgery. Salpingo-oophorectomy, or even ovarian cystectomy, are the procedures of choice, with recurrence rates of 2-3% and up to 20% if a simple cystectomy is performed. Cystectomy is indicated in patients with bilateral borderline tumors or in patients with a residual ovary. Borderline tumors with invasive peritoneal implants behave as an invasive cancer in 10-30% of cases with a survival rate of 10-66% compared with 100% in borderline tumors without invasive implants. Prophylactic oophorectomy is recommended when desire of conception has been accomplished. Conservative surgery in invasive epithelial ovarian cancer is limited to Stage IA, grade 1 tumor, and in some highly selected grade 2 tumors of serous, mucinous or endometrioid type, well-encapsulated and free of adhesions. The standard oncological surgical procedure with preservation of the uterus and normal appearing ovary is recommended. This includes salpingo-oophorectomy, excision of any suspicious peritoneal lesion, multiple peritoneal biopsies, appendectomy (particularly in mucinous tumors), and pelvic and paraaortic lymphadenectomy.

Adenocarcinoma endometrioide en pólipo endometrial / Endometrioid adenocarcinoma in an endometrial polyp

Introducción: En raras ocasiones se diagnostica un adenocarcinoma originado en un pólipo endometrial. Material y métodos: De un total de 1.989 pólipos endometriales diagnosticados en 8 años y medio, 6 presentaban un adenocarcinoma endometrioi de. Se analizan sus características clínico-patológicas y evolución. Resultados: La histeroscopia diagnosticó un pólipo en todas las pacientes, y en 3 de ellas con signos sospechosos de malignidad. En todas las ocasiones la lesión estaba confinada al pólipo y no se observó infiltración miometrial en ningún caso. Los carcinomas fueron de la variedad endometrioide, y el endometrio adyacente era normal. Todas las pacientes están vivas y libres de enfermedad tras un seguimiento medio de 45 meses (entre 6 y 96 meses). Conclusión: Los pólipos endometriales pueden albergar un adenocarcinoma que en muchas ocasiones está confinado al pólipo, y que es de bajo grado de malignidad, por lo que se puede plantear un tratamiento conservador

Introduction: Endometrial polyps bearing an adenocarcinoma are rarely diagnosed. Material and methods: Of 1989 endometrial polyps diagnosed in eight and a half years, only six showed an endometrioid adenocarcinoma. Their clinicopathologic characteristics and outcome are discussed. Results: All polyps were diagnosed by hysteroscopy. Of these, three showed signs suspicious for malignancy. In all cases, the neoplasm was confined to the polyp without myometrial infiltration. Histological type was endometrioid and the adjacent endometrium was normal. All patients are alive and disease free after a mean follow-up of 45 months (range: 6-96 months). Conclusion: Endometrial polyps can bear an adenocarcinoma, which is often confined to the polyp and of a low grade of malignancy. Conservative treatment can be considered

Leiomiomatosis difusa del útero: aspectos clinicopatológicos en 5 casos / Diffuse uterine leiomyomatosis: clinicopathologic features in 5 cases

Introducción: La leiomiomatosis difusa del útero es una entidad rara que cursa con un aumento del tamaño uterino. Descripción de los casos: Se revisan las características clinicopatológicas de 5 casos. La sintomatología más frecuente fue por sangrado uterino. Tres de las pacientes tenían hijos, y 2 de ellas habían tenido algún aborto. En 3 ocasiones se efectuó una histerectomía subtotal. En las otras 2 se practicó una resección parcial por deseos de la paciente de conservar la fertilidad. Conclusión: La leiomiomatosis difusa uterina es una lesión benigna que puede afectar a la fertilidad o complicar de forma significativa el parto (AU)

Introduction: Diffuse uterine leiomyomatosis is a rare entity that increases uterine size. Cases description: The clinicopathologic features of five cases are reviewed. The most frequent symptom was uterine bleeding. Three of the patients had children and two of them had a past history of abortion. In three patients, subtotal hysterectomy was performed. In the remaining two, partial resection was carried out as the patients wished to preserve fertility. Conclusion: Diffuse uterine leiomyomatosis is a benign lesion that can affect patients’ fertility or complicate delivery (AU)

Endometrial cancer: factors affecting survival.

PURPOSE: To evaluate the influence in survival of clinical and pathological findings in patients with endometrial cancer. METHODS: In 152 women treated for endometrial cancer from 1982 to 1996, personal, obstetrical and oncological data, histology, grade, myometrial invasion, peritoneal cytology, FIGO stage and treatment were correlated with survival. RESULTS: Mean age was of 60.3 +/- 11.1 years old. Eight patients had a previous history of other neoplasms (seven of them gynecological). The mean clinical complaint was abnormal uterine bleeding. The most common histological type was endometrioid (84.9%), only 51 cases did not show myometrial invasion and 119 women were in Stage I at diagnosis. Peritoneal cytology was negative in 113 patients. Seven patients out of 85 in whom lymphadenectomy was performed showed metastasis. Seventeen of the patients died. The factors influencing survival were age, myometrial invasion and lymph node metastasis. CONCLUSION: Lack of myometrial invasion, absence of lymph node metastasis and age younger than 60 years seem to be the most significant predicting factors of survival.

Fatty acid and triglyceride profiles of intramuscular and subcutaneous fat from fresh and dry-cured hams from Hairless Mexican Pigs.

The study was designed to compare the fatty acid profiles and triglyceride composition of subcutaneous and intramuscular fat of raw and cured hams from Hairless Mexican Pigs. Curing (180 days) was developed throughout several ordered steps: salting, stabilization, drying and ripening. For the salting step, hams were rubbed with nitrate salt, and kept on salt 1 day per kilogram at 0-4 °C and at relative humidity of 80-85%. The rest of the process consisted of small increments of temperature (from 0-24 °C) and small decrements of relative humidity (from 82-68%). The curing process decreased (P<0.05) significantly the proportion of unsaturated fatty acids (raw: 59.2±0.3% and cured: 55.3±0.4%) and increased the saturated ones (raw: 34.4±0.3% and cured: 39.4±0.5%). Subcutaneous and intramuscular fat had similar (P>0.05) percentages of unsaturated (57.60±0.3 and 56.88±0.4%, respectively) and saturated fatty acids (37.5±0.33 and 38.3±0.4%, respectively). With the exception of the monopalmitate, the curing process decreased (P<0.05) the levels of all acylglycerols studied.

Adenocarcinoma e histeroscopia / Adenocarcinoma and hysteroscopy

La elevada frecuencia del cáncer de endometrio, junto á la baja supervivencia en estadios avanzados, ha impulsado la búsqueda y aplicación protocolarizada de exploraciones complementarías que adelanten su diagnóstico en etapas tempranas. Sin poder justificar un cribado poblacional, van a ser grupos diana las alteraciones ecográficas endometriales, hallazgos casuales endometriales durante revisión anual, las pacientes en tratamiento con tamoxifeno y las hemorragias uterinas anormales. La histeroscopia aporta ventajas especiales: realización de biopsia dirigida en pacientes con sospecha de alteración endometrial, solución de discrepancias diagnósticas y seguimiento intrauterino de forma escasamente traumática. Los resultados obtenidos en nuestro Centro tras 19.000 exploraciones así lo avalan (AU)

Complicaciones en la laparoscopia / Complications of laparoscopy

Objetivo: Determinar la incidencia de complicaciones de la técnica quirúrgica laparoscópica.Diseño: Estudio retrospectivo observacional.Método: Revisión del historial ginecológico de las pacientes sometidas a una laparoscopia quirúrgica desde enero de 1991 hasta diciembre de 1999. Se detallan el tipo de intervención quirúrgica y de complicación. Se considera como complicación cualquier acontecimiento intraoperatorio o postoperatorio no planificado que precise de tratamiento posterior.Resultados: Se han realizado un total de 3.504 procedimientos laparoscópicos, 2.135 (60,7 por ciento) laparoscopias quirúrgicas, 1.026 (20,2 por ciento) laparoscopias diagnósticas y 343 (9,8 por ciento) esterilizaciones tubáricas.La morbilidad total ha sido del 8,56 (30 complicaciones), y no se ha producido ningún fallecimiento. El porcentaje de complicaciones en la laparoscopia quirúrgica ha sido del 13,58 (29), del 0,28 (1) en las laparoscopias diagnósticas y no se ha descrito ninguna complicación en las esterilizaciones tubáricas.En 10 casos, la complicación quirúrgica requirió la conversión a laparotomía (2,85 ), siendo la principal causa las lesiones intestinales. Cuatro pacientes (1,14 ) fueron reintervenidas, tres de ellas por lesión intestinal y una por lesión ureteral.Conclusión: La laparoscopia es una técnica que no está exenta de riesgos. La mayoría ocurren durante el procedimiento quirúrgico. La diversidad de cirujanos y el programa de formación de residentes incrementa el porcentaje de complicaciones, principalmente en la realización del neumoperitoneo por la inserción de la aguja de Veress y del primer trocar. Por todo ello, es necesario sistematizar la técnica laparoscópica y seleccionar a las pacientes para reconocer a aquellas con mayor riesgo, con el fin de extremar las precauciones y evitar las complicaciones quirúrgicas. (AU)

Útero septo total con hemicavidad no comunicante. Tratamiento histeroscópico / Complete uterine septum with non-communicating hemicavity. Hysteroscopic treatment

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Morphological changes in hysterectomies after endometrial ablation.

Electrosurgical ablation of the endometrium is a therapeutic choice for those patients having abnormal uterine bleeding. When ablation is followed by a hysterectomy, tissue damage due to thermal effect can be seen. From a total of 350 women with endometrial ablation, 12 required subsequent hysterectomy. The histological features found in these specimens are described and related to the elapsed time between the two surgical procedures. The mean elapsed time between ablation and hysterectomy was 19 +/- 17.3 months. Scarring with formation of additional endometrial cavities was seen in five cases, and endocervical stenosis in two cases. In seven patients, endometrial regrowth was seen at hysterectomy. Necrosis, granulomatous and foreign-body giant cell reaction, eosinophilic infiltrate and pigment-containing macrophages in the myometrium were seen in the long-term post-ablation hysterectomies. Necrosis was seen in short period post-ablation hysterectomies. Six of the seven patients with endometrial regeneration had adenomyosis in the hysterectomy specimen. Endometrial ablation induces thermal effects in the endometrium and granulomatous reaction with foreign-body giant cell reaction, fibrosis and deposition of pigment within macrophages in the myometrium. Adenomyosis is a possible explanation for endometrial regeneration in cases of ablation failure.

Histological features of the contralateral ovary in patients with unilateral ovarian cancer: a case control study.

OBJECTIVE: Most of the surface epithelial-stromal tumors of the ovary are thought to arise from epithelial inclusion cysts, thus these cysts, and the original surface epithelium, are precursor lesions of ovarian carcinoma. MATERIAL AND METHODS: The histological features in contralateral ovary from 20 patients with unilateral ovarian carcinoma were compared with 20 ovaries of patients without ovarian pathology and with 12 normal ovaries of women with contralateral benign ovarian pathology. RESULTS: Cortical invaginations were more frequent and numerous in ovaries of patients with contralateral ovarian carcinoma. The presence of cortical invaginations and epithelial inclusion cysts showed correlation in patients with cancer and in those without ovarian pathology, but there were no differences in the number of inclusion cysts when the three groups were compared. Mild cytological atypia was detected more frequently in the surface epithelium of contralateral ovaries of patients with ovarian carcinoma. Ovarian size, cortical thickness, stromal hyperplasia, psammoma bodies, and surface papillae did not show differences when comparing patients with cancer and control groups. CONCLUSION: Cortical invaginations, a previous step in the formation of epithelial inclusion cysts, can also play an important role in the genesis of ovarian carcinoma.

Microcolpohysteroscopy: myth or reality?

OBJECTIVES: Our aim was to compare the diagnostic accuracy of microcolpohysteroscopy (MCH) and colposcopy-directed biopsies in the detection of precancer and cancer of the uterine cervix. PATIENTS AND METHODS: Between January and December 1994, a total of 174 patients underwent colposcopic and MCH examinations. Direct biopsies were obtained under colposcopic and MCH guidance. Diagnostic accuracies of the two methods were compared using the chisquare test and the kappa coefficient. RESULTS: Colposcopy showed an overall diagnostic accuracy of 39.7% (69 of 174) with a sensitivity of 50.5%, specificity of 23.2%, positive predictive value of 50%, and negative predictive value of 23.5%. The percentage of agreement between MCH diagnosis and histological findings was 92.4% for cervical intraepithelial neoplasia lesions, 92.5% for human papillomavirus, and 100% for invasive cancer. Of the total 174 cases, colposcopy examination was considered satisfactory in 134 (77%) and unsatisfactory in 40 (23%). In the 40 cases when the limits of the squamocolumnar epithelium could not be seen at colposcopy, satisfactory MCH examinations were obtained in cervical lesions measuring no more than 10 mm in endocervical depth (29 cases), and unsatisfactory MCH examinations were obtained in cervical lesions measuring at least 10 mm of endocervical depth (11 cases). The overall MCH failure rate was 6.3% (11 of 174). CONCLUSIONS: MCH appears more reliable than colposcopy and is capable of showing lesions undetectable by colposcopy.

Hysteroscopic incision of the septate uterus: scissors versus resectoscope.

Out of a total of 81 women who underwent hysteroscopic incision of symptomatic septate uteri during a 5-year period, 70 were analysed with respect to reproductive outcome. Division of the septum was performed with hysteroscopic scissors in 17 patients and by means of the resectoscope in 53. Pre-operative indications included infertility, repetitive pregnancy losses, abnormal uterine bleeding and intractable dysmenorrhoea. There were a total of 51 pregnancies after a mean period of 9.3 months following hysteroscopic metroplasty, of which 29 (56.8%) were carried to term, 12 (23.5%) were spontaneous abortions, and 10 (19.6%) are in progress. The post-treatment pregnancy success rate was 73%. The number of spontaneous abortions, pregnancies to term and mean time between surgery and conception was similar in both groups. There were three cases of perforation in the group of excision with hysteroscopic scissors and a case of pulmonary oedema in the group of the resectoscope. Although different advantages are provided by each technique, and more pregnancies were established using scissors, it seems that operator experience is a major consideration in performing these therapeutic hysteroscopic operations.

Papilloma virus infection. Precancer and epidermoid cancer.

We present a review of the relationship between Human Papillomavirus (HPV), Precancer and Epidermoid Cancer of the uterine cervix, Co-factors that contribute in cervical carcinogenesis and the mechanism through which Papillomaviruses transform normal cells into neoplastic cells by inducing an overproduction of the encoded proteins. We also offer final remarks and conclusions on this pathology that increases its incidence every year.

Oncological indications of hysteroscopy.

On the basis of our experience, we regard hysteroscopy as an important step in oncological propedeutics whenever performed by doctors of an endoscopic unit having experience of the subject. We believe it has a very important role in differential diagnosis of uterine bleedings, in the correct classification of endometrium carcinomas and in the control of non surgical treatments of endometrium carcinomas. It will be increasingly used in specialized hospitals.