ABSTRACT
La apendicitis aguda (AA) es una de las afecciones más frecuentes para la consulta por el servicio de guardia que requiere tratamiento quirúrgico, con una incidencia estimada de entre 6 y 8%. Métodos: Se crearon dos grupos compuestos por 25 pacientes seleccionados al azar: G1. Apendectomía laparoscópica (AL). G2. Apendectomía convencional (CA). Analizamos variables como sexo, edad, tiempo de operación, dolor postoperatorio, estadía en el hospital y complicaciones postoperatorias. Resultados: el 53.2% de los pacientes eran hombres y el 46.8% restante eran mujeres, con una edad media de 31 años. La serie arrojó una tasa de complicación general del 28% para G1 y 68% para G2. Conclusión: lo que marca la evolución no es solo la capacidad del residente interino, sino también la condición del órgano y los propios factores del paciente
Acute appendicitis (AA) is one of the most frequent conditions for consultation by the on-call service that requires surgical treatment, with an estimated incidence of between 6 and 8%. Methods: Two groups made up of 25 randomly selected patients were created: G1. Laparoscopic appendectomy (AL). G2. Conventional appendectomy (CA). We analyzed variables such as sex, age, operating time, postoperative pain, hospital stay, and postoperative complications. Results: 53.2% of the patients were male and the remaining 46.8% were female, with a mean age of 31 years. The series yielded a general complication rate of 28% for G1 and 68% for G2. Conclusión: What marks the evolution is not only the capacity of the acting resident, but also the condition of the organ and the patient's own factors
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Appendectomy/methods , General Surgery/methods , Laparoscopy/methodsABSTRACT
Postoperative cognitive dysfunction, POCD, afflicts a large number of elderly surgical patients following surgery with general anesthesia. Mechanisms of POCD remain unclear. N-methyl-D-aspartate (NMDA) receptors, critical in learning and memory, that display protein expression changes with age are modulated by inhalation anesthetics. The aim of this study was to identify protein expression changes in NMDA receptor subunits and downstream signaling pathways in aged rats that demonstrated anesthesia-induced spatial learning impairments. Three-month-old and 18-month-old male Fischer 344 rats were randomly assigned to receive 1.8% isoflurane/70% nitrous oxide (N(2)O) anesthesia for 4h or no anesthesia. Spatial learning was assessed at 2weeks and 3months post-anesthesia in Morris water maze. Hippocampal and cortical protein lysates of 18-month-old rats were immunoblotted for activated caspase 3, NMDA receptor subunits, and extracellular-signal regulated kinase (ERK) 1/2. In a separate experiment, Ro 25-6981 (0.5mg/kg dose) was administered by I.P. injection before anesthesia to 18-month-old rats. Immunoblotting of NR2B was performed on hippocampal protein lysates. At 3months post-anesthesia, rats treated with anesthesia at 18-months-old demonstrated spatial learning impairment corresponding to acute and long-term increases in NR2B protein expression and a reduction in phospho-ERK1/2 in the hippocampus and cortex. Ro 25-6981 pretreatment attenuated the increase in acute NR2B protein expression. Our findings suggest a role for disruption of NMDA receptor mediated signaling pathways in the hippocampus and cortex of rats treated with isoflurane/ N(2)O anesthesia at 18-months-old, leading to spatial learning deficits in these animals. A potential therapeutic intervention for anesthesia associated cognitive deficits is discussed.
Subject(s)
Aging/drug effects , Anesthetics, Inhalation/metabolism , Brain/drug effects , Isoflurane/pharmacology , Nitrous Oxide/pharmacology , Receptors, N-Methyl-D-Aspartate/metabolism , Aging/metabolism , Analysis of Variance , Animals , Brain/cytology , Caspase 3/metabolism , Cell Death/drug effects , Dose-Response Relationship, Drug , Drug Interactions , Excitatory Amino Acid Antagonists/pharmacology , Male , Neurons/metabolism , Phenols/pharmacology , Piperidines/pharmacology , Rats , Rats, Inbred F344 , Reaction Time/drug effects , Receptors, N-Methyl-D-Aspartate/genetics , Spatial Behavior/drug effects , Time FactorsABSTRACT
BACKGROUND: After total mesorectal excision (TME), a low colorectal or colo-anal anastomosis is usually performed. A prophylactic covering stoma is often used, especially for patients receiving neoadjuvant chemo-radiotherapy. However, morbidity is high, mainly due to anastomotic leakage. METHODS: From May 2000 to October 2008, patients with middle or low rectal cancer who underwent a trans-anal pull-through procedure after TME were prospectively recorded. No covering stoma was performed in these patients. However, they all underwent a delayed colo-anal anastomosis (DCA), which was performed 6 days following the TME, on average. Both the surgical technique and follow-up were standardised. Patients with T3, T4 and/or N+ cancers were given preoperative radiotherapy. A retrospective analysis was done to assess post-operative mortality, morbidity, and oncologic and functional results. RESULTS: One hundred consecutive patients with rectal tumours at a median distance of 5 cm from the anal verge underwent DCA after TME. The 5-year overall and disease-free survival rates were 81% and 66%, respectively. The post-operative mortality rate was 3% and the overall post-operative morbidity rate was 36%, with only 3 anastomotic leakages. After two years, 73% of the patients had good functional outcomes. CONCLUSION: The trans-anal pull-through procedure after TME, followed by DCA seems to be a safe and efficient sphincter-preserving procedure to treat patients with middle or low rectal cancer while avoiding a prophylactic, diverting stoma.
Subject(s)
Anal Canal/surgery , Colon/surgery , Rectal Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Anastomosis, Surgical , Female , Humans , Male , Middle Aged , Retrospective Studies , Surgical StomasABSTRACT
INTRODUCTION: A case of imperforate hymen discovered after a surgical complication is reported. We discuss the lessons to draw from this case in terms of diagnosis and therapeutic management. CASE REPORT: An 11-year-old girl was referred with fever and acute lower abdominal pain. A diagnosis of appendicitis was hypothesized because of rigidity located to the right iliac fossa, a psoas sign, polynuclear leukocytosis, and increased serum C-reactive protein. A McBurney laparotomy showed a brownish hemoperitoneum and a dilated right fallopian tube. The appendix appeared normal and an appendicectomy was done. A diagnosis of hematocolpos aggravated by hematometra, hematosalpinx, and hemoperitoneum was suspected. Pelvic examination revealed an imperforate hymen with a taut pelvic mass confirmed by transabdominal and endorectal ultrasonography. Hymenotomy was performed, which allowed the discharge of 400cc of chocolate-colored fluid. The history-taking revealed recurrent intermittent lower abdominal pain with several referrals to emergency departments. The patient recovered uneventfully and was discharged 2 days later. CONCLUSION: In case of acute abdominopelvic pain in pubertal girls with no previous menstruation, the possibility of an imperforate hymen must be suspected. Examination should include observation of secondary sexual characteristics and inspection of the external genitalia. Treatment is surgical and consists of a hymenotomy.
Subject(s)
Abdomen, Acute/etiology , Abdomen, Acute/surgery , Appendicitis/diagnosis , Appendicitis/surgery , Hematocolpos/diagnosis , Hematocolpos/surgery , Hymen/abnormalities , Intraoperative Complications/diagnosis , Intraoperative Complications/surgery , Appendectomy , Diagnosis, Differential , Female , Hematometra/diagnosis , Hematometra/surgery , Hemoperitoneum/diagnosis , Hemoperitoneum/surgery , HumansABSTRACT
La obesidad mórbida representa un problema mundial cuya prevalencia se encuentra en aumento, sólo el enfoque quirúrgico ha demostrado resultados persistentes en cuanto a la pérdida de peso de manera permanente. Objetivo: evaluación del impacto social de la pérdida de peso en el paciente obeso posterior al tratamiento quirúrgico por medio de un bypass laparoscópico o convencional y análisis de costos operativos.
Morbid obesity represents a health-related problem rising all over the world, just the surgical management has demonstrted persistent and constant outcome in weight lose. Objective: Evaluations of the social impact and operative cost in weight lose obese morbid patients after laparoscopic or open gastric bypass.
Subject(s)
Humans , Anastomosis, Roux-en-Y , Bariatric Surgery , Body Mass Index , Outcome Assessment, Health Care/statistics & numerical data , Obesity, Morbid/surgery , Quality of LifeABSTRACT
La obesidad mórbida representa un problema mundial cuya prevalencia se encuentra en aumento, sólo el enfoque quirúrgico ha demostrado resultados persistentes en cuanto a la pérdida de peso de manera permanente. Objetivo: evaluación del impacto social de la pérdida de peso en el paciente obeso posterior al tratamiento quirúrgico por medio de un bypass laparoscópico o convencional y análisis de costos operativos.(AU)
Morbid obesity represents a health-related problem rising all over the world, just the surgical management has demonstrted persistent and constant outcome in weight lose. Objective: Evaluations of the social impact and operative cost in weight lose obese morbid patients after laparoscopic or open gastric bypass.(AU)
Subject(s)
Humans , Obesity, Morbid/surgery , Anastomosis, Roux-en-Y , Bariatric Surgery , Body Mass Index , Quality of Life , Outcome Assessment, Health Care/statistics & numerical dataABSTRACT
OBJECTIVE: Anastomotic leakage is one of the most important causes of morbidity and mortality in gastrointestinal surgery. We investigated the effect of oral glutamine on the healing of high-output intestinal fistula. SETTING: A tertiary Universitary Hospital of the University of Mato Grosso, Cuiaba, Brazil. PATIENTS AND METHODS: 28 patients (25 males and 3 females; median age = 45 [18-71] years old) admitted with high output post-operative small bowel fistulas (median volume in 24 h: 850 [600-2,200] mL) during a 4 years period were retrospectively studied. INTERVENTIONS: In the first two years 19 (67.9%) patients received only TPN as the initial nutritional support. In the last two years however, due to a change in the protocol for the nutritional support in cases of intestinal fistula 9 patients (32.1%) received oral glutamine (0.3 g/kg/day; 150 mL/day) in addition to TPN. Endpoints of the study were mortality, resolution of the fistula, and length of hospital stay (LOS). RESULTS: The overall mortality was 46.4% (13 patients). Fistula closure was observed in all other 15 patients (53.6%) that survived. In the subset of survived patients LOS was similar in those who received or not received glutamine. The multivariate regression analysis showed that resolution of the fistula was 13 times greater in patients that received oral glutamine (OR = 13.2 (95% CI = 1.1-160.5); p = 0.04) and 15 times greater in non-malnourished patients (OR = 15.4 [95% CI = 1.1-215.5]; p = 0.04). CONCLUSIONS: We conclude that oral glutamine accelerated the healing and diminished the mortality in this series of patients with post-operative high-output intestinal fistula receiving TPN.
Subject(s)
Glutamine/administration & dosage , Intestinal Fistula/mortality , Intestinal Fistula/therapy , Parenteral Nutrition , Administration, Oral , Adolescent , Adult , Aged , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Objective: Anastomotic leakage is one of the most important causes of morbidity and mortality in gastrointestinal surgery. We investigated the effect of oral glutamine on the healing of high-output intestinal fistula. Setting: A tertiary University Hospital of the University of Mato Grosso, Cuiaba, Brazil. Patients and methods: 28 patients (25 males and 3 females; median age = 45 [18-71] years old) admitted with high output post-operative small bowel fistulas (median volume in 24 h: 850 [600-2,200] mL) during a 4 years period were retrospectively studied. Interventions: In the first two years 19 (67.9%) patients received only TPN as the initial nutritional support. In the last two years however, due to a change in the protocol for the nutritional support in cases of intestinal fistula 9 patients (32.1%) received oral glutamine (0.3 g/kg/day; 150 mL/day) in addition to TPN. Endpoints of the study were mortality, resolution of the fistula, and length of hospital stay (LOS). Results: The overall mortality was 46.4% (13patients). Fistula closure was observed in all other 15patients (53.6%) that survived. In the subset of survived patients LOS was similar in those who received or not received glutamine. The multivariate regression analysis showed that resolution of the fistula was 13 times greater in patients that received oral glutamine (OR = 13.2 (95% CI = 1.1-160.5); p = 0.04) and 15 times greater in non-malnourished patients (OR = 15.4 [95% CI = 1.1- 215.5]; p = 0.04). Conclusions: We conclude that oral glutamine accelerated the healing and diminished the mortality in this series of patients with post-operative high-output intestinal fistula receiving TPN
Objetivo: La fístula anastomótica es una de las principales causas de morbilidad y mortalidad en cirugía general. Investigamos el efecto de la glutamina oral en la cicatrización de fístulas intestinales de alto débito. Ámbito: Una unidad terciaria de un Hospital Universitario de la Universidad Federal de Mato Grosso, Cuiabá, Brasil. Pacientes y métodos: 28 pacientes (25 M y 3 F; edad mediana = 45 [18-71] años) admitidos con fístulas pos-operatorias del intestino delgado de alto débito (volumen mediano en 24 h: 850 [600-2.200] mL) durante un período de 4 años fueron retrospectivamente estudiados. Intervenciones: En los dos primeros años 19 pacientes (67,3%) recibieron únicamente TPN como suporte nutricional. En los últimos dos años sin embargo, debido a un cambio del protocolo para el suporte nutricional en casos de la fístula intestinal 9 pacientes (32,1%) recibieron glutamina oral (0,3 g/kg/día; 150 mL/día) además de TPN. Las variables de resultado del estudio fueron la mortalidad, la resolución de la fístula, y el tiempo de hospitalización (LOS).Resultados: La mortalidad fue de 46,4% (13 pacientes). La cicatrización de la fístula fue observada en 15 pacientes (53,6%) que sobrevivieron. Entre los pacientes que sobrevivieron la permanencia hospitalaria fue similar en aquellos que recibieron o no recibieron glutamina. El análisis multivariante mostró que la resolución de la fístula fue 13 veces mayor en los pacientes que recibieron glutamina oral (OR = 13,2(95% CI = 1,1-160,5); p = 0,04) y 15 veces mayor entre los pacientes no desnutridos (OR = 15,4 [95% CI = 1,1-215,5]; p = 0,04). Conclusiones: La glutamina oral acelera la cicatrización y disminuyó la mortalidad en nuestros pacientes con fístula intestinal de alto débito que recibieron TPN
Subject(s)
Humans , Intestinal Fistula/diet therapy , Parenteral Nutrition, Total/methods , Glutamine/administration & dosage , Wound Healing/physiology , Retrospective Studies , Surgical Wound Dehiscence/diet therapyABSTRACT
Los tumores carcinoides son neoplasias poco frecuentes en el tubo digetivo y que se desarrollan a partir de las células que forman el sistema APUD o neuroendocrinas. El objetivo es analizar la nueva nomenclatura, la incidencia en el aparato digetivo, la presentación clínica, diagnóstico y tratamiento quirúrgico
Subject(s)
Male , Humans , Female , APUD Cells , Intestinal Neoplasms , Intestines , Neuroendocrine Tumors , Histological TechniquesABSTRACT
Los tumores carcinoides son neoplasias poco frecuentes en el tubo digetivo y que se desarrollan a partir de las células que forman el sistema APUD o neuroendocrinas. El objetivo es analizar la nueva nomenclatura, la incidencia en el aparato digetivo, la presentación clínica, diagnóstico y tratamiento quirúrgico
Subject(s)
Male , Humans , Female , APUD Cells , Neuroendocrine Tumors/chemistry , Neuroendocrine Tumors/diagnosis , Neuroendocrine Tumors/immunology , Neuroendocrine Tumors/surgery , Intestinal Neoplasms , Intestines , Histological TechniquesABSTRACT
El aborto, por su contribución a la mortalidad materna, ha sido tradicionalmente un problema de salud pública en América Latina y en Chile. En la actualidad, si bien es cierto la mortalidad por esta causa ha disminuido, la cantidad de abortos realizados permanece alta. Por este motivo, se ha querido efectuar una caracterización desde la perspectiva epidemiológica de la mortalidad por aborto ocurrido en Chile entre 1985 y 2000. Los resultados confirman la baja en la mortalidad durante el período estudiado. No obstante, es necesario prevenir la ocurrencia de aborto, puesto que sigue siendo una causa de mortalidad materna en el país.
Subject(s)
Female , Pregnancy , Abortion, Induced , Abortion, Criminal/statistics & numerical data , Abortion, Induced/adverse effects , Maternal Mortality/trends , Chile/epidemiology , Women's HealthABSTRACT
Durante el período invernal las infecciones respiratorias agudas (IRA) son causa de un alto número de licencias médicas, cuando este hecho se manifiesta en el personal de salud, que se encuentra más expuesto y que tiene como objetivo atender a la población en este período, no sólo se trata de ausentismo laboral sino un menoscabo importante en la oferta de atención médica. Estos dos hechos han sido los pilares fundamentales, en muchos países, que justifican la vacunación del personal de salud contra la influenza. Se presenta un estudio de cohorte del personal del Servicio de Salud Metropolitano Sur Oriente vacunado y no vacunado contra la influenza y, la incidencia de infecciones respiratorias durante el año 2000. El total del personal vacunado fue de 3.479 personas y los no vacunados alcanzaron a 272; los casos de infección respiratorias, ocurridos en el período mayo-octubre del mismo año alcanzaron a 644 eventos que se clasificaron en CIE-10 con los códigos: J-00 a J-22 (infecciones agudas del sistema respiratorio). J-45 (asma) y H-67 (otitis media aguda). los resultados de este trabajo demuestran una menor incidencia de gripe, que generan licencia médica, en los funcionarios expuestos a vacuna antiinfluenza. La diferencia entre expuestos y no expuestos a la vacuna fue estadísticamente significativa (p < 0,0001; X²); la vacuna actuó como un mecanismo de protección efectivo, disminuyendo el riesgo de enfermar de influenza (RR = 0,13; IC 0,086 - 0,203). Si bien no es el objetivo de esta vacunación la protección contra otras IRA, se pudo constatar una disminución en la ocurrencia de otras patologías respiratorias entre los vacunados, que resultaron también significativas en el análisis estadísticos
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Health Personnel , Respiratory Tract Diseases , Influenza Vaccines/pharmacology , Age Distribution , Asthma , Bed Rest , Cohort Studies , Influenza, Human , Otitis Media , Respiratory Tract Diseases , Sex Distribution , VaccinationABSTRACT
En Chile, la salud materno-infantil (SM) ha mejorado notablemente a partir de los años 60. Este trabajo compara indicadores de SMI del Servicio de Salud Metropolitano Sur Oriente (SSMSO) y de Chile entre 1980 y 1998. Es un estudio descriptivo que recoge información de Anuarios Demográficos. Los resultados evidencian un mejoramiento en todos los indicadores de SMI en el SSMSO: las tasas de natalidad, tasa de mortalidad infantil y tasa de mortalidad materna descienden a 18,3 por 1000 habitantes, 9,8 por 1000 nacidos vivos (NV) y 0,8 por 10.000 NV respectivamente. Las causas de MI evolucionaron desde un predominio de muertes por enfermedades infecciosas y perinatales en 1980 a un mayor número de muertes por malformaciones y enfermedades congénitas en 1998. En resumen, los indicadores de SMI han evolucionado favorablemente entre 1980 y 1998 en el SSMSO en concordancia con lo ocurrido en el resto del país
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Maternal and Child Health , Maternal-Child Health Centers/statistics & numerical data , Birth Rate/trends , Chile/epidemiology , Epidemiology, Descriptive , Infant Mortality/trends , Maternal Mortality/trends , Nutritional Status , Pregnancy RateABSTRACT
La Transición Demográfica (TD) significa una variación en la estructura por edades de la población determinada por un cambio de sus características de natalidad y mortalidad. Tiene fases sucesivas en que caen la Natalidad y Mortalidad. El concepto de Transición Epidemiológica (TE) complementa el anterior, y también evoluciona en fases, en las que se produce un cambio en las causas de morbimortalidad de la población como consecuencia del cambio en su estructura por edades. El propósito de este trabajo es mostrar el proceso de TD y TE ocurrido en el Servicio de Salud Metropolitano Sur Oriente (SSMSO). Se trata de un estudio descriptivo que recoge información de Anuarios Demográficos. Entre 1980 y 1998 se observa una baja en la natalidad y mortalidad de 21,5 por 1.000 habitantes (hbts.) a 18,3 por 1.000 hbts. y de 4,3 por 100.000 hbts. a 3,6 por 100.000 hbts. respectivamente. Las causas de mortalidad muestran un incremento en la proporción de muertes de origen cardiovascular y tumoral, constituyendo junto a las enfermedades respiratorias y los traumatismos, envenenamientos y violencias un 72 por ciento del total de causas de muerte. Como conclusión se puede afirmar que el SSMSO ha iniciado el proceso de TD y TE
Subject(s)
Humans , Male , Female , Population Dynamics , Health Transition , Age Distribution , Cause of Death , Epidemiology, Descriptive , Indicators of Morbidity and Mortality , Sex DistributionABSTRACT
Proteins secreted by Mycobacterium species have been suggested as major immune targets in the early phase of infection. In this study, we sought to identify specific antigens in culture filtrates and in soluble cell extracts of Mycobacterium paratuberculosis. The release of antigens into the culture medium during growth of the bacilli and the distribution of specific epitopes within the Mycobacterium species were investigated by immunoblot analysis with monoclonal antibodies (MAbs) raised against M. paratuberculosis antigens. MAb B6A interacted with a cellular antigen with an apparent molecular mass of 34.5 kDa in lysates of M. paratuberculosis. MAb B6A did not interact with lysates from any other mycobacterial species, suggesting recognition of an M. paratuberculosis species-specific epitope. MAb FL1-A1 reacted with an antigen of 44.3 kDa in M. paratuberculosis and a 9-kDa antigen in Mycobacterium kansasii. MAb PII-B1 reacted with concanavalin A (ConA)-binding cellular and filtrate molecules of M. paratuberculosis and with lysates of Mycobacterium kansasii and Mycobacterium avium 18. The affinity-purified glycosylated antigens migrated as a diffuse band of between 35 and 45.6 kDa and reacted strongly with ovine and bovine paratuberculosis serum and polyclonal serum against M. tuberculosis lipoarabinomannan antigens. These glycoconjugates were the earliest antigens detected in culture filtrates of M. paratuberculosis. Deglycosylation of the ConA-binding molecules with alpha-mannosidase enzyme abolished the reaction with MAb PII-B1 and with bovine but not ovine paratuberculosis serum, suggesting selective immunogenicity in the different animal species.
