Incidencia de lesión de vías biliares en un hospital universitario: análisis de más de 1600 colecistectomías laparoscópicas / Incidence of bile duct lesion at a university hospital: analysis of more than 1600 laparoscopic cholecystectomies

Introducción. La colecistectomía laparoscópica es el procedimiento laparoscópico más comúnmente realizado por el cirujano general. La lesión de la vía biliar es la complicación más temida debido a sus implicaciones clínicas y económicas. El objetivo de esta investigación fue determinar la incidencia de la lesión de la vía biliar en un centro de formación académica e identificar los posibles factores de riesgo asociados a su presentación. Materiales y métodos. Se llevó a cabo un estudio observacional retrospectivo en pacientes a quienes se les practicó una colecistectomía laparoscópica en el Hospital Universitario San Vicente Fundación de Medellín entre marzo de 2011 y septiembre 2016. Se realizó un análisis univariado y bivariado para explorar la asociación de algunas variables preoperatorias e intraoperatorias con la lesión de la vía biliar. Se utilizó el programa estadístico Stata 2014™. Resultados. Se incluyeron 1.601 pacientes. La incidencia de lesión de la vía biliar fue de 0,8 % (14 pacientes), con una mortalidad global de 0,4 %. La mayoría de estas lesiones fueron tipo A de Strasberg; solo dos pacientes requirieron una reconstrucción compleja de la vía biliar. Se encontró relación estadísticamente significativa con mayor tiempo operatorio (p<0,05) y mayor sangrado intraoperatorio (p<0,05) con la presentación de lesión de la vía biliar. Conclusión. La colecistectomía laparoscópica es un procedimiento seguro en el Hospital Universitario San Vicente Fundación, centro de formación de residentes quirúrgicos. La tasa de lesión de la vía biliar es similar a la reportada en la literatura

Introduction. Laparoscopic cholecystectomy is the most common laparoscopic procedure performed by the general surgeon. Bile duct injury (BDI) is the most feared complication due to its clinical and economic implications. The goal of this study was to determine the incidence of BDI at a teaching hospital and to identify possible related risk factors. Methods. This is an observational retrospective study that included patients who underwent laparoscopic cholecystectomy at San Vicente Foundation University Hospital (HUSVF) in Medellin, Colombia, in the period 2011 to September 2016. Univariate and bivariate analyses were performed to explore possible association of some perioperative variables with BDI. Statistic software STATA 2014 was used. Results. A total of 1,601 patients were included. BDI incidence was 0.8% (14 patients), global mortality was 0.4%. Most of BDIs were type A of the Strasberg classification and only two patients required complex reconstructions of the bile ducts. Longer operative time (p>0.05) and higher intraoperative blood loss (p<0.05) were related with BDI. Conclusion. Laparoscopic cholecystectomy is a safe procedure at HUSVF, a training center for surgical residents. Bile duct injury rate at this hospital is similar to that reported in the literature

Abordaje surgery first en disgnacia clase III con hiperplasia condilar activa / Surgery First approach in skeletal class iii with condylar hyperplasia

Las anomalías dentofaciales funcionales o disgnacias esqueléticas afectan a la población colombiana por encima de un 70%, y son causa de alteraciones sistémicas nutricionales por la maloclusión y la deglución atípica presente, así como en el desarrollo y funcionamiento orgánico por la disnea o inclusive apnea del sueño concomitante, y no menos importante, el impacto psicosocial, que se deriva en baja autoestima, depresión, síndrome maniaco-depresivo y/o suicidio. La cirugía ortognática, como única opción real y definitiva para tal morbilidad, sigue siendo declinada por los planes obligatorios de salud territoriales, debido a su errónea categorización de procedimiento estético, que inherentemente obliga a los pacientes a acceder a ellos de manera particular. A continuación se presenta el tratamiento inmediato de una disgnacia clase III con hiperplasia condilar activa, mediante abordaje “surgery first”, manejado por el Servicio de Otorrinolaringología y Cirugía Maxilofacial del Hospital de San José (Bogotá - Colombia)...

Dentofacial functional or disgnacias skeletal abnormalities affect the Colombian population above 70%, causing systemic nutritional alterations by the malocclusion and atypical swallowing present, alterations in development and organic performance by dyspnea, or even sleep apnea concomitantly, and not least, the psychosocial impact resulting in low self-esteem, depression, manic-depressive syndrome and/ or suicide. Orthognathic surgery as the only real and definitive option for such morbidity is being declined by mandatory territorial health plans because of its erroneous categorization of cosmetic procedure that inherently requires patients to access them in particular. Below an immediate treatment of a disgnacia class III with condylar hyperplasia active approach “Surgery First” managed by the Service of Otolaryngology and Maxilofacial Surgery of the San José Hospital (Bogotá - Colombia)...

Resección mínimamente invasiva y asistida mediante endoscopia de quiste dentígero gigante de crecimiento rápido en seno maxilar / Minimally invasive and endoscopic resection of a fast growing dentigerous giant cyst in the maxillary sinus

El quiste dentígero representa entre el 33,2%-66,8% de los quistes odontogénicos, los cuales por lo general se asocian a inclusión de caninos, premolares y terceros molares maxilares. Para decidir la ruta de abordaje o la técnica quirúrgica implementada para su resección, es necesario determinar si existirán o no secuelas estéticas o funcionales. Entonces, es responsabilidad del equipo quirúrgico, independientemente de la extensión de la lesión y teniendo en cuenta que se trata de una de carácter benigno, preservar la anatomía de las estructuras de soporte. En este artículo se presenta la resección de un quiste dentígero gigante del seno maxilar en un adolescente, en la que se aplica una técnica mínimamente ablativa, realizada por el Servicio de Otorrinolaringología - Cirugía Maxilofacial del Hospital de San José (Bogotá - Colombia)...

Dentigerous cysts account for 33,2%-66,8% of odontogenic cysts, and are usually associated with inclusion of canines, premolars and third molars. In order to decide the route or the surgical technique for the excision, it is necessary to determine whether or not there will be aesthetic or functional sequels. It is then the responsibility of the surgical team, regardless of the extent of the injury and taking into account that this is a benign lesion to preserve the normal anatomy of the supporting structures. We present in this article a giant dentigerous cyst removal of maxillary sinus in a teenager with a minimally ablative handled by the Service of Otolaryngology - Maxillofacial Surgery of San Jose Hospital (Bogota - Colombia)...

Revisión de la medicación en ancianos polimedicados en riesgo vascular: ensayo aleatorizado y controlado / A review of the medication in polymedicated elderly with vascular risk: a randomised controlled trial

Objetivo: Evaluar la efectividad de una intervención basada en la revisión de la medicación dirigida a mejorar la adecuación de los tratamientos a recomendaciones establecidas, el control tensional, lipídico y glucémico de pacientes mayores polimedicados en alto riesgo vascular, en comparación con la asistencia sanitaria habitual. Diseño: Estudio controlado, aleatorizado, con evaluación ciega. Emplazamiento: Catorce centros de salud de Andalucía. Participantes: Se incluyeron 323 personas mayores de 65 años con enfermedad o riesgo vascular alto y polimedicadas. Intervención: Un farmacéutico entrevista al paciente, revisa la adecuación de cada tratamiento teniendo en cuenta los datos de la historia clínica, elabora propuesta de modificaciones y las comunica al médico de familia o enfermera. El grupo control recibe asistencia habitual. Mediciones principales: Proporción de pacientes con uso adecuado de ácido acetilsalicílico en dosis bajas, presión arterial, colesterol LDL, hemoglobina glucosilada y calidad de vida. Resultados: De la población estudiada (edad media de 74 años, 61% mujeres), el 41% presenta enfermedad vascular. Diez meses después de la intervención (tasa de pérdidas del 18,3%) se observó que más pacientes del grupo intervenido frente al control tomaban ácido acetilsalicílico en bajas dosis (52,3 vs. 38,6%; p = 0,024). No se observaron diferencias significativas en otras variables. La calidad de vida percibida tiende a ser mejor, no significativamente, en los intervenidos en 6,1 puntos (escala de 100; p=0,051). Conclusión: La revisión sistemática de la medicación mejora la adecuación de uso del tratamiento antiagregante en ancianos polimedicados en alto riesgo vascular, sin afectar negativamente su calidad de vida. No se constatan mejoras en otras variables(AU)

Objective: To analyse the effectiveness of a medication review based on intervention directed at improving the appropriateness of drug treatments according to the established guidelines, as well as blood pressure, serum lipid and blood glucose control in elderly patients on multiple medication, and cardiovascular disease or high risk of cardiovascular disease. Design: A randomised controlled trial with blind evaluation. Setting: Fourteen Primary Health Care centres in Andalusia. Participants: A total of 323 patients older than 65 on polypharmacy and cardiovascular disease or high risk of cardiovascular disease. Intervention: A pharmacist interviewed the patient, reviewed the appropriateness of the drug treatment, taking in account health record data, proposed modifications and communicated them to the general practitioner or nurse. The control group received usual health care. Main measurements: Percentage of patients with appropriate use of low doses of acetylsalicylic acid, blood pressure, LDL-cholesterol, HbA1c, and quality of life scores. Results: A total of 41% of patients (average age 74, 61% women) had cardiovascular disease. Ten months after the intervention (18.3% withdrawals), more patients in the intervention group used low dose acetylsalicylic acid than in the control group (52.3% vs 38.6%; P=.024). There were no differences between groups in intermediate clinic outcomes. Quality of life scores improve in intervention group by 6.1 points (100 points scale), but was not statistically significant (P=.051). Conclusion: Clinical medication review improves the appropriateness of antiplatelet treatment in the elderly on polypharmacy and with high risk of cardiovascular disease. No improvement in biochemistry measurements was found(AU)

Estudio de un brote epidémico de ámbito poblacional por el virus de la parotiditis G1 en JEREZ de la Frontera / Study of a population-wide epidemic outbreak of mumps virus G1 in Jerez de la Frontera (Spain)

ObjetivosCaracterizar el brote epidémico, evaluar la efectividad vacunal y analizar las medidas de prevención y control.DiseñoEstudio observacional transversal de casos según persona, lugar, tiempo.Emplazamiento: Ciudad Jerez de la Frontera y 8 centros de atención primaria.ParticipantesSe incluyen 116 casos de parotiditis notificados a lo largo de 7 meses, el último caso en junio de 2008.Mediciones principalesVariables principales: edad, sexo, centro de estudio o trabajo, fecha de inicio de los síntomas, descripción clínica, complicaciones, aislamiento y genotipo del virus, antecedentes y composición de las vacunas administradas. Cálculo de la efectividad vacunal total. Se ha realizado una búsqueda activa de casos y estudio de contactos en el medio familiar, laboral y ocio.ResultadosEdad media casos 16,24 años (DE: 10,6). El 68,96% de los casos han sido alumnos y el 31,03% procedían del medio familiar y laboral. Las tasas de coberturas de vacunación antiparotiditis fueron superiores al 90%. La efectividad vacunal completa (2 dosis), en menores de 20 años, ha sido: 99,84% (IC 95%=99,77-99,89), siendo menor en el centro docente con mayor tasa de ataque, inmunizados con la actual vacuna, procedente de cepa Jeryl Lynn: 71,01% (IC 95%=55,85-80,97). El 13,79% de los casos tienen 2 dosis de esta cepa. Iniciado el brote se procedió a vacunar a la población susceptible: 11.381 dosis en el medio docente y 93 en el medio extraescolar.ConclusionesBrote de parotiditis, por virus G1, en población con altas tasas de cobertura de vacuna antiparotiditis, con territorios con baja efectividad con la actual vacuna. La vacunación masiva poblacional ha contribuido a la resolución del brote(AU)

ObjectivesTo characterize the mumps outbreak, assess the effectiveness of vaccines and discuss prevention and control measures.DesignObservational cross-sectional study of cases by person, place, and time.LocationCity Jerez de la Frontera and 8 Primary Care centres.ParticipantsA total of 116 cases of mumps were reported throughout seven months, with the last case in June 2008.MeasurementsMain outcomes: age, sex, place of study or work, symptoms start date, clinical description, complications, and genotype of virus isolation, history and vaccination compositions. Calculation of total vaccine effectiveness. Active case finding and contact studies were performed on the families, work places and leisure areas.ResultsThe mean age of the cases was 16.24 years(SD 10.6). The majority (68.96%) of the cases were children at school and 31.03% arose from family and work areas. Mumps vaccine coverage rates were above 90%. The complete vaccine effectiveness (2 doses); for those under 20 years-old it was: 99.84% (95% CI=99.77 - 99.89), being lower in schools with the highest attack rate, immunised with current vaccine from Jeryl Lynn strain: 71.01% (95% CI=55.85 80.97). Two doses of this strain were used in 13.79% of the cases. Susceptible populations were vaccinated at the start of the outbreak: 11,381 doses used in schools and 93 outside schools.ConclusionsAn outbreak of mumps virus G 1 population with high rates of mumps vaccine coverage, with areas with low vaccine effectiveness with current vaccine. Mass vaccination of population has contributed to the resolution of the outbreak(AU)

Prevalencia de polimedicación y riesgo vascular en la población mayor de 65 años / Prevalence of multiple medication and cardiovascular risk in patients over 65 years

Objetivo: Estudiar la prevalencia de polimedicación en mayores de 65 años. Diseño: Estudio descriptivo transversal. Emplazamiento: Distritos sanitarios de atención primaria Sevilla y Jerez-Costa Noroeste. Participantes: Población mayor de 65 años, seleccionada por un procedimiento aleatorio estratificando por centros. Se excluyeron pacientes institucionalizados, con trastornos de salud mental mayores y enfermedad terminal. Mediciones principales: Se definió polimedicación como el consumo de 5 o más fármacos de forma continuada durante los últimos 6 meses, basado en el registro en historia clínica. Se exploraron otras características de los pacientes mediante entrevista a una submuestra seleccionada aleatoriamente. Resultados: Se evaluaron las historias clínicas de 2.919 pacientes procedentes de 14 centros de salud. La prevalencia encontrada fue de 49,6% (IC 95%: 47,7-51,4), con un rango entre centros de un 33% (IC 95%: 26,8-39,3) a un 82% (IC 95%: 74,3-89,7). El 90,2% (IC 95%: 88,7-91,8) tenía criterios de entrada al Proceso Asistencial Integrado Riesgo Vascular. La entrevista confirmó un consumo promedio de 8,7 medicamentos (IC 95%: 8,4-9,0). Un 83,2% (IC 95%: 78,9-87,4) eran pacientes en riesgo vascular alto. Conclusiones: La prevalencia de polimedicación en mayores de 65 años es cercana al 50%, con amplia variabilidad entre centros. El consumo promedio de medicamentos por paciente es de 8 y la gran mayoría son pacientes en riesgo vascular alto(AU)

Objetive: To describe the prevalence of multiple medication in patients over 65 years. Design: Cross-sectional study. Setting: Sevilla and Jerez-Costa North-West Primary Health Care Districts. Participants: Patients older than 65 years randomly chosen from district databases. Patients in nursing homes, with major mental disease, or end-of- life situations were excluded. Main measurements: Multiple medication was defined as a prescription of five or more drugs during the last six months. We assessed the medication used by clinical health records audit. Other characteristics were studied by interviewing a subsample of patients. Results: A total of 2,919 clinical health records from 14 centres were reviewed. The prevalence of multiple medication was 49.6% (95% CI: 47.7-51.4) with a range from 33% (95% CI: 26.8-39.3) to 82% (95% CI: 74,3-89,7) between centres. The large majority of patients (90.2% [95% CI: 88.7-91.8]) of patients showed criteria to be included in Cardiovascular Risk Health Care Process. Interviewed patients confirmed taking an average of 8.7 drugs (95% CI: 8.4-9.0). Among them, 83.2% (95% CI: 78.9-87.4) were high cardiovascular risk patients. Conclusions: Prevalence of multiple medication in patients over 65 years is about 50% with wide variations between centres. The number of drugs per patient ratio was close to eight. A large majority of them were high risk cardiovascular patients(AU)

[A review of the medication in polymedicated elderly with vascular risk: a randomised controlled trial]. / Revisión de la medicación en ancianos polimedicados en riesgo vascular: ensayo aleatorizado y controlado.

OBJECTIVE: To analyse the effectiveness of a medication review based on intervention directed at improving the appropriateness of drug treatments according to the established guidelines, as well as blood pressure, serum lipid and blood glucose control in elderly patients on multiple medication, and cardiovascular disease or high risk of cardiovascular disease. DESIGN: A randomised controlled trial with blind evaluation. SETTING: Fourteen Primary Health Care centres in Andalusia PARTICIPANTS: A total of 323 patients older than 65 on polypharmacy and cardiovascular disease or high risk of cardiovascular disease. INTERVENTION: A pharmacist interviewed the patient, reviewed the appropriateness of the drug treatment, taking in account health record data, proposed modifications and communicated them to the general practitioner or nurse. The control group received usual health care. MAIN MEASUREMENTS: Percentage of patients with appropriate use of low doses of acetylsalicylic acid, blood pressure, LDL-cholesterol, HbA(1c), and quality of life scores. RESULTS: A total of 41% of patients (average age 74, 61% women) had cardiovascular disease. Ten months after the intervention (18.3% withdrawals), more patients in the intervention group used low dose acetylsalicylic acid than in the control group (52.3% vs 38.6%; P=.024). There were no differences between groups in intermediate clinic outcomes. Quality of life scores improve in intervention group by 6.1 points (100 points scale), but was not statistically significant (P=.051). CONCLUSION: Clinical medication review improves the appropriateness of antiplatelet treatment in the elderly on polypharmacy and with high risk of cardiovascular disease. No improvement in biochemistry measurements was found.

[Prevalence of multiple medication and cardiovascular risk in patients over 65 years]. / Prevalencia de polimedicación y riesgo vascular en la población mayor de 65 años.

OBJECTIVE: To describe the prevalence of multiple medication in patients over 65 years. DESIGN: Cross-sectional study. SETTING: Sevilla and Jerez-Costa North-West Primary Health Care Districts. PARTICIPANTS: Patients older than 65 years randomly chosen from district databases. Patients in nursing homes, with major mental disease, or end-of- life situations were excluded. MAIN MEASUREMENTS: Multiple medication was defined as a prescription of five or more drugs during the last six months. We assessed the medication used by clinical health records audit. Other characteristics were studied by interviewing a subsample of patients. RESULTS: A total of 2,919 clinical health records from 14 centres were reviewed. The prevalence of multiple medication was 49.6% (95% CI: 47.7-51.4) with a range from 33% (95% CI: 26.8-39.3) to 82% (95% CI: 74,3-89,7) between centres. The large majority of patients (90.2% [95% CI: 88.7-91.8]) of patients showed criteria to be included in Cardiovascular Risk Health Care Process. Interviewed patients confirmed taking an average of 8.7 drugs (95% CI: 8.4-9.0). Among them, 83.2% (95% CI: 78.9-87.4) were high cardiovascular risk patients. CONCLUSIONS: Prevalence of multiple medication in patients over 65 years is about 50% with wide variations between centres. The number of drugs per patient ratio was close to eight. A large majority of them were high risk cardiovascular patients.

[Study of a population-wide epidemic outbreak of mumps virus G1 in Jerez de la Frontera (Spain)]. / Estudio de un brote epidémico de ámbito poblacional por el virus de la parotiditis G1 en JEREZ de la Frontera.

OBJECTIVES: To characterize the mumps outbreak, assess the effectiveness of vaccines and discuss prevention and control measures. DESIGN: Observational cross-sectional study of cases by person, place, and time. LOCATION: City Jerez de la Frontera and 8 Primary Care centres. PARTICIPANTS: A total of 116 cases of mumps were reported throughout seven months, with the last case in June 2008. MAIN OUTCOMES: age, sex, place of study or work, symptoms start date, clinical description, complications, and genotype of virus isolation, history and vaccination compositions. Calculation of total vaccine effectiveness. Active case finding and contact studies were performed on the families, work places and leisure areas. RESULTS: The mean age of the cases was 16.24 years(SD 10.6). The majority (68.96%) of the cases were children at school and 31.03% arose from family and work areas. Mumps vaccine coverage rates were above 90%. The complete vaccine effectiveness (2 doses); for those under 20 years-old it was: 99.84% (95% CI=99.77 - 99.89), being lower in schools with the highest attack rate, immunised with current vaccine from Jeryl Lynn strain: 71.01% (95% CI=55.85 80.97). Two doses of this strain were used in 13.79% of the cases. Susceptible populations were vaccinated at the start of the outbreak: 11,381 doses used in schools and 93 outside schools. CONCLUSIONS: An outbreak of mumps virus G 1 population with high rates of mumps vaccine coverage, with areas with low vaccine effectiveness with current vaccine. Mass vaccination of population has contributed to the resolution of the outbreak.

Conciliación del tratamiento farmacológico al ingreso y al alta: un reto multidisciplinario / No disponible

No disponible