RESUMO
OBJECTIVES: To analyse the effect of a primary care consultation at a health centre or at home and to determine the effect of the use of the pre-hospital electrocardiogram on thrombolytic delay. DESIGN: Analytical cross-sectional study. SETTING: La Safor county (136,000 inhabitants), Valencia, Spain. PATIENTS: Sample of 137 patients from the area admitted for acute myocardial infarction. INTERVENTION: None. MEASUREMENTS AND RESULTS: Multivariate analysis through Cox regression models of the thrombolytic delay, comparing the patients who attended a primary care centre (40, 29.2%) and those who called out a doctor to their home (26, 19.0%) with those who attended hospital (71, 51.8%). The thrombolysis proportions in the groups were analysed with logistic regression. Patients referred from primary care arrived at hospital later than those who attended directly, although a greater thrombolytic delay was only seen in those visited at home (RR 0.25, 95% CI 0.09-0.71). A primary care electrocardiogram (14 patients, 10.2%) reduced the thrombolytic delay (RR 8.81, 95% CI 1.20-64.91) by reducing intra-hospital delay. There were no differences between the groups for the thrombolysis proportion (67 patients, 48.9%). CONCLUSIONS: Patients with infarction seen in primary care reach hospital later. Calling and waiting for the doctor at home increases the thrombolytic delay. An electrocardiogram on the infarction patients who attend a health centre reduces thrombolytic delay by reducing intra-hospital delay.
Assuntos
Infarto do Miocárdio/tratamento farmacológico , Terapia Trombolítica , Idoso , Estudos Transversais , Interpretação Estatística de Dados , Eletrocardiografia , Feminino , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Atenção Primária à Saúde , Fatores de TempoRESUMO
Objetivo. Analizar la influencia de la visita en atención primaria en un centro de salud o en el domicilio y determinar la utilidad del electrocardiograma prehospitalario en el retraso trombolítico del infarto de miocardio. Diseño. Estudio transversal. Emplazamiento. Comarca de la Safor (136.000 habitantes), Valencia (España). Pacientes. Muestra de 137 pacientes ingresados por infarto agudo de miocardio procedentes de la comunidad. Intervenciones. Ninguna. Mediciones y resultados. Análisis multivariante mediante modelos de regresión de Cox del retraso trombolítico comparando los pacientes que acudieron a un centro de atención primaria (40 [29,2 por ciento]) y los que llamaron al médico al domicilio (26 [19,0 por ciento]) con los que acudieron el hospital (71 [51,8 por ciento]). Análisis de la proporción de trombólisis en los grupos mediante regresión logística. Los pacientes remitidos desde atención primaria llegaron más tarde al hospital que los que acudieron directamente, aunque sólo se observó un mayor retraso trombolítico en los visitados en el domicilio (RR 0,25; IC del 95 por ciento, 0,09-0,71). La realización de un electrocardiograma en atención primaria (14 pacientes [10,2 por ciento]) redujo el retraso trombolítico (RR 8,81; IC del 95 por ciento, 1,20-64,91) al disminuir el retraso intrahospitalario. No hubo diferencias en la proporción de trombólisis (67 pacientes [48,9 por ciento]) entre los grupos. Conclusiones. Los pacientes con infarto visitados en atención primaria llegan más tarde al hospital. Llamar y esperar al médico en el domicilio incrementa el retraso trombolítico. La realización de un electrocardiograma a los pacientes con infarto que acuden a un centro de salud reduce el retraso trombolítico al disminuir el retraso intrahospitalario (AU)
Assuntos
Pessoa de Meia-Idade , Adulto , Idoso , Masculino , Feminino , Humanos , Terapia Trombolítica , Espanha , Fatores de Tempo , Modelos Logísticos , Infarto do Miocárdio , Prescrições de Medicamentos , Atenção Primária à Saúde , Estudos Retrospectivos , Anti-Hipertensivos , Estudos Transversais , Interpretação Estatística de Dados , Hospitalização , Hipertensão , Eletrocardiografia , Área Programática de SaúdeRESUMO
A case of prolonged gastric retention, after truncal vagotomy and antrectomy, is reported. The clinical picture was initially thought to be due to an organic obstruction. The patient was reoperated, having a Billroth-II anastomosis converted into a Roux--en--Y. The gastric retention reappeared soon after the reoperation. After a long period on nutritional support, the patient resumed tolerance first to a solid food and then to liquids. Later a bezoar of Candida albicans was discovered in the gastric stump. After gastric lavage, the patient remained free of symptoms. The importance on the assessment by gastroscopy as well as the conservative treatment in case of postoperative gastric retention is emphasized in this paper.
