Iatrogenias en la cirugía colónica / Iatrogenesis in colonic surgery

Se realiza ina revisión de la literatura y se clasifican las iatrogenias de la cirugía del colon y recto según el momento de su producción. Se revisa 387 intervenciones de colon realizadas en el servicio de cirugía general desde mayo de 1983 a marzo de 1989 y se encuentra el 3,3 %de lesiones iatrogénicas durante el transoperatorio y 5 pacientes presentaron fístulas intestinales después de la intervención quirúrgica

Severity of Illness Index and the Adverse Patient Occurrence Index. A reliability study and policy implications.

Seven hundred fifty-two randomly selected charts from seven teaching hospitals were rated by pairs of medical record analysts. The Severity of Illness Index was unreliable with an interrater-agreement rate of 73% (kappa statistic = 0.41), and demonstrated a significant (P less than 0.0001) association with the Adverse Patient Occurrence (APO) Index. This suggests that the Severity of Illness Index is not differentiating severity of illness from quality of care. The fair to poor field reliability stems from underlying instrument subjectivity, lack of clear referent groups, and time pressure. The APO Index was also found to be unreliable (r = 0.33 and range = -0.05-0.58). Greater attention should be directed to improving objective discharge abstract, billing, and laboratory data for measuring patient severity and adverse patient occurrences.

Acute orbital pseudotumor with iatrogenic intraorbital air: a diagnostic dilemma.

A 13-year-old black female was referred with unilateral granulomatous uveitis and orbital inflammation of sudden onset. Hematologic, serologic, bacteriologic, and ultrasonographic studies along with high resolution CT scans of the orbits were employed to determine the diagnosis and appropriate treatment. Subconjunctival corticosteroid injection containing air prior to referral obfuscated the ultimate diagnosis of pseudotumor. The Pediatric Infectious Disease service delayed definitive treatment with systemic steroids. Differential diagnosis of granulomatous uveitis with orbital inflammation are discussed. CT scan has significantly advanced the diagnosis and management of orbital pseudotumor.