Cáncer de vesícula en colecistectomías de la región de Tarapacá. Análisis según pertenencia étnica / Prevalence of gallbladder cancer in a Northern Chilean region

BACKGROUND: Gallbladder Cancer (GBC) prevalence varies among countries, associated with different geographical and genetic factors. The Mapuche ethnicity (Ethnia mostly located between the VIII and X Chilean regions) stands out in Chile due to its high GBC prevalence. Aim: To estimate the GBC prevalence in patients undergoing cholecystectomy at a public hospital in the Northern region of Chile (Tarapaca), where other ethnical groups are common. MATERIAL AND METHODS: Pathological reports of 3270 patients (72% women) who underwent cholecystectomy between January 2016 and December 2019 were revised. Subsequently, the accreditation of ethnic belonging for each patient to one of the ten native communities in Chile was requested to the National Corporation for Native Communities Development (CONADI). RESULTS: According to the analysis of pathological reports, the global GBC prevalence was 0.3 %. The prevalence in Aymaras was 0.4% and 0% in Mapuches. The distribution of ethnic origins among analyzed patients was Aymara in 14.3, Mapuche in 2.7%, Diaguita in 1.7%, Quechua in 1.3%, Atacameña in 0.2%, and Colla in 0.2%. No specific ethnic origin was found in 79% of patients. Conclusions: There was a low GBC prevalence rate in Northern Chile and among the Aymara population.

Atención de las necesidades espirituales y religiosas de pacientes por personal de salud: un modelo basado en el acompañamiento espiritual / Attention to the spiritual and religious needs of patients by health personnel: a model based on spiritual accompaniment

Resumen Los aspectos espirituales y religiosos han retomado su importancia en la atención de salud, en la búsqueda de una atención integral, digna y más humana, teniendo en cuenta además, los múltiples beneficios clínicos asociados. Sin embargo, el cuidado de las necesidades espirituales y religiosas, históricamente asumidas por capellanes religiosos y guías espirituales, actualmente, en forma paulatina, son considerados parte de las obligaciones de los equipos de salud, no sin la reticencia de los mismos y sin una manera clara de cómo hacerlo. El objetivo del presente trabajo es presentar la importancia de la atención de las necesidades espirituales y religiosas en el cuidado de salud y un modelo de atención basado en el acompañamiento espiritual.

In the search for comprehensive, dignified and more humane care, the spiritual and religious aspects have regained their importance in health care. Furthermore, the múltiple associated clinical benefits must also be taken into account. However, the care of spiritual and religious needs, historically undertaken by religious chaplains and spiritual guides, have gradually become considered part of the obligations of the health teams, in spite of their reluctance and without a clear way on how to do it. The objective of this work is to present the importance of attending to the spiritual and religious needs in health care and a care model based on spiritual accompaniment.

Procuramiento y uso de aloinjertos cutáneos de piel total criopreservados obtenidos de pacientes sometidas a abdominoplastía / Procurement and use of cryopreserved whole skin cutaneous allografts obtained from patients undergoing abdominoplasty

Resumen Introducción: Los aloinjerto cutáneos (AC) son excelentes sustitutos cutáneos temporales, sin embargo, la donación y procura de piel cadavérica, fuente habitual de AC, es baja. Objetivo: Evaluar la factibilidad de utilizar la piel proveniente de abdominoplastías como fuente de AC y su eficacia clínica. Materiales y Método: Entre el 17 de agosto de 2020 al 28 de febrero de 2021 se analizó una cohorte prospectiva de 14 pacientes femeninas sometidas a abdominoplastía por motivos estéticos, que aceptaron donar la piel del colgajo cutáneo abdominal redundante, la cual fue criopreservada. Se utilizaron los AC de piel total criopreservados (ACPTC) en 10 pacientes con diagnósticos de: pie diabético (4), laparostomía contenida (2) herida compleja extremidad inferior (2), sarcoma de cuero cabelludo recidivado (1) y melanoma (1). Resultados: Se obtuvieron 14 colgajos de piel total, los cuales fueron procesados obteniendo una superficie promedio de 302 cm2 y 8,3 láminas de distintos tamaños de utilidad clínica por paciente. En todos los pacientes en que se utilizó ACPTC hubo un prendimiento inicial del AC para posteriormente, en promedio 21 días, presentar una escara necrótica que al ser retirada presentaba un tejido vital adherido al receptor rico en fibroblastos, siendo algunos pacientes auto injertados y otros manejados con cicatrización por segunda intención como tratamiento definitivo. Discusión: Los ACPTC proporcionan una cobertura intermedia, pues una parte se integra en forma definitiva, actuando como un andamiaje biológico para la formación de una interfase sobre la cual se puede autoinjertar o dejar evolucionar con cicatrización por segunda intención y una parte es rechazada. Conclusión: La procura de piel de donante vivo, en pacientes sometidos a cirugías de contorno corporal es un proceso factible, fuente de ACPTC, los cuales permiten una nueva cobertura intermedia con múltiples aplicaciones clínicas.

Introduction: Skin allografts (SA) are outstanding temporary skin substitutes; however, cadaveric skin donation and procurement, a common source of SA, remains low. Aim: To evaluate the feasibility and clinical efficacy of using skin from abdominoplasties as a source of SA. Materials and Method: A prospective cohort was analyzed from August 17th, 2020 and February 28th, 2021, with 14 female patients submitted to abdominoplasty surgeries for aesthetic motives, who authorized skin donation from the redundant abdominal flap which was posteriorly cryopreserved. Cryopreserved total skin allografts (CTSA) was used in 10 patients with the following diagnoses: diabetic foot (4), contained laparostomy (2) complex wound of the lower limb (2), relapsing sarcoma of the scalp (1), and melanoma (1). Results: 14 CTSA were obtained, which were processed, obtaining an average area of 302 cm2 and 8.3 sheets of different sizes and clinical applications from each patient. In all patients who received CTSA, an initial attachment was observed, followed by the appearance of a necrotic scar in an average of21 days. The peeling of the latter revealed a vital tissue tightly adhered to the receptor and rich in fibroblasts. Some of the patients received autografts, and others were managed with secondary intention scarring as a definite treatment. Discussion: CTSA provide an intermediate coverage since one part is definitely adhered to, acting as a biologic scaffolding for the formation of an interface that can be autografted or left for a secondary intention scarring, and the host rejects the other portion. Conclusión: skin procurement from a living donor in patients submitted to body contour surgeries is a feasible process and significant source of CTSA, which permits a new intermediate coverage with multiple clinical uses.

[Prevalence of gallbladder cancer in a Northern Chilean region]. / Cáncer de vesícula en colecistectomías de la región de Tarapacá. Análisis según pertenencia étnica.

BACKGROUND: Gallbladder Cancer (GBC) prevalence varies among countries, associated with different geographical and genetic factors. The Mapuche ethnicity (Ethnia mostly located between the VIII and X Chilean regions) stands out in Chile due to its high GBC prevalence. AIM: To estimate the GBC prevalence in patients undergoing cholecystectomy at a public hospital in the Northern region of Chile (Tarapaca), where other ethnical groups are common. MATERIAL AND METHODS: Pathological reports of 3270 patients (72% women) who underwent cholecystectomy between January 2016 and December 2019 were revised. Subsequently, the accreditation of ethnic belonging for each patient to one of the ten native communities in Chile was requested to the National Corporation for Native Communities Development (CONADI). RESULTS: According to the analysis of pathological reports, the global GBC prevalence was 0.3 %. The prevalence in Aymaras was 0.4% and 0% in Mapuches. The distribution of ethnic origins among analyzed patients was Aymara in 14.3, Mapuche in 2.7%, Diaguita in 1.7%, Quechua in 1.3%, Atacameña in 0.2%, and Colla in 0.2%. No specific ethnic origin was found in 79% of patients. CONCLUSIONS: There was a low GBC prevalence rate in Northern Chile and among the Aymara population.

Prevalencia de colecistolitiasis y cáncer de vesícula en una población rural aymara de Chile

Background: The prevalence of cholelithiasis and gallbladder cancer may be different across ethnic groups. Aim: To study the prevalence of cholelithiasis and gallbladder cancer among Aymara individuals. Material and Methods: An abdominal ultrasound was carried out in a sample of 182 Aymara women aged 46 ± 16 years and 76 Aymara men aged 55 ± 16 years. In addition, the histopathological reports of both patients with a history of previous cholecystectomy and those operated after the study were reviewed. Results: Ultrasound was normal in 150 participants (58%), 76 had cholelithiasis (30%) and 32 (12%) had a history of cholecystectomy. Pathological reports of the excised gallbladder were available for 106 cases and showed a chronic cholecystitis in 98% of cases. Gallbladder cancer was not reported. Conclusions: There is a 42% prevalence of cholelithiasis and no gallbladder cancer in this sample of Aymara population.

[Prevalence of cholelithiasis and gallbladder cancer among Aymara individuals]. / Prevalencia de colecistolitiasis y cáncer de vesícula en una población rural aymara de Chile.

BACKGROUND: The prevalence of cholelithiasis and gallbladder cancer may be different across ethnic groups. AIM: To study the prevalence of cholelithiasis and gallbladder cancer among Aymara individuals. MATERIAL AND METHODS: An abdominal ultrasound was carried out in a sample of 182 Aymara women aged 46 ± 16 years and 76 Aymara men aged 55 ± 16 years. In addition, the histopathological reports of both patients with a history of previous cholecystectomy and those operated after the study were reviewed. RESULTS: Ultrasound was normal in 150 participants (58%), 76 had cholelithiasis (30%) and 32 (12%) had a history of cholecystectomy. Pathological reports of the excised gallbladder were available for 106 cases and showed a chronic cholecystitis in 98% of cases. Gallbladder cancer was not reported. CONCLUSIONS: There is a 42% prevalence of cholelithiasis and no gallbladder cancer in this sample of Aymara population.

Evaluación de la calidad de vida en pacientes con cáncer terminal / Assessment of quality of life in patients with terminal cancer

Introduction: research on life quality of cancer patients allows giving the attention back to the patient and his/her needs. Materials and Methods: FACT-G survey was performed to 77 terminal cancer patients on the Palliative Care and Pain Relief unit from Iquique's General Hospital. Results: physical welfare was evaluated with a 21.22 out of a maximum of 28, social/familiar welfare had a 12.57 over 28, emotional welfare was 16 over 24 and functional welfare had 17.33 over 28. Final score, which represents the sum of the four prior divisions, with a scale from 0 to 108, was 67.62 percent of the maximum score. Conclusions: performance of life quality surveys is feasible for cancer patients, and allows us to make specific interventions on the patient and his/her close ones to improve his/her life quality.

Introducción: los estudios de calidad de vida en pacientes oncológicos permiten devolver la atención al paciente y a sus necesidades. Material y Método: se realiza la encuesta FACT-G (Functional Assessment of Cancer Treatment) a 77 pacientes con diagnóstico de cáncer terminal pertenecientes al policlínico de cuidados paliativos y alivio del dolor del Hospital Ernesto Torres Galdames de Iquique. Resultados: el bienestar físico fue evaluado con 21,22 sobre un máximo de 28, el bienestar Social/Familiar obtuvo 12,57 de 28; el bienestar emocional obtuvo 16 sobre 24; el bienestar funcional obtuvo 17,33 sobre 28. El Score final, que representa la suma de las cuatro divisiones anteriores, con una escala de 0 a 108, fue de 67, que representa el 62 por ciento del puntaje máximo. Conclusiones: es factible la realización de encuestas de calidad de vida en pacientes con cáncer, las cuales nos permiten realizar intervenciones puntuales sobre el paciente y sus cercanos que mejoren su calidad de vida.

Obstrucción intestinal por hernia obturatriz: caso clínico / Intestinal obstruction caused by an obturator hernia: report of one case

We report a 76 years old female presenting in the emergency room with a history of abdominal pain lasting seven days. A plain abdominal X ray showed few fluid filled loops. Due to persistence of pain and appearance of vomiting, an abdominal CAT sean showed a short bowel obstruction caused by an obturator hernia. The patient was operated, correcting the defect with a mesh. The postoperative evolution was uneventful.

La hernia obturatriz es una rara causa de obstrucción intestinal, se presenta en pacientes mujeres adultos mayores, desnutridos y postrados; se asocia a una elevada mortalidad por los antecedentes mórbidos de los pacientes y al bajo índice de sospecha. Se recomienda el uso de la tomografía axial computada como técnica de elección para el diagnóstico en pacientes con sospecha clínica. El objetivo de este trabajo es presentar un caso clínico de una paciente con hernia obturatriz que consultó en nuestro servicio de urgencia y se solicitó tomografía de abdomen y pelvis para completar estudio que requirió laparotomía exploradora ante el cuadro clínico y los hallazgos imagenológicos.

Tumor desmoide de la pared abdominal y enfermedad de Crohn / Desmoid tumor and Crohn's disease

Se presenta el caso clínico de un paciente varón de 57 años portador de una enfermedad de Crohn de varios años de evolución, tratado con múltiples esquemas de corticoterapia, pentasa e inmunosupresores. El paciente ingresa a nuestro Servicio con un cuadro abdominal de curso agresivo que requiere manejo intensivo y nutrición parenteral. A los 5 días se interviene de urgencia por una obstrucción intestinal, constatándose varias perforaciones de íleon y de ciego con fístula y abscesos múltiples. Se efectúa una resección de la región ileocecal con anastomosis ileocólica terminal funcional con suturas mecánicas con evolución satisfactoria. A los 12 meses presenta un aumento de volumen en relación con la cicatriz media infraumbilical de crecimiento rápido con ulceración y sangrado, cuya biopsia incisional sugiere un tumor desmoide. La tomografía axial computada no logró establecer la relación exacta con las vísceras abdominales y se interviene en forma electiva con el diagnóstico de fibromatosis mesentérica. Se extirpa un tumor gigante de 20 cm de diámetro que compromete exclusivamente la pared abdominal, la cual logra cerrarse en forma primaria sin empleo de prótesis, debido a la presencia de una fístula enterocutánea concominante que se trata con liberación y enterorrafia. La evolución postoperatoria fue sin incidentes y luego de 12 meses de seguimiento no hay evidencias de recidiva local. Aunque la enfermedad de Crohon se asocia con tumores de variado origen histológico y particularmente con sarcomas de partes blandas, la coexistencia con la fibromatosis mesentérica es excepcional y no hemos encontrado ninguna publicación de esta enfermedad inflamatoria asociada con un tumor desmoide de la pared abdominal. Se concluye que no es posible establecer una relación causal entre ambas entidades