RESUMEN
INTRODUCTION: The advantages of single-stage treatment of cholecystocholedocholithiasis are well established, but the conditions for carrying out treatment on an outpatient basis require a review of concepts and practices of medical corporations. OBJECTIVE: To evaluate the practice of treating cholecystocholedocholithiasis by laparoendoscopy on an outpatient basis with cost analysis. METHOD: A retrospective study was conducted on patients with cholecystocholedocholithiasis treated by combined laparoscopic cholecystectomy and endoscopic choledocholithotomy from January 2015 to January 2019. After collecting data from physical and digital medical records, the patients were divided into two groups-AR (n = 42)-ambulatory regimen and HR (n = 28)-hospitalization regimen-which were compared in terms of demographic, clinical and treatment variables and their results, as well as in terms of costs. RESULTS: The mean age of the AR group was lower than that of the HR group and the physical status of the AR patients was better when assessed according to the American Society of Anesthesiologists (ASA) (p = 0.01). There was no difference between groups regarding the risk of choledocholithiasis (p = 0.99). For the AR group, the length of stay was shorter: 11.29 h × 65.21 h (p = 0.02), as was the incidence of postoperative complications assessed by applying the Clavien-Dindo classification: 3 (7.1%) × 11 (39.2%) (p < 0.01). The total mean costs were higher for the HR group (USD 2489.93) than the AR group (USD 1650.98) (p = 0.02). CONCLUSION: Outpatient treatment of cholecystocholedocholithiasis by laparoendoscopy is safe and viable for most cases, has a lower cost and can support the reorientation of training and practice of hepatobiliary surgeons.
RESUMEN
OBJECTIVES: The benefits of using a fibrin sealant to reinforce the pancreaticojejunal anastomosis are still contentious, a fact that justifies the study of its effects on clinical outcomes and costs of pancreaticoduodenectomy. METHODS: Study of 62 consecutive patients submitted to pancreaticoduodenectomy, divided into two groups of 31 patients each: GWS = group with sealant and GWOS = group without sealant that were compared according to demographic, clinical, laboratory aspects, the incidence of postoperative pancreatic fistula (POPF), according to the definition of the International Study Group on Pancreatic Fistula, updated in 2016, and its postoperative complications categorized according to the Clavien classification, as well as hospital costs evaluated by the absorption costing method (with the exception of those related to medications). RESULTS: The groups were homogeneous and there were no significant differences in the postoperative clinical course or in the indicators of hospital care between them. Hard texture of pancreatic tissue was the only protective factor against the development of POPF (RR = 0.29 (95%CI:0,12-0,68); p = 0.005). Moreover, hospital costs were higher in GWS than in GWOS (p < 0.0001). CONCLUSIONS: The use of fibrin sealant to reinforce pancreaticojejunal anastomosis did not improve the clinical and healthcare outcomes and, in addition, increased hospital costs.
RESUMEN
Diagnosis and treatment of pancreatic ductal adenocarcinoma (PA) remains a challenge in clinical practice. The aim of this study was to assess the role of microRNAs (miRNAs-21, -23a, -100, -107, -181c, -210) in plasma and tissue as possible biomarkers in the diagnosis of PA. Samples of plasma (PAp-n = 13), pancreatic tumors (PAt-n = 18), peritumoral regions (PPT-n = 9) were collected from patients during the surgical procedure. The control group consisted of samples from patients submitted to pancreatic surgery for trauma or cadaveric organs (PC-n = 7) and healthy volunteers donated blood (PCp-n = 6). The expression profile of microRNAs was measured in all groups using RT-PCR, serum CA19-9 levels were determined in PA and PC. In tissue samples, there was a difference in the expression of miRNAs-21, -210 (p < 0.05) across the PAt, PC and PPT groups. The PAp showed overexpression of miRNAs-181c, -210 (p < 0.05) when compared to PCp. The combination of miRNAs-21, -210 tissue expression and serum CA19-9 showed 100% accuracy in the diagnosis of PA, as well as miR-181c expression in the plasma (PApxPCp). The expression of microRNAs in plasma proved to be a promising tool for a noninvasive detection test for PA, as well as further studies will evaluate the utility of microRNAs expression as biomarkers for prognostic and response to therapy in PA.
RESUMEN
O centro cirúrgico, por suas particularidades e características, constitui uma das unidades mais complexas do ambiente hospitalar. Assim, percebe-se que o bom desempenho de um centro cirúrgico está diretamente relacionado com a qualidade de seus próprios processos e com os processos dos serviços que o apoiam. Em Julho de 2012, com a portaria 194 HCRP (5), é estabelecido as Diretrizes Gerais de Funcionamento do Bloco Cirúrgico do HC campus.O objetivo do presente estudo é avaliar o impacto do novo modelo gerencial do Bloco Cirúrgico do Campus implantado.Trata-se de séria histórica descritiva e retrospectiva com análise de alguns indicadores comparando anova gestão com a fase prévia.Nota-se melhora progressiva em alguns indicadores analisados, alcançando metas estipuladas pelo próprio Planejamento estratégico vigente.O presente estudo pode ilustrar o impacto de um modelo gerencial dentro do Centro Cirúrgico de um Hospital Escola Terciário de grande porte, mostrando os avanços alcançados e os pontos com oportunidades de melhoria...
The surgical center, by their features and characteristics, is one of the drives more complex hospitalenvironment. Thus, it is clear that the good performance of a surgical center is directly related to thequality of their own processes and with the processes of the services that support it. In July 2012, with ordinance 194 - HCRP, is established General guidelines for the Operation of Block Círurgico HC campus. The objective of this study is to evaluate the impact of the new management model of Surgical Block the HCRP-campus deployed. It would be historic descriptive and retrospective analysis of some indicators comparing the new management with the prior phase. Note progressive improvement in some indicators analyzed, reaching targets set by the strategic Planning current. The present study may serve to illustrate the impact of a management model with in the Surgical Center of a Hospital Tertiary School large, showing the progress made and the points with opportunities for improvement...