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1.
Rev Esp Enferm Dig ; 84(5): 297-9, 1993 Nov.
Artículo en Español | MEDLINE | ID: mdl-8305256

RESUMEN

In the last years the relationship between congenital hypertrophy of retinal pigment epithelium (CHPRE) and familial adenomatous polyposis (FAP) has been described. It has been said that ophthalmoscopy would be a good screening method for following up the relatives of patients with FAP. We present an ophthalmoscopic study of 14 member of a family with FAP. Four members with FAP were operated on in our department. Only a six years-old child, to this date without FAP, presented CHPRE. We review the relationship between FAP and CHPRE, and emphasize the importance of follow-up in FAP specially when CHPRE is present.


Asunto(s)
Poliposis Adenomatosa del Colon/complicaciones , Poliposis Adenomatosa del Colon/genética , Epitelio Pigmentado Ocular/patología , Adolescente , Adulto , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Hipertrofia/congénito , Masculino , Linaje
2.
Rev Esp Enferm Dig ; 83(2): 127-9, 1993 Feb.
Artículo en Español | MEDLINE | ID: mdl-8471352

RESUMEN

A new case of cecal herniation through the foramen of Winslow is reported in a 67 year-old woman, preoperatively diagnosed by water-soluble contrast enema. Herniation through Winslow's foramen is an uncommon variety of internal hernias. Of 144 cases reported up to 1991 in the world literature, the cecum was involved in only 25-30%; and less than 10% of these were radiologically diagnosed before surgery.


Asunto(s)
Enfermedades del Ciego , Anciano , Enfermedades del Ciego/diagnóstico por imagen , Femenino , Hernia/diagnóstico por imagen , Humanos , Peritoneo , Radiografía
3.
Rev Esp Enferm Dig ; 88(1): 46-8, 1996 Jan.
Artículo en Español | MEDLINE | ID: mdl-8616002

RESUMEN

Small-cell anaplastic carcinoma of the colon is a very infrequent tumour (less than 1% of all colorectal neoplasms). Thirty-two cases have been described in the international literature up to 1992. A case, in a 54 year-old patient who underwent successful resection is presented. The importance of this tumour is due to its great aggressivity, and its great tendency to produce early hematogenous and lymph node metastases. It implies a bad prognosis and a survival of around 0% at one year. Because of these facts, treatment must include, beside surgical resection, an aggressive systemic protocol.


Asunto(s)
Carcinoma de Células Pequeñas , Neoplasias del Colon , Carcinoma de Células Pequeñas/patología , Carcinoma de Células Pequeñas/cirugía , Colectomía , Colon/patología , Neoplasias del Colon/patología , Neoplasias del Colon/cirugía , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad
4.
Rev Esp Enferm Dig ; 88(7): 509-1, 1996 Jul.
Artículo en Español | MEDLINE | ID: mdl-8924331

RESUMEN

Hepatic adenoma and focal nodular hyperplasia are unfrequent benign lesions of the liver with individual histologic characteristics, but not always clinically distinguishable. The main difference is the intratumoral or intraperitoneal bleeding risk (high in adenoma and virtually zero in focal nodular hyperplasia). Surgery is the elective treatment for the first, while a more conservative attitude is allowed for the second. We present the case of a woman with an hepatic mass that clinically and radiologically seemed to be an adenoma. An atypical hepatectomy was done uneventfully. The examination of the specimen showed shaw focal nodular hyperplasia. We review the diagnostic and therapeutic controversy between these entities, because only the histologic examination of the entire surgical specimen could demonstrate the real nature of the lesion.


Asunto(s)
Adenoma/patología , Neoplasias Hepáticas/patología , Hígado/patología , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Hiperplasia/patología
7.
Cir Esp ; 80(5): 307-25, 2006 Nov.
Artículo en Español | MEDLINE | ID: mdl-17192207

RESUMEN

INTRODUCTION: Because surgical treatment of gallstones is highly prevalent, this topic is particularly suitable for a national study aimed at determining the most important indicators and developing a clinical pathway. OBJECTIVES: To analyze the results obtained during the hospital phase of the process. To define the key indicators of the process. To design a clinical pathway for laparoscopic cholecystectomy. PATIENTS AND METHODS: A multicenter, prospective, cross-sectional, descriptive study was performed of patients who consecutively underwent surgery for gallstones in 2002. The sample size calculated with data provided by the National Institute of Statistics was 304 patients, which was increased by 45% to compensate for possible losses. Inclusion criteria consisted of elective cholecystectomy for gallstones, without preoperative findings suggestive of common duct stones. A database was designed (Microsoft Access 2000) with 76 variables analyzed in each patient. RESULTS: Completed questionnaires were obtained from 37 hospitals with 426 patients. The mean age was 55.69 years, with a predominance of women (68.3%). The most frequent symptom was biliary colic (23%). A total of 20.3% of the patient had prior episodes of cholecystitis and 18% had a history of mild pancreatitis. Diagnosis was given by ultrasonography in 93.2% of the patients. Informed consent was provided by 93.2%. The intervention was performed on an inpatient basis in 96.1% and in the ambulatory setting in the remainder. Antibiotic and antithrombotic prophylaxis was administered in 78.9% and 75.1% of the patients respectively. The laparoscopic approach was used in 84.6%, with a conversion rate of 4.9%. Intraoperative cholangiography was performed in 17.8% of the patients and common duct stones were found in 7 patients. The most frequent complication was surgical wound infection (1.1%). Possible accidental lesion of the biliary tract occurred in 0.7% of the patients and was described as biliary fistula. There were four reinterventions: biliary fistula (1), hemoperitoneum (2) and cause unknown (1). The mean surgical time was 73.17 minutes, with a median of 60 minutes. Postoperative length of stay was 4.75 days in open surgery and 2.67 days in laparoscopic surgery. Ninety-nine percent of the patients were satisfied or highly satisfied with the healthcare received. CONCLUSIONS: Analysis of the process and review of the literature identified a series of areas requiring improvement, which were gathered in the clinical pathway developed. These areas consisted of increasing the number of patients with correctly indicated antibiotic and antithrombotic prophylaxis, increasing the percentage of patients providing informed consent and undergoing adequate preoperative tests, limiting intraoperative cholangiography to selected patients, and reducing the number of patients with an overall stay of 3 days.


Asunto(s)
Colecistectomía/normas , Colelitiasis/cirugía , Colecistectomía/métodos , Colelitiasis/diagnóstico , Colelitiasis/epidemiología , Vías Clínicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud , Complicaciones Posoperatorias , Estudios Prospectivos , España , Resultado del Tratamiento
8.
Cir. Esp. (Ed. impr.) ; 80(5): 307-325, nov. 2006. ilus, tab
Artículo en Es | IBECS (España) | ID: ibc-049167

RESUMEN

Introducción. La alta prevalencia del tratamiento quirúrgico de la colelitiasis ofrece un gran interés para la realización de un estudio a escala nacional dirigido a conocer los indicadores más importantes y desarrollar una vía clínica. Objetivos. Analizar los resultados obtenidos durante la etapa hospitalaria del proceso. Definir los indicadores clave del proceso. Elaborar una vía clínica para la colecistectomía laparoscópica. Pacientes y métodos. Estudio multicéntrico, prospectivo, transversal y descriptivo, de pacientes intervenidos quirúrgicamente de forma consecutiva por presentar colelitiasis durante el año 2002. El tamaño muestral calculado con los datos suministrados por el Instituto Nacional de Estadística fue de 304 pacientes, que se incrementó en un 45% para compensar posibles pérdidas. Los criterios de inclusión fueron: colecistectomía programada por colelitiasis, sin sospecha preoperatoria fundamentada de litiasis de la vía biliar principal. Se diseñó una base de datos (Microsoft Access 2000®) con 76 variables analizadas en cada paciente. Resultados. Se obtuvieron los cuestionarios de 37 hospitales con 426 pacientes. La edad media fue de 55,69 años, con predominio del sexo femenino (68,3%). La sintomatología más frecuente fue el cólico biliar (23%), con un 20,3% de pacientes con antecedentes de colecistitis y un 18% con pancreatitis leve. Al diagnóstico se llegó con la ecografía en un 93,2% de los casos. El consentimiento informado se completó en un 93,2%. En un 96,1% de los pacientes la intervención se realizó en régimen hospitalario y en el resto, de forma ambulatoria. Se realizó tratamiento antibiótico en el 78,9% y antitrombótico en el 75,1% de los casos. La intervención se realizó de forma laparoscópica en el 84,6%, con un porcentaje de reconversión del 4,9%. En un 17,8% de los pacientes se realizaron colangiografías peroperatorias, y se encontró coledocolitiasis en 7 pacientes. La complicación más frecuente fue la infección de la herida quirúrgica (1,1%). La posible lesión accidental de la vía biliar se produjo en un 0,7% de los casos, descrita como fístula biliar. Hubo 4 reintervenciones: fístula biliar (1), hemoperitoneo (2) y no se informó causa (1). La duración media de la intervención fue de 73,17 min, con una mediana de 60 min. La estancia postoperatoria de los pacientes intervenidos por laparotomía fue de 4,75 días, y 2,67 días la de los pacientes intervenidos por vía laparoscópica. El 99% de los pacientes se mostró satisfecho o muy satisfecho con la atención hospitalaria. Conclusiones. Con el análisis del proceso y la revisión de la literatura médica se ha identificado una serie de indicadores de mejora recogidos en la vía clínica que se desarrolla: porcentaje de pacientes con uso de tratamiento antibiótico y antitrombótico correctamente indicada, porcentaje de pacientes con consentimiento informado y pruebas preoperatorias adecuadas, porcentaje de pacientes con colangiografía peroperatoria correctamente adecuada y porcentaje de pacientes intervenidos con una estancia global de 3 días (AU)


Objectives. To analyze the results obtained during the hospital phase of the process. To define the key indicators of the process. To design a clinical pathway for laparoscopic cholecystectomy. Patients and methods. A multicenter, prospective, cross-sectional, descriptive study was performed of patients who consecutively underwent surgery for gallstones in 2002. The sample size calculated with data provided by the National Institute of Statistics was 304 patients, which was increased by 45% to compensate for possible losses. Inclusion criteria consisted of elective cholecystectomy for gallstones, without preoperative findings suggestive of common duct stones. A database was designed (Microsoft Access 2000®) with 76 variables analyzed in each patient. Results. Completed questionnaires were obtained from 37 hospitals with 426 patients. The mean age was 55.69 years, with a predominance of women (68.3%). The most frequent symptom was biliary colic (23%). A total of 20.3% of the patient had prior episodes of cholecystitis and 18% had a history of mild pancreatitis. Diagnosis was given by ultrasonography in 93.2% of the patients. Informed consent was provided by 93.2%. The intervention was performed on an inpatient basis in 96.1% and in the ambulatory setting in the remainder. Antibiotic and antithrombotic prophylaxis was administered in 78.9% and 75.1% of the patients respectively. The laparoscopic approach was used in 84.6%, with a conversion rate of 4.9%. Intraoperative cholangiography was performed in 17.8% of the patients and common duct stones were found in 7 patients. The most frequent complication was surgical wound infection (1.1%). Possible accidental lesion of the biliary tract occurred in 0.7% of the patients and was described as biliary fistula. There were four reinterventions: biliary fistula (1), hemoperitoneum (2) and cause unknown (1). The mean surgical time was 73.17 minutes, with a median of 60 minutes. Postoperative length of stay was 4.75 days in open surgery and 2.67 days in laparoscopic surgery. Ninety-nine percent of the patients were satisfied or highly satisfied with the healthcare received. Conclusions. Analysis of the process and review of the literature identified a series of areas requiring improvement, which were gathered in the clinical pathway developed. These areas consisted of increasing the number of patients with correctly indicated antibiotic and antithrombotic prophylaxis, increasing the percentage of patients providing informed consent and undergoing adequate preoperative tests, limiting intraoperative cholangiography to selected patients, and reducing the number of patients with an overall stay of 3 days (AU)


Asunto(s)
Masculino , Femenino , Adulto , Persona de Mediana Edad , Humanos , Colelitiasis/economía , Colelitiasis/epidemiología , Colelitiasis/cirugía , Indicadores de Servicios/organización & administración , Laparoscopía/métodos , Encuestas y Cuestionarios , Complicaciones Posoperatorias/cirugía , Laparotomía/métodos , Satisfacción del Paciente/estadística & datos numéricos , Indicadores de Salud , Indicadores de Calidad de la Atención de Salud/organización & administración , Litiasis/complicaciones , Litiasis/cirugía , Estudios Prospectivos , Estudios Transversales
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