Cesarean rate in selected hospital network of private sector: A retrospective study.

INTRODUCTION: In Spain over the last two decades, cesarean section (CS) rates have increased from 15 to 25% in the Public Health Sector and from 28 to 38% in the private sector. There are multiples causes for this rise, which are often unclear. The aim of our study is to collect and analyze all the CS rates data from a hospital network of the 42 Quirónsalud Hospitals (private sector) and to assess its distribution regarding the different types of hospitals and patient characteristics. MATERIAL AND METHODS: An observational retrospective study between 2017 and 2018 was performed. Hospitals are classified into three groups: large hospitals (11), medium hospitals (17) and small hospitals (14). The cesarean section rate was measured by patient categorization into three groups: total deliveries, low risk cesarean sections and low risk cesarean sections without previous cesarean delivery. RESULTS: We analyzed 62,685 deliveries: 42,987 were vaginal deliveries (68.6%) and 19,698 CS (31.4%). The mean age for the total number of deliveries was 34.18 years old, whilst the mean age for the low-risk group was 34.12. Of the 19,698 CS, 18.36% (3618) were in high-risk population and 81.63% (16,080) in low risk population. 69.54% (11,183) of the low-risk CS were in patients without a previous CS. CONCLUSIONS: The overall rate of CS in the Quirónsalud group is slightly higher than the one from the Public Healthcare. The older maternal age as well as the hospital resources involved in the delivery attendance can explain this difference.

Tratamiento del síndrome de dolor miofascial asociado a síndrome del desfiladero torácico. A propósito de un caso / Treatment of myofascial pain syndrome associated with thoracic outlet syndrome: Presentation of a case

Antecedentes y objetivo: El síndrome del desfiladero torácico produce la compresión del plexo braquial en el espacio costoclavicular. El síndrome de dolor miofascial cervical puede provocar sintomatología parecida y, en ocasiones, pasa desapercibido. El objetivo del presente trabajo es exponer las implicaciones que el síndrome de dolor miofascial puede tener en el síndrome del desfiladero torácico y proponer el tratamiento desde la fisioterapia. Descripción del caso: Paciente de 32 años con cervicalgia de 6 meses de evolución que se irradia hacia ambos miembros superiores, edema y parestesias en las manos. Se le pautaron 2 sesiones de fisioterapia a la semana, durante 6 semanas. Se utilizaron técnicas conservadoras. Resultados: Tras 6 semanas, la percepción del dolor y las parestesias desaparecieron y el edema de las manos disminuyó hasta 3 mm en el perímetro de los dedos. Conclusiones: Un abordaje conservador del síndrome de dolor miofascial puede provocar mejoría en el síndrome del desfiladero torácico

Background and objective: Thoracic outlet syndrome produces compression of the brachial plexus at the costoclavicular space. Myofascial pain syndrome of cervical muscles can cause symptoms common to the first, so sometimes goes unnoticed. The aim of this article is to present the implications of myofascial pain syndrome in thoracic outlet syndrome and to propose a physiotherapy-based approach. Case description: The case involves a 32 year-old patient with neck pain of 6 months onset that radiated to both upper limbs, with oedema and paraesthesia in the hands. She was given 2 physiotherapy sessions per week, for 6 weeks, using conservative techniques. Results: After 6 weeks, the perception of pain and paraesthesia disappeared, with the oedema of the hands decreasing to 3 mm in the circumference of the fingers. Conclusions: A conservative approach to myofascial pain syndrome can lead to improvements in thoracic outlet syndrome

Comparative study of extracellular recording methods for analysis of afferent sensory information: Empirical modeling, data analysis and interpretation.

BACKGROUND: Physiological studies of sensorial systems often require the acquisition and processing of data extracted from their multiple components to evaluate how the neural information changes in relation to the environment changes. In this work, a comparative study about methodological aspects of two electrophysiological approaches is described. NEW METHOD: Extracellular recordings from deep vibrissal nerves were obtained by using a customized microelectrode Utah array during passive mechanical stimulation of rat´s whiskers. These recordings were compared with those obtained with bipolar electrodes. We also propose here a simplified empirical model of the electrophysiological activity obtained from a bundle of myelinated nerve fibers. RESULTS: The peripheral activity of the vibrissal system was characterized through the temporal and spectral features obtained with both recording methods. The empirical model not only allows the correlation between anatomical structures and functional features, but also allows to predict changes in the CAPs morphology when the arrangement and the geometry of the electrodes changes. COMPARISON WITH EXISTING METHOD(S): This study compares two extracellular recording methods based on analysis techniques, empirical modeling and data processing of vibrissal sensory information. CONCLUSIONS: This comparative study reveals a close relationship between the electrophysiological techniques and the processing methods necessary to extract sensory information. This relationship is the result of maximizing the extraction of information from recordings of sensory activity.

Development and validation of baseline, perioperative and at-discharge predictive models for postsurgical prosthetic joint infection.

OBJECTIVES: To develop and validate baseline, perioperative and at-discharge risk-scoring systems for postsurgical prosthetic joint infection (PJI) in patients undergoing arthroplasty. METHODS: A multicentre prospective cohort study of patients undergoing hip and knee arthroplasty was performed. Patients were randomly assigned (2:1) to a derivation cohort (DC) or a validation cohort (VC). Multivariable predictive models of PJI were constructed at baseline (preoperative period), perioperative (adding perioperative variables) and at-discharge (adding wound state at discharge). The predictive ability of the models and scores was evaluated by area under the receiving operating characteristic curves (AUROC). RESULTS: The DC and VC included 2324 and 1245 patients, respectively. Baseline model included total hip arthroplasty (THA), revision arthroplasty (RA), Charlson index and obesity. The AUROC for the score was 0.75 and 0.78 in the DC and VC, respectively. Perioperative model included THA, RA, obesity, National Nosocomial Infections Surveillance (NNIS) index ≥2, significant wound bleeding and superficial surgical site infection; the AUROC was 0.81 and 0.77 in the DC and VC, respectively. The at-discharge model included THA, RA, obesity, NNIS index ≥2, superficial surgical site infection and high-risk wound; the AUROC was 0.82 and 0.84 in the DC and VC, respectively. A score ≥8 points provided 99% negative predictive values for all models. CONCLUSIONS: Simple scores for predicting PJI at three different moments of care in patients undergoing arthroplasty were developed and validated. The scores allow early and accurate identification of high-risk individuals in whom enhanced preventive measures and follow-up may be needed. Further external validation is needed.

Hemorragia digestiva alta como primera manifestación de un corstoma pancreático gástrico / Upper gastrointestinal bleeding as presenting symptoms of a gastic pancreatic chrositoma

El páncreas ectópico es un tejido pancreático fuera de su localización anatómica habitual con ausencia de continuidad con el páncreas normal. Describimos la presentación y el manejo de un paciente con tejido pancreático ectópico en el estómago

Ectopic pancreas is pancreatic tissue found outside its usual anatomic location without connection to the normal pancreas. We describe the presentation and management of a patient with ectopic pancreatic tissue in the stomach

Diverticulitis yeyunal perforada: una causa infrecuente de abdomen agudo grave / Perforated jejunal diverticulitis: An infrequent cause of seirous acute abdomen

Los divertículos yeyunales son entidades poco frecuentes y asintomáticos. En la mayoría de casos son hallazgos incidentales durante otra intervención quirúrgica, pero se estima que hasta un 10% presentan complicaciones agudas, principalmente diverticulitis con o sin perforación. Presentamos tres casos de diverticulitis yeyunal perforada, que consultaron por dolor abdominal difuso sin otra sintomatología asociada. Se intervinieron de forma urgente hallando en los tres casos, un plastrón inflamatorio secundario a diverticulitis yeyunal perforada, por lo que se realizó resección de todo el segmento afecto incluyendo todos los divertículos

Jejunal diverticular are uncommon and asymptomatic entities. Mostly, they are incidental findings during another surgical intervention, but it is estimated that up to 10% present acute complications, mainly diverticulitis with or without perforation. We report three cases of perforated jejunal diverticulitis, which were consulted for diffuse abdominal pain without associated symptoms. Urgent isurgery were performed, finding in all cases an inflammatory plastron secondary to perforated jejunal diverticulitis, the whole affected segment was resected

Time-frequency analysis of neuronal populations with instantaneous resolution based on noise-assisted multivariate empirical mode decomposition.

BACKGROUND: Linear analysis has classically provided powerful tools for understanding the behavior of neural populations, but the neuron responses to real-world stimulation are nonlinear under some conditions, and many neuronal components demonstrate strong nonlinear behavior. In spite of this, temporal and frequency dynamics of neural populations to sensory stimulation have been usually analyzed with linear approaches. NEW METHOD: In this paper, we propose the use of Noise-Assisted Multivariate Empirical Mode Decomposition (NA-MEMD), a data-driven template-free algorithm, plus the Hilbert transform as a suitable tool for analyzing population oscillatory dynamics in a multi-dimensional space with instantaneous frequency (IF) resolution. RESULTS: The proposed approach was able to extract oscillatory information of neurophysiological data of deep vibrissal nerve and visual cortex multiunit recordings that were not evidenced using linear approaches with fixed bases such as the Fourier analysis. COMPARISON WITH EXISTING METHODS: Texture discrimination analysis performance was increased when Noise-Assisted Multivariate Empirical Mode plus Hilbert transform was implemented, compared to linear techniques. Cortical oscillatory population activity was analyzed with precise time-frequency resolution. Similarly, NA-MEMD provided increased time-frequency resolution of cortical oscillatory population activity. CONCLUSIONS: Noise-Assisted Multivariate Empirical Mode Decomposition plus Hilbert transform is an improved method to analyze neuronal population oscillatory dynamics overcoming linear and stationary assumptions of classical methods.

Valoración psiquiátrica en pacientes candidatos a cirugía bariátrica / Psychiatric evaluation in patients candidates for bariatric surgery

Introducción: La obesidad no se considera un trastorno psiquiátrico, aunque es muy frecuente la asociación de alguna alteración psicológica. En los pacientes candidatos a cirugía bariátrica se plantea la necesidad de considerar tanto variables cognitivas como afectivas (manejo de estados emocionales displacenteros) y ambientales (costumbres, hábitos familiares). No debe olvidarse que el ser humano es un ser bio-psico-social, de ahí la necesidad de realizar una evaluación completa de la personalidad y del sistema ambiental del paciente obeso. El objetivo de este estudio fue el de conocer la prevalencia de las alteraciones psicopatológicas de los pacientes candidatos a cirugía bariátrica. Material y Métodos: 300 pacientes (213 mujeres) candidatos a cirugía bariátrica a los que se les realizó una entrevista clínica y se aplicaron varias escalas de psicopatología: Eating Attitudes Test (EAT-26), Escala de Depresión de Beck (BDI-II), Cuestionario internacional de evaluación de la personalidad (IPDE), y la Escala de Inteligencia de Wechsler (WAIS III). Resultados: Nuestros pacientes presentaban un nivel intelectual normal, un nivel educativo alto y la mayoría contaba con apoyo familiar. La principal alteración de la conducta alimentaria era la hiperfagia, por delante del picoteo, atracones y vómitos. La mitad de los pacientes presentaban algún trastorno del estado del animo antes de la intervención. Conclusiones: Los factores psicológicos deben ser valorados antes de tomar la decisión de cirugía bariátrica y elegir la técnica quirúrgica, por su potencial influencia sobre los resultados de la pérdida de peso

Introduction: Morbid obesity is not considered a mental disorder, but is associated with a high prevalence of psychopathological conditions. In patients candidates for bariatric surgery is a need to consider both cognitive and affective variables (managing of emotional states) and environmental (customs, family habits). Do not forget that the human being is a bio-psycho-social being, hence the need for a comprehensive assessment of personality and environmental system of the obese patient. The aims of this study were to know the prevalence of the psychopathological alterations among patients with morbid obesity (MO) candidates for bariatric surgery in our centre. Material and Methods: 300 patients (213 women) candidates for bariatric surgery, which underwent a clinical interview. Several scales of psychopathology were applied: Eating Attitudes Test (EAT-26), Beck Depression Scale (BDI-II), Internacional Personality Disorder Examination (IPDE) and Wechsler Intelligence Scale (WAIS III). Results: Our patients had a normal intellectual level, high educational level and most had family support. The main change eating behavior was hyperphagia, ahead of snacking, binge eating and vomiting. Half of the patients had a mood disorder before surgery. Conclusions: Psychological factors should be evaluated before deciding to choose bariatric surgery and surgical technique for its potential influence on the results of weight loss

Banda libre de tensión transobturadora en el tratamiento de la incontinencia urinaria femenina. Cinco años de experiencia en un hospital comarcal / Tension-free baginal transobturador tape for the treatment of femenine urinary incontinence. Five years of experience in a district hospital

Objetivo: Evaluar los resultados de aplicar una banda suburetral transobturadora (TOT) en el tratamiento de la incontinencia urinaria femenina, aislada o asociada a cirugía del prolapso de órganos pélvicos, así como analizar las complicaciones intra y postoperatorias de la cirugía. Sujetos y métodos Estudio prospectivo durante un periodo de 5 años incluyendo 107 pacientes. La valoración preoperatoria incluyó un estudio urodinámico en todos los casos, y la valoración de los resultados fue subjetiva con el cuestionario ICIQ-SF en encuesta telefónica efectuada a 105 de los pacientes. Se define curación como una puntuación de 0 en el citado cuestionario, mejoría como una puntuación de 1 a 5 y fracaso como una puntuación superior a 5.ResultadosLa tasa de curación global de la incontinencia urinaria es del 80%. Se han registrado un 0,9% de lesión vesical, un 5,6% de retención urinaria y un 12% de inestabilidad del detrusor de novo. En el grupo de cirugía de la incontinencia aislada, la curación de la misma es de un 69% y en el grupo de cirugía de la incontinencia asociada a cirugía del prolapso es del 87% (p < 0,05).Conclusiones La banda TOT es un tratamiento seguro y efectivo en el tratamiento de la incontinencia urinaria femenina, tanto aislada como asociada a cirugía del prolapso genital, en el seguimiento a largo plazo (AU)

Objective: To evaluate the efficacy of the tension-free obturador tape procedure in the treatment of female urinary incontinence, alone or associated with pelvic organ prolapse surgery, and to analyze the intra and postoperative complications Subjects and methods: Prospective study over a period of five years including 107 patients. Preoperative evaluation included urodynamic study and assessment of the results was subjective with an ICIQ-SF questionnaire in a telephone survey of 105 patients. Cure is defined as a score in that questionnary, improvement as a score of 1 to 5 and failure as a score more 5.Results: The overall cure rate is 80%.There have been an 0.9% the bladder injury, 5.6% of urinary retention and 12% de novo urgency developed. In the group of incontinence surgery alone overall cure rate is the 69% and in the surgery group of incontinence associated with prolapse surgeryis the 87% (P<.05).Conclusions: The transobturador tape is a safe and effective procedure in the treatment of female urinary incontinence, alone or associated with pelvic organ prolapse surgery, in longterm follow-up (AU)

Hematoma gigante de la vaina de los rectos: diagnóstico diferencial de abdomen agudo / Giant rectus sheath hematoma: differnetial diagnostic of acute abdominal pain

El uso creciente de terapias antiagregantes y anticoagulantes ha aumentado la incidencia de hematomas espontáneos de la vaina de los rectos. El hematoma de la vaina de los rectos (HVR) es una causa de abdomen agudo poco común y que lleva frecuentemente a errores diagnósticos. La forma más frecuente de presentación es como dolor importante en hemiabdomen inferior asociado a masa palpable que no sobrepasa la línea media. Esta entidad clínica bien conocida es normalmente autolimitada y su tratamiento es conservador, pero tiene una alta morbilidad y su índice de mortalidad está en torno al 4% de forma global (AU)

Increasing use of antiplatelet and anticoagulant therapies has led to an increase in the incidence of spontaneous rectus sheath hematoma (RSH). Spontaneous RSH is an uncommon and frequently misdiagnosed cause of acute abdominal pain. The most commonly presented feature is a painful lower abdominal mass that never crosses the midline. This well-described entity is typically self-limited, and has a conservative management, but it has significant morbidity and its overall mortality rate is reported as 4% (AU)

[Incidence of lower extremity amputations in Area 3 of Madrid. Retrospective study during the period 2001-2006]. / Incidencia de amputaciones de extremidades inferiores en el área 3 de Madrid. Estudio retrospectivo del periodo 2001-2006.

OBJECTIVE: To quantify the Lower Extremity Amputations (LEA) incidence in population with and without diabetes mellitus (DM). MATERIAL AND METHODS: Retrospective cohort study of all the LEA carried out during 2001-2006 in area 3 of Madrid, from the codification of the reports of discharge reports. RESULTS: 310 LEA were carried out. The age-ajusted LEA incidence for any reason was 19,2/10(5) inhabitants per year (27,2 y 11,2 for men and women respectively). 261 were not-traumatic and non-tumoural (NTT) LEA, 76% were associated with DM and the incidence was 191/10(5) people with DM per year (95% confidence interval [CI(95)] 122-299) and 4,4/10(5) for people without DM per year (CI(95) 7-23), with a risk ratio of 44 (CI(95) 23-73). CONCLUSIONS: The LEA rates in population with o without diabetes are higher than the previously communicated in Madrid. It would appear convenient to design strategies to reduce the LEA rates.

Incidencia de amputaciones de extremidades inferiores en el área 3 de Madrid. Estudio retrospectivo del periodo 2001–2006 / Incidence of lower extremity amputations in Area 3 of Madrid. Retrospective study during the period 2001–2006

Objetivo Conocer la incidencia de las amputaciones de miembro inferior (AMI) en población con y sin diabetes mellitus (DM). Material y métodos Estudio retrospectivo de cohortes de las AMI realizadas durante 2001–2006 en el área 3 de Madrid a partir de la codificación de los informes de alta hospitalaria. Resultados Se realizaron 310 AMI. La incidencia ajustada a la edad de AMI de cualquier causa fue de 19,2/105 habitantes/año (27,2 y 11,2 para varones y mujeres, respectivamente). Doscientos sesenta y uno fueron AMI no traumáticas ni tumorales, el 76% se realizaron en DM y la incidencia fue de 191/105 sujetos con DM por año (intervalo de confianza del 95% [IC95] 122–299) y de 4,4/105 sujetos sin DM (IC95 7–23) con un riesgo relativo (RR) de 44 (IC, 23–73). Conclusiones La tasa detectada de AMI en población con y sin diabetes es mayor que la comunicada previamente en Madrid. Se plantea la necesidad de diseñar estrategias para reducir las tasas de AMI(AU)

Objective To quantify the Lower Extremity Amputations (LEA) incidence in population with and without diabetes mellitus (DM). Material and methods Retrospective cohort study of all the LEA carried out during 2001–2006 in area 3 of Madrid, from the codification of the reports of discharge reports. Results 310 LEA were carried out. The age-ajusted LEA incidence for any reason was 19,2/105 inhabitants per year (27,2 y 11,2 for men and women respectively). 261 were not-traumatic and non-tumoural (NTT) LEA, 76% were associated with DM and the incidence was 191/105 people with DM per year (95% confidence interval [CI95] 122–299) and 4,4/105 for people without DM per year (CI95 7–23), with a risk ratio of 44 (CI95 23–73). Conclusions The LEA rates in population with o without diabetes are higher than the previously communicated in Madrid. It would appear convenient to design strategies to reduce the LEA rates(AU)

Mortalidad perioperatoria en pacientes diabéticos sometidos a amputación no traumática de miembros inferiores en la Comunidad de Madrid de 1997 a 2005 / Perioperative mortality in diabetic patients after non traumatic lower extremity amputations in Madrid from 1997 to 2005

Introducción: Las complicaciones crónicas de la diabetes condicionanlos costes relacionados con la salud, la productividad y la economía,entre las que destacan el pie diabético. Objetivos: Análisis de latendencia y los factores relacionados con la mortalidad por amputaciónno traumática de miembros inferiores (AMI). Material y método: Estudio observacional retrospectivo de las AMI ocurridas en Madridentre 1997 y 2005. Fuente documental: Conjunto Mínimo Básicode Datos. Se seleccionaron las altas con un procedimiento 84.1X y undiagnóstico 250.XX (CIE-9-MC). Se defi nió amputación menor comodistal a la articulación tarsometatarsiana. La tendencia de la mortalidadse evaluó mediante modelos segmentados de regresión de Poisson yse expresó como porcentaje anual de cambio (PAC). Se estudió elriesgo de muerte mediante regresión logística multivariante para lassiguientes variables independientes: edad, sexo, tipo de amputación ydiabetes. Resultados: Se produjeron 278 muertes en diabéticos (7,3%). En la evolución de la mortalidad se obtuvo un PAC del 1,99% (intervalo de confi anza del 95%: –2,7 a 6,9), no signifi cativo. El riesgo de mortalidad (odds ratio; intervalo de confi anza del 95%) fue en mayores de 65 años de 3,16 (2,03-4,91; p= 0,0001) y en la AMI mayorde 2,75 (2,08-3,64; p= 0,0001). Conclusiones: La mortalidadperioperatoria de la AMI permanece elevada y no muestran tendenciadescendente en el periodo de estudio con un mayor riesgo para losmayores de 65 años y AMI mayor(AU)

Introduction: Chronic diabetic complications greatly affect thecost in health, economic productivity, with an emphasis on diabeticfoot. Objectives: Analysis of mortality trends and related factorsassociated with LEA. Material and methods: A retrospective observational study of LEA in Madrid between 1997 and 2005. Documentarysource: MBDS (discharge minimum basic data set). We selected cases that included an 84.1X procedure and 250.XX diagnosis (ICD-9-CM). Minor amputation was defined as distal to theankle joint and a perioperative death that occurred during hospitalization.The trend of mortality was assessed using joinpoint regressionanaly sis and expressed as percentage of annual change (PAC). We studied the risk of death by multivariate logistic regression using the independent variables age, sex, type of amputationand diabetes. Results: During the study period there were 278 deaths (7.3%) in diabetic patients. Mortality trends: PAC 1.99% (–2.7 to 6.9) was not significant. Risk of death (OR; 95%CI), patients over 65 years old (3.16; 2.03-4.91; p= 0.0001) and major LEA (2.75; 2.08-3.64; p= 0.0001). Conclusions: The perioperativemortality of LEA remains high and showed no downward trend duringthe study period with an increased risk of death for adults over65 years and major LEA(AU)

Effects of soy milk as a dietary complement during the natural aging process.

INTRODUCTION: Oxidative stress is one mechanism that could contribute to the acceleration of aging and age-related diseases. On the other hand, because of their antioxidative qualities soybean derived foods could have beneficial effects on the aging process. OBJECTIVES: The aim of our work was to study the effects of a diet supplemented with soy milk on certain biological features of aging in rats. METHODS: Male Wistar rats of 3 to 18 months of age, were assigned to one of two diets: 1) Experimental Group, commercial rat formula and soy milk; 2) Control Group, commercial rat formula and water. Every three months both lipid profile and lipid peroxidation were determined and neuronal cells of hippocampus were counted in control and experimental rats. RESULTS: The soy milk diet significantly improved the plasmatic lipid profile, decreasing serum cholesterol (total as well as LDL) and serum triglycerides, HDL-cholesterol was significatively higher in experimental animals. The LDL/HDL ratio was thus significantly lowered. The soy diet also produced decreased values of lipid peroxidation in brain, liver and kidney. These effects were significant after 6 to 9 months. The experimental animals lost fewer hippocampal neurons than the controls. Finally at 18 months of age, a greater number of surviving animals in experimental group with respect to the control one was observed. CONCLUSIONS: 1) soy intake could have beneficial effects as a complement of normal diet, but not as a replacement for animal proteins and 2) these effects are the result of a very long period (almost lifelong) of consumption of this diet.

Blockage of vibrissae afferents: I. Motor effects.

In the past, it has been proposed that the rat vibrissae play an important role in other hand, postural abnormalities, muscle tone decreases and hypomotility after sensory organ destructions were proposed as evidence supporting the "level setting" or "tonic" hypothesis. This hypothesis postulates that afferent activity, besides its well know transductive functions, sets the excitability state of the central nervous system. We thought the vibrissal system to be a good model to dissect these two postulated roles because vibrissae trimming would annul the transductive function without affecting the integrity of nerve activity. Thus we compare the effects of trimming the whiskers with blocking the vibrissal afferent nerves on two types of motor behavior: activity in an open field and walking over a rope connecting two elevated platforms. We found that only vibrissal afferent blockage (both nerve section and local anaesthesia) produced severe failures in the motor performances studied. These effects could not be fully explained by the abolition of the vibrissae as a sensory modality because cutting the whiskers did not significantly affect the motor performance. These data are discussed in reference to a tonic or general excitatory function of sensory inputs upon the central nervous system.

Evaluación de la eficiencia en consultas externas: una aplicación del análisis envolvente de datos / Assessment of efficiency in out-patient clinics: an application of data envelopment analysis

Objetivo: Identificar unidades de oferta de consultas externas relativamente ineficientes. Método: Se ha utilizado el análisis envolvente de datos (AED) para el cálculo de la eficiencia relativa. La unidades de oferta analizadas son las consultas externas de alergología, cardiología, dermatología, endocrinología, gastroenterología, neumología, reumatología, ginecología, ORL, oftalmología, traumatología y urología de 10 hospitales públicos de la Comunidad de Madrid. La fuente de información ha sido el sistema de información de asistencia especializada (SIAE) y la base de recursos humanos del año 2001. Como medida de los insumos se ha utilizado el número de facultativos especialistas y la incidencia de derivaciones desde atención primaria, y como medida de los resultados, la frecuentación y presión asistencial en las consultas de atención especializada. Resultados: El nivel medio de eficiencia encontrado varía de 0,84 en alergología a 0,97 en endocrinología. La eficiencia media relativa alcanzada por hospital varía de 0,81 a 0,98.Conclusiones: El conocimiento de la eficiencia relativa de las unidades de producción puede ser una herramienta adicional para la planificación, reasignación de recursos e incentivación de unidades de oferta que presenten un mejor nivel de producción. No obstante, cuando interpretamos los resultados del análisis, no debemos perder de vista las dificultades propias de la aplicación de esta metodología relativas a la elección de las variables que definen los inputs y los outputs o la incapacidad de obtener una medida de eficiencia absoluta (AU)

Funduplicatura de Nissen por laparoscopia como técnica de elección para el tratamiento de la enfermedad por reflujo gastroesofágico / Laparoscopic nissen fundoplication as the technique of choice in the treatment of gastroesophageal reflux disease

Introducción y objetivos. Pretendemos corroborar, mediante la aportación de nuestros resultados y la comparación de los datos manométricos y pHmétricos, pre y postoperatorios, que la funduplicatura de Nissen por vía laparoscópica es la técnica de elección para el tratamiento de la enfermedad por reflujo gastroesofágico (ERGE), obteniéndose resultados similares a los de la cirugía convencional. Material y métodos. Un total de 72 pacientes, intervenidos consecutivamente, afectados de ERGE, 54 varones y 18 mujeres, con una edad media de 42 años. Todos presentaban clínica de ERGE, con una media de evolución de 5 años y habían recibido tratamiento médico correcto durante una media de 24 meses. El estudio preoperatorio incluyó: esofagogastroduodenoscopia, TEGD, pHmetría de 24 h y manometría esofágica. La técnica quirúrgica practicada fue una funduplicatura de Nissen por vía laparoscópica. En el control postoperatorio se realizaron: esofagogastroduodenoscopia, pHmetría de 24 h y manometría esofágica, valorándose el grado de satisfacción mediante la escala de Visick. Los datos obtenidos se compararon estadísticamente mediante el test de la t de Student apareada y el test de Wilcoxon. Resultados. La pHmetría preoperatoria reveló una media de porcentaje de tiempo de pH < 4 del 9,85 por ciento y un índice de DeMeester de 37,4. La manometría dio unas presiones basales medias del EEI de 11,6 mmHg y una longitud media del mismo de 3,13 cm. El tiempo medio de la intervención fue de 75,4 min y las complicaciones intraoperatorias se produjeron en 11 pacientes, siendo el índice de reconversiones a cirugía abierta del 1,3 por ciento. La pHmetría postoperatoria obtuvo un índice de DeMeester medio de 6,06 y un porcentaje de tiempo de pH < 4 medio de 1,1 por ciento. La longitud media del EEI, en el estudio manométrico postoperatorio, fue de 3,5 cm y la presión basal media del mismo, de 20,9 mmHg. Al ser comparados los resultados preoperatorios con los postoperatorios, todos ellos resultaron ser estadísticamente significativos (p < 0,05).Conclusiones. Tras una experiencia de cuatro años y medio en funduplicatura de Nissen por laparoscopia, y a la vista de los resultados obtenidos, pensamos que es la técnica quirúrgica de elección para el tratamiento de la ERGE (AU)

Electrical nerve stimulation in the management of enterocutaneous low-output fistulas: a report of two cases.

Two patients with low-output enterocutaneous fistulas after surgery were treated with electrical nerve stimulation (ENS). Ultrasonography was useful for the application of this treatment method and for the charting of its progress. Fistula output diminished rapidly in both cases, and the closure of the track was achieved after several sessions of ENS. The procedure is simple and safe and is suggested as an option for the treatment of low-output enterocutaneous fistulas.

[Biliary complications in the follow-up of 54 orthotopic liver transplant patients]. / Complicaciones biliares en el seguimiento de 54 trasplantes ortotópicos de hígado.

UNLABELLED: We analyze the biliary tract complications after 54 orthotopic liver transplantation in 49 patients during a 2-year period. Biliary tract reconstruction was achieved by a choledochocholedochostomy over a t-tube in 47 cases and by a Roux-en-Y choledochojejunostomy in 7 cases (2 sclerosing cholangitis, 4 retransplants and 1 secondary biliary cirrhosis). The t-tube was removed between the 12-16 postoperative week in all cases except in two patients (2 and 3 postoperative week). RESULTS: There was not intraoperative mortality. During the first postoperative month 8 patients died (16.3%) none of them because a biliary complications. The one year actuarial survival of patients was 74.6%. During the (first three postoperative months) we observed 5 patients with a bile leak (biloma). In 3 cases the ultrasonographic drainage was effective and in two cases a surgical drainage was necessary. After the 3rd postoperative month, four patients developed a biliary peritonitis after t-tube removal and a reoperation was required in all cases. Finally, 1 patient suffered a hilar biloma cavity due to hepatic artery thrombosis. We stress the low incidence of reoperations due to early biliary complications (2 cases) and the high incidence of biliary peritonitis after t-tube removal.

[Multiple endocrine neoplasia II A syndrome: relationship between age of the patient, levels of basal calcitonin and size of the thyroid tumor]. / Sindromi di NEM II A: relazione fra l'età dei pazienti, livelli di calcitonina basale e grandezza del tumore tiroideo.

This paper presents our experience in four families having the multiple endocrine neoplasia (MEN) II-A syndrome, with a total of 19 affected patients. All had medullary thyroid carcinoma (MTC), 6 also had pheochromocytoma (PH) and 3 had hyperparathyroidism. The screening of the members of the families to measure basal and pentagastrin response calcitonin (CT) serum levels allowed an early diagnosis of medullary thyroid carcinoma, when lesions were only 1 mm in diameter. Measurement of vanillymandelic acid, catecholamines and metanephrines in 24-hour urine collections allowed the diagnosis of pheochromocytoma in patients, some of whom were asymptomatic. A clear relationship was found between the age of the patients, the basal serum calcitonin level and size of the MTC.