La Unidad de Cirugía sin Ingreso: la gestión basada en procesos / No disponible

En septiembre de 2006 se puso en funcionamiento en nuestro centro una nueva área de atención quirúrgica, integrada en el propio complejo hospitalario. Es una nueva estructuración de los espacios quirúrgicos que forma parte de la estrategia de la organización en su tarea de mejora continua en la atención al paciente. Se trata de un área de Cirugía Mayor Ambulatoria denominada Unidad de Cirugía sin Ingreso, y su gestión se ha estructurado en base a la gestión por procesos. Describiremos en este trabajo la metodología empleada para poner en marcha esta unidad y los pasos necesarios para el control de la mejora continua. Creemos que el desarrollo metodológico del subproceso de Unidad de Cirugía sin Ingreso ha sido muy satisfactorio, tanto en cuanto a la metodología aplicada, como por la experiencia del trabajo en equipo (AU)

In September 2006 our center started a new surgical care area, integrated in the hospital premises. As a new structuration of the surgical spaces, it is a part of the organization’s strategy towards continuous improvement in patient care. It is a Major Ambulatory Surgery area known as Outpatient Surgery Unit, and it’s being managed under the methodology of process management. This paper describes the methodology used to set up this unit, and the necessary steps for monitoring continuous improvement. We believe that the methodological development of the Outpatient Surgery Unit subprocess has been very satisfactory, regarding both the applied methodology and the experience of teamwork (AU)

[Acute hypertension and sustained arterial hypertension after unilateral intracranial lesion or section of the glossopharyngeus (author's transl)]. / Crisis hipertensiva e hipertensión arterial mantenida tras sección o lesión unilateral intracraneal del glosofaríngeo.

Some inflammatory processes of the 9th cranial nerve may provoke disturbances of the autonomic nervous system, with parasympathetic irritation. A unilateral intracranial lesion or section of the glossopharyngeus may produce adverse reactions such as sinus tachycardia and transitory hypertension, due to a cut-off in physiological feedback. The two cases presented developed acute hypertension after either lesion or section of the 9th cranial nerve. In one case the hypertension was of a few days duration only, while the second was rather unusual in that it was sustained over a four-month period. The physiopathologic mechanisms are described as well as the favorable response to treatment with drugs. The hypothesis that arterial hypertension is caused by an over-stimulation of the beta-adrenergic system, in particular in its effect on cardiac output is, at least in part, supported by the favorable response to propranolol. In order to either confirm or discard this hypothesis, the measurement of cardiac output in successive patients after lesion or section of the glossopharyngeus is considered to be of special interest.