RESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Feocromocitoma/genética , Paraganglios Cromafines , Células Cromafines , Paraganglioma Extraadrenal/diagnóstico por imagen , Feocromocitoma/epidemiología , Feocromocitoma/cirugía , Tumores Neuroendocrinos , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodosAsunto(s)
Neoplasias de las Glándulas Suprarrenales/genética , Síndromes Neoplásicos Hereditarios/genética , Paraganglioma/genética , Feocromocitoma/genética , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/genética , Síndromes Neoplásicos Hereditarios/diagnóstico , Paraganglioma/diagnóstico , Feocromocitoma/diagnóstico , Succinato Deshidrogenasa/genéticaRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Adulto , Endometriosis/complicaciones , Endometriosis/diagnóstico , Endometriosis/tratamiento farmacológico , Válvula Ileocecal/cirugía , Válvula Ileocecal , Histerectomía/métodos , Histerectomía/tendencias , Colonoscopía , Enfermedades del Sigmoide/complicaciones , Enfermedades del Sigmoide/orina , Enfermedades del Sigmoide , Colon Sigmoide/cirugíaRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Adulto , Síndrome de Li-Fraumeni/complicaciones , Neoplasias de la Tiroides/complicaciones , Carcinoma Papilar/complicaciones , Predisposición Genética a la EnfermedadRESUMEN
Intestinal endometriosis is defined as a bowel infiltration by ectopic endometrial tissue. The prevalence is 3-37% of all women affected by endometriosis. Rectosigmoid colon is the most frequent location (70-93%), followed to ileocecal region, appendix and other colon and small bowel segments. Intestinal endometriosis usually is asymptomatic. Often it is only diagnosed during surgery for other reasons. The symptoms frequently are nonspecific, although it may appear as an acute abdominal pain. Clinical history, physical examination and image techniques are necessary for the diagnosis. The choice of the operative technique depends on the clinical presentation and on the fertility wishes of the patient. Laparotomy and laparoscopy are equally effective, but laparoscopic approach is preferred. We present 17 cases of patients from our Hospital diagnosed with intestinal endometriosis, from 2006 to 2015.
Asunto(s)
Endometriosis/terapia , Enfermedades Intestinales/terapia , Adulto , Endometriosis/complicaciones , Endometriosis/epidemiología , Femenino , Humanos , Enfermedades Intestinales/epidemiología , Enfermedades Intestinales/etiología , Persona de Mediana Edad , Adulto JovenRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano de 80 o más Años , Diagnóstico de Neumomediastino/métodos , Enfisema Mediastínico/etiología , Enfisema Mediastínico/historia , Enfisema/complicaciones , Dehiscencia de la Herida Operatoria/complicaciones , Dehiscencia de la Herida Operatoria/cirugía , Neoplasias del Colon Sigmoide/cirugía , Neoplasias del Colon Sigmoide , Colon Sigmoide/cirugía , Colon Sigmoide , Anastomosis Quirúrgica/instrumentación , Anastomosis Quirúrgica/métodos , Anastomosis Quirúrgica , Laparoscopía/métodos , Tomografía/métodos , Enfisema Mediastínico/patología , Enfisema MediastínicoAsunto(s)
Colon Sigmoide/patología , Divertículo del Colon/diagnóstico por imagen , Divertículo del Colon/cirugía , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Anciano , Anastomosis Quirúrgica/métodos , Biopsia con Aguja , Colectomía/métodos , Colon Sigmoide/cirugía , Divertículo del Colon/complicaciones , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Laparotomía/métodos , Masculino , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: To analyze the degree of compliance with a variety of internationally accepted standards defined for Total Parenteral Nutrition (TPN) quality control in our Surgery Department. PATIENTS AND METHOD: Prospective study of patients treated with TPN over two years in the department of surgery of a university teaching hospital (n = 72). Assessment of quality was performed by measurements of compliance using 19 criteria. The criteria were divided into three groups according to characteristics of TPN standardisation: this must be "appropriate" to the nutritional requirements of the patient, "safe" in order to prevent complications and "accurate" in its daily programming. Corrective measures aimed at resolving the quality problem were applied to the deficient criteria over six months, paying particular attention to those criteria which had the highest percentage of errors in the study carried out using a Pareto analysis. During a third period of six months the information on all 19 criteria was gathered again and the improvement with regard to the standard values and to the compliance in the first period (using the value of z) was evaluated. RESULTS: The compliance with seven criteria was significantly below standard values: all those of the "appropriate" group, except the criteria "type of diet" and "composition of the diet", and the criteria "absence of complications" of the "safe" group, which was also the one with the highest number of grouped non-compliances. In the second period all the below standard criteria improved with compared to the first period. The criteria "time of fasting", "concordance" and "duration" were significantly improved. The criteria "time of fasting", "duration" and "latency" reached the standard. The rest of criteria that reached their standard in the first evaluation maintained the same results. CONCLUSIONS: Corrective measures introduced were effective since all the below standard criteria improved, including metabolic complications. Notwithstanding, it is necessary to continue in this line to improve the criteria still below standard.
Asunto(s)
Nutrición Parenteral Total/normas , Garantía de la Calidad de Atención de Salud , Adhesión a Directriz , Humanos , Estudios Prospectivos , Control de Calidad , Servicio de Cirugía en HospitalRESUMEN
Objetivo. Aplicar un ciclo de evaluación y mejora del cumplimiento de diversos criterios de calidad en la indicación y manejo de la nutrición parenteral total (NPT) en un servicio quirúrgico. Pacientes y método. Estudio prospectivo en 72 pacientes tratados con NPT durante 2 años en el Servicio de Cirugía General del Hospital General Universitario Reina Sofía de Murcia. El ciclo de mejora se realizó en dos períodos: en el primero, de 1 año de duración, se analizó el cumplimiento (porcentaje e intervalo de confianza [IC] del 95%) de 19 criterios respecto a sus estándares internacionalmente aceptados (significación estadística según valor de z para el modelo de una cola) en todas las dietas de NPT prescritas en nuestro servicio de cirugía general. Dichos estándares estaban divididos en tres grupos, ajustada (indicación correcta de la nutrición), segura (ausencia de complicaciones) y exacta (correspondencia de la dieta administrada con la prescrita). Durante los 6 meses siguientes, tras analizar las posibles causas de los incumplimientos, se aplicaron las medidas oportunas para intentar solucionarlos. En un segundo periodo de 6 meses se recogieron nuevamente los datos de los 19 criterios y se evaluó la mejora tanto respecto al estándar como respecto al cumplimiento del primer período (mediante el valor de z para una cola). Resultados. Siete criterios se encontraban significativamente por debajo del estándar: todos los del grupo ajustada, salvo los criterios tipo de dieta y composición de la dieta, y el criterio ausencia de complicaciones del grupo segura, que era además el que mayor número de incumplimientos agrupaba. En el segundo período, todos los criterios por debajo de su estándar mejoraron respecto al primero y en especial los criterios tiempo de ayuno, concordancia y duración mejoraron de forma estadísticamente significativa. Alcanzaron su estándar los criterios tiempo de ayuno, duración y latencia. El resto de los criterios, que alcanzaron su estándar en la primera evaluación, continuaban con los mismos resultados. Conclusiones. Las medidas correctoras introducidas fueron eficaces, ya que se mejoró en todos los criterios por debajo de sus estándares, incluidas las complicaciones metabólicas. A pesar de ello es necesario continuar en la línea de actuación para mejorar los criterios aún por debajo de su estándar The increased use of biomaterials for the repair of abdominal wall hernias has achieved a significant reduction in recurrences and consequently improved the quality of life of patients. However, the appearance of complications such as infection may require the implanted prosthetic material to be removed in a considerable number of patients. A possible treatment option in areas compromised by infection is the implant a biocompatible prosthetic material to generate, or induce the formation of a support tissue so that, in a second stage, the definitive repair of the parietal defect may be undertaken. This is the main goal of bioprostheses. These implants are composed of collagen of animal (usually porcine) or human origin. They should be acellular and fully biocompatible so that they induce a minimal foreign body reaction and immune response (AU)
Objective. To analyze the degree of compliance with a variety of internationally accepted standards defined for Total Parenteral Nutrition (TPN) quality control in our Surgery Department. Patients and method. Prospective study of patients treated with TPN over two years in the department of surgery of a university teaching hospital (n = 72). Assessment of quality was performed by measurements of compliance using 19 criteria. The criteria were divided into three groups according to characteristics of TPN standardisation: this must be appropriate to the nutritional requirements of the patient, safe in order to prevent complications and accurate in its daily programming. Corrective measures aimed at resolving the quality problem were applied to the deficient criteria over six months, paying particular attention to those criteria which had the highest percentage of errors in the study carried out using a Pareto analysis. During a third period of six months the information on all 19 criteria was gathered again and the improvement with regard to the standard values and to the compliance in the first period (using the value of z) was evaluated. Results. The compliance with seven criteria was significantly below standard values: all those of the appropriate group, except the criteria type of diet and composition of the diet, and the criteria absence of complications of the safe group, which was also the one with the highest numer of grouped non-complinces. In the second period all the below standard criteria improved with compared to the first period. The criteria time of fasting, concordance and duration were significantly improved. The criteria time of fasting, duration and latency reached the standard. The rest of criteria that reached their standard in the first evaluation maintained the same results. Conclusions. Corrective measures introduced were effective since all the below standard criteria improved, including metabolic complications. Notwithstanding, it is necessary to continue in this line to improve the criteria still below standard The increased use of biomaterials for the repair of abdominal wall hernias has achieved a significant reduction in recurrences and consequently improved the quality of life of patients. However, the appearance of complications such as infection may require the implanted prosthetic material to be removed in a considerable number of patients. A possible treatment option in areas compromised by infection is the implant a biocompatible prosthetic material to generate, or induce the formation of a support tissue so that, in a second stage, the definitive repair of the parietal defect may be undertaken. This is the main goal of bioprostheses. These implants are composed of collagen of animal (usually porcine) or human origin. They should be acellular and fully biocompatible so that they induce a minimal foreign body reaction and immune response (AU)
Asunto(s)
Humanos , Nutrición Parenteral Total , Calidad de la Atención de Salud , Hospitales Universitarios , Servicio de Cirugía en HospitalRESUMEN
No disponible
Asunto(s)
Humanos , Consentimiento Informado/normas , Transfusión de Componentes Sanguíneos/ética , Derechos del PacienteRESUMEN
INTRODUCTION: Clinical pathways are standardized plans for the integral care of specific processes. In March 2002, a clinical pathway for laparoscopic cholecystectomy was introduced in our service. The aim of the present study was to evaluate this pathway 1 year after its implementation. METHODOLOGY: All patients included in the clinical pathway since its introduction were studied. Evaluation criteria included compliance, indicators of the effectiveness of clinical care, economic impact and indicators of satisfaction based on a survey. The results were compared with those in a series of patients who underwent surgery in the year before the introduction of the clinical pathway. Our hospital uses analytical accounting and the mean cost per process before and after the introduction of the clinical pathway was analyzed. RESULTS: A series of 160 consecutive patients who underwent surgery during the year prior to the creation of the clinical pathway and who fulfilled the accepted inclusion criteria was evaluated. The mean length of hospital stay was 3.27 days. The mean cost per process before the introduction of the pathway was 2149 (+/- 768) euros. During the first year after the introduction of the pathway, 140 patients were included with an inclusion rate of 100%. The mean length of hospital stay in patients included in the clinical pathway was 2.2 days. The degree of compliance with length of hospital stay was 66.7%. The most frequent causes of breach were staff-related, followed by patient-related (oral intolerance, pain, etc.). The mean cost in patients included in the clinical pathway was 1845 (+/- 618) euros. CONCLUSIONS: Laparoscopic cholecystectomy is a suitable process with which to initiate systematization of clinical pathways. The results show that length of hospital stay has been significantly reduced without increasing morbidity. Patient satisfaction has been high.