Characterisation of Community Mental Health Consultations in a Primary Care Centre in Cali, Colombia. / Caracterización de la consulta de salud mental comunitaria de un centro de atención primaria en Cali, Colombia.

OBJECTIVE: To characterise community mental health consultations in a primary care centre in Cali, Colombia. METHODS: Observational, descriptive, cross-sectional study. A secondary database was used, systematically recording patients seen in the community outpatient clinic, and a description of the information recorded therein was prepared. All the records available in the database were used. The data were processed using Microsoft Excel and the program SPSS 25 was used for the statistical analysis. RESULTS: 481 consultations were conducted, of which 272 were first time consultations; in total 383 patients were seen, which indicates that 1.26 consultations were carried out per patient. The average age of the patients who consulted was 43.5±21.7 years. Sixty-one point five percent of the consultations were for women, while adulthood was the stage of life in which the highest percentage (51.8%) attended. The most common socioeconomic stratum was 1, which indicates that this institution serves above all the low-income population. CONCLUSIONS: The results of this study allowed us to recognise the main reasons for consultation in the community mental health service, a necessary input to design and develop preventive programmes that promote and strengthen community-based rehabilitation strategies.

[Histological and clinical characteristics of cases of immunoglobulin G4-related disease in a tertiary hospital, in Cali, Colombia]. / Caracterización histológica y clínica de pacientes con enfermedad relacionada con inmunoglobulina G4 en un centro de alta complejidad en Cali, Colombia.

INTRODUCTION: Immunoglobulin G4 (IgG4)-related disease has been described in the last decade. It is a fibro-inflammatory condition capable of affecting almost every organ and diagnosis requires both clinical and paraclinical confirmation. We present the largest study to date in Colombia. OBJECTIVE: To describe the clinical and histopathological characteristics of patients diagnosed with IgG4-related disease at the Fundación Valle del Lili. METHODS: Observational-descriptive retrospective study. The clinical and pathological records of patients diagnosed with IgG4-related disease at the Fundación Valle del Lili were reviewed and a descriptive statistical analysis made. RESULTS: From 2013-2016, 16 patients were diagnosed. Median age was 44 years (RIC 30-58) and 10 (62.5%) were women. The most common clinical presentation was a combination of a tumefactive mass, constitutional symptoms and site-related symptoms (43.8%) (n=7). No preference for any organ was seen. Histopathology revealed all cases had dense lymphoplasmacytic infiltrate and storiform-type fibrosis; 75% also had obliterative phlebitis. In all cases≥10 cells/HPF of IgG4+ were found and 81% had a ratio of IgG4+/IgG+>50%. CONCLUSION: IgG4-related disease appears to be underdiagnosed, probably due to its broad clinical spectrum as well as a low index of awareness among clinicians. We recommend that, when dense lymphoplasmacytic infiltrates, storiform-type fibrosis or obliterative phlebitis are found, immunohistochemistry for IgG and IgG4should be requested. Positive results then must be correlated with complementary studies to confirm the disease.

Experiencia en colecistectomía por laparoscopia en la Clínica Universitaria CES / Experience with laparoscopic cholecystectomy at Clínica Universitaria CES, Medellín, Colombia

Introducción. La colecistectomía laparoscópica es el estándar de referencia para el tratamiento de la colelitiasis y la colecistitis aguda, y es la cirugía laparoscópica más practicada por los cirujanos generales. Sus ventajas, frente al abordaje abierto, son: menor morbilidad, menor estancia hospitalaria, rápida recuperación, menor dolor posoperatorio y mejor resultado cosmético. Materiales y métodos. Se llevó a cabo un estudio descriptivo retrospectivo de 300 pacientes, entre el 2009 y 2010. Se incluyeron los pacientes mayores de 14 años programados para colecistectomía por laparoscopia. El procedimiento se practicó con la asistencia de un docente universitario del programa de cirugía general de la Universidad CES. Resultados. Se practicaron 208 procedimientos urgentes y 92 cirugías electivas. La principal indicación de cirugía electiva fue la colelitiasis (79,3 %) y, en la urgente, la colecistitis-colelitiasis (74,5 %). La colecistitis fue el hallazgo quirúrgico reportado con mayor frecuencia en las cirugías urgentes (71 %) y la colelitiasis lo fue en las cirugías electivas (79,3 %); otros hallazgos fueron: piocolecisto (5,7 %) y síndrome de Mirizzi (3,5 %). La tasa de conversión fue de 15,8 % y la principal causa fue la inflamación grave (48 %). Hubo complicaciones en 3,7 % de los pacientes, el 2,9 % por sangrado y 0,67 % por lesión de vía biliar. Conclusión. Mediante una adecuada enseñanza de una técnica quirúrgica estandarizada, los cirujanos pueden llevar a cabo la colecistectomía laparoscópica con mínimas tasas de complicaciones. Una técnica quirúrgica estandarizada para la colecistectomía laparoscópica, bajo la supervisión de un docente, en la Clínica Universitaria CES, ha permitido tener resultados comparables con los reportados en la literatura científica, entre ellos, tasas bajas de conversión, corta estancia hospitalaria y, aun más importante, una tasa menor de complicaciones, en especial de lesiones de la vía biliar.

Introduction. Laparoscopic cholecystectomy is the gold standard in the treatment of cholelithiasis and acute cholecystitis, and laparoscopic cholecystectomy is the most frequently performed operation by general surgeons. Its advantages compared with the open approach include lower morbidity, shorter hospital stay, lesser postoperative pain, and better cosmetic result. Material and methods. Retrospective descriptive study of 300 patients admitted to our University Clinic in the period 2009 and 2010. All patients older than 14 years electively programmed for laparoscopic cholecystectomy were included. The procedures were performed with the assistance of a faculty member of our general surgery program. Results. There were 92 elective and 208 emergency procedures. Main indication for elective operation was cholelithiasis (79.3%) and cholecystitis-cholelithiasis for emergency operations (74.5%). Cholecystitis was the most frequent surgical finding in the emergency operation group (71%), and cholelithiasis in the elective operation group ((79.3%). Other findings included empyema of the gallbladder (5.7%) and Mirizzi´s syndrome (3.5%). Conversion rate was 15.8%, and its main cause was severe inflammation (48%). Complications occurred in 3.7% of the patients, 2.9% bleeding and 0.67% biliary tract iatrogenic lesion. Conclusion. With an adequate training program of the standardized surgical technique under the supervision of a faculty member, the Clínica Universitaria CES (Medellín, Colombia) has results comparable to those reported in the scientific literature, including low conversion rates, shorter hospital stays, and, most important, low complications rate, especially lesion of the biliary tract.

Amarrado sublaminar en 88 para estabilización posterior de la columna vertebral: nueva técnica

El autor presenta una nueva técnica quirúrgica, desarrollada inicialmente en el servicio de Columna del deparatamento de Ortopedia de la Santa Casa de la Misericordia de San Pablo, Brasil, que consiste en una artrodesis posterior de columna, a nivel cervical o toracolumbar, efectuada mediante alambres sublaminares a dos niveles y que por la forma del amarre en doble 8 ha recibido este nombre. El procedimiento está indicado en lesiones que comprometen básicamente la estabilidad posterior de la columna, cuya etiología puede ser congénita,traumática o degenerativa. Su mayor ventaja radica en que, siendo una técnica relativamente descomplicada y segura, fusiona únicamente dos niveles y por consiguiente acorta el tiempo quirúrgico y hace que el sangrado intraoperatorio sea mínimo. La estabilidad post operatoria es excelente, lo cual facilita el manejo precoz mediante soportes externos sencillos. Describimos en el presente trabajo 10 casos: dos pacientes con luxación, un paciente con inestabilidad a nivel lumbar por un Síndrome de Morquio; dos pacientes con fractura de columna lumbar tipo Chance; dos pacientes con sección medular por luxación C5-C6, un paciente con subluxación C1-C2 post-traumática, un paciente con inestabilidad C1-C2 por mucopolisacaridosis y un paciente con artrogriposis múltiple. Los resultados obtenidos los consideramos como buenos, a pesar del número reducido de casos y del corto tiempo de evolución. No se presentaron complicaciones inherentes al procedimiento. El paciente con lesión medular completa presentó infección urinaria y escara sacra superficial que evolucionaron satisfactriamente con el tratamiento establecido