Applying Lean in Process Innovation in Healthcare: The Case of Hip Fracture.

Academic literature and practitioners acknowledge that there is a need to improve efficiency and service quality in the healthcare industry. In Spain, osteoporotic fractures represent a great cost in socio-economic and morbi-mortality terms, hip fracture being the surgical pathology with the second highest consumption of resources. The research questions that govern this study concern the use of Lean principles to identify waste, and an evaluation of the application of an innovative approach in the hip fracture surgery process. A research design based on a case study and action research was developed. Findings relate to (i) the identification of the main types of waste or muda (being the most frequent delay, transportation, over-processing and defects); (ii) the analysis of existing processes based on a Lean approach (identifying opportunities for improvement as a reduction of the number of steps and participants, improving communication, automation, standardization, etc.); and (iii) the application of an innovative process based on the Lean approach and action research in the healthcare industry. This research provides insights for academia, practitioners, management, and society: waste identification and process redesign helps to continue the improvement of operations, increase efficiency, reduce costs, and enhance services, providing benefits to patients, families, hospital employees, and the healthcare system.

Monocular Robust Depth Estimation Vision System for Robotic Tasks Interventions in Metallic Targets.

Robotic interventions in hazardous scenarios need to pay special attention to safety, as in most cases it is necessary to have an expert operator in the loop. Moreover, the use of a multi-modal Human-Robot Interface allows the user to interact with the robot using manual control in critical steps, as well as semi-autonomous behaviours in more secure scenarios, by using, for example, object tracking and recognition techniques. This paper describes a novel vision system to track and estimate the depth of metallic targets for robotic interventions. The system has been designed for on-hand monocular cameras, focusing on solving lack of visibility and partial occlusions. This solution has been validated during real interventions at the Centre for Nuclear Research (CERN) accelerator facilities, achieving 95% success in autonomous mode and 100% in a supervised manner. The system increases the safety and efficiency of the robotic operations, reducing the cognitive fatigue of the operator during non-critical mission phases. The integration of such an assistance system is especially important when facing complex (or repetitive) tasks, in order to reduce the work load and accumulated stress of the operator, enhancing the performance and safety of the mission.

Correction to: Quantifying the extent of fistulotomy. How much sphincter can we safely divide? A three-dimensional endosonographic study.

In the Fig. 1 of the original published version of this article the numbers were switched as well as in the text of Results section, lines 5 and 6. The revised figure and the corrected text are now presented correctly in this article.

Personalised and progressive neuromuscular electrical stimulation (NMES) in patients with cancer-a clinical case series.

PURPOSE: Neuromuscular electrical stimulation (NMES) may be a pragmatic short-term alternative to voluntary exercise to augment cancer rehabilitation. However, previous attempts to use NMES as an exercise modality in this cohort have been unsuccessful, largely due to the use of NMES protocols that were developed for other rehabilitation contexts. We assessed the effects of a personalised and progressive NMES exercise intervention, designed with early-stage cancer rehabilitation in mind, on exercise capacity, lower body functional strength and quality of life in (QoL) in patients who are currently undergoing or have recently completed treatment for cancer. METHODS: Ten adult patients were recruited. A personalised and progressive NMES exercise intervention was implemented in each case over a 4-8-week period. The 30-s sit-to-stand test (STS), 6-min walk test (6MWT) and EORTC QLQ C-30 were performed pre- and post-intervention. Patients completed semi-structured interviews post-intervention to explore their experiences and views on the intervention and its impact on their daily lives. RESULTS: Six of the 10 recruited patients completed the intervention and completed pre-and post-assessments. Four of 6 patients improved STS, 5 of 6 patients improved 6MWT and 4 of 6 patients improved Global QoL. Perceived benefits included improved muscle strength and more confidence when walking. CONCLUSION: A personalised and progressive NMES exercise intervention appears safe and may improve functional capacity and QoL in adults who are undergoing or have recently completed treatment for cancer. Replication of these results in a controlled prospective study is warranted prior to clinical implementation.

Influence of the location of nonischemic diabetic forefoot osteomyelitis on time to healing after undergoing surgery.

The forefoot has been reported as the most frequent location of osteomyelitis in the feet of patients with diabetes. The forefoot includes toes and metatarsal heads as common locations of bone infections, but the anatomy of these bones is quite different. As a result, such differences in anatomy may have an impact on the outcomes. The aim of the present study was to determine whether different locations of osteomyelitis in the forefoot have any influence on time to healing after undergoing surgery in a prospective series including 195 patients without peripheral arterial disease and osteomyelitis confirmed by histopathology. Location of the lesion was classified into 4 groups: hallux, first metatarsal head, lesser metatarsal heads, and lesser toes. The time required to achieve healing and the cumulative rate of wounds healed and likelihood of healing were analyzed at 4, 8, and 12 weeks after surgery. Time of healing (mean ± SD) in the whole series was 10.7 ± 8.4 weeks. Osteomyelitis located in the lesser toes has a higher probability of healing by the fourth week (odds ratio [OR] = 5.7, 95% confidence interval [CI] = 2.8-11.6, P < .001), eighth week (OR = 3.2, 95% CI = 1.6-6.4, P < .001), or twelfth week (OR = 3.1, 95% CI = 1.3-7.0, P = .008) than other osteomyelitis locations. Osteomyelitis located in the first metatarsal joint was less likely to heal by the eighth week (OR = 0.4, 95% CI = 0.2-0.9, P = .037) and 12th week (OR = 0.4, 95% CI = 0.2-1.0, P = .040). In conclusion, time to healing is significantly different according to the location of the bone infection in the forefoot.

Serum nitrotyrosine and psychometric tests as indicators of impaired fitness to drive in cirrhotic patients with minimal hepatic encephalopathy.

BACKGROUND & AIMS: Cirrhotic patients with minimal hepatic encephalopathy (MHE) show impaired driving ability and increased vehicle accidents. The neurological deficits contributing to impair driving and the underlying mechanisms are poorly understood. Early detection of driving impairment would help to reduce traffic accidents in MHE patients. It would be therefore useful to have psychometric or biochemical parameters reflecting driving impairment. The aims of this work were as follows: (i) to shed light on the neurological deficits contributing to impair driving; (ii) to assess whether some psychometric test or biochemical parameter is a good indicator of driving impairment. METHODS: We assessed in 22 controls, 36 cirrhotic patients without and 15 with MHE, driving performance using a driving simulator (SIMUVEG) and Driver Test. MHE was diagnosed using the psychometric hepatic encephalopathy score (PHES). Psychometric tests assessing different neurological functions (mental processing speed, attention, visuo-spatial and bimanual coordination) were performed. Blood ammonia and parameters related with nitric oxide-cGMP metabolism, IL-6, IL-18 and 3-nitrotyrosine were measured. RESULTS: Patients with MHE showed impaired driving ability correlating with MHE grade, with impaired vehicle lateral control in spite of reduced driving speed. Patients with MHE show psychomotor slowing, longer reaction times, impaired bimanual and visuo-spatial coordination and concentrated attention and slowed speed of anticipation and increased blood ammonia, cGMP, IL-6, IL-18 and 3-nitrotyrosine. CONCLUSIONS: Impaired mental processing speed, attention and alterations in visuo-spatial and motor coordination seem main contributors to impaired driving ability in patients with MHE. Increased serum 3-nitrotyrosine is associated with impaired driving ability.

Quantifying the extent of fistulotomy. How much sphincter can we safely divide? A three-dimensional endosonographic study.

PURPOSE: To quantify the longitudinal division of the internal anal sphincter (IAS) and external anal sphincter (EAS) after fistulotomy using three-dimensional endoanal ultrasound (3D-EAUS) and correlate the results with postoperative faecal incontinence. METHODS: A prospective, consecutive study was performed from December 2008 to October 2010. All patients underwent 3D-EAUS before and 8 weeks after surgery. Thirty-six patients with simple perianal fistula were included. Patients with an intersphincteric or low transphincteric fistula (<66% sphincter involved) without risk factors for incontinence underwent fistulotomy. The outcome measures were the longitudinal extent of division of the IAS and EAS in relation to total sphincter length and continence (Jorge and Wexner scores). RESULTS: One-year follow-up revealed a 0% recurrence rate. There was a strong correlation between preoperative 3D-EAUS measurement of fistula height with intraoperative and postoperative 3D-EAUS measurement of IAS and EAS division (p < 0.001). The relationship between the level of EAS division and faecal incontinence showed a significant difference in incontinence rates between fistulotomies limited to the lower two thirds of the EAS and those above this level. Five patients (13.9%) had worse anal continence after surgery, although this was mild in all patients (<3/20 Jorge and Wexner scale). There was no significant difference in continence scores before and after surgery (p > 0.05). CONCLUSIONS: In patients without risk factors, division of the EAS during fistulotomy limited to the lower two thirds of the EAS is associated with excellent continence and cure rates.

Exposure system to study hypotheses of ELF and RF electromagnetic field interactions of mobile phones with the central nervous system.

A novel exposure system for double-blind human electromagnetic provocation studies has been developed that satisfies the precision, control of fields and potential artifacts, and provides the flexibility to investigate the response of hypotheses-driven electromagnetic field exposure schemes on brain function, ranging from extremely low frequency (ELF) to radio frequency (RF) fields. The system can provide the same exposure of the lateral cerebral cortex at two different RF frequencies (900 and 2140 MHz) but with different exposure levels at subcortical structures, and also allows uniform ELF magnetic field exposure of the brain. The RF modulation and ELF signal are obtained by a freely programmable arbitrary signal generator allowing a wide range of worst-case exposure scenarios to be simulated, including those caused by wireless devices. The maximum achievable RF exposure is larger than 60 W/kg peak spatial specific absorption rate averaged over 10 g of tissue. The maximum ELF magnetic field exposure of the brain is 800 A/m at 50 Hz with a deviation from uniformity of 8% (SD).

Estimation of head tissue-specific exposure from mobile phones based on measurements in the homogeneous SAM head.

The maximum spatial peak exposure of each commercial mobile phone determined in compliance with the relevant safety and product standards is publicly available. However, this information is not sufficient for epidemiological studies aiming to correlate the use of mobile phones with specific cancers or to behavioral alterations, as the dominant location of the exposure may be anywhere in the head between the chin to above the ear, depending on the phone design. The objective of this study was to develop a methodology to determine tissue-specific exposure by expanding the post-processing of the measured surface or volume scans using standardized compliance testing equipment, that is, specific absorption rate (SAR) scanners. The transformation matrix was developed using the results from generic dipoles to evaluate the relation between the SAR in many brain regions of the Virtual Family anatomical phantoms and in virtual brain regions mapped onto the homogeneous SAM head. A set of transformation factors was derived to correlate the SAR induced in the SAM head to the SAR in the anatomical heads. The evaluation included the uncertainty associated with each factor, arising from the anatomical differences between the phantoms (typically less than 6 dB (4×)). The applicability of these factors was validated by performing simulations of four head models exposed to four realistic mobile phone models. The new methodology enables the reliable determination of the maximum and averaged exposure of specific tissues and functional brain regions to mobile phones when combined with mobile phone power control data, and therefore greatly strengthens epidemiological evaluations and improves information for the consumer.

Implantación de un protocolo de rehabilitación multimodal perioperatoria en cirugía colorrectal electiva. Estudio prospectivo, aleatorizado y controlado / Implementation of a perioperative multimodal rehabilitation protocol in elective colorectal surgery. A prospective randomised controlled study

Introducción La rehabilitación multimodal (RMM) consiste en la combinación de varios métodos para el manejo del paciente quirúrgico encaminados a disminuir la respuesta al estrés quirúrgico y una recuperación más cómoda y precoz. Objetivo Valorar la implantación de un protocolo de RMM en una unidad de cirugía colorrectal y comparar los resultados con el modelo tradicional, valorando su eficacia en cuanto a recuperación y estancia. Material y métodos Se analizó prospectiva y aleatorizadamente a 119 pacientes intervenidos de forma electiva por enfermedad colorrectal entre 2009 y 2010. Se asignó a 58 pacientes al grupo tradicional y 61 al grupo RMM. La RMM consistió en educación preoperatoria, alimentación y movilización precoz. Resultados Ambos grupos eran homogéneos en cuanto a variables preoperatorias valoradas, el tipo de enfermedad y los procedimientos realizados. La sonda nasogástrica se mantuvo en el grupo tradicional 4 (1-9) días frente a 1 (0-2) días en el grupo RMM, sin diferencias en la reinserción de la sonda. Se encontraron diferencias significativas en el inicio de la dieta líquida —3 (1-5) días tradicional, frente a 0 (0-2) con RMM (p<0,001)— y expulsión de la primera ventosidad —3 (1-6) días tradicional, frente a 1 (1-3) con RMM (p<0,001)—. Los pacientes en el grupo RMM tuvieron una estancia postoperatoria de 4,15±2,18, frente a 9,23±6,97 días del grupo tradicional (p<0,001). No se encontraron diferencias significativas en las complicaciones o reingresos. Conclusiones La RMM en cirugía colorrectal en el sistema sanitario público español es factible y permite una más rápida recuperación de los pacientes operados sin aumentar las complicaciones, permitiendo un alta hospitalaria precoz (AU)

Introduction Multimodal rehabilitation (MMR) consists of a combination of several methods for management of the surgical patient, designed to reduce the response to surgical stress and a more comfortable and earlier recovery. Objective To assess the implementation of an MMR protocol in a Colorectal Surgery Unit, and to compare the results with the traditional model, as well as assessing its efficacy as regards recovery and hospital stay. Material and methods A total of 119 patients who received elective surgery for colorectal diseases in a period during 2009-2010 were prospectively and randomly analysed. The patients were divided into 2 groups: 58 patients were assigned to the traditional group and 61 to the MMR group. The MMR group protocol consisted of, preoperative education, early feeding and mobilisation. Results Both groups were homogeneous as regards the preoperative variables evaluated, the type of disease and the procedures carried out. The nasogastric tube was kept in place for 4 (1-9) days compared to 1 day (0-2) in the MMR group, with no differences in the number of re-insertions. Significant differences were found in the introduction of a liquid diet (3 [1-5] days traditional versus 0 [0-2] MMR) (P<.001), and passing of first flatulence (3 [1-6] days traditional versus 1 [1-3] MMR) (P<.001). The MMR group had a postoperative stay of 4.15±2.18 versus 9.23±6.97 days in the traditional group (P<.001). No significant differences were found in complications or readmissions. Conclusions MMR in colorectal surgery in the Spanish public health system is feasible and enables surgical patients to have a faster recovery without increasing complications, leading to an earlier hospital discharge (AU)

[Implementation of a perioperative multimodal rehabilitation protocol in elective colorectal surgery. A prospective randomised controlled study]. / Implantación de un protocolo de rehabilitación multimodal perioperatoria en cirugía colorrectal electiva. Estudio prospectivo, aleatorizado y controlado.

INTRODUCTION: Multimodal rehabilitation (MMR) consists of a combination of several methods for management of the surgical patient, designed to reduce the response to surgical stress and a more comfortable and earlier recovery. OBJECTIVE: To assess the implementation of an MMR protocol in a Colorectal Surgery Unit, and to compare the results with the traditional model, as well as assessing its efficacy as regards recovery and hospital stay. MATERIAL AND METHODS: A total of 119 patients who received elective surgery for colorectal diseases in a period during 2009-2010 were prospectively and randomly analysed. The patients were divided into 2 groups: 58 patients were assigned to the traditional group and 61 to the MMR group. The MMR group protocol consisted of, preoperative education, early feeding and mobilisation. RESULTS: Both groups were homogeneous as regards the preoperative variables evaluated, the type of disease and the procedures carried out. The nasogastric tube was kept in place for 4 (1-9) days compared to 1 day (0-2) in the MMR group, with no differences in the number of re-insertions. Significant differences were found in the introduction of a liquid diet (3 [1-5] days traditional versus 0 [0-2] MMR) (P<.001), and passing of first flatulence (3 [1-6] days traditional versus 1 [1-3] MMR) (P<.001). The MMR group had a postoperative stay of 4.15±2.18 versus 9.23±6.97 days in the traditional group (P<.001). No significant differences were found in complications or readmissions. CONCLUSIONS: MMR in colorectal surgery in the Spanish public health system is feasible and enables surgical patients to have a faster recovery without increasing complications, leading to an earlier hospital discharge.

Novel methodology to characterize electromagnetic exposure of the brain.

Due to the greatly non-uniform field distribution induced in brain tissues by radio frequency electromagnetic sources, the exposure of anatomical and functional regions of the brain may be a key issue in interpreting laboratory findings and epidemiological studies concerning endpoints related to the central nervous system. This paper introduces the Talairach atlas in characterization of the electromagnetic exposure of the brain. A hierarchical labeling scheme is mapped onto high-resolution human models. This procedure is fully automatic and allows identification of over a thousand different sites all over the brain. The electromagnetic absorption can then be extracted and interpreted in every region or combination of regions in the brain, depending on the characterization goals. The application examples show how this methodology enhances the dosimetry assessment of the brain based on results obtained by either finite difference time domain simulations or measurements delivered by test compliance dosimetry systems. Applications include, among others, the detailed dosimetric analysis of the exposure of the brain during cell phone use, improved design of exposure setups for human studies or medical diagnostic and therapeutic devices using electromagnetic fields or ultrasound.

Evaluación de las fístulas perianales mediante ecografía endoanal tridimensional y correlación con los hallazgos intraoperatorios / Evaluation of three-dimensional endoanal endosonography of perianal fistulas and correlation with surgical findings

Objetivo Evaluar la fiabilidad diagnóstica de la ecografía tridimensional (ECO 3D) vs. la bidimensional (ECO 2D) y la exploración física en el diagnóstico de las fístulas perianales correlacionándolo con los hallazgos intraoperatorios. Material y método Estudio prospectivo, observacional con pacientes incluidos de forma consecutiva entre diciembre 2008 y agosto 2009. Se incluyen 29 pacientes diagnosticados de fístula perianal subsidiarios de tratamiento quirúrgico. Se realizó una exploración física, ECO 2D, ECO 3D comparándolos con los hallazgos intraoperatorios. Cuando el orificio fistuloso externo se encuentra abierto, se repiten ambas exploraciones instilando agua oxigenada. Resultados Orificio fistuloso interno: sin diferencias significativas entre la exploración física y las ecografías (p>0,05). Trayecto fistuloso primario: el grado de concordancia entre la ECO 3D y los hallazgos intraoperatorios es bueno (k=0,61), y superior al resto de exploraciones físicas (k=0,41; ECO 2D: k=0,56). Trayecto fistuloso secundario: ECO 2D y ECO 3D muestran buena concordancia con la cirugía (86%, k=0,66; 90%, k=0,73, respectivamente). Abscesos/cavidades adyacentes: las ecografías muestran una concordancia moderada con los hallazgos intraoperatorios (k=0,438, k=0,540, respectivamente).Conclusiones La ECO 3D tiene una fiabilidad diagnóstica mayor a la ECO 2D comparando con los hallazgos intraoperatorios para estimar la altura de las fístulas transesfintéricas. ECO 3D muestra buena concordancia con la cirugía en el diagnóstico de trayectos primarios y secundarios y una alta fiabilidad para el orificio fistuloso interno. Existe una tendencia a sobreestimar la altura de la fístula con ECO 2D, esto se deduce de la menor especificidad de la ECO 2D para el diagnóstico de fístulas transesfintéricas altas y la menor sensibilidad en las fístulas transesfintéricas bajas (AU)

Objective This study aims to assess the accuracy of three-dimensional endoanal ultrasound (3D-US), two-dimensional ultrasound (2D-US) and physical examination (PE) for the diagnosis of perianal fistulas and correlate the results with intraoperative findings. Materials and methods A prospective, observational study with consecutive inclusion of patients was performed between December 2008 and August 2009. Twenty-nine patients diagnosed with a perianal fistula due to undergo surgery were included. All patients underwent PE, 2D-US and 3D-US, and the results were compared to intraoperative findings. The examinations were repeated with hydrogen peroxide instilled through the external opening. Results Internal opening (IO): no significant differences with regards to the number of IO diagnosed by PE and 2D-US or 3D-US (P>0.05). Primary tract: good concordance between 3D US and surgery (k=0.61), and this was higher than any of the other techniques used (PE: k=0.41; 2D-US: k=0.56). Secondary tracts: both 2D and 3D-US show good concordance with surgery (86%, k=0.66; 90%, k=0.73, respectively). Abscesses/cavities: The ultrasound examinations showed a moderate concordance with surgery (k=0.438, k=0.540, respectively).Conclusions3D-US shows a higher diagnostic accuracy than 2D-US when compared with surgery to estimate primary fistula height in transphincteric fistulas. 3D-US shows good concordance with surgery for diagnosing primary and secondary tracts and a high sensitivity and specificity for diagnosis of the IO. There was a tendency to overestimate fistula height with 2D-US as shown by the lower specificity of 2D-US for the diagnosis of high transphincteric fistulas and lower sensitivity of 2D-US for low transphincteric fistulas (AU)

[Evaluation of three-dimensional endoanal endosonography of perianal fistulas and correlation with surgical findings]. / Evaluación de las fístulas perianales mediante ecografía endoanal tridimensional y correlación con los hallazgos intraoperatorios.

OBJECTIVE: This study aims to assess the accuracy of three-dimensional endoanal ultrasound (3D-US), two-dimensional ultrasound (2D-US) and physical examination (PE) for the diagnosis of perianal fistulas and correlate the results with intraoperative findings. MATERIALS AND METHODS: A prospective, observational study with consecutive inclusion of patients was performed between December 2008 and August 2009. Twenty-nine patients diagnosed with a perianal fistula due to undergo surgery were included. All patients underwent PE, 2D-US and 3D-US, and the results were compared to intraoperative findings. The examinations were repeated with hydrogen peroxide instilled through the external opening. RESULTS: Internal opening (IO): no significant differences with regards to the number of IO diagnosed by PE and 2D-US or 3D-US (P>0.05). Primary tract: good concordance between 3D US and surgery (k=0.61), and this was higher than any of the other techniques used (PE: k=0.41; 2D-US: k=0.56). Secondary tracts: both 2D and 3D-US show good concordance with surgery (86%, k=0.66; 90%, k=0.73, respectively). Abscesses/cavities: The ultrasound examinations showed a moderate concordance with surgery (k=0.438, k=0.540, respectively). CONCLUSIONS: 3D-US shows a higher diagnostic accuracy than 2D-US when compared with surgery to estimate primary fistula height in transphincteric fistulas. 3D-US shows good concordance with surgery for diagnosing primary and secondary tracts and a high sensitivity and specificity for diagnosis of the IO. There was a tendency to overestimate fistula height with 2D-US as shown by the lower specificity of 2D-US for the diagnosis of high transphincteric fistulas and lower sensitivity of 2D-US for low transphincteric fistulas.

HLA class I expression in metastatic melanoma correlates with tumor development during autologous vaccination.

Our knowledge of the mechanisms underlying tumor-specific immune response and tumor escape has considerably increased. HLA class I antigen defects remain an important tumor escape mechanism since they influence the interactions between tumor cells and specific T and NK cells in the course of malignant disease. We have studied here HLA class I expression in six subcutaneous metastases obtained from a melanoma patient immunized with an autologous melanoma cell vaccine (M-VAX). We report in this paper that HLA class I antigen expression on these metastatic lesions strongly correlated with the course of the disease. The three metastases that were partially regressing at the time of their excision showed a strong HLA class I expression, whereas the progressing ones showed a very weak or negative staining with most of the anti-HLA class I mAbs used. Real-time quantitative PCR of the samples obtained from microdissected tumor tissue revealed a significant difference in the mRNA levels of HLA-ABC heavy chain and beta2m between the two types of metastases, i.e., lower levels in progressing metastases and high levels in regressing ones, confirming the immunohistological findings. This is, to our knowledge, the first report where the clinical outcome of different HLA class I positive and negative melanoma metastases can be clearly correlated with the regression and progression of the disease, respectively.

Cirugía filtrante ajustable: nueva técnica antiglaucomatosa / Adjustable filtering surgery: technique new in antiglaucomatous surgery

Ofrecer una técnica quirúrgica en pacientes con glaucoma de ángulo abierto, que hemos denominado cirugía filtrante ajustable, de fácil realización, cuyo objetivo fundamental es impedir el cierre de la fístula por el proceso de fibrosis de la herida. Seis pacientes entre 44 y 75 años, con diagnóstico de glaucoma de ángulo abierto avanzado no controlado con terapia máxima, fueron sometidos a esta técnica quirúrgica una vez obtenido su consentimiento, con excavaciones entre 0,6 y 0,7 y presión intraocular mínima de 28 mmHg y máxima de 32mmHg. En 5 de 6 pacientes se obtuvieron niveles de presión intraocular entre 14 y 17 mmHg. Cuando se movilizaba el flap se obtenía una disminución de presión intraocular de 3-4 mmHg. En 1 paciente el nivel de presión persistió elevado y se añadió terapia médica. El mecanismo de acción de nuestro procedimiento consiste en interrumpir el ciclo de formación de la fibrosis subconjuntival mediante un efecto mecánico provocado por la tracción del flap en el lecho filtrante, durante los días de máxima proliferación fibroblástica, pero se necesitan futuros estudios clínicos e histopatológicos para determinar la eficiencia de este procedimiento

Infiltración de triamcinolona en chalazión / Triamcinolone infiltration in chalazion

Treinta e cuatro pacientes, con un total de 43 chalaziones, fueron tratados con inyección de acetato de triamcinolona en el centro de la lesión. Ocho pacientes no concurrieron a control. Veintinueve mejoraron en un lapso no mayor de 2 semanas. A dos les fue necesario aplicar una nueva dosis, y un tercero mejoró pero tuvo una recidiva al segundo mes y hubo de ser nuevamente tratado. A tres pacientes les fue practicado extirpación quirúrgica de la lesión, diagnosticándose en uno de los casos un quiste sebáceo