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1.
ANZ J Surg ; 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31566295

RESUMO

BACKGROUND: Hepatocellular carcinoma is the most frequent primary tumour of the liver. Although often associated with chronic liver disease, it can also occur in non-cirrhotic livers. The aim of this study was to describe post-operative morbidity (POM), and survival of patients with hepatocellular carcinoma in non-cirrhotic liver treated surgically, and to identify variables associated with prognosis. METHODS: Case series of patients who underwent surgery for hepatocellular carcinoma in non-cirrhotic liver at Clínica RedSalud Mayor de Temuco, Chile (2001-2017), were studied. The minimum follow-up time considered was 12 months. Principal outcomes were development of POM and survival. Other variables of interest were age, sex, tumour diameter, surgical time, hospital stay, follow-up time, need for surgical re-intervention, mortality, vascular and lymph node invasion and staging. Descriptive and analytic statistics were calculated. RESULTS: A total of 32 patients were studied. They were characterized by a mean age of 67.3 ± 7.2 years, 62.5% of whom were men. Averages of tumour diameter, surgical time and hospitalization were 12.0 ± 2.6 cm, 114.4 ± 32.3 min and 7.2 ± 2.9 days, respectively. POM was 31.3%. There was no mortality and there were no re-interventions. The overall actuarial survival at 1, 2 and 3 years was 96.8%, 73.4% and 17.3%, respectively. Lower survival was verified in patients with vascular invasion, lymph node infiltration and stages III and IVa. CONCLUSION: Despite the tumour diameter and extent of the resections, POM in patients with hepatocellular carcinoma in non-cirrhotic liver is moderate. However, its prognosis is poor. Vascular invasion, lymph node invasion and advances stages were associated with worse survival.

2.
Sci Rep ; 9(1): 14517, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601993

RESUMO

The aim of this retrospective study was thus to evaluate postoperative morphological changes in the remnant pancreas after pancreaticoduodenectomy (PD) associated with postoperative pancreatic fistula (POPF). Fifty-one patients subjected to PD were enrolled in the study and allocated into 2 groups according to the presence (n = 16) or absence of POPF (n = 35). A morphological evaluation of the pancreas was conducted for up to a 20 months follow-up on CT scans and compared between groups. No significant differences were observed in morphology between the groups at the different preoperative and PO intervals, regardless of the clinical relevance of the POPF or POPF grade. However, in the overall patient analysis we observed a significant reduction of the entire pancreas over time. In fact, thickness decreased 0.4 mm/month, length 1.2 mm/month and volume 1.17 cm3/month over the PO. The impact of age, POPF, type of anastomosis, surgical technique and PO follow-up (time) was evaluated in a multivariate analysis using the general linear model, but only PO follow-up had a significant influence on the final model (p < 0.001). A significant reduction on pancreatic parenchyma (thickness, length and volume) occurs after PD with no significant differences between patients with or without POPF.

3.
Int. j. morphol ; 37(3): 1033-1037, Sept. 2019. graf
Artigo em Espanhol | LILACS-Express | ID: biblio-1012392

RESUMO

RESUMEN: La infección por Actinomices (actinomicosis), es una entidad poco frecuente y que puede crear dificultades diagnósticas y terapéuticas; principalmente cuando por su presentación se asemeja a neoplasias malignas. El objetivo de este estudio fue reportar un caso de actinomicosis de pared abdominal con infiltración hepática y revisar la evidencia existente. Se trata de una paciente sexo femenino, de 33 años de edad, sin antecedentes quirúrgicos ni de utilización de dispositivos intra-uterinos. Consultó por dolor abdominal y masa palpable a nivel epigástrico. Se estudió con imágenes, las que permitieron verificar una masa de pared abdominal con trayecto fistuloso al hígado. Se realizó una exéresis amplia de la lesión antes descrita. Una vez extirpado el espécimen, se fue a estudio histopatológico, que reveló gránulos de azufre consistentes con actinomices. La paciente evolució de forma satisfactoria, sin inconvenientes. Presentamos un caso poco común de actinomicosis de pared abdominal con infiltración hepática. Cuando se encuentra una gran masa intraperitoneal, la actinomicosis debe incluirse en el proceso de diagnóstico diferencial.


SUMMARY: Actinomyces infection (actinomycosis) may create diagnostic conflicts and be confused with malignant neoplasms, especially in the abdomen. The objective of this study was to report a case of abdominal wall actinomycosis with hepatic infiltration, and review the existing evidence. Female patient, 33 years of age, with no surgical history or use of intra-uterine devices. She consulted for abdominal pain and palpable mass at the epigastrium. It was studied with images, which allowed verifying an abdominal wall mass with hepatic fistulae. A broad extirpation of the lesion was performed. The histological study revealed sulfur granules consistent with actinomyces. The patient has evolved satisfactorily, without problems; and is currently in treatment with amoxicillin. We present an unusual case of abdominal wall actinomycosis with hepatic infiltration that resulted in a difficult diagnosis. When a large intraperitoneal mass is found, actinomycosis needs to be included as a differential diagnoses.

4.
Cir Cir ; 87(3): 313-320, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31135772

RESUMO

Objective: To describe the results of the extension of surgical treatment and adjuvant chemotherapy (ACT) in incidental gallbladder cancer (CVB), in terms of postoperative morbidity (POM) and 5-year overall survival rate. Method: Case series of patients operated on for incidental GBC in Clínica Mayor, Temuco, Chile (2001-2016). All cases were treated by partial hepatectomy (segments IVb and V), and regional lymphadenectomy. The minimum follow-up time was 12 months. Outcome variables were MPO and 5-year overall survival rate. Other variables of interest were: infiltration depth in vesicular wall, lymph nodes and resected liver; surgical time, need for reoperation, hospital stay, follow-up and mortality. Descriptive statistics were applied as well as bivariate analysis applying Fisher's exact and t-test and non-parametrical tests for continuous variables and Kaplan Meier curves. Results: The series was composed of 50 patients, whose average age was 58.6 ± 9.6 years; 68.0% of which were women. The mean surgical time and hospital stay were 224 ± 93 min (90 to 480) and 6.9 ± 2.9 days (4 to 20), respectively. POM was 28.0%. 5-year overall survival rate was 47%. There were no reoperations or mortality. Conclusions: The results verified in terms of POM and 5-year overall survival rate are similar to previously reported series.

5.
BMC Surg ; 19(1): 40, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31014318

RESUMO

BACKGROUND: Postoperative adhesions represent 75% of all acute small bowel obstructions. Although open surgery is considered the standard approach for adhesiolysis, laparoscopic approach is gaining popularity. METHODS: A retrospective study with data from a prospectively maintained data base of all patients undergoing surgical treatment for adhesive small bowel obstruction (ASBO) from January 2007 to May 2016 was conducted. Postoperative outcomes comparing open vs laparoscopic approaches were analysed. An intention to treat analysis was performed. The aim of the study was to evaluate the potential benefits of the laparoscopic approach in the treatment of ASBO. RESULTS: 262 patients undergoing surgery for ASBO were included. 184 (70%) and 78 (30%) patients were operated by open and laparoscopic approach respectively. The conversion rate was 38.5%. Patients in the laparoscopic group were younger (p < 0.001), had fewer previous abdominal operations (p = 0.001), lower ASA grade (p < 0.001), and less complex adhesions were found (p = 0.001). Operative time was longer in the open group (p = 0.004). Laparoscopic adhesiolysis was associated with a lower overall complication rate (43% vs 67.9%, p < 0.001), lower mortality (p = 0.026), earlier oral intake (p < 0.001) and shorter hospital stay (p < 0.001). Specific analysis of patients with single band and/or internal hernia who did not need bowel resection, also demonstrated fewer complications, earlier oral intake and shorter length of stay. In the multivariate analysis, the open approach was an independent risk factor for overall complications compared to the laparoscopic approach (Odds Ratio = 2.89; 95% CI 1.1-7.6; p = 0.033). CONCLUSIONS: Laparoscopic management of ASBO is feasible, effective and safe. The laparoscopic approach improves postoperative outcomes and functional recovery, and should be considered in patients in whom simple band adhesions are suspected. Patient selection is the strongest key factor for having success.


Assuntos
Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia , Laparoscopia , Complicações Pós-Operatórias/cirurgia , Aderências Teciduais/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Conversão para Cirurgia Aberta , Bases de Dados Factuais , Feminino , Humanos , Análise de Intenção de Tratamento , Obstrução Intestinal/etiologia , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Razão de Chances , Duração da Cirurgia , Seleção de Pacientes , Estudos Retrospectivos , Fatores de Risco , Aderências Teciduais/complicações
6.
Sci Rep ; 9(1): 5928, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30976043

RESUMO

Radiofrequency energy has been used both experimentally and clinically to manage the pancreatic remnant after distal pancreatectomies. Our goal was to determine whether endoluminal radiofrequency (RF) ablation of the main pancreatic duct in large animals would be more efficient than glue occlusion as an exocrine pancreatic atrophy-inducing procedure. Thirty-four Landrace pigs were assigned to either the transpapilar (n = 16) or transection (n = 18) groups. The transection implied the pancreas neck was severed. In each of these groups the remaining distal pancreatic duct was occluded either by RF or by glue. In the transpapilar group complete atrophy was observed in all the RF cases, while atrophy was incomplete in all the members of the glue subgroup. The failure rate of the main pancreatic duct (usually expressed by a pseudocyst) in the transection groups was dramatically higher in the glue subgroup than the RF subgroups (9 out of 9 and 1 out of 9, respectively) and postoperative mortality occurred only in the glue subgroup (3 out of 9). These results show the superiority of endoluminal RF ablation over glue for main pancreatic duct occlusion, as seen by the degree of atrophy and fewer postoperative pancreatic fistulas.

7.
HPB (Oxford) ; 21(11): 1427-1435, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30922845

RESUMO

BACKGROUND: Equipoise exists regarding the benefit of adjuvant therapy (AT) in patients with gallbladder cancer (GBC). The aim of this study was to critically review the available evidence for the effectiveness of AT in patients with GBC following surgery with curative intent. METHODS: A systematic review was performed. Relevant studies were identified from Trip Database, BIREME-BVS, SciELO, Cochrane Central Register, WoS, MEDLINE, EMBASE and SCOPUS. Adjuvant therapies considered included chemotherapy, chemoradiotherapy, and radiotherapy. The primary outcome was overall survival (OS). Subgorup analysis of patients with positive lymph node disease (PLND), positive surgical margin (PSM), or advanced stage (AS) were performed. RESULTS: 748 related articles were identified; 27 met the selection criteria (3 systematic reviews and 24 observational studies). Evidence provided was moderate, poor and very poor for chemotherapy, chemoradiotherapy, and radiotherapy. Existing evidence is not robust, but suggests certain benefits with AT in improving OS, especially in patients with PLND, PSM and AS. CONCLUSION: Results do not provide strong evidence that AT is effective in patients who undergo resection for GBC. Subgroups of PLND and PSM may have a survival advantage. Future studies with appropriate internal validity and adequate number of patients are required to better answer this question.

8.
Cir. Esp. (Ed. impr.) ; 97(3): 145-149, mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-181132

RESUMO

Introducción: Es recomendable practicar un estoma derivativo en pacientes con resección anterior baja y factores de riesgo, para reducir la gravedad de la fuga anastomótica. Habitualmente se realiza un estudio radiológico previo al cierre del estoma para detectar fugas subclínicas. El objetivo del presente estudio es evaluar la utilidad clínica del estudio radiológico. Métodos: Estudio prospectivo de una cohorte de pacientes sometidos a resección anterior de recto por cáncer rectal, y a los que se les realiza cierre del estoma sin enema de contraste. Este estudio se lleva a cabo después de realizar una revisión retrospectiva sobre los resultados del estudio radiológico previo al cierre del estoma en pacientes intervenidos entre 2007 y 2011. Resultados: Ochenta y seis pacientes cumplieron los criterios del estudio. Trece pacientes (15,1%) presentaron sepsis pélvica. El enema con contraste antes del cierre del estoma fue patológico en 8 pacientes (9,3%). Cinco de los 13 pacientes con sepsis pélvica mostraron un estudio radiológico patológico, en comparación con solo 3 de 73 pacientes sin complicaciones intraabdominales después de la resección del recto (38,5% vs 4,1%; p = 0,001). Basándonos en estos resultados, realizamos un estudio prospectivo omitiendo el enema con contraste en pacientes con curso postoperatorio no complicado. A 38 pacientes se les cerró el estoma sin estudio radiológico previo. Ningún paciente presentó sepsis pélvica. Conclusiones: El estudio radiológico de la anastomosis colorrectal antes de la reconstrucción del tránsito puede omitirse con seguridad en los pacientes sin sepsis pélvica ni íleo paralítico tras la resección anterior de recto


Introduction: Diverting stomata are recommended in patients with low anterior resection and risk factors in order to reduce the severity of anastomotic leaks. Usually, a radiology study is performed prior to the closure of the stoma to detect subclinical leaks. The aim of the present study is to assess the clinical utility of the radiology study. Methods: A prospective cohort study of patients undergoing anterior rectal resection for rectal cancer and those who underwent stoma closure without contrast enema. This study was carried out after a retrospective review of radiology study results prior to the closure of the stoma in patients operated from 2007 to 2011. Results: Eighty-six patients met the study criteria. Thirteen patients (15.1%) presented pelvic sepsis. Contrast enema before stoma closure was pathological in 8 patients (9.3%). Five out of the 13 patients with pelvic sepsis had a pathological radiological study, compared to only 3 out of the 73 patients without intra-abdominal complications after rectal resection (38.5% vs. 4.1%; P = .001). Based on these results, we conducted a prospective study omitting the contrast enema in patients with no postoperative complications. Thirty-eight patients had their stoma closed without a prior radiology study. None of the patients presented pelvic sepsis. Conclusions: Radiology studies of the colorectal anastomosis before reconstruction can safely be omitted in patients without pelvic sepsis after the previous rectal resection


Assuntos
Humanos , Masculino , Feminino , Neoplasias Retais/diagnóstico por imagem , Meios de Contraste , Estomas Cirúrgicos , Fatores de Risco , Anastomose Cirúrgica , Estudos Retrospectivos , Estudos Prospectivos
9.
Int. j. morphol ; 36(4): 1222-1224, Dec. 2018. graf
Artigo em Espanhol | LILACS | ID: biblio-975686

RESUMO

El lipoma gástrico (LG), es un tumor benigno raro que representa el 5 % de los lipomas gastrointestinales y menos del 1 % de todos los tumores gástricos. Se localizan habitualmente a nivel de la submucosa y generalmente en la región antral. La endoscopia y la tomografía computarizada son las herramientas diagnósticas más utilizadas en el proceso diagnóstico. Dada su relativa rareza, quedan a menudo fuera del diagnóstico diferencial de las masas submucosas gastrointestinales superiores. El objetivo de este manuscrito, es reportar dos casos tratados de forma consecutiva y revisar la literatura existente en esta materia. Se trata de dos pacientes de sexo masculino, de 49 y 69 años de edad, a quienes se diagnosticó una lesión submucosa gástrica por endoscopia y fueron tratados quirúrgicamente y cuyos especímenes fueron estudiados histológicamente, concluyéndose en ambos casos la existencia de un LG. Ambos pacientes evolucionaron de forma correcta y permanecen en controles clínicos y endoscópicos hasta la actualidad, sin inconvenientes. El LG es una entidad poco común, que puede simular una enfermedad maligna. Presentamos dos casos tratados quirúrgicamente con resultados satisfactorios.


Gastric lipoma (GL), is a rare benign tumor that represents 5 % of gastrointestinal lipomas and less than 1 % of all gastric tumors. They are usually located at the level of the submucosa and usually in the antral region. Endoscopy and computed tomography are the diagnostic tools most used in the diagnostic process. Given their relative rarity, they are often left out of the differential diagnosis of the upper gastrointestinal submucosal masses. The aim of this manuscript was to report two cases treated consecutively and review the existing literature on this subject. Two male patients, 49 and 69 years of age, were diagnosed with a gastric submucosal lesion by endoscopy and were treated surgically. The specimens were studied histologically; concluding the existence of a GL in both cases. The two patients evolved adequately and have remained in clinical and endoscopic controls until now, without problems. GL is a rare entity, which can simulate a malignant disease. We present two cases treated surgically with satisfactory results.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Neoplasias Gástricas/cirurgia , Lipoma/cirurgia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/diagnóstico , Tomografia Computadorizada por Raios X , Dor Abdominal/etiologia , Endoscopia do Sistema Digestório , Lipoma/complicações , Lipoma/diagnóstico
10.
Cir Esp ; 2018 Oct 19.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30348506

RESUMO

INTRODUCTION: Diverting stomata are recommended in patients with low anterior resection and risk factors in order to reduce the severity of anastomotic leaks. Usually, a radiology study is performed prior to the closure of the stoma to detect subclinical leaks. The aim of the present study is to assess the clinical utility of the radiology study. METHODS: A prospective cohort study of patients undergoing anterior rectal resection for rectal cancer and those who underwent stoma closure without contrast enema. This study was carried out after a retrospective review of radiology study results prior to the closure of the stoma in patients operated from 2007 to 2011. RESULTS: Eighty-six patients met the study criteria. Thirteen patients (15.1%) presented pelvic sepsis. Contrast enema before stoma closure was pathological in 8 patients (9.3%). Five out of the 13 patients with pelvic sepsis had a pathological radiological study, compared to only 3 out of the 73 patients without intra-abdominal complications after rectal resection (38.5% vs. 4.1%; P=.001). Based on these results, we conducted a prospective study omitting the contrast enema in patients with no postoperative complications. Thirty-eight patients had their stoma closed without a prior radiology study. None of the patients presented pelvic sepsis. CONCLUSIONS: Radiology studies of the colorectal anastomosis before reconstruction can safely be omitted in patients without pelvic sepsis after the previous rectal resection.

11.
Int. j. morphol ; 36(3): 1134-1142, Sept. 2018. graf
Artigo em Espanhol | LILACS | ID: biblio-954242

RESUMO

La progresivas preocupación de los países para optimizar el acceso, la eficiencia y la calidad de la salud, han impulsado la utilización más apropiada de las intervenciones en salud. Por ende, el interés tanto de profesionales sanitarios como de tomadores de decisiones en salud, ha sido orientado hacia la medicina basada en la evidencia, la eficacia comparativa y la Evaluación de Tecnologías Sanitarias (ETESA). Aunque los conceptos anteriormente señalados son convergentes en sus características, no son sinónimos. Sin embargo, todos estos, se basan en la orientación sistemática de pruebas y el enfoque en resultados relevantes para el paciente entre otras. Como consecuencia de todo esto, el interés no sólo implica los conceptos de eficacia, efectividad y eficiencia; sino que también en práctica clínica, costes y transparencia. En este artículo se resumen los conceptos de economía de la salud, evaluación económica, tecnología sanitaria (TS) y ETESA. Luego, se comenta el ciclo de vida de una TS, razones para implementar un programa de ETESA; para finalizar con algunos ejemplos de TS emergentes, comentarios respecto de la evidencia científica en la ETESA; y algunos ejemplos de estudios de ETESA en la práctica clínica cotidiana.


The progressive concern of countries to optimize access, efficiency and quality of health have led to the most appropriate use of health interventions. Therefore, the interest of both health professionals and health decision makers has been oriented towards evidence-based policy, comparative efficacy and Health Technologies Assessment (HTA). Although the aforementioned concepts are converging in their characteristics, they are not synonymous. However, all these are based on systematic testing orientation and focus on relevant patient outcomes among others. As a consequence of all this, interest does not only imply the concepts of effectiveness, effectiveness and efficiency, but also in clinical practice, costs and transparency.This manuscript summarizes concepts of health economics, economic evaluation, health technology and HTA. Then, the life cycle of a health technology and the reasons for implementing an HTA program are discussed. Concluding with some examples of emerging health technologies, comments on the scientific evidence in HTA, and some examples of HTA studies in daily clinical practice.


Assuntos
Avaliação da Tecnologia Biomédica , Economia da Saúde , Medicina Baseada em Evidências , Qualidade da Assistência à Saúde , Efetividade , Chile , Eficácia , Análise Custo-Benefício , Eficiência
12.
Ann Surg ; 268(5): 731-739, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30138162

RESUMO

OBJECTIVE: To compare perioperative outcomes of pancreatoduodenectomy (PD) performed through the laparoscopic route or by open surgery. SUMMARY BACKGROUND DATA: Laparoscopic PD is being progressively performed in selected patients. METHODS: An open-label single-center RCT was conducted between February 2013 and September 2017. The primary endpoint was the length of hospital stay (LOS). Secondary endpoints were operative time, transfusion requirements, specific pancreatic complications (pancreatic or biliary fistula, pancreatic hemorrhage, and delayed gastric emptying), Clavien-Dindo grade ≥ 3 complications, comprehensive complication index (CCI) score, poor quality outcome (PQO), and the quality of pathologic resection. Analyses were performed on an intention to treat basis. RESULTS: Of 86 patients assessed for PD, 66 were randomized (34 laparoscopic approach, 32 open surgery). Conversion to an open procedure was needed in 8 (23.5%) patients. Laparoscopic versus open PD was associated with a significantly shorter LOS (median 13.5 vs. 17 d; P = 0.024) and longer median operative time (486 vs. 365 min; P = 0.0001). The laparoscopic approach was associated with significantly better outcomes regarding Clavien-Dindo grade ≥ 3 complications (5 vs. 11 patients; P = 0.04), CCI score (20.6 vs. 29.6; P = 0.038), and PQO (10 vs. 14 patients; P = 0.041). No significant differences in transfusion requirements, pancreas-specific complications, the number of lymph nodes retrieved, and resection margins between the two approaches were found. CONCLUSIONS: Laparoscopic PD versus open surgery is associated with a shorter LOS and a more favorable postoperative course while maintaining oncological standards of a curative-intent surgical resection. TRIAL REGISTRY: ISRCTN93168938.

13.
Cir Esp ; 96(4): 221-225, 2018 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29605451

RESUMO

INTRODUCTION: Hospital readmission is used as a measure of quality healthcare. The aim of this study was to determine the incidence, causes, and risk factors related to emergency consultations and readmissions within 30 and 90 days in patients undergoing laparoscopic gastric bypass and laparoscopic sleeve gastrectomy. METHODS: Retrospective study of 429 patients operated on from January 2004 to July 2015 from a prospectively maintained database and electronic medical records. Demographic data, type of intervention, postoperative complications, length of hospital stay and records of emergency visits and readmissions were analyzed. RESULTS: Within the first 90 days postoperative, a total of 117 (27%) patients consulted the Emergency Department and 24 (6%) were readmitted. The most common reasons for emergency consultation were noninfectious problems related to the surgical wound (n=40, 34%) and abdominal pain (n=28, 24%), which was also the first cause of readmission (n=9, 37%). Postoperative complications, reintervention, associated surgery in the same operation and depression were risk factors for emergency consultation within the first 90 days of the postoperative period. CONCLUSIONS: Despite the high number of patients who visit the Emergency Department in the first 90 days of the postoperative period, few require readmission and none surgical reoperation. It is important to know the reasons for emergency consultation to establish preventive measures and improve the quality of care.

14.
Cir. Esp. (Ed. impr.) ; 96(4): 221-225, abr. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-173187

RESUMO

Introducción: Los reingresos son un indicador de calidad de la cirugía. El objetivo del estudio fue determinar la incidencia, las causas y los factores de riesgo relacionados con las consultas a Urgencias y los reingresos a 30 y 90 días en pacientes sometidos a bypass gástrico laparoscópico y gastrectomía vertical laparoscópica. Métodos: Estudio retrospectivo de 429 pacientes intervenidos desde enero de 2004 a julio de 2015 a partir de una base de datos prospectiva y de las historias clínicas electrónicas. Se analizaron datos demográficos, el tipo de intervención, las complicaciones postoperatorias, la duración de la estancia hospitalaria y el registro de las visitas a Urgencias y los reingresos durante el periodo de estudio. Resultados: En los primeros 90 días del postoperatorio, un total de 117 (27%) pacientes consultaron a Urgencias y 24 (6%) reingresaron. Los motivos más frecuentes de consulta a Urgencias fueron los problemas no infecciosos relacionados con la herida quirúrgica (n = 40, 34%) y el dolor abdominal (n = 28, 24%), que además fue la primera causa de reingreso (n = 9, 37%). Las complicaciones postoperatorias, la reintervención, una cirugía asociada en el mismo acto quirúrgico y la depresión fueron factores de riesgo para consultar a Urgencias en los primeros 90 días del periodo postoperatorio. Conclusiones: A pesar del elevado número de pacientes que consulta a Urgencias en los primeros 90 días del periodo postoperatorio, pocos precisan reingreso y ninguno reintervención quirúrgica. Es importante conocer los motivos de las consultas a Urgencias para establecer medidas preventivas y mejorar la calidad asistencial


Introduction: Hospital readmission is used as a measure of quality healthcare. The aim of this study was to determine the incidence, causes, and risk factors related to emergency consultations and readmissions within 30 and 90 days in patients undergoing laparoscopic gastric bypass and laparoscopic sleeve gastrectomy. Methods: Retrospective study of 429 patients operated on from January 2004 to July 2015 from a prospectively maintained database and electronic medical records. Demographic data, type of intervention, postoperative complications, length of hospital stay and records of emergency visits and readmissions were analyzed. Results: Within the first 90 days postoperative, a total of 117 (27%) patients consulted the Emergency Department and 24 (6%) were readmitted. The most common reasons for emergency consultation were noninfectious problems related to the surgical wound (n = 40, 34%) and abdominal pain (n = 28, 24%), which was also the first cause of readmission (n = 9, 37%). Postoperative complications, reintervention, associated surgery in the same operation and depression were risk factors for emergency consultation within the first 90 days of the postoperative period. Conclusions: Despite the high number of patients who visit the Emergency Department in the first 90 days of the postoperative period, few require readmission and none surgical reoperation. It is important to know the reasons for emergency consultation to establish preventive measures and improve the quality of care


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Serviços Médicos de Emergência/métodos , Cirurgia Bariátrica/métodos , Readmissão do Paciente/estatística & dados numéricos , Fatores de Risco , Gastrectomia/métodos , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Comorbidade
16.
Int J Surg ; 51: 164-169, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29409791

RESUMO

OBJECTIVES: To assess the minimally invasive surgery into the step-up approach procedures as a standard treatment for severe acute pancreatitis and comparing its results with those obtained by classical management. METHODS: Retrospective cohort study comparative with two groups treated over two consecutive, equal periods of time were defined: group A, classic management with open necrosectomy from January 2006 to June 2010; and group B, management with the step-up approach with minimally invasive surgery from July 2010 to December 2014. RESULTS: In group A, 83 patients with severe acute pancreatitis were treated, of whom 19 underwent at least one laparotomy, and in 5 any minimally invasive surgery. In group B, 81 patients were treated: minimally invasive surgery was necessary in 17 cases and laparotomy in 3. Among operated patients, the time from admission to first interventional procedures was significantly longer in group B (9 days vs. 18.5 days; p = 0.042). There were no significant differences in Intensive Care Unit stay or overall stay: 9.5 and 27 days (group A) vs. 8.5 and 21 days (group B). Mortality in operated patients and mortality overall were 50% and 18.1% in group A vs 0% and 6.2% in group B (p < 0.001 and p = 0.030). CONCLUSIONS: The combination of the step-up approach and minimally invasive surgery algorithm is feasible and could be considered as the standard of treatment for severe acute pancreatitis. The mortality rate deliberately descends when it is used.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pancreatite/cirurgia , Doença Aguda , Humanos , Laparotomia/métodos , Tempo de Internação , Pancreatite/mortalidade , Estudos Retrospectivos
17.
PLoS One ; 13(2): e0192958, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29462209

RESUMO

Peritoneal infection after colorectal cancer surgery is associated with a higher rate of tumor relapse. We have recently proposed that soluble inflammatory factors released in response to a postoperative infection enhance tumor progression features in residual tumor cells. In an effort to set up models to study the mechanisms of residual tumor cell activation during surgery-associated inflammation, we have analyzed the phenotypic response of colon cancer cell lines to the paracrine effects of THP-1 and U937 differentiated human macrophages, which release an inflammatory medium characteristic of an innate immune response. The exposure of the colon cancer cell lines HT-29 and SW620 to conditioned media isolated from differentiated THP-1 and U937 macrophages induced a mesenchymal-like phenotypic shift, involving the activation of in vitro invasiveness. The inflammatory media activated the ß-catenin/TCF4 transcriptional pathway and induced the expression of several mesenchymal (e.g., FN1 and VIM) and TCF4 target genes (e.g., MMP7, PTGS2, MET, and CCD1). Similarly, differential expression of some transcription factors involved in epithelial-to-mesenchymal transitions (i.e. ZEB1, SNAI1, and SNAI2) was variably observed in the colon cancer cell lines when exposed to the inflammatory media. THP-1 and U937 macrophages, which displayed characteristics of M1 differentiation, overexpressed some cytokines previously shown to be induced in colorectal cancer patients with increased rates of tumor recurrence associated with postoperative peritoneal infections, thus suggesting their pro-tumoral character. Therefore, the environment created by inflammatory M1 macrophages enhances features of epithelial-to-mesenchymal transition, and may be useful as a model to characterize pro-inflammatory cytokines as putative biomarkers of tumor recurrence risk.


Assuntos
Neoplasias do Colo/imunologia , Inflamação/imunologia , Macrófagos/imunologia , Recidiva Local de Neoplasia/imunologia , Complicações Pós-Operatórias/imunologia , Animais , Morte Celular/fisiologia , Linhagem Celular Tumoral , Movimento Celular/imunologia , Proliferação de Células/fisiologia , Neoplasias do Colo/patologia , Meios de Cultivo Condicionados , Modelos Animais de Doenças , Transição Epitelial-Mesenquimal/imunologia , Humanos , Macrófagos/patologia , Invasividade Neoplásica/imunologia , Fator de Transcrição 4/metabolismo , Cicatrização/imunologia , beta Catenina/metabolismo
18.
Rev. esp. enferm. dig ; 110(1): 25-29, ene. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-170050

RESUMO

Introducción y objetivo: el tatuaje endoscópico preoperatorio es un procedimiento eficaz que permite la localización intraoperatoria de neoplasias de pequeño tamaño. Sin embargo, actualmente no existen unos criterios definidos sobre las indicaciones del tatuaje endoscópico de estas neoplasias en el momento del diagnóstico. El objetivo es establecer unos criterios endoscópicos para seleccionar los pacientes que precisarán un tatuaje. Material y métodos: estudio ambispectivo de pacientes intervenidos de neoplasia colorrectal por laparoscopia en los que se realizó tatuaje endoscópico en el periodo (2007- 2013 y 2016-2017). De acuerdo con la descripción endoscópica de las neoplasias se clasificaron en: lesiones polipoideas, neoplasias que ocupan < 50% o ≥ 50% de la luz intestinal y neoplasias estenosantes. Resultados: se realizó tatuaje de la lesión en 120 pacientes y en 114 (95%) se identificó el mismo durante la cirugía. La mayor parte de las neoplasias descritas como polipoideas y neoplasias que ocupaban < 50% de la luz intestinal no se visualizaban en la cirugía y por tanto precisaban el tatuaje (33 de 42 y 18 de 26 respectivamente, p = 0.0001, χ2). En cambio, aquellas lesiones estenosantes o bien neoplasias que ocupaban ≥ 50% de la luz intestinal se identificaban mayoritariamente en la cirugía (15 de 15 y 36 de 37 respectivamente, p = 0.0001, χ2) sin necesidad de tatuaje. En conjunto la identificación de las neoplasias según los criterios establecidos fue del 98%. Conclusiones: estos resultados sugieren que es posible establecer unos criterios endoscópicos que permitan realizar un tatuaje selectivo durante la endoscopia diagnóstica manteniendo el éxito del mismo (AU)


Background and aim: Preoperative endoscopic tattooing is an effective procedure to identify small intraoperative neoplasms. However, there are no defined criteria with regard to the indications for endoscopic tattooing of these lesions at the time of diagnosis. The aim of this study was to establish endoscopic criteria that allow the selection of patients who will need a tattoo during the diagnostic colonoscopy. Methods: An ambispective study of patients undergoing laparoscopy due to a colorectal neoplasia who underwent endoscopic tattooing during the period from 2007-2013 and 2016-2017. According to the endoscopic description of the neoplasms, the classification was polypoid lesions, neoplasms occupying < 50% or ≥ 50% of the intestinal lumen and stenosing neoplasias. Results: Tattooing of the lesion was performed in 120 patients and the same lesions were identified during surgery in 114 (95%) cases. Most of the neoplasias described as polypoids and neoplasias that occupied < 50% of the intestinal lumen were not visualized during surgery and therefore required a tattoo (33 of 42 and 18 of 26 respectively, p = 0.0001, X2). On the other hand, stenosing lesions or neoplasias occupying ≥ 50% of the intestinal lumen were mostly identified during surgery (15 of 15 and 36 of 37 respectively, p = 0.0001, X2) without the need for a tattoo. Overall, the identification of neoplasms according to established criteria was 98%. Conclusion: These results suggest that it is possible to establish endoscopic criteria that allow a successful selective tattooing during diagnostic endoscopy (AU)


Assuntos
Humanos , Tatuagem , Neoplasias Colorretais/cirurgia , Laparoscopia , Endoscopia , Cuidados Pré-Operatórios/métodos
19.
Rev Esp Enferm Dig ; 110(1): 25-29, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29106287

RESUMO

BACKGROUND AND AIM: Preoperative endoscopic tattooing is an effective procedure to identify small intraoperative neoplasms. However, there are no defined criteria with regard to the indications for endoscopic tattooing of these lesions at the time of diagnosis. The aim of this study was to establish endoscopic criteria that allow the selection of patients who will need a tattoo during the diagnostic colonoscopy. METHODS: An ambispective study of patients undergoing laparoscopy due to a colorectal neoplasia who underwent endoscopic tattooing during the period from 2007-2013 and 2016-2017. According to the endoscopic description of the neoplasms, the classification was polypoid lesions, neoplasms occupying < 50% or ≥ 50% of the intestinal lumen and stenosing neoplasias. RESULTS: Tattooing of the lesion was performed in 120 patients and the same lesions were identified during surgery in 114 (95%) cases. Most of the neoplasias described as polypoids and neoplasias that occupied < 50% of the intestinal lumen were not visualized during surgery and therefore required a tattoo (33 of 42 and 18 of 26 respectively, p = 0.0001, X2). On the other hand, stenosing lesions or neoplasias occupying ≥ 50% of the intestinal lumen were mostly identified during surgery (15 of 15 and 36 of 37 respectively, p = 0.0001, X2) without the need for a tattoo. Overall, the identification of neoplasms according to established criteria was 98%. CONCLUSION: These results suggest that it is possible to establish endoscopic criteria that allow a successful selective tattooing during diagnostic endoscopy.


Assuntos
Neoplasias Colorretais/cirurgia , Endoscopia Gastrointestinal/métodos , Laparoscopia/métodos , Tatuagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Colonoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
J Bone Miner Metab ; 36(4): 462-469, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28766134

RESUMO

Bone disease in long-term survivors after gastric cancer resection has received little research attention. This study aimed to investigate bone health after curative resection of gastric cancer and the consequences of high-dose vitamin D supplementation in patients with low levels of 25-(OH)-vitamin D. Disease-free patients at least 24 months after gastric cancer resection represented the study cohort. Serum markers of bone metabolism were assessed at baseline and at 3 and 12 months. Bone mineral density and presence of fractures were assessed by X-ray at baseline. Patients with 25-(OH)-vitamin D ≤30 ng/mL at baseline received 16,000 IU of vitamin D3 every 10 days during the 1-year follow-up. Forty patients were included in the study. Mean time from surgery was 48.9 (24-109) months. Vitamin D insufficiency and secondary hyperparathyroidism were observed in 38 and 20 patients, respectively. Densitometry showed osteoporosis in 14 women and seven men and prevalent fractures in 12 women and six men at baseline. After 3 months of vitamin D supplementation, 35 patients reached values of 25-(OH)-vitamin D over 30 ng/mL. After 12 months, 38 patients were in the normal range of 25-(OH)-vitamin D. At the same time, iPTH levels and markers of bone turnover (C-terminal cross-linked telopeptide of type-I collagen, serum concentrations of bone-specific alkaline phosphatase and osteocalcin) significantly decreased after vitamin D intervention. Oral administration of high doses of vitamin D is easily implemented and restored 25-(OH)-vitamin D and iPTH values, which are frequently disturbed after gastric cancer resection.


Assuntos
Osso e Ossos/patologia , Sobreviventes de Câncer , Suplementos Nutricionais , Neoplasias Gástricas/patologia , Vitamina D/administração & dosagem , Vitamina D/uso terapêutico , Idoso , Biomarcadores/sangue , Densidade Óssea , Remodelação Óssea , Osso e Ossos/metabolismo , Cálcio/metabolismo , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Fraturas Ósseas/sangue , Fraturas Ósseas/complicações , Fraturas Ósseas/tratamento farmacológico , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Hormônio Paratireóideo/sangue , Estudos Prospectivos , Neoplasias Gástricas/sangue , Vitamina D/sangue
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