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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.
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.

3.
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.

4.
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.

5.
Rev. nefrol. diál. traspl ; 39(1): 50-54, ene. 2019. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1007125

RESUMO

En México la enfermedad renal crónica en la población pediátrica es un grave problema de salud pública. Las alternativas terapéuticas en niños con enfermedad renal crónica (ERC) son la diálisis y el trasplante renal (TxR), siendo esta última, la mejor opción terapéutica actual en niños con estadios terminal de la función renal. El objetivo de este manuscrito, fue reportar nuestra experiencia en el tratamiento perioperatorio de pacientes pediátricos sometidos a trasplante renal en bloque. Paciente de sexo femenino, 12 años de edad, originaria de Veracruz, México. Portadora de ERC estadio IV de KDOQI, secundaria a glomerulopatía. Fue programada para TxR en bloque de donante cadavérico pediátrico; el que se realizó bajo anestesia general balanceada, con ventilación mecánica controlada, isquemia fría de 17 hs, isquemia caliente de 30 min y un tiempo quirúrgico de 5 hs y 10 min. El tiempo anestésico total, fue de 6 hs. La paciente fue trasladada a la Unidad de Terapia Intensiva Pediátrica, con adecuada aceptación del injerto renal. Durante los siguientes siete meses, el curso clínico ha sido satisfactorio, con estudios ecotomográficos renales normales. En esta paciente la glomerulonefritis, le ocasionó que debutara a muy corta edad con una enfermedad renal crónica con terapia sustitutiva de hemodiálisis. El trasplante renal en bloque realizado, fue exitoso debido al manejo multidisciplinario que participa en el programa de trasplante renal


In Mexico, chronic kidney disease is a major public health problem in pediatric patients. The therapeutic options for chronic kidney disease (CKD) in children are dialysis and kidney transplant (KT); the latter constitutes the current treatment of choice for children suffering from end-stage renal disease. The aim of this study was to describe our experience of perioperative treatment of pediatric patients undergoing en bloc kidney transplant. Female patient, 12 years old, from Veracruz, Mexico, suffering from stage 4 CKD according to KDOQI criteria, secondary to glomerulonephritis. An en bloc kidney transplantarion from a pediatric deceased donor was performed; balanced general anesthesia with mechanical ventilation was used. Cold ischemia time was 17 hours and warm ischemia time was 30 minutes. The surgery lasted 5 hours and 10 minutes and the total anesthesia time was 6 hours. The patient was taken to the pediatric intensive care unit and showed an adequate renal graft acceptance. During the following seven months the clinical course was satisfactory and kidney echotomography showed normal results. Glomerulonephritis made this patient undergo hemodialysis replacement therapy due to CKD at a very early age. The en bloc kidney transplantation performed was successful thanks to the multidisciplinary management involved in the Kidney Transplant Program


Assuntos
Humanos , Feminino , Transplante de Rim , Diálise Renal , Glomerulonefrite/complicações
6.
Int. j. morphol ; 36(4): 1485-1489, Dec. 2018. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-975726

RESUMO

La neoplasia papilar intracolecística (NPIC), es un tumor compuesto por células neoplásicas preinvasivas, que forman masas de hasta 1,0 cm, clínicamente detectables. El objetivo de este estudio fue reportar un caso de NPIC y revisar la evidencia existente. Se trata de un paciente sexo masculino, de 33 años de edad, asintomático, que en el curso de un examen de salud, se realiza una ecotomografía abdominal, en la que se verifica una lesión polipoide vesicular de 32 x 19 mm de diámetro. Se programa para colecistectomía electiva, la que se realizó por vía laparoscópica, cirugía que se pudo realizar sin inconvenientes. Una vez extirpado el espécimen, se fue a estudio histopatológico en el que tras un mapeo vesicular se concluye NPIC, colecistitis crónica inespecífica, colesterolosis y pólipos colesterínicos. El paciente ha evolucionado sin inconvenientes. Presentamos un caso de NPIC en un paciente joven, cuyo diagnóstico fue confirmado por anatomía patológica tras una colecistectomía electiva, descartándose la presencia de carcinoma invasivo y displasia de alto grado, por lo que el pronóstico es favorable.


Intracholecystic papillary neoplasm (ICPN) is a tumor composed of pre-invasive neoplastic cells, with up to 1.0 cm clinically detectable masses. The objective of this study was to report a case of NPIC and review the evidence in the literature. A 33-year-old asymptomatic male patient had an abdominal ultrasonography during a health examination, in which a vesicular polyp lesion of 32 x 19 mm in diameter was verified. Thepatient was subsequently scheduled for elective cholecystectomy, which was performed laparoscopically and the surgery was uneventful. Once removed, the specimen was studied histopathologically and after performing vesicular mapping, we determined an ICPN, chronic non-specific cholecystitis, cholesteroliasis and cholesteric polyps. The patient has evolved without reported problems. We present a case of ICPN in a young patient, whose diagnosis was confirmed by pathological anatomy after an elective cholecystectomy, ruling out the presence of invasive carcinoma and high-grade dysplasia, with a favorable prognosis.


Assuntos
Humanos , Masculino , Adulto , Adenocarcinoma Papilar/patologia , Neoplasias da Vesícula Biliar/patologia , Pólipos/patologia , Adenocarcinoma Papilar/cirurgia , Colecistectomia Laparoscópica , Neoplasias da Vesícula Biliar/cirurgia
7.
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
8.
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
9.
Int. j. morphol ; 36(2): 743-749, jun. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-954180

RESUMO

Research in diagnostic accuracy studies (DAS) is a rapidly developing area in medicine, but there are only three instruments used in this scenario. The aim of this study was to design and validate a scale to determine methodological quality (MQ) of DAS. Scale validation study. A systematic literature review about the MQ of diagnostic accuracy studies was accomplished, and an expert panel generated a first draft (content validity) of the scale. An alphanumeric order was given and rated by six researchers (second draft) and a pilot study to optimise its use and understanding was performed (third draft). Two independent researchers applied the final scale (9 items/3 domains) to 110 articles from 13 journals with high, medium and low impact factors. Criterion validity was determined by contrasting MQ scores with the Oxford Centre for Evidence-Based Medicine levels of evidence. The construct validity of the extreme groups and high and low IF were estimated. The intraclass correlation coefficient was used to determine inter-observer reliability, and the cut-off point was calculated using a ROC curve. The best cut-off point was 24 points, with an under curve area of 93.4 %. The content validity rating was 80-100 % for all included items. Criterion and construct validity were statistically significant with p<0.05. Interobserver reliability was estimated in 0.96. A scale to measure the MQ of DAS was designed and validated.


La investigación en estudios de precisión diagnóstica (EPD) es un área de rápido desarrollo en medicina, sin embargo, en este escenario sólo existen tres instrumentos. El objetivo de este estudio fue diseñar y validar una escala para determinar calidad metodológica (CM) de EPD. Estudio de validación de escala. Se realizó una extensa revisión de la literatura sobre el CM de EPD y un panel de expertos generó un primer borrador (validez del contenido) de la escala. Se asignó un orden alfanumérico, el que evaluado por 6 investigadores independientes (2º borrador). Posteriormente, se realizó un estudio piloto para optimizar el uso y entendimiento (3º borrador). Dos investigadores independientes aplicaron la escala final (9 ítems / 3 dominios) a 110 artículos de 13 revistas con factores de impacto alto, medio y bajo. Se determinó validez de criterio contrastando puntuaciones de CM con niveles de evidencia del Oxford Centre for Evidence-Based Medicine. Se determinó validez de constructo de grupos extremos (factores de impacto alto y bajo). La confiabilidad interobservador se estimó aplicando coeficiente de correlación intraclase. Finalmente, se evaluaron puntos de corte construyendo curvas ROC. El mejor punto de corte fue 24 puntos (área bajo la curva de 93,4 %). La validez de contenido fue de 80-100 % para todos los elementos incluidos. Validez de criterio y constructo fueron estadísticamente significativos (p<0,05). La confiabilidad interobservador fue de 0,96. Se diseñó y validó una escala para medir el CM de EPD.


Assuntos
Controle de Qualidade , Medicina Baseada em Evidências , Técnicas e Procedimentos Diagnósticos , Reprodutibilidade dos Testes , Curva ROC
10.
Int. j. morphol ; 36(2): 762-767, jun. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-954183

RESUMO

Research in methodological quality (MQ) of prognosis studies (PS) is relevant in view of the important number of studies developed in this scenario. However, currently there are no instruments designed to measure MQ in PS, thus the aim of this study was to validate a scale to determine the MQ in PS. Scale validation study. Two independent researchers applied the scale (10 items/4 domains) in 119 articles found in 13 Journals of high, medium and low impact factor. Criterion validity was determined by contrasting MQ scores with Oxford Centre for Evidence-Based Medicine levels of evidence. Construct validity of extreme groups and high and low impact factors were estimated. Intraclass correlation coefficient was used to determine interobserver reliability, and the cut-off point was calculated using a ROC curve. The best cut-off point was 33, with an under curve area of 82.6 %. Criterion and construct validity were statistically significant with (p<0.001). Interobserver reliability was 0.91 and a scale to measure the MQ in PS was validated.


El objetivo de este estudio fue validar una escala para determinar calidad metodológica (CM) de estudios de pronóstico (EP). Se realizó un estudio de validación de escalas. La escala, compuesta por 10 ítems y 4 dominios; se aplicó a 119 artículos de 13 revistas, de factores de impacto alto, medio y bajo; por dos investigadores independientes. La validez del criterio se determinó al contrastar las puntuaciones de CM de cada artículo con los niveles de evidencia del Centro de Medicina Basada en la Evidencia de Oxford de la revista en la cual fueron publicados. Se estimó la validez de constructo de grupos extremos (factores de impacto alto y bajo). Se utilizó el coeficiente de correlación intraclase para determinar la confiabilidad interobservador, y el punto de corte se calculó construyendo curvas ROC. El mejor punto de corte fue 33 puntos (área bajo la curva de 82,6 %). La validez de criterio y de constructo fueron estadísticamente significativas (p<0,001). La confiabilidad interobservador fue 0,91. Se validó una escala para medir CM en EP.


Assuntos
Prognóstico , Controle de Qualidade , Medicina Baseada em Evidências , Reprodutibilidade dos Testes , Curva ROC
11.
Int. j. morphol ; 36(1): 373-379, Mar. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-893237

RESUMO

SUMMARY: Ensuring quality in graduate teaching is a guarantee of the competitiveness demonstrated by institutions. The aim of this study was to determine the internal consistency and reliability of the Triple Jump (TJ) instrument applied to Master's and Doctorate students in Medical Sciences to assess compliance of goals. Reliability study conducted at Universidad de La Frontera, Temuco, Chile. TJ was applied by 3 evaluators who performed 2 evaluations, with structured assessment guidelines in three domains (cognitive, attitudinal and procedural), on a Likert scale with scores from 0 (not achieved) to 4 (achieved). The total point score was transformed into a final grade. The evaluated subjects were characterized, and internal consistency and interobserver reliability were determined. Fifty-one Health care professionals enrolled in Medical Sciences graduate programs at the Universidad de La Frontera between 2005-2016 (35 from the Master 's program and 16 from the Doctorate in Medical Sciences). In study subjects had a median age of 29 years, 6 years of professional experience and 3 years as specialists. 66.7 % were male. The internal consistency of the responses to the assessment was characterized by a Cronbach's between 0.734 and 0.938. Interobserver reliability of the instrument had values between 0.86 and 1.0. The levels of internal consistency and reliability were higher than previously reported; therefore, the test is reliable and exhibits solid internal consistency.


RESUMEN: Garantizar la calidad en la enseñanza de posgrado es una garantía de la competitividad demostrada por las instituciones. El objetivo de este estudio fue determinar la consistencia interna y confiabilidad interobservador del instrumento salto triple (ST), aplicado a estudiantes de Magíster y Doctorado en Ciencias Médicas, para evaluar cumplimiento de objetivos de aprendizaje. Estudio de confiabilidad realizado en la Universidad de La Frontera, Temuco, Chile. El ST, fue aplicado por 3 evaluadores que realizaron 2 evaluaciones, utilizando guías de evaluación estructuradas en tres dimensiones (cognitivo, actitudinal y de procedimiento); en una escala tipo Likert con puntajes de 0 (objetivo no logrado) a 4 (objetivo plenamente logrado). El puntaje total se transformó posteriormente en una calificación final. Se caracterizó a los sujetos evaluados y se determinó consistencia interna y confiabilidad interobservador. Para ello, se enrolaron 51 profesionales de la salud matriculados en los programas de postgrado en Ciencias Médicas de la Universidad de La Frontera entre 2005 y 2016 (35 del programa de Magíster y 16 del Doctorado en Ciencias Médicas). Los sujetos a estudio, tenían una mediana de edad de 29 años, 66,7 % eran hombres, tenían 6 años de experiencia profesional y 3 años como especialistas. La consistencia interna de las respuestas a la evaluación se caracterizó por un a de Cronbach entre 0,734 y 0,938. La confiabilidad interobservador del instrumento tenía valores entre 0,86 y 1,0. Los niveles de consistencia interna y confiabilidad fueron más altos que los reportados previamente; por ende, nos parece que esta forma de evaluar objetivos en este tipo de estudiantes, tiene una consistencia interna sólida y es confiable.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Educação de Pós-Graduação em Medicina , Avaliação Educacional/métodos , Variações Dependentes do Observador , Aprendizagem Baseada em Problemas , Reprodutibilidade dos Testes
12.
Rev. chil. infectol ; 35(6): 680-688, 2018. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-990851

RESUMO

Resumen En investigación, la confiabilidad (precisión, consistencia y reproducibilidad), corresponde a una propiedad psicométrica que dice relación con la ausencia de error de la medición; o del grado de consistencia y estabilidad de las puntuaciones obtenidas a lo largo de sucesivos procesos de medición con un mismo instrumento. Por ello, es esperable que, a mayor variabilidad de resultados, menor sea la precisión del instrumento de medición utilizado, concepto que aplica desde el laboratorio a la práctica clínica. La reproducibilidad se determina aplicando el coeficiente de confiabilidad, que es la correlación entre las puntuaciones obtenidas por los sujetos, en dos formas paralelas de una prueba (porque se supone que miden lo mismo). Por ello, asumiendo que midan lo mismo, las puntuaciones de los sujetos en estudio deberían ser iguales en ambas aplicaciones. De este modo, cuando la correlación es 1, la confiabilidad, precisión o reproducibilidad es máxima; y mientras más cercana a 0 es peor. La precisión en las mediciones está influenciada por el que mide (observador), por aquello con lo que se mide (instrumento de medición), y por lo que es medido (lo observado). Por ende, se ha de tomar en cuenta la variabilidad de cada uno de estos componentes al momento de planificar la medición de la variable en estudio; de tal modo de reducir al máximo los sesgos de medición. Así, las formas más comunes de determinar confiabilidad son: modelos de formas paralelas, test-retest y de dos mitades. Este manuscrito se centra en los conceptos de medición y las diversas técnicas estadísticas utilizadas para ello, como paso previo a la aplicación en la clínica. Por ello, el objetivo de este manuscrito es generar un documento de estudio y consulta relacionado con la confiabilidad, reproducibilidad o precisión del proceso de medición.


Reliability (accuracy, consistency and reproducibility) is a psychometric property, which is related to the absence of measurement error, or, to the degree of consistency and stability of the scores obtained through successive measurement processes with the same instrument. Thus a greater variability of results will lower the accuracy or reliability of instrument used, fact that is transverse from the laboratory to the clinical practice. It is determined by applying the reliability coefficient, which is the correlation between the scores obtained by the subjects in two parallel forms of a test. Assuming that the two forms of the test are parallel (measure the same), the scores of the subjects under study should be the same in both applications. In this way, when the correlation is 1, the reliability or precision is maximum. On the other hand, reliability could be influenced by the observer (the one that measures), the measuring instrument (by that with which it is measured), and by the observed (by what is measured). Therefore, the variability of each of these components must be taken into account when planning the measurement of the variable under study, in such a way to reduce measurement biases as much as possible. The most common ways to determine reliability are the models of parallel forms, test-retest and two halves. This manuscript focuses on the concepts of measurement and the various statistical techniques used for this, as a step prior to application in the clinic. Therefore, the aim of this manuscript is to generate a consultation document related to the reliability or reproducibility of the measurement process.

13.
Rev Chilena Infectol ; 35(6): 680-688, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-31095189

RESUMO

Reliability (accuracy, consistency and reproducibility) is a psychometric property, which is related to the absence of measurement error, or, to the degree of consistency and stability of the scores obtained through successive measurement processes with the same instrument. Thus a greater variability of results will lower the accuracy or reliability of instrument used, fact that is transverse from the laboratory to the clinical practice. It is determined by applying the reliability coefficient, which is the correlation between the scores obtained by the subjects in two parallel forms of a test. Assuming that the two forms of the test are parallel (measure the same), the scores of the subjects under study should be the same in both applications. In this way, when the correlation is 1, the reliability or precision is maximum. On the other hand, reliability could be influenced by the observer (the one that measures), the measuring instrument (by that with which it is measured), and by the observed (by what is measured). Therefore, the variability of each of these components must be taken into account when planning the measurement of the variable under study, in such a way to reduce measurement biases as much as possible. The most common ways to determine reliability are the models of parallel forms, test-retest and two halves. This manuscript focuses on the concepts of measurement and the various statistical techniques used for this, as a step prior to application in the clinic. Therefore, the aim of this manuscript is to generate a consultation document related to the reliability or reproducibility of the measurement process.


Assuntos
Pesquisa Biomédica/normas , Análise de Dados , Confiabilidade dos Dados , Humanos , Modelos Teóricos , Variações Dependentes do Observador , Reprodutibilidade dos Testes
14.
Int. j. morphol ; 35(4): 1525-1539, Dec. 2017. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-893165

RESUMO

RESUMEN: El hígado es un órgano sólido, de gran relevancia para la fisiología. Es asiento potencial de lesiones tumorales quísticas y sólidas; benignas y malignas (primarias y secundarias); razón por la cual, conocer su anatomía radiológica y quirúrgica es muy relevante. Los antecedentes históricos comienzan con Berta en 1716, quien fue el primero en realizar una resección hepática; en 1888, Lagenbuch fue el primero el realizar una resección hepática programada. En 1889, Keen realizó la primera lobectomía hepática izquierda, seguido de Webde, en 1910, quien ejecutó la primera lobectomía hepática derecha. Más tarde, Couinaud, en 1957, realizó ua descripción completa de la anatomía segmentaria del hígado, dando una mejor comprensión quirúrgica de la morfología hepática, para su abordaje en distintas patologías. Un hito fundamental en el desarrollo del estudio del hígado, fue el establecimiento de la "Clasificación de Brisbane", por parte del Comité Científico de la Asociación Internacional Hepatobilio-Pancreática, poniendo fin a la confusión terminológica establecida entre los términos franceses y anglosajones. Y desde el ámbito anatómico, se destaca la aparición de Terminologia Anatomica, por parte del Programa Federativo Internacional de Terminologia Anatomica (FIPAT) dependiente de la Federación Internacional de Asociaciones de Anatomistas (IFAA), quienes dentro de la misma, establecieron los términos anatómicos correspondientes al hígado. El objetivo de este manuscrito, es entregar un resumen esquemático de la anatomía quirúrgica y radiológica del hígado, que fundamentan las diferentes opciones de resecciones hepáticas.


SUMMARY: The liver is a solid organ which is most relevant for physiology. It is a potential site for cystic and solid (primary and secondary) benign and malignant tumor lesions. Therefore, thorough knowledge of its radiological and surgical anatomy is important. Historical background of liver resections began with Berta in 1716, who was the first to carry out the procedure. In 1888, Lagenbuch performed the first programmed liver resection and subsequently, in 1889 Keen performed the very first left hepatic lobectomy, followed by Webde in 1910, who performed the first right hepatic lobectomy. Later in 1957, Couinaud recorded a complete description of the segmental anatomy of the liver, providing a greater surgical understanding of the hepatic morphology, for approach in various pathologies. A fundamental milestone in the development of the liver study was the establishment of the "Brisbane Classification" by the Scientific Committee of the International Hepatobiliary-Pancreatic Association, which ended previous confusion between the French and Anglo-Saxon terminology. Furthermore, within the scope of anatomy, the introduction of Terminología Anatómica, by the International Federative Program of Anatomical Terminology (FIPAT) which depends on the International Federation of Associations of Anatomists ( IFAA), established the anatomical terms for the liver The objective of this manuscript is to provide a schematic summary of the surgical and radiological anatomy of the liver, on which the different options for liver resections are based.


Assuntos
Humanos , Hepatectomia , Fígado/anatomia & histologia , Fígado/diagnóstico por imagem , Fígado/cirurgia
15.
Cir. Esp. (Ed. impr.) ; 95(10): 566-576, dic. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-169987

RESUMO

Las publicaciones relacionadas con morbilidad postoperatoria en hidatidosis hepática son escasas y de resultados disímiles. El objetivo de este estudio fue determinar factores de riesgo y protectores de morbilidad postoperatoria en pacientes intervenidos por hidatidosis hepática. Se realizó una revisión global de la evidencia, basada en revisiones sistemáticas, ensayos clínicos y estudios observacionales, obtenidos de Trip Database, BVS, SciELO, Cochrane Central Register of Controlled Trials, WoS, MEDLINE, EMBASE, SCOPUS, EBSCOhost, IBECS, ePORTUGUESe, LILACS y WHOLIS. Se identificaron 1.087 artículos relacionados y 69 cumplían criterios de selección (2 revisiones sistemáticas, 3 ensayos clínicos y 64 estudios observacionales). Se identificaron como factores de riesgo la edad, el antecedente de cirugía previa por hidatidosis hepática, la localización centro hepática, la existencia de comunicaciones biliares y complicaciones evolutivas del quiste y como protectores las técnicas quirúrgicas radicales. Se identificaron factores de riesgo y protectores; sin embargo, los estudios son escasos y de calidad moderada a baja (AU)


There are few publications related to postoperative morbidity in hepatic hydatidosis and these have mixed results. The aim of this study was to determine risk and protective factors of postoperative morbidity in patients operated on for hepatic hydatidosis. A comprehensive review was made of the evidence, based on systematic reviews, clinical analyses and observational studies, obtained from the Trip Database, BVS, SciELO, Cochrane Central Register of Controlled Trials, WoS, MEDLINE, EMBASE, SCOPUS, EBSCOhost, IBECS, ePORTUGUESe, LILACS and WHOLIS. 1,087 related articles were identified; 69 fulfilled the selection criteria (2 systematic reviews, 3 clinical trials and 64 observational studies). Age, history of previous surgery for hepatic hydatidosis, location in the hepatic center, existence of biliary communications and evolutionary complications of the cyst were identified as risk factors, and radical surgical techniques as protective factors. Risk and protective factors were identified; however, the studies are few and the quality moderate to low (AU)


Assuntos
Humanos , Equinococose Hepática/cirurgia , Echinococcus/patogenicidade , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco , Prática Clínica Baseada em Evidências , Indicadores de Morbimortalidade
16.
Cir Esp ; 95(10): 566-576, 2017 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29033069

RESUMO

There are few publications related to postoperative morbidity in hepatic hydatidosis and these have mixed results. The aim of this study was to determine risk and protective factors of postoperative morbidity in patients operated on for hepatic hydatidosis. A comprehensive review was made of the evidence, based on systematic reviews, clinical analyses and observational studies, obtained from the Trip Database, BVS, SciELO, Cochrane Central Register of Controlled Trials, WoS, MEDLINE, EMBASE, SCOPUS, EBSCOhost, IBECS, ePORTUGUESe, LILACS and WHOLIS. 1,087 related articles were identified; 69 fulfilled the selection criteria (2 systematic reviews, 3 clinical trials and 64 observational studies). Age, history of previous surgery for hepatic hydatidosis, location in the hepatic center, existence of biliary communications and evolutionary complications of the cyst were identified as risk factors, and radical surgical techniques as protective factors. Risk and protective factors were identified; however, the studies are few and the quality moderate to low.


Assuntos
Equinococose Hepática/cirurgia , Complicações Pós-Operatórias/epidemiologia , Humanos , Morbidade , Fatores de Risco
17.
Int. j. morphol ; 35(3): 1031-1036, Sept. 2017. ilus
Artigo em Espanhol | LILACS | ID: biblio-893089

RESUMO

La metodología de la investigación científica constituye un conjunto de métodos, leyes y procedimientos que orientan los esfuerzos de la investigación hacia la solución de los problemas científicos con un máximo de eficiencia. El método se basa en el desarrollo de distintas etapas que conducen al establecimiento de una conclusión válida sustentada en la verificación de una hipótesis y supuestos de la investigación realizada. Así, la investigación científica no está exenta a la ocurrencia de errores, los cuales pueden ser originados durante el planteamiento del problema de estudio, el diseño de investigación, el establecimiento de los criterios de elegibilidad, la estimación del tamaño de la muestra, el proceso de medición, durante el seguimiento de los sujetos o debido a la falta de discusión de las limitaciones del estudio. En este contexto, una de las estrategias que permite reducir los potenciales errores en la conducción de un estudio radica en el adecuado desarrollo de un proyecto o protocolo de investigación, el cual, debe ser elaborado en base a un problema de investigación, diseño y método de medición, otorgándole al investigador una serie de ventajas asociadas con la planificación documentada del proceso, reproducibilidad de los protocolos experimentales y facilitación del proceso de divulgación de los resultados. En la presente revisión se discuten los aspectos esenciales referentes al método científico en investigación clínica y se analizan los principales problemas, beneficios y elementos asociados con la factibilidad de desarrollar un protocolo de investigación.


Research methodology is a set of methods, laws and procedures that guide research efforts towards solving scientific problems with maximum efficiency. The method is based on the development of different stages that lead to the establishment of a valid conclusion supported on the verification of a hypothesis and assumptions of the performed research. Thus, scientific research is not exempt from the errors, which can originate during the study issue, research design, establishment of eligibility criteria, sample size estimation, measurement process, during follow-up or due to lack of discussion of study limitations. In this context, one of the strategies to reduce potential errors in conducting a study lies in the proper development of a research project or protocol, which must be elaborated based on a research, design and method problem. This provides the researcher with a number of advantages associated with documented process planning, reproducibility of experimental protocols and facilitation of the results publication. This review aims to discuss the essential aspects regarding the scientific method in clinical research and to analyze the main problems, benefits and elements associated with the feasibility of developing a research protocol.


Assuntos
Pesquisa Biomédica/métodos , Pesquisa Biomédica/normas , Projetos de Pesquisa Epidemiológica , Projetos de Pesquisa
18.
Int. j. morphol ; 35(3): 1083-1090, Sept. 2017. ilus
Artigo em Espanhol | LILACS | ID: biblio-893097

RESUMO

La disfunción hepática postoperatoria del remanente hepático que ocurre en pacientes sometidos a grandes resecciones hepáticas, es un problema complejo y temido, dado su pronóstico incierto. La asociación de partición hepática y ligadura portal para hepatectomía por etapas (ALPPS), es un enfoque novedoso para pacientes portadores de enfermedad hepática oncológica que anteriormente eran considerados "no resecables". El procedimiento se realiza en dos etapas. La primera, comprende la ligadura de la rama derecha de la vena porta. Luego, se realiza la transección del parénquima hepático; incluyendo o no, la sección y ligadura de la vena hepática media. A continuación se empaqueta el hígado tumoral en una bolsa de polietileno y el abdomen es cerrado. La segunda etapa, se realiza 7 a 15 días después. Una vez abierto el abdomen, se retira la bolsa de polietileno; se ligan y seccionan la arteria, el conducto biliar y la vena hepática derechos; y se elimina el hígado tumoral. Pueden instalarse drenes y se procede al cierre de la laparotomía. La técnica ALPPS puede permitir entonces, la resección curativa de hígados tumorales en pacientes con lesiones considerados previamente como no resecables. El objetivo de este artículo fue describir las indicaciones y aspectos técnicos del ALPPS a propósito del primer caso realizado en nuestra ciudad, en una paciente de 47 años con un cáncer de vesícula biliar avanzado y metástasis bilobares.


Postoperative hepatic malfunction subsequent to insufficiency of hepatic remnant is a complex and dire problem in patients subjected to large hepatic resections. The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), is a novel approach for oncology patients whose hepatic tumors were previously considered non-resectable. The technique is performed in two phases. The first one comprises the ligation of the right portal vein branch. Subsequently, a parenchymal transection is performed, including or not, the middle hepatic vein. A plastic bag is employed to cover the tumoral liver, and the abdomen is closed. The second one is performed at 7 to 15 days interval. After laparotomy, the plastic bag is removed. The right artery, bile duct and hepatic vein are sectioned and the tumoral liver is removed. Drain was placed at the resection surface, and the abdomen is closed. ALPPS can enable curative resection of hepatic metastasis in patients with tumors previously considered non-resectable. The aim of this manuscript was to describe the indications and technical aspects of ALPPS in relation to the first case carried out in our city, in a 47-year-old woman with advanced gallbladder cancer with bilobar metastases.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Hepatectomia/métodos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Ligadura/métodos , Veia Porta/cirurgia
19.
Ann Hepatol ; 16(4): 599-606, 2017 Jul-Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28611263

RESUMO

INTRODUCTION: Thoracic involvement (TIHE) is one of the evolutionary complications of hepatic echinococcosis (HE). AIM: The aim of this study was to describe the clinical characteristics and postoperative morbidity (POM) of a series of patients with TIHE treated surgically. MATERIAL AND METHODS: Series of cases of patients treated for TIHE between 2000 and 2014 in the Hospital Regional and Clínica Mayor in Temuco, Chile, with a minimum 12-month follow-up. The outcome variable was "development of POM". Descriptive statistics were used. RESULTS: The series was composed of 37 patients with a mean age of 53.2 ± 47.4 years (51.4% female). Mean cyst diameter was 19.4 ± 15.5 cm, and 75.7% of the lesions were located in the right hepatic lobe. The most frequent surgical technique used for the cyst was subtotal pericystectomy (56.8%); the residual cavity was treated by capitonnage (27.0%) or omentoplasty (21.6%), and a phrenoplasty with or without prosthetic material was performed for the TIHE. Mean hospital stay was 6.0 ± 5.7 days and follow-up was 61.4 ± 79.9 months; a mortality rate of 2.7% (one patient) and a POM of 24.3% (9 patients) were verified. CONCLUSION: TIHE is an uncommon evolutionary complication of HE associated with significant POM rate.


Assuntos
Equinococose Hepática/cirurgia , Equinococose Pulmonar/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Chile , Equinococose Hepática/diagnóstico , Equinococose Hepática/mortalidade , Equinococose Hepática/parasitologia , Equinococose Pulmonar/diagnóstico , Equinococose Pulmonar/mortalidade , Equinococose Pulmonar/parasitologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
Int. j. morphol ; 35(2): 556-563, June 2017. ilus
Artigo em Inglês | LILACS | ID: biblio-893021

RESUMO

Hepatic echinococcosis (HE) is a prevalent health problem, and there is limited published information regarding HE surgery. On the other hand, postoperative morbidity (POM) has not varied significantly. The aim of this study was to describe early and late outcomes in terms of POM of a series of patients with non-complicated liver hydatid cysts (NLHC) treated surgically. Prospective cohort. We included patients undergoing surgery for NLHC in the Hospital Regional and Clínica in Temuco, between 2000 and 2015. The main outcome variable was the development of early and late POM. Other variables of interest were hospital stay, mortality and recurrence. Surgical techniques used were total or subtotal pericystectomy and liver resection. Percentages, measures of central tendency and dispersion, and incidence were calculated. We studied 136 patients with a median age of 41 years and 60.3 % female The median ultrasound diameter of the cysts was 15.0 cm. The median surgical time was 95 minutes. The incidence of POM was 9.6 %, 92.3 % of whose cases were Grade I or II Dindo & Clavien. The aetiology was 5.9 % and 3.7 % medical complications of surgical complications. There was no mortality and with a median follow up of 115 months, recurrence was observed in one patient, representing an incidence of 0.7 %. POM was determined in a cohort of patients with NLHC throughout an extended follow-up period, and the incidence and gravity of POM is smaller and of lower gravity than those previously published.


Siendo una equinococosis hepática (EH) un problema de salud prevalente, la información publicada respecto a la cirugía de EH no es abundante. Por otro lado, la morbilidad postoperatoria (MPO) no ha variado de forma muy significativa. El objetivo de este estudio fue describir los resultados tempranos y tardíos en términos de MPO de una serie de pacientes con quistes hidatídicos hepáticos no complicados (QHHN) tratados quirúrgicamente. Estudio de cohorte prospectiva. Se incluyeron pacientes sometidos a cirugía para QHHN en el Hospital Regional y Clínica en Temuco, entre 2000 y 2015. La variable resultado principal fue desarrollo de MPO temprana y tardía. Otras variables de interés fueron estancia hospitalaria, mortalidad y recurrencia. Las técnicas quirúrgicas utilizadas fueron periquistectomía total o subtotal y resección hepática. Se calcularon porcentajes, medidas de tendencia central y dispersión, e incidencia. Se estudiaron 136 pacientes con una mediana de edad de 41 años; 60,3 % de los cuales son mujeres. La mediana del diámetro de los quistes y del tiempo quirúrgico fue de 15,0 cm y 95 min. Respectivamente. La incidencia de MPO fue 9,6 %, de los cuales 92,3 % fueron Grado I o II de Dindo y Clavien. La etiología fue: 5,9 % de complicaciones médicas y 3,7 % de complicaciones quirúrgicas. No hubo mortalidad; y con una mediana de seguimiento de 115 meses, se determinó una incidencia de recidiva de 0,7 % (1 paciente, en el período estudiado). Se describe la MPO de una cohorte de pacientes con QHHN. La morbilidad observada es inferior a la publicada y de bajo nivel de gravedad.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Equinococose Hepática/cirurgia , Tempo de Internação , Complicações Pós-Operatórias , Estudos Prospectivos , Recidiva , Resultado do Tratamento
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