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1.
Artigo em Inglês | MEDLINE | ID: mdl-31531756

RESUMO

To explore barriers to specialty substance abuse treatment programs among women with recent substance use disorders by race/ethnicity. Qualitative interviews were conducted with 28 women of White, Black, and Latino racial/ethnic descent who reported a substance use disorder in the past 5 years. Interviews were conducted by telephone and were audio-recorded. A codebook was developed using the Theory of Planned Behavior to code and identify barriers within the domains of attitudes, subjective norms, and perceived control toward specialty treatment. Frequencies for coded themes were then compared across all participants and by race/ethnicity. We identified several key differences in barriers to treatment by race/ethnicity. Attitudinal barriers were more pervasive among the narratives of Latinas relative to Black and White women. Latinas were more likely to report not needing treatment and that treatment would not be effective; Latinas were the only group to describe cultural barriers to treatment. Within the subjective norms domain, namely stigma and lack of support, were key barriers. Stigma was more pervasive among the narratives of Latinas and Black women than White women; Latinas were more likely to report a lack of social support for using treatment than both Black and White women. Findings provide deeper insight into barriers that may be contributing to racial/ethnic disparities in the use of substance abuse treatment among women.

2.
Subst Use Misuse ; 54(13): 2108-2116, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31232135

RESUMO

Background: Persons with substance use disorders (SUDs) who do not recognize their substance use as problematic are less likely to perceive needing treatment and less motivated to seek help. Factors that contribute to problem recognition among persons with SUDs are poorly understood. Objective: To explore in-depth factors that may explain why those who meet diagnostic criteria for SUDs do not perceive having a substance abuse problem. Methods: We recruited 54 participants with recent (i.e., past-5-year) SUD for qualitative interviews. Participants were recruited via online ads and screened for eligibility through an online survey. Interview questions focused on participants' alcohol and drug use behaviors, adverse consequences stemming from their substance use, past treatment use experiences, and barriers/reasons for not using specialty treatment. Interviews were thematically coded to identify prominent themes that may explain low problem recognition. Results: We identified two prominent themes that contributed to problem recognition: modifying substance use behaviors to avoid adverse consequences and stigma (i.e., "othering"). Participants who (1) reported adjusting their alcohol and drug use in ways that would not interfere with important life responsibilities, especially work-responsibilities; (2) described those with alcohol and drug problems negatively; and (3) associated treatment with personal defeat were less likely to perceive having a SUD. Conclusions/Importance: These findings can be used to inform intervention strategies aimed at increasing problem recognition among persons with SUDs. Such strategies may facilitate motivation (i.e., desire for help and treatment readiness) to use and complete treatment, thereby reducing the unmet treatment gap among persons with SUDs.


Assuntos
Emoções , Motivação , Aceitação pelo Paciente de Cuidados de Saúde , Autoimagem , Estigma Social , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e Questionários
3.
Plant Biol (Stuttg) ; 21 Suppl 1: 84-94, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29444373

RESUMO

Temperate grasses, such as wheat, become compact plants with small thick leaves after exposure to low temperature. These responses are associated with cold hardiness, but their underlying mechanisms remain largely unknown. Here we analyse the effects of low temperature on leaf morpho-anatomical structure, cell wall composition and activity of extracellular peroxidases, which play key roles in cell elongation and cell wall thickening, in two wheat cultivars with contrasting cold-hardening ability. A combined microscopy and biochemical approach was applied to study actively growing leaves of winter (ProINTA-Pincén) and spring (Buck-Patacón) wheat developed under constant warm (25 °C) or cool (5 °C) temperature. Cold-grown plants had shorter leaves but longer inter-stomatal epidermal cells than warm-grown plants. They had thicker walls in metaxylem vessels and mestome sheath cells, paralleled with accumulation of wall components, predominantly hemicellulose. These effects were more pronounced in the winter cultivar (Pincén). Cold also induced a sharp decrease in apoplastic peroxidase activity within the leaf elongating zone of Pincén, and a three-fold increase in the distal mature zone of the leaf. This was consistent with the enhanced cell length and thicker cell walls in this cultivar at 5 °C. The different response to low temperature of apoplastic peroxidase activity and hemicellulose between leaf zones and cultivar types suggests they might play a central role in the development of cold-induced compact morphology and cold hardening. New insights are presented on the potential temperature-driven role of peroxidases and hemicellulose in cell wall dynamics of grasses.


Assuntos
Parede Celular/metabolismo , Temperatura Baixa , Peroxidase/metabolismo , Folhas de Planta/anatomia & histologia , Folhas de Planta/fisiologia , Triticum/anatomia & histologia , Triticum/fisiologia , Proteínas de Plantas/metabolismo , Polissacarídeos/metabolismo , Estações do Ano
5.
Epidemiol Infect ; 145(7): 1382-1391, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28166858

RESUMO

Mycobacterium avium sp. avium (MAA), M. avium sp. hominissuis (MAH), and M. avium sp. paratuberculosis (MAP) are the main members of the M. avium complex (MAC) causing diseases in several hosts. The aim of this study was to describe the genetic diversity of MAC isolated from different hosts. Twenty-six MAH and 61 MAP isolates were recovered from humans and cattle, respectively. GenoType CM® and IS1311-PCR were used to identify Mycobacterium species. The IS901-PCR was used to differentiate between MAH and MAA, while IS900-PCR was used to identify MAP. Genotyping was performed using a mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) scheme (loci: 292, X3, 25, 47, 3, 7, 10, 32) and patterns (INMV) were assigned according to the MAC-INMV database (http://mac-inmv.tours.inra.fr/). Twenty-two (22/26, 84·6%) MAH isolates were genotyped and 16 were grouped into the following, INMV 92, INMV 121, INMV 97, INMV 103, INMV 50, and INMV 40. The loci X3 and 25 showed the largest diversity (D: 0·5844), and the global discriminatory index (Hunter and Gaston discriminatory index, HGDI) was 0·9300. MAP (100%) isolates were grouped into INMV 1, INMV 2, INMV 11, INMV 8, and INMV 5. The HGDI was 0·6984 and loci 292 and 7 had the largest D (0·6980 and 0·5050). MAH presented a higher D when compared with MAP. The MIRU-VNTR was a useful tool to describe the genetic diversity of both MAH and MAP as well as to identify six new MAH patterns that were conveniently reported to the MAC-INMV database. It was also demonstrated that, in the geographical region studied, human MAC cases were produced by MAH as there was no MAA found among the human clinical samples.


Assuntos
Variação Genética , Genótipo , Complexo Mycobacterium avium/genética , Infecção por Mycobacterium avium-intracellulare/veterinária , Paratuberculose/epidemiologia , Tuberculose Bovina/epidemiologia , Animais , Argentina/epidemiologia , Bovinos , Humanos , Infecção por Mycobacterium avium-intracellulare/epidemiologia , Infecção por Mycobacterium avium-intracellulare/microbiologia , Paratuberculose/microbiologia , Filogenia , Reação em Cadeia da Polimerase/veterinária , Análise de Sequência de DNA/veterinária , Tuberculose Bovina/microbiologia
6.
Braz. j. microbiol ; 44(3): 897-899, July-Sept. 2013. ilus, tab
Artigo em Inglês | LILACS | ID: lil-699784

RESUMO

We here identified for the first time the presence of Mycobacterium avium paratuberculosis (MAP) sheep (S) strain in Argentina. IS900 polymerase chain reaction (PCR) was positive. The S strain was compared with MAP cattle (C) strains by using IS1311 PCR-restriction endonuclease analysis (PCR-REA), multiplex PCR and restriction fragment length polymorphism (RFLP) analysis.


Assuntos
Animais , Mycobacterium avium subsp. paratuberculosis/classificação , Mycobacterium avium subsp. paratuberculosis/isolamento & purificação , Paratuberculose/microbiologia , Doenças dos Ovinos/microbiologia , Argentina , Elementos de DNA Transponíveis , DNA Bacteriano/genética , Reação em Cadeia da Polimerase Multiplex , Mycobacterium avium subsp. paratuberculosis/genética , Polimorfismo de Fragmento de Restrição , Paratuberculose/diagnóstico , Ovinos , Doenças dos Ovinos/diagnóstico
7.
Braz J Microbiol ; 44(3): 897-9, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24516458

RESUMO

We here identified for the first time the presence of Mycobacterium avium paratuberculosis (MAP) sheep (S) strain in Argentina. IS900 polymerase chain reaction (PCR) was positive. The S strain was compared with MAP cattle (C) strains by using IS1311 PCR-restriction endonuclease analysis (PCR-REA), multiplex PCR and restriction fragment length polymorphism (RFLP) analysis.


Assuntos
Mycobacterium avium subsp. paratuberculosis/classificação , Mycobacterium avium subsp. paratuberculosis/isolamento & purificação , Paratuberculose/microbiologia , Doenças dos Ovinos/microbiologia , Animais , Argentina , Elementos de DNA Transponíveis , DNA Bacteriano/genética , Reação em Cadeia da Polimerase Multiplex , Mycobacterium avium subsp. paratuberculosis/genética , Paratuberculose/diagnóstico , Polimorfismo de Fragmento de Restrição , Ovinos , Doenças dos Ovinos/diagnóstico
8.
Plant Biol (Stuttg) ; 15(1): 60-6, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23043732

RESUMO

Several apoplastic enzymes have been implicated in the control of elongation growth of plant cells. Among them, peroxidases contribute to both loosening and stiffening of the cell wall. They appear to be regulated by various mechanisms, including the action of extracellular inhibitors. To obtain evidence of the role of the enzyme-inhibitor interaction during leaf development, the intercellular washing fluids from Helianthus annuus leaves of different ages were isolated using standard methods of vacuum infiltration and centrifugation. Peroxidase activities, assessed using tetramethylbenzidine as substrate, increased during leaf development, reaching a maximum value after the leaves were fully expanded. An inhibitor, chemically characterised as ascorbate, co-localised with the enzyme in the apoplast. Moreover, there was a strong negative correlation between the action of peroxidase and the micromolar concentration of ascorbate in the apoplastic fluid. The results show that in growing leaves, the in planta ascorbate concentration is able to restrain peroxidase enzyme activity. Then, at the time of growth cessation, the loss of extracellular ascorbate relieves the inhibition on this enzyme that contributes to wall fixation.


Assuntos
Ácido Ascórbico/farmacologia , Helianthus/efeitos dos fármacos , Peroxidase/metabolismo , Ácido Ascórbico/análise , Ácido Ascórbico/metabolismo , Parede Celular/metabolismo , Helianthus/enzimologia , Helianthus/crescimento & desenvolvimento , Isoenzimas , Peroxidase/antagonistas & inibidores , Folhas de Planta/efeitos dos fármacos , Folhas de Planta/enzimologia , Folhas de Planta/crescimento & desenvolvimento , Proteínas de Plantas/antagonistas & inibidores , Proteínas de Plantas/metabolismo , Fatores de Tempo
9.
Rev. chil. cir ; 64(5): 452-456, oct. 2012. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-651873

RESUMO

Introduction: Preoperative T staging of rectal cancer is essential for an adequate treatment strategy. Endoscopic ultrasonography (EUS) is one of the available modalities. The reported accuracy of this technique for T staging is variable. This inconsistency might be due to neoadyuvancy, and its downstaging properties. Aim: Determine the accuracy of rectal EUS for T staging of middle and lower rectal tumors in patients not treated with neoadyuvant chemo-radiotherapy. Materials and Methods: Clinical records of all consecutive patients evaluated by rectal EUS between years 2001-2009 in the Catholic University Clinical Hospital were accessed. Of 2.120 patients, 294 had the exam performed for middle or lower rectal cancer. Those who did not receive neoadyuvant chemo-radiation and whose histopathology was available were analyzed. Result: Data was obtained for 69 patients. The overall accuracy of EUS for T staging was 85 percent. For T1 tumors, the sensibility, specificity and accuracy were 82 percent, 96 percent and 94 percent respectively. For T2 tumors the sensibility, specificity and accuracy were 72 percent, 83 percent and 78 respectively. For T3 tumors the sensibility, specificity and accuracy were 82 percent, 83 percent and 83 percent respectively. Conclusion: Rectal EUS continues to be a valuable staging procedure for tumor depth invasion, with an overall accuracy of 85 percent.


Introducción: La estadificación tumoral (T) preoperatoria es esencial para el tratamiento del cáncer de recto. La endosonografía rectal (ER) es una de las modalidades disponibles. La exactitud de esta técnica para la estadificación tumoral es variable en la literatura, y se sospecha que esta inconsistencia se debe a la neoadyuvancia, por el descenso de estadio que esta produce. Objetivo: Analizar la exactitud de la endosonografía rectal para la estadificación tumoral en pacientes con cáncer de recto medio o inferior que no hayan recibido neoadyuvancia. Material y Método: Se estudió a los pacientes sometidos a endosonografía rectal entre los años 2001-2009 en el Hospital Clínico de la Pontificia Universidad Católica de Chile. De un total de 2.120 pacientes, 294 fueron evaluados por cáncer de recto en tercio medio o inferior. Se analizó el examen de aquellos que no recibieron quimio-radioterapia preoperatoria y se encontraba disponible la anatomía patológica para su comparación. Resultados: Se obtuvo información de 69 pacientes. La exactitud global del examen para la determinación del T fue 85 por ciento. Para la determinación de T1 los valores de sensibilidad, especificidad y exactitud fueron 82 por ciento, 96 por ciento y 94 por ciento respectivamente. Para T2 los valores de sensibilidad, especificad y exactitud fueron 72 por ciento, 83 por ciento y 78 por ciento respectivamente. Para T3 los valores de sensibilidad, especificidad y exactitud fueron 82 por ciento, 83 por ciento y 83 por ciento respectivamente. Conclusión: La endosonografía rectal sigue siendo un valioso examen para la determinación de la profundidad de invasión tumoral en cáncer de recto con una exactitud global de 85 por ciento.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Endossonografia/métodos , Neoplasias Retais/patologia , Neoplasias Retais , Estadiamento de Neoplasias/métodos , Invasividade Neoplásica , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
10.
Rev. chil. cir ; 64(4): 368-372, ago. 2012. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-646966

RESUMO

Background: The usual surgical management of acute diverticulitis is Hartmann operation that is associated with high rates of complications and mortality. Recently, less invasive procedures, that avoid ostomies have been proposed as treatment, Alm: To analyze the results of laparoscopic peritoneal lavage in patients with acute diverticulitis. Material and Methods: Prospective analysis of seven patients age 25 to 61 years (four males) admitted for a first episode of acute diverticulitis classified as Hinchey II or III, in whom a percutaneous drainage of collections was not possible. All were subjected to a laparoscopic peritoneal lavage and debridement. Results: The mean body mass index of patients was 30.3 kg/m². Operative time was 55 +/- 28 min and there was no need for ostomies or conversion to open surgery. Two patients had complications. One required a percutaneous drainage of a collection and other required an open surgical procedure for peritoneal lavage. Patients stayed with nil per os for 2 +/- 1 days, required antimicrobials for 14 +/- 4 days and stayed in the hospital for 8 +/- 4 days. Conclusions: Laparoscopic peritoneal lavage is a good alternative surgical procedure for the treatment of acute diverticulitis.


Introducción: Tradicionalmente, el manejo quirúrgico de la diverticulitis aguda complicada (DAC) ha sido la operación de Hartmann. Sin embargo, ésta presenta tasas de morbilidad de 59 por ciento y mortalidad hasta de 12 por ciento. Han aparecido algunos procedimientos no resectivos con algunas ventajas operatorias y que evitarían la confección de una ostomía. Objetivo: Analizar resultados quirúrgicos de una serie de pacientes con DAC sometidos a lavado peritoneal sin resección por vía laparoscópica (LPL). Pacientes y Métodos: Serie de registro prospectiva de siete pacientes, que ingresaron con diagnóstico de DAC Hinchey II en que no fue posible el drenaje percutáneo de las colecciones y pacientes categorizados como Hinchey III, operados entre octubre de 2008 y noviembre de 2010. Resultados: Cuatro pacientes eran de sexo masculino. La edad media fue de 49 años, con un IMC de 30,3 kg/m². Todos los pacientes ingresaron con su primer episodio de DA. El tiempo operatorio fue de 55 +/- 28 minutos. No hubo necesidad de ostomía ni conversión. Dos pacientes presentaron complicaciones que requirieron de nuevos procedimientos durante su estadía. El tiempo de reposo digestivo fue de 2 +/- 1 días y la duración del esquema antibiótico fue de 14 +/- 4 días. La estadía hospitalaria fue de 8 +/- 4 días. Conclusiones: El LPL representa una alternativa al manejo quirúrgico tradicional. Las ventajas teóricas son bajas tasas de morbimortalidad, estadía hospitalaria más corta y sin la eventual necesidad teórica de una ostomía. Esta técnica requiere ser validada en el contexto de un estudio aleatorizado con claridad en criterios de inclusión y exclusión.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Diverticulite/cirurgia , Drenagem/métodos , Laparoscopia/métodos , Lavagem Peritoneal/métodos , Doença Aguda , Diverticulite/complicações , Tempo de Internação , Complicações Pós-Operatórias , Estudos Prospectivos
12.
Ortod. esp. (Ed. impr.) ; 51(4): 180-190, oct.-dic. 2011. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-121696

RESUMO

Introducción: El objetivo de este estudio cefalométrico es analizarla morfología esquelética y dentaria de una muestra de adultos con clase III esquelética. Método: Se han seleccionado dos grupos. El grupo estudio está formado por 89 adultos con clase III y el grupo control por 69 adultos con oclusión ideal. Se han obtenido diferentes medidas lineales y angulares sobre la telerradiografía lateral de cráneo de estos sujetos. Resultados: Los resultados indican diferencias estadísticamente significativas a nivel esquelético y oclusal en el grupo de clase III en comparación con el grupo control (AU)


Introduction: The aim of this cephalometric study is to analys emorphologic skeletal and occlusal characteristics in a sample of adult Class III malocclusion. Methods: For this purpose, two groups were selected: the study group of 89 adult skeletal Class III subjects and the control group of 69 adult subjects with excellent occlussion. Different angular and linear parameters were obtained with the lateral cephalograms of these subjects. Results: Statistical differences were found between both groups in the maxilla, the mandible and the occlusion (AU)


Assuntos
Humanos , Má Oclusão de Angle Classe III/diagnóstico , Cefalometria/métodos , Cabeça/anatomia & histologia , Estudos de Casos e Controles , Anormalidades Dentárias/diagnóstico
13.
Rev. chil. cir ; 63(5): 479-484, oct. 2011. tab
Artigo em Espanhol | LILACS | ID: lil-602998

RESUMO

The development of laparoscopic colorectal surgery began 20 years ago; however it took several years before gaining its acceptance by the international surgical community. The first report in Chile was published in 1995. However, were necessary many years, until the middle of this decade, to know the first prospective series experiences. Out of these reports, no reliable data exist regarding the development of laparoscopic colorectal surgery in Chile, related to the number of centers performing laparoscopic colorectal surgery or the number of procedures performed. For record these data, a standardized questionnaire was send to colorectal chairmans of all hospitals that had reported to be developing laparoscopic colorectal surgery in our country. Ten of 15 hospitals responded to the survey. Most of the procedures performed were hemicolectomies, principally for cancer and diverticular disease. The average conversion rate was 7 percent and hospital stay was 5 days. Morbidity and mortality rates were 12 percent and 0.4 percent respectively. In the last year was seen an increase in the number of laparoscopic procedures in relation to the previous period. In conclusion, laparoscopic colorectal surgery is a recent technique in Chile, which is being implemented progressively, with good overall results.


El desarrollo de la cirugía laparoscópica colorrectal (CLCR) se inició en la década de los 90, sin embargo, pasaron varios años antes de lograr su aceptación por la comunidad quirúrgica internacional. En Chile, los primeros relatos en congresos datan del año 1995 y las primeras experiencias de series prospectivas fueron publicadas 10 años más tarde. Fuera de estos reportes, no existe información fidedigna en relación al desarrollo de la cirugía laparoscópica colorrectal en Chile, relacionados con el número de centros que la realizan, la formación actual de los cirujanos colorrectales en esta técnica ni en cuanto al número de procedimientos realizados. Para conocer estos datos se envió una encuesta estandarizada a los jefes de equipo de los centros que habían comunicado estar desarrollando la CLCR en nuestro país. Diez de 15 centros respondieron la encuesta. La mayor parte de los procedimientos corresponden a hemicolectomías, siendo las principales indicaciones el cáncer y la enfermedad diverticular. La tasa de conversión promedio fue de 7 por ciento y la estadía hospitalaria de 5 días. La morbilidad y mortalidad fue de 12 por ciento y 0,4 por ciento respectivamente. En el último año se ha visto un aumento del número de procedimientos laparoscópicos en relación al período previo. En conclusión, La CLCR es una técnica de reciente incorporación en Chile, que está siendo implementada en forma progresiva, con buenos resultados globales.


Assuntos
Humanos , Doenças do Colo/cirurgia , Doenças Retais/cirurgia , Laparoscopia/estatística & dados numéricos , Chile , Competência Clínica , Colectomia/estatística & dados numéricos , Coleta de Dados , Aprendizagem , Laparoscopia/mortalidade , Morbidade , Neoplasias Colorretais/cirurgia
14.
Rev. méd. Chile ; 139(9): 1157-1162, set. 2011. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-612239

RESUMO

Background: During the perioperative period an adequate intravascular volume must be maintained. Current recommendations overestimate perioperative volume requirements. Aim: To compare perioperative volume administration using standard monitoring methods or guided by left ventricular filling parameters. Material and Methods: Twenty-four patients subjected to colon resection were randomized to monitoring by electrocardiography, blood and central venous pressure, or by transesophageal echocardiography. In the latter, volume administration was adjusted to maintain basal values of left ventricular end diastolic volume and cardiac index. Results: Patients with the standard monitoring system and transesophageal echocardiographic monitoring received 21.1±12 and 6.3 ± 2 ml/kg/h of fluids during the perioperative period, respectively (p < 0.01). Conclusions: The use of transesophageal echocardiography significantly reduced the perioperative fluid administration.


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Colectomia , Ecocardiografia Transesofagiana/efeitos adversos , Hidratação/métodos , Hemodinâmica/fisiologia , Monitorização Intraoperatória/métodos , Volume Sanguíneo , Soluções Isotônicas/administração & dosagem , Período Perioperatório , Estudos Prospectivos , Função Ventricular Esquerda/fisiologia
15.
Rev. chil. cir ; 63(4): 388-393, ago. 2011. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-597537

RESUMO

Background: Conversion to open surgery of laparoscopic procedures is not in essence a complication, but invalidates the benefits of laparoscopy. Aim: To identify the predictive factors for conversion in laparoscopic colorectal surgery. Material and Methods: Revision of medical records of all patients with colorectal disease operated using a laparoscopic approach, from 1998 to 2010. Gender, age, American Society of Anesthesiologists (ASA) score, body mass index (BMI), previous abdominal surgery, elective/urgency procedure, benign/malignant disease, type of resection and surgeon experience were recorded. A logistic regression model was done to determine which variables were predictive for conversion to open surgery. Results: The medical records of 582 patients aged 57 +/- 17 years (45 percent men) were analyzed. The rate of conversion to open surgery was 7.1 percent. The logistic regression model selected as predictors of conversion a BMI over 25 kg/m² (odds ratio (OR) 4.9, 95 percent confidence intervals (CI) 2.4 to 9.9), cancer surgery (OR 2.1, 95 percent CI 1.1 to 4.3) and male sex (OR 2.30, 95 percent CI 1.14 to 4.65). The receiver operating curve (ROC) of the model had an are under the curve of 0.766 with 95 percent CI of 0.69 to 0.84). Conclusions: A BMI over 25 kg/m², male sex and the resection of a malignant tumor were predictive factors for conversion to open surgery.


Objetivo: Identificar los factores de riesgo para la conversión en la cirugía laparoscópica colorrectal. Material y Método: Se revisó la base de datos prospectiva de cirugía laparoscópica colorrectal, desde 1998 a 2010. Se analizaron las variables: sexo, edad, ASA, IMC, presencia de cirugía abdominal previa, procedimiento electivo/urgencia, patología benigna/maligna, tipo de resección y experiencia del cirujano. Se realizó un análisis uni y multivariado. Para determinar las variables predictivas de conversión, la totalidad de estas fueron incluidas en un modelo de regresión logística. Resultados: De un total de 621 pacientes consecutivos, la serie se compuso de 582 pacientes (hombres: 45 por ciento, edad promedio: 56,3 años) Tasa de conversión 7,1 por ciento. El modelo de regresión logística seleccionó tres variables como predictivas de conversión: IMC > 25 kg/m² (OR 4,88; IC95 por ciento 2,40-9,92), cirugía por cáncer (OR 2,12; IC95 por ciento 1,11-4,29) y sexo masculino (OR 2,30; IC95 por ciento 1,14-4,65). No fueron predictivas de conversión: edad, comorbilidades, experiencia del cirujano, tipo de procedimiento, ni cirugía previa. La calibración del modelo fue satisfactoria, al igual que su capacidad de discriminación (ABC ROC = 0,766). Conclusiones: En este estudio el IMC sobre 25 kg/m², el sexo masculino y las resecciones por cáncer son factores predictivos independientes de conversión. Este modelo predictivo mostró una calibración satisfactoria, asociada a una capacidad de discriminación acertada para el evento en estudio.


Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Doenças do Colo/cirurgia , Doenças Retais/cirurgia , Laparoscopia/estatística & dados numéricos , Laparoscopia/métodos , Análise de Variância , Índice de Massa Corporal , Modelos Logísticos , Prognóstico , Fatores de Risco , Curva ROC
17.
Rev Med Chil ; 139(9): 1157-62, 2011 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-22215394

RESUMO

BACKGROUND: During the perioperative period an adequate intravascular volume must be maintained. Current recommendations overestimate perioperative volume requirements. AIM: To compare perioperative volume administration using standard monitoring methods or guided by left ventricular filling parameters. MATERIAL AND METHODS: Twenty-four patients subjected to colon resection were randomized to monitoring by electrocardiography, blood and central venous pressure, or by transesophageal echocardiography. In the latter, volume administration was adjusted to maintain basal values of left ventricular end diastolic volume and cardiac index. RESULTS: Patients with the standard monitoring system and transesophageal echocardiographic monitoring received 21.1 ± 12 and 6.3 ± 2 ml/kg/h of fluids during the perioperative period, respectively (p < 0.01). CONCLUSIONS: The use of transesophageal echocardiography significantly reduced the perioperative fluid administration.


Assuntos
Colectomia , Ecocardiografia Transesofagiana/efeitos adversos , Hidratação/métodos , Hemodinâmica/fisiologia , Monitorização Intraoperatória/métodos , Volume Sanguíneo , Feminino , Humanos , Soluções Isotônicas/administração & dosagem , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Estudos Prospectivos , Lactato de Ringer , Função Ventricular Esquerda/fisiologia
18.
Rev Med Chil ; 138(4): 478-82, 2010 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-20668797

RESUMO

Among patients with short bowel syndrome, surgical small intestine lengthening techniques are employed to increase the absorptive surface. Among these, serial transverse enteroplasty involves transecting the bowel transversally, preserving the blood supply of the small intestine and creating a longer segment of bowel. We report a 51-year-old woman with a short bowel syndrome and multiple hospital admissions for complications. She was subjected to a serial transverse enteroplasty, increasing small intestinal length from 140 to 180 cm. During the postoperative period, she presented intra abdominal blood collections and a septic episode with bacterial endocarditis. One month after the operation, total parenteral nutrition was discontinued and nutritional and fluid balances were achieved using exclusively the oral route. During the ambulatory follow up, the patient continues with exclusive oral feeding and five bowel movements per day.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Nutrição Parenteral Total , Síndrome do Intestino Curto/cirurgia , Feminino , Humanos , Absorção Intestinal/fisiologia , Intestinos/cirurgia , Pessoa de Meia-Idade
19.
Rev Med Chil ; 138(1): 109-16, 2010 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-20361160

RESUMO

Ulcerative colitis (UC) is a chronic inflammatory disease of unknown etiology that affects a variable length of the colon, starting from the rectum. When the disease is confined to the rectum is called ulcerative proctitis (UP). Several studies have unsuccessfully attempted to determine the factors that determine the extent of involvement. The goals of therapy in UP are to induce and maintain remission of symptoms and disease. Topical treatment with 5-aminosalicylates (5-ASA) is the treatment of choice to induce remission. In the maintenance phase, long-term follow up studies suggest that treatment with 5-ASA is better than placebo, to maintain the disease inactive. For those patients that do not respond to treatment with topical 5-ASA or have a moderate to severe disease, there are additional therapies such as oral 5-ASA, topical or systemic corticosteroids, immunomodulators, biological therapies (Infliximab) and cyclosporine. Surgery is seldom needed.


Assuntos
Anti-Inflamatórios/uso terapêutico , Colite Ulcerativa/tratamento farmacológico , Proctite/tratamento farmacológico , Administração Oral , Administração Tópica , Ácidos Aminossalicílicos/uso terapêutico , Humanos
20.
Rev. méd. Chile ; 138(4): 478-482, abr. 2010. ilus
Artigo em Espanhol | LILACS | ID: lil-553220

RESUMO

Among patients with short bowel syndrome, surgical small intestine lengthening techniques are employed to increase the absorptive surface. Among these, serial transverse enteroplasty involves transecting the bowel transversally, preserving the blood supply of the small intestine and creating a longer segment of bowel. We report a 51-year-old woman with a short bowel syndrome and multiple hospital admissions for complications. She was subjected to a serial transverse enteroplasty, increasing small intestinal length from 140 to 180 cm. During the postoperative period, she presented intra abdominal blood collections and a septic episode with bacterial endocarditis. One month after the operation, total parenteral nutrition was discontinued and nutritional and fuid balances were achieved using exclusively the oral route. During the ambulatory follow up, the patient continues with exclusive oral feeding and fve bowel movements per day.


Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Nutrição Parenteral Total , Síndrome do Intestino Curto/cirurgia , Absorção Intestinal/fisiologia , Intestinos/cirurgia
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