Evaluation of bleeding risk and measurement methods in dental patients.

OBJECTIVE: The present study explores bleeding manifestations in routine dental surgical procedures, evaluates the influence of antithrombotic drugs upon bleeding risk, and validates the efficiency of a clinical method for the measurement of bleeding. MATERIAL AND METHOD: A prospective observational study was made involving a cohort of 99 patients in the setting of normal clinical practice, with the added conduction of prior hematological tests including baseline hemostasis and platelet function, based on a new method (Multiplate System®). For evaluation of the bleeding manifestations, a clinical method was selected that evaluates bleeding on the basis of its duration and the hemostatic measures needed to resolve the problem. RESULTS: Almost one-third of the patients (27.3%) were receiving treatment with oral antiplatelet drugs, while 19.2% received oral anticoagulants and 9% received combined therapy with acetylsalicylic acid plus clopidogrel. In turn, an 8% incidence of moderate bleeding episodes was detected correlated to the ASPI platelet function test and to advanced patient age. CONCLUSION: The incorporation of platelet function tests increases the safety of oral surgery in elderly patients subjected to antiplatelet treatment, particularly with acetylsalicylic acid and clopidogrel.

Recidiva paraesofágica de hernia hiatal: diagnóstico radiológico y resolución quirúrgica laparoscópica / Paraesophageal recurrence of hiatal hernia: radiological diagnosis and laparoscopic surgical resolution / Recorrência paraesofágica de hérnia hiatal: diagnóstico radiológico e resolução cirúrgica laparoscópica

La tasa de recidiva radiológica luego de la cirugía de las hernias hiatales grandes tipo IV es cercana al 50%. La mayoría de las veces la recidiva supone un ascenso parcial de la funduplicatura al tórax (telescopaje), y si no tiene expresión clínica puede optarse por un manejo conservador (solo 3-6% requieren cirugía de revisión). Sin embargo, en ocasiones hay otro tipo de recidivas (paraesofágicas) que deben valorarse mediante estudios funcionales, endoscópicos y radiológicos, que dan disfagia con mayor frecuencia. Un tránsito contrastado digestivo superior permite en este caso identificar el tipo de recidiva herniaria, con migración parcial del fundus gástrico hacia el tórax paraesofágico izquierdo, y una funduplicatura continente pero realizada técnicamente en por debajo de lo deseable (cuerpo alto) (figura). La resolución del cuadro implica la reducción de la hernia a la cavidad abdominal, con cierre del defecto diafragmático, desmontar la funduplicatura anterior anatomizando la zona y la reconfección de una nueva funduplicatura.

Morbimortalidad de la colecistectomía laparoscópica electiva en un servicio universitario / Morbimortality of elective laparoscopic cholecystectomy in a university hospital / Morbimortalidade da colecistectomia laparoscópica eletiva em um serviço universitário

Resumen: Introducción: la colecistectomía laparoscópica (CL) es la cirugía más frecuente del tracto digestivo. A pesar de considerarse un procedimiento seguro, la morbilidad se reporta hasta en un 10%, no existiendo registro a nivel nacional. Objetivo: describir la incidencia de complicaciones y morbimortalidad de la CL electiva en una población no seleccionada de un servicio universitario. Método: se realizó un estudio retrospectivo observacional de los pacientes intervenidos en forma electiva de CL, entre el 1/1/2010 y el 31/12/2019 en la Clínica Quirúrgica B del Hospital de Clínicas y en la Unidad Docente Asistencial de Cirugía del Hospital Español. Las variables incluidas fueron demográficas, diagnóstico operatorio, conversión, morbimortalidad, reintervenciones y readmisiones. Resultados: se reclutó un total de 1.499 CL electivas, edad promedio 49 años (15-87), 79% sexo femenino, incidencia de litiasis de vía biliar principal (LVBP) en 210 (17%) casos; 25 conversiones (1,7%). Hubo un total de 64 complicaciones (4,3%) con una incidencia significativamente mayor en pacientes con LVBP (2,8% vs 7,6%, p 0,01). Hubo dos lesiones del hepato-colédoco (0,13%) (tipo Hannover D y C), ambas detectadas y reparadas en la misma cirugía y tres lesiones viscerales (0,20%). Hubo 16 readmisiones (1,07%) y 9 reintervenciones (0,6%). Dos pacientes fallecieron (0,13%) en el posoperatorio (insuficiencia hepatocítica crónica descompensada y pancreatitis grave pos-CPRE posoperatoria). Conclusiones: la CL en la población no seleccionada del servicio universitario analizado en este trabajo demuestra ser un procedimiento seguro, con tasas de complicaciones, reintervenciones y readmisiones que en este estudio se comparan favorablemente con las reportadas en la literatura. La presencia de litiasis en la vía biliar principal se asoció a una incidencia significativamente mayor de complicaciones posoperatorias y de mayor severidad.

Summary: Introduction: laparoscopic cholecystectomy (LC) is the most frequent surgery of the digestive tract. Despite it being considered a safe procedure, morbidity is reported to be up to 10%, there being no record at the national level. Objective: to describe the incidence of complications and morbimortality of elective LC in a non-selected population group in a university hospital. Method: retrospective observational study of patients who underwent elective LC between January 1, 2010 and December 31, 2019 in the Surgical Clinic B at the Clinicas Hospital and the surgery assistance Teaching Unit at Español Hospital. The following variables were included: demographics, surgical diagnosis, conversion, morbimortality, reoperations and readmissions. Results: 1.499 CL were found, average age was 49 years old (15-87), 79% were women, main bile duct lithiasis in 210 cases (17%), 25 conversions (1.7%). There were 64 complications (4.3%), the incidence being significantly higher in patients with main bile duct lithiasis (2.8% vs 7.6%, p 0,01). Two bile duct-hepatic lesions (Hannover type D and C), both detected and repaired in the same surgery, and three visceral lesions (0.20 %). There were 16 readmissions (1.07%) and 9 reoperations (0.6%). Two patients died (0.13%) in the postoperative: decompensated chronic liver failure and post Endoscopic retrograde cholangiopancreatography (ERCP) severe pancreatitis. Conclusions: CL in a non-selected population at the university service analysed in the study proved to be a safe procedure, and complications, reoperation and readmission rates found in the study are positively compared to those reported in literature. The presence of lithiasis in the bile duct was associated with postoperative complications and a greater severity.

Resumo: Introdução: a colecistectomia laparoscópica (CL) é a cirurgia mais comum do trato digestivo. Apesar de ser considerado um procedimento seguro, a morbidade descrita é de 10%, e não há um registro nacional. Objetivo: descrever a incidência de complicações e morbimortalidade das CL eletivas, em uma população não selecionada em serviço universitário. Método: estudo observacional retrospectivo de pacientes submetidos à CL eletiva, realizado no período 1 de janeiro de 2010 - 31 de dezembro de 2019 na Clínica Cirúrgica B do Hospital de Clínicas e Unidade Docente Assistencial de Cirurgia do Hospital Espanhol. Foram incluidas variáveis demográficas, diagnóstico operatório, conversão, morbimortalidade, reoperações e reinternações. Resultados: foram incluidas 1.499 LCs eletivas, a idade média dos pacientes foi 49 anos (15-87), sendo 79% mulheres com incidência de cálculos biliares principais (LVBP) em 210 (17%) casos; 25 conversões (1,7%). Houve um total de 64 complicações (4,3%) com uma incidência significativamente maior em pacientes com LVBP (2,8% vs 7,6%, p 0,01). Ocorreram duas lesões hepato-colédoco (0,13%) (Hannover tipos D e C), ambas detectadas e reparadas na mesma cirurgia, e três lesões viscerais (0,20%). Ocorreram 16 readmissões (1,07%) e 9 reoperações (0,6%). Dois pacientes morreram (0,13%) no pós-operatório (insuficiência hepatocítica crônica descompensada e pancreatite pós-operatória grave por CPRE). Conclusões: a LC na população não selecionada do serviço universitário analisado neste estudo, mostrou-se como um procedimento seguro, com índices de complicações, reoperações e reinternações que neste estudo se comparam favoravelmente com os relatados na literatura. A presença de litíase no ducto biliar principal foi associada a uma incidência significativamente maior de complicações pós-operatórias e de maior gravidade.

Salud sexual en mujeres con cáncer de mama tratadas con Tamoxifeno / Sexual health in women with breast cancer treated with Tamoxifen

El cáncer de mama puede alterar ciertos componentes de la función sexual debidos a la enfermedad y los tratamientos empleados en su abordaje. OBJETIVO: Analizar si las pacientes con cáncer de mama en tratamiento con Tamoxifeno presentan disfunción sexual. MÉTODO: Estudio transversal, observacional para detectar disfunción sexual en pacientes con cáncer de mama en tratamiento con Tamoxifeno y comparar los resultados con población general. Se han analizado los casos de cáncer de mama diagnosticados en el Hospital Virgen de la Luz de abril de 2015 a abril 2016, seleccionando mujeres en tratamiento con Tamoxifeno, menores de 50 años y sexualmente activas, aplicándoseles un cuestionario de salud sexual, posteriormente se compararon los resultados obtenidos con un estudio realizado en población general. RESULTADOS: Se diagnosticaron 130 cánceres de mama en dicho periodo, siendo 34 susceptibles de estudio (26,15 %). Participaron 7 pacientes (20.6%), con edad media de 42,7 años (35-50) y pareja estable en el 85,7%. Se han objetivado trastornos moderados del deseo sexual en un 28,6% y de excitación en 14,28%, así como ausencia de iniciativa sexual en un 42,86%, trastorno de la lubricación vaginal en un 28,6% y problemas para la penetración vaginal en un 14,3 %, pero globalmente están satisfechas con su actividad sexual. Comparando con población general, llama la atención que un 14,2 % de éstas últimas muestra algún grado de insatisfacción sexual. CONCLUSIONES: No hay diferencias significativas en cuanto a disfunción sexual, aunque puede haber mayor ansiedad anticipatoria y disfunción del deseo sexual y lubricación vaginal en el grupo de Tamoxifeno, que probablemente no alcanzan la significación estadística por el tamaño muestral

Breast cancer can alter certain components of sexual function due to the disease and the treatments used. OBJECTIVE: To analyze if patients with breast cancer treated with Tamoxifen have sexual dysfuntion. METHOD: Cross-sectional, observational study to detect sexual dysfunction in patients with breast cancer with Tamoxifen treatment and compare it with general population. The cases of breast cancer at Virgen de La Luz Hospital from April 2015 to April 2016 have been analyzed, selecting women in treatment with tamoxifen, under 50 years and sexually active, applying a sexual health questionnarie and comparing them with general population. RESULTS: 130 breast cancers were diagnosed, 34 were susceptible to study (26,15%). Seven patients (20,6%) participated, with a mean age of 42,7 years (35-50) and stable partner in 85,7%. Moderate disorders of sexual desire have been observed in 28,6% and in arousal in 14,28%, as well as lack of sexual initiative in 42,86%, disorder of vaginal lubrication in 28,6% and problems with vaginal penetration in 14,3%, but overall they are satisfied with their sexual activity. Comparing with general population, it's striking that 14,2% of the last show some degree of sexual insatisfaction. CONCLUSIONS: There are no significant differences regarding sexual dysfunction, although there may be greater anticipatory anxiety, sexual desire dysfunction and vaginal lubrication in the Tamoxifen group, which probably do not reach statistical significance due to sample size

Estudio cadavérico del arco de la vena cefálica / Cadaveric study of the cephalic vein arch

RESUMEN: Dentro de las disfunciones de los angioaccesos, la estenosis del arco de la vena cefálica (AVC) juega un papel significativo. Existen características anatómicas del AVC que explican, en parte, este fenómeno. Todo esto obliga a un conocimiento profundo del AVC y sus principales variantes. Se disecaron 43 (n=43) axilas de cadáveres adultos fijados en solución en base a formol. Se registró: longitud del AVC (LAC), angulación del AVC respecto a la vena cefálica (AAC), tipo de terminación (simple o múltiple), presencia de afluentes y su número. LAC promedio 31,6 mm (rango 17-46 mm); AAC promedio 128,95° (rango 65-165°). En cuanto al tipo de terminación 41 (95,3 %) fueron simples, mientras que 2 casos (4,7 %) fueron de forma múltiple. Respecto a los afluentes, se encontraron en 42 de los casos (90,5 %). Se encontraron válvulas en 27 (62,8 %) de los casos. La longitud promedio del AVC fue de 31,6 mm, se dispuso en la mayoría de los casos en ángulo obtuso, presentando en la mayoría de los casos terminación de tipo simple. Además, en el 90,5 % se encontró afluentes que se agotaban en el AVC y en más de la mitad de los casos se encontraron válvulas. Se discuten las implicancias de estos hallazgos en la génesis de la disfunción de angioaccesos.

SUMMARY: Within the angio access dysfunctions, the stenosis of the cephalic vein arch (AC) has a significant role. There are anatomical characteristics of AVC that partially explain this phenomenon. This requires a deep understanding of AVC and its main variants. 43 axillary regions of formalin-fixed adult cadavers were dissected. For this study, the following were registered: length of the AVC (LAC), angulation of the AVC with respect to the cephalic vein (AAC), type of termination (single or multiple), presence and number of tributaries. LAC average 31.6 mm (range 17-46 mm); AAC average 128,95° (range 65-165°). Regarding the type of termination, 41 (95.3 %) were simple, while 2 cases (4.7 %) were multiple. Tributaries were found in 42 of the cases (90.5 %). Valves were found in 27 (62.8 %) of the cases. The average length of the AVC was 31.6mm. Most cases presented an obtuse angle, and simple termination. In addition, in 90.5 % tributaries were found and in more than half of the cases valves were found. Implications of these findings in the genesis of angioaccess dysfunction are discussed.

De la abstinencia a la educación para el consumo: estrategias psicoeducativas para reducir el consumo de riesgo de alcohol entre los adolescentes / From abstinence to education for consumption: psycho-educational strategies to reduce hazardous drinking among adolescents

Fundamentos: el consumo de riesgo de alcohol en la etapa adolescente es un problema de salud pública, con graves repercusiones en la calidad de vida y consecuencias físicas, psicológicas y sociales negativas a corto y largo plazo en esta población y en su entorno. Objetivo: identificar las estrategias e intervenciones educativas con mayor consenso entre expertos para reducir el consumo de riesgo entre los adolescentes. Métodos: estudio descriptivo basado en el consenso (técnica Delphi). Participaron profesionales de diferentes disciplinas sociosanitarias. Resultados: se obtuvieron 145 ítems distribuidos en tres categorías: Intervenciones más eficaces para lograr un consumo de menos riesgo de alcohol en los adolescentes (54 ítems); contenidos de un programa educativo dirigido a los adolescentes para la educación en el consumo de menos riesgo de alcohol (45 ítems) y estrategias educativas más eficaces para desarrollar los contenidos del programa (46 ítems). El 42.76% de los ítems lograron un consenso total, el 22.76% muy aceptable, el 31.03% aceptable y solo en un 3.45% de los ítems no se alcanzó consenso. Conclusiones: para reducir el consumo de riesgo de alcohol entre adolescentes se requiere combinar intervenciones educativas y psicosociales realizadas desde un enfoque integrador y multicomponente, orientado al desarrollo en habilidades para la vida y valores prosociales y que fomenten la participación activa de los adolescentes a través de un enfoque pedagógico constructivista

Background: the hazardous drinking in the adolescent stage is a public health problem with serious repercussions on the quality of life of this population and negative consequences for their physical, psychological and social health in a short-long-term that not only affects adolescents but also the people around them. Aim: to identify educational strategies and interventions with greater consensus among experts to reduce hazardous drinking on adolescents. Method: descriptive research based on consensus (Delphi Technique). Professionals from different socio disciplines participated. Results: 145 items divided into three categories were obtained: more effective interventions to achieve low-risk alcohol consumption in adolescents (54 items); contents of an educational program aimed at adolescents for education in low-risk alcohol use (45 items) and more effective educational strategies to develop the contents of the program (46 items). 42.76% achieved a total consensus, 22.76% very acceptable, 31.03% acceptable and only 3.45% of the items no consensus was reached. Conclusions: to reduce hazardous drinking among adolescents, it is necessary to combine educational and psychosocial interventions on an integrated approach and multi-component-oriented development life skills and prosocial values ​​and encourage the active participation of adolescents through an approach constructivist teaching

Evaluation of bleeding risk and measurement methods in dental patients

Objective: The present study explores bleeding manifestations in routine dental surgical procedures, evaluates the influence of antithrombotic drugs upon bleeding risk, and validates the efficiency of a clinical method for the measurement of bleeding.Material and method: A prospective observational study was made involving a cohort of 99 patients in the setting of normal clinical practice, with the added conduction of prior hematological tests including baseline hemostasis and platelet function, based on a new method (Multiplate System(R). For evaluation of the bleeding manifestations,a clinical method was selected that evaluates bleeding on the basis of its duration and the hemostatic measures needed to resolve the problem.Results: Almost one-third of the patients (27.3%) were receiving treatment with oral antiplatelet drugs, while 19.2% received oral anticoagulants and 9% received combined therapy with acetylsalicylic acid plus clopidogrel. In turn, an 8% incidence of moderate bleeding episodes was detected correlated to the ASPI platelet function testand to advanced patient age.Conclusion: The incorporation of platelet function tests increases the safety of oral surgery in elderly patients subjected to antiplatelet treatment, particularly with acetylsalicylic acid and clopidogrel (AU)

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