RESUMO
BACKGROUND: Post-operative delirium is a serious complication in patients undergoing major abdominal surgery. It remains unclear whether peri-operative hemodynamic and perfusion variables affect the risk for postoperative delirium. The objective of this pilot study was to evaluate the association between perfusion and hemodynamics peri-operative with the appearance of post-operative delirium. METHODS: Prospective cohort study of adults 60 years or older undergoing elective open colon surgery. Multimodal hemodynamic and perfusion variables were monitored, including central venous oxygenation (ScvO2), lactate levels, and non-invasive cerebral oxygenation (rSO2), according to a standard anesthesia protocol. Fisher's exact test or Student's t-test were used to compare patients who developed post-operative delirium with those who did not (p<0.05). RESULTS: We studied 28 patients, age 73±7 years, 60.7% female. Two patients developed post-operative delirium (7.1%). These two patients had fewer years of education than those without delirium (p=0.031). None of the peri-operative blood pressure variables were associated with incidence of post-operative delirium. In terms of perfusion parameters, postoperative ScvO2 was lower in the delirium than the non-delirium group, without reaching statistical significance (65±10% vs. 74±5%; p=0.08), but the delta-ScvO2 (the difference between means post-operative and intra-operative) was associated with post-operative delirium (p=0.043). Post-operative lactate and rSO2 variables were not associated with delirium. CONCLUSIONS: Our pilot study suggests an association between delta ScvO2 and post-operative delirium, and a tendency to lower post-operative ScvO2 in patients who developed delirium. Further studies are necessary to elucidate this association.
Assuntos
Doenças do Colo/cirurgia , Delírio/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Doenças do Colo/complicações , Doenças do Colo/fisiopatologia , Delírio/etiologia , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Humanos , Hipotensão/complicações , Masculino , Projetos Piloto , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fluxo Sanguíneo RegionalRESUMO
Abstract Background: Post-operative delirium is a serious complication in patients undergoing major abdominal surgery. It remains unclear whether peri-operative hemodynamic and perfusion variables affect the risk for postoperative delirium. The objective of this pilot study was to evaluate the association between perfusion and hemodynamics peri-operative with the appearance of post-operative delirium. Methods: Prospective cohort study of adults 60 years or older undergoing elective open colon surgery. Multimodal hemodynamic and perfusion variables were monitored, including central venous oxygenation (ScvO2), lactate levels, and non-invasive cerebral oxygenation (rSO2), according to a standard anesthesia protocol. Fisher's exact test or Student's t-test were used to compare patients who developed post-operative delirium with those who did not (p < 0.05). Results: We studied 28 patients, age 73 ± 7 years, 60.7% female. Two patients developed post-operative delirium (7.1%). These two patients had fewer years of education than those without delirium (p = 0.031). None of the peri-operative blood pressure variables were associated with incidence of post-operative delirium. In terms of perfusion parameters, postoperative ScvO2 was lower in the delirium than the non-delirium group, without reaching statistical significance (65 ± 10% vs. 74 ± 5%; p = 0.08), but the delta-ScvO2 (the difference between means post-operative and intra-operative) was associated with post-operative delirium (p = 0.043). Post-operative lactate and rSO2 variables were not associated with delirium. Conclusions: Our pilot study suggests an association between delta ScvO2 and post-operative delirium, and a tendency to lower post-operative ScvO2 in patients who developed delirium. Further studies are necessary to elucidate this association.
Resumo Justificativa: O delírio pós-operatório é uma complicação séria em pacientes submetidos à cirurgia abdominal de grande porte. Ainda não está claro se as variáveis hemodinâmicas e de perfusão no período perioperatório afetam o risco de delírio pós-operatório. O objetivo deste estudo piloto foi avaliar a associação entre perfusão e hemodinâmica no perioperatório com o surgimento de delírio pós-operatório. Métodos: Estudo prospectivo de coorte de adultos com 60 anos ou mais, submetidos à cirurgia eletiva aberta do cólon. As variáveis multimodais de hemodinâmica e perfusão foram monitoradas, inclusive oxigenação venosa central (ScvO2), níveis de lactato e oxigenação cerebral não invasiva (rSO2), de acordo com um protocolo-padrão de anestesia. O teste exato de Fisher ou o teste t de Student foram usados para comparar os pacientes que desenvolveram delírio pós-operatório com aqueles que não desenvolveram p < 0,05. Resultados: Avaliamos 28 pacientes, 73 ± 7 anos, 60,7% do sexo feminino. Dois pacientes desenvolveram delírio pós-operatório (7,1%). Esses dois pacientes tinham menos anos de escolaridade do que aqueles sem delírio pós-operatório (p = 0,031). Nenhuma das variáveis de pressão arterial no perioperatório foi associada à incidência de delírio. Quanto aos parâmetros de perfusão, ScvO2 foi menor no grupo que apresentou delírio pós-operatório do que no grupo que não apresentou delírio, sem atingir significância estatística (65 ± 10% vs. 74 ± 5%; p = 0,08), mas o delta-ScvO2 (a diferença entre as médias no pós-operatório e intraoperatório) foi associado ao delírio (p = 0,043). As variáveis de lactato e rSO2 no pós-operatório não foram associadas ao delírio. Conclusões: Nosso estudo piloto sugere uma associação entre delta-ScvO2 e delírio e uma tendência à diminuição da ScvO2 no pós-operatório de pacientes com delírio. Estudos adicionais são necessários para elucidar essa associação.
Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Complicações Pós-Operatórias/epidemiologia , Doenças do Colo/cirurgia , Delírio/epidemiologia , Complicações Pós-Operatórias/etiologia , Fluxo Sanguíneo Regional , Procedimentos Cirúrgicos do Sistema Digestório , Projetos Piloto , Estudos Prospectivos , Doenças do Colo , Doenças do Colo/complicações , Delírio/etiologia , Hipotensão/complicaçõesRESUMO
Resumen Introducción La resistencia a antibióticos es un problema mundial. En los pacientes que requieren cirugía de urgencia, los antibióticos son un apoyo importante concomitante al acto quirúrgico. Objetivo Analizar los cultivos de líquido peritoneal obtenidos de pacientes operados por patología quirúrgica abdominal de urgencia. Materiales y Métodos Se realiza una cohorte prospectiva de los pacientes operados de urgencia. Se tomó cultivo de líquido peritoneal y se procesó según técnica estandarizada. Resultados Se encontró un 39,4% de cultivos positivos. E. coli fue el germen más frecuente. Destacan 5 cultivos positivos para P. aeruginosa. Existe un 25% de resistencia a ampicilina/sulbactam y 19% a quinolonas para E. coli. Conclusión La resistencia encontrada fue menor a lo reportado en la literatura, pero aún destacable. El conocimiento del perfil de bacterias y sus resistencias a antimicrobianos son importantes para las políticas hospitalarias locales de uso racional de antibióticos.
Background Antimicrobial resistance is a worldwide problem. In patients requiring emergency surgery, antibiotics are an important assistance additional to surgical intervention. Objective Analize peritoneal fluid cultures obtaines from patients who underwent emergency surgery. Methods A prospective cohort of emergency abdominal surgical patients were enrolled. Peritoneal fluid cultures were taken and processed according to standarized technique. Results A 39.4% of positive cultures was found. E. coli was the most common bacteria identified. Five positive cultures for P. aeruginosa stand out. E. coli had 25% resistance to ampicillin/sulbactam and 19% for quinolones. Conclusion Resistance found was lower than international reports, but still noteworthy. Knowledge of local bacteria profile and antimicrobial resistance is important for local antibiotic hospital policy.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Bactérias/efeitos dos fármacos , Líquido Ascítico/microbiologia , Abdome/cirurgia , Antibacterianos/farmacologia , Pseudomonas aeruginosa/efeitos dos fármacos , Bactérias/isolamento & purificação , Testes de Sensibilidade Microbiana , Farmacorresistência Bacteriana , Emergências , Escherichia coli/efeitos dos fármacos , Klebsiella pneumoniae/efeitos dos fármacosRESUMO
Introducción: El tratamiento en el cáncer de recto ha progresado en la última década. Hoy es factible ofrecer una cirugía con preservación de esfínteres, realizando anastomosis colorrectales bajas o anastomosis coloanales. Esto ha determinado que muchos pacientes desarrollen disfunción intestinal que puede llegar a ser severa, agrupando una serie de alteraciones que se conocen como síndrome de resección anterior baja. Objetivo: Efectuar una adaptación cultural de la versión 1.0 en español neutro del cuestionario acerca de la función intestinal o Low Anterior Resection Syndrome Score (LARS Score), efectuando traducción, comparación de traducciones, traducción inversa y prueba piloto. Resultados: Los resultados obtenidos de la prueba piloto revelan que la población encuestada logró comprender el instrumento, por lo que no se realizaron modificaciones posteriores. Conclusión: Se cuenta con una versión adaptada del cuestionario LARS para ser usada en Chile, la cual puede someterse a procesos de validación y establecer las características psicométricas para ser usada en pacientes con cáncer de recto operados.
Introduction: The treatment of rectal cancer has progressed in the past decade. Nowadays, it's feasible to provide sphincter sparing surgery with low colorectal anastomosis or coloanal anastomosis. This has determined that many patients develop intestinal dysfunctions that can become severe, grouping a number of disorders known as low anterior resection syndrome. Objective: To perform a cultural adaptation of the version 1.0 questionnaire about bowel function or Low Resection Syndrome Score (LARS Score) in neutral Spanish, making a translation, comparing translations, back translation and pilot test. Results: The results of the pilot test showed that the population surveyed understood the instrument, so that no further modifications were made. Conclusion: We now have an adapted version of the LARS questionnaire for use in Chile, which can undergo validation processes to establish the psychometric characteristics for use in patients with rectal cancer surgery.
Assuntos
Humanos , Complicações Pós-Operatórias/diagnóstico , Neoplasias Retais/cirurgia , Inquéritos e Questionários , Chile , Comparação Transcultural , Defecação , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Flatulência , Complicações Pós-Operatórias/psicologia , Psicometria , Neoplasias Retais/psicologia , Reto/fisiopatologia , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Síndrome , TraduçõesRESUMO
Introducción: La resección total del mesorrecto por vía transanal es un abordaje híbrido que combina el uso de una plataforma transanal y laparoscopia convencional. Objetivos: Realizar el análisis de casos seleccionados con cáncer de recto medio e inferior en los cuales se utilizó un abordaje transanal combinado para su resolución y la descripción de la técnica quirúrgica. Materiales y métodos. Corresponde a una serie prospectiva de pacientes con diagnóstico de cáncer de recto de tercio medio e inferior con resección mesorrectal asistida por monopuerto endoanal entre octubre de 2012 y diciembre de 2015, en Hospital Clínico Universidad de Chile. Se utilizó estadística descriptiva para el análisis de los datos. Resultados: Fueron sometidos a cirugía por cáncer de recto medio e inferior un total de 29 pacientes utilizando monopuerto transanal. De estos, 22 fueron de sexo masculino y 7 de sexo femenino, con edad promedio de 55,5 años e IMC de 26,4. La distancia media al margen anal fue 4,8 cm. Todos recibieron neoadyuvancia. Se realizaron 17 Ta-TME (58,6%) y 12 Ta-TME con abordaje interesfintérico (41,4%). La anastomosis fue coloanal manual en 15 pacientes (51,7%) y grapada en 14 (48,3%). El abordaje laparoscópico se utilizó en 26 pacientes y el abierto en 3, registrando 4 conversiones (15,4%). El tiempo operatorio promedio fue de 282 min. La estadía hospitalaria media fue de 9 días. Conclusión: El monopuerto endoanal aparece como una herramienta útil en la disección total del mesorrecto por su seguridad y factibilidad. Creemos que es necesaria la realización de trabajos prospectivos aleatorizados, donde es relevante la comparación de resultados oncológicos y funcionales a largo plazo.
Introduction: Transanal total mesorectal excision is a hybrid approach that combines the use of a conventional laparoscopic and a transanal platform. Objectives: To conduct an analysis of selected cases with medium and lower rectal cancer, were a combined transanal approach was used and description of the surgical technique. Materials and methods: Prospective series of patients diagnosed with middle and lower third rectal cancer with mesorectal resection assisted by endoanal single port, between October 2012 and December 2015 at University of Chile Clinical Hospital. Descriptive statistics were used for data analysis. Results: A total of 29 patients underwent surgery for middle and lower rectal cancer using a transanal single port. Gender distribution was 22 male and 7 female patients, with a mean age of 55.5 years and a mean BMI of 26.4. The mean distance from the anal margin was 4.8 cm. All patients received neoadjuvant therapy. The surgeries performed were 17 Ta-TME (58.6%) and 12 Ta-TME with intersphincteric approach (41.4%). The colo-anal anastomosis was hand sewn in 15 patients (51.7%), and stapled in 14 (48.3%). The laparoscopic approach was used in 26 patients and the open approach in 3, with 4 conversions (15.4%). The mean operative time was 282 min. The mean hospital stay was 9 days. Conclusion: The endoanal single port appears as a useful tool in total mesorectal dissection for its safety and feasibility. We believe we need randomized prospective studies, where comparison of oncological and functional long-term results is relevant.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Canal Anal/cirurgia , Laparoscopia/métodos , Neoplasias Retais/cirurgia , Cirurgia Endoscópica Transanal/métodos , Procedimentos Cirúrgicos Minimamente Invasivos , Complicações Pós-Operatórias , Estudos Prospectivos , Reto/cirurgia , Resultado do TratamentoRESUMO
PURPOSE: The mayor symptoms of chronic anal fissure are permanent pain, intense pain during defecation that lasts for hours, blood in the stools, and sphincter cramps. It is subsequent to formation of fibrosis infiltrate that leads to an increased anal tone with poor healing tendency. This vicious circle leads to fissure recurrence and chronicity. This study was designed to show the efficacy of gonyautoxin infiltration in healing patients with anal fissures. METHODS: Gonyautoxin is a paralyzing phytotoxin produced by dinoflagellates. Fifty recruited patients received clinical examination, including proctoscopy and questionnaire to evaluate the symptoms. Anorectal manometries were performed before and after toxin injection. Doses of 100 units of gonyautoxin in a volume of 1 ml were infiltrated into both sides of the anal fissure in the internal anal sphincter. RESULTS: Total remission of acute and chronic anal fissures were achieved within 15 and 28 days respectively. Ninety-eight percent of the patients healed before 28 days with a mean time healing of 17.6 +/- 9 days. Only one relapsed during 14 months of follow-up. Neither fecal incontinence nor other side effects were observed. All patients showed immediate sphincter relaxation. The maximum anal resting pressures recorded after two minutes decreased to 56.2 +/- 12.5 percent of baseline. CONCLUSIONS: Gonyautoxin breaks the vicious circle of pain and spasm that leads to anal fissure. This study proposes gonyautoxin anal sphincter infiltration as safe and effective alternative therapeutic approach to conservative, surgical, and botulinum toxin therapies for anal fissures.
Assuntos
Fissura Anal/tratamento farmacológico , Toxinas Marinhas/uso terapêutico , Saxitoxina/análogos & derivados , Saxitoxina/uso terapêutico , Doença Aguda , Adolescente , Adulto , Idoso , Animais , Doença Crônica , Dinoflagellida , Método Duplo-Cego , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Medição da Dor , Resultado do TratamentoRESUMO
The primary clinical symptom of Paralytic Shellfish Poisoning is acute paralytic illness produced by paralyzing toxins. Paralytic shellfish poison is formed by a mixture of phycotoxins and their toxicity is due to its reversible binding to a receptor site on the voltage-gated sodium channel on excitable cells, thus blocking neuronal transmission. We studied the effect of the gonyautoxin 2/3 epimers by local infiltration in the anal internal sphincter of healthy voluntary adults in order to reduce anal tone. The toxin was injected after prior clinical evaluation, anoscopy and anorectal manometry. Post injection clinical examination, electromyography and anorectal manometry were performed. Resting and voluntary contraction pressures were measured and the anorectal inhibitory and anocortical reflexes were tested by manometry. Blood and urine samples were obtained from each participant, and hemogram, basic metabolic panel, and urinalysis were done both before and one week after the injection. This study shows, for the first time, that gonyautoxin 2/3 reduces the anal tone by relaxing the anal sphincters in 100 % of the participants. Manometric recordings showed a significant decrease in anal maximal voluntary contraction pressure after the toxin injection, dropping to 55.2+/-6.2 % and 47.0+/-6.8% (Mean Value+/-Std.Dev.) of the baseline values at 2 minutes and at 24 hours respectively after the injection. Post-injection electromyography showed that activity of the muscle was abolished. We conclude that local administration of gonyautoxin 2/3 to the anal sphincter produces immediate relaxation and a statistically significant decrease in the anal tone (p <0.001).
Assuntos
Canal Anal/efeitos dos fármacos , Toxinas Marinhas/farmacologia , Relaxamento Muscular , Tono Muscular/efeitos dos fármacos , Saxitoxina/análogos & derivados , Saxitoxina/farmacologia , Adulto , Canal Anal/fisiologia , Eletromiografia , Seguimentos , Humanos , Injeções Intramusculares , Masculino , Manometria , Toxinas Marinhas/administração & dosagem , Pessoa de Meia-Idade , Saxitoxina/administração & dosagemRESUMO
The primary clinical symptom of Paralytic Shellfish Poisoning is acute paralytic illness produced by paralyzing toxins. Paralytic shellfish poison is formed by a mixture of phycotoxins and their toxicity is due to its reversible binding to a receptor site on the voltage-gated sodium channel on excitable cells, thus blocking neuronal transmission. We studied the effect of the gonyautoxin 2/3 epimers by local infiltration in the anal internal sphincter of healthy voluntary adults in order to reduce anal tone. The toxin was injected after prior clinical evaluation, anoscopy and anorectal manometry. Post injection clinical examination, electromyography and anorectal manometry were performed. Resting and voluntary contraction pressures were measured and the anorectal inhibitory and anocortical reflexes were tested by manometry. Blood and urine samples were obtained from each participant, and hemogram, basic metabolic panel, and urinalysis were done both before and one week after the injection. This study shows, for the first time, that gonyautoxin 2/3 reduces the anal tone by relaxing the anal sphincters in 100 % of the participants. Manometric recordings showed a significant decrease in anal maximal voluntary contraction pressure after the toxin injection, dropping to 55.2 ± 6.2 % and 47.0 ± 6.8 % (Mean Value ± Std.Dev.) of the baseline values at 2 minutes and at 24 hours respectively after the injection. Post-injection electromyography showed that activity of the muscle was abolished. We conclude that local administration of gonyautoxin 2/3 to the anal sphincter produces immediate relaxation and a statistically significant decrease in the anal tone (p <0.001)..
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Canal Anal/efeitos dos fármacos , Relaxantes Musculares Centrais/farmacologia , Relaxamento Muscular/efeitos dos fármacos , Tono Muscular/efeitos dos fármacos , Saxitoxina/farmacologia , Eletromiografia , Injeções Intramusculares , ManometriaRESUMO
Se revisan 1.248 registros basales no estresantes realizados en el departamento de Ginecología y Obstetricia durante el período noviembre de 1987 a septiembre de 1988. Se seleccionan 65 casos con registro alterado, analizándose las siguientes variables: a) Alteraciones de otros métodos de evaluación de la unidad feto-placentaria. b) Circular de cordón. c) Tipo de Parto y d) Apgar al minuto y cinco minutos. En los casos con registros basales no estresantes hubo un incremento de circulares de cordón (36,9%) y de la resolución del parto por cesárea (32,4%), pero no se observaron alteraciones de la vitalidad del recién nacido cuantificada por el Apgar. Al comparar los casos con alteraciones de otros métodos de evaluación de la unidad feto-placentaria, con los que sólo mostraban un registro basal no estresante alterado, se observaron diferencias estadísticamente significativas en la presencia de circular de cordón y en la resolución del parto por cesárea
Assuntos
Gravidez , Recém-Nascido , Adolescente , Adulto , Humanos , Feminino , Monitorização Fetal , Frequência Cardíaca , Troca Materno-Fetal , Índice de Apgar , Cesárea , Estudos RetrospectivosRESUMO
Se estudió en forma experimental el efecto de la helonías dioica como fármaco hipoglicemiante en 20 ratas de la cepa Wister con diabetes inducida. La diabetes se indujo con aloxano administrado por vía endovenosa femoral y en dosis de 40 mgr por kilogramo. Estos animales se compararon con un grupo control de 20 ratas. El estudio duró 28 días, controlándose diariamente glicemia y consumo de alimento y de agua. El control de peso lo realizó día de por medio, siempre la misma persona. Las ratas diabéticas tuvieron un mayor consumo de agua al compararlas con las ratas sanas. Las ratas diabéticas tuvieron un mayor consumo de agua al compararlas con las ratas sanas. Se demostró un nivel menor de glicemia en las ratas diabéticas en tratamiento con helonías que en las diabéticas, que sólo recibieron solución fisiológica. La helonías dioica podría tener un efecto en los niveles plasmáticos de glucosa, pero se requiere mayor investigación al respecto
Assuntos
Ratos , Animais , Diabetes Mellitus Experimental , Aloxano/administração & dosagem , Glicemia , Estudos ProspectivosRESUMO
Los hallazgos más importantes en el grupo de madres adolescentes y de sus hijos fueron: 1. Frecuencia significativamente mayor de soltería (53,9% contra sólo 19,1%). 2. Porcentaje significativamente mayor de casos con peso de nacimiento bajo (9% contra 0,6%). 3. Mayor proporción de niños con cumplimiento de todos los controles de salud (69% contra 46%). 4. Calendario de vacunaciones completo en el 79,4%. 5. Ausencia de morbilidad durante el primer año de vida en el 19%. Más de 6 episodios de morbilidad en el 29% lo que es significativamente superior a los niños controles (13,7%). 6 Necesidad de hospitalización en el 15% de los caso, porcentaje que es similar al de los controles. 7. Calificación de alto riesgo en el 91% de los casos y sólo en el 48% de los controles, diferencia que es significativa