RESUMEN
INTRODUCTION: Quality is defined as an essential and distinguishing attribute of something, which allows to evaluate its worth. The quality evaluation has become something necessary during the last years. The assistencial quality should be something inherent to the offered service, including scientific and technical quality, management and quality noticed. A periodical assesment, as auto-evaluation or through an outsourcing, is a recommendable way to detect potential improvement items. MATERIAL AND METHODS: Using the EFQM,ISO 9001:2000 and Malcolm Baldrige model, and through the items from National Health System, a self-questionnaire of urological emergency room quality evaluation is proposed. CONCLUSION: A new self-questionnaire of urological emergency room quality evaluation is proposed.
Asunto(s)
Servicio de Urgencia en Hospital/normas , Garantía de la Calidad de Atención de Salud , Encuestas y Cuestionarios , Enfermedades Urológicas/terapia , HumanosRESUMEN
We present the clinical case of a 40 years male patient who, after a TURBt for non-muscle invasive recurrence with inadverted vesical perforation and Mitomycin C immediate instillation, come in his fourth postoperative day to the emergency room with severe irritative urinary symptomatology. An ultrasound was indicated, documenting a perivesical collection. The management was conservative with vesical drilling for 10 days and a puncture/drainage was necessary to solve it.
Asunto(s)
Carcinoma de Células Transicionales/complicaciones , Carcinoma de Células Transicionales/tratamiento farmacológico , Cistitis/inducido químicamente , Mitomicina/efectos adversos , Neoplasias de la Vejiga Urinaria/complicaciones , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Administración Intravesical , Adulto , Carcinoma de Células Transicionales/cirugía , Humanos , Masculino , Mitomicina/administración & dosificación , Rotura Espontánea , Índice de Severidad de la Enfermedad , Enfermedades de la Vejiga Urinaria/complicaciones , Neoplasias de la Vejiga Urinaria/cirugíaRESUMEN
Introducción: Definida calidad por la propiedad o conjunto de propiedades inherentes a algo, que permiten juzgar su valor, su evaluación se ha convertido en algo obligado en las últimas décadas. La calidad asistencial debe, por tanto, ser inherente al servicio ofrecido. Ha de incluir calidad científica, calidad técnica, gestión y calidad percibida. La evaluación periódica, bien a través de una empresa externa o como auto-evaluación, constituye una forma directa de detectar aspectos susceptibles de mejora. Material y métodos: Siguiendo los modelos Europeo de Excelencia empresarial (EFQM), la Norma ISO 9001:2000 y el modelo Malcom Baldrige, y partiendo de los indicadores clave del Sistema Nacional de Salud se crea un formulario de evaluación de la calidad global. Conclusiones: Se propone un cuestionario destinado a evaluar la calidad asistencial de un servicio de urgencias urológicas (AU)
Introduction: Quality is defined as an essential and distinguishing attribute of something, which allows to evaluate its worth. The quality evaluation has become something necessary during the last years. The assistencial quality should be something inherent to the offered service, including scientific and technical quality, management and quality noticed. A periodical assesment, as auto-evaluation or through an outsourcing, is a recommendable way to detect potential improvement items. Material and methods: Using the EFQM, ISO 9001:2000 and Malcolm Baldrige model, and through the items from National Health System, a self-questionnaire of urological emergency room quality evaluation is proposed. Conclusion: A new self-questionnaire of urological emergency room quality evaluation is proposed (AU)
Asunto(s)
Humanos , Masculino , Encuestas y Cuestionarios , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/tendencias , Estudio de Evaluación , Servicios Médicos de Urgencia/estadística & datos numéricos , Medicina de Emergencia/métodos , Medicina de Emergencia/tendencias , Control de Calidad , Atención Primaria de Salud/métodos , Garantía de la Calidad de Atención de Salud , Control de CalidadRESUMEN
Se trata de un paciente masculino de 40 años de edad quien, posterior a una RTU de recidiva de tumor no músculo invasivo sin perforación aparente e instilación inmediata de Mitomicina C, consultó al cuarto día postoperatorio a nuestro servicio de urgencias con sintomatología urinaria irritativa baja severa. Se solicitó una ecografía renovesical que evidenció una colección perivesical. El manejo fue conservador con sondaje vesical por 10 días siendo necesaria la punción-drenaje de la colección (AU)
We present the clinical case of a 40 years male patient who, after a TURBt for non-muscle invasive recurrence with inadverted vesical perforation and Mitomycin C immediate instillation, come in his fourth postoperative day to the emergency room with severe irritative urinary symptomatology. An ultrasound was indicated, documenting a perivesical collection. The management was conservative with vesical drilling for 10 days and a puncture/drainage was necessary to solve it (AU)
Asunto(s)
Humanos , Masculino , Adulto , Cistitis/inducido químicamente , Cistitis/complicaciones , Mitomicina/efectos adversos , Administración Intravesical , Enfermedades de la Vejiga Urinaria/tratamiento farmacológico , Neoplasias de la Vejiga Urinaria/inducido químicamente , Cistoscopía/métodos , Reflujo Vesicoureteral/complicaciones , Reflujo Vesicoureteral/diagnóstico , Instilación de Medicamentos , Vejiga Urinaria , Neoplasias de la Vejiga Urinaria/diagnóstico , Neoplasias de la Vejiga Urinaria/complicaciones , Cistitis/diagnóstico , Vejiga Urinaria/patología , Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/etiología , Pólipos/complicaciones , Pólipos/cirugía , Hidronefrosis/complicacionesRESUMEN
La técnica quirúrgica para el cierre de la pared abdominal se basa a menudo en la tradición más que en la evidencia. Un conocimiento de la función dinámica de la pared abdominal es esencial para su cierre adecuado. Es necesario que los cirujanos identifiquen y utilicen técnicas y materiales apropiados para minimizar la incidencia de fallos incisionales como la evisceración y la eventración. Los errores técnicos locales como el cierre bajo tensión (mala relajación) que estrangula la fascia y la toma inadecuada de tejido con la sutura son las causa más frecuentes de eventración (AU)
Abdominal wall closure surgical practice continues to rely largely on tradition rather tan evidence. We do need to identify appropriate technique and suture material in order to achieve a lower rate of incisional hernia. Local technical errors as high tension closure which stretches fascia and an inadequate fascia´s margin with suture are the most frequent causes of incisional hernia (AU)
Asunto(s)
Humanos , Pared Abdominal/cirugía , Laparotomía/métodos , Laparotomía/efectos adversos , Eventración Diafragmática/cirugía , Suturas , Dehiscencia de la Herida Operatoria/etiología , Dehiscencia de la Herida Operatoria/cirugíaRESUMEN
BACKGROUND: One of the prostate cancer progression complications is the obstructive uropathy, by infiltration and compression of the distal ureteral section, that can entail to an acute renal insufficiency, with affectation of the quality of life and the survival of these patients. The treatment of prostate cancer with secondary ureterohidronefrosis is palliative and following the present tendencies, the positioning of a nephrostomy is considered. MATERIALS AND METHODS: A search was made in PUBMED and the most representative articles were reviewed. The algorithm was constructed with the daily routine clinical base, the protocol of our center and with the scientific evidence available in medical literature. RESULTS: An algorithm of decisions sets out to define the urinary derivation in patients with obstructive uropathy secondary to prostate cancer. CONCLUSIONS: The indication to place a nephrostomy in patients with obstructive uropathy secondary to prostate cancer must be approached individually, according to the general conditions and the quality of life of the patient with base in scales defined in literature (ECOG and Karnofsky) and in factors of good or bad prognosis, always considering ethical considerations and the consent of the patient and his family.
Asunto(s)
Algoritmos , Neoplasias de la Próstata/complicaciones , Obstrucción Ureteral/etiología , Obstrucción Ureteral/terapia , Humanos , MasculinoRESUMEN
Introducción: Una de las complicaciones de la progresión del cáncer de próstata es la uropatía obstructiva, por infiltración y compresión del tramo ureteral distal, que puede conllevar a una insuficiencia renal aguda, con afectación de la calidad de vida y la supervivencia de estos pacientes. El tratamiento del cáncer de próstata con ureterohidronefrosis secundaria es paliativo y siguiendo las tendencias actuales, se debe considerar la colocación de una nefrostomía. Materiales y Métodos: Se realizó una búsqueda en PUBMED y se revisaron los artículos más representativos. El algoritmo se construyó con base en la práctica clínica diaria basada en la rutina, el protocolo de nuestro centro y con la evidencia científica disponible en la literatura médica. Resultados: Se propone un algoritmo de decisiones para definir la derivación urinaria en pacientes con uropatía obstructiva secundaria a cáncer de próstata. Conclusiones: La indicación de colocar una nefrostomía en pacientes con uropatía obstructiva secundaria a cáncer de próstata debe abordarse individualmente, de acuerdo a las condiciones generales y la calidad de vida del paciente con base en escalas ya definidas en la literatura (ECOG y Karnofsky) y en factores de buen o mal pronóstico, siempre teniendo en cuenta consideraciones éticas y el consentimiento del paciente y de su familia (AU)
Background: One of the prostate cancer progression complications is the obstructive uropathy, by infiltration and compression of the distal ureteral section, that can entail to an acute renal insufficiency, with affectation of the quality of life and the survival of these patients. The treatment of prostate cancer with secondary ureterohidronefrosis is palliative and following the present tendencies, the positioning of a nephrostomy is considered. Materials and Methods: A search was made in PUBMED and the most representative articles were reviewed. The algorithm was constructed with the daily routine clinical base, the protocol of our center and with the scientific evidence available in medical literature. Results: An algorithm of decisions sets out to define the urinary derivation in patients with obstructive uropathy secondary to prostate cancer. Conclusions: The indication to place a nephrostomy in patients with obstructive uropathy secondary to prostate cancer must be approached individually, according to the general conditions and the quality of life of the patient with base in scales defined in literature (ECOG and Karnofsky) and in factors of good or bad prognosis, always considering ethical considerations and the consent of the patient and his family (AU)
Asunto(s)
Humanos , Neoplasias de la Próstata/complicaciones , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Algoritmos , Nefrostomía Percutánea , PronósticoRESUMEN
Introduction. The small renal masses (SRMs) have increased over the past two decades due to more liberal use of imaging techniques. SRMs have allowed discussions regarding their prognostic, diagnosis, and therapeutic approach. Materials and methods. Clinical presentation, incidental diagnosis, and prognosis factors of SRMs are discussed in this review. Results. SRMs are defined as lesions less than 4 cm in diameter. SRM could be benign, and most malignant SMRs are low stage and low grade. Clinical symptoms like hematuria are very rare, being diagnosed by chance (incidental) in most cases. Size, stage, and grade are still the most consistent prognosis factors in (RCC). An enhanced contrast SRM that grows during active surveillance is clearly malignant, and its aggressive potential increases in those greater than 3 cm. Clear cell carcinoma is the most frequent cellular type of malign SRM. Conclusions. Only some SRMs are benign. The great majority of malign SRMs have good prognosis (low stage and grade, no metastasis) with open or laparoscopic surgical treatment (nephron sparing techniques). Active surveillance is an accepted attitude in selected cases.
RESUMEN
No disponible
Asunto(s)
Enfermedades Urológicas/epidemiología , Enfermedades Urológicas/historia , Procedimientos Quirúrgicos Urológicos/educación , Procedimientos Quirúrgicos Urológicos/historia , Mycobacterium bovis/aislamiento & purificación , Vacuna BCG/inmunología , Neoplasias de la Vejiga Urinaria/epidemiología , Enfermedades de la Vejiga Urinaria/diagnóstico , Enfermedades de la Vejiga Urinaria/epidemiología , Urología/historia , Urología/educación , Urología/tendencias , Urología/organización & administración , Anticuerpos Antineoplásicos , Ensayos de Selección de Medicamentos Antitumorales , Estudios ProspectivosRESUMEN
Evaluar el fenómeno pT0 en cáncer vesical en nuestra institución y realizar una revisón en la literatura. Entre agosto de 1978 y junio de 2002, 1.114 pacientes fueron sometidos a cistectomía radical en nuestra institución por carcinoma vesical infiltrante. Se realizó una revisón bibliográfica a partir de los estudios publicados en la base de datos Pubmed entre 1981 y 2006. Del total de casos, 141 (12,65%) presentaron estadío pT0. La mediana de seguimiento fue de 42,50 meses (1,03-246). Se estudiaron la supervivencia global y cáncer específica de nuevas publicaciones. A pesar de la buena evolución clínica de la mayoría de los pacientes con estadía pT0 después de cistectomía radical, no se puede considerar a estos pacientes como curados de su enfermedad con tasas de supervivencia global y cáncer específica similares a aquellos con esta´dio superficial o confinado al músculo en la pieza de cistectomía; por lo cual deben ser controlados de manera similar a pacientes con tumor en la pieza de cistectomía
To evaluate the phenomenon pT0 in vesical carcinoma at our institution and to make a literature review. Between August 1978 and June 2002, 1.114 patients were subjected to a radical cystectomy at our institution due to an infiltration vesical carcinoma. A bibliographical review was realized from the studies published in the base of Pubmed information between 1981 and 2006. Of the whole of cases, 141 (12,65%) presented a pT0 phase. The average of the monitoring was of 42.50 months (1.03-246). It was studied the global survival and specific caqrcinoma, as well as the clinical and associated pathological factors with the survival that they will be a motive of new publications. In spite of the good clinical evolution of the majoritiy of the patients with a pT0 phase after the radical cystectomy, they can´t be considered like treated of its disease with rates of global survival and specific carcinoma similar to those with superficial or confined phase in the muscle in the piece of cystectomy; for which they must be controlled of similar way to patients with a tumor in the piece of cystectomy
Asunto(s)
Humanos , Carcinoma/complicaciones , Carcinoma/diagnóstico , Cistectomía/métodos , Neoplasias de la Vejiga Urinaria/diagnóstico , Factores de Riesgo , Carcinoma/tratamiento farmacológico , Cistectomía/estadística & datos numéricos , Adyuvantes Farmacéuticos/uso terapéutico , Adyuvantes Anestésicos/uso terapéutico , Estudios Retrospectivos , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Neoplasias de la Vejiga Urinaria/radioterapiaRESUMEN
In this work, a flow analysis procedure for the determination of copper, chromium, iron and lead in lubricating oils using flame AAS as detection technique is described. The flow manifold was designed to implement the multicommutation approach and it comprised three 3-way solenoid valves controlled by a personal computer. The flow system presented allowed to process the oil samples to determine wear metals without any prior preparation. Aiming to assess accuracy the results were compared with those obtained by manual procedure using flame AAS. Applying the joint-confidence ellipse test, no significant difference at the 95% confidence level was observed. Other profitable features such as a sample throughput of 50 determinations per hour; relative standard deviations (n = 5) below 2% for Cu, and below 8% for Cr, Fe and Pb; and linear responses in the range 0-40ppm (w/w) (Cu, Fe) and 0-15ppm (w/w) (Cr, Pb) were also achieved.
RESUMEN
Insolubles determination is one of the parameters usually recommended to evaluate the residual life of oil because their presence at elevated levels in diesel lubricating oil changes the viscosity, prematurely clogs filters and is one of the major factors in causing abrasive engine wear. The proposed method employs visible spectrophotometric detection in association with flow injection analysis. The results obtained by this method were compared with the ones obtained by Fourier transform infrared spectrometry (FT-IR) since this is the most employed method for insolubles determination. The proposed method presented a linear response from 0 to 3% (w/w) of insolubles in pentane (ASTM D-893). The sampling frequency was about 30 samplesh(-1), with a relative standard deviation (n=5) of 2.4% or better. Accuracy was evaluated analysing 98 real samples and the results obtained with the FIA-spectrophotometric method were plotted against those obtained by the FT-IR method by means of linear regression. Slope and intercept of the straight line obtained were compared with the theoretical values of 1 and 0 by means of the joint-confidence ellipse F-test. At the confidence level of 95% no evidence of a difference was found between both methods.
RESUMEN
We report a rare case of congenital retinal macrovessel with decreased visual acuity, with a 14-year follow-up. Both the clinical findings and the visual acuity remained unchanged throughout the follow-up period.
Asunto(s)
Arteria Retiniana/anomalías , Enfermedades de la Retina/congénito , Vena Retiniana/anomalías , Agudeza Visual , Preescolar , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Fondo de Ojo , Humanos , Enfermedades de la Retina/diagnósticoAsunto(s)
Negro de Almidón/química , Membranas Artificiales , Polivinilos/química , Proteínas/química , Coloración y Etiquetado/métodos , Compuestos Azo/química , Concentración de Iones de Hidrógeno , Metanol , Desnaturalización Proteica , Colorantes de Rosanilina/química , Albúmina Sérica Bovina/química , Tiroglobulina/química , AguaAsunto(s)
Agonistas alfa-Adrenérgicos/uso terapéutico , Antagonistas Adrenérgicos beta/uso terapéutico , Betaxolol/uso terapéutico , Clonidina/análogos & derivados , Glaucoma de Ángulo Abierto/tratamiento farmacológico , Presión Intraocular/efectos de los fármacos , Adolescente , Agonistas alfa-Adrenérgicos/administración & dosificación , Agonistas alfa-Adrenérgicos/efectos adversos , Antagonistas Adrenérgicos beta/administración & dosificación , Antagonistas Adrenérgicos beta/efectos adversos , Adulto , Anciano , Betaxolol/administración & dosificación , Betaxolol/efectos adversos , Enfermedad Crónica , Ritmo Circadiano , Clonidina/administración & dosificación , Clonidina/efectos adversos , Clonidina/uso terapéutico , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Soluciones Oftálmicas , Método Simple Ciego , Suspensiones , Resultado del TratamientoRESUMEN
The results obtained at the end of the first three years of a hepatitis B vaccination campaign in Campania, are reported. HEVAC-B and H-B-VAX proved innocuous and efficacious in producing anti-HBs. Newborn babies and children produced anti-HBs more often and with higher titres than adults. Titre 10 mUI/ml of anti-HBs persisted, in the responders for at least 36 months on average. AVH by HBV was observed in two adult non responders. Transplacental or delivery infection was observed in 9.3% of the babies born of HBsAg positive mothers and more often among babies born of HBeAg positive mothers. Infection by HBV was observed in 6.0% of the babies, in 4.0% of the children and in 12.0% of the adults, in spite of the production of anti-HBs. HB-antigenemia, was as a rule transitory, but sometimes fluctuating or persistent. Careful observation during a prolonged follow up is necessary for these subjects.
Asunto(s)
Hepatitis B/prevención & control , Inmunización , Recién Nacido/inmunología , Adulto , Niño , Femenino , Estudios de Seguimiento , Promoción de la Salud , Hepatitis B/inmunología , Hepatitis B/transmisión , Anticuerpos contra la Hepatitis B/análisis , Antígenos de Superficie de la Hepatitis B/inmunología , Vacunas contra Hepatitis B , Humanos , Inmunización/efectos adversos , Esquemas de Inmunización , Italia , Cooperación del Paciente , Embarazo , Complicaciones Infecciosas del Embarazo/transmisión , Vacunas contra Hepatitis Viral/administración & dosificaciónRESUMEN
A previous study of 159 consecutive cases of HBsAg+ acute viral hepatitis, observed from the onset of disease and seen between May 1977 and May 1980, revealed a higher frequency of evolution to chronicity in the region of Naples than that reported for other areas. This suggested that environmental factors might influence the chronically rate. We investigated 125 HBsAg+ acute hepatitis cases for whom sera were available: 35 patients who remained HBsAg+ at the two-year control (28 chronic hepatitis and 7 healthy carriers) and 90 who recovered and seroconverted HBsAg---- anti-HBs during follow-up. At the onset of disease, all patients who cleared HBsAg showed IgM anti-HBc positivity and 48 were also HBeAg positive; no patient was anti-delta positive. On the contrary of the 28 chronic cases only 7 were IgM anti-HBc+ (6 under 13 years old), while 21 were IgM anti-HBc- but anti-delta+. This study demonstrates that not all HBsAg+ acute hepatitis cases are due to HBV and that in our area, superinfection by the delta agent is responsible for most cases of chronic HBsAg positive hepatitis.