RESUMEN

BACKGROUND: Skills labs and simulation centers have become an integrated part of teaching methods in many medical schools. This study aims to describe the status of simulation in medical education in Iceland by examining student and faculty experience, facilitating and barring factors for its use in teaching and how the concept appears in the Course Catalog. MATERIALS AND METHODS: The study was threefold. In parts one and two, electronic surveys were sent to students and faculty members at the Faculty of Medicine, University of Iceland. Part three was a key word search in the University´s course catalogue relating to simulation. RESULTS: Response rate for both student and faculty surveys was 65%. Simulation as a teaching method was reported for 10% of faculty according to students but approximately a third of faculty, according to faculty. Attitudes of students and faculty were positive. Faculty, previously exposed to simulation, were more likely to use simulation, as were those who had received training in educational methods. Main barriers identified were lack of facilities, equipment, funds, and training. Key words related to simulation appeared rarely in the University Course Catalogue. CONCLUSION: Student and faculty experience with simulation is limited, less than third of faculty claim to have used simulation when teaching medical students. Barring factors in Iceland are similar to what has been reported elsewhere. Lack of words describing simulation in the Course Catalog may raise questions about emphasis on teaching methods or lack thereof. Potential ways to increase the use of simulation could be to improve infrastructure and offer training in diverse educational methods, including simulation, to selected faculty.

Asunto(s)

Educación Médica , Medicina , Humanos , Islandia , Facultades de Medicina , Universidades

RESUMEN

INTRODUCTION: Self-expandable metal stents (SEMS) are a known treatment option for obstruction due to colorectal cancer. The objective of this project was to estimate the usage of such stents in Iceland between 2000-2018. We evaluated the number of patients who received the stent as a bridge to surgery (BtoS) or as a palliative therapy (PT) and evaluated complication rate and the technical and clinical success rate. MATERIAL AND METHODS: Retrospective review of patients in Landspitali University Hospital who received SEMS for malignant colorectal obstruction. Search was conducted using diagnostic and theraputic codes in the Icelandic electronic medical record system. RESULTS: A total of 43 patients with colorectal cancer received in total 53 SEMS for obstruction, the first patient in 2005. More patient received SEMS as PT (n=27) than as BtoS (n=16). Colon perforation occurred in 5 patients (12%). A resection with primary anastomosis was performed in 69% of the BtoS patients. The majority of the PT patients did not receive an operation (63%). Permanent stoma ratio was 27% for BtoS patients and 22% for PT patients. CONCLUSION: SEMS served as BtoS with resection and primary anastomosis for the majority of patients in the BtoS group. For a majority of patients in the PT group, SEMS could be used to avoid surgery. The perforation rate was relatively high. Information on techincal and clinical success was poorly recorded. Because of the retrospective nature of the study and the small population size all results should be interpreted with caution.

Asunto(s)

Enfermedades del Colon/terapia , Neoplasias Colorrectales/complicaciones , Obstrucción Intestinal/terapia , Cuidados Paliativos , Enfermedades del Recto/terapia , Stents Metálicos Autoexpandibles , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/etiología , Neoplasias Colorrectales/diagnóstico , Registros Electrónicos de Salud , Femenino , Humanos , Islandia , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/etiología , Perforación Intestinal/etiología , Masculino , Persona de Mediana Edad , Enfermedades del Recto/diagnóstico , Enfermedades del Recto/etiología , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven

RESUMEN

BACKGROUND: Peritoneal carcinomatosis is a known complication of colorectal cancer and has long been considered very difficult to manage. The survival has been reported to be under two years after systemic chemotherapy with or without palliative surgery. The most recent method of treatment is compiled of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) and has been suggested to significantly increase survival. The aim of this study was to research the cases of Icelandic patients undergoing this treatment overseas and the impact it has had on their disease. METHODS: A retrospective study of all Icelandic patients who have undergone CRS-HIPEC treatment abroad 2008-2017. Information was retrieved from medical records and from registry of the Icelandic Health Insurance committee of medical treatments abroad. RESULTS: A total of 11 patients have undergone CRS-HIPEC treatment after having received their initial treatment in Landspitali University Hospital. All of the surgeries were performed in the United States by the same surgeon in the years 2008-2017. The group consists of 10 women and 1 man with a mean age of 53 years. The cause of peritoneal carcinomatosis was appendiceal cancer for 7 patients (67%) and colon cancer for 3 patients (27%). One patient had a primary malignancy of the peritoneum, mesothelioma. Three patients suffered complications within 30 days of surgery, 2 had infection and 1 had an anastomotic leak. Another patient had a late complication of bowel stenosis and later a fistula. Five patients have completed their five year observation period post surgery without diagnosis of recurrence and mean follow-up time was 44 months. Out of 11 patients, 10 are still alive. Five have been diagnosed with recurrence of disease. CONCLUSION: Icelandic patients who have undergone CRS-HIPEC treatment have in most cases done well and survival is comparable to other studies. Half of the survivors did not have recurrence of disease within 5 years of surgery. Prognosis has improved since the introduction of this treatment and every reason to keep sending selected Icelandic patients abroad to receive it.

Asunto(s)

Neoplasias del Apéndice/terapia , Neoplasias del Colon/terapia , Procedimientos Quirúrgicos de Citorreducción , Quimioterapia Intraperitoneal Hipertérmica , Turismo Médico , Neoplasias Peritoneales/terapia , Adulto , Anciano , Neoplasias del Apéndice/mortalidad , Neoplasias del Apéndice/patología , Neoplasias del Colon/mortalidad , Neoplasias del Colon/patología , Procedimientos Quirúrgicos de Citorreducción/efectos adversos , Procedimientos Quirúrgicos de Citorreducción/mortalidad , Supervivencia sin Enfermedad , Femenino , Humanos , Quimioterapia Intraperitoneal Hipertérmica/efectos adversos , Quimioterapia Intraperitoneal Hipertérmica/mortalidad , Islandia , Masculino , Persona de Mediana Edad , Seguridad del Paciente , Neoplasias Peritoneales/mortalidad , Neoplasias Peritoneales/secundario , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo

RESUMEN

Lipomas are slow-growing, benign soft tissue tumors that are typically asymptomatic. We describe the case of a 52 year old female, severely overweight who presented with an 8 month history of slowly progressive large lower abdomi-nal mass. Clinical workup gave an indication of a subcutaneous lipoma. The patient underwent open surgery where the mass was removed. Pathology results revealed a lipoma without malignancy. Lipomas only require treatment when they are symptomatic or to rule out malig-nancy. Giant lipomas are defined as a lesion that are over 10 cm in length or weigh more than 1000 grams.

Asunto(s)

Neoplasias Abdominales/patología , Lipoma/patología , Carga Tumoral , Neoplasias Abdominales/cirugía , Biopsia , Femenino , Humanos , Lipoma/cirugía , Persona de Mediana Edad

RESUMEN

Backround Sigmoid volvulus is an uncommon cause of bowel obstruction in most western societies. Treatment options include colonoscopy in uncomplicated disease with elective surgery later on. The aim of this study was to assess what treatment sigmoid volvulus patients receive along with long-term outcomes at Landspitali University Hospital. Methods The study was retrospective. Patients diagnosed with sigmoid volvulus at Landspitali University Hospital from 2000-2013 were included. Information regarding age, sex, and duration of hospital stay, treatment, short and long-term outcomes were gathered. Results Forty-nine patients were included in the study, of which 29 men and 20 women. Mean age was 74 (25-93). One patient underwent acute surgery on first arrival due to signs of peritonitis. Others (n=48) were treated conservatively in the first attempt with colonoscopy (n=45), barium enema (n=2) and rectal tube (n=1). Three other patients underwent acute surgery due to failed colonoscopy, 8 patients had planned surgery during the index admission. Thirty-six patients were discharged after conservative treatment with colonoscopy (n=35), barium enema (n=1) or rectal tube (n=1). Two patients came in for elec-tive surgery later on. Twenty-two patients (61%) had recurrence. Median time to recurrence was 101 days (1-803). Disease-free probability in 3, 6 and 24 months was 66%, 55% and 22% respec-tively. Total disease related mortality was 10.2%. Mortality (30 days) after acute surgery was 25% (1/4) and 16,6% (3/18) after planned surgery. Conclusions Sigmoid volvulus has high recurrence rate if not treated operatively. Total mortality due to sigmoid volvulus at Landspitali is low but surgery related mortality high.

Asunto(s)

Tratamiento Conservador , Procedimientos Quirúrgicos del Sistema Digestivo , Vólvulo Intestinal/terapia , Enfermedades del Sigmoide/terapia , Adulto , Anciano , Anciano de 80 o más Años , Enema Opaco , Colonoscopía , Tratamiento Conservador/efectos adversos , Tratamiento Conservador/mortalidad , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/mortalidad , Femenino , Hospitales Universitarios , Humanos , Islandia/epidemiología , Vólvulo Intestinal/diagnóstico , Vólvulo Intestinal/mortalidad , Tiempo de Internación , Masculino , Persona de Mediana Edad , Supervivencia sin Progresión , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Enfermedades del Sigmoide/diagnóstico , Enfermedades del Sigmoide/mortalidad , Factores de Tiempo

Asunto(s)

Competencia Clínica , Médicos Mujeres , Mujeres Trabajadoras , Femenino , Humanos , Masculino , Factores Sexuales

RESUMEN

BACKGROUND: Rectal cancer makes up 2-3% of all cancers in Iceland and surgery is the mainstay of its treatment. Information regarding those who undergo resection of the rectum because of rectal cancer or its precursors in Iceland today is lacking. The aim of this study was to evaluate what kind of surgical treatment rectal cancer patients receive at Landspitali University Hospital along with peri-operative and long-term outcomes. METHODS: The study was retrospective. All patients undergoing total or partial resection of the rectum for rectal cancer or its precursor from 2008-2012 in Landspitali University hospital were included. Information regarding age, sex, surgery, neoadjuvant and adjuvant treatment along with reoperations and survival were gathered. RESULTS: The total number of patients included were 144. Mean age was 66 years (33-89). Neoadjuvant treatment was used in 65 (45%) cases. Most of the patients (65%) underwent anterior resection of the rectum, 21% abdominoperineal resection, 11% Hartmann´s procedure and 3% other surgery. Majority of the patients had a cancer diagnoses (88%) but 12% had dysplastic adenomas. An anastomosis was made in 67% of cases, others (33%) got a permanent stoma. Reoperation rate within 30 days was 12%. Thirty day and 1 year mortality were 0.7% and 6.2% respectively. Average follow up time was 56 months (1-98). Local recurrence rate was 7,1%, five year survival rate was 77%. CONCLUSION: The surgical treatment for rectal cancer in Landspitali is up to international standard. Perioperative and long-term outcomes are similar to what other authors have reported.

Asunto(s)

Procedimientos Quirúrgicos del Sistema Digestivo , Hospitales Universitarios , Lesiones Precancerosas/cirugía , Neoplasias del Recto/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/mortalidad , Femenino , Humanos , Islandia/epidemiología , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/cirugía , Lesiones Precancerosas/diagnóstico , Lesiones Precancerosas/mortalidad , Neoplasias del Recto/diagnóstico , Neoplasias del Recto/mortalidad , Reoperación , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

INTRODUCTION: Colon perforation is a serious illness with mortality reported from 0-39%. Surgery used to be the gold standard but treatment has changed as studies have indicated comparable results with less invasive treatment. The aim of this study was to evaluate the incidence of acute colon perforations in Iceland, causes and treatment. MATERIAL AND METHODS: A retrospective, nationwide, multicenter analysis was performed based on ICD-10 codes from databases of the main hospitals in Iceland. Age, gender, year of perforation, cause, means of diagnosis, treatment and outcome were registered. Patients under 18 years and post mortem diagnosis were excluded. RESULTS: 225 patients met criteria, 131 women (58%) and 94 men (42%), median age 70 years (range 30-95). The most common causes were diverticulitis (67%), colonoscopy (12%) and complications during operations (5%). During the first five study years, 27% received conservative treatment while 71% underwent surgery. By the end of the study era this ratio was 45% and 54% respectively. The rate of permanent stoma was 10%. CONCLUSIONS: Diverticulitis was the most common cause of colon perforation in Iceland during the study period. Many patients still undergo surgery but there has been a dramatic change toward more conservative treatment. The rate of stoma closure is comparable to studies elsewhere. 1University Hospital of Iceland, Dept. General Surgery, 2University of Iceland, Faculty of Medicine, 3Akureyri Teaching Hospital, 4Akranes Hospital and Health Care Center, Iceland. Key words: Colon perforation, diverticulitis, Hartmann's reversal. Correspondence: Elsa B. Valsdottir, elsava@landspitali.is.

Asunto(s)

Enfermedades del Colon/epidemiología , Enfermedades del Colon/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo , Perforación Intestinal/epidemiología , Perforación Intestinal/cirugía , Estomas Quirúrgicos , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/mortalidad , Bases de Datos Factuales , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/mortalidad , Femenino , Humanos , Islandia/epidemiología , Incidencia , Perforación Intestinal/diagnóstico , Perforación Intestinal/mortalidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Estomas Quirúrgicos/efectos adversos , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

BACKGROUND: Transanal abdominal transanal proctectomy is a sphincter-preserving procedure designed to avoid colostomy in patients with cancer in the distal third of the rectum. Oncologic outcomes of this procedure have been established. However, data regarding patient satisfaction and quality of life are scant. OBJECTIVE: The purpose of this study was to evaluate the quality of life and functional outcomes of patients after transanal abdominal transanal proctectomy. DESIGN: This is a cross-sectional study. SETTINGS: The study was conducted at a tertiary referral colorectal center. PATIENTS: Patients who underwent transanal abdominal transanal proctectomy were included and surveyed using the Fecal Incontinence Quality of Life Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, the Quality of Life Questionnaire CR38 module, and a questionnaire designed by the authors to assess satisfaction with quality of life. MAIN OUTCOME MEASURES: Quality of life, functional outcomes, and patient satisfaction were measured and compared by age, tumor level, and stage of the disease. RESULTS: A total of 133 surveys were mailed, and 90 patients responded and were included in the study. Patient quality of life was not significantly different after surgery. Patients with more proximal tumors had better lifestyle, physical, and emotional scores. Older patients performed better on multiple levels, including coping, emotional, body image, future perspective, and digestive. Stage of disease had no impact on quality of life. Compared with reference values, patients who underwent transanal abdominal transanal proctectomy performed better on most of the components. All of patients preferred transanal abdominal transanal proctectomy over having a stoma based on their current anal sphincter function, and >97% of patients preferred transanal abdominal transanal proctectomy based on their current quality of life, sexual function, and level of activities. LIMITATIONS: This study is limited by the lack of a comparison group and a potential selection bias. CONCLUSIONS: Satisfaction with quality of life and functional outcomes is high after transanal abdominal transanal proctectomy. Older patients and those with more proximal tumors performed better. This patient population clearly preferred a sphincter-preserving option for treatment of their rectal cancer.

Asunto(s)

Incontinencia Fecal/etiología , Complicaciones Posoperatorias/etiología , Proctoscopía/métodos , Calidad de Vida , Neoplasias del Recto/cirugía , Recto/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Reservorios Cólicos , Estudios Transversales , Incontinencia Fecal/psicología , Femenino , Estudios de Seguimiento , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Complicaciones Posoperatorias/psicología , Estudios Prospectivos , Calidad de Vida/psicología , Neoplasias del Recto/psicología , Encuestas y Cuestionarios

RESUMEN

INTRODUCTION: A significant proportion of patients with ulcerative colitis (UC) undergo colectomy. The aim was to assess the quality of life (QOL) of these patients. MATERIAL AND METHODS: All patients with UC who underwent colectomy at The National University Hospital of Iceland or Akureyri Hospital 1995-2009 were included. 106 patients received three questionnaires. SF-36v2 and EORTC are standardised QOL-questionnaires. The third contained functional questions designed by the researchers. RESULTS: Eighty-three patients replied (78%), 45 men (54%) and 38 women (46%). Average age at operation was 45 years (10-91 years). Forty-four (53%) had ileostomy, 28 (34%) ileal pouch-anal anastomosis (IPAA) and 11 (13%) ileorectal anastomosis. Among patients who had the rectum removed 37% described changes in urinary habits and 46% in sexual life after surgery. Among patients with IPAA 75% admitted to faecal incontinence but this was mild according to Wexner's scale in 83% of the cases. According to SF-36v2 there was no significant difference in the QOL of colectomy patients compared to the general population. Patients generally felt good about their health, body image and weight and had mild symptoms according to EORTC QLQ-CR29. CONCLUSIONS: Urinary habits and sexual life were commonly affected after rectal removal. Faecal incontinence among IPAA-patients was much more common than expected. There was not much difference in quality of life compared to the general population. The results of the study are important for patient education and may aid them in their decision making since removing the colon or having a stoma does not seem to affect quality of life. Key words: Quality of life, ulcerative colitis, ileostomy, colectomy. Correspondence: Elsa B. Valsdottir, elsava@landspitali.is.

Asunto(s)

Colectomía , Colitis Ulcerosa/cirugía , Reservorios Cólicos , Ileostomía , Calidad de Vida , Adaptación Psicológica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Colectomía/efectos adversos , Colitis Ulcerosa/diagnóstico , Colitis Ulcerosa/fisiopatología , Colitis Ulcerosa/psicología , Reservorios Cólicos/efectos adversos , Incontinencia Fecal/etiología , Incontinencia Fecal/fisiopatología , Incontinencia Fecal/psicología , Femenino , Hospitales Universitarios , Humanos , Islandia , Ileostomía/efectos adversos , Ileostomía/psicología , Masculino , Persona de Mediana Edad , Conducta Sexual , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Micción , Adulto Joven

RESUMEN

INTRODUCTION: Symptoms of choledocholithiasis can appear after cholecystectomy. Stones diagnosed during the first two years following surgery are assumed to have been present at the time of surgery. The purpose of this study was to study patients who presented with choledocholithiasis at Landspitali--The National University Hospital of Iceland, during the period 2008-2011, who had previously undergone cholecystecomy and to assess whether cholodocholithiasis is underdiagnosed at the time of cholecystectomy. MATERIAL AND METHODS: The study was retrospective, data was collected from medical records at Landspitali. Among recorded data were liver function tests, imaging results, time from surgery to diagnosis, treatment and complications. RESULTS: Forty patients presented with choledocholithiasis after previous cholecystectomy. Mean age was 50 years (20-89) and women were 24 (60%). Mean time from surgery to diagnosis was 382 days. Diagnosis was confirmed with imaging in 35 (87.5% cases). Thirty six (90%) patients were treated with ERCP, one with PTC and one underwent open surgery. Three patients healed without treatment. Three patients developed complications from treatment. Thirty one (77.5%) had choledocholithiasis in the first 2 years following surgery. Incidence of previous choledocholithiasis, elevated bilirubin or widening of the choledochus without visible stones where similar for those diagnosed with choledocholithiasis in the first two years and those diagnosed later. CONCLUSION: Majority of patients are treated without surgery. Most stones are diagnosed during the first two years following surgery. For the majority of cases it can not be concluded that stones should have been suspected at time of cholecystectomy.

Asunto(s)

Colecistectomía/efectos adversos , Coledocolitiasis/epidemiología , Cálculos Biliares/cirugía , Hospitales Universitarios , Adulto , Anciano , Anciano de 80 o más Años , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitiasis/diagnóstico , Coledocolitiasis/terapia , Femenino , Cálculos Biliares/diagnóstico , Cálculos Biliares/epidemiología , Humanos , Islandia/epidemiología , Incidencia , Estimación de Kaplan-Meier , Masculino , Registros Médicos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Recurrencia , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven

RESUMEN

Negative pressure wound therapy (NPWT) is a new therapeutic option in wound healing and was first described in its present form in 1997. A vacuum source is used to create sub-atmospheric pressure in the local wound environment to promote healing. This is achieved by connecting a vacuum pump to a tube that is threaded into a wound gauze or foam filler dressing covered with a drape. This concept in wound treatment has been shown to be useful in treating different wound infections, including diabetic wounds as well as complex infections of the abdomen and thorax. NPWT has been used in Iceland for over a decade and its use is steadily increasing. This review describes the indications and outcome of NPWT and is aimed at a broad group of doctors and nurses where recent Icelandic studies on the subject are covered.

Asunto(s)

Terapia de Presión Negativa para Heridas , Cicatrización de Heridas , Diseño de Equipo , Humanos , Islandia , Terapia de Presión Negativa para Heridas/instrumentación , Resultado del Tratamiento

RESUMEN

BACKGROUND: Transanal endoscopic microsurgery (TEM) is a minimally invasive treatment used to excise a variety of rectal lesions. Potential overstretching of the sphincter's musculature due to dilation of the anal canal to allow placement of a 40-mm-wide scope combined with partial resection of the rectum and subsequent loss of rectal volume creates a concern regarding anorectal function postoperatively. Data regarding patient satisfaction with anorectal function and quality of life after TEM are scant. This report presents data on patient satisfaction gathered during a period of 10 years. METHODS: A prospectively maintained database of patients undergoing TEM from 1997 to 2007 was queried to identify patients to survey using the Fecal Incontinence Quality of Life Scale questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) questionnaire version 3, and a questionnaire designed by the authors to assess satisfaction with quality of life. From a group of 86 patients, 57 (66 %) responded to the questionnaires. Patient satisfaction outcomes were determined by age, preoperative diagnosis, tumor level in the rectum, excision method, and radiation treatment. RESULTS: Most of the patients (94.7 %) preferred TEM to having a stoma. Age (p = 0.03) and nature of the lesion (p = 0.03) were the only factors that affected coping. Depression was affected only by the presence of malignancy (p = 0.001). Excision method was the only factor that significantly influenced overall lifestyle (p = 0.002). Neither tumor level (p = 0.8) nor radiation therapy (p = 0.9) affected patient satisfaction with lifestyle after TEM. The presence of malignancy (p = 0.004) and full-thickness excision (p = 0.02) were related to more problems with fecal incontinence. CONCLUSION: Satisfaction with fecal continence generally is high after TEM. Tumor level, size of tumor, and radiation therapy do not affect the level of satisfaction after TEM. Younger age and benign nature of the lesion help patients to cope better with lifestyle changes and reduce depression. Patients with submucosal excision have a significantly higher level of satisfaction.

Asunto(s)

Incontinencia Fecal/psicología , Microcirugia/efectos adversos , Complicaciones Posoperatorias/psicología , Calidad de Vida , Neoplasias del Recto/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Colonoscopía , Incontinencia Fecal/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Neoplasias del Recto/psicología , Encuestas y Cuestionarios

RESUMEN

OBJECTIVE: To study the epidemiology and severity of C. difficile infections (CDI) at Landspítali over 11 year period, 1998-2008. MATERIAL AND METHODS: CDI were identified by a positive toxin assay in stools from the database of the Department of Microbiology. Chart review was conducted on patients diagnosed in January and June each year during the study period, a total of 237 infections. RESULTS: Overall, 1,861 of 11,968 submitted stool samples were positive for C. difficile toxin, representing 1,492 infections. The population-based incidence was 29% higher in the end than in the beginning of the period and was highest in the age group >80 years where it was 387 cases per 100,000 person-years. The incidence per 1,000 admissions and 10,000 hospital days increased by 71% and 102%, respectively. 47% of the infections were nosocomial. Most patients had history of antibiotic exposure prior to the infection and the most common symptom was diarrhea. Response to a single antibiotics course was good (93%). No patient required surgery due to colitis. CONCLUSION: The incidence of CDI was higher in 2008 than 11 years before. Most patients had well characterized risk factors for CDI. For most patients a single course of metronidazole treatment resolved the infection. Based on these data, the severity of CDI does not seem to be increasing in Iceland.

Asunto(s)

Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/epidemiología , Infección Hospitalaria/epidemiología , Antibacterianos/uso terapéutico , Infecciones por Clostridium/tratamiento farmacológico , Infecciones por Clostridium/microbiología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Heces/microbiología , Hospitalización , Hospitales , Humanos , Islandia/epidemiología , Incidencia , Metronidazol/uso terapéutico , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

Volvulus of the intestine is a surgical emergency. Volvulus of the small bowel is more common in children and is most often secondary to malrotation. Small bowel volvulus is an uncommon cause for small bowel obstruction in adults, and is more likely to be secondary to postoperative adhesive bands. Colonic volvulus is a rare cause of large bowel obstruction, but more common than small bowel volvulus. The sigmoid is most frequently involved, with redundant colon as the primary cause. Cecal volvulus most commonly is due to lack of fixation. Colonic volvulus has a specific radiographic appearance; however, small bowel volvulus is difficult to distinguish from other causes of small bowel obstruction by radiographic means. New surgical techniques with minimally invasive surgery are increasingly being applied to this old problem with good results in selected cases.