RESUMO
OBJECTIVES: To analyze morbidity-mortality and results of surgical treatment for colonic volvulus. METHODS: Retrospective review of 33 patients who underwent surgical treatment for colonic volvulus from 1986 through 1996. RESULTS: Mean age was 62 +/- 20 years (SD) with predominance of female sex (2:1). There were 25 cases of sigmoid volvulus (76%), 7 in the cecum (21%) and 1 in the transverse colon (3%). Colonic necrosis and/or perforation were most frequently seen in the right and transverse colon (50%) than in the sigmoid (4%) (P < 0.002). Operative morbidity was 45% with mortality of 21%. Age was the only variable statistically significant for operative morbidity (52 +/- 23 years in patients without morbidity vs 71 +/- 17 years in patients with morbidity, P = 0.02). Surgical procedures for sigmoid volvulus were resection in 13 and fixation in 12. Recurrence after fixation was 38% to 12 months and 69% to 24 months (Kaplan-Meier), with associated mortality of 50%. There was no recurrence after resections. Treatment for cecal volvulus was cecopexy in 4 cases, with one recurrence; and right hemicolectomy without recurrence. CONCLUSIONS: The results should encourage resective procedures in sigmoid volvulus because the risk of recurrence after fixation is high and the morbidity-mortality is similar. Elderly patients are more susceptible to complications.
Assuntos
Doenças do Colo/cirurgia , Obstrução Intestinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Ceco/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recidiva , Estudos Retrospectivos , Doenças do Colo Sigmoide/cirurgia , Fatores de TempoRESUMO
In order to evaluate the quality of the measles vaccine, it was carried out a study in three states of Mexico (Durango, San Luis Potosi and Yucatan) during the intensive vaccination campaign in 1986. Edmonston-Zagreb measles vaccine vials were obtained from the different administrative-sanitary levels of the Ministry of Health in Mexico. Interviews were performed to the vaccine responsibles. Questionnaires had the following aspects of the cold chain: storage, preservation, control and transport of measles vaccine. Answers were evaluated through a system, where 100% indicated the necessary and sufficient level to get a good operating of the cold chain. The vaccine potency did not have variations under the minimum titre recommended for the World Health Organization (W.H.O.). The three states had the following compliment of the cold chain norms: 1) Central state level: 83% in storage, 80% in preservation, 100% in control and 100% in transport norms; 2) Regional level (jurisdiction): 87% in storage, 51% in preservation, 93% in control and 100% in transport norms; 3) Local level: 83% in storage, 64% in preservation, 83% in control and 33% in transport norms.
Assuntos
Vacina contra Sarampo/imunologia , Temperatura Baixa , Estabilidade de Medicamentos , Armazenamento de Medicamentos/normas , Estudos de Avaliação como AssuntoRESUMO
Production and quality of the vaccines, are important activities in the prevention of measles disease. Edmonston-Zagreb measles vaccine is the main strain attenuated virus distributed in México. In order to evaluate the titer of Edmonston-Zagreb and Schwarz vaccines, 50% tissue culture infective dose (TCID50/0.5 mL) and plaque-forming units (PFU) are performed in the National Laboratory of Public Health. Furthermore PFU is a method used in the stability vaccine test. Validation criteria are described in this paper.