RESUMO
Background: The ligation of intersphincteric fistula fract (LIFT) technique avoids postoperative anal continence disturbances and preserves quality of life. Methods: A total of 70 patients with anal fistula (AF) were treated in the Day Surgery Unit. The LIFT technique was the primary treatment in 63 patients. The other had previously undergone placement of a loose seton (two-step approach). The mean follow-up was 66.8 months. Statistical analysis was performed using contingency tables, the chi-square test, and the Student T-test. Results: The use of LIFT was successful in 40 patients (57.1%). However, 6 patients (8.6%) presented persistence of postoperative intersphincteric fistula, being successfully treated by fistulotomy. There were no differences in this technique's success rate between high and low AF (p = 0.45). The success rate of one-step LIFT, however, was significantly higher (p = 0.03). No disturbances of continence were observed. Conclusions: The LIFT technique has a role in the treatment of AF, is suitable for ambulatory surgery, and has a low complications rate. A two-step approach is not always needed. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Fístula Retal/cirurgia , Complicações Pós-Operatórias , Recidiva , Seguimentos , Incontinência Fecal/prevenção & controleRESUMO
Resource allocation in primary health care is a worldwide issue. In Chile, the state allocates resources to city halls using a mechanism called "per capita". However, each city hall distributes these resources according to the historical expenses of each health center. None of these methods considers the epidemiological and demographic differences in demand. This article proposes a model that allocates resources to health centers in an equitable, efficient and transparent fashion. The model incorporates two types of activities; those that are programmable, whose demand is generated by medical teams and those associated to morbidity, generated by patients. In the first case the health promotion, prevention and control activities are programmed according to the goals proposed by health authorities. In the second case, the utilization rates are calculated for different sociodemographic groups. This model was applied in one of the most populated communities of Metropolitan Santiago and proved to increase efficiency and transparency in resource allocation.
Assuntos
Governo Local , Modelos Econômicos , Atenção Primária à Saúde/economia , Alocação de Recursos/organização & administração , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Chile , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mortalidade/tendênciasRESUMO
Resource allocation in primary health care is a worldwide issue. In Chile, the state allocates resources to city halls using a mechanism called "per capita". However, each city hall distributes these resources according to the historical expenses of each health center. None of these methods considers the epidemiological and demographic differences in demand. This article proposes a model that allocates resources to health centers in an equitable, efficient and transparent fashion. The model incorporates two types of activities; those that are programmable, whose demand is generated by medical teams and those associated to morbidity, generated by patients. In the first case the health promotion, prevention and control activities are programmed according to the goals proposed by health authorities. In the second case, the utilization rates are calculated for different sociodemographic groups. This model was applied in one of the most populated communities of Metropolitan Santiago and proved to increase efficiency and transparency in resource allocation.
Assuntos
Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Governo Local , Modelos Econômicos , Atenção Primária à Saúde/economia , Alocação de Recursos/organização & administração , Chile , Custos de Cuidados de Saúde/estatística & dados numéricos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/economia , Mortalidade/tendênciasRESUMO
INTRODUCTION: Cancer patients can be asymptomatic carriers of the hepatitis B virus (HBV), which can be reactivated by chemotherapy. Our aim was to identify the serological markers of HBV in children with cancer who were asymptomatic carriers of the virus. Fifty two (52) children with cancer treated at the Maracaibo University Hospital in Venezuela were studied, 28 of these children (53.8%) were HBV positive, despite no clinical or biochemical signs or symptoms of hepatitis. The type of serological markers present in each of these children.were investigated. We found 7 cases (25%) with hepatitis B surface antigen (HBsAg) and 2 (7.1%) with anticore as the only markers. Multiple markers were found in the other children: 9 (32.1%) HBsAg and anticore; 7 (25%) HBsAg, e-antigen (HBeAg) and anticore; 3 (10.7%) HBsAg, HBeAg antibody and anticore. In total, of the 28 positive children 20 (71.4%) showed positive anticore and of these 4 (20%) were of the IgM type. Our results show a high level of positivity for HBV in the children with cancer studied. In spite of being asymptomatic carriers of the HBV, it is noticeable the presence of serological markers for acute disease. We recommend testing for HBV serological markers before starting chemotherapy. Should the test results be negative, vaccination is indicated and should they be positive, specialized care is indicated.
Assuntos
Hepatite B/epidemiologia , Adolescente , Portador Sadio/epidemiologia , Criança , Pré-Escolar , Feminino , Hepatite B/sangue , Hepatite B/complicações , Antígenos da Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/imunologia , Vírus da Hepatite B/isolamento & purificação , Humanos , Testes de Função Hepática , Masculino , Neoplasias/sangue , Neoplasias/complicações , Prevalência , Estudos Soroepidemiológicos , Venezuela/epidemiologiaRESUMO
En el Servicio de Otorrinolaringología del Hospital "Dr. Domingo Luciani", se reportan laringectomías parciales desde 1986, por lo que nos propusimos evaluar nuestra experiencia desde el punto de vista foniátrico en el manejo de estas intervenciones. La muestra consistió en 3 laringectomías glóticas hasta el 2000 y a partir de ese año: 3 cordectomías vía laringofisura, 4 laringectomías glóticas, 8 hemilaringectomías verticales, 2 laringectomías supraglóticas y 6 laringectomías supracricoideas. De éstas últimas, 5 reconstruidos mediante cricohioidoepiglotopexia (CHEP) y 1 mediante cricohioidopexia (CHP). Se revisó la evaluación de voz y respiración pre y postoperatoria, evolución de la deglución, grado de aspiración y la estrategia de rehabilitación, dieta, tiempo de decanulación (retiro del traqueostomo), retiro de sonda nasogástrica (SNG) y percepción de la voz por el examinador. Se le realizó evaluación foniátrica preoperatoria a 16 de los 23 pacientes operados a partir de 2000. En esta evaluación, todos los pacientes presentaron deterioro franco de los parámetros vocálicos: cualidades de voz, duración fonatoria y parámetros respiratorios: patrón respiratorio, tiempo de retención y emisión, coordinación fonorespiratoria y no se detectaron trastornos deglutorios. En la evaluación postoperatoria: se reportó aspiración en 14 pacientes, la cual se clasificó utilizando la escala de Leipzig y Pearson 7: 8 pacientes grado 1, 1 paciente grado 2, 5 pacientes grado 3. Se inició la rehabilitación foniátrica postoperatoria entre el día 1 y 18, con promedio de 8. La decanulación se realizó entre el día 3 y 78, con promedio de 16 días y el retiro de SNG entre el día 4 y 82, con un promedio de 21 días. Se reportó deglución sin aspiración, en un tiempo variable entre un mes y un año con media de 6 meses. Los resultados son los comparables con los reportados en la literatura.
Assuntos
Humanos , Masculino , Feminino , Laringectomia , Neoplasias Laríngeas/diagnóstico , Fonação , Otolaringologia , VenezuelaRESUMO
En el Servicio de Otorrinolaringología del Hospital "Dr. Domingo Luciani", se reportan laringectomías parciales desde 1986, por lo que nos propusimos evaluar nuestra experiencia desde el punto de vista foniátrico en el malicio de estas intervenciones. La muestra consistió en 3 laringectomías glótivas hasta el 2000 y a partir de ese año: 3 cordectomías vía laringofisura, 4 laringectomías glóticas, 8 hemilaringectomías verticales, 2 laringectomías supraglóticas y 6 laringectomías supracrocoideas. De éstas últimas, 5 reconstruidos mediante cricohioidoepiglotopexia (CHEP) y 1 mediante cricohioidopexia (CHP). Se reviso la evaluación de voz y respiración pre y postoperatoria, evolución de la deglución, grado de aspiración y la estrategia de rehabilitación, dieta, tiempo de decanulación (retiro del traqueostomo), retiro de sonda nasogástrica (SNG) y percepción de la voz por el examinador. Se le realizó evaluación foniátrica preoperatoria a 16 de los 23 pacientes operados a partir del 2000. En esta evaluación, todos los pacientes presentaron deterioro franco de los parámetros vocálicos: cualidades de voz, duración fonatoria y parámetros respiratorios: patrón respiratorio, tiempo de retención y emisión, coordinación fonorespiratona y no se detectaron trastornos deglutorios
Assuntos
Masculino , Feminino , Humanos , Neoplasias Laríngeas , Laringectomia , Distúrbios da Voz , Otolaringologia , VenezuelaRESUMO
The cerebrovascular disease is a common complication in Sickle Cell Anemia (SCA). The objective of the present work was to determine the incidence of cerebrovascular disease in patients with SCA, through physical and radiological examination. Twenty one patients between 5 and 18 years were studied, homozygous SS, with or without history of neurologic manifestations, at the "Instituto Hematológico de Occidente, Maracaibo-Venezuela". A clinical history, neurological clinical examination and Cerebral Magnetic Resonance (CMR) were carried out on each patient. CMR showed findings of cerebrovascular disease (CVD) of the ischemic type, in 5 of 21 (23.8%) patients, 3 of them presented neurological alterations (2 with spastic hemiparesis and one with spastic tetraparesis); the other 2 presented silent CVD). The most affected artery was the cerebral media. We suggest to carry out a neurological evaluation (clinic and images) in patients with SCA, once a year, in order to detect early abnormalities of the central nervous system and to offer timely and adequate therapies, avoiding important sequels for the patient normal life development.
Assuntos
Anemia Falciforme/complicações , Transtornos Cerebrovasculares/etiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , MasculinoRESUMO
INTRODUCTION: Ictus is a complication in patients with Sickle Cell Anemia (SCA), in these is of importance the precocious diagnosis of Silent Cerebral Infarcts (SCI). OBJECTIVE: To determine the incidence of ICS in patients with SCA without neurological symptoms but with images in Cerebral Magnetic Resonance (RMC). PATIENTS: A total of 18 patients (13 males, 5 females) with ages between 5 and 24 years (11.5 4,9), without history of neurological alterations, taken care at the Instituto Hematol gico de Occidente Banco de Sangre, Estado Zulia Venezuela. Methods. A clinical history was made to each patient in addition to detailed physical and neurological examinations that included the state of mind, conscience, language, sensitivity, cranial pairs, muscular force, reflexes, cerebella tests, neck and march. Later, RMC studies were carried out. RESULTS: It was found that 2/18 (11,1%) patients without neurological manifestations showed alterations in the RMC and they were diagnosed as ICS. The findings by images showed asymmetry of lateral ventricles and one of them showed gliosis as well. CONCLUSION: 11,1% of the all the studied cases (2/18) showed SCI, for what is suggested to carry out neurological evaluation and images, once a year, and to offer opportune therapies, for their impact in the function neurocognitive