RESUMO
The most feared complication in spinal surgeries is damage to the spinal cord due to inadvertent compression or interference in the blood supply with the consequent motor and/or sensory déficit. Intraoperative physiological surveillance reduces the risk of generating direct damage or due to hypoxia, helping in the early detection of complications. Publications in the Pubmed database are reviewed.
La complicación más temida en las cirugías de columna es el daño de la médula espinal por una compresión inadvertida o interferencia en el aporte sanguíneo con el consiguiente déficit motor y/o sensitivo. La vigilancia fisiológica intra operatoria disminuye el riesgo de generar daño directo o por hipoxia, ayudando en la detección temprana de las complicaciones. Se revisan publicaciones en base de datos Pubmed.
Assuntos
Humanos , Medula Espinal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Potenciais Evocados , Monitorização Neurofisiológica IntraoperatóriaRESUMO
Total intravenous anesthesia (TIVA) with propofol/remifentanil appears in the literatura as a good option for neurosurgical patients who have increased intracranial pressure (ICP),risk of postoperative nausea and vomiting (PONV), need for neuromonitoring, and in those with impaired brain self-regulation. On the other hand, in patients with normal neurological status, normal ICP, a technique with volatile (halogenated) agents plus an opiiid can be used. This review describes two anesthetic techniques available for use in neurosurgery, highlighting the neurophysiological changes, advantages and disadvantages of each technique. MATERIAL AND METHOD: PubMed search engine was used for bibliographic search. DISCUSSION: The search for an ideal anesthetic in neurosurgery is still a matter of debate. There are numerous investigations aimed at finding an optimal agent that ensure the coupling between cerebral flow (CBF) and metabolism, keeping self-regulation intact without increasing the CBF and intracerebral pressure (ICP). CONCLUSIONS: Both anesthetic techniques, TIVA and volatile agents (halogenated), can be used in neurosurgical procedures and should provide neuroprotection, brain relaxation and a rapid awakening.
La anestesia total endovenosa (TIVA) con propofol/remifentanilo aparece en la literatura como una buena opción para pacientes neuroquirúrgicos que tienen aumento de la presión intracraneana (PIC), riesgo de náuseas y vómitos posoperatorios (NVPO), necesidad de neuromonitoreo, y en aquellos con alteración de la autorregulación cerebral. Por otra parte, en pacientes con estado neurológico normal, PIC normal puede usarse una técnica con agentes volátiles (halogenados) más un opioide. Esta revisión describe dos técnicas anestésicas disponibles para su uso en neurocirugía, destaca los cambios neurofisiológicos, ventajas y desventajas de cada técnica. MATERIAL Y MÉTODO: Para búsqueda bibliográfica se usó buscador PubMed. DISCUSIÓN: La búsqueda de un anestésico ideal en neurocirugía sigue siendo tema de debate. Existen numerosas investigaciones destinadas a buscar un agente óptimo que asegure el acoplamiento entre flujo sanguíneo cerebral (FSC) y metabolismo, manteniendo la autorregulación intacta sin aumentar el FSC y presión intracerebral (PIC). CONCLUSIONES: Ambas técnicas anestésicas, TIVA y agentes volátiles (halogenados), pueden ser usadas en procedimientos neuroquirúrgicos y deben brindar neuroprotección, relajación cerebral y un despertar rápido.
Assuntos
Humanos , Procedimentos Neurocirúrgicos/métodos , Anestesia por Inalação/métodos , Anestesia Intravenosa/métodos , Anestésicos Intravenosos/efeitos adversos , Anestésicos Intravenosos/farmacologia , Anestésicos Inalatórios/efeitos adversos , Anestésicos Inalatórios/farmacologia , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Neuroproteção , Sistema Nervoso/efeitos dos fármacosRESUMO
RESUMEN Introducción: La cirugía ortognática y la rinoplastia son procedimientos consolidados con altas tasas de éxito. La sinergia entre ambos procedimientos ha sido presentada en diferentes investigaciones pero aún no es un procedimiento estándar para pacientes con deformidades faciales. Objetivo: Analizar una serie de casos tratados con cirugía ortognática y rinoplastia y discutir las opciones y fundamentos de la técnica combinada. Material y método: 14 pacientes operados de forma consecutiva fueron incluidos en el estudio. Se identificaron sujetos según el tipo de deformidad facial, el tipo de deformidad nasal y los tipos de cirugías realizadas. El seguimiento mínimo de cada sujeto fue de 12 meses. Resultados: El 50% de los sujetos presentaba deformidad facial de clase III, seguido de deformidades de clase II y I. Las deformidades nasales, de la punta y del puente nasal fueron más prevalentes, siendo el ancho nasal también una deformidad común. En la etapa intraoperatoria, después de realizar la cirugia ortognática, fue necesario realizar un análisis nuevo respecto de la morfologia nasal debido a los cambios que generaba el movimiento maxilar en la condición nasal. Conclusión: La cirugía combinada es sinérgica y viable de ser realizada con bajo número de complicaciones; protocolos y nuevos criterios de análisis son necesarios para obtener mayor predictibilidad en los resultados estéticos.
ABSTRACT Introduction: Orthognathic surgery and rhinoplasty are procedures with high success rate. The synergy between both surgeries has been showed in the past by researches but still they are not standardized procedures for the treatment of patients with facial deformities. Aim: To analyze a case series treated with orthognathic surgery and rinoplasty in the same surgical time, discussing surgical options and techniques in the combined procedure. Material and method: 14 patients were treated consecutively and were included in this research. Subjects were selected by facial deformity, nasal deformity and type of surgery. Minimal follow up was for 12 months to observe results. Results: 50% of subjects showed class III facial deformity, follow by class II and class I facial deformity. In nasal deformities, tip and nasal bridge were more prevalent, being the nasal width a common deformity; in the intraoperative time, after orthognathic surgery, it was necessary to make a new analysis and approach to nasal morphology because the new conditions related to movement of the maxilla. Conclusion: Orthognathic and nasal surgery are good complement and it is possible to do with few complications; surgical protocol and criteria for the analysis are necessaries to obtain more predictability in the esthetic results.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Rinoplastia/métodos , Cirurgia Ortognática/métodos , Anormalidades Congênitas/diagnóstico por imagem , Nariz/cirurgia , Deformidades Dentofaciais/cirurgia , Deformidades Dentofaciais/diagnóstico por imagemRESUMO
RESUMEN La orbitopatía tiroidea es una enfermedad autoinmune, en la que una reacción inflamatoria genera aumento de la presión orbitaria con protrusión de su contenido. A menudo es autolimitada y sus síntomas más frecuentes son retracción palpebral, exoftalmo y diplopía. Existen casos severos con compromiso de la agudeza visual por compresión del nervio óptico. El diagnóstico es clínico, pero debe complementarse con una tomografía computarizada. Su tratamiento depende de la gravedad y actividad de la enfermedad, siendo los procedimientos quirúrgicos, como la descompresión orbitaria, de elección en exoftalmo y neuropatía óptica compresiva. El pilar de tratamiento en la orbitopatía tiroidea severa es la cirugía descompresiva. Se han descrito múltiples técnicas, pero con limitaciones. La descompresión endoscópica transnasal, es considerada actualmente el procedimiento de elección, ya que permite una buena visualización de la pared medial, con resultados comparables y menores complicaciones, respecto a métodos tradicionales. Describimos un caso de oftalmopatía tiroidea severa, con exoftalmo, diplopía y disminución de la agudeza visual, en la que se realizó una descompresión endoscópica con muy buenos resultados.
ABSTRACT Thyroid orbitopathy is an autoimmune disease in which an inflammatory reaction generates increased orbital pressure with protrusion of its contents. It is often self-limiting and its most frequent symptoms are eyelid retraction, exophthalmos and diplopia. There are severe cases with compromised visual acuity due to compression of the optic nerve. The diagnosis is clinical, but must be complemented with a computed tomography scan. Its treatment depends on the severity and activity of the disease and the surgicals procedures such as orbital decompression is the best choice in exophthalmos and compressive optic neuropathy. The treatment in severe thyroid orbitopathy is decompressive surgery. Multiple techniques have been described, but with limitations. The transnasal endoscopic decompression is currently considered the gold standard, since it allows a good visualization of the medial wall with comparable results and less complications, compared to traditional methods. We present a case of severe thyroid ophthalmopathy, with exophthalmos, diplopia and decreased visual acuity, in which a transnasal endoscopic decompression was performed with very good outcomes.
Assuntos
Humanos , Feminino , Adulto , Órbita/cirurgia , Doença de Graves/cirurgia , Descompressão Cirúrgica/métodos , Endoscopia , Tomografia Computadorizada por Raios X , Doenças do Nervo ÓpticoAssuntos
Transtorno Conversivo/complicações , Dispneia/etiologia , Sons Respiratórios/etiologia , Adulto , Transtorno Conversivo/diagnóstico , Transtorno Conversivo/psicologia , Diagnóstico Tardio , Dispneia/diagnóstico , Feminino , Humanos , Sons Respiratórios/diagnóstico , Procedimentos Desnecessários , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/etiologia , Adulto JovemRESUMO
Introducción: La cirugía endoscópica transesfenoidal en la exéresis de patología hipofisaria ha sido ratificada dentro de la mejores opciones para conseguir abordajes exitosos. Para cerrar la brecha ósea, se puede utilizar el colgajo nasoseptal, el cual lograría un cierre adecuado y seguro, evitando complicaciones como persistencia de fístulas de líquido cefalorraquídeo. Dentro de los probables efectos secundarios de este colgajo se señala la presencia de anosmia o hiposmia. Objetivo: Nuestro objetivo es mostrar los resultados obtenidos empleando la técnica del colgajo nasoseptal y la evaluación del olfato posoperatorio. Material y método: Incluimos 14 pacientes con diagnóstico de adenoma hipofisiario intervenidos en nuestro servicio entre diciembre 2014 a diciembre 2015. Se evaluaron diversos parámetros entre otros, olfatometría pre y posoperatorias. A todos se les realizó la técnica endoscópica transesfenoidal. Efectuando la disección del colgajo con la técnica tipo Hadad. La exéresis tumoral fue realizada por neurocirujano, se cubrió la osteotomía con este colgajo. Resultados: De los 14 pacientes, 13 llegaron al estado olfativo preoperatorio. 1 paciente se mantuvo hipósmico mantenidamente. En nuestro estudio, no hemos encontrado deterioro significativo en la calidad del sentido del olfato. Así como tampoco observamos otras complicaciones. Conclusiones: Esta experiencia aún inicial, estimamos que podría ya esbozar una tendencia de mantención de la función olfativa en este tipo de cirugía.
Introduction: Transsphenoidal endoscopic surgery resection of pituitary pathology has been ratified within the best options for successful approaches. To close the gap bone, you can use the nasoseptal flap, which achieved an adequate and secure closure, preventing complications such as persistent cerebrospinal fluid leaks. Among possible side effects of this flap anosmia-hyposmia noted. Aim: Our goal is to show the results obtained using the technique of nasoseptal flap and postoperative evaluation of smell. Material and method: We included 14 patients with a diagnosis of pituitary adenoma surgery in our department between December 2014 to December 2015. Various parameters were evaluated pre and post operative, specially olfactory function. All underwent transsphenoidal endoscopic technique. Performing dissection flap with the technical type Hadad. The tumor resection was performed by neurosurgeon, osteotomy covered with this flap. Results: Of the 14 patients, 13 reached the olfactory preoperative state. 1 patient remained with hyposmia. In our study, we found no significant deterioration in the quality of the sense of smell. Not other complications were found. Conclusions: This is an initial experience, and we estimate that could outline a trend of maintaining olfactory function in this surgery approach.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adenoma/cirurgia , Endoscopia/métodos , Neoplasias Hipofisárias/cirurgia , Seio Esfenoidal/cirurgia , Adenoma/fisiopatologia , Epidemiologia Descritiva , Septo Nasal/irrigação sanguínea , Neoplasias Hipofisárias/fisiopatologia , Olfato/fisiologia , Retalhos Cirúrgicos , Resultado do TratamentoRESUMO
Ozone (O3) soundings have been performed on Easter Island or Rapa Nui (27°S, 23 109°W, 51 m a.s.l.) since 1994 as part of the Global Atmospheric Watch (GAW) Programme of the World Meteorological Organization (WMO). In this work, we analyze 260 soundings compiled over the period 1994-2014, and make the data available for the international community. We characterize O3 profiles over this remote area of the Pacific by means of statistical analyses that consider, on the one hand, a traditional climatology that describes the data in terms of seasonal cycles based on monthly averages and, on the other hand, a process oriented analysis based on self-organizing maps. Our analyses show the influence of both tropical and subtropical/mid-latitude air masses at Rapa Nui. The former occurs in summer and fall when convective conditions prevail, and the latter in late winter and spring when subsiding conditions are recurrent. The occurrence of stratospheric intrusions in late winter and spring in connection with deep troughs and the presence of the subtropical jet stream is also apparent in the data set. The tropospheric ozone column is in good agreement with the corresponding data derived from satellites but with a systematic overestimate of summer and fall values. We show evidence of an upward trend in ozone near the surface, which suggests the impact of local pollution. We look forward to an enhancement of the Rapa Nui observing site, given its location that offers a privileged position to observe climate change over the sparsely sampled and vast South Pacific Ocean.
RESUMO
Pathogenic Vibrio cholerae isolates, the etiologic agents of cholera, generally express one of two O antigens (O1 or O139). Most environmental isolates are nonpathogenic and are referred to as "non-O1, non-O139". However some V. cholerae non-O1, non-O139 strains are clearly pathogenic and have caused outbreaks or sporadic cases of gastroenteritis and extraintestinal infections in humans. We report a case of acute gastroenteritis by a V. cholerae non-O1, non-O139 harboring a genetic region homologous to a segment of the VpaI-7 V. parahaemolyticus pathogenicity island.
Assuntos
Gastroenterite/microbiologia , Ilhas Genômicas/genética , Vibrioses/microbiologia , Vibrio cholerae/genética , Doença Aguda , Anti-Infecciosos/uso terapêutico , Ciprofloxacina/uso terapêutico , Feminino , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Vibrioses/diagnóstico , Vibrioses/tratamento farmacológico , Vibrio cholerae não O1/genéticaRESUMO
Pathogenic Vibrio cholerae isolates, the etiologic agents of cholera, generally express one of two O antigens (O1 or O139). Most environmental isolates are nonpathogenic and are referred to as "non-O1, non-O139". However some V. cholerae non-O1, non-O139 strains are clearly pathogenic and have caused outbreaks or sporadic cases of gastroenteritis and extraintestinal infections in humans. We report a case of acute gastroenteritis by a V. cholerae non-O1, non-O139 harboring a genetic region homologous to a segment of the VpaI-7 V. parahaemolyticus pathogenicity island.
Cepas patogénicas de Vibrio cholerae, el agente causal del cólera, expresan generalmente uno de dos antígenos O (denominados O1 u O139). La mayoría de las cepas ambientales son no patogénicas y corresponden al tipo denominado "no-O1, no-O139". Sin embargo, algunas cepas de este tipo son claramente patogénas y han causado brotes de gastroenteritis e infecciones extra-intestinales en humanos. Se reporta un caso clínico de gastroenteritis aguda causado por una cepa de V. cholerae no-O1, no-O139 que contiene en su genoma una región homóloga a un segmento de la isla de patogenicidad VpaI-7 descrita previamente en V. parahaemolyticus.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Gastroenterite/microbiologia , Ilhas Genômicas/genética , Vibrioses/microbiologia , Vibrio cholerae/genética , Doença Aguda , Anti-Infecciosos/uso terapêutico , Ciprofloxacina/uso terapêutico , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Vibrioses/diagnóstico , Vibrioses/tratamento farmacológico , Vibrio cholerae não O1/genéticaRESUMO
Laparoscopic anterior cardiomyotomy in addition to anterior Dor's fundoplication is the procedure of choice for achalasia of the esophagus with approximately 95% success rate. Redo cardiomyotomy is complicated and associated with rerecurrence of dysphagia. Twelve patients with failed redo myotomy were clinically evaluated with radiology, endoscopy, and manometry in whom achalasia type III or IV was confirmed. We propose as treatment for these selected cases an inversed Y cardioplasty + truncal vagotomy, a partial distal gastrectomy and Roux-en-Y gastrojejunostomy in order to facilitate esophageal emptying and avoid the appearance of postoperative gastroesophageal reflux as a side effect of this procedure. One patient was reoperated on in order to enlarge the cardioplasty. Disappearance of dysphagia was confirmed in all patients. Three patients presented reflux symptoms and were treated with 20 mg of Omeprazole 20 twice/day. No food retention, erosive esophagitis, or Barrett's esophagus were observed. The mean resting pressure decreased from 24.9 +/- 8.5 mm Hg to 7.5 +/- 2.5 mm Hg (P = 0.0001). Furthermore, esophageal diameter decreased significantly after a 5-year follow-up. This procedure could be an option for treating patients in which repeated Heller operations have failed.
Assuntos
Acalasia Esofágica/cirurgia , Estenose Esofágica/cirurgia , Junção Esofagogástrica , Derivação Gástrica/métodos , Gastroplastia/métodos , Vagotomia Troncular , Adulto , Idoso , Idoso de 80 Anos ou mais , Cárdia/cirurgia , Estudos de Coortes , Acalasia Esofágica/complicações , Acalasia Esofágica/patologia , Estenose Esofágica/etiologia , Estenose Esofágica/patologia , Feminino , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/patologia , Refluxo Gastroesofágico/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Prevenção Secundária , Adulto JovemRESUMO
BACKGROUND: Gastric microbiota is a complex ecosystem, composed by diverse microorganisms, where H pylori and Lactobacillus are relevant species. AIM: To study the probiotic properties of Lactobacillus spp isolated from gastric biopsies of subjects bearing or not H pylori. MATERIALS AND METHODS: Gastric biopsies from 197 individuals that consulted for gastrointestinal disorders were cultivated in media specific for H pylori and Lactobacillus spp. Probiotic properties of lactobacilli isolates and histological diagnosis of H pylori colonized patients were performed. RESULTS: Among 197 individuals evaluated, Hpylori was detected in 43%, Lactobacillus spp in 24%, while 8% presented both bacteria simultaneously. Forty one percent of the Lactobacillus spp strains produced hydrogen peroxide, S'3% presented a highly hydrophobic surface and 32% had an inhibitory effect upon Hpylori ATCC 43504, even greater than Lactobacillus LGG or LAL reference strains. The main pathological diagnosis of patients ivas chronic non-atrophic gastritis (73%) followed by intestinal metaplasia (19%). A similar proportion of both conditions were observed in patients colonized by Lactobacillus spp, while not colonized individuals developed preferentially chronic non-atrophic gastritis (p =0.002). CONCLUSIONS: Lactobacillus spp and H pylori were mutually excluded, suggesting a competitive colonization model between probiotic bacteria and pathogens .
Assuntos
Mucosa Gástrica/microbiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/crescimento & desenvolvimento , Lactobacillus/fisiologia , Probióticos/metabolismo , Adolescente , Fenômenos Fisiológicos Bacterianos , Biópsia , Contagem de Colônia Microbiana , Infecções por Helicobacter/patologia , Helicobacter pylori/isolamento & purificação , Humanos , Lactobacillus/isolamento & purificação , Lactobacillus/metabolismoRESUMO
Background: Gastric microbiota is a complex ecosystem, composed by diverse microorganisms, where H pylori and Lactobacillus are relevant species. Aim: To study the probiotic properties of Lactobacillus spp isolated from gastric biopsies of subjects bearing or not H pylori. Materials and Methods: Gastric biopsies from 197 individuals that consulted for gastrointestinal disorders were cultivated in media specific for H pylori and Lactobacillus spp. Probiotic properties of lactobacilli isolates and histological diagnosis of H pylori colonized patients were performed. Results: Among 197 individuals evaluated, Hpylori was detected in 43 percent, Lactobacillus spp in 24 percent, while 8 percent presented both bacteria simultaneously. Forty one percent of the Lactobacillus spp strains produced hydrogen peroxide, S'3 percent presented a highly hydrophobic surface and 32 percent had an inhibitory effect upon Hpylori ATCC 43504, even greater than Lactobacillus LGG or LAL reference strains. The main pathological diagnosis of patients ivas chronic non-atrophic gastritis (73 percent) followed by intestinal metaplasia (19 percent). A similar proportion of both conditions were observed in patients colonized by Lactobacillus spp, while not colonized individuals developed preferentially chronic non-atrophic gastritis (p =0.002). Conclusions: Lactobacillus spp and H pylori were mutually excluded, suggesting a competitive colonization model between probiotic bacteria and pathogens.
Assuntos
Adolescente , Humanos , Mucosa Gástrica/microbiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/crescimento & desenvolvimento , Lactobacillus/fisiologia , Probióticos/metabolismo , Fenômenos Fisiológicos Bacterianos , Biópsia , Contagem de Colônia Microbiana , Infecções por Helicobacter/patologia , Helicobacter pylori/isolamento & purificação , Lactobacillus/isolamento & purificação , Lactobacillus/metabolismoRESUMO
Objetivos: la población de mujeres cuidadoras es un grupo que por sus características necesita especialmente ser estudiada respecto a las variables que están involucradas en los conflictos decisionales de salud a los que se enfrentan. Para ello se plantearon dos objetivos: captar la esencia de variables latentes de conflicto decisional en salud en mujeres cuidadoras informales. Construir tipologías de mujeres que experimentan este conflicto en salud, en una muestra de 50 mujeres de la Comuna de Concepción, Chile. Métodos: se realizó un estudio exploratorio, utilizando la técnica de análisis factorial para variables categóricas, seguido por un análisis de clasificación. Resultados: los resultados arrojaron 2 dimensiones, una que se interpretó como conocimientos para enfrentar el conflicto y la segunda como recursos personales que favorecen la toma de decisión. Conclusiones: el análisis de clasificación permitió identificar 4 grupos distintos de mujeres cuidadoras que enfrentan conflictos decisionales(AU)
Objetives: the population of female care givers is a group that due to their characteristics need to be specially studied as regards the variables involved in the health decisional conflicts they have to face. Two goals were established to this end: to capture the essence of latent variables of health decisional conflict in informal care givers, and to construct typologies of women experimenting this conflict in health, in a sample of 50 females from Comuna de la Concepción, Chile. Methods: an exploratory study was conducted by using the technique of factorial analysis for categorical variables, followed by a classification analysis. Results: the results showed 2 dimensions, one that was interpreted as knowledge to face the conflict and the second as personal resources that favor the decision-making. Conclusions: the classification analysis allowed to identify 4 different groups of female care givers that face decisional conflicts(AU)
Assuntos
Humanos , Feminino , Cuidadores/psicologia , Tomada de Decisões , Assistência ao Paciente/métodosRESUMO
OBJECTIVE: The use of gonyautoxin has been reported to be safe and effective in healing acute and chronic anal fissures. This study was designed to show better efficacy in healing patients with chronic anal fissure by increasing the frequency of toxin injection. METHOD: Twenty-three chronic anal fissure patients were treated with doses of 100 units of gonyautoxin, which was intrasphincteric, infiltrated. The frequency of injection was every 4 days. Anorectal manometries were performed before and 4 min after infiltration. RESULTS: Total remissions were achieved within 7-14 days. The patients healed with a mean time of 8.2 +/- 2.4 days. No relapsed were observed during the 10-month follow up. Neither faecal incontinence nor other side effects were observed. All patients showed immediate sphincter relaxation detected by clinical examination. The maximum anal resting pressures, recorded 4 min after injections decreased to 62.9 +/- 27.7 mmHg, being 65.3 +/- 29.6% of baseline. Immediately after infiltration, patients reported anaesthetic effect with a fall down of the postdefecatory pain. CONCLUSION: Although, gonyautoxin anal fissures treatment recently published proved to be safe and effective, this study shows a better protocol for anal fissure treatment, showing better efficacy by shorting the healing time with better perception of healing by patients. Gonyautoxin anal sphincter infiltration proves to be safe and effective, reducing discomfort and healing time, advantageously comparing with alternative therapeutic approaches for chronic anal fissure.
Assuntos
Fissura Anal/tratamento farmacológico , Toxinas Marinhas/uso terapêutico , Saxitoxina/análogos & derivados , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor , Indução de Remissão , Saxitoxina/uso terapêutico , Fatores de Tempo , Resultado do TratamentoRESUMO
Este trabajo tiene como objetivo determinar el efecto de un taller vivencial de orientación humanista en el nivel de auto-actualización de los adolescentes que cursan enseñanza media. Para ello se utiliza un diseño experimental clásico de pre-test y post-test con grupo control. La muestra es no probabilística y se toma en dos colegios de nivel socioeconómico bajo de la Octava Región, Chile, con alumnos que cursan tercero y cuarto de la enseñanza media cuyas edades fluctúan entre 17 y 19 años, a quienes se les realizará una medición con el instrumento Personal Orientation Inventory (P.O.I.) validado para la población chilena. De acuerdo a los resultados obtenidos, se demuestra que es posible aumentar el nivel de auto-actualización en los adolescentes que participaron en el taller vivencial, siendo estadísticamente significativo (p< 0.05) en 8 de 12 dimensiones que son autonomía, vivir existencial, sensibilidad organísmica, auto-aprecio, auto-aceptación, naturaleza constructiva del hombre, sinergia y capacidad de contacto íntimo, por lo que el taller vivencial de orientación humanista es una modalidad eficaz y recomendable para favorecer un desarrollo integral de los adolescentes.
Assuntos
Humanos , Adolescente , Adolescente , Comportamento do Adolescente , Desenvolvimento do Adolescente , Saúde do Adolescente , Chile , Papel do Profissional de EnfermagemRESUMO
BACKGROUND: Overweight can be a risk factor for pathological gastroesophageal reflux or hiatal hernia. AIM: To study the prevalence of gastroesophageal reflux in patients with severe obesity. PATIENTS AND METHODS: Sixty seven patients, 51 female, aged 17 to 56 years old with a body mass index over 35 kg/m2, were studied. An upper gastrointestinal endoscopy was performed in all, esophageal manometry was done in 32 and 24 h pH monitoring was done in 32 patients. RESULTS: Seventy nine percent of patients complained of heartburn and 66% of regurgitation. In 16 patients, endoscopy was normal. An erosive esophagitis was found in 33 patients, a short columnar epithelium in 12 and a Barret esophagus with intestinal metaplasia in six. Normal endoscopic findings and erosive esophagitis were present with a higher frequency in women. No association between the degree of obesity and esophageal lesions was observed. Lower esophageal sphincter pressure and abdominal length were significantly higher in subjects with a body mass index over 50 compared to those with a body mass index between 35 and 39.9 kg/m2. No differences were observed in 24 h pH monitoring. CONCLUSIONS: A high proportion of severely obese patients had symptoms and endoscopical findings of pathological gastroesophageal reflux.
Assuntos
Refluxo Gastroesofágico/etiologia , Obesidade Mórbida/complicações , Adolescente , Adulto , Biópsia , Índice de Massa Corporal , Chile/epidemiologia , Endoscopia Gastrointestinal , Feminino , Refluxo Gastroesofágico/epidemiologia , Humanos , Concentração de Íons de Hidrogênio , Masculino , Manometria , Pessoa de Meia-Idade , Obesidade Mórbida/epidemiologia , Prevalência , Estudos ProspectivosRESUMO
BACKGROUND: Laparoscopic esophagomyotomy is becoming a good alternative to pneumatic dilatation, injection of botulinic toxin or classical surgery in the treatment of achalasia. AIM: To report the results of laparoscopic esophagomyotomy in patients with achalasia. PATIENTS AND METHODS: Nineteen patients with achalasia, nine women, aged 9 to 66 years old, operated between 1996 and 2001 are reported. RESULTS: There was no surgical mortality. One patient had a subphrenic abscess due to an unnoticed tear of the esophageal mucosa. During surgery, esophageal mucosa was perforated in 4 patients, that was sutured in three. One patient with an extensive tear of the mucosa required conversion to classical surgery. Patients were followed for 2 to 48 months. Radiological controls showed a significant increase in the diameter of gastroesophageal junction and a diameter reduction of the mid third esophageal segment. Lower esophageal pressure was significantly reduced. All patients experienced a weight increase and reduction of dysphagia. CONCLUSIONS: Laparoscopic esophagomyotomy is a safe an effective therapeutic alternative for achalasia.
Assuntos
Acalasia Esofágica/cirurgia , Esôfago/cirurgia , Laparoscopia/métodos , Cirurgia Vídeoassistida , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
BACKGROUND: The diagnosis of patients with short segments of intestinal metaplasia in the distal esophagus, has increased in recent years. AIM: To assess the clinical, pathological and functional features of patients with esophageal intestinal metaplasia. PATIENTS AND METHODS: A prospective study was performed in 95 control subjects, 115 patients with cardial intestinal metaplasia and 89 patients with short Barret esophagus with intestinal metaplasia. All had clinical and endoscopic assessments, esophageal manometry and determination of 24 h esophageal exposure to acid and duodenal content. RESULTS: Control patients were younger and, in this group, the pathological findings in the mucosa distal to the squamous-columnar change, showed a preponderance of fundic over cardial mucosa. In patients with intestinal metaplasia and short Barret esophagus, there was only cardial mucosa, that is the place where intestinal metaplasia implants. Low grade dysplasia was only seen in the presence of intestinal metaplasia. Gastroesophageal sphincter pressure decreased and gastric and duodenal reflux increased along with increases in the extension of intestinal metaplasia. CONCLUSIONS: These findings confirm the need to obtain multiple biopsies from the squamous-columnar mucosal junction in all patients with gastroesophageal reflux symptoms, for the detection of early pathological changes of Barret esophagus and eventual dysplasia.
Assuntos
Esôfago de Barrett/diagnóstico , Cárdia/patologia , Refluxo Duodenogástrico/patologia , Endoscopia Gastrointestinal , Intestinos/patologia , Esôfago de Barrett/etiologia , Refluxo Duodenogástrico/complicações , Esôfago/patologia , Feminino , Humanos , Masculino , Metaplasia/diagnóstico , Metaplasia/etiologia , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: Medical care of HIV infected and AIDS patients may represent an important economical burden for public hospitals. AIM: To assess direct and indirect costs of medical care for HIV infected and AIDS patients in public hospitals of the Metropolitan Region of Chile. MATERIAL AND METHODS: Between August 1994 and February 1995, information about outpatient and hospitalized medical care of 417 HIV infected patients was gathered (representing approximately 16% of the seropositive population). Patients were divided as having or not having AIDS. The latter were those included in groups I, II, III and category C2 of group C (group 4). The cost of medications, procedures and examinations of these patients was calculated. RESULTS: Thirty six percent of studied patients had AIDS. The annual cost of care for AIDS patients was US$3760 compared to US$1450 for HIV infected patients without AIDS. Medications represented 75% and 65% of total costs in patients with and without AIDS respectively. The figures for examinations and procedures were 17% and 22% and for medical attentions were 7.5% and 8.8% respectively. CONCLUSIONS: Medical care of patients with AIDS has higher costs than that of HIV infected patients without AIDS. Thus, the retardation of the progression of the disease would have social, humanitarian and economical benefits. Our costs are similar to those of other countries with a similar level of economic development.
Assuntos
Síndrome da Imunodeficiência Adquirida/economia , Síndrome da Imunodeficiência Adquirida/terapia , Infecções por HIV/economia , Infecções por HIV/terapia , Custos de Cuidados de Saúde , Hospitalização/economia , Adulto , Chile , Hospitais Públicos , Hospitais Urbanos , HumanosRESUMO
BACKGROUND: Laparoscopic antireflux surgery is a minimally invasive procedure that should have similar results than classical surgical treatment. AIM: To report the results of a prospective study of laparoscopic antireflux surgery in patients with gastroesophageal reflux. PATIENTS AND METHODS: Thirty two patients with gastroesophageal reflux and without Barret's esophagus, were subjected to endoscopy, manometry and measurement of intraesophageal pH before and after laparoscopic surgery. RESULTS: There were no postoperative deaths or complications. Gastroesophageal sphincter pressure and abdominal sphincter length increased from 9.1 +/- 3.9 to 13.0 +/- 3.5 mm Hg and from 8.1 +/- 6.2 to 13.5 +/- 5.4 cm after surgery (p < 0.01). There was a decrease in acid reflux in 82% of patients. CONCLUSIONS: Laparoscopic antireflux surgery reproduces exactly the results of open surgical procedures.