RESUMO
Plant-insect interactions are a determining factor for sustainable crop production. Although plants can resist or tolerate herbivorous insects to varying degrees, even with the use of pesticides, insects can reduce plant net productivity by as much as 20%, so sustainable strategies for pest control with less dependence on chemicals are needed. Selecting plants with optimal resistance and photosynthetic traits can help minimize damage and maintain productivity. Here, 27 landrace accessions of lima beans, Phaseolus lunatus L., from the Yucatan Peninsula were evaluated in the field for morphological resistance traits, photosynthetic characteristics, insect damage and seed yield. Variation was found in physical leaf traits (number, area, and dry mass of leaves; trichome density, specific leaf thickness and hardness) and in physiological traits (photosynthetic rate, stomatal conductance, intercellular carbon, water-use efficiency, and transpiration). Five accessions (JMC1325, JMC1288, JMC1339, JMC1208 and JMC1264) had the lowest index for cumulative damage with the highest seed yield, although RDA analysis uncovered two accessions (JMC1339, JMC1288) with strong positive association of seed yield and the cumulative damage index with leaf production, specific leaf area (SLA) and total leaf area. Leaf traits, including SLA and total leaf area are important drivers for optimizing seed yield. This study identified 12 important morphological and physiological leaf traits for selecting landrace accessions of P. lunatus for high yields (regardless of damage level) to achieve sustainable, environmentally safe crop production.
RESUMO
PURPOSE: Although the wind, rain, and flooding of Hurricane Maria in Puerto Rico abated shortly after its landfall on September 20, 2017, the disruption of the electrical, communications, transportation, and medical infrastructure of the island was unprecedented in scope and caused lasting harm for many months afterward. A compilation of recommendations from radiation oncologists who were in Puerto Rico during the disaster, and from a panel of American Society for Radiation Oncology (ASTRO) cancer experts was created. METHODS AND MATERIALS: Radiation oncologists throughout Puerto Rico collaborated and improvised to continue treating patients in the immediate aftermath of the storm and as routine clinical operations were restored gradually. Empirical lessons from the experience of radiation therapy administration in this profoundly altered context of limited resources, impaired communication, and inadequate transportation were organized into a recommended template, applicable to any radiation oncology practice. ASTRO disease-site experts provided evidence-guidelines for mitigating the impact of a 2- to 3-week interruption in radiation therapy. RESULTS: Practical measures to mitigate the medical impact of a disaster are summarized within the framework of "Prepare, Communicate, Operate, Compensate." Specific measures include the development of an emergency operations plan tailored to specific circumstances, prospective coordination with other radiation oncology clinics before a disaster, ongoing communications with emergency management organizations, and routine practice of alternate methods to disseminate information among providers and patients. CONCLUSIONS: These recommendations serve as a starting point to assist any radiation oncology practice in becoming more resiliently prepared for a local or regional disruption from any cause. Disease-site experts provide evidence-based guidelines on how to mitigate the impact of a 2- to 3-week interruption in radiation therapy for lung, head and neck, uterine cervix, breast, and prostate cancers through altered fractionation or dose escalation.
Assuntos
Tempestades Ciclônicas/mortalidade , Desastres Naturais/mortalidade , Radioterapia (Especialidade)/normas , Humanos , Porto RicoRESUMO
Sepsis is the combination of infection and physiological changes known as the systemic inflammatory response syndrome. There have been improvements in mortality rates and outcomes of septic patients based on "Surviving Sepsis Campaign" guidelines. Current management of sepsis at our Institution follows no specific mandatory protocols. This study aimed to verify the incidence and outcome of sepsis in Manati Medical Center, Puerto Rico. An observational retrospective study was conducted. All the Emergency Department admissions from May 1/ to October 31/ 2013 were screened for sepsis per ICD-9 code. For all included patients, demographic and clinical data at ED admission were collected. During this period 8931 patients were admitted and 148 met criteria for sepsis and related conditions. The overall mortality rate was 43.91%. Mortality increased with age, from 10.52% among ≤ 44 years old to 68.75% in those ≥ 85 years old. The main infection sources were respiratory (32.66%) and urinary tract (24.62%). Mean age among non-survivors was 10.8 years higher than the survivor group (95% Cl 5.2-1 6.5, p < 0.05). Multivariate analysis showed an increased fatality rate associated to severity of sepsis (HR 1.33; 95% Cl; 1.03-1.72, p = 0.02) and the APACHE2 score (HR 1.05; 95% Cl, 1.01-1.09 p = 0.03). Our data suggests that sepsis is an important problem to consider. We strongly encourage an institutional standardized protocol to diminish the mortality impact. Our results will allow adequate preventive strategies to improve early diagnosis, mortality rates and outcomes of septic patients.
Assuntos
Pacotes de Assistência ao Paciente , Sepse/terapia , APACHE , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Gerenciamento Clínico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes , Mortalidade Hospitalar , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/epidemiologia , Insuficiência de Múltiplos Órgãos/etiologia , Modelos de Riscos Proporcionais , Porto Rico/epidemiologia , Estudos Retrospectivos , Sepse/epidemiologia , Choque Séptico/epidemiologia , Choque Séptico/etiologia , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVE: The Asthma Control Test (ACT) questionnaire has been widely used and validated in various ethnic groups, showing an adequate correlation with physician assessment of asthma control. We sought to evaluate the relationship between ACT-defined asthma control and peak flow measures in subjects living in Puerto Rico. METHODS: A retrospective evaluation of data collected by a mobile asthma clinic in 2 cities in Puerto Rico was conducted. The participants completed an asthma and rhinitis survey. Self-reported asthmatics answered the age-appropriate Spanish version of the ACT. Peak flows (PEF) were measured. Subjects were skin-tested against the common local aeroallergens. The study was approved by the University of Puerto Rico's IRB. RESULTS: We evaluated data from 70 subjects aged 4 to 68. Of them, 82.85% were 12 years old or older, 64.3% reported having a history of asthma, 57.14% reported that they still suffered from asthma, 81.4% reported that they suffered from rhinitis, and 78.57% were sensitized to at least 1 antigen. The mean ACT score of current asthmatics was 18.97, while that of past asthmatics was 23.83 (p = 6.6e-6). The variability of PEF increased as the ACT score increased. Age had no impact on asthma control (p > 0.25), while the effect of PEF on the control of asthma was tied to gender. Rhinitis was also associated with poor asthma control as defined by the ACT score. No other covariate was found to be statistically significant (p < 0.05). CONCLUSION: Our study supports the use of the ACT to evaluate asthma control in asthmatics living in Puerto Rico. Research into factors associated with poor asthma control, and the importance of rhinitis with regard to such control, is needed.
Assuntos
Asma/diagnóstico , Asma/fisiopatologia , Pico do Fluxo Expiratório , Adolescente , Adulto , Idoso , Asma/prevenção & controle , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: To build, validate and apply an instrument to evaluate the clinical aptitude in intraepitelial cervical neoplasia (ICN) in residents. METHODS: The instrument included four clinical real cases, validated by experts and included 106 items using true, false and don't know answers. A pilot test and the 21 Kuder-Richardson formula were used to estimate consistency. It was applied to residents, in an observational, transversal, comparative and open study, including 11 second year residents, 13 third year residents and 12 fourth year residents. RESULTS: Consistency of 0.88 was obtained; 22% were located in the middle level, 39% were located in the low level and 39% in the very low level. There were no residents in the high or very high level or by chance answer level. The Kruskal-Wallis test showed significant differences among the three groups and with the U test of Mann Whitney there were no differences between groups. CONCLUSIONS: The year of residence did not show differences in the development of clinical aptitude in ICN. Most of the residents were located in the inferior level of clinical aptitude. This study makes evident the need to reframe our educative processes in a qualitative different manner.
Assuntos
Competência Clínica , Internato e Residência/normas , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Estudos Transversais , Feminino , Humanos , Inquéritos e Questionários , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapia , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/terapiaRESUMO
INTRODUCCION: La ropivacaína, un nuevo anestésico local, presenta menos toxicidad sistémaica y bloqueo motor que la bupivacaína en dosis equipotente con similar calidad analgésica y sin aumentar la toxicidad con el embarazo. Esto la convierte en un fármaco apropiado para la anestesia intratecal en cesáreas. Objetivo: demostrar que el bloqueo de ropivacaína tiene similares ventajas comparativas respecto al de bupivacaína evaluando la calidad del bloqueo, los efectos analgésicos, neonatológicos y colaterales y desde la óptica de anestesiología, obstetricia y perinatología en cesarea electiva. Lugar: Servicio de Anestesiología, Hospital Universitario de Maternidad y Neonatología dependiente de la Universidad Nacional de Córdoba, Córdoba-Argentina. Diseño: prospectivo, abierto, doble ciego y randomizado. Población: Doscientos cuarenta pacientes entre 15 y 45 años, ASA I-II, elegidos para cesárea bajo anestesia raquídea completaron el estudio, fueron divididos en dos grupos de ciento veinte cada uno. Método: ambos grupos recibieron 3 ml del anestésico local correspondiente, Grupo A:bupivacaína 0,5% hiperbárica y Grupo B: ropivacaína 0,75% isobárica, utilizando aguja raquídea nº 27 punta lápiz, según técnica. Monitoreo: signos vitales maternos, monitoreo automático no invasivo de presión arterial, pulsioximetría, cardioscopía y latidos cardíacos fetales.
Assuntos
Humanos , Masculino , Feminino , Anestesia , Anestésicos Locais , Anestesia/métodos , Bupivacaína/efeitos da radiação , Cesárea/métodosRESUMO
Introducción: La ropivacaína, un nuevo anestésico local, presenta menos toxicidad sistémica y bloqueo motor que la bupivacaína en dosis equipolente, con similar calidad analgésica y sin aumentar la toxicidad con el embarazo. Esto la convierte en un fármaco apropiado para la anestesia intratecal en cesárea. Objetivo: demostrar que el bloqueo de la ropivacaína tiene ventajas similares al de la bupivacaína evaluando su calidad y los efectos analgésicos, neonatológicos y colaterales, desde la óptica de la anestesiología, obstetricia y perinatología en cesárea electiva. Lugar: Hospital Universitario de Maternidad y Neonatología (UNC). Diseño: prospectivo, abierto, doble ciego y randomizado. Población: Completaron el estudio 140 pacientes entre 15 y 45 años, ASA I-II, elegidos para cesárea y bajo anestesia raquídea, los que fueron divididos en dos grupos de setenta pacientes cada uno. Método: Ambos grupos recibieron 3 ml del anestésico local correspondiente; Grupo A: bupivacaína 0,5 por ciento hiperbárica, y Grupo B: ropivacaína 0,75 por ciento isobárica, utilizándose aguja raquídea Nº 27 punta lápiz, según técnica. Monitoreo: signos vitales maternos, monitoreo automático no invasivo de presión arterial, pulsioximetría, cardioscopía y latidos cardíacos fetales. Resultados: No hubo diferencias significativas en las variables demográficas, quirúrgicas ni neonatológicas. Tampoco en la extensión y la altura del bloqueo sensorial, ni en el tiempo de latencia, ni en el grado del bloqueo motor. La calidad de la anestesia y la relajación muscular fueron similares. Se pudo determinar que el comienzo del bloqueo motor fue más rápido con bupivacaína, aunque fueron mayores la duración del bloqueo sensorial y motor y el tiempo analgésico con ropivacaína. Los efectos adversos fueron similares, salvo una mayor incidencia de hipotensión y bradicardia transoperatoria en el grupo de la bupivacaína. No se observaron signos de toxicidad local ni sistémica.
Introduction: The ropivacaine, a new amide-type local anesthetic, exhibits less systemic toxicity and causes less motor blockage than bupivacaine when used in equivalent analgesic doses, reaching similar analgesic and anesthetic quality without increasing the toxicity during the pregnancy. These characteristics indeed make it an appropriate drug for intrathecal anesthesia in caesarean section. Objectives: evaluate ropivacaine's blockage quality as well as its analgesic, neonatological and adverse effects, and demonstrate that ropivacaine possesses similar comparative advantages in relation to bupivacaine, from the point of view of anesthesiology, obstetrics and neonatology, for elective caesarean section. Place: Hospital Universitario de Maternidad y Neonatología (UNC) Design: prospective, open, double-blind, and randomized study. Population: One hundred and forty patients between 15 and 45 years old, ASA I-II for elective caesarean, in two groups: seventy patients in each one. Method: Both groups received 3 ml of either bupivacaine 5 mg/ml hyperbaric (Group A) or ropivacaine 7,5 mg/ml isobaric (Group B) using intrathecal pencil-point needle Nº 27. Monitoring: vital parameters, automatic non-invasive blood pressure, transcutaneous O2 saturation, heart monitor and fetal heart rate. Results: There were no demographic, surgical or neonatological significant differences. Nor there were any significant differences in the extension and height of the sensorial blockage, the onset time, or the motor blockage. Both the quality of anesthesia and the muscle relaxation were similar. The start of motor blockage was faster with bupivacaine but the durations of sensorial and motor blockage and ananalgesic time were superior with ropivacaine. The adverse effects were similar with the exception o higher incidence of hypotension and bradicardy with bupivacaine. Signs of local and systemic toxicity were not found.
Introduçao: A toxicidade sistêmica e o bloqueio motor da ropivacaína, um novo anestésico local, é menor que os que correspondem a bupivacaína em doses eqüipolentes, com qualidade analgésica similar e sem aumentar a toxicidade durante a gravidez. Isto a torna um fármaco apropriado para a anestesia intratecal em cirurgia cesariana. Objetivo: demonstrar que o bloqueio da ropivacaína apresenta vantagens similares ao logrado com bupivacaína avaliando sua qualidade e os efeitos analgésicos, neonatológicos e colaterais, desde a óptica da anestesiologia, da obstetrícia e da perinatologia, em cesariana eletiva. Lugar: Hospital Universitario de Maternidad y Neonatología (UNC) Desenho: prospectivo, aberto, duplo-cego e aleatório. Populaçao: Completaram o estudo 140 pacientes de 15 a 45 anos de idade, ASA I-II, escolhidos para cesariana sob anestesia raquiana, que foram divididos em dois grupos de setenta integrantes cada um. Método: Ambos grupos receberam 3 ml do anestésico local correspondente; Grupo A: bupivacaína 0,5 por cento hiperbárica, e Grupo B: ropivacaína 0,75 por cento isobárica, utilizando-se agulha raquidiana Nº 27 ponta de lápis, conforme técnica. Monitoraçao: sinais vitais maternos, monitoraçao automática nao invasiva da pressao arterial, pulsioximetria, cardioscopia e batimentos cardíacos fetais. Resultados: Nao houve diferenças significativas nas variáveis demográficas, cirúrgicas e neonatológicas, e tampouco na extensao e altura do bloqueio sensorial, nem no tempo de latencia, nem no grau do bloqueio motor. A qualidade da anestesia e a relaxaçao muscular foram similares. Comprovou-se que o início do bloqueio motor foi mais rápido com bupivacaína, mas foi maior a duraçao do bloqueio sensorial e motor e maior o tempo analgésico com ropivacaína. Os efeitos adversos foram similares, salvo uma maior incidencia de hipotensao e bradicardia transoperatória no grupo da bupivacaína. Nao se observaram sinais de toxicidade local nem sistêmica.
Assuntos
Humanos , Adolescente , Adulto , Feminino , Gravidez , Amidas/administração & dosagem , Raquianestesia/métodos , Bupivacaína/administração & dosagem , Bupivacaína/efeitos adversos , Cesárea/métodos , Período de Recuperação da Anestesia , Anestésicos Locais/administração & dosagem , Bloqueio Nervoso/métodos , Monitorização Intraoperatória , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Interpretação Estatística de DadosRESUMO
OBJECTIVE: to build, validate and apply a test that explores and evaluates the clinical aptitudes of Gynecology and Obstetrics (Ob/Gyn) residents. MATERIAL AND METHODS: the test included five actual clinical cases representing the main obstetric conditions associated with obstetric bleeding. The validation process included rounds with experts and the final version of the test included 100 items in which the answers had the options "true." "false " and "don't know." A pilot study and the 21 Kuder-Richardson formula served to increase the consistency of the test. Then, 33 Ob/Gyn residents (8 of 2nd year; 14 of 3rd year and 11 of 4th year) answered the test. RESULTS: According to the 21 Kuder-Richardson formula the consistency of the test was 0.80; regarding the clinical aptitudes, 18 % of residents scored in the middle level, 66 % in the low level and 15 % in the very low level. No resident scored in the high or very high levels or by chance answers level. The Kruskal-Wallis test did not show statistically significant differences among the three groups and with the U test of Mann-Whitney no differences between groups were observed after comparing 2nd year versus 3rd year; 3rd year versus 4th year, and 2nd year versus 4th year residents. CONCLUSIONS: The years of residence did not show differences to developing clinical aptitudes. Most of the residents were located in the low level of these clinical aptitudes. This study underlined the need to reconsider our educative processes in a qualitative different manner.
Assuntos
Competência Clínica , Ginecologia/educação , Internato e Residência , Obstetrícia/educação , Complicações Hematológicas na Gravidez/terapia , Estudos Transversais , Feminino , Humanos , Gravidez , Inquéritos e QuestionáriosRESUMO
Introducción: El quiste de colédoco es una anomalía congénita de la vía biliar caracterizada por dilataciones quísticas de los conductos biliares intra y/o extrahepáticos. Caso clínico: Paciente femenino de 18 años de edad, diabética tipo 1 sin adherencia al tratamiento, que consulta por dolor abdominal localizado en epigastrio e hipocondrio derecho de 24 hs de evolución junto con polidipsia y poliuria. Se realiza diagnóstico clínico-humoral de cetoacidosis diabética. La Ecografia y la Tomografía Computada abdominal muestran: vesícula alitiásica de paredes finas, vía biliar intrahepática no dilatada y formación liquida con burbuja aérea en su interior en contacto con la cabeza del páncreas. Colangioresonancia: muestra quiste de colédoco tipo I con imágenes negativas en su interior. Comienza con tratamiento médico de la cetoacidosis y una vez estabilizada, se realiza resección del quiste con hepaticoyeyunoanastomosis en Y de Roux. Resultados: Buena evolución postoperatoria. Anatomía patológica confirma quiste de colédoco con ausencia de células atípicas. Alta hospitalaria al 7º día postoperatorio, con control por consultorio externo de cirugía y endocrinología. Conclusión: El quiste de colédoco en el adulto, en forma infrecuente puede presentarse como un hallazgo en el contexto de otra enfermedad...(AU)
Assuntos
Humanos , Feminino , Adolescente , Cisto do Colédoco/diagnóstico , Cisto do Colédoco/cirurgiaRESUMO
Introducción: El quiste de colédoco es una anomalía congénita de la vía biliar caracterizada por dilataciones quísticas de los conductos biliares intra y/o extrahepáticos. Caso clínico: Paciente femenino de 18 años de edad, diabética tipo 1 sin adherencia al tratamiento, que consulta por dolor abdominal localizado en epigastrio e hipocondrio derecho de 24 hs de evolución junto con polidipsia y poliuria. Se realiza diagnóstico clínico-humoral de cetoacidosis diabética. La Ecografia y la Tomografía Computada abdominal muestran: vesícula alitiásica de paredes finas, vía biliar intrahepática no dilatada y formación liquida con burbuja aérea en su interior en contacto con la cabeza del páncreas. Colangioresonancia: muestra quiste de colédoco tipo I con imágenes negativas en su interior. Comienza con tratamiento médico de la cetoacidosis y una vez estabilizada, se realiza resección del quiste con hepaticoyeyunoanastomosis en Y de Roux. Resultados: Buena evolución postoperatoria. Anatomía patológica confirma quiste de colédoco con ausencia de células atípicas. Alta hospitalaria al 7º día postoperatorio, con control por consultorio externo de cirugía y endocrinología. Conclusión: El quiste de colédoco en el adulto, en forma infrecuente puede presentarse como un hallazgo en el contexto de otra enfermedad.
Introduction: The choledochal cyst is a congenital anomaly of the bile duct characterized by cystic dilatations of intraand/ or extra- hepatic bile ducts. Clinical Case: 18 year old female patient with type 1 diabetics showing no adherence to treatment goes for consultation because she was suffering a 24 hour evolution abdominal pain located at the right epigastrium and hypocondrium with polydipsia and polyuria. A clinical/humoral diagnosis of diabetic ketoacidosis was reached. Ultrasound and abdominal CT scan show: alitiasic gallbladder with thin walls, undilated intrahepatic bile duct, and liquid formation with an air bubble inside in contact with the pancreas' head. The cholangio magnetic resonance shows a Type I choledochal cyst with negative images inside. The patient starts medical treatment for ketoacidosis and, once this condition is stabilized, the cyst is resected by Roux -en- Y hepaticojejunoanastomosis. Results: The patient shows good post-surgical evolution. Pathological findings confirm a choledochal cyst with absence of aty pical cells. The patient is discharged on the seventh day after surgery and controlled at the surgery and endocrinology outpatient service. Conclusion: The choledochal cyst in adults is rare to appear as a finding within the context of another disease.
Assuntos
Humanos , Feminino , Adolescente , Ducto Colédoco , Cistos , Sistema Biliar , Cetoacidose Diabética , Doenças do Sistema Endócrino , NeoplasiasRESUMO
Evaluar los resultados de la colecistectomía laparoscópica en nuestro hospital, luego de 20 años de la descripción del procedimiento...(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Colecistectomia Laparoscópica/mortalidade , Colecistectomia Laparoscópica/estatística & dados numéricos , Litíase , VesículaRESUMO
Introducción: El abordaje laparoscópico para el tratamiento de la litiasis vesicular, es el más aceptado en nuestros días. Objetivo: Evaluar los resultados de la colecistectomía laparoscópica en nuestro hospital, luego de 20 años de la descripción del procedimiento. Materiales y Métodos: Lugar de Aplicación: Hospital público de atención terciaria. Diseño: Observacional, retrospectivo.Se evaluaron a través de un fichaje prospectivo sistemático en una base de datos Access diseñada para tal fin, una cohorte de 1225 pacientes, a los cuales se les realizó colecistectomía laparoscópica entre los años 1998 y 2005. Sexo femenino: 65%. Media de edad: 44.5 años (r: 15-90). Se evaluaron: diagnósticos, porcentaje de colangiografía intraoperatoria, procedimientos asociados, porcentaje de conversión y morbi-mortalidad. Resultados: Diagnóstico preoperatorio: litiasis vesicular sintomática 682/ 1225 (55.7%), colecistitis aguda 543/1225 (44.3%). Porcentaje de colangiografía intraoperatoria (CIO): 84.4%. Procedimientos asociados: la plástica de pared 16 (1.3%) fue la más común. Conversión: 34 casos (2.8%). Morbilidad: 70 pacientes (5.7%), siendo la más frecuente la infección del sitio quirúrgico y las complicaciones generales. Se reoperaron 16 pacientes (1.3%). Mortalidad: 4 casos (0.3%), de las cuales 3 (75%) correspondieron a complicaciones generales. Conclusiones: La colecistitis aguda representa un porcentaje similar a la litiasis vesicular sintomática, en la indicación de colecistectomía laparoscópica. La posibilidad de conversión a cirugía abierta es mayor en casos de colecistitis aguda. La morbi-mortalidad relacionada a la colecistectomía laparoscópica en nuestra serie, se encuentra dentro de los estándares internacionales publicados. El abordaje laparoscópico para el tratamiento de la litiasis vesicular es un procedimiento factible de realizar en un hospital público.
Background: The laparoscopic approach for treatment of vesicular lithiasis is the most widely accepted today. Objective: Assess the results of laparoscopic cholecystectomy in our Hospital, twenty years after the description of the procedure. Population and Method: Application site: Public Hospital for tertiary health care. Design: Observational, retrospective. By means of a systematic prospective recording in an Access Database specifically designed for this purpose, a cohort of 1225 patients, who had a laparoscopic cholecystectomy between the years 1998 and 2005 was assessed. Female patients: 65%. Age mean: 44.5 years (range: 15-90). The following material was assessed: diagnosis, intra-surgical cholangiography percent, associated procedures, conversion percentage, and morbi-mortality. Results: Pre-surgical diagnosis: Symptomatic vesicular lithiasis: 682 patients (55.7%), acute cholecystitis 543 patients (44.3%). Intraoperative Transcytic Cholangiography percentage: 84.4%. Among the associated procedures, wall plastic surgery: 16 patients (1.3%) was the commonest. Then, followed: Conversion: 34 cases (2.8%); Morbidity: 70 patients (5.7%), with surgical site infection and general complications as the most frequent ones. 16 patients had to be re-operated (1.3%). Mortality: 4 cases (0.3%), of which 3 (75%) where due to general complications. Conclusions: In our Hospital, acute cholecystitis represents a percentage similar to symptomatic vesicular lithiasis in laparoscopic cholecystectomy indication. The possibility of conversion to open surgery is greater in cases of acute cholecystitis. Morbi-mortality associated to the procedure in our series was low. It is possible to perform laparoscopic cholecystectomy in a public hospital.
Assuntos
Humanos , Colecistectomia Laparoscópica , Litíase , Processos Patológicos , Procedimentos Cirúrgicos do Sistema Biliar , Colecistite Aguda , Doenças do Sistema DigestórioRESUMO
OBJECTIVE: To assess apoptosis frequency in the nasal mucosa of patients with perennial allergic rhinitis. PATIENTS AND METHODS: Eleven patients and five healthy subjects accepted to participate, from 10 to 16 years old. None of them had evidence of acute infectious disease, tobacco exposure or use of corticosteroids, antileukotrienes, antihistamines or immunotherapy. After a clinical evaluation and a skin prick testing, a nasal symptoms questionnaire was applied and a nasal washing was performed. Two hundred cells were examined (Giemsa and eosin yellowish) and apoptosis was identified by immunohistochemistry (Active-Caspase-3) (p20L18, sc-1225. Santa Cruz Biothecnology, Inc. Santa Cruz). RESULTS: The most common allergen was Dermatophagoides sp in 10 patients (91%). The total score of the nasal symptom questionnaire was 3 to 8 (median 6) in patients and 1 to 4 (median 2) in healthy subjects (p < 0.05, Mann Whitney U test). Frequency of eosinophils was 11 to 80% in patients and 0 to 1% in healthy subjects (p < 0.05, Z for proportions). Apoptosis was less frequent in patients (0 to 5, median 2) than in healthy subjects (4 to 16, median 8) (p < 0.01, Mann Whitney U test). CONCLUSIONS: Perennial allergic rhinitis may be associated with decreased apoptosis in the nasal mucosa.
Assuntos
Apoptose , Mucosa Nasal/patologia , Rinite Alérgica Perene/patologia , Adulto , Alérgenos/efeitos adversos , Animais , Estudos Transversais , Dermatophagoides pteronyssinus/imunologia , Eosinofilia/etiologia , Eosinofilia/patologia , Células Epiteliais/patologia , Feminino , Humanos , Masculino , México/epidemiologia , Índice de Gravidade de Doença , Testes Cutâneos , Inquéritos e Questionários , Irrigação TerapêuticaRESUMO
INTRODUCTION: Vaginal vault prolapsed is a rare complication, with a frequency from 0.2 to 1% after hysterectomy, which is presented due to a bad surgical technique in fixation of the vault suspension elements, as well others factors as the multiparity, menopause, chronic lungs disease, obesity, smoking and weak physical activity. There are many techniques reported to correct this pelvic disease, although the conventional sacropexy has been established for abdominal way, where the diversity of materials of fixation is varied, including natural material as the abdominal fascia and aponeurosis of muscle rectos. OBJECTIVE: This descriptive and clinical study was carried out in a group of patient with vaginal vault prolapsed, with the objective to know the results and experience of this correction with the surgical technique of sacropexy utilizing abdominal fascia. MATERIAL AND METHODS: 32 menopausal patient with mean age of 53.9 years, 5 gestations, as well as index of Quetelet of 26.2, were studied, a following of a year was carried out. In these women the main symptom were the sensation of vaginal strange body and subsequently urinary incontinence of effort. Moreover, considering to all group the mean in presentation of the vaginal vault prolapsed after hysterectomy was of 7.7 years, with surgical time of 129 minutes and bled of 172 milliliters. RESULTS. The 97.5% of the patient returned to its sexual life without difficulties and only one referred dyspareunia. Post-surgical complications were not presented and only a patient presented vault prolapsed again (0.31%). CONCLUSIONS: With this results we can consider that the sacropexy with abdominal fascia is a good technique for the correction of the vaginal vault prolapsed in healthy menopausal women with regular sexual activity and then is a natural material who cause not any.
Assuntos
Prolapso Uterino/cirurgia , Fáscia , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Reto do AbdomeRESUMO
Introducción: La ropivacaína, un nuevo anestésico local, presenta menos toxicidad sistémica y bloqueo motor que la bupivacaína en dosis equipotente, con similar calidad anestésica y analgésica y sin aumentar la toxicidad con el embarazo. Esto lo convierte en un fármaco apropiado para la anestesia peridural en cesárea. Objetivo: los objetivos de este estudio comparativo con bupivacaína 5 mg/ml fueron evaluar eficacia, seguridad y tolerabilidad materna, fetal y neonatal, incluyendo farmacoeconomía cuando usamos ropivacaína 7,5 mg/ml asociados a fentanilo, para anestesia epidural en cesárea electiva. Lugar: Servicio de Anestesiología, Hospital Universitario de Córdoba, Córdoba, Argentina. Diseño: estudio prospectivo, abierto, a doble ciego y randomizado. Población: ciento veinte pacientes entre 15 y 45 años, ASA I-II, para cesárea electiva, divididos en dos grupos: sesenta en cada uno. Método: los pacientes recibieron 18 ml de bupivacaína (5 mg/ml) o ropivacaína (7,5 mg/ml), más 100 µg de fentanilo por vía epidural utilizando aguja metálica Tuohy n§ 18. Monitoreo: signos vitales maternos, monitoreo automático no invasivo de presión arterial, pulsioximetría, cardioscopía y latidos cardíacos fetales. Resultados: El tiempo de latencia fue menor con ropivacaína y la relajación muscular fue superior según la evaluación de los cirujanos. Los efectos adversos más frecuentes en ambos grupos fueron hipotensión, naúseas y escalofríos/temblores. Todos fueron de pequeña a moderada magnitud y respondieron al tratamiento etiológico correspondiente. En el grupo de ropivacaína fue mayor la incidencia de hipotensión arterial (18,3 por ciento), bradicardia (3,3 por ciento) y prurito (0,6 por ciento) siendo sólo estadísticamente significativo el primero (p<0,05). Es destacable la mejoría en la saturación de O2 postbloqueo en ambos grupos (p<0,05). No se observaron signos de toxicidad sistémica. Los anestésicos fueron bien tolerados por el feto y el neonato en ambos grupos, evaluados por los latidos cardíacos fetales, el test de Apgar y la clínica neonatológica, observándose una puntuación significativamente mayor en el test de Apgar en el grupo ropivacaína. Conclusiones: la ropivacaína es un anestésico local bien tolerado con una eficacia superior al de la bupivacaína cuando se la usa asociada a fentanilo. Por ende, puede ser una opción preferida debido al reducido potencial cardio y neurotóxico, por no aumentar su toxicidad en el embarazo..
Assuntos
Humanos , Gravidez , Recém-Nascido , Anestésicos Locais/administração & dosagem , Anestésicos Locais/economia , Anestésicos Locais/efeitos adversos , Anestésicos Locais/farmacologia , Bupivacaína/administração & dosagem , Bupivacaína/economia , Bupivacaína/efeitos adversos , Bupivacaína/farmacocinética , Cesárea , Fentanila , Calafrios , Estado de Consciência , Feto , Hemodinâmica , Náusea e Vômito Pós-Operatórios , Interpretação Estatística de Dados , Tremor , Retenção UrináriaRESUMO
Introducción: La ropivacaína, un nuevo anestésico local, presenta menos toxicidad sistémica y bloqueo motor que la bupivacaína en dosis equipotente, con similar calidad anestésica y analgésica y sin aumentar la toxicidad con el embarazo. Esto lo convierte en un fármaco apropiado para la anestesia peridural en cesárea. Objetivo: los objetivos de este estudio comparativo con bupivacaína 5 mg/ml fueron evaluar eficacia, seguridad y tolerabilidad materna, fetal y neonatal, incluyendo farmacoeconomía cuando usamos ropivacaína 7,5 mg/ml asociados a fentanilo, para anestesia epidural en cesárea electiva. Lugar: Servicio de Anestesiología, Hospital Universitario de Córdoba, Córdoba, Argentina. Diseño: estudio prospectivo, abierto, a doble ciego y randomizado. Población: ciento veinte pacientes entre 15 y 45 años, ASA I-II, para cesárea electiva, divididos en dos grupos: sesenta en cada uno. Método: los pacientes recibieron 18 ml de bupivacaína (5 mg/ml) o ropivacaína (7,5 mg/ml), más 100 Ag de fentanilo por vía epidural utilizando aguja metálica Tuohy nº 18. Monitoreo: signos vitales maternos, monitoreo automático no invasivo de presión arterial, pulsioximetría, cardioscopía y latidos cardíacos fetales. Resultados: El tiempo de latencia fue menor con ropivacaína y la relajación muscular fue superior segú
Assuntos
Humanos , Estudo Comparativo , Gravidez , Recém-Nascido , Bupivacaína/administração & dosagem , Bupivacaína/efeitos adversos , Bupivacaína/economia , Bupivacaína/farmacocinética , Anestésicos Locais/administração & dosagem , Anestésicos Locais/economia , Anestésicos Locais/farmacologia , Anestésicos Locais/efeitos adversos , Fentanila/administração & dosagem , Fentanila/efeitos adversos , Fentanila/farmacocinética , Cesárea , Feto/efeitos dos fármacos , Interpretação Estatística de Dados , Hemodinâmica/efeitos dos fármacos , Calafrios , Tremor , Náusea e Vômito Pós-Operatórios , Estado de Consciência/efeitos dos fármacos , Retenção UrináriaRESUMO
Antecedentes: La incontinencia fecal constituye un serio problema social que afecta a todos los grupos de edad. Su tratamiento es tan complejo como desconocido. Métodos: Efectuamos un estudio longitudinal, prospectivo, experimental, entre 47 pacientes consecutivos que presentaban incontinencia total por un periodo de 55.4 ñ 7.6 meses (intervalo: seis meses a 21 años), con 2.4 ñ 0.2 episodios de incontinencia (intervalo: 1-7 por día). A todos se les efectuó cuestionario para validar el diagnóstico de incontinencia, historia clínica completa, laboratorio, colon por enema, rectosigmoidoscopia, sensibilidad rectal, manometría rectoanal, y retroalimentación biológica sin instrumentación electrónica. Veintiún sujetos normales sirvieron como grupo control. Resultados: Los pacientes con incontinencia fecal presentaron disminución de la sensibilidad rectal (p<0.01) y alteraciones en el reflejo recto anal inhibitorio espontáneo. Todos obtuvieron curación completa en un periodo de 4 ñ 0.5 meses (intervalo: 15 días a 15 meses) y fueron seguidos por uno a ocho años. Conclusiones: La nueva modalidad de retroalimentación biológica aquí descrita no utiliza ningún instrumento electrónico. La curación y el tiempo de curación de los pacientes no solamente es comparable, sino superior a lo hasta ahora informados. Puede ser reproducido, con el entrenamiento adecuado, por mayor número de médicos en cualquier centro y condicionar, por tanto, un beneficio significativo en la calidad de vida de un mayor número de pacientes