Pub Date : 2018-04-19DOI: 10.4067/S0718-40262018000200102
M. D. Daroch, M. D. Espínola, Z. A. Cuneo
{"title":"Perforación de colon sigmoides por migración de dispositivo intrauterino","authors":"M. D. Daroch, M. D. Espínola, Z. A. Cuneo","doi":"10.4067/S0718-40262018000200102","DOIUrl":"https://doi.org/10.4067/S0718-40262018000200102","url":null,"abstract":"","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"81 1","pages":"102-103"},"PeriodicalIF":0.0,"publicationDate":"2018-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75842439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-19DOI: 10.4067/S0718-40262018000200147
Manuel Figueroa-Giralt
Background: The identification of survival prognostic factors for gastric cancer, allows us to create clinical guidelines. Chile has a deficit in the analysis of long-term survival prognostic factors. Aim: To assess different prognostic factors of long-term survival in gastric cancer. Determine the survival rate at 5 and 10-years post gastrectomy, and the value of a new prognostic factor of long-term survival called N+/T. Material and Method: Prospective study of the oncological database of the Clinical Hospital of the University of Chile between May 2004 and May 2012. Results: A total of 284 patients were included, 65.4% were men and the mean age was 64.5 years. Seventy-five percent were advanced gastric cancer, 72.5% of the patients required a total gastrectomy. The lymphadenectomy practiced was D2 in 85.2%, and average lymph node harvest was 30 lymph nodes. The postoperative morbidity and mortality was 17.2% and 1.7% respectively. The average global survival was 69.9 months, the 5-year survival was 56.9% and the 10-year survival was 53.4%. The N+/T index presented a statistically significant difference in the global survival of all the subgroups (p < 0.0001). The multivariate analysis showed that the significant variables were: N+/T index (p = 0.0001, OR: 1.1 [1.05-1.12]), LNR (p = 0.0001, OR: 5.8 [1.04-15.6]), age (p = 0.008, OR: 1.03 [1.00-1.06]), lymphovascular permeation (p = 0.0001, OR: 2.19 [1.49-3.23]), T classification (p = 0.03, OR: 3.4 [1.10-8.93]), N classification(p = 0.001, OR: 1.06 [1.02-1.10]), and TNM stage (p = 0.004, OR: 1.03 [1.01-1.06]). The areas under the ROC curves of the N+/T, LNR and T classification, were 0.789, 0.786 and 0.790 respectively (p = 0.96). Conclusion: The independent prognostic factors of long-term survival were N+/T index, LNR, age, lymphovascular permeation, T classification, N classification and TNM stage. Concomitantly, a new prognostic factor has been created to assess survival in gastric cancer, the N+/T index.
{"title":"Factores pronósticos de sobrevida alejada en cáncer gástrico. Introducción del nuevo índice N+/T","authors":"Manuel Figueroa-Giralt","doi":"10.4067/S0718-40262018000200147","DOIUrl":"https://doi.org/10.4067/S0718-40262018000200147","url":null,"abstract":"Background: The identification of survival prognostic factors for gastric cancer, allows us to create clinical guidelines. Chile has a deficit in the analysis of long-term survival prognostic factors. Aim: To assess different prognostic factors of long-term survival in gastric cancer. Determine the survival rate at 5 and 10-years post gastrectomy, and the value of a new prognostic factor of long-term survival called N+/T. Material and Method: Prospective study of the oncological database of the Clinical Hospital of the University of Chile between May 2004 and May 2012. Results: A total of 284 patients were included, 65.4% were men and the mean age was 64.5 years. Seventy-five percent were advanced gastric cancer, 72.5% of the patients required a total gastrectomy. The lymphadenectomy practiced was D2 in 85.2%, and average lymph node harvest was 30 lymph nodes. The postoperative morbidity and mortality was 17.2% and 1.7% respectively. The average global survival was 69.9 months, the 5-year survival was 56.9% and the 10-year survival was 53.4%. The N+/T index presented a statistically significant difference in the global survival of all the subgroups (p < 0.0001). The multivariate analysis showed that the significant variables were: N+/T index (p = 0.0001, OR: 1.1 [1.05-1.12]), LNR (p = 0.0001, OR: 5.8 [1.04-15.6]), age (p = 0.008, OR: 1.03 [1.00-1.06]), lymphovascular permeation (p = 0.0001, OR: 2.19 [1.49-3.23]), T classification (p = 0.03, OR: 3.4 [1.10-8.93]), N classification(p = 0.001, OR: 1.06 [1.02-1.10]), and TNM stage (p = 0.004, OR: 1.03 [1.01-1.06]). The areas under the ROC curves of the N+/T, LNR and T classification, were 0.789, 0.786 and 0.790 respectively (p = 0.96). Conclusion: The independent prognostic factors of long-term survival were N+/T index, LNR, age, lymphovascular permeation, T classification, N classification and TNM stage. Concomitantly, a new prognostic factor has been created to assess survival in gastric cancer, the N+/T index.","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"93 1","pages":"147-159"},"PeriodicalIF":0.0,"publicationDate":"2018-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74349704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-19DOI: 10.4067/S0718-40262018000200185
R. Henríquez, C. Yáñez, F. Searle
Fasciotomy is the mainstay of treatment and prevention of acute compartment syndrome. Given the important deep tissue edema, closure of the resulting wound generates a significant reconstructive challenge for the surgeon. The aim of this article is to provide an update concerning alternatives for closure of fasciotomy of limbs, for which a search of articles indexed in PubMed, Scielo and Epistemonikos databases was performed. At least 6 techniques were found, each of them with specific advantages and disadvantages. We recommend that the choice should be according to the surgeons experience, resources and context of each patient.
{"title":"Alternativas de cierre de fasciotomías en extremidades","authors":"R. Henríquez, C. Yáñez, F. Searle","doi":"10.4067/S0718-40262018000200185","DOIUrl":"https://doi.org/10.4067/S0718-40262018000200185","url":null,"abstract":"Fasciotomy is the mainstay of treatment and prevention of acute compartment syndrome. Given the important deep tissue edema, closure of the resulting wound generates a significant reconstructive challenge for the surgeon. The aim of this article is to provide an update concerning alternatives for closure of fasciotomy of limbs, for which a search of articles indexed in PubMed, Scielo and Epistemonikos databases was performed. At least 6 techniques were found, each of them with specific advantages and disadvantages. We recommend that the choice should be according to the surgeons experience, resources and context of each patient.","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"70 1","pages":"185-193"},"PeriodicalIF":0.0,"publicationDate":"2018-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75477671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-19DOI: 10.4067/s0718-40262018000200099
J. Yarmuch
{"title":"La revista en una etapa diferente","authors":"J. Yarmuch","doi":"10.4067/s0718-40262018000200099","DOIUrl":"https://doi.org/10.4067/s0718-40262018000200099","url":null,"abstract":"","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"14 1","pages":"99-99"},"PeriodicalIF":0.0,"publicationDate":"2018-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80228227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-19DOI: 10.4067/S0718-40262018000200117
M. Astudillo, M. Losada, H. P. Schneeberger, F. Coronado, S. S. Curitol
Aim: To assess the degree of emotional exhaustion, personal accomplishment and depersonalization in the work of physicians of the Hospital Hernan Henriquez Aravena surgery service and department of surgery of the Universidad de La Frontera, Temuco, Chile. Material and Method: Cross-sectional study. 19 medical interns, 11 surgical residents and 15 surgeons of Hernan Henriquez Aravena Hospital and surgery department of Universidad de La Frontera were included. Applied instrument: MBI questionnaire in its adaptation of the Spanish population. Calculation of measures of central tendency and percentage, as well as comparison of variables through t Student and values of Cronbach’s alpha coefficients were performed. Results: Regarding the MBI scale, the overall prevalence of the syndrome was 64.4%, whereas, by dimensions, emotional exhaustion showed a prevalence of 76%; Low personal accomplishment at work, 55%, and depersonalization 62%. Statistically significant differences were found in emotional exhaustion and depersonalization according to socio-demographic variables: men and women, single and married, subjects without children and with children, whether or not they take emergency room shifts, obtaining higher levels in women, unmarried, subjects without children and those who take emergency shifts. Conclusions: It is accepted that the central triggering factor is the high emotional exhaustion that gradually leads to a state of emotional and cognitive distancing in their daily activities, with the consequent inability to respond to demands of the service. In this distancing occurs depersonalization, indifference and cynical attitudes toward responsibilities or towards people. Therefore, measures should be taken to try to reduce the prevalence of this syndrome in our medical interns and residents, mainly.
{"title":"Prevalencia de Síndrome de Burnout en un Centro de Cirugía Académico-Asistencial Público en Chile","authors":"M. Astudillo, M. Losada, H. P. Schneeberger, F. Coronado, S. S. Curitol","doi":"10.4067/S0718-40262018000200117","DOIUrl":"https://doi.org/10.4067/S0718-40262018000200117","url":null,"abstract":"Aim: To assess the degree of emotional exhaustion, personal accomplishment and depersonalization in the work of physicians of the Hospital Hernan Henriquez Aravena surgery service and department of surgery of the Universidad de La Frontera, Temuco, Chile. Material and Method: Cross-sectional study. 19 medical interns, 11 surgical residents and 15 surgeons of Hernan Henriquez Aravena Hospital and surgery department of Universidad de La Frontera were included. Applied instrument: MBI questionnaire in its adaptation of the Spanish population. Calculation of measures of central tendency and percentage, as well as comparison of variables through t Student and values of Cronbach’s alpha coefficients were performed. Results: Regarding the MBI scale, the overall prevalence of the syndrome was 64.4%, whereas, by dimensions, emotional exhaustion showed a prevalence of 76%; Low personal accomplishment at work, 55%, and depersonalization 62%. Statistically significant differences were found in emotional exhaustion and depersonalization according to socio-demographic variables: men and women, single and married, subjects without children and with children, whether or not they take emergency room shifts, obtaining higher levels in women, unmarried, subjects without children and those who take emergency shifts. Conclusions: It is accepted that the central triggering factor is the high emotional exhaustion that gradually leads to a state of emotional and cognitive distancing in their daily activities, with the consequent inability to respond to demands of the service. In this distancing occurs depersonalization, indifference and cynical attitudes toward responsibilities or towards people. Therefore, measures should be taken to try to reduce the prevalence of this syndrome in our medical interns and residents, mainly.","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"26 6 1","pages":"117-126"},"PeriodicalIF":0.0,"publicationDate":"2018-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77846976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-19DOI: 10.4067/S0718-40262018000200140
L. Domínguez T., Álvaro Sanabria Q., Diego Sierra B.
Introduction/Aims: The use of the inverted classroom as a teaching approach in the surgical curriculum is under development. There is a need for studies informing about their effectiveness and relationship with the learning climate. The aim of this study is to present the accumulated measurement of the learning climate in the inverted classroom in surgery, and share some recommendations for its implementation. Material and Method: The Dundee Ready Educational Environment Measure (DREEM) evaluated the student´s perceptions about the learning climate. The overall score of instrument, as its five domains were calculated. Results: A total of 444 students were included. The overall DREEM score indicated a learning climate of excellence. In general, teaching was well perceived by the students, who felt confident about their academic abilities, perceived their teachers as models, identified a positive attitude in the learning atmosphere, and perceived an acceptable social environment. Discussion: The approach of inverted classroom in surgery is associated with a productive learning climate. These results provide new evidence to the high levels of student satisfaction and adequate perceptions about student self-confidence for learning in surgery showed in other studies. Conclusions: The longitudinal measurement of the learning climate in surgery by using the inverted classroom model demonstrates scores of excellence in the evaluated population. Further studies are needed to explore in depth their effects on learning and cognitive abilities in students.
{"title":"¿Cómo perciben los estudiantes el clima de aprendizaje en el aula invertida en cirugía?: Lecciones aprendidas y recomendaciones para su implementación","authors":"L. Domínguez T., Álvaro Sanabria Q., Diego Sierra B.","doi":"10.4067/S0718-40262018000200140","DOIUrl":"https://doi.org/10.4067/S0718-40262018000200140","url":null,"abstract":"Introduction/Aims: The use of the inverted classroom as a teaching approach in the surgical curriculum is under development. There is a need for studies informing about their effectiveness and relationship with the learning climate. The aim of this study is to present the accumulated measurement of the learning climate in the inverted classroom in surgery, and share some recommendations for its implementation. Material and Method: The Dundee Ready Educational Environment Measure (DREEM) evaluated the student´s perceptions about the learning climate. The overall score of instrument, as its five domains were calculated. Results: A total of 444 students were included. The overall DREEM score indicated a learning climate of excellence. In general, teaching was well perceived by the students, who felt confident about their academic abilities, perceived their teachers as models, identified a positive attitude in the learning atmosphere, and perceived an acceptable social environment. Discussion: The approach of inverted classroom in surgery is associated with a productive learning climate. These results provide new evidence to the high levels of student satisfaction and adequate perceptions about student self-confidence for learning in surgery showed in other studies. Conclusions: The longitudinal measurement of the learning climate in surgery by using the inverted classroom model demonstrates scores of excellence in the evaluated population. Further studies are needed to explore in depth their effects on learning and cognitive abilities in students.","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"6 1","pages":"140-146"},"PeriodicalIF":0.0,"publicationDate":"2018-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82321388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-19DOI: 10.4067/S0718-40262018000200133
M. Losada, S. S. Curitol, Andrés Troncoso., C. H. Herrera, A. J. Silva
Introduction: Pancreatoduodenectomy is a complex surgery, with morbidity close to 30% and mortality between 1% and 5%. The main contributing factor to morbidity and mortality is postoperative pancreatic fistula (POPF). At present, there is no globally standardized technique for pancreatic reconstruction. Aim: To determine the prevalence of clinically relevant POPF in a sample of patients who underwent pancreaticojejunal anastomosis reconstruction with Blumgart’s modified technique for post-pancreatoduodenectomy reconstruction at Hospital Hernan Henriquez Aravena between 2014 and 2017. Material and Method: Case series with follow-up from july 2014 to april 2017. Patients who underwent pancreatic reconstruction with Blumgart’s modified technique were included. The modification consisted of the use of Pledgets® (poly-tetrafluoro-ethylene) at the inicial points in pancreas with the idea of reducing the possibility of tissue tearing. We excluded patients who underwent another reconstruction technique. Clinically relevant POPF (grade B/C) was considered to asses morbidity. Descriptive statistics were used with measures of central tendency and dispersion. Results: Case series of 12 patients, 9 (75%) were female and 3 (25%) were male. The mean age was 59 ± 8.5 years. The morbidity was 25% and the rate of grade B/C fistula was 0%. All pancreatic fistulas were grade A, not clinically relevant. Conclusion: The Blumgart’s modified technique seems to be a safe and reproducible technique for pancreticojejunal anastomosis. Key words: pancreatic fistula; blumgart/pancreatoduodenectomy; pancreatic fistula score.
{"title":"Pancreatoyeyunoanastomosis con técnica de Blumgart modificada para reconstrucción post-pancreatoduodenectomía. Estudio de serie de casos con seguimiento","authors":"M. Losada, S. S. Curitol, Andrés Troncoso., C. H. Herrera, A. J. Silva","doi":"10.4067/S0718-40262018000200133","DOIUrl":"https://doi.org/10.4067/S0718-40262018000200133","url":null,"abstract":"Introduction: Pancreatoduodenectomy is a complex surgery, with morbidity close to 30% and mortality between 1% and 5%. The main contributing factor to morbidity and mortality is postoperative pancreatic fistula (POPF). At present, there is no globally standardized technique for pancreatic reconstruction. Aim: To determine the prevalence of clinically relevant POPF in a sample of patients who underwent pancreaticojejunal anastomosis reconstruction with Blumgart’s modified technique for post-pancreatoduodenectomy reconstruction at Hospital Hernan Henriquez Aravena between 2014 and 2017. Material and Method: Case series with follow-up from july 2014 to april 2017. Patients who underwent pancreatic reconstruction with Blumgart’s modified technique were included. The modification consisted of the use of Pledgets® (poly-tetrafluoro-ethylene) at the inicial points in pancreas with the idea of reducing the possibility of tissue tearing. We excluded patients who underwent another reconstruction technique. Clinically relevant POPF (grade B/C) was considered to asses morbidity. Descriptive statistics were used with measures of central tendency and dispersion. Results: Case series of 12 patients, 9 (75%) were female and 3 (25%) were male. The mean age was 59 ± 8.5 years. The morbidity was 25% and the rate of grade B/C fistula was 0%. All pancreatic fistulas were grade A, not clinically relevant. Conclusion: The Blumgart’s modified technique seems to be a safe and reproducible technique for pancreticojejunal anastomosis. Key words: pancreatic fistula; blumgart/pancreatoduodenectomy; pancreatic fistula score.","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"518 1","pages":"133-139"},"PeriodicalIF":0.0,"publicationDate":"2018-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77547795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-19DOI: 10.4067/S0718-40262018000200112
F. J. Bombin, A. Kotlik, S. M. Bombin, Constanza Gómez
Objective: To evaluate short and midterm results after endovenous radiofrequency obliteration for treatment of saphenous reflux. Material and Method: Review and updated follow-up of a clinical series of patients after endovenous radiofrequency obliteration of insufficient saphenous trunks at the Hospital Dr. Eduardo Pereira, Valparaiso. Diagnosis was based on clinical parameters and color doppler ultrasonography. A preoperative and postoperative quality of life questionnaire was executed. Results: 77 patients (57 female) with an average age 58.3 years (23-83) and a mean follow-up time of 13.6 months. Patients consulted for symptomatic primary varicose veins of one lower extremity (49) or both (28) with 105 extremities. According to CEAP classification there were C2:84, C3:1, C4:9, C5:4 and C6:7. There were no C0 or C1 extremities. Superficial tributaries of more than 3 mm diameter were removed using Muller’s method in all extremities. Furthermore, in some patients procedures were performed as complementary treatments: perforating veins ligation, skin grafting of ulcers or cutaneous-aponeurotic resection and deferred skin graft. A color doppler ultrasonography was performed one month later observing proper saphenous vein obliteration in 99% of cases and 94% at 6-months follow-up. There were no signs of deep vein thrombosis in all patients. The quality of life questionnaire revealed symptomatic relief and surgical satisfaction in the majority of patients. Conclusion: Endovascular radiofrequency obliteration for treatment of saphenous reflux is an effective method for the short and mid terms and can be done alongside other procedure.
{"title":"Resultados en el corto y mediano plazo del tratamiento con radiofrecuencia de la insuficiencia venosa superficial","authors":"F. J. Bombin, A. Kotlik, S. M. Bombin, Constanza Gómez","doi":"10.4067/S0718-40262018000200112","DOIUrl":"https://doi.org/10.4067/S0718-40262018000200112","url":null,"abstract":"Objective: To evaluate short and midterm results after endovenous radiofrequency obliteration for treatment of saphenous reflux. Material and Method: Review and updated follow-up of a clinical series of patients after endovenous radiofrequency obliteration of insufficient saphenous trunks at the Hospital Dr. Eduardo Pereira, Valparaiso. Diagnosis was based on clinical parameters and color doppler ultrasonography. A preoperative and postoperative quality of life questionnaire was executed. Results: 77 patients (57 female) with an average age 58.3 years (23-83) and a mean follow-up time of 13.6 months. Patients consulted for symptomatic primary varicose veins of one lower extremity (49) or both (28) with 105 extremities. According to CEAP classification there were C2:84, C3:1, C4:9, C5:4 and C6:7. There were no C0 or C1 extremities. Superficial tributaries of more than 3 mm diameter were removed using Muller’s method in all extremities. Furthermore, in some patients procedures were performed as complementary treatments: perforating veins ligation, skin grafting of ulcers or cutaneous-aponeurotic resection and deferred skin graft. A color doppler ultrasonography was performed one month later observing proper saphenous vein obliteration in 99% of cases and 94% at 6-months follow-up. There were no signs of deep vein thrombosis in all patients. The quality of life questionnaire revealed symptomatic relief and surgical satisfaction in the majority of patients. Conclusion: Endovascular radiofrequency obliteration for treatment of saphenous reflux is an effective method for the short and mid terms and can be done alongside other procedure.","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"62 1","pages":"112-116"},"PeriodicalIF":0.0,"publicationDate":"2018-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79675872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-15DOI: 10.4067/S0718-40262018000100035
Juan Bombin, A. Kotlik, Gregory Córdova, Constanza Gómez, M. Bombin
Introduction: During carotid endarterectomy (CEA) clamping cerebral perfusion is maintained by contralateral circulation through the Circle of Willis and it is correlated to the stump pressure (SP). If it is below 50 mmHg there is risk of stroke due to hypoperfusion and a shunt must be used, but systemic blood pressure can be temporarily elevated making the use of shunt unnecessary. Aim: Results of CEA with SP measurement to evaluate cerebral perfusion in cross-clamped hemisphere and hemodynamic intraoperative management reducing the use of shunt. Material and Methods: Retrospective study of CEAs performed in 73 patients under general anaesthesia with SP measurement, hemodynamic management and selective use of shunt. Demographics, clinical and perioperative morbimortality variables were analized. Results: 73 patients, average age 71.1 years, 69.9% symptomatic. In 54 patients SP was above 50 mmHg and shunt was not used, in 19 SP was below 50 mmHg, it was elevated through intraoperative hemodynamic management and shunt was not needed. In only 3 cases SP did not reach 50 mmHg and a Pruitt-Inahara shunt was used. Two patients presented postoperative transient central neurological deficit and 2 died due to myocardial infarction. Conclusion: CEA with SP measurement and hemodynamic management reduced the use of carotid shunting and it was a safe procedure to treat patients with severe carotid stenosis who need surgical intervention.
在颈动脉内膜切除术(CEA)夹持术中，脑灌注是通过威利斯环(Circle of Willis)对侧循环维持的，并与残端压力(SP)相关。如果低于50mmhg，则有因灌注不足而卒中的风险，必须使用分流器，但体表血压可能暂时升高，因此无需使用分流器。目的:CEA结合SP测量评价交叉夹持半球脑灌注及术中血流动力学处理，减少分流术的使用。材料和方法:回顾性研究73例全麻下的cea患者，采用SP测量、血流动力学管理和选择性分流术。分析人口统计学、临床和围手术期病死率变量。结果:73例患者，平均年龄71.1岁，有症状者69.9%。54例患者血压高于50 mmHg，未采用分流术;19例患者血压低于50 mmHg，经术中血流动力学处理后血压升高，无需分流术。只有3例患者SP未达到50mmhg，并采用Pruitt-Inahara分流术。2例术后出现一过性中枢神经功能缺损，2例因心肌梗死死亡。结论:CEA结合SP测量和血流动力学管理减少了颈动脉分流术的使用，是治疗需要手术干预的严重颈动脉狭窄患者的一种安全的方法。
{"title":"Endarterectomía carotídea con medición de presión de muñón, manejo hemodinámico y uso selectivo de shunt","authors":"Juan Bombin, A. Kotlik, Gregory Córdova, Constanza Gómez, M. Bombin","doi":"10.4067/S0718-40262018000100035","DOIUrl":"https://doi.org/10.4067/S0718-40262018000100035","url":null,"abstract":"Introduction: During carotid endarterectomy (CEA) clamping cerebral perfusion is maintained by contralateral circulation through the Circle of Willis and it is correlated to the stump pressure (SP). If it is below 50 mmHg there is risk of stroke due to hypoperfusion and a shunt must be used, but systemic blood pressure can be temporarily elevated making the use of shunt unnecessary. Aim: Results of CEA with SP measurement to evaluate cerebral perfusion in cross-clamped hemisphere and hemodynamic intraoperative management reducing the use of shunt. Material and Methods: Retrospective study of CEAs performed in 73 patients under general anaesthesia with SP measurement, hemodynamic management and selective use of shunt. Demographics, clinical and perioperative morbimortality variables were analized. Results: 73 patients, average age 71.1 years, 69.9% symptomatic. In 54 patients SP was above 50 mmHg and shunt was not used, in 19 SP was below 50 mmHg, it was elevated through intraoperative hemodynamic management and shunt was not needed. In only 3 cases SP did not reach 50 mmHg and a Pruitt-Inahara shunt was used. Two patients presented postoperative transient central neurological deficit and 2 died due to myocardial infarction. Conclusion: CEA with SP measurement and hemodynamic management reduced the use of carotid shunting and it was a safe procedure to treat patients with severe carotid stenosis who need surgical intervention.","PeriodicalId":49615,"journal":{"name":"Revista Chilena De Cirugia","volume":"129 1","pages":"35-39"},"PeriodicalIF":0.0,"publicationDate":"2018-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74762410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-15DOI: 10.4067/S0718-40262018000100046
Gustavo Sáenz-Poma, Roberto Chávez-Asmat, J. Silva-Valencia, Sonia Simón-Romero, P. J. Tejada-Llacsa
Objective: To determine the level of satisfaction of patients who underwent surgery for facial trauma in the Dos de Mayo National Hospital (HNDM). Materials and Methods: Quantitative, cross-sectional analytical study. The population consisted of 36 patients diagnosed with facial trauma who underwent surgery in the Head and Neck service of the HNDM during the period July 2014-February 2015. A Global satisfaction questionnaire, previously validated for this research, was used whose reliability is r = 0.95 and evaluates aspects of Limitation functional, facial appearance, sexual and physical appearance, negative self- concept and social appearance. The average scores on the Likert scale were compared with the paired Student t test. A p-value < 0.05 was considered statistically significant. Results: Regarding the overall satisfaction of patients, the number of patients who reported having a high level of satisfaction was significantly higher in the post surgery compared to what was achieved in the pre surgery (p = 0.01). In respect of functional limitations, facial appearance, negative self-concept and social appearance 100% achieved a high level of satisfaction in the post surgery. In the dimension of sexual and physical appearance, 100% was in the post surgery a medium level of satisfaction, from the low level obtained in the pre surgery. Conclusions: The patients operated after facial trauma in the Dos de Mayo National Hospital have a high level of satisfaction on a functional level, facial appearance, negative self-concept and social appearance. Key words: Facial injuries, patient satisfaction, postoperative period.
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