Sebastián Urrutia

Laparostomía contenida con bolsa de Bogotá. Resultados de una serie de casos

INTRODUCTION The «Bogota bag» (BB) is one of the options for contained laparostomy (CL). The aim of this study was to report the procedure associated hospital morbidity (PAHM) in patients undergoing relaparotomy followed by a laparostomy using the BB. MATERIAL AND METHOD Between 2002 and 2008, a prospective series of patients who underwent relaparotomy at the Hospital Hernán Henríquez, Temuco (Chile) was evaluated. The main end point was «development of PAHM». Secondary end points were: indications of the CL, time to first change of the BB, type of abdominal wall repair, hospital mortality and development of ventral hernia. Descriptive statistics were used, with the calculations of percentages and measures of central tendency and dispersion. RESULTS The BB was used in 86 patients (median age of 53 years, 63% female). The PAHM was 38% (surgical-site infection and enterocutaneous fistula). The most frequent indication of CL was intra-abdominal sepsis (60%). The median time until the first change of the BB, the time period between surgical operations, and the time until removal of the BB were 65 hours, 2 days and 9 days, respectively. Laparostomy was repaired exclusively with skin, fascial closure or dermal-epidermal graft in 50, 39 and 10%, respectively. In hospital mortality was 12%. Sixty percent of the patients developed a ventral hernia within a 48 month follow-up. CONCLUSIONS CL with a BB is associated with a high rate of PAHM and delayed complications.

Confiabilidad de la escala MINCIR para valorar calidad metodológica de estudios de terapia

Validation of a scale for assessing methodological quality of therapy studies. Pilot study Introduction: The methodological quality (MQ) is a complex multidimensional concept that assesses multiple items as design, methodology and analysis. There are few tools to assess MQ of studies in the field of therapy and these are also partially validated. The aim of this study is to determine the intra and inter observer reliability of the MINCIR scale for assess MQ of therapy articles. Methods: Study of validation scales. Was calculate sample size considering confidence level of 95%, accuracy of 2 points and standard deviation of 4.95, which gives 21 articles, select by simple random probabilistic sampling with Stata 10.0. Was determined intra and inter observer reliability of the scale and each one of its domains using intraclass correlation coeffi - cient (ICC). Results: The ICC for interobserver reliability was 0.9. The ICC observed for the domains one, two and three was 0.97, 0.88 and 0.64 respectively. The ICC observed for intraobserver reliability was 0.99. The ICC observed for the domains one, two and three were 1; 1 and 0.91 respectively. Conclusion: Interob- server and intraobserver reliability for the MINCIR scale to assess MQ of therapy articles were determined.

Contained Laparostomy With a Bogota Bag. Results of Case Series

Abstract Introduction The «Bogota bag» (BB) is one of the options for contained laparostomy (CL). The aim of this study was to report the procedure associated hospital morbidity (PAHM) in patients undergoing relaparotomy followed by a laparostomy using the BB. Material and method Between 2002 and 2008, a prospective series of patients who underwent relaparotomy at the Hospital Hernan Henriquez, Temuco (Chile) was evaluated. The main end point was “development of PAHM”. Secondary end points were: indications of the CL, time to first change of the BB, type of abdominal wall repair, hospital mortality and development of ventral hernia. Descriptive statistics were used, with the calculations of percentages and measures of central tendency and dispersion. Results The BB was used in 86 patients (median age of 53 years, 63% female). The PAHM was 38% (surgical-site infection and enterocutaneous fistula). The most frequent indication of CL was intra-abdominal sepsis (60%). The median time until the first change of the BB, the time period between surgical operations, and the time until removal of the BB were 65 hours, 2 days and 9 days, respectively. Laparostomy was repaired exclusively with skin, fascial closure or dermal-epidermal graft in 50, 39 and 10%, respectively. Inhospital mortality was 12%. Sixty percent of the patients developed a ventral hernia within a 48 month follow-up. Conclusions CL with a BB is associated with a high rate of PAHM and delayed complications.

Risk factors of postoperative morbidity in patients with uncomplicated liver hydatid cyst.

PURPOSE To determine postoperative morbidity (POM) in patients undergoing surgery for uncomplicated hepatic echinococcosis (HE) and determine associations with the variable POM looking for possible risk factors for POM. METHODS Nested case-control study. We included patients undergoing surgery for uncomplicated HE in two hospitals in Temuco between 2000 and 2012. The main outcome variable was development of POM. Other variables of interest were hospital stay, mortality and recurrence. Surgical techniques used were pericystectomy and liver resection. Descriptive statistics and analytical statistics were applied using T-test, ANOVA and Kruskal-Wallis test to compare continuous variables; Chi(2) and Fishers exact test for categorical variables, and logistic regression models were used, estimating OR. RESULTS 126 patients, median age 41 years, 61% female. The incidence of POM was 10.3%, with 76.9% Clavien grade I or II. The etiology was 6.5% and 4.1% of medical and surgical complications, respectively. There was no mortality and with a median follow-up of 83 months, recurrence incidence was 0.8%. Association was found between cases and controls and the variables age, alkaline phosphatase, cyst location and hospital stay. Applying regression models age (p = 0.002 and OR 1.07) and cyst location (p = 0.003 and OR 3.94) were found to be risk factors. CONCLUSIONS Observed POM is lower and of less severity than those previously published. Risk factors were determined.

Publicaciones de autores chilenos en revistas quirúrgicas durante los últimos diez años

Resumen es: Introduccion: Caracterizar la produccion cienti fi ca personal, institucional o nacional es una necesidad para comprender y mejorar la generacion de cono...

Morbilidad postoperatoria en pacientes con hidatidosis hepática complicada

BACKGROUND Vaginal infections are a frequent cause for consultation, but their prevalence and etiology vary in different populations. OBJECTIVES To determine the prevalence and etiologies of vaginal infection in women attending a family health center in the Metropolitan Region of Chile. METHODS The microbiological diagnosis was made by wet mount and Gram stain. Diagnosis of trichomoniasis was performed by wet mount, culture and polymerase chain reaction. RESULTS 101 women aged 15-54, not selected by signs or symptoms of vaginal infection, 46 of them pregnant were included. In 47 women (46.5%), vaginal infections were diagnosed. An association was observed between age and frequency of vaginal infection. The proportion of infections among pregnant and non-pregnant women was similar. The most frequent infections were bacterial vaginosis (16.8%), vulvovaginal candidiasis (11.9%) and co-infections (6.9%). We found 5.9% of intermediate microbiota cases, 3% of trichomoniasis and 2% of aerobic vaginitis. Symptoms of vaginal infection had poor agreement with microbiological findings. Otherwise physical signs had good agreement with the presence of infection, but low to moderate concordance with a specific etiology. CONCLUSIONS We found a high prevalence of vaginal infections in the study population. It is necessary to improve the definitions and criteria of microbiological diagnosis of co-infections and intermediate microbiota, for them to be diagnosed in the clinical practice. More descriptive questionnaires are recommended to enhance the usefulness of clinical examination.Introduccion: La cirugia de la hidatidosis hepatica (HH) es habitual en hospitales del sur de Chile; sin embargo, las publicaciones relacionadas son escasas y sus resultados disimiles, en especial respecto de la morbilidad postoperatoria (MPO), debido a la diversidad en la gravedad. El objetivo de este estudio es determinar la incidencia de MPO en pacientes intervenidos quirurgicamente por HH complicada. Material y Metodo: Serie de casos, parte de una cohorte prospectiva. Se incluyeron pacientes intervenidos quirurgicamente por HH complicada, en el hospital Hernan Henriquez Aravena y en la Clinica Mayor de Temuco, entre 2000 y 2012. La variable resultado principal fue desarrollo de MPO aplicando la escala de Clavien. Otras variables de interes fueron estancia hospitalaria, mortalidad y recurrencia. Se aplico estadistica descriptiva y, se determino incidencia de MPO. Resultados: 73 pacientes, con mediana de edad de 41 anos (16 a 84 anos); 58,9% de genero femenino. La mediana del diametro ultrasonografico de los quistes fue de 15,0 cm. El tiempo quirurgico promedio fue de 125,4 ± 26,3 min. El procedimiento quirurgico utilizado con mayor frecuencia fue periquistectomia (84,9%); y en 84,9% de los casos se realizo de forma concomitante algun otro procedimiento quirurgico. La incidencia de MPO fue 19,2% (10,9% de tratamiento medico y 8,2% de tratamiento quirurgico); 78,6% de cuyos casos eran Grado I o II de Clavien. Se registro 1,4% de mortalidad; y con una mediana de seguimiento de 97 meses, no se verifico recurrencia. Conclusiones: La incidencia de MPO en pacientes con HH complicada es inferior a la publicada y de bajo nivel de gravedad. Los subgrupos de complicaciones evolutivas con mayor MPO fueron la co-existencia de mas de una complicacion, la colangiohidatidosis y el absceso hepatico de origen hidatidico.

Calidad de vida relacionada con salud: una variable resultado a considerar en investigación clínica

MANTEROLA, D. C.; URRUTIA, S. & OTZEN, H. T. Calidad de vida relacionada con Salud. Una variable resultado a considerar eninvestigacion clinica. Int. J. Morphol., 31(4):1517-1523, 2013.Antecedentes: Es aceptada la conveniencia de medir calidad de vida relacionada a salud (CVRS) como variable de interes eninvestigacion clinica, para lo cual, existe una gran variedad de instrumentos de medicion disponibles. El objetivo de este articulo esdescribir los conceptos basicos referentes a CVRS y algunos ejemplos de instrumentos utilizados para valorar este constructo. Materialy metodo: Se realizo una busqueda en los motores Google y Yahoo; en los metabuscadores Ixquick y Copernico; y en la base de datos“Documents in Information Science” (DoIS). En la estrategia de busqueda, se utilizaron los terminos “calidad de vida”, “calidad de vidarelacionada con salud” y “CVRS”. Una vez localizados los resumenes de los articulos localizados, se evaluaron los documentos enextenso y se desarrollo un documento resumen de la informacion recolectada. Resultados: La busqueda realizada arrojo una granvariedad de instrumentos genericos y especificos. Conclusion: Existen multiples instrumentos para medir CVRS. Conocerlos constituyeuna ayuda para la practica profesional y la investigacion clinica.PALABRAS CLAVE: Calidad de vida; Calidad de vida r elacionada con salud; Cirugia digestiva alta; Cirugiagastrointestinal, Base de datos, toma de decisiones en salud, medicina basada en evidencias.

Morbilidad postoperatoria en pacientes con hidatidosis hepática no complicada: Utilización de una propuesta de clasificación de complicaciones

Introduccion: La cirugia de la hidatidosis hepatica (HH) es habitual en hospitales del sur de Chile. El numero de publicaciones relacionadas es escasa y los resultados disimiles. Hablar de morbilidad postoperatoria es complejo debido a la diversidad en la gravedad e implicancias para el paciente; basado en ello, Clavien publico una clasificacion basada en la gravedad de la morbilidad postoperatoria. El objetivo de este estudio es reportar la morbilidad postoperatoria en pacientes intervenidos por HH no complicada aplicando la clasificacion de Clavien. Material y Metodo: Estudio de cohorte prospectiva. Se incluyeron pacientes intervenidos quirurgicamente por HH no complicada, en el Hospital Hernan Henriquez Aravena de Temuco, entre 1997 y 2008. La variable resultado principal fue desarrollo de morbilidad postoperatoria aplicando la escala de Clavien. Otras variables de interes fueron estancia hospitalaria, mortalidad y recurrencia. Las tecnicas quirurgicas empleadas fueron periquistectomia total o subtotal y reseccion hepatica. Se calcularon porcentajes, medidas de tendencia central y dispersion; intervalos de confianza de 95% e incidencia. Resultados: 116 pacientes, con mediana de edad de 40,5 anos; 60,3% de genero femenino. La mediana del diametro ultrasonografico de los quistes fue de 15,0 cm. El tiempo quirurgico promedio fue de 115,4 ± 23,2 min. La incidencia de morbilidad fue de 8,6%; 90% de los cuales eran Grado I o II de Clavien. La etiologia fue 5,2% de complicaciones medicas y 3,4% de complicaciones quirurgicas. No se registro mortalidad. Con una mediana de seguimiento de 95 meses, se verifico recurrencia en 1 paciente, lo que representa una incidencia de 0,9%. Conclusiones: Se describe la morbilidad postoperatoria de una cohorte de pacientes con HH no complicada con enfasis en la gravedad de esta. La morbilidad observada es inferior a la publicada y de bajo nivel de gravedad.

CALIDAD DE VIDA RELACIONADA CON SALUD: INSTRUMENTOS DE MEDICIÓN PARA VALORACIÓN DE RESULTADOS EN CIRUGÍA DIGESTIVA ALTA

Health-related quality of life. Measurement tools to assessing upper gastrointestinal surgery outcomes Background: Since a while, clinicians and surgeons recently have recognized the desirability of Health-related quality of life (HRQOL) measure to inform their patients, even health authorities in respect of decision making in health and as a variable to be considered in clinical research. For this, there are multiple questionnaires (including self-administered) that are available for measuring this construct. In the field of upper gastrointestinal surgery, there are tools that have been generated and validated for this purpose (some of them generals and other specifics). The aim of this article is to describe specific measurement instruments to assess HRQOL in upper gastrointestinal surgery. Material and Methods: A search on engines Altavista, Google and Yahoo, in Ixquick and Copernico metasearch and in the database “Documents in Information Science” (DoIS) was performed. The search strategy used the terms “Quality of Life”, “Health-related quality of life”, “HRQOL”, “Outcome Assessment (Health Care)”, “upper gastrointestinal surgery” and “digestive surgery”. After locating articles, these were evaluated and a summary document of collected information was developed. Results: The search performed gave 23 instruments: related with upper gastrointestinal benign disease (10), with obesity and bariatric surgery (4), and related with digestive neoplasms (9). Conclusion: There is an interesting variety of instruments to measure HRQOL in upper gastrointestinal surgery. Knowing is a user support to both the development of everyday surgical practice, as for decision-making in health and as measurement instruments in clinical research.

DÓNDE Y CÓMO BUSCAR EVIDENCIA CIENTÍFICA EN MEDICINA

Where and how to search scientific medical evidence? The practice of evidence based medicine requires strategies to efficiently search relevant medical infor mation. This paper provides tools to optimize literature searches and access the best papers available. There are several electronic databases that can be consulted such as MEDLINE, LILACS, Web of Knowledge, The Cochrane Library, TRIP database, EMBASE and Google Scholar. Prior to the search, a research question must be formulated, structured according to the mnemonic rule PICO (Patient, Intervention, Comparator and Outcome). The question must be adapted to the language of the search engine with the help of Boolean operators, MeSH terms, keywords and methodological filters such as type of study, type of population, clinical category and sensitivity. These techniques will allow the performance of an efficient literature search in a shorter lapse.