RESUMO
Introducción: La hernia inguinal es una de las enfermedades que más comúnmente requiere tratamiento operatorio y representa entre el 10- 15 por ciento de todas las intervenciones programadas. El porcentaje de complicaciones posoperatorias es de 5- 10 por ciento y aunque no son totalmente evitables, deben conocerse sus posibles causas para lograr reducir su incidencia. Objetivo: Identificar los factores asociados a las complicaciones de la cirugía electiva de las hernias inguinales. Métodos: Se realizó un estudio observacional y descriptivo, de una serie de 246 pacientes operados de hernias inguinales mediante cirugía electiva en el servicio de Cirugía General del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba durante el bienio 2016-2017. Resultados: Se constataron 18 complicaciones (7,3 por ciento). Predominó el grupo etario de 51 a 70 años (47,8 por ciento) y el sexo masculino sobre las féminas con razón de 15,4:1. El estado físico preoperatorio fue clasificado ASA 1 en 183 pacientes (74,4 por ciento) y ASA 2 en 62 (25,2 por ciento). El 72,2 por ciento de los complicados tenían al menos una enfermedad asociada. El tipo 2 según clasificación de Nyhus prevaleció con 73 (29,7 por ciento) y 8 (44,4 por ciento) de los complicados. Conclusiones: Los factores referentes a la edad mayor de 50 años, sexo masculino, antecedentes de hipertensión arterial y diabetes mellitus, y hernias tipo II según la clasificación de Nyhus se asocian a la presentación de complicaciones agudas (edema del cordón espermático e infección del sitio operatorio) y crónicas (recidiva y granuloma) de la cirugía electiva de las hernias inguinales(AU)
Introduction: Inguinal hernia is a common surgical treatment illness and represents 10-15 percent of the programmed surgery. The postoperative complications records are 5-10 percent, although they are not avoidable, it is mandatory to know the possible causes to decrease the incidence rate. Objective: To identify the associated factors on the complications of elective inguinal hernia surgery. Methods: An observational and descriptive study of a series of 246 patients operated on elective inguinal hernia surgery in the General Surgery Service of "Saturnino Lora" Hospital of Santiago de Cuba during the years 2016-2017. Results: There were 18 complications (7,3 percent) of the sample. The age group of 51 to 70 years (47,8 percent) predominated and the male sex over females with a ratio of 15,4:1. Preoperative physical state was classified ASA 1 in 183 patients (74,4 percent) and ASA 2 in 62 (25,2 percent). 72,2 percent of the complicated patients had at least one associated disease. Type 2 according to Nyhus classification prevailed with 73 (29,7 percent) patients of the sample, and eight (44,4 percent) of complicated patients. Conclusions: Associated factors on acute and chronic complications of elective inguinal hernia surgery related to age, sex, associated illness, preoperative physical state and type of hernia according to Nyhus classification do not differ from that reported by the national and foreign literature(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Cordão Espermático , Cirurgia Geral/métodos , Granuloma , Hérnia Inguinal/cirurgia , Infecções/cirurgia , Grupos EtáriosRESUMO
Not only laymen but also dentists generally believe that extraction of acutely infected teeth should be avoided until the infection subdues by using systemic antibiotics. The aim of this study was to compare perioperative complications in routine extractions of acutely infected teeth with extractions of asymptomatic teeth. This prospective study was performed with 82 patients. Severe pain on percussion of the relevant tooth was considered as basic criteria for acute infection. The acutely infected teeth were labeled as the study group (n = 35) and the asymptomatic teeth as the control group (n = 47). The extractions were done using standard procedures. The amount of anesthetic solution used and duration of extractions were recorded. Postoperative severe pain and exposed bone with no granulation tissue in the extraction socket were indications of alveolar osteitis (AO). The level of statistical significance was accepted as 0.05. Symptoms that could indicate systemic response, including fever, fatigue, and shivering were not found. There was no statistically significant difference between groups in terms of AO, amount of anesthetic solution used, and duration of extraction. The presence of an acute infection characterized by severe percussion pain is not a contraindication for tooth extraction. Infected teeth should be extracted as soon as possible and the procedure should not be postponed by giving antibiotics.
Assuntos
Infecções/cirurgia , Doenças Dentárias/cirurgia , Extração Dentária/métodos , Doença Aguda , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Infecções Assintomáticas/terapia , Alvéolo Seco/etiologia , Feminino , Humanos , Infecções/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doenças Dentárias/tratamento farmacológico , Extração Dentária/efeitos adversos , Odontalgia/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
Abstract: Not only laymen but also dentists generally believe that extraction of acutely infected teeth should be avoided until the infection subdues by using systemic antibiotics. The aim of this study was to compare perioperative complications in routine extractions of acutely infected teeth with extractions of asymptomatic teeth. This prospective study was performed with 82 patients. Severe pain on percussion of the relevant tooth was considered as basic criteria for acute infection. The acutely infected teeth were labeled as the study group (n = 35) and the asymptomatic teeth as the control group (n = 47). The extractions were done using standard procedures. The amount of anesthetic solution used and duration of extractions were recorded. Postoperative severe pain and exposed bone with no granulation tissue in the extraction socket were indications of alveolar osteitis (AO). The level of statistical significance was accepted as 0.05. Symptoms that could indicate systemic response, including fever, fatigue, and shivering were not found. There was no statistically significant difference between groups in terms of AO, amount of anesthetic solution used, and duration of extraction. The presence of an acute infection characterized by severe percussion pain is not a contraindication for tooth extraction. Infected teeth should be extracted as soon as possible and the procedure should not be postponed by giving antibiotics.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Idoso , Adulto Jovem , Doenças Dentárias/cirurgia , Extração Dentária/métodos , Infecções/cirurgia , Doenças Dentárias/tratamento farmacológico , Extração Dentária/efeitos adversos , Odontalgia/cirurgia , Doença Aguda , Estudos Prospectivos , Resultado do Tratamento , Alvéolo Seco/etiologia , Infecções Assintomáticas/terapia , Infecções/tratamento farmacológico , Pessoa de Meia-Idade , Antibacterianos/uso terapêuticoRESUMO
RESUMEN: Las infecciones en el territorio maxilofacial, son cuadros frecuentes, de origen polimicrobiano, con manifestaciones clínicas muy variables y que están asociadas a múltiples vías de ingreso de los microorganismos al territorio. Un gran porcentaje de estas infecciones se origina en la cavidad oral, principalmente en lesiones bacterianas que sufren los dientes. La compleja anatomía de la cabeza y el cuello, permiten que muchas de estas infecciones se diseminen por espacios profundos, llegando a comprometer órganos o regiones anatómicas adyacentes, que pueden llevar a cuadros clínicos de alto riesgo vital. Los casos clínicos presentados en este artículo corresponden a pacientes tratados en el hospital San Juan de Dios a causa de procesos infecciosos del territorio maxilofacial, por equipos multidisciplinarios.
ABSTRACT: Infections in the maxillofacial territory are frequent cases of polymicrobial origin, with very variable clinical manifestations and are associated with multiple entering pathways of microorganisms in the territory. A large percentage of these infections originate in the oral cavity, mainly in bacterial lesions that undergo experienced by the teeth. The complex anatomy of the head and neck allows many of these infections to spread through deep spaces, leading to compromising adjacent organs or anatomical regions, which can lead to high-risk clinical conditions. The clinical cases presented in this article correspond to patients treated at the San Juan de Dios hospital because of infectious processes of the maxillofacial territory, by multidisciplinary teams.
Assuntos
Humanos , Masculino , Adulto , Idoso , Doenças Maxilares/cirurgia , Doenças Maxilares/microbiologia , Doenças Maxilares/tratamento farmacológico , Face/microbiologia , Drenagem , Fasciite Necrosante/complicações , Tumor de Pott/complicações , Infecções/cirurgia , Infecções/tratamento farmacológico , Antibacterianos/uso terapêuticoRESUMO
El absceso hepático piógeno es una enfermedad secundaria a un foco primario cuyas vías básicas de infección son: vía biliar y el sistema portal. Se presenta el caso de un paciente de 23 años que presenta dolor a nivel de hemiabdomen superior que refiere haber ingerido un alambre en forma de gancho. Sobre la base de los antecedentes y exámenes complementarios se interpreta la posibilidad de un absceso hepático secundario a un cuerpo extraño. Se realizó drenaje del absceso y yeyunotomía para extracción del cuerpo extraño endoluminal. Actualmente, el paciente se encuentra totalmente recuperado(AU)
Pyogenic hepatic abscess is a disease secondary to a primary focus whose basic pathways of infection are the bile duct and the portal system. The case is presented of a 23-year-old patient with pain at the level of the upper hemiabdomen and who reported having ingested a wire in the shape of a hook. Upon the basis of the antecedents and complementary examinations the possibility is interpreted for a hepatic abscess secondary to a foreign body. Drainage of the abscess and jejunostomy were performed to remove the foreign body from the endoluminal system. Currently, the patient is fully recovered(AU)
Assuntos
Humanos , Masculino , Adulto , Corpos Estranhos/diagnóstico por imagem , Infecções/cirurgia , Abscesso Hepático Piogênico/diagnóstico por imagem , Jejunostomia/métodosRESUMO
INTRODUÇÃO: As Infecções de Sítio Cirúrgico (ISCs) são as complicações mais freqüentes que ocorrem nos pacientes após as cirurgias e são responsáveis pela elevação da morbidade, mortalidade e dos custos hospitalares. OBJETIVO: O objetivo deste estudo foi estimar o custo direto adicional associado às ISCs ocorridas no período de 2011 a 2013 em um Hospital Universitário de Salvador, Bahia. Para tanto buscou-se caracterizar a população de pacientes acometidos por ISC, segundo os aspectos sócio-demográficas, condições clínicas e cirurgias realizadas, realizar uma revisão integrativa atualizada da literatura mundial sobre o custo dessas infecções e analisar os custos associados aos cuidados à saúde dos pacientes cirúrgicos segundo presença de ISC. METODOLOGIA: Trata-se se um estudo epidemiológico do tipo caso-controle pareado, realizado com informações dos registros hospitalares dos pacientes. Foram incluídos como população do estudo todos os casos de ISCs em cirurgias eletivas e limpas. Os controles foram pareados por idade, sexo e tipo de cirurgia realizada respeitando o princípio da similaridade. As proporções foram comparadas por meio dos testes 2 e exato de Fisher quando adequados com nível de 5% de significância estatística. Para estimar as diferenças das médias de custos utilizou-se o modelo de regressão linear. RESULTADOS: No total foram selecionados 259 pacientes. Os casos de ISC ocorreram predominantemente em mulheres, com idade entre 61 a 75 anos. Os principais fatores atribuídos aos custos com as ISCs foram o uso de antibióticos para o seu tratamento, a internação em Unidade de Terapia Intensiva, a realização de exames e reabordagens cirúrgicas. No geral, o custo médio hospitalar em pacientes com ISC foi aproximadamente o dobro do valor aferido daqueles não infectados. CONCLUSÕES: Foi evidenciado neste estudo a necessidade de reforçar o desenvolvimento constante de ações preventivas e de controle das ISCs a fim de garantir a segurança na assistência prestada aos pacientes cirúrgicos e conseqüentemente a redução dos custos atribuídos a essa complicação para o hospitais e sistema de saúde.
INTRODUCTION: The Surgical Site Infections (SSI) are the most frequent complications occurring in patients after surgery and are responsible for high morbidity, mortality and hospital costs. OBJECTIVE: The aim of this study was to estimate the additional direct costs associated with SSIs occurred in the 2011-2013 period at a University Hospital in Salvador, Bahia. For that sought to characterize the population of patients affected by ISC, according to the socio-demographic aspects, clinics and surgeries conditions, carry out a integrative and updated review of the literature on the cost of these infections and analyze the costs associated with health care to patients surgical according to the presence of ISC. METHODOLOGY: This is an epidemiological study of the case-control matched, conducted with information from the hospital records of patients. They were included in the study population all cases of ISCs in elective surgery and clean. The controls were matched for age, gender and type of surgery performed respecting the principle of similarity. Proportions were compared using the Fisher's exact test and χ2 when appropriate and at 5% statistical significance. To estimate the differences of the average costs used the linear regression model. RESULTS: In total 259 patients were selected. The cases of ISC occurred primarily in women between 61-75 years. The main factors attributed to the costs of the ISCs were the use of antibiotics for their treatment, to stay in the Intensive Care Unit, conducting exams and news surgical interventions. Overall, the average hospital cost in patients with SSI was approximately twice with those not infected. CONCLUSIONS: It was shown in this study the need of to reinforce the constant development of preventive and control of SSIs in order to secure the assistance provided to surgical patients and therefore reducing costs attributed to this complication for hospitals and health care system.
Assuntos
Humanos , Infecções/cirurgia , Infecções/complicações , Infecções/imunologia , Infecções/mortalidadeRESUMO
INTRODUÇÃO: Orelha em abano é caracterizada pelo pobre desenvolvimento da anti-hélice, hiperplasia da concha, ângulo céfalo-auricular anormal, lóbulo grande e proeminente ou qualquer combinação dos itens citados. MÉTODOS: Foi realizado um estudo prospectivo, em que foram acompanhados 60 pacientes submetidos à otoplastia, no período de janeiro de 2014 a janeiro de 2015, no Hospital Municipal Barata Ribeiro. RESULTADOS: Entre as complicações precoces, citamos infecção (0%), hematoma (1,6%) e necrose de pele (3,3%). Entre as complicações tardias: assimetria (10%), recidiva (3,3%), extrusão de pontos (10%), granuloma, cicatriz hipertrófica (0%) e queloide (0%). Quando os pacientes foram questionados quanto aos resultados obtidos com a otoplastia, 3,3% responderam que o resultado foi ruim, 3,3% regular, 3,3% bom, 3,3% ótimo e 86,8% excelente. CONCLUSÃO: As taxas de complicações precoces e tardias são semelhantes às descritas na literatura.
INTRODUCTION: Protruding ears are caused by poor development of the antihelix, hyperplasia of the concha, abnormal cephaloauricular angle, a large and prominent lobule, or any combination of the above. METHODS: A prospective study was performed, in which 60 patients who underwent otoplasty were followed up from January 2014 to January 2015 at the Hospital Municipal Barata Ribeiro. RESULTS: Early complications included infection (0%), hematoma (1.6%), and skin necrosis (3.3%). Late complications included asymmetry (10%), recurrence (3.3%), extrusion of sutures (10%), granuloma formation (0%), hypertrophic scarring (0%), and keloid formation (0%). When patients were asked to rate the otoplasty, 3.3% stated that it was poor, 3.3% fair, 3.3% good, 3.3% very good, and 86.8% excellent. CONCLUSION: The rates of early and late complications are similar to those described in the literature.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , História do Século XXI , Complicações Pós-Operatórias , Estudos Prospectivos , Inquéritos e Questionários , Procedimentos de Cirurgia Plástica , Deformidades Adquiridas da Orelha , Orelha Externa , Pavilhão Auricular , Infecções , Complicações Pós-Operatórias/cirurgia , Inquéritos e Questionários/normas , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Deformidades Adquiridas da Orelha/cirurgia , Orelha Externa/anormalidades , Orelha Externa/cirurgia , Pavilhão Auricular/anormalidades , Pavilhão Auricular/cirurgia , Infecções/cirurgia , Infecções/complicaçõesRESUMO
As infecções pós-artroplastia (IPA) de quadril acarretam alta morbidade e tem o S.aureus como um de seus principais agentes etiológicos. Este estudo teve por objetivo avaliar o impacto de um pacote de intervenções preventivas na incidência e no perfil microbiológico das infecções precoces pós-artroplastias primárias de quadril realizadas no INTO. Trata-se de um estudo quasi-experimental, prospectivo, não randomizado, tipo antes e depois, controlado. O grupo submetido à intervenção (GI) foi composto por pacientes submetidos à artroplastia total primária de quadril (ATQ) durante os mutirões de cirurgia de quadril realizados no 2o semestre de 2013 e no 2o semestre de 2014 (período intervenção). As taxas de IPA desses pacientes foram comparadas com as taxas dos pacientes operados no mutirão do 1o semestre de 2013 (período pré-intervenção) grupo controle 1 (C1). As taxas dos pacientes desses dois grupos foram comparadas com as dos pacientes submetidos a ATQ de rotina nos períodos correspondentes grupos controle 3 e 2, respectivamente (C3 e C2). A intervenção consistiu na adoção de banho com clorexidina no perioperatório, na identificação pré-operatória de pacientes portadores nasais de S. aureus, a fim de realizar a descolonização com pomada de mupirocina intranasal, e na associação de um glicopeptídeo ao esquema de antibioticoprofilaxia cirúrgica padrão em pacientes sabidamente colonizados por S. aureus resistente a meticilina (MRSA). A adesão ao banho com clorexidina foi completa em 78,0% dos casos e parcial em 15,2%. A adesão à mupirocina intranasal foi completa em 87,5% e parcial em 6,2%. Um (50%) dos pacientes portadores de MRSA recebeu vancomicina adicional como antibioticoprofilaxia; entretanto, a droga não foi administrada em tempo adequado. Ocorreram 44 IPA nas 1.168 cirurgias avaliadas, 21 das quais por S. aureus. No período pré-intervenção, houve duas IPA por S. aureus nos pacientes do mutirão (C1) e cinco nos pacientes da rotina (C2), com incidência semelhante (1,9% vs. 1,9%; RR=1,01 (IC95% 0,20-5,11; p=1,000). No período intervenção, houve quatorze IPA por S. aureus no grupo C3 e nenhuma no grupo GI, havendo, portanto, maior incidência de IPA por S. aureus nos pacientes da rotina quando comparados aos dos mutirões em que foi aplicado o protocolo (2,3% vs. 0,0%; p=0,027). Não houve diferença estatisticamente significativa entre as taxas de IPA dos grupos C1 e GI (3,8% vs. 1,6%, RR=2,40 (IC95% 0,55-10,53); p=0,253), tampouco entre as taxas de IPA por S. aureus, apesar da redução de 1,9%, para 0%, (p=0,128). Os resultados sugerem um efeito protetor do pacote de medidas na prevenção das IPA de quadril por S. aureus. Estudos prospectivos randomizados controlados e com maior poder são necessários para confirmar ou refutar os achados do presente estudo, assim como dos estudos já publicados sobre o tema, na nossa população
Periprosthetic infections (PJI) of the hip carry high morbidity. S. aureus is one of its main etiological agents. This study aimed to evaluate the impact of a bundle of preventive interventions on the incidence and microbiological profile of early PJI of the hip performed at INTO. This is a quasi-experimental, prospective, nonrandomized, controlled, pre- and post study. The group submitted to intervention (GI) consisted of patients undergoing primary total hip arthroplasty (THA) during task force weeks in the second half of both 2013 and 2014 (intervention period). PJI rates of these patients were compared with the rates of the patients operated during the task force week of the first half of 2013 (pre-intervention period) - control group 1 (C1). The rates of these two groups of patients were compared with those of patients undergoing routine THA during the corresponding periods - control groups 3 and 2, respectively (C3 and C2). The intervention consisted in adopting perioperative chlorhexidine shower, in the preoperative identification of patients colonized with S. aureus in the nares in order to accomplish the decolonization with mupirocin ointment applied intranasally, and the combination of a glycopeptide to standard surgical antibiotic prophylaxis scheme in patients known to be colonized with S. aureus resistant to oxacillin (MRSA). Adherence to showering with chlorhexidine was full in 78.0% of cases and partial in 15.2%. Adherence to intranasal mupirocin was full in 87.5% and partial at 6.2%. One (50%) of patients with MRSA received additional antibiotic prophylaxis with vancomycin; however, the drug was not administered at the appropriate time. There were 44 PJI in 1168 surgeries, 21 of which were caused by S. aureus. In the pre-intervention period, there were two PJI caused by S. aureus in C1 group and five in the C2 group, with similar incidence (1.9% vs. 1.9%, RR = 1.01 (95% CI 0.20 to 5.11), p = 1.000). In the intervention period, there were fourteen PJI caused by S. aureus in the C3 group and none in the GI group, showing a higher incidence of PJI by S. aureus in routine patients when compared to patients in which the protocol was applied (2, 3% vs. 0.0%; p = 0.027). There was no statistically significant difference between the rates of PJI in C1 and GI groups (3.8% vs. 1.6%, RR = 2.40 (95% CI 0.55 to 10.53), p = 0.253), neither between PJI rates for S. aureus, despite the reduction of 1.9% to 0% (p = 0.128). The results suggest a protective effect of the bundle on preventing PJI by S. aureus. Prospective randomized controlled trials with more power are necessary to confirm or refute the findings of this study, as well as of published studies on the topic, in our population
Assuntos
Artroplastia de Quadril , Infecções/cirurgiaRESUMO
BACKGROUND: Mesenteric cysts are very rare abdominal growths, generally asymptomatic, and which are usually detected incidentally while performing a physical examination or an imaging test. Complications such as infections, haemorrhage, torsion, rupture, or bowel obstruction, are seldom found in this pathology, but they can be a cause of acute abdomen. The purpose of this report is to describe the characteristics and the clinical outcome of a male patient with an infected mesenteric pseudocyst of the jejunum. CLINICAL CASE: A 49 year-old male was admitted to the emergency department with 6-day onset of abdominal pain, bowel obstruction signs, palpable tumour located in the upper hemi-abdomen, systemic inflammatory response syndrome, 36,100/mm(3) white cells, 4.21 ng/ml procalcitonin, abdominal computed tomography scan with evidence of a mesenteric cystic tumour. An exploratory laparotomy was performed, finding the presence of a mesenteric pseudocyst of the jejunum with infection signs, extirpated and sent for histopathological examination. The clinical progress of the patient was satisfactory with the discharge of the patient 7 days after the surgical intervention. CONCLUSION: These cysts can debut as an acute abdomen due to haemorrhage, infection, obstruction and/or bowel perforation, complications can be life threatening if not detected and surgically treated at an early stage by performing a resection of the pseudocysts, with or without bowel resection, depending on the location and the size of the cyst.