AÑO 7, 1° semestre de 2001, Vol. 7, No. 1
Contenido | Contents | |
Comité Editorial de la Revista Mexicana de Coloproctología | 1 | Editorial Board of the Mexican Journal of Coloproctology |
Mesa Directiva 2000-2002 de la Sociedad Mexicana de Cirujanos del Recto y Colon, A.C. | 1 | Executive Council of the Mexican Society of Colon and Rectal Surgeons. 2000-2002 |
CONTRIBUCIONES ORIGINALES
PANORAMA 2001 DE LA AMIBIASIS QUIRÚRGICA, |
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ORIGINAL CONTRIBUTIONS SURGICAL AMEBIASIS OUTLOOK 2001 |
EFECTIVIDAD DE LA INTERVENCIÓN ALIMENTARIA Y NUTRIMENTAL EN EL TRATAMIENTO QUIRÚRGICO RADICAL DEL CÁNCERCOLORRECTAL
Dr. José Antonio Llovera Ruíz *1 *Hospital Clínico-Quirúrgico “HermanosAmejeiras” Ciudad La Habana, Cuba. |
17 | EFECTIVENESS OF NUTRIOTIONAL AND ALIMENTARY INTERVENTION IN THE RADICAL TREATMENT OF COLORECTAL CANCER
Dr. José Antonio Llovera Ruíz *1 *Hospital Clínico-Quirúrgico “HermanosAmejeiras” Ciudad La Habana, Cuba. |
PROLAPSO RECTAL E INCONTINENCIA FECAL, Conducta después del procedimiento de FrykmanDr. M. Abel Morales Díaz *** Dr. Salvador Estévez Sánchez * Dr. Jorge Sosa Gallegos * * Dr. Fidel Ruiz Healy * * *Hospital Ángeles del Pedregal *Centro Hospitalario “Sanatorio Durango” |
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RECTAL PROLAPSE AND FAECAL INCONTINENCE Behaviour after Frykman´s ProcedureDr. M. Abel Morales Díaz *** Dr. Salvador Estévez Sánchez * Dr. Jorge Sosa Gallegos * * Dr. Fidel Ruiz Healy * * *Hospital Ángeles del Pedregal *Centro Hospitalario “Sanatorio Durango” |
REQUISITOS UNIFORMES PARA PREPARAR MANUSCRITOS ENVIADOS A REVISTAS BIOMEDICAS Comité Internacional de Editores de Revistas Médicas |
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REQUIREMENTS FOR THE PREPARATION OF MANUSCRIPTS SUBMITTED TO BIOMEDIACAL JOURNALS Comité Internacional de Editores de Revistas Médicas |
PANORAMA 2001 DE LA AMIBIASIS QUIRURGICA
DIAGNOSTICO Y TRATAMIENTO DE VARIEDADES CLINICOPATOLOGICAS INTRA Y EXTRAINTESTINALES
Resumen
La amibiasis invasora es una enfermedad parasitaria por Endamoeba histolítica, protozoario causante de la tercera causa de muerte por infecciones parasitarias en el mundo actual, de importancia para la salud de áreas endémicas y riesgo para la salud de los viajeros. El espectro clínico muestra que los cirujanos de los países en desarrollo encaran retos quirúrgicos semejantes a los de sus contrapartes del primer mundo.
La amibiasis tiene diferentes formas de manifestación clínica que varían desde huéspedes asintomáticos a formas graves poco frecuentes de colitis fulminante, necrotizante y absceso hepático característicamente asociadas a morbilidad y mortalidad altas y global del 60%, además de otras amibiasis que afectan el espacio retroperitoneal, cavidad torácica, pélvica, sexuales y del sistema nervioso.
El diagnóstico temprano de estas variedades clínico-patológicas, seguido de tratamiento antiamibiano efectivo. específicamente metroimidazol, e intervención quirúrgica oportuna ha mejorado la sobrevivencia, pero se requiere de una identificación temprana, así como terapia intensiva y monitoreos de parte de médicos y cirujanos experimentados en el cuidado de estos pacientes.
Se revisan aquí las tendencias actuales de diagnóstico y tratamiento en el panorama mundial.
Summary
Invasive amebiasis is a widespread parasitic disease caused by Entamoeba histolytica. Thís protozoan organism is the third leading parasltic cause of death in the developing world important in endemic areas and upon health risk to travelers in endemic areas. The clinical spectrum shows that surgeons in developing countries are facing surgical challenges similar to those of their counterparts in developed countries.
Amebiasis has Dífferent clinical forms of presentatíon, varying from the asymptomatic carrier state to severe, although not frequent. Fulminant or necrotizing colits, toxic megacolon, and amebic hepatic abscess characteristically associated with high morbidity and mortality and with a global mortality of 60%, besides other amebiasis which affects retroperitoneum, thorax, pelvis, genitais and nervous system.
Early diagnosis, treatment with effective antiamebic agents -specifically metronidazole- and opportune aggressive surgical intervention have resulted in better survival rates, but is require prompt identification as well as intensive medical therapy and monitoring by physicians and surgeons experienced in the care of such patients.
Present trends on diagnosis and treatment are reviewed on world panorama contributions.
Resumen
Se presentan las tasas de morbimortalidad posoperatoria y la estadía hospitalaria de 29 pacientes diagnosticados de, y operados por, enfermedad colorrectal maligna, en el Servicio de Coloproctología del Hospital Clínico-Quirúrgico “Hermanos Amejeiras”, durante 1999 y 2000 (primer semestre) (Cohorte prospectiva) después de una intervención alimentaria, nutrimental y metabólica en dos tiempos: Prequirúrgico: Dieta pobre en residuo, 3 claras de huevo (si Albúmina sérica e 35 g/L), y un nutriente enteral sin fibra (si Albúmina sérica e 35 g/L), un estado nutricional deteriorado, y un turno quirúrgico a realizarse en un plazo de tiempo no mayor de 15 días); y Posquirúrgico:
Rehabilitación de la vía oral 48 horas después del acto quirúrgico, primero con el nutriente enteral, y progresando después hacia una dieta pobre en residuo, antes de instalar una dieta general (libre), las tasas de morbimortalidad posoperatoria y la estadía hospitalaria naturales (en ausencia de la intervención alimentaria, nutrimental y metabólica) se establecieron del análisis retrospectivo de los datos clínicos de 53 pacientes atendidos por el mismo motivo durante 1998, 1999 y 2000 (primer semestre) en el Hospital Ameijeiras (Cohorte retrospectiva). El 63.4%
Abstract
We present in this article the post-operatory morbimortality rates and the length of stay of 29 patients operated upon after a diagnosis of a malignant colorectal discase, at the Coloproctology Service, “Hermanos Ameijeiras” Hospital, during 1999 and 2000 lfirst half) (Prospective Cohort) after a metabolic, nutrient and food intervention in two stages: Preooeratory: A low-residue diet, ovoalbumine supplements as 3 eggs whites (when serum Albumine -c 35 g/L), and a fiberfree, fiquid, entera] diet (when serum Albumine < 35 gIL, a detefiorated nutritional status, and an impending laparotomy to be due in no more than 15 days; Postoperatorv:
Reasumption of the oral feeding 48 hours alter the laparotomy, first with the enteral diet, and with a low-fiber diet afterwards, before recommending a fuil diet. The natural post-operatory morbimortality rates and the length of stay (in the abscense of the metabolic, nutrient and food interventioní were estimated after retrospectiva analysis of clinical data collected from 53 patients essisted for the saíne motive at “Hermanos Ameijeiras” during 1998, 1999 y 2000(first hall) (Retrospective cohort). 63.4% [CI(95%): 54.9 – 72.0%] of the patients was older than
60 years. 59.8% ICI(95%(: 51.1 – 68.5%l were women. The corresponding mainutrition rates were 33.9% [CI(95%): 27.2 -40.7%] Retrospective cohortí and 20.7%[CI(95%l: 16.4 – 25.0%l (Prospective cohort). The corresponding postoperatory complication rates were 41.5% [CI(95%(: 34.5 – 48.5%] (Retrospective cohortí and 37.9% [CI(95%): 32.8 – 43.5%] (Prospective cohortí. In the Retrospective cohort, complications were seen in 77.7% [CI(95%): 76.0 – 79.5%l of the malnourished patients. Qn the contrary, in the Prospective cohort, complications aflected 33.3% [Cl(95%): 31.1 – 35.6%] of the undemourished ones. 6 III .3%) deaths occurred in the Retrospective cohort. Ah of the deceased had a deteriorated preoperatory nutritional status. Those undemourished patients who did not receive the nutrient intervention spent up to 6 days/bed more than their counterparts who did received it. Nutrient intervention reduced 2.4 times the probability of the undemourished patient to get complicates, and made the probability of the complicated, undernourished patient of dying equal lo zero. Nutrient intervention did not after the probabiiity of the wellnourished patient to get complicated, nor the probability of dying in case of complications. It is concluded that the inception of an nutrient, metabolic and food intervention program lowers the post-operatory complications, the mortaihy and the length of stay of the malnourished patients affected mith colorectal cancer.
PROLAPSO RECTAL E INCONTINENCIA FECAL,
Conducta después del procedimiento de Frykman
Resumen
El prolapso rectal es un problema poco común, pero en ocasiones es de difícil abordaje, en especial cuando el paciente reporta incontinencia después de la operación restauradora. Se realizó en nuestra unidad de coloproctología un estudio retrospectivo de nuestra experiencia para corroborar la efectividad del Procedimiento de Frykman, para controlar la incontinencia, asimismo se intenta conocer el resultado de los pacientes que se sometieron a una segunda intervención (Parks) para el control de la incontinencia fecal. Se reportan doce pacientes sometidos a cirugía para reparación del prolapso rectal, de los que, dos pacientes finalmente reportaron incontinencia a pesar del procedimiento de Parks, llegando a la conclusión que la neuropatía puede ser una causa importante en su incontinencia fecal.
Summary
The rectal prolapse is a not very common problem, but in occasions of difficult boarding, especially when the patient reports incontinence alter restoring operation. It was carried out in our Coloproctologic Unit a retrospective study of our experience to corroborate the effectiveness of the Frykman Procedure, to control the rectal prolapse, likewise it is tried to know the result of the patients that underwent a second intervention (Parks Procedure), for the control of the fecal incontinence. 12 subjected patients are reported to surgery for repair of the rectal prolapse, of those that, 2 patients are reported to surgery for repair the rectal prolapse, of those that, two patients finally reported incontinence in spite of the Parks procedure, reaching the conclusion that the pudendal alteration can be an important factor in the failure of the Park´s procedure.