Resultados en el tratamiento quirúrgico de la úlcera gastroduodenal perforada

Fundamento: En la actualidad el tratamiento de la úlcera gastroduodenal perforada ha experimentado importantes cambios; pues no sería indicado la cirugía antisecretora ni resectiva, ya que se puede conseguir el mismo efecto con los inhibidores de la bomba de protones y con la erradicación del Helicobacter pylori. La recidiva es infrecuente, aunque en ocasiones con la cirugía no definitiva los síntomas reaparecen y hasta surgen nuevas perforaciones. Objetivo: Describir los resultados obtenidos en el tratamiento quirúrgico de la úlcera gastroduodenal perforada. Métodos: La investigación fue desarrollada en el Servicio de Cirugía General del Hospital Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos, entre enero del año 2008 y mayo del año 2009, realizándose un estudio descriptivo sobre una serie de 55 casos con diagnóstico de úlcera gastroduodenal perforada, que fueron intervenidos quirúrgicamente. Resultados: El 31,2 % de los pacientes que presentaron úlcera gastroduodenal, había recibido previamente terapia anti Helicobacter pylori, siendo la perforación el debut de la enfermedad en el 45,5 % de los casos. A pesar de presentar como antecedente alguna enfermedad digestiva, el 41,7 % de estos pacientes consumía algún tipo de medicamento ulcerogénico. Las técnicas quirúrgicas más utilizadas fueron las no definitivas, predominando la sutura y epiploplastia no pediculada (78,2 %). Se encontró persistencia de la úlcera en el 20,0 % de los pacientes a los que se pudo dar seguimiento. Conclusión: Después de tres meses de evolución, algunos de los pacientes operados con una técnica quirúrgica no definitiva y terapia anti-Helicobacter pylori no resolvieron su problema de salud

Polyp as unusual cause of gastric subocclusion. Case Repor

This paper presents a case report of a 27 years old female that entered in the Gustavo Aldereguía Lima Hospital of Cienfuegos with diagnosis of Pyloric Syndrome. Endoscopic examination showed a gastric polyp with pedicle located at level of the pylorus that occluded parcially it and passing through it toward the duodenal bulb. Endoscopic excision was carried out without complications being solved the clinical situation

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care