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Fuentes Valdes E.,Hospital Clinico Quirurgico Hermanos Ameijeiras
Revista Cubana de Cirugia | Year: 2016

Introduction: Surgery is the treatment of ch oice in Zenker’s diverticula, but there are different opinions about the access to be used, that is, open or endoscopic Objective: To compare the results of the surgical treatment results of Zenker’s diverticulum according to the access employed. Methods: A literature review was made in PubMed/Medline using the keywords: diverticulum, Zenker, pharyngoesophageal, crycopharyngeal, diverticulectomy, diverticulopexy, diverticulotomy, diverticulostomy in articles published from 2006 to 2016. There were included several studies of more than 40 cases, either comparative or not in English, Spanish, French, Italian and Portuguese languages. The studied variables were surgical indications, recurrence, surgical time, length of time for oral feeding, hospital stay, reoperations, complications, symptoms improvement and mortality. Results: Randomized studies were not found. Four systematic reviews, one metaanalysis, comparative studies on perioral and transcervical access and others which compare the results of the endoscopic and of the conventional access were all included. Most of them were retrospective. For evaluation of long-term results, those articles with follow-up periods over 12 months were taken. Conclusions: The open access provides better long-term results, but it has more immediate complications. It is advisable to use it in young patients and when anatomic conditions are unfavorable for the endoscopic treatment. Finally, the endoscopic treatment is an adequate choice for patients with high surgical and anesthetic risk. © 2016, Editorial Ciencias Medicas. All rights reserved.

Pantaleon F. G.,Hospital Clinico Quirurgico Hermanos Ameijeiras | Juvier R. T.,Institute Neurologia Y Neurocirugia Prof Rafael Estrada
Revista Chilena de Pediatria | Year: 2015

Rett syndrome (RS) is a neurodevelopmental disorder that exclusively affects girls, and occurs along with autism. It is very uncommon, and has five distinct forms, one classic and the others atypical, which generally compromise manual skills, language, and mobility, and widely associated with the appearance of stereotypy and early epilepsy. With the aim of updating the information about RS, a search was performed in the computer data bases of PubMed, Hinari, SCIELO and Medline, as well as consulting other web sites including OMIM, ORPHANET, GeneMap, Genetests, Proteins and Gene, using the descriptors “Síndrome de Rett”, “genes y Síndrome de Rett”, “Rett Syndrome gene”, “Rett Syndrome”, “Rett Syndrome gene therapy”, and “Rett Syndrome review”. Of the 1,348 articles found, 42 articles were selected, which reported 3 genes causing the syndrome: MECP2, CDKL5 and FOXG. The MECP2 gene is mutated in 80% of patients with classic RS, as well as in 40% of those affected by any of its atypical forms. RS with early epilepsy and the congenital variant are mainly due to variations in the CDKL5 and FOXG1 genes, respectively. Conclusions: The diagnosis of RS is based on clinical criteria. However, the advances in molecular biology and genetics have opened a wide range of possibilities for diagnosing the different clinical forms that could not be classified before. Molecular analysis can help confirm the clinical criteria and provided information as regards the prognosis of the patient. © 2015 Publicado por Elsevier España.

Cordero Escobar I.,Hospital Clinico Quirurgico Hermanos Ameijeiras
Revista española de anestesiología y reanimación | Year: 2011

We report the use of sugammadex to reverse a rocuronium block in a man who had received a kidney transplant 4 years earlier. The patient was admitted for gastric non-Hodgkins lymphoma and bleeding that required surgery. Arterial hypertension, tachycardia, and frequent ventricular extrasystoles were detected. Anesthetic induction was accomplished with propofol, fentanyl, and rocuronium; intubation was uneventful. We monitored pulse oximetry, capnography, heart rate, electrocardiography, arterial pressure (invasive), cardiac output, end-systolic volume, bispectral index, temperature, and neuromuscular function. Anesthesia was maintained with an infusion of propofol, fentanyl, and rocuronium guided by train-of-four (TOF) ratio. Total diuresis was 1100 mL. The operation lasted 4.5 hours. Recovery of neuromuscular response was spontaneous until the second TOF twitch, after which we injected 2 mg/kg of sugammadex. A TOF ratio of 0.94 was recorded 158 seconds after injection of the reversal agent. The patient was extubated without complications. Sugammadex can be used in patients with a transplanted kidney, provided the glomerular filtration rate has recovered sufficiently to allow full excretion of the sugammadex-rocuronium complex.

Hernandez I.S.F.,Hospital Clinico quirurgico Hermanos Ameijeiras | Porben S.S.,Hospital Clinico Quirurgico Hermanos Ameijeiras
Nutricion Hospitalaria | Year: 2015

Every medical surgical action implies costs. Costs of medical provisions should be translated into tangible, and thus, measurable, benefits for the health status of the patient. Nutritional support therapies might increase the costs of medical provisions, but it is expected their implementation to result in lower morbidity and mortality rates as well as shortening of hospital stay, all of them leading to important savings. It is then required the assimilation of tools for costs analysis for a better management of nutritional support therapies. A proposal for the design of a hospital system (regarded anywhere in this text as SHACOST) for the analysis of the costs of interventions conducted in a patient in accordance with the guidelines included in the Metabolic, Nutrient and Food Intervention Program (referred everywhere for its Spanish acronym PRINUMA) is presented in this article. Hence, strategies are described to estimate the costs of a specified intervention. In addition, a primer on cost-effectiveness (ACE) and incremental cost-effectiveness (ACEI) analyses is shown relying on examples taken from the authors’s experience in the provision of nutritional care to patients electively operated for a colorectal cancer. Finally, costs of surgical treatment of a mandibular tumor are described, followed by a discussion on how a better impact of the adopted surgical action could be achieved without considerable increases in total costs should a perioperatory nutritional support program be included. Implementation of SHACOST can provide the medical care teams with accounting tools required to assess the effectiveness of hospital nutritional support schemes, decide whether to acquire and introduce new technologies, and measure the impact of the performance of hospital forms for provision of nutritional care upon health management and perceived quality of life of the patient and their relatives. © 2015, Grupo Aula Medica S.A. All rights reserved.

Myasthenia gravis is an autoimmune disease marked by high titers of immunoglobulin G antibodies, which accelerate destruction of cholinergic receptors and interfere with neuromuscular transmission. This study aimed to determine whether neuromuscular function under a rocuronium block is different from function under a vecuronium block patients with myasthenia gravis and to describe extubation conditions in the operating room or the intensive care unit. Randomized, single-blind clinical trial enrolling patients with myasthenia gravis type IIa and IIb according to the classification of Osserman. The patients were randomized to groups receiving a vecuronium or rocuronium block. We recorded arterial oxygen saturation, capnogram, heart rate, noninvasive blood pressure, electrocardiogram, and neuromuscular function by accelerometry. During surgery 25% of the total dose of the neuromuscular blocking agent was administered. Maintenance was with a continuous infusion of propofol and fentanyl. All patients were extubated according to clinical criteria, confirmed by train-of-four ratio (T4/T1). The mean (SD) time elapsed before recovery of 25% of neuromuscular function was 53.1 (1.9) min in the rocuronium group and 56.2 (0.8) min in the vecuronium group (P = .01). Time elapsed before recovery of 90% of function was 71.3 (2.7) min in the rocuronium group and 96.3 (1.2) min in the vecuronium group (P = .001). Twenty-eight of the 30 patients in the rocuronium group (93.3%) were extubated with recovery of 89.1% (0.5%) of twitch response and a T4/T1 ratio of 0.83. The difference between groups was statistically significant (P = .01). In no case was it necessary to administer a maintenance dose or reverse the block. The rocuronium block had a better profile than the vecuronium block in this study. With this blocking agent we were able to circumvent respiratory depression, with its immediate consequences, and thus meet the main clinical criterion when anesthetizing patients with myasthenia gravis.

An education research was conducted to identify the satisfaction of residents and professors of the specialty of Physical Medicine and Rehabilitation with the course on Physical Agents given in the Diploma Course on Rehabilitation in Primary Health Attention and evaluate retention of the contents studied as well as the need to deal with these contents again, because of their importance, in the course design of the specialty. To measure the level of satisfaction, inquiries were applied to the 23 second year residents of the specialty and 16 professors who gave lessons in the course. A theory exam was applied to all residents to evaluate retention of the above contents. For information analysis, all data were processed by means of frequencies and percentages, they were shown in tables and, to emphasize their importance, a triangulation of data with theoretical elements was presented. The results showed low satisfaction with the contents on physical agents given in the Diploma Course which are not sufficient; they are not updated and present difficulties in their depth and application what means that they should be undertaken again in depth in the course design of the specialty. Residents showed not to have enough knowledge of the contents received. © 2013 2002, Editorial Ciencias Médicas.

Duran Arrieta G.,Hospital Clinico Quirurgico Hermanos Ameijeiras
Revista Cubana de Educacion Medica Superior | Year: 2013

Professional guidance in nursing postgraduate studies is mainly aimed at consolidating knowledge with an efficient and responsible character in the search of solution to problems in the professional practice. Taking into account the present need for the perspectives on development of human resources in the nursing personnel in the National Health System, what demands their professional strength as well as the need to be at the level of Scientific and Technical Revolution what will redound to the improvement in the quality of the attention to the patient, the family and the community, it has been important to carry out a work for professional guidance directed to professional nurses who are involved in postgraduate studies (Masters Degrees, nursing specialties and diploma Courses) in different modalities in hospitalization centres in Centro Havana Municipality. For this work, a universe of 60 professional nurses was used and a sample of 25 was taken representing a 41.6%. The method used was the descriptive, explanatory one. Courses on professional guidance were given. A control was made at the beginning of the postgraduate studies as well as halfway through them to know if they knew the importance of applying the knowledge of professional guidance; besides, surveys and interviews to experts in Nursing Studies were made. At the beginning of the introductory course, it was realized that they didn't know the importance of the application of the material studied; later, achievements in obtaining knowledge about professional guidance and the connotation it has in the course of their professional competence were observed. © 2013 2002, Editorial Ciencias Médicas.

Medell M.,Hospital Clinico Quirurgico Hermanos Ameijeiras | Hart M.,Hospital Clinico Quirurgico Hermanos Ameijeiras | Batista M.L.,Hospital Clinico Quirurgico Hermanos Ameijeiras
Biomedica | Year: 2014

Introduction: Enterococcus spp is currently considered as one of the most important nosocomial pathogens. The antibiotic resistance of this group of bacteria is a particularly important problem in health centers. Objective: To characterize the antibiotic resistance of 50 Enterococcus spp strains isolated from hospitalized patients clinical samples. Materials and methods: We conducted a cross-sectional descriptive observational study in 50 clinical isolates of Enterococcus spp. Only one isolate per patient was analyzed. The identification and antibiotic susceptibility were studied by conventional and automated methods. The phenotypic analysis of glycopeptide resistance mechanisms was performed as recommended by the Spanish Society of Clinical Microbiology and Infectious Diseases. Results: Of 50 isolates obtained from clinical samples, 30 (60.0%) belonged to Enterococcus faecalis and 20 (40.0%) to Enterococcus faecium. The global resistance expressed by this genre was as follows: Ampicillin, 38/50 (76.0%); high-level gentamicin, 33/50 (66.0%); high-level streptomycin, 34/50 (68.0%); ciprofloxacin, 26/50 (52.0%); linezolid, 4/50 (8.0%); teicoplanin, 17/50 (34.0%); vancomycin, 25/50 (50.0%); minocycline, 31/50 (62.0%); tetracycline, 34/50 (68.0%); nitrofurantoin, 9/50 (18.0%). As regards glycopeptides, 25/50 (50.0%) showed a Van A mechanism and 10/50 (20.0%) a Van B mechanism.Conclusions: The isolates obtained at Hospital Hermanos Ameijeiras showed higher resistance rates than those reported in the consulted literature. The high percentage of vancomycin-resistant strains might have influenced the development of other Gram-positive bacteria resistant to this drug. This is the first report on Enterococcus faecium resistant to linezolid in a Cuban hospital.

Scherle-Matamoros C.E.,Hospital Clinico Quirurgico Hermanos Ameijeiras | Perez-Nellar J.,Hospital Clinico Quirurgico Hermanos Ameijeiras
Revista de Neurologia | Year: 2010

Introduction. The anterior cerebral arteries are often affected by vasospasm secondary to subarachnoid haemorrhage. The effectiveness of transcranial Doppler ultrasonography to detect this complication has still not been accurately determined. Aim. To assess the usefulness of transcranial Doppler ultrasonography for diagnosing vasospasm of the anterior cerebral arteries in patients with subarachnoid haemorrhage. Patients and methods. We studied 56 patients between the 4th and 14th days of their subarachnoid haemorrhage; all of them were submitted to a contrast-enhanced neurovascular study and daily monitoring with transcranial Doppler ultrasonography. All the patients had a clinical degree of between 1 and 3 on the World Federation of Neurological Surgeons scale, 46 of them had aneurysms, and bleeding was intense in 20 cases (degree 3-4 on the Fisher scale). Results. The frequency of angiographic vasospasm was 41% in the anterior cerebral arteries. The mean flow velocities in patients with vasospasm were 84.5 cm/s. The maximum peaks of mean blood flow rate were obtained on the tenth day. Sensitivity was 57.9% for flow rates equal to or above 87.5 cm/s, and the predictive positive value was 66.6%. No significant relation was found between the findings of the transcranial Doppler ultrasonography scan, the degree of clinical symptoms and the intensity of bleeding in the computerised axial tomography scan. Conclusions. The overall precision of the test was good, the specificity and predictive negative value were excellent, but sensitivity was low. © 2010 Revista de Neurología.

INTRODUCTION: The transtemporal insonation with transcranial duplex sonography (TCDS) allows assessment of brain parenchyma structures, including the third ventricle. OBJECTIVE: To test the usefulness of TCDS to measure the third ventricle diameter in a sample of patients with different neurological illnesses. METHODS: It was selected a group of adult patients admitted to the stroke unit or sent to interconsultation and to whom by protocol a head CT scan was performed. The measurement of the diameter of the third ventricle was performed with TCDS and CT in axial planes. The results obtained by each technique and the linear correlation between the two measurements is presented. RESULTS: A total of 45 patients were included (mean age 59.6 years, 68.9% males). The third ventricle diameter increased with age. The diameter of the third ventricle increased with age. The average length (± SD) with the TCDS was 5.4 (2.3) mm and bt CT it was 5.6 (2.4) mm. The linear correlation between the values obtained by the two techniques was high (r = 0.93). CONCLUSION: Transcranial duplex is a technique easy to perform and it has similar results in comparison with those obtained with the CT scan when the third ventricle size is measured.

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