Clinical and surgical aspects of hydatidosisHydatidosis is common in Southern Chile and it is usually located in the liver. The complications of surgical procedures for liver hydatidosis, which fl uctuate from 11 to 86%, are superposed to the own complications of the disease. The frequency of surgical complications is associated with evolutionary complications of the cysts, the need to perform additional procedures to treat the disease in other simultaneous locations and previous surgical interventions for the disease. Operative mortality is lower than 5%. The surgical treatment of hydatidosis is divided in four phases: isolation of the surgical zone, cyst evacuation, treatment of cyst complications and treatment of residual cavity. The conservative surgical procedures are marsupialization, cystostomy, Posadas intervention and cystojejunostomy. Surgical procedures involving resection are pericystectomy, subtotal cystectomy and liver resections. ResumenLa hidatidosis es una zoonosis endémica en el sur de Chile, por lo que tenemos la oportunidad de tratar un número importante de pacientes, especialmente hepática, localización más común de esta enfermedad. La hidatidosis hepática (HH) tiene morbilidad y mortalidad propia debido a sus complicaciones evolutivas, a lo que se agrega el riesgo de complicaciones asociados a los procedimientos quirúrgicos, cuya morbilidad se ha reportado entre 11% y 86%; la que se ha relacionado con intervenciones previas por HH, complicaciones evolutivas de los quistes, la necesidad de realizar procedimientos adicionales como el tratamiento de la enfermedad en otras localizaciones simultáneas. La mortalidad reportada es inferior al 5%. Sin embargo, tanto morbilidad como mortalidad persisten altas a pesar de los avances tecnológicos terapéuticos. El tratamiento quirúrgico de la HH se puede dividir en cuatro fases: aislamiento de la zona quirúrgica, evacuación del quiste, tratamiento de las complicaciones del quiste; y tratamiento de la cavidad residual. Por otro lado, la cirugía de la HH se puede clasifi car en procedimientos conservadores (marsupialización, quistostomía, operación de Posadas y quistoyeyunostomía) y resectivos (periquistectomía, quistectomía subtotal y resecciones hepáticas). Por último, cabe señalar el rol de la cirugía laparoscópica, que aún se encuentran en evaluación.Palabras clave: Equinococosis, hidatidosis, equinococosis hepática, hidatidosis hepática, quiste hidatídico hepático.
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 coefficient (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: Interobserver and intraobserver reliability for the MINCIR scale to assess MQ of therapy articles were determined.
Intrabiliary rupture of hydatid cysts as a risk factor for postoperative complicationsBackground: Intrabiliary rupture is a complication of hepatic hydatid cysts. Aim: To determine if intrabiliary rupture is a risk factor for postoperative complications of hydatid cysts. Material and Methods: Prospective follow up of patients operated for hepatic hydatid cysts between 1996 and 2006. Patients were evaluated every six months during the first years and every 12 months thereafter. The presence of intrabiliary rupture was evaluated as a risk factor to develop complications during the follow up. Results: Ninety six patients with and 156 patients without intrabiliary rupture, 56% females, aged 42 years, were followed for a mean of 86.5 months. The overall incidence of complications was 17%. The incidence in patients with and without intrabiliary rupture was 9,4 and 21,8% respectively (p = 0.01). The bivariate analysis showed differences between patients with and without complications in leukocyte count, serum bilirubin, alkaline phosphatases, transaminases, cyst diameter, hospital stay and cyst complications. The relative risk for complications of intrabiliary rupture was 3,4 (95% confidence intervals 2,6-4,2). Conclusions: The presence of intrabiliary rupture of a hepatic hydatid cyst is an independent risk factor for the development of complications in the postoperative period.
Where and how to search scientific medical evidence?The practice of evidence based medicine requires strategies to efficiently search relevant medical information. 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.Key words: Literature, medical, search, databases. ResumenCon el advenimiento de la medicina basada en la evidencia, los clínicos deben mantenerse vigentes respecto de los rápidos avances en ciencias biomédicas. Sin embargo, debido a la inmensa cantidad y variada calidad de la evidencia es necesario contar con estrategias que permitan optimizar su búsqueda. El objetivo de esta comunicación es entregar algunas de las herramientas que permitan al usuario optimizar el tiempo dedicado a la búsqueda de información y acceder a la mejor evidencia disponible. Existen variados recursos electrónicos para acceder a información médica, entre las más relevantes se cuentan: MEDLINE, LILACS, Web of Knowledge, The Cochrane Library, TRIP database, EMBASE, Google Scholar, entre otras. Para plan-
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