Tesis Especializaciones (Ciencias Médicas)

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Complicaciones postapendicectomía convencional y factores asociados, Hospital Vicente Corral Moscoso, período agosto 2008-enero 2009, Cuenca 2009
(Universidad de Cuenca, 2009-11-11) Ayora Calle, John; González Vázquez, Cristian; Morales San Martín, Jaime; Figueroa Morales, Francisco Efraín
Costo beneficio de los exámenes preoperatorios o de rutina realizados a los pacientes quirúrgicos del Hospital José Carrasco, Cuenca 2009
(2010) Gutiérrez Piedra, Italo; Figueroa Morales, Francisco Efraín; Merchán Bueno, Miguel Oswaldo
The preoperative routine examines have been appealed due to an increase in health costs. In the United States from $3 to $11 million dollars are spend annually in routine examines. The majority of routine examines can be omitted, information about this topic in our country is limited and we cannot relay on evidence that justify the utility of routine examines; therefore it is recommended examines to be held in a directed manner and with clinical criterion. A cross-sectional study was elaborated, its objective was to determine the frequency of unnecessary preoperative routine examines held to patients who were submitted to a surgical procedure and the beneficial cost of the same in the Jose Carrasco Arteaga Hospital during the year 2009. Three hundred patients were studied, the majority (69%) were submitted to a major surgery, the frequency of complimentary studies inadequately requested was 32.3%, the possibility to request inadequate examines is greater in patients with minor surgeries (22.4%), the total cost was $4293 dollars and the impact of loss of institutional operational level cost above this number was 49.2% (-2.113 dollars), according to the analysis the ideal cost should not surpass the $2.180 dollars. If we extrapolating the costs of those that are situated outside the public sector the “real” costs surpass $9000 dollars. Key Words: Preoperative routine examines; beneficial cost.
Detección precoz de infección de herida operatoria postapendicectomías en el Hospital Vicente Corral Moscoso, Cuenca 2012
(2013) Bravo Jaramillo, Edison Leonardo; Figueroa Morales, Francisco Efraín; Tenezaca Tacuri, Ángel Hipólito
Acute appendicitis (AA) affects up to 12% of the population, morbidity and treatment produces suffering. Bacterial colonization of the appendix wall is multifactorial, depends on: guest, surgeon, hospital environment, and clinical stage, the frequency of surgical site infection (SSI) varies from 2 to 10%, it may be associated with appendix bacteriology. The SSI is the most common postoperative complication in open appendectomy which was raised in the use of sentinel predictor of surgical site infections in post appendectomy, determining the bacterial load of the abdominal wall. OBJECTIVE: To determine the utility of point guard, as predictor of surgical site infection in post appendectomy patients at Hospital Vicente Corral Moscoso. Methodology: It is a cross-sectional study, that determined whether the use of a guard point, helped as predictor of surgical site infection in patients undergoing appendectomy. RESULTS: The sensitivity of point guard (with positive bacterial load) for prediction of surgical wound infection was 100%, with a specificity of 99.32%, higher in patients with drilled appendicitis (73.3%), surgery time > 60 minutes (28.3%), antibiotic prophylaxis (18.4%) and incision infra-umbilical (50%). CONCLUSIONS: The point guard crop was projected as a predictive tool of surgical wound infection in patients undergoing appendectomy, and it is most useful in advanced stages of the disease, and long periods of surgery when the incision is infra umbilical DeCS: APPENDECTOMY- ADVERSE EFFECTS; SURGICAL WOUND INFECTION-DIAGNOSIS; EARLY DIAGNOSIS; PREDICTIVE VALUE OF TESTS; SENSITIVITY AND SPECIFICITY; EPIDEMIOLOGY, DESCRIPTIVE; HOSPITAL REGIONAL VICENTE CORRAL MOSCOSO; CUENCA-ECUADOR
Determinación de la frecuencia de infección en el sitio operatorio en pacientes intervenidos quirúrgicamente de cirugía abdominal de emergencia en el Hospital Vicente Corral Moscoso julio-enero 2006-2007
(2007) Almestar Montenegro, Artidoro Leiter; Sánchez Solis, Juan Carlos; Figueroa Morales, Francisco Efraín; Pinos Abad, Guido Marcelo
Hipertensión intra-abdominal y síndrome abdominal compartamental prevalencia postlaparotomía por abdomen agudo, HVCM Cuenca 2010-2011
(Universidad de Cuenca, 2011-11-11) Muñoz, Jenny; Merchán Bueno, Miguel Oswaldo; Astudillo Ochoa, Jhony Camilo; Figueroa Morales, Francisco Efraín
Hipertensión intra-abdominal y síndrome abdominal compartamental prevalencia postlaparotomía por abdomen agudo, HVCM Cuenca 2010-2011
(2011) Muñoz Arévalo, Jenny Maribel; Figueroa Morales, Francisco Efraín; Merchán Bueno, Miguel Oswaldo; Astudillo Ochoa, Johnny Camilo
The intra-abdominal hypertension (HIA) and the abdominal compartmental syndrome (SCA) they are important cause of postoperative morbid-mortality. Advance in their opportune diagnosis and treatment they have provided better improvement in these patients. Objective: To determine the prevalence of HIA, SCA and to associate it with (surgical discoveries, pressure of Intra-abdominal perfusion (PPI), obesity) intervened by sharp abdomen in the Department of Surgery of the Hospital Vicente Corral Moscoso of Cuenca. Methodology: We was carried out an analytic traverse study in patient bigger than 16 years that need abdominal decompression of September of 2010 until August of 2011 and that they completed exclusion approaches, the PIA was measured by means of indirect method and the information you gathers in a form elaborated for the study. Results: 347 patients were included in the study, the age stocking was located in 46.72 ± 22.30 years, they presented overweight 5.2%, in the pre-surgical stadium we was Intra-abdominal Hypertension in 41.2% and 10.4% of abdominal compartment syndrome; after the abdominal decompression the intra-abdominal hypertension diminished to 37.7% and the syndrome compartmental to 8.4%. The PIA same or bigger at 12mmHg they increase the risk of hiccup-perfusion intestinal in 3.56 times (IC 95%: 1.81-6.99), p <0.05; the obesity behaved as factor of risk with a RP 1.73 (1.451-2.13); the opposing surgical discovery was significant for Abdomen sharp perforation: 2.45 with IC 95% 1.91-3.13; Abdomen sharp hemorrhagic 1.83 with IC 95% 1.46-2.30 and intestinal occlusive sharp Abdomen 2.32 with IC 95% 2.05-2.64. Conclusion: The intra-abdominal Hypertension diminishes progressively in the postoperative one; while in whom the SCA is manifested it remains risen by more time. You evidence that the Obesity influences increasing the PIOUS one, the same one that produces decrease of the PPI predicting worse presage; the representative surgical discoveries for the increment of the PIOUS one were the abdomen sharp perforation and occlusive. KEY WORDS: ACUTE ABDOMEN, LAPAROTOMÍA, INTRAABDOMINAL HYPERTENSION.
Localización de la punta del cateter venenoso central mediante control electrocardiográfico, Hospital Vicente Corral Moscoso, Cuenca 2010
(2011) Quichimbo Sangurima, Fausto Marcelo; Figueroa Morales, Francisco Efraín; Merchán Bueno, Miguel Oswaldo
Use of central venous catheter (CVC) has become general, there are several techniques applied for its positioning and depends, to a great extent, of the preference and experience of places who it. Once installed a central line, correct location of the tip of catheter is importance very much. In this point the guide with electrocardiographic control assures a suitable location and greater effectiveness in relation to the methods classically used. Objective: To validate cardioscopía as method for the suitable location of the tip of CVC in the of subclavian vein catheterization in front of the chest radiograph control applied in patients of the Hospital Vicente Corral Moscoso. Methods: A study of validation of diagnostic test for the location of the tip of CVC by subclavian via was realized, 142 were included patients. Results: Central venous catheterization by subclavian vein via was realized to the study population, of them was reached a positive result in the electrocardiographic guide in 90 patients (63.4%). The location of the tip of CVC was verified according to the standard method used in our means, the thorax x-ray and it was observed that the 77.78% of the electrocardiogram-guided central venous catheterization were correctly placed, whit a RP of 3.67 (IC 95% = 2.15 -6.28 p = 0.000), demonstrating the validity of the method in study. Also one determined that the distance skin/tip of the catheter average for the population in study is of 11.5 ±1.27cm Conclusions: Use of Electrocardiogram-guided central venous catheterization technique is most reliable that method done blindly, to ensure an adequate placement of tip of CVC. Key Words: Venous central catheterization, electrocardiographic monitoring.
Modificaciones clínicas y metabólicas de los pacientes intervenidos de cirugía bariátrica en los hospitales José Carrasco Arteaga y Vicente Corral Moscoso del 2005 al 2010
(2013) Saavedra Acosta, Oswaldo Fabián; Figueroa Morales, Francisco Efraín; Tenezaca Tacuri, Ángel Hipólito
Obesity is considered an epidemic of the XXI century, seeing increased worldwide. A large majority of the population is overweight reaching some sort of morbid obesity, which is often accompanied by serious associated diseases reduce both the quality and expectancy of life. An alteration in clinical settings such as anthropometric type, hypertension, central obesity, and metabolic disorders such as glycosylated hemoglobin, triglycerides, HDL cholesterol, presents some of the morbidly obese patients. Bariatric surgery today is proving to be one of the best treatments to improve clinically and metabolically patients with these disorders can’t be ruled effectively influencing the postoperative diet and exercise. Objective: to determine the clinical and metabolic changes before and after surgery in patients undergoing bariatric surgery at the hospital José Carrasco Arteaga and Vicente Corral Moscoso from 2005 to 2010. Methods: we performed a study of quasi-experimental (mode before and after), were included in the study 43 patients undergoing bariatric surgery at hospitals José Carrasco Arteaga and Vicente Corral Moscoso during the period 2005-2010. Results: we performed 43 bariatric procedures, most were female (86% n = 37) with obesity grade 2 3 and 4. The body mass index (BMI), waist circumference and blood pressure, and blood chemistry tests: cholesterol, triglycerides, glucose and glycated hemoglobin, had a significant reduction (p=0.002; <0,001; 0.001; <0,001; 0,002; 0,001 y <0,001). For HDL no significant differences were found (p=0.501). Conclusions: bariatric surgery produces a significant reduction in BMI, waist circumference, blood pressure, cholesterol, triglycerides, glucose and glycated hemoglobin.
Nalbufina, bupivacaina, y su combinación para el control del dolor en pacientes sometidos a colecistectomía laparoscópica, Hospital Vicente Corral Moscoso, Cuenca 2010
(2010) Ojeda Orellana, Silvana Magaly; Figueroa Morales, Francisco Efraín; Merchán Bueno, Miguel Oswaldo
Acute pain post-laparoscopic cholecystectomy is complex and different assessment, however the goal of treatment should be to get the comfort of patients undergoing surgical procedures. Objective: To determine the Nalbuphine and Bupivacaine preincisional periportal infiltration efficacy in patients undergoing laparoscopic cholecystectomy. Methodology: A randomized single-blind experimental study was performed, 99 patients are included, which compared the Bupivacaine and Nalbuphine effect with their separate effects in patients undergoing laparoscopic cholecystectomy. Three groups sere formed: A receiving Nalbuphine 10 mg intravenous preincisional, in B group, bupivacaine 0.25% periportal infiltration was administered, and C group (experimental group), receiving the combination 10 mg of Nalbuphine preincisional and bupivacaine periportal infiltration. The pain was assessed by visual analogue scale (VAS) using Nalbuphine as an analgesic supplement. Results: The Nalbuphine group had less pain than the experimental group and especially the buoivacaine group, so the Bupivacaine need more supplementary doses of analgesia (2.88 ± 0.89) on the Nalbuphine ( 1.55 ± 0.71) and experimental group (2.12 ± 0.78). Conclusions: Preemptive analgesia with Nalbuphine obtains better scores in comparison to Nalbuphine and bupivacaine combination. Bupivacaine alone does not have good results on pain control postcholecystectomy laparoscopy, and need more supplementary doses of analgesia Key words: Nalbuphine, Bupivacaine, Laparoscopic cholecystectomy, postoperative pain, patient controlled analgesia
Prevalencia bacteriológica en apendicitis aguda no complicada y su asociación con infección del sitio quirúrgico, Hospital Vicente Corral Moscoso, 2010
(2010) Astudillo Bravo, Xavier Eugenio; Figueroa Morales, Francisco Efraín; Merchán Bueno, Miguel Oswaldo
The acute apendicitis (AA) afects to 12% of the poblation, the morbility of this pathology and its treatment produce suffering, more hospitary stay, delay work and socioeconomic repercussions. The germs culture of the appendix wall is multifactorial depends of: guest, surgeon, hospitary ambient, and clinic phase; the fecuently of the wound infection (WI) vary of 2 to 10% and should relate with appendix germs. Objective: To determine the germs prevalency of the appendix wall in patients with non-complicated acute appendicitis and association with pathology time and WI in patients of Vicente Corral Hospital (octuber 2009 - september 2010). Methodology: We achieved a transversal study to determine the bacteriological prevalency of the wall appendix in patientes with non-complicated acute apendicitis and its relation with wound infection. Outcomes: We study 114 patients, 107 (93.9%) patients show positive culture of the appendix wall; 87,7% show a process upper to 12h. 60,5% of appendix were supuratives. The appendix wall culture show a hight incidence of E. Coli (64,5%), and Bacteroides frágilis (19,6%). The frecuently of ISQ was 10,5%. Therefore, presence of anaerobic germs and the ISQ were associated with a upper to 12 h evolution of this pathology, but the diference was not significantly. Conclusion: The wall appendix culture is not frecuently, the presence of germs in the wall appendix increase according to time of evolution of this pathology and its associated with increase of ISQ but without stadistical significantly. The germs find in non-complicated acute apendicitis were E. Coli y B, Frágilis. Key words: Appendicitis, infection of operating wound, prevalence, bacterial infection.
Prevalencia de las lesiones quirúrgicas de la vía biliar post colecistectomía y determinación de sus factores asociados, Hospital Vicente Corral Moscoso 1994-2010
(2012) Verdugo Abad, Juan Carlos; Figueroa Morales, Francisco Efraín; Astudillo Ochoa, Johnny Camilo
The surgeries that involve the bilious tract every day are more frequent, this with the population increase makes that the lesions also increase in frequency and this associates to different related factors between the anatomy, the technique and the personnel who carries out it. Objective: To determine the prevalence of the lesions of the bilious tract post cholecystectomy during the period 1994 to 2010 and the association with factors of risk. Methods I study descriptive traverse of the prevalence and analytic of a surgical lesion of bilious tract according to: sex, age, type of agreement, lesion with the classification of Bismuth, surgeon's experience, concomitant local pathology, type of cholecystectomy, anatomical variant, intervention of urgency and hour of the intervention. Results: The prevalence of lesions of the bilious tract in the last 16 years reached 0.92%. The age stocking was about 44.56 years, the sex more prevalent was the feminine one with 79.6%, the lesion Bismuth type II were the most frequent, the specialist it was the surgeon in most of the cases, 55.6% of the cases was with boarding laparoscopic, in 59.1% the surgery was of urgency, the most frequent anatomical variant was in the artery, most of the surgeries were carried out in the morning. The masculine sex was the most affected, the conventional boarding it represents an enhanced risk for lesions of the bilious tract Conclusions: The prevalence of lesions of the bilious tract during the last 16 years reached 0.92%, the most frequent lesion it was the type Bismuth II. KEYWORDS: CHOLECYSTECTOMY, BILIOUS TRACT, SURGICAL INJURY, FACTORS, BISMUTH.
Prevención de infección del sitio quirúrgico, Hospital José Félix Valdiviezo, Santa Isabel, 2010
(2011) Vázquez Sarmiento, José Luis; Figueroa Morales, Francisco Efraín; Merchán Bueno, Miguel Oswaldo
Objective. Improving knowledge and good practices of a group of health professionals based at two hospitals (cantonal) and recommended. Material and methods. With a quasi-experimental method before and after, it included 70 health professionals from hospitals José Félix Valdiviezo of Santa Isabel and Aida León Rodriguez Lara who measured the level of knowledge of good practices of antisepsis, then applied a educational intervention and outcomes were measured post intervention. The knowledge and practices on a topic included hand washing, shaving skin, skin antisepsis, use of appropriate clothing, sterilization of surgical equipment and proper use of antibiotic prophylaxis. Results. 35 health professionals were included in each hospital doctors distributed holders (25,7%), medical care residents (20%), internal medicine (11.4%), nurses (15,7%) and nursing assistants (27,1%). Professionals belonged to the specialties: surgery (45%), gynecology and obstetrics (35%), pediatrics (8%), clinical (7.0) and emergency (5%). After the intervention was achieved a highly significant increase in most knowledge and practices (P <0.05). Discussion. Educational interventions and methodology for improving health knowledge and practices is a tool introduced in recent years in clinical and epidemiological research with satisfactory results especially in support of preventive measures. KEY WORDS: SURGICAL WOUND INFECTION-PREVENTION & CONTROL; HEALTH KNOWLEDGE, ATTITUDES, PRACTICE; HANDWASHING-STANDARDS; HOSPITAL JOSÉ FELIX VALDIVIEZO; CANTON SANTA ISABEL-ECUADOR
Prevención de trombosis venosa en pacientes sometidos a cirugía general en el Hospital Vicente Corral Moscoso durante el período de julio a septiembre del 2004
(2006) Chalaco Vega, Marco Vinicio; Ledesma Palacios, Giordano Roberto; Figueroa Morales, Francisco Efraín; Pinos Abad, Guido Marcelo
Sutura subcuticular en apendicectomías no complicadas, Hospital Viente Corral Moscoso, 2006-2007
(2008) López Macas, Luis Vinicio; Salamea Molina, Juan Carlos; Figueroa Morales, Francisco Efraín; Pinos Abad, Guido Marcelo
Validez de la leucocitosis de control en pacientes con duda diagnóstica de apendicitis aguda, Hospitales Vicente Corral Moscoso y José Carrasco Arteaga, Cuenca, 2012
(2013) Bravo Medina, Rubén Darío; Figueroa Morales, Francisco Efraín; Tenezaca Tacuri, Ángel Hipólito
BACKGROUND: Acute appendicitis is a disease that affects 12% of the population in our country is one of the most common surgeries are performed, complications have a high economic and social impact, that is why its diagnosis and treatment is essential. OBJECTIVE: To validate the control leukocytosis and neutrophilia in cases of uncertain diagnosis in patients with suspected acute appendicitis in Vicente Corral Moscoso and José Carrasco Arteaga in Hospitals in the city of Cuenca in 2012. METHODS AND MATERIALS: Test of validation study, we worked with a sample consisting of 180 patients with surgical patients in hospitals Vicente Corral Moscoso and Jose Carrasco Arteaga during 2012, that met the inclusion criteria . With a sample.Confidence level of 95%.Sensitivity of 86.05%, Specificity 92.86%, Reason diagnosed / undiagnosed 1.0; disease prevalence of 26.7%.A survey, informed consent. The results obtained were processed in Microsoft Excel and SPSS 15.0 statistical software. RESULTS: The mean age of the study population was 38.3 ± 18.7 years, Being higher in women. Appendicitis was confirmed histologically in 86.7%. Suppurative appendicitis was the most prevalent. Leukocytosis validation was 98.72% sensitivity, 75% specificity and neutrophilia validation was 76.92% sensitivity, specificity 70.83%. DeCS: APPENDICITIS-EPIDEMIOLOGY; APPENDICITIS-DIAGNOSIS; APPENDICITIS-CLASSIFICATION; LEUKOCYTOSIS-DIAGNOSIS; GRANULOCYTES-PATHOLOGY; BLOOD CELL COUNT-UTILIZATION; PREDICTIVE VALUE OF TESTS; SENSITIVITY AND SPECIFICITY; HOSPITALS, PUBLIC; CUENCA-ECUADOR
Valoración del Test de Alvarado en el diagnóstico dudoso de la apendicitis aguda. Hospital Vicente Corral Moscoso y José Carrasco Arteaga. Cuenca, octubre del 2002 a abril 2003
(2003) Delgado Pauta, Jorge Antonio; Zaldúa Reyes, Jorgito Antonio; Figueroa Morales, Francisco Efraín; Maldonado Sánchez, Luis Rogelio

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