Neurophysiology of learning in basic skills of laparoscopic surgery in undergraduate students

Background: The development and progress in laparoscopic surgery requires greater emphasis on surgical skills, developing skills in undergraduate students allows them to be at the forefront in health demands.Methods: An experimental and descriptive study of a group of 30 undergraduate students of the Faculty of Medicine. They attended 30 hours of theoretical and practical sessions distributed by 10 sessions, supported by basic simulators minimally invasive, being evaluated by checklist. Their brain activity was monitored with an electroencephalography before and after the development of skills.Results: It was observed that the average necessary for the acquisition of skills is 5 sessions. The competition in which further progress was observed is video assistance. There is an increase in the activity of the prefrontal cortex on the electroencephalography.Conclusions: A series of neurophysiologic processes involved in learning of laparoscopic surgery are described. Laparoscopic skills development lies in keeping them updated on the teaching-learning, where the use of simulators is growing

Comparison of early complications using regular mesh versus Atramat® Neoflex 25 mesh in inguinal, umbilical and post incisional hernias

Background: Hernias are one of the most common reasons of primary health care with subsequent surgery and this has led to search new techniques to approach them. Comparing traditional techniques with polypropylene mesh versus one bioabsorbible mesh there has been a decrease in postoperative complications.Methods: 100 patients with inguinal hernia, umbilical and post incisional were surgically intervened and divided into two groups according to mesh material used. The patients were tracked for two months after surgery.Results: Traditional mesh was used to repair hernias in 50 patients and Atramat® Neoflex 25 mesh was used in the other half.  Two patients developed infection with traditional mesh and one patient using Atramat® Neoflex 25 mesh (p 0.558). Hernias recurred in 4 patients with traditional mesh compared with 0 patients with Atramat® Neoflex 25 mesh ( p.041 ) , seroma formation was found with a 6: 1 ratio, traditional mesh: Atramat® Neoflex 25 mesh ( p.050 ) and hematoma in a 2:1 ratio (p .558). The total of complications showed a total of 14 using traditional mesh and 3 with Atramat® Neoflex 25 mesh. The use of mesh made from absorbable materials is a better alternative to reduce chronic pain and recurrence due to its high biocompatibility.Conclusions: Using Atramat® Neoflex 25 mesh demonstrated a significant reduction of complications (recurrence and seroma formation) and length of hospital stay (2 days vs 1 day in abdominoplasty after surgery).   

Current perspective in the treatment of bile duct injuries

The laparoscopic cholecystectomy is considered the gold standard for the treatment of benign gallbladder disease, which is associated with an increased incidence of biliary injuries. These types of injuries are multicausal, and anatomical variations or anatomical perception errors are the most common risk factors. The objective of this study is to describe the evolution in the management of bile duct injuries and actual, diagnostic tools, incidence, prognosis and treatment. A literature research about diagnosis and treatment of iatrogenic bile duct injuries as well as their impact on the incidence of morbidity and mortality, based on a 30-year period, was performed on Medline, Cochrane, Embase, MedScape and PubMed database, for all studies that met the eligibility criteria. A thorough quality assessment of all included studies was performed. Synthesis of the results was achieved by narrative review. The bile duct injury is a complication that requires a complex therapy and multidisciplinary management. Reconstruction and treatment techniques have been evolving. The selection of adequate treatment will impact on the patient´s quality of life. The results of the existing studies reporting on iatrogenic bile duct injuries are useful; because the iatrogenic bile duct injuries are complex alterations and constitute one of the most serious complications of a cholecystectomy and require a comprehensive approach, immediate repair, proper drainage and timely referral to adequate treatment to improve long-term prognosis. According to the literature review, currently there better treatments such as absorbable prosthesis, which improve the prognosis and patient´s quality of life, and represent less risk of complications in short/long term.

Colorectal cancer: a review

Colorectal cancer (CCR) is the third most common cancer worldwide in men and women, the second largest cause of death related to cancer, and the main cause of death in gastrointestinal cancer. The risk of developing this cancer is related to bad alimentary habits, smoking, intestinal inflammatory disease, polyps, genetic factors, and aging. Of the patients that are diagnosed with colorectal cancer 90% are older than 50, with a median age of 64 years; however, the disease is more aggressive in patients that are diagnosed at younger ages. According to the American Cancer Association, it was accounted for more than 49,700 deaths in 2015. The goal is to reduce the mortality rate with early diagnosis and treatment. Currently, the survival rate is used to predict a patient’s prognosis. The patient is considered to have a positive familial history if a first-degree relative has been diagnosed with colorectal cancer or colonic polyps before the age of 60, or also if two or more first-degree relatives have been diagnosed with cancer or polyps at any age. There are several methods for detecting colorectal cancer, such as the guaiac test, immunochemical test of stool, DNA stool test, sigmoidoscopy, colonoscopy, and barium enema. The stage in which the cancer is detected determines the prognosis, survival, and treatment of the patient. Provide a review about generalities, genetic basis, risk factors, protective factors, clinical course, diagnostic methods, therapy and survival in colorectal cancer. Conducted research from different databases such as PubMed, Medline, MedScape, on the definition, genetic factors, classification, risk factors, protective factors, diagnostic methods, epidemiology, survival and treatment of colorectal cancer. Articles from 2000 to 2017 were included using the following keywords

Open radical nephrectomy for early treatment of renal cell carcinoma: a case report and review

We report the case of a 46-year-old male with no previous medical background. He complained of abdominal right-sided flank pain, spreading to ipsilateral flank, thermal hikes, hematuria, and positive giordano. The ultrasound found a 5 x 5 cm mass located in right kidney upper pole, which did not compromised renal capsule and presented a fresh bruise, suggesting a malignant tumor. Radical nephrectomy was satisfactory performed; sending the whole kidney to pathology and the patient was discharged within 72 hours. The histopathologic report concluded a conventional clear cell renal cell carcinoma tumor (5.5 x 4.8 cm) Fuhrman grade II, limited to the renal parenchyma. We concluded that the best treatment for this type of cancer is the radical nephrectomy even though you lose a part of the renal function. Radical nephrectomy guarantees the extraction of the whole tumor and avoids dissemination, one of the most common complications

Acute abdomen secondary to dependent rectus sheath hematoma: a case report

The rectus sheath hematoma as a rare clinical entity and self-limited, resulting from the accumulation of blood within the sheath of the rectus abdominis, secondary to breakage the epigastric artery higher or lower, or direct damage by fiber tear of rectus abdominis muscle. Female patient, 37 years old, enters the service of emergencies by refer abdominal pain of sudden onset, diffuse, with 5 hours of evolution with irradiation to lumbar region ipsilateral. In the CT scan in single stage and with IV contrast, it was reported an asymmetry in the thickness of the muscles of the anterior wall at the expense of a lesion of occupying space dependent anterior rectus muscle, as diagnostic impression is concluded a intramuscular injury dependent of the right anterior abdominal straight; likely bruising of the sheath of the straight abdominal by what is being decided its income to operating room to perform surgical drainage and epigastric vessel ligation. for the general doctor, specialist and it is important to take into account the pathology, symptoms, diagnostic and therapeutic strategy for a hematoma dependent of the rectus abdominis muscle, due to the high percentage of error diagnosis in patients who are admitted to the emergency department with acute abdominal pain, because you can Confused with other abdominal pathologies, which shows the importance of an appropriate differential diagnosis, and treatment prescribed, which optimize and reduce unnecessary intervention as well as morbidity and mortality of this disease