Surgery for benign insulinoma: An international review

In a multiinstitutional review, data on 396 patients with benign solitary or multiple insulinomas operated on in 15 centers were collected. In these 396 patients, 419 laparotomies (375 primary procedures and 44 reoperations) were performed. The rate of unnecessary laparotomies was 1.7%. Complications occurred after 132 operations (31.5%), requiring 27 reinterventions (6.4%). Ten (2%) patients died within 30 days of surgery. The success rate of first procedures in the centers was 94.9%. After reoperation, all but 2 (99.5%) of these patients were cured. The overall cure rate including those patients who had their primary operations elsewhere was 97.5% . Compilant les dossiers de 15 établissements internationaux, nous avons colligé les données concernant 396 patients présentant un insulinome bénin unique ou multiple, opérés. Chez ces 396 patients, 419 laparotomies (375 interventions de première intention et 44 reprises) ont été effectuées. Le taux de laparotomie inutile était de 1.7%. Des complications sont intervenues à la suite de 132 opérations (31.5%), nécessitant 27 réinterventions (6.4%). Dix (2%) patients sont morts dans les trente jours après l'acte chirurgical. Le taux de succès des interventions de première intention dans les centres de l'étude était de 94.9%. Après réinterventions, tous les patients sauf 2 (99.5%) ont été guéris. Le taux global de guérison, y compris les patients ayant été opérés une première fois ailleurs, était de 97.5%. En una revisión multiinstitucional se recolectaron los datos sobre 396 pacientes con insulinomas benignos solitarios o múltiples operados en 15 centros. En estos 396 pacientes se efectuaron 419 laparotomías (375 procedimientos primarios y 44 reoperaciones). Se registró una tasa de laparotomías innecesarias de 1.7%; se presentaron complicaciones después de 132 operaciones (31.5%), las cuales requirieron 27 reintervenciones (6.4%). Diez (2%) pacientes murieron dentro de los primeras 30 días después de la cirugía. La tasa de éxito del procedimiento primario realizado en estos centros fue 94.9%. Después de las reoperaciones la totalidad de los pacientes, menos 2 (99.5%), fueron curados. La tasa global de curación, incluyendo los que tuvieron su operación primaria por fuera de los centros del estudio, fue 97.5%.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41289/1/268_2005_Article_BF01658536.pd

Transformational learning in health care students through international service in developing world environments

Health care and health care education are in dynamic transition in attempting to address the increasing demands of a diverse global population across a widening gap in health resource constraints. Health care students must be prepared to care for a much wider patient population across a diverse spectrum of cultures, economics, and technologic facilities with resourceful approaches. Individual students and practitioners of the healing arts, and the educational system that supports them, should undergo transformational learning to address these new realities in expanding paradigms of health and health care. This study was designed to observe health care students and practitioners in the setting of international medical missions in the developing world. Almost all of the participants reported changes characteristic of transformational learning brought about through encounters with developing world patients, and most qualified these changes in both perceptions and practices as profound, life-changing experiences. These reported changes were measured with a previously validated quantitative instrument, Perceptions of an International Healthcare Mission Questionnaire, with responses correlated with demographics and answers to semistructured qualitative questions in essays and follow-up interviews. On the basis of these positive findings, it can be recommended that the opportunity of international health care missions be made more widely available for students. The students themselves benefit, as well as the developing world patients who receive care. These very patients appear to be the agents of the transformational learning experience. Institutionalization of medical mission opportunities would enhance health care education by providing the transformational kind of learning that is needed to address the diverse demands required in reforming global health care