Intervención con ejercicio y alimentación mejorando el rendimiento académico asistencial en un posgrado de cirugía

El presente trabajo se realizó en un grupo de 31 sujetos de estudio que fueron 25 hombres y 6 mujeres todos ello estudiantes del posgrado de la Especialidad de Cirugía General a los cuales se les implementó una intervención integral de 12 semanas, incluyendo un entrenamiento de fuerza con enfoque en hipertrofia muscular y asesoría nutricional. El objetivo principal era analizar la influencia que la profesión médica y la institución laboral ejercen sobre el autocuidado de la salud del personal médico. Posterior a la intervención se pudieron obtener resultados significantes en unos indicadores que fueron evaluados tales como Composicion de grasa corporal, pliegues cutáneos y masa muscular. Es indiscutible el hecho de que el trabajo, el medio ambiente del estrés al que están sometidos, los cambios en los ciclos circadianos por las jornadas de trabajo arduo, guardias y cirugías impactan importantemente en el peso y la composición corporal y salud de los residentes. Es de todos conocidos el hecho de que el constante estrés, consumo de comida rápida por falta de tiempo, los cambios negativos en los hábitos alimenticios saludables, por lo que es urgente realizar intervenciones para revertir éste efecto

Terminal interruption of relux source technique in the treatment of active venous ulcers

Introduction: The treatment for venous ulcers in most cases is unsatisfactory, with recurrences and poor healing. Objective: to evaluate adjuvant therapy in the treatment of active venous ulcers. Methods: We analyzed 20 patients with active venous ulcers attending the general Surgery outpatient clinic at the “Dr. José eleuterio gonzález” University Hospital from October 2012 to January 2013. they were randomly divided into 2 groups: group A (11 patients) underwent compression therapy and group B (9 patients) underwent compression therapy plus removal of the vein that gives terminal relux to the ulcer, guided by ultrasound (microphlebectomy). Patients were evaluated weekly (8 weeks). At each assessment, photographs and lesion measurements were taken and pain was evaluated using the visual analog scale. Results: No significant differences were found between the study groups in terms of age, weight, height, body mass index (BMi), ankle-brachial index, and baseline measurement of the ulcer (p>0.05). Group B showed a greater reduction in ulcer size and a statistically signiicant lower score on the visual analog pain scale (p<0.05) from the second and third week of treatment, respectively. Conclusions: the results obtained in patients with surgical procedure (group B) are consistent with the reported eficacy of chronic venous ulcer treatment with saphenectomy (conventional surgery), the difference is that in this study we used a minimally invasive procedure (microphlebectomy)

Askin tumor: Case report and literature review

Askin tumor is an uncommon malignant neoplasm of a neuroectodermic origin that arises from the soft tissues of the thoracopulmonary wall. Defined histologically by Askin and Rosai in 1979 as a malignant small round cell tumor. It is described within a group of malignant neoplasms with an aggressive behavior. The lack of clinical guides that establish a standardized management contributes to its poor prognosis and short overall survival. Once a primitive neuroectodermal tumor has been diagnosed, treatment will consist of a multimodal management

Self-inflicted wound with a nail in the heart: case report

Adequate diagnosis and treatment of penetrating cardiac injury (PCI) represents a great challenge for the surgeon in the emergency department (ED) because of its high mortality. It is estimated that more than 90% of mortality happens before the patient reaches the hospital and only 15---50% of those will receive appropriate medical treatment. Case report: A 42-year-old hemodynamically stable male is brought to the ED with a protruding nail in his thorax. He is taken to the operating room (OR) where a medial sternotomy is performed and an injury is found in the left ventricle. Cardiac muscle repair is performed with pericardial patch. Discussion: PCI from a suicide attempt secondary to a nail hammered into the chest is very rare and no previous reports were found by the author. Conclusion: The objects that penetrate cardiac structures must be removed in a proper OR with capable personnel and the resources available to perform procedures like an urgent thoracotomy or sternotomy

Surgical treatment of a pseudoaneurysm of the femoral artery secondary to a gunshot wound: clinical case report

We report a case of a 18-year-old male patient with a diagnosis of pseudoaneurysm of the right supericial femoral artery secondary to penetrating injury by gunshot, which was treated in our Hospital with an aneurysm resection and a saphenous vascular graft inverted with a satisfactory evolution

Laparoscopic diaphragmatic plication for paralysis posterior to trauma. Case report

Diaphragmatic paralysis is a pathology characterized by the elevation of a plastic and inactive atrophic diaphragm, followed by an injury to the spinal column or to the phrenic nerve. Because it involves the phrenic nerve, it is often associated with an injury at its exit in the spinal cord at the radicular level, at the conduct or in the peripheral nerve. Clinical case: A 50-year-old male patient with a history of thoracic trauma and diagnosis of unstable thorax is admitted for progressive dyspnea in the following 8 months. Diaphragmatic paralysis is diagnosed and a laparoscopic diaphragmatic plicature is performed. Patient improved his clinical status by 29%. Discussion: The consequences of the elevation of a hemidiaphragm can be respiratory, causing hypoxemia and decreases in the ventilation---perfusion ratio. This procedure is considered a corrective surgery from the morphological and functional point of view. Conclusions: Our patient’s clinical status improved according to the Saint George respiratory questionnaire, thanks to an improved perfusion of the basal lung expansion. Laparoscopic diaphragmatic plicature is a safe procedure associated with a minimal hospital stay, and more cases need to be reported. This is the procedure of choice in our institution

Dermatoscopia en melanoma cutáneo

ResumenAntecedentesLa mortalidad del melanoma cutáneo no ha disminuido en los últimos 50 años. Las únicas medidas que permiten reducirla son la prevención primaria y el diagnóstico oportuno; la evaluación dermatoscópica es fundamental para lograrlo. Permite identificar características del melanoma que pasarían desapercibidas al ojo desnudo.El objetivo es reportar los hallazgos dermatoscópicos más frecuentes en pacientes con diagnóstico de melanoma in situ e invasivo.Material y métodosEstudio observacional, retrospectivo en el que se realizó dermatoscopia de contacto utilizando dermatoscopio LED DermliteMR, y cámara fotográfica DermliteMR. Se evaluó asimetría en 2 ejes, asociación de colores, falta de pigmento, puntos irregulares, red atípica, pseudópodos, velo azul, ulceración y anillo rosa perilesional, y se comparó el diagnóstico histológico con los hallazgos dermatoscópicos.ResultadosFueron 65 pacientes con melanoma cutáneo: 10 in situ y 55 invasivos. La media de Breslow en invasivos fue 3mm. La mayoría de los pacientes (35) tuvieron localización en extremidades. El hallazgo dermatoscópico más frecuente fue asimetría en 2 ejes, seguida de asociación de 2 o más colores; en melanoma in situ el hallazgo más habitual fue la asimetría en 2 ejes seguida de los puntos atípicos; en melanoma invasivo la asimetría en 2 ejes, la asociación de 2 colores o más y los pseudópodos fueron los hallazgos más frecuentes.ConclusiónLa asimetría en 2 ejes es el hallazgo dermatoscópico más frecuente en melanoma ya sea in situ o invasivo; la presencia de 2 colores o más en una lesión pigmentada debe hacer sospechar de un melanoma invasivo.AbstractBackgroundThe mortality of cutaneous melanoma has not declined over the past 50 years. The only interventions that can reduce mortality are primary prevention and early diagnosis, and the dermoscopic evaluation is essential to achieve this. Dermoscopy identifies characteristics of melanoma that would go unnoticed to the naked eye.The aim of this paper is to report the most frequent dermoscopic findings in patients diagnosed with in situ and invasive melanoma.Material and methodsAn observational and retrospective study of contact dermoscopy was performed using LED DermliteTM and camera DermliteTM dermoscope. The findings evaluated were: asymmetry in two axes, association of colours, lack of pigment, irregular points, atypical network, pseudopods, blue veil, ulceration, and peri-lesional pink ring. These dermoscopic findings were compared with the histological diagnosis.ResultsThe study included 65 patients with cutaneous melanoma; 10 in situ, and 55 invasive. The mean Breslow in invasive melanoma was 3 mm. Most patients (35) had localization in extremities. In all patients, the most frequent dermoscopic finding was asymmetry in two axes, followed by association of two or more colours; in melanoma in situ, asymmetry was the most frequent, followed by atypical-irregular points. In invasive melanoma asymmetry in two axes, the association of two or more colours, and pseudopods, were the most frequent findings.ConclusionAsymmetry in two axes is the most common dermoscopic finding in in situ and invasive melanoma. The presence of two or more colours in a pigmented lesion should be suspected in an invasive melanoma

Sigmoid fixation associated with rectopexy using a laparoscopic approach could prevent relapse of rectal prolapse in pediatric patients with spinal dysraphia

Recurrent rectal prolapse, resistant to medical treatment, is an indication for surgical treatment. Patients with spinal dysraphia frequently have already been treated by sclerotherapy or other surgical techniques, but unsuccessfully. Methods: We present 2 patients, who underwent laparoscopic rectopexy, with spinal dysraphia and complete rectal prolapse relapse after conservative treatment. In these patients, we performed, as an additional technique, fixation of the rectosigmoid to avoid recurrence by invagination or prolapse of the anterior wall. Results: Follow-up at 14 and 11 months, respectively, did not find any recurrence. Conclusion: We suggest that laparoscopic rectopexy with sigmoid fixation should be considered as an alternative for the treatment for patients with spinal dysraphia and rectal prolapse to avoid recurrence